Welcome to Everyday Wellness Podcast. I'm your host, nurse practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. this is the start of a new thursday series called the midlife minute that is really designed to address listeners questions in a little bit longer length of time and or deeper dive into topics ideally we're going to keep these podcasts under 20 minutes occasionally we make over to 30 but I'm trying to reinforce some key concepts and ensure that I'm addressing listeners questions in a way that's really helpful. So the questions that I will be addressing topics are going to be items that I'm being asked over and over and over again. I hope you enjoy this series. Please share with your friends. And as you know, you can always send your questions to support at Cynthia Thurlow.com. I appreciate each and every listener. Okay, this is the first official Midlife Minute of 2026. And the most requested recent thing I've been asked is what is my current hormone replacement regimen? So today it's gonna be devoted to unpacking exactly what I do, both transdermally, orally and topically for hormone replacement therapy. So it's probably not surprising that I have the basics. And then I have more than the basics. And I will share at the end an idea that Dr. Felice Gersh just gave me about an additional topical option that we can use for facial skin. But let's talk about my basics. And as I tell everyone, you want to major in the majors, these are the things to dial in on first before you even think about adding additional items. So number one, I'm taking a Dottie estrogen patch, 0.05 milligrams. I have a feeling when I check my labs that I will probably need to increase this because we've been watching my estrogen levels kind of trend a little lower than we want them to be. Personally, I want to see my estradiol levels greater than 80 picograms per ml. And on this dose, I may need to jump up to the very next dose. But I will keep you posted because I'm having labs drawn next week for my provider. And I think the important thing about estradiol is this is the most potent form of estrogen that our bodies make prior to menopause. the reason why an estrogen patch works better for me personally, and I had been on compounded biased before, and I was just annoyed with having to rub so many creams on my body. And for each one of us, we have to decide what works best for us. And for me, I was tired of rubbing testosterone and separately estradiol cream into my skin. And to be totally transparent, my levels were nowhere near where they needed to be. And I was having a lot of skin itching. and as we all know, itching is not fun. So on the Dottie patch, I've done much better. I do feel better. I feel like my brain is a little bit clearer when I'm trying to articulate my thoughts, which I do all the time. And so estradiol patches have worked better for me. You that may be listening, I say you as in my community, each one of you may find that there's something different that works better for you. Some of you may be on a gel. Some of you may be on a patch. Some of you may be on a compounded option. Some of you may be on an estrogen ring inserted in the vagina because you're just having localized as opposed to systemic effects. Number one, I like estradiol for bone health protection as primary prevention for osteoporosis. I already have osteopenia. Some of it is related to just genetics. I'm thin-boned. I'm a female Caucasian. I am more likely to be prone to thinner bones. I do everything I can, both with lifestyle and I have my patch. We also know that estradiol is really important for reducing our risk of developing cardiovascular disease. I'm very metabolically healthy. I do have an elevated LP little a, which I've talked about on the podcast a lot. I take Zetia to lower my ApoB, and that has worked really well. It is a localized drug. It is not a systemic drug. It's cheap. It's inexpensive. And to me, because I'm a hyperabsorber of cholesterol, it has worked beautifully. But my main concern for utilizing estrogen and talking to you all about it, number one, bone protection, heart protection. We're still evolving research on brain health protection, but it's looking like it will trend that direction. And certainly with regard to the gut microbiome, it sounds like the research is leaning in the direction that utilizing estradiol is going to be beneficial both for its immune regulating properties. And we know that our immune system takes quite a hit as we are navigating perimenopause and menopause but also really important just for nitric oxide production et cetera You going to ask me what are the values We don know yet We do know definitively with bone We definitely want to see our estradiol levels greater than 60 Some people even like it closer to a hundred picograms per ml. When I interviewed Dr. Lindsay Berkson for the second time, she was talking about making sure estradiol levels are high enough