Rebellious Wellness Lifestyle

Menopause has gotten plenty of media attention. What it hasn't gotten is day-to-day direction, especially on the parts nobody likes to say out loud. This week I sat down with Dr. Cat Brown, a board-certified OB-GYN and the medical director at Winona, to talk about why a little dab of vaginal estrogen can protect you from recurring UTIs (and the urosepsis they can lead to), why the age-60 guideline doesn't mean what you think it means, and how one badly handled study cost a generation of women their care. If you've been told hormone therapy isn't for you, this episode is worth your 35 minutes.Who is Dr. Cat BrownBoard-certified OB-GYN and medical director at Winona, an online telemedicine platform created to bridge the gap for low-risk women who are good candidates for hormone therapy but don't have a doctor willing, or experienced enough, to prescribe it. She came to this personally, too: most of her own menopause education was self-directed after she hit roadblocks seeking care following her hysterectomy.What we actually talk aboutWhat Winona is, and what telemedicine can't do (00:38–02:19) — Winona was born during COVID, when nobody was prescribing hormone therapy by telemedicine. Dr. Cat is upfront that it's a bridge, not a replacement: you still need an in-person gynecologist, a breast exam, and a Pap smear if you have a cervix.You don't have to be a patient to use it (02:19–04:20) — A quiz, a library of free education on the long list of menopause symptoms, the Winona Women's app, and a Winona Women's Facebook group. Dr. Cat points to research showing that women with strong female friendships live healthier, longer lives, which is why community is part of the model.Why estrogen matters, and why it starts in perimenopause (04:21–09:05) — The Women's Health Initiative backstory, and why Dr. Cat says headlines reached the media before other doctors had peer reviewed the results. Then the case for estrogen as the hormone that fuels skin, joints, blood vessels, the heart, and the brain, plus why the goal isn't your 20-year-old hormone levels and why she says "hormone therapy," not "replacement." Her reframe: let menopause be the pause that makes you reevaluate what you're feeding your body and your soul.Why UTIs spike after menopause (09:06–11:43) — Estrogen loss thins the tissue around the urethral opening and weakens the barrier that keeps normal vaginal bacteria out of the bladder. That's the same reason we're taught to pee after sex. Left to recur, UTIs can lead to urosepsis, which Dr. Cat calls deadly for older women.Vaginal estrogen is not "taking hormones" (11:43–13:44) — Cream applied around the urethral opening treats the surface changes of menopause, with very little absorbed systemically. Dr. Cat says even women who can't take systemic hormones, including those with a history of breast cancer or blood clots, are safe to use it, and that menopause providers think it should be sold over the counter.Cream, tablets, rings, and painful sex (13:44–16:08) — Your options for vaginal estrogen, including a heads-up that some rings are designed to release hormone systemically. Plus the negative feedback loop of painful intercourse and what it does to long-term relationships. Dr. Cat's observation: every man gets the little blue pill, and most women get nothing for their own tissue.The estrogen face cream (16:09–18:36) — Estriol plus tretinoin, what it does for texture and fine lines, why it's controversial in the medical community, and why Dr. Cat says it's still a personal decision. I use it, and it feels great.The age-60 question (18:37–22:06) — Why 60 is Winona's line for starting hormone therapy by telemedicine, and what it is not: it isn't a deadline for stopping. Dr. Cat explains the window of opportunity (within 10 years of menopause), the slightly higher clotting risk when starting after 60, and why starting in early perimenopause, before your final period, gets you more heart and bone protection. Her analogy: don't wait for the gas tank to hit empty.If you're over 60 and curious (22:07–23:32, 29:29–29:47) — You're not locked out, you just need a different front door. Dr. Cat recommends an in-person menopause provider who can work with your other physicians and monitor you closely, and The Menopause Society has a zip code search to find one.The black box warning, birth control, and breast cancer risk (25:36–27:05) — Dr. Cat on why the warning never applied to topical estrogen, why she says birth control carries higher hormone doses and more clot risk than hormone therapy, and why she says daily alcohol is a much bigger breast cancer risk factor. (Yes, there goes the wine.)Patch, pill, or cream? (27:06–29:28) — Why Dr. Cat generally recommends transdermal, why she still prescribes pills, and her rule: the best method is the one you'll actually use consistently. Hormone therapy is like trying on jeans. Five women, five different cuts.Tell your doctor everything (30:12–31:22) — Even if they won't prescribe. Dr. Cat shares how patients' in-person doctors came around after seeing their labs and how much better they felt. "We've converted another doctor."The physician education gap (31:23–34:14) — Dr. Cat was taught in residency to learn this for the exams and never prescribe it. She mentions a large grant from Melinda Gates's foundation to The Menopause Society to educate physicians, why we should talk to younger women about menopause the way we talk about first periods, and why answering surveys and showing up is how the black box warning came off in the first place.Resources mentionedWinona, including the quiz and free education: bywinona.comWinona Women's app and Winona Women's Facebook groupFind an in-person menopause provider: The Menopause SocietyInstagram: Dr. Cat OBGYN (she's also on Facebook and TikTok)A note on the medical talkThis episode is education, not a prescription, and Dr. Cat's own point is that telemedicine doesn't replace in-person care. If you have a history of breast cancer or blood clots, or you're over 60 and thinking about starting, take these questions to your own doctor or an in-person menopause specialist. Use this episode to ask better questions.Enjoyed this one? Leave a review. It helps other women find the show. And if you want more of this in your inbox between episodes, sign up for the Rebellious Wellness Lifestyle newsletter.

