11-20-23 Menopause and Hormone Replacement Therapy with Dr. Kristen Colwell

None

Episode Transcript

(00:00):
Mix when I was six' five. Good morning, it is Christina Woolford.
Welcome to Lady Parts with doctor RichardVillarreal of a Dina Women's Health.
Good morning, doctor Villarreal, Goodmorning to you. How are you?
I'm doing great? How are youall doing well? So we've got another
topic today. We always do thismonthly, we address women's health. We've
got a special guest with us today. I know that's the most important thing
it is, So we've got totake care of the women. And today

(00:22):
I have a wonderful woman with me, doctor Calwell, one of my partners,
and we are going to talk aboutmenopause and hormone replacement therapy. Right
this is a topic we've been askedabout a lot, and a lot of
the women have a lot of issueswith this and it's something that you know,
it's sort of a silent thing thatmost of them suffer with, and
it's something that can be taken careof. And doctor Calwell is wonderful.

(00:45):
She does a lot of horror replacementtherapy, she does a lot of the
peladine and a lot of the womenreally like it. So we're going to
talk about that today. So everybodyknows about it. Awesome. So let's
start with menopause. So you knowwhen we talk about menopause, you know,
everybody's like, well, am Imenopausal? Am I not menopausal?

(01:07):
And they want to know, Well, we usually tell them say, there's
kind of a stairstep method going in. So you have like the perimenopause.
Then you have which is a fewyears, and usually the studies will show
us eight ten years of time.It's like that forty ish block, right,
and hot flashes, night sweats,mood swings, those can all kicking
gear. Then menopause is when youknow, our definition that we go by

(01:30):
is one year without a period.Okay, it's one year without amensis and
you go a year and you're you'redone. That's menopause. And then some
people will say, well menopause goeson or they call it postmenopausal, and
they say the time frame after that. So during that time frame, and
I'm going to let doctor Carwell talka little bit because I just blab a
lot, but it's an interesting timeframe, and what do you think about this?

(01:56):
So I think it's really variable dependingon the female that you're talking to.
I think that as a practitioner,we do not see the women that
go through it without any problems,they just don't need us, and so
we don't even hardly know they exist. But the women who are very symptomatic,
moderately symptomatic, they're usually learning tovoice their concerns. I think that

(02:19):
it's been a suppressed concern and Ithink it's just becoming more public now,
and so people are actually starting totalk about it with their health providers.
They're starting to talk about it amongstthemselves at the watering hole, if you
want to call it that, atthe you the beauty parlor. But everybody

(02:39):
has a different experience. I tellpeople that they're going to have their personal
journey through this transition, and Ithink everybody wants to feel good because you
know, I tell you abody,your fifties are like your thirties, and
your sixties are like your forties.You know, but everybody wants to do
more. And I think our generationis a lot healthier and do a lot

(02:59):
more than what they used to do. Because I look pictures. Do you
remember the Golden Girls? I mean, they were in their fifties. I
thought they were older. I know, I thought they were like eighties.
They were in their fifties serio,and so I about died my wife about
dieful for that. But it's true. And so you think of them as
being much older and not doing stuff. But a fifty year old nowadays up
to sixty year old and on,they're active. They're out athletically, they're

(03:23):
doing things. They're running, they'rebiking, they're traveling there, you know.
So we want to keep them ashealthy as we can. So we
have a lot of options. SoI guess that, Kristina, how do
we know? How would a womanknow number one if she needs homeone replacement
therapy or if she's a candidate forholmone replacement therapy. So I get to
ask that all the time, andI think it really depends on the person.

(03:46):
And again, symptoms, we havethe traditional symptoms of menopause, which
you've already rattled off, and that'swhat we read about in the books,
that's what we're trained in, andwhat I've learned over time personal experience,
personal experience with my patients. Theyteach me a lot is that there's a
lot more outside of menopause other thanhot flashes, night sweats, fasional dryness,

(04:11):
and they talk a little bit aboutmoodswings too. So what we've found
is that people have a sense ofwell being that they've lost. I have
almost eighty percent of people that cometo me wanting to discuss hormones are concerned
about their sex drive and the relationshipwith their partner. It usually is a

(04:34):
mismatch when it's a concern, andthat's because they feel like they're numb to
their partner. They don't dislike theirpartner, they don't find them unattractive,
but they just have no desire andtheir partner takes it the wrong way and
their partner is sure they're having anaffair on the side that you know,
they find them disgusting whatever it is, and they don't understand that the woman

