And I think you were at 250 pounds and how you've been able to become even healthier and a healthy weight and looking great but it's not just about looking but how you feel for those who are really struggling through the symptoms and as they enter this sort of second spring of their lives what would you say are the most important sort of foods to have as part of their diet because you menu pause your book talk a lot about that

Yeah, definitely.

The biggest one is healthy fats.

Healthy fats because our hormones are derived from fats and actually is anti-inflammatory.

So healthy fats are omega-6 fats, omega-3 fats, for instance.

So our salmon, our wild-caught salmon is an excellent source of omega-3 fats.

Sardines is a superfood and oysters are superfoods if you can do those.

How can we actually make that effective for us?

So I'll just let you take it away.

Yeah, I do love talking.

I've lectured, I've taught physicians, I lecture on women's sexual health all over the world.

I've talked Brazil and Portugal and Poland and Israel.

I mean, name it.

I've been all over talking about this.

I'm so passionate about this topic because universally, there's no area more vulnerable to any individual or couple than our sexual health.

You've alluded a little bit to that, but let's expand on that.

Was there a head-scratching moment where you're like, "Whatever I learned is not working"? W- what ha- what did you find?

Yeah.

Yeah, no, there was a lot, and it really was, like, the clients coming in early, like, early in my medical practice, with PMS, the perimenopause issues, which we didn't really call perimenopause at that time.

The dysfunc- the things that brought a, a patient in to see me, the dysfunctional uterine bleeding, the PMS symptoms, the anxiety.

So the GYN issues tied into the neurologic issues, the mood swings and the insomnia and the forgetfulness, and all of this was this constellation of symptoms.

And the way we'd been taught in residency, and I trained at Emory University in Atlanta, and I think it's one of the best residency OBGYN training programs in the world, and, um, I, you know, I was equipped to give, you know, Prozac and to be, you know...

Again, maybe it's just two weeks a month that they need the Prozac, right? Like, the cyclic SSRI type therapy or birth control pills.

[laughs]

meet her.

Yeah, she's amazing.

So really, this experience changed my life.

But when I delivered her, I was...

PTSD, right? Like I say, I've gone from PTSD to post-traumatic growth.

I have, absolutely.

But at that point, I was still in the three-hour-a-night sleep.

But what wisdom might you offer to clinicians around exploring this topic in a way that their female patients can be comfortable with?

Yeah

... cardiac prevention, right? But they were using, again, the worst forms that we have available.

We have much better options.

And so that's how that came into play.

Oh, if you don't have a uterus, you don't need pro, you don't need progesterone.

But you do need progesterone, not the progestin, because progesterone, we look, and I studied this, in the brain.

And I trained at Emory University in Atlanta, and our neuro ICU was doing IV progesterone in traumatic brain injury, um, patients because they saw better recovery, less edema, you know, a r- quicker return to normal function.

Oh, wow

Give me the doctor level view of what oxytocin actually does to different systems in the body.

Yeah.

Well, it's so powerful.

And first, you know, we know as an OBGYN, I trained at Emory as an OBGYN, and what's one thing that we give women, we give women oxytocin to augment labor called Pitocin, right? So many people have had oxytocin exogenously.

They'd never even realize it.

Pitocin is oxytocin.

But one of those...

Yeah, they're totally okay with it.

I had a hysterectomy after a baby at age 35," and they, they have no idea, am I gonna go through perimenopause? Should I be on hormone replacement therapy now? So to a woman who has had a hysterectomy, maybe even younger than that, what does she need to know?

Yeah, she needs to know, like, she needs to know to protect her hormones.

Like, this is all about supporting your bodies.

If she has her ovaries...

If she doesn't have her ovaries, absolutely she has to be on hormones.

If you've had a hysterectomy and your ovaries were removed, you have to be on estrogen, progesterone, and testosterone.

And this is another big myth or mistake that the medical society's been told, if you don't have a uterus, you don't need progesterone.

Oh, wow

Mm-hmm

... adrenal health.

But the ABCs of Sexual CPR is, like, accepting where you are, being present in intimacy and in conversation in general, and C is communication.

