PERI and POST Menopause Testing and Therapy Choices with Dr. Jill Carnahan

Betty Rocker (00:18):

What’s up, rock stars Coach Betty Rocker right here. Hey, thanks a lot for becoming a member of me. My visitor at present is Dr. Jill Carnahan, a frequent visitor on this present. You will have heard her earlier than. She is dually board licensed in household drugs, a practitioner of built-in holistic drugs, and can be a practical drugs professional. She’s the writer of Surprising, a really inspiring learn, and he or she’s additionally the topic of a documentary referred to as Physician Affected person. She’s received a wonderful podcast and a extremely, actually useful weblog, simply full of nice free content material you possibly can entry anytime and is a survivor of breast most cancers, Crohn’s illness and poisonous mould sickness. She brings a novel perspective to treating sufferers within the midst of complicated and continual sickness. She’s the medical director on the Flatiron Useful Medication Heart simply exterior of Boulder, Colorado. And my very own private physician and I all the time really feel actually fortunate to get to work along with her and likewise to have the ability to share her with you guys as a result of she actually helps make sense out of so many complicated well being associated topics which might be related to us all. Please be part of me in welcoming her to the present. Nice to see you, Dr. Jill. Thanks a lot for becoming a member of me at present.

Dr. Jill Carnahan (01:31):

You’re welcome. So good to be with you once more.

Betty Rocker (01:34):

Sure, it’s all the time nice to get to test in and, and have a dialog. And one factor I really feel like has been on my thoughts and on the minds of most of the girls I serve, um, is that this dialog about menopause, perimenopause and submit menopause. Proper? The all-encompassing menopause umbrella, . And it’s nice to see menopause having its day. I really feel like lastly we’re listening to extra about it. There’s much more analysis than there was once. And after I suppose again to our conversations possibly early on in my very own perimenopause journey, I take into consideration how a lot nervousness I had about listening to about issues like bioidentical hormones or hormone substitute remedy and the way that dialog type of developed and the way far more we all know today. Why, why are individuals nonetheless, I really feel like there’s nonetheless plenty of concern round hormone substitute remedy, although. I imply, simply to get us into it, like the place’s that come from?

Dr. Jill Carnahan (02:33):

Nicely, it really comes from our occupation and I’ll inform you the story and it’ll make a lot sense. So I graduated 2001 and received out of medical college and that 12 months was the 12 months the Ladies’s well being Initiative first got here out within the information. Because the researchers are compiling the info, the information took this info earlier than they even completed compiling and mentioned, oh my goodness, is there an elevated threat of breast most cancers with hormone substitute? And actually a whole bunch of hundreds of girls stopped their hormone substitute as a result of this media took this story, put it on the market. And whilst a health care provider, that was the story that we have been advised. So all of us began, that is 20 plus years in the past, being afraid of this. What occurred in that 20 12 months sense is that they analyzed the info in that largest randomized management trial of girls on hormone substitute. And the info got here out very clearly.

(03:18)
Primary, there was two arms, one was an estrogen solely arm, they usually used Premarin, which is definitely a horse estrogen, not even one of the best cleanest bioidentical, however it’s an estrogen. And the opposite arm was a Premarin, which is an estrogen plus, um, a purvey, which is an artificial progestin. I’ll clarify that actual briefly in a minute. So these two arms, the primary arm got here out and this has been the final, uh, analyzed analysis, effectively documented by anybody who’s checked out this. There was really a 34% discount in breast most cancers in that arm. So not solely was it not impartial like simply, or or dangerous, it was really a discount. And we’ve recognized for all of this time that hormones, particularly estradiol, helps the mind, the bone, and the um, menopause signs dramatically and the center. So these issues have been by no means questioned. It was solely this query about breast most cancers.

(04:09)
Now, in that different arm, right here’s the place the controversy got here in. That they had this slight enhance above baseline with the Premarin Provera arm for breast most cancers incidents. However what occurred is what they have been, um, going towards because the baseline really had the next incidence of regular. So it skewed the info. And the second factor about that was, as I discussed earlier than, this was an artificial progesterone. It wasn’t progesterone in any respect, which might really mimic progesterone deficiency in the long run as a result of it hits these receptors, but it surely’s not a pure progesterone. So neither of those trials, although they confirmed a decreased threat of breast most cancers, have been even utilizing the type of hormones that you just and I are speaking about, which is the very same as our our bodies, our ovaries produce. So I confidently, and also you talked about earlier than, I’m a breast most cancers survivor, so I’m 20 plus years out.

(04:53)
And for me, it is a very private concern. ’trigger right here I’m in menopause and I’m like, what’s secure for me? As a result of I’ve had breast most cancers and I can confidently say with out a shadow of the doubt, I used to suppose we had to decide on. We don’t. I believe so long as you’ve practitioner who is aware of what they’re doing, you’re checking ranges. And we’ll discuss all that at present. Um, it is a large concern for girls and it’s gonna have an effect on bone, mind and coronary heart in constructive means. And now we expect it could even be protecting towards breast most cancers.

Betty Rocker (05:25):

I’ve been studying that knowledge as effectively and it’s nice to listen to it from you. And a part of why I wished to ask you that query to start out us off is in order that that you’d share that you’re a breast most cancers survivor. It’s one thing that’s so deeply private to you. I do know that there’s no means that you’d’ve prescribed that to me. You wouldn’t have prescribed hormone substitute remedy to me or to quite a few different sufferers you’ve served in case you thought there was a threat for us. Now, after all, there are gonna be some individuals who it’s contraindicated for. There’s sure issues as a clinician, I’m certain that you just have a look at, I’m certain there’s the blood clotting issue. There’s all of those various things that we wanna be careful for, and that’s one thing that when somebody’s individually working with a health care provider, they should care about.

(06:06)
However I believe it’s actually necessary to simply, although that was, to me that was somewhat technical, what you shared, and in case you’re listening and also you’re pondering, I didn’t fairly observe every little thing she was saying, but it surely, you perceive the info as mm-hmm . A physician who reads the science, you perceive that it’s secure. Sure. That’s mainly what you’re saying. And like that these research in some methods had some actual flaws. Sure. They have been finding out, um, types of hormones that we don’t really use in girls’s drugs. And in addition that the, the, and, and so it, and so there’s all this concern, there’s all this concern round it. And, and it’s not for everybody both, proper? Like, you’re proper. I do know we’re not gonna say, oh, everybody must be on hormone substitute remedy, however

Dr. Jill Carnahan (06:46):

In the event you’re present process breast most cancers therapy, for instance, I’d not give somebody hormones throughout therapy. In order that’s a really clear contra.

