PERI and POST Menopause Testing and Remedy 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 could have heard her earlier than. She is dually board licensed in household drugs, a practitioner of built-in holistic drugs, and can also be a purposeful drugs professional. She’s the writer of Sudden, a really inspiring learn, and she or he’s additionally the topic of a documentary referred to as Physician Affected person. She’s obtained a wonderful podcast and a very, actually useful weblog, simply full of nice free content material you’ll be able to 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 advanced and continual sickness. She’s the medical director on the Flatiron Practical 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 in addition to have the ability to share her with you guys as a result of she actually helps make sense out of so many advanced 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 lots of the girls I serve, um, is that this dialog about menopause, perimenopause and publish 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. 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 sort of advanced and the way far more we all know today. Why, why are folks nonetheless, I really feel like there’s nonetheless lots 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 truly comes from our occupation and I’ll inform you the story and it’ll make a lot sense. So I graduated 2001 and obtained 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 lots of of 1000’s 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 had 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 the very 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, properly documented by anybody who’s checked out this. There was truly a 34% discount in breast most cancers in that arm. So not solely was it not impartial like simply, or or dangerous, it was truly a discount. And we’ve identified for all of this time that hormones, particularly estradiol, helps the mind, the bone, and the um, menopause signs dramatically and the guts. So these issues had 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 improve above baseline with the Premarin Provera arm for breast most cancers incidents. However what occurred is what they had been, um, going towards because the baseline truly had a better 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 truly mimic progesterone deficiency in the long run as a result of it hits these receptors, nevertheless it’s not a pure progesterone. So neither of those trials, though they confirmed a decreased threat of breast most cancers, had been even utilizing the sort of hormones that you simply 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 problem. ’trigger right here I’m in menopause and I’m like, what’s protected for me? As a result of I’ve had breast most cancers and I can confidently say with no shadow of the doubt, I used to suppose we had to decide on. We don’t. I believe so long as you will have a very good 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 big problem for ladies and it’s gonna have an effect on bone, mind and coronary heart in a very good optimistic means. And now we expect it could even be protecting towards breast most cancers.

Betty Rocker (05:25):

I’ve been studying that information as properly and it’s nice to listen to it from you. And a part of why I wished to ask you that query to begin us off is in order that you recognize 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 for those who thought there was a threat for us. Now, in fact, there are gonna be some individuals who it’s contraindicated for. There’s sure issues as a clinician, I’m certain that you simply take 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 vital to only, though that was, to me that was a little bit technical, what you shared, and for those who’re listening and also you’re considering, I didn’t fairly comply with all the things she was saying, nevertheless it, you perceive the info as mm-hmm . A health care provider who reads the science, you perceive that it’s protected. Sure. That’s mainly what you’re saying. And like that these research in some methods had some actual flaws. Sure. They had been learning, um, types of hormones that we don’t truly use in girls’s drugs. And likewise 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 remedy, for instance, I might not give somebody hormones throughout remedy. In order that’s a really clear contra.

Betty Rocker (06:52):

Proper. So there you go. There’s a, there’s a purpose not that, and there are most likely another causes too. And, and but it needs to 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 only begin us off speaking about that. ’trigger you recognize, if we’re gonna get into a few of the viable remedy choices for ladies within the menopause years, it’s vital to know that we’ve considered this firstly, as a result of I believe security, girls’s security and, and and their entry to healthcare choices is actually vital. It’s important. Yeah. At all ages, and that is an age that I really feel like has been missed, has been ignored, has been too lengthy, simply kind of like, you’re simply getting previous. I can’t inform you what number of girls have written me, and also you’ve most likely seen this in your observe as properly, 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 only 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 foundation 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 simply mentioned it’s even at present, day by 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 completely no, and there’s no dialogue, you then wanna discover a completely different supplier as a result of it isn’t for everybody. And there’s an important selection. And you probably have lots 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):

Alternative, you mentioned selection. That’s the phrase. That’s, that’s it. And the schooling about it, to know that you could make an knowledgeable selection for your self to know there are threat components for sure folks, after which a few of us there aren’t. Nicely, let’s speak a little bit bit concerning the, the levels of a lady’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 publish menopause and menopause kind 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 completely different levels of their menopause journey. And so they wanna know all types of issues. Like, properly, 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 completely different levels? And I might think about that these are the sort of issues that you simply assist tackle 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 take a look at for? And what sort of signs do they present up with? In order that possibly you can, we might assist somebody on the market who’s attempting, who’s possibly struggling proper now or attempting 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 could actually go so long as 55. I believe the common age of that menopause date is round 52, 55. After which after is publish. However this could once more be nearly a 20 12 months span from 35 to 55 that some girls wrestle. 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 complete nother lecture price of fabric as a result of relying on for those who’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 a complete different dialogue. Nevertheless it’s vital that you’ve a health care provider that may assess the place you’re at as a result of you will have the signs usually.

