Episode Transcript
[00:00:01] Welcome to Anti Aging Unraveled, the podcast where we redefine aging and empower you to age your way.
[00:00:08] I'm Dr. Laurie and this show is rooted in the lifeevity philosophy. Living life the way you want to with energy, clarity, purpose and longevity. Here we break down integrative functional medicine, bioidentical hormones, peptides, metabolic and brain health, gut immune connection, and cutting edge longevity therapies. So you're not just living long, longer, you're living better.
[00:00:34] If you believe aging should be intentional, personalized and on your terms, you're in the right place. Welcome to Anti Aging Unraveled. Let's unlock longevity and help you age your way.
[00:00:47] All right, here we are, back for another episode of Anti Aging Unraveled. And this is a good one. I know I always say that, but this is really a good one. It is the perimenopause lie that's keeping women sick. And I think I'm going to bring together a lot of topics mix today. So just kind of sit back, relax, start taking in all the data. We're going to really demystify everything that has been going on in the menopause world. And of course, I'm Dr. Lori Gerber, I'm a board certified osteopathic physician, founder of Refresh Wellness, and Dr. Lori Integrative Health. And if you're new to our podcast, welcome. Please join our podcast. Like it, share it, all the good things. But today I want to talk about something that I see every week, every day in my practice. And women in their late 30s and 40s, sometimes early 50s and 60s, coming in exhausted, weight gain they can't explain, barely sleeping, struggling to think clearly, feeling anxious, out of nowhere, and maybe dealing with heavier periods or no period at all. And they've been told over and over again by a doctor or another provider that your labs are normal, that you're feeling fine, this is just stress, maybe you're depressed. I'm here to tell you they are not fine.
[00:02:02] They are. You're definitely not crazy. They are perimenopause or menopausal symptoms. And these people have been lied to. This is a bold face lie. Today's episode, like I said, called the perimenopause lie that keep that's keeping women sick. And I promise you, by the end of today's episode, you are going to understand exactly what is happening to your body, why the conventional medicine system keeps missing it, which hormones are at the root cause of everything and what you can actually do about it. This one's for Every woman who has ever left their doctor's office feeling dismissed.
[00:02:35] So let's dive right in. Let's go. So before we dive right in, if you're watching this on YouTube, hit that like button right now and subscribe to my channel so that you never miss an episode. Click that little bell, that notification bell. So YouTube actually shows you when a new episode drops. I put out evidence based content all the time on hormones, integrative medicine, what it means to really age well. And I don't want you to miss a single episode. And if you've never been dismissed by a doctor, or if you've ever been dismissed by a doctor, sorry about your symptoms, drop a comment below and tell me your story. Every single one. So if you've ever been dismissed by a doctor for your symptoms, drop a comment, tell me your story. I read every single one. So let's get into it. So let's start with the basics, guys, because I think there's a lot of confusion here. That begins with how we define perimenopause. Most women have been taught that menopause is when your period stops.
[00:03:29] And technically, that is true. The clinical definition of menopause is 12 consecutive months without a menstrual period. In the United States, the average age at which this happens is about 51. But what nobody tells you is the hormonal transition that leads to the moment when your period actually stops can begin a full decade or more before your last period.
[00:03:50] So let's talk about some key data. I'm going to put key data throughout this podcast. The average age of menopause we just talked about is 51.
[00:03:59] Perimenopause typically begins four to 10 years before that menstrual period. So you can have symptoms literally for a quarter of your life. Most women notice symptoms as early as 35 to 38. The duration averages four to seven years, up to 14 years in some women, according to a 2011 study. And only 10% of women transition into menopause abruptly without symptoms. So for those women who think, I'm just going to blink an eye and go through it, that is not the majority of people.
[00:04:28] So when we talk about menopause, we're talking, talking about a window of time that can span your 30s all the way into your late 50s. So some women, it's nearly 15 years or more of hormone volatility. So 15 years of symptoms that left unaddressed are silently damaging their brain, their heart, their bones, their metabolism. And that is not a minor inconvenience. Right? That should be brushed off. It's a major health event and it deserves to be treated like one.
[00:04:55] So this lie, here's the lie. The lie is that perimenopause is short, it's transitional, it's a blip defined by hot flashes and irritability. And that you just have to like air quotes, get through. That framing has done enormous damage to women's health. And because when that story is this, when that's the story, anything that doesn't fit into the narrative of hot flashes gets attributed to something else. Your weight gain becomes a calorie problem, your brain fog becomes a sleep problem, or maybe early dementia.
[00:05:28] And your anxiety because of mental health problem, your joint pain becomes aging, your exhaustion becomes burnout. And you get a referral to a million different specialists for every single symptom. And nobody actually connects the dots, nobody puts the pieces together that this is all symptoms of the same pathway, menopause or perimenopause. So again, going back to the key data that I'm going to insert in here, there's over 34 recognized symptoms of perimenopause that's documented in peer reviewed literature. Most common irregular periods, sleep disturbance, mood changes, brain fog, weight gain, joint pain, vaginal dryness, fatigue, anxiety and heart palpitations.
[00:06:09] And 77% of women experience significant symptoms enough to impact their daily functioning. That should be addressed, right? An average, it's two to three years from symptom onset to diagnosis. That is never acceptable in the medical community.
