Fempower Health

Hormone Repair After 40 | Dr Lara Briden

March 15, 2021 Georgie Kovacs / Dr Lara Briden Season 2 Episode 8
Fempower Health
Hormone Repair After 40 | Dr Lara Briden
Fempower Health
Hormone Repair After 40 | Dr Lara Briden
Mar 15, 2021 Season 2 Episode 8
Georgie Kovacs / Dr Lara Briden

Dr. Lara Briden is a naturopathic doctor and author of the bestselling books Period Repair Manual and Hormone Repair Manual. She has more than 20 years’ experience in women’s health and currently has a consulting room in Christchurch, New Zealand, where she treats women with PCOS, PMS, endometriosis, perimenopause, and many other hormone- and period-related health problems.

In this episode, Dr Briden covers:

  • Stages of perimenopause and menopause
  • Truths about HRT and why they are no longer called that
  • Symptoms women tend to fear and solutions for each
  • Why women can and should embrace this stage of life

If you liked this episode and you're feeling generous, don't forget to leave a review on iTunes!

Referenced in the podcast & related episodes:

And be sure to:

  • Follow Fempower Health on Instagram for updates and tips.
  • Subscribe to the podcast and tell your friends!
  • Shop the Fempower Health store, which has many products discussed on the podcast.


  • ReceptivaDx the sponsor of all of Season 2.  Provide code FEMPOWER-HEALTH for $75 off.

**The information shared by Fempower Health is not medical advice but for information purposes to enable you to have more effective conversations with your doctor.  Always talk to your doctor before making health-related decisions. 

Contains affiliate links

Support the show (https://www.patreon.com/fempowerhealth)

Show Notes Transcript

Dr. Lara Briden is a naturopathic doctor and author of the bestselling books Period Repair Manual and Hormone Repair Manual. She has more than 20 years’ experience in women’s health and currently has a consulting room in Christchurch, New Zealand, where she treats women with PCOS, PMS, endometriosis, perimenopause, and many other hormone- and period-related health problems.

In this episode, Dr Briden covers:

  • Stages of perimenopause and menopause
  • Truths about HRT and why they are no longer called that
  • Symptoms women tend to fear and solutions for each
  • Why women can and should embrace this stage of life

If you liked this episode and you're feeling generous, don't forget to leave a review on iTunes!

Referenced in the podcast & related episodes:

And be sure to:

  • Follow Fempower Health on Instagram for updates and tips.
  • Subscribe to the podcast and tell your friends!
  • Shop the Fempower Health store, which has many products discussed on the podcast.


  • ReceptivaDx the sponsor of all of Season 2.  Provide code FEMPOWER-HEALTH for $75 off.

**The information shared by Fempower Health is not medical advice but for information purposes to enable you to have more effective conversations with your doctor.  Always talk to your doctor before making health-related decisions. 

Contains affiliate links

Support the show (https://www.patreon.com/fempowerhealth)

Georgie Kovacs (4s):

Why is it that women spend years either grinning and bearing it or visiting doctor after doctor seeking answers, whether it be a diagnosis or treatment, given the limited data available on women's health and the lack of education we have about our own bodies, it is no wonder this is the case. Welcome to the Fempower Health Podcast, which aims to change this narrative. And I'm Georgie Kovacs, your host, interviewing experts who provide you the answers you deserve, and perhaps didn't even know you needed. So listen, learn and follow on your favorite podcast platform. Hi Georgie here with the Fempower Health Podcast.

Georgie Kovacs (45s):

In today's episode, I interviewed Dr. Lara Briden also known as The Period Revolutionary. Last year, I interviewed her about her first book, Period Repair Manual, and given the rave reviews, I wanted to make sure I interviewed her again for her latest book, Hormone Repair Manual, Every Woman's Guide to Healthy Hormones after 40. And she has outdone herself. This book has such helpful information to guide you, as you transition through perimenopause and menopause and given the amount of information in the book in today's episode, we cover the high points so that you get a better understanding of what this transition may be like and how you can support yourself as you may incur some of the symptoms that come with this.

Georgie Kovacs (1m 28s):

However, I do recommend that you check out her book because that's where you can get some of the customized information that would be relevant to you. And as you listen to the episode, that will become a lot more clear.  Now, a few things before we talk to Dr. Briden. One, it would be really great if you love this episode for you to rate it and write a review, because that's how the algorithms work to make sure that episodes like this get to the top of women's lists so that they can have the information they need to empower them on their health journey. Additionally, because I can't always cover key topics in my episodes. I do post other tips and quotes and helpful information on my Instagram and Facebook feed, which you can find @FempowerHealth.

Georgie Kovacs (2m 12s):

And last but not least, there are lots of great products that are discussed in my podcast. And I did build a shop and you can check out the shop on my website or in the link in my Instagram page. And you will find all of the great products there. So without further ado, let's talk to Dr. Briden.  So why don't we start with the four stages of perimenopause and menopause, because I think that really lays the foundation of why these nuances are so important. So educate us.

Dr Lara Briden (2m 42s):

Absolutely. So perimenopause just for, you know, to start with basics, is that anywhere between two to 10 years before the final period. So it starts in our late thirties or forties. I did a little social media posts recently about "were you born in the eighties or the, you know, the early eighties, this book is for you." So anyone listening, who's kind of tuning it out, thinking, Oh no, that's for someone older, it's like it might be for you. Yep. So that's very important, because that's a very important part of the message because if there are going to be symptoms and not all women have symptoms, but women who do have the symptoms, are usually at their worst during perimenopause and start.  And you know, the first, including the first year after the final period, which is still perimenopause and then most symptoms tend to subside later into our fifties.

