Everything You’ve Been Told About Menopause Is Wrong

[0:00] All right, Kathy. I’m going to explain menopause. Oh, this should go well. All right, I’ve done some research and Stop. Stop. Stop. I already know this is going to end with you saying something wrong. So, I’ll take it from here. We don’t need mansplaining about menopause. I can tell you that mansplaining is when — what — Stopping. You’re stopping. Okay. So, in menopause, perimenopause, for a lot of women, it seems like the body suddenly flips a few switches. Sleep changes, joints hurt, workouts feel harder, and you’re randomly overheating

[0:30] like someone turned on a space heater inside your body. And then 5 minutes later, you’re freezing. So, you’re asking yourself, am I sick? Am I dying? Or is this just perimenopause? And historically, the medical system’s response has basically been, well, that’s menopause. Anyway, see you next year. So, today we brought in someone who spends her entire career helping women navigate exactly this. That’s right. Today, we’re talking menopause, hormones, gynecology, and

[1:00] what actually works with Jessica Bell, who’s a physician assistant with Samaritan Health and has just started her own business in addition to an already full-time job. Okay, Kathy, this is the part where I say this. Yeah. No. Let’s get started. This is the PTCH. What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast? But chiropractors and physical therapists don’t like each other. Oh, think again. I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get stronger. I’m Dr.

[1:30] Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Welcome to the PTCH Podcast. Remember, there’s no I in PTCH. Okay, welcome back. This is the PTCH Podcast. I’m Dr. Jason Young. And I’m Dr. Kathy Lynch. And this is our special guest who we’re going to get to in just a second, but I have to do a little bragging about the podcast. Did you know that this is our last episode? This is it. Yes. This is our last

[2:00] episode of the year because after this, we — we’re — we’re going on to a little bit of a 1-year celebration. We’ve been doing this for a full year. It’s crazy. Yeah. We now — oh, thank you. Thank you. Hey, hey, every — hey, everybody shut up. Shut up. I’m trying to — I’m trying to get to my part. Hey, trying to get to my part. So, we have thousands — thousands of followers and just more than we ever would have imagined. We were — we were originally

[2:30] projected at being at dozens at this point. And I guess technically we do, we just — many, many dozens. So, thank you to everybody who subscribed. If you’re hearing this for the first time and you don’t want to be some sort of a loser anymore, just go ahead, hit the subscribe button. You could be one of the PTCHes and you can join along with the show. So, I just want to throw that out there really quickly because so excited to get to our guest. So, take it away, Kathy. Tell us who we have here. Oh, well, I’m just — just super lucky to call Jessica a friend. Does she call

[3:01] you a friend, too? Well, mostly. Yeah. Yeah. Those are the best kind. It’s mutual. It is mutual. Okay, but she — let me get to the real deal about Jessica. So, she’s a board-certified physician assistant licensed in Oregon, specializing in perimenopause, menopause, and sexual medicine. And she holds certifications — this is the important part — as a Menopause Society Certified Practitioner. Woo, that’s a mouthful. It is. It is. But there — but you need to —

[3:33] when you’re asking questions about menopause to your health care provider, make sure they’re certified. Oh, yeah. Yes. And she’s also a fellow of the International Society for the Study of Women’s Sexual Health, otherwise called ISSWSH. ISSWSH. Yeah. ISSWSH. Do you have to yell Kobe before you say ISSWSH? Kobe, ISSWSH. She’s a local provider at Samaritan Health Services in town, but also what’s very exciting is she just opened up her own

[4:03] online telehealth medicine. What? Would you say it’s not a clinic, but it’s online? Yeah. Yeah, service. Yes, it’s a service. Yeah, called GynJess, so G-Y-N-J-e-s-s, G-Y-N-J-E-S-S. Going to talk about this. Okay, cool. Awesome. Love it. Yeah. Yeah. So, welcome, Jessica. Yes, welcome. Thank you so much. So happy to be here. She’s the final compadre of the Novo Collective. Collective. Now collected the entire collective.

[4:33] Oh my goodness. Well, these are always great episodes. No pressure. No, this one’s — Jessica’s going to knock it out of the park. It’s going to be — you know what I’m impressed by? We have managed to lure so many experts. And you just — you kind of feel a little bad for them because they’re like, hmm, okay. I want to be here. Yeah, good. But we’re so glad that you’re here. So glad that you’re here. Can you just kind of tell us — this is usually my first question — about your journey to get to where you are right

[5:03] now in your career? Absolutely. Patients, really, truly. So, when I started in gynecology 10 years ago, I had patients coming to me that had this constellation of symptoms that I now know were perimenopausal. I would admit that I did not necessarily back then. And they really inspired me to dig into this education. So, that’s when I went to my first Menopause Society conference, and then I went to my ISSWSH conference, and now I’m

[5:33] certified. So, honestly, just inspired by patients and their needs, I would say, from clinicians — and I’m just somebody that then digs in to get the answer, yeah, if I don’t have it. So. What is it — what’s it take to get that certification? So, to be a Menopause Society Certified Practitioner, I mean, basically what that means, I would say, is I spend all of my time listening to podcasts. I’m serious — about perimenopause and menopause.

[6:04] Legit, though. Reading books about perimenopause and menopause, reading all of the studies. My friends sometimes challenge me to read something that’s not about perimenopause and menopause. So, that’s the life of an MSCP. And then the certification itself — You’re like, this — this book is called Hop on Pop. You’re going to enjoy it. You’re going to enjoy it. Yeah. Yeah, this is — this Dr. Seuss isn’t a real doctor. Yeah. No. No. Give me the menopause books, the

[6:35] perimenopause books, the sex med books, the history of this stuff books. Yeah. And the podcasts about them. But to be an MSCP, I had to go to a lot of conferences. So, it’s a lot of continuing medical education. And then a pretty difficult test, too, that I had to pass. So, yeah. We’re establishing you as the expert. Jessica: Well, thank you. I do feel expert at this time. Jason: Quick question. I think is she the first physician’s assistant that we’ve had on the show? Okay, so we have to talk a little bit about

[7:05] a little bit about that, cuz I’m sure that there’s people that have questions about what a physician’s assistant is and how is that different — like, is it the same thing as a doctor? Okay. So, break it down for us. Jessica: Yeah, yeah. So, we are now called physician associates. So, yeah, physician assistant — Jason: have to change the initials from PA. Okay, cool. Jessica: I think that was purposeful. But so, a physician associate or a PA works very independently, as my work similar to

[7:35] an MD or a DO. So, I see independent patients. In the past, we used to have a supervising physician. Now, it’s a collaborative agreement is what we have. So, there’s some limited scope of practice for PAs, but I can do all of the things that I want to do. Jason: Yes. And yeah, I also work in the operating room. So, I would say that’s a space where my role is definitely as a PA. So, the physician in the operating

[8:05] room is the primary surgeon and I’m the first assistant in there. So, that’s another way of we’re different, but Jason: Cool. That’s really good cuz I think that there’s a lot of people who maybe didn’t understand the distinction. I know I refer back and forth with a lot of PAs and they’re really good. Jessica: Yeah. I would say sometimes people might not even know that their doctor, quote unquote, is a PA. Jason: Yes. And anytime somebody tries to call me Dr. Bell, I will say — I always correct them. I say, I’m just Jessica. Yeah.

