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- [00:01]
Progressive Insurance Announcer
This episode is brought to you by Progressive Insurance. Fiscally responsible financial geniuses, monetary magicians. These are things people say about drivers who switch their car insurance to progressive and save hundreds. Visit progressive.com to see if you could save Progressive Casualty Insurance Company and affiliates. Potential savings will vary. Not available in all states or situations.
- [00:32]
Dr. Kelly Casperson
Welcome to the you are not broken podcast. I'm your host, Dr. Kelly Casperson, a board certified urologist, thought leader, and conversation starter on midlife living, hormones and sexuality. Enjoy the show.
- [00:46]
Okay, you guys have been asking and I have been listening. You guys have been dying for me to do a podcast on surgical menopause and hysterectomies and the whole journey. And so here we are. I have Dr. Juliana Hauser, who is so nice to come on. Second time on the podcast. Thank you very much. Dude, we were baby podcasters when you were on the first time. It's back there.
- [01:10]
Dr. Juliana Hauser
I remember when we looked before, it didn't even have a number.
- [01:13]
Dr. Kelly Casperson
Yeah, it was before I numbered the pod. That's how much trust I had and that this was gonna keep happening. Now we're in the 300s and we're welcoming you back. Thank you so much. We reconnected because we were on stage together in Florida at Dr. Vonda Wright's event. Was amazing at the end of 2024, and we were instructed to talk about sex. And so, like, we had a chat.
- [01:38]
Dr. Juliana Hauser
It was so fun. We could have talked for hours.
- [01:41]
Dr. Kelly Casperson
I know, it was super fun. And so you were so kind to come on today and tell me, tell us about your journey and catch us up with what you've been. The other unique thing about you and your story is your background as a sex therapist and understanding midlife treating how many unknown midlife people who've also had this journey. And now you personally went through the journey, so you have that, like, double lens to share.
- [02:06]
Dr. Juliana Hauser
Yeah, it was. It was interesting to get to the point of making the decision to have the surgery. Both my mother and sister had hysterectomies in their early 40s. And my mom kept looking at me saying, you're a ticking time bomb. You're a ticking time bomb. And that messaging wasn't landing with how I was experiencing my body, but then there was this. This voice, literally my mom's voice, but also in the back of my head going, what if you're making mistake? What if you're waiting too long? And all of this was happening when perimenopause menopause was starting to become a much bigger part of the conversation and healthcare and a bigger part of my work also. So I waited and waited and waited because I didn't have symptoms that really that I needed. It was going to be completely preemptive. And that didn't feel right for me. And the choices that I was making with the knowledge that I had and the conversations I was having with the experts in the country. And then I started having pretty significant symptoms. It just almost like, for me, happened pretty quickly. And I realized that I had a fibroid and I watched it and had a really good medical team. And I joke that when I like to teach people how to go to a medical appointment, I say, how much do you care about my sexual health and how a provider responds to it. I joke when I have, you know, when I have options with health care is how I stay with them or not. And I. And I love watching how they respond. And I love the ones who are like, a lot. Let's talk about it. And when I started having my period was coming every two to three weeks. It was miserable. And my father was radiologist, my mom's sister. A lot of people in my family are in the nursing medical community. And I kept hearing the line growing up interfering with the quality of life. And at that point, it absolutely was. And I do a lot in the sex space. I do a lot in my private practice revolved around sexuality. I make a point to be comfortable in my own life and fascinating when I started talking about it impacting my quality of life. And my doctor, who I love, said how. And I had this weird feeling of, like, it was hard for me to start talking about my sex life. And I know better, and I teach that. I speak about this. And I was like, well, it really sucks that, you know, we are. How many sheets have I had to buy or comforters if I had to buy because I was ruining it with all the bleeding and I wasn't feeling well. And in July, I was officiating a wedding, and when we got the pictures back, you could see my fibroid. You could see it. I could tell what it was. You may not, anyone know, may not notice it, but I could see it in my dress. And I was like, okay, everything about this is wrong for me. Again, I had a lot of research at my disposal, and I started interviewing physicians in the area of who I wanted to do the surgery and getting consensus as to what it was and that I paid for it on my own. My insurance wasn't going to pay for me to have these consults. And I Was happy to do it. This felt like any very important decision to make because I need to make a decision. I was just going to have the fibroid, my uterus taken out. If I was going to have taken out. And with everything, was it going to be my ovaries and my cervix or just my ovaries, fallopian tubes and all of that? And again, I can't say enough how I felt so informed. I felt so confident going into these. Except, you know, once I'd gotten past like, you know, revealing that this was affecting my sexual life, which wasn't the only reason why I was considering this, I was floored. How many decisions I had to keep making.
