Season 3 Episode 11 of Quiet the Diet Podcast with Michelle Shapiro, RD and Kristin and Maria from Wise and Well
All About Women’s Hormones, Menopause & Hormone Replacement Therapy (HRT) with Kristin and Maria of Wise and Well
In this episode, Michelle sits down with not one, but TWO health experts that specialize in perimenopause and menopause. Kristen and Maria of Wise and Well are friends and practitioners who share a passion for women’s health, especially women’s health at midlife. Tune in as they explore an array of important topics surrounding women’s hormones, health, and the journey to finding balance and empowerment.
- Hormone changes in women’s bodies as they age [7:44]
- The impact of hormones and hormonal changes on women’s overall health [12:54]
- The truth about Hormone Replacement Therapy and Breast Cancer Risk [17:26]
- Hormone therapy for menopause and its benefits [30:54]
- The need for more education around menopause and health for mid-life women [39:38]
- Body image, aging, and self-acceptance [55:06]
Wise and Well Resources:
Mighty Network Community: https://mastering-midlife-mayhem.mn.co/
Work with Michelle:
Connect with Michelle:
All About Women’s Hormones, Menopause & Hormone Replacement Therapy (HRT) with Kristin and Maria of Wise and Well
I am joyously here with my friends, my colleagues, in many ways role models too. Maria and Kristen of Wise and well, I am so excited to have you both here today.
Thank you. We’re super excited. Thank you.
So funny because before we got on today we were viciously laughing and screaming about all these things that are going on in the nutrition world. So what I love so much about both of you is that you take topics that are very controversial and I know you’re very passionate about, but you still approach them deeply with science and with so much compassion. And the field that you’re working in should not be controversial, but it is. And that’s why I always find your approach so refreshing and I know so many women find your approach so completely necessary and different, which is weird. Can we talk first just about a little bit about what you both do and what your business does and how you help women?
Yeah, I would say we are primarily in the education business, really. There’s a dearth of education when it comes to menopause. Well, maybe up until about three to five years ago there was a dose of education. Now there’s every philosophy you want to choose from. But yeah, to put it simply, I’ll let Kristen expand on.
You know, for all I think many of us come to working as practitioners in the health field simply because we have a personal experience that ends up, sort know, opening our eyes to maybe some things that are broken. In the system and we want to change know. And I think that’s what Marie and I are trying to be a little bit our change agents. But we find that the only way to do that because there’s so much inertia right now against women’s health beyond maybe menstruation fertility, pregnancy and lactation. And that’s it. And after that, women’s health doesn’t seem to matter all that much. And any woman over the age of 40 knows it matters a lot. And we’re going to be spending maybe half our lives in a state of whether we call it the menopausal transition or post menopause, but in a state of hormone depletion that has significant ramifications for women’s health. And there’s no education on this being taught to our doctors, there’s no standard of care that addresses it, there’s no training that helps people navigate this space. And so we’re just trying to educate sort of where the holes are and we take a lot of abuse for it because it’s a bit disrupting to the status quo. And so if people want to call us disruptors, go ahead. We’ll wear that badge with honor.
Are you saying it’s disruptive to believe that 50% of the population, how they feel should matter for half of their lives.
And that’s the funny thing, is, is it a cultural sort of paradigm that’s created this situation, right? And that we rear the children and kind of see a sunset on our career and then just kind of go quietly, right? And people want to argue that. They want to argue, is it a pathology, is it because of the patriarchy? They have all these kind of descriptors to explain what’s going on, and then that leads them to decide whether or not it’s a valuable discussion. And Marie and I are like, full stop. It does not matter what angle you approach this at. There are some distinct truths, which is if women do not have sufficient hormone status as they age, they have a limited health span, lifespan is going to be long, health span ain’t going to be so great. And that’s wrong. I don’t care why we got to this place, to be perfectly honest. Maria and I are just like, you guys go fight about all that yourselves. We’re going to talk about what can we do about it? And I think that’s, like, Maria hit on we’re educators. That’s all we’re trying to do is get women to be like, look, you don’t need to be gaslit by your doctor anymore, you don’t need to be dismissed by your doctor, all of these things. You just need to understand what’s going on and then advocate. And women are great advocators. We do it our entire lives for everyone around us. It’s difficult sometimes to put that hat on for ourselves. So we’re just trying to give women sort of the teeth that they need to take that bite and run with.
Oh, I already feel myself getting. I’m burning with questions. I’m burning with passion. Kristen and Maria, it’s getting intense already in here, because, again, what always appeals to me so much about the work that you’re doing is how non controversial it should be. And there is not a woman that I have on a discovery call, there’s not a client that I have who has not asked me the question before. Post menopause, I thought hormone replacement therapy causes cancer. I don’t know why I would even take it. There’s so much fundamental systemic issues with the work that you’re doing, and that’s why it’s so sticky and why you’re getting abused. I hate that you use that word. I hate that that happens online about it. So I want to just like, let’s really lay down the law here. Let’s law for Kristen, who’s a lawyer too. Let’s lay down the facts here about what is happening in a woman’s bodies as we age. And we can also talk about why that gap in knowledge is so vast and probably one of the greatest gaps in knowledge. So much so that I feel myself educating on a discovery call about this topic. Can we just lay down the facts of women’s hormones as we age? You can give general time and say what happens, what the changes are, and roll us through that.
Yeah. Okay. So starting typically in the late 30s, early 40s, we start to have decline in our hormones. So that is things like DHEA. We don’t talk about that too much, but progesterone does decline and it usually.
Doesn’T bounce around much. Okay.
So it kind of just creates kind of starting to go downhill. Estrogen will bump around a bit and we’ll get so many women saying, oh, I’m estrogen dominant. Well, you’re probably not. You just probably caught your estrogen in a bit of a spurt. So that happens for can be many years, can be two years, four years, maybe ten years. Once you go 60 days, though, without a menstruation, if you are over the age of 45, you are definitely late stage perimenopause at that point. Okay, so then we get to that menopause, which is that one day and.
