Empowered Ease

Dr Darcy Graham- Hot Flashes, Brain Fog, And Seven Kids Walk Into A Clinic

• Jenn Ohlinger HN-BC, BSN, RN • Season 2 • Episode 3

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Hot flashes at dinner, brain fog at work, zero interest in intimacy by night—if that sounds familiar, you’re not broken and you’re not alone. We sit down with Dr. Darcy Graham, DNP and founder of Grit and Grace Wellness, to demystify perimenopause and menopause with clarity, compassion, and real-world tools that fit a busy life.

Darcy shares how she moved from labor and delivery to hormone-focused care, why a single lab draw can’t define your story, and what has changed about hormone replacement therapy now that outdated fears are being challenged. We get specific about the symptoms most women whisper about—fatigue, anxiety spikes, night waking, and libido loss—and map them to practical options: balanced estrogen and progesterone, careful use of testosterone, and simple lifestyle shifts that lower inflammation and stabilize energy. Expect candid talk on weight gain through the middle, why protein matters more now, how light strength training protects your metabolism, and the surprising ways alcohol and sugar sabotage sleep and hormones.

We also dig into access and advocacy. Learn what questions to ask your provider, how to find clinicians trained in menopause care, what insurance often covers, and where compounded options fit. Darcy’s philosophy is grounded and doable: treat the person first, use labs wisely, make small changes that compound, and build a circle of women who keep you buoyant when life gets loud. If you’ve been told to “just deal with it,” consider this your permission to expect better care and a better baseline.

Ready to feel like yourself again? Hit follow, share this episode with a friend who needs it, and leave a review with the question you want us to tackle next.

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SPEAKER_01:

Hello and welcome back to Empowered Ease. This is season two, episode two, and I'm your host, Jen Olinger, a holistic coach and a critical care nurse. Twice a month I sit down with women who are making a difference in the lives of others. This week I am thrilled to bring you Dr. Darcy Graham, a DMP and founder of Grit and Grace Wellness. Dr. Darcy brings more than 25 years of healthcare experience to our conversation. She specializes in women's health, hormone replacement therapy, and medical weight loss. She's also a wife, a mother of seven, a dog mom to three. So she knows the real life challenges women face, and she focuses on practical, compassionate care that helps restore balance, energy, and confidence. Today we'll talk about realistic strategies for hormone balance, sustainable approaches to weight and wellness, and how grit and grace can coexist in a messy, beautiful work of being a woman. So help me in welcoming Dr. Darcy Graham. Welcome, Dr. Darcy Graham. I'm so excited to have you here. This is such a relevant topic, and I have so many questions for you. First of all, how are you doing today? Doing great. How's everything going where you are? It's got a gloomy, gloomy Christmas weekend day. So, or overcast. So typical of the Midwest. So do you can you tell me a little bit of how you kind of came to be like a DMP and the founder of Grit and Grace Wellness? Like where'd you get started? How'd you get into women's health?

SPEAKER_00:

Women's health came easily to me. I when I got my bachelor's of nursing back, oh my gosh, 23 plus years ago, I was, I just had my first son and was pregnant with my second child, my daughter, and absolutely loved labor and delivery nurses and how much they had helped me. And my goal actually was to become a lactation consultant because I knew nothing about breastfeeding. My parent, my mom didn't do it. My nobody in our family did it. And I relied so heavily on my nurse at Missouri Baptist to teach me that that was my goal. That's actually why I went into nursing. And I love that. She got me into labor and delivery. And then when I decided back in my mid-30s that I needed more, I went back for my nurse practitioner and I got my family nurse practitioner. And then here comes the question of like, well, what do you want to do with that? And I was blessed that I worked with a really awesome OBGYN, Dr. McDonald, who kind of took me under her wing and was like, hey, we have a nurse practitioner that's about to retire. Would you like to fill her shoes? And it was kind of like a duh, like you already work with these doctors, you know them, they know you. Everybody, you know, gets along. And so they invited me into their practice, and I've been there 11 years now. And that's kind of how women's health kind of naturally happens. And then what inspired me to go back for my doctorate is uh my constant need for learning everything. Like I feel like I my patients will ask me a question, and if I don't know it, I will spend, you know, 24 hours deep diving to find out. And so COVID hit, and we're kind of twiddling our thumbs in the office, and I was very, very bored for a while. Like we were doing phone visits, which you can't do a GYN visit over the phone. Oh my gosh, no, how would that go? So I had so many patients who would call me and be like on the phone, like we would do the phone visit, and they'd be like, Can I show you this? I'm like, no, we're not, we're not like gonna stuff like that on the phone.

SPEAKER_01:

But well, I can imagine being a patient too, trying to describe that, like, because that's not an area, you know. I'd be like, Yes, at a loss.

SPEAKER_00:

Yeah, patients were wanting to send pictures and you know, because they couldn't get in. And then we were only doing like eight visits a day on a 10-hour day. Like that was just we were so bored. So I decided to go back for my doctorate during that time.

SPEAKER_01:

Smart.

