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

Betty Rocker (00:18):

What’s up, rock stars Coach Betty Rocker right here. Hey, thanks a lot for becoming a member of me. My visitor in the present day is Dr. Jill Carnahan, a frequent visitor on this present. You might have heard her earlier than. She is dually board licensed in household medication, a practitioner of built-in holistic medication, and can be a useful medication professional. She’s the writer of Sudden, a really inspiring learn, and he or she’s additionally the topic of a documentary referred to as Physician Affected person. She’s received a wonderful podcast and a very, actually useful weblog, simply full of nice free content material you possibly can entry anytime and is a survivor of breast most cancers, Crohn’s illness and poisonous mould sickness. She brings a novel perspective to treating sufferers within the midst of advanced and persistent sickness. She’s the medical director on the Flatiron Purposeful Drugs Heart simply outdoors of Boulder, Colorado. And my very own private physician and I all the time really feel actually fortunate to get to work together with her and in addition to have the ability to share her with you guys as a result of she actually helps make sense out of so many advanced well being associated topics which might be related to us all. Please be part of me in welcoming her to the present. Nice to see you, Dr. Jill. Thanks a lot for becoming a member of me in the present day.

Dr. Jill Carnahan (01:31):

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

Betty Rocker (01:34):

Sure, it’s all the time nice to get to test in and, and have a dialog. And one factor I really feel like has been on my thoughts and on the minds of lots of the ladies I serve, um, is that this dialog about menopause, perimenopause and put up menopause. Proper? The all-encompassing menopause umbrella, . And it’s nice to see menopause having its day. I really feel like lastly we’re listening to extra about it. There’s much more analysis than there was once. And once I suppose again to our conversations perhaps early on in my very own perimenopause journey, I take into consideration how a lot nervousness I had about listening to about issues like bioidentical hormones or hormone alternative remedy and the way that dialog type of developed and the way far more we all know lately. Why, why are individuals nonetheless, I really feel like there’s nonetheless loads of concern round hormone alternative remedy, although. I imply, simply to get us into it, like the place’s that come from?

Dr. Jill Carnahan (02:33):

Nicely, it really comes from our career and I’ll let you know the story and it’ll make a lot sense. So I graduated 2001 and received out of medical college and that yr was the yr the Ladies’s well being Initiative first got here out within the information. Because the researchers are compiling the info, the information took this data earlier than they even completed compiling and stated, oh my goodness, is there an elevated danger of breast most cancers with hormone alternative? And actually tons of of hundreds of ladies stopped their hormone alternative as a result of this media took this story, put it on the market. And whilst a health care provider, that was the story that we had been instructed. So all of us began, that is 20 plus years in the past, being afraid of this. What occurred in that 20 yr sense is that they analyzed the info in that largest randomized management trial of ladies on hormone alternative. And the info got here out very clearly.

(03:18)
Primary, there was two arms, one was an estrogen solely arm, and so they used Premarin, which is definitely a horse estrogen, not even the perfect cleanest bioidentical, however it’s an estrogen. And the opposite arm was a Premarin, which is an estrogen plus, um, a purvey, which is an artificial progestin. I’ll clarify that actual briefly in a minute. So these two arms, the primary arm got here out and this has been the final, uh, analyzed analysis, effectively documented by anybody who’s checked out this. There was really a 34% discount in breast most cancers in that arm. So not solely was it not impartial like simply, or or dangerous, it was really a discount. And we’ve recognized for all of this time that hormones, particularly estradiol, helps the mind, the bone, and the um, menopause signs dramatically and the guts. So these issues had been by no means questioned. It was solely this query about breast most cancers.

(04:09)
Now, in that different arm, right here’s the place the controversy got here in. That they had this slight improve above baseline with the Premarin Provera arm for breast most cancers incidents. However what occurred is what they had been, um, going in opposition to because the baseline really had the next incidence of regular. So it skewed the info. And the second factor about that was, as I discussed earlier than, this was an artificial progesterone. It wasn’t progesterone in any respect, which might really mimic progesterone deficiency in the long run as a result of it hits these receptors, however it’s not a pure progesterone. So neither of those trials, though they confirmed a decreased danger of breast most cancers, had been even utilizing the type of hormones that you simply and I are speaking about, which is the very same as our our bodies, our ovaries produce. So I confidently, and also you talked about earlier than, I’m a breast most cancers survivor, so I’m 20 plus years out.

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

Betty Rocker (05:25):

I’ve been studying that knowledge as effectively and it’s nice to listen to it from you. And a part of why I wished to ask you that query to begin us off is in order that that you’d share that you’re a breast most cancers survivor. It’s one thing that’s so deeply private to you. I do know that there’s no means that you’d’ve prescribed that to me. You wouldn’t have prescribed hormone alternative remedy to me or to quite a few different sufferers you’ve served in the event you thought there was a danger for us. Now, after all, there are gonna be some individuals who it’s contraindicated for. There’s sure issues as a clinician, I’m certain that you simply take a look at, I’m certain there’s the blood clotting issue. There’s all of those various things that we wanna be careful for, and that’s one thing that when somebody’s individually working with a health care provider, they should care about.

(06:06)
However I believe it’s actually vital to only, though that was, to me that was a bit technical, what you shared, and in the event you’re listening and also you’re considering, I didn’t fairly observe all the pieces she was saying, however it, you perceive the info as mm-hmm . A physician who reads the science, you perceive that it’s protected. Sure. That’s mainly what you’re saying. And like that these research in some methods had some actual flaws. Sure. They had been finding out, um, types of hormones that we don’t really use in ladies’s medication. And likewise that the, the, and, and so it, and so there’s all this concern, there’s all this concern round it. And, and it’s not for everybody both, proper? Like, you’re proper. I do know we’re not gonna say, oh, everybody must be on hormone alternative remedy, however

Dr. Jill Carnahan (06:46):

In case you’re present process breast most cancers therapy, for instance, I’d not give somebody hormones throughout therapy. In order that’s a really clear contra.

Betty Rocker (06:52):

Proper. So there you go. There’s a, there’s a cause not that, and there are most likely another causes too. And, and but it ought to be an accessible, viable possibility that girls have entry to is all I’m seeing with out all of the concern. And, and that’s why I wished to only begin us off speaking about that. ’trigger , if we’re gonna get into a number of the viable therapy choices for girls within the menopause years, it’s vital to know that we’ve thought of this before everything, as a result of I believe security, ladies’s security and, and and their entry to healthcare choices is absolutely vital. It’s important. Yeah. At all ages, and that is an age that I really feel like has been ignored, has been ignored, has been too lengthy, simply kind of like, you’re simply getting previous. I can’t let you know what number of ladies have written me, and also you’ve most likely seen this in your observe as effectively, saying, I’ve been dismissed, I’ve been instructed I used to be depressed. I’ve been placed on anti-anxiety medication. I’ve been instructed I would like to only train extra and eat much less. I’ve been instructed I’m simply lazy. Um, it’s all in my head. I’ve been placed on contraception, like all of those various things which might be like getting at signs however not likely addressing the basis trigger, which is that this shift in our hormones that occurs. I don’t know, it’s simply, it’s it’s

Dr. Jill Carnahan (08:05):

