Navigating Perimenopause and Menopause with Hormone Replacement Therapy and How it Affects Weight Loss with Dr. Rosensweet [Ep. 41]

Lisa: 0:00

This is the eat. Well, think. Well live well podcast. I'm Lisa Salsbury, and this is episode 41, navigating perimenopause and menopause with hormone replacement therapy and how it affects weight loss with Dr. David Rosensweet. Now before you younger listeners tune out thinking that this isn't affecting you. You're going to learn from Dr. Rosensweet, that once you reach your thirties, your hormones are declining and you are in peri-menopause as this is the time proceeding menopause. So just by virtue of your age, once you reached the thirties, you may not be having classic symptoms, but things that you may not attribute to menopause or perimenopause rather. Are actually occurring because of the decline in hormones. I loved editing this episode and listening and learning from Dr. Rosensweet. Again, we recorded this about a month ago and I've been dying to put it out. I was saving it to do a whole series on menopause, but those other interviews just haven't happened yet. So I will put those out when we get them scheduled and keep talking about these things that are affecting us in this peri-menopause time and how to combat them. So please feel free to send me any questions about this and I will be sure to ask the next expert I have on this topic. I will tell you too, that after doing this interview, I did ask my regular gynecologist about bioidentical hormone replacement therapy. And she agreed with me and started me on a very tiny dose of topical estrogen. She isn't trained in Dr. Rosensweet menopause method, but just for those listening, wondering when we get to the point in the interview talking about HRT and what doctors will prescribe it. You totally can start with your regular gynecologist and see what she can do for you. It is totally worth an ask. So don't forget also to download Dr. Rosensweet, free book to have a little bit more language around this topic. And that link of course, is in the show notes. Welcome to Eat Well, Think Well, Live Well; the podcast for women who want to lose weight, but are tired of counting and calculating all the food. I'm your host, Lisa Salsbury. I'm a certified health and weight loss coach and life coach, and most importantly a recovered chronic dieter. I'll teach you to figure out why you are eating when you aren't hungry, instead of worrying so much about what you are eating. Welcome back to the Eat Well Think Well Live Well podcast today. My guest is Dr. Daved Rosensweet. I'm super excited. He reached out to me and thought that his knowledge about menopause and his expertise was really gonna be a value to my audience, and I totally agreed. So. We have had a couple of questions recently about menopause. A little bit about perimenopause, so I know this is kind of the age range that my listeners are in, so I'm super excited to have him. I'm gonna let him introduce himself and then we'll jump into our conversation.

Dr. Daved Rosensweet: 2:52

I'm a medical doctor. I was traditionally trained. I I love medical school, I love my traditional training. It was like arriving at temple or synagogue for me. And then, uh, when I left medical school, I started getting interested in things that really related to health and, and root cause. So I did a lot of work with nutrition and, uh, the exposure we have to toxicity and detoxification. With exercise and with the elephant in most people's room, a dysfunctional response to the stresses of life because that disrupts the immune system, disrupts the hormonal system. Yeah, we can do fight or flight biology, but it takes a toll on us. Cuz I was really interested in what's getting my patients ill. I mean, how do we. And then, um, about 30 years ago, a patient of mine that I knew really well stormed into my office. She was in her mid forties She did not have an appointment. She flew open my examining room door, my consultation room door, and she told me, look, I'm going crazy and don't pretend, you know, I'm telling you I'm going crazy. This is big. and, uh, serendipitously, so to speak, although I don't think life works like that. Um, I had been speaking to a world expert on progesterone and I gave her progesterone. She was in her mid forties and she, three weeks later, I got a letter from her saying, my God, this stuff is miraculous. I mean, I feel so much better. That was pretty dramatic. You don't often people, by the time they've gotten ill, it's, it is often a slow moving process to do the various changes we need to do, and we don't necessarily see these tremendously dramatic results. Well, I, these were tremendously dramatic and before I knew it, I was seeing a lot of women in the perimenopause and menopause. And then I decided to specialize in it for the last 30 years. I, I've really headed towards total specialization in it because it's a, it's an amazing thing. It happens to a hundred percent of men and women. We start out at the age of 20, and that's when we're putting out our peak ovarian or testicular hormones,

Lisa: 5:13

Mm-hmm.

Dr. Daved Rosensweet: 5:13

and then it's declined from that moment. and in the thirties a lot of women don't really feel that decline, but it's taking place. And some women do. They periods start getting irregular and they start getting, uh, return of ps. They start not sleeping as well, mood issues because they're losing their ovarian hormones.

Lisa: 5:35

Mm-hmm.

Dr. Daved Rosensweet: 5:36

And then comes the magic day when the period ceased entirely and there's a almost a full. Of, of the most powerful biochemicals in a woman's body amongst them, there's other powerful biochemicals of that magnitude. Thyroid hormone, some adrenal hormones. But these ovarian hormones, estrogen, progesterone, a woman's body treasures these and without them, the declines that you see that ultimately result in assisted living facilities, nursing homes. Adult, diapers. Why do people wind up there? And most Women wind up there because of the loss. of ovarian hormones,

Lisa: 6:18

Hmm.