We’Re probably pretty hormone deficient at that.
Point, and then everything else is postmenopause. But we try to remove fertility, right. Because so many women see the period as sort of like a marker and a harbinger of fertility and it’s ovarian senescence and it can start years and years and years before.
And then what kind of follows that is a certain degree of immunosinescence with age. So now we’re talking like mid 50s, late 50s, early 60s, inflammaging this is greatly kind of magnified when we are hormone insufficient, which is what we are at some point along that journey if we are not replacing back those hormones.
Yeah. So this piece of the puzzle is really important for people. People believe progesterone and estrogen, if they don’t know, are hormones that are just related to fertility. This is such a huge question and you do not have to go into excruciating detail, but can you tell us just briefly some of the other functions of progesterone, some of the other functions of estrogen, and why it’s so important for us to have adequate amounts of those hormones at any age?
Yeah, I mean, I think we’d say that if we think of the menstrual cycle as what everyone focuses on. The menstrual cycle is just one thing that is happening throughout our monthly cycle that fluctuation, which for women who don’t know, we have a day twelve peak of estradiol. And then we start progesterone production around day 14, that peaks around day 21, get another little bump of estrogen, they both decline, progesterone stops and we get our period. Okay. It’s not just the period that’s happening. We are maintaining our bones. We are literally triggering bone remodeling through this rhythmic dance of estradiol and progesterone. We are maintaining our muscle architecture. We all have type one and type two fast twitch, slow twitch muscles. That changes as women. You can see a lot of women, they start to go towards like endurance sports as they age. Well, that’s because they are losing their fast twitch muscle architecture when we’re younger. Our estradiol and progesterones dance actually maintains that muscle architecture. It maintains the flexibility of our ligaments and tendons. It maintains the cushioning in our bones. It also maintains our vaginal tissues. Ladies. It prevents recurrent UTIs. It makes us get nice and moist when we have intimate encounters. It protects our brain. It is making sure that our arterial endothelium, the walls of our arteries and glycocalyx maintain intact structures. So it’s truly not just our menstrual cycle. It’s actually our whole body health. It’s maintaining how we process carbohydrates, how much insulin we can release. There’s so much that goes into it. And that is the piece that we feel is really an injustice. Girls need to be taught this in middle school, right? I think they’re still teaching about periods in health class. I don’t know, but I don’t have girls. But that needs to be an element that they need to understand because I think we’re conditioned to see these hormones as almost the antichrist in our body, that our period is a major drag on our life and that this whole hormonal milieu is really kind of a drawback from our quality of life. And if women and girls started to learn that actually this is our freaking superpower, right? This is what makes us be able to multitask, this is what keeps us calm. This is what keeps our muscles being able to respond. I mean, Maria and I are older than you, but when we grew up, girls weren’t necessarily as competitive athletics at younger years as they are now, right? Well, when you see a girl really come into her own at age 13, 1415, and start to become this really cool athlete, that’s your hormones, girls. So that sort of stuff is what we wish people understood, because then they would be able to see that when those hormones decline, like Maria described, and they eventually disappear, so does their work behind the scenes, so does the bone remodeling, so does the maintenance of the muscle architecture. So does the maintenance of our arteries. So does the strength of our heart, our neurotransmitter production, our gut microbiome. Everything changes when we lose those hormones. So why do we want to age without them?
How did this kind of gap in knowledge come to be? And this could be a theoretical question. This could be an actual science question. This could be a funding question. When in time did we start to just accept that women are not going to feel well after 50 or whatever that number is for them? When did this gap start to happen? And is the gap also a result of us just living longer? Is that part of the reason why we’re only starting to acknowledge how important this is now? I don’t know. Again, very theoretical question, but I’m curious what your take is.
Yeah, so there’s someone who we respect, but who loves to hammer this theory that women didn’t used to live this long. Well, that’s just fact. You look back in census data and whatnot, we didn’t live this long. Now, why didn’t we usually because we didn’t have antibiotics. We were still out running animals. We were threatened by more acute threats. Right. So women had a much shorter health span. People can claim that. That’s not true. It is true. We’ve got the data to back it up. Our lifespan our lifespan started to increase as conventional medicine started to be able to address people got shelter, people got food, people got antibiotics, et cetera. So lifespan started to increase, but women’s health span did not follow. We stopped dying of childbirth. We stopped dying of pneumonia, but we started dying of other things. And it was actually the early 19 hundreds that menopause was actually deemed a medical condition, and that hormone replacement was characterized as preventative medicine for women.
Okay, what happened?
Yeah, it’s really cool. And if you look way, way back, I mean, the Chinese, God bless them, they were on this with Chinese medicine hundreds of years, not decades, centuries before us, that they would look at a woman who maybe had what we now call PMDD. Right. She had severe mood disorders. When she’d menstruate, they would start using metabolites out of a woman’s urine in order to create hormones and replace them to flatten out her moods. Like really shocking cool stuff. But by the 19 hundreds, in terms of the Western civilization, it was accepted by the American Heart Association, the American, you name it. Every medical society saw replacing hormones in the early 19 hundreds as preventative medicine. What happened, unfortunately, was the medicalization of those hormones, right? The pharmaceuticalization shock. I know. And we had some pharmaceutical companies decide that they could mass market hormones and that they would do it by using non human extracts of various things and then synthesize them in a lab. So we started going from giving natural hormones to women to giving them hormones that, at a molecular level, were not the same as what we normally produced. They were close, and they sometimes could do the job, but we didn’t appreciate that they were also then causing other changes. And so it was around the 1950s and 60s, they started to see some heart issues. And eventually in the United States, they said, hold up until you can show that these are not cardio deteriorating medicines. We cannot have this as the standard of care to prevent chronic disease from where it is.
