Menopause Myths & HRT Truths

[Uncle Marv]
Hello friends, I'm from Marv here, another episode of my unhealthy podcast, the show where we go beyond diet and exercise and all that stuff that we say is healthy, and we dive into all areas of our life in a more holistic way to get rid of that, which is unhealthy, so that we can live healthy and be happy. Today I am back with my friend Jennifer Gularson, and we're talking menopause. And on our last episode, we kind of dipped our toes into understanding what went all around hormone replacement therapy.

And Jennifer, I think you did a good job trying to explain to me and the men out there, all the things that we need to know, first of all, the fact that we have our own menopause called andropause.

[Jennifer Gularson]
Yes, this is true. Yes.

[Uncle Marv]
I did not know that.

[Jennifer Gularson]
It is not an isolated thing just for women.

[Uncle Marv]
Right. And to remind the listeners, you are a functional medicine certified practitioner, you're a board certified physician assistant, and you are based at the Osteopathic Center for Healing in Rockland, Maryland. There's a lot going on there.

[Jennifer Gularson]
Yes, I think the more initials you get behind your name, the more alphabet soup it becomes. But yes.

[Uncle Marv]
And you do have you do have alphabets behind your name. I don't know what they are, so I didn't say them. You got a P-A-C and then I-F-M-C-P.

[Jennifer Gularson]
Correct. So, yeah, I'm a physician assistant. And for those of you that don't know what that is, it's nurse practitioner, physician assistant, same sort of in the same realm where advanced practice practitioners.

I went to college, I got a degree, and then I went on to PA school for my advanced degree. So, PAs are modeled under the physician paradigm, and we're taught to diagnose and treat patients, all under the umbrella of a collaborating physician, somebody who is there in case we have any questions. Sometimes they're on site, sometimes they're not, but you're in a collaborative relationship so that there is always somebody backing you up if you have a have a hard question.

[Uncle Marv]
Okay. Now, the Osteopathic Center for Healing, let's also clarify, that's your center, right?

[Jennifer Gularson]
Correct. I work there with my partner, Neil Spiegel, who's an osteopathic doctor, much like an MD, but they're trained in a little bit different way than typical medical doctors. They're more of a holistic approach, and his specialty was sports medicine and pain medicine.

And in that pain medicine realm, he got frustrated with how pain is handled and went to alternatives like he does acupuncture and osteopathic manipulations, just as osteopathic doctors as a whole are just a little bit more holistic, which blends itself or lends itself right into that functional medicine mindset where we are just not naming it and throwing medicine at it. We're trying to get to the root cause of why you feel poor and say, okay, you have this, but why do you have it? And can we fix anything else so that you don't have that chronic disease anymore?

[Uncle Marv]
Okay. Let me ask you this question because for some reason, I always feel that people that have done functional medicine in a way, it's not that they turn their back to regular medicine, but it's considered like the alternative. It's like the insurance-based medical system isn't working.

Let's do this either holistic slash functional medicine approach. Well, let me ask this first, which came first for you, the functional medicine part or the HRT, the hormone replacement therapy?

[Jennifer Gularson]
Those two, the functional medicine and the HRT sort of came hand in hand. I was a regular allopathic person and I still prescribe medicine. I still do the testing.

I still use labs. I'm not all supplements. I do prescribe.

That's the big thing. It's just taking a holistic look at our patients. Gone are the days where your primary care knows you.

They used to be sort of your hub, if you will, and then they loan you out to a pulmonologist. They loan you out to a cardiologist, but then you come back to the hub and then they know everything about you. We don't really have that anymore because really internal medicine doctors are just, and family practice, you're just one of the cogs in the wheel that they never know what the rheumatologist is doing or the ophthalmologist.

There's no communication anymore. You almost have to become your own general practice person. The functional medicine person almost is like that family doctor that takes over and looks at every aspect of you and figures out, do you have one problem?

That's causing all of these symptoms and these problems, or do you have a multitude of other things that we need to fix that's causing this one problem or one disease?

[Uncle Marv]
So we're not anywhere close to that one pill fixes all things.

[Jennifer Gularson]
No. No. They keep asking me for it, and if I had it, I probably would be on an island somewhere.

