更年期大师课：激素替代疗法的安全性、贴片吸收、孕酮不耐受与骨密度

即使使用激素替代疗法，症状仍然持续。

Persistent symptoms despite HRT.

你猜怎么着？

Guess what?

你绝对想不到这话会从我嘴里说出来。

Y'all aren't gonna believe this comes out of my mouth.

不是所有问题都是更年期引起的。

Not everything is menopause.

有时候，你的关节炎和更年期根本没关系。

Sometimes you have arthritis unrelated to menopause.

有时候，你身上其他疾病和更年期也完全无关。

Sometimes you will have other disease processes that have nothing to do with menopause.

如果你开始激素治疗，是希望关节痛、焦虑或失眠能改善，但结果没用，那我们还有别的办法。

So if you start hormone therapy in the hopes your arthritis will get better or in the hopes your anxiety or insomnia, you know, or joint pain will get better, and it doesn't, you know, we can do a couple of things.

每次病人来诊所，我对他们的激素水平其实不太在意，除了睾酮。

You know, I am always when my patients come into clinic, I am not so interested in what their actual hormone you know, other than testosterone.

你知道的。

You know?

如果我没法确定她是不是已经完全进入更年期，我们会查激素水平，但更重要的是先排除其他可能的原因。

And if I can't determine if she's fully menopausal or not yet, you know, we'll check hormone levels, but they're not as important as me ruling out other stuff.

要排查甲状腺功能减退，检查自身免疫性甲状腺炎，查看自身免疫指标、炎症标志物，还有关键的营养指标。

Hypothyroidism, looking for autoimmune thyroiditis, looking at autoimmune disease markers, looking at inflammation markers, looking at key nutrition labs.

我们为患者做这些检查，是因为这些情况往往相互关联。

We do all of this for our patients because so much of this is intertwined.

甲状腺功能减退和更年期的很多症状，其实都高度重叠。

A lot of the, you know, in the columns of hypothyroidism and menopause, so many of the symptoms check off the same.

所以我必须排除这些其他疾病，或者确认它们是否存在。

So I need to rule out these other conditions or rule them in.

这些情况完全可能同时发生。

All of this can be happening at the same time.

所以如果你正在接受激素治疗，但某些症状没有改善，我会去查一下相关指标。

So if you are on hormone therapy and certain parts of your presentation are not getting better, I check a level.

你的雌二醇水平现在怎么样？

What is your estradiol level doing?

如果你一直有炎症，我会检查炎症指标。

You know, if you're having persistent inflammation, I'm checking inflammation markers.

我再仔细看看你的甲状腺检查结果。

I'm looking at your thyroid labs again.

我们是不是漏掉了什么？

Like, did we miss something?

然后我们可以增加剂量，看看效果如何，或者寻找其他方法来缓解这些症状和问题。

So then we can go up on the dose and see how you do, or we can start looking for other ways to treat those symptoms and conditions.

这已经是最好的状态了吗？还是需要调整剂量或用药时间，包括睾酮？

Is this the best I it will get, or do I need dose forming timing changes, including testosterone?

我希望每个人都能过上最好的生活，我相信你完全可以做到。

I want everyone to be living their best life, and I really think you can.

我真心觉得，人生的最后四分之一，甚至是最后三分之一，应该是你一生中最精彩的阶段。

I really think the last the last quarter of your life, the last third of your life should be the best in your life.

你最有智慧。

You have the most wisdom.

你理应被最多的爱包围。

You should be surrounded by the most love.

你应该是有史以来最自信的自己。

You should be the most confident that you've ever, ever, ever been.

你知道吗，激素治疗在帮你恢复平衡方面能起很大作用，但它不是万能药。

You know, hormone therapy can go a long way to help restore balance when you've lost it, but it's not a miracle.

你得把自己放在首位。

You have to prioritize yourself.

没人会来救你。

No one is coming to save you.

你得把你自己、你的健康、你的生活、你的精神状态放在第一位。

You have to start putting yourself, your health, your life, your sanity first.

设立界限，让你成年的孩子自己照顾自己，让你的伴侣或身边的人分担家务，现在正是你专注自己的时候。

Putting up boundaries, letting your grown ass children take care of themselves, letting your partners in life or whoever do their share of the domestic labor, like, this is the time for you to focus on you.

我们去回访病人，她进来就说，我现在过得特别好。

So we are checking on our patients, and she comes in, and she's like, I am living my best life.

我感觉棒极了。

I feel absolutely amazing.

今天一点毛病都没有。

I have zero complaints today.

谢谢你帮我找回了韧性，不管你们给我用了什么药。

Thank you for giving me my resilience back, you know, with whatever concoction we gave her.

我不会只凭某个随机的化验指标就改她的剂量。

I'm not changing her dose based on some random ass lab marker.

我们会给她做骨密度检查。

We're gonna get her bone density.

我们会关注一些特定的指标。

We're gonna look for certain things.

但只要她自己说状态很好，所有筛查结果也都正常，我们就继续维持这个剂量。

But like, if she comes in saying she's doing amazing and all of her screening tests look good, we're keeping her on that dose.

所以这个时候，不一定非得调整剂量。

So it doesn't, you know, necessarily require adjustments at that point.

这个效果真是太好了。

Oh, this one's so good.

明白了。

Okay.

接下来要注意的是出血和子宫安全性问题。

Bleeding and uterine safety is the next caveat.

刚开始用雌激素或者调整剂量时，有点滴血正常吗？

Is spotting normal when starting or changing estrogen doses?

正常。

Yes.

好的。

Okay.

大家都过来一下。

Everybody gather around.

开始激素治疗后，有一半的人会出现非预期的阴道出血。

Fifty percent of you will have unscheduled vaginal bleeding when you start hormone therapy.

一半左右，经皮吸收的比口服的更多一些。

Fifty percent, more with transdermal than with oral.

我说清楚一点。

Let me be clear.

有一半的人会出现非预期的阴道出血。

Fifty percent of you will have unscheduled vaginal bleeding.

这很正常，是预期中的反应，不是病理性的。

It is normal, it is expected, and it is not pathologic.

你的子宫刚重新接触激素，容易出现出血，这是正常的反应。

Your uterus is getting used to having hormones thrown at it again, and it tends to bleed.

好消息是，这种情况通常会自己消失，不需要特别治疗。

Now, good news, it usually goes away on its own with no treatment.

你不需要做活检，也不用做其他检查。

You do not need a biopsy or a workup.

如果有临床医生在听，别让这些女性做活检、宫腔镜或者刮宫，至少要等六个月，出血还没停止再说。

And if any clinicians are listening, do not put these women through biopsies and hysteroscopies and DNCs until it's been six months and the bleeding has not resolved.

可以降低雌激素剂量，或者提高孕激素剂量，来控制出血。

You can go lower on the estrogen, go higher on the progestogen to get the bleeding.

只要确认过检查，出血不是来自阴道，而是来自子宫内膜，就可以先观察几个月，调整用药剂量，看看效果。

As long as you've determined you've done an exam and the bleeding is not coming from the vagina, it's coming from the endometrium, you can monitor her for a few months, change the doses around, see.

