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

Betty Rocker (00:18):

What’s up, rock stars Coach Betty Rocker right here. Hey, thanks a lot for becoming a member of me. My visitor right this 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 medication, a practitioner of built-in holistic medication, and can be a useful medication 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 bought a superb podcast and a extremely, actually useful weblog, simply filled with nice free content material you’ll be able to entry anytime and is a survivor of breast most cancers, Crohn’s illness and poisonous mildew sickness. She brings a singular perspective to treating sufferers within the midst of complicated and power sickness. She’s the medical director on the Flatiron Purposeful Drugs Middle simply outdoors 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 complicated well being associated topics which might 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 right this moment.

Dr. Jill Carnahan (01:31):

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

Betty Rocker (01:34):

Sure, it’s all the time nice to get to test in and, and have a dialog. And one factor I really feel like has been on my thoughts and on the minds of most of the ladies 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 once. And once I suppose again to our conversations perhaps early on in my very own perimenopause journey, I take into consideration how a lot anxiousness I had about listening to about issues like bioidentical hormones or hormone alternative remedy and the way that dialog type of developed and the way rather more we all know today. Why, why are folks nonetheless, I really feel like there’s nonetheless a variety of concern round hormone alternative 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 bought out of medical faculty and that yr was the yr the Girls’s well being Initiative first got here out within the information. Because the researchers are compiling the info, the information took this data earlier than they even completed compiling and mentioned, oh my goodness, is there an elevated threat of breast most cancers with hormone alternative? And actually tons of of 1000’s of girls stopped their hormone alternative as a result of this media took this story, put it on the market. And at the same time as 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 yr sense is that they analyzed the info in that largest randomized management trial of girls on hormone alternative. And the info got here out very clearly.

(03:18)
Primary, there was two arms, one was an estrogen solely arm, and so they used Premarin, which is definitely a horse estrogen, not even one of the best cleanest bioidentical, however it’s an estrogen. And the opposite arm was a Premarin, which is an estrogen plus, um, a purvey, which is an artificial progestin. I’ll clarify that actual briefly in a minute. So these two arms, the primary arm got here out and this has been the final, uh, analyzed analysis, effectively documented by anybody who’s checked out this. There was 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 center. 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 the next incidence of regular. So it skewed the info. And the second factor about that was, as I discussed earlier than, this was an artificial progesterone. It wasn’t progesterone in any respect, which might truly mimic progesterone deficiency in the long run as a result of it hits these receptors, but it surely’s not a pure progesterone. So neither of those trials, despite the fact that they confirmed a decreased threat of breast most cancers, had been even utilizing the type of hormones that you just and I are speaking about, which is the very same as our our bodies, our ovaries produce. So I confidently, and also you talked about earlier than, I’m a breast most cancers survivor, so I’m 20 plus years out.

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

Betty Rocker (05:25):

I’ve been studying that knowledge as effectively and it’s nice to listen to it from you. And a part of why I needed to ask you that query to begin 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 alternative remedy to me or to quite a few different sufferers you’ve served in the event you 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 positive that you just have a look at, I’m positive 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 feel it’s actually vital to only, despite the fact that that was, to me that was slightly technical, what you shared, and in the event you’re listening and also you’re pondering, I didn’t fairly observe all the things she was saying, but it surely, you perceive the info as mm-hmm . A physician who reads the science, you perceive that it’s secure. Sure. That’s mainly what you’re saying. And like that these research in some methods had some actual flaws. Sure. They had been learning, um, types of hormones that we don’t truly use in ladies’s medication. And in addition that the, the, and, and so it, and so there’s all this concern, there’s all this concern round it. And, and it’s not for everybody both, proper? Like, you’re proper. I do know we’re not gonna say, oh, everybody must be on hormone alternative remedy, however

Dr. Jill Carnahan (06:46):

For those who’re present process breast most cancers therapy, for instance, I might not give somebody hormones throughout therapy. In order that’s a really clear contra.