So true. And I like that you simply stated it’s even in the present day, day-after-day in my observe, I’ve these discussions with ladies and there’s some who select to not, and that’s okay too. However everybody deserves a dialogue with an informed supplier. Um, and in case your supplier is completely no, and there’s no dialogue, you then wanna discover a completely different supplier as a result of it isn’t for everybody. And there’s an important alternative. And if in case you have loads of nervousness or concern, I by no means push anybody. So there’s nonetheless, I could also be perhaps 20% of my ladies that we discuss and so they don’t go on hormone alternative, and that’s okay too. However to have the choice and to know the

Betty Rocker (08:34):

Selection, you stated alternative. That’s the phrase. That’s, that’s it. And the training about it, to know that you would be able to make an knowledgeable alternative for your self to know there are danger elements for sure individuals, after which a few of us there aren’t. Nicely, let’s discuss a bit bit concerning the, the phases of a girl’s life that we undergo. There’s the perimenopause years, these years main as much as menopause, the occasion the place our interval stops for 12 months after which we’re within the postmenopausal years. So there’s actually perimenopause and put up menopause and menopause kind of like defines that cusp the place we go to the subsequent stage, as we name it. Proper? And, and so there are ladies who come to you at, at these completely different phases of their menopause journey. And so they wanna know every kind of issues. Like, effectively, how do I do know I’m in perimenopause? How do I do know I’m, how do I, what, what ought to my hormones appear to be at these completely different phases? And I’d think about that these are the type of issues that you simply assist tackle in your observe. So if, if somebody involves you and says, I believe I’m in perimenopause, or I’m having these bizarre signs, what do you check for? And what sort of signs do they present up with? In order that perhaps you would, we might assist somebody on the market who’s attempting, who’s perhaps struggling proper now or attempting to determine what to ask their

Dr. Jill Carnahan (09:44):

Physician. So generally ladies as younger as 35 can begin to expertise these perimenopausal signs. And normally from 35 to 45 is that realm. It could go so long as 55. I believe the common age of that menopause date is round 52, 55. After which after is put up. However this will once more be nearly a 20 yr span from 35 to 55 that some ladies battle. So one factor I’m a fan of, and never all medical doctors do that is testing. I take advantage of blood, urine, several types of issues to evaluate various things. And this can be a entire nother lecture price of fabric as a result of relying on in the event you’re utilizing a cream or an oral or the way you’re doing it, sure checks choose up issues in a different way. And that’s an entire different dialogue. However it’s vital that you’ve a health care provider that can assess the place you’re at as a result of you have got the signs sometimes.

(10:26)
And the signs can, um, for instance, in that early half, so say 35 to 45 or 50, typically you begin to first have an absence of luteal section progesterone. That’s normally the very first thing that drops. So that you typically expertise estrogen dominance and hormones are all about steadiness inside each other. So if we’ve got our cycle follicular section, estrogen goes up, second a part of our cycle, luteal section, progesterone goes up and that simply yin and yang occurs all by means of our twenties and thirties. Nicely, in our late thirties or early forties, what begins to occur is that progesterone will typically diminish manufacturing. So you have got this dominance of the estrogen all through the cycle that may trigger breast tenderness, moodiness, heavy, painful intervals, uh, endometrial ache, endometriosis, fibroids, all these sorts of issues. And that may be a symptom in and of itself that may be handled with pure progesterone or generally herbs that can improve the lead section progesterone.

(11:16)
And that’s normally the very first thing. Then someplace in there your ovaries begin to sputter. And I all the time say it’s nearly like in the event you had a bottle of Heinz ketchup and also you’re squeezing out the final bit and the, then the hormones are beginning to go, , simply kinda like this little simply tapering off. There’s a large number of a spurting out and anyone can have a day that’s excessive and high and low and you’ll’t work out what’s happening. And even testing, you must watch out as a result of in the event you’re testing that interval, you check one month, you may need excessive estrogen, low progesterone the subsequent month it could be low and it simply does this dance. And that’s the time when ladies are so annoyed ’trigger like, I don’t really feel effectively what’s happening? They could begin to have scorching flashes, however they’re nonetheless having heavy cycles.

(11:50)
And so in that window, ladies can nonetheless do bioidentical hormones. However it’s vital to have a clinician that is aware of easy methods to assess the signs associated to what they’re seemingly experiencing hormonally. After which additionally check understanding that the check may be up and down. And in that section it’s gonna be just like the Heinz ketchup spurting out randomly. And you then get to some extent the place these ovaries identical to, I’m achieved. And that’s when the estrogen begins to actually drop. And that is when ladies would begin to have scorching flashes, evening sweats, rapidly they can not keep in mind names. Locations the place they put their keys, the place they’re going, they get within the automobile like the place am I driving to? Like issues the place they actually, ladies have come to me and stated, I believe I’m dropping my thoughts. They will begin to have this such as you and I’ve been pushed ladies in our discipline.

(12:33)
And I do know once I first hit menopausal, just like the overwhelm, the sensation like I couldn’t deal with issues usually is absolutely frequent with ladies. ’trigger they’re pushed and so they’re doing effectively and the estrogen actually helps our mind keep on monitor. And when that drops we’re like, oh wait, my government perform, the planning, the executing is impaired. And I’m like, I really feel like I’m dropping my thoughts. Or that the issues that I used to have the ability to deal with are more durable. Mm-hmm . Emotionally, you’re up and down. You might be extra tearful sooner or later extra offended, sooner or later extra unhappy, you received, don’t wanna get outta mattress sooner or later and when none of these issues had been there earlier than. So I like speaking to ladies as a result of so many ladies actually really feel like they’re going loopy if nobody validates this and it’s a standard expertise, however it will probably really feel so disorienting. And , even the dad so far as damaged relationships and divorces on this time, it’s not shocking that that goes up as a result of ladies really feel like they’re going loopy. And most males and lots of medical doctors gaslight them into considering they’re going loopy and it’s simply their hormonal transition.

Betty Rocker (13:29):

So I hear you saying that there are these actual distinct phases of perimenopause that we undergo and this is the reason it’s more durable to pinpoint generally as a result of it’s a shifting goal. Sure. As we undergo these, these years of our lives. And it’s shocking to listen to you say that it will probably begin as early as 35, however it additionally is sensible, proper? And, and it, I assume you could not know precisely the place you’re. It might not go precisely along with your age. Proper? So if we keep on the perimenopause dialog for a minute, say

(13:57)
Say I’m a youthful lady, or say I’m like 40 years previous mm-hmm . And I come to you and I say, I believe I’m in perimenopause. What would you particularly check for? I can keep in mind a number of the stuff you examined me for particularly once I got here to see you. And naturally I had advanced signs and many alternative issues happening. It wasn’t simply menopause once we first began working collectively. However I do do not forget that over time you’ve examined me for some particular basic items. Sure. To assist see what if, if it was perimenopause. So would you share a few these? Sure.

Dr. Jill Carnahan (14:31):

So one factor is this may be achieved at any standard lab. And though blood work isn’t all the time good, in the event you’re utilizing like a cream or no matter, it’s a terrific place to begin. It typically will likely be coated by insurance coverage. And what you’d wanna do is a fundamental panel. Estradiol is the primary E two estrogen and you will get estriol and estro. However simply estradiol is an effective place to begin.

