369. Perimenopause, Testosterone and AMA with Dr. Casperson

Summary

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Podcast Summary: You Are Not Broken – Ep 369

"Perimenopause, Testosterone and AMA with Dr. Casperson"

Host: Dr. Kelly Casperson | Guest Moderator: Sarah Reardon, PT
Original Air Date: May 3, 2026

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Episode Overview

This energetic and educational Q&A, led by pelvic floor physical therapist Sarah Reardon and urologist/sexual medicine expert Dr. Kelly Casperson, dives deep into perimenopause, menopause, hormones, sexual function, and the realities of navigating midlife as a woman. The conversation is a mix of myth-busting, practical advice, advocacy, and humor, with an emphasis on lived experience, science, and gender equity in healthcare.

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Key Discussion Points & Insights

1. Dr. Casperson’s Backstory & Mission [03:47–09:10]

• Professional Journey: Dr. Casperson is a board-certified urologist who transitioned to focus on women’s sexual health after feeling unprepared to help a patient with sexual concerns following cancer surgery.
• Gender Disparity: She highlights how men’s sexual health is normalized and easily treated within urology (Viagra, testosterone), while women’s concerns are often dismissed. This lack of gender equality is a driving force in her advocacy.
• Advocacy Defined:
  • “I realized, oh, this is what advocacy is. This is what showing up is. This is what trying to change the world is... I’ll keep doing it.” (Dr. Casperson, 08:55)

2. What is Perimenopause? How Do You Know You’re In It? [10:20–14:31]

• Definitions:
  • Menopause – One year with no periods; an arbitrary medical definition.
  • Perimenopause – The years leading up to menopause with wide hormonal fluctuations.
• Misconceptions: Many think menopause is an event you finish and then you’re “over it,” but post-menopause is actually living with low ovarian hormone function.
• Symptom Onset: Perimenopause can last up to 10 years, starting as early as mid-30s and as late as late 40s.
• Age Bias:
  • “You’re too young or you’re too old is gender bias in medicine… Would we tell a man that he’s too young or too old for erectile dysfunction? No.” (Dr. Casperson, 12:17)

3. Signs and Symptoms of Perimenopause (Beyond Hot Flashes) [15:15–23:40]

• Widespread Effects: Declining estrogen/testosterone/progesterone affects the vulva, vagina, urethra, bladder, and beyond.
• Urinary + Sexual Symptoms:
  • Urgency/frequency
  • Recurrent UTIs, yeast infections
  • Vaginal dryness, thinning tissues, pain with sex
  • Decreased orgasm, libido
• Sleep Disturbance:
  • “Progesterone helps you fall asleep. Estrogen helps you stay asleep... If your sleep is more light, your bladder is more likely to wake you up.” (19:09)
• Confusion with Postpartum: It’s common to be unsure if symptoms are due to postpartum or perimenopause, especially for older mothers: “Who the F cares? Go get help. We don’t care. We’ve got options, right?... It’s wasted time trying to figure it out.” (Dr. Casperson, 22:37)

4. Advocacy, Support, and Finding the Right Care [24:23–29:44]

• Finding Community:
  • “Find familiar friends... this is 50% of the population!” (Dr. Casperson, 24:23)
• Self-Education: Learning empowers women to advocate and seek informed providers.
• Where to Find Care:
  • Pelvic health PTs can refer to well-informed MDs.
  • Online platforms (e.g., MIDI, Alloy, Get Interlude) are expanding access, especially for vaginal estrogen.

5. Real Talk on Hormones: Estrogen, Testosterone, Progesterone [30:18–45:18]

A. Estrogen: Delivery, Dosing, Myths

• Vaginal vs. Systemic:
  • Vaginal estrogen is local, low-dose, often best delivered as a cream for vulvar and vaginal tissue—especially for pain with sex.
  • “If your face needs moisturizer, your vulvovaginal skin probably does, too.” (28:33)
  • “I have an estrogen cream bias because I want the vulva treated.” (35:50)
• Bioidentical Confusion:
  • “Bioidentical means it’s what your ovaries made... There are many FDA-approved bioidentical products.” (41:01)
• Indications for Systemic Estrogen:
  • Used for broader symptoms: mood, sleep, bones, hot flashes.

B. DHEA: The Under-Discussed Option

• DHEA in the Vagina:
  • Acts locally; a precursor for both estrogen and testosterone.
  • Some studies show slightly better sexual function than estrogen alone.
  • Dr. Casperson is developing a DHEA serum to be released soon.

C. Testosterone: Gender Bias, Indications, Access

• Reality Check:
  • No FDA-approved testosterone for women in the U.S.
  • “Ovaries make testosterone and we have zero FDA approved products.” (43:55)
  • Access is hampered by regulatory issues (Olympic doping history) and gender bias.
• Approved Only for Low Libido?
  • That’s the wrong approach: “We don’t want this approved for low libido… because women will still get big biases to say it’s only for libido.” (44:07)
• Symptoms Helped: Mood, cognition, energy, lean mass, bone health.
• Lab Monitoring: Baseline and follow-up recommended; labs can fluctuate greatly in perimenopause.

D. Progesterone:

• Role: Helps with sleep and balances estrogen in those with a uterus on systemic therapy.
• Cautions:
  • “Progesterone cream off the Internet... can never be used for uterine protection if you’re on systemic estrogen because it’s very, very low dose.” (59:46)

E. Duration of Hormone Use

• Can/should be lifelong:
  • “As long as the benefit outweighs the risks, you can continue on your hormones.” (49:49)
  • No age cutoff for vaginal estrogen.

6. Supplement, Lifestyle & Self-Care Advice [52:02–56:38]

• Gut Health:

  • Loss of estrogen alters the gut microbiome; women on hormones have lower colon cancer risk.
  • “Stop looking for the magic supplement… Stop the alcohol. Alcohol is horrible for gut microbiome.” (53:39)

• Alcohol: Majorly detrimental to gut, brain, weight, and mood for midlife women.

• Exercise:

  • “Only exercise on the days you want to take care of your body.” (54:40)
  • “No hormone does what exercise does.” (54:48)
  • Meds (like GLP-1s or hormones) can help make exercise more possible for those struggling.

• Cannabis: Not recommended for mood or sleep (risk of brain and lung effects). Warns against using THC gummies for sleep—can contribute to dementia risk.

7. The Power of Self-Advocacy & Finding the Right Healthcare [51:27–52:00]

• If your provider is dismissive—find another: "If you're going to somebody who... it's very apparent they're not going to be best for what you need help with, you can find somebody else." (Sarah Reardon, 51:27)
• Online services are helping fill the gap. Education (books, podcasts) arms women to have more effective doctor visits.

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Memorable Quotes & Takeaways

• “This is the power of the female voice in urology… we see the gender bias in how women are treated versus men. The why is gender equality.” (Dr. Casperson, 06:13)
• “Perimenopause is reverse puberty.” (Dr. Casperson, 11:43)
• “Women spend so much time spinning their wheels trying to figure it out… We’ve got you. We will help you.” (Dr. Casperson, 23:27)
• “Advocacy is real solutions… Not knowing what your body is doing, not knowing this is hormones, not knowing where the books are, advocacy is the solution.” (Dr. Casperson, 29:44)
• "No one thing is the answer—if you find someone selling a 'one-size-fits-all' solution, you're being sold a bill of goods." (31:07)
• “There’s nothing better [than exercise] for brain, body, menopause... and sometimes hormones give you the energy to exercise.” (Dr. Casperson, 54:49)
• “If you stop, [your symptoms] will go back to how it was… you can be buried with your hormones if you want.” (Dr. Casperson, 49:27)

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Educational Moments & Practical Tips

• Estrogen cream for the vulva is cheap and often preferred for physical symptoms with sex; don't let insurance overcharge—use Mark Cuban Cost Plus Drugs if needed [35:50].
• Never too late for vaginal estrogen, even in the 90s, and don't let age bias sway you [51:06].
• If you're not getting answers, seek out pelvic health physical therapists or online menopause services.
• Advocacy as solution: Don’t be discouraged if you need to self-educate and push for the care you need.

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Notable Demonstration [63:01–64:45]

• Dr. Casperson showcases a 3D-printed vulva and explains where estrogen should be applied and the anatomy of the clitoris:
  • “If you don’t engorge your clitoris, you have much less pleasure. Pleasure with sex comes from arousal and female erection. We don’t say female erection enough—I think we should.” (Dr. Casperson, 63:09–64:18)
• Discusses her newly designed vulva-friendly vibrator, The Explorer (“sold out, but watch for restock!”).

