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 the moment 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 knowledgeable. She’s the creator of Sudden, a really inspiring learn, and he or she’s additionally the topic of a documentary known as Physician Affected person. She’s bought a wonderful podcast and a extremely, actually useful weblog, simply full of nice free content material you may entry anytime and is a survivor of breast most cancers, Crohn’s illness and poisonous mildew sickness. She brings a novel perspective to treating sufferers within the midst of complicated and power sickness. She’s the medical director on the Flatiron Practical Drugs Heart simply outdoors of Boulder, Colorado. And my very own private physician and I at all times 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 complicated well being associated topics which can be related to us all. Please be a 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 the moment.

Dr. Jill Carnahan (01:31):

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

Betty Rocker (01:34):

Sure, it’s at all times nice to get to examine 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 ladies I serve, um, is that this dialog about menopause, perimenopause and put up 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 type of advanced and the way way more we all know today. Why, why are individuals nonetheless, I really feel like there’s nonetheless loads 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 bought out of medical faculty and that yr was the yr 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 danger of breast most cancers with hormone substitute? And actually a whole bunch of 1000’s of ladies stopped their hormone substitute as a result of this media took this story, put it on the market. And at the same time as a physician, 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 yr sense is that they analyzed the info in that largest randomized management trial of ladies 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 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 identified 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. They’d 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 in opposition to because the baseline really 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 really mimic progesterone deficiency in the long run as a result of it hits these receptors, however it’s not a pure progesterone. So neither of those trials, though they confirmed a decreased danger of breast most cancers, have been even utilizing the type 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 and not using a shadow of the doubt, I used to suppose we had to decide on. We don’t. I feel so long as you have got a very good practitioner who is aware of what they’re doing, you’re checking ranges. And we’ll discuss all that at the moment. Um, it is a large problem for ladies and it’s gonna have an effect on bone, mind and coronary heart in a very good optimistic method. And now we expect it could even be protecting in opposition to breast most cancers.

Betty Rocker (05:25):

I’ve been studying that knowledge as properly and it’s nice to listen to it from you. And a part of why I needed 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 method 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 should you thought there was a danger 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 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 physician, they should care about.

(06:06)
However I feel it’s actually vital to only, though that was, to me that was a bit technical, what you shared, and should you’re listening and also you’re considering, I didn’t fairly observe the whole lot she was saying, however 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 have been finding out, um, types of hormones that we don’t really use in ladies’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):

If you happen to’re present process breast most cancers remedy, for instance, I’d 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 ladies have entry to is all I’m seeing with out all of the concern. And, and that’s why I needed to only begin us off speaking about that. ’trigger , if we’re gonna get into among the viable remedy choices for ladies within the menopause years, it’s vital to know that we’ve thought of this before everything, as a result of I feel security, ladies’s security and, and and their entry to healthcare choices is basically 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 ladies have written me, and also you’ve most likely seen this in your follow 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 want 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 can 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 really like that you simply mentioned it’s even at the moment, every single day in my follow, I’ve these discussions with ladies 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, then you definately wanna discover a totally different supplier as a result of it isn’t for everybody. And there’s a vital selection. And you probably have loads of nervousness or concern, I by no means push anybody. So there’s nonetheless, I could also be possibly 20% of my ladies 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 which you can make an knowledgeable selection for your self to know there are danger components for sure individuals, after which a few of us there aren’t. Nicely, let’s discuss a bit bit concerning the, the levels 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 put up menopause and menopause kind of like defines that cusp the place we go to the following stage, as we name it. Proper? And, and so there are ladies who come to you at, at these totally different levels of their menopause journey. And so they wanna know every kind 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 seem like at these totally different levels? And I’d think about that these are the type of issues that you simply assist handle in your follow. So if, if somebody involves you and says, I feel 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 ladies as younger as 35 can begin to expertise these perimenopausal signs. And normally from 35 to 45 is that realm. It could go so long as 55. I feel the common age of that menopause date is round 52, 55. After which after is put up. However this could once more be virtually a 20 yr span from 35 to 55 that some ladies wrestle. So one factor I’m a fan of, and never all medical doctors do that is testing. I exploit blood, urine, several types of issues to evaluate various things. And it is a complete nother lecture value of fabric as a result of relying on should you’re utilizing a cream or an oral or the way you’re doing it, sure checks choose up issues otherwise. And that’s a complete different dialogue. But it surely’s vital that you’ve got a physician that may assess the place you’re at as a result of you have got the signs sometimes.