Betty Rocker (14:48):

Simply to say simply she stated E two after which she stated all these issues. In order that’s E one, E two, and E three. There’s three sorts of estrogen. So estradiol is E two and that’s the one you wanna learn about, proper?

Dr. Jill Carnahan (14:58):

Yeah, that’s the primary one. So once more, it’s nice if you will get ’em all, however in the event you simply get one, get estradiol. And currently the lab now has a extremely delicate estradiol. So HS are extremely delicate is best as a result of that is very, very, very tiny components within the blood. So that they’re measuring little tiny issues and it will get a bit extra, um, particular and delicate with that extremely delicate estradiol. You wanna get proactive.

Betty Rocker (15:17):

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

Dr. Jill Carnahan (15:20):

No, this might be only a common LabCorp quest common hospital lab. Simply writing estradiol on the lab order would do it.

Betty Rocker (15:27):

Okay, good. Good to know. Okay. Sorry to interrupt. I simply wished to verify there wasn’t one thing particular we needed to ask for .

Dr. Jill Carnahan (15:32):

Yeah, no, estradiol. After which progesterone additionally vital. ’trigger we all the time take a look at the ratio. Identical to we stated, these two are the dance companions. So we’re checking these two in conjunction. Um, if I’ve a alternative, I’m testing all these and I’ll proceed with the remainder of them on day 19 by means of 21 of the cycle. In order that’s assuming you have got a typical 26, 28 day cycle ’trigger that’s gonna hit your LAL section. And what you’re gonna see there may be if the estrogen and progesterone are in steadiness. Proper? In order that’s the timing of what you may do for this. So estradiol, progesterone, DHEA sprint S is how we check DHEA, which is one other steroid hormone within the blood. Testosterone, I prefer to get each free and whole. Mm-hmm . After which cortisol within the morning. ’trigger that’s type of an ordinary, though you would get it randomly by means of the day. And in the event you simply get these 5 estradiol progesterone, uh, DHEA free and whole testosterone and cortisol, you’re gonna have a reasonably good thought. Now you will get fancy and get one thing like DHT. This can be a, a really potent steroid hormone like testosterone that may trigger hair loss or may cause pimples or PCOS. However you don’t must get that fancy. In case you simply get these imply 5, that’ll offer you an excellent map.

Betty Rocker (16:38):

And I keep in mind these. That’s that fundamental panel I’ve had repeatedly and I wished to the touch on that as a result of A, these, so that you’ve had these checks achieved for me a number of methods over time. So at first we’d do a mixture of the Dutch check, which is a urine check that we do on these very particular days of the luteal section of the cycle. And you’ll want to be monitoring your cycle with the intention to know the place you’re and when your luteal section is. And I discover that it’s really actually useful to be monitoring your cycle if you’re in perimenopause as a result of it’s gonna offer you some indication of understanding as your cycle begins to get erratic. It, it’s simple to only neglect about your cycle. Actually, I typically would neglect I used to be even gonna get my interval in my common biking years as a result of it was simply so like I I’d be like, oh, this once more.

(17:27)
Proper, proper. Yeah. I wouldn’t have a lot sense. Me too. Proper. So, however now, like in perimenopause it’s been actually useful to trace it, to have a way of it. And I, after all I’m carrying my Oura ring and that actually helps me. ’trigger I can see my basal physique temperature go up when round ovulation and it stays elevated by means of that second half of the cycle. However anyway, again to, um, these checks, I’d sometimes try this Dutch check. You’d order that Dutch check for me, the urine check. After which I’d additionally go fasted very first thing within the morning, early morning and get a blood check as effectively. And that was the place you had been checking that T three, the free T three, the, the free thyroid hormones. Proper. The free T three and T 4. One in every of ’em is free, I don’t keep in mind. Mm-hmm.

(18:05)
However T three and T 4. And you then, you’d even be checking the fasting cortisol within the morning ’trigger we’d wanna see like the place that was. After which we’d additionally additionally, I believe you would see issues like testosterone and you would see the opposite hormones mm-hmm . Um, however it was the, the mixture of that with the Dutch check that collectively gave you a a lot clearer image of what you wished to see that may provide help to see if my hormones had been in steadiness, how out of steadiness they had been. We began to see over the course of the few years that we examined these two issues again to again the, the blood and the urine, how my hormone ranges actually went down and down and down. Yeah. And I keep in mind at first I used to be in a position to get by with merely utilizing some adaptogenic herbs that actually helped assist my stress response and helped nourish my hormones.

(18:52)
And, and I used to be in a position to really feel higher though it didn’t actually make my hormone ranges go up a lot, I felt quite a bit higher and it decreased loads of the signs I skilled. However then as I received a bit farther into the perimenopause journey, it grew to become actually important for me to begin utilizing issues like hormone alternative remedy. After which I really feel like I’m perhaps within the, the tip of that center stage of perimenopause now I’m like utilizing a mixture of several types of hormone alternative remedy. I’ve some props right here to point out you guys, in case you’re watching this on YouTube. I’ve received my patch mm-hmm . So I take advantage of this little patch and I’ll simply open up the little foil packet so you possibly can see it. It’s just a bit sticker that I placed on and, um, you alter it each few days. Or Dr.

(19:40)
Jill had even given me some suggestions as I’m very delicate to loads of these items the place we tried it for an extended interval at the beginning to see how I responded. After which we examined once more just a few months later and I’ve additionally received some completely different lotions, topical lotions. She prior to now had had me attempt, an oral progesterone. And we discovered that for me personally, the everyday advice was I believe to take it at evening. My physique didn’t like that, so I took it within the morning. So there’s simply all of those wonderful tuning kind of nuanced points of this. After which there’s additionally a pellet, which I do know you advisable for very particular conditions, however in the event you’ve received a pellet injected below your pores and skin, which we talked about in different podcasts, you possibly can’t change that. Yeah. It’s there. You may’t take it out simply your self. Proper. So it simply gotta do its factor so it’s much less customizable. Whereas with the lotions you want, you are able to do two clicks, you are able to do one click on, you possibly can actually management your dosing, I believe actually, very well. These are all issues that I’ve skilled based mostly on the testing. And I may even say that you simply and I examined an excellent quantity, like it could be a, just a few occasions a yr we’d check to see like

Dr. Jill Carnahan (20:51):

Each three to 4 months. That’s

Betty Rocker (20:53):

Nice. Each Yeah. Completely. To see like, how did my physique reply to the therapy? We wished to present it sufficient time for it to, to have some impact. And we wished to then see how was the physique doing with this stuff. After which if there was, if one thing responded, we might see that. And if it didn’t, we might regulate my dosage. However we didn’t simply go actually quick into issues we needed to like take. And that may be, that may be a bit little bit of a course of, proper? Like, ’trigger you need outcomes instantly, however in the event you overdo it, you possibly can really feel worse. And that’s,

Dr. Jill Carnahan (21:26):

That’s like, you don’t need breast tenderness with the estrogen, which is the use typical. And one factor, lots of people are fearful about clot danger. And what if I’ve this, uh, there’s completely different gene issues that you simply may’ve been instructed

Betty Rocker (21:35):

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

Dr. Jill Carnahan (21:38):

Yep. Or, um, sure different ones on the market. And so in the event you’ve been instructed that’s a danger, the deal is oral hormones, particularly estrogens do improve the danger of clot. It’s why you’ll nearly by no means see me prescribe oral estrogen as a result of I don’t wanna even go in that class, proper? Mm-hmm . Transdermals do not need the identical danger. Transdermal simply means a patch or a cream or one thing you apply to your pores and skin. Our pores and skin absorbs hormones very well mm-hmm . So I nearly solely do the compound of lotions that you simply confirmed or the patch that you simply confirmed. And, um, there’s alternative ways to do these, however these are actually nice and protected methods to use. Now you talked about typically doing blood and urine on the similar time. The dutch hormones is what you talked about. I sometimes to observe the hormones, love to do the Dutch, as a result of within the blood you received’t all the time see the true ranges of a cream or a patch.

