Navigating “Life Hormones” Through Supplementation & Lifestyle – with Dr. Felice Gersh

Dr. Mindy  

On this episode of The recenter podcast, I have an incredible hormonal discussion for you. I have brought you Dr. Felice Gersh, who is a rare gem. She is a practicing integrative OBGYN, and I can’t tell you how hard it is to find a practicing OBGYN that takes an integrative approach. And what I love about Felice is that she not only is willing to revisit HRT, and you’ll hear that in this discussion, and she believes in, in strategies for leaning into bioidenticals. But she also strongly feels we need to pair that with lifestyle changes. So what you’re going to hear in this episode, I believe, is one of the best discussions that I have personally ever had on this podcast around hormones. And here’s why. When we go into our late 30s, and into our early 40s, we start to lose one of the most powerful sex hormones, she calls them, by the way, life hormones, which is so good, but we lose one of the most powerful hormones that we were blessed with as women, and that is estrogen dial. And estradiol has not only been helping you release an egg every month, but as you’re going to learn in this discussion, she has been stimulating many mechanisms that keep you mentally alert, keep you happy, allow you to sleep, allow you to learn new information, give you surges of oxytocin to allow that bonding to happen with other humans and gives you that libido and, and the intensity of an orgasm, like this one hormone estradiol has been doing so much for every organ in your body, and now she’s going away. And as she starts to diminish in your early 40s, there are many things you can do. And that is why I wanted to bring Dr. Gersh to you all because I hear so many women struggling with weight gain and cognition and depression and there’s so many things that we struggle with as we lose Astra dial and we’re not given a solution to and you’re gonna find a lot of solutions in this conversation with Dr. Gersh. So as I mentioned, we go through what are what estradiol has been doing for you, if HRT or bioidenticals are appropriate for you, and what lifestyle changes you need to make so that you can make menopausal your menopausal transition from an ovulating woman to a postmenopausal woman so you can make that smooth. And if you’re postmenopausal and you still have some symptoms, there’s so much you can do to unwind those symptoms and Dr. Gersh is going to bring it to us. So, holy cow. This is one of the best episodes I’ve literally have brought you all it is such a gift to you to women. And I hope you resonate with it as much as Dr. Gershman I enjoyed having it. So as always enjoy.

Dr. Mindy  

Hey, Dr. Mindy here and welcome to season four of the resetter podcast. Please know that this podcast is all about empowering you to believe in yourself again. If you have a passion for learning, if you’re looking to be in control of your health and take your power back, this is the podcast for you. Enjoy.

Dr. Mindy  

Let’s start by just how do you know if you’re in perimenopause. How do you know if you’re in menopause? Like we don’t even know these markers very well.

Dr. Gersh  

Well, Mindy, here’s the scoop on perimenopause. There is no official definition. There is no set of markers. It’s basically a non entity in our conventional medical world. There was a word you know, like perimenopause or transition, but nothing is done about it. In fact, in terms of the approach by the conventional medical world, it’s just that what I call the whack a mole approach, you know, as a symptom pops up, then you find a pharmaceutical to address it. So if we leave that aside, and we say, well, what’s really happening forget about the conventional lack of approach or anything. We have to redefine the whole concept of menopause because the definition is officially for menopause and this is a

Dr. Gersh  

made up thing. Of course, it’s 12 consecutive months without any vaginal bleeding, you can’t say a period because you don’t know what that bleeding is. A period by definition should mean you ovulated. But you can have dysfunctional uterine bleeding and so forth. So they don’t just define what that bleeding is because nobody’s doing an investigative report on it. So it’s just any bleeding is just they call it bleeding. And so you have to go 12 months without any bleeding. In fact, I’ve had patients come in and say, after nine months, I had bleeding. So I start over, right? The clock starts over, like, reset, it’s like, well, first of all, if you don’t go, if you go nine months, and you don’t bleed, and then you start bleeding, that like is considered abnormal until further, you know, proof that is actually is okay. Because that’s a lot of months without bleeding, we don’t know what that bleeding, it’s very unlikely that you will suddenly start up ovulating again after nine consecutive months. So you know, they define menopause as 12 consecutive months, because our Earth has a 12 month, you know, like, year, it doesn’t make there’s nothing magical about 12 months versus nine months or 13 months, it’s just arbitrary, okay, so we have to like let go of the whole concept of menopause as you cross the finish line. And now you get the label, it’s actually a process. And it’s a process of ovarian aging, or we can say ovarian senescence. This is a very long, slow process. But sometimes like a lot of processes, it’s kind of speeds up at the end, okay, so it’s like flow through flow, and then speed up, okay. But every woman has her own unique journey through this transition. So it’s the transformation of a reproductive woman into a non reproductive woman. And it’s the loss of ovarian production of those two vital hormones that are called sex hormones. But I changed the name, it’s no longer in my world, a sex hormone. These are life hormones. And that’s not love that it’s not perceived as what they are, because these are vital for every organ system in the body to work optimally. So what happens is, we evolved as human females to have a limited lifespan of reproductive capability. And so we’re all sort of on like this, you know, timer, and like time’s up, and, and we fortunately can continue living. But a long life after menopause is really very modern, very recent. And I’ll touch on that because I was very curious about ancient societies. Well, when you go back, they didn’t have they didn’t have a life. And I’ll talk about that, you know, after menopause, except in rare cases. So think of it as just the process of ovarian aging. And with the aging comes aging of the eggs, and fewer numbers of eggs because we’re born with our entire egg supply, and then it windows over time. And not only like I said, does it dwindle, but the functioning of the ovary in terms of its egg quality, we use the word a quality becomes less so the eggs don’t work as well. And that’s why even if you like having ovulation as an older, like Peri menopausal woman, even if you ovulate, you’re less likely to succeed in conceiving, you know, if you want to get pregnant at a later age, which is so popular now. You know, because your eggs are old, it’s just and they don’t work as well. So this process of ovarian aging is built into us. Every female doesn’t matter what continent you live on your ethnicity, any news nothing like I love like meditation or eating vegetables or even like fasting but you cannot stop this inevitability of going through menopause and ovarian aging. You may Leyton the process a little bit delay it a little bit, you know, but you’re not going to stop it. Okay, that is going to happen. One One question that I’ve been dying to get really clear answer on is, what is the what would be considered the healthy time to officially go into let’s say post menopause because I feel like we call perimenopause that time where your hormones are going up and down and now post menopause is when that when you’re officially done bleeding. So what’s what’s a healthy age to do that? Okay, so these are, you know, from population studies. So, menopause is considered normal between the age of 45 up to 55. That would be like the normal span it’s a decade that’s a lot right there. For 55 is called late menopause. Early would be 40, right up to 45. And premature menopause would be before the age of 40.

