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The Hormone Secret That Could Transform Your Menopause, Energy & Longevity

Dr. Serena and Dr. Heidi explore the science and safety of Bioidentical Hormone Replacement Therapy (BHRT), its role in longevity, and how hormone balance supports metabolism, brain health, and graceful aging.

Dr. Serena and Dr. Heidi explain how Bioidentical Hormone Replacement Therapy supports longevity, brain and bone health, and graceful aging. Learn how hormone balance, nutrition, gut health, and heavy lifting all work together to optimize vitality during perimenopause and menopause.

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#FunctionalMedicine #BHRT #MenopauseSupport #HormoneHealth #TheFunctionalEdge

About the Expert

Julia Ward, MD

Dr. Julia Ward

Dr. Julia Ward is a compassionate and forward-thinking physician with over a decade of experience in functional medicine, known for her systems-based approach to healing chronic illness. She is the founder of Balanced Body Functional Medicine, where she helps patients uncover the deeper drivers of disease and restore health by addressing the body as an interconnected whole.
After earning her medical degree from the University of Southern California, Dr. Ward served in the U.S. Navy, practicing general, urgent, and emergency medicine both domestically and abroad. Her own personal struggle with unexplained fatigue led her to question the limitations of conventional medicine and ultimately guided her toward functional medicine.
While she initially focused on identifying root causes, Dr. Ward’s approach has continued to evolve. She now emphasizes the importance of how and when the body is treated—not just what is treated. Through her Balanced Body System Reset™ framework, she focuses on restoring nervous system balance, improving mitochondrial function, reducing inflammation, and addressing root causes in the right sequence to create lasting and meaningful healing.
Dr. Ward integrates advanced diagnostics, personalized care plans, and innovative therapies such as hyperbaric oxygen and ozone therapy, while also emphasizing foundational elements like nervous system regulation, lifestyle, and patient engagement. She believes that healing is not a one-size-fits-all process, but a guided journey that requires both strategy and active participation.
A lifelong learner, Dr. Ward continues to expand her expertise in areas such as precision genomics, brain health, and complex chronic illness. She is deeply committed to helping her patients not only feel better, but truly understand their bodies and take ownership of their health.
A devoted wife and mother of five, Dr. Ward brings both clinical expertise and personal insight to her work, with a mission to transform the way chronic illness is understood and treated.

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Guests

Dr. Serena Russum, ND, CNCB

Dr. Serena Russum, ND, CNCB

Practicing Physician at Blossoming Longevity

Dr. Serena Russum specializes in hormonal health, especially women’s health from puberty to menopause with extensive training in BHRT and pelvic floor therapy. Being a naturopathic doctor by trade she is an expert in holistic functional medicine, nutrition, whole person health and is a certified longevity medicine practitioner. As an award winning speaker and practicing physician at Blossoming Longevity, she is passionate about teaching and healing people by addressing root causes of health, so that they can thrive at every stage of life.

More from Dr. Serena Russum, ND, CNCB on DrTalks

Dr. Heidi Codino, ND, CNCB

Dr. Heidi Codino, ND, CNCB

Advisory Board Member, Menopause Association

Dr. Heidi Codino is an award winning speaker and expert in Women's Health from puberty to post menopause. She is an advisory board member for the Menopause Association and is passionate about helping others thrive through perimenopause and menopause. She is also an industry leading expert in Longevity Medicine and helps patients live their best lives!

More from Dr. Heidi Codino, ND, CNCB on DrTalks

estrogen, progesterone, and testosterone all help with inflammation. And as we know, as doctors, inflammation is the number one cause of cancers and pain and just sitting, really.

Because if you’re in pain, you are going to sit. And if we can get all of that gone before we even get into the part where we don’t have any of our own hormones, then we live longer and healthier and actually feel better while we’re living longer.

Welcome to the Functional Edge. I’m Dr. Julia Ward, and this is where science meets real-world strategies for living healthier, sharper and stronger. From uncovering hidden environmental toxins to unlocking peak performance and mental clarity, we cover it all.

Ready to take control of your health and thrive? Let’s dive in. Okay, hello and welcome to the Functional Edge podcast. I’m your host, Dr. Julia Ward, medical director and founder of Balanced Body Function Medicine.

Today, we’re honored to welcome Dr Serena and Dr Heidi to our show. In this episode, they’ll be sharing insights about bioidentical hormones, offering expert guidance to help you navigate your health journey with the latest advancements in functional medicine.

