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The Ultimate Guide to Women’s Hormones: Use Science to Reset Your Body, Balance Mood, & Feel Amazing

Order your copy of The Let Them Theory 👉 https://melrob.co/let-them-theory 👈 The #1 Best Selling Book of 2025 🔥 Discover how much power you truly have. It all begins with two simple words. Let Them. — Today’s episode is your ultimate guide to fixing your hormones at any age—and it’s a MUST listen for every woman in your life. If you’re tired, bloated, gaining weight in places you never used to, struggling with thinning hair, acne, brain fog, low sex drive, mood swings, PMS, painful periods — this is not how it has to be. Mel sits down with top OB-GYN and hormone expert Dr. Jessica Shepherd, MD to unpack the science of women’s hormones in a way you’ve never heard before. Whether you’re in your 20s and dealing with irregular cycles and PMS, or in your 40s and 50s navigating perimenopause and menopause, Dr. Shepherd breaks down exactly what’s going on in your body—and how to get it back in balance. You’ll learn: -The signs of hormone imbalance and how to fix it -The surprising ways hormone shifts mess up your skin, cause weight gain, disrupt your sleep, and more -The best foods to support your hormones (and the ones to cut back on) -How to stop hair thinning and hormonal acne -Why your skin starts to sag and what you can do to restore collagen -What happens when you stop birth control—and how long it takes your body to reset -Everything you need to know about PCOS, endometriosis, thyroid disease, and more This is your science-backed step by step guide to balancing your hormones for health, happiness, and longevity. Whether you’re 25 or 65, you’ll finally learn how to work with your body, instead of against it, to feel your absolute best. For more resources related to today’s episode, click here for the podcast episode page: https://www.melrobbins.com/episode/episode-293/ Follow The Mel Robbins Podcast on Instagram: https://www.instagram.com/themelrobbinspodcast 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. In this episode: 00:00 Welcome 12:39 What Hormones Actually Do in Your Body 19:47 Hormones in Adolescence and Early Adulthood 27:18 How Your Hormones Shift in Your 20s 35:24 What Happens When You Stop Taking Birth Control 40:10 Estrogen Decline During Menopause: What to Expect and Why It Matters 51:48 Symptoms and Physical Changes in Perimenopause 1:00:00 What to Know About Hormone Replacement Therapy (HRT) 01:15:13 How Hormones Affect Your Sleep 1:19:54 The Link Between Your Thyroid and Hormones 01:22:42 PCOS and the Connection to Metabolism 01:25:48 Breaking Down Endometriosis 01:28:28 How Hormones Impact Your Skin and Hair 01:37:28 Taking Charge of Your Hormonal Health — Follow Mel: Instagram: https://www.instagram.com/melrobbins/ TikTok: http://tiktok.com/@melrobbins Facebook: https://www.facebook.com/melrobbins LinkedIn: https://www.linkedin.com/in/melrobbins Website: http://melrobbins.com​ — Sign up for Mel’s newsletter: https://melrob.co/sign-up-newsletter A note from Mel to you, twice a week, sharing simple, practical ways to build the life you want. — Subscribe to Mel’s channel here: https://www.youtube.com/melrobbins​?sub_confirmation=1 — Listen to The Mel Robbins Podcast 🎧 New episodes drop every Monday & Thursday! https://melrob.co/spotify https://melrob.co/applepodcasts https://melrob.co/amazonmusic — Looking for Mel’s books on Amazon? Find them here: The Let Them Theory: https://amzn.to/3IQ21Oe The Let Them Theory Audiobook: https://amzn.to/413SObp The High 5 Habit: https://amzn.to/3fMvfPQ The 5 Second Rule: https://amzn.to/4l54fah

Mel RobbinshostDr. Jessica Shepherdguest
May 29, 20251h 41mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 12:39

    Welcome

    1. MR

      Wow. I, I think I hear somebody hitting share right now and sending this to their mother.

    2. JS

      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 and our best version of ourselves.

    3. MR

      Today's episode, it is the ultimate guide to understanding and optimizing women's hormones for better health at all ages. Our guest today is world-renowned OB-GYN Dr. Jessica Shepherd. She's here with the answers you need. If you have really bad PMS, what does that tell you as a medical doctor?