Dr Lara Briden (3m 37s):

And certainly by our sixties, we're in terms of most things and should be feeling quite good. Although, as we can discuss, there are a couple of outlying issues that can continue mainly vaginal dryness, which we can talk about. But the four phases, the descriptions I used were provided by Professor Jerilynn Prior, who's a Canadian endocrinologist who I have worked with quite closely. I published a peer reviewed paper last year. She is very passionate about ovulation and progesterone. And she's a real game changer in terms of women's health. So she fact checked the book. You'll see these quotes throughout the book from her.

Dr Lara Briden (4m 15s):

So the phases are actually based on broader research, but the way she describes it, as you know, very early perimenopause phase one is when periods are still regular, but we start to develop symptoms mainly from losing progesterone. So I provide her nine list of symptoms. If you have three of those, and you're in your late thirties, forties, this is possibly used. So they include things like periods, getting heavier, increased frequency of migraines, you know, weight gain insomnia is a list of them. And although cycles are regular in that very early perimenopause in general, the cycle shortens.

Dr Lara Briden (4m 58s):

So by "cycle shortens," I mean, counting from day one to day one of the cycle. If it used to be, say 30 days, it might shorten down to 26 days. That's really common. It's basically just because of higher amounts of FSH from the pituitary, talking to the ovaries, very emphatically to keep ovulating. And that makes ovulation happen more quickly. And sometimes oblation starts to not happen, which is a feature of perimenopause. And when ovulation doesn't happen, we don't make progesterone. So that's phase one, phase two is when you start to get some irregularities. So the cycle counting from day one to day, one could start to vary by up to, you know, up to seven days.

Dr Lara Briden (5m 43s):

That's a little bit, you know, wobbling with a cycle that's normal that can last two or three years. In the book, I provide a little graphic with the expected timeframe for each of those phases. Phase three is once you've had a very different cycle, like a 60 day cycle, you know, counting from day one to day one. So things start to look quite different, keeping in mind in the background, you always have to rule out, is it just perimenopause or is it something else? Because I provide a patient story where it was actually PCOS, that was kind of like, you know, affecting her cycles at that time. So they could still get the other factors, even in our forties. And then phase four is the phase I'm in now, which is what you've had, what you think is your final period.

Dr Lara Briden (6m 29s):

And you're in the waiting room to see if you can reach 12 months without a period, which will then mean you graduate to menopause. You've achieved menopause. That's the kind of language that Professor Prior uses, which I love. So I'm waiting to achieve menopause. I have not yet, you know, it's not unusual. You get, I had what I thought was my last period last January or last April. And then I went like nine months and then I got one this January. I'm like, okay. And you have to start counting all over again at that stage. And that's pretty typical. It's I don't know if I've ever met any woman who had, you know, what she thought was her last period. And then that's, it, it varies somewhat, but yeah, so those are the four phases. And then the next phase is menopause, which lasts the rest of our life.

Dr Lara Briden (7m 11s):

So menopause is a life phase that begins one year after our final period.

Georgie Kovacs (7m 17s):

Okay. And what I also appreciate in the book is that, I mean, honestly, I've been dreading it as well because I hear so many people talking about, you know, the horrible... side effects...isn't really a word because I guess symptoms because it's not a condition, it's a stage of life, but you know, all these things that aren't so fun to deal with, we can call them and I've, I've been really afraid. And what I really enjoy is I've been hearing so many people talk about, you know, your life's not over. And, you know, first I heard your forties are the best, which I agree with. And then I hear fifties or even better, which I now can't wait for because forties are pretty awesome. And so I appreciate all the hope that you share.

Georgie Kovacs (7m 59s):

And even my acupuncturist, I'm trying to record her. She does not want to be on the podcast and be published, but she had a beautiful way of talking about the Chinese medicine philosophy on menopause, which is amazing. So if I can write it down, I will definitely verbalize it because it was absolutely gorgeous. And I'll share it with you because it really, it almost made me cry. It was just so beautiful, but nonetheless, let's get right into it. So there are solutions and there are ways to make this not so difficult. So I thought we would take, you know, step by step. Just a few of the things that, that I thought would be themes based on concerns. I hear people having and just, you know, high level things that I noticed from your book. And then again, I think women just really need to read this book.

Georgie Kovacs (8m 39s):

So one is the myths and facts around hormone replacement therapy. You know, again, I haven't, I didn't dive into this until your book. And I just know the themes I keep hearing are, you know, it's dangerous to be on it. You know, there's the bioidentical hormones. Then is it good or bad? And the interesting part to me also was when to use estrogen versus progesterone. So can you just give us the actual facts around how we view hormone replacement therapy and when progesterone and estrogen treatment comes into play.

Dr Lara Briden (9m 18s):

First of all, we don't normally say hormone replacement therapy anymore, which I explained in the book. It's a menopausal hormone therapy MHT and the reason they got rid of the word replacement is you're not replacing. It's not like thyroid replacement or, you know, growth hormone is like a, it's not like an endocrine or hormone pathology where you've lost a hormone like low estrogen is normal for menopause. It's a normal life phase. And in the book, I do talk about that, how it's really existed for as long as we've been human. I debunk the idea that everyone used to die by 40 and that therefore menopause is just an artifact of modern life.  That it's an accident of living too long.