(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 an absence of luteal part progesterone. That’s normally the very first thing that drops. So that you typically expertise estrogen dominance and hormones are all about stability inside each other. So if we now have our cycle follicular part, estrogen goes up, second a part of our cycle, luteal part, progesterone goes up and that simply yin and yang occurs all by means of 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 will have 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 generally herbs that may improve the lead part 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 for those who had a bottle of Heinz ketchup and also you’re squeezing out the final bit and the, then the hormones are beginning to go, you recognize, simply kinda like this little simply really fizzling out. There’s a large number of a spurting out and any individual may have a day that’s excessive and high and low and you may’t determine what’s happening. And even testing, you must watch out as a result of for those who’re testing that interval, you take a look at one month, you might 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 properly what’s happening? They could begin to have sizzling flashes, however they’re nonetheless having heavy cycles.

(11:50)
And so in that window, girls can nonetheless do bioidentical hormones. Nevertheless it’s vital 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 take a look at realizing that the take a look at could be up and down. And in that part it’s gonna be just like the Heinz ketchup spurting out randomly. And you then get to some extent the place these ovaries similar to, I’m accomplished. And that’s when the estrogen begins to actually drop. And that is when girls would begin to have sizzling flashes, evening sweats, unexpectedly they can not keep in mind names. Locations the place they put their keys, the place they’re going, they get within the automobile like the place am I driving to? Like issues the place they actually, girls have come to me and mentioned, I believe I’m shedding my thoughts. They will begin to have this such as you and I’ve been pushed girls in our area.

(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 actually frequent with girls. ’trigger they’re pushed they usually’re doing properly and the estrogen actually helps our mind keep on monitor. And when that drops we’re like, oh wait, my govt perform, the planning, the executing is impaired. And I’m like, I really feel like I’m shedding my thoughts. Or that the issues that I used to have the ability to deal with are more durable. Mm-hmm . Emotionally, you’re up and down. You could be extra tearful sooner or later extra indignant, sooner or later extra unhappy, you received, don’t wanna get outta mattress sooner or later and when none of these issues had 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 might really feel so disorienting. And you recognize, 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 lots of docs gaslight them into considering 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 for this reason it’s more durable to pinpoint generally 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 might begin as early as 35, nevertheless it additionally is sensible, proper? And, and it, I assume chances are you’ll not know precisely the place you might be. It could not go precisely together 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 previous mm-hmm . And I come to you and I say, I believe I’m in perimenopause. What would you particularly take a look at for? I can keep in mind a few of the belongings you examined me for particularly after I got here to see you. And naturally I had advanced signs and many various issues happening. It wasn’t simply menopause after we first began working collectively. However I do do not forget that over time you’ve examined me for some particular basic 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 accomplished at any typical lab. And though blood work isn’t all the time good, for those who’re utilizing like a cream or no matter, it’s a terrific place to begin. It typically might be coated by insurance coverage. And what you’d wanna do is a primary panel. Estradiol is the primary E two estrogen and you will get estriol and estro. However simply estradiol is an efficient place to begin.

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 varieties of estrogen. So estradiol is E two and that’s the one you wanna learn 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 for those who simply get one, get estradiol. And currently the lab now has a extremely delicate estradiol. So HS are extremely delicate is best as a result of that is very, very, very tiny elements within the blood. So that they’re measuring little tiny issues and it will get a little bit extra, um, particular and delicate with that extremely delicate estradiol. You wanna get proactive.

