Episode Fifteen: Show Notes


  • perimenopause: hormonal changes/transitional ones usually start 5-10 years prior to menopause: but we are all seeing women as young as early 30’s going through this. Has many of the symptoms of menopause (listed below) plus irregular/changing periods: from rare/light to frequent/heavy and anything in between. A time of emotional roller coastering: progesterone levels dropping/often estrogen dominance
  • menopause (average age 51): 12 months in a row without a period, then beyond. Or removal of ovaries: surgical menopause. Simple hysterectomy (just removal of uterus): periods stop but ovulation can continue: often menopause happens a little sooner in this last group 
  • self care : imperative for women: stress management/ healthy diet/exercise: helps ease the transition
  • post menopause: after the 12 months of no periods: Kyle and Candace both don’t love this term. Kyle uses it to describe bleeding after official menopause but they both prefer “menopausal” to describe women from this point on
  • symptoms: Hot flashes/night sweats (in 80% of women), brain fog, memory changes, moody, emotional roller coaster, decreased patience, insomnia, palpitations, recurrent UTI’s, vaginal dryness/low libido, belly fat, sudden weight gain, decreased muscle tone, tearful, lack of concentration, anxiety, depression, sore muscles, aches and pains, breast tenderness

Learn WHY you have these symptoms: TEST YOUR HORMONES, find the imbalances: treat with the right dose of bio-identical hormones and supplements.

Why treat? Prevention of osteoporosis/cardiovascular disease/dementia/overall aging/improved quality of life.

Is menopause a disease? Why are we recommending testing and treating?

What bring women to see their providers? Those symptoms!, weight gain, despair, they don’t feel like themselves.

Too many providers don’t test but offer anti-depressants or oral contraceptives. This is not usually the best answer: KEEP LOOKING!!

Common tests: 

  • FSH (Follicle stimulating hormone): an indicator of hormonal changes: not enough to make a diagnosis
  • Serum hormone levels: okay but not the whole picture
  • Pelvic ultrasound: usually done for irregular bleeding
  • Insist on saliva testing: measures the available amount of hormones: test estradiol, progesterone, testosterone, DHEA-S and cortisol throughout the day

Next: we talk about Oprah’s own journey (Oct 2019 issue): At around 48, she was having terrible insomnia/palpitations/couldn’t focus on reading (think Oprah’s book club, yikes!). She went to cardiologist and wore a cardiac monitor. All was normal. Finally a friend told her about estrogen: she went on an estrogen cream and felt 100% better. Life was good again. Oprah had her uterus removed years ago so it is ‘ok’ to just be on estrogen, according to providers in the U.S. WE DON’T AGREE: BALANCED HORMONES is the answer. However, this is what happens to many women in menopause who have had their uteri removed. Going on estrogen alone will alleviate many symptoms but will lead to ESTROGEN DOMINANCE. 

We then discussed another article, same issue, “The agony and the ecstasy of menopause.” All the fears women have re: menopause, but there are some amazing rewards. We dive into this, plus we discuss the historical background of hormone replacement, the debacles, the book “The Feminine Mystique” by Robert Wilson, plus some of the feminist backlash, and where we are today. Do listen: it is a fun conversation.

Main take-home message: use bio-identical hormones (doses based on TEST results), NOT synthetic ones: PROGESTIN (synthetic) does NOT equal PROGESTERONE (what your body naturally makes after ovulation;  made in lab from natural sources). We talk about the WHI study, the Fournier study. We also discuss the important work of Dr. John Lee, a primary care doctor In his studies he observed that many perimenopausal women had symptoms of low thyroid due to low progesterone levels (“functional hypothyroidism”): who, once given low dose of PROGESTERONE, had alleviation of their symptoms.

Plus the book, ‘Oestrogen Matters’. The author went up against Dr. Susan Love, who objected to menopause being called a ‘disease’ (which it is not: more a transition). She believed that women actually were more productive once they were no longer cycling hormonally. Dr Love had a fairly substantial influence in the world of women’s health. This message led to more confusion for women trying to sort through how to deal with menopause and its many symptoms and treatment options.

This brings us back to ‘why treat menopause?’ Candace talks about the idea of ‘topping up’, or treating with the right amount of BHRT(bio-identical hormones)in physiologic doses(the Goldilocks dose) geared to not only alleviating symptoms but to help prevent diseases as women move into menopause. Many women are living longer now , many 30-50 years past their last period.

Without BHRT, we face the increased risk of cardiovascular disease (kills 500,000 women/year in the U.S.), osteoporosis (affects approx. 5,000,000 women, leading to fractures/pain/decreased quality of life, sometimes fatal), and dementia.

Next we ask: why is it so hard to find providers who test and treat? Who use BHRT? In a previous episode, we had discussed this, but in the 1990’s, Dr. SHerry Sherman noticed the lack of studies done on women about perimenopause and menopause. She was instrumental in founding SWAN (Study of Women Across the Nation) which has generated over 500 studies on these issues.

Several OB/GYN doctors (Chen and Christiansen) from Johns Hopkins University also noted that most OB/GYN programs had little to no education on these issues, so they have helped to improve this situation.

NAMS (North America Menopause Society) has undergone a shift and now recommends TRANSDERMAL (medication absorbed through the skin) estrogen.

There are many kinds of hormone delivery: creams, troches, suppositories, pellets (Kyle is not a big fan of these: listen why not): indivualization of treatment is KEY.

Transdermal delivery of estrogen is NOT associated with an increased risk of DVTs (blood clots) so is preferred over oral delivery.

TEST TEST TEST (we recommend salivary testing) your levels prior to starting treatment.

Michelle Obama has a lovely new podcast about women. In her third episode she talks with her OB/GYN friend Sharon Malone about their menopausal issues. Both of them are on hormones after struggling with symptoms. We recommend listening to their conversation.

Kyle and Candace did a webinar at ZRT Labs years ago: ‘The Good Menopause’. The take home message:

  1. Determine your own symptoms
  2. Test to confirm what imbalances you have
  3. Insist on BHRT, tailored to you, at lower doses

Use DIM (extract of cruciferous veggies): helps to push the metabolism  of estrogen (and testosterone) down the ‘good pathway’

What do women fear the most about taking hormones? Breast cancer.

Dr Zava studied breast cancer for years. He observed that women who had the following imbalances were at higher risks for developing breast cancer:
High estrogen/low progesterone, high cortisol at night, high testosterone (converts to estrogen) and elevated ‘flat line ‘ of cortisol (consistently high levels of cortisol throughout the day): this last one causes suppression of the immune system

Again: HORMONE BALANCE is the key to prevent disease states and what we DO know: BHRT leads to greatly reduced risks of heart disease, dementia and osteoporosis, as well as alleviation of symptoms and improved quality of life.

In closing, we talk about the joys of menopause, a time where we have permission to say no to some things but YES to US. We are open to new opportunities. This can and should be a wonderful chapter of our lives.

Kyle is setting up to offer some consults/hormone testing (should be up and running by early October). Contact her through email: [email protected] for more information.

Candace already offers consults and testing. Check out her wonderful website.

Bottomline: menopause is inevitable but it can be grand.We are both here for you.

Please let us know what topics you want to hear about, any questions and comments you may have about our podcasts: we would love to hear what you think. Email us at [email protected] and [email protected].

Thank you for listening.