Dr Lara Briden (10m 2s):

That it's not the case. Yes. Many of our ancestors died young because of childbirth or accidents or infections. You know, obviously that's true, but even going way back into antiquity, we know that several, a significant number of people, including women lived into old age, like into their seventies and eighties. So menopause has been there. Some women benefit from hormone therapy, absolutely both in terms of symptoms and in some cases, in terms of, you know, risk reduction for things like osteopetrosis. So that's real, but also at the same time, some women are fine and you know, don't need it for any of those things.

Dr Lara Briden (10m 43s):

So I think that's important to understand heading into it. It's an option, but it's not, it doesn't have to be for everyone. You don't have to think, Oh, after I lose my estrogen, that's it I'm broken. I, you know, it's, it's not like that at all. Our body is, it's a recalibration to lower estrogen, which if you're healthy in all the ways I talk about it in the book, particularly around insulin sensitivity, the real dangers come, if there's insulin resistance, because estrogen normally supports insulin sensitivity and shelters us from some of those long-term negative outcomes from insulin resistance or pre-diabetes. So I do I even state in the book, you know, I think some of the long-term health prevention outcomes that are seen with estrogen therapy is actually mitigating the risks of insulin resistance, but there are other ways to not have insulin resistance, right?

Dr Lara Briden (11m 36s):

It's not that taking estrogen isn't the only way. It's not as dangerous as people think like that. I can, I guess I can safely say that. I think modern hormone therapy is generally safe, not in every situation obviously, and certainly not every type. So this is what it comes down to. And I put this right at the beginning of the hormone therapy chapter. We have finally reached the time, thank goodness, when body identical, what used to be called bioidentical, although doctors don't like the term bioidentical, so don't use that term really. Yeah. Well, it depends on your country, I guess, but bioidentical is associated with the old days when, you know, naturopaths and compounding pharmacists were the only way to access body identical hormone therapies.

Dr Lara Briden (12m 22s):

So, but most, not most, but not all modern hormone therapy products are body identical, which means they are hormones that are, I mean, the drive still from plant based precursors in a lab, but they're identical. They're made to be identical to estradiol, our main estrogen and progesterone. Now that's a huge departure from what was happening back in the eighties and nineties. Like, I can't even emphasize enough those drugs, hormonal drugs, they were using back then, including Premarin and the horse estrogens and the progestins, which are not progesterone. They had a breast cancer risk much, much higher than moderate, like just to use breast cancer as the example.

Dr Lara Briden (13m 3s):

So modern hormone therapy does not carry a high breast cancer risk. It really does not. If you can get the right prescription from your doctor, which is in the U S in terms of the progesterone part of it, the US it's called Prometrium. In some countries it's called Utrogestan. That is body identical progesterone. And that is a huge departure from the progestins. They used to use what we, we look, we know now looking back at the research, like the women's health initiative and put some of those studies, you know, 20 years ago, the breast cancer risk was probably mostly from the progestin they were using back then.

Georgie Kovacs (13m 37s):

Got it. Okay. And then the other thing that I found really interesting is how, if I remember this correctly, progesterone is more helpful in perimenopause and estrogen, and I, I can't remember if it was all cases or most cases, estrogen plus progesterone once you've hit menopause

Dr Lara Briden (13m 59s):

Meaning once you've had your final period. So I guess we'd include that final stage four of perimenopause. Okay. Yeah. This is where my book departs from some other stuff that's out there. And this is from Professor Jerilynn Prior, who has, she's a scientist, as well as a clinician. So she's done multiple studies about progesterone, the benefits of progesterone, and those are referenced in the book. And again, as opposed to progestin, I can't emphasize this enough. The difference between progesterone and progestin is so huge.

Georgie Kovacs (14m 32s):

Let's, let's clarify something. Progestin is in a lot of birth control, correct? And I want to bring this up only because like I told you, I spoke to many friends and birth control comes up as a topic, and it was really eye opening to see how birth control impacts your view of what's happening with your body relative to what's actually going on. And so I did want to just at least make that high-level statement. And just again, remind people like birth control does have progestin in it.

Dr Lara Briden (15m 2s):

Absolutely. There's no progesterone in any type of hormonal birth control. Okay. As much as ever, you know, our forties are a time to have natural cycles and not pill bleeds, you know, not drug-induced please. So, but carrying on with progesterone, progesterone is the hormone we lose first, during second puberty progesterone, we start to make less progesterone. We make more, more estrogen, which is important. So I show a little graph where estrogen goes up sometimes by three times actually, and then progesterone drops away. So this is the kind of classic estrogen dominance that let people talk about it. I don't know if you use that term, but it's sort of the idea. So taking progesterone during, especially the earlier years of perimenopause can bring great relief to mood insomnia, heavy periods, migraines, and the book provides protocols for all of those.

Dr Lara Briden (15m 54s):

Now there has been this conventional narrative that progesterone is bad from mood. That is not the case. Progestins are bad for mood. Progesterone is normally good for mood. Although some women it's about one in 10, it's the minority, but there are some women out there who are not, just have to acknowledge them. And I have a section of the book about it, who, who maybe have tried natural progesterone or Prometrium and did not feel good mood wise on that. So there's a few things going on with that. And I'm going to be probably blogging about that more in the future, but in general, I'll just, I'm just referring to it by brand name for most doctors. If you, look, you go in there asking for natural progesterone, a bioidentical progesterone, you'll get shut down. If you go in there asking for Prometrium and say, this is a protocol from this Canadian endocrinologist who has studied that Prometrium can be helpful for heavy periods or in different things.

