SEASON 4, EPISODE 3 - PERIMENOPAUSE: PERILS AND PREVENTION

Dr. Mueller is back and here to tell us all about Perimenopause - what your mom never told you and more!  What it is, what is happening in your body, and what are some of the best practices for handling this volatile time! 

Transcript

SPEAKER_01 0:13

Welcome menopause warriors. Come join us where few women have gone before. Our mission is to demystify the menopause journey. We seek to break through the stigma surrounding getting older and provide our listeners with real solutions and support and answers to give women the tools to live their healthiest, fullest lives. Embrace the heat. Welcome, menopause warriors. Today we have Dr. Tony Mueller. She is coming back. She was in episode one and was really one of the very first doctors we spoke to about menopause in general. Paramenopause, menopause, and postmenopause, and really explained to us the stages. She is a board-certified OBGYN and has been practicing since 2007 in the South Bay. She has an amazing practice here. And her website is, I want to give it right at the top of this because it's called BeyondMymenopause.com, all one word. And I'm just for her intro today, I thought I'm reading this because this, I feel like we've been on this journey together, Dr. Mueller. I mean, you've been doing it a long time. But I mean, I feel like you were really one of our first that we talked to that was really explaining. And on her website, she has a quote. And it says, Patients often come to me in tears as their day-to-day stressors have left them imbalanced, preventing them from effectively managing their daily life. They have difficulty sleeping, report low energy and libido, poor memory and concentration and emotional lability. Medical school and residency never prepared me for this challenge, even though it affects all women eventually. Unhappy with conventional therapy, I threw myself into a more integrative approach. And I just feel like that to me gives me it gives me goosebumps because you were doing this before it became fashionable to talk about menopause. And I just want to give you a shout out for that. So welcome, welcome. So good to see you. I hope it's gonna be really exciting, and I hope you're gonna tell us we've come a long way, baby. But I think we have since the last time we talked. And I think what we want to really concentrate on today, I know it's your, you're very passionate about this. I'm passionate about it. I'm of course I'm always more targeted to postmenopause because that's my world. So I think what we want to try to do in in this episode is really touch on paramenopause because that is where the prevention comes in, right? And I think that's when we had discussed this and coming back on for our season four, you were saying, I really want to hit on this. So why don't we just start out? Just give us real quick those three stages again. And then I mean, I know why I think perimenopause is important because that's where the prevention comes in. If I had really paid attention to my doctor when I was in perimenopause and went on some HRTs and had done some things that I was told to do, I may not have suffered like I suffered. So why don't you start with those stages for us?

SPEAKER_02 3:11

So um I guess perimenopause starts in our early 40s. And I think it's, you know, best defined as a time when you have a decrease in progesterone, decrease in testosterone, and fluctuating levels of estrogen. And that's why you're getting withdrawal symptoms because you're having estrogen up and down, up and down, and your brain is signaling uh to the ovaries push out more, push out more. And that's why you're having the symptoms that you have, like the night sweats and the and the hot flashes. And then the decrease in the progesterone that starts in your early 40s is accompanied by the irritability, the anxiety, uh, the poor sleep, you know, the I want to leave my family and I just want to get my own apartment. Um so yeah, and then the low veto.

SPEAKER_01 4:01

Why are we laughing at that?

SPEAKER_02 4:02

We're not laughing because that's the truth. Every woman that comes into my office secretly is like, I can't stand anyone. So um, so that's what happens. So that's perimenopause, and it could be like um, you know, anywhere from five years to 10 years for some women. I even have some women in their late 30s experiencing these symptoms. And then finally, menopause is defined as your last egg that is released. So you no longer ovulate, so you don't have the hormones to support the egg. Therefore, you don't have estrogen, you don't have progesterone, you don't have testosterone, and no more periods. And so you enter menopause. Menopause is just a, you know, the end of ovulation, the end of fertility. Right. And you may or may not have symptoms. Some women don't have symptoms in menopause. Right.

SPEAKER_01 4:51

Okay, so let's talk about that because I think that's the real tricky mystery here. Now that people really have this, you know, everyone's talking about it and it sort of flows in conversation. But what I think is not addressed, and I'd love for you to answer this for us, is when a woman comes in to you and says, I cannot sleep at night. I want to get my own apartment and not be around anybody, and they go through their plethora of symptoms. But then you do the blood work and they look fine. Their numbers look good, their estrogen looks normal, their testosterone looks normal, their progesterone looks normal. But they're 45, right? What do you do with it? Because I know back in the day, years ago, 10 years ago, when I was perimenopause, it was all about, oh no, you're fine. You're no, you're not in it yet. See, this is where, and I remember them showing me what, you know, my numbers, but I clearly was, clearly was now that I'm educated in it. So what do you do with that?