(04:57):
in the relationship just doesn't have anycontrol over its part of her transition,
and they want help. And ofcourse, the medications that we have available
to us are all for premenopuzzle womenthat deal with hyposexual sex frive disorder situation,
so they are desperate for help withthat too. So what I find
is that my patients are teaching methat besides the traditional things that we learn,

(05:23):
is that there's a big box ofthe tiredness. I don't feel good.
I have mental fog. I can'tremember things. I don't know if
you remember. But when we wereworking together in the basement and I was
transitioning, I couldn't remember from mydesk to the room and back unless I

(05:43):
wrote it down because I wasn't sleeping. And people tell you when I started,
I was in my early thirties andI inherited a very advanced practice that
were a lot of women transitioning inmenopausal because of people in the previous practice
that we're retiring. They would talkto me about things that I didn't believe
really could happen. But since theywere telling me, I was. I

(06:05):
was believing them, but I didn'tsee how it could. They talked about
night sweats and being drenched and thebed being soaked, and I'm like,
how can the body do that?But I've lived through it now I know
the body does that, and youreally do have to change the sheets or
sleep on a towel. So Imean, it's just amazing things that you
don't get taught, that you justlearn. No. I remember, I've

(06:27):
had phone calls in the middle ofthe night. I had one patient call
me up and says, doctor villa. Do you know where I am right
now? And I'm like, well, well, no, it's two o'clock
in the morning. She goes,I am in my freezer. He's like,
it is. I am so hot. I have got my head in
the freezer. Oh my goodness.She said, you have to do something
about this, and I'm like,well, two o'clock in the morning,
we're not going to do anything.But I said, let's talk about this

(06:48):
tomorrow. You know. But yes, it is something and it's real,
and you're right, you know,most of us, you know, like
the guys. I mean, Ibelieve the women. I have no doubt.
I mean, my wife has gonethrough it and seeing this, Yes,
absolutely, it is something, youknow, significant, And I think

(07:09):
one of the biggest issues that peopledon't talk about is what you brought up,
Kristen. I think that's so important, is that the guys don't understand
the women just don't feel it.They don't It's not that they don't love
their husband or their partners that theydo, but it's just like that want
to have sex, want to youknow, I want to be there.
They just don't have that, andthey're not. The drive isn't there,

(07:31):
and you know, I had onelady come and tell me. She says,
you know, you know, Ihave my bucket list. You know,
I have twenty things on she has. Sex is not on it,
you know, And yeah it is. And and so that's what's this is
so important to talk about it sopeople understand it's not you, it's not
just you. If this is everywoman goes to well not everyone, but

(07:53):
most women go through this in someform or another, and it's okay.
And so but they're there things thatwe can do, and that's what we're
going to talk about today, thingsthat you can do to try to help.
Right, So people, let's talkabout who are candidates for something that
we can do or what can wedo for them? So we like traditional

(08:15):
harm and replacement, which is prescriptionmedications are usually estrogen based and they come
in patches, creams, pills.They are nice and comfortable because they've been
around for a long time. Theyare covered by prescriptions for insurance services,
so they are not usually very costlyand they're very well studied. But they

(08:39):
do have their risks and they actuallycome with black box warnings and they are
usually wrisks of stroke, blood clots, which is DBT's pulmonary embolie and then
breast cancer. So that is abig concern to a lot of women.
And some people have more family historythat causes their level of concern to be

(09:03):
higher than other people. Some peoplehave a personal history. I have had
patients who had to have a hysterectomyand both overs removed in their late twenties
early thirties and became immediately postmenopausal.Then had either a blood clot that went
to their lungs or had a strokeand they no longer could have anything.
And there they were a menopausal ata very early age. And then they're

(09:24):
at risk for cardiovascular disease, they'rerisks for ossioporosis or bone disease and are
absolutely miserable. Then they have thesymptoms of menopause like vatial dryness, They
could no longer have intercourse, that'stoo uncomfortable, they have no desire,
and it is a spiral. Sothere are things that we do. So
you know, we have a lotof the women that come in and they