Betty Rocker (06:52):

Proper. So there you go. There’s a, there’s a cause not that, and there are in all probability another causes too. And, and but it must be an accessible, viable possibility that girls have entry to is all I’m seeing with out all of the concern. And, and that’s why I wished to simply begin us off speaking about that. ’trigger , if we’re gonna get into a number of the viable therapy choices for girls within the menopause years, it’s necessary to know that we’ve thought of this firstly, as a result of I believe security, girls’s security and, and and their entry to healthcare choices is basically necessary. It’s important. Yeah. At all ages, and that is an age that I really feel like has been ignored, has been ignored, has been too lengthy, simply form of like, you’re simply getting outdated. I can’t inform you what number of girls have written me, and also you’ve in all probability seen this in your observe as effectively, saying, I’ve been dismissed, I’ve been advised I used to be depressed. I’ve been placed on anti-anxiety drugs. I’ve been advised I would like to simply train extra and eat much less. I’ve been advised I’m simply lazy. Um, it’s all in my head. I’ve been placed on contraception, like all of those various things which might be like getting at signs however not likely addressing the basis trigger, which is that this shift in our hormones that occurs. I don’t know, it’s simply, it’s it’s

Dr. Jill Carnahan (08:05):

So true. And I like that you just mentioned it’s even at present, day-after-day in my observe, I’ve these discussions with girls and there’s some who select to not, and that’s okay too. However everybody deserves a dialogue with an informed supplier. Um, and in case your supplier is totally no, and there’s no dialogue, you then wanna discover a totally different supplier as a result of it isn’t for everybody. And there’s an important alternative. And when you’ve got plenty of nervousness or concern, I by no means push anybody. So there’s nonetheless, I could also be possibly 20% of my girls that we discuss they usually don’t go on hormone substitute, and that’s okay too. However to have the choice and to know the

Betty Rocker (08:34):

Selection, you mentioned alternative. That’s the phrase. That’s, that’s it. And the training about it, to know which you could make an knowledgeable alternative for your self to know there are threat components for sure individuals, after which a few of us there aren’t. Nicely, let’s speak somewhat bit concerning the, the phases of a girl’s life that we undergo. There’s the perimenopause years, these years main as much as menopause, the occasion the place our interval stops for 12 months after which we’re within the postmenopausal years. So there’s actually perimenopause and submit menopause and menopause form of like defines that cusp the place we go to the subsequent degree, as we name it. Proper? And, and so there are girls who come to you at, at these totally different phases of their menopause journey. They usually wanna know all types of issues. Like, effectively, how do I do know I’m in perimenopause? How do I do know I’m, how do I, what, what ought to my hormones appear to be at these totally different phases? And I’d think about that these are the type of issues that you just assist deal with in your observe. So if, if somebody involves you and says, I believe I’m in perimenopause, or I’m having these bizarre signs, what do you check for? And how much signs do they present up with? In order that possibly you could possibly, we may assist somebody on the market who’s making an attempt, who’s possibly struggling proper now or making an attempt to determine what to ask their

Dr. Jill Carnahan (09:44):

Physician. So generally girls as younger as 35 can begin to expertise these perimenopausal signs. And normally from 35 to 45 is that realm. It will possibly go so long as 55. I believe the common age of that menopause date is round 52, 55. After which after is submit. However this will once more be nearly a 20 12 months span from 35 to 55 that some girls battle. So one factor I’m a fan of, and never all docs do that is testing. I exploit blood, urine, several types of issues to evaluate various things. And it is a entire nother lecture price of fabric as a result of relying on in case you’re utilizing a cream or an oral or the way you’re doing it, sure assessments decide up issues in a different way. And that’s an entire different dialogue. Nevertheless it’s necessary that you’ve a health care provider that can assess the place you’re at as a result of you’ve the signs sometimes.

(10:26)
And the signs can, um, for instance, in that early half, so say 35 to 45 or 50, typically you begin to first have a scarcity of luteal section progesterone. That’s normally the very first thing that drops. So that you typically expertise estrogen dominance and hormones are all about steadiness inside each other. So if we have now our cycle follicular section, estrogen goes up, second a part of our cycle, luteal section, progesterone goes up and that simply yin and yang occurs all via our twenties and thirties. Nicely, in our late thirties or early forties, what begins to occur is that progesterone will typically diminish manufacturing. So you’ve this dominance of the estrogen all through the cycle that may trigger breast tenderness, moodiness, heavy, painful durations, uh, endometrial ache, endometriosis, fibroids, all these sorts of issues. And that may be a symptom in and of itself that may be handled with pure progesterone or typically herbs that can enhance the lead section progesterone.

(11:16)
And that’s normally the very first thing. Then someplace in there your ovaries begin to sputter. And I all the time say it’s nearly like in case you had a bottle of Heinz ketchup and also you’re squeezing out the final bit and the, then the hormones are beginning to go, , simply kinda like this little simply really fizzling out. There’s a multitude of a spurting out and anyone could have a day that’s excessive and high and low and you’ll’t work out what’s happening. And even testing, you need to watch out as a result of in case you’re testing that interval, you check one month, you may need excessive estrogen, low progesterone the subsequent month it may be low and it simply does this dance. And that’s the time when girls are so pissed off ’trigger like, I don’t really feel effectively what’s happening? They could begin to have scorching flashes, however they’re nonetheless having heavy cycles.

(11:50)
And so in that window, girls can nonetheless do bioidentical hormones. Nevertheless it’s necessary to have a clinician that is aware of easy methods to assess the signs associated to what they’re seemingly experiencing hormonally. After which additionally check figuring out that the check might be up and down. And in that section it’s gonna be just like the Heinz ketchup spurting out randomly. And you then get to a degree the place these ovaries similar to, I’m finished. And that’s when the estrogen begins to actually drop. And that is when girls would begin to have scorching flashes, night time sweats, abruptly they can’t keep in mind names. Locations the place they put their keys, the place they’re going, they get within the automotive like the place am I driving to? Like issues the place they actually, girls have come to me and mentioned, I believe I’m dropping my thoughts. They will begin to have this such as you and I’ve been pushed girls in our subject.

(12:33)
And I do know after I first hit menopausal, just like the overwhelm, the sensation like I couldn’t deal with issues usually is basically frequent with girls. ’trigger they’re pushed they usually’re doing effectively and the estrogen actually helps our mind keep on monitor. And when that drops we’re like, oh wait, my government operate, the planning, the executing is impaired. And I’m like, I really feel like I’m dropping my thoughts. Or that the issues that I used to have the ability to deal with are tougher. Mm-hmm . Emotionally, you’re up and down. It’s possible you’ll be extra tearful at some point extra indignant, at some point extra unhappy, you gained, don’t wanna get outta mattress at some point and when none of these issues have been there earlier than. So I like speaking to girls as a result of so many ladies actually really feel like they’re going loopy if nobody validates this and it’s a standard expertise, however it may well really feel so disorienting. And , even the dad so far as damaged relationships and divorces on this time, it’s not shocking that that goes up as a result of girls really feel like they’re going loopy. And most males and plenty of docs gaslight them into pondering they’re going loopy and it’s simply their hormonal transition.

Betty Rocker (13:29):

So I hear you saying that there are these actual distinct phases of perimenopause that we undergo and that is why it’s tougher to pinpoint typically as a result of it’s a shifting goal. Sure. As we undergo these, these years of our lives. And it’s shocking to listen to you say that it may well begin as early as 35, but it surely additionally is smart, proper? And, and it, I suppose you might not know precisely the place you’re. It might not go precisely along with your age. Proper? So if we keep on the perimenopause dialog for a minute, say

(13:57)
Say I’m a youthful lady, or say I’m like 40 years outdated mm-hmm . And I come to you and I say, I believe I’m in perimenopause. What would you particularly check for? I can keep in mind a number of the stuff you examined me for particularly after I got here to see you. And naturally I had complicated signs and many various issues happening. It wasn’t simply menopause once we first began working collectively. However I do keep in mind that over time you’ve examined me for some particular staple items. Sure. To assist see what if, if it was perimenopause. So would you share a few these? Sure.

