Send us a text with a question or thought on this episode ( We cannot replay from this link)
Navigating menopause while managing endometriosis can feel like a battle with conflicting information and limited options. In this episode, we sit down with Vanessa Weiland, a primary care nurse practitioner and certified menopause specialist, to uncover the truth about menopause, hormone replacement therapy (HRT), and post-hysterectomy care.
Vanessa breaks down the gaps in traditional medical training surrounding menopause and why so many women feel unheard when seeking treatment. We explore the role of HRT in endometriosis care, how testosterone can benefit women, and the real risks associated with estrogen. Plus, we dive into natural strategies like the Mediterranean diet and phytoestrogens to support hormonal balance.
From debunking myths about the Women’s Health Initiative study to navigating medical gaslighting and post-surgical hormone options, this episode is packed with practical insights and expert-backed strategies. Whether you’re in perimenopause, postmenopause, or managing surgical menopause after an endometriosis diagnosis, this conversation will leave you feeling empowered and informed.
🔎 What You’ll Learn in This Episode:
✅ How menopause impacts endometriosis and pelvic pain
✅ The truth about estrogen, progesterone, and testosterone in HRT
✅ Managing menopause symptoms naturally and through diet
✅ How to advocate for yourself in the doctor’s office
✅ The importance of community and self-care in long-term health
🎧 Hit play now and take control of your menopause journey!
Website endobattery.com
Menopause and Hormonal Health Insights
Speaker 1
0:02
Welcome
to
EndoBattery
,
where
I
share
my
journey
with
endometriosis
and
chronic
illness
,
while
learning
and
growing
along
the
way
.
This
podcast
is
not
a
substitute
for
medical
advice
,
but
a
supportive
space
to
provide
community
and
valuable
information
so
you
never
have
to
face
this
journey
alone
.
We
embrace
a
range
of
perspectives
that
may
not
always
align
with
our
own
.
Believing
that
open
dialogue
helps
us
grow
and
gain
new
tools
always
align
with
our
own
.
Believing
that
open
dialogue
helps
us
grow
and
gain
new
tools
.
Join
me
as
I
share
stories
of
strength
,
resilience
and
hope
,
from
personal
experiences
to
expert
insights
.
I'm
your
host
,
alana
,
and
this
is
IndoBattery
charging
our
lives
when
endometriosis
drains
us
.
Welcome
back
to
IndoBattery
.
Grab
your
cup
of
coffee
or
your
cup
of
tea
and
join
me
at
the
table
.
Speaker 1
0:45
Today
we're
diving
into
a
topic
that
impacts
so
many
of
us
but
is
often
misunderstood
or
dismissed
,
and
that's
menopause
and
hormonal
health
.
And
to
help
us
navigate
this
journey
,
I
am
thrilled
to
welcome
Vanessa
Whelan
to
the
table
.
Vanessa
is
a
primary
care
nurse
practitioner
with
over
a
decade
of
experience
and
a
menopause
society
certified
practitioner
.
She
created
the
phases
framework
,
a
course
that
takes
a
holistic
approach
to
managing
menopause
symptoms
,
covering
everything
from
lifestyle
shifts
to
over
the
counter
solutions
and
medical
interventions
.
If
you're
in
Washington
state
,
you
can
even
see
her
in
person
at
phases
clinic
,
where
she
blends
hormone
therapy
,
hypnotherapy
and
more
to
support
menopause
and
sexual
health
.
You
can
also
follow
her
on
Instagram
,
at
phasisclinic
,
for
insightful
tips
and
expert
guidance
.
Speaker 1
1:33
So
,
whether
you're
navigating
perimenopause
,
postmenopause
or
surgical
menopause
,
or
just
want
to
be
more
informed
about
this
stage
of
life
,
vanessa
is
here
to
break
it
down
for
us
.
So
please
help
me
in
welcoming
Vanessa
Whelan
to
the
table
.
Thank
you
,
vanessa
,
so
much
for
joining
me
today
at
the
table
and
taking
the
time
to
share
your
passion
and
your
wisdom
and
your
insight
into
hormone
replacement
therapy
and
something
that's
near
and
dear
to
my
heart
,
which
is
surgical
menopause
and
hormone
replacement
therapy
.
But
I
think
,
in
the
broader
context
,
I
love
that
we're
talking
about
this
topic
.
So
thank
you
so
much
for
joining
me
today
.
Speaker 1
2:09
Thank
you
so
much
for
having
me
.
It's
a
pleasure
.
Can
you
give
us
a
background
of
what
you
do
and
what
you're
passionate
about
,
and
the
things
that
you're
striving
to
change
in
women's
health
care
?
Speaker 2
2:20
Thank
you
so
much
for
having
me
.
Speaker 2
2:22
I'm
an
adult
gerontology
primary
care
nurse
practitioner
.
I've
been
doing
that
for
about
12
years
and
in
my
training
as
a
nurse
practitioner
I
got
about
a
one
hour
lecture
on
menopause
and
,
for
whatever
reason
,
I
didn't
think
twice
about
whether
that
was
adequate
,
even
though
this
is
something
that
the
population
goes
through
for
a
large
portion
of
our
lives
.
So
I
was
practicing
in
gerontology
mostly
the
older
adults
for
the
last
10
years
or
so
and
then
I
realized
,
by
listening
to
a
podcast
of
all
things
,
that
the
training
I
had
gotten
in
menopause
was
not
only
so
little
,
it
was
also
really
out
of
date
and
inaccurate
and
that
just
made
me
mad
.
So
I've
spent
a
lot
of
time
since
then
learning
more
about
menopause
care
and
busting
a
lot
of
the
myths
around
hormone
therapy
,
and
I've
decided
to
dedicate
my
career
to
this
now
,
and
I
own
a
menopause
and
sexual
health
clinic
in
the
Seattle
area
and
also
really
enjoy
doing
education
around
this
for
both
you
know
,
the
folks
going
through
it
and
also
clinicians
,
to
try
to
move
that
needle
forward
.
Speaker 1
3:25
Yeah
,
I
feel
like
that's
probably
one
of
the
biggest
challenges
that
we
face
is
that
there's
a
lot
of
misinformation
or
outdated
information
surrounding
not
only
menopause
,
but
I
would
say
women's
care
in
general
is
very
outdated
,
and
that's
partly
because
women
weren't
researched
for
a
very
long
time
and
so
that's
been
kind
of
the
struggle
even
with
endometriosis
is
there's
so
much
outdated
information
out
there
that
really
wasn't
encompassing
the
complete
picture
,
and
I
think
what
I
like
about
your
story
is
that
you're
looking
at
it
from
a
holistic
standpoint
,
which
I
think
we
miss
.
That
right
and
in
our
healthcare
is
looking
at
menopause
as
being
holistic
because
it's
a
natural
thing
to
go
through
,
but
it's
not
natural
to
live
as
long
as
we
do
without
the
hormones
that
we
have
to
function
.
Speaker 2
4:20
Yeah
Well
,
you
touched
on
a
big
debate
in
the
menopause
community
about
whether
menopause
is
a
evolutionary
adaptation
or
if
it's
just
an
evolutionary
accident
.
But
regardless
,
we've
always
had
women
that
lived
until
their
70s
.
But
to
have
the
majority
of
us
live
into
our
70s
and
spend
a
third
of
our
life
in
menopause
,
that's
definitely
new
.
So
I
think
we
need
to
take
on
that
new
paradigm
with
new
solutions
.
Speaker 1
4:48
Yeah
,
I
agree
and
I
like
that
you're
not
afraid
to
speak
about
that
.
That's
great
for
future
generations
.
The
other
thing
that
I
admire
about
what
you're
doing
is
you
know
,
prior
to
us
doing
this
podcast
,
you
had
put
some
questions
out
there
,
and
I
kind
of
just
want
to
go
over
some
of
these
questions
,
because
these
are
questions
that
if
one
person
has
them
,
multiple
people
have
them
.
And
so
one
of
the
questions
that
was
asked
is
if
you've
had
a
hysterectomy
but
still
have
ovaries
,
what
symptoms
warrant
hormone
replacement
therapy
?
Speaker 2
5:20
Yeah
,
so
normally
menopause
is
a
clinical
diagnosis
and
we
use
periods
to
kind
of
help
figure
out
where
you
are
in
the
transition
.
So
oftentimes
early
perimenopause
you're
still
having
periods
,
but
they
get
longer
and
closer
together
and
heavier
,
and
then
later
perimenopause
is
when
they
start
to
get
more
spread
out
,
and
then
the
definition
of
menopause
is
one
year
without
a
period
at
all
.
So
obviously
all
that
is
all
out
the
window
if
you
don't
have
a
uterus
.
But
all
the
other
symptoms
ought
to
be
pretty
similar
.
So
a
lot
of
people
in
that
early
perimenopause
phase
the
reason
you're
having
heavier
and
longer
periods
is
that
you
have
less
progesterone
on
board
,
and
progesterone
also
can
make
you
sleepy
and
calmer
.
You
know
our
progesterone
is
naturally
highest
when
we're
in
that
week
before
our
period
.
Everyone
likes
talking
about
the
luteal
phase
now
where
you
just
chill
out
and
be
left
alone
.
So
when
you're
low
on
that
you
can
get
anxious
and
have
trouble
sleeping
.
So
if
you
start
to
notice
that
that
can
be
a
sign
of
early
perimenopause
,
and
then
in
that
middle
perimenopause
phase
where
your
periods
are
getting
spaced
out
,
that
means
that
you're
starting
to
lose
the
estrogen
and
so
low
estrogen
symptoms
are
the
stereotypical
symptoms
of
menopause
Hot
flashes
and
night
sweats
and
vaginal
dryness
.
Speaker 2
6:36
Some
common
things
that
are
less
well
known
are
heart
palpitations
,
itchy
skin
,
itchy
inside
your
ears
,
joint
pain
.
Speaker 2
6:43
A
lot
of
people
notice
brain
fog
and
forgetfulness
during
this
time
,
and
those
symptoms
tend
to
basically
ramp
up
to
their
most
extreme
in
that
,
I
would
say
,
two
years
,
right
around
the
last
period
,
typically
.