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Important Timestamps

| Topic | Timestamp | |---------------------------------------------|----------------| | Dr. Casperson’s mission & advocacy | 03:47–09:10 | | Defining perimenopause & menopause | 10:20–14:31 | | Hormonal impacts on pelvic & urinary health | 15:15–23:40 | | Sleep changes in midlife | 19:09–20:24 | | Finding support & informed healthcare | 24:23–29:44 | | Hormones (estrogen/delivery/DHEA) | 31:15–38:39 | | Testosterone in women: barriers & uses | 43:36–47:52 | | Hormone therapy duration: “forever?” | 49:17–51:27 | | Lifestyle: Gut, alcohol, exercise | 52:02–56:38 | | Demonstrating vulva/clitoral anatomy | 63:01–64:45 |

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Closing Thoughts

This episode is a masterclass in understanding, demystifying, and advocating for midlife women’s health. Dr. Casperson and Sarah Reardon break down myths, clarify confusion, and repeatedly reinforce that you are not alone and you are not broken. Their blend of evidence, real talk, and advocacy will leave any listener—midlife or not—with more knowledge and confidence.

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Find more:

• KellyCaspersonMD.com
• Podcast: You Are Not Broken
• Instagram: @kellycaspersonmd
• Books: You Are Not Broken & The Menopause Moment

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Transcript

[Podcast Host]

Hey everybody, welcome back to the you are Not Broken podcast. Today is a cool episode because it was a Q a I actually did with Sarah Reardon. She's a pelvic floor physical therapist and author of the book Floored. She also has an amazing Instagram, so I did a Q A in her group and it was just so good and feisty and fiery that I asked her if we could put it on the podcast. So thanks for Sarah Reardon and her team and she's putting an exclusive discount in the show notes for for people who are listening and interested in more so Sarah Reardon, amazing physical therapist who wrote the book Floored and this is a Q and A where she asks me a bunch of questions. So I hope you enjoy. The one other thing I wanted to tell you before we get started is I've got really exciting things coming out for the rest of 2026 and if you are not on my email list, you're not going to be the first to know. So head over to kellycaspersonmd.com sign up and make sure you're on my email list where you'll hear the basically the newest stuff because if you follow me on socials, those posts don't go to everybody and you might miss it. So make sure you're on the email list for exciting things that are coming out in 2026 and if you already know, you already know. All right, see you soon and enjoy the you are Not Broken podcast.

[Dr. Kelly Casperson (Podcast Intro/Outro Voice)]

Welcome to you Are Not Broken, the podcast that challenges everything we've been taught about midlife hormones and sexuality. I'm Dr. Kelly Casperson, board certified urologist, author and a leading voice in women's sexual and hormone health. Enjoy the show.

[Sarah Reardon]

Hello everyone and welcome to this live Q and A with myself, Sarah Reardon, the vagina whisper and Dr. Kelly Casperson, who is just a social media phenom, author, podcaster, sexual health, urologist, hormone specialist, all the things. So to introduce myself, some of you may be new to this community. I am a board certified pelvic floor physical therapist. My social media handle is the Vagina Whisperer where I share tons of pelvic floor tips through for every stage of life as a woman. But being a perimenopausal woman myself, this is a really exciting conversation that we're going to have today with Dr. Kelly Casperson. And I am the creator of the Beehive app which is app on Apple and Google that has pelvic floor training workouts. So it's something that after today's call we are going to send you an exclusive offer to access that app for an extended free trial and has a specific perimenopause program for pelvic floor issues. So make sure that you check out that email to get access to that exclusive deal. Without further ado, I want to introduce Dr. Kelly Casperson. She is one of my favorite people. We have collaborated on a handful of Q and A's in the past. She's at Kelly Kaepperson, MD, on Instagram and is absolutely a must follow if you are. If you have a vagina, because she really is a specialist in this or if you love one, if you have a partner who has one. Her first book, you are Not Broken, is just an amazing book to really demystify gynecological pelvic health and neurological issues for women. And again, just really helps women feel like they're not alone in their solutions to their issues. She has a new book called the Menopause Moment, which is really just so timely because all of us want to learn so much from her. And my favorite is her podcast, you, are Not Broken, which is just a must listen with so many, you know, insights and specialists and her own expertise on everything that we're navigating through midlife and beyond. So without further ado, I'd love to, you know, have Kelly, Dr. Casperson, introduce herself. The accolades could go on and on, and then we'll jump right into your questions.

[Dr. Kelly Casperson]

Hey, everybody, thank you for being here. What a great big room we have today. I'm Dr. Kelly Casperson. I am a urologist. A urologist, for people who don't know, is somebody who went to medical school and did a surgical subspecialty specializing in the genital urinary organs. From top to bottom. It is adrenal glands, kidneys, ureter, bladder, prostate, urethra, external genitalia. So that's what we did. And I started getting bored at about year seven. How do you know you have adhd? You do a surgical residency, be at the top of your class, and then be bored seven years in, like, in hindsight, it all makes sense. So at seven years, I was bored. And I think the universe decided I was ready for the next step. And I truly believe this was like a universe delivered by a patient who was crying in my office because of a sexless marriage. And I didn't know how to help her. And I was deeply bonded with this person. I had helped her with some significant cancer surgery and deeply was bonded. So this wasn't a stranger crying in my office. This was A. Oh, crap. I don't know how to help this person. Big, big problem. And that really started for me going into female sexual health. Aren't the gynecologists taking care of this? Turns out, no, they aren't. The gynecologists who are. Will admit, no, as a group or not, they're busy. They didn't get trained in female sexual health. They. They got trained in the consequences of female sexual health, but not in female sexual health. And I just went down a big rabbit hole of learning. And again, ADHD with hyperfocus isn't every. Doesn't everybody get completely obsessed about a fascinating topic and, like, go big on it? So a year in to that learning, I started the podcast, started the Instagram to get people to listen to the podcast. The podcast is called you are not broken in seven years Old Now. Sarah was on it this year for Floored, which was awesome. And I've written two books. The first one's on female sexual health called you are not Broken. The second one is called the Menopause Moment, because the publishers were like, will you write another book about sex? And I'm like, sure, but I kind of want to write a book about menopause, because everybody kept saying, do you know what happens to your sex life after menopause? And I'm like, I don't know that either. So let's dive deep. So the menopause moment came out September 2025, there on my auto screen. Put it where my face is. Anyways, the menopause moment. And I still talk about sex in this book. And it's really become a passion project of gender equality and medicine for me, because urologists, again, as surgeons of the genital urinary organs, we take care of men's sexual quality of life, testosterone and Viagra, every day. Risks are low, benefits high. They feel great. These things work. We don't lose sleep over it. And then when women come in and they say, but what about my hormones and my sex life? We. We clutch our pearls and we say, I don't know if that's safe, and do you really need it? And isn't aging just natural? And when you take care of both men and women and transgender individuals, you realize that the women have the really short stick in this scenario. And the gynecologists don't always see that because they don't take care of them. So it really became. And I think that's the power of the female voice in urology. Me and a lot of my friends who are also Female urologists feel this way, see this way. We see the gender bias in how women are treated versus men. And ultimately, sex is a fascinating topic. Hormones are a fascinating topic. But the why is gender equality. Every as. As long as everybody gets the same options and is treated the exact same in the clinic, then my job is done and I'll go put my feet up and thank you very much for all the hard work. Unfortunately, that. Well, or fortunately for me in my career, that was going to take a very long time because we are nowhere near gender equality.

[Sarah Reardon]

The.

[Dr. Kelly Casperson]

The average woman goes to five to six different doctor visits before being properly treated and diagnosed for her perimenopause and menopause, let alone sexual health, which she probably just never brings up to the doctor in the first place. So that's the big. The. The big ask. I remember being young and sitting in lectures and people were like, be an advocate. People should advocate. Get involved. And I'd, like, ate the free pizza and was like, I don't know what the hell you guys mean. Like, how do you do that? How does. How does that work? And now that I've done it and I'm on calls with HHS to try to figure out why the f. Don't we have a female dose testosterone yet? And I was on stage getting the boxed warning off of vaginal estrogen and all this. And on, you know, on the Sydney Opera House stage talking to laypeople about the word vulva is not a dirty word. Right? Like, you realize, oh, this is what advocacy is. This is what showing up is. This is what trying to change the world is.

[Podcast Host]

And.

[Dr. Kelly Casperson]

And this is my lane. And I. The world's got a ton of different problems, but this is. This is the one that I'm obsessed with, and I'll keep doing it. So that's my very long intro.

[Sarah Reardon]

I.

[Dr. Kelly Casperson]

People who didn't know me, now, you know.

