Hello my loves. Uh, we are back with an amazing guest. guess this week. I’m very excited to talk about menopause and hormones. I feel like it’s long overdue. I’ve been trying to find the right guest for this topic and I think I found the perfect person. So Dr. Kelly Casperson is a urologic surgeon. Author, sex educator, and top international podcaster whose mission is empowering women to live their best love lives.

Kelly identified the need for better resources and developed a sex education membership that covers topics like sexual health, intimacy. Mind Work and the Science of Desire. She combines education, humor, and candor in her podcast, You Are Not Broken, where she dismantles the myths people have learned and normalizes healthy, enjoyable sex worth desiring.

For more information, follow Dr. Kelly on Instagram at kellycaspersonmd or visit kellycaspersonmd. com. So welcome, Dr. Casperson. How are you? So good. Thanks for having me. Yeah. I’m excited. I really am excited to have you. You know, I am. I’m 43. I have friends who are like starting to go into perimenopause or menopause and it’s one of those things where it’s.

Yet another one of those things I should say that just kind of baffles me like how do I not know more like, you know I’m in this age range. I have specialized training in sex therapy and And yeah, I still don’t really feel even like prepared for this phase of life. And so I’m like I don’t know now. The average woman certainly doesn’t know enough.

Um, what do you think of like, think if you like put in your brain menopause, right? Yeah. Like what picture comes into your brain? For me, it’s like a 70 year old golden girl, you know, Betty White

sort of thing. And you’re

like, no, no, no, no, no, no. We’re talking 38, 42. for certainly 48 is normal for menopause with the bell curve of average age of 51.

So it’s like,

dude, if we don’t get to the women who are younger, they’re going to have gone through this alone and, you know, feel like they got hit by a Mack truck alone.

Right. And that’s like exactly what I don’t want for people either. And it just, I don’t know, I just feel like we kind of have these, like, we have the right to know how our body

works.

Oh, totally. Dude, our, our body health education in this country slash world is abysmal. Like so bad. And doctors, like we always forget that, right? Because we’re like, you kind of just think everybody’s talking the same language and it’s ridiculous to think that. Women don’t even know how many holes they have down there.

No.

Right? Like.

No.

Right? Or that there’s a clitoris. Right? Or where it is. Or where it is. I just saw something like 62 percent of people can identify a clitoris on a drawing of a body. That’s like all genders. That seems high to me. It seems high to me. Yeah. Maybe that was like after a

course. Yeah, it was like aspirational.

Um, but yeah, I mean, we skip over all that when we’re going through sex ed. If we even have sex ed, it’s like our parents aren’t talking to us. All the messaging, you know, I don’t have to really tell you this, but it’s like, yeah, it’s like, where do people find this information?

Podcasting, which thank God isn’t censored.

Because it’s long, it’s a long format, so you can actually get into something and you’re not censored. You can say things like clitoris. Right. That’s nice. The, I have a friend who was like on a prominent talk show and they, they, the legal team censored the clitoris on the drawing that she wanted to bring on.

Yeah. And uh, so we’re like, yeah, it still happens. But you know, I think with menopause, people think it just means no more periods, right? And with that means no more babies. Correct. Right? So like, that’s what people think menopause is. And hot flashes. We know hot flashes. Those are the two things. Yeah. And the, and the, you know, the myth with that is if you didn’t have a hot flash, then you didn’t go through menopause.

How many women do I see where they’re like, I didn’t go through that. And I’m like, no, what you mean is you didn’t have a hot flash. Right. So about 60 to 80 percent of people, 80 percent of people will have some sort of hot flash, but that a hot flash is experienced in different ways by different people.

It’s not a universal thing. Night sweats are basically hot flashes while you’re sleeping. Okay. But so many people think that nothing happened if they didn’t experience the hot flash.

And I would

also argue that the loss of periods, the loss of pregnancy is a consequence of what happens, but that’s not what it is.

Right. So what it is Oh, let’s define it. Yeah, let’s start there. I know, let’s define it. So the technical definition of menopause is one day So you’ve had, you have menopause for one day and it’s actually a retrospective day because it’s one day after you haven’t had a natural period for a full year,

right?

So like you don’t really even know it’s that day until like, yeah, right. So that’s menopause the day and then you’re post menopause and before that you’re pre menopause or what they call perimenopause, which peri means around. Got it. So around, some people will define perimenopause as up to a year after the year after no periods.

