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You Are Not Broken

Kelly Casperson, MD
You Are Not Broken
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  • 324. Perimenopause is Real
    🎙️ Episode 324: Perimenopause is Real—What You Need to Know with Jackie Piasta, WHNP-BC Perimenopause is real—and often misunderstood. In this episode, I sit down with women’s health nurse practitioner Jackie Piasta to unpack the truth about this critical (and neglected) phase of midlife. If you’ve been told “you’re too young” or “just tough it out,” this conversation will feel like the validation you’ve been missing. Jackie and I dive into what perimenopause really looks like—from migraines and mood swings to weight gain and disrupted sleep—and why these symptoms deserve real answers, not dismissal. We talk through what’s happening hormonally, why lab tests aren’t the gold standard, and how to shift from a “birth control” mindset to a hormone-optimization mindset in your 30s, 40s, and beyond. In this episode: Why perimenopause can start in your 30s—even with regular periods Common myths that keep women suffering in silence How to track symptoms and cycles instead of chasing lab results The role of hormonal birth control—and when it helps vs. masks symptoms How estradiol, progesterone, and vaginal hormones can support brain, sleep, and libido Supplements and newer options: magnesium, L-theanine, flibanserin, even topical CBD Real-world patient cases that show how individualized care changes lives Top takeaways: Perimenopause is a clinical diagnosis—there’s no perfect test. Hormonal fluctuations can cause real physical, emotional, and cognitive changes. Bone loss, lipid changes, and heart risks start before menopause. Progesterone is often underused but powerful for night sweats, anxiety, and sleep. SSRIs are not first-line for new-onset mood changes in perimenopause. Early intervention matters—don’t wait until menopause to get help. We also talk about newer birth control formulations, managing migraines, and what the research is showing us about how menopause impacts heart health and brain function. Spoiler: it’s not just about hot flashes. This episode is your permission slip to stop toughing it out and start asking for care that actually helps. 🔗 Referenced Studies & Resources: Brinton RD et al. Perimenopause as a neurological transition state. Nat Rev Endocrinol. 2015;11(7):393-405. Wu B et al. Trajectories of Blood Lipids Profile in Midlife Women. J Am Heart Assoc. 2023;12(22):e030388. SWAN Study: Lipid trajectory insights through the menopausal transition https://www.instagram.com/jackiep_gynnp https://www.mymonarchhealthco.com/ Want more honest, empowering conversations like this one?⁠Preorder my Next Book⁠ share this episode, and leave a review to help others find this important work. Let's stop leaving women out of the conversation—especially when it comes to sex, health, and healing. Listen to my Tedx Talk: ⁠⁠⁠⁠⁠⁠⁠Why we need adult sex ed⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠Take my Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠ Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠ To learn more about GennaMD by Solv Wellness, visit ⁠⁠⁠⁠⁠⁠⁠gennaMD.com ⁠⁠⁠⁠⁠⁠⁠for 20% off your first order. For an additional $5 off, use coupon code DRKELLY5. Providers can request patient education materials or samples at ⁠⁠⁠⁠⁠⁠⁠gennaMDHCP.com⁠⁠⁠⁠⁠⁠⁠.   Thanks to our sponsor ⁠⁠⁠⁠⁠⁠⁠Midi Women's Health⁠⁠⁠⁠⁠⁠⁠. Designed by midlife experts, delivered by experienced clinicians, covered by insurance.Midi is the first virtual care clinic made exclusively for women 40+. Evidence-based treatments. Personalized midlife care.⁠⁠⁠⁠⁠⁠⁠https://www.joinmidi.com Learn more about your ad choices. Visit podcastchoices.com/adchoices
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  • 323. Sexual Healing After Cancer
    In this episode, I sit down with Erin Sullivan Wagner for a raw and powerful conversation about something that’s too often ignored—sexual health in the context of cancer. Erin shares her personal experience with anal cancer, and what it was like to navigate the trauma of diagnosis and treatment while also feeling abandoned when it came to intimacy and her sexual well-being. We talk about the gaps in cancer care, especially when it comes to women. Why is it that sexual health is often dismissed or completely left out of the conversation? Erin and I unpack how deeply cultural biases and medical liability fears impact the way sexual health is (or isn’t) addressed—especially for women. We also dive into the concept of prehabilitation—starting sexual health conversations before treatment begins—and why it's critical that providers get educated and empowered to offer resources, referrals, and support for their patients. Because survivorship isn’t just about staying alive—it’s