Live Like a Girl with Dr. Mindy Pelz - Navigating "Life Hormones" Through Supplementation & Lifestyle with Dr. Felice Gersh

Episode Date: September 25, 2023

Dr. Mindy is joined by the remarkable Dr. Felice Gersh, a practicing integrative OB-GYN, to delve deep into the intricate world of hormones. Dr. Gersh is a true rarity, advocating an integrative approach to women's health, and she's here to discuss Hormone Replacement Therapy (HRT), bioidenticals, and the essential role lifestyle changes play in hormonal balance. To view full show notes, more information on our guests, resources mentioned in the episode, discount codes, transcripts, and more, visit https://www.drmindypelz.com/ep198/. Felice Gersh, M.D. has degrees from Princeton University and the University of Southern California School of Medicine and is fellowship-trained in Integrative Medicine from the University of Arizona School of Medicine. She is a multi-award-winning physician with dual board certifications in OB-GYN and Integrative Medicine. She is the founder and director of the Integrative Medical Group of Irvine, a practice that provides comprehensive health care for women by combining the best evidence-based therapies from conventional, naturopathic, and holistic medicine. She taught obstetrics and gynecology at Keck USC School of Medicine for 12 years as an Assistant Clinical Professor, where she received the highly coveted Outstanding Volunteer Clinical Faculty Award. She now serves as an Affiliate Faculty Member at the Fellowship in Integrative Medicine, through the University of Arizona School of Medicine, where she lectures and regularly grades the case presentations written by the Fellowship students for their final exams. Felice Gersh, M.D. is the bestselling author of PCOS SOS and the PCOS SOS Fertility Fast Track, and Menopause: 50 Things You Need to Know. She has also had numerous scientific articles published in peer-reviewed medical journals.  Check out our fasting membership at resetacademy.drmindypelz.com. Please note our medical disclaimer.

On this episode of the Resetter podcast, I have an incredible hormonal discussion for you. I have brought you Dr. Felice Gersh, who is a rare gem. She is a practicing integrative OBGYN. And I can't tell you how hard it is to find a practicing OBGYN that takes an integrative approach. And what I love about Felice is that she not only is willing to revisit H.R.T. And you'll hear that in this discussion. And she believes in strategies for leaning into bioidenticals, but she also strongly feels we need to pair that with lifestyle changes. So what you're going to hear in this episode, I believe is one of the best discussions that I have personally ever had.

on this podcast around hormones. And here's why. When we go into our late 30s and into our early 40s, we start to lose one of the most powerful sex hormones. She calls them, by the way, life hormones, which is so good. But we lose one of the most powerful hormones that we were blessed with as women, and that is estradiol. And estradial has not only,

been helping you release an egg every month. But as you're going to learn in this discussion, she has been stimulating many mechanisms that keep you mentally alert, keep you happy, allow you to sleep, allow you to learn new information, give you surges of oxytocin

to allow that bonding to happen with other humans. It gives you that libido and the intensity of an orgasm. like this one hormone, estradiol, has been doing so much for every organ in your body. And now she's going away. And as she starts to diminish in your early 40s, there are many things you can do. And that is why I wanted to bring Dr. Gersh to you all. Because I hear so many women struggling with weight gain and cognition and depression

and there's so many things that we struggle with as we lose estradiol and we're not given a solution to. And you're going to find a lot of solutions in this conversation with Dr. Gersh. So as I mentioned, we go through what estradial has been doing for you if HRT or bioidenticals are appropriate for you and what lifestyle changes you need to make so that you can make menopause. your menopausal transition from an ovulating woman to a postmenopausal woman so you can make that smooth. And if you're postmenopausal and you still have some symptoms, there's so much you can do to unwind those symptoms. And Dr. Gersh is going to bring it to us. So holy cow, this is one of the best episodes I literally have brought you all. It is such a gift to you, to women. And I hope you

resonate with it as much as Dr. Gersh and I enjoyed having it. So as always, enjoy. Hey, Dr. Mindy here and welcome to season four of the Resetter podcast. Please know that this podcast is all about empowering you to believe in yourself again. If you have a passion for learning, if you're looking to be in control of your health and take your power back, this is the podcast. for you. Enjoy. Start by it just, how do you know if you're in perimenopause? How do you know if you're in menopause? Like, we don't even know these markers very well.

Well, Mindy, here's the scoop on perimenopause. There is no official definition. There is no set of markers. It's basically a non-entity in our conventional medical world. There is a word, you know, like perimenopause or transition, but nothing is done about it. In fact, in terms of the approach by the conventional medical world, it's just that what I call the whackamol approach.

You know, as a symptom pops up, then you find a pharmaceutical to address it. So if we leave that aside and we say, well, what's really happening? Forget about the conventional lack of approach or anything. We have to redefine the whole concept of menopause because the definition is officially for menopause, and this is a made-up thing, of course. It's 12 consecutive months without any vaginal bleeding. You can't say a period because you don't know what that bleeding is. A period by definition should mean you ovulated, but you can have dysfunctional uterine bleeding and so forth. So they don't define what that bleeding is because nobody's doing an investigative report on it. So it's just any

bleeding is just, they call it bleeding. And so you have to go 12 months, without any bleeding. In fact, I've had patients come in and say, after nine months, I had bleeding, so I start over, right? The clock starts over, like reset. It's like, well, first of all, if you don't go, if you go nine months and you don't bleed and then you start bleeding, that, like, is considered abnormal until further, you know, proof that it actually is okay, because that's a lot of months without bleeding. We don't know what that bleeding is. It's very unlikely that you'll suddenly start up ovulating again after nine consecutive months. So, you know, they define menopause as 12 consecutive months because our earth has a 12 month, you know,

like year. It doesn't make, there's nothing magical about 12 months versus nine months or 13 months. It's just arbitrary, okay? So we have to like let go of the whole concept of menopause as you cross a finish line and now you get the label. It's actually a process and it's a process of ovarian aging or we can say ovarian senescence. And this is a very long, slow process, but sometimes, like a lot of processes, it kind of speeds up at the end, okay? So it's like slow, slow, and then speed up, okay? But every

woman has her own unique journey through this transition. So it's the transformation of a reproductive woman into a non-reproductive woman. And it's the loss of ovarian production of those two vital hormones that are called sex hormones, but I changed the name. It's no longer in my world a sex hormone. These are life hormones. And that's not, it's not perceived as what they are because these are vital for every organ system in the body to work optimally. So what happens is we evolved as human females to have a limited lifespan of reproductive capability. And so we're also of on like this, you know, timer and it like times up. And we fortunately can continue living. But a long life after menopause is really very modern, very recent. And I'll touch on that

because I was very curious about ancient societies. Well, when you go back, they didn't have, they didn't have a life. And I'll talk about that, you know, after menopause, except in rare cases. So think of it as just the process of ovarian aging. And with the. aging comes aging of the eggs and fewer numbers of eggs because we're born with our entire egg supply and then it dwindles over time and not only like I said does it dwindle but the functioning of the ovary in terms of its egg quality we use the word egg quality becomes less so the eggs don't work as well and that's why even if you like have an ovulation as an older like perimenopausal woman, even if you ovulate, you're less likely to succeed in conceiving, you know,

