Not Done Yet: A Podcast for Midlife Women

Ep. 16 - Is It Perimenopause or Am I Just Losing It? with Dr. Shannon Cothran

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Rachel sits down with Dr. Shannon Cothran, a board-certified gynecologist who left 15 years of private practice to build Menostart, a direct-to-patient practice designed entirely around perimenopause and menopause care. They get into the real reason Shannon walked away from the traditional system, the messy history behind hormone replacement therapy, and why so many women are told to just take more Zoloft instead of getting an actual answer. Rachel also shares her own story of being dismissed, shamed, and talked out of asking for hormones, and what changed once she finally got a doctor who listened. This one gets into the specifics: symptoms, timelines, testosterone hype, and what to ask for at your next appointment.

In this episode:

  • My story: the doctor who wanted to just bump up my Zoloft instead of checking my hormones, and the question my husband asked me that changed everything
  • Why perimenopause has over 70 identified symptoms, and how wild some of them get (a hot flash that only happens below the waist, water in your ear, joints that ache for no reason)
  • The wild history of hormone replacement therapy: the book that started it, the study that scared everyone off it, and the data that got walked back decades later
  • The truth about testosterone for women: what the research actually supports versus what influencers and a certain PBS documentary are hyping up, and why pellets can do real damage
  • What to actually do first if you think you're in perimenopause or menopause, and what's included in Shannon's six-month program at Menostart

Mentioned in this episode:

  • Menostart (Dr. Cothran's direct to patient practice for midlife women's health): www.menostart.com
  • The M Factor (PBS documentary on menopause and testosterone)

Connect with Rachel:

  • Website: rachelaperry.com
  • Instagram: @rachelaperry
  • TikTok: @rachelaperry

If this episode hit close to home, send it to the friend who's been telling you her hair is falling out and nobody will listen. She's not done yet either.

Ready to stop circling the thing you can't stop thinking about? Take the free Not Done Yet Spark and discover your next step.

www.rachelaperry.com/spark 

Midlife Is Not The End

SPEAKER_00

Welcome to Not Done Yet, the podcast for midlife women who know deep down their story isn't finished. I'm your host, Rachel Perry, and here we're gonna talk about what's really happening in this season of life: the identity shifts, the quiet questions, the courage it takes to listen to yourself again, what it actually looks like to step into what's next, and why our boobs are hitting our knees. If you've ever looked at your life and thought, wait, is this it? Girl, you're in the right place. Because midlife isn't the end of your story. It's the moment you start paying attention to it. So take a breath and let's talk about what's really going on and what you want to do with it. Because, sister, you are not done yet. Hello, everyone. Welcome back to another episode of Not Done Yet. Okay, I know I say this at the beginning of every podcast when we have guests, but for real, you guys are gonna be so excited about this guest today because this woman we just met and we're instantly best friends. We're total besties. Yes, yeah. And we just discovered, so so well, let me introduce you first and then we'll we'll do a little background. So I'm gonna read her bio. Um, but this is Shannon, Dr. Shannon Cotheryn. She's known for her outgoing, yes, would it would attest to that and warm personality and her sharp clinical mind. So Dr. Cotherren is a gynecologist, right? Like that's you consider yourself a gynecologist. Yeah.

SPEAKER_02

I mean, I identify as a gynecologist.

unknown

Yeah.

SPEAKER_00

She grew up in Fairbanks County and attended UVA. Okay, so all you local listeners, listen up because you're gonna want to connect with her after this episode. She's a board-certified gynecologist and her expertise is fully focused on meeting women's health care needs. Don't we need more of that? After residency, she began her successful career in private practice, where she worked for 15 years, taking care of women in all phases of life. She's attended numerous conferences, workshops,

Meeting Dr Shannon Cotheryn

SPEAKER_00

and learning events centered on providing effective menopause care. Yes, please. In 2024, she created Mennow Start to dedicate more time and attention to patients during perimenopause and menopause. And I can't tell you how excited I am to have you here on the show today. Shannon, welcome.

SPEAKER_02

Thank you. Oh my gosh. I'm happy to be here. These are my favorite subjects.

