Dr. Deb Matthews also known as, The Happy Hormones Doctor, is a best-selling author, international speaker, educator, wife and mom of four boys. After suffering for years from fatigue and irritability due to hormone imbalances, her quest to resolve her personal health led her to change everything about her practice of medicine. She has been featured on national podcasts, radio, and broadcast shows, including NBC, ABC, CBS, and FOX.

Dr. Matthews and Karen take a deep dive into women's sexual dysfunction.

In this episode

• Why is this an important topic to talk about?
• What are the most common symptoms of sexual dysfunction?
• The impact on relationships.
• Causes of sexual dysfunction in your 20s, 30s, 40s, 50s and beyond.
• The role of hormones in sexual function.
• Stress and sex.
• How do women describe sex when this happens?
• Best way to apply HRT for sexual function.
• Can women of any age in menopause start HRT?
• Is it safe?
• Does HRT cause breast cancer?
• What is the new stance from the menopause society say about how long women can safely use HRT?
• What else can affect sexual health besides our sex hormones?
• What else besides HRT can women do to help with their sexual dysfunction?
• and more!

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Listen to the episode with Carlee Hayes onHow a Continuous Blood Sugar Monitor Can Help You Find Your Perfect Diet. Check out this episode oniTunes orSpotify ! Read the episode transcript below.

https://youtu.be/GqpaSsJu5RY

00:00 Karen Martel Ladies, this month we are talking about sexual health and vagina health, but mostly sexual health. And I wanted to do this because I feel like it's such a complicated area for women already. And then we go through perimenopause and menopause and it just seems like it gets even more complicated. It's really unfair. Men are born into this world just ready to roll in most cases at all times. They are meant to just spread their seed. And women, we have this little tiny window of opportunity in a month where we can get pregnant, where all the hormones align or at least they're supposed to align to make us want to go out there and have sex for a couple of days. Now I know that there are women out there with super healthy sex drives and they can have sex all the time, but I have worked with literally thousands of women at this time and I can safely say from the women that are in my life as friends and family and then the women that I work with, I can honestly say that women typically don't have a sex drive that matches a man's sex drive. Women tend to have that week to two weeks out of the month where they feel like having sex and even then might not be a lot. And the rest of the month as they get closer to their period, it really tanks. Let's be honest, it tanks. This is the way it's been for me my whole life. I'm very cyclical with my sex drive and I am very grateful that I have a husband that honors that cycle. We still have regular sex throughout the entire month. It's just different from the times that I want to have a lot. I'm not a lot of sex, but I want to have sex and I'm way more into it. And then as the second half of the month creeps along, I don't want to have it, but I can get into it and I can still enjoy it. Just the drive to go out and get it is just not there like it is in the first half of the month. So it's different. And I think most women, they're so hard on themselves when it comes to the amount that they want to have sex. They feel super guilty because they feel like they should want to have as much sex as their partner does. And if that doesn't line up, then they think there's something wrong with them. Well, I will tell you that it is far more normal to be honest, to be cyclical with your sex drive, than want to have sex all the time. I think that it's a lot more common. And not to say that it's not normal for women to have a great sex drive. That's awesome. I mean, I wish. Good on you. You're probably not listening to these episodes. But for the rest of us who find it a little bit more challenging, don't be hard on yourself. Go with your cycle. Honour that cycle. I had a good friend tell me once, this was, oh my gosh, probably like 10 years ago. The first half of the month, I can really be frisky and flirtatious and I'll go out and get it from my husband and I want it. And she's like, it's awesome. And she's like, I don't need much foreplay and I can get a little bit more, let's say, risque in the bedroom. And then she said, in the second half of the month, I don't really feel like having sex. But I just think of it as a time to connect with my partner. And so I need more foreplay. I need more romance. I need to be more wine and dined because my hormones just aren't there supporting that. And she said, and then I can because I'm more in the mood because of the foreplay and because of the whining and dining. And she said, I just, I see it differently. I just see it as more romantic, more of a time to connect. And then the first half of the month, it's more like, hey, let's just go and have some good times in the bedroom. And I really loved that because it made me honor where I was in the month. And I was able to teach that to my husband and say, hey, look, like, I'm not really in the mood in the second half of the month, especially the week before my period where I just feel like, I don't know any other way to describe it. And I'm not going to be really in the mood for it, but you could get me in the mood. And this is how you do that. So give it a try, ladies. Give it a try. Give it give honoring your system and your body a try. And in today's episode, I've got Dr. Deb Matthews back. She's well, she was here a long time ago talking about hormones and bioidentical hormone replacement therapy. And so I asked her to come back and talk about the impact of hormonal loss in perimenopause and menopause. And actually we talk about the years even leading up to that and how this can all impact our sex drive. And which hormones we want to hone in on to really get that drive back and get the get the mood back into the bedroom. So of course, you still need to honor the system. And even if when you're putting on hormones and you're not even cycling anymore, you still need to honor how you're feeling throughout the month, because even when you're putting even women that aren't cycling, I find they still sexually cycle. So there'll be times of the month where they really feel into it and times of the month where they don't. And sometimes that goes with the full moon, actually. So pay attention to that. I find that my sex drive definitely goes up during a full moon. So you can kind of start to see a little pattern and start to honor that pattern and then use the hormone replacement therapy to really help you out because it really can. I hear from women all the time like, Oh my gosh, Karen, my sex drive is back. Hallelujah. I literally do. I hear it all the time. It's one of the biggest like reports, like the most common reports of once women start to replace their hormones. It's like this, you can hear it in their voice. It's so much relief. They're like, Oh my goodness, my sex drive is back. Thank goodness. So it really can help. Okay. So without further ado, ladies, let's hear from Dr. Deb Matthews. You're listening to The Other Side of Weight Loss. I'm your host, Karen Martel, Certified Hormone Specialist and Nutrition Coach. If you are ready to go beyond diet and exercise, then tune in each week to hear from leading experts in weight loss, psychology, nutrition, and hormone health as we explore the many avenues of what it really takes to lose weight and feel your best. When I come across a menopausal woman, neck, even an adult woman who has a super healthy, robust sex drive, I'm always a little surprised and I get excited for that woman because unfortunately it's rare. Sadly, many of the women I coach struggle with sexual dysfunction, but don't worry. Today we are going to explore ways to prevent and reverse it as you age. I was recently listening to an anti-aging conference and I heard Dr. Deb Matthews speak about this topic. I had the pleasure of interviewing her previously on the show about bioidentical hormones, actually quite a few years ago now, which I'll link to that in the show notes. I invited Dr. Matthews back on the show to talk to you wonderful ladies about this critical issue. Dr. Deb Matthews is also known as the Happy Hormones Doctor, which I love that name. She is a bestselling author, international speaker, educator, wife, and mom of four boys. After suffering for years with fatigue and irritability due to hormonal imbalance, her quest to resolve her personal health led her to change everything about her practice of medicine. She has been featured on national podcasts, radio, and broadcast shows including NBC, ABC, CBS, and Fox. So ladies, let's welcome Dr. Matthews back to the show. Welcome. Thank you so much. It's great to be back. Great to be back. We were just talking, so you're down in where, Carolina? I'm in Charlotte, North Carolina. Yes, and her parents live in the city that I live in, which I think is just such a small world. So we're going to go for coffee one day, right Deb?