So stay tuned for an engaging conversation that promises to empower and inspire your path to wellness. Welcome, Drs. Serena and Heidi. Hi. How are you today?

Thank you so much for having us here today. Thank You. Why don’t you tell us a little bit about yourself and your practice? Yeah, so I’m Dr. Serena and Heidi and I started our business pretty much right after we got out of school.

We have a brick and mortar where we do, you know, primary care, lots of holistic functional medicine for primary and then we have our other business, Blossoming Longevity, which focuses on hormone health for both men and women throughout life.

That’s really our passion and where we put a lot of our focus. And is there anything you want to add to that? No, I mean, we’re naturopathic doctors. So we’ve really, our whole medical school training was on the more natriopathic side.

We do medications also, but we really try to go to the root cause of everything to actually fix the issues and to help the issue instead of just kind of glossing over them with some medications.

That’s awesome. We love that. Well, let’s start with the basics. What exactly is bioidentical hormone replacement, or BHRT, and how does it differ from traditional hormone-replacement therapy?

Yeah, so bioidentical hormone replacement therapy is really different than traditional hormone treatment therapy, mostly because of their molecular structures.

So when you get bio identical, it’s molecularly identical or chemically identical to the hormones that your body was producing itself. And so when you have a bioidentical form, your body knows exactly how to use it, how process it and how do absorb it.

And just does what it’s supposed to do with the hormones versus older synthetic forms or non-bioidentic forms. They’re still active as estrogen, progesterone, testosterone.

any of them. However, they are not chemically identical to ours. And because of that, the safety profile is different. There has been studies, so we have the Women’s Health Initiative, that came out back in the day.

All of the risks that were found from that study were based off a non-biogenical form of hormone replacement therapy. And now, since we’ve had the Traverse Trial and the updated Women’s Health Initiative follow-up, we see that bioidentical hormone replacement therapy is much safer than those other forms.

And they actually are showing that they may decrease the risks that we originally thought were directly tied to hormone placement therapy, such as those cardiovascular risks and estrogen-sensitive cancers, and those types of things.

Big difference is their molecular structure, how the body processes them, and then their safety profile. That’s great. So how can BHRT support longevity, not just symptom relief, but especially for women navigating perimenopause and beyond?

So I’ll take this one because I am in perimenopause and I’m on hormones with BHRT. So, really, when you start in period menopausal, your hormones start declining naturally, right?

And when your hormone starts declining, naturally you’re losing all of those protective mechanisms that progesterone, estrogen, even testosterone do for you.

You lose muscle mass, you lose brain health, heart health and bone health. Even within starting permenopasal you loose 10% of your bone and we don’t want to get any further and have osteopenia by the time we’re still in perimenopause and not even menopausal because it’s really hard to it back versus if we start earlier and start helping ourselves earlier, and having more of a level estrogen and level progesterone and even testosterone, while we are going through these, it helps our longevity because we aren’t damaging our body.

estrogen, progesterone, and testosterone all help with inflammation. And as we know, as doctors, inflammation is the number one cause of cancers and pain and just sitting, really.

Because if you’re in pain, you are going to sit. And if we can get all of that gone before we even get into the part where we don’t have any of our own hormones, then we live longer and healthier and actually feel better while we’re living longer.

Yeah, that’s awesome. That makes total sense. To add to that also, as far as like longevity goes, it’s hard to reverse aging, not just around bone health, but also around brain health and heart health skin health.

And our muscle mass in general. If we let our body do that whole transition, then that’s going to impact our longevity versus if we use bioidentical hormone replacement therapy earlier on in that transition and prevent basically the aging that happens, that’s a natural part of that transitions, then you can preserve those aspects of health for longer in your life.

Instead of having to go back and try to fix it. Right, right. It makes sense. You know, it’s easier to stay warm versus to rewarm yourself after being cold.

Exactly. Yeah. It’s just easier to prevent that damage in the first place versus going back and trying to repair stuff. Right. Makes total sense. What are some of the most common hormonal imbalances you see in perimenopausal women and how do they affect quality of life and aging?

Really the biggest thing that we see is like when women start getting into perimenopause, we start to see progesterone be kind of the first one that starts to decrease.

And when progeterones is the 1st one to go, then you start having this estrogen dominant picture. That’s when periods get more irregular, they get heavier, and they more painful.

You start have all these symptoms that are common in that peri-menopausal phase. But really it’s like what’s happening is your progenitor is going down and now you’re in this estrogen dominance phase and that’s aggravating all of our cycling issues that we may have had before, or if not, now we’re having at this point in our lives.

