The Ultimate Guide to Women’s Hormones: Use Science to Reset Your Body, Balance Mood, & Feel Amazing
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Hey, it's your friend Mel, and welcome to the Mel Robbins Podcast. Oh my God, I just walked out of the studios here in Boston. I am so thrilled you're here. I can't wait for you to listen to this.

Today's episode, it is the ultimate guide to understanding and optimizing women's hormones for better health at all ages. This conversation is so important, whether you're in high school, you're in your 20s, 30s, 40s, 50s, 60s, or beyond, because women's health is hormone health.

So if you're tired, bloated, gaining weight in places you never used to, if you're struggling with thinning hair or acne, brain fog, low sex drive, mood swings, PMS, painful periods, our expert today is going to tell you this is not how it needs to be. And there is so much you need to understand and that you can do.

Today, you're gonna learn the signs of hormone imbalance and how to fix it at any age. You'll also learn the surprising ways that hormone imbalance screws up your skin, messes with your weight, disrupts your sleep, and so much more. You'll hear about the best foods that support hormone health

how to fix thinning hair, and everything you want to know about hormones and skin, including acne and aging, saggy skin. Our guest today is world-renowned OBGYN, Dr. Jessica Shepard. She's here with the answers you need.

And I'm telling you something, this conversation is so incredible. As soon as I'm done talking to you, I'm sending this to my two daughters, every single one of their friends. I'm sending this to every single person in my life who is struggling to get pregnant, who's ever complained about their period. I'm going to send this to my mom because she's going to feel so vindicated and every one of my girlfriends. And I know you're going to too. But mostly I am just so happy you're listening today because I personally have never understood the female body.

or what hormones truly are, or what they do, or what is actually going on in your 20s, 30s, 40s, 50s, and beyond. And after listening today, I do, and so will you.

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Hey, it's your friend Mel, and welcome to the Mel Robbins Podcast. I am so excited that you're here. The conversation that you're about to hear is life-changing. And I want to say it's always such an honor to spend time and to be together with you. And if you're a new listener, I also want to take a moment and welcome you to the Mel Robbins Podcast family. And here's one thing I wanted to say. Because you made the time to listen to this particular episode, here's what I know about you.

You're the kind of person who values information that can help you take control of your health and make you feel your absolute best every single day, no matter how old or young you may be. And if you're listening to this right now because someone in your life shared this episode with you,

I just think that's really cool because here's what that means. It means you have people in your life that care about you. They want you to be healthy and they know that understanding and knowing how to optimize your hormones, that it's critical for your overall health. That's why they sent that to you. And I think that's just really cool.

that you have people in your life that care about you. So thank you for listening to this. Thank you for being here. I'm so excited because our guest today is gonna help us do exactly that, understand our bodies, understand our hormones, and help us optimize them for better health. Dr. Jessica Shepherd is a board-certified OBGYN who specializes in women's health, sexual wellness, and menopause. Dr. Shepherd completed her medical residency at Drexel University.

She also completed a fellowship in minimally invasive gynecological surgery at the University of Louisville, where she also earned her MBA. Dr. Shepard also served as the director of minimally invasive gynecological surgery at the University of Illinois at Chicago before leaving to practice at Baylor University, where she is still affiliated today.

She sits on the advisory boards for Women's Health Magazine, womenshealth.org, and the Society for Women's Health Research, and is the chief medical officer at the healthcare company, HERS. Dr. Shepard is also the author of the bestselling book, Generation M, Living Well in Perimenopause and Menopause. So please help me welcome Dr. Jessica Shepard to the Mel Robbins Podcast.

Dr. Jessica Shepard, I am so excited to meet you. Thank you for hopping on a plane. Thank you for making the time. I cannot wait to have this conversation with you. I'm just doubly excited to be here. You are someone who I've listened to for a long time and the ability to be able to share my little slice of life with you and with everyone here. I love it.

Well, it's actually a very big slice of life and it's an aspect of life that a lot of us don't understand. And so I cannot wait to learn from you. And where I want to start is I'd love to have you speak directly to the person who is with us right now.

who has made the time to learn from you. And can you tell them what might be different about their life or the life of a woman that they love if they really take to heart everything you're about to teach us and share with us today and they apply it to their life? What could change? I would say, you know, for everyone who's listening and even myself, I think this is where this really resonates is I'm going through that journey as well. But

why am I here and where do I want to be? And that really is that

opportunity of self-care to say, I get to be in charge of myself. And many times we don't take that time to say, what is really going on? Because that's when we really start to push away all the narratives and the stories and what society tells us. And that really is this transformation in life is to take some time, take pause and say, why am I here and where do I want to be? Wow.

And what I'm excited about to learn from you, Dr. Shepard, is oftentimes when you realize you don't feel how you want to feel or you're not where you want to be in your life in terms of your relationship to your health or how you feel or your energy or all aspects of your life, right, that you're not quite sure what the problem is. And so I think today is going to be life-changing because you're about to teach us

about our bodies and about hormones and the vital and transformative role that they can play. So let's start with just talking about what made you interested in medicine and women's health.

Yeah, it actually started from the OB world, right? Bringing babies into the world. And that was so fascinating to me. And it's very exciting. And as I was going through residency, still love OB is when I really realized that there is this whole scope of a woman's life outside of pregnancy. But when I really started to see women, whether it was in their adolescence or even later on in life, is that there's still so much to be taken care of.

that we really have that ability to interact and build relationship with women. And that's where I really thrived. And so that after residency, I actually did a surgical fellowship because I loved being in the OR. I love being able to really take something very complex and transform in a way that's helpful for them in the operating room. And then coming back to who are you and how can I help you there? And how did being a surgeon change

impact you and lead you to where you are now and the philosophy that you have about medicine and women's health. And most of the surgeries that I was doing, a lot of times it had to do with women in their midlife. Okay. And so when they would come into me with their diagnosis, whether that was fibroids, endometriosis, I got to sit with them and talk to them about this diagnosis. But what actually came out in the visit was all the other things that were going on in their life.

And so that's where I started to see our physical health has so much more to do with the mind-body connection. So they would come in and have a certain disease or something that was going on. And I was like, I know I can help you there because that's a surgical thing that I know I'm very skilled to do.

But what I'm really paying attention to are the other things that you're telling me that's going on with your life and your career, taking care of your kids, your relationship. And that really has so much more to do with how we show up and what we're able to capacitate, what we're able to take in. And that's when I was like, something's going on in this midlife that I need to pay attention to more.

Well, what I'm excited about is that, you know, you mentioned pregnancy. Yeah. You mentioned doing all these surgeries. If you really think about it, and in the foreword of your book, Dr. Jennifer Ashton writes about the fact that for most women, the first time we truly get proactive about learning about our biology and our body for real,

is when we either are wanting to get pregnant or we are pregnant. And so we dive into all of it and we track what's happening in our bodies. And then even afterwards, we're tracking what's happening with our bodies as things are changing. You know, when I think about myself and when I first got my period, it sort of came and then I just had to deal.

I had to figure out how to use a tampon. I had to figure out how to navigate a swimming pool. I had to figure out like that sort of stuff. We didn't have any of the tracking tools or any of that stuff.

But it is interesting that a woman's body and health is incredibly elegant and intelligent and designed in this system, right, around the fertility cycle and the menstruation cycle. And honestly, most of us don't understand the role that hormones play. Yeah. At all. Not at all. I think pregnancy, you said it perfectly there, is...

That's what society tells us what our worth is in the reproductive years. But even as you said it, in your experience, which was similar to mine as far as getting your period, you're just kind of like, okay, I'm going to figure this out. But that was something that had to do with just self, right? But no one was really paying attention to that. But when it came to now you have to take care of someone else, society is like, here's your importance. And then we dive into it because we're kind of feeding into that. Not to say that pregnancy is important, that we don't love it, but now we're fascinated and...

kind of giving more towards because we have to take care of someone else when we didn't even choose to take care of ourselves earlier when we were going through transition, which is why I always see this with my patients that come in is that they're like, now that I've kind of finished that phase of my life, no one's really paying attention anymore. And society has kind of deemed me maybe not that important. Right. So that's where I want women to pay attention to their worth.

Yeah, and I'm so excited to dig into the role that hormones play in your health. And on that point about women really thinking about this, and if you are listening and you're one of the millions of guys that listen to the show, this is a really important conversation to listen to because it's going to help you understand the women and young women in your life, but it's also a resource that you can send to them.

because women are not little men. That is what Dr. Stacey Sims loves to say. And understanding the unique physiology and biology is critical. And we're going to talk today about how hormones impact

your skin and acne and hair and thinning hair and growing hair in places that you don't want, how hormones impact all kinds of health conditions. And what I find to be very exciting is that finally we're at a moment where there is a lot of attention and education around menopause, but that's like 50 years into a woman's story.

truly understanding the role that hormones play, what they are, it impacts every aspect of your life. And one other thing that you made me think about is that when I think, for example, just one human being ago, so just think about our moms. How old are you? I am 47. Okay, great. So I'm 56. If I think about our moms, they typically grew up in a generation

where the messaging, at least in kind of like the 60s and 70s, was, okay, you know, you got to do it all. You got to look good. You got to also keep the house together. You got to be able to take care of everybody. There was zero messaging about taking care of yourself. Oh, no, that wasn't part of the memo. No. And in fact, if you look at any of sort of the marketing and advertising and television shows that our mothers watched, there was no one helping them.

No. They just had to do it all themselves. And so no wonder our moms neglected themselves. No wonder we don't really understand that putting ourselves first is really...

a skill that you need to learn. And society has conditioned us to think, oh, no, no, no, no. Go see a doctor when you're sick. Oh, no, no, no, no. Like I have a friend that has prolapse right now. She's like, it literally feels like, which is, I guess, what, when your uterus is falling? Yeah, when things are kind of coming out. Things are coming. You know, one of my relatives had it. They would literally be like, it's like walking around with half a baby coming out of you. And I'm like, you're walking around? You should go see a doctor, you know? But that's taking care of self.

And we're not trained to do that. And so let's just start by talking about hormones.