SPEAKER_00:

Yeah. So I started it during COVID when I was really, really kind of low on patients and got that done. And about I still work at my full-time job, but I'd say back in January, well, I'd say the last two to three years, four years maybe, a lot of my patients and a lot of my best friends were all in that mid-40s age range, were asking me about hormone replacement therapy and menopause, and and then, you know, and so they're there encouraged me to that deep dive. It's like, okay, I need to know everything I need to know about menopause and everything. And back in January, I started playing with the idea of um going into kind of specializing in hormone replacement therapy. And then I a good friend of mine who's a local chiropractor, kind of, I guess, read my mind and got in touch with me there and said, Would you want to do some hormone replacement therapy in our office? And so I started looking into that, and then Grit and Grace was kind of born because I needed a a forum to talk about hormones that wasn't a business with my full-time job, business forum. And yeah, it just kind of has grown. It's actually exploded probably since April of telehealth visits and constant text messaging with patients for hormones, men and women, because we do, I do men um testosterone as well. But yeah, it's just it's it's become a second full-time job, but I absolutely love it.

SPEAKER_01:

I love it. This is such a relevant topic for me where I'm at in my life, and for so many of the women in my life too. And I think it wasn't talked about until recently, and now everyone's talking about it. So there's a lot of confusion, there's a lot of information out there. There's a lot of well, I'm finding more and more things are related to this time in my life and hormone changes and probably have been for a long time. So, what are some of the like more common complaints that you heard women coming to you that like like your friends and all of that that got you interested in this?

SPEAKER_00:

And I could take I can speak from a very personal level too, because I I'm I just turned 47 yesterday. So I happy late birthday. Thank you. I would definitely say the last like four to five years, and this is what my friends are coming to me saying, like, I need help with and and patients as well, is fatigue, brain fog, and loss of libido. I would say are the top three that patients will come to me and be like, okay, like I feel like I have ADHD, but I don't have ADHD. And I feel like my anxiety is through the roof, but I've never dealt with anxiety before. Or I love my husband, but or my significant other, but I just have absolutely no interest in having sex or being intimate. And then, or I feel like I need to take a nap every day and I'm not getting any sleep and I'm up every morning from two to three in the morning. Like those are probably the most frequent things. Or I I really think what people come into our off my office or call me, the first thing that they say is, I just don't feel like myself. That's probably the the line that I hear the intro the most. And then people will kind of expand on that.

SPEAKER_01:

Yes, I can relate with this a ton and a ton of for my friends too, where we're like scrambling to see what where it is, where's the, you know, is it my hormones? Is it, you know, life situation? Is it for me burnout? Because that's really big in my career. Like, is it what is going on? So I love that. What so okay, what it what is this about? What's going on? Why are we all struggling? Is it and when does it really start? I guess is a good question I want to ask you. So I've heard it can start like early 30s, and now going back, I'm like, well, some of the weird things I had happen, I'm wondering like, was that perimenopause starting? Right.

SPEAKER_00:

There's there's no great, there's no timeline, there's no cookie cutter. I, you know, I can't sit here and say, oh, every woman's gonna start this at age 32 or age 38 or age 42. And truthfully, some women never feel this hormonal shift. There's a very small percentage. I wish I was yes, I wish I was one of them. Very much so, mid-30s is typically about when that shift starts to change. And what it is is your hormones are are decreasing, our body stops naturally producing estrogen. In the healthcare field, as you know, you hit that magical age of 35 and you're considered advanced maternal age.

SPEAKER_01:

I know one of my friends is pregnant and she's like, This is a geriatric pregnancy. Do you believe that? I'm like, I know, I'm so sorry they call it this.

SPEAKER_00:

Whenever I have my pregnant patients that come into me that are like that 34 or 35, 36 age range or older, I absolutely and I always apologize to them because they're gonna see that on their paperwork, and I have to refer them to a high risk doctor just for an evaluation. And I'm like, you are not old, you're younger than me, like you are not old. But yeah, I think naturally, and that's kind of why we have 35 is kind of like the magic medical number that they use for that shift, but that's when our hormones naturally start decreasing. Also, I think like you had touched on earlier, the situational thing does not help. Mid-30s is when most of us have children, careers, husbands, things get really, really busy. So you're kind of coupling. I think people start experiencing some of this emotional turmoil and hormonal decline at the same time because our children are growing up, we're busier with careers. Some of us maybe have decided to go back to school. You've got, well, take me for instance, you know, we have seven kids.

SPEAKER_01:

So my gosh, I know we were gonna get to that, but girl. So anyone listening, she has seven children and does all of this. So it's like, take her advice.

SPEAKER_00:

I mean, this is just a crazy time in our life. So you couple that with like your hormones decreasing and your estrogen, of course, you don't want to have sex with your spouse or your your significant people.

SPEAKER_01:

You've got too much to do on your running to-do list that never ends.

SPEAKER_00:

And you're you're tired all the time, obviously, because you're, you know, lacking. Yeah, parents.

SPEAKER_01:

I know it's a lot of people become caregivers for their parents. Also, this thing starts happening around 40, where like it, which is just like natural, is that instead of like trying to prove who we are as people, like our natural need for like to become who we are in the world, that's kind of over, and we start valuing peace a lot more. And that can rearrange a ton of things of like, why am I doing what I'm doing anymore? I know I woke up, wake up some days and it's a little better now, but in the beginning, it would throw me off because I'm a nurse, I've always been an oldest daughter, so I'm like caretaker from the get-go. And there would be days I would wake up, like when I in my PMS stage, where I didn't want to take care of anything, and I could not understand how I've based my whole life off of caring for people because I'm like, why do I do anything for anyone else? I have none of that right now. And I was like, Who am I? This is not me. And that was scary because I'm like, oh my God, that like if this were to drop off forever, who would I even be anymore?

