How To Understand Your Menopause Labs With Confidence - Episode 343

Welcome And Science Plus Soul Sandy Kruse 0:02 Hi everyone, it's me, Sandy Kruse. Welcome to Sandy K Nutrition Health and Lifestyle Queen. For many years now, I've been a trusted voice for people in midlife and beyond who want a deeper, more honest conversation about wellness. One that includes the physical, the emotional, the mental, and the esoteric.

Most episodes are solo now because I want to bring you thoughtful research, lived experience, and grounded insight without noise or bias. And when I do bring on a guest, it's because their work genuinely adds something meaningful to the conversation. Here we explore the full spectrum of what it means to be well, how the body functions, how the mind heals, how the spirit expands, and how all of these layers shape life lived with clarity and joy. Thanks for being here.

And if this show resonates with you, please follow, rate, review, and share it. It truly helps the message reach more people. How To Read Menopause Bloodwork Sandy Kruse 1:32 Hi everyone, welcome to Sandy K Nutrition Health and Lifestyle Queen. Today I'm going to talk about a really fun topic.

I'm going to teach you how to read your menopause blood work. And I'm also going to explain to you functional lab ranges versus the lab ranges you see on your lab report that are typically standard ranges, often much lower and not optimized. So I'll just give you a little breakdown before we start. I am Sandy Kruse.

I am a registered holistic nutritionist with multiple health certifications, including functional lab testing and endocrinology and hormones, as well as peptides and anti-aging. But this is not medical advice. What I am doing is not saying, take this, don't take that, do this, don't do that. I'm not doing that.

I am here to empower you to understand this journey we call menopause. And that's really everything that I do. So it's really more so so that you can have a great conversation with your hormone practitioner and really optimize your hormones. I'm also going to say I don't care either way.

I don't have a super strong stance that you must take HRT because I was just at my parents' house today. My dad is 89 and my mom is 80. Neither of them have ever been on any kind of hormones. My dad was all excited about getting his cabbage for the the winter because they make fermented uh cabbage for their uh we call it sodoma.

It's it's stuffed cabbage rolls. You know, I look at my parents and yeah, my mom was diagnosed with osteopenia in her 50s. However, she also had chemotherapy. So I think that that's always a factor.

Then there's genetics. Anyway, I am not here to give you advice, I am here to educate you. So let's get going here. Oh, and before I keep going, I'm gonna ask you to share this with a friend.

Share this with a girlfriend going through menopause who really wants to understand what's going on. And believe me, you're not gonna need to know every little detail. And I did develop a spreadsheet where you can plug in your own values and all of the other values are there. I just haven't decided how I'm going to implement this yet.

It's probably gonna be something like you give me your, you know, you give me your email and I'll give you this as a free download or something to that effect. Anyway, that's to come. Make sure that you're subscribing wherever you are listening. If it's Apple or Spotify, remember I am an independent podcast host.

There's not a lot of us out here who do all the work ourselves, including all the research, including the scripts, including the editing. That's me. And I've actually also entered to win a contest. And that's going to be more details to come.

Maybe I'll have a link depending on when this comes out. Okay, now. Why Labs Look Normal When You Feel Bad Sandy Kruse 5:12 So you finally get your blood work back. You open up your little portal, and half the lines will say normal, your hormones say uninterpreted, please see details, then there's no details, and your doctor looks at it and says, Everything looks fine, except you don't feel fine.

You are on HRT. I'm gonna assume you're on HRT if you're listening to this. Your breasts are sore, your jeans are tight, your hair is shedding in the shower, your rings are really, really tight on your fingers. Maybe you have a little bit of moon face going, and you're exhausted by 3 p.m.

Maybe you're even spotting years after your last period. What's that printout actually telling you? That is what this episode is about. I'm gonna walk you through the numbers that matter most in menopause.

And you know, I may leave one or two things out, and a lot of this is based on opinion. You're gonna hear some other practitioners have different opinions, and that's okay too. But the part that nobody explains often enough is how often some of these markers in your blood work actually affect the other. So once you see how they connect, your blood work stops being a list of numbers and starts to tell you a story.

And then I'm gonna go deeper into what your uterus, your ovaries, and your hormones might be saying that no lab will ever measure. This is my soul part, my friends. You know, I'm always about science and soul. So go grab your last results and let's go.