SPEAKER_00

Yeah, right. This is uh me too. Um, and what's so fun about this, you guys, is we were just chatting and our kids all go to the same high school, basically. And our boys were have actually they know each other. And you guys who know me, I'm gonna say, like he was actually really nice to John Mark in high school. So um that makes me really happy. And you guys know how how that is. So anyway, super excited to have this conversation with you today. And I said before we even hit record, like I feel like this might become a series. So, guys, if you love this, be sure to let us know because I think this is what we need more of as women and peri and menopause. We need doctors who understand us and who don't dismiss us. And I'll share my story in a few minutes, but I would love to start with menostart, which is what you have created and built. What you left your traditional private practice to start menostart? And and can you share how you came up with the name? Because I'm obsessed. And then what which what kind of led you to start Meno Start? Can I say start anymore? I'm not sure. I know, yeah.

SPEAKER_02

We can say start as many times as possible. It also is good for my brand, so it's it's perfect. Yeah. So um, yes, private practice for 15 years, definitely feeling um the burnout of that with three teenage kids and you know, working full time, also getting to this phase myself, you know, realizing there is a life beyond our fertility, which is good to know. And I know, shocking, right? But it's it can be amazing. And I wasn't feeling a lot of hope with my patients or um myself, my friends, you know, entering this phase. And luckily for us, their menopause started getting talked about a lot more, more celebrities getting into it, influencers, and really, I think kind of turning around that anti-aging bias that kept a lot of people from talking about menopause, you know, the angry old lady on the porch, you know, which um is not true. We live half of our lives in this phase. We have a lot to give, a lot of life. There is a lot of hope. There's a lot more therapeutics and kind of the turning around of the WHI study uh and the thinking about hormones and just all of it happened at once, which was, you know, good for me personally and professionally. So is thinking about kind of doing a different kind of practice, one where I'm really able to talk to people more longer, personalized care, really get into it, because these issues that we have affect our whole body, not just like a 15-minute annual. Um, and I also started a fitness journey after my third baby, really learned a lot from that, and never could understand why the health and wellness industry and medicine were fighting each other. And so I was like, we should combine together because we're all looking for the same thing. So talked to my own trainer and we decided to build a practice together combining fitness and nutrition and medicine for midlife women's health.

Why Menostart Exists

SPEAKER_00

I love that so much. And it's called Menostart.

SPEAKER_02

Menostart. And so, like we were talking about before the podcast started, um, you know, that 2 to 3 a.m., 2 to 4 a.m. wake up time that our brains do in this phase, which we don't really know why, but it's very universal and frustrating. Um, but sometimes some creativity happens, and I was in that state trying not to look at my phone so I could fall back asleep. Yeah. And I was thinking, why pause? You know, we're ready, we're not ready to pause, we're ready to just get started on the next phase. And I was like, Mino start, that's what I should call my practice. So I was thinking of like pressing the triangle, pressing start, you know.

SPEAKER_00

Yes, I love that so much because as you know, my podcast is not done yet. And I truly believe that, and I think this is a narrative that we need to change. Yeah, it like I said earlier, you know, society is just sort of shelving us and it can feel that way anyway. And that's not true. I mean, we're at our best. I mean, granted, our bodies might not be feeling at our best, but for sure, I think this is a beginning for many of us, right? Because we've been so focused on everybody else. Everybody else. My story is basically that I was in my early 40s and I went to my doctor and I said, My hair is falling out, and my my my anxiety is especially high. Now I'm on Zoloft, okay. I have been since I had my son, not because of my son. But anyway, that's another story. And she looked at me and she goes, Okay, we'll check your thyroid. And I was like, Okay, okay. And she's older than me. So it's not as if she hadn't been through, you know, she was dead. Anyway, then several years later, I think I was 48, I said, Okay, my hair is still falling out and my anxiety is insane. She said, Show me a 40-something year old woman who doesn't have anxiety. And I was like, Okay. She said, Let's just up your Zoloft. And I was like, Well, can we can we check my hormones? And she said, Are you still having your period? And I said, Yes. And she was like, then we're not going to do hormones because you I don't give hormones. I don't, I don't prescribe hormones unless you're uh done with your period. And I was like, Okay. And she said, the problem is we need to up your Zoloft. So let's bump up your Zoloft. I'm on 50 milligrams. She was like, let's bump up your Zoloft. And I was like, I don't want to do that. And she goes, Well, that's that's the solution. And then she said, and you need to lose weight. I was like, I know. I've been trying every time I come in. I tell you I can't lose weight. So all these massive signs. I ended up leaving crying that day because no, I cried in front of her. And a lot of the ladies who are listening have probably heard this story if you're local. I was crying because she was shaming me for my weight gain. Shaming me for it, then announced it to the nurse. And you know, those walls are thin. So I just felt so embarrassed. And it was at that point that I left. I was like, and she had delivered all three of my kids. So I felt some sort of loyalty to her. She knew my story, she knew all the things. But my husband said to me, which was shocking, he said this. He was like, Rachel, how long are you going to choose loyalty to her over your self-worth? Like, oh, okay. So it was at that point that I was like, okay, well, MIDI Health, I'd heard all these great things about how they prescribe hormones and whatever. And I did that. And then now I'm somewhere else. But it was such a revelation for a doctor to look to listen to what I was saying and be like, oh yeah, we're gonna prescribe estrogen and progesterone for you. And it changed my life. So I so hearing what you do and that you started this business solely to help women in this stage of life feel seen, heard, and understood and help them navigate this weird, weird stage of life is massive. And so I I put some questions out there about some of the weird things that happen to people during perimenopause. Okay. Um menopause, I guess. I don't know.

