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Sex in the City and Golden Girls at the same age! If you were born with ovaries, your hormone levels—specifically estrogen and progesterone—will eventually decline. This process typically begins naturally in your mid- to late 40s, but it can occur earlier or later, depending on your body and overall health. After a few years, around age 52 on average, this transition leads to the end of your menstrual cycle, a life phase known as menopause. Menopause, along with the years leading up to it, can bring about a range of frustrating symptoms. Despite being a shared experience (approximately one million people go through menopause at any given time, according to the National Institute on Aging), it remains poorly understood. A July 2023 online survey conducted in the U.K. and reported in BMC Women’s Health revealed that only 47% of respondents at various stages of menopause felt knowledgeable about managing their symptoms. This lack of understanding often leads to the spread of menopause myths. Below, I dispel five misconceptions about menopause. Myth 1: It's All in Your Head While not ALL women experience symptoms, 85% of all women report experiencing symptoms of varying types and severity. Dismissing symptoms is not okay. Doctors/friends/partners may diminish the severity of symptoms and/or may not recognize lesser-known symptoms such as anxiety and sleep disruption.   Don’t let anyone gaslight you! Myth 2: You're Too Young A U.S. survey found that only one in five  obstetrics and gynecology residents received formal training in menopause medicine. As a result, many doctors feel unprepared to treat women in perimenopause and menopause.  Perimenopause can start as early as the 30s and may last from a few months to several YEARS , often with significant symptoms.  If your symptoms are disruptive, you deserve treatment! Myth 3: Menopause Hormone Therapy (MHT) is Dangerous This may be the most concerning myth! Many folks (including doctors) are stuck on outdated information from the 2002 Women's Health Initiative Study. For many women, hormone therapy is a safe and effective way to manage menopause symptoms, including prescription pills, patches, and low-dose vaginal estrogen.  The 2022 guidelines from the North American Menopause Society recommend the lowest effective dose of MHT for women under 60 or within 10 years of menopause for optimal symptom relief.  If you're healthy and have no contraindications, such as a history of stroke, blood clots, or breast cancer, the benefits of hormone therapy generally outweigh the risks. Myth 4: Menopause Only Affects Women Whether you identify as a cisgender woman, genderqueer, or a trans man, if you were born with ovaries, you will go through some form of menopause transition. The experience will differ from person to person, particularly for those who receive gender-affirming care, but everyone will undergo this transition regardless of their gender identity. Myth 5: It's Downhill From Here Menopause can be among the best times in life! You don’t have to worry about contraception anymore, and if you were troubled by heavy periods or PMS, menopause cures that problem! It can offer greater clarity about priorities, stronger relationships, more financial stability, the freedom to pursue personal passions, and the ability to let go of societal expectations that may have previously held you back, allowing for a more authentic life experience. I always think of the Carry Bradshaw quote from Sex in the City: "Your 20s are for mistakes, your 30s are for the lessons, and your 40s are to buy the drinks." And I would add that your 50s are for giving zero f*cks! Embrace the F*ckery Menopause is unavoidable, but suffering is avoidable! While menopause brings physical and emotional changes, it can also be a time for newfound freedom and empowerment. I know that sounds corny, but it's true! It is vital to foster open discussions, educate ourselves, and support one another. Seeking help from a certified menopause medical practitioner or an expert like me can offer valuable resources and insights for successfully navigating menopause. You deserve to feel your best at every age. I'm rooting for you!

As we age, our bodies naturally change in terms of our movement and flexibility. You might feel stiffer in the morning or struggle to touch your feet during a workout or Pilates session. While many of these symptoms are normal, some may be linked to the menopause transition.   When it comes to menopause symptoms, we spend a lot of time talking about hot flashes, night sweats, and brain fog. These things suck for sure, but it's essential to recognize that menopause can also impact your bones. Specifically, bone density can decrease during this time, and you might also experience sarcopenia (the progressive loss of muscle mass, strength, and function).   The Estrogen Connection   Up to 20 percent of this bone loss can occur within the first five years of menopause, which typically begins between the ages of 45 and 55. Some individuals may experience menopause earlier (at age 40 or younger) due to genetic factors, removal of the ovaries, or other medically induced scenarios.  You can read more about my friend Sarah and her experience with osteoporosis and early menopause here . The body contains hundreds of estrogen receptors, and this includes your bones. Your bone density begins to decline as estrogen levels drop.  Estrogen helps to build new bone and prevent the breakdown of old bone. So. Obviously, when estrogen levels fall, this process gets disrupted, resulting in bones that are lower in density, more fragile, and more susceptible to fractures.   This drop in estrogen can lead to osteoporosis—a condition that progressively weakens bones, raising the risk of fractures and breaks. Osteoporosis affects both men and women, but the loss of estrogen makes women more susceptible, with one in five women over the age of 50 developing it. Additionally, the condition can also be genetic, meaning you are more likely to get osteoporosis if you have a family history of the disease.   