Dr Lara Briden (16m 48s):

The success rate will be a lot higher. Yeah. Very often taking that can relieve symptoms. It's very sedating. So you have to, if you take it during the day, you'll feel groggy and weird. So that's quite important as well.

Georgie Kovacs (17m 0s):

Okay. Since we went on the topic of birth control for a second there, one of my friends asked about the Mirena IUD, will it mask symptoms. And when do I know I no longer need it because I don't want a surprise baby at 50.

Dr Lara Briden (17m 17s):

Short answer, hormonal IUD, Mirena, or Jaydess or whatever. And they're all, they have different names depending on the dose of the progestin that's used. That's usually a drug called levonorgestrel. The pill totally masks menopause like a combined pill, estrogen pill, totally masks menopause. I have a patient story about that. You could be having pill bleeds into menopause. You're basically on a type of hormone therapy with this synthetic estrogen and the pills. So it, the pill definitely masks menopause. The pill can even mask symptoms of menopause, because like I said, it's, it's estrogen. It's a type of hormone therapy already. The hormonal IUD can mask menopause even only in the sense that you, if it completely stops bleeding, then you won't know if your period has stopped.

Dr Lara Briden (18m 4s):

Now, it doesn't always stop bleeding for some women. It's just really dramatically lightened bleeding and you still get a real period coming through. So it really depends. Like if it shuts down your bleeding, then you're not going to know from the period point of view, if you've achieved menopause or I've had your last menstrual cycle, but the hormonal IUD, because it's just a progestin, no estrogen, no, no progesterone. It has no effect on symptoms. It can't give symptom relief for hot flushes or insomnia or migraines or anything like that. Obviously can give symptom relief for heavy periods. Cause that's the one thing it can definitely do.

Dr Lara Briden (18m 45s):

So what I say in the book is if you're on the hormonal IUD and you haven't been having bleeds, so you're not sure your signal that you've reached that final phase of perimenopause might be the onset of hot flashes. Well, actually at any phase, you'll still go through all the phases of perimenopause. You start getting the increased migraines, the night sweats, all the different symptoms leading through the phases and the hormonal IUD will not do anything for those. You can actually use both the hormonal IUD and Prometrium. And you can actually take progesterone along with that. So with the hormonal IUD you do, you're still cycling, but you're still, you know, going through the, losing your progesterone, just like anyone else in perimenopause. So there's no reason, like there's nothing against combining them. So just for what it, for what it's worth.

Dr Lara Briden (19m 26s):

I think I do mention that briefly in the book.

Georgie Kovacs (19m 28s):

I was on birth control from when I was 18 to 35. Yeah. I go off birth control and I have what I think. And maybe it is, I don't know. I have endometriosis 26 day on the dot cycle. Yes. When I get off birth control. Yeah. I am moody, anxious, stressed out. My AMH is low. Was I in stage one then? And then I obviously, you know, had fertility trouble. And I went through in my, I think soon after my son, I went back to the 26 day cycle. And then I started having the, every other month, I'd have my 26 day than my 40 day, 26 day 40 day, 26 40.

Georgie Kovacs (20m 11s):

And now it's like, Lord only knows when it's coming. But I, like as I'm listening to him, like, hold on a minute.

Dr Lara Briden (20m 18s):

Yes. Short answer is yes. You could have gone straight from the pill to phase one at perimenopause. Yep. Yeah. But you could still fall, you can still become pregnant. And that's the thing I want to say. Cause everyone

Georgie Kovacs (20m 28s):

I used my own eggs.

Dr Lara Briden (20m 31s):

So you just give people, a lot of my followers, hear the word perimenopause and think, Oh my God, but I haven't had babies yet, but you can still become pregnant. Especially in those earlier phases of perimenopause. It's more about just understanding what's happening with your body and understanding you're already in that second puberty phase. Cause we only meant like we were only in our reproductive years for, you know, 30 years or so. And you've got, you know, eight to 10 years of first puberty and the other end in eight to 10 years of second puberty. So in the middle is really only like, you know, 20 years and this is just the way it is the way I've started to see it, just to share my perspective. I've started. It's kind of interesting. Actually, I started to think that the baseline of experience of being female, which includes childhood and menopause is not being reproductive. You know, our reproductive years are just, you know, one phase of the lifespan of being female.

Dr Lara Briden (21m 23s):

And it's a great, it's a fantastic phase. Obviously I'm a huge fan of our reproductive years and hormones, not just for making babies, but the whole thing. I'm a cheerleader for the whole process, but it's temporary.

Georgie Kovacs (21m 33s):

This is something that I wouldn't say people fear, but I'm hearing it happen. And it was so little in your book that I wanted to just double check on. If you had additional thoughts, which is cysts. So many of my friends are starting to talk about it. I've had two friends now that have had surgery and these are only the friends who've told me about it. And I tell you every time I have a little cramp, I'm like, Oh, is it a cyst? So can you educate us around why I'm starting to see this theme? And it may just be just the n=2. And it's really not that many folks, but I just didn't know if you had words of wisdom, because I also remember in the book, you talking about so many things that we can do early on in life to make this transition in life a lot smoother.

Dr Lara Briden (22m 17s):

Lots of different kinds of cysts, right? So it really is. It depends what we're talking about. Like there's endometrioma is obviously what your endometriosis cysts, which is a totally different thing. There's polycystic ovaries, which we want to talk about today, but are not cysts basically. There's a, but then this is probably what you're describing are functional cysts, which can grow quite large, which can happen at any age. But they happen when there's been a glitch in ovulation. It's like, Ooh, that didn't quite work. Now we're forming this. Now that what was supposed to be just the follicle, turning into a Corpus Luteum is now like filling with fluid and it's common. I mean, I think part of what's going to be factoring in is being on the pill generally tends to reduce the frequency of those, of course, because you're not ovulating, the hormonal ID increases the frequency of them because it sort of impairs ovulation just enough, I think, to increase the frequency.

