Kim Vopni (00:01.986)
Dr. Maldonado, it's really a pleasure to have you here. I am looking forward to our conversation about thyroid, but also hormones, mainly hormones, and how it influences thyroid. This is something that became very apparent to me. I, through my own sleuth work,
found out I had an autoimmune thyroid, well first that my thyroid was needing some help, then there was an autoimmune component, plus it was right when I was in perimenopause, not knowing what perimenopause was at the time. And when I came out the other end, what I started to recommend to women in my community, especially if we can catch it earlier, so in our maybe 30s, earlier in life, but.
whenever you learn about it, get some baseline hormone testing and get some full thyroid testing done as well. Because I saw the two of them so intertwined and thought like, why is nobody talking about this? I feel like we say that a lot about women's health. Why is nobody talking about this?
Dr. Hilda Maldonado (01:01.95)
percent
Kim Vopni (01:02.846)
Yeah, so I'm really happy to have you here. I can't wait for our conversation. But first, can you please let the listeners know who you are, what you do, and what got you into the world of women's health?
Dr. Hilda Maldonado (01:14.615)
you
scheme I'm super happy to be here with you. I'll just say it again my name is Dr. Hilda Maldonado and I have been in the world of women's health for longer than I can actually think about. What got me into that world was a few things. When I was in medical school I absolutely loved hormones and endocrine which is not normal. Most medical students do
Kim Vopni (01:44.174)
Hahaha
Dr. Hilda Maldonado (01:45.168)
not like that subject and I absolutely loved it. And then I proceeded to do internal medicine residency. And when I went into the real world to work being a young female in a world of man, it was just organic where women started gravitating to want to make appointments with me. And at the very beginning, it was really truly all about menopause. And and later on in life, when I went through my own
perimenopausal nightmare was when I started going more into perimenopause. it's truly been my life's work, working with females, helping them first understand how their hormones work, be able to restore their internal balance, their system, their beauty, because hormones dictate beauty from the inside out as well. They dictate how we look even.
Kim Vopni (02:18.007)
hehe
Kim Vopni (02:42.936)
Mm-hmm.
Dr. Hilda Maldonado (02:44.921)
And finally to help them feel happy and comfortable inside their own bodies again. So that's been the greatest part of what my life's work has been. And what got me more into it, just because you asked me what got me into it was my own story, but we can leave that. Okay, well.
Kim Vopni (02:53.432)
Mm-hmm.
Kim Vopni (02:58.648)
Mm-hmm.
Kim Vopni (03:06.274)
No, tell us your story. think it's important for other people to hear stories so that we can either relate or not, but we can learn a lot from what other people have experienced and what they learned and what they did. So I would love to hear your story.
Dr. Hilda Maldonado (03:12.949)
Yes.
Dr. Hilda Maldonado (03:22.785)
Well, my story is that when I was 38, my system got completely out of control. Weight gain, brain fog, severe fatigue, was not able to get out of bed. I felt like I was 80 years old. Everything was hurting. Of course, this didn't happen from one day to the other. It was a progressive accumulation of symptoms. And I started looking for answers and I couldn't find the answers inside the conventional.
system. In fact, all my blood tests were normal and I decided to go to one of my colleagues to get another set of eyes because I was like, okay, everything looks normal. And I'm talking, I was doing even more advanced testing and she looked at me. I actually took her out for lunch before I saw her in the office and she looked at me and she said, you know, I really think you need to go on antidepressants. So make an appointment so I can give you antidepressants.
and I was like, no. I know I do not have a deficiency of antidepressants and I went on this journey of physician heal thyself where I was already doing functional medicine and a lot of gastrointestinal health and detoxification and that part of functional medicine but then I went in and as poorly as I was feeling went on to complete the fellowship on anti-aging and regenerative medicine.
Kim Vopni (04:24.91)
You
Dr. Hilda Maldonado (04:52.505)
and during that process, I was very blessed to find some of the instructors for the fellowship that took me under their wing and basically helped me connect the dots to gain my health back. Basically, we had to address everything. We had to address my adrenals, my thyroid, my progesterone, because now we know that perimenopausal is mostly progesterone deficiency. But back then, I'm talking a long time ago, that was not even...
on the table. And then after I was able to put myself back together, it literally became a stronger mission of mine to support women. I fired myself from my primary care practice. I let go of all the insurances and I went into a new location where all I did was consulting for women's health. In the midst of all of that, part of the story is that then right when I get myself put together and
I start in the process of helping women, the Women's Health Initiative study happened. Estrogen was taken away from women. Nobody wanted to prescribe it. And basically in my town, I was the go-to for females that wanted somebody that would listen to them and help them.
Kim Vopni (06:00.281)
Hm. Mm-hm.
Dr. Hilda Maldonado (06:14.739)
replace hormones when appropriate because there's times that they're not appropriate. So it all blends together with my story, but it took my health, suffering, where to the point I almost have to quit medicine because I couldn't get out of bed. To... Yes.