Betty Rocker (06:52):

Proper. So there you go. There’s a, there’s a purpose not that, and there are most likely another causes too. And, and but it must 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 a few of the viable therapy choices for ladies within the menopause years, it’s vital to know that we’ve considered this in the beginning, 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 type of like, you’re simply getting outdated. I can’t inform you what number of ladies have written me, and also you’ve most likely seen this in your apply as effectively, saying, I’ve been dismissed, I’ve been advised I used to be depressed. I’ve been placed on anti-anxiety medication. 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 might be like getting at signs however not likely addressing the basis trigger, which is that this shift in our hormones that occurs. I don’t know, it’s simply, it’s it’s

Dr. Jill Carnahan (08:05):

So true. And I really like that you just mentioned it’s even right this moment, on daily basis in my apply, 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 totally no, and there’s no dialogue, then you definitely wanna discover a totally different supplier as a result of it isn’t for everybody. And there’s a vital alternative. And in case you have a variety of anxiousness or concern, I by no means push anybody. So there’s nonetheless, I could also be perhaps 20% of my ladies that we discuss and so they don’t go on hormone alternative, and that’s okay too. However to have the choice and to know the

Betty Rocker (08:34):

Alternative, you mentioned alternative. That’s the phrase. That’s, that’s it. And the schooling about it, to know which you could make an knowledgeable alternative 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 slightly bit in regards to 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 type 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 all types of issues. Like, effectively, how do I do know I’m in perimenopause? How do I do know I’m, how do I, what, what ought to my hormones appear like at these totally different levels? And I might think about that these are the type of issues that you just assist tackle in your apply. 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 what sort of signs do they present up with? In order that perhaps you might, we might assist somebody on the market who’s making an attempt, who’s perhaps 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 often from 35 to 45 is that realm. It might probably go so long as 55. I feel the common age of that menopause date is round 52, 55. After which after is publish. However this may once more be virtually a 20 yr span from 35 to 55 that some ladies battle. So one factor I’m a fan of, and never all medical doctors do that is testing. I exploit blood, urine, various kinds of issues to evaluate various things. And it is a entire nother lecture price of fabric as a result of relying on in the event you’re utilizing a cream or an oral or the way you’re doing it, sure exams decide up issues otherwise. And that’s a complete different dialogue. However it’s vital that you’ve a health care provider that may assess the place you’re at as a result of you could have the signs usually.

(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 section progesterone. That’s often the very first thing that drops. So that you usually expertise estrogen dominance and hormones are all about steadiness inside each other. So if we’ve our cycle follicular section, estrogen goes up, second a part of our cycle, luteal section, progesterone goes up and that simply yin and yang occurs all by way of 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 could 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 typically herbs that may improve the lead section progesterone.

(11:16)
And that’s often the very first thing. Then someplace in there your ovaries begin to sputter. And I all the time say it’s virtually like in the event 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 multitude of a spurting out and someone could have a day that’s excessive and high and low and you may’t work out what’s occurring. And even testing, you need to watch out as a result of in the event you’re testing that interval, you check one month, you may need excessive estrogen, low progesterone the following month it is likely to be low and it simply does this dance. And that’s the time when ladies are so annoyed ’trigger like, I don’t really feel effectively what’s occurring? They could begin to have sizzling flashes, however they’re nonetheless having heavy cycles.

(11:50)
And so in that window, ladies can nonetheless do bioidentical hormones. However it’s vital to have a clinician that is aware of how you can assess the signs associated to what they’re possible experiencing hormonally. After which additionally check realizing that the check might be up and down. And in that section it’s gonna be just like the Heinz ketchup spurting out randomly. And then you definitely get to a degree the place these ovaries identical to, I’m carried out. And that’s when the estrogen begins to actually drop. And that is when ladies would begin to have sizzling flashes, evening sweats, rapidly they can not bear in mind names. Locations the place they put their keys, the place they’re going, they get within the automotive like the place am I driving to? Like issues the place they actually, 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 discipline.