Dr. Jill Carnahan (14:31):

So one factor is this may be finished at any typical lab. And although blood work isn’t all the time excellent, in case you’re utilizing like a cream or no matter, it’s an amazing place to start out. It typically will likely be lined by insurance coverage. And what you’d wanna do is a fundamental panel. Estradiol is the primary E two estrogen and you will get estriol and estro. However simply estradiol is an effective place to start out.

Betty Rocker (14:48):

Simply to say simply she mentioned E two after which she mentioned all these issues. In order that’s E one, E two, and E three. There’s three sorts of estrogen. So estradiol is E two and that’s the one you wanna find out about, proper?

Dr. Jill Carnahan (14:58):

Yeah, that’s the primary one. So once more, it’s nice if you will get ’em all, however in case you simply get one, get estradiol. And currently the lab now has a extremely delicate estradiol. So HS are extremely delicate is healthier as a result of that is very, very, very tiny components within the blood. So that they’re measuring little tiny issues and it will get somewhat extra, um, particular and delicate with that extremely delicate estradiol. You wanna get proactive.

Betty Rocker (15:17):

Do you need to get a particular check to check for that. Does your physician,

Dr. Jill Carnahan (15:20):

No, this may very well be only a common LabCorp quest common hospital lab. Simply writing estradiol on the lab order would do it.

Betty Rocker (15:27):

Okay, good. Good to know. Okay. Sorry to interrupt. I simply wished to ensure there wasn’t one thing particular we needed to ask for .

Dr. Jill Carnahan (15:32):

Yeah, no, estradiol. After which progesterone additionally crucial. ’trigger we all the time have a look at the ratio. Identical to we mentioned, these two are the dance companions. So we’re checking these two in conjunction. Um, if I’ve a alternative, I’m testing all these and I’ll proceed with the remainder of them on day 19 via 21 of the cycle. In order that’s assuming you’ve a typical 26, 28 day cycle ’trigger that’s gonna hit your LAL section. And what you’re gonna see there’s if the estrogen and progesterone are in steadiness. Proper? In order that’s the timing of what you may do for this. So estradiol, progesterone, DHEA sprint S is how we check DHEA, which is one other steroid hormone within the blood. Testosterone, I wish to get each free and complete. Mm-hmm . After which cortisol within the morning. ’trigger that’s type of a regular, though you could possibly get it randomly via the day. And in case you simply get these 5 estradiol progesterone, uh, DHEA free and complete testosterone and cortisol, you’re gonna have a fairly good thought. Now you will get fancy and get one thing like DHT. It is a, a really potent steroid hormone like testosterone that may trigger hair loss or may cause zits or PCOS. However you don’t have to get that fancy. In the event you simply get these imply 5, that’ll provide you with map.

Betty Rocker (16:38):

And I keep in mind these. That’s that fundamental panel I’ve had repeatedly and I wished to the touch on that as a result of A, these, so that you’ve had these assessments finished for me a number of methods over time. So at first we might do a mix of the Dutch check, which is a urine check that we do on these very particular days of the luteal section of the cycle. And it’s good to be monitoring your cycle with the intention to know the place you’re and when your luteal section is. And I discover that it’s really actually useful to be monitoring your cycle while you’re in perimenopause as a result of it’s gonna provide you with some indication of figuring out as your cycle begins to get erratic. It, it’s straightforward to simply overlook about your cycle. Actually, I typically would overlook I used to be even gonna get my interval in my common biking years as a result of it was simply so like I I’d be like, oh, this once more.

(17:27)
Proper, proper. Yeah. I wouldn’t have a lot sense. Me too. Proper. So, however now, like in perimenopause it’s been actually useful to trace it, to have a way of it. And I, after all I’m sporting my Oura ring and that basically helps me. ’trigger I can see my basal physique temperature go up when round ovulation and it stays elevated via that second half of the cycle. However anyway, again to, um, these assessments, I’d sometimes do this Dutch check. You’ll order that Dutch check for me, the urine check. After which I’d additionally go fasted very first thing within the morning, early morning and get a blood check as effectively. And that was the place you have been checking that T three, the free T three, the, the free thyroid hormones. Proper. The free T three and T 4. Considered one of ’em is free, I don’t keep in mind. Mm-hmm.

(18:05)
However T three and T 4. And you then, you’d even be checking the fasting cortisol within the morning ’trigger we’d wanna see like the place that was. After which we’d additionally additionally, I believe you could possibly see issues like testosterone and you could possibly see the opposite hormones mm-hmm . Um, but it surely was the, the mixture of that with the Dutch check that collectively gave you a a lot clearer image of what you wished to see that may assist you see if my hormones have been in steadiness, how out of steadiness they have been. We began to see over the course of the few years that we examined these two issues again to again the, the blood and the urine, how my hormone ranges actually went down and down and down. Yeah. And I keep in mind at first I used to be in a position to get by with merely utilizing some adaptogenic herbs that basically helped help my stress response and helped nourish my hormones.

(18:52)
And, and I used to be in a position to really feel higher although it didn’t actually make my hormone ranges go up a lot, I felt loads higher and it lowered plenty of the signs I skilled. However then as I received somewhat farther into the perimenopause journey, it turned actually important for me to start out utilizing issues like hormone substitute remedy. After which I really feel like I’m possibly within the, the tip of that center stage of perimenopause now I’m like utilizing a mix of several types of hormone substitute remedy. I’ve some props right here to indicate you guys, in case you’re watching this on YouTube. I’ve received my patch mm-hmm . So I exploit this little patch and I’ll simply open up the little foil packet so you possibly can see it. It’s just a bit sticker that I placed on and, um, you alter it each few days. Or Dr.

(19:40)
Jill had even given me some suggestions as I’m very delicate to plenty of these things the place we tried it for an extended interval at the beginning to see how I responded. After which we examined once more just a few months later and I’ve additionally received some totally different lotions, topical lotions. She previously had had me strive, an oral progesterone. And we discovered that for me personally, the everyday advice was I believe to take it at night time. My physique didn’t like that, so I took it within the morning. So there’s simply all of those positive tuning form of nuanced facets of this. After which there’s additionally a pellet, which I do know you advisable for very particular conditions, however in case you’ve received a pellet injected beneath your pores and skin, which we talked about in different podcasts, you possibly can’t change that. Yeah. It’s there. You’ll be able to’t take it out simply your self. Proper. So it simply gotta do its factor so it’s much less customizable. Whereas with the lotions you want, you are able to do two clicks, you are able to do one click on, you possibly can actually management your dosing, I believe actually, rather well. These are all issues that I’ve skilled based mostly on the testing. And I can even say that you just and I examined quantity, like it will be a, just a few occasions a 12 months we might check to see like

Dr. Jill Carnahan (20:51):

Each three to 4 months. That’s

Betty Rocker (20:53):

Nice. Each Yeah. Completely. To see like, how did my physique reply to the therapy? We wished to provide it sufficient time for it to, to have some impact. And we wished to then see how was the physique doing with this stuff. After which if there was, if one thing responded, we may see that. And if it didn’t, we may modify my dosage. However we didn’t simply go actually quick into issues we needed to like take. And that may be, that may be somewhat little bit of a course of, proper? Like, ’trigger you need outcomes instantly, however in case you overdo it, you possibly can really feel worse. And that’s,

Dr. Jill Carnahan (21:26):

That’s like, you don’t need breast tenderness with the estrogen, which is the use typical. And one factor, lots of people are apprehensive about clot threat. And what if I’ve this, uh, there’s totally different gene issues that you just may’ve been advised

Betty Rocker (21:35):

Issue V(5) Leiden, proper? Like that’s my household. Yep,

Dr. Jill Carnahan (21:38):

Yep. Or, um, sure different ones on the market. And so in case you’ve been advised that’s a threat, the deal is oral hormones, particularly estrogens do enhance the danger of clot. It’s why you’ll nearly by no means see me prescribe oral estrogen as a result of I don’t wanna even go in that class, proper? Mm-hmm . Transdermals wouldn’t have the identical threat. Transdermal simply means a patch or a cream or one thing you apply to your pores and skin. Our pores and skin absorbs hormones rather well mm-hmm . So I nearly completely do the compound of lotions that you just confirmed or the patch that you just confirmed. And, um, there’s other ways to do these, however these are actually nice and secure methods to use. Now you talked about typically doing blood and urine on the similar time. The dutch hormones is what you talked about. I sometimes to observe the hormones, love to do the Dutch, as a result of within the blood you gained’t all the time see the true ranges of a cream or a patch.

