Perimenopause Unplugged: Why Addressing Hormones Early Improves Long Term Health with Dana Culp

Today, we welcome Dana Culp, a doctor of nursing practice, founder of Thrive Midlife Medicine, and a certified menopause expert, for a candid and empowering conversation about navigating the complexities of perimenopause and menopause. Dana shares her personal journey from critical care medicine to becoming a passionate advocate for women’s midlife health after her own symptoms were repeatedly dismissed by healthcare providers.

Dana explains the foundational pillars of midlife wellness and shares practical strategies for advocating in the doctor’s office, the essential lab tests every woman should consider.

The episode also explores the impact of weight gain, the role of GLP-1 medications, and the importance of building a supportive care team. Dana’s insights on symptom tracking, self-advocacy, and incremental lifestyle changes offer hope and actionable steps, as well as a better understanding why self-education and persistence are crucial in a healthcare system that often overlooks women’s experiences.

Connect:

• Website: https://www.thrivemidlifemed.com/
• Instagram: @thrivemidlifemed
• Facebook: https://www.facebook.com/thrivemidlifemed
• LinkedIn: https://www.linkedin.com/company/thrive-midlife-medicine/

Resources:

• FREE WORKBOOK: The Midlife Belly Fat Reset: A 7-Day Hormone-Friendly Plan for Women in Menopause

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Transcript

That is my story. I didn't realize how many things had gone sideways in my life that actually were related to the hormones. So, when that, that got balanced out it was just this huge epiphany. All of a sudden people around me weren't irritating me.

I loved my job again. I was excited about life again. The weight was falling off. I could sleep. And all of the mental health stuff, the anxiety, the really not engaged with my own life, it all fell away. 

Welcome back to the Menopause Disruptor Podcast. Here I am your host, Mary, and today we are being very disruptive, as we always are. One guest after another, an expert in their field of hormonal health, women's health, This one is no different.

I'm pleased to welcome Dana Culp, a doctor of nursing practice and a certified menopause expert. As well as the founder of Thrive Midlife Medicine, Dana brings a wealth of experience from her background in critical care, clinical leadership, and family medicine, and now leads a rapidly growing telehealth platform dedicated to empowering women through the midlife transition.

And in this episode, Dana shares her personal journey from navigating her own perimenopausal challenges to becoming a passionate advocate for women's health. We'll dive deep into the basics of hormonal health, estrogen, progesterone, and definitely testosterone. Why nervous system regulation is so crucial, and how to advocate for yourself in a healthcare system that too often.

Yes, dismisses women's concerns. Dana shares practical advice on lab work, metabolic health, and the importance of building a strong foundation covering Covering everything from sleep and nutrition to movement and mindset, and you'll also hear about the nuanced role of hormone therapy, the impact of stress, and why having the right support team can make all the difference in your menopausal transition Plus.

We'll discuss the most overlooked symptoms, red flags to watch for and daily habits that will support your midlife health. So get ready for an episode packed with real stories, actionable insights, and the encouragement we all need to disrupt the status quo and thrive in midlife. But before we begin, here's something you need to know about Dana.

Dana Culp. Has over 25 years of clinical experience and her journey to create Thrive. Midlife medicine actually began from her own experience not having symptoms taken seriously. her science-based and individualized approach and her ability to turn complex medical advice into practical support makes her a trusted resource for women navigating perimenopause and menopause.

Whether it's persistent brain fog, weight gain, mood swings, sleep struggles, or intimacy concerns, Dana helps women across California and Nevada finally make sense of what their bodies are telling them. Without fear or overwhelm. Her website is thrive midlife med.com. You scroll down about, oh, two thirds way down the page and you will find a very handy menopause quiz.

This quiz will help you learn if what you're feeling could be the early signs of perimenopause. More importantly, just taking the quiz is knowledge. Knowledge is power, and power is the difference between being told what is going on with your body and you making choices for yourself. Please join me in welcoming Dana Culp to the Menopause Disruptor Podcast.

Dana Very excited to have you on this show,

So happy to be here.

I'm gonna get right into it. We were

Okay, before we get into it, I want to hear about your story. What was happening in your own body and healthcare experiences that ultimately led you to create Thrive midlife medicine?

Ah, okay. So for myself, my own personal journey through the hormonal chaos that is perimenopause, uh, actually led me to make this pretty big change in my life. going from, critical care medicine into clinical leadership and the hospital system, and then moving into family medicine that had been my focus and, I loved every minute of it and.

Till things started changing with myself. And I had no idea what was going on. I assumed life was happening to me. And this is just what happens. Life gets complicated and how we deal with it or, or what comes at us. So what that looked like for me was, I have always been passionate about my career.

I started having some being a little disgruntled here and there and not being that happy. I started having some challenges in my interpersonal relationships. I was really irritable, uh, in my head, very critical, not as engaged in my own life was feeling anxious. 

and none of those things had ever been part of my life before.

But I thought, well, maybe that person deserves me to be a little irritated or those type of things. Again, I figured this is just what happens when your life gets really complicated. A lot of weight gain. A lot of physical changes, that were my health was starting to decline.

My lab values were out of whack. and this is what happens when we get older, right? This is what the healthcare system tells us. and I had a little seed planted in my head. thank goodness that maybe some of this stuff has something to do with all the hormonal shifts. That happen at this stage of life.