Then as you further get into the perimenal phase, then your estrogen really starts to go down, and that’s when you start seeing a lot more of those aging effects as well that were just talking about, classic perimenopause symptoms, I’ll say.

I feel like there’s a lot of symptoms that we don’t talk enough about, but like classic ones of like the hot flashes, the mood swings, those types of things.

So you really start to see those even more so when the estrogen starts to decline. And then, you know, it’s little bit different for everyone, But I do tend to the testosterone be kind of the last one that hangs on there towards the edge.

but eventually you see them all decline. And throughout the process, you can have peaks and valleys of all of them, which was why sometimes you feel better and sometimes do you fell worse throughout process.

But, ultimately, they’re on a decline with kind of a roller coaster ride along the way and aggravating the symptoms along that whole process Yeah. That’s the most common pattern we see.

Yeah, I definitely see that the Most. And to be fair, when you’re having those fluctuations, it really makes the symptoms so much worse. So when You are having Those fluctuations even if you have like a normal estrogen, When you get tested, It could be super low for you or it could just be at that time that they did the blood test or they do the urine test, you had okay levels because it’s so hard to predict in perimenopause.

It’s constantly up and down. So really, when we’re working with our patients, we really work a lot. We do testing, obviously, because we’d never want to do too much, but we go off of symptom picture.

Yeah. Because if they’re experiencing symptoms, they are having a lot more fluctuations. You just can’t catch it. Right. And you can always catch on blood tests or urine tests.

They’re great helpful markers that we can track, but they aren’t everything. When your ovaries are starting to kind of peter out and they… really done trying to make all these hormones, you’ve got these fluctuations that are causing all the problems.

So that’s why like having the BHRT on board really helps to kind of just level it out so that you’re not having to have those fluctuations and you having like a base level like you usually would when you were younger.

And I’ve found, too, that when women are going through this perimenopausal phase and the progesterone is the first one that drops off the chart, and that makes the estrogen dominant and makes them gain weight really easily.

Or maybe it’s really difficult to lose weight and they’re like, they get so frustrated, like I’m eating the same, I exercise the the, yet I am gaining all this weight, it is really frustrating.

It is very frustrating, myself was a nutritionist and a master trainer before I went to med school, with a six pack. And then came out, obviously, you know, with all the stress.

Came out not with a six pack. But I know how to work out. I knew how eat. Eat very, very clean. And I have had the struggles of trying to lose weight and I gained weight.

It was my progesterone dropped and the brain fog. Nobody talks about the braing fog! The brain from progesterone not being there is ridiculous. Or the sleep, yeah.

The sleep for sure. Inability to sleep, that’s another big one, yeah. Which makes the brain fog worse. Right, which makes everything worse because then you’re tired throughout the day and then, you just naturally gravitate towards, carbs or sugar to give you a little energy and the vicious cycle.

Yes, for sure. Can you speak to the role of estrogen, progesterone, and testosterone in maintaining muscle mass, brain health, metabolic function, in midlife?

Sure. I mean, we kind of touched on it a little bit. This is kind I think people forget that estrogen, progesterone, and testosterone receptors are in every cell of our body.

So it’s not just a sex hormone, right? It’s in our brains, it in in muscles, in heart, our vascular system, everywhere. And when we have declining levels, that’s when everything starts to decline.

One of the biggest things that estrogens does is when estrogen starts going down, specific molecular signaling. So like the microRNA pathways that promote cell health and cell growth, those kind of decline.

And so that’s when you start seeing the sagging skin, the fading breast health, you know, everything starts kind Gravitating downwards. And muscle mass.

You start to lose a ton of muscle, mass everybody thinks that just testosterone is for muscles, which testosterone, is great for muscle. But estrogen is huge for mussels too.

We can’t get that signaling and the growth without having estrogen as well. So testosterone especially, you know, in muscle health, but it’s also for brain health too, and fatigue.

And progesterone also, especially for gut health. Progesteron is great too. So it really helps to have all of them at optimal levels to keep your muscle mass up.

You can’t just have one or the other. You really need to have all three of them in good levels because they really work in every cell of our body. And the signaling to get new growth for those cells comes from all of that.

Yeah, yeah, absolutely. So they all have to be like balanced and at youthful levels. And I think a lot of women are surprised to know that they naturally have more testosterone than they do estrogen.

Yes, thank you so much! We don’t talk about that very much. I know! Yeah, most people are like, women have testosterone? I’m like yes, yes we actually have more than estrogen.

