Dr. Kerry Reller:
Hi, everybody. Welcome back to the Get Healthy Tampa Bay Podcast. I'm your host, Dr. Kerry Reller, and today we have Dr. Nicole Perrotte. Welcome to the podcast.

Dr. Nicole Perrotte:
Thank you. Thank you so much for having me.

Dr. Kerry Reller:
Why don't you tell us a little bit about who you are and what you do?

Dr. Nicole Perrotte:
So I'm Dr. Nicole Perrotte, as Dr. Reller just introduced. I'm a board-certified internal medicine physician, and my focus is currently in women's health around perimenopause and menopause. I'm also a certified life coach and health and wellness coach, so I’m bringing those two pieces together because that’s really what women in midlife need.

Dr. Kerry Reller:
Absolutely. I do agree. How did you kind of get into all of this? What made you want to get into health coaching and specifically menopause care?

Dr. Nicole Perrotte:
So I’m internal medicine, and I actually spent a big chunk of my career as a hospitalist. I spent about 12 to 14 years in the hospital working 12-hour shifts, seven on, seven off, seeing acutely ill patients — strokes, GI bleeds, pneumonias, ICU patients — the constant go, go, go. It was fine until I started to burn out after I had kids.

As I started dealing with burnout, I realized how much it was connected to trying to do all the things without good boundaries. That’s when I discovered coaching. As I worked through my own burnout, I started helping others with theirs.

Then over time, I realized there was significant overlap between burnout and women in midlife dealing with perimenopause and menopause. I started noticing I was exhausted, not sleeping well, waking up at 2:00 or 3:00 in the morning, having hot flashes and all the symptoms.

I went to my OB-GYN and asked, “What’s going on?” and she said, “Oh, you’re fine. You’re stressed. You need a vacation. Go on a date night.” I kid you not.

Dr. Kerry Reller:
Wow. How old were you at that point?

Dr. Nicole Perrotte:
Early 40s. And she also told me, “Oh, you’re young.” So I thought, “Okay, maybe I’m just stressed.” I tried all the things — vacations, date nights, better boundaries — but things actually got worse over the next year.

I wasn’t sleeping, my energy was low, I was gaining weight, and she kept counseling me on eating better and exercising more. The problem was that in med school and residency, we really didn’t learn much about perimenopause and menopause. What we heard was, “The WHI study says hormones are bad, so women should just push through.”

Eventually a friend mentioned hormones to me, and I thought, “Wait, what? I’m a doctor and I don’t know this?” So I started researching it myself and realized I checked so many boxes for perimenopause.

Dr. Kerry Reller:
Yeah, I feel like your story is just so common, and it’s sad. You can be burned out in any profession, and then you add hormone changes and estrogen dropping on top of that, and suddenly every system is affected. Then you end up seeing all these specialists trying to figure out what’s wrong.

Unfortunately, so many women have had similar experiences, and many still do. We just didn’t get that education in medical training. So how did you decide to start helping others with this?

Dr. Nicole Perrotte:
It really came from hearing the same story over and over again. Women were seeing family doctors, internists, OB-GYNs, cardiologists, therapists, sleep specialists — everyone — and still getting dismissed.

I realized this wasn’t going away. Half the population is eventually going to go through this. So I decided I wanted to be part of the solution and help provide women with resources and access to care.

Once I jumped into this field, I met so many other physicians and practitioners doing the same work, and it became very obvious how widespread the problem is.

Dr. Kerry Reller:
It’s so true. Unfortunately, the Women’s Health Initiative trials from 2002 created a lot of fear around hormones, and those findings were often misunderstood or misapplied. We still don’t have all the randomized controlled trials people want, but sometimes you have to listen to the patient and treat the person in front of you.

And I imagine that with your coaching background, you’re able to spend more time with patients and really individualize care.

Dr. Nicole Perrotte:
Absolutely. One of the most rewarding things is being able to spend 60 to 75 minutes with a new patient and really hear the whole story. When you have that time, you can put all the pieces together instead of immediately sending someone off to another specialist because of one isolated symptom.

Dr. Kerry Reller:
How do you incorporate health coaching into your menopause care?

Dr. Nicole Perrotte:
The foundation of treatment isn’t just medication. Yes, hormones matter, but so do nutrition, stress management, sleep, hydration, exercise, and strength training.

Because of my coaching background, I’m able to help patients build those habits in a sustainable way. We talk about protein intake, hydration, stress reduction, movement, and how to actually make all those things fit into their lives.

Dr. Kerry Reller:
This might be an unfair question, but why can’t someone just take estrogen? Why do they need all the other lifestyle changes too?

