Q&A: Ozempic & emotional eating; HRT for bone health; depression meds; & bladder pressure

ICYMI 👉

• The Uncanny Upside of Health Anxiety

• How to Manage Anxiety When the World Feels Like It’s Falling Apart 🌎

• What is Your Blood Pressure Telling You?

---

Today’s LIVE Q&A is about cholesterol, blood pressure & preventing heart disease. Join me HERE TODAY at 4/25 at 3 pm ET!

Paid subscribers can submit their questions for me to answer live, right here!

---

In this week’s reader-submitted Q&A, we’re tackling these questions:

• Can GLP-1s mask the emotional roots of overeating?

• Does HRT protect bone health?

• Do I need medication to treat my depression?

• What’s causing my bladder pressure?

---

📣 Send me your questions for future Q&As! Click here to write me. ✍️

Photo by Oskar Kadaksoo on Unsplash

The following subscriber questions have been lightly edited for length and clarity.

QUESTION #1: OZEMPIC & EMOTIONAL EATING

Do you ever see patients using GLP-1s to avoid dealing with the emotional reasons behind overeating? Can these medications mask important inner work like other compulsive behaviors that aren’t related to eating?

- NK

Dear NK,

Yes. Absolutely. And I’m so glad you asked this—because this is where the conversation about GLP-1 medications like Ozempic gets real and interesting.

I’ve written about this before, but it bears repeating: these drugs are not magic. They don’t erase emotional pain or the stress of modern life. What they can do, however, is create more space between an impulse and response, such as the urge to emotionally eat and the act of eating. They can help quiet what is called “food noise.” They can allow people to feel full, which, for some people, can be a novel experience. They help liberate brain space that’s been occupied with ruminations about food and scarcity thinking.

Sometimes that quiet can feel uncomfortable. Because when food has been someone’s primary coping mechanism—for soothing, for numbing, for celebrating—and then that coping tool is suddenly gone or muted, it can leave people face-to-face with feelings that were previously managed by eating.

So yes, in my practice, I’ve seen both: people who experience profound freedom with GLP-1s—and people who realize, often with some surprise, that their relationship with food was just the visible tip of a much deeper emotional iceberg.

It’s why I don’t view Ozempic or any GLP-1 medication as a standalone solution for anything. It’s why I talk so much about agency, self-awareness, and treating the whole person—not just the number on the scale.

GLP-1s are powerful tools. But they work best—and do their most meaningful healing—when paired with behavioral modifications, curiosity about the origins of those behaviors, and always the reminder that weight loss alone doesn’t equal health.

---

QUESTION #2: HRT AND BONE HEALTH

Is there any role for hormone replacement therapy (HRT) in bone health—or is that mostly for menopausal symptoms?

- Jane

Jane,

Short answer? Yes—HRT absolutely plays a role in bone health. In fact, preserving bone density is one of the most well-documented (and often overlooked) benefits of hormone replacement therapy.

Estrogen isn’t just about hot flashes, mood swings, and vaginal dryness. Estrogen receptors are all over the body—including in the bones. During the menopause transition, when estrogen levels drop, bone breakdown speeds up dramatically. That’s why bone loss can accelerate in the years right after menopause—sometimes silently, sometimes not-so-silently, like with stress fractures or a surprising DEXA scan.

HRT isn’t the only tool for protecting bones, but it’s a powerful one—especially if started around the time of menopause. The North American Menopause Society and other expert groups recognize HRT as a first-line option for bone loss prevention in early postmenopausal women who are also dealing with other symptoms like hot flashes or sleep disruption.

Particularly for women within the 10-year window after their last menstrual period (i.e., someone navigating menopause), who need symptom relief and who want to protect bone health, HRT can check a lot of boxes.

Bone health is never just about calcium and vitamin D. It’s about hormones, muscle strength, movement, nutrition, and yes—sometimes medications that support your whole-body health, not just your skeleton.

---

QUESTION #3: MEDS FOR DEPRESSION

I’ve always preferred “natural” approaches to mental health, but I’m exhausted from trying to out-supplement and out-yoga my depression. Is there a middle ground between medication and lifestyle support?

- Cathy

Dear Cathy,

Yes. There is absolutely a middle ground—and I’d argue it’s not only where most people live, but where the most sustainable healing tends to happen.

First, let me say this clearly: You are not weak, wrong, or a failure for feeling exhausted by the constant effort of trying to “optimize” your way out of depression. I hear this all the time—people desperately trying to biohack their way to mental health with supplements, ice baths, yoga, journaling, adaptogens, therapy, breathing techniques, and a side of magnesium glycinate… all while quietly wondering why they’re still not okay.

Of course, those strategies can help. Lifestyle medicine is powerful. Movement, sleep, connection, nourishment, stress reduction—these are foundational to mental health. But when depression digs in, they’re often not enough on their own. And trying harder can become its own form of burnout.

This is where medication comes in—not as a last resort or a moral failure, but as a tool. A bridge. The right antidepressant, when used thoughtfully and in combination with therapy and lifestyle support, can give you the reserves—the margin—to do the work that healing actually requires.

As I’ve written before, mental health is health. Depression is not a “mindset.” It stems from the complex interaction of genetics, life experiences, brain chemistry, hormones, inflammation, and stress. And treating it often requires a layered approach—just like we’d use for blood pressure, diabetes, or chronic pain.

There’s no virtue in suffering needlessly. There’s wisdom in asking for help. And there’s power in using all the tools available—science, self-awareness, and yes, sometimes a little serotonin support—to feel more like yourself again.

---

QUESTION #4: BLADDER PRESSURE WITHOUT A UTI

I’m 72 and had a hysterectomy years ago. Lately I’ve had constant pressure in my bladder and that “need to pee” feeling, even right after I go. It’s not a UTI. Could this be from vaginal atrophy or something else? I’m on vaginal estrogen already but still miserable. What else can help?

- Leigh

Leigh,

You are describing such a common—and wildly under-discussed—issue for women in midlife and beyond. And you are absolutely not alone in feeling frustrated.

It sounds like it could be part of something called genitourinary syndrome of menopause (GSM)—a fancy medical term for the very real and very annoying bladder, vaginal, and urinary symptoms that happen when estrogen levels decline after menopause.

Even though you’re already using vaginal estrogen (which is absolutely the right starting point), sometimes it takes time—and additional strategies—to get real relief.

Estrogen is essential for maintaining the health of the vaginal and urethral tissues. Without it, the tissues can thin, become dry, irritated, and lose some of their natural elasticity. The bladder and urethra can become more sensitive too—leading to exactly what you’re describing: pressure, frequency, urgency, and that “never quite empty” feeling.

Things that can help beyond vaginal estrogen:

• Vaginal moisturizers (not just lubricants)—products like Replens or Revaree can help support tissue health in addition to estrogen.

• Urethral estrogen cream—sometimes applying a tiny bit of estrogen cream right at the urethral opening can specifically target bladder symptoms.

• Pelvic floor physical therapy—yes, even at 72! Especially after hysterectomy, pelvic floor muscles can become tight, weak, or uncoordinated—contributing to bladder symptoms.

• Hydration (but not overhydration)—too little fluid can irritate the bladder, but too much can overwhelm it.

• Avoiding bladder irritants like caffeine, alcohol, spicy foods, and artificial sweeteners if they seem to trigger symptoms for you.

• And sometimes, medications like vaginal DHEA or even low-dose bladder-specific medications can help if symptoms persist.

My big picture advice? Don’t give up. There are options. And it’s not in your head—it’s in your wise, lived-in body that deserves comfort and care!

Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.