The Consequence Over time, osteoporosis can lead to weaker, more fragile bones that are more prone to fractures. This condition often goes unnoticed until a sudden fracture occurs, usually in the back or hips, which is why it is sometimes referred to as a "silent disease."   While deaths from hip fractures are rare today, thanks to advances in medical technology, a paper published in 2019 found that the one-year mortality rate after a surgically treated hip fracture still hovers around 21 percent. That's not nothing!   Four Tips for Avoiding Osteoporosis While there's no certainty that you can entirely avoid the effects of bone density loss during menopause, there are steps you can take—either during or (ideally) before menopause—to help keep your bones healthy and strong.   LIFT HEAVY SH*T Weightlifting , or resistance training, increases bone density by stressing bones and stimulating bone-forming cells. This process can help prevent bone loss and even create new bone tissue. I would argue that this is the MOST critical thing you can do!   COLLAGEN SUPPLEMENTATION Collagen is essential for maintaining bone mass and may help improve bone mineral density and slow osteoporosis. A 2018 study assessed the impact of collagen peptides on bone health in 131 postmenopausal individuals with reduced bone mineral density. Participants received 5 grams of collagen peptides daily for 12 months, and results were compared to a placebo group. The findings? " S upplementation with 5 g of specific collagen peptides significantly increases bone mineral density of the lumbar spine and the femoral neck (thigh bone) as well as blood levels of the bone marker, P1NP, in postmenopausal women with age-related decline in BMD."   MENOPAUSE HORMONE THERAPY MH T  (Menopause Hormone Therapy) is of ten viewed as the first line of defense against osteoporosis, especially in postmenopausal women. Maintaining bone density by slowing down bone resorption and promoting bone formation when adequate levels are needed is crucial. As I said before, as estrogen levels decline during menopause, the risk of developing osteoporosis significantly increases. Therefore, supplementing with estrogen can slow and even reverse the effects of osteoporosis. GET AN ASSESSMENT Assessing your risk is essential.   To  determine your risk, you should undergo a bone density test, also known as a DEXA scan, which measures bone density. According to the CDC , the ideal time to have your first DEXA screening will depend on your risk factors but should occur no later than age 65. As always, working under the guidance of a menopause specialist is a great start! You can find a doctor/nurse practitioner or physician's assistant using the Menopause Society's finder tool here . You can also book a discovery Zoom with me here !

There is no one-size-fits-all approach to treating menopausal anxiety. Early in my marriage, I struggled with an unfounded fear that my husband was going to die. Not long term, because, duh, everyone dies, but like, every minute of every day. When he left the house to get bagels, if it took him longer than usual to return, I immediately assumed the worst — that he was DEAD. On my walk home from the train, if I saw the lights of emergency vehicles, I just knew they were on their way to my house because my husband was DEAD. Ridiculous, I know! Logically, I understood that this was crazy. While it's true that we can lose our loved ones  unexpectedly, I knew it wasn't likely. Despite this understanding, I couldn't control my fear. These unsettling thoughts felt like worms; once they penetrated my mind, they burrowed so deep that I felt paralyzed by dread. The Uninvited Guest: Menopausal Anxiety I started my perimenopausal  journey around 40. I struggled primarily with sleep issues, fatigue, and a shift in body composition . I also had an extremely stressful corporate job that wasn't doing me any favors. At the time, I had no idea what perimenopause  was, but as symptoms worsened (I basically stopped sleeping) and anxiety  entered the party, I was like, "Who invited this a**hole?" That was when I knew it was time to get some help. Addressing these crazy death thoughts  about my husband felt like the most urgent, so I went looking for a shrink. Finding the Right Support and Connecting The Dots Finding a good therapist  is a lot like dating. Not everyone is a match. Luckily, I found someone quickly who also took insurance, AND I happened to really, really like her! If you've ever been in therapy, you know these things are RARE. We began exploring the source of my anxiety, and it quickly became apparent in my first few therapy sessions that it was a cocktail of past trauma and, you guessed it, a drop in estrogen. This led to what I call "background anxiety," which would often spiral into catastrophic thinking about various situations, most significantly an overwhelming fear of my husband dying  unexpectedly. The prevalence of anxiety symptoms in midlife women is substantial, with estimates as high as   51% of women 40-55 years old . During the menopause transition, hormonal fluctuations affect neurotransmitters in the brain. This decline in hormones can lead to increased anxiety and mood swings. There is also a correlation with ADHD . But. That's another story. Understanding this connection was crucial for me. Finding Treatment First, my shrink had me do some thought reframing  - a technique I would come to use often in my coaching practice. I needed to come up with a sentence or mantra to repeat to myself when I began to catastrophize. I settled on saying, "I can't control it, but I know I can survive it." Meaning, I knew I couldn't control the world around me, but I knew I was resilient enough to get through tragedy. This professional guidance proved to be