S1 E10 Beyond Hot Flushes: Optimizing Your Hormones After Menopause

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Welcome to the Dr 50-something podcast.
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I'm your host, dr Nicole Norris.
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Whether you are in the midst of midlife or you want to prevent the physical and mental signs of aging that occur in midlife, this is the podcast for you.
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This is a show where I share my knowledge gleaned in family practice, preventative medicine and aesthetic medicine, to shed light on aging or, better yet, how not to feel or look like you are aging.
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We should be taking an active role in how we age from an early age.
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We should not settle with growing old gracefully or letting nature take its course.
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How we age directly affects our confidence, which impacts all of our relationships with those around us.
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The length of time in our lives that we feel really good in terms of energy, aches and pains and thought clarity has a definite impact on the mark we can leave on this world.
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My wish for my listeners is to always be mistaken for being 50-something or less in mind.
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Action and appearance.
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Let's go.
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It is never too late.
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This is one of the most common concerns that I get in my office.
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When I'm bringing up the idea of hormone optimization to patients who are already in menopause, they say will optimizing my hormones do anything for me if I'm already in menopause?
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Will optimizing my hormones do anything if I don't have hot flashes anymore?
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Side note is it hot flushes or hot flashes?
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Well, if you've ever had one, it could be both.
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You really feel hot in a flash and then your whole body flushes red.
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I think the textbooks say this loathsome symptom of perimenopause or menopause is a hot flush, but you can call it either.
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Hot flushes are actually caused by loss of inhibin.
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Inhibin is the first hormone that we lose as our ovaries start to shut down, and so hot flushes can actually start in perimenopause, before your menses has quit.
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The treatment for hot flushes is really multifactorial, but we often see improvement with progesterone in perimenopause and with estradiol in menopause.
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Eventually, when our ovaries have completely failed and you stop having periods, you likely will have many more symptoms than just hot flushes.
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In fact, every organ system of your body could potentially have a symptom of menopause.
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So let's start at the top.
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You have potentially loss of memory and brain fog when you are in menopause due to lower T3 thyroid production.
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Your skin also is affected by menopause and becomes paper thin due to loss of 5 to 10% of your collagen per year when menopause hits.
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To put that in perspective you only lose 1% of your collagen per year prior to menopause and our skin is 80% collagen.
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So when we lose that key component of our skin, our skin is thinner.
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Thinning skin is crepey skin.
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It's the main cause for the appearance of wrinkles and overall sagging of the skin.
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Now do you know which hormone causes this acceleration of your older look in menopause?
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A lot of you would probably answer estradiol, but actually our hormonal skin aging is primarily due to loss of testosterone, and better skin is one of the first things that our patients notice when we start optimizing their testosterone.
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In menopause you may also notice you have visits to your primary care doctor and you have your yearly labs, and you suddenly start seeing a trend every year that your cholesterol is not as good as it used to be, that blood sugar is a little higher than it used to be fasting, and that blood pressure of yours.
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Every time you come in, they say you should get a blood pressure cuff and check it at home.
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And on top of that, when they weigh you in the doctor's office, your weight seems to go up about five to 10 pounds every year.
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It seems that even though you're doing the same things in terms of lifestyle.
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You just keep gaining weight.
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All of these changes in menopause are a result of the combination of low testosterone and low estradiol.
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It also makes sense that if you are noticing higher blood pressures, glucose intolerance and high cholesterol, your risk for a heart attack or a stroke is going to be higher.
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In fact, the number one cause of death in men and women over 50 is cardiovascular disease.
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When you are postmenopausal, you also suddenly become high risk for many forms of cancer.
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Did you know that only 5 to 10% of cancer are truly due to genetics?
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So this increased risk of cancer that's not due to genetics is largely due to loss of our natural hormones.
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Our natural hormones are able to keep our immune system functioning properly and help us to prevent getting cancer.
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Optimizing testosterone levels has been shown over and over to reduce the risk of breast cancer.
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Optimized progesterone levels reduces the risk of uterine, breast and colon cancer.