So
if
things
are
really
reaching
a
a
point
where
it's
almost
unmanageable
or
is
unmanageable
,
then
hopefully
you're
getting
toward
the
end
of
it
,
and
then
you
know
,
two
to
five
years
past
the
last
period
,
things
usually
start
to
settle
down
because
our
hormones
aren't
going
through
the
roller
coaster
anymore
.
They're
stable
but
they're
low
,
and
so
for
most
of
us
the
hot
flashes
do
calm
down
,
but
some
other
symptoms
of
low
estrogens
stick
around
,
like
the
vaginal
dryness
and
urinary
complaints
and
dry
skin
.
When
should
you
try
to
get
treatment
,
which
,
in
my
opinion
,
is
whenever
you
have
any
of
those
symptoms
,
is
reasonable
to
pursue
treatment
,
and
it
might
turn
out
that
it
wasn't
perimenopause
.
But
the
treatment
is
really
quite
safe
and
you
can
do
a
little
bit
of
an
experiment
and
see
if
you
do
feel
better
with
progesterone
for
those
anxiety
and
sleep
symptoms
early
on
.
Speaker 1
7:51
Do
you
think
that
there's
benefit
for
those
who
are
going
to
have
a
hysterectomy
and
maybe
not
even
a
nephrectomy
,
but
just
like
a
hysterectomy
and
or
a
nephrectomy
to
get
blood
work
prior
to
having
that
done
,
so
that
it
gives
the
providers
who
do
hormone
replacement
therapy
a
good
base
to
go
off
of
and
track
those
numbers
?
Or
is
that
not
significant
in
the
fact
that
maybe
it's
just
better
to
track
symptoms
?
Speaker 2
8:16
Yeah
,
the
blood
work
is
tricky
,
even
when
someone
hasn't
had
a
hysterectomy
a
lot
of
times
in
perimenopause
.
It
just
comes
back
normal
and
so
a
lot
of
people
have
experienced
basically
gaslighting
from
that
,
because
they
go
see
their
provider
and
they
say
I
have
all
these
symptoms
of
menopause
and
then
they
go
do
labs
and
they're
normal
.
So
I'm
always
happy
to
draw
labs
if
people
are
curious
and
if
you
draw
them
sequentially
,
like
a
lot
of
those
over-the-counter
perimenopause
kits
are
trying
to
get
your
FSH
.
You
know
,
I
think
it's
usually
several
months
in
a
row
and
then
you
might
catch
it
if
it's
going
into
the
menopause
range
sometimes
.
But
if
you
just
check
it
one
time
,
odds
are
it'll
just
be
normal
and
it's
hard
to
interpret
that
.
Speaker 1
8:56
Yeah
,
and
I
think
that
was
something
that
I
wasn't
sure
of
,
like
when
I
had
my
hysterectomy
,
my
oophorectomy
.
I
wasn't
sure
what
I
should
even
be
looking
at
.
So
I
think
what's
important
for
a
lot
of
people
considering
these
life
altering
changes
is
what
should
we
be
looking
at
prior
to
going
into
surgery
?
I
mean
,
we
know
our
bodies
are
going
to
change
,
but
how
fast
are
they
going
to
change
when
we
get
ovaries
removed
?
Or
even
how
fast
are
they
going
to
change
if
we
don't
,
but
we
cut
off
that
blood
supply
potentially
to
the
ovaries
?
Speaker 2
9:26
So
I'll
take
that
in
two
steps
.
So
if
you
do
have
the
oophorectomy
meaning
both
ovaries
are
removed
then
you
go
into
menopause
overnight
.
That's
surgical
menopause
,
which
is
really
well
documented
to
be
a
more
difficult
form
of
menopause
.
I
mean
,
it's
hard
enough
to
go
through
these
ups
and
downs
over
the
course
of
five
to
10
years
,
but
to
do
it
overnight
is
a
really
it's
whiplash
,
right
.
And
you're
not
only
losing
the
estrogen
and
progesterone
overnight
,
you're
also
losing
a
significant
portion
of
your
testosterone
,
because
that's
also
made
in
the
ovaries
,
it's
made
in
the
adrenals
too
,
so
you're
not
losing
all
of
it
,
but
you're
losing
a
bigger
chunk
than
even
someone
going
through
natural
menopause
.
So
that
can
cause
a
lot
of
changes
in
mood
,
and
one
study
found
that
almost
80%
of
women
after
surgical
menopause
have
a
change
in
their
sexual
desire
because
of
that
testosterone
loss
.
So
and
I'm
sure
we'll
talk
more
about
it
there
are
reasons
to
do
the
more
extensive
surgeries
versus
not
,
but
that's
definitely
something
to
keep
in
mind
.
Speaker 2
10:28
And
then
you
were
also
touching
on
if
you
have
the
hysterectomy
without
removing
both
ovaries
,
so
you
still
have
those
hormones
.
In
theory
,
you
still
have
those
hormones
functioning
normally
.
But
you're
right
that
there's
been
quite
a
few
studies
now
showing
that
when
you
have
the
hysterectomy
alone
,
it
tends
to
lead
to
earlier
menopause
.
And
you
know
,
it's
not
totally
clear
that
due
to
the
surgery
or
due
to
inflammation
or
due
to
changes
in
blood
flow
,
or
maybe
it
could
be
vice
versa
,
that
the
people
getting
hysterectomies
had
other
conditions
that
led
to
that
,
that
might
have
led
to
earlier
menopause
.
Anyway
,
we
don't
know
that
answer
and
there
is
some
data
that
endometriosis
,
regardless
of
surgery
status
,
can
lead
to
earlier
menopause
.
Speaker 2
11:12
So
there's
some
validity
to
that
too
.
Speaker 1
11:15
Yeah
,
I
think
I
experienced
a
lot
more
symptoms
and
I
think
partly
because
of
the
medical
management
of
my
endometriosis
.
There's
studies
that
indicate
that
taking
GnRH
agnus
drugs
can
decrease
your
ovarian
reserve
permanently
.
And
so
you
already
are
kind
of
up
against
the
wall
with
medical
management
of
that
.
And
then
when
you
do
actually
maybe
have
a
hysterectomy
and
it's
just
your
uterus
and
cervix
and
all
of
that
,
I
can't
imagine
that
.
That
doesn't
add
insult
to
injury
,
if
you
will
,
to
the
ovarian
reserve
.
Speaker 2
11:53
We
do
a
test
called
the
AMH
or
antral
follicle
count
,
which
is
an
imaging
test
,
but
I
actually
don't
know
if
there's
any
studies
looking
at
before
and
after
hysterectomy
for
those
things
.
Speaker 1
12:12
Yeah
,
it
would
be
interesting
to
find
that
out
,
just
because
I
think
that
there's
so
many
of
us
that
have
gone
through
medical
management
and
then
later
on
had
a
hysterectomy
,
and
I
think
you
know
I
can
only
speak
for
myself
,
but
I
can
tell
you
that
having
the
oophorectomy
for
me
was
essential
,
but
I
know
that
there's
other
people
that
have
had
both
and
it
is
there's
so
much
challenge
and
they
were
32
,
33
,
early
to
mid
thirties
when
that
happened
and
had
their
hysterectomy
and
they
went
into
perimenopause
early
and
so
I
don't
know
,
it'd
be
an
interesting
study
to
have
.
I
don't
know
if
there's
one
out
there
,
but
do
you
find
that
with
your
patients
with
endometriosis
,
there's
risk
to
having
hormone
replacement
therapy
for
menopause
symptoms
?
Speaker 2
12:56
So
I
did
look
at
this
and
it
seems
that
as
long
as
you
have
both
a
progestogen
which
is
either
a
natural
progesterone
or
a
synthetic
progesterone
along
with
the
estrogen
,
that
you're
in
good
shape
,
it's
not
going
to
make
the
endometriosis
grow
again
.
It's
just
if
you
have
estrogen
alone
that
can
potentially
make
the
endometriosis
grow
.
So
the
only
trick
about
that
is
if
you've
had
a
hysterectomy
,
most
providers
don't
think
about
doing
estrogen
plus
a
progestogen
,
because
usually
the
standard
of
care
is
only
estrogen
.
After
hysterectomy
,
you
don't
need
the
progestogen
to
protect
the
uterine
lining
anymore
,
right
?
So
you
have
to
find
a
provider
that's
a
little
bit
savvy
about
this
or
you
know
,
bring
the
research
to
them
yourself
that
there's
really
a
good
indication
to
add
the
progestogen
in
your
case
,
right
Hormone Replacement Therapy
Speaker 2
13:50
?
Speaker 1
13:50
And
and
.
For
me
and
this
is
something
maybe
you
can
speak
to
or
maybe
you
can't
we've
talked
about
this
a
little
bit
,
but
for
me
,
having
no
uterus
,
no
ovaries
,
I
chose
to
skip
the
progesterone
therapy
piece
of
this
because
of
my
hypermobility
,
and
so
it
caused
a
lot
of
issues
with
that
.
So
I
think
for
me
it
was
important
to
look
at
the
whole
picture
,
which
is
why
having
an
expert
in
hormone
replacement
therapy
could
be
beneficial
for
people
walking
through
this
.
Often
,
we
have
different
comorbidities
,
we
have
more
than
one
comorbidity
or
co-challenge
,
so
having
an
expert
actually
looking
at
your
whole
case
is
,
I
think
,
so
important
as
well
,
and
I
think
that's
kind
of
what
you
were
speaking
to
is
like
having
that
expert
look
at
whether
you
have
all
the
organs
or
not
,
to
look
at
what's
best
for
you
individually
.
Speaker 2
14:42
Another
piece
of
the
pie
is
the
testosterone
piece
,
particularly
if
you've
had
both
ovaries
removed
.
But
I
did
find
some
interesting
data
that
on
average
,
women
with
endometriosis
have
lower
testosterone
levels
.
