324. Perimenopause is Real

324. Perimenopause is Real

🎙️ Episode 324: Perimenopause is Real—What You Need to Know with Jackie Piasta, WHNP-BC Perimenopause is real—and often misunderstood. In this episode, I sit down with women’s health nurse practitioner Jackie Piasta to unpack the truth about this critical (and neglected) phase of midlife. If you’ve been told “you’re too young” or “just tough it out,” this conversation will feel like the validation you’ve been missing. Jackie and I dive into what perimenopause really looks like—from migraines and mood swings to weight gain and disrupted sleep—and why these symptoms deserve real answers, not dismissal. We talk through what’s happening hormonally, why lab tests aren’t the gold standard, and how to shift from a “birth control” mindset to a hormone-optimization mindset in your 30s, 40s, and beyond. In this episode: Why perimenopause can start in your 30s—even with regular periods Common myths that keep women suffering in silence How to track symptoms and cycles instead of chasing lab results The role of hormonal birth control—and when it helps vs. masks symptoms How estradiol, progesterone, and vaginal hormones can support brain, sleep, and libido Supplements and newer options: magnesium, L-theanine, flibanserin, even topical CBD Real-world patient cases that show how individualized care changes lives Top takeaways: Perimenopause is a clinical diagnosis—there’s no perfect test. Hormonal fluctuations can cause real physical, emotional, and cognitive changes. Bone loss, lipid changes, and heart risks start before menopause. Progesterone is often underused but powerful for night sweats, anxiety, and sleep. SSRIs are not first-line for new-onset mood changes in perimenopause. Early intervention matters—don’t wait until menopause to get help. We also talk about newer birth control formulations, managing migraines, and what the research is showing us about how menopause impacts heart health and brain function. Spoiler: it’s not just about hot flashes. This episode is your permission slip to stop toughing it out and start asking for care that actually helps. 🔗 Referenced Studies & Resources: Brinton RD et al. Perimenopause as a neurological transition state. Nat Rev Endocrinol. 2015;11(7):393-405. Wu B et al. Trajectories of Blood Lipids Profile in Midlife Women. J Am Heart Assoc. 2023;12(22):e030388. SWAN Study: Lipid trajectory insights through the menopausal transition https://www.instagram.com/jackiep_gynnp https://www.mymonarchhealthco.com/ Want more honest, empowering conversations like this one?⁠Preorder my Next Book⁠ share this episode, and leave a review to help others find this important work. Let's stop leaving women out of the conversation—especially when it comes to sex, health, and healing. Listen to my Tedx Talk: ⁠⁠⁠⁠⁠⁠⁠Why we need adult sex ed⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠Take my Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠ Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠ To learn more about GennaMD by Solv Wellness, visit ⁠⁠⁠⁠⁠⁠⁠gennaMD.com ⁠⁠⁠⁠⁠⁠⁠for 20% off your first order. For an additional $5 off, use coupon code DRKELLY5. Providers can request patient education materials or samples at ⁠⁠⁠⁠⁠⁠⁠gennaMDHCP.com⁠⁠⁠⁠⁠⁠⁠. Thanks to our sponsor ⁠⁠⁠⁠⁠⁠⁠Midi Women's Health⁠⁠⁠⁠⁠⁠⁠. Designed by midlife experts, delivered by experienced clinicians, covered by insurance.Midi is the first virtual care clinic made exclusively for women 40+. Evidence-based treatments. Personalized midlife care.⁠⁠⁠⁠⁠⁠⁠https://www.joinmidi.com Learn more about your ad choices. Visit podcastchoices.com/adchoices

Avsnitt(334)

#38 - Psychological Erectile Dysfunction

#38 - Psychological Erectile Dysfunction

One day away from my course launch!   Go to www.kellycaspersonmd.com Today we learn about how the penis can have trouble when the mind is being tricky.   --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

20 Sep 202011min

Erectile Dysfunction, does the intimacy have to stop after prostate cancer?

Erectile Dysfunction, does the intimacy have to stop after prostate cancer?

