Episode 54: Perimenopause Isn’t a Diagnosis, It’s a Midlife Shift with Dr. Theresa Pugh

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hello everyone and welcome backto TMI talk with Dr.
Mary.
I'm your host, Dr.
Mary.
I'm excited about this episode.
We're talking about howperimenopause is not a
diagnosis, it is a midlife shiftand all the things that come
with that.
And if you follow my socialmedia in the past or recently,
you know that I am in my earlyphases of perimenopause at the

(00:22):
age of 39.
And many times I've been toldI'm too young and.
It just can be incrediblydismissive.
And so I wanted Dr.
Theresa Pew to come on with meto talk about what's actually
happening in perimenopause,especially with all of the
information, and it can bereally confusing to understand
what's what I.

(00:42):
So if you're in your thirtiesand or forties or even fifties
and you work or you work withwomen in this age, this podcast
episode is for you.
So a little bit about Dr.
Theresa Pugh.
She is a board certified familypractitioner with over 20 years
of experience in familymedicine.
She received her medical degreefrom the Medical College of

(01:03):
Virginia at VCU, which is theVirginia Commonwealth University
and has completed residency.
C at Carle on health systemswhere she was able to train with
sports medicine department atVirginia Tech, A lifelong horse
woman.
She continues to ride andcompete in hunter and jumpers
and has become trained in equineassistant learning in the Epon

(01:26):
method.
She is a facilitator for anAustin-based nonprofit called
Horse Length that provides asanctuary for retired
competitive horses that provideequine programs for people who
have experienced trauma.
Dr.
Pew has become interested inintegrative medicine after she
was diagnosed with Sjogren's.

(01:47):
Through her own healing journey,she has gained valuable insight
into understanding and utilizingdifferent healing modalities to
help balance the body, mind, andspirit.
She's currently in privatepractice at Resilient Health in
Austin, Texas, and she enjoyshelping others with autoimmune
condition.
Conditions such as practicingprecision, personalized

(02:08):
healthcare, and using advancedtesting and medical genomics.
So what we're gonna go over inthis episode will be, we're
gonna cover why perimenopausestarts earlier than most people
think.
Like I was mentioning earlier,the difference between estrogen
dominance and low progesteroneand perimenopause, and how they
can show up together what'sreally happening when you wake

(02:30):
up at 3:00 AM and feel ragey.
I love that one just becauseit's what I'm feeling sometimes
how symptoms like constipation,hip pain, frozen shoulder, and
all anxiety can be related toperimenopause and the hormone
changes.
Why labs don't always tell thefull story.
What to know about dimM-T-H-F-R, methylated B vitamins

(02:53):
and hormone detox.
How fascia nervous systemdysregulation and stress can
play into perimenopause.
Why some people don't tolerateprogesterone and what to do
about it.
We also talk about why manypeople are told they're too
young to be in perimenopause,and that it's important to track

(03:13):
your symptoms so you canadvocate for yourself or tell
this to your patients as well.
Because we know in our currenthealthcare system, time is
limited with practitionersunless they're out of network.
That.
They can get more time, but thereality is there's still a lot
of people that are unable to dothat.
And so we talk about trackingyour symptoms to fully
understand or be able toarticulate with faster results

(03:36):
to your client's practitioner,or for you as well if you're
going through this.
So without further ado, we willjump into this episode.
Welcome back to TMI talk withDr.
Mary where we dive intonon-traditional forms of health
that were once labeled as tabooor dismissed as Woo.
I'm your host, Dr.

(03:56):
Mary.
I'm an orthopedic and pelvicfloor physical therapist who
helps health.
Movement and rehab professionalsintegrate whole body healing by
blending the nervous system intotraditional biomechanics to
maximize patient outcomes.
I use a non-traditional approachthat has helped thousands of
people address the deeper rootsof health that often get
overlooked in conventionalwestern training.

(04:18):
And now we are gonna be startingour next episode.
welcome to the show, Dr.
Pugh.
I'm excited that you're here.
Thank you so much for having me.
Yes.
We're gonna dive into all thingsperimenopause, and you've
already taught me so much justwith you and I being friends
outside of this and just youradvice that you've given.
Even just when we went to dinnera few weeks ago, I was like, oh

(04:39):
my gosh.
Just so mind blowing the stuffthat you know.
So thank you for coming on.
Absolutely.
Well, let's just go ahead andjump in.
Yeah.
So what, how can somebody knowwhen they're in perimenopause?
It can actually be difficult toknow early on because some of
the symptoms can overlap with alot of different things.
Um, particularly my patientswith thyroid disorders.

(05:02):
Some of those symptoms are verysimilar and so it can be hard to
tease out at first exactlywhat's happening.
But I think if you start tonotice particularly any kind of
cyclical changes, so if youstart having headaches that seem
to happen in a cluster for acouple of days each month, uh,
if you start to have mood swingsthat happen for a couple days
and then all of a sudden youfeel like yourself again,

(05:25):
something like that would kindof clue a person in that it
might be a hormonal issue.
Yeah.
Well, what are you seeing?
Like for me, I, I startedrealizing it was like the end of
my luteal phase.
So those last like as myestrogen.
And progesterone were decliningin the luteal phase.
Mm-hmm.
That was when I was seeing a lotof my symptoms.

(05:45):
When do you see, is that formost people or like is there a
common theme like maybe thespike of estrogen during
ovulation?
When do you tip, when, what arelike the common times that
people notice it?
Those would be the two.
So right mid cycle, maybe day,you know, 10 to 14.
12 to 14.
When the estrogen is spiking upat ovulation, you can see more

(06:08):
of the estrogen.
Uh, really strong estrogensymptoms.
So breast tenderness andswelling.
Weepiness, I always tellpatients like, if you start
crying at at t commercials, yourestrogen is probably a little
high.
Are there sad at t commercials?
No, they're not sad.
So if you're just like, oh, oh,you know, kind of crying at

(06:28):
something that you normallywouldn't, that might be a clue
that your estrogen's a littlehigh.
That's.
Thing ever.
You're probably an at tconvertibles.
Yeah.
You really shouldn't be.
Okay.
And then you, and then you kindof come back into your body for
a bit, and then, you know, thenthe progesterone's coming in for
the luteal phase, so yourprogesterone comes up.

(06:49):
People might feel a little morestable when that comes in, but
then as both hormones are divingright before your period, so
that week, right before yourperiod, for some people it's
just two days, three days.
But for some people it's longer.
It might be seven days dependingon that ratio of the
progesterone and estrogen.
Um, but when those hormonesstart to drop, that's, that's

(07:11):
probably when most people noticethe most symptoms.
And it's, it's the mostdramatic.
Yeah.
That was when I startednoticing, I'm like, why am I in
a rage?
Mm-hmm.
Why do I just hate everything?
Mm-hmm.
I'm, I don't understand.
I'm doing all this.
Inner work and mindset work andslowing down.
I mean, that's when I knew, Iwas like, okay, I had been
waking up and meditating.
I was walking in the morninggetting sunshine, eating, eating

(07:35):
super, like, you know, wholeFoods going to bed early.
And I was like, this is not,something is off.
Yeah.
And you can almost gaslightyourself.
Yeah, yeah, yeah.
I mean, estrogen keeps us fromeating our young, so just think
about that.
So when you want to just like,ah, you know, go after everyone
for no reason, that's a cluethat your estrogen is dropping.

(07:57):
Yeah.
Uhhuh.
Yeah.
Yeah.
Well then how, I think the partthat I have questions on is how
much of that though, how do youdetermine between estrogen
dominance and perimenopause?
So perimenopause, one of thefirst things that happens is
your progesterone levels startto drop.

(08:18):
Yeah.
That's the first thing thatstarts to happen.
So it actually throws you intoan estrogen dominant type state.
I see.
Okay.
Yeah.
So as the ovaries start to kindof wind down, your ovulation is
not as good.
Your eggs are not as healthy.
You may not be ovulating all thetime.
So when you don't ovulate,you're not gonna make the corpus

(08:38):
lium, which is what the, thefollicle turns into after you
ovulate.
The corpus luteum is whatproduces the, the progesterone.
So particularly during months,you don't ovulate, your
progesterone levels will beterrible, but just in general,
you start to not produce as muchprogesterone.
So then your estrogen levels,relatively speaking, are gonna
be higher than they would'vebeen when you were younger.

(09:00):
I think when people think aboutestrogen dominance, they think
like estrogen is actually morethan the progesterone.
So can you explain like whatthat.
Is for people so they canunderstand.
It's, it's pretty complex.
So it's, we did a whole episodeon it too.
You wanna listen but just, yeah.
Maybe more of explaining howlike progesterone is more than

(09:23):
estrogen.
Yes.
So in the luteal phase, so inthe follicular phase, we'll,
we'll back up.
So during your period, both ofthose hormones are pretty low.
Then during the follicularphase, progesterone stays low.
So those first really, if we, ifwe go on the classic 28 day
cycle for the first two weeks,your progesterone stays low
while the estrogen starts torise.