So like it gets very definitional, but when people like the, when we talk about the menopause transition,

right,

that kind of means like the years leading up to, and then the early couple of years with no periods, it’s a crappy definition because how many women have had hysterectomies or IUDs or birth control, right?

So they don’t have that marker of like, I have a uterus that has stopped bleeding. Right. Okay.

So,

how do you define But why does it happen?

Okay. Can we define perimenopause too? Yeah. Because now, now I’m like, wait, is perimenopause So yeah, so You’re saying perimenopause can be after?

Depending upon what definition you want.

Okay. And I don’t care. But yeah. So perimenopause can mean the year surrounding menopause, and so people will extend that to be like a year after what the menopause date is. So there’s kind of this bubble around that one day is perimenopause. Other people will describe perimenopause as up to 10 years before menopause, which how do you know you’re in perimenopause?

It’s, this is a clinical diagnosis. There’s no test. You know, I had, I had one woman, she was like obsessed of like, but am I in perimenopause? And I’m like, Well, you’re 44 by definition, you’re within 10 years of average age of menopause, which is 50. Yeah. But she was like, but am I? But she was trying to hound, she was in perimenopause and I’m like, what are you actually asking?

And what she was actually asking was, is it okay for me to take hormones? Oh,

wow. People are fascinating. Yeah. So it’s always

pro tip to the doctors of some, if somebody like get into actually what they’re wanting to know. Right. Right. Right. And I was like, of course you can take hormones. You absolutely can take hormones and

perimenopause.

Um, and perimenopause is really what, you know, an easy way to describe it as reverse puberty. So puberty is this like on off irregular periods. Maybe they’re super light, you know, basically trying to get you on to this like smooth cyclical, not that everybody’s life is smooth cyclical periods. But like kind of getting you onto the on ramp of the highway of reproductive period in life.

And then perimenopause is the off ramp of kind of being done with the reproductive period of your life. So heavy periods, 25 percent of women, heavy periods, some people light periods, the periods start to space out. You might start to skip a period

and

again, this it’s because of the ovarian hormones that are decreasing.

It’s, it’s, this isn’t exactly like, Oh, my periods are crazy. It’s like. that’s a result of the ovaries trying to, they’re basically sputtering out. We are outliving our ovaries.

Yeah. Oh,

that’s, yeah, that’s interesting. But the good news is, the good or bad news, the good news is we’re outliving everything, right?

Yeah. We outlive our hip, you get a new hip. You outlive your teeth, you get new teeth. You outlive your eyes, you get glasses. Right. You outlive your hearing, you get hearing aids. And I really want to normalize this of like, the exceptional thing is our lifespan. It’s not that like ovaries are the, you know, for some reason ovaries aren’t made to live to a hundred, but we are now like Western medicine’s amazing.

We can prevent, you know, dying from trauma and infections, which was the major killer of people before a hundred years ago. So really, you know, in thinking of perimenopause and menopause is like, we are lucky to have, to get the opportunity to keep living. That doesn’t mean we should suffer.

Yeah, so I think part of what I’m curious about with the perimenopause is, like, when should we be aware of symptoms and do we need to, like, when should we

do something about it?

Um, so symptoms, like, if you look up symptoms of perimenopause, like, it can be, like, a hundred different things. Not to stress people out, but to emphasize. We’re all going to feel this in different ways. Some of us aren’t going to feel anything. We’re just going to be hopping along and then no more periods.

I’m hoping for that. Right. So the, the healthier your system is, and what do I mean by that? People who exercise frequently, people who have healthy diets, people who have their glucose under control, people, you know, people who don’t smoke, um, do tend to have a smoother time with the hormonal changes.

Doesn’t mean you’re going to sail through it, but really healthy habits. Have been proven to take the edge off of things.

Okay. So that’s good to know that there’s, you know, things that are within our control in terms of managing blood sugar, exercising diet, that kind of thing. Um, yeah, I think part of what I’m curious about is like, if you do start having symptoms, is it good?

Is it good to go on hormones? You know, you, I’ve heard you talk about this a little bit, so I somewhat know your answer , but I would love for, you know, some of our listeners to understand like, what are the impacts of hormones, you know, and. Is this a healthy thing? I’ve also listened to some like Dave Asprey and he talks about like the Wiley protocol.

