Hormone Replacement Therapy in Menopause with Dr. Mache Seibel

March 17, 2018by Reena1

 

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Read the Transcript Below the Questions and Highlights

This interview is just for the ladies 35 years and older especially for Women going through Menopause and Peri-Menopause, and are currently experiencing its known effects on the body and mind such as Anxiety, Hot Flashes, Depression, Hair Loss  and more! We are also going to talk about its hidden issues like Alzheimer’s, Heart Disease, Breast cancer which have a big impact on one’s life.

Listen to the podcast as we have world renowned Dr. Mache Seibel, an expert and one of the most entertaining, informative and influential speakers on women’s wellness and menopause. He is a 20 year veteran of Harvard Medical School, winner of multiple patient education awards, appearances on NPR, PBS, People magazine and a doctor who has taken care of over 10,000 women as they journey into and through menopause.

Dr. Mache is an author of the best selling book, The Estrogen Fix: The breakthrough guide to being Healthy, Energized, and Hormonally Balanced – Through Perimenopause, Menopause, and Beyond, creator of MenopauseQuiz.com and Editor of The Hot Years Magazine.

 

 

Here are the Key Questions answered and highlights:

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1. What is Peri-Menopause? What’s Menopause? What age do these begin? (02:53)

– Menopause is one year after the last menstrual period of a woman.

– Surgical Menopause is women still menstruating but have ovaries taken out of their uterus.

– Peri-menopause is the window of years around menopause, usually 3-6 years for most women up and can go up to 10 years.

– It’s when the hormones start to become unbalanced.

– Menopause is not an age; it’s a transition.

2. Why do we have these amount of symptoms? 75% will have hot flashes, will kill sleep, libido, and mood. What is going on in the body? (04:30)

– The mean age of menopause is 51. Women are going to live a 3rd of their life beyond menopause.

– When you were going through puberty, your hormones were raging, your mood was up and down, your body was changing, etc.

– Your hormones, estrogen, and progesterone, were transitioning from unmeasurable levels to imbalanced levels until through puberty where you become reproductive and hormonally balanced.

– Every month you have a menstrual period with very paired and cycling hormonal balance.

– In peri-menopause, the same things are happening but backward. The hormones come from paired to unpaired.

– It can lead to symptoms that can affect your mood, skin, intestines, libido, sleep.

– All are unraveling because of hormonal imbalance.

– The hormones will drift once again to those low levels that you’ve had pre-puberty. It’s all related to hormonal imbalance.

3. What are the 3 types of menopause? (07:23)

– Natural Menopause

– Surgical Menopause

– Iatrogenic Resulting from treatment such as chemotherapy

4. Can you help us understand Peri-menopause with respect to how does a woman figure that out? Is there a test or is there a number I’m looking for? (11:10)

– In peri-menopause, the common symptom is “I don’t feel right” or “What’s happening to my body, my mind?”

– If you feel that you aren’t the way you think is normal for you, seek medical help and find out why that is.

– The time of Peri-menopause is the time women will experience gut issue, low thyroid, diabetes, symptoms overlapping.

– May cause frequent urination, foggy thinking, anxiety, sleep problems, acne, sadness, depression, hot flashes, changes in hair quality.
– Frequent urination is a sign of diabetes or can be sensitive bladder due to changes in estrogen
– Check your Blood. Follicle Stimulating Hormone (FSH) is a pituitary protein hormone that stimulates the ovaries to produce an egg each month.
– High levels of FSH is a good indicator of Peri-menopause where ovaries are transitioning to a new role.

5. What are the long-term effects of bloom/menopause? What is the deep long-lasting impact of menopause if we don’t handle it correctly? (19:16)

– “Noisy” Symptoms: Hot Flashes, Sensitive bladder, Mood Swings, Vaginal Dryness
– “Silent” Symptoms: Changes in blood vessels that can lead to heart disease and dementia, Changes in bones that can lead to osteoporosis or thinning of the bone
– Hot flashes can be an indicator that something bad is happening the body. Blood vessels in your body are narrowing and causing a shift in the blood flow.
– If you have frequent, severe hot flashes, it can be an indicator of hearing problems because of the narrowing
of the blood vessels which can lead to chest pain, mood swings.
– As a result of lower estrogen after you go through Peri-menopause, the endothelial cells, the lining of the blood vessels throughout the body, as the estrogen gets lower, the damage to the endothelial cells go up which increases the risk of plaque forming and narrowing of blood vessels.
– In the brain, a lot of thinking and motor activity is based on the estrogen working as a lubricant for the
brain. Estrogen allows synapses of the brain to work faster as the brain needs 15% of the blood flow from the
heart.
– Estrogen makes serotonin higher which improves mood and the impact on the blood flow to the brain is giving more oxygen, making it more efficient.
– In bones, the estrogen is responsible for keeping cells in putting calcium into the bones in balance with what is taken out, keeping balance in the cells.
– It is important to realize silent conditions before they reach a tipping point.
– Get your bone density, cardiac evaluation, keep brain moving, do exercise and exercise your brain.

6. What is the window of time to act? What do you recommend? (27:01)

– The study presented in 2001 was incorrect and inaccurate that women who take hormone therapy increased risk of breast cancer, heart disease, and dementia. It was an unfair study and it had issues with time and medication. It compared women who were mostly 50 to 59 and who took a placebo with women who were mostly 60 to 79 and who took a combination of estrogen plus a synthetic progesterone called provera.
– A redo of the study testing hormones vs. placebo was done on 2013, where the results showed hormones helped women. Symptoms went away except for a small risk of breast cancer at level of 1/1000 cases. For those who took only estrogen, there was a 23% reduction of breast cancer and 32% reduction in heart disease. A follow up of the same patients published in JAMA in 2017 found that taking estrogen or estrogen plus provera did not increase overall lifespan or risk of dying from heart disease or breast cancer. –  The best time to begin taking hormone is take it closest to the time of menopause beginning to start the estrogen. Evaluate yourself for 5-10 years.

7. What are the different kind of hormone replacement therapy? Which is the one that is least risky? What do you typically recommend? (33:30)

– Bioidentical are biologically identical in structure to what the body makes, but are synthetic because they are made in chemical plant. The only plant that can make a hormone is the Chemical plan

– The bioidenticals can be put on your skin as patch, spray, gel, in the vagina as a ring, cream. There are lots of ways to take bioidenticals like pills and creams.

