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

Mel Robbins 0:00 Wow. I, I think I hear somebody hitting share right now and sending this to their mother.

Dr. Jessica Shepherd 0:05 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.

Mel Robbins 0:16 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?

Dr. Jessica Shepherd 0:38 When women come in, I always like to-

Mel Robbins 0:41 Can you speak to, you know, a person listening who, you know, comes off birth control?

Dr. Jessica Shepherd 0:47 Mm-hmm.

Mel Robbins 0:47 Like, what do you want them to know?

Dr. Jessica Shepherd 0:49 I want them to know that...

Mel Robbins 0:50 Wow.

Dr. Jessica Shepherd 0:51 Yeah.

Mel Robbins 0:52 Why do so many women in their 20s get, quote, "hormonal acne"?

Dr. Jessica Shepherd 0:57 There can be stuff that is due to chemicals that-

Mel Robbins 1:00 Top foods you should eat for good skin.

Dr. Jessica Shepherd 1:01 Oh, I think the top foods should be blueberries, nuts, but also-

Mel Robbins 1:08 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.

Dr. Jessica Shepherd 3:33 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.

Mel Robbins 3:46 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?

Dr. Jessica Shepherd 4:22 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?

Mel Robbins 4:32 Hmm.

Dr. Jessica Shepherd 4:33 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?"

Mel Robbins 4:59 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-

Dr. Jessica Shepherd 5:10 Yeah.

Mel Robbins 5:10 ... or you're not where you want to be in your life in terms of your relationship to your health-

Dr. Jessica Shepherd 5:15 Mm-hmm.

Mel Robbins 5:15 ... 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.

Dr. Jessica Shepherd 5:36 Mm-hmm.

Mel Robbins 5:36 So, let's start with just talking about what made you interested in medicine and women's health.

Dr. Jessica Shepherd 5:43 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.

Mel Robbins 6:01 Hmm.

Dr. Jessica Shepherd 6:01 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-

Mel Robbins 6:26 Mm-hmm.

Dr. Jessica Shepherd 6:27 ... 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?"

Mel Robbins 6:36 And how did being a surgeon impact you and lead you to where you are now and the philosophy that you have about medicine-

Dr. Jessica Shepherd 6:45 Yeah.

Mel Robbins 6:45 ... and women's health?

Dr. Jessica Shepherd 6:46 And most of the surgeries that I was doing, a lot of times it had to do with women in their midlife.

Mel Robbins 6:51 Okay.

Dr. Jessica Shepherd 6:52 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.

Mel Robbins 7:14 Mm.

Dr. Jessica Shepherd 7:14 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 'cause that's a surgical thing that I know I'm very skilled to do. But what I'm really paying attention 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."

Mel Robbins 7:45 Well, what I'm excited about is that, you know, you mentioned pregnancy.

Dr. Jessica Shepherd 7:49 Yeah.

Mel Robbins 7:49 You mentioned doing all these surgeries. If you really think about it, and in the forward of your book, Dr. Jennifer Ashton-

Dr. Jessica Shepherd 7:56 Mm-hmm.

Mel Robbins 7:57 ... 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.

Dr. Jessica Shepherd 8:13 Mm-hmm.

Mel Robbins 8:13 And so we dive into all of it, 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-

Dr. Jessica Shepherd 8:25 Mm-hmm.

Mel Robbins 8:25 ... and when I first got my period-

Dr. Jessica Shepherd 8:28 Mm-hmm.

Mel Robbins 8:28 ... it sort of came and then I just had to deal.

Dr. Jessica Shepherd 8:30 Right.

Mel Robbins 8:30 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-

Dr. Jessica Shepherd 8:42 Mm-hmm.

Mel Robbins 8:43 ... 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-

Dr. Jessica Shepherd 9:02 Yeah.

Mel Robbins 9:02 ... at all.

Dr. Jessica Shepherd 9:03 No, not at all. I think pregnancy, you said it perfectly there, is that's what society tells us-

Mel Robbins 9:08 Right.

Dr. Jessica Shepherd 9:08 ... what our worth is and 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 gonna figure this out."

Mel Robbins 9:16 Right.

Dr. Jessica Shepherd 9:17 But that was something that had to do with just self, right?

Mel Robbins 9:20 Yes.

Dr. Jessica Shepherd 9:20 But no one was really paying attention to that. But when it came to now you have to take care of someone else, society's like, "Here's your importance," and then we dive into it 'cause we're kind of feeding into that. Not to say that pregnancy isn't important, that we don't love it, but now we're fascinated and kind of giving more towards 'cause 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's kind of deemed me maybe not that important."

Mel Robbins 9:55 Right.

Dr. Jessica Shepherd 9:56 So, that's where I want women to pay attention to their worth.

Mel Robbins 9:59 Yeah, and- 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- if you are listening and you're one of the millions of guys listening to this show, this is a really important conversation to listen to because it's gonna 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.

Dr. Jessica Shepherd 10:29 They are not.

Mel Robbins 10:29 That is what Dr. Stacey Sims loves to say. And understanding the unique physiology and biology is critical. And we're gonna 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-

Dr. Jessica Shepherd 10:46 Yeah.

Mel Robbins 10:46 ... 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-

Dr. Jessica Shepherd 11:09 Yeah.

Mel Robbins 11:09 ... it impacts every aspect of your life. And you know, 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.

Dr. Jessica Shepherd 11:19 Mm-hmm.

Mel Robbins 11:19 How- how old are you?

Dr. Jessica Shepherd 11:20 I am 47.

Mel Robbins 11:21 Okay, great.

Dr. Jessica Shepherd 11:22 (laughs)

Mel Robbins 11:22 So, I'm 56.

Dr. Jessica Shepherd 11:23 Yeah.

Mel Robbins 11:23 If I think about our moms, they typically grew up in a generation where the messaging, at least in kinda like the '60s and '70s was, "Okay, you know, you gotta do it all. You gotta look good, you gotta also keep the house together, you gotta be able to take care of everybody." There was zero messaging about taking care of yourself.

Dr. Jessica Shepherd 11:47 Oh, no, that wasn't part of the memo.

Mel Robbins 11:48 No.

Dr. Jessica Shepherd 11:48 (laughs)

Mel Robbins 11:49 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.

Dr. Jessica Shepherd 11:57 No.

Mel Robbins 11:57 They just had to do it all themselves. And so, no wonder our moms neglected themselves.

Dr. Jessica Shepherd 12:02 Mm-hmm.

Mel Robbins 12:03 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. Go see a doctor when you're sick. Oh, no, no, no." Like I have a friend that has prolapsed right now, she's like, "It literally feels like-" Which is I guess when your uterus is falling.

Dr. Jessica Shepherd 12:23 Yeah, when things are kind of coming out.

Mel Robbins 12:25 Things are coming-

Dr. Jessica Shepherd 12:25 Right.

Mel Robbins 12:26 My, uh, well, 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."

Dr. Jessica Shepherd 12:31 Yeah.

Mel Robbins 12:31 And I'm like, "You're walking around like... You should go see a doctor, you know." And- and-

Dr. Jessica Shepherd 12:36 But that's taking care of self, and we're not trained to do that.

Mel Robbins 12:39 And so, let's just start by talking about hormones-How do you want to frame the conversation around hormones?

Dr. Jessica Shepherd 12:45 I think hormones are these beautiful, complex messengers. So, it's like we have these little mailmen that are, or male women-

Mel Robbins 12:53 (laughs)

Dr. Jessica Shepherd 12:53 ... 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.

Mel Robbins 13:15 So, is it like a liquid? Like, what is a hormone?

Dr. Jessica Shepherd 13:17 That is great, you know-

Mel Robbins 13:17 Like, you know what I'm saying? Like, I, I'm-

Dr. Jessica Shepherd 13:19 ... I think if you-

Mel Robbins 13:19 '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?

Dr. Jessica Shepherd 13:24 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.

Mel Robbins 13:32 Okay.

Dr. Jessica Shepherd 13:32 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.

Mel Robbins 14:16 Well, you know what's interesting is that, like, if you really think about the experience, whether you, uh, are male or female-

Dr. Jessica Shepherd 14:22 Yeah.

Mel Robbins 14:23 ... is when puberty hits-

Dr. Jessica Shepherd 14:26 (laughs)

Mel Robbins 14:27 ... the only thing that you hear from adults is, "Oh, hormones. Oh, the hormones-"

Dr. Jessica Shepherd 14:31 Yeah.

Mel Robbins 14:31 "... are raging. Oh, here it..." Like, and, and nobody understands what it-

Dr. Jessica Shepherd 14:35 No.

Mel Robbins 14:35 ... actually means or what the hormone is doing. So, when you get to puberty, though-

Dr. Jessica Shepherd 14:41 Yeah.

Mel Robbins 14:42 ... 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-

Dr. Jessica Shepherd 14:50 That is a great question.

Mel Robbins 14:50 ... going crazy during pu- puberty?

Dr. Jessica Shepherd 14:52 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.

Mel Robbins 15:03 Okay.

Dr. Jessica Shepherd 15:04 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."

Mel Robbins 15:23 Yep.

Dr. Jessica Shepherd 15:23 Everyone's running around 'cause 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."

Mel Robbins 15:38 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-

Dr. Jessica Shepherd 15:45 Mm-hmm.

Mel Robbins 15:45 ... that are delivering a particular message, and that your body has receptors all over it that are designed to receive the message from the hormone.

Dr. Jessica Shepherd 15:54 Yeah. It's receiving, delivery and receiving is the most important part, I would say, of a hormone, because they want to get that message across. And then the (laughs) the, uh, hormones that disassemble, you know, so the job now is kind of falling apart, is what's happening in perimenopause and menopause.

