I'm Celeste and I'm a nurse practitioner and I am the founder and creator of Inspire Medical Spa. At Inspire, we do functional medicine, hormones, and aesthetic medicine. So here, we talk about this every day and it kind of comes up as an ethical part of aesthetic medicine. People come in feeling a certain way and sometimes there's mental health issues, sometimes there's hormonal issues, and sometimes there's skin problems or sun damage, right? So when we don't have it in house, then we'll refer it out.

If it's body dysmorphia or things like that, but that's kind of the evolution of how you get into hormones with aesthetic medicine. So the biggest question I get asked as a provider is when does it start? And I would say that's variable based on your experience, your genetics. So for you, tell me what you felt and kind of your thoughts around this whole part of your life. Yeah, I think for me, moments that made me start to wonder if I was creeping into that category of like, am I in premenopause?

Really started with skin changes. Skin and hair. So I started gray kind of early and then along with that, I started to notice shifts in my skin. And then also like itchy ear. And somewhere around me, I remember someone at one point saying like, hey, if you get really itchy ears, like that's a sign.

That's interesting. I don't know if that's true or not. But mine was probably the skin changes. Yeah, but mine was always this left ear and it would just get itchy just randomly, sometimes not associated with like seasonal allergies because I get fall and summer seasonal allergies. So you're like more skin concerns outside of that.

Yeah, more skin concerns outside of that. And then like all of a sudden, I stopped sleeping through the night and I would wake up hot, but I was like kind of like sweating and I thought are these hot flashes? What's going on? I started to have shoulder, specifically my left shoulder was starting to have issues. I like to work out in the morning and I couldn't, for some reason it was like freezing.

And I had heard that was potentially a symptom, but really I think the kicker for me when I was, oh yeah, I think I might be, I'm officially, this is my start line, is my cognitive like impairment. I couldn't think as quickly, I was losing words and that was a struggle for me at work, like huge struggle. It was starting to impair my ability to function on a day-to-day basis was just. Just being able. Cognitively not be as flexible.

So like your memory or you said recall. My recall and yeah, my recall with words and my memory, I think that was kind of the big red flag for me and then the second big red flag for me was my ability to like buffer my frustration and my anger, kind of like behavior where you like lash out at people. I've always had a pretty good buffer and I could pause. I could feel it and I could pause and it was as if that switch just got turned off and all of a sudden I was reacting and I was lashing out. I think a lot of people call estrogen the hormone of accommodation.

So as it declines people's ability to give a damn declines and their ability to like you said filter yourself. You're like, nah, that's a fuck you type situation. I don't give a crap what you get. Yeah, no, I was so frustrated and so angry and I would just lash out and I would say things that I wouldn't normally not say. I would surprise myself.

But also like the afterwards it was, there was a sense of curiosity. Like why am I changing so quickly? Why am I becoming this person? That was mostly the part that would scare me was I'm not used to behaving like that and all of a sudden I was. Was the first thing, like this is another question I get asked a lot.

Like what was the first thing you attributed it to? Like is there an age range where you're like, oh, this is about to happen because of your mom or your aunts or sisters or was it like you thought it was something else and then we're like, oh, it's hormones because there's a lot of people that when they come to me, they will be like, ah, this is happening to me. You know, like it's like targeted but also then there's other people that were like, I thought I was going crazy. I didn't know what was happening. And then I was so relieved when it was just my hormones and sometimes I feel like saying just your hormones is kind of a little bit hilarious.

I'm like, just, it kind of regulates your whole personality and behavior. So people are like. I would say that for sure. Yeah. I mean, I didn't have anyone, I guess, preparing me for this phase of life or not even like my friends.

If they were going through it, we weren't talking about it. Yeah. So. Let me, I think we skipped something. Will you introduce yourself?

Tell me your name. Tell me who you are and tell me like kind of what you, what you're doing right now with your life. Yeah. So I'm Miriam Solan. Yeah.

And what I'm doing with my life right now. Is a big question. What am I doing with my life right now? I'm in between stages. I feel like old me is slowly letting go to become new me.