SPEAKER_00:

Yeah, it is, and I think a lot of women start questioning. Well, I mean, they say you've everybody's heard the term midlife crisis. Yeah, that's what I called what I just said. That's a midlife crisis for a lot of people. So I think women especially start questioning your mortality, right? Because your parents are getting older, you might have some friends that are getting chronically ill. Your kids are growing up and not needing you as much, your parents are starting to need you more. So I think as women, like you said, we're all caregivers, especially if you're in a healthcare or teaching role. I think everybody's kind of got a caregiver heart.

SPEAKER_01:

Yeah.

SPEAKER_00:

Um, and yeah, you're there's a paradoxical, paradoxical shift of your hormones are changing, your life is changing, you're kind of got this mortality of like, okay, I've hit that midlife thing. What do I do? So everybody kind of is battled and you feel like you're losing your mind in a little more ways than one. Yeah, and it's super isolating, but you're not alone.

SPEAKER_01:

We're all there in some way. Um, so I do want to ask you, so I I know they say like everyone's different, and that's true of a lot of things, but is there any kind of like typical cycle that as our hormones decrease it goes through, or for every woman is it just different?

SPEAKER_00:

I really feel like there's no cookie cutter on any anything. And like I said, I can base my my experiences on like what I myself, like what I have felt and experienced. And then what like a majority of my patients come in and talk to me about. And like, and like I said, usually it's it's that lack of motivation, lack of of just not feeling like themselves. I can't say that there's any like time frame where people start feeling it one way or the other. Um, I think most people will start saying, you know, their mid to late 30s is like, well, they felt that lack of motivation and they their sex drive decreased and they they might not be able to reach orgasm as easily. Or I wish there was a cookie cutter way. If I could come up with some formula, I would be so massively rich of like, oh yeah, let's just you fill this out and let's take your blood, and oh, yep, there you go. Like that's that's your problem. But I think I really truly honestly believe in more ways than one. As the as hormones, hormone replacement therapy is becoming more mainstream. I really think that in the next five, 10 years or even sooner, we're gonna have more of a a understanding. Like a blood test of like a fingerprint of like, oh yeah, your hormones are definitely doing this right now, and we need to fix this. And I I think it'll get I think it'll get there. I really do.

SPEAKER_01:

Do you do more thorough blood work when people come see you? Do you send off any blood work? Because I know sometimes there's like difference what you can get at your OB office than you can with someone who does a little more of the functional medicine.

SPEAKER_00:

Correct. Yeah, functional medicine is something I'm I'm really into right now, learning more about it. And I will not call myself an expert by any means, and I don't have any certifications in that. But functional medicine is amazing as far as like the hair testing and the saliva testing, and there's the urine testing, you know, they they can find out so much more, and I think it's so much more in-depth um than some of the the blood testing that we can do at a regular MD's office. I think that we're gonna start. I really think functional medicine is probably going to be more popular, more oh, what's the word I'm looking for? Is gonna be the thing in the next five to ten years. I think we're gonna start focusing more on that than we are on this this health healthcare system that we're in currently.

SPEAKER_01:

I agree for a lot of things. Like GI in this area, especially. I feel like modern health, like what's I call it modern healthcare, the system we have in place is like learned a lot from what functional medicine's been doing in the two areas I see are this um women's health and then GI stuff are the two areas I see. And then which is related to everything. I think GI is related to everything, but yes, true.

SPEAKER_00:

Oh, yeah, everything starts in the gut. And I it took me a long time to believe that. And I I'm a firm believer in that. I really think, excuse me, that one of the biggest things. So going back to hormone testing, yes, we do blood work. Whenever a patient comes to see me for hormones, we do a baseline, but that can get a little tricky because that's just a snapshot in time. That is just what your hormones are right there. I could draw your blood one hour after that, three hours after that, and it's gonna be completely different for your hormone levels. And then there's certain times that are better than others. And then if you're a shift worker, things are gonna be a little bit, you know, it there's it's very complex. So for me and my practice, and I think a lot with functional medicine, which I absolutely love, is yeah, we do look at the overall labs and overall kind of things, but we're we're looking at your symptoms.

SPEAKER_01:

Okay.

SPEAKER_00:

I want to know, so I yeah, I have your hormone levels, I have your estrogen level, I have your testosterone, and I have some ranges and some guidelines that I use. But I want to know when you first start coming to see coming to see me, how are you feeling? And what do you want to change on how you're feeling? And then when you come back in three months, we might do another set of labs just to kind of see where some levels are. But when you saw me three months ago, you were having six hot flashes a day and mood swings, and you weren't sleeping through the night and you were up every night. So three months later, is that improved? Do we need to add a little bit more estrogen to kind of help you through some of this? Or, you know, just I like to treat the person and the symptoms because again, none of this is cookie cutter, and there's no the labs that we have now in the ranges are just not up to date with what we know we're learning with these things.

SPEAKER_01:

We are it's kind of exciting how much we are learning now because I feel like this is this is an area that we didn't spend a lot of effort on, but now there's so much energy behind it. So, okay, I know before we got on, you mentioned I didn't know this that some black box label had been removed from the hormone replacement therapy. So tell me a little bit about that and how that affects your our your practice and how that is benefits women.

