Navigating Menopause with Dr. Berman

If you're gaining weight around your midsection, you're losing your muscle, your brain fog, you don't have that extra oomph, you could be heading towards menopause or in menopause. And guess what? Medicine is not living out for you. Some women are more predisposed to significant weight gain. And we have testing now that is available to help women understand and navigate menopause. Like what symptoms am I going to get? What symptoms, what can I expect? It's called the menopause biotype. It's like a 23andMe test. So if you want to know... What can I expect that's a great resource? Dr. Jennifer Berman is a renowned urologist, sexual health expert, and women's wellness advocate. She is one of the few female urologists in the United States that has pioneered research around female sexual health. Dr. Jennifer Berman comes on the show and gives us the exact medical insight on what women need to do to be your happiest, healthiest version of yourself as you hit menopause. All right, Doc, thank you for coming on the show. Before we came online, we were having a conversation and you said something that still stuck out to me. And I'm still thinking about it, that you said, after a woman has a baby, sort of the medical industry kind of just forgets about you. What did you mean by that? Well, from the standpoint of the symptoms that women have as they age, once we're done having children. and we're entering into perimenopause and menopause, meaning symptoms are starting to crop up, moodiness, fatigue, hot flashes, night sweats, weight gain, sexual health issues, vaginal dryness, and low libido. Those are symptoms of hormone imbalance that are not, at this time, recognized by the medical community as warranting medical attention. or medications or intervention. So when women come to their gynecologist or their primary care doctors or their family or their internist or whoever, and talk about these symptoms, they are met with, you know, I don't know, or they're given antidepressants, or they're told to do, you know, have a glossop, they're dismissed. And the reason for that is that the The medical community, our OB and GYN obstetricians and gynecologists are not trained. There's no algorithms. There's no protocols that exist today out there in the medical field for treating perimenopausal and menopausal women. I don't know if you remember back in 2010, there was this big outcry, basically, that there was a WH, the Women's Health Initiative study was published. And the ACOG, the American College of Obstetricians and Gynecologists. released this information. And at the root of it, it was hormones are bad and hormones cause breast cancer. And everybody needs to stop hormones right now. So women that were on hormones are getting yanked off and women that were, and there was this big scare, which by the way, was completely unfounded. They had to recant that statement and it was not true. It was not the opposite is true. However, they never came out with anything else. So it left all of the gynecologists practicing, all of the new ones coming out without any leadership, without any guidance, without any direction. So then what do women do? Where do they go? So then they have to go out and network. They have to find other doctors. They have to search around to find providers that understand and know hormone replacement therapy. I happen to know, like I've been working in this field since the 1990s for decades. And. My, and I'm a woman, obviously, and my specialty, I'm a urologist specializing in sexual health. But through the course of my, as I'm aging and the course of my career, as I'm aging, I'm noticing changes in my body. I'm getting hot flashes and night sweats and mood and low libido. And I'm reaching out to my gynecologist and nobody knows anything. So I literally had to learn myself. through other doctors in Europe. There was nobody here in the United States really talking about it, but in Europe and Canada, there were other doctors that were treating women with testosterone and optimizing hormone balance. And that's kind of where I learned that I became my first patient. And from there, I started treating other patients. And from there, there were more women. But that's kind of the situation that we're in right now here in the United States with dealing with aging women. Our doctors aren't trained in menopause. And what we're seeing is all this media attention coming out with new publications and new articles and new things. The research is happening, but yet... where do women go? So that's, you know... Yeah, that's a state of affairs here, basically. Okay, so a few things. At what age does a woman hit menopause? What happens? What are the main symptoms of menopause? And when we talk about hormone replacement therapy, I want to go into how safe it is. Okay. So prior to menopause, I want to just mention there's perimenopause. So these are women in their mid to late 30s, early 40s, and that's when symptoms can start. And that's when symptoms often get overlooked, dismissed, or mischaracterized. I don't know if you remember seeing in the media recently, Halle Berry was misdiagnosed. She's menopausal, not even perimenopausal, but they misdiagnosed her menopause as having herpes. She was having vaginal dryness, painful and painful intercourse. And instead of recognizing that she had vaginal dryness due to low estrogen levels, they told her she had herpes and that was plastered all over. I remember that. So in the perimenopause, when women start to develop symptoms of moodiness, difficulty sleeping, weight gain, some vaginal dryness, maybe low libido, that's the beginning of menopause. Now, the only difference between those women and the actual menopausal women is one thing, is the perimenopausal women are still having their periods. A menopausal woman, the definition of menopause means you haven't had a period for 12 months. So if it's been six months, if it's been eight months, or if it started and stopped, that's still, you're still technically perimenopause. It's just a definition that when your period ceases, For a period of 12 months, that's the definition of menopause. But the problem is that women in perimenopause have the same symptoms, maybe not as worse, maybe not as bad, maybe not as profound, but they're still having symptoms. And those women are definitely right now in the United States not getting treated with and should be treated with hormone replacement therapy. The menopausal women who haven't had a period in 12 months who have the same symptoms, hot flashes, night sweats, difficulty falling asleep or staying asleep, memory, focus, concentration changes, foggy thinking, they can't remember things, they feel less creative, less motivated, they're not the same as they were, they're not functioning on all cylinders, they're not able to compete in the workplace with men and other people due to hormone imbalance. not to mention vaginal dryness, painful intercourse, low libido, joint pain, and weight gain is a big one. So all of those that can vary, and every woman has some semblance of those symptoms, sometimes worse than others, and there's a genetic predisposition to symptoms. Like some women are more predisposed to having severe hot flashes. Some women are more predisposed to significant weight gain, and we have testing now that that is available to help women understand and navigate menopause. Like, what symptoms am I going to get? What symptoms, what can I expect? It's called the menopause biotype. It's like a 23andMe test. So if you want to know what can I expect, that's one option that's a great resource. But so perimenopause and menopause, these are the symptoms, and it's just a consequence of aging and the changes that occur in our bodies. And the... When hormone replacement therapy, I'm a huge proponent for hormone replacement therapy, and we talk about safety, the concerns that we initially had originating back about 10 years ago when they released the Women's Health Initiative study saying hormones are bad, hormones cause breast cancer, that's been completely debunked. In those studies, they were looking at synthetic estrogen plus synthetic progesterone in the form of PremPro. It was an oral medication, actually. And oral hormones or oral estrogen, in my opinion now, is completely passe. Nobody should be doing estrogen orally. Because when you give estrogen orally, that's when you do have the potential risk, and not necessarily cancer risk, but thromboembolic risk of stroke and heart attack and things like that. When it's given transdermally through the skin, you don't have the thromboembolic events. So... There's not concerns about stroke or not concerns about cardiovascular disease or raising your cholesterol and things like that. The other concern was breast cancer. And that was with, again, synthetic estrogen plus synthetic progesterone given orally. Today, we're not using synthetic estrogen and synthetic progesterone. We're using bioidentical estrogen and bioidentical progesterone, which does not have the same risk factors. And when they went back and teased back and reviewed the data again, really, even with the synthetic progesterone, what it comes out to is that in some women, in a small percentage of women, after seven to 10 years. of consecutive use, there is a slight increase in breast cancer, but not the preponderance of what they originally discussed. However, what we do know now that we didn't know then is that testosterone, which by the way, is equally important in women as it is in men. Everyone thinks that that's a male hormone because testosterone makes you strong, whatever, but it is extremely important in women as well. and declines significantly with aging and leads to a lot of symptoms also. What we know now is that testosterone is protective against breast cancer, literally prevents breast cancer, prevents the recurrence of breast cancer. If you've had breast cancer, it prevents you from getting breast cancer. If you haven't had breast cancer, and that is a fact that's known. We also know now that estrogen prevents degeneration, cognitive decline. with aging, women's brains shrink during menopause and estrogen deprivation, our brains actually shrink. So when women say, I just feel out of it, I feel, you know, stupid, I feel I can't remember anything, I feel like I'm not, you know, productive anymore. There's reasons for that. And it's hormonal imbalance. So in my opinion, in order to remain and if we're talking about well being and longevity and health. Everything starts and stops with hormone balance. As soon as we start to, our ovarian function, adrenal gland function starts to decline, in my opinion, is when we start to really age and die. So now today with advances in modern medicine and technology, we have ways to prolong our lifespan and prolong our health and do so not just live sick, but live with well-being and live with health. And prevent disease. So why do you want to start? So why would a perimenopausal woman want to start hormone replacement therapy? In addition to alleviating her symptoms and making her feel better, it will prevent disease, prevent Alzheimer's, prevent osteoporosis, prevent breast cancer. So improve your cardiovascular health, improve your strength, improve your cognitive function. So it's a no-brainer for me. And the risks and side effects that we're talking about is not cancer, death, stroke, you know, the side effects of hair growth, oily skin, acne, some breastfulness, tenderness, all things that are manageable and reversible. We're not killing people with hormone replacement therapy, which is what, you know, the, the, you know, the mindset is right now. Oh, that's dangerous. It's bad. Or it's, there's just confusion and uncertainty and unknown. So if we don't know it or it's bad, you know, that's kind of the ethos that the medical community has. And then that scares consumers. But what happened during COVID, this is when I first started to change. Women, we have social media now that we didn't have back in the day when I started. And women were talking to other women. And they were seeing, I think Kris Jenner or one of the Kardashians got on. TikTok, the mom was talking about like this menopause. And then it like, whoa, like, we're talking about it. And there's also shame and taboo. Like the word menopause is symbolic of, you know, the withering, withering of your fertility, the you know, I'm no longer feminine. I have patients, a lot of my patients are the housewives of Beverly Hills. And I kept telling, I was like, you should talk about this. And they were like, no, I don't want anyone to know that I'm menopausal. And now so that was, you know, three or four years ago. Now they're three or four years older. And now they're they're reaping the benefits of hormone replacement therapy. And now they're realizing that they have a platform that can impact that is beneficial. They can provide women with with help and resources, tools and information. And they are starting to talk about it. So this movement that's happening around menopause is women. It's not driven by. politics is not driven by the FDA or the medical community. It's being driven by women, the consumer. And they're starting to, you know, get louder and they're starting to be, you know, more prominent voices involved, like Huberman Lab has covered it. And, um, There's Mel Robbins. So these larger pockets, you know, you are covering it. And I think with the more conversations that we're having, more awareness that's developing and male voices chiming in that hopefully change is on its way. Yeah, big time. I've seen the benefit of bioidentical hormones on patients years ago and how much better they do. But for those who've never heard of them, what are they? What's the difference between like the synthetic ones that they were talking about in the 90s that go, you take this, you're going to get breast cancer or a thromboembolitic event or something like that. And the delivery is through a lotion or a patch. Like how easy is it? Do they need a prescription? And basically the women listening, how do I get my hands on bio? Let's talk about something that affects us all. 