SPEAKER_02

Do they have menopause still is a thing? It's so they are different phases and they have different treatment um strategies. And I think that that's something that can be confusing now that everyone's getting hormones. Right. You know, you're like, my neighbor feels amazing and I'm on this hormone, it's not helping. It's like, well, she's 52 and you're 42. Right. You may need different things. Right. So there's still a lot of um personalization that needs to happen. And, you know, the kind of private equity-based corporate practices are just not set up for that. Right, right. This was and I have a lot of compassion for your GYN too, because I know how that feels, you know, when I was in, I was at Capital Women's Care, and they're great doctors, everybody's, you know, well trained and really good intentions. But um, you know, I had a very long waiting list,

When Care Feels Like Shame

SPEAKER_02

but they were always coming to me and being like, You're our lowest biller because you're taking too long, you know, and then they would make me my patients get a handout before the annual exam that said you're only allowed to ask Dr. Cawtran one question. I know, can you imagine? Because I was, you know, take always behind because I didn't believe that you could do all this in 15 minutes. But that was the push, you know. So when I would see menopause symptoms on my schedule, I get so stressed because I knew, like, well, this is gonna put the whole day behind. And and so then I would, I'm sure I would take that stress into the visit, you know, and just be like invalidating and because you're just trying to get through the schedule that you have to get through. So it's not good for the doctor or the patient, you know, that especially this type of, you know, there's they're now identified 70 symptoms associated with perimenopause.

SPEAKER_00

Can we talk about that? Let's talk about some of those. I mean, we don't we don't have to go through the whole like line, but I was talking to a friend the other night, and she said, I have been having this weird, it feels like I have water in my ear. And she was like, I had it for I had it for so long. I finally went to the doctor, and the doctor, they did everything. My hearing is great, everything. And the doctor said it could be associated with perimenopause.

SPEAKER_01

Yeah, what?

SPEAKER_00

So is basically every weird thing. Do we really do we generally it's probably perimenopause?

SPEAKER_02

I think that's why it's important to have a professional talk, you know, talk to because some things aren't perimenopause, right? And you do want to rule out any dangerous things, you know, but it is a head-to-toe, you know. I did a head-to-toe talk because it affects hair, skin, ears, all of those things, your heart, you know, um, your lung capacity, your joints, your skin, right? Then obviously the pelvic things, the vagina. Yeah, you know, all the way, yeah. My favorite. All the things. All the things. And so, you know, you have to make sure it's not something dangerous. And then, like, yeah, it's probably this change you're going through, but the messaging that gets lost is the hope message. Like, you're gonna get through this. We have some therapeutic options, like what um what you finally found, and to validate is so important, and to say to the people, like, yeah, it's gonna feel like your body is going crazy because it kind of is, but you're gonna come out on the other side, and you know, we're here with you to partner. Let's get through this, you know. So that is what I think we're not messaging enough is the the hope.

SPEAKER_00

And I think that's in that moment, and I know that I'm not alone, and that's why I'm sharing this story, is because there is that feeling of like, I'm there's something wrong with me, and I'm going through this all alone. And like you said earlier, there there is more talk about it. People are, it's not, you know, like for our parents, our moms, right? They just had to suffer through it. But I do think, I mean, I went to the doctor, I'm just now realizing this. I went to the doctor because I was having heart palpitations and everything was fine. And now I'm like, oh wait, maybe that was also related. Like all these things.

SPEAKER_01

Yeah.