[8:35] Jason: go to school that long. I get a lot of referrals from one and they’re like, “Oh, Dr. So-and-so,” and I just quit correcting them. I’m like, that is up to her if she wants to correct them. Jessica: Yeah. If they — I correct them like one, two, three times, and then after that, no. Then you’re just rude for correcting me. Jason: Yeah. But cool, thank you for explaining that. Yeah, and different than medical assistant. I think that that’s one of the things and that’s one of the reasons why we changed the name to associate. So, sometimes when I say that I’m a physician assistant, people think that

[9:06] I’m a medical assistant and that’s definitely a different scope of practice. Yes, we love you, medical assistants. Yes, we do. Oh my gosh, my medical assistant is the best in the world. Shout out. Shout out. Jason: She’s now been on a podcast. Jessica: Yeah, I know. Jason: Yeah, because PAs can order imaging, you can prescribe meds, you can do a lot of the things that physicians do. Jessica: Yeah. And there are a lot of times the last person in the surgery room closing

[9:36] things up. Jason: You’re kind of doing the clean-up work. Jessica: Yep, we do a lot. Yes. Jason: Yes, and that’s why I’m not a PA. Jessica: Yeah. Jason: Yeah. And there’s reasons why PAs aren’t doctors. Jessica: Yes. Yeah. Yes, so. There is that. Okay, so we kind of started to talk about why menopause. Jessica: Mhm. So, when did you start to see the shift into

[10:07] Actually, you know what? Let’s go back to why have we not learned about menopause up until this point, really? I mean, if I remember correctly, I feel like you told me in the past that we really didn’t start researching menopause till the ’90s. Jessica: Mhm. Is that — was that — am I remembering that? I think probably what we talked about is that we did not include women in randomized controlled trials. We also didn’t identify the full anatomy of the clitoris until the ’80s.

[10:37] 1980s? Jessica: Uh-huh. Yeah. And so, I would say one of the reasons why I think in medical training there has not been a focus on menopause or perimenopause is that we as a society are very focused on fertility. Jason: Yeah. Jessica: and reproduction. And so, generally the OBGYNs have been — most of their training, I would say, is often obstetric, and I think that that also relates to why we also don’t study things like endometriosis,

[11:07] you know, period syndromes and adenomyosis — those kinds of things. We’re definitely behind, I would say, in regards to emphasizing the importance of general gynecology and hormone health throughout the lifetime. I often say it just because you have a uterus does not mean you’re going to ever make a baby in it or want to. Jason: Right. Yeah. And nor do you have to. Well, and some uteruses have different ideas about that. They do. So true. Jessica: Yeah, they definitely do. Yeah, but right.

[11:37] Like, you might want one, but nah. Yeah. Yeah, we’re not doing that. Yeah. So, I have a question. So, is that just in the US there hasn’t been much research or is it worldwide, or are there some areas that may be ahead of the curve on this? Jessica: It’s pretty much worldwide, honestly. It was in Australia — Women were a pretty recent invention. Yeah, Jason: right. You know, like I think it was — what — like Jane Austen, didn’t she invent women when she wrote that book? Yeah. That checks out.

[12:07] Yeah. Goodness gracious. No, I think it’s similar everywhere. Okay. Yeah. Yeah. Well, that sucks. I know. Yeah. Totally. We’re all behind. Uh-huh, yeah. Yeah. Can we talk about the study? Yes. Yes. The study that — Jessica: The study. The study — I haven’t read the study. that got us off on the wrong foot with hormones. Jessica: Okay, yeah. Hormone replacement. Jason: Yeah, the Women’s Health Initiative study, which came out in 2002. Yes.

[12:38] It sought to determine if hormone therapy would be preventative in regards to cardiovascular disease, osteoporosis. But one of the issues was — the average age of people in the study was 63 years old. We haven’t gotten around to this yet, but the average age of menopause is 51. And so, when they’re doing a study regarding prevention, just the design from the start was not set up to look at

[13:08] prevention. If you want to look at prevention, then you should be studying people before menopause. So, you want to study the ship while the ship is still in port not after it’s sailed and it’s just disappearing over the horizon. Perfect analogy. Okay, got you. Yeah, all right. So, I’m following. Yeah. So, there was some study design errors. It had a lot of people in it, so I can’t say that it was a bad study necessarily, but for one thing, it also was not asking the questions that we’re asking

[13:38] now and it was not using the medications that we typically use now. So, different age range of people that we’re curious about, different chemistries, and what happened was the study was stopped because the estrogen-progestin wing had a non-statistically significant increased risk of breast cancer. Mhm. The estrogen-only wing had a decreased risk of breast cancer. Mhm. But that’s also a curious thing. We often say in our conferences and whatnot that there’s no other studies that have been stopped for a

[14:09] non-statistical significance. So, the WHI, I think, is the only one that was stopped for that. Mhm. Okay. Yeah. You know what? We forgot to just define what menopause is. Yeah. Oh, let’s start from the beginning. Let’s go. Okay, shall I? I defer to you. All right. Well, so menopause is 12 months without a menstrual cycle. Average age of menopause is 51 years old, but 45 would not be considered

[14:40] premature. So, some people will have their last menstrual cycle at 45, which is much younger, I would say, than most people think. And I’m sure we’re going to talk about perimenopause today, which is — you make it sound so exciting. It’s exciting! Very menopause. Let’s go. Hey, ladies. Hey, ladies. You want to know what’s coming? Can I interest you in perimenopause? So, somebody coined the term “cougar puberty.” Oh, yes. Talk about a party.