And thank goodness that seed had been planted. So then I thought, oh, well maybe I'll go a little further upstream and see if any of this is related to hormones as opposed to life just coming at me. And when I started down that path, I felt very hopeful, that some of this would be mitigated.

I was met with dismissal. I was met with you just need to manage your stress better. You just need to exercise more and eat better. And those kind of things. And the more educated I got, the more I recognized. Well, of course those things are important, but that's not the answer to everything.

 so I, I became. Just on my own, more and more educated, I ended up going to four different, very highly regarded providers, in different specialties. To get this hormonal insight into my own care, I was dismissed each time. I was given, uh, by one very prominent. Ob, GYN a medication that actually helped a little bit, but I later learned nobody prescribes that anymore.

It's due to the safety concerns for it. and if you want me to call it out, I can, but nobody per, uh, per prescribes that anymore. I went to the.

do it.

At OB GYN. Yeah. Yeah. So this was a really highly regarded OB, GYN because of course that's, that's, they know everything about women's health. Right?

That was sarcasm. by the way, I love OB GYNs and there's many amazing ones. then I went to a very highly regarded one from the Stanford system who she had one, one. Size fits all, and that's what she provided. I had some additional questions and some, well, what about this? And was completely dismissed.

And so long story short, it was shocking to me as a healthcare provider and as a patient and as a woman. To be so disregarded. And each one of these were women, by the way. so I, what, what ended up happening to me is I had to go in to yet a new provider armed with all of the data and all of this is what I want, can you help me?

And luckily she. Embraced me with open arms and started me to feeling like myself again. So that is my story. I didn't realize how many things had gone sideways in my life that actually were related to the hormones. So when that. Got balanced out. it was just this huge epiphany. All of a sudden people around me weren't irritating me.

I loved my job again, I was excited about life again. The weight was falling off. I could sleep. And all of the mental health stuff, the anxiety, the really not engaged with my own life, it all fell away. and for me, and I'm not saying this for other women. Every single thing was for me related to hormones.

And then, so that's where my shift came of how I desperately wanted to help women not only get this education, but also to feel amazing in this stage of life. I'm in my late fifties and I thought, this is it. It's a slow slide into, irrelevance and deterioration, and I feel like this is just the beginning of everything.

So my my own, practice, which at that time was family medicine, slowly, well, not that slowly actually. It quickly turned into a specialty practice. And I realized that, and that was like my corporate job, and I realized I need to be able to help more women. There's only so many hours in the day, so I, that's where Thrive Midlife Medicine came in.

 it's a telehealth platform, so I'm able to now see women far and wide. They don't have to be in my geographic location. I'm in a couple of different states in the United States at this point, uh, and we're expanding pretty rapidly. 

Fantastic.

Yeah. So I hope, that was a long, rambling story, but I feel like so many women have the same experience, but without the healthcare background and without the the self-advocacy to just keep pushing and get help and not be sent away, dismissed.

Exactly. Yeah. Not putting up with the No for an answer.

Yes.

the misogynistic approach

Oh, yeah.

the gaslighting. But interesting you were saying that this was coming even from women

Okay.

We have heard stories. Even Dr. Mary Claire Haber, one of the leading experts and outspoken women in menopause health and OB, GYN has even said she went through her schooling, this was well before her perimenopause and menopausal transition experience. There was this term called the ww, and she asked, what is that?

Yes.

When midlife women get to a certain age, they become whiny women. And so that was how the medical practice was regarding it and teaching it to her as a woman. And then one day she entered into that phase where things like you described we can all attest to and have that experience.

Things were shifting. There things weren't normal. We weren't showing up the same way from the mood to the sleep, to the waking, which is a real indication right there.

Yes,

again, yourself, these are, you are clever, intelligent, bright women who didn't have all the answers, could had to figure it out on your own.

yes.

Uh, I wanna take us back to something you said about lab work. Your lab work was all out of whack, so let's identify what kind of lab work should women be asking for? What kind of data should they be looking at when they ask to get some blood work to give an indication of what might be shifting and changing in their body so they can get at least get ahead of the process and know what to prepare for?

Right. I'll speak to that from two perspectives. The first is when I was talking about myself uh, that. I thought, what am I'm not doing anything different. I'm eating the same. I, I've always exercised and ran and, my cholesterol was going through the roof. My blood pressure was going through the roof.

These were labs, just my regular yearly labs that just started. Slowly going, going wrong. And I hadn't done anything different. So that, was one of my wake up calls on my list of what is happening to me. and then the, I think the broader question that you're ans asking is about lab work for women who are starting down this road of what kind of lab work, uh, should you be getting, should you be asking for?

And that's a little more nuanced. 

Okay.

 but I do have some strong opinions about that. I like to always tell my patients hormones are not the cause for everything and they're not the cure for everything. There can be a few things going on at the same time and lab work, while it's not the be all end all, it's really important.

 for instance, if you're having, anxieties. Sleep problems, weight problems temperature regulation problems then you need to look at other metabolic factors like what's happening with your thyroid. And comprehensive metabolic panels. Those to me are baseline.

You have to rule out other things first before you can go further upstream with the hormones. And then. As far as hormone testing, that is also a little nuanced once you rule out other things and or manage for instance, thyroid or something else. Then. It depends on where a woman is at in this journey.

 if she is still getting her monthly cycle, even if it's sporadic lab values, for the basic hormones, estrogen, progesterone, testosterone, have a little less. Value. It's good to have the baseline, but they are have a little less value because it's har. You can't really direct the care based on the lab values since they do fluctuate so much while a woman is still having a cycle at at some point.