SPEAKER_00:

Perfect example. I guess part of the reason when I started hitting that perimenopausal stage, I thought back immediately to my mother. So my mother was in the 1990s, had to have a complete hysterectomy. I don't even think she was 40 yet. She was very young. And her doctor, her OBGYN, had put her on estrogen and estrogen replacement therapy. Um, because once you have a hysterectomy, your body automatically is kind of thrown into menopause, right? With whether, you know, ready or not, there it is. Here it is, full blown. And she was on the hormone replacement therapy for a couple of years, everything was going great. And then I think it was about high school, that's when the the world, the women's health initiative kind of came out in the 90s, um, late 90s, early 2000s. It was actually fully released by 2002. And it said, all hormones are bad for everybody. If you have a patient on hormones, stop them. It's gonna kill them. It's you know, breast cancer, oh my gosh, heart disease, strokes, blood clots, all patients are gonna die. I mean, it was like totally scary. So almost every doctor, my mom's included, called them and said, Oh, sorry, no more hormones for you. You're just gonna have to suffer. And I just remember her. I love my mom to death. The hot flashes. Like we would be sitting there dinner time, and all of a sudden she would just be like soaked, or she'd be crying for no reason. Like we could be watching a Toyota commercial, and she'd start crying, you know, just yeah. Like a couple of years were really, really rough on her until she could kind of get through it. And so I'm like, I don't want to go through that. And so I was so happy to hear that this year they redid all those studies. So those studies have been kind of re-looked at and reevaluated, and it was bad information, it was misinformation that was sent out there. And they've relooked at everything. They're saying that hormones are not bad for you. Um, certain people can't take hormones, but they said now the recommendations, if it started before 60, it actually, you know, really is your signs and symptoms of hot flashes. It's improving the quality of life in most patients. It actually protects your bones, it's cardioprotective. So all these scary things. And in some cases, there's actually prevention for certain kinds of cancers. It's it's all it's a myth. And so two or three months ago, I can't remember the exact date, the FDA released, they took off the black box war black box warnings. And so now they're saying, like, yeah, with that, it's just like with anything. Like, you can take Tylenol and you can take ibuprofen with risk. It's just like anything. So if you go talk to a doctor that knows about this and they evaluate your risk versus benefits, that it's perfectly safe. And they're actually recommending it for more women now more than ever for these benefits. I love that.

SPEAKER_01:

I've seen so many people talking about how it gave them their life back. I haven't personally tried it, but I know I definitely need it. So, if how quickly do women s notice changes once they start this?

SPEAKER_00:

That's a great question. And I I tell every patient that starts this that okay, so you've heard the term practicing medicine. Um, I feel like this is so practicing medicine because it's it's hard to say. Everyone is completely different. So I'll use myself as an example, probably TMI, but like, so you know, going probably 45, 46, I started having the irregular periods, which is kind of one of the first things that starts kind of happening to your body is your periods are not regular anymore. And some women never have regular periods, but I was always like to the date. And then I'd go 60 days or I'd go 48 days, and and then I was having the hot flashes started at night, and I was having the irritability and the anxiety and not sleeping, loss of libido type, the whole everything that you you say. So I started, um, I talked to my provider who happens to be my coworker, and we talked about it. And so I started taking the estrogen patch, which is the patch you change twice a week on your skin. And then I started doing the progesterone pill that you take at night, which, if you have a uterus, you have to take the estrogen and progesterone together, and we can kind of circle back to that. But huge thing, uterus, you have to have both. So I started doing the patch and the pill, and I started doing the testosterone cream, which is a whole nother whole nother topic with testosterone. I started at the lowest doses of everything, probably January of last year. Started noticing a difference in libido and energy, sleep right away. The progesterone you take right before bed. I'm not a good sleeper. Oh my gosh, it was a game changer. Like I like suffered from chronic fatigue. Like I was having to take a nap like twice a day sometimes on my lunch hour. The girls knew at work if my door was closed, you don't bother me for 30 minutes. Like I was sleeping on my lunch hour and I was chalking it up to seven kids, full-time job, like, and it wasn't. It's it was my hormones. Like for me, it has been completely life-changing in multiple ways. But um, I would say within three months, sleep, energy, motivation, fatigue, libido were like on the way up. It took me about seven months to get adjusted and to where my testosterone levels were up to where I wanted them without being like a burly man. Women's levels and men levels are totally.

SPEAKER_01:

But we do make testosterone. That's some people don't realize that we don't make near as much, but we do need and make testosterone.

SPEAKER_00:

Absolutely, testosterone is very, very important for um energy motivation, libido for sure. But I would say by July, things were a game changer for me in more ways than one. And we were sitting at our local restaurant, we go there on a couple Thursday nights a week or a month, sorry. And it was so funny. One of the uh she's acquaintance. We're sitting there with her husband, and they were we were chatting at the bar. We're sitting there eating dinner, and she knew that I was doing the hormone replacement therapy, and she looked at me and she asked, She's like, So, like, can you tell me a little bit more about it? And my husband literally like kind of like tapped her husband on the shoulder around me and said, Definitely get your wife on this stuff. Like, it's amazing.

SPEAKER_01:

So I'm like, Okay, like he's I've heard sometimes the people in your life notice before you do.

SPEAKER_00:

Apparently, my husband noticed way before I gave it. I knew the internal changes that I guess he was seeing the external, the stuff you don't notice.

SPEAKER_01:

Yeah.