Dr Lara Briden (23m 8s):

In fact, I think it's something like women on the hormonal IUD, 5% develop ovarian cysts. So it's a couple of factors in terms of like, in terms of the numbers of like, is it more common in perimenopause? I'm off the top of my head in terms of the stats on that? I'm not a hundred percent sure it wouldn't surprise me if it is okay. But as a quick takeaway for what it's worth for reduced risk reduction for ovarian cysts, I would say just know the risk of the hormonal IUD potentially. And then my two quick things for risk reduction for other answers is really take a look at cows dairy and maybe that one more women's health condition where I think the inflammation from dairy seems to be quite unfriendly to the situation.

Dr Lara Briden (23m 52s):

And the other one is iodine, which you'll notice I talk about at great length for breasts, breast health, the ovaries love iodine as well. Clinically, I feel like iodine helps to reduce the risk of ovarian cysts. All of this said, please also read the safety section in my book about iodine because I then can harm the thyroid. Especially if you have Hashimoto's or autoimmune thyroid disease. And there are unfortunately all different doses out there. You could get a dose, you could, he just bought iodine online. Like no joke you could get anywhere you could be taking anywhere from a hundred, 100 micrograms per dose to 50,000 micrograms per dose, depending on what you end up buying.

Dr Lara Briden (24m 32s):

So you really do need to think about the dose and the safety. And, but all that said, I prescribe iden all the time for my perimenopausal patients. I think there's a higher requirement for iodine during perimenopause, for me, a combination of reasons. 

Georgie Kovacs (24m 48s):

Yeah. Okay. No, that's very helpful. I have to admit when I read Period Repair Manual, my takeaway was don't touch iodine all really scared. And again, this was six years ago, right. But it was, my takeaway was there's disagreement on the dose. And if you take too high of a dose, it's dangerous. And I was like, I don't know who to trust. And I don't have it. Back then, I wouldn't have had the concern now I'm in perimenopause, so it'd be different. But I was like, I'm scared. Who do I go to?

Dr Lara Briden (25m 16s):

I didn't want to make it that scary. I mean, I guess I was just trying to be careful because I didn't want to find getting into trouble, but for what it's worth actually iodine is becoming one of my favorite treatments for endometriosis. 

Let's take a moment to hear from our sponsor.

Georgie Kovacs (25m 30s):

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Georgie Kovacs (26m 13s):

So if you or anyone, you know, is going through these challenges, definitely check out the ReceptivaD test. Admittedly, I wish it were around when I was going through my four years of infertility. So thank you ReceptivaDx.

Dr Lara Briden (26m 26s):

And now let's get back to the episode.

Georgie Kovacs (26m 28s):

So now the fears. Libido. Talk about libido. And one thing I did want to note, so I interviewed a woman who works at a company here in the US called Parsley Health. It's like a bunch of functional medicine doctors that work through a central organization and she is a hormone specialist there. And she had mentioned that there are patients that come to her and there isn't an equation for level of testosterone and libido. Now we know libido's complex cause there's mental health factors that could contribute and all these underlying causes. But I'd love for you to talk about libido and perimenopause / menopause, the role of testosterone, because I know that you also mentioned in the book that you're a little bit nervous about testosterone.

Dr Lara Briden (27m 15s):

Yup. Testosterone in excess causes weight gain, and women contribute to insulin resistance. So it, by, in excess, I mean when it's in excess compared to estrogen and progesterone. So there's that now, but as you saw in the book, I'm not, I understand that when you use testosterone appropriately and at the right dose, it can increase desire. You also need estrogen and progesterone in place, especially estrogen for vaginal tissue thickness of the tissue and everything. So yeah, libido, I thought about that a lot like in writing the book. It's because we have this stereotype that libido always goes down with menopause.

Dr Lara Briden (27m 56s):

I actually don't think that's true from my reading of the literature, from my own personal experience, to some extent, you know, I think so many things factor in and I'll just talk about them sort of briefly. There's certainly, there's a big section in chapter 10 of Hormone Repair Manual about what's called the genitourinary syndrome of menopause. Vaginal dryness is just part of that, but some women could have prolapse. Like if you like, obviously if you have symptoms, if your vagina is not comfortable for all different reasons, that's going to affect desire big time because you know, if you, if it hurts or you're embarrassed or that it's, you know, so that requires treatment.

Dr Lara Briden (28m 38s):

Like, you know, and that's when actually vaginal estrogen really comes into it plus other things. So I think yes, feeling comfortable down there, you know, feeling, not dry, like just all of that needs to be addressed. And this is if women want to keep having sex. And I don't think we have to necessarily assume that every woman has to keep having sex, but I'd like, you know, most women probably do or many women probably do not just sex or masturbation, the desire part of that. So you wanna make sure you're not, you know, having dryness or symptoms. And then on top of that, you know, the desire I'd see with my own patients, actually one of the biggest factors is fatigue and thyroid and other things affecting general energy. Cause you have to have that general mental energy to want to have sex.