[00:06:25] And one in five women are feeling well supported, which is abysmal, right in their by their health care provider. We need to change that narrative. So guys, 34 symptoms and women are supposed to just push through them.
[00:06:39] So now what I want to do is acknowledge, Listen. Every woman does not have a difficult time with perimenopause. Some women sail through it with minimal disruption. But for the majority of women that we're talking about here, there's millions and millions of women. This is a profoundly disruptive and medically significant time of life. The health care system is failing them. This is not the way our medical system should run and it's failing our women in a big, big way. This is a hormonal emergency, not a lifestyle problem. Let me reframe menopause for you in a way that I hope changes the way you think about it. Perimenopause is not simply your body running out of estrogen. It's a cascading multi system hormonal reorganization. It affects every organ system in your body, your brain, your heart, Your gut, your immune system, your musculoskeletal system, all of them are exquisitely sensitive to the hormonal changes that are happening during this phase in life. And when we talk about hormones, we're not just talking about estrogen, we're talking about progesterone, we're talking about testosterone, cortisol, insulin, thyroid hormones, dhea. A whole symphony that starts to fall out of tune, sometimes subtly and then with increasing intensity. And that is exactly what we're going to dig into in this next segment. So I really want you to understand that this last year has really, hopefully changed everything for what I would call the menopause or perimenopause lie. And really, the study that changed everything for women's hormones was the WHI disaster. It's a study that changed everything. And to understand why conventional medicine has failed perimenopause, we really need to go back to 2002, which is the year that the Women's Health Initiative was published. That sent shockwaves through medicine. It was a massive federally funded clinical trial. It looked at hormone therapy in postmenopausal women. And when the preliminary data showed, and I'm going to put air quotes on this, too, statistically significant or increased risk of breast cancer, stroke and blood clots in women on combination hormone therapy, they actually stopped the trial early and didn't continue.
[00:08:49] So the headlines, of course, were terrifying. They scared everyone to death. And overnight, millions of women were told to stop their hormone therapy. Prescriptions of hrt dropped by 50% within one year.
[00:09:04] So let's talk a little bit about that key data.
[00:09:07] The WHI in 2002 was a randomized trial of 16,608 women post menopausal women aged 50 to 79.
[00:09:16] They use conjugated horse estrogen or equine estrogen, plus synthetic medroxyprogesterone acetate, which is not a bioidentical hormone. And it was halted early due to, again, air quotes, increased risk of breast cancer by 26%.
[00:09:32] It's an absolute risk of eight more cases per 10,000 women per year. And actually, if you look at the statistical significance of this, and we read through it, it is not statistically significant data. HRT, again, prescriptions fell by 50% in the US within 12 months. And physicians were just fearful of prescribing hormones. I'm not saying those researchers were wrong to be cautious, but here's the critical problem and how the medical community interpreted those results.
[00:10:00] The women were not in menopause or perimenopause rather they were postmenopausal. The average age was 63. These women were more than a decade past menopause.
[00:10:11] They were using synthetic hormones, not bioidentical. The conjugated horse urine estrogen has way more than the three estrogens that are in our human body. And medoxyprogesterone acetate is a synthetic progestin that behaves differently in the body than natural progesterone. And yet the clinical takeaway was applied uniformly to all women, all ages, all forms of hormone therapy, which is a massive scientific overstep. So women have been paying for this lie ever since. And thank gosh, in 2026 we have reversed that information per the FDA. And the good news is that the research has caught up. We've seen a major re evaluation of the WHI data and a growing body of evidence supporting the safety and benefits of hormone therapy, particularly started early during perimenopause windows when bioidentical hormones are used. And this is called the timing hypothesis or a critical window hypothesis. And it's one of the most important concepts in women's health today, is starting it early with bioidenticals is a huge health benefit to these women. So okay, this is not fringe medicine. This is evidence based medicine catching up with what integrative practitioners like myself have known for years. And yet the fear that was generated by the 2002 WHI headlines is still alive in doctor's offices until this year where the FDA came out and basically has said that it is not clinically significant data and that there is no potential risk for adding on hormone therapy to a perimenopausal female. I hear still that patients are getting every single week. They're told by their doctor, gynecologist, primary care doctors, I won't prescribe hormones because they cause cancer, which in 2026 is medically outdated. And in truth in 2002 was not medically statistically significant or valid.
[00:12:11] So the medical community, beyond the hormone therapy debate there, there's a broader problem.
[00:12:17] Women are getting medically gaslighted.
[00:12:20] And this is the broader problem and I need to call it out directly. And really, women's symptoms are being dismissed. There's a well documented phenomenon backed by research, not anecdote, suggesting that women's pain and symptoms are significantly under treated, under diagnosed compared to men. And in the context of perimenopause, this plays out every single day. Women are told their hormones are just anxiety or that their symptoms are just anxiety, not hormones. They're prescribed antidepressants instead of having hormones evaluated or told that their labs are normal, when in fact these labs are not even designed to catch perimenopausal fluctuation.
[00:13:01] Those normal values give you the entire range of what you can be, possibly as a female in this world. And because here's the thing, standard hormone panels, the fsh, the estragile, the testosterone, they're notoriously not reliable during perimenopause. And the hormone levels are all over the map.
[00:13:20] So every day and hour to hour hormone levels are fluctuating and variable. A single lab draw can look completely normal even when a woman when their hormones are dysregulated. So again we go back to that key data. 2 to 3 years onset from symptoms to correct diagnosis.