[Uncle Marv]
Right. All right. So let's now dig back a little bit and talk about what one of your passions are, this hormone replacement therapy, and I guess spreading the gospel about that.

And last time we talked about, from a male perspective, things that we need to know. So I guess this time we can start to dig in to HRT from the female perspective, but we probably need to do a little foundation because I can tell you that when I talk to women about menopause and HRT, it's limited. Because if I know as much as you about menopause, that's not enough.

And I know that there's menopause. I know that there's perimenopause.

[Jennifer Gularson]
Post menopause.

[Uncle Marv]
So I guess we probably should, for the women that either were taught their entire lives, you don't talk about it. It's a closed door thing behind family doors only with your doctor, but there's things that people just need to know, and women also need to be able to know all the things about the pauses. So where do you normally start when you're talking with somebody?

[Jennifer Gularson]
So the first thing is that everything that they are feeling is valid, and that they are not crazy, and that I will listen and I will believe them. Because they've been dismissed for a lot of, by the time they get to me, usually they've been dismissed at least once or twice. So perimenopause is that time before you lose your period for good.

And perimenopause can, for some, start in their late 30s. So we always hear of these women who are having kids later and later and later, but to have kids after 35 is pretty, number one, a miracle, because your eggs are getting less and less and the quality less and less. But you're also experiencing a decline.

So 35 to 45 is sort of that perimenopause. It can start as early as in their mid-30s and then last until you hit this magic day where you have not had a period for 365 days. That is the definition of menopause.

No period for one year. If you go 11 months and you have a period, it starts over. Yes.

So then it's even, it's funny because that one day, day 366, that is you're in menopause for that day, and then you're post-menopause, because you're never coming out of menopause. And if I can just stress that, if you take nothing else away, like once you end your periods, you are never out of menopause. You are forever in menopause.

You are never going to grow back an ovary. Your body's never going to make estrogen again. And you are on a slow decline throughout the rest of your life, unless you do something about it.

[Uncle Marv]
Okay. So obviously we've been poorly educated because I thought that once you're done, you're done. No more menopause.

You're saying that that's not true.

[Jennifer Gularson]
Nope. You're always in it. So sometimes the pesky- I'm sorry.

[Uncle Marv]
So then there's no post-menopause.

[Jennifer Gularson]
So technically you're correct. Yes. But we call it your post-menopausal, meaning like I'm well past that time where I made it through that year.

Okay. I'm 10 years down the road of having no period. That would be post.

You are forever post-menopausal after that.

[Uncle Marv]
Okay.

[Jennifer Gularson]
That one day.

[Uncle Marv]
Now you mentioned that if you have your period, you got to start over. Now is that, this is going to sound gross, but I mean, is that a full blown period or is that spotting or- Good question.

[Jennifer Gularson]
I think you, for a lot of people, and that's another thing, this whole journey is different for everybody. No two people are the same and no people's, you know, menopause is going to be the same. So usually women, once they get close to menopause, they start skipping periods.

They might have one every quarter. They might have two regulars, then none for six months, and then two regulars. So if you technically, and technically, if you do bleed as even if it's a little spotting, that's technically a bleed and it does reset the clock.

However, you do not have to be in menopause to start hormone replacement. That's a big misnomer. Okay.

You do not need to be without a period for a year. You do not need to suffer and you can take hormone replacement. That's another big myth that I sort of tell people, they're like, but I'm still regularly menstruating.

I'm like, well, do you have hot flashes? Yes. Do you have night sweats?

Yes. Are you having heavier periods? Yes.

Are you not sleeping? Yes. Are your libido?

Yes. Like if you are symptomatic, there are things that we can do and you do not have to wait and suffer until you no longer have your period in order to start some sort of hormone replacement or supplements or lifestyle changes that makes the transition a little bit better.

[Uncle Marv]
Okay. So let me ask this sort of dumb question. If you're having a period.

[Jennifer Gularson]
Can you still get pregnant? Is that the?

[Uncle Marv]
No.

[Jennifer Gularson]
Okay.

[Uncle Marv]
No, I'm trying to go off of your concept of if you're suffering.

[Jennifer Gularson]
Yes.

