{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"The HRT Questions Most Women Never Get Answered with Karen Martel | Rational Wellness Podcast 481","description":"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 \u201cestrogen dominance,\u201d 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. &amp;nbsp; 00:00 Show Intro and Mission 00:59 Why Midlife Hormones Matter 02:23 Perimenopause Starts Early 03:18 Progesterone Drop Signs 06:17 Testing Hormones and Thyroid 08:02 Bad Advice and Quick Fixes 09:33 When Supplements Aren\u2019t Enough 10:52 Starting Progesterone Therapy 12:49 Best Hormone Testing Methods 15:36 Endocrine Disruptors Cleanup 17:40 Choosing Estrogen Delivery 18:43 Pellets and Testosterone Risks 22:27 Progesterone Forms and Dosing 25:21 Why Avoid Oral Estrogen 27:00 Estradiol for Life 27:38 Estriol vs Estradiol 30:23 Patch vs Cream Dosing 31:56 E4 Estrogen Debate 33:39 Cycling Progesterone 35:38 DHEA and Pregnenolone 37:39 Vaginal Hormone Options 40:18 Optimizing HRT Levels 43:52 Starting HRT After 70 47:45 Perimenopause Timing Tips 50:19 Where to Find Karen     Karen Martel is a Certified Hormone Specialist and Transformation Nutrition Coach and the host of The Hormone Solution podcast, which focuses on perimenopause, menopause, hormone replacement therapy, metabolic health, weight loss resistance, and thyroid health.&amp;nbsp; Her website is KarenMartel.com.&amp;nbsp;&amp;nbsp;     Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS\/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.  ","author_name":"Rational Wellness Podcast","author_url":"https:\/\/www.drweitz.com","html":"<iframe title=\"Libsyn Player\" style=\"border: none\" src=\"\/\/html5-player.libsyn.com\/embed\/episode\/id\/43081578\/height\/90\/theme\/custom\/thumbnail\/yes\/direction\/forward\/render-playlist\/no\/custom-color\/88AA3C\/\" height=\"90\" width=\"600\" scrolling=\"no\"  allowfullscreen webkitallowfullscreen mozallowfullscreen oallowfullscreen msallowfullscreen><\/iframe>","thumbnail_url":"https:\/\/assets.libsyn.com\/secure\/content\/206807523"}