– Compounding pharmacies vs drugstore:
In a Regular drugstore, all of those have FDA approved hormones where every batch is same, wherein Compounding pharmacies, what you get in prescription may not be the same as what your doctor ordered. Typically estrogen doses are higher and progesterone dosages are lower.
– If you are a person who insist that you want to have hormones form a compounding pharmacies, be sure that you’re having your health care provider check your uterine lining so any changes can be caught early and can be reversed before becoming uterine cancer.

8. How do you check your Uterine Lining? (40:55)

– Vaginal Ultrasound

– Endometrial Biopsy

– Hysteroscopy – looking inside with a very small telescope

– Get checked every year or two.

9. What kind of hormones do you like? Ingesting hormone impacts gut – What is truth around that? Best form to take hormone? (42:20)

–  People who have bad GI track bacteria or people whose intestinal track has been fed too much sugar, fast food, processed food, or other food that are unhealthy have changed the bacteria in their intestine. Those bacteria cant digest estrogen.

– The worse the gut the higher the blood levels of estrogen.

– The healthier your diet , the more you’re going to digest estrogen and keep estrogen lower in bloodstream.

– Its been shown that the best way to take hormones on skin, transdermal – through skin, vaginal, less risk of blood clot or stroke. Lower dosages of oral may be as safe.

– If you’re going to use oral, go with a lower dose oral to prevent downside of taking it.

10.  What are your Natural Remedies for menopause and Peri-Menopause? (45:28)

– Hormones are only one keystone for healthy menopausal transition and life beyond 35 or 40. If you’re going to take estrogen or not, the healthy lifestyle is essential.

– 4 tiers of a healthy lifestyle:

  • Sleep
  • Exercise
  • Nutrition
  • Stress Levels

– You have to work in all of these things. Improve all areas.

– Drink a lot of water – at least 8 glasses daily

– Alternative medication: A lot of Cognitive Behavioral Therapy (CBT) or like hypnosis, which is a mind-body approach

– For Hot flashes, sleep!

– Over the counter treatments are available – black cohosh, chaste berry, dong quai, estrogen, evening primrose, flaxseeds, soy

–  Try taking supplements one at a time for at least 3 months to see if it works for you.

– Soy has been used for long time, can be effective. Most effective ingredient is Genestein.

11. There is a negative notion on soy – if you have breast cancer, take soy products out? What’s the truth about that? (50:47)

– It is a MYTH!

– If you have cancer already, soy or estrogen or any kinds of these hormones may stimulate growth but they don’t increase death. Even women with breast cancer can eat soy, studies have proven.

– The overall benefit of hormones, if there’s a minimal increased risk of breast cancer, people don’t die with hormones any sooner. Duration of life is not affected, it’s the same with soy.

– Stick with Genestein.

12. How do you take charge of yourself off of hormones and thrive through this time period? (53:13)

– Be proactive. Have a list of questions.

– Talk to someone knowledgeable and someone comfortable to speak with.

– Decide what are your priorities. Are you considering hormones or alternatives?

13. What are those alternative Medicine? (54:49)

There are several FDA approved non-estrogen prescriptions

– Osphena for Vaginal Dryness.

– You can use estrogen locally even if you have breast cancer or going to treatment.

– A new medicine, a form of DHEA, Prasterone, is a medicine for vaginal dryness which doesn’t get into your bloodstream and no black box warning.

14. There are 4 approaches that can minimize risk of hormones. What are some of the things women can do to minimize those risks? (57:10)

– Skin approach or transdermal

– Start with lowest dose

– Regular checkups while on hormones

– Check every 5 years as data may change or your condition may change

Bonus: Hear Dr. Mache’s song about Menopause! >> 

15. What is the one thing to get out there to do to feel better? (1:01:13)

– It’s never too late to start. Invest the time to know what to do next. The time spent on you isn’t lost, it’s invested. The return on your investment is better health, happiness, and hormonal balance.

Learn more about Dr. Mache’s Books here!

The Estrogen Fix: The breakthrough guide to being Healthy, Energized, and Hormonally Balanced – Through Perimenopause, Menopause, and Beyond – Available at www.EstrogenFixBook.com

The Soy Solution for Menopause


TRANSCRIPT:

This is auto-generated and may have mistakes. Please listen to the interview for accuracy.

[00:25] Reena Jadhav: Hello everyone. This is Reena and this episode is for the women and for the ladies because we’re going to talk about.

[00:34] Reena Jadhav: Menopause today and Peri perimenopause and all those myths and how to get rid of those awful symptoms like weight gain and hot flashes and anxiety and brain fog and fatigue and hair loss and depression.

[00:48] Reena Jadhav: You know what.

[00:50] Reena Jadhav: Those are the least of your issues ladies. The bigger issue is all those hidden issues of menopause. The big impact of things like Alzheimer’s and heart disease and breast cancer. All that stuff that really no one tells us anything about. And of course we’re going to talk about myths around hormone therapy. Someone says it’s good. Someone says it’s bad. Someone says it gives you breast cancer. What we’re going to talk to the renowned leading expert on menopause on women’s health so he can help answer the question. And what is the truth around hormone replacement therapy. And finally we’re going to give you a plan going forward to not only beat those pesky symptoms but to also make sure that you live a very long healthy happy life without all those health problems like osteoporosis. And who do we have. As our renowned guest today it’s Dr. Cybil. He is an international expert. One of the most entertaining fun informative influential speakers on women’s wellness and menopause.

[01:57] Reena Jadhav: In fact he’s a 20 year veteran of Harvard Medical School winner of multiple patient education awards has had great appearances on NPR PBS People magazine.

[02:08] Reena Jadhav: He is taking care of tens of thousands of women as they journey through menopause. And what’s exciting is that his brand new bestselling book The estrogen sex just came out. So we’re going to try to get him to give us all great insights from that book. It’s a breakthrough guide to brain healthy energized and hormonally balanced through peri menopause menopause and beyond. He’s also got a menopause quiz which you are all going to get a chance to take the free is the editor of The Hot ear’s magazine and can be found and Dr. Match.com. Dr. mation welcome. What a pleasure.

[02:44] Mache Seibel: Well thank you for that introduction. It’s very wonderful to be here with you and I’m excited to share some information.

[02:52] Reena Jadhav: So let’s start with the most important question first.

[02:55] Reena Jadhav: What the heck is perimenopause. I hadn’t heard about it for the longest time. What’s menopause. And at what age do these wonderful things again well many pauses.

[03:07] Mache Seibel: Definition of one year after your last menstrual period. That’s the medical definition.

[03:14] Mache Seibel: And if it’s surgical menopause if you’re a woman who is menstruating and still in her reproductive years and your ovaries are taken out even if your uterus is still left in well that’s menopause.