Now postmenopausal, I have a different opinion that again, it doesn't have to direct the care, but it's really good to have those baseline labs and they don't have to be complicated. There's a lot of very expensive, complicated tests out there. I'm talking about some basic tests for your basic hormones.

Okay.

And then one that is I think, imperative where no matter where you're at in this hormonal journey is if testosterone is something a woman is looking into to see how that would benefit her potentially. I do feel you need baseline labs for testosterone. It's exceedingly important for women, but we also have a really tiny little narrower range for us that we need to make sure we stay in uh normal physiologic level.

So that is, is for me, a non-negotiable, but the rest is a more nuanced conversation.

So, uh, let's go back.

Mm-hmm.

health. So

Yes.

important that the woman takes a look at her overall health, metabolic health, because as we understand loss of muscle.

Yes,

is the most metabolically active tissue in the body that can have an effect overall health. and then specifically the thyroid tests.

So what thyroid tests should be looking at in terms of like, free T three, free four, not all thyroid tests are the same as I understand.

Correct.

that a little bit.

Sure. I love that question. When you go to your regular gp, family medicine, there's a, there's some basic tests that get run to rule in or out if you're going to look, uh, further if, if things are going okay. Uh, and typically, especially when it comes to thyroid, an older practice is to just te check the TSH how much of this hormone is your body making? And that, in my opinion is, and I've been doing this for decades, so I was guilty of this decades ago as well. I feel like that's quite old school and does not give you enough information to be able to then.

Go to the next step. in my own personal practice, I also check T three and T four. And for folks who don't understand what these terms mean this, these, the, you have, what does your body make? And then, but how much of these hormones. Can you access? So how much you have floating around, is it not the same as how much now can your body access?

And those are also the same type of tests you would do for, your, hormones your sex hormones. Just knowing how much you make, it doesn't give enough information to actually then act on it. So there are a lot more sophisticated thyroid tests that may or may not be necessary.

But if you just check TSHT three, T four, you'll have enough information to know if you need additional testing or if you're doing Okay. I hope that it is a little simplified, but but that is the way I practice and I try not to make this overly complicated.

So in terms of active and accessing

Yes.

the, the hormones, testosterone, of our hormones and the T three, so. What's the indication that what is available is actually being converted to something that can be active in the body to be useful, I guess is

Correct.

term. Is that

Perf, that's a perfect explanation. Exactly. And, and both of those are really important to know, to know what your next step is.

Okay. So if numbers are still okay, what is the indication that it's, it's converting the way it should be

That's where you would check T three and T four.

Okay. Gotcha.

Yeah.

Now, when it comes to hormones, as you said, it was very nuanced.

Yes.

and I've had this question before and I asking the experts always important. I hear, well, should I be getting my hormones tested?

And as you said, if you're still cycling from day to day, month to month, those shifts in changes are such a variable.

Yes,

could a woman, whether, and, and I always say. your symptoms. If

yes.

symptoms are gonna be the best indication, and you can almost guarantee that by the time you hit 40, you know it's inevitable.

You'll be somewhere in the transition.

Yes.

if it gives the woman confidence to know those numbers, what should she be advocating for when she goes into her doctor and says, I'd like to get my hormones tested, they're met with. Dismissal. Oh, you're too young for that. Oh, you don't need to take that. What could she then be saying, asking her doctor?

Mm. Okay. I, again, back to education. I love this question. So, although in perimenopause, the labs in my opinion, should not direct the care. It's just what you said, symptoms. It should be the most important thing to track. Uh, but if a patient came in and said I'm a data person.

I, I want these levels. My aunt said estrogen dominance and my mom said this. And, and so some folks they. I'm a data person, so I a hundred percent understand if you want your baseline labs. That's great and, and it's not I wouldn't dismiss it because what if a couple years from now, things really change, you have that baseline or at least some data to compare it to.

So I would never dismiss a woman who said, I really would like this. Even if it's not going to change our plan of care. So, uh, and a woman can ask for that. These labs, if you, uh have the right diagnosis codes, insurance will cover them. So, uh, so asking for estrogen specifically estradiol is really helpful because that will indicate if you.

Do you end up using an estradiol, uh uh, medication to actually measure how well it's working? Uh, progesterone, you could get a baseline. That's perfectly fine. Uh, and then testosterone again, I think that one is a, is a must. Uh. Your total, uh, back to the, the thyroid, how much is floating around in your body?

And then the the, the free, how much can you actually access of that? So you have to have both of those, uh, for testosterone to have any ability to interpret what's happening in your body. So to speak more directly to what you said, if you want that data and you are dismissed, you are either at the wrong place or it just needs to be, but I would like this.

Yes, and of course we only have certainly here in Canada, we get 10 minutes with telehealth or

Yeah.

doctor's office, and you don't wanna be wasting nine and a half minutes of that pleading your case.

yes.

Uh, and so my, uh, practice, my opinion always been, or, or my belief has always been if you can go marching in like a lawyer in the courtroom, marching in with this evidence and be

prepared to speak on it in a very efficient way, what would be some of the things. The woman could present in terms of, okay, rather than saying, I heard this. Hi, I heard that. 'cause I think doctors might even roll their eyes to that

Yeah.

and be more specific. Like, help me understand that these lab tests that I'm asking for will give me. Some peace of mind. These are my symptoms that have come up of recent.