如果出血持续存在，而且已经做了全面检查，结果都正常，那我们还有其他办法。

Now if the bleeding is persistent and you've done a workup and everything's normal, we have options.

有一种药叫Duavee，或者也叫Duavee。

There is something called Duavee or Duavee.

我都不太确定该怎么念才对。

Don't even know how to pronounce it correctly.

D-U-A-V-E-E。

D U A V E E.

它是结合了结合雌激素和巴多昔芬的复方制剂。

It is a combination of Premarin plus Basadoxifene.

Basadoxifene 这个名字跟他莫昔芬很像。

Basadoxifene is a term similar to tamoxifene.

哦，是他莫昔芬。

Okay, tamoxifen.

但它只在乳腺和子宫组织里结合、阻断并下调雌激素受体。

But it binds, blocks, and down regulates the estrogen receptors only in the breast tissue and the uterus.

所以对于那些持续出血或乳腺癌风险很高的患者，我们通常会选用 Duavee，让它在乳腺里结合、阻断并下调雌激素受体。

So for my patients, our patients who are having persistent bleeding or very high risk for breast cancer, we are usually going with DuoVe for those patients to bind, block, and down regulate the estrogen receptors in the breast.

然后她们就不会出血了。

And then they don't bleed.

就是不会出血。

They just don't bleed.

这算是这种药特别好的一个副作用。

It's a wonderful side effect of that particular formulation.

问题是，现在还没有仿制药。

The problem is there's no generic.

这是一种标准剂量。

It's one standard dose.

不是对所有人都有效，但我希望大家知道，还是有选择的。

It doesn't work for everyone, but I just want everyone to know that there is an option.

阴道给药或其他途径的孕激素在保护子宫内膜方面更好吗？

Are vaginal or alternative progesterone routes better for endometrial protection?

我们其实还不清楚它们在保护子宫内膜方面是否更优。

We don't really know if they're better for endometrial protection.

当我们的患者对孕激素不耐受，出现副作用，比如头晕时。

When our patients are having progesterone intolerance, meaning they're having side effects, they feel dizzy.

我以前做不孕治疗时用过孕酮，手术室里晕得厉害。

I was on quinone for fertility, and I had horrible dizziness in the Operating Room.

那时候我还在当住院医，做各种不孕治疗，用过某种孕激素，整个人都晕乎乎的。

Like, I was a resident doing all these fertility treatments, and I used a certain progestogen, and it it made me loopy.

所以我完全理解。

So I get it.

有些人对孕激素会有不良反应，我们估计大约有百分之十到十五。

Some people have about, we think, ten to fifteen percent will have an adverse reaction to progesterone.

你可以改用阴道给药的孕激素，这样就能避开肝脏的首过效应，药物直接进入血液循环。

So you can go vaginal progesterone and kinda skip that first pass effect in the liver, and it gets absorbed straight into the bloodstream.

你只需把平时吃的那种凝胶胶囊形式的雌二醇片，放进阴道里就行。

You just take the regular oral estradiol pill that has a gel cap, and you can put it in the vagina.

晚上睡觉时放进去，它会整晚慢慢溶解。

Like, when you go to bed, it will dissolve overnight.

这样就能通过阴道吸收所需的孕激素了。

You'll be able to absorb your progesterone that way.

很多患者用这种方法效果非常好。

Some patients do really, really well with that.

这确实是一个可行的选择。

So that is an option.

但目前还没有人系统比较过口服和阴道给药在子宫内膜保护方面的效果。

But no one has measured, like, oral versus a vaginal approach for endometrial protection.

常识告诉你，这种方式能直接作用于子宫。

Common sense will tell you it's getting right to the uterus immediately.

所以我们都不犹豫，直接用它来保护子宫内膜。

So none of us hesitate to use it and worry about endometrial protection.

我从来没遇到过用这种方法的患者出现子宫内膜增生。

I've never had a patient who did it that way who had any endometrial hyperplasia.

如果孕激素引起胃酸倒流、情绪波动或耐受不良，该怎么办？

What do I do if progesterone causes reflux, mood changes, or poor tolerance?

你对孕激素不耐受。

You don't tolerate progesterone.

找其他替代方案。

Look for alternatives.

杜阿维是其中一个选择。

Duavy is an option.

换成孕激素类药物，比如联合贴片。

Switching to a progestogen, something like combi patch.

我用过康比贴片好几年。

I was on Combi Patch for a couple of years.

这药并不差。

It's not a bad medication.

你可以考虑使用其他孕激素替代方案。

Using one of the progesterone alternatives may be an option for you.

或者选择曼月乐或洛雷塔这类含孕激素的宫内节育器，也是个不错的选择。

Or doing a Mirena IUD or a Loleta, you know, one of the progestin containing IUDs could be a great option for you.

乳膏、阴道栓剂或其他给药方式有效又安全吗？

Are creams, pessaries, or other delivery methods effective and safe?

听我说。

Listen.

你真正想问的是，定制配方的产品和经FDA批准的药品一样安全吗？

So think what you're really asking, are compounded options as safe as FDA approved option?

我们已经有经FDA批准的乳膏、阴道环和栓剂了。

Because we have creams, we have the rings or pessaries all available in FDA approved options.

这些都经过了测试，我可以很有把握地告诉你，它们都经过了临床试验，我们很清楚它们的安全性和有效性。

Those have been tested, and I can tell you with confidence that they ran those through clinical trials, and we know the safety efficacy of those types.

但如果你现在从配药房拿药，我也会用复方制剂。

But if you're getting them from a compounder now I use compounding.

我觉得在很多情况下，复方制剂都是个不错的选择。

I think it's a great option to have for a lot of things.

不过，我首选的激素替代疗法还是像在CVS药店就能买到的那些FDA批准的产品。

But my go to for HRT is the FDA approved options that you would pick up at CVS.

什么时候该加用睾酮？

When should testosterone be added?

这是个好问题。

Oh, good question.

没错。

Okay.

如果你有性欲减退症，我一定会跟你好好聊聊睾酮的事。

Definitely, if you have hypoactive sexual desire disorder, I'm gonna have a conversation with you about testosterone.

那是什么？

What is that?

HSDD只是对那个长名字的简单说法。

HSDD is just the easier way to say that big long thing.

指的是性欲低下，让你感到困扰。

Hypoactive, low activity of your sexual desire that causes distress.

我们都需要接受，有些女性就是再也不想有性生活了。

You need to we, we, me, we all need to normalize when women don't ever wanna have sex again.

这没什么问题。

That's okay.

这完全由你自己决定。

That is totally up to you.

只有当它让你感到痛苦时，才叫HSDD。

HSDD is when it causes you distress.

你以前有这种欲望，现在却怀念它。

You had it, you miss it.

如果你再也不在乎要不要再发生性关系，这完全没问题。

If you don't ever care if you have sex again, that's okay.

这真的完全没问题。

That is totally okay.

我说的不是这个意思。

That is not what I'm talking about here.

我们并不是想让你突然就恢复性欲。

We're not trying to magically induce a libido in you.

明白吗？

Okay?