SPEAKER_02 5:45

So the issue is, and I've I've uh I've had this dilemma, is the labs are only a baseline into secondary diagnoses that could be causing the symptoms that you're experiencing. So we want to look to make sure you're not anemic, you don't have thyroid disease, your ferritin is not low or elevated, suggestive of inflammation. We want to look at vitamin D deficiency because everyone has fatigue, everyone reports some inflammatory symptom. And so you have to rule that out because you don't want to just throw hormones at somebody without knowing that there's nothing else going on that you have to deal with medically. That being said, what we have to understand is that the hormone levels in our blood, estrogen and progesterone, they travel bound to a protein. They're not free, they're not free floating and able to go to the cells to give the cells what they need. So the only free level hormone that we have available for analysis is testosterone because of men, sadly. So the only level that I can tell you with certainty that is low is a free testosterone level. When you ask me what your estrogen is or your progesterone, I'm only going to tell you the total amount, which means that's the total amount that you have, which could look completely normal, but it doesn't mean that that's what's bioavailable and capable of entering your cells. So when the doctor tells you your levels are fine, that means nothing because it's not letting you know what is actually available.

SPEAKER_01 7:15

Okay, so two of our listeners out there that are 39, 42, 45, and are experiencing hot flashes, irritability, not sleeping. What do you recommend for them right now today? Like what would you say get yourself?

SPEAKER_02 7:30

Definitely get so here's the my issue. I feel like a lot of perimenopause women are seeking hair, but they're just all getting the same regimen. Uh, whether it's online or from a provider, they're all getting like estrogen and progesterone thrown at them without understanding that perimenopause is actually a state of estrogen dominance. You have way more estrogen to progesterone. And that is why a lot of women in perimenopause have heavier bleeding, more painful periods, and severe PNS. So the last thing they need is estrogen thrown at them.

SPEAKER_03 8:03

Yeah.

SPEAKER_02 8:03

So you need to see someone who is able to evaluate you and your uterus to make sure that adding estrogen is not going to make your symptoms worse. So labs are not really going to give you the answers that you you need. You want to make sure that you don't just need progesterone and sometimes just progesterone and testosterone is all you need until your cycles calm down and then you could add back estrogen.

SPEAKER_01 8:27

Okay, that's interesting because you don't hear a lot about that. You do hear them go right into that. The patch, the estrogen to the Which is why there's a shortage, right? Because everyone's getting right. I know. I know. So you really like you as far as when people come into you, it is really it's so bio-individual, right? Extremely, extremely so difficult as a doctor. There is no one-shot deal, like a one-shot, you know, regime. Would you say that no?

SPEAKER_02 8:56

I mean, you target the symptoms, you you go based on what the patient's feeling, like you know, like the most important symptoms that are greatly affecting her quality of life. And sleep is the is at the forefront because if someone's not sleeping, they're not going to be able to exercise, to to eat well, to carry on their daily function or have libido. So if we can't get you sleeping first, then nothing else matters. Right, right.

SPEAKER_01 9:21

Okay, so let's go into those HRTs, the hormone placement therapy. Okay, when we met five years ago, you were very pro-compounding because of the whole risk that was put the FDA black label on um pharmaceutical bioidenticals. Right. So maybe give us, I I try to explain to people that come to me, and I am not a doctor. I can barely pronounce the name of any sort of medication, but I do am very clear now on what a bioidentical at a compounding pharmacy does compared to a bioidentical in a in your pharmacy like CVS Target and what is paid by insurance and what is not paid by insurance. So I want you to speak to that because I know you really like the compounding. And I'm gonna say right now, my concern for that, doing what I do with just getting out to the masses and talking to people is not everybody can afford that compounding.

SPEAKER_02 10:13

Correct.

SPEAKER_01 10:14

So tell me what you what what what do you do there? How do you prescribe a regime to your patients, knowing their socioeconomic background and what they can and cannot afford?