I can tell you from month one to month two, or maybe even month three, that this is what has happened with my cycle. What more could she go in there armed with opposed to just saying, know, Sally said this, this Instagram influencer said that to make it her case more solid.

Yeah. So uh, I'm not, uh, as familiar with the, the Canadian system. I know in the states, you you can go to who you want to if, as long as it's within your system, uh, or within your, uh, under your insurance umbrella, or if you're just going to pay for a specialist. So the first thing is, is to vet who you're going to be seeing.

I don't. You're not gonna go see somebody who just has no knowledge about hormones and, and midlife women. So if there is an ability to Google people, research them, uh, look at reviews just, you don't wanna waste your time if you get there and they're just, they put their hands up and they don't know anything about.

Hormones. So that's the first thing. If, if you have the ability to pick, uh, see who you're going to see, the second thing is uh, coming in armed with, uh, potentially a plan. 

Oh, I

so yeah, so that is actually a big part of my practice is and so, and I'll just give you the, the general concept. So uh, like I started out saying I can't see everybody and.

Do we really want our, our ladies having yet another doctor's, a doctor that they have to be weighing into their care. I love the idea of having your beloved gp, uh, your, your beloved family medicine person who's like the ring master of your health. They and if you talk to a specialist, uh, say for instance, thrive Midlife Medicine, i, I don't care if I'm the person who carries out the plan. What I want is for women to be educated, to know what their particular risks are. What, what the best plan, uh uh, directed by a specialist would be this medication, this dose. Then do this, then do that. And, and take the plan. Like you said, you have 10 minutes.

I, I think anyone worth their salt, uh, would love that, that I have special, I used to, when I was in family medicine, have specialist plans presented to me that maybe were a little bit outside my comfort zone, but if I have that specialist directing the care. I usually will carry it out, I feel, would feel comfortable.

So that maybe would be the, the next level. And, and so for instance, ladies that come to see me and they're like, I don't need another doctor, but I need a plan. I will send the note that is very specific with this is the medication, this is the timeline, this is the rationale. They will take that note that I provided to their primary that has been, uh, hugely successful.

And then I think the third thing is, is to come in, like you said, being pretty darn educated of what you think might be going on. And these are some baseline things I would like checked thyroid, A1C, complete metabolic panel, basic hormones. And. But I think with that approach, a woman has to be very uh, capable of advocating for herself and not taking no for an answer.

And that that can be, that can be challenging. We come, we come into situations, uh, I think we've all experienced it. Come in our hands on our hips, we're ready and. They say something and it is very hard to push back for, for a lot of, a lot of women. So that's why I would recommend a little more upstream approach.

If, if it's possible. I think it's be a more streamlined way to, for women to get what they need. I hope that, I hope that answers your question.

It actually doesn't. We're gonna

Okay.

that

Okay.

Clarity, A1C for our

Yeah. Oh, that is the gold standard for looking at metabolic dysfunction or for diabetes. So that is typically, at least in the states, not included in your, basically your, your basically your labs.

Uh, that's usually they look at what was happening with your blood glucose on that particular day. Hopefully you were fasting the way you, you're supposed to if it's out of range. Unfortunately I see every day, uh, providers. Thinking, well, it's not that far out of range and ignoring it for yet another year, uh, or sending the patient back for yet another blood draw and then getting the A1C.

So it's, it's, uh, hemoglobin A1C. So it's, it looks at what the blood sugar has been doing over the course of, uh, three months versus just that one particular day. Uh, and so it, that's why it's the gold standard and in the states if. I, I have always included it in my basic yearly labs, and you just have to you just have to put the right code and insurance will cover it.

So there's no reason not to run it, in my opinion.

Okay, so that's another one we should be requesting from our doctor. Say, I would like to have this tested.

Definitely, I.

And so, and it would seem common because it is one of those tests, as I understand, to diagnose any pre-diabetes precursor for diabetes type two diabetes, which of course is a major health concern in North America.

So it

Absolute.

something that would keep our eyes open. Why should women, uh, particularly in the midlife with the weight gain. Increased inflammation and rising cortisol, which are common when the hormones are dysfunctioning fluctuating with the change in estrogen and progesterone levels, as well as their testosterone levels. should then we women start paying attention that this weight gain, although common is not healthy. And start at taking this quite seriously for the next phase of her life, which is pretty much post-menopausal and all those years beyond.

Absolutely. I think as a, as a culture, we look at this from an aesthetic perspective. Weight gain. My clothes don't fit. I don't look the same. And, and again, uh, we focus on the, the number on the scale, and it, it is more about. Aesthetics as, as a culture. 

Yes.

the reason though that that is not the right way to look at it, in my opinion, is just what you said.

So excess adipose tissue especially for women in midlife where it starts to accumulate in the midsection, uh, that's, that's really common. And there's, there's an actual biological reason why that happens. Directly linked to our dropping estrogen levels. But it is a huge, hugely inflammatory uh, it can impact our cardiovascular system.

It can impact cancer and heart disease and there's a lot of connection with mental health dementia and Alzheimer's. That extra. That extra adipose tissue. And then it also can really affect uh, psychologically as as well. There's a, there is a, a actual. Uh, chemistry component, but there's also women who don't feel good, they can't breathe as well because they're carrying around this extra weight.