if you want to get pregnant at a later age, which is so popular now, you know, because your eggs are old. It's just, and they don't work as well. So this process of ovarian aging is built into us. Every female doesn't matter what continent you live on, your ethnicity, any, there's nothing, like I love like meditation or eating vegetables or even like, fasting, but you cannot stop this inevitability of going through menopause and ovarian aging. You may latent the process a little bit, delay it a little bit, you know, but you're not going to stop it, okay? That is going to happen. One question that I've been dying to get a really clear answer on is what is the, what would be considered the healthy time to officially go into,

let's say, postmenopause? Because I feel like we call perimenopause, that time where your hormones are going up and down and now postmenopause is when you're officially done bleeding. So what's a healthy age to do that at? Okay. So these are, you know, from population studies. So menopause is considered normal between the age of 45 up to 55. That would be like the normal span. It's a decade. That's a lot right there. Over 55 is called late menopause. And early would be 40 right up to 45, and premature menopause would be before the age of 40. So if you're going to pick in that so-called normal span of a decade, 45 to 55, 55, okay, you want to have ovarian function as long as possible. Absolutely. Early onset of menopause,

like say, you know, 42, 43 is associated with earlier onset of all the conditions associated with aging. So I don't think of aging as due to how many years you've lived. I think of aging as related to how many deficiencies have you accumulated. And it starts with hormonal deficiencies, which of course is preceded by insufficiency. And then it turns into full-blown deficiency. And the process of the ovarian aging is going to end, you know, and start, you know, whether you end up in full-blown, so-called menopause, you know, you've not had a period for a year at 45, then you've started that perimenopausal journey a whole decade earlier than a woman who's going, or potentially, because it's not exact science here, of everyone is like a certain timeline, but a woman who

doesn't stop having periods at 55 is going to have a different timeline for when everything is beginning. So it's really not a fixed thing for everybody. And it has to do with a variety of things, like genetics, your diet, your stress, a lot of things relating to lifestyle will impact along like always genetics with what is the date that you will expire as far as your reproductive capabilities. And in terms of, you know, what is going on during the perimenopause years, You mentioned like fluctuations. So it's kind of for some women, it's very variable from woman to woman. But for many, it's really like being on a roller coaster of hormone.

You can have dramatic swings. So I have measured, I love data. So I measure estradiol a lot. And so estradial is the, and we can talk about like what is estrogen anyway, but estradile is the estrogen that is made by the ovaries. And so you can measure it in a lab. And the gold standard is blood. And so you measure estradiol.

I've gotten levels in a woman spontaneously. This is not with any kind of drug or anything of like 800. I mean, now if you know what levels are, at ovulation, just before ovulation, there's a big spike of estradiol production, which initiates and triggers ovulation. Okay, then it triggers the pituitary to make a different hormone, LH with spikes. And this triggers ovulation. So the highest usually would get would be maybe like 500.

But it could be 300. No, there's a range. It could be 300 something, 400 something, maybe up to 500. But I've gotten levels of like 800. Like that woman is on a massive dose of self-dosed estradiol. But then also I could get levels of 20. I mean, this is like post-menopausal level. And if you look at gonadotropins, those are the hornetopans.

Those are the hormones made by the pituitary gland under the direction of the hypothalamus of the brain, the portion of the brain that directs the pituitary gland. So think of the pituitary as the executive assistant to the brain, okay? And it carries out the task assigned to it by the brain, which is to tell many different endocrine organs, including the ovaries, what to do. So there are these little hormones that come out from the pituitary gland. and when the brain says, I want more estrogen, come on, ovaries, make more estrogen, then the pituitary shoots up the production of its hormones that trigger the ovary, when an ovary can do it, lutinizing hormone, LH, and FSAH, follicle stimulating hormone. So if you get really high levels of those hormones, what does that tell you?

It doesn't tell you you're a postmenopausal because this can go up and down, but it tells you you are in the journey. You would not have high levels unless you are in the journey of ovarian aging, that you were definitely like on the timeline, but not in the very beginning. You're like further down the road to the end of ovarian function if you have high gonadotropins. So that's one way to market. And looking, the other thing that I love to do as a test, but this is not like standard, but I love it is doing like mapping.

So this is with urine. And you can actually map out. This is for someone who's having a cycle. But a woman who has regular cycles even, but she's say 48. Okay. Oh my gosh. What you find out is that her like spikes, which are like little blips. They didn't go.

They're not spiking anymore. They're blipping. And then you look at the levels of hormones that she's producing. And instead of having this nice, like sort of a mound that comes up of progesterone mound and like it dips after that spike of estradiol, and then you get sort of another mound of estradiol. Instead of that, you get like little like little bitty blippies that come up. Like it's like a molehill instead of like a little sort of an Appalachian mountain, you know, like a rounded one. Yes.

But you're not getting much. And so those women are really in a state of insufficient hormone production. and they benefit from, well, attention, which in my case would include the option of supplementing with hormones. So it's not hormone replacement. Yes, yes. So, you know, it's really important because, you know, when you look at other, like, hormones that are, like, insufficient, like thyroid, if a woman and women do make up the majority

of people, not all, but the majority of people who have low thyroid, hypothyroid. So if you test someone and their thyroid is low, they don't say, well, it's not zero. So we're not going to treat you. They supplement with thyroid. So that's how I think about the hormones of the ovary, even though they're not zero yet, but they're insufficient to do all the things to optimize health. Then I will supplement them. And I can do that after I actually prove, you know, on a lab test that these hormones are really

being produced at a really insufficient. quantity. Okay, so I think that is the most brilliant explanation for hormone replacement therapy, BHRT, however we want to call it, because I'm just going to speak for what I see out there in the public, is that women have this belief that, oh, I entered perimenopause, my hormones are on this wild ride, they go into their doctor's office, now we're revisiting HRT, they go in and they think this is the solution. I'm going to take this pill. It's going to be the solution. But there's still a navigating that has to happen of our body. And one of the areas I'm very interested in understanding is how our brain does. How does it recalibrate to the loss of these life hormones?

And so what I just heard from what you're saying is when we see we're getting close to the end, And that's a great place to come in and really supplement with age-appropriate hormones. Am I hearing that right? Well, yes. And so if we look back and we talk about the women who are on that roller coaster, it's high, it's low, it's high, it's low. Why is that even happening? It's because the brain is perceiving that there's not enough estrogen.

So it puts out that giant signal of FSA and LH, the hormones from the pituitary. and the ovaries are still capable. This isn't at the end of the road. This is sort of like in the middle of the road. So the ovaries are still capable of producing estrogen and then progesterone, but we'll focus on estrogen because that's like the dominant. I think of estrogen as Batman and Robin is a progester. I call her the extrovert.

