Ep. 637 HRT Dosing: Absorption, Timing, and Lab Testing |Menopause, Perimenopause, Hormone Replacement Therapy

I’m honored to connect with Dr. John La Puma today. Dr. La Puma spent three decades building the case that food, nature, and light are clinical tools, not just lifestyle add-ons. He was the first physician to complete a professional cooking curriculum, and he used that training to co-develop the first cooking and nutrition course taught in a U.S. medical school, a course now adapted across roughly 80% of U.S. medical schools. He later did the same thing for Nature, co-developing and teaching the first skills-based Nature as Medicine CME course for physicians with UCLA. His most recent work extends the same logic to the built environment, coining the phrase "digital obesity and indoor epidemic" to describe a specific underdiagnosed driver of modern fatigue tied to how little time people spend outdoors and how much artificial light and screen exposure they get instead. In our conversation, Dr. La Puma discusses how we went from chefs' training to co-developing the first culinary medicine course; the indoor epidemic and digital obesity; how most people spend about 93% of their lives indoors; how light impacts bone health; and deep sleep metrics. We also explore how poor air quality can reduce cognitive performance, the significance of phthalate exposure and other endocrine-mimicking chemicals, and green dopamine. Dr. La Puma highlights the health benefits of gardening, explaining how it exposes us to microbes and stimulates serotonin. We also cover nervous system awe, movement, how forest bathing can boost your immune system while reducing inflammatory markers, how exercise can help us live longer, nighttime red light therapy exposure, sleep and recovery, and animal companionship as a health intervention. Stay tuned for today’s interesting and highly informative conversation about lifestyle as medicine with Dr. John La Puma. I highly recommend his book, The Indoor Epidemic, with the actionable information it contains. IN THIS EPISODE, YOU WILL LEARN: Dr. La Puma shares his motivation for bringing nutritional science and cooking into his medical practice How spending much of your life indoors can affect your nervous system, circadian biology, and metabolism The value of morning light for supporting sleep and rebuilding bones during perimenopause, menopause, and andropause How indoor air quality impacts cognitive performance Dr. La Puma shares his approach to reducing exposure to chemicals from household cleaning products The potential benefits of gardening and spending time with your hands in the soil How intentional time outdoors can support sleep, mood, energy, and memory A bright blue-white light at night may interfere with restorative sleep. Animal companionship and how it can improve our health and wellbeing Bio: John La Puma, MD, ChefMD™ is a two-time New York Times bestselling author, board-certified internist, and professionally trained chef who pioneered Culinary Medicine. He now pioneers EcoMedicine from his small regenerative teaching farm. His upcoming book, Indoor Epidemic, reveals how spending 93% of life indoors steals sleep, focus, and years, and how reclaiming just 7% outdoors can restore them using the evidence-based Outdoor Rx framework. This is a clinically validated intervention, presenting nature as foundational medicine, an essential component of health and the missing pillar in optimizing longevity and healthspan. Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Dr. John La Puma On his website The (Indoor Epidemic) book website