Dr Lara Briden (29m 20s):

And so that's that often needs to be addressed. I included a couple of quotes about how it makes sense to me actually, some of the drop in desire that has been attributed to menopause generally is actually from the natural boredom that occurs after 20 years of marriage. Like that's just a thing. I don't think that's, I don't, it's bad to say that that's happening for both partners. That's, you know, that's just, that's a reality. So I think once you kind of factor that in because you, you, you know, you talk to those occasional you guys, Oh. And even in menopause and she's in a new relationship, it's like, yeah, there's no problem with desire. Kind of, you know, it's like, you can still get that, you know, excitement.

Dr Lara Briden (30m 1s):

One of the questions I ask about desire is what I try with my patients is what I'm trying to figure out what's going on. It's like, do you still, when you're watching a, like a sex scene or romantic scene, that's well done, you know, that's, do you still get that little, like paying of interest from that's to me that's quite a good marker of what's actually happening with desire rather than, you know, how often do you feel like having sex with your partner just sorta helps.

Georgie Kovacs (30m 29s):

Thank you for, I mean, honestly that was really well written. So thank you for sharing that. Now you've talked about vaginal dryness and some of the hormones that you need for that. So tell us a little bit more that if there's anything you wanted to add outside of what you already stated.

Dr Lara Briden (30m 46s):

Well, vaginal estrogen is it's number one. And just to circle back to our conversation about safety, vaginal estrogen is safe. Like every, you know, from every angle even potentially for when you have a personal history of breast cancer, I provide a quote from ACOG in there about, you know, the, the safety of vaginal estrogen. So that's just something to know about and not be scared of. And that that's some of the longer term treatments too, because most, as I said, most symptoms are only during the phases of perimenopause, including just after the final period, but vaginal estrogen or sorry that vaginal dryness will just, and the bladder symptoms that go along with it and all of that will just continue to progress without some treatments.

Dr Lara Briden (31m 37s):

So I will talk about vaginal estrogen. I talk about the importance of a microbiome, potentially the role of vaginal probiotics. I talk about zinc for vaginal health, which I just want to mention. Yeah. I've seen good results with patients. Yeah. I think zinc can help to maintain the integrity of the epithelial cells in the vagina, which is important for then they make glycogen that feeds the good bacteria in the microbiome. So there's a close relationship between the call it, like the health of the tissue and the microbiome.

Georgie Kovacs (32m 9s):

So what I'm hearing from you is once you're struggling with whatever it is that your body's doing to react to this, the changes in, in stage of life, what I'm hearing is take care of yourself earlier, rather than later. And this is really interesting to hear. Cause I'll, I'll just share, like right now, I'm starting to put the pieces together because when you live with yourself every day, you don't necessarily notice things. Yeah. And so after my Transcendental Meditation class, I was really calm. And then a couple of days later, I couldn't like focus and I was anxious and I thought I was going crazy.  And I'm like, and that was really like being hard on myself because I couldn't focus.

Georgie Kovacs (32m 55s):

And I just paid all this money to do this class. And I'm supposed to be the most relaxed human being and I'm losing my mind. And then I got my period and I had also interviewed someone about intermittent fasting. And one of the things she was talking about is when you should do fasting based on the phases of your cycle. And she was even talking about, you know, the perimenopause menopause and I'm like, well, how are you supposed to monitor your phase? If you have no idea when your period's coming. And she said, anxiety is one of them. Then I put the pieces together. I'm like, aha. That is why. And honestly, I am now motivated to go see a doctor because I'm like, I can't live like this.

Georgie Kovacs (33m 35s):

Maybe it's worse than I had thought. What I'm hearing you say is take care of it. Because you don't want things to get worse in your life. So I'm kind of motivated to just get into action because I mean, this is horrible. It's horrible for me.

Dr Lara Briden (33m 50s):

You're right. It's true that premenstrual mood symptoms can worsen or amplify during these years for sure. And it can reach the point of, as you say it, like you can't go through many more cycles like that. Like it can be quite debilitating depending on the doctor, there may be limited options, you know, in terms of offered by the doctor, like there is the option of course, to get, to try to access Prometrium, which is the progesterone. For what it's worth, for progesterone. I should also mention, and I do mention in the book, it's also available like a first step towards getting progesterone, depending on what the condition is. And sometimes with mood, progesterone cream can help, you know, that can be, and you don't need a prescription for that.

Dr Lara Briden (34m 33s):

So I'm just also putting that out there that that can sometimes be a starting place. Certainly I've had patients and many friends who say progesterone cream, like magnesium. Like when I talk about the book, magnesium, taurine, B6 plus progesterone cream, that's it like, you know, that can really help relieve premenstrual mood.

Georgie Kovacs (34m 53s):

To be honest with you. Part of why I haven't gone is I had to argue with my doctor to do a full thyroid panel, like the discussion and debate about that was so annoying. I felt like I was being a jerk and I knew I was standing up for myself. And I'm just so scared to go to a doctor and now get into this debate.

Dr Lara Briden (35m 8s):

It's pretty doable to access Prometrium for heavy periods, because there's some protocols.. Professor Prior protocols for those potentially for perimenopausal symptoms. If you kind of frame it that way for perimenopause, cause she's got a published paper about that, that you can reference. Doctors will not generally not prescribe progesterone for PMS. Like if it's kind of put it to them that way, they're not going to cause them to work from the perspective that progesterone is the cause of PMS, which is so crazy. Like this is one of those situations where my view and Professor Prior's view is actually completely opposite to the conventional. So there's a little bit of negotiation to be had, but actually what works for some of them sometimes is to say, Oh, I tried the progesterone cream and that extra really helped.

