698: How to Get Your Health Back in Midlife With Dr. Inna Lozinskaya

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Katie: Hello and welcome to the Wellness Mama Podcast. I’m Katie from wellnessmama.com and this episode is all about hormones and how to get your health back in midlife when everything you’ve done stops working the same. And I’m here with someone it was a joy to talk to, Dr. Inna Lozinskaya, who is a physician and an award-winning speaker, author, and mentor. She’s also board certified by the American Board of Internal Medicine and the American Board of Integrated Medicine. She’s fully trained in functional medicine by the Institute for Functional Medicine and the American Academy for Anti-Aging Medicine. And she’s founder of the Midlife Wellness Institute. And she’s practiced medicine for 26 years from patients in the ICU and specialty floors and now in patients in the last 30 years, they’re suffering from various different things.

And she realized that while conventional medicine is great at helping people survive, it doesn’t always have the best tools to help them thrive. And when she had her own experience with this, she broadened her focus and now helps many, many women in their journey as well. Like I said, we go deep on the topic of hormones. We start off with a fun story about her life and when she decided to learn English as an adult. Then we talk about how hormones shift at different phases of life for women. The first hormone to drop in perimenopause, how progesterone is a natural anti-anxiety hormone, understanding progesterone, testosterone, and estrogen in perimenopause, menopause, and beyond. How these phases of life can affect the adrenals. Why nutrition is 80% of success for hormone health at every phase, as well as other lifestyle factors that we need.

We talk about why we need more protein as we age, the best sources of fat for hormone health, all of the foundational habits that help lead to optimal hormone function, how hormones are activated and deactivated in the liver and how to keep our livers healthy, how to break the stress cycle and replenish our hormones, how there is no relaxation in the body without magnesium being available, when to test our hormones and what to look for in the results, why some women feel better on hormone replacement and some feel worse, and then we get nuanced on hormone replacement and when it’s a good idea, when it’s not, and dispelling some myths surrounding that. So, very informative episode with Dr. Inna. She’s a wealth of knowledge and so fun to talk to. So, let’s join her now. Dr. Inna, welcome. Thank you so much for being here.

Inna: Hey, Katie, so glad to be here. Thank you.

Katie: I’m super excited to delve into all about hormones and many other aspects of women’s health, especially, especially for the ages of a lot of people listening. I think this is super relevant. But before we get to go deep on that, I also would love for you to tell this story. So I have a note about something really cool that happened when you actually started learning English. And I would love for you to tell this story because I think it’s such a cool story.

Inna: Well, I didn’t study foreign language as a child and I didn’t have it in school. And so when I decided to move to United States, I was 25 and I needed to learn English. And I wanted to be prepared, so I decided to hire a private teacher to learn conversational English. And I did my research and life is short, I always study with the best, so I found the best English tutor in town and approached her and she said, oh no, I never teach adults. Adults are not capable to learn foreign languages, they always have excuses, they never do homework, and so it’s just not adult capability. So I only teach kids.

Well, I don’t take no for an answer. I kept approaching her again and again. And finally one day she said, fine, I will teach you honestly, it’s waste of my time. I have another guy just like you, just as hopeless, helpless and useless. And so why wouldn’t I put two of you together in a class? So at least I’m wasting one hour of my life a week rather than two. And that’s how I met my future husband. And two of us worked very hard on proving her wrong, and I hope we did.

Katie: Well, I love that story. That’s such a cool turn of events. And also, obviously, you did learn how to speak English very well. So you proved her wrong as well. I can only imagine what it must have been like to transition to such a different language as an adult and move to a foreign country and then now to have built such an amazing life and business around that. I think that’s incredible and much respect to you for doing that.

Well, the topic I’m excited to learn from you today really goes deep in the world of hormones. And I know that there’s so much misinformation in this world and there’s so much conflicting information and people often maybe feel confused or a little bit lost when they try to start researching it and understanding it. So I feel like to start broad, maybe walk us through just on a broad level, what are some of the hormone shifts that maybe happen in perimenopause and then through menopause, what’s physiologically going on with our hormones at that point? And then we can go into the possible solutions for that.

Inna: Certainly. So menopause is when you don’t have your periods for 12 months. That’s the definition of it. Perimenopause is the time prior to that and it can last up to 12 years for some women. It really begins on average after age 35. And we still have our periods and they’re usually still regular. But for the next however, whatever years, our hormones begin to shift. And as our hormones shift, so shifts the way we feel.

And the main hormones that will change the way we feel during that time is first of all, the very first hormone to go downhill in perimenopause is progesterone. And progesterone is your nature anti-anxiety, it makes us calm, it allows us to deal with things on regular basis without making big problem out of it. It helps us sleep soundly and deeply and feel rested in the morning. So obviously when this hormone goes downhill, we lose our sleep and it’s not as rested in the morning. But more importantly, we feel anxious and we often make a big deal out of small things and you look back a week later and it’s like, what was the big deal about that? But then you go through it over and over again and some months are better than others. But that’s probably the first thing that starts changing on perimenopause.

Then sometimes, and that can start as early as mid-30s. For some women, it doesn’t begin until 40s, but at some point we’ll experience that. Second hormones that changes in perimenopause is testosterone. And testosterone is very important hormone. We call it male hormone because guys have so much of it, but it’s actually a cool fact. We have 10 times more testosterone in woman’s body than estrogen. And so obviously it has really a lot of functions in the body. And when testosterone goes down, we feel less motivation, less testosterone as you go get there. It gets things done hormones. So women will come in their 40s and they will say, You know, it just, it takes more energy. I’m easy, I’m tired easier. I just can’t do things that I used to do 10 years ago. More importantly, I don’t feel like doing them. Or I will start doing something, I wake up in the morning and I have a long list and I’ll do this, this, this and this. And then on the evening, I barely got through one quarter of it. And even that was too much. And I wasn’t this way just 10 years ago or five years ago. So that’s usually a hallmark of your testosterone sliding down. And women who exercise will not notice it as much because exercise will make your body produce more testosterone. But more or less all of us will notice the difference at some point in our 40s.