[Sarah Reardon]

Thank you. And I think that not only the work that you do, but the meaning and the mission behind it is so important because I think it's. So many of us on here are shaking our heads. Yes. Like, yeah, we do feel flighted. We do feel like we're not getting adequate. We care. We feel like we're not being heard. And to have a voice like yours advocating for us is so helpful and. But so necessary. Like, we need you to keep doing this, so thank you for that. And there are so many folks on here who are just looking for information and education and answers about their body. And so we kind of open this up to let's talk about perimenopause. Let's talk about menopause. Let's talk about hormones. Let's talk about sex. So I want to just kind of start with some of the basics for folks who are here. We're going to kind of. I'm in perimenopause, so this is kind of for me and many of the patients that I see. But how do you even know that you are starting to go through menopause? Like, there's no blood test that you can take that's like, yep, she's there. I have patients who are coming in that are 37, 38, and I have patients who are 47, 48, and they're like, I'm not sure yet. What would you say? How would someone know that they're starting this kind of perimenopause transition? Yep.

[Dr. Kelly Casperson]

So perimenopause, by definition, Perry, means surrounding. But what we tend to mean when we say perimenopause is the years before menopause. And again, we need to define menopause, because a lot of people don't know what that means. So menopause, the definition of menopause is no natural periods for a year, coined by a man in the 1800s. Not a very useful term because it doesn't actually describe what's happening in your body. Remember? What do I mean by that? No periods is a consequence, a side effect, a symptom, whatever you want to say of what's actually happening. What's actually happening is your ovary only has so many packets of hormones and eggs, and we are outliving them. There's a whole big discussion about, as a society, we didn't usually live till 86 for a long time. So to say no natural periods and to say, oh, my periods are done, then people will say, I'm over menopause. Right. We hear that a lot. There's no over. There's no over you outliving your ovaries.

[Sarah Reardon]

Right.

[Dr. Kelly Casperson]

But the. The. Because people don't know what menopause means, they think they're over it when their periods end. And by definition, menopause is actually one day. It's the one day after a year of no periods. So technically, to be pedantic, you can be over menopause. Right. But when women say over menopause, so they tend to be. They tend to think that thing happened, and now it's done, and now there's like, no consequences of living pasture ovarian function because they didn't know it was limited ovarian function in the first place. So perimenopause means surrounding that one day of a year of no periods. Average age of menopause year of no periods in America is 51. Remember, that's average. I hate when people get told they're too young or too old. My joke in the do you're two, you're two different ages in the doctor's office. You're too young for something and you're too old for something if you're a woman. Men don't have that problem. Men are never too old or too young. I have an 89 year old on testosterone of Viagra because he wants it and it's benefiting his life, right? So you're too old or you're too young is gender bias in medicine. So realize that when you're being told that. Realize. Would we say it, would we tell a man that he's too young for erectile dysfunction, he's too old for erectile dysfunction? No, that doesn't make any sense. Right, so, so we don't approve of somebody saying we're too old or too young. Perimenopause basically means the start of hormonal off boarding, right? So ovaries on board, they take a couple of years to onboard. It's called puberty. Periods are irregular, they're light, they're heavy, they're spaced out, they're, they're erratic. Your hormones spike. That's puberty. Everybody knows that. Everybody knows that puberty is a thing. Perimenopause is reverse puberty. So hormones can spike, ovaries cannot ovulate that month. They, periods can space out, they can become erratic. 20% are really heavy. And again, puberty took years. Perimenopause can take years. People say up to 10 years. But like that one day where you went from completely normal ovarian cycling and periods to the start of it, that's, it's not a thing, right? There isn't like the start of perimenopause is like, hey, 10 years up to menopause. Menopause, 51, 10 years before. That's 40. And remember, 51 for menopause is just the middle, right? So menopause can be 47, it can be 46. Ten years before that, 35. 36. Right. And I think it's very dismissive when we tell people they're too young. I, I met a woman on my book tour who went into menopause at age 19, right? So certainly that's atypical and rare, but it happens. So for anybody to it's just so dismissive to say let's look at your driver's license, see what day you were born and judge you based upon how I think you should be at that age.

[Sarah Reardon]

Yeah, everything you're saying, I'm like yeah, let's, I'm like let's storm the streets. I mean it really is. And I think so much of what you're saying equates back to the, the root cause of so much of is dismissiveness of women's concerns, lack of research under education and, and challenges in healthcare. So from a pelvic floor and sexual health perspective, what would you say some of the signs of per menopause would be? Whether like sexually or sexual health wise? Urologically, Bladder health. What are some of the things that people may start to see like huh, maybe this isn't just like oh I, I, I'm, you know, not sleeping as well so I'm waking at night to pee. Like what are some of the things Because I think people don't realize that like oh, you're waking at night more to pee. Like that could be a sign of perimenopause. Like what are some of the things that people can start like investigating.

[Dr. Kelly Casperson (Podcast Intro/Outro Voice)]

Now it's time for an ad from MIDI Health, the online experts in menopause and perimenopause. If you're about to hit pause or

[Dr. Kelly Casperson]

grab a snack, give me 30 seconds here.

[Dr. Kelly Casperson (Podcast Intro/Outro Voice)]

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[Dr. Kelly Casperson]

in your body and brain is just

[Dr. Kelly Casperson (Podcast Intro/Outro Voice)]

in your head, it's not.

[Podcast Host]

Stay with me.

[Dr. Kelly Casperson (Podcast Intro/Outro Voice)]

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[Podcast Host]

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[Dr. Kelly Casperson (Podcast Intro/Outro Voice)]

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[Dr. Kelly Casperson]

Yeah, great question. So let's back up a second because people don't, it's it. If you don't understand the basics, it makes no sense that your bladder doing something is a sign of hormones. Right? But the basics are ovaries make hormones, ovaries make estrogen, testosterone and progesterone. And those hormones go everywhere in the body. And the job of hormones is to travel around the body and communicate. But the job of hormones is to keep healthy cells healthy. What do I mean by that? Hormones don't do very well at curing disease. Not what they're made for. They're made to help healthy cells function healthy. And that's everywhere in your body. Well, now that you know that, you can know that when the hormones start to go down, which is what perimenopause is, because remember menopause and no periods. No periods is a sign of low hormones. Right. So this is a. All of this is a low hormone situation. So low hormones in the vulva, vagina, urethra, bladder, can look like urgency, frequency. I got to go more than I used to. I used to be able to drive to Seattle, but now I know where all the bathrooms are. I've started to get a urinary tract infection. I actually got two this year. Recurrent urinary tract infections, recurrent yeast infections. You see more bv. Why? Because the microbiome of the vagina loves estrogen. You need estrogen to help the lactobacillus be lactobacillus. And what lactobacillus do, which is the microbiome, the predominant microbiome of the vagina is it. It acidifies the vagina. And so when you lose that acidity, you start becoming more prone to infections. Right. So there, all of this makes sense. And that's what I want to pound into people's heads is people just think our body's a mystery of like, it's not a mystery. We actually know a lot. It's just your health literacy is very, very poor. So you think it's like magical or a mystery or unknown. And that puts you very, very vulnerable to people who want to sell you things, tell you things, dismiss you all of those situations. So understanding your body and why it makes sense that when hormones go down, you get more UTIs. When hormones go down, your bladder does things. When hormones go down, Dryness, thinning of the tissue, pain with sexual intercourse, decrease orgasm. All of the sexual function things that happen is because it's hormones.

[Sarah Reardon]

It's.

[Dr. Kelly Casperson]

This is not a mystery. So stop acting as if, like this is some magical thing we haven't figured out yet.

[Sarah Reardon]

Is there anything that happens more specifically at nighttime versus the day? Like, a lot of people have night sweats or waking at night more to pee. Is there anything that happens specifically during that nighttime period or is it just like. No, that's just an eight hour extended period of time where things.

[Dr. Kelly Casperson]

Right. Yeah, it is a third of your day. Yeah. The so progesterone helps you fall asleep. Estrogen helps you stay asleep. Testosterone, in my experience, is kind of a mixed bag. Some people will say testosterone really helps them sleep. Some people will say it's energizing. But if you're. If you think of sleep, if I just have my hand is I'm sleeping like this, and then all of a sudden my sleep is more light.

[Sarah Reardon]

Right.

[Dr. Kelly Casperson]

It's not as deep of a sleep. If your sleep is more light, your bladder is more likely to wake you up because you're just more sensitive to, like, the sound that's going on or the bladder fullness or temperature changes and all that stuff. So I. To answer your question, I would say sleep starts being affected, and then you might start. And I, as a urologist, that is. That is a question I ask people frequently. Are you waking up and then going pee because you're awake, or did having to pee wake?