[03:30] Mache Seibel: Now perimenopause is like perimeter Perry means around. So Perry is the window of years around menopause and it can be anywhere up to a 10 year window. For women it’s commonly three to six years for most women but for many women it’s up to 10 years so perimenopause has that window of time around menopause. And it’s when the hormones start to become unbalanced and the symptoms begin to make you feel like you are on balance.

[04:11] Reena Jadhav: You know it’s so interesting because we always think of many pauses a moment in time. And what you’re saying is it’s not.

[04:16] Reena Jadhav: It’s a journey and it’s a slow steady journey and that’s why I think a lot of us miss those symptoms.

[04:24] Mache Seibel: Yes it’s an age it’s not. It’s a it’s a transition it’s not an age is no one age of menopause.

[04:31] Reena Jadhav: Now why do we have these insane amount of symptoms. And I know not every woman has the same symptoms but we know that 75 percent of women going through menopause will have hot flashes.

[04:43] Reena Jadhav: We know hot flashes will kill everything from sleep to libido to your mood. They’re awful. And 75 percent is a huge number of women going through the same exact symptom. So I tell our listeners why are we going Why do women go to these enormous symptoms. What is going on in the body.

[05:06] Mache Seibel: Well first realize that in nineteen hundred which is not that long ago the average woman was living to be 48 years old. And the mean age of menopause is 51.

[05:20] Mache Seibel: So men applause is really a phenomenon of our more recent history because women are living longer men and women are living longer and in fact women are going to live a third of their life or more beyond that. Applause.

[05:34] Mache Seibel: And when you think back to your youth and the time that you were going through puberty you remember that it was a crazy time your hormones were raging your mood was up and down your body was changing. You were starting to have sexy thoughts. So many things were going on. And that’s because your hormones are predominantly estrogen and progesterone were going from very very almost unmeasurable levels through a window of imbalance over a number of years until finally you got through puberty and on the other side you became a reproductively competent woman. In other words you may have been a young lady but your body was hormonally ballons and you were in a position to have children.

[06:28] Mache Seibel: And so every month you had a menstrual period with very Parad and cycling hormonal balance and then you flash forward 35 years or so 30 years and you hit this window of peri menopause when the same thing starts happening backwards and then that window of time the hormones go from paired to unpaired and that leads to a series of symptoms again affecting your mood and your skin and your intestines and your libido and your sleep and your sexy thoughts in all of that is happening kind of unraveling almost because of hormonal imbalance until finally the hormones drift into once again those low levels that they were at pre puberty and so it’s all related to hormonal imbalance.

[07:24] Reena Jadhav: Now you talk about three types of men applies what are the three types of nanobots.

[07:31] Mache Seibel: Well there’s the natural menopause that happens which is the age 51 as a Maine where women continue to cycle and then eventually the ovaries start producing eggs the eggs either become resistant that there’s some left and stop working or they are depleted and there’s no more eggs in the ovary. And I would just say that the mean age of menopause this natural menopause is age 51. The range is about forty six to fifty five. But some women will go into menopause as late as 60 and five to 10 percent of women will go into menopause before age forty five and one percent will go into menopause before age 30 and one in a thousand will go into menopause before age 30. So that’s why I’m saying menopause is an age it’s about a transition and the symptoms can start up to 10 years before that.

[08:40] Mache Seibel: Then there’s surgical menopause which I alluded to earlier which simply means that for either disease conditions such as cancer or maybe you have a bad condition of endometriosis where the lining of the uterus invades the ovaries and causes internal bleeding and pain the ovaries may be removed for that. Or maybe you’re one of a growing number of women who become aware that she has a genetic condition such as the BRCA or the breast cancer gene and the ovaries are removed preventively so that you lower your risk of breast or ovarian cancer. So in any of those conditions that surgical then a pause because once the ovaries come out of the estrogen levels abruptly stop and there there’s no really perimenopause just one day you’re healthy hormonally healthy woman and the next day to you are suddenly at a baseline of hormones so that’s a rather drastic drop and then there is a third kind which comes as a result of either treatments. You know it’s called iatrogenic or in other words something happens medically. So perhaps you had a condition or where you needed chemotherapy and you had exposure to some toxin. So all of the sudden your ovaries over time months or maybe up to a year or so would be exposed to some external source of a substance that could lead to the ovaries stop working. And you go into the polls that way. But all of these ways do happen. The most common is natural menopause.

[10:29] Reena Jadhav: Got it.

[10:30] Reena Jadhav: Let’s talk about peri menopause the word menopause is very well now and you know most women are aware of what it is but very menopause is not something that most women truly understand or are even aware of. And as you know one of my goals but the podcast is to create awareness so at least women are knowledgeable and hey nany 538 in my digestions misbehaving. I don’t have a gut issue. I had an estrogen issue or FMI. Suddenly all my weight coming around my my belly you know hey it’s not that something’s gone wrong with my thyroid. Maybe it’s my estrogen level that’s dropping.

[11:10] Reena Jadhav: Help us understand hairy menopause.

[11:14] Reena Jadhav: With respect to how does a woman figure that out. Is there a test that I can do with a round number I’m looking for. So I can say I’m having these five six different symptoms where I don’t sleep as well I’m getting a little moodier then now I go and get myself tested and sure enough it shows I’m an perimenopause.

[11:34] Reena Jadhav: Or is there some other way we can figure that out.

[11:37] Mache Seibel: Well you’ve really raised you know some very important points here. So let me just back up one second and just say in peri menopause probably the most common symptom that you hear are the most common thing you hear is I just don’t feel right. This is just what’s happening to my body. What’s happening to my mind. Those kind of broad strokes. And I think it is important that if you feel that you aren’t the way you think is normal for you it’s important to seek out medical help in make sure why that is. And I will tell you that there at the time of Perimenopause is a time when many women will experience the gut issue. It is a time when they may experience a low thyroid in particular. The symptoms are overlapping and I’m going to talk about the symptoms and also it may be a time when diabetes is coming into play singly common problem.

[12:35] Mache Seibel: All of those things may cause frequent irritation or foggy thinking or a little bit of anxiety or just not sleeping well. Those are all symptoms that go along with all of those conditions potentially. The difference is not everybody gets those other conditions. Everybody that lives long enough is going into menopause. So you might notice skin conditions like acne or a little bit of course hair coming out of your face are a commonly emotionally people experience anxiety or a little bit of sadness. And those are common common conditions. More than half maybe 60 percent experienced some element of that. And then of course a subset of people will experience real depression if you’re a woman who had a history of postpartum depression or really bad M.S. or a history of clinical depression in an earlier age then you’re more at risk for depression but you could feel bloating or breast tenderness or crying spells or decreased libido or changes in your remembering the forgetfulness. You know I was talking to a lady the other day and she was talking about her husband told her way on the way home from work when she was going to pick up the kids to get some dog food because they needed dog food. And so she got home and she was at home. And he says did you get the dog food. And she said Oh man. Not only that I forget the dog food I forgot to pick up the kids.