Dr. Daved Rosensweet: 6:19

the loss of muscle and bones.

Lisa: 6:21

big cause of like generalized aging then? Is that what you're

Dr. Daved Rosensweet: 6:24

there there's very specific declines because these hormones are so important. Yeah, we could say generalized. But specifically, there's loss of bones, loss of muscle, loss of cognitive ability, loss of energy, loss of libido, loss of vagina, loss of bladder control, loss of arterial protection, that estrogen confers vulnerability to a heart attack and stroke. These all derive primarily from the loss of ovarian hormones.

Lisa: 6:56

Yeah. Yeah. I'm a big fan of, I've, I've said this phrase on the podcast before and I got it from someone else. I don't, I don't even remember who, but just the idea of making our health span. match our lifespan. And so this is really critical here because I don't just wanna live to a hundred. I wanna live to a hundred and be completely functional and still be driving and getting up and down off the floor in my nineties. I really want to be As healthy as possible, yes, I'm gonna have beautiful wrinkles, and yes, I'm gonna have gray hair and that is all completely fine with me. I just wanna be able to get my own groceries and not worry that I'm gonna fall down. And so this is really critical then to pay attention to those female hormones. When we start having these symptoms and we could go over things like what are like menopause and perimenopause symptoms. I think you kind of covered some of them. I recently had I, well, let me just be honest. I have a marina i u d and I know that that's, some people are like, it's not a problem at all. Other people are like, rip that thing out. I don't know how you feel about that. And my listeners can decide what they want, but in any. Very, very, very light periods because of it. but I've noticed, even though I have that. it's getting more irregular and all of a sudden, like I have like this tiny period and then 10 days later I'm like, gushing, wait for the first time. Like since I've even been on it and I'm like, okay. Hello, hello. Perimenopause. Uh, this morning I woke up in, um, a complete sweat. I was like, why are my pajamas so, so wet this morning? That's fun. So it's just these tiny little things. I think most women probably are pretty aware. But what do you think is, what do you think are symptoms. we aren't aware, like we know irregular periods, night sweats. most women know this. What are some things that are happening that are perimenopause that women don't realize or don't attribute to that and are maybe signals for them to start getting help?

Dr. Daved Rosensweet: 9:05

Well, it's a, it's a great question because although 75% of women have really dramatic symptoms, such as the ones you just named. Welcome to Perimenopause Year in, um, 25% of women don't have symptoms and they look around, they say, what's this big deal about menopause? It's my menopause is easy yet for a hundred percent of women, as estrogens decline, you start losing bone. We don't feel. you start losing cognitive function. You start having memory issues and o often the ability to think clearly. You start having mood issues from the loss of these hormones. I've heard women tell me that they didn't even realize it until they started getting treated with testosterone, that they lost some core drive there in decision making. Because testosterone is not a male hormone. That's very, very incorrect. Women have twice as much, testosterone as they have estrogen, estrodiol, the most potent estrogen. So mood sleep. a natural calmness can be replaced by a subtle anxiety, you know, it's not a hundred percent of the day, but, uh, this, there can be a, a declining mood and the ability to sleep deeply. Or you can wake up in the middle of the night and and be in a sweat. Now by the time you make it to sweats, you have got major estrogen. And the optimal time to address it is now. we love, when we're able to interact with a woman who's in the perimenopause, it's the easiest time. It's a, it's a more complex time to treat because of the erraticness of the hormonals, Environment in the perimenopause. But it's the best time of all.

Lisa: 11:08

So best to really start treatment. When we're first seeing signs of perimenopause. Is there a certain age or just watch for symptoms?

Dr. Daved Rosensweet: 11:16

Well, it cha it's different women, woman to woman for a lot of different reasons. Some women start picking up on irregular periods and the kind of symptoms that you're having in their thirties. Well, for sure. Here's the, the, the benchmark. your optimal ovarian output took place when you were 20 plus or minus a couple years, and it gradually declined. So what's the impact of that decline and when does it lead to really life alerting symptoms? Sometimes it's in the thirties, if a woman is regular, is used to clockwork periods and she realizes she's not clockwork. And that there's even some cycles where she gets breast tenderness or irritable, or PMs, oops. She stopped ovulating that cycle. She didn't ovulate, she didn't put out progesterone. The greatest calmer that exists for women. So the best thing I could offer is, and I believe my team has done this, is that your listeners could receive a. PDF copy of our, the book we wrote for women. We wrote it for women. It's called Happy, healthy Hormones, and it describes insignificant detail, the kind of things to be on the lookout for and how to address it. I think, uh, we've really laid down the roadmap, the best way to address this,

Lisa: 12:45

And you're a fan of, of hormone treatment.

Dr. Daved Rosensweet: 12:47

oh, am I

Lisa: 12:48

Yeah. Tell us about that. So, so we are like, okay, it's time to get treatment, it's time to like, address this. what is the best treatment?