(12:33)
And I do know once I first hit menopausal, just like the overwhelm, the sensation like I couldn’t deal with issues usually is basically frequent with ladies. ’trigger they’re pushed and so they’re doing effectively and the estrogen actually helps our mind keep on observe. And when that drops we’re like, oh wait, my government operate, the planning, the executing is impaired. And I’m like, I really feel like I’m 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. Chances are you’ll be extra tearful in the future extra offended, in the future extra unhappy, you gained, don’t wanna get outta mattress in the future and when none of these issues had 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 possibly really feel so disorienting. And , even the dad so far as damaged relationships and divorces on this time, it’s not shocking that that goes up as a result of ladies really feel like they’re going loopy. And most males and lots of medical doctors gaslight them into pondering they’re going loopy and it’s simply their hormonal transition.

Betty Rocker (13:29):

So I hear you saying that there are these actual distinct phases of perimenopause that we undergo and this is the reason it’s more durable to pinpoint typically as a result of it’s a shifting goal. Sure. As we undergo these, these years of our lives. And it’s shocking to listen to you say that it could possibly begin as early as 35, but it surely additionally is sensible, proper? And, and it, I assume you might not know precisely the place you’re. It might 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 girl, or say I’m like 40 years outdated 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 a few of the belongings you examined me for particularly once I got here to see you. And naturally I had complicated signs and many alternative issues occurring. 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 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 carried out at any standard lab. And despite the fact that blood work isn’t all the time good, in the event you’re utilizing like a cream or no matter, it’s an ideal place to begin. It usually can 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 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 sorts of estrogen. So estradiol is E two and that’s the one you wanna find out about, proper?

Dr. Jill Carnahan (14:58):

Yeah, that’s the primary one. So once more, it’s nice if you will get ’em all, however in the event you simply get one, get estradiol. And these days 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 slightly extra, um, particular and delicate with that extremely delicate estradiol. You wanna get proactive.

Betty Rocker (15:17):

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

Dr. Jill Carnahan (15:20):

No, this 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 important. ’trigger we all the time have a look at the ratio. Similar to we mentioned, these two are the dance companions. So we’re checking these two in conjunction. Um, if I’ve a alternative, I’m testing all these and I’ll proceed with the remainder of them on day 19 by way of 21 of the cycle. In order that’s assuming you could have a typical 26, 28 day cycle ’trigger that’s gonna hit your LAL section. And what you’re gonna see there’s if the estrogen and progesterone are in steadiness. Proper? In order that’s the timing of what you may do for this. So estradiol, progesterone, DHEA sprint S is how we check DHEA, which is one other steroid hormone within the blood. Testosterone, I prefer to get each free and whole. Mm-hmm . After which cortisol within the morning. ’trigger that’s type of an ordinary, though you might get it randomly by way of the day. And in the event 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 pimples or PCOS. However you don’t have to get that fancy. For those who simply get these imply 5, that’ll offer you 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 exams carried out for me a number of methods over time. So at first we might do a mix of the Dutch check, which is a urine check that we do on these very particular days of the luteal section of the cycle. And you want to be monitoring your cycle with a view to know the place you’re and when your luteal section is. And I discover that it’s truly actually useful to be monitoring your cycle if you’re in perimenopause as a result of it’s gonna offer you some indication of realizing as your cycle begins to get erratic. It, it’s simple to only overlook about your cycle. Actually, I usually would overlook I used to be even gonna get my interval in my common biking years as a result of it was simply so like I I 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 way of that second half of the cycle. However anyway, again to, um, these exams, I might usually try this Dutch check. You’ll order that Dutch check for me, the urine check. After which I might additionally go fasted very first thing within the morning, early morning and get a blood check as effectively. 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. Certainly one of ’em is free, I don’t bear in mind. Mm-hmm.