[14:13] Mache Seibel: So it’s like it happens often frequent urination which again can be a sign of diabetes. But it’s also can be a sign of sensitive bladder due to changes in estrogen hair loss or hair thinning headaches hot flashes. We talked about. So all of these things are possible. The good news is most women don’t get all of them. They get some of them. And if you notice that you’re having changes in your libido or changes in any of these other things that you don’t feel like you. You don’t feel quite right. Then it’s time to go talk to your healthcare provider and ask for a test. The simplest test to get is a blood test called F S H or follicle stimulating hormone and that’s a pituitary protein hormone that stimulates the ovary to produce an egg each month. And when the ovary runs out of eggs or the eggs get more resistant the FSA age has to shout louder to the ovary so the levels go up higher and higher.

[15:22] Mache Seibel: Trying to get the ovary to respond. So a higher level F.S. age is a good indicator that your ovaries are transitioning into their new position which is perimenopause.

[15:37] Reena Jadhav: This is such critical information.

[15:40] Reena Jadhav: You are so right in that a lot of women start to feel different.

[15:46] Reena Jadhav: They don’t feel as good as they felt all their life. And so what they do is they start they go to their primary care. I mean I’m speaking literally from experience of having talked to so many women I’m post menopause. I’ve gone to dust myself where I would go and say I don’t feel right something’s not right.

[16:03] Reena Jadhav: I’m going to the bathroom or I’m not sleeping as well I just don’t feel right. Never do the task and they do there’s nothing wrong with you go home.

[16:11] Reena Jadhav: Oh really depressed take an antidepressant or oh you must have got issues go CGI. So what happens is today because we haven’t yet connected the dots that it could be hairy men applause we start to see specialists got specialized or an endocrinologist like Oh you may have diabetes. Let’s get it right out. It’s so important for people listening to this. For women listening to this podcast to realize that when you don’t feel God if your friends are saying they don’t feel good at the FSA task done right before you spend time with 20 specialists see if this is the issue and if this is the issue then keep less name because we’re in a hope they have documents give us some recommendations on how to treat ourselves and not level with these very debilitating symptoms.

[17:00] Mache Seibel: Let me say Raina that what happens a lot of times is maybe you’re 35 and you know this as said five to 10 percent of women go into menopause before 45 and the symptoms start up to 10 years sooner so maybe your 35 year old woman or your 36 or 37 and you know you just had a kid a year ago or two or you know you’ve got one kid and you’ve been waiting because of work and waiting for promotion or something and you want to have that second kid. So you’ve been thinking about getting pregnant then all of a sudden you just don’t feel right. And the last thing you might have on your mind is I’m heading towards menopause because my goodness you’re thinking about having babies. You’re not like an old lady who’s going to have these symptoms but menopause is not about age it’s about transition. I keep saying that because so many people have in their mind an older woman and it’s not necessarily so. It is only if you’re proactive and can understand that then you can start making steps towards having a healthy lifespan beyond this point in optimizing your health and your wellness and your vitality.

[18:13] Reena Jadhav: So true.

[18:14] Reena Jadhav: And you know I have to say that at this point I don’t like the word menopause.

[18:20] Reena Jadhav: It means stopping of menses and that’s like to your point. It’s a long term change. It’s not something that’s a moment in time. I don’t like the word change.

[18:30] Reena Jadhav: I’ve crafted the word lume. I think it’s all about love. We’re blooming we’re becoming the best version of ourselves.

[18:39] Reena Jadhav: And it’s not an overnight process it’s something that takes time.

[18:44] Reena Jadhav: And so I referred to it as you’re in bloom you’re changing you’re growing but now the question is What are the long term effects of this. So Dr. Maneesh as I understand hair loss and anxiety are the least of the problems. There are bigger issues that women have to worry about because to your point we’re living longer now when I die at 55 or 60 we don’t we have to worry if we have dementia or Alzheimer’s or heart attacks. Tell us a little bit about what are the long lasting impact of menopause if we don’t handle it correctly.

[19:24] Mache Seibel: Well first of all the point you’re making here is a critical one for women because I think that there are two kinds of symptoms. There are the noisy ones I call them and those are the ones like the hot flashes or sensitive bladder or Agil dryness. These are things that get your attention. But then there are the silent conditions like changes in your blood vessels which can lead to heart disease or increase the risk for dementia changes in your bones that can lead to osteoporosis or tearing of the bones. And one of the things that people don’t realize for instance if we’re talking about the blood vessels in the heart in hot flashes this is something that a lot of people don’t ponder and that is when you think of hot flashes what do you think about. I mean you know oh this is like it could be and this is embarrassing. This is like uncomfortable not thinking you know that could be an indicator that something bad is happening in your body. So what do I mean by that. Well here’s what happens. What is going on with a hot flash.

[20:38] Mache Seibel: What’s happening is the blood vessels in your body are narrowing and they are causing a shift of the blood flow and then all of a sudden there’s a release in the blood vessels will then dilate and then you have this heat in this hot the hot flashes and the blood vessels will show your face will be in your neck and chest will be red and so forth.

[21:06] Mache Seibel: But if you’re having really frequent hot flashes and intense hot flashes it also can be an indicator of a problem going on with your heart. Because the narrowness of the vessels are also happening in your heart. So sometimes people have chest pain or some people will have mood swings with these with these hot flashes. Now the good news is is that some people’s chest pain is a result of this kind of this temporary ischemia or lack of blood flow from the hot flashes and when they go on hormones it actually makes that going way. But if they’re constantly Goyang there’s actually pain and so forth frequent severe hot flashes can actually be an indicator that there is narrowing of the arteries around the heart. So it could be an indicator so hot flashes can mean that. Is kind of like a lack of blood flow that comes with these hot flashes.

[22:16] Mache Seibel: So this is important to understand. But what happens as a result of lower estrogen after you go into peri menopause is that there’s a series of there’s a Leininger one layer so lining up the blood vessel vessels called the endothelial cells and these act the lining of the blood vessels throughout the body from your toes to your head. And what happens is is that as estrogen gets lower the ability of damage to those in the filio cells goes up and there is an increased risk of plaque forming and narrowing of the blood vessels in the brain. What happens as a lack of estrogen happens is that we don’t realize that a lot of our thinking and motor activity is based on estrogen working as a lubricant for the brain. What happens is estrogen is important because the brain needs about 15 percent of all the blood flow that comes out of your heart in with out if there’s narrowing of the blood vessels in the brain and so forth they don’t have any other source of energy there’s no fat stores or other stuff they can point from.

