Midlife hormones : See Ya late Ovulator with Esther Blum, MS, RD, CNS
This week on The Less Stressed Life Podcast, I am joined by Esther Blum, MS, RD, CNS. In this episode, we discuss all things related to midlife hormones.
Hormone baselines & Meno - Mythbusting
The symptoms of perimenopause and menopause
The benefits of hormone replacement therapy
Why do some doctors dismiss HRT in favor of The Pill or an IUD
The importance of pelvic floor therapy for maintaining vaginal health
GUEST SHARED HELPFUL TIPS ON:
How to determine the best types of hormone replacement therapy?
Where to start first when treating perimenopause and menopause?
What is the dreaded “menopot” and how can women lose it?
Organic water-based lube - recommendations
Supplements & sustainable food recommendations to support midlife hormones
Esther is the bestselling author of Cavewomen Don’t Get Fat, Eat, Drink and Be Gorgeous, Secrets of Gorgeous, and The Eat, Drink, and Be Gorgeous Project. She currently maintains a busy virtual practice where she helps women balance hormones, lose stubborn body fat, and treat the root cause of health struggles.
Esther was voted Best Nutritionist by Manhattan Magazine. She has appeared on Dr. Oz, the Today Show, A Healthy You with Carol Alt, the ISAAC show, ABC-TV, FOX- 5’s Good Day NY, and Fox News Live. Esther is an in-demand authority frequently quoted in E!Online, In Touch, Time Magazine, The New York Post, The Los Angeles Times, In Style, Bazaar, Self, Fitness, Marie Claire, and Cosmo.
Esther received a Bachelor of Science in Clinical Nutrition from Simmons College in Boston and is a graduate of New York University, where she received her Master of Science in Clinical Nutrition. Esther is credentialed as a registered dietitian, a certified dietitian-nutritionist and a Certified Nutrition Specialist (CNS), the certification from the Board for Certification of Nutrition Specialists (BCNS). She is also a member of the American Dietetic Association, Dietitians in Functional Medicine, Nutritionists in Complementary Care, and the Connecticut Dietetic Association.
Esther is a 4-time bestselling author whose new book SEE YA LATER, OVULATOR: Mastering Menopause with Nutrition, Hormones, and Self-Advocacy hits shelves on October 6, 2022.
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The great thing about protein is it's the only nutrient that shuts off hunger in the brain. So it's gonna sustain your blood sugar for four to six hours after you eat it, it will support adrenal function, it boosts and sustains your serotonin and your dopamine. And it gets rid of cravings.
Stress is the inflammation that robs us of life, energy and happiness. Our typical solutions for gut health and hormone balance have let a lot of us down we're overmedicated and underserved at the less Stressed life. We are a community of health savvy women exploring solutions outside of our traditional Western medicine, toolbox and training to raise the bar and change our stories each week. Our hope is that you leave our sessions inspired to learn, grow, and share these stories to raise the bar in your life and home
Access to functional or specialized medicine testing and standard blood work is a big piece of personalizing care plans to help our clients succeed by getting accounts with multiple labs and ordering and tracking results from many different web portals slows efficiency by bogging us down in admin work. This is why I'm completely obsessed with our podcast sponsor at Rupa health. It's a single portal that allows you to order from over 20 specialty labs in one incredibly simple dashboard, I'm talking less than 30 seconds to set up your free account and about 30 seconds to order the labs you need. All the results are in one place, and I can securely send clients their results with a click of a button. A big advantage for our clients is that standard blood work can be ordered for almost two thirds, less than other direct to consumer lab sites.
Rupa is a lab concierge, so they send the lab invoices on your behalf of a client pays for their own labs. They help them get set up with a lab, draw, navigate testing questions, and they provide the requisition forms. It's literally a dream. Go sign it for free to help streamline your practice and simplify ordering labs for your [email protected], that's RUPA health.com and let them know I sent you when you sign up, you can also check out the show notes for this episode for a short video walkthrough of how I use Rupa health in my own practice. All right, today, the less stressed life I have Esther bloom, who is the best selling author of CA women don't get fat, eat, drink, and be gorgeous secrets of gorgeous and the eat drink and be gorgeous project. She currently maintains a busy virtual private practice where she helps women balance hormones, lose stubborn body fat and treat the root causes of health struggles. She's voted best nutritionist by Manhattan magazine and is an impaired all over the place, including the Dr. Oz show, the today show, et cetera, et cetera. She is from just outside of New York and is a registered dietician and certified nutrition specialist and many all other things she's active in, in all kinds of boards, et cetera. So what I really like about her is that she brings a really spicy angle to everything. And so I think this will be a fun conversation talking about hormones today and not very boring. So welcome.
<Laugh> thanks for having me today, Christa.
