00:02
Dr. Ade
Welcome to the Modern Midlife Collective podcast. The place where we get unapologetically real about thriving in midlife health, hormones, and everything in between.
00:12
Dr. Jillian
I'm Dr. Gillian.
00:13
Dr. Ade
And I'm Dr. Aday.
00:14
Dr. Jillian
Together we're your guides to navigating this powerful season with confidence, strength, and the wisdom you deserve. Welcome back to the Modern midlife collective. I'm Dr. Jillian Woodruff, a board certified gynecologist, cosmetic gynecology surgeon, sexual medicine expert, and a nationally certified menopause provider.
00:37
Dr. Ade
And I'm Dr. Aday, doctor of nurse and practice, board certified family nurse practitioner, functional medicine expert, and metabolic health specialist. So, Dr. Jill, give us some insights to what you see in gynecology. What are some things that you're educating your women about? About the importance of testosterone. That it's not just a man's hormone?
00:55
Dr. Jillian
Yes, absolutely. I think the biggest thing that I like to tell them is that we have more testosterone than we do our other sex hormones. So when comparing testosterone and estrogen, there's more testosterone than there is estrogen. This is why it's tricky, because if you look at your lab values, you'll see the units of measurement are different. And so you have to multiply your testosterone level by like a multiple of T. So it says that it's 47. If you want to compare it to estrogen, it's going to be 470. That's significant. They why would they measure it differently? Why do you measure estrogen and testosterone in different units? I think to confuse us. But, you know, that's my conspiracy theory, Dr. Attay. So it's definitely not a man hormone. Men have it. Yes, but women do too.
01:44
Dr. Jillian
And for both men and women, it is our most abundant sex hormone. But you brought up this thought or this issue with muscle mass. That's super important to talk about. And maybe you can discuss the myth about weight gain with hormones. So that's a myth. I think that we should debunk that hormones will make me gain weight, whether that be estrogen replacement or testosterone replacement. Do they make you gain weight?
02:13
Dr. Ade
Oh, man, that is not true. I'm sure you know that's not true at all. In fact, it's the opposite. It's when you start to lose those hormones that women tend to get that midsection weight gain where they say they just have that belly fat. And that's the hardest thing. And women start to unfortunately take drastic measures, maybe cutting back on their calories, exercising really hard. And unfortunately, what that does is actually increase your inflammation. Basically, the stress on your body and actually makes your body go into fight or flight code where it's like, I'm starving, I really need the energy. So instead of doing all those drastic things, we need to actually nourish it.
02:50
Dr. Ade
So nourishment, you know, making sure that you're getting your protein in, your healthy fats in, and of course, balancing hormones, either through hormone replacement, if that's something that you're interested in, or actually looking at lifestyle measures that will balance your hormones and not make it so hard to lose weight. So of course, you know, we are so many diets out there and they're being told you're in midlife, you know, go into intermittent fasting or do keto. And there's so many different things. And unfortunately with midlife, there's got to be that shift in realizing how your body, especially women in perimenopause, right? It's like there's that balancing act. Your hormones are low, you're not in menopause yet. So it's that time between that gets it really challenging for women. So the bottom line is the hormones don't cause weight gain.
03:38
Dr. Ade
It's the decline, the steady decline hormones that makes it more difficult. But it's really important to try to know how to nourish your body. So that's my answer to that. What are your thoughts, Dr. Joe?
03:48
Dr. Jillian
Yeah, I agree with that. Two things that I would want to add is that even with women who know that this myth is indeed a myth, they think that once they start hormones, they are going to lose weight right away. So once they start that testosterone, they're expecting weight loss. But you brought up how testosterone increases muscle mass. And the way that I'm seeing it, timeline wise is really the first thing. Maybe they're having just more motivation for movement, for exercise, and then seeing having better recovery after exercise with testosterone and then increased muscle mass, like maybe feeling more strong and then seeing physical changes like increased muscle mass and physical. And changes in what they're able to do and their strength. And then over time, you know, we know muscle burns fat. That's what they. They're telling us, it burns fat.