(09:45):
Then estrogen spikes up andpeaks at ovulation.
It's gonna dip down afterovulation, and then it's gonna
come back up and have anotherlittle sort of rollercoaster
hill.
During that time, so right afterovulation, that's when the
progesterone is coming in.
But the progesterone really iskind of higher, relatively
speaking, than the estrogen atthat point.

(10:05):
So when, so if, you know, ifwe've got progesterone, now I'm
using my hands, which you can'tsee on the audio only podcast,
but if you've got it,progesterone higher than if
you've got progesterone, higherthan estrogen.
But then all of a sudden inperimenopause, your progesterone
comes down.
Now you're sort of left,relatively speaking with more
estrogen.
But really the, you know, we, wekind of put it simply like that,

(10:26):
but it's, it's a bit like asymphony where everything's
playing.
It's all making lovely sounds,but sometimes an instrument will
come in a little stronger andyou'll hear it a little more.
Then it'll fade back and anotherinstrument will come in.
So the endocrine system, that'show I imagine it in my head, is
we've got all of these hormonesin tiny, tiny amounts too.

(10:47):
It's amazing how these tinyamounts of chemical messengers
have such big effects on ourbody.
But really on a minute tominute, hour by hour, day-to-day
basis, there's all thisfluctuation and ebb and flow of
all these things.
So when we're talking aboutthese levels, you know, we're
talking about them verygenerally, but you have to keep

(11:07):
in mind that when you do sayblood testing, we're getting a
one second in time picture ofwhat's happening there.
So I use a lot of the patient'ssymptoms to kind of tell me
about the picture.
I do use serum levels as well,but I like to have my patients
track their symptoms over acouple of months with their
periods, you know, kind ofmarking on a calendar when their

(11:30):
periods are seeing when thesesymptoms happen, because then I
can say, oh, okay.
The these things are happeningwhen your estrogen is dropping.
These are happening when it'sgoing up, and we can get a
little bit better picture of it.
Then when you look at the bloodlevels, you can say, okay, with
this progesterone estrogenquestion, is this somebody who
has normal estrogen and theirprogesterone is just coming down

(11:52):
like it does in perimenopause?
Or do we have somebody whoseprogesterone maybe is still
okay, but they're estrogendominant?
So maybe they're not inperimenopause yet.
Maybe they're just estrogendominant.
Or do we have both?
Do we, you know, do we havesomeone who's coming in estrogen
dominant and their progesteronestarts to drop and now they've
got a big gap here between.
You know, those hormone levelsand, and you need to kind of

(12:14):
address both those things sothen we might support their
progesterone as well assupporting some estrogen detox,
you know, maybe supporting theirliver or something like that so
that they can normalize thoseestrogen levels.
No, I love that you brought upthe detox part'cause I feel like
this isn't talked about as much.
Mm-hmm.
In the perimenopause andmenopause movement, people are
talking about, oh, hormones,hormones, hormones.

(12:36):
But we're not talking about howthey break down in us excreting
them.
Mm-hmm.
Another piece too is fascia.
So if our fascia's restricted,our lymphatic system that flows
through, it can't move asfreely.
And then if our estrogen and is,and progesterone declining it,
it like limits that resiliencymm-hmm.
In that too.
And so.

(12:58):
It's just another, from mystand, from like a PT
perspective.
Mm-hmm.
You know, I'm talking to peopleabout their fascia and
understanding like hydration andmovement.
Even if it doesn't feel likeit's much just even just walking
10 minutes a day.
Even if you're like, I didn'twanna do anything today.
It's like, just move 10 minutes.
Mm-hmm.
'cause it's helping pump thatlymph through the body and help

(13:19):
the body detox.
But I think kinda what you'resaying about the liver detox,
that is a whole nother level of,oh my gosh, this is insane.
And so explain to me.
Okay, so when we were at dinner,I was telling you, um, so I
actually went down.
So I started at a hundredmilligrams of progesterone.

(13:40):
Couldn't tell.
It was too sed sedative.
Mm-hmm.
So, because.
There's nothing lower than thatthat can be prescribed.
I had to have it compounded.
Mm-hmm.
So I went to 50 and that's beenthe sweet spot.
Mm-hmm.
Like I have felt good.
I'm sleeping through the night.
Like the biggest symptom for mewas sleep.
Yeah.
Um, and so what was it that youwere saying about.

(14:02):
Being careful about the wayprogesterone breaks down too.
Weren't you saying somethingalong that, uh, I don't remember
what, what the conversation wasat dinner.
That's okay.
But sometimes early in theperimenopause, uh, timeline,
women sometimes don't toleratethat full dose of progesterone
that we typically use, which isa hundred milligrams and it's a

(14:24):
gel cap, so we can't like, breaka piece off of it.
We couldn't.
Yeah, yeah, yeah.
So sometimes what you'll see is,yes, it's too sedating.
Uh, occasionally I have womenthat, you know, will retain
fluid or get headaches with it.
Progesterone is pretty early inthe, um, steroidogenesis
pathway.
So the pathway of how we makeall of our hormones, so they all
start with cholesterol.

(14:45):
We make a parent hormone calledOL alone, and then progesterone
kind of follows right afterthat.
And there's some.
Other things going on.
So then progesterone can feedsome testosterone and also feed
estrogen, but it also makescortisol.
Um, and I think you've coveredthat in some other podcasts, and
that's a whole nother, maybeseparate conversation about
stress effects here.

(15:05):
But, um, so.
Early in the, in the process ofperimenopause, if you're still
making some progesterone andyou, then you get another big
slug of progesterone that'smaybe more than your body needs.
It might shunt into these otherplaces.
So it might go down into makemore cortisol or make more
testosterone.
And then a person's having acne.
Oh wow.
Yeah.
Oh, that's okay.

(15:26):
That's what you were sayingthen.
Yeah.
So yeah, so sometimes we justneed to give a little bit.
So I'll do some low dosecompound or maybe a little bit
of topical progesterone, like a20 milligram cream or something
like that.
Uh, because.
Yeah, progesterone helps ussleep.
It's calming.
You know, some women, theirfirst symptom is they just start

(15:46):
having anxiety, heartpalpitations, or they can't fall
asleep.
They wake up at 3:00 AM whenyour adrenals turn on and your
cortisol starts to pop up.
So those are some of the firstsort of subtle symptoms for some
people.
Yeah.
I had no idea.
I was like, why do I keep wakingup middle of the night to pee?
Yeah.
I never did that.
Yeah.
And then I was, then I wentthrough my PT mind.

(16:06):
I'm like, oh, am I not?
I need to retrain my bladder,but I'm like, nothing's changed.
Yeah.
There's not like I'm eating.
Any things that irritate mybladder before bed.
And then finally I was justlike, I can't, I'm so tired.
And so it's just, I'm thankfulthat I found it pretty quickly,
like how it, how it worked forme.
And who knows.
It will probably, it will adjustthe time.

(16:28):
But what about the people?
'cause I've had patients thatcan't tolerate progesterone at
all.
They almost have like theseadverse effects where they're
just like extremely anxious.
They just don't feel good.
Is that because they're probablygiven too much and it's breaking
down into these other pathways?
Yeah.
And then again, if they reallyare sort of in, in adrenal

(16:50):
stress mode, so if sympatheticnervous system is in overdrive,
their body's in fight or flightmode and it's going danger,
danger, danger, uh, we need tomake cortisol, it'll be.
It's kind of going great.
We have progesterone, let's makemore cortisol from that.
And so then I might approach itfrom a totally different place.
I might go, okay, first, then weneed to work on that piece.

(17:12):
So where, what's the source ofthat stress?
Let's get you doing some breathwork, some meditation.
Do you need to outsource thatand go get acupuncture and let
someone else help you with it?
You know, do you need some bodywork?
You know, just whatever it willtake to kind of get the nervous
system calming down.
We might do some adrenal calmingtype herbs or supplements, uh,

(17:34):
any number of ways.
It doesn't matter really how youapproach that.
It's gonna be whatever works forthat person.
And then you can sometimes comeback later.
And just use a much lower doseof the progesterone.
Oh, that makes so much moresense.
And then you kind of ease theminto it.
Yeah.
And most people can end uptapering up on the progesterone
and tolerating it just fine.
Wow.
Yeah.
But initially they may not, theymay just not need that much.

(17:57):
They may just need to be nottaking away their progesterone
by making cortisol.
I see.
Well, and the other thing thatI've seen in this phase of life
is like, as the hormones arechanging, people have less
tolerance to bullshit.
Yes.
Literally.
Like it is.
No.
Yeah.
And so I, I also feel likeduring this phase of life,

(18:18):
there's a lot of questioning,like relationships, like there's
a lot of divorces, there's a lotof like changing of friendships.
Mm-hmm.
And like switching jobs, becauseI think the capacity is so much
lower for anything that doesn'tfeel like aligned for that
person.
Yeah.
That then it's like what I'veseen, and I've seen it in my
friends and clients and even.