Oh yeah. But I mean, meanwhile, I am in the middle of working. You know, I work for Breeze Airways in the instructional design learning and development team. And then you and your husband are opening. My husband and I have a mental health counseling center we own in Lehigh.

So we run that together. And then on top of that, I have an aging mother myself. You know, and so I take care of my aging mom. And yeah. The one thing that made me really wanna talk to you about this is we were talking about doulas, right?

Yeah. And if you guys don't know, doulas are somebody that helps people through childbirth. So you have a nurse that is from the hospital. And doulas are usually women's support that know about childbirth, but it's been an external certification or a training. And it varies all over the country.

But we were talking about how right now our culture lacks transitions. So the first transition is like when you're having a period. We were trying to talk about having doulas or guides for different phases of your life, especially as you're taking care of your mom. What was the culture that she was raised in? How much did they acknowledge that or discuss that?

And was it treated like a disease or a natural part of your life, you know? Like, so I think as I've experienced other cultures and patients and kids, it's variable on what people are willing to discuss until they kind of feel desperate. Yeah. Yeah. So for you, you talked about a doula for...

I talked about how we have like, yeah, we have birth doulas and we even have death doulas. So we have the beginning of life and the end of life. But for women especially, there's so many transitions, especially as we step into our fertility and childbearing years. Maybe to your point, like depending on your family and the culture you come from, their level of openness and how they share varies. And we stopped having multi-generational homes.

Yes, we did. So we're all, you know, like participating in the economy. So we each have our house and we're kind of taught to move away and develop ourselves. But I think part of that, we're losing some of that, a grandparent teaching the child, like the shared knowledge. Yeah, I agree.

I think we are losing that. It takes a village, right? And I think that village has been monetized now. Oh, that's so weird. And so, you know, you have to go out and seek the service and pay for the service.

But yeah, I come from a Latina, you know, Latin background. Both my parents were Mexican. My dad's family was huge. He came from a family of 18. Oh, wow.

My mom's family was big, I think, eight kids. She's, you know, the oldest of eight kids. And so there's a lot, and they're boomers, but you know, there's a lot of this old mindset of you don't talk about your health with other people. Your body. Oh, your bodies.

And so I was approached with, you have a stomach ache, you kind of, you know, plow through it, drink some water, and you try to go to the bathroom and you deal with it. You know, you don't complain of a stomach ache to your parents. I'm trying to decide with my teenagers on how much of it we should. I was like, I remember when you would get better most of the time and how we balance with listening to everything the kid has to say versus maybe like somewhere like a wedgie in the middle. I mean, you want there to be curiosity.

You want them to be curious about their bodies and you want to nurture a healthy sense of body image and for them to trust you enough to come to ask you some hard questions, but then, I don't know, I was never mentored or brought up that way, so I felt like I was taught to just do the best. And I had really painful periods, and so I would complain about that to my mom and she couldn't relate. She was like, you're probably okay. Yeah, she would walk it off. Drink some water.

Yes, it was like, she was like, I never had painful periods. What are you talking about? You know, and then I struggled to have children. I went, you know, went through my own infertility journey and that was also a really lonely phase of my life where it's like, who do I open up to and talk about this? My family couldn't make sense of it.

They couldn't understand it. My in-laws couldn't make sense of it. They couldn't understand it. And so now I'm at this, I'm coming on the other end of this and I'm kind of still sitting with this ambiguous, like, what do I do with this health? Like, I don't think I ever resolved that, all that stuff.

And so we were talking about, I would think it would be valuable to have a menopause doula because for some of us, I don't know how to transition and now this is kind of a big deal. Well, I guess like you don't have the people to ask the questions that you trust their opinion and chat GPT doesn't have arms and it's not gonna hug you and tell you that it's gonna be okay. Like it explains your symptoms sometimes. So I think talking to groups of women about it and I think the other thing that's really beneficial is there's like two sides, right? There's them and us and women.

There's their experience and my experience, is that what you mean? There's like a them and us, right? There's like a separation from age and youth and women or people that have something and that don't, people that are and that are not. And I think if there was a little bit more of a bridge to say, hey, like you're 30, you're 35, you're 40, like you're only going towards this. So here are the things that you should worry about and be not scared of, right?