[23:32] Mache Seibel: So the vessels are important the estrogen actually allows the synopses of the brain to work faster. So what does that mean. Why the you know the if you’ve ever unwrapped a baseball or you see all those strains it’s just a bunch of strings and the brain is just a by a little bit the nerves trillions of these nerves one connecting to another and things happen by one nerve communicating with the next nerve. It’s kind of a hey here’s the secret passage down. And they can do it really fast. Estrogens speeds up that process. So if you’re a walking and you slip on the curb and you get a fall if you’re younger part of the reason that it happens that you gain your balance has to do with estrogen. Moving those nerve stimulus faster estrogen also makes this the serotonin higher in your brain so that it’s a better feel and it influences mood. Estrogen also has an impact on the entire blood flow to the brain give it more oxygen and making it more efficient in terms of thinking. So it plays a big role in the brain in your bones. Estrogen is responsible for keeping more of the cells that put bone in calcium in your bones and keeping a balance between the cells that are taking calcium out because people think of the bones as like Halloween and they’re kind of dead and inert.

[25:11] Mache Seibel: But in fact the bones are very Liddick and there always if you ever look at a sheet rock on your walls you might see those little cracks that happen some time where the bones get those little micro cracks too. And what happens is these little cells go in and kind of Pac Man it out. They just go in and munch out the crack and then the other cells they ask the Oblasts we’ll put calcium back in and kind of patch it up. So they asked the class take it out the steel blast put it in. And what happens is when estrogen goes down there’s more osteo class taking it out and as you blast putting it in.

[25:48] Mache Seibel: And so there’s loss of bone in a 50 year old healthy woman has the same risk of dying of a complication of osteoporosis as she does of breast cancer.

[26:02] Mache Seibel: So it’s very important to realize that these silent conditions that you don’t know are going up right until the tipping point are completely unknown to you. So it’s important for women to get bone densities to know where their bones are.

[26:17] Mache Seibel: It’s important for women to have cardiac evaluations of out 50 and beyond to see where they are. And you know you want to keep your brain active as you can and eat properly exercise properly and hormones if they’re appropriate to optimize your brain function. So those silent conditions are happening and you can do things to prevent it.

[26:40] Reena Jadhav: So there is hope for all of us yet we’re not out it.

[26:44] Mache Seibel: No there’s more than hope. There’s actually things you can absolutely do to prevent or minimize.

[26:51] Reena Jadhav: Let us talk about that and you talk about the fact that timing is very important that there is a specific window of time when you must act. So let’s start with the what is that window of time. And then tell us we’re waiting for you to share all your great wisdom and insights from years of experience.

[27:10] Mache Seibel: What do you recommend well in 2002 a paper came out called the Women’s Health Initiative or the W age Zhai. And many of you may have heard of this paper because it was the first in the series of age papers. And in that paper it suggested incorrectly I’m going to tell you that women who take hormone therapy were at increased risk for breast cancer heart disease dementia and a whole lot more.

[27:47] Mache Seibel: But here’s how that paper was done that made the outcome the results incorrect and totally inaccurate.

[27:54] Mache Seibel: And I explained this in my book the estrogen six because this is the beginning of opening up clarity the study that was done used a hormone combination of oral pills that included Premarin a type of estrogen plus Provera a type of synthetic progesterone and it was called Prempro and some other women got Prempro and some of the women who got a placebo. Now it turned out the reason that the women who got the hormones did more poorly is because of this although the age range of the women in this study was age 50 to 79.

[28:43] Mache Seibel: In other words in both groups the women were aged 50 to 79 in the hormone group 75 percent of the women were age 60 to 70 nine and in the placebo group 75 percent of the women were 50 to 59. So we were comparing 50 the 59 year old healthy women on a placebo with 60 to 79 year old women on a hormone. Now just think commonsensical the data of 60 to 79 year old women is more likely to have breast cancer heart disease dementia than 50. Fifty nine year old healthy woman and that’s a true fact. But to add to it it was supposed to be only well women in this study but there were so many women already on hormones at the time that the women who were in the hormone group the 60 the 79 year old mostly 16 79 year old group also included many smokers women who were overweight. Women who had high blood pressure and women who had diabetes in all of these things are risk factors for heart disease and some for breast cancer et cetera.

[30:02] Mache Seibel: So it was an unfair study. And what has happened is in 2013 they did a redo of the same patients.

[30:14] Mache Seibel: And this time they took all the overlap that they could and they just looked at the women who were the same age and the women who were 50 to 59 in fact did not have an increased risk of almost any of those things. I say almost because there was a slight a very minimal increased risk of breast cancer was one per thousand and the risk was equivalent to the risk of women who have five cystic brassed and that was very dense breasts are women who are quite overweight. They also have an increased risk of breast cancer are women who drink one to two glasses of wine all week. They also have a very slight increase risk. So if you look at that slight risk aside almost all the other things went away and it turns out that in and in just a month ago another study came out with these same patients again lined up for age and now following them for 12 years after the study and almost everything went away except just one small increased risk of breast cancer as I mentioned at the level of.

[31:39] Mache Seibel: 1 per thousand additional cases. However women who took only estrogen in other words women who had had a hysterectomy actually had a reduction in breast cancer 23 percent reduction in breast cancer and thirty two percent reduction in heart disease. So we talk about a timing issue and a medication issue. And now we know that we can swap out that synthetic progestin the Provera for other bioidentical progesterone and. Lower the risk even further. So there’s a lot to do with which medicine you use and when you take it and the best time to take hormones as I explain it the estrogen fix is to take it close to the time of menopause beginning to start the estrogen when menopause starts and then evaluated it five or 10 years. There are some women they can continue taking that long and for some kids to continue taking it even longer.

[32:48] Reena Jadhav: That is such an important myth that you’ve just busted and you know what breaks my heart is that how did such a poorly designed and poorly executed study get so much media visibility.

[33:02] Reena Jadhav: You know how did that become the norm of what we understand about hormone replacement therapy. I’ve heard from different gynecologists and different doctors that there were also issues in the kinds of. Hormones that were used. So that’s my next question. Is there a difference and the they called it the horse be estrogen versus the new bio identical cells that seemed to be more in favor. So help us understand what are the different kinds of hormone replacement therapy and which is the one that is least risky and what do you typically recommend.