10:21 Dr. Deb Mathews Yes. It'll be wonderful. We'll be there soon. Okay.
10:25 Karen Martel Okay, so I loved your talk. I was so happy that you did this. There was a lot of people there too, so I just love that you're bringing this education to other healthcare providers because, you know, something you even said in that speech was, women aren't really comfortable talking about this very much, right? They're not going to their doctor saying, hey, I've got some problems with my vagina or my problems with my sex life. It's not talked about enough, so I appreciate it, but I would love for you to just kind of tell your story actually, and I think we talked about it in the first episode, but I really like the story about Suzanne Summers and how you kind of got into all of this.
11:07 Dr. Deb Mathews Sure. Well, I wasn't feeling like myself. I was short-tempered. My husband would chew too loud and I would lose my mind, or my kids would leave the soccer cleats by the front door, and when I tripped over them, like I just wanted to pick the shoe up and throw it against the wall because I was so annoyed, and so my reactions to things were more than what they really needed to be, and I didn't really understand what was happening to me because I knew that my behavior and how I was feeling, I knew it wasn't normal, but nothing in my medical training helped me understand what was going on. It's how hungry you. I was in my late 30s at this point, and I was hypothyroid, and I knew that. I was on Synthroid. That's the standard medicine that they give to everybody, and it had taken me. I had symptoms of hypothyroidism for 10 years before I actually finally got diagnosed. Me too. It had to get so bad before I kind of finally, my lab went out of the range and I got diagnosed, but then I got put on this medicine and I never felt better, so now it's a whole other 10 years that I've been on this pill, and my lab test looks fine, but I don't feel fine, but now in my late 30s, all of a sudden I was waking up in the middle of the night with panic attacks for no reason, and at least as a doctor, I knew what it was because otherwise it feels like you're having a heart attack. It feels like you're dying. It's really scary, but I couldn't understand why it was happening, and my husband came across this book written by Suzanne Summers, and it was called The Sexy Years, so I can assure you it was anything but that at our house at that time, and I'm sure that if the book was called The Woman's Big Book About Hormone Issues, you would not have touched that book with a 10-foot pole, but she's smart, so that's not what it was titled, and when he picked up the book, and you know on the back of the book it's got those bullet points, and so he could see like feeling irritable, tired all the time, not sleeping well, you know, he saw all these things that he recognized in me, and he brought this book home and suggested that maybe I could read it. Did you want to shove that book where the sun don't shine? Yeah, he was kind of grieved, right, but the reality is that I knew something was wrong, and I didn't know what to do about it, and I sure didn't want to get my medical information from a celebrity, and of all people, like what I knew of Suzanne Summers was Chrissy Snow from Three's Company, right, so did C. It's of all time, and then like the Thigh Master, you know, like I just, this is not where we as doctors go to get our medical information, but I had nowhere else to turn. He's a great guy, he's a great husband, he's super patient, but like he's over it at this point, so I read the book, and my whole life changed, because when I read all these stories of women who were feeling just like me, and how much better they felt when they got their hormones back in balance, it allowed me to really open my mind, and I realized that there's all these things they didn't teach me at medical school. Another colleague of mine recently said, like, once she learned about this, she felt like they ought to give her a partial refund, because they missed some of the really important parts at medical school, but it also had resources to help me learn where to go in order to learn more, so like the A4M is one conference, for example, where practitioners can get all of this education, and you know, it's not woo-woo, like this is based in science and research, and it's just that because it's not based in pharmaceutical drugs, it doesn't really trickle down as much in through our medical schools and to our doctors, but once I got my hormones back in balance, I got my energy back, my kids got their mom back, my husband got his wife back, I had my life back, but I couldn't go back to just writing prescriptions all day long in my old job, because that just didn't feel right anymore, and so I retired, this is now 17 years ago, and I retired in my 30s, and I opened my practice, and so now for the last over 16 years, I've been helping men and women get their hormones back in balance so that they can get well, they can
15:15 Karen Martel get off their prescription drugs and love the way they feel. Amazing, amazing, and all from, you know, like how sad is that really that as a medical doctor that you got this information, not from
15:31 Dr. Deb Mathews med school, but from Suzanne Summer's book, from Chrissy's book. I've had a chance to meet her now a couple of times to tell her like how she changed my life, and then because of her, I'm able to touch other people's lives, and I've had a chance to meet Oprah, and Oprah is on bioidentical hormones, and I said when I met her, like I'm a doctor that prescribes bioidentical hormones, she did a whole series of shows on hormones back in 2009, my phone rang off the hook, all these women looking for bioidentical hormones, so I told her this story, and she told me that she's still on her hormones, she feels better than she ever does, and she feels so bad for women who are afraid of hormone replacement therapy, because they just don't know what they're missing, and then I had a chance to meet Dr. Oz, and what I said to him was like Suzanne Summer's and Oprah, like this is where me and my patients are learning about hormones, like why do women have to learn about this from the celebrities instead of from their doctors, and what he said, which is totally true, is that the pharmaceutical industry has a lot of, not control isn't the right word, a lot of influence over our medical education, and it's helping women have balanced hormones is nuanced, we have to listen, we have to customize things and personalize things, it's not like this quick here's a prescription, see you back in a year, and so it doesn't fit with our medical insurance model of
17:00 Karen Martel in and out in 10 minutes, and so that's what Dr. Oz had to say about it. And I love what you said about what Suzanne said in her book about sexual dysfunction, about the smoothie, can you please repeat that because I love that.