Estrogen's the extrovert, progesterone's the introvert. She's the one that shows up and is the life of the party. That's what I have to look for the female equivalent of Batman, right? Wonder Woman. Who's the Wonder Woman? She can be Wonder Woman. Help her. So when the brain perceives insufficient, it puts out the signals to make more. And the ovaries are being actually hyperstimmed. So actually, most women know that if they want to like have egg freezing or if they want to have IVF, that they go to the reproductive endocrinologist who gives them actually, it's a It's like an FSAH, and it's like a shot of this FSA. It's like, you know, a similar to what the pituitary would produce. And they're trying to get hyper-stimulation of the ovaries, so the ovaries will release or ovulate a lot of eggs, like maybe 10 eggs,

so that they can retrieve them and create from one retrieval session, like a whole bunch of embryos, you know, or egg freezing if they're not going to create embryos. So what this same kind of thing is happening spontaneously in these perimenopausal women, They're going through like the equivalent of a hyperstem, and their brains are telling the pituitary to make all of this FSAH to push it out and LH. And then you get this surge of because the ovaries are still able to respond. It's sort of like, I could think of it sort of like the fireworks show before the blackout, you know, and you get this gigantic, this like, gigantic, like, whoa, of estrogen coming out. But if you give estrogen as a bioidentical estradiol as a supplement, then the brain won't go into that.

Oh my gosh, give me more estrogen because it has the sensors. All the sensors are in the brain, like the master control center, and it senses. And it can sense if you give estrogen, so it won't put you on that wild. You may have a little bit of a roller coaster still, but it's not going to be the wild, you know, like whatever, that Madhatter ride in Disneyland. And you know, wow. So you've got to at least have lesser excursions of crazy ups and downs if you give estrogen in the first place. And then also it's an interesting thing, you know, the hyperstim, who gets the most twins?

It's perimenopausal women who get pregnant because you're more likely to have two eggs come out. And they go get if they, you know, if you're just sort of still fertile but not extremely, and then you get that hyperstim from your brain that says, hey, I want more estrogen. you're basically going through a comparable to if you went and had a stimulation at the infertility office and they gave you the hypersim and you got two eggs out, you know, in this case, and then you end up with twins because that's like the most common age group to get twins. Of course, these are fraternal twins because they're two different eggs is in that perimenopausal like around the 40-year-old woman who, surprise, you have twins kind of thing.

Wow. Wow. So we can work with all of these kinds of issues. And in terms of like, say, supplementation, it's so important to, like, that's why I changed the name to life hormones, to realize that these hormones. Here's like a fundamental thing. Humans are the only species on planet Earth that tries to control their reproductive destiny, right? So if it's like mating season and you have a couple of, you know, elk or rabbits or pick any species of animal, when it's mating season, they don't say, hmm, you know what? I think I want to wait till next year so that we can get a better home or something, you know?

Or let's migrate or something, you know. No, it's mating season. They just are animals and they mate. Okay. So interesting. Don't do that now, you know. Now they want to control it. But understanding that we are part of the animal kingdom and that the prime directive of life

is the creation of new life. Now, remember, on board certified OBGYN, I delivered thousands of babies. And I figured that out really early in my career that women's bodies were designed for procreation and not just having a baby. First of all, you have to be healthy to be fertile. then you have to be healthy to be successful through pregnancy and not end up with some horrible complications. And these complications are really rising in incidents now. You know, terrible, you know, maternal mortality and morbidity rates are rising and they're very high in the U.S. And then you have to,

as a human female, you know, you can't be like the black widow or something or, you know, like octopus, you know, can lay their eggs and die. No, no, no. We as humans have to raise our young. And we have to raise them until they reach sexual maturity. And we have to do this several times over for survival of the species. Now, remember, I'm saying everyone should have babies or not, whatever they want. I'm talking about how we fundamentally are designed, so to speak. So in order to be successful as reproductive creatures, we need not just a functioning set of ovaries and tubes and a uterus and so on. we need a really well-functioning cardiovascular system.

And we know now that when you have, when you're pregnant, your blood volume goes up like 50% and you have tremendous needs for energy production. And you have, it's like a very, that's why they call pregnancy now. I mean, I knew this way back in the day. But it's like the ultimate stress test of a reproductive baby. And so you need to have a really robust functioning heart. and you need great vascular system so that you can have a healthy placenta. Otherwise, you end up with preeclampsia and gestational hypertension.

And you need to have great functioning kidneys. And you need great bones and muscles and a brain. Basically, you need the gut, of course. You have every organ system working perfectly to have optimal health for fertility, for pregnancy, for raising the children and being a lot. around for a long time because it takes quite a while for humans to become sexually mature and so on. So all of these organs unbelievably are controlled by estrogen. I call it the master of metabolic homeostasis who are receptors in every single organ.

So like when we talk about like the brain, like that's a huge topic. Okay. Women suffer two and a half at least two and a half times the incident. of Alzheimer's disease as men. If you have like 100 age-matched women and men, two-thirds of all the Alzheimer's patients are going to be female. That's crazy. It is amazing.

The difference, and we're not talking about women live a little bit longer. They do statistically a little bit, but they live with more chronic diseases. So, okay, I want to point this out because that was such a brilliant explanation of the power of estrogen. And what I've been looking at recently is that, specifically, estradiol did everything that you talked about, right? It's like, I think of estradiol as a diva. She's like, she's like the queen that comes out and she's like, she deserves all the, all the praise she can get. And so what I just heard and what you just said is she didn't just help release an egg, which is the, which is the myth that I think too many people have. But she improved the cardiovascular system and she

improved your brain and she went to all these different organs so that you can have a baby. And then you can raise that baby. But then when you go into menopause, she goes away and all those systems are left like raw and open and vulnerable because they're not getting her nourishment anymore. Am I looking at the right? Absolutely. We can like look at, you know, like the gut. Okay. So everyone's talking about the gut microbiome, this collective of trillions of microbial life forms. Well, this has been shown. After as menopause is developing, the gut microbiome changes. And for the worst, women as they go into and through menopause develop impaired gut barrier, leaky gut. And so that, of course, can affect all different aspects of health in terms of nutrition and inflammation.

And, of course, inflammation underlies all the diseases of aging. That's why some clever person called it inflamaging. But I really think it's not about, like I said, aging. It's about loss initially of estrogen and then, you know, estradiol. And then when you lose that and your gut is now altered. In fact, the neurological system, that's called the enteric nervous system. That's the neurological system that innervates the GI tract that controls motility, you know, movement. And that's a very complex kind of a function because everything has to be perfectly timed and moving.

It's like amazing. And that's actually regulated by the autonomic nervous system and the neurotransmitters because neurological system is nerves. The nerves have neurotransmitters. And there's two branches of the autonomic nervous. system and the parasympathetic is the one that's sort of calming it makes gut function like optimal you know like things are moving okay and that has the neurotransmitter acetylcholine that is modulated like regulated by estradiol and of course acetal colin is the neurotransmitter which in the brain helps with cognition that's the neurotransmitter that the drugs like a receptor trying to increase

Okay. And then the sympathetic nervous system of the autonomic nervous system is the one that's activated as a stress response. And let's put it this way. If you're very stressed out, the last thing, I mean, stress meaning like in the olden times, like you need to run for your life, fight for your life, you know, that kind of stress, you know, the fight or flight kind of thing. That's the last time that, you know, that you would be thinking about, I think I need to digest food. Okay. That's not a survival priority at that moment, you know. So you're not going to be putting a lot of energy into the GI tract at that moment. You want to put it into your brain, into your muscles and so on. So if you're chronically stressed, then you're going to have poor gut function, poor gut motility that can lead to SIBO and constipation and all these problems. And that's what happens to women as they transition into menopause. They become more sympathetic. And that's not like an empathy thing.

