You Are Not Broken: Episode 336 — Author Q&A #1: The Menopause Moment
Host: Dr. Kelly Casperson, MD
Date: September 21, 2025

Episode Overview

In this special Q&A episode, award-winning urologist and midlife women’s health advocate Dr. Kelly Casperson discusses her new book, The Menopause Moment. She unpacks the inspiration, research, and approach behind the book, aiming to move the conversation beyond Menopause 101 into a deeper, evidence-based understanding (the “201” level). Dr. Casperson answers listener questions on hormone therapy, debunks common myths, voices her frustrations about the lack of menopause education in medicine, and offers practical guidance for patients and providers alike. Throughout, her signature humor, candor, and empowerment shine.

Table of Contents

• Background & Development of The Menopause Moment (00:50)
• Systemic Barriers: Research, Education & Advocacy (07:40)
• Key Insights from Book Research (13:23)
• Listener Q&A: Hormone Therapy, Practical Tips & Myths (23:10)
• Menopause, Partners, and Communication (56:05)
• Testing, Supplements & Lifestyle (01:05:50)
• Memorable Quotes & Moments

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Background & Development of The Menopause Moment (00:50)

• Dr. Casperson reflects on writing her first book (You Are Not Broken) compared to her latest, calling The Menopause Moment a “bigger baby,” emphasizing greater research depth and a drive to fill key knowledge gaps for women in midlife.
  • “I clearly had more carbs going on when I made this baby than when I made the 'You Are Not Broken' baby.” (01:23)
• The publisher initially asked for another book about sex; Dr. Casperson instead advocated for a menopause focus, feeling this topic had moved rapidly in recent years with growing demand but a need for more advanced, data-driven resources (the “201” vs. “101” level).
• She hopes the book serves as education “for not running into my office in panic 10 years post-menopause... now we can no longer say we don’t have the information.” (06:10)

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Systemic Barriers: Research, Education & Advocacy (07:40)

• Despite “80 million women over age 40 in America,” menopause care and education remain marginalized:
  • “Women’s health is not a niche. Can we stop being like, ‘Look at us, we’re getting into women’s health’? It’s 50% of the world. It’s human health.” (09:58)
• Dr. Casperson criticizes the outdated belief that “there’s no research.” She highlights that there is ample data (RCTs, observational studies), but it's often behind paywalls or simply not taught or utilized.
  • “Stop saying there’s no research. The research is just not getting out.” (07:55)
• She details the long shadow of the 2002 Women’s Health Initiative, which led to a near-halt in hormone therapy teaching after results were sensationalized:
  • “We basically took 80% of women off their hormones and stopped teaching hormones for two decades after... If you’re not pissed, you’re not paying attention.” (12:45)

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Key Insights from Book Research (13:23)

Surprising Research Highlights

• Hormone Therapy Reduces Pancreatic Cancer Risk:
  • “Women on hormone therapy have a 50% decreased risk of pancreatic cancer... It’s pretty shocking, and I don’t think many people know that.” (14:15)
• Benefits for Eye Health:
  • Hormone therapy may lower the risk of macular degeneration, which hits close to home for Dr. Casperson: “My mom and grandma both have macular degeneration... several studies showing that hormone therapy decreases the risk.” (16:02)
• Colon Cancer:
  • “Most people don’t know that being on hormones after menopause decreases your risk of colon cancer by about 30%.” (15:32)

Addressing Misconceptions

• Hormone therapy isn’t universally mandatory, but Dr. Casperson’s aim is that patients are truly informed before deciding against it.

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Listener Q&A: Hormone Therapy, Practical Tips & Myths (23:10)

Starting Hormones Later in Life (28:45, 34:55)

• Women in their 70s: Still can benefit from starting hormone therapy; risks are low for transdermal estradiol, testosterone, vaginal estrogen, and oral micronized progesterone, even after 10+ years post-menopause.
  • “The risk... is very, very small and there’s usually a benefit.” (36:40)

Vaginal Estrogen — Brands & Application (39:15)

• Recommends generic estradiol cream for versatility (“I care about your clitoris, I care about your labia... the cream can best address the labia”) and affordability. Discusses absurdities of insurance hurdles.

Testosterone Access & Gender Bias (42:32)

• Insurance often covers testosterone for men but not women; Dr. Casperson calls this out as gender bias and predicts a female-dose product “within three years.”

Hormone Therapy & Dementia (46:20)

• Early hormone therapy initiation is key for brain/cognitive benefits; starting at 72 offers symptom relief (bone, mood, sleep), but less preventive value vs. earlier starts.