vital. Working with a therapist who understood menopause-related anxiety  gave me clarity and tools to manage my feelings. However, I recognized that this was only one part of the solution, and there were other steps I needed to take. Putting it All Together I had really let some things fall to the wayside, and I hadn't even noticed until I started therapy. Exercise:  I refocused my exercise program , hired a personal trainer, started lifting weights regularly, and recommitted to a regular Pilates practice that I had fallen out of. Nutrition: This was a mess. I spent many days eating whatever I could get my hands on because time felt limited with my job, and we were eating out and ordering in a lot. I started meal-prepping more, and I cut back on my sugar intake (under 35 grams a day) and limited my alcohol consumption. Meditation:  I had fallen out of my twice-a-day Transcendental Meditation  (TM) practice; no wonder I was stressed! I picked that back up. Medication:   I sought the help of a menopause practitioner and started Hormone Replacement Therapy  (HRT). Sleep:   Finally, I practiced better sleep hygiene by limiting my screen time and getting to bed early, AND with the addition of micronized progesterone, I began to sleep like a normal human again! Let me be clear and say that this did NOT happen overnight. It took  literal years to figure out the right combination of lifestyle, nutrition, and pharmaceutical intervention. Even now, as I write this, I'm still figuring this sh*t out because the annoying thing about perimenopause  is that until you are post-menopausal, hormones continue to drop until the ovaries are entirely out of gas . Once they're out of fuel, it's a bit easier to manage hormone levels because they no longer change. Until then, it's a roller coaster you have to manage because you can't get off. Your hormones will fluctuate until they're gone, and you must keep reassessing your treatment approach as things change. While there is no one-size-fits-all solution for treating anxiety related to perimenopause and menopause, there are so many things you can do! It will likely be therapy, lifestyle changes, medication , or some combination of those, but you have to start somewhere. First and foremost, if you're struggling, acknowledging the fact that something is going on is paramount. Next, please don't keep it to yourself. Ask for help . That might be finding a menopause practitioner here , making an appointment with a therapist, or even working with someone like me . 😉 Whatever choice you make, don't let it take you years to get help like it did me. You deserve to feel your best at every age! I'm rooting for you!!

I had to eat a lot of whipped cream to get this picture right! In June 2023, we interviewed Dr. Stacia Alexander  for the Circling the Drain Podcast, season 3, episode 51, I Choose Me . She was a fantastic guest, and we discussed a wide range of topics, including her use of testosterone in her hormone replacement therapy, her dedication to improving mental health among college students , and knowing when it's time to press the Emergency Stop Button and take stock of your life. However, what resonated with  me the most was her declaration that she is " sugar sober ." Since then, I have been dying to give this a try! In a world overflowing with sweet treats, deciding to go “ sugar sober ” can be a daunting task. Sugar is often viewed as harmful during menopause because it can lead to high blood sugar levels and insulin resistance and contribute to weight gain and/or changes in body composition. Additionally, it can exacerbate vasomotor symptoms such as hot flashes and night sweats. Reducing sugar intake can help manage these symptoms and improve overall health. Understanding Sugar's Role in Our Diet Sugar does more than enhance flavor; it affects our bodies in complex  ways. While it provides quick energy, there are notable drawbacks. For example, spikes in blood sugar levels can trigger insulin release, which may lead to mood swings and fatigue. On average, Americans consume about 77 grams of sugar daily, significantly exceeding the American Heart Association's recommendations of 25 grams for women and 36 grams for men. High sugar intake is associated with serious health issues, including a 20% increased risk of heart disease and double the likelihood of developing type 2 diabetes over time. Also. There is hidden sugar in EVERYTHING, from granola bars to crackers and salad dressings. Yup. Your salad dressing. In fact, condiments are the worst offenders! The Immediate Effects of Reducing Sugar Intake Removing sugar from your diet can lead to both physical and mental changes. Many individuals experience withdrawal symptoms, such as headaches and fatigue. While these symptoms can be uncomfortable, they typically subside within a few days. Once the withdrawal phase is over, many people notice more stable energy levels throughout the day. Without the ups and downs associated with sugar consumption, energy becomes more consistent. Additionally, many report enhanced focus and cognitive function, as excessive sugar can diminish mental clarity.   I don’t know about you, but menopausal brain fog is REAL, and I need all of the help I can get.  That’s why I’m giving up sugar for ten days! The 10-Day Sugar Sober Challenge I think I've said before that I consider myself a human pin cushion. I'm always trying new things that might improve my health, especially with the ever-evolving state of perimenopause. This is one of those things I've meant to try but haven't gotten around to. So... I'd love it if you could join me ! Click here for details, where you'll receive your guide to get started, along with an invitation to the Sugar Sober Facebook group, because we all know that having a supportive community for this will be really, REALLY important. Sugar is so yummy, and giving it up will be challenging, but I know we can get it done together. AND. It will be worth it!