So
testosterone
replacement
has
great
evidence
for
libido
and
growing
evidence
for
mood
and
body
symptoms
and
energy
evidence
for
mood
and
you
know
body
symptoms
and
energy
.
But
not
a
lot
of
providers
,
at
least
in
the
United
States
,
offer
it
for
women
at
all
,
because
there's
no
FDA-approved
version
of
testosterone
for
women
.
So
we
menopause
providers
often
use
the
male
version
and
only
a
tenth
of
it
,
which
is
not
ideal
.
Right
,
that's
what
we're
working
with
right
now
.
Speaker 1
15:23
As
someone
who
takes
it
,
I
appreciate
that
they
give
it
out
in
any
dose
.
A
question
that
was
asked
was
can
estrogen
increase
endometriosis
pain
post-excision
,
and
have
you
had
experience
with
this
?
I
can
tell
you
from
my
personal
experience
what
it's
been
.
But
for
you
,
what's
your
take
on
that
?
Speaker 2
15:41
All
I
can
go
is
off
of
the
data
,
which
is
that
if
you
do
the
estrogen
alone
,
you're
putting
yourself
at
risk
for
that
.
And
then
estrogen
plus
the
progestogen
most
likely
the
answer
is
no
,
but
I
know
that
in
your
case
you
weren't
feeling
so
great
on
the
progesterone
,
so
it's
going
to
be
case
by
case
.
Speaker 1
16:02
Yeah
,
there's
a
couple
I
think
a
couple
studies
that
kind
of
highlight
this
.
There's
one
,
and
the
title
of
it
is
Management
of
Menopause
in
Women
with
History
of
Endometriosis
.
They
talk
a
little
bit
about
that
.
There's
another
one
that
looks
at
the
review
of
literature
on
hormone
replacement
in
women
with
endometriosis
and
really
I
don't
think
there's
like
a
ton
of
research
to
back
up
one
way
or
the
other
.
It
does
highlight
,
I
think
in
these
research
articles
it
highlighted
that
it
could
potentially
perpetuate
some
of
the
pain
,
but
theoretically
,
if
it's
properly
excised
and
properly
removed
by
an
expert
,
you
shouldn't
see
those
symptoms
by
an
expert
.
You
shouldn't
see
those
symptoms
theoretically
speaking
,
and
that
goes
to
having
an
approach
where
you're
having
an
actual
expert
take
that
out
as
opposed
to
having
it
ablated
.
So
that's
just
my
take
on
it
.
Speaker 1
16:58
When
I
was
looking
into
it
and
asking
around
,
that
was
something
that
I
found
interesting
.
I
was
like
I
don't
know
if
pain's
going
to
come
back
.
I
think
there's
always
room
for
pain
to
come
back
with
endometriosis
.
It's
a
sneaky
little
monster
that
can
reappear
at
any
point
in
time
and
it's
different
for
everyone
and
I
think
we
can't
really
put
every
endometriosis
patient
into
the
same
category
.
We
are
so
individualized
because
the
disease
acts
so
differently
for
everyone
and
how
we
respond
to
it
.
So
that
was
something
that
I
thought
was
an
interesting
question
,
and
one
that's
valid
.
Speaker 2
17:33
Yeah
,
yeah
,
I
came
across
some
interesting
studies
too
,
looking
at
how
the
skill
of
the
surgeon
really
makes
a
big
difference
in
endometriosis
care
and
how
one
study
found
that
if
a
surgeon
had
performed
more
than
30
laparoscopies
for
endometriosis
they
had
much
better
rates
for
recurrence
and
also
the
fertility
if
that
was
a
concern
.
And
you
know
,
generally
speaking
the
remission
from
endometriosis
is
better
with
the
radical
hysterectomy
where
you
remove
the
uterus
and
ovaries
.
But
that's
something
to
keep
in
mind
if
you're
hoping
still
for
,
you
know
,
to
carry
a
baby
or
,
you
know
,
just
prefer
to
keep
your
uterus
and
ovaries
.
Based
on
the
rest
of
the
conversation
we've
had
,
that
really
seeking
out
a
skilled
surgeon
is
going
to
be
a
big
piece
of
that
puzzle
.
Speaker 1
18:26
Yeah
,
I
mean
,
you
don't
want
a
cardiologist
working
on
your
brain
and
it's
similar
in
endometriosis
you
know
you
.
You
want
the
the
right
provider
providing
a
service
to
you
that
is
going
to
be
a
holistic
approach
to
helping
give
you
your
quality
of
life
back
,
or
just
giving
it
to
you
.
In
general
,
some
of
us
have
lived
with
this
forever
.
So
have
you
noticed
a
difference
for
those
patients
who
have
started
hormone
replacement
therapy
right
after
having
a
hysterectomy
versus
those
who
have
waited
?
Is
there
risk
versus
benefit
in
doing
that
?
Speaker 2
19:02
I
mean
there's
no
need
to
wait
.
I
know
that
some
surgeons
are
wary
of
estrogen
because
of
some
studies
showing
higher
risk
of
blood
clot
Right
,
but
actually
no
study
has
ever
shown
an
increased
risk
of
blood
clot
as
long
as
the
estrogen
is
delivered
through
your
skin
.
So
that
means
a
patch
or
a
gel
or
the
vaginal
ring
.
So
that
can
and
,
in
my
opinion
,
should
be
given
.
Basically
,
you
should
wake
up
from
surgery
with
that
patch
on
so
that
you're
not
having
to
deal
with
this
extreme
drop
in
estrogen
levels
and
progesterone
.
I
can
see
where
the
surgeon
might
be
,
you
know
,
feel
like
they
want
to
just
play
it
safe
with
that
.
But
,
as
I
say
,
there's
literally
no
data
showing
a
higher
risk
of
blood
clot
,
whether
surgical
or
not
,
with
the
patch
.
Speaker 1
19:49
Are
there
risks
versus
benefits
in
doing
hormone
replacement
therapy
?
Because
since
the
Women's
Health
Initiative
I've
talked
about
this
before
but
they've
kind
of
taken
that
back
.
Can
you
explain
the
risk
versus
benefit
of
doing
hormone
replacement
,
versus
maybe
seeking
out
a
more
homeopathic
route
?
Speaker 2
20:12
So
it
depends
a
little
bit
on
how
old
you
are
when
you
go
through
this
.
So
if
you
go
through
surgical
menopause
or
natural
menopause
before
age
45
,
then
basically
across
the
board
,
from
medical
society
standpoint
,
you
really
should
be
on
hormone
therapy
,
at
least
until
the
average
age
of
menopause
,
which
is
about
51
,
52
.
Because
when
we
don't
do
that
there's
a
higher
risk
of
heart
disease
and
osteoporosis
and
dementia
.
So
in
that
case
I
feel
pretty
strongly
about
it
.
Of
course
some
people
will
still
choose
not
to
,
but
it's
going
to
be
a
really
uphill
battle
to
not
have
osteoporosis
if
you
go
into
surgical
menopause
before
age
45
.
So
if
you
go
into
surgical
menopause
after
age
45
or
natural
menopause
you
know
,
maybe
you
have
your
uterus
removed
and
you
go
into
natural
menopause
,
according
to
labs
,
in
your
50s
Then
there's
no
international
guidelines
saying
everybody
needs
to
be
on
hormone
therapy
,
but
it
still
will
have
those
same
benefits
as
far
as
brain
health
and
heart
health
and
bone
health
and
actually
lower
risk
of
diabetes
if
that's
in
your
family
,
something
to
consider
and
a
lower
risk
of
colon
cancer
.
So
we've
already
talked
a
little
bit
about
blood
clot
and
how
to
avoid
that
Hormone Replacement Therapy Considerations
Speaker 2
21:36
risk
.
Speaker 2
21:36
And
then
the
other
thing
that
people
worry
a
lot
about
is
the
risk
of
breast
cancer
,
and
that
is
meaningful
in
this
conversation
because
estrogen-only
hormone
therapy
hasn't
been
shown
to
increase
the
risk
of
breast
cancer
.
And
that
is
meaningful
in
this
conversation
because
estrogen-only
hormone
therapy
hasn't
been
shown
to
increase
the
risk
of
breast
cancer
and
in
fact
it
seems
to
lower
the
risk
.
But
when
you
combine
estrogen
plus
a
progestogen
,
which
is
what
we
said
you
ought
to
do
if
you've
had
endometriosis
,
then
we
think
it
increases
the
risk
of
breast
cancer
.
Now
we're
not
talking
about
a
huge
risk
in
the
that
WHI
study
which
put
the
fear
for
hormone
therapy
in
a
lot
of
people
.
Yes
,
it
actually
wasn't
a
statistically
significant
change
and
the
change
was
about
four
women
in
the
placebo
group
got
breast
cancer
for
every
thousand
,
versus
five
in
that
combined
group
.
So
we're
talking
about
less
than
one
in
a
thousand
additional
risk
.
Speaker 2
22:27
But
there
was
an
additional
risk
.
As
I
mentioned
,
the
risk
of
colon
cancer
is
lower
.
So
actually
the
overall
risk
of
cancer
is
lower
.
So
it's
all
things
to
take
into
account
.
If
you
have
a
family
history
of
breast
cancer
,
maybe
you're
coming
at
this
differently
than
someone
that
has
a
family
history
of
colon
cancer
,
right
but
so
basically
at
this
point
we
say
that
if
you
start
hormone
therapy
within
10
years
of
menopause
.
So
on
average
,
if
you
start
before
age
60
or
so
,
the
benefits
outweigh
the
risks
,
with
all
that
I
just
said
.
That's
the
way
to
summarize
it
.
So
if
you
have
symptoms
as
well
,
then
you
really
don't
need
to
feel
like
you
should
suffer
through
it
because
of
these
risks
.
Actually
,
the
health
benefits
outweigh
the
risks
.
Plus
,
you
can
stop
suffering
with
your
symptoms
.
Speaker 1
23:10
Yeah
,
something
that
people
have
asked
me
is
or
and
that
I've
heard
.
Actually
,
I've
had
a
deep
conversation
with
a
family
member
about
this
,
about
is
it
ever
?
