#253 ‒ Hormone replacement therapy and the Women’s Health Initiative: re-examining the results, the link to breast cancer, and weighing the risk vs reward of HRT | JoAnn Manson, M.D.

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In this special episode, Peter addresses the common questions about starting or returning to an exercise routine over the age of 50. Individuals in this age group have frequently reached out with questions about whether it's too late to start exercising and often express concern over a lack of prior training, a fear of injury, or uncertainty about where to begin. Peter delves into the importance of fitness for older adults, examining all four pillars of exercise, and provides practical advice on how to start exercising safely, minimize injury risk, and maximize potential benefits. Although this conversation focuses on people in the “older” age category, it also applies to anyone of any age who is deconditioned and looking to ease into regular exercise.

We discuss:

• Key points about starting exercise as an older adult [2:45];
• Why it’s never too late to begin exercising and incorporating the four pillars of exercise [5:45];
• The gradual, then sharp, decline in muscle mass and activity level that occur with age [10:00];
• The decline of VO2 max that occurs with age [15:30];
• Starting a training program: exercise variability, movement quality, realistic goals, and more [18:30];
• Improving aerobic capacity: the malleability of the system, the importance of consistency, and setting long-term fitness goals [25:15];
• Starting cardio training: base building, starting with low volume, and zone 2 training [30:45];
• The critical role of VO2 max in longevity [36:45];
• How to introduce VO2 max training to older or deconditioned individuals [46:15];
• Options for performing zone 2 and VO2 max training [53:45];
• The ability to make gains in strength and muscle mass as we age [57:00];
• How to implement strength training for older individuals [1:01:00];
• Advice for avoiding injury when strength training [1:07:30];
• Risk of falls: the devastating consequences and the factors that increase fall risk [1:12:15];
• Mitigating fall risk: the importance of foot and lower leg strength, ankle mobility, and balance [1:19:45];
• Improving bone mineral density through resistance training [1:24:30];
• The importance of protein in stimulating muscle protein synthesis, especially in older adults [1:31:00];
• Parting advice from Peter [1:34:00]; and
• More.

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In this “Ask Me Anything” (AMA) episode, Peter provides insights on a broad range of important topics. He delves into the prevention of cognitive decline, the link between cardiovascular disease and Alzheimer's disease, and methods to lower blood glucose, insulin, and apoB. He also addresses nutrition-related queries, exploring the impact of dietary habits on weight loss and longevity, how a person can identify the best diet for themselves, and common nutrition myths. Additional discussions include optimal blood pressure, daily step goals, the benefits of standing versus sitting desks, and much more.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #60 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

• Overview of topics and episode format [1:40];
• Preventing cognitive decline [5:00];
• How to lower blood glucose and insulin [13:30];
• The relationship between lipids, CVD, and Alzheimer’s disease, and whether statins can increase the risk of neurodegenerative disorders and AD [23:15];
• Reducing apoB levels through exercise and diet [31:45];
• Pharmacological options for lowering apoB [38:00];
• How nutrition impacts longevity via metabolic health, muscle mass, BMD and more [40:15];
• How can someone determine the best diet for themselves? [43:45];
• Nutrition myth: All weight loss is good [46:45];
• Nutrition myth: Metabolic rates are dramatically different among individuals based on genetics [49:00];
• Nutrition myth: Losing weight after a brief period of overeating is impossible [53:45];
• Nutrition myth: GLP-1 agonists are a replacement for a healthy lifestyle [57:45];
• Nutrition myth: There is a single best diet for weight loss [1:03:00];
• Nutrition oversimplification: All calories are created equal [1:05:45];
• Daily step goals [1:06:45];
• The benefits of standing versus sitting throughout the day [1:10:45];
• How to identify the most impactful and easiest-to-implement ways to improve your health [1:12:30];
• The critical importance of emotional health [1:14:30];
• Why supplements should be considered as supportive aids rather than primary solutions in one’s strategy to improve longevity [1:18:00];
• Strategies for reducing high blood pressure [1:20:45];
• Peter’s biggest frustrations with "mainstream health advice" [1:28:00];
• Peter’s chaotic, yet cherished, morning routine [1:31:00]; and
• More.

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Joel Jamieson is a conditioning expert who developed Morpheus to give people a smarter way to build their conditioning regimen and improve their recovery. In this episode, Joel dives deep into the world of heart rate variability (HRV), explaining its scientific foundation, how it measures the balance between the sympathetic and parasympathetic nervous systems, the various methods of measurement, and how it can guide healthier lifestyle choices and improved training performance. He explores the nuances of HRV calculation, the impact of aging on HRV, and the roles of genetics, exercise, and other lifestyle factors in this process. He also covers Morpheus, the innovative training tool that won Peter over after his initial skepticism, highlighting its practicality and effectiveness in guiding training and optimizing fitness outcomes.

We discuss:

• Heart rate variability (HRV): evolution, science, and practical applications of HRV in athletic training [4:00];
• Methods of measuring HRV: EKG, wrist-based sensors, and more [11:30];
• How HRV is calculated from the data [22:30];
• The role of the autonomic nervous system (ANS) in regulating HRV [25:45];
• The decline in HRV with age, and the mitigating effects of fitness and other lifestyle factors [33:30];
• The role of genetics in HRV, the modifiability of HRV, and a comparison of VO2 max and HRV as predictors of mortality [37:00];
• How aging affects HRV and sympathetic drive, and the importance of spontaneous movement and exercise in maintaining the body's adaptability [43:30];
• How Morpheus measures HRV using RMSSD and normalizes it to a 100-point scale for easier interpretation [49:45];
• The Morpheus system: development, integration with various metrics, and personalized daily training recommendations to optimize fitness and recovery [51:30];
• The benefits of morning HRV readings for assessing daily readiness compared to overnight HRV measurements [1:03:00];
• Why Morpheus recommends using a chest strap rather than an arm band [1:10:00];
• The impact of consistent exercise, stress, alcohol, and other lifestyle factors on HRV [1:11:15];
• Optimizing zone 2 training with Morpheus [1:18:15];
• Using heart rate recovery (HRR) as an indicator of athletic conditioning and the balance between aerobic and anaerobic systems [1:22:45];
• The importance of tracking HRV trends over time rather than focusing on data from a given day [1:29:00];
• Effect of GLP-1 agonists on heart rate and HRV [1:34:45];
• Where HRV belongs in the hierarchy of health metrics [1:42:00];
• Parting thoughts [1:46:30]; and
• More.

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In this quarterly podcast summary (QPS) episode, Peter introduces a new format aimed at summarizing his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from each episode, covering diverse topics such as protein and muscle building with Luc van Loon, toe strength with Courtney Conley, VO2 max with Olav Aleksander Bu, liquid biopsies for cancer with Alex Aravanis, gut health and probiotics with Colleen Cutcliffe, and road safety with Mark Rosekind. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these engaging discussions.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the episode #304 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

• How Peter keeps track of his takeaways from each podcast episode [5:15];
• Luc van Loon episode: fat utilization, muscle protein synthesis, dietary protein, aging and inactivity, and more [8:45];
• Behavioral changes that have come about from the conversation with Luc van Loon [23:45];
• Courtney Conley episode: importance of toe strength and the impact of dedicated foot training [26:45];
• Olav Aleksander Bu episode: the importance of VO2 max for lifespan, and the practicalities of measuring and improving VO2 max [36:45];
• Behavioral changes that have come about from the conversation with Olav [56:00];
• Alex Aravanis episode: liquid biopsies for cancer detection [1:01:30];
• Colleen Cutcliffe episode: the importance of gut bacteria balance, and the potential therapeutic uses of probiotics, particularly Akkermansia [1:16:45];
• Mark Rosekind: the significant issue of road fatalities and injuries, their causes, and practical safety measures to reduce risks [1:27:00]; and
• More.