Me, looking surly in 1990, long before I knew what TM was. In my teens, if anyone had suggested that spending 20 minutes a day in silence could change my life, I would have said, "Whatever, dude." Not only because I considered meditation a part of woo-woo culture but most importantly because I knew there was NO WAY I could sit still for 20 whole minut es. Life is hectic, filled with deadlines, responsibilities, and a daunting flood of notifications. How could something as simple as meditation make a difference? Yet here I am, a person who has been practicing Transcendental Meditation (TM) for more than ten y ears. It completely reshaped my outlook and interactions with the world, and in many ways, I have David Lynch to thank for that. It's hard to believe he's gone. It All Started With Twin Peaks Twin Peaks was the Beverly 90210 for weirdos! While I had seen Dune  (let's not debate if it's better or worse than the new ones) around the age of 13 (in the theatre) and loved it, I was a freshman in high school when I became a true fan. While the "normies" were watching Beverly Hills 90210, weirdos like me were sucked into its equivalent, Twin Peaks , which was (basically) the same show, but on acid. Oh, and it had murder. And sex. Sometimes, both at the same time. Although it only ran for two seasons, it was impactful and Lynch's work would continue to influence my and many of my friend's artistic life as we grew older. In particular, he profoundly affected a director/writer friend who, around 2012, decided to pursue training in TM. We both knew that Lynch was an avid practitioner, had even written a book  about it, and started a foundation  and school for training, but the pricing was pretty expensive for an artist. Still, my friend was compelled to find a way and try it. Enter Philosophy Works . About a year or so later, she received her mantra and convinced me to attend class and start my journey to receiving mine. Why did I do this after years of believing it wasn't for me? There are a few reasons. Firstly, I had just ended an intense seven-year relationship and was looking for something . That something  was a deeper connection to myself and some direction in my life. I had been feeling pretty rudderless and knew I needed to shake things up. Besides, what did I have to lose? Classes were affordable, at $35-$40 instead of the $1k at the Lynch school, so why not?! What Exactly is Transcendental Meditation? Lynch's explanation of how Transcendental Meditation works. Transcendental Meditation (TM), also known as Vedic meditation , was developed by Maharishi Mahesh Yogi in the 1950s. It is based on a meditation technique from the Hindu Vedas. With the TM program, you silently repeat a mantra in your head. The method focuses on settling your body into a state of restful alertness. Your body is deeply relaxed, and your mind is quiet but wide awake. Many folks ask how it differs from mindfulness meditation, which also has value but differs in that mindfulness involves breathing methods, guided imagery, and other practices to relax the body and mind. Some of these techniques are certainly shared between the two, but the mantra is the secret sauce of TM. Your mantra is given to you by a guru or certified teacher/practitioner  and is never said out loud or shared with anyone. Most TM mantras are unique Sanskrit sounds (not words) without direct meaning or translation to English. It is spoken  in the mind repeatedly for the duration of the session. Philosophy Works requires several classes before you receive your mantra. It's work, but they firmly believe in walking before you run. You learn philosophical basics (hence the school's name) and discuss the concepts (critical thinking required), then develop a mindfulness practice, and only then do you begin TM training. We were taught to practice 20 minutes daily but in two sessions. One ten-minute session upon waking and the other ten at the end of the day, usually between 4 - 6 pm. The school has one mantra that everyone uses. What is it? I'll never tell!   😉 Being a person with ADHD (though I didn't know it at the time), I was shocked at my ability to sit and focus. In retrospect, I think the reason this type of practice works best for me is because of the mantra; it tricks my ADHD brain into grabbing on to the repetitive sound (which my neurodivergent brain REALLY likes) and then frees up the rest of my brain to settle and be open to what I believe is the collective unconsciousness  or what some people call the unified field . How It Changed My Life After practicing for about six weeks, I experienced a significant breakthrough during a meditation session. I was working on a movie script, and the story and dialogue began to flow through me. I know! It sounds woo-woo, but it's true. I would finish my meditation and immediately run to the computer to write. David Lynch talks about this type of experience while working on scripts as well. From that point on, my perspective transformed. It became a place to contemplate, channel creativity, and sometimes, do NOTHING. There is no good or bad meditation session. That's not what it's about. It's called a meditation practice for a reason. It became a part of my daily routine, and it felt weird if I missed it, which I certainly did and still do occasionally. What I love most is that it's like riding a bike: if I stop for a period, I can pick it right back up without a problem. My biggest takeaway has been a new ability to pause and reflect. I didn't do much of that until I started meditation, and it became incredibly crucial to maintaining patience and managing stress as I began perimenopause! Real Benefits of Transcendental Meditation Reduced Stress and Anxiety:  My overall sense of well-being improved drastically. Studies indicate that practitioners of TM report a 50% reduction in anxiety levels. Improved Focus and Productivity:  Those 20 minutes of quiet were a game changer. I approached work tasks with fresh energy and clarity. Research shows that meditation can increase productivity by up to 120%. Better Sleep Quality:  My sleep improved remarkably. According to the Sleep Foundation, regular meditation can enhance sleep patterns by 42%. Better Relationships:  People practicing meditation report stronger relationships with their friends and partners. As I became calmer and more present, my relationships flourished. Friends and family noticed I was more patient and empathetic, leading to deeper connection and eventually meeting my future husband. Heightened Happiness:   It can decrease cortisol levels (a stress hormone) by 30% and has been shown to be more effective than other relaxation techniques in boosting happiness. I find it much easier to focus on the good things in my life and am certainly more resilient. I credit this more to my education leading up to my meditation training, though the practice influences my ability to focus on happiness by being more present. Is Meditation for You? Does the idea of meditating make you want to roll your eyes? Take a nap? Punch yourself in the face? I get it! The most common concern I hear from friends, family, and clients is the limiting belief  that sitting still for ten minutes is impossible. I KNOW. I felt the same way, which is why you need training in HOW. Sure, you can try an app like CALM, which I encourage, but you're better off working with a human who offers training like Mark Price , who we had on the CTD Podcast, or going to a school like Philosophy Works . So. Is it for you? The answer is YES. It is for everyone. If my busy-a** ADHD brain can do it and reap the benefits, so can you! You just have to be open to trying, find the right way to get your training, and give it a chance to change your life. What do you have to lose??