04:42
Dr. Jillian
And so over time we're seeing these other changes. We like to give them like a year. It didn't go on just like that usually, and it's going to take about a year to come off. But another very important thing is that it's not just your hormones. And many times people aren't sleeping well. Right. And this is what the time we need for recovery. They're not sleeping well, or they have. Like you deal with the metabolic issues, some of the metabolic changes have come from perimenopause or started at that point, and others are metabolic issues that they've had over years that have not been fully addressed.
05:18
Dr. Ade
Yeah, absolutely. Great point. It's that optimization, whether it's one of the things you said about testosterone is just the energy. I find sometimes women just don't have the energy to do anything. And it's like, if you don't have the energy, how do you lose weight? If you're not sleeping, if you don't have the right nutrients, if you're perimenopausal and you have iron deficiency, for example, from, you know, irregular breathing or heavy bleeding, it's hard. So getting those nutrients, making sure that your vitamin D is optimized, making sure that your iron is optimized, if you need an infusion, sometimes it might take an infusion to get your iron levels to be where they need to be. So, yes, it's multifaceted. It's not necessarily the hormones that's causing the weight gain.
06:00
Dr. Ade
Could there be fluid shifts, especially if you're in hormone replacement and, you know, your body's not used to having that level. That could happen. Maybe some fluid shift, but not weight gain due to fat, but just some readjustment that's happening. But is it not. It's something that's temporary that's happening.
06:15
Dr. Jillian
So, yes, absolutely. Thank you for bringing that up. That is so true. Because when you start hormones in general, and you may have seen this in your early years, maybe you took birth control pills and you can have some bloating, some water retention, that happens at the beginning. This certainly can happen. And also some of the issues that I see in people who are starting hormones is that they may start too high because you want to help that person feel better. And you're like, this is the answer I'm going to. To help you. And it's too much. And then the woman may not like how they feel because they've had no hormones, and then they had this surge of hormones, and then they may stop it and then never have the benefits of their hormone replacement.
06:55
Dr. Jillian
And so the journey of getting where you need to be may not be super quick. You may have to work up to it. And everybody responds to things differently. So that's the point. It's not like an overnight success. Maybe some symptoms may go away, but other things are going to take some time to get through. And I think an important thing to mention is just the Provider you're seeing, like, can you. We've just named so many things that we need to look at that there's so many issues that go into weight gain. Right. How can you go to your 15 minute appointment, maybe 10 minutes of face to face time with your provider and get through all of that?
07:34
Dr. Jillian
So I think even when some people may have been, you know, dismissed when they went to their doctors and told things are normal, the issue is there's just no time to get through all of these things in the traditional medical system. There's no way to attack all of these different points in traditional medicine.
07:52
Dr. Ade
Yeah, you bring up a really great point about that. It's like, where do you find the time? It's like the consult. Sometimes I end up doing a lot more education before and not to talk about going over the labs and then figuring out what plan might best for you. So. And in talking about labs too, sometimes the myth is like, if your labs are normal, then, sorry, you don't have a hormonal issue. So it's either. Sometimes they'll come to the clinic and they'll say, yeah, the lots were done and I'll see. Maybe an estrogen was done, maybe a progesterone was done. But we have no idea where you are on the map, whether you're perimenopause or menopause. So you don't have the full picture. But again, perimenopause that we talked about. Right. Can be so many different symptoms even if your labs are normal.
08:34
Dr. Ade
So that's only part of the picture. What are your symptoms? It's really about treating the person for where they are. I think it was Oprah that mentioned she was having heart palpitations. And they did all this test and they found out it wasn't her heart, it was horform of. She was perimenopausal. So, yeah, labs are not the only part of the puzzle. Right.