Yeah. All right. So first, thanks. First. We're gonna talk about menopause, hormone replacement therapy, all of that. And I feel like usually our current work is inspired by our own stories a little bit. I could be wrong, but just to guess, I don't feel like this was always your, maybe it's ebbed and flow a little bit over the years. I feel like I've seen you online here and there over the years, but why is this a topic of interest to you right now? Well,
My audience has definitely grown with me over the years. You know, when I wrote each drink could be gorgeous. It was sex in the city, meets nutrition. I was really inspired by Carrie Bradshaw and that was my life as a 20 year old with like a martini in one hand and wheatgrass in the other and just like celebrating the duality of it all. And my clients have really grown with me over the years. I've been doing this 27 plus years, and now I'm 51 and not really drinking martinis, drinking a lot more at green juice instead. And, you know, I really got pretty pissed off at the stories that I was hearing from my clients of how fantastically gaslit they were going into their doctors and being completely dismissed or being, you know, they would say I'm, I'm having hot flashes and I, I can't sleep and I'm, I'm gaining weight, am my libidos kind of low.
And they're like, well, that's just menopause. And they would just be sent home without options or offered the pill or an I U D or the craziest story I heard was one of my patients said her doctor was like, well, I personally just do shots of Benadryl every night, but here's an I U D for you. And she was like, no, thank you. I don't think I want that. And you know, I keep thinking if this was men, we would have menopause solutions. Every man would be on hormone replenishment. This would not be an issue. And it's an issue internationally. And it's, it's interesting. Like if you compare the us to the UK, the UK's leap years ahead of us, and there's like a revolution going on there where the women are all demanding so much HRT that there's shortages right now. And, and it's fascinating.
And I, I do believe we're at the tipping point, I actually wrote a book which is gonna be released in the fall called see a later ovulate. Oh yeah. And mastering menopause or nutrition, hormones. And self-advocacy because there just, there isn't enough out there to support women. And there are treatment options out there. We don't have to even wait to menopause to start hormone replenishment. So I wrote this book and based on, you know, what I've been treating for years at this point, and really seeing the amazing changes that can help women, whether it's diet lifestyle, sometimes stealing with stress, sometimes changing exercise and sometimes yes, starting biodentical hormone replenishment, and it makes a huge difference. Perfect.
All right. So, so many questions that could stem from that, but first of all, actually the title of the new book, I love see you later ator <laugh> because of course in menopause, our ovaries are our ovation and our ovaries are downregulating. They're like, Hey, checking out. Now I did my job. And now adrenals and other tissue, it's up to you to produce the remainder of the hormones. So this decline in hormones, which is a great term, right? Depending on the level of inflammation of the body, sometimes that's easier for some than others. It's not necessarily easy in general. I was unaware until the recent last one or two years, I was unaware that of all of the potential long term negative effects, not having those hormones. I mean, I was familiar with the fact that like, okay, low estrogen is hot flashes all of these symptoms, but from a perspective of what it does for heart health and cardiovascular health and all those things, it's actually really damaging to not have those hormones as well, which I did not realize until the last couple of years. So it's kind of like, nature's like, yeah, actually you're gonna shrivel up and die. Now. Now that you're, oh
That's how it feels. That's how it kind of feels on the inside. Right. And so I think the message here is like doesn't need to feel like that. And you are a living, <laugh> a living, breathing Testament to that. I feel.
Yeah. Well, as I am appearing on this podcast, and as I wrote my book, I'm in per menopause now and have starred hormone replenishment, but it has made a world of difference in my sleep and moods for sure. And cognitive function. But I will say, yes, there's three big degenerative diseases that start people don't realize and connect the dots that they start during perimenopause. Okay. Alzheimer's dementia that decline in estrogen is the early processes of dementia or Alzheimer's. And if you walk into a room and you're like, I don't even know what the heck I'm doing here right now. Like, what was I here for, you know, for getting your keys? I just booked a vacation, like completely not even noticing that I already had family coming during the time I booked my vacation call a subconscious, who knows, but you know, so Alzheimer begins early heart disease and osteoporosis all start 10 to 20 years prior thyroid disease also can really get kicked up in perimenopause menopause.
And that can take an average of 10 years to get diagnosed because we're dismissed. We're told you're tired. Of course, you're tired. You're in menopause. You have a teenager, you have aging parents. Of course you're tired. No, this is not my baseline normal, you know? And we're just constantly dismissed. So we have to either fire our doctors or find new ones that listen to us, or hopefully God willing to get new one outta the gate that does listen to us and does run a complete thyroid test, which is actually seven thyroid test. Not one, not TSH. That alone is a very port excuse for a thyroid panel. We need it full, comprehensive thyroid panel. So just, you really need to be on top of your care and what's required what tests you have done, which I put all of that in my book, I really opened the kimono on my practice and was like, let me show you exactly how I treat my patients and the tests we do and what you should ask your doctor for, because it's shameful that it's just not offered freely.