Dr. Gersh  

So if you’re going to pick in that so called normal span of a decade, 45 to 5555, okay, you want to have ovarian function as long as possible, absolutely. Early onset of menopause, like say, you know, 40 to 43 is associated with earlier onset of all the conditions associated with aging. So I don’t think of aging as due to how many years you’ve lived, I think of aging as related to how many deficiencies have you accumulated, and it starts with hormonal deficiencies, which of course, is preceded by insufficiency, and then it turns into full blown deficiency, and the process of the ovarian aging is going to end you know, and start big. You know, whether you end up in full blown so called menopause, you know, you’ve not had a period for a year at 45, then you’ve started that Peri menopausal journey, a whole decade earlier than a woman who’s going or potentially this is not exact science here of everyone is like a certain timeline. But a woman who doesn’t stop having periods at 55 is going to have a different timeline for when everything is beginning. So it’s really not not a fixed thing for everybody. And it has to do with a variety things like genetics, your diet, your stress, your a lot of things with leading to lifestyle will impact along like always genetics with what is the date that you will expire as far as your reproductive capabilities. And in terms of you know, what is going on during the perimenopause here. So you mentioned like fluctuations. So it’s kind of For some women, it’s very variable from woman to woman. But for many, it’s really like being on a roller coaster of you can have automatic swing. So I have measured, I love data. So I measure estradiol a lot. And so estradiol is the and we can talk about like what is estrogen anyway, but estradiol is the estrogen that is made by the ovaries. And so you can measure it in the lab, you can the the gold standard is blood. And so you measure estradiol, I’ve gotten levels in a woman, spontaneously. This is not with any kind of drug or anything of like 800. I mean, now if you know what levels are at ovulation, there’s just before ovulation, there’s a big spike of estradiol production, which initiates and triggers ovulation. Okay, through then it triggers the pituitary to make a different hormone LH with spikes. And this triggers ovulation. So the highest usually would get would be maybe like 500. But it could be 300. Now there’s a range, it could be 300, something 400, something maybe up to 500. But I’ve gotten levels of like 800, like that woman is on a massive dose of self self dosed estradiol, but then also I could get levels of 20. I mean, this is like post menopausal level. And if you look at gonadotropins, those are the hormones made by the pituitary gland under the direction of the hypothalamus of the brain, that portion of the brain that directs the pituitary gland. So think of the pituitary as the executive assistant to the brain, okay, and it carries out the tasks assigned to it by the brain, which is to tell many different endocrine organs including the ovaries, what to do. So there are these little hormones that come out from the pituitary gland. And when the brain says I want more estrogen Come on, ovaries make more estrogen than the pituitary shoots up the production of its hormones that trigger the ovary and when an ovary can do it. luteinizing hormone LH and FSH follicle stimulating hormone. So if you get really high levels of those hormones, what does that tell you? It doesn’t tell you you’re postmenopausal. Because this can go up and down. But it tells you you’re in the journey, you would not have high levels, unless you were in the journey of ovarian aging that you are definitely like on the timeline, but not in the very beginning. You’re like further down the road to the end of ovarian function if you have high gonadotropins. So that’s one way to market and looking. The other thing that I love to do as a test, but this is not like standard, but I love it is doing like mapping. So this is what urine and you can actually map out this is for someone who’s having a cycle, but a woman who has regular cycles even but she say 48 Okay, oh my gosh, what you find out is that her like her spikes, which are they’re like little blips, they didn’t go they’re not spiking anymore. They’re blipping, and and then you look at the levels of hormones that she’s producing thing. And instead of having this nice like, like sort of a mound that comes up of progesterone mound and like it dips after that spike of estradiol, then you get sort of another mount of estradiol. Instead of that you get like little like little bitty blip ease that come up, like, it’s like a molehill instead of like a little sort of Appalachian Mountain, you know, like a rounded one. Yeah. So, but you’re not getting much. And so those women are really in a state of insufficient hormone production. And they benefit from well attention, which in my case, would include the option of supplementing with hormones. So it’s not for replacement. This Yes, yes. So you know, it’s really important because, you know, when you look at other like hormones that are like insufficient, like thyroid, if, if a woman and women do make up the majority of people that the not all, but the majority of people who have low thyroid hypothyroid. So if you test someone and their thyroid is low, they don’t say, well, it’s not zero. So we’re not going to treat, you know, they supplement with thyroid. So that’s how I think about the hormones of the ovary, even though they’re not zero yet, but they’re insufficient to do all the things to optimize health, then I will supplement them. And I can do that after I actually prove, you know, on a lab test, that these hormones are really being produced at a really insufficient quantity.

Dr. Mindy  

Okay, so I think that is the most brilliant explanation for hormone replacement therapy. BHRT, however, we want to call it because I, I’m just going to speak for what I see out there in the public is that women have this belief that, oh, I entered perimenopause, my hormones are on this wild ride. They go into their doctor’s office, now we’re revisiting HRT, they go in and they think this is the solution, I’m going to take this pill, it’s going to be the solution. But there’s still a navigating that has to happen of our body. And one of the areas I’m very interested in understanding is how our brain does, how does it recalibrate to the loss of these life hormones. And so what I just heard from what you’re saying, is when we see we’re getting close to the end, that’s a great place to come in, and really supplement with age appropriate hormones. Is that is Am I hearing that right?

Dr. Gersh  

Well, yes. And so if we look back, and we talk about the women who are on that roller coaster, it’s high, it’s low, it’s high, it’s low. Why is that even happening? It’s because the brain is perceiving that there’s not enough estrogen. So it puts out that giant signal of you know, FSH and LH the the the hormones from the pituitary, and the ovaries are still capable. This isn’t at the end of the road. This is sort of like in the middle of the road. So the ovaries are still capable of producing estrogen and then progesterone, but we’ll focus on on estrogen because that’s like the dominant I think of estrogen as Batman and Robin is I guess

Dr. Mindy  

I call it I call her the extrovert estrogens the extrovert progesterone. She’s the one that shows up in his the life of the party. That’s