Testing Timing And Delivery Methods Sandy Kruse 7:01 And I certainly hope if you are on HRT, the one thing I will say, and I do have a very strong opinion on, is that you do get regular testing, whether it's saliva, whether it's urine, whether it's blood, if you're in menopause and you're on hormones and you really want to optimize your HRT, BHRT, I'm a big believer in bioidentical hormones, and you want to optimize it, you got to do the blood work. Otherwise, you're never gonna know the proper ratios. Blood is typically the cheapest. And here in Canada, if you do do blood work, it's usually covered.

If you have a functional nurse practitioner, there are ways in Canada anyway, you can explore this more wherever you are, that you know, you maybe pay a small amount and get blood work. At least I always recommend, at least when you're starting to do it every three months. Um, and then maybe a later time you can move to six months. But I highly recommend it.

And it is not true when you hear a general physician saying blood work is useless once you're already in menopause. I'm gonna stand strong on that statement. Are you on the hormones or not? The exact same astradiol number means something completely different in a woman on HRT or B A B H R T versus a woman who isn't.

Secondly, how are you taking these hormones? Is it a cream? Is it a gel? Is it a patch?

Is it a pill? Is it a pellet? They all show up differently in your blood. Third, when was your last blood drawn compared to your previous one?

If you take your hormones at night and get tested at 7 a.m., you're seeing your levels about 12 hours later. And that's fine. But do it the same each time. You know, test it around 7 a.m.

and 2 p.m. the next time, and you know, you'll chase if you do those two dates or times, I should say, you're gonna chase numbers that aren't real. Typically, it is recommended that if you are testing hormones, you test them within uh the first two hours of waking. That's typical if you're in menopause and you're doing blood.

But again, talk to your practitioner because it also depends on what you're taking. So if you are using a cream or a gel, never let them draw from the same arm that you rubbed it into. That alone can make your number come back sky high the next morning. Estradiol Targets And High Low Signs Sandy Kruse 9:52 Most women don't really get it, they just go estrogen, right?

But we need to understand that there are three main estrogens. There's estrone, there's estriol, and then there's estradiol. Nobody talks about estrone. I mean, you definitely don't want to use anything that with estrone in it.

It's actually not a good idea. But estradiol is the one that runs the show, it is the strongest estrogen, it's what controls the hot flashes, the night sweats, sleep, mood, brain fog, joints, bones, your heart, your skin. But estriol controls that too, just so you know. I'll get into that.

If you're not on hormones after menopause, it usually sits at about, well, it'll be under 100 PMOLs per liter. Okay. I'm gonna use certain metrics, and you know, unfortunately, you're gonna have to do the conversion wherever you are listening. If you're on hormone replacement therapy, a lot of menopause practitioners aim for roughly 250 to 370 PMOLs per liter.

In American units, that's about 70 to 100, and it's PGs per milliliter ML. It's individual. How you feel matters as much as the number. Okay, this is why HRT is never going to be a one size fits all.

This is also why I say you must go to a hormone practitioner, one that gets it, because most general physicians, at least not in Canada, are educated in doing hormone replacement therapy for women in menopause, unless they go and do certain certifications. Because the facts are this if it's too low, you're gonna know it. The hot flashes come back, the sleep starts to fall apart, your mood dips, and your joints ache. If it's too high, you're gonna have sore, swollen breasts, bloating, your rings get tight, like I was saying, and the scale can jump overnight.

You can feel really puffy, you could feel wired, and then you might even be bleeding when you shouldn't be bleeding. I'm gonna get into my situation a little bit deeper. So I had this happen. Uh so in the end of July, this is why knowing your body is so important.

I'm gonna take a little turn here because I have an amazing nurse practitioner who is specifically certified in bioidentical hormone replacement therapy. Now, I'm not your usual gal. I don't have a thyroid gland. I am also extremely sensitive to estrogen and always has been.

Ever since I was put on the pill at age 18 and gained 20 pounds in one year, my friends. So this girl right here, I'm very sensitive to estrogen and I'm aware of that. So the number one thing I'm gonna say is be in touch with your own body and understand it. It is so powerful when you do.

I'm giving you the breadcrumbs, but you need to be in touch with your own body to get it and know what's your formula. Okay. And then you work with your doctor to figure out the right thing for you. So what happened was end of July, we looked at my hormones and we're like, uh, not exactly optimized.

I had a little dip. I am 56 years old. I went into official menopause in March of uh 2025 at 55. It was one year of no periods.

So it looked like in the summer I had another change. We're not robots, my beauties. We change. And even though people will say, Oh, you know, you you lose all your hormones, you don't.