(09:45):
have issues and they're just like justtake everything out, and I think most
of them don't realize the risks andwhat happens when we do you know make
you menopausal, you know, especiallyat a young age. So all those
things that you just mentioned with thehot flashes and vatial dryness, cardiovascular risk
and those are big issues. Oneof the recent articles we just had on
our board series was about women andeupherectomies or removing both ovaries at an age

(10:11):
less than forty, even less thanfifty, increasing the cardiovascular risks, and
that you can mitigate that with hormonereplacement. So it's important to do.
And then it also talks about memoryloss and all those other issues, and
it does. It's a serious thingand it does happen. So that's why
we're talking about this today. Soshe brought up some of the things that
we do. We do have pills, we have patches, we have rings,

(10:33):
we have creams and lotions that wecan use and they don't come without
the risks, as doctor Colwall mentioned. And the other thing that we need
to bring up is, you know, we have estrogen and we have progesterone.
And the interesting thing is, youknow, and what a lot of
people forget. They say, well, the estrogen takes away my symptoms.
But if you have a uterus,you have to use progesterone or you'll give

(10:54):
yourself an end mutual cancer. Soit just builds up that lining in there.
So you have to be on bothhormones if you still have your uterus,
and that's something that we find occasionallythat just people just say, well,
I'm not going to pay for bothof these and I'm just going to
take the wand that helps my hotflashesor whatever, and they develop a cancer
and it's unintentional, but you're justbasically feeding it. So we don't want

(11:16):
to do that. And then theother thing, as she mentioned, is
that we want to make sure thatyou know, anybody going on this,
they have to be very good abouttheir self brest exams and their mammograms.
So you know, every year,if you're on hormone replacement therapy, you
have to have mammograms and you shouldbe doing your monthly self breast exams.
And that's that's so important. Wecouldn't stress that enough. So we've got

(11:39):
some other things that we can talkabout, not just you know the difference
between well, let's go back onesecond. Let's talk about issues with sex.
Let's talk about that for a littlebit, because I think that's a
huge issue so there's some things thatwe can do to that's sort of like
you said, mitigate some of thesymptoms and sort of make it more comfortable
for the women and make it moreenjoyable for them. So what are some

(12:03):
of the things that you usually dofor these people. So, just with
the pharmacologic piece of it is usuallyan estrogen based product. Now it depends
on what they're reporting. So alot of times when they report that they
have pain with intercourse, the majorityof that is vaginal joyness. So and
we have a medical term called dysprunia, but it is basically I'll be told

(12:24):
it feels like I have razor bladesinside me. I'm ripping and tearing.
I'm not big enough anymore. Idon't have any lubrication. I've tried over
the counter lubrications. It's not helpingme. Those are a lot of the
symptoms that get reported to me.And so we have direct treatment, which
is the vaginal applications. There's creams, there's actual vaginal tablets that people can

(12:48):
take the problem that people tell me, and you know, I have some
personal experience too, is that it'shard to be we call compliant, it's
hard to do it as it's prescribed. Even the best intentions do not always
happen. Even if it's once aweek or twice a week. You don't
always remember when to do it.And if you're not taking it, you're

(13:11):
not going to get better. Andthen some people are very good at taking
their medication and still don't get thelevel of achievement. Moisturization. I tell
people that the vagina is skin,and it's like the bottom of your foot.
And I tell you that when youstart out in your menopause situation,
the lining is very thin. It'slike when it was springtime when you were

(13:33):
a kid and you went out tobe barefoot on the gravel and it was
very uncomfortable. And over the summer, as you used it more that thickened
up. You weren't as sensitive.That's going to happen to your vagina as
you're able to tolerate more intercourse,so your body accommodates what it's being used
for, and then the esergon helps, and then there's also a lot of
lubrications we talk about. Okay,and then you have to remember you don't

(13:56):
want to get the sper so youdon't have intercourse and use that as lubricant
right for the men. So wedon't want to get that on them.
So we want to make sure thatyou use that all nights that you're not
planning to be a little amorous,right and and so that's where I think
like the tablets, like the vegtumtablet type situation where it's really a delayed
absorbing situation, is not going tobe affecting your male partner. We talk

(14:18):
a lot of lubricunts. We talkedabout silicon water based lubricunts. I tell
people even vegetable based oils from thekitchen, you know, extraversi and olive
oil. Yes, coconut oil,it's very good, yep. And they
say that they're you know, sincethey're biodegradable, they're absorbed there. They
say, no petroleum based, sothat's your baby oil, your vasoline,

