Podcast Summary:

How I Built My Small Business
Host: Anne McGinty
Episode: Dr. Sarah Daccarett – What Everyone Needs to Know About Perimenopause & Hormones
Date: August 19, 2025

Episode Overview

This episode features Dr. Sarah Daccarett, board-certified physician, hormone specialist, and founder of Inner Balance, a personalized hormone therapy platform. The discussion centers on perimenopause, menopause, and postmenopause, busting myths, addressing misdiagnosis and the neglect of women’s health, and diving deep into hormone replacement therapy (HRT)—all wrapped in Dr. Daccarett’s mission to empower women to advocate for their wellbeing.

Key Discussion Points & Insights

1. Understanding Perimenopause: Myths, Symptoms, and Early Onset

• Perimenopause can start much earlier than common wisdom suggests—sometimes even in the late 20s or early 30s.

• Symptoms often mimicked or misattributed to life stress or mental health issues.

• Common symptoms: unexplained weight gain, anxiety, depression, insomnia, food sensitivities, chronic bloating, and even autoimmune issues.

• Quote:

  “Women shouldn’t feel like, oh, I’m 35, I’m too young to be going through this. That is not true. You could be 28 and going through it.”
  – Dr. Sarah Daccarett [01:25]

• Early signs often dismissed as lifestyle issues rather than hormonal. Women sometimes only receive proper attention “when she’s actually been struggling for probably a decade.” [01:25-04:15]

• Autoimmunity is highlighted as an early indicator, with drops in hormones sometimes preceding autoimmune disease due to their role in immune modulation.

2. Differentiating Normal Aging from Treatable Symptoms

• Aging is natural, but “you don’t have to feel terrible while you’re aging.” [04:25]

• Symptoms like joint pain, mood swings, or hair and skin changes may signal hormone decline, not just aging.

• Dr. Daccarett emphasizes prevention—heart disease, osteoporosis, and dementia risks begin to rise in perimenopause, not suddenly in menopause.

  Quote:

  “We want to start to prevent heart disease and Alzheimer’s when you’re 35, not be thinking about it when you’re 51 and your period stops.”
  – Dr. Sarah Daccarett [05:50]

3. HRT: Controversy, Misunderstandings, and Updated Science

• Historical resistance due to dogma and misinterpretation of the Women’s Health Initiative (WHI). The WHI’s findings about estrogen and breast cancer were overstated and misunderstood for years.

• Many studies cited are over 20 years old; newer studies show estrogen can protect against breast cancer.
  Quote:

  “Mark Twain said that a lie will travel halfway around the world before the truth can put its shoes on. This is exactly what happened with estrogen.”
  – Dr. Sarah Daccarett [07:38]

• Medical sexism and defensive medicine are barriers.

• Synthetic hormones (found in birth control, etc.) are not the same as bioidentical hormones. Many risks are linked to synthetics, not bioidentical HRT. [07:00-09:59]

• Quote:

  “When they held a press conference… we spent a billion dollars on the Women’s Health Initiative and told everybody that it caused breast cancer when that was not what the study showed. And doctors never forgot it.”
  – Dr. Sarah Daccarett [07:54]

• Even for those with a family history of hormone-sensitive cancers, it’s a nuanced, case-by-case discussion. Dr. Daccarett reframes the receptor-positive status as a good sign of cellular control. [10:50-12:23]

4. Is HRT “Dependency”?

• Supplementation is logical when the body doesn’t produce enough—comparable to taking vitamins.
  Quote:

  “Is that a bad thing, to be dependent on my own natural hormones? No, it’s about acceptance, women. It’s not shameful that you’re aging.”
  – Dr. Sarah Daccarett [13:31]

• HRT is derived from plant sources and highly regulated. [15:00]

5. Non-Hormonal Approaches: Diet, Supplements, and Lifestyle

• While possible, supporting wellbeing without hormones is challenging and requires discipline and significant lifestyle changes.

  • Diet: Higher protein intake helps preserve endogenous hormone levels. Vegan diets can dramatically lower hormones.

  • Supplements: Collagen (for skin and dopamine), creatine (mental clarity), L-tyrosine, turmeric, reishi mushrooms, glutathione, NAD, and maintaining gluten/dairy-free diets were all recommended.

  • Quote:

    “If you want to age well, especially if you want to prevent heart disease and cancer, it’s all about the immune system.”
    – Dr. Sarah Daccarett [18:53]

  • Exercise: Do what feels sustainable and brings joy; resistance training and adequate protein become more critical if not using HRT. HRT users are less dependent on heavy resistance training for bone and muscle health. [20:44]

  • Sauna use can also boost longevity markers and NAD levels. [22:00]

6. Lab Testing vs. Symptom-Driven Diagnosis

• Labs provide snapshots, but symptoms and lived experience must guide care.