[33:42] Mache Seibel: I want to just finish one thought on what we were talking about a hop immediately on to what you just asked you and part of what perpetuates this is that as a result of that study in 2002 eighty eight 0. 80 percent fewer women are on hormones today than in 2002. And as a result good doctors in training have 80 percent fewer patients and a pause in 82 80 percent fewer women. They prescribe hormones too so their experience is down. And that’s part of the problem is that many of the doctors have read the same papers as you’ve read haven’t gotten the updates it’s like I know that information all around. One of the reasons that I’m at Beth Israel a Harvard Medical School is teaching the residents and the interns and the fellows what to do with these hormones because they are not sure. And it’s really imperative to get people when they’re learning so that they have this formative information Saqlain. Now in terms of the choices of hormones there are several there’s look there’s dozens of options of hormones so I’m going to try and break it down easily as I can because this is chapters of the estrogen tics where I explain all this stuff.

[35:03] Mache Seibel: But in simplest terms there’s basically two kinds of hormones.

[35:11] Mache Seibel: There’s the bioidentical. And then there are the conjugated. Technically there’s also synthetic ones too. I’m just going to keep it at let’s just say bioidentical. And there are other ones. Let’s do it like that. So and then they can be compact. They can be purchased at two places either at regular drugstores or at compounding pharmacy. So to address these two points The first is bioidentical versus the other ones. Whatever the whatever you want to call them at first is the bioidentical means that they are. Identical in physical structure and chemical structure if you remember your chemistry from high school. Those steroid hormones had all that chicken wire looking chemistry and the chicken wire in what your body makes an bioidentical are the same. So they’re biologically identical in structure. Now they are synthetic themselves because they are made in plants. As I say the only plant they can make a hormone is the chemical plant.

[36:24] Mache Seibel: There are no bodies no where that can synthesize a plant precursor into a usable endpoint. Harmo we don’t have the enzymes and plants therefore have to go through a process so there bioidentical but not natural. The second thing is is that the bioidentical can be put on your skin. They put on your skin as a patch they can be put on your skin as a spray as a gel they can be put into the vagina as a rainy day can be also put in the vagina or the skin as a cream. So there are a lot of ways to take the bioidentical and the in so there is a lot of forms.

[37:15] Mache Seibel: The other kinds of hormones are typically pills and creams and so there is one patch that’s made with that as well.

[37:28] Mache Seibel: But primarily it breaks up like that so a lot of ways are taken and I hope I’m not confusing any piety but basically there’s a lot of ways to take hormones. Now the second point is that what’s the difference between compounding pharmacies and a traditional drugstore. People do not realize that the same bioidentical hormones that they purchased in a compelling pharmacy are also available in the regular drugstores. Though. It’s the same hormone exactly the same hormone. It’s been probably made in the same laboratory. The difference is is that in regular drugstores in the you know the CBS the rye they are all greens.

[38:16] Mache Seibel: Wayne Reid but one it is all of those have FDA approved hormones where every batch is the same whereas in the bio identical world of Come Palley pharmacies they tend to be made as one of eggs. So a lot of times what happens is what you get in the in the prescription filled is not the same as what the doctor ordered. And the reason that I am confident to say this and I’ll tell you this study so that you realize is just not my opinion is that in one study done where 12 prescriptions the same prescription was sent to 12 cup compounding pharmacies around the country. And then the full prescription was then mailed to a chemical analysis lab that does hormone analysis in that particular analysis. None of the hormones were the same from any prescription other words every one of them was different from each other. And in general the estrogen tended to be 60 to 200 percent higher than what was ordered and the progesterone tended to be 6 80 percent lower than what was ordered.

[39:37] Reena Jadhav: That is frightening. That’s a huge difference.

[39:41] Mache Seibel: It is a huge difference and has huge implications I’m assuming it does because we’re now seeing the first reports coming out of uterine cancer from women who have taken bioidentical hormones from compounding pharmacies.

[39:57] Mache Seibel: There are several reported cases and that before I scare anybody too much let me say that delight.

[40:06] Reena Jadhav: I’m already scared but continue

[40:09] Mache Seibel: the transition from a normal uterine lining to cancer is probably a five year to ten year transition. So if you are a person who insists that you want to have your hormones from a compounding pharmacy that’s fine. But be sure that you aren’t having your health care provider check your uterine lining so that these these changes can be caught. Is there early changes and can be reversed hormonally they don’t require even surgery to reverse them if you catch them early enough so you just have to be proactive to check your uterine lining because this stuff happens across the country all the time.

[40:56] Reena Jadhav: And how do you check their uterine lining.

[40:59] Mache Seibel: OK that’s a good question. The way you do that is one of two ways you go to your healthcare provider and either they will do a vegetal ultrasound they’ll put a probe into the national canal and look to see the thickness of the lining of the uterus and it normally should be four millimeters or less. Indirectness and when it starts to get to be much more than that then you have to do the second way you can check that is by doing an endometrial biopsy or putting a little bit the instrument into the uterus the size of a very thin straw and scraping out some of the cells to look at the tissue under a microscope and make sure it’s not abnormal some occasionally will actually go in the uterus with a small telescope called the history Rosko bestrode meaning uterus Insko means you know to look in and it’s very rare. It’s about four millimeters in diameter and it goes into the uterus and then you can look inside. But you still end up having to scrape the cells and check. So it’s easy to do as an office visit. But it should be checked every year or two at the absolute most to make sure you’re not missing something.

[42:19] Reena Jadhav: This is such incredible advice. What kind of hormones do you like.

[42:23] Reena Jadhav: By the way I’ve been told by various functional medicine naturopath doctors that ingesting hormones impacts the gut and obliterate some of the good microbiome. And so despicably I’ve heard it’s better to do either imaginal insertion or a lotion or cream or a patch. What is the truth around that which is the best form in which to take that hormone while it’s interesting you mention about the estrogens impact on the gut.

[42:57] Mache Seibel: In fact it’s also true that the gut impacts the hormones and what do I mean by that I mean that people who have a bad G.I. tract bacteria people whose intestinal tract is been fed too much sugar or too much fast foods or processed foods or other kinds of foods that are not ideally healthy for you actually have changed the bacteria in their intestines and those bacteria can’t digest estrogen as well. So what ends up happening is the worst your got the higher your estrogen. And I actually believe that some of the problems with estrogen has been have been given to people who have had Jihae. And I think bacteria and I think that it’s been caused internally.