(18:40):
I am not married now, but it'slike just not saying all
marriages are gonna just fallapart during perimenopause, but
I'm saying like maybe the stuffthat we were putting up with for
a long time that wasn't workingfor us, it just like kind of
rears its head and it's rightthere.
So you're talking estrogen therebecause estrogen makes us kind
of pee.
People pleasers.
Right?
It makes you really tolerate,how would you raise a toddler

(19:02):
otherwise, right?
Like, I don't know.
I don't have a toddler.
You have to have estrogen.
Yeah.
To have to have that love andcompassion and that I'm gonna
care for this and I'm gonna, nomatter if it throws up on me or
throws a temper tantrum or keepsme up all night, I still love it
so much.
And so that estrogen just givesyou all of that love and people
pleasing all that.

(19:23):
So then when you start on thisestrogen rollercoaster of
perimenopause, and you get thesetimes where your estrogen is
really low, now what do we havemore testosterone.
Right?
So we get ragey, oh my gosh.
Then we get to feel like whatit's like to be a man.
Wow.
That, I mean, I always thoughtit was.
To actually hear you validateit.

(19:43):
'cause that was a theory ofmine, of being like, oh, it must
be that their estrogen isdecreasing.
Mm-hmm.
So they have less tolerance forbs.
Mm-hmm.
But the other piece too, Ithink, is that because the
hormones are so in this fluxstage, that the nervous system
is like hyper reactive.
Mm-hmm.
Mm-hmm.
And there's less tolerance evenfor.
Any people policing or thingslike that.

(20:04):
'cause they just don't have itin them.
Yeah.
And then that's when I see theirbodies kind of developing.
Like hip pain is a big one.
I see.
Or um, pelvic pain in anycapacity, like low back pain or
constipation are some big ones.
And I know that estrogendecreased.
Estrogen cause constipation too.
Yeah.
So estrogen is moisturizing.

(20:24):
Okay.
Yeah.
So when you start to getdeclining estrogen levels, and
this is a big one that I thinkisn't talked about enough, but
again, some women, their, one oftheir first symptoms is
constipation.
Well constipation or some kindof joint problem.
Mm-hmm.
So frozen shoulder, um, hip,yeah.
Hip stiffness, plantarfasciitis, lateral

(20:44):
epicondylitis, tennis elbow.
If you have someone, especiallyPTs out there, if you have
someone that's coming to you andthey're like, I have never had a
shoulder problem in my entirelife.
I didn't have an injury.
I don't play a shoulderdependent sport.
And all of a sudden I can'tsleep'cause I can't lay on that
side, I can't, I can't raise myarm.
And if they're in their forties,early fifties, you know, you

(21:06):
could really help that person bysaying, Hey, you know this, this
can happen because of decliningestrogen levels.
You know, if you're a candidate,that might be a great way to
approach this, is to get on somehormone replacement therapy, get
your estrogen levels at least sothey're not bottoming out.
'cause the way I think about itis, again, estrogen is
moisturizing.
It makes everything stretchy.
So when that level comes down,if you think about a joint

(21:29):
capsule, it basically shrinkwraps.
Mm-hmm.
Right?
Yeah.
So think about that frozenshoulder just goes and tightens
up and.
There you go.
You can't raise your shoulderanymore and you can put, you can
help someone so much.
Now, the natural course of it,if you don't do anything, I have
found, and I think a lot ofpeople see this, is that frozen
shoulder usually starts on oneside and goes to lasts for a

(21:50):
year.
Yeah.
Goes to the other side, lastsfor a year, and then for some
reason the body can adjust tothose lower estrogen levels and
it lets up, but you're, you'retalking two years of horrific
pain, no sleep, uh, not able toput a bra on, not able to put
certain shirts on it's misery.
You know, it's so you can reallyshorten up that course, uh, by

(22:14):
Yeah.
Getting some estrogen in yoursystem.
That makes, I mean, I just thinkback to earlier in my career
before, first of all, weweren't.
Really even talking aboutmenopause, at least publicly
until like the last year or so,or maybe even a little bit more.
But thinking about all of thewomen that I have treated that
in that phase of life,experiencing severe shoulder

(22:36):
pain.
Mm-hmm.
And this was not like somethingyou learned?
No.
Yeah.
And it, it just, I think there'salso a piece of perimenopause
that like really makes me angryis that like it's 2025 and, and,
and we still don't understandit.
I think there's a piece of methat's grieving this like
sadness of.
Okay, so we're, we're justsupposed to just have babies and

(22:58):
like, then it declines, right?
And then that's it.
And it's like, so evenbiologically, I think there's a
little bit of grief of like, mybody's not the same anymore.
Mm-hmm.
What's going on?
And then people are inundatedwith all this information.
Mm-hmm.
And one of the things that I, Itold people I was speaking at an
event, um, a few weeks ago.
I was like, listen, you all aregonna hear a lot of information
over the next few weeks at thisevent.

(23:20):
It's important that you sit withit.
Do some breath work and realizelike what resonates with you.
Mm-hmm.
Because there's so many pathwaysthat there's so many people
talking about this and, but theone thing that we're not taught
is discernment.
So like how to determine who tolisten to.
Yeah.
And like what to here, becauseit can be, it, it, yeah, it's a

(23:41):
lot of information, but alsopeople present in different ways
and that makes it hard.
I think, you know, if someonecomes in with very classic, oh
gosh, now I'm having hot flashesand night sweats, and I, I can't
sleep.
It's like, okay, they're,they're in perimenopause, great.
But if you come in and you say,my shoulder hurts and I can't
raise my arm.
And then I also, you know, I'vebeen crying that, uh, you know,

(24:04):
uh, your practitioner may notthink right away, oh, this could
be perimenopause unless they'vebeen there.
Totally.
And they, and they kind of putthose pieces together.
So if, yeah, I think it's, it'sdifficult because it's not.
A very straightforwardprogression.
Mm-hmm.
For each person the picturelooks different.
So yeah.
So that's why I tell people ifthey're in it or listening, I'm

(24:26):
like, just when you find theinformation, just see what
resonates with you.
'cause there is a piece of like,oh that, you know, when you can
sit and your nervous system's abit calm or like doing some
breath work, which can be hardto do if you're dysregulated
because of all this, but youknow,'cause you can go like, oh
this person's selling thesesupplements so I need to do
that.
Or everybody's taking thissupplement.
But it's like there's so much Idon't respond to Chase very

(24:50):
well.
Yeah.
And that's a big supplement alot of people are talking about.
I'm like, I break out on it.
Mm-hmm.
My skin gets worse.
Mm-hmm.
I become angry.
So Yeah.
It's interesting'cause yeah,Vitex or Chase Tree Berry often
raises progesterone and youdidn't do well with, with it.
I Progesterone well did so.
Yeah.
Makes sense.
But I did do well with.

(25:10):
The, like broken downprogesterone.
Mm-hmm.
Yeah.
So the um, compounded version.
Yeah.
So it's so interesting.
Yeah.
Knowing, like being on the sideof this, of, of learning it
while I'm going through it.
'cause the researchers are justconstantly evolving.
Like daily.
Yeah.
And there's, and and I thinkthat's important that you
realize that there's not thesame tr there's not a protocol,

(25:32):
there is not an algorithm.
And I think people who don'tunderstand the process want this
algorithm of how do you treatperimenopause?
And it's not like that.
You have to individualize it.
You have to do, I like to thinkthat I do personalized medicine.
Like I talk to the patient, Isee what their specific symptoms
are, what is their, you know,what are their other underlying
health issues.

(25:52):
And you've gotta personalizethat because what works for one
person will not work for anotherperson.
Oh yeah.
And there are so many factorsinvolved with that, but we're
also starting to see, it's allthe way down into your DNA.
Yeah, the genomics of yourhormone production, hormonal
metabolism, hormonal clearance,and detox through the liver of
estrogen pathways.
That's all different fordifferent people.

(26:13):
So it's not going to be thiscookie cutter type of treatment
for every person.
So if you find, you know, ifyou're, if you're seeing someone
who says, well, everyone needsthis, or Everyone needs that.
I have heard that Yes.
And heard some podcasts thatwere saying a hundred percent
for ev, vaginal, estrogen foreverybody.
And it doesn't.
Okay.
Well, maybe that, but, but noteverybody, like, I just think

(26:36):
that it just depends.
Right?
Yeah.
Like, you know, yeah.
There's some people that can'ttolerate it and then people will
say, well, it's the additives init.
Mm-hmm.
And I'm like, well, I've hadpeople where we've compounded it
Yeah.
And they've tried everything andit just doesn't work for their
body.
That's true.
Yeah.
True.
You know, but that is a theme Ihear a lot of, uh, it's safe for
everybody and it doesn't go inthe bloodstream.
I'm like, but it's still in yourbody.
Mm-hmm.

