H.O.W. MD - Your Hormone Optimizing Warrior
The Hormone Optimizing Warrior MD (The H.O.W. MD) Podcast is your trusted guide to hormone therapy for menopause, postmenopause, and beyond. Hosted by Dr. Mirela Cernaianu, a passionate women’s health advocate and practicing physician, this show delivers clear, evidence-based insights on optimizing hormones to reclaim vitality, strength, mental clarity, and confidence in the second half of life. Discover how hormone therapy, peptide therapy, and the latest regenerative approaches can help you thrive after menopause. Each episode cuts through the myths and dogma, providing actionable strategies so you can work with your provider to achieve true hormone optimization (not just symptom management). Whether you’re in your 30s–40s preparing for the change, navigating menopause now, or thriving in your 60s, 70s, and beyond, you’ll gain practical tools for heart health, beauty, longevity, and whole-body balance.
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136 - Is Our Estrogen Hormone the Key to a Healthy Heart?
05/08/2026
136 - Is Our Estrogen Hormone the Key to a Healthy Heart?
Estrogen plays many significant roles in a woman’s body, but on this episode of HOW MD, we’re talking about why estrogen is so important for heart health. In 2002, women and doctors were told estrogen therapy would increase the risk of a cardiovascular event. But the truth is much more complicated, and when taken correctly, estrogen can be more beneficial despite its potential—and often minimal—risks. In this episode you’ll learn… Why women started fearing estrogen therapy, and what has changed since. Why the truth about estrogen is more complicated than one simple study. Which types of estrogen are easiest on your liver and heart. Why knowing about cardiovascular health risk factors for women is so important. What the biggest risk factor for heart disease is (and what you can do about it). What FSH is and how it’s impacted by low estrogen during menopause. What happens with your FSH levels over time and the symptoms that can arise. Why getting treatment to control symptoms isn’t good enough—and what to do instead. How hot flashes impact your health in the short term and in the long run. How physicians who understand hormone therapy can help you deal with fluctuations. Why untreated hot flashes are bad for your heart. Why addressing hot flashes can be even more important than a pap smear. The lifestyle choices that influence your risk of heart disease. What typically happens to your cholesterol during menopause and beyond. The truths you haven’t heard about hormone therapy that you need to know. Connect with Dr. Cernaianu
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135 - Introducing the Hormone Optimizing Warrior: Your Guide for Perimenopause, Menopause and Beyond
05/01/2026
135 - Introducing the Hormone Optimizing Warrior: Your Guide for Perimenopause, Menopause and Beyond
When I started this podcast, I focused largely on overall wellness and even beauty. After looking back on the last three years of my journey, I came to realize it was time for a change. I’m shifting to focus specifically on optimizing hormones for women in menopause and beyond. From now on, I’ll be providing hormone tips and strategies you can bring to your medical provider to help you feel your best! In this episode you’ll learn… How my passion and focus has shifted with time. The services I actually provide in my practices and what it highlights for me. How menopause actually opens a new chapter for women. What the real safety concerns around hormone therapy actually are. The areas of medical care that call for specialties that don’t yet exist. How demand for estrogen has changed over time and where it stands today. Why all women have the basic human right to be educated about hormone therapy. Why very few doctors offer hormone optimization (hormone therapy isn’t the same). Why I’m changing the name of this podcast from Wow MD to How MD. Why some women feel stuck on their hormone journey and how this podcast can help. How I vow to serve you on this podcast moving forward. Connect with Dr. Cernaianu
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134 - Rethinking Breast Cancer Screening on Hormone Therapy: A Fresh Perspective, Part 4
04/24/2026
134 - Rethinking Breast Cancer Screening on Hormone Therapy: A Fresh Perspective, Part 4
In this episode we’re concluding our conversation about breast cancer screening. This part discusses the importance of breast exams and what an ideal breast surveillance process could look like (versus how it looks today for most women). Many women today are bypassing a breast exam by believing that a mammogram is sufficient. Here’s the truth: 10% of breast cancers are not picked up by a mammogram. You should have a breast exam performed at the doctor’s office annually. You can also perform your own regular breast exams at home. Regardless of whether or not you need a pap smear, you will still always need an annual breast exam. Breast cancer risk increases as you get older, so during menopause and beyond is not the time to put off testing. While a pap test can identify potential risks very early, the mammogram does not screen for pre-cancer changes. A mammogram picks up breast cancer early on—hopefully early enough to save your life. Introducing new testing that could identify harmful cell growth early on in breast tissue will allow time for the woman to create a plan of action with her health care provider. We should also be screening for inflammatory markers, hormone imbalance markers, and more so we can identify risks as early as possible. Not using hormone therapy isn’t a guaranteed protection against breast cancer. It may also not decrease your risk. Hormones are not to blame for increasing breast cancer risk. In fact, the picture is so much bigger than that. We have to take a look at our lives as a whole to really identify what actually increases breast cancer incidence. Connect with Dr. Cernaianu
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133 - Rethinking Breast Cancer Screening on Hormone Therapy: A Fresh Perspective, Part 3
04/17/2026
133 - Rethinking Breast Cancer Screening on Hormone Therapy: A Fresh Perspective, Part 3
We’re moving on to part 3 of our conversation about breast cancer screening in this episode. Previously, we’ve covered breast health surveillance in general. Today, we’re going to dive into breast cancer screening when a woman is on hormone therapy, as this therapy often brings up concerns for breast cancer risk. So, is there an association between hormone therapy and breast cancer? Although hormone therapy doesn’t cause breast cancer, this kind of therapy can act as a catalyst for existing cancerous tissues—if they’re already growing, estrogen-sensitive cancers can respond. Generally, the outcome is that your already present cancer may grow more quickly or become apparent faster. That said, hormone therapy isn’t the cause of the cancer. Some women experience extremely difficult issues going through menopause—so much so it creates an actual medical need to be on hormone therapy. Women who are on hormone therapy during menopause should consider increasing their surveillance. Ultimately, the responsibility will fall on you to figure out what caused your cancer in the first place. You’ll have to investigate and address the environmental factors, lifestyle factors, and more that could have contributed to it so you can avoid recurrence. The decisions you’ve made in years prior, like birth control use, for example, can have a significant impact on your risk of breast cancer. Generally, the further away from menopause you progress, your risk of cancer is going to go up no matter what. But will a lower dose of hormone therapy reduce the risk of associated cancer growth? While this is an option, remember that all hormones should be balanced and optimized to protect your health, as ultimately this will provide you with the most resilience. Connect with Dr. Cernaianu