Estrogen we produce throughout the perimenopause. Estrogen will go away in menopause. However, what we experience in perimenopause is estrogen starts going up and down, so it’s a little bit less reliable. And as it gets higher, we have amounts with earlier PMS and more irritability and… Um… and then we’ll have a month with a little bit of vaginal dryness and maybe a little bit of less of sex drive. So those are the things that we experience in perimenopause, I would say. And then in menopause, all hormones go down. And your adrenals will take over and make some hormones and adrenals are responsible for stress hormone production. So if woman is experiencing a lot of stress and she barely makes any sex hormones. If your stress is overall at lower level and balanced, she will make a little bit more sex hormones.

But overall, it’s so much less than it used to be in perimenopause and before that, that everyone notices it. And women will experience hot flushes and night sweats and just feeling warmer than they used to and irritability and short fuse and… Many women will lose their sleep and we start aging visibly. Our skin changes and we get wrinkly and skin gets thinner. Our hair doesn’t look as lustrous as it used to. We lose muscle tone. We start losing muscle mass. All of those things are hallmarks of menopause. And that’s difference in how we feel.

And then of course there is whole another side to hormones. They not only help stop or slow down that biological aging. They also help us to prevent diseases of aging. So once we slide into menopause, not only we feel different and we start looking different, we also start experiencing signs and symptoms of diseases associated with age. And your cholesterol goes up, your blood pressure might go up things like that.

Katie: That makes sense. And I definitely want to go deeper in a few minutes on the it correlating with the diseases of aging, because even just a couple of those things you mentioned, I know, for instance, muscle loss correlates with lower longevity and the more muscle we’re able to maintain, typically that correlates with longevity as well. So I know there are many connections that probably overlap here. But I also really was fascinated by you talking about progesterone as a natural anti-anxiety. And I wonder if women, maybe even if they’re not in perimenopause, can understand this through the lens of their monthly cycle, because if I’m remembering, progesterone drops right before we start bleeding, right? And often women will feel a surge of mood changes or a lot of volatility then. So would that be similar to what someone in perimenopause and menopause would feel as their progesterone continues to drop?

Inna: Exactly. That’s exactly what women will describe and I certainly experienced it. And most of our clients will notice that. And it’s really it’s a first signs that your hormones change. Usually right before the bleeding, if the levels are good and steady, right before the bleeding, you will have it a day or two, your mood will change, and then you know that you’re going to start your period tomorrow. But as we shift along the perimenopause, that period gets longer and longer, and so now you are experiencing those emotions for three days and for five days and for seven days, and now our husbands are looking for places to hide, because obviously that’s where it all goes. So yeah, you’re absolutely right.

Katie: Okay, that makes sense. And also, it’s great context. I find it funny that having had a period now for over 20 years, it still seems to always surprise me where I have that day where I’m like, why does everything feel so hard and insurmountable today? And I have yet to reliably be able to be like, oh, it just means my period is coming tomorrow and everything is fine. But that’s a great preview, I guess, of what might feel like in perimenopause or menopause, which also then brings a whole host of other questions.

And I know this will depend on lots of hormones and we’ll go into each one separately but if we understand this ahead of time and we understand that those hormones do just naturally decline, so this is not something pathological, nothing is wrong with us, but we know we can expect this, it would seem like maybe there’s things we can do preventively at every phase of life, even long before perimenopause to help give ourselves the best experience throughout those phases. So I would love for you to go deeper on that topic of maybe… by age or by hormone phase of those of us who are not perimenopause yet, but know that eventually we will be and those who are in perimenopause and then those who are already in or through menopause, what are some of the things we can do preventatively or then more actively to help mitigate some of these things you’re talking about?

Inna: So hormones require healthy body to work well at any age. And each decade of life actually has its own requirements, so to say, but there are some things that can be optimized in every stage of life to make it easier for your hormones to work well in your body. And nutrition goes throughout all phases. Nutrition is extremely important. That’s 80% of your success, making sure you get enough protein is extremely important. And as we age, we actually need more protein because we absorb less, but at any age, having protein in your diet will stabilize that mood and help to prevent your Hormones going up and down.

Fats is another very important part. You know, we did such a disservice with low fat diets 10, 20 years ago. Fats are extremely important, good fats. Cholesterol is a part of every single hormone your body makes. And so your testosterone, your progesterone, estrogen all require the cholesterol ring to be built. And so if you’re not eating enough fats, very simply just no, not enough, something that needs to be for hormones to even be built. So avocados, olive oil, olives, any good coconut oil, ghee butter, really good sources, clean sources of fats are extremely important for women’s health. So that’s nutrition.

Second, your hormones get activated and deactivated in the liver. And if your liver is inundated with ton of toxins that you’re getting on daily basis, by putting it on your skin because you have it in your skin care or by having it in your food. You know, obviously the busier liver is dealing with toxins, the less bandwidth it has to deal with your hormones. And so you get more symptomatic. So it’s very important to make sure that you are eating clean, that you don’t have palm of additives and dyes and artificial stuff that you read and it doesn’t sound like it could grow. You probably shouldn’t put it inside your body. And it was skin care. Unfortunately, these days is also having, I mean, it depends what line you use, but some lines. you look at the ingredients, and there is not a single ingredient that your liver would not classify as toxin. And it has to be everything that comes through your lips or through your skin from body standpoint, from your liver standpoint, comes only in two flavors.

One is it’s something that nourishes and builds, and the other one is classified as toxin that needs to be removed, it requires work to be removed. So making sure that you bring less toxicity inside your body so you liver is more available for hormones will optimize things for you. And detoxification sounds fancy, there is science to it, you can go as deep and scientific as possible, but simple things that you can do on daily basis. We detox by sweating, by peeing, by pooping. And so making sure that you have one or two bowel movements a day is extremely important for your hormones. Making sure that you sweat on regular basis, whether you’re using infrared sauna, or you’re using red light therapy, you’ll use them daily exercise. All of those are great. They almost don’t substitute each one has its own benefits, but bottom line is bring less toxicity in and allow more toxicity to come out naturally so your liver is less busy with processing toxins.