[00:13:39] Unacceptable. It wouldn't be acceptable for any other diagnosis, cancer or otherwise.
[00:13:44] 46% of women say their GPS didn't recognize their symptoms as perimenopause.
[00:13:49] That's sad. 10 year study women are 50% more likely to have than men to have cardiovascular symptoms attributed to psychological causes. While we know many psychological causes late in life, anxiety and otherwise are menopause related.
[00:14:04] And antidepressant prescriptions for women ages 40 to 49 increased to 63% in 2000 from 2000 to 2015. So between those 15 years they increased by 63%, ironically coinciding with the WHI backlash on hormone therapy. And women in perimenopause are two to three times more likely to be prescribed psychotropic medications before hormones are even considered. That is just sad because honestly, I have tons of podcasts on SSRIs, but the antidepressant numbers make me furious as a physician, because antidepressants don't fix a hormone problem. It's not a serotonin problem directly. You can't SSRI your way out of progesterone deficiency.
[00:14:50] And women taking them are really not getting better. For the select few that are, that is fabulous. Serotonin has helped you, but for the vast majority of people, they're not getting better. They're just getting quieter about their symptoms because they're being dismissed. That is not medicine, that is management.
[00:15:08] And we can do so much better than just managing a symptom.
[00:15:12] So speaking of doing better, if this episode is resonating with you, I want to hear from you. Drop a comment. Tell me below. Have you ever been prescribed an antidepressant when you think you really needed a hormone workup? That conversation is so important.
[00:15:26] And the more women share their stories, the more we change this narrative together. If you have not subscribed yet. Please do so right now. Share this video with a woman who needs to hear this in their life. You might literally change the trajectory of her health. So thank you for that. And let's dive in to science. This is the time we're going to talk about the hormones, what falls, what, what goes up, what goes down. And this is the part of the episode that I, I'm excited about because once you understand what's happening hormonally during menopause, everything starts to make sense. The symptoms aren't random, they're physiology. They're not just aging.
[00:16:04] Every single one of them has a biochemical explanation. So let's walk through the key players and the first one is progesterone. So progesterone is almost always the first hormone to decline in perimenopause and actually testosterone really is, but we're going to talk about at the end. But in a healthy menstrual cycle, progesterone rises dramatically in the second half of your cycle after ovulation and actually holds in the lining for a while and then sheds it. But during perimenopause, you begin to have these, what we call an ovulatory cycles where you don't ovulate and therefore your body doesn't produce progesterone that month sufficiently. And over time this becomes more frequent. Without adequate progesterone, estrogen goes completely unopposed, which is never good. So let's talk about the data with progesterone. Progesterone has GABA modulating effects in the brain, acts as a natural anti anxiety and sleep promoter. Low progesterone is linked to insomnia, anxiety, heart palpitations, heavy periods, PMS symptoms and breast tenderness, just to name a few.
[00:17:09] You can start with these, what we call an ovulatory cycles as early as 37 to 40. And honestly, with birth control, I've seen it earlier than that with people coming off of birth control and not regulating their cycle appropriately.
[00:17:22] Microionized progesterone or bioidentical progesterone has been shown to really help with sleep architecture. And unlike synthetic progestins in birth controls, bioidentical progesterone does not increase breast cancer risk. It's because it balances estrogen, whereas the synthetic progesterones do not. So when a woman tells me she suddenly can't sleep, she's waking up at three in the morning, racing heart, anxious brain going, I can't shut my head off. My first question is, when did you Last, have a period and are your periods changing in frequency or duration? Progesterone deficiency is one of the most common and treatable causes of these symptoms, and it is routinely not discussed or missed. So that's number one. Number two, estrogen. Estrogen, contrary to popular belief, has wild swings, ups and downs, and early perimenopause is not characterized by low estrogen. Low estrogen is a later sign of menopause. It's actually just characterized by fluctuating estrogen levels. It can swing from dramatically high to low and back again, sometimes in the same week. So this is why early perimenopausal women have symptoms of estrogen excess and estrogen deficiency at the same time or different times of the month. They might have breast tenderness and bloating one week, then hot flashes and brain fog the next. It's probably the hardest time to treat a female.
[00:18:47] And it's not contradictory, it's just the nature of the transition is that there's massive fluctuations, mostly keeping estrogens higher and progesterones lower early on.
[00:18:58] So let's give some key facts about estrogen. So estrogen receptors are found in every tissue, almost brain, heart, bone, skin, vagina, bladder, gut, joints, eyes. So it can affect everything. It's the primary biologically active estrogen during reproductive years, which is estradiol. The brain has the highest concentration of estrogen receptors of any organ. And estrogen is neuroprotective. Declining estradiol specifically has been linked to beta amyloid deposits, which is a marker of Alzheimer's risk, which is also from data from 2008. It's a great anti inflammatory, which is why we don't lower men's estrogen levels as much as we used to.