Mel Robbins 16:11 Wait, what do you mean disassemble?

Dr. Jessica Shepherd 16:11 Well, when we go through a hormone decline, which is the opposite of what we're doing when we're getting towards puberty-

Mel Robbins 16:17 Okay.

Dr. Jessica Shepherd 16:17 ... and adolescence, perimenopause is they're like, "Biologically, we're not gonna be doing that delivery system anymore. Uh, we're gonna 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."

Mel Robbins 16:45 Huh.

Dr. Jessica Shepherd 16:45 And so that's when you start to see the offloading of what happens with hormones, which is why we now experience all those symptoms in perimenopause.

Mel Robbins 16:53 Got it. And does the same thing happen to men if they experience low testosterone?

Dr. Jessica Shepherd 16:57 They do, but their decline is much slower over a longer timeframe.

Mel Robbins 17:02 Gotcha.

Dr. Jessica Shepherd 17:03 And so, that's why you still can have men who are (laughs) 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.

Mel Robbins 17:17 Gotcha. Okay. So, in ter- 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-

Dr. Jessica Shepherd 17:36 Mm-hmm. Mm-hmm.

Mel Robbins 17:36 ... during that period of time. What are the key hormones-

Dr. Jessica Shepherd 17:41 Mm-hmm.

Mel Robbins 17:42 ... that you need to actually understand are important and play a role in your health?

Dr. Jessica Shepherd 17:49 Well, all hormones for men and women obviously play that specific role. But when we speak to just women-

Mel Robbins 17:55 Mm-hmm.

Dr. Jessica Shepherd 17:55 ... 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-

Mel Robbins 18:06 Mm-hmm.

Dr. Jessica Shepherd 18:06 ... 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.

Mel Robbins 18:21 And...Can we group the thyroid hormones together? Or are there-

Dr. Jessica Shepherd 18:24 We can.

Mel Robbins 18:25 ... a bunch of them, or-

Dr. Jessica Shepherd 18:25 They're kind of like cousins.

Mel Robbins 18:26 Okay.

Dr. Jessica Shepherd 18:26 So they're kind of like in separate pods but they're kind of in the same neighborhood and-

Mel Robbins 18:30 Okay.

Dr. Jessica Shepherd 18:30 ... and really contribute towards each other, but estrogen, progesterone, and testosterone.

Mel Robbins 18:33 Okay, so estrogen, progesterone, testosterone.

Dr. Jessica Shepherd 18:36 Yeah.

Mel Robbins 18:37 Now, we hear a ton-

Dr. Jessica Shepherd 18:38 Uh-huh.

Mel Robbins 18:39 ... about cortisol-

Dr. Jessica Shepherd 18:40 Yeah.

Mel Robbins 18:40 ... and sero- serotonin.

Dr. Jessica Shepherd 18:42 Uh-huh.

Mel Robbins 18:42 And that's, that's a hormone, right?

Dr. Jessica Shepherd 18:44 Yeah, those are hormones.

Mel Robbins 18:45 Okay. And some other ones-

Dr. Jessica Shepherd 18:46 Yeah.

Mel Robbins 18:46 ... who I now can't remember.

Dr. Jessica Shepherd 18:48 (laughs)

Mel Robbins 18:48 But are they as important-

Dr. Jessica Shepherd 18:50 They are important.

Mel Robbins 18:50 ... for understanding when it comes to women's health, or-

Dr. Jessica Shepherd 18:53 Yeah.

Mel Robbins 18:53 ... is it important for us to just start with estrogen, progesterone, and test- testosterone?

Dr. Jessica Shepherd 18:58 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 kind of family of when we talk about hormones, because it has such a broad, uh, impact on our entire body system, whereas-

Mel Robbins 19:15 And what does metabolic mean?

Dr. Jessica Shepherd 19:17 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's able to absorb glucose, utilize glucose as a fuel.

Mel Robbins 19:35 Mm-hmm.

Dr. Jessica Shepherd 19:36 So cortisol really has a lot to do with that as far as metabolic functions.

Mel Robbins 19:39 Okay. So we're gonna shove that to the side.

Dr. Jessica Shepherd 19:41 We can shove that to the side.

Mel Robbins 19:42 And we'll stay right here with estrogen, progesterone, testosterone.

Dr. Jessica Shepherd 19:46 Yeah.

Mel Robbins 19:46 And let's start with puberty.

Dr. Jessica Shepherd 19:47 Mm-hmm.

Mel Robbins 19:47 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-

Dr. Jessica Shepherd 19:59 Yeah.

Mel Robbins 19:59 ... hormones-

Dr. Jessica Shepherd 20:00 Mm-hmm.

Mel Robbins 20:00 ... play for a woman?

Dr. Jessica Shepherd 20:02 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.

Mel Robbins 20:11 Why?

Dr. Jessica Shepherd 20:11 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-

Mel Robbins 20:31 I would think so.

Dr. Jessica Shepherd 20:31 ... 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.

Mel Robbins 20:57 Mm-hmm.

Dr. Jessica Shepherd 20:58 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-

Mel Robbins 21:23 Got it.

Dr. Jessica Shepherd 21:23 ... menstrual cycle.

Mel Robbins 21:24 So what is the role of estrogen?

Dr. Jessica Shepherd 21:26 Estrogen really, I, I like to call it our vitality hormone-

Mel Robbins 21:29 Okay.

Dr. Jessica Shepherd 21:29 ... 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."

Mel Robbins 21:48 Mm-hmm.

Dr. Jessica Shepherd 21:48 "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.

Mel Robbins 22:08 Is it important as a woman-

Dr. Jessica Shepherd 22:10 Mm-hmm.

Mel Robbins 22:10 ... 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?

Dr. Jessica Shepherd 22:31 I would say biologically. That's what, if we were to look at it just from like key, you know, key framework.

Mel Robbins 22:37 Just, just like, I'm just literally-

Dr. Jessica Shepherd 22:38 Absolutely.

Mel Robbins 22:38 ... just like your tongue is designed to taste-

Dr. Jessica Shepherd 22:40 Absolutely.

Mel Robbins 22:41 ... your legs are designed to-

Dr. Jessica Shepherd 22:42 Yeah.

Mel Robbins 22:42 ... move in a certain way.

Dr. Jessica Shepherd 22:44 Yeah.

Mel Robbins 22:44 You're, like that-

Dr. Jessica Shepherd 22:45 Mm-hmm.

Mel Robbins 22:45 ... that you are designed with-

Dr. Jessica Shepherd 22:48 I would say-

Mel Robbins 22:48 ... sort of this biological impera- and I'm only saying that, you know what I mean?

Dr. Jessica Shepherd 22:50 It's designed biologically to do that function.

Mel Robbins 22:54 Yes.

Dr. Jessica Shepherd 22:54 What I w- want to make sure that we understand is, it doesn't necessarily mean that we have to do that.

Mel Robbins 23:00 Oh, of course.

Dr. Jessica Shepherd 23:01 Right. Right.

Mel Robbins 23:02 Of course.

Dr. Jessica Shepherd 23:02 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.

Mel Robbins 23:07 Yes.

Dr. Jessica Shepherd 23:08 Yeah.

Mel Robbins 23:09 I, the, the reason why I'm, I'm kind of taking a highlighter to that is because, you know, we know that, of course-

Dr. Jessica Shepherd 23:14 Uh-huh.

Mel Robbins 23:15 ... 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."

Dr. Jessica Shepherd 23:23 Mm-hmm.

Mel Robbins 23:23 "And our bodies all the way down from chromosomes to the way our muscles are, to the way the hormones work, we, our bodies are completely different."

Dr. Jessica Shepherd 23:32 Yeah.

Mel Robbins 23:33 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?

Dr. Jessica Shepherd 23:44 And I would say that once you understand that, then you can embrace it for what it is.

Mel Robbins 23:48 Okay.

Dr. Jessica Shepherd 23:49 And not fight it.

Mel Robbins 23:49 And work with it.

Dr. Jessica Shepherd 23:50 Right, and work with it and not work against it.

Mel Robbins 23:52 Okay, so before you get your period, this is gonna sound like the world's dumbest questions, do you have estrogen? Like, like I-

Dr. Jessica Shepherd 23:59 Yes.

Mel Robbins 23:59 Like, you know what I'm saying? Like, is this stuff-

Dr. Jessica Shepherd 24:00 Everyone is born-

Mel Robbins 24:01 ... like, in your body?

Dr. Jessica Shepherd 24:02 ... with the amount of hormones, or the, the hormones that we have. How they function changes during the life cycle.

Mel Robbins 24:08 Wait, you were born with the amount of hormones you have?

Dr. Jessica Shepherd 24:11 Well, not the amount.

Mel Robbins 24:12 Okay.

Dr. Jessica Shepherd 24:12 But you have the hormone.

Mel Robbins 24:13 Okay, gotcha.

Dr. Jessica Shepherd 24:13 How they function-

Mel Robbins 24:15 Gotcha.

Dr. Jessica Shepherd 24:15 ... changes over the course of our lives-

Mel Robbins 24:17 Okay.

Dr. Jessica Shepherd 24:17 ... which is why we see those changes at adolescence and then perimenopause.

Mel Robbins 24:21 Gotcha. So even before you have a-

Dr. Jessica Shepherd 24:23 Yeah.

Mel Robbins 24:23 ... period, you still have estrogen, testosterone-

Dr. Jessica Shepherd 24:26 Mm-hmm.