你没有任何义务要和任何人发生性关系。

You don't owe sex to anybody.

从来没有人因为没发生性关系或没达到高潮而死去。

No one ever died because they didn't have sex or didn't have an orgasm.

确实如此。

Truth.

我直接引用蕾切尔·鲁宾的话。

And I direct quote from Rachel Rubin.

你去看看我和她做的那期播客吧，她特别棒，真的是顶尖的。

You should go watch that podcast that I did with her because she's fantastic, and she's the best.

她明确说过，没人会因为没高潮或者没性生活就死掉。

But she says clearly, no one ever died because they didn't have an orgasm or they didn't have sex.

你不会死的。

You won't die.

如果你根本不想有这方面的欲望，那也没关系。

And if you don't want to want, that is okay.

但如果你希望自己能有欲望，怀念那种亲密感，怀念所有曾经拥有的感受，我们也有办法帮你。

However, if you want to want, you miss it, you miss the intimacy, you miss whatever, you miss just all the things, we have options for you.

我们有睾酮疗法，对大多数患者都挺有效，耐受性也很好，不需要用到那种让身体变成男性的高剂量。

We have testosterone, which works pretty well in most patients, is very well tolerated, and doesn't require super physiologic doses like turning you into male giving you male doses to work.

还有一些个案经验。

There is anecdotal evidence.

我们有很多证据表明，如果你在锻炼，睾酮能帮你保持骨骼和肌肉的力量。

We have lots of evidence that suggests probably gonna help you if you're working out, gonna help you maintain your bone and muscle strength.

我们的大脑里也有睾酮受体。

There are testosterone receptors in our brain.

所有针对男性的研究都显示，心理健康和睾酮水平密切相关，整体健康、幸福感和生活质量也都和睾酮有关。

We know, like all the studies that were done in men, that mental health and testosterone are related, that overall general health, well-being, quality of life, and testosterone are related.

我们身体里的睾酮自然含量其实比雌激素还高。

We have more testosterone naturally in our bodies than we do estrogen.

听清楚了，女士们。

Be clear, ladies.

明白吗？

Okay?

我们的量当然没男人那么多。

We don't have as much as men.

大概只有男性的十分之一，但在健康年龄段，包括绝经后，我们的睾酮水平还是高于雌二醇的。

We have about a tenth of what men have, but it is still in our healthy years, postmenopausal, more than the estradiol we have.

所以我的很多患者都希望试试睾酮治疗，这很合理。

So it makes sense that so most of my patients wanna go ahead and give testosterone a try.

说明一下，目前有两款获FDA批准用于提升性欲的药物。

To be clear, there are two FDA approved medications for libido.

明白吗？

Okay?

一款叫Addyi，另一款叫Vyleesi。

One is Addy, and the other is Vyleesi.

Addyi是一种每天服用的药片。

ADDIE is a pill you take every day.

它通过促进多巴胺分泌来起作用。

It works to stimulate dopamine production.

多巴胺让人感到快乐，激发人去做让自己开心的事，对一些患者效果非常好。

Dopamine makes us happy, makes us want to do things that make us happy, and for some patient works very, very well.

但它也会让人稍微有点犯困。

It also makes you a little bit sleepy.

所以它对助眠很有帮助。

So it's great for sleeping.

你最好在睡觉前服用。

You wanna take it before you go to bed.

Vyleesi 是一种注射剂，能让你体内大量释放黑色素细胞刺激素，从而刺激多巴胺分泌。

Vyleesi is an injection that you have this massive release of melanocortin, which stimulates dopamine.

你得在活动开始前大约四十五分钟打这一针。

You wanna do that injection, I think it's forty five minutes before the onset of activity.

我的患者不太喜欢这个，主要是因为打完针后，另一边的人就像螳螂一样，盯着等药效发作。

Less popular with my patients, mostly because there seems to be a praying mantis situation on the other side of that injection waiting for it to kick in.

有效果了吗？

Like, is it working?

有效果了吗？

Is it working?

有效果了吗？

Is it working?

但归根结底，亲密就是亲密。

But again, intimacy is intimacy.

哪种方式对你有效就用哪种。

Whatever works for you.

我很高兴我们能为患者提供多种选择。

I'm so glad that we have options for our patients.

所以我们会在这个时候和患者讨论睾酮的问题。

So that is when we discuss testosterone with our patients.

睾酮能单独使用吗？特别是对乳腺癌患者或正在服用选择性雌激素受体调节剂的女性？

Can testosterone be used alone, especially in women with breast cancer or on SERMs?

当然可以，完全没问题。

Yeah, 100%, absolutely.

有哪些证据支持它的益处和风险？

What benefits and risks are supported by evidence?

对于绝经期患者来说，证据是非常明确的。

Definitely in a menopausal patient, the evidence is absolutely clear.

最大的风险似乎是不该长毛的地方长了毛，而太阳穴这些该有毛的地方却掉光了，就像男性型脱发那样。

The biggest risks seem to be hair growth where you don't want it and hair loss where you do want it here in the temple areas, like male pattern baldness.

如果剂量特别高，可能会出现阴蒂肥大、声音变低沉，而且这些变化是不可逆的。

When really high doses, you can have things like clitoral megaly and enlarged clitoris or deepening of the voice that is nonreversible.

所以如果你靠声音吃饭，比如是配音演员、歌手，或者在合唱团唱歌，更年期本身就会改变声带。

So those of you who rely on your voice, if you're a voice actor, if you are a singer, if you sing in choir, menopause already changes the vocal cords.

如果你的睾酮水平过高，声带区域可能发生肥厚，导致声音变得你自己都不喜欢，而且这种变化是不可逆的。

And then if you do end up running high on your testosterone level, you could have some hypertrophy in the area and change your voice into something that you may not like, and it is not considered to be reversible.

本集《UNPAUSED》由Alloy Health赞助播出。

This episode of UNPAUSED is brought to you by Alloy Health.

我们经常聊激素如何影响情绪和精力，但它们对皮肤的影响同样重大。

We talk a lot about hormones affecting mood and energy, but they also play a major role in your skin.

胶原蛋白、水分、弹性，这些都很关键。

Collagen, hydration, elasticity.

到了中年，激素水平开始变化，皮肤也会跟着改变。

And in midlife, when hormone levels start to shift, your skin changes too.

我最早是通过一位当皮肤科医生的密友听说Alloy的。

I first heard about Alloy through a close friend who is a dermatologist.

她告诉我，真正能应对荷尔蒙引起的皮肤变化的产品少之又少。

She shared how few products truly address hormonal skin changes.

当我了解到Alloy的方案是基于荷尔蒙科学和生理学原理时，我就决定亲自试试。

Once I understood that Alloy's approach is rooted in hormone science and physiology, I decided to try it myself.

它彻底改变了我对这个年龄段护肤方式的看法。

It changed the way I think about how skincare is at this stage of life.

Alloy的M4系列包括M4面霜、M4精华液和M4眼霜。

Alloy's M4 line includes the M4 face cream, M4 face serum, and M4 eye cream.