(10:26)
And the signs can, um, for instance, in that early half, so say 35 to 45 or 50, usually you begin to first have a scarcity of luteal part progesterone. That’s normally the very first thing that drops. So that you usually expertise estrogen dominance and hormones are all about steadiness inside each other. So if now we 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 via our twenties and thirties. Nicely, in our late thirties or early forties, what begins to occur is that progesterone will usually diminish manufacturing. So you have got this dominance of the estrogen all through the cycle that may trigger breast tenderness, moodiness, heavy, painful intervals, 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 enhance 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 at all times say it’s virtually like should 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 tapering off. There’s a large number of a spurting out and someone may have a day that’s excessive and high and low and you may’t work out what’s happening. And even testing, you must watch out as a result of should you’re testing that interval, you check one month, you may need excessive estrogen, low progesterone the following month it is perhaps low and it simply does this dance. And that’s the time when ladies are so annoyed ’trigger like, I don’t really feel properly what’s happening? They may begin to have scorching flashes, however they’re nonetheless having heavy cycles.

(11:50)
And so in that window, ladies can nonetheless do bioidentical hormones. But it surely’s vital to have a clinician that is aware of find out how to assess the signs associated to what they’re seemingly experiencing hormonally. After which additionally check figuring out that the check will be up and down. And in that part it’s gonna be just like the Heinz ketchup spurting out randomly. And then you definately get to some extent the place these ovaries similar to, I’m finished. And that’s when the estrogen begins to actually drop. And that is when ladies would begin to have scorching flashes, night time sweats, unexpectedly they can’t bear 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, ladies have come to me and mentioned, I feel I’m shedding my thoughts. They’ll begin to have this such as you and I’ve been pushed ladies 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 widespread with ladies. ’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 operate, 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 tougher. Mm-hmm . Emotionally, you’re up and down. You might be extra tearful in the future extra indignant, in the future extra unhappy, you gained, don’t wanna get outta mattress in the future and when none of these issues have been there earlier than. So I really like speaking to ladies as a result of so many ladies actually really feel like they’re going loopy if nobody validates this and it’s a traditional expertise, however it could really feel so disorienting. And , even the dad so far as damaged relationships and divorces on this time, it’s not stunning that that goes up as a result of ladies really feel like they’re going loopy. And most males and lots of medical doctors 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 that is why it’s tougher 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 stunning to listen to you say that it could begin as early as 35, however it additionally is smart, proper? And, and it, I suppose it’s possible you’ll 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 girl, or say I’m like 40 years previous mm-hmm . And I come to you and I say, I feel I’m in perimenopause. What would you particularly check for? I can bear in mind among the belongings 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 do not forget 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 standard lab. And though blood work isn’t at all times good, should you’re utilizing like a cream or no matter, it’s an awesome place to start out. It usually shall 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 should you simply get one, get estradiol. And these days 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 elements within the blood. In order that they’re measuring little tiny issues and it will get a 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 check to check for that. Does your physician,

Dr. Jill Carnahan (15:20):

No, this might 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 needed to verify there wasn’t one thing particular we needed to ask for .

Dr. Jill Carnahan (15:32):

Yeah, no, estradiol. After which progesterone additionally essential. ’trigger we at all times 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 via 21 of the cycle. In order that’s assuming you have got a typical 26, 28 day cycle ’trigger that’s gonna hit your LAL part. 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 prefer to get each free and whole. Mm-hmm . After which cortisol within the morning. ’trigger that’s type of a typical, though you could possibly get it randomly via the day. And should you simply get these 5 estradiol progesterone, uh, DHEA free and whole testosterone and cortisol, you’re gonna have a reasonably 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 could cause zits or PCOS. However you don’t must get that fancy. If you happen to simply get these imply 5, that’ll offer you a very good map.