Mel Robbins 24:26 ... and progesterone in your system. It's that when you start getting your period, those hormones-

Dr. Jessica Shepherd 24:32 Yeah.

Mel Robbins 24:33 ... flood into the system-... in order to bring this developmental phase online.

Dr. Jessica Shepherd 24:38 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, uh, that's what I love about the kind of basic, fundamental part of the body, and that's why we do, we should embrace every part of our lives.

Mel Robbins 25:01 So, you said that the average age-

Dr. Jessica Shepherd 25:06 Mm-hmm.

Mel Robbins 25:06 ... is getting younger and younger-

Dr. Jessica Shepherd 25:08 Yeah.

Mel Robbins 25:08 ... and one of the reasons is the food we-

Dr. Jessica Shepherd 25:09 Environmental-

Mel Robbins 25:11 ... and ultra-processed foods-

Dr. Jessica Shepherd 25:12 ... cortisol.

Mel Robbins 25:12 ... and cor- cortisol stress?

Dr. Jessica Shepherd 25:13 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 earlier in our lives, a lot of it has to do with the experiences that we have-

Mel Robbins 25:27 Mm-hmm.

Dr. Jessica Shepherd 25:27 ... environmental factors and food, then that's why we're starting to see that girls are starting to have their periods much younger.

Mel Robbins 25:33 Is that because cortisol confuses the kind of design of the body in terms of when it's time to bring this online, or-

Dr. Jessica Shepherd 25:43 It's more-

Mel Robbins 25:43 ... or is it the food, like-

Dr. Jessica Shepherd 25:44 It's more so that the cortisol is responding to these stressors-

Mel Robbins 25:48 Mm-hmm.

Dr. Jessica Shepherd 25:49 ... and then onboarding much too early or much too high of a level-

Mel Robbins 25:53 Mm-hmm.

Dr. Jessica Shepherd 25:53 ... than when it's supposed to.

Mel Robbins 25:54 Oh.

Dr. Jessica Shepherd 25:55 Mm-hmm.

Mel Robbins 25:56 Gotcha.

Dr. Jessica Shepherd 25:56 Yeah, it enters the scene when it shouldn't be-

Mel Robbins 25:59 Yes.

Dr. Jessica Shepherd 25:59 ... and we're like, "You're not really supposed to be appearing at this part of the script, but you're here-"

Mel Robbins 26:03 Yeah.

Dr. Jessica Shepherd 26:03 "... and so now we are gonna respond to you."

Mel Robbins 26:05 Gotcha.

Dr. Jessica Shepherd 26:05 Yeah.

Mel Robbins 26:06 So, what are some of the issues-

Dr. Jessica Shepherd 26:08 Mm-hmm.

Mel Robbins 26:08 ... 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 that window in the teenage years up to 20?

Dr. Jessica Shepherd 26:29 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.

Mel Robbins 26:37 Okay.

Dr. Jessica Shepherd 26:37 So, that's when you start to see, like, the breasts enlarge. You start to see hair growth, right?

Mel Robbins 26:42 Mm-hmm.

Dr. Jessica Shepherd 26:42 You start to 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, 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. How, I mean, how many times have you heard, you know, adolescent girls and, 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.

Mel Robbins 27:17 So,

Mel Robbins 27:18 when you move into your 20s, what is, what's going on with hormones?

Dr. Jessica Shepherd 27:23 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-

Mel Robbins 27:46 Yeah.

Dr. Jessica Shepherd 27:46 ... or maybe heavier cycles.

Mel Robbins 27:48 Yes.

Dr. Jessica Shepherd 27:48 Yeah, and so, it really should be kind of even keel during this timeframe-

Mel Robbins 27:53 Oh.

Dr. Jessica Shepherd 27:53 ... but that's not what we always see.

Mel Robbins 27:54 So, if it's not even keeled-

Dr. Jessica Shepherd 27:56 Mm-hmm.

Mel Robbins 27:56 ... meaning a pretty regular cycle-

Dr. Jessica Shepherd 27:59 Mm-hmm.

Mel Robbins 28:00 ... and a pretty predictable kind of route of, "These are the days I'm kind of moody or grumpy," or whatever, or, "These is-"

Dr. Jessica Shepherd 28:06 Yeah.

Mel Robbins 28:07 "... 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?

Dr. Jessica Shepherd 28:19 When women come in, I always like to peel the layers back-

Mel Robbins 28:23 Okay.

Dr. Jessica Shepherd 28:23 ... because that's very subjective, and subjective meaning everyone has different experiences.

Mel Robbins 28:28 Mm-hmm.

Dr. Jessica Shepherd 28:29 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-

Mel Robbins 28:49 Hmm.

Dr. Jessica Shepherd 28:49 ... 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-

Mel Robbins 28:57 Yep.

Dr. Jessica Shepherd 28:58 ... a lot of what they're experiencing is a lot different to women who are not in those particular environments-

Mel Robbins 29:03 Uh-huh.

Dr. Jessica Shepherd 29:04 ... 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.

Mel Robbins 29:25 Like, what foods change how your hormones respond?

Dr. Jessica Shepherd 29:28 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.

Mel Robbins 30:24 I think it's fascinating that-... stress in your life-

Dr. Jessica Shepherd 30:28 Yes.

Mel Robbins 30:29 ... and the food that you're eating impacts the hormones in your body?

Dr. Jessica Shepherd 30:34 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 really does change the game. And that's why we are starting to see when we get into later life, or even in mid-life, 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."

Mel Robbins 31:07 Where exactly is estrogen made?

Dr. Jessica Shepherd 31:10 Estrogen-

Mel Robbins 31:10 You know what I'm saying?

Dr. Jessica Shepherd 31:11 Yeah.

Mel Robbins 31:11 Like, I, so I'm starting to think now, okay, now wait a minute. So, uh, I mean, it makes sense-

Dr. Jessica Shepherd 31:16 Mm-hmm.

Mel Robbins 31:16 ... 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-

Dr. Jessica Shepherd 31:26 Yeah.

Mel Robbins 31:26 ... or you're under a tremendous amount of stress because you're caring for somebody, um, or you're just c- constantly eating terrible stuff, or I think about somebody that I love deeply who had a-

Dr. Jessica Shepherd 31:36 Mm-hmm.

Mel Robbins 31:37 ... 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 it of- I mean, of course it would impact your b- like, it-

Dr. Jessica Shepherd 31:48 Yeah.

Mel Robbins 31:49 I, when you explain it that way, Dr. Shepherd, it makes a lot of sense. But why do these things impact estrogen and progesterone and testosterone?

Dr. Jessica Shepherd 31:57 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.

Mel Robbins 32:05 Mm.

Dr. Jessica Shepherd 32:06 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 gonna give off this much. We're gonna dial it down on this day because we're getting ready for ovulation." All those different messages 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're almost run over by a car-

Mel Robbins 32:30 Mm-hmm.

Dr. Jessica Shepherd 32:30 ... versus exactly what you said, a stressor in life that's really taking over your, 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.

Mel Robbins 32:58 It makes so much sense.

Dr. Jessica Shepherd 32:59 Yeah.

Mel Robbins 33:00 And what's sad is, you know, you, you, your period gets irregular-

Dr. Jessica Shepherd 33:04 Mm-hmm.

Mel Robbins 33:04 ... 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-

Dr. Jessica Shepherd 33:20 (laughs)

Mel Robbins 33:20 ... is going to, of course, impact the hormonal functioning of my body 'cause I'm confusing it-

Dr. Jessica Shepherd 33:26 Yeah.

Mel Robbins 33:26 ... with all these things.

Dr. Jessica Shepherd 33:28 Yeah.

Mel Robbins 33:28 Why do so many women in their 20s get, quote, "hormonal acne?"

Dr. Jessica Shepherd 33:34 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-

Mel Robbins 33:49 What?

Dr. Jessica Shepherd 33:50 ... where you're getting, yes. So most hormonal acne can be mostly in kind of the area by un- right under the eyes or the chin. Yeah.

Mel Robbins 33:58 H- why does it go there?

Dr. Jessica Shepherd 34:00 Because when we're thinking of where the hormones... You have receptors all over your body-

Mel Robbins 34:04 Okay.

Dr. Jessica Shepherd 34:04 ... that respond to hormones, and so the receptors that maybe respond more to estrogen or testosterone, there's gonna be features on y- or areas on your face that are gonna be more prone to the actual area of the breakout, right? 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.

Mel Robbins 34:31 Okay.

Dr. Jessica Shepherd 34:31 'Cause we need oi- 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 be an increase in testosterone as well, which then elicit the buildup of oil, which then you get bacteria, and then you have acne.

Mel Robbins 34:47 Wow.

Dr. Jessica Shepherd 34:47 Yeah.

Mel Robbins 34:48 And so do you see this a lot with 20-year-olds?

Dr. Jessica Shepherd 34:50 I do. They come in and usually what is the best way to treat them... So it's a great (laughs) relationship we have with dermatologists because they'll have these patients come in to them. And a lot of dermatologists will actually send the patient back to an OB-GYN because typically we will put them on birth control pills to kind of help quiet down this kind of overwhelm of hormones-

Mel Robbins 35:12 Uh-huh.

Dr. Jessica Shepherd 35:12 ... and a response 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.

Mel Robbins 35:23 Wow.

Dr. Jessica Shepherd 35:24 Yeah.

Mel Robbins 35:24 Can you speak to, you know, a person listening in their 20s or 30s who, you know, comes off birth control-

Dr. Jessica Shepherd 35:32 Mm-hmm.

Mel Robbins 35:33 ... and then has a lot of issues after? Like, what do you want them to know?