(26:57):
You know?
Mm-hmm.
So I, I have a, that, thosetypes of things Yeah.
Frustrate me a little bit.
Me too.
You know?
'cause I'm like, if you, you'restill, it's still in your body,
right?
So it still might be minute, butyou're still getting estrogen in
your body.
Right.
Right.
So to say that it doesn't crossthat.
Yeah, that's, I have, I have,what do you think?
Well, it was speakingspecifically for that the, the

(27:19):
vaginal estrogen that we use isa very extremely low dose.
Yeah.
Uh, but that's not to say therearen't people who don't have
problems with it.
There are people, I've hadpatients that were so sensitive
to that small amount that itdid, you know, cause them some
issues.
There are, if you get the, uh,you know, typical non-compounded
type that's produced by apharmaceutical company, there

(27:40):
are parabens and other things init.
Those, they, they react more so,yeah.
Yeah, yeah.
Uh, but no, there, uh, there aresome people, so that's
Estrodiol, which is the typicalestrogen that our body is used
to.
And there are people that justdon't tolerate that for whatever
reason.
We don't know why theirreceptors don't like it in the
vaginal area, but they mightlike estriol, which is a weaker
form of estrogen.

(28:01):
So, yeah, e even with that,which you know, is kind of one
of those universal things that.
Most perimenopausal women willbenefit from some vaginal
estrogen to, to keep that tissueYeah.
You know, healthy andmoisturized and reduce the risk
for urinary tract infections andpain with intercourse.
Yes.
And all of those benefits.
Sometimes you still have toindividualize that treatment.

(28:22):
That's what, yeah.
But that's what I'm saying.
Yeah.
Especially with systemictreatment though with, with
systemic estrogen, you, youreally, you know, will see some
people can tolerate patchesreally well, other people don't.
Someone might, their body mightlike the gel better.
Somebody might not be able toabsorb it very well in one spot
versus another, a differentform.

(28:42):
So it, it really makes adifference to individualize that
for people.
Totally.
And from a pelvic floorstandpoint, I've seen vaginal
estrogen work.
Yeah.
Wonders for people.
Yeah, absolutely.
But then I've had people belike, I don't want to keep
putting this stuff in my vagina.
Mm-hmm.
You know?
And so there's just, I'll alsorecommend if they don't wanna
use vaginal estrogen, have youheard of reverie?

(29:04):
Mm-hmm.
So reverie, the hyaluronic acid.
Mm-hmm.
Yep.
I've seen that work really well.
'cause it kind of plumps up thetissue a bit.
Mm-hmm.
Very similar to estrogen.
'cause even though like there'sstill people that are fearful of
using estrogen.
Yeah.
Um, and, and so we wanna like,support them.
Don't be scared of vaginalestrogen, but I mean the, the,

(29:25):
what was the study that scaredeverybody?
It was the Women's healthInitiative.
Yeah.
So that's decades of peoplebelieving something.
And so it's, yes.
It's, it's getting people torealize, oh, that was actually a
lot of misinformation.
Well, yeah.
The biggest thing is the Women'sHealth Initiative used
conjugated equine estrogens,which are estrogens from

(29:47):
pregnant horses.
That is not the type of estrogenthat the human body makes, that
type of estrogen bonds to adifferent estrogen receptor than
what estradiol binds to.
So estradiol in any form is whatwe consider a bioidentical form.
It doesn't have to becompounded.
There are patches that are madeby pharmaceutical companies.
There's gels, there's alldifferent forms.

(30:08):
So that's one myth I wanteddispel is some people think that
bioidentical means that it'scompounded.
That's not what it means.
It's about the type of estrogen.
So estradiol is the bioidenticalform of estrogen ES three.
So it doesn't have to be,'causeI know that there was debate.
I've heard people say like, ifit's compounded, then it's not
regulated.
And then there's, it's not sayI, I've just heard so many

(30:31):
different things, but that'smore about, you know, the, the
compound forms are gonna be madeby a compounding pharmacy.
Mm-hmm.
So you have a human who is goingin and making each batch of it.
And so there is a little risk oferror with that.
Right.
So you have to trust thepharmacy.
You have to trust the pharmacy.
That's important.
That's, that's not talked aboutis like Yeah.

(30:52):
Looking up to see, looking,yeah, yeah, yeah.
The reputation of the pharmacy.
Yes.
Has the, does this phar, you canactually, at least in Texas, you
can go on the Texas PharmacyBoard, you can look and see if
there have been complaints abouta pharmacy.
Oh, good to know.
Yep.
And so, uh, there are pharmaciesthat I am not comfortable using,
um, because I've had some issueswith them and there are ones

(31:12):
that I trust.
And so, uh, the experience ofyour compounding pharmacist
makes a difference the morethey've done.
Um, probably, you know, butit's, it's still a chance for
human error.
I mean, even a person who'sexperienced, who's done a lot.
You know?
Yeah.
If, if you're having a bad day,there's a risk for error.
Yeah.
So, you know, that's one thingabout the non-compounded forms.

(31:35):
If it's produced in a factory,you gotta think they've got
their, you know, system set upand it's gonna be made the same
each time.
Now you can have differencesbetween different brands.
So if you take, say, anestrogen, an estradiol patch, a
0.05 patch, there are, I don'tknow how many companies make
that, but there's a lot ofdifferent companies that make
that.
And you will also see sometimeswhen you go to the pharmacy,

(31:57):
they give it to you from companyA, and then maybe the next time
you pick it up, they might havegotten a better deal from
company B, and now they'veswitched you from this companies
to this company.
Well, maybe there's a differentadhesive, or the patch is a
different size or.
Any a number of factors thatcould have changed your
absorption of that estradiol.
So that's something that ifsomeone's stable and doing well

(32:20):
and then all of a sudden seemslike they're off, I kind of, I
always say like, did your, didyou switch?
Yeah.
Did your medication lookdifferent?
Did it change?
And that's true for pills, forpatches, for anything.
Yeah.
'cause that happens too.
So there's a lot of places,there's a lot of nuance.
Oh my God.
I mean, I knew there's nuance,but just to know, even just like
these little details.

(32:40):
Mm-hmm.
It's so important for people toknow and even practitioners or
anybody in the health andwellness field.
Mm-hmm.
To know, hey, if,'cause peoplemight be like, oh, well it
didn't work for me.
Well what didn't work?
What did you use?
Right.
What you know.
Yeah.
Did you try a different brand?
Right.
You know, was your system likethere's so much in that.
Yeah.
And during perimenopause, ifsomething didn't work for you

(33:02):
two years ago.
That doesn't mean it's not gonnawork now because your system is
very different two years laterthan it was when you were
younger.
Guarantee you, that's good to toremember.
Yeah.
I was just like, you're rightthough, that is not talked about
very much with, you know, allthe little places it can go
wrong.
Well, I think it's important forlike practitioners and consumers

(33:24):
to know.
Mm-hmm.
Because, you know, I'm figuringthis out too.
And you know, just to know thatit break can break down in these
different pathways.
And you know, one of the thingsthat we talked about with
estrogen dominance is like,well, why is progesterone low in
the first place?
And if you're chronically infight or flight, the body

(33:45):
produces cortisol.
Mm-hmm.
Is it instead of, or it's.
It prioritizes it more, right?
Uh, well, it's, if you thinkabout sort of water flowing
down, you know, in a river andthen sort of diverting into
different parts of a stream,it's like sometimes it'll go a
little more to the right.
Sometimes it'll go a little moreto the left.
So it's, you're not gonna shutone of those off completely.

(34:07):
You're just might divert moreresources towards one pathway
over another.
So when the body is in fight orflight mode.
So I, I like to tell mypatients, like, let's think
about how the body survivedthousands of years, right?
The primitive systems are allabout survivals.
So if they're, if you leave yourcave and there's a tiger in the

(34:30):
grass.
Okay.
We need to be able to fight,flee, or freeze, right?
So we need cortisol to spike up.
We need adrenaline if we need torun, like we need to have these
systems on ready to go at thatmoment.
The last thing your body needsto use resources for is your
reproductive system.
Yep.
Because that is not the time tobring a baby into the world is

(34:52):
when there's a tiger rightthere.
So the trouble is those systemsin our body have not evolved to
realize that your text messageis dinging you.
Or the breaking news thathappens every five minutes is
not a tiger snapping a twig.
It responds the same way.
So we're getting hit by theselittle.
Tiger attacks essentially allday long from the minute you

(35:16):
wake up and you look at yourphone to the minute you put it
on the charger at night, we'rejust getting hit with it all the
time.
Every time somebody cuts you offin traffic or, I mean, if you
think about all the littlethings that give you a tiny, you
know, internal jump every day,that's a lot.
Well, I think so.
Of course our body's gonna beshunting these resources towards

(35:39):
our survival hormones, and so Ireally encourage my patients
that you have to stop, you haveto have time during the day.
That you are sending a signal toyour body that we are not being
stalked by a tiger.
And that doesn't mean thatyou're sitting there playing a
game on your phone because thosenotifications are still coming
in.
You're putting it away, you'regoing outside, you're getting

(36:00):
away from anything that could beinterrupting you.
You're just lying and breathing.
I, I don't care what people do,but I'm like, you've gotta stop
at some point.
Mm-hmm.
You know, take a break even ifit's for a couple minutes.
Well, totally.
And one of the things that I'llget,'cause we treat with a lot
of people in a lot of chronicpain and have, have done a lot
of like the generic kind of PTstuff and I'm like, we need to

(36:21):
be looking at the nervoussystem.
Right.
But then, but I think people getstuck'cause it's like they can
do that, but they don'tunderstand why they're in that
mode in the first place.
Yeah.
So I'll even, I mean, I havethem go to therapy if they're
ready to do that.
Mm-hmm.
But also starting to questionwhy are you running around with
your head cut off?
Like, what are these, like,let's go deeper.
Mm-hmm.
And just notice, just noticelike sometimes I'll give journal

(36:43):
prompts.
I'm not.
Telling them what to do.
I'm just like, just startthinking like, why?
And you know, why is it that weneed to fill the kids' schedules
back to back to back to backevery weekend?
Where did we learn that from?
Yeah.
Who showed us that that wasnormal?
And then we have to challengethose beliefs because we can't
stay in that.

