← You Are Not Broken
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- [00:00]
Dr. Kelly Casperson
Hey everybody, welcome back to the you
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Podcast Host
are Not Broken podcast. Today is a cool episode because it
- [00:05]
Dr. Kelly Casperson
was a Q and A I actually
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Podcast Host
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 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.
- [01:16]
Dr. Kelly Casperson
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.
- [01:29]
Enjoy the show.
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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&As in the past. She's KellyCasperson 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.
- [03:47]
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 hyper focus 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. And it seven years old now. Sarah was on it this year for Floor, 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?
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Podcast Host
We.
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Dr. Kelly Casperson
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.
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Sarah Reardon
The.
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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.
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The.
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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 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 vaginal estrogen and all this. And on, you know, on the Sydney Opera House stage talking to lay people 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. And, and this is my lane. And I, 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. I didn't know me. Now you know.
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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. Clear. 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.
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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.
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Right.
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We hear that a lot. There's no over. There's no over you outliving your ovaries.
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Sarah Reardon
Right.
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Dr. Kelly Casperson
But the.
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Advertisement Voice
The.
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Dr. Kelly Casperson
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, 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 and 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.
- [14:32]
Sarah Reardon
Yeah, everything you're saying, I'm like, yeah, that'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 health care. So from a pelvic floor and sexual health perspective, what would you say some of the signs of per menopause would be? Whether how? 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 me.
- [15:24]
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- [15:54]
Dr. Kelly Casperson
Yeah, great question. So let's back up a second because people don't. If you don't understand the basics, it makes no sense that your bladder doing something is a sign of hormones. 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 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, 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.
- [18:26]
Sarah Reardon
It's.
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Dr. Kelly Casperson
This is not a mystery. So stop act acting as if, like this is some magical thing we haven't figured out yet.
- [18:34]
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. Right.
- [18:48]
Dr. Kelly Casperson
Yeah, it is a third of your day. Yeah.
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Sarah Reardon
The.
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Dr. Kelly Casperson
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 it. I'm sleeping like this and then all of a sudden my sleep is more light?
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Sarah Reardon
Right.
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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 up?
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Sarah Reardon
Yeah. Right.
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Dr. Kelly Casperson
Because, you know, if you're like, oh, no, my cat jumped on me, and I was awake anyways, Right. 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.
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Sarah Reardon
And I love that because I think often people are just waking up and they're like, oh, mine as well, to scope, you know, and we start to kind of see that.
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Dr. Kelly Casperson
What do you say to that, Sarah,
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Sarah Reardon
about whether they wake up and just have to go pee? Yeah, 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?
- [21:04]
Dr. Kelly Casperson
Yeah, it can all blur together. My favorite word to say is Perry. Postpartum pause.
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Sarah Reardon
Oh,
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Dr. Kelly Casperson
I know you'd have something for that word. 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.
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Sarah Reardon
Boom.
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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.
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Sarah Reardon
And I think.
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Dr. Kelly Casperson
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?
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Sarah Reardon
Is it.
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Dr. Kelly Casperson
Is it I'm breastfeeding and I have no sleep, or is it perimenopause? Who the f cares?
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Sarah Reardon
I know.
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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 for. How the hell are you gonna figure that out first? We don't know.
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Sarah Reardon
Right?
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Dr. Kelly Casperson
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.
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Sarah Reardon
I'm like, no, we're gonna find the root cause of what's happening and just treat that. Like, we're gonna. I know I always say that.
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Dr. Kelly Casperson
So, like, women spend so much time spinning their wheels trying to figure it out and like, dude, we're. We've got you. We've got you. We will help you.
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Sarah Reardon
Yeah.
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Dr. Kelly Casperson
Because I think it's. I think it's wasted time, frankly.
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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. Find.
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Dr. Kelly Casperson
Find familiar friends.
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Sarah Reardon
Yeah.
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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, do you think?