Dr. Daved Rosensweet: 12:58

Well, the things that you focus your professional career on, they all matter. Big time, proper nutrition, detoxification, proper exercise, they all matter. But when it comes to hormones, you're gonna do one of two things. Those ovaries and that those testicles. they do decline. And I've never seen it different. It happens to everybody. You know, for the couple hundred thousand years humans have been alive. There was no such thing as menopause women. That's right. Yeah. Little, little death therapy took care of that. But when hygiene improved and all the other agriculture improved, nutrition improved, uh, we started living beyond the natural design here.

Lisa: 13:45

Mm-hmm.

Dr. Daved Rosensweet: 13:48

the Chinese figured this out. They, for over a thousand years, they have been administering hormones to their aristocracy. What they figured out doing was they sent healthy young women into an outhouse and collected vast amounts of healthy young women urine. And they sent healthy young men into a different outhouse, collected their urine, dried it out, and the aristocracy took the powder that was left behind because they contained hormones. That was the beginning of bioidentical hormones, same molecule, but in medicine when something's not working like it used. you've got two choices. You either figure out some medicine or herb. Herbs are medicine that forced the body to react in such a way that you get the desired outcome. So for example, could you take an herb that would jolt those ovaries back into production? It doesn't work. Can you take a variety of herbs cuz people seem to be more friendly to herbs. I certainly, uh, I'm a holistic medical doctor. I love herbs for their medicinal use. Could a woman take something that's sort of simulated the effects of these powerful biochemicals? Yeah, but it doesn't work. You're gonna run across very, very few women who say, oh yeah, I took this Herb Cohosh or Vitex and everything returned to normal. These women don't exist out there,

Lisa: 15:23

Mm-hmm.

Dr. Daved Rosensweet: 15:25

Yeah, Jining helps. There's things you can do or we've, we've had this opportunity since the 1980s to take plant derived same molecule as produced in the ovary or the testicles. We can take it in topical form, we can rub it onto our skin, cuz that's the healthiest way to take estrogen is to rub it on your skin

Lisa: 15:49

So that's considered a bioidentical hormone.

Dr. Daved Rosensweet: 15:52

Yeah, same molecule as the ovary used to put out. Same molecule as the testicle used to put out

Lisa: 15:57

And when, when people say they're on bioidentical hormones for menopause treatment, what hormone is that? What are they taking?

Dr. Daved Rosensweet: 16:05

Well, there there's a wide variety of beginners treating women Menopause or very at the other end of the spectrum experts, very few experts, a lot of beginners, a few intermediates, and so it depends on the quality of what the woman is receiving. When you get into the compounded bioidentical world, it gets a lot better.

Lisa: 16:29

and that's what you do. For your patients. So what do you

Dr. Daved Rosensweet: 16:33

because we, because we individualize the treatment of every individual woman, because women are so individual, as are men. There's some women who they function beautifully and are very healthy with this level of estrogen. They have periods or the periods of regular, they, uh, can, they're fertile. They can have babies, but there's other women who need three times that amount. to be healthy regular periods. So there's a tremendous variance, individual woman. So the best approach to this is you individualize the treatment with each individual woman and you go on a journey to do that.

Lisa: 17:12

yeah. That's why people don't say I'm on bioidentical estrogen. They say I'm on bioidentical hormones because it's customized

Dr. Daved Rosensweet: 17:20

Then they get four, they. Well, every woman loses all four.

Lisa: 17:26

okay?

Dr. Daved Rosensweet: 17:27

The estrogen family, progesterone, testosterone, and D H E A, they're all coming out of the ovary

Lisa: 17:34

Mm-hmm.

Dr. Daved Rosensweet: 17:35

and, and women lose all of them. Women are in nursing homes. The major reason is the loss of testosterone. You lose muscle.

Lisa: 17:45

Which I've always taught is the natural sarcopenia is a natural muscle wasting that happens with age. And I encourage my clients to continue weight training and that sort of thing lifestyle-wise, but we also then need some of that testosterone to, to carry on. Okay.

Dr. Daved Rosensweet: 18:04

and sarcopenia. There's nothing natural about it. It's just happened

Lisa: 18:11

right. I just mean like it's kind of like what happens with aging as far as you're not so much doing anything wrong is this is just what happens if you don't do anything. If you don't do anything to combat it, that's what will happen.

Dr. Daved Rosensweet: 18:26

that's a hundred percent accurate. As a gerontologist taught us in medical school, sarcopenia is the bane of the elderly.

Lisa: 18:34

Mm.

Dr. Daved Rosensweet: 18:34

they're all losing muscle, and the ones who aren't losing muscle, sometimes you can really achieve decent things with vigorous, robust exercise programs,

Lisa: 18:45

Mm-hmm.

Dr. Daved Rosensweet: 18:46

that's rare. You need the combination of a vigorous or decent or humane exercise program. You can't get away without it. And the hormones you need, you need the androgens, you need testosterone and d h A. That combination will give you what you want, is to be alive and active. And God, you might even have libido. You might even,

Lisa: 19:11

What?