The testosterone connection! Testosterone is a crucial hormone in all humans at varying levels, regardless of gender.  While people often underestimate its importance, it is essential for health and vitality, working alongside estrogen and progesterone.   It is the most well-known androgen, influencing several important systems, including cardiovascular, muscular, skeletal, and reproductive systems.   As women age, testosterone levels decline, especially during perimenopause and menopause.  It can significantly impact intimate relationships and possibly bone density, cognitive performance, and mood.  Approximately 40% of U.S. women report sexual problems, with hypoactive sexual desire disorder (HSDD) being the most prevalent issue, characterized by low desire and distress.   Currently, no testosterone product is approved for treatment in women.  However, it is prescribed “off-label” for the treatment of HSDD, most commonly with FDA-approved gel or a compounded cream. So why hasn’t more attention been given to the use of testosterone for women?  It’s plain and simple.  We live in a society where a woman’s libido is not a priority.      According to the British Journal of General Practice : “Numerous studies have shown that adding testosterone to hormonal therapy can improve sexual function and general wellbeing among women during their menopause. A recent systematic review and meta-analysis of testosterone treatment in women has provided robust support for a trial of testosterone in women when clinically indicated. In postmenopausal women, testosterone supplementation improved several domains of sexual response, including sexual desire, pleasure, arousal, orgasm, and self-image. It has also been shown to have additional benefits including the improvement of urogenital, psychological, and somatic symptoms, an increase in bone density, and enhancement of cognitive performance when combined with oestrogen as part of HRT. Many women notice that taking testosterone improves their mood, concentration, motivation, and energy levels.”   The UK has published some guidance on testosterone dosing for women, putting them ahead of the US on this issue.  Also, a paper  just released on January 7th, 2025 , shows that testosterone in both males and females correlates with osteoarthritis . The lower your testosterone, the more likely you will experience OA. PS - the annual economic burden of osteoarthritis is $136B !   It seems there is more to the testosterone connection than meets the eye. You can read more about my personal experience with testosterone here .

Here is what happened when I stopped taking it: I was miserable! I started FDA-approved testosterone (off-label for women) almost exactly a year ago with a previous doctor who had advised me to rub a significant drop of gel (once daily) on my thigh, switching from right to left because I would grow dark hair wherever I put it. The best way to mitigate that would be by changing legs instead of rubbing it on the same leg every day. My doctor wasn't wrong. Not only did I find dark patches of hair on my mostly fair-haired body, but I also started breaking out in the area, particularly on my left leg. It got to a point where it was truly embarrassing. I felt like a teenager with acne, except the acne was all over my legs! So, in August, when I had an appointment with a new medical provider, we tested my levels, and they were high. I wasn't surprised. So, I quit it cold turkey, figuring I'd take a little break from the stuff and see what happened. The positive was that the hair and acne disappeared in about a month, but the negative was that I WAS MISERABLE. The most immediate thing I noticed was a return of chronic and sometimes debilitating fatigue and brain fog. The second was persistent joint pain, particularly in my knees. The third was general inflammation - this is hard to describe, but for my auto-immune disorder people, you know what I'm talking about. However, I thought it was important to leave it until my follow-up appointment to see where my levels were, so I set my mind to tough it out . This is where it gets tricky. Early November arrived, and I went in for my appointment and blood draw. My provider messaged me in the portal and said that everything was normal, yet my free testosterone was low and out of range, and my Sex Hormone Binding Globulin (SHBG) was high and out of range. What does that mean? If your SHBG levels are too high, it likely means that less of your total testosterone is free testosterone and available for your tissues to use. In short, your tissues may not be getting enough testosterone. What can this result in? Decreased libido. Lack of motivation. Irregular periods. Vaginal dryness. Decreased bone mass. Memory loss. Fatigue. Mood changes and depression. I checked all these boxes, yet my provider told me everything was normal . Now. I like this person. A lot. She is very forward-thinking and works in a department specializing in menopause care. However, the topic of testosterone is where we disagree. She doesn't prescribe it for reasons I'm still unclear about. Luckily, I purchased my testosterone in bulk (it was cheaper that way), so I still have quite a bit from seeing my previous doctor. I began using it again immediately after getting my blood results (but using a smaller amount), and I felt the difference within two weeks. The first thing that lifted was the brain fog and fatigue, and then, slowly but surely, I began to feel BETTER. I feel more like myself again. Only recently, testosterone has been approved for the treatment of low libido (though not covered by most insurance because the FDA doesn't