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Dena Dubal is a physician-scientist and professor of neurology at UCSF whose work focuses on mechanisms of longevity and brain resilience. In this episode, Dena delves into the intricacies of the longevity factor klotho: its formation and distribution in the body, the factors such as stress and exercise that impact its levels, and its profound impact on cognitive function and overall brain health. Dena shares insights from exciting research in animal models showing the potential of klotho in treating neurodegenerative diseases as well as its broader implications for organ health and disease prevention. She concludes with an optimistic outlook for future research in humans and the potential of klotho for the prevention and treatment of Alzheimer’s disease.

Disclosure: Peter is an investor in Jocasta Neuroscience, a company working to develop klotho as a therapy for people with Alzheimer’s disease.

We discuss:

• Dena’s fascination with aging and how she came to study klotho [3:30];
• Biological properties of klotho: production, regulation, decline with age, and factors influencing its levels [11:45];
• Potential benefits of klotho on brain health [22:00];
• The relationship between soluble klotho protein, platelet factors, and cognitive enhancement [33:45];
• The role of platelet factor 4 (PF4) and it’s interaction with GluN2B in mediating cognitive enhancement [46:45];
• Benefits of klotho observed in a mouse model of Parkinson’s disease [55:45];
• Benefits of klotho observed in a mouse model of Alzheimer’s disease [1:03:00];
• Promising results of klotho in primate models, and the importance of finding an appropriate therapeutic dose before moving to human trials [1:08:00];
• Speculating why a single klotho injection has such long-lasting effects [1:25:30];
• Potential cognitive benefits of klotho in humans, the impact of the KL-VS genetic variant on klotho levels, and the need for human trials to confirm these effects [1:27:45];
• The interaction between the KL-VS genetic variant and APOE4 and how it impacts risk of Alzheimer’s disease [1:34:45];
• The significance of klotho levels: studies linking lower levels to increased mortality and the broader implications for organ health and disease prevention [1:47:15];
• Measuring klotho levels and determining an individual’s KL-VS status [1:52:15];
• The promising potential of klotho for Alzheimer’s disease treatment, and the importance of philanthropy for funding research [1:58:00]; and
• More.

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Julia Wattacheril is a physician scientist and director of the Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) program at Columbia University Irving Medical Center. In this episode, Julia delves deep into the complex world of liver health, beginning with a foundational overview of liver physiology. She provides an in-depth look at how alcohol impacts liver function, breaking down the metabolism of ethanol and its detrimental effects. Julia then shifts the focus to understanding liver function tests and optimal enzyme levels, providing a detailed explanation of AST and ALT and elucidating why fluctuations in these levels may or may not be concerning. She provides a primer on the four major stages of liver disease, discussing risk and emphasizing the importance of early diagnosis. Julia highlights the role of liver disease in increasing the risk of cancer and cardiovascular disease and covers in detail the various strategies for diagnosing, treating, and preventing the progression of liver disease.

We discuss:

• Julia’s training, the importance of liver health, and the challenges and innovations of hepatology [3:15];
• The complex and crucial functionality of the liver, its four most essential functions, and more [8:45];
• Liver injuries: historical and evolving understanding of causal factors, and the progression to liver diseases and cancer [13:15];
• How the liver metabolizes nutrients and what happens in the presence of excess calories or alcohol [24:45];
• Methods of diagnosing liver disease and how insights guide treatment and management strategies [33:30];
• The poisonous nature of ethanol to the liver [40:30];
• Varied responses to alcohol, damaging effects of alcohol beyond the liver, and the process of advising patients on their alcohol consumption [47:15];
• Understanding liver enzymes AST and ALT—interpreting levels, lifestyle factors that affect them, and diagnostic approaches [58:30];
• Interpreting liver function tests for fatty liver disease, and the challenges of diagnosing liver pathologies, particularly in children versus adults [1:13:15];
• Comprehensive liver health assessments via imaging and various diagnostic tools to prevent overlooking potential liver pathologies [1:18:45];
• Potential impact of recreational drugs, statins, and other medications on liver function test results [1:26:45];
• Shifting nomenclature from NAFLD to MASLD to reflect accuracy in the underlying pathophysiology and understanding of liver diseases [1:30:30];
• Pathophysiology of MASLD, the need for proactive screening, and the significance of liver fat percentage as an indicator of metabolic health [1:36:30];
• The importance of screening for rare conditions alongside common metabolic diseases associated with fatty liver accumulation [1:42:45];
• Practical strategies for managing MAFLD [1:45:30];
• The impact of fructose consumption on liver health and the challenges of disentangling its effects from other factors like obesity and insulin resistance [1:52:45];
• The potential of GLP-1 agonists for the treatment of MASLD [1:57:45];
• How the four stages of liver disease have evolved [2:00:30];
• Increased cancer and heart disease risk associated with early-stage MAFLD [2:05:15];
• Emerging drugs and therapies for addressing fat accumulation and fibrosis related to MAFLD [2:12:15];
• Peter’s major takeaways [2:18:45]; and
• More.

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In this “Ask Me Anything” (AMA) episode, Peter delves into the often misunderstood concept of inflammation. He first defines inflammation and differentiates between acute inflammation and chronic inflammation, the latter of which is linked to aging and a plethora of age-related diseases. Peter breaks down the intricate relationship between chronic inflammation, obesity, and metabolic health, and highlights the signs that might suggest someone may be suffering from chronic inflammation. From there, the conversation centers on actionable advice and practical steps one can take to manage and minimize chronic inflammation. He explores how diet plays a crucial role, including the potential benefits of elimination diets, and he examines the impact of lifestyle factors such as exercise, sleep, and stress management. Additionally, he discusses the relevance of food inflammatory tests and concludes by examining the potential benefits and drawbacks of drugs and supplements in managing inflammation.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #59 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

• Defining inflammation (and the cultural impact of Napoleon Dynamite) [1:45];
• Acute vs chronic inflammation [8:00];
• The connection between chronic inflammation, aging, and age-related diseases [11:00];
• The impact of inflammation on metabolic health [18:30];
• Understanding and diagnosing chronic inflammation: blood tests and other approaches, and challenges with measurement [20:00];
• Factors that contribute to low-level chronic inflammation [28:00];
• Minimizing inflammation through diet [29:45];
• The important role of fiber for gut health and inflammation [33:45];
• A closer look at the impact of trans fats and saturated fats on overall health [34:45];
• Why Peter prefers dietary fiber from food sources over supplements [38:30];
• Debunking “superfoods”: emphasizing proven methods over marketing claims for reducing inflammation [39:00];
• Is there any value in over-the-counter food inflammatory tests? [42:30];
• Food elimination diets: how they work, symptoms and markers to watch, challenges and limitations [45:15];
• Identifying dietary triggers for gut-related symptoms through low-FODMAP diets like the “carnivore diet” [51:15];
• Dairy: the complex role of dairy on inflammation and individual responses [55:00];
• Wheat: the complexities and conflicting evidence around wheat's inflammatory effects [57:45];
• How exercise influences inflammation [1:02:00];
• How sleep quality and duration impacts inflammation [1:07:00];
• The potential impact of chronic psychological stressors on inflammation [1:13:00];
• The impact of oral health on inflammation and overall well-being [1:15:00];
• The role of medications in managing chronic inflammation [1:18:15];
• Supplements: evaluating the efficacy of various anti-inflammatory supplements [1:22:15];
• Parting thoughts and takeaways [1:27:00]; and
• More.

