Karen Martel is a Certified Hormone Specialist and Transformation Nutrition Coach and the host of The Hormone Solution podcast, which focuses on perimenopause, menopause, hormone replacement therapy, metabolic health, weight loss resistance, and thyroid health. Her website is KarenMartel.com.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Transcript:
Dr. Weitz: If you’re looking for clinically useful insights, not wellness hype, then this is the place for you. Welcome to the Rational Wellness Podcast, the podcast for functional and integrative practitioners who wanna practice with greater clarity and precision. I’m Dr. Ben Weitz, and each week I sit down with the leading clinicians, researchers, and lab innovators to explore the science, lab testing, and clinical reasoning behind modern root cause medicine. This is a show focused on practical evidence-informed insights that you can actually use in patient care. Please subscribe to the Rational Wellness Podcast on Apple, Spotify, or YouTube. Please tell your friends and colleagues, and if you could give us a ratings and review on Apple or Spotify, we would certainly appreciate it. Finally, to access the show notes and the full transcript, please go to my website, drweitz.com. [00:01:00]
Today, we’re going to take a deep dive into one of the most important and often misunderstood areas of women’s health, the hormonal changes that occur during perimenopause and menopause. For decades, women were often told that symptoms such as weight gain, insomnia, brain fog, hot flashes, declining libido, mood changes, loss of muscle, were simply an inevitable part of getting older. But now we understand that through these dramatic changes, that the dramatic changes in estrogen, progesterone, testosterone, and other hormones during midlife can have profound effects on metabolism, body composition, cardiovascular health, bone health, cognition, sleep, quality of life.
My guest today is Karen Martel, a certified hormone specialist and transformational nutrition coach, and the host of The Hormone Solution Podcast, which focuses on perimenopause, menopause, [00:02:00] hormone replacement therapy, metabolic health, weight loss resistance, and thyroid health. Her own experience with hormonal dysfunction helped lead her into this field, and she has since worked with thousands of women to better understand and address their hormonal health. Karen, welcome to Rational Wellness.
Karen: Well, thank you so much for having me, Ben. I’m happy to be here.
Dr. Weitz: Absolutely. So can you explain what is the midlife transition that women go through?
Karen: Absolutely, yeah. A lot of women don’t realize that perimenopause actually starts quite early in life, and we don’t notice it because the symptoms creep up really slowly for most women. But we’re starting to see perimenopause symptoms starting even in our mid-30s. It’s getting earlier and earlier, I think just from everyone’s always like, “Why? Why are we do- ” And it’s like, well, look at our environment. [00:03:00] You know, our environment has so many things in it that mimic estrogen in the body, but these are xenoestrogens. And then all the toxins, and the heavy metal, and the air pollution, and the lighting all affect the hormonal system. And in perimenopause, so let’s say, you know, on average we’re starting at, you know, mid to late 30s, we start to see a drop in progesterone.
And that is seen with, you know, heavier periods. That’s probably one of the first things that start to happen. And so it’s not one of those things women go, “Oh, my hormones must be dropping.” It’s… We just think, “Okay, well, we’re having a bad cycle this month.” But then two months later you have another bad cycle, and then, you know, your, women will say, “I just suddenly am, like, bleeding out, and it’s terrible.” And they go to the doctor’s like, “Oh, I’ll put you on birth control pills.” That’s always the answer. [00:04:00] And then we start to see usually a little bit of weight gain. I always tell women that if you suddenly see a f- you know, a five-pound weight gain kinda come out of nowhere, that could be a sign that your progesterone’s dropping because we stop ovulating as often, right? We start running out of eggs. You know, you’re in your late 30s, early 40s. We are going to stop ovulating, and women, they don’t realize that if you don’t ovulate, guess what? You don’t produce the bulk of your progesterone. So now we become what’s n- very commonly known as estrogen dominant. And so every woman’s like, “Oh my gosh, I’ve got weight.
I’ve got all the symptoms of too much estrogen. I’ve got these heavy periods. I’ve gained a little weight.” It’s always in the hips and stomach, and they start doing things to [00:05:00] detox their estrogen. And that’s typically actually not what you should be doing. What you should be doing is actually looking at your progesterone. Very few women actually have, don’t actually have too much estrogen. Like, that’s not very common. You know, I’ve seen thousands and thousands of labs, and women are always thinking they’ve got this huge abundance of estrogen, and typically it’s normal. You might be xenoestrogen dominant, but not actual too much estrogen, and it typically has to do with it’s too little progesterone being made to counterbalance the growth of estrogen in the uterine lining and other places of, in the body.
So women will say, “Oh, I’ve got, you know, heavy periods.” Maybe they’re not sleeping as well. Progesterone acts on the GABA receptors of your brain, which help induce sleep, so women will start noticing in the second half of their cycle that they’re [00:06:00] not sleeping very well, that they’re a little more emotional. They start to ride that r- the emotional roller coaster prior to period gets really intense and you feel like, “Oh my gosh, I feel like I’m having PMS for two weeks now out of the month.” So ladies, this is your sign. This is the sign y- it’s time to look at what’s happening to your hormones and the symptoms, because sometimes labs don’t actually show the full picture.
