In this episode of SHE MD, Mary Alice Haney and Dr. Thaïs Aliabadi welcome back Dr. Kelly Casperson to discuss perimenopause, menopause, and hormone therapy with clarity and science instead of fear.
Dr. Casperson explains why perimenopause is a clinical diagnosis, not simply a lab result, and why so many women are dismissed as “too young” or “too old” when their symptoms are real. She addresses the biggest myth about hormone replacement therapy and reframes the conversation around individualized, science-backed risk-benefit decisions.
The discussion dives into testosterone for women, including its impact on libido, motivation, muscle mass, and mood, along with the risks of high-dose hormone pellets. They explore progesterone for sleep, the hysterectomy myth, and why vaginal estrogen is one of the safest and most effective treatments for dryness, painful sex, bladder urgency, and recurrent UTIs.
The episode also tackles the midlife brain, brain fog, and how estrogen influences glucose metabolism. From restoring desire in long-term relationships to navigating alcohol, supplements, and exercise, this conversation reinforces one powerful truth: women are not broken. With the right knowledge and support, midlife can be a season of clarity, strength, and transformation.
Subscribe to SHE MD Podcast for expert tips on PCOS, Endometriosis, fertility, and hormonal balance. Share with friends and visit SHE MD website and Ovii for research-backed resources, holistic health strategies, and expert guidance on women’s health and well-being.
Sponsors:
Premier Protein: Find your favorite flavor at PremierProtein.com or at Amazon, Walmart, and other major retailers.
Prolon: Ready for your own reset? For a limited time, Prolon is offering SHE MD listeners15% off site wide plus a $40 bonus gift when you subscribe to their 5-Day Program! Just visit ProlonLife.com/SHEMD to claim your 15% discount and your bonus gift.
Mill: Try Mill risk-free for 90 days and get $75 off at mill.com/SHEMD and use code SHEMD at checkout.
Peloton - Let yourself run, lift, sculpt, push, and go. Explore the new Peloton Cross Training Tread+ at onepeloton.com
Talkiatry: Head to Talkiatry.com/shemd and complete the short assessment to get matched with an in‑network psychiatrist in just a few minutes.
Warby Parker: Warby Parker gives you quality & better-looking prescription eyewear at a fraction of the going price. Our listeners get 15% + Free Shipping when they buy 2 or more pairs of prescription glasses at WarbyParker.com/SHEMD.
What You’ll Learn:
What perimenopause actually is and why labs are not required for diagnosis
The biggest myth about hormone therapy and how fear shaped menopause care
How testosterone supports libido, motivation, and muscle strength in women
Why vaginal estrogen is safe and essential for preventing dryness and UTIs
What happens to the brain in midlife and why brain fog occurs
Key Timestamps:
(01:30) Introduction and why Dr. Casperson wrote The Menopause Moment
(04:10) The biggest myth about hormone therapy and why fear still shapes menopause care
(09:25) Meet the hormones: testosterone, estrogen, and progesterone in midlife
(11:50) Testosterone for women: libido, motivation, muscle, and dosing concerns
(14:45) Hormone pellets explained: side effects, hair loss, and why removal is difficult
(17:15) Progesterone for sleep and the hysterectomy myth clarified
(24:25) Symptoms of too much estrogen
(26:00) “Senile Vagina” - the “use it or lose it” myth
(33:05) Vaginal atrophy, bladder symptoms, UTIs, and why vaginal estrogen matters
(34:00) How to properly apply vaginal estrogen and why cream can be more effective
(41:20) Great sex in midlife: lube and honest communication
(50:30) Responsive vs spontaneous desire and bringing novelty back to long-term relationships
(56:15) The midlife brain: estrogen, glucose metabolism, and brain fog
(01:02:50) Alcohol, supplements, exercise, and non-hormonal tools for cognitive health
(01:05:00) Final advice for women entering midlife and why you are not broken
Key Takeaways:
Hormone therapy decisions should be individualized and based on science, not fear
Perimenopause is common, real, and often underdiagnosed
Testosterone plays a significant role in women’s well-being beyond libido
Vaginal estrogen is one of the safest and most effective preventive treatments in menopause
Midlife can be a powerful reset when women prioritize their health and mindset
Guest Bio:
Dr. Kelly Casperson is a urologist, educator, and top international podcaster whose mission is empowering women to live their best love lives. In her podcast, You Are Not Broken, she combines science, humor, and candor to dismantle the myths women have learned about sex, intimacy, midlife, and hormones.
Dr. Casperson earned her medical degree from the University of Minnesota and completed her surgical training and residency at the University of Colorado. She is a proud member of the American Urological Association, International Society for the Study of Women’s Sexual Health, and the Society of Women in Urology.
See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
SHE MD 