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132 - Rethinking Breast Cancer Screening on Hormone Therapy: A Fresh Perspective, Part 2
04/10/2026
132 - Rethinking Breast Cancer Screening on Hormone Therapy: A Fresh Perspective, Part 2
In today’s episode we’re continuing our conversation about breast cancer surveillance, focusing on the risks of getting a regular mammogram. Last week, we discussed the cumulative risk of radiation damage that women are subjected to over decades of annual mammogram screenings. Mammograms also have shortcomings: they don’t detect pre-cancer changes. Many women aren’t aware of the unintended harm a regular mammogram can cause. One of those issues is overdiagnosis. This doesn’t refer to a false-positive diagnosis, but rather when a mammogram finds a cancer that grows slowly or not at all (which requires no treatment). However, mammograms can’t firmly identify these types, so all cancer is treated the same. This means some women enter aggressive treatment when it isn’t actually necessary, especially if they are older in age and may not recover well from the treatment they’ve been recommended. These false-positives can also lead to psychological harm. After the detection of an abnormal finding on a mammogram, women are often sent for additional screening tests (such as a diagnostic breast ultrasound). If this process continues, a woman may also be sent for a biopsy. However, this diagnostic process can take some time—months or even years—and may hurt her mental and emotional wellbeing. 93% of the additional testing required after an abnormal screening mammogram will yield normal, reassuring findings. The chance of false-positives also increases over time. This isn’t about dissuading women from getting screened, but it does highlight the importance of exploring screening options. Connect with Dr. Cernaianu
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131 - Rethinking Breast Cancer Screening on Hormone Therapy: A Fresh Perspective, Part 1
04/03/2026
131 - Rethinking Breast Cancer Screening on Hormone Therapy: A Fresh Perspective, Part 1
Today we’re beginning our conversation about breast cancer screening when on hormone therapy. There are biological markers and overall wellness indicators that need to be assessed every time a woman has an annual checkup when on hormone replacement therapy. Regardless of what therapies she is taking, every woman should have their breast wellbeing monitored, especially as she ages. Is an annual mammogram done over decades actually safe? Some medical experts say that the benefits of identifying cancer early outweighs the risk of yearly exposure to radiation. But the reality is that radiation exposure is cumulative, so you can achieve the maximum threshold for tolerance sooner than you’d think. On top of this, breast sensitivity is heightened when the breast cells are younger, so the risk is higher the younger you are. Aside from mammography, we now have other techniques for breast cancer detection. These advancements, like ultrasounds and thermography, should also be considered for use. Thermography offers great benefits and can do so much more than identify cancer when it’s present. This technology is also able to recognize abnormalities that could lead to cancer later on. When abnormal findings come up on mammograms, there is very little information to go on in terms of what should happen next. Early intervention is of the utmost importance when screening for breast cancer, but the question remains: what kind of screening methods are available for women? Mammograms are uncomfortable, and it would be much better for women to explore alternative options than to forgo any regular breast health monitoring at all. Connect with Dr. Cernaianu
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130 - The Future of Aging: Embracing Hormone Optimization, Part 3
03/20/2026
130 - The Future of Aging: Embracing Hormone Optimization, Part 3
In this episode I’m concluding our conversation about hormone optimization. Previously, we’ve discussed the difference between hormone therapy and hormone optimization, as well as the myths and benefits about hormone use for health optimization. Today, we’re looking at the bigger picture of overall health and how the rest of your body plays a role in hormone balance. How well our bodies function as we age is highly dependent on how balanced our hormones are. For women, that’s not just about estrogen. It’s also about how all the other major hormones in your body are balanced together. The integrity of your digestive lining is also a very important aspect of maintaining optimal hormone balance, as it plays a critical role for metabolizing and eliminating hormones. An unhealthy, highly processed diet, a sedentary lifestyle, and common use of some medications can seriously harm your gut health—and therefore your body’s ability to process hormones effectively. There are also environmental factors and stress factors that can cause inflammation and further harm your hormone and overall health. Inflammation of the gut lining needs to be addressed if you want to improve your overall health. When estrogen is lost during menopause, it will impact the levels of all other hormones. A loss of estrogen can also reduce thyroid function too. Simply replacing estrogen during menopause is not enough to ensure a woman is feeling her best. When estrogen declines in menopause, it affects insulin sensitvity, and this can lead to weight gain that seems more difficult to lose as you age. The earlier you start optimizing your hormones, the better you’ll feel through menopause and beyond. Connect with Dr. Cernaianu
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129 - The Future of Aging: Embracing Hormone Optimization, Part 2
03/13/2026
129 - The Future of Aging: Embracing Hormone Optimization, Part 2