(18:05)
However T three and T 4. And then you definitely, 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 might see issues like testosterone and you might see the opposite hormones mm-hmm . Um, but it surely was the, the mix of that with the Dutch check that collectively gave you a a lot clearer image of what you needed to see that might enable you see if my hormones had been in steadiness, how out of steadiness 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 bear in mind at first I used to be in a position to 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 in a position to really feel higher despite the fact that it didn’t actually make my hormone ranges go up a lot, I felt loads higher and it decreased a variety of the signs I skilled. However then as I bought slightly farther into the perimenopause journey, it grew to become actually important for me to begin utilizing issues like hormone alternative remedy. After which I really feel like I’m perhaps within the, the top of that center stage of perimenopause now I’m like utilizing a mix of various kinds of hormone alternative remedy. I’ve some props right here to point out 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’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 a variety of these things the place we tried it for an extended interval at the beginning to see how I responded. After which we examined once more just a few months later and I’ve additionally bought some totally different lotions, topical lotions. She prior to now had had me strive, an oral progesterone. And we discovered that for me personally, the standard suggestion was I feel 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 positive tuning type of nuanced points of this. After which there’s additionally a pellet, which I do know you beneficial for very particular conditions, however in the event you’ve bought a pellet injected below your pores and skin, which we talked about in different podcasts, you’ll be able to’t change that. Yeah. It’s there. You’ll be able to’t take it out simply your self. Proper. So it simply gotta do its factor so it’s much less customizable. Whereas with the lotions you want, you are able to do two clicks, you are able to do one click on, you’ll be able to actually management your dosing, I feel actually, very well. These are all issues that I’ve skilled based mostly on the testing. And I may even say that you just and I examined 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 therapy? We needed to present 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 might see that. And if it didn’t, we might modify my dosage. However we didn’t simply go actually quick into issues we needed to like take. And that may be, that may be slightly little bit of a course of, proper? Like, ’trigger you need outcomes instantly, however in the event you 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 fearful about clot threat. And what if I’ve this, uh, there’s totally different gene issues that you just may’ve been advised

Betty Rocker (21:35):

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

Dr. Jill Carnahan (21:38):

Yep. Or, um, sure different ones on the market. And so in the event you’ve been advised that’s a threat, the deal is oral hormones, particularly estrogens do improve 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 should not have the identical threat. Transdermal simply means a patch or a cream or one thing you apply to your pores and skin. Our pores and skin absorbs hormones very well mm-hmm . So I virtually completely do the compound of lotions that you just confirmed or the patch that you just confirmed. And, um, there’s other ways to do these, however these are actually nice and secure methods to use. Now you talked about usually doing blood and urine on the similar time. The dutch hormones is what you talked about. I usually to observe the hormones, love to do the Dutch, as a result of within the blood you gained’t all the time see the true ranges of a cream or a patch.

Betty Rocker (22:25):

Mm-hmm .

Dr. Jill Carnahan (22:25):

So I typically do each, like we did with you. If I’ve a affected person who’s keen to do each, that’s one of the best. However you’ll be able to see the variations as a result of in the event 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 had been simply making an attempt to observe their hormones, in the event that they had been simply, if they may simply check type of consecutively, perhaps not each month clearly, however like on a good foundation, perhaps each three or 4 months they’d use the Dutch check as their major to, to see in the event that they had been doing hormone alternative 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 various kinds of these transdermal or cream-based mm-hmm

Dr. Jill Carnahan (23:10):

.

Betty Rocker (23:10):

Hormone alternative remedy varieties. May you wanna communicate on that slightly bit? I really feel like there’s a variety 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 in regards to 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 often about each six months is type of when, typically sooner in the event that they’re having signs, however on a routine, and on the very least, I’m gonna test them yearly.

Betty Rocker (23:35):

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 typically 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 yearly and I’m secure 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 just’re gonna see. And this may be prescribed as a cream, um, as a, um, foam like a, roll-on, as a patch, which is my favourite commonest ’trigger ladies don’t have to consider it.

Betty Rocker (24:09):

Yeah.

Dr. Jill Carnahan (24:09):

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

Betty Rocker (25:24):

That’s so cool. Uh, I 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 speak slightly 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 now have testosterone – decrease than males, however we’ve testosterone. We’d like testosterone. It helps our bones, it helps our brains, it helps our motivation, it helps our physique composition. Girls 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 truly will increase threat of autoimmunity. So there’s, I’ve even used off-label testosterone as a part of a protocol to deal with autoimmunity as a result of it’s so highly effective in 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 might 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 all the time making an attempt to bypass the intestine with hormones that’s both a cream or a patch. With testosterone, there’s a pair methods you are able to do it. You are able to do a cream, however for ladies, wherever you apply that cream, internal thigh or wrist, you’re gonna get slightly hair development. So a variety of ladies don’t like that. And so as an alternative of doing the cream, I’ll usually do a trochexf or a sublingual tab that dissolves below your tongue so that you just get that dose with out stepping into your intestine and thru the liver. Um, a variety of ladies, uh, do injectable now.

