← Extend Podcast with Darshan Shah, MD
Extend Podcast with Darshan Shah, MD
177. Dr. Jila Senemar: The Hormone Conversation Women Should Have Before Menopause
00:41:31
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- [00:00]
A
Before we get started with this episode, I'd like to invite all of you to the first ever next Health Longevity Summit. Happening in Nashville, Tennessee at the Conrad Hotel on Saturday, September 12, 2026. This is an all day summit where you're going to be hearing from some of the best speakers in longevity medicine, including Dr. Vonda Wright, Dr. Luisa Nicola, many of the podcast guests that you've heard here on the Extend podcast. And of course I'm going to be there curating the entire day. We also have incredible vendors coming so that you can try the latest technologies in health, wellness and longevity.
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B
Go to next health.com summit and buy your ticket today.
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A
We only have 400 spots and they're going quickly. That's next health.com summit. I look forward to seeing you all there.
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B
Welcome to Xtend with me, Dr. Darshan Shah. A podcast dedicated to cutting edge science research, tools and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results. When it comes to your health span, we are living in a new era where we are creating a new healthcare system no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world renowned experts who are offering you a step by step guide to proactively avoid disease and most importantly, extend your health span. Dr. Gila, how are you?
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C
Thank you so much for having me. I'm great. I'm so excited to be here with you today.
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A
I'm so excited. So this is incredible because 20 plus years ago, not to age us, we met at a county hospital in California where I was a resident and you were a medical student.
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C
Yes. I'll never forget you were my surgery chief resident.
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A
Yes, you.
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C
I always tell people, Mike, he taught me everything I know about how to operate and suture.
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A
Basically. Yeah, we did a lot of suturing together because you were the medical student working with me. I mean, I remember like 4 or 5 o' clock in the morning rounds with you.
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C
Yeah.
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A
And now you're now husband.
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C
Yes, yes, yes. We were both little medical students learning from you and you know, you were a mentor. You really, it was, it was a different experience with you than with other people in the field. And it was a very positive like, you know, experience for me because surgery for women you know, it's not really a field a lot of us women are pushed into or told to go into due to the lifestyles and things like that. However, I'll never forget you told me, like, you got to do what you have passion about, and if you love it and you feel strongly, do what you want to do and everything else will work out. And that advice stuck with me throughout my whole career as an obgyn.
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A
That's awesome. So good. And then you did surgery. You did obgyn.
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C
I did, I did.
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A
And now you're here, one of the foremost experts in women's health in the country and you have your own podcast and you're speaking, you have a big company of yours. And I'm so excited to have seen you go through your career now where you are now. And now we're in the same kind of space again. Ex.
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C
I love that, that we ran into each other 2 1/2 years ago in the longevity and in the, you know, forward thinking space that we're all in and a part of, and to just kind of see how this whole field is evolving and how we can make changes to how we treat our patients. It's just really exciting for me. And it's like the next chapter.
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A
Yeah, it really is. It's like what we all kind of wish we had learned in medical school. Like, I really wish, and I'm so happy I learned the deep amount of knowledge that we did on how to do surgery and disease care. And, you know, we were in the intensive care unit a lot, like we were saving lives. Right. But now to add this other piece to that knowledge, which is how to stay healthy in the first place and then bringing all those worlds together, it really is like the way, hopefully every medical school in the future is taught that way. You know, those two pieces together is critical.
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C
It's really, you know, it behooves us as the people in this field who are kind of like trailblazing to get this information out as much as we can. And by doing the things that we're all doing in, you know, in this field, in this journey, basically, the podcasting, the speaking, getting the information out, I think that's what's going to help future generations have access to all of this, where it's going to be kind of like second nature for them.
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A
Yes.
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C
Right. We're talking to our younger kids. Our kids, yes, the 20 year olds. You know, those people, they're gonna have this as if it's nothing. And it's like, well, of course, you do this. And of course you have to eat this way and of course you have to move this way. Why would you do it any other way? And this is, I think, what's so amazing about the space that we're in with the longevity care and being proactive and preventative rather than reactive. That's what brings it all together so nicely.