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It has become an essential part of my daily health regimen. I think you're going to love it too. Peoria is offering 20% off of their O3 Ultra Pure Fish Oil and all their other fantastic products to heal myself. Listeners, that is 20% off, even on top of the already discounted subscription price. Just go to peoria.com and use the code DRG for 20% off already the discounted subscription price. That is peoria.com slash DRG. Use the code DRG. So all bioidentical means bioidentical is the same as your body makes. So the same. the same molecule that your ovaries make. So 17-beta-estradiol is the estrogen molecule, and it works on the estrogen receptor. So there are bioidentical hormones right now for women, only estrogen, the only one that is available, well, there's two. There are two hormones, at least the ones that I use, that are bioidentical, that are commercially available, that are FDA approved, that can be prescribed, that you can get. 17-Beta-Estradiol comes in the form of a patch and progesterone, micronized progesterone is the same as our body makes, not Provera, not the synthetic progesterone, but regular progesterone is also commercially available and FDA approved and comes for menopause and comes in two doses. What testosterone is not FDA approved yet, despite all that we know about the beneficial effects in terms of cognitive function and breast cancer and everything else, still not FDA approved. And that so what that means is that that has to be compounded by a compounding pharmacist and they can make testosterone in a lot of different versions in the form of patches, creams, lozenges, trochees, pellets, lots of different ways. that can be delivered also transdermally. The problem that exists now related to testosterone, I was just telling you about how doctors aren't trained, like our medical providers aren't trained in just estrogen and like regular hormone replacement therapy. Testosterone is basically, we're in the dark ages when it comes to women in terms of that. And the reason for that, I'm not really sure because I've been treating. women with testosterone since the 90s. And people and there were many doctors that were doing research with testosterone and women well before I became age, like decades before I started doing it. So and now with the preponderance of evidence of the beneficial effects, it makes no sense to me why we haven't pushed forward further. But testosterone is tricky because and if doctors aren't trained, they don't know like, well, what should the levels be or how high should they get? or how do we give it or what, you know, and if you, I don't know about you, but for me, if I don't know how to do something and I don't feel comfortable, I'm not going to do it. I'll be like, either refer you to somewhere else or be like, no, you know, and that's what's happening. Nobody knows how to do it and they don't know. And they refer to somebody else and women are left flailing around having to become resource for themselves and find providers out of network and provide this and do the research themselves. But that's basically. And where can you go? Where do you go to get bioidentical hormones? They do have to be prescribed by a medical doctor that, you know, that obviously knows what they're doing. And many do, but, and many are learning. So just because your doctor may not be certified in bio, you know, in hormone replacement therapy and, you know, be an expert, what they're doing now is doctors are taking matters into their own hands. If they're not trained, they're taking courses, they're... doing, they're shadowing other doctors, they're learning and reading and doing what I did back in the night, how I had to do it, you know, they're starting to try to educate themselves and try. But what happens with that is that patients can tell like, you know, I'll try this cream. And, you know, they believe the doctors will believe that it'll help you, but they don't, well, let's try this. And let's try that. And if the patient doesn't feel that you have an authority, and that you can say, this is going to happen because these patients come to me and they say, well, she helped me, but she didn't, you know, she didn't test labs. And she said, you know, she didn't know she wasn't, maybe, you know, there were, it just made me feel nervous. So that's, you know, kind of the sentiment that, that women, the consumer feel either confusion or anxiety about hormones. And the reason for that is that our doctors aren't trained. And so when they find one like me or you or whoever that, that, that, that understands it's. a huge relief. And then they tell their friends and then they tell their other friends and, and hopefully little by little, things are, things are going to start to improve. But bioidentical hormones are safe and effective. They need to be, you know, under a, you know, a doctor's supervision. There are levels that need to be checked and levels that need to be maintained. And there are risks. I'm not going to say that there's, you know, it's like drinking water. There are potential risks, which is why. you know, we, it needs to be under a doctor's supervision. But the cool thing is now, even women with breast cancer back in the day, when I, like when I was, you know, coming up and becoming menopause, it was unheard of, like even giving vaginal estrogen to a woman with breast cancer. And those women really suffer. They're put on tamoxifen or loxapine and they're shriveled up hormonally into like frail, like no estrogen. thin vagina, brittle bones, like weak muscle, but they don't have cancer. Like I said, you don't have cancer, but quality of life is equally important as quantity of life. And that gets lost in the breast cancer patient. Now, today, breast cancer patients are now able to use vaginal estrogen products. And we're even able to give breast cancer patients testosterone because we give them testosterone plus anastrozole. Anastrozole blocks the conversion of testosterone to estrogen and keeps it as testosterone. So even if they have breast cancer, estrogen positive breast cancer, they can take. they can receive testosterone. And testosterone helps with hot flashes, night sweats, memory, mood, energy, lean muscle mass, libido. And many, many, many women now with breast cancer are thriving and living active lives where before, you know, they couldn't go windsurfing or they couldn't, you know, go biking anymore. And now they've got their lives back and their energy back and their sex life back and they're cancer free. Yeah. And it's beautiful that that can be offered to women. I mean, I've worked a lot of breast cancer. I can see how women degrade into this, like you said, frail, in many ways, like lifeless. It's just like, wow, there's no more oomph to that person. They become a breast cancer survivor and that's their identity instead of I'm a woman, I'm Jennifer. Who's thriving, who's thriving. So I'm intrigued by the talk on testosterone because I hadn't heard much about testosterone being given. with women, bioidentical hormones, women who are going through menopause, the testosterone in itself, you said, still isn't approved for that. Yeah, no, testosterone in any format is not FDA approved for use in women yet. And there is no explanation for that. Originally, it was, they say about safety and safety to the unborn fetus, but these are women that are not having babies anymore. They are menopausal women where there's no chance of a fetus. By the time they've stopped having a period for 12 months, they're not having babies anymore. So the safety issues related to that are nominal to none. And now we have an overwhelming body of evidence, not just talking about the safety of it. We already had that. And I was annoyed back then. We have safety data. It's safe. OK, guys, let's move it. But now we know not only is it safe. but it prevents breast cancer. So how can you like what there's nothing. And so I don't, you know, again, I, it could be political, it could be financial, it could be any, any number of things. But, but what I do know now professionally and personally as a woman, an aging woman now who's in her almost 60 is that I am not competitive in the workplace without hormone replacement therapy. So the glass ceiling that we talk about that was set by corporate America, in my opinion, is not set by corporate America. It's set by menopause because as soon as a woman becomes menopausal, you can't sleep. Our memory's bad. We're foggy. We're not as assertive and aggressive. And then once that happens, you're not eager to take on new projects. So if you're working with a guy, let's say a 58-year-old guy and you're 58 and nothing's happened to him, his memory's fine. His mood is fine. He's not getting fat and tired and all that other stuff. But we are. And so without hormone replacement therapy, then we are not firing on all cylinders. We're not as assertive, not as aggressive, not as confident. And as soon as we realize that, then we're here. We're not equal anymore. With hormone replacement therapy, it's going to allow, it allows me, because I'm that woman. I actually was 37. So it hit me. I was one of the women that was very sensitive. to fluctuations in estrogen. Every woman feels a little bit. Some women worse than I. We know about postpartum depression, right? Those are the women that are really sensitive to it. When estrogen falls, they become suicidal, homicidal, hallucinate. But that doesn't have to happen. For me, my estrogen levels fell. I wasn't suicidal or homicidal, although maybe I was a little homicidal. But- I was miserable and not able to function. Very, very angry, irritable, edgy, weepy, all of it. And I also have a very strong history of breast cancer in my family. My mother died of it. My sister, who's four years younger, got it twice. We don't have the BRCA gene, but I was advised highly not, you know, do not go on hormone replacement therapy. But there wasn't a choice because I couldn't function. I was in the middle of my fellowship. I had to take boards. I was like, okay, I'm gonna give up now. And so I did a cost benefit analysis. I knew what my risks were compared to the general population. It's higher because of my family history. And I knew what the risks were with, because they can calculate, with hormones that my risks were higher, but not like hugely higher, a little bit higher. And so I did, I said a little bit higher, you know, I'm willing to take that risk because I want to live. I want to have a life and, you know. I might get a, I just, I'm going to, breast cancer is going to be for somebody else. So we're going to push that away. And so this is since 2000. So it was after my daughter was born. So 2003 is when I, when I started this. Today is 2024. So for all of those years, I've been on