Kim Vopni (06:29.869)
Yeah, yeah and I think that's common. When I guess can you highlight what is it about perimenopause? You said the word progesterone deficiency which is a kind of a hallmark of perimenopause if you would. So what why are we facing a
progesterone deficiency. What's happening in perimenopause? Maybe define what is perimenopause? And then at what point would estrogen need to be brought on board?
Dr. Hilda Maldonado (07:03.921)
Absolutely. And this is so important because the same person goes through these two transitions back to back that are completely different. And just when you feel like you got yourself put together, then something else happens. So let's talk about perimenopause. By definition, perimenopause is the period of about 10 years before the time a woman hates menopause. It can start
In my case, it started at 38. I've seen people that it starts at 35. It could be 42, anywhere in that time. And it becomes a time where we're still ovulating, but the corpus luteum, which is the part that produces progesterone, doesn't produce progesterone efficiently. In addition to that, because it's the time of our lives when we have added stress,
We may be taking care of our children, know, there is school activities, our careers, marriages, elderly parents, community support, saying yes to everything, Type A personalities, all of those things come together and the adrenals start creating higher demands and the body is going to choose between survival or reproduction.
and it's extremely important for reproduction, but it's going to choose survival. So it's going to go into adrenal survival mode. then during that process, we can also have what's called an ovulatory cycles, which is cycles where you have menstruation, but you do not ovulate. And when I mentioned earlier, the corpus luteum, that is the ripe ovum. So that gets formed as a result of ovulation.
ovulating were not properly producing progesterone. Okay, so those are factors that contribute to that.
Dr. Hilda Maldonado (09:12.343)
Then what happens is that as a result, the estrogen and the progesterone get out of balance and during that period of time, we can be in what's called a state of estrogen dominance, but it's not because estrogen is bad for us. It's simply because we're having a progesterone deficiency. However, depending on lifestyle, when there is increased stress or maybe there is gastrointestinal
you know, healthy imbalances or there's lots of high cortisol in the system, you're going to then impair proper estrogen detoxification or chronic constipation, for example, which we can see that with thyroid problems as well, right? It's going to impair estrogen detoxification. Now there's going to be more estrogen accumulating. for the listeners, if you're impairing menopause,
and you want to really see how this is affecting yourself, just simply keep a calendar. Keep a calendar right when you have your period. You'll see that it's going to be almost always the 10 days before the next cycle where the symptoms happen. You can be more fatigued. You can be more bloated. You can retain more water. You can have headaches. You can be cranky. You can have more anxiety. I mean, it goes on and on and on. So did I answer your question?
Kim Vopni (10:40.559)
Mm-hmm. Yeah, absolutely. With the, and it's like, I'm thinking back to when I was going through all that again. I didn't, at the time, know the term perimenopause. I didn't know what was going on in my body. didn't, I...
I knew about the thyroid gland of course, but I didn't really know the thyroid. I didn't know all the intricacies about it. And I struggled with a lot of symptoms. You said yours was a bit of a nightmare. Same thing. It was all of these things. And constipation was a big one that I had always been so, I'd been the most regular pooper of all time. And all of a sudden I hadn't changed anything, but my body was changing, me not knowing it.
What role, so there's a thyroid and there was a thyroid component for me, but there's also the progesterone component as it relates to constipation. So what is it about the peri-, so take out the thyroid piece, I know that that's influenced. What is it about the progesterone piece that can make us constipated as well?
Dr. Hilda Maldonado (11:42.072)
On that I would have to research that to see what the mechanism but the one thing I will tell you is progesterone is a natural muscle relaxant. So when we don't have progesterone we're going to be more tense everywhere. In fact you can have muscle aches from tension that are because you don't have proper relaxation. Also progesterone is a
Kim Vopni (11:50.529)
Mm-hmm, mm-hmm. When we don't have it.
Kim Vopni (11:57.209)
Yeah.
Kim Vopni (12:05.007)
Yeah.
Dr. Hilda Maldonado (12:08.893)
All hormones support the neurotransmitters in our brain. So the neurotransmitters are the chemicals in our brain. Like everybody is going to probably relate with serotonin, right, which is a neurotransmitter. But then when it comes to progesterone, progesterone supports the neurotransmitter that's called GABA, G-A-B-A. And when it comes to neurotransmitters, not to get off subject, but I think this is important to be able to go to the bathroom because
Kim Vopni (12:13.061)
Mm-hmm.
Kim Vopni (12:20.026)
Mm-hmm.
Kim Vopni (12:29.016)
Mm-hmm.
Dr. Hilda Maldonado (12:38.877)
When it comes to neurotransmitters, there's excitatory and inhibitory neurotransmitters. And the excitatory neurotransmitters will lead to more anxiety versus the inhibitory neurotransmitters are going to help us be more relaxed. And progesterone supports GABA. So if I had to give you an off the cuff explanation, I really think it has to do more with not being able to relax yourself than anything else. Now we can research and if you know B.
Kim Vopni (12:53.359)
Mm-hmm.
Kim Vopni (13:01.658)
Mm-hmm.
Kim Vopni (13:06.032)
Yeah.
Dr. Hilda Maldonado (13:08.777)
please share it. If there is a biochemical component that I'm not aware of where progesterone actually physically has an effect on the bowels but I think it's going to be more from a muscle relaxation because the bowels do have a muscle layer, a smooth muscle layer.