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Sarah Reardon
Yeah. What are your solutions?
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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.
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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?
- [25:49]
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. 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. I just really 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 get trained 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 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 people who told you no three or four years ago might not tell you no now. And this really does change because women are becoming advocates.
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Sarah Reardon
Yeah.
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Dr. Kelly Casperson
So knowing how to advocate.
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Sarah Reardon
Bring in the book.
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Dr. Kelly Casperson
Bring my book in.
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Sarah Reardon
Yeah. I would say that, doctor.
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Dr. Kelly Casperson
Right.
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Sarah Reardon
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 yeah. Pts know, like, we're the dot.
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Podcast Host
The.
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Sarah Reardon
The. The specialist in this area that are like, okay, that doctor that. That ob GYN you're seeing 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. From, like, you need topical estrogen, go see so and so, you know, so
- [27:49]
Dr. Kelly Casperson
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.
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Sarah Reardon
Great.
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Dr. Kelly Casperson
We've got online now. 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. Are. Advocacy is the solution. And I will die on that soapbox.
- [28:46]
Sarah Reardon
Yeah.
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Dr. Kelly Casperson
What 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.
- [29:06]
Sarah Reardon
Yeah. Yeah.
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Dr. Kelly Casperson
The fact that I look kind 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.
- [29:18]
Sarah Reardon
But I can so nuanced. I think people want, like, a protocol.
- [29:22]
Dr. Kelly Casperson
Yes.
- [29:22]
Sarah Reardon
And it's not even on 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 that if you go
- [29:35]
Dr. Kelly Casperson
online and somebody says, I have the one thing everybody needs to solve all your problems, you are being sold a bill of goods.
- [29:42]
Sarah Reardon
Yeah. Can you. Can you break down a little bit about questions about hormones? 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 vulvar veg vaginal health piece where I'm like, topical estrogen. I am topical estrogen for everybody. Like, that's it. A lot.
- [30:13]
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.
- [30:22]
Sarah Reardon
Yeah.
- [30:23]
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?
- [31:14]
Sarah Reardon
Oh my gosh, it's so, it changes so mommy, you just can't say that either.
- [31:18]
Dr. Kelly Casperson
You can't say that. It's not how it works.
- [31:20]
Sarah Reardon
It's such a, but it's such a size.
- [31:22]
Dr. Kelly Casperson
What's the right size jeans to buy?
- [31:26]
Sarah Reardon
Like, I think 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?
- [31:53]
Dr. Kelly Casperson
Tons of different options. Like many. And, and here's a good tip for you. If you go to a doctor, a nurse practitioner, Penns 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, 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. Thirteen 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.
- [33:21]
Sarah Reardon
Cash.
- [33:22]
Dr. Kelly Casperson
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 whereas the majority of pain with sex, with perimenopause and menopause and low hormones, it's 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, 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.
- [34:17]
Sarah Reardon
Right.
- [34:17]
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.
- [34:34]
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.
- [34:52]
Dr. Kelly Casperson
Yep. So DHEA is a precursor hormone that makes both estrogens and androgens. And our vulva and our vagina, clitoris, et cetera, 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.
- [35:14]
Sarah Reardon
Right.
- [35:14]
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 Rosa. 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.
- [36:02]
Sarah Reardon
Oh, great. So would you take. Oh, I'm. I love anything for the Volvo. If you open my nightstand, somebody's like,
- [36:09]
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.
- [36:16]
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?
- [36:25]
Dr. Kelly Casperson
I haven't seen the studies.
- [36:27]
Sarah Reardon
Okay.
- [36:28]
Dr. Kelly Casperson
To the studies that we have. They. Vaginal estrogen and DHEA are pretty comparable.
- [36:34]
Sarah Reardon
Okay.
- [36:35]
Dr. Kelly Casperson
A brand new study just came out basically saying comparable. However, DHEA is looking a little bit better on sexual function.
