100. How to Talk to Your Doctor About Perimenopause and Menopause [VIDEO]

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Hey, pod pal.

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Nice to be with you today.

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Today's episode is an answer to questions that I've got from you about advocating for yourself in the doctor's office, especially regarding women's health.

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So I am bringing on a guest today, Dr.

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Elizabeth Bostock.

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You may recognize her name.

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She was a contributor to Everyday Ayurveda for Women's Health, my book that came out a few years ago, that is actually being released in paperback on September 16th, which is very exciting.

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You're gonna love this episode, 'cause She gave us some, trusted resources for educating ourselves specifically about perimenopause symptoms, menopause, hormone therapy, and also a very specific list of questions that you can write down and bring into your doctor's office.

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So we have got you when it comes to...

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I don't know about you, but I can clam up.

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I get super nervous in those kinds of environments, dentists, doctors, et cetera, and I have to have the things written down, and so Dr.

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Bostock tells us what to write down.

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She's been a, OBGYN for 30 years.

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She's, semi-retired right now, still practicing, but sort of taking a step back, thinking about what's next, and becoming really interested actually in, advocacy, women's advocacy.

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Questions like the one you asked about, how to talk to your doctor and how to improve the medicine that is available for women's health.

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So let's get right to it.

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This is some super practical stuff from an OBGYN who has been in practice for 30 years right after this Welcome to Everyday Ayurveda with Kate, a podcast that translates ancient wisdom for modern lives.

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I'm your host, Kate O'Donnell.

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I've been living and teaching Ayurveda, India's traditional medicine, for over 25 years, and I've authored four best-selling books on bringing Ayurveda practices into our lives.

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If you're tired of battling digestive issues, hormonal imbalances, menopause symptoms, or are seeking a deeper spiritual connection and purpose, you're in the right place.

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This podcast is for you, offering practical, accessible advice to help you heal through diet, optimize your daily routines, and enhance your overall wellbeing.

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Follow this space for insights on a diet that heals, strategies for better digestion, sleep, hormone health, and direction for finding a deep sense of meaning and purpose.

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Join me, my pod people, for this empowering journey into self-care and self-discovery.

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Together, we'll explore how to bring balance and vitality into your everyday life.

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Let's do this.

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Welcome to the podcast, Dr.

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Elizabeth Bostock.

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It's so great to be here with you.

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Thank you.

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It is really wonderful to be here with you today.

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So anybody who's read, you know, my book, Everyday Ayurveda for Women's Health, might recognize your name, 'cause you were a contributor to that book.

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bringing you on today because I'm getting this question from listeners, and also something I'm seeing in my own community of women, about how to talk to your doctor about women's health.

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and more specifically, perimenopause and menopause symptoms.

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That's the stuff that's been coming up, uh, you know, in my community the most.

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So you're a practicing OBGYN, right? Yes.

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Yeah.

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For how many years? 30 years.

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30 years, yeah.

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And when I met you, 'cause I, I met you when you were an Ayurveda student at the time, and a, a client, and you also were stepping into an advisory role, I was just like, "Wow, you are doing a lot."

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Can you just explain to us a little bit about your clinical experience, your life as an OBGYN these past 30 years? well, I started out, uh, in private practice as a generalist OBGYN, meaning, I did obstetrics, I delivered babies.

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I did gynecology, saw women in the office for their annual wellness exams, and then, problem visits.

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Took care of surgery, took care of people who were going through menopause.

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Uh, did all the things, and I did that initially for about 12 years, and then I changed to working for a health system.

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and working with more migrant and underserved communities for a lot of years, which was incredibly gratifying.

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but continuing the same work, right? And seeing people across the lifespan and across the health span.

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people who were well and people who were not well, and people who had fertility issues, and people who had menopause issues.

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and then in that journey, I started taking on progressive leadership roles for not only teaching other, healthcare providers, but managing a greater and greater number of, offices and hospitals who were providing women's healthcare.

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up until about a month ago, when I decided that it was time, to turn back to, finding my own true north, and where that was gonna lead in this whole journey.

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so I'm on my own adventure right now to find my own next thing.

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Yeah.

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how old are you, Elizabeth? I am 67.

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Wow.

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I'll turn 68 in a month.

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So you're, could we say you're semi-retired? Would that be accurate? Yes, that is accurate.

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I guess I'm retired with a twist.

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Right.

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Right, 'cause before we hit record, you were saying you, you potentially will continue to serve as a doctor, but it sounds like you probably just want more time for yourself or for other pursuits.

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Yeah.

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Both, right? Both.

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For example, this morning I was able to take a sunrise walk with a friend.

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Right.

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Right? These are the things that I haven't been able to do easily for 30 years except when I was on vacation.

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and I Very much believe in the idea that the direct experience of the world is how we maintain our health and health span.

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so that's important to me.

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And also, I just...

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There's a lot of things I'm really interested in further studying.

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Like, maybe I'm gonna spend more time on Ayurveda, or m- maybe I'm gonna spend more time thinking about how to talk to women about asking for what they need, I just am in a active what's-my-next-adventure phase.

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I love it.

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Turning 68, next-adventure phase, that's fabulous.

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I think it's inspiring, for the- those of us who, or folks who are listening who might be at that stage, and it's a big leap.

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I'm sure it's huge, and I'm sure, There's a lot of shoes to fill, all the jobs you were doing.

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So it's a big deal.

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but, it's funny that I reached out to you about this question, how to talk to your doctor, and then w- you and I were just wrapping before we hit record about your interest in helping women advocate for themselves in this, eh, world that can be, like, somewhat intimidating.

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So I think that's- Mm-hmm our mission today.

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I wanna ask you so many questions about what you see, you know, in your work.

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But we're gonna also stay focused, hopefully, on this, sort of self-advocacy in the doctor's office, but also in the...

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I think sometimes it's, like, a multi-step process, to get the help that you need, and so I wanna kinda unpack that as well.

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If I could just dork out with you for a minute though, something I'm so curious about.

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A- 30 years of practice, Tens of thousands, hundreds of thousands of women potentially that you see, you know, walk into your office or the offices of people that you're overseeing.

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Are there trends, in the kinds of, problems that women are having? Eh, h- have you seen changes, like, oh, in this decade I got a bunch of this, and then I started seeing more and more of that? Or is it pretty consistent? No, I think there are, pretty clear trends Across the decades.

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But I would also say the one clear trend that often expands across the lifespan, and I think this comes to me because of the kind of provider I am, right? I get many women coming to me, telling me that they haven't been heard, right? Wow.

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That nobody has listened to them, and so beyond the symptoms that women have that do differ somewhat by decade, right, or the predominance of which differs by decade, right? I get a lot of women coming in saying, "Nobody listens to me-" Wow.

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or has listened to me," Which is heartbreaking Because going to the doctor is hard enough.

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Leaving the doctor feeling like you haven't been heard is just, like, a devastating experience for so many people, especially if you're coming with a problem you're hoping to get help with.

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Yeah.

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Right? So if we were to break it down by decades, when we talk about what's happening in the teen years, right? Those, things that women are coming in with are often more either pain- Mm-hmm pelvic pain, period pain, problems with their menstrual cycles in one way or another.

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Too scanty, too frequent, too heavy, right? And/or, a, a need for a conversation around birth control and safe sexual practices.

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You know, what are healthy sexual practices? Let's call it that, right? When you move into the 20s, that trend of pain, I think, often continues because pain in women is completely unanswered in allopathic healthcare, I think, or has been, right? There's a little bit more attention to it now, particularly with all the, different fem tech startups beginning to really target this issue.

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but, There just has been this e- expectation that women should have pain with their periods- Mm-hmm and you should just, like, person it up and deal with that, right? and take some ibuprofen and get on with it, right? And I think we in current day are understanding something very different now, and hopefully more practitioners are approaching this with compassion and a willingness to look at what solutions might be.

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And I think there's a ton of solutions out there, Ayurvedic, allopathic, new tech solutions involving electrical and magnetic stimulators.

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Like, some crazy effective stuff out there, right? and then as you get into the late 20s and 30s, right, many more women with fertility as part of their conversation, which is big these days.

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Infertility is- Yeah on the rise worldwide.

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Yeah.

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It's a big issue.

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Mm-hmm.

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Right? By the time you get into the mid-30s, late 30s, right, women are starting to really notice the changes in their bodies.

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Right? We have this impression somehow, and you and I talked about this when you wrote your book, we have this impression somehow that our bodies are gonna arrest at about the age of 25, right? And that we'll go through the rest of our lives with a 25-year-old body.

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But I think when you get into your 30s, late 30s, right, it becomes apparent that is not what's gonna happen.

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And I believe many women actually start experiencing perimenopause intermittently in their late 30s, right, going into their 40s.

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and it can be very intermittent in the beginning, and then throughout the 40s can become more frequent, into the 50s, right, into menopause, and making a transition.

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I think the piece that we're missing in our current day conversations that I like to highlight is that right now we're talking a lot about perimenopause, menopause.

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Yeah.

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We're really not talking about late menopause, like women in my age range.

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Right.

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And I will tell you from the women I've taken care of in personal experience, the changes keep going.