Dr. Gersh  

a look for the female equivalent of that man, right? I wonder woman, Wonder Woman, she. So I love when when the brain proceeds insufficient, it puts out the signals to make more and the ovaries are being actually hyper stamped. So actually, most women know that if they want to, like have egg freezing or if they want to have IVF that the they go to the reproductive endocrinologist who gives them actually it’s like an FSH and it’s like a shot of this FSH is like you know, a similar to the what the pituitary produce, and they’re trying to get hyperstimulation of the ovaries. So the ovaries will release or ovulate a lot of eggs like maybe 10 eggs so that they can retrieve them and create from one retrieval session, like a whole bunch of embryos, you know, or egg freezing if they’re not going to create embryos. So what this same kind of thing is happening spontaneously in these Peri menopausal women. They’re going through like the equivalent of a hyper stem and their brains are telling the pituitary to make all of this FSH to push it out and LH and then you get this surge of puts the ovaries are still able to respond. It’s good. Like think of it sort of like the firework show before the blackout, you know, you get this gigantic, like, man feels like estrogen coming out. But if you give estrogen as bioidentical estrogen dial as a supplement, then the brain won’t go into that. Oh my gosh, give me more estrogen because it has the sensors all the sensors are In the brain, like the Master Control Center, and its senses and it consents, if you give estradiol so I won’t put you on that, while you may have a little bit of a roller coaster still, but it’s not gonna be the wild, you know, you know, like, whatever that man had arrived in Disneyland, you know. So you can at least have lesser excursions have crazy ups and downs, if you give estrogen in the first place. And then also, it’s an interesting thing, you know, I hyper stem, who gets the most twins, it’s Peri menopausal women who get pregnant because they’re more likely to have to eggs come out, and they go skip if they you know, if you’re just sort of still fertile, but not extremely. And then you get that hyper stem from your brain that says, hey, I want more estrogen. You’re basically going through a comparable to if you went and had a stimulation at the infertility office, and they gave you the hyper stem and you got two eggs out, you know, in this case, why and then you end up with twins, because that’s like the most common age group to get twins. Of course, these are fraternal twins, because they’re two different eggs is in that Peri menopausal like around the 40 year old woman who surprised you have twins kind of thing. Wow. So so we can work with all of these kinds of issues. And in terms of like, like, say supplementation, it’s so important to like, that’s why I changed the name to life hormones to realize that these hormones, here’s like a fundamental thing. Humans are the only species on planet earth that tries to control their reproductive destiny, right? So if it’s like mating season, and you have a couple of, you know, elk or rabbits or pick any species of animal when it’s mating season, they don’t say, You know what, I think I want to wait till next year, so that we can get a better home or something, you know, or let’s migrate or something, you know, no date, it’s mating season, they just are animals, and they mate, okay, human, interesting. Don’t do that. Now, you know, now they have, they want to control it, but understanding that we are part of the animal kingdom, and that the Prime Directive of life is the creation of new life. Now, remember, I’m board certified OBGYN, I delivered 1000s of babies. And I figured that out really early in my career, that women’s bodies were designed for procreation, and not just having a baby, first of all, you have to be healthy to be fertile, then you have to be healthy, to be successful through pregnancy and not end up with some horrible complication, then these complications are really rising in incidence. Now, you know, terrible, you know, maternal mortality and morbidity rates are rising, and they’re very high in the US. And then you have to as a human female, you can’t be like the black widow or something, or, you know, like octopus, you know, can lay their eggs and die. No, no, no, we as humans have to raise our young, and we have raised them until they reach sexual maturity. And we have to do this several times over for survival of the species. Now remember, I’m saying everyone should have babies or not whatever they want, I’m talking about how we fundamentally are designed so to speak. So in order to be successful as reproductive creatures, we need not just a functioning set of ovaries and tubes and a uterus and so on, we need a really well functioning cardiovascular system. And we know now that when you have a when you’re pregnant, you’re your blood volume goes up like 50%, and you have tremendous needs for energy production. And you have, like a very, that’s why they call pregnancy now, I mean, I knew this way back in the day, but it’s like the ultimate stress test of a reproductive thing. And so you need to have a really robust functioning heart, and you need great vascular system to, you know, so that you can have a healthy placenta, you know, otherwise you end up with preeclampsia and gestational hypertension. And you need to have great functioning kidneys, and you need great bones and muscles and a brain basically, you need ever the gut, of course, you know, you have every organ system working perfectly to have optimal health, for fertility, for pregnancy for raising the children and being around for a long time because it takes quite a while for humans to become sexually mature and so on. So all of these, Oregon’s unbelievably are controlled by estrogen I call it the Maslow’s metabolic homeostasis are receptors in every single Oregon. So like when you talk we talk about like the brain like that’s a huge topic, okay, women suffer two and a half at least two and a half times the incidence of Alzheimer’s disease as Men, if you have like 100 age matched women and men, two thirds of all the Alzheimer’s patients are going to be female. That’s crazy. It is amazing. The difference we’re not talking about women live a little bit longer. They do statistically a little bit, but they live with more chronic diseases.

Dr. Mindy  

So okay, I want to point this out, because that was such a brilliant explanation of the power of estrogen. And what I’ve been looking at recently is that so it’s specifically Astra dial did everything that you talked about, right? It’s like, I think at best or dial as a diva, she’s like, she’s like the queen that comes out. And she’s like, she deserves all the all the praise she can get. And so what I just heard, and what you just said, is she didn’t just help release an egg, which is, which is the myth that I think too many people have. But she improved the cardiovascular system, and she improved your brain and, and all and she went to all these different organs so that you can have a baby, and then you and you can raise that baby. But then when you go into menopause, she goes away. And all those systems are left, like raw and open and vulnerable, because they’re not getting her nourishment anymore. And what am I looking at?

Dr. Gersh  

Absolutely, we can like look at, you know, like the gut. Okay, so everyone’s talking about the gut microbiome, this collective of trillions of microbial life forms. Well, this has been shown after as menopause is developing, the gut microbiome changes, and for the worse, women as they go into and through menopause, develop impaired gut barrier, a leaky gut. And so that, of course, can affect all different aspects of health in terms of nutrition and inflammation. And of course, inflammation underlies all the diseases of aging. That’s why some clever person called it inflammation aging, but I really think it’s not about like I said, aging, it’s about loss initially, of estrogen, and then you know, ASTRA dial, and then when you lose that, and your gut is now altered, in fact, the neurological system, that’s called the enteric nervous system, that’s the neurological system, that innervates the GI tract that controls motility, you know, movement. And that’s a very complex kind of a function, because everything has to be perfectly timed and moving is like amazing. And that’s actually regulated by the autonomic nervous system. And the neurotransmitters because neurological system is nerves, the nerves have neurotransmitters, and there’s two branches of the autonomic nervous system. And the parasympathetic is the one that sort of calming, it makes gut function like optimal, you know, like things are moving, okay? And that has the neurotransmitter acetylcholine, that is modulated, like regulated by Astra dial. And of course, acetylcholine is a neurotransmitter, which in the brain helps with cognition, that’s the neurotransmitter that the drugs like our receptor trying to increase, okay. And then the sympathetic nervous system of the autonomic nervous system is the one that’s activated as a stress response. And let’s put it this way, if you’re very stressed out, the last thing in my mind, stress meaning like in the olden times, like you need to run for your life fight for your life, you know, that kind of stress, you know, the fight or flight kind of thing. That’s the last time that you know, that you would be thinking about, I think I need to digest food, okay, that’s, that’s not a survival priority at that moment, you know, so you’re not going to be putting a lot of energy into the GI tract at that moment, you want to put it into your brain, into your muscles, and so on. So if you’re chronically stressed, then you’re going to have poor gut function, poor gut motility that can lead to SIBO and constipation and all these problems. And that’s what happens to women as they transition into menopause, they become more sympathetic. And that’s not like an empathy thing. That’s a stress and less parasympathetic. And it turns out that the neurotransmitters of the sympathetic the stress part of the autonomic nervous system, and that is normal. That’s the norepinephrine and epinephrine and they are modulated by by extra dial and the branches from all of these nerves like from the sympathetic and the parasympathetic, which is the vagus nerve. They go everywhere in the body to every organ system, so and they become dysregulated when you don’t have enough estradiol. So that’s why so many of the symptoms associated with menopause are related to the autonomic nervous system dysregulation like palpitations, and women get all the time they get palpitations as they are transitioning and in menopause, and they run to the cardiologist. Who put them on beta blockers? These are types of pharmaceuticals. And that slow heart rate but they don’t just slow heart rate, they make you more sluggish. They can cause wake, you know, so they have side effects like a problem. Yeah, right. But it’s an Yeah, if you can see or insufficiency, and then you go Oregon, I could go Oregon system by Oregon system for what the effects are. And that’s why the effects just from that one thing, I’m just talking about one thing, and then you could go, you know, who every other aspect. And the one of the things is like the immune system, which we can talk about too, because that’s like key to everything, you know, the immune system, and that every immune cell in the body has estrogen receptors.