It's not like we turn into a dude, right? We don't lose all of our hormones at menopause, but they could also fluctuate a little bit. We changed the dose. One little dose increase took me from 182 to 690.

And within 10 days, I had all those symptoms, the source will impress, the bloating, the waking, the puffiness, and I bled for 24 hours. So this triggered a whole series of events because I come from a history. My aunt she passed away. It began with uterine cancer.

If you're on HRT and your breast suddenly hurt, take a look at your estradiol first. Now I'm gonna talk a little bit about estriol versus estradiol. Know what's in your cream or gel. A lot of women in Canada get an estragel or a patch.

Wherever you are, there's gonna be different recommendations. If you're on a compounded cream, which is what I am on, it's called biest, and it's two estrogens in one, and it's a ratio. So the one that I take right now is a 50-50. It's that means it's 50% esterol and 50% estradiol.

Most women have no idea what either one does, but it matters. Estradiol, remember, is the strong one, it does the heavy lifting for your whole body. And this is when I'll go back to my story with my MP, who's wonderful. She wanted to put me on straight up estradiol, no more biased, which is the mix.

And I went, if I do that kind of a jump, I know my body enough to know it's gonna be a problem for me. Doesn't mean it's gonna be a problem for you, but I know my body. Biest Ratios Estriol And Skin Changes Sandy Kruse 16:42 So it's a good thing we didn't do the big jump to the straight up estradiol. We just increased the ratio.

I went from a 60-40 ratio, which is 60% estriol, 40% estradiol, to a 50-50. Little bit of a dose increase, and boom, triggered a period, triggered it, was not a real period. It was like 24 hours of bleeding. But now I gotta go and get a uterine biopsy tomorrow.

So there you go. So um remember, you have to know your body. Estriol, which is the lighter one, the one that's not as intense, but also some women do not resolve their menopause symptoms when it's this kind of a ratio. Estriol is actually the big pregnancy estrogen.

You know, when you're pregnant, your placenta makes 35 to 45 milligrams of it in a day. Levels go up about a thousand times when you're pregnant. It binds to your estrogen receptors at a fraction of estradiol's strength. It's gentle, but gentle does not mean it's weak.

Okay. In Japan, women in menopause, this is a study, um, took estriol daily for a full year, their symptoms dropped by about half by 80% in women who had surgical menopause with normal breast ultrasounds and uterine biopsies. Women with MS often go into remission in the third trimester of pregnancy, exactly when that estriol peaks. When UCLA tested estriol in women with MS, they had a third to a half as many flare-ups, and their memory and thinking scores improved.

And women with constant bladder infections who used a vaginal estriol cream saw their infections drop by more than 90%, my friends. I recorded an entire podcast all about vaginal estrogen estrogen. So go back and look at my catalog because that's also a rare thing to talk about, but super important. Estriol still needs progesterone beside it, otherwise, it's unopposed, just like estradiol, but it's doing far more than most women even realize.

So I started taking progesterone. I started doing it with a cream. I would have been in my 40s when I started that, just to help my sleep and everything. So you can take your doctor can prescribe you progesterone unopposed.

Typically, it's in a cream, but estrogen should not be unopposed. Talk to your doctor about that. Here's why all of this matters in your blood work. Biest has a ratio.

Like I was saying, 80-20, 60-40, 50-50. The first number is supposed to be estriol. When your ratio changes, you're not just getting a stronger cream, you're getting more or less of that strong one. So going from 6040 to 5050 can raise the estradiol.

Remember the stronger estrogen that you get by a lot more than you think. Look at me. So if your symptoms change after a new prescription, you need to understand the ratio and speak with your hormone doctor about it. Then there's your face.

This is always a fun one. When estrogen drops, you can lose up to 30% of your skin collagen in the first five years of menopause. That's why so many women look in the mirror one day and think, What? When did my face change?

In one study, women put an estrogen cream on their faces for six months. Some used estradiol, some used estriol. Their skin got firmer, more elastic, and more hydrated. Wrinkle depth and pore size dropped by sixty-one to a hundred percent.

Under the microscope, you could see new collagen and estriol worked just as well as the estradiol. This matters more if you're prone to melasma, like I am. Those brown blotchy patches, estrogen tells your pigment cells to make more pigment, and estradiol sends that loudest signal. Dermatologists have seen women develop melasma after putting estrogen cream on their face.

If you want an estrogen cream for your face, ask your hormone practitioner about a low-dose estriol-only cream from a compounding pharmacy. And of course, you know, wear sunscreen on your face because sun plus estrogen is what lights melasma up. The first time I talked about this was back in 2022. I had a number of posts go viral because I did a ton of research on this myself.