I’m a big believer in getting tested. There’s some practitioners that are like, “Oh, don’t bother testing. Your hormones are, you know, doing this up and down in, in your 40s. No point in testing.” I completely disagree, because we start to see this progesterone going down. We start to see luteinizing hormone go up. We… A lot of women will start losing testosterone very early in their 40s, sometimes late 30s. Thyroid, progesterone has an effect [00:07:00] on thyroid function, so we wanna look at thyroid panel because- Thyroid and being hypothyroid, getting, having hypothyroidism can mimic a lot of the symptoms that we get in perimenopause from the loss of the progesterone and estrogen.
So that is kind of like the beginning stages of perimenopause, and then typically when we hit that mid-40s to late 40s, now we start going on the estrogen rollercoaster. Progesterone typically is almost gone at that point for most women. Some women will con- continue to ovulate well into their 40s, but a lot of women in the late 40s, that’s when they s- you know, the eggs are pretty much gone, and the progesterone’s completely depleted, and now estrogen starts to go down as well. And then by the time you hit that early 50s, the common age of losing the cycle completely, which is then considered [00:08:00] menopause, is about 51.
Dr. Weitz: You know, you mentioned that some doctors will put patients on birth control at this point in time. I’ve seen that so screws up the whole hormonal picture, and then you gotta wait for them to come off the birth control, and then it takes even longer, and it just makes it so much more complicated, and Yeah … I just think that’s really a bad idea.
Karen: Yeah, it’s usually, you know, the things that are offered to women in that phase of those early perimenopausal years, number one is the birth control. Number two would be an ablation or a hysterectomy, where it’s just like, “Okay, well, let’s just tear it all out because you’re not using it anymore.” And I’m, “Oh my, really?” Or they start to treat the symptoms like, “Here’s your antidepressant. Here’s your anti-anxiety. Here’s your sleeping pill. Here’s the birth control.” And it’s like, “Well, why aren’t we actually looking [00:09:00] at what is going on? What’s actually missing?” And what’s interesting, Ben, is there’s a lot…
Because we’re, you and I, we’re in the functional space, a lot of women are also thinking or being told by influencers that, “Oh, well, just start taking this supplement,” which is- Not as bad as, “Here’s your medication,” but it still isn’t addressing the root problem because it’s a matter of ovarian function going down. And when you hit, when you don’t have any eggs left and you’re just not ovulating anymore, there’s no amount of herbals, there’s no amount of diet, exercise, biohacking, fasting, that’s gonna bring back ovarian function.
Dr. Weitz: Right.
Karen: And I want women to hear that because they’ll typically, you know, in their earl- early days, like 35, 40, 41, 42, for sure, [00:10:00] taking a good menopause supplement or a supplement that’s gonna help balance-
Dr. Weitz: Like something with Vitex that’s a-
Karen: Exactly
Dr. Weitz: precursor for progesterone and
Karen: Yeah. Yes, exactly. But Vitex is not going to bring back ovarian function. It’s not gonna make egg, new eggs in your ovaries. Right. So th- there just comes a point where that’s a waste of money to, to an extent, depending on what’s, of course, in that formula, because there’s a lot of things that could help support what’s going on. But you can’t bring back progesterone, you can’t bring back estradiol by taking supplements or exercising more or doing red light therapy or whatever it is. You wanna do all of those things. They’re very helpful, and they’ll help with the situation, but it’s not gonna bring back the hormones.
Dr. Weitz: Do you ever start with progesterone at the beginning of perimenopause and then bring in-
Karen: Absolutely
Dr. Weitz: estradiol later?
Karen: [00:11:00] Yes. Yes. I do like to bring in progesterone. If a woman is showing on her labs and she’s having those symptoms, 100%, it can be life-changing for women in perimenopause to bring back the progesterone. Because a lot of women will start getting anxiety. Like I said, they’re not sleeping very well, so this is then gonna feed into insulin resistance and their mood. I mean, what woman wants to eat healthy if she’s riddled with anxiety, she’s not sleeping, and you’re telling her, “Well, just eat better, exercise more,” when they feel like garbage because they’re not sleeping and they have these emotional issues, and there’s so, there’s like 100 symptoms of perimenopause and menopause. So it could be a number of different things, and it’s just not fair to say that to women, in my eyes.
Dr. Weitz: Assuming at that point you’re going to use the progesterone [00:12:00] periodically, like every two weeks…
Karen: Yeah. Yeah. If you’re still cycling… it is… Yeah. I- if you’re still cycling, we want women to use it from days 14 to 28, or the last two weeks of their cycle because that’s naturally when we make it. Right. A lot of women will still continue to cycle their progesterone, even in menopause, because there is a little bit of research and theory around whether or not we should continue cycling, because that could be more beneficial for the entire hormonal profile when you’re on HRT. But that’s a personal preference. But yeah, a lot of women though, because it helps them with sleep, it does help them to feel better, they’ll in menopause they’ll take it every day, a lot of women.