Dr. Mindy  

This is why she’s a diva. This is why she’s a diva, like she needs to be she needs a crown, she needs to be highlighted. You know, I’ve been doing some research on what happens to the female brain as we go through menopause. It’s part of what I’m writing for my next book. And if I look at estradiol, she can act as she can activate serotonin, dopamine, acetylcholine, glutamate, and even oxytocin, I’m finding a lot of really interesting research on how she commingles and stimulates oxytocin. So if we just look at those neurotransmitters that she has power over, we’re now looking at happiness, we’re looking at cognition, we’re looking at Build ability to hold on to new information, we’re looking to add the ability to feel connection to others, we’re looking at orgasms like these, this is a big deal when she goes away, because it’s not just her that is starting to go into this down moment. But it’s all her learning little neurochemical friends that are going to start to follow. And I believe this is the biggest mental challenge is for us to figure out how to deal with this. I call it the neuro chemical armor. I feel like our neuro chemical armor starts to shed. And then And then what do we do? How do we help women at that point?

Dr. Gersh  

Well, absolutely. And, you know, really excited for your, you know, researching and understanding all this because so few people understand that there are serotonin neurons that actually require estradiol they actually shrivel, okay, they really drivel. And like you said dopamine and oxytocin, the receptors for oxytocin do not work properly and an absence of adequate estradiol. So it’s like, so critical. And oxytocin has many different functions in the body, but it’s very important for sexual function. A lot of people don’t know that. So oxytocin is important if you want to have an orgasm. And that’s one of the reasons why that changes, a lot of people think it’s all testosterone, but it is not. And testosterone, by the way, has its own set of receptors, which estradiol helps to activate and like makes it is more functional in an environment with estradiol. So all of these things, and then it is it’s just so amazing oxytocin, another thing that it does is it helps regulate appetite. In fact, all of the appetite regulators like ghrelin, leptin, the things that turn on and off appetite, are all regulated because by estradiol, because part of reproductive success, if you go back to thinking, how does this relate to reproductive success? Well, for an animal humans included, in order for them to be successful, they have to match their intake of energy, aka eating to their energy needs. And so estradiol helps to regulate that. So when you talk about in the brain, okay, so in the brain, there’s a thing apart called the hypothalamus. And that has estrogen receptors everywhere in the brain has estrogen receptors and not just one type. Because there’s more than one type. That’s why you have you don’t want to give a pretend estrogen that only works on like, say one receptor, you want to get the whole balance. And the hypothalamus is very critical for many of the metabolic functions of the body, like temperature regulation, that’s where you get hot flushes and flashes and things when you don’t have enough estradiol and appetite regulation is so key. And so women after menopause and perimenopause, they often will have binge eating disorder. This is all brain controlled stuff until sepsis mood, there is cognition. There’s no regulation of all these metabolic functions. And the master clock of the body is sits in a cluster of neurons, a top the optic nerve that senses light and dark and nutrients. And this is a cluster of neurons called the Super kayas Matic nucleus, but it’s the master clock, and so few people understand this but Astra dial is a key come opponent of regulating and keeping us on the beat so that all our Oregon’s no work in different time zones. And we don’t and without extra dial, we end up having a drifting of this master clock. So women without adequate extra dial basically, they live a life of jetlag. And there’s so much research on the harms that happen if you’re jet lagged, you will have more depression, anxiety, insomnia, diabetes, cancers, all these things. And this is all in the brain. So like we’re gonna have and they’re not leaving.

Dr. Mindy  

They’re not even leaving their timezone. And they’re jetlag. Oh, that’s right. And

Dr. Gersh  

then if you add a woman who is like, maybe she stays up late on the weekends, or she travels across time zones in a plane, that’s just fuel to the fire of circadian rhythm dysfunction. So all of this is brain related. And the immune system I mentioned the immune system, the brain has its own embedded special immune system. And it includes things like the microglia. And the astrocytes, the Astra glia, these specialized immune cells that reside in the brain are they’re surveilling, they’re supposed to be in like a calm state normally, but without estrogen, they become like weapons of mass destruction, with no control. And they can release toxic like enzymes that dissolve and cause damage. So it’s like a bunch of teenagers on a rampage with nobody in control of them. That’s what happens with these microglia, they leave their sort of quiet surveillance state and become like aggressive animals inside the brain. And they can actually start destroying healthy neurons. And then in response, the neurons are trying to heal, and that’s when they produce the amyloid beta. So now we know that all those drugs that are trying, they’re giving out like water to mostly women who have Alzheimer’s, that to try to destroy or get rid of the amyloid beta. That’s not the underlying, we always talk about root causes. That’s not the root cause of dementia of Alzheimer’s disease, not at all. That’s the body’s response to ignore neuronal damage that’s caused by neuro inflammation that is occurring because of inadequate extra dial in the brain. And the brain loves estradiol so much that it has the enzymes to make estradiol. And in fact, reproductive aged men versus reproductive age women, their brains make six to eight times as much estradiol in their brain, and they make it from testosterone, because all estradiol is derived not just a little bit, all of it. 100% is derived from testosterone through the action of an enzyme called aromatase, and this enzyme aromatase exists in the ovaries, but it exists in other tissues as well. And that’s how men get estradiol, like the artery, their own extra dolphin testosterone men.

Dr. Mindy  

So okay, so if we, I hope everybody listening just got what one life hormone has done for you. And, and it and there, I can tell you as a menopausal woman, there’s this moment where I’m like, Man, I took all these hormones for granted, like I had no idea what they were doing until they went away. So if we look at estradiol, and we know the impact she has on everything you just said, how do we help? I mean, we’re going like you said, we’re going through menopause. So do we need to do supplement with estradiol earlier in our 40s? Do we? What lifestyle tools do we have? Like, how do we accommodate for her loss? Because man, was she helpful, and now she’s gone?

Dr. Gersh  

Well, all of the above. So basically, no matter how hard we try, we haven’t gotten to the point yet where we can replicate all of what a healthy functioning 21 year old set of ovaries can do. So when we give hormone supplementation hormone replacement, it’s not the same as giving replacement ovaries, we have to be very honest about that. It’s just better. It’s a lot better than not having the hormones and we want to get out of the mindset that came from that study. Have you maybe talked about it? So the Women’s Health Initiative was a study that ended just over 20 years ago, and they did not use human bioidentical hormones. They used Premarin that’s the brand name for equine conjugated equine estrogens, which is estrogens that have already gone through the liver for transformation so they can be removed from the body through the urine through the kidneys, and it’s from a horse that’s where you know it’s equine horse. It’s a pregnant horses, your end estrogen, just you know, discarded grab, you know, the horse doesn’t even want it and More. And it’s modified. Actually, this was all they could do, like 70 years ago, they didn’t have the ability to make human bio identical, but we don’t come a long way. But that means we have to change what we’re doing. But that’s what they used in this study, because it was still commonly used. And they gave it that, you know, like, they dry the you horses urine, they turn it into a tablet, and then they feed it to women. And it does do one thing, it does definitely reduce night sweats and hot flashes, even a horses, you know, you know, discarded estrogens, you know, I can still do that. But they combined it with a chemical medroxyprogesterone acetate, which turned out to be even more evil than the Premarin. And so the results of that study, which actually weren’t as bad when they re analyzed it, but it really was not what they’d hoped for anyway, the bottom line is, they shut down the study early, and then all the media put out all this stuff about estrogen increases everything bad, you know, it increases strokes and heart attacks and, and dementia and breast cancer. And it really was not had nothing to do with the hormones I prescribe. And they actually blowed it all out of proportion. Anyway, it was crazy. And, but the legacy of that study just won’t go away. And the legacy was, first of all, don’t give hormones unless you absolutely have to, when you do give them give the smallest dose for the shortest time. That is ridiculous. It would be like saying, broccoli is good for you. So eat the smallest amount for the shortest time, you know, like, one night a month, but don’t take it for more than five years. You know, that’s what they did with my beautiful extra dial, you know, the Devo.