[15:14] I’m laughing about menopause. Yes. Yes, here we are. Here I am. Welcome to the party. But yeah, perimenopause — 10 years before that last menstrual cycle — and that really is the volatile, erratic hormonal roller coaster that I think we are all excited about, because we’re actually acknowledging and honoring it as an experience for people. I would say 10 years ago when I got into this space, I remember women coming to my office

[15:46] with severe perimenopausal symptoms, severe mood changes, and at that time we were still taught to really not have a conversation with people until it had been a full 12 months without their menstrual cycle. Wow. You know, so I just think — yeah. Yeah. Like, let’s keep this a secret. Yeah. And it’s a surprise. They’re going to love it. I have no idea what you’re talking about. They’re going to love it. Yeah, right. In the past, we used to just tell people, you know, get through that 7 to 10 years of volatile, erratic hormonal roller coaster and then let us know how it feels once it’s been 12

[16:18] months without a cycle and then we’ll see how you’re doing then. Right. Which negates like age 35 to 45, which is also, I have to say, for some women, a very important time in their life when it comes to maybe career or family and other relationships. So, not the time to be experiencing a volatile, erratic hormonal roller coaster. Just grind it out for 7 or 8 years. You’ll be good. You got to do this. I was going to say “volcanic” and it’s like — I mean, this

[16:49] isn’t just good for women, it’s good for everybody, because have you ever stood next to a volcano? Yeah. Yeah, not a lot of people who are alive have. And that’s all I’m going to say. Yeah. That’s it. Well, I mean, it’s no joke. Yeah. It’s no joke. These big hormonal changes do impact people in various significant ways. So, and we can help them. Yeah, let’s get into that. Let’s get into, you know, what symptoms are of perimenopause. Mhm. Yeah, so I would say

[17:20] mood changes. Yeah. And I should — we should preface this with: this is going to be a revelation to somebody listening. You’re going to listen and you’re going to be like, holy crap, that’s what it is, you know? That’s what I’m going through. Listen up. Listen up. So, I’m sorry. So, mood changes. I know, and that’s why I say it that way, because I have to admit even in my late 30s — this is something I study — I don’t think I realized how perimenopausal I was until I

[17:50] realized I was perimenopausal. And the mood changes that happen for women in their late 30s — the irritation, agitation, pressure-cooker feeling, short fuse, the sense that they rationalize that they’re not rational — is really significant. So, that’s the big thing. And yes, I’m very excited for that person that’s listening right now that is feeling validated in their experience. It’s also true — I often say — like, I mean, the world is happening always to us and stress is happening,

[18:22] but through these hormonal fluctuations, what occurs is it makes it more difficult to navigate those life stressors because hormones are just on their wild roller coaster. So, mood changes, definitely. Hot flashes, night sweats, sleep disturbances — there’s kind of a classic waking up at 2:00 or 3:00 a.m. that happens for people. Brain fog, difficulty finding words, difficulty multitasking, people are reporting a new onset or worsening of ADHD symptoms, musculoskeletal

[18:54] symptoms — perimenopausal — joint pain, absolutely. Andropause is a thing. Hip pain, hip pain. That person listening right now. Yes. The hip pain that happens at night is oftentimes related to hormonal fluctuations, skin changes — people will notice dry skin all over. Oh, and then irregular menstrual cycles, Mhm. also. Well, and that’s typically the only thing that people think about. Oh, my cycle’s changing.

[19:25] Yes. Right? But it’s like — but there’s all that other stuff. All of those things that I just listed can be happening while having a regular menstrual cycle. So, you’re still having a regular cycle. You don’t even — I didn’t know I was going through perimenopause till now, and then I look back — I mean, I was at night sweating through my clothes, Mhm. waking up at 2:00 or 3:00 and having to change my entire outfit

Kathy: Yeah, and go back to sleep. And I didn’t — it was like, I don’t know what’s happening. Why is the difficulty level turned up to 11 on this?

[19:55] Yeah. Yeah, jeez Louise. Yeah. And it’s intense. Kathy: Quite the list. Yeah, intense, volatile. Very Jason: Kathy: Yeah. Yeah, so that’s if you’re experiencing these things and you’re in your 30s and 40s, it’s perimenopause. Mhm. Don’t be in denial. And one of the things I like to point out too is that again not all of us get this training or education. So one of the places where a lot of people

[20:25] are left untreated or their symptoms are left unheard is in the context of this constellation of symptoms but irregular menstrual cycle. So this is the scenario where they go to their PCP or honestly even their general gynecologist and they tell them all of these things and they say, “Well, how’s your bleed?” And they say, “Well, it’s regular.” Okay, well then it must be something else. Come talk to me in a year. Yeah. Yes. Figure it out. So you’ve said it twice now. You say constellation of symptoms. And when I was getting my

[20:56] education, I learned that a constellation of symptoms is also another name for a syndrome. So would you call it like perimenopause syndrome? Yeah. Are we calling it that? I don’t know. Perimenopause and menopause. Yeah. Yeah. Yeah. I don’t know. We could. But I don’t know why that’s important to me, but that’s that’s just sense to me too. Mhm. But maybe it’s not a syndrome because we all go through it. All women go through it. I don’t know. I don’t know either. At the definition. Either. Right, if it’s not in the

[21:27] literature, get publishing. There you go. Get publishing. Yeah. Yeah. That’s right. What do — what most commonly — what do patients come to you and ask? Mhm. When they’re going through these kinds of things? I think the most common question is is it too early? Yeah. Dude, yeah, that’s the question I get all the time. Is it too early? Yeah. They’re 37 and they have like checked every box of the list that I just said, but their cycle is regular and I’m like, “Babe, no, it’s not too

[21:58] early.” Does anybody ask if it’s too late? And yeah, they do. Yeah, that’s the lady on Titanic. It was 81 years ago. Is it too late for — Oh, that’s happening all the time right now. Oh yeah, there’s big conversations about perimenopause and menopause. And so a lot of the women that were caught in the Women’s Health Initiative study felt left out as an option. And so I do have people that are maybe past — well, past an age where they would

[22:29] find a lot of preventive benefit from the medication. But they might still find symptomatic benefit and then we get to have a conversation regarding risk-benefit ratio, because sometimes there can be clotting risk associated with starting hormone therapy at a more advanced age, I would say. So, hormone therapy — can you explain that? Is that just a fancy name for taking some estrogen? Or like what what’s involved in hormone therapy?

[23:00] Well, hormone therapy could be a lot of different things. Birth control I suppose could be considered hormone therapy. Probably right now the conversations around hormone therapy that we’re hearing is regarding the body-similar or bioidentical forms of hormones. So estrogen and progesterone, and then testosterone is also a hormone that we’re using for menopausal — Becoming more popular, I hear. Like I’m actually kind of surprised at the number

[23:31] of patients that come in and they’re like, “I’m taking testosterone.” And it’s like, “Are you trying to transition?” No, it’s like it’s because I’m perimenopausal, so — Absolutely. Yeah. Yeah, testosterone declines in women just like it does in men. Did you know that a 60-year-old man has more estrogen than a 60-year-old woman does? I did not. I did not. I call 60-year-old men boys. Hormones aren’t gender, right?