How do you want to frame the conversation around hormones? I think hormones are these beautiful, complex messengers. So it's like we have these little mailmen that are, or male women, going around delivering messages every day. Like they are consistent. They know what they're supposed to be doing. And our bodies are beautiful machines. And they're meant to be, well, oil machines with these messengers giving off these messages, whether it's to an organ like the brain or the ovaries.

hormones are probably one of the most important parts of how our machine runs. So is it like a liquid? Like, what is a hormone? Like, you know what I'm saying? Because as you're thinking messengers, I'm like, wait, is it the wiring? Is it liquid? Like, what actually is a hormone? It's more of a, you know, we should go inward and talk about these hormones, but it's actually the delivery of a kind of chemical. Okay. Yeah. So it's a chemical that's released and

And from these messages that are being sent, then someone can respond. So it's like, I'm giving you a message and you're supposed to be doing this today at this time. And so as we go through our lives, we usually through our younger years in our reproductive life, have these hormones that are giving off these messages and they're just going like clockwork. They're like, I know where I'm supposed to be. I know what time I'm supposed to go off. And then we start to see that the hormones have little glitches. They don't want to show up to work.

Some of the messages aren't being delivered. And that's where we start to see those changes and fluctuations, which is why exactly like you said, we need to be having these conversations about hormones earlier so that we're aware before they just kind of kaput and they're out. Well, you know, what's interesting is that like if you really think about the experience, whether you are male or female, is when puberty hits...

The only thing that you hear from adults is, oh, hormones, all the hormones are raging. Oh, here it comes. And nobody understands what it actually means or what the hormone is doing. So when you get to puberty, though, and the, quote, hormones start going crazy...

Are you not born with this level of hormones? You know what I'm saying? Like, why are hormones going crazy during puberty? Yes, because they are now getting the response of we now biologically want to start to deliver our follicles, right? So we're born with the amount of eggs that we'll ever have. Okay. But the delivery of when they're going to release every month

starts at a certain time because our bodies are, again, beautiful machines, which they know when they're going to start this process. So in the ramping up for this actual delivery of like, guys, we got a job to do. We got a new design of a job that we have to start. Everyone's running around because they're like, where am I supposed to be? Okay, you're there. Okay, wait, am I supposed to be doing this? And over time, which is when you start to see that fluctuation, everyone's getting ready for the job.

And then finally, they're like, we've got it down. We've done enough rehearsal. We're ready to do the job. Okay. I think I've got, and I hope as you're listening or watching, you kind of have this understanding of messengers, number one, that are delivering a particular message and

and that your body has receptors all over it that are designed to receive the message from the hormone. It's receiving, delivery and receiving. It's the most important part, I would say, of a hormone because they want to get that message across. And then the hormones that disassemble, you know, so the job now is kind of falling apart

is what's happening in perimenopause and menopause. Well, when we go through a hormone decline, which is the opposite of what we're doing when we're getting towards puberty and adolescence, perimenopause is they're like, biologically, we're not going to be doing that delivery system anymore. We're going to slow down this project now. And people are like, okay, then I'll come off here. I'm just not going to show up to work anymore. And that's when you start to see the fluctuation of what happens to hormones in the perimenopausal phase.

So they're kind of saying that job that we used to do for 30 plus years of giving off an egg at a certain time every part of the month, we're not really doing that anymore. So that's when you start to see the offloading of what happens with hormones, which is why we now experience all those symptoms differently.

In perimenopause. Got it. And does the same thing happen to men if they experience low testosterone? They do, but their decline is much slower over a longer timeframe. Gotcha. And so that's why you still can have men who are in their 70s and 80s still, you know, being able to have or, you know, contribute sperm and you get pregnant.

But we no longer can after a certain age, which is why women experience menopause. Gotcha. Okay. So I would love to break down...

each time period in a person's life and kind of understand exactly what's going on with your hormones and what hormones matter the most during that period of time. What are the key hormones that you need to actually understand are important and play a role in your health?

Well, all hormones for men and women obviously play that specific role. But when we speak to just women and how they're going to experience life, I think that's the best way to frame it is how are you experiencing life? What's contributing to the factors that really are kind of key and specific to women? I would say estrogen, progesterone, and testosterone, as well as our thyroid hormones.

But men do have thyroid hormones as well, as well as estrogen and testosterone. We just have it in different levels. But for women, I would say estrogen, progesterone, testosterone, and our thyroid hormones. And...

Can we group the thyroid hormones together or are there a bunch of them? We can. They're kind of like cousins. So they're kind of like in separate pods, but they're kind of in the same neighborhood and really contribute towards each other. But estrogen, progesterone, and testosterone. Okay, so estrogen, progesterone, testosterone. Yeah. Now, we hear a ton about cortisol,

Yeah. And serotonin, and that's a hormone, right? Yeah, those are hormones. Okay. And some other ones who I now can't remember. But are they as important for understanding when it comes to women's health? Or is it important for us to just start with estrogen, progesterone, and testosterone? I usually like to categorize it as maybe if we were to say our menopausal, metabolic, and mitochondrial hormones. And so cortisol is really, I like to put it in the metabolic category.

kind of family of when we talk about hormones because it has such a broad impact on our entire body system. And what does metabolic mean? So metabolic means the things that function in how we regulate the activity of our entire body. So metabolically, we would say if you have metabolic hormones that are being shifted, that's usually when we talk to insulin and glucose.

and how our body is able to absorb glucose, utilize glucose as a fuel. So cortisol really has a lot to do with that as far as metabolic functions. Okay, so we're going to shove that to the side. You can shove that to the side. And we'll stay right here with estrogen, progesterone, testosterone. Yeah. And let's start with puberty. What is going on when puberty hits...

For a young woman, what is the general age range at this point? And what are the roles that those three hormones play for a woman? So I would definitely say what we have started to see, you know, over the last few decades is typically when we start our period, that age has become younger. Why? And so that age has become younger because of

environmental factors, a lot of the things that we have in our environment, a lot of the foods that we eat. So it actually is something that we should be researching in a way of why is this happening? And is this something that has implications on our life later on? And when I say later on, like your 50s and- I would think so. Absolutely. You know why? Because cortisol, which we kind of bring it back into the conversation a little, has a lot to do with, is this the reason why we're starting to see

are women or young girls starting to have their periods at a younger age. And so what's happening is you're starting to have this onboarding, right? We talked about this complexity of our bodies and the systems and how it's being regulated. So the onboarding time is a little bit earlier now. And so what's happening is that estrogen is starting to rev up because

Our bodies want to release this egg in order to have a menstrual cycle. And so it starts that process earlier in estrogen and progesterone are going to be those key hormones that are going to filter into progesterone.

when am I going to be high? When am I going to be low, right? We talked about how they're coming into themselves as a system and a bodily function in order to accomplish an event, which is your menstrual cycle. So what is the role of estrogen? Estrogen really, I like to call it our vitality hormone because we really see when we look at our menstrual cycle or even when women come to me and they have changes in their menstrual cycle, we typically like to say, how is estrogen functioning?

And as a vitality hormone, what is it contributing? Maybe it's a little bit too much here or a little too little. And how can we alter it in a way where you can get back to your maybe your normal rhythm or your normal menstrual cycle? So it builds up when we're starting our period.

And it really is creating your body's in default actually to get pregnant, which is the whole reason for your menstrual cycle is to conceive and to get pregnant. Is it important as a woman to understand that your entire health and the way to think about your health, you really have to embrace that the natural intelligence of your body

The baseline is it is designed as a baby making machine.

I would say biologically, that's what, if we were to look at it just from like key, you know, key framework. Just like, I'm just literally like, just like your tongue is designed to taste. Absolutely. Your legs are designed to move in a certain way. You're like, that you are designed with sort of this biological imperative. And I'm only saying that, you know what I mean? It's designed biologically to do that function. Yes. What I want to make sure that we understand is

it doesn't necessarily mean that we have to do that. Oh, of course. Right, right. Of course. But I think that society does teach us that that's what you're designed to do and that's what you're supposed to do. Yes. The reason why I'm kind of taking a highlighter to that

It's because, you know, we know that, of course, because you have a period that you have to deal with. But if you really start at a baseline and you say to yourself, okay, women are not little men and our bodies, all the way down from chromosomes to the way our muscles are to the way the hormones work, our bodies are completely different. And understanding that it is designed to work on this cycle

and the cycle is driven by hormones is the base of all health, correct? And I would say that once you understand that, then you can embrace it for what it is. Okay. And not fight it. Right. And work with it and not work against it. Okay. So before you get your period, this is going to sound like the world's dumbest questions.

Do you have estrogen? Yes. You know what I'm saying? Is this stuff in your body? Everyone is born with the amount of hormones or the hormones that we have. How they function changes during the life cycle. Wait, you are born with the amount of hormones you have? Well, not the amount, but you have the hormone. Okay, gotcha. How they function changes over the course of our lives, which is why we see those changes constantly.

at adolescence and then perimenopause. Gotcha. So even before you have a period, you still have estrogen, testosterone, and progesterone in your system. It's that when you start getting your period, those hormones flood into the system and

In order to bring this developmental phase online. And that's why I love the body. It is so complex, but so elegant because it was always there. But the need for it to do the job that it was designed to do at that time in your life, that's when it knows I need to start doing this. So it's the onboarding. But that's what I love about the kind of basic body.

fundamental part of the body. And that's why we should embrace every part of our lives. So you said that the average age is getting younger and younger. And one of the reasons is the food we eat and ultra-processed foods and cortisol stress. Yep, and cortisol as well, stress. And that's where cortisol is our stress hormone, and it responds to stress.

And so when we have stressors that are showing up early in our lives, a lot of it has to do with the experiences that we have, environmental factors and food. Then that's why we're starting to see that girls are starting to have their periods much younger. Is that because cortisol confuses the kind of desire?

design of the body in terms of when it's time to bring this online or is it the food? It's more so that the cortisol is responding to these stressors and then onboarding much too early or much too high of a level than when it's supposed to. Oh. Mm-hmm.

