🎙️ 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:⁠⁠⁠⁠⁠⁠⁠

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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

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In this episode, I sit down with Erin Sullivan Wagner for a raw and powerful conversation about something that’s too often ignored—sexual health in the context of cancer. Erin shares her personal experience with anal cancer, and what it was like to navigate the trauma of diagnosis and treatment while also feeling abandoned when it came to intimacy and her sexual well-being.

We talk about the gaps in cancer care, especially when it comes to women. Why is it that sexual health is often dismissed or completely left out of the conversation? Erin and I unpack how deeply cultural biases and medical liability fears impact the way sexual health is (or isn’t) addressed—especially for women.

We also dive into the concept of prehabilitation—starting sexual health conversations before treatment begins—and why it's critical that providers get educated and empowered to offer resources, referrals, and support for their patients. Because survivorship isn’t just about staying alive—it’s about staying connected to your body, your relationships, and your pleasure.

This is the conversation I wish every oncology team would hear.

Cancer profoundly affects sexual health, yet it’s often ignored.

Erin’s story is a powerful reminder of the trauma that comes with being left in the dark.

There’s a huge disconnect in how cancer care approaches female sexuality.

Male sexual health gets prioritized—female sexual health, not so much.

So many patients feel invisible when it comes to intimacy concerns.

These conversations need to happen early, not after damage has been done.

Cultural discomfort and medical fear of liability keep people from addressing sex.

Women are rarely told what to expect sexually after cancer treatment.

Quality of life includes sex, pleasure, and connection.

We have to normalize sexual health in survivorship care.

When we ignore it, the damage can be long-lasting and irreversible.

Emotional intimacy matters as much as physical recovery.

Prehabilitation should be standard practice.

Providers need training—patients need validation and direction.

Advocacy matters. This change starts with conversations like this.

Youtube

https://www.aftercancer.co/

https://allofmeiowa.org/

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

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In this episode, number 322, I sit down with sex therapist Dr. Juliana Hauser for a deeply personal and powerful conversation about her experience with surgical menopause. She opens up about the decision-making process around her hysterectomy—what led her there, what she wishes she'd known beforehand, and how it impacted her physically, emotionally, and sexually.

We discuss the importance of thoroughly understanding your hysterectomy options—not all procedures are the same, and having the right information can make a significant difference. Dr. Hauser shares how guided imagery became a key part of her healing process, and we dive into the complicated (and often frustrating) world of hormone therapy.

She also brings up the role of doulas—not just for birth, but for menopause—highlighting how emotional support can be just as essential as medical care. We explore why open communication in relationships matters so much, especially when it comes to sexual confidence and intimacy post-surgery.

This conversation is raw, real, and full of wisdom for anyone navigating hormonal changes, recovery after hysterectomy, or simply learning to advocate for themselves in a system that doesn’t always listen.

https://dr-juliana.com/

https://flourishwholehealth.com/

⁠⁠⁠⁠⁠Order my book⁠⁠⁠⁠⁠ "You Are Not Broken: Stop "Should-ing" All Over You Sex Life" and ⁠⁠⁠⁠"Menopause Moment: Science, Hormones and Mindset for Optimal Longevity"⁠⁠⁠⁠

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

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Welcome back! In this episode 321, I sit down with the incredible Dr. Tiffany Moon—an anesthesiologist, mom, entrepreneur, and yes, former Real Housewife. We delve into what it truly means to find joy in midlife and how social media often distorts our perception of happiness. Tiffany gets real about the pressure so many professionals—especially women in medicine—feel to "do it all" and how that expectation can lead straight to burnout.

We talk about the addiction to busyness, the cultural layers that shape how we view therapy, and the wild (and often hilarious) intersection of medicine and reality TV. We also touch on AI’s growing presence in healthcare and what it means to redefine professionalism in today’s world.

This one’s about self-trust, self-acceptance, and not waiting to enjoy your life. Dr. Tiffany brings humor, honesty, and a refreshing dose of perspective to a conversation that every working woman—especially in medicine—needs to hear.

Joy Prescriptions by Dr. Moon

Order my book⁠⁠⁠⁠⁠ "You Are Not Broken: Stop "Should-ing" All Over You Sex Life" and ⁠⁠⁠⁠"Menopause Moment: Science, Hormones and Mindset for Optimal Longevity"⁠⁠⁠⁠

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

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In this episode of the You Are Not Broken podcast, I’m diving into the brand-new clinical guidelines for Genitourinary Syndrome of Menopause (GSM)—because you deserve facts, not fear.

We’re breaking down what GSM actually is, why it’s so often overlooked, and how these updated recommendations can help you and your clinician make informed, collaborative decisions about your care. I walk you through the full range of treatment options—yes, including hormones—and explain why vaginal estrogen remains a safe, effective choice, even for breast cancer survivors.

We also talk about:

Why education around hormonal changes in midlife isn’t optional

The role of pelvic exams (and how to make them less intimidating)

Non-hormonal treatments that actually work

Why this all matters: GSM impacts your quality of life, intimacy, and overall health

This episode is your call to action. Use these new guidelines as a springboard for conversations with your healthcare provider—especially if they’re not up to speed. Your body. Your voice. Your choice.

AUA 2025 GSM Guidelines

⁠⁠⁠⁠Order my book⁠⁠⁠⁠ "You Are Not Broken: Stop "Should-ing" All Over You Sex Life" and ⁠⁠⁠"Menopause Moment: Science, Hormones and Mindset for Optimal Longevity"⁠⁠⁠

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

Hey friends!