[Sarah Reardon]

Yeah, yeah, Right.

[Dr. Kelly Casperson]

Because, you know, people are like, oh, no, my cat jumped on me, and I was awake anyways.

[Sarah Reardon]

Right.

[Dr. Kelly Casperson]

And it's like. But they come in saying they have to pee two times. So you don't want to figure out, like, is this a bladder problem? Is it a sleep problem? Is it your cat's jumping on you problem? Right. So those are some of the questions I ask people. Yeah.

[Sarah Reardon]

And I love that because I think often people are just waking up and they're like, oh, might as well just go pee, you know, and we start to kind of see that.

[Dr. Kelly Casperson]

What do you say to that, Sarah?

[Sarah Reardon]

About whether they wake up and just have to go pee?

[Dr. Kelly Casperson]

Yeah.

[Sarah Reardon]

Like, if you don't really have the urge to go, then, like, I teach them deep breathing, and I tell them to, like, do some contractions or distract themselves or something like that. But I say, if you don't have the urge to go, don't go. Like, and I think I see that a lot with postpartum as well, that moms are just up multiple times during the night, and they're just going pee because they're up. Which is an interesting kind of question for you, too, is that right now, moms are having babies later in life. There are more women getting pregnant over 40 than there are in their teens. And so I'm seeing clinically a lot of moms who are postpartum, but then they're transitioning into this perimenopause in, like, one blurry season. And they're like, wait, is this vaginal dryness postpartum, or is this, you know, or in period kind of irregularity from that. Or is it more along the lines of perimenopause? And is that just like. That can all just blur together?

[Dr. Kelly Casperson]

Yeah, it can all blur together. My favorite word to say is Perry. Postpartum pause.

[Sarah Reardon]

Oh, I know you'd have something for that word.

[Dr. Kelly Casperson]

I give credit to that word by. For a gynecologist, Dr. Shiva Gofrani, because it. It's very interesting because, you know, in my years of doing this, now I'm like, dude, there is something about having a baby super late. That the ovaries, like, here was my last party and my last, you know, final draft. I'm done now.

[Sarah Reardon]

Boom.

[Dr. Kelly Casperson]

Like, yeah, perimenopause post menopause, very poorly documented in the literature. But you ask. You start asking the gynecologists, the endocrinologist, the reproductive infertility people, they're. Oh, yeah, that's a thing. Like, the ovary gives its last. Like, this is my final workout. Life. You know, I'm out, I'm tapped. And I think. I think a lot of women. The second part of your question I wanted to address. I think a lot of women spend a lot of time trying to figure it out. Is it this or is it this?

[Sarah Reardon]

Is it.

[Dr. Kelly Casperson]

Is it, I'm breastfeeding and I have no sleep, or is it perimenopause?

[Dr. Kelly Casperson (Podcast Intro/Outro Voice)]

Who the f cares?

[Sarah Reardon]

I know.

[Dr. Kelly Casperson]

Go get help. We don't care. We've got. We've got options, right? But people like. And in thinking, like a doctor, how do doctors think? Like, let's treat it. It's more. It's more likely this, but it could be, like, we can work with that. So I think a lot of women are like, I gotta figure it out first. It's like, we don't effing care that you figure it out first. How the hell are you gonna figure that out first? We don't know, Right? It's probably, like, so bad because you're perimenopause and you're breastfeeding and you're not sleeping and all the things, right? So, yeah, it's like. It's like if somebody comes to you and they're like, I have hip pain, but I haven't figured it out yet.

[Sarah Reardon]

I'm like, no, we're gonna find the root cause of what's happening and just treat that like that's it. I know. I always say that.

[Dr. Kelly Casperson]

So, like, women spend so much time spinning their wheels trying to figure it out, and like, dude, we've got you. We've got you. We will help you.

[Sarah Reardon]

Yeah.

[Dr. Kelly Casperson]

Because I think. I think it's wasted time, frankly.

[Sarah Reardon]

We'll get to this at the end, too, because I think you are a jam, and I think that, you know, you're in Washington. So where. This is why I love you and your voice, because it's like, there are solutions. I think it just feels like we have to peel, like, get through the muck of so many, unfortunately, medical providers, public health therapists included, that just aren't informed about how to help navigate these seasons for women and help direct them. So we'll get to that at the end, too, about what your recommendations are to how. How people can kind of access this care. So before we get into this kind of huge, huge conversations about hormones, are there other things that you would say can be supportive of someone navigating perimenopause and menopause? So whether it's supplements, I would say find a.

[Dr. Kelly Casperson]

Find. Find familiar friends.

[Sarah Reardon]

Yeah.

[Dr. Kelly Casperson]

Like, this is 50 of the population, right? Like, do not feel alone. If you feel alone, realize this is 50 of the population and there's. There's a lot of power in keeping women isolated. Right. There's a lot to gain by keeping a woman, like, not knowing about her body, wondering what it is first. Like, but this is so common. It's 51% of the population. So I would say you think, yeah,

[Sarah Reardon]

what are your solutions?

[Dr. Kelly Casperson]

Yeah, find the friends, man. Like, just find the friends. And. And if you start talking about it, likely other people are like, oh, that's not just me. Like, itchy ears isn't just me. So, I mean, more than. And I think that's the best supplement.

[Sarah Reardon]

So having conversations, I think, with other individuals. And then the. I think the biggest frustration comes from, like, where do we. How do we find a medical provider? I mean, I think, to be honest to me, I think that self education is a huge piece of this. So, like, reading your book, like, when people read Florida, they were like, oh, my gosh, this is the first time, like, I don't feel like an alien in my body. You know, and then they bring their book into their doctor and they're like, hey, I read this and this is me. You know, because we're in the process of. Just as we are getting educated, I think other medical providers are getting educated on how to really better navigate hormonal support for, and lifestyle support for perimenopausal and postmenopausal women. So is there a way for people to find a good provider? Which. I'm sure you get that question all the time because you are one of them. But being in New Orleans, it's like, it's not easy, you know?

[Dr. Kelly Casperson]

Yep. So hormone perimenopause is happening because of hormones. Postmenopause happens because of hormones. Like, and hormones don't exist in a bubble. Meaning I just did a reel today because somebody's like, I'm trying to adjust my hormones, so my libido's back. And I'm like, libido is so big and complicated. Like, it's not just hormones. Right. And so I think one of the pushbacks we get a lot on social media is, is people are like, you only want women on hormones. And I'm like, I desperately want you educated and. Yeah, Desperately want you educated to decide if hormones are right for you or not. I have a chapter in my book on how to talk to doctors about this. Doctors did not train for two decades because of the Women's Health Initiative. They are getting trained. I was just presenting at Harvard three weeks ago. There was 1750 humans who prescribe hormones at that conference. They are getting trained in droves. So it's quite likely that the person in your town is doing this now. I mean, I just saw a patient this morning who I. I helped got her optimized, and now she has a primary care doctor who's like, oh, I'll totally take over your hormones. So even told you no three or four years ago. Might not tell you no now. And this really does change because women are becoming advocates.

[Sarah Reardon]

Yeah.

[Dr. Kelly Casperson]

So knowing how to advocate.

[Sarah Reardon]

Bring in the book.

[Dr. Kelly Casperson]

Bring my book in.

[Sarah Reardon]

Yeah, I would say that. And I would say as a pelvic floor provider, Pelvic health specialist. Like, when people come to me, they're like, what doctors do I need to be seeing? I'm like, okay, let me tell you the ones that are informed about how to take care of you, because we know who the pts know. Like, we're the dot.

[Dr. Kelly Casperson (Podcast Intro/Outro Voice)]

The.

[Sarah Reardon]

The. The specialists in this area that are like, okay, that doctor that. That OB GYN you're saying delivers babies, they're not going to be able to help you. You know, so it's like we kind of know the ones who we really collaborate well with. One like, you need topical estrogen. Go see so and so, you know,

[Dr. Kelly Casperson]

so online Get Interlude is a great one for just. For vaginal estrogen. I love that. Company owners. The operator is awesome. MIDI is huge. They're kicking butt. They're amazing. They do a lot of perimenopause. Alloy is great. They do tons. So a lot of people, truthfully, don't have somebody in their town. Great. We've got online now if your face

[Dr. Kelly Casperson (Podcast Intro/Outro Voice)]

needs a moisturizer, your vulvovaginal skin probably does too. And for that I recommend Via Vaginal moisturizer from Solve Wellness. I'm a huge advocate for vaginal estrogen and Via is the perfect complement. It's a non hormonal, hyaluronic acid based moisturizer that replenishes moisture while soothing and conditioning dry vaginal tissue. It can be used alongside vaginal estrogen on off days or daily for those who prefer not to use vaginal estrogen during menopause. Lower estrogen levels can thin and dry skin everywhere, including vaginal and vulvar tissue, leading to irritation, pain with sex, and even urinary tract infections. That's why maintaining healthy and hydrated vaginal tissue is important. For more information on Via by Solve Wellness, visit viaforherher.com that's via the number4her.com where new customers get 20% off their first purchase. This Women's Health Month, use code DRKELLY5. That's D, R, K, E, L, L, Y5 for an extra $5 off. If you are a clinician, you can visit hcp.solvewellness.com for patient education materials and samples.