这些是处方级配方，含有雌三醇——这是身体会自然停止产生的黄金标准荷尔蒙，并且有临床研究支持。

These are prescription strength formulas made with estriol, the gold standard hormone your body stops producing naturally, and they are backed by clinical research.

女性们希望皮肤更光滑、更有紧致感，肤色也更明亮均匀。

Women are seeking smoother looking skin, improved firmness, and a brighter, more even tone.

如果皮肤在变化，你的护肤方式也该跟着调整了。

If your skin is changing, your skin care should change too.

使用Alloy，你可以在线问诊医生，获得专业指导，产品还会直接送到你家。

With Alloy, you consult with a doctor and receive expert guidance and have your treatment delivered right to your door.

去myalloy.com，使用优惠码MCH20，首单立减20美元。

Head to myalloi.com and use code MCH20, that's MCH20, to get $20 off your first order.

以前我觉得打扮得好看，就是化妆要堆得越多越好。

I used to think looking good meant doing the most when it came to makeup.

层层叠加，步骤繁多，产品用了一大堆。

More layers, more steps, way too many products.

可结果还是不像我自己。

And somehow, it still didn't look like me.

这当然不像你了。

Well, of course it didn't.

我一直在遮盖皮肤，而不是让皮肤自然呈现真实的自己。

I was covering up my skin instead of actually letting it look like me.

正因如此，Jones Road Beauty对我而言简直是颠覆性的改变，尤其是那些赶时间出门、却还想看起来精神一点的早晨。

And that's exactly why Jones Road Beauty has been such a game changer for me, especially on those mornings when I'm running out the door, but still want to feel a little more put together.

我就是随手拿一下奇迹膏，就这么简单。

I just grab the miracle balm and that's it.

几秒钟就能打造出自然的光泽感。

It gives me that effortless glow in seconds.

我之所以这么喜欢，是因为这个：

And here's why I love it.

它把所有步骤都简化了。

It simplifies everything.

腮红，搞定。

Blush, check.

修容，搞定。

Bronzer, check.

高光，没问题。

Highlight, yep.

抹一点在嘴唇上也行。

Even a little on your lips.

这等于把整个护肤化妆流程都浓缩成一步了。

It's basically your entire routine in one step.

不用纠结，也不费时间，就是让我做回自己。

No overthinking, no extra time, just me feeling like myself.

如果你想要更浓一点的遮盖效果，可以试试他们新出的粉底棒。

And if you want a little more coverage, try their new foundation stick.

质地轻盈，可叠加，能打造出顺滑自然的妆感，完全不会显厚重。

It's lightweight, buildable, and gives you that smooth, natural finish without ever looking cakey.

现代妆容就该这么干净、有策略、多功能，让日常打扮轻松无负担。

Modern day makeup that's clean, strategic, and multifunctional for effortless routines.

限时优惠，听众首次购买时，结账时输入代码 UNPAUSED，就能免费获得一份赠品。

For a limited time, our listeners are getting a free gift on their first purchase when they use the code UNPAUSED at checkout.

去 jonesroadbeauty.com 下单，结账时记得输入 UNPAUSED 这个代码。

Just head to jonesroadbeauty.com and use the code UNPAUSED at checkout.

买完之后，他们会问你是从哪儿了解到他们的。

After you purchase, they will ask you where you heard about them.

请支持我们的节目，告诉他们你是从我们这儿听说的。

Please support our show and tell them our show sent you.

如果我不能举重，或者刚做完子宫切除手术，该怎么保护骨骼呢？

How can I protect bone if I can't lift or if I'm early post hysterectomy?

所以我采访了一位医生。

So I interviewed Doctor.

她是乔塞琳·维特斯坦，在我们的播客里。

Jocelyn Wittstein stein here on the podcast.

她是一位骨科医生，也是我们所知的第一位发现肩周炎与更年期、肩周炎与乳腺癌治疗之间关联并发表论文的临床专家。

She's an orthopedic surgeon, and she basically is the first clinician that we know of that made the connection and wrote the papers between frozen shoulder and menopause, and frozen shoulder and breast cancer treatment.

她是我心目中的英雄。

She is my hero.

她在自己的平台上做了大量关于骨质疏松预防的科普，特别是针对那些不能负重、不能跳跃的人。

She does a ton of education on her page about osteoporosis prevention, including for those of you who can't do heavy lifting, who can't jump.

她提供了很多替代方案。

She has lots and lots of alternatives.

她还写了一本《全身骨骼与关节养护计划》，我们会在节目笔记里放上链接，里面包含食谱、锻炼方法，还有她亲自示范这些动作的图片。

And she wrote the and we'll put it in the show notes, the Total Body Bone and Joint Plan, and they have recipes, exercises, pictures of her doing all these different exercises.

所以我建议你们关注她，去她的Instagram上看看。

So I would invest in her, following her on Instagram.

她是一位真正的医生，持有正规认证。

She is also a real doctor, board certified.

她有三四个专业认证，真是厉害。

She has like three or four certifications, and gah.

她是经过认证的骨科外科医生，专长运动医学，还接受过多项专科培训。

She's a board certified orthopedic surgeon and sports medicine and fellowships.

可以说，在女性健康、运动医学、骨科损伤，尤其是冻结肩和骨骼强健方面，她是全球最受尊敬的临床专家之一。

And I mean, she's like one of the most highly regarded clinicians on the planet when it comes to women's health, sports medicine, orthopedic injuries, etcetera, and frozen shoulder, and how to keep your bones strong.

为什么有些女性在使用激素替代疗法后会出现高血压、腹胀或体重增加？

Why do some women develop high blood pressure, bloating, or weight gain on HRT?

这是个非常好的问题。

Great question.

高血压通常和口服雌二醇关系更大，而不是经皮贴剂。

So hypertension is usually more related to oral estradiol than transdermal.

如果你正在服用口服药并出现了高血压，可以考虑换用非口服形式，看看血压会不会改善。

So if you're on oral and you've developed high blood pressure, you would want to ask to be switched to a non oral form to see if your hypertension resolves.

进入更年期后，你的肠道菌群会发生变化。

Your gut microbiome changes when you go through menopause.

明白吗？

Okay?

更年期期间，体内的炎症水平也会升高。

Your inflammation levels increase when you go through menopause.

幸运的是，激素替代疗法中的睾酮是一种同化类固醇。

Fortunately, the weight gain on HRT testosterone's an anabolic steroid.

只要是同化类的物质，都可能导致体重增加。

So anything anabolic can make you gain weight.

你的骨头在长吗？

Are your bones growing?

你的肌肉在增长吗？

Are your muscles growing?

这是体重增加。

That's weight gain.

这是体重增加。

That's weight gain.

你是不是因为肠胃里积了太多气体、空气或者液体而胀气？

Are you bloated because you have tons of gas, air, liquid, I mean, in your in your gut?

这会让你看起来腹部隆起，而且特别不舒服。

That could make you look distended and very, very unhappy.

刚开始接受激素治疗时，尤其是口服药物，你的肠胃需要适应一段时间。

When you're first starting on hormone therapy, your gut, especially if you're doing oral, your gut is gonna have to adjust.