[24:01] Yeah, so I think that that’s a bit of — yeah, oftentimes a misnomer that testosterone is for males and not for women. But testosterone declines in women too and can contribute to decreased energy, decreased exercise tolerance, stamina, decreased libido. We’re starting to study the benefit of testosterone in regards to muscle mass and muscle wasting, which happens. We know that estrogen helps prevent osteoporosis in the future. And so we

[24:32] definitely hypothesize that testosterone can help with muscle wasting, similar to in male-bodied people too who use testosterone for health measures, you know. So yeah, women are finding they can do the same thing. I had a patient tell me, “You got to get on the T, doc.” It’s like, okay. Are you — I’m sorry, what? I don’t even know, but like this guy was and he’s like, “Yeah, you got to get on the T.” Oh. And I’m like, I’m — Well, the thing is his voice is normally like this, but when he says it, “You got to get on the

[25:02] Yeah. Yeah, doc. Yeah, yeah. Yeah, it’s like, “Oh my gosh.” So — Well, can I ask one more question? Because I — Yeah, ask all the questions. Inquiring minds. Since it’s just popping in my head. So We live in a crazy world because of social media. Mhm. And there’s like lots of influencers out there and people who think that they have education about this and maybe they don’t have much, but what they really have education in is a supplement that they want to sell or something like that. So can you comment on

[25:34] some of the relative dangers of working with somebody who thinks that they understand balancing female hormones — or anybody’s hormones — and they don’t know what they’re talking about. Yeah. What are the dangers? Yeah. Well, that is a scary space, I would say. Not everybody has the education — the Menopause Society certified practitioner education — to be evaluating

[26:04] and prescribing the right treatment recommendations. So I would look into their credentials, you know. Nowadays, you can Google the person and find out about them before you trust them with your health and your hormones. Please. And I think we’re saying that it almost doesn’t matter what the letters — what the first letters behind somebody’s name are, right? Absolutely. MD, DO, DC,

[26:34] DMD. If you’re talking to your dentist about balancing your hormones, I don’t know. Yeah. But yeah, it’s pretty specialized, especially since — I was shocked to learn that the research is also young. It’s so young. Unfortunately, there’s a lot of profit over patients in this space right now too. Yeah. And yeah, I mean, excellent clinicians that are board certified can sometimes find themselves

[27:05] maybe in that trap, or whatever that is, the profit over patients trap. And I think sometimes providers promote supplements or treatments that aren’t necessarily evidence-based. And they might say to that, “Well, it’s not harmful.” And that might be true, but I consider economics. It’s not hurting me. Yeah. Or yeah, a certain therapy that doesn’t cause a true medical harm, but we don’t have the data that says it causes a true

[27:37] benefit. Then what I say to that is, when I consider the risk benefit ratio, I also consider somebody’s pocketbook. I consider their economics. Like, that’s important to me. So, let’s go back to the study, the Women’s Health Initiative. So, 2002, okay. Jessica kind of alluded to it that they actually stopped the study because what their conclusion was — and we know now that it was a faulty conclusion — was that hormone therapy caused breast cancer, basically. And

[28:07] that’s where everything stopped and that’s where the press kind of stopped too, and they ran with it. Correct. And that scared doctors into not using hormone therapy for people in perimenopause and menopause. Correct, yeah. Yeah. Yeah, the study — I mean, the whole world had a hot flash. Everybody stopped their hormone therapy at once, and it’s taken years and years for providers to feel confident prescribing the medication again. And it’s also so interesting because it’s

[28:38] not even apples to apples. I will often use analogies in my visits. So sometimes I’m like, “Fruit: apple, banana, kiwi. You’re all fruit. They’re not the same thing.” Estrogen — yeah. High dose synthetic estrogen in birth control pills, not the same as the estrogen we get from horses, not the same as the body-similar estrogen that we are using nowadays. Not the same as soy. No. And that really is important because the chemistry, the molecule, is totally different, and I really geek out on mechanism of action and chemistry.

[29:09] And so, yeah, that is a big issue. I would say with leaning on the WHI to direct our treatment recommendations, or to state fear based around it, is that we’re not talking apples to apples. We’re talking about body-similar medications now. And it is important to consider those in perimenopause in particular. Again, that is that 7 to 10 years before the last menstrual cycle that is very volatile

[29:39] and erratic, and the time I would say when people need hormonal support more than ever. I mean, they likely need it post-menopause, but before, too. And so, in that study, they were using synthetic — yes, correct. They were using conjugated equine estrogen, which we get from pregnant mare urine. And then synthetic progestogen. Yes. So it wasn’t bioidentical, so it was definitely different. Yeah, right.

[30:10] Well, yeah, and that’s also why sometimes there’s conversations around the word bioidentical with the hormones that we’re using. I tend to use body-similar, because it’s still made in a lab. But, well, and we should clarify that natural does not automatically equal safe. Just the same as — natural things like arsenic, mhm, and, you know, brown recluse bites — yes — those aren’t safe. Correct. Right?

[30:41] They’re not safe. Yes, exactly. Exactly. So, it’s natural to go through perimenopause and menopause, and you don’t have to suffer. Okay, let me ask you this. So, uh, let’s see, who was it? Oh, jeez, who was the Thigh Master lady? Suzanne Somers? Suzanne Somers. Yeah. Okay, talk to me about Suzanne Somers. And you know what I’m — ‘cause Suzanne Somers was really big about — what was it? Like,

[31:11] was it keeping your period your whole life, or stopping your period? I can’t remember what it was. Yeah, she was out there biohacking before it was cool. And like, should that be the goal? I think it was that she was like, yeah, you should keep your period your whole life. So, I think some people are trying to research how to not go through menopause. Yes, that’s what it was, yeah. Yeah. How — well, how to not age? I’m trying to research that. It’s basically you just take a Thigh Master,

[31:42] and that’s it. Yeah, mhm. Goodness gracious. So, would there be an advantage to that? I think that opens up a lot of questions. Okay, yeah. Because if we all of a sudden don’t age — yeah. Yeah. Yeah, that’s a scary prospect, right? Are we going to live forever? Okay, so, when someone comes in with these kind of symptoms — mhm —

[32:13] well, take me through that. If I came in and said, I got all these things. I check all the boxes. So, the first thing is I listen to you. Mhm. And I believe you. Mhm. I say it like that. That’s a good one. Yeah. I know. Well, it’s funny when I hear people talk about our encounters together. One of the things they’re always so surprised at is that I listened and I believed them. And it is surprising to me that that’s not how every encounter with a clinician is. Disappointing. Yeah. Yeah. Honestly, I start the visit by

[32:44] saying, you know, there’s a story that brought you into this conversation, and I’d love to take a minute to just listen to your story to start. And then I, you know, can ask my questions, kind of thing. But, yeah, this is very much a pretty significant lived experience for people, so I’d like to give them the space to just tell me what they’ve been through, and then, you know, I ask all my questions, all my history questions, and then we talk about options. Sometimes I might do