[Dr. Kelly Casperson]

Online's a little trickier with testosterone because of the Olympic doping scandals of the 1980s. And that's why it's restricted. But we're working on that. We might have it de restricted by the end of the year. I don't know. I just want to call, like, I will die on this effing soapbox. Somebody said I would love real solutions, not just advocacy talk, girlfriend. Advocacy is real solutions. You not knowing what your body is doing, you not knowing this is hormones. You not knowing where the books are, you not knowing where the clinics are. Advocacy is the solution. And I will die on that. Soap opera sucks.

[Sarah Reardon]

Yeah, so what?

[Dr. Kelly Casperson]

What good does it do me to be like, everybody needs an estrogen patch? If you don't understand why, you don't understand what's happening. You don't understand where to get it. Like, I've been doing this so long, I understand why I have to lead with advocacy. And I don't come out of the gate being like, testosterone for everybody.

[Sarah Reardon]

Yeah, besides the fact I look kind

[Dr. Kelly Casperson]

of like a crazy person when I say that. Do I think everybody should be on hormones? I don't care because I. Because I am not living your life.

[Sarah Reardon]

But I'm so nuanced and I think people want like a Protocol.

[Dr. Kelly Casperson]

Yes.

[Sarah Reardon]

And it's not even on health and floor care. There's. There's nuance to everyone's case. And I don't think we should be like, if you have this, take this. It just. It doesn't work that way. Medicine is a practice, and I think

[Dr. Kelly Casperson]

that if you go online and somebody says, I have the one thing everybody needs to solve all your problems, you are being sold a billion bill of goods.

[Sarah Reardon]

Yeah. Can you, can you break down a little bit about questions about hormone? So let's start with. Because I think it's helpful to kind of understand if you Are you mentioned, like, some people take, you know, progesterone. It helps you fall asleep. Estrogen helps you stay asleep. Testosterone. Can you break down, like, what someone would use topical estrogen for versus systemic estrogen? Because I don't even think people realize those are two separate things. I'm kind of very much in the vulva, vaginal health before. I'm like, topical estrogen. I am topical estrogen for everybody. Like, that's a lot.

[Dr. Kelly Casperson]

I mean, truthfully, I am too, but I, I know enough how people are perceived when they come out saying, this is a black and white issue.

[Sarah Reardon]

Yeah.

[Dr. Kelly Casperson]

But to me, I'm like, listen, your ovaries make hormones. Your ovaries stop making hormones. Why wouldn't you put the hormones back? We do that with thyroid, we do that with insulin, we do that with everything else. It just makes sense. But if people don't know that, again, the majority of people don't know what menopause is. Right. So we have to go back to the basics. And for the people who do know what menopause is, fantastic. Share that with your friends, share that with your daughter, Share that with your doctor. Like, be part of the change. Because the pickle we're in is because we didn't have advocates and we didn't have people standing up for women. And it just, like, irritates me to no end when people. You see this a lot online, people are like, what's the right estrogen patch dose? What's the right testosterone lab?

[Sarah Reardon]

Oh, my gosh. It's so. It changes. So, I mean, you just can't say that either.

[Dr. Kelly Casperson]

You can't say that. It's not how it works.

[Sarah Reardon]

It's such a. But it's such a size.

[Dr. Kelly Casperson]

What's the right size jeans to buy?

[Sarah Reardon]

Like, I think of what it is. What it is, is it's a. It's a. It's a desperate seeking because we're not getting. We don't have answers. And so we're looking to an expert like you who's like, can somebody just guide me? You know, can you talk a little bit about the different hormones and what they can help with and like the different, I would say like maybe we'll just start with estrogen. Like what are the different methods of estrogen delivery and what might somebody benefit from? From them, from that?

[Dr. Kelly Casperson]

Tons of different options, like many. And here's a good tip for you. If you go to a doctor, nurse practitioner, pa, clinician and they say there's one way to get this, that's, that's not an expert, that's a one trick pony. Like I literally have printed out all the different ways to deliver estrogen to yourself and it's like multiple page document, right? So and it's not your job to know all that, but it is your job to know there's multiple options. Because if you see somebody who says there's one way to do things, that's not true. Let's talk about vaginal pelvic estrogen. What that means is it's incredibly low dose and it's only delivered to the tissues that are local. So it's called local estrogen, pelvic estrogen, local low dose estrogen, non systemic estrogen. All of that just means if I drew your blood, I couldn't tell you were on vaginal estrogen because it's not going into your bloodstream. So you can do creams, you can do pills, you can do rings, you can do estrogen, you can do dhea, you can do estrogen plus testosterone. Know that there's so many options, I tend to go towards the estrogen cream. Why? Number one, it is the cheapest damn thing that you can get. There's nothing cheaper. 13 plus shipping. Mark Cuban pharmacy. If your insurance wants you to pay over $60 for it, they're making money off of you. Transfer it to Mark Cuban Cost plus drugs and save yourself a bunch of cash. So I like it because it's cheap and I like the cream because I like targeting the vulva. And I think a lot of the low dose tabs, Invexi, Vagifem, they treat the vagina well, they may help reduce urinary tract infections, but they don't treat the vulva well. Again, vulva is the tissues towards the entrance of the vagina. Vagina is the inside tube you can't look at unless you have a speculum. Right? So I like treating the vulva because where is the majority of pain with sex with perimenopause and menopause and low hormones at the 6 o' clock entrance to the vulva. And if you put a piece of bird seed estrogen, meaning a small, small piece of estrogen way up here in the vagina, it's not helping the skin care. Yeah, I'm always like, I have an estrogen cream bias because I want the vulva treated. But I also know that some people think it's messy. Just use less than.

[Sarah Reardon]

Right.

[Dr. Kelly Casperson]

If you're putting it in before you go to bed and you're waking up in the morning and dunk, a whole bunch comes out. You're using too much, like, back it off. But I really like putting it all over the vulva and skin care because estrogen helps skin.

[Sarah Reardon]

Fame. And then what about. You mentioned dhea, Is that. Do you take that the same time as you take estrogen or is it. My understanding it's different. It's like a precursor to androgen. So when would you introduce, like, why would somebody say, oh, no, that I need dhea or you need DHEA and not estrogen or in addition to.

[Dr. Kelly Casperson]

Yep. So DHEA is a precursor hormone that makes both estrogens and androgens. And our vulva and our vagina, clitoris, etc has androgen and estrogen receptors. So sometimes people be like, I'm taking this vaginal estrogen like two to three times a week. I've been doing this for three months. Nothing's getting better. They need androgen.

[Sarah Reardon]

Right.

[Dr. Kelly Casperson]

Again, most people don't know that our ovaries make testosterone. When we say androgen, we mean testosterone. We don't call them testosterone receptors, we call them androgen receptors. Like, it's just annoying, but it's the exact same thing. So DHEA makes basically converts into testosterone and estrogen where it's applied. So there is a prescription product called Intro roa. It is an amazing product. The biggest problem with it is it's expensive and a lot of insurance doesn't cover it. I've been doing a lot of advocacy and trying to get that cheaper. It is more complicated and stories you wouldn't believe. So it's not, it's not happening right now. But follow me for more. I'm actually, I have a DHEA serum. I'll send this to you, Sarah. You can have it.

[Sarah Reardon]

Oh, great. So would you take. Oh, I'm. I love anything for the vulva. If you open my nightstand, somebody's like,

[Dr. Kelly Casperson]

whoa, this is not, this is not for sale. Yet. People in my clinic get this, this. It's not for sale yet, but it should be by the end of the year. But Sarah, I'll just.

[Sarah Reardon]

Oh, that's great to know. That's awesome. I heard that DHEA can be more beneficial for bladder health issues. Is that true or not true?

[Dr. Kelly Casperson]

I haven't seen the studies.

[Sarah Reardon]

Okay.

[Dr. Kelly Casperson]

To the studies that we have, they vaginal estrogen and DHEA are pretty comparable.