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Mm-hmm.

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Right? You don't arrive at menopause and then stop there like you thought you would y- with your 25-year-old body.

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You don't get to stop with your 52-year-old body and continue with that.

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Like, it's a continuous shift Yes.

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So a long answer, but...

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Right, right.

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So you're talking about menopause care, like, going into 60s, 70s.

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80s.

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Yeah.

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Like- Yeah the, the entire, health span post-menopause- Right is, Menopause care.

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And I think in the past, a lot of women stopped thinking about getting gynecologic care, stopped thinking about themselves as female beings- Mm-hmm once they went through menopause, right? Mm-hmm.

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but the truth is that all of that remains incredibly relevant through your entire lifetime, Whether you choose to take hormones, which is another topic, but whether you choose to take hormones, do other things, right? Your health span is relevant to being female, or being female is relevant to all of that, right? And so some of that is talking about things like sexual health, physical health, spiritual health, right? All of those are relevant topics within all of this, right? Right, right, which is potentially why we're having a hard time expressing ourself in the doctor's office when it's such a short period of time, and the scope of what we're experiencing is so kind of all-encompassing, y- it's a funny one, 'cause I, I feel like in my mind, I separate, like, s- things that are bothering me into, like, physical.

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I'm trying to figure out, like, how much of this, pain, let's say, or irregularity is, like, a physical thing, and how much of it has to do with stress, the lack of rhythm in my days, e- emotions, All these other things that really do affect things like your period, and your hormonal balance and all that.

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Elizabeth, the thing that, that kind got me going on this was hearing my friends talk about, and they're, we're all in our late 40s, so people are starting to exper- like wake up in the middle of the night, soaking wet, kicking off the sheets.

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people are having periods going every which way.

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You know what I mean? You have it for two weeks without stopping, two months without stopping.

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You have it, and then you don't get it again for three months, and then you get it for three weeks without stopping you know, and it's like all these, all over the place.

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Yeah, people are concerned about, bone density.

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Y- there's, so many concerns, I think, especially because we're also, being perimenopaused to death right now, algorithmically.

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It's kind of coming from all sides, something that I didn't even hear about, you know, maybe even five years ago, and now everyone's looking for symptoms, talking about symptoms.

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You know, they're going into their PCP for the annual visit.

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say you're 48 years old.

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some of my friends, they were kind of excited about this visit to start talking about, some of these changes.

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Like, what should I expect, or is there anything I should be doing or could be doing, And just really felt shut down and like nothing, nothing happened at all.

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so I think my line of questioning for you today is, okay, how...

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And correct me if I'm wrong, but like, 'cause you go to your primary care once a year, and then some women will also- Ideally Yeah, ideally.

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some women will also go to a OBGYN once a year or not.

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like I know I'm getting a pap from my PCP, and if there's nothing, no irregularities going on or nothing's bothering me, then I'm not going to see a specialist of any kind.

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I'm just going to primary care.

147
00:18:37,951.2194695 --> 00:18:55,651.2354695
So what do we wanna say when we go in to the PCP? Is that different than how, what we would discuss if we were going to see an OBGYN? Do we need to like get a referral to be heard? Do you know what I mean? Mm-hmm.

148
00:18:56,145.2344695 --> 00:19:09,305.2344695
So in our country, right, you don't need a referral to see an OBGYN, though your PCP may have an OBGYN that they work with.

149
00:19:09,915.2344695 --> 00:19:10,345.2344695
Mm-hmm.

150
00:19:10,675.2344695 --> 00:19:28,495.2324695
Right? In terms of menopause care in our country, because there has been such a deficit in care in this area, there are providers who are in family medicine, internal medicine, who have become menopause certified.

151
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and so those are always good people to look for.

152
00:19:33,295.2344695 --> 00:19:40,5.2324695
and you can find a listing of that on the Menopause Society's site, right? Mm-hmm.

153
00:19:40,5.2324695 --> 00:19:42,775.2324695
And that number has expanded greatly.

154
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So that is always a resource.

155
00:19:46,85.2344695 --> 00:19:56,725.2344695
I believe that the Menopause Society also has resources for patients in terms of what to look for and what conversation to have with your doctor.

156
00:19:56,745.2344695 --> 00:20:16,695.2304695
But assuming that you're going in to see your doctor for that annual preventative visit, right, I think, first of all, go in with the understanding that your doctor or provider, right, whether that's a nurse practitioner, a PA, a physician, Has an agenda for that visit, Yeah.

157
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That's all set up based on your age range that they're trying to get through in this potentially 15 or 20-minute visit, and there really is probably not time for you to have questions in that visit.

158
00:20:30,435.2304695 --> 00:20:44,785.2264695
And so there is an expectation on the part of many healthcare systems and healthcare providers that if you have a need to ask questions, that you're gonna schedule what's called a problem visit rather than a preventative visit.

159
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In an ideal world, and where I hope that healthcare evolves, the conversation about menopause is part of a preventative visit.

160
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In my mind, this is a conversation we should start having with women in their mid-30s, and continue every year through to inquire, right? But again, I would direct women to look at resources like the Menopause Society site to think about what questions they have- Mm before they go in.

161
00:21:21,788.5658028 --> 00:21:23,188.5548028
Or talk to their friends.

162
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I think friends are a great source of information, about what questions to ask.

163
00:21:31,243.8971362 --> 00:21:40,413.8971362
I hesitate to send people to social media, 'cause I think social media ranges all over the place and is not necessarily the most reliable source.

164
00:21:40,473.8971362 --> 00:21:55,463.8971362
But I think, you know, questions to think about off the top are, what symptoms might I be having that are part of this that I should keep track of? Mm-hmm.

165
00:21:55,493.8961362 --> 00:22:12,244.3971362
What things can I do to help myself maintain health throughout this period of my life, right? Are there any specific tests I need to think about doing based on my health background, right? Yep.

166
00:22:12,444.3961362 --> 00:22:17,514.3971362
those three main questions I think will take any woman pretty far.

167
00:22:17,814.3951362 --> 00:22:19,804.3971362
Mm-hmm.

168
00:22:19,894.3971362 --> 00:22:30,774.3941362
And I think if your provider is not willing to have this discussion with you or uncomfortable about it, right? The other one people should ask, what do I need to think about for my sexual health?" Mm-hmm.

169
00:22:30,774.3941362 --> 00:22:49,174.3921362
right? We are so uncomfortable talking about sex and sexual health, right? And the reality is it's just part of our biology, right? And so rather than, like, pretending like it doesn't exist, find a way, space to talk about it.

170
00:22:49,414.3971362 --> 00:22:56,414.3931362
And if your provider doesn't wanna talk about it, then ask your provider, "Do you have someone else that you think I should talk to?" Yeah.

171
00:22:56,814.3991362 --> 00:23:04,252.3971362
And if they don't see a need for that- I question whether they're the right provider.

172
00:23:04,282.3971362 --> 00:23:05,402.3971362
And it's okay.

173
00:23:06,552.3971362 --> 00:23:09,402.3971362
It's okay for someone to not be the right provider for you.

174
00:23:09,402.3971362 --> 00:23:09,932.3971362
Right.

175
00:23:09,932.3971362 --> 00:23:11,162.3961362
Right? Yeah.

176
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Some people work- Yeah some people don't.

177
00:23:13,282.3971362 --> 00:23:14,982.3971362
It's kinda like going to therapy.

178
00:23:14,982.3971362 --> 00:23:15,812.3961362
Right, right.

179
00:23:15,832.3971362 --> 00:23:19,802.3961362
Not every therapist is right for every person, not every doctor is right for every person.

180
00:23:20,132.3961362 --> 00:23:24,672.3961362
So we might, like, ask your three questions of our primary provider.

181
00:23:25,2.3971362 --> 00:23:42,422.3991362
So what symptoms might I e- expect to see through this time in my life? Is there anything based on my health history that I should be doing, that to offset that or d- keep things moving smoothly? And then are there any tests that, that you would recommend? That's a great question.

182
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And if it's not flowing in a way that is satisfying for the patient in this environment, they could ask, "Is there someone in this office that you could refer me to who maybe specializes in menopause medicine?" Right? Or how, is that what we would say? I would say menopause medicine or women's medicine.

183
00:24:03,562.3961362 --> 00:24:04,12.3961362
Women.

184
00:24:04,22.3951362 --> 00:24:04,342.3951362
yeah.

185
00:24:04,392.3981362 --> 00:24:04,742.3931362
yeah.

186
00:24:04,822.3931362 --> 00:24:06,32.3971362
Right? Right, Yeah.

187
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Right.

188
00:24:07,202.3981362 --> 00:24:07,582.3981362
Right.

189
00:24:07,832.3911362 --> 00:24:15,212.3891362
'cause I, I could imagine something like, like painful intercourse, vaginal dryness, that sort of thing could be awkward.

190
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Yeah.

191
00:24:16,462.3911362 --> 00:24:23,182.3901362
So you s- almost, you're almost suggesting, like, do the little legwork to find a practitioner that you can talk with about that stuff.