- [05:33]
Dr. Kelly Casperson
It's a lot.
- [05:35]
Dr. Juliana Hauser
It is a lot. And I felt so informed going into that. And I'd leave an appointment and my. The physicians I was interviewing were incredible. There was nothing on them. It was. I didn't know and I appreciated. They were giving me agency, making the decisions, and they would say, this is what I recommend. And then here are your options beyond that, and here are the consequences of all of these things as well. And for me, one of the biggest factors beyond that and reason why my mom was saying that I was taking time bomb was that we had. I had ovarian cancer in my family history. And that was another reason why both of them had had it. So I had that and this unknown factor as well about making it. But I had been doing retreats with Dr. Vonda. I had been doing lots of conversations with, with here, you know, compiling all these women's stories as to what it was like to be in menopause. What I couldn't find was a lot of people who had their experience of going into instant menopause through surgical menopause, through having hysterectomy. It was very hard for me to find anybody that was doing it was a person of a friend or I was looking online for. For groups and I found one his or sisters. And I got a lot of information from. From that website. But I started having experience, like when I had a miscarriage, and I started asking people and realizing there were so many more people that had it that they just weren't talking about it. I felt the same way with surgical menopause. I actually knew more people that had had it, but no one was talking about it. So that's usually when I start talking more, is when I realize that, you know, no one's. So I started talking about mine, my experience, and I started documenting it. I remember at one point I was sitting against my bathtub crying, taking a video. I was like, oh, I've turned into one of those. I'm one of those women crying, videotaping myself. But I videotape myself every single day from the decision that I made to have the surgery to two weeks afterwards. And the rollercoaster of emotions that I went on was remarkable. And feeling isolated was one of them.
- [07:36]
Dr. Kelly Casperson
Yeah, well, absolutely. Especially if you don't know other people who've gone through it who aren't your mentors. Right. Of like, what's it like? And I think surgery is such a foreign thing. I do it every single day. And when it's my turn on the other side, I will probably behave just like all the patients that I see behave. Then it's real. And it's a completely. Like, by definition, surgery is a lack of control. You have anesthesia, you are in the hands of other people. It's a very lack. And people are like, I don't know why I feel this way. It's like, because you're losing control for a little bit. And that's a very scary thing. Even though it's a very controlled lack of control. Like, it's going to happen at 8am on Tuesday, right. It's very scheduled. Like, you know, how about how long it's going to last? Like, you know, you can kind of prepare for it, but it's still a very lack of control thing to do. I want to back it up just for people who don't know. Removing the uterus doesn't always cause lack of hormones. The ovaries are the hormone producing organs. That said, with a hysterectomy, even if it's just a uterus, those people can go into menopause earlier, likely because of blood flow affecting the ovaries. So it isn't always like you have to have the ovaries out in order to be in menopause. Certainly just. And I think that was the big misnomer for a while of like, you kept your ovaries is like, yeah, but they might have a shorter lifespan because they've been affected by blood flow issues or, you know, for whatever else. So surgical menopause doesn't always mean everything had to be removed. But kind of the more common way when people, when people talk about surgical menopause is this is to mean the ovaries went in a bucket with or without the uterus. So I just wanted to back up for people who might. Do you want to clarify surgical. The definition of surgical menopause? Any More for people.
- [09:24]
Dr. Juliana Hauser
It was interesting when I started going through my options that there are about eight different, quote, ways to have a hysterectomy, which I didn't understand as well. And again, I'm in this space talking about this. I didn't go to medical school, but I am talking to so many people and in the rooms with all the experts, I really thought that I understood what that meant and had family members that had had it. So your clarification is really important. And it was something that when I started asking women, have you had a hysterectomy? And then going like, was it this kind? Was it this kind? Number one, I was shocked how many people didn't know.
- [09:58]
Dr. Kelly Casperson
Yeah.
- [09:58]
Dr. Juliana Hauser
And then they would say, I'm embarrassed to tell you, I don't know if I have my ovaries or not. And their surgery had been two years previous to the conversation. This is not something that happened 15 years ago. And in particular when I ask people, do you still have your cervix? That is probably 80% have no idea. So I think there is still a lot of confusion as to what the names mean. Partial, total, all of that changes. And we have to inform ourselves of the terminology, even with the doctor that you're speaking with, because I found that could be different as well. And I need have a body part. So I started asking when I was talking to all three, I was like, show me a diagram. And I wanted to make sure that I understood exactly what they were saying. Because for some total or radical, maybe have, have a difference. But for others it could be the exact same thing. And to your point about those who I spoke with who had kept their ovaries and fallopian tubes, they also talked a lot about the change and they felt pretty invisible in the space of menopause. They felt really confused. This isn't everyone, but just the ones that I was speaking to because they felt like, well, you didn't actually have a. You really didn't go into menopause because of it. But they were experiencing it and having vast changes and didn't feel as prepared because they had kept their ovaries and flipping tubes. They didn't think that they were going to have any menopausal symptoms. And they did.
