This week I had a wide ranging, super informative, conversation with Dr. Gillian Goddard, endocrinologist and assistant professor at NYU Langone Hospital. With 15 years of clinical experience, Dr. Goddard specializes in thyroid health, PCOS, menopause, nutrition, weight management, and diabetes. This episode dives deep into the complex world of hormones during perimenopause and menopause, going far beyond just estrogen to explore the full endocrine picture.

Let’s start with this quote from Dr. Goddard: “The endocrine system is endlessly complex.” And so no conversation on hormones at perimenopause and menopause is going to be complete in 35 minutes. But I did my best to ask Dr. Goddard the questions I think cover what we experience and have questions about.

The Hidden Hormone Story

• Why estrogen is just one piece of the menopause puzzle
• The role of FSH (follicle stimulating hormone) in symptoms
• How thyroid, cortisol, aldosterone, and parathyroid hormones are affected
• The metabolic hormone connection: insulin, glucagon, and blood sugar regulation

Finding the Right Healthcare Provider

• How to assess your GP's comfort level with menopause
• Questions to ask your doctor to gauge their expertise
• When to seek out a specialist vs. staying with your current provider
• Using The Menopause Society to find certified practitioners

Telehealth and Online Menopause Care

• What to look for in online menopause platforms
• Pros and cons of virtual care vs. traditional practice

GLP-1 Agonists (Ozempic, etc.) in Menopause

• Why these weight loss drugs are actually hormone analogs
• How they might interact with other menopause treatments
• Potential effects on oral hormone absorption
• The complexity of introducing new hormones during perimenopause

Natural Alternatives and Supplements

• Berberine and inositol for insulin sensitivity
• The truth about allulose as a "natural Ozempic"
• Why current natural options pale in comparison to prescription medications

Birth Control Pills During Perimenopause

• How low-dose pills can regulate heavy, irregular periods
• The contraception factor: pregnancy is still possible
• How birth control acts like hormone therapy
• Safety updates from early high-dose formulations

Non-Hormonal Treatment Options

• SSRIs vs. SNRIs for mood and physical symptoms
• Viosa: the current non-hormonal option for hot flashes
• Upcoming Bayer medication targeting mood and sleep
• The expanding pharmaceutical interest in menopause

Individual Variability in Menopause

• Why some women "sail through" while others struggle significantly
• The mystery of symptom variation between women
• Potential connections between childbirth experiences and menopause

• The Menopause Society: For finding certified menopause practitioners
• MIDI: Telehealth platform example (fee-for-service, accepts insurance)