SPEAKER_00

What is the weirdest symptom that you have had someone come to you with? Or that you have, or that you know of that would be related probably to perimenopause, menopause. I don't know.

SPEAKER_02

I had a patient who was getting hot flashes, but only below the waist, like only her legs were getting sweaty.

SPEAKER_00

And I was like, Oh my god.

SPEAKER_02

I don't know. But it was a hot flash. That's just how her body was doing the hot flash. So that was an unusual one. Usually the hot flash is all over. Yeah.

SPEAKER_00

And what how what should someone do if they're listening? And and even if they're if they're not local, let's say. How do you how do we know? I know the answers go to the doctor, but like how when is HRT a good option?

SPEAKER_02

So perimenopause, I'll talk about perimenopause and then menopause. Yeah. So HRT just means hormone replacement, you know, and it just is giving, in our case, as women, it's estrogen and progesterone, and then sometimes testosterone. Those are all the sex hormones, that's what we call it. And perimenopause, usually the ovary is still working, still making those hormones. That's where those hormones come from in us. And the problem is that as opposed to our 20s and 30s in the 40s, usually seven to 10 years before menopause, with the average age of menopause being 51. So it can be early 40s to late 40s, the ovaries starts going kind of crazy, and you get these huge fluctuations in hormones. You know, a couple months in a row, you may be fine. And then you just have like a super high estrogen month. And we don't really know why that's happening. It's very similar to puberty, which we all are a lot of us, I should say, if we have female children, are also going through that fun. I don't know why God did that, like making puberty and parenopause at the same time, but it's good times, right? But it but puberty is celebrated, you know, like, oh yeah, you're getting a woman body, you know, it's celebrated in society, all of those things, you know, it's kind of like expected that you're gonna have mood changes and other body issues. Um, perimenopause, we're supposed to just, you know, not talk about it. The body changes aren't really celebrated. Um, and but it's equally as frustrating. So, in that phase, it's more of stabilizing the hormones than replacing them because you have hormones, they're just kind of in an unstable situation. And it depends a lot on what your fertility plans are, and you know, do you need contraception? How are your periods? Do you still have a uterus? You know, all of that can affect our decision making on what type of hormones to give. So in perimenopause, a lot of times I'm trying to suppress the ovarian hormones because they're going crazy, and then replace them in a more stable, steady state. And then after menopause, estrogen and progesterone are gone. Like they just precipitously drop,

The Head To Toe Symptom List

SPEAKER_02

and that's where you need the replacement. So it's kind of a different strategy. Right. So anybody that is having any of the symptoms that we're talking about and kind of alluding to is a candidate for hormone replacement or menopause hormone therapy. MHT was a term going around for a while.

SPEAKER_00

Okay. Okay. So something that I've noticed, and I I've been taking, like I said, estrogen and progesterone for probably a year and a half now. And I've noticed recently that I'm, and I'm sharing this, it's not so that I have my own doctor's appointment with you. It's because I think other people are probably experiencing other things like this. Is it normal to all of a sudden, after you've been on it a while, like through perimenopause, to then be like, wait, I'm actually having hot flashes now, or my joints are hurting more than they were, or my anxiety has increased. Is that normal while you are on hormones? Because your hormones are changing.

SPEAKER_02

Right. And sometimes it sometimes it involves what we need, you know? And so I do find in my practice that perimenopause seems to be more distressing because the symptoms are more kind of acute and um, you know, I guess not as straightforward. And people have had that situation that you had where they're dismissed, not validated, made to feel like guilty about their body changing, and we don't like that. Um, so sometimes we don't really have the language as much to talk about it as we do in menopause. Um, but definitely it it can be something that is changing, you know, as your ovarian situation is changing. Right. It's called the ovarian situation.

SPEAKER_00

I'm gonna of course it's a situation. Of course it's a situation.

SPEAKER_02

The ovari's having a situation.

SPEAKER_00

So funny.

unknown

Yeah.

SPEAKER_00

So I know that there was a lot of negativity and like sort of like you know, hormone replacement therapy is not a good idea, and that's changed, right?