- [11:13]
Dr. Kelly Casperson
Yes, a couple. All of that. I had a man ask me, a non medical guy, I was doing a podcast a while ago and he's like, my buddy told me that if a woman gets a hysterectomy then she doesn't go through menopause. Is that true? True. And it's like, okay, well that's out there also.
- [11:27]
Dr. Juliana Hauser
Right.
- [11:27]
Dr. Kelly Casperson
And so it's like the exact opposite of what's happening. I think most gynecologists hate the term partial hysterectomy. What is partial? Partial just means your uterus and not your ovaries, but it's still your whole uterus. It's not half of your uterus. It doesn't explain what happened to the cervix.
- [11:42]
Dr. Juliana Hauser
Right.
- [11:42]
Dr. Kelly Casperson
So I think most gynecology, I don't want to speak for the entire department of gynecology, but I think most of them hate it because it is so confusing. Confusing and lack of clarity. But like the lay terminology is not going away at this point. So like you said, you got to be very. I love the diagram idea is like, okay, what's the pros and cons of keeping your cervix? Because is that still, you know, are we still calling that a partial hysterectomy? Right. Is that a sub partial hysterectomy? What do you call that? I think the, the other confusing thing with the cervix is, number one, you still need cervical cancer screenings afterwards. But number two is the role for not all women, but many women in preserving vaginal length and also deep vaginal sensation and the different nerves that are targeted via the cervix versus clitoris. And that doesn't matter to a lot of women. But you don't know unless you ask. And I would say most people are not asked about that in deciding, like, you know, they're just like, oh, take your cervix. Cause they don't have to get screened for cervical cancer. It's like, yeah, but cervical cancer is actually quite rare and you haven't had it yet. And now we're vaccinating more and more people against cervical cancer. So is it just put it in a bucket because you won't get cervical cancer? That's oversimplifying a complex situation.
- [13:00]
Dr. Juliana Hauser
And that felt tricky because I realized when I was educated with that information, I wanted the answer. You won't ever be at risk for this again. I thought that was going to be my like, check, you're okay on that. When I realized it's significantly decreases it, but it doesn't make it 100%. It wasn't as easy when I knew some of the other aspects of it that was concerned about with my sexual health and the surgeon that I went with. We spoke for at least 15 minutes, which is a long time in a doctor's Appointment just about preserving my sexual pleasure. And what were the options that I had to make sure that that was going to be something that was prioritized with everything else. I didn't want it to be last on the list. I want it to be something. I wanted to know what my options were. And I greatly appreciate that she gave me that time and didn't push it off and really made it as important as every other aspect of the decisions I was making. And I greatly appreciated that. I didn't feel embarrassed. The personal aspect of it. Saying, I'm afraid of what it's going to feel like afterwards. I'm afraid that this will be the last orgasm that I have. Even though I knew better than that, I still had the fear for myself. And I realized how I think a lot of people have fear. Going into surgery. I realized that I felt like I had a lot at stake with this being in the space and speaking about it a lot too. And being someone that's doing a lot of work with clients with sexuality and wanting my own pleasure to continue. I feel very young to that and feeding ahead. What my recovery was. Absolutely. I've had zero effect on my sexual life and my sexual pleasure. In fact, the first orgasm my head after surgery when I was allowed to have it was fantastic. And I remember crying. I actually cried. It's like, oh, thank goodness I'm okay. Like, everything's okay.
- [14:49]
Dr. Kelly Casperson
Totally. The motor runs.
- [14:51]
Dr. Juliana Hauser
Yes. I wanted to go back and actually talk about something that I don't hear a lot in about the conversation. Menopause 2, which is. I was expecting when I made the decision that it was going to take a long time to get in for surgery. And so I was thinking I would have three or four months. In fact, I was. I had it before the event that you and I spoke with. I was afraid it was going to happen right before it and I wouldn't be able to make the event. And she said, oh, no, I can get you in three, three weeks, four weeks. I was like, wait, what? Like, I need time.
- [15:17]
Dr. Kelly Casperson
I thought I had time to prepare.
- [15:18]
Dr. Juliana Hauser
That's right.