(37:03):
I mean, that was my life for 33years is just, that's because
what I saw my mom do, and thenmy mom did what her mom did and
then, you know, and it's likemm-hmm.
It's this pass down thing.
And I feel like we're all kindof getting to this breaking
point of like, we just can't doit anymore.
Yeah.
It's too much.
We're not meant to see peoplelike so many breaking news

(37:23):
stories on social media.
Mm-hmm.
People fighting on these, allthese different things.
There's so much more in love andkindness in the world than we
see on social media and on tv,and we're more isolated than
ever.
Mm-hmm.
Right.
We're, we're.
We're just, we heal incommunity.
Mm-hmm.
Like safe, healthy community.
Mm-hmm.
Not just community.

(37:43):
Just to have it.
And so I like challenge peopleto really start like, what are
some hobbies you'd like to goand you've always wanted to do.
Yeah.
Because your body's gonna forceyou to do it.
Either you do it now or youcrash later.
Mm-hmm.
Like there's no choice.
Yeah.
Absolutely.
We get sick.
I mean, I got cancer.
It's like, I'm not sayingeveryone's gonna get cancer.
I'm just saying like, we haveto, there has to be a point

(38:05):
where we have to Yeah.
Slow down and start questioningwhy we're constantly triggered
by things.
Right.
Right.
I mean, I'll even notice it too,is if I wake up and the first
thing I grab is my phone, it'slike blue light text.
Oh my God, I have to catch upwith all this stuff.
Mm-hmm.
So I'm already like putting mybody Yeah.
In that state immediately.
Yeah.
And even before bed, that's likesome of the easiest things that

(38:27):
people can do.
Mm-hmm.
Turn your phone into airplanemode.
Mm-hmm.
To reduce EMF.
Mm-hmm.
Put it away from your bed.
Put it in the kitchen.
Put it in the kitchen, read.
Mm-hmm.
To music, read an actual book,music something for 30 minutes
to an hour at least.
Mm-hmm.
Mm-hmm.
And see how you feel.
Absolutely.
Yep.
And same thing in the morning,slow.
Like,'cause the, those twothings have changed my life.

(38:50):
Yeah.
Yeah.
Like just changed.
I wanna hit on your point aboutconnection.
Yeah.
Being so important because Ithink that this has gotten so
much worse post COVID a thousandpercent, right?
I mean, we lost a lot of beingin community, being in
connection.
I think there's still thatlittle bit of reflex of like,
Ooh, danger when I see get tooclose to a person or in a

(39:11):
crowded place.
And that puts us right back inthat fight or flight,
sympathetic nervous system mode.
And what we need to do is havetimes where we're really.
Cultivating that connection.
And when you make eye contactwith a person, that increases
your production of oxytocin.
Oxytocin is the love hormone.
It, it, it, you get it.

(39:32):
Just even from looking at a dogas well, like animal, we can
have it with animals.
So oxytocin makes us wannaconnect.
It makes us have love, it getsfor women, it gets the breast
ready to redu to, uh, releasebreast milk.
So that's why when a lactatingmother sees a baby and looks
them in the eye, they canactually express breast milk.
Yeah.
So oxytocin, it's a short actinghormone, but if you think about

(39:56):
it, oxytocin is gonna put usback into a healthy reproductive
state because it, it's gonna getthe body ready for that
connection.
So if you're someone who'strying to get pregnant and
you're in stress mode all thetime.
Your body's not gonna wanna getpregnant.
So we've gotta have these timeswhere we come back into this
healthy connection, increasingthe oxytocin, relaxing, making

(40:19):
it a safe environment to, tohave a baby.
And, and you'll have much moresuccess that way.
Well, I think that adding tothat, like laughter, yes.
Laughter releases dopamine,serotonin, oxytocin.
And I wanna say the, the fourthone is nore, I'm not mm-hmm.
Endorphins probably.
Yeah.
It would be.
Anyways, the point of that isthat even just with those three,

(40:43):
serotonin, oxytocin, anddopamine.
Yeah.
And you laugh, you know, youhear the saying, laughter is
medicine.
It truly is.
I mean, it truly freaking is.
Yeah.
We have little, like, we have alittle pharmacy in our brain.
Yes.
And if we can hack it, we don'thave to hack it.
We have to work with the body.
Yeah.
Even like the first few minutesof like getting up, like going
outside and like letting youreyes like the sun, like.

(41:05):
Y you, you see sunlight withyour eyes.
'cause the other piece I thinkis we're staying inside all the
time.
Yeah, yeah.
Like just today I didn't get myfull walk in and I'm like, oh.
'cause I was rushing a littlebit this morning and I was like,
okay.
But I was actually okay'cause Ididn't have any coffee, which I
was like, okay, I can't berushing and have coffee'cause
then I'm gonna be even moredysregulated.

(41:28):
So I was like, okay, well I'mgonna choose to not have that
today.
Yeah.
And I'm gonna go for a walk thisevening.
Mm-hmm.
But still, there's that piece ofthese little details that we're
not, we're wondering why we'reconstantly depressed and anxious
and yes, there's a lot going on.
But if even just these minutechanges Yeah.
Can make.
Yeah.

(41:48):
'cause if you're having troublesleeping in perimenopause Yeah.
Getting up, having that lightearly in the morning to wake the
body up and then having thatquiet time at night can really
help you reset.
And it seems trivial and notimportant, but it really, it's,
it's, I'm here to say, reallyimportant.
Say it is life changing.
Mm-hmm.
And the days that I don't do it.
Yeah.
I am dysregulated the whole day.

(42:08):
Yep, yep.
Because it sets the, and, andthis sets the tone.
Sleep is so, oh my gosh.
Mm-hmm.
It is so important foreverything.
Absolutely.
But that also wasn't taughtyears ago, you know, it was like
this hustle, hustle, hustle.
Mm-hmm.
And now we're starting torealize, especially with HRV
stuff coming out to measure ourstress, which is on, most people
are tracking on their iPhones,and they have no idea they're

(42:30):
tracking it.
Exactly.
I love showing my patients, I'llbe like, Hey, you've been
tracking this for like threeyears, you know, what happened
this day?
Or that, you know, and of courseit's a glimpse of it.
Mm-hmm.
But still.
Mm-hmm.
But I think that there's, yeah,there was, there's a lot there
about that.
And, and then it, and then myheart goes to the people dealing

(42:51):
with infertility.
Mm-hmm.
Because they're not taught thisstuff.
They're No.
And usually they're shoved rightinto IVF, which you're pumping
yourself with all thesehormones.
Well, not only that too, what Isee is also just the, the
process of it.
All the appointments, all theblood draws, all the needles,
all the, that is not a.
A nurturing environment to haveyour body in.

(43:13):
And it gets very stressful andyeah, I, I, I think it's a hard
place to put your body in whilealso telling it to, to try and
hold a pregnancy.
So I think that that's reallyimportant and I really encourage
my patients during that time to,I, I send them quite often to
acupuncture, um, because I'mlike, you've gotta be
counteracting some of thisreally stressful stuff, um, if

(43:36):
you wanna hold onto thatpregnancy.
But yes, but even knowing thehormonal disruption is pretty
huge.
And I think for some patientscertainly can have long lasting
lifelong effects and sometimesthrow them into perimenopause
maybe earlier than they wouldhave.
It's hard to know if that'strue, but, well, I mean, people
were saying it's all safe.
I'm like, yeah, but let's see.

(43:56):
Long term.
And I'm not saying like I didIVF, like I did IVF'cause I'm a
genetic carrier for a terminalillness.
And so I didn't end upconceiving,'cause I.
It just didn't end up workingout and I got divorced, so, but
I know what it's like to gothrough that process.
It is incredibly stressful.
Yeah.
And I remember just injectingmyself being like, everyone
keeps saying this is safe, butlike for me it was the only way

(44:20):
to have for me to have kids inthe way that I wanted to.
'cause I didn't wanna take arisk of that being a 25% chance
Yeah.
Of that versus people are kindof pushed into it really soon.
Mm-hmm.
Without like having people kindof walk through them.
Mm-hmm.
And this isn't blaming thepeople going through IVF by any
means.
It's, it's you's more of, theydon't have the re they're not.

