This Is Woman's Work with Nicole Kalil - Perimenopause, HRT, and Why Women Are Being Gaslit Into Thinking It’s “Just Aging” with Dr. Sarah Daccarett | 381

Episode Date: January 21, 2026

Women’s bodies get endlessly analyzed from the outside… while our internal health gets treated like an optional group project nobody studied for. Cool cool cool. In this episode of This Is Woman���s Work, Nicole Kalil goes deep on the perimenopause/menopause mess: the years of brain fog, 3 a.m. wake-ups, mood swings, weight gain, and the medical equivalent of a shrug. Enter Dr. Sarah Daccarett, hormone specialist and aging expert, to explain why so many women are confused, dismissed, and exhausted—and why hormone replacement therapy (HRT) should be viewed as foundational health support, not a “last resort once you’re fully miserable.” What We Cover Why most women (including doctors) are confused about perimenopause + HRT—and why that’s not your fault The “natural” misconception: why Sarah argues HRT can be more natural than the supplement aisle Why waiting for hot flashes is like waiting for your car to explode before you change the oil Hormones as the “CEO of the body”: brain, bones, metabolism, sleep, libido, digestion—ALL of it The real problem with “just fix your gut / cortisol / diet” advice when your hormones are the actual root issue PCOS, insulin resistance, and why “just lose weight” advice can be straight-up useless Why hormone testing can be wildly unreliable—and why symptoms still matter Medical gaslighting: how women lose trust in themselves when the system keeps minimizing them If you’ve been white-knuckling your way through perimenopause symptoms, you’re not weak—you’re under-supported. Better info + better care isn’t “extra,” it’s the bare minimum. Thank you to our sponsors! Get 20% off your first order at curehydration.com/WOMANSWORK with code WOMANSWORK — and if you get a post-purchase survey, mention you heard about Cure here to help support the show!  Sex is a skill. Beducated is where you learn it. Visit https://beducate.me/pd2550-womanswork and use code womanswork for 50% off the annual pass. Connect with Sarah: Website: www.innerbalance.com $50 off Discount code: PODCASTDRSARAH Related Podcast Episodes: Don’t Let Your Doctor Kill You: The New Hormone Solution with Dr. Erika Schwartz | 305  Endometriosis & Women’s Health with Somer Baburek | 238  Floored: Why Our Pelvic Floor Health Matters with Dr. Sara Reardon I 314 Share the Love: If you found this episode insightful, please share it with a friend, tag us on social media, and leave a review on your favorite podcast platform! 🔗 Subscribe & Review:Apple Podcasts | Spotify | Amazon Music | YouTube Learn more about your ad choices. Visit megaphone.fm/adchoices

If this show adds something to your life, I'm asking for your help so it finds its way to the next woman who needs it. The three best ways to do that, rate, share, and support the sponsors. I am Nicole Khalil and you're listening to the This Is Woman's Work podcast. We're together. We're redefining what it means, what it looks and feels like to be doing women's work in the world today. And I don't know how we do that without addressing what's happening beneath the surface. because, and I'm sure you'll notice my frustration when I say this, women's bodies have been endlessly talked about, looked at, and judged from the outside. Our appearance is consistently overstudied, while our internal health is wildly understudied. For as long as I can remember,

there has been no shortage of opinions about what women's bodies should look like. But when it comes to what's actually happening inside those bodies, our hormones, our cycles, our energy, are aging. We're left in the dark. We have billion-dollar industries built around anti-aging, detoxing, and weight loss, but we still can't accurately diagnose endometriosis without surgery, even though 10 to 15 percent of women have it. Menopause is inevitable, yet only about 20 percent of us feel informed about it. I can find 53,416. resources on reducing belly fat, but have only had two doctors who could or would help me with paramedopause. What the actual fuck is happening here? If we take me as an example, I'm educated

privilege with access to great doctors and wellness resources, and I still had no clue I was in paramedopause for more than five years. That's at least five years of brain fog, random 3 a.m. Wakeups, weight gain, and mood swings. And the medical consensus was based on. basically a shrug, and that's a just part of getting older. The non-medical consensus? Buy these supplements, cold plunge, lift heavy, stretch daily, do cardio, meditate, sleep, wake up early for your morning routine, get your steps in, eat clean, detox your liver, and manifest your health while dry brushing your thighs. I don't know about you, but the last thing I need is more shit to do. And I definitely don't want to minor in nutrition, biology,

and biohacking just to feel like myself again. When hormone therapy finally came up, only after the hot flashes started, I said no immediately because I didn't want to put something unnatural in my body, which is laughable if we consider the amount of caffeine, alcohol, and hair dye that has been consumed in my lifetime. But nobody challenged me. Nobody educated me.