Are
you
ever
too
old
to
start
hormone
replacement
therapy
,
and
specifically
testosterone
and
estrogen
?
But
are
you
ever
too
old
to
start
it
?
Or
is
there
a
decrease
in
benefit
the
later
you
start
?
Speaker 2
23:33
That's
definitely
the
case
that
there's
a
decrease
in
benefit
and
maybe
even
a
danger
to
starting
it
.
So
the
Women's
Health
Initiative
the
biggest
thing
they
were
studying
is
whether
hormone
therapy
could
prevent
heart
disease
.
There
were
a
lot
of
studies
showing
that
in
the
90s
and
they
enrolled
women
anywhere
from
50
to
79
.
So
in
that
entire
group
of
women
they
actually
found
a
higher
risk
of
heart
disease
in
the
women
on
hormone
therapy
.
Speaker 2
23:56
So
,
that
was
actually
the
original
finding
that
shut
down
the
study
.
But
when
they
reanalyzed
the
data
and
only
those
women
within
10
years
of
menopause
it
was
the
reverse
it
was
actually
a
lower
risk
of
heart
disease
.
So
we
don't
totally
know
what
that's
all
about
.
But
what
the
theory
is
is
estrogen
is
actually
beneficial
for
your
arteries
and
keeps
them
open
.
But
if
you
go
10
plus
years
without
any
estrogen
in
your
body
and
your
arteries
have
gotten
closed
up
and
then
all
of
a
sudden
you
blast
them
back
open
again
and
there
was
a
little
clot
forming
there
,
then
maybe
that's
what
knocks
the
clot
off
and
causes
a
blood
clot
or
heart
attack
.
And
it
does
seem
like
those
risks
of
clots
are
the
highest
in
the
first
six
months
.
So
that
kind
of
backs
that
up
,
I
would
say
.
Speaker 2
24:39
But
we
don't
know
that
for
sure
,
that's
just
the
guess
.
So
basically
there's
a
window
of
opportunity
where
it's
beneficial
and
then
if
you
already
have
artery
disease
and
you
add
it
,
then
you
actually
might
be
doing
more
harm
than
good
.
So
what
some
menopause
specialists
do
is
we
say
there's
no
age
where
you
can't
start
it
.
But
I
want
to
do
a
little
assessment
to
see
if
you
already
have
established
artery
disease
,
in
which
case
we're
probably
actually
doing
more
harm
than
good
.
But
if
someone's
70
and
their
artery
disease
checkup
is
completely
perfect
,
then
I
do
think
it's
still
safe
to
start
.
Maybe
they
want
to
improve
their
bone
health
or
maybe
they
still
have
hot
flashes
Some
people
still
do
even
20
plus
years
after
menopause
then
there
might
be
some
reasons
to
consider
starting
it
later
.
Speaker 1
25:26
What
about
testosterone
?
Is
that
similar
to
estrogen
or
is
it
different
?
I
don't
think
there's
ever
been
a
study
looking
at
.
Speaker 2
25:32
Is
there
a
correct
time
to
do
testosterone
replacement
,
but
I'm
not
aware
of
any
concerns
around
a
window
of
opportunity
with
that
.
So
if
your
main
symptom
is
low
libido
or
you're
having
a
really
hard
time
with
gaining
muscle
mass
and
you're
getting
really
tired
and
we
check
your
blood
levels
and
your
testosterone
is
low
,
then
we
can
try
replacing
it
.
If
your
testosterone
is
already
normal
or
high
normal
,
then
we're
not
going
to
give
you
testosterone
because
we
can
just
give
you
side
effects
like
knee
and
chin
hair
and
even
changing
your
voice
deeper
,
without
improving
any
of
those
symptoms
.
Speaker 1
26:07
Let's
go
the
reverse
now
,
because
I've
had
this
question
before
from
endopatients
who
are
like
I
don't
feel
right
still
and
they've
been
known
to
have
fluctuating
hormones
.
They've
been
known
to
have
a
lot
of
symptoms
of
perimenopause
but
aren't
showing
perimenopause
in
lab
work
.
And
they're
pretty
young
.
So
we're
going
to
say
,
looking
at
anywhere
between
the
25
to
35
age
range
,
is
there
risks
to
starting
hormone
replacement
therapy
prior
to
what
is
your
typical
perimenopause
starting
age
?
Speaker 2
26:43
No
,
I
mean
we
don't
typically
do
it
,
partly
because
hormone
therapy
is
not
birth
control
,
and
so
a
lot
of
times
younger
women
,
if
they're
having
some
symptoms
of
hormones
going
up
and
down
,
we
reach
toward
birth
control
because
we're
fixing
that
problem
and
making
sure
they
aren't
getting
pregnant
,
assuming
they
still
have
a
uterus
.
So
if
you
don't
have
a
uterus
,
then
obviously
we
don't
have
to
think
about
that
.
So
I
do
personally
think
that
hormone
therapy
is
safer
than
birth
control
.
We're
really
loose
with
how
we
prescribe
birth
control
.
We're
like
oh
,
you
have
acne
,
here's
your
birth
control
.
You
know
you
get
headaches
,
here's
your
birth
control
,
whatever
the
case
might
be
.
Speaker 2
27:21
And
so
I
do
think
it's
okay
to
experiment
a
little
bit
with
hormone
therapy
.
In
the
same
light
,
I
mean
we
shouldn't
avoid
ruling
out
other
causes
for
your
symptoms
.
I
mean
,
if
you
have
high
or
low
thyroid
,
that
can
really
mimic
perimenopause
,
If
you
have
vitamin
deficiencies
,
sleep
apnea
,
all
kinds
of
things
.
So
if
someone
is
younger
,
I'm
definitely
thinking
about
ruling
out
other
causes
.
But
if
that's
kind
of
the
last
remaining
piece
,
I
think
it's
fine
to
do
an
experiment
for
a
few
months
and
see
if
you
feel
better
.
Speaker 1
27:51
Yeah
,
is
that
true
,
even
still
with
testosterone
and
not
just
estrogen
?
Is
it
if
they're
feeling
low
libido
at
an
earlier
age
and
they've
had
maybe
multiple
surgeries
,
so
things
maybe
don't
feel
the
same
?
Is
that
something
to
consider
?
Speaker 2
28:06
Yeah
,
testosterone
we
can
replace
at
any
age
,
assuming
it's
low
,
and
our
testosterone
tends
to
drop
off
even
after
our
20s
.
So
a
lot
of
my
patients
on
testosterone
are
actually
premenopause
.
Speaker 1
28:19
Interesting
.
That's
really
interesting
because
I
haven't
heard
very
much
about
that
.
I
have
been
talking
to
multiple
people
who
have
been
advocating
for
themselves
to
get
hormone
therapies
and
most
providers
say
they're
too
young
.
But
what
they're
saying
is
I
have
symptoms
that
I
need
help
with
and
you're
not
hearing
me
.
And
a
lot
of
them
are
saying
we'll
just
throw
birth
control
at
you
and
there's
risks
with
birth
control
,
and
I
think
when
we
were
talking
clotting
risks
,
that's
a
huge
risk
in
birth
control
,
and
then
,
on
top
of
that
,
it
is
being
processed
through
your
liver
,
whereas
a
lot
of
the
hormone
therapies
are
not
processed
through
the
liver
because
they're
transdermal
.
And
so
I
think
how
do
we
shift
that
conversation
as
patients
to
get
better
care
around
this
issue
?
Speaker 2
29:07
You
know
what
?
I
do
think
things
are
changing
,
but
most
providers
,
like
me
,
got
very
little
education
in
menopause
and
what
we
did
get
was
hormone
therapy
is
bad
.
It
causes
heart
disease
and
breast
cancer
.
So
I
do
think
a
lot
more
providers
are
kind
of
hearing
in
the
ether
that
hormone
therapy
isn't
so
bad
as
they
thought
it
was
and
they're
willing
to
prescribe
it
.
But
they
don't
know
how
to
prescribe
it
,
and
so
I
think
maybe
seeing
a
menopause
specialist
for
a
little
while
,
just
to
get
on
the
regimen
that
works
for
you
,
and
then
checking
with
your
primary
care
provider
,
are
they
willing
to
take
over
on
the
prescribing
?
Speaker 2
29:38
I've
had
a
lot
of
luck
with
that
and
maybe
that's
where
I
am
in
Seattle
,
things
are
a
little
bit
more
liberal
,
I
don't
know
,
but
it
seems
like
a
lot
of
providers
are
like
okay
,
the
expert
says
this
is
okay
,
I'm
okay
with
it
,
with
the
exception
of
testosterone
.
A
lot
of
providers
are
really
not
comfortable
because
,
as
I
say
,
it's
not
FDA
approved
for
women
and
it's
a
scheduled
drug
,
so
I
even
have
I
mean
,
I
fight
with
pharmacies
all
the
time
I
actually
give
hand
out
what
I've
ordered
.
I
went
back
and
forth
with
a
pharmacist
yesterday
because
she
said
we
can
only
do
compounding
with
testosterone
for
women
.
I
said
that's
not
true
and
I
actually
sent
her
the
menopause
society
guidelines
specifically
recommending
against
compounded
testosterone
for
women
and
to
use
the
male
testosterone
at
one
10th
of
dose
,
and
she
said
okay
,
I
see
that
I
still
can't
do
it
.
Oh
my
goodness
,
wow
.
Speaker 1
30:28
That
brings
up
another
question
With
hormone
replacement
therapy
or
hormone
therapies
.
There's
multiple
different
versions
of
these
things
,
and
so
can
you
break
down
what
you
can
do
for
estrogen
,
what
you
can
do
for
testosterone
,
because
there's
a
lot
of
question
.
That
is
bioidentical
hormone
replacement
therapies
safe
,
are
they
efficacious
?
Are
the
pellets
better
?
Are
the
creams
better
?
You
know
,
there's
all
these
questions
and
there's
not
a
lot
out
there
,
and
yet
there
is
.