This is what's gonna happen. This is how we can treat it. And we don't have to have this big fear that everything about us is just going to change because you have also other older women that we don't talk to. Instead of just having like a professional person that's doing it, what about like our 60 year old women right now that have experienced it and they're able to talk about it a little bit more freely because I treat a lot of patients in their late 50s and early 60s and they're like, woohoo, I feel so much better. Or I loved going through menopause because then I didn't care about this.

Or there's people that are like, I'm so tired of having sex, I don't want to. Or there's the people that come in and are like, I really miss sex. So I think it would be more beneficial to have like a group, to have like a group where people come and kind of talk about it so that they can find someone within that group that they identify with. Because even when you have like, you'll have doulas and they may not be sensitive to what infertility has looked like for somebody. Or they may not be sensitive to being like, well, in my family, this is how we identify being a woman.

As soon as your period's over, you're another and now you're an old lady. You know what I mean? And when we categorize somebody as other, you start to remove the feelings that make you have a shared experience, right? I agree. So the most offensive thing to kids is like, oh, my parents had sex, oh, gross.

They take away like the human element of their parent, right? And when we say, okay, well, this lady's menopause, she can't have kids now, we start to take her value and say, well, she's not participating in the things of being a woman now. You know what I mean? I know exactly what you mean. So I personally see when people come in, they have that fear starting on, when will I not feel like a woman and when are people gonna treat me like I'm old?

Yes, I do. I do think having, my gosh, it would be awesome to just have a round table of women where we all sort of share and then we identify what that spectrum looks like, I think is what you're talking about. And then, you know, if you resonate with someone's experience or if there's something that's shared that you're like, oh, my gosh, I'm curious to learn more because I'm wondering if maybe that's gonna fit into my future, then there's the ability to connect and sort of anticipate and prepare. Yeah, because I think that's the basis of the fear is like, I don't feel like myself. I don't feel like myself.

And how am I going to take up space going forward? Because the way we live now is 80, you know, just above 80 for a lot of people. And if you're in your early to mid 40s, many people go through paramenopause symptoms within 43 to 47. They say the average onset for menopause in the US is about 51 to 52. Okay.

So the symptoms start like a dimmer switch, right? It's not like just the lights are off, it's over. Like, it turns on with a dim and it turns off with a dim. But it's so gradual that maybe you adjust and acclimate, you don't even realize it's dimming until something happens, right? Until you stub your toe, because you can't see anything.

Because you can't see, yeah. No, I agree. There are changes that you can control and that you can choose for yourself. And then I think paramenopause, premenopause, menopause, create changes that are outside of your control. That you're just going to have to adjust and go with because it's a natural part of the aging cycle.

What are the things that you feel like that you're just going to have to adjust? Yeah, that's I think the question, right? Is that sometimes we aren't always given the education to know how to classify what fits into that. I can control this versus the, this is the way it's going to be. This is happening to me and I'm going to be different as a result of this.

Yeah. And I guess there's other things too, where you change kind of each decade with jobs, with people you are married to, with people you date. And when it's more consistent, I think the biggest thing is that people talk about is cognition, like their memory and then their irritability. How much they care or don't care about sex, right? So those are things that they can control.

Those are things that people can control. I guess choices they can control and decide what to do with it. but some people don't want to, right? So what they get, I think the coolest thing in my opinion from, I haven't gone through this yet, but I am watching and learning to see how I want to go through it and what type of a guide I can be for people that are going through it. And my most favorite thing is I think it's an opportunity to reshape yourself.

So when you talk about what you're doing right now is there's a level of like, you're brave. You went to another country, freestyle, speaks a different language, nobody else with you because you wanted to, right? And then you're seeking spiritualism through the way you're expressing yourself through a creative outlet, right? Through art, yeah. Probably a 20 year old version of you wouldn't have done that.

So there's like different, I think value systems that we have to start to be comfortable with. And I think that's the whole part with aesthetic medicine is are you seeking confidence or are you seeking perfection? Because confidence can be delivered and support in different ways, but perfection isn't something that is found in that type of medicine. Yeah, I like that. And so for like you with the cognition, that sounds like something you need some more support with.