Yeah. I would agree with that completely for thyroid issues, all nutrient testing in general. And then I have this recent feeling over the last year or two that I like that you said that thyroid issues can take 10 years to diagnose, because I feel like all the symptoms are there well in advance of any blood labs being off. And so I think there's a lot that can be supported from a thyroid. I mean, just like with everything, right? Just support all the cofactors for this to create itself. You're much farther ahead, but back to perimenopause, see you later aviator all of the things. So I wanna ask this question first, because I think it's like so goofy and this is another, like what in the world like WTF moment for me is why would some doctors dismiss HRT or hormone replenishment or replacement therapy in favor of the pillar of the IUD? This makes literally no sense in my brain to suppress hormones that are already essentially suppressed her like down regulating, like what in the
World? Thank you. Thank you. You and I are twins separated at birth. Exactly. So the pill, there is clinical research such as the pill can suppress hot flashes, but it certainly won't get to the root cause of, you know, maybe you have a lot of adrenal issues going on. Maybe you need to meditate more and start, stop doing all that high intensity cardio and drinking so much coffee and booze. Mm-Hmm <affirmative>, you know, how do we support your body that way? But yeah, so a lot of doctors will bandaid. It's a bandaid approach. You know, I always say menopause is not a contraceptive deficiency. I got a lot of flack for that on social people got really pissed. Like we still need birth control and like you can use a barrier method, but the thing is with the pill and with the I U D it suppresses ovulation and progesterone production.
Well guess what falls first in perimenopause is progesterone. That's why you feel really Ragy. You have all this unopposed, estrogen, your periods get even more heavy. Youer heavy bleeder. Before you can get blood clots, you can get water retention, weight gain, painful, sore, tender breasts. So suppressing it further with the pill and the I U D is really not a great idea. Now that being said, there are plenty of women that will tell me on social. They feel fine, but the majority of women that I see have lots of side effects and complications that don't forget the pill, you know, can increase your risk of blood clots, which progesterone replenishment does not mm-hmm <affirmative>. So I really recommend when someone is in the early stages of perimenopause and does have a progesterone deficiency, you know, depending on her FSH level, she could use some, an herb like chase tree, which is going to naturally enhance and boost progesterone levels. Or she can do topical progesterone cream, or even nice gentle dose of an oral bio, identical progesterone, like a trophy. But it, it really depends on your levels. Right? I don't wanna get ahead of myself. Sure. But you know, I see women even in their thirties who have really crappy progesterone levels.
Oh, that's an epidemic, right? It's
Because everyone wants better progesterone. I always like a person I like to personify hormones. So to remember them, and I always call like progesterone, kind of the homecoming queen, like very friendly and kind and like happy. And so everyone wants more progesterone typically, usually. And it's the thing that we struggle with the most. And that's why very occasionally women will say, I feel the best during my pregnancy, because that is when your progesterone levels are the highest. And if you've never experienced them at that level, maybe you do feel good during pregnancy. Maybe you're one of those people. But I think because it's so suppressed by stress and nutrient issues, it's just, I feel like it's an epidemic that it's well, like low pressure is a problem
Period. It's a real problem. And, and hormones start from the top down. I mean, you nailed it. It's, it's the stress really tanks it. And then women get put on. So a, a, a woman who has a regular period, and this happened to me when I was 16, got put on the mini pill for a while, but most women go on it or they have P C O S diagnosed young, and then they stay on it until they're pregnant. So that's 15 years, plus you chemically overriding your body's natural production of progesterone and a lot of women, you know, then they'll get pregnant, but the progesterone never bounces back. Mm-Hmm <affirmative> so we have to, we do treat that. I mean, I have young women who I do have using oral micronized progesterone drops. Yeah. Yeah. Cause it just, it ain't coming back.
Yeah. That is lame. That is good for you to bring up. So thank you so
Much for doing
That because I like to think that women should be able, like, can we do as much as possible to get them to produce their own progesterone first before giving them that. But you know, you're sometimes
It just, I don't see the needle move and, you know, progesterone for those of you don't know it's it is that chill out hormone. It's a precursor to GABA, which is a very calming neurotransmitter. It helps with sleep helps with irritability. I mean, it's the only reason why my 15 year old isn't like thrown outta the house by now because of progesterone. I, I tell him every day, you know, so I really don't discuss that with him, but in my head, I'm thinking, thank you for JustOne because you know, <laugh>, we all need to like take the edge off sometimes.
Yeah, for sure. So I wanna talk much more about hormone replacement therapy. I don't think that there's a lot of amazing resources around this, out there. So I do wanna give a lot of service to that. However, before we go into that, I've had, I've interviewed a handful of people on perimenopause menopause, and I'm intrigued by their approaches to diet, exercise, et cetera. And my question for you is where do you start first? But before you answer that I wanna tee up, I will tell people that it's never gonna be outta style support their adrenals because as your ovaries start to downregulate, your adrenals are gonna take the brunt of hormone production. And so often people have all this long term stress and some of the diet stuff that is recommended seems to cause a lot more stress for people. So I'm curious how you navigate that because that's kind of a tricky thing. It's like chicken or the egg a little bit. It's like, should I make these changes or are they gonna look like a bigger stressor in my life overall? Does that make sense?