Dr. Daved Rosensweet: 19:12

I know, I know a patient who's 81, he and his partner are having, uh, the most intense orgasms they've ever. In their lives. A lot of it is because the great personal growth that occurred that allows them to get more intimate and close on every level. And a lot of it is the bio identical hormones, that they just kept up with not useful levels. They're not taking youth useful levels,

Lisa: 19:41

So how does that work with, long-term use then? If we are getting on those bioidentical hormones at the start of perimenopause, so sometime for some women in their thirties, typically, probably more in the forties. Then do we plan to be on those adjusted every so often for the rest of our lives? Or how does that work?

Dr. Daved Rosensweet: 20:04

answer is yes,

Lisa: 20:05

Yes. Okay.

Dr. Daved Rosensweet: 20:07

Or another way to find out is not to interview me as a doctor, cuz I've got a pony in the race here, right? ,strongly opinionated. Talk to a woman who's been on bioidenticals for a while and ask her how, how much she'd love to stop taking them or talk to a man. And for example, I take my testosterone every day and I wouldn't dream of stopping. For every single day that I'm on this planet,

Lisa: 20:36

Okay.

Dr. Daved Rosensweet: 20:36

to stop them. You're this whole, the whole fallacy around stopping occurred by this outrageously odd, crazy, misogynistic, human historical event that took place in the early two thousands with the public. Of an article, a medical study that scared women into thinking that if I take hormones, I'm going to get breast cancer, I'm gonna increase risk for breast cancer. That was never in the study.

Lisa: 21:08

I think most women are probably aware of it and wondering like, why are we talking about these? Because it's been shown that like, that's not safe. So yeah, please, please get into that.

Dr. Daved Rosensweet: 21:17

Yeah, it poisoned the medical community. It poisoned women all over the world. And even in the original article that came out, the press grabbed something out of that article and failed to see what the science actually said in the article. There was two hormones being tested, pregnant me urine derived estro. And what that study showed is that women who were on pregnant marrow, urine derived estrogen had less incidence of breast cancer, heart attack and stroke than women who went untreated. That was right in the study,

Lisa: 21:52

and yet the opposite is what the press published.

Dr. Daved Rosensweet: 21:56

That's right. it was because there was this other arm of the study in which women were given something called prempro that's a combination of Premarin and something like, like in your marina i u d. It's a progestin. And it did not ha have a scientifically proven increased risk. In fact, it said, the 1.26 relative risk was statistically insignificant, and that's what it said in the study in medicine. That means don't draw any conclusions about this folks. There is no medical significance of it proven, and that original article, it's authors republished a retraction of that article in 2016. They said after 18 years of follow up, there is no increased. But so few people have heard of that. That means the American public and the providers, they're still working off of false knowledge. But here's the science, and I'm so glad you brought this up. Here's the science. We are all at risk for thousands of diagnoses. A lot of 'em are not cool. And we're all at risk for hundreds of cancers. And the very factors that you are addressing in your work in helping people with their health are the causes. There are causes of illness, there's causes, and they come down to basically issues of nutrition, issues of toxicity, issues of too little or too much exercise or issues of a dysfunctional. To the stress of life, a perpetual fight or flight response. Those are the only causes. There aren't other causes. There are some mysteries. There are some people who get ill and they're unexplainable, but those four causes that you're addressing are the causes of all illness, including cancer. And there's hundreds and thousands of indiscretions that people can do over the course of their life of nutrition, detoxification, et cetera, and that's causes illness. But at any rate, we're all vulnerable to hundreds of cancers we could have. And as a male, I have especially increased relative risk for prostate cancer and there's risk for that. And they're modern reasons they didn't used to be this way. And women. Have slightly increased relative risk for getting breast cancer over other cancers. And there's very specific reasons for this and they're modern reasons that has changed over the course of my medical lifetime. It didn't used to be as prevalent as it is today. However, given all that, and thanks for bearing with me here, but it's such an important topic given all that women who are treated with hormones are at less. Risk for breast cancer, heart attack, and stroke than women who go untreated. And that is the science. And it's beautifully outlined in my book for women who get my book. Chapter three, I go into it in depth. And then there's a bible written by an oncologist, a cancer specialist who specialized in breast cancer. And that book's called Estrogen Matters, and I cite that in my book. So if you wanna know the. We're all at risk, but we're at less risk if we're treated with hormones.

Lisa: 25:27

So how do we, how do we ask for this? If our kind of mainstream medical doctors, which I think most people are, you know, that's their first line of defense. They're probably not heading to a functional medicine doctor first, or a naturopath that might be able to prescribe these. If we are just using our regular doctors, are they able to prescribe these bioidentical hormones or do we have to go to some sort of specialist? And the other part of this is what kind of testing do we need prior to requesting this or saying, Hey, I, I think I need this. I'm a big fan of advocating for yourself. I appreciate those that have, you know, done the education and gone to middle school school and I want their wisdom, but at the same time, I want to advocate and I think there's a difference between, you know, being a, a Google doctor and just web m d everything, and saying, Hey, I need some help with this. So I, you know what I mean?