Yeah it’s technically our predominant sex hormone but they don’t ever think about that. It’s measured differently so it looked like we had more estrogen but it is our predominantly sex hormones and it not just for men, we need it too.

But through my training in medical school and stuff, we never really talked about testosterone in women that much, except to blame it for the problems of, oh, this is what happens when you have PCOS.

So all of a sudden it becomes this sort of bad actor, but we need it, and it is highly beneficial. Yeah, and it’s really frustrating too. I see a lot of patients come to us and we see it all the time where, you know, they’ll maybe put them on a little like low dose of estrogen and a low-dose of progesterone, but then they didn’t even test testosterone.

And they’re still struggling with massive fatigue, sarcopenia. They don’t have any motivation to do anything. Well, did they ever test your testosterone?

Let’s test it. It’s like at a nine. and you’re super low and then you give them testosterone and it’s like a game changer. And it is really frustrating that, you know, it has not talked about enough.

So when you said that that made me so happy. Also, if we’re talking about longevity and testosterone, we’ve got to talk about libido too. Because if you want to have good longevity throughout life, that means you wanna have a good sex life too and like we want a libito and if don’t have any testosterone you are not gonna have that either.

Yes. Women like sex too. And I think we should be able to want it also. Yes, and I that is part of like the natural, I don’t know, course of things as you especially, you know maybe you’ve had some babies and you’re getting perimenopausal range and your hormones are low and have no interest in sex.

And you’re just like, wow, I feel like I could just go the rest of my life without ever having sex and I’d be okay with that. But, you know, we realize that that’s not okay.

It’s one of the things that it is very healthy for you as a person to have an active sex life. Right. For many reasons. I mean, it’s great for immune health.

It’s good for emotional connection. And that’s a big thing as we age. We often lose a lot of our emotional connections in our community. Being able to have a sexual relationship with your chosen partner is going to be huge at maintaining the quality of that throughout life.

and we know how much relationships impact quality life and longevity as age as well. So that is a huge part of it too. Yeah, absolutely. Well, how does nutrition support or hinder hormonal balance during perimenopause and are there specific nutrients or eating patterns that you recommend?

Yeah, I’ll start with this one and then you can talk about what you’ve done personally. So the biggest thing that I always tell people is that you got to get off the standard American diet.

It’s hugely inflammatory. it has no nutrients in it and it’s going to mess up your microbiome and your gut microbiomes is going play a huge role in regulating your hormones.

So cutting out processed foods, cutting our sugar and increasing fiber and protein are kind of like my main rules around what you should be focusing on at any stage of life, but especially as you get older.

And then also, I’m really big on food intolerances and I think they’re not looked into enough within medicine. So, you know, a lot of people are like, oh, well, like I don’t have any food and tolerances because I am not having any gut symptoms.

But are you having like early onset arthritis? Are you have brain fog? are having fatigue? Your food intolerances could be causing that and if you cut them out, then you’re going to have less inflammation in your gut.

And then when you less information in you gut, you’ll have more inflammation on your entire body, which means everything’s going be functioning better.

To summarize kind of like the key places to start is eat a whole food diet that’s high in protein, high and fiber and has a good amount of healthy fats and don’t eat your food intolerances.

Yeah. And then to go more into that for perimonopause especially, our bodies work very differently than it used to. So we actually have to feed our bodies more in order to lose that weight that we probably gained during the first part of perimenopause, if not haven’t lost yet.

So the biggest thing is having the correct ratios, and whole foods is the big thing. You can’t have the ultra-processed crap. And all of it causes so much inflammation that it just makes it even worse.

So what I generally go by for people in perimenopause, menopaus is it for protein, I want you to have at least one gram for every pound of your ideal weight.

My ideal would be 135 to 140 because I’m 5’7″. So, and I don’t wanna be skinny, I just wanna fit, right? I wanna have the muscle. So in order to get that muscle though, it is harder for us to muscle, so even when we are on hormones.

I want them to eat 130 grams of protein, but they have to be good sources of proteins. We spend hours going through all of this. And you also have feed yourself more fat.

Like I grew up in the 80s and 90s, everything was fat free, calories in calories out. It really doesn’t work like that anymore. And you have to have natural fats in order for your body to burn actual fat.

So it’s kind of counterintuitive for the Gen X generation for sure, because that’s definitely not what we were taught. It’s a mind game also. But you’ve got to really good amounts of healthy fats.