Nobody said, hey, you deserve to feel good and here are your options. No matter how much I tried to find the answers myself. Not until episode 305 with Dr. Erica Schwartz did I finally feel like I got some real advice that made sense. So, no, this isn't turning into a health and wellness podcast, but doing woman's work means addressing our bodies from the inside. I'm frankly exhausted and bored with talking about how they look. This is about how they function, how we support them, understand them, and advocate for them. And today, we're joined by somebody who's doing exactly that. Dr. Sarah Dacorette is a leading hormone specialist and aging expert and the founder of

Inner Balance, a revolutionary solution for women seeking a convenient, effective, and personalized way to manage their hormones. Her mission is to break the silence surrounding hormonal issues and empower women with the knowledge and the tools to thrive. Sarah, thank you for being here, clearly have feelings about this topic. And I want to start by asking, if my experience based on your experience is within the norm or if I'm an outlier. Like are most people coming to you with a good sense of understanding and education? Or are most people like me where we're just figuring things out as we go? Thanks for having me. Great intro. Couldn't have said it better.

And most people are in your shoes. Like most women are incredibly confused. Even the ones that have decided that they want HRT and that they know that they needed. that there's benefits, they're confused at what to take because the formulations are so inferior and not effective, that they're even still confused on how to act on that. So even taking it one step further is they just don't have the tools. And when I went through it myself, I'm a doctor. If I can't figure it out, I mean, I don't, what general women are trying to do. It's, it's overwhelming. Yeah, that actually, it doesn't make me feel better for you. It makes me feel better for me that if a doctor is struggling or was struggling to figure it out for themselves that I'm like,

because sometimes I'm like, am I an idiot? Why is this so hard? And it is like, and Talmos feels intentionally confusing to women. The messaging is confusing. It's like if we keep women and their hormones could be 80 to 90 percent of the results that they're looking for. They can look good and feel good by doing this only, nothing else. If they did nothing else but this, Yes, sure, you can add diet and exercise and saunas and stacking and dry brushing and all the things you mentioned at the beginning. You can add that on top and get the extra 10%. But women are trying that first when it's not foundational. If they did the HRT and that's foundational, they would get the vast majority of the results they're looking for for less cost, less effort.

Let the hormones do the work for you so that you can keep doing your thing. Yeah. Okay, I want to dive into that because for me, hormone replacement therapy, at least initially, it was like, I'm putting something in my body, or it kind of fell in this like medication category for me. It didn't feel natural, you know, all this stuff. So what is your medical expert opinion on hormone replacement therapy for women, like generally speaking? When should we be talking about it and considering it? Why are the reasons to do it? What are the reasons to hesitate? What are your thoughts?

I mean, I would argue that it's the most natural thing we can do. Your body does not make turmeric in black cohosh and plants and herbs. And women tend to think that that's safer and more natural. Like by taking a plant, the plants are medicine. They actually do things in the body, but we don't fully understand them. We make hormones. We make estradial, testosterone, and progesterone. It is the most natural thing you can do in order to maintain your health and age and age healthy.

We should be thinking about it very early on because if you go, these long gaps without the hormones, as you mentioned, to five years. That's five years that you lose. That's five years that you don't feel well. Your relationship suffers, your job suffers, you suffer, and your health declines. Right. So like even you gain weight, do you get bloated? Your digestion gets impacted. If women understood that hormones are needed for every process of the body to function, to simply function, your vagina doesn't work, your gallbladder doesn't work. Your brain, your bones, like your immune system won't even function correctly without the signaling that hormones offer. Hormones are like the CEO of the body. They dictate and they signal so that everything can

function properly. So when women have 100 symptoms, it's because they're missing the actual mechanics or the people, the pieces of the puzzle that are orchestrating your body in order to function properly. Instead of looking at hormones as a treatment for menopause, Let's wait until your period stops. Let's wait until you are so debilitated with hot flashes and anxiety and vaginal dryness and your life is falling apart. Why are we waiting to treat? We don't wait to treat diabetes until it's like full-blown diabetes.

We try to prevent it. It's easier to prevent heart disease than to treat it. Hormones should be treated the same way. We should be using them as prevention, which means starting as early as sometimes your 20s. Women, like I think that we, there's no shame. Our ancestors died in their 30s. and now we're trying to have babies in our 30s, and now we're expected to live well into the 80s

and live well, but we're not living well. We're living longer, but we're not living well. We're actually taking a lot of, we have a lot of sickness in later in life, and women are, you know, getting the bulk of the diseases after the age of 30. And so there's no shame in really, like, just understanding its biology

that the ovaries don't work as well over the age of 30. They're failing. It's not something that you're doing. You don't lower your stress or in your cortisol, and all of a sudden your hormones start working again. This is just simply aging. And we are supporting the ovaries that can no longer do their job, really. Yeah.