(27:19)
It was once that the industrial kinds had been just for males. So to get the tiny doses that we would have liked, had been actually onerous to attract it in a syringe. However I do discover, effectively now we will 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 a good way. It usually does give a stage that type of goes up and down each time you inject. So you could have slightly bit extra variation than you’d with a day by day dose. So testosterone might be cream, it may be in troche or an oral sublingual, and it may be injectable. And people are the primary methods. And since proper now our pharmaceutical trade is geared in 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 steadiness. 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 bear in mind a extremely fascinating dialog. You and I had some time again the place you had been like, , you see ladies who’ve a extremely sturdy, um, adrenal operate have a neater time in, in going by way of perimenopause as a result of they don’t seem to be strapped of the backup hormone system. Nearly. Did I say that proper? That’s

Dr. Jill Carnahan (29:13):

That’s precisely proper. As a result of when our ovaries conk out and so they’re like, I’m carried out, 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 slightly 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 mother and father and your youngsters and all these generations, then it’s actually frequent to have a way more troublesome in menopause. And I really like DHEA, to begin with, it’s the one one in all these that isn’t requiring a prescription. The remainder of these, you do want a prescription. Proper. Um, and only for the document, testosterone remains to be thought-about managed, whether or not it’s athletes or there’s some issues that they, so that’s a type of which you could nonetheless get a prescription no drawback.

(29:57)
However it’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 obtainable over-the-counter and ladies usually do effectively on 5 or 10 milligrams upwards of 25. However that’s a reasonably excessive dose for lots of girls. And what can occur there’s 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 type of a pleasant adrenal assist in case your adrenals are in a weakened spot. For those who’re actually excessive cortisol and also you’re liable to breakouts, these are the type of folks I most likely wouldn’t placed on DHEA. ’trigger then you definitely elevate the cortisol and you could have some extra breakouts, however often ladies will know as a result of they’ll take 5 milligrams, which is a tiny dose and so they escape. So cease the DHEA.

Betty Rocker (30:41):

Proper. Uh, I feel it is a good alternative for us to shift slightly bit to the postmenopausal dialog. I wanna discuss all the things all of sudden, in every single place, in fact. However, however I really 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 bought a variety of ladies who pay attention who’re in publish menopause, and so they wanna know, effectively, what ought to, is there one thing, how, what exams ought to I get? After which what choices are there for me? What ought to we do and the way can we assist them?

Dr. Jill Carnahan (31:14):

Yeah. So there’s mainly two or 3 ways this might occur. We talked about like, say you’re 35, 40, 45, and also you’re beginning up signs and your physician’s open and also you get some prescriptions. You’ll be able to truly 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 and so they 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, effectively, what about me? Nicely, very first thing is Dr. Dale Bredezen does a ton of analysis on Alzheimer’s. And he’s one Who’s that? Dr. Dale Bredezen. Okay.

Betty Rocker (31:42):

He

Dr. Jill Carnahan (31:42):

Wrote the e book Finish of Alzheimer’s. And he’s one in all our researchers and main 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 outdated 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 outdated for hormones. That isn’t true. Our brains, until the top of our life can use the hormones. Now, perhaps in some unspecified time in the future you want lesser doses, however I might say to any girl who’s postmenopausal and perhaps having signs, perhaps 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 if you first begin hormones, in case you have by no means been on them, there’s slightly little bit of adjustment as a result of you might not both be capable to sense that hormone effectively, or you might in a short time get flooded with an excessive amount of. So it simply takes a practitioner who’s cautious with that, however they’re really with coronary heart, mind, and bone. There is no such thing as a age too outdated that doesn’t profit from hormones so long as there’s a dialog and all of that

Betty Rocker (33:06):