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In this special edition celebrating 300 episodes of The Drive, Peter discusses a variety of popular topics and health interventions and classifies them based on their level of evidence and relevance using the following categories: proven, promising, fuzzy, noise, and nonsense. Peter first delves into the topic of geroprotective molecules, covering rapamycin, metformin, NAD and its precursors, and resveratrol. Next, he explores the significance of metrics like VO2 max and muscle mass, as well as emerging concepts like blood flow restriction and stem cells. The conversation extends to nutrition, addressing questions surrounding long-term fasting, sugar consumption, sugar substitutes, and the contentious role of red meat in cancer. Peter not only provides his current stance on each topic—most of which have been covered in great detail in the previous 300 episodes—but also reflects on how his opinion may have evolved over the years.

We discuss:

• Defining the categories of “proven, promising, fuzzy, noise, and nonsense” [3:15];
• Rapamycin [9:30];
• Metformin [17:00];
• NAD and its precursors [24:30];
• Resveratrol [32:45];
• The importance of VO2 max, muscle mass, and muscular strength for lifespan [38:15];
• Blood flow restriction (BFR) training [44:00];
• Using stem cells to treat osteoarthritis or injury [51:30];
• Fasting as a tool for longevity (and why Peter stopped his fasting protocol) [55:45];
• The energy balance theory [1:06:30];
• The idea that sugar is poison [1:12:00];
• The idea that sugar substitutes are dangerous [1:22:15];
• The debate on red meat and cancer [1:28:45]; and
• More.

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This is a special episode of The Drive with Peter’s friend and fellow car enthusiast Dax Shepard. In this podcast, which commemorates the 30th anniversary of the death of Brazilian Formula One legend Ayrton Senna, Dax sits down with Peter to better understand what made Senna so special and why Peter remains an enormous fan. This conversation focuses on Senna’s life, the circumstances of his death, and his lasting impact and legacy on the sport of F1.

We discuss:

• Peter’s interest in motorsports began as a child [2:30];
• The drama and dangers of F1 [6:00];
• What made Senna special [13:00];
• What Senna meant to Brazilians [24:00];
• The cause of the fatal crash [28:15];
• Why Peter is obsessed with Senna [40:30];
• Being the best versus having the best record [43:30];
• Senna’s unique driving style and incredible intuition about automotive engineering [46:30];
• Back to the day of the dreadful race [53:00];
• What Peter believes caused the crash [1:02:45];
• Views on dying young, in the prime of life [1:13:00];
• Senna lives on in his foundation and in safety changes adopted by F1 [1:21:00];
• Statistics aren’t enough for fandom, and why people like who they do [1:24:15];
• The biggest difference between F1 today and F1 in the 80s [1:28:30];
• Senna’s driving superpower [1:30:30];
• The fastest drivers currently in F1 [1:38:30];
• Current F1 obsessions [1:45:00];
• How hard it is to do what the top F1 drivers do [1:50:15];
• Dax’s love of motorcycles and his AMG E63 station wagon [1:52:15];
• Awesome Senna mementos from Etsy [2:01:15];
• What makes specialists interesting, and Max’s devotion to F1 [2:10:15];
• What Senna might have done if he had not died that day [2:14:00];
• Michael Schumacher and Max Verstappen are also top F1 drivers [2:17:30];
• Interlagos in Sao Paulo Brazil is always an incredible experience [2:18:45]; and
• More.

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Luc van Loon is an internationally renowned expert in skeletal muscle metabolism. In this episode, Luc starts with an exploration of the roles of insulin and triglycerides in endurance exercise, highlighting their impact on skeletal muscle metabolism, and he offers profound insights into the significance of protein in this context. He elucidates how different protein types and forms influence muscle protein synthesis rates, exploring the nuances of protein absorption, digestibility, amino acid quality, and their implications for performance and recovery. Delving deeper, he differentiates between animal and plant protein sources, unraveling the distinctive properties of various protein types, from the differences between whey and casein to the emerging trends in collagen protein supplementation. Moreover, Luc dissects the intricate connections among physical activity, lean muscle mass, muscle protein synthesis induced by resistance training, and dietary protein.

We discuss:

• Luc’s background and insights about fuel selection during exercise [3:30];
• Fuel utilization during endurance exercise [9:30];
• Fat metabolism, intramuscular lipids, and the nutritional dynamics of endurance sports [17:15];
• The optimal window for replenishing intramuscular fat stores and glycogen post-exercise [25:15];
• Luc’s interest in protein metabolism and exploration of amino acids' dual role as building blocks and signaling molecules in driving muscle protein synthesis [32:15];
• How protein metabolism differs between sedentary individuals and those engaged in predominantly strength training or endurance training [38:45];
• The basics of how proteins are digested and absorbed, and how muscle protein synthesis is measured [50:30];
• How factors like food texture, cooking methods, and protein composition impact muscle protein synthesis, and the importance of protein distribution throughout the day [59:45];
• Differences in whey and casein proteins, and the ability of ingested protein to stimulate muscle protein synthesis [1:03:30];
• Dietary protein distribution and quantity for the maximization of muscle protein synthesis [1:09:00];
• Muscle loss with age and inactivity and the importance of resistance exercise to maintain type II muscle fibers [1:17:15];
• Differences between whey and casein proteins, and the importance of both quantity and quality of protein sources [1:28:30];
• Optimizing muscle protein synthesis: exercise, timing of protein intake, protein quality, and more [1:37:00];
• How to preserve muscle while trying to lose weight [1:46:00];
• Anabolic resistance and overcoming it with physical activity [1:55:45];
• Importance of protein intake and physical activity in hospitalized patients [2:06:30];
• Reviewing the efficacy of collagen supplements [2:13:30];
• Plant-based diets: how to ensure a balance of amino acids, and other considerations [2:20:30];
• Future research: understanding protein metabolism in the brain [2:23:45]; and
• More.

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Join us for a conversation about menopause, hormones, and how sex changes during this phase of a woman’s life. I’m joined today by Ann Bell, who started working in 1998 as a massage therapist, where she discovered the deep need for addressing mental, emotional, and relationship health in people's lives. Clients found solace in confiding in her during their sessions, and in 2012, she made the decision to formalize her commitment to their overall wellness. In 2020, she earned her certifications in relationships, sex, and love coaching.

As a Love and Sex Coach, Ann's mission is to help individuals uncover their true selves, foster deep connections, and unlock their full potential in self-development, all while infusing a sense of humor into the journey. 