Healthy fats is not the saturated fats, it is the crappy fats it not fried foods, not any of the ultra processed fats It’s nice, healthy fats like olive oil, avocados, nuts, seeds, those kinds of things.

And again, whole foods. So if you are gonna have carbs, that’s fine. You need carbs to survive. I want all of your veggies. Those are free. you can have as many veggies as you want.

But if are going to have other types of carbs they need to be whole grain. You can’t just have a bunch of pasta or short grain rice or anything that’s super processed again.

Our bodies just don’t metabolize like they used to and you really have to feed it good, healthy medicine. On that note, I think in longevity, a lot of people are talking about fasting and intermittent fasting.

when you get into perimenopause and menopausal in particular, those types of diets and habits don’t serve your microbiome and your metabolism very well.

And I mean, even just with like your story too, because like before you hit perimentopose, I know like we used to do a lot of intermittent fasting together and then you had that and it’s just started aggravating everything.

So we really don’ t recommend doing those type of diet in permenopos or menopsis. either because they’re not supportive of your metabolism and your goals to have a healthy weight and build muscle because your body’s not set up to do that anymore.

Yeah. I always find that that’s a very hard point to drive home because most women are thinking, if I eat less, I will lose weight faster. And I think the biggest pitfall of these GLP-1 injections to lose weight is that it takes out the appetite.

And so now the woman goes down to eating maybe once or twice a day and she’s not losing that much weight. I’m like, well, because now your body’s in this winter metabolism mode where it’s like hanging on every calorie.

It’s counterintuitive, but you have to eat more. to lose weight, but it’s more food of high quality proteins, vegetables, all the good stuff that you were just talking about.

Yeah, for sure. You have to feed your body in order for it to actually build muscle. And it’s so much harder for us to build muscles and keep a healthy, balanced weight when we’re in perimenopause and menopaus that you really have feed it.

Like, you just have it feed. Yeah. Exactly. From my experience working out at the gym quite a bit and being in bodybuilding, sometimes at gym you would see these, what we call the cardio queens, where they’re doing, usually they are instructors and they doing like, six hours of classes of spin and pump and whatever it is and yet they don’t look particularly healthy because they’re burning their muscle mass all day long and they are just not getting there.

That’s the weight they losing is muscle. Yes. Not fat. Right, they become skinny fat. All right, well let’s turn towards something similar or a little bit different.

What role does gut health play in hormone metabolism and detoxification? And how can we support it during this hormonal transition? Okay, so my favorite thing, there’s so many aspects of this, like we’ve already covered quite a bit, but my favourite thing to talk about during this is our estrobolo, which are specific bacteria that help us regulate our hormones and specifically estrogen.

estrobolam are bacteria that make beta-glucaronidase. And beta glucaronidases is an enzyme that helps us recycle our estrogen. So when we are processing our estrogens and our body says like, okay, we’re done with that, let’s send it through and out, then it goes through this.

When it’s going through the gut, the beta glucaronides has the opportunity to make it active again and send it back into circulation. So, this is hugely important when you’re in perimenopause and menopausal because we don’t want to get rid of more of our estrogen, we want keep it.

It’s really important to support the estrobolum and one of the best ways to do that is to eat a high fiber diet. And if you are doing gut testing, if your low on your lactobacillus and your bifidobacterium, then you should be doing probiotics with those in it, as well as doing things to increase those.

So fiber is one of the best ways to be increase though, but also eating things that are rich in polyphenols like pomegranate, blueberries, your dark, rich colored fruits and vegetables are gonna be a natural way to your poly phenols, which are also gonna support that microbiome diversity and support a better estrobolo.

as well as eating the overall fibers. So that is probably the biggest thing that I like to talk about, how it relates to carrying menopause and menapause.

But like we were talking about nutrition and overall gut health, you got to keep the inflammation down, and you’ve got eat the right things. It’s also important to support the bacteria that are actually responsible for processing our hormones.

And the other aspect of that is if you have, you know, as your estrogen decreases, it completely disrupts your estrobolum. And so it makes our, like, increases the inflammation.

It makes us more prone to leaky gut. So you’ll have to be doing all the things to support a healthy gut when you’re in this phase of your life to maintain that estrobolum and to just overall maintain good health.

Yeah, that’s great. Great advice. I also think that people forget that eating more fiber or taking, I prefer people eating fiber. There are fiber supplements.

I don’t prefer them as much. Yeah. So I would rather you chew your fiber so it’s a nice good broom to clean out your gut. But having more fibers actually helps you lose weight.