Betty Rocker (15:17):

Do you must get a particular take a look at 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 important. ’trigger we all the time take 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 selection, I’m testing all these and I’ll proceed with the remainder of them on day 19 by means of 21 of the cycle. In order that’s assuming you will have a typical 26, 28 day cycle ’trigger that’s gonna hit your LAL part. And what you’re gonna see there may be if the estrogen and progesterone are in stability. Proper? In order that’s the timing of what you may do for this. So estradiol, progesterone, DHEA sprint S is how we take a look at DHEA, which is one other steroid hormone within the blood. Testosterone, I wish to get each free and whole. Mm-hmm . After which cortisol within the morning. ’trigger that’s sort of an ordinary, though you can get it randomly by means of the day. And for those who simply get these 5 estradiol progesterone, uh, DHEA free and whole testosterone and cortisol, you’re gonna have a reasonably good concept. 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 could 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 a very good map.

Betty Rocker (16:38):

And I keep in mind these. That’s that primary 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 accomplished for me a number of methods over time. So to start with we might do a mix of the Dutch take a look at, which is a urine take a look at that we do on these very particular days of the luteal part of the cycle. And it’s essential to be monitoring your cycle so as to know the place you might be and when your luteal part is. And I discover that it’s truly actually useful to be monitoring your cycle whenever you’re in perimenopause as a result of it’s gonna provide you with some indication of realizing as your cycle begins to get erratic. It, it’s straightforward to only neglect about your cycle. Actually, I typically would neglect 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 might 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, in fact I’m sporting my Oura ring and that actually helps me. ’trigger I can see my basal physique temperature go up when round ovulation and it stays elevated by means of that second half of the cycle. However anyway, again to, um, these assessments, I might usually do this Dutch take a look at. You’d order that Dutch take a look at for me, the urine take a look at. After which I might additionally go fasted very first thing within the morning, early morning and get a blood take a look at as properly. And that was the place you had 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 can see issues like testosterone and you can see the opposite hormones mm-hmm . Um, nevertheless it was the, the mix of that with the Dutch take a look at that collectively gave you a a lot clearer image of what you wished to see that might aid you see if my hormones had been in stability, how out of stability they had 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 to start with I used to be capable of get by with merely utilizing some adaptogenic herbs that actually helped assist my stress response and helped nourish my hormones.

(18:52)
And, and I used to be capable of really feel higher though it didn’t actually make my hormone ranges go up a lot, I felt loads higher and it diminished lots of the signs I skilled. However then as I obtained a little bit farther into the perimenopause journey, it turned actually important for me to begin 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 point out you guys, in case you’re watching this on YouTube. I’ve obtained my patch mm-hmm . So I exploit this little patch and I’ll simply open up the little foil packet so you’ll be able to see it. It’s just a bit sticker that I placed on and, um, you modify it each few days. Or Dr.

(19:40)
Jill had even given me some suggestions as I’m very delicate to lots of these items the place we tried it for an extended interval firstly to see how I responded. After which we examined once more a couple of months later and I’ve additionally obtained some completely different lotions, topical lotions. She prior to now had had me strive, an oral progesterone. And we discovered that for me personally, the everyday suggestion was I believe to take it at evening. My physique didn’t like that, so I took it within the morning. So there’s simply all of those superb tuning kind of nuanced points of this. After which there’s additionally a pellet, which I do know you really helpful for very particular conditions, however for those who’ve obtained a pellet injected beneath your pores and skin, which we talked about in different podcasts, you’ll be able to’t change that. Yeah. It’s there. You may’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’ll be able to actually management your dosing, I believe actually, very well. These are all issues that I’ve skilled based mostly on the testing. And I may even say that you simply and I examined a very good quantity, like it might be a, a couple of instances a 12 months we might take a look at 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 remedy? 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 these items. After which if there was, if one thing responded, we might see that. And if it didn’t, we might alter my dosage. However we didn’t simply go actually quick into issues we needed to like take. And that may be, that may be a little bit little bit of a course of, proper? Like, ’trigger you need outcomes instantly, however for those who overdo it, you’ll be able to 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 frightened about clot threat. And what if I’ve this, uh, there’s completely different gene issues that you simply 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 for those who’ve been advised that’s a threat, the deal is oral hormones, particularly estrogens do improve 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 do not need 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 very well mm-hmm . So I nearly solely do the compound of lotions that you simply confirmed or the patch that you simply confirmed. And, um, there’s alternative ways to do these, however these are actually nice and protected 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 usually to comply with the hormones, love to do the Dutch, as a result of within the blood you received’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 generally do each, like we did with you. If I’ve a affected person who’s keen to do each, that’s the very best. However you’ll be able to see the variations as a result of for those who’re actually following a cream or a patch or a protocol, um, your Dutch urine take a look at is gonna present extra the correct ranges of your physique versus the blood.