[Uncle Marv]
So I guess the question is what is suffering to the point that hormone replacement therapy is considered? Because, I mean, that to me sounds like, oh, well, as soon as I get a period, I can start getting replacement therapy and not have to go through this.

[Jennifer Gularson]
So it's we have some things available to us. So there are some women who use an IUD and inter uterine device like Mirena that gives progesterone and they actually lose their period. So I was one of them.

I had a Mirena for many years and I didn't get my period that I wasn't in menopause. I just didn't ovulate and therefore I didn't bleed. But I was experiencing symptoms, low desire, weight gain, brain fog, all of those things.

So there are some women who don't have their period who still have symptoms and they can take part of hormone replacement. And there are people that are on birth control pills that have symptoms that maybe should come off of them and go on hormone replacement.

[Uncle Marv]
OK, I thought IUD was part of birth control.

[Jennifer Gularson]
It is. It is. But you also in Europe, actually, they use an IUD throughout this perimenopausal time to try and help regulate.

And then at 55, they take it out and then they hope you're through it and you don't have any symptoms and then they may do other things. So like I said, everybody's journey is different. If you are with a partner who can't get you pregnant, like he's had a vasectomy or you're with a different sexual partner, you don't need that birth control aspect.

You can do hormone replacement.

[Uncle Marv]
OK, so.

[Jennifer Gularson]
We're very complicated. Yes, we are very complicated.

[Uncle Marv]
So it sounds confusing. So that sounds like there can be all these misconceptions about menopause. So I guess.

You've talked about so. We talked about the perimenopause, the menopause, the post menopause. Isn't there a premenopause?

[Jennifer Gularson]
So that would sort of be in that peri part, peri pre. And one thing that we need to remember is that in order for you to have a cycle, a menstrual cycle, there are a multitude of things that happen. But briefly and simplistically, your estrogen increases, it stimulates an egg, an egg is formed.

Now, as we get older, the quality of that egg declines. So an egg that when you were 20 is not the same quality as an egg at 40, usually. So once that egg is developed, it is released.

It goes down your fallopian tubes, goes into your uterus, which your uterus is now full of blood because you've stimulated your estrogen. It's now ready to receive this egg. And if a sperm comes, it's going to implant and you're going to have a baby.

Most months you don't do that. The egg sort of just hangs out there. And the shell that was left over from that egg produces something called progesterone.

As we age in our 30s and 40s, that egg shell declines. It's not as good and it doesn't give you as much progesterone. So you get this imbalance of estrogen and progesterone, which causes some of those symptoms.

Women may feel during their 30s and 40s that the second half of their cycle where the progesterone is supposed to be high, you might not sleep as well. You might get a little bit irritated. You might get anxious and you might have those PMS symptoms that scare the heck out of our partners and our family members.

In the perimenopausal time, I will give women a little bit of oral progesterone during that time to mitigate some of those symptoms. And some practitioners will say, oh, just go on the pill because that'll stop you from ovulating. It'll stop all this chaos.

But it's a synthetic estrogen and a synthetic progesterone. And we know that those aren't as safe as they should be. And there's some natural bioidentical things that are a little bit better for you.

So then when I say you don't have to suffer and you don't, there are little things you can do. Also, your ovaries are getting older. They're producing less testosterone.

Women need testosterone. So in their 40s and 50s, they may see a decline in their muscles. They may see a decline in their mood, in their motivation and in their libido.

That's a time to get tested and maybe give them a little bit of testosterone. So this ovary is sort of limping along until it gives you, it just like finishes and it's done. But you don't have to wait that long in order to replace or help supplement so that your symptoms aren't as good or aren't as bad.

And the other thing that women need to understand is that you may not feel any symptoms. You may just all of a sudden your period stops and you're fine. I have many patients that have that happen.

The question is whether those patients need hormone replacement. And the question and that answer is it's it should be discussed with them just because they're not suffering doesn't mean that they're losing a lot of bone. You lose that within the first three years of you losing your period, you lose a tremendous amount of bone.

And that when you're 80 is really important. You lose your muscle, you lose the protection of estrogen for your heart and for your blood vessels. So you're at increased risk of cardiovascular events like a stroke or a heart attack.