They might not engage in the activities that they did before because they just can't, or now, now my knees hurt. Or or which whatever joint hips and ankles and things like that. So it is. Not just aesthetics. It is really, really important to stay as close to our, i, our ideal weight as possible for so many reasons.

And I, to go back to the hormones when we get that piece right assuming we don't have all of these other metabolic changes that don't need to be worked on, uh, our body won't fight so hard against us to hold on and continue to accumulate more and more. Fat, uh, yeah. Adipose tissue.

It will, it will go, okay, I don't need to hold onto this anymore. Because for women, that is part of what's happening. And I'm not saying hormone replacement therapy specifically is a weight loss drug, but it will have your body stop fighting against you so hard.

And so you indicate yourself once you started recognizing, got, you, got yourself educated and realized the role that hormones were playing

Yes.

both for you and against you that suddenly that. Weight gain that you experienced didn't, was a non-issue, and you started losing the weight.

Yes.

because you went specifically on a hormone therapy was it a number of things? And I wanna get into this about nervous regulation, nervous system regulation, and cortisol.

Yes, yes. I think that it is this, it's this feedback loop. So I'll speak about myself, but I do think that m most women will resonate with this. So for myself, I was gaining, gaining, gaining, gaining a lot of weight. Uh, I couldn't sleep. So in the morning you don't want to do any of the physical activities 'cause you don't feel good.

You definitely make different food choices when you're sleep deprived. And so it goes so for myself, once I was able to sleep again, uh, and that happened very quickly because my sleep was really really tortured, uh, for a long time. So once I could sleep again, I woke up. I've, I am rested.

I'll, I'll go for that walk. I'll, I'll go for that hike. And you, you make the different food choices. And so the, the hormones don't make you lose weight, but they make you feel like yourself again, and you're engaged in your life again.

I love.

And so that part happened a little slower. You, you.

Start feeling good again and doing the things you love again. And and then it just, and making better choices. And, and not to blame women, but that is something that happens when you're sleep deprived. We, we reach for sweets and things to give us energy. So so once that baseline was corrected, and I see this in my women patients every single day, the weight does start to just.

Fall off. And if it doesn't because that's not. The fix for everything, and it's not the volume for everything. And I know you didn't ask about this, but weight loss medications can be really, have a really synergistic effect, uh, for women in this stage because the weight is not just aesthetic.

It is very important to to get, get as close to how you used to be or maybe even better, uh, and sometimes. And, and specifically these GLP ones uh, really play a, a big role for women in, in midlife to help them get back to where they were.

Yes, I've had a couple of guests already on the show to talk about GLP one Agness and its role in helping with the weight management,

Yes,

of the fact, like you said. The metabolic risk, the cardiovascular metabolic risk that

yes.

now exposed to with her new hormone profile in her body as she hits midlife.

And because of the fact that the, what's the terminology? I-D-F-L-M, I don't feel like myself

Yes.

impacts our

Oh God. That that just made, that just hurt my heart. I hear that every day. Yeah.

Like the motivation to even be active in any. sense of the word,

Yes.

or picking up weights, uh, the brain fog and fatigue. Which, like you said, we reach for the carb, carb rich foods because the brain is saying, glucose, glucose, glucose, I need fuel.

Gimme something I've gotta perform today. I've gotta go to the office, but I haven't slept. And so gimme something as a quick fix to get through

Yes.

it's like you said, it's just this, this vicious cycle

Mm-hmm.

we can at least break it with one fork in the road. Being okay, some hormones, but then

Yes,

a multi-pronged approach

absolutely.

then you bring in some exercise, you'll look at your nutrition. Uh, weight starts to become a little bit more managed, starts normalizing, and then sleep improves. But what about stress? Because we are still constantly triggered, stressed, triggered stress, and we never close that loop or actively take steps to close that loop. How does the nervous regulation, nervous system regulation play in this whole multi-pronged approach midlife management, symptom management?

Yes. Uh, I love this. This is huge. I love that you're, you're really highlighting this. So what I hear from my patients every day is, uh. I used to be able to, to manage all this, my family, my career fill in the blank. And I can't seem to do it anymore. I can't seem to juggle all those balls anymore.

I can't seem to to manage it. So I keep going back to the baseline foundation. A lot of that is because of estrogen dropping. And if a woman wants to just trial to see if that can,help her juggle those balls again. That there, you've got the baseline. 

 I don't think the hormones necessarily fix everything, but they, they fix the foundational parts that are, are. Not working for us anymore so we can get back online and manage. All of those things we managed before. So I, I keep going back to the foundational piece.

You're still gonna have stress, you're still gonna have, especially in this age, you might have still kids under your roof. You might still, you might be caring for aging parents. You might be your career might be getting really, really challenging. But if you are fighting with both you're not fighting with your arms tied behind your back then you can.

Hopefully tackle your life again. And once you do have those foundational pieces handled, if there are things that need to change you know that it is too stressful then at least you can assess it properly.

Right.

but you have to have your basics handled. And I, that's where I think hormone balancing is, is just essential to this conversation.

I love that and I think of an analogy and I'm gonna get it wrong, but, so I made it up my own, in my own head. like when you're improving your, your fireproofing, your home, you're putting up better insulation, fireproofing, insulation, firewall protection in your home, but. Suddenly a fire lights up in your home, you're not gonna go, oh, but if we continue to put on the better firewall and the, and the better insulation, we can address these issues, no, you're gonna stop down tools and put out the damn fire

Exactly.

emergency number one.