(44:42):
Given like the full, the fullpicture spectrum.
And if they get that fullspectrum and they choose to do
IVF, by all means.
But I, I really think it's superimportant that patients and
people going through thisunderstand what's happening in
the body.
And even the tests, they'll belike, we don't know why, but if
you're, if somebody's workinglike a hundred hours a week and
they're chronically, they're notsleeping mm-hmm.

(45:04):
And they're, you know, dealingwith sick parents or something
like that.
Mm-hmm.
And it's like eating processedfoods.
Eating processed foods, likelet's work on that first.
Right.
You know, and there's, there'sa, there's a lot in there,
especially add-on if you're in amale dominated field.
Mm-hmm.
And you're in a high stress job.
Like there's just live in a highcost of living area and you've
just gotta work, work, work toeven survive there.

(45:26):
But these are the things abouthealth that we're not talking
about.
Yeah.
Yeah.
I mean, supplements can'treplace that.
A healthy meal can't replacethat.
Mm-hmm.
You know, and I've just been astrong advocate for it after I
got sick.
'cause I was like, oh, I did allthose things.
Right.
Yeah.
And then I got sick.
Right.
So what, what else is there?
Yeah.
Yeah.
So it's so interesting.

(45:46):
And so, um, yeah.
Are there any other commonthemes that you see?
I mean, I know that you and Iwere just chatting a little bit
before too about how I see a lotof people get gaslit if they're
starting to have symptoms intheir thirties.
Mm-hmm.
Mm-hmm.
And we know that it's startingsooner.
Mm-hmm.
And especially with people thathave history of maybe
endometriosis, which most peopledon't even know if they have

(46:08):
endometriosis.
Mm-hmm.
They have the symptoms.
So I think that'sunderdiagnosed.
Well, and, and maybe we shouldeven like start at square one
and tell people.
Menopause.
The definition of menopause isthat you've gone a full year
without a period.
Mm-hmm.
And that's not someone who sayhad a hysterectomy or a IUD or
something where that's causingthem to not have a period.
But if you've naturally not hada period for a year, there's

(46:30):
nothing magical about a year,but it's just at a year, if
you've gone that long, thenstatistically you're probably
done.
Um, now I've had women thatovulated 14 months out and we've
restarted the clock again.
But I do see people don't reallyunderstand this concept of like,
well, what is menopause?
So menopause is when you've hitthat time where you've gone a
full year without a period, thenyou are menopausal.

(46:53):
You are menopausal then the restof your life.
And people go, oh my God, I hadthese symptoms the rest of my
life.
No, no, that's not what'shappening.
That's just simply that your ovovarian function has essentially
shut off at that point.
So perimenopause is the timebefore menopause.
Mm-hmm.
That can start.
10 years before you get to thatpoint where you're not having

(47:15):
periods anymore.
So these little hormonalfluctuations can start to
happen, you know, really early.
And, and the range for goinginto menopause, for most people
it's gonna be about ages 45 to55.
Now you're gonna have women thatgo later.
You're gonna have women thathave premature menopause and go
earlier.
But if you think, okay, well 45is sort of the start of that and

(47:37):
this can perimenopause can start10 years before that, 35 is
reasonable that some women maystart to have some changes at
that time.
Totally.
Yeah.
Even with their medical history,like I was talking to another
friend, I went through chemo,she's like, I'm pretty sure I'm
in early perimenopause.
Mm-hmm.
I was like, probably mm-hmm.
You know, we were told that itwouldn't affect it, but I'm
like, come on, your body's inlike extreme distress.

(47:59):
Right, right.
For as long as you were onchemo.
Right.
But there's so many factors tothat and I think it, it makes
total sense.
Mm-hmm.
And then even withendometriosis, especially if we
have it around the ovaries, howthat can reduce.
Yes, the scar, the ovarianfunction from the scarring
mm-hmm.
And things like that.
Yep.
And so.
You know, you add on all ofthese things.

(48:19):
Yeah.
And it can make sense when youstart looking at it from that
overall perspective.
But I love that you clarifiedlike, Hey, this is actually what
mm-hmm.
Menopause is.
And it was cool though, is whenI've talked to people that.
Our, like, post menopause.
We're like, oh, it's great overhere.
Yeah.
That's pair, that's what I tellmy patients is like, you, you're
scared of menopause, butactually what you should be

(48:41):
scared of is pairingperimenopause and not having
help.
If you've got somebody that canhelp you out and get you through
it, it's gonna be fine.
There will be some little bit ofbumps in the road, but
perimenopause, here's myanalogy, is a little bit like a
blindfolded roller coaster.
It might be in the dark, youknow?
So like you're on this rollercoaster, you don't know whether

(49:02):
you're going up, down, left.
Right.
You might be making a loop andgoing upside down.
It's hard to know.
You don't know what's ahead ofyou, but, oh my God.
Um, yeah.
So, but it's not gonna lastforever.
Yeah.
Like, so it, it's when, so we,we kind of touched on the, the
beginning stages when theprogesterone starts to drop.
So the important thing to knowalso is your progesterone levels

(49:22):
are starting to go down and theestrogen is really, uh, that's
the thing that's, that's.
Causing a lot of the issuesbecause what's happening is the
body is trying to have a firesale on these last remaining
eggs.
It's like, let's spit these outand see if we can get one more,
you know, baby out here, firesale.

(49:42):
So, yeah, so, so what'shappening is, is the ovaries are
kind of sluggish.
The body's going go, go, go, go,go.
And stimulating all of thisestrogen.
So instead of your estrogen justgoing up like a nice normal peak
at ovulation, it's, you're nowgetting hyperstimulation very
similar to what happens infertility treatments.
That's a hyperstimulation.

(50:03):
You're trying to really get theovaries going.
So you get this huge surge ofyour estrogen goes way, way up
higher than you're, you're usedto.
And then what?
It's gotta crash, right?
It's gotta come down.
So it's a bigger cliff to falloff of, right?
So these big swings in estrogenare really what cause a lot of
the problems and a lot of thefluctuating symptoms that

(50:25):
whiplash us back and forth inperimenopause.
So, you know, one of myapproach, well, I mean we, we
could go into approaches and Isaid I personalize it, but if we
know that somebody's having bigestrogen swings, uh, and if
their overall estrogen levelsare starting to come down, you
know, when they've gettinggotten into perimenopause for a
little bit, we might give them alittle bit of estrogen just so

(50:47):
they're not bottoming out somuch.
Oh, I see.
It's kinda like blood sugar alittle bit.
Yeah.
Like you don't wanna like justhave a bunch of blood sugar and
then spike and crash.
You wanna add protein with it alittle bit.
Yes.
So it's like a little bit ofestrogen.
Yeah, that makes sense.
You've got a little safety netthere that you're not totally,
they're they're not bottomingout.
Right.
Because that would make, thatmakes total sense.
'cause I think we think of somuch of menopause perimenopause

(51:09):
as, oh, not enough estrogen, butit's having that spike and it's,
it's when, right.
So sometimes I've had somepatients that their main symptom
was horrific migraines a fewdays before their period.
So they're starting to get theseestrogen swings that are bigger.
Bigger crash right before theirperiod as it's coming down.
There's a really easy solutionthere, and I've done it in the

(51:31):
office where I've given them anestrogen patch to put on.
They put the patch on, theyleave it on for three, four
days.
They get a little bit ofestrogen coming in, so they're
not going so far down into thebasement.
You can literally see someone'sheadache melt away within 45
minutes in the office by justgiving them a little bit of
estrogen so they may not need itall the time.
Right.
That's what I, so this is whereyou, you gotta know it's

(51:52):
nuanced.
You gotta know the process.
Yeah.
It's nuanced.
And so they don't need estrogenat ovulation.
That's not gonna go well.
They've got plenty at that pointthis, or they're early in the
process, but they're bottomingout right before their period.
So just a little safety netthere.
Take away those migraines.
I mean, now you've given thatwoman back two, three days of
their life that they were inmisery before, so, yeah.

(52:14):
Yeah.
I know, like for me, like, Ilike the idea that even just
having the progesterone, dopeople ever go on progesterone
the whole time, or is it always.
The second half of the LT orthe, you'll see different
approaches there.
Okay.
Um, so sometimes early we willjust do it in the luteal phase.
So you might take it for twoweeks during the luteal phase

(52:34):
and then stop for two weeks asyou get further into
perimenopause.
And those levels are droppingmore.
If, if someone's comes back andthey go, I, I cannot sleep
during my follicular phase, youknow, so every time I stop it, I
feel worse.
I'm not sleeping, I'm feelingmore anxious.
I will go ahead and just do itevery evening.

(52:54):
Um, and then because lateryou're gonna start to get more
irregular ovulation and skippingovulation and having irregular
periods, then you don't knowwhen to take it.
You know?
I was gonna say, at what pointdo you, because I'm like, okay,
mine stuff's predictable now,but Yeah.
So then it's just impossible,you know?
'cause if you start having likeintermittent bleeding, you're
like, do I take it now?