Betty Rocker (22:25):

Mm-hmm .

Dr. Jill Carnahan (22:25):

So I generally do each, like we did with you. If I’ve a affected person who’s prepared to do each, that’s the perfect. However you possibly can see the variations as a result of in the event you’re actually following a cream or a patch or a protocol, um, your Dutch urine check is gonna present extra the correct ranges of your physique versus the blood.

Betty Rocker (22:41):

Mm. That’s tremendous attention-grabbing. So if somebody had been simply attempting to observe their hormones, in the event that they had been simply, if they might simply check type of consecutively, perhaps not each month clearly, however like on a good foundation, perhaps each three or 4 months they might use the Dutch check as their main to, to see in the event that they had been doing hormone alternative remedy. Sure. Now you talked about compounded.

Dr. Jill Carnahan (23:04):

Sure.

Betty Rocker (23:04):

That that’s, so, so there’s a few several types of these transdermal or cream-based mm-hmm

Dr. Jill Carnahan (23:10):

.

Betty Rocker (23:10):

Hormone alternative remedy sorts. Might you wanna communicate on that a bit bit? I really feel like there’s loads of

Dr. Jill Carnahan (23:15):

Certain.

Betty Rocker (23:15):

There’s, you hear about HRT, you hear about BHRT. Yeah. You hear about all these items. So inform us concerning the variations

Dr. Jill Carnahan (23:21):

There. Certain. And simply to reiterate what you stated about testing my customary affected person, we would begin them on a protocol and normally about each six months is type of when, generally sooner in the event that they’re having signs, however on a routine, and on the very least, I’m gonna test them yearly.

Betty Rocker (23:35):

Certain.

Dr. Jill Carnahan (23:35):

So everyone who will get hormones is required by me to do a yearly check. So I do know, and generally extra steadily if we’re altering doses, in the event that they’re actually steady, yearly does fairly good. Certain. Like I’m at a spot now, I do every year and I’m steady on doses. So what is out there? So there are common pharmaceutical professional prescriptions you will get at CVS, Walgreens or your common pharmacy which might be bioidentical hormones. Estradiol, as we already talked about, is the primary hormone that you simply’re gonna see. And this may be prescribed as a cream, um, as a, um, foam like a, roll-on, as a patch, which is my favourite most typical ’trigger ladies don’t have to consider it.

Betty Rocker (24:09):

Yeah.

Dr. Jill Carnahan (24:09):

Um, so there’s a number of alternative ways. And that is just one, it’s the E two, the estradiol that’s probably the most robust. It really works, it’s a good way to do it. However loads of occasions ladies wish to have a mixture and we are able to prescribe compounded estriol, which is that weaker type of estrogen. And for instance, if we’ve got somebody who has latest breast most cancers or very, very involved, estriol is type of a caboose, estrogen that means finish of the road. And the physique doesn’t take and make different issues with it. So it tends to be the most secure, even amongst oncologist with somebody being handled for breast most cancers with vaginal dryness, they might say, oh, this sort of estrogen is absolutely protected. So if in case you have any concern, you possibly can all the time compound these. And sometimes I’ll do both 80 20, imply 80%, one 20% one other or 50 50, and also you mix these two estriol and estradiol right into a cream. And since you possibly can compound it, I can begin with a lot tinier doses for somebody who’s actually delicate. And you may also put progesterone in that cream. So lots of my ladies have like a biased that means like two sorts of estrogen with a bit progesterone multi functional, and so they use a pair clicks on their pores and skin at bedtime or morning. So it may be fairly simple to do, however that means I can really choose the precise dosages for that particular person affected person and regulate it based mostly on their outcomes with wonderful tuning.

Betty Rocker (25:24):

That’s so cool. Uh, I like that. I, I really feel like I’ve been having my very own little apothecary over right here. Yeah. And I can see that my estriol estradiol is a combo and I can, I’ve a separate progesterone mm-hmm . And I even have my little testosterone.

Dr. Jill Carnahan (25:42):

Sure.

Betty Rocker (25:42):

And that’s been I really feel like actually useful. Um, sure. You wanna discuss a bit bit about that as a result of we don’t typically discuss testosterone and, and

Dr. Jill Carnahan (25:50):

I do as a result of I get so enthusiastic about, simply, so that is, we consider it as a male hormone. Now we have testosterone – decrease than males, however we’ve got testosterone. We’d like testosterone. It helps our bones, it helps our brains, it helps our motivation, it helps our physique composition. Ladies who’re poor in testosterone. It’s one of many the explanation why there may be 4 occasions the incidence of autoimmunity in ladies as there may be in males, as a result of that decrease testosterone really will increase danger of autoimmunity. So there may be, I’ve even used off-label testosterone as a part of a protocol to deal with autoimmunity as a result of it’s so highly effective in ladies. So I’m an enormous fan now. You don’t need extreme, however getting the correct dose will actually change your life, your thoughts and all these issues. Along with the estradiol libido for girls, it completely has an impact. Vaginal dryness.

(26:39)
And like I stated, bone and mind are large with testosterone. So testosterone may be given as a, we nearly by no means wish to give a tablet the place you swallow as a result of your liver has to course of estrogen, testosterone, no matter. And we don’t wanna load up the liver. So I’m all the time attempting to bypass the intestine with hormones that’s both a cream or a patch. With testosterone, there’s a pair methods you are able to do it. You are able to do a cream, however for girls, wherever you apply that cream, inside thigh or wrist, you’re gonna get a bit hair progress. So loads of ladies don’t like that. And so as an alternative of doing the cream, I’ll typically do a trochexf or a sublingual tab that dissolves below your tongue so that you simply get that dose with out moving into your intestine and thru the liver. Um, loads of ladies, uh, do injectable now.

(27:19)
It was once that the business types had been just for males. So to get the tiny doses that we wanted, had been actually exhausting to attract it in a syringe. However I do discover, effectively now we are able to compound it like ladies concentrations. And I do like, so long as ladies’s are afraid of doing a injection as soon as every week or as soon as each 10 days, that’s a good way. It sometimes does give a stage that type of goes up and down each time you inject. So you have got a bit bit extra variation than you’d with a day by day dose. So testosterone may be cream, it may be in troche or an oral sublingual, and it may be injectable. And people are the primary methods. And since proper now our pharmaceutical trade is geared in the direction of males and testosterone, a lot of the business, if not the entire business, um, ones, patches, lotions, even injectable, are sometimes made for male dosing. So that is sometimes compounded for girls, um, to get that dose.