And that's, it appears to me's like, okay, let's triage this with. What's the most urgent, situation or urgent of care required, and then go back to the foundational pieces

Yes,

the overall structure so that it's more fortified and strong

yes,

years to come.

yes, yes. I, I love that. That is, that is such a good analogy. I think, I think household analogies are always just brilliant. it's the foundation. You still have to put out the fire, but you have to make sure your foundation is good. And so I love that.

 and then you can feel like, okay, I'm in better control because we've addressed some of the urging issues immediately.

 I really believe this for women, when we feel a sense of control, even though we don't have all the answers, but we feel that we're back in the driver's seat, that in itself. Helps our nervous system. It helps regulate that fight flight almost to a, okay, got this. got some tools in the toolbox. I'm trialing. I like this. I'm trialing, I'm experimenting. I'm opening myself up to experimentation to see if a little dose of estrogen will work or a little dose of testosterone will

Mm-hmm.

of course in Canada, United States not easy to get testosterone, but we can work with

Oh,

pharmacies

 in Canada. Health Canada still doesn't prescribe as it would estrogen and progesterone therapy, but nevertheless, it's still, it's still there.

Yes,

Science is marching on And I'm hoping one day that we will arrive at a point where we can have now commercial doses, uh, that are 

yes. 

body for testosterone. we're getting there.

Yes.

back to just being able to. Test and trial and know that it's, these are the, just some of that triage approach

Mm-hmm.

we get into the other factors. So at all those other tools in the toolbox, when you have women come to Thrive, midlife medicine, what else are you prescribing in terms of lifestyle that can help her on her journey so that she has, she can optimize all the tools in the toolbox.

Okay. the big picture is so important. The hormones are not the only issue, but I I do take a backwards approach to this. I have had many colleagues who say. Go on a diet, get your exercise and your stress managed, see what you're left with, and then come back to me and we'll talk about hormones.

I do not subscribe to that approach. I think it's completely backwards. Because if you don't feel good and you can't sleep and you can't think straight and you can't, your brain is not looking at stress the same way again. Then you're again fighting with your arms tied behind your back. So the foundational pieces, I think are very important to have in place first. And then,

absolutely, you have to take care of your body. You need to eat healthy food. I do know that there's a lot of, complicated messages out there right now, and I don't wanna make this complicated. As much as I love those messages, I think they're like the next step. Again, I'm back to the basics.

So, eating the appropriate calories for your activity level. Prioritizing protein which is so important at this stage of life because we do need to really protect the, our muscles. And and so exercising I prescribe all of these things eating correctly with protein at the highest priority.

Getting daily movement in Would I love every woman to be at the gym, pumping iron and lifting heavy, which is the big catchphrase these days? Absolutely. But, for some women, they just need to start moving. And so movement every day that they enjoy and that they will do once they feel great, they're going to get there to these higher levels.

But, but back to the basics. As far as food goes, I love to keep it really simple. I do have some wonderful nutritionists and dietician. That I will refer my patients to when they're ready for that. But again, I'm not trying to make their lives so complicated, but, uh, focusing on whole foods as close to their natural state as possible.

So proteins, whether they're from plants or from animals. Fruits and vegetables and limiting processed carbohydrates, that is my basic prescription. Having sweets and other things only as a treat. And, uh, moving every day getting some sunlight. Really building your your connections with friends and family.

I think that is really underappreciated. 'cause we're all so busy and I think that is imperative to our health and our mental health. and protecting your sleep like it's your job. those are the foundational pieces I speak about with all of my patients.

And then some of them are a little bit farther advanced, so then maybe now we'll talk about what role alcohol might have in their life or taking their exercise regimen up to the next level. But that's just when they're ready for it. We have to make sure our house is insulated, like you said, and we have our foundation built, and then beautiful things will blossom from that.

But without the foundation you can't expect much to happen. And you'll work really, really, really hard without all of the foundational pieces in place.

I had a couple of previous guests summarize it nicely. It's not about taking away this and eliminating that and removing this because that is almost like negative reinforcement.

Yes.

rid of it. It's bad. It's get rid of it. It's what can you add in that's

Mm-hmm.

benefit. And then take note.

How did that make you feel? How does it change? Oh a 10 minute walk to a, oh, add another five minutes.

Mm-hmm.

add another gram of protein, or, oh, another serving of vegetables over a course of time so that these tiny little shifts add up over significant period of time. And almost psychologically, we start making those choices because we feel in control. Say, I am feeling good, maybe I could do away with this. Maybe I don't have to have a, chocolate bar three times a week. Maybe I'll just save it for a, know, a, a nice little sweet treat a blue moon, but not that deprivation such that we feel like this is gonna be a grind.

And that's just negative reinforcement. And in my opinion. It just drives up the nervous system all over. It's like, ugh, deprivation, panic, fight, flight, freeze, we're just allowing our bodies to be that experiment and enter this new era with a, an open heart, an open mind. Mm-hmm.

Absolutely. I have subscribed to that philosophy for a very long time, that as soon as you tell a patient or anybody what they shouldn't be doing and what they can't have anymore it's all this is just it. The way our brains work, that's what we focus on. And it's about scarcity and deprivation and I can't do this and, and all or nothing or never, or black and white.

But if you frame it the way you just did, our nature. it's not what I can't have. It's put all of these good things in place and then see what room you have left. And it's, it's really easy to do that, have that conversation with food. if this is what you are adding into your, into your diet, all these beautiful colors and beautiful flavors and.