192
00:24:24,232.3881362 --> 00:24:31,792.3871362
Well, and here's where I think talking to your friends and being willing to say things to your friends is incredibly helpful.

193
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Because I, I think we go along and get- I hate using the word gaslit, but kinda gaslit into thinking things are normative, like painful sex, let's say- Yeah right? Or painful periods, right? Yeah.

194
00:24:44,828.3911362 --> 00:24:55,478.3901362
and that's not normal, and you do not have to live with that, right? You do not have to live with some of the crazy skin changes that happen in perimenopause, let's say.

195
00:24:55,918.3911362 --> 00:25:06,478.3911362
so I think you need to find friends who will help you talk about it, and then have that on your list of things to bring to your doctor.

196
00:25:06,478.3921362 --> 00:25:14,38.3901362
And if your doctor's not comfortable talking about it, right, who do they recommend? Right.

197
00:25:14,608.3891362 --> 00:25:15,848.3921362
Yeah, that's super helpful.

198
00:25:15,878.3901362 --> 00:25:16,818.3891362
Very clear.

199
00:25:17,338.3921362 --> 00:25:29,918.3921362
and something I do that I also talk about in my book is I log my symptoms so I can walk in with, like, very specific, you know, to date, like, how long it's been going on, what's been going on.

200
00:25:29,918.3921362 --> 00:25:57,68.3851362
Because as I was telling you just now, I get nervous in the doct- Yeah, I get nervous at the dentist, I get nervous- in any of the, these kind of health environments, and it's very easy to just go blank and forget all these things, right? So they could write down your three questions, right? Right? Log any symptoms that we're experiencing, or just, like, questions that we have, about, our bodies, and go in there kinda with the little notebook, with everything right there.

201
00:25:57,488.3911362 --> 00:25:57,758.3911362
Yeah.

202
00:25:57,798.3881362 --> 00:25:58,18.3881362
Yeah.

203
00:25:58,18.3881362 --> 00:25:58,658.3861362
Which is something I do.

204
00:25:59,158.3891362 --> 00:26:03,38.3911362
I highly recommend that, and I love your idea about logging symptoms.

205
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If people are into using apps, right, there are some of the newer FemTech apps that are symptom loggers.

206
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Yeah.

207
00:26:10,958.3841362 --> 00:26:17,228.3791362
some that are menopause specific, some that are more specific t- or more general to women's health.

208
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And I do think those are helpful if you're willing to put your information out there, because they will often allow you to download, like, a, a form of that you can hand to your provider and say- Oh, wow "Look, here's what's happening with my sleep, my energy, my periods," right? So you're not trying to, like, thumb through your tracker and say, "Hey, four months ago-" Yeah, right right? so I think that if you're willing to have your information out there in the- ether, right? that those are very good ways to do it.

209
00:26:57,722.3741362 --> 00:27:16,472.3731362
And I think also, right, as people are, more and more using wearables, and that's something you didn't talk about ahead of time and I'd love to talk to you more about probably not today, right? But I think the information from your wearables can also be incredibly helpful for documenting what's happening.

210
00:27:16,982.3731362 --> 00:27:17,132.3731362
Yeah.

211
00:27:17,162.3741362 --> 00:27:18,512.3731362
Right? Sure.

212
00:27:18,522.3741362 --> 00:27:18,542.3741362
Yeah.

213
00:27:18,832.3741362 --> 00:27:24,2.3731362
Because then it's harder for your provider to say, "Well, stop..."

214
00:27:24,62.3721362 --> 00:27:31,792.3721362
if you're saying, "I have sleep problems," right? Yeah, "Stop using screens an hour-" Mm-hmm "before bedtime.

215
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Like, make sure you're in a cool room."

216
00:27:34,602.3731362 --> 00:27:45,282.3741362
Right? Those things are okay first steps, but they're kind of glossing over the total conversation that needs to be had about sleep, right? Right.

217
00:27:45,282.3741362 --> 00:27:52,402.3731362
'Cause it's not just because people are badly behaved and have poor sleep habits that sleep is being disrupted.

218
00:27:52,402.3731362 --> 00:27:53,252.3711362
Right.

219
00:27:53,252.3711362 --> 00:27:55,932.3711362
Right? This is a biological thing that's happening.

220
00:27:56,452.3761362 --> 00:27:56,962.3761362
Right.

221
00:27:57,2.3711362 --> 00:28:01,562.3761362
Right, And, like, not necessarily the fault of the patient.

222
00:28:01,652.3761362 --> 00:28:01,672.3761362
Yeah.

223
00:28:01,682.3761362 --> 00:28:01,712.3761362
Yes.

224
00:28:02,642.3731362 --> 00:28:20,662.3681362
And I think that a lot of people like yourself and a lot of people who study Ayurveda or other lifestyle type medicines, right, have tools to work on this, but there's still underlying biological things to talk about.

225
00:28:21,492.3721362 --> 00:28:21,672.3721362
Yes.

226
00:28:21,752.3661362 --> 00:28:28,522.3711362
Right? Even with all those lifestyle changes, so I think it's important to have a good tracking of what's going on so that- Yeah.

227
00:28:29,12.3671362 --> 00:28:31,932.3701362
Right you can really say, "Here, this is what's going on."

228
00:28:32,229.0368029 --> 00:28:32,559.0368029
Yeah.

229
00:28:32,559.0388029 --> 00:28:36,419.0328029
So that sounds kind of n- like a non-negotiable to be tracking symptoms.

230
00:28:37,349.0398029 --> 00:28:45,859.0378029
Speaking of symptoms, what are you seeing? What's going on? I mean, crazy skin stuff, I'd love to hear more about that as well.

231
00:28:45,869.0388029 --> 00:28:46,789.0388029
Yeah.

232
00:28:46,929.0318029 --> 00:28:47,229.0318029
I'm...

233
00:28:47,829.0338029 --> 00:28:59,165.6884695
I have a fair bit of curiosity about this one, and- you know, if women wanna let you know, I'd be curious to know if there's a specific set of women who have these symptoms.

234
00:28:59,165.6914695 --> 00:29:24,573.6984695
But- Mm-hmm I would first of all start out by saying that- Estrogen receptors, right? The main hormone or one of the main hormones impacted by menopause are in every single tissue of your body, right? So every single tissue of your body is affected by changes in estrogen and what's happening during perimenopause is that it's going kind of wacko, right? Mm-hmm.

235
00:29:24,583.6974695 --> 00:29:27,933.6984695
And then you get to menopause, and it's just this downhill slide.

236
00:29:28,543.6984695 --> 00:29:40,293.6974695
And what I have seen over the years, I used to talk about it in thirds, right? About a third of women seem to not really experience much in the way of symptoms.

237
00:29:40,323.6974695 --> 00:29:40,343.6974695
Yeah.

238
00:29:40,953.6984695 --> 00:29:42,933.6974695
Those lucky women, right? Mm-hmm.

239
00:29:42,933.6974695 --> 00:29:48,963.6964695
About a third of women are so profoundly affected that they're disabled- Mm-hmm and really need intervention.

240
00:29:48,973.6984695 --> 00:29:48,993.6984695
Yeah.

241
00:29:49,813.6984695 --> 00:29:53,153.6984695
And about a third sort of go through symptoms transiently.

242
00:29:53,803.6964695 --> 00:30:01,473.6984695
And the list of things that we're now considering symptoms are probably numbering about 100- Wow these days.

243
00:30:01,773.6974695 --> 00:30:01,853.6974695
Yeah.

244
00:30:01,963.6964695 --> 00:30:08,307.0258029
Right? I think everybody's familiar with the main ones, hot flashes, night sweats, vaginal dryness.

245
00:30:08,577.0258029 --> 00:30:08,687.0258029
Yeah.

246
00:30:08,847.0298029 --> 00:30:10,247.0288029
Right? Painful intercourse.

247
00:30:10,797.0268029 --> 00:30:22,627.0288029
Then comes sleep disturbances, which I think is in many ways the more common- Mm-hmm of those and related to those, and looks to be, related to a specific brain change that's occurring.

248
00:30:23,657.0238029 --> 00:30:25,997.0218029
due to changes in estrogen? Yep.

249
00:30:26,397.0248029 --> 00:30:26,967.0248029
Yeah.

250
00:30:27,397.0248029 --> 00:30:35,357.0218029
Changes in a thermal regulatory part of the brain, in the hypothalamus, so probably also related to the hot flashes and night sweats.

251
00:30:35,357.0238029 --> 00:30:35,437.0178029
Mm-hmm.

252
00:30:35,647.0248029 --> 00:30:44,137.0258029
But it's really a signal for, changes in your brain that are beginning to happen as a consequence of menopause and that bears thinking about.

253
00:30:44,137.0258029 --> 00:30:44,667.0268029
Mm-hmm.

254
00:30:44,667.0268029 --> 00:30:45,367.0248029
Mm-hmm.

255
00:30:45,367.0248029 --> 00:30:59,167.0248029
Skin changes can be huge, right? from sort of minor flare-ups of dermatitis to pretty bad dermatitis needing acute interventions like steroids.

256
00:30:59,697.0228029 --> 00:30:59,767.0218029
Mm-hmm.