Gotcha. Yeah, it enters the scene when it shouldn't be. Yes. And we're like, you're not really supposed to be appearing at this part of the script, but you're here. And so now we were going to respond to you. Gotcha. Yeah. So what are some of the issues that happen during that window? Because, you know, I can think about

it seems like so many young women also now have complicated cycles, whether it's lots of cramps. And so what are the roles that estrogen, progesterone, and testosterone are playing in

in that window in the teenage years up to 20? So the roles that they're playing is getting the body ready for this now 30-year or maybe 20-year thing that they're going to be doing. Okay. So that's when you start to see like the breasts enlarge, you start to see hair growth, right? You sort of see changes in the external genitalia. And that has a lot to do with how the hormones are responding. It's getting the body ready and also to do the thing that we talked about, to get ready for pregnancy, right?

and that's what the body has the capacity to do in your reproductive years. And so that's when women start to see changes in their moods. I mean, how many times have you heard adolescent girls and going through puberty? Again, yes, that mood is there because our neurotransmitters, which are also hormones, are responding to these changes when we start to onboard our estrogen, progesterone, and testosterone to do the function of the period. So when you move into your 20s,

What is, what's going on with hormones? Hormones are, at this point, should be functioning very consistently. We know what our job is. We're having a cycle. We may get pregnant, go through the pregnancy, repeat baseline, what we're doing again. So that's when it should be kind of,

we should be okay. This is typically when women might start to come in with issues with maybe pain with their cycles or maybe heavier cycles. Yeah. And so it really should be kind of even keeled during this timeframe, but that's not what we always see. So if it's not even keeled, meaning a pretty regular cycle and a pretty predictable kind of route of these are the days I'm kind of moody or grumpy or whatever. These are the days I kind of get those weird cramps.

But if you have an irregular period or you have heavy bleeding or you have really bad PMS, what does that tell you as a medical doctor?

When women come in, I always like to peel the layers back because that's very subjective and subjective meaning everyone has different experiences. What are their tolerance to that experience? What's going on in their life? How do they deal with stressors? And I'll give you an example. And this is where I love the beauty of these conversations is to always recognize that everyone has a different template and everyone has a different experience in life. And

And so a lot of my women, especially women of color who come in, have different stressors. And because of what's going on in their environment, whether that's racism, whether that's poverty, whether that's increased stress or that's the cortisol, a lot of what they're experiencing is a lot different to women who are not in those particular environments. And so that's part of peeling the layers back, especially as a physician,

when women come into me, is not looking at just the issue that's going on. It's saying, what else is going on in your life? And that's the mind-body connection. And so when we are able to look at those factors versus maybe it's a food issue. There are a lot of foods that can change how our hormones respond. Like what foods change how your hormones respond? Your processed foods, your foods that have high glycemic index, that have a lot of sugar.

a lot of soft drinks. I do see a lot of my patients who are in that timeframe when I look at their diet. I'm like, let's start here. Because for me, that's a lifestyle change that can impact you greatly. And I don't necessarily have to put you on a medication. So that might be a better way of looking at it. And also with exercise. Exercise does have a beautiful way of releasing other chemicals and hormones in our body that can help regulate our

our period, but we have to utilize that. And then also stressors, what's going on in your life. This is notorious for stressors. Women come in and they will say, I'm having all these changes in my cycle, whether it's heavier, lighter, irregular, doesn't matter. I will always ask them what's going on in your personal life, what's going on in work life,

And again, when we have that session, that's why OBGYNs are actually usually said that they're also psychologists because we absorb a lot of what's going on in their life when they come in for a visit. I think it's fascinating that stress in your life and the food that you're eating

the hormones in your body? Categorically, and I will say that like emphatically because our lifestyle and how we conduct our lives on the outside with those factors of food, nutrition, exercise, vaginal

really does change the game. And that's why we are starting to see when we get into later life, or even in midlife, that that is also a very important part of what your body's going to be able to do. Your body can only do what you give it. And if we're not giving it the things that it can thrive, then that's when it's like, I may not be able to perform at my best ability.

where exactly is estrogen made? You know what I'm saying? So I'm starting to think now, okay, now wait a minute. So I mean, it makes sense that if you're going through a breakup or you're, you know, a person who is subjected to chronic like bias and, you know, racism, or you're under a tremendous amount of stress because you're caring for somebody, um,

Or you're just constantly eating terrible stuff. I think about somebody that I love deeply who had a very big issue with an eating disorder and just destroyed their gut health. And I can't even imagine the kind of stress that they put themselves under. And I mean, of course it would impact you. When you explain it that way, Dr. Shepard, it makes a lot of sense. But

Why do these things impact estrogen and progesterone and testosterone? I'm so glad you asked this question because what does it have to do with the mind? Because the brain usually is the control center for a lot of hormones. So it is the one that is going to tell the ovary, I need you to kind of give off a little bit of estrogen today. We're going to give off this much. We're going to dial it down on this day because we're getting ready for ovulation. All those different messages. Right.

are usually generated from the brain. So imagine what happens with our neurotransmitters when we undergo stressful situations, whether it's something that happens when you're crossing the street and you almost run over by a car versus exactly what you said, a stressor in life that's really taking over all your thoughts, your everyday life, that your brain can respond to that in a way where it's trying to help you cope with that stress.

But what happens is when we have stress, the brain can't give off the message to all the other hormones in the way that it could when it wasn't as distracted. And that's why we have to, as physicians, get better at mind-body connection.

It makes so much sense. And what's sad is, you know, your period gets irregular or you start, you know, having massive cramps and then you think that you need some medication and you're not looking at the underlying factors because I'd never understood that stress or eating ultra processed food or basically starving myself to be skinny is going to, of course, impact

the hormonal functioning of my body because I'm confusing it with all these things. Yeah. Why do so many women in their 20s get, quote, hormonal acne?

Yeah, hormonal acne, again, when we think of there's different types of acne, just there can be stuff that is due to chemicals that maybe you know you're using on your face that are not the best, but usually a lot is hormonal and you can actually sometimes tell by where it is on your body. What? Where you're getting yes. So most hormonal acne can be mostly in kind of the area by and right under the eyes or the chin.

Why does it go there? Because when we're thinking of where the hormones, you have receptors all over your body that respond to hormones. And so the receptors that maybe respond more to estrogen or testosterone, there's going to be features or areas on your face that are going to be more prone to the actual area of the breakout, right? Yeah.

And so when we think of what kind of spurs on these changes in hormones, which will then trigger hormonal, a lot of it has to do with testosterone. Testosterone has a lot to do with sebaceous glands, right? So our sebaceous glands are the ones on all parts of our body that hold the oil. Because we need oil, you know, your face, that's how our body functions, we need oil secretion. But when there's a buildup of those areas and in the glands, can you...

can be an increase in testosterone as well, which then elicit the buildup of oil, which then you get bacteria and then you have acne. Wow. Yeah. And so do you see this a lot with 20-year-olds? I do. They come in and usually what is the best way to treat them? So it's a great relationship we have with dermatologists because they'll have these patients come into them. And a lot of dermatologists will actually send the patient back to Nobigyn because typically we will put them on birth control pills

to kind of help quiet down this kind of overwhelm of hormones and it responds to that. And a lot of it has to do with the testosterone feature of what's being elevated, what's creating that message being sent, and then you have the outcome of the hormonal acne.

Wow. Yeah. You know, I want to take a quick pause right here so we can give our amazing sponsors a chance to share a few words. And I also want to give you a chance to share Dr. Jessica Shepard.

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Depending on certain loan attributes, your business loan may be issued by OnDeck or Celtic Bank. OnDeck does not lend in North Dakota. All loans and amounts subject to lender approval. Welcome back. It's your buddy Mel Robbins today. You and I are learning from Dr. Jessica Shepard. Her bestselling book is called Generation M, and we are doing a deep dive

dive into the medical and scientific research around hormones and the roles that it plays in women's health. This is such a critical topic. So I'm thrilled that you're here. I'm thrilled that we're learning together. So Dr. Shepard, can you speak to, you know, a person listening in their 20s or 30s who, you know, comes off birth control and then has a lot of issues after

Like, what do you want them to know? I want them to know that the body is really trying to get to homeostasis. And homeostasis is just that kind of perfect balance that the body needs to be able to do the functions that it wants to do. Now, when we're on birth control, the goal of birth control is to somewhat suppress or kind of

decrease the activity of your hormones that your body naturally produces. Okay. And when it does that, it is doing the job of what it's supposed to be doing is preventing pregnancy by decreasing the suppression or rather the release of an egg, right? Your body's in default to get pregnant every month. Right. So it wants to release an egg. So what happens to all those hormones in your body if- They're still there. They're still there. They're still doing what they're supposed to be doing, but

The birth control is kind of keeping it a little bit more suppressed so it can't do the function it wants to do. So when you come off, now you're lifting off this veil that was always there and suppressing. So now your hormones are like, we can go back to what we were doing. And it's trying to find that homeostasis. And sometimes you might have highs. Sometimes you might have lows. So what might somebody expect? And what would you say, Dr. Shepard, is a good amount of time

To give your body to like, ah, okay, what's happening here? Immediate gratification is usually what we want when it comes to our bodies. And I always am coaching my patients to give their bodies grace. And when I say that in a timeframe, that may be three to six months. I've had some patients who may take nine months to a year to kind of regulate and get back to what they used to be.

But just like after pregnancy, we always want our bodies to kind of be perfect like eight weeks after, but our body doesn't function like that. And so even in the perimenopausal phase, going through these changes, we need to give our bodies more grace and time to do the thing that it's designed to do, but we can't push the agenda as quickly as we would like. So three to six months

usually I would say, give it that timeframe. And when they come back in, I'll be like, well, where are we? Because remember, it's a gradient. They may see, you know, that they're improving over three to six months, but maybe not getting all the way back to where they were. And so maybe we can push out time a little bit more. Okay. And, you know, it's interesting because I think about the fact that so many young women go on birth control. Right. And, you know, you do it for a number of medical reasons, which I am in full support of.