Yeah. So we need a study. We need a study. Now, ironically, we all like to focus on what’s called the who, the Women’s Health Initiative. But there were actually studies that predated that, unfortunately, they were small or they weren’t designed correctly, or they just didn’t have the right endpoint. So we did have a couple of decades where people had mixed results depending on what form of hormones they were using. And then we enter what is very interesting, because no one wants to talk about it, is women got emancipated, women got many more rights. And then we have the feminist movement start in the 60s, right? Feminism. It’s like burn the bra, women can work, delay childbirth, all this kind of stuff. And ladies, here’s a birth control pill. Sexual revolution. Here we go. So what happened then is the FDA and the US government said, hey, we’re going to give a ton of money to anyone who’s willing to study women’s health issues. And as much as people might know about the Whi, what they don’t realize is that the original study architects, they were intending to show that hormones were dangerous. That was their end goal.
And why was that their end goal, Kristen?
Because they were paid by the pharmaceutical companies. I was just like, tin hat conspiracy. I think we’re in an agency. So anyway, they went at it with a study design that would show that this was problematic. Ironically, they really fouled the ball by managing to make an even worse study than they thought they were making, using horrible things. Women who were already well past menopause, who had changes in their health already were not monitored and screened, all of these kind of things. And we all know the who comes out and says, oh my God, not only are hormones bad for your heart, they actually cause cancer and they do these other things. And so we must avoid hormones. And so in the early two thousand s, the study was stopped abruptly. Women had their hormones pulled out of their hands. Medical schools said no more. We’re going to now teach HRT is dangerous. Now we’ve got generations of doctors who believe that. And sadly, the own study people, authors, have come back and they’ve walked back their conclusions and they said, we were wrong. It was the wrong design, wrong hormones, wrong women, all of these sorts of things. And so the conclusions should not be kind of extrapolated out as they have been. And unfortunately, that’s fallen on duff ears in many circles.
Wow, so much like I had an episode on cholesterol, which you guys speak about all the time too, and we really walked through the exact layout of which studies led to which conclusions. And we now know if you review the literature yourself, it’s pretty defendive like that intake of dietary cholesterol does not cause these things in the same exact way that you feel and know and sorry, let me not use the word feel. You know, the science points in one direction because the people who designed the studies themselves walked it back. They even themselves said this wasn’t true. Is this also related to the breast cancer piece of the and that was one of the conclusions from that, too.
Yes, and it was. Maria, do you want to kind of talk about the, you know, we’ve talked about estradiol or estrogen and progesterone, the hormones that were used were synthetic. One was conjugated from horse urines called cee. We know it as premarin now. And then we had a synthetic progesterone. And you would call that a progestogen is kind of a bucket term. So women, it’s important that they understand kind of what someone’s saying when they hear these things because it definitely sort of unmasks the speaker as to their bias or lack of understanding of things. So a progestogen is the bucket term. Within that, we have progestins, which are synthetic, and then we have progesterone, which is what our natural body makes. And unfortunately, they use a synthetic progestin in this study. And it is well known that progestins which girls is in your birth control pill, are endocrine disruptors. And what that means in terms of women’s health and breast cancer risk is that it actually alters the receptor for estradiol in the breast. And so what happens is then when progestins are used in an HRT formulation, even with a natural estrogen, whether the estrogen is safe or not, the progestin disrupts that receptor and can cause proliferative behavior by the estrodiol, meaning a lot.
Of tissue growth for estrogen dominant breast cancers, obviously.
Estrogen receptor dominant, yes, exactly. Yes. And so that is part of the issue is that we’ve drawn this global conclusion and we don’t bother to say that any progestin is an increased risk of breast cancer. We don’t say that. We just say HRT is dangerous. And we had yesterday, Maria and I had someone who said my mom had estrogen receptor positive breast cancer and so I will never, ever take estrogen. And yet I thought, well, have you had a baby? Yes. Well, if you had a baby, your estrodiol at some points were like thousands of times higher than it is under your everyday life and you came out of pregnancy without breast cancer. Estrogen in and of itself is not dangerous, right? We have to have an underlying environment that creates kind of a failure of apoptosis, cellular delt, DNA issues, et cetera. And that’s usually what comes into play with these progestins.
It has to be taken in the context of there’s no one singular thing that also causes cancer. That’s not how it works. But of course, if the environment is proliferative or supports proliferation, then introducing something can be dangerous. But the biggest problem with the kind of that working theory from what you’re saying is that it’s in a lot of birth controls and the birth controls never do you hear a discussion of birth control causing breast cancer and how quickly do we prescribe birth control? Like, how quickly are people getting those prescriptions and staying on it forever? Like you said, that’s the easiest way to kind of poke holes in that fun little argument is like, if your doctor is so against HRT, are they also against birth controls that contain the exact same chemical. And that’s the question offering it exactly.
Considered okay for women up to age 55 to use the birth control pill as a means of controlling symptoms as they are transitioning through menopause.
The worst advice.
That’s like an unbelievable thing to me, too, that you’re stopping natural hormone production in order to promote natural hormone production that doesn’t feel natural or right. So this is the kind of context of which we’re understanding. Again, let’s say people are living to I know the average lifespan is also decreasing every year horrible in the United States, but let’s say people are living to their seventy s. Eighty s. Ninety s and beyond from the age of 50 if women do not kind of go on hormone replacement therapy. This is a ridiculous question. Is there a percentage of people, you would say, who would feel as good without the hormones as they do with the hormones before they went through menopause? Ridiculous question, I understand that, but I’m just speculation.
Maybe there are maybe.
But here’s the thing, Michelle, a couple of thoughts on that. We tend to normalize negative kind of health downturns in our life. Like we put up with pain or headaches or aching shoulders because I’m 60.
Dry vaginas, totally dry vaginas. I mean, we’ve been told that’s normal, right? You just have less sex when you’re older because your vagina is dry.
And also the normalization of woman’s pain is also a bigger part of this conversation, too, obviously, and suffering.