Betty Rocker (16:38):

And I bear in mind these. That’s that fundamental panel I’ve had repeatedly and I needed to the touch on that as a result of A, these, so that you’ve had these checks finished for me a number of methods over time. So to start with 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 part of the cycle. And it’s worthwhile to be monitoring your cycle with a purpose to know the place you’re and when your luteal part is. And I discover that it’s really actually useful to be monitoring your cycle whenever you’re in perimenopause as a result of it’s gonna offer you some indication of figuring out as your cycle begins to get erratic. It, it’s straightforward to only neglect about your cycle. Actually, I usually 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’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 carrying 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 checks, 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 properly. 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. One in every of ’em is free, I don’t bear in mind. Mm-hmm.

(18:05)
However T three and T 4. And then you definately, 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 feel you could possibly see issues like testosterone and you could possibly see the opposite hormones mm-hmm . Um, however it was the, the mixture of that with the Dutch check that collectively gave you a a lot clearer image of what you needed 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 bear in mind to start with 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 though it didn’t actually make my hormone ranges go up a lot, I felt quite a bit higher and it decreased loads of the signs I skilled. However then as I bought a bit farther into the perimenopause journey, it grew to become 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 top 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 bought my patch mm-hmm . So I exploit this little patch and I’ll simply open up the little foil packet so you may 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 loads of these things the place we tried it for an extended interval in the beginning to see how I responded. After which we examined once more just a few months later and I’ve additionally bought some totally different lotions, topical lotions. She previously had had me attempt, an oral progesterone. And we discovered that for me personally, the standard advice was I feel 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 high quality 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 should you’ve bought a pellet injected beneath your pores and skin, which we talked about in different podcasts, you may’t change that. Yeah. It’s there. You possibly can’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 may actually management your dosing, I feel actually, very well. These are all issues that I’ve skilled based mostly on the testing. And I will even say that you simply and I examined a very good quantity, like it might be a, just a few occasions a yr 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 remedy? We needed to provide it sufficient time for it to, to have some impact. And we needed 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 regulate 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 bit little bit of a course of, proper? Like, ’trigger you need outcomes instantly, however should you overdo it, you may 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 anxious about clot danger. And what if I’ve this, uh, there’s totally 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 should you’ve been advised that’s a danger, the deal is oral hormones, particularly estrogens do enhance the chance of clot. It’s why you’ll virtually 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 would not have the identical danger. 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 virtually completely 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 usually 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 at all times 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 may see the variations as a result of should 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 fascinating. 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 a bit bit? I really feel like there’s loads 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 things. So inform us concerning the variations

Dr. Jill Carnahan (23:21):

There. Certain. And simply to reiterate what you mentioned about testing my customary affected person, we’d begin them on a protocol and normally about each six months is type of when, generally sooner in the event that they’re having signs, however on a routine, and on the very least, I’m gonna examine 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 check. So I do know, and generally extra incessantly if we’re altering doses, in the event that they’re actually secure, yearly does fairly good. Certain. Like I’m at a spot now, I do every year and I’m secure on doses. So what is out there? So there are common pharmaceutical professional prescriptions you will get at CVS, Walgreens or your common pharmacy which can 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 ladies don’t have to consider it.

Betty Rocker (24:09):

Yeah.