Betty Rocker (22:41):

Mm. That’s tremendous fascinating. So if somebody had been simply attempting to comply with their hormones, in the event that they had been simply, if they may simply take a look at sort of consecutively, possibly not each month clearly, however like on an honest foundation, possibly each three or 4 months they’d use the Dutch take a look at as their main to, to see in the event that they had 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 sorts. May you wanna converse on that a little bit bit? I really feel like there’s lots of

Dr. Jill Carnahan (23:15):

Certain.

Betty Rocker (23:15):

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

Dr. Jill Carnahan (23:21):

There. Certain. And simply to reiterate what you mentioned about testing my normal affected person, we’d begin them on a protocol and normally about each six months is sort of when, generally 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):

Certain.

Dr. Jill Carnahan (23:35):

So all people who will get hormones is required by me to do a yearly take a look at. So I do know, and generally extra often if we’re altering doses, in the event that they’re actually steady, yearly does fairly good. Certain. Like I’m at a spot now, I do every year and I’m steady on doses. So what is obtainable? 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 simply’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 commonest ’trigger girls don’t have to consider it.

Betty Rocker (24:09):

Yeah.

Dr. Jill Carnahan (24:09):

Um, so there’s plenty of alternative ways. And that is just one, it’s the E two, the estradiol that’s essentially the most sturdy. It really works, it’s an effective way to do it. However lots of instances girls need to have a mix and we will prescribe compounded estriol, which is that weaker type of estrogen. And for instance, if we now have somebody who has latest breast most cancers or very, very involved, estriol is sort 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, one of these estrogen is actually protected. So you probably have any concern, you’ll be able to all the time compound these. And infrequently 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’ll be able to compound it, I can begin with a lot tinier doses for somebody who’s actually delicate. And you may as well put progesterone in that cream. So a lot of my girls have like a biased that means like two varieties of estrogen with a little bit 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 truly decide the precise dosages for that particular person affected person and alter it based mostly on their outcomes with superb 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 a little bit 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’ve got testosterone – decrease than males, however we now have testosterone. We want 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 may be 4 instances the incidence of autoimmunity in girls as there may be in males, as a result of that decrease testosterone truly will increase threat of autoimmunity. So there may be, 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 precise dose will actually change your life, your thoughts and all these issues. Along with the estradiol libido for ladies, it completely has an impact. Vaginal dryness.

(26:39)
And like I mentioned, bone and mind are big with testosterone. So testosterone could be given as a, we nearly by no means need 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 attempting 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 ladies, wherever you apply that cream, inside thigh or wrist, you’re gonna get a little bit hair progress. So lots of girls don’t like that. And so as a substitute of doing the cream, I’ll typically do a trochexf or a sublingual tab that dissolves beneath your tongue so that you simply get that dose with out stepping into your intestine and thru the liver. Um, lots of girls, uh, do injectable now.

(27:19)
It was that the industrial kinds had been just for males. So to get the tiny doses that we would have liked, had been actually laborious to attract it in a syringe. However I do discover, properly now we will compound it like girls concentrations. And I do like, so long as girls’s are afraid of doing a injection as soon as per week or as soon as each 10 days, that’s an effective way. It usually does give a degree that sort of goes up and down each time you inject. So you will have a little bit bit extra variation than you’d with a each day dose. So testosterone could 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 all the industrial, um, ones, patches, lotions, even injectable, are usually made for male dosing. So that is usually compounded for ladies, 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 stability. After which I additionally take, um, the oral DHEA complement to assist, as a result of that’s in fact 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 fascinating 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 more durable for them to make a few of these backup hormones. And I keep in mind a very fascinating dialog. You and I had some time again the place you had been like, you recognize, you see girls who’ve a very sturdy, um, adrenal perform have a better time in, in going by means of perimenopause as a result of they don’t seem to be strapped of the backup hormone system. Virtually. 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 accomplished, I’m for drained. Proper. Which is what occurs after we hit menopause. They ovaries cease producing the hormones, our adrenals take over. So we nonetheless do produce a little bit little bit of hormones from the adrenal glands after menopause, not almost 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 caring for your mother and father and your youngsters and all these generations, then it’s actually frequent to have a way more tough in menopause. And I like DHEA, initially, it’s the one one in every of these that isn’t requiring a prescription. The remainder of these, you do want a prescription. Proper. Um, and only for the report, testosterone continues to be thought of managed, whether or not it’s athletes or there’s some issues that they, so that’s a type of that you could nonetheless get a prescription no drawback.