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So we keep moving down as we started at the top.
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So now let's talk about vaginal tissue.
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Vaginal tissue atrophy is the primary cause of increased risk of urinary tract infections and intolerance to intimacy in menopause.
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The hormone actually driving these symptoms is testosterone.
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I bet you thought I was going to say estradiol.
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In menopause, our risk for fracture of our bones increases exponentially due to loss of testosterone and estradiol.
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Osteoporosis can be reversed with hormone optimization.
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You don't need really expensive shots or pills that give you heartburn for your osteoporosis.
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You really just need to optimize your hormones at any age.
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And another side note calcium supplements do not help you build bone.
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Now, on the other hand, natural sources of calcium like dairy and blueberries are very important for our bones, but anything that is fortified with calcium or a calcium supplement truly has been shown to do nothing for our bones.
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There are even some studies that say too much calcium supplementation or products with fortified calcium actually increase calcium deposits in important arteries.
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This is also incidents of confirmation bias where, even though there is good literature to back up everything I just said about calcium, we think calcium pills prevent and treat osteoporosis.
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That is false.
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And lastly, let's talk about how hormones affect our productivity.
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Why do many older adults eat really early?
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Well, because they are tired and they need to go to bed earlier.
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Yes, loss of testosterone and thyroid drains your energy and you just cannot get done what you used to in a day at least without naps.
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Are you picking up what I am putting down.
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Losing your hormones as you age has many more significant symptoms than hot flashes or hot flushes.
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And guys this is an extremely important point for you too.
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Guys rarely have a hot flush associated with andropause, but they sure can have every other symptom I just mentioned.
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Just substitute poor libido and sexual dysfunction for vaginal atrophy and add low testosterone as a major risk factor for prostate cancer.
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I maintain that it is never too late to start replacing your body identical hormones.
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You have to be open to the mindset that you are not destined to all the diseases of old age, and if you have some of these diseases already, I will give you some hope that hormone optimization can improve whichever old age affliction you have and even possibly reverse it.
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And if you have some of these diseases of old age already, I will give you some hope that hormone optimization can improve whichever old age affliction you have and even possibly start reversing it.
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I think this all starts with changing your mindset about going to the doctor.
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I do understand why my patients over 50 back when I was doing family practice really didn't want to come see me every year.
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They would begrudgingly have labs done that I ordered for them and come in and just wait for me to tell them the bad news the next chronic disease of aging that was showing up on their labs.
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No one likes bad news and no one likes losing control of their health.
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I used to be that doctor giving bad news all the time, but I am not her anymore.
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Now, when patients come to see me as their preventative medicine physician, they are happy when they come in and happier when they leave, because they are taking control of their health and doing everything everything they can to slow the progression of chronic disease.
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They have a sense of well-being they did not have before.
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They have less fear and more control.
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They have more energy and better cognition.
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They are more productive in society and able to participate in their family's lives longer.
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Preventative medicine is the opposite of sick medicine.
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It is a mindset that a patient does have some control over their health.
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A book I read this year by Dan Martell, a successful business coach, said when you are healthy, you have a thousand dreams.
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When you are not, you have but one.
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Life is about choices.
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The trajectory of your health as you age is all about your choices.
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You do have control of how you will age To heck with aging gracefully.
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I see aging as a strategic battle with winners and losers.
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The winners have optimized their hormones and see their preventative medicine physician more often than their sick medicine doctor.
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If you are ready to wage war on how you are aging, keep listening to this podcast.
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In my practice, hormone optimization is one of the big guns in this war, but soon we will also discuss the benefits of peptides, gi mapping, measuring your telomere length to determine your biologic age, and yearly blood tests that screen for early cancer with incredible accuracy.
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Thanks for listening.
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Thank you for joining this episode of the Dr 50-something Show.
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The content of this episode is not intended to be a substitute for professional medical advice, diagnosis or treatment.
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Always seek the advice of your physician or other qualified healthcare provider to answer any questions you may have about your personal medical conditions.
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Until next time, get fit, get fabulous, get firm and take care of yourself.