    4. JS

      When women come in, I always like to-

    5. MR

      Can you speak to, you know, a person listening who, you know, comes off birth control?

    6. JS

      Mm-hmm.

    7. MR

      Like, what do you want them to know?

    8. JS

      I want them to know that...

    9. MR

      Wow.

    10. JS

      Yeah.

    11. MR

      Why do so many women in their 20s get, quote, "hormonal acne"?

    12. JS

      There can be stuff that is due to chemicals that-

    13. MR

      Top foods you should eat for good skin.

    14. JS

      Oh, I think the top foods should be blueberries, nuts, but also-

    15. MR

      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 wanna 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 wanna 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 at 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 OB-GYN 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. Shepherd also served as the director of minimally invasive gynecologic 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. Shepherd is also the author of the best-selling book, Generation M: Living Well in Perimenopause and Menopause. So, please help me welcome Dr. Jessica Shepherd to the Mel Robbins Podcast. Dr. Jessica Shepherd, 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.

    16. JS

      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.

    17. MR

      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 wanna 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?

    18. JS

      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?

    19. MR

      Hmm.

    20. JS

      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, 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 wanna be?"

    21. MR

      Wow. And what I'm excited about to learn from you, Dr. Shepherd, is oftentimes when you realize you don't feel how you wanna feel-

    22. JS

      Yeah.

    23. MR

      ... or you're not where you want to be in your life in terms of your relationship to your health-

    24. JS

      Mm-hmm.

    25. MR

      ... 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.

    26. JS

      Mm-hmm.

    27. MR

      So, let's start with just talking about what made you interested in medicine and women's health.

    28. JS

      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.

    29. MR

      Hmm.

    30. JS

      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 'cause I loved being in the OR. I loved being able to really take something very complex-

  2. 12:39 – 19:47

    What Hormones Actually Do in Your Body

    1. JS

    2. MR

      And so, let's just start by talking about hormones-How do you want to frame the conversation around hormones?

    3. JS

      I think hormones are these beautiful, complex messengers. So, it's like we have these little mailmen that are, or male women-

    4. MR

      (laughs)

    5. JS

      ... going around delivering messages every day. Like, they are consistent, they know what they're supposed to be doing. And our, our bodies are beautiful machines, and they're meant to be well-oiled 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.

    6. MR

      So, is it like a liquid? Like, what is a hormone?

    7. JS

      That is great, you know-

    8. MR

      Like, you know what I'm saying? Like, I, I'm-

    9. JS

      ... I think if you-

    10. MR

      'Cause as you're thinking messengers, I'm like, wait, is it the wiring? Is it, is it liquid? Like what, what actually is a hormone?

    11. JS

      It's more of a, uh, you know, we should, we should go inward and talk about these hormones. But it's actually the delivery of a kind of chemical.

    12. MR

      Okay.

    13. JS

      Yeah. It's, it's a chemical that's released. 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, 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, 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.

    14. MR

      Well, you know what's interesting is that, like, if you really think about the experience, whether you, uh, are male or female-

    15. JS

      Yeah.

    16. MR

      ... is when puberty hits-

    17. JS

      (laughs)

    18. MR

      ... the only thing that you hear from adults is, "Oh, hormones. Oh, the hormones-"

    19. JS

      Yeah.

    20. MR

      "... are raging. Oh, here it..." Like, and, and nobody understands what it-

    21. JS

      No.

    22. MR

      ... actually means or what the hormone is doing. So, when you get to puberty, though-

    23. JS

      Yeah.

    24. MR

      ... and the "hormones" start going crazy, are you not born with this level of hormones? You know what I'm saying? Like, why are hormones-

    25. JS

      That is a great question.

    26. MR

      ... going crazy during pu- puberty?

    27. JS

      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.

    28. MR

      Okay.

    29. JS

      But the delivery of when they're gonna 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, 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."

    30. MR

      Yep.

  3. 19:47 – 27:18

    Hormones in Adolescence and Early Adulthood

    1. MR

    2. JS

      Mm-hmm.