  • FSH is the most reliable indicator, but even that is limited; hormonal panels can be “normal” even when women feel unwell.
  • Quote:

    “Symptoms should always trump a lab test… You are better than any lab test, you know, better than any physician. You’re the one that has to live with yourself every day.”
    – Dr. Sarah Daccarett [29:29]

• Perimenopause is a clinical diagnosis, not purely a laboratory one.

7. Risks: Taking vs. Not Taking HRT

• The genuine risks to consider are those of declining to treat: increased chance of osteoporosis, dementia, colon cancer, urinary tract issues, and heart disease.
  Quote:

  “People are asking the wrong question. They’re asking what’s the risk of taking the HRT long term? The question actually is what are the risks of not taking the HRT long term? And they’re big.”
  – Dr. Sarah Daccarett [23:57]

8. Partner & Societal Support

• Men often misinterpret a partner’s symptoms and withdrawal as personal rejection.

• Spousal support and patience are critical. Women may spend years searching for answers and experimenting.
  Quote:

  “If she doesn’t want to have sex with you, it’s not because of you or your relationship. She needs help. And this is a health problem.”
  – Dr. Sarah Daccarett [26:40]

• Society provides Viagra and testosterone “all day long” for men, but treats women’s needs as personal or psychological.

9. Accessibility & Democratization of HRT

• HRT is often a costly “luxury” available through expensive longevity clinics. Insurance rarely covers treatment before full menopause.
• Dr. Daccarett’s company aims to make evidence-based hormone therapy affordable and available online nationwide.
• Quote:

  “It should be a right. It should be democratized. Like, it should be accessible. It should be easy with no gatekeeping. It’s safe for them to try.”
  – Dr. Sarah Daccarett [27:52]

10. Hopeful Reframing: Agency and Optimism

• Perimenopause and menopause can be the best, most empowered years with the right support.
  • The sense of agency, hope, and opportunity for women to take ownership of their health is central. Quote:

  “It could potentially be the best time of your life… You get to choose that we have the choice and capacity and control of how our journey looks like.”
  – Dr. Sarah Daccarett [33:23]

Notable Quotes & Moments

• On shame and early onset:

  “There’s no rule book that you should or shouldn’t be doing this. Like, your body is just doing it and you need to support it.” [01:50]

• On medical resistance and outdated science:

  “Doctors are very dogmatic. They are resistant to that innovation. I think there’s some underlying sexism that happens with women still, that they want to control women’s bodies.” [07:07]

• On lab testing limitations:

  “The labs are kind of like one snapshot in the day, and they’re maybe not even accurate, but like, she will tell you what she’s been going through. And this is so much more powerful to listen to than a lab test.” [31:21]

• On the costs and accessibility:

  “It’s like thousands of dollars. They’re going to charge you a lot for labs… we’re in 44 states and soon to be 50. And the idea is, can we make it a price point that is more affordable?” [27:51]

Timestamps for Important Segments

• Perimenopause can start as early as your late 20s: [01:25–04:15]
• Differentiating aging from treatable symptoms: [04:15–07:00]
• Controversy and outdated beliefs around HRT: [07:00–09:59]
• Women’s Health Initiative Study & breast cancer risk: [09:54–10:33]
• HRT for those with cancer risk: [10:50–12:23]
• Is HRT dependency? Supplementation explained: [12:48–15:00]
• Non-hormonal interventions & optimal supplements: [15:52–17:59]
• Immune system & aging—glutathione, NAD, mushrooms: [18:00–20:25]
• Diet, blood sugar stability, and lifestyle: [22:00–23:47]
• The real risks of NOT taking HRT: [23:57–25:18]
• Men’s role & relationship support: [25:18–27:39]
• Is hormone therapy a “right” or a “luxury”? [27:39–29:14]
• Lab tests vs. listening to symptoms: [29:29–33:15]
• Empowering message for women: [33:23–34:39]

Final Message

Dr. Daccarett leaves listeners with optimism: with the right information and advocacy, women can navigate perimenopause and menopause on their own terms—without unnecessary suffering, shame, or confusion. The body’s capacity to heal and thrive remains, at every age, and women deserve accessible, up-to-date, and respectful support as they age.

For informational purposes only. Not intended as medical advice. For more information, visit annemcginty.com.