SPEAKER_02

The data hasn't changed, but the thinking has changed really. So a lot of things in the past 25 years with HRT has has happened. So in the 30s, 1930s, estrogen was identified as a hormone and isolated and, you know, used for contraception and all of those things. And then a book was written without any randomized controlled trial or really good evidence called Feminine Forever or something like that, where, you know, we were gonna fix the grouchy old menopause lady. She was gonna be nice and happy and want to have sex. And, you know, of course, everybody wants, you know, all the men were happy with that model of person. And so they just started giving everyone estrogen that was in menopause without any studies really. And then doing that fixed a lot of the menopause symptoms, but without progesterone was causing uterine cancer. So then in the 70s, they realized you can't just give estrogen on its own. You need progesterone to protect the uterus. Unless you don't have a uterus, you need uh estrogen and progesterone. But because of that, there was some reluctance then to take, you know, the estrogen because people associated it with cancer. But the issue is fixed with progesterone. And then the birth control pill got, you know, easier and more acceptable, and people were taking hormones, you know, really revolutionized women being able to go to work, you know, control their family size, a lot of good things from um from that happening in the 60s. And in the 70s. And I think that's, you know, part of why our generation, you know, our moms were the first women in society that could control that part of their life.

SPEAKER_01

Right.

SPEAKER_02

No one was really focusing on menopause then. They were just like, oh, this is new. And we're kind of the daughters of that. And realizing, like, great, I'm happy I could control how many babies I'm going to have. Um, but now what about after the babies?

SPEAKER_01

Right.

SPEAKER_02

In the 90s and 80s and 90s, they found that um women were getting heart attacks about 10 years later than men. So they figured that estrogen was protective on the heart and that was actually good. And that once we got into menopause, we're getting heart disease and strokes, all the things men get. And so there was a push from the drug companies and women's health providers that um, you know, menopause is a disease and everybody should be on estrogen and progesterone, not only to stay feminine forever, but to protect the heart and other, you know, health reasons. And then to prove this, they did the WHI study. Um, this was a randomized controlled trial. It's still going on, but it was supposed to prove that HRT was awesome and everybody should be on it forever. Unfortunately, the study design was really flawed. It wasn't, it was older women who had already been in menopause for a while, already had heart disease in a lot of cases. Um, and it was actually stopped early because they found an increase

Perimenopause Vs Menopause Hormones

SPEAKER_02

in heart attack and stroke. Um, and then in 2002, that did that data came out, went to the media, and everyone's like, hormones are actually harmful. There's increased risk of heart attack and stroke. Um, there was a slight increased risk in breast cancer, but the media was like, it also causes breast cancer. And so everybody at that point, and I was in med school, so I remember, stopped taking hormones. Um, 20 years, 24 years. I can't do math. I'm a gynecologist. I'm a vagina doctor, not a math doctor. So, whatever it is, 20-ish years later, kind of the pendulum is swung back. Everyone looked at that data again and was like, actually, that's not what the findings showed. You know, I think women our age were kind of advocating more for ourselves, like, especially the millennials, like a little bit younger than me. They're they are not accepting women's suffering as the norm. And, you know, let's relook at the data. And it didn't actually show that increased risk as much as we thought. Um, and so hormones are kind of having a resurgence, and it's still not safe for everybody.

SPEAKER_01

Right, right.

SPEAKER_02

That's why you do have to have, you know, people that understand that and who you are, really, you know, take your blood pressure and all those things, which um is part of my kind of reluctance about the telehealth only options. I think it's nice to have an in-person, you know, we have an exam room, all the things. Um, but it's really opened up access to these medicines. And then recently, um, when that WHI study came out in 2002, they put a black box on all estrogen and and um products, and that's just the FDA warning people like, you know, this drug could be dangerous. So you have your estrogen that's in your whole body, and then you just have vaginal estrogen. Two different types, different safety mechanisms. The amount of vaginal estrogen we use doesn't get into the rest of our body, but is very good for sexual health issues and urinary issues. And so we've always been trying to get the black box off of that estrogen because it's safe. Even breast cancer survivors, everybody can take that. And so the menopause influencer advocate advocates uh have been fighting for that for a long time. And, you know, this administration was like, great, we're gonna do that. And we were so excited, but then they took the black box off all estrogen, so it's kind of like, oh, okay. Not exactly what we were thinking. Um, but it's interesting, it's opened up the conversation, you know, again about the safety and who should be on HRT and when. Um, but it's very nuanced. Um, there's new data coming out, but it's it's still kind of the frontier, honestly.

SPEAKER_00

Yeah. Well, that actually brings me to my next question. Who is a good candidate for HRT and who might not be?