And then a lot of people started, you know, jumping on that bandwagon, I will say, which is fine because I'm pretty proud of the fact that I was one of the first people talking about it because I started to see, you know, that crisscross crepiness under your eyes. It almost looks like tissue paper. And I'm like, I do not like that at all. Did some research and I'm I so now I'm gonna be 57 in January.

I started using estriol cream. It also has a vitamin E in it, it's very nourishing when I was 52 and haven't stopped since. So if you want to see any of those posts, I think they might be pinned on my TikTok and on my Instagram. It's just at Sandy Knutrition everywhere.

Be sure you're following me on my Progesterone Balance And Bleeding Risks Sandy Kruse 23:45 social media. Okay, let's get into progesterone. This is the one that keeps the estrogen in check. Remember, I talked about unopposed estrogen.

And I know some women who got into some trouble with their family doctor prescribing estrogen only, thinking that was the right thing to do to help their hot flashes. Not the right thing to do for your beautiful menopausal uterus, my beauties. You should not be taking, and I'm very strong on this stance because there's enough research to say it's not safe at menopause to take estrogen unopposed. You need the progesterone.

Okay. There is a difference between progesterone and progestin. Progestin, if you go on a progestin only IUD, that is synthetic progesterone, not bioidentical. I've also had some great conversations with Dr.

David Rosensweet of the menopause method. He's been on my podcast twice. We talk in great detail about hormones, bioidenticals. He's been doing this since he was a very young man, and he's got a lot of experience in this industry, the hormone industry.

But he's very against oral estrogen, and he is uh, whereas oral progesterone is fine, micronized, micronized, compounded. Unless there's a real, real reason for oral estrogen, you got to talk to your doctor about that, but it should typically always be a gel or a cream. Okay, let's get to this progesterone, the one that keeps the estrogen in check. Progesterone protects your uterine lining, it also calms your brain, my beauties.

It helps you to sleep, and it also helps protect your breasts from too much estrogen. Could you imagine if I was not taking progesterone? Honestly, I would be dying of pain. After menopause, without hormones, it's basically almost gone.

That's the facts, and it's usually under one or two uh NMOLs per liter. If you prote if you do take progesterone as a pill at bedtime, don't panic over a low number on a morning blood test. It peaks a few hours after you take it, and then it drops kind of fast. By a 7 a.m.

draw, you're probably catching it on the way down. Most of its calming effect comes from a byproduct. The standard test doesn't even measure. With oral progesterone, your sleep tells you more than your lab does.

You got it. That's why you have to have a practitioner who asks you the questions. Now let's talk about the ratio. So functional hormone practitioners will compare progesterone to estradiol.

And the target most use is 100 to 1, both in the same units. When that ratio is way off, most women think I need more progesterone. But if your estradiol is too high, more progesterone isn't gonna fix it. You're never gonna catch up.

So most practitioners will bring the estrogen down. That's what's happening with me. This whole story about high estrogen is really a long, long story. And the reason I'm gonna say that is because now, in hindsight, I can say I always had estrogen dominance.

And I do know some practitioners who work with even younger women that will give younger women a progesterone cream for that estrogen that's too high because the ratios, even at that age, can be off. So if you have a daughter that has really heavy periods and really, you know, bad cramping and severe mood fluctuations and all of that, have them see a hormone doctor. Now let's talk about bleeding after menopause. Estrogen builds your uterine lining.

Progesterone keeps it stable. So when estrogen is way ahead of the progesterone, the lining builds faster than it can hold and then it sheds. So bleeding on HRT is often a sign your estrogen is too high for your progesterone, often. But any bleeding after menopause gets checked.

Even if you're on HRT, look at me. Even when you're not sure or you are sure you know why, like I think I do, I hope I do. Uh that usually means a transvaginal ultrasound to look at the thickness of your lining. And sometimes a biopsy, which is what's happening in my case.

I've done both, or I'm gonna do the biopsy tomorrow. Most of the time the answer is reassuring, but this is the one symptom you never just manage with a dose change at home. Okay. FSH LH Testosterone And SHBG Links Sandy Kruse 29:23 Let's talk about FSH and LH, follicle stimulating hormone and luteinizing hormone.

This is your built-in dose meter. Okay, almost no one uses these numbers this way, but I think they should because FSH and LH come from your brain. They're the messengers that tell your ovaries to get to work. Okay.