give a sh*t about your sex drive), and yes, that's how I got it prescribed. Still, I was more interested in its lesser-studied effects, as indicated in this PUBMED article here , including increased muscle mass, bone density, cognitive performance, and decreased inflammation. These are all things I experience when I'm using it. So...why isn't this acknowledged, and why isn't it included in the gold standard of care that is Menopause Hormone Therapy? Because studies take FOREVER , and the world is run mainly by male doctors, researchers, and scientists. Only recently, somebody started giving a f*ck about our libido, and it will take years for any solid research to come out regarding the other positive effects that may come with using testosterone. The good news is that there are some forward-thinking doctors out there shouting to the world about the positive effects of its use, like Dr. Mary Claire Haver , and if you don't follow her on Instagram, I strongly recommend that you do. With that, if you're interested in giving testosterone a try (there is also evidence that it can help with Cronic Fatigue Syndrome and fibromyalgia ), it's essential to gather all of the information you can before speaking to your provider. What's more, finding a doctor who is receptive to your request is important but challenging. A great place to start is at NAMS (the North American Menopause Society), though it's not always guaranteed that every menopause specialist will prescribe testosterone. Lastly, working with someone like me can help. I provide resources and knowledge around these issues; we discuss them in-depth so you feel armed and empowered to advocate for yourself. I can also help you search for the right medical provider, which can be an arduous and daunting task. To schedule a 1:1 free introductory session, you can do so here .

The best advocate for you is you! Download the free guide for speaking to your doctor about menopause. When Donna first came to me, she was very interested in trying Menopause Hormone Therapy (MHT). My usual process is to provide information on MHT when asked. We then discuss the treatment’s pros and cons. If my client decides to proceed with MHT, they make an appointment with their current gynecologist to discuss treatment.   This is where things can get a bit tricky.   A 2023 survey  found that only 31.3% of obstetrics and gynecology (OB/GYN) residency programs include a menopause curriculum. As a result, the likelihood that your doctor has current knowledge and training in menopause care is pretty slim.   Donna had been seeing the same gynecologist for several years. When I asked her about her experience with this doctor, she noted that although her gynecologist didn't have the best bedside manner, she felt confident in the doctor's abilities because she had prescribed MHT for a friend who had also seen her.  With that, Donna scheduled her appointment, and we planned to check in later.   I texted her the day after she saw her doctor to see how things went.  Unfortunately, it wasn’t great, even though we did some prepping.   Since Donna always felt rushed by this practitioner, I asked her to prepare a list of discussion items to make the most of their time. Sadly, this annoyed her doctor, and she proceeded to treat Donna like an “idiot” (her words, not mine).  The doctor then blamed her for not talking to her about this sooner and for not requesting menopausal hormone therapy during her first signs of menopause. Huh? Last time, it's the doctor's job to diagnose and walk their patient through all available treatment options. I mean, would you blame a cancer patient for not asking for chemo?!?   In the end, the doctor made her cry out of frustration.   I wish I could say this experience is unique. Earlier in my career, when I was still in training, my best friend texted me in tears from the parking lot of her gynecologist's office, sharing a similar story. This scenario was the first of many similar experiences I would encounter in the following years.   Many of my clients share a common thread: they have all faced doctors who undermined their power and autonomy. These doctors seemed to believe that their medical degrees granted them the authority to condescend to patients for daring to ask questions and take an active role in their treatment.   Here’s the thing.  A doctor should never make you feel small. Nobody should!   I imagine you wouldn’t tolerate that kind of treatment in your everyday life, so why should you accept it from a doctor?  Yet, so many women are gaslit and made to feel stupid or worse, CRAZY .   I am not claiming that all doctors are bad. There are incredible practitioners out there, but it can be challenging to find a doctor who feels more like a partner and less like your sh*tty boss at work. Add the extra layer of finding someone who is menopause literate , and it can be even harder.   Trust me. I’ve been there, and finding the right medical practitioner requires a lot of effort. Researching, navigating health insurance, making calls, preparing, and reviewing all the necessary information takes time. Then you cross your fingers and hope the person you booked works out. It's exhausting and time-consuming!   That’s why I’ve put together a resource guide to help you speak to your doctor, possibly break up with your doctor, and find a qualified menopause specialist.    You deserve compassion, kindness, and information about all available treatment options. This way, YOU can determine the best course of treatment for yourself.   Not only are you the best expert on you, but you're the best advocate for you!   Download the free Advocate guide here .