That's a stress thing kind of. And then less parasympathetic. and it turns out that the neurotransmitters of the sympathetic, the stress part of the autonomic nervous system, and that's the norepinephrine and epinephrine, and they are modulated by estradiol. And the branches from all of these nerves, like from the sympathetic and the parasympathetic, which is the vagus nerve, they go everywhere in the body to every organ system. And they become dysregulated when you don't have enough estradiol. So that's why so many of the symptoms associated with menopause are related to the autonomic

nervous system dysregulation, like palpitations. And women get all the time, they get palpitations as they are transitioning in menopause, and they run to the cardiologists who put them on beta blockers. These are types of pharmaceuticals and that's low heart rate. But they don't just slow heart rate. They make you more sluggish. They can cause waking. You know, so they have side effects.

It's a problem. Yeah. Right. But it's an infection deficiency. or insufficiency. And then you can go organ, I could go organ system by organ system for what the effects are. And that's why the effects just from that one thing. And I'm just talking about one thing. And then you could go to every other aspect. And one of the things is like the immune system, which we can talk about too, because that's like key to everything, you know, the immune

system. And that every immune cell in the body has estrogen receptors. This is why she's a diva. This is why she's a diva. Like she needs to be, she needs a crown. She needs to be highlighted. You know, I've been doing some research on what happens to the female brain as we go through menopause. It's part of what I'm writing for my next book. And if I look at estradiol, she can activate serotonin, dopamine, acetycholine, glutamate,

and even oxytocin. I'm finding a lot of really interesting research on how she comelyteum. mingles and stimulates oxytocin. So if we just look at those neurotransmitters that she has power over, we're now looking at happiness. We're looking at cognition. We're looking at ability to hold on to new information. We're looking at the ability to feel connection to others.

We're looking at orgasms. Like this is a big deal when she goes away because it's not just her that is starting to go into this down moment, but it's all her little neurochemical friends that are going to start to follow. And I believe this is the biggest mental challenge is for us to figure out how to deal with this. I call it the neurochemical armor. I feel like our neurochemical armor starts to shed. And then what do we do? How do we help women at that point? Well, absolutely. And I'm really excited for your, you know, researching and understanding all this because so few people understand that there are serotonin neurons that actually require estrodial. They actually shrivel. Okay? They really shrivel. And like you said, dopamine and oxytocin, the receptors for oxytocin do not work properly in an absence of adequate estradiol. So it's like so critical. And oxytocin has many different functions in the body, but it's very important for sexual function.

A lot of people don't know that. So oxytocin is important if you want to have an orgasm, and that's one of the reasons why that changes. A lot of people think it's all testosterone, but it is not. And testosterone, by the way, has its own set of receptors, which estradial helps to activate and, like, makes them make them... Testosterone is more functional in an environment with estradiol. So all of these things.

And then it is, it's just so amazing. oxytocin, another thing that it does is it helps regulate appetite. In fact, all of the appetite regulators like grolin, leptin, the things that turn on and off appetite are all regulated by estradiol, because part of reproductive success, if you go back to thinking, how does this relate to reproductive success? Well, for an animal, humans included, in order to them to be successful, they have to match their intake of energy, aka eating, to their energy needs. And so estradiol helps to regulate that. So when you talk about in the brain, okay, so in the brain, there's a thing, a part called the hypothalamus. And that has estrogen receptors. Everywhere in

the brain has estrogen receptors. And not just one type, because there's more than one type. That's why you have, you don't want to give a pretend estrogen that only works on, like, say, one receptor. You want to get the whole balance. And the hypothalamus is very critical for many of the metabolic functions of the body, like temperature regulation. That's why you get hot flushes and flashes and things when you don't have enough estradial. And appetite regulation is so key. And so women after menopause and perimenopause, they often will have binge eating disorder. This is all brain-controlled stuff. And so much, there's mood. There's cognition. There's regulation of all these metabolic functions, and the master clock of the body sits

in a cluster of neurons atop the optic nerve that senses light and dark and nutrients. And this is a cluster of neurons called the super kiosmatic nucleus, but it's the master clock. And so few people understand this, but estradiol is a key component of regulating and keeping us on the beat so that all our organs don't work in different time zones. And we don't, without estradiol, we end up having a drifting of this master clock. So women without adequate estradiol, basically, they live a life of jet lag. And there's so much research on the harms that happen if you're jet lagged, you will have more depression, anxiety, insomnia, diabetes, cancers,

all these things. And this is all in the brain. So like, what can have? And they're not leaving. They're not even leaving their time zone and their jetlight. No, that's right. And then if you add a woman who is like, maybe she stays up late on the weekends or she travels across time zones in a plane, that's just fuel to the fire of circadian rhythm dysfunction. So all of this is brain related. And the immune system, I mentioned the immune system, the brain has its own embedded space. immune system, and it includes things like the microglia and the astrocytes, the astroglia. These specialized immune cells that reside in the brain are there surveilling. They're supposed to be in like a calm state normally, but without estrogen, they become like

weapons of mass destruction with no control, and they can release toxic like enzymes that dissolve and cause damage. So it's like a bunch of teenagers on a rampage with nobody in control of them. That's what happens with these microglia. They leave their sort of quiet surveillance state and become like aggressive animals inside the brain. And they can actually start destroying healthy neurons. And then in response, the neurons are trying to heal.

And that's when they produce the amyloid beta. So now we know that all those drugs that are trying, they're giving out like water to mostly women who have Alzheimer's to try to destroy or get rid of the amyloid beta. That's not the underlying. We always talk about root causes. That's not the root cause of dementia, of Alzheimer's disease, not at all. That's the body's response to a neuronal damage that's caused by neuroinflammation that is occurring because of inadequate estradial in the brain.

and the brain loves estradiol so much that it has the enzymes to make estradiol. And in fact, reproductive aged men versus reproductive aged women, their brains make six to eight times as much estradiol in their brain, and they make it from testosterone because all estradiol is derived, not just a little bit, all of it, 100% is derived from testosterone through the action of an enzyme called aromatase. And this enzyme aromatase exists in the ovaries, but it exists in other tissues as well. And that's how men get estradiol.

Like the arteries take their own estradial from testosterone in men. So, okay. So if we, I hope everybody listening just got what one life hormone has done for you. And I can tell you as a menopausal woman, there's this moment where I'm like, man, I took all these hormones for granted. Like I had no idea what they were doing until they went away. So if we look at estradiol and we know the impact she has on everything you just said, how do we help? I mean, we're going, like you said, we're going through menopause.

So do we need to do supplement with estradiol earlier in our 40s? Do we, what lifestyle tools do we have? Like, how do we accommodate for her loss? because man, was she helpful and now she's gone? Well, all of the above. So basically, no matter how hard we try, we haven't gotten to the point yet where we can replicate all of what a healthy functioning 21-year-old set of ovaries can do. So when we give hormone supplementation, hormone replacement, it's not the same as giving

replacement ovaries. We have to be very honest about that. It's just better. It's a lot better than not having the hormones. and we want to get out of the mindset that came from that study. You maybe you've talked about it. Yeah, no, talk about it. So the women's health initiative was a study that ended just over 20 years ago,

and they did not use human biodentical hormones. They used peremarin. That's the brand name for equine conjugated equine estrogens, which is estrogens that have already gone through the liver for a transformation so they can be removed from the body through the urine through the kidneys. and it's from a horse. That's where, you know, it's equine horse. It's a pregnant horse's urine, estrogen, you know, discarded grab.