[Sarah Reardon]

Okay.

[Dr. Kelly Casperson]

A brand new study just came out basically saying comparable. However, DHEA is looking a little bit better on sexual function.

[Sarah Reardon]

Okay. Okay. That's good to know.

[Dr. Kelly Casperson]

Androgen receptors, right? It's just, it's.

[Sarah Reardon]

Yeah, that makes sense.

[Dr. Kelly Casperson]

It's giving you one more thing that the estrogen's not giving you.

[Sarah Reardon]

Okay.

[Dr. Kelly Casperson]

Is the testosterone part. But as far as specifically bladder leakage urgency, I haven't seen a head to head. The, the paper that just came out is like the first head to head DHEA estrad.

[Sarah Reardon]

Can you combine those or is it one or the other dhea?

[Dr. Kelly Casperson]

And again going back to like, just tell me. The solution is like not everybody needs everything and some people need a lot of androgens and some people. Yeah, like how perfect if we were just all Toyotas. Right? But, but we're not, so.

[Sarah Reardon]

That's funny. I'm about to get a new Toyota too, so. Good. Right, let's talk, let's talk about systemic estrogen. So this can be a patch, a pill, a gel. Can you talk about when someone would say we might need to talk about taking a blood test or not? But like when somebody's like should advocate for their dog to their doctor, like hey, I think I need X or can I try X if the doctor's not offering them. But, or is it something that like, hey, if you're experiencing these symptoms, these are things that correlate with low estrogen levels and you might want to investigate supplementation.

[Dr. Kelly Casperson]

So most pelvic issues are benefited by taking local vaginal estrogen or dhea. A lot of people are like I'm on the patch and it's not helping with my recurring UTIs. That's because it's not getting. I, I always say the pelvis is the last stop on the train. Right? So like if you do a systemic it, it doesn't always give enough to the pelvis. Remember hormones that you take systemically. And what systemic means is if I draw your blood level, I can tell you're on this stuff. It's a high enough dose that it's in your blood.

[Sarah Reardon]

Right.

[Dr. Kelly Casperson]

That's what systemic. Systemic means full body.

[Sarah Reardon]

Right.

[Dr. Kelly Casperson]

So and to compare Systemic from vaginal.

[Sarah Reardon]

Right?

[Dr. Kelly Casperson]

You can be on both. Because remember, vaginal doesn't increase your blood levels. What's X plus 0?

[Sarah Reardon]

X?

[Dr. Kelly Casperson]

Simple math equation. You can be on both. So but I see that a lot where doctor. A doctor or a pharmacist. The pharmacists are like, you can't be on both. Yes you can. X zero equals X. So math equation. So you can do patches, you can do pills, you can do injections, you can do. There's actually a V. Just to complicate the world. There's a vaginal ring that's systemic estrogen. It's called the fem ring, as opposed to the estring, which is local vaginal estrogen. So, and that's not to be complicated, it's to remind you there's a lot of different ways to skin a cat. Some people love the patches, some people need the cheapest freaking option out there. That's going to be an oral estradiol.

[Sarah Reardon]

Right?

[Dr. Kelly Casperson]

And I want to address, just because I saw it in the comments, what does bioidentical mean? Bioidentical means it's what your ovaries made. Thyroid is bioidentical. Insulin's bioidentical. It's what your pancreas makes. It's what your thyroid makes. There are many FDA approved products that your insurance covers that are bioidentical. So people will confuse bioidentical with compounded or more natural or whatever. All it means is this is what your ovary made. Contrast that to birth control pills. Birth control pills are not bioidentical. Does that mean they're bad? No, birth control pills are great. They help with lots of things. They're just not what your body naturally makes. Right. So don't get confused about what all these terms mean in that you know, you need to pay more for them or that the, the non bioidentical are deadly. Like, no, high blood pressure medications aren't bioidentical.

[Sarah Reardon]

Right.

[Dr. Kelly Casperson]

Like, yeah, it's just.

[Sarah Reardon]

So what you're saying is either is fine, either can be fine. It doesn't have to be a bioidentical.

[Dr. Kelly Casperson]

There's pros and cons of all evidence.

[Sarah Reardon]

Okay.

[Dr. Kelly Casperson]

And that, and that's the discussion to have with your doctor. But don't be swayed by some online situation saying there's one best way for everybody. There is not.

[Sarah Reardon]

Okay, so that's estrogen. And so let's talk about progesterone and progesterone. No, no, I meant estrogen with your world, like when your kind of Explanation of the different ways to have it delivered to your body. And what are some of the symptoms that somebody could have that are like low estrogen symptoms? Like is it like I, like, obviously I follow all the stuff like joint pain and low libido or skin changes. Like what are the things that like

[Dr. Kelly Casperson]

this is like a, in perimenopause. Moods, Mood, not feeling like bad mood

[Sarah Reardon]

or like mood swing or not feeling like myself. Okay.

[Dr. Kelly Casperson]

NFLM. It's very well studied. 46% of perimenopause. NFLM not feeling like myself. Why? Because hormones work in the brain.

[Sarah Reardon]

Yeah, Right.

[Dr. Kelly Casperson]

And so when the hormones change, the brain changes. So mood, sleep, blood pressure can go up, cholesterol can go up, insulin can go up, joint aches and pains, frozen shoulder.

[Sarah Reardon]

Yeah, I see that a lot. And brain fog, you know. And then what about testosterone? Can you talk about the delivery of testosterone, how somebody would get that delivered and what would be indications that somebody might need that?

[Dr. Kelly Casperson]

Yeah, so we don't usually and explain

[Sarah Reardon]

kind of the situation with testosterone because I think people do not know like the, there's so much kind of red tape behind the scenes of why this is. People have a hard time getting it prescribed or we don't have kind of a, kind of systematic approaches to like

[Dr. Kelly Casperson]

how it's the simple answer is it's gender bias. Like just this gender bias is the simple answer to why this is going on. Ovaries make testosterone and we have zero FDA approved products.

[Sarah Reardon]

Sex

[Dr. Kelly Casperson]

worrisomely, we might get it approved for low libido. I, I, I'm happy just to get anything approved, but it's a big problem if it's low libido because low libido is a symptom of low testosterone. But insurance tends to not cover sexual health things. Doctors tend to not be able to talk about sexual health things. Well, and women will still get big biases to say it's only for libido. And how do I know this? Yes, because in Australia it's approved for low libido. And what do women get told in Australia? That you don't get testosterone because you're not married. So believe me, what I say, we don't want this approved for low libido. I'm happy to get it. I, I'm happy to get an FDA approved female product. We need one. Because I want insurance product coverage. I want this to be normalized for people. But people don't, it's shocking that people don't understand why it being for a sexual health indication is actually like the worst thing it could be indicated for

[Sarah Reardon]

and it's what would some of the things it be indicated for?

[Dr. Kelly Casperson]

Low testosterone.

[Sarah Reardon]

Right. What were like, like symptoms with it? Is it energy, is it hair loss? Like what are the, some of the things that people like? Oh, this could be a low testosterone

[Dr. Kelly Casperson]

mood, lean body mass, bone health, cognition, brain fog.

[Sarah Reardon]

Are doctors doing blood testing to see what you need to do? Or is it kind of more symptom based, do you think? Or like what's your, what do you do in your clinic? What's your kind of recommendation?

[Dr. Kelly Casperson]

I always get baseline labs. I like to know where you started from.

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[Dr. Kelly Casperson]

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[Dr. Kelly Casperson]

Yeah, I like to know that you're absorbing the product I so I can recheck the lab, make sure you're absorbing the product. I like to know that it doesn't get too high. So I think labs are in the testosterone guidelines for women. They say check baseline testosterone, check it again six to eight weeks after you start it. Okay. And I think not to overgeneralize, but I think a lot of menopause specialists are starting to get baseline estradiols. That said, if you're 65 and you haven't had a period in 15 years, I know what your hormones are. By and large, they're zero. Right? You're, you don't need a lab. And, and in the same sense in perimenopause, your labs can be all over the place. Specifically, yeah. And if you get your labs checked that women will have that used against them to be like, see, you have estrogen, but remember, it's the fluctuation in hormone that causes the symptoms, not the lab value on a Tuesday.

[Sarah Reardon]

Right.

[Dr. Kelly Casperson]

So I never like it when labs are used against women to withhold care. You in a perfect world, you're going to work with a trained clinician who knows how to interpret labs.

[Sarah Reardon]

Yeah, I do feel lucky. I have that in New Orleans where she was like, let's do some basins. I was like, yeah.