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A
It really, really does. So I want to begin this conversation where we normally don't begin. You and I were talking like, you know, a lot of these women's health conversations start in menopause, right. And we're gonna take it way back before menopause. And we're gonna have a little bit different spin to this is let's talk about the 20 year old woman that wants to make sure that she is healthy as possible. And one of the signs as we know for women's health is actually the health of their ovaries.
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B
Is that correct?
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C
110%. So you know, we, a lot of things in women's health has been looked upon in silo reproductive and that's it. And everything else is kind of put to the side. Right. But what we know is it's all interweaved together, interrelated. And the ovary is an organ just like any other organ in the body that sends signals. And you can actually look at those signals and see the quality of the ovary, how it's doing, and have a predictor for the future, not just in terms of fertility, but in terms of hormone production and how you can change different lifestyle things that you're doing, lifestyle modifications to improve the health and length of hormone production naturally by the ovary. So this is all newer technology that is in use being built and created to help us help younger women know the trajectory of where they're going to end up. Because, you know, we're born with a finite number of eggs per se. You have this many eggs and then when you hit puberty you lose half of them. And then you have, you know, what 500,000 eggs left to work with in your reproductive age frame. And then every month you have a follicle that gets dropped, ovulated and either you get pregnant or you don't. Then you move on to the next month. And we, we think it's just done and over with at menopause and that's it. But we actually can make modifications, changes to how we live and we can try and extend that length of that over as long as possible to kind of give us all the benefits that all of these hormones have. Impact on our overall well being and organ system.
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A
Right, right. It's so true. It's like the ovary in a woman is kind of a window to the overall health. And what's so important about the ovary is two things. Number one, obviously, that's where the eggs are and that's where you make babies, but also the hormone production. Right. And so this whole concept of menopause where the ovary is basically done doing its job, so it doesn't have the eggs anymore, but it also stops making hormones. Right. And this is a problem because now, as humans are just living longer and longer and longer, we still need those hormones to be healthy. Right. And for women, that, that those hormones are estrogen, progesterone, testosterone. Right. And so it's in, in your mind, like, well, not in your mind. I mean, in the mind of all longevity physicians now, like, these are critical hormones. Can you talk a little bit about why women need these hormones after menopause?
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C
You know, it's interesting that you're, we're bringing this up and to us it makes so much clearer sense. Yet I have women who come and sit across from me every day and they say, but if my ovary is done making hormones at menopause, and that's the way nature intended it, why do I need to replace them now? Right. If I'm done, I don't need them. Obviously, there's a reason. And what I say to them is women are living longer than this age span of their ovary. So we're kind of outliving because originally women, you know, we lived in until our 40s, basically. And then, you know, this is way back when.
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A
Yeah.
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C
And then, so if you pass, then the ovary was done. So, you know, it made sense then.
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It lasts as long as it needed to.
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C
It needed to. But now we are. Women are actually living longer than men by even five years longer than men, yet they're living in poorer health those later years.
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Yes.
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C
And the hormones in the ovary, they are a communication system in the entire body. They communicate with the brain. The brain has estrogen receptors. They communicate with the heart because the vessels around the heart have estrogen receptors on them to keep the flexibility of those vessels. That way you prevent plaque formation, high blood pressure, and heart disease. Bones, our bones, our muscles all have hormone receptors on them. And so to tell me that a woman's ovaries and their hormones are just for reproduction is just not incomplete. It's medically inaccurate. It just doesn't make sense. We have all these Receptors everywhere. And now at 50, 51, 52, 50, no more hormones. But now you're still gonna live the next 40 years. And every system is basically going to start to decline and show that decline as you get older. So, yes, we live longer, but we live in poorer health because we have now frailty fractures due to osteopenia and osteoporosis. We actually outnumber men in heart disease risk as soon as we go through menopause. Women, our risk of heart disease converges with men and exceeds it at menopause. We don't talk about this enough. No, because heart disease women, when I ask them, what do you think your risk of death and mortality is now that you're past menopause? And everybody goes straight to breast cancer. Not just cancer, breast cancer. And we know that why they go there. And everybody is surprised when I tell them it's actually heart disease. And so, you know, put that all, put a bow on that.