NYT article: Women Have Been Misled About Menopause

Esther Perel's Mating in Captivity

Learn more about Ann:

Website: https://www.aconfidentialconversation.com/

Facebook: https://www.facebook.com/aconfidentialconversation

Instagram: https://www.instagram.com/aconfidentialconversation/

YouTube: https://www.youtube.com/channel/UCeSWI061rAoqlJfVAwc916A

Karin's information:

Website: https:www.drcalde.com

Instagram: https://www.instagram.com/theloveandconnectioncoach/

Get your FREE copy of Karin's "12 Conversation Starters" to help you talk to your partner about sex: 12 Questions to Help Increase Intimacy and Deepen Your Connection with Your Partner

TRANSCRIPT

Podcast Intro:

[00:00] Karin: This is Love Is Us, Exploring Relationships and How We Connect. I'm your host, Karin Calde. I'll talk with people about how we can strengthen our relationships, explore who we are in those relationships, and experience a greater sense of love and connection with those around us, including ourselves. I have a PhD in clinical Psychology, practiced as a psychologist resident, and after diving into my own healing work, I went back to school and became a coach, helping individuals and couples with their relationships and personal growth. If you want to experience more love in your life and contribute to healing the disconnect so prevalent in our world today, you're in the right place. Welcome to Love is Us.

Episode Intro: 

Karin: Hello everybody! Perimenopause, which is the transition to menopause, can start as early as the mid 30s for some women. Now, the average age for the onset of menopause, which is marked by going twelve months without one's period, is age 51. That used to be that no one talked about it, but it was thought of as something bad, and that's changing, and there's a lot more information about it starting to become available, and it is about time!

Menopause does have its challenges. Hot flashes probably come to mind for you when you think about it, but there's a long list of other symptoms that women might experience, such as joint and muscle pain, sleep disturbances, increased belly fat. Women's interest in sex often wanes, their vaginal linings get thinner and drier, which can lead to pain during intercourse, itchy ears, and the list goes on. There's also a significant increased risk for different medical conditions, especially cardiovascular disease.

We talk a little bit about this in today's episode, but neither my guest nor I are medical doctors. So I would encourage you women to seek out a doctor who specifically has training in hormones and hormone therapy and hopefully has some specialized knowledge about menopause, because the knowledge of many doctors these days is lagging behind the research. And so that's why I would also encourage you to do a bit of your own research before seeing your doctor, so you know what questions to ask and you can be more informed, especially when it comes to estrogen and progesterone. And I'm going to link a recent article about this in the show Notes. It came out in the New York Times, so hopefully you'll be able to access it.

I also want to say that menopause can be the start of a really happy time in a woman's life, but it's a significant transition that often doesn't get the attention that it serves. Also, when we don't fully understand what's happening in our bodies, it can be scary and overwhelming and sad as you say goodbye to a younger part of you, and yet you have control over what meaning you give to it in your life. So I want to challenge you to think about what menopause means to you. Does that meaning serve you? Or might you benefit from shifting that belief in a way that is still real and true but is more likely to support you and make your life better?

On today's episode, I talk with Anne Bell, a love and life coach, and she specifically works with women to help them make their sex lives better. We have a conversation about menopause and hormones, and then toward the second half of the show, we talk about sex during this phase of a woman's life. And although there is some overlap in what Anne and I do, our styles and personalities are really different. So it was fun to have this conversation, and I hope you'll get something out of it.

Now, there is one thing that we fail to talk about, and so I want to make sure to talk about it now. And I have talked about it. I think it was in the Desire episode from two weeks ago, and that is the importance of using lube during this time in your life. I would recommend it at any time, but especially during midlife. It's going to be really important to keep you healthy and keep things comfortable and enjoyable. So that's my two cents about that. All right. Thanks very much for being here. And here we go.

Karin: Hello, Ann.

[04:34] Ann: Hi, Karin.

[04:35] Karin: It's nice to have you today.

[04:37] Ann: Thank you. It's lovely being here.

[04:39] Karin: Great. I think I can hear it a little bit in your voice, but tell us where you are located.

[04:47] Ann: I know I got this on my last podcast. I'm a New Yorker, but I'm actually upstate New York. I'm 60 miles north of New York City in the Hudson Valley, and it is beautiful country here, all four seasons. It's beautiful here.

[05:07] Karin: I'd love to go and visit. I was actually born in New York, but I lived there for maybe three weeks of my life. Then my parents got me out of the cold weather.

[05:19] Ann: Yeah, that's the only part, is the cold. But we're not having a lot of winters, drastic cold winters the last couple of years. It's alarming, actually, because now we're in a little bit of a drought.

[05:35] Karin: Right? Yeah. We're definitely experiencing that on the West Coast, where I am as well.

[05:41] Ann: Well, what keeps you move? I have tried to move. I really tried to leave this area a couple of different times. It just doesn't work for me. My family's here. My business is here. I do love it here. As I get older, I'm not fond of the winters, truthfully, but I like the mindset, I like the freedom, especially what's happening in other states. I tried moving south. I don't know, maybe I could try it again. I just couldn't wrap my brain around the mentality and the thinking and the restrictions and how they treat, you know, I kept saying to myself, because I've done a lot of traveling around the world, and I kept saying, God, I feel like I'm in a foreign country. I feel like I'm in a foreign country, and I'm like, Anne, you're in the and I said, Ah, this isn't for me. I can't do this. So maybe it's like the saying, it's a nice place to visit, but I wouldn't want to live there type of mentality. I don't know. Yeah, I don't know. I mean, I'm used to New York's, our freedoms and our mindset, so to go to such harsh restrictions, I just can't understand it. I mean, look, no state is perfect.

[07:07] Karin: Absolutely.

[07:08] Ann: We all have issues, the whole country. So I end up back here, and I'm a traveler, so I like to travel. So this is kind of I look at this as my home base.

[07:20] Karin: Yeah, that's great.

[07:22] Ann: Yeah, I agree.

[07:24] Karin: I just don't think I could live anywhere else, and there are great people and beautiful places everywhere, and yet this just is my comfort zone.

[07:33] Ann: Yeah, I think that's what happens. You're used to a certain I'm very, very happy I did all the traveling that I did because I think every American needs to leave the United States of America. You need to leave and see what's out there, what other people are thinking, feeling, seeing, doing, acting, and it really opens up your mindset tremendously.

[08:03] Karin: Yeah, I couldn't agree more. It is such a perspective, broadening experience, and we could probably have a whole conversation about that, but we've got other things you want to talk about. So what do you do for work?

[08:20] Ann: Well, I'm a very interesting person, I believe. Awesome. I've been a licensed massage therapist for 26 years, and I attract clients that like to talk, so I don't get the quiet ones. I get the talkers and the sharers. And I learned very early on in my career that people don't have a safe space and they're not comfortable talking to everybody. And I learned that's one of my gifts is that I can do that. I provide that for people because I'm curious, and I generally like people. I like understanding what makes them tick. I like helping them figure out where they could maybe reframe something. And actually, this is how I began massage therapy. On the table was Gestalt Therapy with my therapist. So I didn't know any other way. So then I started to I'm going.

[09:19] Karin: To interrupt you for a second. Could you give us just a really quick overview, a few sentences about what Gestalt Therapy actually is for the people who don't know?