Dr. Daved Rosensweet: 26:23

I I love it. This is exactly how I love a discussion like this to take place. You're bringing up the most important questions, well, you know. Traditionally trained medical doctors and nurse practitioners, they can do a tremendous service for us when we catch them in their knowledge base and their expertise. But if you tie and take them outside their knowledge base, you're not gonna get anywhere. And the whole medical community has been poisoned. Their minds have been poisoned. I use that intense language because it's been so disrupt. they're afraid to treat their patients with hormones because of that 2002 study that got so much press. And so you've named the remedy, you gotta advocate for yourself. Now the landscape is changing. This how I laid down the non-risk. The women who had are treated with hormones are at less. It's creeping back in, but creeping.

Lisa: 27:39

the bioidentical hormones are creeping back in, is that what you're saying?

Dr. Daved Rosensweet: 27:43

no. no. The knowledge that women are at less risk if they're taking

Lisa: 27:48

So some people are starting to say, Hey, we really read the study, and that's not really accurate.

Dr. Daved Rosensweet: 27:55

a few. and a few have read Dr. Blooming and Dr. TAVR's book and they get what the real science is, but it's pretty rare. I, if I had to guess, I'd say less than 1%, 2% of the world population are really familiar with the science is, I told you what the science is. I'm gonna go farther with the science is a little bit of a distraction. Women who have had breast cancer and have had that breast cancer properly treat. They have an increased relative risk of getting a recurrence over a woman who's never had breast cancer is of getting breast cancer. But women who have had breast cancer had that breast cancer properly treated. They're at less risk for recurrence if they're treated with hormones than if they're not treated. That's how profound this is. Women who have a special genetic propensity for breast cancer and ovarian cancer, they have something called a documentation. They have an increased relative risk of getting breast cancer over women who don't have that mutation, but they're at less relative risk for getting breast cancer if they're treated with hormones. And the hormones that have been most studied in this regard are horse urine derived estro. or horse urine drive estrogens coupled with the, abnormal molecule that's in the Mirena, iud. God bless IUDs. They're a fantastic, tool, that's for sure. Um, and Mirena is very popular and for good reasons, but there are others The bottom line is a woman has got to, at this day and age, 2023, these very primitive human times. A woman has got to become an advocate for her own self. And here's the only job, the only. you have to go find a healthcare provider that has gotten education in treating women in menopause. It's not there in our original training. It's you have to go outta your way to get that training and you've gotta find a provider in your state that really understands this, the whole of treating women with hormones and that the woman yourself, you feel comfortable with that. That's your only job really. You can facilitate that job by reading my book, happy Healthy Hormones, Because you'll be more informed, but your main job is to find someone who's saying, I treat women in menopause with compounded bi identical hormones.

Lisa: 30:30

Okay. So. Those are the words we're, we're looking for. And then they will know what testing to do in order to,

Dr. Daved Rosensweet: 30:37

me answer that. No testing.

Lisa: 30:39

No testing.

Dr. Daved Rosensweet: 30:41

We test a hundred percent of the women's hormone levels, but not in the beginning. It's perilous. Like to test a woman like you, would be a a mistake. Big, big.

Lisa: 30:53

why is that?

Dr. Daved Rosensweet: 30:55

10 years ago, your ovaries were putting out estrogens, for example, in a very predictable, amazingly coordinated way. If this is day one of the cycle, it gradually rises, then it falls, then it rises a little bit and falls again. You have a period once a month. It's just so amazingly astounding, predictable, and a healthy woman. It's, uh, miraculous. but when the ovaries stops putting out the robust levels of estrogen, for example, this holds true for the other hormones too. The brain, the pituitary register that, and they go, where's the sufficient estrogen? We don't have enough here. And so there is a remedy. The pituitary gland can push. Some more stimulating hormone to the ovary to get it to wake up a little more. But it only works momentarily. So what happens to a woman in a perimenopause is things get erratic. Oh, you described an erratic cycle thing happening. That's exactly what happens. You, your brain registers that you're too low. It puts out a stimulating hormone. You get this high level, but you can't keep it up. So it goes low. S. up and down. So when you tested women in the perimenopause, you get erratic, unpredictable, and results that aren't useful. How did I learn this? I tested women in the perimenopause and I remember sitting in front of a patient of mine. She was your age. I'm showing her her test results. We use state-of-the-art test results, 24 hour urine hormone testing. and she's having hot flashes and she's waking up in the middle of the night and she can't fall back to sleep. I know she's got low estrogen and I'm showing you that her test shows high estrogens and I say, well, I definitely wanna treat you with estrogens cuz you're having hot flashes. So I know that you're low. In general, you might have been high on that. She looks at me like, what kind of crazy man are you? You you're gonna give me estrogens. One of my estrogens are high. So it's perilous to test a woman, the perimenopause, and there's no need to

Lisa: 33:09

Because if you tested her two days later, she would show low and four days later she's high again. Or mid, like it's just not, you'd have to test every single day of the month. And that would be cost prohibitive.