Betty Rocker (22:25):

Mm-hmm .

Dr. Jill Carnahan (22:25):

So I typically do each, like we did with you. If I’ve a affected person who’s keen to do each, that’s one of the best. However you possibly can see the variations as a result of in case you’re actually following a cream or a patch or a protocol, um, your Dutch urine check is gonna present extra the correct ranges of your physique versus the blood.

Betty Rocker (22:41):

Mm. That’s tremendous attention-grabbing. So if somebody have been simply making an attempt to observe their hormones, in the event that they have been simply, if they might simply check type of consecutively, possibly not each month clearly, however like on a good foundation, possibly each three or 4 months they’d use the Dutch check as their main to, to see in the event that they have been doing hormone substitute remedy. Sure. Now you talked about compounded.

Dr. Jill Carnahan (23:04):

Sure.

Betty Rocker (23:04):

That that’s, so, so there’s a few several types of these transdermal or cream-based mm-hmm

Dr. Jill Carnahan (23:10):

.

Betty Rocker (23:10):

Hormone substitute remedy varieties. Might you wanna communicate on that somewhat bit? I really feel like there’s plenty of

Dr. Jill Carnahan (23:15):

Positive.

Betty Rocker (23:15):

There’s, you hear about HRT, you hear about BHRT. Yeah. You hear about all these things. So inform us concerning the variations

Dr. Jill Carnahan (23:21):

There. Positive. And simply to reiterate what you mentioned about testing my customary affected person, we would begin them on a protocol and normally about each six months is type of when, typically sooner in the event that they’re having signs, however on a routine, and on the very least, I’m gonna test them yearly.

Betty Rocker (23:35):

Positive.

Dr. Jill Carnahan (23:35):

So everyone who will get hormones is required by me to do a yearly check. So I do know, and typically extra steadily if we’re altering doses, in the event that they’re actually steady, yearly does fairly good. Positive. Like I’m at a spot now, I do yearly and I’m steady on doses. So what is accessible? So there are common pharmaceutical professional prescriptions you will get at CVS, Walgreens or your common pharmacy which might be bioidentical hormones. Estradiol, as we already talked about, is the primary hormone that you just’re gonna see. And this may be prescribed as a cream, um, as a, um, foam like a, roll-on, as a patch, which is my favourite most typical ’trigger girls don’t have to consider it.

Betty Rocker (24:09):

Yeah.

Dr. Jill Carnahan (24:09):

Um, so there’s numerous other ways. And that is just one, it’s the E two, the estradiol that’s essentially the most sturdy. It really works, it’s a good way to do it. However plenty of occasions girls wish to have a mix and we are able to prescribe compounded estriol, which is that weaker type of estrogen. And for instance, if we have now somebody who has latest breast most cancers or very, very involved, estriol is type of a caboose, estrogen that means finish of the road. And the physique doesn’t take and make different issues with it. So it tends to be the most secure, even amongst oncologist with somebody being handled for breast most cancers with vaginal dryness, they’d say, oh, the sort of estrogen is basically secure. So when you’ve got any concern, you possibly can all the time compound these. And sometimes I’ll do both 80 20, imply 80%, one 20% one other or 50 50, and also you mix these two estriol and estradiol right into a cream. And since you possibly can compound it, I can begin with a lot tinier doses for somebody who’s actually delicate. And you may also put progesterone in that cream. So lots of my girls have like a biased that means like two sorts of estrogen with somewhat progesterone multi function, they usually use a pair clicks on their pores and skin at bedtime or morning. So it may be fairly straightforward to do, however that means I can really decide the precise dosages for that particular person affected person and modify it based mostly on their outcomes with positive tuning.

Betty Rocker (25:24):

That’s so cool. Uh, I like that. I, I really feel like I’ve been having my very own little apothecary over right here. Yeah. And I can see that my estriol estradiol is a combo and I can, I’ve a separate progesterone mm-hmm . And I even have my little testosterone.

Dr. Jill Carnahan (25:42):

Sure.

Betty Rocker (25:42):

And that’s been I really feel like actually useful. Um, sure. You wanna speak somewhat bit about that as a result of we don’t typically discuss testosterone and, and

Dr. Jill Carnahan (25:50):

I do as a result of I get so enthusiastic about, simply, so that is, we consider it as a male hormone. We now have testosterone – decrease than males, however we have now testosterone. We’d like testosterone. It helps our bones, it helps our brains, it helps our motivation, it helps our physique composition. Ladies who’re poor in testosterone. It’s one of many the reason why there’s 4 occasions the incidence of autoimmunity in girls as there’s in males, as a result of that decrease testosterone really will increase threat of autoimmunity. So there’s, I’ve even used off-label testosterone as a part of a protocol to deal with autoimmunity as a result of it’s so highly effective in girls. So I’m an enormous fan now. You don’t need extreme, however getting the fitting dose will actually change your life, your thoughts and all these issues. Along with the estradiol libido for girls, it completely has an impact. Vaginal dryness.

(26:39)
And like I mentioned, bone and mind are large with testosterone. So testosterone might be given as a, we nearly by no means wish to give a tablet the place you swallow as a result of your liver has to course of estrogen, testosterone, no matter. And we don’t wanna load up the liver. So I’m all the time making an attempt to bypass the intestine with hormones that’s both a cream or a patch. With testosterone, there’s a pair methods you are able to do it. You are able to do a cream, however for girls, wherever you apply that cream, interior thigh or wrist, you’re gonna get somewhat hair development. So plenty of girls don’t like that. And so as an alternative of doing the cream, I’ll typically do a trochexf or a sublingual tab that dissolves beneath your tongue so that you just get that dose with out stepping into your intestine and thru the liver. Um, plenty of girls, uh, do injectable now.

(27:19)
It was once that the industrial varieties have been just for males. So to get the tiny doses that we would have liked, have been actually exhausting to attract it in a syringe. However I do discover, effectively now we are able to compound it like girls concentrations. And I do like, so long as girls’s are afraid of doing a injection as soon as every week or as soon as each 10 days, that’s a good way. It sometimes does give a degree that type of goes up and down each time you inject. So you’ve somewhat bit extra variation than you’d with a every day dose. So testosterone might be cream, it may be in troche or an oral sublingual, and it may be injectable. And people are the primary methods. And since proper now our pharmaceutical trade is geared in the direction of males and testosterone, a lot of the industrial, if not the entire industrial, um, ones, patches, lotions, even injectable, are sometimes made for male dosing. So that is sometimes compounded for girls, um, to get that dose.