There's
a
lot
of
chatter
around
these
methods
,
but
there's
not
a
real
conclusive
way
to
approach
that
that
I
have
found
.
Speaker 2
31:09
Yes
,
basically
,
bioidentical
hormone
therapy
.
That's
kind
of
a
buzzword
,
it's
almost
a
marketing
term
more
than
anything
meaningful
,
but
it
means
that
the
hormone
looks
exactly
like
what
your
body
makes
.
So
the
three
bioidentical
hormones
are
estradiol
,
micronized
testosterone
and
testosterone
,
and
those
can
all
be
delivered
with
FDA
approved
options
.
Most
of
my
patients
are
on
bioidentical
estrogen
patches
,
estradiol
patches
.
So
that's
the
big
misunderstanding
is
it
has
to
be
compounded
.
For
some
people
compounding
is
the
right
choice
.
I
mean
I
have
patients
that
are
allergic
to
peanuts
and
they
need
to
be
on
compounded
progesterone
because
the
FDA
approved
option
is
made
with
peanut
oil
.
So
there's
reasons
that
I
reach
for
compounding
.
Speaker 2
31:50
Some
people
,
the
10th
of
a
male
dose
of
the
testosterone
just
is
not
realistic
,
is
not
going
to
work
for
them
and
we
can
do
the
compounding
.
But
it's
not
considered
first
line
because
there
have
been
some
studies
showing
from
batch
to
batch
within
the
same
lab
or
between
labs
,
even
with
the
same
prescription
,
it's
not
quite
the
same
dosing
versus
the
FDA
approved
.
You
know
what
you're
getting
.
Yeah
,
even
there
was
one
sub
of
cream
.
It
was
a
different
dose
on
the
top
versus
the
bottom
,
so
I
try
to
avoid
it
,
but
I
know
for
a
lot
of
people
in
their
local
area
.
Speaker 2
32:23
That's
all
that's
being
offered
by
providers
if
they
do
want
hormone
therapy
,
especially
testosterone
.
So
I
get
it
.
There's
a
vacuum
of
care
there
.
I'm
never
mad
at
any
woman
that
chooses
to
go
with
pellets
if
that's
literally
the
only
option
and
you're
just
trying
to
feel
better
.
But
I
do
recommend
against
the
compounding
and
especially
the
pellets
,
because
once
it's
placed
we
can't
remove
it
and
if
the
dose
is
too
low
or
too
high
you're
just
stuck
with
it
for
three
or
even
six
months
.
I
mean
too
low
,
that's
not
a
huge
deal
,
but
too
high
,
you
know
,
especially
testosterone
.
We're
talking
about
maybe
unintentionally
transitioning
.
So
that's
a
big
deal
,
right
.
Speaker 1
33:02
Yeah
,
and
that's
something
that
I
think
a
lot
of
people
struggle
with
is
knowing
how
to
approach
hormone
therapies
,
Because
in
my
specific
area
,
the
only
providers
that
I've
been
able
to
find
only
offer
the
compounding
.
But
the
compounding
,
too
that's
something
I
want
to
mention
is
it's
very
expensive
and
insurance
does
not
cover
it
.
And
I
don't
think
insurance
covers
the
testosterone
,
the
male
version
for
women
either
does
it
,
or
am
I
wrong
in
that
?
Speaker 2
33:36
Usually
no
.
Sometimes
,
if
you
use
the
correct
diagnosis
code
,
they
will
.
But
honestly
,
since
you're
using
the
male
dose
at
only
a
tenth
of
it
,
it's
very
affordable
.
A
lot
of
times
it's
about
$100
for
30
tubes
,
which
for
men
that's
a
one
month
supply
,
but
for
women
that's
a
300
day
supply
Very
manageable
.
Speaker 1
33:50
I
didn't
realize
Navigating Menopause and Hormone Therapy
Speaker 1
33:51
that
.
How
do
we
approach
our
providers
about
talking
about
that
though
?
Speaker 2
33:54
Yeah
,
I
think
so
.
There's
a
,
the
International
Society
for
Sexual
Health
and
Women
,
isswsh
.
They
have
a
list
of
providers
and
I
would
say
that's
probably
one
of
the
best
go-to
sources
of
providers
that
would
order
testosterone
without
doing
pellets
.
And
then
also
Heather
Hirsch
.
I
actually
studied
how
to
provide
hormone
therapy
through
her
course
for
clinicians
and
that's
what
her
course
recommends
,
and
she
now
has
a
directory
of
providers
that
have
taken
her
course
.
So
that's
another
resource
.
I
know
that
MIDI
I
think
in
certain
states
MIDI
will
prescribe
testosterone
.
So
,
yeah
,
I
wish
there
was
one
size
fits
all
approach
for
folks
,
but
there
are
some
resources
out
there
to
try
to
find
a
provider
.
Speaker 1
34:43
It's
hard
.
It's
so
hard
as
someone
that's
had
to
walk
through
this
and
I'm
continuing
to
struggle
finding
providers
.
It's
especially
challenging
when
you've
already
had
medical
trauma
because
of
urinometriosis
.
So
I
want
to
validate
you
in
saying
like
it
is
already
hard
when
you've
experienced
it
with
one
particularly
hard
illness
to
diagnose
,
treat
and
manage
.
And
then
moving
into
the
menopause
,
where
again
it's
misunderstood
,
misdiagnosed
and
ignored
.
Oftentimes
it
can
be
triggering
for
a
lot
of
people
to
try
to
find
another
provider
to
give
them
the
best
quality
care
,
and
so
I
want
to
just
take
the
time
to
acknowledge
that
because
it
is
very
challenging
.
But
I
do
think
that
there's
value
in
finding
people
and
having
those
resources
available
that
you
mentioned
to
look
up
people
that
really
are
passionate
about
menopause
,
because
it
makes
a
world
of
difference
for
your
quality
of
life
.
Speaker 2
35:47
And
something
else
I
want
to
call
out
,
which
is
the
case
for
me
as
well
,
that
a
lot
of
us
menopause
specialists
actually
don't
work
within
the
insurance
system
,
so
it
would
be
out
of
pocket
,
you
know
,
with
a
super
bill
or
something
like
that
,
and
so
that's
adding
another
barrier
for
folks
.
And
I
get
that
for
me
personally
.
Every
time
I
work
with
insurance
I
lose
a
piece
of
my
soul
.
It
was
for
my
mental
health
.
But
I
will
say
,
you
know
,
you've
already
heard
through
this
conversation
,
like
I
know
,
some
tricks
and
ways
to
kind
of
save
money
and
help
you
get
prescribed
by
your
primary
care
provider
.
I
think
a
lot
of
us
,
you
know
,
really
care
about
access
to
menopause
care
and
we'll
try
to
make
it
as
affordable
for
you
as
possible
.
So
it
might
be
worthwhile
to
see
a
specialist
for
three
to
six
months
to
get
on
that
regimen
and
then
see
if
your
primary
care
is
willing
to
take
over
,
so
that
you
don't
have
to
keep
paying
out
of
pocket
.
Speaker 1
36:38
Yeah
,
I
think
that's
one
of
the
hardest
things
about
navigating
health
journeys
in
general
right
now
is
the
accessibility
,
because
of
cost
and
our
insurance
system
is
not
built
to
include
both
provider
and
patient
.
It's
a
business
,
unfortunately
,
anymore
,
and
so
that
does
get
challenging
to
kind
of
navigate
,
which
again
can
add
a
little
bit
of
the
trauma
piece
to
it
as
well
.
But
are
there
ways
that
food
and
lifestyle
can
help
in
this
process
?
Speaker 2
37:11
Yeah
,
I
would
say
the
diet
that
has
the
best
overall
evidence
,
both
for
helping
you
live
longer
and
for
menopause
symptoms
,
is
the
Mediterranean
diet
,
which
is
considered
pretty
anti-inflammatory
,
so
it
can
be
helpful
for
a
lot
of
chronic
conditions
as
well
,
and
then
even
within
that
,
chronic
conditions
as
well
,
and
then
even
within
that
,
really
focusing
heavily
on
vegetables
.
You
know
,
even
some
studies
have
shown
a
vegan
diet
is
helpful
.
I
don't
know
if
it
needs
to
be
vegan
,
but
leaning
toward
fatty
fish
and
lean
meats
and
especially
a
lot
of
soy
seems
to
be
helpful
.
So
I
know
it's
boring
,
that's
what
the
data
supports
.
Speaker 1
37:46
And
it's
hard
too
,
because
then
we
have
like
opposite
opinions
on
soy
for
endometriosis
.
So
it
gets
really
tricky
for
that
.
Speaker 1
37:57
I
know
that
for
me
and
this
may
not
be
valid
,
so
I
don't
really
know
,
but
there
were
times
that
I
definitely
in
my
journey
,
was
told
soy
is
not
good
for
endometriosis
because
it
is
kind
of
like
a
synthetic
estrogen
,
so
to
speak
,
and
so
I
think
it's
something
to
talk
to
a
specialist
about
if
you're
really
concerned
about
that
piece
of
it
,
because
I
don't
know
the
answer
to
that
unless
you
have
any
evidence
that
points
otherwise
.
But
I
don't
really
know
whether
that's
valid
or
not
,
but
I
do
think
that
there's
concern
there
.
Speaker 2
38:27
Yeah
,
I
have
seen
studies
looking
at
the
endometrial
lining
with
soy
because
,
yeah
,
that's
a
concern
of
someone
using
soy
as
a
supplement
for
their
menopause
symptoms
and
it
doesn't
seem
like
it
thickens
the
endometrial
lining
,
so
that's
kind
of
a
correlate
to
endometriosis
.
But
I
don't
know
of
any
studies
specifically
around
endometriosis
.
It
does
seem
like
,
even
though
soy
acts
like
an
estrogen
,
it's
almost
more
like
a
CIRM
,
which
are
the
medicines
we
use
for
breast
cancer
,
for
instance
,
where
it
activates
estrogen
receptors
in
some
places
and
blocks
it
in
other
places
,
and
it
doesn't
seem
like
soy
is
as
active
in
breast
tissue
I
know
but
,
it
does
seem
to
be
helpful
in
bone
.