[00:19:41] And it can correlate with rising inflammation markers in patients, CRPs, inflammatory levels and genital urinary symptoms of menopause. GSMs affect 50 to 70% of women. Vaginal dryness, painful intercourse and recurrent UTIs profoundly impact the quality of life, which are again, they go undiagnosed and untreated because they think it's just a random symptom, not a symptom of estrogen variation or low estrogen. It has to be treated and has to be addressed. All right, let's talk about three. Testosterone. I cannot tell you how often I see women who are surprised when I bring this up. Women have testosterone too. In fact, in their 20s and 30s, women produce three times more testosterone than estrogen by volume. And testosterone declined significantly during perimenopause and menopause. And even earlier than perimenopause, it is the first hormone really to decline.
[00:20:36] And it gives almost identical symptoms to menopause or perimenopause itself. Low libido, fatigue, decreased motivation, muscle loss, brain fog, depression and decreased bone density. So conventional medicine doesn't really address that. And it's never tested. We're testing this estrogen and progesterone, maybe in LH and fsh, but we're never testing testosterone levels, which is really an early decline number.
[00:21:03] So it's actually, we know that women's testosterone peaks in their 20s and declines about 50%. I see even more by menopause, but according to the data, it's about 50 by menopause. Testosterone is produced in the ovaries and the adrenal glands. So don't think about only the ovarian failure. You can still make testosterone by your adrenal glands. So surgical menopause causes an immediate drop in testosterone. I'm going to say that again. It's not just progesterone and estrogen, guys. Surgical menopause or hysterectomy causes an immediate drop in testosterone as well. So the consensus is testosterone therapy is the only evidence based treatment for hypoactive sexual disorder in women in 2019 as a consensus study.
[00:21:49] So why are we not doing this more? Low testosterone in women is independently associated with reduced bone density, sarcopenia, which is decreased muscle mass and depression. So mood mojo, Bones. Right, Muscular, like that, that physique. We lose that when we lose our testosterone. And despite robust evidence, the FDA is still not approved testosterone products for women in the United States right now. It is all off label prescribing that is required, which is again, a gross disservice to women and a lie that we don't need testosterone for women when we absolutely do.
[00:22:27] So I like to bring up two more hormones that really play a big role, actually three, if you really want to dig into it a little bit deeper. But cortisol is our stress hormone and cortisol is one that really doctors really never address because stress in a physician's office is a really hard one thing to measure, but two, something to address that they really don't get paid for. And doctors never connect cortisol to menopause. And if we really think about this critically, during menopause, ovarian function declines, okay? The adrenal glands are asked essentially to pick up more of the hormone slack, they have to make more. And if they're stressed in any way other than just making hormones like for Example, if your body is stressed, it's gotta make sex hormones or cortisol, and it's gotta, it's gotta pick. And then all of a sudden it becomes the adrenal responsibility to be the main production backup site for specifically vadhea pathway. If your adrenals are already taxed, chronic stress, poor sleep, type A personality, inflammatory diet, they cannot do that effectively. And in all honesty, for most people, they can't pick up the slack anyway, 100%.
[00:23:41] So elevated cortisol, which is an incredibly common phenomenon in perimenopausal women, actively worsens every single aspect of menopause and perimenopause. It disrupts sleep, it drives belly fat and impairs thyroid function, destabilizes sugars, blood sugars, and depletes progesterone, which also makes the insulin less sensitive. And your body can, because your body can actually convert progesterone into cortisol when it's under stress.
[00:24:08] So what that means is we actually have this thing called pregnenolone steel.
[00:24:13] So this hormone in the middle of the pathway is actually being driven to make cortisol instead of sex hormones. And it makes everything worse. So all the stress hormones, hormone stuff gets worse and you make less and less and less sex hormones and your DHEA goes up and you're not able to make hormones. Eventually both sides of the pathway can crash. All right, so that's one of the reasons that I'm really big on treating hormones, pro hormones and peptides all together. Okay. Because if we don't touch the cortisol, we don't touch the thyroid, which we're going to talk about. We don't help the insulin. A lot of the times the hormones don't stay corrected efficiently.
[00:24:55] So that brings me to my next hormone. Let's talk about insulin.
[00:24:58] Insulin is like the silent metabolic shift, when in reality it should be the primary metabolic shift. It is early markers of glucose metabolism problems and weight gain and estrogen as well as progesterone, are insulin sensitizing. So as estrogen declines, insulin sensitivity declines with it. This is why women who have had a stable weight for years and years and years suddenly start gaining weight around the abdomen. Progesterone goes down, insulin go, estroge goes up, we get cortisol abnormalities, insulin gets more resistant, estrogen starts declining, insulin gets worse, and we have more and more sugars that we can't process efficiently. So when we, when diet and exercise habits haven't changed and you're gaining weight, it's really not about willpower it's about the biochemistry. And that is really why, again, I go back to treating all everything as a whole and not treating things in isolation.
[00:25:54] So let's just do some key data again. And this is all pulled from literature that's out there. I will pop some of the data and the citations into the chat for you guys as well as on the podcast chat.
[00:26:07] Insulin sensitivity decreases by approximately 30% during menopausal transition. That's huge. 30%.
[00:26:14] Visceral fat increases by 49% during perimenopause, independent of your total body fat. To start with, women with metabolic syndrome are significantly more likely to report severe vasomotor symptoms. What are those? Hot flashes, Night sweats.
[00:26:30] Why? Because their insulin is more resistant, their cortisol is more disrupted, and they have this tug of war between their adrenals and their ovaries.