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A
Because one more.
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C
Alzheimer's, Alzheimer's brain, cognition. So it affects us from head to toe.
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Right.
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And to, you know, not at least have the conversation with women about this, it just doesn't make any sense.
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A
Yeah, yeah, absolutely. It's very well said. So we know that the longer a woman is making estrogen, progesterone and even testosterone, the healthier they will be, the longer their health span is, I think. Isn't there some statistic too, that the later a woman has babies in life that they say their health span is extended as well, and that's because they have hormones later in life, Right?
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C
Yeah. And they have that spike. Remember, in pregnancy, you have the highest spike in all of your hormones, specifically estrogen. And so those women, you know, their ovaries are going to last longer as well. But I think what we miss with those patients is because, you know, women are having their families later in life due to career building and all of that. And so they're having their kids in their 40s. But what they're not being told or kind of prepped for is that they can go from postpartum straight into perimenopause and not even recognize it. Because, you know, those hormonal shifts are, when is perimenopause? 10 years. Right. A decade before actual menopause. And so you can start having some of those hormonal fluctuations after you have a baby and not understand what's happening in your body.
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Right.
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C
And just kind of, you know, be dismissed by, okay, well, it's life. Oh, well, you just have a new baby or it's stress, it's anxiety. It'll get better, and it might. You may compensate enough for a while. But what we're missing in our conversations is the fact that we're trying to be preventative, proactive before disease starts to set in. And it's this decade right before menopause. Late 30s, early 40s. This is the window of opportunity is what I like to call it.
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Yes.
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C
You need to set these building blocks in place then.
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Yes.
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If you already haven't in your 20s and 30s. Right. So now you're hitting your late 30s, early 40s. You have kids, they're little. They're not, you know, you're not sleeping well. You're definitely not, you know, taking care of yourself that well. Because we put ourselves on the back burner.
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B
Right.
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C
We have to run the family. We have careers. You know, we're wives, we're taking care of elder parents, whatever have you. Right. And we just kind of dismiss everything that's going on.
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Yeah.
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And this is, I think, where you need to really hone in and at least get that sleep every night. Right. The pillars of health that we talk about, the sleep, the nutrition, has to be dialed in. Movement has to be a part of it. Okay. Having community, having people around you that, you know, you. You connect with family, that connection is important. Stress reduction. And then you talk about hormone management and other things that come along with it.
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A
Yeah. It all has to come together.
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C
Yeah.
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A
So going back to, you know, the ovary being a window into a woman's health, going all the way back even to, like, the 20s, like when women are now thinking about pregnancy, potentially maybe between 20 and 30. And then obviously, we know women are waiting later and later, but there's measurements that you can make that can tell you kind of like the health of your ovary. And these could almost become biomarkers of not just your ovarian health and your chance or your likely of getting pregnant, but also your overall health. Right. So can you talk about that? Like, how should women think in their even twenties about their health? And what are some of these markers that they can be following? Yeah.
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C
So in the 20s, you know, a lot of younger women, they're just basically not really thinking about this because it's just not on their. In their forefront. Right. They've been to their gynecologist with their mom, their mom's doctor, and they're going off to college, and they're put on some kind of birth control and said, okay, this is great, and move on. But they're not really asking the questions. Okay, well what am I on and what dose am I on? Do I really need this? Do I need to be on hormonal contraception or can I do non hormonal options? A lot of 18, 19, 20 year olds aren't having these discussions. It's not a part of the armamentarium. And we need to do better.
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Right.
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Even in adolescent gynecology, we need to do better and really break this down. You know, we're at least American College of Ob gyn, they have separated all of this. Now they're realizing that there needs to be an adolescent component where it really does get to the root cause of things with like PCOS and endometriosis as well as different contraceptive options. And so we are getting better. But other things that you would never think that they would check an AMH on a younger woman. Right. Anti malarian hormone. What? This is a test that I remember when we were taught it was like, oh, reproductive endocrinology will do this if somebody is having an infertility issue.