- [15:19]
Dr. Kelly Casperson
But thank you.
- [15:20]
Dr. Juliana Hauser
Yeah. Because I actually wanted my last period to have some meaning to it. I wanted to have a goodbye for it. And I realized that I had a really pretty big intersection with my mental health of. I was so excited to be free of the symptoms of the fibroid. And I mean, I couldn't get that quick enough. That would have been the next day if she could have done it. But I didn't have enough time. To kind of say goodbye to this phase of life. I also started feeling. Feeling some of the things I was looking up. Some of the articles that were already out there were a lot about, like, my womanness being gone. Like, what does that mean, not to have a womb anymore? And before it became relevant to me, that conversation seemed interesting. It didn't. I felt like, oh, you just changed the terminology. When I realized that was going to really impact who I was, it became very personal. And I started grieving ahead of time. And I wasn't prepared for that either. No one was talking about the loss of it. Everyone was saying how much I'm going to feel better. And I remember one of the doctors that I work with who had then switched over to do my hormonal treatment afterwards, she held my hand at one point. She's like, you have been feeling miserable for so long. I am so excited to talk with you after the surgery. You're going to feel so much better. And that was just beautiful to hear that. And she was correct. But I didn't have anyone saying, how are you feeling about this. This aspect, which is not their job, like to talk about that. That was why. So I ended up hiring a menopause doula who is, you know, she came to our or your event in Seattle that we got to speak to, and I was so grateful to have that conversation. She. I met with her every week leading up to the surgery, and she was one that asked, how am I doing emotionally? How am I navigating? I'm also unpartnered. So I had to do all the figuring out of all the decisions. And I have a young daughter making sure she was okay. He was going to take care of me. A lot of things I was in charge of on a very quick time period. And I'm so grateful that I gave myself that space to talk and to say goodbye to that phase of life and to say that it was important. I kept saying, gosh, I wish there was a party. I wish there was a ritual for this. And I felt lucky. I actually knew when I was going to be going to menopause, because a lot of the stories that I hear from women that I work with, women, they don't know. I mean, it's just such an unknown and such a vague time period. So I felt like, well, I could actually plan the party. I know exactly what my date was that I went into menopause. And also I wanted there to be women, quote, waiting for me. Like, you know, metaphorically waiting for me, saying, it's Great. It's wonderful. Welcome, welcome, welcome, welcome. And there wasn't such a thing, so we started making one up. And actually the night before my surgery, in my backyard, we took the rest of products and burned them. And we did a goodbye to the period bonfire.
- [18:17]
Dr. Kelly Casperson
And.
- [18:17]
Dr. Juliana Hauser
And it was a really lovely way to usher out that phase of my life and go into a new one. And I think it made a really big difference in my recovery afterwards too.
- [18:27]
Dr. Kelly Casperson
That is so cool. I know that you will help other people think that they now have permission when they want to do that. And for those who are listening, you can even do an anniversary of if you missed the original party. You can do an anniversary of and not miss a party. But I want to get into the hormone journey, but let's. We got to hit on doulas for a hot second. For people who don't know what a doula is or who think it's just for giving birth, what's a doula? And how did you know that that was a thing that you wanted to support yourself with?
- [18:55]
Dr. Juliana Hauser
I was having a conversation with my just amazing Caitlin, who's on my team, and I. And I said it to her. I was like, I. I actually didn't think I wanted a therapist because again, we're not really trained in this either. And I thought I didn't have time to find someone who was an expert in it. And I said, but you know what I really need? I need a doula. And I thought maybe I'd made it up. And she knew somebody who was a postpartum doula. She talked to her and she's like, well, I've never done. I know what you're asking for. So if you're okay co creating this with me, then let's. Let's go for it. Let's try it. So we made it up together, and then we were probably three sessions in, and she's like, do you know there is a menopausal doula certification? Like, there is this. There is this out there. So we both started looking into it, and now I feel as passionate about menopause doulas as I do about pelvic floor therapists that I think that you don't have to. I think you shouldn't hire one just if you're having a hysterectomy. I think it should be for everybody. The space that she held for me and the information that she grew, and if she was already. She'd already been through a training, which she would have had waiting for me, would have been amazing. And I don't know if you feel this way also, but when you are already an expert, it can be really hard to let. To lay the expertise down and be held and not be the expert in that space.
- [20:07]
Dr. Kelly Casperson
Yeah.
- [20:08]
Dr. Juliana Hauser
And just in such a skilled way knew exactly how to honor what I knew and also give space for what I didn't. And then held that space for me. And in reflective what I was saying when I felt like I was babbling and. And not knowing what I wanted and what I was going through. And I recommend it highly. And there are. There are certain people who are certified in this. There is an organization that is specifically for menopause doula. I think it's called Menopause Doula Institute, But I could look it up. Yes.