Inside and outside of the bedroom, what makes you happy, what feels good, what turns you on? In the same sense, what turns you off? Like say for example, you know that you go into your bedroom and there's dirty laundry on the floor.

You are totally turned off.

Like, forget it.

It's, you know, that fleeting thought has now left the building.

Eight pounds.

Gluconeogenesis, meaning the creation of glucose inside of the brain, the energy store that we're gonna use.

Yeah.

And utilizing glucose in the brain is an estrogen-dependent phenomena, so it's an end- estrogen-dependent process.

So it's understandable now for women, as estrogen declines, we need to switch our optimal fuel source for the brain from glucose to ketones.

And switching that, Arielle, was game-changing for me.

I talk a lot about this in my book, The Hormone Fix, is the power of, of using ketones for brain fuel on a cyclical basis, right? So in the brain, glucose is like gasoline and ketones are like jet fuel, especially in the post-menopausal brain.

So we use that source of ketones for fuel even better.

So let's talk about the emotional post-menopausal growth.

Hmm.

And so I was like, okay, first I was intimidated.

I'm like, I'm gonna find an answer for her, right? I always, like, you know, I joke, I say I looked in my doctor's bag, and I looked and I looked and there was nothing there.

Like, I didn't have anything.

Like, what do we give someone, you know, she was not breast cancer, but she was DCIS and we treat them like breast cancer.

So what do, what do I do? What did the research show? And because she was the president of, and she was highly intelligent, she brought me research.

We asked questions.

Um, does this affect, do people see when they start to recolonize, do they see a shift in sexual desri- desire, sex performance, et cetera?

Right.

And cortisol goes up, glucose goes up, inflammation goes up.

I mean, it's a nasty, uh, circle.

But y- then you get when the cortisol is then suppressed, and you get in this dangerous state where cortisol is low and oxytocin's low at the same time.

And that really is a physiology of depression, a physiology of disconnect, a physiology of burnout, uh, you know, maybe even a physiology of suicide.

It's a very dangerous physiology.

And as I started to understand that in myself, 'cause for me, you know, from completely desiring and loving my marriage to post-traumatically becoming divorced and, and burnout from my medical practice, I mean, I, I s- speaking from experience here.

Right

Mm-hmm.

Your start, the way you start the day is the way you end your day, versus you wake up, you do a deep breathing, grounding exercise.

For me, I always ask myself three questions before I open my eyes in the morning.

It's like, where did I see love yesterday? Where did I feel love? Where was I loving? Okay, so that's part of my one question, love.

What am I grateful for? And where did I laugh? What could I have laughed? Like, what was funny? [laughs] And focus on those things, love, gratitude, and laughter.

Those all increase oxytocin, and as a result, because there's, oxytocin goes up, cortisol goes down.

So now you shift this alkalinizing really, and they're anabolic, healing, regenerative physiology.

[laughs]

Yeah.

So I'm now 60 this year, I'll be 60 this year, and I have, um, witnessed through my own lens, of my own personal story, that of my family, and certainly that of, you know, the more than 15,000 women I've personally taken care of.

And it's, it's so important to understand what's happening physiologically, and where we need to support along this timeline.

And I think that's really important, because there's a lot of confusion, and media, and social media, and all that s- it doesn't help.

But there's a lot of confusion in it.

So in understanding the physiologic changes as we age, and o- the entire ovarian adrenal connection and how important that is, and looking at the hormonal, um, cascade.

So we think of, first of all, that in our 20s we have our peak levels of DHEA, a pro- predominantly adrenal and ovarian hormone.

Yeah.

Mm.

The very classic one is the French routeAnd I, going through the Pyrenees Mountains, and I did the Portuguese coastal route.

I did 100 miles of the Portuguese coastal route, and it was r- literally transformative.

It really is one of the most impactful things that I've done in my life.

And now you can do the full...

Like, depending on all the different routes have different starting points.

But I started, you have to walk at least 100 kilometers to get, and get stamps, um, two stamps in each city along the, each town along the way, and in order to get what's called the Compostela de Santiago.

[laughs]