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Yes.
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C
That's the only place it was really ever taught to us that it was useful. Now fast forward. You know, when you start actually getting into the space and self educating on all of this, you realize actually you can use it earlier to kind of predict how the ovary is functioning. Because I remember having 30 year old patients come to me and say, you know, I'm not ready to have a baby or family yet. I don't have a boyfriend or husband. It's just not in the picture. But I kind of want to make sure I'm okay to wait and not proceed. Oocyte preservation per se. Right, right. And so I would just run their fsh, their estrogen, their testosterone, I would run the whole hormonal panel on them as well as the amh. And I found a handful of women whose AMH was a lot lower than where it should be at the age of 30. And so we. Then you start to look in deeper. Okay, so what's happening? And that's when I started talking to them about their lifestyle. Are you sleeping? How is your stress? What are you eating? And you know, come to find out they're not sleeping well, they're stressed, they have new jobs that they're trying to really, you know, make an impact and kind of showcase themselves. So this is on the back burner. They're not thinking about any of this. And what we know is making small modifications in these things will really change the health of the ovary and will improve those Levels of the amh. And so I kind of trialed it out on my patients. I'm like, this is what we're going to do. This is not anything over the top. I need to make sure you're sleeping seven to nine hours a night consistently. And you know, I would make them get the oura ring just so we have data points, because women love data points. You give them labs, you give them data points. They're amazing. And they follow it because they like to see improvement. And then I would give them a specific diet. I want to make sure you're getting your protein, 30 grams of fiber. Again, nothing, you know, mind blowing. The basics that we have kind of veered away for so long, right? And stress management, they would laugh at me. They're like, doc, seriously, what do you want me to do stress wise? Like I said, you know, you need to kind of remember what's happening. Walk outside in the morning, don't pick up the phone, don't start scrolling as soon as you turn over in bed, because that's what we tend to do. And all of these are, you know, you're, it's mixing up and resetting of the circadian rhythm that really will pay you back in ways that you never imagined. So little alterations. And in three to six months I would repeat their levels and it was completely back to normal, if not like this, like at the top.
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A
How old are these women? The 30 or so?
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C
30, 29, 30, 32. That was the age range.
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A
So, so you're not even talking about like reproduction here. You're talking just about, like, let's use this as a marker of your overall health and let's use this as a marker to see kind of how these habits, these small changes are adding up to better ovarian health, which is then also indicative of your overall health. Right?
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C
100%. That's exactly the way. And again, it's a matter of sitting down and explaining all of this to it. This is not a 5, 10 minute visit, right? This is 30 to 60 minutes of explanation and then kind of following up with them, right? You know, having touch points, hey, how are you doing? What else do you need? How else can we support you to improve? And within six months that they saw those changes, they started implementing more into their lifestyle. So the overall goal would be, I mean, in a, in a perfect world, our 20, 30 year olds have these five pillars knocked down, meaning set in stone. They got it and they have it because what it does for them is all of their pms, PMDD symptoms Lessen.
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Yeah.
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C
As they go into perimenopause and menopause, all of those symptoms are actually improved. So their transition, their journey, will not be as dramatic as what we have seen happen to some women where they hit the wall. Basically. They. They're coming. They're jumping off a cliff because of their hormones, going from zero, you know, from here to zero, or fluctuating so much where they don't even know what to do with themselves.
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Right.
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C
So it's an impact that can be made at an earlier stage and there's small little alterations.
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A
Got it.
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C
That can add up to really big changes.
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A
Yeah, absolutely. And the side benefit of that is when they do want to get pregnant, it'll be easier. They'll have better health for the baby, better health for themselves, and say they do want to go egg donation as well. The healthier you are, the more successful that whole process is too. And to your point, it can delay menopause too. Right. So that. Just less time. You need hormone replacement therapy in the future. So the benefits are so huge. And now we can use this AMH marker, which was only used in fertility clinics now in women's health instead. And you were mentioning an app that. Can you talk about that?