SPEAKER_00:

So I would say about seven months for me. Now I've had other women say two to three months once we kind of get adjusted. And then a couple of patients, like, we don't even have to do an adjustment. We do the patches, the pills, and maybe a little bit of testosterone cream, and like immediately, like they follow up with me at their three-month appointment and they're like, This is phenomenal. Like, I will never go back. This is this is great. I love it. I love it. So I always I tell my patients anywhere from like three to six months before they start seeing a noticeable change. And then sometimes to get them to max max potential, it can it can take a little bit longer.

SPEAKER_01:

Okay, okay, I love this. So, what kind of role do you think does hormones play in? Because I know weight weight management's a big part of it. What role does that play? And I know immediately, like when I hit 40, my fat changed from being like like this like baby thick, like pudgy fat to like thin and like to the point where like I've heard my thighs slap just from how loose the skin is, and I was like, oh my god, like it's different now. Like my body is different.

SPEAKER_00:

Yep. So as we lose estrogen, which again, you know, starts occurring in our mid-30s, our estrogen levels start to decrease, our skin loses that elasticity, that that it starts getting that crepey look, what they call crepe skin, and things start sagging in places that yeah. Here's where I feel it.

SPEAKER_01:

Well, I'm everywhere I have fat, but yeah.

SPEAKER_00:

Yeah, people start really like focusing, I think, in our late 30s of like things definitely change. So yeah, and and you might start a lot of women will complain of that weight gain through the middle.

SPEAKER_01:

My upper belly, like I never gained weight there before, but now I have like a little weight gain in my upper belly. I'm like, that's so weird.

SPEAKER_00:

Yeah. So all the research that I have done shows like high protein, low carb diets, just to kind of to help with inflammation because that inflammation, estrogen helps keep inflammation at bay. So that is one thing I think a lot of patients will say that once they've been on the estrogen therapy for a while, their inflammation starts to decrease and we're not as bloated and we don't feel that like up and down of the weight changes. But yeah, it it is very much that midlife 20 pounds or more sometimes in some cases kind of happens. And it's harder for us to get off as we age. So light uh weight training, not like muscle building and cardio exercise is like extremely important during that time. Now, if you're like me and I have absolutely no time, it gets it becomes a struggle. But a lot of people will turn to like the GLP ones and the compounded medications to kind of and like micro-dosing with those just to kind of help while they're getting adjusted to get some of that weight off or to maintain their weight. So that's something you can prescribe as well. Okay, cool. Through great grace, I do the compounding, compact. We can't call them GLP ones, but the the compounding weight loss medications.

SPEAKER_01:

Got you, got you. Okay. Is there any like small habit changes that you would recommend for women who are in this process right now to help out? I know you mentioned a couple with like eating high protein. That's something I change. I start every morning with a protein shake, and I feel like it makes a world of difference.

SPEAKER_00:

Yes, high protein. I can't stress that enough. And protein shakes are amazing. I do recommend that. I have formulated, I have not formulated, I have put together a low-carb, high protein diet plan and low, like 30-minute, very low exercise or a low, low intensity, fast little exercise group that people can request from me and I can email it out. But it's for busy people that do not have time to meal prep, and it's just got a lot of ideas on it. Um, hydration. I know everybody talks about hydration, but that is so important whenever we're talking about our skin changes because our skin starts to get like dried and it or well, it'll go either way, really dry or super oily. But you don't want that like sunken look, you don't want that like it helps with the inflammation, kind of ridding our body. I can't stress hydration enough. Um but protein and hydration are definitely and decreasing your sugars. Sugars feed so many things, and I'm guilty of it too. I like MMs and all the sweet stuff. But I know we preach it, everybody preaches moderation, but definitely I feel like when you hit that midlife time, it's we got to start focusing on ourselves and our our health for that preventative background.

SPEAKER_01:

Yeah, sugar's one of my big I'm trying to detox from it because once I can cut it all the way out, I'm good. But it's like getting there is so hard. Not all the way out, like I eat no natural sugar so when I get like that, but cutting out the fake sugar is really hard because I have like legit withdrawals for I'm like, uh, I need it.

SPEAKER_00:

Yeah. And alcohol, I'm not saying not to drink at all if you want to drink socially, but people don't realize that how alcohol, when it metabolizes, it messes with your hormones. So patients that are out drinking all the time, and then I can't get their hormone hormones regulated. And whenever we we sit down and look at what well, tell me exactly everything that you ate and drank this weekend. And when they they say, Oh, we went to a party Friday night and I had two beers or I had two mixed cocktails and I did this. And then Saturday we went to another, you know, get together, especially holiday seasons, is really hard.

SPEAKER_01:

Oh, yeah.

SPEAKER_00:

And they they can't figure out why they've gained that five or six pounds over the week, or why there's they kind of are going back into that not sleeping well pattern. Oh yeah, sleep and alcohol is bad.

SPEAKER_01:

Yeah, I was gonna say the sugar in a lot of those drinks is probably bad too, without even the alcohol, depending on what you're drinking.

SPEAKER_00:

Yeah. So we we try to break it down and and kind of look because there's medications and what your body produces is so heavily affected by what you're taking in internally. I mean, alcohol is a big factor. And that's why I really push the hydration, the fluids of water, um, just to kind of flush all of that out. Yeah, that's great.