Betty Rocker (28:06):

And also you and I’ve discovered that my physique simply loves that. It simply, it simply has actually helped me a ton. Mm-hmm. And I’ve taken such a tiny dose over the, the time that I’ve been utilizing it. It’s been actually useful, I really feel like, for steadiness. After which I additionally take, um, the oral DHEA complement to assist, as a result of that’s after all a precursor to is estrogen and testosterone. Proper. It’s a precursor. It helps our adrenal manufacturing. Um, as, and that’s one thing that I all the time so discovered actually attention-grabbing is that due to course we’re making our estrogen and progesterone primarily in our ovaries, however we additionally make some hormones in our adrenals. Appropriate?

Dr. Jill Carnahan (28:46):

Yeah. Sure.

Betty Rocker (28:46):

And if our adrenals get overwhelmed by stress, the stress response, it’s gonna be tougher for them to make a few of these backup hormones. And I keep in mind a extremely attention-grabbing dialog. You and I had some time again the place you have been like, , you see girls who’ve a extremely strong, um, adrenal operate have a neater time in, in going via perimenopause as a result of they don’t seem to be strapped of the backup hormone system. Nearly. Did I say that proper? That’s

Dr. Jill Carnahan (29:13):

That’s precisely proper. As a result of when our ovaries conk out they usually’re like, I’m finished, I’m for drained. Proper. Which is what occurs once we hit menopause. They ovaries cease producing the hormones, our adrenals take over. So we nonetheless do produce somewhat little bit of hormones from the adrenal glands after menopause, not practically as a lot as ovarian. But when these adrenals are so taxed, ’trigger you’ve been working 80 hour weeks and never getting sleep and taking good care of your mother and father and your youngsters and all these generations, then it’s actually frequent to have a way more troublesome in menopause. And I like DHEA, to begin with, it’s the one one in all these that isn’t requiring a prescription. The remainder of these, you do want a prescription. Proper. Um, and only for the file, testosterone continues to be thought of managed, whether or not it’s athletes or there’s some issues that they, so that’s a kind of which you could nonetheless get a prescription no drawback.

(29:57)
Nevertheless it’s within the class of managed prescription. So that you may need to get a decrease quantity, like six months versus a 12 months or sure issues. Um, however DHEA is accessible over-the-counter and girls typically do effectively on 5 or 10 milligrams upwards of 25. However that’s a fairly excessive dose for lots of girls. And what can occur there’s that can help your manufacturing of cortisol. If the adrenals are low and also you’re low cortisol, it’ll help testosterone and DHEA. So it’s type of a pleasant adrenal help in case your adrenals are in a weakened spot. In the event you’re actually excessive cortisol and also you’re vulnerable to breakouts, these are the type of individuals I in all probability wouldn’t placed on DHEA. ’trigger you then increase the cortisol and you might have some extra breakouts, however normally girls will know as a result of they’ll take 5 milligrams, which is a tiny dose they usually escape. So cease the DHEA.

Betty Rocker (30:41):

Proper. Uh, I believe it is a good alternative for us to shift somewhat bit to the postmenopausal dialog. I wanna discuss every little thing suddenly, in every single place, after all. However, however I really need, I’m actually and curious as a result of I’ll be in submit menopause quickly and I wanna know what to anticipate. And I’ve received plenty of girls who hear who’re in submit menopause, they usually wanna know, effectively, what ought to, is there one thing, how, what assessments ought to I get? After which what choices are there for me? What ought to we do and the way can we assist them?

Dr. Jill Carnahan (31:14):

Yeah. So there’s mainly two or 3 ways this might occur. We talked about like, say you’re 35, 40, 45, and also you’re beginning up signs and your physician’s open and also you get some prescriptions. You’ll be able to really undergo this very easily after which hit menopause and type of have been on hormones. Positive. However what you’re speaking about, I believe is say that lady out there’s 65 they usually have by no means been on hormones. By no means.

Betty Rocker (31:33):

Sure.

Dr. Jill Carnahan (31:33):

Proper.

Betty Rocker (31:34):

Proper.

Dr. Jill Carnahan (31:34):

They usually’re like, effectively, what about me? Nicely, very first thing is Dr. Dale Bredezen does a ton of analysis on Alzheimer’s. And he’s one Who’s that? Dr. Dale Bredezen. Okay.

Betty Rocker (31:42):

He

Dr. Jill Carnahan (31:42):

Wrote the e book Finish of Alzheimer’s. And he’s one in all our researchers and main consultants in dementia. And I discussed this as a result of in his protocols, there’s a kind of Alzheimer’s that’s associated to lack of estrogen within the feminine mind.

Betty Rocker (31:55):

Wow.

Dr. Jill Carnahan (31:56):

So he’s placing 85-year-old girls on hormone as a result of it’s so essential to our mind operate. And, and so this outdated delusion was that, oh, after 65, we don’t want hormones. So if we’re on hormones, we cease at 65. Or if we’re above 65, you’re too outdated for hormones. That isn’t true. Our brains, until the tip of our life can use the hormones. Now, possibly in some unspecified time in the future you want lesser doses, however I’d say to any lady who’s postmenopausal and possibly having signs, possibly not, I’d nonetheless begin with testing after which speak clinically about signs after which discuss security. Security’s the identical factor right here. However what occurs is, say you went, uh, into menopause at, otherwise you hit menopause 55 and also you’ve been with out hormones for 10 years, your receptors begin to and shrink up. So what occurs is while you first begin hormones, when you’ve got by no means been on them, there’s somewhat little bit of adjustment as a result of you might not both have the ability to sense that hormone effectively, or you might in a short time get flooded with an excessive amount of. So it simply takes a practitioner who’s cautious with that, however they’re really with coronary heart, mind, and bone. There isn’t any age too outdated that doesn’t profit from hormones so long as there’s a dialog and all of that

Betty Rocker (33:06):

Taking place, and it’s approached fastidiously. That makes complete sense. And I’m so glad you mentioned that. Um, a number of the telehealth websites that assist girls with balancing their, their hormones submit menopause, they are saying that they’re, they’re not gonna prescribe in case you’ve, or they, they, there’s some wording about in case you’ve been 10 years with out having a interval and also you haven’t by no means been on HRT, like they, they wanna test in about that due to precisely what you’re speaking about. Like these receptor websites form of, are they atrophy, such as you mentioned? Yeah. However that there nonetheless may very well be, that you just nonetheless may have that chance. So, so say, say somebody got here to you and he or she’s similar to possibly just a few years in to submit menopause. What would you check her for? What would you be ? Would you have a look at, I imply, you in all probability nonetheless wanna see like what her ranges of estrogen or like, you in all probability wanna test her cortisol, I don’t know. What, what do you form of have a look at to, to assist her? And, and clearly it’s individually based mostly as effectively, but when she’s concerned with some sort of hormone substitute remedy, I suppose what, what dialog and the way do you check?