Sign up for my sex education class starting September 21st! www.kellycaspersonmd.com First, we need to hear the importance of erections from the male perspective. Okay, now that we did that, what should we do when couples stop having sex after erectile dysfunction.  In this episode we will specifically talk about prostate cancer as an example. We learn why erections can falter after treatment for cancer.   We learn how relationships change. We learn that the embarrassment in talking about this actually hurts couples because they can't think of what to do after their sex life has changed. Communication is key! But we have to start by acknowledging that this is a really really hard topic for couples to talk about. --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

13 Sep 202017min

Thoughts about sex

Thoughts about sex

The MASTER CLASS is starting soon!  From boring to mind blowing!  Sex education and coaching! www.kellycaspersonmd.com Thoughts about sex Let’s hear about a “typical” woman who comes to me for sexual issues. KY Jelly is the Betty Crocker of lube – it is everywhere, but not always great. Figure out what your sexual goals are. Your thoughts about sex influence your sexual satisfaction. Your thoughts are not facts. If your goal is to be a happy sexual person but your thoughts tell you otherwise, we are stuck! Sometimes thoughts are put in your head by other people, things, society. Especially about sex. I can’t get you to comfortable enjoyable sex if your thought is, “I am not a sexual being” Your body is listening to your thoughts. Sex and body image. Thoughts create our feelings which create our actions. Some of our thoughts aren’t serving us anymore. Sometimes we can’t make a thought go away, but we can see it for what it is – not a fact and not helping you. You can work on replacing your thoughts. Negative thoughts can’t get you to a positive solution. Sex coaching! Your biggest sex organ is your brain. --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

10 Sep 20208min

#35 - Endometriosis and pelvic pain - Talk to a pelvic pain Physiatrist Dr. Ahmed

#35 - Endometriosis and pelvic pain - Talk to a pelvic pain Physiatrist Dr. Ahmed

After spending the last five years honing her skills in outpatient care, Dr. Ahmed is ready to focus on her passion for treating pelvic pain. Dr. Ahmed has chosen a focused practice, because she believes concentrating on a specific field creates the greatest expertise. Chasing that greatness has been her consistent driving force. https://www.pelvicrehabilitation.com/ www.instagram.com/drtayahmed Learn how she found her calling in pelvic pain after doing her residency training in New York. She treats men and women! Learn how adenomyosis is different from endometriosis. Adenomyosis is different from fibroids. The “classic” endometriosis pain characterization. “endobelly”. Pain with periods, urinary symptoms. The only way to 100% diagnose endometriosis is with diagnostic laparoscopy – which is a surgery. Relationship between fibromyalgia and pelvic pain and endometriosis. The power of cognitive behavioral therapy in chronic pelvic pain. The role of BREATHING in pelvic pain The role of pelvic floor PT The role of pelvic floor trigger point injections – releasing pelvic muscle tension Post partum pelvic pain concerns! It can be many different things. The role of peri menopause and post menopause in pelvic pain. Lifestyle improvements people can make if they are living with pelvic pain – made endorphins!! What is NOT helpful when living with pelvic pain. – stop eating your triggers! Persistent Genital Arousal Disorder (PGAD) – under-diagnosed, very bothersome, chronic and debilitating. Learn about “hard/flaccid” – something new to me! Is it a male PGAD? --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

6 Sep 202035min

#34 - Inventor of leak proof underwear ONDRwear.com founder and urologist - Dr. Lubahn

#34 - Inventor of leak proof underwear ONDRwear.com founder and urologist - Dr. Lubahn

Meet Dr. Lubahn –  Mom, entrepreneur, urologist and creator of https://ondrwear.com/ Learn about both of our crazy stories about becoming urologists. Incontinence is very common. 50% of women!!! There are common reasons that people leak. Stress incontinence – increase in abdominal pressure – leaking with cough, sneeze, laugh. It is a pelvic support problem. Urge incontinence – “I gotta go now!!” It is a bladder problem. Overflow incontinence – the bladder can’t empty well, so it overflows with urine. The myth of “incontinence is normal when we get older”. Lifestyle changes – watch the amount of fluids you take in. Avoid or decrease caffeine and alcohol. Strengthen your pelvic floor with physical therapy. Use a Pessary or Poise Impressa. Surgery for Stress Incontinence – urethral bulking agents, midurethral slings Learn how Dr. Lubahn’s quest for baby diapering solutions lead her to make the perfect underwear for women. Listen to what advice she has for other people with a great idea sitting in their brain. --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

30 Aug 202032min

#33 - Let's talk about diet, exercise, mindset (oh and how this affects your sex life)