SPEAKER_02

So let me answer it this way. Um the estrogen can cause, you know, it's thrombogenic or it can cause blood clots. And so we know that for pregnancy, you know, people getting their period, people being on birth control, people in menopause. So we call estrogen a thrombogenic molecule. It can promote clots. And so anybody that has a clot or a risk of a clot, you know, heart attacks and strokes are diseases of clotting, you know, then they should not take estrogen. So if you've had a heart attack, if you've had uh, if you have a clotting disorder, you know, if you've had a stroke, those people are not candidates for estrogen. Now that we have, you know, a lot of different formulations, we know that estrogen that's absorbed through the skin or transdermal, the metabolite of that is less thrombogenic than oral estrogen. And so that's why everyone's like, we're do the patch, we'll do the the creams.

SPEAKER_01

Okay.

SPEAKER_02

And so in somebody that doesn't have a heart attack history but has hypertension or diabetes, you know, an increased risk, but not having the event yet, in those people, you know, having the transdermal option has been nice because it kind of expands who it can be safely used for. But because of that, I think everybody, you know, MIDI, all those guys are just saying all menopause people should be on a patch, which isn't totally true, but that's why there's the patch shortage. Yeah.

SPEAKER_00

Yes. I will tell you in my experience, while I was so relieved and happy that I felt seen and heard, like it was such a relief. I started getting a little bit concerned when the person that I saw changed. And I got on the call. My this is the last time I I met with them. And the the I think she was a nurse practitioner, and she was like, Okay, so we're gonna give you the testosterone. And I was like, What? What? I'm sorry, what? And she was like, Yeah, we're just gonna give you the cream, it said, and I was like, I don't, I'm not on that. Like my my levels looked okay, like maybe slightly low, but low average, I guess. And um, she was like, Well, we'll just try it and see. And I was like, push that's a push that's a form on you. Yeah, yeah. I was like, Oh yeah, and I and I never, never, I never did it. Um, because then I actually went to Capital Women's Care and the doctor, she was like, No, I do not prescribe, I do not do testosterone. Estrogen and progesterone, yes, not testosterone. I was like, okay. Now I wish I'd asked why. Yeah. So can I do that?

SPEAKER_02

Testosterone is a whole nother, you know, world. And traditionally, GYN, we're not doing testosterone for women that much. Um, you know, some people, I guess, actually, no, I never in residency or early in my practice heard of giving women testosterone replacement. Um, but it's really been, huh? It was just like a cream she had.

SPEAKER_00

Yes, it was the cream.

SPEAKER_02

So that's a testosterone is a different type of medication. It does have pills, but they're not available in the US. So it's transdermal

WHI Study Fear And What Changed

SPEAKER_02

or an injection and or these pellets. So there is good data. There's actually a study that shows that uh testosterone in women can increase libido. So sexual health, metabolism, hot flashes, irregular periods, those are the big four like bad symptoms of perimenopause, you know, and menopause. So, of course, sexual health, there's tons of incentive to fuck to figure out how to make how to make us want to do it more, right? So I mean, I would love that. So that's the only thing that the only actual data for testosterone in women is for libido. But there are a lot of influencers and I'm gonna call them advocates because they are advocating for women. And some observational studies and kind of suggestions that testosterone and women can also help with the joint pain, you know, increasing muscle mass. We know it does that in men and women, and then um helping with cognitive and some mood issues, you know, also that that have been shown on testosterone. Um, PBS did a documentary called the M Factor a couple years ago. It came out. And, you know, when you watch that, you're like, maybe I should be on testosterone, you know, because they they make it sound like that, you know, it it changed everybody's life, made them get back to who they were, all of that. It's hard to differentiate if that's testosterone or also the estrogen progesterone combination. Um, the data when you look at the literature doesn't show as strong of a case for that with testosterone, but it's pretty safe at the doses that we're using. So if people want to try it, I'm very open to that. And I do have that's one where I do recommend the labs. And I do have a patient whose testosterone was zero, and she's an elite athlete and wasn't feeling strong. And you know, we restarted testosterone and she feels great. So I think it does help people in certain situations, but I don't think everybody who's you know 40 to 60 we should be like, here's your bag of hormones, like have a nice day, like you know. Um yeah, I was just gonna say pellets are a thing that uh testosterone pellets, a lot of pharmacies and some doctors are using. It's not recommended really by the menopause society or the American College of OBGYN. The issue is that you get these super physiologic doses, very, very high doses, uh, and people feel amazing on it at first, like I could lift up a car, you know, because it's just like steroids back in the day. But it can cause uh viral, oh gosh, here's my perimenopause, virilization. There we go. Where you know, you get voice deepening, um, male pattern hair, loss, and growth. It can cause clitoral megaly, and you know, which maybe sounds good at first to have a bigger clitoris, but it actually causes pain. It's not like happy, happy big clitoris, it's sad big clitoris, um, where people even sometimes see surgery. Yeah. Uh, but luckily, another modern medicine phenomenon that's happening that's really helping us learn about testosterone and hormones in in people's bodies as they age, uh, is trans medicine. And some of the people with pellet pellets are having levels the same as someone like a trans man who's so unless you're wanting to be more masculine, you know, those levels of testosterone, blood levels aren't good.