[00:26:39] Declining estrogen increase creases, hepatic glucose production and adipose insulin resistance. So that's a key driver of type 2 diabetes risk in post menopause. So it's a direct driver with estrogen declining. So why not replace it? The metabolic risk far outweighs any physiologic cancer risk for the majority of patients, especially when it's done with progesterone. And finally, let's talk about the last hormone that honestly, this is part of my primary care soapbox here, is often not talked about, especially in the time of perimenopause. It's the thyroid.
[00:27:20] So many women have come to me told they're in menopause or perimenopause, when really they're not. They're just hypothyroid or they're in their hypothyroid and they're in perimenopause because the symptoms overlap so much exponentially.
[00:27:35] Fatigue, weight gain, brain fog, constipation, dry skin, depression, hair loss, feeling colds, these are all symptoms that could really be brought to both sides.
[00:27:47] An autoimmune disease or Hashimoto's thyroid can be triggered by worsening hormonal fluctuations of perimenopause can be worsened by pregnancy too. Right. Any kind of massive hormonal shift can throw your body into an autoimmune state. So the standard thyroid test that again, most doctors run is a tsh.
[00:28:06] It really misses what I would call subclinical hypothyroidism. So it's really important to run a TSH, a free T3, a free and total T4, reverse T3 and thyroid antibodies to see where you're at. Are you fighting your thyroid? Are you subclinically low on your T3 and T4 levels? So every time these go unchecked, if a woman has untreated thyroid problem, no amount of hormone optimization is going to fix it because she's still got a thyroid issue that needs to be addressed underlying. Which again goes back to that point I'm making with our lifelinks. We really need to treat all of our six to seven life lengths or at least make sure that you're treating the whole body so that we can treat the acute, the chronic and the preventative care. And if we're not, most people don't feel 100% success.
[00:28:57] 5 to 10% here. Key facts. 5 to 10% of women have hypothyroidism and the rates increase with age. Hashimoto's thyroid is seven to 10 times more common in women than men.
[00:29:10] And perimenopause, again, can unmask that autoimmune thyroid disease. Subclinical hypothyroidism is frequently missed by standard TSH testing. And this is kind of insane. Up to 40% of women with hypothyroid symptoms have a normal TSH on labs. So why are we just checking a TSH level? It just doesn't make sense to me.
[00:29:32] So. All right, we've talked about all those hormones, so we're going to do a quick pause here. We're halfway through. I want to ask you something really important. Of those seven hormones we just talked about, estrogen, progesterone, testosterone, cortisol, insulin, and thyroid and dhea, which one surprised you the most?
[00:29:50] Which one do you think might be your missing link in our life links? Drop it in the comments. I'm genuinely curious and like I said, I respond.
[00:29:58] If you put something in there, I will reply personally, if you are finding this valuable, the best thing you can do is hit that like button right now. It tells YouTube to share more of this content with women that need it. So let's go. Let's keep going. Let's keep moving on. I want to really talk about what we're going to do about it, right? How are we going to shift gears? We're going to go from hormones to consequences and treatment. And I want to go to consequences first because perimenopause is not just uncomfortable again. It's not just, you know, something that you can leave untreated. It is a disease process and it has consequences. It's a direct contributor to some of the most severe or serious chronic diseases that women face in the second half of their lives. And this is part of the conversation that I wish more women and doctors were having. Right, let's talk about cardiac and heart. It is your biggest risk factor, and it's hormonally driven. Heart disease is the number one killer of women in the United States. Not breast cancer, not ovarian cancer. It's heart disease. And yet for decades, it's been considered a man's disease.
[00:30:57] And I feel like we're changing that narrative with some of the. The fundraising that has been going on and some of the nonprofits. But here is what we know. Estrogen is profoundly cardioprotective.
[00:31:08] So is testosterone. It supports healthy cholesterol. It supports blood vessel flexibility and reactivity. It reduces inflammation. It helps blood pressure. When estrogen declines during perimenopause and menopause, cardiovascular risks increase, and they start to climb sharply. A woman who has a low cardiovascular risk for her whole life can see her LDL go up, her bad cholesterol, her triglycerides, the fat in her blood, go up, and her crp, which is an inflammation marker, rise significantly in the space of just a few years during perimenopause. And doctors never connect that to her hormones. They will say, oh, they'll look at the trend. They'll see it's starting to go up, and they'll want to put her on a statin. Well, how about just fixing the hormone decline?
[00:31:50] Because here's the key data. Cardiovascular disease is responsible for one in three women in the United States for their death. Women's risk of heart attack increases dramatically, as I said, after menopause. Postmenopausal women. Postmenopausal have two to three times higher rates of cardiovascular events compared to premenopausal. Hot flashes are independently associated with subclinical cardiovascular disease. So. And women with frequent vasomotor symptoms have actually higher carotid issues and arterial stiffness. And last but not least, women who go through premature menopause have significantly higher lifetime of cardiovascular disease risk factor. Less than 40 would be premature menopause. So, again, why are we not addressing these hormones first as opposed to saying, all right, well, let's get you on the these statins and other lipid control agents. All right, let's talk about the brain. This is a really interesting one. I love talking about the brain because I think there are so many autoimmune processes that are happening within the brain that we can actually reduce the risk factors for dementia. Risk starts basically with women and perimenopause and estrogen. So this one actually, like I said, kind of keeps me up at night. I think about it a lot because women account for nearly two thirds of all Alzheimer's disease cases. For a long time, that was attributed to the fact that women live longer. But the research is really starting to suggest that hormonal transitions play a significant role. And the brain, with all of its estrogen dependent receptors, it's a very estrogen dependent organ. And estrogen promotes neurogenesis, or synaptic plasticity, or the ability to basically have neurons firing appropriately. It also has to do with mitochondrial function in those neurons and the clearance of what we call amyloid, which is the protein that accumulates in Alzheimer's.