08:54
Dr. Jillian
Yeah. And I know that people are going to ask us about the labs and how to diagnose perimenopause. And the labs are a guide. There's not a diagnostic key to perimenopause because those levels fluctuate so much. Now there are certain things that we can look at and with experience, we can compare to a reproductive age woman at certain points of the cycle. It's a really detailed process that is more than just numbers, but has to take into account what your symptoms are as well, because you may have completely menopausal hormones one month and then the Next cycle, it's, you know, you're like, it's a completely normal and typical of a reproductive aged woman. So even if you had this menopausal level, that's not giving you the answer that you're in menopause or that you're in perimenopause. Menopause is one year since your last period.
09:55
Dr. Jillian
It's been one year of no periods. That's weighing your menopause is it's not a lab value. And then I think that brings me to another myth, is that if your period is occurring regularly, then you're not in perimenopause. No, that is not true. You can have normal periods, you can have missed periods, you can have heavy periods while still experiencing major hormonal shifts and symptoms. Now, as you get closer to menopause, maybe you'll experience more changes of your period. But like we said, perimenopause can go on for like 10 years sometimes. And in that time, you're not having 10 years of abnormal bleeding. You shouldn't be. Let's talk if you are.
10:40
Dr. Ade
Oh, my goodness. What. I mean, I'm sure this is probably very enlightening for many women. Your periods are regular. Well, I guess everything's fine. I'm not there yet. But no, this could be years. You could be experiencing those symptoms. So it's really important to kind of. I'm a proponent for journaling or, you know, just kind of finding a way to kind of document your symptoms. I know there's a lot of tech out there too. They can look at your cycling, you know, what your mood is like at certain times. It can really key you into how your body is really feeling. And then when you bring it to your provider, sometimes that might give some insight. So that's great that you mentioned that. And, you know, sometimes people think maybe another myth is hot flashes.
11:22
Dr. Ade
You know, I'm having periods, but I'm having a hot flash, and that's the only symptom. Or if I'm not having a hot flash, rather, I'm not in menopause because there's no hot flashes. And eyesights, when we not we talked about it the last episode, that it could be lack of sleep because of loss of progesterone, rain, fog, you walking into a room and forgetting why you were in there in the first place, Weight changes, anxiety, which is a huge one for women, just feeling anxious, the things that you were able to cope with before, that was a no big deal. It might take a little bit of time. You know, irritability, joint pain, that's another one. You know, sometimes people will go to their provider and get a diagnosis of, you know, indeed, fibromyalgia. Maybe it is.
12:02
Dr. Ade
Maybe it's your hormones and a host of more symptoms. Right?
12:06
Dr. Jillian
Yes. As you're saying these. I'm like, yes, yes. These are all symptoms that can come that people may not necessarily think of menopause or perimenopause. And Yeah, I think also between hot flashes and night sweats, I think some people get hooked on the term hot flashes and they think that's during the day or night sweats. I mean, you can have hot flash, sweat, all sorts of things. It's just your body's feeling hot and then you're. You may or may not sweat. Right. But an issue, I think that happens even before the traditional daytime hot flashes where you want to put your head in the freezer. Right. Or people have described it as like burning from the inside out. Totally not pleasant sounding. But night sweat typically would start even before that. And this can happen with your normally menstruating cycles. And this just comes.
12:59
Dr. Jillian
We have normal cycling twice a month of our hormones where your estrogen progesterone goes up and then it goes down, and then again it goes up and it goes down. Right. And so that time where it goes down, maybe before the period, typically when people are getting those, if they're getting PMS symptoms, they may start having night sweats during that time because the drop from estrogen at a high level to down here is just more extreme than it was before. And so then they can start having these night sweats or feeling hot at night or feeling warmer than typical. Right. It doesn't have to be the extreme to be significant and important to check out.