Um, you know, and I know sometimes people try to just, uh, stay in sort of the youthful fertile period. So what’s, what’s actually healthy for us?

First of all, I would say some people who make claim or look like experts are not. Very true. And that’s all I’ll say about your previous comment. Uh huh. I’ll remain professional.

Uh huh. That was very professional.

Um. Um, so for the first thing to know is that hormones, the hormones that are commercially available, FDA approved and covered by your insurance, which means low cost for most people are the hormones that your body makes. So we’re just think your thyroid’s low. We give you thyroid, your pancreas doesn’t produce insulin.

We give you insulin. These are hormones that your body naturally makes and we just give them back. So as far as people, you know, When trying to reach all people, some people have big stigmas around what a drug is or the fact that I don’t take drugs. Keep in mind these people take 30 different unregulated supplements, but their perspective is somehow a prescription means something different than something bought at CVS or Target.

But I would say that these medications are highly regulated, very safe, and are basically just what your body makes, and we’re just giving it back as your body starts declining its own production.

Okay. And I

really hope that, I really hope that helps people’s minds open up to like, these are, you know, there are lots of different drugs that can be helpful and that have side effects.

Oh yeah. Hormones are, Legitimately, just what your body makes, and we’re just giving it back to you, usually in smaller amounts than what your body naturally makes. So, I always want to introduce that because I know listeners come from all different, you know, belief systems.

Absolutely.

About, you know, what they do or do not want to put in their body.

I just want to give people different ways to think about it.

Yeah, that makes sense. But I

would say, when your symptoms are affecting your quality of life. I’m a lot more anxious about getting on airplanes now. I’m a lot more short with my kids and my partner. Uh, I cannot get more than 5 hours of sleep.

I’m waking up drenched. I had one woman, she’s like, I don’t have many symptoms, but I have 18 different nightgowns because I have to change my nightgown at least 2 or 3 times a night because I soak them. It’s like, wow, people will downplay what’s actually going on in their life. Unless you give them space to open up about it.

Yeah, I absolutely see that. It’s like, unless we get very kind of granular, sometimes people are like, Oh, it’s fine. Like I just found out a couple that I’m working with. doesn’t sleep in the same bedrooms and like retreats to their room like a couple hours before bed and I was like, that would have been really good information to have, but I think when people are so used to it, you know, they’re just like, this is just my normal, you know, and so they don’t always think to report it.

So,

yeah, yeah, I mean, especially coupled with the lack of medical education about their own bodies of like, Oh no, these are all mood changes. Like the, the rate of anxiety disorders, depression disorders skyrocket in midlife, 25 percent of midlife women are on an SSRI and all the experts would argue giving that, giving you your hormones back naturally is first line treatment.

An SSRI would be second line treatment for mood changes associated with perimenopause. And I always do my asterisk caveat, severe depression needs to be treated. But if you’re noticing like, ah, some moodiness, some anxiety, blah, blah, blah. Try, I would try the natural hormones first if you can, if given that option.

A hundred percent. And then the SSRIs can be our backup plan.

Yeah.

I think so. Some people need both, but many, many people, some, many, many people are like, I got back on the hormones. I’m smooth. I’m good. Yeah.

Right. And I, and I think you’re, I, that’s an important point for mental health is like, people don’t necessarily realize what a big impact their hormones can have on mental health, you know, like.

Hormones are life. And I actually know what I’m thinking about it. This woman was probably in the menopausal age range, but she came in and she’s like, I have so much anxiety and I have to address this, this, this. And we found out she had a thyroid issue. And like the second she got on thyroid hormone, it like all resolved itself, you know?

And it’s like, yeah, we have to look at. These biological aspects, like it’s a mind body system. It’s, you know, not separate. So, um, so yes, look at your hormones. Um, and yeah, so one of the other things I wanted to ask about is this phrase, like bioidentical hormones. So you hear things like that. Like, is it not all hormones are created equal?

Is there something people should be looking for?

Yeah. So let’s, let’s understand where that came from. So the women’s health initiative came out in 2002, basically scared the crap out of everybody. 70 percent of women were taken off their hormones in this country. Hormones are bad. Hormones cause cancer.