[09:28] Ann: Well, Gestalt Therapy, if I get it correctly, because there were so many other modalities in there, is for people that it's connecting your emotions to your physical body. How does all of that store itself? How can you reframe it? So it's a lot of talking on the table for that also, so my therapist was very keen into it. I didn't know I was very new into my journey, my spiritual journey, and I had no clue what was happening, to tell you the truth. I look back and I'm like, oh, I was just going along for the ride because I found it interesting. I hadn't asked myself these type of questions. I was a recent widow at 29. My life was in one direction and the next. Here I was, single, unmarried, and heartbroken and had no clue what I was supposed to do next with all of that. And I had to rediscover myself. I had to like, wow, this is really I don't know what to do next. And people would come in. I remember sitting in my home. I was really having a bad moment. It was of despair, nothing suicidal, but I was just like, God, is there more out there for me? Is this all there is? And I remember it so distinctly, and it was like very shortly thereafter, new people came into my life to start giving me answers. And I'm like, oh, wow, this works. This works. You ask the question, and if you open and you allow it to happen, people will come into your life and start to shift, shift your mindset, ask you questions. I was a very black and white thinker. Now I'm so far in the gray. I don't know, it's so funny. But I like living here. Yes, there are things that are yes and no, right or wrong, if that's what you need. But there's always nuances to everything. There's always two sides. You can hold two thoughts, you can hold contradictory thoughts, and they can be true for you. And five minutes later, one could be not true anymore. So that's how rapidly it can change when you're mindful of your growth, when you're asking the questions, when you're open to the process. But I will tell you, it's hard work. It's not easy. It's hard. It's a lot of self reflection. It's a lot of looking in the mirror and going, you again. Here you are. You again. What do you want? Can't you leave me alone?

[12:19] Karin: And yet it's so worth it, isn't it?

[12:21] Ann: Yes, it is so worth it. So back in 2012, then I became a life coach, and I really kind of mixed them both on my table. Then what happened is when the pandemic happened, and I had to shutter my business for four months, and I'm like, uh oh, something's going on here, Anne. You better pay attention. And that's when I had a lot of time, and I decided to become certified in love, sex and relationship coaching. And I'm headed toward retirement for massage and picking up speed for full time coaching, speaking, whatever comes my way. I'm very creative, and I just kind of see where it all leads me. So that's how I got where I am. And I have a lot of conversations about sex. I come from myself, where in my marriage, as a young woman, I knew nothing of sex. We a very conservative family. We didn't talk about it and enter marriage. And I'm like, something's wrong here. He seems very happy, but there's nothing happy going on with me. And before we could get into it, I had asked, and he's like, no. And it kind of stifled it for me right then and there. And then he passed on, and then I'm left with, is there more? Is there more of my life? Will sex ever be really fun and nourishing and good for me? And I will tell you yes and yes. But I practiced, I experimented, I became open minded. I found what I like, what I didn't like. And I'm going to tell you that changes and changes, and it just keeps evolving. It evolves for people. What you like, I'm 62. I'm going to be 62 next month. So I'm in Menopause, and I've noticed the changes that are happening for me, where my body is different, my mind is there. My mind is like, let's get this on. But my body's, like, slow down, Jack. We're going to do this differently. So it's a whole mindset that you have to go through. And I just read this fabulous book by Marty Klein called Sexual Intelligence. Oh, my God, that man is please, please read it, because what he talks about is sexual intelligence is how can you change? How can you adapt? How can you accept where you are with all of your aches and pains, your menopause, your desire, your low desire? What is it that you can continually move through and have good sex with? And I just find it's just such a fascinating question, but it's getting people to talk about sex with themselves and with their partners.

[15:39] Karin: Yeah. And that is such a big hurdle for so many people, isn't it? Initiating that conversation just can really shut people down.

[15:50] Ann: Just the thought of it, it terrifies them. I just had a client on I had a coaching client, and she said to me, and I found it amazing, she says, I can't talk to my therapist about sex. Yeah, I'm nervous about talking it with you, but I can't talk to my therapist about sex.

[16:09] Karin: Yeah. And sadly, a lot of therapists don't actually have special training in sex and intimacy, so they don't necessarily bring it up. And so it makes it seem like that's not an area that people can.

[16:21] Ann: Talk about because they're awkward. Even the doctors, if you think your doctor, maybe especially I asked one of my gynecologists. I have a lot of gynecologists. I can't seem to get one I really love. I asked her about female Ejaculation squirting. You could see the horror on her face. I don't know anything about that. I don't know what that is. And you know what? It was a few years ago, and I was embarrassed, and I felt shame. Like, is my body not supposed to do this? Is this something that's wrong or bad? And then as I kept diving deeper into all of this, I realized they are just uneducated.

[17:03] Karin: Yeah.

[17:04] Ann: They don't know. They're awkward. They're embarrassed. They don't want to broach the subject.

[17:12] Karin: And I hate to say it across the board because I don't know that that's necessarily true, but I think in general, they don't necessarily have that specific training and don't really know how to talk about it.

[17:24] Ann: Right. It's exactly what you know. I have a few younger doctors that I listen to on Instagram and their podcast, and one's a urologist, and she says, we got zero sexual education. She says, I'm in your pelvis all day long, but I did not know how sexuality worked. I didn't know how. And it was so brave of her, and she's taken this deep dive into it. I don't have all the answers either, but my God, I'm going to find them out. I'm going to say, I don't know, but I'm going to get back to you on the issue.

[18:03] Karin: So tell me what you're hearing from women who are perimenopausal and menopausal. What are their experiences with sex and how are those bodies changing?

[18:18] Ann: I think women in general at this stage are shocked. They are shocked at what their bodies are doing. They don't have the education. They don't have the awareness. This is a subject we are not talking about. It's not given its full due diligence. I think it's now starting because I think our later, like myself later, boomers and Gen what is it?

[18:48] Karin: Gen gen X. Xers. Gen Xers.

[18:50] Ann: They are demanding relief. They're like, we're not putting up with this. We want relief. So it's their age that's pushing it. They want understanding. They want relief of their symptoms. And I think we're watching the transformation happening right now.

[19:09] Karin: I agree.

[19:10] Ann: If you're in the movement, you know that hormone replacement therapy, it was taken away, and I'm in that decade, for two decades, women were on HRT hormone replacement therapy. You'll hear it referred to as MHT menopause hormone treatment. Different doctors will refer to it, but women were on it previously. And then there was a study, and the study was done. The portion of the study focused on elderly women 75 and older that were given hormone treatment. You cannot have hormone replacement therapy at 75 because it's detrimental. If your body has not have estrogen, you can't reintroduce it because it will cause heart issues, dementia, it will exacerbate those issues. But they neglected to say how beneficial it was for the younger women. Women have been served in injustice over and over and over. Pregnant women, women that have breast cancer will get pregnant. They'll allow them, quote, unquote, allow them to get pregnant, stop treatment. And, you know, estrogen is at its highest when you're pregnant. And their treatment and their breast cancer, it doesn't exacerbate it.

[20:37] Karin: Yeah.

[20:38] Ann: So if they're doing that, what does that say? I mean, there's so many studies now women, go get your hormones. I mean, it's not just hormones. It's nutrition, it's good sleep, it's exercise. There's a lot of components. But why are we afraid of estrogen? That is in our natural it's a natural hormone in our body, and we've been made to be fearful of it. It makes no sense to you know.

[21:09] Karin: There was a great article, New York Times article called women have been Misled about Menopause that came out earlier this year. It was phenomenal. And I think it would be a good idea for every woman to read it, if you can get a hold of it. And yeah, it talks about this issue.

[21:32] Ann: And the thing is because doctors what is it, 20% to 30%, 80% of women are suffering lifelong symptoms from menopause, and that's including perimenopause. Perimenopause can happen as soon as 35. Yeah, menopause is the definition of menopause, which is around 51 years. I was a late menopauser, I was 56. But 51 is one year and one day without your period. You are in menopause.