This episode is another in our podcast series of conversations with highly vetted brands I feel confident recommending to my community. Today, I was delighted to connect with Julie Sawaya, Co-founder and Co-CEO of Needed, a women's health company advancing nutrition standards across the mother span, from fertility through menopause. Julie holds a degree from Northwestern and an MBA from Stanford. In our conversation, Julie and I discuss the silent epidemic of nutritional deficiency. We explore how oral contraceptives and food restriction can contribute to nutrient depletion, current RDA standards, and the impact of pregnancy, breastfeeding, the postpartum period, and perimenopause on women's nutritional needs. We examine the MTHFR SNP and its variants, explain how to read supplement labels and what pixie dusting is, and discuss why it's important to know your omega-3 index and how this can influence both food choices and supplementation. Julie also shares a "repletion, not restriction" reframe for midlife and discusses the policies and standards she would like to see improved, including updated recommendations for pregnant and breastfeeding women and a straightforward perimenopause RDA. We also discuss practical takeaways, including specific supplement recommendations and testing that may be helpful. Stay tuned for another conversation you'll likely want to listen to more than once. IN THIS EPISODE, YOU WILL LEARN: How depleted food, environmental toxins, and normalized fatigue have contributed to the silent nutrient deficiency epidemic among women How oral contraceptives can deplete key vitamins and minerals, and how pregnancy, breastfeeding, postpartum, and perimenopause increase women’s nutritional needs What the current RDA standards were developed for—and how the research underpinning them largely excluded women of reproductive age How symptoms and cycle changes can overlap between perimenopause and nutrient depletion Nutrients that are essential for bone health, cognitive function, energy, nutrient absorption, and overall health during the menopause transition Julie reviews the evidence surrounding MTHFR variants What to look for on supplement labels Why nourishing your body properly can support your metabolism more effectively than food restriction How your omega-3 index can help you decide whether supplementation is needed Julie shares practical recommendations for supporting your nutritional health during perimenopause. Bio: Julie Sawaya is the Co-Founder and Co-CEO of Needed, a women’s health company advancing nutrition standards across the motherspan—from fertility through menopause. Julie earned departmental honors in Economics at Northwestern University for her work on nutritional access and her MBA from the Stanford Graduate School of Business. She is a frequent speaker and writer on women’s health and modern motherhood. Julie is a trained nutritionist and a mother of three. Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Julie Sawaya Needed Instagram TikTok

Today, I’m thrilled to connect with Dr. Aleksandra Gajer. Dr. Gajer was previously an academic emergency medicine physician who pivoted after realizing ER medicine was functioning less as a place that saves lives and more as a place that manages chronic conditions that should have been caught and addressed years earlier. That observation led her to leave ER medicine and take over an established Northern Virginia internal medicine practice focusing on hormone optimization, peptide therapy, and preventative longevity-oriented care. In our conversation today, we discuss how perimenopause is treatable and suffering through it is optional. Dr. Gajer explains how she manages body composition changes, weight loss resistance, bone health, and orthopedic-related complaints in midlife. We take a deep dive into the sourcing and research limitations of peptides, exploring healing peptides, growth hormone-promoting peptides, and thymic peptides, and also discussing immunosenescence, bioregulators, mitochondrial RNA-coded peptides, pheno age testing, and using low-dose ketamine, when appropriate, for mental health challenges. Stay tuned for a fascinating conversation about the science and limitations of research on peptide therapies, and what Dr. Gajer is looking forward to in the near future. IN THIS EPISODE, YOU WILL LEARN: The health struggles Dr. Gajer experienced that led her to explore integrative therapies Why women may wake up at 2 or 3 a.m. during perimenopause How hormone changes in midlife can contribute to weight loss resistance Why Dr. Gajer encourages women to have their bone mass assessed earlier than conventionally recommended How declining estrogen and estradiol can contribute to orthopedic-related symptoms during perimenopause and menopause What women need to understand about sourcing peptides and the limitations of peptide research The different ways in which growth hormone-promoting peptides, thymic peptides, epitalon, and MOTC work How GLP-1s can be helpful for midlife women beyond changing their body composition and assisting with weight loss How Dr. Gajer uses low-dose ketamine lozenges for treatment-resistant anxiety and depression   Bio: Dr. Aleksandra Gajer is a board-certified physician and founder of The Gajer Practice. In this precision and longevity medicine clinic, she helps high-performing patients optimize their healthspan through a whole-person, root-cause approach. Trained in emergency medicine at the University of Maryland and George Washington University, she brings rigorous clinical thinking to hormone optimization, peptide therapy, metabolic health, and gut healing. Her own journey through Lyme, alongside more than twenty years of contemplative practice, shapes her belief that emotional and spiritual health underlie physical wellness. A recurring Fox 5 DC health expert with more than fifty podcast appearances, she is also building physician education around the responsible, evidence-based use of peptides. Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected].  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Dr. Aleksandra Gajer The Gajer Practice 

Welcome to this week’s Midlife Minute episode. Today, we’re diving into listener questions about HRT dosing and the confusion surrounding administration. We explore several key themes, including absorption issues, lab draws, and cycling versus daily continuous dosing. I also compare oral progesterone with vaginal and transdermal progesterone. Stay tuned for more! IN THIS EPISODE, YOU WILL LEARN: The estradiol dosage range I prefer, for bone protection How heart disease risk can influence the route you select for HRT I clarify the “start low and slow” approach to HRT dosing Why women with uteruses need progesterone when taking estrogen  Why HRT dosing can become more complicated during perimenopause How FDA-approved bioidentical hormones differ from compounded preparations Various factors to consider when using an estradiol patch Alternative routes of administration for women who feel unwell when taking progesterone orally How providers can safely transition women from transdermal estradiol patches to other options Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Research: Please visit https://www.cynthiathurlow.com/podcast for research.