- [20:39]
Dr. Kelly Casperson
Good for them to keep it simple.
- [20:41]
Dr. Juliana Hauser
Yes. Right. I could be wrong on that. But I'll find it for you for the show notes.
- [20:45]
Dr. Kelly Casperson
That's all. I kind of want to have your menopause doula on the podcast.
- [20:48]
Dr. Juliana Hauser
Now.
- [20:49]
Dr. Kelly Casperson
This is a real good story about Bronx and his dad Ryan.
- [20:52]
Dr. Juliana Hauser
Real United Airlines customers.
- [20:54]
Progressive Insurance Announcer
We were returning home, and one of the flight attendants asked Bronx if he wanted to see the flight deck and meet Kath and Andrew.
- [21:00]
Dr. Kelly Casperson
I got to sit in the driver's seat. I grew up in an aviation family, and seeing Bronx kind of reminded me of myself when I was that age. That's Andrew, a real United pilot. These small interactions can shape a kid's future. It felt like I was the captain.
- [21:14]
Progressive Insurance Announcer
Allowing my son to see the flight deck will stick with us forever.
- [21:17]
Dr. Kelly Casperson
That's how good leads the way.
- [21:18]
Dr. Juliana Hauser
I'd love for you to have her. She's outstanding and a very good soul, and she's an amazing history that led her to this. This as well.
- [21:26]
Dr. Kelly Casperson
Yeah. Nobody's, like, in, you know, senior in high school, and they take the, like, career aptitude test, and they're like, menopause doula. When you're 50, there's always a. There's always a good journey. That's so good.
- [21:39]
Dr. Juliana Hauser
You.
- [21:39]
Dr. Kelly Casperson
You keep in contact with her to this day.
- [21:41]
Dr. Juliana Hauser
Yes. Yeah. And the other thing I did is I hired somebody to help me do. She's a therapist that I do know who does, like, hypnotherapy and does a lot of guided imagery. And so I hired. When Cilla and I were talking about I wish there was this party. She's like, why don't you make a guided one? And I knew exactly who I wanted to ask. Caitlin Peterson. She's amazing. So I wrote her and too, I was like, hey, how would you feel about doing this guided imagery thing with me? And she said the same thing. I'm not an expert in this. I've never done it in this detail, but, yeah, let's go for it. So we met and I told her what my dream was. And it was like it was in the woods and there was great music and there was a bridge. I went over, like, all these very woo woo things. Then she took some time and came back with me and did. Got an imagery session. And I. It was all virtual. I closed my eyes and she guided me through the process. And so my body felt like it went through it, but it hadn't actually gone through. And that brought me a whole lot of peace going into it as well. And so when I got to the day of my surgery, I felt. I think overall I felt I really showed up for myself and. And I wasn't embarrassed to ask for what I needed. What I needed may not be what other people need. Like, they may not need a guided imagery walking into a wood party or a goodbye tampon party, but I, I did. And I had those, those meetings with the physicians. I picked my. My doctor. I know there's a lot of privilege with that, but that's what I would say. I walked away, number one, feeling like I, I walked in with agency. I walked in because, as you said earlier, there's a lot that feels out of control in this experience. Menopause feels a lot of out of controlness in it, which is what I hear a lot in my work and as a therapist and with my clients and felt it myself. And I'm going to be compiling the video and when Caitlin's watched the video, she's like, whoa. She's like, you were, you were up, you were down. That was like within one day. And I made it matter. And that was something that I had said to Priscilla that I said, it feels like it doesn't matter that I'm going through this and I know everything is going to change for me afterwards, so I want this to matter. And so I found the ways that would help me make. Make it matter.
- [23:58]
Dr. Kelly Casperson
Oh, I love that. Thank you so much for coming on and sharing your story. Did you wake up with an estrogen patch on? Were your doctors like, oh, yeah, obviously, or were you like, hey, let's have a plan, like, who kind of steered that ship?
- [24:10]
Dr. Juliana Hauser
I ended up waiting two days, and that was just because of my level, something that was happening with my surges. But I, we had it already. I had everything planned out and as things go, something that I found really interesting that I didn't expect was my skin wasn't absorbing any of the anything. So my topical testosterone and my patch, I wasn't. My numbers weren't there. And because I didn't know what it was supposed to feel like, I didn't know that it wasn't happening until we did my numbers. And we had been doing a lot of numbers, and I was paying for that out of pocket, too. I wanted to have a whole lot of different numbers leading up to it. So we had to move through different ways, which I haven't heard, which I don't. I know you do this, but, like, I didn't know anybody personally who wasn't doing a patch and who wasn't doing gel. And it was a lot of feeling alone and not making that feel wrong and be wrong and continuing to educate myself. Like, my body's just different and there's a lot of options out there. And I'm going to keep asking and I'm going to keep advocating for myself and I'm going to keep checking in with how I am and what I need.
