S2-Ep10: Menopause, Hormones and Sex Drive - SPECIAL EDITION with Allison

Our Sexy And Single Sisters Over 50 Podcast welcomes Allison Fox, MSN FNP, to this Special Edition!

Whether you're over 30, over 40, or over 50, SASSover50 is talking openly about menopause, hormones, and sex drive.  From mood swings, depression, and hot flashes to vanishing libidos personal dryness, and facial hair this podcast might just change your life (and help you to enjoy sex again)!   

As a Registered Nurse specializing in Hormone Replacement Therapy (HRT), and menopause for 18 years, Allison reminds us that, 'women have been sold a lie that they just have deal with menopause', but that's simply not true!  We ask all the questions about Estrogen, Progesterone, Testosterone, DHEA, pellets, and libido that you wanted to know, but didn't know who to ask!  Share this podcast with women of all ages who may be approaching their "change of life".

DISCLAIMER NOTE:  This podcast is for informational purposes only.  All information, content, and material is to inform our listeners about what we have learned or experienced.  It is in no way intended to serve as medical advice, medical consultation, medical diagnosis, and/or substitute treatment from a qualified physician or healthcare provider.  The listener assumes full liability for their medical care.  All persons and businesses associated with this podcast, any platforms on which it is shared, or otherwise associated with the podcast or any of its creators and contributors, expressly disclaim responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result information provided in this podcast.

Transcript

Unknown: 0:14

Welcome to another episode of sexy and singles. Over affinity. Welcome to another episode. Hello, ladies. Hello. Oh, what a fun night we have in store. I'm very excited about this topic. We've been talking about it especially. I think Danny and I have talked about a little bit extra. And Kate's a little bit younger than we are. So the hormone issue isn't as big of a deal yet. It is just common knowledge from Yes. Yeah. So there's, you know, of course menopause. Many of us are either going through it or have been through it or are still going through it or are Peri menopause. So I'm so excited. We have a wonderful guests, I would say expert because this is right in her wheelhouse. We have Allison box, who is an MSN FNP, which I have no idea what that means, but she's definitely going to tell us what that means. And give us a quick overview of what she does. I know the nurse part, but I'm excited to introduce Allison. So welcome, Allison. Hey, thank you for having me. Yes, I'm a nurse practitioner and I work in Portland, Oregon and community health and I have been working for almost 18 years and helping people along that whole time with their journey into menopause and helping them you know, some people don't have many needs during menopause, but most people are the majority of women do. And so I am happy to be here today to kind of help your audience you. Yeah, absolutely. We're so happy to have you and we have so many questions, but I'm just gonna kind of fly off with first of all, menopause. When does it typically start if you can just give us kind of and then I know there's perimenopause or Peri menopause, perimenopause. How many stages are there and when do you typically start? There's three stages in menopause. So perimenopause is the in between. So hormones are starting your ovaries are starting to kind of peter out. And that can last if you know, a year to a couple of years, maybe even six years. Sometimes people will start to go into early, you know perimenopause. And they're typically mid 40s is when people are gonna start having some period menopausal symptoms. There's some genetic, so some different races, people will have different Asian people tend to go through earlier menopause. So there there are some genetic variations, but usually between 45 and 52, you're going to start hitting that current menopausal window. Okay. And did you say that was the middle one? Is there one before then and one after then? So perimenopause is the first one and then a year of not having your menstrual cycle you are considered officially in menopause? Okay. And then after that there is just post causal. So changes sort of down the road? Is there a typical time period that menopause takes place? I mean, is that usually going to last for five years or 10 years or two years? In theory that much? Yeah, it's variable depending on the person. Some people get away really easily. And it's a maybe a year of a transition, and other people will tell me 10 or 15 years, which it's the best indicator when you're gonna go through menopause is when your mom went through menopause. So if you're lucky enough to know, if you weren't adopted, or your mom didn't have a hysterectomy, something like that, that would have kind of you don't have that information. Mom's age of menopause is that's interesting. I didn't realize that. So it's almost like a hereditary, you know, and and as far as the actual menopause symptoms, we all know about the whole hot flashes. And I guess vaginal dryness is a pretty common thing. Like lethargy, there's so many different symptoms, and I'll let you review those. But first, I'm gonna just ask if Kate and Danny have any specific questions. I think that something that our listeners would want to know is while there are the more common things like the hot flashes, like you said, but I think there's still a world of women out there that don't know that this is a possibility or capability of being able to rejuvenate so to speak with the with hormone therapy, and like, there was a woman I was talking to a couple of weeks ago and she was talking about the weight gain in the hair on her face and just not caring about things anymore. And I think menopause is more than just the hot flashes. It creeps up on us. Like what is it that you would have encourage women to be aware of more so than just a hot flash. You know what, um, because I, I think depression, like, it's not just a mood swing like PMS, I don't think, um, but I feel like I've gone through a lot of different changes. Some were probably depression that was not related to menopause. But it just happened that the big life changes happened at the same time, which brought that on, but I don't know, maybe one made the other worse. So maybe