Lifestyle, super important. We are so stressed and we’re a culture of oversubscribing and for moms this is classic. There are a million things that need to be done. And especially when you have a kid or two kids or more, I mean, the list just endless. And it doesn’t matter how over-achieving you are, you get through half of your list by the end of the day. So there is frustration and there is a space and we forget about life, work, rest, balance. And we always think that if I do a little bit, just a little bit more right now, it will give me more extra time later, but it never happens. We still have more things to do. And so making sure that we stop and breathe and spend some time in nature and it doesn’t have to be whole day hike It can be step outside for three minutes and take three deep breaths and go in body has to have that reset.

Sleep is extremely important. Again, moms and kids are in bed, finally have time to get stuff done, right? And so instead of going to bed, she is doing millions of things, trying to catch up on that to-do list, and then your sleep time shortens, and then kid wakes up in the middle of the night, and then… You know, alarm clock goes off and all of a sudden you’re having less and less time. And initially your body will create stress hormones to ace to get you through it, but it comes at the cost. And we often don’t realize that we don’t have unlimited resources. We feel unlimited when we’re 35, but we’re honestly not designed that way. And so it’s almost borrowing, borrowing, borrowing. And if you don’t put back what you borrow, you will end up with empty accounts, right? Well, it works the same way with the body.

And hormones are extremely sensitive. And if body is stressed and overworked and tired and malnourished, the very first sense that body will sacrifice is sex hormones. You will not feel good, you will not look good, but for survival, it doesn’t matter. And so body will say, well, what is the main thing here? What is the main goal? And so it will push hormones away and all of a sudden you’re out of balance. And that’s why women also always almost, I hear it frequently. You know, I get hot flashes, but somehow on vacations I have way less of them. Well, you’re less stressed, you have more time to rest, you get more sleep. So natural things, as simple as they sound, actually have tremendous impact on your hormone balance.

Katie: I love that. It seems like this is a recurring theme of the simple daily habits make a much bigger difference in the long-term than the fancy biohacky things we can do. And I think they can both be very useful and important, but I’m always on the soapbox of get the foundational things first because then anything else you do is going to be more effective anyway because your body has those core things it needs.

And I was nodding in agreement with all these things you were saying, especially the protein thing. I’m glad this is being talked about more especially for women. I feel like maybe guys have always had this more naturally dialed in a little bit with food consumption in general and protein consumption especially. And to your point, I think the low calorie, low fat movement was really harmful, especially to women. It seems like maybe guys’ bodies can withstand that better than ours can with our changes in hormones.

But I know even for myself, even being aware of nutritional stuff, I for a lot of years was undernourished and certainly not getting enough protein. And to your point, as you were talking about this, I had that phase of six babies in nine years, not getting enough sleep just by nature of motherhood. And then when I was able to move out of that lack of sleep and lack of stress a little bit, my body, I felt like my nervous system went into a couple years of recovery where I was tired a lot more and I needed to listen to my body and just sleep. And I realized in that time, the best thing I could do for myself was to get enough rest and not do the super intense workouts, not push myself really hard, not be in a building phase of business, but just listen to my body and rest. And that paid off. I think I was like refilling my bank account to use your analogy.

It also seems like these all of course work in concert with each other and that if you start getting a depletion in one, it’s going to affect the other. So whether it’s you’re getting toxins through your personal care products and that’s impacting your liver, that’s going to by nature impact your sleep because your liver is very active trying to rebuild while you’re sleeping. And then now you’re not getting enough rest. And now it’s going to be hard to make good nutritional choices. And then now it’s going to be hard to get better rest

So I love that it’s a very holistic, comprehensive method. Unfortunately, I think that means there is no silver bullet, which is another theme. There’s not one magic pill that any of us can take that will fix these problems. It actually is going back to being your own primary health care provider and doing the daily habits that actually make the difference. But I love how clearly you laid that out.

And you also mentioned that there is the adrenal compensate a little bit as we move into these phases with hormone production. And it seems like I hear from a lot of women who struggle with what would be defined as adrenal related problems when they hit that like late 30s early 40s phase. Are there any things we can do, especially for our adrenals preventatively, as we move into those phases to guard against that?

Inna: Working on your stress is probably number one. We’re going back to the same basics. It’s almost like any, you know, I spent 26 years working in a hospital, in ICU, sickest patients, but every single disease or condition or dysfunction or imbalance you give me, I can go back to four basic pillars of health. What you eat, how you rest, how you move, how you balance your stress, and those things are foundational for anything.

Adrenals are responsible for survival. So they’re there making sure that you’re still waking up every morning. And their job, if they feel that you are surrounded by danger, their job is to maximize all resources for one goal, survival. Your field is going very narrow, you’re staring at your danger because you need to survive. Your whole body goes through this process where everything narrows down just to survival. Everything else is sacrificed.

And for survival you need high heart rate, you need high pulse, you need high respiratory rate because you need to fight or flight. And so everything in your body now targets fight or flight. Single focus, you lose big view, you stop paying attention to everything. You lose that mindfulness being in the moment by definition. Your heart rate compensates getting you ready to fight or flight. And so are your hormones. So, uh, your digestion shuts down your, um, so it’s all about running or fighting. And certainly other hormones, other than cortisol, are not as much of a priority for the body. So everything goes downhill.

Now we are very well created for dealing with acute stress because we’re still pretty much genetically, we’re still our ancestors. And for ancestors, really, when they faced that tiger, it was a short-term stress. And you either kill the tiger or tiger eats you, so it’s a short-term, and then it’s over one way or another. Nowadays, it’s like staring at that tiger 20 years, day and night, and it’s a whole different experience. Our body is not created to face, to be in fight or flight response around the clock. We just, we’re not created for that. We don’t have means, we don’t have resources for that.