Systemic vs. Local Hormones — Math Explained (48:10)

• Local (vaginal/vulvar) estrogen does not raise blood levels and is safe in combination with systemic therapy.
  • “If you take systemic hormones... and then you use vulva estradiol... it raises your serum estradiol zero... X plus zero = X.” (49:00)

Progestogen Safety (51:44)

• “Micronized progesterone is not dangerous without a uterus. That’s absolutely insane... How would the rest of your body know if you had a uterus or not?” (52:10)

Value of Communication, Not Convincing (53:05)

• Dr. Casperson’s mission: education and body autonomy, not conversion. “Some people think the earth is still flat... that’s their journey.” (53:45)

Surgical Menopause, Ovarian Hormone Production & Dementia (54:32)

• Emerging research suggests that loss of ovaries (and thus testosterone) post-menopause is linked to higher rates of Alzheimer’s, supporting the role of testosterone.

Menopause Myths: Cycling Progesterone, “Natural,” and Estrogen Dominance

• Cycling Progesterone: No evidence supports that every postmenopausal woman needs to cycle; historical “natural” periods were rare due to pregnancy/breastfeeding.
  • “For experts to say we should do what is like a normally cycling every month... that’s not physiologic. That’s not how we evolved.” (01:01:12)
• The "Natural" Fallacy: Criticizes the obsession with “natural” as misleading.
  • “‘Natural’— socks aren’t natural. Wearing glasses aren’t natural. Flossing isn’t natural.” (01:02:43)
• Estrogen Dominance: “Estrogen dominance is not a fixed state. It’s not eye color. You will not have estrogen dominance forever. So stop saying that.” (01:13:30)

Lab Testing & Hormone Monitoring (01:04:28)

• Serum tests are the gold standard; saliva/urine expensive and not superior. Encourages validation of patient concerns, but reminds listeners of limitations due to hormone fluctuations.

Men, Penises, and Vaginal Estrogen (01:16:30)

• Addresses concerns about partner exposure: “Men have more estrogen in their body than a postmenopausal female... we actually studied it and it’s fine.”

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Menopause, Partners, and Communication (56:05)

• Talking to Men:
  • “You basically say, listen, cut your testicles off. See how you feel. That’s what menopause is. This is a biologic issue. Support me through it. I need you to hold space.” (56:30)
  • Humor is used strategically to drive home the impact of hormone loss and elicit empathy.

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Testing, Supplements & Lifestyle (01:05:50)

HRT vs. Birth Control Pills (01:22:20)

• Pills are synthetic, high-dose, and riskier (blood clots) in older women — Dr. Casperson advocates for transitioning to more physiological therapies at the right age.

Menopause Certification and Provider Education (01:08:20)

• Recommends practical resources (retreats, reputable courses, latest books) to empower clinicians with prescribing expertise.

Supplements (01:24:31)

• Dr. Casperson’s favorites: Creatine (“cheap, inexpensive, great for muscle, great for brain”), vitamin D, magnesium, omega 3, fiber.
  • “Supplements are like the candles on top of the cake... Nice to have but the candles don’t make the cake.”

Testing Hormone Levels in Perimenopause (01:26:40)

• Patient labs are useful for validation and baselining, but single days don’t capture fluctuating perimenopausal levels.

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Memorable Quotes & Moments

• Menopause in Medicine:
  • “Why isn’t everyone taught this in med school? Great question... Women are 50% of the population.” (10:21)
• Research Accessibility:
  • “We have a lot of research. Stop saying there’s no research. The research is just behind paywalls and not being... trickled down to the real world.” (07:55)
• Soapbox on Women's Health as a ‘Niche’:
  • “Women’s health is not a niche... It’s human health. Stop calling it women’s health.” (09:58)
• Empowerment:
  • “I care that you’re educated and you know how to advocate and you get to do what’s best for your body and you have body autonomy.” (53:18)
  • “Hormones are simply hormones. Healthy living, stopping alcohol, all the things... get you feeling good enough so you can go out and change the world in your unique way.” (01:29:50)
• On Communication Skills:
  • “If you can communicate well and you know something, the world’s your oyster, my friend. If you can communicate well and you know a lot about something, you get paid to be on stages.” (07:23)

Takeaways

• There is robust research on hormone therapy, but a massive gap in public and physician education.
• Myths from past studies still drive fear-based and restrictive menopause care.
• Hormone therapy offers substantial benefits well beyond symptom relief, including reduction of certain cancers and potentially neuroprotection.
• Shared decision-making, body autonomy, and up-to-date knowledge must be at the forefront of menopause care—for patients, clinicians, and society.
• “Natural” is not necessarily better; survival past menopause is historically new for humanity.
• Supplements are an adjunct, not a substitute, for evidence-based therapy and lifestyle.

For more:

• Visit kellycaspersonmd.com
• Check out her award-winning books, courses, and further podcast episodes.

Next Q&A is in September—submit your questions and join the conversation!