SPEAKER_02 10:24

Yeah, so in a nutshell, when when we say bioidentical, we mean that um the hormones are manufactured in such a way to copy exactly what your body's producing so that they bind to the exact same receptors without causing side effects. Birth control pills are synthetic, they are not identical to your own hormones, therefore they can bind to those receptors and other receptors, which is why you have side effects from birth control pills. So when we say bioidentical, whether it's compounded or from CVS, they're made to be identical to your own body's production. That being said, why I got into compounding was because the formulations were smaller and more titratable and individualized. So for someone who's going through perimenopause and is still cycling, only a compounding formulation of estrogen could be given to someone when they're not cycling so as to not disrupt their periods. You can't do that with a patch. You could do that with a Divi gel. Um, the problem is the concentrations are so much higher. And so you can't microdose. But I think that the patches work for majority of women. They're bioidentical. It's estradiol, it's the strongest form of estrogen, and it comes in four doses. The issue is it's hard to give that to someone when they're still having periods, and it's hard to prevent extra estrogen causing more or excessive bleeding. The other thing is we all have dense breast tissue, and estradiol causes proliferation, which is cellular development at the level of the breast tissue. So one of the reasons why I like the compounding is because you can also use estriol, which is the weaker estrogen, that doesn't cause that. So for women who have fibroids, run to getting polyps, really dense breast tissue, we can use a compounding estrogen that is stronger with the weaker estrogen than let's just say the more potent form in a patch. So it is individualized depending on every single patient's presentation and underlying risk factors. But for the most part, the patches work and yeah, the insurance covers it. But if you have an adhesive reaction, let's say you don't do well with that, then what? Then we can try the DiviGel and hope the doses work for you, you know.

SPEAKER_01 12:45

So next step. Am I just I'm just assuming this? I'm gonna ask you this question. So let's say in perimenopause you decide I'm gonna really do compounding because you know the patch is too much for me, it's not working. I want to do exactly that. Really makes sense to me what you're saying, especially in that paramenopause phase. Postmenopause, when women are now on this for some women for the rest of their lives. Like I have friends, and I think probably I'm gonna fall into that category because I have the bone issue, the osteoporosis. So um, is to be on this for the rest of my life. So, would it be safe to say that once you're in postmenopause, that it would be okay to be on a steady regime because you're not having just that crazy fluctuation? 100%.

SPEAKER_02 13:27

I think if you found a dose that works for you, keeps your bone density stable, you have great cognitive function, um, great sleep, then stay on the patch. It's it's easy, it's so convenient. Absolutely.

SPEAKER_01 13:40

Okay, because that's that's interesting. So you can say to it's fair for me to say to people that in my talks and when I have friends that give me a call that, you know, if you need to pay for the it up front now and perimenopause, pay it. And then once, you know, eventually you can probably get it paid for by CVS. That's my biggest concern is I just want women to get care. It's so it still is, and it's crazy because we've been living it. Tammy and I talk about this all the time. We've been living it for so many years now and talk about it all the time, too much, probably. But people still are freaked out by them. And you know, you just said something so interesting about the birth control pill that it's synthetic. And how many women just take that without a without any testing? I always say to my friends, you know, when they're like, I just know I'm not going on that. You know, it causes cancer. I said, Well, you've been on the birth control pill, and they're always like for 30 years. And I'd be like, Yeah, that's not the good pill. Like, that's a that's really bad stuff you were putting in your body. So it's crazy that we just blindly took that without really understanding hormones, too, which is why I love your practice too. Another thing that you say on in, you know, on your website is you really take the w women's health from teen all the way till death, really, right? The whole entire the whole entire stages of women and what we go through. And I just think that that's brilliant. I hope that more people start to really get um, really understand how important hormones are in our body. So for the paramenopause, what is their biggest benefit for taking an HRT for you in your opinion?

SPEAKER_02 15:11

I I think for the most part, because progesterone is the first hormone to go, I think adding back progesterone improves the PMS that we all have. So having um laceratic mood swings, improved sleep, I mean, that's just a you know a huge improvement in your quality of life. And it also helps calm down the cycle so you're not bleeding as heavy or as painful. So that that makes all the difference in the world. And then testosterone, if you're trying to like build muscle and you're you're trying to maybe lean out a little bit and have a little bit more energy and improve libido, the testosterone can also help, but that has to be compounded because it's not dosed adequately when you get it from the pharmacy in a packet of androgel. So that's the other hormone.