So the idea of fight or flight, mobilize all resources, throw them out, being available right there and then. And then the assumption is that you rest and you replenish. Now, if you are stuck in that fight or flight response for days and months and weeks and years, there is no time to replenish. So the only way to get out of that cycle is to stop and replenish. How you stop? Situations are different, people are different, but find the way. Just like you said, I went through a lot of stress and multiple pregnancies in a short amount of time. And then my body forced me to pretty much stop for two years and take it easy and not push myself because that’s body wisdom. I don’t have reserves for you to push anymore. You have to stop and replenish. And then it’s all about good nutrition and again grounding, calming, protein and fat. Your carbs give you spark, spark of energy which goes up and goes down very quickly. If you need long burning energy, it’s your protein and fat.

So your nutrition has to align. You need to make sure that you have vitamins and minerals in your, so your food is really nutritious, you have to be able to calm and rest. Sleep is probably, if I had to identify one key factor that affects your adrenals more than anything else, I would say sleep. Because the only time our body can cleanse and restore is sleep. So if you shorten your sleep, I mean, nutrition is great and it matters, but if you deprive your body of that rest, rest and time, nothing else has time and place to work. So I would say you start with sleep. You make sure you give yourself ample time and your body will decide how much it needs. Some women need six hours and some women need eight. And when they deplete it, it can go to 10 and 12. That’s one of the symptoms of weak depleted adrenals. If that’s what body needs right now, then that’s what body needs to get.

Katie: Yeah, I would say in the basically 700 episodes of this Podcast now, I’m yet to have any sleep or any expert ever argue that sleep is not important. It seems like the one universally agreed upon, no matter what the specialty, nobody doesn’t understand that sleep is super important. That said, I get it’s easier said than done in today’s world and how fast paced it is. But I truly think if that’s the one thing you prioritize first, if that’s your first baby step, that’s going to be the one that has the biggest ripple effects to every life that we know, even a couple of nights of impaired sleep drastically affects your glucose levels, your hormone levels, your stress levels, everything gets harder when we don’t get enough sleep. And I know for moms, I have so much empathy because I’ve been there with the little ones. It’s hard at certain phases. Thankfully, I do think our hormones when we have newborns know how to adapt to get us through that, but that’s not a permanent phase. So to your point, when we’re able, then it’s important to refocus on sleep and rebuild those good sleep habits.

And this is why for me, that’s one area that I really prioritize, not just in the amount of sleep. I think that’s really important, but also my sleep environment, realizing we spend a third of our life sleeping. So anything I can do to improve sleep, whether it be the right temperature, whether it makes it completely dark, however, I can make my sleep more comfortable and deeper in the time I’m already going to be sleeping. I feel like that’s a worthwhile investment for my health no matter what.

And I’m curious your take on this. One thing I know that seemed to really improve my sleep, especially in that rebuilding phase, you mentioned vitamins and minerals. And I noticed for me, certain minerals made a huge difference. And when I started even just getting enough salt, but salt and magnesium made a drastic difference for me. Is that a commonality you see in many women that they can benefit from really focusing on getting enough minerals, a range of minerals, and then also getting enough magnesium?

Inna: Yes, so first of all, women who come to us with depleted adrenals will tell you they crave salt. So again, body wisdom, body knows what it needs to restore itself. And magnesium is probably the key ingredient in this whole magic sauce for restoring your adrenals and dealing with stress. Magnesium has several hundred functions in the body, but one of them is restoration and detoxification and cleansing and relaxation.

There is no relaxation in your body without magnesium being available.

And so having magnesium in a good form that is actually absorbable, whether it’s glycinate or malate, Certainly depends on situation, but magnesium has to be absorbable and it has to be enough of it. And really you need at least 300 milligrams to give yourself what you need. On average, I mean some women again, it’s one-on-one work, some we need more and some can get away with less. but you need magnesium for sure. For good night’s sleep, for relaxation, for your muscle, muscles to restore and relax and rebalance and just call me.

Katie: So I feel like we’ve gotten to delve into a lot of the foundational lifestyle things that again, I would argue, get these dialed in first, no matter what, no matter if you are in any of these phases, this will help you across all areas of health. But I know also as we move through different hormone phases and we acknowledge that there are declines that happen with age, there are also additional steps that women can take with things like hormone replacement.

And I think this is where there’s a lot of that misinformation and potentially fear and confusion. So I would love to dispel some myths and build some understanding around hormone replacement and if or when it can be helpful or if or when it can be necessary. So can you walk us through some of the foundation of that? Maybe when is a good idea to start getting tested, what we’re looking for, and then if a woman opts to do hormone replacement, what to look for in that path.

Inna: When to do testing. It’s certainly not mandatory to test everybody. When I shifted into menopause, all of a sudden, I thought I wish I tested myself way back when, when everything was perfect, so I would know what my body needs in terms of being balanced. You never try to replace back to when you were 20. You’re not going to get to those levels. That’s history. But just having an idea of what is the right ratio for you because it’s so individualized for each one of us.

And so can you test yourself if your doctor is agreeable to do it? Is it worthwhile to test yourself when everything is normal in 30s? Well, it’s a good thought. It’s certainly not mandatory. I would say when you start getting symptoms and you start wondering, would it be my hormones? That’s time to get tested for sure. And it might be at that point that everything is perfect except one hormone that’s out of balance. And that’s how perimenopause begins. It’s just one hormone that gets out of balance. And hormones all work together, they’re related. So one out of balance. Everything else doesn’t feel right anymore.

And so, the symptoms, mood swings, went to bite your husband’s head off, you know, wasn’t twice a month, I don’t know. Being emotional, having irregular periods, having too heavy periods, having very light periods, having periods with clotting, those are definitely the signs of hormonal imbalances. It would be worthwhile testing. In general, there are a lot of hormone quizzes online we do one in our practice as well.