SPEAKER_00

Right. Oh my gosh. Yeah, no, thank you. Like I already struggle enough to feeling attractive and desirable and all of that with all the things that are changing, my boobs, reaching my knees, like, you know, the the the thicker belly, the and you know, it taking forever, you know what I'm saying?

SPEAKER_02

Um, just there, they're so that's that's really on the doses we're we're using here, you don't get that, you know, and all of those things are reversible except for the voice changes. So if you start getting acne or hair growth and you stop the testosterone, it you know, it gets better.

SPEAKER_00

Right. So if a woman is listening, and listen, we have only like touched the the tip of the iceberg in this conversation. So I do think that we need to, if you're okay with that, have more. And if you're listening and you would like us to have um Shannon back on, then let us know and let us know what questions you would like answers to. But if a woman is listening, well, if if someone is listening to this and is like, wait a second, I see me. Like I feel this on so many levels in everything that we've talked about, what should and she's not on HRT, or maybe she is, what should she do first? Do you mean like which therapeutic should she take first? Like if she's if someone's probably someone who hasn't had who isn't on hormones, but if someone's like, okay, yes, yeah, I feel all this, I have the hair loss, I have the anxiety, I have the the weirdness, I have the hot flashes on the bottom half of my body. What should she do?

SPEAKER_02

Good callback. Yeah, the honestly, the first step I would say is a consult. It's very consultative because you gotta talk about your medical history, your OB history, you know, birth trauma increases the chance that you're gonna have worse menopause symptoms, which is in like very interesting to me how our body processes trauma. We don't talk about birth traumas enough. Um, your family history, all of those things. You need to get a whole picture before we can say you need this, you know, hormone X and Y. And so the first step is gonna be to find somebody where you feel comfortable having a consultation about these issues. That's number one.

SPEAKER_00

What are some what are what are some questions, you know, in her five five minutes? If you're local, clearly, we you need to, and I will give you all the information on MeadowStart at what are some questions that will get her better care? That's a good question.

SPEAKER_02

Um like how to navigate this medical system in this phase of life is kind of what I'm hearing you ask. I mean gosh, Rachel. It's tough. I'm not gonna lie, it's just tough. I would just one thing that I can I think that can help is to make a separate consult visit, not try to do it at your annual because the system's just not designed for that, you

Testosterone Hype And Pellet Risks

SPEAKER_02

know. And there's lots of um, you know, resources online and things about what different perimenopause symptoms can be. And if you if you kind of think of a list, like which one is the most distressing to me right now? You know, you're not gonna fix every single symptom in one visit. Um, and then how do you feel about medicine? You know, some people want a bag of pills at the end of the visit, some people don't. They want to think about more holistic options or natural options. And so kind of figure out what what the goal is of the of the question. You know, if you're like, I'm having such terrible hot flashes, I cannot sleep, and it's affecting my work performance. I'm grouchy all the time because I'm so tired. I don't know if this is my anxiety or sleep or which one, you know, and that's the main issue that I want to talk about today. I think that could really help. But sometimes it's hard to know what the issue is until you have that conversation. And so yeah.

SPEAKER_00

And actually, that is something all the symptoms that I was having before with my, I had I would wake up from sleeping, um, and my lower back was so painful. I couldn't bend down to touch my toes. I mean, I can't bend down to touch my toes now, but but it wasn't flexibility that it was like I was just in so much pain. I'm like, do we need another bed? We just got another mattress. Like, what what is happening? And it wasn't until I did more research that I discovered that in fact is perimenopause. Um my shoulder hurt, my shoulder was so painful, and I thought it was because I was sleeping on it. Hormone. Nope. Yeah. That was there's just there's so many, so many things that are a result of this that we don't have to suffer through. And I think that's something that I've I'm hearing from you is like there is hope.