Dr. Jill Carnahan (34:04):

Yeah. So we’d nonetheless do in all probability blood work or Dutch hormones, one or the opposite, or each. After which what we’d wanna do is there’s a threat of when you’ve got uterine fibroids which might be unchecked and really massive, otherwise you had extreme endometriosis, so any of the endometrial illnesses, this implies like the liner of your, your uterus was irregular or thick. Or you’ve these growths which might be benign development, however they’re stimulated by estrogen. These circumstances, um, may very well be stimulated even by wholesome bioidentical hormones and fibroids are benign, however they’re a ache when you’ve got them. They’re massive or uncomfortable. They’re sometimes not malignant, which implies like they’re not most cancers. However these are caveats or issues that as, as a doctor, I’d be very involved or have a dialogue about. And in addition, if you’re perimenopause or in these earlier years, forties or fifties, and you’ve got had a large concern with fibroids or endometriosis, these are discussions we wanna have about easy methods to dose this and be watching that fastidiously.

(35:00)
So sometimes a girl who’s by no means had any hormones, I’d display screen them with a pelvic ultrasound to simply have a look at that pelvis and ensure every little thing’s secure. As a result of if they’ve fibroids, these may develop with hormones. And you need to know that after which have the ability to watch it. If any lady has breast tenderness with these, uh, hormones, that’s an indication. I’m all the time like, oh, that’s, you’re hitting your threshold. We’ll, in all probability ought to decrease it. In order that’s like a warning factor. I’ll say, you don’t wanna have breast tenderness, or in case you do and it’s simply transient for every week and it goes away, that’s in all probability okay. After which the third factor is in case you ever cease bleeding for over a 12 months, that’s technically the definition of menopause. You’ve gone into submit menopause, um, and also you begin to have bleeding that 12 months with out a cycle that requires you to get an endometrial biopsy and a workup to ensure your lining is just not getting too thick. And these are simply these cautious issues {that a} good physician would do in case you’re on hormones, as a result of hormones may cause that lining to get thicker. And so when you’ve got a excessive threat of that, or some cause, you’d need to have that dialogue about security and efficacy along with your physician. However I’d all the time do a pelvic ultrasound and test their scientific historical past after which speak with them fastidiously. I’d additionally in all probability begin a 70-year-old lady on a a lot, a lot, a lot decrease dose than I’d a 45-year-old lady.

Betty Rocker (36:10):

Positive. Thanks for sharing that. And that’s so useful to know as we go into this stuff, we wanna have our eyes open about threat components. And also you talked about that you just, you do a Dutch check as one of many choices for a post-menopausal lady. However since she isn’t having a cycle anymore, when does, when do you, when do you do do this? Yeah, anytime You are able to do it that

Dr. Jill Carnahan (36:29):

Anytime. Proper,

Betty Rocker (36:30):

Proper. Since you’re simply trying to see the place her ranges are at in order that you could possibly decide now. After which for somebody who’s post-menopausal, are you gonna be placing her or a person as an anyone, I suppose, would they be getting on an analogous protocol to what somebody in perimenopause is getting on? Are you gonna be giving all of them the identical sorts of hormones? Would they want all of them? Or are you, are they extra more likely to be simply getting on an estrogen or possibly some testosterone? Or is there a cause to nonetheless add progesterone? I’m simply so .

Dr. Jill Carnahan (36:57):

Sure. So, um, the, the everyday medical coaching is when you’ve got a uterus and you employ unopposed, estrogen, that means all you get is estrogen, that’s a threat for that lining being thicker and truly growing endometrial most cancers. So we as physicians who’re doing good work, would by no means give a girl who nonetheless has her uterus unopposed estrogen by itself. You’ll all the time give it with progesterone. Progesterone protects you from having that. So no matter age it’s, and if I consider order of operations so far as security, and even from 35 on what you do, progesterone nearly all the time comes first for a lot of girls, as a result of many ladies from 35 to 45 do rather well with simply progesterone. They don’t want any estrogen. There’s estrogen dominant, that’s what the ketchup, the Heinz ketchup factor is.

Speaker (37:39):

Yeah.

Dr. Jill Carnahan (37:40):

After which finally as they hit the ovaries begins to tank, then they, we add the estrogen. And so somebody older, I’d begin with progesterone estrogen alone, earlier than I’d add plenty of testosterone DHEA, as a result of then you could possibly, there’s, as you possibly can inform, the variables are nearly infinite in how with, yeah. So it’s a lot simpler to, to evaluate with some small quantities of estrogen, progesterone first, see how they do in two or three months, after which if wanted, add somewhat testosterone. Um, and see, and I’d say extra girls above the age of 65 are on a really small dose of estrogen, progesterone with out testosterone. However even they’ll profit from small doses if acceptable.

Betty Rocker (38:17):

Fascinating. Wow. Nicely, you’ve given us plenty of actually nice info to consider, however I believe that one factor that we have now not talked about but, that’s all the time been part of our work collectively that I wanna be certain that girls hear about is what hormones are doing in our physique and the way they’re really excreted. As a result of there’s a actually necessary facet of our hormone steadiness that has to do with our intestine well being. Proper. And would you communicate on that somewhat bit, as a result of I, I believe that is one thing that you just care loads about and also you’ve guided me rather well on as effectively.

Dr. Jill Carnahan (38:51):

Thanks, um, Bree, as a result of it’s, so what occurs is estrogen, progesterone, all these hormones in our physique, they’re handled by our liver, similar to a drug or a chemical. So we have now to detoxify these. And sometimes when girls get into bother, even with threat of breast most cancers, endometrial most cancers, any form of hormone associated concern, it’s not that their hormones are the dangerous guys, it’s that they’re not in a position to do away with the surplus. They accumulate sure metabolites that may harm DNA, and that results in dangerous issues. And apparently, in our world that we stay in, there are hundreds and a great deal of issues that mimic estrogen. They’re referred to as endocrine disruptors on our physique. So plenty of occasions the, our bathtub and physique merchandise are make-up, um, issues that since we use in our home, um, even atrazine that’s used on corn within the Midwest, and these chemical compounds act like hormetic or hormone results on our physique, and it’s very poisonous.

(39:43)
So it’s nearly worse the setting than the hormones we take, however we have now to consider that. So if I’m actually going deep or somebody has plenty of concern, I’ll even go so far as to do genetic testing on their liver’s capability to deal with hormones, as a result of there’s just a few totally different genetic, we name them snips, which simply means issues that you just don’t course of usually. Um, like say a standard particular person is 100% processing, you might course of it 60% or 30%. So typically I have a look at sure ways in which you course of hormones. And people individuals, I’d do decrease doses, I’d monitor them extra steadily. Um, and once more, that may be the ten% of the inhabitants. So when you’ve got a household historical past of most cancers, particularly hormone associated, or you’ve a, you may wanna get right into a deeper dialogue along with your physician, however on the core, what you are able to do is that this, you possibly can just remember to are utilizing clear merchandise in your hair, in your face, in your physique.

(40:31)
Transdermal drugs work for a cause as a result of we soak up every little thing via our pores and skin. And if we’re placing stuff on our pores and skin, typical perfumes or stuffed with phthalates, um, or any non-organic produce typically has, um, glyphosate residues or, or, uh, pesticide residues and all this stuff have a poisonous impact. So I wish to preserve it easy. And if we simply begin with clear air, clear water, clear meals to one of the best of our capability, that offers us a basis for secure hormone substitute as a result of we’re not getting a bunch of additional alerts to our physique from the meals that we eat or the water that we drink.