Dr. Jessica Shepherd 35:38 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.

Mel Robbins 36:02 Okay.

Dr. Jessica Shepherd 36:03 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-

Mel Robbins 36:14 Right.

Dr. Jessica Shepherd 36:14 ... so it wants to release an egg.

Mel Robbins 36:15 So what happens to all those hormones in your body if it's suppressing-

Dr. Jessica Shepherd 36:18 They're still there.

Mel Robbins 36:19 ... their, it's-

Dr. Jessica Shepherd 36:19 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-

Mel Robbins 36:27 Okay.

Dr. Jessica Shepherd 36:27 ... do the function it wants to do.

Mel Robbins 36:28 Okay.

Dr. Jessica Shepherd 36:29 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.

Mel Robbins 36:44 So, what might somebody expect-

Dr. Jessica Shepherd 36:46 Yeah.

Mel Robbins 36:46 ...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?"

Dr. Jessica Shepherd 36:58 Immediate gratification is usually what we want when it comes to our bodies-

Mel Robbins 37:02 Yeah.

Dr. Jessica Shepherd 37:02 ...and I always am coaching my patients to give their bodies grace. And when I say that in a timeframe-

Mel Robbins 37:08 Yeah.

Dr. Jessica Shepherd 37:08 ...that may be three to six months.

Mel Robbins 37:10 Okay.

Dr. Jessica Shepherd 37:11 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-

Mel Robbins 37:23 Bounce back, right.

Dr. Jessica Shepherd 37:23 ...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.

Mel Robbins 37:47 Right.

Dr. Jessica Shepherd 37:47 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.

Mel Robbins 37:55 Okay. And, you know, it's interesting 'cause I think about the fact that so many young women-

Dr. Jessica Shepherd 38:01 Mm-hmm.

Mel Robbins 38:01 ...go on birth control-

Dr. Jessica Shepherd 38:02 Right.

Mel Robbins 38:03 ...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-

Dr. Jessica Shepherd 38:13 Mm-hmm.

Mel Robbins 38:13 ...if you have been on the pill or you're taking one of the coated IUDs-

Dr. Jessica Shepherd 38:19 Right.

Mel Robbins 38:20 ...for two decades of your life?

Dr. Jessica Shepherd 38:22 Yeah.

Mel Robbins 38:22 And then, all of a sudden, you're like, "Okay, let's, like, stop taking the pill. Let's take out the IUD."

Dr. Jessica Shepherd 38:27 Mm-hmm.

Mel Robbins 38:27 And you've been doing this hormone suppression for 15 or 20 years.

Dr. Jessica Shepherd 38:33 Yeah. You are gonna see changes. And, and a lot of that has to do with we were not used to seeing what the body was naturally-

Mel Robbins 38:40 Hmm.

Dr. Jessica Shepherd 38:40 ...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 kinda doing this all along. We just weren't really aware of it because we had some suppression." So, that can be changes in how your cycle comes back. People may experience that it's heavier, or maybe they're having longer cycles and duration, and that may be because the birth control is kind of not doing what it wanted to do.

Mel Robbins 39:05 Yeah.

Dr. Jessica Shepherd 39:05 You also may see changes in skin. You may also see changes in hair.

Mel Robbins 39:09 What changes do you see in hair?

Dr. Jessica Shepherd 39:11 So hair, you can start to see that maybe they're gonna have more, uh, thinning or falling out-

Mel Robbins 39:15 Really? Why?

Dr. Jessica Shepherd 39:15 ...of their hair because it, it's the, it's the shift in the hormones, right? So it's not that there's something wrong all the time.

Mel Robbins 39:21 It feels like it's wrong when there's literally-

Dr. Jessica Shepherd 39:23 Doesn't it?

Mel Robbins 39:23 ...like a dust ball on the drain.

Dr. Jessica Shepherd 39:24 When there is a clump of hair in your hands-

Mel Robbins 39:27 Yes.

Dr. Jessica Shepherd 39:27 ...it does feel so wrong. (laughs) And what the body's trying to do is get back to that homeostasis, right? So our-

Mel Robbins 39:32 But why are you losing hair?

Dr. Jessica Shepherd 39:34 Because the, 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, no one's kinda keeping me down. I'm gonna come out." And the hair cycle is impacted by hormones, right? So how our, our hair goes through cycles and phases of growth, when it falls out, when it's gonna, you know, be what it wants to be within the cycle-

Mel Robbins 39:59 Mm-hmm.

Dr. Jessica Shepherd 39:59 ...those can all change due to what our hormones are telling it, right?

Mel Robbins 40:03 Wow.

Dr. Jessica Shepherd 40:03 Hormones are chemical deliverers.

Mel Robbins 40:06 So, is every single function in a woman's body

Mel Robbins 40:10 impacted by estrogen?

Dr. Jessica Shepherd 40:12 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.

Mel Robbins 40:25 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-"

Dr. Jessica Shepherd 40:30 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."

Mel Robbins 40:58 What is, uh, a few places in a woman's body that somebody might be surprised to hear-

Dr. Jessica Shepherd 41:04 Mm-hmm.

Mel Robbins 41:05 ...has estrogen as a very critical piece of how that part of your body functions?

Dr. Jessica Shepherd 41:12 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.

Mel Robbins 41:20 Mm-hmm.

Dr. Jessica Shepherd 41:21 I don't think I realized how much of an impact that estrogen makes on the brain until maybe five, 10 years ago.

Mel Robbins 41:28 So, what impact does it make on the brain?

Dr. Jessica Shepherd 41:30 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.

Mel Robbins 41:41 What does limbic mean?

Dr. Jessica Shepherd 41:42 Limbic means that emotional.

Mel Robbins 41:43 Oh, yes.

Dr. Jessica Shepherd 41:44 Right? That kind of jump to the... Right?

Mel Robbins 41:46 Uh-huh.

Dr. Jessica Shepherd 41:46 And what do we hear? That women who are in their perimenopausal phase are more moody, right?

Mel Robbins 41:49 Well, that's also what we hear about PMS.

Dr. Jessica Shepherd 41:51 Absolutely.

Mel Robbins 41:52 So, is PMS like a mini drop in estrogen in your body?

Dr. Jessica Shepherd 41:57 It's a drop and then... So it's the fluctuation.

Mel Robbins 41:59 Gotcha.

Dr. Jessica Shepherd 41:59 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.

Mel Robbins 42:04 (laughs)

Dr. Jessica Shepherd 42:04 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.

Mel Robbins 42:17 Wait, hold on. You see the most diagnoses-

Dr. Jessica Shepherd 42:21 Yes.

Mel Robbins 42:21 ...of anxiety and depression in women between the ages of-

Dr. Jessica Shepherd 42:23 In midlife women.

Mel Robbins 42:23 ...45 and 55?

Dr. Jessica Shepherd 42:25 Absolutely.

Mel Robbins 42:26 Why, Dr. Shepherd?

Dr. Jessica Shepherd 42:27 Because this is when estrogen, our key response, our key hormone, and 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.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 gonna 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 gonna be okay, but I also understand why," wouldn't that make someone feel better?

Mel Robbins 43:14 Of course.

Dr. Jessica Shepherd 43:14 Absolutely.

Mel Robbins 43:15 Of course. Because you can't solve the problem if you don't know what the problem is.

Dr. Jessica Shepherd 43:18 You can't.

Mel Robbins 43:19 And if you are starting to experience higher states of anxiety or you're feeling depressed-

Dr. Jessica Shepherd 43:27 Yeah.

Mel Robbins 43:28 ... 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-

Dr. Jessica Shepherd 43:40 Mm-hmm.

Mel Robbins 43:40 ... which literally can be the cause of this happening to you.

Dr. Jessica Shepherd 43:44 Do you see how it impacts careers, it impacts relationships-

Mel Robbins 43:48 Of course.

Dr. Jessica Shepherd 43:48 ... 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 feel like I'm just so emotional I can watch, you know, TV and cry at a commercial."

Mel Robbins 44:05 Mm-hmm.

Dr. Jessica Shepherd 44:05 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-

Mel Robbins 44:14 Well, it kind of is because you are-

Dr. Jessica Shepherd 44:16 Yeah.

Mel Robbins 44:16 ... out of the body-

Dr. Jessica Shepherd 44:17 Yeah.

Mel Robbins 44:17 ... you have been living in-

Dr. Jessica Shepherd 44:18 Yeah.

Mel Robbins 44:19 ... for the last 40 some years-

Dr. Jessica Shepherd 44:20 Mm-hmm.

Mel Robbins 44:20 ... because the hormones are radically changing, and so your body's probably like, "What the hell is going on?"

Dr. Jessica Shepherd 44:28 Mm-hmm.

Mel Robbins 44:29 Can you explain how estrogen starts to decline-

Dr. Jessica Shepherd 44:35 Mm-hmm.

Mel Robbins 44:35 ... in your late 20s? And kind of, what are the big general age markers, Dr. Shepherd-

Dr. Jessica Shepherd 44:40 Mm-hmm.

Mel Robbins 44:41 ... 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-

Dr. Jessica Shepherd 44:52 Yeah. (laughs)

Mel Robbins 44:52 ... that you're kind of like the, the, the, the one (laughs) that's doing it right on the planet. What age, Dr. Shepherd, do you start to see estrogen decline, or progesterone, or testosterone-

Dr. Jessica Shepherd 45:04 Yeah.

Mel Robbins 45:04 ... in women?

Dr. Jessica Shepherd 45:06 Mel, this is why this conversation is so important for our 20 and 30 year olds.

Mel Robbins 45:10 Okay.