Dr. Weitz: What’s the best way to measure hormones, both to assess where women are, as well as while they’re undergoing hormones?
Karen: [00:13:00] In those early years, it’s actually a really good idea to do not just blood work. I always wanna see blood work because we want that full picture. We wanna see your metabolic panel, we wanna see your thyroid, we wanna see your liver health. All of those things have a lot to do with how you’re going to be processing your hormones. So having that, and we- and then we can also see are the hormones starting to affect certain lab markers? Because we wanna catch that, right? Cholesterol starts going up, blood sugar will start going up. And so we wanna see what’s happening with the blood. But in those early years, it is beneficial to also do functional testing, so either a saliva hormone test or a urine metabolite test. Now, urine metabolite tests like the Dutch, that’s the most, you know, popular one. Yes. It can be super beneficial because it gives you a good reflection of [00:14:00] free hormone levels and how you are metabolizing your current hormones, which can be really important. And we also get a look at what the adrenal system’s doing, because that starts to get affected as women lose these hormones.
We lose the buffer to stress Which then feeds into all of the other things as well. They all work synergistically together. And so taking, taking a urine metabolite test, it’s great. It is ex- tends to be more expensive, of course. Of course. But it’s a good idea to at least do it once. But if you are losing your period, you’re losing…Like, you’re not cycling as often anymore, or you’re in menopause and not on HRT, then I don’t suggest saliva or urine until you are. Because it just is, it’s gonna be a waste of money. You’re gonna see just no hormones. Right? So you can’t [00:15:00] tell how you’re metabolizing them. And you’ll see a good adrenal picture, but the rest, no. You wanna get on the HRT so you actually have hormones in the body to metabolize so you can see which pathways you might be struggling with. And then in… But we always do blood work. In our clinic, we always do blood work coinciding with those tests, because they tell you two different things.
Dr. Weitz: Right. I think that’s a good clinical pearl, is a lot of times we’re debating, do we want to do urine, do we want to do serum? It’s probably optimal to do both.
Karen: Yes. Yep. Completely. Yep.
Dr. Weitz: Now that it’s become available, what do you think about measuring endocrine-disrupting substances at the same time?
Karen: You know, I went through a period of time where I was testing women, it and their levels of BPA in the body and other things. I didn’t at that time, I didn’t see that it was a reliable test.
Dr. Weitz: Okay.
Karen: Yeah. [00:16:00] But I know that there are great test kits. They’re much better than they used to be, so- I think yes, but we all have them. Do you know, to, so to what extent, yeah, sure, go test and see what levels, but every single one of us, men included, you guys are- Right drastically affected by these- Of course … toxins in the environment. We should all be doing that lifestyle cleanup to try to minimize the exposure to those chemicals as much as possible. Right. Like, get the plastics out of the house. Only use glass containers. Don’t be microwaving things in plastic. Right.
You know, there’s, get rid of all pr- artificially scented products out of your house. There’s so many options now to have clean, you know, body lotion and facial products and- Yeah … makeup and hair. Like, there’s so many alternatives now that we [00:17:00] don’t need, we should never have to go and use things like a v- I don’t know, O- Oil of Olay cream for your body or face. Right. Like, with, that have chemicals in them. We, there’s so many things to replace that with now.
Dr. Weitz: Yeah, it’s kind of like leaky gut on a stool test. Yes. It’s nice to get it tested and know for sure what the levels are, but we can pretty much assume that everybody has some level of leaky gut in this society.
Karen: That’s it. Yes, exactly. Yes, and I think that we all need to be doing that kind of detoxification and digest- digestive support because we do, we all have leaky gut.
Dr. Weitz: So let’s talk about hormones. When prescribing hormones let’s start with estrogen. What do you typically prefer? And I’m sure it probably depends on the patient, but we have oral, we have bio-identical compounded topicals, such as Biest. We have the FDA-approved [00:18:00] patch. We have pellets.
Karen: Okay. So- … everybody always wants to know about this. I have been… We’ve had our clinic now for about five years, so we prescribe in every state, so we’ve literally helped thousands of women optimize their HRT. And so we’ve seen the full spectrum. We have women coming in that have been put on pellets. We’ve seen women on oral, Biest, estradiol, the patch, oral progesterone, topical progesterone, vaginal progesterone, all the things. And I can tell you that there’s method, there’s delivery forms that we absolutely prefer, but you are right to say that it’s individual. There’s some women that do really well, for instance, on pellets. They love them. And then we have the opposite end of that spectrum, where women are like, “Oh my gosh, I got pellets put in. I lost my hair. My voice was cracking. I blew up. I gained so much weight.” [00:19:00] And you can’t get them out, right? So you gotta wait it out for three months, and we’ve heard horror stories.