But is there anything that we should be aware of if you have been on the pill or you're taking one of the coded IUDs for two decades of your life? And then all of a sudden you're like, okay, let's like stop taking the pill. Let's take out the IUD. And you've been doing this hormone suppression for 15 or 20 years. Yeah. You aren't going to see...

And a lot of that has to do with we were not used to seeing what the body was naturally doing for that long. So now when you're exposed to it, you're like, this is off-putting or this is weird. But really, the body may be like, oh, I was kind of doing this all along. We just weren't really aware of it because we had some suppression. Yeah.

So that can be changes in how your cycle comes back. People may experience that it's heavier or maybe they are having longer cycles in duration. And that may be because the birth control is kind of not doing what it wanted to do. You also may see changes in skin.

You may also see changes in hair. What changes do you see in hair? So hair, you can start to see that maybe they're going to have more thinning or falling out of their hair. Because it's the shift in the hormones, right? So it's not that there's something wrong all the time. It feels like it's wrong when there's literally like a dust ball on the drain. When there is a lump of hair in your hands, it does feel so wrong. Yes.

What the body is trying to do is get back to that homeostasis, right? So our- But why are you losing hair? Because it's the shift, right? So you were suppressing your hormones with this birth control. And now that you're lifting it off, it can skyrocket back to what it wanted to be, right? It's like, oh, well, no one's kind of keeping me down. I'm going to come out. And the hair cycle-

is impacted by hormones, right? So how our hair goes through cycles and phases of growth, when it falls out, when it's going to be what it wants to be within the cycle, those can all change due to what our hormones are telling it, right? Hormones are chemical deliverers. So is every single function in a woman's body

impacted by estrogen. Absolutely. There are estrogen receptors all over the body. In Generation M, I was like, this diagram has to go in this book because we have typecasts

estrogen and progesterone just to the pelvis, just to the pelvis. It's true, because I think about estrogen and I'm like, well, it's just talking to my ovaries. Like, what are you talking about? Why do I- And it's talking to your brain, it's talking to your muscle, your heart, which is exactly why we see when estrogen goes down after menopause, what do we have? We have heart disease. Our bones are weaker. Our brain goes through this fog. And that's because estrogen receptors are there. So if it's not able to deliver the message-

then that area of your body is like, I'm not going to function the way that I used to or would like to because estrogen is not there. What is...

A few places in a woman's body that somebody might be surprised to hear has estrogen as a very critical piece of how that part of your body functions. You know what I say is the most fascinating is the brain. And you know why? Because even as an OBGYN, it's like you know it, but you don't know it. I don't think I realized how much of an impact that estrogen makes on the brain until maybe...

Five, 10 years ago. So what impact does it make on the brain? It has an impact on mood. It has an impact on cognition, how we're able to function, how we're able to use our prefrontal cortex. We become more limbic in our responses. What does limbic mean? Limbic means that emotional, right? Oh, yes.

That kind of jump to the, right? And what do we hear? That women who are in their perimenopausal phase are more moody, right? Well, that's also what we hear about PMS. Absolutely. So is PMS like a mini drop in estrogen in your body? It's a drop and then, so it's the fluctuation. It may go down, then come up really quick. But unfortunately, in perimenopause, it's going down, but it's not really coming back up. It's like, I'm really going down and I'm not coming back up.

And so that's why you start to see in between the ages of 45 and 55, we have the most diagnoses of anxiety and depression. It makes so much sense. Wait, hold on.

You see the most diagnoses of anxiety and depression in women between the ages of 45 and 55? Absolutely. Why, Dr. Shepard? Because this is when estrogen, our key response, our key hormone in how it interacts with the brain is going to be impacted because our mood, our neurotransmitters, our dopamine. After menopause, we start to see that dopamine receptors are 30% less effective.

And so if that's our hormone that's going to be around to make us feel good, and now it's not there anymore, what do you think is going to happen? And so this is why it's so crucial that people understand the mind-body connection is so important. And you are not alone during this journey. You are not the only one who's experiencing this. And the more that we can look inward and say, I'm going through this, I'm going to be okay, but I also understand why. Wouldn't that make someone feel better? Absolutely. Absolutely.

Because you can't solve the problem if you don't know what the problem is. You can't. And if you are starting to experience higher states of anxiety or you're feeling depressed and you're not looking at the correlation...

with your age and understanding that by 45, a lot of the estrogen is gone and your body's going through major changes which impact your brain, which literally can be the cause of this happening. Do you see how it impacts careers? It impacts relationships, your personal life. Yeah, you're feeling you're going through just like this. And that's what women used to come in and tell me because they couldn't put their finger on it. They would say, I don't feel right. Something's off. I

I feel like I'm just so emotional. I can watch TV and cry at a commercial or someone can say one thing to me

and I will snap. And they feel as if it's an out-of-body experience. They're literally watching themselves have these responses. Well, it kind of is because you are out of the body you have been living in for the last 40 some years because the hormones are radically changing. And so your body's probably like, what the hell is going on? Can you explain...

how estrogen starts to decline in your late 20s and kind of what are the big general age markers, Dr. Shepard, for when you got 100% of this, if things are working well and you're not eating too much processed food and you're managing your stress okay and you're taking care of yourself, which a lot of us don't, let's just assume that you're kind of like the one that's doing it right on the planet. What age is

Dr. Shepard, do you start to see estrogen decline or progesterone or testosterone in women? Mel, this is why this conversation is so important for a 20 and 30-year-old. Okay. So let's bring it back to the reproductive phase, right? Yes. So our body's designed to do this. We know in the reproductive phase as OBGYNs, we start to see a change and a decline in egg quality and the ability to get pregnant spontaneously after the age of 35. Okay. And why do you think?

Oh, because estrogen starts to fall off a cliff. Yeah. Is that right? Yeah. Does testosterone and progesterone also change in a woman's body at the age of 35? Estrogen and progesterone, which impacts what we're able to do with releasing that follicle, right? So our chemical messenger is not able to tell the ovary we're going to fire off an egg as readily, right? So it's like, I'm not doing it this month or the quality of the egg, not really going to be that great. And then testosterone is also taking a decline, although it is more subtle.

But that's where we start to see that drop in estrogen, which is some women, especially, I'm one of them who had kids later on in our age. What is that awful term that we use? They use geriatric pregnancy. Yeah, what the? Who came up with that? Clearly not a woman. Not a woman. Yes. And so, you know, even I start to see a lot of my patients having kids later on in their life. Right.

What happens is usually after they deliver, they start to experience the perimenopausal kind of symptoms, hot flashes, night sweats, mood changes, because they've kind of entered into that phase just like very quickly after delivering their children. Wow. So at 35, do you know the percentage roughly of how much estrogen kind of functioning is left? Well, what we do know is looking from a pregnancy perspective in the ability to get pregnant after the age of 35,

versus after 40. And then 42 is another marker when we're thinking of fertility of when it really starts to drop off. And so the ability to get pregnant in your 20s is much more than in your 30s. And then after 35, it does take a drop, then again at 40. And 42 is usually when we start to see another decline. Wow. Well, it's so helpful to understand this against the backdrop

of, from an evolutionary perspective, what a woman's body is actually designed to do from, you know, like a physical and biological standpoint. And when you look at it that lens and you understand, you know, we were, I was researching something else and was kind of gobsmacked to consider that 50 years ago, the life expectancy was in our 50s. And we've gained 30 to 40 more years in the last 50,

five to six decades based on improvements in health and sanitation and medical research. You know what we haven't accounted for? That gap in life expectancy with now estrogen still gone. And that's why we still see women living longer. Yes, that's great. I'm all for that. But we're living life in poor quality of health and

And we're seeing these health measures of what women, typically they have more dementia. They have more osteoporosis. They have more heart disease. Number one killer of women is because that estrogen was gone, but we're still living longer. This is so important to understand because I think what we do as women is we throw our hands in the air and say, well, there's nothing. Why is this happening? All this stuff. But when you look at it across the historical perspective and the fairly recent studies

Life expectancy jump. So when we look at life expectancy, we know that women are typically, used to be 57, 58 was the life expectancy, but what is the average age of menopause? 51, 52. So it makes sense biologically that estrogen is kind of tanked and the life expectancy of what the body is able to do because estrogen is not there. 50 or 60 years ago. Is gonna be- Not a problem. Not a problem, makes sense. But now we have-

improved with science, technology, nutrition, sanitation to our 70s and 80s, but we have not accommodated the body to function without estrogen. Wow. It's almost like, you know, if you have a car...

And you don't have any gas in it. Yeah. How is it going to work for you for the next 20 miles? You just got to keep driving it, Mel. Just keep driving. Just hit the gas harder and stop complaining. Right. And it'll work. But isn't that the analogy of what we're told to do? Yes. Just keep going. I don't care if you feel crazy. I don't care if your bones are breaking. Just keep going. And so this allows us, again, to take that step back and have more grace with our bodies. But it's because we now understand the biology of our bodies.

You know, I have never heard it put that way before. I feel like I'm starting to understand this topic

at a completely different level. I'm just so grateful that you are here with us today. I have so many more questions, but I want to give our sponsors a chance to share a few words. And I also want to give you a moment to be able to share this with women in your life that you care about. And don't go anywhere because we have so much more to learn from the amazing Dr. Jessica Shepard when we return after the short break. So stay with us. ♪

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Welcome back. It's your buddy Mel Robbins. Today, you and I are getting to spend time with the extraordinary Dr. Jessica Shepard. The bestselling book is Generation M, and we're talking all things hormone. I feel smarter. Don't you feel smarter? I'm so proud of us for learning about this.

So, Dr. Shepard, is there things that you can do in your 30s and 40s to slow the breakdown of this hormone decline? There is not, but there are ways that you can help your body do better things. In other words, optimize the ability for the body to do it even better.

in the absence of estrogen and progesterone. Like what? What are the most important things? I would say nutrition and exercise because those are fundamental things you can do every day or even if it's four times a week, but those are things that are giving our metabolic health and our mitochondrial health the best...

ways that they can function even in the absence or the decline of some of these hormones. So that's going to be paying attention to decreasing your processed foods, your sugar, because your body just doesn't respond to it as readily as it did in 20s and 30s, which I would not advocate for people just because they're 20 and 30 to eat these types of foods, but then also exercise in weight training to be able to build that muscle up so it can utilize the glucose better so that your body's just not sitting with the glucose.