Okay. So in there, you said something that triggered the thought in me, which is I had doctors say, like if the hot flashes are impacting your ability to do your work or this or that. And there was a little bit of this like, oh, I can tough it out, almost like it would have been a failure on my part if I would. And it just, that part bothers me. And the way you explain it, it's so obvious.

A, it is natural. It is something that our own bodies are creating. And our bodies are losing it. That's the way our bodies are designed. And this is not just impacting our sleep, though that is very important. It's our brains, our bone health, right? Everything. Literally your skin, your hair, your mental health, like everything.

when you, and doctors do not look at it that way, and they do give this kind of, it's almost like, well, you should wait until they're completely, it's, again, it's a treatment and only take it if you need it, and only take the just a small amount that you need in order to get through these hot flashes because they're like very debilitating and severe. And when you think about what a hot flash is, it's very sad, actually. The hypothalamus in the brain is what regulates our body temperature. It what makes us a warm-blooded animal, okay? And so if you are, if you don't, and it's the last thing to happen, that means that you're so depleted. You have so little estrogen because the body actually prioritizes this part. It'll send what's left, what estrogen is there to the brain, to the hypothalamus.

And if you don't have any estrogen, then you're getting hot flashes, which means you're not even able to regulate your own. you're like basically like reptiles can't even, you know, regulate their own body temperature. And we wait until this like point of time for women. Like it's not okay. So it really needs to be looked at as foundational to health, just like nutrition and exercise and everything else. So my next question, you talked about how we're living longer, but we're not necessarily living well. And longevity is my key motivator.

my question is how do we know what we should be taking in what dose, especially if our doctors are in the camp of, let's wait until you really need this. So I think women also need to recognize that you should be going to your traditional doctor for this. They're not trained in it. And I don't know what to do surgery. Like OBTIAns are surgeons. Like you don't come to me to deliver a baby or save your life if you're pregnant. This is what these doctors are for, like an acute event, and they will save your life. and this is what they're trained for, and that takes years to do. So we shouldn't, you know, just discount that. That's what they're for, and it's very valuable. But to expect these doctors to also understand complex hormonal system and the immune system and health and wellness and prevention. They're two totally different things, and it took me years to learn this.

So why would I expect these traditional docs to even understand it? Women just need to get used to the fact that they cannot go to their OBGYN for everything or their PCP for everything. They need to go to a specialist and a different doctor. to start with that. And then you won't get as much attitude of, because if you go to a longevity specialist or a hormone placement therapy specialist, they're going to understand the benefits of starting them early. They should anyway. And if they're not, they're not the right doctor. And they understand the limitations of the testing and things like that. But I would even argue that, let's say you've come to

the point where you know you want hormone replacement therapy. And now you've found a specialist, okay? And there are specialists that do that. We're still finding the problem. that women's health and hormone replacement therapy is so outdated. We are a decade behind men's that even the formulations on the market are terrible. Like if this is the standard of care for women, we have a lot of work to do. And it's not anything against the doctors that are doing it. We should just recognize that we have a lot of room to improve. Like, hey, let's look at where we're at. And for example, we were in the same place 12 years ago for men. And now we've made a lot of advancements for them. And we've been ignoring this problem in women for so long that doctors don't know how to

prescribe it. We've not had any innovation in the space. We're still using outdated patches and pills and low-dose vaginal creams that are very ineffective. They might cover your hot flashes, but they don't really. They're not going to bring you up to like appropriate physiological levels that make you feel better. Again, it's just this like barely, like here I'm just going to give you a little tiny bit so that you can get out of my office. Like, you know, I'll shoot your flash so you can leave. I'm going to give you an oral progesterone pill to put you to sleep so you can sleep. And it's kind of like a little bit of a, let's get going here. Whereas men, when we recognize that the longevity and the anti-aging effect of testosterone therapy, we pour it on them. Let's give them enough so that they get muscle from it.

They feel great. They're getting a lot of energy and libido from it. We don't have the same philosophy for women and we need to. So even then, women are going to go to a specialist and they're going to get subpar formulations. Like in formulation matters. So if you're doing your research and you're listening and you're like kind of even learning about it, women, when you take hormones a certain way and try to get them into your body, there are going to be side effects. And the formulation matters because the body you want to mimic. One, we talked about it being the most natural thing you can do. It's great. But you also want to take it in a way that mimics your own natural rhythm, your cycle, and the way that your body metabolizes it. And you're going to get the better, the best results, and you're also

going to get the least amount of side effects. And it's safer. Right? So theoretically, you're going to be doing it the most safest way possible as well. And you said, you don't have the time, like, why should you get like a minor in nutrition? And now you've got to like learn all this hormone risk of therapy. So the answer is to find, you know, to find that product or something that is just like, the only thing you have to worry about is 30 seconds a day and just do it once a day and not think about it. And this is what women need. This is a solution women need. Every January, women feel pressure to fix themselves. Be smaller, be better,

