How Hormone Therapy Can Improve GLP-1 Results (with Dr. Arianna Sholes-Douglas)

In this episode, Elizabeth welcomes back Dr. Arianna Sholes-Douglas — board-certified OB-GYN, author of *The Menopause Myth*, founder of Tula Wellness and Aesthetics, and host of the *Stay Juicy* podcast — for a powerful and wide-ranging conversation about menopause, metabolism, hormone therapy, GLP-1 medications, inflammation, and what it really means for women to thrive after 40.Dr. Arianna brings her signature mix of medical expertise, humor, candor, and whole-person wisdom to a topic so many women are quietly struggling with: why their bodies suddenly feel different, why weight loss becomes harder, why sleep, mood, sex drive, energy, and brain function can all shift in midlife — and why none of this is a personal failure.Together, Elizabeth and Dr. Arianna explore how estrogen, insulin sensitivity, thyroid function, gut health, cortisol, inflammation, nutrition, muscle mass, and GLP-1s all intersect. They also discuss why women using hormone therapy may experience better outcomes on GLP-1 medications, why estrogen is not simply a “weight loss tool,” and why menopause can be understood not only as a biological transition, but as a "body, mind, and soul" transformation.SHOW NOTES[ 00:00 ] GLP-1s, estrogen, and the anti-inflammatory lifestyle[ 00:53 ] Key question for women over: “Why is it so hard to lose this weight?”[ 03:05 ] Why so many women in perimenopause and menopause feel like their bodies have changed overnight[ 05:00 ] Estrogen, metabolism, gut health, inflammation, and abdominal fat[ 07:00 ] Why estrogen alone does not simply make midlife weight gain disappear[ 08:22 ] The hormone “orchestra”: estrogen, cortisol, testosterone, progesterone, thyroid, and gut health[ 10:00 ] Why midlife weight gain is due to biology, not personal failure[ 10:30 ] Thyroid health, Hashimoto’s, and why “normal labs” may not tell the whole story[ 12:17 ] T4 to T3 conversion, gut health, vitamin D, and thyroid optimization[ 16:37 ] Why deeper thyroid testing matters, especially for women[ 17:21 ] Hashimoto’s, gluten, gut health, and autoimmune thyroid issues[ 18:35 ] Why being “stuck” with weight loss can involve more than food or GLP-1s[ 19:29 ] How hormone therapy and GLP-1 medications may work together[ 21:56 ] Declining estrogen and insulin resistance[ 24:40 ] How GLP-1s and estrogen may support metabolic health through different but complementary pathways[ 25:27 ] Why women do not take estrogen simply to lose weight[ 26:00 ] Hot flashes, bone health, and the clinical indications for hormone therapy[ 27:21 ] Estrogen, skin, brain health, heart health, and the importance of understanding the evidence[ 30:29 ] Transdermal estrogen, oral estrogen, and why delivery method matters[ 32:35 ] Vaginal estrogen, vaginal tissue health, urinary tract health, and sexual wellness[ 35:21 ] Topical estrogen cream for the face and skin aging[ 36:36 ] How Dr. Arianna talks with patients about hormone therapy and GLP-1s together[ 38:24 ] Why women should know their A1C and metabolic numbers[ 39:00 ] Dr. Arianna’s personal experience with GLP-1s[ 41:39 ] GLP-1s, autoimmune conditions, joint pain, and inflammation[ 42:57 ] The inflammatory lifestyle versus the anti-inflammatory lifestyle[ 43:51 ] Do people need to stay on GLP-1s forever?[ 45:35 ] Elizabeth’s experience coming off a microdose GLP-1 and relying on her lifestyle toolkit[ 47:39 ] Why long-term GLP-1 use may make sense for some people based on family history, inflammation, and cardiovascular risk[ 49:24 ] Why weight regain is often about returning to old habits, not “failure” of the medication[ 50:49 ] Muscle loss, strength training, body composition, and doing GLP-1s the right way[ 52:35 ] Menopause as a "body, mind, and soul" transformation[ 53:34 ] The “estrogen veil,” authenticity, people-pleasing, and the “I do not care” era[ 56:43 ] Menopause, self-care, spirituality, and stepping into a new chapter[ 58:20 ] Dr. Arianna shares more about Tula Wellness and Aesthetics, *Stay Juicy*, and her work in women’s health[ 59:52 ] Compounded estrogen facial cream, hyaluronic acid, retinol, and slowing visible aging[ 01:01:05 ] Travel, pleasure, and what Dr. Arianna is most excited about next[ 01:02:18 ] Closing thoughts