Could there be women that feel okay with HRT? I’m going to say yes.
But I said one thing is we normalize. The second thing is you can feel okay, but you don’t see the degradation of a vascular endothelium or the thickening of your blood vessels, stiffening of your blood vessels, or your bones deteriorating.
I mean, we have someone right now who has got all the things, if you looked at them on the surface, right? Lean, active, lifts heavy weights, eats lots of protein, all the things, but has struggled from a hormonal standpoint for a long, long time because of just some bad care and compliance issues and whatnot. And it’s just been diagnosed osteopenic or osteoporotic. Maria, which one was it?
So that’s what Marie and I always try and get to women to say is like, it’s kind of irrelevant how you feel. The statistics are there. We lag men and cardiovascular disease issues until 55. Then we catch up and we match them.
It’s 50% after the age of 55, right. Or women.
And then you look at the number of prescriptions that your average 65 year old woman is on. It’s horrifying. Now tell me that’s health. That’s not health. And when a woman will be like, I breezed through it. We’re like, okay, A, how old are you? Because the vast majority will say that are like 58, 59, whatever. Talk to me when you’re 63. Because Maria and I have had the benefit of literally working with thousands of women. And I tell you, there is like a magic window between 60 and 65, just like there is between 40 and 45. In that perimenopausal transition, women feel like the rug gets pulled out from underneath them. Everything that they used to do doesn’t work. 60 to 65, they go, oh my God, how did I become so health challenged? And it’s very tragic because it doesn’t have to be that way. If we had the information, if we gave it to women at 40 and we followed them, monitored them, and made sure that we stayed in front of any hormone depletion, they wouldn’t be that statistic that we all know. And that is what’s so frustrating.
Yeah. And this conversation again, when I’m having it with clients, even on a discovery call, and they’ll say to me something know, Michelle, do I have to go on hormones? First of all, beginning of the conversation, they’re saying, I feel all these symptoms and it really changed for me during know what’s going on. And they’ll say, Do I have to go on hormones? And I’ll say, Listen, I’m a great dietitian, but I can take you to a point. But at some point you might need some sort of medical intervention. And that is like the reality. And it’s not like a harsh medical intervention. We’re not talking about surgery here or something like that, but from a functional nutrition perspective, I think people are always saying, are there natural solutions to all these things? But it’s like, honestly, evolutionarily, like, no, I can help you feel better symptom wise, obviously, in many ways. But at the core of the issue, we have a real problem, which is that we are living very long and accepting that we feel really not good during that time. And it’s like it’s a similar conversation with fertility. I have clients who functional dietitian, clients who work with women with fertility, you know, most of them and are friends with most of them. And they will say, like, listen, are there so many things we can do now because of modern medicine that we couldn’t do before in ways of, like, IVF and all these solutions that work for many women that are more targeted, precise and everything like that? Yes. Is there still an age limit on what our bodies do also? Yes, there is an age limit. And it’s like, sorry, there is a hard limit. There’s like some facts about biology that are just true, which is that women will reach menopause and they will not have those hormones anymore. And those hormones are really important to health. So that is the tougher conversation I have to have with people, which is like most of my clients are actually in their fifty s and sixty s. A vast majority of my clients are over the age of 50. But I have a split between half man, half woman. But I do have that conversation where I’m saying, listen, can I help you with your gut issues? Can I help you with all of this 100%? But I will tell you, there is a factual limit to feeling that 100%. Most people don’t need to feel 100%, but if they wanted to, which a lot of my clients ultimately want to, it’s just like there’s fact that you have to take into account, and I think I’m glad that you guys are also saying that over time, you’re liking these solutions a lot more too. And then I want to talk about that too. Tell me what you’ve been excited about in ways of scientific progress, in ways of the HRT that you I’m not going to use the word recommend, but that you acknowledge as being more safe or more helpful and healthful. I know you mentioned horse urine as being the component of the initial one. What do you like now? What are you excited about?
Before we get to that, can I just point out one thing? In the back of everything that you just said is something that I think women overlook, which is it’s not just our hormones. We cannot drink three glasses of wine after dinner, stay up late, eat crap food, fast extensively while working out extensively all of these things that if women are opposed to hormones, right, if they are saying, Michelle, I don’t want to do these or I’m scared of them, then say, okay, but are you willing to do all the other things?
Because that’s part of the vast majority of the picture. Hormones are just one piece of that puzzle, right? There are a ton of other pieces. So if women have any reluctance or concerns, it’s like, well, why don’t you then invest your time into deeply, intentionally dialing in every facet of your health. Then you can make the decision, right? Then you’ll feel less like there’s a gun pointed at your head. But too often, women are asking the hormone question with completely putting blinders on to their own contributions to their shitty health. And I’m sorry, you have to wake up and own it. And this is where Marie and I get really bitchy.
And I love that. And I love the word you used. I love it. I also will say that the funny part of that equation is that people do come to me for the personal accountability. They actually want to be more accountable for their health. And that is, like I said, I’m not quantifying, but like, jokingly quantifying. Let’s say speculatively quantifying. Let’s say I can take them 60% of the way, 70% of the way. The part that they should be more apprehensive about is their ability to make those 80% changes, not about taking the medication or something like that. It’s funny that that’s the thing that’s more risky when it’s the one that they’re not accountable for the piece that they are accountable for and they. Can take control of because it’s much bigger and grander and harder to accept. Again, most of my clients are amongst that are above the age of 50. Not all of them are on HRT. Some of them, like we said, feel amazing. But if it’s a question of do we think it’s necessary, no. But could it make you feel a lot better? Yes. Do we think the lifestyle piece is necessary? Yes, it is necessary to feel well. And again, the hormones are helpers for, like you’re saying, muscle building, cardiovascular health, all of these things, they are necessary and probably necessary, but not necessary. The reason I’m not using that word is because I know they’re not accessible for everyone. So I also want to say, like.