After menopause, your ovaries stop answering. So your brain keeps yelling, right? And then your FSH and LH climb high. So they're supposed to be high after menopause.

So FSH is usually over 30 or 40. However, when you go on estrogen, your brain notices and it quiets down. Okay. So FSH and LH can drop a little.

So you kind of have to have a practitioner that reads them almost like a dose meter. If FSH is still sky high, even on HRT, your estrogen dose may not be landing, right? Because you should see a little bit of a drop. If FSH and LH have dropped all the way back into perimenopausal ranges, your brain thinks that you're perimenopausal again.

That's what's happening to me right now. So since then, I've had like two bleeds, short and not major, but and they but and funny thing is, just over 30 days apart. It's like my body's like, oh Sandy, you're kind of in premenopausal stages again. So this means your estrogen is sitting at pre-menopausal levels, and your body may start acting like it with the sore breasts, the bleeding.

Okay. However, I do know some women who do this on purpose because they believe that continuing to have this mini period uh helps contribute to their longevity. I'm not going to say too much about it, except that's not for me. How about that?

Testosterone. This is the one that often quietly disappears, and it's usually the last one. First one that lowers pretty significantly, and it can lower at a very young age, is the progesterone. Estrogen comes, you know, at pre-menopausal, perimenopausal phase.

And then testosterone is usually the last one. It's usually the one that quietly disappears. And I do believe you need to be more careful with this one if you're deciding to take it. We do need testosterone.

It's our muscle and our strength and our drive and confidence, our libido, our bones. Yes, our bones. Testosterone matters too. And our metabolism.

Many menopause practitioners like to see total testosterone somewhere around 1 to 2 NMOLs per liter. I was there until my estrogen shot up. And now, guess what's happening? My testosterone has dropped.

It's all the way down to 0.3 because the ratios for me are all off. So here's the connection that almost nobody knows. After menopause, your ovaries stop making the estrogen, but they keep making a little bit of testosterone. And what tells them to make it LH, that same messenger from your brain.

So follow it. Your estrogen goes all the way up, your brain quiets down, LH drops, LH stops telling your ovaries to make testosterone, and then your testosterone falls too. That's exactly what's happened to me right now. Raise one hormone and you can quietly lose another.

It's like I talked to about B vitamins. You know, everyone's like, oh, you got to take your B12. But I'm like, and then they, or they go B6, B12, B6, B12. I'm like, every once in a while, pulse in a B complex that is methylated because you can mess up those ratios.

Same thing with hormones. Our body is so smart. There's another way that testosterone could disappear. If you take your estrogen as a pill, it raises a protein that's called SHBG, sex hormone binding globulin.

SHBG grabs onto that testosterone, holds it, so less of it is free to work. Creams, gels, patches, don't do this nearly as much. That's why you always want free testosterone and SHBG, not just your total testosterone. My doctor always checks the free as well.

Total will tell you how much you have. Free will tell you how much you can actually use. It's kind of like the whole thyroid thing with free T3, free T4. Let's talk about prolactin.

Prolactin is the quiet one that is behind those sore breasts of yours. Prolactin is the hormone that gets your breasts ready to make milk. God damn it, I don't want to have milk. I'm just kidding.

Estrogen pushes it up. Your lab range goes up to about 24 or 25. Functionally, many practitioners prefer it to be at about 15. I'm currently sitting at a 19.

So if your breasts are sore and your prolactin is creeping towards the top of the range, along with a high estradiol, that's a double hit on your breast tissue. You need to fix the ratios, my friends. Insulin Thyroid Ferritin And Vitamin C Sandy Kruse 35:25 Let's talk about fasting insulin. This is a very important number that your doctor probably never ordered.

They do fast and glucose all the time, but not fasting insulin. So your blood sugar and A1C, HBA1C, can look perfect for years while your insulin is quietly working overtime to keep them there. Fasting insulin catches the problem years later. Earlier, sorry, not later.

So functionally, you want it low, about 35 to 42 PMOLs per liter. Mine sits at an 82, but I have different issues. High insulin is what drives belly fat, makes weight loss feel impossible, and it lowers the sex hormone binding globulin, the SHBG, which changes how much estrogen and testosterone are active in your body. And here's a connection that often will surprise women.

Estrogen actually helps insulin. It's true. Because my insulin actually did go down from before when she decided my hormone practitioner and I both decided we should go up a little bit. My estrogen was going too low.

And guess what? My insulin was going up. Look at that. It makes your muscles and liver respond better.