Do women that have children after 35 tend to enter perimenopause or menopause earlier? It's not necessarily that they're entering it earlier. It's that we do have a significant change of hormones in pregnancy. And what we do see is after pregnancy, so in the postpartum phase, you're going to have that shift again, trying to get back

to homeostasis. What you have taught us, Dr. Shepard, you got to give your body grace. Give your body grace. Nine months to a year it could take till you feel like yourself again. So if you think that's nine months postpartum, nine months typically for a pregnancy, that's almost like a year and a half timeframe. And so in that year and a half is where you start to see that now they're entering into the natural kind of fluctuation on the decline towards menopause. And so it does seem a little jarring or quick, but

But really, the body was already on its way. Gotcha. And now we've kind of distracted our body or ourselves from what was happening because we were pregnant. And then after, your body's like, well, I was still going in this direction. I'm going to continue to go in that direction. So we've covered what happens at 35, 40, and 42. Let's talk about perimenopause. Medically speaking, Dr. Shepard, what does that word mean? And what is the kind of typical age range?

of women that covers. Well,

Well, that would be me. I'm perimenopausal, proud of it. But perimenopause has been more of a confusing term, I think, in what we've seen in this menopause surge, because menopause is very clinical in its definition. But perimenopause is confusing because it can last anywhere from three years, seven years, 10 years, because everyone's different in that decline and fluctuation. But it's truly when our hormones, estrogen, progesterone, and testosterone are starting to go down and shift down

and you start to have these symptoms here or there. Some people may not have symptoms. I mean, wouldn't that start when you're 35? Some people, I have had patients, and I would definitely say sometimes I'm like, wow, you are pretty young, but I'm never going to take that experience away from them, that they may start to experience symptoms of perimenopause. So...

What are the symptoms of perimenopause and what physical changes happen when you are in that zone that I'm just going to put a big hoop here, like 35 to 50-ish. Yeah, I would say it is... Like this could be the zone that you're in. This could be the experience and the timeframe. So I would definitely say...

hot flashes and night sweats kind of here or there. People will be like, did I just have a hot flash? And then you may not feel it again for months. Definite change in weight. I've had so many women who come in and being like, I'm doing the same two mile run. I'm doing the same elliptical for an hour. And now the weight's going absolutely nowhere. Irregularity in periods. That's where we start to see lighter, heavier. Now I have two times a month. Now I skipped three months. Then it came back.

And a lot of that has to do with that fluctuation. Remember the car assembly line? Some people didn't show up to work that day. They're just like, I'm not doing the assembly line. Or the car that you've been driving is starting to sputter. It's sputtering. Yes. And so those start to happen through that timeframe. Why do we gain weight?

in the middle? Like, why do we get the back fat and the fanny pack in the front and all the things that you've been doing? And all the things that you're not asking for, quite frankly. Yeah. And like the flappy ass arms, like you don't have those, but I, but like, I would have like these meat wings. It didn't matter how often I was doing triceps. It didn't, it still doesn't work. But what, what

Why did we gain weight there? So we gain for multiple reasons. Again, it's never just one thing. So our fat cells do respond to estrogen.

We know that this estrogen receptors all over the body. Because there's estrogen every part of the body. Right. So think about when you're pregnant and you do gain weight. That's for a safety reason to kind of cushion the body to accommodate the pregnancy. Right. So fat cells do respond to estrogen. I thought it was because I was eating my way through the entire day. That may have been some of the reason, but we can blame it on the fat cells. But there's accommodations into how they respond. So they can shrink. They can get bigger. They can migrate. Right.

And then they can usually go back. So typically after pregnancy, a lot of people will go back to the way that their bodies appeared before. In perimenopause, that response, remember we said chemical messengers, but if there's no estrogen, the receptors, they're waiting for it. It's not responding. So fat cells can enlarge, but maybe they now don't have the capacity to shrink. Oh, wait a minute.

So you have estrogen receptors in your triceps and in your- In your fat cells and in your muscle. Yeah, but there's certain fat cells. Like I think everybody listening can go, yes, Mel, it's true. There's certain areas. It's like every pair of pants. Fits different. So that's the migration. Didn't fit. It's literally, I'm like, what happened? I feel like a Twinkie on legs here. Like I just like- It migrates. So it goes from your hips and your butt, which is what we see in 20s and 30s, right? Because it's-

that's where it's supposed to be in that timeframe. And then it migrates to that abdominal area, the fanny pack area, because the estrogen is like, well, we're not responding in that way, but we're also going to shift now where the fat cells are. So they kind of migrate more to that area. Is it because as the estrogen declines,

your reproductive center is like sucking it all up and then everybody else is starving for it in your body? It's really the biology of the body. It's really what your body is designed to do as we get older. Because even men go through that. They don't go through it as, I would say, maybe as rapidly or profound as women. But you do notice too, as men start to age, they get that. They start to look pregnant. There's a lot of guys that's because of the testosterone. That's...

But they also have estrogen as well, just smaller amounts. But this is the beauty in what the body is designed to do. It does it even though we don't love for it to do it. But it does happen during that time frame, a lot to do with estrogen and also our muscle. Our muscle starts to decrease as well. So if you have, if you think of like a pie graph. Why does our muscle start to decrease?

Yeah, so this is, again, because estrogen receptors are in the muscle. And when your muscles are getting estrogen, your muscles stay strong? Right. Well, not necessarily strong. Strong is more of like a power kind of force thing. But the actual muscle mass, so the amount...

Wow. So how does... Keep going. I'm sorry. No, think of a pie graph. Jesus. Okay, go ahead. If you think of a pie graph and maybe most of it was filled out with muscle and a little bit of fat content there in the pie graph, as we start to age, that pie graph shifts and we start to see the fat increase. I don't want it to increase. I know. Neither do I. This is not what I want either. But the muscle mass...

starts to decrease as well as the fat mass is increasing. You know what's crazy about this is that when you go through it, you literally, like what I'm getting from this conversation is that the composition of the body itself is changing. Absolutely. Because the hormones have changed. So literally, I love that image of a pie chart because if you think of a whole pie,

And if for a lot of your life as a woman, the majority of it was kind of muscle mass, but then as estrogen declines, that freaking wedge starts to get smaller and smaller. Yeah. And now fat's there and you didn't do anything different. You didn't do anything different. Wow. Yeah. And so we have the ability, you'd asked earlier. This is not fair, Dr. Shepherd. It is not fair. Do something. Why don't we just like help us? Why don't you

is not fair. And this is one of those things that you're like, if we could maybe take this part out. But you'd said it earlier about, is there a way to maybe stave off this kind of hormone change? We can't, but we can fix the pie graph, which is why I say that weight training- Okay, I have a crazy question. Ask. Is anybody researching whether or not it's possible to have women continue to have a period

Like for the rest of their life. Most women are like, I don't want to have a period for the rest of my life. But I literally like if I will have no brain fog and I'll keep my muscles and there's no flesh fanny pack down there and I'm not an irritable bitch, I would take a period. Actually, there is research that is actually mentioned in Generation M that

of how do we prolong, not necessarily the period, how do we prolong the durability and duration of estrogen? Right, we talked about that gap. Your own estrogen versus hormone replacement therapy. How do we keep the ovary alive in the sense of

allowing it to still emit estrogen on its own. And that's where the research is really looking at. Because what did we say? There's a gap. Life expectancy, because estrogen was down. Now we're living longer. If we could fill that gap with

having estrogen around naturally, then there is a likelihood that we would start to see decline in heart disease, decline in osteoporosis, decline in dementia. And that would be an amazing, innovative way for us to have better quality of life, even though we're living longer. Have they done any studies? And I realize hormone replacement therapy had a

had issues because if I understand it correctly, when it first came out, there was like a bunch of junk science that has been disproven that scared people. And now all of those old claims have been basically refuted. And so for the vast majority of women, it is a extraordinarily safe and life-changing medical option that

And for women who have a certain risk of cancer or a certain health history, it is not an option. But given the kind of limited scope

of wide range use, has there been any research that suggests that women that are candidates for hormone replacement therapy and who do take it have lower risks of dementia and osteoporosis and heart disease? Absolutely. So I'm glad we are in this day and age in science where we can definitely say that there is an impact in how women live their lives and decreasing their risk of death.

In osteoporosis, I'll start with osteoporosis because when we actually look at the recommendations, even from the Menopause Society, which when they say, if you take HRT, this is what it's going to help with.

Now, we know that it helps with the symptoms of menopause, hot flashes, night sets, etc. But when we look at bone health, it is actually proven that estrogen impacts bone health in a good way, obviously. But it's not our first line of therapy. They haven't said it's a first line of therapy. If someone comes in and they're like, I have osteopenia, which is like weakening of the bone, that I should say, you should automatically go on estrogen. But we know it helps.

So that is there for osteoporosis. Now, dementia, brain health, which to me is like fundamentally one of the biggest parts. But hold on, let me ask a question. So if we know though that when there is a complete drop off of estrogen,

that it spikes a woman's risk for osteoporosis. It doesn't take somebody, like no offense to people who are just wildly brilliant like you are, but common sense, it tells you. Clearly there's a connection because we don't see women in their 30s getting osteoporosis. Absolutely, which is why I think that's where we need to challenge. I'm like, why on earth wouldn't you immediately put somebody on estrogen if they're a candidate for it?