You know, the horse doesn't even want it anymore. And it's modified. Actually, this was all they could do like 70 years ago. They didn't have the ability to make human bioidentical, but we don't come a long way, but that means we have to change what we're doing. But that's what they used in this study because it was still commonly used. And they gave it, you know, like they dry the, the horses urine, they turn it into a tablet, and then they feed it to women. And it does do

one thing. It does definitely reduce night sweats and hot flashes. Even a horse's, you know, discarded estrogens, you know, can still do that. But they combined it with a chemical medroxyprogesterone acetate, which turned out to be even more evil than the Perman. And so the results of that study, which actually weren't as bad when they reanalyzed it, but it really was not what they'd hope for anyway. The bottom line is they shut down the study early and then all the media put out all this stuff about estrogen increases everything bad. It increases strokes and heart attacks and dementia and breast cancer and it really was not, had nothing to do with the hormones I prescribe and they actually bloated all out of proportion anyway. It was crazy. But the legacy of that study

just won't go away. And the legacy was, first of all, don't give hormones unless you absolutely have to. When you do give them, give the smallest dose for the shortest time. That is ridiculous. It would be like saying broccoli is good for you, so eat the smallest amount for the shortest time. You know, like one bite a month, but don't take it for more than five years. That's what they did with my beautiful esradial, you know, the diva. Oh, God. The diva got that. No, she got one song she can sing at the stage. Oh, my gosh. It was so sad. And of course, I never believed it. I was in, you know, practice at the time. This is like I was around 20 years ago. And I was practicing. And I said to all my patients, this makes no sense. This makes no sense. Stay on your hormones. And a lot of them did. And some of them didn't. And the ones who didn't are sorry, they didn't stay on them. But, you know, it was the pressure. that came out from other doctors, from the media was so powerful, so fear-inducing that hormones were evil that even if you were going to use them, you wanted to use very little. So what I'm telling you is that when you give hormones now, you want to give human cloned type hormone. So it's identical to what the ovaries made. And you want to give it at a dose that's physiologic. You want to give a dose that's like about the average level that, say, a woman who is 21 might have in

her body. It's not exact. It's not an exact science. It's still an art. But you don't want to give tiny doses. It's like it depends on what your goal is. If all you want to do is suppress night sweats and hot flashes, it's amazing how little you can give. But if your goal is maintaining optimal total body function, then you cannot do the tiniest possible dose. So you have to give physiologic dosing and you have to pulse the progesterone because you have to try to mimic sort of, mimic what a normal, healthy woman would have in her 20s. And, you know, you have to then accept some of the, you know, some of the, but, you know, you can compromise.

Everything in life can be compromised. Okay, here's a really interesting idea. So I'm a fan of pulsing everything, especially for the female body, because we work rhythmically. So that goes for supplements, that goes for fasting, that goes for food. Like, I'm a big fan of that. But when you end up looking at a menopausal woman, since we don't really have like a bleeding cycle to follow, I have been encouraging women, especially with fasting and food, to look at the moon cycle.

Because some of the research that I saw is that actually if we didn't have all this blue light, that we as women would actually be more in tune with the rhythms and the light of the moon. And I actually recently had a conversation with a yoga instructor on the island of Kauai that told me that they have figured out the north shore of Kauai that many of the women that are there, they're outside so much, they've all started cycling together. And I asked her, are you guys cycling with the moon? And she goes, I don't know, I have to go back and look. So I bring this all to you to say, could we, like if the new moon would be what the day, one of your cycle and ovulation would be like day 1415. Could you look at cycling your bioidenticals according to the met? Well, definitely that has been talked about. Now, oh, it has. Okay, great.

Oh, yeah. Yeah. So in turn, but not not by a lot of people, but I know. I'm familiar with it. And it's been talked about now. Where would that even come from? Well, let's think, remember, we are earthlings. That's why our circadian rhythm is based on the 24 hour of Earth, not of Saturn. Okay? So we are earthlings, even though I love Star Trek, we are earthlings. And we have a moon. And what did women develop? A lunar cycle, right? A 28-day cycle, just like the lunar, you know, kind of a full moon and then you go to the new moon and that sort of thing. It's the lunar cycle. So the theory is, you can't prove it because we can't, we don't have documentation. from prehistory. That's why they call it prehistoric times. But that the full moon would be

romantic. In fact, we talk about the full moon is so romantic. And you can see because you have light. Remember, this is like prehistoric times. Okay. So you have light at night. So all women would cycle, just like if you look at animals in the wild, there is a mating season. So for human females, the mating season was the full moon. moon. But it was every month, okay? Because women didn't, you know, humans don't just have a mating season for a few months of the year or a little bit. We do it every month. So the idea is that you are most fertile and all women would then cycle together with accordance of the full moon. And what would happen on the full moon? That's when ovulation would occur. And it's been shown

that there's a slight peak in testosterone as well. And that would drive up sex drive. And you have that big spike of estradiol, which would increase oxytocin, and they would have warm and fuzzies and, you know, like more sex drive. And then they have a little spike of testosterone all works together. And they're ovulating. All the women are now going through their same mating season of the one day, you know, the one day. Because remember, your egg is only good for one day. That's like an amazing thing. It's only good for one day for fertilization. The sperm can hang around for a while for like a few days, but only one day, 24 hours, and that egg is no good. So everyone would ovulate on the full moon, and that's how the men would find them

because everyone would have an increased sex drive at that time. And then would have a little spike of their testosterone too. So they could find everyone, they could see it, it's romantic, and everyone would cycle together, and they would all, you know, be ovulating together. And they talk about like the red tent. If you didn't get pregnant, you would have your periods together. and the women would go into the tent and they would go through their mental cycle. We don't do this anymore.

We need to do this. We need to do this again. If you have women and one is like the alpha female, not because we're not outside like in prehistoric time. So we don't live with our nature, with our moon and so on. So we're like indoors and now even, you know, with all the ambient light outside. Some people can't even see the stars or the moon, right? Because it's like, oh, all that light out there. But if you have a dominant sort of alpha women in like a college dorm, they've shown that

there can be that nowadays, unfortunately, they're all on birth control pills. Oh, my gosh, that's another whole story. But if they're having natural cycles, you know, if that were to happen, they would have followed, not the moon, because the moon, they're not outside enough. They're not getting that, you know, that whole stimulation from the stars and the solar system and the moon and the sun. So they just start cycling together, but based on the dominant female. You know, so it's kind of an interesting thing there.