[43:51] Mache Seibel: So for that reason the healthier your diet and healthier your biome your microbiome that your intestine that three pounds of bacteria that lives in your intestines the healthier that is the more you’re going to digest the estrogen keep the actual levels lower in your bloodstream and that’s a kind of an interesting little opposite to what the person was saying.

[44:15] Mache Seibel: Not contradicting it but adding to it in terms of your point though.

[44:22] Mache Seibel: It’s been shown that the best way to take it in terms of risk is probably on the skin. So probably transdermal or or vaginal transdermal meaning through the skin gradually by putting some form of estrogen into the vagina probably is less risk for blood clots or stroke. And the reason is by avoiding the intestinal track it doesn’t go through the liver to increase clotting enzymes that can increase the risk of blood clots and so forth. So the oral way if you’re going to use oral some of the data suggests that if you go with a lower dose oral you actually can prevent a lot of the downside of taking it orally. In other words you can use it on your skin in most dosages without increasing that risk. But if you’re going to use it orally it’s safest to lower dosages.

[45:25] Reena Jadhav: Oh interesting hormones is one option.

[45:29] Reena Jadhav: What are your thoughts on alternative or natural remedies for menopause and perimenopause Centeno.

[45:36] Mache Seibel: So what have you seen work well first of all it’s important to realize that if you take hormones and expect your life to be perfect you will be disappointed because hormones are only one keystone of the options for healthy menopausal transition and life beyond 35 or 40 or whatever age you begin to beget them. And so by that I mean if you’re going to take estrogen or not take estrogen a healthy lifestyle is essential. It’s just part of what’s required and by that I’m talking about four things that I think it’s like if it was a car before tires with the sleep it would be your exercise. It would be your nutrition and it would be your stress levels. And if you people have the idea that if they just fix one of those things like if I can just lower my stress my life will be perfect.

[46:44] Mache Seibel: I can keep beating. I can hit no fast food that I can keep drinking sodas and I can sit on my behind and I’d do any exercise and I’ll need sleep around I can work on four hours or five hours and still be fine. Well if you do that. What’s going to happen is you’re going to be disappointed because you have to work on all of these things.

[47:08] Mache Seibel: If you had two flat tires and you fixed one you wouldn’t be going anywhere.

[47:16] Reena Jadhav: If you had if you had four tires and you just improved each of them and put a little air in each of them at least you could keep going forward and tell you can improve. All of those areas.

[47:31] Mache Seibel: So I think it’s really important to realize lifestyle goes with it but in terms of other things then what else can you do.

[47:42] Mache Seibel: Well first of all I mean a lifestyle and clearly drinking a lot of water is one of the first things that I would do if I wanted to help somebody improve the quality of their life.

[47:54] Reena Jadhav: You have to improve just some of you and not just some of you. This is really important conceptually because if you don’t look at yourself as a unit as an entity and neglect portions of your life they will end up being suboptimally benefited from whatever you do and then you can go for a lifestyle and hydration. Then there are things that you can do. There are for instance alternative medication things and by that I mean a lot of the cognitive behavioral therapy approaches CBT or cognitive behavioral therapy and these are sort of hypnosis type of things are mind body approaches and they haven’t studied and are very effective flashes specifically or for sleep. They’re particularly good and those are approaches they can be they can go into the over-the-counter treatments of which there are so many black Quraish Chase Barry Don why Astrovan. Evening Primrose flaxseed red clover soy. I mean there is.

[49:06] Mache Seibel: Dozens of things you go got a drugstore you just get views walking down the aisle with your options. The thing that I like to say is that all of them work for some people and not all of them work for everyone. And so I give people guidelines for taking supplements. This is to try one thing at a time because if you don’t know if it works or not. For sure then you’re infused at the end of the time. So at the end of three months and I would give it three months because these are not pharmacologic doses these are small doses. So try one thing for three months. If it doesn’t work throw it away get the next one because adding another one will confuse me. If you if it gets better was it one the new or was it the combination. And then by the time you end up with three or four of these things your bill for the month is going to be hundreds of dollars just supplements of which you’d maybe only need one. I’ve had lot of experience with all of these. I like soy in particular as a food. And there are some supplements that soy has been used for a long time and it can be quite effective. The most essential ingredient is in it is the Genise thing s t i n.

[50:29] Mache Seibel: That seems to be the most effective but all of these can be helpful. And then there’s other kinds of things that you can do as well because I have to pause you there and say Oh.

[50:44] Reena Jadhav: God I wish all your doctors would get together and just agree on a single story because there’s a lot of negative information on soy out there. Right. They say well especially if you’ve got concerns are on breast cancer Arctic or soy products out of it.

[50:58] Reena Jadhav: Is that a myth. What’s the truth from that.

[51:01] Mache Seibel: I have interviewed because I’m the editor of height years magazine and I have interviewed the top soy people in the world. They interviewed Candace Setchell and he’s an Sinth University of Cincinnati he’s probably done more papers on this as the candidate imaginate Mark Messina who’s done many of the studies on soy and the data don’t hold up for cancer worries. In other words the later studies have shown that you can even if you have breast cancer take soy or eat soy and it has not held up that’s a myth and their papers that strongly support this in spite of vehement objections of some oncologists and other people are absolute data to support.

[51:54] Mache Seibel: I can’t quote the paper up the top of my head but I have those papers and I’ve written about them in my magazine in my books and there’s it’s just not true.

[52:05] Mache Seibel: Now if you have a cancer already Dan Tsoi or estrogen or any of these kinds of estrogen type of hormones may stimulate growth but they don’t increase debt for instance in the Women’s Health Initiative with estrogen. The overall benefit of hormones for instance is like even if there’s a minimal increase risk of breast cancers as I should mention that people don’t die any sooner with hormones than without the clout that the duration of life isn’t affected at all ends up saying We’re soy be it just the soy is just I have a whole book on soy called the soy solution for menopause. It’s like it does the data don’t support it. I understand it’s out there but it’s not accurate particularly if you stick with the generosity that’s really got to now.

[53:03] Reena Jadhav: So let’s talk about the plan.

[53:07] Reena Jadhav: What do you recommend as a plan for someone who is going through peri menopause or menopause. How can she take charge of her health. Offer hormones and really thrive through this time period.

[53:22] Mache Seibel: Well first of all you have to be proactive.

[53:26] Mache Seibel: You have to go and try to have a list of questions and see whether you see what is your ideal self what is it that is bothering you. What are your risk factors. What are the things your motive most a risk for. Did your mother have breast cancer. Did your mother have osteoporosis that your mother or you or your grandmother had dementia. What’s your family history. Is there a family history of cancer. You need to know about me. You have to really understand who you are and you want to understand where you want to get to. The second thing is to get someone who you’re comfortable with and who will listen to you because you want to be able to have a partnership here you want to be helped and not herded into what seems to work for everybody the same thing. You will go into a shoe store and get one shoe for every woman that walks in it isn’t going to work for menopause either.