Hormones cause strokes. Like it made national news on a very large scale. So women are suffering. What are they to do? Who’s going to help them? And a group of helpers said, it’s okay. These are bio identical. These are safer.

Oh, interesting.

Now, fast forward to now, like I previously said, the medications you get that are FDA approved and covered by your insurance now are bioidentical.

Okay. The UK doesn’t even use the term bioidentical because it’s a marketing term and it confuses people.

Okay.

Right. So they use body, body identical, which helps you understand these are just the hormones that your body makes and we’re giving them back to you.

Okay.

And the point is, if you go to somebody who sells bioidentical and jacks up the price 10 times, they’re marketing to you because it.

Bio, bioidentical feels safer until you realize, yeah, until you realize all the hormones, all the standard hormones for perimenopause and menopause treatment now are bioidentical. Okay. So the caveat, birth control is not bioidentical. It can’t be. It needs to trick your body into thinking you’re pregnant.

That’s how it works. So it’s a very important education for people and education is power and it’s like, absolutely. But we, you know, when you go in needing birth control, we don’t say, this isn’t natural. We don’t say that. We say we’re going to help your body not get pregnant until you’re ready to get pregnant.

Right. Right? So like the judgment that people throw on medications and hormones is absolutely insane sometimes. And I think it comes from lack of knowledge, lack of education.

That makes sense. And I think the way you’re describing that, like, hey, these are all the hormones your body produces. Like. for sure that reduces anxiety for me.

You know, it’s like, okay, well that, you know, my body will probably receive it well. And I think that’s also important too, because we know the placebo effect is a thing. And so if people’s mental state when they start something is like, okay, cool, this will work great. Then it’s probably going to have a higher likelihood of working great.

Um,

yeah, that’s an important point. If you did not tolerate oral birth control pills for whatever reason, that does not mean you’re not going to tolerate. Perimenopause menopause hormone therapy. There are incredibly different molecules. Yeah. Estrogen doesn’t equal estrogen doesn’t equal estrogen when you kind of throw that term around.

Okay. Right. So so many people are like, I can’t take hormones because birth control x, y, and zed me. It’s like, these are Yeah, this is different, completely different product, right? And the more people are educated about that, they understand like, okay, well, let’s, and it’s a much lower dose.

That makes sense.

And I think the fact that you can like explain it in a way that people understand is so helpful because I also think there’s a lot of, you know, mistrust of big pharma and it’s like they just want to make money off of us and it’s like they’re, yes, and there’s also good products out there. You know, there’s also things that will change your life in a good way.

The same could be said for the supplement industry. Oh, for sure. You’re a sitting duck, my friend. Mm hmm. Menopause is undertreated and you’re looking for solutions. Yeah. You know how many people want your money? A lot. Right? And so I, I, I think, yeah. So I, the supplement industry, I think is it sees a large opportunity.

Right. Right. And supplements don’t mean safe, supplements don’t mean effective.

Right. Like

that is way more the wild west. Right. Than something that’s been through rigorous packaging, testing, sterilization, you know, purity testing of an FDA approved medication.

Mm hmm.

Right. And I think there’s, yeah, I think there’s good and bad in, in both categories.

And I also think it depends on the person and their body, you know, it’s like everyone’s going to respond different, but for sure what you’re saying, you know, I am someone who probably was taking 35 supplements at one point and, you know, definitely realize just because it’s a supplement doesn’t mean it won’t have side effects.

You know, some of it, oh yeah, there’s

liver, there’s liver failure documented in some menopause supplements. Oh, like you, by definition, you don’t know what’s in that pill. Right.

Right.

And that’s, that’s, that’s the supplement industry.

Right. And so, yeah, I’ve, I’ve done, you know, a good amount of research to figure out like what’s legit, but it’s like, yeah, you’re on your own doing that.

Like you’re. There’s no, uh, regulating body. So that is a good point. I appreciate that. And, and I, I often found that with functional doctors who I love, I love what functional medicine is all about, but, um, It would sometimes just be like, you’re still giving me pills. It’s like, they’re just different pills, but it’s like, we’re still kind of defaulting to that.

So, um, yeah, so that was an interesting experience to go through. Um, but yeah, so what can people expect? Like what, what are some of the challenges of perimenopause and menopause? Um, and. you know, in terms of even I’m thinking like, uh, how the tissues in your body changes, how this impacts your sex life. Um, so what do you see with that?