hormones and testosterone. So, and back then I was giving testosterone to myself and other patients. And I was. people were freaking out like, oh my God, like, what are you doing? But honestly, I think that my being on testosterone is what prevented me from getting breast cancer. I thought like, oh, I just manifested myself. I was my positive thinking. It was my, maybe it was both, but chronic testosterone over time, long-term testosterone use is now what they know prevents breast cancer. So it was just, you know, I prevented myself from getting breast cancer through both ways, probably. But, um, But it's a testament to the safety of it and the efficacy of it. And, you know, I'm a living model of that. So testosterone is really important for women for energy, mood, sexual energy, physical energy, and your emotional kind of joie de vivre energy. So those three forms of energy. And also cognitive function. And while. Estrogen is more, helps with short-term memory and focus and concentration. Testosterone is even a higher level of almost intelligence, creativity, you know, connecting the dots. Like, you know, if I were to tell you something and then you say, like, what was it? I'm going to go look that up. Like that desire to go look it up goes away without testosterone. The even thought that, oh, that may apply to something else. goes away. I notice it in myself when my testosterone levels start to decline. My son even notices it. I think you're due for your pellets, mom. So it definitely impacts how we feel, how our bodies function, and equally as important, at least to me, is how we look. Our skin, our hair, our nails, our lean muscle mass, our weight, all of that is optimized through home. and unbound. I'm putting you onto my favorite green powder period. New zest, good green vitality. It's the best one out there. It's a revolutionized approach to holistic health. 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Thyroid is another one that kind of get, and these are becoming like hypothyroid metabolic disorder, but it's once the ovaries start to get out of balance, your adrenal glands have to kick in to compensate for that happening. And then they get tired and burn out for a period of time. You know, and that's when cortisol levels rise, the stress hormones. So menopause, your metabolism in menopause is completely flipped around, upside down. You're storing fat as opposed to burning fat. You start to gain weight centrally. Women will say, you know, I'm dieting, I'm exercising, I'm eating like two almonds a day and I'm not able to lose weight. Or I can lose a couple pounds, but as soon as I have like, you know, a bowl of pasta, I gain it back and more. And so their metabolism is shifting and what happens is, is that. Menopause, in my opinion, is a risk factor, a risk factor for cardiovascular disease, a risk factor for metabolic disease, type 2 diabetes, a risk factor for depression and anxiety, and a risk factor for obesity, for just being unhealthy. So why we're not treating menopause and taking menopause seriously, just if nothing else, forgetting how women feel, but their health. We haven't connected the dots that to remain healthy, we have to optimize hormone balance. And it's just like somebody tore that chapter out of the textbook or they erased it from our brains. It's very weird because even now, like I'll see, I just saw a patient the other day, an older woman in her 70s. And she was having really horrible urinary. urgency. I forgot to mention that. That's another symptom. Urinary symptoms, frequency, urgency, urge incontinence, leakage or stress incontinence. They call those genitourinary symptoms of menopause. So this woman was having urge, urgency and urge incontinence that was like debilitating and driving her nuts. And she's seen all sorts of different doctors, neurologists. And the last one she saw was a urologist from Columbia. So Columbia University is a very prominent university in New York. In the Department of Urology, which is my field, she saw a female urologist, a very well-trained one, who did an exquisite workup on her and diagnosed her with this urge incontinence. And they prescribed her with a medication for overactive bladder. So for somebody like that had a neurological condition, like with MS or a spinal cord injury or Parkinson's disease, none of which she had to quiet the bladder. So it wasn't, you know, which didn't do anything for her. And the issue, and it didn't occur to that doctor. I was like, well, she was a urologist, so it's even less, but she wasn't a gynecologist, but why it didn't occur to her to say, okay, the urgency, urgent continence is genital urinary symptoms of menopause. She needs vaginal estrogen. And so, yeah, so that it's, it's women of all ages, even in the premenopause, the premenopausal women struck premenopausal women are on birth control pills. Okay, all let's, let's say so birth control, birth control pills for many women can, you know, because what happens in the birth control pill is that it dramatically lowers all your hormone, all your hormones. If you're a young, reproductive, healthy woman, most of them, you know, aren't impacted by that. But there are a handful, I'm not going to say few, I'm not going to say many, but somewhere between few and many, there are a lot of women that don't tolerate the birth control pills because of that, because it makes them moody, because it makes their vaginas dry, because it causes low libido. Why? For the same reason a menopausal woman struggles with it. So that's a lot of what I do too. So if a premenopausal woman can't take... hormonal contraceptives, what do you do? What are the alternatives? So I do have premenopausal women in my practice too that are sensitive to fluctuations in the hormones that need a little bit more, a little bit less, that need options for birth control, that can't take birth control pills. I had a young girl the other day that got the Exponon, the implant, who had everything she needed. including bleeding, nonstop bleeding. And so we had to take that out and get her, you know. So it's, hormones are relevant regardless of what your age are, whether you're in your 20s, 30s and 40s. or 50s and up, it's important to have an understanding of what they are. And in fact, I would encourage women to know what their levels are, especially when they're feeling good, to get your levels checked, to look. So what does my estrogen level need to be for me to feel good? I know what mine is. I know what hers is. So mine is 242. Another woman's might be 80 or 40 or 60. We're all... different. So just what works for me isn't necessarily what works for you. I think that's another thing that's fallen, you know, that's been challenging for the medical community, because they want to do one size fits all. Everybody gets this, everybody gets that. And if you can't do that, then, you know, then it's bad, or then there's something wrong. And we can't do that with menopause. There's not a blanket, you know, pill, just like what came up with. with female sexual function, female sexual health, there's not a little blue pill like Viagra that's going to fix women's sex lives. It's just, we're more complicated. And there's more factors and more variables and our reproductive health and our, and our brains are different and our emotions are different and how we process things is different. So it leaves a lot, a lot untold and a lot misunderstood. But there is, the cool thing is, is that now today women with With social media and with the internet, women can take matters into their own hands. And there's a lot of information that's available online and a lot of resources that are available online and through social media. And people are finding their way. They're finding a way to different doctors, to different providers, to different healers, to different groups, different educational forums that are talking about it. And momentum is starting to build. And hopefully. You know, the medical community will follow. They have to. You know, it doesn't feel good to have a patient come to you and be like, I don't know what to do. Like, that alone as a doctor should hopefully, you know, it is. I see it. It is spurring them to learn, to do, you know, to step out of their comfort zone, to, you know, you can't be a gynecologist and not do hormone replacement therapy. Like, it's like an oxymoron. It doesn't. So hopefully all of them are going to, you know, that start, the ones that are already trained are going to start learning and that they'll start teaching the medical students. They'll start teaching the residents. They'll start being, you know, it's impossible for that not to happen with the data and research that we have that's coming out. The sexual changes, the libido, major one that a lot of women are suffering with. What's happening in the body of a woman, perimenopause, going into menopause, in menopause, what's happening to their hormones that they aren't feeling as sexual or sexually driven, or even during sex, not having the amount of pleasure and how much they enjoyed it? And does it come back to the same thing? Like those are the women that really benefit from this hormone replacement therapy. And then is there an emotional component to it too? Do you find a lot of these women become... depressed from this. Marital issues are starting to arise. 100%. Yeah. My marriage is in crisis. We have a lot of men that get their women in. My husband made this appointment. My boyfriend called. Yeah. So the thing at the root of all of it, if I had to think of, off the top of my head, what is it that they say that's kind of universal? I don't. feel like myself. I'm not myself, whether it be from a mood standpoint that she's snapping at her kids and her husband, or be it from a sexual standpoint. I used to want to have sex all the time. We were having, I was multi-orgasmic. I was, and this is not me. I don't, you know, I don't know why this is happening. And from the standpoint of the emotional perspective, that was originally when we, when I first started, you know, in this field, we were met with a lot of resistance by people. the therapist and psychologist, and they were saying, you're medicalizing a condition that is more emotional relational. And I don't, it's both. In women in particular, I'm not going to say that men don't have emotions, but men are much better at compartmentalizing. They can... Be, you know, have these thoughts and feelings, but still focusing on the task at hand. OK, right now I'm having sex and I'm going to get her and I'm going to do it. And then I'm going to go over there and cry and whatever else. Women, there are women that can do that, too, but it's harder. And so their emotions and their thoughts and their feelings. um, interfere with arousal and orgasm and libido for that matter. And, um, and it's important. So one, it's not to say one with there's medical issues and there's emotional and relational issues and the two work together. But the point from my standpoint as a medical doctor, there are real medical, physical reasons why women have sexual function complaints that are amenable to medical treatment and that should be addressed. And there's also emotional relationship issues that need to be addressed and attended to and thought about. And the two together, not either one in isolation is better, but need to be working harmoniously. And in terms of the other part of the question was testosterone, what was it? They'll do the bioidentical hormones. Is that the answer then also for the libido part? Yeah. So for so what women will say. So estrogen. is crucial for arousal, lubrication, engorgement, the warmth and tingling that occurs in the genital area, blood flow. And then testosterone is important for libido, your desire, the motivation to be sexual, the motivation to initiate sex. So your motivation to masturbate or whatever, to have sexual thoughts. interest fantasies. And orgasm is also testosterone. I'm not going to say testosterone dependent, but impacted. But if testosterone levels decline, orgasm can be affected. It's less intense, harder to come by, you know, cost benefit analysis of even having sex doesn't pay off. So it is a frequent complaint that women have. So testosterone is essential for sexual function, arousal, orgasm, libido, all of it. And so when your physical energy, your lean muscle mass, you know, so when testosterone levels are low, women feel apathy about sex. A lot of them say they're not, but they're not like