And so I always tell women, “If pellets is something that you’re considering, start with transdermal or injectable first. Don’t go straight to pellets because you don’t know how your body’s going to respond to that.” We all have different degrees of how much, for instance, we convert testosterone to the more androgenic form, which is dihydrotestosterone. That’s where you get the acne, and the greasy skin, and the hair loss, and the voice changes. So some women can have little tiny bits. I just saw a woman’s labs yesterday who had hardly any testosterone, but she was on a testosterone cream, and she said, “My voice is cracking, and my skin is super greasy.” And the, and even though her levels were [00:20:00] low, so she was a high converter.
And so we wanna make sure we see how you’re going to respond before we go put implant pellets into your butt for three months. Sure. And then same with, usually it’s estrogen and progest- or sorry, estrogen and testosterone that’s used in pellets, so same thing goes for the estrogen. We just, we wanna see to- what you’re gonna, how you’re gonna respond first. And so with testosterone, we see that women respond best to inject subcutaneous injectable testosterone. So subcutaneous is the little tiny needles, and you inject it into a fatty spot on the body. And when you inject testosterone, you have to use way, way less than if you were using topical. So for example, you would typically do a five to 10 milligram injection a week, or five milligrams twice a week for a lot [00:21:00] of women versus if you’re gonna do a topical cream, the equivalent we’ve seen to that to get the same lab numbers, you’re looking at 5 to sometimes 10 milligrams of cream a day, which is a lot more expensive.
Dr. Weitz: So where are we with the FDA? As far as I know, there’s no FDA-approved testosterone for women.
Karen: There is not. None. Okay. Nope. Nope. There’s one in Europe now for women that’s like an AndroGel for women, but not in North America. Canada and the United States neither country has an approved testosterone for women. So you have to have it compounded in a cream, or we do a typically if it’s an injectable, we do a testosterone cypionate, which is what’s typically given to men as well. We just have a way smaller dose, of course. But testosterone really important. It’s not just a male hormone. [00:22:00] Your audience probably knows that by now I hope. It is one of our most abundant hormones when we’re in our fertile years. So we want to be looking at it. We wanna be watching for it. It does much more than just help with libido. You know, of course, it helps you with your muscle recovery, but a lot of women find it helps with energy and brain function. It can even help with your thyroid to function better.
So we definitely wanna be keeping eye on testosterone. And then progesterone, we see either a topical progesterone, a vaginal progesterone, or the oral. Like, all forms of progesterone really seem to work really well. We just don’t want to be going down the road of progestins- Right … which is what’s in birth control, and that’s the more toxic of the progesterones. It’s synthetic, and so doing a topical is better or oral. Now, a lot of women are very sensitive to the oral progesterone, and we’re seeing that more and more, where they get [00:23:00] depressed, really tired anxious from the use of oral progesterone because oral creates a lot more of the progesterone metabolites, and we’re, we see that some women have sensitivity to those metabolites. And in which case, we wanna then do a vaginal suppository or do a topical cream.
Dr. Weitz: Yeah, Felice Gersh is a friend of mine, and she’s-
Karen: Oh, she’s fabulous …
Dr. Weitz: really concerned about oral progesterone over-converting to allopregnanolone.
Karen: Exactly. Yeah. And she’s got a little bit, like, unfortunately there’s no great research yet- Right but she did like I saw her talk at A4M, and she was showing that maybe it could be affecting the heart, cardiovascular system negatively. And we do see that these higher doses of oral progesterone and the amount of metabolites that they’re creating can cause issues in the system, but there’s [00:24:00] no concrete evidence to prove it yet. Right. But it’s not the natural way. Right. You know, we’re not supposed to pass it through the liver and the digestive system. And so I kind of see oral being almost like two different drugs. You’re getting the, this boatload of metabolites, and then you’re also getting a little bit of progesterone from that.
And so topical, unfortunately, once again, it’s a terrible… Like, you can’t test topical progesterone unless you do spot testing, like blood spot testing or saliva, because it holds it in the tissues, and so it doesn’t show up well in blood. So there’s some research that showed that it wasn’t protective of the uterine lining, but then there’s been research that shows that it did protect the uterine lining. But there’s just not, once again, not great research. So I prefer a combination, like a low dose of the oral so that they can… it helps them sleep, and then using a topical or a vaginal one in [00:25:00] conjunction with it.
Dr. Weitz: But what’s a low dose of oral progesterone? Is that 50 or 100, or
Karen: Between 50 and 100, yeah.
Dr. Weitz: Okay.
Karen: Usually 100 is good. 100, you’re gonna get about 20 milligrams of actual progesterone from that. And then the topical, it holds more into the… It does give you some metabolites, but nowhere near as the amount that an oral’s gonna give you. And then same with estrogen. We you know, we just should never give oral estrogen in my eyes.
And we don’t in our clinic. We r- you know, unless somebody, like, says, “No, I thrive on oral estrogen,” then we’ll say, “Okay, great, then that- that’s what we’ll give you.” But that’s, that… I don’t even know if that’s ever happened, to be honest.
