Empowering Midlife Wellness with Dr. Susan

Periodically it’s great to talk about one of my favorite topics- sex! After many years of focusing on midlife sexual wellness, I can say with confidence that intimacy CAN improve with age if we approach it with an attitude of curiosity, self awareness and intention. Today I’m sharing REAL ACTIONABLE STEPS that have worked for me and my patients to revive our sex lives after 50, or at any age. Get my best-selling book, Sexually Woke: Awaken the Secrets to Your Best Sex Life in Midlife & Beyond: https://amzn.to/3rm47IU Join my Well Past Midlife Masterclass to gain a deeper understanding of how to optimize every aspect of your midlife wellness: https://www.wellpastmidlife.com/

This is the third in our resistance training series with master trainer Kelley Workman, who teaches us four whole body exercises that can be completed at home in 30 minutes. Watch the first part here: The 30-Minute Workout That Will Chang... Watch the second part here: The 30-Minute Workout That Will Chang... This week will be presenting four additional exercises that you could choose to mix and match with the others. You may choose to master these alone for a month before we continue to add more! The important thing is to be consistent and not get injured, and also provide variety that keeps you interested. You can connect with Kelley at www.kelleymoves.com Explore more resources: #1 Treatment For Bone Health video • https://www.youtube.com/watch?v=agW5ub-51XM&t=0s MUST-WATCH VIDEO - Queensland research helping osteoporosis sufferers - The Bone Clinic • https://www.youtube.com/watch?v=9EZw_wrFnmI&t=0s The LIFTMOR Randomized Controlled Trial https://drive.google.com/file/ d/1ZNh1...

Now a few weeks into January, it’s good to reflect on the resolutions that we made on January 1 and consider how those are going. Today I’ll be sharing some of my insights into how to regroup and reset to be successful in making long-term transformation based on what we truly believe is good for us, instead of focusing on what we “should” be doing. I’ll also share some of my other favorite ways to regroup and return to our intentions for the year, including (not popular in the west, but it really works!) reflecting on death, and going back to the old favorites of generosity, gratitude, and forgiveness.

Dr Susan Face Estrogen Mixdown by Dr. Susan Hardwick-Smith

Today I’m revisiting the common idea that hormone pellets are somehow worse or more dangerous than other options for testosterone delivery. Derogatory language like “pellet pushers” is divisive and unhelpful, and suggests that all providers who prescribe pellets are practicing irresponsibly. While irresponsible providers exist in all fields, well educated menopause experts find that pellets are a viable option for patients who choose them, after being given the pros and cons of all available hormone delivery methods. Remember that we do not have an FDA approved testosterone product available for women, so all testosterone for women comes from a compounding pharmacy- and whether it is a cream, a pellet or a sublingual troche, it’s exactly the same product, and the delivery method should be the patient's choice.

This is the second in our resistance training series with master trainer Kelley Workman, who teaches us four whole body exercises that can be completed at home in 30 minutes. On November 27, we posted our first video, and Kelley’s suggestion is to master four exercises (3 x weekly for 30 minutes) for a month before adding more. Watch the first part here: https://youtu.be/X_YMrHiz2ek This week will be presenting four additional exercises that you could choose to mix and match with the others. You may choose to master these alone for a month before we continue to add more! The important thing is to be consistent and not get injured, and also provide variety that keeps you interested. You can connect with Kelley at www.kelleymoves.com Explore more resources: #1 Treatment For Bone Health video https://www.youtube.com/watch?v=agW5ub-51XM MUST-WATCH VIDEO - Queensland research helping osteoporosis sufferers - The Bone Clinic https://www.youtube.com/watch?v=9EZw_wrFnmI&t=0s The LIFTMOR Randomized Controlled Trial https://drive.google.com/file/d/1ZNh1GfV02RPVVpkGtkIwSbYvDaJ5vWlU/view

Most of us have heard that the lifetime risk of breast cancer for a woman in the United States is 1 in 8, which is alarmingly high. It’s important to keep in mind that this is a population based risk, and that your own personal risk might be significantly lower or higher than this. Today I’m talking about a new FDA regulation requiring that mammograms assess our level of breast density, since this is one of the factors that can increase our breast cancer risk. For patients with high breast density (in the level C or D range), which is more than 50% of patients, the recommendation is to use a risk calculator and consider additional testing (with ultrasound or MRI) for a patient whose calculated lifetime breast cancer risk is greater than 20%. Anyone can do this risk assessment themselves using the link below. If your risk is 20% or greater you can talk to your physician about ordering additional testing. https://bcrisktool.cancer.gov/calculator.html