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Peducated. You mentioned changing our philosophy towards women's health and, like, the research that's being done is funding an element of this? Because I remember looking into this, we did an episode on endometriosis. And I forget the exact information, but it was something like the funding for Viagra is the same as the funding for PMS, which obviously half the population. And like endometriosis impacts the same amount of women as erectile dysfunction does men, but were like 10 times more fun. Okay, so I'm probably, you're actually on point. Like, and the point of your point is that women have to understand that the funding, a lot of it,

is driven by the pharmaceutical companies that are trying to sell a drug. So like the erectile dysfunction studies were done around Viagra because big pharma needed to prove that it was effective and all the things. so there's going to be a lot of studies around it. Nobody's going to make money off of PMS. And there's no endometriosis drug that Big Pharma has made in order to study. And Big Pharma is the only one that has like the money because they can patent their drug and then the FDA, the whole process is set up for them. FDA approval, manufacturing, clinical trials, and then like literally the only ones that can afford it.

So the bioidentical hormone space, these are natural products made in nature. and by definition you cannot patent them because like of their natural products. So Big Pharma is not going to touch it because they're like not going to make any money off of it. And so they're not going to study it. But that being said, there are actually a lot of studies and robust literature around hormone placement therapy. So we have studied it. And we, but the problem is that the studies are 50 and above. They are for menopause.

They have waited until that woman has stopped her period because there's been this really inaccurate assumption that your hormones are completely normal if you're still having a period. So that means that we study fertility, because one, we have like a treatment and we can make money off of fertility drugs and fertility stuff. And when we tend to, as a society, care about women who can get pregnant. This is like a phase that we care about, fortunately or unfortunately, and then menopause. So these two very extreme populations, like over the age of 50 and then under the age of 30, practically. And then there's this entire group of women between the ages of 30 and 50 that have been ignored. There are already zero studies. practically on hormone replacement therapy and starting it in your 30s and the benefits of

doing that. And it's because of like our society tends to devalue, I think, in my opinion, this population of women because when we, maybe we're just worthless after we can. But I don't mean to make it so cynical or whatever because I'm not bitter about it, but it is the reality. Well, I am and I'm cynical, so you can do it for us or for me. You just kind of like obvious that we're being ignored in this like specific group because of the infertility, but we're kind of like, and this is the most miserable group. They're the ones also, I wouldn't say they're the most miserable, right, because menopause is too, but I'm just saying, like, they take the bulk of, I mean, who has the, they're the most stressed, I'll say that.

We'll lose, though. Like, who has a lot to lose? Big Pharma, women will stop taking their antidepressants. Their, women go to, like, seven different doctors. They'll go to the cardiologists for heart palpitations. They go to here for, like, their vaginal infections. They're on antidepressants. They can't sleep. They're taking Xanax. They're taking. I mean, you know, like you said, there's all this money around, like, the face and, like, Botox and fillers and anti-aging and hair growth. And, I mean, if women just went on hormone replacement therapy and they felt better, they wouldn't need, like, all this other stuff. Like, in our, like, entire, like, you know, they would stop spending money on. I mean, it would be pretty devastating for everybody who's trying to make money off of women in this group of 30 to 50, which is a large buying group, if you think about it.

Well, I mean, that is 100% aligned with my experience between my 30s and 50s. I've gone to, I can't even count how many different doctors or specialists or wellness clinics. I don't know how many vials of blood I've given or sleep apnea or this test or that. I mean, like, it's just endless. And my general experience has been ignored and dismissed. So I can't speak for all women from their 30s to 50s, but what you just talked about certainly resonates with my own experience. Now, I clearly have feelings about this and it's my stuff, but I find that a lot of this is positioned,

you know, like bloating gut health, belly fat, things like that are talked about. And then we all pay attention as a way to attract people or get interest over things that we should be doing. Is that at all annoying to you? Like, we should care about gut health. We should care about our hormones. We should care about our energy. Do you feel like you have to be doing? You have to to do a song and dance as far as getting people hooked or interested by talking about the external, the way we look changes that are going to happen. Is my question making any sense? There's a couple things that you're touching on. One, women need to also understand that hormones are going to give them that external look that they want. Right. So like, it's no shame and like wanting that. Like,

I want to look good and feel good when I'm aging too. So it's like, this is something that you deserve and you can have. But do you need to like do all this other stuff? No. And I do think that they have. And I do think that they have, they understood, like, I think they're being told that they are being told, that, like, high cortisol is their root cause or that their gut health is their root cause. So, like, there's a lot of functional medicine doctors out there saying, well, you have leaky gut, and that's why you're feeling the way you're feeling. And if you just fix your leaky gut, then your hormones would get better. And this is really, really harmful to women because it's not the root cause. So they spend a fortune and a lot of time trying to do this. And ultimately,

it's not just about, like, the looks for women want it all. And they do get to, they should have it all. So the gut health, it kind of starts earlier with that. So like if you're in your 30s, some of those early signs do look like digestion and leaky gut and bloating because the gallbladder and the digestion starts taking a hit. Again, the hormones are needed for everything to function. So you can't even make mucin in your gut. You start to gain weight because all of the pathways that regulate metabolic flexibility are governed by hormones.