Dr. Weitz: I’ve got women who say that, and I’m like, ah, try to talk them out of it, but you know.
Karen: Right? Like, the thing with oral estrogen is it mostly is going to convert to estrone, which is a more inflammatory estrogen. It also raises thyroid-binding globulin and sex hormone-binding globulin. [00:26:00] The globulins are a protein that tie themselves to a hormone, and that’s how it gets around your system, but it has to get off of that binding protein in order to work and dock in on the receptor. And so if you’re raising thyroid-binding globulin, that means it’s gonna tie up your thyroid hormone, so you can’t use it. Gonna tie up testosterone. It’s gonna… If it’s sex hormone-binding globulin, it’s gonna tie up testosterone and estrogen. And so, and it’s oral estrogen that increases the risk of heart attack and stroke.
Right. And that’s where that whole window of menopause theory comes from, where the you’ll hear, “Oh, you can’t be on HRT past 10 years post-menopause,” or you can’t start it because danger, it’s gonna increase your risk of heart attack and stroke. But transdermal estrogen, so on the skin, vaginally, injectable estrogen works really [00:27:00] well. That doesn’t increase your risk of heart attack and stroke, and the Menopause Society now says women can take their transdermal estrogen for as long as they want, until the day they die. And I will tell you right now, Ben, I am taking my hormones into the grave with me.
Dr. Weitz: I’ve been trying to talk Mark Newman of Dutch Labs into adding allopregnanolone and some of the progesterone metabolites into their testing, so.
Karen: Yes. I think it’s important. Maybe, see if you should… You should suggest that.
Dr. Weitz: Maybe if he hears from enough people, they’ll add that.
Karen: Yeah, yeah.
Dr. Weitz: So, what do you think about estriol versus estradiol? So, a lot of women are taking this Biest cream that’s 80/20 estradiol, estriol, so they’re they’re actually…Or 80/20 estriol to estradiol, and they’re actually getting a lot more estriol.
Karen: Yeah. So I- [00:28:00] And I don’t believe that we should have this abundance of estriol in the body. Estriol is extremely weak. It’s the weakest of the three estrogens. We produce the bulk of estriol when we’re pregnant, so it’s a pregnancy hormone. And your estradiol and your estrone will make what your body needs of, it’ll convert down into some estriol. And it’s estradiol, Ben, that we see in the research everywhere that is the most important of the hormones for women’s health. It is the mother, and then she’s gotten such a bad rap since the me- WHI, and so we’re really trying to change that. Well, that’s all we…
Dr. Weitz: And I think a lot of doctors are using the estriol ’cause they think it’s gonna protect against breast cancer.
Karen: Exactly. And there’s nothing to show that. We know that estradiol, even in the WHI study, we know now that even [00:29:00] Premarin, horse’s estrogen, oral estrogen, actually was breast protective, and that didn’t have the estriol in it. And so what we see is if a woman is on 80/20, which is the most common formulation, we don’t see their estradiol typically getting high enough. And it’s the estradiol that’s gonna protect your bones. It’s the estradiol that protects the heart, the brain. Estriol’s great for skin, so we have it in our over-the-counter face cream because it’s amazing for skin as well as vaginal tissue.
So we have it in our vaginal moisturizer. We’ve got it in the skin products. And that’s where I feel like that’s where it should be used. And if you’re gonna do a Biest, at least make sure that you’ve got it as a 50/50 ratio or 80% estradiol with 20% estriol. But [00:30:00] in our practice, we typically, we use straight estradiol on most of our patients because we just see it working best and get them getting the most effects from it, and we see the numbers getting up, their estradiol getting up to therapeutic levels, where we’re gonna see more of that bone protection, heart protection, and brain protection.
Dr. Weitz: I think there’s some data indicating that the patch is actually the most reliable way to get the estradiol rather than topical creams
Karen: It’s not that it’s the most reliable. It is the strongest form of estradiol, and what it does, which is great, is it gives you more of a steady baseline because estrogen can…it just gets out of the system within about six hours after applying it. And so when you have a patch on, you’re getting that continuous estrogen [00:31:00] coming into the system. But we do see it’s still, you know, you put your patch on, and if you were to test a woman for three days post patch, you’ll see dramatic differences in their estrogen level And so a lot of our patients will actually use a combination of a patch, this is what I do, a patch with topical estrogen. So you top up your patch, and so your levels stay more even keel. And ’cause it’s the swings that a lot of women, they d- don’t like the swings of estrogen. So e- we see that the patch or cream, th- both work very well. Some women don’t absorb patch even.
Dr. Weitz: So if they use the patch, when do they use the cream?
Karen: They’ll use it on days two and three of the patch.
Dr. Weitz: Oh, okay.
Karen: Yeah.
Dr. Weitz: Interesting.
Karen: And that works great. That’s what I do, is I top it up and I use more on the third day than I did on the second day. So I increase this, ’cause I know that the patch really drops off.
Dr. Weitz: Right. So now there’s an even weirder form of [00:32:00] estrogen, E4, estriol, that is now coming on the market. And I assume at some point it’s gonna be marketed for menopause as well. What do you think about that option?