Dr. Daved Rosensweet: 33:19

Precisely, and what you would happen is you would see that she might have be high on some days, low on others, but when you add up the total amount of estrogen she's putting out in a month, it's low, and that's why she broke out in a sweat. The general lovely level of estrogen that women thrive on it's not there anymore. It's low. Now we test a hundred percent of the. Perimenopause, menopause, but we only do. So when we've developed a program where the woman says to me, at the three month market, the six month mark, she says, wow, I feel great. I feel really good. I feel like myself again. Well, we, we confirm that with testing because just alleviating symptoms doesn't work. It's not accurate. in 75% of the women who say, wow, we went on this dose determining journey where we started low and gradually increased and we alleviated my symptoms. I feel so much better now when we do that. You can get symptom alleviation, but 75% of the women will not have their optimal amount, and we want optimal amount and we know what those.

Lisa: 34:29

Okay.

Dr. Daved Rosensweet: 34:30

Uh, for example, on the low end, a woman's gotta have enough estrogen to protect her bones in her vagina, and we know what those numbers are. And the high end, we don't want a woman to have too much estrogen, so she's overstimulating her breast glandular tissue in leading to breast density. That's a risk. We don't wanna do that. So we know if that wonderful, optimal zone is not too much and not too. And so even though when we alleviate symptoms, 25% of the women are in that optimal zone, but 25% have got too much and 50% have got too little. So we tweak it. We don't even have to test them again because, we've gotten so close that a tweak will carry them a year easily.

Lisa: 35:12

Okay. So, a little bit of a different topic, but because my show, we talk a lot about maintaining and losing weight, a big deal is women just are constantly saying, well, you know, you just can't lose weight after menopause. You just, it's just too hard. Well, I'm in perimenopause, so it's just too hard to lose weight. And I work with them on the thoughts on that because that's just not helpful, like, Of course you're not gonna lose weight if you're thinking I'm not gonna lose weight. But what are the real hormonal effects of perimenopause and menopause on weight loss, weight maintenance, those kinds of things. And how does the bioidentical hormone affect that?

Dr. Daved Rosensweet: 35:50

Well, you're naming one of the most common complaints of midlife women.

Lisa: 35:54

Hmm.

Dr. Daved Rosensweet: 35:55

They used to be able to maintain healthy weight and now they can't.

Lisa: 36:00

unexplained weight gain too is really frustrating.

Dr. Daved Rosensweet: 36:03

exactly. Exactly, but it is explainable. It might be unexplained, but it is

Lisa: 36:10

Right. Like they, they're like, I haven't changed my eating habits, or, you

Dr. Daved Rosensweet: 36:14

That's right. And I'm exercising like a banshee, and I'm doing better than I ever have in the gym, and I'm still gaining weight. And here's the. Hormones are the most powerful biochemicals in our body, and they affect such things as energy metabolism. When you eat food, you eventually convert it to energy and heat. that's called metabolism. Well, metabolism in young people is red. But if we measure the metabolism of most human beings as they grow older, that metabolism declines. And instead of burning off those calories, you deposit those calories in the form of fat cuz you don't have the fire power to burn 'em off anymore.

Lisa: 37:04

Okay. I'm gonna interrupt for a second and I just have a quick question on Another thing that, I have heard and and admittedly taught is part of the reason for that is the sarcopenia that's happening because we have less muscle. Is that a contributing factor or not? Like what causes the metabolism?

Dr. Daved Rosensweet: 37:22

Indirectly, I'd say there's more direct. There's more direct. Like for example, and I'm gonna take you on a little journey here. If a woman wants to know if she's fertile because she's having trouble getting pregnant, one of the things she can do is a daily temperature to determine whether or not she's ovulating. And if she's ovulating, that temperature is gonna go up mid-month. Well, why does it go up? Why do you get warmer? mid month if you ovulate. If you don't ovulate, that temperature does not go up. You don't get warmer. You get warmer because your metabolism increased. And the principle hormone that relates to the rate at which you burn, the rate at which you produce energy is thyroid hormone. Well, midlife thyroid declines are really epidemic. and every functional medicine doctor knows it and is a trained in it. But the reason the thyroid hormone starts functioning better mid-cycle is because of a hormone called progesterone. When if a woman ovulates, she puts out a, a huge amount of progesterone, mid-cycle, a hundred times more than progesterone than she has estro. And that progesterone has so many effects, and one of 'em is it helps thyroid hormone work better in thyroid receptor sites. So her metabolism goes up if she ovulates and produces that huge amount of progesterone. So she gets a temperature increase. She produces more energy and more heat. If she doesn't ovulate, that doesn't happen. The thyroid hormone doesn't get that acceleration. Progesterone critical for proper metabolism. Metabolism. As you eat food and you combine that with oxygen and you produce energy and heat, and them that don't have a vigorous metabolism, they gain weight.

Lisa: 39:20

Hmm. Okay.