SPEAKER_01 15:55

Okay, I'm gonna share that. Listeners out there. I did try to get test. Well, I my doctor gave it to me from the pharmacy, you know, and it's in a packet that looks like a Tabasco or mayonnaise packet. And it says it's horrible. 10 times, 10 times out of that packet. It has 10 applications, I think it says, out of this mayonnaise packet. And I'm like, well, well, some days I was the whole packet, half came out, and then you know, other things. It was awful, awful, awful. And then I and then I read how we do not have any sort of dose that has been approved to treat us in testosterone.

SPEAKER_02 16:30

So I I will be looking into compounding for my my it's actually sad because Franca, so uh testosterone therapy is not FTA approved for women, it's off label for lola beetle, and it has to be documented as such. It has to be documented as the lola beetle is affecting the quality of her relationship. Can you believe that? I have to document that. And it's a controlled substance. So because men are suffering as a result of your lolabido, then we're allowed to dispense it.

SPEAKER_01 17:03

That's not right. Yeah, it's cream. It never ends, it just never ends in pretty. It never ceases to amaze me. Oh my god. Okay, so do you think there's any risk to these HRTs?

SPEAKER_02 17:18

No, no. I mean, I I've been doing this, you know, I've been doing this forever. And I have just a handful of women that have maybe developed breast cancer, most of whom developed it prior to seeing me. Um, no, I I mean I'm I watch them like a hawk. And what I love about what I do is that I'm able to like evaluate their uterus as a baseline with an ultrasound, I do myself. I have to take them to surgery, I do it myself. I just monitor them from A to Z. So I'm very confident that I can provide long-term care without risk because I'm not taking on other management or outsourcing, right? I won't take care of you if I can't see you from the beginning to the end and examine you.

SPEAKER_01 18:00

Have you seen a significant change since November 11th of 2025? Have you are there?

SPEAKER_02 18:05

Sure. More women are seeking Yeah. I think a lot of women are going online and getting hormone therapy, but they don't feel the connection with an online provider. I mean, they're getting the medication dispensed, but they want someone who can perhaps individualize care for them. So we're definitely getting more uh calls for uh perimenopausal treatment. That's probably huge. I think that spike in perimenopauses. And I'm also getting more and more referrals from primary care doctors, which I've never had before.

SPEAKER_01 18:33

Oh, that's good.

SPEAKER_02 18:34

Kind of legitimizing it. Right. When I first started this, no one was referring to me. That's awesome. So finally it's recognized.

SPEAKER_01 18:41

That's great. Okay, so supplements. Do you uh now that we talked about?

SPEAKER_02 18:46

Yeah, we're not really allowed to talk much about supplementation because it's it's not FDA approved. But magnesium glycinate definitely is important to take at night to help sleep, but especially because magnesium is is depleted with stress, and that's a lot of us right now. So it's a cofactor in in a lot of our biological processes. Vitamin D3 with K is important because the K keeps the D in the bones, it's not a very smart supplement, and you want to take that with food. Um, omega fish oil is also important or flaxseed oil for inflammation. Um, let's see. Those are probably the top three that I would say all women should be on. And then a probiotic, if you can do that, if you can find the probiotic, yeah.

SPEAKER_01 19:31

Okay, good, good. I feel good, Tammy. Do you feel good? Yeah, I know. I feel like I got it covered. So thank you very much. What would you say in the past year, um, what has been like the biggest trend or difference that you've seen in your practice of people coming in? You know, are people putting their vaginal estrogen on their face?

SPEAKER_02 19:49

Oh, yeah, that's interesting. Sure. Um I think somewhere they they found out that there are estrogen receptors on the skin. So, and well, here's the thing, you know, we lose 30% of collagen in the first five years of menopause.

SPEAKER_01 20:03

Oh, I that's a fact. That's huge.

SPEAKER_02 20:07

Yeah, oh my God. Yes. So, you know, dermatologists were not prescribing it. Um, I usually prescribe the estriol, which is like the weaker estrogen, but it has to be compounded only because the vaginal estrogen has a lot of fillers in it. Okay, to keep it shelf life stable. Right. So that's probably I wouldn't put that on my face. That's why. But it it may work for some women. I just think if you have sensitive skin, you have to be careful.

SPEAKER_01 20:31

And you recommend putting it just in like moisturizer, like people have been saying to do, or like mix it with your moisturizer and put it in. Yeah, exactly.

SPEAKER_02 20:39

Yeah.