But there's nothing wrong in giving hormones to blend with the moon if people would like to do that. We don't know that that makes you healthier. I think, you know, it's kind of romantic anyway, you know. It's kind of, well, it's fun. You know. Yeah. And it makes total sense for reproductive success, you know, that we would. have these identical cycles and everyone would be fertile on the full moon and that's our true mating

season for humans. And so it's just, but it's like, you know, it's such, I love, you know, the romance of it. Yeah, it's me too. And it gives us, it makes me feel connected to the earth. So I love that. We are. We have to. Right. Totally. And that's that's another win for it. So, okay, let's go back to this idea. So I'm in maybe my early 40s. I'm finding Estradial doing her things. I'm starting, I have a lot of my friends in their early 40s will say like, yeah, I notice my personality is changing. Things are changing. So your recommendation would be like, let's map, let's map your cycle, understand where you are, let's get some blood work, and let's start to put you on some bioidenticals. Now, and I'll let you respond to that in one

moment because I may have gotten that wrong. But my other question to you, and this is the one that I don't think is being discussed enough is because we like to pop pills. We like a pill to save us. We like a patch to save us, a cream, however we're going to do this. We lose sight of the lifestyle that needs to be matched to that. So what lifestyle would you match to somebody going on either HRT or biore identicals? Right. Well, perfect leading because what I was like starting off and then we got on that beautiful tangent is that no matter how hard we try, we're not going to replace the ovarian cycle and the hormones are the same. We try to get closer, but it's not the same. So we need lifestyle. It's never, I call the hormones are foundational, like you might say, necessary,

but not sufficient. Okay. So we need to pull all our tricks out of our therapeutic toolbox for lifestyle medicine. So it's basically the fundamentals of like functional medicine. You need to start with nutrition and you have to, knowing that you're going to have leaky gut, you need to really work hard to nurture your gut microbiome, to eat high, you know, nutritionally dense foods and avoid chemical-laden foods, of course. You know, processed foods are like evil. Let's just be real, okay? The only processed foods that I would ever, like, say, or okay, would be a glass jar and in it, if you look at the ingredients, on the label, it says ingredients,

organics do tomatoes. That's it. So that would be what you call minimally processed, okay? That's it. Like if it has chemicals, no, that's not food. In fact, it's weird. Like, would you lick the floor? It's so weird what we'll actually consume.

It's really well said. It's weird. It is so weird. So you've got to eat to nurture your gut microbiome to help maintain gut integrity. It's so, so important. And part of maintaining gut integrity helps with having nutritional status. You know, you don't want to be malnourished.

That's like the key to poor health is to be malnourished. So you want to get all the potent antioxidants. You want to have all the, you know, the micronutrients, the macronutrients. And here's the other thing, the polyphenols. And this is like really important because nature was very kind to us if we take advantage of it, you know. Their gift. It's a bounty of fiber. phytoestrogens. They are our best pals, okay? All the foods, and all the food groups have

phytoestrogens. A lot of the foods that people have talked about as, you know, like these are, are like the best foods, you know, like these are the star foods and like pomegranates. You know, that got like, oh, you know, like great food, you know, eat pomegranates. Well, I'm all for eating pomegranates. But what was it that was made so special? I mean, all fruits are very special. But well, pomegranates have oligic acid, which, turns into the urolithins. Those are phytoestrogens. And a flaxseed, a lot of people talk about like flaxseeds for helping to regulate menstrual cycles and for health. Flax seeds, they have lignins. Lignins are another type of phytoestrogen. Soy, which has been maligned, as long as it's whole

organic soy, it's really healthy. Okay, it's a bean. Right. Soyed. People in Japan had the longest lifespans. They ate a lot of soy. Okay. So do you know they also, by the way, in Japan, only 4% of women going through menopause go on HRT. Now, and that's because of symptoms. That's not because of compared to what we do here in America, which is still lower than necessary. But I've often wondered, is there something in their lifestyle that makes them turn less to HRT?

Maybe it's more of a gradual decline. Well, as a sort of separate also issue, how you fare when you're transitioning has a lot to do with what I call your health savings account. Like the health that you have when you hit this time of life is going to dictate a lot of what happens to you from that point forward. That's why you have to start working to be healthy early, early in life. Of course, like in prenatal times, you know, you don't want to like when you're a fetus,

you got to go. Like before you were born, you needed to work on it. A mom who gives you the right nutrition when you're, you know, still in the womb, so to speak. Yeah. But you really need to look. at these, yeah, the effect of phytoestrogens. Actually, there was a study by Dr. Bernard, who's a sort of renowned cardiologist, vegan. He loves to do studies about veganism. And by the way, I don't advocate for veganism, but I do tolerate vegans very well because they, I have two of my

kids are vegans. So I love a lot of vegans. You tolerate vegans. I love them. I love them. I try, you know, I feed them. I feed them. I birth them. I feed them. I do. And so his study was very interesting. He gave women who had very substantial hot flashes and night sweats, very substantial. And he gave them like a cup of soybeans every day for 12 weeks. And they had dramatic reductions in their night sweats and hot flashes from the phytoestrogen. So, and that's what probably is going on in those Japanese women. So this is nature's gift to women because, you know, I'm all for giving hormones. But there are some women that, for whatever reason, They can't or they won't.

Well, take advantage of nature's gift with the phytoestrogen. So, like, the soy has the isoflavones, which are, and then a lot of people talk, they know about resveratrol, okay? Resveratrol is in the still bean family of polyphenols. That's a phytoestrogen. That's what they talk about red wine and the skin of red grapes. That's a phytoestrogen. We can go, all the beans and nuts, the seeds, the fruits, the vegetables, they all have all

these phytoestrogens. So this is like, has to be included in your diet. And of course, not just, of course, for the polyphenols. And it's also for the antioxidants, the vitamins, the minerals, all of these things. So a really great plant-based diet with small amounts of animal, okay? From the healthiest source, the healthiest source that you can, that you can get, you know, for some animals. And so you got to work first on nutrition, you know, as supporting your overall health. And then we get into all the other aspects of lifestyle. Right. I mean, there's so many things that we could unpack. It's, and I just want, what I'm hoping people gleam from this conversation is there are so many things you can do to help yourself. And we're not,

we're not talking about that. So, and I want to talk about exercise in a moment because I just found some really interesting studies on exercise in BDNF and neuroplasticity that I think is really interesting. But before I do that, you brought up resveratrol. We have to bring up wine. Okay. There's so much like lashing out about drinking right now. And I'm not saying that alcohol is a health food in any way, shape, or form. But when we look at the menopausal woman, we're also losing progesterone, which causes us to lose GABA and calming our shit down. I was going to say it can be a little difficult and a little glass of wine here or there. it can be that thing that just allows you to calm yourself.

Now, having said that, you also have to process wine through the liver and the liver and it goes into the gut, and this is what's breaking down the little bit of astrodial you might be getting. So where do you feel like wine alcohol fits into the menopausal life? Are you like completely knock it out in small amounts? Don't worry about it. Where do you feel like it does? Well, there is no...

to find health benefit from alcohol itself. And so, in fact, they keep coming out, like you said, stricter and stricter restrictions on, you know, intake of alcohol. If you are healthy, so not when you're trying to rebuild your gut microbiome or deal with a lot of symptoms, but say you are now like replete on all your nutrients, you're, you're properly hormonalized, and you're just living the good life. You know, you're the ideal, my ideal patient to have. after I treat her, right? So now everything is good. And, you know, you go out and you celebrate and it's Saturday night at this fine restaurant and you want a little bit of wine. Having one glass, four ounces, not this jumbo thing. Okay. Like four ounces of wine, like, you know,

for a special occasion, if you're already in good shape, you're healthy, your gut is in the disaster zone, then that's okay. You know, it's just like, can you go to a wedding if you're not, like, you don't have like a gluten problem, you know, and have one piece of wedding cake. And it's like, you know, like someone you love as part of your family, best friend or something. Can you have any birthday cake? Can you have any wedding cake? Yes.