Taking place, and it’s approached rigorously. That makes whole sense. And I’m so glad you mentioned that. Um, a few of the telehealth websites that assist ladies with balancing their, their hormones publish menopause, they are saying that they’re, they’re not gonna prescribe in the event you’ve, or they, they, there’s some wording about in the event you’ve been 10 years with out having a interval and also you haven’t by no means been on HRT, like they, they wanna test in about that due to precisely what you’re speaking about. Like these receptor websites type of, are they atrophy, such as you mentioned? Yeah. However that there nonetheless might be, that you just nonetheless might have that chance. So, so say, say somebody got here to you and she or he’s identical to perhaps just a few years in to publish menopause. What would you check her for? What would you be taking a look at? Would you have 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 type of have a look at to, to assist her? And, and clearly it’s individually based mostly as effectively, but when she’s concerned with some sort of hormone alternative remedy, I assume 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 threat of in case you 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 could have these growths which might be benign development, however they’re stimulated by estrogen. These circumstances, um, might be stimulated even by wholesome bioidentical hormones and fibroids are benign, however they’re a ache in case you have them. They’re massive or uncomfortable. They’re usually not malignant, which suggests like they’re not most cancers. However these are caveats or issues that as, as a doctor, I’d be very involved or have a dialogue about. And in addition, 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 how you can dose this and be watching that rigorously.

(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 have a look at that pelvis and ensure all the things’s secure. As a result of if they’ve fibroids, these might develop with hormones. And you need to 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 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 in the event 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 in the event you ever cease bleeding for over a yr, that’s technically the definition of menopause. You’ve gone into publish menopause, um, and also you begin to have bleeding that yr with out a cycle that requires you to get an endometrial biopsy and a workup to verify your lining will not be getting too thick. And these are simply these cautious issues {that a} good physician would do in the event you’re on hormones, as a result of hormones could cause that lining to get thicker. And so in case you 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 scientific historical past after which speak with them rigorously. I might additionally most likely begin a 70-year-old girl on a a lot, a lot, a lot decrease dose than I might 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 threat components. And also you talked about that you just, 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 try 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 might 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 the same 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 perhaps 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 in case you 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’ll all the time give it with progesterone. Progesterone protects you from having that. So no matter age it’s, and if I consider order of operations so far as security, and even from 35 on what you do, progesterone virtually all the time 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 might begin with progesterone estrogen alone, earlier than I might add a variety of testosterone DHEA, as a result of then you might, there’s, as you’ll be able to 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 slightly testosterone. Um, and see, and I might say extra ladies above the age of 65 are on a really small dose of estrogen, progesterone with out testosterone. However even they’ll profit from small doses if acceptable.

Betty Rocker (38:17):

Fascinating. Wow. Nicely, you’ve given us a variety of actually nice data to consider, however I feel that one factor that we’ve not talked about but, that’s all the time been part of our work collectively that I wanna ensure that ladies 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 facet of our hormone steadiness that has to do with our intestine well being. Proper. And would you communicate on that slightly bit, as a result of I, I feel that is one thing that you just care loads about and also you’ve guided me very well on as effectively.

Dr. Jill Carnahan (38:51):

Thanks, um, Bree, as a result of it’s, so what occurs is estrogen, progesterone, all these hormones in our physique, they’re handled by our liver, identical to a drug or a chemical. So we’ve to detoxify these. And sometimes when ladies get into bother, even with threat of breast most cancers, endometrial most cancers, any type of hormone associated problem, it’s not that their hormones are the unhealthy guys, it’s that they’re not in a position to eliminate the surplus. They accumulate sure metabolites that may injury DNA, and that results in unhealthy issues. And curiously, in our world that we stay in, there are masses and a great deal of issues that mimic estrogen. They’re referred to as endocrine disruptors on our physique. So a variety 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 we’ve to consider that. So if I’m actually going deep or somebody has a variety 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 just a few totally different genetic, we name them snips, which simply means issues that you just don’t course of usually. Um, like say a traditional individual is 100% processing, you might course of it 60% or 30%. So typically I have a look at sure ways in which you course of hormones. And people folks, I would do decrease doses, I would monitor them extra incessantly. Um, and once more, that is likely to be the ten% of the inhabitants. So in case you have a household historical past of most cancers, particularly hormone associated, or you could 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 be sure you 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 soak up all the things by way of our pores and skin. And if we’re placing stuff on our pores and skin, standard perfumes or filled 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 preserve it easy. And if we simply begin with clear air, clear water, clear meals to one of the best of our capacity, that provides us a basis for secure hormone alternative 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 alternative remedy, if our intestine will not be working optimally, we aren’t gonna be capable to course of extra. So like we talked slightly bit about estrogen dominance slightly 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, perhaps 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 in a position to operate effectively, it, it’s gonna ship that again into our system as soiled estrogen. What does that imply precisely? And the way does that, how does that influence us?