disgusted, abhorrent, like repulsed, but it's sort of like apathy. And over time, if a woman is a widow or is divorced or whatever, over time, you don't even notice, you just stop thinking about it. And so she thinks she's fine and normal, and I have this patient, she's fine, going about her life, until, uh-oh, there's a guy. And he looks at me, and maybe I'll go to dinner. And then, wait, now I like this guy. Oh, I'm starting to have some feelings. Let's have, maybe we'll have sex with this guy. And it's like, breaks come on, I'm dry, it hurts, I can't have it, like, what the hell, what do I do? So, yeah, so. That's what sort of the experience is. You see, huh? That is the spirit. And I guess to the point where the menopause biotype test comes in is that there are women, I'll say a small percentage of women, that float through seamlessly without any hiccups. And, you know, God bless those women. Most women suffer to some degree with something like weight gain or, you know, I can't sleep or I'm getting migraines and mooniness. The majority. you know, really struggle with all of the hormones and navigating through menopause. And the thought was like, let's just get them through menopause. And then once they're done with menopause, so when are you done with menopause? Menopause, you're technically done with menopause and by our medical definition, when you stop having hot flashes and night sweats. So those eventually, if you were to do nothing, if I gave you no bioidentical, no nothing, and eventually... You'll be miserable and your hot flashes and night sweats will eventually stop, but you'll still be miserable. So even though the hot flashes and night sweats stopped and you're not menopausal anymore, you're postmenopausal, you still have everything else. You can't sleep. You're fat. Your bones hurt. You can't lift weights. You're moody and irritable. Your vagina is dry. You've got no libido. All of that still. Your bones are... cracking and you're a mess, that continues. So I get asked a lot, well, how long do I have to stay on them? You have to stay on them. And then the demand increases. As you age through menopause, you might need a little bit more. And then as you become post-menopausal, then maybe we can taper back down. But if you want to live a happier, healthier, sexually fulfilled life, For the majority of us, not that small few of the lucky ones, but for the majority of us, it requires hormone balance, optimizing hormone balance. into our 60s, 70s, 80s and on. Yeah. Men are doing it. We don't think twice about men jacking themselves up with testosterone. Right, right. 50, 60, 70 or 80-year-old guys bench pressing, you know, a million pounds and wearing cut, like, white-beater's shirts. You know, they turn into silver foxes and get better as they age. Why do we have to, you know, have... have the opposite experience. Yeah, absolutely. So there's women listening going, oh, wow, this is my experience and I'm heading towards there. What I'm hearing from you is they got to get their blood work done. And even if you're not heading towards there and you're feeling good, get your blood work done and look at your numbers. Especially when you're feeling good. Especially when you're feeling good, look at your numbers. Get a baseline. Estrogen, progesterone, testosterone. Those are the three. And thyroid. And a thyroid. Get that, ask your doctor and just get your numbers. Mark it down, put it in a file on your folder and say, this is when I feel good. And, you know, there's a lot of women going, oh, well, I know about like functional doctors and naturopathic doctors, but how do they, is there a database that they can find someone in their town who, you said there's not a lot of people. Not, but there is a company called BioTee and BioTee is, makes pellets, hormone pellets, bioidentical hormone pellets. And they're pretty much in every state. And people can search for a bio-T provider near me. Okay. And that would be at least a doctor that is addressing hormone replacement therapy. The one thing that I'll say just to keep an eye out is at least this is just me. And I don't want to undermine bio-T because I use bio-T. I love the company. I love their products. But they are training. It's not just gynecologists and people like me that are interested in hormones. Other doctors are as well, ER doctors. So they're training doctors and other specialties and nurses and nurse practitioners and a lot of medispas on how to do hormone replacement therapy because everybody's wanting to learn. But what I would recommend for patients that are new to this, that are looking for a biotech provider near me, they'll give you a list of them. Open up that list. Look at each doctor's name and the specialty. So if it says like whatever, Susan Smith, OBGYN, or, you know, look for ones that are actually doctors, not in a medispa. And you'll be- You'll be in good hands. In good hands. Even in a medispa, you'll be in good hands. It's just a different vibe. Like for me personally, maybe I'm speaking for myself personally. Like if I'm dealing with a medical issue, I don't want to be going where- You know, the whole place is Botox fillers. For sure, for sure. I'm just kind of in a back room to the side, but I saw one nurse that is the one lady that was trained. You know, it's just, I think for right now, that if you're new and naive to hormones, that you want to be under a medical doctor that's there. See, in many spas, there's no MD there. These are nurses working under the medical license of a, you know, so he's not even there. Um, and so things go, yeah, things go awry. If you have, you know, it's just, just from, that's just my preference. Um, and it's easy to do. And when, and the biotech providers can address, draw your hormone levels, talk to you about hormone replacement therapy and give you the options. And hopefully like patients come to me, like biotech is not the only option for hormone. There are other options. Cause the biotech is a. a pellet which is implanted and not everybody wants that or not everybody tolerated not everybody can afford that by the way they're not covered by insurance so there's a cost so um so it individually tailoring treatments to meet each woman's specific needs her medical needs her financial needs her emotional needs and and goals um is is is important and maybe that's why it's not covered by insurance because The way that medicine is now with managed care, the doctors have 15 minutes. They have to see 30 patients a day on a 15-minute slot. You can't do that with menopause. I have to spend at least an hour with a new patient going over everything and then explaining everything. So if I had to do that under insurance, it wouldn't work. Well, you wouldn't make any money. Yeah, it's just not a... format that would even fit. Yeah, because I'm not seeing 30 patients today. You know, you see eight, and then 10 are here, then I need to clone myself. So that's the challenge that gynecologists have, that especially the new ones that are still delivering babies and still taking insurance, that insurance isn't isn't reimbursing them properly. So they can't spend the time. So then women are going outside of their their primary care divided to alternative medicine, doctors to holistic medicine, to acupuncturist, to these other places. But they're having to pay out of pocket. As a last part of this. We talked a lot about those hormones, the bioidentical. It's wonderful that you're bringing them to light because maybe we spoke about them years ago, but now we have them really like the most updated and plus the testosterone part. Is there anything else, lifestyle, anything that really has helped you or your patients that you know, okay, outside of these hormones, here's some really important stuff also to do for your menopause journey? There's two things. One thing that I know about and practice myself. There's another thing that... that I don't know about that I have to learn about actually. I'll tell you the thing that I don't know about that I have to learn about. Just like other doctors are learning about hormones, I don't know anything about plant-based medicine and plant meaning psychedelics or like the whole thing of microdosing and also ketamine. I'm not an expert in that. And I actually don't even have a referral base of where. to send women for those therapies. And so that's new to me and something that I'm learning about and reading about and that patients are doing, and I'm seeing the benefit of it. But I haven't experienced it personally. And I haven't done enough. I mean, I've done research, but not enough to at least talk about it. But I do think that that's going to play a role, that those therapies will play a role in this. And so the other thing, if you said, what do I do know, is I know about... your self-care and your mind and your thoughts. And what I've learned over all this time that I'm practicing is that when women buy, like, all they have to have is a seed of hope. Like, a lot of them have been to 15 other places. You know, now today we're getting them, like, every Tom, Dick, and Harry, but back in the day when I first started, I got the, like... broken cases that they had seen everybody else and this person had tried this and this one they'd seen and um the what i realized is that if i can just impart like one small like for them to believe okay this lady sounds like she knows what she's talking about i granted i have a lot of fear and i'm not totally trusting but i'm gonna give it a chance i'm gonna i'm gonna buy her story and i'm gonna try this so that one little seed of hope is all it takes to, you know, to, for trans the beginning of transformation is. So when there's resistance or when there's fear, when they go, this isn't going to work, and that's, or I'm not, or patients, I'm not going to do this. Or she told me when the, that voice, when you allow that voice of fear, like inside out fear, anxiety, whatever her name was, um, to when that voice gets loud, um, that impacts, that impacts your health and wellbeing. So. I also, I talk about meditation. I talk about, I have a lot, I have different meditation tapes. I have retreats and groups and all sorts of things that I encourage women to take part in. And most of them totally get it. Like today, I think, you know, when we're talking about mind-body, like everybody understands. And now that we're starting to understand that the way that we think can impact every cell, every organ. every gland, everything in our bodies. And I elevate the placebo effect. It doesn't matter to me whether it's placebo or whatever matters. If you think and believe that this is working, it's working and that your perception is reality. So I guess that's been my growth, my personal growth over the decades. And then also my personal growth in terms of mental health and meditation and spirituality. So that comes across in my treatments and that's imparted and delivered to them, which I think helps to or has helped to optimize my results and success. I don't know whether it's me or the hormones or just being part of it that makes them all better, but I don't have any failures. I have people that had to go off, that have fibroids and bleeding and they just can't do it. Those cases. But ones that can tolerate it, they're happy. Beautiful. A lot of hope out there for women undergoing perimenopause, menopause. And I know it can be very difficult. I remember my mom going through it. So it's like every kid out there remembers. How can the audience find you? So for more information, they can go to my website, BermanSexualHealth.com. My Instagram is at JenBermanMD. We have a Shopify account too, a shop associated with the website where women can learn more about the menopause biotype. test if they want to learn more about the biotype and find out whether what their risk factors are and what they can expect, they can do that too. Beautiful. Thank you for sharing this with us. I can hear your passion and it's beautiful that you've had your own experience. So you can really speak firsthand and be supportive to so many women that it seems like the medical industry has forgotten, like you said. But you being a leader and a voice for it is really powerful. And I'm so happy to have this as a real first perimenopause, menopause talk. and all the women out there. Sorry I did it. It took so long, but we got it out there for you. You're empowered. You know where to go. You got some information. Thank you for coming on the show. Thank you for having me.