[Dr. Kelly Casperson]

You know, and remember in most states you can just go to a quest labs and check any labs you want. Like the people still think you need a doctor to access labs of like, no, you want.

[Sarah Reardon]

Really? I didn't know that. I always thought you had to have an order.

[Dr. Kelly Casperson]

It depends upon states, I think. I think New York's actually pretty strict. But no, there's entire online websites that are valued at billion dollar companies whose only job is to get you laptop labs.

[Sarah Reardon]

Like, interesting.

[Dr. Kelly Casperson]

You don't need a doctor. You might want, you might want a doctor to help you interpret them.

[Sarah Reardon]

Right. And then like, what's the next step after that? Yeah. And then what about. I have one more question about hormones and I kind of want to go into some lifestyle stuff. What. How long should people stay on these? Like if you kind of start your or two questions. If you start some hormone therapy during per menopause, you stay on it post menopause, how long would somebody stay on them? I know. Is it like forever? Like with topical estrogen, I'm like, it's forever, you know, so at least my thought. But how long would somebody stay on these? Is it just till they're like kind of over a hump or what does that look like, that journey.

[Dr. Kelly Casperson]

Let's answer your question with again, understanding what's happening with the body. If you're on hormones and all of your symptoms are managed well and you're as happy as a clam, what happens when you stop your hormones?

[Sarah Reardon]

Hormones changes. Yeah.

[Dr. Kelly Casperson]

Goes back to zero hormones. Right. So I, I always like get people thinking about that to be like, if you stop, it'll go back to how it was. The recurrent urinary tract infections will come back, hot flashes tend to come back, bone loss will tend to come back. All of that stuff. And, and now you know that. So now you can say, how long would you like to keep taking these? And most people will say, you can bury me six feet under with them. And the data supports women taking hormones as long as the benefit outweighs the risks, that's in the guidelines. Use the guidelines to your benefit. We have 20, 22 menopause guidelines. Print them out, bring them to your doctor. As long as benefits outweigh risks, you can continue on your hormones. Again, going back to the you're too young or too old in the doctor's office, there is no too. I just saw a patient this morning, she was 8.

[Sarah Reardon]

8.

[Dr. Kelly Casperson]

She's 82. She's been on hormones. She each through the WHI. Amazingly enough, she's been on hormones for over 30 years. She moved here, got a new primary care doctor. And the primary care doctor says, you're old enough now. And I'm like, dude, I will tell because I've seen it happen. You know how the body will deteriorate at 82 if you stop somebody's hormones? Like it's real.

[Sarah Reardon]

Yeah.

[Dr. Kelly Casperson]

And she's like, I'm like, dude, you got through 30 years on this stuff and now some Joe Schmo who doesn't know the guidelines is gonna rip you off your hormones.

[Sarah Reardon]

Like, yeah, that's scary. That's scary.

[Dr. Kelly Casperson]

It's concerning.

[Sarah Reardon]

Is it ever too late? Like if say folks are tuning in and they're 60, 65, would you be like, no, you're kind of past it. Like just. Or is it ever too late?

[Dr. Kelly Casperson]

Never too late for vaginal hormones.

[Sarah Reardon]

Okay.

[Dr. Kelly Casperson]

Never too late. Get your 98 year old grandma with recurrent UTIs on these things. As far as systemic goes risk benefit discussion. What do you want them for? What's the safest route for you? But again, if somebody tells you that you're too old, that's gender bias.

[Sarah Reardon]

And then my. When people say like when I go to a doctor and they tell me that like you don't need pelvic floor therapy, just like deal with it. And I'm like, well then you find a new doctor. Would you say that? That's what I think in the situation, like, and it's, it's like, I know it's easy to say and I don't mean to be glib, but I'm like, if you're going to somebody who's. It's very apparent that they're not going to be best for what you need help with. Like you can find somebody else. You might have to do the work to do it, you know. But as you said, with a lot of these online platforms now, there, there are options in every state.

[Dr. Kelly Casperson]

Yep.

[Sarah Reardon]

So a lot of questions came in and this is interesting. So I'm sure, you get this a lot, but. And there's so much. And so I kind of asked this so that you can help, like, you know, make this as clear as mud for us. But so many supplements are recommended. Gut health is something that gets talked about a lot. Is there any connection that you know of about, like, gut health and perimenopause or menopausal symptoms?

[Dr. Kelly Casperson]

Yeah. So gut health. Gut health is moving fast. Even five years ago, people were like, that's not real. And now we're like, yeah, it's real. When you lose your ovarian hormones, your gut microbiome changes to that of a man's. Now, I don't mean that to sound weird or scary. I just mean it to say we've got multiple papers showing women on systemic hormones after menopause have a lower rate of colon cancer, likely because the. The healthier colon, healthier microbiome. Just like we're talking about estrogen in the vagina. Right. Estrogen in the gut. So the gut's very, very real. Simple stuff that people can do is like, if you have any gut issues, if you have any depression, if you have any anxiety, you better not be pouring any alcohol down your throat. Like, knock it off. Stop looking for the magic supplement on the Internet. Stop the alcohol. Alcohol is horrible for gut microbiome. It's horrible for depression and anxiety and. And it's such low hanging fruit. Right. 70% of women drink, you know, so when everybody's looking for like the magic cure, and I'm like, put down.

[Sarah Reardon]

Interesting. I thought you were going to take coffee and then I was gonna have to panic. But no alcohol. I can do, like, zoom this. You're gonna be coffee. I'm like, oh, my gosh. Like, ah, this might just deal with it.

[Dr. Kelly Casperson]

Every time a study comes out, they're like, like, eight cups of coffee makes people live forever. I'm like, great, yes, we're all gonna be fine. No.

[Sarah Reardon]

Okay, so alcohol, yeah, it's horrible for

[Dr. Kelly Casperson]

the brain if you have brain fog. If you are starting to forget things like, do not be putting alcohol down your body. It is absolutely a neurotoxin. And, you know, everybody gets so pedantic about it. They're like, what about that one time on the 4th of July when I want to. I'm like, like, fine, do it. But yeah, every week. It's not good for you.

[Sarah Reardon]

Or every day. I mean, people have a glass of wine every day, you know? Yeah.

[Dr. Kelly Casperson]

And then they're like, I can't lose these last ten pounds. And I'm like, you could stop.

[Sarah Reardon]

Yeah. And then what are your thoughts on exercise for this journey? I mean, I have my own personal thoughts, but I want to know what your recommendation.

[Dr. Kelly Casperson]

Only exercise on the days you want to take care of your body.

[Sarah Reardon]

Okay. I mean, to me it is the biggest switch of a flip that you can make.

[Dr. Kelly Casperson]

There's nothing better.

[Sarah Reardon]

There's nothing better for brain.

[Dr. Kelly Casperson]

I am like the biggest hormone proponent out there, me and all my friends. And I'm still like, nothing. No hormone does what, what exercise does. And sometimes getting on hormones actually gives you enough energy and sleep so you can exercise.

[Sarah Reardon]

Okay.

[Dr. Kelly Casperson]

So I again, what. I don't like it when people are, when they use things against women. So when they're like, well, first you need to start exercising and then we'll get you on your heart. No, don't do all the things. Right. Do all the. But there is nothing that does what exercise does.

[Sarah Reardon]

No, I agree with you. And I even see this with GLP1 that I have patients who just couldn't. They were just not exercising regularly and now that they are on them and have some significant weight loss, like they're regulars in the gym, like it just gave them this kind of boost of energy and confidence to go to the gym and start moving. And so I think that it's, and it's, it's great to kind of know that. I think the biggest thing too that I'm hearing from you is like this is a puzzle that we have to find the pieces that we put together. It's not going to be one thing or not. Somebody just asked a question about the use of cannabis for mood regulation and physical relief from symptoms or cramping.

[Dr. Kelly Casperson]

Yeah. Not, it's, it's not my favorite thing. It's a mood altering substance. Now when we're talking about local, you know, CBD cream, stuff like that, versus you're affecting your brain cells and your lungs.

[Sarah Reardon]

Right. Yeah.

[Dr. Kelly Casperson]

So there's a big, there's a big range of products that people use, but by and large, I don't think, I don't think it's a value add for most people. That said, when pain control. There is some very, very promising things there, but I wouldn't.

[Sarah Reardon]

Okay.

[Dr. Kelly Casperson]

I wouldn't be smoking it.

[Sarah Reardon]

It. Okay.

[Dr. Kelly Casperson]

That's long health. Right?

[Sarah Reardon]

Okay. Okay.

[Dr. Kelly Casperson]

I, I think a lot of, a lot of people use health reasons to justify their unhealthy habits.

