Becoming Real with Dr. Lori—with Ann Konkoly, DNP, WHNP-BC, MSCP

Many women reach midlife knowing that something has changed. They are not sleeping well. Their mood feels different. Their thinking is not as clear, their joints hurt, or they simply do not feel like themselves. Then their lab results come back normal, and they are left wondering whether it is stress, aging, hormones, or something else entirely.

Perimenopause does not always begin with an obvious change in menstrual periods. Symptoms can start years before the final period, and some women—including those who have had a hysterectomy or use certain forms of birth control—do not have that marker at all.

In this episode, women’s health nurse practitioner Ann Konkoly joins me for a candid conversation about perimenopause, menopause, and hormone replacement therapy.

We look at what hormone testing can and cannot tell us, why so many symptoms are treated separately, and how changes in estrogen, progesterone, and testosterone may affect a woman’s physical, cognitive, emotional, and sexual health.

At the center of our conversation is the fear surrounding hormone replacement therapy. Much of that fear can be traced back to the 2002 Women’s Health Initiative and the way its early findings were communicated and applied. More than two decades later, many women still believe hormone therapy is automatically unsafe or simply not available to them.

The reality is more nuanced. The type of hormone, how it is delivered, when it is started, and a woman’s personal health history all matter. A blanket yes or no does not reflect the complexity of the science or the individual woman sitting in the exam room.

We also discuss symptoms women may not connect to hormonal changes, including sleep disruption, brain fog, anxiety, joint pain, frozen shoulder, dry eyes, changes in libido, and shifts in metabolic health. We address testosterone, off-label prescribing, and why it can be difficult to find a clinician with specific training in menopause care.

This episode is not intended to convince every woman to use hormone replacement therapy. HRT is not appropriate for everyone. It is intended to help women understand the conversation, recognize that treatment decisions are highly individual, and know what questions to ask.

Women deserve accurate information, thoughtful medical guidance, and the opportunity to participate fully in decisions about their own bodies.

About the Guest

Ann Konkoly, DNP, MBA, WHNP-BC, MSCP, is the founder of Kultivate Women’s Health. Her practice focuses on perimenopause, menopause, hormone therapy, metabolic health, sexual health, thyroid care, and preventive care for women in midlife.

Kultivate Women’s Health
Instagram: @annkonkoly.np
LinkedIn: Ann Konkoly

Resources

• Estrogen Matters, by Avrum Bluming, MD, and Carol Tavris, PhD
• The Menopause Society: Find a Menopause Practitioner
• The ’Pause Life Recommended Physicians
• Health by Heather Hirsch
• The Women’s Health Initiative
• ISSWSH guidance on testosterone therapy for women

An Important Note

The FDA announced changes to menopausal hormone-therapy labeling on November 10, 2025. The agency initiated the removal of boxed warnings concerning cardiovascular disease, breast cancer, stroke, and probable dementia. The boxed warning concerning endometrial cancer remains on systemic estrogen-only products.

This change does not mean hormone therapy is appropriate for everyone or free of risk. Treatment decisions should be based on a woman’s health history and made in consultation with a qualified clinician.

Read the HHS announcement.

If this episode touched something real in you, share it with a woman who may need it. To stay connected beyond the podcast, sign up for my email list at drloristevic.com.

Until next time, be brave enough to be real.

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