这可能会引起胀气或不适，但通常只是暂时的，过一段时间就会缓解。

And that may cause some bloating, some discomfort, but it's usually self limited and goes away over time.

睡眠呼吸暂停、胰岛素抵抗或炎症有影响吗？

Does sleep apnea, insulin resistance, or inflammation play a role?

更年期的时候，腹部脂肪确实会明显增加。

In menopause, abs, fucking lutely yes.

女性在更年期后，睡眠呼吸暂停的发生率会大幅上升。

Women see a dramatic increase in sleep apnea.

我曾经请到一位非常出色的医生。

And I had the incredible Doctor.

安德莉亚·马图苏拉医生来做过播客，她是睡眠医学专家，详细讲过这些内容。

Andrea Matsumura on the podcast who is a sleep medicine specialist, and she goes into detail about all of this.

真的非常值得你听一听。

It is so worth your listen.

因为我学到了一点重要的事。

Because here's what I learned.

女性的睡眠呼吸暂停问题被严重低估了。

Sleep apnea is massively underdiagnosed in women.

因为女性打鼾没男性那么明显，所以容易被忽略。

We don't snore as much as men, so it's not recognized.

但女性会出现缺氧。

But women are hypoxic.

我们之所以能发现这个问题，是因为很多人戴了各种类型的穿戴设备，都在监测血氧饱和度。

And one of the ways we are picking it up is that so many of us are wearing trackers of different types that are tracking our oxygen saturation.

如果你在睡觉时血氧水平持续偏低，半夜醒来，血糖正常，也不是潮热，那就要警惕了，这很可能是睡眠呼吸暂停，女性中这种病非常普遍，但常常被忽略，长期下去会对健康造成严重影响。

So if you're getting a pattern of low oxygen levels while you sleep, and if you're waking up from sleep, you know, in the middle of the night, and your blood sugar is fine, you're not having a hot flash, this is consistent, you deserve to be evaluated for sleep apnea because it is so common in women, and we are missing it, and they are suffering long term because of it.

为什么用了阴道雌激素，尿急和漏尿还是持续存在？

Why do urgency and leaks persist despite vaginal estrogen?

这是个好问题。

Great question.

那我们为什么会漏尿呢？

So why do we leak?

为什么会尿失禁呢？

Why do we leak urine?

这确实是个好问题。

That's a great question.

所以我跟病人解释，这跟解剖结构有关，就是身体的构造问题。

So I explain it to patients that there's anatomic reasons, meaning the anatomy.

我们有个膀胱。

So we have our bladder.

如果你在视频里看着我，我用手比划一下，这儿是膀胱，然后连着一根尿道，像根小管子伸出来，对吧？

So if you're watching me on video, I'm trying to my hand out here is a bladder, and then we have a urethra with a little tube that comes out, right?

然后就是这样。

And then like that.

年轻健康的时候，尿道下面有一层支撑组织。

And so when we're young and healthy, we have a sling that goes under the urethra.

把膀胱里的尿排出去的那根管子，叫尿道。

The tube that drains the bladder is called the urethra.

那层支撑组织会在你咳嗽、大笑、打喷嚏或者跳跃时，把尿道稳稳托住，明白吗？

There's a sling there that when we cough and laugh and sneeze and jump, the sling holds that urethra in place, okay?

但生完孩子、有产伤，或者年纪大了，要是经常咳嗽、胶原蛋白差、营养不良、体重超标，那层支撑就会松垮。

But after we have babies and we have obstetric injury and we get older, if you cough a lot, if you have poor collagen, if you're malnourished, if you're obese, that sling goes out.

明白吗？

Okay?

你就会逐渐失去这个支撑。

You start losing that sling.

一旦盆底受到压力——比如跳跃、大笑、咳嗽或打喷嚏，这个支撑失效，尿就会漏出来。

And then your ability to hold onto urine when you're stressed, when you physically go through a stress in the pelvic floor, like jumping, laughing, coughing, sneezing, that sling fails and you leak.

这叫做压力性尿失禁。

That is called stress incontinence.

还有一种叫急迫性尿失禁。

Now we have something called urge incontinence.

虽然表现一样，都是漏尿，但原因完全不同。

It's very different with the same outcome, you leak.

这是膀胱不自主地抽搐，膀胱壁全是肌肉，突然就一阵痉挛。

So it is an involuntary spasm of the bladder, meaning the bladder wall is full of muscle and it just starts spasming.

这到底是为什么呢？

Why does that happen?

这可能是由炎症引起的。

It can be because of inflammation.

也可能是随着年龄增长出现的。

It could be because of aging.

也可能是神经系统传给膀胱的信号出了问题。

It could be because of signaling, bad signaling coming, you know, to the bladder itself from our nervous system.

尿急性失禁有时会有诱因，比如你拿钥匙开门，膀胱就突然抽搐了。

So urge incontinence, sometimes there's a trigger and you can, like, put a key in the lock and it triggers your bladder to spasm.

你一下子就觉得急着要上厕所。

You all of a sudden feel like you have to go.

赶紧往厕所跑，结果半路上就漏了，或者根本来不及。

And you start running to the bathroom and you leak usually on the way or you just can't make it.

每个人偶尔都会这样，可惜啊。

Now everybody does that from time to time, unfortunately.

但对有些人来说，这就成了一种常态。

But for others, it's just a pattern.

幸运的是，这种急迫性尿失禁可以通过药物来治疗。

And so fortunately, this is treated, this urge incontinence is treated with medication.

它作用于副交感神经，帮助放松膀胱壁。

It's a parasympathetic action and it calms the bladder wall.

常用的药物之一是奥昔布宁，或者它的长效制剂。

Side effects oxybutynin is usually one of the meds that we use or one of the long acting forms.

可能会引起口干、眼干这些副作用。

And it can cause dry mouth, dry eyes.

所以，具体怎么治，还得跟医生仔细聊聊。

So again, nuanced conversation with your doctor on how to treat that.

如果是更年期相关的泌尿综合征，雌激素水平正常时，泌尿系统功能通常会更好。

So if it's just GSM, so general urinary syndrome of menopause, everything kind of acts better, acts more healthy in the presence of estrogen.

我们一般先给身体补充一点雌激素，看看症状有没有改善。

So the first thing we usually do is give your general urinary system estrogen back and then see how the symptoms are.

如果还是没好，那就得进一步检查是不是压力性尿失禁了。

And if they persist, then we need further evaluation for stress incontinence.

那该怎么治疗呢？

How do we treat that?

通常是手术解决。

Generally surgical.

明白吗？

Okay?

就是通过手术把吊带重新提上去。

Some surgical way to lift that sling back up.

也可以用子宫托，或者其他一些方法。

There's also pessaries and some other things we can do.

但如果你身体好、年纪轻，能承受手术，修复吊带的手术创伤很小。

But if you're healthy and young and can tolerate surgery, it's a very minimally invasive procedure to have that sling repaired.

大多数患者术后恢复得都非常好。

And most patients do really, really well with it.

这类手术通常由泌尿妇科医生或专攻女性解剖的泌尿科医生来做。

That's typically done by a urogynecologist or a urologist with special training in female anatomy.