so that we can support hippocampus volume. And that is a very important memory consolidation area in the brain. No specific research on that. She also talks a lot about our FSH being low. Last time I checked my FSH, it was greater than 70. So it's not considered to be low. I think for each one of us, there's very much a Goldilocks effect. So don't get caught up in the numbers. I would focus on how you feel. Next is testosterone. And I've been speaking very openly that I've been using androgel. And this little packet is 1%. And I'm supposed to put a pea size amount on my skin. I usually rub it on my lower leg. I do that daily. And this packet should last me ideally 10 days. Sometimes it's eight days, some days it's nine. I don't stress over it. I just cut a corner off and I like on an angle, and then I can measure it out pretty easily. But I got an entire bag of testosterone gel this fall, and I'm still using it. So it's incredibly cost effective. This cost me $5. My Dottie patch cost me $5. I realize not everyone has their insurance set up that it's that way. And I'll be totally transparent. I have great insurance. I hate CVS. CVS, if you're listening, as a prescriber, I hate working with you. And as a patient, I hate having to have my prescriptions filled through them because almost always there's a backlog for hormone replacement therapy, which is a never-ending source of frustration for me personally. But why I think testosterone is really important. everyone thinks of it as a libido thing. It's a sexual health thing. Yes, that's important for that. But it's also important for executive function, drive, focus, body composition. For me, I can tell my testosterone levels are where they should be because I'm very motivated to do this stuff, like get the stuff done, get shit done. I'm all about that. So testosterone for many reasons. If you're a woman in midlife or beyond, you'll probably notice those changes in energy, strength, and recovery just don't feel like they used to. And what's frustrating is that for many women, this happens even when you're eating well, lifting weights, prioritizing protein, and doing all the right things. You're not lazy, you're not unmotivated, and you're not doing anything wrong. A big part of what's changing actually starts inside your cells. As we age, our mitochondria, the energy producing structures inside our cells become less efficient. And when mitochondrial function declines, it can show up as lower energy, slower recovery, reduced muscle strength, and feeling less resilient overall. This is a normal part of aging physiology, and it's one of the reasons midlife can feel so different. And that's why I've added MitoPure gummies from Timeline Nutrition into my daily routine. MitoPure is the only clinically proven form of urolithin A, a compound shown in human clinical trials to support mitochondrial renewal. In simple terms, it helps your cells do a better job of making energy. And when your cells have more energy, your body is able to support strength, endurance, and recovery as you age. What I appreciate most about Mitopure is that it's foundational, not flashy. This isn't a stimulant or a quick fix. It's a daily habit that supports how your body actually works at the cellular level. And the gummies make it easy. They're just two sugar-free gummies per day. They're vegan and cleanly formulated. They're independently tested and certified for quality. And if supporting your energy, muscle health, and overall resilience as you move through perimenopause and menopause is important to you, MitoPure is worth considering. You want to go to TimelineNutrition.com slash Cynthia and use code Cynthia Thurlow for 20% off your order. Again, that's Timeline.com slash Cynthia and use code Cynthia Thurlow for 20% off your MitoPure gummies. If you're in your 40s and 50s and feel like your body suddenly stop responding the way that it used to, you're not imagining it. Bloating, weight gain, sleep disruptions, food sensitivities, and unpredictable energy are incredibly common in perimenopause and menopause. But here's what most people aren't told. Your gut microbiome is changing right alongside your hormones. And those changes can influence everything from how you store fat to how well you sleep to how your body processes estrogen. That's exactly why I wrote my new book, The Menopause Gut. In this book, I walk you through the science of how the microbiome, metabolism, immune system, and hormones are all connected during midlife. But most importantly, I give you practical, realistic strategies you can start using right away without extreme diets or complicated protocols. You'll learn why the same diet that worked in your 30s may not work now, how your gut influences hot flashes mood and weight the truth about fiber protein and blood sugar and midlife and the daily habits that help your body feel safe stable and resilient again If you tired of blaming yourself for changes