257
00:30:59,817.0218029 --> 00:31:04,687.0288029
there's a phenomena called formication, which is really quite common.

258
00:31:05,47.0178029 --> 00:31:05,367.0198029
I know.

259
00:31:05,857.0158029 --> 00:31:07,307.0288029
Big word, sounds pretty scary.

260
00:31:07,577.0198029 --> 00:31:11,247.0218029
but it is the feeling of ants crawling under your skin.

261
00:31:11,937.0208029 --> 00:31:12,197.0238029
Oh, wow.

262
00:31:12,207.0248029 --> 00:31:14,797.0248029
Right? It is a sensory thing that happens- Yeah.

263
00:31:15,37.0298029 --> 00:31:16,807.0228029
that is actually quite common.

264
00:31:17,117.0318029 --> 00:31:24,757.0218029
myalgias, arthralgias, so joint pain, muscle aches and pains- Yeah are very common, and those start- Yeah early in the process.

265
00:31:24,757.0218029 --> 00:31:24,957.0248029
Mm-hmm.

266
00:31:25,387.0198029 --> 00:31:38,977.0278029
So often women in the late 30s, that's their first symptom, right? Of course, we can't get through this conversation without talking about the changes in body composition and weight regulation, right? Yeah.

267
00:31:38,997.0278029 --> 00:31:48,547.0268029
many women sort of are coming into this period of their life, certainly by the time they get to their 40s, saying, "I'm not doing anything different-" Right "and now I'm gaining weight."

268
00:31:48,807.0268029 --> 00:31:49,207.0268029
Yep.

269
00:31:49,497.0278029 --> 00:31:54,487.0268029
And as that progresses, now I'm gaining weight around my middle where I never did before.

270
00:31:54,487.0268029 --> 00:31:54,887.0268029
Mm-hmm.

271
00:31:54,887.0268029 --> 00:32:18,597.0278029
Right? And so, yeah, your body's response to the nutrients that you're taking in is different than it was before, right? And your body's response to physical activity is different than it was before, right? And so those are all things heavily impacted by estrogen that I think a, a good provider will talk to people about.

272
00:32:19,347.0258029 --> 00:32:19,497.0258029
Mm-hmm.

273
00:32:19,507.0258029 --> 00:32:26,217.0228029
Right? and talk to people about, here's your options, right? You can balance your lifestyle factors.

274
00:32:26,257.0238029 --> 00:32:28,797.0218029
You can change your nutrition.

275
00:32:28,807.0228029 --> 00:32:35,587.0258029
You can change your physical activity, right? You can think about these herbal supplements.

276
00:32:35,587.0258029 --> 00:32:53,773.6864695
You can think about hormone therapy, and I think the huge explosion we're seeing is because, some people were willing or there was a huge hue and cry about the fact that the data on hormone therapy had been completely misinterpreted.

277
00:32:54,293.6814695 --> 00:32:54,683.6854695
Mm-hmm.

278
00:32:54,833.6814695 --> 00:33:04,223.6844695
And we have deprived an entire generation of women from having a tool- Mm-hmm that actually seems to be incredibly beneficial.

279
00:33:05,313.6854695 --> 00:33:05,533.6854695
Yeah.

280
00:33:05,543.6814695 --> 00:33:27,543.6854695
So I think every woman should have a conversation about hormone therapy and what the impact of that might be, right? Because the decisions that you're making at 40 and 50 are impacting the life you're gonna be living at 80, 75, right? Yeah.

281
00:33:27,553.6844695 --> 00:33:27,733.6824695
Mm-hmm.

282
00:33:27,743.6864695 --> 00:33:34,553.6754695
And so you have to think about this in terms of what's your long term bet on yourself? Right.

283
00:33:34,843.6774695 --> 00:33:35,303.6774695
Yeah.

284
00:33:35,893.6804695 --> 00:33:44,253.6804695
Which when I think about the hormone therapy conversation right now, which you mentioned the term MHT, menopause hormone therapy.

285
00:33:44,443.6844695 --> 00:33:44,853.6764695
Mm-hmm.

286
00:33:44,853.6884695 --> 00:33:57,13.6864695
So it, I mean, it sounds like, yes, we've- we're getting a lot more specific about how we use them, and that maybe you need to use, a combination of things and not just one hormone.

287
00:33:57,813.6824695 --> 00:34:22,713.6854695
I'm seeing conversations about, hormone therapy not only being used for symptoms that people experience now, but also to head things off at the pass, like, osteoporosis, cardiovascular risk, dementia, et cetera, But I personally feel like I don't want to use an allopathic medicine preventively like that.

288
00:34:22,763.6854695 --> 00:34:23,993.6854695
You know what I, you know what I mean? Mm-hmm.

289
00:34:24,673.6854695 --> 00:34:25,853.6854695
Right yeah.

290
00:34:25,853.6854695 --> 00:34:27,323.6844695
And I think that's fair, right? Mm-hmm.

291
00:34:27,323.6854695 --> 00:34:53,337.6854695
I think having an honest conversation about what it might give you and when you might think about utilizing that, 'Cause if you're in your late 40s, and you're managing your symptoms in other ways, I'm not sure that we understand exactly Risk versus benefit profile in that situation Sure Right? Right.

292
00:34:53,367.6854695 --> 00:34:53,827.6854695
Yeah, absolutely.

293
00:34:53,837.6854695 --> 00:35:02,147.6844695
Um, I think that, there's some areas where the evidence is incredibly solid, right? Mm-hmm.

294
00:35:02,637.6844695 --> 00:35:16,857.6824695
hormone therapy, menopausal hormone therapy is in fact the most effective thing for osteopenia, osteoporosis with the least number of negative side effects.

295
00:35:16,857.6834695 --> 00:35:23,987.6824695
So, like, if that's a big thing for you, if you have a big family history- Right maybe that's a different conversation.

296
00:35:24,957.6834695 --> 00:35:27,377.6834695
It does seem to help with cardiac health.

297
00:35:27,387.6844695 --> 00:35:33,377.6864695
It does reduce, the incidence of several kinds of cancers.

298
00:35:33,907.6844695 --> 00:35:39,437.6844695
The dementia thing is still, that's out, that's still out being studied.

299
00:35:39,437.6844695 --> 00:35:42,547.6834695
I think nobody knows where that's gonna end up, right? Mm-hmm.

300
00:35:42,547.6834695 --> 00:35:42,677.6854695
Mm-hmm.

301
00:35:42,727.6854695 --> 00:36:07,367.6864695
I think if we think about any allopathic medicine, and I think menopausal hormone therapy falls into this space, right? It's not a magic bullet that cures everything, and you don't have to do anything else with it, right? You still have to exercise, engage cognitively, be part of a community.

302
00:36:07,397.6874695 --> 00:36:16,417.6864695
Like, you still have to do all the things that generate a healthy life, right? There's places where it's appropriate, and it's a conversation you should be having with your doctor.

303
00:36:16,717.6864695 --> 00:36:17,717.6814695
That's what your doctor's for.

304
00:36:18,607.6864695 --> 00:36:19,57.6864695
Right.

305
00:36:19,207.6844695 --> 00:36:19,517.6844695
Right.

306
00:36:19,517.6844695 --> 00:36:42,391.6864695
And I have a question of sort of like what is the age at which women should be asking this question or considering this kind of therapy? I certainly think that by the time you reach your mid to late 40s, you should start having this conversation and finding sources of information.

307
00:36:42,701.6864695 --> 00:36:50,771.6874695
and in my ideal world, your provider gives you- Right a reliable source of information, right? Mm-hmm.

308
00:36:50,821.6864695 --> 00:36:56,951.6874695
Again, the Menopause Society, the American College of OBGYN are some great sources.

309
00:36:56,961.6864695 --> 00:37:06,651.6874695
The Mayo Clinic, for instance, are all great public online sources that have great patient education- around these topics.

310
00:37:06,681.6884695 --> 00:37:06,701.6884695
Yeah.

311
00:37:06,701.6884695 --> 00:37:15,131.6854695
And so I think people should also go and read about it, but ask their providers for information.

312
00:37:16,181.6864695 --> 00:37:32,98.3531362
I think, I just really wanna make the point, right, relative to what you said, Like, as we go through living this life, I don't know how you find it, but, I find it, like this is all an experiment, you are experimenting.

313
00:37:32,558.3531362 --> 00:37:39,958.3541362
And so things might work for a while, and then not work for a while, right? Right.

314
00:37:39,958.3541362 --> 00:37:39,988.3511362
Mm-hmm.

315
00:37:39,998.3471362 --> 00:37:48,808.3491362
Or you might change your mind I think your body and how you live your life is an experiment and a choice you make all the time.

316
00:37:49,418.3481362 --> 00:37:49,898.3471362
Mm-hmm.

317
00:37:50,18.3471362 --> 00:37:59,85.0158029
Right? the current I just wanna come back to the question you said, when should they talk about this? Start talking about it no later than your late 40s.

318
00:37:59,635.0128029 --> 00:37:59,825.0128029
Mm-hmm.