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C
Yeah. So there's a new product that's been being released called Menno Time. And what this does is it takes a lot of this. The biomarkers that we have, the AMH and other levels of blood work as along with a patient survey of their symptoms. And together with AI, it will then give a lifespan of the ovary, per se, and say, okay, you're doing great. Keep doing what you're doing. Or these are the modifications we can implement here to help improve the outcome.
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A
Nice. Very cool.
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C
Yeah.
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A
And this app is available now.
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C
It's app. We're. So we're like the beta trialing it now. So there's a group of doctors across the country who have signed up to be a part of this.
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A
Incredible.
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C
And we're lucky to have it here.
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A
Yeah, yeah. It's just a whole new world for women's health starting so much earlier.
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B
Doctor Shah here, and I want to take a quick moment to talk to you about metabolism. So you probably already heard. Unfortunately, 88% of Americans are metabolically unhealthy, and it's not because of what they're eating. It's actually a lot about what's living in your gut. I'm talking about your microbiome. This is the community of bacteria that controls everything from how you process sugar to your energy levels to your mood. There's actually one specific strain in your microbiome called Akkermansia mucinophilia that's absolutely critical for metabolic health. This is a bacteria that strengthens your gut lining. It helps you metabolize carbs more efficiently, and it increases GLP1 production naturally. The problem is almost everybody is completely deficient in it. And until recently, there was no way to get this. But that's why I'm really excited about joining Pendulum. They're the first company in the US to bring live Akkermansia to the market. The company was founded by PhD scientists and doctors with the Mayo Clinic as their first investor. The Metabolic Daily formula that I take every single day doesn't just contain Akkermansia. It's formulated with multiple next generation strains. And these all work together to optimize your metabolism from the inside and out. So you can track every macro and calorie if you want. But if your gut microbiome is out of balance, you're going to be fighting an uphill battle. Pendulum is going to give you the tools that you need to fix your gut at its source. Try Pendulum today. Head to my link below and use a discount code. You're going to feel the difference a healthy gut microbiome can make.
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A
I want to dive into what is a talk that you give to your adolescent patients that come in wanting birth control. Let's talk about the different options. You know, I mean, you're manipulating a woman's hormones very early in life. And to me, from all the things that I'm reading, it's very controversial now, right? So talk, let's talk through this.
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C
This is, I think, the pendulum of medicine, right? It swings from one end to the other end. And, you know, you always have to be somewhere in the middle. Everything is very individualized, personalized, Right? So what are they here for really? What is a story? Why are you here? What's on, going, going on? Is it really just for contraceptive purposes? Okay, then that's a different conversation most of the time. A lot of the patients I saw over the past 25 years, it was really more for cycle management. Heavy periods, irregular periods, really bad pmdd, those were the big things I was seeing. And our newest thing, pcos, which is now pmos. Right. About time. That's all I had to say when it happened, I was like, thank you so much. Yes, we have known it's a metabolic syndrome, but now we're caught up with that, right? And so I find that in those situations, I actually Changed how I would approach those patients. Right. So at the beginning it was just, it was birth control pills. Let's go. We see how you do come back in three to six months and then we go from there. Now I really take a detailed history what's happening, how is it impacting your quality of life? Right. This is 15, 16 year olds here in front of me and some of them are at very, you know, unchallenging schools where they have to be present and they have to be there and they can't be missing school. And in that individual, I say, listen, we're going to start with this lifestyle modification. And they don't love it, you know, because they're, everybody wants a prescription, they want a quick fix and they want out. And the mom doesn't want to be called every day to come pick her up from school. So I understand. I was a mom like that and I was like, you're not coming home, you're fine, you can stay there. And so we really, I have to, it's education, you have to educate them. If you're eating the right foods and if you are sleeping, I assure you all of the pain and all of this will calm down certain supplementations because a lot of my adolescent, they're not eating full, nutritious meals. Right. So we need to make sure the supplementation there that, you know, we bridge the gap there, right. And fill in the missing pieces and stress management, sleep as best as possible. There are those outliers that no matter what I do, right, it doesn't improve or they just come back and they're like, listen, I don't, then I will talk to them about and I will explain. These are synthetics.