like the symptoms or that type thing. Things that look for. What do you think Allison? Yeah, absolutely. Um, yeah, I think that, you know, I'm, I'm glad that we're here talking about this, because I think that women are often sold this lie that they have to suffer, right? And that it's part of the journey and just suck it up, buttercup, right? Oh, you you want to do you know, change, you know, feel better during this time, you know, then you're, then you're not doing it right? Or somehow that's like, you're doing womanhood wrong. And absolutely, there are some people who become almost murderous, like their mood, you know, shifts are so volatile, that they go from feeling pretty common normal to feeling like the ground is out, and you know, from under them. So that's one, but it's also just a lack of sex drive. And so we'll I think we'll talk about a little bit later with hormones. But I think on a fundamental level, if men experienced what women do, where their testicles just stopped giving them sex hormones, I think there would be a lot more information for women, honestly, because it is, is that kind of the equivalent? No, no. That's what I'm asking. Yeah, men and get testosterone, you definitely declines decade by decade, but you can be 60 or 70, and still have testosterone levels where that's not the case for women. And it really, yeah, so I think that women had been sold a lie that they have to suffer. I think it's unnecessary. And I think, you know, maybe we'll get into later, the whys about that. But I think that women need to be educated that they have options. Good. Oh, I'm so glad to have you. Because this is exactly. I mean, it's on our minds anyway. And Kate, you're not going through it yet. But I mean, you're gonna be so wise, you'll, you'll be so ready for it. I do have a question, though. So, you know, I'm still so you know, I'm still on birth control. So like, you know, if I'm on birth control, and I going to feel this change, basically. I mean, what, what kind of, are you talking about oral contraception? Like, yeah, birth control pills? You didn't? You wouldn't know. But I mean, you're over 4.0? Yes. Okay. Yeah. Usually, providers will start to have conversations after I call it 4.0. That's my way to get around, you know, a gene is I make it like a decimal. That's pretty clever, actually. Yeah. Yeah. 4.5, just to be totally transparent here, your problem. And usually people will have a conversation with you about it, because people try to pull you off of those types of hormones. They aren't bioidentical, which is not ideal. But you wouldn't know, though if and when based on your cycle, which is a good way to start to say, Oh, hey, my cycles are getting irregular and Oh, my diet hasn't changed, my activity level haven't hasn't changed. You're not going to have that marker when you're on a birth control pill because it's going to keep you regular. So you would have to look out for other signs and symptoms of like, your mood, you know, becoming like your mood shifting or something like that. Because your cycles, your cycles would still be the same. Okay. Yeah. And that's kind of what I was. I was thinking you were gonna say because I was thinking, well, if my hormone level is you know, consistent, basically then, you know, how am I going to know basically hopefully, you're not going to be on oral contraception for that much longer because Is it risky? I thought I always thought that was a risky thing. That doesn't smoke. But you know, I I really like Mirena IUDs I just think they're easier. You don't get any of that. Most of the estrogens are from I think most people know by now like horse urine. That is that is like Premarin based and so. Yeah, I think IUDs are just easier all around. You don't have to remember to take a pill every day, but it's Not necessarily dangerous unless someone had migraines. It was making their migraines worse, like, oh, we'll cross that bridge in a second. Okay, Danny's got a little something about that situation. It's funny. We were talking about that before you came on. You know, I know we all have a little, a few examples of things we've been through. But I think it's really helpful just to kind of get the some of these major questions out of the way and kind of dive into some of that hormonal treatment, because I think that's what most of us are looking for. And I had no idea it was actually Danny, who had said something about taking testosterone or DHEA, and all this stuff. And I was like, What is she talking about, though? I started looking into it literally this weekend. And I knew Alison, you were coming on board. So I'm like, during my quest for question, or in my kind of my research for questions to talk to you about it. I learned a lot, but I ordered something. So you and I talked, I was in just briefly you mentioned what did you order? You said you ordered something I did. I ordered Wynonna and it's all prescription. Okay, so yeah, so it's the estrogen therapy and the pedestrian mix together in the cream. Okay, great. It's a cream. So it's an intra vaginal cream. No, it's, um, skin. Yeah. Topical, and then the DHEA pill. Right. So that's, that's what so that's great. Yeah, I'm glad that you mentioned, I think that the lack of vitality, you know, people can consider it just part of aging. And like you said, Oh, I'm just, you know, getting in my 40s or 50s. Or life is slowing down. This is what's common. I'm just more fatigued. And sometimes it really is, if I wrote thing, you know, thyroid issues are really common in perimenopause. So they, some things can actually happen simultaneously. But I do think that Western medicine often fails and women around this time because we are taught to not go chasing hormone labs. Right. And it's not considered standard of care, which means it's it's a it's our way of saying just tell women to suck it up. Yeah, exactly. Like the client. Yeah, yeah. And so we'll deal with it. Yeah. So if someone comes to me, of course, I feel really strongly about this because I'm want to go to bat for my patients. And I don't want to get keep that I'll check their hormones, particularly FSH is a follicle stimulating hormone will be really elevated in someone who's in menopause. How do you check them if I can enter just a lab test? Okay, it's it. Yeah, it's a simple lab test. And it's not even that expensive. And so I think encouraging your listeners, if you're a