Totally. And that is why I test, I don't guess because I used to not test and say, oh, I don't wanna make people, you know, have to pay extra money for testing, but it really yields such specificity that I can know exactly what your hormone production is like, how you detox your hormones, what your cortisol levels are like, what the neurotransmitter's like in your brain and whether or not you're reabsorbing, estrogen into your gut. What's your gut function. Like? Because if your gut function, isn't great, you're gonna feel really crappy on hormones. So I, and you know, you're supporting your methylation pathways is also really important. Methylation is a very fancy word for detoxification mm-hmm <affirmative>. So I test first, before I even see people in my practice, they need to go, I have a lab, send them test kits, they run their tests. Then we review, we look at their blood and I look at inflammatory markers, glucose, insulin, thyroid.
And then I will also look at, you know, hormone levels as well as gut function from there. I put all the pieces together, right? And we talk about diet. So let's say you're listening to S new think, ah, I wanna test, but not now a great where place to start is by getting protein at each meal, that's really important. At least four to six ounces, three to four times a day. I usually have people aim for a gram per pound of their ideal body weight. So if you've gained weight, you know, you can notch it down. But for the average person, it ends up being, you know, somewhere in the ballpark of four to six ounces. The great thing about protein is it's the only nutrient that shuts off hunger in the brain. So it's gonna sustain your blood sugar for four to six hours after you eat it, it will support adrenal function, it boosts and sustains your serotonin and your dopamine, and it gets rid of cravings.
So it's really a super food because you know, you get a lot of cravings when you're estrogen and progesterone drop. And lastly, it's gonna support bone density and muscle growth. You can't, if you're working out, but not eating enough protein, good luck building muscle. It's not gonna happen. Especially as estrogen, progesterone and testosterone, all decline. The next thing is I really like to have good quality carbs in a woman's diet and a lot of diets. You know, I have a lot of clients who say I had hot flashes and a keto. It helped me lose weight. It usually works for about two to three months. And then there is this wall. People seem to hit where it stops. I personally could never sustain myself on a keto diet. So I, I really don't ask my clients to do anything. I wouldn't do myself. And I think the healthy relationship with food is really, really important.
And so allowing carbs in gives good balance. Now here's the thing with carbs. I actually have people have carbs at night, especially if they're having, having sleep issues because carbohydrates, you know, and I'm talking like potatoes, a sweet potato, white potato, rice beans, legumes, winter squash, fruits, veggies, but carbs at night, especially like a good cup of, for me. I could tell you, white rice and white potatoes are like my happy sleep foods. Mm-Hmm <affirmative>, but it does bump up your insulin and people think, well, I'm gonna gain weight and get a, a big belly and midsection, not the case because when your insulin is bumped up, your cortisol gets tamped down, which cortisol's a stress hormone that helps you store a lot of excess body fat around your midsection. Your, your muffin top turns into a cake top lot times menopause. So I always say you lot protein by day, have your carbs at night, knock yourself out, get a good night's sleep. And that will actually help improve your blood sugar and your insulin sensitivity.
Totally. I couldn't agree more. There's circadian rhythm research from like the eighties that is like, yeah, this is exactly how you should do it. And that's what I teach as well. It's kind of a little bit complicated if gut health is not like in per, in real amazing shape because you're not digesting anything well, so it can be a little bit of a double edged sword. If there's a lot of gut issues. Like if you have carbs at night and you're waking up, it might actually be some gut issues that just need to be resolved. So you can tolerate that. Well, but carbs are my favorite. I mean, they're always at night thing. And
If the, if the day has been stressful, I'm like, I'm gonna go and make myself some spaghetti or
Delicious or, or whatnot, but all the potatoes of all the types. So that's actually really helpful. And I think that's welcome. I think it's very welcome. Like I think it's so much more sustainable. So I really appreciate, and I also think like both of those things are things people can do easily and they're not doing already most likely
That's right. Yeah. A lot of women, I see starving themselves. I mean like 12 to 13, that doesn't work calories that
Doesn't work like that may have worked a little bit when you were in your early twenties. And that's why people are like, this worked in my twenties. Like, well, you're not 20 anymore. <Laugh> like, this is not the same.
That's right. And your, your hormone profile is different. Your cortisol levels are different. Your BMR is different unless, I mean, that's why weight lifting is so, so, so helpful. But yes, all of those things are really, really important and you don't get the same results starving yourself. So I end up having to increase client's calories and increase their carbs because I get these women who are like super superwomen they're Redding on exhaust. They have no energy, but they're mentally forcing themselves through these high intensity cardio workouts starving themselves. And then they can't figure out why they're exhausted and irritable. I'm like, dude, start increasing your calories with carbs. And that, you know, have a big spoon of honey with some sea salts on a rice cake, after a hard workout, get those carbs in, or have some white rice with maple syrup on it or a smoothie with some fruit in it. Right? When's the last time anyone told you to actually bump up your carbs will carbs support the conversion of T4 to T3. Yes. Which is active form of thyroid. So we need carbs. Lovely ladies. We need them. We need calories. We need to fuel our workouts. And if you're eating better, you're gonna have better workouts build more muscle. You will naturally burn better fat that way.
Right. It makes so much more sense to fuel your muscles, which are gonna actually burn everything that you want to burn versus adjusting your diet to this starvation that will not actually take you anywhere.