Estrogen does. That's one big reason insulin and belly fat climb when estrogen disappears at menopause. There's your answer. I don't know if your doctor ever told you that.

In the women's health initiative, women on hormone therapy had about 21% fewer new cases of diabetes. So if your insulin is improving after starting HRT, that's actually not a coincidence. I just explained the mechanics of this, okay? Thyroid.

We want to look past our TSH. So TSH is important. It's the signal from your brain to your thyroid, and it's what most doctors will only test that. But I'm going to say it's the least useful on its own.

It's kind of useless. Free T4 is the storage form. So I personally, you guys know I don't have a thyroid gland. So I take a bunch.

You guys, one day I'll do a podcast on that. If you don't have a thyroid gland, make sure you're subscribing because I'll do one. So free T4 is actually the storage, and free T3 is the active hormone that actually gets into your cells, runs your metabolism, and it also keeps you warm. Many functional practitioners like free T3 in the upper half of its range.

If your free T4 looks great, but your free T3 is low, that means you're not converting well. In Canada, I don't think anyone tests reverse T3, actually. It would be great if your doctor did test that. And then a few things that you can look into from a nutritional perspective is up your selenium.

Eat a Brazil nut or two every single day. That's the highest source of selenium and the easiest way to get it. And it helps with that conversion. But there are other factors as well, such as stress levels, that affects that conversion of the T4 to the T3, which is the T3 does all the beautiful stuff.

Two connections to know. First, if you take estrogen as a pill, it raises the protein that carries thyroid hormone in your blood. Women on thyroid medication often need a higher dose after starting oral estrogen. Very few women should be worried about that because very few women should be on oral estrogen.

Creams and patches don't do this as much. If you change how you take your estrogen, make sure you recheck your thyroid. And second, converting T4 into T3 also needs iron. I did mention selenium, but it also needs iron, which brings us to one of the most overlooked numbers in menopause, and that is ferritin.

Think of it as your iron savings account. So ferritin is how much iron you have in storage. Many labs call anything above a 15 to 30 normal, but functionally, most practitioners want it closer to 50 to 100. I currently am sitting at a 32.

So low ferritin looks like fatigue. But at one time, I think I went down to a six when I was still menstruating. So low ferritin can look like a problem with your thyroid, by the way. It can look like it with symptoms like feeling cold all the time, being tired, breathlessness on the stairs, brain fog, your hair is falling out.

So when so many women blame their hormones for thinning hair. When a lot of times it's just the iron being too low. And here's what most women don't know when your period stops, they don't no no doctors talk to you about this. When your period stops, you stop losing iron every month.

You're not bleeding anymore, right? So ferritin normally will go up after menopause. Mine hasn't. And there's a very specific reason for that.

If you want to know more about that, maybe you need to listen. Listen to all my podcast episodes. How about that? Anyway, if yours is low after menopause, that's a red flag.

You're either not absorbing iron or you're losing it somewhere. Bleeding on HRT is one way. Acid blockers are another because stomach acid helps you to absorb iron among other minerals. Don't stop at ferritin.

Ask for the full iron panel from your doctor. That is serum iron, TIBC, transferrin, saturation, and a CBC. Now, you rarely hear vitamin C talked about in a hormone panel. But here's where vitamin C comes in, and it ties together your iron, your thyroid, and your skin.

First, iron. Vitamin C can more than double how much iron you absorb from food and supplements. Whenever I do my hormone panel, guess what my doctor checks? Vitamin C.

So take your iron with vitamin C. I always do. Eat iron-rich food with red peppers, citrus, kiwi, strawberries, broccoli. Red pepper has more vitamin C than an orange.

And keep coffee and tea at least an hour away from your iron because they block that absorption. And then, second to that, I am gonna say heme form of iron is often better absorbed than um the other forms of iron. I once ended up in a merge, I thought it was gallbladder. I had such bad stomach pains.

My doctor in my 40s gave me, I don't know, it was a pharmaceutical form of iron, and it was horrific. My stomach could not take it. So, and I'm not the only one who has had these issues. It's very common.

So let's uh yeah, so second is collagen. Your body can't build strong collagen without vitamin C. Without it, your collagen falls apart. So that's literally what scurvy is bleeding gums, wounds that are reopening, skin is breaking down.

So picture it. Menopause is costing you up to 30% of your skin collagen. Your estrogen is telling your skin to rebuild. But without enough vitamin C, your skin doesn't have the material to do so.