Kim Vopni (13:10.138)
Mm-hmm.
Kim Vopni (13:15.855)
Mm-hmm.
Kim Vopni (13:19.642)
Mm-hmm. Mm-hmm.
Kim Vopni (13:26.575)
Yeah.
And the piece of the estrogen dominance, remember also when I was researching, so similar to yourself, I was being told I was normal, but I knew I wasn't, so I was doing all this research and I came across these terms, sorry, estrogen dominance. And as you said, it's not that we have too much estrogen.
or that estrogen is bad, but when that ratio is out of balance, when we aren't producing the progesterone from the corpus luteum, and then we don't have the progesterone to offset the estrogen, so then it's high relative to the progesterone or what its normal ratio is. And then the not being able to poop. And so I was in this cycle of estrogen dominance. Really, it was a progesterone.
deficiency, yet I was put on things like DIMM to try to bring my estrogen down, which I don't think was necessarily the best approach. should have been put on progesterone earlier than I was. Would you agree with that?
Dr. Hilda Maldonado (14:31.357)
It depends. It depends. Because at a foundational level, think about it this way. It depends on where were your systems before you got to that milestone. If we look at these hormonal changes as their milestones in life, right?
Kim Vopni (14:51.706)
Mm-hmm.
Dr. Hilda Maldonado (14:55.803)
If you were having a cellular subclinical low thyroid that was contributing to that constipation as well, we do need thyroid in order for the estrogen detoxification pathways to work properly. We also need thyroid to be able to not be constipated.
Kim Vopni (15:14.544)
Mm.
Got it.
Kim Vopni (15:22.926)
Mm-hmm.
Dr. Hilda Maldonado (15:23.575)
Okay, and in addition to that.
Estrogen itself goes through a roller coaster ride before you get to menopause Where one month you could be low the next month you could be high you can test it different times and get like crazy fluctuations, okay? so Some women can become estrogen dominant just because they're over producing estrogen because their bodies their bodies are saying This is the end of reproduction. Let's go for the last
Kim Vopni (15:44.464)
Mm-hmm.
Dr. Hilda Maldonado (15:58.326)
And he's going to be making estrogen as well. So it's hard to tell Kim because it is possible that you may have had if they did other tests, right? You may have had estrogen dominance for other reasons, but also if your thyroid was off, it's going to affect estrogen detoxification pathways. It's kind of interesting to me because a lot of women say, why is
Kim Vopni (15:59.365)
Hahaha
Kim Vopni (16:18.458)
Mm-hmm.
Kim Vopni (16:22.074)
Mm-hmm.
Dr. Hilda Maldonado (16:28.099)
is that I suddenly had low thyroid when I went into menopause, right? But I believe that what happens is that menopause, en masse, underlying...
Kim Vopni (16:44.026)
That's right. Yeah.
Dr. Hilda Maldonado (16:45.619)
suboptimal thyroid because you also need estrogen for your thyroid to work optimally at a tissue level. Okay. So then suddenly you remove the estrogen and you're unmasking the subclinical hypothyroidism. Does that make sense?
Kim Vopni (16:53.178)
Mm-hmm.
Kim Vopni (17:02.372)
Yeah, so interesting. The adrenal piece for those that aren't, like, I think the word, if you've done some deep diving into hormones and menopause and reading and what have you, you've most likely heard the term adrenal fatigue. There are some people who say, adrenal fatigue isn't a thing.
that there's other people that say it absolutely is a thing. What are the adrenal glands? What is their role and what does adrenal fatigue or adrenal like when they're overworked, what does that mean?
Dr. Hilda Maldonado (17:33.848)
Okay, this is,
one of my favorite areas to talk about because I lived all the stages of adrenal issues. First of all, the adrenals are very small glands that sit on top of the kidneys. They're about the size of a bean. And they are in charge among other jobs that the adrenals have. One of them is our fight or flight responses when it comes to cortisol. The interesting part of the adrenals
Kim Vopni (17:42.192)
Hehehe. Hehehe.
Dr. Hilda Maldonado (18:07.033)
is that they have the cortex, which does certain functions, and then the middle part, the medulla, that does other functions. But for this purpose, we're talking about adrenal fatigue. And you are right. In the conventional system, there is not such a thing as adrenal fatigue, which was one of my problems that we couldn't find what was wrong with me, because nobody knew
Kim Vopni (18:27.632)
Mm-hmm.
Dr. Hilda Maldonado (18:37.133)
to check my cortisol. I had to finally learn it and get my cortisol checked and in order to check your cortisol you cannot just do morning cortisol. You have to literally check your cortisol four times in one day.
And the easiest way to do that is to do saliva. Conventional physicians don't get taught anything about saliva. So I had to go and learn all of that, do it on myself, find out that I was flat-lined, absolutely flat-lined.
but actually the worst test I've ever seen. before you get to be flatlined, you go through a lot of different phases. And one of the phases being that you're basically getting the second winds in the evening. A lot of women that have adrenal issues, they have a difficult time getting up in the morning. They feel great around 10 in the morning. They have another down in energy between three and four p.m., which usually gets solved with cough.