Dr. Nicole Perrotte:
That’s actually a very fair question. Hormones can absolutely help, but you still need the foundations in place — protein, muscle-building exercise, hydration, stress management. Those things support long-term health and help you feel your best.

On the flip side, lifestyle changes alone can help too, but you can’t fully replace hormones that your body naturally used to produce. The best outcomes usually come from combining both approaches.

Dr. Kerry Reller:
Exactly. Bone health, osteoporosis prevention, muscle preservation — it all ties together.

I also love your quote: “Your body is not broken, it’s asking for a reset.” What does that mean to you?

Dr. Nicole Perrotte:
Women often feel like their body is falling apart during this stage of life. I use the analogy of a car. As cars age, you don’t throw them away — you replace the oil, the wipers, the fluids. You maintain them.

It’s the same thing here. Your body isn’t broken. We just know more now than we used to about how to support women through this transition and reduce risks for chronic diseases down the road.

Dr. Kerry Reller:
What are some of those chronic risks that can increase after menopause?

Dr. Nicole Perrotte:
Weight gain and visceral fat accumulation are big ones. Cardiovascular disease risk also increases significantly after menopause. Then there’s osteoporosis and fracture risk, especially hip fractures.

We also think estrogen may play a role in brain protection and cognitive health, although we still need more research there. And then there are the genitourinary symptoms — recurrent urinary tract infections, vaginal dryness, discomfort — all tied to lower estrogen levels.

There are so many things we now recognize can potentially be improved or prevented when women are appropriately treated.

Dr. Kerry Reller:
Absolutely. And I think people forget that women are disproportionately affected by dementia, and not just because they live longer. We suspect estrogen may play a protective role there too.

You also mentioned abdominal weight gain and visceral fat. That likely contributes to insulin resistance as well, which itself is linked to dementia risk. It’s all interconnected.

Dr. Nicole Perrotte:
Exactly. We know visceral fat and insulin resistance become more common during this transition, which is why “eat less and exercise more” often doesn’t work the same way it did in your 20s or 30s.

That’s why strength training, adequate protein, hormones when appropriate, and lifestyle changes all matter together.

Dr. Kerry Reller:
Do you have a patient story that stands out to you?

Dr. Nicole Perrotte:
I recently saw a woman who had seen six or seven doctors — therapists, cardiologists, sleep specialists, emergency rooms — and she was going through a divorce because she felt like her whole life was falling apart.

She told me every doctor said she was “too young” for perimenopause, even though she was having all the symptoms. Her labs looked “normal,” but when I took a comprehensive history, she checked every box clinically.

We started treatment, and within three to four weeks, her symptom scores improved dramatically. She told me she was sleeping better, exercising more, eating less sugar, and no longer snapping at her kids.

It was such a powerful reminder of how life-changing appropriate treatment can be.

Dr. Kerry Reller:
That’s amazing. And I think it’s important to point out that labs are just a snapshot in time, especially in perimenopause when hormones fluctuate so much. Sometimes you really have to listen to the symptoms and treat the patient clinically.

Dr. Nicole Perrotte:
Exactly. The labs don’t always tell the whole story, especially during perimenopause when hormone levels can swing dramatically. Symptoms matter.

Dr. Kerry Reller:
If a woman listening to this feels like she’s resonating with everything you’re saying, what are a few things she can do right now?

Dr. Nicole Perrotte:
First, start tracking your symptoms. Sleep, mood, hot flashes, energy, cravings — everything. It helps create a clear picture.

Second, focus on sustainable lifestyle changes. Incorporate strength training, movement, hydration, and balanced nutrition rather than crash dieting.

Third, prioritize hydration. It sounds simple, but being adequately hydrated makes a huge difference in how women feel.

Dr. Kerry Reller:
Is there anything else you’d like to share about your approach to care?

Dr. Nicole Perrotte:
I think what makes my approach unique is combining hormone management with coaching and lifestyle support. It’s not just “Here’s your prescription, see you later.” It’s helping women truly change how they feel and function in everyday life.

Dr. Kerry Reller:
Are you running into shortages with estrogen patches in your practice?

Dr. Nicole Perrotte:
Not really, because I tend to use smaller pharmacies instead of the big chains. I’ve also used resources like Cost Plus and HRT Club to help patients access medications more reliably.

Dr. Kerry Reller:
Where can people find you if they want to work with you?

Dr. Nicole Perrotte:
I have a virtual practice called Thrive MD, and I currently see patients in seven states: Florida, Georgia, South Carolina, North Carolina, Iowa, Texas, and Washington.

I’m also on Instagram and LinkedIn.

Dr. Kerry Reller:
Love it. We’ll put all of that information in the show notes. Thank you so much for coming on the podcast today, and everybody stay tuned for next week’s episode.

Dr. Nicole Perrotte:
Thank you so much for having me.