[22:05] Karin: Yeah.

[22:06] Ann: You're now menopausal.

[22:08] Karin: I went eleven months.

[22:10] Ann: I did, too. Okay, come on. Eleven months. You're almost there and it starts again.

[22:18] Karin: And you're like, okay, all right.

[22:21] Ann: So there's studies to prove that breast cancer is not from hormone replacement therapy. Do you know what the number one killer of women is?

[22:35] Karin: It's heart disease, isn't it?

[22:37] Ann: Heart disease?

[22:38] Karin: Yeah.

[22:38] Ann: Now they've taken women. I have a sister who's one of them breast cancer took her all her hormones away. Hysterectomy. What's she going to die of? She's going to die of a heart attack.

[22:52] Karin: And estrogen actually helps with that, right?

[22:55] Ann: Yes, heart health. Dementia. We have so many elder women because of lack of estrogen are dementia. I mean, it's so vaginal health. Oh, my God, please go get vaginal estrogen. Please. Vaginal estrogen. Hormone replacement therapy is systematic throughout the body. Vaginal estrogen is very for the vagina, for the vulva and the vagina.

[23:29] Karin: You're talking about like, topical or suppositories?

[23:32] Ann: Yes, topical comes in creams, I think. Topical, yes. I would do the cream. I'm on my way to get mine. But it helps with most women that are having UTIs, and it'll prevent UTIs, especially later in life where the elders, oh, she has a UTI. I'm like, go get your mother some vaginal estrogen. It'll help with all of that. It'll help with vaginal atrophy. It'll help with painful sex. Please don't have painful sex. Ladies and people with all of us, there is much help out there for you. But the barrier is 80% of women are suffering. Only 20% to 30% of women are seeking help. But the barrier is women think they're going to get breast cancer from estrogen. And number two is the doctors are uneducated. They are uneducated about hormone replacement therapy.

[24:32] Karin: They'll say, oh, I don't think you're going to need it. Yes. And that's really doing women a disservice. You should get onto estrogen as soon as you start showing symptoms of perimenopause. Is that yeah.

[24:46] Ann: Yes.

[24:47] Karin: So the sooner you do it, the better.

[24:49] Ann: The better. And you can be on them lifelong. Lifelong. You can take them. You don't have to come off unless there's an issue. But they just did a study in Sweden where women, 85, 80 to 85, they're still on their hormones and fine.

[25:06] Karin: Okay. Yeah, because I had heard that at some point that you might want to come off of them, but I don't know that that's true.

[25:12] Ann: You don't have to come off of them. You know what? When men and here's where we talk about our patriarchal society, okay, and I'm going to agree. Men, when they have low testosterone, guess what? They get prescribed testosterone. And guess what? Oh, yes. You'll have to be on it the rest of your life if you want to function. Women, we are shamed. We're humiliated. We're told, Why go through it naturally? I just want to poke my eye out with that mentality. Why are we suffering? Why are women suffering for no reason?

[25:53] Karin: So tell me what the effect of menopause is on our bodies and how it affects us sexually.

[25:59] Ann: Well, you're getting stripped. Your estrogen, at a certain level, once you're in menopause, drops dramatically. So what will that do? Is desire, fixed desire? You now become dry. Your vulva, your vagina becomes dry. Makes sex painful. Hot flashes, night sweats. I got vertigo, and I actually went to the ENT, and she says, all right, we're going to send you for, let me say it correctly, vestubular therapy, which is physical therapy for the crystals in your ear. Do you know that made it worse? I said to the guy, I don't know what's happening here, but I can't do this anymore because it's making it worse. I went back to her and I says, you know, I think this is a symptom of menopause. It blew me right on off about it. Like, she wasn't even taking it in, and she wasn't that much older than me either. And I said, okay, but it's a symptom of menopause, weight gain, breast issues. So there's a plethora, and it's like I don't know if you remember going through puberty. We were so young. You were so discontented and moody, and I think it's the same thing in the opposite direction.

[27:29] Karin: I was going to say the same thing. It's puberty in reverse.

[27:31] Ann: Yeah. But I look at menopause also as a woman's spiritual reawakening, because here you are. Let's call it midlife, whatever you want to call it. But women, have you've been a mother, you've been a wife, you've had a career, you've been doing for parents, possibly you've been doing and I find that at this stage, you're asking yourself, what about me? What about me? When is it my turn? When do I get to just focus on me? Because women are caretakers, and I think this is the phase that they're going through is like, I don't want to be your mother, I don't want to be your wife, I don't want to be your girlfriend. You get to that point because it's so strong, your feelings, like, I don't want to do for another person. But your hormones are out of whack.

[28:28] Karin: Yeah. I was recently hearing how the happiest segment of the population is women over 65.

[28:37] Ann: Yeah.

[28:38] Karin: And I think that's so interesting that I've also heard, and I don't know if this has anything to do with it, but that there's something about the hormonal changes that makes women feel like they just don't give a shit anymore about the little stuff. They're just ready to be happy.

[28:56] Ann: Well, that's what it is. And now women are financially better off.

[29:01] Karin: Yeah.

[29:02] Ann: So they've been in maybe long term relationships. They don't want that. They might want a lover, they might want a companion. They have their own homes, they have their animals. Some of them are very content. Unless you're not. The woman who my last client, she was mid sixty, s, and she had been in abusive marriage. She was leaving nine years of no sex. And she says, I want pleasure, I want sex, I want love, and I want respect and kindness. And this is what's happening. Is she's willing to sacrifice it all? I don't care about the house. My children are grown. I'm ready for it to be about me now.

[29:48] Karin: Yeah.

[29:49] Ann: And this is what's happening. They've had it up to here, and they want different they want for themselves.

[29:58] Karin: Yeah. They're finally saying, it's my turn.

[30:01] Ann: Yeah. And it is. It's your turn because you look at it and you have I have less years on this planet than I have more how do I want to spend them?

[30:10] Karin: Yes. So you value that time that you have left.

[30:13] Ann: Yes. And now health issues are coming. Things that I've not had before. I've been basically very healthy most of my life, and now it's like, oh, look what's happening. Oh, pay attention. So all of this matters when it comes to sex. How do you have fun sex? How do you have pain free sex? My knee hurts, my back hurts. I have a couple who they're 79, and she says to me, oh, we would never give up sex. Shoulder hurts. His hip hurts. My this hurts. We figure it out.

[30:51] Karin: Yeah. And the thing is that sex can actually help. It can be an analgesic, right?

[30:59] Ann: Yeah.

[30:59] Karin: It can help relieve pain. So that's one of the benefits. But also, I just want to say that a lot of women I know hit perimenopause and menopause, and they just say, maybe I'm just done with sex.

[31:17] Ann: Yes.

[31:18] Karin: So what is your response to that?

[31:21] Ann: Please, no. Please, no, don't do that to yourself. And I find that it's either because sex has not been good for them prior, so the menopause is the excuse to say, done over. It's either relationship or it can be menopausal symptoms. They just don't know what to do. You're such an influx, sex is the last thing on your mind. I just had a young client, what is she, in her mid forty?

[32:00] Karin: S?