Kim Vopni (19:15.22)
wow.
Kim Vopni (19:28.325)
Mm-hmm.
Dr. Hilda Maldonado (19:41.45)
coffee and sugar and then finally at 8 or 9 p.m. is when they take the second wind and they stay open till 2 or 3 in the morning. That happens way before you end the flatline because by the time you're flatline trust me you're not going to do any of those things all you want to do is get into a room and sleep for three days.
Kim Vopni (19:43.3)
Mm-hmm.
Kim Vopni (20:02.616)
Yeah, wow.
Dr. Hilda Maldonado (20:03.723)
So in the conventional world, only processes that you get taught when it comes to adrenals is Addison's disease, which is a severe deficiency of cortisol, or Cushion syndrome, which is an excess of cortisol. There is no conversation whatsoever of adrenal fatigue. And I will tell you, the person that saved my life, this is going to be broadcasted, but Dr. James Wilson literally took me under
Kim Vopni (20:16.848)
Mm-hmm.
Dr. Hilda Maldonado (20:33.497)
his wing and he saved my life. And he has a book that's called Adrenal Fatigue.
Kim Vopni (20:35.93)
Mm-hmm. Mm-hmm.
Amazing, And what like you've mentioned some symptoms, adrenal fatigue, that basically not wanting to do anything. How does that, how does do the adrenals? I know it's all tied together. How do adrenals influence the thyroid, influence hormones? You know, what's the cycle there of influence between them all?
Dr. Hilda Maldonado (21:03.627)
Well, at that point, we have to also talk about the mitochondria. Because at the end of the day, this lack of energy is really the mitochondria not being able to kick in the ATP. The ATP's are the small energy.
Kim Vopni (21:18.864)
Mm-hmm.
Kim Vopni (21:22.606)
Energy currency. Yeah.
Dr. Hilda Maldonado (21:23.511)
currencies, right? That the mitochondria produces and we have mitochondria everywhere in our body. there's that part, the energy, but also when we're going through the high stress where cortisol is high, okay?
Kim Vopni (21:41.263)
Mm-hmm.
Dr. Hilda Maldonado (21:43.234)
For thyroid to properly work, we need to be able to turn T4 into T3. And I can do a summary of how this system works before I continue the conversation. So the listeners can maybe pull out a piece of paper and write this down, right? So the brain produces TSH, thyroid stimulating hormone. The hypothalamus produces something that tells the pituitary gland in the brain to make that
Kim Vopni (21:51.236)
Mm-hmm.
Kim Vopni (21:57.659)
Sure, that'd be great.
Mm-hmm.
Kim Vopni (22:07.664)
Mm-hmm.
Dr. Hilda Maldonado (22:13.237)
thyroid stimulating hormone. That thyroid stimulating hormone is going to come to your thyroid which sits in your neck and tell it to produce thyroid hormones. It will produce T4, it will produce some T3, but that T4 has to take a tour in your bloodstream and most of it converts to T3 in the gastrointestinal tract and the liver.
So it goes from D4 to D3.
Then T3 goes to the cells and the cells have receptors which are the duct stations and then it gets into inside the cells and the mitochondria has receptors more docking stations to take that T3 inside and then produce ATP and many other processes that have to do with preventing what's called oxidative stress.
Kim Vopni (23:12.965)
Mm-hmm.
Dr. Hilda Maldonado (23:14.393)
the cortisol when the cortisol is high what happens is that T4 to T3 conversion gets blocked.
And that's not the only thing that blocks that conversion. There are prescription medications, there are nutrient deficiencies, are other reasons why that conversion doesn't happen. But when it comes to the adrenal glands and when you are go, go, go, a lot, I remember myself, and you probably can relate to this, I remember...
showing up for work, doing my things that I needed to do at home, and I had no energy or desire. I was pushing. It was push, push, push. And the more you push, the more caffeine, the more sugar, the worse habits, the more staying up late, not functioning in the daytime. And it becomes such a vicious cycle.
Kim Vopni (24:08.57)
Mm-hmm.
Mm-hmm.
Dr. Hilda Maldonado (24:12.723)
And the same thing when you finally get flatlined and you really don't have energy for your body to work on metabolic processes.
Kim Vopni (24:21.538)
Yeah, yeah, yeah, it's crazy. The transition, so we've talked about what perimenopause is, menopause being that one day of 12 consecutive months without a period, and then after that we have, we're basically post-menopause. Sorry if you can hear the fairy horns in the background.
How does this shift, so the fluctuations in perimenopause and then getting to really a perpetually low hormone state, how does that influence our overall health when we think about our cardiovascular system, our brain, our bones, what's happening?
Dr. Hilda Maldonado (25:06.667)
Yes. And this is where there is a monkey wrench that happens because you're dealing with all these other things that have to do with bari manapause. Estrogen did not decline suddenly. It went through this whole entire roller coaster. And finally, estrogen starts to decline to the point that it may get to very low levels. OK.
Kim Vopni (25:24.24)
Mm-hmm.