Last week, I introduced the concept of what hormone optimization is and how it differs from hormone therapy. In this episode, let’s focus on exploring the myths about using hormones and how you can use hormone optimization to age on your own terms. Going through menopause means experiencing significant changes in hormone levels, including estrogen, testosterone, and progesterone. These hormone shifts will have an impact on how you feel (both mentally and physically) and may even lead you to feel a loss of control over things you had a handle on before. Hormone therapy, especially hormone optimization, gives women the opportunity to age the way they desire. It helps women experience these changes gradually and gracefully while maintaining physical and mental function as much as possible. The process of repair is driven by anabolic hormones, and these are the very hormones we lose with age. The earlier you start hormone optimization, the more likely you are to maintain the physical strength you have and protect yourself against osteoporosis. Despite what you may hear, hormone therapy is not risky or dangerous. When facilitated by a medical expert and professional, you can look forward to a lot of benefits. If you choose not to look into hormone therapy or hormone optimization, you deserve to do it with both eyes open. If you’re worried about being judged for asking your medical professionals about it, you’re not alone. But don’t let misinformation stop you from making an empowered decision for your health, especially one that can significantly impact the later years of your life. Connect with Dr. Cernaianu
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128 - The Future of Aging: Embracing Hormone Optimization, Part 1
03/06/2026
128 - The Future of Aging: Embracing Hormone Optimization, Part 1
Hormone optimization is a new and complicated topic, and we’re going to begin covering it in today’s episode. As women enter menopause and seek hormone replacement therapy as a solution, it’s important to have an understanding of how aging impacts the body and how hormone optimization can help. I recently listened to a podcast which compared hormone therapy to home renovation. The host, a retired doctor, discussed using the estradiol patch with oral progesterone (a common pair used in hormone therapy today). Taking into account the doses available for these products, there are only 10 possible dose combinations available. Do we honestly believe that these 10 combinations are going to balance the hormones of all individually unique women? While hormone replacement therapy can reduce unwanted symptoms like hot flashes, it doesn’t necessarily mean you’re achieving the best quality of life and highest function possible. Optimal functional levels reflect peak performance and wellbeing—not just the reduction of one or two symptoms. It goes beyond replacing what’s deficient, but instead focuses on restoring hormone levels to mirror a time in life where you looked and felt your best. Knowing the difference can help you manage expectations, should you pursue hormone replacement therapy. Menopause management should be (and may become over the next decade or two) its own specialty. It takes vast knowledge to truly help a woman reach a balanced, optimal state through hormone replacement treatment. I believe every woman should know what hormone optimization is and the benefits it can offer. Connect with Dr. Cernaianu
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127 - Prolapse Warning: The Unspoken Role of Estrogen in Female Health, Part 3
02/27/2026
127 - Prolapse Warning: The Unspoken Role of Estrogen in Female Health, Part 3
On today’s episode we’re concluding our conversation about prolapse, specifically focusing on pelvic prolapse. These pelvic floor muscles are a small yet crucial aspect of your overall muscle structure. Women who have given birth vaginally are more susceptible to experience pelvic floor prolapse, making this area of muscles even more important to know about. Menopause can also cause various changes in the pelvic area, and the farther ahead a woman when she started menopause, the more likely she is to experience pelvic prolapse. Yes, this is in large part due to hormonal changes, however after menopause many women stop having sex. Overall, their body may be healthy, but this lack of intimacy impacts the pelvic area too. Women tend to become highly motivated to pursue pelvic floor therapy and other types of support only after they've experienced prolapse. Essentially, they’re waiting until it’s too late. Pelvic prolapse is usually diagnosed in an advanced state, and women aren’t usually informed about it in any meaningful way during their lives. The earlier you start working on your pelvic health, the better results you’ll have. It’s important to have a significant amount of control over those muscles already in order to strengthen them. There’s also a treatment called EMSELLA which is designed to help you work on your pelvic floor muscles. There’s another device called the VTone which uses electrical stimulation. This intravaginal device makes contact with the appropriate muscle groups that women can control to their level of comfort. Neither of these treatments works overnight. It takes multiple treatments to produce significant results. Connect with Dr. Cernaianu
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126 - Prolapse Warning: The Unspoken Role of Estrogen in Female Health, Part 2
02/13/2026
126 - Prolapse Warning: The Unspoken Role of Estrogen in Female Health, Part 2
Let’s continue on with our conversation about prolapse. A great number of women experience prolapse after childbirth trauma, but this can also come up many years after menopause when the loss of estrogen starts to impact a woman’s pelvic floor muscles and tissues. Women on some form of hormone therapy can still experience issues with prolapse, especially since the replacement dose is nowhere near the level a woman has when she is younger. Even a relief of symptoms, like hot flashes for instance, doesn’t necessarily mean that her estrogen is back to the same level it was pre-menopause. A woman’s pelvic organs are held up by muscles, ligaments, tendons, and bones. These muscles also play a crucial role in bodily functions related to bladder control, bowel control, sexual function, and stabilizing organs during physical activity. When this is compromised, the uterus can descend into the vaginal canal to the point where you may even be able to feel it. This is called uterine prolapse. Something similar can happen with the bladder, which is called bladder prolapse. It can lead to significant urinary incontinence and discomfort. The rectum can also prolapse into the posterior wall of the vagina. This can cause difficulty passing stool. Generally speaking, women can usually recall the event that triggered their prolapse. Before this, they have likely already experienced a gradual weakening of the pelvic floor. Childbirth greatly increases the risk for pelvic floor prolapse. Delivering a baby through the vaginal opening results in great pressure and stress on the pelvic organs and tissues. The bigger the baby’s head, the greater the risk is for prolapse. Increased abdominal fat (obesity) can also weaken pelvic floor muscles. Some individuals may also have genetic disorders that impact muscle groups, including the pelvic floor. Connect with Dr. Cernaianu
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125 - Prolapse Warning: The Unspoken Role of Estrogen in Female Health, Part 1
02/06/2026
125 - Prolapse Warning: The Unspoken Role of Estrogen in Female Health, Part 1