319
00:37:59,835.0098029 --> 00:38:24,245.0108029
The current guide- formal guideline is that women should start by, if they're going to start hormone therapy, no later than the age of 60 or 10 years after menopause, right? And that is not a hard and fast rule, right? I have put some women on hormone therapy who benefited after that time.

320
00:38:24,765.0098029 --> 00:38:30,437.9641375
but- The risk-benefit ratio changes- Mm-hmm once you get that far out.

321
00:38:30,817.9641375 --> 00:38:31,377.9641375
Mm-hmm.

322
00:38:31,511.2974708 --> 00:38:36,429.2974708
not in your favor? Right, not necessarily in the patient's favor.

323
00:38:36,439.2974708 --> 00:38:36,479.2974708
Right.

324
00:38:36,479.2974708 --> 00:38:41,49.2974708
Depends a lot on, like, your own health background, your family health background.

325
00:38:41,459.2964708 --> 00:38:46,749.2974708
Like, there's a number of- Yeah variables in there about- Sure how the risk goes up in that circumstance.

326
00:38:46,749.2974708 --> 00:38:47,789.2974708
Right, right.

327
00:38:47,899.2974708 --> 00:38:49,109.2964708
Right? Yeah.

328
00:38:49,339.2984708 --> 00:39:11,919.2934708
Which, and I just had this conversation, we got an episode that'll come out two weeks after this one about GLP-1s, w- which, what I walked away with was really, that when you have a family history of, diabetes or some sort of metabolic dysfunction, then that puts you in that group for which that medication could be incredibly beneficial.

329
00:39:12,239.2934708 --> 00:39:16,559.2984708
And it r- kind of makes me think about how you have your one third, one third, one third.

330
00:39:16,619.2974708 --> 00:39:27,969.2964708
that you have this one third of women, like, over, all of your decades of practice with hundreds of thousands of people that I get pretty basically you've got a third of the women who are, like, really suffering.

331
00:39:27,979.2984708 --> 00:39:34,959.3014708
And so, yes, that's, that puts you in that group, right, for which this therapy would be incredibly beneficial.

332
00:39:35,409.2944708 --> 00:39:50,499.2994708
So the question of family history, and that's very Ayurvedic, right? It's your prakriti, the nature of your body- Right is, I think an important thing to take into account when we think about using allopathic medicines- Yes including hormone therapy.

333
00:39:50,759.2984708 --> 00:39:51,89.2984708
Yeah.

334
00:39:51,359.2974708 --> 00:40:05,249.3004708
I think so, too, and I think an interesting thing that's happening in medicine that sort of segues right into that is that, we are getting closer and closer to, precision medicine being the norm.

335
00:40:05,729.2984708 --> 00:40:20,249.2994708
And so with precision medicine in its fully developed state, right, the, your provider would know your entire chromosomal arrangement, right? Oh, wow.

336
00:40:20,259.3044708 --> 00:40:35,579.2944708
And that would be able to tell your provider what your propensity for disease was, what kind of foods you would ideally be eating, like a whole bunch of things that really, to me, map also to your prakriti, right? Mm-hmm.

337
00:40:35,589.2984708 --> 00:41:02,889.2914708
This is your inherent, constitution that you are working with, right? So I think that Ayurveda wonderfully provides, like, a simplified way of thinking about this, right? I am quite sure that women who are predominantly vata, predominantly pitta, predominantly kapha coming into menopause are experiencing quite different things.

338
00:41:03,449.2784708 --> 00:41:03,769.2784708
Yes.

339
00:41:03,879.2864708 --> 00:41:05,9.2784708
Right? Mm-hmm.

340
00:41:05,169.2794708 --> 00:41:05,889.2794708
Absolutely.

341
00:41:05,979.2924708 --> 00:41:17,85.2884708
Yeah, and I like how you sa- suggest that the Ayurvedic framework actually is simplified because the way that we're talking about hormones right now is not very simple it's...

342
00:41:17,105.2884708 --> 00:41:26,675.2884708
And I think it's confusing the hell out of a lot of women, and so then you go into the doctor's office hoping to understand things better, and it's, ju- just makes things worse.

343
00:41:27,785.2884708 --> 00:41:35,145.2884708
It does, right? I think the other thing, I don't know, this is my social commentary on everything that's going on, right? Yeah.

344
00:41:35,145.2894708 --> 00:41:57,585.2904708
We've kind of taken Barbie mythology and made it menopausal Barbie mythology now, right? And GLP-1s are compounding that, and I don't know if you've heard, there's a whole, like, movement out there about using GLP-1s and menopausal hormone therapy together to get, like, bigger bang for your buck.

345
00:41:57,845.2904708 --> 00:41:57,915.2874708
Mm-hmm.

346
00:41:57,975.2884708 --> 00:42:19,925.2884708
right? And I, again, what I would ask women to think about is, like, who do you wanna be when you're 80, right? Talk to your future self and have your future self say, "Hey, I wish I'd done X, Y, and Z," and I'm pretty sure it doesn't involve being Barbie- Yeah when you're 55, right? Yeah.

347
00:42:21,285.2894708 --> 00:42:21,605.2894708
Yeah.

348
00:42:22,895.2854708 --> 00:42:28,225.2814708
I'm gonna guess that in this semi-retired place, you're talking to your 80-year-old self a lot.

349
00:42:29,85.2794708 --> 00:42:29,705.2854708
I do.

350
00:42:29,815.2834708 --> 00:42:29,835.2834708
Yeah.

351
00:42:29,845.2824708 --> 00:42:33,195.2854708
But I've been doing it probably for a decade anyway, but- Yeah.

352
00:42:33,205.2824708 --> 00:42:33,895.2844708
Right? Yeah.

353
00:42:34,115.2784708 --> 00:43:02,149.9491375
What's your, vision? You know, my 80-year-old self is telling me that, she is healthy, active, traveling, hiking, biking, going on adventures, still having great conversations with people, laughing a lot, because of the things she started doing when she was in her 30s, 40s, and 50s.

354
00:43:02,149.9491375 --> 00:43:02,849.9491375
Mm-hmm.

355
00:43:03,359.9491375 --> 00:43:31,419.9481375
and it again comes back to the things that I love about Ayurveda, right? It gives you, in its simplest form, a roadmap, right? Respect who you are, be active, eat healthy, engage with your community- Mm-hmm believe in your own spiritual self, right? So yeah.

356
00:43:31,419.9481375 --> 00:43:31,519.9481375
Yeah.

357
00:43:31,799.9491375 --> 00:43:34,429.9481375
My 80-year-old woman keeps encouraging me.

358
00:43:35,9.9501375 --> 00:43:35,569.9501375
Right.

359
00:43:35,719.9491375 --> 00:43:36,239.9491375
Right.

360
00:43:36,579.9491375 --> 00:43:38,179.9491375
So I mean, everything you...

361
00:43:38,329.9491375 --> 00:43:41,749.9481375
your list there is so...

362
00:43:41,759.9491375 --> 00:43:58,299.9481375
It's so common sense and also so all-encompassing, right? Like m- respect who you are, like your individual-ness, right? Which I think social- Mm-hmm media's problematic there- Yes 'cause we end up all thinking, we're supposed to be feeling this, thinking that.

363
00:43:59,339.9511375 --> 00:44:06,19.9521375
Being active, being engaged in your community, and being connected to your spiritual self.

364
00:44:06,59.9491375 --> 00:44:07,189.9521375
I mean, that's pretty much it.

365
00:44:07,329.9531375 --> 00:44:07,539.9531375
It's...

366
00:44:07,559.9491375 --> 00:44:08,19.9481375
That is...

367
00:44:08,49.9541375 --> 00:44:11,199.9481375
Yeah, that is pretty much it, right? Mm-hmm.

368
00:44:11,199.9481375 --> 00:44:21,59.9541375
And the thing that, I feel like we go into our doctor, the, the tools in the toolbox there are not about, all of those things.

369
00:44:21,59.9541375 --> 00:44:22,819.9581375
You can definitely be active.

370
00:44:22,869.9571375 --> 00:44:27,459.9511375
You can definitely respect the individual, constitution of the client or the patient.

371
00:44:28,169.9521375 --> 00:44:42,39.9611375
but I feel like is that part of the problem, that the tools that are available to a allopathic, physician as far as women's health goes are limited at this time? I think that is an essential truth.

372
00:44:42,859.9631375 --> 00:44:55,719.9591375
and I think that, we have to go back to, how allopathic physicians are trained even today, right? They get very little training in nutrition.

373
00:44:56,99.9591375 --> 00:44:56,449.9591375
Yeah.

374
00:44:56,859.9621375 --> 00:45:07,939.9511375
Very little training in alternative therapies, very little training in, exercise physiology or movement, right? Unless they go into a specific field.

375
00:45:08,479.9491375 --> 00:45:22,729.9591375
and so those things that are most essential for living a healthy life are things that most allopathic physicians are not knowledgeable about about unless they choose to educate themselves.

376
00:45:22,819.9471375 --> 00:45:23,709.9581375
And many do.

377
00:45:23,759.9501375 --> 00:45:26,539.9531375
I'm not gonna throw the whole system under the bus.