Dr. Jessica Shepherd 45:10 So, let's bring it back to the reproductive phase, right?

Mel Robbins 45:12 Yes.

Dr. Jessica Shepherd 45:12 So, our body's designed to do this. We know in the reproductive phase, as OB/GYNs, we start to see a change and a decline in egg quality and the ability to get pregnant spontaneously after the age of 35.

Mel Robbins 45:23 Okay.

Dr. Jessica Shepherd 45:24 Now, why do you think?

Mel Robbins 45:25 Oh. Because estrogen starts to fall off a cliff.

Dr. Jessica Shepherd 45:29 Yeah.

Mel Robbins 45:29 Is that right?

Dr. Jessica Shepherd 45:30 Yeah.

Mel Robbins 45:30 Does testosterone and progesterone also change in a woman's body-

Dr. Jessica Shepherd 45:33 Yeah.

Mel Robbins 45:33 ... at the age of 35?

Dr. Jessica Shepherd 45:34 Estrogen and progesterone, which impacts what we're able to do with releasing that follicle, right?

Mel Robbins 45:39 Yeah.

Dr. Jessica Shepherd 45:39 So, our chemical messenger is not able to tell the ovary, "We're gonna fire off a egg as readily," right? So, it's like, "I'm not doing it this month," or the quality of the egg, not really gonna be that great. And then testosterone is also taking a decline, although s- it is more subtle. But that's where we start to see that drop in estrogen which is, some women especially, I'm (laughs) I'm one of them who had kids later on in our age-

Mel Robbins 46:01 Right.

Dr. Jessica Shepherd 46:01 ... I think-

Mel Robbins 46:01 What, what is that awful term that they, we use?

Dr. Jessica Shepherd 46:03 They use geriatric pregnancy.

Mel Robbins 46:04 Yeah, what the f-

Dr. Jessica Shepherd 46:05 I d-

Mel Robbins 46:06 Like, I-

Dr. Jessica Shepherd 46:06 Who came up with that?

Mel Robbins 46:07 I-

Dr. Jessica Shepherd 46:08 Not-

Mel Robbins 46:08 Clearly not a woman.

Dr. Jessica Shepherd 46:09 Not a woman.

Mel Robbins 46:09 Yes.

Dr. Jessica Shepherd 46:10 And so, you know, even I start to see a lot of my patients having kids y- later on in their life.

Mel Robbins 46:16 Right.

Dr. Jessica Shepherd 46:16 What happens is a- usually after they deliver, they start to experience the perimenopausal kind of symptoms, hot flashes, night sweats, mood changes, 'cause they've kind of entered into that phase just, like, very quickly after delivering their children.

Mel Robbins 46:29 Wow. So at 35-

Dr. Jessica Shepherd 46:31 Mm-hmm.

Mel Robbins 46:32 ... do you know the percentage roughly of how much estrogen kind of functioning-

Dr. Jessica Shepherd 46:37 Well, we-

Mel Robbins 46:37 ... is left?

Dr. Jessica Shepherd 46:37 Well, what we do know is, looking at it from a pregnancy perspective-

Mel Robbins 46:41 Yeah.

Dr. Jessica Shepherd 46:41 ... 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-

Mel Robbins 46:53 Mm-hmm.

Dr. Jessica Shepherd 46:54 ... 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.

Mel Robbins 47:03 Wow.

Dr. Jessica Shepherd 47:03 Yeah.

Mel Robbins 47:03 Well, it's, 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-

Dr. Jessica Shepherd 47:16 Mm-hmm.

Mel Robbins 47:16 ... and biological standpoint.

Dr. Jessica Shepherd 47:18 Yeah.

Mel Robbins 47:18 And when you look at it that, that lens and you understand... You know, we w- we were, I was researching something else and was kind of gobsmacked to consider that in n- the 1920s, the average life expectancy-

Dr. Jessica Shepherd 47:31 (gasps)

Mel Robbins 47:31 ... in America was 27 years old.

Dr. Jessica Shepherd 47:33 Isn't that crazy?

Mel Robbins 47:34 And literally, just like a couple people ago, like 50 years ago, the life expectancy was in our 50s.

Dr. Jessica Shepherd 47:40 Mm-hmm.

Mel Robbins 47:41 And we've gained 30 to 40-

Dr. Jessica Shepherd 47:44 Yeah.

Mel Robbins 47:44 ... more years in the last five to six decades based on, you know, improvements in health and sanitation-

Dr. Jessica Shepherd 47:52 Mm-hmm.

Mel Robbins 47:52 ... and medical research.

Dr. Jessica Shepherd 47:54 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-

Mel Robbins 48:03 Yes.

Dr. Jessica Shepherd 48:03 ... I'm all for that, but we're living life in poor quality of health and we're seeing these health measures of what women, typically they have more dementia, they have more osteoporosis-

Mel Robbins 48:14 Mm-hmm.

Dr. Jessica Shepherd 48:14 ... they have more heart disease, number one killer of women is because that estrogen was gone, but we're still living longer.

Mel Robbins 48:21 This is so important to understand because I think what we do as women is we throw our hands in the air and say-

Dr. Jessica Shepherd 48:26 Mm-hmm.

Mel Robbins 48:26 ... "Well, there's not... And why is this h..." and all this stuff, but when you look at it across the historical perspective-

Dr. Jessica Shepherd 48:32 Mm-hmm.

Mel Robbins 48:32 ... and the r- the v- fairly recent life expectancy jump.

Dr. Jessica Shepherd 48:38 So, when we look at life expectancy-

Mel Robbins 48:40 Yeah.

Dr. Jessica Shepherd 48:40 ... we know that women are typically was, was 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-

Mel Robbins 48:53 Yep.

Dr. Jessica Shepherd 48:53 ... and the life expectancy of what the body's able to do because estrogen-

Mel Robbins 48:57 Right.

Dr. Jessica Shepherd 48:57 ... is not there-

Mel Robbins 48:58 50 or 60 years ago.

Dr. Jessica Shepherd 49:00 ... is gonna be at fif-

Mel Robbins 49:01 Not a problem.

Dr. Jessica Shepherd 49:01 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.

Mel Robbins 49:14 Wow. It's almost like h- you know, if you have a car, (laughs) h- and, and, and you don't have any gas in it-

Dr. Jessica Shepherd 49:21 Yeah.

Mel Robbins 49:21 ... how is it gonna work for your Lexus to want-

Dr. Jessica Shepherd 49:23 You just gotta keep driving it, Mel.

Mel Robbins 49:24 Yeah, just keep drive, just hit the gas harder and stop complaining-

Dr. Jessica Shepherd 49:28 Right.

Mel Robbins 49:28 ... and it'll work.

Dr. Jessica Shepherd 49:29 But isn't that the analogy that, of what we're told to do?

Mel Robbins 49:32 Yes.

Dr. Jessica Shepherd 49:32 "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-

Mel Robbins 49:41 Mm-hmm.

Dr. Jessica Shepherd 49:41 ... but it's because we now understand the biology of our bodies.

Mel Robbins 49:45 Is there things that you can do in your 30s and 40s to slow the breakdown of this hormone decline?

Dr. Jessica Shepherd 49:53 There is not. But there are-

Mel Robbins 49:55 Okay.

Dr. Jessica Shepherd 49:55 ... ways that you can help your body do better things, in other words, optimize the ability for the body to do it even in the absence of estrogen and progesterone, which is-

Mel Robbins 50:06 Like what?

Dr. Jessica Shepherd 50:06 So-

Mel Robbins 50:06 What are the most important things?

Dr. Jessica Shepherd 50:07 I would say nutrition and exercise, because those are fundamental things you can do every day, or, you know, 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 gonna be paying attention to decreasing your processed foods, your sugar, 'cause your body just doesn't respond to it as, 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 and 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.

Mel Robbins 50:47 Do women that have, uh, children-

Dr. Jessica Shepherd 50:50 Mm-hmm.

Mel Robbins 50:51 ... after 35 tend to enter perimenopause or menopause earlier?

Dr. Jessica Shepherd 50:55 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-

Mel Robbins 51:06 Yep.

Dr. Jessica Shepherd 51:06 ... you're gonna have that shift again, trying to get back to homeostasis.

Mel Robbins 51:09 Mm-hmm.

Dr. Jessica Shepherd 51:10 And-

Mel Robbins 51:10 Which you have taught us, Dr. Shepherd. You've gotta give your body grace.

Dr. Jessica Shepherd 51:13 Give your body grace.

Mel Robbins 51:13 Nine months to a year, it could take-

Dr. Jessica Shepherd 51:15 Yeah.

Mel Robbins 51:15 ... till you feel like yourself again.

Dr. Jessica Shepherd 51:17 So, if you think, that's nine months postpartum, nine months typically for a pregnancy.

Mel Robbins 51:20 Mm-hmm.

Dr. Jessica Shepherd 51:21 That's almost like a year and a half timeframe.

Mel Robbins 51:23 Mm-hmm.

Dr. Jessica Shepherd 51:24 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 really, the body was already on its way.

Mel Robbins 51:38 Gotcha.

Dr. Jessica Shepherd 51:38 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, and I'm gonna continue to go in that direction."

Mel Robbins 51:48 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?

Dr. Jessica Shepherd 52:05 Well, that would be me. I'm, I'm perimenopausal. Proud of it. But perimenopause has been more of a confusing term, I think-

Mel Robbins 52:12 Yes.

Dr. Jessica Shepherd 52:12 ... in, in what we've seen in this menopause surge.

Mel Robbins 52:14 Uh-huh.