In this episode we’re talking about something I haven’t yet approached on this show: prolapse, specifically as it relates to a very specific female condition. Many women aren’t aware of the vital connection between estrogen and the health of the tissues of their pelvic floor, but you’ll learn about it today. A prolapse is caused by a weakening of the pelvic floor that supports the female organs, and this displacement can lead those female organs to descend towards the vaginal opening. There is no pill or cream that can correct this condition, especially if it’s more advanced. Surgery can help, but sometimes only temporarily due to the underlying cause of the issue. Prolapse is associated with the trauma of childbirth, but other women may never experience it until after they’ve gone through menopause. The loss of estrogen impacts the elasticity, tone, and consistency of the connective tissues of the pelvic floor and vaginal walls. If you maintain a strong pelvic floor, it may help you avoid prolapse as you get older. Estrogen plays a vital role in the health of your pelvic floor, but for years, women have been told that estrogen therapy is bad for them. Therefore, so many are missing out on something that could really help them maintain the flexibility and integrity of the ligaments and connective tissue of their pelvic floor. For women, estrogen is your best friend when it comes to your health. An optimal level helps women support their pelvic floor. Estrogen enhances blood circulation, which also brings oxygen and nutrients to the tissues (including pelvic tissues). Estrogen therapy, applied early, can prevent a severe prolapse. Consider consulting with a health professional who is trained in estrogen therapy who can give you more information. Connect with Dr. Cernaianu
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124 - Managing Your Health Expenses: Beyond the Monthly Insurance Premiums
01/30/2026
124 - Managing Your Health Expenses: Beyond the Monthly Insurance Premiums
Today we’re continuing our conversation about health insurance, health expenses, and what to consider when you’re budgeting for your health. We often forget that health insurance is a business. And just like any other business, there’s a lot to know, and it takes a few extra intentional steps to truly understand it. Last episode, we discussed how your health insurance plan is not designed to maintain your health, but rather to treat diagnosed conditions and illnesses. Many people find it difficult to save for their health expenses while also paying for their insurance. So what can normal people who want to stay healthy and keep their insurance do? More than likely, your doctors (and their support staff) are far removed from what is happening with your specific insurance plan. Between their busy schedules and managing their own work environment, they’re not able to keep up with individual patient health insurance plans. The onus is on you to be prepared for your bill after each visit. In an ideal world, insurance plans would be a lot clearer and easier to understand. The financial burden on the patients is real, but so is the financial burden on the clinic. By the time your bills are generated for your medical services, weeks may have gone by. Delayed bills confuse patients and cripple doctors, but this is just how the process goes. Spend the time it takes to become educated on your health insurance plan. You will save yourself a lot of stress at the doctors office if you know what to expect. It’s not fun to talk about it, but it is very important. Don’t renew your plan without doing your due diligence, and be sure to check if your coverage will be the same as it was in previous years. Connect with Dr. Cernaianu
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123 - The Real Cost of Staying Healthy (Beyond Having an Insurance Plan)
01/23/2026
123 - The Real Cost of Staying Healthy (Beyond Having an Insurance Plan)
In this episode we’re diving deeper into health expenses to help you gain insight into where your money is best allocated. In the last episode, we explored how your health insurance is designed to treat illness, not to keep you healthy. Often, saving for your health treatments is the best option if you want to stay healthy. Unfortunately, that’s not an option for everybody, especially those who are already paying for expensive health plans. Be aware that most physicians, especially those working for corporations, are removed from the process of healthcare expenses. Their schedule is full and they don’t have time to deeply guide you through your healthcare expenses and options. Educating yourself is so important, especially as you get older. You have to know the basics of your insurance plan and be prepared as to what your bills will look like when you go visit your doctor. The four main numbers you need to know are: copay, coinsurance, deductible, and maximum out-of-pocket cost. Your copay is what you have to pay every time you see your doctor, no matter what the visit is for. Your coinsurance is a percentage of the medical cost for the services you receive, and percentages vary greatly. The deductible is the amount you must pay before your health insurance plan covers any expenses. Lastly, your maximum out-of-pocket cost is the ceiling you have to meet before your insurance will pay 100% your in-network healthcare expenses. Privately-owned, independent practices accepting health insurance are becoming less and less common. This is because their reimbursement is delayed, low, and there is poor coverage. Plus, there is also a rising cost of building a workforce, medical supplies, and more. If you can begin by educating yourself on your health insurance plan, you will make your life and your doctor’s life much easier. Connect with Dr. Cernaianu
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122 - 2026 Health Outlook: The Intersection of Insurance and Self-Care
01/16/2026
122 - 2026 Health Outlook: The Intersection of Insurance and Self-Care
Let’s talk about your health goals for this year and beyond. The truth is that basic self-care practices don’t always restore us to the level we desire. That’s where seeking additional support comes in, but in order to use that, we first have to understand insurance plans. The first basic question you can ask yourself is this: What kind of expense can actually bring the greatest value to your health? This can help you uncover where your money is best spent. Dedicating more time, effort, and money to your self-care now is the key to avoiding many of the health issues that some people accept come with aging. Having an insurance plan is vital if you have a serious health condition. Not after it happens, but at the point of diagnosis. The purpose of health insurance is to support treatment of disease, not to help you maintain your health. In fact, coverage often discourages care unless it’s part of an approved treatment plan for a diagnosed disease. Don’t invest in a health insurance plan if your goal is to maintain your health. The majority of people who purchase health insurance with the intention of safeguarding their health end up experiencing a rude awakening at their doctors office. It’s not the best place to put your money, especially considering the other expenses many people face today outside of their health. You may not know this, but your health insurance plan may be charging you triple (if not quadruple) what services used to cost, and here’s the catch: Doctors are being paid less by insurance companies than ever before. When you find out where your money is really going, you may want to take another look at your health insurance plan and what it’s really offering. Connect with Dr. Cernaianu