(29:57)
Nevertheless it’s within the class of managed prescription. So that you might need to get a decrease quantity, like six months versus a 12 months or sure issues. Um, however DHEA is obtainable over-the-counter and girls typically do properly on 5 or 10 milligrams upwards of 25. However that’s a reasonably excessive dose for lots of girls. And what can occur there may be that may assist your manufacturing of cortisol. If the adrenals are low and also you’re low cortisol, it’ll assist testosterone and DHEA. So it’s sort of a pleasant adrenal assist 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 sort of folks I most likely wouldn’t placed on DHEA. ’trigger you then elevate the cortisol and you could 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 get away. So cease the DHEA.

Betty Rocker (30:41):

Proper. Uh, I believe it is a good alternative for us to shift a little bit bit to the postmenopausal dialog. I wanna discuss all the things abruptly, in every single place, in fact. However, however I actually need, I’m actually and curious as a result of I’ll be in publish menopause quickly and I wanna know what to anticipate. And I’ve obtained lots of girls who pay attention who’re in publish menopause, they usually wanna know, properly, 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 may truly undergo this very easily after which hit menopause and sort of have been on hormones. Certain. However what you’re speaking about, I believe is say that lady out there may be 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):

And so they’re like, properly, 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 every of our researchers and main specialists 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 perform. And, and so this previous fantasy 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 previous for hormones. That’s not true. Our brains, until the tip of our life can use the hormones. Now, possibly sooner or later you want lesser doses, however I might say to any lady who’s postmenopausal and possibly having signs, possibly not, I might 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 whenever you first begin hormones, you probably have by no means been on them, there’s a little bit little bit of adjustment as a result of chances are you’ll not both have the ability to sense that hormone properly, or chances are you’ll 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 actually with coronary heart, mind, and bone. There is no such thing as a age too previous that doesn’t profit from hormones so long as there’s a dialog and all of that

Betty Rocker (33:06):

Occurring, and it’s approached fastidiously. That makes whole sense. And I’m so glad you mentioned that. Um, a few of the telehealth websites that assist girls with balancing their, their hormones publish menopause, they are saying that they’re, they’re not gonna prescribe for those who’ve, or they, they, there’s some wording about for those who’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 kind of, are they atrophy, such as you mentioned? Yeah. However that there nonetheless may very well be, that you simply nonetheless might have that chance. So, so say, say somebody got here to you and she or he’s similar to possibly a couple of years in to publish menopause. What would you take a look at her for? What would you be taking a look at? Would you take a look at, I imply, you most likely nonetheless wanna see like what her ranges of estrogen or like, you most likely wanna test her cortisol, I don’t know. What, what do you kind of take a look at to, to assist her? And, and clearly it’s individually based mostly as properly, but when she’s all for some kind of hormone substitute remedy, I assume what, what dialog and the way do you take a look at?

Dr. Jill Carnahan (34:04):

Yeah. So we’d nonetheless do most likely blood work or Dutch hormones, one or the opposite, or each. After which what we’d wanna do is there’s a threat of you probably have 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 will have these growths which might be benign progress, 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 you probably have them. They’re massive or uncomfortable. They’re usually 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 likewise, if you’re perimenopause or in these earlier years, forties or fifties, and you’ve got had a large problem with fibroids or endometriosis, these are discussions we wanna have about easy methods to dose this and be watching that fastidiously.