And then estrogen also like prevents you from eating, not eating like, But it's like this emotional eating and also that suppresses appetite. So estrogen's needed for that. So when it goes away, there's like a lot of different eating habits that come a place. So it's not just the metabolic flexibility, but your eating habits do change too. Your gallbladder can't work as well. So you end up with SIBO and a lot of different problems. So digestion can be one of the early signs.

But yet women are not recognizing it or there is still shame, as you mentioned, around it. Like, oh, I can't be going through it. That's like something in my 50s. I'm 32. Like, how is it happening to me when it actually is starting to happen to them? They don't, they're not getting hit with hot flashes. They're not getting hit with vaginal dryness. But their gut health is suffering. Their cortisol is rising. And it's because cortisol is regulated by estrogen and dampened by progesterone. So you will see cortisol rise in that early couple of years too. So they're, they're kind of seeing these early things, but they're not

addressing the hormones because I still think there's like some shame. Then there's not only shame around the aging. We just need to take it out, the shame out. Look, women. Like, it's fine. Like, we're just like in your 30s, but you can, you can actually not have to do it all, everything. You can just do the hormone or placement therapy. And I'm like that. If women understood how easy it was. Another thing, too, is not only shame, but the fear. I think that we have intentionally made women fear their own hormone. And what better way to control, like, it's, it's like, when you, you seem overly concerned about somebody, oh, like, I'm worried about you. I don't want you to drive to the store, I'm worried that you're going to get a car accident. This is actually just

masked as control. Like, it's like you're, you're trying to control somebody, only you're just masking it as concern. This is a really common, like, manipulation tactic. And women, when we basically distract them with the breast cancer thing, because it's not even a risk. Estrogen was never shown to cause breast cancer. And we continuously talk about women like they're only their breasts. We're like, oh, yeah, if we ignore the heart disease, like one in three women will die of heart disease. One in five will get a hip fracture and die. Talk about Alzheimer's and dementia, colon cancer, diabetes, like waking, urinary, track infection. I mean, all the stuff that starts happen in continents as we age. Forget all of that. Let's just talk about you, like, it's only your

breasts. And even though it's like one and 10,000 or something like, it's really rare, actually, breast cancer is very rare and stroke is even more rare compared to all of these other things that are like literally, even if you get breast cancer, you are more likely to die of heart. disease while you have breast cancer. Okay, so women are not, like, we're not appropriately counseling them on the risks and saying, like, you need to worry about your heart. And hormone replacement therapy most definitely protects you against heart disease. And we're doing it. It's almost feels intentional because women's bodies are constantly wanting to be, like we want to constantly control what women are doing with their bodies, like pregnancy and fertility and abortion and birth

control. And the hormone replacement therapy is just another part of the, control and I wish that women could see that so that they would realize that it's all BS. Because if they were to step away from it and say, oh, it's just another way that they're trying to control me, then they'll be able to not take that fear out of it. Because right now, I still hear it from women in their 30s. Well, I'm afraid to start. I don't understand it. Do you have to take it forever? Is it going to hurt my cycle? You know, there's a lot of fear around it too. Yeah. You said that articulately and beautifully. And you said something as it relates to estrogen and our breasts and we talk about us ourselves like we're only our breasts or we talk about women like

they're only our breasts and I think that's a little bit where I'm getting at is I'm not saying we shouldn't care about her skin or our belly fat or looking good or feeling good I'm just wondering if sometimes that's the distraction big pharma or you know people need so that we don't go deeper and that we don't set aside just the external to go into the internal and like set aside some of the shame and the fear around a lot of this stuff. I don't know. Any thoughts on that? No, I think you're right. I mean, there's a lot of money to be made off of you.

Just keep that in mind, like women listening. Like, I think we have to be very diligent as we're being marketed to. And we get, especially women in their 40s, it's like the most popular group, probably to market too. And so, yeah, it is the, and you're right, there's a lot of opinions and talk about it. But if there's just as many opinions, don't do HRT, that's an opinion, right? It's actually not, it's fear-based and it's not based on any science. So again, it's still like, here, let me tell you what to do about your body. There was like a pharmacist

who, I had a patient, and the pharmacist counsels her on. You know, estrogen is hormone poisoning therapy can increase your risk by stroke, or this and this, which isn't true, because it was not an oral formulation. But we don't, pharmacists don't pull patients aside for any other medication and talk about a risk, right? But that pharmacist, that male pharmacist felt that he had to like kind of instill fear into this woman. Why? Because he wanted to control. Like, what else could it be besides control? So because there's no science what he was saying. And they don't do it for any other drug. And then we're like there's more risks with lipitor and the, you know, antilipids that we do. Or like a thyroid medication. Did he pull her aside and say, hey, you know, there's a risk for AFib with this,