In a study of over 4,000 women in their 40s to 70s, the women who got more vitamin C had fewer wrinkles and less dry skin. It'll be interesting to see if they were also on HRT or not, or if they even measured that. So your body can't make vitamin C. Remember, humans used to be able to do that.

And it can't store much. So we need it every day. It's a water-soluble nutrient. So let's The Soul Side Genes Stress And Trauma Sandy Kruse 44:51 get into the part that your blood work can't show you.

This is the soul part. You guys know I always do science and soul. Every woman goes through menopause. But no two women go through it the same way, do they?

One woman sails through with very few of those hot nights. Another can't sleep for five years, drenched, anxious, gaining weight, and feeling like a stranger in her own body. Why is this? We know part of it is genetics.

Your mother's menopause is one of the best clues to yours. For me, it's hard to say because my mother was diagnosed with cancer at age 52, right in the crux of that uh before and after menopause. She was in perimetopause. So I can't really say because after the chemotherapy and radiation, she was literally thrown into menopause.

Researchers who studied almost 18,000 women found variants in one gene called TACR3 that were tied to whether women got hot flashes at all. That gene works in the exact part of the brain that sets off a hot flash, but genes aren't the whole story. Women with moderate anxiety are about three times more likely to have hot flashes. And women with high anxiety about five times more likely.

Women who lived through abuse or neglect as children have more night sweats at menopause decades later. Think about that. Something that happened to you at seven can show up in your night sweats at 52. So your body keeps the score.

Your hormones and your nervous system are in constant conversation, and your history is part of that conversation. This is where I love to bring in that soul side. There are teachers who have spent their lives on what the body is trying to tell us. Yvette Rose in Metaphysical Anatomy looks at conflicts and trauma underneath a symptom, including patterns passed through our families.

Michael J. Lincoln in Messages from the Body looks at family dynamics and beliefs that we soaked up growing up. And Bjorn Ebel in the psychic roots of disease ties each organ to a specific kind of emotional shock. They all come at it differently, but when you put them all side by side, the themes for a woman's pelvis line up in a way that actually gives me chills.

It's where you create, you nurture, you hold. Being the one who takes care of everyone. When there's trouble here, the questions are: where am I holding everyone else but myself? Where do I give and give and never receive?

Evil links the lining of the uterus to the ugly, unfair conflicts in our closest relationships, the ones that we can't digest. Your ovaries are your creative fire. They're about creation, not just babies, but ideas, projects, and the life that you're building. They're tied to your worth as a woman.

In Evil's work, the ovaries respond to deep loss, losing someone you love, a child, even a beloved pet. Think of how many women hit menopause right as their kids leave home, or their parents are dying, or their marriage is changing. That's a lot of loss that's landing on the ovaries at once. The cervix is the threshold, it's the doorway about what you let in and what you keep out.

It speaks to boundaries, to intimacy, and to feeling wanted and chosen. Evil connects it to sexual frustration, to longing for closeness that isn't there. And hormonal imbalances itself across all of this work keeps coming back to balance, doing and being, giving and receiving, pushing and resting, overriding every signal your body sends because you don't have time to stop. Then there's menopause.

So many of us walk into it with fear, fear of getting old, fear of not being wanted, fear of becoming invisible, fear of losing the role that defines us. And the more we fight it, the harder it seems to hit. But for most of human history, this was the wise woman's stage. The years when a woman stopped pouring her energy into everyone else's life and finally kept it for her own.

Your energy isn't leaving, it's coming home to you. So when you look at your blood work, ask what the numbers are saying, and then ask what your body has been trying to tell you all these years. This sits beside your blood work, never instead of it. You read your labs, you get your bleeding checked, and you do the soul work too, and that's where real healing and balance and peace resides.

You work with a qualified hormone practitioner. You are always welcome to email me if you want to know more about this. In Canada, I know a lot about it. In the US, I can recommend maybe a couple.

In Europe, I don't really know what practitioners you're gonna have to do the homework yourself, but you need somebody qualified who respects everything that I just talked about. Not because they have to respect me and what I'm saying, but because I always come from it from an educational standpoint point and a balanced viewpoint. Uterine Cancer Risk And Safer HRT Sandy Kruse 51:59 I'm gonna get into why I won't review, refuse HRT just because my aunt died of uterine cancer. She was never on hormones, not one day.

She also never had children. So when people hear that and then hear that I'm on estrogen and progesterone, they look at me like I might have lost my mind. Like, oh my God, imagine what's gonna happen to you then if she was not on it and she got the cancer. But if HRT were the reason that women got uterine cancer, facts are my aunt would have never had it, right?