Karen: I don’t know much about that at all. So I haven’t, we haven’t, we don’t have it at our compounding pharmacy yet.
Dr. Weitz: Yeah. It’s something that’s only present in the in, during the birth process. So it’s, it’s-
Karen: So why would we do that, you know?
Dr. Weitz: You know, because- It’s
Karen: like
Dr. Weitz: I think
Karen: Why are we mimicking pregnancy in menopause?
Dr. Weitz: I know. Because there’s still this fear that we can’t get over, that estrogen is dangerous. And now this one doesn’t affect the breasts, and so it might be even safer.
Karen: Yeah. I, and I just think that this is just ridiculous. You know, estrogen is a hormone that… estradiol is a hormone that we have copious amounts of through our entire [00:33:00] fertile years. And nobody’s going, “Everybody, get rid of your estradiol. You’re gonna get breast cancer.” I mean, the highest rates of breast cancer are in women in menopause when they- Right have no estradiol. Right. Right. And they used to treat breast cancer with high dose estrogen back in the day. And s- and it used to be one of the, the number one prescribed medication was Premarin for a very long period of time. And we just, we know from all of the research now that, you know what? It is safe. We don’t need to be afraid of it. I mean, I could shower in it if I was allowed to. That’s how much I love it.
Dr. Weitz: When you use progesterone in women who’ve stopped cycling, do you ever use it cyclically or- Yeah … do you have women take it every day of the month?
Karen: We love either, because we’ve seen both work. So I think that cycling, you’re gonna be mimicking the natural cycle, and so there are [00:34:00] things that… Well, you’ve spoken with Felice Gersh. So she’s a big proponent of cycling the progesterone. And I love Felice Gersh. I have followed her forever. I’ve taken her course. It’s fabulous. And so, of course, no research, but when you look at what happens in a fertile woman when she cycles progesterone, like, it’s not just, oh, you ovulate, you start producing progesterone, but, and there’s no effect on anything with that cycle.
Wrong. I mean, we… Estrogen peaks. It creates, you know, the progesterone. The testosterone peaks right before ovulation, and then progesterone comes on board, and it helps to upregulate the receptors in the second half of the cycle, and actually helps to balance out the estrogen. And then it also creates this [00:35:00] rebound effect where you get a tumor-suppressing gene turns on from that cycle of the estrogen peaking and then the progesterone coming on board and peaking as well.
And so we want a tumor-suppressing gene, and you don’t see that happening if you’re taking a static dose of progesterone. But once again, no research. So we can’t say like, f- in, you know, this is what’s happening. This is great. You just can’t. So it’s to each his own. I see that static works great for thousands and tens of thousands of women, so.
Dr. Weitz: Do you ever use pregnenolone and/or DHEA?
Karen: Yes. I think that those two hormones need more attention. They need the spotlight because we just always look at estrogen, progesterone, testosterone. Well, DHEA is an aging hormone, which [00:36:00] means as you get older, it starts dropping, like the rest of these hormones do. DHEA counterbalances cortisol. It’s anabolic. Rather, cortisol’s catabolic. It’s great for the adrenal system, so stress. It helps support the stress system. And so as it’s going down, and then cortisol’s going up in perimenopause, now you’ve get that nervous system dysregulation. You’re not sleeping as well. You’re waking up between 3:00 and 4:00 AM every single night because your cortisol’s popping on at the wrong time. DHEA can give you energy. It helps with muscle building. It’s a precursor to making testosterone and estradiol, and it’s this adrenal hormone. So it can be good for so many different things.
It’s cheap. You need very little of [00:37:00] it. And then pregnenolone, pregnenolone I always say you should test it because not everybody loses it. And so some women will have t- totally fine levels, even into menopause But a lot of women will lose it, and it’s really important for brain health, the pregnenolone. I’m sure, I don’t know if Dale Bredesen talks about it, but I know that you just interviewed him. But it’s one of the brain hormones. They’re using it even post-concussion, like in high doses, because it reduces brain inflammation.
Dr. Weitz: Progesterone is sometimes used post-concussion as well.
Karen: Yeah, in high doses.
Dr. Weitz: Interesting. When it comes to vaginal symptoms, do you prefer vaginal estradiol, estriol? There’s vaginal DHEA even vaginal testosterone.
Karen: All of the above. Throw it all in there, Ben.
Dr. Weitz: Mix it up into a soup.
Karen: You know, [00:38:00] you don’t have to do all of them, obviously. But all of them work and have been shown to work for vaginal dryness, atrophy, urogenital issues that start to happen in perimenopause and menopause for so many women. It can be a very painful issue. More than 50% of us will have vaginal problems and that urogenital problems. This can be reoccurring infections, urinary infections, yeast infections, and then the vaginal atrophy, thinning of the walls. And so starting early taking care of the vagina, I think, is really important.