Betty Rocker (28:06):

And also you and I’ve discovered that my physique simply loves that. It simply, it simply has actually helped me a ton. Mm-hmm. And I’ve taken such a tiny dose over the, the time that I’ve been utilizing it. It’s been actually useful, I really feel like, for steadiness. After which I additionally take, um, the oral DHEA complement to assist, as a result of that’s after all a precursor to is estrogen and testosterone. Proper. It’s a precursor. It helps our adrenal manufacturing. Um, as, and that’s one thing that I all the time so discovered actually attention-grabbing is that due to course we’re making our estrogen and progesterone primarily in our ovaries, however we additionally make some hormones in our adrenals. Right?

Dr. Jill Carnahan (28:46):

Yeah. Sure.

Betty Rocker (28:46):

And if our adrenals get overwhelmed by stress, the stress response, it’s gonna be more durable for them to make a few of these backup hormones. And I keep in mind a very attention-grabbing dialog. You and I had some time again the place you had been like, , you see ladies who’ve a very sturdy, um, adrenal perform have a better time in, in going by means of perimenopause as a result of they don’t seem to be strapped of the backup hormone system. Virtually. Did I say that proper? That’s

Dr. Jill Carnahan (29:13):

That’s precisely proper. As a result of when our ovaries conk out and so they’re like, I’m achieved, I’m for drained. Proper. Which is what occurs once we hit menopause. They ovaries cease producing the hormones, our adrenals take over. So we nonetheless do produce a bit little bit of hormones from the adrenal glands after menopause, not practically as a lot as ovarian. But when these adrenals are so taxed, ’trigger you’ve been working 80 hour weeks and never getting sleep and caring for your dad and mom and your kids and all these generations, then it’s actually frequent to have a way more tough in menopause. And I like DHEA, initially, it’s the one considered one of these that isn’t requiring a prescription. The remainder of these, you do want a prescription. Proper. Um, and only for the report, testosterone continues to be thought of managed, whether or not it’s athletes or there’s some issues that they, so that’s a kind of that you would be able to nonetheless get a prescription no downside.

(29:57)
However it’s within the class of managed prescription. So that you may need to get a decrease quantity, like six months versus a yr or sure issues. Um, however DHEA is out there over-the-counter and ladies typically do effectively on 5 or 10 milligrams upwards of 25. However that’s a reasonably excessive dose for lots of ladies. And what can occur there may be that can assist your manufacturing of cortisol. If the adrenals are low and also you’re low cortisol, it’ll assist testosterone and DHEA. So it’s type of a pleasant adrenal assist in case your adrenals are in a weakened spot. In case you’re actually excessive cortisol and also you’re vulnerable to breakouts, these are the type of individuals I most likely wouldn’t placed on DHEA. ’trigger you then elevate the cortisol and you might have some extra breakouts, however normally ladies will know as a result of they’ll take 5 milligrams, which is a tiny dose and so they escape. So cease the DHEA.

Betty Rocker (30:41):

Proper. Uh, I believe this can be a good alternative for us to shift a bit bit to the postmenopausal dialog. I wanna discuss all the pieces unexpectedly, all over the place, after all. However, however I actually need, I’m actually and curious as a result of I’ll be in put up menopause quickly and I wanna know what to anticipate. And I’ve received loads of ladies who pay attention who’re in put up menopause, and so they wanna know, effectively, what ought to, is there one thing, how, what checks ought to I get? After which what choices are there for me? What ought to we do and the way can we assist them?

Dr. Jill Carnahan (31:14):

Yeah. So there’s mainly two or 3 ways this might occur. We talked about like, say you’re 35, 40, 45, and also you’re beginning up signs and your physician’s open and also you get some prescriptions. You may really undergo this very easily after which hit menopause and type of have been on hormones. Certain. However what you’re speaking about, I believe is say that lady out there may be 65 and so they have by no means been on hormones. By no means.

Betty Rocker (31:33):

Sure.

Dr. Jill Carnahan (31:33):

Proper.

Betty Rocker (31:34):

Proper.

Dr. Jill Carnahan (31:34):

And so they’re like, effectively, what about me? Nicely, very first thing is Dr. Dale Bredezen does a ton of analysis on Alzheimer’s. And he’s one Who’s that? Dr. Dale Bredezen. Okay.

Betty Rocker (31:42):

He

Dr. Jill Carnahan (31:42):

Wrote the e book Finish of Alzheimer’s. And he’s considered one of our researchers and main consultants in dementia. And I discussed this as a result of in his protocols, there’s a sort of Alzheimer’s that’s associated to lack of estrogen within the feminine mind.

Betty Rocker (31:55):

Wow.

Dr. Jill Carnahan (31:56):

So he’s placing 85-year-old ladies on hormone as a result of it’s so essential to our mind perform. And, and so this previous delusion was that, oh, after 65, we don’t want hormones. So if we’re on hormones, we cease at 65. Or if we’re above 65, you’re too previous for hormones. That’s not true. Our brains, until the tip of our life can use the hormones. Now, perhaps sooner or later you want lesser doses, however I’d say to any lady who’s postmenopausal and perhaps having signs, perhaps not, I’d nonetheless begin with testing after which discuss clinically about signs after which discuss security. Security’s the identical factor right here. However what occurs is, say you went, uh, into menopause at, otherwise you hit menopause 55 and also you’ve been with out hormones for 10 years, your receptors begin to and shrink up. So what occurs is if you first begin hormones, if in case you have by no means been on them, there’s a bit little bit of adjustment as a result of you could not both be capable to sense that hormone effectively, or you could in a short time get flooded with an excessive amount of. So it simply takes a practitioner who’s cautious with that, however they’re really with coronary heart, mind, and bone. There isn’t any age too previous that doesn’t profit from hormones so long as there’s a dialog and all of that

Betty Rocker (33:06):

Taking place, and it’s approached rigorously. That makes whole sense. And I’m so glad you stated that. Um, a number of the telehealth websites that assist ladies with balancing their, their hormones put up menopause, they are saying that they’re, they’re not gonna prescribe in the event you’ve, or they, they, there’s some wording about in the event you’ve been 10 years with out having a interval and also you haven’t by no means been on HRT, like they, they wanna test in about that due to precisely what you’re speaking about. Like these receptor websites kind of, are they atrophy, such as you stated? Yeah. However that there nonetheless might be, that you simply nonetheless might have that chance. So, so say, say somebody got here to you and he or she’s identical to perhaps just a few years in to put up menopause. What would you check her for? What would you be taking a look at? Would you take a look at, I imply, you most likely nonetheless wanna see like what her ranges of estrogen or like, you most likely wanna test her cortisol, I don’t know. What, what do you kind of take a look at to, to assist her? And, and clearly it’s individually based mostly as effectively, but when she’s taken with some kind of hormone alternative remedy, I assume what, what dialog and the way do you check?