Yes, I know it's been really bad this week. Yeah. Yes, and that's the other thing is there are days, it's like when that mile marker hits and you're like, why am I having a worse week? Yeah. You know, is this stress?

Is this controllable or not? Yes, is this manageable or not? What other aspects of my life do I need to look at to be like, is this impacting, making a difference in this area? Or no, it's kind of go back to hormones, like what you're saying, reach out to my doctor and ask, what am I missing? What should I do?

What can I control and what can I do? And what do I accept and what do I not? I think that that's probably the most accurate description of what's happening with wellness medicine across the whole world. Like with peptides, with stem cells, with GLP1s, with HRT, with the FDA saying, okay, well, I guess it's okay, maybe. You know, like I think what people are saying right now is I don't wanna live with this and what do I have to live with?

Yeah. All the shed videos, the LED, the ultrasound, the plates, everything is, people are like, what version of me gets to exist tomorrow that I can control? Yeah. That I can choose because that feels empowering. Yeah.

And. Yeah. I think that that is, yeah, that's the best way to put it. But I think even with things where, again, the natural aging process is happening to our bodies, it is empowering to also be educated enough to know, okay, I'm here, I am in this phase of my aging. Yeah.

You know, and. Well. Accept it. Yeah. I mean, you can do something about it.

It's not always gonna be like your hands are tied, deal with it. I mean, time works like that, but other than time. Yeah, well, I think that people aren't actually accepting that answer anymore. I don't think people are. Okay.

I think all the kids that we're told, every kid that was like, your mom said, you're fine, go to bed. If you still have a problem in the morning, those kids hold on to that experience where they were like, mom, my arm was really broken. Remember? Okay, yeah. Or I was actually sick and I had a fever and I threw up and I actually had my appendix removed.

Yeah. Right? So there's all those kids right now that are adults saying no, right? I think is the most fun part is before we said, this is how you're a woman. There was a template and a definition and you fit in the box or you didn't.

And I think that's what's broken and it's stressing everybody out. 100%. The template. They're like, excuse me, get back in the corner. Yeah, you get in your template.

Yes, yes, yes. You can choose now. And then fortunately, the template used to be like that dude on the book, right? And it was a dude, it wasn't even a lady. So I think that's the other thing that's happening is we're making our own template and saying we want it color coordinated based on- We are customizing it.

Yeah. We're taking a blueprint and we're like, that was a nice template, but now we're creating our own blueprint or customizing it based on what we want. I think the most important thing that you said that takes the value for me going forward as I talk to people is to rephrase how we talk about it with somebody are what are things that you can control through either bioidentical hormones, supplements, behavioral changes, and what are things to expect? Like, this is your new leg, you know? Or this is the way, you know, this is something that is not actually going to change.

Like if you stay on estrogen, it's going to change your bone density, right? So you may not get as short, but you're still going to age, right? What do you do for disc health, right? Yeah. Because those are the type of things, your omega-3 is like, if your body doesn't make it, then what are you supplementing in your diet or with oral supplementation that you need?

So how do you work that into a consult? Like, is it best practice for me to bring up my own list of questions or should I wait for the practitioner to like? I think you have to do both. Okay. I think if you, most practitioners have a script or a template that they follow that are the most typical symptoms they seem.

Okay. But some people have different symptoms and some people maybe have other actual disease processes or comorbidities or co-occurring things. Like you have a lot of people with PCOS, you have people with Ehlers-Danlos right now that they're having symptoms that are outside of hormonal problems. So you need to start helping them screen for disease processes. So both are valuable.

Yeah. Because sometimes like for you, if you're like, my left ear has a skin problem. Well, if it's unilateral, it tends not to be as much of a systemic effect from a hormone. Yeah. Right?

Yeah. If our skin is changing on our face, if it's a patch, it's gonna be more of a contact dermatitis or... Or melasma for me. Exactly. That's kind of the big one is like all of a sudden I started to notice that.

The melasma. The melasma becoming more of a problem. Prevalent. But I wasn't seeing a specialist. I was just going to my primary care doctor during my annual checkups.