So that's right. And it's good. You know, if you do cut your calories, it should be for very, very short term, like a couple weeks. And then you bump up. Now what you can do is you can do car cycling. If you want to, where you have more carbs on the days that you're lifting and less on the days you don't. But certainly I have found it's just better to be consistent overall, cuz your thyroid's gonna be so much happier that way. And your sleep will be better too.
Right? Yeah. And if you're consistent, you can actually build a habit and then you don't have to think about it constantly. That's a thing that's a novel idea to not be consumed by, by the way, you're hating on your body. <Laugh> but we do want it to support you and feel good. So let's talk about, I wanted to ask this question first, before we get into like hormone replacement and supplements a little bit further, which I think is gonna be very useful. But tell me about the dreaded me pot.
Oh my God. The me pot, the me pot is that belly. You get, you just wake up and you're like, I don't understand why I have a rubber tire around my midsection or love handles or just this belly bloat. So that is the culmination of, you know, declining hormones. And it, it comes on slowly. It's very sneaky comes on slowly. You know, you may notice little shifts here and there and all of a sudden you wake up and you're like, I can't button my pants. Like my legs. And my butt are the same size. My chest is the same size, but it all collects in your stomach. So that's kind of a combination of declining hormones loss in muscle mass and higher cortisol levels or imbalance cortisol levels. Some people have low cortisol during the day. They're rocking it out at night. So I really work on addressing that meta pot with again, strength training, lots of walking, actually training in that high intensity cardio for longer more restorative exercise and Dr. Jade TIDA, T E T a is the king of mastering your metabolism. You should definitely follow him. He has taught me so much of what I know about hormones and cortisol. And at the end of the day, lower more restorative walking, yoga, swimming, breathing is better and getting your cardio through weights and not overstressing and doing these extra long workouts. Like I actually work out a lot less now than I did in my twenties, thirties, even forties. And just making them smarter, not harder. You don't have to grind.
Right? Well, you're describing that. You're not trying to get all of your activity in, in a half hour, an hour, a day. You're actually separat like dividing up your day and being active throughout the day. So you're increasing, what is it called? Neat. You know? Yes.
It, your active, whatever neat stands for, which is basically whatever activity you do throughout the day is worth more by the way than like those food changes that you're making your BMR and your muscle mass is worth much more than all of that. But like just getting up and moving and like walking throughout the day. I think it's funny. It's like, I just need to pretend I have a dog that I need to go walk. Right. <laugh> so like drink so much water. I just have to get up and like go for a walk. Every time I have to pee or something or schedule it in so many people, we had a client, he was a guy and he was like, I don't have time to use the bathroom. We're like, well, that is an unhelpful thought. Like that is just your belief. Like you created this prison for yourself. Like, so alls you can do is like the opposite of that. Like you're not gonna go anywhere with that kind of mentality right there that you have.
Is he like peeing in a Gatorade jar his desk? I mean, what's the deal.
I know, you know, like why do people say that? But anyway, you know, it's fine.
It's fine. No, you know, I just have a standing desk tray that goes on my desk and I just stand, I'll see clients for eight hours at a time. I mean, I have a, an hour break for lunch, but it's like three and a half hours in the morning, four hours in the afternoon. And I'm standing almost the whole day or I sit on a ball and I'm moving my hips around, but you better believe I'm not sitting on my ass all day and I'm getting out and I do walk the dog numerous times a day. So it is fidgeting, moving, getting up to pee. All that is super important. Mm-Hmm
<Affirmative> okay. So we talked with the meta pot, let's get into home and replacement therapy and the benefits of hormone replacement therapy. So best types synthetic biodentical choosing this is can be a bit of a, like, you can go too far as well, right? Like if you're not supposed to be on DHA, you shouldn't just go pick up DHA and start taking it. Right. So
That's right. Let's
Talk about this.
That's why I test and don't guess so I don't put everyone on D H E a. I don't put everyone on hormone replacement therapy, not everyone's candidate. So, and let me just do some men myth busting here and tell you that, you know, the north American menopause society finally updated its position paper on hormones and cancer risk in 2018 and low and behold women. The studies were very flawed that hormones do cause cancer. And by the way, the hormone of choice was synthetic hormones generated from the urine of pregnant horses. That's not exactly biocompatible with a woman's biology. So
I mean, I mean, why
Is this like the norm, right? It's like, oh, I guess this is cheaper. So continue, you know?
We make drugs. Like we make food, right?
Oh my goodness. That's a whole nother ball of wax to unpack, but I will say that in terms of hormones, you know, you can do synthetic hormones, which you can get over the counter and your doctor can prescribe it to you orally as a pill. Or there there's so many different delivery systems, estrogen patches, believe it or not are even conventional ones are relatively bio identical. So that's not a bad thing. And over the counter at the drug store, not over the counter, but prescription at the drugstore, you can get progesterone as Perme, which is a much better bio identical hormone than synthetic progesterone. The problem is it's in a pace of peanut oil. So if you have peanut allergies, you should definitely be aware of that. And also it has to be processed through your liver and your gut. So if you're having issues with detoxification and you're not metabolizing hormones, while I would really recommend bio identical hormones.