(35:00)
So usually a lady who’s by no means had any hormones, I might display screen them with a pelvic ultrasound to only take a look at that pelvis and ensure all the things’s protected. As a result of if they’ve fibroids, these might develop with hormones. And you must 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, most likely ought to decrease it. In order that’s like a warning factor. I’ll say, you don’t wanna have breast tenderness, or for those who do and it’s simply transient for per week and it goes away, that’s most likely okay. After which the third factor is for those who ever cease bleeding for over a 12 months, that’s technically the definition of menopause. You’ve gone into publish menopause, um, and also you begin to have bleeding that 12 months with no cycle that requires you to get an endometrial biopsy and a workup to ensure your lining shouldn’t be getting too thick. And these are simply these cautious issues {that a} good physician would do for those who’re on hormones, as a result of hormones could cause that lining to get thicker. And so you probably have a excessive threat of that, or some purpose, you’d need to have that dialogue about security and efficacy together with your physician. However I might all the time do a pelvic ultrasound and test their medical historical past after which speak with them fastidiously. I might additionally most likely begin a 70-year-old lady on a a lot, a lot, a lot decrease dose than I might a 45-year-old lady.

Betty Rocker (36:10):

Certain. Thanks for sharing that. And that’s so useful to know as we go into these items, we wanna have our eyes open about threat components. And also you talked about that you simply, you do a Dutch take a look at 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 seeking to see the place her ranges are at in order that you can decide now. After which for somebody who’s post-menopausal, are you gonna be placing her or a person as an anyone, I assume, 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 varieties of hormones? Would they want all of them? Or are you, are they extra prone to be simply getting on an estrogen or possibly some testosterone? Or is there a purpose to nonetheless add progesterone? I’m simply so .

Dr. Jill Carnahan (36:57):

Sure. So, um, the, the everyday medical coaching is you probably have 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 creating endometrial most cancers. So we as physicians who’re doing good work, would by no means give a lady who nonetheless has her uterus unopposed estrogen by itself. You’d 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 very 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 ultimately as they hit the ovaries begins to tank, then they, we add the estrogen. And so somebody older, I might begin with progesterone estrogen alone, earlier than I might add lots of testosterone DHEA, as a result of then you can, there’s, as you’ll be able to 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 a little bit testosterone. Um, and see, and I might 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 applicable.

Betty Rocker (38:17):

Fascinating. Wow. Nicely, you’ve given us lots of actually nice info to consider, however I believe that one factor that we now have not talked about but, that’s all the time been part of our work collectively that I wanna make sure that girls hear about is what hormones are doing in our physique and the way they’re truly excreted. As a result of there’s a actually vital side of our hormone stability that has to do with our intestine well being. Proper. And would you converse on that a little bit bit, as a result of I, I believe that is one thing that you simply care loads about and also you’ve guided me very well on as properly.

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 now have to detoxify these. And infrequently when girls get into bother, even with threat of breast most cancers, endometrial most cancers, any kind of hormone associated problem, it’s not that their hormones are the unhealthy guys, it’s that they’re not capable of do away with the surplus. They accumulate sure metabolites that may harm DNA, and that results in unhealthy issues. And curiously, 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 lots of instances the, our tub 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 surroundings than the hormones we take, however we now have to consider that. So if I’m actually going deep or somebody has lots of concern, I could even go so far as to do genetic testing on their liver’s capacity to deal with hormones, as a result of there’s a couple of completely different genetic, we name them snips, which simply means issues that you simply don’t course of usually. Um, like say a standard particular person is one hundred percent processing, chances are you’ll course of it 60% or 30%. So generally I take a look at sure ways in which you course of hormones. And people folks, I’d do decrease doses, I’d monitor them extra often. Um, and once more, that may be the ten% of the inhabitants. So you probably have a household historical past of most cancers, particularly hormone associated, or you will have a, you may wanna get right into a deeper dialogue together with your physician, however on the core, what you are able to do is that this, you’ll be able to just remember to are utilizing clear merchandise in your hair, in your face, in your physique.

(40:31)
Transdermal medicines work for a purpose as a result of we take up all the things by means of 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 these items have a poisonous impact. So I wish to maintain it easy. And if we simply begin with clear air, clear water, clear meals to the very best of our capacity, that provides us a basis for protected hormone substitute as a result of we’re not getting a bunch of additional indicators 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 shouldn’t be working optimally, we aren’t gonna have the ability to course of extra. So like we talked a little bit bit about estrogen dominance a little bit bit in the past, and I do know that one of many issues that may make estrogen dominance worse, whilst we’re shedding that progesterone, possibly we’re within the early levels 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 capable of perform properly, 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 impression 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 imagined to be eliminating, and that’s in our stool. So for those who’re a lady who has continual constipation, that alone places you at larger threat of reabsorbing toxins out of your surroundings or meals. And even for those who’re on hormones and you’ve got continual constipation, you’re gonna have extra bother eliminating the identical dose as a lady with out constipation. So the bowels and eliminating are so essential to this complete pathway and to changing hormones appropriately. So if we’re not, mainly that, that enterohepatic circulation, which is a very 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):

