Everyday Wellness with Cynthia Thurlow ™

Ep. 472 What Women Aren’t Told About Menopause & HRT with Jaclyn "Jackie" Piasta

Jun 7, 2025

Jaclyn 'Jackie' Piasta, a Vanderbilt-trained nurse practitioner and women’s health expert, shares vital insights on menopause and hormone replacement therapy. She discusses the importance of personalized treatment, highlighting the challenges healthcare providers face in staying informed. Jackie also sheds light on the historical stigma around oral estrogen and the necessity for improved education on hormone therapies. Furthermore, she emphasizes proactive management of vaginal, urinary, and sexual health symptoms during menopause, making this conversation a must-listen for women navigating this phase.

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INSIGHT

Importance of Bio-Individuality

Bio-individuality is crucial in menopause care as female hormonal dynamics vary greatly from textbook models.
Many clinicians lack up-to-date training, limiting effective menopause treatment.

INSIGHT

Dismissal is a Form of Harm

Dismissing women in menopause is itself a form of harm, often driven by provider fear of hormone therapy risks.
Balanced discussions about hormone therapy's risks and benefits are essential to patient advocacy.

INSIGHT

Nuanced Menopause Treatment Needed

Menopause treatment requires nuance beyond vilifying oral estrogen or insisting on compounded hormones.
Patient preferences, budgets, and simplicity of use must guide personalized care.

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

In our discussion today, we dive into the challenges menopausal women face with hormone replacement therapy due to the lack of provider education on the effects of oral estrogen, the importance of bio-individuality, and how nuanced messaging can make all the difference for women. Jackie unpacks the latest guidelines from the American Urological Society, which address vulvovaginal, urinary, and sexual health symptoms, and explains the importance of addressing those issues proactively. We also explore fertility tracking in perimenopause, especially for women using long-acting reversible contraception (LARCs), and the latest trends in hormone testing.

You will not want to miss this insightful conversation where Jackie sheds light and offers practical guidance on the often-missed details of women’s health.

IN THIS EPISODE, YOU WILL LEARN:

Why bio-individuality is essential in menopause treatments
The challenges OB-GYNs and other clinicians face in staying updated on menopause treatments.
Why healthcare providers must become more educated about hormone therapy
Jackie explains the historical context surrounding the vilification of oral estrogen.
How the new American Urological Society guidelines are now addressing symptoms of perimenopause and menopause
Why vaginal laser therapy might be harmful for some individuals
Why diagnosing menopause in women using long-acting reversible contraceptives (LARCs) is so challenging
Why hormone level labs are needed to guide clinical decision-making on menopause treatments
Jackie highlights the need for more research to understand the hormone levels that protect bone health.

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Connect with Jaclyn Piasta

Monarch Health
Jackie on all social media: Jackiep_gynnp
The justASK Podcast