If they are starting to decline in bone, that just seems like stupidity. I would actually echo exactly what you're saying, because even in the clinical space, we need to do a better job at saying, we know this, this is data, and we should be encouraging our patients to consider, because the goal is not to say that everyone has to be on it, like it's mandated, but to give you information.

the data, the literature, so that you know the reason why, and you get to make that decision for yourself. But if I'm not giving you that information or that choice, you may not even know to make that decision for yourself. Let's talk about dementia. What does the research say about the impact of hormone replacement therapy, giving women estrogen, and

the outcomes with dementia. Now, that was one of the studies when they looked at the WHI, which is 20 years ago. And now we have so much better research that links estrogen depletion and decline and what that does for later on in life when we look at dementia. So I'll give you numbers that make sense. When we look at Alzheimer's and neurodegenerative diseases, 70% of those cases are women. So clearly there's a link between why are women getting this more than males? And

And the answer is because when we look at that sharp estrogen decline, estrogen is one of the best anti-inflammatory substances in our body. So when we lose estrogen, we have an increase in inflammation and that inflammation causes our neurons to have problems.

hardened plaques, which lead later down the line because the course of how it builds and how it shows up is as much as 30 years. So that's why you start to see women having dementia in their 70s and 80s, but the process started back in their 50s. Why? Because of estrogen decline. Wow. Yeah.

Can you share just the data on HRT? Because when you're in perimenopause, are you a candidate for HRT?

this is one of the biggest questions like now that we see in hormone replacement therapy and perimenopause. What we used to do, and this is again when I was training, which was about 15, 18 years ago, is that we would wait till women reached menopause. It's like they almost had to prove it. They would come in in buckets of sweat and I would be like, well, when was your last period? And they're like, well, it was five months ago. And I'm like,

so sorry, can't offer you HRT. We have now gotten into a day and age where we know if your hormones are declining and fluctuating and you're having a symptom, I absolutely should be offering you hormone replacement therapy as something. Why wouldn't we? It's the car analogy again. Why am I going to wait until there's no more car or no more gas in the engine, but I'm still plugging away? Why wouldn't when the indicator comes on,

why would I not say, this is a great opportunity for me to get gas? It's the same thing with hormones. Why are we depleting ourselves? Why are we allowing women to feel their absolute worst before we will offer them something that is going to help how they feel and their vitality? So what about women who are not candidates? Yeah.

for it. What are their options? So their options, so there are actually a lot of options. I would, well, maybe not a lot, but there are options. And so coming from a day and age when there were no options, I think that it's really amazing that we are able to offer that. I think that the list of

who cannot take hormone replacement therapy is probably good to go over. Yes. So that everyone can make sure that if I am or not, I need to know. Great. So this would be someone who has a personal history, right? They themselves have had breast cancer and specifically a hormone receptor positive type of cancer, right? It responds to hormones.

So the reason why I kind of doubled down on personal history is that there is a lot around breast cancer when we think I've had a family member, a cousin, an aunt. That doesn't put you in the same category as having a personal history of breast cancer. So...

Not all breast cancers are the same. Correct. And just because you've had breast cancer doesn't mean you're automatically not a candidate for HRT. It's a very nuanced conversation. Okay. And you definitely should be talking to your doctor specifically about what type of cancer that you've had, the course of cancer that has taken on your life, but also the age of when you were diagnosed and what that means. Okay. And the second thing is if you've had an

Pulmonary embolism, you've had a clot in your lung, or even if you've had maybe a very large event of a clot somewhere else in your body, has to be pretty significant for you not to be a candidate for hormone replacement therapy. And why do those two things work?

make you not a candidate for hormone replacement therapy? That's a great question because of the hormones and the response of the body, whether it's the clot or the breast cancer, that introducing hormones again may precipitate or cause another event like that. Gotcha. So based on your personal history, and there's a narrow window of women who have a particular type of personal breast cancer that may make them not a candidate, or if you've had a certain type of pulmonary embolism,

that you're not a candidate in those cases because the introduction of hormone might stimulate that condition coming back. Yeah. Got it. And so for a clot, you may get another one, and for breast cancer, it may cause recurrence. Got it. Yeah. Okay. But even, because I think there's also this widespread belief that if you've had it

any breast cancer history, or if you yourself have had breast cancer, automatically you can't do it. Yeah, because there's a history of, has your family had it and been exposed to, and what was that and why? Do you have a genetic predisposition to that same cancer in your family? So those, again, that should be where that list is being kind of narrowed down when you talk to your doctor. But I want women to, even if they have a family history, that's where the conversation starts. Because if you just...

Exactly. I've had so many women who are like, oh, I can't do it. Then they just never talk about it. And I'm like, but what if, what if you found yourself that you can be exposed to it? Wouldn't that be great?

Is there an age where it's too late to start hormone replacement therapy? This is another beautiful question because for a long time from that WHI study 20 years ago, we used to say you can't start hormones if you've started 10 years after your last period, which is clinically menopause, or after the age of 60. And so we have shifted those, quite frankly. And again, it's a nuanced conversation, but there are plenty of women

And we know it's safe to start after the age of 60 and also more than 10 years after menopause, especially that last one I just said. Because what if you experience menopause at 42, 45, which is not typical, but what if you did? And now you're 55 hearing us today and you're like, well,

it's 10 years, I can't start hormone replacement therapy. Absolutely, you should be in your doctor's office saying, is this a possibility for me? Well, if you've already pushed through that window, so you have not had a period for years and you've just muscled your way through this, you're driving that car down the road, no gas in the tank, pedal to the metal, you're exhausted all the time.

What might happen if you introduce hormone replacement therapy now? You know what might happen? You might feel better. Really? Yeah. There's so many women who, again, going back to the, I'm going to numb, not really feeling that, but you are.

And so many women, once they get on hormone replacement therapy, that exact example that you gave, 55-year-old who maybe went 10 years. Or I'm even thinking the 60-year-old or the 62-year-old who was like, oh, well, you know, it was still taboo and it's too late for me now. Yeah. A lot of women don't understand how they could feel because we subject ourselves to feeling, I don't feel great, but I'm just going to keep going.

And the other thing that we talked about, what do we say? Osteoporosis, heart disease. So it may not have the same effect. I will make that statement if you started hormone replacement earlier. Right. But it might have a preventative effect. It might. It might also get rid of the brain fog. Yeah. It might help you sleep better. Let me give you an example. I had a patient who came in and again, nuanced conversation. She was 67th.

But she was still having hot flashes, which is, again, not typical because usually they'll wane and they'll go down, you know, in your 50s. She was still experiencing them to a way where it was impacting her quality of life. So I did have that conversation with her. She was very nervous. And I said, well, here's what we'll do. Why not give yourself the chance?

And what if we just trial and see how you feel after three to six months? She's still on it. How did she feel? She felt amazing. She was like, why was I living like this for so long? Wow. I think I hear somebody hitting share right now and sending this to their mother and to their aunt and to so many women who honestly, like were not served enough.

the medical care that they deserve. And the diligence. And I think the conversations, because someone else could walk in behind her who's the same age or even maybe younger. And we're like, maybe you're not the candidate, but we had the conversation. Right. But if we're not having the conversation, then there's nothing to talk about. Right. And maybe you are a candidate and maybe you could feel better. And wouldn't that be absolutely incredible? Yeah. Wow.

You know, what are other tools in addition to hormone replacement therapy that women need to understand? I think that this is where...

When I talk about grieving the loss of what we used to be, that's where the mind and body come in. And so being able to modulate how our body functions has a lot to do with what we give it. And so giving it that loving care with looking at our diet, but also alternatives, which I advocate for all of my patients is things such as mindfulness, meditation.

meditation. How do we take the brain and allow it to not be as jittery and over-processed and over-stimulated comes with how we are able to teach it to quiet down. Acupuncture, Tai Chi has actually been shown in study to help decrease some hot flashes and night sweats, vasomotor symptoms for women and

And even if you think of the culture of Asians, Asian women, if you look at a study, they had their vasomotor symptoms and menopausal symptoms for shorter duration and not as intense

What is a vasomotor? What'd you call it? Hot flashes and night sweats. Oh, that's the fancy word for it? That's the fancy word for those two. Okay, so my husband's like, you just soak the sheets. I'm like, I'm having my vasomotor. Yeah, absolutely. And so when you look at their- Sounds sexier too. Doesn't it? Yes. It doesn't like make it so, you're like, that doesn't sound, I'm having a vasomotor symptom. Yeah.

is that they have shorter duration, decrease intensity. And a lot of that has to do with their lifestyle, their practice, what they eat, what they consume, but how they live their lives. And also the practices that they do with movement of their body and being able to create the mind and the body throughout this whole transition. So there's no way...

to actually naturally recreate estrogen by lifting weights or taking supplements or doing that kind of thing? No, it's kind of like you're hijacking and bypassing the actual decline in hormones, but using the other parts of the body to,

to elevate those and to optimize those parts of the body to offset what's going on biologically with the hormones. Oh, so I see. So the exercise and the stress reduction and the change in the diet

forces your body to make new connections and workarounds in the place of the role that estrogen played. Right. So we're using our body. Yeah. So if you exercise and you get that incredible flood of neurochemicals, I think they call it, after you go for a walk or after you lift weights or after you do that yoga class,

that works its magic in your brain and helps a little bit with the brain fog. Right, because our dopamine and our serotonin, our neurotransmitters, which when we see depression, they are decreased. Okay. You just said when you exercise, you get that flood of dopamine, you get that increase in serotonin, which is going to elevate our mood

in lieu of losing hormones. Dr. Shepard, could you talk to us about sleeping? Every one of my friends is having trouble sleeping. Every woman I know in their 40s or 50s, and I have a particular person that I love who has what

what she calls her little helper, her Advil PM. I'm like, you got to stop taking that. She's like, but I'm taking my melatonin. I'm taking my progesterone. And, you know, I got my cooling sheets. Like I still can't sleep. What is going on with hormones and sleep?