- [36:44]
Sarah Reardon
Okay. Okay.
- [36:45]
Dr. Kelly Casperson
That's good to know androgen receptors, right?
- [36:47]
Sarah Reardon
It's just, it's. Yeah, that makes sense.
- [36:49]
Dr. Kelly Casperson
It's giving you one more thing that the estrogen's not giving you.
- [36:52]
Sarah Reardon
Okay, is the testosterone part.
- [36:55]
Dr. Kelly Casperson
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 estradiol.
- [37:06]
Sarah Reardon
Can you combine those or is it one or the other?
- [37:09]
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.
- [37:22]
Podcast Host
Right?
- [37:22]
Sarah Reardon
But.
- [37:23]
Dr. Kelly Casperson
But we're not. So that's funny.
- [37:25]
Sarah Reardon
I'm about to get a new Toyota too. So. Good. Right?
- [37:29]
Dr. Kelly Casperson
Let's talk.
- [37:30]
Sarah Reardon
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.
- [38:00]
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 always say the pelvis is the last stop on the train, right? So, like, if you do a systemic, 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, it's in your blood, right? That's what's systemic. Systemic means full body, right? So, and to compare systemic from vaginal, right? You can be on both because remember, vaginal doesn't increase your blood levels. What's x plus 0x? 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 0 equals x. It's a math equation 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, Right? 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.
- [40:24]
Sarah Reardon
Right.
- [40:25]
Dr. Kelly Casperson
Like, yeah, it's just.
- [40:26]
Sarah Reardon
So what you're saying is either is fine, either can be fine. It doesn't have to be a bioidentical.
- [40:31]
Dr. Kelly Casperson
There's pros and cons of all.
- [40:32]
Sarah Reardon
Okay.
- [40:33]
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.
- [40:44]
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
- [41:13]
Dr. Kelly Casperson
this is like a, in perimenopause. Mood.
- [41:17]
Sarah Reardon
Mood. Not feeling like bad mood or like
- [41:20]
Dr. Kelly Casperson
mood swing or not feeling like myself.
- [41:23]
Sarah Reardon
Okay.
- [41:23]
Dr. Kelly Casperson
NFLM. It's very well studied. 46% of perimenopause. NFLM. Not feeling like myself. Why? Because hormones work in the brain.
- [41:35]
Sarah Reardon
Yeah, right.
- [41:36]
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.
- [41:49]
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?
- [42:03]
Dr. Kelly Casperson
Yeah, so we don't use them and
- [42:07]
Sarah Reardon
explain 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 how it's.
- [42:23]
Dr. Kelly Casperson
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.
- [42:34]
Podcast Host
Sex
- [42:36]
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. And it's.
- [43:33]
Sarah Reardon
What would some of the things it be indicated for?
- [43:35]
Dr. Kelly Casperson
Low testosterone. Right.
- [43:38]
Sarah Reardon
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
- [43:45]
Dr. Kelly Casperson
mood, lean body mass, bone health, cognition, brain fog.
- [43:54]
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?
- [44:03]
Dr. Kelly Casperson
I always get baseline labs. I like to know where you started from. 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.
- [44:29]
Sarah Reardon
Okay.
- [44:30]
Dr. Kelly Casperson
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.
- [44:45]
Sarah Reardon
Right.
- [44:46]
Dr. Kelly Casperson
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. 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.
- [45:12]
Sarah Reardon
Right.
- [45:12]
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.
- [45:22]
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, you know, and
- [45:29]
Dr. Kelly Casperson
remember in most states you can just go to a quest labs and check any labs you want. Like, like the people still think you need a doctor to access labs of like, no, you want.
- [45:39]
Sarah Reardon
Really? I didn't know that. I always thought you had to have an order.
- [45:42]
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 labs.
- [45:54]
Sarah Reardon
Like, interesting.
- [45:55]
Dr. Kelly Casperson
You don't need a doctor. You might want. You might want a doctor to help you interpret them.