And then also that brain protection. I think some people who don't have physical, physical symptoms like hot flashes, night sweats, not sleeping, the brain fog can be they think they're going crazy. They can't remember.

They can't remember somebody's name. The short term memories, they can't multitask like they could. They can't.

They have to write everything down now instead of just like, oh, yeah, I'm going to remember that. So all of those things sort of coalesce into there are things you can do.

[Uncle Marv]
So it sounds like there's so many things that can be different from person to person from cycle to cycle, even from what it sounds like. Correct. It feels like there could be a lot of misconceptions, both when it comes to understanding menopause and when it comes to HRT.

And then when we talked about the last time you mentioned the Women's Health Initiative, where we started to study, you know, HRT and are we doing too much? And I'm assuming that there were a ton of misconceptions that that came out of that as well. Can you talk about those?

[Jennifer Gularson]
Yes. So I think we talked about how it was a small section of the Women's Health Initiative that was looking at does estrogen prevent cardiac events and is it at risk for breast cancer? And is it as good as we think it is?

Right. So the study ended early. Based on and there's a ton of problems with the study, but based on this one part, one arm of the study that was using synthetic estrogen, something called Prempro, synthetic estrogen and synthetic progesterone, which we don't even use anymore.

So how I mean, it's relevant in that we can glean some information from it. But just know that we don't use those. I don't use those medications anymore.

There was one portion of the study where women were taking that Prempro versus a control, and it showed that the treated women were at a not statistically significant increased risk. So they were at a slightly an increased risk, but it wasn't statistically significant. And confounding that was that the control group were a group of women who just so happened to have a lower incidence of breast cancer.

So you have this one group versus a lower group. It artificially skews the treated group to having more. Does that make sense?

[Uncle Marv]
So it sort of does.

[Jennifer Gularson]
Yeah. There's one group that was just artificially low. So it makes the treated group look worse.

[Uncle Marv]
Right.

[Jennifer Gularson]
But even then, it wasn't statistically significant. But Ann Curry on the Today Show or on the Today Show said breast cancer or estrogen causes breast cancer. So then there we are.

The cat was out of the bag and to pull it back, put the toothpaste in the back in the tube or whatever the euphemism is, you couldn't do it. So now we have 20 years’ worth of people that think that estrogen causes breast cancer. And it just actually isn't true.

And thank goodness we're doing studies now with women who have had breast cancer and who are BRCA positive, who are at high risk, who are now going through menopause. And we're giving them estrogen and we're watching them. We're doing those studies now.

But we know that if you don't really have a risk, that it is safe. And whether you take hormones or not, it doesn't you're either going to get breast cancer or not. Whether you're on hormones doesn't matter.

[Uncle Marv]
Does it doesn't matter if they're synthetic or real?

[Jennifer Gularson]
It does matter. That matters. Yes.

OK, so we do. We have safer we have estradiol now, which is bioidentical, meaning it's exactly chemically what your ovaries used to make and progesterone, which again is bioidentical, meaning it's a fancy way of meaning. It's exactly what your body used to make.

Chemically, it looks exactly the same. The Prempro, they look different. They sit in the receptors different.

Maybe that's why there's an increased risk of breast cancer. But the stuff that we have now in the right hands is safe and probably does help cardiovascular bone breaking risk and stroke and dementia helps all those things.

[Uncle Marv]
So my question is this, how are we making real hormones?

[Jennifer Gularson]
They are still so it's not like we go out back and we dig them up or whatever, but they are manufactured. So when people are like bioidentical, they're made from soy and yams, but they are made in a manufacturing facility. Even if you get compounded hormones, which I prescribe all the time, they are made with chemicals, but they are identical chemically to what you used to make the parts versus Prempro is made from the especially the estrogen is conjugated equine estrogen.

It's pregnant horse urine. They take urine from horses who are pregnant and they get the estrogens from that. So you're using actually horse estrogen versus soy and yams, which is more natural.

[Uncle Marv]
OK. Because for some reason, all I could see is you're taking real hormones and multiplying them because I know they can do that in the lab, right? They do that blood stuff where you just take the real stuff.