They’Re necessary but not essential. Right.
They’re necessary but not essential. Exactly. And there are many of my clients who, again, don’t take them and feel well, but I don’t know, they wouldn’t feel even better, or they wouldn’t have better bone health, or they wouldn’t have better muscle health, or they wouldn’t have better internal health.
As a result, the bottom falls out. This is why we’re kind of loud about this. In the beginning, there is a window of opportunity in which initiating hormone therapy will provide not just the best outcomes, but have the best situation. And the reason for that is because these things are happening in the background, whether you can feel them or not. So if you wait, let’s say, until you’re 67 and all of a sudden you go, oh my gosh, I want to start HRT, the reality is you may have some cardiovascular changes that then make that HRT a limited option for you. So that’s the only issue for us is that to make sure that women understand that there is a window of opportunity. Yes, dialing in your health is essential. Because just as when we’re in our 30s, if we’re smoking all the time, we’re putting ourselves at risk for blood clots right. And changes. So you don’t put hormones in an unhealthy body. So do all the hard work, but know whether or not this is something that’s within your reach. Because if it is, there is sort of this limited opportunity. We have a client who started in her 70s. She’s thriving, but she also was someone who went into it. Lean, always a good eater, not a drinker. She had so much going for her coming into that window. So anyway, that’s just the one thing I wanted to point out, because the work that you do is essential to every woman, regardless of where she is on her age thing. Because as she ages, the better her metabolic condition is, the less her symptoms are going to be. Right. And then the better any hormone choices would be. So anyway, now we can get to kind of maria, do you want to talk about the types of not so?
We really prefer transdermal estradiol there are some women that can do estrogen injections that can be an option. Not testosterone injections, though, okay. Because we’ve seen too many labs where women just the numbers are just way too high. It’s not physiologic, it’s just not normal. And then progesterone can be cream or can be oral. I would say we both like oral a little bit better, but cream is certainly doable. And I will also say this progesterone cream can be accessed. It’s like you don’t need a prescription, at least in the US.
Women shouldn’t play around with progesterone cream on their own, even.
Well, hormones are not a DIY. That’s what we always say. HRT is not a DIY. And too many women are doing that.
No, it’s a prescriptive medication. I mean, let’s be serious about this. Yes, exactly. What are the progesterone creams made of now? What are these? The transdermal estradiol too? Tell me.
All come from a specific plant compound called diogenin. And that is in, I believe it is in Mexican wild yam. And I think soy as well now, love it. You cannot eat yams and get progesterone.
No, it’s true.
It’s one specific component of it. Magnified. You’d need like how many sweet potatoes? Like millions. And your body break it down.
They can’t be the sweet potato that you’re finding in the produce section either.
Here’s a little bit of an interesting thing. If you eat soy, will you get some estrogen? Yes, but we don’t recommend that generally.
And this is actually the same conversation that always comes back with soy and breast cancer too. That was always the conversation because of the estrogenic effects, because of the similar receptor site. So that has always been the conversation.
And here’s why. It’s kind of a little bit of a problem. Some of the okay, let’s kind of throw in flax as well because that is also a pretty potent phytoestrogen. Again, if you are dead set, I’m not doing HRT.
Come hell or high water.
We can recommend several great supplements. We have a handful that are great that can kind of be a bit of a stand and doesn’t replace HRT at all. And you can do flax totally. However, we always like to say if you are doing HRT, don’t go crazy with the soy and the flax because it actually can be it’s real.
Yeah, it can occupy the receptor.
Which in some aspects might be considered good at certain receptor level in the breast, but it’s too much of an unknown. And for women taking HRT. It’s HRT. That’s it. It’s not all that other stuff as well.
I like that you’re saying that too, because for people to know A, there are some things that can make a modest improvement and again, no replacement in symptoms. If you’re having a modest improvement in estrogen or something, it doesn’t mean that you’re getting the benefits of the hormone itself. And that’s really important to say. I got your back. I know exactly what you’re saying. So again, I don’t want people to feel blocked out because the bigger part of the conversation that I want to get to is that it’s lovely for us to have this conversation. If people don’t have you both, the likelihood they’re going to get the right dose of HRT and that they’re going to get to the right doctor is freaking hard. It’s so low and it’s so behind the times. I know you both have created these pathways for people to get directly to where they need and how to learn about their own bodies, to advocate for themselves. That’s a lot of the work you do is education, advocacy, and that’s the absolute truth. How the heck do people even start this conversation with their Gynecologists or with their primary care doctors? How do we start the advocacy on an individual level? If let’s be real, they really can’t get to a compounding pharmacy or a doctor or something like that.
Yeah. There are other formulations like the patch, which is technically considered standard of care by various medical societies, is a fine stand in. It does deliver bioidentical estradiol, which is what we want. That’s the one thing I think we’ll just kind of side note is that we have various estrogens. There are three main ones estriol, estradiol and estrone. Estrone is primarily produced by the fat cells and it’s what we tend to have the most often as we age. Unfortunately, it doesn’t act the way we want it to. Estriol is primarily a hormone and estrogen of pregnancy, we’re all going to have some a little bit, but it also is not potent enough to trigger the bones and protect the heart and protect the brain and all these good things. So what we want is estradiol. Important for women to know because unfortunately there are some formulations that combine them or kind of subterfuge like this is estrogen when it’s estriol. So the estradiol patch is available to almost all women, I believe it’s Medicare, everything can get that oral prometrium. It’s a branded oral progesterone that’s bioidentical perfectly fine. So those are available to most people even if you don’t have insurance. GoodRx has phenomenal coupons. You can go during the pandemic, I was moving. I couldn’t get my prometrium. I was like, oh, crap. And I literally used my Good RX and it was like $12. So there is more accessibility than what women realize, I think maria and I have had the unbelievable good fortune to be approached by a book company. We’re publishing a book and we’re going to give women that A to Z, right. So that they can make that decision as to sort know what’s the whole spectrum of what’s available to me. And sadly, it’s going to start with, well, nothing or the birth control pill or an IUD or Pellets or something that’s very fashionable these days. And then it’s going to go into these bioidentical options that are more physiologic and sort of give women that sort of survey of the landscape so that they’re able to go and have that conversation with their doctors. Now, OBGYNs admit this is, again, not me and Maria Bean, conspiracy theorists. 74% of OBGYN say they never received any training and education on menopause. They don’t feel comfortable speaking about menopause to women as they age. So unfortunately, the one person that we’ve had some pretty intimate moments with in our lifetime as a doctor might not be the best person now. Some of them are. I moved across the country and went to see someone new, kind of just threw a dart at it, and she was 100% on board and super supportive and whatever. So they are out there. We don’t want to disparage doctors generally just know that they’re not necessarily getting the training. But antiaging doctors tend to be people who are more focused on this. I think some gerontology doctors are starting to come around. Ironically, my cardiologist was someone who was like, please go on hormones.