Now bear in mind. The levels that I'm talking about are at about a fifth of the dose of the birth control pill. These are low dose. These are to mimic what your body would make at this biological age. And we're not trying to get you back to the levels you were in your twenties. We're not trying to Jack you up. So to that end, I do not recommend testosterone pellets. They Jack up your hormones. First of all, there's zero published research on testosterone pellets. There isn't even a significant amount of research on bio identical hormones, because they're not made by a drug company they're made by compounding pharmacies. So it's harder to find research, but there is in the back of my book, I have six pages of published credible research studies. So I will tell you, biotech hormones are plant based. They are much kinder to our bodies because the delivery system is either a dissolving tablet in the mouth, like a progesterone trophy.
So it's absorbed through your oral mucosa. You can deliver it through a topical estrogen patch, which you change every three days and that you can wear in shower. You can swim with it. You can also do a transdermal testosterone cream. You can take oral D H E a, but D H E a can also be used vaginally as a suppository to an a cream like you can give estrogen creams, you can give progesterone creams, vaginally. You can give D H E a, because that's another mucosal tissue. You do get absorption there. And vaginal estrogen, and D H E a can help thicken vaginal walls and restore moisture and hydration and prevent loss of collagen and elasticity. So that means sex is not painful for you. That means that you can get your libido back rather than your loins feeling like sandpaper on fire. You can actually feel comfortable and not in pain, which is the goal.
So all of those things are very, very beneficial. Now let's say that you have a history of cancer. You're not comfortable doing this. Then what do you do? First of all, there is vaginal laser rejuvenation therapy to help thicken the vaginal walls and restore collagen and moisture production. You can certainly use water based organic lubricants for intercourse, and you can also use nutrients, right? There's adrenal supporting nutrients. There is ma there is great research on ma and reducing hot flashes and supporting adrenal function and blood sugar. You can use calming adaptogenic herbs to help manage your stress response like Ola and ashwaganda and holy basil. And you can also work on replenishing. Your melatonin. Melatonin is a really powerful antioxidant that really helps prevent cancer recurrences. And so supplementing orally, you know, I've run neuro Transer tests on my clients, and a lot of them are not producing melatonin while either. So yes, you can say, well, your progesterone's low. You're not gonna sleep, but you may also want to replenish melatonin to help facilitate sleep too. So there's so many ways to get support, but you know, you have to really work with partner with a practitioner and figure out what works for you. For sure.
I always amazed, but I love that there's always options. So I love that we can use vaginal estrogen and DHA to restore vaginal health, but also that we can use laser therapy. And I've seen that cause my laser lady does this, but I just think that's so cool that both work well, right? Like how amazing that you have all these options that you may not even realize you have. I think that's the travesty is that people just don't know that you have an option,
So they don't know. And the other thing I really wanna talk about for a quick minute here is public floor therapy and the importance of that, because a really big symptom of menopause. Some of the reason why we can't sleep so well is we're getting up a lot to pee at night, whereas before we weren't. So, and even when you curtail your fluid intake, you can still get up a lot to pee. So I do recommend some good pelvic floor therapy or getting assessed by a pelvic floor therapist, which is always done by a woman <laugh>, which is good because they, you know, can insert a finger inside the vaginal walls and feel for trigger points, feel if you're hypotonic, which is when you have poor muscle tone in the pelvic floor or hypertonic, and you're like overdoing your keels and you're holding everything in.
So constrictive also mm-hmm <affirmative>, you know, they can gently release those trigger points manually. You can be sent home with a wand to get up all in there and gently press on the walls to release the trigger points. So your bladder can actually expand to full capacity and empty properly. And then you can also do pelvic floor strengthening exercises. So there's squats, there's single leg deadlifts, there's hip bridges. There's so many amazing things you can do to support your pelvic floor. And that's also a really important piece of menopause, which no one discusses or thinks about. But if you, you don't take care of it, if you've had an epitomy or if you have bladder leak, adapt your children, if you don't take care of that, you will be in diapers when you are an older adult. So if this is preventable and it can be improved at any age
Well, and isn't that kind of the thing with muscles, if you're not strengthening them, then their atrophy, essentially. So yeah, at any moment, if you're not supporting it there's room for supporting it, right.
If that's right, that's right. And you don't even have to go to a gym to do it. These are very simple at home exercises. You can do.
Yeah. I really appreciate you saying that because that is a really common thing that no one talks about, especially when we get into this conversation about hormone replacement just doesn't even come up. It almost comes up separately as a separate conversation. Like, oh, I'm getting up to pee. You don't even think about it's one of the most common symptoms, right. That we see for sure. Yeah.