(14:41):
those are no no's. But basicallyanything you can find in the kitchen,
including Crisco, is fine. Sothere you go. So you like cooking,
this is good? This is whythat's awesome. Okay, So are
there any other side effects that wetalk about? I mean, when we
put people on hormones, they canhave some issues with them. So what
are some things that we have towork that we look for when somebody would

(15:05):
go on home in replacement therapy.I think the most the two most common
things, and again it depends onif you've had like aysteractomy or not.
But number one is breast tenderness.Your breasts are going to react to estrogen
and they are, especially if you'vebeen menopausal for a significant period of time.
The addition to any estrogen, you'regoing to fill it in the breast,
and usually it's a limited amount oftime. It's usually I think about

(15:26):
three to six months, and there'scertain things that we can do to mitigate
the symptoms and it does go away, but that is something that people will
notice. Okay, Bleeding I thinkis another one. You add the estrogen.
If they're not taking their protesterone,they're more likely to bleed, which
is sometimes a good thing. Sowe find out even if they do take

(15:48):
their progesterone, sometimes it unmasks actualproblems structural issues within their uterus like apoly
up or something else that's going on, and so that just alerts us to
do further investigation as to why theymight be doing that, and then you'll
see us we'll do biopsies or ultrasoundsand things like that just to look and
see what's going on. So alwaysreport it if you have it, particularly

(16:10):
if you're on the hormone replacement therapy, So that's important. And then I've
seen some women that can get headacheswith the hormones. They can have,
bloating, they can have and someother things nausea and there are other issues.
Don't Like she said, we havedifferent forms of hormones that we can
use and we can try to seewhat works best for everybody. So not
one, you know type works foreverybody, And I think depending on how

(16:32):
it is given as far as likewhich form you take it, because when
you're taking an oral pill, you'regoing to have a big surge of hormones
and it's going to taper off,and you're gonna do that every day because
it's a one a day product,Whereas if you have a patch, you
get a little you have a spikeof an increase and then it levels off,
and so I think you tend toget less side effects the more stable
you're able to keep the levels.Okay, so do you have any Have

(16:56):
you used some of the bioidentical stuffbefore personally or with patients with patients.
Yes, okay, yep. I'vebeen doing biodentical hormone therapy for about five
years. Okay, so we wantto get into this. So this is
this is sort of more of anew thing, and I wanted to talk
about this because I have a lotof patients that are asking about it,

(17:19):
and doctor Kobble has been doing thisfor a year like or five years like
she said, and this is something. It's good. It works. Women
feel good. They come back andI see them back and they're like,
I feel good, you know,I feel like myself again, and it's
wonderful. So let's talk about thata little bit. So how do you
know when somebody is a candidate forthis or who's the person the type of

(17:41):
person that you would see that youwould place on this. And I see
probably three to five people a daywho are coming and asking me about bidentical
hormones. And it really varies becauseI have young women who have had the
complete hysterectomies and don't have ovaries andare basic failing everything else that's been tried

(18:02):
by their other providers. I havewomen in their twenties or thirties that have
libido issues and have tried some ofthe other medications that are available to them
for that and they're not helping.When I'm checking somebody who's like premenopausal,
are they a candidate for basically testosteronetherapy because that is something that I have

(18:23):
available to me with the biodentical hormones. So let's talk about that, because
we haven't mentioned testosterone. Okay,So because we've talked a little bit about
estrogen and progesteron, which are thetwo female hormones, So why do we
look at testosterone? So testosterone isactually a female hormone too. Now people
want to associate it with men,but we do know that women's ovaries make
levels of testosterone, and as theygo through menopause or they have their ovaries

(18:45):
removed, they all of a suddenare lacking that. Now, there are
certain levels of testosterone that we typicallysee in somebody who has their ovaries and
they're doing normal function. But atthe same time, as I say that,
there is no absolute level of whatis considered normal for a woman.
But adding the testosterone to it,what does that give to the woman?