378
00:45:26,739.9481375 --> 00:45:27,359.9431375
many do.

379
00:45:27,949.9551375 --> 00:45:51,47.9501375
But, Thinking about physical activity, your doctor might hand you a sheet of exercises, And that is not gonna be the same as going out and exploring, like, what your body, A, wants to do or- what, sometimes it's just walking, right? Mm-hmm.

380
00:45:51,47.9501375 --> 00:45:58,487.9501375
we're advancing the idea on social media that everybody needs to do X, Y, and Z, right? yes.

381
00:45:58,797.9501375 --> 00:46:01,417.9501375
Everybody's gotta strength train three days a week.

382
00:46:01,417.9511375 --> 00:46:05,667.9491375
Everybody's gotta do, like, this amount of aerobic activity.

383
00:46:05,707.9501375 --> 00:46:11,931.2834708
Like, everybody's gotta eat this super high protein diet, which is again a really controversial issue.

384
00:46:12,331.2834708 --> 00:46:36,241.2844708
right? I would caution people on using social media to find their knowledge on this, and I would urge people to go to women they know who are active, trainers in their community, their local Y, right? their local yoga studio if they wanna give that a try, right? I think you should think about physical activity as a form of play.

385
00:46:37,111.2824708 --> 00:46:42,801.2824708
Right? A way of engaging with yourself that should be, for the most part, kind of fun.

386
00:46:43,281.2804708 --> 00:46:43,721.2804708
Yeah.

387
00:46:44,81.2834708 --> 00:46:47,371.2814708
Right? 'Cause you're never gonna do it if you don't like it.

388
00:46:47,931.2814708 --> 00:46:48,151.2814708
Yes.

389
00:46:48,161.2774708 --> 00:46:55,591.2774708
Right? And i- and in the end, right, truth is the most important thing is to move.

390
00:46:57,685.2824708 --> 00:46:59,105.2824708
Right? And any movement counts.

391
00:47:00,205.2824708 --> 00:47:00,845.2824708
Yeah.

392
00:47:01,135.2824708 --> 00:47:02,205.2824708
Right? There you go.

393
00:47:02,865.2824708 --> 00:47:04,165.2824708
Yep, any movement counts.

394
00:47:04,335.2824708 --> 00:47:04,595.2824708
you're...

395
00:47:04,625.2824708 --> 00:47:09,195.2824708
Yes, you're the second person to say that, t- on this podcast i- in this season.

396
00:47:09,805.2834708 --> 00:47:16,705.2844708
it's just move in ways that are interesting, and different, and diverse, and often, right? Just like- Yeah keep moving.

397
00:47:16,875.2844708 --> 00:47:17,155.2844708
yeah.

398
00:47:17,185.2844708 --> 00:47:17,875.2844708
Try new things.

399
00:47:18,195.2844708 --> 00:47:18,585.2844708
Right.

400
00:47:18,675.2844708 --> 00:47:20,385.2844708
Take a dance class, right? yes.

401
00:47:20,555.2844708 --> 00:47:20,805.2844708
Yeah.

402
00:47:20,805.2844708 --> 00:47:21,545.2844708
Make it social.

403
00:47:21,635.2834708 --> 00:47:22,305.2854708
Do it with friends.

404
00:47:22,785.2854708 --> 00:47:23,205.2854708
Right.

405
00:47:23,235.2844708 --> 00:47:24,845.2854708
Zumba, get some Zumba going on.

406
00:47:26,225.2844708 --> 00:47:26,875.2844708
There you go.

407
00:47:27,115.2834708 --> 00:47:27,245.2834708
Zumba.

408
00:47:28,35.2854708 --> 00:47:30,695.2844708
So many people I've, like, been like, "Hey, just go to a Zumba class."

409
00:47:30,753.2854708 --> 00:47:33,315.2844708
They're like, "Really?" And they do it, and they just have the best time.

410
00:47:33,665.2824708 --> 00:47:34,935.2834708
They're like- Yeah "That was hilarious.

411
00:47:34,985.2834708 --> 00:47:36,285.2844708
Everyone there was awesome."

412
00:47:36,295.2834708 --> 00:47:36,635.2834708
Yeah.

413
00:47:37,185.2834708 --> 00:47:44,475.2864708
Yeah, right? I think the other thing that is so very important for people to know is it's never too late to start.

414
00:47:45,55.2864708 --> 00:47:45,295.2864708
Yeah.

415
00:47:45,395.2834708 --> 00:47:59,941.9491375
I think there are good studies now showing that people in their 80s who go from being completely sedentary to walking 10 minutes a day, get tremendous benefit and gain from that, right? Yeah.

416
00:47:59,951.9501375 --> 00:48:05,391.9481375
So wherever you are, just start wherever you are, and move.

417
00:48:05,901.9541375 --> 00:48:06,491.9541375
Yes.

418
00:48:06,701.9501375 --> 00:48:07,31.9501375
yeah.

419
00:48:07,251.9451375 --> 00:48:07,741.9451375
Super.

420
00:48:09,201.9501375 --> 00:48:16,161.9471375
One more sort of line of questioning I have for you, Elizabeth, is about, it's about finances.

421
00:48:16,221.9491375 --> 00:48:34,501.9501375
I think a lot of women are probably concerned with, what will my insurance cover, Does it cover, HRT? does it cover physical therapy, And I think that's part of the, potentially the navigation with a, with the primary care provider as well, is, trying to get help that you can afford.

422
00:48:34,511.9471375 --> 00:48:51,775.9481375
Y- So how do we talk about that, and like what is the reality right now of, like, insurance coverage and the kind of symptoms that we're talking about today? Hormone therapy up until about, what, five years ago, four years ago wasn't covered at all.

423
00:48:52,195.9481375 --> 00:48:52,385.9481375
Right.

424
00:48:52,385.9481375 --> 00:49:07,395.9481375
And was a tremendously expensive venture, so that was part of what was making it so that most women simply couldn't afford it, right? To the tune of, like 3 or $400 a month for- Wow.

425
00:49:07,415.9481375 --> 00:49:08,775.9481375
Yeah those kind of prescriptions.

426
00:49:09,185.9481375 --> 00:49:09,265.9481375
Yeah.

427
00:49:09,325.9481375 --> 00:49:11,375.9481375
that has changed a lot.

428
00:49:12,45.9491375 --> 00:49:18,385.9491375
but I would say it is very insurance dependent, right? Mm-hmm.

429
00:49:18,625.9491375 --> 00:49:25,615.9501375
So- Okay I would say most insurances are covering basic hormone therapy.

430
00:49:26,105.9481375 --> 00:49:31,115.9491375
your doctor will have to use specific diagnoses in order to- Right get those covered.

431
00:49:31,535.9491375 --> 00:49:31,655.9491375
Mm-hmm.

432
00:49:31,725.9481375 --> 00:49:41,425.9511375
and, generic patches for estrogen, generic patches are good, and that's what I mostly recommend and give to my patients, right? And those should be very cheap.

433
00:49:41,905.9491375 --> 00:49:49,535.9581375
You can also, get coupons for those from GoodRx- Mm-hmm and, Mark Cuban Pharmacy.

434
00:49:50,145.9581375 --> 00:49:54,855.9551375
you can get those very cheaply if your insurance is expensive and you want to work with those.

435
00:49:55,645.9561375 --> 00:50:05,675.9541375
Testosterone therapy, which I think is a lower percentage of women who are taking that, but is, the coverage there is more variable, right? Mm-hmm.

436
00:50:05,675.9541375 --> 00:50:22,245.9591375
And that is often more expensive, and again, a place where, going for something like Mark Cuban, if you don't know that, that is, Mark Cuban is this billionaire guy who created a pharmacy, that- Never heard of it sells drugs, At much cheaper prices than you can get at mo- most pharmacies with your insurance.

437
00:50:22,245.9591375 --> 00:50:22,275.9561375
Okay.

438
00:50:23,195.9531375 --> 00:50:24,695.9491375
yeah, it's a whole thing out there.

439
00:50:25,45.9511375 --> 00:50:25,385.9511375
Yeah.

440
00:50:25,425.9561375 --> 00:50:28,345.9551375
You need a prescription- though for most of those- You still need a prescription HRT.

441
00:50:28,375.9561375 --> 00:50:28,795.9561375
Yeah.

442
00:50:28,795.9561375 --> 00:50:28,975.9541375
Yeah.

443
00:50:28,975.9541375 --> 00:50:29,375.9541375
Yes.

444
00:50:29,425.9591375 --> 00:50:31,975.9561375
You still need a prescription for those things, right? Yeah.

445
00:50:32,495.9541375 --> 00:50:41,25.9521375
so I would say in terms of physical therapy- Mm-hmm I think the world is not very good about covering physical therapy.

446
00:50:41,445.9511375 --> 00:50:41,645.9531375
Mm-hmm.

447
00:50:41,655.9501375 --> 00:50:57,555.9531375
Right? In my mind, everybody would be allowed to go for physical therapy assessment every year just the same way that they go to a primary care doctor and then have a session quarterly to just make sure that they're maintaining their tuneup, right? Yeah.