So I think people forget about that. And I, think our society especially is really focused on the weight loss aspect. So a lot of times when I am seeing patients and that’s what their main focus is, I’m like, okay, well, you need to have 30 grams of fiber a day if you want to lose weight.

Yeah. It’s really important to be pooping every day. You know, having a bowel movement every is critical because otherwise you’re sort of recirculating some of these toxins that need get out.

Exactly. So why is strength training especially important for women in perimenopause, and how does it interact with hormone health, both naturally and when on BHRT?

I lift heavy weights. I love going to the gym. My family says that’s how I get my crazies out. It really is. Really great for your mental health. But weight lifting and strength training, it’s different in menopause and perimenopausal because we need to make sure that we are building muscle.

And again, It’s harder for us to build muscle So in order to build muscle, you really need to activate your satellite cells that send signals to all of your muscles saying, hey, we’re getting heavier loads.

We need build more muscle. When you’re in perimenopause and menopausal and your hormones are a little bit lower and everything’s just kind of slower, it takes more to get that activated.

and have them do that. So strength training is huge because one, it’s great for brain health, heart health skin health muscle health obviously and bone health.

And again, we lose 10% of our bone mass during perimenopause and in two menopausal and then more after that so we want to make sure that we’re keeping it up because like we said before it is much harder to fix it after it has already broken.

Right. But when you’re doing strength training, I’m not talking about, hey, here I’ve got my five pound weights and I am going to do 20 of them here and then I’ll do three sets of that.

I talk about when, you need to heavy weights. So in order to build muscle, you really need to do heavy weights. And so like, for instance, what I do is I break mine up into four sections of my body.

I Do bice tris and shoulders, Ido chest and back, Ido core, which is, you know, front andback core. People forget that our back is part of our core and then IDo leg day.

So legday, which is my favorite. It really is, it really gets me happy. But what you want to do is you wanna do heavy weights. And I know, especially in the Gen X generation, we were always taught, oh, do a little weights because you don’t want big muscles.

That’s not really how it works. It is not how really it work. You’re not gonna bulk up unless you’re on really high testosterone. Or steroids. Yeah, or other steroids.

That’s not really how it works. To build lean muscle, you actually have to lift heavy weights. And so what I do is I loading. So the first set, I did three sets of six, four to six depending on how heavy or how great I feel that day.

But I will do an 80% of my personal max. and for the first six. And then the second six is 85 to 90 and then 95 percent of my personal rep. Usually it’s by the fourth rep of that third set.

I’m just like barely lifting it up. You know, I am barely getting it. But that’s the kind of weight you have to do. That progressive loading is how you build your muscle because that sends more signals to those satellite cells telling your muscles, oh, we’re getting more.

We need to actually build more to be able to lift this. And it’s really a disservice for women of my age and older when we tell them, oh no, just do cardio and you’ll lose your fat.

And you can use your little ankle weights and that’ll be fine for building muscle and body weight. Body weight is good and it is great and I love all the moves.

Cardio is for your heart health and do need to do that also. But in order to build that muscle that we’re losing at a steady rate in perimenopause and menopausal, you really have to lift heavy.

in order to trigger our cells in our muscles to actually build more. Yeah, yeah. I always point out, you know, like when the astronauts go to space and they’re in a zero-gravity situation, they are losing bone mass quite rapidly, because they don’t have that pull of gravity on their bones.

And so if you’re not lifting weights and you are past a certain age, You’re losing bones mass. So we need to reverse that. Are there women who are not good candidates for bioidentical hormones and who they are and what kind of monitoring or customization is needed?

Well, first I’d like to say that you should have a conversation with your doctor. Whoever’s going to be prescribing you hormones, you have to have thorough conversation about are you a good candidate or aren’t you good candidates.

And then once you’ve had that general conversation, I think it’s okay to then have further conversation of like, well, based off my risk, does it still sound worth it to me for quality of life?

And then that’s where you really need to individualize it and have a really good doctor who knows what they’re doing and what the risks are, and you can work through that with them.

However, in general, the rules are women who are not good candidates are ones who have hormone-sensitive cancers. So like breast cancer, uterine ovarian cancer are the most common ones, but any hormone sensitive cancer.

And that also includes if you have a strong family history of hormone, sensitive cancers, there is genetic testing. You can see if your part of like the genetic carrier, those are all things that need to be discussed and looked into.

But the general rule is strong, family, history or personal history, of our own sensitive, cancer is not a good candidate. Other women who tend to not be good candidates are ones who have a strong history of cardiovascular events.