But if you have a couple of symptoms of hormone imbalances, maybe you have imbalances, it’s worthwhile testing. If you have multiple, you get vaginal dryness, mood swings, you forget the words, you forget why did you enter the room, you forget three days where the keys are and we just had them. So forgetfulness, emotional rollercoaster, changes in your periods, all of those things should at least make you question, is it my hormones? There are multiple things that can go wrong, but could it be my hormones? And if it comes to your mind, is it what is happening with me is not normal? That’s first layer. Never assume that feeling bad is normal.

I remember seeing my Doc at 30 because that’s when I really very stressful life and I had few symptoms. And I came and my Doc said, and I said, you know, like this and this and this. And he said, well, you’re 30 now. And I thought, oh, maybe that’s how it feels to be 30. And I was dismissed. And then at 40, it was way worse. And I was there again and I was like, well, what do you want you’re 40 now? And I thought, gosh, I just cannot wait to be 50 then.

But you know, we often get dismissed and don’t let that happen. If you’re not here in one place, find the place where you’re hurt. If. You are not feeling right if things change, if you’re not feeling well, that’s not normal and there is a reason for it and that reason can be identified and tested as a first step. So not feeling well, get tested.

And when you’re periods as you get closer to age, every change of menopause in the US is 52, but a lot of women slide into menopause in their 46 to 49 range. So I will say in late 40s, your periods get… less and less frequent, definitely time to test yourself. Definitely for sure. So the more symptoms you have, the more you should think about getting tested. Get on that baseline, figuring out what is wrong, figuring out how to get yourself back. It’s not always about hormone replacement. Sometimes it’s like we said, it’s foundational things that need to get better. But you need to know what’s happening in order to know how to help yourself or where to get help.

Katie: That makes sense. And I know, like for me, I had the experience of after so many pregnancies in a row, I worked with a functional medicine doctor and did just even progesterone, topical progesterone for a little while. And that made a big difference in how I felt. Are there, for most women, is it that they need replacement of all of the hormones or is there more ones that tend to be more commonly depleted at different phases? Like for instance, does every woman find a benefit from testosterone or is it often a woman might just need progesterone or what do you find when you work with people on that?

Inna: So nothing is ever mandatory. Hormone replacement therapy really needs to be individualized. That’s the essence of hormone replacement therapy done right. And at different places in life, women need one or two or three hormones or four, it depends.

Usually, like you said, in younger women, progesterone is the first thing that goes. And so just giving them a little bit of progesterone cream helps a lot with bleeding and with many other symptoms. If the main issue is with sleeping, sometimes oral capsule with progesterone capsule before bedtime will make a major difference. So usually it starts with one hormone. And then as a woman gets wiser and shifts into her 40s, and things start changing further, then again, you need to see what is changing. A lot of women will make enough testosterone, all women will make enough estrogen until their postmenopausal. So really don’t replace estrogen before women begin menopause.

Progesterone is the first hormone that goes. We sometimes have to give it to women in early thirties and everything else is still normal. Testosterone, something that needs to be tested. And sometimes women don’t make enough in early 40s, and sometimes women will make enough, we even in menopause. So not everybody has to have all hormones. We have to test. There is no guesswork there. It doesn’t help. You have to test, you have to see what’s going on. You have to put it together with symptoms because at the end of the day, good provider will not tweak your lab numbers. Good provider will listen to you choose a story to the way you feel. And that’s what guides our therapy.

And if there are certain things that need to be replaced, we use labs to confirm what we’re hearing, not vice versa. It’s always about the person and the story and how they feel in their own body. And the lab says they’re to confirm our guesses and or rule out. And if it looks like the story and low hormone levels go together and it makes sense and we optimize lifestyle habits and nutrition and all that and it still doesn’t get them to optimal level, time to replace a hormone. So it’s not so much about the age, it’s really about the needs, how you feel in your body, and what needs to happen to help you to feel your best.

Katie: And I would guess many women have had an experience like yours in some realm with healthcare where they had symptoms and then they felt like they were dismissed or not listened to. So I love that your approach is to actually listen to the woman first and then use the data to help dial in based on what she’s actually feeling, not the other way around. I think that alone is a paradigm shift that is long awaited and so important, especially for women.

It seems like for premenopausal women also estrogen can often be high as well. Like women will have conditions where estrogen is high. Do you see that as well? And obviously you can’t take away estrogen directly like you can supplement with it, but I know there are things that can help reduce excess estrogen if a woman has too much. Can you speak to that a little bit?

Inna: Yeah, so it is true that especially towards the end of perimenopause second part of the perimenopause, women are in their second part of 40s, they start experiencing symptoms of estrogen dominance. And they start gaining weight around their hips and mood swings and all that. And the reason for that can be, occasionally, in some cases, women truly have higher estrogen levels. And then we have to look why is it, what is the reason for that? In women who have constipation, that’s almost guaranteed because estrogen is eliminated through your gut and so if she’s constipated then she keeps recycling your estrogen over and over again in addition to what your body makes every day. And so we need to restore normal gut functions. That’s important.

Sometimes estrogen breaks down and that’s genetically determined. Sometimes estrogen breaks down in unfavorable way and then there are supplements that will help block such pathway and shift all estrogen towards good pathways so we get benefit of it and not subjected to the risks.

Most of the time when I see estrogen dominance is really when progesterone is deficient. And so estrogen by itself is just fine when not trying to lower it. But it’s progesterone that becomes so deficient towards the second part of perimenopause that now estrogen and progesterone work together as they counterbalance each other. It’s sort of like estrogen is fire and progesterone is water. And when there is the right balance, they play together and it feels good in the body. When progesterone goes way down, there is nothing to balance the estrogen, so it’s relative dominance. So you don’t really want to bring estrogen down. You want to bring progesterone up. And that’s the time where you actually give. as a progesterone replacement to restore that balance. And it feels great and estrogen helps you look great. Estrogen is needed for your brain, for your bones, for your heart. Estrogen is extremely important. So you don’t want to necessarily bring it down. You just want to balance it.