provider, if you bring up these concerns that your 38 would be the young end of it, but particularly if you're in your mid 40s, you know, I started when I menopause or perimenopause when I was 3738. But it's pretty uncommon, but if your periods are to be irregular around that time, or you're curious, you know, asking your provider and if they say no, you know, I think it's it were it bears some thought as is is the provider for you. Because if they're not taking your concerns seriously, you know, maybe that means you also then you find a naturopath or find a naturopath tend to be a little bit more they have more time with patients and will often do deeper dives with hormones. But the FSH is an easy lab test to be able to see if someone is their hormones are starting to go offline. And yeah, a common complaint is like the lack of sex drive that the vaginal dryness but also just lack of vitality. I think for me, just from a perimenopause perspective, just to put this out for people to know from an experience perspective, I was in my early 40s. And I was the mood swings were so bad. It was the more of it like angry like the temper, and I wasn't that type of person. But anyway, I had gone to my gynecologist he tried me on birth control. He wanted me to be he wanted to try to flip my hormones. That was a disaster. And I don't remember if he did labs or not. Now this was 10 years ago. I was a Suzanne Somers hormone cheerleader. So then I found a woman who did deemed that she was a gynecologist that did bioidentical. I went to her. Not one lab said, here's the combo pill based on your symptoms go take this, which was I think they were bioidenticals but it was just it was a pill and I couldn't tell you what was in it. Other than some mixture of whatever. So I took that it didn't work. By the third visit. I went to see her she said to me, you need to admit that you're depressed and go see if they're honey. Oh, so then I finally another amount of time has gone by and a company had started doing hormone therapy. They called themselves 25 Again, and finally got the labs done. And they started me on just progesterone because I was still projet producing estrogen. And once you get that level of progesterone, right, my husband would go, where is it? Do not Did you pack it like we're going on? You cannot forget your progesterone was a miracle. That's awesome. I go to the mountaintops about how well that helps me and I did do the thyroid thing not because my thyroid was it, what is it about your if your thyroid isn't performing at peak? They just want to give it a boost? or So yeah, yeah, like the supplements like something some iodine? Yeah, for so I was doing that. So I just stayed with that program. And don't I don't even talk to my gynecologist about it anymore. Yeah, I think that if someone doesn't do baseline labs on you, and you're going in with a concern that's hormonally related to me, then how do you know what's working and what's not? I know, it's not one size fits all. There's just Yeah. And that's a lot of experimentation to be adding and taking away more hormones from somebody who's already crazy. I have had patients who come in and say, I think I'm in impossible, or peri peri menopausal, can you check some hormone labs, and I've had people who have all of these complaints and their hormones look great. And I and I do have to say, hey, like, you're, it's not right now. So maybe it is something mental health can be overlapped, you know, and some people need to hear that is like, okay, that go see the counselor, right, that sort of thing. So that does happen occasionally, or am I boo, you're making your May, it's working all that seems to be fine. You know, so yeah, that's that's a good point. Yeah, just not the one size fits all because yeah, it's so I think checking those hormone levels. And then also, you know, doing a testosterone panel, not just a regular testosterone, because there's free testosterone and there's there's bound testosterone and really, whatever your free is, is all it's circulating in your system. And so, sort of jump ahead to testosterone before we even talk about the estrogen but you know, your adrenals make testosterone and if your free testosterone is not circulating in your body, then you don't have access to it. So if your provider just does a regular testosterone level and gives you a number it could look okay, but it you know, if you have to do the panel, which shows your sex height like hormone binding globulin like someone who probably hopefully self identifies is doing some hormones or you know, and I think with with Google, it's pretty easy. Now you just type in your city and hormone specialist, I would I would hope that these people are, you know, are doing those kinds of panels that can look a little bit more just under the surface levels. Excuse me, I wanted to that's exactly one of my questions was, where would somebody go to get a panel like that? So you could Google that? And yeah, and just go to that type of a specialist. And so they wouldn't have to be like an ongoing care doctor necessarily, but they definitely be the labs people. Okay. Yeah. And honestly, and of course, this is not just the disclaimer first, this is not medical advice, you know, but even I mean, I'm in western medicine and I have not found my gynecologist or my regular Western medicine, it's, she's an integrative medicine. They, it's not I go to a naturopath because I have found that the gynecologist sort of said, Oh, you're 42 I said, my boobs are getting saggy. My vagina is getting dry. And I want to continue to like not to be TMI, but enjoy sex and I getting wet is part of like how I stay. Yeah, like, you know, it's one thing when they think you just tell a patient like oh, there's lupus, but then when it happens to you, you're like, No, I don't want to use like organic cherry glue. So when the gynecologist told me that like oh, your boobs are getting saggy, just like deal with it. I was like, No, I'm going to I'm going to seek care elsewhere. And so yeah, I would be Google hormone specialist and and you know, whoever was covered by insurance so me there I'm sure there are Western medicine people like me that are out there doing it. But I don't I think people often are can run into some some gatekeeper. One of the things that when I moved to Florida, and I was trying to find a new hormone health care specialist in Florida