[33:14] some risk stratification, depending on what the treatment option is. And then, yeah, we initiate treatment, make sure that I have a 3-month follow-up typically scheduled with them. You always want to follow up with your people and make sure that things are going well. Yeah, so, say someone has a regular, you know, cycle, but they have all these symptoms. Are they a candidate for hormone therapy? Absolutely. And it does not need to be birth control pills. Yeah. That’s another thing that happens. A lot of the times a person, you know, they’re 38,

[33:46] they have all of these symptoms, they’re still having a cycle, and they might be offered a birth control pill, which is an option, particularly if their cycle is getting difficult for them. But, one of the things I am — I am the gynecologist that honors that for some people birth control can cause mood changes. It can also decrease libido by mechanism of action. We see that. And so, for some people it can also contribute to some weight concerns. And oftentimes, when we’re coming in

[34:17] with these symptoms, we don’t need mood changes, decreased libido, or new weight concerns. And so, birth control pill is usually not my first option. So, I usually go with a bioidentical estrogen patch, and then the bioidentical progesterone if they’ve got a uterus. I do always start with a patch now, a transdermal route of administration, to make sure that we are decreasing any risk of clot. Transdermal estrogen

[34:49] does not increase clot above baseline. So, if a person had a history of clotting disorder or history of clot, they could use that medication. And that’s the main advantage of the patch. Jason: Mhm, correct. It’s a patch, actually. Kathy: I get that question a lot. Yeah, it’s — yeah, well, a lot is relative. Jason: Yeah. Yeah, but I do hear that question. Why are they doing everything with patches and creams and stuff like that? So, transdermal is a bit safer. Kathy: Yeah, oral estrogen has to be processed by the liver and the stomach first. It has the first-pass effect. So, it can increase clotting risk slightly above

[35:19] baseline. So, the transdermal routes are nice. They provide really steady-state release of medication, absorbed in the body most naturally. One of the things we’re starting to maybe consider more, too, is a lot of people are starting to take GLPs, which can cause some slowing of the gut. So, we are starting to ask the question if our people that are using hormone therapy and are on GLPs, and it’s oral, is there some kind of

[35:49] getting eaten up and are they not getting the — yeah, the results they could get from the medication. So. And also explain to our listeners, too, why you have to pair estrogen and progesterone. Kathy: Oh, yeah. So, a person with a uterus needs to use estrogen and progesterone for what we call endometrial protection. So, if you use estrogen only and you have a uterus, the endometrial lining can thicken inside of the uterus, which can cause concern. And so, you have to use

[36:19] both. Or have an IUD. An IUD is a good option as well for endometrial protection. Honestly, IUDs are amazing tools in the perimenopause landscape because they treat the intolerable bleeding pattern, they serve as endometrial protection, protect against endometrial cancer in the future, provide contraception if needed. And you can still use your oral progesterone. That’s another little pearl today. Jason: Okay. Not even a lot of clinicians know this, but you can use an estrogen patch, have an IUD, and you can still

[36:51] use that oral progesterone nightly, which can help with sleep, mood, and hair thinning, people think, too. Interesting. I’ve seen this with a lot of social media influencers, you know, encouraging people to go get their estrogen tested. Can you talk about that? Kathy: Yeah. Yeah. Yeah. Yeah. Another misconception. Yeah. Well, again, there’s just a — there’s a big profit margin

[37:23] in perimenopause and menopause, and I think some really well-intentioned people are making profit off of that. So, right now, our data does not recommend checking estradiol levels because it is this volatile, erratic hormonal roller coaster. In my visits, I always draw this picture to my patients, where in the beginning, it looks like an EKG. I’m like, hormones go up and down and up and down each month. Jason: You warned us not to do this. Kathy: Yes. Yeah, here it comes, everybody. We feel good.

[37:54] And then, just before the bleed, we feel really bad. And then, perimenopause happens, and it’s like this huge, volatile, erratic hormonal roller coaster. And that is estrogen. So, that’s why we don’t check estrogen. Because it’s not as meaningful. Yeah, it might be 200 one day and 12 another day. And that’s where oftentimes people go wrong. So, they go see somebody, they have this constellation of symptoms, they get their labs checked, and they hear back from their clinician, “Well, your estrogen is normal.” Like, I knew that before you did the lab. Yeah.

[38:25] Actually. Yeah. Jason: So, let me ask you a question that might seem kind of basic. So, is the primary goal of hormone replacement therapy to control those perimenopause symptoms, or is there another kind of underlying goal that is like protective or for health, like avoiding cancer or anything like that? Every once in a while — like, it was about four episodes. It’s about four episodes since I asked a good question. And I saved it up. Kathy: Yeah, I was sitting here, I was like, “Do it, Jason.”

[38:57] Yeah, it’s both. So, you can feel better on a daily basis, Jason: Okay. Kathy: and you can think about your future self, too. It’s not all hormones. We’ll talk about that at some point. But, when it comes to hormone therapy, that medication does create a more even-keel space to navigate life through, so mood improves. Hot flashes, night sweats get better, the sleep disturbances go away, energy gets better, people’s skin gets better, their hips don’t hurt anymore. And then,

[39:29] their future self might be thanking them, too. So, I often say like the 80-year-old you could be very happy that you were being intentional about weight training and using hormones to prevent osteoporosis. Jason: Right. Kathy: We also see that hormone therapy is a tool for cardiovascular disease prevention if started in perimenopause or within 5 to 10 years. It’s not what we call primary prevention. That would be like Jason: exercise and don’t drink and smoke. Kathy: good life. Yeah, yeah, yeah. But estrogen can be helpful too. It

[39:59] helps keep the arteries and veins soft, which allows the blood to move more freely. Jason: Yeah, and I imagine if you already have like some sort of genetic predisposition or some of those markers, that’s probably just another plus. So would you recommend something like this even for — cuz I know there’s probably some woman who’s listening and they’re like, “Oh yeah, you know, I’ve got some of those, but they’re not bad, you know, and it’s not real serious. It’s not affecting my life too much, right?” Or maybe they just have one or two

[40:29] symptoms. Would you still recommend that somebody explore this or yeah? Kathy: Absolutely. I just really would. And we’re starting to now — we’re starting to do some studies to ask the true preventative questions, you know, if we do start this medication at 35, can we prevent that osteoporosis we were looking at in the WHI? So, but from a clinical experience and a lived experience, I would say do not wait. We do not need to wait for things to be so

