Everyday Wellness: Midlife Hormones, Health, and Science for Women 35+

Ep. 440 Why Less Than 3% of Women Use HRT: Myths, Labs & Lifestyle Jackie Piasta, RN, MSN, RNFA, WHNP-BC, NCMP

Feb 15, 2025

Jackie Piasta is a Vanderbilt-trained, board-certified women’s and gender health nurse practitioner with over a decade of experience. In a thought-provoking discussion, she delves into why less than 3% of women choose hormone replacement therapy, dispelling myths and sharing insights on personalized care. Jackie explains the impact of conditions like endometriosis on menopause and differentiates between hypoactive sexual disorder and low libido. The conversation also highlights the complexities of treatments like IUDs and the importance of tailored health strategies for women.

Ask episode

Chapters

Transcript

Episode notes

Intro

00:00 • 2min

Navigating Hormone Replacement Therapy

02:27 • 9min

Achieving Health Goals with Supplements and Quality Sleep

11:13 • 4min

Navigating Hormone Replacement Therapy

15:36 • 25min

Navigating Menopause and Intimacy

40:06 • 11min

Paluva Shoes and Women's Health Insights

50:58 • 8min

Understanding Ovarian Health and Menopause

59:26 • 9min

I am excited today to connect with my friend and colleague, Jackie Piasta. Jackie is Vanderbilt-trained and has been board-certified as a women’s and gender health nurse practitioner. She has been practicing since 2010. She serves on medical advisory committees for several foundations and co-hosts the justASK Podcast.

In our conversation, we dive into the challenges and complexities surrounding menopausal hormone replacement therapy and FDA-approved formulations, looking at the minute percentage of women currently on menopausal hormone replacement therapy. We discuss supraphysiologic-dosing of hormones and lab work strategies regarding prescribing lifestyle, and Jackie clarifies how she differentiates hypoactive sexual disorder from low libido and dysfunctional uterine bleeding from early menopause. We explore IUDs, ablations, and other long-term bleeding therapy options, explaining how endometriosis can impact the onset of menopause. Jackie also shares her approach to managing patients who have had ablations or are using IUD therapies and not getting regular menstrual cycles, helping them to determine when they transition into menopause.

This conversation is full of valuable insights, and we look forward to having Jackie back for a further deep dive into this pivotal stage of women’s health.

IN THIS EPISODE YOU WILL LEARN:

Jackie compares the varying information and lack of a one-size-fits-all approach in HRT with that of other medical treatments.
Overwhelming options and fear surrounding HRT can make it challenging for clinicians to prescribe those treatments.
How compounded HRT formulations differ from commercially available formulations
The difference between a normal physiologic and a supraphysiologic dose
How low libido differs from hypoactive sexual desire disorder
Challenges of diagnosing menopause in women who have had ablations or hysterectomies or use long-acting reversible contraceptives
Importance of evaluating postmenopausal bleeding to rule out endometrial cancer
Transparency and open communication with patients about the benefits and risks of HRT
Other health interventions to be addressed alongside HRT
How endometrial biopsies confirm the presence of uterine disease rather than ruling it out

Connect with Cynthia Thurlow

Follow on Twitter
Instagram
LinkedIn
Check out Cynthia’s website
Submit your questions to support@cynthiathurlow.com

Connect with Jackie Piasta

On her website
My Monarch Health on Instagram
Jackie on Instagram
The justASK Podcast