Speaker 2
39:04
So
overall
it
seems
beneficial
,
but
I
totally
understand
being
wary
for
those
reasons
.
Speaker 1
39:10
Yeah
,
there
are
some
people
that
are
going
to
be
hesitant
to
doing
hormone
replacement
therapy
with
estrogen
or
testosterone
.
Is
there
a
homeopathic
way
of
managing
perimenopause
or
menopause
symptoms
,
and
does
it
change
if
you've
gone
through
surgical
menopause
,
or
is
it
really
imperative
that
you
seek
out
more
estrogen
testosterone
therapies
?
Speaker 2
39:34
there
are
.
I
don't
know
of
any
homeopathies
that
have
scientific
evidence
for
being
helpful
.
I'm
sure
that
you
know
you
could
find
people
that
have
found
certain
things
helpful
,
or
maybe
working
with
a
provider
that
specializes
in
that
,
but
I
am
aware
of
some
supplements
that
are
helpful
,
like
we
were
just
talking
about
.
A
lot
of
the
supplements
that
are
most
effective
are
the
ones
with
phytoestrogens
,
meaning
you
know
a
plant
compound
that
can
actually
activate
your
estrogen
receptors
.
Black
cohosh
is
not
a
phytoestrogen
,
so
that
is
one
to
potentially
consider
if
you're
worried
about
that
.
Speaker 2
40:07
There
have
been
rare
cases
of
liver
damage
.
There's
like
no
good
thing
without
the
bad
side
,
so
I
think
probably
it
was
like
contaminated
supplements
.
So
it's
something
to
be
aware
of
.
If
you
suddenly
turn
yellow
after
you
start
your
black
cohosh
supplement
,
you
should
get
back
off
of
that
.
Yeah
,
it
really
depends
what
symptoms
of
menopause
you're
trying
to
target
,
but
I
do
think
there
are
supplements
that
seem
effective
for
hot
flashes
and
trouble
sleeping
and
arthritis
symptoms
,
things
like
that
.
It
kind
of
depends
what
you're
trying
to
target
.
It
doesn't
seem
like
one
thing
is
going
to
fix
all
of
those
.
Speaker 1
40:41
Yeah
,
and
that's
where
I
think
it
gets
challenging
,
because
obviously
we
talk
hormone
replacement
therapy
as
being
,
I
would
say
,
gold
standard
,
but
that's
not
what
everyone
is
comfortable
with
,
and
so
I
think
it's
important
that
we
address
that
.
There
are
those
people
who
aren't
comfortable
taking
it
and
there
are
other
modalities
that
they
could
potentially
look
at
.
But
is
this
different
for
surgical
menopause
?
Because
I
think
it's
hard
to
reproduce
a
hormone
when
you
don't
have
the
factory
that
does
the
hormones
.
Is
that
different
?
And
what
are
some
risks
of
not
doing
?
I
mean
,
we've
talked
a
little
bit
about
the
risks
of
not
having
replacement
therapy
for
after
a
hysterectomy
.
Is
there
benefit
to
not
doing
it
and
doing
a
more
homeopathic
route
,
or
is
it
not
beneficial
at
all
?
Speaker 2
41:30
I
guess
the
main
difference
with
surgical
menopause
would
be
the
testosterone
piece
,
and
there
are
less
.
So
if
we're
thinking
about
testosterone
for
libido
,
there
are
less
supplements
that
seem
to
work
really
well
for
that
.
Boron
seems
to
increase
testosterone
,
but
I
actually
don't
know
if
that's
working
through
the
ovaries
or
through
the
adrenal
gland
,
because
those
make
testosterone
as
well
.
Yeah
,
I
don't
have
a
great
answer
for
that
,
but
I
do
think
if
you
go
into
surgical
menopause
,
as
I
mentioned
before
age
45
,
then
that
is
really
where
I
draw
a
line
in
the
sand
.
I
think
hormone
therapy
is
really
important
for
your
long-term
health
,
but
after
that
you
can
definitely
explore
,
you
know
,
whatever
feels
best
for
you
.
Speaker 1
42:11
Is
there
something
that
you
wish
every
perimenopause
menopausal
or
surgical
menopausal
person
could
know
?
Speaker 2
42:20
I
feel
like
we've
covered
a
lot
of
it
,
that
you
know
there's
so
many
myths
around
this
and
that
we
don't
need
to
be
so
scared
of
hormone
therapy
.
And
then
the
other
big
piece
is
that
advocacy
piece
just
knowing
when
you
go
in
to
see
your
provider
and
almost
like
protecting
your
heart
,
that
they
probably
don't
know
a
ton
about
this
and
you
might
know
more
than
them
already
by
the
end
of
this
conversation
.
And
so
bringing
some
of
the
guidelines
with
you
,
like
the
Menopause
Society
Guideline
on
Hormone
Therapy
,
which
came
out
in
2022
,
it's
available
online
for
free
.
You
can
just
that
out
and
bring
it
with
you
,
and
that's
where
it
says
really
clearly
that
the
benefits
outweigh
the
risks
if
you're
within
that
age
timeline
.
It
wouldn't
talk
specifically
about
progesterone
,
even
after
a
hysterectomy
,
but
you
know
,
hopefully
they
will
take
your
word
for
it
on
that
.
As
far
as
the
endometriosis
history
,
Fortunately
a
lot
of
us
are
going
to
have
to
lean
into
the
self-advocacy
to
get
some
of
these
things
.
Speaker 1
43:14
Yeah
,
I'm
going
to
flip
the
switch
a
little
bit
on
you
.
You
want
to
try
something
new
?
Yeah
,
I'm
going
to
flip
the
switch
a
little
bit
on
you
.
You
want
to
try
something
new
.
I've
never
done
this
before
as
a
provider
that
isn't
an
endometriosis
provider
.
What
are
questions
that
you
,
as
a
provider
,
would
ask
a
patient
or
ask
someone
that
has
a
background
in
endometriosis
?
Speaker 2
43:31
Oh
,
I
love
this
because
one
of
the
questions
we
got
was
what
can
I
do
to
prevent
endometriosis
coming
back
?
I
don't
know
.
The
answer
to
that
was
what
can
I
do
to
prevent
?
Speaker 1
43:38
endometriosis
coming
back
?
I
don't
know
the
answer
to
that
.
Well
,
I
don't
think
there's
a
definitive
way
to
prevent
it
,
and
I
think
the
reason
for
that
is
is
that
first
of
all
,
you
need
to
have
proper
excision
by
a
real
expert
.
That
will
give
you
the
best
overall
outcome
and
if
you
can
do
that
the
first
time
around
,
that's
best
.
There's
always
a
risk
it
will
come
back
and
it
is
different
for
everyone
.
True
reoccurrence
does
happen
for
those
people
who
are
just
prone
to
having
endometriosis
lesions
form
.
So
there's
no
definitive
answer
to
that
.
But
you
have
a
better
chance
of
not
having
it
come
back
with
a
vengeance
if
it's
properly
excised
by
a
true
expert
symptom
relief
.
Speaker 1
44:28
It's
not
been
proven
to
eliminate
lesions
or
the
endometriosis
as
a
whole
,
but
it
is
important
to
highlight
the
fact
that
having
less
stress
in
your
life
because
it
tends
to
be
inflammatory
in
nature
,
and
the
way
that
it
responds
to
how
we
eat
,
how
we
respond
to
stress
,
how
we
respond
to
life's
challenges
,
can
translate
in
how
we
feel
with
our
endometriosis
.
Is
it
producing
more
flares
because
we
are
putting
things
in
our
body
that
respond
negatively
?
So
I
mean
there's
a
different
ways
to
look
at
that
True
endometriosis
.
I
don't
think
that
there's
any
one
very
definitive
way
,
but
there's
symptomatic
reliefs
that
you
can
do
to
help
alleviate
some
symptoms
,
but
it
won't
get
rid
of
the
endometriosis
.
I
hope
that
makes
Managing Inflammation and Self-Care for Endometriosis
Speaker 1
45:22
sense
.
Speaker 2
45:22
Are
you
aware
of
any
diet
that
can
help
or
other
lifestyle
things
that
can
help
as
far
as
inflammation
piece
?
Speaker 1
45:28
The
inflammation
piece
.
I
think
that's
going
to
be
varied
to
the
specific
person
.
That
is
because
a
lot
of
people
in
the
endometriosis
community
will
say
,
or
the
health
industry
that
does
endometriosis
stuff
as
well
,
will
say
do
gluten-free
,
do
dairy-free
,
go
vegan
,
and
those
can
be
all
really
good
,
but
they
can
also
be
really
bad
if
you
don't
need
to
,
and
so
I
think
that
it's
very
dependent
on
the
person
.
So
a
lot
of
people
will
say
I
have
to
go
gluten-free
because
I
feel
terrible
,
like
I
can
feel
it
in
my
joints
,
my
flares
are
significantly
worse
,
my
belly
the
blow
is
significantly
worse
,
and
I
haven't
experienced
that
.
Mine
is
like
beef
and
eggs
.
So
I
know
that
in
order
to
prevent
inflammation
from
happening
,
I
have
to
kind
of
avoid
those
foods
.
But
along
those
lines
,
making
sure
that
you
get
plenty
of
water
in
your
system
,
making
sure
that
you're
getting
sleep
,
which
is
really
hard
when
you
are
in
pain
and
you
have
chronic
illness
A
lot
,
of
us
really
struggle
with
sleep
A
lot
of
us
really
do
,
and
so
there's
another
challenge
there
.
Speaker 1
46:33
Right
,
but
trying
to
get
as
much
sleep
as
you
can
,
even
though
you're
exhausted
and
you
can't
sleep
that's
the
other
part
of
that
,
but
the
fatigue
,
fatigue
part
of
it
is
hard
.
And
then
this
is
one
thing
that
I
am
learning
is
balancing
your
boundaries
,
and
what
I
mean
by
that
is
that
we
in
society
are
trained
to
go
full
speed
ahead
,
and
when
you
have
a
chronic
illness
body
.