Yeah. And the whole urethra really Aros with a loss in estrogen, you can be more prone to UTIs. So you wanna make sure you're, you know, if candidate, you replenishing your hormones, but also really work that pelvic floor mm-hmm <affirmative> and then caffeine and alcohol, you know, a, those are not really good partners with HRT because one cocktail can raise your circulating estrogen for about four to six hours after you have it. So just drink judiciously. I'm not saying never have booze, but drink judiciously and, and booze boozing caffeine can really trigger the bladder. They suppress antidiuretic hormones. You're gonna naturally peel a lot more anyway. So just be judicious with all that.
Perfect. Love it. Do you think we covered throughout this, the benefits of hormone replacement therapy enough? Or do we need to cut? We need to like
Points. Yeah. I mean, bullet points are really helping prevent chronic degenerative diseases, de cognitive decline, Alzheimer's heart disease and bone density issues. So, but also, you know, it's quality of life issues, right? It's less irritability and rag us. It is better quality sleep. I mean, sleep's one of the first things I fix in practice and progesterone. It's not miracle drugs. It's a miracle hormone. I have so many clients that are just up all night and they're just, they wake up at three and cannot fall back to sleep. And we put them on progesterone with some estrogen, cuz progesterone helps you fall asleep, but estrogen helps you stay asleep. So when we optimize hormones, sleep is improved in such a short period of time, like weeks a week or two, that's it. So a problem you've been dealing with for years can clear up relatively overnight. I mean, sign me up, just tell me where to go and where to write the check. So yes, a lot of benefits. And of course, you know, keeping the vaginal walls healthy, it's so important that you don't atrophy and that you don't have pain. Mm-Hmm <affirmative>, that's really, really important. That really
Just drives that stress up again. Anytime you have pain in your body is this kind of people don't recognize this as a stressor, but especially in that area, I've seen it happen again and again, but like it's a stressor. And so when you have a stressor now you're like dumpy nutrients. Again, it's kind of like a rough cycle. So like if you're having pain, what can we do about it? Right. So I love that you brought this because people don't really wanna talk about that one either, but they have the desire to have a healthy vagina as well.
Exactly. And a healthy love life too. And I see a lot of marital strife when your libido goes away and listen, libido is multifactorial at ladies. It is not just vaginally. It's also emotionally and it's so cool. Did you know women can orgasm in their sleep?
Hmm, I did not. I just thought that was a, such something reserved for men. <Laugh>
Right. Teenage boys in particular. No, but women, I mean, there's such a brain body connection with that. So you really need to, by this age, you may have been with your partner a long time. So you wanna make sure that you're really, you know, removing pain is the first roadblock, but then doing things to really connect with your partner, your own body, you know, I list definitely some good vibrators and lube in my book to just get the party going, even if it's by yourself and just like really strengthening the vaginal muscles that way. But really, you know, all those pieces do add up to better quality of life. Mm-Hmm
<Affirmative> I was gonna ask you about water based organic lubricants. <Laugh> that was very specific. I've been to multiple conference sessions where they talk about disrupting the vaginal microbiome from like crappy loop. And I was like, no idea. That was even a thing, but what anyway, so organic water based loop, since you were talking about this, I just have to ask, I was like, oh, I wonder what brand's that? I wonder what that, I don't know. I don't know where I would direct people for that.
Yeah. There's a brand called Hey taboo, T a B U that I really, really love. They have a beautiful lubricant that comes with their personal massager as they call it. But let's be clear. It's a vibrator people. Okay. So you know those toys, it looks like a mini ice cube tray. There's silicone. And they have these tiny, circular little bases that you can pop out one by one with your, it looks like wrap and like little bubbles you can pop. So there tiny silicone trays, you can melt coconut oil and free and pour them in that little mold and freeze them. Oh. And then
Pop it a pop it, thank you. That's it. And you can freeze them and insert them vaginally. I use there's a company called Bekin. They have these hydration, ovals that I love. And it's got bees, wax and vitamin E and the tiniest tiniest amount of, I believe it's estriol no, it should be estradiol. Pardon me? I'm having a, I'm having a craft moment. You know, a craft bonus? No. Can I remember an, I can't remember an effing thing. <Laugh> <laugh>
I like that. Thank you. I might start
Using that yeah. Half moment, but you can insert that vaginally as well. So there's so many ways to hydrate, hydrate and moisturize. Yeah.
You are so kind to share this with our listeners.
How can I not it's that's we have to share this there's no, you know, I always read, oh, there's all these taboos. I'm like, why look at the age we live in, everything is out there on the interwebs. Like mm-hmm, <affirmative> no more shame. Let's just empower women to have the tools we need and like have the conversations that we wish everyone had before us. Like when I had my son, one friend said, oh, sex is gonna be painful after childbirth. It wasn't until I was doing research for this book that I learned about. I mean, I did public floor therapy myself a couple years ago, but I still didn't learn until I was researching for the book that, oh, sex, actually, isn't supposed to be painful after childbirth. That's pelvic floor dysfunction. So I never even knew that myself. And I'm like, that's why I write the books I do because they're the books I wish someone wrote for me. Hmm.
I love it. And they're gonna speak to a, I hope they speak to a wide audience because I wanna read your book because I think it's gonna be entertaining. I have a real short attention span for how much nutrition stuff I can read. I'm just like, I actually need to be entertained after talking about nutrition a lot during the day. I'm sure you do too. And so, but I feel like you have a nice combination of entertainment plus nutrition.