17:15 Dr. Deb Mathews Yeah, so she was saying that you know at the end of the day, you know she'd hop in bed, and her husband would look over at her with a hopeful look in her eye, and she would just
17:23 Karen Martel feel like, oh I'd rather have a smoothie, you know. Which I think so many women are going to be like, yes, like that is me, that's the last thing that I want to do is have sex with my partner, which is so tragic and so upsetting, and you know we've got clinics and commercials all about
17:44 Dr. Deb Mathews just for men and their sexual dysfunction. And you know, in fairness, there actually is a medication out now to try to help for women with sexual dysfunction, but it's got some really significant side effects, like frequent side effects, which is nausea and headache.
18:04 Karen Martel Like who wants to have sex when you feel like puking and you have a headache? Yeah, and then you have to prescribe anti-nausea medicine to help prevent the vomiting, you know. Wake interruption ladies, if you have not checked out the new weight loss peptide program that I have and you are struggling with weight, please go check it out. It is mind-blowing how amazing the results are from these weight loss peptides. Like really incredible, I just spoke to a client the other day, she said I'm down 20 pounds, I have not been this thin for since I was probably in my 20s. A lady told me yesterday, she's like, Karen, I bought a summer dress and I no longer have an armpit muffin top, which I'd never heard of that before. And she was so pleased that she no longer had her armpit muffin top. Anyways, I am getting this all day long. The results are phenomenal. I am taking terzapotide myself. We are now offering terzapotide in one of our membership tiers. So you can have access to terzapotide starting at a mere $170 a month, which is unbelievable for terzapotide. So terzapotide is when you get it through a pharmacy and it's called Monjaro, it is about $1,500 a month. So this, and it works extremely well. So we are offering both semaglutide and terzapotide. You can go check it out at karenmartel.com. I will link to it in the show notes. This is revolutionizing weight loss. And for you perimenopausal and menopausal women that have been struggling so hard like myself for so many years, trying to keep your weight off, trying to keep the weight down, this is a very welcomed relief. It's like, oh my gosh, it's so easy. You feel so good. At least I do. I feel so good on it. I've got so much energy. I'm working out like crazy. I just, I feel great. And it's just, it's easy. It's easy. And we can have that. We're allowed for it to be easy. Ladies, we've put the work in. Now it's time to have this nice little helping hand to get those pounds off. Okay. I'll stop there. Let's get back to our show. Yeah. Yeah. No, but at least they're trying, right? Kudos for at least recognizing we've got a problem that maybe a solution can be found. Right. Yeah. I just think there's not too many. I mean, I know that rectal dysfunction is a problem and it's actually becoming a growing problem,
21:13 Dr. Deb Mathews but I will safely say there are far more women with sexual dysfunction than men. And not just in perimenopause and menopause. You're right. And men are very aware. Like if they have a problem with erections or like lots of desire, they are very aware this is not normal, that, you know, they would love to be able to have a solution for that. For women, it's so much more confusing. Like what's normal, you know? And the answer that we give isn't very satisfying. It's like, well, it depends. You know, everyone's a little different. Like you and your partner might be happy having intimacy once a month or once a week, whatever, as long as you're happy with it, then it's fine. Right? Okay. Well, that's fine. But it's not like there's a right answer there. And so many women are confused. Like how interested should I be or how much work should it take to have an orgasm? Like, we don't know, right? You only know your own personal experience, kind of like bowel movements. What's it supposed to be like? You only know like you. So it's confusing. And if you are worried that maybe there's something wrong or there's a problem or you're not normal or whatever, you can try talking to your doctor about it. But, you know, it's not something that doctors have a pill for, for women, right? For men, we do, the little blue pill. But when we as doctors don't know what to do about something, we don't really like to talk about it. Like we like to be smart and have all the answers. So first of all, we tend to be down on the things that we're not up on. So that's part of the bioidentical hormone business. They're not so familiar with it. And so they kind of feel like if it was really all that great, they would have taught me at medical school. And since they didn't, therefore it must not be that great. But the same thing is true here. They don't really know what to say. Like they don't really have a solution. They don't have a way to fix you. They can tell you, well, it's because of your stress or, you know, this is just part of menopause and it's
23:14 Karen Martel normal or it's just your age. But those are all such unsatisfying answers. They really are. And I found that most women compare their sex drive to their partner's sex drive, if they're with a man. And they think that there's something wrong with them because they don't want to have sex every day and their partner does. And they go through their entire marriage thinking like this, like that there's something wrong with them because they can't keep up with their partner and they
23:43 Dr. Deb Mathews feel bad. And it's like, why don't I want to have sex all the time? It really causes problems in relationships sometimes because, and it can go either way. I mean, men can get low testosterone and other medical problems or beyond medicines and they lose the desire to, so it could go either way. But if one partner has more desire than the other partner, sometimes the less desired partner takes it personally, right? Like, so if a woman kind of loses interest, because like, really, like sometimes it just like the thought doesn't even pop into our mind. Like we're just don't even think about it. We don't even care about it anymore. Sometimes it's a chore. And the other partner sometimes feels that it's them, right? Like they don't understand. They feel like you're not interested in me. It's me. You're not attracted to me anymore. It makes them, it hurts their self-esteem. And if they, if their self-esteem is suffering, you know, that just starts conflicts happening and this affects families, right? I mean, if the spouses aren't getting along, that affects the children. I mean, it's, you know, it's a problem. And a lot of times we don't think of like our sexual health as an important problem, but the World Health Organization actually has sort of officially declared that women's sexuality is a, it's a human right for us to have the opportunity to, you know, express ourselves and have, you know, these kinds of intimate relationships. And we know that when things aren't working, that it is something that impacts our health on different levels. And it's something that we should be able to talk about so that for people who are bothered by it, worried about it, upset by it. I mean, if it's a problem for you,
25:27 Karen Martel then let's talk about things that we can do to make it better. Absolutely. Let's, let's talk about this because it's a bit of a spectrum, you know, there's physical things that are happening, but also, you know, you talk about what's going on in the brain and how that can influence our sexual functions. So give us the symptoms, like the range of what can happen.