that are actually biological this book will help you understand what really happening and what to do about it You can pre-order The Menopause Gut wherever books are sold. And when you do, be sure to check out the special pre-order bonuses I've put together for you. Again, you can go to www.cynthiatherlow.com. You'll click on the banner. It'll take you to multiple options for where you can order the menopause gut in presale. Progesterone. Now I take oral compounded sustained release progesterone. There are other options. I have taken oral micronized progesterone. That's generic. It's super inexpensive. I think it's anywhere from five to $9 a month. I wanted the sustained release. So I have to pay extra for that. And this is 90 quantity of 90. This is compounded through PD labs, which is located, I believe in Texas. And I take 200 milligrams a night. I do that six days a week. I give myself a break on Friday night. I still sleep really well. And a lot of that is done just to kind of give those receptors a break. But oral micronized progesterone is one option that's generic. I wanted sustained release, which is why mine is compounded. And if it's compounded, you can pick any amount. Like I have friends that are on 50 milligrams, a hundred milligrams, 200 milligrams. Why am I on 200 milligrams? Because that's where I started when I started taking HRT five years ago. So that is where I am. And after my conversation with Dr. Felice Gersh, I've given more thought to whether or not I'm on too high of a dose, but whatever dose you're on is the right dose for you. And definitely talk to your prescriber Next. So let's talk about, oh, and before I forget, why do I take progesterone? You know, obviously for sleep support, I think progesterone is really helpful for falling asleep, has a nice sedating effect. You get this upregulation and allopregnenolone, which is a metabolite, which can be very sedating. And, you know, for me, I take my progesterone and I'm feeling sleepy within 10 or 15 minutes. So it works pretty effectively. With that being said, I have other people that feel like they need progesterone for like mood. Maybe they have more anxiety. Maybe they have more depression and perimenopause or menopause. That was never like really part of my mid to late perimenopause issue, kind of an issue in the beginning. I didn't recognize it as such because I was still probably in my late thirties, but now understanding, I think a lot of why I personally take it and whatever the indications are for you is totally fine. We're all individuals. I find that progesterone is great. So those are my, what I refer to as my core. And then from there, I talk a lot about the value of intravaginal products. And so I have a compounded product. I'm going to show it here. And so this is estradiol, estriol, which is a weaker form of estrogen, testosterone, and DHEA. Now, and this is inversabase, which is one of the common ways that these medications are compounded in. It's a base that's very easily absorbed. it's not messy. And the reason why I have a combination of two estrogens and then also testosterone and DHEA is we know that estradiol is certainly very important for, I remind people that part of the genitourinary symptoms of menopause, what drives that is the loss of estrogen that impacts pH levels, that impacts the quality of the bacteria, specifically lactobacilli that produce mucus. So it's helping to bolster that. But what's interesting is the research certainly suggests that DHEA and or testosterone, they're part of the androgen family, that they're very important for that muscular layer. When I started taking this particular preparation, I found like I was waking up less at night. I don't even use the applicator anymore. I know so many of us have applicators. Mine's still encased in plastic. I don't use it. I just put it on my finger and then I can rub it internally and externally. And to be totally transparent, is just much easier to apply. And then you can be very specific. If you have an area that's sensitive or uncomfortable, you can apply more in that area. And that's worked really well. So you're probably gonna ask me, what is the breakdown of these medications? So I'm looking at this right now. I don't have my glasses on. So for EstroDial, it's 0.0375 milligrams. For Estriol, it's the same. For Testosterone, it's one milligram. and then DHA is 2.5 milligrams per gram. So in each one of these instances, it's milligrams per gram. And, you know, I can just click this. It's supposed to be four clicks is one gram. What I do is, you know, anywhere from two to three clicks is what I use on a daily basis. This will last me several months. This is compounded. This is also from PD Labs, which is located in Texas. A lot of whether or not you can get certain prescription or compounded pharmacies to send stuff to your areas, they actually have to have a license in your area. So depending on where you are in the