Some women are more predisposed to significant weight gain. And we have testing now that is available to help women understand and navigate menopause. Like what symptoms am I going to get?

What symptoms, what can I expect? It's called the menopause biotype. It's like a 23andMe test.

So if you want to know... What can I expect that's a great resource? Dr. Jennifer Berman is a renowned urologist, sexual health expert, and women's wellness advocate.

She is one of the few female urologists in the United States that has pioneered research around female sexual health. Dr. Jennifer Berman comes on the show and gives us the exact medical insight on what women need to do to be your happiest, healthiest version of yourself as you hit menopause. All right, Doc, thank you for coming on the show. Before we came online, we were having a conversation and you said something that still stuck out to me.

And I'm still thinking about it, that you said, after a woman has a baby, sort of the medical industry kind of just forgets about you. What did you mean by that? Well, from the standpoint of the symptoms that women have as they age, once we're done having children.

and we're entering into perimenopause and menopause, meaning symptoms are starting to crop up, moodiness, fatigue, hot flashes, night sweats, weight gain, sexual health issues, vaginal dryness, and low libido. Those are symptoms of hormone imbalance that are not, at this time, recognized by the medical community as warranting medical attention. or medications or intervention.

So when women come to their gynecologist or their primary care doctors or their family or their internist or whoever, and talk about these symptoms, they are met with, you know, I don't know, or they're given antidepressants, or they're told to do, you know, have a glossop, they're dismissed. And the reason for that is that the The medical community, our OB and GYN obstetricians and gynecologists are not trained. There's no algorithms. There's no protocols that exist today out there in the medical field for treating perimenopausal and menopausal women. I don't know if you remember back in 2010, there was this big outcry, basically, that there was a WH, the Women's Health Initiative study was published.

And the ACOG, the American College of Obstetricians and Gynecologists. released this information. And at the root of it, it was hormones are bad and hormones cause breast cancer.

And everybody needs to stop hormones right now. So women that were on hormones are getting yanked off and women that were, and there was this big scare, which by the way, was completely unfounded. They had to recant that statement and it was not true.

It was not the opposite is true. However, they never came out with anything else. So it left all of the gynecologists practicing, all of the new ones coming out without any leadership, without any guidance, without any direction. So then what do women do?

Where do they go? So then they have to go out and network. They have to find other doctors. They have to search around to find providers that understand and know hormone replacement therapy.

I happen to know, like I've been working in this field since the 1990s for decades. And. My, and I'm a woman, obviously, and my specialty, I'm a urologist specializing in sexual health. But through the course of my, as I'm aging and the course of my career, as I'm aging, I'm noticing changes in my body. I'm getting hot flashes and night sweats and mood and low libido.

And I'm reaching out to my gynecologist and nobody knows anything. So I literally had to learn myself. through other doctors in Europe. There was nobody here in the United States really talking about it, but in Europe and Canada, there were other doctors that were treating women with testosterone and optimizing hormone balance.

And that's kind of where I learned that I became my first patient. And from there, I started treating other patients. And from there, there were more women.

But that's kind of the situation that we're in right now here in the United States with dealing with aging women. Our doctors aren't trained in menopause. And what we're seeing is all this media attention coming out with new publications and new articles and new things. The research is happening, but yet...

where do women go? So that's, you know... Yeah, that's a state of affairs here, basically.

Okay, so a few things. At what age does a woman hit menopause? What happens? What are the main symptoms of menopause? And when we talk about hormone replacement therapy, I want to go into how safe it is.

Okay. So prior to menopause, I want to just mention there's perimenopause. So these are women in their mid to late 30s, early 40s, and that's when symptoms can start. And that's when symptoms often get overlooked, dismissed, or mischaracterized.

I don't know if you remember seeing in the media recently, Halle Berry was misdiagnosed. She's menopausal, not even perimenopausal, but they misdiagnosed her menopause as having herpes. She was having vaginal dryness, painful and painful intercourse. And instead of recognizing that she had vaginal dryness due to low estrogen levels, they told her she had herpes and that was plastered all over.

I remember that. So in the perimenopause, when women start to develop symptoms of moodiness, difficulty sleeping, weight gain, some vaginal dryness, maybe low libido, that's the beginning of menopause. Now, the only difference between those women and the actual menopausal women is one thing, is the perimenopausal women are still having their periods.

A menopausal woman, the definition of menopause means you haven't had a period for 12 months. So if it's been six months, if it's been eight months, or if it started and stopped, that's still, you're still technically perimenopause. It's just a definition that when your period ceases, For a period of 12 months, that's the definition of menopause. But the problem is that women in perimenopause have the same symptoms, maybe not as worse, maybe not as bad, maybe not as profound, but they're still having symptoms.

And those women are definitely right now in the United States not getting treated with and should be treated with hormone replacement therapy. The menopausal women who haven't had a period in 12 months who have the same symptoms, hot flashes, night sweats, difficulty falling asleep or staying asleep, memory, focus, concentration changes, foggy thinking, they can't remember things, they feel less creative, less motivated, they're not the same as they were, they're not functioning on all cylinders, they're not able to compete in the workplace with men and other people due to hormone imbalance. not to mention vaginal dryness, painful intercourse, low libido, joint pain, and weight gain is a big one.

So all of those that can vary, and every woman has some semblance of those symptoms, sometimes worse than others, and there's a genetic predisposition to symptoms. Like some women are more predisposed to having severe hot flashes. Some women are more predisposed to significant weight gain, and we have testing now that that is available to help women understand and navigate menopause. Like, what symptoms am I going to get? What symptoms, what can I expect?

It's called the menopause biotype. It's like a 23andMe test. So if you want to know what can I expect, that's one option that's a great resource.

But so perimenopause and menopause, these are the symptoms, and it's just a consequence of aging and the changes that occur in our bodies. And the... When hormone replacement therapy, I'm a huge proponent for hormone replacement therapy, and we talk about safety, the concerns that we initially had originating back about 10 years ago when they released the Women's Health Initiative study saying hormones are bad, hormones cause breast cancer, that's been completely debunked. In those studies, they were looking at synthetic estrogen plus synthetic progesterone in the form of PremPro.

It was an oral medication, actually. And oral hormones or oral estrogen, in my opinion now, is completely passe. Nobody should be doing estrogen orally. Because when you give estrogen orally, that's when you do have the potential risk, and not necessarily cancer risk, but thromboembolic risk of stroke and heart attack and things like that. When it's given transdermally through the skin, you don't have the thromboembolic events.

So... There's not concerns about stroke or not concerns about cardiovascular disease or raising your cholesterol and things like that. The other concern was breast cancer. And that was with, again, synthetic estrogen plus synthetic progesterone given orally. Today, we're not using synthetic estrogen and synthetic progesterone.

We're using bioidentical estrogen and bioidentical progesterone, which does not have the same risk factors. And when they went back and teased back and reviewed the data again, really, even with the synthetic progesterone, what it comes out to is that in some women, in a small percentage of women, after seven to 10 years. of consecutive use, there is a slight increase in breast cancer, but not the preponderance of what they originally discussed. However, what we do know now that we didn't know then is that testosterone, which by the way, is equally important in women as it is in men. Everyone thinks that that's a male hormone because testosterone makes you strong, whatever, but it is extremely important in women as well.

and declines significantly with aging and leads to a lot of symptoms also. What we know now is that testosterone is protective against breast cancer, literally prevents breast cancer, prevents the recurrence of breast cancer. If you've had breast cancer, it prevents you from getting breast cancer. If you haven't had breast cancer, and that is a fact that's known. We also know now that estrogen prevents degeneration, cognitive decline.

with aging, women's brains shrink during menopause and estrogen deprivation, our brains actually shrink. So when women say, I just feel out of it, I feel, you know, stupid, I feel I can't remember anything, I feel like I'm not, you know, productive anymore. There's reasons for that.

And it's hormonal imbalance. So in my opinion, in order to remain and if we're talking about well being and longevity and health. Everything starts and stops with hormone balance.

As soon as we start to, our ovarian function, adrenal gland function starts to decline, in my opinion, is when we start to really age and die. So now today with advances in modern medicine and technology, we have ways to prolong our lifespan and prolong our health and do so not just live sick, but live with well-being and live with health. And prevent disease. So why do you want to start?

So why would a perimenopausal woman want to start hormone replacement therapy? In addition to alleviating her symptoms and making her feel better, it will prevent disease, prevent Alzheimer's, prevent osteoporosis, prevent breast cancer. So improve your cardiovascular health, improve your strength, improve your cognitive function. So it's a no-brainer for me. And the risks and side effects that we're talking about is not cancer, death, stroke, you know, the side effects of hair growth, oily skin, acne, some breastfulness, tenderness, all things that are manageable and reversible.

We're not killing people with hormone replacement therapy, which is what, you know, the, the, you know, the mindset is right now. Oh, that's dangerous. It's bad. Or it's, there's just confusion and uncertainty and unknown.

So if we don't know it or it's bad, you know, that's kind of the ethos that the medical community has. And then that scares consumers. But what happened during COVID, this is when I first started to change. Women, we have social media now that we didn't have back in the day when I started.

And women were talking to other women. And they were seeing, I think Kris Jenner or one of the Kardashians got on. TikTok, the mom was talking about like this menopause.

And then it like, whoa, like, we're talking about it. And there's also shame and taboo. Like the word menopause is symbolic of, you know, the withering, withering of your fertility, the you know, I'm no longer feminine.

I have patients, a lot of my patients are the housewives of Beverly Hills. And I kept telling, I was like, you should talk about this. And they were like, no, I don't want anyone to know that I'm menopausal. And now so that was, you know, three or four years ago.