SPEAKER_01:

I love that. What was some other questions? I had some great ones here. But do you well, I don't want to like put you on the spot because you work in the current healthcare system. But is there a way that women can advocate for themselves that you recommend in the common healthcare system? Because I know sometimes it's really hard to be heard. And like when I brought these symptoms to my more like typical healthcare settings, most of the time I they recommend an SSRI, which I'm on it, it helps, don't get me wrong, but I don't think that's like the answer here.

SPEAKER_00:

Back in the day, like so when I say back in the day, I mean or back whenever they took the hormones away from everybody, there are some great SSRIs out there that help with hot flash, like those vasomotor skills or vasomotor symptoms. So the hot flashes, the night sweats, and stuff like that. So Venlofaxine is a SSRI that was one of the first line treatments. A lot of patients, I feel like, are not being heard, especially if their doctor is really not trained or not comfortable prescribing hormones. So let's say I come to you, you're my doctor, and I come in and I'm in my mid to late 30s, early 40s, and my doctor already knows me because I've been going down, you know, going to him or her for the last couple of years. So they know I have a stressful job and I have kids at home and I'm doing this. And I come to them and I'm like, oh, I'm just not sleeping. My anxiety is through the roof. I feel like I'm having heart palpitations all the time. Usually, and I don't want to say always, but usually that would be their first thing is like, are you depressed? Well, yeah, I'm kind of depressed. Like, I don't feel like myself anymore, and I just don't feel like doing anything, and I don't have any motivation. Immediately they're gonna be like, Oh, well, you need some Zoloft, or you need, you know, some Lexapro, or let's try this. And in some cases, and I'm not saying every case is the same, some cases it is clinical depression, and they need to be on something and it makes them feel fantastic. Other times I think we're gonna learn now, and I've had several patients who have come to me, and we've been able to get them off of all of their their antidepressants or anti-anxiety meds because it was the hormones all along. And so advocating for yourself, really, I think podcasts like this to introduce listeners to other practitioners, like there's other options out there to find out and and learn about. But calling ahead, call your doctor's office and ask what their opinion opinion is on hormone replacement therapy, ask what trainings they've had, ask if they're on it themselves. Some doctors, like I will tell you, yeah, I've been I'm on hormone replacement therapy. This is my experience, and I love it. Also, there's some different websites you can look at, like the North American Menopause Society will list practitioners in areas by zip code who didn't know that was there. I think there's only two in the Alton area the last time I checked, me being one of them, and then another doctor in my building. But that's a good place to start because you know that they're gonna be open to listening to you. Yeah. And if you're not happy with if you go to your doctor, and if there's not a legitimate cause or a little legitimate reason of why you know, like you can't be on hormone replacement therapies, then find another one, you know. Like, I hate to say it, but doctor shop until you find who's a reputable somebody that knows what they're doing with hormones, physician that takes you seriously and listens.

SPEAKER_01:

No, I've said that on here, I think, several times before, but if you're not being heard, find a new doctor. Absolutely.

SPEAKER_00:

They have to listen to you and care about what you have to say. Multiple patients will still see because you know, most people fall in love with their GYNs. They've delivered their babies, and it's a comfort, yeah. Yeah, like they're you know, it's it's a a very uh vulnerable patient situation when you're in your GYN because you're exposed, and so you feel comfortable. A lot of my patients still keep their GYN and see them for their yearlies and their annuals and their problems, and then because their GYN doesn't feel comfortable prescribing hormones or doesn't believe, you know, that they truly are a thing. I've heard of that. I have a one doctor friend who women don't need hormones and he's an OBJYN, and I'm like, oh, oh, it's horrible. But but they'll come to see me for the hormone part of it, and then see their GYN or their other physician or family physician for their annuals, which is perfectly fine.

SPEAKER_01:

Yeah. So can is this at a point where it's insurance is accepted or is not quite yet?

SPEAKER_00:

So through most insurance that companies, now everybody's um policies are different without going into that, they will cover if you go through your regular doctor's office, they will go, they will cover estrogen and progesterone in the blood work that that entails. And then testosterone is where it gets tricky because insurance companies and still a lot of the research is still saying women don't need testosterone. And I I kind of joke with my patients, the two medications that they will have to pry out of my 90-year-old hand in the nursing home that I will never ever give up is my progesterone at night before I go to sleep and my testosterone. Game changers for me. Testosterone doesn't, insurance doesn't want to cover that, unfortunately. So it's not very expensive, about$50 to$60 a month for the creams. Um but I will never, I will work a fifth job if I need to to to continue getting that's how that's how impactful it's been for you.

SPEAKER_01:

Interesting. You know, it's funny, this is so random, but I've always heard like elk meat has like the only red meat, only meat that has like natural occurring testosterone in it. And I used to eat it a lot when I lived at West. And I swear I would tell people, I'm like, I feel so much better. Like after I eat elk, it's so weird. So I wonder if there's any truth to that. I'm gonna have to look into it. Possibly. I was like, holy cow, because I was like, I felt great. Okay, so if they're if women are listening to this and they're like, oh my gosh, and they live locally and they want to see you, how what can they expect? Number one, if when they see you, like is it virtual? Do they see you in person? And then how would they get a hold of you?