Katie: Got it. And understanding that there’s that elimination component and if your body is not effectively eliminating, that’s going to also affect your estrogen. Seems like it’s back to those foundational habits of getting enough sleep, hydration, minerals, and also things just like fiber and green vegetables, things that are going to help move that more efficiently.

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And also when it comes to testosterone, you mentioned that exercise can be a component here. And I’ve had this experience where as I’ve now gotten through my rest phase, I feel like I have much more energy and I’m lifting weights really consistently. I’ve noticed that my testosterone is trending upward. But I know this is also something some women will choose to replace. Is there a good guide for knowing when or when not to consider testosterone replacement?

Inna: Always start with foundation first, good life habits, making sure you exercise, making sure so for women, women’s body is extremely sensitive to the environment and to stress. And so if she is not exercising, it’s stressful for the body and the cortisol goes up, the testosterone goes down. If she’s over-exercising, cortisol goes up, the testosterone goes down. And so it’s almost counter-intuitive. A woman tries to look better and feel better, and so she’s exercising, then she gets results, and then she pushes it one notch up, because that’s what we all do. And she did so well with 30 minutes, how about an hour, and how about an hour and a half if she has time. And there is a line where too much of a good thing becomes a bad thing, and body gets stressed out, and testosterone goes downhill. So before, and so that’s body compensating actually. And so you don’t want to replace testosterone in that environment. You want to get your exercise to the reasonable levels that are good for your body, not bad.

And so when there is a question whether testosterone needs to be replaced? Again, get the symptoms, you hear how she feels. Maybe you question maybe the testosterone is low. and you test and you see it, you really have to go through the history and see are there foods that needs to be, is nutrition needs to be optimized, is lifestyle supporting the good levels. And if all of that is already in place or you can work with her to get those things balanced out and she gets enough sleep. In other words, she gets stress level in her body low enough that body can prioritize making sex hormones. And we often see that just with those foundational things, testosterone will come up. You don’t always want to replace it. Your body goes first. It has its wisdom. So if testosterone is low, you always ask why before you just shell it inside the body.

But if you see that it’s truly just decreased production and everything else is already optimized, at that point, certainly you can replace testosterone and you measure the levels, I usually start low, I’m conservative, I don’t want any risks, I want benefits, and so we start low, we increase according to the symptoms and to the benefits and to the level. Of course, we always test and retest and see where we’re at. Body can use testosterone to make estrogen, so body will not just passively accept what we put in. It will decide what the needs are and it can change things and make one out of another. So you will never overpower body’s wisdom. That’s why it’s so important to honor it and figure out what’s going on and where we add before we start adding things.

But if we’re at the point where we know that testosterone replacement is needed. You replace, you measure. and you measure, you talk about symptoms or assess the symptoms and you measure the levels. and you get to the place where it feels good. You make sure that it breaks down in the right way and that’s where women stay. And there is no age, number to the replacement per se. There are women who will need it in their 30s and even guys sometimes need replacement at very early age. It’s not typical but we see it. And since there are women who will not need replacement until age 52 or even later.

Katie: And it seems like in the experience of women who do hormone replacement, it seems like often they find huge benefit and feel a lot better, but it does seem like some women will have a negative experience with this. At least I’ve heard from a few. So why does it seem like some women feel great on hormone replacement and others feel like they don’t feel better or even feel worse?

Inna: So several things that come into this, the way how it feels. One, what are the dosages? Are you on the right doses? Are you on the right levels? Do you get, is it not enough for you? Is it too much for you? You will not feel well in this group. It has to be just right in terms of the amount.

Second, are your hormones in the right balance? Because again, they all work with each other. It’s not, we test isolated one hormone, but there is no circumstance in your body when one hormone works by itself. They’re not working in vacuums. They all interact, they talk to each other, they influence each other. So sometimes you get seemingly the right dosages for hormones, but if they are not in the right balance, just like we talked about estrogen dominance, I can give estrogen replacement to women in menopause. and she goes through the point of feeling great and then things get worse, she gets bloated, she gains weight, she gets breast tenderness, in other words, she is getting estrogen dominant. It could be that the dose is too high, or it could be that she doesn’t get enough progesterone to counterbalance that. So it’s complex and you have to look at the context of the whole body, at the whole, at big picture, not at just one hormone.

And we start seeing side effects when there is wrong balance, wrong dosage, or if hormones went into the unhealthy environment. Because like I said, hormones are small, it’s one piece of the puzzle. It’s really icing on the cake. It’s not the solution for everything. You have to have the foundation for hormones to work well. Hormones have to come into a healthy body. And so if gut or liver or both are not working well, than just throwing hormones there and not going to help you feel good. And that’s how we often see, you know, when hormones come to the healthy body. You really need low doses to feel good. The more out of balance an inflamed body is, the higher dosages you have to drive your Hormones to, to even experience the effect. And at higher doses, of course, you will start experiencing side effects as well. And so it’s very important to make sure healthy environment, i.e. healthy body, right balance and right doses.

Katie: Got it. That makes sense. And I know this is going to be maybe the most controversial thing we touch on, but I know many women are hesitant to do hormone replacement because they’ve perhaps heard that it can be linked to increased risk of cancer. And so I feel like this is really important to address even just briefly to understand because I think we’ve made a strong case for this can be very helpful for a lot of women, but certainly nobody wants to jump into higher cancer risk either. So what is the real story when it comes to hormone replacement and cancer risk?

Inna: So when I started practicing in early 90s, yes, I’m that old. We knew that hormones are very important for your body. And back then in 90s, all postmenopausal women were actually placed on, not all, but most, were placed on hormone replacement. And we knew that it prevents urinary tract infections and it prevents decreases incidence of dementia and heart disease. So it was all great.