In this episode, I’m joined by the amazing Dr. Heather Quaile, DNP, as we dive into all things ISSWSH — that's short for the International Society for the Study of Women's Sexual Health (try saying that five times fast). We talk about how this incredible organization has exploded in size and why that matters for women everywhere.

We get into the power of staying curious in sexual medicine, why funding research is still such a grind, and how hormones — yes, especially testosterone — play a huge role in sexual function. Heather and I also share some of our favorite takeaways from recent ISSWSH conferences, like new ways of looking at orgasm and sexual dysfunction that actually make sense.

We don't shy away from the hard stuff either — off-label meds, outdated guidelines, and the frustrating lack of clarity around hormone therapy. But more than anything, this convo is about how we, as healthcare professionals, need to collaborate and push for change that reflects real women’s needs.

If you’re curious about the future of female sexual medicine or just want to hear two clinicians geek out over the latest research, this episode is for you.

Let’s get into it!

www.isswsh.org

https://theshowcenter.com/

Sedona in October - ONE slot left: ⁠⁠⁠https://www.ascendretreats.com/menopause-and-sexual-health-2025⁠⁠⁠

⁠⁠⁠Order my book⁠⁠⁠ "You Are Not Broken: Stop "Should-ing" All Over You Sex Life" and ⁠⁠"Menopause Moment: Science, Hormones and Mindset for Optimal Longevity"⁠⁠

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

This episode is the audio from a lecture I gave to a large group of physicians on how (and why) to prescribe hormones - both systemic and local.

The end of the podcast is a Q&A where I discuss contradictions and myths.

Whether you are a prescriber or just want to go deeper in your knowledge, I hope you enjoy being a fly on the wall for this conversation.

Sedona in October - only two slots left: ⁠⁠https://www.ascendretreats.com/menopause-and-sexual-health-2025⁠⁠

⁠⁠Order my book⁠⁠ "You Are Not Broken: Stop "Should-ing" All Over You Sex Life" and ⁠"Menopause Moment: Science, Hormones and Mindset for Optimal Longevity"⁠

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

This episode is from an interview I did with Dr. Shauna Watts while in Austraila for her podcast, "All About You With Dr. Shauna Watts"

This conversation delves into the complexities of menopause, hormone therapy, and the societal perceptions surrounding them. We discuss the misconceptions about menopause, the evolutionary perspective, and the naturalistic fallacy that often leads women to avoid hormone replacement therapy. We also explore the stigma surrounding men's health issues, particularly testosterone treatment, and the importance of education in making informed choices about hormone therapy. Additionally, the discussion touches on interstitial cystitis, bladder cancer risk factors, and the benefits of rucking for women's health. In this conversation, the speakers delve into the complexities of women's sexual health, focusing on libido, the impact of menopause, and the societal pressures surrounding body image and sexual desire. We discuss the importance of education and resources for understanding sexual health, as well as the challenges faced by women in navigating their sexual experiences. The conversation emphasizes the need for open dialogue about sexual health and the normalization of women's experiences.

https://www.allaboutyoupod.com/

Sedona in October - only two slots left: ⁠https://www.ascendretreats.com/menopause-and-sexual-health-2025⁠

⁠Order my book⁠ "You Are Not Broken: Stop "Should-ing" All Over You Sex Life" and "Menopause Moment: Science, Hormones and Mindset for Optimal Longevity"

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

In this powerful episode, Dr. Kelly Casperson sits down with James Swanwick, alcohol-free advocate and entrepreneur, to unravel the truth about alcohol's impact on our health, relationships, and society. With 15 years of alcohol-free living under his belt, James shares how choosing not to drink isn’t about loss—it's about liberation.

Together, they explore the deeply ingrained cultural narratives that glamorize alcohol and the neuroscience behind why our brains keep reaching for that next drink. From celebrity endorsements to outdated health myths, James and Kelly challenge the illusion that alcohol equals a good life.

This conversation is packed with truth bombs, science, and personal insight into why being alcohol-free can unlock clarity, presence, and purpose—especially for high achievers and anyone craving a more fulfilling life.

What You'll Learn:

Why “alcohol-free” is a powerful choice—not a limitation

How cultural conditioning has normalized drinking from a young age

The truth about alcohol and brain degeneration

The real story behind alcohol and heart health myths

How dopamine drives alcohol cravings

The link between alcohol and dementia, anxiety, and relational breakdowns

Why more high performers are choosing sobriety for clarity and focus

How to confidently navigate social events without alcohol

The role of community in embracing a sober-curious or alcohol-free lifestyle

Why societal change around alcohol is already happening

Key Takeaways:

Alcohol-free is a choice, not a lamentation.

No amount of alcohol is beneficial for your health.

Drinking can disrupt relationships, performance, and mental clarity.

Alcohol is a drug—marketed as a reward but loaded with consequences.

Society is slowly waking up to the truth: we don’t need alcohol to celebrate, connect, or succeed.

Resources & Links:

Learn more about James Swanwick and his alcohol-free programs at jamesswanwick.com

Clear book by James Swanwick

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

Late Breaking news today! Now we have guidelines!

Thanks to Dr. Rachel Rubin for coming on IG to do this live with me!

AUA GSM Guidelines

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