Five Steps for CRUSHING Your Goals in 2025! Millions of people make resolutions every year!   Research on the " fresh start effect " reveals that specific dates can motivate change. The new year represents a new beginning and pursuing resolutions can enhance willpower and determination, but how can you stick to those changes?   SMART goals (my favorite approach) have a 90%  success rate because they provide a clear path for achieving objectives, making them an excellent choice for setting New Year’s resolutions.   So, what are SMART goals, and how can you use this framework to CRUSH your New Year’s resolutions?    Follow this five-step acronym for success!   S PECIFIC  Get clear on your goal and break it down into something more precise.  If you want to get more sleep in 2025, that’s a general goal.  A more specific goal would be to commit to going to bed by 10 PM Sunday through Thursday, ensuring you get a minimum of 8 hours of sleep for work.   M EASURABLE  How will you evaluate your progress and hold yourself accountable?  You could use an app to track your sleep or go analog and write it all down in a notebook.  You then review your progress every Friday and decide if it’s working.  NOTE – if things are not working, this is a great time to adjust the path to achieving your goal or the goal itself.   A CHIEVABLE Is this goal realistic?  Are you truly capable of going to bed by 10 PM?  This requires you to be truly honest with yourself.  Maybe 10 PM isn’t going to work, but 10:30 PM will. However, for  that  to work, you need to change your morning routine a bit so you can sleep later.  You can see how this clarifies the path!   R ELEVANT How motivated are you to achieve this goal?  If your overall lack of sleep affects your work performance and relationships, that is a strong motivator!  However, it doesn’t need to be that dramatic.  It just needs to align with what is most important to you.      T IME-BOUND Set a deadline to create a sense of urgency.  Most folks function better with structure, and creating a due date supports accountability and discourages procrastination.    PRO TIP: Remember that resilience is KEY as you work on your SMART goals! It’s beneficial to think about how you will handle setbacks to prepare for challenges that will inevitably arise.    Once you have maintained the behaviors needed to achieve your goal for six months, you will enter what is known as the "maintenance" stage. This indicates that the change is sticking, and it’s time to celebrate!   Every day is an opportunity to make a change.  Whether it’s today or the new year, know these proven steps can help you get there!

Five tips for coaching yourself through the chaos of your holiday to-do list! If you know me at all, then you know that I bake an EPIC amount of Christmas cookies each year for friends and family. As the holiday approached, I realized I was dreading this long-time tradition of mine when it's usually something I LOVE.   What's different this year?   I have several projects I'm working on that launch in January and February, and I'm on a deadline. Every second I have counts, and I don't have many to spare. (Updates on that coming soon!)   I’m known for intricate icing decoration, particularly with my snowflake cookies, and this is the part of the experience that is most time-consuming. So, I began a conversation with my Inner Coach to figure out a plan.    My Inner Coach asked, “Julia, what is the most important part of eating a Christmas Cookie?”   “The taste,” I replied.   “With that in mind, how can you do less while still giving out delicious cookies?”   “…but the icing decoration is important; it’s what people expect!”  I replied stubbornly.    I paused and thought momentarily, and my Inner Coach asked, “How can you simplify this process and still produce a decorative and delicious cookie that takes up less of your time?”   I immediately knew what I had to do.  For starters, I picked THREE cookie cutters to use instead of the TEN different designs I typically choose.  A tree, a candy cane, and one medium-sized snowflake.  Those three were the easiest to bake and decorate.  Then I made three batches of cookie dough – the first without dye for snowflakes, the second green for trees, and the third red for candy canes.    I baked some candy canes and trees with peppermint bark and Andes mint sprinkles so that they would not require any icing for decoration but would be pretty and tasty.  I would not “flood” the other cookies with icing and do my usual ornate decoration on top of that.   Instead, I would use simple icing designs to accent the dyed cookie.  I would do the same with the snowflakes.  I would skip the “flooding” and only do the icing spires that make the snowflake look like a snowflake!   My first batch took HALF the time it usually takes me, so I could also get my cookies shipped sooner.  To save even more time, instead of taking my boxes to UPS, I measured the boxes, created USPS Priority mail labels, and scheduled a free pickup with USPS of all boxes.    You might be thinking, “Julia, who cares about your cookies? I have REAL problems I’m dealing with!”   I get it.   I told you this story because we all have to-do lists for the holiday season. Some tasks are more daunting than others. This was an example of how I re-thought one item on my list. It was more efficient, and it helped with my stress level! If I can do it, so can you. It's time to reframe, simplify, and refocus. I’ve got five great tips for coaching yourself through the chaos of your holiday to-do list below!   Ask for help. People love you and want to help; don't be afraid to ask. Write down your list. Refocus by separating items into two categories: What MUST get done and the if-it-doesn't-get-done-nobody-will-die. Only focus on the MUST-get-done category. List them in order of HARDEST to easiest. Always attack the most complex tasks first! Ask yourself, "What about this task makes it difficult?" Then, ask, "Is there a way to simplify the work in completing the task without hurting the outcome?" Sometimes, this means troubleshooting and simplifying as I did with my cookies, but it can often mean making a PLAN . This might mean breaking down the next two weeks, day by day, and writing on your calendar or in your phone notes - or going analog with a piece of paper - the tasks you need to complete every day. This could also be a reframe where you look at the task differently. Check things off that list. Removing things from your list after completion can be incredibly satisfying! Once everything is done, or you feel you're in good shape, now is a time to revisit the if-it-doesn't-get-done-nobody-will-die category of items. Give yourself grace. We are incredibly adept at putting pressure on ourselves. That pressure usually doesn't exist outside of our brains. Back to my cookies; had I not made cookies this year and explained why, I would have received everyone's full support. While folks might be disappointed, they would still understand. Be kind and forgiving with yourself.