13:39
Dr. Ade
That's right, absolutely. And I think one of the other things, too, that we see is what's considered natural and what's not considered natural in terms of, like, hormones. If they. People go to their provider and they're looking for something, they only use the word I want natural. So natural really is just bioidentical, meaning, you know, that hormone that is being replaced is very similar to how your body produces it and uses it. I tell patients, I describe, like a locking key. So you have these receptors and you have these messengers, so they have to bind to a particular receptor. So the way they work is that it's like a locking key. They need to fit perfectly. So they fit very identically to what your body's normally produces. So it's bioidentical. It's most closest to what your body naturally produces.
14:30
Dr. Ade
So some of them are FDA approved, which are totally fine, and some are not. Some are compounding pharmacies and some are not. But the biggest thing is, you know, dosing, making sure, like Dr. Jill mentioned before, that you're not starting too high and you're getting side effects and you're not getting the benefits that you need. You know, getting acne or facial hair or irritability from the dosing not being where you want it to be enough that you're getting the benefits that you would normally get. You know, natural response. Right. And of course, the delivery method, whether it's pill or cream or a pellet, and then there's injectables, but injectables are kind of a different kind of thing. And then you have the medical supervision that goes along with it. It makes sure that you're getting it from not just these things.
15:12
Dr. Ade
Online, I hear stories about people actually getting these things from different places. So you have to make sure that you are getting a prescription, you being monitored for symptoms. Are the symptoms getting better, are they not? And that's kind of how a good hormone therapy program should work. Whether you're seeing your primary, whether you're seeing your gynecologist, it really depends on who you're going to. Making sure that you're getting the quality care that you need.
15:39
Dr. Jillian
Absolutely. I think bioidentical, that term is loved in some communities and other communities. It's like a hated term. And it's associated with, I don't know, like a type of voodoo medicine. And just like you said, it's just a type of. The chemical structure of the hormone is identical to the chemical structure in your body. Most bioidentical hormones are found from plant sources. And you think about our plants, they're the creators of medications in general.
16:09
Dr. Ade
Right.
16:09
Dr. Jillian
Like, they were things that back in the ancient times, right. Plants were identified that had medicinal purposes. So it's no different in terms of hormone. They've identified plants that have these medicinal purposes, these hormones in them, and then identified that the structure of the hormones were the same as the structure in our body. Whereas synthetic hormones, there's a little difference. It's made in a lab. But if you think about it, all of these things are made in a lab. You have to get the hormone from the plant and synthesize it into something that could be used by our body. But that's going down a rabbit hole. So when they're synthesizing a non plant source hormone or animal source hormone. When they're synthesizing it, the chemical structure is a tad different. You can't take this plant and say, but you've created it, right?
16:58
Dr. Jillian
So you make it a little different. You make it something that can be mass produced. And it's not necessarily that these are bad. I think it's exactly what you said it is. The mode that you take these medications, whether by mouth, whether topically, whether injectable, whether whatever form that may be, the dosage that you're using is important. I know we both prefer bioidentical hormones because, you know, we believe that they are identical to what we've made and so they're going to function in that same way. But I have patients where, hey, it's not right for them and they need a different method. And so a good hormone provider is somebody that can acknowledge all types, all methods and is knowledgeable about what can work in different situations.
17:44
Dr. Jillian
And then exactly what you said, making sure you're monitored, not just given something and gone on your way. And your body may not even be utilizing these hormones. You may not be clearing the metabolites, the breakdown products out of your body. So you're not actually getting the most benefit from what you're using. And then maybe we should do a whole different episode about pharmacies and compounding because that's another controversial issue.
18:12
Dr. Ade
Yeah, absolutely, I agree. And you know, I think the next thing too is when you're seeking this out, you may get pushback from other people and say, well, this is a natural process, right? You're supposed to lose your hormones, you go to menopause, you're supposed to just deal with it. So that's another myth. You don't have to deal with it. I mean, if it's really impacting your quality of life and you're not sleeping and it's making your life miserable, you're gaining weight and you're not able to control that. All the other symptoms, you know, heart issues, there's no need to suffer. So there are evidence based options from hormone therapy to nutrition, stress management, supplements. So women going through these, you know, navigating these things really need that support.