Oh, it's very entertaining. And I have to say, I got pretty Randy writing all those sex chapters. I was like, damn, this is some good sensual stuff here, but yeah, no, I really try and have a ton of humor around it. Cuz like you, I think nutrition books are often dry and boring. So I try to make mine really funny, but user friendly and very practical and really teach women how to have a voice in the care of their body, how to ask for hormones if they want it. How to find where to find a new doctor, if they wanna change medical care and just give people the tools and the knowledge they need to get through menopause. Because as I know, we're listing all the gloom and doom symptoms, but you can come out the other side intact and it's really nice to not have a period at some point.
And it's really nice to like have moved on to what Chinese women call the second spring, right. Is what love is called. I've never heard that, you know, it's a whole different time in our lives where we're not stressed about reproduction and we're not raising young children anymore. We may be grandparents, you know, in this window, but you know, it's just, it's very liberating and it's also empowering me. I don't know how old you are, Krista I'm 51. And I just find it gets easier and more comfortable to just get loud and have no shame around it at all and just share, you know, it's wisdom. I love it. Yeah. Wisdom. Yeah. That's
The perfect place to wrap, but I have one last question, you know, from your list, which was, so if you don't mind we'll address it because I think this has been lovely. If someone, you know, wants to try some other supplements before going to hormone replacement therapy, where would she start there? Because I think that can be a little bit, sometimes that's not, sometimes people are on ma and they already have really high estrogen and that can potentially push up their estrogen for example. So it's gonna depend. Correct. But what would you like to say about this?
Correct? Absolutely. So first and foremost, you know, I do like to bring in adrenal support. I don't see too many women with optimal cortisol, curves. People either rock in the cortisol either I call them my cortisol cowgirls or they're like rock bottom and just exhausted all the time. They're either up all night or then totally exhausted and still up all night and depleted. So I like to bring some energy back, right? So that can be a combination of adaptogenic herbs like Ola, holy basil. Ashwaganda all of those are very beneficial. Sometimes GSEN can also be helpful for some women who have really low cortisol levels. I give them licorice root because that extends the halflife of cortisol or I'll even put them on a glandular for a little bit to really replenish and rebuild their stores of healthy cortisol curve and help with blood sugar and help with stress and help with sleep.
Next is yeah. Vitamin D for sure, because most of us are very deficient and geez, it's just good immune support, magnesium glycinate at bedtime to optimize sleep, to help you poop every day. You've gotta poop every day, especially when you're on hormones or you're not gonna excrete them. They're just gonna sit inside your body like a smelly trash bag that really needs to be taken out and isn't being taken out. So you gotta take out the trash and poop every day. But magnesium gly is specific to treating anxiety. And with that drop in progesterone and estrogen, a lot of women get anxiety because duh, you don't have the hormones to support a more relaxed, calm, nervous system. So I love to start there. Certainly digestive enzymes come into play, whether or not you use hydrochloric acid depends on whether or not you have each pylori and gut inflammation. So, you know, that's why I say just try and work with a practitioner. A good probiotic can be helpful too, but I, I really try to test a not guess, but for those of you who are doing this over the counter, you know, you can a B complex is another really, really useful supplement because it supports methylation and detoxification of your hormones and it helps with energy. So those are just a good foundational protocol for sure. Yeah.
There's a lot of options, right? So we've
Worked, oh, so many
We've covered kind of like baseline hormone baseline. We've covered some supplements largely around adrenals and supporting it's. I just don't think we go outta style. When we support adrenals. When we support adrenals, we technically support our ovaries. We technically support a thyroid. We, we support everything. I think that's where our stress, a lot of our stress hormone is produced. Yeah. We talked about best types of hormone replacement therapy. You talked about, you used a word let's do some me myth busting. So that was fun. <Laugh> we talked about importantly pelvic floor therapy. We talked about benefits, a bullet point list of benefits of hormone replacement therapy and the three major conditions that kind of start 20 years in advance. What was the osteoporosis heart disease? And I don't know where it is in my notes. I'm just and cognitive decline. That can happen as we decline in these hormones that we see in advance talked about sustainable food, recommendations enough protein, enough carbs, increasing calories and carbs because your thyroid needs those. And then so often we're trying to like run on nothing and expect ourselves to, and that just increases our cortisol and increases the rubber tire effect essentially. And you have a book coming out, see you later ovulate October 6th.
Yes. Right? Yes. So yes, yes, yes. So you must not only all get it, but tell your friends about it. If you want to be in the know and get some sneak peeks, you can go to my website, Esther blum.com. That's E S T H E R B L U M. And also follow me on Instagram at gorgeous Esther. And we're doing a lot of really fun things right now that we are building up and just, it's gonna be a plethora of information that will empower you and give you the tools you need to navigate through menopause as optimally as possible.
Perfect. Thank you so much for coming on today and sharing all this. That'll be so helpful to our listeners.
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