We have an extra-special podcast today with my husband, Todd, where we answer many listeners' questions about our relationship, how we met, and our shared interests. In this episode, Todd and I discuss ways to support your partner through perimenopause and menopause, the importance of shared interests and connections, and why communication is essential in midlife relationships. Todd shares his views on fatherhood and marriage, how physical activity and food are integral to our relationship, and the empty-nest/open door season of our lives. He also describes his own health and daily lifestyle, the bigger picture in our relationship, and we share some lighthearted and fun discussions. I love the interest this topic has generated, and I truly hope you and your significant other will find it an invaluable conversation about navigating midlife as a couple. IN THIS EPISODE, YOU WILL LEARN: What Todd came to understand about my perimenopause to menopause experience   How education and communication can help couples navigate the menopause experience The changes Todd has noticed in my personality since my 30s  How our shared values have influenced our business decisions What Todd values most about being a husband and father How, over time, Todd came to understand more about my childhood experiences and appreciate how I focused on creating a different environment for our children How the prospect of having both boys leave home is affecting us, both as individuals, and as a couple How Todd’s approach to his health has changed due to my influence What Todd believes men should understand as their partners navigate the perimenopause-menopause transition Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line

Today, I am thrilled to reconnect with a previous guest, Dr. Mary Claire Haver.  Dr. Haver is a board-certified OBGYN, a certified menopause provider, and the founder of Mary Claire Wellness, a private medical practice focusing on women in midlife. Her best-selling book, the Galveston Diet, and her latest New York Times best-seller, The New Menopause, are fabulous resources for middle-aged women. In today's discussion, we dive into various aspects of perimenopause and the associated challenges. We discuss factors accelerating ovarian aging, the role of contraception, mental health shifts, and the often delayed diagnosis of premature ovarian insufficiency. We examine the differences between hormone replacement therapy and oral contraceptives, discussing the importance of advocacy for women's health and the benefits of vaginal estrogen. We explore the disparity in federal funding for women's health research, the impact of the Women's Health Initiative, body composition changes, the estrabolome, the 30 Plant Challenge, and the advantages of HRT. Dr. Haver also talks about her preferred supplements.  I'm sure you will find this conversation a valuable resource that you will likely revisit several times. IN THIS EPISODE YOU WILL LEARN: Why perimenopause is so fraught with chaos Some of the factors that hasten ovarian aging How perimenopause causes significant changes in neurotransmitters, leading to cognitive changes The differences between HRT and oral contraceptives How estrogen loss during menopause affects vaginal tissue The benefits of vaginal estrogen for symptoms of menopause  How women's health research funding prioritizes reproduction over menopause and perimenopause How HRT can help with fat loss and muscle mass in postmenopausal women The emergence of eating-disordered behaviors in menopausal women Some of the lesser-known symptoms of menopause and ways to overcome them How HRT could impact the longevity and cognitive health of women Bio: Dr Mary Claire Haver Dr. Mary Claire Haver is a board-certified OB-GYN who has devoted her adult life to women's health. When she began experiencing the changes of menopause and midlife weight gain, she created her online program, The Galveston Diet, which currently has over 80,000 students. The Galveston Diet is the first and only nutrition program in the world created by a female OB-GYN, designed for women in menopause. As part of her ongoing research, she became certified in Culinary Medicine in 2019, specializing in medical nutrition. In 2021, Dr. Haver opened Mary Claire Wellness; the clinic grew out of repeated requests from Galveston Diet students and Dr. Haver's social media followers for personal guidance.  Dr. Haver lives with her husband and two daughters in Galveston, Texas. She is the author of The Galveston Diet (Rodale; January 10th, 2023). Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Dr. Mary Claire Haver On the⁠ Mary Claire Wellness website⁠ ⁠Instagram⁠ ⁠TikTok⁠ ⁠Facebook⁠ ⁠YouTube⁠ Books Mentioned Dr. Haver’s books, ⁠The Galveston Diet⁠ and ⁠The New Menopause ⁠ ⁠The Menopause Brain⁠ and the⁠ XX Brain⁠ by Lisa Mosconi Previous Episode Mentioned ⁠Ep. 308 Dr. Mary Claire Haver: Weight Gain in Middle Age, Perimenopause and Inflammation