[Jennifer Gularson]
Yes. And there are and this is another misnomer with bioidentical or hormone replacement. There are commercially available hormones that are bioidentical.

You don't have to always go to a compounding pharmacy for certain things you do. But there are things available commercially like you can get at CVS, Walmart, any pharmacy you can get them. And insurance usually covers most of them.

They don't cover testosterone, but they do cover the progesterone and the estrogen.

[Uncle Marv]
So can I take us back to the men's part of the conversation when we talk about the low T and what they're selling online? Does it matter to us if that's synthetic or real?

[Jennifer Gularson]
So a testosterone cypionate is a manufactured thing and manufactured drug and that is FDA approved for low testosterone. You can get it in multiple different. I mean, there's probably 50 different things that are FDA approved for men.

Guess how many FDA approved forms of testosterone there are for women?

[Uncle Marv]
One. Do you want none? Zero.

[Jennifer Gularson]
None.

[Uncle Marv]
You got to get some women in the lab.

[Jennifer Gularson]
I know. Not for lack of trying. We got really close with one study, but they wanted six more months of data.

So this is another funny thing. So we had six months of data, safety data for this one testosterone product. And they went to the FDA and they're like, we need a little bit more.

So get us six more months. And the company was like, we'll go broke. We can't do it.

Guess how much, how much, how many months of safety data men needed for their testosterone?

[Uncle Marv]
I was going to say 10 minutes.

[Jennifer Gularson]
Three, three months.

[Uncle Marv]
So that's worth it for hours. That's probably what they do.

[Jennifer Gularson]
So this is where like the frustration and women, when you get into the women's health and you really dive in, it's like it's super frustrating. But so for men, they have gels, they have creams, they have pumps, they have shots, they have pellet, they have all kinds of things available to them. And then women just have to take the men's availability and then either compound it to their, to their dosing.

Cause we're about a 10th of a dose of what a man takes. Um, or we get it specially compounded. So there's like an, even an added, there's almost a barrier to entry for women to get proper hormone replacement because they have to pay.

I mean, there's cheap ways to do it with the testosterone, but, um, it's, it's, it's rather frustrating.

[Uncle Marv]
All right. So two different avenues for men and women when it comes to hormone replacement. Um, so you mentioned all those different things that are available for men with treatment.

You mentioned spray cream.

[Jennifer Gularson]
Did you say gel? Yep. Pellets.

Pellets are, um, these compressed powder. They put them in, it almost looks like a Motrin tablet, or I also say like a big Arborio rice, like a risotto rice. Um, and they're placed underneath the skin subcutaneously.

Um, and they dissolve over the course of about three to four months, depending on your dose. Um, they're controversial. I offer them at my clinic, but it, by no means is the only thing that I offer.

Some, for some patients, it actually is, you know, if they're non-compliant, if they can't absorb, if they, they're, uh, adverse to needles, it's something that they can still get, you just have to be really judicious about testing and you can't, um, overdose patients. That's a bit controversial, but it's, it can be a good modality for certain people. They just, it's something that you, you know, and I always tell my patients, like, if you choose this month to do a patch for your estrogen replacement and you choose next month to do a cream, we can, it's, it's all interchangeable.

This is a very, um, we work together to find out what's best for their lifestyle. For some people, they just cannot remember to take a pill at night or, or they can't remember to put the cream on or it's too much trouble or they're just in a rush. So we just modify things to make it, you know, better for them.

[Uncle Marv]
Right. So how much of what you do is really about what you are and I are doing right now in educating?

[Jennifer Gularson]
So my, um, my consultations are 90 minutes, uh, for the first time that I meet you and I would say like, uh, all but like 10 minutes where I'm like finally prescribing and writing up a plan is allaying fears, validating, um, symptoms, um, explaining why they have been led astray, um, help explaining that, that study, um, and just reassuring that this is the right path for them. Um, I do have patients. I have one specific patient where she has the stuff at home.

She has her estrogen, she has her progesterone, and she's just too scared to start it, even though she's super symptomatic because she has no friends in her friend group that are on hormones and she just feels alone.

[Uncle Marv]
There's a stigma to HRT, right?