(19:07):
So if I'm giving so I havea level where I know if I'm checking
somebody's levels of testosterone, and theirlevel is above and the number is a
total testosterone, the number is aroundsixty five to seventy five. They are
not going to be a candidate fortestosterone replacement. But given that, at
the same time, if I'm givingthem testosterone because they're a candidate, I'm

(19:27):
looking to bump up their levels tobetween one hundred and fifty and two hundred
and fifty. And the first questionI get, and we're not back to
your original question, but the firstquestion I get is at that level,
am I not going to be aman? It's true, So I say
no because the reason that level hasbeen established is because that's how we know

(19:48):
when women are low at that level, they start feeling the things that we
want them to feel with their testosterone, which we'll get back to. Men's
levels are normally nine hundred to twelvehundred, so even close. So I
always reassure my women, right,we're not turning right. Well, occasionally
that's a side effect, but wecan get into that and that's always treatable.

(20:11):
But so while we're looking for withwomen in testosterone is again we know
that it is a hormone that womenproduce it tanks when women go through menopausea
loser ovaries. I've actually had.There is a combination, an oral combination
that is traditional called estrotest and ithas a generic name too, but it

(20:32):
is an estrogen testosterone oral pill,and so I have women that have been
on that. I still have afew, not many, but a few
that still take that. Recently,I had a patient who was finally making
the decision to switch to bidentical hormones, and we did her hormone levels with
her on her estrotest. She hadbeen on it for at least a decade,

(20:52):
if not longer, and I havebeen prescribing it. Her testosterone level
was six now and remember we're talkinga typical menopausal woman would be twenty five
to thirty five with their overars notmaking anything that that's just their their baseline
levels. So she was super lowand that's being on that doesn't make sense
pill, So it doesn't. Itwasn't doing anything for her. So that's

(21:14):
really disturbing to me that somebody wouldbe paying for a medication and have it
not helping with the expectation that itdoes. But so testosterone, it does
a lot of the general well being. But what we know it does physiologically
or inside the body is as healingblood vessels, and that is a very
well established fact. So we're increasingblood flow to a lot of places.

(21:37):
So for somebody's symptoms as women age, they'll start complaining and not even thinking
about it being menopause, because againit's not in the box that my hips
hurt, my knees hurt, myjoints ache, my elbows hurt. It
will just go on and on.I can't build any muscle, I don't
have any endurance. Those are thingsthat happen when women are lacking testosterone.

(22:00):
So when we give it back,all of a sudden, they start to
realize that their exercise program is helping, that they're able to actually do better
with a lot of the things thatthey're trying to do that they just weren't
seeing any progress. And I cantake myself as a personal example. When
I went into this, I've beenin Apostle for ten years and I didn't

(22:21):
really plan on starting bio identical hormones, but I was like to use myself
as a guinea pig, so Isaid, well, I'm learning about it,
so I'll do it myself too.And see what's going on. So
I went from a bilateral plantar fasciitis where I could not walk, I
got out of bed, I couldnot put my heels on the ground,
I could not do anything but whereorthotics and really gross shoes. I'd had

(22:41):
all sorts of treatments, never gotbetter, and now I run four mile
today. Yeah, and you cantell a difference in you because your energy
level, everything else it's back right, right, So it's a huge difference,
right, absolutely, Yeah, Soand everybody not everybody's going to do
that. Everybody has a different responseto treatments. And I run really low

(23:02):
testosterone levels. I mean, Ijust have my low work done in mine
was a one thirty eight so andagain one fifty to two fifties kind of
where we were looking. So evenat that low level, I'm still seeing
benefits. Okay. And then theother two hormones you play so and you
also sometimes will do to thyroid,right, yep, we'll treat thyroid.
That's part of our original panel.So we'll look at what your thyroid levels

(23:26):
are. There's a lot of peoplethat don't want to touch thyroid and they're
afraid of it. So it's kindof a learning curve. It is a
hormone. We're used to the feedbackof how the brain works with that hormone.
There's some newer literature coming out ofEurope that says that the desiccated thyroid
rather than the synthriid or synthetic thyroidmedication may be better for the heart,

(23:48):
particularly in younger women. And sowe are looking at all levels, whereas
a traditional practitioner may look at justat a TSH level or thyroid stimulating hormone,
where as we're looking at a freeT three we call it, and
a free T four. And we'realso looking at thyroid antibodies. So sometimes

(24:08):
with antibodies we're diagnosing like a hashtmotive thyroiditis situation where there's some genetic disorder
that your body's trying to kill offyour thyroid, that your thyroid function is
still find but your body's attacking yourthyroid and you have no clue. And
that's pretty common in women. AndI was really surprised at how often we
find that and people have never knownbefore. So how does this work?