- [25:13]
Dr. Kelly Casperson
I love that. Yeah, let's normalize that a second for people. So about 20% of people are. When I say poor absorbers, like you failed a test or something, you have thicker skin, your skin is more resilient to absorbing things from the outside world, which is kind of a compliment in that way. Same with men. About 20% of men are poor absorbers for testosterone. So it's not like women are weird. It's just that all skin is different. When I think we lose that message when we kind of harp on transdermal as being the go to bread and butter, blah, blah, blah. And I'm like, you have to. You gotta start somewhere. You know, you gotta start with, like, the easy, the cheap, because otherwise it's too overwhelming for people to be like, hey, well, there's gonna be like eight different things you can do. That's not as kind of grounding as like, hey, let's start with what's common. But we can always adjust as needed. When you got. When you were on the transdermal, were you like, oh, I feel this now. Like, did it turn on when you were on the right dose? How did you.
- [26:09]
Dr. Juliana Hauser
Well, it took a while because the liver pass through was. My liver was working really well also. So it took a while for it to build up as well. But once I got to the levels that I wanted to, I was like, oh, gosh, wow, do I feel different? And same with testosterone. That was a game changer for me. Frankly, that was the biggest of like, once I got that dosage right, I felt, I felt like myself again.
- [26:30]
Dr. Kelly Casperson
Yeah. Injectable oral. Do you mind sharing?
- [26:33]
Dr. Juliana Hauser
I did actually end up having to do pellets and being in those conversations and it felt like, oh no, this is the worst thing ever. I was pretty scared to try that route. And I actually remember a woman in one of the retreats, she stopped, she said, I want to advocate that there are just some people who none of the other options work. And honestly, I not remembered her saying that had she not had the bravery to say that in front of me. It helped me to say yes to something that I had felt scared of and had felt like it was, it was something wrong. And you were saying, I felt like something was wrong. I was doing menopause wrong because I wasn't able to do the preferred route of all the medications. But as of now, I really feel wonderful. I'm so grateful. And I walk around just saying I feel so grateful. We live in this era and I've had some really interesting conversations with my mom and my sister who had their surgeries many, many, many, many years ago and what they had at their disposal compared to what I have, I'm so grateful for the options, for the conversations, and for menopause being in a very different place than it was.
- [27:37]
Dr. Kelly Casperson
Yeah, we, I mean, we have in America, as the UK also Canada and Australia don't have the crazy access like we do. Like, we're literally like, you want to pill, you want to patch, you want to gel, you want to spray, you want an oral, you want an injection, you want to pellet, Right? Like, we have all, we have this embarrassment of riches and with that comes the like, are you doing it right though? And we get, we get very comparisony with that of like, what's your dose? And people don't understand that like what dose you're giving somebody isn't what that ends up being for that person. The way your skin absorbs, the way your liver metabolizes, the way your risk, we can't measure your receptors. Do you have more sensitive receptors? Right. It's like you lose all of that. That's why podcasts are so good, so you can get into it. But it's like, I hate the comparison, I hate the dosing comparison because, because it's meaningless. You know, it gets some very good people into trouble because they're like, they put em on such high patch doses and it's like some People need high patch doses. It's not that they're a bad doctor. That doctor knows a different dose is gonna get somebody to a different level. Compared to Susie down the street. Was your sister and your mom supportive of you going on hormones?
- [28:49]
Dr. Juliana Hauser
They were scared, especially my mother. And with my father being the medical community, we were looking at his practice, and my. Was thinking through it, and it was very few of the wives who had their uteruses after a certain age that it was just like, get it out. You don't need them. Get them out. You don't need them. That mentality. And I think it was hard for her at first for me to go about this differently and to trust that the information that I had access to was accurate.
- [29:19]
Dr. Kelly Casperson
You're like, all of my friends are wrong, Mom.
- [29:21]
Dr. Juliana Hauser
Or I was like, mother, would you like to see who I'm. Who I'm speaking to? And I'm telling you, these are. These are the experts in the country. And.
- [29:32]
Dr. Kelly Casperson
And I know it's different with the wrong crowd or.
- [29:35]
Dr. Juliana Hauser
Right.