It’s goint to be really important to, for sex drive orgasm even. Like, women have a very hard time having a good quality orgasm or even orgasming at all if you’re low in estrogen in the tissue. And so we have an over-the-counter vaginal moisturizer that’s got estriol [00:39:00] and DHEA in it, because we’ve seen that combination seems to work really well, and it’s not gonna raise levels of estradiol systemically. It’s not that we don’t want that. We do want that, but a lot of women, you know, they get nervous. Or if they’re in perimenopause- Or maybe if we- … and their estrogen’s fine … right.
Dr. Weitz: Or maybe you have a woman who’s had a breast cancer scare- Exactly … or had a history of breast cancer, and they have been told never, ever to take any estrogen anywheres. Can vaginal DHEA or testosterone be used safely, and can it do what vaginal estrogen- With doof
Karen: Absolutely. And then you’re not gonna see this systemic rise in estradiol, so it’ll make your cancer doctor really happy. So yeah, putting it in locally, we don’t see a raising systemic levels, and it does, it works really well, and it’s… And you wanna do that in conjunction with using lubrication. I think a lot of women get [00:40:00] confused, or they’re told by a doctor or by social media, like, “Just, you know, use the, use more lubrication.” And it’s like, well, no, because you’re, you want to bring the tissue back in, not just have lubrication when you’re having sex. So you want to always make sure that you’re hitting both sides of that
Dr. Weitz: When it comes to dosage for hormones, do we base it on labs? Do we base it on how women feel? Do we use a combination? When do we… Now, I’ve heard some doctors who are really big on labs say, you know, “A lot of women think they’re fine with this lower level, but their labs are down here. We’ve gotta bring those labs up.” And other doctors- Mm-hmm … say, “No we it doesn’t matter what the labs are. If women still aren’t feeling good, then we bring it up till they feel good.”
Karen: Yes. And so this, I this is something I’m very passionate about. I actually have a free download. I’ll give you the link for your audience. It’s- Okay … it’s called Is Your HRT Optimized? And here’s the thing: it takes [00:41:00] very little estrogen and progesterone and testosterone to get rid of the little sympt- the O word symptoms. Like, it takes very little estrogen to get rid of hot flashes. You can just use Estriol, a lot of people, and a lot of women, and that will get rid of the hot flashes. And so women will think, “Oh, I feel great. I don’t have my hot flashes and night sweats anymore. Everything’s good.” But the… And then you look at their lab levels, and you’re go- and they’re terrible. Their estradiol is tanked. And we know from some research that we need certain levels of estradiol to be bone protective, and that’s something you can’t feel.
It’s like the woman that says, “Oh, I’m not gonna use HRT because I have no symptoms.” But what’s going on the inside? What’s happening in the brain, in your bones, in the skin? Collagen drops [00:42:00] significantly as estrogen drops, so that’s why we start getting fine lines and saggy skin and thin skin, because of that drop of estrogen. And so that’s not something that you can go measure. And you can’t be like, “Oh, this is why I’m having skin problems, because my estrogen’s low.” But we know that it does impact that. And so we wanna see a woman optimized on HRT. And w- once again, we have very little research to show, but there is some. Like, there’s some research that shows, for instance, that higher levels of estradiol create brain volumization in certain areas of the brain Hello, I think we want some vo- brain volumization.
But they showed in that research that lower levels of estradiol HRT didn’t give that volumization. We see some cardiovascular stuff that shows that a higher level is [00:43:00] better. We see in women’s labs all the time things like insulin resistance and the high cholesterol, LDL. Without a good dose of estradiol, those numbers will continue climbing in most women, so it’s not affecting their metabolic health as well as it could be. So we definitely, we like to see things in certain ranges at our clinic because that’s where we see women feeling their best and where we know that there’s a better chance that they’re gonna be getting that internal protection on so many of their organs. There’s estradiol receptors in everywhere in your body, and so we wanna make sure that estrogen is at a certain level so that it is reaching all of those places
Dr. Weitz: Let’s say a woman who’s 70 who’s considering reading about the brain health effects of [00:44:00] estrogen, as you were just mentioning, and because when she was in her 40s and early 50s, her doctor said, “Don’t ever consider taking hormones because they’re gonna cause breast cancer and heart disease and everything else.” What about her considering taking hormones?
Karen: There’s no age limit. And, you know, as I said before, like, the studies have really been done mostly on Premrin, and so they did… That was where the whole 10-year thing came from, and it was like, oh, God forbid if you were 70 to start estrogen. But that’s oral
Dr. Weitz: Right. So, so for people- who aren’t following what we’re talking about, I’m just gonna summarize really quick, is the Women’s Health Initiative, most of the women were 60 to 70, I th- or 60 to 65. They were, like, 10 years past menopause, and there was an increase in breast cancer and heart disease. And one of the conclusions was, oh, they needed to start earlier when they were just starting to go through perimenopause or [00:45:00] starting menopause. And if you wait 10 years, then it’s more dangerous.