18:57
Dr. Ade
So going to a provider who's just saying there's nothing you can do, just know that it's not true.
19:02
Dr. Jillian
That's right. To piggyback off that myth. Another one is once you're in menopause, symptoms stop. That is not true. Symptoms can persist, they can even worsen in menopause they can go on for years. It could be that maybe your hot flashes stop, but these other symptoms remain. Or maybe your hot flashes remain. It is totally different person. But I think maybe that's where that myth came from that you mentioned, which was, you know, you just have to get through it, tough it out. Because I think it was being spread that after you go through menopause, one or two years later, your symptoms go away. And now women are saying, hey, but I'm still feeling this, that, and. And these other symptoms are getting worse.
19:48
Dr. Jillian
And thank goodness they are sharing this so that people can acknowledge, oh, wait a second, we may have been wrong. You do still have symptoms. You may not have this specific symptom, but you have 10 others. Or there are absolutely people who do not have appreciable symptoms in menopause. Good for them. But yes, that it can go the other way. Not everybody has these traditional symptoms of menopause.
20:14
Dr. Ade
Absolutely. And leading to that. Right. So menopause doesn't mean you have top it out. Menopause is the end of beauty and vitality. I'll let you take that one.
20:24
Dr. Jillian
It's a new beginning. It can be your healthiest, most confident, most powerful stage yet. We just have to navigate changes that are occurring in our body. And there are so many things. We're in a very blessed time right now because there are so many things that we can do to accentuate the parts of us that we love and to change the parts that we may want to have adjusted. Yes. Hormones as they decline. There are some cosmetic changes that may come along with that, but we can counteract that. And I believe we do have an episode coming up where we discuss just that. We're going to discuss the changes that come, you know, aesthetic changes that come with perimenopause and menopause. And then we will discuss what you can do about it.
21:13
Dr. Ade
I'm looking forward to hearing all about that, because I know that aesthetics part, there's a lot of debate around that too, about what you should and should not do. But like he said, you deserve to feel your most confident self and healthier. So looking forward to that episode. So if you're sitting at home thinking, wait, I believe some of these myths before, you're not alone. That's why we're here.
21:33
Dr. Jillian
Yes. We want you to feel seen, heard, understood, supported, and not just with medications, but with the power of knowledge and with the ability that you can take the knowledge that you gain and share that with those that you love. The more we talk about this, the more solutions there will be, the more education for your providers, the more education for your family members. So we want you to come away with this, with real education and with the ability to make your own personalized plan that includes lifestyle and maybe hormones and most importantly, mindset.
22:14
Dr. Ade
Absolutely. And so we'll continue this every week. We're giving you the evidence. We're giving you empowerment and a path forward to optimizing your health in midlife and beyond.
22:24
Dr. Jillian
Thank you for joining us on the Modern Midlife Collective. I'm sure you know somebody who needs to hear the information that we shared with you today. So share this episode with a friend. Give this to someone that you think needs to hear what we are telling you. And if you have some questions for us or a topic that you think that we should cover, we do want to hear from you because you are a part of this collective. You're a part of the Modern Midlife Collective.
22:54
Dr. Ade
Until next time, stay tuned. Bye bye. Thank you for tuning in to the Modern Midlife Collective podcast. We hope today's episode has inspired you to take bold steps towards thriving in midlife.
23:07
Dr. Jillian
If you loved what you heard, please leave us a review and share this episode with a friend who's ready to step into their power.
23:14
Dr. Ade
We'll be back next week with more insights, strategies and real talk to help you live your best life at any age.
23:21
Dr. Jillian
Until then, remember, thriving at 40 and beyond isn't just possible, it's your birthright. We'll see you next time.