(24:30):
So you know, I send somebodyin to you because when it comes to
me and says, you know,we've tried regular horne replacement therapy. She
says, I've tried it, andwe're gonna talk about some of the over
the counter stuff. But I've triedall the over the counter things. I've
tried the hormones, I've tried thevaginal creams. Is there anything else you
can offer me? And I sayyes, one of my partners does this,
and so she comes over to you, and then what do you do?

(24:52):
We go through just a general screeningchecklist and it goes through a lot
of different things. There's about twentythings with it, and they frequently will
fill it out even before they come. And so I go through and they'll
let me know, is it somethingthat they never experience, they do it
sometimes, or it's like very severeand a lot of times that most common

(25:14):
are like the decrease sex drive,the vaginal dryness, can't have an orgasm,
hot flashes, night sweats, basicallythings aren't working. And so we
go through that and I say,okay. They ask me questions, you
know what, you know, whatis the process And we talk about doing
the lab work to get a baselinefor where your estrason levels are and we

(25:36):
can get that with or without thembeing on hormone replacement therapy. We just
need to know what they're on ifthey're on something, because that will skew
what the results are. But wehave a computer program that takes that into
consideration as far as establishing a dose, so they will do a fairly large
panel of lab work to start outthe process. After we get a dose

(25:59):
established, we will bring them infor a pellet appointment and we use the
hormone replacement is made out of yamand soy and there are no allergens in
yam and soi, so once theytake out the hormones, that's all you're
getting. You're not getting anything else, So it's pure hormones. And that's
why they call it biodentical perfect andthat's why they don't people don't have reactions

(26:21):
to the hormones that we place.Then how often do you do this?
So it depends on the person.It's they talk about it being a cardiovascular
situation, but really really why Itell people the easiest to understand it is
blood flow released. So people thinkabout time release, but it's not.
That is blood flow. So peoplewho are more active, or you take

(26:41):
a marathon runner, they're going toburn through their hormones that we're giving them.
You know, in four to sixweeks versus somebody who's just doing their
normal amount of exercise or daily living, they're going to be three to four
months. Over time, as yourbody needs less, you can come less
frequently. Myself personally, even thoughI've been in a puzzle for a good

(27:02):
ten years, when I first started, I could tell things changing after three
months. So I was an everythree month person and that's a pretty typical.
And I tell people that, youknow, when you're first starting,
three months is pretty normal, butover time you need it less often.
And so now I'm an every fourto five month person. Okay, you
know, but your body will riteyou out because people are thinking, okay,
I don't think it's doing much forme anymore. I'm not going to

(27:23):
do it anymore. And they getto that for a five month piece of
it, and they're like, okay, knocking on the door, let's sign
me up. I need more.I see that your body rats you out,
so that's that's it's true. Sothen you know say okay, we've
got to do something, or yourpartners that you've got to do something well,
and that's funny too, because Ihave a lot of patience to tell
me that their partners will say,is a time yet, you know,

(27:44):
do you need me to pay forit? You know, because anymore you
don't do this, you're not yourself, right, And so yeah, it
does make a huge difference. Sowe have this available, Doctor Calwell is
available at the hospital and we canget in you know, people can call
and get in to see you.Yeah, pretty quickly. Yeah. So,
and it's just a thing we doin the office, so it's easy

(28:07):
to do. It's not even asterile procedures, just a clean procedure,
and it's just used a hollow needleand the pellets are they're kind of in
between like a pencil eraser and agrain of riser in between that side.
So okay, yeah, well that'swonderful. So now hormone replacement therapy isn't
so we don't want you get theopinion that this is for everybody. So
hormone replacement therapy isn't for everybody.And like we've talked about at the beginning

(28:30):
of this, some women sail rightthrough this and don't need anything, you
know. But then we have theothers, you know, like doctor cole
Weller's and some others that really needthis. It makes a whole difference in
your life. So it can bevery important. If you think you're one
of these people, you know youcan call get ahold of doctor Colwell,
doctor Blake does this at a dO B and I'll absolutely be glad to

(28:51):
take care of you well. Andwhat we found too is I and I
am very honest with people. Ifyou've done this a couple of times and
you're not getting the results you thinkyou need to get, then it's time
to switch and do something else anddon't keep going down there. Right,
So we don't want you to dothat, but but if it does help,
absolutely want you to go that route. But then, like we said,
we have all the other options availablefor you. And then we also

(29:11):
have some just over the counter thingswhich we didn't really get into, but
there's all kinds of things that shehad mentioned, just some of the fruits,
some of the things that you canjust get over at the GENC store
or some of the regular the store. I've have patients taking soy tablets and
they've had a lot of relief ofthe vatinal Dryness Act. Pretty high doses,
but they like they started at fifty. They went to the store and
they started at fifty milligrams, didn'tnotice anything. Then they found another supplement.