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A
Yeah.
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C
These are not what your ovary naturally makes and hence we can use them for a trial low doses. I always start with the lower dose birth control pills. And now we have 10 and 15, 20 microgram estrogen pills. So those are amazing. Which, you know, in training we were using 35 and 50 microgram estrogen pills. That was a different mentality. And now the 10 really will help control symptoms, minimize, you know, their cycle irregularity. And it's quite reversible. So as soon as you stop within a month you're back to cycling again.
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A
Got it.
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C
So it's, it's not bad.
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A
So that's the state of the art now is a low dose estrogen birth control pill. And are there brands, are there many brands of them?
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C
There are now. It's become more popular because originally when, you know, I started doing this it was low. Estrin was the only one, right? There was one, and now it's gone generic. So there are different varieties of it, but it's a combination pill. But still the estrogen component is really where it's at. Low dose, low dose. And then now, you know, again, the pendulum swinging. Intrauterine devices.
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A
Exactly right.
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C
It was always, you only use it if they've had a baby before and if they're in a monogamous relationship, and on and on and on. Well, that conversation shifted. It's now you can use it in the younger patient population. As long as there's an understanding, there's a conversation, that it is only for contraceptive purposes. Right. It is not going to protect you from any kind of sexually transmitted disease. Hence other protection needs to be used along with it.
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A
Right.
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C
And those you can.
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A
And birth control pills don't protect you from sexual transmission.
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C
They don't protect you from sexually transmitting diseases anyway. So you have to use the barrier methods as well. But we have hormonal and non hormonal. So then I have moms who are like, I don't want to mess with her hormones, which I love that conversation because that means we're at a different level now. Right. They're understanding of the impacts long term of, you know, manipulating the hormones. And so in that situation, I would use a paraguard IUD with a younger patient who has not had a baby, because we can actually use lidocaine. We can do a cervical block to help with the pain and all of that of insertion. And.
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A
And these are non hormonal.
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C
This is a non hormonal contraceptive option and it will give you contraception. But once again, the barrier method has to be used alongside it. And it really helps cycle a woman as well.
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A
Right.
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C
So it's good for up to 10 years.
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A
And then when would you use a hormonal barrier method?
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C
So the hormonal IUD I would use if they're having heavier periods. Right.
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A
So it's for symptom management.
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C
For symptom management. Right.
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A
So then you get both, and then the hormonal IUDs. How often do you have to change them?
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C
Or it used to be five years and now they've extended it to seven. And now we have two options. It used to be just a mirena, which had 52 micrograms of progestin in it, and now we have a lower dose one. So we have Mirena and we have Kyleena. So we have different options.
- [29:21]
A
Got it, Got it. So it's so great to talk about all these options because I know a lot of our listeners have daughters at home. You know, I have a daughter that, that she's younger now, but these are all things that we're going to need to talk about. And everything's changed so much in the last decade to be. People need to have the newer information because I do think like, you know, this kind of reactive. My daughter's 15 and I need to get her on birth control pills. And then you just get like the standard birth control pill. It's still happening a lot, you know. And so I see women in my clinic, you know, they're now in their 30s, they've been on the same birth control pill for 15 years already. And it's the older birth control pills or high dose estrogen birth control pills. Right. And so can you talk a little bit about, like, what are the negatives of taking some of these higher dose estrogen pills for a long time?
- [30:09]
C
So the problem with those is actually, you know, it really suppresses the ovary. Right. So it's overriding the hypothalamic, pituitary and ovarian axis. So this whole thing is just being shut down. And when you remove that signaling now, it's going to take longer for your body to recover from that, as well as the side effects, which are bloating, weight gain, acne, things that women don't want anyway. And again, when I used to talk to patients about this was like, am I going to gain weight on this? That was always the first question, am I going to gain weight? And I would always have to explain the differences between the hormone doses and why one was and one wouldn't give you the weight gain. And I kind of want to segue into our perimenopausal women because there are those who are now still on birth control pills for perimenopause. Right. And they're told, yeah, it's good and it will control your periods and all your symptoms. And to a point it does. But again, now we're still using synthetics versus we could be using bioidentical.