- [45:59]
Sarah Reardon
Right? And then like, what's the next step after that? And then what about. I have one more question about hormones and I kind of want to go into some lifestyle stuff.
- [46:09]
Dr. Kelly Casperson
What.
- [46:10]
Sarah Reardon
How long should people stay on these? Like if you kind of start your or two questions. If you start some hormone therapy during perimenopause, 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?
- [46:37]
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?
- [46:48]
Sarah Reardon
Changes. Yeah.
- [46:49]
Dr. Kelly Casperson
Goes back to zero hormones. Right. So I always like get people thinking about that to be like, yeah, 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 now you know that. So now you can say, how long would you like to keep taking these? 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 risk. 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 two. I just saw a patient this morning. She was. 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.
- [48:04]
Sarah Reardon
Yeah.
- [48:05]
Dr. Kelly Casperson
And she's like, I'm like, dude, you got it through 30 years on this stuff and now some Joe Schmo who doesn't know the guidelines is gonna rip you off your hormones.
- [48:13]
Sarah Reardon
Like, yeah, that's scary. That's scary.
- [48:17]
Dr. Kelly Casperson
It's concerning.
- [48:19]
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?
- [48:27]
Dr. Kelly Casperson
Never too late for vaginal hormones.
- [48:29]
Sarah Reardon
Okay.
- [48:30]
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.
- [48:47]
Sarah Reardon
And then my. When people say like, what if 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 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.
- [49:21]
Dr. Kelly Casperson
Yep.
- [49:23]
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?
- [49:48]
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 healthier colon, healthier microbiome. Just like we're talking about estrogen in the vagina.
- [50:25]
Podcast Host
Right.
- [50:26]
Dr. Kelly Casperson
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.
- [50:59]
Sarah Reardon
Interesting. I thought you were gonna say coffee, and then I was gonna have to panic, but no alcohol I can do.
- [51:04]
Dr. Kelly Casperson
You're like, zoom, this.
- [51:06]
Sarah Reardon
You're gonna be coffee. I'm like, oh, my gosh. Like, ah, this might just deal with it.
- [51:10]
Dr. Kelly Casperson
Every time a study comes out, they're like, eight cups of coffee makes people live forever. I'm like, great, yes. We're all gonna be fine. No.
- [51:20]
Sarah Reardon
Okay, so alcohol is a big one. Yeah.
- [51:22]
Dr. Kelly Casperson
It's horrible for 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, fine, do it. But, yeah, every week. It's not good for you.
- [51:44]
Sarah Reardon
Or every day. I mean, people have a glass of wine every day, you know? Yeah.
- [51:48]
Dr. Kelly Casperson
And then I think.
- [51:48]
And then they're like, I can't lose these last ten pounds. And I'm like, like, you could stop.
- [51:54]
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 is.
- [52:00]
Dr. Kelly Casperson
Exercise on the days you Want to take care of your body.
- [52:03]
Sarah Reardon
Okay. I mean, to me it is the biggest switch of a flip that you can make.
- [52:08]
Dr. Kelly Casperson
There's nothing better.
- [52:10]
Sarah Reardon
There's nothing better for brain health.
- [52:13]
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, what exercise does. And sometimes getting on hormones actually gives you enough energy and sleep so you can exercise.
- [52:26]
Sarah Reardon
Okay.
- [52:27]
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 horse. No, don't do all the things. Right. Do all the. But there is nothing that does what exercise does.
- [52:42]
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 their 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, it's great to kind of know that. I think the biggest thing too that I'm hearing for 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.
- [53:20]
Dr. Kelly Casperson
Yeah.
- [53:21]
Not.
- [53:22]
It's. It's not my favorite thing. It's a mood altering substance. Now when we're talking about local, you know, CBD creams, stuff like that, versus you're affecting your brain cells and your lungs.
- [53:34]
Sarah Reardon
Right? Yeah.