I'll name three that are really categorical to sleep. And the reason why sleep is so important, let's lay the foundation, is that sleep actually is critical for our body in repair and recovery. And if our body's not able to do that, then it cannot function well. So when people have sleep issues,

disorders or sleep issues. These are the people that we see later getting obstructive sleep disorder, heart disease, asthma, and also increase in obesity, right? So all things that are going to continue to decrease in quality of life. So now that we have that foundation of why sleep is so important, the three hormones that are crucial for that are going to be your estrogen, your progesterone, and your cortisol. And your cortisol, which I'll start with, has to do with your circadian rhythm.

the reasons why we sleep, why we should sleep certain times. And cortisol has releases throughout the night, usually in the midnight and then early in the morning around 5 a.m. Okay. So if your cortisol, remember, these are chemical messengers that work on a timeframe. If they're disrupted... And cortisol is highly impacted by your lifestyle and the stress factors. Stress, life, and estrogen as well. Okay.

Right. So the estrogen decline now gives you hot flashes and night sweats. So now you're waking up at the middle of the night because you're having a night sweat. Right.

So then your circadian rhythm, which was impacted by cortisol, is also taking a hit. It's deregulated and you're not getting good sleep quality. And then progesterone, progesterone is the comfy hormone. It likes to relax us. It likes us to kind of settle down and feel good. And so we're also having fluctuations in progesterone. So it can't do the job that it really would like to do, which is give you sleep quality and relaxation. So all of these different turns and declines and

it's impacting our sleep, which then impacts our health. And that's why we're starting to see that sleep or sleep health rather is so imperative and we need to pay more attention to our sleep. So what do we do? Yes. So this is where we look at repleting maybe our hormones. Hormone replacement therapy can be a vehicle or a tool to kind of get you back to where you need to be hormonally. But then also we can look at practices. A

A lot of times during that kind of deregulation or brain, a lot of women will say, my mind just races at night. What should we do? Ruminating. So decreasing rumination is where we need to do our work, our homework with quieting the brain down. So that is going to be your meditation and your mindfulness.

Taking the screen away before you go to bed. I'm talking to myself as I say that. And then the other thing is actually when we look at CBD and what it's able to do as well has been helpful. It is very important. I'll say this candidly. You have to know where you're sourcing it from.

And so CBD, we have endocannabinoid receptors in our bodies, which also contribute to relaxation, is that you have to appreciate where it's being sourced and then seeing, does it have CBN, which is another part of the plant that actually helps with relaxation. So that's another way as well. So mindfulness, that's our homework, making sure what are you eating? There are foods that are going to be inflammatory and going to kick off that cortisol. So

Decline in alcohol. Oh. Decline in processed foods and sugar. You're fired, Dr. Shepard. I'm just kidding. It's true, though. And it's not fair. No, it's true. If you want to get a good night's sleep, don't even have a glass of water. One of the things, though, is do you believe as a medical doctor that you can, through some of these lifestyle changes—

Boundaries with your phone, not even having your phone in your bedroom, having more of a set schedule, all the stuff that experts recommend, mindfulness. Mm-hmm.

Do you believe you can train yourself to be a better sleeper if you get serious about it? Absolutely. I've seen it through and through. I think that even in my personal life, I was starting to see sleep disturbances and I had to take a real hard stop and being like, what's really going on? And taking that time to, again, reflect on yourself. And I think that is self-care. Sometimes self-care, yeah, can be getting a manicure or a pedicure, but having

But how am I going to take care of myself requires peeling away the layers of saying, am I contributing to the best version of myself or not? And what are the ways that I can do that? And am I going to pay attention to myself? Let's talk about the thyroid. It seems like a lot of people talk about having a thyroid issue. Yeah.

What does the thyroid do? The thyroid is this cute little organ that is the metabolic kind of engine of our bodies. It really is kind of the, we are going to go at this pace, at this rate. We're going to make things go quick. We're going to make things go slow, which is why when people have hypo, which is less levels of that thyroid hormone, things are moving slower, right? Typically, they'll gain a little bit more weight. They're a little bit more sluggish, have fatigue syndromes.

And then people who have too much of that thyroid, they're doing things too fast. It's like this metabolic train is like really pumping. It's like the speed train. And you're like, slow it down. So the goal is to keep it in that range where everything is moving right. It's kind of like, is that the Goldilocks? A little bit too much, a little bit too little, just enough. So we want it in that just enough phase. So the thyroid...

which is basically setting the pace. It's either going too slow, hypo, or too fast, hyper. That

It impacts hormones because it impacts the rate of release. Right. The rate of release and how quickly things should be going or how slow they should be going. Gotcha. And so when we start to see you can have heat intolerance if it's too much and cold intolerance if it's too slow. So the goal really is to kind of keep it in that homeostasis. And so when that starts to shift, it is very interconnected with energy.

And so we start to see a little bit more thyroid issues as women go through perimenopause and menopause because the estrogen is not there to talk to the thyroid. If you have a problem with your thyroid, how would you know it? Oh, that is one of the, I would say that is one of the hormones we can definitely see on labs.

Okay, so you can do that? That's like a blood test? Absolutely. Gotcha. And then how do you treat it? So you can treat it either through medication, depending on if it's severely too high or too low. That's when a patient needs medication to kind of get it to homeostasis.

then you do have people who have symptoms and it may not be all the way out of that kind of normal range. That's how you can impact with diet. That's how you can impact with exercise as well. And so it's really important that you understand your body. If it's changing, if something is happening that doesn't feel right to you, to make sure that you see your doctor because the goal is not to wait until you're like completely just feeling horrible and then now we do have a problem.

is that if it's shifting in that normal range to too high or too low, but it's not quite disease state yet, that we know that, right? And so that, again, is the preventative portion of why we need to take care of our bodies before we hit that wall and now we're in disease.

You know, I want to shift gears a little bit and talk about a few health conditions that women see and have you, Dr. Shepard, help us understand them. One is PCOS. Can you talk to us about what that is? PCOS is one of those. I wish it were termed differently. It stands for polycystic ovarian syndrome.

So when we use the word syndrome in medicine, it means it has a variety of different things that contribute to the disorder. Okay. So it's not just one specific thing. So the reason why it's a syndrome is because it relates to the amount of follicles in your ovaries may be increased, right? So your body is supposed to be doing a certain thing. So I'll give you an example. If it's supposed to say, I'm using arbitrary numbers here. If you're going to have five follicles in your ovary,

And that's what it does every month. And now someone has 20, that's different when it should do, right? So you're going to have kind of these fluctuations of hormones. So now we're back to the hormone part of the syndrome, which is we usually see an increase in testosterone, right? So everything is supposed to be at the level it's supposed to be. So now if testosterone is a little bit higher, it's going to be sending messages not in the way or the amount or frequency that it should be.

So there's another thing is how we have our cycles, right? So you start to see your cycles be more irregular. I've had patients who have severe PCOS

And they won't have a period for like nine months or a year. And then they'll get one just randomly. So you have all these changes that are ovarian in nature, but the real heart of PCOS is actually a metabolic disease. So I'll go back to what metabolic means is really the function of how your body is doing internally, usually from a glucose and insulin perspective.

We spend so much time doubling down on the ovaries malfunctioning and it's an issue there. But really, a lot of it has to do with gut health, nutrition, and insulin and glucose. But do you typically treat it

By birth control? I would say that's what we typically treat it with. Am I a fan of what we typically treat it with? No, because then we're just focusing on the ovarian portion of it. So many of my patients I work with functional nutritionists, but I also use that timeframe to say maybe so for example now put you on a GLP, which can then impact your insulin and glucose.

and then shift the body's ability to function the way it should. Oh, that's so cool. Yeah. Wow. So GLP-1s,

are a medical tool to help balance hormone and regulate hormones? Absolutely. Well, to balance the insulin and glucose and the metabolic health portion of PCOS. And a lot of times the diseases that we have are from a metabolic perspective. And so that's why when we look at the studies now with GLP-1s, yes, you get the benefit of weight loss or people are on it because they're diabetics.

But when we look at the whole body as this beautiful machine and how insulin and glucose can actually shape or maybe not help some of the functions of the bodies, when you're able to, again, get it back to where it's supposed to be, the rest of the body is like, thank you. Now I can do what I need to do. Wow.

Let's talk about endometriosis. Yes. What is it and what are signs that you may be at risk for it or that you have it? So endometriosis, which is, I'm so glad I spent 10 years being a minimally invasive gynecologist because that's the patients we would see mainly were endometriosis patients, is that it is when the lining, so when we have our uterus, we have that little kind of cavity within our uterus, which is where we shed endometrium and the lining and we get our period.

So endometrium is the medical name for the thing that ends up on the pad? That's it. Wow. Okay. I love that you just put that perspective to it, but that's exactly what it is. And so when you shed the lining, that lining is only supposed to be there in that cavity.

What happens is when that tissue may go somewhere else, could go on the bowel, could go on the uterus, it could go on the bladder. Wait, what do you mean that tissue goes somewhere else? So it kind of like trails and ends up in other places in the abdominal cavity. So it's almost like you're lining the...

that makes up what is your period starts to flake and float around other parts of your body? Yeah, it can kind of travel in other places. And when it gets to those places, it causes pain. Most common symptom of endometriosis is pain and also infertility, right? Because it's impacting the other organs in the reproductive system. Now, we do know that

there are, it's an underdiagnosed disease. One in 10 women will have endometriosis. One in 10? One in 10. They may not experience it the same, but we are underdiagnosing it. And the other thing is that there is somewhat of a genetic predisposition or a likelihood of getting endometriosis if you had your mother and or sister have endometriosis. How do you treat it? The best way to treat it is to look at it from the root cause, which is estrogen.

So if we are able to say, how can we decrease the level of estrogen that's creating this inflammatory response? So there are many ways that we can do that. Some people are put on birth control. Remember we talked about suppressing. We can also use medications that are specifically designed to decrease estrogen specifically for that reason, for endometriosis.

And then some people need surgery. And the reason they need surgery is because it creates these kind of adhesions or these kind of scar tissue in the pelvis.

And so that can cause the pain and or infertility. And we can go in there as a minimally invasive surgeon and get those kind of nodules and adhesions out. And that's how the patient can feel better. So there's a lot of different ways that we can actually impact endometriosis, which is why we should be talking about it more. Definitely.