[Jennifer Gularson]
Um, there's, I think there's a stigma to, well, and we talked about this earlier. There's a stigma with women not wanting to confess that maybe they're going through quote unquote, the change. I think that's my mom's generation.

I think women my age, I'm 52, I think are 40 year olds. I think 30 and 40 year olds are talking about perimenopause a lot. Thank you.

Tick tock. It is good for some things and Instagram. And then 40 to 50 people are talking about menopause.

And a lot of women are sort of opening up and saying like, I don't, I don't feel like myself, my body has let me down. Is this all there is what's wrong with me? Am I going crazy?

I heard all of that today from three different patients. So I think, um, starting the conversation, doing things like that you're doing and thank you so much for doing it. Um, all the podcasts, all the women who are out there, you know, shouting from the rooftops that this is out there.

It's an option. Does everybody need hormones? No.

Should everybody have a discussion? Yes. Should everybody be able to make a decision?

Yes. Should they know all the facts? Yes.

And should they be able to talk to their partners and their friends about, Hey, what are you doing? Oh, I do this. Oh, I didn't know they had that, you know, or, Oh, you're on.

I mean, I, I, I get patients all the time that come in on estrogen and progesterone, they're doing great. They just want to see if they can, they're eligible for the testosterone. What is their level?

Because they're either GYN or primary, whoever they're seeing won't do the test. So sometimes it's just even gathering information. So.

[Uncle Marv]
Is it that they won't do the test because they don't believe in it or they just, they know that that's not their area.

[Jennifer Gularson]
Um, both of those can be true. I think there's a lack of education. You have to go.

We didn't learn this. This was, we did not learn this in school and there has to be sort of a motivation to go on to, to learn a little bit more. That's a barrier for care for testosterone for women is that it's a controlled substance.

So it's kind of scary. A controlled substance means that the, the, you know, you're monitored. It's kind of like all the opioids.

Those are controlled substances. Um, pain medicines, things like that. Adderall testosterone, because it's an abuse, it has an abuse potential because of you men, I'm just going to give a little jab there.

Um, the, we need to know who's, who's prescribing and who's getting it. And so that we just, it's a safety issue. So that's another thing.

Sometimes people don't want to take that on that responsibility of making sure, um, that, that it's monitored. And then, um, that the FDA, you know, there's no FDA approved form. So we have to go outside of the box, especially for specifically for women.

There's, I can't write a women's dose and send it to CVS and have it filled. It just doesn't happen. It doesn't happen.

And then insurance doesn't cover it anyway. So you have to go about it a different way.

[Uncle Marv]
So education, a big part of it, um, allowing a place for women to, uh, feel safe, judgment free, I guess is a big part of it.

[Jennifer Gularson]
Yeah. Talking about how, um, a big one is, and they're embarrassed. They're embarrassed of how little sex they're having.

They want to know what's normal is once a week. Normal is once a month. Normal is once a year.

Normal. You know, there's embarrassment around that. It hurts to have sex.

That's embarrassing to say, because it feels like, um, and this is where men can, can really step up. They need to know that the moisture in your partner's vagina is not necessarily a reflection on how she feels about you. That can be a completely physiologic thing.

She can still want to have sex with you, but her body is not responding. Um, she also can be super stressed and tired and had a bad day and you didn't pick up your socks. And you said you were going to fix the light bulb and you didn't.

So you could have had a fight with your wife at eight in the morning and she's not ready to have sex at eight at night because you never apologize. So there's a lot that goes into that. But, um, and this is where men can sort of step up and say, like, I know you're going through some hard things.

Um, tell me about your symptoms. Tell me about, like, I listened to Marv's podcast and they were talking about these things and you complain that you're not sleeping. Well, have you talked to your doctor about this?

Is there any way, how can I support you here? It's, it's just starting the conversation and just like, Hey, I've noticed that we haven't had sex in a month. Like, how can we make this work?

Do we need to find time? Do we need to go away? Um, do we need to use lube?

Yes. Everybody needs to use lube. I noticed that you're, it's, it, it hurts a little bit.

Am I, how can I fix that? Should we use, you know, she talked about this stuff called estrogen. Do we need some of that?