SPEAKER_01 20:39

If you can tolerate it, yeah, absolutely. Okay, that's going on my face tonight. What do you think of those pellets?

SPEAKER_02 20:47

I have so I've never really done, I've never really used them because I I always figured that I was going to tailor my practice to the treatment modality that I would like to take on myself personally. So I feel that once the pellets are inserted in the body for the next three months, I really can't control the potential side effects, right? Right. So I usually see women back in a month after I start them on hormone therapy because right away we'll know if this is going in a good direction and how to titrate accordingly. And I cannot do that with the pellet.

SPEAKER_01 21:20

Do you think they're safe? We have Tammy and I have actually had a hard time finding someone who will come on and talk about it. Very good. And a lot of people that take it. And I know that it's not approved by the FDA, and there's a lot of like aestheticians and people like that in, you know, your cosmetol, you know, the um dermatology offices that are, you know, implanting the pellets. So I I you know that it it that freaks me out a little bit, but we have had a hard time. But I I have friends that love it, that don't have to worry about it, that it's there and they feel good and they have a little bit of the estrogen with the progesterone and the and the um testosterone. Testosterone, yeah.

SPEAKER_02 21:57

I think the convenience is there. I think something every three months is so much better than applying a cream every morning or a patch twice a week, in theory, but it it may not work for everybody, right? Some women love that love the feeling of the higher doses of hormones in their body, others do not. Most of my patients seek balance, want a very conservative approach. They don't want to feel like they're flying a helicopter. I think it really depends on what it is that you're you're seeking. And I think that um I don't know. I don't I don't I don't have clientele that is looking for that high. And I think that the pellets can can give you that. I'll I'll tell you, I've been going to conferences twice a year, like A4M for all the bioidentical hormone conferences twice a year for the past decade, and they never talk about it. That is not something endorsed by the bioidentical hormone community, by the PCCI, I go to that every year for the compounding pharmacies, and they never talk about it. So I've never been exposed to it in an academic setting. So I don't, I can't really take it on. Whereas I can talk about compounding all day long, right? Even though I'm a board certified doctor, it's hard, right? Because FTA doesn't approve it. But I I'm very, very comfortable with it, but I'm not there with the pellets.

SPEAKER_01 23:17

Okay, that's good to know. Okay, so walk me through, you know, 46-year-old woman comes into your office and she's in tears, like you just said on your website when you know in the intro, and she's not managing her life. She has all the symptoms. How do you deal with that? What what what's the first thing you do for her?

SPEAKER_02 23:37

Well, I mean, we definitely talk about the symptoms that she finds to be the most disruptive, and we create a like a systematic approach, how we're gonna tackle it. Because I think they want to know what is it that we're gonna do and what is our end goal. So we start with you know, tackling the sleep. And for that, we do have to make sure that the progesterone is the first hormone that she gets back. Now, if she's still having periods, she takes it at night orally because it affects the GABA receptors and it helps you sleep. It helps with the irritability and the anxiety, like we said. And oftentimes I'll I'll start off by telling her not to take it during her cycle. Maybe it disrupts her cycle. So we stop during that time, but then we can see how she feels during her cycle moving forward, if she should continue it or not. And then I follow up with her, see how she did. The progesterone works right away. Within a week, you'll know that or a couple days if it's worked or not. And then we do an ultrasound to kind of get an idea of her uterus. Are there fibroids? Is there pathology before we discuss adding estrogen?

SPEAKER_01 24:40

So you do do we do biopsies on uteruses?

SPEAKER_02 24:44

I only do a biopsy if the bleeding is abnormal. Like she's if she's bleeding more than seven days, if she's having heavy bleeding, like um soaking a pad an hour for sure. Yeah, you do not want to throw estrogen at that at that person. Right. Right. So the first hormone we would talk about adding back is estrogen, uh, progesterone. They usually feel great. When perimetopause, you can tackle 80% of the symptoms with just progesterone.

SPEAKER_01 25:10

Right. And then they just come, then they'll continue to come back to you and be not necessarily even tested, right? You do do now. Do you do that saliva test that estrogen?