Dr. Jill Carnahan (34:04):

Yeah. So we’d nonetheless do most likely blood work or Dutch hormones, one or the opposite, or each. After which what we’d wanna do is there’s a danger of if in case you have uterine fibroids which might be unchecked and really massive, otherwise you had extreme endometriosis, so any of the endometrial illnesses, this implies like the liner of your, your uterus was irregular or thick. Or you have got these growths which might be benign progress, however they’re stimulated by estrogen. These circumstances, um, might be stimulated even by wholesome bioidentical hormones and fibroids are benign, however they’re a ache if in case you have them. They’re massive or uncomfortable. They’re sometimes not malignant, which implies like they’re not most cancers. However these are caveats or issues that as, as a doctor, I’d be very involved or have a dialogue about. And likewise, if you’re perimenopause or in these earlier years, forties or fifties, and you’ve got had an enormous difficulty with fibroids or endometriosis, these are discussions we wanna have about easy methods to dose this and be watching that rigorously.

(35:00)
So sometimes a girl who’s by no means had any hormones, I’d display them with a pelvic ultrasound to only take a look at that pelvis and ensure all the pieces’s protected. As a result of if they’ve fibroids, these might develop with hormones. And you must know that after which be capable to watch it. If any lady has breast tenderness with these, uh, hormones, that’s an indication. I’m all the time like, oh, that’s, you’re hitting your threshold. We’ll, most likely ought to decrease it. In order that’s like a warning factor. I’ll say, you don’t wanna have breast tenderness, or in the event you do and it’s simply transient for every week and it goes away, that’s most likely okay. After which the third factor is in the event you ever cease bleeding for over a yr, that’s technically the definition of menopause. You’ve gone into put up menopause, um, and also you begin to have bleeding that yr with out a cycle that requires you to get an endometrial biopsy and a workup to verify your lining is just not getting too thick. And these are simply these cautious issues {that a} good physician would do in the event you’re on hormones, as a result of hormones may cause that lining to get thicker. And so if in case you have a excessive danger of that, or some cause, you’d must have that dialogue about security and efficacy along with your physician. However I’d all the time do a pelvic ultrasound and test their scientific historical past after which discuss with them rigorously. I’d additionally most likely begin a 70-year-old lady on a a lot, a lot, a lot decrease dose than I’d a 45-year-old lady.

Betty Rocker (36:10):

Certain. Thanks for sharing that. And that’s so useful to know as we go into this stuff, we wanna have our eyes open about danger elements. And also you talked about that you simply, you do a Dutch check as one of many choices for a post-menopausal lady. However since she isn’t having a cycle anymore, when does, when do you, when do you do try this? Yeah, anytime You are able to do it that

Dr. Jill Carnahan (36:29):

Anytime. Proper,

Betty Rocker (36:30):

Proper. Since you’re simply trying to see the place her ranges are at in order that you would decide now. After which for somebody who’s post-menopausal, are you gonna be placing her or a person as an anyone, I assume, would they be getting on an analogous protocol to what somebody in perimenopause is getting on? Are you gonna be giving all of them the identical sorts of hormones? Would they want all of them? Or are you, are they extra prone to be simply getting on an estrogen or perhaps some testosterone? Or is there a cause to nonetheless add progesterone? I’m simply so .

Dr. Jill Carnahan (36:57):

Sure. So, um, the, the everyday medical coaching is if in case you have a uterus and you employ unopposed, estrogen, that means all you get is estrogen, that’s a danger for that lining being thicker and truly creating endometrial most cancers. So we as physicians who’re doing good work, would by no means give a girl who nonetheless has her uterus unopposed estrogen by itself. You’d all the time give it with progesterone. Progesterone protects you from having that. So no matter age it’s, and if I consider order of operations so far as security, and even from 35 on what you do, progesterone nearly all the time comes first for a lot of ladies, as a result of many ladies from 35 to 45 do very well with simply progesterone. They don’t want any estrogen. There’s estrogen dominant, that’s what the ketchup, the Heinz ketchup factor is.

Speaker (37:39):

Yeah.

Dr. Jill Carnahan (37:40):

After which ultimately as they hit the ovaries begins to tank, then they, we add the estrogen. And so somebody older, I’d begin with progesterone estrogen alone, earlier than I’d add loads of testosterone DHEA, as a result of then you would, there’s, as you possibly can inform, the variables are nearly infinite in how with, yeah. So it’s a lot simpler to, to evaluate with some small quantities of estrogen, progesterone first, see how they do in two or three months, after which if wanted, add a bit testosterone. Um, and see, and I’d say extra ladies above the age of 65 are on a really small dose of estrogen, progesterone with out testosterone. However even they’ll profit from small doses if acceptable.

Betty Rocker (38:17):

Fascinating. Wow. Nicely, you’ve given us loads of actually nice data to consider, however I believe that one factor that we’ve got not talked about but, that’s all the time been part of our work collectively that I wanna make sure that ladies hear about is what hormones are doing in our physique and the way they’re really excreted. As a result of there’s a actually vital side of our hormone steadiness that has to do with our intestine well being. Proper. And would you communicate on that a bit bit, as a result of I, I believe that is one thing that you simply care quite a bit about and also you’ve guided me very well on as effectively.

Dr. Jill Carnahan (38:51):

Thanks, um, Bree, as a result of it’s, so what occurs is estrogen, progesterone, all these hormones in our physique, they’re handled by our liver, identical to a drug or a chemical. So we’ve got to detoxify these. And sometimes when ladies get into bother, even with danger of breast most cancers, endometrial most cancers, any kind of hormone associated difficulty, it’s not that their hormones are the dangerous guys, it’s that they’re not in a position to do away with the surplus. They accumulate sure metabolites that may harm DNA, and that results in dangerous issues. And apparently, in our world that we stay in, there are masses and a great deal of issues that mimic estrogen. They’re referred to as endocrine disruptors on our physique. So loads of occasions the, our bathtub and physique merchandise are make-up, um, issues that since we use in our home, um, even atrazine that’s used on corn within the Midwest, and these chemical substances act like hormetic or hormone results on our physique, and it’s very poisonous.

(39:43)
So it’s nearly worse the atmosphere than the hormones we take, however we’ve got to consider that. So if I’m actually going deep or somebody has loads of concern, I could even go so far as to do genetic testing on their liver’s means to deal with hormones, as a result of there’s just a few completely different genetic, we name them snips, which simply means issues that you simply don’t course of usually. Um, like say a standard individual is one hundred percent processing, you could course of it 60% or 30%. So generally I take a look at sure ways in which you course of hormones. And people individuals, I’d do decrease doses, I’d monitor them extra steadily. Um, and once more, that could be the ten% of the inhabitants. So if in case you have a household historical past of most cancers, particularly hormone associated, or you have got a, you may wanna get right into a deeper dialogue along with your physician, however on the core, what you are able to do is that this, you possibly can just remember to are utilizing clear merchandise in your hair, in your face, in your physique.

(40:31)
Transdermal medicines work for a cause as a result of we take up all the pieces by means of our pores and skin. And if we’re placing stuff on our pores and skin, standard perfumes or stuffed with phthalates, um, or any non-organic produce typically has, um, glyphosate residues or, or, uh, pesticide residues and all this stuff have a poisonous impact. So I prefer to preserve it easy. And if we simply begin with clear air, clear water, clear meals to the perfect of our means, that provides us a basis for protected hormone alternative as a result of we’re not getting a bunch of additional indicators to our physique from the meals that we eat or the water that we drink.