about staying connected to your body, your relationships, and your pleasure. This is the conversation I wish every oncology team would hear. Cancer profoundly affects sexual health, yet it’s often ignored. Erin’s story is a powerful reminder of the trauma that comes with being left in the dark. There’s a huge disconnect in how cancer care approaches female sexuality. Male sexual health gets prioritized—female sexual health, not so much. So many patients feel invisible when it comes to intimacy concerns. These conversations need to happen early, not after damage has been done. Cultural discomfort and medical fear of liability keep people from addressing sex. Women are rarely told what to expect sexually after cancer treatment. Quality of life includes sex, pleasure, and connection. We have to normalize sexual health in survivorship care. When we ignore it, the damage can be long-lasting and irreversible. Emotional intimacy matters as much as physical recovery. Prehabilitation should be standard practice. Providers need training—patients need validation and direction. Advocacy matters. This change starts with conversations like this. Youtube video - Erins Story https://www.aftercancer.co/ https://allofmeiowa.org/ Want more honest, empowering conversations like this one?Preorder my Next Book share this episode, and leave a review to help others find this important work. Let's stop leaving women out of the conversation—especially when it comes to sex, health, and healing. Listen to my Tedx Talk: ⁠⁠⁠⁠⁠⁠Why we need adult sex ed⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠Take my Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠ Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠ To learn more about GennaMD by Solv Wellness, visit ⁠⁠⁠⁠⁠⁠gennaMD.com ⁠⁠⁠⁠⁠⁠for 20% off your first order. For an additional $5 off, use coupon code DRKELLY5. Providers can request patient education materials or samples at ⁠⁠⁠⁠⁠⁠gennaMDHCP.com⁠⁠⁠⁠⁠⁠.   Thanks to our sponsor ⁠⁠⁠⁠⁠⁠Midi Women's Health⁠⁠⁠⁠⁠⁠. Designed by midlife experts, delivered by experienced clinicians, covered by insurance.Midi is the first virtual care clinic made exclusively for women 40+. Evidence-based treatments. Personalized midlife care.⁠⁠⁠⁠⁠⁠https://www.joinmidi.com Learn more about your ad choices. Visit podcastchoices.com/adchoices
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  • 322. Surgical Menopause - A Personal Narrative
    In this episode, number 322, I sit down with sex therapist Dr. Juliana Hauser for a deeply personal and powerful conversation about her experience with surgical menopause. She opens up about the decision-making process around her hysterectomy—what led her there, what she wishes she'd known beforehand, and how it impacted her physically, emotionally, and sexually. We discuss the importance of thoroughly understanding your hysterectomy options—not all procedures are the same, and having the right information can make a significant difference. Dr. Hauser shares how guided imagery became a key part of her healing process, and we dive into the complicated (and often frustrating) world of hormone therapy. She also brings up the role of doulas—not just for birth, but for menopause—highlighting how emotional support can be just as essential as medical care. We explore why open communication in relationships matters so much, especially when it comes to sexual confidence and intimacy post-surgery. This conversation is raw, real, and full of wisdom for anyone navigating hormonal changes, recovery after hysterectomy, or simply learning to advocate for themselves in a system that doesn’t always listen. https://dr-juliana.com/ https://flourishwholehealth.com/ ⁠⁠⁠⁠⁠Order my book⁠⁠⁠⁠⁠ "You Are Not Broken: Stop "Should-ing" All Over You Sex Life" and ⁠⁠⁠⁠"Menopause Moment: Science, Hormones and Mindset for Optimal Longevity"⁠⁠⁠⁠ Listen to my Tedx Talk: ⁠⁠⁠⁠⁠Why we need adult sex ed⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠Take my Adult Sex Ed Master Class:⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠ Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠ To learn more about GennaMD by Solv Wellness, visit ⁠gennaMD.com ⁠for 20% off your first order. For an additional $5 off, use coupon code DRKELLY5. Providers can request patient education materials or samples at ⁠gennaMDHCP.com⁠.   Thanks to our sponsor ⁠⁠⁠⁠⁠Midi Women's Health⁠⁠⁠⁠⁠. Designed by midlife experts, delivered by experienced clinicians, covered by insurance.Midi is the first virtual care clinic made exclusively for women 40+. Evidence-based treatments. Personalized midlife care.⁠⁠⁠⁠⁠https://www.joinmidi.com Learn more about your ad choices. Visit podcastchoices.com/adchoices
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  • 321. Joy, Burnout, and Being Real in Medicine with Dr. Tiffany Moon