Dr. Mindy  

Dave, I got that. No, she got one song she can sing at that stage. Oh, my gosh,

Dr. Gersh  

it was so sad. And of course, I never believed that I was in you know, practice at the time. This is like I was I was around 20 years ago, and I was practicing. I said to all my patients, this makes no sense. This makes no sense stay on your hormones, and a lot of them did. And some of them didn’t. And the ones who didn’t, or sorry, they didn’t stay on them. But you know, it was the pressure that came out from other doctors from the media was so powerful. So fear inducing, that hormones were evil, that even if you were going to use them, you want it to use very little. So what I’m telling you is that when you give hormones now, you want to give human cloned type hormone. So it’s identical to what the ovaries made. And you want to give it at a dose that’s physiologic, you want to give a dose that’s like about the average level that say a woman who was 21 might have in her body. It’s not exactly it’s not an exact science, it’s still an art. But you don’t want to give tiny doses, it’s like, it depends on what your goal is, if all you want to do is suppress night sweats and hot flashes, it’s amazing how little you can give. But if your goal is maintaining optimal total body function, then you cannot do the tiniest possible dose. So you have to give physiologic dosing, and you have to post the progesterone because you have to try to mimic sort of mimic what a normal healthy woman would have in her 20s And you know, you haven’t done except some of the you know, some of the but you know, you can compromise everything in life can be compromised.

Dr. Mindy  

Okay, here’s a really interesting idea. So I’m I’m a fan of pulsing everything because especially for the female body because we work rhythmically, so that goes for supplements that goes for fasting that goes for food, like I’m a big fan of that. But when you end up looking at a menopausal woman, since we don’t really have like a bleeding cycle to follow, I have been encouraging women to especially with fasting and food to look at the moon cycle. Because some of the research that I saw is that actually, if we didn’t have all this blue light, that we as women would actually be more in tune with the rhythms and the light of the moon. And I actually recently had a conversation with a yoga instructor on the island of Hawaii, that told me that they have figured out the North Shore of Hawaii, that many of the women that are there, they’re outside so much they’ve all started cycling together. And I asked her Are you guys cycling with the moon? And she goes I don’t know. I have to go back and look. So I bring this all to you to say Could we like if the new moon would be what the day one of your cycle? And ovulation would be like day 214 15 Could you look at cycling your bio identicals according to the men

Dr. Gersh  

well definitely that has been talked about now. Oh, it has Okay great. Oh, yeah, yeah. So um, so in turn, but not not by a lot of people but I really with it, and it’s been talked about now, where would that even come from? Well, let’s think remember, we are Earthlings. That’s why our circadian rhythm is based on the 24 hour of earth, not of Saturn. Okay, so we are Earthlings. Even though I love Star Trek, we are Earthlings. And we have a moon. And what did women develop a lunar cycle, right, a 28 day cycle, just like the lunar, you know, kind of have a full moon and then you go to the new moon and that sort of thing. That’s the lunar cycle. So the theory is you can’t prove it because we can’t we don’t have documentation from prehistory. That’s why they call it historic times. But that the full moon would be romantic. In fact, we talked about the full moon is so romantic. And you can see because you have light. Remember, this is like, prehistoric times. Okay? Yeah. So you have light at night. So all women with cycle just like if you look at animals in the wild, there is a mating season. So for human females, the mating season was the full moon, but it was every month, okay, because women didn’t, you know, humans don’t just have a mating season for a few months of the year or a little bit, we do it every month. So the idea is that your most fertile, and all women would then cycle together with accordance of the full moon, and what would happen on the full moon, that’s when ovulation would occur. And it’s been shown that there’s a slight peak in testosterone as well. And that would drive up sex drive, and you have that big spike of extra dial, which would increase oxytocin, and they would have warm and fuzzies. And, you know, like more more sex drive, and then they have a spike of testosterone all works together. And they’re ovulating, all the women are now going through their same mating season of the one day, know the one day because remember, your egg is only good for one day, that’s one thing, it’s only good for one day for fertilization, the sperm can hang around for a while for like few days, but only one day, 24 hours, and that egg is no good. So everyone would ovulate on the full moon. And that’s how the men would find them. Because everyone would have increased sex drive at that time, would have a little spike of their testosterone too. So if they could find everyone, they could see it, it’s romantic, and everyone would cycle together. And they would all you know, be ovulating together and they talk about like the red tent, if you didn’t get pregnant, you would have your periods together, and the women would go into the tent, and they would go

Dr. Mindy  

do this anymore, we need to do this, we need to do this again,

Dr. Gersh  

if you have women and one is like the alpha female, not because we’re not outside, like in prehistoric times. So we don’t live with our nature with our moon and so on. So we’re like indoors, and now even, you know, with all the ambient light outside, some people can’t even see the stars or the moon, right? Because it’s like, oh, that light out there. But if you have a dominant sort of alpha woman in like a college dorm, it they’ve shown that there can be that nowadays, unfortunately, they’re all on birth control pills. Oh my gosh, that’s another whole story. Oh, that’s it, they’re having natural cycles, you know, if that were to happen, they would have followed not the moon because the moon they’re not outside enough. They’re not getting that, you know, that whole stimulation from the, from the stars in the solar system and the moon and the sun. So they they just start cycling together. But based on the dominant female, you know, so it’s kind of an interesting thing there. But there’s nothing wrong in giving hormones to blend with the moon. If people would like to do that. We don’t know that that makes you healthy. I think, you know, it’s kind of romantic anyway, you know, it’s kind of Yeah. And I It makes total sense for reproductive success, you know, that, yeah, that we would have these identical cycles, and everyone would be fertile on the full moon. And that’s our true mating season for for humans. And so it’s just been, like, you know, it’s, I love you know, the romance of it. Yeah,

Dr. Mindy  

me too. And it gives us it makes me feel connected to the earth. So I love

Dr. Gersh  

that you have to write.