- [29:35]
Dr. Kelly Casperson
I might actually know something. Yes. Yeah.
- [29:38]
Dr. Juliana Hauser
But. And the other thing, too, which was fascinating. They felt very different about. They couldn't relate to me worrying about what was it going to feel like to not have a uterus anymore. And back to that. That aspect of, like, still feeling like a woman. The conversation went nowhere because they're like, no. I was just so grateful. Who cares? It's nothing. Which is. Which is a very way to experience it also. And we were just kind of looking at each other like, yeah, different. Yeah. Not wrong, just different. And I worked through that for me. And I didn't think I was going to feel that way of feeling lesser than or looked at differently, but I did for a bit. And I was only 2 months post op when we were on stage together and. And still figuring out my. How my life was going to be post surgery. One of the things I wasn't expecting was I actually, I got a walker. I got all these things. I look at this. This to do list. I was expecting not to be able to move very much. And within hours, I was walking very easily. The robotic surgery was something I hadn't thought about. I thought it was going to be 10 times worse. I joke. I could have been doing dancing, could have danced the next day. And I felt so grateful.
- [30:56]
Dr. Kelly Casperson
I mean, you are a f person. You care about your body strength, and it's like people don't realize how strong you are. Going into surgery matters huge. Absolutely matters. And mindset matters huge.
- [31:11]
Dr. Juliana Hauser
Yes. Which is a lot of why I was doing the doula is I really wanted to have a good mindset and nutrition. I did. I quickly started talking to my nutritionist friends and like, what do I need to be doing to prepare for the surgery?
- [31:21]
Dr. Kelly Casperson
Were they like protein, protein, protein, yes.
- [31:24]
Dr. Juliana Hauser
And I did some really healthy soups the days leading up to the surgery. And I talked to, I work with a hair loss company. I talked to them about being proactive before the surgery. I mean, I was doing everything I could think of. I mean, you'd think, yeah, it's an important surgery, it's a major surgery. But in some ways I dove in a whole lot more than I normally would have. I wanted to know if it made a difference and how I felt and how I was interacting. And it did.
- [31:50]
Dr. Kelly Casperson
Does your experience with surgical menopause and your preparation for it and your experience with hormones after it, all the pieces, does that now translate into how you're caring for patients with your sexual therapy practice?
- [32:05]
Dr. Juliana Hauser
Absolutely. I know to ask follow up questions more than I did before. And again, I would have thought I was acing it, acing it, but I know to say so not just are you feeling different but how. How are you feeling different and following up after that. I've been doing this survey about mental health, the impact of perimenopause and menopause on mental health. And there's one question on has anyone told you or have you thought to your. I feel different. And the statistics are staggeringly high.
- [32:35]
Dr. Kelly Casperson
It's very high. The not feeling like myself is about.
- [32:38]
Dr. Juliana Hauser
60% in perimenopause, which is extraordinary. I wasn't understanding some of the complexity of the rise of anxiety, the rise of depression. I wasn't sure and I'm not sure research has really been enough yet to know. Was it just hormonally based? Is it where we are in our relationships and our age and all of that? And I haven't seen any research that then adds the surgery on top of it. So what is that, what is that aspect or the quickness of the change? I went in, my estrogen was extreme. It was triple digits, which is really high. To go from that down to zero within, you know, a week. I mean, that was really hard on my body to go through.
- [33:21]
Dr. Kelly Casperson
Could you feel it? Did you have hot flashes?
- [33:23]
Dr. Juliana Hauser
No, I didn't have any of that. And you know, because it stays in your body, you still are having it for a bit. So. And so by the time we think it was still. That's why, that's why I waited, because we thought I'd probably still have a higher dosage. So I was. I had warm flashes. I certainly have felt an increase of depression and an increase of irritation that I didn't have before. My daughter's about to hit puberty, and so I've actually been talking her a whole lot about. I was like, you know, I'm having some different feelings in my body that aren't related to you or the environment. It's just happening in my body. And I need a moment to go be a better mommy. And I walk away. And we've talked about. I was like, that's how I want you to explain to me when you're going through puberty, how you're feeling. You'll have a different version of this. But I've been trying to model it for her of. Without making it be this dismissive or, you know, this joking kind of comment, it's legitimately happening. And I have to figure. I have to now figure out how to regulate my body differently. My emotional regulation is very different now than it was before the surgery, and I had to work hard to make sure. And I do that with my clients, too. And so now anyone that I. I know that is in the phase, and they're close to, like, the year mark or their perimenopause phase is pretty difficult, or they're going through surgery, I start talking about mental health immediately and then talking about how to have the appointments differently, too. And I share my experience. It just. It's just one experience. There's so many, many, many different versions of this. And that's like, the story that I share is just my story, but I think it's important to share it. I wish I had been able to go on a. On a website and just read story after story after story or heard videos of women speaking about it. It was. Would have made a big difference for me leading up to it.