[Sarah Reardon]

Oh yeah. And then somebody just asked and I think this is a good one to clarify.

[Dr. Kelly Casperson]

Let me just go, let me just elaborate. On that. The amount I pride myself, the amount of people I've gotten off of THC gummies for sleep by getting them on the correct hormones that their body naturally makes. And th. Just so people know. THC gummies for sleep. Sleep doctors hate that. It's not natural.

[Sarah Reardon]

Yeah.

[Dr. Kelly Casperson]

And there might be an association with dementia. So these things are not benign. Just know what you're playing with if you're going to play with them. But I take great pride in every time a woman comes in and she's like, I don't need to use my THC gummies to sleep anymore.

[Sarah Reardon]

Yeah.

[Dr. Kelly Casperson]

Because they're not good for your brain.

[Sarah Reardon]

Yeah. Okay. This is good for us to kind of hear because I think, again, this is. These are all kind of a result of people grasping for straws because we don't know how to navigate the current systems because we haven't been given the support. We're here for education and information. And I really look at it as a result of that. It's like, we don't want to, like, be drinking wine every night. We're just super stressed and anxious and not sleeping great. So it's like, what do we do? You know? Two quick questions before you have to go. So somebody said, if we're having all the perimenopause symptoms and using progesterone cream, we could also benefit from vaginal estradiol. Can you answer that? Which. I know the answer, but say that again. If you're using progesterone cream, is using vaginal estradiol, would that also be beneficial if you're in perimenopause?

[Dr. Kelly Casperson]

Yeah. Two separate. Completely separate things.

[Sarah Reardon]

Yeah.

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[Sarah Reardon]

Yeah.

[Dr. Kelly Casperson]

So you know progesterone cream off the Internet is like an incredibly low dose and can never be used for uterine protection if you're on systemic estrogen because it's very, very low dose. Does it help some people with symptoms? Yes, absolutely. Because you'll get like a very black and white. Like, don't use the progesterone cream because they can be very helpful for sleep. But if you take systemic estrogen, not vaginal systemic estrogen, you must also take a progestin or progesterone if you have a uterus. And the progesterone creams don't count.

[Sarah Reardon]

Okay.

[Dr. Kelly Casperson]

They're just not high enough dose.

[Sarah Reardon]

Can you take progesterone orally, like systemically and not take estrogen?

[Dr. Kelly Casperson]

Yep.

[Sarah Reardon]

Yep. Okay.

[Dr. Kelly Casperson]

And you can take systemic estrogen without progesterone if you don't have a uterus,

[Sarah Reardon]

if you've had a hysterectomy, you've had a history. Total hysterectomy. Or like ovaries also or just uterus gone.

[Dr. Kelly Casperson]

Ovaries are irrelevant in this conversation.

[Sarah Reardon]

Okay. Because they are just not doing anything anyway.

[Dr. Kelly Casperson]

Uterine lining needs both.

[Sarah Reardon]

Okay.

[Dr. Kelly Casperson]

You're going to be on estrogen. And that's all in my book. Like, you guys read the. Read the books.

[Sarah Reardon]

Will you show the COVID again so that people can. And we'll link this in your. Put it in front of your face, Dr. Casperson. So it. That's it right there.

[Dr. Kelly Casperson]

You know, the pro tip. There you go.

[Sarah Reardon]

Well, I know that you.

[Dr. Kelly Casperson]

It's a good read. It's. It's written with facts, but in a very digestible way. Just like.

[Sarah Reardon]

And I think. Thank you. Well, I think more than anything, folks came here and they're like, but what next? And I think that you're saying that this is an individualized process. There is no one size fits all getting information and education like they can get in your book. And I also would recommend y' all to listen to her podcast because I think it just really helps people feel seen and Brings in experts from all different kind of walks and your own kind of expertise. As to folks, it doesn't. It just kind of helps things feel a little bit more clear. Like, hey, there is no one size fits all. But there is a path for you to move forward and a lot of it starts with finding the right providers and having the right information. So I want to thank you for coming on. I want to thank all of you for attending. This is one of our highest attendant. I think, again, it's a testament to how much we want and need this information, especially what you're offering. For everyone who is here, make sure to check your email because we'll be sending you a special access to the Beehive. My app, which has a specific perimenopause program, talks all about specifically pelvic floor changes during this process and gives you exercises to help with pelvic floor weakness, which can really occur during the season of life. And then, Dr. Casperson, can you again, just let everybody know where to find you online on social media, your website, your podcast, and your book?

[Dr. Kelly Casperson (Podcast Intro/Outro Voice)]

Yes.

[Dr. Kelly Casperson]

Thank you. So website is kellycasperson md.com email list is the best thing to be on to find out when you can get the dhea because. Because it's going to come on the market later this year. I'm very excited about it. Podcast is called you are not Broken. The first book is called you are not Broken. And then Instagram is where I like to hang out at. Kelly Casperson, MD.

[Sarah Reardon]

Okay, and then really quickly, will you just show everybody your 3D model of the vulva that you. I want to make sure everybody sees it.

[Dr. Kelly Casperson]

We're talking about like 3D printed vulva, and we like estrogen cream all around. This is labia minora. This is clitoris, vaginal entrance. And then. But this is where the pain with sex comes when the hormones go down and the estrogen gets low. So that's why I like cream. Estrogen cream, DHEA serum on here. And then the other cool thing about this 3D printed vulva is that this is the clitoris. So people think that the clitoris is just this teeny little head up at the top. This is a very sensitive part. This is the tip of the penis in males. This is the tip of the clitoris in women, but it actually wraps around the vagina and we get erections just like penises get erections. So these are. This is an erect clitoris right now. See, it's kind of full and just like the corpora of the penis. And if you don't engorge your clitoris. You have much less pleasure. Right. So arousal, Arousal. Arousal is. We. I. I think we don't say female erection enough. I think we should, because that's where pleasure with sex comes from. So realize that that's why the vulva is so amazing. Dude, Sarah, we didn't talk about my vibrator.

[Sarah Reardon]

Oh, yeah. Do you have a second?

[Dr. Kelly Casperson]

Because it's sold out, but if you go to Elixir play, I have a vibrator. It is called the Explorer. It's for the vulva. It's sold out through. It should be coming up. Back mid April, Oprah Daily did a did a bit on it and sold

[Sarah Reardon]

us out for a good. But I tell people this all the time. You need blood flow to these muscles and tissues to keep them. Yeah. So this is a great. And like, don't be careful that vulva

[Dr. Kelly Casperson]

vibrator for pelvic floor, pain, for arousal, for vaginal, for anybody who can't penetrate or it hurts to penetrate. There's some big, painful vibrators on the market. Do not buy those things.

[Sarah Reardon]

Okay. They're asking you to come back to talk about orgasm. So maybe I'll hit you up for the second half of the day.

[Dr. Kelly Casperson]

We didn't even talk about orgasm. That's okay. Basics. And yeah, it's like you can't talk about

[Sarah Reardon]

all of this hormones.

[Dr. Kelly Casperson]

Right?

[Sarah Reardon]

Yeah. No. Thank you so much. I think that this is just so helpful just to have somebody with the expertise that you have and who's so knowledgeable and really great at explaining this to folks in a very kind of clear way and for the advocacy work you do. I think everybody's seeing the results of the hard work that you have done for years and years and years and not even understanding, like, everything that it has taken to get to this point. And we still have a very long way to go. So thank you so much, Dr. Caspersen. I love every time we get to collaborate and chat. And please, everybody, make sure that I'm going to send out all your links to her book and her Instagram and website in our newsletter that you'll be getting. And please, everybody, you know, keep coming to these live Q and A's because they're a great way to kind of talk with different pelvic health and women's health professionals who can get you the answers that you need. So thank you, Dr. Casperson, so much. We appreciate you.

[Dr. Kelly Casperson]

Thank you. Till next time.

[Sarah Reardon]

Bye. Thanks. Bye, everyone.

[Dr. Kelly Casperson (Podcast Intro/Outro Voice)]

If you found this episode funny, helpful, insightful, please take a moment to follow, rate and share the you are Not Broken podcast with someone who might need this conversation too. That support is how this information reaches more people. And thank you. For courses, books and my monthly membership and the Caspersen clinic information, visit KellyCaspersonMD.com this podcast and all content from Dr. Kelly Casperson is intended for educational and informational purposes only, and this is not a substitute for individual medical coaching or psychological advice, diagnosis or treatment. Always seek the guidance of your qualified healthcare professional with any questions you may have regarding your health. Never disregard or delay medical advice because of something you've heard on this or other podcasts. Thanks for being here. And remember, you are not broken.