So, such as a history blood clotting, history heart attacks, a story of strokes, those types of things make women not the best candidate for them. However, like I said, I think you can have conversation with your doctor about this may increase my risk for these things.

But do I want to take that chance? Also, you know, if you had more of those issues earlier on in life and you’ve done a lot to heal your body, even though you have that history, You may be an okay candidate now.

Either way, it really needs to be individualized and You need to have a good doctor who knows what they’re doing to really have That in-depth conversation with you.

But the big rules are, history of the cancers, History of cardiovascular event, active cancer. Yeah. active panther as well. And then also if you have any unexplained vaginal bleeding currently, generally makes you not a good candidate.

The other thing that I like to chat though is like, you know, we first talked about the difference between biojunction hormone replacement therapy and the traditional like synthetic forms.

If you do have that history of blood clotting or cardiovascular events, you transdermal estrogen does seem to be a lot safer based off newer research.

And protective. Yes, and potentially protective compared to the old research, so that’s why I say you really need to have a conversation with a doctor who knows what they’re doing.

who knows the updated research, who know the different forms, and can really dive into your health history and individualize it, because just using the transdermal as the example right now, that one, like we said, can be protective, but also it’s not going through that first pass metabolism, which is what causes that increased risk of the cardiovascular events, also because you’re not having to take a higher dose.

to get through the first pass metabolism to then get an active form into your body. If you’re just doing transdermal and you are absorbing it directly into the bloodstream and your forgoing all of those extra risks.

And also if you have a history of migraines with estrogen, trans dermal is probably going to be the one for you. So there’s lots of individualizing it.

Ultimately it’s got to a personal conversation with you and with your doctor. But just know that if like you had a story of the things that we just talked about, you may not be best candidate for it I don’t see a lot of women on oral estrogen, but when I do, I generally try to get them off of that right away.

Never use it. Whether it’s bioidentical or synthetic, it is still causing that liver inflammation. We never keep women in it, people come to us all the time that have been put on things and we’re just like, okay, we are just switching things right now because it isn’t healthy and I will not do this to your body.

Yeah. Yeah and I actually had a friend a long time ago who when she and she was in her 40s and when he stopped her oral contraceptive she lost 30 pounds just from stopping oral-contraceptives.

Also I’ve had alot of patients that came to me on Madroxy progestin and It affects their mental health so extremely like I have seen multiple people have like beyond that medication for their hormone replacement therapy and it severely aggravated their depression or their anxiety or just generally made them feel like, I’ve never had these issues before and now I’m feeling like i’m going crazy and I don’t know why.

switch them off that and get them on the oral micronized progesterone. And they’re like, oh my gosh, I feel like a new person. So that was the synthetic projestins that you were talking about.

Yeah. In the in the Synthetic Progestins, they don’t block the negative effects of estradiol or estrone. Generally, estridiol is very safe. It’s estrone when it converts in your body to the inflammatory estron.

That’s usually the one that kind of causes the problems. I call it I call it the naughty middle sister that progesterone has to kind of take care of. But projestins don’t do that.

Yeah. I think it was that the original Women’s Health Initiative back in the 90s, and they ultimately did link the synthetic projestins to the breast cancer risk.

That was the riskiest thing. So how do you integrate BHRT with lifestyle medicine like nutrition, movement, stress management when you’re working with perimenopausal women?

I’ll start with like nutrition. So I mean, we’ve covered a lot about nutrition already, but whenever I have someone that’s coming in and they want to get on hormones, it’s like, you know, We do our initial screening to see if they’re a good candidate, make sure that we’re optimizing other aspects of health, like their cholesterol, blood pressure, all those types of things.

But then I also like yeah, I start them on the hormones. but I Also start then on let’s get this nutritional stuff because I want them to feel good enough to do it.

And I do feel like if you have women come to you and you’re like, okay Well, we’re not gonna give you the hormones until you do all these other things They’re, not going to do it because they don’t feel good enough to so start the Hormones and then start, the long-term plan of like optimizing nutrition starting to manage stress better and Get into strength training as, well so we kind of do a step-by-step process but it’s a whole process you got to work together it’ll take months and to really get all the pieces in place.

I like to start with nutrition and movement as my biggest things because those also decrease stress and those often take the longest to get people on board and making them part of their routine.

But I’ll let you talk a little bit more about that stuff. She’s a lot nicer than I am. She is, she’s just a lots nicer. I’m in perimenopause, so I have lost all of my patience.