    3. MR

      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-

    4. JS

      Yeah.

    5. MR

      ... hormones-

    6. JS

      Mm-hmm.

    7. MR

      ... play for a woman?

    8. JS

      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.

    9. MR

      Why?

    10. JS

      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, and-

    11. MR

      I would think so.

    12. JS

      ... there are 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 our, our 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 complexi- uh, complexity of our bodies and the systems and how it's being regulated. So the onboarding time is a little bit earlier now.

    13. MR

      Mm-hmm.

    14. JS

      And so what's happening is that estrogen is starting to, 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, and estrogen and progesterone are th- gonna be those key hormones that are gonna filter into, "When am I gonna be high? When am I gonna 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-

    15. MR

      Got it.

    16. JS

      ... menstrual cycle.

    17. MR

      So what is the role of estrogen?

    18. JS

      Estrogen really, I, I like to call it our vitality hormone-

    19. MR

      Okay.

    20. JS

      ... 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."

    21. MR

      Mm-hmm.

    22. JS

      "And how can we alter it in a way where you can get back to your, maybe your, 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.

    23. MR

      Is it important as a woman-

    24. JS

      Mm-hmm.

    25. MR

      ... 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?

    26. JS

      I would say biologically. That's what, if we were to look at it just from like key, you know, key framework.

    27. MR

      Just, just like, I'm just literally-

    28. JS

      Absolutely.

    29. MR

      ... just like your tongue is designed to taste-

    30. JS

      Absolutely.

  4. 27:18 – 35:24

    How Your Hormones Shift in Your 20s

    1. MR

      when you move into your 20s, what is, what's going on with hormones?

    2. JS

      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-

    3. MR

      Yeah.

    4. JS

      ... or maybe heavier cycles.

    5. MR

      Yes.

    6. JS

      Yeah, and so, it really should be kind of even keel during this timeframe-

    7. MR

      Oh.

    8. JS

      ... but that's not what we always see.

    9. MR

      So, if it's not even keeled-

    10. JS

      Mm-hmm.

    11. MR

      ... meaning a pretty regular cycle-

    12. JS

      Mm-hmm.

    13. MR

      ... and a pretty predictable kind of route of, "These are the days I'm kind of moody or grumpy," or whatever, or, "These is-"

    14. JS

      Yeah.

    15. MR

      "... 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?

    16. JS

      When women come in, I always like to peel the layers back-

    17. MR

      Okay.

    18. JS

      ... because that's very subjective, and subjective meaning everyone has different experiences.

    19. MR

      Mm-hmm.

    20. JS

      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 a, 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 so, a lot of my women, especially women of color who come in, have different stressors-

    21. MR

      Hmm.

    22. JS

      ... 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-

    23. MR

      Yep.

    24. JS

      ... a lot of what they're experiencing is a lot different to women who are not in those particular environments-

    25. MR

      Uh-huh.

    26. JS

      ... 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.

    27. MR

      Like, what foods change how your hormones respond?

    28. JS

      So, your processed foods, your foods that have high glycemic index, that have a lot of sugar, uh, 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, let's start here," 'cause 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 period, but we have to utilize that. And then, also stressors. What's going on in your life? This i- uh, it's 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 OB-GYNs 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.

    29. MR

      I think it's fascinating that-... stress in your life-

    30. JS

      Yes.

  5. 35:24 – 40:10

    What Happens When You Stop Taking Birth Control

    1. JS

      Yeah.

    2. MR

      Can you speak to, you know, a person listening in their 20s or 30s who, you know, comes off birth control-

    3. JS

      Mm-hmm.

    4. MR

      ... and then has a lot of issues after? Like, what do you want them to know?

    5. JS

      I want them to know that the body is tr- 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.

    6. MR

      Okay.

    7. JS

      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-

    8. MR

      Right.

    9. JS

      ... so it wants to release an egg.

    10. MR

      So what happens to all those hormones in your body if it's suppressing-

    11. JS

      They're still there.

    12. MR

      ... their, it's-

    13. JS

      They're still there. They're still doing what they're supposed to be doing, but the birth control is kinda keeping it a little bit more suppressed, so it can't-

    14. MR

      Okay.