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121 - Why Self-Care is the Key to Achieving Your Health Goals in 2026
01/09/2026
121 - Why Self-Care is the Key to Achieving Your Health Goals in 2026
How you can achieve your health goals in 2026 and in all the years to come? Life can (and does) get busy, and time can move by quickly. Self-care doesn’t always feel easy, but prioritizing self-care is so important if you want to achieve a truly optimal state of health Many people struggle to intentionally dedicate time to their selfcare. Why? It’s often due to putting other people's health and wellness before our own, and this is especially true for women. For me, rest is going to be at the top of my priority list this year. I have a lot of obligations, responsibilities, and goals, and if I want to do all those things well I need to maintain a feeling of restoration and balance. Our culture of achievement has its upsides. It pushes us to do more and pursue our goals, but if you want to be at your best to accomplish those things, you have to be at the top of your game. And being at the top of your game requires the best, most cared-of version of yourself. When you take care of yourself, you’re better able to deal with stress. You don’t have to fight through fatigue or brain fog while working towards your goals. Self-care looks different for everybody, but for me it includes doing activities I enjoy (like pickleball and reading) and getting lots of sleep. For you, self-care activities could include balanced hormones and hormone therapy. It may also mean eating well and getting outside. You can also include what you love to do, whether that’s yoga, a community activity, or somewhere else you feel your best. I hope you’ll go into each week this year remembering to put yourself first. Connect with Dr. Cernaianu
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120 - Estrogen’s Role in Urinary Health for Aging Women: An Eye-Opening Discussion, Part 2
12/26/2025
120 - Estrogen’s Role in Urinary Health for Aging Women: An Eye-Opening Discussion, Part 2
Today we are continuing our conversation on women’s urinary health and the issues that arise during and after menopause such as loss of elasticity, vaginal discomfort, and urinary incontinence. These changes are all related to the loss of estrogen over time. Other conditions can impact estrogen production too, for example PCOS, certain medications, and eating disorders. Understanding the core issue of estrogen loss, regardless of the woman’s age, is extremely important. Estrogen therapy can make a significant difference for women struggling with urinary issues. Estrogen promotes healthy skin elasticity, which can support the bladder as it typically holds around 300-500ml of urine. Estrogen therapy doesn’t just increase estrogen in the body, but pellet therapy, for instance, can offer more stable levels of estrogen over time. More consistent levels of estrogen can help manage weight gain, which is another issue many women struggle with during and after menopause. It also promotes a healthier sleep, and quality of sleep heavily impacts a woman’s quality of life. It’s crucial that you don’t ignore these urinary issues once they begin to develop. A loss of elasticity is difficult to reverse the longer it goes on. The sooner you start hormone therapy, the more effective it will be in reducing the impact of menopause. Early intervention can keep some of the most difficult urinary challenges from becoming permanent struggles. As a woman, incontinence is something that’s likely to happen, especially if you don’t address it quickly. You deserve to age with dignity and a high quality of life and not with fear about tools like estrogen therapy which can actually support you later in life. Connect with Dr. Cernaianu
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119 - Estrogen’s Role in Urinary Health for Aging Women: An Eye-Opening Discussion, Part 1
12/19/2025
119 - Estrogen’s Role in Urinary Health for Aging Women: An Eye-Opening Discussion, Part 1
In today’s episode I’m talking about urinary health and the problems that can arise during and after menopause. These urinary problems can become an ongoing or worsening problem as time goes on. So what’s happening to the urinary tract as we age? The problems start in perimenopause, primarily beginning with an increase in urgency. Sometimes this change is subtle; an increase in getting up during the night to empty your bladder. It’s disturbing to your sleep, but it may not necessarily stand out at first. Increased urgency, frequency, and discomfort can also be a typical presentation of interstitial cystitis. These are also the same signs of a urinary tract infection (UTI). However, with a UTI, there tends to be more discomfort and pain at the end of voiding. Another urinary issue is urinary incontinence, such as urge incontinence, stress incontinence, or both. Involuntary leakage can vary depending on the woman experiencing it. These types of incidents can be extremely debilitating. Even though many women in their 8th decade of life experience incontinence, they tend not to bring it up with their doctor. As a result, they may not know the different treatments available, including lasers, PRP injections, hormone injections, and more. Most of the options for treatment are also affordable and can actually save you money on incontinence pads and diapers moving forward. Untreated urinary incontinence comes with health consequences like chronic UTIs, skin irritation, and an increase in falling and injuries. It can also lead to stress, anxiety, and depression. These issues naturally arise as estrogen declines, making it a normal part of the aging process for women. However, that doesn’t mean women shouldn’t explore the support that’s available for them, especially if it can increase their quality of life. Connect with Dr. Cernaianu
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118 - Painful Sex: The Story of Lichen Sclerosus, a Shockingly Under-Diagnosed Post-Menopause Skin Condition, Part 3
12/12/2025
118 - Painful Sex: The Story of Lichen Sclerosus, a Shockingly Under-Diagnosed Post-Menopause Skin Condition, Part 3