[54:16] Mache Seibel: So you’ve got to have a situation where you have someone that is working with you and that’s knowledgeable. So the third thing is you have to decide what are your absolute priorities. You’re going to consider hormones if they’re reasonable for you or you’re not. You want strictly alternatives or not because there is another category of medicines they get to that are treatments that are prescription medicines that are non estrogens that are available for many of the symptoms of menopause more like hot flashes vaginal dryness and why are those. Well for hot flashes there is a medication that’s actually the same medicine that goes into one of the it’s like Paxil is one of the paroxetine but it’s a very low dose and the brand name for that is Brazil. And that is one that can be used as a non estrogen choice for hot flashes.

[55:15] Mache Seibel: There is us Phina which is a pill that can be used for vegetal dryness that can be used. But you can also use estrogen locally even if you have breast cancer currently and even if you are going to treatment and that is an opinion piece published last year by the American College of Obstetricians and Gynecologists. But there is a new medication that’s come out in just the last month or so that’s actually a form of DHEA it’s prast around Peoria’s TDR which is very interesting medicine for vaginal dryness because you put it into the vagina and it’s not estrogen it’s not testosterone but it breaks down in the cells of your vagina into testosterone into estrogen and it is completely metabolized further and never gets in your bloodstream. So it doesn’t have to have any of the black box warnings that say a black box warning is those little things you know caution may cause breast cancer may cause this may cause that that’s not required for the oppressed around. Intra Rosa is the brand. So. So there’s these new medications and increasingly new things are coming out. So there are many options and you have to kind of understand what are your symptoms and what are you doing to prevent these silent conditions.

[56:48] Mache Seibel: We talk about the osteoporosis dementia heart disease etc.. You mentioned that there are four approaches in your back that can help minimize the rest.

[57:01] Reena Jadhav: Of hormones. I want to make sure we get that information in our podcast. For women who are still listening to the podcast and still worried about hormones. What are some the things that you recommend they can do to minimize those risks.

[57:16] Mache Seibel: Well first of all the skin approach seems to be the absolute safest. At least that’s what the data seems to show. So transdermal second make sure that you start at the lowest dose and you can always I always start people at the lowest dose because about half of the people maybe more will be very satisfied with the lowest dose. And then you can always add more but if you give more you’re just exposing the person to more and they may have worked with less. So why start with more than the least. And then you just have people coming back every one to three months in the beginning until they get to the right maintenance dose. Now then the third thing is to have ongoing regular checkups initially and ongoing only while you’re on these hormones just to be sure and by that I mean this may be every one to three months and then every six months and every year. And then finally you have to have at least annual exams and come back. Because in every five years I find that two things happened. One you change meaning you might have some new conditions or something that makes it different or the data may change or maybe something better for you or there may be some new information that you should be aware of with what you’re taking. So these are some of the things that are very helpful for ongoing treatment.

[58:48] Reena Jadhav: This has been so insightful. Thank you for writing your book. For really taking up our cause. The cause of women driving through menopause through boom.

[59:01] Reena Jadhav: As we wrap up are you going to sing a little song for us.

[59:06] Reena Jadhav: Well I can’t see you know I’ve I’ve heard your songs and you’ve got quite a beautiful voice and you enjoy writing and singing songs about menopause.

[59:21] Reena Jadhav: We’ve got to hear you saying

[59:23] Mache Seibel: here’s one just about growing old gracefully. And. It is doing liposuction tummy tuck a facial reconstruction we all learn to live with what we got.

[59:42] Mache Seibel: Of Botox and facial peel white sheet of teeth was really with what we got. You did a book by its cover your sister from your father. That it used to be 30 Gavins 53. We learned to go gracefully.

[01:00:22] Reena Jadhav: Oh that was awesome. That was so fine. You get a whole different career.

[01:00:27] Mache Seibel: Dr. Mays you’re wasting your time doing all this stuff. You should get out there in the music business.

[01:00:34] Mache Seibel: Well it’s fun to sing because it breaks down barriers and people can be you know if you can sing about it you can talk about it.

[01:00:41] Reena Jadhav: You can laugh about it. God knows we need some laughter when we’re going through perimenopause and menopause gets harder and harder to laugh at yourself when you look in the mirror.

[01:00:51] Reena Jadhav: But this has been so much but thank you for taking the time out today. Last parting it by supper.

[01:00:59] Reena Jadhav: What is it like 40 million women going through menopause at this point. And gosh God knows how many more millions going through perimenopause.

[01:01:08] Reena Jadhav: There’s a lot of us out there suffering. Give us give us your parting was done. What is the one thing you want a woman listening to this podcast get out there and do it get better or to look better.

[01:01:23] Mache Seibel: I think the most important thing to realize is it’s never too late to start. I mean wherever you are is a great place to begin.

[01:01:31] Mache Seibel: You just have to get started and invest the time to really know what to do next to become a part in your health care because the time spent on you isn’t lost it’s invested and the return on your investment is going to be better health or happiness and better hormonal balance.

[01:01:55] Reena Jadhav: Beautiful a sad.

[01:01:57] Reena Jadhav: Thank you again and for the rest of the women listening to this podcast. Do me a favor share this with the women in your life. They will thank you for it.

[01:02:06] Reena Jadhav: Let’s all live together through our years of blossom and bloom and let’s make these the best darn years of our lives because we have so much to give with so much to create such beauty to contribute to the world. Let’s not let some brain fog and irritability add a little weight around the tummy.

[01:02:28] Reena Jadhav: Get us down or stop us from being the amazing magical creatures we really are meant to be. So thank you for listening. We’re going to be putting a lot of great links in the Schoenaerts including Dr. mishit new book the estrogen effects as well as webinars. And they will even put a link to his awesome song until the next podcast. Stay smiling stay happy and I’ll see you very soon.

 

KEY LINKS:

WEBSITE: https://drmache.com/

http://menopausequiz.com/

SOCIAL MEDIA

https://www.facebook.com/MyMenopauseMagazine/

https://twitter.com/drmacheseibel

https://www.youtube.com/channel/UCapKJVMLLgYuMOmz2U7nnMw

https://plus.google.com/108235154819728126230

Dr. Mache’s Courses:

http://www.HotYearsMag.com

https://drmache.com/better-sex-blueprint-kit/

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