[40:59] bad. And PS, getting in to see somebody to have a conversation about this might take 6 months. Oh, yeah, yeah. And in 6 months, your experience could be much different. So Kathy: Yes. Or they don’t wait, yeah. Let me ask one more question for the conspiracy theorists out there. Aren’t you just a big pharma shill? Yes. Jason: You get some — you get some sort of kickback, you know, like not as big as we’re paying you to be on the show, but like, aren’t you just a shill for the

[41:30] pharmaceutical industry? Kathy: Yeah, no. Jason: Kathy: No, I am not. Oh, sorry, ladies. You hear that? Oh, man. You’re going to have to get off Reddit. Oh, dang. And I would say too, I do prescribe — I do prescribe FDA-approved medications. So that is big pharma, but it’s — some people are prescribing kind of proprietary compounded medications, which do have a financial incentive and

[42:02] maybe not the same — well, not the same quality to them. So yeah, no, I’m doing this because I love this work. And it is really rewarding to see somebody feel better. We live 40% of our lives in this other hormonal state. So it’s also not just like one moment in time. It’s not one day is menopause. It’s like one day is menopause and then the rest of your life you’re postmenopausal. So yeah, so I do it because I love

[42:32] making people feel better. I’m a really good people pleaser. I’ve got one more good question. I don’t know if this is a good one. Jason: I don’t know if you’ve done any — I joked at the beginning that I’ve done my research, right? Which — if people didn’t catch the joke — when you say, “I’ve researched this,” and it’s something with health care, you haven’t researched it, okay? You’ve read some stuff about it. But I wonder, have you ever been involved in any research? And if not, like if you could pick

[43:02] a topic or study to do — just hypothetically — what would your research project be in this Kathy: Yeah. Jason: arena? Kathy: Ooh. Genitourinary syndrome. Jason: Oh, yeah. Yes, we haven’t talked about this yet. Kathy: We’re about to. Yes, we are. So there’s a low estrogen effect that happens. I can say all anatomy words, right? Jason: Yeah, all of them. Vulva and vagina. Yeah. Kathy: Jason: Penis. Kathy: There we go.

[43:34] A low estrogen effect that happens at the vulva and the vagina that can cause symptoms of urinary urgency, frequency, light incontinence, itching, burning, decreased lubrication, decreased sensation, decreased arousal, etc. It also leads to pH changes that contribute to urinary tract infections. This happens — Jason: are more dangerous than people realize. Kathy: Absolutely. Jason: Yeah, it’s crazy. Totally. Yeah, for sure. In fact, so it turns out vaginal estrogen can help prevent urinary tract

[44:05] infections. So it’s the first-line treatment for preventing. Actually know somebody that did a study on like how much money could we save the health care system by just putting people on estrogen cream and preventing ER visits and hospitalizations. It’s a lot. Jason: Mhm. And probably starts with a B. Kathy: Yeah. Yeah. Bazillion. Bazillion. But this happens also at very young ages and a lot of times girls don’t know this. So this can happen — there’s something called hormonally mediated vestibulodynia,

[44:37] which is a side effect of systemic birth control. So some young girls are put on systemic birth control pills, which they might definitely need for a million reasons. Hooray for reproductive health. But it lowers the hormone impact at the tissue level and so they are sometimes diagnosed with a bladder pain syndrome. And it is actually this low hormone effect that causes a hypertonic pelvic floor, exactly. And it goes dismissed forever, and then — I mean, it’s

[45:07] just this big downstream effect. You think of this 15-year-old girl, she’s on a birth control pill. She gets UTIs or is having all of this pain. Maybe her first intimate encounter is also very painful — that I’ve seen lead to relationship distress. I had one person who they weren’t sure if they were going to be able to conceive because of the discomfort. It was all due to her history of birth control use. Jason: Got you. And this low hormone —

[45:37] Kathy: And that can be mitigated though. Yes, so you can put them on estrogen cream. Jason: Uh-huh. Kathy: So honestly, I think that we need to see what it looks like to put people — if you get your birth control pill prescription, you get your estrogen cream prescription, too. That’s something that you would do. Jason: Yeah, yeah. That’s really interesting. Kathy: Absolutely. We do this thing where we wait. We wait until it’s so bad and then we’re like, “Okay, here you go.” And because this also happens in perimenopause and menopause. But what happens is these tissue changes occur.

[46:08] We wait until a woman tells us in an encounter that she’s experiencing pain with intimacy. Well, she’s been experiencing pain at this point for probably many years, you know? And maybe we waited for her to bring it up. We didn’t even ask the question to her. And that could have been prevented all along. So in my encounters, I’m like, “Here’s your estrogen cream. You don’t need it yet, but we don’t need to wait until things are so painful and uncomfortable.

[46:39] You’re getting infections and you have this constellation of symptoms — you have a syndrome — for us to say, ‘Oh yeah, it’s kind of like —’” I often use the dentist analogy. We don’t go to the dentist without ever brushing our teeth — like with cavities, yeah. And then the dentist is like, “Here’s the toothpaste that was going to prevent that all along, you know?” So yeah. Jason: This is so interesting and thank you for sharing this because I’m just having light bulbs go off, because you know, really commonly what goes along with

[47:09] that is low back pain, pelvic pain. Those are patients I see all the time. And it’s — you know, these are questions that are on the intake and I’ve never connected the dots. And so yeah, that’s giving me a lot to think about. Now, was this somehow an intervention that you previewed? Hey, listen, start — Kathy: Start asking. But that tissue issue is kind of like a rash or a burn. And then the muscles underneath become reactive and then you know the bones

[47:39] stuff. Looks like a sacroiliac joint problem that we can’t fix. Yeah. Oh, that’s so interesting. Treat the rash or the burn, then you’re not going to get any — you know, you’re not going to make much progress at the musculoskeletal level if there’s like a rash or a burn that’s there the whole — they worry about going on birth control because they’re like, “Why are you worried about?” Because of the side effects. Which side effects? I hear there’s side effects. And so — but — and nobody talks about that one though. That’s the thing that’s also frustrating

[48:09] is that I mean, you pretty much have to be an ISSWSH fellow in the sex medicine space or menopause space. I don’t know a lot of those. I met my first one today. There’s not a lot of us. Actually, I think I’m the only MSCP and ISSWSH fellow in Oregon. Holy smokes. Okay. One of a kind. One of a kind. Oh, okay. So I had a question and my menopause brain just let it go right

[48:40] out. We’re experiencing it in real time. In real time. It just came back. All right. Well, I guess one of the other questions was, are there quote unquote bad side effects to the bioidentical estrogen and things that you can prescribe to people? Honestly, estrogen for most people just helps them feel better. I mean, it’s really the way it is. It made us — we felt good when we had estrogen in our bodies when we were, you

[49:11] know, cycling more regularly, and that happens again when people go back on — when people are supplemented with it. The person that does not have a good experience, or might have too high estrogen, is somebody that reaches out and describes a too-many-cups-of-coffee energy. I kind of — I — hands. I do hand things. I kind of have to do this every time I say it. Like, I just don’t feel good — is, yeah, kind of an amped — is that a Jason: ADHD type of thing that you were talking about? Well, that’s kind of different.