SPEAKER_00:

So I'd have I have an office in Alton, Illinois at Southern Illinois Healthcare Foundation, and I can give you that number to put up there. If they wanted to make an appointment through my office there, and then we what we would do is you come in in person and we would talk about symptoms and kind of what your goals are and what your plans are, and then do blood work and kind of base it off of of uh symptoms and and uh testosterone is really the only one that I have to look at the blood work to kind of figure out dosage and and where to start with that one. And then, but I have a Facebook page called Grit and Grace Wellness, and I have a lot of patients or people that will reach out to me there and just to ask general questions. And it's more of an information page. I post a lot of actually I've kind of been on this. I like to, I don't want to say make fun of menopause, but there's a lot of great reels out there that people are sharing now that perimenopause and menopause is a thing, and I've been sharing a lot of those lately, but that is more information, a way to reach out and ask questions to see if you're a candidate, if you if because it does take a little bit of time to get into me at the office.

SPEAKER_01:

Okay. Do you see people separately through that avenue as well? Like virtually through Grit and Grace.

SPEAKER_00:

We do the weight loss through Grit and Grace. Oh, okay, okay, great.

SPEAKER_01:

So you can see through there. Awesome. Let me see. What else did I want to know about? There's there's so many great questions about this topic. Anything you think we that we miss that you think women should know too?

SPEAKER_00:

Other than it's like fantastically life-changing. Yeah, I I just I I'm amazed at the patients that will come to me and say how much it's changed their life. Like, and so that kind of gives me that reinforcement of like, okay, this is this is probably what where I need to be and need to be focusing, and this is why I'm doing the way that what I'm doing.

SPEAKER_01:

Is it expensive? That's one thing I want to is a good question too. Is it pricey?

SPEAKER_00:

Um so that kind of depends on your pharmacy coverage. Um like for me, I think I pay$4 a box a month for my extrogen patches. So it's kind of whatever your copay is for your insurance. Okay. Like I said, the testosterone cream is the only thing that I can't get covered through insurance, and it's about$50 to$60 a month. And then whatever your doctor's office co-pay is. Okay, perfect. That's yeah, super, super affordable if if you have insurance. And then at my office, too, we also do self-pay. So patients that don't have insurance, we can put them on a sliding scale, either income-based or they make it very affordable.

SPEAKER_01:

What is there anything women should avoid while they're going into this process? Or with hormone replacement therapy or any of the weight loss stuff? To avoid probably anything I mean, besides like sugar, that's good.

SPEAKER_00:

Yeah, I mean, all the good stuff. You definitely have to avoid all the good stuff, you know, none of the fried fatty foods. No. I don't want to say I I am very much a I have been a lifetime dieter my entire life. Yeah, I feel like I've been on a diet since high school. And I am very much not. If you tell me I can't have something, I am gonna want it a million times more. So I've never, I try to never tell patients like, oh, you can't have this and you you should avoid this, because then my I'm like, I guess maybe I have a little bit of oppositional defiant disorder, like, oh, you told me I can't have this, watch me. Like, um I think my husband has learned that lesson too, because he'll tell me, no, you can't have that, or don't go by that. And I'll be like, oh, watch me, and I'll go. That's right.

SPEAKER_01:

Now I want it more.

SPEAKER_00:

I I really can't say, I mean, smoking obviously is what we really smoking and vaping is something you really should avoid. However, there are alternatives um to some of this hormone therapy that are safer options for patients that smoke. So instead of doing an estrogen pill, we always would rather do an estrogen patch. It's safer for patients that are smokers, that have had a past history, and this is again doctor-dependent and history dependent. Somebody might have had a blood clot for whatever reason in their early 20s, and now they're in their 40s and they've had no issues. Like, and they the estrogen patches are deemed safe in most instances for patients that have kind of a weird medical history or smokers. So, but really there's no like contraindications to anything other than a personal history of estrogen-driven breast cancer, recent blood clot, recent PE, pulmonary embolism. But really, yeah, nothing to really avoid. Okay, that's good to know. Yeah, like, and I I would never ever tell somebody to avoid something because I know that, like I said, most people are just it just draws them to wanting to do it more. So we try to work around lifestyles.

SPEAKER_01:

I never diet because then I know like I just try to tell myself like if if I want. Like then I have to have like the best version of it. I don't cut myself cheap, you know what I mean? So if it's like if I love cheesecake or whatever, if it's my favorite one and it's really good, I'm gonna eat it, but I'm not gonna waste it on one that isn't my favorite. That's how I do it because otherwise I'll eat it anyway. I don't care absolutely with all that stuff. Oh, great. This is so great. I love this. I've learned so much. And I like so informed. I feel like so many women need to know this. Okay, before we wrap up, will you say your Facebook? Because some people don't actually look at the show notes, they just listen slow so someone knows how to find you.

SPEAKER_00:

Grit, G-R-I-T and Grace, G-R-A-C-E, wellness. Love it.

SPEAKER_01:

And then I ask everybody this that, but like, what's your go-to self-nurture or self-care whenever things get really stressful for you?

