The HRT Questions Most Women Never Get Answered with Karen Martel | Rational Wellness Podcast 481

Perimenopause to Menopause: Testing, Progesterone First, and Evidence-Informed HRT with Karen Martell

Dr. Ben Weitz introduces the Rational Wellness Podcast and interviews hormone specialist Karen Martell about perimenopause and menopause, emphasizing that midlife hormonal shifts affect metabolism, sleep, mood, cognition, bone and cardiovascular health. Martell says perimenopause can begin in the mid-30s, often with declining progesterone from less frequent ovulation, leading to heavy periods, insomnia, anxiety, and perceived "estrogen dominance," while estrogen later becomes erratic and then declines toward menopause around age 51. She critiques common responses like birth control, hysterectomy, and symptom-only medications, and recommends combining bloodwork with saliva or urine metabolite testing (e.g., DUTCH) when cycling. For HRT, she prefers transdermal estradiol over oral estrogen, discusses progesterone delivery options and sensitivities to oral metabolites, addresses testosterone (often compounded; injectable preferred), and notes roles for DHEA and pregnenolone. She also covers vaginal therapies, dosing based on both symptoms and protective lab ranges, and cautious later-life initiation.