[49:42] Yeah, this is an estrogen side effect. So if I start somebody at a certain dosage — oh, right. Yes, okay. Yeah, I’m following now. — they — and they’re like, I don’t think it’s right for me, and I’m like, what’s going on? Then they say, I feel like I’ve had too many cups of coffee — that’s an estrogen side effect. Mhm. Progesterone — the body’s similar progesterone. I often say there’s like three camps of progesterone. The first one is, I’ve never slept better in my life until I started taking Prometrium 100 mg

[50:12] nightly. Hands. The second one is neutral — like they don’t know what all the fuss is about. And then the third one is side effects, which is a pretty small percentage of people. But that would be somebody that felt groggy the next morning, had new breast tenderness, or a new bloat. Or I’ve had some people that say that it gave them weird dreams. Pretty much most people are progesterone lovers. One of my favorite things to do honestly is that person that has an IUD, that’s

[50:44] been on an estrogen patch only and never been offered oral progesterone because they don’t need it for endometrial protection — to give them a trial of progesterone is usually a beautiful thing. It’s often a missing piece to their puzzle. They sometimes notice more clarity. We’re finding that progesterone decline can be a contributing factor to some of the severe PMDD that people start to experience in perimenopause, and some of the maybe new onset or worsening of

[51:15] ADHD as well. Yeah. So interesting. Right. And since I started working with Jessica and being friends with her in the Novo Collective, any woman that comes in that is in their 30s and above — if they have these pains that they describe to me, my first question is, okay, you know, what’s your menstrual cycle like? Where are you with perimenopause? And a lot of them are like, I don’t know. I have no idea. I have a regular cycle. I said, well, you should probably check with your

[51:46] gynecologist. You know, check on the hormones. And I kind of — now that I’m educated as a PT, I can educate them. Like, go back to your doctor, ask about these certain things, tell them that you check all the boxes for these things, because some of this pain you might be having may just be hormonal. Yeah. You know, and they’re like, really? Mhm. I say, yeah. I mean, we’re going to try to work on it in PT, but I also say, hey, you got to go check this with your doctor too, because you have too many of these symptoms for it

[52:16] to be just musculoskeletal. Absolutely. You’re a whole person. And yeah, I get referrals sometimes from orthopedists that are like, we have done all the imaging. We’ve done all of the things. The hip pain is not improving. Well, I’m imagining — you probably, just based on your level of knowledge, I’m picking up that you are some sort of an expert. I imagine you’re probably getting referrals from gynecologists too, because I know somebody who

[52:46] has recently gone to a gynecologist and the gynecologist was like, so what do you want? Do you want like a hysterectomy? Or like we could leave the ovaries? Or like do you want us to just like scope around and go looking for some endometrial cells? Or like whatever you want? And it’s like — and this is — this is not — this is a young person, right, who’s thinking about like, do I want to have a family? And you know, and what does all this mean? And so it sounds like that’s probably somebody who should be talking to you and not the

[53:18] gynecologist who’s just like, when can we get you booked to start removing pieces? Yeah. Jeez, that’s crazy. Right. It is — it’s mind-blowing. That’s — I think one of the things you’re speaking truth to is that as consumers of medicine, we don’t always know what a person’s bank of knowledge is, you know? We would assume that an OB/GYN would be a menopause expert. And they’re not. And they often will admit that that’s the case too.

[53:50] Yeah, so — yeah, we all remember that person from that class, right? Like I got somebody from chiropractic school who they cheated their entire way through it. And like now I see them and I’m like — I look at their business and I’m like, bro, I remember you getting caught cheating so many times. Like if only these people knew. But I don’t know. I have had patients tell me — and I’m sure you’ve heard more nightmarish than what I’ve heard — but one patient told me recently that they asked their gynecologist about hormone

[54:20] therapy. And this doctor, physician said, oh, it’s just a trend. Yeah. Kathy: Just a trend. It’ll fade. Jason: It’ll pass. Just wait long enough. The hormone therapy will go away. Kathy: I’m sure you’ve heard — oh, I mean, every day, multiple times a day. The amount of times the patients have said like, “Thank you for listening. Thank you for believing me. I’ve told so many other people this and you’re the first one that has listened to me.” That just — I can’t. Yeah. Fathom that.

[54:50] What is going on? And I’m not the person to say that it’s all hormones, either. I think that that can kind of — in all of my visits, I’m like, you are a whole person, you know? But they shouldn’t be negated. And that’s one of the things that happens is like, okay, well, it’s probably just like your mental health, school is hard. Yeah, all that stuff is true. Oh, it must be, you know, your kid. Yeah, kids wake us up at night, or, you know? And so that’s what happens a

[55:20] lot of the times is that they go down the list of treating things individually or looking at them individually and not as a whole person, not as a constellation of symptoms. And when we honor hormone decline as the primary driver, then we can get — some people can use hormones as medication. And I think it might be game time. It is. My brain is full. And you know, I — so I’ve prepared a game for you.

[55:51] Jason: A creative outlet. Kathy: Well, it’s actually — now the game is embarrassing because I know I already know the scores you’re going to get in the game. Jason: Oh no. Kathy: This is going to be like the biggest landslide since — who is it? Simon was dominant in his game. Knew everything about shoes. Who else was good? Vu was also a very strong force. Um, yeah, here we go. Jason: All right. It’s like, can we just pause and I’ll

[56:21] make a different game? It’s like based on cartoon trivia or something like that. Kathy: No. No pressure now. This game is called Myth or Menopause. It’s a true or false game, okay? So yeah, I’m pretty much sure you’re going to get all of these, okay? So true or false — question one. All women experience depression during menopause. True or false? Jason: False, but mostly true. Kathy: Okay, you are correct. It is false.

[56:52] They’re very common, but not everybody does. You can’t say everybody about anything. Jason: Yeah, and I think some people maybe miss it because maybe they got a girlfriend who that was her biggest symptom and they’re like, well, I’m not depressed. And so it’s probably not — okay, good. 100%. I should have — like March Madness is coming up and this is a safer bet than any of those teams. This is like a 16 versus one, right? Here we go. All right, question two. Hot flashes only last for a year or two during menopause. No.