但你不该漏尿。

But you should not be leaking.

成年人根本不需要用纸尿裤。

We should see no diapers for adults.

真的不该这样。

We shouldn't.

每次看到纸尿裤货架，我都很难过，因为我得给妈妈买。

That makes me sad every time I see the diaper aisle, because I to buy them for my mother.

我们怎么会允许这种情况发生？

How do we let this happen?

我们为什么要这样对待女性？

Why are we doing this to women?

你想想，女性尿失禁的比例远高于男性，真的让人心酸。

You know, when you look at the percentage of women that end up being incontinent versus men, it's really sad.

男性也会有尿失禁的问题。

Men get incontinence too.

但每当我看到性别之间的差异，我就感到难过，忍不住想为什么会有这样的情形。

But, you know, when I see sex based differences, it just makes me sad and wonder why.

我们怎么能让这种情况继续下去？

Why are we allowing this to happen?

除了荷尔蒙治疗，还有什么其他办法能帮上忙？

What else can help beyond hormones?

盆底肌物理治疗。

Pelvic floor physical therapy.

盆底肌物理治疗真的能改变人生。

Pelvic floor physical therapy can change your life.

我觉得每个生过孩子的女性都应该接受这项治疗。

I think it should be mandatory for every single woman who has a baby.

想想看，怀孕后期肚子里揣着个大西瓜，还得靠盆底肌把它生出来，这得多大压力。

Think about the stress we're putting on our pelvic floor, carrying a giant watermelon around at the end of pregnancy, and then pushing such watermelon out of our pelvic floor.

我们身体里那些组织都被拉伤、撕裂、磨损了，可它们并不一定能自己恢复。

We are ripping and herring and shredding things that don't necessarily bounce back.

我认为，任何涉及生殖器官的手术——无论是子宫切除术，还是其他任何相关操作，尤其是生完孩子之后，哪怕是剖腹产——都应该常规评估盆底功能。

And everyone should be evaluated, I think, for pelvic floor PT as a normal routine part of any any genital surgery, any any hysterectomy, anytime we're jacking with anything down there, especially after having a baby, even a C section.

你有权利接受盆底评估和科学管理，这样才能过上真正高质量的生活。

You deserve to have your pelvic floor evaluated and managed so that you can live your best life.

哪些补充剂？

Which supplements?

来了。

Here we go.

好的。

Okay.

我得先说明一下，医生。

Full disclosure, Doctor.

哈弗有自己的保健品公司。

Haver has supplement company.

所以我说的每一句话，你都得留个心眼，你完全没必要从我这儿买，我提供的建议都是通用性的。

So take everything I say with a grain of salt, know that you do not have to buy from me, and that the advice I give you is generic.

我就不告诉你我卖哪些补品了。

I'm not even gonna tell you what supplements I sell.

明白吗？

Okay?

你得自己去网站上查。

You have to go to the website and look it up.

她列了Omega、镁、胶原蛋白、辅酶Q10、NAD这些等等。

She lists omega, magnesium, collagen, CoQ10, NAD, etcetera.

好吧。

Okay.

真希望没人需要吃补品。

I wish that no one needed a supplement.

真希望你们天天吃天然全食物，让我这生意直接黄了。

I wish you could put me out of business by just eating whole world foods all the time.

可惜啊，现在大多数人的生活方式就是这样。

Unfortunately, most people, it's just the way we live.

我们这儿有食物荒漠。

We have food deserts.

不是想吃啥就能吃到啥。

It's not always available.

光靠饮食很难满足所有的营养需求。

It's hard to meet all of those nutritional checkboxes with your diet alone.

这时候补充剂就该派上用场了。

And that's where supplements should come in.

补充剂应该是对健康饮食的补充，而不是替代。

Supplements should supplement a healthy diet.

话虽如此，我们在诊所里看到的是什么情况呢？

Now that being said, what do we see in our clinics?

我们只接诊更年期患者。

We only take care of menopause patients.

大多数女性，因为年龄增长，更年期后肠道菌群变化，再加上为了防皮肤癌，我们又特别注意防晒。

Most women, due to the aging process, due to the microbiome changing across menopause, due to the way we are protecting, rightly so our skin against the sun so we don't get skin cancer.

如果你还不相信晒太阳会导致皮肤癌，那你听错节目了。

If you don't believe sun causes skin cancer, you are listening to the wrong podcast.

你该换个频道了。

You need to move on.

我们普遍缺乏维生素D。

We are deficient in vitamin D.

我们对患者做血液检测时发现，百分之八十的人不仅偏低，简直是严重缺乏维生素D。

Eighty percent of my patients when we surveyed the labs are not just low, deficient in vitamin D.

缺乏维生素D，意思是你的摄入量连身体基本功能都维持不了。

A deficiency means that you are not getting enough vitamin D to reach the basic minimum processes.

明白吗？

Okay?

这跟理想水平是两回事。

That's different than optimal.

理想水平，是指你摄入的量足够让身体所有系统都运转在最佳状态。

Optimal means you're getting enough for everything to be working at an optimal level.

从严重缺乏到达到理想水平，中间差距很大。

There's a big gap between I am horribly deficient and I am at an optimal level.

所以你得知道自己的维生素D水平是多少。

So you should know what your vitamin D level is.

在我们诊所，我们尽量让患者的维生素D水平保持在60到100之间。

In our clinic, we try to make sure that our patients are reaching a level of 60 to about a 100.

明白吗？

Okay?

缺乏的起点是30。

Deficiency starts at 30.

我们实验室认定缺乏的临界值是30。

The cutoff for deficiency in our labs is 30.

但光是刚过线还不够。

But that's not enough.

我们不希望你只是勉强超过那个标准。

We don't want you to just be barely over the line.

我们希望你的维生素D水平达到最佳状态。

We want you to be at an optimal level.

所以我们的每位患者都会检查维生素D水平。

So all of our patients, we are checking a vitamin D level.

如果水平偏低，有时我们会开大剂量处方，每天五万国际单位。

If it is low, sometimes we have to give them a prescription amount, which is fifty thousand IUs per day.

先用这个剂量快速补充，之后建议每天补充两千到四千国际单位。

We'll do that as a loading dose, and then we're recommending somewhere between two thousand and four thousand IU per day.

你要是听过丽莎·莫斯康的播客，就是我们之前做的那期关于大脑健康的，跟医生聊过之后就会明白。

When you talk to Lisa Moscone, another fantastic podcast that we did, and brain health, when you talk to Doctor.

路易莎·尼古拉这两位大脑健康专家，对欧米伽-3脂肪酸都有很多见解。

Luisa Nicola, the two brain health specialists all have tremendous amount of things to say about omega-three fatty acids.

明白吗？

Okay?

如果能从饮食中摄取，那就再好不过了。

If you can get them in your diet, great.

挺难做到的。

Hard to do.

挺难做到的。

Hard to do.

所以你可以考虑每天补充大约两千毫克的欧米伽-3脂肪酸，包括DHA和EPA。

So you may wanna consider supplementing somewhere around two thousand milligrams of omega three fatty acids, which includes DHA and EPA.