[32:00] Ann: And she's like, Aunt, I'm going crazy with this. My husband and I, we have a great sex life. I don't want sex. And he doesn't understand it. And I said to her, are you telling him what's happening with you? She goes, yes, but he's still taking it personal. I said, well, he needs to educate himself about menopause. You have to be proactive men. What is menopause to your woman? And I said to her, look, there's going to be times she's like, when you're going through you don't get your period and you feel like every month it's coming, it's coming, it's not you're going through that transition. I said, of course. It's the worst feeling on the face of the earth. You just want to bleed, but it's the process you're going through. I said to her, but there are days, I bet you, when you feel good. She says yes. I says, Those are the days. Have sex. Those are the days. Maybe dress yourself up sexy, have a glass of wine, whatever it is, seduce your husband. But those are the days. Connect. Connect with your husband. If your desire is there, even it might be a little bit low, but you're having a good day, you feel good, have sex.

[33:16] Karin: Yeah. And I think it's also important to mention that there's also often so many other things happening during that time of a person's life that can add that stress on top of menopause. And so that can be another reason why women say, I'm just done that might be that, well, they're tired, they might have kids that just left, and so they're newly empty nesters. And that life transition can be scary for some people. They could be caring for elderly parents. It could be that they or their partner is feeling depressed or has a new diagnosis of some sort. I mean, there can be a lot of these things, and yet we know that none of those things means that it has to be the end of sex.

[34:05] Ann: Well, and here's the other thing. Sex is just not penis in vagina.

[34:11] Karin: Yes.

[34:12] Ann: Okay. Everybody thinks I think it's what you have to reevaluate what is sex to you. Because a lot of people think the pinnacle, the hierarchy of sex is penis and vagina. That's it. That's the crescendo. And it's so untrue. There's so many other ways to have sex. If you have a partner with Ed.

[34:42] Karin: There'S other erectile dysfunction just for people to know, which is, oh, when the.

[34:48] Ann: Penis doesn't work, when he can't get an erection. And it could be medication. I mean, that's the other factor, is everybody's on a lot of medication, right? Medication have side effects. I. Mean, even your pharmacist will not talk about sex and side effects if you don't get the right pharmacist. Nobody's talking about it. So people won't take their medication properly because they don't want to lose their erections, they don't want to lose their desire. So you have that factor in there, too. But there's other ways. There's oral sex. There's so many different ways to have sex. So I think as we get older and these problems pop up, you keep redefining, you keep rediscovering, you keep exploring. I've said this since way back when. It doesn't have to be about the orgasm. Could you please just go have some fun?

[35:49] Karin: Yeah, it's about the pleasure, right?

[35:51] Ann: Go have fun, pleasure, whatever that means to you. If you want to orgasm, do it. If you don't, don't. But we put that other expectation on your partner. Did you orgasm? Do you know how many times I have to say, could we just take that off the table and let's just play, let me relax, let me be in the moment, and it's going to happen. Yeah, but it's so goal oriented. Why are we so goal oriented with sex? That's not the goal. The goal is to have pleasure. It's to have fun. It's to laugh, it's to explore. What is it that turned you on? And I'm also a big believer in self pleasure and masturbation. Yeah, you got to know yourself first. Got to know yourself first.

[36:38] Karin: And that'll help you ask for what you want from your partner, right? Because you'll know what you like.

[36:44] Ann: Yes, you can redirect them. Keep redirecting them. Trust me. Oh, when you go right there, right there, right there, and they're off to the next shiny object, come back. So it's a little tug of war sometimes with them, but you can make that fun, too. If you're not laughing during sex, you're not doing it right.

[37:11] Karin: And it's really true. We think we've learned somewhere along the way that this is what sex is. Or people define sex as intercourse, when in fact, that's just one option, and there are a lot of options. And if couples can rewrite the rulebook for themselves, the world is going to open up for them.

[37:35] Ann: Exactly. Especially as we get older. But people, if you're clinging to that mindset, well, I want to be that sex bunny I was when I'm younger. It's not going to happen. Because those days, we were younger, we were viral, it happened. Our bodies responded. This is a fact of life, that your body's going to shift and change, and you can still have the pleasure you want, just differently. But you have to be open minded to it.

[38:12] Karin: And what I love is, I don't know if you've read the book Magnificent Sex by Maynard and Kleinplatz. They're these Canadian sex researchers, and they did a fabulous study and found that actually, when they interviewed people who were in midlife and beyond, but they interviewed people, a whole range of kinds of people, but all older. They found that they had the best sex of their lives starting in midlife.

[38:40] Ann: Yes.

[38:40] Karin: Because they are not so focused on performance and doing it a certain way. And they are connecting at this emotional level with their partners and they are creating their own rulebooks. That's a really great book for anyone's interest. It talks about the research and what they found. But yeah, it really makes it clear that menopause is absolutely not the end. It actually could be the beginning.

[39:10] Ann: It's the beginning. I think it's a matter of even for myself, some of my symptoms were so pronounced that I just had to pay attention and do things differently. But now I'm responding differently again, so it's just noticing. But here's the thing. As women, we have so much on our minds. We're so busy. We're doing and you tend to have sex when you're exhausted. We have sex late at night. You're exhausted. You're not giving it your best go to begin with. So don't attach a lot of meaning to it. Just have fun with it. If you feel like you want to have sex, make love to your husband, fuck them. Just do it. And it doesn't have to be anything other than that. But we have to think it's this big, grandiose love gesture. It doesn't have to be. It can just be that.

[40:11] Karin: Yeah. And it could be just a touch session.

[40:15] Ann: Yes. People handholding kissing, cuddling. Why do we cuddle our babies skin to skin? It helps regulate them. Why wouldn't it be different for you? Skin to skin, cuddling. Just it'll help regulate the two of you breathing together. But if you can be more mindful during sex and not think about all the shit you got to do, if you could really just change that one thing during your session, I think you would enjoy the process so much more.

[40:52] Karin: And the other thing that I think is worth mentioning is that for both men and women, there are some other physical changes going on, like vascular changes, so you don't get as much blood flow to your genitals. And so that can mean that it takes you longer to get aroused. It can mean erections that are less firm for men, it can mean it's harder to get erections for men.

[41:23] Ann: And orgasms aren't the same. Your orgasms are maybe not as intense. Maybe they're different.

[41:30] Karin: Yeah. But it doesn't mean that they're not as good. But they will be different. And given those vascular changes, sex in the morning sometimes can be a really good option for people because that's blood flow is better in the morning. Right. And erections are stronger. Yeah.

[41:46] Ann: Well, that's what I call it. Etz. Erotic time zone. What's your erotic time zone? When is it that you like to have sex and go for that time? When is it that you feel most fully alive?

[42:03] Karin: Yeah. It doesn't have to be at night?

[42:05] Ann: No.

[42:05] Karin: When you're both exhausted. Right.

[42:07] Ann: And I heard this thing they call it a splash blanket. So here's the other thing. Find yourself a sex blanket. If you need clean sheets and they're not clean, or you just change your sheets, you don't want them to get dirty or you don't want who gets to lay in the puddle of what all night long? Put your blanket down, roll it up. If you don't want the kids to know. Put your blanket down, do your thing, roll it up and put it right in the washing machine.

[42:36] Karin: Yeah.