- [53:35]
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.
- [53:52]
Sarah Reardon
Okay.
- [53:52]
Dr. Kelly Casperson
I wouldn't be smoking it.
- [53:55]
Sarah Reardon
Okay.
- [53:56]
Dr. Kelly Casperson
That's lung health. Right?
- [53:57]
Sarah Reardon
Okay. Okay.
- [53:59]
Dr. Kelly Casperson
I think a lot of people use health reasons to justify their unhealthy habits.
- [54:05]
Sarah Reardon
Oh yeah. And then somebody just asked and I think this is a good one to clarify.
- [54:13]
Dr. Kelly Casperson
Let me just go, let me just elaborate on, 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 sleep.
- [54:31]
Sarah Reardon
Yeah.
- [54:32]
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.
- [54:48]
Sarah Reardon
Yeah.
- [54:49]
Dr. Kelly Casperson
Because they're not good for your brain.
- [54:51]
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. 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?
- [55:41]
Dr. Kelly Casperson
Yeah. Two separate, completely separate things.
- [55:43]
Sarah Reardon
Yeah. Yeah.
- [55:46]
Dr. Kelly Casperson
Just 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 creams 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.
- [56:22]
Sarah Reardon
Okay.
- [56:23]
Dr. Kelly Casperson
They're just not high enough dose.
- [56:26]
Sarah Reardon
Can you take progesterone orally, like systemically, and not take estrogen?
- [56:30]
Dr. Kelly Casperson
Yep.
- [56:31]
Sarah Reardon
Yep. Okay.
- [56:34]
Dr. Kelly Casperson
And you can take systemic estrogen without progesterone if you don't have a uterus,
- [56:40]
Sarah Reardon
if you've had a hysterectomy, you've had a history, total hysterectomy. Or like, ovaries also or just uterus gone.
- [56:47]
Dr. Kelly Casperson
Ovaries are irrelevant in this conversation.
- [56:49]
Sarah Reardon
Okay. Because they are Just not doing anything. Anyway.
- [56:52]
Dr. Kelly Casperson
Uterine lining needs both.
- [56:55]
Sarah Reardon
Okay.
- [56:55]
Dr. Kelly Casperson
Gonna be on estrogen. And that's all in my book. Like, you guys read the. Read the books.
- [56:59]
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.
- [57:10]
Dr. Kelly Casperson
You know, the pro tip. There you go.
- [57:14]
Sarah Reardon
Well, I know that you.
- [57:16]
Dr. Kelly Casperson
It's a good read. It's. It's written with facts, but in a very digestible way. Just like.
- [57:22]
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 V. 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?
- [58:40]
Dr. Kelly Casperson
Yes. Thank you.
- [58:41]
So website is kellycaspersonmd.com email list is the best thing to be on to find out when you can get this DHEA 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's called you are not Broken. And then Instagram is where I like to hang out at.
- [58:59]
Sarah Reardon
Kelly Casperson MD 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.
- [59:10]
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. So it's kind of full, 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.
- [60:18]
Sarah Reardon
Oh, yeah. Do you have a second?
- [60:21]
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 V. It's sold out through. It should be coming up. Back mid April, Oprah Daily did a did a bit on it and sold
- [60:34]
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 scared.
- [60:44]
Dr. Kelly Casperson
That vulva 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.
- [61:00]
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.
- [61:08]
Dr. Kelly Casperson
That's okay. We covered a lot of basics. And yeah, it's like, you can't talk about
- [61:14]
Sarah Reardon
all of this.
- [61:15]
Dr. Kelly Casperson
I don't know about hormones. Right.
- [61:17]
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&As 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.
- [62:07]
Advertisement Voice
Thank you.
- [62:07]
Dr. Kelly Casperson
Till next time.
- [62:08]
Sarah Reardon
Bye. Thanks. Bye everyone.
- [62:11]
Dr. Kelly Casperson
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.