For your heart. So you start to kind of be a sleuth and interview providers around you and see who has the chops.
Women sleuth. It’s something women do. We sleuth. I mean, this is an absolute fact. Also, we were talking about the facts about men. This is a fact. Women know how to sleuth for sure. And I think what’s very painful and disheartening for me is not that doctors won’t prescribe the medications if they’re accessible in other ways. But when someone goes into a doctor’s office and says, I’m in pain and I’m uncomfortable, and the result is this thing causes breast cancer, it’s some of the most unusable information and invalidating response you can ever get. And that is what I think I want people to leave with this message of which is, don’t try to disprove or fight your doctor. You got to go a different route. I think that’s the real other way to say it is that doctors have belief systems built in. The most amazing doctors who are healers and are like, thank God for modern medicine. It’s not even a question. But some doctors, and what I’m hearing is 74% of doctors don’t feel they have education on menopause. And certainly the only thing they’re going to know is that HRT potentially is dangerous. That’s the only thing they’re going to have heard. So you don’t have to really prove that to that doctor. And I think every time we hear that, we lose hope. And I think hope is one of the most important factors in all of our health, for us to believe that we deserve to feel well and that we can feel well. So if you are hearing that message, I need you to hear the exact opposite message today, which is that no matter where you are at, you always can move the needle in one way or another and it might just not be the expected way that you thought you were going to go.
Maria has a favorite quote. Do you want to share that, Maria, about when you’re down on oh, doctors.
Are down on what they’re not up on.
Oh, I love that. Yeah, except that sentence that sounds like.
I’m bashing all doctors. That’s really not true.
It’s not? No. What that sentence means is ego. That just means that you have an ego problem. Because I love the, you know, the Dunning Kruger effect, which is like the two psychologists who did the study that says it’s basically like the audio slave zone. The more I see, the less I know. So basically when you start in your career, you have the highest level of confidence and the lowest level of competence. And then as time goes on, if you are like an awesome practitioner and I will talk to my friends all the time who’ve been dietitians 1020, 30, 40 years, and they’re like, do we know anything? I’m like, we don’t know anything anymore. That’s how you know. I think that’s the practitioner I want to go to who’s like, I don’t know. Let’s find out. That curiosity about things. But absolutely if you’re going to a practitioner who shoots something down instantly says there’s no science to support that, it’s like, first of all, there’s going to be some science to support everything. So that in and of itself is very closed minded and not helpful. We were ranting this morning, all three of us, about this study that came out in the Washington Post today. It’s September 14 that we’re recording. By the time this is released, it’ll be a little bit later. But about dietitians basically who are receiving money from literally big sugar. It’s the funniest thing that I can saying that phrase in seriousness and from other companies to say that aspartame is not actually dangerous to human health. And again, my biggest thing in all of this is what is the usable and helpful information that you’re taking away from an appointment from an education session? What I take from you both so much is that every single thing you say is hopeful but also factual. You’re not going to say, it’s okay. I’m so sorry you don’t feel well. It’s okay that you don’t feel well. Women just don’t feel well sometimes. You’re like, no, it’s not okay that you don’t feel well and it’s your responsibility to take care of it and take care of yourself.
Yeah, we like to use the word agency, too. It’s that women need agency over their health because nobody’s coming to save us. That’s kind of become a popular phrase lately, but it’s true. Nobody’s coming to save us. And we are tending to outlive the men.
By the way, men have their own hormonal changes and their own kind of coming into that hormonal decline in a state of cardiovascular disease and everything else, but we need to feel as though we can steer the ship in some way. And I think that’s, unfortunately, if you are in a doctor meeting in which the doctor of any stripe I don’t care if it’s in Ndmdod, do whatever DC, if they make you feel as though you are not in charge of your health, walk away.
Walk out of that damn office. That’s exactly.
What happened to both Marie. Marie. I mean, she got kind of over medicalized and treated when she was low in hormones. I got gaslit. I was living in Boston. I love my doctor to this day. She’s a wonderful, wonderful woman. She’s from India. She believed in Ayurveda, but she worked for Mass General.
You got to follow the rules of Mass General if you work for Mass General. Exactly.
And she’s flat. I knew something was wrong, and my mom went through menopause early at 32 because of surgery, and so I didn’t have a paradigm to help me understand what might be going on. And fun fact, my mom ended up with breast cancer at 40 without any hormones.
I didn’t know it was possible. I thought hormones were the only reason anyone developed cancer.
I know. So when I went to my doctor, I’m like, Something is wrong. We women, we know our bodies. We can gaslight ourselves plenty. But there becomes an inflection point where we know something is not right. And when you seek care for that and you are told nothing is wrong, this is normal, or you’re too young. I have harsh four letter words for that, like, literally, get the heck out of there.