You aren't really gonna have enough room for all of the, all of the things that are not benefiting us. So I always approach it from that perspective and I find that it's a lot more successful. And then folks are focusing on The abundance and the positiveness as opposed to all the things they can't have.

Which, which then leads to self blame, oh, maybe I did this to myself with those extra candy bars or whatever. So yeah, the small approaches, but looking at it from a perspective of abundance, this is what I can have, and then I don't really have room for the rest of the stuff that's not benefiting me.

 Bringing it back full circle now to

Okay.

said earlier on is when you have that coach that. Person who helps you, that specialist or whatever role they have, make that plan carry you through that plan

Mm-hmm.

are all the little pieces to put in there.

If it requires a little going to see a specialist in healthcare that's focuses on this, add a little bit of that. How important is it for you that a woman does work with somebody who can hand through that journey?

I think that it is essential it is complicated. We are complicated, and it it really requires a couple of things. One, I think every, and we all have had this experience, somebody that really resonates with us, that we really trust, that we count on that. We just feel like they're on our side and they're on our team.

And I think that can go back to the beloved family provider family practice provider, and why I really support I really support cultivating that relationship. Assu, assuming that is. The relationship, that's not always the case. And why I think that fragmenting the care with all these different specialties isn't always the best choice, but getting those specialist perspectives and consultations to then bring back to your team really, really helps a lot of women.

 But we can't expect everything from one provider. I don't care how amazing they are. We say this in medicine all the time that we can't know everything about everything. So, I, I love that there's so many wonderful resources now your audience is just gifted with all of these different specialists that you talk to and that share their information.

And then take that back to your trusted team leader. I do think it's really important, but I do think though that in, in medicine we're very siloed. So if somebody is fortunate enough to, and has the time and the resources to have all of these different. Specialists they don't necessarily agree with each other.

And so the woman is left to be the ring leader, the ring master of all of this. So if whenever I can support they're just beloved primary care provider that is definitely on my list of one of my goals. And, and then where do you start with that? Right.

Yes.

So. I think that perimenopause is a lot more confusing than just when a woman is fully in menopause.

We all I think, recognize that delineation. Like, oh, okay, I know what this is now, or at least what's part of it. but when you're in perimenopause, it's like. What is happening to me? Is this really perimenopause or is this something else? So at my website, I do have a perimenopause quiz that is super it's really informative.

So depending on how the questions are answered, it will tell you what your next steps are, where you're at, probably in the journey. So a lot of women find that really valuable. So, thrive midlife med.com. And then there's a, you can just go to the website and there's, it's very prominent on there, the perimenopause quiz.

Or you could type in perimenopause quiz. And that's a great, that's a great place to at least start to know if this is what is really happening.

We'll get that in the show notes and share that for

Oh, wonderful. Wonderful.

back to knowledge is power. Just to know it's like.

Absolutely.

Oh, but as you said earlier, still gotta go and check those underlying issues if there's something at the metabolic

Absolutely.

definitely needs addressing.

Absolutely,

How dangerous is it though? When we hear doctors say, oh honey, you're too young to worry about therapy. You're too young to be in perimenopause because we know that, uh, new research and science is telling us that it could happen as early as mid thirties.

yes.

is this

That's, doesn't that sound so young? That sounds so young. But

Yeah.

The window where 80% of women will go into actual menopause, which is 12 months without a menstrual cycle,  is between the ages of 45 and 55. That's 80% of women. Some a little bit later, some a little bit earlier, but that's the vast majority.

And then we know from research that eight to 10 years before a woman's final period it can be perimenopausal and it can be really dramatic, uh, and really. Awful. Or it can be a little more subtle. So doing the math backwards, you're right,  mid-30s and  I have several patients who are in their early 30s So to have. That be dismissed has been such a disservice to women. It goes back to lack of understanding, lack of education on the provider's, point, but yeah, being dismissed and not even looking under the hood to see. And that's where a perimenopause quiz. So women could come in and maybe not be brushed off as easily because they're like, no, I'm pretty sure this might 

Have a component to this. And you're right, there's been some incredible studies that are getting a lot of attention that if women do address this hormonal chaos earlier improvements in mental health, in cardiovascular health, in so many things, can be improved upon the long-term health.

This isn't just about symptom management. This is. About our health span and our long-term health.

so true. 

So it's very dangerous for this, for women to be dismissed, and I love that women like you are advocating for women and sharing this really important message.

It absolutely is. This has been really invaluable information. Before we close,

Yes.

doing those rapid fire questions

no. Okay.

get some more fun but insightful answers from the experts in the field of

Okay.

who just love disrupting the status quo.

Yes.

Okay, they're fine. First question, one symptom wo, women normalize but they shouldn't.

Ooh. gosh, I have several, but, I would say pain pain without an etiology. That is something a lot of us dismiss. 

 it can be a sign of estrogen changes. We have estrogen receptors all over our bones. And so that is probably one that people don't think of is how much body pain that they have.

Joint pain, muscle pain, fibromyalgia is a really common diagnosis in this age group. And fibromyalgia is a diagnosis of exclusion when there is no. There is no identifiable etiology, and that's where fibromyalgia comes in. You have pain, but we don't know why. Dr. Vonda Wright talks a lot about this.

She's a orthopedic surgeon.

That's right.

that it could be estrogen receptors.