Yeah. So I mean, so I really got into menopause because of sex because I, you know, became pretty knowledgeable in female sexual health, sexual dysfunction, and people are like, yeah, but you know what happens? Yeah. But you know what happens? And I’m like, I’m looking down the barrel of this, you know, I’m, I’m of the age, what happens?

So I, I deep dove in the, the two main reasons that women become not sexually active in the perimenopause menopause transition is two things. Number one, availability of partner. Number two, vasomotor symptoms of menopause. Okay. I always say I can’t, I can’t help you with the first one. Yeah. I’ll try to help with that one.

Yeah. Yeah. You help with the availability of Um, but you know, certainly if you don’t have the, if you’re not in the sexual con, you know, context, if somebody’s, you’re kind of like, well, whatever, um, not everybody, but so vasomotor symptoms of menopause happens in perimenopause. You’re allowed to have hot flashes and periods, a big, big myth.

Big myth. If your doctor or provider tells you that you can’t start on hormones until your periods end, that’s bullshit. There’s, tell them, show me the rule. There is no rule. Okay. And why would that make sense? Why does the woman who gets a hysterectomy get to be on hormones or the woman who has an IUD get to be on hormones?

Like, right? We’ve like, fakely removed her period.

Right.

And the, then the natural woman has to wait for her periods to end. It’s, That’s completely made up.

Yeah,

it makes no sense. Yeah, right. So you can have basal motor symptoms of menopause in perimenopause Some would argue they are worse in perimenopause because of the extreme fluctuations of hormones in perimenopause Hmm, so if you’re not sleeping if you’re anxious if your joint aches and pains the musculoskeletal symptoms People have no idea frozen shoulder really happens at age 51 Yes.

Oh, wow. Um, and estrogen. They’re studying estrogen as a protective, uh, mechanism to say, what if you just start hormones a little earlier? Can you prevent frozen shoulder? Right? Um, so if all those things are happening, you are not feeling desirous, you’re not feeling relaxed, you’re not feeling receptive, you’re not feeling sexy, you know, you’re exhausted.

Yeah. Your body is, your body is going through some things. So really treating menopausal symptoms. Improve your sex life. Shocker. You’re sleeping better. You can have sex better. Right? So those are the two things. And then the other really important thing for your people to know is genital urinary syndrome of menopause or GSM.

Again, it’s good that they named it that because it used to be called vaginal atrophy. Nobody liked the atrophy term. Before vaginal atrophy, it was called senile vagina. Nobody liked that term.

That’s a terrible term. Senile

vagina. Welcome to the 1980s. Senile vagina. Senile vagina. I know, like I legit can’t make this up.

It writes it, this stuff writes itself. The comedy writes itself. Oh my gosh, that one’s special. Okay. So we’re getting better at calling it what it is. Yeah. But um, it certainly can happen in perimenopause.

The

thing people don’t know is it gets worse and worse the longer you go without estrogen. So estrogen is everywhere in your body.

It’s in your brain. It’s in your ears. It’s in your joints. It’s in your clitoris. It’s in your bladder. It’s in your heart. Like, estrogen’s everywhere. So to call these things sex hormones is really a misfunfortunate. It is. Because it really like, oh, it’s a sex hormone. It’s extra. Right? Right. These are brain hormones.

Wow. These are cardiovascular hormones. I do feel so misled. These are incredibly important. Wait. You have been misled, my friend. Okay. Like, don’t get me started on testosterone. Yeah, so listeners, if you’re

feeling this way, I am also feeling this way. You’re not alone.

Yeah. You’re not alone. Testosterone’s been erased from 50 percent of the bodies.

Right? Like I asked Google what testosterone is and it says it’s the male sex hormone. Oh my god. Which is, you know, yes and. Right. It’s, it’s in all bodies and it’s not just for sex. And regardless of gender, it could impact your sex drive, you know? So the

Okay. And then you take the hormones away and you get atrophy, burning when you pee, urinary frequency, getting up at night to pee, dry painful vagina, decreased lubrication, um, And it gets worse with time. So people don’t know that, again, remember, menopause is a hot flash. And if you didn’t have a hot flash, you didn’t have menopause.