And not patience as in my patients, but patience and I don’t have the time for that. And I feel like, especially in perimenopause, when you feel crap, you need to make all of the changes, right?

And you are going to feel better when make you all the of changes. So when I first do hormones, we usually start them out at a certain level, just depending on if they’re peri-menopaus or menopau.

And we have to do follow-up testing. We have do dose adjustments, because it’s not one size fits all. So we will do dose adjustments, we’ll do all that stuff, but even in that very first thing, I’m like, okay, this is the thing.

If we’re doing hormone therapy, you can’t just do this. We need to do, because it will help you. It’s not your saving grace. You have to actually still work for your health.

And generally speaking, The patients I’ve seen feel like such crap, they’re willing to do anything, right? They’re will to feel better. I’m not gonna put them, I talk to them about strength training and I talked to about nutrition and make sure I give them handouts for diet plans, not, hate the word diet, like food plans.

And I tell them like the macros that I’d like them to eat and just kind of like have them start with that while I am getting their hormones on board. And when we get to a level where they’re not so freaking fatigued that they feel like they have to take a nap three times a day, because their hormones are so low and everything else, and we’d get their eating better, cause most of the time we see people who are on the standard American diet.

They don’t know any better. That’s just what it is, convenience. We clean up all of that stuff. We generally will do food intolerances, test for their food and tolerances so that we can make sure that they’re getting everything inflammatory out.

And then I layer in different levels of nutrition and movement. I always put in there something with stress. Reduction, not everybody is the same with that either.

Like meditation does not work for me. I can’t do it. So I have to do other things like read a book or I do exercises, definitely kind of my de-stressor.

everybody is different so we kind of work with that depending on what will work for them but I layer it in but i do start it right away i’m like listen this is if you want hormones that’s fine we’re going to put you on hormones you know if they’re the right candidate but you have to do these things too Like, I’m not going to work with you if you’re not gonna do these things.

I don’t say that, but. Right, right. Because, and that’s been my experience too, if we just focus on the hormones and nothing else, you know, depending on their health, it may or may not have an effect.

Exactly, and it might have a little bit of effect, but not as much as it would if you do all the other things with it. Right, right. And so I had a number of patients who early on said, I just want my hormones tuned up.

I don’t want to work on anything else. and I would do that and then they’d come back and they’re like, well, didn’t really feel much difference. Like, okay, because we didn’ t address the others sources of inflammation in your body that we need to with diet and movement and everything else, so.

Yeah, exactly. So for a woman in her early to mid 40s starting to notice hormonal shifts, what are three things she can do now to support her health and set herself up for graceful aging?

Well, let’s do our top three that we’ve just said. Movement, nutrition, and hormones. Yeah. I think the biggest thing with hormones, though, is you need to find somebody who knows what they’re doing.

Because there is a lot of misinformation out there. There is lot doctors who still don’t know anything about hormones and who really haven’t done any of the research.

So they’re still going off of old research and they are like, no, it’s too dangerous. You can’t do it. And they like oh, that’s just a part of aging. It’s fine.

Yes, you can do the movement, the food, but you also need the hormone support. You’ve got to do your research and find a good doctor in your area that can help you with it and start it earlier.

Like you start during perimenopause and it’s very helpful because like we said earlier, if you started earlier you’re combating that damage from happening instead of having to try to fix the damage after it has already happened.

Yeah. So, you know, basically finding a good doctor that you can talk to and talk about all of this, getting your movement, finding somebody that can help you with your movements.

I don’t care if it’s a personal trainer, hopefully they’re trained in perimenopause and menopausus because it is very different. It is different, it needs a lot more loading and you need a help with different things.

And then even a nutritionist or just hopefully you find a doctor that has all of that encompassed in one and then stick with it. Like it’s going to be a journey for the lifetime.

It’s not like a one-and-done fix all. Right, right, awesome. Well, thank you guys so much. It’s been so informative and thanks everyone for joining us today on the Functional Edge podcast.

I hope you’ve enjoyed this insightful conversation with Dr. Serena and Heidi and come away with a deeper understanding about how hormone optimization can be a powerful tool for restoring health and vitality.

So to learn more about Dr. Serena and Dr Heidi, we’ll put their website on our show notes section. And I also encourage you to start a conversation with your primary care provider who understands the full picture of your health.

So until next time, I’m Dr Julia Ward. Stay informed, stay balanced, and keep leaning into the functional edge and what’s possible for your heath. Thank you.

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