Now they're three or four years older. And now they're they're reaping the benefits of hormone replacement therapy. And now they're realizing that they have a platform that can impact that is beneficial. They can provide women with with help and resources, tools and information.

And they are starting to talk about it. So this movement that's happening around menopause is women. It's not driven by.

politics is not driven by the FDA or the medical community. It's being driven by women, the consumer. And they're starting to, you know, get louder and they're starting to be, you know, more prominent voices involved, like Huberman Lab has covered it. And, um, There's Mel Robbins. So these larger pockets, you know, you are covering it.

And I think with the more conversations that we're having, more awareness that's developing and male voices chiming in that hopefully change is on its way. Yeah, big time. I've seen the benefit of bioidentical hormones on patients years ago and how much better they do.

But for those who've never heard of them, what are they? What's the difference between like the synthetic ones that they were talking about in the 90s that go, you take this, you're going to get breast cancer or a thromboembolitic event or something like that. And the delivery is through a lotion or a patch.

Like how easy is it? Do they need a prescription? And basically the women listening, how do I get my hands on bio? Let's talk about something that affects us all.

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So all bioidentical means bioidentical is the same as your body makes. So the same. the same molecule that your ovaries make.

So 17-beta-estradiol is the estrogen molecule, and it works on the estrogen receptor. So there are bioidentical hormones right now for women, only estrogen, the only one that is available, well, there's two. There are two hormones, at least the ones that I use, that are bioidentical, that are commercially available, that are FDA approved, that can be prescribed, that you can get.

17-Beta-Estradiol comes in the form of a patch and progesterone, micronized progesterone is the same as our body makes, not Provera, not the synthetic progesterone, but regular progesterone is also commercially available and FDA approved and comes for menopause and comes in two doses. What testosterone is not FDA approved yet, despite all that we know about the beneficial effects in terms of cognitive function and breast cancer and everything else, still not FDA approved. And that so what that means is that that has to be compounded by a compounding pharmacist and they can make testosterone in a lot of different versions in the form of patches, creams, lozenges, trochees, pellets, lots of different ways. that can be delivered also transdermally.

The problem that exists now related to testosterone, I was just telling you about how doctors aren't trained, like our medical providers aren't trained in just estrogen and like regular hormone replacement therapy. Testosterone is basically, we're in the dark ages when it comes to women in terms of that. And the reason for that, I'm not really sure because I've been treating. women with testosterone since the 90s. And people and there were many doctors that were doing research with testosterone and women well before I became age, like decades before I started doing it.

So and now with the preponderance of evidence of the beneficial effects, it makes no sense to me why we haven't pushed forward further. But testosterone is tricky because and if doctors aren't trained, they don't know like, well, what should the levels be or how high should they get? or how do we give it or what, you know, and if you, I don't know about you, but for me, if I don't know how to do something and I don't feel comfortable, I'm not going to do it.

I'll be like, either refer you to somewhere else or be like, no, you know, and that's what's happening. Nobody knows how to do it and they don't know. And they refer to somebody else and women are left flailing around having to become resource for themselves and find providers out of network and provide this and do the research themselves.

But that's basically. And where can you go? Where do you go to get bioidentical hormones? They do have to be prescribed by a medical doctor that, you know, that obviously knows what they're doing. And many do, but, and many are learning.

So just because your doctor may not be certified in bio, you know, in hormone replacement therapy and, you know, be an expert, what they're doing now is doctors are taking matters into their own hands. If they're not trained, they're taking courses, they're... doing, they're shadowing other doctors, they're learning and reading and doing what I did back in the night, how I had to do it, you know, they're starting to try to educate themselves and try.

But what happens with that is that patients can tell like, you know, I'll try this cream. And, you know, they believe the doctors will believe that it'll help you, but they don't, well, let's try this. And let's try that.

And if the patient doesn't feel that you have an authority, and that you can say, this is going to happen because these patients come to me and they say, well, she helped me, but she didn't, you know, she didn't test labs. And she said, you know, she didn't know she wasn't, maybe, you know, there were, it just made me feel nervous. So that's, you know, kind of the sentiment that, that women, the consumer feel either confusion or anxiety about hormones. And the reason for that is that our doctors aren't trained. And so when they find one like me or you or whoever that, that, that, that understands it's.

a huge relief. And then they tell their friends and then they tell their other friends and, and hopefully little by little, things are, things are going to start to improve. But bioidentical hormones are safe and effective.

They need to be, you know, under a, you know, a doctor's supervision. There are levels that need to be checked and levels that need to be maintained. And there are risks. I'm not going to say that there's, you know, it's like drinking water. There are potential risks, which is why.

you know, we, it needs to be under a doctor's supervision. But the cool thing is now, even women with breast cancer back in the day, when I, like when I was, you know, coming up and becoming menopause, it was unheard of, like even giving vaginal estrogen to a woman with breast cancer. And those women really suffer. They're put on tamoxifen or loxapine and they're shriveled up hormonally into like frail, like no estrogen.

thin vagina, brittle bones, like weak muscle, but they don't have cancer. Like I said, you don't have cancer, but quality of life is equally important as quantity of life. And that gets lost in the breast cancer patient. Now, today, breast cancer patients are now able to use vaginal estrogen products.

And we're even able to give breast cancer patients testosterone because we give them testosterone plus anastrozole. Anastrozole blocks the conversion of testosterone to estrogen and keeps it as testosterone. So even if they have breast cancer, estrogen positive breast cancer, they can take. they can receive testosterone. And testosterone helps with hot flashes, night sweats, memory, mood, energy, lean muscle mass, libido.

And many, many, many women now with breast cancer are thriving and living active lives where before, you know, they couldn't go windsurfing or they couldn't, you know, go biking anymore. And now they've got their lives back and their energy back and their sex life back and they're cancer free. Yeah.

And it's beautiful that that can be offered to women. I mean, I've worked a lot of breast cancer. I can see how women degrade into this, like you said, frail, in many ways, like lifeless. It's just like, wow, there's no more oomph to that person. They become a breast cancer survivor and that's their identity instead of I'm a woman, I'm Jennifer.

Who's thriving, who's thriving. So I'm intrigued by the talk on testosterone because I hadn't heard much about testosterone being given. with women, bioidentical hormones, women who are going through menopause, the testosterone in itself, you said, still isn't approved for that. Yeah, no, testosterone in any format is not FDA approved for use in women yet. And there is no explanation for that.

Originally, it was, they say about safety and safety to the unborn fetus, but these are women that are not having babies anymore. They are menopausal women where there's no chance of a fetus. By the time they've stopped having a period for 12 months, they're not having babies anymore.

So the safety issues related to that are nominal to none. And now we have an overwhelming body of evidence, not just talking about the safety of it. We already had that. And I was annoyed back then. We have safety data.

It's safe. OK, guys, let's move it. But now we know not only is it safe. but it prevents breast cancer.

So how can you like what there's nothing. And so I don't, you know, again, I, it could be political, it could be financial, it could be any, any number of things. But, but what I do know now professionally and personally as a woman, an aging woman now who's in her almost 60 is that I am not competitive in the workplace without hormone replacement therapy. So the glass ceiling that we talk about that was set by corporate America, in my opinion, is not set by corporate America.

It's set by menopause because as soon as a woman becomes menopausal, you can't sleep. Our memory's bad. We're foggy. We're not as assertive and aggressive. And then once that happens, you're not eager to take on new projects.

So if you're working with a guy, let's say a 58-year-old guy and you're 58 and nothing's happened to him, his memory's fine. His mood is fine. He's not getting fat and tired and all that other stuff.

But we are. And so without hormone replacement therapy, then we are not firing on all cylinders. We're not as assertive, not as aggressive, not as confident.

And as soon as we realize that, then we're here. We're not equal anymore. With hormone replacement therapy, it's going to allow, it allows me, because I'm that woman. I actually was 37. So it hit me.

I was one of the women that was very sensitive. to fluctuations in estrogen. Every woman feels a little bit.

Some women worse than I. We know about postpartum depression, right? Those are the women that are really sensitive to it.

When estrogen falls, they become suicidal, homicidal, hallucinate. But that doesn't have to happen. For me, my estrogen levels fell.

I wasn't suicidal or homicidal, although maybe I was a little homicidal. But- I was miserable and not able to function. Very, very angry, irritable, edgy, weepy, all of it. And I also have a very strong history of breast cancer in my family. My mother died of it.

My sister, who's four years younger, got it twice. We don't have the BRCA gene, but I was advised highly not, you know, do not go on hormone replacement therapy. But there wasn't a choice because I couldn't function.

I was in the middle of my fellowship. I had to take boards. I was like, okay, I'm gonna give up now.

And so I did a cost benefit analysis. I knew what my risks were compared to the general population. It's higher because of my family history.

And I knew what the risks were with, because they can calculate, with hormones that my risks were higher, but not like hugely higher, a little bit higher. And so I did, I said a little bit higher, you know, I'm willing to take that risk because I want to live. I want to have a life and, you know.

I might get a, I just, I'm going to, breast cancer is going to be for somebody else. So we're going to push that away. And so this is since 2000. So it was after my daughter was born. So 2003 is when I, when I started this.

Today is 2024. So for all of those years, I've been on hormones and testosterone. So, and back then I was giving testosterone to myself and other patients. And I was. people were freaking out like, oh my God, like, what are you doing?

But honestly, I think that my being on testosterone is what prevented me from getting breast cancer. I thought like, oh, I just manifested myself. I was my positive thinking.

It was my, maybe it was both, but chronic testosterone over time, long-term testosterone use is now what they know prevents breast cancer. So it was just, you know, I prevented myself from getting breast cancer through both ways, probably. But, um, But it's a testament to the safety of it and the efficacy of it.