Betty Rocker (41:05):

Sure. And even, even with out hormone alternative remedy, if our intestine is just not working optimally, we’re not gonna be capable to course of extra. So like we talked a bit bit about estrogen dominance a bit bit in the past, and I do know that one of many issues that may make estrogen dominance worse, whilst we’re dropping that progesterone, perhaps we’re within the early phases of perimenopause, is, uh, not with the ability to course of the surplus estrogen that we do have out of our physique. Proper. And we’ve, there’s this part of the intestine microbiome referred to as the estrobolome that helps to course of the estrogen. And if it’s not working, if it’s not in a position to perform effectively, it, it’s gonna ship that again into our system as soiled estrogen. What does that imply precisely? And the way does that, how does that affect us?

Dr. Jill Carnahan (41:51):

So that is actually massive and I’m so glad you introduced it up, as a result of what occurs is, um, our liver’s all the time doing the detox work and it simply squirts out stuff into the bile that’s presupposed to be eliminating, and that’s in our stool. So in the event you’re a girl who has persistent constipation, that alone places you at larger danger of reabsorbing toxins out of your atmosphere or meals. And even in the event you’re on hormones and you’ve got persistent constipation, you’re gonna have extra bother eliminating the identical dose as a girl with out constipation. So the bowels and eliminating are so essential to this entire pathway and to changing hormones appropriately. So if we’re not, mainly that, that enterohepatic circulation, which is a very fancy phrase for the…,

Betty Rocker (42:28):

Did you say entero? And say it once more.

Dr. Jill Carnahan (42:30):

Enterohepatic. So it’s like intestine hepatic.

Betty Rocker (42:34):

Received it. Intestine liver.

Dr. Jill Carnahan (42:34):

Kinda like one other means for intestine liver circulation, that pathway on a regular basis is being reabsorbed. And so if we’ve got a bunch of poisons in our intestine and we’re not pooping out day by day, um, we’re gonna reabsorb toxins and we’re gonna reabsorb hormones and we are able to get extreme ranges. Um, so it’s a actually massive deal to, it’s like fiber alone, getting good fiber out of your meals, which you’re professional at that along with your meal plans and all of the issues that you simply do as a result of that’s,

Betty Rocker (42:58):

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

Dr. Jill Carnahan (43:08):

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

Betty Rocker (43:17):

Yep. Yep. Precisely. So I, I’m so glad that you simply talked about that as a result of it’s, apart from any kind of hormone alternative remedy, our physique has this elimination course of naturally for the hormones that we have already got in our system, our pure hormones. And so if we’re not eliminating effectively already, and we go pile hormones on prime of that, like bioidentical hormones or no matter type of hormone alternative remedy you’re utilizing, and also you’re not eliminating effectively, you simply set it so effectively, we’re poisoning ourselves reasonably than serving to ourselves. You’re, you’re turning one thing that’s this potion right into a poison. Proper, precisely. Which precisely we don’t need. Proper. We would like wanna take. Yeah. So, um, we talked about fiber, we talked about strolling extra. I believe staying hydrated additionally. So important for supporting intestine perform, chewing extra mindfully, chewing extra, slowing down if you eat to assist your salivary glands and the amylase and the entire issues that assist digestive digestion start in your mouth. What different like little scorching suggestions do you have got for individuals to assist them with higher intestine well being? I simply stated just a few.

Dr. Jill Carnahan (44:19):

Like it. So I believe an excellent probiotic, I love to do spores. Um, however there’s so many good ones on the market. I simply spores have tended to work with even my robust, uh, , tough to deal with shoppers with intestine points. These are usually very well tolerated. Um, one factor actually attention-grabbing is there’s loads of pure substances that may assist us on these pathways, and you’ll discuss to your physician about these, however some which might be actual frequent are sulforaphanes, which come from broccoli sprouts mm-hmm . And sprouted, um, seeds and issues. In order that’s a terrific place. You should purchase it as a cap, however you may also sprout your broccoli and have that in your salads. Um, Calcium D Glucarate is a sort of, it helps this section two of the liver, so processing that hormones and we are able to really see markers within the stool if we’re doing particular testing for somebody who isn’t processing effectively.

(45:02)
And we are able to add that calcium deg glucarate as a complement to assist them get rid of on this liver intestine entry. After which a 3rd one is DIM, and that is additionally a very highly effective one. Um, the one caveat with DIM is it’s so good at decreasing estrogen, and if somebody was like 65 and already having osteoporosis and already actually low estrogens, that’s robust sufficient that I most likely wouldn’t use it in that inhabitants, however I’d, if it’s a 45-year-old lady on hormone alternative, having a tiny little bit of breast tenderness, these are type of the ways in which you would use that sulforaphane, Calcium D Glucarate, and DIM. After which after all methylated B nutritional vitamins, simply B nutritional vitamins are essential for this course of. Um, and issues like NAC, which is absolutely supportive for the liver as effectively.

Betty Rocker (45:46):

So, attention-grabbing as you’re saying all of these, I’m remembering all of the protocols we did if you had been serving to me heal from, uh, mould publicity, which was horrible. And it, that occurred proper firstly of my perimenopause journey and loads of these issues that I wanted, the liver assist, all of that. It was simply in, it’s simply attention-grabbing considering again on it now, , there’s that nice Steve Jobs quote that was that “you possibly can’t join the dots wanting ahead, solely wanting backwards.” And now as I’m considering again on the entire various things, oh yeah. The way you handled me, I’m understanding the connections that we made there and the ways in which you actually had been attempting to assist assist all of these holistic processes and all of these issues I used prior to now that I don’t want particularly anymore mm-hmm .

(46:28)
And that, that actually will get me again to this factor that girls want entry to particular, individualized healthcare that’s this, that has this breadth, that has this depth that, that cares about these completely different points of our well being and is educated in that sense. You already know, and and I, I’ve been so fortunate to have you ever in my life, and for individuals who, who don’t get to have you ever as a result of you have got a observe. You, you have got, you have got a tremendous e book. There’s a film about you . You have got, uh, an unimaginable web site with this depth of data so that folks can study extra and develop into advocates for themselves with their very own medical doctors. You have got a complement retailer the place individuals should purchase loads of some of these dietary supplements for themselves. And I simply, I really feel like you have got loads of superb assets. And is there something I omitted of that as a result of, effectively, your social media, what else did I neglect to say? Your

Dr. Jill Carnahan (47:28):

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

Betty Rocker (47:30):

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

(47:34)
Um, however the place I used to be going partly with that, apart from saying, okay, women, all of us want these assets and right here’s a few of what you will get from Dr. Jill. Um, and Dr. Jill and I had been speaking earlier than this podcast began about, effectively, the place else can ladies go? Sure. And I used to be saying, I’ve been researching these completely different corporations that try this observe telehealth, and I’m gonna learn just a few and I’ll after all have all these linked within the present notes. And, um, I keep in mind I ran them by you earlier, Dr. Jill. ’trigger I simply wanna guarantee that this was an excellent, that I wasn’t going. You already know, I, I believed they had been nice. However it’s good to listen to your vote of confidence in these as effectively, as a result of that is I believe the way forward for that kind of medication. And, and for girls particularly? Sure.