Speaker 1
46:57
Our
bodies
aren't
able
to
do
that
,
but
we
still
try
to
push
through
,
and
so
I
think
managing
expectations
of
yourself
and
having
good
boundaries
with
what
you're
able
to
do
and
what
your
body's
able
to
give
without
exceeding
its
limits
,
is
important
.
And
that's
another
piece
that
I
think
a
lot
of
us
in
the
endometriosis
community
struggle
with
is
putting
those
boundaries
without
guilt
,
and
you
know
,
stress
and
guilt
and
all
of
those
other
things
kind
of
play
into
how
our
bodies
respond
,
in
my
experience
.
And
so
I
would
say
,
setting
realistic
expectations
,
setting
those
good
,
healthy
boundaries
and
practicing
good
self-care
will
help
with
symptomatic
relief
,
in
my
opinion
.
Speaker 2
47:42
I
think
that's
very
wise
,
that's
something
.
I
need
to
hear
too
.
Speaker 1
47:45
I
feel
we
all
do
.
I
mean
,
I
was
talking
to
someone
else
about
this
recently
,
about
just
how
much
pressure
society
puts
on
us
to
perform
.
Speaker 2
47:55
How
much
?
Speaker 1
47:56
pressure
we
put
on
ourselves
to
do
things
that
our
bodies
really
struggle
to
do
,
and
then
what
it
does
is
it
creates
this
stress
factor
and
we
feel
guilty
because
we're
not
able
to
do
certain
things
,
because
our
bodies
are
in
pain
or
tired
or
even
our
brain
fog
and
fatigue
is
severe
,
and
that
tends
to
be
pretty
prevalent
with
endometriosis
.
And
giving
yourself
the
grace
to
say
I
can't
today
and
step
back
and
not
allow
others
to
dictate
your
well-being
,
I
think
is
important
because
it
is
really
really
hard
and
that's
not
going
to
eliminate
all
the
pain
.
It's
not
going
to
eliminate
if
you
have
pelvic
pain
,
you
need
to
see
a
pelvic
for
PT
and
there's
other
modalities
that
will
help
with
pelvic
pain
as
well
.
So
just
advocating
for
yourself
in
those
realms
is
important
.
But
when
we're
talking
relationally
whether
that's
family
members
,
coworkers
or
whatever
to
dictate
your
wellbeing
is
probably
where
a
boundary
should
be
drawn
.
Our
bodies
respond
to
that
in
my
experience
.
Yeah
.
Speaker 2
49:03
Now
that
was
something
we
didn't
talk
about
is
that
I
studied
hypnotherapy
as
well
,
so
that
can
be
really
helpful
for
menopause
symptoms
because
,
like
you're
saying
,
it
doesn't
necessarily
remove
the
source
of
what's
bothersome
,
but
it
can
change
your
relationship
with
it
.
Speaker 1
49:20
Yeah
.
Speaker 2
49:20
And
maybe
turn
down
the
dial
.
Like
,
for
instance
,
you
know
,
let's
say
you
stub
your
toe
and
then
immediately
go
and
watch
an
engrossing
movie
and
you
completely
forget
about
it
.
Right
Versus
you
stub
your
toe
and
then
immediately
take
off
your
sock
and
your
shoe
and
stare
at
it
and
prod
it
and
it
feels
10
times
worse
,
so
that
it
was
the
same
injury
.
But
how
you're
relating
to
it
can
really
impact
how
it
feels
and
hypnotherapy
and
other
forms
of
therapy
and
mindfulness
and
meditation
can
be
really
helpful
for
changing
that
relationship
a
little
bit
.
Speaker 1
49:54
Absolutely
,
and
I
think
that's
another
thing
that
is
helpful
for
patients
with
endometriosis
because
,
you
know
,
a
lot
of
us
associate
pain
and
even
after
excision
,
this
is
something
that
is
being
talked
about
a
little
bit
more
,
but
probably
needs
to
be
talked
about
even
more
is
the
fact
that
our
bodies
are
trained
to
respond
to
the
pain
that
we
have
.
Right
,
it's
that
connection
,
that
neuro
connection
.
Speaker 1
50:20
And
so
sometimes
,
when
we've
had
surgery
and
we're
still
feeling
pains
not
to
invalidate
your
pain
,
but
sometimes
it's
important
to
get
those
therapies
to
identify
whether
this
is
an
actual
pain
or
it's
a
trauma
.
And
I
think
that's
something
that
I
didn't
realize
when
I
went
through
my
surgery
and
have
gone
through
this
journey
of
learning
more
is
that
there's
a
huge
connection
between
what's
actually
going
on
in
your
body
and
the
trauma
it's
experienced
,
and
so
for
me
,
that's
something
that
I've
had
to
learn
along
the
way
is
therapy
is
not
a
bad
thing
.
It's
a
really
,
really
good
thing
and
,
in
fact
,
it
can
help
your
pain
management
.
Speaker 2
51:00
Yeah
,
I
think
that's
very
true
.
Speaker 1
51:01
I
also
think
that
community
that
was
the
other
part
of
this
that
you
know
as
providers
I
think
something
that
would
be
helpful
is
to
really
pointing
your
patients
into
community
,
because
when
you're
not
feeling
your
best
,
our
natural
response
is
to
be
very
isolated
.
Speaker 1
51:22
We
isolate
ourselves
because
we
don't
feel
good
and
we
don't
want
to
do
these
things
,
and
so
that's
something
that
I
,
for
myself
,
have
noticed
.
A
huge
difference
is
being
in
community
,
where
people
who
have
shared
experiences
can
help
you
.
I've
been
there
,
you
know
,
and
they're
like
oh
,
I
went
to
this
doctor
and
it's
been
really
helpful
.
I
experienced
this
symptom
and
they
actually
found
that
it
was
this
and
that
was
super
helpful
.
So
,
getting
in
community
with
people
who
understand
it
or
,
you
know
,
you're
having
a
bad
day
and
you're
like
I
just
cannot
pull
myself
together
they're
going
to
show
you
more
grace
than
those
who
don't
or
haven't
experienced
what
you've
experienced
,
and
so
,
from
that
perspective
,
I
think
community
can
be
a
great
healer
and
it
can
be
really
helpful
for
symptoms
.
Speaker 1
52:03
So
those
are
the
things
that
I
would
pass
on
to
providers
.
Those
are
helpful
for
patients
.
Speaker 2
52:08
Yeah
,
I
think
that's
true
for
menopause
as
well
,
and
I
think
that's
happening
more
and
more
.
Speaker 1
52:13
Yeah
,
and
I
think
there's
more
conversations
happening
to
surrounding
menopause
and
endometriosis
.
I
think
,
as
a
whole
,
you
can't
ignore
the
chatter
happening
around
.
Patients
are
becoming
more
savvy
and
I
think
you
know
,
as
a
community
mostly
made
up
of
women
,
we
are
kind
of
tired
of
being
ignored
,
and
so
I
think
conversations
are
happening
surrounding
both
menopause
and
endometriosis
,
because
it's
been
such
a
lackluster
care
until
this
point
and
because
the
system
at
large
was
not
made
for
women
,
it
was
made
by
men
for
men
,
and
that's
what
they
researched
for
so
long
.
But
we're
the
biggest
consumers
of
healthcare
,
and
to
have
a
lack
of
information
,
a
lack
of
studies
and
a
lack
of
understanding
surrounding
our
healthcare
,
I
think
we're
getting
a
lot
more
vocal
about
that
,
and
I'm
sure
social
media
has
done
a
good
job
at
that
too
.
So
that's
,
I
mean
,
that's
kind
of
what
I've
noticed
,
and
I
don't
know
if
you've
noticed
that
a
lot
more
with
your
patients
coming
in
.
Speaker 2
53:16
Yeah
,
even
in
this
kind
of
micro
generation
between
my
patients
in
their
mid
fifties
versus
mid
forties
,
I
think
a
lot
more
are
talking
about
it
and
hearing
about
it
from
their
friends
.
So
,
yeah
,
I
think
Gen
X
is
leading
the
charge
for
us
.
Speaker 1
53:34
I
think
they
are
,
and
I
do
think
like
there's
this
generational
difference
,
right
,
because
if
you
think
back
to
the
fifties
,
no
one
talked
about
their
period
,
no
one
brought
up
what
their
ailments
were
if
you
will
,
you
know
and
so
I
think
that's
shifted
,
even
in
the
family
dynamic
that
shifted
.
I
think
.
I
look
back
at
you
know
,
when
I
was
growing
up
,
my
mom
didn't
really
talk
a
lot
about
her
period
you
know
,
and
she
didn't
talk
a
lot
about
menopause
.
Speaker 1
54:03
But
I
think
that's
shifting
and
I
think
people
are
talking
more
in
the
family
setting
,
not
just
in
like
a
clinical
social
media
setting
.
I
think
people
are
talking
more
in
the
family
setting
and
I
actually
think
if
we
start
talking
earlier
on
with
our
family
members
,
because
we
know
endometriosis
has
a
genetic
component
,
I
think
earlier
diagnosis
will
be
more
achievable
at
that
point
.
Speaker 2
54:27
Yeah
,
no
,
I
think
that's
true
for
Empowering Conversations on Women's Health
Speaker 2
54:29
menopause
too
.
Your
your
menopause
is
most
likely
to
follow
a
similar
path
to
your
,
your
mom
or
your
older
sisters
.
Yeah
,
so
you
can
have
these
conversations
to
know
what
to
expect
.
Speaker 1
54:40
Yeah
,
talking
about
that
though
,
for
like
the
generational
,
would
it
follow
more
your
mom
and
sisters
or
your
family
in
general
?
So
like
your
dad's
side
as
well
,
do
you
look
at
that
?
I've
?
Speaker 2
54:51
heard
that
it's
your
mom
,
but
I
mean
probably
just
because
it's
so
hard
to
ask
our
dad's
mother
.