明白吗？

Okay?

如果你是素食者或纯素食者，那就更难一些了。

If you are a vegan or vegetarian, that's gonna be a little tougher to do.

你得加大剂量，因为需要选择藻类来源的。

You're gonna have to go higher on that level because you're gonna have to get, like, an algae based.

Nordic Naturals品牌出的这款产品，特别适合素食者和纯素食者补充欧米伽-3脂肪酸。

Nordic Naturals makes a really nice one for a vegan or vegetarian form of that omega three fatty acid.

幸运的是，这种脂肪酸在富含油脂的鱼类中含量很高。

Fortunately, it's found in large amounts in fatty fish.

对于我们的患者，我们通常建议把维生素D、欧米伽-3脂肪酸搭配起来，再加一点维生素K，帮助提高吸收效果。

So for our patients, we usually recommend a combo of vitamin D with omega-three fatty acids and throw in some vitamin K in there for increased absorption.

这样一次就能把这几个关键营养素都补到位了。

And it's a real tidy way to kind of hit those nutrients at once.

你必须清楚知道自己每天到底吃了多少纤维。

You should know beyond the shadow of a doubt how much fiber you are getting per day.

实话跟你说吧。

And here's the truth.

大多数女性每天只摄入十到十二毫克的纤维，但你至少需要二十五毫克。

Most women are getting ten to twelve milligrams of fiber in their diet per day, and you need minimum of 25.

为了心脏健康，女性最好能达到三十五毫克。

Optimal for heart health is 35 for women.

所以我建议你一天之内把纤维摄入量增加三倍？

So am suggesting you triple your fiber intake in one day?

绝对不建议这样。

Absolutely not.

你的肠胃会受不了，会胀气，还会讨厌我，甚至说我的坏话。

Your gut will not be happy, you will be bloated, and you'll hate me, and you'll say mean things about me.

明白吗？

Okay?

这事儿得慢慢来，一点一点加进去。

This is something you need to slowly introduce over time.

饮食中纤维来源越丰富越好，比如坚果、种子、豆类、蔬菜、水果，还有全谷物。

The more variety of sources of fiber that you get in your diet, and that is things like nuts, seeds, legumes, vegetables, fruits, whole food.

如果你能从食物里每天摄取三十五克纤维，那最好不过了——我就特别爱吃牛油果，每天一个，能帮我补不少纤维。

If you can get thirty five grams a day from your food, avocado, I'm like an avocado a day ish girl, and that helps me get a ton of fiber in my diet.

太棒了。

Amazing.

就这么办吧。

Go for it.

实在做不到的话，吃点纤维补充剂也完全没问题。

If you can't, supplementing with fiber, it's basically harmless.

这对你不会造成伤害。

It's not gonna hurt you.

通常价格还挺便宜的。

It's usually pretty cheap.

选一种以车前子壳为基础、最好还添加了其他营养成分的产品，是个不错的选择，我自己也在补纤维。

Using something with a base of psyllium husk, hopefully, with some other nutrients added to it would be a reasonable thing to do, and I supplement my own fiber.

我每天大概吃八克的补充剂。

I use about an eight gram supplement on a daily basis.

我觉得肌酸这东西挺值得考虑的。

I think creatine is something.

我们虽然不常规检测人体内的肌酸水平，但数据很清楚：对女性，尤其是更年期女性，好处非常明确，哪怕你不举重。

We don't measure creatine levels in humans, but the data is very clear on the benefits to women, the benefits to women in menopause, even if you're not lifting weights.

如果你确实有在举重，那研究显示，肌酸和蛋白质摄入之间有种协同作用。

Definitely, if you are lifting weights you know, when we look at the studies done on creatine and strength training, it seems to be a synergistic thing with protein intake.

针对女性的研究表明，每天补充三克或五克都有明显效果。

So the studies for women were done showing benefits at three and benefits at five.

现在你看北卡罗来纳州艾比·史密斯·莱恩的研究，医生。

And now when you look at Abby Smith Ryan's work coming out of North Carolina, Doctor.

史密斯·莱恩正在大量研究围绝经期和绝经期女性，发现的好处不仅限于肌肉和骨骼。

Smith Ryan, she is doing a lot of work on women in perimenopause and menopause and seeing benefits outside of just muscle and bone.

我们还看到对心理健康和认知功能的益处。

We're seeing mental health, we're seeing cognition.

所以你最好慢慢开始补充肌酸。

So you wanna kind of ease into creatine.

每天先从三克开始，抱歉，我说错了。

Start with about three milligrams per day, and then you Gram, sorry.

之后可以逐渐加量。

And then you can increase.

我平时一般吃五克。

I, on a regular basis, do five.

但当我旅行、压力大、睡得不好，或者进行高强度训练时，我会增加到每天十克。

But when I'm traveling or stressed or didn't sleep well, and certainly on like heavy, heavy lifting days, I double that up to 10 per day.

我们再看看他们还问了些什么。

Let's see what else did they ask about.

关于辅酶Q10，其实已经有不少研究针对更年期女性，探讨它对心脏的潜在益处，这个值得你去了解一下。

CoQ10, really great studies actually done on menopausal women looking at potential heart benefits of CoQ10, something you should probably look into.

我就不参与关于NAD的讨论了。

I'm gonna stay out of the NAD conversation.

我觉得那更多是健康养生圈子里的话题。

Again, I think that's more with the wellness crowd.

我还没看到足够多针对更年期女性的研究数据，能让我对NAD感到兴奋，或者在我的诊所里推荐它。

I haven't seen enough data done in menopausal women showing benefit for me to be excited about NAD or to recommend it in my clinic.

欢迎回到另一个Midi Pause。

Welcome back to another Midi Pause.

我是医生。

I'm Doctor.

玛丽·克莱尔·哈弗，UnPaused节目的主持人。

Mary Claire Haver, host of UnPaused.

在医疗方面，没有一种方案适合所有人。

When it comes to healthcare, there's no one size fits all solution.

当你用量身定制、个性化的办法应对症状时，找到真正需要的解决方案的机会会大得多。

When you face your symptoms with a tailored, individual approach, you'll have a better chance of finding the solutions you need.

Midi Health 提供的是现代化、有科学依据的护理，专为这个生命阶段的女性设计。

Midi Health is modern, evidence based care designed specifically for women in this stage of life.

你能接触到理解你身体变化的医生，并获得个性化的治疗方案。

You get access to clinicians who understand what's happening in your body, along with personalized treatment plans.

更年期远不止是潮热那么简单。

Menopause is so much more than just hot flashes.

通过研究和亲身经历，我们越来越清楚，这些荷尔蒙变化会波及身体几乎每一个系统。

What we're continuing to understand, through both research and lived experience, is that these hormonal shifts can ripple through nearly every system in the body.

而且它们并不总是以明显的方式表现出来。

And they don't always present in obvious ways.

对很多女性来说，这是一系列症状的集合，一开始可能觉得彼此无关——比如关节不适、心悸、脑雾、皮肤变化，甚至有刺痛感或焦虑加重。

For many women, it's a collection of symptoms that can feel disconnected at first joint discomfort, heart palpitations, brain fog, skin changes, even tingling sensation or a rise in anxiety.