Dr Lara Briden (35m 56s):

But you know, I think I might need a bit more. And then like, could you consider prescribing Prometrium it kind of can, it can go like that in that direction. 

Georgie Kovacs (36m 2s):

And this is why I wanted to bring up this story. And I didn't know it was going to go in this way, but I just think it's, this is why I'm just imploring people. Like this is what we are doing in this podcast interview as such the surface. There is so much in the book that I think people need to read because you do. I mean, I love there were a few parts and to talk to your doctor, it was like, print this article, the attachment, bring it to your doctor. And I giggled, I giggled. That was like, thank you. Thank you. You go, I love this. So this book will set you up for success. Okay. Hot flashes. Yes. What do we do about those hot flashes? Which I'm so happy to report? I didn't get them much and I stopped getting them so far.

Dr Lara Briden (36m 46s):

So they start, usually start with night sweats. I'm just kind of circling back to the women in the earlier phases of perimenopause that usually the first symptom will be premenstrual night sweats and then it can progress to sort of some daytime hot flashes as well. And then certainly they're usually at their worst just before the final period, just after the final period around those years, I've got a little flow chart I talked about in the book, but also have a blog post about it. So obviously there's different things that can work. But generally just starting from the top, what I say is what I call it. The basic action plan for the brain. Cause hot flushes hot flashes started the brain. It's really about this kind of energy shift in the brain, which I described in the book.

Dr Lara Briden (37m 29s):

But you start with magnesium plus taurine. My couple of supplements that I give a lot.

Georgie Kovacs (37m 35s):

I just ordered taurine.

Dr Lara Briden (37m 37s):

Make sure you try to identify and reverse insulin resistance because insulin resistance worsens hot flashes obviously reduce stress because stress is a big factor in hot flashes. And I would estimate that those, just those things, magnesium and taurine address, insulin resistance and stress and cut and quit alcohol for what it's worth or dramatically reduced. Probably quit. Though, that layer, that tier, if you will, of treatment, probably at least 60% of women. That's all they need. So that can, that can I just had a patient last week actually, where she's, I'd laid out. The whole thing was about to say to you, you know, start with tier one, then you go to progesterone and then you go to estrogen, all the different tiers and she, yeah, she's like, I'm good.

Dr Lara Briden (38m 25s):

Like I'm done. I'm just going to keep using this no more hot flashes, no more night sweats. I'll just keep doing this. And I said, if it changes, we can progress to the other treatments. She's like, that's fine. She'll come back to me if she needs it, but it can be like that. So that's tier one, magnesium taurine diet, quit alcohol what'd you stress movement. And exercise is very helpful.  Then tier two would be progesterone alone, like sorry, all those things plus progesterone, but not yet. Not yet estrogen. And that's according to Professor Prior's protocols, who's found that progesterone alone can relieve symptoms of perimenopause. In fact, she argues that during perimenopause, while you're still having periods, progesterone is a better option than estrogen plus progesterone.

Dr Lara Briden (39m 10s):

But even into, even after the final period, progesterone for some women can give relief. And then if that doesn't work, I'd always take it, always take it at bedtime. If you're going to take progesterone, especially capsules, because it's very sedating. If that doesn't work, then you look at all of the tiers, tier one, tier two, which is add the progesterone. And then you look at adding estrogen, which, and there's no question estrogen can dramatically relieve hot flashes. I mean, that is a fact. And on the topic of estrogen and I described this in the book, if you're going to take it, I think that the really safest, the best is transdermal. So a patch or a gel that's body, identical estradiol, this is the modern hormone therapy.

Dr Lara Briden (39m 55s):

You don't have to fight for this. This is what they give through the skin transdermal. It's just a lot safer in a couple of things. It mainly in terms of the blood clotting risk, it doesn't go through the liver and form clotting factors like oral estrogen does. And arguably transdermal estrogen is also safer for breast cancer risk because it doesn't go through the liver and forms another estrogen called estrone, which has a higher breast cancer risk profile. So that'd be a patch that you put on your belly twice a week kind of thing, or rub the gel in. So, and then the thing to know about once, if you do start taking estrogen, that's fine then. So it was the question of, for how long do you take it?

Dr Lara Briden (40m 36s):

And I guess that's a whole other, in terms of symptom relief, if it's really just for hot flashes, then I think the strategy would be to take it for a few years, you know, three or four years or something. And then if you wanna try coming off, the, the most important thing is to taper it down because estrogen is addictive. Progesterone is not, but estrogen is addictive. So if you were on estrogen and then just stop it like that, you will almost certainly get hot flashes back. It doesn't mean that, you know, you still sort of need it per se, but like it's, it, it needs to be tapered down over several weeks. I would say in terms of maybe cutting the patch or just applying it less often.

Dr Lara Briden (41m 16s):

So, but also, you know, as I say in the book, stay on progesterone during that time, because that can really shelter you from the tapering down process. So that's, if you want to come off because you want to see if maybe you don't need it anymore for symptoms, if you're on estrogen in part for protecting bone health and reducing the risk of osteoporosis or slowing down osteoporosis, the short answer is as soon as you stop it, the bone risk comes back. Like it, what it's kind of looking like is, you know, for something like bone health, it might need to be quite long-term. And I'm also at the point where even just from my own patients and I'm just, I'm also in the kind of watch this space.