Dr. Mindy  

And so that’s, that’s another win for it. So okay, let’s go back to this idea. So I’m in maybe my early 40s. I’m finding estradiol doing her thing she I’m starting, I have a lot of my friends in their early 40s will say like, Yeah, I noticed my personality is changing, things are changing. So your recommendation would be like, let’s map let’s map out your cycle, understand where you are. Let’s get some blood work. And let’s start to put you on some bio identicals. Now, my and I’ll let you respond to that in a moment because I may have gotten that wrong. But my other question to you and this is the one that I don’t think has been discussed enough, is because we live could pop pills, we like a pill to save us we’d like a patch to save us a cream, however, we’re going to do this, we lose sight of the lifestyle that needs to be matched to that. So what lifestyle would you match to somebody going on either HRT or BI are identical,

Dr. Gersh  

right? Well, perfectly, because what I was, like starting off, and then we got on that beautiful tangent is that no matter how hard we try, we’re not going to replace the ovarian cycle and the hormones are the same. It’s we tried to get closer, but it’s not the same. So we need lifestyle. It’s never I call the hormones are foundational, like you might say, necessary, but not sufficient. Okay, so we need to pull all our tricks out of our therapeutic toolbox for lifestyle medicine. So it’s basically the fundamentals of like functional medicine, you need to start with nutrition, and you have to knowing that you’re going to have leaky gut, you need to really work hard to nurture your gut microbiome to eat high, you know, nutritionally dense foods and avoid chemical laden foods. Of course, you know, processed foods are like evil, let’s just be real. Okay? The foods that I would ever like, say are okay, would be a glass jar. And in it, if you look at the ingredients on the label, it says ingredients, organic stewed tomatoes, that’s it. It’s like so it’s that would be what you call minimally processed. Okay, that’s it. Like if it has chemicals. No, that’s not food. In fact, it’s weird. Like, would you lick the floor? It’s so weird, what will actually consume?

Dr. Mindy  

It was really sad.

Dr. Gersh  

It is so weird. So you got to eat to nurture your gut microbiome to help maintain gut integrity. It’s so so important. And part of maintaining the gut integrity helps with having nutritional status. You know, you don’t want to be malnourished. That’s like the key to poor health is to be malnourished. So you want to get all the potent antioxidants. You want to have all the you know, the micronutrients, the macronutrients, and here’s the other thing, the poly phenols and this is like really important because nature was very kind to us. If we take advantage of it, you know, their gifts, the bounty of phyto estrogens, they are our best pals. Okay, all the foods and all the food groups have phyto estrogens, a lot of the foods that people have talked about as you know, like these are like, the best foods, you know, like these are the star foods and like pomegranates, you know that like, oh, you know, like fake food, you know, eat pomegranates. Well, I’m all for eating pomegranates. But what was it that was made so special? I mean it well, fruits are very special. But well pomegranates have allergic acid which turns into the Euro liscense those are phyto estrogens and of flaxseed. A lot of people talk about like flax seeds for helping to regulate menstrual cycles and for health, flax seeds. They have lignans. lignans are another type of phyto. Estrogen soy which has been maligned as long as it’s whole organic soy really healthy okay. It’s a been raised soybean people in Japan had the longest lifespans ate a lot of soy. Yeah. Okay. So do you

Dr. Mindy  

know they also been a in Japan, only 4% of women going through menopause go on HRT now. And that’s because of symptoms. That’s not because of compared to what we do here in America, which is still more than necessary. But I’ve often wondered, Is there something in their lifestyle that makes them turn last to HR Teaming is your gradual decline?

Dr. Gersh  

Well, you know, I’ve Well, as I sort of separate also issue, how you fare when you’re transitioning has a lot to do with what I call your health savings account, like the health that you have, when you hit this time of life is going to dictate a lot of what happens to you from that point forward. That’s why you have to start working to be healthy, early, early in life, of course, like in pre natal times, you know, you know what you’re like, when you’re a fetus, you got to vote,

Dr. Mindy  

where you’re born, you need to work on it. Or not, who

Dr. Gersh  

gives you the right nutrition when you’re, you know, still in the womb, so to speak. Yeah, but you really need to look at these. Yeah, the effect of phyto estrogens actually, there was a study by Dr. Barnard who’s sort of renowned cardiologist vegan he loves to do studies about veganism. And by the way, I don’t advocate for veganism, but I do tolerate vegans very well because I’ve two of my kids are vegans. So I love a lot of vegans told that I love them. I like tried, you know.

Dr. Mindy  

I birthed them, I feed them.

Dr. Gersh  

So his study was very interesting. He gave women who had very substantial hot flashes and night sweats very substantial and He gave them like a cup of soybeans every day for 12 weeks. And they had dramatic reductions in their night sweats and hot flashes from the phyto. Estrogen So, and that’s what probably is going on in those Japanese women. So this is nature’s gift to women, because, you know, I’m all for giving hormones, but there are some women that for whatever reason, they can’t or they won’t, well take advantage of nature’s gift with the phyto. Estrogen. So like, because soy has the isoflavones which are and then a lot of people talk they know about resveratrol, okay, Resveratrol is in the stilbene family of poly phenols. That’s a phyto. Estrogen. That’s what says I talk about red wine and the skin of red grapes, that’s a phyto. Estrogen we can go every all the beans and nuts, seeds, the fruits, the vegetables, they all have all these phyto estrogens. So this is like, has to be included in your diet. And of course, you’re not sure, of course for the poly phenols. And it’s also for the antioxidants, the vitamins and minerals, all of these things. So a really great plant based diet with small amounts of animal, okay, to help you source the healthiest source that you can, you can get, you know, for some animals, and so you got to work first on nutrition, you know, as supporting your, your overall health. And then we get into all the other aspects of lifestyle,

Dr. Mindy  

right? I mean, there’s so many things that we could unpack, it’s and I just want what I’m hoping people gleaned from this conversation is there are so many things you can do to help yourself. And we’re not, we’re not talking about that. So, and I want to talk about exercise in a moment because I just found some really interesting studies on exercise and BDNF and neuroplasticity that I think is really interesting. But before I do that, you brought up resveratrol, we have to bring up wine. Okay, there’s so much like, lashing out about drinking right now. And I’m not saying that alcohol is a health food in any way shape, or form. But when we look at the menopausal woman, we’re also losing progesterone, which, which causes us to lose GABA and calming our shit down. It’s gonna say it can be a little difficult and a little glass of wine here or there, it can be that thing that just allows you to, to calm yourself. Now having said that, you also have to process wine through the liver and the liver is and it goes into the gut. And this is what’s breaking down the little bit of estradiol you might be getting. So where do you feel like why alcohol fits into the menopausal life? Are you like completely knock it out? in small amounts? Don’t worry about it. Where do you feel like

Dr. Gersh  

there is no defined health benefit from alcohol itself? And so in fact, they keep coming out like you said stricter and stricter restrictions on you know, intake of alcohol, if you are healthy, so not when you’re trying to rebuild your gut microbiome or deal with a lot of symptoms with say you are now like replete on all your nutrients. You’re you’re properly hormone alized and you’re just living the good life. You know, you’re the ideal, my ideal patient after I treat her, right, so good, everything is good. And you know, you go out and you celebrate, and it’s Saturday night at this fine restaurant, you want a little bit of wine, having one glass four ounces, not this jumbo thing, okay, like four ounces of wine, like, you know, for a special occasion. If you’re already in good shape, you’re healthy. Your gut isn’t a disaster zone, then that’s okay. You know, it’s just like, can you go to a wedding? If you’re not like you don’t have like a gluten problem, you know, and have one piece of wedding cake and it’s like, you know, like someone you love. It’s part of your family best friend or something. Can you have any birthday cake? Can you have any wedding cake? Yes. Okay, for me, I have to get the gluten free cake. But yes, I will know for special occasions. Yes, you’re allowed to have some special indulgences. But you shouldn’t be doing it when you’re trying to really get back your health. You have to first have your health and then you can have these little splurge is