is I did Google women's hormone health. And that's a good way to find it because some offices are just doing women's health and they specialize in hormones. So I mean, I think those are key words. Right? Um, one more thing, Allison that I think is important is our generation mothers grew up with hormones being a controversy of when they started giving women hormones for menopause, they were creating the scare of heart attacks and strokes. And I don't know, I don't know the whole thing. I just know that a lot of us had mothers who stopped taking it because of the controversy. And I think that has since changed, but I don't know that it's been loudly spread. It has since changed. And yeah, in my in my mother was a person who was on hormones and smoked and then had a stroke. So there were a wow, I'm sorry. Thanks. So yeah, we did some some things. First of all, the hormone doses and the medications in the 70s and 80s. The estrogen levels were much higher, they're at least like a third of what they were back events, smoking tobacco, any kind of, you know, very prevalent. Yeah, exactly. And we didn't have it was, you know, after the 60s or 50s, that you know, they ads for it's like, you know, these are the best, this is the way to say it's Prem those kinds of ads. So yeah, it's smoking and I it, I do not gatekeeper. But I would be really cautious if you're still smoking cigarettes, and you want to start a hormone journey, because I do think that that combo is not ideal. I would use a patch. If if someone really and I've had patients who are like, if you don't help me, I'm gonna kill my husband. Well, I don't I don't want you to murder. I know, that's that. So we'll do a low dose hormone patch or, you know, black cohosh, until symptoms are relieved, something like that. Um, but yeah, absolutely. I think that the cardiovascular risks and even you know, honestly, brain health, those things were, or the cardiovascular risks were overblown, and I don't think that that's accurate anymore. If anything, I think having sex hormones can be protective to organs and the brain, your brain needs sex hormones. So your brain starts to decrease in size. When you go through menopause and everything the crazy you eyes. Your boobs, like your brain like Oh, shut up. Yeah, I difference. Yeah. So I think that when I give women a pep talk, you know, it's usually like, I want you to continue to enjoy your life. And that includes sex, sex as part of being human and enjoy and having pleasure in the human body that we exist in. And for some women, that means if if, let's say vaginal dryness is your only symptom that might be just targeting your, you know, with a intra vaginal estrogen product, which can be great, or if someone is a smoker, and they are having vaginal dryness, and they're like, Well, I'm having this issue, but I don't really want to put myself at risk. You know, I'll quit smoking in two years. And we can talk about doing it, you know, a different type of estrogen. But there can be spot treatments. Now, that used to be hundreds of dollars a month. And now badger femme is a tablet that you put into your vagina once a week. It's a Wow. 10 to $20 a month. That's about that's incredible. And what does that do specifically? It just helps with that. So your vagina as you start to lose your ovaries start to peter out the vaginal lining atrophies or thins out so you it gets thinner, and then it stops creating its own lubrication. And so there's also a vaginal cream that has estrogen but that tends to be messy and when you are still sexually active putting a cream inside your vagina that sex and I say I you know, it's again Yeah, yeah, it doesn't usually just go right into sex. Usually there's foreplay and there might be some flavor situation. Yeah. Yeah, not alone. I hope yes, there's cream and I think when people haven't gone through it themselves, I was shot. Yeah. On someone's penis, and I wanted to say like, Have you never heard this from a person that like literally you're you didn't warn me that like yeah, so um, so yeah. Visualizing, I put this cream in my bed and the guy's going down on me. He comes up he's got like yes, like no, no, get that off. And don't try and even think about kissing me with that. Anyway, I'm sorry. I had an image emoji person. Oh, yeah. That's hilarious. So so that's it and you call it bad pill badger Finn is that da g i FTM Okay, okay. All right. Well, hey, listeners who you may have heard it first here. I know I did. So thank you for sharing that. That that might be the ticket, you know, that might be the ticket. And that's easy and low hanging fruit and no kind of systemic, you know, sort of issues. But I don't I am not worried about as far as if someone had a heart attack already, that might put them in a different category of risk. So I'm not saying you know, in medicine, it's not hard. Everything has a risk. Yeah, yes. Exactly. It's all about risk, like, you know, mitigation and recognizing what's more important to you at the time. I think the only true really contra indication or a reason that I would not prescribe is if someone had an estrogen positive breast cancer. So if someone had been diagnosed with breast cancer, they get it gets typed and they there can be no estrogen and progesterone that that would be your reason that would be a hard stop for me. In migraine with aura is a conversation that's another one that if anyone out there has migraine aura, it I would use patches which tend to be a bit safer as far as just it bypasses your the first pass of the liver. And so there's less clotting risks with topical topical or the or patches. But yeah, I think that for most women, it's a conversation of the plus and minuses about it. That is very interesting. I'm learning so much. I look good in menopause, but I've already had it. But for some reason this past week, I had been so many hot flashes, I thought they were gone. I was getting like one or two a year. And this week has been and I'm thinking what have I changed and I haven't changed anything yet. I have been eating a little bit more sugar. And I don't know if that impacts it or not if sugar is a bearing or brings it on, but I definitely that's the only thing I come up with. There's no other reason but I've tried a lot of hot flashes. So I'm very excited because I did just order the cream. Now I went to Wynona online, it's my wet Wynonna like Winona Ryder. It's