#33 - Let's talk about diet, exercise, mindset (oh and how this affects your sex life)

Today we will meet an emergency department physician who has started a company to help women take control of their health, weight, and mindset. How we think about our bodies affects our sex life!  So we can't neglect the whole body in our discussions! https://www.wholisthealth.com/ https://podcasts.apple.com/us/podcast/curate-your-health/id1478410990 Join us as she shares how she created a space for helping women use food and exercise as medicine to prevent and reverse disease. The side effect of this is weight loss and comfortableness with themselves. What is a health curator? Someone to specifically fit the needs someone has in their life. What is lifestyle medicine? A new specialty in medicine. Using the evidence behind food, sleep and medicine to help prevent and reverse disease. Neuroplasticity allows us to rethink the way we think about food and choose to be healthy. It takes work, but it is entirely possible. We make 700 neurons a day. Can you use mindfulness to help your sex life? Heck yeah! Negative body image affects your sex satisfaction. What do you wish women knew about exercise? Skill with how we eat and exercise is a mindset issue. Relying on motivation won’t get the job done. Discussing peri and post menopause. Mindset work – who you are, who you want to be. --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

23 Aug 202022min

A Urologist interviews a Urologist - and Dr. Casperson is in the interview seat!

A Urologist interviews a Urologist - and Dr. Casperson is in the interview seat!

Urologist interview king Dr. John Lin interviews Dr. Casperson! Today’s episode is sponsored by KGOAL. Use the code NOTBROKEN for a 20% discount on your purchase! www.kgoal.com Topics discussed today: Orgasmic Inequality Why PIV sex doesn’t always work It takes a female longer to reach climax than a man Clitoral anatomy – knowing anatomy helps people realize they are normal. www.OMGyes.com – a great resource for sex education What do sex therapists do? – they are therapists comfortable talking about sex. Solo-sexual – having sex with yourself. Orgasmic inequality – everyone has more orgasms than the heterosexual female Why? Our society doesn’t value female orgasms as much. Women want to please their partners – but don’t neglect your own pleasure. HSDD – hypoactive sexual desire disorder – now there are FDA approved medications. BUT WARNING! If you think that the solution for desire is in a pill, you are likely to get disappointed. Responsive desire is the majority! You Are Not Broken! Common female sexual problems I see in clinic - Not enough lubrication – desire, arousal mismatch. - A woman takes longer to orgasm than a man does - Perimenopause and low estrogen status of vulvar tissues She Comes First – Ian Kerner https://www.amazon.com/She-Comes-First-Thinking-Pleasuring/dp/0060538260 Sex Toys –  FEM TECH! they aren’t scary, they are just toys. They will not save your marriage. https://techcrunch.com/2019/01/08/ces-revokes-award-from-female-founded-sex-tech-company/ https://loradicarlo.com/ The Vagina Bible – Dr. Jen Gunter. https://amzn.to/31AU6ve Becoming Clitorate – Dr. Laurie Mintz. https://amzn.to/3fMwUz9 Reclaiming Desire – Dr. Andrew Goldstein  https://amzn.to/30M6Ks6 --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

16 Aug 202038min

#31 - The Software - Desire and Orgasm

#31 - The Software - Desire and Orgasm

The WEBSITE IS UP!!!  www.kellycaspersonmd.com Announcement!  Sept 21st course registration is open! www.instagram.com/kellycaspersonmd The Software - Desire and Orgasm Do I actually need a loading dose of estrogen cream? What is vaginal DHEA for? What to do if estrogen cream burns? Desire and orgasm. My why - why did I learn about this stuff. Desire in long term relationships. Reactive and spontaneous desire I can’t make you like something that is painful. The theory behind why women can have multiple orgasms Why women’s arousal is necessary to prevent pain with sex Basson’s model of women’s sexual cycle. How many times a week am I supposed to have sex. Orgasm Inequality. Correction from audio - Dr. Laurie Mintz, Phd - she wrote “Becoming Clitorate.” The Melted Ice cream analogy for desiring sex. The FDA approved meds for hypoactive sexual desire disorder. Filbanserin and Bremelanotide. Why do men who wash dishes have more sex? Testosterone and women. NOT FDA approved and is not dosed for women. What do you do? --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

9 Aug 202035min

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