Dr. Daved Rosensweet: 39:21

They're storing the calories rather than burning them, so that's progesterone's relationship. Estrogen is so energizing so much so that when you look at the Olympics and you see women athletes who are doing all kinds of phenomenal, crazy, phenomenal skills, very few of those women are menstruating

Lisa: 39:47

At all or At the event.

Dr. Daved Rosensweet: 39:49

At all.

Lisa: 39:50

Oh.

Dr. Daved Rosensweet: 39:52

at all because they've forced their bodies into these really high level output production states, and in order to do that, they need every hormone they got going. So they not only use adrenaline in cortisol, which are so energizing, and thyroid, which is so energizing, estrogen is energizing estrogen, energizes metabolism. So instead of the estrogen going down the female pathway, it goes down the Olympics training schedule pathway, and she stops menstruating cuz she's recruiting and diverting her estrogen into those needs. The fight or flight.

Lisa: 40:34

And not menstruating is a whole other That's a whole other

Dr. Daved Rosensweet: 40:37

Yeah.

Lisa: 40:38

in and of itself,

Dr. Daved Rosensweet: 40:39

But that's another reason, when your hormones decline, you're not producing enough energy because estrogen matters, testosterone matters. And that gets around to your question around testosterone. you're less motivated, but mainly it's also an energizing hormone as well. And when that starts to decline, you can put on weight for low testosterone reasons. So, thyroid, estrogen, progesterone, testosterone. These are crucial for an act of vital, high firing output metabolism that burns your food and converts it to energy and heat rather than stores your food, which you do not want. to happen. So midlife, there's a lot of things that coalesce. There's other things that really matter too. We tend to get insulin resistant, and that's a whole other subject. And there's no better recipe for putting on weight, like than low hormones and insulin resistance. So there's a lot of things that coalesce. It's not a simple thing, but what do you do? You improve the insulin resistance through diet and other, tools that we. and you, replenish the hormones because they really matter and you're not gonna get that normal metabolism, decent metabolism without it.

Lisa: 41:57

All right. Well, I think that we have a lot to think about here and, listeners need to really advocate for themselves, and if they don't have a doctor that's willing to prescribe these bioidentical hormones is to seek one out. Sounds like we've got some language available to use. in your downloadable book that we can use to talk to our medical professionals about that. Um, this is gonna be a compounding pharmacy thing, is that correct?

Dr. Daved Rosensweet: 42:25

Well, that's the best of the best of the best. You know, there's all kinds of hormones that are being offered out there, but compounders can individualize for an individual woman. Like, no, you just can't do what's with what's commercially available. So compounding is the best.

Lisa: 42:41

One idea might be to go, if you're just not sure who to go to for a practitioner, find a local compounding pharmacy. Go in there and ask who is prescribing?

Dr. Daved Rosensweet: 42:51

Bingo. Lisa. Bingo. Bingo, bingo, bingo, bingo. They know who's prescribing And there are 9,000 of 'em in the United States. Compounding pharmacists they know who's prescribing, and even more than that, they know who's doing a really good job.

Lisa: 43:08

Mm. Yeah.

Dr. Daved Rosensweet: 43:10

of the quality of prescriptions that they're getting. So that's the one of the best resources that you can imagine. We also, I, I spend 80, 90% of my professional career training and mentoring physicians and nurse practitioners to become expert at.

Lisa: 43:25

Hmm.

Dr. Daved Rosensweet: 43:26

So you can contact us. And another great advantage about this time is a woman does not need to see a nurse practitioner or a physician in person. For some things, yes, but for menopause, no. So that means you got access to your whole state.

Lisa: 43:44

Right. Yeah.

Dr. Daved Rosensweet: 43:45

So anyone who's got a license to prescribe in your state, that's taken on specializing in women. So you can do the whole thing by telemedicine. There is a testosterone exception where you have to see them once in person.

Lisa: 43:58

Okay.

Dr. Daved Rosensweet: 43:59

and there's more and more people getting trained. We're, we're, we're training people every day. We do weekly grand rounds. We've got, we've got a lot of people we've trained, so you might check in with us as well, but what you, what you mentioned, Lisa, that can be a great resource. Go to your local con and I like how you said it. You said go in there, talk to 'em, get 'em out from behind the glass because that personal connect. it can mean so much rather than trying to do it on the phone or something like that. I, I, I loved how you said that. that's the, the human way to do it. And they care. These are, these are caring professionals, so they get to see in person, it's gonna be all that more meaningful to them.

Lisa: 44:37

Yeah. I am gonna ask you one other just bonus question since I did kind of mention this about myself. For those of us on birth control and I'm well past my childbearing years, I had four kids. I'm done with all that. My youngest is 15, so I've had an I U D a Mirena i u d for 15 years since my last. Should I get it out? Is it time? How do I know? I'm concerned about when do I get this out and start bioidentical hormones? Or do I do it in conjunction with.

Dr. Daved Rosensweet: 45:07

Great question. I have a, a deep regard for IUDs. to me, they're one of the most effective ways of planning when you want to have children. that exist, And they're not giving yourself hormones at a young age, which can have some not so wonderful effects, like in the birth control

Lisa: 45:30

Mm-hmm.