This week, let’s wrap up our series on lichen sclerosus by discussing more of the therapies available for treatment. If diagnosed and treated early, the condition can be greatly improved—especially if you’re using a hormone replacement therapy approach that’s been optimized. Aside from steroid medication, tacrolimus, estrogen therapy, and testosterone therapy (which were all options discussed in a previous episode), there are other treatment options like platelet-rich plasma, which can be injected to improve vaginal and sexual wellness. PRP is gaining in popularity because it’s considered to be minimally invasive. It’s done under topical anesthesia, and although the vaginal tissues may be sensitive after, there are very few side effects. PRP treatment can improve itching and burning, and may even support regeneration of healthier skin. However, it does need to be injected in the area that is impacted the most to be effective. The major downside to PRP therapy is cost. It is considered experimental, so no insurance plan will cover it. It’s also important to know that results may vary. While some patients experience great success, others see little effect. The success depends greatly on the overall regenerative capacity of the individual. Exosomes are a useful alternative to PRP and may even work better in women of an older age (or younger women with autoimmune issues or nutrient deficiencies). Exosomes are transport molecules that facilitate communication between the cells. Injecting exosomes locally or applying topically may reduce symptoms associated with lichen sclerosus or potentially eliminate them completely. Just like PRP, exosomes are considered experimental and not covered by insurance. Connect with Dr. Cernaianu
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117 - Painful Sex: The Story of Lichen Sclerosus, a Shockingly Under-Diagnosed Post-Menopause Skin Condition, Part 2
12/05/2025
117 - Painful Sex: The Story of Lichen Sclerosus, a Shockingly Under-Diagnosed Post-Menopause Skin Condition, Part 2
Let’s continue our conversation about lichen sclerosus, specifically focusing on treatment options this time. The treatments and therapies I’m discussing in this episode can actually be quite useful for many vaginal conditions and are something all women should know about. The first line of approved care for lichen sclerosus is a local application of a steroid medication, usually in an ointment form. Prolonged use of a steroid medication can lead to thinning of the skin, but it is particularly useful for women dealing with significant itching and plaque formation. Keep in mind that treatment does not mean reversing the course of the disease. Another treatment option—one I rarely use due to side effects and cost—is a topical tacrolimus. Tacrolimus is a potent immune system suppressant, and it can decrease the inflammation associated with this skin condition (as well as some others). It is only intended for short-term use, and can be compounded for application. There are also some unconventional options for care, including topical estrogen. It can improve dryness, reduce pain during sex, and support elasticity. Estrogen can also be used as treatment in the form of pellet therapy. This treatment option can help women return to more comfortable intimacy in as little as 4-6 weeks. Nothing is perfect, but estrogen pellets offer more consistent exposure than other options. Testosterone is another hormone that can be used in the treatment of lichen sclerosus. This hormone plays an important role in skin quality, and it has been demonstrated in improving skin elasticity and strength. Side effects and an adjustment of dose can reduce the risk of unwanted side effects. Connect with Dr. Cernaianu
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116 - Painful Sex: The Story of Lichen Sclerosus, a Shockingly Under-Diagnosed Post-Menopause Skin Condition, Part 1
11/28/2025
116 - Painful Sex: The Story of Lichen Sclerosus, a Shockingly Under-Diagnosed Post-Menopause Skin Condition, Part 1
Let’s talk about a surprisingly common skin condition that impacts women after menopause: Lichen sclerosus. It’s a chronic inflammation of the skin which creates a pathological change at the vaginal entrance. These skin changes are often underdiagnosed and even misdiagnosed, sometimes even for years. This debilitating skin condition can cause persistent and uncomfortable itching, white patches on the skin, and may also result in thinning of the skin. It can cause a disappearance of sensitive skin areas where certain tissue areas fuse. The skin can also crack, resulting in irritation and pain. Many women, after visiting their gynecologist, are shocked to find out their doctor missed their lichen sclerosus diagnosis. Often this means they’ve suffered with the symptoms for years without knowing the root cause of their issues. Unfortunately, the reality is many doctors mistake this condition for atrophy during menopause. If you’re experiencing painful sex, this skin condition is something worth investigating—especially if the initial stages of intimacy and penetration is where the discomfort happens. This condition is diagnosed through a skin biopsy. For accurate results, you’ll have to ask your doctor specifically to rule out lichen sclerosus. There are many skin disorders that can create inflammation and skin changes of the vaginal area. Many are accompanied by dryness and hinder the act of sexual penetration. Telling a woman to simply use a lubricant is subpar medical care, as it’s an important part of a woman’s wellness and life. Connect with Dr. Cernaianu
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115 - Holistic Non-Hormonal Approaches to Menopausal Urinary and Vaginal Health, Part 2
11/21/2025
115 - Holistic Non-Hormonal Approaches to Menopausal Urinary and Vaginal Health, Part 2
Today we’re continuing our conversation about natural solutions for vaginal wellness after menopause. There are various issues that can arise after menopause due to a drop in estrogen, and vaginal lubrication is one of the main ones that women seek to address. The tissues in the vaginal canal and opening are very sensitive, and after menopause, the area can be dry and the skin begins thinning. One of my favorite solutions is DHEA (dehydroepiandrosterone)—a hormone typically made by the adrenal gland but that can also be obtained through supplementation. For purposes of vaginal wellness, DHEA has to be applied directly to the tissue to be effective. Maintaining vaginal wellness isn’t just for women who have a partner, it’s also for women who are single too. When you find a man who you want to be intimate with, taking care of your vaginal health now will ensure that you’re ready. That’s where the specific devices designed to support the health of vaginal tissues can come in. I carry a device in my office to help with this particular issue. It’s a home use, red-light therapy device used purely for medical issues like vaginal atrophy. There is an 80-90% chance of improvement when used as recommended: three times a week for a maximum of ten minutes. When the desired outcome is achieved, it can be used just once a week. Women entering menopause, or going through it, should have an exam with an experienced gynecological doctor to assess tissue changes and to get support as quickly as possible. If your annual exam is already uncomfortable, it’s a sign that vaginal intercourse will also be uncomfortable. The sooner you address these changes, the less you will have to deal with difficult symptoms. Connect with Dr. Cernaianu
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114 - Holistic Non-Hormonal Approaches to Menopausal Urinary and Vaginal Health, Part 1
11/14/2025
114 - Holistic Non-Hormonal Approaches to Menopausal Urinary and Vaginal Health, Part 1