Dr. Jill Carnahan (24:09):

Um, so there’s a number of alternative ways. And that is just one, it’s the E two, the estradiol that’s probably the most sturdy. It really works, it’s an effective way to do it. However loads of occasions ladies need to have a mix and we are able to prescribe compounded estriol, which is that weaker type of estrogen. And for instance, if now we have somebody who has current breast most cancers or very, very involved, estriol is type of a caboose, estrogen which 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 basically protected. So you probably have any concern, you may at all times 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 may compound it, I can begin with a lot tinier doses for somebody who’s actually delicate. And you too can put progesterone in that cream. So a lot of my ladies have like a biased which means like two sorts of estrogen with a bit progesterone multi functional, 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 method I can really choose the precise dosages for that particular person affected person and regulate it based mostly on their outcomes with high quality tuning.

Betty Rocker (25:24):

That’s so cool. Uh, I really 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 discuss a bit bit about that as a result of we don’t usually 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 now we have 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 explanation why there’s 4 occasions the incidence of autoimmunity in ladies as there’s in males, as a result of that decrease testosterone really will increase danger 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 ladies. So I’m an enormous fan now. You don’t need extreme, however getting the correct 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 large with testosterone. So testosterone will be given as a, we virtually by no means need to give a capsule 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 at all times 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 ladies, wherever you apply that cream, interior thigh or wrist, you’re gonna get a bit hair development. So loads of ladies don’t like that. And so as a substitute of doing the cream, I’ll usually do a trochexf or a sublingual tab that dissolves beneath your tongue so that you simply get that dose with out moving into your intestine and thru the liver. Um, loads of ladies, uh, do injectable now.

(27:19)
It was that the industrial varieties have been just for males. So to get the tiny doses that we wanted, have been actually onerous to attract it in a syringe. However I do discover, properly now we are able to compound it like ladies concentrations. And I do like, so long as ladies’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 sometimes does give a stage that type of goes up and down each time you inject. So you have got a bit bit extra variation than you’d with a day by day dose. So testosterone will 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 direction of males and testosterone, many 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 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 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 at all times 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. Right?

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 bear in mind a extremely fascinating dialog. You and I had some time again the place you have been like, , you see ladies who’ve a extremely strong, um, adrenal operate have a better time in, in going via 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 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 a 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 taking good care of your dad and mom and your kids and all these generations, then it’s actually widespread to have a way more tough in menopause. And I really like DHEA, initially, it’s the one one among these that isn’t requiring a prescription. The remainder of these, you do want a prescription. Proper. Um, and only for the document, testosterone remains to be thought of managed, whether or not it’s athletes or there’s some issues that they, so that’s a type of which you can nonetheless get a prescription no downside.

(29:57)
But it surely’s within the class of managed prescription. So that you may need to get a decrease quantity, like six months versus a yr or sure issues. Um, however DHEA is out there over-the-counter and ladies usually do properly on 5 or 10 milligrams upwards of 25. However that’s a reasonably excessive dose for lots of ladies. And what can occur there’s that may 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. If you happen to’re actually excessive cortisol and also you’re vulnerable to breakouts, these are the type of individuals I most likely wouldn’t placed on DHEA. ’trigger then you definately elevate the cortisol and you’ll have some extra breakouts, however normally ladies 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 feel it is a good alternative for us to shift a bit bit to the postmenopausal dialog. I wanna discuss the whole lot , in all places, after all. However, however I really need, I’m actually and curious as a result of I’ll be in put up menopause quickly and I wanna know what to anticipate. And I’ve bought loads of ladies who hear who’re in put up menopause, they usually wanna know, properly, what ought to, is there one thing, how, what checks 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 possibly can really undergo this very easily after which hit menopause and type of have been on hormones. Certain. However what you’re speaking about, I feel is say that girl 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):