which is a tiny risk for that. But we don't counsel patients on that. So what? Why did he feel that he completely overstepped his, like, into her boundary and her space to make her feel uncomfortable about her body and hormones? This is going on all day long every day. And these are, like, traditionally trained doctors and pharmacists. So, but you're right, women need to, I think if they, they understood that they could win. They could not only treat the inside of their body and give the foundation that they want for excellent health. They get their brain health, cognitive function. They could perform better at their jobs, be happier with their families and their kids, like in their relationships, and have better skin and hair.

Like, I mean, you literally, it's almost like you can have your cake and eat it too, and you can do it really cost effectively. You don't have to spend a fortune on all these biohacking things. You don't have to be an expert in everything. Hormones will get you 80% of what you're looking for. If you can do one thing and get 80%, why wouldn't you do it? And then you can still do all the other stuff. It's great. One thing that I noticed on your website and when I've done some digging into hormone replacement therapy is that it's possible to get some of the these things without taking tests or without needing to have like a full diagnostic. Is that because we know all women are losing estrogen and progester and we all know we need it? What is necessary from a testing or diagnostic standpoint? What isn't? Yeah. One, symptoms are pretty good. Like they're pretty specific. And if you start because of the hormones and their nature, but I think women just need to understand that we have not made advancements in laboratory medicine the way that we should in order to support the testing. So federal law does not even a stress, like, so for example, let me just give you an idea of how bad

hormone testing is for women. If you were to pull out a vial of blood and send it to the lab and run hormone panel, you would get a set of answers. And then you were to run that same test again on that same vial of blood, you're going to get a different result. And then again, a different result and again and again and again. And this is called precision. And it has a very low precision. And In fact, it varies by 30% one way or the other, plus or minus 30%. So each result will vary by 30%. This is almost like a worthless test because it's so inaccurate. Okay.

So now you're trying to judge what to do and how to intervene in her by like this really crappy test. Let's be honest, that's a worthless test. The reference intervals have not been established for progesterone. There are five papers in the entire world, the entire world and none of them were done in the U.S. on what is the optimal reference range for progesterone. There are hundreds on testosterone. So now you don't even know what her progesterone supposed to be because nobody is studied it. Laboratory medicine is failing women, and I'm a clinical pathologist by training.

So my colleagues out there, like you're not doing it. And then we also don't, everything's in a different unit. So that confuses everybody further. And then nobody even gets the right tests. So if you're like wondering, hey, what should I get? you got to get an estrogen, an estradiol, a progesterone, which nobody orders, which is like your main hormone, which everybody forgets, and then testosterone, and then an FSAH. And an FSAH is very regularly, rarely ordered. So if you do the labs correctly and you do a blood test and you're just looking at them with the whole picture of her and talking to her, then it's okay. But what tends to happen is that doctors will just get an astrodial. And they'll be like, oh, it's normal. Because labs don't even flag z zero as being abnormal. Literally, there's nothing to flag an abnormal estrogen. So doctors, they will show up as like 30 picograms for a milliter, which is way low. And they'll be like,

you're normal. It's fine. Like, doctors literally won't even treat that because you're still having a period. It's fine. You're normal. So the problem with the labs is that it's another way to just get, just to kind of like get women out of their office and not treat them. So if you do, do decide to do the labs, though, and you get the full panel and you get an FSAH. Yes, it can help guide you an FSAH, once it starts rising above eight, you know that your ovaries are struggling. So if you're personally, like, informed and you're trying to make a decision, you could follow this marker. And as you see it rise, you're like, okay, every year, like my ovaries are just not able to function anymore. And if you need that kind of quantitative thing to drive you, if like the fact that you're

not sleeping and you feel miserable isn't enough and you need like a lab test, then this could be a really good way to do it, although I would see normal FSAHs and women really, really obviously struggling. So even then you need to be, you need to know when to ignore the lab too. Okay. You mentioned this earlier, and I just want to reiterate that hormones are the largest portion or percentage of what we're talking about here. And then there are things that we can and may possibly should be doing above and beyond that things like cold plunges or fasting or treating gut health, what have you. What about PCOS?