SPEAKER_02

There is hope, and you deserve to feel good, and you deserve to invest that time. So that's why we designed a six-month program because sometimes that's how long it takes. You know, it's not gonna be just one appointment, right? It's kind of a program that people need. And I think as women, you know, and moms and career people and daughters, all the other roles, wives that we are, we forget that we also deserve some time, you know, and that investing now is gonna help us be better at all of those things. So yes.

SPEAKER_00

So let me, I that's it brings me to my next question. Thanks for like doing me there. I know, I love it. I love it. I'm like, I want to be my doctor, but not weird for me. Yeah, but not weird for me. You can look at my vagina. I'll show you mine if you show me yours.

SPEAKER_01

That's so funny.

SPEAKER_00

How does Mennow Start work for women who want to work with you specifically? So you mentioned the six-month program. Can you tell me?

SPEAKER_02

So I'm the only physician here right now. So when you make an appointment, I'm who you're gonna see. I don't have like 10 closet NPs that are gonna come out and see you. It's just me. Um, and you go to the website www.menostart.com. It's M-E-N-O-S-T-A-R-T. The dash is for hot flash. One of my friends gave me that one. Like, I love it. I know. People are so creative. And then you can schedule a free 15-minute consult, which is a call, and we can see if it's a good fit. Um, I don't take insurance, so it's we used to call it concierge, now we're calling it direct-to-patient care, which I like that uh better, but the whole program's less than your deductible in a lot of instances, and you get such better one-on-one. I give you my cell phone number, I give you my email, you know, direct access, we have openings, and we have time to really get into it, which is is nice. And then any meds, imaging, labs, we all try to use um the insurance for those because we do want to work in the system that we're in. And then the program includes fitness and nutrition consult as well, and then up to two sessions a week with the trainer or our group class. So that part is nice for the community that we're talking about. The group class is really fun, and um, you know, even elite athlete to someone who's never been in a gym is private, it's you know, a place where you could just be Rachel, you're not John Mark's mom, or in my case, Dr. Cothrin,

How To Get Help That Fits

SPEAKER_02

you know, just Shannon. And it's like it's kind of the only place that I have like that.

SPEAKER_00

Yeah. I and that is such a vulnerable time, I think, for us as women, and being able to see someone who totally gets it, where you are it's the whole picture. It's not just like, let me look at your vagina, it's the whole picture. And I think that's what's so appealing to me. So it is out of network, but that gives you more, I would imagine, more flexibility and more ability.

SPEAKER_02

I could do virtual, I can do a phone call while you're stuck in traffic on the beltway because I don't have to bill every visit, it's just taken care of. Um but we can submit HSA and FSA too. I don't charge for super bills or anything.

SPEAKER_00

I want it to be easy. Okay. Yeah. Yes. I love that so much. I love that so much. So wrapping this up, what's one thing that you want every woman listening to walk away knowing today?

SPEAKER_02

Um, I want every woman in midlife to know, no matter how you what your path was to get to this, you know, self in this body right now, that all of those things that built you, you know, some of them are good, some of them are bad, but they all made who you are now. And we can make who you are gonna be in the next four decades even better. So it's not an end. Like you said, we're not done. We have a lot of things to do. No, we're we did cool things, we grew people in our bodies, you know. We were in college before social media, like, thank God, none of that's online. You know, we built careers, like a lot of cool, awesome things got us to this place, but there's a lot to look forward to.

SPEAKER_00

I love that so much. I loved, I love ending on that note. All of the information for those of you who are local or who, you know, are still want to talk to her and make it a consult. I don't know how it works, but um, I'll put all the information down there. We are talking about Shannon and I are talking about doing things together in person. We can speak to that. Yeah. So, so again, be on the on the lookout for all of that information. Shannon, thank you so much for being here. Yeah, oh my gosh, this is so fun. And again, if you guys want us to do a series, if Shannon would be up for that, like I'm down with it, we'll we'll do it. So let us know. Thank you. Thank you for being here. And you guys share this with a friend who is also in midlife because this is what we need to do. We need to support one another, share, share all the things. This was a weird conversation, right? These are conversations well, not actually weird, but these are conversations that we don't want to have because we feel embarrassed or whatever. We're here to make sure we'll ask all the uncomfortable questions. And for my son who is editing this podcast, sorry. All right, you guys, thank you so much for being here. I can't wait to see you next week for another episode.