I am so excited to announce our new “Well Past Midlife Masterclass” being introduced in early 2025! Today I’m going to give you an exciting opportunity to be part of the first cohort of this eight week course, for a massive discount! I’ll be discussing how the course will work, but in brief, you will receive two 30 minute videos a week, and join in a weekly 90 minute zoom meeting with me and 20 of your classmates, who will soon become your new best friends! This is not only learning about everything to do with perimenopause, menopause and beyond, including nutrition, exercise, sleep, lab, testing, sexual wellness and more….but it’s also a genuine invitation to connect with other women going through the same struggles. Members of our online course will forever become members of our “inner circle” and receive early invitations to our retreats and events as well as a 10% discount for all in-office procedures. We will be announcing the dates of the first cohort early next year, and if you are interested in being first on the list, please send an email to MenopauseEducation@completemidlifewellness.com This program is open to anyone no matter where you live, since it is a coaching and education program, and it does not involve the practice of medicine. If you are a provider, we will be launching a simultaneous course for medical providers teaching you how to incorporate menopausal medicine into your practice, so we can increase education about this important topic throughout the world, and encourage more women to connect and not feel alone!

By now we are all aware of the countless benefits of resistance training, but it can be hard to know where to start. Today I will show you my real 30 minute workout with master personal trainer Kelley Workman. You can do this at the gym or in your own home with a few simple free weights. Studies have shown that 30 minutes of heavy resistance training twice a week reduces bone loss, falls and resulting injury, and every chronic disease including dementia. These four exercises use the entire body, and Kelley recommends doing these twice a week for a month before adding anything new. Next month we will be back with 4 additional exercises to mix it up a bit. With all of my ironman training I haven't lifted weights in a couple of months so I am starting along with you! You can connect with Kelley at www.kelleymoves.com

These recent times have left many of us feeling very unsettled and uncertain, and feeling like we have no agency to change things in the world. Today, I’ll share a simple way to switch our mindset from feeling like the world is “happening to us” where we have no power, to a place of agency and choice. From this place we can move forward even in difficult times and make positive changes that affect us and all of those around us, moving towards creating the optimal older version of ourselves.

Many patients ask how to find a menopause provider and how to evaluate your provider’s credentials and education. At Complete Midlife Wellness Center we are proud to have three Board Certified Ob/Gyn physicians who are certified through the menopause society, as well as nurse practitioners with menopause society certification. We are thrilled to announce that Dr. Hillary Boswell will be joining us in November to expand our services, and huge congratulations to Brandi, Hollie and Hayley who recently passed their menopause society certification exam! If you are a provider interested in joining our provider education program in 2025, please email PractitionerEducation@CompleteMidlifeWellness.com to be added to the first to know list. A link to our Menopause Education Platform will be provided as soon as possible, and no later than early 2025.

Reduction in bone density, which can lead to osteoporosis and increase our risk of fracture as we age is one of the most important goals of a healthy second half of life. We’ve talked extensively before about the benefit of menopausal hormone therapy for reducing the risk of osteoporosis, but today I’m going to focus on how important exercise is in the process of helping our bones to stay healthy and even to improve their strength. Traditionally as women age and develop low bone density, we were taught to stick with very low intensity exercises, but this has been shown to not only be incorrect, but also harmful. Strenuous exercise, including use of heavy weights is not only safe if monitored properly, but incredibly beneficial for improving bone density and reducing the risk of falling and fracturing, as well as improving quality of life! MUST-WATCH VIDEO - Queensland research helping osteoporosis sufferers - The Bone Clinic https://www.youtube.com/watch?v=9EZw_wrFnmI The LIFTMOR Randomized Controlled Trial https://drive.google.com/file/d/1ZNh1GfV02RPVVpkGtkIwSbYvDaJ5vWlU/view?usp=sharing

While knowledge about how to be healthier is skyrocketing, our health as a country is not improving. Knowledge alone clearly doesn't work. What's missing is the motivation to put our knowledge into action consistently, so that we can truly transform into a healthier, happier way of living. Today I'm sharing the work that I'm passionate about in the field of motivation; a passion that inspired my second book. After 25 years of helping patients create their healthiest life, I've observed 3 states of being; one of which leads to an almost effortless commitment to make healthy choices. For those of us who still feel stuck making choices that we know are not in our best interests, wondering "why did I do that again?", I'll share a system that works for both me and my patients, to finally make lasting change from a place of peace and ease. The best news is that we get to feel better now and improve our immediate health, while create the healthiest older version of ourselves. When you live in alignment with what you deeply believe is good, you will notice healthy choices naturally falling into place. I'll be sharing more as the book progresses!

Despite the numerous well known benefits of menopausal hormone therapy, it's important to talk about some common side effects. The most common frustrating side effect that we seen our practice is a new onset of bleeding, which affects about 5% of patients. The good news this is very rarely anything to worry about. It is certainly a major annoyance that needs to be addressed. Today I'll discuss why this happens in both menopausal and perimenopausal patients, how to evaluate it and most importantly how to make it stop!