my n o n a. So I'm very excited because I think I'm getting kind tomorrow. My kit, if you will, it's all prescription but it's the cream with the and I mentioned earlier before you jumped in. But it's it's the combination. So it's the estrogen and progesterone and the cream and then the oral DHEA for the testosterone. So so let's let's talk about the differences on the green. It's my understanding that estrogen and progesterone cream. That's the best way to trends, isn't it? Right. And there's two different kinds of estrogens. Is that right? Well, yeah, I've been there. I tend to use Estrid die all that's the one that's bioidentical. So there might be other ones, but that that's what I use in my practice. And there, there's compounded cream that you can put on your forearm or there's patches, I tend to use patches just because I think it's a little easier and cost effective. Compounding is a little bendy, and it's not covered by insurance. How much would you say just throwing it out there? Yeah, like 60 bucks every 60 to 90 every maybe two or three months depending on your goes bad is actually the patches are yours. They're not compounded. They're not bioidentical, right. They're from the horse urine. I think no, they're bio identical. Okay, the patches are two patches are two and they are it depends on your insurance. This is where it gets a little bit tricky. It depends on your insurance coverage. Like I've got pretty good insurance. And so my co pays I $10 a month. So it I think cheaper for me to do patches to so you have to kind of price things out and see how it works for you. But when you start to add, I guess everything in like the testosterone, some progesterone and extra dial, it can get spendy when you are kind of either way. So I think it's good to do a little research. I'd like with your insurance plan and figure out like, okay, if I'm going to be spending $60 a month with insurance, maybe it is more cost effective just to get something compounded at a compounding pharmacy. Okay, well, that's very interesting. Okay, I want to kind of ask the questions that I'm thinking our listeners would be interested in knowing and now I know I've heard of the pellets I don't personally know. I know two people who have used them and they really like them that when I hear pellets, they just sound painful. I feel like somebody's shooting something in my butt. And I think that's what they do, if I'm not mistaken, but nonetheless, we do not have any experts here on that. And nor maybe that's for another conversation, but it sounds like a lot of people are going more towards these creams and the topicals and some of the orals and the patches and all that so different. Yeah. And I know people who really love the pellets. I don't do it as part of my practice because it's pretty bendy, it's you know, it's I heard Yeah, five to $600. And that would be just for extra dial or just testosterone and to me, yeah, it's great that you get a consistent amount of hormones, but it just seems pretty. It's a little bougie that like a little too much i Yeah. Ready just have no, that's very it is very expensive. I know people have told me I'm like, Oh, I mean, they're talking five$600 A quarter. Yeah, yeah. And then it's labs on top of that, and then you get co pays with labs. And I think that there's a way to do it just as well, without it being you know, I think is as important about well, there are a couple of things. I they I did testosterone pellet a few years back in my numbers, my labs came back that I should have been screaming with testosterone, but I physically felt nothing different. And they said, there's some some people the makeup of their body doesn't absorb or transfer something I don't know. So pellets don't really work for me. But um, the other thing when you do a combo, where you've got estrogen and progesterone together with a dose that's mixed in, like, how do you adjust, like, I've always done mine separate, and we are in but I only started taking estrogen last six months, which is really been I've been all over the place with my estrogen, Rush. Um, so I have an appointment Thursday to talk about it again. Yeah, but like I forever for years have done 200 milligrams of progesterone, but it's by mouth. And so when I started taking the estrogen, they sort of have me still take that even though that's a higher dose, but I'm used to take a higher dose they said stay with it. But when you do a combo, how do you know especially if you do pellet, aren't you kind of just stick with those pellets at whatever dose they just put in there until they're done? Yeah, I think so. Yeah, use them. So that's why I don't I can't speak to them. But yeah, I think it's three or four months that they you know, they probably start you out at a like a lower dose. And so then you have to Yeah, add I like mine being separate. I've had them compounded together and I've had them creams. I've had the MS. tro keys where I put them under my tongue and the recipes can always change. But I you know, I'm happily like a bit of a control freak. I like to just have everything kind of be separate. And I like the progesterone is the metabolites of the progesterone cause sedation, so taking it before asleep. We like helpful for sleep and so sleep is an issue with menopause and perimenopause, too. So I like it being separate because I if I was on a lower dose of progesterone, like 50 milligrams, but took it during the day, I'm like, Is this making me sleepy? Like, I don't really want to be taking progesterone first thing in the morning. Yeah. So So what, what's a low dose versus a high dose? Since you mentioned progesterone, progesterone, I use micronized progesterone, and it's usually it's either 100 milligrams or 200. So I start people on 100 at nighttime and then move up to 200. If they're either having heavy periods which can happen during perimenopause, especially, you know, it's very common for women to have fibroids and they'll start to get the heaviest periods. You know, they're 4748, and then they're going out with the Bing and clothes and sheets. And you know, it's like really, so I would go up on their progesterone and that might be you might have some mood adjustment issues those first couple of days that you go on it you know, progesterone switches are what cause like PMS symptoms, but once you stay on it after that week, they should fall into the background. And