Dr. Mindy  

little splurge. It’s okay, perfect. Thank you for answering that. Okay, now exercise. So to me exercise for the menopausal woman is a little bit of a catch 22 Because as estradiol declines, we also lose collagen. And what I mean this is one of the reasons why we wrinkle but what I also see with some extreme athletes is they really are women that just work out a lot. They start to injure themselves more so I can tell you, in my 53 year old body I had to really change the way I exercised because I couldn’t go as long or as hard. But when I look at the research on exercise, it It does a lot of the same things estradiol did, it helps upregulate BDNF, it can actually stimulate the five H T to a serotonin receptor site like estradiol did. And so it has some characteristics that are similar to extra dial and I can tell you for me, if I go walking, if I do yoga, if I do even short, high intensity training, the more I exercise, the better my brain feels. So, what are your thoughts on exercise? Is there a balance to what we should be doing? Is there a type we should be doing? And can we look at as just like we would look at the soy bean as giving us this, you know, extra little burst of phyto estrogens? Can we look at it to help recover our brains from the loss of our divas, our diva Esther dial? Well,

Dr. Gersh  

absolutely, nature gave us some really amazing tools like and we’ll we’ll say support systems. So you know, we have the foods support system with the phyto. Estrogen and we have exercise. So people have talked about this, and I agree if you have to pick one, like we’ll say master therapeutic, it is exercise because exercise, reboots the gut microbiome, exercise is a fasting mimetic is like it can mimic some of the same benefits as as fasting, you know, life’s increasing brain derived neurotrophic factor, helping reboot the gut microbiome triggering all these rejuvenating functions of the body. So yes, it is amazing. And the thing that you said is so really critical, when if you’re not on any estrogen, and even if you’re because it’s not going to be the same, understanding that there are changes in your musculoskeletal system with the loss of these hormones, and it sets you up to more potential for injury because like you mentioned, you know, like collagen, that’s a huge thing. But also as part of like, in the joints, and ligaments, tendons, you know, elastin, which keeps things like soft and flexible, instead of everything bending and being flexible, things become stiff, and tear instead of bend. So like more likely to have you know, injuries, if you’re not careful to, it’s really important not to over stress, you know, your joints and, and so on. And just be aware of your limitations. And but resistance training is really sort of come into its own now, in terms of trying to maintain bone and vital muscle, which has never seen, you know, the, the PR that it should deserve, you know, because muscle is not just about strength and movement, which of course are vital, but it’s they’re also endocrine organs, like everything else, you know, they make these special signaling agents Mitel kinds, they also are the structure in the body that burns glucose. So if you don’t have enough muscle, you’re going to be ending up, you know, one of the skinnies that gets diabetes, and they actually have worse outcomes. They overweight ones with diabetes. So you don’t want to be that person, you want to maintain your muscle mass. And it takes the whole combination of nutrition and exercise and in my book, right, the hormones and the hormones. And that’s the point

Dr. Mindy  

that I that I think I really want everybody to get is that if I could go to every woman when she hits 40 I would say just know there’s a lifestyle change that needs to happen at this moment. And if you make these changes, along with testing your hormones along with staying open to what do you call it? You didn’t call it real placement you called it I forget you had a different name, I liked the way you said it. But that we can maybe take some exogenous hormones and but there’s a change that needs to happen and that is what’s not getting out to the world. We just are going along going along and then boom all these symptoms hit and then there’s no resource for women to be able to put the puzzle pieces together and then we go looking for one thing we’re like what’s the one thing you know when I have a headache I take some medication if I you know if I want to lose weight I exercise more like we’ve been this one thing culture. But I don’t think the menopausal experience is a one thing approach. Don’t you

Dr. Gersh  

know and I am so happy you said like 40 Because when they look at the data, okay? The bad things that start that are associated with aging are happening in those pre menopausal years. The perimenopause, for example, vascular changes like plaque developing more rigidity of the arteries more likelihood of starting the beginnings of hypertension. loss of bone bone density can be dramatically reduced during those Peri menopausal years. So you still can have cycles, but the hormones are not the same. You know, and like you talk about the brain word finding. So they’ve done studies published that word finding. It’s always nouns. Okay? Women have trouble getting names. And this happens before menopause before the official menopause. And it makes women think, what am I getting demented? Well, it is actually a brain change. And it’s real. And it’s, it’s universal. They’ve shown it’s really universal, different degrees for different women. And it’s like I said, always now. So everyone’s playing charades. It’s like, you remember it was that person? Remember, they, they wore glasses, they had brown hair. She had the salmon, you know, like, what was her name again? You know, they can’t remember names, or what was that movie? Remember, remember, there was like a star in it. And the plot was about saying, but I can’t remember the name of the movie. You know, they just can’t remember names. And so it’s like, playing guessing games, or, you know, it was bigger than a breadbox, you know? It’s like, oh, yeah, it’s really quite universal. True, published on that. Because like you asked me, like, early on in our little conversation, like, how does the body adapt to for the brain loss of estradiol? And the answer is, it tries as best it can, but it can’t really make it up by itself. So you have to take the steps and and going back like looking at ancient civilizations, like I checked out Ancient Egypt, okay, so they How can I check out Ancient Egypt because they actually had hieroglyphics they were like, they actually wrote history. I remember before that there was no written word, you couldn’t know what was happening because there was no written record of it. And when they found the Rosetta Stone, and they could actually decipher the hieroglyphics so much of what was going on in ancient Egypt was known. And this is three to 5000 years ago. This is not that far into the history of humanity. Humans go back way before three to 5000 years ago. But what was the average lifespan of a female in ancient Egypt? Well, if she survived childhood, which was a feat in itself, you know, not everyone got past childhood, her life expectancy was maybe 35. So you know what, menopause was not really a thing, you know. And then you look like 1200, you know, and then up until maybe a couple of 100 years ago, the life expectancy, if you survived childhood was maybe into the early 50s, maybe 55. So women would just live a very short, relatively short part of their lives in menopause. And so it really not that there was anything they could do about it, particularly, but it really wasn’t such a big thing, because it was really the end of life. It’s really modern times, I mean, really modern times that women can literally live half their lives as a menopausal woman. Yes. So this is so new, it’s like a blip in the whole timeline of humans on planet Earth. And there was no grand scheme for this in nature when people say, but it’s natural nature plant, but no nature didn’t plan for it, they didn’t think you’d live this long, to be honest, they thought you know that you would be a reproductive female live a little bit maybe. And that’s the end of it. If that, you know, most of the time on planet Earth, we didn’t live to hit menopause period. So we really need to undo so we need to figure out how we’re going to navigate and make a beautiful life for ourselves as postmenopausal women. So we either adapt all of the lifestyle, you know, wonderful lifestyle, you know, things that we can do like fasting and exercise and stress control and sleep circadian rhythm, issues of nutrition, avoidance of toxic ins, you know, we live in a challenging poisoned kind of world, you know, so do everything we can to keep, you know, toxic chemicals out of our bodies and do everything we can. And then in my book, you know, add hormones in most cases, and it’s a personal choice, but um, but by we have to create our own definition of what it means to be a menopausal woman, because this didn’t happen until recently that we had so much time like this. And, you know, the whole idea that as everything goes wrong, you get a drug like, here’s your drug for your osteoporosis, here’s your drug for your High Blood Pressure. Here’s your you know, not working drug for you know, your dementia. And you know, you go on and on for all these things, and it’s not the life I want to live as a menopausal and I don’t think anyone out there wants that life and we can change our destiny as menopausal women by understanding that this these vital life hormones, ASTRA dial, you know, which is the master and it’s wonderful sidekick progesterone that aren’t just about making babies. This these are about sustaining health in every organ system, and you name it I could go on for at least an hour for every organ system about What estradiol and progesterone do, and these are not optional for health, you have to remember what is a hormone anyway, a hormone is an information delivery vehicle, else’s cell what to do. So just think of this, you want to build a house, but you have no instructions, you simply have a dump truck, a big truck, and it dumps off lumber, and screws and nails. And but you have no plan, you have nothing. And then you take a bunch of people who have no experience in construction, and there’s no foreman, there’s no plans, and you just say to them, okay, do it. Like, do what, there’s no instructions, you can’t even if you have the nutrients, well, what is the cell going to do without the instructions, the cell tell is needs the instructions, make this protein, make this enzyme, you know, make, you know, make this kinase you know, that, you know, get the instructions for now you will do autophagy you know, with cellular rejuvenation, I know you talk about that, you know, estrogen actually controls this signal to have autophagy, you know, so it’s like a beautiful synergy between all the different things that go into play. And you can’t just take out one ingredient, it’s like you can’t not that I bake cakes, but you can’t bake a cake and have, you know, like one of the key ingredients just missing. Like if it’s a flour based cake, you can’t just leave out the flour. And all you have is eggs and baking powder and vanilla or something you you need all the ingredients to be healthy. And the foundation is really the hormones, but it’s not necessarily sufficient. It is necessary but not sufficient. You have to add all the other things and and then you have the full menopausal life.