Nobody prepares us to become a caregiver for our own parents, but Nicole Hilgenkamp did it twice, with both of her parents, and turned what she wishes she'd known into a system for the rest of us.Nicole is the founder of Your Parents' Keeper, a caregiver education company built around 12 essential documents and a 7-phase roadmap from independence to end of life.In this episode:The 12 documents every family needs before a crisis — not afterHow to open the conversation with a parent who won't talk about itThe home safety signs that get missed until it's too lateWhy polypharmacy is one of the most under-caught risks in aging parentsHow to build a caregiving team so it's not all on youThe skilled nursing bed shortage — and why you need a plan before you need a bedWhat to do about a parent's digital accounts after they passNicole lost her mother this past June. This conversation is the guide she wishes someone had handed her first.Resources: Your Parents' Keeper — yourparentskeeper.comEnjoyed this one? Leave a review — it helps other rebellious spirits find the show.

The Nitric Oxide Truth: Why Your Supplements (and Toothpaste) Might Be Working Against YouBiochemist Dr. Nathan Bryan has spent 30 years researching nitric oxide (NO) — a molecule he calls the earliest event in the onset of every chronic disease.But despite all the supplements, powders, gummies, and health claims surrounding nitric oxide, much of what people are being sold isn't backed by the science.In this episode, we sort the real science from the Instagram-ad noise and explore what nitric oxide actually does, how your body makes it, and the everyday habits that may be shutting down your body's own production.In this episode we cover:What nitric oxide actually does and why loss of NO production may come before chronic disease, not afterWhy many arginine and beet supplements don't work the way people think they do — including the surprising gummy trick that can completely inactivate active ingredientsThe everyday habits that may be shutting down your body's own nitric oxide production, from oral health products to medications and other lifestyle factorsHydroxyapatite, what it is, and why Dr. Bryan uses it in his fluoride-free toothpaste — along with the surprising connection between your mouth, inflammation, and heart healthWhy sunlight, vitamin D, and nitric oxide are connected — and why you can't necessarily out-supplement the sunA simple nasal-breathing practice that can support nitric oxide production for freeHow topical nitric oxide helped heal a wound doctors had called “unhealable”Dr. Nathan Bryan is a biochemist and one of the world's leading researchers on nitric oxide. His work explores the role nitric oxide plays in cardiovascular health, mitochondrial function, aging, and chronic disease.Find Dr. Nathan Bryan at N101.com.His book, The Secret of Nitric Oxide: Bringing the Science to Life, is also available now.Instagram: @drnathansbryanX: @DrNitric

Most everyday pain isn't “just aging”, and it's not permanent. This week, chiropractic physician Dr. Ya-Ling joins the show to talk about why so much everyday pain — stiff necks, cranky backs, tight shoulders — is actually retrainable.We get into:The real difference between everyday pain and true chronic painWhy ignoring pain trains your nervous system to expect more of itThe nocebo/placebo effect and how belief shapes what you feelYour “pain personality” and what your first pain memory reveals about itWhy painkillers need an exit strategy, not an open-ended commitmentThe graded movement approach: release, retrain, strengthenWhy slouching isn't the enemy (and “sit up straight” might be hurting you)Whether zero-drop shoes or heels are better for your back (spoiler: it depends)Dr. Ya-Ling practices in Seattle and is the author of Fix the Fire Damage and What's Your Pain Personality? Find her books, her free Pocket Pain Relief app, and more at ya-ling.com.Enjoyed this episode? Leave a review — it helps other rebellious spirits find the show.

Neurosurgeon Dr. Ravi Kumar returns to break down what the science actually says about melatonin — including a new study linking long-term use to heart failure — plus why popular sleep meds like Ambien and Benadryl come with hidden costs, his real sleep protocol (temperature, timing, screens), and two blood tests you should ask for once in your life: Lp(a) and ApoE4.In this episode:Why Dr. Kumar generally doesn't recommend melatonin as a nightly sleep aid — and when it actually helpsThe correct melatonin dose (hint: it's a fraction of what's on most labels)Why up to 80% of melatonin supplements don't contain what the bottle says — and what certification to look forWhat the new melatonin/heart failure study does and doesn't proveThe real risks of Z-drugs (Ambien, Lunesta) and antihistamine sleep aids (Benadryl, Tylenol PM)Dr. Kumar's 5-step sleep protocol: screens, showers, socks, room temp, and CBT-IWhat Lp(a) is, why it's genetic and untestable by diet, and why you only need to check it onceApoE4 and Alzheimer's risk — and why genetics isn't destinyFull protocol PDF and more research: drkumardiscovery.com