And, you know, I'm a living model of that. So testosterone is really important for women for energy, mood, sexual energy, physical energy, and your emotional kind of joie de vivre energy. So those three forms of energy.

And also cognitive function. And while. Estrogen is more, helps with short-term memory and focus and concentration. Testosterone is even a higher level of almost intelligence, creativity, you know, connecting the dots. Like, you know, if I were to tell you something and then you say, like, what was it?

I'm going to go look that up. Like that desire to go look it up goes away without testosterone. The even thought that, oh, that may apply to something else. goes away.

I notice it in myself when my testosterone levels start to decline. My son even notices it. I think you're due for your pellets, mom.

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Use the code DRG for 20% off. So in a woman who's heading towards, they're in premenopause, heading towards menopause, testosterone is also going down with the estrogen. So we have to understand that because there's women, they go straight to the bioidenticals without even thinking about testosterone. But for you, you're saying...

bioidenticals and testosterone. Testosterone is bioidentical. So your compound, it is bioidentical. All together under one.

All three of them, estrogen, progesterone, and thyroid. Thyroid is another one that kind of get, and these are becoming like hypothyroid metabolic disorder, but it's once the ovaries start to get out of balance, your adrenal glands have to kick in to compensate for that happening. And then they get tired and burn out for a period of time.

You know, and that's when cortisol levels rise, the stress hormones. So menopause, your metabolism in menopause is completely flipped around, upside down. You're storing fat as opposed to burning fat. You start to gain weight centrally.

Women will say, you know, I'm dieting, I'm exercising, I'm eating like two almonds a day and I'm not able to lose weight. Or I can lose a couple pounds, but as soon as I have like, you know, a bowl of pasta, I gain it back and more. And so their metabolism is shifting and what happens is, is that. Menopause, in my opinion, is a risk factor, a risk factor for cardiovascular disease, a risk factor for metabolic disease, type 2 diabetes, a risk factor for depression and anxiety, and a risk factor for obesity, for just being unhealthy.

So why we're not treating menopause and taking menopause seriously, just if nothing else, forgetting how women feel, but their health. We haven't connected the dots that to remain healthy, we have to optimize hormone balance. And it's just like somebody tore that chapter out of the textbook or they erased it from our brains. It's very weird because even now, like I'll see, I just saw a patient the other day, an older woman in her 70s.

And she was having really horrible urinary. urgency. I forgot to mention that.

That's another symptom. Urinary symptoms, frequency, urgency, urge incontinence, leakage or stress incontinence. They call those genitourinary symptoms of menopause. So this woman was having urge, urgency and urge incontinence that was like debilitating and driving her nuts. And she's seen all sorts of different doctors, neurologists.

And the last one she saw was a urologist from Columbia. So Columbia University is a very prominent university in New York. In the Department of Urology, which is my field, she saw a female urologist, a very well-trained one, who did an exquisite workup on her and diagnosed her with this urge incontinence. And they prescribed her with a medication for overactive bladder.

So for somebody like that had a neurological condition, like with MS or a spinal cord injury or Parkinson's disease, none of which she had to quiet the bladder. So it wasn't, you know, which didn't do anything for her. And the issue, and it didn't occur to that doctor.

I was like, well, she was a urologist, so it's even less, but she wasn't a gynecologist, but why it didn't occur to her to say, okay, the urgency, urgent continence is genital urinary symptoms of menopause. She needs vaginal estrogen. And so, yeah, so that it's, it's women of all ages, even in the premenopause, the premenopausal women struck premenopausal women are on birth control pills. Okay, all let's, let's say so birth control, birth control pills for many women can, you know, because what happens in the birth control pill is that it dramatically lowers all your hormone, all your hormones.

If you're a young, reproductive, healthy woman, most of them, you know, aren't impacted by that. But there are a handful, I'm not going to say few, I'm not going to say many, but somewhere between few and many, there are a lot of women that don't tolerate the birth control pills because of that, because it makes them moody, because it makes their vaginas dry, because it causes low libido. Why?

For the same reason a menopausal woman struggles with it. So that's a lot of what I do too. So if a premenopausal woman can't take... hormonal contraceptives, what do you do?

What are the alternatives? So I do have premenopausal women in my practice too that are sensitive to fluctuations in the hormones that need a little bit more, a little bit less, that need options for birth control, that can't take birth control pills. I had a young girl the other day that got the Exponon, the implant, who had everything she needed. including bleeding, nonstop bleeding.

And so we had to take that out and get her, you know. So it's, hormones are relevant regardless of what your age are, whether you're in your 20s, 30s and 40s. or 50s and up, it's important to have an understanding of what they are. And in fact, I would encourage women to know what their levels are, especially when they're feeling good, to get your levels checked, to look.

So what does my estrogen level need to be for me to feel good? I know what mine is. I know what hers is. So mine is 242. Another woman's might be 80 or 40 or 60. We're all...

different. So just what works for me isn't necessarily what works for you. I think that's another thing that's fallen, you know, that's been challenging for the medical community, because they want to do one size fits all. Everybody gets this, everybody gets that.

And if you can't do that, then, you know, then it's bad, or then there's something wrong. And we can't do that with menopause. There's not a blanket, you know, pill, just like what came up with. with female sexual function, female sexual health, there's not a little blue pill like Viagra that's going to fix women's sex lives. It's just, we're more complicated.

And there's more factors and more variables and our reproductive health and our, and our brains are different and our emotions are different and how we process things is different. So it leaves a lot, a lot untold and a lot misunderstood. But there is, the cool thing is, is that now today women with With social media and with the internet, women can take matters into their own hands. And there's a lot of information that's available online and a lot of resources that are available online and through social media.

And people are finding their way. They're finding a way to different doctors, to different providers, to different healers, to different groups, different educational forums that are talking about it. And momentum is starting to build. And hopefully. You know, the medical community will follow.

They have to. You know, it doesn't feel good to have a patient come to you and be like, I don't know what to do. Like, that alone as a doctor should hopefully, you know, it is. I see it. It is spurring them to learn, to do, you know, to step out of their comfort zone, to, you know, you can't be a gynecologist and not do hormone replacement therapy.

Like, it's like an oxymoron. It doesn't. So hopefully all of them are going to, you know, that start, the ones that are already trained are going to start learning and that they'll start teaching the medical students. They'll start teaching the residents.

They'll start being, you know, it's impossible for that not to happen with the data and research that we have that's coming out. The sexual changes, the libido, major one that a lot of women are suffering with. What's happening in the body of a woman, perimenopause, going into menopause, in menopause, what's happening to their hormones that they aren't feeling as sexual or sexually driven, or even during sex, not having the amount of pleasure and how much they enjoyed it?

And does it come back to the same thing? Like those are the women that really benefit from this hormone replacement therapy. And then is there an emotional component to it too? Do you find a lot of these women become...

depressed from this. Marital issues are starting to arise. 100%.

Yeah. My marriage is in crisis. We have a lot of men that get their women in.

My husband made this appointment. My boyfriend called. Yeah.

So the thing at the root of all of it, if I had to think of, off the top of my head, what is it that they say that's kind of universal? I don't. feel like myself. I'm not myself, whether it be from a mood standpoint that she's snapping at her kids and her husband, or be it from a sexual standpoint. I used to want to have sex all the time.

We were having, I was multi-orgasmic. I was, and this is not me. I don't, you know, I don't know why this is happening. And from the standpoint of the emotional perspective, that was originally when we, when I first started, you know, in this field, we were met with a lot of resistance by people.

the therapist and psychologist, and they were saying, you're medicalizing a condition that is more emotional relational. And I don't, it's both. In women in particular, I'm not going to say that men don't have emotions, but men are much better at compartmentalizing.

They can... Be, you know, have these thoughts and feelings, but still focusing on the task at hand. OK, right now I'm having sex and I'm going to get her and I'm going to do it.

And then I'm going to go over there and cry and whatever else. Women, there are women that can do that, too, but it's harder. And so their emotions and their thoughts and their feelings.

um, interfere with arousal and orgasm and libido for that matter. And, um, and it's important. So one, it's not to say one with there's medical issues and there's emotional and relational issues and the two work together. But the point from my standpoint as a medical doctor, there are real medical, physical reasons why women have sexual function complaints that are amenable to medical treatment and that should be addressed. And there's also emotional relationship issues that need to be addressed and attended to and thought about.

And the two together, not either one in isolation is better, but need to be working harmoniously. And in terms of the other part of the question was testosterone, what was it? They'll do the bioidentical hormones. Is that the answer then also for the libido part?

Yeah. So for so what women will say. So estrogen. is crucial for arousal, lubrication, engorgement, the warmth and tingling that occurs in the genital area, blood flow.

And then testosterone is important for libido, your desire, the motivation to be sexual, the motivation to initiate sex. So your motivation to masturbate or whatever, to have sexual thoughts. interest fantasies.

And orgasm is also testosterone. I'm not going to say testosterone dependent, but impacted. But if testosterone levels decline, orgasm can be affected.

It's less intense, harder to come by, you know, cost benefit analysis of even having sex doesn't pay off. So it is a frequent complaint that women have. So testosterone is essential for sexual function, arousal, orgasm, libido, all of it. And so when your physical energy, your lean muscle mass, you know, so when testosterone levels are low, women feel apathy about sex. A lot of them say they're not, but they're not like disgusted, abhorrent, like repulsed, but it's sort of like apathy.

And over time, if a woman is a widow or is divorced or whatever, over time, you don't even notice, you just stop thinking about it. And so she thinks she's fine and normal, and I have this patient, she's fine, going about her life, until, uh-oh, there's a guy. And he looks at me, and maybe I'll go to dinner.