I've heard a lot of people talking about treating it from a dietary standpoint. Is that effective, ineffective? Is this mostly a hormone thing? Where does that fall in? So again, like when you look at PCOS, and when doctors say that the root cause, in my opinion, my professional opinion,

and I've been doing this for years, is that it's like, oh, it's an insulin resistance. If you just treat the insulin resistance, then the PCOS will go away. insulin resistance is a symptom it's not the root cause so here again you're just treating a symptom you're just trying to get that insulin resistance down and you're trying to get the weight loss off because it's like this chicken and egg argument well which one came first oh the weight loss or the weight gain came first and that's her cause of her PCOS so she just loses weight and you're telling this woman

the impossible like somebody who like literally cannot lose the weight because her lh is elevated and that's the root cause so it is happening. in her brain. So, okay, the problem is, like, she dropped in hormones, like, for whatever reason, we can, it's like on almost a separate podcast to talk about why they're dropping potentially in their 20s, okay, or even earlier. These are can be teenagers that can happen to them. But her hormones have dropped.

Okay, there's no progesterone. And then the LH is a leutinizing hormone in the brain. It's a marker will rise. The brain will start to release it. And it does stimulate the ovaries. And what do they make? They make testosterone. And then the testosterone is what causes the insulin resistance.

Okay. And then the insulin resistance causes ovaries to form cysts because the ovaries are very sensitive to insulin. And now you have this like really vicious cycle going on that you have like, and then you just try to target one part of the cycle, which is the weight loss and expecting the whole cycle to get better. And I feel like these women are banging their heads against the wall, we give them birth control, you tell them to lose weight.

They're putting them on high fiber diet. which is making them worse. Like, I have never seen a PCOS woman get better, a high-fiber diet. And so I just, you're not addressing it and her where her progesterone is what she's missing. Okay. And it's the same thing with like endometriosis, these younger women, genetically they're different. Like one woman ended up with endometriosis and one ended up with PCUS. But she should still be thinking about her hormones, both of these populations.

Okay. that her progesterone, these hormones, like if women, if anybody left today just like with this impression is that your hormones are protecting you. Like they're protecting your immune system. They prevent inflammation. They're regulating your cycles. They are also this metabolic flexibility in preventing insulin resistance in you. So the core problem of PCOS is still hormonal. And when you put a PCOS woman on hormone placement therapy, bioidentical, like an appropriate one that's systemic. And I would argue that the formulation is all that are not appropriate, but like, if you put her on one, she will get better over, this takes a while for her to get better because

she still has to do like the really, like the diet because it is such like a cycle that she's really has to break. But she's not going to be able to do it with diet alone. She needs to do them both. She needs to do the hormone replacement therapy and then target that insulin and like try to lower that testosterone because once she gets that testosterone lower, she'll be able to lose the weight. And then once she gets the weight off, then the cycle will stop. I could almost cry. I feel like you're literally describing all of my late 20s and 30s and early 40s. Like I couldn't explain to people in a way that I felt like they were really hearing me. It's like, it does not matter what I do or what I eat or don't eat or how much I exercise or don't exercise. I literally cannot get the weight.

off and my periods are all over the place and it got to a point where I felt like a crazy person and it got to a point where it impacted my confidence but not because of how I looked, but because I didn't trust myself anymore. I felt like I lost agency. It's called gas lighting. Yeah. It's abuse and actually that's what happens to that person is that they feel like they don't trust their internal compass or what's happening and that is gas. That is like what happens when you gaslight somebody. So, and it is like medical gaslighting. And it's not like doctors don't do it intentionally. I don't really feel like they're doing it intentionally. I think that they're afraid or they don't know. They don't know. And they also don't want to admit that they

don't know. So they tend to just reflexively like kind of, well, it's your problem. You're the one that's not losing weight or you can't do it. And when women, you know, I, in my opinion, women who do go through that really early, you're describing like most PCOS women and endometriosis women will describe it happening very early, like in their 20s. And when I look back to it, my life, I always had problems when we didn't, I don't think we really talked about PCS. I'm like 40 in my 40s right now, you know, so I'm kind of like wondering, I don't know, I thought it was stress or something. But I struggled as well. I didn't, I couldn't really fit into a category. But these women that like us, you and I and like other women like us, we probably metabolize hormones very quickly.

And what I mean by that is there's pathways in the body that methylate get rid of them. And so, yes, I took birth control and I was probably exposed to environmental toxics. And there was probably this other stuff going on. But even if I tried to control my environment, like I tried to control the food I was eating or the environment around me or like my stress level, all the things that, you know, you're trying to do, there's an internal genetic thing going on here. So even if you're like doing everything, literally you guys like, believe me, believe me, you cannot fight this like mechanism.

And that's why I'm saying that the high fiber diets are making these women worse because we're telling them to stay away from meat and protein. and if you are getting rid of hormones too quickly, you need a different diet. Like a diet like for you. And so biohacking and longevity, like you actually need to understand these genetics and who you are because your diet is going to be different than somebody who does better on a vegan diet. Like you would not thrive on a vegan diet, I would say. So this is like you need a really high protein diet.