[42:37] Ann: There's little tricks to help the mindset flow, to get where you need to, because some people contextual desire. Things have to be just in a certain the dishes have to be done, the laundry, the kids in bed. There's things that have to be in place. And I understand that as long as it's not a barrier roadblock, a barrier to having sex, because then you can take it to the nth degree on that. And I think spontaneous sex, it's another one, I think that happens in our younger years. Even though nothing's spontaneous, to tell you the truth, if you were going out as a young woman, you still dressed up, you showered, you shaved your leg, you had intention, possibly you could have sex. Even though you might have met a man out and you had sex, you still had a little pre planning towards it. So if you're of the class that I want it to be intimate and spontaneous, you still did a little planning way back when.

[43:50] Karin: Planning is not your enemy. Planning having a date for sex is not a bad thing. In fact, it can make it even more erotic and exciting because of anticipation. Right.

[44:04] Ann: And here's the other thing. Some couples are very intimate. They know each other in an emotional intimacy. But emotional intimacy can put a damper on your eroticness because you know your partner so well that the eroticness like, oh, I would like this, or the fantasy or it's a hard dance to do between intimacy and eroticism.

[44:38] Karin: Yeah. And that's a whole other subject. But it's so important that, yes, when we get really emotionally close for some people, it can almost feel like your family with your partner and you don't want to have sex with your family.

[44:52] Ann: Right.

[44:53] Karin: And so how do you create some of that distance that will bring back some of that eroticism between you and your partner?

[45:01] Ann: I think you have to let your imagination flow. I don't know if we ever know anybody truly 100%, because everybody has their own thoughts. So whatever your fantasy is, whatever you're thinking, I'm a voyeur, but doesn't mean everything I see, I want to do. But I find the process to be a turn on. So you can use your imagination to get yourself turned on and whisper here, there.

[45:39] Karin: Like using fantasy.

[45:41] Ann: Yeah.

[45:44] Karin: And I always encourage people. It's always really important for you to still have your life outside of apart from your partner. Right. And that can bring back some of that excitement.

[45:56] Ann: Yes. Isn't that what we struggle with is partnership and autonomy? That's what we battle within know, I want to be in this relationship, but I still want my so, and some couples do that better than know.

[46:13] Karin: Yeah. And I know know. Esther Perel talks a lot about that.

[46:16] Ann: Yes. I love Esther.

[46:17] Karin: Yeah. So she talks about that kind of line between too much closeness and how that can affect things in the bedroom. I think it's Mating in captivity. She talks about that specifically in that.

[46:31] Ann: Book and her other book that she what was the one about having an affair?

[46:37] Karin: It's the state of affairs.

[46:40] Ann: Yes, the state of affairs.

[46:41] Karin: Yeah.

[46:42] Ann: That's another very good book. But yeah, I'm always reading myself because I just think I'm like a sponge. You can never well, my belief is I'm only going to take people as far as I am, as far as I go. So I continually challenge myself and my beliefs so I can help people go further with themselves.

[47:07] Karin: Yeah. And you're walking the talk.

[47:10] Ann: I do try. Yes, I do.

[47:15] Karin: So as we kind of get toward the end of our conversation, if there's one thing that you'd like women in menopause specifically to walk away with after this conversation, what would it be?

[47:27] Ann: I would like them to know that it can be look at it as more of a spiritual experience, that your body is also a period of grief. Even though, myself, I chose not to have children, I still had to go through the process of grieving that I couldn't have children. So it's a big process, I think, of grief, of letting go of who we were, so we can step into who we are to become. And it's just as magnificent. We have many deaths every single day. We grieve many little things. We just never really fully realize it. It's such a wonderful phase. And I think if we talked about women in their cycles, when they get their periods, when their periods are ending in more of a spiritual mindset or a more favoring mindset, that this is a wonderful process. It's a transition. It's you being a woman, and now you're going to step into your wisdom, your years of experience, and you're going to help younger women go through the process. I mean, it's really such a fabulous stage if you want to manage your symptoms and your emotions, and there is help out there for it.

[48:56] Karin: I couldn't agree more. I mean, for me, my 50s have by far been the best years of my life.

[49:03] Ann: My 40s were terrific. My 50s were fabulous. And my 60s here we go. It is different walking into your 60s, because it's like, okay, this really gets real. How do I want to live my life? With intention now is when I ask.

[49:25] Karin: My guests my standard ending question, and that is, what role does love play in the work that you do?

[49:32] Ann: I think we have to learn what love is, and then we have to start with self love. I think it's about loving ourselves, especially women loving ourselves more. We're okay as we are. We are enough. That mindset, we're not good enough. Whatever we've been told is a bunch of nonsense. And whatever our bodies are, they're perfectly fine. And I think you are enough. And just remember that.

[50:04] Karin: Yeah. And how can people learn more about you and working with you?

[50:10] Ann: My website is acconfidentialconversation.com. I'm on Instagram, YouTube and Facebook. I also have a free love assessment you can take on my website. I also have a free love your libido workbook that you can download. And I'm in the process of making a couple's massage video, a sensual couple's massage video that should be out in the fall for couples to learn how to massage each other.

[50:43] Karin: And this was a really fun conversation for me. So thank you so much for joining me. I really loved it.

[50:50] Ann: Oh, good. Thank you, Karin. I enjoyed it.

Outro

[50:52] Karin: Thanks for joining us today on Love Is Us. If you liked the show, I would so appreciate it if you left me a review. If you have questions and would like to follow me on social media, you can find me on Instagram, where I'm The Love and Connection Coach. Special thanks to Tim Gorman for my music, Aly Shaw for my artwork, and Ross Burdick for tech and editing assistance. Again, I'm so glad you joined us today, because the best way to bring more love into your life and into the world is to be love. The best way to be love is to love yourself and those around you. Let's learn and be inspired together.

Welcome to another amazing episode with Dr. Betsy Greenleaf where we sit down with the incredible Dr. Kyrin Dunston to discuss what you really need to know about hormones.   Tune in for an insightful conversation and learn from the experts on what you are not being told and how to get the change you deserve.  Get ready to be blown away! #Podcast #ExpertInsight #DrKyrinDuston #DrBetsyGreenleaf

If you enjoyed this episode please like and subscribe.

Also check out Dr. Kyrin's Hormone Balance Bliss Challenge

In this episode of the BioBalance Healthcast, Dr. Maupin and Brett Newcomb talk about the mulptiple ways to a woman's orgasm.

In 2002, the Women's Health Initiative released the results of its study, claiming use of Hormone Replacement Therapy (HRT) increased a woman's risk of breast cancer.

Almost overnight, use plummeted, leaving a great many women without a good alternative for managing their menopause symptoms.

In their book Estrogen Matters, Dr. Avrum Bluming and Dr. Carol Tavris take a deep and detailed look at the WHI study and its conclusions.

Not only, they argue, did the WHI unnecessarily frighten women and leave them suffering with very real symptoms, they may also have prevented women from taking a life-changing, even life-prolonging treatment.

In this podcast with genneve CEO Jill Angelo and genneve Director of Health ob/gyn Dr. Rebecca Dunsmoor-Su, Drs. Tavris and Bluming take us through their research and make a compelling case for the safety and effectiveness of HRT.

If you're in or approaching menopause, this podcast and the book Estrogen Matters can help you better understand HRT, its true risks, and the very real benefits it can offer.

Learn more and find the full transcript at genneve.com.

This week we are taking our new book, The Secret Female Hormone, to London. Actually, the book is already there; it is being published by Hay House International in six different countries, including the United Kingdom. We are quite excited about this opportunity. We’ve been learning many interesting things about how the UK’s National Health Service (NHS) is different from the medical system in the United States.