Betty Rocker (41:05):

Sure. And even, even with out hormone substitute remedy, if our intestine is just not working optimally, we aren’t gonna have the ability to course of extra. So like we talked somewhat bit about estrogen dominance somewhat bit in the past, and I do know that one of many issues that may make estrogen dominance worse, whilst we’re dropping that progesterone, possibly we’re within the early phases of perimenopause, is, uh, not with the ability to course of the surplus estrogen that we do have out of our physique. Proper. And we’ve, there’s this part of the intestine microbiome referred to as the estrobolome that helps to course of the estrogen. And if it’s not working, if it’s not in a position to operate effectively, it, it’s gonna ship that again into our system as soiled estrogen. What does that imply precisely? And the way does that, how does that influence us?

Dr. Jill Carnahan (41:51):

So that is actually massive and I’m so glad you introduced it up, as a result of what occurs is, um, our liver’s all the time doing the detox work and it simply squirts out stuff into the bile that’s presupposed to be eliminating, and that’s in our stool. So in case you’re a girl who has continual constipation, that alone places you at increased threat of reabsorbing toxins out of your setting or meals. And even in case you’re on hormones and you’ve got continual constipation, you’re gonna have extra bother eliminating the identical dose as a girl with out constipation. So the bowels and eliminating are so essential to this entire pathway and to changing hormones appropriately. So if we’re not, mainly that, that enterohepatic circulation, which is a extremely fancy phrase for the…,

Betty Rocker (42:28):

Did you say entero? And say it once more.

Dr. Jill Carnahan (42:30):

Enterohepatic. So it’s like intestine hepatic.

Betty Rocker (42:34):

Acquired it. Intestine liver.

Dr. Jill Carnahan (42:34):

Kinda like one other means for intestine liver circulation, that pathway on a regular basis is being reabsorbed. And so if we have now a bunch of poisons in our intestine and we’re not pooping out every day, um, we’re gonna reabsorb toxins and we’re gonna reabsorb hormones and we are able to get extreme ranges. Um, so it’s a actually massive deal to, it’s like fiber alone, getting good fiber out of your meals, which you’re professional at that along with your meal plans and all of the issues that you just do as a result of that’s,

Betty Rocker (42:58):

However I’m an advocate for it as effectively. Yeah. In addition to strolling, strolling after a meal Sure. Or strolling extra normally, like mm-hmm. That helps peristalsis all this stuff that assist the intestine and assist you’ve your common motion. Sure. Yeah.

Dr. Jill Carnahan (43:08):

And that’s a part of hormone substitute, as a result of in case you’re not shifting your bowels, you’re going to get extra poisonous. And this stuff which might be useful and exquisite may change into a poison to your system.

Betty Rocker (43:17):

Yep. Yep. Precisely. So I, I’m so glad that you just talked about that as a result of it’s, except for any sort of hormone substitute remedy, our physique has this elimination course of naturally for the hormones that we have already got in our system, our pure hormones. And so if we’re not eliminating effectively already, and we go pile hormones on prime of that, like bioidentical hormones or no matter type of hormone substitute remedy you’re utilizing, and also you’re not eliminating effectively, you simply set it so effectively, we’re poisoning ourselves quite than serving to ourselves. You’re, you’re turning one thing that’s this potion right into a poison. Proper, precisely. Which precisely we don’t need. Proper. We wish wanna take. Yeah. So, um, we talked about fiber, we talked about strolling extra. I believe staying hydrated additionally. So important for supporting intestine operate, chewing extra mindfully, chewing extra, slowing down while you eat to assist your salivary glands and the amylase and the entire issues that assist digestive digestion start in your mouth. What different like little scorching suggestions do you’ve for individuals to assist them with higher intestine well being? I simply mentioned just a few.

Dr. Jill Carnahan (44:19):

Find it irresistible. So I believe probiotic, I love to do spores. Um, however there’s so many good ones on the market. I simply spores have tended to work with even my robust, uh, , troublesome to deal with shoppers with intestine points. These are usually rather well tolerated. Um, one factor actually attention-grabbing is there’s plenty of pure substances that may assist us on these pathways, and you’ll speak to your physician about these, however some which might be actual frequent are sulforaphanes, which come from broccoli sprouts mm-hmm . And sprouted, um, seeds and issues. In order that’s an amazing place. You should purchase it as a cap, however you may also sprout your broccoli and have that in your salads. Um, Calcium D Glucarate is a kind of, it helps this section two of the liver, so processing that hormones and we are able to really see markers within the stool if we’re doing particular testing for somebody who isn’t processing effectively.

(45:02)
And we are able to add that calcium deg glucarate as a complement to assist them eradicate on this liver intestine entry. After which a 3rd one is DIM, and that is additionally a extremely highly effective one. Um, the one caveat with DIM is it’s so good at decreasing estrogen, and if somebody was like 65 and already having osteoporosis and already actually low estrogens, that’s sturdy sufficient that I in all probability wouldn’t use it in that inhabitants, however I’d, if it’s a 45-year-old lady on hormone substitute, having a tiny little bit of breast tenderness, these are type of the ways in which you could possibly use that sulforaphane, Calcium D Glucarate, and DIM. After which after all methylated B nutritional vitamins, simply B nutritional vitamins are essential for this course of. Um, and issues like NAC, which is basically supportive for the liver as effectively.

Betty Rocker (45:46):

So, attention-grabbing as you’re saying all of these, I’m remembering all of the protocols we did while you have been serving to me heal from, uh, mould publicity, which was horrible. And it, that occurred proper at first of my perimenopause journey and plenty of these issues that I wanted, the liver help, all of that. It was simply in, it’s simply attention-grabbing pondering again on it now, , there’s that nice Steve Jobs quote that was that “you possibly can’t join the dots wanting ahead, solely wanting backwards.” And now as I’m pondering again on the entire various things, oh yeah. The way you handled me, I’m understanding the connections that we made there and the ways in which you actually have been making an attempt to assist help all of these holistic processes and all of these issues I used previously that I don’t want particularly anymore mm-hmm .

(46:28)
And that, that basically will get me again to this factor that girls want entry to particular, individualized healthcare that’s this, that has this breadth, that has this depth that, that cares about these totally different facets of our well being and is educated in that sense. You recognize, and and I, I’ve been so fortunate to have you ever in my life, and for individuals who, who don’t get to have you ever as a result of you’ve a observe. You, you’ve, you’ve an incredible e book. There’s a film about you . You’ve, uh, an unimaginable web site with this depth of knowledge so that folks can be taught extra and change into advocates for themselves with their very own docs. You’ve a complement retailer the place individuals can buy plenty of a majority of these dietary supplements for themselves. And I simply, I really feel like you’ve plenty of wonderful assets. And is there something I not noted of that as a result of, effectively, your social media, what else did I overlook to say? Your

Dr. Jill Carnahan (47:28):

YouTube podcast visitor, however yeah, that’s it.

Betty Rocker (47:30):

Your podcast, proper? Your unimaginable podcast, which I’ve been honored to be a visitor on myself.

(47:34)
Um, however the place I used to be going partly with that, except for saying, okay, women, all of us want these assets and right here’s a few of what you will get from Dr. Jill. Um, and Dr. Jill and I have been speaking earlier than this podcast began about, effectively, the place else can girls go? Sure. And I used to be saying, I’ve been researching these totally different corporations that do this observe telehealth, and I’m gonna learn just a few and I’ll after all have all these linked within the present notes. And, um, I keep in mind I ran them by you earlier, Dr. Jill. ’trigger I simply wanna make it possible for this was , that I wasn’t going. You recognize, I, I believed they have been nice. Nevertheless it’s good to listen to your vote of confidence in these as effectively, as a result of that is I believe the way forward for that sort of drugs. And, and for girls particularly? Sure.