Speaker 1
54:58
Right
,
no
one's
sitting
there
at
the
Thanksgiving
table
talking
about
all
of
that
.
Hopefully
this
past
Thanksgiving
they
were
.
Speaker 1
55:04
Yeah
,
we
can
change
that
too
.
I'm
so
open
.
It's
so
funny
to
see
the
difference
in
generations
.
Now
that
I'm
starting
to
talk
more
about
my
struggles
with
endometriosis
and
menopause
,
it's
starting
to
open
up
my
mom
and
my
mother-in-law
my
mother-in-law
and
I
actually
had
a
conversation
about
this
recently
and
talking
about
menopause
and
our
feelings
about
it
and
our
approach
to
hormone
replacement
therapies
and
things
like
that
.
So
it
actually
opened
up
that
conversation
and
what's
interesting
is
she's
my
mother-in-law
has
been
a
big
proponent
of
talking
to
people
about
endometriosis
now
that
she's
learning
more
,
and
so
it
takes
just
one
person
being
out
and
spoken
about
it
,
and
that's
not
true
for
everyone
.
Speaker 1
55:53
There
is
going
to
be
those
family
members
that
don't
receive
that
as
well
,
but
I
would
say
that
for
me
,
the
conversations
are
happening
more
because
I'm
willing
to
talk
about
it
.
I
mean
,
it
has
to
be
an
inappropriate
time
,
it's
probably
not
going
to
be
around
Thanksgiving
table
or
the
Christmas
table
,
but
to
talk
about
those
things
I
think
will
change
the
trajectory
for
women's
health
in
general
.
Speaker 2
56:17
I
think
so
,
Especially
at
work
.
We
need
to
be
the
squeaky
wheel
.
Yeah
,
so
that
accommodations
.
Speaker 1
56:23
And
that's
an
interesting
thing
to
think
about
too
.
For
your
patients
who
are
struggling
through
menopause
symptoms
.
Are
there
ways
that
you
help
them
navigate
accommodations
for
what
they
need
at
work
or
in
a
different
setting
?
Speaker 2
56:40
You
know
I
don't
have
a
specific
way
that
I
do
that
,
but
I
definitely
would
recommend
it
for
anyone
.
You
know
there's
actually
been
studies
showing
that
if
you
have
a
hot
flash
at
work
and
you
say
,
oh
I'm
sorry
,
I'm
having
a
hot
flash
,
people
respond
better
to
that
than
if
you
just
don't
say
anything
and
appear
kind
of
flustered
and
strange
.
So
there
actually
is
benefit
to
talking
about
it
.
And
I
also
think
,
as
far
as
getting
accommodations
where
,
like
you
,
can
work
from
home
if
needed
or
have
more
control
over
the
temperature
in
the
room
,
things
like
that
the
more
people
that
bring
it
up
,
the
more
quickly
we'll
get
change
there
.
But
there's
some
interesting
data
coming
out
that
you
know
women
are
really
taking
that
seriously
and
are
willing
to
leave
a
job
and
find
a
different
one
for
better
menopause
benefits
.
So
I
really
think
that
more
employers
are
taking
it
seriously
too
.
But
maybe
what
they
think
is
adequate
is
not
Right
.
It's
probably
going
to
take
us
educating
them
a
little
bit
about
what
we
need
.
Speaker 1
57:37
That's
interesting
that
you
talk
about
what
we
think
is
adequate
versus
what
they
think
is
adequate
.
There
was
a
recent
Stephen
Colbert
interview
,
actually
,
and
he
was
talking
to
gosh
,
I
don't
remember
I
think
I
don't
remember
who
it
was
and
asked
what
is
menopause
?
He's
like
I'm
a
grown
man
and
I've
seen
this
all
my
life
.
We've
we've
heard
here
and
there
but
what
is
menopause
?
Grown
man
,
and
I've
seen
this
all
my
life
,
we've
,
we've
heard
here
and
there
,
but
what
is
menopause
?
Speaker 1
58:05
And
it
was
interesting
because
that's
where
the
education
lacks
as
well
,
right
,
Like
we're
really
good
at
educating
ourselves
,
but
I
think
it's
important
that
we
spread
that
education
to
those
who
maybe
it
doesn't
affect
directly
,
um
,
but
maybe
indirectly
.
And
spreading
that
information
because
maybe
we
would
get
more
accommodations
,
because
maybe
we
would
get
more
accommodations
or
maybe
we'd
get
more
understanding
when
we're
having
a
fiery
moment
of
perimenopause
and
want
to
scream
one
minute
and
laugh
the
other
.
You
know
,
just
that
understanding
piece
of
it
.
Speaker 2
58:31
Yeah
,
I
think
so
too
.
Speaker 1
58:33
This
conversation
.
It
was
interesting
,
you
know
,
when
you
and
I
had
talked
previously
offline
when
we
talked
about
the
correlations
between
the
care
of
menopause
and
the
care
of
endometriosis
.
They're
very
,
very
similar
and
they're
along
with
a
slew
of
other
comorbidities
,
if
you
will
,
but
they're
very
similar
in
the
lack
of
education
,
the
lack
of
understanding
,
the
lack
of
treatment
the
lack
of
education
,
the
lack
of
understanding
,
the
lack
of
treatment
.
What
is
?
Speaker 2
59:05
your
hope
moving
forward
for
not
only
menopause
but
for
women's
health
.
Yeah
,
I'm
really
optimistic
.
The
Menopause
Society
holds
an
annual
conference
and
they
sold
out
for
the
first
time
this
past
summer
Like
I
mentioned
,
Heather
Hirsch
that
course
that
I
took
to
learn
more
about
prescribing
hormone
therapy
.
I
mean
,
that
group
is
always
growing
and
growing
and
growing
,
and
more
and
more
providers
are
choosing
to
get
educated
about
this
.
So
I
do
think
it's
on
the
upswing
.
I
think
it
started
with
patients
,
so
kudos
to
us
,
Right
,
but
it's
filtering
into
the
clinician
side
.
I
can
tell
you
from
being
part
of
that
.
So
you
know
,
I
do
think
that
newer
providers
are
generally
a
little
bit
better
about
shared
decision
making
too
,
so
I
think
it's
getting
better
and
all
we
can
do
is
keep
advocating
and
keep
helping
to
move
that
forward
.
Speaker 1
59:50
Yeah
,
I'm
excited
about
all
the
people
talking
about
it
and
it's
becoming
more
of
a
talking
piece
across
all
platforms
,
not
just
women's
platforms
.
I
think
that's
really
important
.
I
think
it's
becoming
more
of
a
talking
piece
across
all
platforms
,
not
just
women's
platforms
.
I
think
that's
really
important
.
I
think
it's
true
with
endometriosis
as
well
.
I
am
hopeful
that
maybe
we
could
define
endometriosis
more
accurately
more
often
in
the
future
,
and
that's
going
to
take
a
patient
and
provider
team
to
make
that
happen
as
well
.
So
I'm
excited
for
that
.
But
the
correlations
are
strong
and
we
have
to
understand
endometriosis
and
menopause
as
they
go
hand
in
hand
a
lot
of
times
.
So
I
think
this
conversation
has
been
really
enlightening
for
that
purpose
alone
.
Any
parting
words
of
wisdom
that
you
have
for
our
listeners
?
Speaker 2
1:00:35
I
gave
you
some
good
resources
to
find
providers
.
The
Menopause
Society
also
has
a
list
of
providers
.
You
can
kind
of
know
ahead
of
time
if
they
have
some
particular
interest
in
menopause
and
then
,
even
before
you
make
the
appointment
,
you
can
ask
about
those
questions
about
you
know
,
do
you
offer
testosterone
,
do
you
offer
pellets
only
,
or
you
know
FDA
approved
options
,
so
that
you
aren't
wasting
your
time
with
an
appointment
with
somebody
that
doesn't
provide
care
the
way
you'd
like
.
I
personally
work
in
Washington
state
.
I
do
telehealth
all
through
Washington
and
then
,
for
those
of
you
that
are
more
interested
in
supplements
or
lifestyle
pieces
for
all
these
symptoms
we
were
talking
about
,
like
mood
changes
and
changes
in
libido
and
trouble
sleeping
,
I
have
a
course
actually
at
phasesacademycom
where
I
go
through
lifestyle
changes
,
supplements
and
then
medical
management
.
Speaker 2
1:01:27
That's
the
way
I
practice
.
That's
the
way
I
am
as
a
patient
is
,
when
I
have
a
medical
condition
,
I
want
to
know
what
are
the
few
things
I
can
do
with
my
diet
and
then
,
if
that
doesn't
work
,
okay
,
what
supplement
can
I
supplement
?
All
right
,
who
should
I
talk
to
about
medical
management
?
So
that's
the
way
I
designed
my
courses
,
basically
for
myself
.
So
hopefully
I'm
not
the
only
one
that
thinks
that
way
.
Speaker 1
1:01:46
No
,
I
don't
think
you
are
.
I
think
a
lot
of
us
do
think
that
way
.
I
know
I
do
and
I
think
that
a
lot
of
people
I
talk
to
really
appreciate
that
approach
,
because
sometimes
less
is
more
,
but
sometimes
you
still
need
support
.
Speaker 1
1:02:00
So
I
think
that's
valuable
information
and
I
will
make
sure
to
put
these
links
all
in
the
podcast
episode
description
so
that
they're
easily
accessible
for
everyone
to
get
to
.
If
you
want
more
information
on
that
,
so
I
will
happily
put
those
in
there
.
But
,
vanessa
,
thank
you
so
much
for
taking
the
time
to
sit
down
with
me
and
to
go
over
all
of
this
nuanced
information
for
society
.
I
appreciate
your
time
and
your
willingness
to
share
your
expertise
with
all
of
us
.
Speaker 2
1:02:29
Well
,
thank
you
for
sharing
your
expertise
with
me
also
.
Speaker 1
1:02:31
Yes
,
that
was
fun
.
I
should
do
that
more
often
.
I
like
it
.
Until
next
time
,
everyone
continue
advocating
for
you
and
for
those
that
you
love
.