(53:15):
Do I stop it?
I dunno what to do.
That gets stressful.
Then you just take it every day.
Because even though it like.
Is there, there's still like alower dose of progesterone all
the time.
Is that correct?
Do you mean, so like when wethink of progesterone, we, we
mean, okay.
It spikes of luteal phase today,four, roughly 14 to 28.
What about, you know, one todays, one to 20 to 14?

(53:38):
Do you mean the naturalprogesterone production?
Yes, correct.
It's very little.
Okay.
But it's still there.
I'm sure there's still some,yeah, yeah, yeah, yeah.
But it is not like the L tealphase.
Okay.
Yeah.
It's a big shift.
That's what I was thinking.
No, I loved, I love knowingthat.
'cause it's, it can be soempowering for people to listen
because people don't even knowwhere to go for how, like you, I
think you're, you're booked,right?

(54:00):
Yeah, yeah, yeah.
So you're booked and there'sother people that are, that I
know in Austin that are doingthis and they're booked, you
know, six mm-hmm.
To 12 months out.
And so I'm hoping, my hope is inthis podcast that.
Whether people are practitionersor they're, you know, people
wanting to learn for themselves,that then now they can start

(54:20):
understanding their body andasking and almost,'cause I've
seen other primary cares belike.
Well, what do you want?
You know?
'cause they're not educatingmm-hmm.
Themselves on it.
And so there has, there's almostlike this, okay.
At least they can advocatemm-hmm.
And start being like, Hey, whatdo you think about this or that.
Mm-hmm.
Because there's not a lot ofpeople that are helping even
OBGYNs.

(54:42):
Yeah.
Yeah.
I mean, I think one thing thatpatients can do that is helpful,
and, and I have my patients dothis, but I I, I think a lot of
doctors don't necessarily dothis, but, um, start jotting
your symptoms down because youthink you know what's happening
and you, two days later, you'veforgotten what was happening.
So I like to, I actually have a,a little, uh, tracker that I

(55:04):
give people.
It's a grid with all thesymptoms and then they kind of
score the symptoms each day.
But you can even do it, I thinkit's helpful to have it on a
calendar where you can see thewhole month and when your period
happens, and then you can seelike, oh, that was the couple
days before that I was having aheadache or.
I had a mood swing or somethinglike that.
If you can take a specific thingto your doctor and say, this is

(55:29):
my symptom, and this is whenit's happening.
If they know a little bit, atleast it will guide them more.
Yes.
They can help you with thatsymptom, right?
Yeah, you could.
You're giving them someinformation because like I said,
early on, you know it, we don'talways know.
Is it just that yourprogesterone is low?
Is it, do you have too muchestrogen?
Is, is there a little bit ofboth?

(55:50):
You know, it's kind of figuringthat out early on.
Once you get further in, it's,it's actually a little more easy
because then it's like, well,everybody needs the progesterone
probably, and then at some pointyou add the estrogen in and then
you just kind of titrateaccording to symptoms.
But I think having thosespecific symptoms that you want
addressed is, is helpful andsaying like, it's happening when

(56:12):
my.
Estrogen is dropping or I'mhaving this symptom at
ovulation.
Is that something you can helpme with?
Yeah.
'cause then they can kind ofdistill it and it's good for any
healthcare people or wellnesspeople listening is tell this to
your clients.
Right.
Or, or, you know, if you aregoing through this yourself,
then we can help guide that.
I even use like the app and, andI don't know, it's like the

(56:34):
iPhone app or whatever, that youcould track your cycle and then
you can input, um, yeah.
Some of them just make like alist though.
Like, and I, they don't, thevisual of it is not easy to see
like, oh, that, especially ifyou have symptoms of ovulation.
Yeah.
It's hard to see that.
'cause that's why I kind of likehaving like a month big one
month on a one page to, to beable to see, ah, that's, that's

(56:56):
two weeks before your period,that's ovulation.
That's when your estrogen ishigh.
Mm-hmm.
So at that point, you know,maybe we need to work on your
estrogen levels, so, yeah.
Yeah.
Yeah.
That's so cool.
It's so good to know.
And, um, I've learned so much.
Just, oh, and then the otherpiece, what were you, uh, what
about dim?
Mm-hmm.

(57:17):
So dim, uh, we didn't talk aboutestrogen.
So when we talk about estrogen,we're typically talking about
estrodiol, right?
That's the, the kind of normalestrogen.
But there are actually a lot ofdifferent forms of estrogen.
Uh, so one of the firstestrogens that's made is called
estro.
And then most of the estro, whenyou're not pregnant, most of the
estro gets converted intoestradiol.

(57:39):
When you're pregnant, youactually switch to making the
estro gets converted more intoestriol, which is a weaker
estrogen.
Um, so there, that's adifference between pregnant and
non-pregnant, but any of theestrogen that's sort of left
over and not being utilized hasto be cleared from the body.
There are enzymes in the liverthat do that.
And there are some geneticsbehind this as to which of those

(58:03):
enzymes might work better orwork less for certain people.
There are kind of two mainpathways here.
One is called the two hydroxypathway that makes more
anti-inflammatory type ofmetabolites.
The other pathway is called afour hydroxy pathway or four
hydroxy metabolites, and thoseare more in pro-inflammatory.
Those are gonna be the estrogensthat are more likely to

(58:24):
stimulate, say, the cells thatturn into endometriosis may
increase the risk for breastcancer.
All the things that we think,ugh, the bad stuff we think of
Bad estrogen.
Bad estrogen, because I think itdoes get a bad rep.
Yeah.
Yes.
And the chemicals that are inplastics stimulate that enzyme
that produces more of the fourhydroxy pathway.

(58:45):
Mm.
So please.
Limit your use of plastic.
Do not heat your food in plasticas much as you can avoid, you
know, drinking.
Don't leave pl, we're in Texas.
Don't leave a case of plasticwater bottles in your car and
drink the water from that.
I think that's horrible.
I think a lot of these plasticchemicals are really affecting
our estrogen metabolites.

(59:05):
So back to your thing about dim,what DIM does is it encourages
that estro to be co to convertmore into those two hydroxy
metabolites, the lessinflammatory metabolites.
Oh.
So it's gonna pull it away fromthat four hydroxy pathway.
Wow.
Yeah.
Oh my gosh.
Yeah.
This is so, so dim is veryprotective.

(59:26):
Um, if I have someone who has,say a, a family history of
estrogen, you know, receptorpositive breast cancers,
prostate cancers, and menactually, uh, we see sometimes
are stimulated by some of those,um, estrogen metabolites.
So we think it's justtestosterone.
It's not, it can just, it can beestrogen as well.
Wow.
There's some good studies on DIMand prostate cancer and lowering

(59:48):
PSA in men.
So, uh, DIM can be very, veryprotective for those hormonally
driven cancers.
But if you've got a woman who'shaving really low estrogen, she
may not feel well on dim.
Right.
I see.
Yeah, because it's trying toexcrete.
Okay.
You're you're encouraging moresort like the excreting of it.
Yeah.
Yeah.
It wouldn't excrete the, thefirst kind would the hydro,

(01:00:12):
what'd you say?
It was the, so dim encouragesyou to take any SS estrogen you
have, it encourages it to godown the two hydroxy pathway,
make two hydroxy metabolitesthat get cleared through the
liver.
So, so you're kind of sucking itout there.
So if, would it amplify the per,like the detoxing through the
liver.
Mm-hmm.
So people that are on estrogenor that have low estrogen, it's

(01:00:35):
gonna make them feel worse.
Right.
Versus that's somebody like me,it like.
I started taking dim after wetalked because I was like, oh, I
need to help excrete this extraestrogen.
I just didn't know that we weretalking about where, like, we
didn't go into details, but likethat, that, those two pathways.
Yeah, yeah, yeah.
Are there, is there a specificdosage that is often recommended

(01:00:55):
or what is the typical dosageis?
Obviously it depends on theperson, but what I mean,'cause
there's so many different typesof dim, most, uh, most of them
are a hundred milligrams.
Uh, and then depending on,again, I kind of personalize it
depending on, you know, how muchI, how much support I think
someone needs.
Most of the time we do eitherone or two capsules a day.

(01:01:18):
Oh, okay.
Yeah.
Yeah.
Cool.
Now, I, I said that like somepeople don't tolerate dim, most
people do benefit from dim, so Iuse DIM a lot, but I know there
are certain situations wherepeople may not, you know,
tolerate it very well.
Are there other types of like.
Other types of minerals orvitamins that assist during this

(01:01:39):
time, like to help with, I knowthat, um, during my luteal
phase, things anxiety we foundhelpful or like B complex and
B12 vitamins.
Mm-hmm.
Are there common ones thatyou've have seen helpful?
Uh, there's a ton.
There's a ton.
So yeah.
Vitamin D with K, vitamin D.
Yeah.
Your, your methylation.
A B12, methylated B12 methylatedfolate.