Dr. Jessica Shepherd 52:14 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.

Mel Robbins 52:37 I mean, wouldn't that start when you're 35?

Dr. Jessica Shepherd 52:39 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.

Mel Robbins 52:51 So, what are the symptoms-

Dr. Jessica Shepherd 52:53 Yeah. So this-

Mel Robbins 52:54 ... of perimenopause-

Dr. Jessica Shepherd 52:55 Mm-hmm.

Mel Robbins 52:55 ... and what physical changes happen-

Dr. Jessica Shepherd 52:57 Yeah.

Mel Robbins 52:58 ... when you are in that zone that, I'm just gonna put a big-

Dr. Jessica Shepherd 53:02 Mm-hmm.

Mel Robbins 53:02 ... hoop here.

Dr. Jessica Shepherd 53:03 Yeah.

Mel Robbins 53:03 Like, 35 to 50-ish. Like, like, like that-

Dr. Jessica Shepherd 53:05 Yeah. I would say it, it-

Mel Robbins 53:06 This could be the zone that you're in.

Dr. Jessica Shepherd 53:08 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.

Mel Robbins 53:19 Mm.

Dr. Jessica Shepherd 53:19 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."

Mel Robbins 53:45 Or, or the car that you've been driving is starting-

Dr. Jessica Shepherd 53:47 Yeah. (laughs)

Mel Robbins 53:47 ... to sputter.

Dr. Jessica Shepherd 53:48 It's sputtering.

Mel Robbins 53:48 Yes.

Dr. Jessica Shepherd 53:49 And so, those start to happen through that timeframe.

Mel Robbins 53:52 Why do we gain weight in the middle? Like, why do we get the back fat and the fanny pack in the front and, and all the things that you've been doing?

Dr. Jessica Shepherd 54:04 And all the things that you're not asking for, quite frankly. (laughs)

Mel Robbins 54:06 Yeah, and like, the flappy ass arms.

Dr. Jessica Shepherd 54:08 Yeah.

Mel Robbins 54:09 Like, uh, you don't have those. But I, but like, I would have like, these meat wings.

Dr. Jessica Shepherd 54:12 (laughs)

Mel Robbins 54:12 It didn't matter how often I was doing triceps.

Dr. Jessica Shepherd 54:16 Yeah.

Mel Robbins 54:17 It didn't, it still doesn't work. But what, what, why do we gain weight there?

Dr. Jessica Shepherd 54:23 So, we gain, m- multiple reasons, again. It's never just one thing. So, our fat cells do respond to estrogen.We know that this-

Mel Robbins 54:31 Why? Why? They responded-

Dr. Jessica Shepherd 54:31 ... the estrogen receptors all over the body.

Mel Robbins 54:32 ... because they were, 'cause there's estrogen in every part of the body, but-

Dr. Jessica Shepherd 54:34 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-

Mel Robbins 54:39 Uh-huh.

Dr. Jessica Shepherd 54:39 ... to a-accommodate the pregnancy, right? So, fat cells do respond to estrogen.

Mel Robbins 54:42 I thought it was because I was eating my way-

Dr. Jessica Shepherd 54:44 (laughs)

Mel Robbins 54:44 ... through the entire day, and the baby was growing-

Dr. Jessica Shepherd 54:46 Well, I mean, that, that may have been some of the reason, but-

Mel Robbins 54:47 (laughs)

Dr. Jessica Shepherd 54:47 ... we c- we can blame it on the fat cells.

Mel Robbins 54:49 Okay.

Dr. Jessica Shepherd 54:49 But there's accommodations into how they respond. So, they can shrink. They can get bigger. They can migrate, and then they can usually go back. So, typically, after pregnancy, a lot of people will go back to their, their, the way that their bodies appeared before. In perimenopause, that response, remember we said chemical messengers, but if there's no estrogen, the receptor is there waiting for it. It's not responding, so fat cells can enlarge, but maybe they now don't have the capacity to shrink.

Mel Robbins 55:16 Oh, wait a minute. So, you have estrogen receptors in your triceps and in your-

Dr. Jessica Shepherd 55:21 In your fat cells and in your muscle.

Mel Robbins 55:23 Yeah, but they, but there's certain fat cells.

Dr. Jessica Shepherd 55:25 (laughs)

Mel Robbins 55:25 Like, I think everybody listening c- can go, "Yes, Mel. It's true."

Dr. Jessica Shepherd 55:29 There are certain areas-

Mel Robbins 55:29 It's like, it's like every pair of pants.

Dr. Jessica Shepherd 55:31 Mm-hmm. Fits different. So, that's the migration-

Mel Robbins 55:34 Different. Didn't fit.

Dr. Jessica Shepherd 55:34 (laughs)

Mel Robbins 55:34 It's literally... I'm like, "What happened?" I feel like a Twinkie on legs here. Like, I just, like, it just-

Dr. Jessica Shepherd 55:40 It migrates. So, it goes from your, your hips and your butt-

Mel Robbins 55:43 Yes.

Dr. Jessica Shepherd 55:43 ... which is what we see in 20s and 30s, right?

Mel Robbins 55:45 Uh-huh.

Dr. Jessica Shepherd 55:45 'Cause it's, that's where it's supposed to be in that timeframe.

Mel Robbins 55:48 Okay.

Dr. Jessica Shepherd 55:48 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 gonna shift now where the fat cells are." So, they kind of migrate more to that area.

Mel Robbins 56:00 Is it because as the estrogen declines, your, your reproductive center's like (slurps) sucking it all up, and then everybody else is starving for it in your body?

Dr. Jessica Shepherd 56:11 It's really the, it's the biology of the body.

Mel Robbins 56:14 Okay.

Dr. Jessica Shepherd 56:14 It's, it's really what your body is designed to do as we get older-

Mel Robbins 56:17 Uh-huh.

Dr. Jessica Shepherd 56:17 ... 'cause 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.

Mel Robbins 56:26 Again, they get that, they start to look pregnant.

Dr. Jessica Shepherd 56:27 Yeah, so that's-

Mel Robbins 56:27 There's a lot of guys, is that because of the testosterone that's... (laughs)

Dr. Jessica Shepherd 56:30 (laughs) But they also have estrogen as well, just s-smaller amounts. But this is the, 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 timeframe, a lot to do with estrogen and also our muscle. Our muscle starts to decrease as well. So, if you have-

Mel Robbins 56:48 Hmm.

Dr. Jessica Shepherd 56:48 ... if you th-think of, like, a pie graph.

Mel Robbins 56:50 Why does our muscle start to decrease?

Dr. Jessica Shepherd 56:52 Yeah. So, this is, again, because estrogen receptors, and we're all-

Mel Robbins 56:55 Are in the muscles?

Dr. Jessica Shepherd 56:56 ... are in the muscle.

Mel Robbins 56:57 And when your muscles are getting estrogen, your muscles stay strong?

Dr. Jessica Shepherd 57:01 Right. Well, not necessarily strong. Strong is more of a, like, a power kind of force thing.

Mel Robbins 57:05 Okay.

Dr. Jessica Shepherd 57:05 But the actual muscle mass, so the amount.

Mel Robbins 57:08 Wow.

Dr. Jessica Shepherd 57:09 So, if-

Mel Robbins 57:09 S- so, how does, uh, uh, g- keep going. I'm sorry.

Dr. Jessica Shepherd 57:11 No, think of-

Mel Robbins 57:12 It's fascinating. I'm like-

Dr. Jessica Shepherd 57:12 ... think of a pie graph.

Mel Robbins 57:13 ... Jesus. Okay, go ahead.

Dr. Jessica Shepherd 57:14 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-

Mel Robbins 57:21 Okay.

Dr. Jessica Shepherd 57:21 ... as we start to age, that pie graph shifts, and we start to see the fat increase.

Mel Robbins 57:26 I don't want it to increase, though.

Dr. Jessica Shepherd 57:27 I know. Neither do I. I'm (laughs) ... This is, this is not what I want either. But the muscle mass starts to decrease as well as the fat mass is increasing.

Mel Robbins 57:35 You know what's crazy about this, is that you, when it, when you go through it, you liter- like, what I'm getting from this conversation is that the composition of the body itself-

Dr. Jessica Shepherd 57:49 Mm-hmm.

Mel Robbins 57:50 ... is changing.

Dr. Jessica Shepherd 57:51 Absolutely.

Mel Robbins 57:52 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 fricking wedge starts to get smaller and smaller-

Dr. Jessica Shepherd 58:12 Yeah.

Mel Robbins 58:12 ... and now fat's there, and you didn't do anything different.

Dr. Jessica Shepherd 58:15 You didn't do anything different.

Mel Robbins 58:17 Wow.

Dr. Jessica Shepherd 58:17 Yeah. And so, we have the ability, you'd asked earlier...

Mel Robbins 58:20 This is not fair, Dr. Shepherd.

Dr. Jessica Shepherd 58:22 It is not fair.

Mel Robbins 58:22 Do something.

Dr. Jessica Shepherd 58:23 You know why?

Mel Robbins 58:23 Why won't you, like, help us, right? (laughs)

Dr. Jessica Shepherd 58:25 Right? Life is not fair.

Mel Robbins 58:26 (laughs)

Dr. Jessica Shepherd 58:26 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, you know, maybe stave off this, this kind of hormone change? We can't, but we can fix the pie graph, which is why I say that weight training-

Mel Robbins 58:40 Okay, I have a crazy question.

Dr. Jessica Shepherd 58:41 Ask.

Mel Robbins 58:43 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 listen and are like-

Dr. Jessica Shepherd 58:55 I love this question.