    15. JS

      ... do the function it wants to do.

    16. MR

      Okay.

    17. JS

      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.

    18. MR

      So, what might somebody expect-

    19. JS

      Yeah.

    20. MR

      ...and what would you say, Dr. Shepherd, is a good amount of time to give your body to like, "Aah! Okay, what's happening here?"

    21. JS

      Immediate gratification is usually what we want when it comes to our bodies-

    22. MR

      Yeah.

    23. JS

      ...and I always am coaching my patients to give their bodies grace. And when I say that in a timeframe-

    24. MR

      Yeah.

    25. JS

      ...that may be three to six months.

    26. MR

      Okay.

    27. JS

      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-

    28. MR

      Bounce back, right.

    29. JS

      ...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?" 'Cause remember, it's a gradient.

    30. MR

      Right.

  6. 40:10 – 51:48

    Estrogen Decline During Menopause: What to Expect and Why It Matters

    1. MR

      impacted by estrogen?

    2. JS

      Absolutely. There are estrogen receptors all over the body. You know, in Generation M, there is, like, this... I was like, "This diagram has to go in this book" because we have typecast estrogen and progesterone just to the pelvis. Just to the pelvis.

    3. MR

      It's true. 'Cause I think about estrogen, and I'm like, "Well, it's just talking to my ovaries. Like, what are you, what are you talking about? Why do I-"

    4. JS

      No, 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, are weaker. Our brain goes through this fog. And that's because estrogen h- is... 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 gonna function the way that I used to or would like to because estrogen is not there."

    5. MR

      What is, uh, a few places in a woman's body that somebody might be surprised to hear-

    6. JS

      Mm-hmm.

    7. MR

      ...has estrogen as a very critical piece of how that part of your body functions?

    8. JS

      You know what I say is the most fascinating is the brain, and you know why? 'Cause even as an OB-GYN, it's like you know it, but you don't know it.

    9. MR

      Mm-hmm.

    10. JS

      I don't think I realized how much of an impact that estrogen makes on the brain until maybe five, 10 years ago.

    11. MR

      So, what impact does it make on the brain?

    12. JS

      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.

    13. MR

      What does limbic mean?

    14. JS

      Limbic means that emotional.

    15. MR

      Oh, yes.

    16. JS

      Right? That kind of jump to the... Right?

    17. MR

      Uh-huh.

    18. JS

      And what do we hear? That women who are in their perimenopausal phase are more moody, right?

    19. MR

      Well, that's also what we hear about PMS.

    20. JS

      Absolutely.

    21. MR

      So, is PMS like a mini drop in estrogen in your body?

    22. JS

      It's a drop and then... So it's the fluctuation.

    23. MR

      Gotcha.

    24. JS

      It may go down, then come up really quick. But unfortunately, in perimenopause, it's going down, but it's not, (laughs) it's not really coming back up.

    25. MR

      (laughs)

    26. JS

      It's like, "I'm, 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.

    27. MR

      Wait, hold on. You see the most diagnoses-

    28. JS

      Yes.

    29. MR

      ...of anxiety and depression in women between the ages of-

    30. JS

      In midlife women.

  7. 51:48 – 1:00:00

    Symptoms and Physical Changes in Perimenopause

    1. MR

      So, we've covered what happens at 35, 40, and 42. Let's talk about perimenopause. Medically speaking, Dr. Shepherd, what does that word mean, and what is the kind of typical age range that, of women, that covers?

    2. JS

      Well, that would be me. I'm, I'm perimenopausal. Proud of it. But perimenopause has been more of a confusing term, I think-

    3. MR

      Yes.

    4. JS

      ... in, in what we've seen in this menopause surge.

    5. MR

      Uh-huh.

    6. JS

      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. Some people do.

    7. MR

      I mean, wouldn't that start when you're 35?

    8. JS

      Some people, I have had patients, and I would definitely say sometimes I'm like, "Wow, you are pretty young," but I'm never gonna take that experience away from them, that they may start to experience symptoms of perimenopause.

    9. MR

      So, what are the symptoms-

    10. JS

      Yeah. So this-

    11. MR

      ... of perimenopause-

    12. JS

      Mm-hmm.