(48:15)
So listed here are a pair that I discovered. One known as Midi and I like midi. It’s like M-I-D-I and it’s, it’s a feminine based firm. It’s all these cool ladies medical doctors and it’s telehealth firm. There’s telehealth choices, proper? After which in addition they will prescribe hormone alternative remedy or no matter you’re comfy with and no matter you want. And I simply watched a pair movies from one of many co-founders and was simply so impressed. She jogged my memory of you. She was so cool and right down to earth and like she, it was all very private for her ’trigger she’s gone by means of the journey herself. So I like Midi. One other one which I discovered, clearly you’ve most likely heard of Winona. I believe Winona’s been round for a short while and so they’re nice. Additionally they have the telehealth choices. Um, one other one I discovered that’s down in Tampa, however they do, uh, telehealth and, and do numerous cool prescribing is defy, like they’re referred to as Defy, which I like.

Dr. Jill Carnahan (49:04):

Love

Speaker (49:04):

It. Def. I adore it.

Betty Rocker (49:06):

Yeah. Defy. After which there’s one referred to as Stella And Stella I believed was actually cool. They’re additionally, in addition they have telehealth choices. They’ve the hormone alternative remedy choices. They’re, um, they’ve a web site for US based mostly sufferers in addition to UK based mostly sufferers. Oh, good. So you possibly can, you should utilize one or the opposite relying. I do know loads of you guys are within the UK that, that take heed to my podcast. Thanks a lot. Um, after which I additionally, I used to be serious about my, my individuals in Australia. Um, there’s one thing referred to as Clinic 66, and if, in the event you’re, in the event you’re searching for choices for your self in your nation, I believe simply utilizing a few of these key phrases that Dr. Jill and I had been speaking about in the present day on this podcast, like, search for issues like telehealth, choices for hormone assist in menopause. I really feel like I did that myself at completely different occasions and I’ve, and and I put it into completely different international locations to see like, the place are they doing these items? And you then simply learn what’s on the web site and you then simply type of must observe the threads and see the place, the place, the place it’s gonna give you the results you want. And I’ve observed the US based mostly ones, a few of them have limitations by state Yeah. That they’re gonna deal with. And have you learnt a lot about that or like, , I do know you’re not gonna know what every individual gonna do, however what are a number of the limitations that you simply do know of in

Dr. Jill Carnahan (50:15):

State? Sure. Um, medical medical doctors are nonetheless licensed by state. So you actually, um, sometimes are, except somebody involves see me in Colorado, I’m, I’ve to be extra cautious about who I deal with outdoors of the state. In order that’s an entire deal. One of many issues that could be tremendous useful is if in case you have a compounding pharmacy in your space, that’s a terrific place to name as a result of they know what physicians in your space are prescribing hormones. And normally the compounding pharmacies additionally know who actually know, as a result of they’re gonna be, like, for me, they know I prescribe loads of hormones. I discuss to the pharmacies on a regular basis. And so a good way is that if there’s a compounding pharmacy in your space, you name ’em and say, Hey, what medical doctors have you learnt in my space which might be doing this? And that’s one other good method to get in your space. Somebody who’s legit and your compounding pharmacy will sometimes know who that could be.

Betty Rocker (50:56):

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

Dr. Jill Carnahan (51:00):

Yeah. Yeah. There’s P-C-C-A was once the largest, um, group that, uh, licensed Okay, so PCCA, I don’t know precisely what it’s one thing “Coumpounding Pharmacies of America”. However, um, if it’s simply pcca.org, I assume, I don’t know the precise web site you must be capable to discover, uh, firm pharmacies. However yeah, you may also simply Google compounding pharmacy in my space.

Betty Rocker (51:21):

That’s nice. And I, I believe, I imply, and there are numerous greater than those that I simply, that brief listing I gave you guys. I, I’ve, I’ve, I like all, I like all these choices which might be on the market for us. And I really feel prefer it’s, it’s, it’s gonna get higher. It’s, there’s gonna be increasingly of them hopefully over time, however actually simply having this dialog, asking for what you want, advocating for your self. I, you and I had a dialog, um, a month or two in the past and we had been speaking about the way you stated in the present day, like some medical doctors you are feeling like they gaslight their sufferers and it it’s as a result of they don’t know. Proper? They don’t have a clue. Proper. And I stated on a podcast the place we had been speaking about this, I used to be like, I really feel just like the medical doctors don’t imply to be jerks about these items. They simply don’t know. And in the event that they knew, they might perhaps attempt to get extra data, proper? As a result of all of them

Dr. Jill Carnahan (52:07):

Have, you concentrate on like, even me, if I graduated from med college and I’m instructed that that is harmful and that I by no means look and by no means study, which loads of docs cease studying after, proper? Then why wouldn’t I say, oh, nope, don’t do it. That’s what I heard 2001, which is previous information now. Proper? In order that’s loads of them simply don’t know the most recent knowledge and the protection.

Betty Rocker (52:22):

If we had been to count on science to be this static factor, and we are able to solely take no matter’s been stated earlier than, I imply, we’d by no means have any ladies particular,

(52:29)
Proper? Like we’d don’t have anything we, that we’ve got to permit science to be this evolving like, studying course of. That’s what science is. You already know, they’re, they’re observing knowledge and so they’re reporting on it, and over time they get higher and higher at their strategies, hopefully. And yeah, I imply, simply seeing them, simply seeing, not them, however seeing the extra particular research achieved on ladies particularly. I imply, it’s like a revelation. You’re like, effectively why didn’t we try this earlier than? I do know , it’s about time , proper? Don’t y’all have a mother? Like, don’t you have got a sister? Don’t. Yeah. So it’s simply, it’s nice to see that and I’m glad we’re having these conversations. However Dr. Jill, I simply wanna thanks once more a lot for taking the time to speak about all of this in the present day. We coated a lot in a short while. And is there something that I didn’t say or didn’t ask you that you simply’d wanna make sure that to get throughout simply in case?

Dr. Jill Carnahan (53:17):

No, simply thanks for the great work you do on this planet and uh, thanks for having me on. It’s all the time a lot enjoyable. It’s like having espresso with a buddy and in the event you’re on the market and also you’re struggling for hormones, you don’t must. And there are simply, I like the assets you gave. There are such a lot of individuals who do perceive this. Um, and uh, I’d simply proceed to look till you discover these solutions.

Betty Rocker (53:36):

I’d agree. I’d agree with that. Sure. And thanks a lot in your work. And I’ll have hyperlinks within the present notes after all. And with this video so that you guys can observe up with Dr. Jill and get all of her unimaginable assets. She has so many, you’ve achieved a lot work for girls and a lot work in your sufferers generally, women and men. Um, thanks once more a lot for being right here and we stay up for speaking to you once more. Thanks you, thanks a lot. And hey Rockstar, thanks a lot for listening in the present day. It’s been nice to spend time with you. I hope you realized one thing that’s useful and I’ll have all these hyperlinks to the issues that we talked about, in addition to a few books and assets Dr. Jill shared with me that we didn’t get an opportunity to speak about on the present. You’ll want to take a look at the present notes web page for this episode over on my weblog at thebettyrocker.com within the podcast part for all of these hyperlinks. And I hope that wherever this finds you, you’re taking nice care of your self. Until subsequent time, I’m Betty Rocker and you’re so superior, flawsome and superb. Bye for now.