Yeah, I feel that way, too. And I think what I need people to understand is even hearing that information after, just think of the hope of someone who’s been feeling like crap for five years to say, oh, my God, this might be what’s going on with me. It really has been since menopause. I have not felt well, wise and well. And to think that they have that hope and then that hope is squashed by a 1 minute appointment with a doctor, and they don’t keep seeking that is what just devastates me. I hate when people lose hope because I’m so confident that women, especially in this case, can feel better. You both have seen it thousands of times. And certainly, again, it’s a trialing process. It’s not a perfect science, and everyone’s bodies respond differently, and you know that. But to just lay down and accept illness is not something that I’m ever going to do. It’s not something either of you are going to do, and it’s certainly not something that we want for half of the population, half of their lives. That’s certainly not what we want for them. Absolutely. Yeah.
The proposition is long. That’s the biggest thing, ladies. It’s like, understand what you’re choosing, because that’s a long life of misery.
And until then, again, I think the lifestyle recommendations you would give people are the same that I would probably give people, like eating, especially for women, eating high quality protein. Shout out, of course, to Dr. Gabrielle Lyon, who says muscle is the organ of longevity. This is so critical. I know both of you believe so much in muscle mass as being healthful, not only for the lifespan, but the health span. More importantly.
Yeah, the biochemistry of muscle cannot be know. This is not about lowering yourself onto a toilet without a grab bar, ladies. This is about being able to combat an infection in your 70s. Right. That is what muscle really comes to help us with.
And we know one of the main. Exactly.
It’s also not about being skinny. I find I had to go through my own kind of early mid forty s, and something I probably grapple with occasionally now as well. I won’t be dishonest, but it’s about looking a certain way. Michelle, I know we didn’t even touch on this, but just as women’s bodies are changing and typically in their 40s, they’re just, like, clinging on to so many things. Like fasting and excess cardio or just.
Like or a number on the scale.
On a scale yourself in the gym. Or really just like trying to achieve a certain look. And we try to get women look.
Your values are your values, okay?
But we try to get them to look at the bigger picture. Isn’t it really about your health? Are you really going to care at 75 how flat your belly is? No.
And you know what, Maria, can I add to you saying that what I learned in my dietetics degree, one of the things I loved was that after a certain age, it’s actually more protective to be in the overweight category than it is to be in the normal weight category. By the way, this was like since I learned this like, what, twelve years ago or something like that, I at the time was like, Whoa. Because it was definitely a time where weight loss was king, for sure, and I was like, Whoa. And I’m assuming now, and reflecting on it, that it has to do with not having lost such severe muscle mass and everything like that over time, but the act of weight loss itself what did you say? And bone loss. Exactly. Bone loss, yeah, exactly. So for sure, especially if we’re talking about midlife women focusing on those last five to ten pounds might just be those five pounds might be protective, if anything.
Chinese medicine calls them money bags.
I love that they call it money.
Bags, and we tell that to women all the time. I’m like, I’m not getting rid of my money bags. Because we just had something where I mean, obviously we all just had the global pandemic, but I had a really strange thing happen in July where I got bit by a bug. Oh, no, I don’t even remember seeing the bug. It wasn’t a tick, and I just kind of wiped it off. I felt like a sting or a bite, whatever. Let it go. Well, within 24 hours, I had boils all the way down my leg out of here.
Kristen I didn’t know this happened. End.
Oh, my God. Really bad. And then within about 36 hours, I was systemically ill to the point where I’m like, Something is really wrong. So I ended up being on prednisone for a week. They were like, you’re having a severe allergic reaction to whatever toxin this bug had. Now it’s in your system. Now it’s turned bacterial. You could go septic. So I ended up three, four weeks. Maria right where I was sick. I mean, really sick. And this is where modern medicine we love you gave me the steroids, gave me antibiotics, whatever. And had I been at my leanest point with 3% body fat and everything else, I would not have fared as well, because those extra five to ten pounds actually help us modulate our inflammatory response, actually mobilize the cytokines that we need to fight infection. There’s so much going into our health that if we focus on aesthetics entirely, we will lose. And that is something that Maria and I are like. The scale should never be your measuring stick, ever.
Especially if you are losing weight rapidly from something like that. You want to have reserves. That’s why our body holds on to weight in the first place. We have to remember our initial evolutionary biological need, which is that we need to stay alive, and that’s a really important component, is body fat. And we also know that, lifespan wise, there’s a U shaped curve for the people who are in the largest bodies, and smallest bodies are at great risk. So it’s, again, focusing on just that little if you’re a person. Kristen who’s lean already, again, those five to ten pounds might be very protective for you in a situation like this. And I’m so glad you’re okay, and I’m so glad that you had your money bags to protect you. And I’m so glad. Exactly. I think that’s a really powerful message for women, too, who, again, who are spending their time chasing in the second half of their life where they’re like, maybe not even working. This is the cool half. This is the fun half. You don’t have to raise your babies, even though it’s a wonderful experience, I’m sure. But this is like a part of your life where you want to feel really good and experience everything. And the message is not to focus on those last 510 pounds. Even though both of you respect so much how important aesthetics are to people and everything like that, of course we.
Acknowledge we struggle with it. Marie and I are both incredibly blessed. We have men and who have been in our lives for 35, 40 years, and they still walk past us and pinch our asses at the same right?
And we’re like, don’t pinch my fat, or whatever. Leave it alone, or whatever. And I was just in Norway. We were in this sauna floating out in the middle of the Arctic Sea, and I’m in a bathing suit, and I’m like, oh, my God, I look horrible. Like, I was just upset with myself. I was getting my period, whatever. And my husband’s like, Babe, he’s like, I do you. And I really, at the end of the day, what matters is not this image in the mirror, but like, do you have people who love you whether it’s a spouse or not, right? Do you have good relationships? Do you have good health? Do you have community? Do you have all those things? That is what we should be focusing on as we age, because we’re starting to learn that’s a hell of a lot more impactful than whether or not we manage to only get 1400 calories today.