In 2002, we did this big study, it was called Women’s Health Initiative. And that study was designed to prove that firm hormone replacement therapy is actually beneficial for women. What we learned in the study was that there was some set of women that had higher incidence of breast cancer. And we went into share panic and it was on the news and it was 2002 and whole content was on every news channel in every journal and everywhere and overnight women were taken off hormone replacement. And I personally believe we did such a disservice. In fact, recently I just saw a patient in my practice. She’s in her 80s, she’s certainly not on hormone replacement. She has severe osteoporosis, history of multiple bone fractures. She’s wearing braces. Her dream was to travel the world. She worked really hard. Now that she is retired and has money to travel, she can’t, she cannot do it for health reasons. Wearing braces, this surgery, that surgery. It’s just, she says, every time I turn around, it seems like I get another injury. And we talked and she said, you know, way back when, 30 years ago, when I went through my menopause, I was placed on hormone replacement therapy. I was like, I didn’t have any side effects. But then that big study came out. And I was taken off hormones the very next day by my doctor and my life was never the same again.

And I just had this whole body experience. It was, we took whole generation of women and we basically had them experience all symptoms of menopause and suffer needlessly and suffer through all diseases of aging just because we made an earnest mistake. When we went back and looked at that, so what we what we learned about that study later on, when we looked back, first of all those women were not on bioidentical hormones. In other words, they were not hormones that are exactly the same that made they were synthetic drugs that were mimicking hormones in your body.

So for estrogen, we used Baxen, we used Premarin. And Premarin comes from nature. It’s basically horse estrogen. It’s just not human estrogen. And we gave it orally, and we gave the same dose to all women, because that’s all we had. We had one drug, and so everybody got the same dose. And for some women it was too much, for some it was too little, it was unfortunate. That’s all we knew and had at that point. Half of the women who didn’t have uterus got just that. Second group of the women who had uterus got that plus synthetic progestin. It wasn’t progesterone, it wasn’t bioidentical, it wasn’t the hormone, it was a drug that had some properties of a hormone, but not all of them.

It turned out that actually the group that got progestin had a little bit higher incidence of cancer, breast cancer. When you look at the numbers, it wasn’t huge actually, it was less than 1%. So 99% of women were taken off that, for the sake of protecting 1% of women who did have high incidents of breast cancer. But bottom line is it wasn’t by identical hormone, it was a drug. It was synthetic. And when you look further into that study, those women were in their seventies on average, so they were much older. So, and hormones were given orally, which we know for estrogen, oral route is not great. It puts them at higher risk for clotting and when it takes it at a younger age for birth control, it’s one story. Your risk for clotting is very low at 20, but when you take women at 72, naturally she’s at higher risk for clotting. You give her oral estrogen, of course you will increase your chances a little bit.

And so that study, unfortunately, initially the way it was misinterpreted, created this huge fear and hormones were demonized and for many years women were not doing anything. And even now, Docs who are trained way back when and experience that, you know, study coming out and learn that hormones are not good for you, they still, they will still tell you the same thing. My GYN when I was going through menopause, said whatever you do, don’t go on hormones. You’ll gain, you’ll get fat. You will gain weight, you will get clots, you can get cancer. She’s really good GYN, she’s a great surgeon. She was just not trained in hormones and all she knew was that study.

Well, there were several studies done since then when we tried to look into hormones, and even looking at that study, even though in progestin group we had a little bit higher incidence of breast cancer, but overall in that study women had 42% less risk of death if they were on hormone replacement therapy. Even with less than perfect, non-bi-identical oral route, they still had benefit. They had less osteoporosis, less bone fractures. less lung cancer, less colon cancer. So they have benefits even with less than ideal hormonal replacement therapy.

And we looked into it, North America Menopause Society issued a statement, I think, three years ago or where they talked about ages. And at this point, we know for sure that bioidentical hormone replacement therapy is actually very beneficial. Women 50 to 59 years old, women who are anywhere from six to 10 years postmenopause within that window, if you put them on hormones, you actually reverse a lot of aging processes that already happen. If it’s beyond 10 years, if women were menopause, post menopause longer than 10 years, they will Um, you, you cannot really reverse everything that happened in 10 years, but you can modify or decrease the risk going forward. And we’re talking about less risk of heart disease.

And at the end of the day, when you look at national statistics, most women do not have breast cancer. 50% of us are going to die of heart disease. And estrogen is extremely important for prevention of heart disease. So we really don’t have proofs that at this point that Estrogen is really going to die. Hormones cause cancer. We know that progestin will increase your risk and that synthetic drug shouldn’t be used for hormone replacement therapy anyway. We know that there are different types of estrogen and some are, if woman already has cancer, hear different stories very different risk and should be done or at least it should be discussed and run by oncologist etc. If women has every female in your family dying early of breast cancer against all different story and it’s all different discussion and risk, etc, probably shouldn’t be done. But if she’s healthy and she’s doing what she needs to be doing to stay well. And she wants to use hormone replacement therapy. Benefits of far outweighed in the risk. And that was a statement by North America Menopause Society, I think in 2019 or 20.

So overall, I think consensus at this point is getting to the place where hormone replacement therapy is beneficial. It has to be done, right? there are right routes, there are right doses, history has to be taken and evaluated very thoroughly. It has to be decided one-on-one basis, but overall I think hormone replacement therapy has so many benefits of stopping biological clocks, maybe reverse it a little bit. Definitely preventing or slowing down diseases of aging, which ultimately dementia, heart disease, osteoporosis, bone fractures, those are the things that change our quality of life dramatically in our last parts of life, last parts being 20, 30, 40 years sometimes, so it’s important. Quality of life is huge.

And I don’t think at this point we have any proof that hormones cause cancer. Estrogen can feed specific type of breast cancer that is estrogen sensitive, that has estrogen sensitive receptors that’s already in place. In other words, if one has breast cancer, like I said, that’s not time when you’re offering hormone replacement therapy. But as far as we know, so far we do not have any data that shows that estrogen would cause breast cancer. In fact, we have opposite.

Katie: Well, I think you explained that perfectly and you answered my question from earlier too about how hormones relate to diseases of aging and how they can increase or decrease risk. I think it makes a very strong case for women at least testing, having a baseline and keeping an eye on this in a personalized way as we get older at every various phase to really take into account both the symptoms and the data and hopefully have the best outcome for each individual woman.