448
00:50:57,615.9461375 --> 00:51:10,805.9481375
physical therapists are fighting to get that kind of coverage, right? But to my knowledge, that hasn't happened, although most of my knowledge is really in New York State, which tends to be a more progressive state.

449
00:51:11,305.9481375 --> 00:51:11,325.9431375
Mm-hmm.

450
00:51:11,335.9471375 --> 00:51:24,765.9391375
So I think physical therapy is out of range for the majority of people because, the co-pays for it are often incredibly high, like 85 bucks- Yeah a visit or something, right? Yeah.

451
00:51:24,995.9381375 --> 00:51:25,305.9381375
Yeah.

452
00:51:25,705.9301375 --> 00:51:39,443.9371375
A good physical trainer- Is a place to go and often- Yeah even doing, like, just, I don't know, two to five sessions with a good physical trainer is a really helpful thing to do.

453
00:51:39,883.9361375 --> 00:51:40,183.9361375
Yes.

454
00:51:40,193.9371375 --> 00:51:44,463.9371375
Right? To get you started with a plan, and then maybe you check in with them once a quarter.

455
00:51:44,473.9371375 --> 00:51:44,493.9371375
Yeah.

456
00:51:44,913.9371375 --> 00:51:53,663.9371375
And again, ask your friends, go to your Y or your local gym, are all good places to find good physical trainers.

457
00:51:54,73.9371375 --> 00:51:54,993.9371375
Yes.

458
00:51:55,53.9361375 --> 00:51:55,113.9351375
Right? Yeah.

459
00:51:55,113.9361375 --> 00:52:01,763.9351375
Somebody who can actually watch you move, talk to you about what you like to do, and make some good concrete recommendations.

460
00:52:01,993.9371375 --> 00:52:02,743.9371375
Absolutely.

461
00:52:02,883.9361375 --> 00:52:03,633.9361375
Absolutely.

462
00:52:03,693.9381375 --> 00:52:05,483.9361375
Yep, you're so right about that.

463
00:52:06,393.9351375 --> 00:52:16,273.9331375
What I love about this conversation, Elizabeth, is how you're, like, encouraging us to all, to really, like, take the reins here, And it...

464
00:52:16,273.9331375 --> 00:52:42,153.9331375
a- and I think sometimes we have an expectation of Western medicine that, it's the, the be-all, end-all, like, answer, But you're actually- Mm-hmm talking about a lot of the lifestyle components a- as well, and how we can approach, like, something like staying active as we age, and as our bodies change, I've also heard you t- I've heard you say change is inevitable, right? All these different...

465
00:52:42,163.9321375 --> 00:52:45,763.9401375
Your skin, your belly, your joints.

466
00:52:45,763.9401375 --> 00:52:49,63.9351375
Like, everything's changing, It's also, it's an aging process.

467
00:52:49,63.9391375 --> 00:52:54,603.9331375
I think the decline of estrogen is a part of how, what bodies do, fa- female bodies do as they get older.

468
00:52:55,513.9361375 --> 00:53:07,403.9341375
And you're suggesting there's no, like, magic bullet for that, but experimentation and, and, like, curiosity is actually the key.

469
00:53:08,73.9331375 --> 00:53:12,833.9361375
I love that word curiosity, right? I think that is the way to go, right? Yeah.

470
00:53:12,833.9361375 --> 00:53:20,693.9321375
I mean, I wake up every morning and I check in with my body, my mind, my spirit, and see where I'm at.

471
00:53:20,873.9361375 --> 00:53:30,233.9301375
But, Yeah, you can take the changes of aging in a negative way that can take you down.

472
00:53:31,233.9291375 --> 00:53:31,653.9301375
I know.

473
00:53:31,653.9301375 --> 00:53:32,313.9301375
Right? Yeah.

474
00:53:32,393.9301375 --> 00:53:37,683.9291375
Or you can sort of take them as part of your adventure.

475
00:53:38,183.9301375 --> 00:53:38,603.9291375
Mm-hmm.

476
00:53:39,273.9301375 --> 00:53:39,463.9301375
Yeah.

477
00:53:39,473.9291375 --> 00:53:52,973.9331375
Right? and say, "Well, okay, my, like, right foot hurts today," right? So what does that mean that I'm gonna, like, work with today? Like, what's that energy? Mm-hmm.

478
00:53:53,33.9331375 --> 00:54:03,863.9341375
I think there's ways to work with it and play with it instead of, like, working against it and trying to rail against the inevitable.

479
00:54:04,173.9331375 --> 00:54:04,853.9331375
Yes.

480
00:54:04,903.9321375 --> 00:54:05,173.9321375
Yeah.

481
00:54:05,183.9311375 --> 00:54:06,303.9331375
Right? Yeah.

482
00:54:06,413.9311375 --> 00:54:06,773.9311375
Yeah.

483
00:54:06,783.9331375 --> 00:54:08,753.9341375
Seeing it as part of the adventure is a...

484
00:54:08,783.9331375 --> 00:54:09,123.9331375
Yeah.

485
00:54:09,763.9331375 --> 00:54:09,853.9331375
Yeah.

486
00:54:09,933.9311375 --> 00:54:10,303.9311375
Yeah.

487
00:54:10,613.9311375 --> 00:54:31,513.9341375
Which, for listeners- I mean, the the analogy I would make is, I was incredibly, fortunate this morning to go for a sunrise walk, to watch the sun rise over Lake Ontario, right? And one of the things that so struck me about it as I watched this really spectacular sunrise was that every...

488
00:54:31,833.9361375 --> 00:54:47,843.9331375
It's a moment in the day when you can really see, like, things are really changing, like, every moment, right? Your life and your body is exactly that way, and you may not always be aware of it, but it is always happening.

489
00:54:47,863.9341375 --> 00:54:51,593.9321375
So you can't stop that.

490
00:54:51,853.9331375 --> 00:54:52,473.9301375
Work with it.

491
00:54:52,473.9301375 --> 00:54:53,203.9321375
Right.

492
00:54:53,203.9321375 --> 00:54:53,583.9321375
Right.

493
00:54:54,33.9331375 --> 00:54:55,513.9291375
See the beauty in it.

494
00:54:55,513.9291375 --> 00:54:55,983.9291375
Yeah.

495
00:54:56,403.9291375 --> 00:54:57,223.9281375
Thank you for that.

496
00:54:57,313.9331375 --> 00:55:04,333.9281375
We can think about that the next time we see a change in nature, you know- Yeah sunrise, sunset, et cetera.

497
00:55:04,813.9281375 --> 00:55:14,83.9281375
the adventure, just to share with listeners, when I reached out to you about, can we make this podcast about, talking to your doctor, you were like, "Yeah, sure.

498
00:55:14,83.9281375 --> 00:55:18,123.9261375
In, like a month, because I'm sitting by a lake reading a book about fairies."

499
00:55:18,623.9221375 --> 00:55:20,253.9241375
"And, like, I won't be available for..."

500
00:55:20,253.9261375 --> 00:55:21,963.9211375
I was like, "Right on."

501
00:55:22,523.9261375 --> 00:55:25,693.9331375
that's what we want, is to have...

502
00:55:25,743.9371375 --> 00:55:27,13.9431375
and you're always camping.

503
00:55:27,163.9291375 --> 00:55:28,763.9211375
you'll disappear for a while.

504
00:55:28,763.9321375 --> 00:55:33,13.9291375
I was camping, hiking, doing all these, like, cool, adventuresome things, And I...

505
00:55:33,43.9281375 --> 00:55:39,333.9301375
That's inspiring, and I think, yes, we wanna maintain that excitement, about life and, kind of do it.

506
00:55:39,383.9301375 --> 00:55:41,183.9281375
you're a great role model, I would say.

507
00:55:42,733.9271375 --> 00:55:43,373.9271375
Yeah.

508
00:55:43,473.9181375 --> 00:55:49,83.9271375
So, so speaking of role model though, can we ask you some, some rapid fire questions? Yes.

509
00:55:49,173.9301375 --> 00:55:49,853.9301375
Yeah.

510
00:55:49,863.9171375 --> 00:55:50,723.9261375
So I...

511
00:55:50,753.9321375 --> 00:55:58,133.9281375
Well, you may have already answered this, but first thing you do when you get up? I, I get up, I make my bed.

512
00:55:59,33.9281375 --> 00:56:08,663.9281375
I do some stretches on my way to the bathroom, and do my oral and facial care routines.

513
00:56:09,213.9281375 --> 00:56:09,633.9281375
Yeah.

514
00:56:09,633.9281375 --> 00:56:10,323.9271375
Yeah.

515
00:56:10,323.9271375 --> 00:56:10,663.9271375
Yeah.

516
00:56:10,673.9281375 --> 00:56:11,183.9281375
Nice.

517
00:56:11,353.9281375 --> 00:56:14,263.9261375
Yeah, you make the bed, do some stretching, do the oral care.

518
00:56:14,743.9271375 --> 00:56:23,83.9271375
How about, uh, what's your first food or drink? I usually start my day with a drink we make called Jamba.

519
00:56:23,93.9281375 --> 00:56:24,393.9271375
We call it Jamba Juice.