Exactly. I’ve never shared this before, I don’t think on any platform or with anyone before. But I had this friend who was not a friend anymore. I had a friend who was a trainer in the city, and he was completely unsolicited said to me, like, Michelle, are you happy with your diet? And I’m like, yeah, I’m good. He wasn’t training me either. He was like a random friend of mine. He’s like, Are you happy with your diet? And I’m like, Yep. I’m great on it. I’m a registered dietitian. I’m a functional dietitian, and I have my own Naturopathic doctor who works on my diet with me, and I have my own training coach. Like, what a weird question. And he was like, I just don’t think you’re eating enough protein, because do you like what you see when you look in the mirror? Is what this dude said to me. And I was like, first of all, he doesn’t know who he’s talking to. I was like, that’s cute that you have no idea who you’re talking to. But my response in my head was like, dude, not only do you not know who the fuck you’re talking to, but I lost 100 pounds ten years ago, right? At the time, it was like ten years ago, and now it’s like 15 years ago. But I was like, I lost 100 pounds. My body is not going to look like other people’s bodies at this point, and I’m totally cool with that. The fact that my body can do what it’s done and go through such transformation and end up where it is. I’m never going to look like a person who was a gymnast their whole lives and never carry it’s the same thing with women as they age. It’s not going to look the same. But I wouldn’t change an inch of myself because Michellehapiro and not even being Michellehapiro is a good or bad thing. But it’s just literally who I am. And that is literally the story that I tell. And I believe that our bodies tell the story of our lives. You have sons. Like, Maria has like a million sons who she has to cook like, 85 pounds of meat for every single day. I can’t even believe what goes on in that household, these bodies that have done these mountains. Can you hear?
Yeah, you were kind of going in and out a little bit. No, I was going to say to that. The other thing, too, is women. Because of the proliferation of social media, we’ve suddenly developed a universal standard, right, that women are trying to achieve. And there’s even times where Maria and I have to remind each other, I mean, we’re not short women. I’m five eight, Maria’s five seven.
I’m five nine, by the way, are we so tall?
I love fun together. But Maria’s Italian, I’m Scandinavian and German. We’re not going to have the same body structure. She is much more fine boned than I am. I’m a broad Viking. And what struck me was that we really do kind of forget those things, right? We forget our ethnicity, we forget our background, our genetics. I had a really tall dad and a really short mom, and she was squatting. Whatever. All of that is really shaping us more than we want to appreciate. And so constantly trying to put a square peg in a round hole is actually just going to amp up stress, which newsflash is going to prevent any weight loss. So we had this funny experience. I was in Norway for the last few weeks, and my husband and I are walking through the streets of Oslo and they had this really cool iron statue. Oslo is a very cool architectural city, and they have this iron statue. And my husband goes, oh my God, stop. And I said, what? And he’s like, Just stop. And he takes this picture and it’s this kind of OD, it’s this naked woman, and she’s holding a man by his neck. And the man is like this tall, and the woman is just massive. She’s like this Amazon. And it was a war memorial. It ended up being this kind of cool conceptual thing. But anyway, my husband takes this picture and he sends it to my boys, okay? He sends it by text message to my boys with no message. And I’m like, Why did you do that? And all of a sudden, my boys, all in their twenty s I love them to death, come back and say, oh my God, it’s mom.
And I was like horrified at first because this had like moderate, but on the small side, boobies, broad shoulders, very straight hips, a massive ass, and big thighs. And so it was very obvious. And my sons were like, it’s mom. You can tell she’s Norwegian. I’m like, okay.
I love your Viking spirit. I love that. And Viking body. Exactly, yes.
It was a reminder to me, though. It’s like, Ladies, be who you are. We are all unique and individual. Stop supplanting that universal image of this lean aesthetic from social media onto your own mere reflection. That is not it. Again, go back to, are you happy? Do you have a good faith background? Do you have community? Do you have your health? Do you have great dogs and kids and spouses or partners or friends or whatever that ultimately please just value that as you age. This other stuff is kind of gravy, and if it bothers you, that’s fine. But you have to play an active role in accepting kind of who you are, what you’re bringing into this fifth decade of life, and then kind of what’s within your power and then work with it.
But really, the point of the hormones and the point of all this is only to enjoy those foundational pieces anyway. The point is not to, again, push an aesthetic or anything like that. The goal is to take you closer to the things that you love. It’s all for the same reason, for us to be healthy and happy. That’s all for the same that I don’t even want to touch. Yes, I’m putting a pin because that’s exactly where I want people to. I want them to take that exact message with them as they leave. I want women to take that exact message as they leave. Kristen and Maria, I can never thank you. I threw out different parts of the conversation was getting overly jazzed, and you let me go there and I came up and down with you and we all went together on this ride. Where can people find you? Even though I’m sure they’re probably following you already because you’re like, literally the best and everyone already knows about you. But where can people find you, work with you, learn from you?
So wise and well is our Instagram and then our website is Wiseandwell Me.
I’m going to put the link too.
Yeah, in our Instagram bio, too. We do have an online free community for women. It’s just instagram, self limiting and how much we can kind of provide in terms of information and education. So we do have something within something called Mighty Networks, Facebook, very noise free, et cetera. But it’s just kind of a nice space for Maria and I to be offering more long form content to women. So we’d say, if you’re interested, go ahead and there you can ask us questions on the post.
Oh, they’re interested.
I have a book coming out in end of 2024.
Yeah. Fall of 2024, I think. In time for Menopause Awareness Month.
Next Doctor, I’m going to be running around from different bookstores, like, pointing at it, be like, this is my friend’s book. Read it. I’m very excited. Thank you both so much.
Yeah, I was going to say, you got quite the cash, but I love.
Your book the most. Okay. And I mean that.
We have no money to give you. Michelle exactly.
Thank you both so much. And I know we’ll have further conversations and everything, and I hope everyone will check you out. I don’t have to tell them that. They already will. Thank you.
Thank you very much. Thank you.