25:46 Dr. Deb Mathews So if it's okay, can we go kind of sort of by age? Yes. Let's start with like you're in your 20s. And one of the really, well, there's two really common causes of just loss of interest, like, you know, not becoming aroused, like just sexual functions, not quite right. One of those is birth control pills, because when women go on birth control pills, one of the things that the pills do is they increase a binding protein in our bloodstream that lessens testosterone. And the messages from our brain to get our ovaries to make more testosterone get lessened. So testosterone actually goes down when you're on birth control pills. Now, we use birth control pills on purpose for that reason in women who have acne, because for some women, they have too much testosterone. If we give them the birth control pills that can lessen their testosterone, that can help their acne get better. But for the rest of women, if they just started off with just a normal amount of testosterone, now it goes too low, well, you know, their sex drive can go out the window. Another really common one is certain antidepressant medications. Specifically, they're called SSRIs. So there's Prozac and Zolot and Slexo. There's all different ones. But in men who have premature ejaculation, we give them on purpose these medicines to lessen their sexual arousal in order to prevent premature ejaculation. But when we're putting women on birth control pills or giving them an antidepressant medication, I'm pretty confident that these are not really discussed because at least if you knew, you could know, okay, well, here's where I am now. And now, you know, a couple months from now, I can kind of take stock and see if something has changed so that if it's different, at least I know what I can do to go back and change it. And listen, if you are horribly depressed, if you are in the pits of despair, like, you know, an antidepressant may be more important than your sex drive. Like I'm not, you know, and I don't want young women to get pregnant before they're ready. I mean,
27:54 Karen Martel yes, but it's important to know this. Yes, I was put when I had my hormonal disaster that happened to me. My doctor put me on I want to call it Cyprolex. I think it was called Cyprolex. Okay, it's an antidepressant. She wanted me to take it the second half of my cycle for my PMS. And so I got on it. And lo and behold, I couldn't orgasm anymore. Like it just went it went flat. Like, nothing was there. So I went off of it. I was like, No, not for me. Sorry. Because it was just I mean, I had to get to the root of the problem anyways. But yes, 100% it affected my sex drive,
28:36 Dr. Deb Mathews as did the birth control pill at a very young age, it really messed with my hormones. And you know, if you don't know, then you wonder, well, am I really attracted to my partner? Like, is there something wrong with me? Let you know, and especially when you're young, and this is happening, like, you know, you don't have a lot of, you know, to go on. And so it can be confusing. But so then, maybe let's just doesn't have to be in your 30s. But I'm going to lump this one in your 30s. Because this is when it happened to me is hypothyroidism. If your thyroid isn't working, libido goes down, like desire for sex arousal, all those kinds of things just go down. But that's, you know, if you go in and complain, you know, I don't know, maybe something's wrong with me. I'm not sure if like my libido is okay. I promise your doctor's not immediately gonna say, aha, we got to check your thyroid, and we want it to be optimal, not just normal. And you know, we want to do like the full panel, not just the screening test. But low libido is something that I see very commonly in women who have hypothyroidism, low thyroid function. And if we can get your thyroid doing what it needs to do, then it can come back again. Yeah, I would say that probably happened to me too. Same thing in my 30s, undiagnosed hypothyroidism. And so there you are hypothyroidism makes it affects your mood and your energy. And so when you go in and you complain, like, I'm not motivated to do anything. I'm tired all the time. I'm sleeping all the time. Well, then you get your antidepressant with your hypothyroidism. And then you're on birth control pills because of, you know, you're still in your childbearing years. So now you've got three things going on that are killing your sex drive. Yes. Okay. So we've got the 20s, the 30s, now what's going on in our 40s. So in the 40s, there's actually a couple of different things that are happening. One is your progesterone level is going down. Progesterone is the progestational hormone. It's one of the ones that go up and down over your menstrual cycle. But as we get into our 40s and our fertility is starting to kind of go downhill a little bit, we just don't make as much progesterone anymore. And that typically affects us right before our period. So that's when they had you take that antidepressant, right? It's the weeks before your period. And so in those weeks, we tend to be more irritable or anxious or we want to eat everything in the whole fridge. And we sure don't feel like going to the gym and you know, your husband chews too loud. You want to punch him and you know, we just don't feel our best. And so a lot of times libido kind of goes out the window. Generally, our best time for our sex drive is when we're ovulating in mid cycle around day 14 of our menstrual cycle. But things often get worse leading into your period. And this becomes very common when we're in our 40s. The other one though, that's really big for libido is testosterone. So we think of testosterone as the male hormone, but we women have testosterone too. In fact, we have 10 times more testosterone than estrogen, which is kind of mind blowing. It's just that men have 10 times more testosterone than women do. But testosterone is really important for everything to do with sex. Like the idea of popping into your head in the first place, any kind of arousal or desire and vaginal lubrication and having an orgasm, like all of that just kind of goes down if you don't have testosterone. And of course, testosterone is not the whole picture, right? Like you still might be on your antidepressants or your birth control pills or you know, your thyroid is not optimal or whatever, but testosterone is really important. And testosterone is not just important for sex. Testosterone is our motivation, our confidence, our get up and go, our self-esteem, our competitive drive, our decisiveness. So if testosterone goes down, a lot of times we just feel blah, flat. Like we make our way through our day, everything sort of feels forced. We do what we have to do. If something must happen today, you know, you'll make it happen, right? You got to get food on the table and you know, you'll brush your teeth. But if it doesn't really have to happen today, you kind of don't really feel like it. You just kind of push it off to the side and kind of procrastinate on things. And so when you think about, and you know, oftentimes you're tired. So then by the time, you know, your spouse looks at you with that twinkle in his eye, you kind of feel like, oh, you know, just another thing I don't feel like doing today. Yeah. And now what about estrogen? Okay. So for most women, estrogen drops sometime, you know, around about 50, which is kind of, you know, the general age when we are going through menopause. So menopause is the lead up happens over years, kind of like puberty in reverse. Once you haven't had a period for 12 months, that's called menopause. But you know, estrogen is fluctuating over this timeframe. But by the time we're in our fifties, for a lot of us, our estrogen level has dropped. Estrogen is an antidepressant. So it gives us energy and perks up our mood, keeps our brain sharp so we can remember why we walked in the room. But it's also really important for keeping moisture in our body. So when estrogen drops, we tend to get dry. We get dry eyes and dry mouth and dry skin and dry hair and a dry vagina. Our vagina is supposed to be kind of plump and juicy. But once we lose our estrogen, it gets thin, it gets dry, it's not very stretchy anymore. It can kind of tear, we can get like little irritations from intercourse. And so now it's not just that you're not interested. Now it can actually hurt. So when women come in their menopausal, I literally have women come and sit down and say, I just don't really feel like a woman anymore. Like I don't feel feminine. I kind of feel like an it. And like that's sort of a hard thing to put into words, but they just know that something doesn't feel right. And then sex hurts. Like one lady described it, it felt like somebody's shoving a cactus inside her. You know, it's painful. So of course you're not really going to be too interested in it if it's a really unpleasant experience. And sex shouldn't be painful. So because so many women are unfortunately and unnecessarily frightened of estrogen, they feel like they're making the best decision for themselves. And they're doing the best thing if they stay far away from hormone replacement therapy. But then, you know, their doctor gives them some kind of like a lubricant cream or even some kind of a little dab of estrogen cream to try to help. And a lot of times, sometimes it can help, but a