And this isn't always something they ask about. Well, okay. I used to do primary care. Okay. And I have great love for them because it's me.

It's old me. We are taught how to screen for diseases, right? We're making sure that you don't have colon cancer, breast cancer, diabetic screening, kidney screening. We're your first line of defense, right? As far as being somewhat more preventative with certain markers.

But the type of medicine that we have primarily in the US is it's not live well, it's don't die medicine. We're autonomous and you are responsible for yourself, but you'll... You know, you go to the ER and your leg is cut open, they fix it. So back together and they say, follow up with your primary care. Your primary care filters you and refers you out to the specialist or the ER will send you to your orthopedic specialist.

So primary care is taught about hormones in the way as if there's a severe dysfunction, that is a disease process and then it's called this specific disease. Is it Hashimoto's? Is it type one diabetes, right? And then you get filtered to an endocrinologist who specializes in that. So, you know, like you're right.

Primary care doesn't live there. And then the other people were... The other place where people kind of go to die and hormone hell, I guess, I don't know is OB. I was just gonna say, is it your OB-GYN? Because I feel like those were my two gates that I had to go through.

It's a natural gate, but they're not taught to manage the discomfort or the wellness of aging. Right. They're taught to GYN be like, do you have a disease? Do you have cancer in there? Is your vagina vagina-ing?

Is there a baby coming out? Do you wanna keep a baby in? Do you wanna get a baby in there? Like, you know, they're the first line of defense for the function of the vagina uterus as organs. But as soon as something like hormones start, they don't actually...

The other thing that is a little bit, they don't really make money off of that, right? Their biggest money comes from delivering babies, right? Yeah, I think so. And if they're keeping your vagina healthy so that you can have babies, that's their job. That's what they wanna focus on.

That's their money maker. But there's no education that follows. No, we don't have a category of medicine for it right now. That's why it falls into functional. That's why it gets such little respect from standard doctors, because it's not a curriculum that's being taught and pursued.

You can do it in secondary medicine or secondary education post-graduate, right? Where you're doing certifications, right? So those are the ways that people become better at it. Functional medicine, DOs, they do a lot more. Yeah.

So there's not a place for you to go that's doing it. There's something that's emerging here in Utah that I've started to see with some of my other patients that they maybe have had cancer, right? So the University of Utah and Huntsman have a HRT clinic for people that have had to have their reproductive organs removed that are responsible for making some of those hormones. So I've seen a lot more in that regard than I have in the last 10 years. I hope that it is an emerging form of medicine that is not relegated to endocrinology or GYN, that it is autonomous and exists for the wellness of a person, not for just disease.

I feel like there's a lot of change, but there are like those pillars that we have. Like, even if the way we approach how we wanna treat something, the pillar of menopause and perimenopause are the heralds of symptoms, right? So irritability, memory changes, vaginal lubrication, sexual interest. Just your body temperature too and how it shifts. Sleeping at night.

Yes, sleeping patterns, habits. Yeah, quality of sleeping, falling asleep, staying asleep. Yes. So there are those things that will help us discern when they're in that area. And we can look at labs, but labs don't always correlate to the way you feel.

Right. That's why you go to your primary care and they're like, within normal. Well, we're telling you, you don't have a disease. Yeah. We're not telling you that this means you should feel well.

Especially for- But that's what we're doing in primary care is we're filtering you for diseases and protecting you. Yeah. So that is a very valuable thing to have. We just need another segment, right? You need to go to a clinic that specializes in HRT and you have to understand that when you start HRT, your body is no longer producing these hormones.

You can eat better, you can lose weight, you can do many things that can optimize your body's function, but there's not very many things you can do that's going to turn back on estrogen production. Yeah, there's no going back. No. You can eat yams until you die, you can eat soybeans. There's a lot of ways that you can get it out of the diet, but it doesn't come up as the right isomer or molecule, right?

Yeah. The version of it, E2, E4, P2, P4. There's a lot of different ones, right? So when you start HRT, this is going to be something you take until you don't want to. And that's really just up to you.