Um, so there's, there's a lot of ways to increase your intimacy in your partners with your partner and just having conversations around sex and not making them so taboo, um, making them, maybe it's outside your, you're at dinner and you talk about it rather than right after the fact. Um, but ladies, if you have an orgasm, it increases your oxytocin. It makes you happier.

It makes your skin brighter. If there's a physiologic response that happens. And when men, when you give your partner an orgasm, um, it increases your testosterone.

That is a fact that is a study. So when you please your partner, your, you yourself get benefit from that. So just starting the conversation, it's a hard one, but money has got to do it.

[Uncle Marv]
And if you're listening and wondering Marv, why are you so quiet? I did not get permission from my wife to talk about that part of our life on this show, but, um, Hey, that's okay.

[Jennifer Gularson]
That's right. Yes. But if you, as long as you talk together, yeah, you, you definitely do.

[Uncle Marv]
And there's some things that you said that I'm going to leave it at that. The conversations have been had and I was quite surprised.

[Jennifer Gularson]
Yeah. Yeah. It's, it's, it's, it's very interesting.

And, you know, one thing, one word of advice would be the word hysterical. When you look, listen to that word, Oh, she's hysterical. When a woman has a hysterectomy, that means they take her uterus out.

So the word for uterus is hyst, the hyst, H Y S T of that word. That in and of itself is a derogatory thing. So why are you being hysterical?

That's where that word comes from. Women have for a long, long ago have thought, you know, they get put in the, they can put in the sanitarium because, you know, their husband's done with them. She can't have any more kids.

She's hysterical. Go, go take the opium. So be gentle and think, and just always be curious.

You didn't sleep well last night. Why do you think that is? Is there anything I can do to help you?

Did I snore? Did you take your melatonin? Did you, you know, did you have too much sugar that night?

Whatever. But, um, a lot of these crazy symptoms, itching ears, joint stiffness, frozen shoulder, um, hair loss, uh, can't remember where they were losing track of their keys. Um, they're, uh, trying to think of some of the other things, um, restless leg syndrome, sometimes their knees, uh, frozen shoulder.

So this is a big one where they just have like shoulder pain. Um, it's where the, your, your scapula just basically rubs up against, um, your tissue. Estrogen is very lubricating, um, in all aspects, your eyes, your ears, your nose, your lungs and everything.

But that, um, space in your shoulder is really narrow where your shoulder blade glides over. It is a very common thing for like a woman in their mid-forties and fifties to get this thing called frozen shoulder. They just wake up one morning and they just can't raise their, their arm above their, uh, you know, their shoulder, their arm above their head.

And then they go to physical therapy, they go to the orthopedist, they may get a cortisone shot, but what they really need is estrogen because estrogen lubricates joints.

[Uncle Marv]
Interesting.

[Jennifer Gularson]
Yeah. That's a, that's a weird one. Um, but a very common one and, and is actually getting a little bit more.

There's a big study about that. Um, but they calling it the muscular skeletal syndrome of menopause, just like you have the genital urinary syndrome of menopause, there's a bunch of syndromes and things that we now are all linking together with menopause. But the good thing is that there's hope.

[Uncle Marv]
There is. So I was going to ask you, you know, if there was one, you know, big myth, you could debunk, but you've already mentioned a whole ton of them.

[Jennifer Gularson]
There's so many of them.

[Uncle Marv]
Um, it, it's really, I mean, obviously there needs to be more conversation. People just need to be willing and open to talk about this. So first of all, I want to say thank you for, uh, I know that you're not brave talking about it but coming on this show with me to talk about it and, uh, explain all these things for bringing it to your listeners.

[Jennifer Gularson]
It's really important. And if we change one life, we'll have done our work.

[Uncle Marv]
Yeah. Yeah. So here's going to be the question, because I know that if my listeners do decide that they want to have more of a conversation, you do all of your work in Maryland, you see all of your patients.

It's not something that you do. This isn't like a telehealth kind of conversation, is it?

[Jennifer Gularson]
So interesting. You bring that up. So there, there are some good, um, telehealth for hormones.

Midi health comes to mind right away. And I think there's a bunch of other ones. They cannot prescribe testosterone, so they can do estrogen and progesterone.