Mel Robbins 58:55 ... "I don't wanna have a period for the rest of my life."

Dr. Jessica Shepherd 58:57 Yes.

Mel Robbins 58:57 But I literally, I'm like, if I will have no brain fog, and-

Dr. Jessica Shepherd 58:59 Yeah.

Mel Robbins 58:59 ... 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.

Dr. Jessica Shepherd 59:06 Actually, there is research that is actually mentioned in Generation M of how do we prolong-

Mel Robbins 59:13 Mm-hmm.

Dr. Jessica Shepherd 59:13 ... not necessarily the period. How do we prolong the durability and duration of estrogen?

Mel Robbins 59:18 Mm-hmm.

Dr. Jessica Shepherd 59:18 Right? We talked about that gap.

Mel Robbins 59:20 Your own estrogen versus-

Dr. Jessica Shepherd 59:22 Correct.

Mel Robbins 59:22 ... hormone replacement therapy.

Dr. Jessica Shepherd 59:23 Correct. How do we keep the ovary alive in the sense of allowing it to still emit estrogen on its own?

Mel Robbins 59:31 Okay.

Dr. Jessica Shepherd 59:31 And that's where the research is really looking at 'cause what did we s- we say there's a gap. Life expectancy-

Mel Robbins 59:36 Yes.

Dr. Jessica Shepherd 59:36 ... 'cause estrogen was down. Now, we're living longer. If we could fill that gap with having estrogen around-

Mel Robbins 59:43 Right.

Dr. Jessica Shepherd 59:43 ... naturally-

Mel Robbins 59:44 Yeah.

Dr. Jessica Shepherd 59:44 ... then there is a likelihood that we would start to see decline in, in-

Mel Robbins 59:49 Health outcomes.

Dr. Jessica Shepherd 59:49 ... 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,

Dr. Jessica Shepherd 1:00:00 even though we're living longer.

Mel Robbins 1:00:01 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-

Dr. Jessica Shepherd 1:00:16 Mm-hmm.

Mel Robbins 1:00:16 ... there was, like, a bunch of junk science that has been disproven that-

Dr. Jessica Shepherd 1:00:19 Yeah.

Mel Robbins 1:00:19 ... scared people.

Dr. Jessica Shepherd 1:00:20 Yeah.

Mel Robbins 1:00:21 And now, all of those old claims have been basically-

Dr. Jessica Shepherd 1:00:26 Refuted.

Mel Robbins 1:00:27 ... 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.

Dr. Jessica Shepherd 1:00:43 Mm-hmm.

Mel Robbins 1:00:43 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?

Dr. Jessica Shepherd 1:01:00 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-

Mel Robbins 1:01:35 Hm.

Dr. Jessica Shepherd 1:01:35 ... 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-

Mel Robbins 1:01:55 But hold on-

Dr. Jessica Shepherd 1:01:55 Yeah.

Mel Robbins 1:01:55 ... let me ask a question. So, if we know though that-

Dr. Jessica Shepherd 1:01:58 Yeah.

Mel Robbins 1:01:59 ... when there is a complete drop-off of estrogen that it spikes a woman's risk for osteoporosis-

Dr. Jessica Shepherd 1:02:07 Mm-hmm.

Mel Robbins 1:02:07 ... 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-

Dr. Jessica Shepherd 1:02:16 Right.

Mel Robbins 1:02:16 ... clearly there's a connection because we don't see-

Dr. Jessica Shepherd 1:02:19 Oh, there's a clear connection.

Mel Robbins 1:02:19 ... women in their 30s getting osteoporosis.

Dr. Jessica Shepherd 1:02:22 Absolutely, which is why I think that's where we need to challenge-

Mel Robbins 1:02:25 I'm like, "Why on earth wouldn't you-"

Dr. Jessica Shepherd 1:02:26 ... medical societies, absolutely.

Mel Robbins 1:02:28 ... immediately put somebody on estrogen if they're a candidate-

Dr. Jessica Shepherd 1:02:32 Yeah.

Mel Robbins 1:02:32 ... for it if they are starting to decline in bone?" Uh, that just seems like stupidity.

Dr. Jessica Shepherd 1:02:36 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-

Mel Robbins 1:02:52 Mm-hmm.

Dr. Jessica Shepherd 1:02:52 ... but to give you the data, the literature, so that you know the reason why-

Mel Robbins 1:02:57 Yeah.

Dr. Jessica Shepherd 1:02:57 ... 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.

Mel Robbins 1:03:05 Let's talk about dementia. What does the research say about the impact of hormone replacement therapy, giving women-

Dr. Jessica Shepherd 1:03:13 Mm-hmm.

Mel Robbins 1:03:13 ... estrogen and the outcomes with dementia?

Dr. Jessica Shepherd 1:03:17 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 ... Well, why are women getting this more than males? And the answer is because when we look at that sharp estrogen decline, estrogen is one of the best antiinflammatory substances in our body. So, when we lose estrogen, we have a increase in inflammation, and that inflammation causes our neurons to have hardened plaques which lead later down the line, th- 'cause the course of how it builds and what it, uh, you know, how it shows up is as much as 30 years.

Mel Robbins 1:04:11 Hm.

Dr. Jessica Shepherd 1:04:11 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.

Mel Robbins 1:04:20 Wow.

Dr. Jessica Shepherd 1:04:21 Yeah.

Mel Robbins 1:04:22 Can you share just the data on HRT? Because, because you ... When you're in perimenopause-

Dr. Jessica Shepherd 1:04:30 Mm-hmm.

Mel Robbins 1:04:31 ... are you a candidate for HRT?

Dr. Jessica Shepherd 1:04:33 This is one of the biggest questions, like, now that we see in hormone replacement therapy in 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. We had... 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-

Mel Robbins 1:05:11 Of course. Why, why would-

Dr. Jessica Shepherd 1:05:12 Why wouldn't we?

Mel Robbins 1:05:12 ... y- y-

Dr. Jessica Shepherd 1:05:12 It's the car analogy again. Why am I gonna wait until there's no more car or no more gas in the engine, but I'm still pluggin' 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?

Mel Robbins 1:05:38 So, what about women who are not candidates-

Dr. Jessica Shepherd 1:05:41 Yeah.

Mel Robbins 1:05:41 ... for it? What are their options?

Dr. Jessica Shepherd 1:05:43 So, their options, so there aren't 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 can not take hormone replacement therapy is probably good to go over-

Mel Robbins 1:06:00 Yes.

Dr. Jessica Shepherd 1:06:00 ... so that everyone can make sure that, "If I am or not, I need to know."

Mel Robbins 1:06:03 Great.

Dr. Jessica Shepherd 1:06:04 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, I kind of double 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.

Mel Robbins 1:06:32 So, not all breast cancers are the same?

Dr. Jessica Shepherd 1:06:34 Correct.

Mel Robbins 1:06:35 And just because you've had breast cancer doesn't mean you're automatically not a candidate for HRT, that there-

Dr. Jessica Shepherd 1:06:41 It's a very nuanced conversation-

Mel Robbins 1:06:43 Okay.

Dr. Jessica Shepherd 1:06:43 ... 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, you know-

Mel Robbins 1:06:52 Mm-hmm.

Dr. Jessica Shepherd 1:06:52 ... your life-

Mel Robbins 1:06:53 Mm-hmm.

Dr. Jessica Shepherd 1:06:53 ... but also the age of, of when you were diagnosed and what that means.

Mel Robbins 1:06:56 Okay.

Dr. Jessica Shepherd 1:06:56 And the second thing is if you've had an-... pulmonary embolism, you've had a clot in your lung.

Mel Robbins 1:07:02 Mm.

Dr. Jessica Shepherd 1:07:02 Or even if you've had maybe a very large event of a, of a clot somewhere else in your body, it has to be pretty significant for you not to be a candidate for hormone replacement therapy.

Mel Robbins 1:07:13 And why do those two things make you not a candidate for hormone replacement therapy?

Dr. Jessica Shepherd 1:07:19 That's a great question. Because of the hormones and the response of the body, where the, whether it's the clot or the breast cancer-

Mel Robbins 1:07:25 Uh-huh.

Dr. Jessica Shepherd 1:07:25 ... that introducing hormones again may precipitate or cause another event like that.

Mel Robbins 1:07:30 Gotcha. So based on your personal history-

Dr. Jessica Shepherd 1:07:33 Mm-hmm.

Mel Robbins 1:07:33 ... and there's a narrow window-

Dr. Jessica Shepherd 1:07:34 Mm-hmm.

Mel Robbins 1:07:34 ... of women who have a s- particular type of personal breast cancer-

Dr. Jessica Shepherd 1:07:38 Mm-hmm.

Mel Robbins 1:07:38 ... that may make them not a candidate, or if you've had a certain type of pulmonary embolism-

Dr. Jessica Shepherd 1:07:43 Mm-hmm.

Mel Robbins 1:07:44 ... that you're not a candidate in those cases-

Dr. Jessica Shepherd 1:07:47 Right.

Mel Robbins 1:07:47 ... because the introduction of hormone might stimulate that condition coming back.

Dr. Jessica Shepherd 1:07:52 Yeah.

Mel Robbins 1:07:53 Got it.

Dr. Jessica Shepherd 1:07:53 And so for a clot, you may get another one, and for breast cancer, it may cause recurrence.

Mel Robbins 1:07:56 Got it.

Dr. Jessica Shepherd 1:07:57 Yeah.

Mel Robbins 1:07:57 Okay. But even, 'cause I think there's also this widespread belief that if you've had any breast cancer history-

Dr. Jessica Shepherd 1:08:03 Mm-hmm.