Dr. Mindy  

Yes, I love that explanation. I gotta tell you my vision for menopausal women. I feel like as we enter our 40s if we take the opportunity to really dive into our health the way you and I have talked about today, and I call it a menopausal redesign, it’s an opportunity to like redesign your life redesign who you are. And when you come out of that 10 year ish journey of the peri menopausal years and you go into the postmenopausal years you’re going in as your best self. And when you look at there are cultures like in Indonesia, where postmenopausal women are considered the elders of the community, and people go to them and ask them for advice and their opinion because of the wisdom that they have. Well, in our culture, we don’t create a solution for perimenopause, women are suffering through it, we get to the other side of it were tossed aside, I see us changing that. I see us every woman stepping into her health power when she hits 40, redesigning whatever part of her life needs to be redesigned, coming out indoor postmenopausal years, and then being this incredible wise source for all of us to lean into. What do you think of that?

Dr. Gersh  

I’ll buy into it. I love it.

Dr. Mindy  

i It’s a new theory I have. And it’s based off of listening to people like Jane Fonda who would talk about that 60s, she went into the third act of her life, and I just, I want to end this suffering that women are going through, I want to end tossing us aside, but it’s going to start with us taking responsibility for the process. And that’s what I hope we did today. So really, that was this was such a brilliant discussion, and I really appreciate it. And I have to ask you my last question, which I ask all my guests which is twofold. One What do you do for self care every day? What are your self care habits? And what do you think your superpower is that you bring to the world?

Dr. Gersh  

Well, what I do every well not every but most nights, this is my sort of meditation time. Okay, everybody needs some alone downtime. So I happen to love the warmth and comfort of a bath. Okay, so I go into actually I’ve taken over one of my kids bit of bathrooms because it’s I like it and now that my kids moved out

Dr. Mindy  

I was gonna say

Dr. Gersh  

I took you know, territorial possession. So I go into that lovely bathroom, and I put on some soft music and sometimes I have some aromatherapy and sometimes I’ll put some into my bathwater my kids are always giving me gifts of you know, essential oils and things so they know I love baths and you know, like organic candles to burn and everything’s everybody knows this is my thing. And I just Relax, I mean it is just so calming. I just do sort of a little bit of progressive relaxation where you tighten up all the muscles in your body then relax them. I listen to the music. And I just find it super soothing. Okay, no matter how stressful my day was. So that’s really a key thing for myself care. And my my superpowers are that I just am the I would say, the Energizer Bunny, I don’t know how I got the energy to deliver so many babies for so many years, all through the night. And I just have like, the gift of stamina. So I guess my thing is that I won’t quit, I won’t retire, I won’t stop. I want to think of myself as unstoppable. So my mission is to help women at every stage of life for as long as I can. And I just won’t stop. You know, I see my friends retiring, and joining book clubs and movie clubs. And it’s like, that’s really nice. But I want to do this like with you, I just like, I have a burning passion for this, that’s and I won’t, won’t get a title. That’s it. I’m just keeping

Dr. Mindy  

oh my god, it’s such a bad. That’s a good, it’s such a good superpower. And again, I’m going to finish this with where we started, like you are a true gem for women. I have searched for integrative OBS across the country to get my my the people who follow me try to get them into those offices. And it’s hard to find. And you are an incredible example of somebody who’s willing to look at root cause somebody who’s willing to bring in lifestyle into your treatment plan, and is also willing to lean into your conventional medical medical care solutions that you were trained in you. I cannot say enough about what a blessing you are to women. So I just want to thank you Dr. Gersh for being here. And this conversation, hopefully was as exciting to everybody else says it was to you and I?

Dr. Gersh  

Well, we sure had fun. We hope everybody else has had at least a couple of pearls out of this. Because this is it. This is our lives, we got to make the best of it. Enjoy every minute as much as we can.

Dr. Mindy  

Great. And how do people find you just because if people are still listening, I want to make sure they go Oh,

Dr. Gersh  

pretty easy. I mean, you could probably Google me, but I am still old fashioned doctor. I’m actually one of my i, this I set this up as a little bit of a recording room. But it’s actually an exam room. In fact, over there, you can see it, there’s an exam table. Okay, so I still have a work in brick and mortar practice. It’s called integrative Medical Group of Irvine, it’s in lovely Southern California in Orange County. And so I see patients all the time, usually five days a week unless I’m doing a lecture or something. And in addition, I am trying to get more and more active on Instagram Live. So I hope everybody will follow me on Instagram Live. And, you know, I love doing, you know, webinars and podcasts and health summits and so I have a fair amount of body of you know, stuff out there on the internet that you can find and I have three books that I’m very proud of. So my first two were on PCOS polycystic ovary syndrome PCOS SOS and PCOS, SOS fertility, fast track, and the my newer book, which is now like a year old but it was I’m gonna write another one coming up to I don’t know if I can match you. I don’t think so. But I’m not an active practice like you. So you can’t do it all the time. But so my newest book is menopause. 50 things you need to know. So I definitely recommend my books. Yes, of course. And books are a great way these books do I definitely recommend. You’re so sweet. You know, books,

Dr. Mindy  

I always say are the best way to really dive into an expert’s brain because it you know, when we think about the sentences, we think about the structure of information. So it’s really one of the best ways to dive into an expert sprain. So anyhow, I can talk to you forever and I just appreciate you on on so many levels. This this, I know this conversation will save lives and will really help women understand themselves and hopefully move into action. So thank you

Dr. Gersh  

ppreciate you My pleasure.

Dr. Mindy  

Thank you so much for joining me in today’s episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we’d love to know about it. So please leave us a review, share it with your friends and let me know what your biggest takeaway is.