Dr. Hilda Maldonado (25:35.21)
I think the first mistake that's being done in our conventional system is precisely that we're holding on to that definition of menopause being one year without periods.
because that's a key year that gets lost. A lot of women decide to wait, maybe their own doctors tell them, we cannot do anything for you until you've had one year without periods. In the meantime, you probably went one year with low estrogen, not sleeping, which is going to affect your immune system.
feeling tired, gaining weight because you become more insulin resistant. Now if you had an underlying thyroid condition now it really shows up.
You may be swelling. You may have pain in the plantar surface of your feet. You may have joint aches. Suddenly you start seeing you go to the gym and your workouts are not working and your muscle tone is, you know, your density muscle mass is not progressing. And then for those that become educated and finally take care of it, they wasted an entire year.
Kim Vopni (26:49.264)
Mm-hmm.
Kim Vopni (26:58.756)
Such a good point.
Dr. Hilda Maldonado (27:00.777)
an entire year. Marriages suffer, children suffer, workforce suffers. That year is absolutely important, but I want to make a distinction. Very early on, you can be without periods and not need estrogen.
So not every person that's missing her periods needs to go on estrogen. That's why it's important to test. And a lot of the conventional system goes and says, we don't need to test. We're only wait until you get hot flashes or night sweats or you cannot sleep. Now we know that finally the ban was lifted on the black box warning for estrogen. And now everywhere,
Kim Vopni (27:43.632)
Mm-hmm.
Dr. Hilda Maldonado (27:56.042)
there is information about the benefits for cardiovascular health and brain health. And if I had to sum it up for you on why estrogen is so important for cardiovascular and for brain health, we gotta go back and revisit the mitochondria.
because the mitochondria being the energy powerhouses, not only benefits from estrogen when it comes to ATP production, but it also benefits from estrogen when it comes to antioxidant protection. Okay? And...
And you probably know, but not everybody knows, there's these things that are called reactive oxygen species, which are the ones that create more cellular damage. Well, estrogen helps keep that all under control. And what are the organs that depend the most on mitochondria? The heart? Everything, but the heart and the brain.
Kim Vopni (28:51.632)
Everything.
Dr. Hilda Maldonado (28:55.861)
because they're very, you know, energy, they need a lot of energy. So, and in addition to that, we had been told that estrogen was bad for cardiovascular health, which was never true. Never was that true, even though was in a black box warning. And the distinction really was, and it still is, that if you replace estrogen and you do it orally,
Kim Vopni (28:58.692)
Mm-hmm.
Kim Vopni (29:11.76)
Mm-hmm.
Kim Vopni (29:16.922)
Mm-hmm.
Dr. Hilda Maldonado (29:25.845)
it by mouth. It goes through your liver and then you become inflamed. You get inflammation. You get increases in something that's highly sensitive CRP which becomes an independent cardiovascular risk factor and you also increase your risk for ghost stones as well as for blood clots. basically oral estrogen in my world is a no-no even if it's bioidentical.
Kim Vopni (29:42.116)
Mm-hmm.
Kim Vopni (29:54.64)
I didn't know there was bioidentical oral estrogen, got it. Okay. Compounded, I'm assuming. Yeah. Okay.
Dr. Hilda Maldonado (29:55.575)
Okay.
Yes, yeah, there is. huh, yes.
Yes, bioidentical compounded estrogen. And going back to my story, back in 1997, I made a decision to stop using any type of oral estrogens because like everybody else in the very early stages, I was using horse derived conjugated estrogens. And by following those women, I started seeing their lipids go up, more cardiology referrals. And in 1997, I stopped completely.
Kim Vopni (30:05.626)
Mm-hmm.
Kim Vopni (30:16.057)
Mm-hmm.
Kim Vopni (30:23.824)
Mm-hmm.
Dr. Hilda Maldonado (30:33.235)
and I transitioned to bioidentical transdermal estrogen as well as bioidentical progesterone, which has been available all along, but women were deprived of it because of the misinformation that was given to them through this study. And for those who don't know, it's the Women's Health Initiative study, what I'm talking about, which was just lifted this last year.
Kim Vopni (30:36.26)
Mm-hmm.
Mm-hmm.
Kim Vopni (30:43.525)
Right.
Kim Vopni (30:49.317)
Yeah.
Kim Vopni (30:53.988)
Yeah. Yeah. Yeah.
Dr. Hilda Maldonado (30:59.159)
So you asked me, your question really had to do with the navigation of perimenopause to menopause. So I think one of the things we have to do is define if that person is truly estrogen dominant without periods or is already estrogen deficient. And one of the symptoms that will let you know if you're starting to become estrogen deficient is vaginal odor.
Kim Vopni (31:17.22)
Mm-hmm.
Dr. Hilda Maldonado (31:29.995)
because the pH changes. And then that vaginal odor sometimes is very brief, like maybe for a week a month. And the woman goes, like, did I need to clean myself more? But if you start writing it in a calendar, you'll see that it's cyclical. And that will be a clue to the fact that you're starting to decline on estrogen.
Kim Vopni (31:38.052)
Mm-hmm.
Kim Vopni (31:42.362)
Mm-hmm. Mm-hmm.
Kim Vopni (31:49.69)
Mm-hmm.