So going back to what you were saying earlier, you get to choose when you stop. And then it very much reminds me of when somebody would be on a blood pressure medicine and they'd be like, my blood pressure's better, and you're like, woohoo, it's working. And they'd be like, woohoo, I'm done. I'm not taking this medication anymore. And you're like, oh, but it's working.

And I think that that happens here a lot as well. Oh, I went through that. Yeah. Where people are like, I feel great. I don't need you.

I feel great. So I think that's the hardest thing when you first talk about HRT is your body has a baseline. And when you take a supplement, your body's like, sweet, somebody else is doing this for me. Yeah. So if your baseline was 10, when you stop it, it'll drop below 10.

And then it usually goes back to your baseline. So if your baseline for progesterone or estrogen or testosterone is minus or zero, when you drop below that, you feel a little bit worse when you stop, and then it goes back to zero. So a lot of people have that misconception that they're like, sweet, I feel great. And then they'll stop everything, or they'll be like, I read this thing that said you shouldn't feel great, like do this. Or you can take this supplement and you can sit under red light.

And if you sun your butthole, you'll be fine. You know, like that. Like they find alternative ways to subsidize. And if you think about it, it's so funny because HRT therapy, what I currently do is fringy. And it's getting more mainstream right now, but it's always been on the fringe.

Yeah. So now when people are like, oh, it's almost like they're looking for a trend, not actually a solution, you know, where there's a difference. Yeah. Yeah. And also I think going back to what we were saying earlier, when we don't have people close to us talking about this, and how they went through it or how they chose, again, that round table of women and that spectrum of experiences, when we don't expose ourselves to that, all of a sudden we have a TikToker or an Instagram influencer who is talking about it.

Who's your current round table? Which we just- And then we give them all the credit, all this like, and then we override our doctors. I feel like we can't fight social medias because it's a new way we're being social, but we maybe just need to qualify the source. Yeah. Right?

Maybe she has great solutions for underwear or tummy compression or hairstyles, but somebody's hormone journey is not really gonna be the same as yours. Yeah. And that's why a group that talks about it together so they can see where they relate and where they don't, that person's not really an authority, but they have value in at least telling the message, getting the message out, which that has value. And letting people start to be curious is what can help change, right? Yeah.

That curiosity and that demand for saying, what can I control and what am I going to just live with? And I think that's one thing that makes women the most special. Yeah. Is they don't wanna live without their blanket that's snuggly and I come in and there's like fresh flowers here and somebody thought about what coffee I wanted. Like, I think they're at a point where they're wanting to take up space differently and for themselves and not have to deal with it.

It's just, it's true. It's a different phase of life. It's almost... I have such an unpopular, I do feel bad for men in hormones though, a little. Okay.

Because they just... Being on the receiving end, you mean? Like because they're on the receiving end of a lot of our behavioral changes or why? No, I don't feel bad for that. Okay.

Fuck that. No. Okay. I feel bad because at least we can talk about stuff and we're just like, oh, ladies are crazy or they're drama, whatever people bullshit and say about us. Yeah.

I don't think very much men don't have that space to say their feelings. I said, you know, like you can watch a TikTok lady tell you how bad a bra hurts her and here's a new bra, you know? Where I don't see a lot of support for men being able to say like testosterone, they only talk about as far as like, does my wiener work or not? Am I horny or not? Like they don't talk about how much it does for mood, energy, emotions.

I see what you're saying. You know? So their version, what do we call that? Well, we have, is there even a term for that? Well, we call when men go through this phase, we call it andropause.

Okay. Because it's the pause of male hormones or the slowing and it happens to men too. Yeah. But they just get viagra about it, right? But that doesn't address like, listen, I was somebody's midlife crisis.

It doesn't address the emotional component of it and it doesn't address like their energy or the mood or how they take up space differently. Okay, so. So I just say like, I am 100% grateful to be a woman and have people around me and provide that to people. A safe place to say my feelings and their feelings without it affecting my virility, my masculinity, how strong I am. Yeah.

You know, like it's hard to be a woman, but I was, you know, like I listen to men every day that come in and want help and I feel like they're deeper than we give them credit for. And I think that if we talked about it in relationships, it would be better. Cause so many relationships when hormones change for a man or for a woman, it's one of the things that can break a relationship really quickly because someone that has no testosterone in their body, their sexual desire is almost gone. Yeah. So as a woman or a man being on the other end of that, it feels personal.