[00:33:42] So when estrogen declines, all of those protective mechanisms are compromised cognitive symptoms that perimenopausal women report. The word finding, difficulty, the mental fog, the memory lapses, they're not trivial. They can be early signs of cognitive decline.
[00:33:58] So I really think we need to think about menopausal brain studies. And because they do show, according to the data, decrease in cerebral blood flow and glucose, and you'll show metabolic issues during that transition phase. Women who use hormone therapy before age 65 have a decreased risk of 26 to 48% of Alzheimer's dementia. That's huge. And that's from a study in 2017 in the journal Neurology Surgical. Menopause or a hysterectomy doubles the risk of dementia from a study in 2007. And the brain fog of menopause, again, is associated with measurable reductions in processing speed, verbal memory and attention. It isn't just a perceived, perceived decline. It is actually a measurable decline.
[00:34:45] So I want to say that we undervalue treating brain fog early and actually treating the hormonal symptoms in relation to Alzheimer's disease and cardiovascular disease. Last but not least, the silent killer, or the silent countdown. Because we know how much bone health is important to women as they age. Osteoporosis, it's another condition that gets tragically underestimated. Women lose, lose up to 20% of their bone density in the five to seven years surrounding menopause. That's massive. So 20%. That's not a slow, gradual decline. It's a rapid, clinically significant loss that happens during perimenopause. So if you treat perimenopause and either slow it down or treat it over a long period of time, that decline of osteoporosis is going to slow. Most women are not even screened that early for their bones. We Talk about DEXA scans pretty early on, especially in perimenopause, but most docs do not. And estrogen is critical for maintaining that bone density. It suppresses what we call osteoclast activity, which is the breakdown of bone, the cells that break down the bone. And when you suppress that, you're actually stopping that breakdown. Right. So when estrogen drops, the brakes come off. Like you're allowed to break down as much bone as you want, basically.
[00:36:04] And we know that we need to slow that down to basically reduce H fractures in women because we know the hip fractures have a 25% mortality within one year in a female over 65.
[00:36:16] Routine DEXA scans are not recommended till 65, but honestly, when estrogen goes down, we're talking about our early 40s.
[00:36:24] So most bone loss occurs and is undetected in early perimenopause decades. A really, really big take home is these DEXA scans early. And you can self pay for DEXA scans. They can be done. They don't, especially if it's not covered by insurance because you're not of age.
[00:36:40] They can be paid for and I highly, highly recommend getting them early.
[00:36:44] Okay. And last but not least, I was just talking about this in my house the other night. I want to spend a minute talking about the underrated health crisis of sleep. We know that sleep is the rest and reset, it literally gives you the ability to repair without sleep. And in our type A and our go go go timing personalities right now, and with everything being on screens and digital things at our fingertips instantaneously, it really does not give our brains and sleep is really the only way that we're going to do that. And obviously kind of changing your screen time and your brain, shutting the brain down and meditating. Chronic sleep deprivation is not an inconvenience. It's a direct driver of cortisol dysfunction, insulin resistance, cardiovascular disease, immune dysfunction, weight gain, depression and cognitive decline. And not necessarily in that order. But when cortisol gets disrupted and you lack the repair mechanisms and you don't sleep, what you're going to find is all these things start to occur. And perimenopausal women are some of the most sleep deprived people on earth. They can't fall asleep, they can't stay asleep. Night sweats wake them up. Low progesterone prevents them from falling into a deep restorative sleep. And that cortisol Dysregulation causes them 3am Wake up.
[00:38:05] They function for four to five hours of broken sleep for years and years and years. And they're told by their doctors, try some melatonin or go on a sleep aid. Right. We all know the sleep aids and unfortunately they don't fix the problem. That's not restorative sleep. It's a progesterone problem. It's a cortisol problem, it's an insulin problem. Okay. And consequently a sleep problem. Progesterone is going to help calm that brain down. There's actually a lot of peptides that do a really nice job with doing that as well.
[00:38:35] So just some key data on that front. 61% of perimenopausal and postmenopausal women report significant sleep disturbance. Night sweats on an average wake, three awakenings per night. In most symptomatic women, chronic sleep deprivation of less than six hours is associated with a 48% increase risk of cardiovascular disease and 36% increase of type 2 diabetes. That's huge. If we can just get people to turn their screens off, get some natural light going in the morning, get some progesterone or GABA stimulation on board and get good sleep, we could definitely work on metabolic issues like this.
[00:39:12] Progesterone receptors are directly modulates GABA receptors promoting sleep and its decline is a primary driver of perimenopausal insomnia. And that data was published this particular study in 1997. So not new data, but definitely something that needs to be addressed more and more in traditional care.