Kim Vopni (31:55.312)
With testing, you mentioned earlier from a cortisol testing perspective, you mentioned doing the saliva and doing it multiple times in a day. There's also Dutch, the urine test multiple times in a day. I guess one question is, how do you feel saliva versus urine for cortisol? And then in terms of testing for...
the other hormones testing for thyroid. I only know of testing thyroid through blood, but please correct me if I'm wrong. What are your preferred testing, what would you use for testing? How often would you recommend people have them? And then once they're postmenopause, does any of that change in terms of your recommendations for testing?
Dr. Hilda Maldonado (32:45.687)
Okay, so I'll start one at a time. write a complex question. It's like, whoa, I need an assistant taking notes here. So, when it comes to cortisol, I still think that four-point saliva test is very helpful.
Kim Vopni (32:47.791)
I'm good at asking about five questions at once.
Kim Vopni (33:07.533)
Mm-hmm.
Dr. Hilda Maldonado (33:08.491)
But the reality of the situation is that if you sit down and you observe your energy patterns, you can pretty much know what your test is going to look like. It may be good to be able to show it to somebody that doesn't believe that that's going on with them, but it's not always necessary. You can just sit down with your pen and see how your body fluctuates during the day.
Kim Vopni (33:16.835)
Yeah. Yeah.
Kim Vopni (33:28.739)
Mm-hmm.
Mm-hmm. Yep.
Dr. Hilda Maldonado (33:35.608)
Because it's not practical to get poked four times in one day to get your blood for cortisol, right? That's not going to be practical. Then you mentioned urine. for me, personally, I choose urine when I'm looking at estrogen metabolites, which we've alluded to when we were talking about estrogen metabolism and the fact that they gave you DIM. So they gave you DIM in
Kim Vopni (33:42.071)
Yeah. Yeah.
Kim Vopni (33:55.406)
Mm-hmm.
Dr. Hilda Maldonado (34:05.591)
an effort to support your estrogen metabolism.
Kim Vopni (34:10.093)
And sort of detoxification, people call it that too, right? Yeah, okay.
Dr. Hilda Maldonado (34:13.303)
Right. So I do do urine when I'm looking at estrogen metabolites. And that's a whole other conversation. But bottom line is, I'll explain it this way to keep it simple. There are two roads, the number four road and the number two road. There's stop signs on that road, the OH and the ME. A new one, your metabolites to make it down to the ME.
Kim Vopni (34:18.543)
Mm-hmm.
Kim Vopni (34:29.049)
Mm-hmm.
Kim Vopni (34:42.489)
Mm-hmm.
Dr. Hilda Maldonado (34:43.221)
Now there's reasons why people don't metabolize properly besides constipation that we talked about and all the other things that we talked about. Also it could be genetics. They just have bad genetics for estrogen metabolism. So when it comes to estrogen metabolism, I like to look at the urine.
Kim Vopni (34:48.185)
Mm-hmm.
Dr. Hilda Maldonado (34:59.031)
When it comes to estrogen, estradiol, testosterone, progesterone, I really like to look at blood because it's easy, accessible. And the only difference would be if you're getting your blood done while you're in perimenopause and you're still cycling and you want to know your progesterone levels, then you want to do it on day 19, 20, or 21 of your cycle. And if you're, go ahead.
Kim Vopni (35:03.257)
Mm-hmm.
Kim Vopni (35:21.711)
Mm-hmm, got it.
I was just going to say and then post menopause what would change, if anything.
Dr. Hilda Maldonado (35:29.227)
Well, if it's early menopause and you want to know if you're deep in your estrogen, like especially if you're feeling that vaginal odor. And I can tell you because I went through these. Literally the same dates every month. And I'm like, what?
Kim Vopni (35:36.911)
Mm-hmm.
Mm-hmm.
Mm-hmm.
Dr. Hilda Maldonado (35:48.056)
What is this? Did I not shower? This is horrible. So this is the appropriate conversation in the Vagina Coach podcast. And then I started looking at my estrogen on day five, six and seven, and it just was not ramping up. So I did something for me that I'm not suggesting other people do, but I really started.
Kim Vopni (35:57.84)
Yeah.
Kim Vopni (36:07.481)
Mm-hmm.
Dr. Hilda Maldonado (36:16.137)
estrogen replacement very early on and I was no I was doing transtermal I started transtermal very early on on that perimenopausal time because that vaginal odor was I'm not making I'm not Suggesting people do this without talking to their physician But I was not willing to live that way. No it's in and
Kim Vopni (36:20.515)
vaginal estrogen or systemic estrogen?
Kim Vopni (36:36.387)
Yeah, absolutely.
And that changed then when you started using the systemic, the transdermal estrogen. That's very cool.
Dr. Hilda Maldonado (36:44.359)
my goodness, immediately, immediately. But also when you start estrogen at the very beginning, you gotta be careful because if your thyroid is off and you have a lot of inflammation and you start estrogen, you actually can make things worse. So it's...
Kim Vopni (36:57.967)
Mm-hmm.
Kim Vopni (37:03.416)
And why is that?