Which, again, not true, but that’s what a lot of people think. So people will come to see me like seven years after their periods. They haven’t had sex in Oh my god. Um, and they don’t know that that’s because of low hormones.

So yeah. So let’s say people are experiencing, uh, GSM as we’re calling it, which used to be called vaginal atrophy.

What are some of the symptoms of that and how do you help people with that stuff?

Yeah. So some of the symptoms, and remember this can happen in perimenopause, it can happen years after menopause, and a lot of people don’t correlate it with a drop in hormones. And that’s really what it is. Interesting.

It’s a drop in estrogen and testosterone that can cause issues in the pelvis. Um. Yeah. Yeah. Urinary urgency, frequency, burning. So many women, recurrent urinary tract infections. They just keep taking antibiotics and not getting better. Getting up at night to urinate, decreased sensation sexually, decreased ability to orgasm, painful penetration.

Especially at that six o’clock entrance, that bottom part of the, uh, of the entrance of the vulva vagina, very, it gets thinned, it gets tight, you lose your elasticity. Estrogen is important for collagen and for elasticity and moisture.

Okay. So

you can use That all

makes sense.

Everybody should use lube with sex, whether you’re 21 or 70, like lube, lube just makes everything better.

It’s just a great idea. It’s just a great idea. Pro tip.

Yeah.

Get a tube of lube. I really like silicone lube for drier vulvas because it doesn’t get absorbed like a water base does. Uh, it will last a lot longer. So I have a silicone bias with dry skin. Um, and then this is a 20 solution, my friends. This is a tube of vaginal estrogen cream.

Oh. And yes, you 20

solutions.

We love 20 solutions. If your insurance does not give you a 20 solution, I’m gonna give you three pro tips to remember. So I, and this is, I, I went through this too. I’ve got Blue Cross Blue Shield, went into my pharmacy. They said, that’ll be 260. I said, do you know who I am and how much vaginal estrogen I put through this place?

And I pulled up my GoodRX app. I know. Uh, GoodRX, you type in the tube of cream, you type in your zip code, that should be about 20. Um, Mark Cuban Cost Plus Drugs is an amazing mail order pharmacy. Vaginal estrogen is right around 20, 25. So you just have your prescriber, prescribe on Epic, you know, all the main things you can prescribe to Mark Cuban Cost Plus Drugs.

Um, so that’s going to be less than 30. And then Amazon Pharmacy is kicking some butt. Um, Okay. And doing, again, this is cash, it’s a crime that we all have health insurance and you have to pay cash to get the lower price. This is not okay. I do not. It is. I do not consent to this. This should not be okay.

This is not okay. But uh, this is the world in 2024 until you complain more to your insurance companies and say, why am I not getting the lowest price by having insurance? Why is paying cash the lowest price? This is a crime. Um, but yes, it is a, it is a 20 solution. Yeah. This is generic. It’s been around since the 60s and 70s.

It’s over the counter in multiple countries. That’s how safe this is. Now the problem with a vaginal estrogen product and you can get it in a ring, in a tab and in a cream. I love the cream because you get it at the six o’clock spot. You put it on your labia so your labia don’t go away. People don’t know your labia minora resorb and go away after menopause.

Get it on your clitoris. Keep your clitoris healthy. Most, a lot of people, not everybody, but a lot of people.

Even if you’re doing the vaginal estrogen? No,

not if you’re doing the vaginal estrogen. Hormones keep labia. That’ll prevent it. That’s going to be my next t shirt. Hormones keep labia.

Wait, what did you say?

Hormones keep labia.

Catchy. Very catchy, Kelly. Very catchy. Thank you. I’m going to write that one down. That is a good, at least that’s a good meme. I’ll wear one

for you. Right? Thank you. That was pretty funny. Hormones

keep labias. I love it.

But no, it’s like these are things people don’t talk about. People don’t talk about the specifics that like your labia minora, which is the smaller lips of your vulva for people who maybe are not sure what we’re talking about, can just be reabsorbed.

And then you only have the labia majora, the bigger outer lips.

Yeah. And so, so people would say, so what? Well, the so what is that labia minora has at least two roles. Number one, sexual arousal, right? Great nerve endings. Great for sexual arousal. Number two, it protects the urethra. It protects the inside of the vagina.