这种情况特别复杂的地方在于，这些症状经常被忽视。

What makes this especially complex is just how often these experiences are dismissed.

很多女性都被告诉说，这只是压力大而已。

So many women are told it's just stress.

但当你用更年期的视角来看待这些变化时，就会豁然开朗。

But when you begin to view these changes through the lens of menopause, it can bring a completely different level of clarity.

这不仅让人感到被理解，也让你真正明白发生了什么，更知道有切实有效的方法可以应对。

There's validation and understanding what's actually happening, and real empowerment in knowing there are effective ways to address it.

改变从制定个人计划开始。

Progress starts with a personal plan.

预约Midi Health的首次咨询，不到十分钟就能搞定。

Booking your first visit with Midi Health takes less than ten minutes.

找一个真正懂你状况的专家聊聊，非常重要。

It's important to talk with an expert who understands what you're experiencing.

这才是真正的个性化护理。

That's personalized care.

Midi Health 正在重新定义医疗保健的标准。

Midi Health is setting a new standard for healthcare.

作为全美增长最快的女性远程医疗公司，Midi 提供保险覆盖的便捷服务。

As the nation's fastest growing women's telehealth company, Midi provides accessible insurance covered services.

Midi 填补了女性在围绝经期和绝经期面临的重大医疗空白。

Midi fills the critical health gaps women face in perimenopause and menopause.

如果你需要一位真正懂你身体和大脑当前需求的医生，Midi 就在你身边。

If you want a clinician in your corner who understands what your body and brain need right now, Midi is there for you.

前往 joinmidi.com 了解更多。

Go to joinmidi.com.

访问 joinmidi.com，今天就与他们的医生取得联系。

Join midi.com and connect with one of their clinicians today.

针灸或饮食调整能有效缓解症状吗？

Can acupuncture or diet meaningfully improve symptoms?

明白了。

Okay.

我们有很多生活方式上的调整，都能有效缓解更年期症状。

So we have lots of lifestyle things that we know can improve your symptoms of menopause.

你可以改善潮热、关节疼痛、体重增加、胰岛素抵抗，还有肠道健康，所有这些问题都能得到改善。

You can improve your hot flashes, you can improve your joint pain, you can improve your weight gain, you can improve your insulin resistance, your gut health, all of the things.

所以我谈更年期护理时，总是在我们诊所的框架下，把它看作一个工具箱。

So when I talk about menopause care, I always do it in the framework in our clinics of a toolkit.

明白吗？

Okay?

这正是我写的《新更年期》一书的核心内容。

This was the basis of my book, The New Menopause.

这就是更年期工具箱。

It is the menopause toolkit.

我们要怎么优化你的饮食？

And it is looking at how can we optimize your nutrition?

哪些方面还存在缺口？

Where are the gaps?

你每天摄入多少纤维？

How much fiber are you getting?

你摄取的蛋白质够不够，来维持骨骼和肌肉质量？

Are you getting enough protein to maintain your bone and muscle mass?

说到运动，你有没有做足够且合适的有氧运动来保护心脏健康？

Or, you know, when we look at exercise, are you doing enough of the right kind of cardio to maintain your heart health?

你有没有做足够的力量训练来保持骨骼和肌肉强健？

Are you doing, you know, enough lifting to keep your bones and muscles strong?

这些对你来说具体该怎么做？

What is that gonna look like for you?

我们还要关注减压问题。

We're looking at stress reduction.

我觉得现在有必要专门谈一谈这一点。

And I think it's important that I talk about this here now.

我之前做了一次深入研究。

I was doing a deep dive.

说实话，我经常思考长寿这件事。

You know, I think about a lot a lot about longevity.

我不想在这儿谈得太政治化。

And I don't wanna get too political here.

当我们讨论长寿，以及它现在被怎么推动的时候——特别是最近曝光的一些文件和某些医生的丑闻——你得小心，别把长寿当成一种信仰来崇拜。

When we look at the longevity conversation and how it's being driven and given, you know, what's happened with the files that have been released recently and revelations about certain physicians, I I think you have to be careful about wor worshiping at the altar of longevity.

我觉得这些讨论对女性并不适用，因为我主要照顾女性。

I think the conversation isn't relevant to women because I take care of women.

我会认真听女性的声音。

I listen to women.

我知道她们真正需要什么、想要什么。

I know what their needs and wants are.

我接触的这类人，几乎没有，或者一个都没有。

And I don't have very many, if any.

有几个人在社交媒体上说，他们想活到一百二十岁。

A couple of people on social media have said, I wanna live to 120.

我们诊所里，我从来没遇到过一个病人走进来就说，我想活得越久越好。

I can't think of a single one in our clinic who has walked in the door and said, I wanna live as long as possible.

我从没想过要死。

I never wanna die.

我希望死亡不是必然的。

I want dying to be optional.

这些话他们从来不会说出口。

That does not come out of their mouths.

他们跟我讲的是这些：

Here's what they say to me.

我想成为别人的依靠，而不是负担。

I wanna be a benefactor and not a burden.

我想尽可能久地陪在家人身边。

I wanna be with my loved ones for as long as possible.

我想好好享受那些时光。

I want to enjoy those years.

你猜怎么着？

Because guess what?

女性不用做任何事，也能在长寿赛跑中胜出。

Women win the longevity race doing nothing.

现在，我们的寿命比男性平均长六七年左右。

Right now, we live six ish years longer than our male counterparts.

问题就在这儿。

Here's the problem.

但我们并不更健康。

We are not as healthy.

在这些多出来的日子里，我们更多时间都被慢性病困扰。

We are spending more of that life plagued with chronic conditions.

我们需要长期住进护理院的可能性是男性的两倍。

We're twice as likely to require long term nursing home admissions.

我们更容易因身体衰弱而失去自理能力，从而丧失独立性；女性患阿尔茨海默病和痴呆症的概率更是男性的三倍。

We are twice as likely to lose our independence because we become so frail we can't take care of ourselves, or women are three times more likely to develop Alzheimer's and dementia than their male counterparts.

这些病也会发生在男性身上。

These diseases happen to men.

我们当中有一半的女性，在去世前都会经历一次骨质疏松性骨折。

Woman can expect to have an fifty percent of us will have an osteoporotic fracture before we die.

一半。

Fifty percent.

明白吗？

Okay?

降低这些风险的窗口期，越早开始越好。

The runway to decrease those risks starts as early as possible.

不管你现在是什么状态，改变这些数据永远都不晚，但你得主动去努力。

However you are listening to me, it is never too late to change those statistics, but we have to work at it.

当我研究长寿相关的文献、书籍，还有网上那些男性专家的讨论时，发现他们完全没提一个关键问题：创伤和性侵。

When I look at the longevity literature and the books that have been written and all the bros talking online, here's one key thing they're not discussing, trauma and sexual assault.

数据显示，童年时期遭受性侵，如果得不到治疗，会缩短你的寿命。

When I looked at the data, a history of childhood sexual assault will decrease your longevity if untreated.