Sarah had been at a circus school workshop a few years ago, doing training on a trampoline, and had hurt her back.  Now.  Sarah and I met in the late 90s while working for Cirque Du Soliel, so this was not unusual to hear.  However, hearing that she was injured from doing a simple back bounce on the trampoline was SHOCKING.  She was 55, very active, and took excellent care of herself.  Initially, she assumed she had pulled something and that the pain would dissipate once healed; however, some time went by, and the pain was not resolving, so she finally went to see a doctor.   That was when she found out that she didn’t just hurt her back; she fractured her spine, and with that also came the shocking news that she had full-blown Osteoporosis.     She was devastated.   When she came to me with this news, she wanted to know how and why!  She was only 55; how could this be??   Osteoporosis is a disease that causes bones to become weak and more likely to break. It's often called a "silent disease" because it doesn't usually cause symptoms, and you might not know you have it until you break a bone…while taking a circus trampoline workshop.   Risk factors include age, race, genetics, thyroid issues, and body frame size (men and women with small body frames tend to have a higher risk).  However, the most common cause of the disease is simply being a woman.  The drop in estrogen levels in women at menopause is one of the highest risk factors for developing osteoporosis.    Estrogen regulates bone metabolism and promotes the activity of osteoblasts, which are the cells that make new bone. When estrogen levels drop, a person may lose bone density.  This is why a DEXA scan (bone mineral density test) is recommended for women between 50 and 65.    While it is not guaranteed that you will get osteoporosis if you are a menopausal woman, The National Osteoporosis Foundation estimates that half of all women over 50 will eventually develop the disease.   Initially, Sarah and I were texting.  We went over lifestyle interventions and her concerns over side effects associated with the drug Fosamax, a drug her doctor prescribed her that slows bone loss.  I knew there was more to her story and much to be done here, so I scheduled a Zoom with her to get the entire background.   Sarah had gone through early menopause about 15 years ago .  Menopause is considered “early” when it occurs between the ages of 40 and 45.  Given the fact that this was around 2009, she was not offered HRT (Hormone Replacement Therapy), which is currently the gold standard of care for menopause.   You have to remember that in the late aughts, people were not discussing menopause as they are today.  Not only that, but it was also only a few years earlier (2002) that the Women’s Health Initiative published a very flawed  and misinterpreted study on the use of HRT and its health risks, which had doctors up in arms about prescribing HRT for fear of giving their patients cancer.    This was debunked years later.  You can read the NAMS repositioning statement here .   Sarah’s timing was unfortunate, and now her bones were paying the price for that lack of estrogen!   We’ve all heard stories or had a female elder in our life who was doing “fine” but then fell and broke her hip, and that’s when it was “over.”  Sarah was aware of this and was (rightfully so) completely freaked out that she was officially frail and could break a bone at any moment from the slightest movement, and she was only 55!!   She was scared and felt “hopeless,” but I assured her it wasn’t over.   We had a long talk about Menopause Hormone Therapy (MHT/HRT) and the effect of estrogen on bone density.  She had already started lifting weights and taking calcium, vitamin D, and Fosamax .   She was doing all the right things!  The only thing missing was estrogen, which (according to the latest data ) is associated with a 3.4%-3.7% increase in BMD (Bone Mineral Density) within one to two years of use.   Last we spoke, she had an appointment with a NAMS provider to get her MHT prescription and felt hopeful about her future.  I plan to check in with her periodically and am excited to see how things are going.   In the meantime, here are some tips for avoiding osteoporosis: Begin using MHT while in perimenopause if appropriate for you.  Estrogen remains the “ treatment of choice ” for osteoporosis prevention. You can do a free breast cancer assessment here You can find a NAMS provider here You can use The Pause Life database here Start lifting heavy sh*t!  Lifting weights increases bone density and muscle strength Eat adequate protein Maintain a healthy weight Amp up your calcium Amp up your vitamin D Crowd out alcohol   This blog offers general information about health and related topics. The information and other content provided in this blog, website, or any linked materials are not a substitute for medical advice, diagnosis, or treatment. If you have a medical concern, please consult your healthcare provider or seek professional medical treatment immediately.