SPEAKER_02 25:19

So the saliva, no, the ZRT labs for the saliva testing was kind of disproven. They found out that it's not really accurate in terms of what's bioavailable for the cells. What I do love is the Dutch test. The urine dutch test allows me to identify if the hormones, especially when you're on estrogen, if they're being metabolized by your liver appropriately. Because when they're metabolized by the liver, they're metabolized into metabolites that can then cause damage to the DNA. And so only the urine dutch test gives me insight into that. But that's usually for someone who's in menopause and is on all the hormones, and we're just trying to make sure that her body's doing a good job detoxing it. Right.

SPEAKER_01 26:01

Okay, is there anything that we need to know that you've learned since uh, you know, I've seen you as far as like when you say you you do, you you keep up on all your academic research and studies and and you go to all these conferences. Is there anything exciting that you see on the horizon? Are you more hopeful about women's self?

SPEAKER_02 26:22

I think what's exciting to me, and I'm gonna go to the conference next week, actually, it's in West Palm Beach, um, for the A4M. What's exciting to me is finally we can't really say that there is an end to treatment. In the past, it was, you know, you have to stop at 65 or you can't start at 60. And we just don't have the data to support that. And I've never stopped and I've never not given it to someone who comes into my office at 63 because of osteoporosis or prevention of cardiovascular disease. So I'm really excited about the prospect of starting it even later on in life and just continuing indefinitely.

SPEAKER_01 27:00

So you do believe in that? Yes, 100%. Always have. So you're not part of the belief that, and this is based on what you're hearing and what you what you're seeing, right?

SPEAKER_02 27:10

That's what I've seen in my own practice and everything that I've read. I mean, there are there there's a study that came out of Israel that it was in menopause uh recently that says that starting at 65 increases risk of cancer and cardiovascular disease. But I mean it is such a flawed study, right? Like most of them are, and it just scares everybody.

SPEAKER_01 27:28

Right. Also, that when you turn 65, that's when all your numbers go up, regardless. So it doesn't matter. Exactly. Right. I mean, that's what was so wrong with the 2000 uh study that really the risk benefit has to be there, so it's individualized always. Right, right. So my friends that keep telling me, I'm 62, I'm 65, it's too late for me. And it's not true. No, no, I love that. I love that because there is a generation that missed out, right?

SPEAKER_02 27:57

20 years, 20 years have missed out, and we're seeing more osteoporosis, more Alzheimer's because of that.

SPEAKER_01 28:03

Yeah, okay, that's exciting. And then overall in women's health, you know, we've been throwing some money at us and we finally have some research. Are you hopeful about that? Do you think that's going to continue? Do you I hope so?

SPEAKER_02 28:15

I I hope that there's research into the ovaries because they're they're merely seen as reproductive organs when they're really not. I think that they produce way more hormones than we know about. And we just don't understand why menopause happens only in us and I think whales and no other female species. Why? Why does that happen? So if we can, if we could do something to prolong the the lifespan of the ovary, I think that would be huge for women.

SPEAKER_01 28:44

Oh, that's interesting. Well, is there anything else that you felt that you wanted to tell us about perimenopause that you feel that our listeners can?

SPEAKER_02 28:53

I think that, you know, a lot of women also will listen to podcasts or listen to their friends and just jump on the same train. But you guys are all individual and with your own underlying risk factors. So take that into account and seek care catered to you as an individual, not because your friend is on this regimen or because you heard about it on a podcast. Really advocate for yourself and for your symptoms and what your goals are long term.

SPEAKER_01 29:20

I think that's so important. I know when I get a phone call from a friend, I'll say, look, I tried it and it didn't work for me, but try it, do it, because it might work for you. Or I know Tammy and I come from that. We have well, so many friends that call us about advice and who we what doctors they should go to and things. And we are always saying, yeah, it worked great for us. And I mean, Tammy and I talk about it. We, what worked for her didn't work for me, you know, and what works for me doesn't necessarily work for her. And it is so crazy by an individual that, you know, you really have to pay attention. And I think that's what makes it so hard to, you know, navigate healthcare in that way when, you know, you can't just just give me a pill, just give me a pill, just give me a pill.

SPEAKER_02 30:04

I think Franca, you nailed it because what frustrates me is the idea that there are four doses of patches for every single woman on this planet. There are, there's only a set of normal values at Lab Core or Quest that we all have to comply with. That's terrible. That is not how we were made. Um, we should not be treating and catering patients according to values that Lab Core constitutes as normal within normal range. That's not okay. So we have to stop with that kind of medicine and we have to do more individualized, you know, approach.