You gotta look at the logic here. And here's what actually drives most uterine cancer estrogen with nothing to balance it. It's what I talked about earlier, the unopposed, right? The S and think about it.

Think about how high your estrogen is at 20. You don't see a ton of 20-year-old women with uterine cancer. Because if that theory was true, that would be the case. That estrogen doesn't come, doesn't just come from a prescription.

After menopause, your body fat becomes your main estrogen factory. Insulin resistance and diabetes raise the risk. So does never having children, like my aunt, having a late menopause as well, and taking estrogen without progesterone. And for some families, there's a genetic piece like Lynch syndrome.

So I'm not trying to fat shame you, but if you're overweight, your fat is becoming the main estrogen factory. It's not good. So here's what protects your uterus progesterone does. In the Women's Health Initiative, women who took estrogen with a progesterone every day had 35% fewer uterine cancers than women on a placebo.

Fewer, not more. So my family history isn't my reason to refuse HRT. It's my reason to do it carefully. That's why I take progesterone every single night.

That's why I watch my insulin, watch my weight, I watch carefully. That, you know, if I have a bleed, I don't wait. I go see the doctor, I get the test, get all the things done that's recommended. That's also why I read my blood work the way I just taught you to.

This is power, my friends. If you have uterine cancer in your family like I do, make sure you tell your practitioner, your hormone doctor, make sure your estrogen is always balanced with progesterone. If you have a uterus, get any bleeding checked right away. And if several people in your family have had uterine, colon, or ovarian cancer, ask about genetic counseling for Lynch syndrome.

And the soul side of this, my genes may carry some history. That doesn't mean I have to carry, you know, the story. Most genes aren't a sentence, they're switches. How you eat, you move, your stress levels, and help decide which genes get flipped on.

And as Yvette Rose teaches in a lot of what we carry in our bodies, sometimes it's handed down. We get to look at it, honor it, and decide what we're gonna keep. This has been a pretty long podcast. I'm Lab Checklist Tracking And Next Steps Sandy Kruse 55:50 going to give you some quick bullet points at the end here.

I'm gonna tell you what to look at when you feel something and talk to your doctor about this. Sore breasts, check estradiol and prolactin. If you're bleeding, check estradiol against progesterone and get it examined with your hormone doctor. Hot flashes, night sweats, bad sleep, estradiol may be too low.

If you're on an oral progesterone, look at your dose and your sleep. No drive, no libido, losing muscle, no matter how hard you train. Check total and free testosterone, SH, BG, and LH. Weight gain around the middle, check fasting insulin, free T3, testosterone and ferritin.

HBA1C is important too. And if it came on fast with bloating, think estrogen and fluid. That's what's happened to me since you know the start of August. Hair shedding, check ferritin and free T3 first.

Exhausted and cold, ferritin, free T3, reverse T3. Suddenly your skin looks older. Think estrogen, collagen, vitamin C. And finally, how to make your blood work work for you.

Test at the same time, the same number of hours after your dose each time. Write down your dose, your ratio, how you took it next to every set of results. I have a spreadsheet for that, as I said. Email me if you're interested.

If I get enough interest, then I'll do something. Sandy at sandyknutrition.ca. I've got an amazing spreadsheet for tracking. Look at relationships, not single numbers.

Estradiol with progesterone, estradiol with FSH and LH, LH with testosterone, SHBG with free testosterone, ferritin with free T3. Ask for the tests that don't come standard. Fasting insulin, free testosterone, SHBG, free T3, reverse T3, and a full iron panel. Change one thing at a time.

Then retest in six to eight weeks. Because if you change everything all at once, you're never going to know what worked, right? Track your numbers over time. Remember, one result is a snapshot.

The trend is your story. And that's how you catch things like testosterone sliding or insulin coming down or going up before anyone else does. And your dose is a conversation with your hormone practitioner. Make sure they're a hormone practitioner, that they are trained and hopefully trained in bioidentical hormones.

But, you know, you should also walk into every conversation knowing exactly what your numbers are saying. So, you know, your body isn't being random. It's answering what you give it. Now you know how to read the answer without paying somebody for a consult, whatever they charge you per hour, probably two, three hundred dollars.

There you go. I just gave it to you for free. So what I'm gonna ask of you is to follow wherever you are listening. Hit follow or subscribe, share this with a friend, rate and review my podcast wherever you are listening.

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