that's what I was going to ask is about how long is the the period is now that's for progesterone, so your body takes about a week to kind of acclimate? Roughly obviously, we're not doing any medical advice here, right? Because the numbers because you said you have about 1200 patients in your office and you would know you're you're an authority topic. Yeah. And I would say if you're still not well or feeling like it's hitting the spot and the bullseye and three weeks I would tell your provider because something especially after a couple weeks Okay, so I think green takes a bit doesn't like taking progesterone by mouth seemed like that was sort of a more instant but the cream getting does it take like a certain amount of time for your body to regulate the cream. I think it's just harder to absorb. Okay, I think it's more an absorption issue. It just is a you try to put it on this part of your forearm because it's very thin skin. So it's yeah, the absorption and they have me do it on my lower abdomen or my lower back. That's unusual. That's part of my problem. Yeah. Yeah, it says use it here. Yeah. I've always done the forearm just because otherwise because it doesn't it you want the least amount of tissue to get it into tell me to put it as close to my ovary. This is I would, I would check with a pharmacist because the pharmacists are the ones who like, yes, you're black and white. Just see because that might be intuitively what you know what you think. But that's yeah, that's not what I what are ya? How are ya? I'm calling tomorrow. I think Danny, Danny started to move it. Wouldn't that be great though? Like, you just put it on your forearm now and then it solves all your issues. Fabulous. Okay. My oh my lord. I like that is my problem. Can you imagine? Oh my gosh. And I literally try to line it up like, oh, there's got to be an ovary there. You get you have to eat? Or you say like, yeah, yes, yes. No. Oh, yeah. We'll we'll do the email unless you know, if any progress. Could you imagine if it was that simple? Oh, my God, that'd be great. Let's move on to the estrogen. And because I'm sure you know, there's estrogen is what everybody goes in our minds thinking. And first of all, I want to ask there's over the counter things like Prem oven or whatever these names are, do any of those things actually work? And are they estrogen based? Or what is what are those things on the shelf? Honest, I other than the supplements? Like black hole harsh? I don't know. Because I don't prescribe things that are over the counter. And they're not FDA regulated. So I Yeah, that's fine. I just thought I'll ask that in case it was in the mind of one of our listeners. So moving on to estrogen do that. Now if somebody's going through menopause it could it be possible that they would. It's a possibility, they might just be prescribed estrogen. Is that right? It may also be progesterone, if they don't have a uterus, you can be prescribed just estrogen. But if someone has a uterus, you have to be on both estrogen and progesterone. That's very important. Otherwise, it could lead to an increase in uterine like cancer. That's okay. I thought I read something that's I wanted to ask that question. That's important. If you've had a hysterectomy, you could be just on estrogen alone and yeah, there's there's oral there is topical to either patches or compounded. And then there's the pellets or their shots. There's extra thought, if you do oral I would probably sublingual worry melts under your tongue. But most people I like patches because like I said, they stay on your skin, it lasts for me, you know, three and a half days. So it's just twice a week, I put it out with my supplements and just have it you know, twice a week so so it's easier to me it decreases my pill burden too. So if you are on supplements, you know, I'm talking about you already feel like you're taking like your turmeric or whatever, all these things pharmacy in the bedroom. They're like stuff there. But they're still like a lot of pills. So I I prefer patches. And so I usually kind of encourage my patients to go that route too. But and I said you start with the lowest dose until you either relieve symptoms and so I don't choose lab values as much as I do symptoms. So if people feel good on a dose I still check lab so I can make sure that something's not at like super out of range. Okay, it's congruent with what someone's experienced, but I trust their experience over what a blood test me. Okay, so I want to mention something about the estrogen that's so common for many of us and myself included is the low libido. Is that not where the estrogen would help? I mean, more so than the progesterone or do they both or how does that work? So this is I want to be clear, too, that this is anecdotal. Okay, so this is there is not a lot of evidence that anything helps with sex drive. Even testing testosterone is not even testosterone, but there is plenty of anecdotal evidence where people will tell me and that it helps so I just to be clear there and I don't know if it's a paucity of research funding, you know, who who is paying for these things or who's not like putting money forth to it so I mean, women enjoying sex doesn't matter. Hey, that men would be pretty freakin like invested in. Right, right. Yeah, yeah. So I always preface it with Hey, there's not a lot of research but at the same time, you will know if it's something that helps and I think that it low dose testosterone, I've seen a lot of women at help and also DHEA a lot Other women, their DHEA level is, is lower and especially if someone's DHEA is under 100 getting them on a little bit of DHEA sometimes in three or four days I'll get a message back that like that was it and it's not like all of a sudden you're you know horny now like like your first couple of months meeting someone but it yeah it is a noticeable you can find that that sex drive feel that passion again in your body and it? Yeah, again vitality and life like this is this is yeah. Do you think how much of it do you think is also related to just the confidence of knowing so that I kind of like to think about it as when we go through menopause, they they would have read your estrogen falls off like a cliff. And then like you said, their testosterone goes down slowly over time. We literally go from 100 to zero. I mean, and all of a sudden, everything does change. And we feel crappy and