It acts as curtains and you don’t want them to go away. The urethra will become more pronounced. After, with low hormones, making it more susceptible to being irritated, burning with pee, recurrent urinary tract infections. So we want to protect our tender, sensitive structures. Keep them healthy.

So basically what I’m hearing, and I’ve, I’ve seen you say this on social is like, get on the hormones early.

Like don’t wait for things to get

bad. I mean, that’s what, that’s what anybody who is an expert in GSM is like. Why would you wait for this to happen? And odds are, like flip of a coin, GSM happens 50 80 percent of vulva owners. So, like,

it’s not like,

you know, why are you trying to prevent something that happens 5 percent of the time?

Of like, I will be darned if I start suffering before I start preventing the suffering. It just makes sense to me. Like, why should I wait to get out of shape to decide to get into shape, right? Like, there are some things that They’re just something. Yeah, right. Like why wait for heart disease to start eating vegetables, right?

Just like starting in the vegetables. Just take care of your body. Just take care of your body. Yeah, so and because it’s okay Local hormones either come local or pelvic or vaginal and we don’t call them vaginal on social media because they block Anatomically correct words on social media. So a lot of times I call it pelvic hormones There you go.

I know it’s so upsetting that’s not going into your body It’s too low dose. It’s like sunscreen, right? So it will not help you sleep. It will not help your moods. It will not protect your bones. It will not help hot flashes. That is local hormones only for GSM. Very safe. The, the problem, there are multiple problems, including cost, but one of the problems is the warning on the local hormones is the same warning as very high dose.

oral, synthetic, non bioidentical. So the FDA doesn’t care, it’s estrogen, it’s estrogen, it’s estrogen, and they’re gonna put the same warning on everything. So literally the warning says it’s gonna kill you. It says probable dementia, probable, not possible.

It’s

all wrong. Breast cancer risk, wrong. Heart disease, stroke risk, wrong.

Can’t use if you don’t have, if you’ve had a blood clot, wrong. It is all wrong. We’re working on changing it. But if, if, if your provider doesn’t tell you those warning labels are wrong, you’re going to read it and be like, they’re trying to kill me. I’m not going to use this.

That’s really wild to know though about the hormones having kind of misleading labels.

Um, and you know, I’m curious, like, is there anyone where it is contraindicated? You know, I had a breast cancer survivor as a client and, um, Not contraindicated.

There’s nobody that can’t take vaginal estrogen. We have got, when we have guidelines, you can go online, you can search the ACOG, American College of Obstetrics and Gynecology.

There’s online statements saying this is safe for breast cancer survivors. Why? Why? Because we don’t absorb it. It’s not going in your body. This is skin care.

I mean, but

it gets into your vagina, which, which helps her not to

do this.

Doctors don’t know. Okay. People are only about 5 percent of breast cancer survivors are on vaginal estrogen.

It is not, they do not know they can be on it. And again, doctors think estrogen equals estrogen equals estrogen, and it’s not true.

Okay,

okay, and they’re suffering and they’re getting doctors

do actually know like like if people listening are kind of like what type of provider do I look for and how do I make sure I find someone who knows what you know, Kelly Casperson is talking about.

Yeah. Um, this would be my advice It doesn’t matter so much what they know is that they care.

Oh, that’s cute.

Thank you. I know it’s cute. Um, because you can, you can go in and you can bring them the guidelines and you can, and this is the other pro tip for seeing a doctor and asking hormones. Can I just try this for three months?

Let’s just try it for three months and I will, I will schedule a followup and I will tell you how it’s going. That is the power move way to talk to doctors to try something. Because the doctor knows you’re reliable, you’re going to come back, if it doesn’t work we’ll stop or we’ll change doses. Right.

Like that is the power move. And if they don’t want to give it to you, you can ask, and you know, you always do this in a nice way, but you can ask, why can’t I try this? And if they say, if they say, cause estrogen causes breast cancer, you can then say, right. The current studies say that it doesn’t. Can you show me, you know, what you’re referring to?

Because a lot of doctors, sadly, have not gotten the memo that the WHI is flawed. But yeah, you can ask nicely. Women’s Health Initiative. That’s the

2002 thing.

That’s the 2002 car wreck for women’s hormones.

Okay. This is, it’s, this is so helpful just to like get this information from someone who’s like in it all day, every day with people and really helping people with their bodies.