Dr. Jill Carnahan (41:51):

So that is actually large and I’m so glad you introduced it up, as a result of what occurs is, um, our liver’s all the time doing the detox work and it simply squirts out stuff into the bile that’s presupposed to be eliminating, and that’s in our stool. So in the event you’re a lady who has power constipation, that alone places you at greater threat of reabsorbing toxins out of your setting or meals. And even in the event you’re on hormones and you’ve got power 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 entire pathway and to changing hormones appropriately. So if we’re not, mainly that, that enterohepatic circulation, which is a extremely fancy phrase for the…,

Betty Rocker (42:28):

Did you say entero? And say it once more.

Dr. Jill Carnahan (42:30):

Enterohepatic. So it’s like intestine hepatic.

Betty Rocker (42:34):

Acquired it. Intestine liver.

Dr. Jill Carnahan (42:34):

Kinda like one other method for intestine liver circulation, that pathway on a regular basis is being reabsorbed. And so if we’ve 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 will 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 together with your meal plans and all of the issues that you just do as a result of that’s,

Betty Rocker (42:58):

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

Dr. Jill Carnahan (43:08):

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

Betty Rocker (43:17):

Yep. Yep. Precisely. So I, I’m so glad that you just talked about that as a result of it’s, except for any sort of hormone alternative remedy, our physique has this elimination course of naturally for the hormones that we have already got in our system, our pure hormones. And so if we’re not eliminating effectively already, and we go pile hormones on high of that, like bioidentical hormones or no matter type of hormone alternative remedy you’re utilizing, and also you’re not eliminating effectively, you simply set it so effectively, we’re poisoning ourselves somewhat 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 if 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 could have for folks 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 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, , troublesome to deal with shoppers with intestine points. These are typically very well tolerated. Um, one factor actually fascinating is there’s a variety 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 an ideal place. You should purchase 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 section 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 effectively.

(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 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 robust sufficient that I most likely wouldn’t use it in that inhabitants, however I might, if it’s a 45-year-old girl on hormone alternative, having a tiny little bit of breast tenderness, these are type of the ways in which you might 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 basically supportive for the liver as effectively.

Betty Rocker (45:46):

So, fascinating as you’re saying all of these, I’m remembering all of the protocols we did if you had been serving to me heal from, uh, mildew publicity, which was horrible. And it, that occurred proper in the beginning of my perimenopause journey and a variety of these issues that I wanted, the liver assist, all of that. It was simply in, it’s simply fascinating pondering again on it now, , there’s that nice Steve Jobs quote that was that “you’ll be able to’t join the dots wanting ahead, solely wanting backwards.” And now as I’m pondering 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 making an attempt 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 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 could have a apply. You, you could have, you could have a tremendous e book. There’s a film about you . You’ve, uh, an unimaginable web site with this depth of knowledge so that individuals can be taught extra and change into advocates for themselves with their very own medical doctors. You’ve a complement retailer the place folks should buy a variety of these kinds of dietary supplements for themselves. And I simply, I really feel like you could have a variety of superb sources. And is there something I neglected of that as a result of, effectively, your social media, what else did I overlook to say? Your

Dr. Jill Carnahan (47:28):

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

Betty Rocker (47:30):

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

(47:34)
Um, however the place I used to be going partly with that, except for saying, okay, girls, 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 had been speaking earlier than this podcast began about, effectively, the place else can ladies go? Sure. And I used to be saying, I’ve been researching these totally different firms that try this apply telehealth, and I’m gonna learn just a few and I’ll in fact 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 guarantee that this was , that I wasn’t going. You already know, I, I believed they had been nice. However it’s good to listen to your vote of confidence in these as effectively, as a result of that is I feel the way forward for that sort of drugs. And, and for ladies particularly? Sure.