we we don't like our guys, but even when you're single you might not feel like dating because you don't feel sexy. Things are drying up. You feel different. You're cranky, you're hot. Who wants to go on a date when the back of your neck is ringing wet? I mean. So when you start taking the hormones, even if it's not, you know, making your clit light up. Yeah, the confidence and just knowing that you're not going to have a hot flash or you don't have to feel like you're 100 years old, literally. Yeah, makes your sex drive go. Yeah. I was thinking yeah, I think it's part of self care. And you're right there. I think that there is a there's can be a magic element to taking care of yourself and putting that effort in. It can be really helpful. And I think absolutely, if you're not having hot flashes, that's sure it's gonna make you feel sexier. You know that you're not like stringent who your sheet? Yeah, yeah, no, for sure, too. I didn't even oh my gosh, can you imagine on a day over? I was laying in my bed. I'm not this I'm not lying. Last night, I'm laying in bed and I'm thinking I'm really warm. I'm actually having to turn my fan on what is with my body this week? It's like, it's anticipating that I'm getting all of these hormones. And it's like willing me to take them. It's a strangest thing. I mean, I just the timing couldn't be more uncanny. But I'm laying there and I'm thinking, I think my sheets are gonna be wet. And I touched my sheets. And I'm like, Oh my gosh, I'm thinking while I'm glad nobody is spending the night that exact thought crossed my mind less than 24 hours ago. Yeah. And then you're cold, you know, and you're like, you wake up and then you're wet and cold. Yeah, it's not fun, it doesn't feel and it doesn't feel then you want to shower so that you feel clean and that you you know, go back into bed on a cold wet, sweaty cheat now to put towels down before I got because I you know, I was like too tired to change the sheets, but then I'm like, Okay, I'm gonna tell down so it's not done that I'm sure. Yes, yeah, that's what we want to do. But so that's, that's super interesting. And, and I know, I know, you know, we thought we could taper this down to such a short conversation. There's it's just so important. There's that many questions and we haven't even hit them all. So I did want to kind of skip over over to the DHEA unless there's something else we need to know about the estrogen that you don't think so? No, I think struggle low start you know, start slow go low and you don't you know, more is not always better. I think that that going before it gets to be a 10 out of 10 problem. Okay, you start is ideal, it just because then you just are kind of aiding your body along and kind of helping. If you've already waited three or four years, not a big deal. You can still I still think there's a lot of benefit to things. But I Yeah, more is not always better, I think is just the other venue. Not everyone has a high dose so Okay, so don't Okay, okay. Well, that's good to know. Okay, so the DHA, I think that's kind of the third prong here. Now, this isn't something for everybody, either. From what I've read about it. It's a hormone that's naturally made by our bodies, specifically testosterone. So that's what I read about it. So I wanted to kind of note some things down because I really, I'm like to learn, what are we doing to our body? So you're educating us, but we'll pick it up from there, if you will. Totally, it's a precursor to testosterone. And so sometimes that can be an easy over the counter thing to do. It's I usually it's a 10 I think it's Miller it might be micrograms i It's 10 milligrams or micrograms. I should know that. But if people can start that and at least try it, there isn't there aren't negative side effects to it. And you would know that testosterone increasing is something that it occurs pretty quickly. So the benefit of getting your DHEA it depends on the pathway. There's two kind of pathways of how much it's actually going to increase and you don't know that unless do you get a much more extensive kind of hormone panel done, but you know which kind of kind of hundreds of dollars but it you'll know within three or four days because when your testosterone level comes back in it, it's not usually subtle, a, you know, estrogens, I kind of feel like people sometimes can feel it sometimes can't or sometimes will feel more emotional. But testosterone, you feel the things a lot more quickly. And promising. Yes. And isn't it supposed to be good for waking as well, and brain fog and changes? I think all of those things are possible. It's all the those are very nebulous kind of symptom that it Yeah, they they're not always black and white, but I think it's worth you know, that DHEA cost me $4 a month. Okay. And that one is an oral Oh, that's an oral that's. Now, is this something that somebody would take every day? Yes. Okay. Okay, and is this something that what would you say would be a low dose on the DHEA versus a higher dose? Five to 15? And so I usually start at 10. Just like in the middle on i 25 milligrams, because that seems high. Yeah, I thought it was five to 15. Yeah, I think that's how i That's why I'm asking because I'm like, tell me because I want to know, this feels like it's going to be too much interesting. Yeah. I'm not saying it's wrong. It's not how, when I looked it up, it's not what I what I remember and what how I practice but yeah, that's a guy go make now it's, no, this is only for women, but but maybe every other day, if they specialize in hormones that you know, trust the trust and plan that you're on with the provider. And if it if it feels like something's too much, I mean, I guess the worst that's gonna happen is what if you I mean, too much testosterone is I don't think you're gonna get there from honestly from DHEA. But you know, too much testosterone can cause you to get a little chin here. Yeah, that's what I was going to ask is what makes you hairy, and I didn't know which one it was. But so it sounds like the combination of these things that these are such great, viable options that nobody has to suffer. I can't even believe it's taken me six years to even think about or learn about, and I'm just so grateful. I mean, Danny really brought it to the attention and then I mean, Alison, what a fluke how we met, you know, we on social media, completely other topic. We're not going