And I think that they do a pretty good job. I have inherited a couple of people who've started but then felt that they didn't have a personal connection with the people that they were on the line with. Um, but if you want testosterone, you're going to have to find someone that you physically can go to.

That's an FDA requirement. Um, and you can find, um, on menopause.org. That's the menopause society's website.

They have a list of menopause providers that have gone through extra training. Um, I have not done their certification. I just haven't gotten to them yet, but I've done many others.

Um, but that's a good place to start. And, um, having a conversation with your GYN, usually within a bigger practice, they have someone who sort of quote unquote specializes in hormone replacement. Um, but just, yeah, start the conversation with, but just know that sometimes the allopathic doctors only have eight to 10 minutes to talk to you.

So you may want to see a specialist and pay the money because a lot of us, because I spend 90 minutes with patient, I can't take insurance. Um, but we give you all the forms to file. But if you find someone who is a specialist and you, um, start your care, a lot of times you can transfer over to the primary care and say like, do you feel comfortable prescribing this for me?

That's what some, some people have done with us. And you don't see me very much. As soon as I get you started and we get y'all going, I see him maybe twice a year.

Um, so I have patients that come from all over. I can telehealth to, to states that touch Maryland. It sounds stupid, but that's our malpractice.

Um, so I have a lot of people from Pennsylvania, from Delaware, Virginia, West Virginia, DC. Um, and then also I'm toying with starting like a, like a health coach. Like if you just want advice on what tests should I run?

How do I talk to my partner? How do I do all this? Like that's non-medical.

I can give that kind of advice, but yes, menopause.org is a great place to start.

[Uncle Marv]
All right. Well, I've got that there. That'll be in the show notes.

I'll have your osteopathic center website up and available, but because you've been doing this, this teaching, uh, you've got this passion. Are there other places that people can go to learn more or do you just want to say, get them to menopause.org?

[Jennifer Gularson]
Yeah. So I think if you're on social media, there's some really great big in my, in my world, there's celebrities. Um, Mary Claire Haver has a great book out called the new menopause.

Um, I think that's a great book plus follow her on Instagram. And then, um, if you're having, you know, trouble in the bedroom or you want to have, you know, some conversations there, uh, Kelly Casperson. She's a, a urologist and she has a book called you are not broken.

Um, that's a, and she has a podcast and she has Instagram. She's great. Um, and then, um, one of my fellow Washingtonians, uh, Rachel Rubin, she's here locally and she has a, um, she's been on many podcasts.

She does tons of studies. She's great on Instagram. Um, so just watching those people, listening to podcasts.

Um, I know Mel Robbins, she's super popular. She's had several, she has had Mary Claire on and she's had, um, Kelly Casperson, I think. Um, and then also a great resource on p pbs.org.

Um, they have a movie called the M factor and you can watch that in your own home. I actually suggested to a patient yesterday to have her girlfriends over and you all watched it together and then, you know, have a conversation, but it's, it's called the M factor about menopause. It's wonderful.

It's free. Watch it.

[Uncle Marv]
Okay. As I feverishly write all this down and I know I will do my best folks to have all these links in the show notes. Um, and you can go and grab these books.

I'll find either their websites or if they're on the Amazon, you can go purchase them there. And that'll be a way you can help support the show and help me more, have more conversations like this. So Jennifer, thank you very much.

[Jennifer Gularson]
That was, uh, it is, it is a lot. Like I said, we're very complicated, but there is, there are things that are that'll help us feel better.

[Uncle Marv]
Yeah.

[Jennifer Gularson]
And there you have it folks.

[Uncle Marv]
Jennifer Gularson. And again, I'll have her information there. And maybe if you guys send me a bunch of questions, I'll have her back and explain a menopause one Oh two for men.

And we'll see how that goes. But Jennifer, thank you very much.

[Jennifer Gularson]
Oh, you're so welcome.

[Uncle Marv]
And that'll do it folks. And be sure to head over to unhealthy podcast.com and find the show and your favorite pod catcher. If this is your first time listening, thank you very much for tuning in.

Share it with a friend and, uh, help me reach more people and, uh, learning how to live healthy and be happy. We'll see you soon. Holla.