    Welcome back! In this episode 321, I sit down with the incredible Dr. Tiffany Moon—an anesthesiologist, mom, entrepreneur, and yes, former Real Housewife. We delve into what it truly means to find joy in midlife and how social media often distorts our perception of happiness. Tiffany gets real about the pressure so many professionals—especially women in medicine—feel to "do it all" and how that expectation can lead straight to burnout. We talk about the addiction to busyness, the cultural layers that shape how we view therapy, and the wild (and often hilarious) intersection of medicine and reality TV. We also touch on AI’s growing presence in healthcare and what it means to redefine professionalism in today’s world. This one’s about self-trust, self-acceptance, and not waiting to enjoy your life. Dr. Tiffany brings humor, honesty, and a refreshing dose of perspective to a conversation that every working woman—especially in medicine—needs to hear. Joy Prescriptions by Dr. Moon Order my book⁠⁠⁠⁠⁠ "You Are Not Broken: Stop "Should-ing" All Over You Sex Life" and ⁠⁠⁠⁠"Menopause Moment: Science, Hormones and Mindset for Optimal Longevity"⁠⁠⁠⁠ Listen to my Tedx Talk: ⁠⁠⁠⁠⁠Why we need adult sex ed⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠Take my Adult Sex Ed Master Class:⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠ Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠ To learn more about GennaMD by Solv Wellness, visit ⁠⁠⁠⁠⁠gennaMD.com ⁠⁠⁠⁠⁠for 20% off your first order. For an additional $5 off, use coupon code DRKELLY5. Providers can request patient education materials or samples at ⁠⁠⁠⁠⁠gennaMDHCP.com⁠⁠⁠⁠⁠.   Thanks to our sponsor ⁠⁠⁠⁠⁠Midi Women's Health⁠⁠⁠⁠⁠. Designed by midlife experts, delivered by experienced clinicians, covered by insurance.Midi is the first virtual care clinic made exclusively for women 40+. Evidence-based treatments. Personalized midlife care.⁠⁠⁠⁠⁠https://www.joinmidi.com Learn more about your ad choices. Visit podcastchoices.com/adchoices
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  • 320. New GSM Guidelines: Science, Safety, and Speaking Up
    In this episode of the You Are Not Broken podcast, I’m diving into the brand-new clinical guidelines for Genitourinary Syndrome of Menopause (GSM)—because you deserve facts, not fear. We’re breaking down what GSM actually is, why it’s so often overlooked, and how these updated recommendations can help you and your clinician make informed, collaborative decisions about your care. I walk you through the full range of treatment options—yes, including hormones—and explain why vaginal estrogen remains a safe, effective choice, even for breast cancer survivors. We also talk about: Why education around hormonal changes in midlife isn’t optional The role of pelvic exams (and how to make them less intimidating) Non-hormonal treatments that actually work Why this all matters: GSM impacts your quality of life, intimacy, and overall health This episode is your call to action. Use these new guidelines as a springboard for conversations with your healthcare provider—especially if they’re not up to speed. Your body. Your voice. Your choice. AUA 2025 GSM Guidelines ⁠⁠⁠⁠Order my book⁠⁠⁠⁠ "You Are Not Broken: Stop "Should-ing" All Over You Sex Life" and ⁠⁠⁠"Menopause Moment: Science, Hormones and Mindset for Optimal Longevity"⁠⁠⁠ Listen to my Tedx Talk: ⁠⁠⁠⁠Why we need adult sex ed⁠⁠⁠⁠ ⁠⁠⁠⁠Take my Adult Sex Ed Master Class:⁠⁠⁠⁠ ⁠⁠⁠⁠My Website⁠⁠⁠⁠ Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠Waitlist is open⁠⁠⁠ To learn more about GennaMD by Solv Wellness, visit ⁠⁠⁠⁠gennaMD.com ⁠⁠⁠⁠for 20% off your first order. For an additional $5 off, use coupon code DRKELLY5. Providers can request patient education materials or samples at ⁠⁠⁠⁠gennaMDHCP.com⁠⁠⁠⁠.   Thanks to our sponsor ⁠⁠⁠⁠Midi Women's Health⁠⁠⁠⁠. Designed by midlife experts, delivered by experienced clinicians, covered by insurance.Midi is the first virtual care clinic made exclusively for women 40+. Evidence-based treatments. Personalized midlife care.⁠⁠⁠⁠https://www.joinmidi.com Learn more about your ad choices. Visit podcastchoices.com/adchoices
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Empowering women (and the partners who love them) to live their best mid lives. Combining the power of mind-work, body-science and relationships, I joyously smash the societal barriers that are keeping us from living our best intimate lives. Whether you are young or past menopause, single or in a long-term relationship, it is never too late or too early to realize YOU ARE NOT BROKEN. With humor, candor and ease, I break down the stories that we have been told about being sexual beings, to help us play, and normalize our intimacy and health. Nothing in this podcast is personal medical advice, of course.
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