Um, yeah, I’m kind of, yeah, I’m just like blown away still. Um, my one other question would be, you know, thinking for myself, but also my listeners is like, how will I know it’s time to like go get the hormones?

Yeah. So for most people, symptoms will drive them in, right? They’ll be like, I can’t live like this anymore.

I need some solutions. So that’s kind of the clear cut case, right? Um, the not clear cut is I’m, I’m going to make something up. I’m 48. I feel fine. Yeah. Or let’s say I’m, let’s say I’m 52. So I’m, let’s say I’m a year past average age of menopause and I feel fine. Let’s talk about it. Cause this is, this is the interest.

This is the future. I truly think this is the future. I’ve had no symptoms like once a woman is educated on what’s happening to her body, I guarantee you she will notice something. But let’s, let’s say she hasn’t noticed, let’s say she hasn’t noticed her body, her lean body mass going down and her fat deposits.

Let’s say she’s noticed nothing. Right. Okay. You can’t, you can’t see osteoporosis, you can’t see heart disease, you can’t see brain changes. Mm-hmm . You can’t see insulin sensitivity changing. All of these things change when your estrogen goes down and you can’t see it. Okay. So there’s a role for saying, Hey, can you check my insulin sensitivity?

Can you check, you know, all the, can I get a bone scan, see what my lean body mass is? Okay. See if I’ve, you know, have osteopenia so you can check to, try to check for the things that you can’t see, or. I think you should be allowed to say I’d like to be put on this low dose hormones to help prevent these things.

I think a woman should be able to make that choice.

That makes sense. Like when you know it’s kind of imminent and it sounds like, you know, yeah, if it’s, if it’s coming your way anyways and it’s a low dose and I would think by the time you’re 48, 52, your estrogen has at least started declining.

Oh, yeah, absolutely.

For the majority of people. Some people are late menopause. Some people will have periods till they’re 58. Um, and this is what we know about estrogen. Estrogen is good. It’s not perfect. We all age. Estrogen does not prevent you from aging. This is not a, this is not a miracle. This is just a hormone. So estrogen is good at preventing disease.

Estrogen is not good. at treating disease. Once you have heart disease, once you have memory loss, once you have, you know, significant osteoporosis and fractures, it cannot reverse those things. And some would argue it’s actually might be unsafe to give you estrogen once you have those things going on. So you have a critical window of, I feel fine, but I want to lower my risk of disease.

Okay. That is the conversation. I

like what you said about checking the glucose, checking the bone density, you know, like look for those things.

Yeah. You can look because you can’t feel that. You can’t. You certainly can’t feel that. Um. But we’re not there yet as a nation. We’re not going to, and the guidelines say we’re not going to throw the nation on estrogen to prevent disease.

We, we, there’s no medication that is indicated for prevention for primary prevention of any disease in women, not baby aspirin, not statins, not a blood pressure pill. There is nothing as a nation that we do to prevent disease. But as an individual who’s healthy and cares about, I need to, I need to get to 95.

Because I got to see how this world turns out and I want to be as functional as I can. I think she, if she wants to, To accept, you know, the risks and benefits of hormones, she should be able to take them.

So this is really honestly amazing, like, knowledge bombs that you are dropping on all of us today, Kelly.

And like, if people are just like, I need to get more of Kelly, I, she’s amazing, she’s so smart. Where can they find you?

Um, my podcast is called You Are Not Broken. I talk a lot about sex podcast, so please come, come over and find me. Amazing podcast.

Yes. The

book is, uh, for pre order on Amazon right now, coming out in September.

It’s called You Are Not Broken, Stop Shitting All Over Your Sex Life.

Yes. Love this. So

fun. I do, I have a, I have a menopause chapter in there.

Oh, cool. But yeah, everyone go buy the book because, um, it also really helps creators when you buy during pre order time, so go do that. I will go buy one as well.

And then Instagram, the Instagram’s blowing up, so go hang out on Instagram. Kelly Casperson, MD.

And that’s how I found you. You create amazing content and I think you’re just very, you know, real and like tell it like it is and people need that. So thank you.

Thank you. Thanks for having me.

Absolutely. This was awesome.

Thanks everybody for listening and we will catch you next Monday. Bye. Bye.