Dr. Hilda Maldonado (37:04.791)
It is because of the inflammation itself. Some women actually will turn on their influence, especially if they were progesterone deficient, estrogen dominant, those type of people, whether PCOS or even fibrocystic breasts or uterine fibroid, people, heavy menses, people that have had to have DNCs, even uterine ablations. Those histories, I would go really
Kim Vopni (37:17.401)
Mm-hmm.
Kim Vopni (37:24.559)
Mm-hmm.
Dr. Hilda Maldonado (37:34.745)
slow with the estrogen in the very beginning.
Kim Vopni (37:38.106)
Got it. Cool. Right. Yeah. If you, as we're kind of wrapping it up, what would you say to people who are in perimenopause, who are maybe starting to experience symptoms, or maybe they have no symptoms, but yet they're hearing the conversation around hormone therapy? What would you recommend for them to do? Would it be testing? Would it be?
Dr. Hilda Maldonado (37:40.183)
because they have a tendency for estrogen dominance.
Kim Vopni (38:05.411)
doing a consultation with somebody like yourself? Would it be reading books or listening to podcasts? How could they become more educated and take steps to, I guess, like not make it so tumultuous?
Dr. Hilda Maldonado (38:18.345)
I think the first thing is keep a calendar of your periods and your symptoms. Be very self-aware. Understand what's happening and that may take you two to three months.
Kim Vopni (38:25.539)
Mm-hmm.
Kim Vopni (38:35.279)
Mm-hmm.
Dr. Hilda Maldonado (38:35.831)
Then if you want to get your baseline, go get your baseline blood done, but make sure you do it on day 19, 20 or 21 of your cycle. And by the way, when it comes to blood, you can do the normal blood tests or you can do finger prick testing also for hormones and for thyroid. And
Kim Vopni (38:43.801)
Mm-hmm. Mm-hmm.
Kim Vopni (39:00.587)
I didn't know that. Okay, yep.
Dr. Hilda Maldonado (39:05.211)
If you are having symptoms, 10, seven days, 10 days, even five days before your cycle, you can start using low doses of transdermal progesterone with a caveat. That progesterone, you're either going to love it or hate it.
Kim Vopni (39:18.318)
Mm-hmm.
Dr. Hilda Maldonado (39:25.055)
because most women love it, but the few that hate it, they go like, don't give me that thing. Because basically they get severe tiredness, they don't do well with it, they don't metabolize it well. And then you may need to work on gastrointestinal health, maybe some other things are off. And that's the reason you cannot tolerate it. But low dose transdermal progesterone is even available over the counter.
Kim Vopni (39:30.521)
Mm-hmm.
Kim Vopni (39:37.859)
Mm-hmm.
Kim Vopni (39:42.927)
Mm-hmm.
Kim Vopni (39:50.008)
Mm-hmm. Mm-hmm. That is, I'm finding that's becoming a bit more challenging. I see it sometimes in stores. I know some people have it online, but I know that there are some people whose shops are getting shut down because they're supposed to be prescription only. You know, it's just another barrier for us to access things that are beneficial to our health, and it's so frustrating. yeah.
Dr. Hilda Maldonado (40:17.289)
One thing to watch out if you're going to use transdermal progesterone, whether it's over the counter or it's prescribed, and I'm just talking about my experience here, other people that listen may have different experiences, is that...
Kim Vopni (40:22.639)
Mm-hmm.
Mm-hmm.
Kim Vopni (40:29.081)
Mm-hmm.
Dr. Hilda Maldonado (40:31.517)
I see a lot of even prescribed progesterone where the physicians are writing it, they're writing it the same dose as an oral progesterone. So if they wanted to give the person 100 milligrams of progesterone, they're writing for 100 milligrams transdermal. And you want to decrease your transdermal progesterone by a tenth. So 100 milligrams oral would be 10 milligrams.
transdermal. And my favorite dose used to be 12 milligrams transdermal instead of the 20 that's available over the counter.
Kim Vopni (41:06.263)
So what's the reason why, why is that absorption or?
Dr. Hilda Maldonado (41:12.981)
Because when you're applying it on your skin, it's going straight in your capillary blood, and it doesn't have to go through the liver. So most of the progesterone, when you take it orally, it gets destroyed in the liver. So you really need to be using way lower transdermal than...
Kim Vopni (41:16.985)
Mm-hmm.
Kim Vopni (41:20.853)
Mm-hmm. Mm.
Kim Vopni (41:32.292)
Got it.
Kim Vopni (41:37.311)
Would you recommend people use transdermal as a whole instead of oral then? Like do you prefer using transdermal progesterone for people because of that so it's not getting destroyed in the Yeah.
Dr. Hilda Maldonado (41:47.798)
So it depends. If you are in perimenopause and you're just using it because you're starting your transitions, transdermal progesterone worked very well. If you're in perimenopause, closer to menopause, and you are not sleeping whatsoever, you may do better with an oral progesterone because oral progesterone is very helpful for sleep.
Kim Vopni (41:56.367)
Mm-hmm.
Mm-hmm.
Kim Vopni (42:06.713)
Mm-hmm.
Kim Vopni (42:10.905)
Mm-hmm.
Mm-hmm.