(29:34):
It was seven hundred and fifty milligrams. Right away they noticed a difference.
So that's something we talk about.The traditional estraven that's on the counter
and they have multiple doses right andsome of the dark ale if you're a
beer drinker. So it's to help. So, I mean, there's a
lot of nice things that you cando just over the counter to try to
just take that edge off if youjust need just a little bit help.

(29:56):
So but before we you know finish, you know, is there anything else
that you want to talk about oranything you'd like to say. I think
that the progesterone piece of it isreally important, and I think that's why
a lot of people were discontinued onhormone replacement. Back when we started a
women's health initiative, study came outand said hormone replacement is bad. People
are getting breast cancer. Everybody needsto stop, and like across the board,

(30:19):
everybody was discontinued, and then peoplebecame super symptomatic, and gradually people
kind of sucked up and the providerstarted prescribing it again. But over time,
as I drilled down into the informationand data that they had, they
found that it wasn't the estrogen thatwas the bad actor. It was actually
the progesterone, which was a syntheticpedesterone that they were being given, and

(30:40):
they thought that was really more ofthe trigger for the breast cancer than the
actual estrogen. And what we've foundnow and what a lot of people are
doing, is that the natural whatwe call micronized pedesterone, which is plant
based again from the Z we havea lot of different ways to give that
that that doesn't have the risk factorsthat we talked about before. For they're

(31:06):
some of the the other hormone replacementsthat we use people do really well with
and don't need to change. Weare able to do bidentical hormones for people
with breast cancer. That is somethingthat's important. A lot of times the
breast cancers have a testing for receptorsand are they sensitive to pedesterones? Are

(31:29):
they sensitive to estrogens? And nobodywants to give any estrogen to somebody who
has an estrogen receptor positive breast cancer. And I do take care of several
patients who do have that, andwe give them testosterone and testosterone is thought
to decrease the risk for breast cancerand it is a good help in taking
away a lot of their symptoms ofbeing menopausal because they do have estrogen blockers

(31:53):
given to them. That's nice.Yeah, Okay, so that's good to
know. So a lot of goodinformation. So you know, we want
to make sure people aren't suffering.You know, it's it's important to talk
about things now. And you knowthat's the whole inference behind this radio show
is to know that you can talkabout things. There's a lot of people
out there like you. We're tryingto get the information out to you.

(32:15):
Please please, if you are havingissues, please call get into any of
our providers and they'll take care ofyou. If they think that the bioidentical
hormonese is a route for you,they'll get you over to doctor Calwell,
she's wonderful and doctor Blake. Theydo such a fantastic job. So but
we thank you so much, andit's great, and thank you so much
for coming on the show today.My pleasure. I really appreciate it very

(32:37):
much, and this has been veryeye opening to hear you say all those
symptoms and thank you for your personalstory of you going through this too,
because you know, I can kindof relate to some of that too.
So it's been very eye opening andI think I'm going to ask my OBG
I and some questions too coming up. So I encourage you guys to do
that. Everybody out there, allthe women out there, and you know,
if you don't have an OBG yN, just go to a Dina

(32:57):
dot org. You can kind ofshop around. I like how they do
that. You see a picture ofall the positions there and it kind of
get their history and even make anappointment right there online. It's so easy.
They have a videos too. Ohnice. Yes, yeah, you
can chop around for your position.Again, it's all there at a Dina
dot Org. Again. Lady Partswith Doctor Richard Villarreal airs the third Monday
of every month at ten am.Right here, I'll mix one O sixty

(33:20):
five and Chilicafe. You can alsocatch the podcast on iHeartRadio. Just open
the free iHeartRadio app, click onpodcasts and do a search for Lady Parts
with Doctor Richard Villarreal.