Karen: Yes, exactly. And so w- if you are past the 10 years post-menopause, we definitely approach it differently than if you were under that. You know, the, the receptors haven’t had estrogen in over 10 years, sometimes 20 years, and so you have to be very careful with how you dose it.
You wanna start at a really low dose and very slowly increase it. Now, if you start at 70, let’s… There’s a lot of women that will say, “Well, is this gonna then now give me bone protection? Is it gonna build back my bone?” We don’t see it, that happening, but what we do see is it can stop the progression of bone loss or slow it down when you start using estrogen, even in the [00:46:00] later years.
Obviously, it’s gonna be better if you start it early so you get that bone protection right out of the gate, but you can still get… It can still help, and it can still help with the brain. Alzheimer’s research shows two different things, unfortunately. They do show in some research that starting estrogen later in the, like, post-10 years- can increase the risk of Alzheimer’s and dementia.
But once again, it wasn’t on transdermal bioidentical estrogen. Right. This was oral, and it was taken with progestins. Right. And so it’s just not good evidence right now. Right. But my mom is a great example. She had a hysterectomy when she was 40, and then at 60, so 20 years post-menopause, she was, you know, had gained stomach weight.
I had the meno belly. She was losing her cognition. Like she said, “I can’t find my words anymore.” Her [00:47:00] father died of Alzheimer’s, so she was freaking out. And I said, “Mom, you gotta get on estrogen.” And of course she was like, “What? I was told never to take estrogen.” Right. Anyways, I put her on it, and she’s now 72.
She’s been on it for 12 years, and she’s like, “I will never go off my estrogen,” because it brought back her brain. She said, “Okay, I can find my words.” She lost the stomach weight. She felt so much better. And so you just wanna be careful with it, and you wanna, y- you wanna work with a practitioner if you are te- post 10 years menopause.
Dr. Weitz: Right. So, I think that’s the questions I had for today. Anything else you felt was really important to include before we wrap up?
Karen: I think, you know, we talked about bringing in progesterone and testosterone in good time, right? Right. We don’t wanna wait. We wanna usually start using those hormones in our early 40s, the latest. Now, [00:48:00] estradiol is something that most doctors, once again, they’ll… Even hormone doctors will say we’re not gonna give you estrogen until you’re in menopause.” And ladies, perimenopause is eight to 10 years on average, and the worst metabolic problems that happen from the loss of estrogen happen in the perimenopausal years, and that’s where we see the most weight gain happening.
And this will happen for even the fittest of women. We know that a majority of women will gain some weight in perimenopause, and some will gain a lot of weight. I’ve spoken to women that’s, like, 20 pounds, 30 pounds when they were going through the perimenopausal years, and this is mostly from the drop of estradiol. Estradiol has the biggest impact on metabolic health. And so we want to start estradiol [00:49:00] replacement in the perimenopausal years when it starts to go down so that we can hopefully mitigate that menopause metabolic storm that’s coming down the pipeline like I said, for the majority of us. And it’s, like, 80% of women are gonna be affected by that loss of estradiol.
And so we want to bring it in, even if it’s just a small dose, just to keep things even, because estrogen starts to go on this wild co- rollercoaster ride where one month it’s high, one month it’s low. But if you actually put in a static small dose of estradiol, then you won’t have those swings as bad because the body sees that there’s estrogen in there.
And so always be looking at your hormone levels on labs, even if it’s be- you know, one m- one month it could show low, one month it could show high. It doesn’t matter. Still [00:50:00] test. Test your FSH. That’s a good indicator if y- if your ovaries are struggling to make estrogen. And get on that low dose, because you will have such a better perimenopausal experience if you do. And we see this, we just see this clinically.
Dr. Weitz: That’s a great clinical pearl! So how can listeners find out about you and you off- you have some products that are available. You were mentioning your topical estrogen.
Karen: Yes. And so- Okay … karenmartell.com, and then the shop is midlifesolutions.org, but you can get there from karenmartell.com. And yeah, we have a really nice over-the-counter line of estrogen face creams, the vaginal moisturizer, DHEA, Pregnalon, all the, all those good things. And then also we have, yeah, a HRT clinic that we can prescribe in every state, including [00:51:00] testosterone, and we also look at thyroid, which most cl- HRT clinics that are online like that don’t. They just deal with estrogen and progesterone. So we offer that full, like let’s look at all of the hormones, and we take a functional approach to menopause. So we bring in the lifestyle factors. We bring in the biohacking peptides. We do GLP-1s. We do it all for… we really try to target all, all pieces of the perimenopause and menopause.
Dr. Weitz: Yeah. I’d love to have time to talk to you about some of those other topics. Unfortunately, I do have a patient coming up, so
Karen: Yeah, no problem. Next time.
Dr. Weitz: Next time. Thank you so much, Karen.
Karen: Thank you for having me.
Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition, and want to prevent chronic problems, and want to promote longevity, please call my Santa Monica White Sports Chiropractic and Nutrition office at 310-395-3111, and we can set you up for a consultation for functional medicine. And I will talk to everybody next week.
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