Okay, for me, I have to get the gluten-free cake. But yes, I will. You know, for special occasions, yes, you're allowed to have some special indulgences. but you shouldn't be doing it when you're trying to really get back your health. You have to first have your health and then you can have these little splurges. Little splurges. Okay, perfect. Thank you for answering that. Okay. Now, exercise. So to me, exercise for the menopausal woman is a little bit of a catch-22 because as astrodial declines, we also lose collagen. And I mean, this is one of the reasons why we wrinkle. But what I also see with some extreme athletes is they really, or women that just

work out a lot, they start to injure themselves more. So I can tell you, in my 53-year-old body, I had to really change the way I exercised because I couldn't go as long or as hard. But when I look at the research on exercise, it does a lot of the same things estradiol did. It helps upregulate BDNF. It can actually stimulate the 5H2A serotonin receptor site like estradiol did. And so it has some characteristics that are similar to estradiol. And I can tell you for me, if I go walking, if I do yoga, if I do even short high intensity training, the more I exercise, the better my brain feels. So what are your thoughts on exercise? Is there a balance to what we should be doing? Is there a type we should be doing? And can we look it as,

just like we would look at the soybean as giving us this, you know, extra little burst of phytoestrogens, can we look at it to help recover our brains from the loss of our divas, our diva estradia? Well, absolutely. Nature gave us some really amazing tools, like, and we'll, will say support systems. So, you know, we have the food support system with the phytoestrogen and we have exercise. So people have talked about this and I agree. If you have to pick one, like we'll say, master therapeutic, it is exercise because exercise reboots the gut microbiome.

Exercise is a fasting memetic. It's like it can mimic some of the same benefits as fasting, you know, like increasing brain-derived neurotrophic factor. helping reboot the gut microbiome, triggering all these rejuvenating functions of the body. So yes, it is amazing. And the thing that you said is so really critical. If you're not on any estrogen, and even if you are, because it's not going to be the same, understanding that there are changes in your musculoskeletal system with the loss of these hormones,

and it sets you up to more potential for injury. because like you mentioned, you know, like collagen, that's a huge thing. But also as part of like in the joints and ligaments, tendons, you know, elastin, which keeps things like soft and flexible. Instead of everything bending and being flexible, things become stiff and tear instead of bend. So you're more likely to have, you know, injuries if you're not careful. So it's really important not to overstress, you know, your joints and so on. and just be aware of your limitations.

But resistance training has really sort of come into its own now in terms of trying to maintain bone and vital muscle, which has never seen, you know, the PR that it should deserve, you know, because muscle is not just about strength and movement, which of course are vital, but they're also endocrine organs like everything else. You know, they make these special signaling agents, mitokines. they also are the structure in the body that burns glucose. So if you don't have enough muscle, you're going to be ending up, you know, one of the skinnies that gets diabetes. And they actually have worse outcomes.

They overweight ones with diabetes. So you don't want to be that person. You want to maintain your muscle mass. And it takes the whole combination of nutrition and exercise and in my book, the hormones and the hormones. And that's the point that I think I really want everybody to get. is that if I could go to every woman when she hits 40, I would say, just no, there's a lifestyle change that needs to happen at this moment. And if you make these changes along with testing your hormones, along with staying open to what do you call it, you didn't call it replacement,

you called it, I forget you had a different name. I like the way you said it, but that we can maybe take some exogenous hormones. But there's a change that needs to happen. and that is what's not getting out to the world. We just are going along, going along, and then boom, all these symptoms hit, and then there's no resource for women to be able to put the puzzle pieces together. And then we go looking for one thing. We're like, what's the one thing? You know, when I have a headache, I take some medication.

If I, you know, if I want to lose weight, I exercise more. Like we've been this one thing culture, but I don't think the menopausal experience is a one thing approach, don't you? No, and I am so happy you said like 40, because when they look at the data, okay, the bad things that start, that are associated with aging are happening in those premenopausal years, the perimenopause. For example, vascular changes like plaque developing, more rigidity of the arteries, more likelihood of starting the beginnings of hypertension, loss of bone, bone density can be

dramatically reduced during those perimenopausal years. So you still can have cycles, but the hormones are not the same. And like you talk about the brain, word finding. So they've done studies that published, that word finding, it's always nouns, okay? Women have trouble getting names. And this happens before menopause, before the official menopause. And it makes women think, what am I getting demented? Well, it is actually a brain change.

And it's real. And it's universal. They've shown it's really universal, different degrees for different women. And it's, like I said, always now. So everyone's playing charades. It's like, you remember it was that person. Remember they wore glasses. They had brown hair.

She had the salmon. You know, like, what was her name again? You know, they can't remember names. What was that movie? Remember, remember there was like a star in it and the plot was about something? But I can't remember the name of the movie. You know, they just can't remember names. And so it's like playing guessing games or, you know, it was bigger than a breadbox.

You know, it's like, oh, yeah, it's really quite universal. So true. Published on that because you asked me like early on in our little conversation, like, how does the body adapt to for the brain loss of estradiol? And the answer is it tries as best it can, but it can't really make it up by itself. So you have to take the steps. And going back, like looking at ancient civilizations, like I checked out ancient Egypt. Okay. So they, how can I check out ancient Egypt? Because they actually had hieroglyphics. They were like, they actually wrote history. Remember before that, there was no written word. You couldn't know what was

happening because there was no written record of it. And when they found the Rosetta Stone and they could actually decipher the hieroglyphics, so much of what was going on in ancient Egypt was known. And this is three to five thousand years ago. This is not that far into the history of humanity. Humans go back way before three to five thousand years ago. But what was the average lifespan of a female in ancient Egypt? Well, if she survived childhood, which was a feat in itself, you know, not everyone got past childhood. Her life expectancy was maybe 35. So you know what? Menopause was not really a thing, you know? And then you look like 1,200, you know, and then up until maybe a couple hundred years ago. The life expectancy, if you survived childhood, was maybe into the early 50s, maybe 55.

So women would just live a very short, relatively short part of their lives in menopause. And so it really, not that there was anything they could do about it, particularly, but it really wasn't such a big thing because it was really the end of life. It's really modern times, I mean, really modern times that women can literally live half their lives as a menopausal woman. Yes. So this is so new. It's like a blip in the whole timeline of humans on planet Earth. And there was no grand scheme for this in nature when people say, but it's natural. Nature plan for it. No nature didn't plan for it. They didn't think you'd live this long. To be honest, they thought, you know, that you would be a reproductive female, live a little bit maybe, and that's the end of it. If that, you know, most of the time on planet Earth, we didn't live to hit menopause, period. So we really need to understand that. We need to figure out how we're going to navigate and make a beautiful life for ourselves as postmenopausal women. So we either adapt all of the lifestyle, you know, wonderful lifestyle, you know, things that we can do like fasting and exercise and stress control and sleep, circadian rhythm issues, nutrition, avoidance of toxicants. You know, we live in a challenging poison kind of world, you know. So do everything we can to keep, you know, toxic chemicals out of our body.

and do everything we can. And then in my book, you know, add hormones in most cases. And it's a personal choice. But we have to create our own definition of what it means to be a menopausal woman because this didn't happen until recently that we had so much time like this. And, you know, the whole idea that as everything goes wrong, you get a drug. Like here's your drug for your osteoporosis. Here's your drug for your high blood pressure.

here's your not working drug for, you know, your dementia. And, you know, you go on and on for all these things. And it's not the life I want to live as a menopausal woman. And I don't think anyone out there wants that life. And we can change our destiny as menopausal women by understanding that this, these vital life hormones, estradiol, you know, which is the master and it's wonderful sidekick progesterone. that these aren't just about making babies.