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 among 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 ladies on hormone as a result of it’s so essential to our mind operate. 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 top of our life can use the hormones. Now, possibly sooner or later you want lesser doses, however I’d say to any girl who’s postmenopausal and possibly having signs, possibly not, I’d nonetheless begin with testing after which discuss 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 bit little bit of adjustment as a result of it’s possible you’ll not both be capable to sense that hormone properly, or it’s possible 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 isn’t any 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, among the telehealth websites that assist ladies with balancing their, their hormones put up menopause, they are saying that they’re, they’re not gonna prescribe should you’ve, or they, they, there’s some wording about should 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 examine 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 might be, that you simply 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 put up menopause. What would you check her for? What would you be ? 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 examine 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 serious about 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 most likely blood work or Dutch hormones, one or the opposite, or each. After which what we’d wanna do is there’s a danger of you probably have uterine fibroids which can be unchecked and really giant, 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 have got these growths which can be benign development, however they’re stimulated by estrogen. These situations, um, might be stimulated even by wholesome bioidentical hormones and fibroids are benign, however they’re a ache you probably have them. They’re giant 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 likewise, in case you are perimenopause or in these earlier years, forties or fifties, and you’ve got had an enormous problem with fibroids or endometriosis, these are discussions we wanna have about find out how 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 only take a look at that pelvis and ensure the whole lot’s protected. As a result of if they’ve fibroids, these may develop with hormones. And you must know that after which be capable to watch it. If any girl has breast tenderness with these, uh, hormones, that’s an indication. I’m at all times 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 should you do and it’s simply transient for per week and it goes away, that’s most likely okay. After which the third factor is should you ever cease bleeding for over a yr, that’s technically the definition of menopause. You’ve gone into put up menopause, um, and also you begin to have bleeding that yr and not using a cycle that requires you to get an endometrial biopsy and a workup to verify your lining is just not getting too thick. And these are simply these cautious issues {that a} good physician would do should you’re on hormones, as a result of hormones could cause that lining to get thicker. And so you probably have a excessive danger of that, or some purpose, you’d should have that dialogue about security and efficacy along with your physician. However I’d at all times do a pelvic ultrasound and examine their medical historical past after which discuss with them fastidiously. I’d additionally most likely begin a 70-year-old girl on a a lot, a lot, a lot decrease dose than I’d a 45-year-old girl.

Betty Rocker (36:10):

Certain. Thanks for sharing that. And that’s so useful to know as we go into this stuff, we wanna have our eyes open about danger components. And also you talked about that you simply, you do a Dutch check as one of many choices for a post-menopausal girl. 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 identical 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 purpose to nonetheless add progesterone? I’m simply so .

Dr. Jill Carnahan (36:57):

Sure. So, um, the, the standard medical coaching is you probably have a uterus and you employ unopposed, estrogen, which means all you get is estrogen, that’s a danger for that lining being thicker and really creating 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 at all times 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 virtually at all times comes first for a lot of ladies, 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 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 loads of testosterone DHEA, as a result of then you could possibly, there’s, as you may inform, the variables are virtually 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 bit testosterone. Um, and see, and I’d say extra ladies above the age of 65 are on a really small dose of estrogen, progesterone with out testosterone. However even they will profit from small doses if acceptable.

Betty Rocker (38:17):

Fascinating. Wow. Nicely, you’ve given us loads of actually nice info to consider, however I feel that one factor that now we have not talked about but, that’s at all times been part of our work collectively that I wanna be certain ladies 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 vital facet of our hormone steadiness that has to do with our intestine well being. Proper. And would you communicate on that a bit bit, as a result of I, I feel that is one thing that you simply care quite a bit 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 now we have to detoxify these. And sometimes when ladies get into bother, even with danger of breast most cancers, endometrial most cancers, any kind of hormone associated problem, 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 injury DNA, and that results in dangerous issues. And curiously, in our world that we dwell in, there are hundreds and a great deal of issues that mimic estrogen. They’re known as endocrine disruptors on our physique. So loads of occasions 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 substances act like hormetic or hormone results on our physique, and it’s very poisonous.

(39:43)
So it’s virtually worse the setting than the hormones we take, however now we have to consider that. So if I’m actually going deep or somebody has loads of concern, I’ll even go so far as to do genetic testing on their liver’s skill 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 simply don’t course of usually. Um, like say a traditional particular person is 100% processing, it’s possible 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 individuals, I would do decrease doses, I would monitor them extra incessantly. Um, and once more, that is perhaps the ten% of the inhabitants. So you probably have a household historical past of most cancers, particularly hormone associated, or you have got 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 may just remember to are utilizing clear merchandise in your hair, in your face, in your physique.