SPEAKER_00:

Oh, I don't know. We have a lot of hobbies. So my husband has a very stressful job too. And then we are a blended family. So there's a lot of stressors that come from that. We've been together for almost 10 years. And I would say probably like my self-care, myself, we like to camp and we like we have a side by side. So we like to like, so like just getting out in nature, putting my feet in the grass. Like that's definitely I want to be outside and I just want to be away from my unplug. So and I will tell anybody that contacts me on great and grace, like sometimes I don't get, sometimes I get back immediately because I'm already on my phone or I'm already like at my computer and I'm I'm there. But I have to put my phone down sometimes on the weekends and and literally only check it for text for emergencies. So I would say unplugging is probably for me one of my biggest self-cares. I have a love-hate relationship because he takes us on all these wild adventures where a lot of times we don't have cell phone service. So it it stresses me out because if something happens to the kids or our parents or, you know, like there's an emergency, I'm like, oh, what if, what if? But then also I love it because I can't check my notes at work and I can't check my messages. And and so I would say for me, just getting out. And then the other thing, and I think this is another thing to kind of check off to check off. I think this is something the women need to really, really focus on because you you had mentioned earlier, you just kind of want to, you've kind of gone through this phase where you're you're so busy caregiving, you're you just don't have any more to give, right? And we're we just kind of get stuck in this rut, and you don't want to get out of bed and you're off for the day, and you just kind of let the dishes sit, kind of sulk a little bit. I go through those days too. Find your group of women. Like, I can't stress that enough. I have three of the best friend groups, and they kind of overlap and they kind of don't overlap. So they're kind of three separate groups, plus my work besties, because I have my like my work family. And there's something about them, each group that I value the most. And so find your find your girls. We do a weekly girls night, and there's a group of us that will just text like randomly, like, hey, can you do happy hour and appetizers, or can we go over to our friend's house, or and sometime all of us can go, sometimes only three of us can go. There's no pressure. We have a monthly bunko night where we all just kind of get together at one of our girlfriend's houses and play bunko. And again, during I have a senior this year, so I can't do a lot of the Friday night stuff because we have senior night, we had football, and now we're into basketball season, so that's every Friday night. But I would say that for me, getting out and unplugging and just spending time with my husband alone, because we're never alone. Yeah, and then my girls. Like, if I did not have my girls, like I think I would lose it. I have, you know, they're my sounding board, they're my I can bitch and vent and talk to them about things I wouldn't necessarily talk to my husband about.

SPEAKER_01:

Yeah, yeah. That comes up on the show a lot too, is how important like finding your community is and finding people who to talk to who like understand what you're going through, who like get it because it's so validating, and we need that as women. We need to validate it.

SPEAKER_00:

I can't stress like girl friendships enough at this age, like going through this and navigating it together.

SPEAKER_01:

I love that. That's how I met you through one of my good friends. She recommended me to you. So I think so much.

SPEAKER_00:

I need to introduce you to our bitch fest. We have a girls group. Oh my god, I would love it. 22 girls right now. We keep adding, and we actually had to start a group me page, like what sports teams you like, the big groups do. Yeah. Anybody up for drinks? Or hey, and we're all different. There's a couple of doctors, there's a couple of nurse practitioners, there's a couple of nurses, there's teachers, there's a stay-at-home, there's an entrepreneur, a couple of entrepreneurs, there's a couple of stylists. So yeah, like we're just very tactic. And me. Oh my God. Yeah, you would, I think you would totally fit right in. And that's how we've kind of added is like we've we meet other women who want to empower each other and be there for each other, and there's no judgment. And I know women, you people like to say, oh, Caddy, like this group of girls have just been amazing and lifesavers. And we've rallied. We've had a couple of really scary health diagnoses and some spouses recently. And I mean, you name it, and we're we're there. Like if somebody posts a need, like, hey, I need you know, somebody's there, I need my dogs taken out because we've got a doctor's appointment or whatever. We're there. Like it's it's been amazing.

SPEAKER_01:

I love that because it's hard to find community in this like day and age, and unless you're like like uber religious, it's hard to have like a consistent community, and even that only fits like one of your needs. So I love that so much.

SPEAKER_00:

And face to face, like real, real human interaction. Like, yeah, like it, like we're all, you know, we'll go out and everybody hugs, and you know, like it's just yes, I love that.

SPEAKER_01:

I also like one thing I loved about this is I think that like that you coming on here too is like you're also showing like before, I think I was under the misconception that in order to do this, you like to take care of my hormones, I have to go see a functional medicine doctor who doesn't take insurance, which there's nothing wrong with functional. I love them. We talked about that and I do, but I it's hard to afford that for a lot of women because the labs are very expensive. The seeing that the appointments are very expensive because they don't generally take insurance, and then you either have to like do a membership or and it's an expensive process. So finding out that now that this is becoming more and more common practice in like a doctor's office where I could use the insurance I have, that's really like liberating as well. Yeah, absolutely. So exciting. Okay, is there anything you want to leave us with before we go?

SPEAKER_00:

I can't think of anything. I I just want women to know that there's options out there and you can feel like yourself again. Like I might not be able to get you to your 18-year-old self again, but just you don't I I went so long, and I and this was with me working in healthcare, but I went several years of feeling like crap and just felt like I had to plan my life around taking a nap or you know, just and I felt like I couldn't be there for my kids. Like I just felt like I was so drained and pulled, and I'm always pulled in different directions, but I couldn't handle it the way that I could handle it when I was younger. And you don't have to feel that way. Like I can't fix everything. I wish that I could. Um and hormones won't fix everything, and I don't want anybody to think, well, I I just put this patch on and poof, everything is good. But I definitely encourage women who are just kind of feeling off to explore this avenue because it can be life changing for a lot of people.

SPEAKER_01:

Yes.

SPEAKER_00:

Oh my gosh, I love it.

SPEAKER_01:

Okay, thank you so much. I'm so excited to share this.

SPEAKER_00:

Absolutely. Anytime.

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Jenn Ohlinger

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