These are about sustaining health in every organ system. And you name it, I could go on for at least an hour for every organ system about what estradiol and progesterone do. And these are not optional for health. You have to remember what is a hormone anyway. A hormone is an information delivery vehicle. It tells to sell what to do. So just think of this.

You want to build a house. but you have no instructions. You simply have a dump truck, a big truck, and it dumps off lumber and screws and nails, but you have no plan. You have nothing. And then you take a bunch of people who have no experience in construction

and there's no form and there's no plans and you just say to them, okay, do it. Like do what? There's no instructions. You can't, even if you have the nutrients. Well, said. And what is the cell going to do without the instructions?

The cell, needs the instructions, make this protein, make this enzyme, you know, make, you know, make this kinase, you know, that, you know, get the instructions for now you will do autophagy, you know, with the cellular rejuvenation. I know you talk about that. You know, estrogen actually controls this signal to have autophagy, you know. So it's like a beautiful synergy between all the different things that go into play. And you can't just take out one ingredient. It's like you can't, not that I bake cakes, but you can't bake a cake and have, you know, like one of the key ingredients just missing. Like if it's a flour-based cake, you can't just leave out the flour and all you have is eggs and baking powder and vanilla or something.

You need all the ingredients to be healthy and the foundation is really the hormones, but it's not necessarily sufficient. It is necessary, but not sufficient. You have to add all the other things. And then you can have the beautiful menopuzzle life. Yes. I love that explanation. I got to tell you my vision for menopausal women. I feel like as we enter our 40s, if we take the opportunity to really dive into our health,

the way you and I have talked about today, and I call it a menopuzzle redesign, it's an opportunity to like redesign your life, redesign who you are. and when you come out of that 10-year-ish journey of the perimenopausal years and you go into the post-menopausal years, you're going in as your best self. And when you look at there are cultures like in Indonesia where post-menopausal women are considered the elders of the community and people go to them and ask them for advice and their opinion because of the wisdom that they have. Well, in our culture, we don't create a solution for perimenopause. Women are suffering through it. We get to the other side of it. We're tossed aside.

I see us changing that. I see us every woman stepping into her health power when she hits 40, redesigning whatever part of her life needs to be redesigned, coming out into her post-menopausal years, and then being this incredible wise source for all of us to lean in. into. What do you think of that? I'll buy into it. I love it. It's a new theory I have, and it's based off of listening to people like Jane Fonda, who would talk about at 60s. She went into the third act of her life, and I just, I want to end this suffering that women are going

through. I want to end tossing us aside, but it's going to start with us taking responsibility for the process. And that's what I hope we did today. So really, that was, this was such a brilliant discussion and I really appreciate it. And I have to ask you my last question, which I ask all my guests, which is twofold. One, what do you do for self-care every day? What are your self-care habits? And what do you think your superpower is that you bring to the world? Well, what I do every, well, not every, but most nights, this is my sort of meditation time. Okay, everybody needs some alone downtime. So I happen to love the warmth and comfort of a bath.

Okay. So I go into, actually, I've taken over one of my kids' bathrooms because it's, I like it. And they moved out. My kids moved out. Yeah, I was going to say. That's a domestic life. I took possession. I took, you know, territorial possession.

So I go into that lovely bathroom. and I put on some soft music and sometimes I have some aromatherapy and sometimes I'll put some into my bathwater. My kids are always giving me gifts of, you know, essential oils and things. So they know I love baths and, you know, like organic candles to burn and everything. Because everybody knows this is my thing. And I just relax. I mean, it is just so calming. I just do sort of a little bit of progressive relaxation where you tighten up all the muscles your body, then relax them. I listen to the music. And I just find it super soothing. Okay, no matter how stressful my day was. So that's really a key thing for my self-care.

And my superpowers are that I just am the, I would say, the energizer bunny. I don't know how I got the energy to deliver so many babies for so many years all through the nights. And I just have like the gift of stamina. So I guess my thing is that I won't quit. I won't retire. I won't stop. I want to think of myself as unstoppable. So my mission is to help women at every stage of life for as long as I can. And I just won't stop. You know, I see my friends retiring and joining book clubs and movie clubs. And it's like, that's really nice. But I want to do this, like with you. I'm so it's just like I have a burning passion for this that's and I won't won't stop that's it I'm just keeping oh my god it's such a battery it's such a good it's such a good superpower and again I'm going to finish

this with where we started like you are a true gem for women I have searched for integrative obies across the country to get my my the people who follow me try to get them into those offices and it's hard to find. And you are an incredible example of somebody who's willing to look at root cause, somebody who's willing to bring in lifestyle into your treatment plan, and is also willing to lean into conventional medical care solutions that you were trained in. I cannot say enough about what a blessing you are to women. So I just want to thank you, Dr. Gersh, for being here.

and this conversation hopefully was as exciting to everybody else as it was to you and I. Well, we sure had fun. We hope everybody else had at least a couple of pearls out of this because this is it. This is our lives. We got to make the best of it. Enjoy every minute as much as we can. Great. And how do people find you?

Just because if people are still listening, I want to make sure they go and absorb all your stuff. I am pretty easy. I mean, you could probably Google me, but I am still old-fashioned. doctor. I'm actually in one of my, I set this up as a little bit of a recording room, but it's actually an exam room. In fact, over there, you can't see it. There's an exam table. Okay. Oh my gosh. That's awesome. I still have a work in brick and mortar practice. It's called Integrative Medical Group of Irvine. It's in lovely Southern California in Orange County. And so I see patients all the time, usually five days a week, unless I'm out doing a lecture or something.

And in addition, I am trying to get more and more active on Instagram live. So I hope everybody will follow me on Instagram live. And, you know, I love doing, you know, webinars and podcasts and health summits. And so I have a fair amount of body of, you know, stuff out there on the internet that you can find. And I have three books that I'm very proud of. So my first two were on PCOS, Polycystic Overy Syndrome. PCOS, SOS, and PCOSSOS Fertility Fast Track and the my newer book, which is now like a year old, but it was, I'm going to write another one coming up too.

I don't know if I can match you. I don't think so. I'm not in active practice like you. Well, you can't do it all all the time. But so my newest book is menopause 50 things you need to know. So, you know, I definitely recommend my books. Yes, of course. And books are great ways. And send these books, too, I definitely recommend. You're so sweet. You know, books I always say are the best way to really dive into an expert's brain because, you know, we think about the sentences. We think about the structure of information. So it's really one of the best ways to dive into an expert's brain. So anyhow, I can talk to you forever. And I just appreciate you on so many levels. This, I know this conversation will save lives and we'll,

really help women understand themselves and hopefully move into action. So thank you. Appreciate you. My pleasure. Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it. So please leave us a review, share it with your friends, and let me know what your biggest takeaway is.