During the last decades of confusion about menopausal hormone therapy, many well-meaning solutions were offered to patients claiming to be safer than the feared traditional HRT. These include combinations of estrogens, progesterone and testosterone in the form of topical creams and sublingual preparations. Now that we are emerging from this fog of confusion, and understand that estradiol, progesterone and testosterone are not only safe, but also provide numerous health benefits for women, it's important to reevaluate whether compounded estrogen products still have a place. Today I’m discussing the different types of estrogen that are available in compounded form, why progesterone cream is not a safe solution for patients who have a uterus, and why at the current time we need to rely on testosterone in compounded form, and how to ensure that we're getting the safe and most beneficial dose.

Managing the time leading up to menopause, known as "peri-menopause," can be particularly challenging due to fluctuating hormone levels and their often unpleasant side effects. These years can feel like an unpredictable roller coaster, making it difficult for both patients and providers to find balance. However, understanding what's happening in your body during this period is key. With the right knowledge, we can develop a treatment plan that includes effective options to alleviate symptoms and bring your life back into balance, helping you navigate through these challenging years with greater ease.

As science progresses, it's so important to recognize when we got something wrong and tell patients that we have learned something new and better. Too often, doctors are stuck in their old ways and are not up-to-date in the latest science, and are continuing to practice out-of-date medicine without recognizing that they were wrong. Today I'm addressing the top five things that I personally got wrong, and I told patients these things for years before learning that there was a better way based on modern science. Even what we tell patients today no doubt will change as our understanding progresses, so it's important to see medicine (and science in general) as an ever-changing growing body of knowledge. As patients it's so important for us to stay educated and advocate for ourselves if we hear that our providers are giving information that is out-of-date or incorrect. If we learned anything at all from the debacle about menopausal hormone therapy, it's that we get things wrong sometimes, and we need to accept that, learn from it and move forward with a better way of practicing to take great care of our patients.

With metabolic dysfunction on the rise (including everything on the insulin resistance/pre-diabetes and diabetes spectrum) it's critical to understand how we are metabolizing glucose and carbohydrates. When you come to the doctor's office, we typically check glucose, insulin and other markers in a fasting state, but we have no idea what happens later in the day. Until recently, continuous glucose monitors have only been approved by insurance for diabetic patients and have required a prescription. Recently Dexcom released an over-the-counter continuous glucose monitor called Stelo, which measure is your glucose every 15 minutes, 24 hours a day. Today I'm talking about my experience with Stelo and why it might be something to consider, especially if you're struggling with weight gain or if you simply want to be educated about how different foods affect your metabolism.

Now that we are all aware of the multiple health benefits of taking menopausal hormone therapy, let's dig into some of the questions regarding timing, particularly for estrogen. There's no doubt that starting estradiol as soon as possible after menopause helps keep our blood vessels healthy, and reduces the risk of cardiovascular disease as well as multiple other diseases, including Alzheimer's. But what if you were not offered hormones and you are now more than 10 years past menopause? Today I'll be talking about what studies have shown regarding the possible risks of starting estrogen later in life, and why these risks may have been overblown and don't apply to everybody. I'll also talk about the myth that hormones should be stopped at some point, and discuss why this idea ever became popular.

This has been an exciting year with much more attention being paid to midlife women's hormonal health. Finally perimenopause/menopause is getting a voice, and the use of MHT (menopausal hormone therapy) is becoming widely accepted. Once we have decided to take menopausal hormone therapy, there are multiple options of products and routes of administration. Today I'll be discussing the different options for bioidentical menopausal hormone therapy, and the pros and cons of each. It's also important to understand why the doses are vastly different for the various different products, and why it's important to have your blood drawn to make sure that you are reaching optimal levels, because absorption is highly variable between patients. In the end, reaching the appropriate blood levels is much more important than the route of administration, which is really just a matter of personal choice and lifestyle. While the vital hormone testosterone continues to be controversial, in my practice we consider "optimal" for female testosterone to be in the upper range of what is physiologic for women (restoring levels to the high end of what they were when we were younger). Multiple studies have shown that these levels safely provide benefits for sexual wellness as well as muscle and bone conservation, sleep and mood. We recognize that long-term very high levels of testosterone put patients at risk of not only nuisance symptoms, but also irreversible masculinizing effects, which is why we never dose at that level, and why we have developed a novel dosing protocol which has proven to be safe and effective. Unfortunately, the practice of "Supra-physiologic dosing" continues elsewhere in the community, and is at the root of many people's misunderstanding about the safety of testosterone . We set ourselves apart from others who put their patients at risk with levels that are too high, and we pay the utmost attention to making sure we keep hormone levels optimal, without elevating risk.