- [35:07]
Dr. Kelly Casperson
Yeah, totally. Well, before we're wrapping up, I have to talk about the advice you gave on stage at Vonda Right's thing, because I used it and I actually wrote about it in my new book coming out. I wrote about it. So you're quoted in there. So you were on stage and you said, ask your partner what you're good at in bed. And I was like, God, how did. I had never heard that one before, right? And so, like, literally, like, I got home from the conference and I was like, what am I good at? And so my husband told me what I was good at, and I was like, really? And he's like, yeah. And I'm like, you're telling me we've been together for almost 20 years at this point, and I didn't know I was good at that. He's like, he's like, you know, And I'm like, so I just like, bow down to you now because I'm like, dude, everybody needs to do that, whether it's a brand new relationship or you're 30 years in. First of all, everybody loves knowing what they're good at. It's the best feedback to get. And then you can ask your partner, like, you know, you know what you're good at. I'll tell you what you're good at. Like, everybody loves that. So, like, that is like the pro move. I'm writing about it, my next book. Thank you for that pro tip.
- [36:20]
Dr. Juliana Hauser
Thank you for saying that and for noting it. And I love it that you went and asked him for. Because that's part of the thing too, is if we don't know how to have those conversations or ask those things, we don't know how to. What the entry point is. And my work, one of the questions that I came from is that I love asking people to rate themselves and to say what they think they're good at. One of the clients that she's allowed me to tell this story is we were. She was actually. I was actually actually working with her on career counseling, which is not what you would think for sex therapy that you'd be talking about. But I'm able to put everything in the context of sex. And we were kind of at a, at a hurdle in insight. And I said, okay, it's like, tell me the three things you're best out in bed. And she was like, wait, what? Like, I know that you, you do sex therapy, but that's not what we're doing here. I was like, no, no answer. And she's like, oh, well, I know what it is. And her number one thing was risk taking. And that she, in the environment of a sexual relationship, she's a big risk taker. And she loves pushing boundaries and going to challenging. And we went through what does the environment and her sexual relationship provide that allows her to be a risk taker? And we looked at that and we translated that into what she needed to be looking for in her next career move in the next environment. And even though you wouldn't think it.
- [37:33]
Dr. Kelly Casperson
Relates directly to it, that is so badass.
- [37:36]
Dr. Juliana Hauser
It was very cool. And, and it works both ways too. And if you, if you do that, you can often figure out really what you'd be best at in bed, too. And, and the whole there's such a wide range of things that people are really good at. It's not just a sex position. There's. It's the, you know, the nine pillars of sexuality that I've talked about. You figure out within that. And when you figure out what you're good at that you feel good about and what your partner thinks you're good at, I think it makes a big difference in sexual confidence. Confidence too.
- [38:04]
Dr. Kelly Casperson
I love that. So your book coming out September 19, a new position on Sex A Guide to Greater Sexual Confidence, Authenticity and Pleasure. Pre orders are up now. You have to send me a copy and come back on the podcast once that's out this fall. But I'm absolutely looking forward to it and I'm honored that you came on to share your story with us today.
- [38:24]
Dr. Juliana Hauser
Oh, thank you. Thank you so much, Kelly. And thank you for the work you do.
- [38:28]
Dr. Kelly Casperson
Thank you for listening to this week's episode of youf Are Not Not Broken. If you want to dig deeper with me, sign up for my Adult Sex Education Masterclass where you learn adult things like communication skills, anatomy lessons and desire types, and how to talk to your doctor about sexual health concerns. If you want the Adult Sex Education Masterclass for free, join my monthly membership for more in depth exclusive content, more time with yours truly. A private podcast, coaching and educational empowerment and you can watch my interviews live and get them immediately without asking advertising. Head over to www.kellycaspersonmd.com for the membership and Adult Sex Ed Masterclass members. Get the Master class for free. This podcast is presented solely for educational, entertainment and informational purposes only. I am a doctor but not your doctor in this format and all of my platforms and guests including on this podcast are not giving individual medical advice or practice medicine. See in Consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician, therapist or other qualified professional. This podcast does not constitute the practice of medicine, in case you were curious about that and no doctor patient relationship is formed. But I still love you. Using the information on this podcast or any of my platforms is at your own risk. Until next time. Remember, you are not broken.