Obtained 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 now have a bunch of poisons in our intestine and we’re not pooping out each day, um, we’re gonna reabsorb toxins and we’re gonna reabsorb hormones and we will 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 together with your meal plans and all of the issues that you simply do as a result of that’s,

Betty Rocker (42:58):

However I’m an advocate for it as properly. Yeah. In addition to strolling, strolling after a meal Sure. Or strolling extra basically, like mm-hmm. That helps peristalsis all these items that assist the intestine and assist you will have your common motion. Sure. Yeah.

Dr. Jill Carnahan (43:08):

And that’s a part of hormone substitute, as a result of for those who’re not shifting your bowels, you’re going to get extra poisonous. And these items which might be useful and exquisite might develop into a poison to your system.

Betty Rocker (43:17):

Yep. Yep. Precisely. So I, I’m so glad that you simply talked about that as a result of it’s, other than any kind 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 properly already, and we go pile hormones on prime of that, like bioidentical hormones or no matter sort of hormone substitute remedy you’re utilizing, and also you’re not eliminating properly, you simply set it so properly, 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 perform, chewing extra mindfully, chewing extra, slowing down whenever you eat to assist your salivary glands and the amylase and all the issues that assist digestive digestion start in your mouth. What different like little sizzling ideas do you will have for folks to assist them with higher intestine well being? I simply mentioned a couple of.

Dr. Jill Carnahan (44:19):

Adore it. So I believe a very good 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 powerful, uh, you recognize, tough to deal with shoppers with intestine points. These are usually very well tolerated. Um, one factor actually fascinating is there’s lots of pure substances that may assist us on these pathways, and you may 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 a terrific place. You should purchase it as a cap, however you may as well sprout your broccoli and have that in your salads. Um, Calcium D Glucarate is a kind of, it helps this part two of the liver, so processing that hormones and we will truly see markers within the stool if we’re doing particular testing for somebody who isn’t processing properly.

(45:02)
And we will add that calcium deg glucarate as a complement to assist them get rid of on this liver intestine entry. After which a 3rd one is DIM, and that is additionally a very highly effective one. Um, the one caveat with DIM is it’s so good at reducing estrogen, and if somebody was like 65 and already having osteoporosis and already actually low estrogens, that’s sturdy sufficient that I most likely wouldn’t use it in that inhabitants, however I might, if it’s a 45-year-old lady on hormone substitute, having a tiny little bit of breast tenderness, these are sort of the ways in which you can use that sulforaphane, Calcium D Glucarate, and DIM. After which in fact methylated B nutritional vitamins, simply B nutritional vitamins are essential for this course of. Um, and issues like NAC, which is actually supportive for the liver as properly.

Betty Rocker (45:46):

So, fascinating as you’re saying all of these, I’m remembering all of the protocols we did whenever you had been serving to me heal from, uh, mould publicity, which was horrible. And it, that occurred proper at first of my perimenopause journey and lots of these issues that I wanted, the liver assist, all of that. It was simply in, it’s simply fascinating considering again on it now, you recognize, there’s that nice Steve Jobs quote that was that “you’ll be able to’t join the dots trying ahead, solely trying backwards.” And now as I’m considering again on all the 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 had been attempting to assist assist all of these holistic processes and all of these issues I used prior to now that I don’t want particularly anymore mm-hmm .

(46:28)
And that, that actually 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 completely different points of our well being and is educated in that sense. , 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 will have a observe. You, you will have, you will have a tremendous e-book. There’s a film about you . You might have, uh, an unimaginable web site with this depth of knowledge so that folks can be taught extra and develop into advocates for themselves with their very own docs. You might have a complement retailer the place folks should buy lots of these kinds of dietary supplements for themselves. And I simply, I really feel like you will have lots of superb assets. And is there something I overlooked of that as a result of, properly, your social media, what else did I neglect 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, other than 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 had been speaking earlier than this podcast began about, properly, the place else can girls go? Sure. And I used to be saying, I’ve been researching these completely different firms that do this observe telehealth, and I’m gonna learn a couple of and I’ll in fact 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 guarantee that this was a very good, that I wasn’t going. , I, I assumed they had been nice. Nevertheless it’s good to listen to your vote of confidence in these as properly, as a result of that is I believe the way forward for that kind of medication. And, and for ladies particularly? Sure.