But you didn't give, I wouldn't know what he told me that in my 20s, right? So even if I were to give in the right diet, maybe I could have prevented a lot of problems, but you're not. So I think we need to stop one way. We need to start recognizing the differences in the women. And when they're developing these syndromes early on, it's not because they're doing something. I think they actually are trying to stop this whole train wreck. I think they're coming and they're trying to stop it and they can't.

And it's because of it's genetics. I think it's genetics. And it's really interesting. I did have a lot of frustrations with the medical community. and I am trying really hard to give them and everybody the benefit of the doubt. It wasn't that they knew and weren't telling me. It's not enough research, not enough knowledge, and not enough admitting, I don't know. But I will tell you, far worse than the medical community was the non-medical community.

It's the other women, the people on social media, it's like, just eat this yogurt or just go vegan. And I know, again, best of intentions, we care. If something works for us, we want to tell somebody else about it. And just the loving reminder that we all are different. And what works for you might not work for somebody else. And just because what works for you doesn't work for somebody else doesn't mean that they're doing it wrong or that. I'll add to that. That I really think that you're going to fail if you try to fix a hormonal problem with a lifestyle intervention like a diet and exercise.

You cannot replace hormones with supplements. You cannot replace them with diet. It's very hard to like these, these mechanisms are breaking down, not because of like your diet. And so recognizing that maybe that did help for that person, but I have a feeling that it's just getting buying her time. Okay. So she, like if she was already feeling it and she managed to get some relief with the diet change or something, it could last like a year. But pretty soon, like she's going to be in the same boat as the rest of us, right? Like it's just like a matter of time before.

Like this is the universal thing that all of us are going to experience together, like something that should bring us together. And just because I experienced it at 32 and you were 28 and somebody else was 38 or whatever. Like it could have been just because like it's all coming for us. And so the social people and social who are like, well, why don't you just do this and that? And I'm like, it's okay. Your day is coming. Like you're just like your time. Like you know what I mean?

Like you're able to like. But like I have people in my life like women who are not quite ready for hormone and I don't, I don't stress it. It's okay. Like it's everybody's individual choice when they're ready. But you can see what they have to do. and their diet is so strict. If they, like, veer at all from it, they will gain, they'll gain weight or they'll feel terrible or they can't sleep the next day.

Or when you're at the point where your lifestyle is so strict, like, you have to wake up at a certain time and the sun has to hit your eyes to fall asleep the night next night and you can't drink anything and you can't eat anything, you are struggling with a hormone thing, right? Like you cheat. So I think they're just not recognizing. They're just like, they have this really, like, strict regimen. And I mean, I don't know about you, but like I'm okay with the healthy eating, but I don't want it to dictate my life necessarily either.

And I want, again, let the hormones do the work for you. It's actually like easier if you get those up. And then if you have a latte one day, it's not going to like wreck your sleep the night next night. You know, give me a break. Well, and I go back to what you said earlier is like we're living longer, but are we living well? And I guess everybody has their definition of living well. But for me, living rigidly isn't living well. If I can't have a latte or can't eat a piece of cheese or can't enjoy, you know, pasta and when I go to Italy, then that isn't a living life well for me. And I'm sure you've heard this a lot, but I wish I would have heard of you, known you, known of your work in my 20s. It would have saved me a lot of heartache. And I am so grateful that you're out there doing this and for you being on the show.

And I just genuinely hope anyone, someone listening in, will go actively seek a hormone specialist, go to your website, or at the very least, take a breath and let go of all of the shoulds and the supposed tos and like, hey, this is hormones. And we have them and we're aging and we're losing them. And it is what it is. And there is zero shame to be had in any of that. And it's your life. Like, you get to choose how you want to live it.

Not somebody else. Don't let your doctor tell you that you're too young or that you can't feel, you have to feel terrible until you're older. Oh, you're too young for this. Like, don't, like, it's your life. You get to choose, like, how you feel. You're in control. Yeah.

All right, friend, you can go to innerbalance.com to learn more about Dr. Sarah and her work. And you can use the promo code podcast, Dr. Sarah, for $50 off. And I will put all of the links and all of the ways to find Dr. Sarah in show notes, thank you. Again, truly, thank you for being here and for doing this much needed and incredible work. Thank you. Thanks for having me. My pleasure. All right, friend, here's what I hope you take from this conversation. You're not crazy and your body isn't broken. You're just living in one that has been misunderstood and overlooked because our health

has never been studied or valued the way our looks have. We've been taught to tough it out to just deal with it, to accept that exhaustion, brain fog, and joint pain are the cost. of being a woman. But that's not biology. That's bullshit. It's time we start trusting our bodies more than we trust the noise about them to ask better questions and demand better answers because what's happening inside us matters, how we feel matters, and we deserve care that actually cares. Understanding our hormones isn't vanity, it's agency, it's clarity, it's power. This isn't about chasing youth, it's about reclaiming balance, energy, and confidence at every stage of our life. Because listening to your body and refusing to apologize for doing so, well, that is woman's

work.