There has been very little research done in the area of urinary and vaginal wellness for menopausal and perimenopausal women, despite the number of women experiencing these issues increasing. This week, I’m starting a series of episodes about non-hormonal options available to women to overcome these concerns. Urinary tract infections (UTIs) tend to increase as women age, and staying hydrated is one thing that can help flush bacteria from the bladder wall, reducing the instance of infection. Cranberry juice can also protect the bladder from bacteria, but it has to be unsweetened (or you can take cranberry in supplement form). Our digestive health is interconnected with our vaginal health. Probiotics help maintain a healthy gut microbiome, and they can also support a healthy vaginal microbiome. There are even specific probiotic brands available for vaginal health. Good hygiene is also key to a woman’s urinary and vaginal health. Avoiding douching, holding in urine, and getting dehydrated can help. Women should also change their underwear after a workout. Some women may need to take antibiotics to protect themselves during times of sexual activity. Uva ursi (also known as bearberry) and goldenseal are herbs that can support urinary wellness, thanks to their anti-microbial elements. During menopause, many women experience vaginal dryness and irritation. Vaginal moisturizers can be used to reduce tears in the urethra and vaginal opening, which also supports a reduction in urinary tract infections. Coconut oil is an all-natural, safe vaginal lubricant that is widely available. Connect with Dr. Cernaianu
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113 - Restoring Comfort and Confidence in Menopause with Vaginal Estrogen, Part 2
11/07/2025
113 - Restoring Comfort and Confidence in Menopause with Vaginal Estrogen, Part 2
We’re getting intro part 2 of our conversation about vaginal estrogen and its usefulness for treating GSM (genital urinary syndrome of menopause) symptoms in this episode. Last time, we began discussing the importance of timing for hormone replacement therapy, including estrogen therapy. When you act early—before your symptoms get worse—it can make a big difference. The vaginal walls and vaginal lining will lose lubrication and architectural support over time without estrogen. This is also called vaginal atrophy. The loss of moisture, which is the main symptom, is directly linked to a decrease in estrogen. Exposing your body to increased estrogen, like through vaginal estrogen for example, won’t lead to a quick fix. It can take months of treatment before you start to notice a decrease in uncomfortable symptoms. Bringing your body back to a place where you feel a desire, or even a comfortability, with increased intimacy requires patience. Women have a right to know how valuable estrogen is to their intimacy. Portraying this hormone as the enemy when it’s actually a vital hormone leads to a lot of suffering. There are safe products available on the market for women, and everyone should know about them. This includes vaginal suppositories and estrogen creams. The differing options of vaginal estrogen each come with their own benefits and potential side effects. When exploring your options, remember that, in large part, the fear behind estrogen is generally unfounded. After menopause, women should be getting an annual pelvic ultrasound and discuss estrogen treatment options with their doctor if desired. Connect with Dr. Cernaianu
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112 - Restoring Comfort and Confidence in Menopause with Vaginal Estrogen, Part 1
10/31/2025
112 - Restoring Comfort and Confidence in Menopause with Vaginal Estrogen, Part 1
Today we’re talking about GSM: genitourinary syndrome of menopause. This new term encompasses the vaginal and urinary changes that happen during menopause. These changes don’t just impact women during menopause—they have long-lasting implications post-menopause as well. Some of these changes include increased urinary frequency and urgency, plus recurrent vaginal infections. Menopausal women may also experience urinary tract infections differently: they aren’t as painful. While this could be seen as a positive, it also makes it much more difficult to identify when the woman is experiencing a UTI. Many of the symptoms associated with GSM can be prevented when treated with vaginal estrogen. Vaginal estrogen is safe for women who have been diagnosed and treated for breast cancer, for women who have clotting disorders, and for women who have suffered heart attacks and strokes. Contrary to prior beliefs, the purpose of estrogen in a woman’s body is not limited to reproduction. Estrogen plays a significant role in making us feel good. So why shouldn’t we replace it when it’s lost? Vaginal estrogen can be used for specific, local effects, targeting the actual area it’s being administered too. Vaginal estrogen can be used by women who are also using other forms of hormone replacement therapy. Whether you’re already taking another type of estrogen, or you haven’t been but you want to explore vaginal estrogen to help manage your GSM, the sooner you talk to your health professional about it, the better. There is relief for your vaginal, sexual, and urinary wellness symptoms caused by a lack of estrogen. Connect with Dr. Cernaianu
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111 - Understanding Hormone Therapy Timing: The Secret to Post-Menopausal Optimal Health
10/24/2025
111 - Understanding Hormone Therapy Timing: The Secret to Post-Menopausal Optimal Health
Get ready to learn all about the timing for estrogen therapy and exactly when you should start hormone therapy for menopause. Timing is crucial because many women don’t know when the best time to use it is, often realized when there have been irreversible changes and it’s too late to undo them. Previous studies done on estrogen have scared women away from taking advantage of its benefits as a therapy earlier on. Yet, one of the main studies that led to widespread misinformation used oral synthetic estrogens. Keep in mind this hormone was one of the main ones available at the time. As soon as transdermal estrogen became available, the benefits it had over oral estrogen were clear. It works well and is associated with less risks than oral synthetic options. The median average age of the women in this study was 63 years old, which means these women had been in menopause for at least the last decade. At this stage, the benefits of estrogen therapy have been limited. Based on the issues contained in this study, the outcomes are skewed. What you have been told about the dangers of estrogen is simply not true. They have led to a lot of harmful myths about estrogen, even in cases where hormone replacement therapy with estrogen could actually be helpful. Using synthetic progestin should also be avoided. Instead, ask your doctor for bioidentical progesterone, which is highly available since its approval decades ago. The timing of your hormone replacement therapy is critical to the outcome. The earlier the better, especially if you want to proactively protect your health. Connect with Dr. Cernaianu
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110 - The Truth About Estrogen and Breast Cancer: What You Should Know - Part 3
10/17/2025