520
00:56:25,93.9271375 --> 00:56:28,523.9251375
it is a tonic that I made.

521
00:56:28,523.9251375 --> 00:56:34,643.9261375
I have a sister who, started a cancer journey last year.

522
00:56:35,23.9251375 --> 00:56:35,133.9261375
Mm-hmm.

523
00:56:35,143.9241375 --> 00:56:53,13.9231375
And, so we made up this tonic, an anti-inflammatory tonic, and it is, you take whole lemons and ginger and turmeric and star anise and cayenne, and you simmer that in a pot, and then you blend it all up together.

524
00:56:53,223.9221375 --> 00:56:58,243.9231375
And then I put it in hot water and drink that first thing in the morning.

525
00:56:58,683.9211375 --> 00:56:59,193.9211375
Wow.

526
00:56:59,203.9261375 --> 00:57:01,293.9241375
So the whole lemon, so the skin and everything.

527
00:57:01,293.9241375 --> 00:57:01,503.9211375
Yeah.

528
00:57:01,503.9211375 --> 00:57:02,233.9211375
Yeah.

529
00:57:02,233.9241375 --> 00:57:12,193.9221375
Apparently, we started out doing it, like fishing out the lemons, but apparently there's, like, a whole bunch of beneficial things in the skins and pith of lemons.

530
00:57:12,493.9191375 --> 00:57:12,843.9191375
Yeah.

531
00:57:12,853.9191375 --> 00:57:14,663.9221375
So we just throw the whole thing in there.

532
00:57:16,589.9241375 --> 00:57:17,129.9241375
Fabulous.

533
00:57:17,149.9241375 --> 00:57:19,239.9241375
Wow, that's a wild and crazy beverage.

534
00:57:20,419.9241375 --> 00:57:21,19.9241375
That's good.

535
00:57:21,29.9241375 --> 00:57:21,59.9241375
Right.

536
00:57:21,69.9241375 --> 00:57:22,219.9241375
That'll get things moving.

537
00:57:22,899.9241375 --> 00:57:23,839.9241375
That'll wake you right up.

538
00:57:23,969.9231375 --> 00:57:24,329.9231375
yeah.

539
00:57:24,829.9241375 --> 00:57:33,309.9241375
Okay, and someone who's worked, as intently as you have for so long, I would, I really wanna know what your wind down is in the evening.

540
00:57:34,709.9241375 --> 00:57:37,489.9251375
I would say that is, like, the...

541
00:57:38,429.9241375 --> 00:57:41,689.9241375
It is my current work in progress.

542
00:57:42,89.9241375 --> 00:57:42,369.9251375
Mm-hmm.

543
00:57:42,439.9251375 --> 00:57:45,789.9241375
I really am working on reading.

544
00:57:47,69.9241375 --> 00:57:59,559.9241375
So I do, again, a whole, like, oral facial routine to begin and end my day, right? And that includes, the facial part of that includes, like, a marma point massage and massaging my ears.

545
00:57:59,889.9231375 --> 00:58:01,929.9201375
and then I read.

546
00:58:02,249.9231375 --> 00:58:03,39.9231375
I try to read.

547
00:58:03,519.9231375 --> 00:58:06,509.9241375
and I try very hard to stay off of screen.

548
00:58:06,929.9231375 --> 00:58:07,129.9221375
Mm-hmm.

549
00:58:07,219.9231375 --> 00:58:12,379.9211375
because in my work life it was impossible to ever get away from screens, so.

550
00:58:12,399.9231375 --> 00:58:12,659.9231375
Yeah.

551
00:58:13,9.9201375 --> 00:58:15,209.9201375
and then I go to sleep.

552
00:58:16,299.9211375 --> 00:58:19,819.9191375
Are you reading, like, fun books or smart books? Fun books.

553
00:58:19,819.9251375 --> 00:58:21,169.9251375
I don't try to read smart books at night.

554
00:58:21,209.9201375 --> 00:58:21,479.9201375
yeah.

555
00:58:21,879.9261375 --> 00:58:22,589.9221375
Right? Fun books.

556
00:58:22,629.9261375 --> 00:58:22,809.9261375
nice.

557
00:58:22,809.9261375 --> 00:58:23,909.9251375
Fun books.

558
00:58:23,909.9251375 --> 00:58:25,159.9221375
Books about fairies and such.

559
00:58:26,619.9231375 --> 00:58:27,659.9251375
Exactly so.

560
00:58:29,149.9221375 --> 00:58:29,759.9221375
Great.

561
00:58:30,109.9211375 --> 00:58:30,289.9211375
Yeah.

562
00:58:30,299.9211375 --> 00:58:30,399.9211375
Exactly so.

563
00:58:30,399.9211375 --> 00:58:36,919.9251375
What's your current read? I am reading a book, uh, called...

564
00:58:37,569.9241375 --> 00:58:39,949.9251375
Oh, gosh, I'd have to go look at it, but.

565
00:58:39,999.9251375 --> 00:59:04,449.9231375
it's a third book in a very long series, that is based on, East Indian culture, and it's talking about a magical city and society of djinns- who, cross over into the mortal world and back, and all the things that happen, the intrigue and- Oh, that sounds cool and so on.

566
00:59:04,449.9231375 --> 00:59:04,489.9231375
The...

567
00:59:05,309.9221375 --> 00:59:05,549.9221375
Yeah.

568
00:59:05,549.9221375 --> 00:59:06,319.9231375
That sounds cool.

569
00:59:06,319.9231375 --> 00:59:06,609.9221375
All right.

570
00:59:06,609.9231375 --> 00:59:09,219.9231375
You have to tell us the title, and we'll put it in the show notes.

571
00:59:09,509.9241375 --> 00:59:10,119.9241375
I will.

572
00:59:10,289.9241375 --> 00:59:10,729.9241375
Yeah.

573
00:59:10,839.9231375 --> 00:59:14,959.9241375
I can't tell you how many times a guest, I've asked them what they're reading, and they can't remember.

574
00:59:15,59.9241375 --> 00:59:27,899.9191375
So we'll also put the resources that you mentioned, for sort of like boning up and, educating ourselves and potentially getting that little list of talking points ready before we go see our doctor.

575
00:59:27,969.9201375 --> 00:59:28,319.9201375
Yeah.

576
00:59:28,329.9201375 --> 00:59:31,129.9191375
So Menopause Society came up a number of times, Mayo Clinic.

577
00:59:31,669.9201375 --> 00:59:31,859.9191375
we'll...

578
00:59:31,879.9181375 --> 00:59:36,649.9191375
All of that'll be in the show notes for the, those of you who are listening if you want to link right there.

579
00:59:36,649.9191375 --> 00:59:45,209.9201375
And I s- appreciate so much just your c- your, like, personable and candid share, and your decades of, clinical experience.

580
00:59:45,219.9231375 --> 00:59:47,179.9211375
It's l- lucky for...

581
00:59:47,189.9241375 --> 00:59:52,59.9261375
You're like our friend that we get to talk to and ask questions of, so thank you for being available for that today.

582
00:59:52,69.9211375 --> 00:59:52,249.9211375
Yeah.

583
00:59:52,249.9211375 --> 00:59:54,879.9251375
And I am happy to hear people's questions.

584
00:59:54,999.9221375 --> 01:00:07,19.9201375
You can, give people my contact information, and who knows? Maybe I'll pop back up on Substack when I finish taking my pause, and, we will see what happens there.

585
01:00:07,279.9191375 --> 01:00:09,129.9211375
I also wanna say thank you.

586
01:00:09,659.9241375 --> 01:00:25,369.9241375
Right? I appreciate all your decades of clinical experience and how much I learn from you, right? I am a better physician and a better person, because of all the things that I learned from you over the years, so thanks.

587
01:00:25,509.9241375 --> 01:00:26,169.9201375
Thank you.

588
01:00:26,509.9241375 --> 01:00:32,719.9221375
So we will put your contact info, along with the cool book you're reading and the resources in the show notes.

589
01:00:32,749.9251375 --> 01:00:38,269.9191375
And yeah, like me, you wanna hear what people are asking, right? So that you can- I know so that you can speak to it.

590
01:00:38,529.9241375 --> 01:00:41,879.9261375
So thank you so much for being our expert today.

591
01:00:42,819.9171375 --> 01:00:43,779.9211375
Have a beautiful day.

592
01:00:44,159.9291375 --> 01:00:44,829.9261375
You too.

593
01:00:45,648.685946 --> 01:00:46,868.685946
One more thing before you go.

594
01:00:47,598.685946 --> 01:00:56,418.685946
If you've ever dreamed of studying Ayurveda at the source, join me in India next February for a 10-day culinary and nutrition immersion 2027.

595
01:00:56,868.685946 --> 01:01:03,498.685946
We'll cook, we'll study, and we'll explore Mysore together, and you'll come home with the confidence to make food medicine.

596
01:01:04,468.684946 --> 01:01:07,648.684946
Learn more and enroll at ayurvedicliving.institute.

597
01:01:07,688.685946 --> 01:01:09,348.684946
I would love to have you with us.