(48:15)
So listed here are a pair that I discovered. One is named Midi and I like midi. It’s like M-I-D-I and it’s, it’s a feminine based firm. It’s all these cool girls docs and it’s telehealth firm. There’s telehealth choices, proper? After which in addition they will prescribe hormone substitute remedy or no matter you’re snug with and no matter you want. And I simply watched a pair movies from one of many co-founders and was simply so impressed. She jogged my memory of you. She was so cool and right down to earth and like she, it was all very private for her ’trigger she’s gone via the journey herself. So I like Midi. One other one which I discovered, clearly you’ve in all probability heard of Winona. I believe Winona’s been round for a short time they usually’re nice. Additionally they have the telehealth choices. Um, one other one I discovered that’s down in Tampa, however they do, uh, telehealth and, and do numerous cool prescribing is defy, like they’re referred to as Defy, which I like.

Dr. Jill Carnahan (49:04):

Love

Speaker (49:04):

It. Def. I find it irresistible.

Betty Rocker (49:06):

Yeah. Defy. After which there’s one referred to as Stella And Stella I believed was actually cool. They’re additionally, in addition they have telehealth choices. They’ve the hormone substitute remedy choices. They’re, um, they’ve a web site for US based mostly sufferers in addition to UK based mostly sufferers. Oh, good. So you possibly can, you should utilize one or the opposite relying. I do know plenty of you guys are within the UK that, that take heed to my podcast. Thanks a lot. Um, after which I additionally, I used to be fascinated with my, my individuals in Australia. Um, there’s one thing referred to as Clinic 66, and if, in case you’re, in case you’re in search of choices for your self in your nation, I believe simply utilizing a few of these key phrases that Dr. Jill and I have been speaking about at present on this podcast, like, search for issues like telehealth, choices for hormone help in menopause. I really feel like I did that myself at totally different occasions and I’ve, and and I put it into totally different nations to see like, the place are they doing these things? And you then simply learn what’s on the web site and you then simply type of need to observe the threads and see the place, the place, the place it’s gonna give you the results you want. And I’ve seen the US based mostly ones, a few of them have limitations by state Yeah. That they’re gonna deal with. And are you aware a lot about that or like, , I do know you’re not gonna know what every particular person gonna do, however what are a number of the limitations that you just do know of in

Dr. Jill Carnahan (50:15):

State? Sure. Um, medical docs are nonetheless licensed by state. So you actually, um, sometimes are, until somebody involves see me in Colorado, I’m, I’ve to be extra cautious about who I deal with exterior of the state. In order that’s an entire deal. One of many issues that may be tremendous useful is when you’ve got a compounding pharmacy in your space, that’s an amazing place to name as a result of they know what physicians in your space are prescribing hormones. And normally the compounding pharmacies additionally know who actually know, as a result of they’re gonna be, like, for me, they know I prescribe plenty of hormones. I speak to the pharmacies on a regular basis. And so a good way is that if there’s a compounding pharmacy in your space, you name ’em and say, Hey, what docs are you aware in my space which might be doing this? And that’s one other good strategy to get in your space. Somebody who’s legit and your compounding pharmacy will sometimes know who that may be.

Betty Rocker (50:56):

And with the intention to discover a compounding pharmacy, would you simply Google compounding pharmacy in my space?

Dr. Jill Carnahan (51:00):

Yeah. Yeah. There may be P-C-C-A was once the largest, um, group that, uh, licensed Ok, so PCCA, I don’t know precisely what it’s one thing “Coumpounding Pharmacies of America”. However, um, if it’s simply pcca.org, I suppose, I don’t know the precise web site you need to have the ability to discover, uh, firm pharmacies. However yeah, you may also simply Google compounding pharmacy in my space.

Betty Rocker (51:21):

That’s nice. And I, I believe, I imply, and there are numerous greater than those that I simply, that brief checklist I gave you guys. I, I’ve, I’ve, I like all, I like all these choices which might be on the market for us. And I really feel prefer it’s, it’s, it’s gonna get higher. It’s, there’s gonna be increasingly of them hopefully over time, however actually simply having this dialog, asking for what you want, advocating for your self. I, you and I had a dialog, um, a month or two in the past and we have been speaking about the way you mentioned at present, like some docs you’re feeling like they gaslight their sufferers and it it’s as a result of they don’t know. Proper? They don’t have a clue. Proper. And I mentioned on a podcast the place we have been speaking about this, I used to be like, I really feel just like the docs don’t imply to be jerks about these things. They only don’t know. And in the event that they knew, they’d possibly attempt to get extra info, proper? As a result of all of them

Dr. Jill Carnahan (52:07):

Have, you consider like, even me, if I graduated from med college and I’m advised that that is harmful and that I by no means look and by no means be taught, which plenty of docs cease studying after, proper? Then why wouldn’t I say, oh, nope, don’t do it. That’s what I heard 2001, which is outdated information now. Proper? In order that’s plenty of them simply don’t know the most recent knowledge and the protection.

Betty Rocker (52:22):

If we have been to anticipate science to be this static factor, and we are able to solely take no matter’s been mentioned earlier than, I imply, we’d by no means have any girls particular,

(52:29)
Proper? Like we’d don’t have anything we, that we have now to permit science to be this evolving like, studying course of. That’s what science is. You recognize, they’re, they’re observing knowledge they usually’re reporting on it, and over time they get higher and higher at their strategies, hopefully. And yeah, I imply, simply seeing them, simply seeing, not them, however seeing the extra particular research finished on girls particularly. I imply, it’s like a revelation. You’re like, effectively why didn’t we do this earlier than? I do know , it’s about time , proper? Don’t y’all have a mother? Like, don’t you’ve a sister? Don’t. Yeah. So it’s simply, it’s nice to see that and I’m glad we’re having these conversations. However Dr. Jill, I simply wanna thanks once more a lot for taking the time to speak about all of this at present. We lined a lot in a short while. And is there something that I didn’t say or didn’t ask you that you just’d wanna be certain that to get throughout simply in case?

Dr. Jill Carnahan (53:17):

No, simply thanks for the great work you do on the planet and uh, thanks for having me on. It’s all the time a lot enjoyable. It’s like having espresso with a buddy and in case you’re on the market and also you’re struggling for hormones, you don’t need to. And there are simply, I like the assets you gave. There are such a lot of individuals who do perceive this. Um, and uh, I’d simply proceed to look till you discover these solutions.

Betty Rocker (53:36):

I’d agree. I’d agree with that. Sure. And thanks a lot in your work. And I’ll have hyperlinks within the present notes after all. And with this video so that you guys can observe up with Dr. Jill and get all of her unimaginable assets. She has so many, you’ve finished a lot work for girls and a lot work in your sufferers normally, women and men. Um, thanks once more a lot for being right here and we stay up for speaking to you once more. Thanks you, thanks a lot. And hey Rockstar, thanks a lot for listening at present. It’s been nice to spend time with you. I hope you discovered one thing that’s useful and I’ll have all these hyperlinks to the issues that we talked about, in addition to a few books and assets Dr. Jill shared with me that we didn’t get an opportunity to speak about on the present. Make sure you try the present notes web page for this episode over on my weblog at thebettyrocker.com within the podcast part for all of these hyperlinks. And I hope that wherever this finds you, you take nice care of your self. Until subsequent time, I’m Betty Rocker and you’re so superior, flawsome and wonderful. Bye for now.