[00:39:31] So I know that was a lot. I know it can feel heavy. But here's the thing. Everything I just described is addressable, every single piece of it. And that is exactly what we're going to talk about next, is how to address this and how to dive into our LifeLink and our Real3 method. But before we get there, I want to be sure you are set up for every future episode. If you are on YouTube, click that subscribe button and the ring notification bell. I break down topics like this every week. Hormones, longevity, brain health and metabolic medicine. You do not want to miss what's coming. And drop me a comment telling me which of these brain symptoms or brain systems, rather brain, heart, bone, sleep. You most want me to do a deep dive on my next episode. I would love to hear your opinion. It can be thyroid, it can even be metabolism and insulin. But your comments literally shape the show. So I highly appreciate them and I will comment back and use your input, I promise.
[00:40:26] Okay, so it is time. We've talked about the lie. We've talked about the science, the hormones and the damage that can Go unaddressed for years. Now I want to share with you exactly how I approach this in my practice. It's not a simple five step checklist. It's actually a really complicated, complete framework that I built over years of clinical work. And we call it the real three method. It is the foundation of what we call our Live jevity model at Dr. Lori. And live Jevity is a fun word. I like to think that I created it. I don't know that it was out there before. But it's not just longevity living a long time.
[00:41:04] It's life plus longevity, living a long life that's actually worth living. We like to call it aging your way, feeling vital, sharp and strong and just like yourself. That is the goal. And real3 method is our roadmap to get you there. And I just want to briefly break down what real three stands for. It's R and our E is a backwards three al to the third power. So let's break this down. The R stands for retrieve, reconstruct and review. That is why that little E is a 3 backwards. Before I do anything for a patient, I am not just a like a random online intake and you're done and we give you like your treatment protocol. I want to know your whole story, not just today's symptoms and today's labs. I mean the entire story. Childhood health, prior diagnoses, medications you've been on, family history, stress history, gut history, hormones going back to your first period. I retrieved everything. I reconstruct your timeline of how you got there. And I want to review the labs that you've had in the past and a really comprehensive new panel. It's a system wide workup. You can't really treat what you have not found and you can't treat what you haven't looked for or spoken about.
[00:42:19] So I'm really big on these three Rs, retrieve, reconstruct and review and making sure that we're all on the same page with acute, chronic, and then our long term goals.
[00:42:30] Our second thing is elimination. That's why that E is there. And it's also that backwards three eliminate what's driving dysfunction. We can do so much with lifestyle, we can do so much with binding agents and getting rid of some things that are in your system that shouldn't be there. Also getting rid of medications we might not need, any hormonal disruption, disruptors, pathogens. We're here to help make things work better. That is where our elimination comes from. A is for additions. What are we going to put back into your System, targeted nutrients, targeted vitamins, bioidentical hormones, peptides. How are we going to add to your system to make it work better? We're using science backed, right? Data and supplements and hormones and therapies that have been on the market for a long time, some of them. Or maybe we're going cutting edge with newer technology. We're using a lot of advanced therapies, things that are kind of maybe on the a little bit of the left of center cutting edge. But we're also using tried and true products and supplements. And then last but not least, the l to the third power that is reviewing all your lifelinks.
[00:43:37] So LifeLink ll and longevity pathways to give you the ultimate in Lifeevity, that is our L3 or L cubed, we have six lifelinks plus a seventh one for longevity. And they are very important to address all of them over a period of time. We start with the acute problem so we can get you feeling better and then we move towards more chronic issues that we see that are underlying. And then last but not least, we add in what I call the LifeEvity or the Longevity protocols that help you live longer and promote overall wellness and also prevent some of the hereditary diagnoses that you guys are all scared about. The genetics, right? Also deprescribing. So, so this is where we dive into the nitty gritty, right? We're not a cookie cutter protocol. We're a customized plan built from the story and the data and it's also based upon how you want to proceed.
[00:44:34] So we get these life links, we have our gut life length which is the foundation of everything. Immunity, mood, hormone metabolism, nutrient absorption, inflammation. If I can't get you absorbing things, then nothing I do orally is going to work.
[00:44:47] The entire ecosystem in your gut is called the estrobolone and the bacteria that literally regulate how your body metabolizes and recirculates estrogen live there. So when the gut microbiome is dysbiotic or doesn't work, that estrogen metabolism goes sideways.
[00:45:03] So you might not even be in perimenopause, it might just be how your estrogen is recycled. And even if your ovaries are trying to do their job, your gut might be thwarting you at every step. Just one example of why we treat the gut, gut, the immune and inflammation pathways. We are attacking this all very early on because menopause is very pro inflammatory. So we want to get rid of that inflammation. We also want to put the estrogen and or progesterone back and testosterone, it's a great anti inflammatory to help reduce those chronic disease states, the heart disease, the dementia, the autoimmunity and the cancers.
[00:45:38] So we don't want to, we need to measure active inflammation so we don't miss an important upstream issue. Right. We want to make sure we're actually regulating everything so that everything is running smoothly downstream. Hormones. This goes without saying. We're looking at all of your hormones make, showing how they're interconnected, making sure we treat them to adequate levels for your body, even thyroid adrenals, and also your cortisol levels. That ties us in perfectly to metabolic optimization, which is LifeLink number four. Insulin sensitivity, blood sugars, body composition, and also your mitochondrial efficiency, which will also also talk about in LifeLink 6 for cellular health. But this is where weight gain, fatigue and metabolic dysfunction of perimenopause live. So we have to address those metabolic issues so that we can get you on a better track for menopause and not gain weight. Detox is our LifeLink number five. This is a big one. It's your primary hormone processing organ. It packages up your estrogens, clears them from your body. When detox pathways are sluggish from poor nutrition, alcohol, environmental exposures, genetic variants in your detox genes, these hormones don't recyculate appropriately and they create an imbalance again that gut and your liver both need to work for your hormones to be processed efficiently. No one talks about this liver being cleaned out. Again, it's something we do as part of your prolonged protocols and our LifeLink protocols. It's what I call your more chronic issues.