35:14 Karen Martel lot of times it's just not enough. Is that because we really, I mean, it's good to have, you know, the estrogen right on the labia or inside the vagina for the dryness, but is it, have you seen in your practice that it's really important to also get systemic levels of estrogen
35:33 Dr. Deb Mathews up in order to help with sexual function? Yeah, because for women, especially a whole lot of what goes on surrounding sex happens between our ears. And so, of course, we don't want it to hurt, you know, we want the tissues there to be normal. But yeah, if estrogen, all of these hormones impact who we are on the inside, how we react to the world around us, how we relate to other people. And so our sexual desire is all tied up in all of that. And so definitely, we would want to make sure that there's enough estrogen getting to all those tissues. But if we can get your whole body healthy and well, if you're exa- oh, let me talk about one more. Yes. This could be at any age, and that's cortisol, which is your stress hormone. When we are stressed out, who's not stressed out these days? When we're stressed out, cortisol goes up to help us cope with stress. That's great in the short term. But when we're chronically stressed day in and day out, cortisol gets out of whack. Sometimes it's too high, sometimes it's too low, sometimes it's too high at the wrong time of the day and too low at the other time of the day. If it gets out of whack, it's very difficult to cope with stress. We get tired. We can be tired, but wired at the same time. Like you're tired all day, then you're lying awake at night staring at the ceiling and you can't sleep. Little things feel overwhelming, like just getting the groceries home from the grocery store and putting them away is exhausting and it feels overwhelming when it doesn't need to. If cortisol is supposed to help you cope with stress and your cortisol is now out of whack, in your body's infinite wisdom, it knows this is not the right time to procreate and bring another baby in the world when you're all stressed out. It just really shuts down our desire. It shuts down the other hormones. It lowers testosterone. It gets in the way with how our thyroid hormones work. Stress is another really important cause of low libido for all of us. I think a lot of women probably have had the experience that if their spouse takes them to a Caribbean island and they are sipping fruity drinks in a pineapple and laying under the palm trees besides aqua blue water, their sex life is better while they're on vacation. So if I could write a prescription for a tropical island vacation, that would probably help a lot of women with their sexual dysfunction. But of course,
38:09 Karen Martel most insurance companies won't cover that. Yeah, I can definitely say for myself that I always know if my stress is too much and it's out of control because it's honestly like I don't even have a vagina. All the energy's in my brain and going into my brain and thinking about way too many things. And it's like, don't touch me. Don't come near me. I don't even want to have a
38:32 Dr. Deb Mathews vagina right now. You just imagine, right? You've just made it through the day. Thank God you've made it through the day. It is now bedtime. You get in that bed, your head hits the pillow, and now somebody wants you to be energetic. Are you kidding me?
38:48 Karen Martel No, they want to touch you. You're like, do you want a punch in the face? Because that's what's going to happen. I actually have made a point with my partner, with my husband, almost through our entire marriage, we're going on over 10 years now, to we don't have sex at nighttime. And it's like, I'm like, who wants to have sex at nighttime? We were raising two little children, right? At the end of the day, that's the last thing that's on my mind. So we just made it like we have our sex daytime, put in the calendar pretty much. It's like, okay, this day and it's going to happen in the morning. And it's so much better. Well, good for you. So everybody hear that though, because I think we get into these head spaces of, and I know it can be hard when you have children, and if you're not home by yourself, all that. But if you can, sometimes some women just need that suggestion. And they're like, oh, I've had many people be like, oh, I never even thought to have a daytime sex. Yes, it's so much
40:03 Dr. Deb Mathews better. At least for me. And even just the idea that you've made a plan, you've decided, you've carved out the time. This is the priority in that moment. That's what you're going to do. Because otherwise, you've just done everything else on your list of things to do. It's like, just another, like you said before, it's just another chore, another list on the thing. Whereas just like if you go out for date night, that's really good for your relationship. So you can just
40:33 Karen Martel carve out your date time in your own home. Yes. And I think that is a good idea. Some people think, oh, that's really like taking the romance out of it or the spontaneity. And I'm like, no, you've been married for 10 years. You can put it in your scheduler, or at least you have a specific time and day. And because then you're right, you just block out that time. Because we always have a million things to do that are in our eyes more important.
41:00 Dr. Deb Mathews You got to think about what are you going to call it in your scheduler?
41:06 Karen Martel Date day. Date day. That's a good thing. Date day. Date morning. How about that? So yeah, I've had women that have come to me that have said, you know, I had this one woman recently who said, the last time I had sex was two years ago. It hurt so bad. It tore. It tore my inside of my vagina. And I could not do that. I couldn't have sex again. And she had come from having a really healthy sex life. You know, her and her husband had been very intimate. They had a healthy sex life together. So for them to suddenly have it be this, you know, really painful experience, she was devastated, which like, of course, right. And there's so many women that, that, you know, they, it's, it is, it's just devastating because this is, you know, with their partner. And like you said, if that was a big part of your relationship, and suddenly that's not happening anymore, that's a huge strain to the marriage. It just is. Ladies, I'm excited to tell you about today's sponsor, NutriSense. NutriSense combines cutting edge technology and human expertise. So you can see how your body responds to different food, exercise, stress, and sleep in real time. Now you hear me often talk about the importance of finding your weight loss code. And part of that is discovering what foods can negatively affect your blood glucose levels. This is key because if you are eating foods that you think are healthy, but they are spiking your blood sugar, well, that won't be good when it comes to your ability to lose weight. You would be shocked at the difference between each person as to what foods spike their glucose. A great example is when I was wearing my NutriSense monitor and discovered that sushi was the worst food out of everything I ate in a two week span. I think most of us assume that sushi isn't that bad of a food, but for me personally, it is. Might not be for you, but it is for me. I discovered things like a bad night's sleep made my glucose go up. I did an entire podcast about my CGM experience with one of the founders, Carly Hayes. I'll link to it in the show notes and I would definitely go take a listen. Here's how it works. Continuous Glucose Monitor, a CGM, is a small device that tracks your glucose levels in real time. Application is easy and painless. Each device lasts for 14 days. You can use their app to scan your CGM, visualize data, log meals, run experiments, and much more. You get expert dietitian guidance and each subscription plan includes one month of free dietitian support. Your dietitian will help you to interpret the data and provide suggestions. Some of the key benefits can be weight loss, stable energy, better sleep, understanding of which foods are good for you, and controlling cravings. Lasting sustainable change takes time and can be achieved through their longer term subscription. We encourage people to choose six and 12 month subscriptions which are cheaper per month and allow you to not only achieve your goals, but also to ensure that you stick to your healthy lifestyle for the long term. You can visit NutriSense.io forward slash weight loss and use code weightloss all capital letters to save $30 and get one month of free dietitian support. Now let's get back to our show.