    13. MR

      ... and what physical changes happen-

    14. JS

      Yeah.

    15. MR

      ... when you are in that zone that, I'm just gonna put a big-

    16. JS

      Mm-hmm.

    17. MR

      ... hoop here.

    18. JS

      Yeah.

    19. MR

      Like, 35 to 50-ish. Like, like, like that-

    20. JS

      Yeah. I would say it, it-

    21. MR

      This could be the zone that you're in.

    22. JS

      This could be the experience and the timeframe. So, I would definitely say, uh, 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.

    23. MR

      Mm.

    24. JS

      Definite change in weight. I've had so many women who come in and been 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 (laughs) . They're just like, "I'm not, I'm not doing the assembly line."

    25. MR

      Or, or the car that you've been driving is starting-

    26. JS

      Yeah. (laughs)

    27. MR

      ... to sputter.

    28. JS

      It's sputtering.

    29. MR

      Yes.

    30. JS

      And so, those start to happen through that timeframe.

  8. 1:00:00 – 1:15:13

    What to Know About Hormone Replacement Therapy (HRT)

    1. JS

      even though we're living longer.

    2. MR

      Have they done any studies, and I realize hormone replacement therapy is, had a, ha- had had issues, because if I understand it correctly, when it first came out-

    3. JS

      Mm-hmm.

    4. MR

      ... there was, like, a bunch of junk science that has been disproven that-

    5. JS

      Yeah.

    6. MR

      ... scared people.

    7. JS

      Yeah.

    8. MR

      And now, all of those old claims have been basically-

    9. JS

      Refuted.

    10. MR

      ... refuted. And so, for the vast majority of women, it is a extraordinarily safe and life-changing medical option. And for women who have a certain risk of cancer or a certain health history, it is not an option.

    11. JS

      Mm-hmm.

    12. MR

      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?

    13. JS

      Absolutely. So, I am 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, uh, 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 gonna help with." Now, we know that it helps with the symptoms of menopause: hot flashes, night sweats, et cetera. But when we look at bone health, it is actually proven that estrogen impacts bone health, in a good way-

    14. MR

      Hm.

    15. JS

      ... 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-

    16. MR

      But hold on-

    17. JS

      Yeah.

    18. MR

      ... let me ask a question. So, if we know though that-

    19. JS

      Yeah.

    20. MR

      ... when there is a complete drop-off of estrogen that it spikes a woman's risk for osteoporosis-

    21. JS

      Mm-hmm.

    22. MR

      ... it doesn't take somebody ... Like, no offense to, to people who are just wildly brilliant like you are, but common sense, it tells you-

    23. JS

      Right.

    24. MR

      ... clearly there's a connection because we don't see-

    25. JS

      Oh, there's a clear connection.

    26. MR

      ... women in their 30s getting osteoporosis.

    27. JS

      Absolutely, which is why I think that's where we need to challenge-

    28. MR

      I'm like, "Why on earth wouldn't you-"

    29. JS

      ... medical societies, absolutely.

    30. MR

      ... immediately put somebody on estrogen if they're a candidate-

  9. 1:15:13 – 1:19:54

    How Hormones Affect Your Sleep

    1. JS

    2. MR

      Dr. Shepherd, could you talk to us about sleeping? Every one of my friends is having trouble sleeping.

    3. JS

      Yeah.

    4. MR

      Like every woman I know in their 40s or 50s, and I have a particular person that I love who has what she calls her little helper, her Advil PM. I'm like, "You gotta stop taking that." She's like, "But I'm taking my melatonin, I'm taking my progesterone and, you know, I, I got my cooling sheets." Like, "I-"

    5. JS

      Yeah.

    6. MR

      "... Like I'm... I, I still can't sleep." What is going on with hormones and sleep?

    7. JS

      I'll, 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 disorders or sleep issues-

    8. MR

      Mm-hmm.

    9. JS

      ... these are the people that we see later getting obstructive, uh, sleep disorder, heart disease, asthma, and also increase in obesity, right? So all things that are gonna 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 gonna 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 5:00 AM.

Episode duration: 1:41:03

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