United States or abroad, you may need different compounding companies and obviously your licensed prescriber knows who they like to work with And this is one of many Next fun things So things that are not necessary but I do think are helpful And I actually pulled up some research and I going to include it in the show notes. So for any of you that want to nerd out on the science, I have a copper peptide topical cream that I use. I try to alternate. I also have a copper peptide cream that also has DMAE in it, estriol and hyaluronic acid, which I find a little more hydrating. Right now it is cold, unseasonably cold in Virginia. Like today when I was walking my dogs with my husband, I'm always game. Any time of the year, walk the dogs longer, fart. It was really windy. The snow that fell yesterday was whipping up into my face and I said, forget it, we're going to go back. So I've been using a more moisturizing product. So let's talk about copper peptides. We know that like every other thing else in our bodies naturally declines with age. And so the clinical studies have shown that it stimulates collagen, it improves skin thickness and elasticity, and then it reduces fine lines and wrinkles. In one study topical and the way that it's written, it's GHK-CU. So copper peptide, copper is CU, increased collagen production in 70% of treated women and improved overall skin appearance. So you can use it by itself, like I have this option, or you can use it together with these other options. So estriol is a weaker form of estrogen, helpful for skin elasticity, improved moisture retention, which so many of us struggle with, especially in the winter. And some trials report 61 to 100% reduction in wrinkle depth and pore size after six months of use. So again, it's not like you use it once and you see the improvement that's cumulative over time. And I'll give you the breakdown of percentages on this product so that you have that as well. DMAE is a compound studied for its skin firming effects. Also important for skin tone and firmness, reduces wrinkles, enhances overall skin appearance. And the hyaluronic acid I think is really cool because it holds up to a thousand times its weight in water. So it's very moisturizing. And this time of the year, I feel like I really need it. Again, it's the dryness symptoms that this is really helpful for. So I'm going to read out exactly the percentages. So DMAE is 3%. Estriol is 0.3%. GHKCU, which is the copper peptide, 0.2%. And then hyaluronic acid is 0.5%. Like I mentioned, in winter, I'm using more of this combination copper peptide product because it just works better. Obviously, I use the copper peptide. I typically will use it at night. I usually will wash my face. Me personally, I usually put it on my face next. I let it dry and then I layer in whatever else I need. The copper peptide by itself is really light. Depending on the pharmacy, this actually comes from South Lake Pharmacy, which is based out of Florida. Again, depending on where you live, maybe dependent on where these companies can ship things to. I think the biggest thing to mention is this is what I do. You find what works for you. I do find most women benefit from estradiol therapy, plus or minus some testosterone, and then some progesterone. Almost everyone will eventually need intravaginal estrogen of some kind and there are some really inexpensive options. They're a prescription, but you can get intravaginal estradiol that is really inexpensive. There's also products like Dr. Anna Kabeca's Jolva, which is DHEA and coconut oil and some other, I think it's coconut oil and some other very soothing options that are available. But I find even for people who are cancer survivors, that intravaginal products are game changers. I see a lot of women who wake up at night because they have a lot of nocturia, which is a fancy medical word for getting up at night to pee. And we don't want that to be our norm. So I know that when I'm doing a really good job with remembering to take this six days a week, I don't get up at night to pee. And I don't know about you, but my sleep is so precious that the last thing I wanna do is have to get up multiple times a night. This is my current HRT and skincare regimen that involves hormones and peptides. Keep your questions coming. Remember, you can send your questions directly to support at CynthiaTherlo.com. We also have a free Facebook group. It's called The Midlife Pause, backslash my name. It's a group of women. There are some men in there as well, but they're in there because they want to support their spouses, significant others. When we hit 15,000 in that group, I'm going to do some fun giveaways. So just know that community is growing. I'm really proud of it. There are some really dynamic women in there who like to ask really great questions. So I appreciate each and every listener. Keep your questions coming. If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.