- [31:11]
A
Yes.
- [31:12]
C
What the body naturally is making and will recognize as such and use as such. So in my patients who have had, the husband has had a vasectomy or she had a tubal ligation so that permanent contraception and they're still on birth control just to control symptoms of perimenopause. We have a deep conversation about this and we switch from OCPs to more bioidentical, newer, modern hormone therapy.
- [31:43]
A
Got it. Why don't we use bioidenticals for birth control like in younger women?
- [31:47]
C
In the younger woman? Yeah, it's not, the dose isn't high enough to protect her contraception. Yeah, it doesn't prevent the obvious.
- [31:54]
A
I never knew that. I never knew that answer. So thank you for educating me. And so now women that are perimenopausal, which is now starting earlier and earlier, I think should really consider getting off their standard birth control and going to bioidentical because it's just a better way of doing it.
- [32:11]
C
It's a better way. I mean, listen, as long as they have other contraception because they can still get pregnant in this timeframe, but you're going to be on this long term, at least 10 years past menopause. That's what we consider. Now there are those of us who are like you're, you're going to find me in my grave with my estradiol patch. I am not getting rid of it. But the window of opportunity or the timing hypothesis is 10 years after menopause. So 51 to 61, approximately what we know now is you can still use it in perimenopause. So let's say you have a 42 year old with all the symptoms affecting her quality of life, where she just, you know, doesn't know what to do with herself and her birth control pill isn't doing anything anymore. Meaning the symptoms are, we're fine now, they're still worse. With that in place, this is individual that you need to make that conversion. You need to convert her from OCPs to bioidentical hormones because you're going to be better able to manage her symptom fluctuations. And then they ask me, so wait, does this mean I can only use it for 10 years total? So I'm only 45, I want. No, it means you use it from 45 to menopause and then another 10 after that. So they get maybe 15 years of hormonal therapy.
- [33:23]
A
Right.
- [33:24]
C
And then my patients, after that point, it is a year to year discussion where we make sure no changes in their medical history that would set them up to be risk, you know, have risk factors with this onboard. And we continue.
- [33:35]
A
Yeah, that's perfect. That's such a great way of addressing the entire journey from puberty to, you know, getting pregnant to perimenopause to menopause. This is how women should be thinking about their hormones the whole way through. And so just to summarize, puberty, if you're a adolescent, you want to consider Using the lowest dose estrogen, if at all, and. Or a device. Right. Instead. And maybe even a device that also has a hormone in it. And then you go from there to bioidentical hormone replacement therapy when you are in perimenopause and then continue that throughout the journey. And then it's a year to year conversation for 10 years plus after menopause on whether you continue it or not. Like you said, some women are like, no way am I stopping other women. Maybe they have risks that outweigh the benefits. And I think it's so smart to think of it this way because there's a lot of places people getting hormones online without talking to someone that takes them through the whole journey and we haven't even touched upon. We have to bring you back metabolic health and how this ties in, gut health and how this ties in. Right. I mean, these are so many important factors. Like isn't hormone replacement therapy should not be done in isolation in a silo. You have to address the gut, the metabolic health, the inflammation, all of it.
- [34:55]
C
Like you said, it's all interrelated. And this is really the reason I kind of left conventional obgyn because I wasn't doing what I needed to be doing the way it should be done.
- [35:06]
A
Right, right, right.
- [35:07]
C
That was the, that was a kicker for me. I was like, wait, what about their heart health? Yeah, well, what about their bones? And you know, I'll never forget, I was, you know, because I order. So I was seeing 40 patients a day and they're like, why are you ordering so many dexas and why are you doing this? I said, because they're all perimenopausal and we don't even know what their bone status looks like. And believe me, 4 out of 10 women would have some kind of osteopenia that we weren't catching until. If we waited Till they were 65, they would already have osteoporosis. So it is not just reproductive and it is not just hormones you have to look at. It's a whole overall picture that you need to address. Otherwise you're only treating parts of the problem and it's not going to work. It's going to backfire.