[00:47:06] And we definitely treat it throughout your process.
[00:47:09] And then similarly, cellular health and mitochondrial energy. Your mitochondria are the energy factories of your cells.
[00:47:17] So if you can't create appropriate energy, then you're tired, you don't feel good, it's you're exhausted. And estrogen directly supports your mitochondrial function. So if we don't help that estrogen to be where it needs to be, and even put other things back, like CoQ10, NAD precursors, everyone's talking about NAD these days.
[00:47:37] We really are not managing your cellular detoxification pathways efficiently. We need to make sure that you're pulling things out of the mitochondria and making your energy very, very appropriately so that when you sleep well, you get the benefit of those cellular reset and last but not least, longevity link. Longevity is exactly why people come to us. They want to take their life of dysfunction, make it functional, feel better, and then live longer in the capacity that they want to live. And this is critically important. So we talk about brain health, cardiac health, genetic predispositions, we talk about medications and deprescribing. Right. Family histories, biomarkers. Do we do genetic testing? What are you at risk for? What can I check? And this is where some of these alternative labs also come into play. Because in perimenopause and menopause we might have a chance to actually stop and prevent some of these things because this is a very inflammatory state in your life. Would I love to start these things earlier? Absolutely. But sometimes we don't think about it till we're ill. I would love if you thought about it in your 20s and 30s and made those lifestyle modifications earlier on. Because those health decisions that you make early in the earlier decades are the most consequential to your life and how you live a long term term.
[00:48:57] So our seven lifelinks, gut, immune and inflammation hormones, sex hormones, thyroid and cortisol, metabolic optimization, detoxification, cellular health and mitochondria, and what we call our longevity or lifeevity. Longevity link are key to lifeevity. All seven of those is how we make it work. And this is work, all right. It's not easy. This is why, you know, I practice medicine the way I do. Because when you approach perimenopause through the lens of a whole body treatment and all seven life links, it starts to make sense. We fix all these body parts and all these systems. When you don't just chase symptoms, but you actually optimize the symptom. The transformation is not incremental, it's profound. And it's whole body results. Women tell me they feel better than they did in their 30s. And that is not an accident. That is what happens when you stop managing a problem and start solving it. Let's bring this home. The perimenopause lie is this, that your symptoms are normal, they are just part of aging, that you should wait them out and that hormone therapy is dangerous. None of that is supported by the current evidence. None of it. The truth is, is that perimenopause is a medically significant hormonal transition that affects your heart, your brain, your bones, your metabolism, your sleep and your quality of life. It deserves comprehensive evaluation and an individualized evidence based treatment plan.
[00:50:28] So if you are listening and you think this is me, but I've been told my labs are fine, I want you to know this is not the end of the conversation. But it's the beginning. You deserve a provider who will dig deeper, who will run a complete panel who understands the complexity of this transition, who won't dismiss you, and will work with you on a plan that treats the root cause, not just the symptoms. And at Dr. Lurie Integrative Medicine, I work with women every day who have been dismissed, misdiagnosed, most under treated, and we use this Real3 method to work through all seven life links over time and build a personalized path towards life jevity. Because true health is not just about living longer, it's about living better, feeling like yourself, and aging your way. You don't just have to survive menopause, you can thrive through it and come out the other side healthier than you went in. So if you found this episode helpful, please share it with a woman in your life who needs to Hear it on YouTube. Like this video? Subscribe to the channel. Click that bell icon to get notified every single time I post. It takes five seconds, maybe even less, and it means the world to me. This content can reach more women who are suffering in silence and deserve real answers. On the podcast side, leave me a review wherever you listen. It helps more women find this show. And if you're ready to take the next step, just Visit me at mydrlori.com to learn more about our integrative Menopause programs and our real three LifeEvity models.
[00:51:53] I've also put together a perimenopause Symptom guide that is linked in the show notes and in the description below. Download it, fill it out, bring it to your next appointment. You'll deserve answers and I'm here to give it to you. So one last thing, guys. Drop me a comment right now and tell me what was your biggest takeaway from today's episode. I will look through the comments, I will respond myself, and I can't wait to hear from you.
[00:52:17] So thank you so much for being here today and I will see you on the next episode of Anti Aging Unraveled. Thanks for joining me on this episode of Anti Aging Unraveled, where longevity is personal and you're empowered to age your way. If you found today's episode helpful, be sure to subscribe to the podcast or our YouTube channel, Anti Aging Unraveled. And of course, follow us on Social for more tools, insights and conversations rooted in lifeevity philosophy. Living life the way you want to take your next step, visit mydrlori.com, click get started now and fill out your wellness or weight loss intake to begin your personalized longevity journey. Until next time, keep living with intention, vitality and purpose here's to longevity, life jevity and aging your way.