Mel Robbins 1:08:04 ... or if you've h- yourself have had breast cancer, automatically you can't do it.

Dr. Jessica Shepherd 1:08:07 Yeah, 'cause there's a history of, has your family had it and been-

Mel Robbins 1:08:10 Right.

Dr. Jessica Shepherd 1:08:10 ... exposed to it, and what was that and why? Do you have a genetic predisposition to that s- same cancer in your family?

Mel Robbins 1:08:16 Mm-hmm. Mm-hmm.

Dr. Jessica Shepherd 1:08:16 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.

Mel Robbins 1:08:26 You should still-

Dr. Jessica Shepherd 1:08:26 'Cause if you just, exactly.

Mel Robbins 1:08:28 ... ask about it.

Dr. Jessica Shepherd 1:08:28 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?"

Mel Robbins 1:08:39 Is there an age where it's too late to start hormone replacement therapy?

Dr. Jessica Shepherd 1:08:42 This is another beautiful question because for a long time from that s- WHI study 20 years ago, we used to say you can't start hormones if you started 10 years after your last period, which is clinically, you know, menopause.

Mel Robbins 1:08:56 Mm-hmm.

Dr. Jessica Shepherd 1:08:57 Or after the age of 60.

Mel Robbins 1:08:58 Okay.

Dr. Jessica Shepherd 1:08:59 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?"

Mel Robbins 1:09:32 Well, if you've already pushed through that window-

Dr. Jessica Shepherd 1:09:35 Mm-hmm.

Mel Robbins 1:09:35 ... so you have not had a period for years-

Dr. Jessica Shepherd 1:09:39 Mm-hmm.

Mel Robbins 1:09:40 ... 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?

Dr. Jessica Shepherd 1:09:58 You know what might happen? You might feel better.

Mel Robbins 1:10:01 Really?

Dr. Jessica Shepherd 1:10:01 Yeah. There's so many women who, again, going back to the, "I'm gonna numb, I'm 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-

Mel Robbins 1:10:16 Or I'm even thinking the 60-year-old-

Dr. Jessica Shepherd 1:10:17 Right.

Mel Robbins 1:10:17 ... or the 62-year-old who is like, "Oh, well, you know, it was still taboo and it's too late for me now."

Dr. Jessica Shepherd 1:10:24 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 gonna keep going." And the other thing that we talked about, what did we say? Osteoporosis, heart disease. So it, it may not have the same effect, I will make that statement, if you started hormone replacement earlier.

Mel Robbins 1:10:42 Right.

Dr. Jessica Shepherd 1:10:42 Right?

Mel Robbins 1:10:42 But it might have a preventative effect.

Dr. Jessica Shepherd 1:10:45 It might add some, it might.

Mel Robbins 1:10:45 It might also get rid of the brain fog.

Dr. Jessica Shepherd 1:10:48 Yeah.

Mel Robbins 1:10:48 It might help you sleep better.

Dr. Jessica Shepherd 1:10:50 Mm-hmm.

Mel Robbins 1:10:50 And so-

Dr. Jessica Shepherd 1:10:50 Let me give you an example. I had a patient-

Mel Robbins 1:10:52 Give me an example.

Dr. Jessica Shepherd 1:10:52 ... who came in, and again, nuanced conversation. She was l- uh, 67, but she was still having hot flashes, which is, again, not typical 'cause usually they'll wane and they'll go down, you know, in your, 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.

Mel Robbins 1:11:10 Mm-hmm.

Dr. Jessica Shepherd 1:11:10 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?"

Mel Robbins 1:11:21 Hm.

Dr. Jessica Shepherd 1:11:21 She's still on it.

Mel Robbins 1:11:22 Mm-hmm. How did she feel?

Dr. Jessica Shepherd 1:11:24 She felt amazing. She was like, "Why was I living like this for so long?" Yeah.

Mel Robbins 1:11:29 Wow. I, I think I hear somebody hitting share right now and sending this to their mother and to-

Dr. Jessica Shepherd 1:11:37 Yeah.

Mel Robbins 1:11:37 ... their aunt and to so many women who honestly, like, were not served-

Dr. Jessica Shepherd 1:11:46 Mm-hmm.

Mel Robbins 1:11:46 ... the medical-

Dr. Jessica Shepherd 1:11:47 Yeah.

Mel Robbins 1:11:48 ... care that they deserve.

Dr. Jessica Shepherd 1:11:49 And the diligence and I think the conversations 'cause someone else could walk in behind her who's the same age or even-

Mel Robbins 1:11:54 Right.

Dr. Jessica Shepherd 1:11:54 ... maybe younger, and we're like, "Maybe you're not the candidate." But we had the conversation.

Mel Robbins 1:11:58 Right.

Dr. Jessica Shepherd 1:11:59 But if we're not having the conversation, then there's nothing to talk about.

Mel Robbins 1:12:02 Right. And maybe you are a candidate.

Dr. Jessica Shepherd 1:12:04 Right.

Mel Robbins 1:12:04 And maybe you could feel better.

Dr. Jessica Shepherd 1:12:05 Yeah.

Mel Robbins 1:12:05 And wouldn't that be absolutely incredible?

Dr. Jessica Shepherd 1:12:08 Yeah.

Mel Robbins 1:12:09 Wow. You know, what are other tools-

Dr. Jessica Shepherd 1:12:12 Yes.

Mel Robbins 1:12:13 ... in addition to hormone replacement therapy that women need to understand?

Dr. Jessica Shepherd 1:12:19 Mm-hmm. I think that this is where, when I talk about grieving the loss of what we used to be-

Mel Robbins 1:12:27 Mm-hmm.

Dr. Jessica Shepherd 1:12:27 ... 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. How do we take the brain and allow it to not be as jittery and, and over-processed and over-stimulated? It 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 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 a shorter duration and not as intense.

Mel Robbins 1:13:16 What is a vasal motor... What'd you call it? Oh-

Dr. Jessica Shepherd 1:13:18 Hot flashes and night sweats.

Mel Robbins 1:13:20 Oh, that's the fancy word for it?

Dr. Jessica Shepherd 1:13:21 They're what we classify. That's the, that's the fancy word for those two.

Mel Robbins 1:13:23 Okay. So when my husband's like-

Dr. Jessica Shepherd 1:13:24 Vasomotor symptoms.

Mel Robbins 1:13:24 ... "You just soak the sheets," I'm like, "I'm having my vasomotors." Okay.

Dr. Jessica Shepherd 1:13:27 My vasomotor. Yeah, absolutely.

Mel Robbins 1:13:29 Okay.

Dr. Jessica Shepherd 1:13:29 And so when you look at their-

Mel Robbins 1:13:30 Sounds sexier too.

Dr. Jessica Shepherd 1:13:30 Doesn't it?

Mel Robbins 1:13:31 Yes.

Dr. Jessica Shepherd 1:13:31 It doesn't, like, make it so...

Mel Robbins 1:13:33 (laughs)

Dr. Jessica Shepherd 1:13:33 You're like, "That doesn't sound... I'm having a vasomotor symptom."

Mel Robbins 1:13:35 (laughs)

Dr. Jessica Shepherd 1:13:36 (laughs) Is, is that they have shorter duration, decreased intensity, and a lot of that has to do with their, their lifestyle, their practice-

Mel Robbins 1:13:42 Hm.

Dr. Jessica Shepherd 1:13:42 ... 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.

Mel Robbins 1:13:54 So there's no, no way to actually naturally recreate estrogen by lifting weights or taking supplements or doing that kind of thing?

Dr. Jessica Shepherd 1:14:05 No, you're... It's kind of like you're hijacking and bypassing the actual decline in hormones, but using the other parts of the body to elevate those and to make... and to optimize those parts of the body to offset what's going on biologically with the hormones.

Mel Robbins 1:14:21 Oh, so I see. So the exercise and the stress reduction and the change in the diet forces your body-

Dr. Jessica Shepherd 1:14:30 Mm-hmm.

Mel Robbins 1:14:30 ... to make new connections and workarounds-

Dr. Jessica Shepherd 1:14:33 Yeah.

Mel Robbins 1:14:34 ... in the place of the role that estrogen played.

Dr. Jessica Shepherd 1:14:37 Right. So we're using our body.

Mel Robbins 1:14:38 So if you exercise... Yeah, so if you exercise and you get that incredible flood of neurochemicals, I think they call it-

Dr. Jessica Shepherd 1:14:46 Mm-hmm.

Mel Robbins 1:14:46 ... 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-

Dr. Jessica Shepherd 1:14:54 Right.

Mel Robbins 1:14:54 ... and helps a little bit with the brain fog.

Dr. Jessica Shepherd 1:14:56 Right, 'cause our dopamine and our serotonin-

Mel Robbins 1:14:58 Got it.

Dr. Jessica Shepherd 1:14:58 ... our neurotransmitters, which when we see depression, they are decreased.

Mel Robbins 1:15:03 Okay.

Dr. Jessica Shepherd 1:15:04 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.

Mel Robbins 1:15:13 Dr. Shepherd, could you talk to us about sleeping? Every one of my friends is having trouble sleeping.

Dr. Jessica Shepherd 1:15:18 Yeah.

Mel Robbins 1:15:18 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-"

Dr. Jessica Shepherd 1:15:35 Yeah.

Mel Robbins 1:15:35 "... Like I'm... I, I still can't sleep." What is going on with hormones and sleep?

Dr. Jessica Shepherd 1:15:39 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-

Mel Robbins 1:15:56 Mm-hmm.

Dr. Jessica Shepherd 1:15:56 ... 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