(40:31)
Transdermal drugs work for a purpose as a result of we take in the whole lot via our pores and skin. And if we’re placing stuff on our pores and skin, standard perfumes or stuffed with phthalates, um, or any non-organic produce usually has, um, glyphosate residues or, or, uh, pesticide residues and all this stuff have a poisonous impact. So I prefer to maintain it easy. And if we simply begin with clear air, clear water, clear meals to the very best of our skill, 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 is just not working optimally, we’re not gonna be capable to course of extra. So like we talked a bit bit about estrogen dominance a bit bit in the past, and I do know that one of many issues that may make estrogen dominance worse, at the same time as we’re shedding that progesterone, possibly we’re within the early levels of perimenopause, is, uh, not having 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 known 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 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 affect us?

Dr. Jill Carnahan (41:51):

So that is actually large and I’m so glad you introduced it up, as a result of what occurs is, um, our liver’s at all times doing the detox work and it simply squirts out stuff into the bile that’s alleged to be eliminating, and that’s in our stool. So should you’re a girl who has power constipation, that alone places you at larger danger of reabsorbing toxins out of your setting or meals. And even should you’re on hormones and you’ve got power 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 complete 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 method for intestine liver circulation, that pathway on a regular basis is being reabsorbed. And so if now we have a bunch of poisons in our intestine and we’re not pooping out day by 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 large 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 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 this stuff that assist the intestine and assist you have got your common motion. Sure. Yeah.

Dr. Jill Carnahan (43:08):

And that’s a part of hormone substitute, as a result of should you’re not shifting your bowels, you’re going to get extra poisonous. And this stuff which can be useful and exquisite may 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, 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 properly already, and we go pile hormones on high of that, like bioidentical hormones or no matter type of hormone substitute remedy you’re utilizing, and also you’re not eliminating properly, you simply set it so properly, we’re poisoning ourselves fairly 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 feel staying hydrated additionally. So important for supporting intestine operate, chewing extra mindfully, chewing extra, slowing down whenever 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 have got 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 feel 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 robust, uh, , tough to deal with purchasers with intestine points. These are usually very well tolerated. Um, one factor actually fascinating is there’s loads of pure substances that may assist us on these pathways, and you may discuss to your physician about these, however some which can be actual widespread are sulforaphanes, which come from broccoli sprouts mm-hmm . And sprouted, um, seeds and issues. In order that’s an awesome place. You should buy it as a cap, however you too can 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 are able to really see markers within the stool if we’re doing particular testing for somebody who isn’t processing properly.

(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 most likely wouldn’t use it in that inhabitants, however I’d, if it’s a 45-year-old girl 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 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 have been serving to me heal from, uh, mildew publicity, which was horrible. And it, that occurred proper originally of my perimenopause journey and loads of these issues that I wanted, the liver help, all of that. It was simply in, it’s simply fascinating considering again on it now, , there’s that nice Steve Jobs quote that was that “you may’t join the dots trying ahead, solely trying backwards.” And now as I’m considering 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 ladies want entry to particular, individualized healthcare that’s this, that has this breadth, that has this depth that, that cares about these totally different points of our well being and is educated in that sense. You already know, 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 have got a follow. You, you have got, you have got a tremendous e-book. There’s a film about you . You have got, uh, an unbelievable web site with this depth of knowledge so that individuals can study extra and develop into advocates for themselves with their very own medical doctors. You have got a complement retailer the place individuals can buy loads of a lot of these dietary supplements for themselves. And I simply, I really feel like you have got loads of wonderful sources. And is there something I not noted 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 unbelievable 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 sources 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, properly, the place else can ladies go? Sure. And I used to be saying, I’ve been researching these totally different corporations that do this follow 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 bear in mind I ran them by you earlier, Dr. Jill. ’trigger I simply wanna ensure that this was a very good, that I wasn’t going. You already know, I, I assumed they have been nice. But it surely’s good to listen to your vote of confidence in these as properly, as a result of that is I feel the way forward for that sort of medication. And, and for ladies particularly? Sure.