(48:15)
So listed below are a pair that I discovered. One is known as 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 additionally 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 all the way down to earth and like she, it was all very private for her ’trigger she’s gone by means of the journey herself. So I like Midi. One other one which I discovered, clearly you’ve most likely heard of Winona. I believe Winona’s been round for a short while 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 various 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 like it.

Betty Rocker (49:06):

Yeah. Defy. After which there’s one referred to as Stella And Stella I assumed was actually cool. They’re additionally, additionally they have telehealth choices. They’ve the hormone substitute remedy choices. They’re, um, they’ve an internet site for US based mostly sufferers in addition to UK based mostly sufferers. Oh, good. So you’ll be able to, you should use one or the opposite relying. I do know lots of you guys are within the UK that, that hearken to my podcast. Thanks a lot. Um, after which I additionally, I used to be occupied with my, my folks in Australia. Um, there’s one thing referred to as Clinic 66, and if, for those who’re, for those who’re searching for choices for your self in your nation, I believe simply utilizing a few of these key phrases that Dr. Jill and I had been speaking about at present on this podcast, like, search for issues like telehealth, choices for hormone assist in menopause. I really feel like I did that myself at completely different instances and I’ve, and and I put it into completely different nations to see like, the place are they doing these items? And you then simply learn what’s on the web site and you then simply sort of need to comply with 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 have you learnt a lot about that or like, you recognize, I do know you’re not gonna know what every particular person gonna do, however what are a few of the limitations that you simply do know of in

Dr. Jill Carnahan (50:15):

State? Sure. Um, medical docs are nonetheless licensed by state. So you actually, um, usually 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 a complete deal. One of many issues that may be tremendous useful is you probably have a compounding pharmacy in your space, that’s a terrific 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 lots of hormones. I speak to the pharmacies on a regular basis. And so an effective way is that if you recognize there’s a compounding pharmacy in your space, you name ’em and say, Hey, what docs have you learnt in my space which might be doing this? And that’s one other good solution to get in your space. Somebody who’s legit and your compounding pharmacy will usually know who that may be.

Betty Rocker (50:56):

And so as to discover a compounding pharmacy, would you simply Google compounding pharmacy in my space?

Dr. Jill Carnahan (51:00):

Yeah. Yeah. There’s P-C-C-A was the largest, um, group that, uh, licensed Okay, 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 assume, I don’t know the precise website you must have the ability to discover, uh, firm pharmacies. However yeah, you may as well simply Google compounding pharmacy in my space.

Betty Rocker (51:21):

That’s nice. And I, I believe, I imply, and there are a lot of 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 had been speaking about the way you mentioned at present, like some docs you are 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 had been speaking about this, I used to be like, I really feel just like the docs don’t imply to be jerks about these items. 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 concentrate on 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 lots 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 previous information now. Proper? In order that’s lots of them simply don’t know the most recent information and the protection.

Betty Rocker (52:22):

If we had been to count on science to be this static factor, and we will 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 now have to permit science to be this evolving like, studying course of. That’s what science is. , they’re, they’re observing information 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 accomplished on girls particularly. I imply, it’s like a revelation. You’re like, properly 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 will have 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 coated a lot in a short while. And is there something that I didn’t say or didn’t ask you that you simply’d wanna make sure that to get throughout simply in case?

Dr. Jill Carnahan (53:17):

No, simply thanks for the great work you do on this 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 for those who’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 might simply proceed to look till you discover these solutions.

Betty Rocker (53:36):

I might agree. I might agree with that. Sure. And thanks a lot in your work. And I’ll have hyperlinks within the present notes in fact. And with this video so that you guys can comply with up with Dr. Jill and get all of her unimaginable assets. She has so many, you’ve accomplished a lot work for ladies and a lot work in your sufferers basically, 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. Be 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 might be so superior, flawsome and superb. Bye for now.