Yeah, the psychology is shifting too. It takes up a lot of energy to say, hey, this is a hormone that is currently off. It's like flipping off the light and trying to put your, you know, like your plug in the plug. You're like, ooh, fill it, get it. You know, like it's, I've seen a lot of relationships really struggle.

Yeah. Because either party doesn't have that access to intimacy, which is really important for that relationship for them. And it's been a way that they've coped for so long. And then it's not a coping mechanism and it's not a way to have intimacy or bond. So when we talk about being on the other end, and when we talk about someone being 50 years old and being able to dance in a leotard on the screen and have that as people still want to be sexual, they still have that, our shells age, but our goals and desires are relatively the same.

Yeah. I guess like 20 year old me had different goals, but I still wanted naked Olympics. Right. Right? Yes.

Yes. I still wanted naked adventures. I still wanted intimacy and bonding and friendship. What motivates me may have changed. If I drink alcohol late or stay up late or, you know.

And then like how much money you have to hang out, that's changed. Going to Hungary and painting, that's changed. For two weeks. Very different, for sure. But I think like for the takeaway from this conversation for me is I think communicating in relationships when your body is changing, there's a lot more safety.

Yeah. And being able to talk about that as a form of prevention and your relationship over time is probably gonna be very healthy. And explaining when you're upset, like, oh, this is not your fault and this is how I'm acting. And then starting hormones and stopping hormones is a choice. Yeah.

And what do you feel like you want to have control over and what's realistic to have control over? I think this was educational. I think the biggest thing, the biggest takeaways, if you're at the beginning stages of this and you're wondering where to start, you know, it's like document their symptoms and if you've already gone through those gates that we talked about, if you've already gone through your primary care, if you already went to your OB-GYN, if you did the birth control or not, or even if your gut's like, there's something more, like I should consult, you know. Well, specialist. Yeah.

Go out there and do it. The first steps I would say is to document the symptoms that you have, what has changed that's making you feel this way. And then getting a full comprehensive lab panel so that a person can explain to you what's high, what's low, what's good, what's bad, and then you can start to kind of understand how to consume medicine, functional medicine, DO, primary care, because you can navigate it. Some people, HRT therapy becomes expensive because insurance will not cover it. It is not a preventative care, it's not a disease model.

Until you hit menopause, they're usually not supplementing it. That's the saddest part to me. So it's not covered by insurance for that and then it becomes not a part of, once you have a diagnosis on your chart, it's not a preventative lab. It's a disease-based lab, right? Yeah.

So we want to have a place that is going to do your labs and a few times a year for men, you wanna check a little bit more often to make sure that the testosterone isn't increasing their red blood cells too high or it naturally increases cholesterol just to make sure there's not creating a problem. And then for women, we want to find the level at which your symptoms decrease. So you're gonna do a lab for a baseline to make sure there's not a disease process. We don't wanna treat you if there's a cancer or if you have, there's a lot of other genetic things that kind of show up in puberty. In puberty?

So we are past that now. Right, but there's different genetic things that may not have been caught. Okay. And they're being caught a little bit more now. So by the time you're in paramenopause, right, you wanna get a comprehensive lab and you wanna talk to a specialist.

Okay. And that is going to be someone that does HRT. You're gonna look up their reviews and you're going to check and see if you can research the information they're giving you and it's valid. Yeah. Yeah.

Because there's a lot of data and there's a lot of ways to check. I am advocating for you to check chat GPT and to check CLAWD and to check Google Copilot, but not to use that as a replacement for a primary care or a doctor or a specialist. Because listen, you still need somebody with thumbs and that is able to discern the difference between a disease process or a purpose of growing hair, of supporting immune systems. Do you have omega-3s to even grow? Yeah.

Does your liver have a dysfunction and that's why the cholesterol, you know what I mean? Like there's too many variables that using chat GPT or an AI model as a guideline to understand is very valuable, but it is not a replacement. Yeah, okay. If at the very least you can bounce around some questions with the AI to take to your doctor and just be like, Because that's in everybody's hands and I don't think we should be scared of it. I think we should use it as a tool, but not make it.