(48:15)
So listed here 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 alternative 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 way of 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 and so they’re nice. In addition they have the telehealth choices. Um, one other one I discovered that’s down in Tampa, however they do, uh, telehealth and, and do numerous cool prescribing is defy, like they’re referred to as Defy, which I like.

Dr. Jill Carnahan (49:04):

Love

Speaker (49:04):

It. Def. I like it.

Betty Rocker (49:06):

Yeah. Defy. After which there’s one referred to as Stella And Stella I believed was actually cool. They’re additionally, additionally they have telehealth choices. They’ve the hormone alternative 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 need to use one or the opposite relying. I do know a variety 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 eager about my, my folks in Australia. Um, there’s one thing referred to as Clinic 66, and if, in the event you’re, in the event you’re searching for choices for your self in your nation, I feel simply utilizing a few of these key phrases that Dr. Jill and I had been speaking about right this moment on this podcast, like, search for issues like telehealth, choices for hormone assist in menopause. I really feel like I did that myself at totally different occasions and I’ve, and and I put it into totally different nations to see like, the place are they doing these things? And then you definitely simply learn what’s on the web site and then you definitely simply type of need to observe the threads and see the place, the place, the place it’s gonna give you the results you want. And I’ve seen the US based mostly ones, a few of them have limitations by state Yeah. That they’re gonna deal with. And are you aware a lot about that or like, , I do know you’re not gonna know what every individual gonna do, however what are a few of the limitations that you just do know of in

Dr. Jill Carnahan (50:15):

State? Sure. Um, medical medical doctors 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 outdoors of the state. In order that’s a complete deal. One of many issues that is likely to be tremendous useful is in case you have a compounding pharmacy in your space, that’s an ideal place to name as a result of they know what physicians in your space are prescribing hormones. And often the compounding pharmacies additionally know who actually know, as a result of they’re gonna be, like, for me, they know I prescribe a variety of hormones. I speak to the pharmacies on a regular basis. And so a good way is that if there’s a compounding pharmacy in your space, you name ’em and say, Hey, what medical doctors are you aware in my space which might be doing this? And that’s one other good technique to get in your space. Somebody who’s legit and your compounding pharmacy will usually know who that is likely to be.

Betty Rocker (50:56):

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

Dr. Jill Carnahan (51:00):

Yeah. Yeah. There may be P-C-C-A was once the largest, um, group that, uh, licensed Ok, so PCCA, I don’t know precisely what it’s one thing “Coumpounding Pharmacies of America”. However, um, if it’s simply pcca.org, I assume, I don’t know the precise web site 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 a lot of greater than those that I simply, that quick checklist I gave you guys. I, I’ve, I’ve, I really like all, I really 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 more 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 right this moment, like some medical doctors 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 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 perhaps attempt to get extra data, proper? As a result of all of them

Dr. Jill Carnahan (52:07):

Have, you consider 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 be taught, which a variety of docs cease studying after, proper? Then why wouldn’t I say, oh, nope, don’t do it. That’s what I heard 2001, which is outdated information now. Proper? In order that’s a variety of them simply don’t know the most recent knowledge 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 ladies particular,

(52:29)
Proper? Like we’d don’t have anything we, that we’ve 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 and so they’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 carried out on ladies particularly. I imply, it’s like a revelation. You’re like, effectively why didn’t we try this earlier than? I do know , it’s about time , proper? Don’t y’all have a mother? Like, don’t you could 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 right this 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 just’d wanna ensure that 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 all the time a lot enjoyable. It’s like having espresso with a buddy and in the event you’re on the market and also you’re struggling for hormones, you don’t need to. 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 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 to your work. And I’ll have hyperlinks within the present notes in fact. And with this video so that you guys can observe up with Dr. Jill and get all of her unimaginable sources. She has so many, you’ve carried out a lot work for ladies and a lot work to your sufferers usually, 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 right this 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 try the present notes web page for this episode over on my weblog at thebettyrocker.com within the podcast part for all of these hyperlinks. And I hope that wherever this finds you, you take nice care of your self. Until subsequent time, I’m Betty Rocker and you’re so superior, flawsome and superb. Bye for now.