Dr Lara Briden (41m 57s):

I want to see what the research starts to tell us I'm not prepared to do. Well, I'm certainly not prepared to say every woman should be on estrogen for the rest of her life. No, no, no, no, no, no, no, no, no. You know, lots of women don't need it for women that are at high risk of bone health for like all, you know, early menopause or history of anorexia. Like it's different situations where your bones might be particularly at risk. And then if, if those women are getting the advice, okay, you need to stay on estrogen. Long-term like for decades and decades, I would be supportive of that too. So I'm like, you know, I'm got it. I'm willing to go with what the research is suggesting for that individual.

Georgie Kovacs (42m 38s):

Okay. Hysterectomies. I would just love your perspective on how women should view it. And to be honest with you, I think this is so close to my heart, just because I remember being at a conference around endometriosis and I was hearing stories of 21 year olds getting hysterectomy is, and even in your book, I think you indicate that. And I know that's not for menopause, but I think I just I'm so like, Oh my gosh, are there women getting hysterectomy that don't need to? And so I think it's just really important to just hear like, you know, the short version of, of hysterectomy is and how, what women should be prepared for and how best to understand if one is truly unnecessary.

Dr Lara Briden (43m 20s):

Sometimes it's necessary. I mean, I'll say, I'll say that, you know, sometimes obviously if severe adenomyosis or the pain or the bleeding is just out of control, then yes. Sometimes it's necessary. If, and just one quick clarification, if your uterus has been removed, but your ovaries remain, you still go through all the normal four phases of perimenopause. You're not in, you're not in menopause just because you lost your uterus. I mean, if the ovaries are there, you still cycle. So that's quite important because that can lead to a lot of confusion. That's obviously because I had a lot of patients who've had hysterectomies. So I have a lot of experience with, you know, trying to start that at work, all that said my key message would be keep your uterus if you can, because you know, giving a perspective, you know, I've been working for 25 years.

Dr Lara Briden (44m 7s):

25 years ago, I would say the majority of women in their late forties had their uterus out. Like it was a much more common back then. And so even back then, I wanted to get like a bumper sticker for my car. That's it keep your uterus hanging on to your uterus 25 years later, it's different because now we have the hormonal IUD there's ablation and other techniques and women are less at risk of losing their uterus and also Prometrium or you just didn't like the higher dose progesterone capsules can also help to stop the crazy heavy bleeding that can lead to uterus removal. So in the book, I have a little section of benefits from keeping your uterus.

Dr Lara Briden (44m 49s):

I kind of frame it that way. Like acknowledging sometimes you can't, but if you, if you can, if you can just hang on for a couple of years, knowing that it, you know, when periods, when you achieve menopause, all these symptoms, most of the symptoms will go away. Well, obviously heavy bleeding, painful symptoms will, should go away all the fibroids. I'll just say fibroids do shrink with menopause. Not completely though, not a hundred percent depending on the woman. Yeah. There's benefits just in terms of just simple things like, you know, structure of the pelvis and prolapse and things like that, like in the uterus is part of the whole anatomy of the area. And cause even a bit of intriguing research that it's, it's connected with the nervous system, which is not a surprise cause our whole body is connected.

Dr Lara Briden (45m 30s):

And this seems to be something there's an animal study where they found that animals with females who keep their uterus perform better, like in mazes and things like it seems to be related to cognition, which I find as a cause I'm a biologist. So I find this very intriguing just to kind of think about, you know, all different things about aspects of health that we might not be immediately obvious basically, just to debunk the idea that the uterus is only for making babies, like obviously it's part of the body, it affects other things. And I would hope the majority of women can keep it.

Georgie Kovacs (46m 3s):

Okay. No, that's helpful. If you could just say one last thing to women who are about to go through this transition are going through the transition. What message would you like to leave us with?

Dr Lara Briden (46m 14s):

It's so different from what you expect. I, you know, I guess anyone who's feeling fearful of the process, I just want to share that it, well, this is once you kind of get here and once you go through it and especially if it's not as bad as you're thinking, and then you arrive as a menopausal woman and you realize that it's going to be all going to be okay. Like, you know, it's yeah. It almost feels like it's kind of like an insider secret because that's kinda how I feel now that I'm here. It's like, Oh right. Like all the, you know, women 50 something. Yes. They're more confident because once you get here, you stop being such a people pleaser. And you've just got this kind of new perspective that is quite refreshing. I don't know. Yeah. I mean, I talk about it in chapter two of the book.

Dr Lara Briden (46m 55s):

I try to put it into words, but I was scared of menopause. And now that I'm here, I'm like, Oh yeah, it's, it's actually fine.

Georgie Kovacs (47m 1s):

Well thank you for taking time. I don't know what spare time you have, but for putting all of these thoughts in a book, we need it. And I can't wait for more people to be reading it. I think it's going to help so many women. And just thank you so much for all of your advocacy and this. Cause I feel like these books are being written to help women advocate for themselves. So thanks for giving us the tools.

Dr Lara Briden (47m 25s):

Yes. Thanks for having me, Georgie. It's always nice to chat with you. Yeah. And it's, this is now a topic that's very near and dear to my heart.

Georgie Kovacs (47m 35s):

Thank you for joining us today on the Fempower Health Podcast. Join us next week. As I interviewed Dr. Mindy Pelz, who will talk to us about intermittent fasting, we weren't able to cover it in today's episode with Dr. Briden, but it's definitely something that will support those of you transitioning into perimenopause and menopause. 

Thank you for joining us. If you like what we discussed in today's Fempower Health Podcast, follow on your favorite podcast platform rate and review to ensure greater access to the information shared by my guests. The more we work together, the bigger the impact we can make on women's health. Now follow us on social @fempowerhealth. And remember the information we discussed is not to be substituted as medical advice, always go to a trained professional of your choosing.