44:49 Dr. Deb Mathews For women, right, so much of our self-worth we end up tying to our appearance and you know our weight and so if we aren't, if we're not looking attractive for our partner then we worry about it or you know if this is a part of the relationship that we feel like we're not really satisfying them then you know it's just all these things are tied up in our self-esteem and the good news is there are a lot
45:21 Karen Martel of things that we can be doing in order to make things better for you. Yes, so let's talk about those things. So first HRT because that's why this happens for a lot of women, especially as we're going into perimenopause and menopause. If you know suddenly you have a drop in sex drive you can definitely start with looking at your hormones and as Dr. Matthews was just saying, it's not just testosterone. I think most women think it's all testosterone and I remember hearing a doctor saying that you know testosterone like he said it's that like gives you the oomph to go out and get the sex but estrogen he said is the hormone that makes you actually want to do the act of sex and I thought ah that's brilliant and I've definitely found in my practice that there's a lot of women I would say 50% it's the estrogen that brings the sex drive back. What about you?
46:14 Dr. Deb Mathews Yeah you know and I think that's a really important point. We're complicated and lots of things that are going on and if we oversimplify things down to well all you need is a prescription of testosterone and it's going to fix everything then it doesn't always work first of all or sometimes in an effort to help more and more we give you a big old dose and then you end up getting side effects so we don't want to try to oversimplify it too much because we want to go through the list. Are you on birth control pills? Are you on antidepressants? Are you really stressed? What's going on with your cortisol? Like those are all things that can be addressed. If your testosterone though really is low sometimes there's things we can naturally do to get it to boost you know if we get your cortisol normalized that can boost it. There's DHEA is a hormone that is made in our adrenal glands that our body can use to make more testosterone and so sometimes when we're stressed our DHEA level goes down and as we age it goes down. For some women we can give them some DHEA and then their body can naturally make a little bit more testosterone and that can help them so there's lots of things we can do even without hormone replacement therapy but for women who are low in testosterone we can give them back some natural testosterone and it just helps us have stronger muscles and bones so less risk of osteoporosis and frailty as we get older. It gives us more energy motivation. In fact just recently I saw a patient who's a serial entrepreneur like she's always opening new companies and she thrives on juggling a million things all at the same time she's always done that and now that she's in her mid-40s she's dropping the balls and it's very much bothering her because she doesn't feel right and when we got her back and her testosterone level had dropped quite low and she lost that drive and when we got her testosterone back restored she's back to juggling the balls and doing all the things that she used to do because it affects how we feel so it's more than just for sex and it's more than just testosterone. The one that women fear the most is usually estrogen replacement and this is really unfortunate and it's because we, us medical doctors, told you, everybody else, that estrogen caused breast cancer and as it turns out estrogen does not cause breast cancer. I'm going to say that again estrogen does not cause breast cancer. For women who get breast cancer and it's estrogen receptor positive it doesn't mean it was caused by estrogen it just means that estrogen can feed their cancer so estrogen doesn't cause breast cancer. The thing that did cause breast cancer was a drug form of progesterone which is one of our hormones. It was a synthetic man-made chemical that we were using. We didn't know but it was increasing the risk for breast cancer by a little tiny bit. Yeah but none the less. Progestin which is what's in birth control pills. Yes which is what is in birth control pills. There's many different progestins. Probably some do the breast cancer risk more than others but we don't have it all sorted out which is which. So if we put you on hormone replacement therapy with the natural form of progesterone, not the synthetic kind, it does not increase the risk for breast cancer. So we are able to give women hormone replacement therapy if they choose to have it in a way that should not increase your risk for getting breast cancer in a way that can help make your bones stronger and keep you feeling your best. Make it so that sex isn't painful. You know help you have some desire. Less depression,
49:46 Karen Martel sleeping better, all these things they can contribute to that sex drive. Yeah so it's just not necessary to suffer. No and then also check your thyroid ladies because that also goes down a lot of the time in menopause. Thyroid problems are very common in women. Very, very common. I feel like way more have that very end, the very bottom of the range. That's what I see constantly. So no doctor would look at that. Well you know typical medical doctor is going to say oh you need thyroid. It's like oh your thyroid's great. Right it's like going one away from being
50:32 Dr. Deb Mathews flagged. Right so even though like for me right your thyroid is enlarged. You have every single symptom of low thyroid but until that number gets so bad that it's outside of the range,
50:44 Karen Martel that's when you've suddenly got the thyroid problem. Yeah exactly. Oh it's so frustrating. What about the women that are over the age of 60 that have because they came from a time when it was really like do not do hormones. It's going to kill you and they're in their 60s now and they're being told they can't start HRT or a woman that gets to her 60s on hormone replacement therapy and
51:12 Dr. Deb Mathews is being told that she shouldn't continue taking them. Okay these are so important because there's so much doctors are taught. It's so ingrained in their psyche. So what doctors are taught is that women should go off hormones as soon as possible because they're still thinking that we're giving the women the one that increases their risk for breast cancer. The North American Menopause Society has put out a statement to all the doctors to say there's no medical studies that say that anything bad happens if women keep going on their hormones. So this idea that you should stop it that's not actually based on any science or research or data. I don't know who made it up but what the statement says is if a woman is getting benefit from the hormones for example if she has osteoporosis or osteopenia hormones are good for her bones or if she's got the vaginal dryness or the painful sex or she's still having hot flashes without the hormones if she's still getting a benefit from the hormones it's okay to continue the hormones no matter how many birthdays you've had. But the regular doctors have not got that memo and so they're still trying to get people off the hormones. The other thing is what we saw in the original study that would scare women about breast cancer is that when we gave women that synthetic progestin pill it hormones are supposed to be good for your heart but women were having more heart problems and it was because of that synthetic progestin pill is because we weren't giving them the bio identical form of estrogen that's natural to our bodies so there were other things going on. But what we now know having looked at this for many years is that when we gave women the synthetic pill that there was a slight increase in the risk for heart problems within the first year of starting hormones if they started the hormones when they were older. So if you start on hormone therapy when you're you know in your 50s like right around the time that you're going into menopause we saw a protective benefit on your heart. If you waited and