[57:24] Not even thinking about that. Some people are super flashers. Yes. Oh, wow. They never go away. Oh, that’s not fun. That’s not fun. You know, I have some women who are perimenopausal and when they get adjusted, instant hot flash. Oh, yeah. It’s like, oh my gosh. Like yeah, I had — Kathy: vasomotor symptom. You’re like, you know. Jason: I had one patient in particular who’s like — she would have to time her appointments because she knew if she got

[57:54] adjusted, she’d have to go home and take a shower after. Yeah. She was — I was like, hey, it’s all good. I’m that powerful. Not really. Okay, question three. Hormone therapy always increases your risk of breast cancer. Jason: False. Kathy: Okay. And it sounds like it can do the opposite. Yeah, well, what I can say is that I can say with all confidence if I put somebody on hormone therapy and they get breast cancer in the future, that it was not caused by the hormone therapy.

[58:25] Jason: Yeah, so association is not causation. Kathy: Yeah, there you go. Got you. All right, question four. Menopause causes inevitable weight gain. Jason: No. Kathy: Okay, good. And aging, yes. Weight gain causes weight gain. Yeah. So let’s go there first. Jason: Well, and aging causes weight gain because you got to be more active, right? Like you get older and you’re doing less and there you go. Kathy: Uh oh, goodness. Where — okay, question

[58:56] five. Sexual desire always decreases after menopause. Jason: No. No, ladies. I think that’s great news. I think everybody’s happy to hear that. But it can be common. Okay, question number six. There are no effective treatments for hot flashes besides hormone therapy. Jason: Incorrect. Kathy: So what are some of the non-hormonal therapies that people can use for hot flashes? Yeah, there are two

[59:26] non-hormonal medications that are fairly recent. They work on the kappa receptors — kappa Y receptors. One of them requires liver monitoring. The other one doesn’t, but those are two of them. And then we can also use sometimes SSRIs or SNRIs, gabapentin, oxybutynin, but I am a urogyne person and I — Jason: Girl, you just like read the whole list. Okay. Kathy: It’s because I really am a specialist. Jason: Yes, you’re good at this. All right.

[59:56] She really is an expert. Question seven. We got four more here. Question seven — vaginal dryness and discomfort will go away on their own after menopause. Jason: No. And it’s not a use it or lose it thing. That is a huge misnomer. Some people are told that if you keep blood flow to the area, that you will not experience hormonal changes at that tissue level, which is so not true. And what a — and what a weird thought that

[60:26] that would be what it is. It’s like, you know — just it’s blood flow. I think a man told a woman. Absolutely. That was a man who told me. Jason: Keeps the blood flowing. It was a man who guessed and so — let me explain to you why that’s true. It’s my mansplaining voice. Kathy: Question number eight — you can’t get pregnant during perimenopause. Jason: Oh, no, it’s true. You can. Kathy: Surprise. Yeah. That’s why the IUD could be really good. Jason: I know. I have some friends who hit

[60:57] the reset button, I call it. And yeah, surprise. Yeah. I also have a 16 and a 1-year-old. You know, not me. Mm-hmm. Yes. And tune in next time to learn — Question number nine — black cohosh and soy supplements are proven to be as effective as prescription medications for hot flashes. Jason: Incorrect. Kathy: Okay. What? No. Cohosh. But what if

[61:27] they’re from a supplement company that publishes their own white paper? It’s so hard. Yeah. But if the black cohosh is coming from a company that works through multi-level marketing — mhm — that’s more effective, right? Don’t you think? All right. All right. Final question. So, so far you’ve got 90% on this quiz. Here we go. Most women spend about 40% of their lifespan in the postmenopausal —

[61:57] Wow. True. You are nailing the answer to this. Oh, see. Nailed it. Kathy: Yeah, just absolute superstar. She’s an expert, certified expert. Jason: Awesome. I thought I passed your test. You can start now. You can start putting the letters PTCH after your name. Yes, so — but it’s got to go — got to go right. Yeah, it’s sure. Okay, good. Okay, so to wrap up, we usually finish with takeaways. Takeaways, yeah. Okay.

[62:28] Jason: What are your takeaways, Jason? All right, so first of all, I’m shocked. I’m surprised. Okay, we — I’m going to admit we talked about this beforehand and Kathy’s like, you can just sit there and listen, Jason. It’s fine. Yeah, you’ll survive this. But I’ve learned so freaking much. I think the biggest thing that I’m going to take home and I’m going to integrate is I am going to not shy away from noticing the connection between women who come in who have back pain, pelvic

[63:00] pain, what looks like SI joint pain, and they’re also reporting things like dysmenorrhea or symptoms of perimenopause — because that is somebody who could potentially benefit from hormone replacement therapy. So, wow. Yeah. Right? Wow. Yes. You’re a better doctor. Oh my goodness. A convert. So good. All right, Kathy, smarty pants. What about you? What are your take-homes?

Kathy: Well, every time I’m around Jessica, I learn

[63:30] something new. And so today, what did I learn today? Oh, I think what I learned today was that — my menopause — menopause, tuck it away. Yes. Just kidding. That we spend 40% of our life in menopause. I don’t know. No. Yeah, but yeah. So, that is

[64:02] a perspective I hadn’t thought of. That’s crazy to think about, huh? Jessica: Isn’t it? And that’s — and that’s our menopause statistics. If we include perimenopause — Kathy: All right. Yeah, you’re about 50%. Yeah, that’s a really good point. I just came up with that point. So, I’m going to guess that it’s not worth ignoring. Yeah. No. Yeah. Yeah. Sounds good. So, Jess, tell us — if you can, if you want to summarize — what do you want people to know about you and your practice? Yeah.

[64:33] And how do they get in touch with you? Jessica: Wonderful. Yeah, so I am doing a telemedicine cash-pay perimenopause, menopause, and sexual health practice. They can find me at gynjess.com. I’m also on social media. Jason: Spell that for people? Jessica: gynjess.com. Jason: Okay. Jessica: Yeah. Good. Yeah, gynjess.com. Tomato, tomato. We’ll pop it up on the screen and we’ll also put these links in the show notes. Okay, so gynjess.com and

[65:04] then did you say there’s an email or social media? Jessica: I’m gynjess on Instagram as well and on Facebook. Um, yeah, and then in our community, look out for educational opportunities with the Novo Collective. I do a few things. I love doing education around perimenopause, menopause, and sexual medicine because I do believe education is powerful. It’s good to know what’s going on with our bodies — that anticipatory guidance for the future is very powerful as well. So, yeah, Novo

[65:34] Collective in our community here and then online, gynjess. Jason: Outstanding. Another outstanding episode. SLOW CLAP. HEY, EVEN RAUL’S OVER THERE LAUGHING. So good. All right, really appreciate it. I really think that this is fantastic. Yeah, so I think that there’s only like one little cherry that we can put on top and that is that there is no “I” in PTCH.

[66:12]