Dr. Daved Rosensweet: 45:31

uh, I really much prefer it over the,

Lisa: 45:34

the marina does have some, okay. Sorry. Go ahead.

Dr. Daved Rosensweet: 45:39

I much prefer like a copper i u d or other IUDs that are there,

Lisa: 45:43

yeah.

Dr. Daved Rosensweet: 45:44

and there's just no way that anyone can guarantee you that you won't get pregnant unless you have some kind of contraception, until you've gone one year without a cycle. These is what the gynecologists tell us, and they are correct. You can, you can go nine months without having a menstrual period and pop an. Out of the blue. as you can already see, your periods are declining. That's not from the Mirena i i u d. It's from your natural function. You could leave the marina in and also start hormones. No problem. You could, you could have the Marino replaced with a copper. I. and start the hormones, but it doesn't matter that the marine is in there. if you go to a provider who really knows what they're doing, they're gonna dial in the optimal amount of progesterone. Well, let's start with estrogen. They're gonna help you figure out how to arrive at the optimal amount of estrogen, the optimal amount of testosterone. and yeah, you've got some artificial progesterone in there called progestins. It's in the i o D. So what you just augment that if you need a little more W you augment it with bioidentical progesterone, so it's very easy to work with a Mirena.

Lisa: 47:05

Okay.

Dr. Daved Rosensweet: 47:06

is not going to stop the ultimate ending of your ovaries. So there'll come a time when, look at this. I haven't had a period for a year. Well, now's the time to take out the Mirena.

Lisa: 47:19

Mm. It's just so hard to tell cuz they're so very, very light So sometimes I'm like, was that a period? I dunno.

Dr. Daved Rosensweet: 47:27

Well, that's a natural process. And you know, the Mirena might be augmenting that, but it doesn't matter so long as you're having, uh, any kind of menstrual bleeding, you're in the range where an ovulation though, not common could happen.

Lisa: 47:42

Yeah.

Dr. Daved Rosensweet: 47:43

So birth control is still an issue. I mean, if it was, if it was, up to me and someone, a family member of mine, and I have a lot, a lot of women in my, my family, um, I would recommend switching to a copper i u d

Lisa: 47:56

I've, I've also been considering switching to, uh, you know, a vasectomy cause I could just maybe not be in charge of the birth control.

Dr. Daved Rosensweet: 48:04

well, that's ideal. vasectomy is wonderful.

Lisa: 48:09

Yeah. that's kind of, I just kind of wanna be done with the birth control.

Dr. Daved Rosensweet: 48:13

So you, you nailed it. I mean, that would be the best. I think vasectomy is the best. The healthiest. The safest. And it works.

Lisa: 48:22

All right. Good. And that, that way we can just focus on getting the hormones for the, for the woman to, to styled in and not have to worry about the birth control Well, again, thank you so much. Appreciate that extra bonus question. That wasn't really part of our topic. A little personal there for me. Sometimes I, I do ask these personal questions of my guest. I'm like, well, I have you. Let me just ask you this,

Dr. Daved Rosensweet: 48:44

Well, there's millions of women who have that same

Lisa: 48:47

Yeah, marinas are pretty common,

Dr. Daved Rosensweet: 48:50

Yeah.

Lisa: 48:50

so. Good. Well, again, thanks so much and we'll put the link to the book in the show notes.

Dr. Daved Rosensweet: 48:56

I'd want to say, just to just to add on, the marina doesn't have no, has no, estrogens,

Lisa: 49:03

right.

Dr. Daved Rosensweet: 49:04

which is the very reason you're getting those hot flashes. It has no androgens. It has no testosterone in there. And you're gonna love testosterone. And we all, I often think it's one of the best things we do for women, keep 'em out of nursing homes and diapers,

Lisa: 49:19

Yes, please.

Dr. Daved Rosensweet: 49:20

so, yeah, that's right. Let's have that health span like you described.

Lisa: 49:26

All right. Thank you so much for your time and your wisdom and your experience and sharing it. I really, really appreciate it.

Dr. Daved Rosensweet: 49:34

You're welcome.

Lisa: 49:36

I hope you enjoyed this episode with Dr. Rosensweet. Our recording of got cut off at there at the end, but I did thank him and he was gracious to come on the podcast, and his expertise. Grab his in the and let me know how you're doing with perimenopause and menopause, and if you have any questions related to we talked about those times, I'd love to help you. hey, thanks for listening today. If you're ready to get some personalized coaching from me, I'd encourage you to schedule a free strategy session. Visit www.wellwithlisa.as.me or it's easier just to find that link in the show notes. We'll talk about where you currently are with your weight loss goals. And I'll give you some actionable tools. You can start implementing right away. Before you go, make sure you subscribe to the podcast so you can receive new episodes, right when they're released. And if you're learning something new and enjoying the podcast, I'd love for you to leave me a five star rating and a review. Thanks again for joining me, Lisa Salisbury in this episode of Eat Well, Think Well, Live Well.