110 - The Truth About Estrogen and Breast Cancer: What You Should Know - Part 3
In this episode we’re bringing our conversation about the WHI study about estrogen to a close. This study scared many health care professionals (and their patients) out of using estrogen therapy. Today, we’re focusing on the reality of the risks associated with estrogen replacement therapy, especially whether or not there are actually any cancer-related risks. The breast cancer incidence in the women who took part in this study but did not receive hormone therapy (the placebo group) was almost identical to the women who received hormone treatment. The results, percentage wise, presented in this study were misleading. Another part of the study not explored was that women who took part who also had a hysterectomy showed a decrease in the incidence of cancer. Another idea not explored is the benefit of using estrogen and progesterone together, as it’s critical to balance these hormones in women. Long term birth control use can increase a woman’s risk for cancer, yet birth control is widely prescribed. Further to this point, when a woman who has used birth control most of her life and hormone replacement therapy after menopause gets cancer, no one will talk about the birth control. The people around her will likely point to the estrogen therapy as the culprit, even if she has been on it a very short amount of time. It takes courage to move even a single step towards what you feel is right for you. Don’t let the misconceptions about estrogen (and misleading public opinion) stop you from taking action and improving your life. I hope the takeaway for you today is that estrogen is not what some people would have you believe! Connect with Dr. Cernaianu
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109 - The Truth About Estrogen and Breast Cancer: What You Should Know - Part 2
10/10/2025
109 - The Truth About Estrogen and Breast Cancer: What You Should Know - Part 2
Today we’re continuing our conversation about the WHI study that led to some serious misconceptions about estrogen therapy. This study involved oral estrogen, synthetically made from pregnant horse urine, given to women 10+ years past menopause. It’s important to remember that by this time, these women had experienced irreversible changes due to how far into menopause they had been. This study looked specifically at the effect of estrogen in cardiovascular health in women. Estrogen therapy can help improve various unwanted symptoms in women, even past menopause. However, once you have plaque in your arteries, it’s nearly impossible to reverse it. The options for estrogen administration have also expanded since this study. At the time this research was conducted, transdermal patches hadn’t been embraced on the scale they would be. Many hormone specialists have criticized how this research was done and point out the many things they would have done differently at the time the study was done and today. I, and many doctors like me, do not use oral estrogen therapy with clients. Transdermal estrogen bypasses the liver, which is just one reason why it’s superior to oral estrogen. It therefore also has a much different risk profile than oral estrogen. Many women who are prescribed this potentially life-changing therapy feel dissuaded by FDA warnings and labels. It’s been designated as a warning for all estrogen products indiscriminately, when it should have been applied to oral estrogen products only. As a result of these labels, so many women are missing out on this life saving treatment. Connect with Dr. Cernaianu
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108 - The Truth About Estrogen and Breast Cancer: What You Should Know - Part 1
10/03/2025
108 - The Truth About Estrogen and Breast Cancer: What You Should Know - Part 1
For the next few episodes, I’m going to be focusing on the misconceptions around the relationship between estrogen and breast cancer. Many women are surrounded by people (even healthcare professionals) who tell them that estrogen is dangerous after menopause. However, this simply isn’t true. Recently, I have had a few women come to me with similar issues related to menopause. These patients spent years suffering as opposed to seeking options for support. But if we can prevent significant loss of function, why not try it? That’s where hormone replacement therapy comes in. Most women I see who decide to start hormone replacement therapy after menopause are so happy that they did. Instead of following their social conditioning to wait, or even suffer in silence, they decide to set themselves and their health as a priority. The mental shift I’d like to highlight here is instead of thinking “it’s not broken, let’s not fix it”, the thinking should be “it’s not broken, let’s maintain it.” Many women, including those who are already on hormone therapy, are afraid of taking estrogen due to the misconceptions about its role in breast cancer. For decades, estrogen therapy was recommended as a treatment for women during menopause. But in the early 2000s, a study was released that misled the public on how estrogen impacts women. It’s important to keep in mind this study was also run by cardiologists, not hormone specialists. In the next few episodes, I’ll be shedding more light on this topic, including how this study was done on the wrong women using the wrong medication and method of administration. Connect with Dr. Cernaianu
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107 - Why Women Aren't Told the Whole Truth About Estrogen
09/26/2025
107 - Why Women Aren't Told the Whole Truth About Estrogen
In this episode we’ll continue to explore the true value of estrogen and why it’s so important for women. It’s important to recognize that there are limiting factors as to why more women don’t invest in hormone replacement therapy treatments like estrogen. One of those factors is the cost, especially for women who put their wallet over their wellness. The health issues caused by menopause can be quite significant, and I believe hormone therapy should be much more accessible for women. It is the responsibility of health care professionals everywhere to convey why estrogen therapy is so valuable and how it can make a difference in their patient’s lives. The problem is most doctors aren’t trained in hormone replacement therapy (although this doesn’t necessarily stop them from talking badly about it). The idea that estrogen replacement could be harmful is illogical. Think about it: You have it in your body for decades before it’s lost during menopause. Of course, there are other drugs you can take to help you manage the various symptoms of menopause. Keep in mind that these drugs come with side effects, but estrogen replacement can come with a lot of benefits. The slanderous campaign against estrogen is unfounded. Without exposure to estrogen, a young girl would never become a young woman. She would have no secondary sex characteristics or puberty. Without estrogen, she’ll experience early cardiovascular issues and events. Estrogen doesn’t increase the risk of cancer—but the lack of it does increase the risk of various health issues. Connect with Dr. Cernaianu
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