(48:15)
So listed below are a pair that I discovered. One is named Midi and I really like midi. It’s like M-I-D-I and it’s, it’s a feminine based firm. It’s all these cool ladies medical doctors and it’s telehealth firm. There’s telehealth choices, proper? After which additionally they will prescribe hormone substitute remedy or no matter you’re comfy 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 via the journey herself. So I really like Midi. One other one which I discovered, clearly you’ve most likely heard of Winona. I feel 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 known 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 known 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 a web site for US based mostly sufferers in addition to UK based mostly sufferers. Oh, good. So you may, you need to use one or the opposite relying. I do know loads 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 desirous about my, my individuals in Australia. Um, there’s one thing known as Clinic 66, and if, should you’re, should you’re on the lookout for choices for your self in your nation, I feel simply utilizing a few of these key phrases that Dr. Jill and I have been speaking about at the moment 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 international locations to see like, the place are they doing these things? And then you definately simply learn what’s on the web site and then you definately simply type of should observe the threads and see the place, the place, the place it’s gonna be just right for you. And I’ve observed 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 among the limitations that you simply do know of in

Dr. Jill Carnahan (50:15):

State? Sure. Um, medical medical doctors are nonetheless licensed by state. So you actually, um, sometimes are, except somebody involves see me in Colorado, I’m, I’ve to be extra cautious about who I deal with outdoors of the state. In order that’s a complete deal. One of many issues that is perhaps tremendous useful is you probably have a compounding pharmacy in your space, that’s an awesome 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 loads of hormones. I discuss to the pharmacies on a regular basis. And so an effective way is that if there’s a compounding pharmacy in your space, you name ’em and say, Hey, what medical doctors are you aware in my space which can be doing this? And that’s one other good solution to get in your space. Somebody who’s legit and your compounding pharmacy will sometimes know who that is perhaps.

Betty Rocker (50:56):

And with a purpose 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 the most important, 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 suppose, I don’t know the precise website you must be capable to discover, uh, firm pharmacies. However yeah, you too can simply Google compounding pharmacy in my space.

Betty Rocker (51:21):

That’s nice. And I, I feel, I imply, and there are various greater than those that I simply, that brief listing I gave you guys. I, I’ve, I’ve, I really like all, I really like all these choices which can 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 an increasing number of 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 the moment, like some medical doctors 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 medical doctors 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 concentrate on like, even me, if I graduated from med faculty and I’m advised that that is harmful and that I by no means look and by no means study, which loads 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 loads of them simply don’t know the newest knowledge and the protection.

Betty Rocker (52:22):

If we have been to count on 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 ladies particular,

(52:29)
Proper? Like we’d don’t have anything we, that now we have to permit science to be this evolving like, studying course of. That’s what science is. You already know, 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 ladies 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 have got 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 the moment. We lined 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 be certain to get throughout simply in case?

Dr. Jill Carnahan (53:17):

No, simply thanks for the fantastic work you do on the planet and uh, thanks for having me on. It’s at all times a lot enjoyable. It’s like having espresso with a buddy and should you’re on the market and also you’re struggling for hormones, you don’t should. And there are simply, I really like the sources 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 on 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 unbelievable sources. She has so many, you’ve finished a lot work for ladies and a lot work on your sufferers basically, women and men. Um, thanks once more a lot for being right here and we look ahead to speaking to you once more. Thanks you, thanks a lot. And hey Rockstar, thanks a lot for listening at the moment. It’s been nice to spend time with you. I hope you realized 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 sources Dr. Jill shared with me that we didn’t get an opportunity to speak about on the present. Make sure you take a look at 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’re taking nice care of your self. Until subsequent time, I’m Betty Rocker and you’re so superior, flawsome and wonderful. Bye for now.