SPEAKER_01 30:37

Okay. Well, that's something to work on and talk up and push women's health forward. And I so appreciate you spending the time today to talk to us. It's so great seeing you. I really love your practice. I think, ladies, if you're in the South Bay, uh in the LA area, uh, look up Dr. Mueller. She is really doing it the right way and she's doing it for all the right reasons. And I just so appreciate your time today and everything you've done.

SPEAKER_02 31:02

It's my pleasure. You guys are amazing for reaching out to women. I really appreciate it.

SPEAKER_01 31:07

We're trying, we're trying, we're trying. Okay, thanks a lot. So I thought that was great as it always is and enlightening as it always is. I feel like I just am, I have some ammunition loaded to go out there in my next conversations with some friends and some people that I know that are really like the fact that birth control pill is a synthetic, you know, that we put in our bodies for all those years, and people are still afraid to put a horm a bioidentical that is mimicking our own natural hormones into our body, and that's what they have issues with, but yet they took the birth control pill for so long. When they're young, when they're super young, too. They're young, yeah. I thought was really interesting. I feel it always gets me when we talk about the medical misogyny of our journey in the medical world. That always brings me down, especially the testosterone, which we have talked about here on this podcast. And really knowing that, you know, we don't have a prescription for it. I don't even know how to, I don't even know how to nicely say that. It infuriates me, really infuriates me. And that she has to write a code, a diagnostic code on her chart that says this woman's a libido is affecting her relationship.

SPEAKER_00 32:26

It has to be the libido, it can't be anything else.

SPEAKER_01 32:29

Yeah, it can't be energy or your bones or that just really gives me. I try not, I tried not to like divert and go off on that. Um, that pissed me off. And then um I just think, you know, she's always so hopeful. I always love talking with her, meeting with her because she is constantly furthering her education and she's in it. I mean, she is in it at the forefront of it. And I just think that keeps us at the forefront. I love everything that she comes back and tells us. I'm I'm hoping that after this conference, you know, she did tell us she's going to this conference, and uh, you know, offline she did say she's she's it's a lot about GLPs. So we're gonna have Dr. Mueller back on to hopefully give us some insight on GLPs and women's health and PCOS and endometriosis, which we've talked about for the the young I again. I love her practice because it's it goes from, you know, the time you're a woman that you have your period to the time you die. And I think that that's just an uh that comprehensive looking at you as a whole human being, woman, I should say, and all stages is is really brilliant.

SPEAKER_00 33:35

Yeah, um, I'm glad we talked about perimenopause because I feel like nobody talks about it. Everybody talks about menopause, but not peri. And you know, you like me, I think we were just kind of shocked when it happened. No one had said anything to us about it. And no, you know, I I really felt like more people need to talk about it. So I'm glad she talked about it. And what I found interesting was when she said um that you really only need progesterone. Yeah, doing peri. Yeah. Which I found interesting. I didn't know that before.

SPEAKER_01 33:59

So well, it makes sense because you're still fluctuating all that. So she's but the progesterone is I think the first to go, is what she said. And that's affecting sleep, right? That that's and that's what she wants to do. She wants to correct that. I think I think that's what's awesome. I loved how she said when they come in because when I went in, I got my blood taken, you know, you know, drawn. I went back in. Oh, your numbers look at you. You're right in this range. You're not in you're not in menopause, you're not in perimenopause. Oh, here you go. Here's Paxel, which was an SSRI, which is you know, an antidepressant. To because one of my massive symptoms at the time was hot flashes, and it took care of that. It did, it took care of it, it went right away.

SPEAKER_00 34:35

But not the root of the problem.

SPEAKER_01 34:37

No, no, not at all. You know, it's so it's it is um, it's just it's it's nice. I also I also thought was super interesting was what she said she's really looking forward to the furthering of studying of the ovaries and that the ovaries are just not reproductive. That what they like it is it like an organ like our thyroid that you know it has everything to do with hormones and it has a lot more to do than reproductive. And I think that that's super interesting. So yeah, yeah, it's great.

SPEAKER_00 35:05

Yeah.

SPEAKER_01 35:05

So happy.

SPEAKER_00 35:06

Short, sweet, but chalk full of information.

SPEAKER_01 35:08

Yep. And looking forward to seeing what she has to say after this conference for sure.

SPEAKER_00 35:12

Yeah, we'll have her back for sure. All right, all right onward. Meanwhile, embrace the heat.

SPEAKER_03 35:18

Embrace the heat.