- [35:51]
A
Yeah, yeah. For a few minutes, if you don't mind. I mean, this whole topic, gut health and hormone health are really, I mean, I feel like it has a new life right now or its first life really, where we now have terms like the strobalome. Right. Can you talk a little bit about what we're seeing now? How the gut and the hormones are interconnected in women.
- [36:12]
C
So remember the gut brain axis, they're all connected. Right. And so in the gut, the microbiome in the gut, those bacteria there is the estrobolome. Basically there's a, there's a enzyme in there, the beta glucuronidase, which takes estrogen and breaks it down and allows for your body to use it appropriately. The gut also has a barrier, the gut barrier, where, you know, as long as the estrobolome and the gut microbes are all in sync, everything works well. Otherwise that junction opens up in the gut lining and things that should not be getting out leak out. Leaky gut syndrome. Right, right. And it causes a low grade infection along the intestinal wall and that's where women get bloating, gassiness after eating the same foods that they were eating before. And they don't understand why. If there is an imbalance in the gut microbiome due to hormonal shifts, which again, estrogen plays a role in this, then everything downstream is not going to work well. It's not going to function well. And then also in the gut, you produce serotonin, which is good for sleep or your brain. So it's the gut and, you know, hormone brain connection, they're all interrelated. And if one part isn't functioning well or it's not online, everything else falls apart as well. And the gut microbiome is getting a big kick right now and it's becoming more spoken about as it should because it's not in isolation. These things all work together and it can be fixed a lot easier than what people think.
- [38:00]
A
Yeah, yeah. I think, you know too, I have a relationship with Colleen from Pendulum. And one of the things that they're really looking at is their specific structure, strains of microbiome that actually metabolize estrogen. And if they're not metabolizing in a healthy way, then people end up with some of the toxic metabolites of estrogen. Right. As well. And so some of the tests that we do at our clinic, which you probably do too, is the urine test for toxin metabolites too. Right. And so this is really important for women to know that the gut and hormones and metabolites of hormones, like we like there's, it's not as easy as, as just three numbers. Estrogen level, progesterone level and testosterone level. Right. There's a lot more we need to look at to really understand what's happening here.
- [38:52]
C
It's. And the thing is, there are Terms that are thrown around like estrogen dominance or estrogen this. And all that means is those toxic metabolites of estrogen are being produced and your body isn't recognizing it well. And it's actually backfiring on your hormone replacement therapy regimen. So it's the woman is not going to be feeling better. And those are the patients that I can tell. Then they come in and again, everyone's on the same standard hormone dosage, like it's a patch or a pill or a gel or a cream and oral progesterone. So it's not really anything crazy. But some will respond and others not so well. And that's where you have to make sure you're addressing the gut, because that's why their hormones aren't working well for them. It's not that it's not the right dose or it's not that it's the hormones didn't work. No, no, no, they're working. It's just the gut isn't metabolizing it correctly because you don't have the right strains of microbiome in the microbiome.
- [39:49]
A
Makes sense. Makes sense. Well, this was an incredible conversation. Thank you so much for breaking down so many aspects of women's hormones and how it ties into everything about a woman's health. And it's so exciting to see so many advances being made right now, and you're at the forefront of those. So thank you so much for joining me today.
- [40:07]
C
Oh, my gosh, what an amazing conversation. It was always a pleasure speaking with you. Thanks for having me.
- [40:12]
A
Where can people learn more from you?
- [40:14]
C
I'm on social media, so my Instagram, Dr. Gila Senimar and my podcast is Her Time her Health with Dr. Gila, and we're going to have you on there shortly.
- [40:21]
A
I cannot wait. And you also say you also have, like, a pretty large virtual practice now too, right? What is that one called?
- [40:27]
C
So my practice is Gila md It's in person and we do have some virtual options for that.
- [40:32]
A
Got it. And you're based in Florida area? Yep, exactly. Thank you so much for joining.
- [40:37]
C
Thank you.
- [40:41]
B
Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps us support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important important to seek their guidance.