 If midlife care were truly done right, what would be different for women?

it would become a screening tool in your regular,

yearly check-ins. And it would be on the differential. We screen for depression, we screen for substance use. We screen for so many things. And I think for women. There should be screening for, hormonal changes, symptom changes that could be related to perimenopause.

Just standard, standard practice. I would love to see that.

 One red flag. Phrase that women hear often from doctors that absolutely needs to disappear.

Oh gosh. Red flag phrase. Phrase. That's not what's happening.

I hear that all the time. Instead of, instead of tell me more or Can you elaborate? To be dismissed, oh, that's not what's happening. And yeah,

Yeah.

love to see that Just Xed right out. I would like more engagement with patients that if you don't understand what they're saying, get them to tell you more and tell you understand.

Yeah. I think we've probably talked about this one, but we'll keep it nice and sweet on the

Okay.

on the last question,

Okay.

you wish every primary care provider knew about menopause.

 it is going to happen to every single solitary woman and that. It will impact most of them. And so adding hormonal changes, hormonal chaos to the differential whenever they come in with with anything to have that just in the, of back of the mind, I would love to have that be part of every single encounter for a woman who's.

maybe 35 ish on up. and then there's no limit.

 And let's leave on a

Okay.

habit that supports midlife health more than people realize.

Ooh, uh, sleep. I.

Yes.

Sleep. That is just the key to, to so many things in my opinion. and it always is the thing that we all, we can just push away if we're too busy and no, we can't,

 It's a non-negotiable.

non-negotiable, in my opinion.

Absolutely. This has been a great conversation, just full of so much knowledge. I can't wait to share it with listeners. Dana, thank you for your time, your expertise, your energy, your insightfulness, and sharing your story. It's real, and we can relate to that, so

Thank you so much for having me. I love your show and I love what you're doing for women. I.

 yes. We've gotta keep disrupting the status quo, changing the narrative, and coming together in community. Women do better together. 

Absolutely. Absolutely.

Today's conversation with Dana Culp reminds us that midlife symptoms are not random imagined or something women simply have to endure. There are signals, and when we understand the hormonal, neurological, and biological shifts in perimenopause those signals begin to make sense. Here are my biggest takeaways from today's episode.

Number one, women Take agency over your health and advocate. Advocate. Advocate, advocate. Go into that doctor's office and request You get the help. You want lab tests, hormone therapy? Don't let a doctor tell you you're too young or that's not necessary. Pretty soon, our voices are gonna get so loud and the pushback will be so strong.

Doctors will be running for the hills or running to get some more menopause education because that's where it is needed most. But until that time. Unfortunately, many of us still have to navigate through outdated models in women's healthcare, but this is leaving too many women to bounce around between providers, still feeling dismissed and confused.

Second biggest takeaway then for me and Dana, remind us of this. Modern menopause care must be individualized science-backed and rooted in listening, not protocols built on fear or that one size fits all. Number three, weight gain after 40. It is not failure of willpower. It is not your inability to properly manage your diet and your exercise no.

In fact, it is a very complex interaction between hormones, muscle loss, which happens rapidly after age 40, and definitely stress and sleep. Sleep being the panacea. I've said it before. I'll say it again. These are all part of the hormonal shifts that deserve real support.

Oh, which brings me right to my last point. Women deserve to be heard in order to feel supported. When women are properly educated about their bodies, equipped with the right language and supported by informed providers, midlife becomes a period of clarity and of strength, not confusion, decline, or shame.

So if this episode resonated with you, let's take it to the next step. Start with awareness. Notice what your body has been trying to tell you without judgment or without blame. Just get curious, then get educated. Seek evidence-based information about perimenopause and menopause so that you can make informed decisions, not fear-based ones.

then next, advocate for yourself. You are allowed to ask questions, request options, and expect care that treats you 

as a whole person and not just another number.

another 10 minute appointment in and out the door. So if you are in the California and Nevada area and you're looking for personalized menopause informed medical care, Be sure to explore Dana Culp's work at Thrive Midlife Medicine.

Her website is thrive midlife med.com. And if you'd like to take a deep dive into the science of symptoms like brain fog and sleep issues for women who just don't feel like themselves, I encourage you to check out. Dana Culp's free live event. on February 14th called It's Not You, it's Menopause. You can find all the details and register@thrivemidlifemed.com slash event.

I'll have that link in the show description below, anyone who registers a replay will be available for anyone who can't make it. This resource remains evergreen. It's for you to have at any time. You can always go back to it. Dana Culp's free gift to you. Go check it out. Would love to have you join in

 take your learning journey one step further and feel completely empowered prepared, educated, and informed to have a conversation with your doctor. Sign up for my Menopause Intelligence course, mq.

You can find that on my website@mlcoaching.com. It's an eight module self-paced online digital course That's midlife Intelligence mq. You can find more on ml coaching.com.

and if you're not ready to dive into the Menopause Intelligence course right away, I'm offering you my freebie.

It's the seven day Belly Fat Reset plan. I unpack all the resources that you need to start addressing belly fat from what is happening to your hormones, how to incorporate strength training and sprint interval training into your daily regime, as well as some nutrition choices loaded with protein options 

That can help you get off the rollercoaster of sugary carbs and onto some really good amino acids to fuel muscle, most metabolically active tissue in the body. the link is in the episode description below. Go check it out. The Midlife 7-Day Belly Reset Program.