Today, I’m honored to connect with Dr. Salome Masghati, founder of Precision Gynecology, which provides the unhurried, root-cause-oriented care often missing in a system where women are rushed through short appointments, focusing on bioidentical hormone therapy, perimenopause, and menopause. Dr. Masghati has extensive surgical training and specializes in longevity medicine. In today’s discussion, we explore the ovary as a signaling hub, not just a reproductive timer, and Dr. Masghati shares her views on hormone replacement therapy timing, intrinsic and infradian rhythm, ovarian function, and the differentiators between PCOS and PMOS in midlife women. We also cover oral versus transdermal estradiol therapy, FSH testing as an independent risk factor for bone and heart health, hysterectomies, ferritin and iron deficiency, coronary vasospasm, elevated Lp(a), estradiol and thyroid therapy, peptides, regenerative and esthetic offerings. Dr. Masghati also offers her personal perspective on what influences orgasms. Stay tuned for today’s invaluable conversation with Dr. Salome Masghati on optimizing women’s health in midlife and beyond. IN THIS EPISODE, YOU WILL LEARN: How a hysterectomy, partial hysterectomy, and other surgical interventions can impact ovarian function Dr. Masghati shares her approach to hormone replacement therapy for women going through premature or early menopause How elevated androgen levels, insulin resistance, and inflammation can affect the response to hormone replacement therapy in women with PCOS/PMOS Why Dr. Masghati generally prefers transdermal rather than oral estradiol How optimizing hormone levels can improve libido when women’s hormones change  Women may have low ferritin even when their serum iron looks good. Declining estrogen may contribute to coronary vasospasm in women. What women should know about regenerative therapies using PRP Why the source of peptides matters, and why Dr. Masghati specifically advises against using research peptides Bio:  Dr. Salome Masghati is a board-certified gynecologic surgeon who now focuses on hormonal wellbeing, functional medicine, and disease prevention. She specializes in women’s health conditions including perimenopause, PCOS, endometriosis, gut health, and metabolic dysfunction, using a root-cause and physiologic approach to help women restore balance and optimize their health. Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Dr. Salome Masghati On her website On Instagram Email: [email protected] 

Welcome to this week’s Midlife Minute episode! Statistically, one in three women will die of heart disease. So, today, we’re answering some of the many questions I received about lipids and heart health. Although I’ve done other lipid-focused Midlife Minutes before, this episode is yet another dedicated to Dr. Tom Dayspring, as I’ve received such a vast number of questions on this particular topic.    IN THIS EPISODE, YOU WILL LEARN: Why understanding your ApoB and Lp(a) is an essential part of assessing your cardiovascular risk Why treatments for lipid abnormalities should be individualized to fit each specific abnormality  Essential lifestyle measures for supporting overall cardiovascular health How CAC scoring, CT coronary angiography, and Clearly AI-assisted imaging differ, what each test measures, and their limitations  How cardiovascular disease can sometimes present differently in women  Why are premature atrial contractions and premature ventricular contractions often benign when the heart is structurally normal? How the roles of statins, ezetimibe, PCSK9 inhibitors, GLP-1 medications, and emerging RNA therapies differ, and why they should not be considered interchangeable How declining estrogen impacts cardiovascular health Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line