And then, wait, now I like this guy. Oh, I'm starting to have some feelings. Let's have, maybe we'll have sex with this guy.

And it's like, breaks come on, I'm dry, it hurts, I can't have it, like, what the hell, what do I do? So, yeah, so. That's what sort of the experience is.

You see, huh? That is the spirit. And I guess to the point where the menopause biotype test comes in is that there are women, I'll say a small percentage of women, that float through seamlessly without any hiccups. And, you know, God bless those women.

Most women suffer to some degree with something like weight gain or, you know, I can't sleep or I'm getting migraines and mooniness. The majority. you know, really struggle with all of the hormones and navigating through menopause.

And the thought was like, let's just get them through menopause. And then once they're done with menopause, so when are you done with menopause? Menopause, you're technically done with menopause and by our medical definition, when you stop having hot flashes and night sweats.

So those eventually, if you were to do nothing, if I gave you no bioidentical, no nothing, and eventually... You'll be miserable and your hot flashes and night sweats will eventually stop, but you'll still be miserable. So even though the hot flashes and night sweats stopped and you're not menopausal anymore, you're postmenopausal, you still have everything else.

You can't sleep. You're fat. Your bones hurt. You can't lift weights. You're moody and irritable.

Your vagina is dry. You've got no libido. All of that still.

Your bones are... cracking and you're a mess, that continues. So I get asked a lot, well, how long do I have to stay on them?

You have to stay on them. And then the demand increases. As you age through menopause, you might need a little bit more.

And then as you become post-menopausal, then maybe we can taper back down. But if you want to live a happier, healthier, sexually fulfilled life, For the majority of us, not that small few of the lucky ones, but for the majority of us, it requires hormone balance, optimizing hormone balance. into our 60s, 70s, 80s and on.

Yeah. Men are doing it. We don't think twice about men jacking themselves up with testosterone. Right, right.

50, 60, 70 or 80-year-old guys bench pressing, you know, a million pounds and wearing cut, like, white-beater's shirts. You know, they turn into silver foxes and get better as they age. Why do we have to, you know, have...

have the opposite experience. Yeah, absolutely. So there's women listening going, oh, wow, this is my experience and I'm heading towards there. What I'm hearing from you is they got to get their blood work done. And even if you're not heading towards there and you're feeling good, get your blood work done and look at your numbers.

Especially when you're feeling good. Especially when you're feeling good, look at your numbers. Get a baseline. Estrogen, progesterone, testosterone.

Those are the three. And thyroid. And a thyroid.

Get that, ask your doctor and just get your numbers. Mark it down, put it in a file on your folder and say, this is when I feel good. And, you know, there's a lot of women going, oh, well, I know about like functional doctors and naturopathic doctors, but how do they, is there a database that they can find someone in their town who, you said there's not a lot of people. Not, but there is a company called BioTee and BioTee is, makes pellets, hormone pellets, bioidentical hormone pellets.

And they're pretty much in every state. And people can search for a bio-T provider near me. Okay. And that would be at least a doctor that is addressing hormone replacement therapy.

The one thing that I'll say just to keep an eye out is at least this is just me. And I don't want to undermine bio-T because I use bio-T. I love the company.

I love their products. But they are training. It's not just gynecologists and people like me that are interested in hormones.

Other doctors are as well, ER doctors. So they're training doctors and other specialties and nurses and nurse practitioners and a lot of medispas on how to do hormone replacement therapy because everybody's wanting to learn. But what I would recommend for patients that are new to this, that are looking for a biotech provider near me, they'll give you a list of them.

Open up that list. Look at each doctor's name and the specialty. So if it says like whatever, Susan Smith, OBGYN, or, you know, look for ones that are actually doctors, not in a medispa.

And you'll be- You'll be in good hands. In good hands. Even in a medispa, you'll be in good hands. It's just a different vibe.

Like for me personally, maybe I'm speaking for myself personally. Like if I'm dealing with a medical issue, I don't want to be going where- You know, the whole place is Botox fillers. For sure, for sure. I'm just kind of in a back room to the side, but I saw one nurse that is the one lady that was trained. You know, it's just, I think for right now, that if you're new and naive to hormones, that you want to be under a medical doctor that's there.

See, in many spas, there's no MD there. These are nurses working under the medical license of a, you know, so he's not even there. Um, and so things go, yeah, things go awry. If you have, you know, it's just, just from, that's just my preference. Um, and it's easy to do.

And when, and the biotech providers can address, draw your hormone levels, talk to you about hormone replacement therapy and give you the options. And hopefully like patients come to me, like biotech is not the only option for hormone. There are other options.

Cause the biotech is a. a pellet which is implanted and not everybody wants that or not everybody tolerated not everybody can afford that by the way they're not covered by insurance so there's a cost so um so it individually tailoring treatments to meet each woman's specific needs her medical needs her financial needs her emotional needs and and goals um is is is important and maybe that's why it's not covered by insurance because The way that medicine is now with managed care, the doctors have 15 minutes. They have to see 30 patients a day on a 15-minute slot.

You can't do that with menopause. I have to spend at least an hour with a new patient going over everything and then explaining everything. So if I had to do that under insurance, it wouldn't work. Well, you wouldn't make any money.

Yeah, it's just not a... format that would even fit. Yeah, because I'm not seeing 30 patients today. You know, you see eight, and then 10 are here, then I need to clone myself.

So that's the challenge that gynecologists have, that especially the new ones that are still delivering babies and still taking insurance, that insurance isn't isn't reimbursing them properly. So they can't spend the time. So then women are going outside of their their primary care divided to alternative medicine, doctors to holistic medicine, to acupuncturist, to these other places.

But they're having to pay out of pocket. As a last part of this. We talked a lot about those hormones, the bioidentical.

It's wonderful that you're bringing them to light because maybe we spoke about them years ago, but now we have them really like the most updated and plus the testosterone part. Is there anything else, lifestyle, anything that really has helped you or your patients that you know, okay, outside of these hormones, here's some really important stuff also to do for your menopause journey? There's two things.

One thing that I know about and practice myself. There's another thing that... that I don't know about that I have to learn about actually.

I'll tell you the thing that I don't know about that I have to learn about. Just like other doctors are learning about hormones, I don't know anything about plant-based medicine and plant meaning psychedelics or like the whole thing of microdosing and also ketamine. I'm not an expert in that. And I actually don't even have a referral base of where.

to send women for those therapies. And so that's new to me and something that I'm learning about and reading about and that patients are doing, and I'm seeing the benefit of it. But I haven't experienced it personally.

And I haven't done enough. I mean, I've done research, but not enough to at least talk about it. But I do think that that's going to play a role, that those therapies will play a role in this. And so the other thing, if you said, what do I do know, is I know about... your self-care and your mind and your thoughts.

And what I've learned over all this time that I'm practicing is that when women buy, like, all they have to have is a seed of hope. Like, a lot of them have been to 15 other places. You know, now today we're getting them, like, every Tom, Dick, and Harry, but back in the day when I first started, I got the, like...

broken cases that they had seen everybody else and this person had tried this and this one they'd seen and um the what i realized is that if i can just impart like one small like for them to believe okay this lady sounds like she knows what she's talking about i granted i have a lot of fear and i'm not totally trusting but i'm gonna give it a chance i'm gonna i'm gonna buy her story and i'm gonna try this so that one little seed of hope is all it takes to, you know, to, for trans the beginning of transformation is. So when there's resistance or when there's fear, when they go, this isn't going to work, and that's, or I'm not, or patients, I'm not going to do this. Or she told me when the, that voice, when you allow that voice of fear, like inside out fear, anxiety, whatever her name was, um, to when that voice gets loud, um, that impacts, that impacts your health and wellbeing. So. I also, I talk about meditation.

I talk about, I have a lot, I have different meditation tapes. I have retreats and groups and all sorts of things that I encourage women to take part in. And most of them totally get it. Like today, I think, you know, when we're talking about mind-body, like everybody understands. And now that we're starting to understand that the way that we think can impact every cell, every organ.

every gland, everything in our bodies. And I elevate the placebo effect. It doesn't matter to me whether it's placebo or whatever matters. If you think and believe that this is working, it's working and that your perception is reality. So I guess that's been my growth, my personal growth over the decades.

And then also my personal growth in terms of mental health and meditation and spirituality. So that comes across in my treatments and that's imparted and delivered to them, which I think helps to or has helped to optimize my results and success. I don't know whether it's me or the hormones or just being part of it that makes them all better, but I don't have any failures. I have people that had to go off, that have fibroids and bleeding and they just can't do it.

Those cases. But ones that can tolerate it, they're happy. Beautiful.

A lot of hope out there for women undergoing perimenopause, menopause. And I know it can be very difficult. I remember my mom going through it. So it's like every kid out there remembers. How can the audience find you?

So for more information, they can go to my website, BermanSexualHealth.com. My Instagram is at JenBermanMD. We have a Shopify account too, a shop associated with the website where women can learn more about the menopause biotype.

test if they want to learn more about the biotype and find out whether what their risk factors are and what they can expect, they can do that too. Beautiful. Thank you for sharing this with us. I can hear your passion and it's beautiful that you've had your own experience.

So you can really speak firsthand and be supportive to so many women that it seems like the medical industry has forgotten, like you said. But you being a leader and a voice for it is really powerful. And I'm so happy to have this as a real first perimenopause, menopause talk. and all the women out there.

Sorry I did it. It took so long, but we got it out there for you. You're empowered. You know where to go. You got some information.

Thank you for coming on the show. Thank you for having me.

Transcript for:Navigating Menopause with Dr. Berman

Transcript for:
Navigating Menopause with Dr. Berman