you were more than 10 years since you had your last period and then you started on hormone therapy we saw an increase in the risk for heart problems within the first one year of starting on those synthetic hormones. If you made it past the first year and you didn't have a heart problem then your risk for heart disease went down and down and down and down as you went forward. But all that doctors know now is you got to start on the hormones within the first few years otherwise you've missed the window you can't have hormones because it's bad for your heart. So it's misinformation. What I do for women if they come in and they're over 60 and they've got symptoms and they want to be on hormone therapy maybe they've learned more about it and you know now they feel like this is something they'd like to try is I will still give them hormone therapy. I mean we talk about it we say all these things and help them understand why their other doctor might be telling them something different and you know we talk about all risks and benefits and side effects and you know give full informed consent. And if they would like to go ahead with it I typically like to do it in a cream applied to the labia because first of all that's going right where most of the time they need it you know to help there. And it doesn't when we take estrogen as a pill it can increase in some women it may increase the risk for blood clots. It depends whether it's the natural form of hormone or the synthetic form of hormone there's also controversy around that. But most medical doctors believe that if we give women vaginal hormones that it only works on your vagina. And if depending on what dose we give you we can get hormones to work in lots of parts of your body but when we give it to you in the vagina or at least the outer part of the vagina most of the other doctors don't get as bent out of shape. So women can get the hormones they can feel better their other doctor doesn't give them a hard time about it and so it's sort of a way that we can help you feel better you know without you kind of getting yourself caught between two doctors that have different opinions which is always so hard. Yes and so but would you say that it is okay to start at any age? In my medical opinion as long as you understand right all the stuff that I just said you know it is okay to start at any age especially if you're going to use the hormones topically because what we worry about as you get older and older is the risk for blood clots the risk for strokes because any like birth control pills increase your risk for blood clots and strokes it's just that if you're 19 you know your risk already started so low that even when it's increased it's still infinite. When you're 70 you really could have a heart attack or a stroke and so you know we just don't want to be doing anything that would increase your risk. So with the synthetic pills there was an increase in the risk so even though we're not using the
56:18 Karen Martel synthetic pills you know that that's why the other doctors are still scared. Right so topically through the skin or the labia can be that there hasn't been anything that showed that that
56:31 Dr. Deb Mathews increased your risk of heart attack and stroke. That's right and even the bioidentical version of estrogen does not increase the risk for heart attacks and strokes and blood clots and things the way that the horse estrogens did it's just not the same thing but nonetheless it's something that the doctors are still very worried about and even if your doctor has read the research and they're like me they believe it's okay if they were to give you hormone replacement therapy and then you did have a heart attack or a stroke because you're 70 regardless of hormone replacement therapy or not they will be blamed and their license is on the line.
57:08 Karen Martel Right yes yeah but there was there all the research does show that if you take the estrogen topically throughout your 50s that and that it helps it reduces risk of heart attack and stroke yeah so I just want everybody to just be very clear about that.
57:28 Dr. Deb Mathews If you don't start on your estrogen until you're 67 it can't go backwards in a race what happened over the last you know 10 or 15 years since you went through menopause but it still has positive benefits going forward on your bones on your skin on your mood on your you know intimacy.
57:44 Karen Martel Yeah yeah exactly yeah okay that's great because I you get you get a lot of women that are like oh
57:51 Dr. Deb Mathews I would like to do this like I've been suffering for 20 years. Can I tell you a really quick story I had a man came in to see me he had some issues with testosterone and sexual dysfunction and so we got him spiffed up and he was doing great the problem is his wife couldn't tolerate intercourse because it was painful so you know we got him all great but you know he's all dressed up nowhere to go so he he convinced his wife to come in and she was a little hesitant she didn't want hormones she had heard all about how they're dangerous but you know she came in and we just kind of talked to her and and gave her just a little bit you know we didn't go like full on but I had a telehealth appointment with her a couple months later and so she's you know in her kitchen on her computer and we're talking and she's feeling better and you know she's whatever so her husband came around behind her and like behind her shoulder he's like this thumbs up it's working he was giggling like a second grader but you know what they were enjoying themselves
58:53 Karen Martel and they were having fun and they couldn't do that before. Oh that's great that's a great story yeah I and I've heard to um Dr. Lindsay Berkson talking about if you haven't been on hormone replacement therapy for over 10 years and you're in your 60s or 70s that you can start very low and slow to basically kind of give those hormone receptors a time to kind of up regulate because the I always say it's like they're going to sleep because they're not being used yes so you know you can go very small and just kind of ease your way into it and that's a possible way that you could talk to your doctor about possibly trying that so just an option out there okay so there's the hormones great and you know you can testosterone in the vagina can be great estrogen inside the vagina can be great there's um things there's one called an E-string which is this little um circular rubber of what would you call it like I don't it looks like a bracelet yeah yeah that you insert into your into your cervix and it releases a little bit of estradiol if you have a very dry vagina that can be uncomfortable so cream might be better for you you can always do they can give you applicators to put that inside you can do suppositories so there's lots of options out there you guys lots of options and it can also help with your your like um preventing urinary tract infections which is great yeah and just
01:00:24 Dr. Deb Mathews bladder control yeah one thing that I would say is there are lots of things out there so if you try one thing and it doesn't really work for you maybe it's irritating or makes you itch or whatever don't give up like then you go back to your doctor and let them know this isn't working for me and
01:00:37 Karen Martel they can try something different yeah because like sometimes like you know I've done the suppositories and this can be a little bit leaky and messy and uncomfortable for some some women they don't mind it you know cream can be better so there's yeah lots of options so you know find what's going to work for you yeah because there's lots of tutes from let's um talk about nitric oxide