I’m delighted to bring you a midlife metabolic health masterclass for women today, with experts Dr. Yael Joffe, Dr. Ben Bikman, Dr. Lara Briden, Dr. Felice Gersh, and Dr. Alexandra Sowa. In this masterclass, our panel of experts explores how women’s metabolisms change in perimenopause, how our fat cells change with age, and how those changes influence our estrogen, insulin, and body composition. We examine how muscle, estrogen, and satiety mechanisms can improve or worsen metabolic health, the roles of aging, stress, inflammation, and ovarian health, and how body changes become metabolic risks. Join us for today’s impactful masterclass with our insightful panel of metabolic health experts. IN THIS EPISODE, YOU WILL LEARN: Why the amount of body fat you carry does not necessarily determine your metabolic health How declining estrogen during menopause can change where women store their body fat Why women have to work harder to maintain and build muscle as estrogen declines in perimenopause and menopause How women can continue building muscle at any age Why progesterone is not only a reproductive hormone or something prescribed to protect the uterine lining The changes women may experience as their estradiol and progesterone production declines in midlife What women considering GLP-1 medications for menopausal weight gain should look at, beyond the number on the scale How to support your gut health and manage gastrointestinal symptoms when taking a GLP-1 The factors Dr. Joffe takes into account when evaluating women during their menopausal transition Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Dr. Yael Joffe 3X4 Genetics Instagram Facebook Connect with Dr. Ben Bikman On his website Social media: @benbikmanphd Connect with Dr. Lara Briden Website Social media: @Lara Briden Connect with Dr. Felice Gersh On her website: Integrative Medical Group of Irvine Instagram All of Dr. Gersh’s books are available on Amazon. Connect with Dr. Alexandra Sowa On her website   Social media: @alexandrasowamd  Purchase a copy of Dr. Sowa’s book, The Ozempic Revolution: A Doctor's Proven Plan for Success to Help You Reverse Obesity, End Yo-Yo Dieting, and Protect Yourself from Disease Podcast Episodes:  Ep. 558 Your DNA Isn’t Your Destiny – The Most Actionable Way to Use Genetics for Weight Loss with Dr. Yael Joffe  Ep. 316 The Impact of Age, Gender and Lifestyle on Metabolic Health with Dr. Ben Bikman Ep. 372 Metabolism Repair for Women: Strategies and Insights with Dr. Lara Briden Ep. 570 We’ve Been Wrong About Progesterone! – The Most Powerful Hormone for Heart, Brain & Longevity with Dr. Felice Gersh|Menopause & HRT Ep. 438 - The Rise of GLP-1s: Key to Weight Loss and Metabolic Health with Alexandra Sowa, MD

I’m excited to share another episode in our series of highly vetted companies. Today, I’m delighted to reconnect with Angelo Keely, the Co-founder and CEO of Kion, for our third conversation. I’ve been using essential aminos. I really leaned into them during my book launch, and I credit them with helping me maintain my muscle mass despite training at a lower volume. In today’s conversation, Angelo and I discuss GLP-1s and muscle loss, exploring protein intake, the leucine threshold hypothesis, the association between declining estrogen and blunted muscle protein synthesis, and using essential aminos to build and maintain muscle. We unpack the role of sleep and recovery for muscle health, daily versus as-needed creatine monohydrate and essential amino acid supplementation, what omega-3s are, why they matter, and how to supplement. We also cover midlife women's body composition, weight loss, and muscle building, and Angelo shares his take on the disconnect between body composition changes in midlife women and how companies actively market to midlife women, knowing the challenges we face in that area. Stay tuned for today’s insightful and informative discussion with Angelo Keely of Kion. IN THIS EPISODE, YOU WILL LEARN: How caloric restriction leads to fat loss but can also cause the body to break down muscle  How essential aminos can help preserve our muscles as we age The essential amino formula Angelo recommends for midlife women Hormone changes may affect muscle protein synthesis The huge impact poor sleep has on whole-body protein synthesis  Essential aminos vs. whey protein and how they differ Value of essential aminos for maintaining muscle during caloric deficits  How aminos and creatine both need to be taken consistently, but for different physiological reasons What to look for when choosing a quality omega-3 supplement How to make daily supplementation easier to maintain Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Angelo Keely Visit GetKION.com/Cynthia for 20% off!