there. But anyway, how neat, you know, but this is the whole concept between sexy and single sisters over 50 I mean, not every single necessarily, but but just learning from each other. And I really wanted to get some good information that's going to help all of us be not just be more sexy, but do more sex. Yeah, yeah, it means a lot to make yourself feel like yourself. And normally, that is so true, Kate, because you don't feel when you start having those hormone shifts, and you just sit and go what is wrong with right like, why am I unhappy? I was happy two hours ago, what's going on? And I I'm so excited to try this stuff, or the people around you and the men in your life or whatever our like, you gotta think that take away is find a provider that takes you seriously. And if you say like, Hey, I want my sex drive back or hey, I want to feel some more vitality, if you don't feel kind of heard. I think that you know, we all have those instincts of when someone is listening to us and hearing us and we trust and and if you don't have that, then it is worth sticking around and find somebody Yeah, ask around, you know, or Google what's a good you know, to find that person because I think that you're I don't think that we have to spend decades without a sex drive and with Drive policies and and honestly just not feeling like sexy and the mood. Yeah. So Allison, I haven't I do have a question for you. So like, so what's perimenopause, right. Is there any way? I mean, you said early on that basically you know, menopause is based on your mother's age, you know, when she had it is a good you know, gauge when you're going to have it. Is there any way to make the perimenopause part, you know, a lot easier is there naturally that will help Yes, supplements that you can take or even you know, medication that can be prescribed during the process basically be set before you get to all that we just talked about, you know, yeah, black cohosh would be the one if you are starting to have irregular periods or hot flashes, black cohosh is a supplement that you start again low and you go up to when your your symptoms are relieved, but I'm actually advocating for during that perimenopause to to get things checked out and just see at least get some labs on to check in on it so that way, you know kind of along the way, even if It's once a year or once every other year, let's say you're 44. And you're like, I kind of think something might be going on. I've had people come in and I'll check, I'll be like, No, boo, everything looks great. But you know, come back in a year or two, and we'll check it again. So you can kind of see, because I think that doing it on your own without, I mean, I guess there's not a ton of risk, but I think that it costs I'm a medical provider. So I feel like it's it's good to have someone on your team to help guide you. Right. Yeah. And with black cohosh, if you're, if you're not having an estrogen problem, it's probably not going to it's not going to help you. And so then it sends people down these like Doctor go rabbit holes. If you're on birth control, you wouldn't be able to take anything to help it anyway, because you wouldn't feel it. But I wasn't on birth control. But we I did start on progesterone, which help level out least my mood, right, because my moods were crazy. So just around during periods, I took progesterone, probably six years before I ever went through menopause, right? Oh, wow. Okay. And it just helped level me out. I mean, it was the Godsend that, that progesterone for that period of my life was a godsend. Wow. Had you not gone and got it checked? Right? You would be doing all these other little remedies? I don't know. And yeah, I know, exercise is supposed to be good naturally. Because you do get and Kate, you're a gym enthusiast. So I have to imagine that you're not going to probably have as many but I don't know, I feel like people who are more fit tend to have less is that. Is there any factual or any anecdotal evidence testing to that exercise helps everything. Right. Right. Okay. And it just water? Yeah, it just helps mood in general. So I don't know about anything specific to like menopause. But I think that exercise can probably help or dissolve your stress hormone and you know, chill out and that's going to help your your ovaries keep kind of going without it just being like an up and down kind of thing. And how does alcohol interact with any of these? I need to ask that because for sexy and single sisters, after all, so there might be a cocktail tonight. I'm having one. You're having one. I'm actually having a Diet Pepsi, which I probably Yeah. And I mean, I think it's important in your life, you know, I mean, there are lots of things coming out about alcohol and cancer risks. And so we tell people really, like want no more than one a day. And that's true for men and women. Now, it used to be just true for women. I know. Like just in general alcohol is a little inflammatory. So but yeah, okay. And I think um, there's just one last tiny question before we segue and wrap this up, but I asked you, and I'll ask the the other ladies if they have questions, but any final thoughts? About how long would somebody be on this? Are we talking like for the rest of their life? I keep swimming on it for the rest of their lives. Yeah. Why would I? Why would I take off so it doesn't really help your body to do its own thing. It's always going to need that assist. I got Yeah, that's what I was wondering. Okay, so get used to it. Yeah. That's good. Some people just want to take it, you know, and then they're, they're 70. And they might not need it. Or they I mean, or they might not want it anymore and different time in their life. And they don't really know they're either their spouse or you're single or why. Yeah, you're not accurate. Yeah. Okay. This is okay. Ladies, do you have a last question? We do have to let Allison go because she actually was supposed to have a meeting a while ago. I think he may have been more fine. I'm sure listeners to Danny. Kate. Any more questions, no questions, but I just want to say thank you, Alison, for joining us and sharing your I think this has been awesome. Absolutely Fabulous. Thank you. very compassionate. Yes. Yeah. So excited. So when you say goodnight now. Thanks, listeners. Shout SAS over fifty@gmail.com Follow us on Instagram. That's over 50 We appreciate it. Thank you.