Chapter nine of your bestselling book, Generation M. I love the title. Thin Skin, Thinner Hair. Let me read a little from page 169. Dry, irritated skin, bruises, breakouts, too much hair where you don't want it, your face, too little hair where you do want it, your head. These are just some of the changes fluctuating hormone levels can unleash on your appearance. And this is no matter what age you are.

And this was fascinating to read, that estrogen spurs the growth of collagen, a protein that helps support skin, muscle, and bones. It's essentially the scaffolding that holds everything up. So let's talk about the role of hormones with your skin and with your hair. Where do you want to start? I want to start with skin because...

We all know when we're in our younger ages that our skin is very kind of, it glows. It has this ability to not have wrinkles. And so as we start to age, which is a biological feature of what we're going to go through,

decline in estrogen can't then go to that part of our skin that impacts the collagen, which gives us our ability to be plump, to be firm. And so what do we start to see as we age is decline in estrogen now can't support the collagen, which is the framework of that structure and the ability for our skin to do that. So another example is pregnancy, right?

In pregnancy, we usually see, which is a different type of estrogen, but it's a severe increase, right? Because that's what supports the pregnancy. A lot of women will say, my skin in pregnancy and my hair in pregnancy is just phenomenal. And the reason is, is because there's this amazing estrogen support. When the baby comes out and the estrogen declines, a lot of people are like, now I'm losing my hair or my skin is really, really crappy. Right.

That has to do with that balance of estrogen. So now when we're losing estrogen at a decline and it's not coming back, the skin responds. It's like, estrogen's not around. I can't be plump. I'm going to have these wrinkles. My skin is starting to sag a little. And that's because of the estrogen can't contribute to the collagen, which is scaffold. Gotcha. So is there anything that you can do to... Yeah.

Improve collagen? Yes. So it's the way that you can do it directly on your skin, which is when now we start to hear more about estrogen creams that you can apply to your skin, right? And then that stimulates collagen growth? So it's the collagen growth, but also the blood flow. Estrogen is a very big proponent of blood flow and vascularity, two areas. And that's what we need in order for our skin to look plump and not have the issues that it has, in addition to the collagen, yes.

And so then the other part of that is if a woman is on hormone replacement therapy and she's either taking a pill, a patch, a cream, she's now giving her body back that estrogen, which allows it again to have the replenishment of estrogen, which supports our skin.

Amazing. Women get marketed to like crazy, and particularly for those 20 and 30-year-olds that are buying 50 products and going through a 30-step skincare routine. Dr. Shepard, based on the research, what actually, in terms of the products, can help your skin improve?

I think that there is a lot of consumerism. So there's a lot of products out there that are not necessarily going to get you the outcome that you want. And so when we look at skin products specifically, I think as we're getting older, we need to look at products that have maybe retinol, retin-A, that have things that actually are supporting collagen. Estrogen is one of those things. But it doesn't necessarily mean because something claims to get the outcome that you're going to do it. The other thing that I would say is we have to watch our diets.

So what we're inputting into our body has a lot to do with what the skin is able to do, whether that's with foods that are supporting hydration, whether it's foods that's supporting vitamin deficiencies that have a lot to do with what we go through in menopause, but our gut.

right? Our gut health is always very impactful for how our skin can respond to. What are the top foods you should eat for good skin? Oh, I think that top food should be obviously your protein intake, which can help your muscle, but also antioxidants. I love blueberries. I don't think that it's a power food and everyone just has to eat a blueberry. But what I do know is it has so many

ways that it can kind of fill your day, whether it's a snack, whether it's added to something, that it has the antioxidants, which is also very helpful for our kind of gut health. And the last thing that I think is looking at how we use our omega fatty acids is an important part. So that would be like in nuts. I think nuts are a great snack, but also salmon has omega fatty three acids as well. So that's important again for our gut health.

And again, I think that when we look at our diet, not everyone responds. And that's why I don't love power foods is some people just don't respond the same way to certain foods. So making sure that you maybe talk to a nutritionist as you go through these stages in life because your body is going to respond differently and find out what's best for you and just don't take everything that you hear and think that's going to apply to me.

When you start going through perimenopause or menopause, do you need to change your skincare routine as estrogen plummets? You should. Really? Yes, absolutely. Because the things that served your skin well when you're in your 20s and 30s are probably not going to serve it in the same way. One, because of how our skin absorbs product is going to be different. How does it change?

It changes where it's not as porous. Porous just means if you were to think of like a screen on a window and things that can go in versus come out, those things change because maybe it's more porous and it doesn't allow for the things that really should be staying in. It kind of seeps out.

The other thing is that we have hot flashes and night sweats. So that increases the amount of sweat that is going to be around our face. And so that actually impacts it as well. And then we talked about the whole collagen and the estrogen, which is not there. So there is multiple layers of why the skincare should change. And things that I think are important to incorporate are

We talked about Retin-A earlier, but also when we look at maybe using devices that get to a deeper level of our skin to help restore that vitality to our skin, but also helping correct

some of the things on a deeper layer that we could never get to just from washing our face. Like what? Like lasers. I think lasers are a beautiful way that people should, if they can, because sometimes they are pricey, but even if you have the opportunity to get a laser treatment, I think intermittently those can, again, create this better foundation so that when we go home and maintain with other products, we're having a good foundation. Let's talk about thinning hair. Yeah. Because it's really- It's real.

It is real, and it's very disconcerting. Why does our hair thin? Our hair has cycles. It has a growth phase, right? So it goes through these different cycles, and estrogen is a very big part of those cycles and how long it's going to stay maybe in the growth phase. Hmm.

And so that's, again, akin to when we were pregnant is we started to see a lot more hair growth because it stayed in that phase longer. So if I were to take folic acid, because you know how you take folic acid and then your nails and your skin, is that going to help me now? It will help you, but it's not going to solve the problem. What is the problem? I think that the problem is our decline in estrogen is not able to impact the hair follicles. It's not allowing to bring the blood flow to the hair follicles for growth, but also the growth phase.

because if estrogen is a big part of how long it's going to stay in the growth cycle of your hair, then when you're taking away estrogen, it can't stay in that phase forever. So if you're in your 20s or 30s and your hair is kind of thinning,

Should you also be looking very seriously at hormone balance? I would say hormone in the sense of thyroid. Thyroid is that, but also going back to our lifestyle factors, what are some environmental factors? Are you taking maybe medications that are contributing to hair? What foods are you eating? And are you stressed?

Wow. Yeah. And do any of those products that everybody is selling, you see all of those help? I think that there are products that actually work. So for example, minoxidil. Minoxidil is an actual medication that's used for hair growth and helping in that hair cycle and maximizing the hair cycle, but also creating vasodilation, which just means opening the vessels and allowing the blood to flow to that area more. So it does work. The caveat to that is when you're not using it, then it can't do the thing that it's

going to do. So you may have some hair changes or hair growth cycle changes when you stop the drug. Wow. You are so brilliant and so fascinating. I have absolutely loved. I feel like I have learned so much today. I feel so empowered. I cannot wait to share this with every single woman I know, starting with my two daughters and my mother and all my good friends. What do you think, Dr. Shepard, the most important thing

that you want women to understand about their hormonal health? I think hormonal health represents who we are as women. And the more that we vilify it or kind of fight against it, then that's not ultimately helping who we can be in our best version of ourselves. And so this transition really should be embraced and it really can herald the change in who we think of ourselves in identity, in relationships, in our power, in our advocacy for ourselves and

And so I don't want you to leave yourself behind. You should never leave yourself behind and bring yourself into this transition with your hormones in a way that it can be beautifully constructed to be the best version of yourself. If the person listening

who's been with us today takes just one thing from everything you've shared and does something, what is it that you want them to do? I would say that the recreation of yourself requires that inner look into having self-care and self-love because we all deserve it. And

And so as you go through transitions in your life, whether it's adolescence, whether it's pregnancy, whether it's menopause, is those are moments in which you get to reflect inward and decide what would I like to do for myself and asking the important questions of who am I and where would I like to be? Dr. Shepard, what are your parting words? My parting words would be that we all have this opportunity to

change the journey of what we've been given, whether that's with circumstances, whether that's with our family life, whether that's with obstacles we go through.

to recreate and redirect who we are in our health. But our health really requires the ability to take mind-body connection. And many times we dissociate and we disconnect. And I would encourage anyone who's listening today and anyone that they can tell is that the importance of who we are in the end requires a mind-body connection. And I encourage everyone to take that opportunity to do that.

Well, Dr. Jessica Shepard, I cannot thank you enough. The bestselling book is Generation M. But what I love most about what happened today, at least for me, is the mind-body connection is a critical thing. But because of everything you shared today, I actually understand my body in a way that I've never understood it before.

And for that, I am so grateful. And I know I speak on behalf of the person who's listening and for all of the women in their life that they will be sharing this with. So thank you. Thank you. Thank you.

Thank you. And I also want to thank you. Thank you for being here with us today. Thank you for being interested in your health and your happiness. Thank you for wanting to learn about this. Thank you for sharing this with all the women in your life that you care about. And in case no one else tells you, I wanted to be sure to tell you that I love you and I believe in you. And I believe in your ability to use this information today to better understand your health, to put yourself first.

to know that you deserve better. And now that you understand how hormones work and how important they are, that you use this information to improve your life and your health because you deserve that. All righty. I'll see you in the very next episode. I'll be waiting to welcome you in the moment you hit play. I'll see you there. All right. You guys tell me when you're ready. Are you good? Thanks, hon. Okay, good. I was like, it's not going to be... Okay. Does that sound right? Okay, great. Here we go.

That was so unexpected when I walked out. I'm typically not like a crier and I was like, oh my God. It was, it was, yeah. Well, you did a great job. I don't think so. You good? Yeah. I loved it. Fantastic. Yeah, we need to get Em in to take some photos. Yes. All right, let's get you on TV. I know, I'm just so grateful. Thank you. You were just magnificent. Of course.

Oh, and one more thing. And no, this is not a blooper. This is the legal language. You know what the lawyers write and what I need to read to you.

This podcast is presented solely for educational and entertainment purposes. I'm just your friend. I am not a licensed therapist. And this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I'll see you in the next episode. Stitcher.