Dr. Hilda Maldonado (42:14.397)
If you're in menopause and you're taking hormone replacement with estradiol and hopefully it will be bioidentical, I prefer to use oral because the studies to protect the uterus have been done with oral progesterone. It is possible to do it with transdermal and I have seen it work, but you really have to be a little bit more vigilant.
Kim Vopni (42:34.713)
Mm-hmm.
Got it. Very cool. That's, and like as you're talking, that's really what, in terms of.
what worked with me. I don't mean to make this about me, but again, I like hearing people's stories and sharing. I was in the tumultuous, I had crazy symptoms and did lots of things. When I started the transdermal progesterone, it was helping. And then as I got closer, then I transitioned to the oral and that's where I'm at right now too. So it's following what your recommendations have been. So that's good, I guess.
Dr. Hilda Maldonado (42:48.256)
No.
Dr. Hilda Maldonado (43:08.631)
Yeah. And even with the estrogen, sometimes you have to transition. Sometimes when you start in the very early stages, you may only be able to do compounded 80 % estriol with 20 % estradiol.
Formula which is a weak formula and then later on some people may even need a stronger compounded product or they may need to go to a Patch there's people that do very well with patches. I have nothing against patches unless the person says that they cannot tolerate them They're convenient if you don't have allergy to them to the adhesive They work very well for some people. So you you have to progress. You're the same person but your
Kim Vopni (43:27.983)
Mm-hmm.
Kim Vopni (43:38.393)
Mm-hmm. Mm-hmm.
Kim Vopni (43:46.915)
Mm-hmm. Mm-hmm.
Dr. Hilda Maldonado (43:55.355)
hormones are shifting.
from decade to decade and because your hormones are shifting from decade to decade, now your systems as a whole down to the cellular system are going to be changing and the interactions with all the other hormones and then the outcome of that that we are all looking for, at least you and I, is resilience, is strength, is being able to work out, recovery, be alert, have mental clarity.
Kim Vopni (44:26.884)
Mm-hmm.
Dr. Hilda Maldonado (44:29.149)
focus, muscle mass, mean, all the good stuff, sleep well, know, not deal with hot flashes or night sweats or all these, I mean, I'm sorry, I don't mean to offend anybody, but there are people that have bought into this story that they are champions because they're tolerating their hot flashes and their night sweats.
Kim Vopni (44:33.358)
all the things we deserve and need. Yeah. Yeah.
Kim Vopni (44:56.078)
Yeah, they feel like they need to just tough it out. Yeah, yeah, I agree. I agree, yeah. No need to suffer. Yes, hallelujah. Let's leave it right there. Where can people find you and learn, potentially work with you, learn more about what you offer?
Dr. Hilda Maldonado (44:59.735)
There's no need.
No need. No need to suffer. Leaving suffering is not normal.
Dr. Hilda Maldonado (45:17.377)
they can go to drhildaMD.com and I think you have the link for that. And I also have purepassionwellness.com. And I have a gift for your listeners, which is a guide.
Kim Vopni (45:33.603)
Amazing, thank you.
Dr. Hilda Maldonado (45:35.541)
that I wrote and it's called The Truth about hormones, but it's specifically on estrogen. And it tells them also how to prep themselves when they go to the physician and what questions to ask and how to look at themselves as a whole entire system instead of just looking at. So that's a great way of finding me by getting that gift. And I am sure that you'll have the link for that.
Kim Vopni (45:48.25)
That is huge.
Kim Vopni (46:00.046)
Yeah, I'll have that linked in the show notes. Yeah, amazing. Thank you for that.
Dr. Hilda Maldonado (46:05.175)
And due to our conversation, I'm in the process of reviewing that book that's behind me, The Truth About Thyroid. It'll be revised and relaunched, and I will add a chapter on estrogen and thyroid connection.
Kim Vopni (46:12.741)
Mm-hmm.
Kim Vopni (46:18.147)
Amazing.
Amazing, thank you. That's a treat and a gift, a special gift. Thank you so much. was a pleasure chatting with you. I am looking forward to reading those myself and I really appreciate all that you do. Sometimes we have to go through our own stories that it's part of what allows us to help others. I'm glad you're on the other side. Your radiant, amazing, optimized well-being is...
very obvious when I hang out with you in person. So what you're doing is working and thank you for what you do for others and what you share here.
Dr. Hilda Maldonado (46:53.687)
Thank you so much. And I will say I'm about to turn 62 and I've gone through all of these transitions. The very menopause, the menopause.
Kim Vopni (47:01.87)
Yeah. Anybody who's watching this, if you go watch the video, like I would have said 40, maybe, you look extraordinary for your age. You look extraordinary just in general, not just because of your age, but nobody would guess that you're 62.
Dr. Hilda Maldonado (47:10.903)
you
Thank you.
Dr. Hilda Maldonado (47:20.085)
Yeah, but it's been a journey. I had to go through that nightmare to get to the other side.
Kim Vopni (47:26.244)
Yeah, but you did and you learned and now you're here. Thanks so much, Dr. Hilda.
Dr. Hilda Maldonado (47:31.764)
It's been my pleasure, Kim.