And I know you have many more resources available online and through your private work that people can find and access. I will make sure for all of you guys listening, all of that will be at wellnessmama.fm. So if you want to keep learning, like I said, you have a ton of educational resources, much more than we can cover in a one hour podcast.

But a couple last questions I want to make sure we also get to touch on. The first being if there is a book or number of books that have had a profound impact on you personally and if so, what they are and why.

Inna: Well, first book that had a big impact on me was the book by Christiane Northrup, Women’s Bodies, Women’s Wisdom. And the reason it was so big for me, I found it somewhere around 2009, I believe. And she’s a doctor, she’s an MD, she’s a GYN, so she was a colleague. Her view of woman’s health was so different from anything else I’ve ever learned or experienced before. I think she was really the first physician who had wealth of experience in conventional medicine, who put together physical health with emotional and spiritual health and connected it and showed very clearly that woman’s health is not just determined by physical health, that there is way more to it and it’s all connected and you cannot disregard emotional and spiritual health and disconnected from the body because you cannot access everything from the body and you cannot get the best results. It has to be women’s health, has to be looked at as a whole, whole person, not just what the symptoms, what the lab tests.

So that was one book and that’s… Later on, I went to study Chinese medicine and Ayurvedic medicine. I just wanted to have different healing traditions view of women’s health. And I think she was an inspiration for me. It was almost like getting a permission from a colleague to say there is more to health and wellness than just physical body and it cannot be disregarded. It has to be known and incorporated in your approach to women’s health.

Second book that really determines what I’m doing now is the book of Suzanne Somers, Sexy Years. And I accidentally ran into the book by standing in line in compounding pharmacy, actually picking up my mom’s medication and there was a line and I had to kill time and there was a shelf on the side with several books on it, and one book was called Sexy Years, and it sounded sexy. So I pick up the book and open that randomly. And I started reading and I just couldn’t stop. And it was about hormones. And while by then I had what, 27 experience in medicine, 25? That was not the, that’s not how I learned hormones. That’s not what I learned in medical schools. And even with my FM experience by them, I still did not understand hormonal health and women’s health to such depths.

And I just assumed it was written by a doctor. So I guess it was just assumption because the book was so well referenced. I got home and I purchased the book and I downloaded it and I was reading it. And then at some point I had no, I didn’t grow up in the United States. I had no idea who Suzanne Somers was. You know, I didn’t know celebrity. And so I Googled her and I said, Suzanne Somers MD. And there were multiple interviews coming up on. Google and she was interviewed by MDs. She was not an M.D. and I was so surprised to learn that she was actually a celebrity, and not the doctor, but I so appreciate that her being so brave, I’m coming forward and saying I understand mainstream medicine is saying this, but this is my experience, my tools, and nobody can deprive me of feeling well, just because right now this is not the guidelines. And so she was brave enough to open that subject and make it public. And maybe because she was celebrity, she was able to gain traction more than probably doctors would be. But bottom line is, first of all, it resonated with what I was experiencing in my body and wondering what in the world is happening to me.

Her book was very well written and after reading that I was like, I just need to learn more. And that’s how I ended up in A4, I am studying hormones and. The more I delve into it, the more I realize. How much I was already practicing functional medicine, I just didn’t use hormones. I did everything else. And I could see how we get strong foundation and everybody gets better and even hormones balance get better, but it only goes so far. And it was a missing part in my practice and I felt that I just didn’t know how to change it and where to look for. And so because of your book, I found that missing piece and I added it. And I can tell that now that I’m practicing it and adding it to our wellness programs, goodness, we have so much better results and women are much happier and they’re feeling better and they’re looking better. I think it was so deserved.

Katie: Well, I love that. I will link to those books as well in the show notes for you guys listening. And lastly, any parting advice for the listeners today that could be related to hormones and everything we’ve talked about or unrelated life advice that you find helpful.

Inna: Well, never take no for an answer. If you’re not feeling right… It’s true, it’s real, don’t let anybody tell you it’s on your head. Um, there is a reason that got into your head. You’re experiencing it in your body. So if somebody says no, or calls it normal. It just means that they are not the right people to work with you. They don’t know. We don’t know everything. We know what we’re trained in. And no matter how much you train, there is only so much… you learn in traditional, in conventional medicine. And so just because, and even with functional medicine training or anything else, there’s only so much you learn.

And so if somebody comes to you and saying, I’m feeling, I’m experiencing this and I don’t know, it honestly means I don’t know. It’s just we’re not trained to say I don’t know. So instead we’re trying to convince you that that’s normal because you’re 20, 30, 40, 50, whatever it is and we justify it. Don’t take no for an answer. I had so many clinical experiences in my 30 years of practicing medicine, traditional and then functional. There is so many things that seem to be impossible, that become possible with the right guidance and the right resources, and the good combination of things. And so there is always a solution. I honestly, part of it is also what you believe for yourself. So if you believe that everything is possible and you deserve to feel well and there is a way to feel well, you will find a solution. And if somebody says, no, it’s impossible, move on to the next one. Don’t waste your life, it’s short.

So that’s probably the biggest thing I learned in my life experience and clinical experience. And I just want every woman out there to stand for herself and know that she deserves to feel well and feel her best and then care what age. It’s not about age. Age is a number. It’s all about your energy and outlook on life and being able to live the life you want. And there is always ways to get there. And if somebody cannot help you get there, find another one.

Katie: I think that’s a perfect place to wrap up for today. Dr. Inna, thank you so much for sharing so much wisdom today and for all the work you do for women. I’m very grateful that you are here and thank you for your time.

Inna: Thank you so much for having me here, Katie.

Katie: And thanks as always to all of you for listening and sharing your most valuable resources, your time, your energy and your attention with us today. We’re both so grateful that you did. And I hope that you will join me again on the next episode of the Wellness Mama Podcast.

If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.