01:01:00 Dr. Deb Mathews oh sure okay so as women get well as men get older and they start to have problems with erections the reason is that they're not getting enough blood flow to the penis because little blood vessels get clogged with plaque just like our heart you know arteries can get clogged with plaque the blood vessels to the penis are teeny weeny they get clogged easily men get erectile dysfunction so there's all sorts of research going on to help the men but if you think about it for women similar things are happening we've got blood vessels like really the clitoris is kind of the same thing as like a penis just it's most inside a woman but in any case all the things that can help men can help women too so nitric oxide is something that is naturally found in certain um foods like especially beets are very rich in nitric oxide you can take it as a nutritional supplement and what it does is it opens up blood vessels so that's how like viagra and cialis that's how they work is they open up blood vessels so nitric oxide is kind of a natural way to open up blood vessels and it doesn't just improve blood flow to our private parts it improves blood flow to our brain and our heart and lots of other places you know your fingertips if you got bad circulation in your hands but nitric oxide is a supplement that's sort of kind of like nature's version of a natural viagra that can work for women just like it can work for men perfect uh scream cream i don't like that name but yeah um they're compounding pharmacies or special pharmacies that personalize prescriptions just for you and they can actually make up a cream that then you can apply to the clitoral area and they they there can be different combos of things but um some of it has um a cream that's got like a mintiness to it you know that like you know like when you put the cream on if your muscles are sore what's that called um yeah camphor freeze so yeah yeah all those lines just to kind of make things like tingle and wake up and they can put um some of the the um like medicines in it that open up our blood vessels arginine is something that's a um an amino acid it's one of the building blocks of protein but it it can open up blood vessels so they can make this little combo cream you can apply it topically and it helps for some women i've had some women that found it didn't really do much for them but you know it's an option if you march into your regular doctor's office and ask for it though it's probably they won't know what to do because i get some scream cream yeah they can't just call it into you know your corner pharmacy because it only comes from a compounding pharmacy where they make up the prescription and the doctor has to say like what the recipe is that they want and if they never
01:03:45 Karen Martel heard of it before then they won't know how to do it okay oxytocin now this is a hormone and i just never see it being used very often but it's the lovey-dovey hormone so have you seen that
01:03:57 Dr. Deb Mathews help for some women it can help so um when when when we hug when women breastfeed um it releases oxytocin which is our bonding hormone and hugs need to be at least 20 seconds long so usually when we see somebody we give a quick hug and we go like that's not even long enough but um but it it helps us feel more connected to other people and and want to be more intimate and for some people um you know there's a whole variety of reasons why our oxytocin level may not really need be where it needs to be and it just can help us to to to be more interested in intimacy to be more responsive you know have better orgasms um and again you can't walk into your regular doctor's office and say that you want to try it because they can't just call in a prescription easily you know into the corner pharmacy they know about this in terms of pregnancies because it's one of the um things that they put in the iv to help a woman along when she's having um when she's in labor so if you were to walk into your doctor and say hey can i try some oxytocin they would think what the heck are you talking about because it's it's not something that's routinely available by a prescription it is available from compounding pharmacies um but it's just not something that the routine doctors know about to use in a sense it's usually used in a nasal spray is that right it can be used in a nasal spray it can be used as an injection there's different ways but it's not just typically we don't just give it as a pill okay do you use it much you know what we had we went through a phase where we tried it in the practice um we didn't have a lot of people coming back to ask for more which we sort of interpreted as you know whatever it is that we are doing with it maybe it's not really doing enough that that it makes a difference which doesn't mean that it's the oxytocin's fault it could be what how we were prescribing it wasn't really optimal too right i remember hearing dr hurtog theory hurtog talk about it yeah how he suddenly just so liked his wife again yeah thank you and love you dovey dr anica becca uses it a lot too but see the other thing may be that it's hard we don't have easy tests like we can't just easily test your oxytocin level so if your oxytocin level is fine and we give you more maybe it doesn't do anything whereas if your oxytocin level was low and now we restore it that person might have
01:06:18 Karen Martel a really important impact yeah i was interviewing a woman uh nat netum about peptides and she was saying that oxytocin shots she said you know this is the power of peptides she's like you can take oxytocin and give yourself this minuscule little amount and in 30 minutes you're going to be running to the bathroom with diarrhea but i was like oh that's a side effect of oxytocin that's not so good for your sex drive if you're running the bathroom hold on like yeah no not at all okay so i think we've covered most things here um where can people find you and i know you've got a great
01:06:57 Dr. Deb Mathews book that you give out so let's talk about that sure okay so my practice signature wellness is in charlotte north carolina while we do do some telehealth i am only licensed in north carolina so we can work with people here or you would have to come here for your initial appointment in order to establish care and then we can do telehealth after that um i wrote a book because i found that a lot of women would come in and what they were saying is like i don't feel right this doesn't feel normal i just want to feel like myself again i'm not sure if this could be from my hormones like i'm not really sure and so i wrote this book to help women figure out could how they're feeling be because of their hormones so it's called this is not normal a busy woman's guide to symptoms of hormone imbalance and it has a whole bunch of quizzes like checklists you know low testosterone you know check check check check down the list you know high cortisol whatever it is so you can start to figure it out it's got some tips for helping yourself to start feeling better and then really importantly it has some resources for where you can find doctors who can help you um so there's
01:08:09 Karen Martel just great we are out there but sometimes we're the best kept secret in town i yes 100 i've had you on my list of doctors for many years since we did our last interview so you are on my list of doctors to see so because i think you're fabulous and i can't wait to go for coffee with you it'll be great yes to find a nice like-minded person that we could just sit there and talk about hormones so there's nobody around me wants to hear well thank you very much for coming back on the show and bringing light to this topic that is not being talked about enough and so i hope that all of you listeners have been taking notes and you're going to take charge of your sexual health because there is so much that you can do for it so do not settle for suffering right amen amen all right thank you so much for coming on the show thank you i hope you enjoyed today's show new episodes come out every saturday morning if you enjoy my show please be sure to leave me a review on itunes it helps me to keep the show going so the more people that hear it the more i will continue being this excellent podcast host all right you guys you can find me at karen martel hormones on facebook and instagram and i'm always posting some amazing facts on hormones and weight loss and women's health in general so check it out and you can always find me over at karenmartel.com all right have a wonderful day wherever you are in the world and we will see you next saturday