An expert in your life. Track your symptoms. See kind of what the reason you're concerned. Find a person that can help you with the labs and then decide if you're ready to go down this road. And then also the benefit is you can stop anytime.

It's not an all or nothing. If you're like, hey, this isn't for me, I wanna stop. But it is an all or nothing because I did stop. And then I quickly was like, Oh crap, I maybe should have done that. Well, but that's the benefit is you're in the type of medicine where you're not fighting a disease.

This is not cancer. You're not like, if I stop, I'm going to die. If you stop, you're not gonna sleep really good. You're gonna notice things. Your vagina is gonna get dry.

Your sex drive is gonna go away. Your skin is gonna get saggy or on the inside and outside. But behaviorally for me, cognitively for me, I think that's kind of, those are big, big deals. They can create, I guess, bigger consequences that might be harder to come back from. Yeah, fuck you in the middle of a team meeting or a Zoom call.

Yes. If you're not remembering to mute yourself, what would that do? Yes, yes. Son of a, oops. So I guess paramenopause is coming for all you bitches.

Yes. Right? But at what age? I mean, it's just such a big. It's 43 to 47 for the majority of the population.

I would say when we talk about the bell curve, the wedgie right in the middle, most people. And most people are finished by 51, 52. That's when menopause. Really? I feel so young.

I feel like my mom was older when she went through menopause. That's because of the golden girl phenomenon. I know, but I could, I mean, I was, now I have to do the math. I remember my mom going, but again, I don't know if she was in menopause or pre-menopause. I think it's that other category, because the other funny thing that happens, I noticed a ton, is like someone, someone will be like 50, and someone will be like 44, and the 44 year old groups themselves with the 30 year old, and the 50 year old groups themselves with the 40 year old.

Okay. I'm like, you're within five years, 10 years, you're in the same cohort. You're in the same, you have the same pop culture references, things like that. It happens all the time. I accidentally group myself up, because I date somebody that's older, but my social references aren't the same.

I'll be like, what? Who's that? But it, you know, like I mean, it's how people group themselves. So if you're like, well, my mom was so old, it's just that whole, your brain is like, what, 15, 20? I know, well, I was 21 getting married, and my mom, I remember was, you know, she would have random hot flashes or something, but it was behaviorally, like what you were saying earlier, like, oh man, mom, where's your buffer?

Like, that's not like you, you don't get angry about these kinds of things, or. You don't fly off the handle, you know? And I'm like, is my wedding stressing you out? Probably yes, but this doesn't, this doesn't match, like this seems bigger than that. The reaction doesn't match.

Yeah. So. That does happen. Family and friends will notice for sure, and they will call you out, so. The, yeah.

Paramount Impulse is common, and you can do a lot to mitigate the way it feels. Okay. So. Well, I'm excited, I'm excited what you do, and I'm excited to keep working with you, I'm excited. Oh yeah.

So to get a handle on this, and. But also, it's a new level of self-care. I have to find my ways of coming up with a growth mindset. Like, this is a part of my life now, I'm growing with this, and. Yeah, it's a good attitude.

It's a self-care that I have to approach. If I wanna show up for other people, I need to show up for myself. So. Yeah. Or I'm gonna fly off the handle.

Yeah. And then. There'll be regrets and repairs. Relationships may give lessons. Yes.

So. You may get the mob call from the whole work. Yeah. That's what happened here. They were like, I don't know what she's taking, and I don't wanna know, but if she ever stops again, we're gonna beat her up.

Yeah. I was like, oh wow. That's the need for a menopause doula. Oh my god. Here's how you navigate sleep.

Yes, here's how you navigate sleep. And oh, you said things, and that's okay, you can still fix it. And while we're having a meltdown, what was I, I don't know, you know. Yeah, yeah. So.

Yeah, there's a lot of hope. It's changing and it's improving, and we get to be a part of it. I'm so glad you're gonna be my menopause doula, Celeste. Yeah, let's cheers. Woo-hoo!

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