(01:02:01):
So supporting that methylationpathway of detox is important.
Um, what, what, can you explainwhat that means though?
Because I'm like methylated?
Explain to me what that means.
Yeah, so there are different,uh, essentially there are
different detox pathways in thebody.
One of them is methylation,where the body will chemically
attach a methyl group ontosomething.
Think of it like a handle thatthe body can go, oh, lemme grab

(01:02:24):
onto that and take it out to thetrash bin.
Right?
So we, uh, that's themethylation detox pathway.
There are a lot of vitaminsthat.
Assist in pro, assist in thatpathway, and B12 and folate are
two of the big ones.
So when you take in a folate,say you eat some leafy greens
that contain folate, you'rebringing in just natural folate.

(01:02:47):
It has to go through a series ofchemical reactions to get turned
into something calledmethylfolate.
Um, methylfolate is like theactive version.
That's what the cells actuallyuse to run these other pathways.
So there's the methylation detoxpathway, but there's also the
process of methylating thesevitamins to activate them.
So there, and there's a lot ofgeno genetics behind this as

(01:03:10):
well.
Is, is that like M-T-A-H-F-R?
Yeah.
So M-T-H-F-R is the, the lastenzymatic step in that pathway
of methylating folate.
Over 50% of people have at leastsome issue with M-T-H-F-R, so
it's very, very common.
There are a lot of other genesand a lot of other enzymes that
are involved in that pathway.
My practice utilizes medicalgenomics and we actually look at

(01:03:31):
those genes to see which formsor which types, you know, you
might need more support in.
Um, but that's one that a lot ofpeople have heard of, but it's
really just a tiny, tiny pieceof that picture.
Uh, but either way, everyone cantake methylated folate.
Everyone can take, I will saythere are a couple of exceptions
here, or people may not feelwell with high doses of these,

(01:03:53):
but uh, if you take in, uh, nonmethylated folate and then you
can't convert it into methylatedfolate, it's not gonna work that
well.
So it can kind of accumulate andthen you may not feel well from
that.
So.
Okay.
Yeah.
'cause I take the methylatedit'd B12.
Yeah.
Yeah.
I see.
Yeah.
And is it also just kind ofeasier to do that, like easier
on the body if you're taking asupplement that's not methylated

(01:04:15):
versus, right, so you'reessentially allowing it to skip
a bunch of biochemical steps andit's like, oh, this is already
the methylated form.
This is a lot easier for me touse.
Are there a bunch of, is everyvi, this might sound silly, but
it is every vitamin, should youget that in the methylated form?
Is that a thing?
Not all of them are methylated,are methylated, but there are
activated, so, uh, not all ofthem do this, but there are

(01:04:38):
other pathways like B six, the,the activated form is called
PARADOXAL five phosphate or Pfive P, uh, riboflavin, or B two
is riboflavin five phosphate.
So it's got an extra phosphategroup onto it.
So yeah, there is sort of thisactivation of, of the vitamins.
I, I don't know all of them, butno, I don't expect you to, I
just, because I've seen that.

(01:05:00):
And then the other one I've seentoo, like vitamin D.
So vitamin D is good and vitaminD is, you know, kind of a
special one.
'cause it's actually a hormone.
Yeah, essentially.
So, and we can, we can absorb,you know, through the skin and
it can get converted in the skinfrom sunlight and then it, it ha
so it's a little bit of adifferent, a different beast.
But vitamin D works with methylB12 and methylfolate to run a

(01:05:23):
lot of detox pathways, but alsoneurotransmitters.
So to balance our dopamine,norepinephrine, it all relies
on, on those vitamins.
So if you, that is a, that isvery low hanging fruit too for
people.
Like if you, you should haveyour vitamin D level checked.
Um, if you're tired, check a B12level.

(01:05:44):
And here's a pet peeve of mine.
The labs have ridiculous rangesfor B12.
They're so.
Absolutely ridiculous.
So what, and, and vitamin D too,right?
Uh, that was, let's say I'mnormal at 30.
Yeah.
But I'm exhausted.
Yeah.
I, the B12 one is really worse.
Ridiculous.
Okay.
So what labs do is they'll take,I don't know how many samples

(01:06:06):
they use, but let's say theytake a hundred samples and they
go, okay, 95% of people fallbetween this range and this
range.
Yeah.
Well, who's getting their blooddrawn?
Like, people who don't feelwell.
Yeah.
And mostly older people, mostteenagers are not getting their
blood drawn, right?
Yeah.
As we get older, it's harder toabsorb B12.
We don't pull it into the body.
There's a hormone in the stomachcalled intrinsic factor that we

(01:06:28):
need to pull it in.
Most of us make less intrinsicfactors as we get older.
So older people have lower B12levels, that's not necessarily a
good thing.
Yeah.
So these ranges on B12 for a lotof these labs go anywhere from
like either 250 or 300 to 1100.
That's a ridiculously widerange.
My, it's like a, what, what isthat called?

(01:06:49):
It's um.
The standard deviation orsomething.
Yeah.
So it'll be 95% fall, you know,and if you look at a bell curve,
right, the biggest chunk of thatbell curve is gonna fall between
this number and this number Iwas talking to.
But most people with levels ofB12 below 400 are experiencing
some kind of symptom.
They might be tired, they mightbe having headaches, cognitive

(01:07:09):
dysfunction, memory issues, uh,nerve tingling.
All kinds of things can happenwith low B12.
So B12 is one that I have.
A lot of patients come to mewith chronic fatigue and they
bring me their labs from theirprevious, whoever they were
seeing, and they go, well, I hadmy B12 checked and it was
normal.
And I go, well, it was 300.

(01:07:30):
That's terrible.
Yeah.
We get them up to 800.
900, a thousand.
They feel so much better.
It's so simple.
Well, the other piece too, Ithink that's interesting, even
about like vitamin D is we'vebeen so scared of the sun'cause
of skin cancer, right?
Yes.
That's huge.
But it's like we can't absorbthe sun if we have sunscreen on.

(01:07:50):
Right, right.
So even just depending on themelanin in your skin mm-hmm.
Like just getting out in thesun.
Like I've been starting to walkmy dog in shorts in a tank top.
Mm-hmm.
Every morning just to like get15 minutes of no sunscreen.
Mm-hmm.
Just sun on my legs.
Mm-hmm.
On my shoulder.
Like the most things that I canexpose my skin to, but we're.
It's so, no.

(01:08:11):
And most people in Texas,everyone's surprised about this.
Most people in Texas are vitaminD deficient, probably because
it's hot.
And June, July, August,September, it is so hot.
You are not gonna be out atnoon.
And when you go out, when it'sactually cool enough to walk,
you know it's, it's nighttime,it's 8:00 AM or 10:00 PM and
there's either no sun, or thesun is at such an angle, those

(01:08:32):
rays don't hit your skin.
They kind of glance off of it sothey don't actually penetrate
in.
Same thing in the winter, likeit's nice here in the winter,
you can be out in the sun, butthe sun, the angle of the sun is
lower, so you're getting lesshours where it actually will
penetrate the skin and give youthat vitamin D.
So, oh my gosh, I didn't eventhink about I, yeah, the angle
of the sun matters, so.
I just wanna live in your brain.

(01:08:53):
I'm like, how do you, you're sofreaking smart.
It's just so many years of No,but you, but your analogies too.
You're like, it's like this.
It's like this handle and thenit's taking it over here.
And I just, I think that reallyresonates with people when you
can explain stuff that way.
'cause the hormone pathways canget so overwhelming.
But I've been like following youthis whole time.

(01:09:14):
'cause I would've, but it'sreally complex.
But yeah.
But also I've been stu trying tostudy it myself mm-hmm.
And be like, I don't understandhow is this and this and this.
And you know, even just knowingthat, you know, cholesterol's
the start of the hormonecascade.
Mm-hmm.
You know, I, I think back tolike the nineties with the low
fat stuff.
Oh yeah.
And people going throughmenopause, then perimenopause.
Oh my gosh.
Yeah.
They're going throughperimenopause.

(01:09:35):
Yeah.
On a non-fat diet.
Mm-hmm.
Mm-hmm.
And we know all doing hours ofaerobics and hours of aerobics,
chewing up everything thatthey're taking in, not able to
produce their hormones.
I mean, I just have so muchempathy.
For those people.
Yeah.
You know, it's just, it's, it'scrazy.
And even when I talked to mymom, she's like, I don't

(01:09:55):
remember perimenopause.
I go, I do, I remember we woulddo through perimenopause.
I think we all do.
I mean, she's like 72 now.
But I remember my first reactionto menopause.
She was like, I don't know whyI'm screaming.
I, and then she start crying andI was like, is she okay?
Yeah.
Yeah.
But I don't even think, yeah,they, they weren't talking about

(01:10:15):
it back then with her.
I'm sure she would've.
Oh, goodness.
No.
Mm-hmm.
But, and sadly, medical schoolsaren't teaching it.
Most of them aren't.
I don't think.
I mean, I, I've been out fordecades now, but I wasn't
taught, taught.
I think there's gonna be a bigpush because people are just,
and, but I have a, a, a residentworking with me now who's only a
couple years out of school, andshe was really taught very, very

(01:10:37):
little to nothing about this.
So, yeah, the thing that is wildto me, I had to learn it
afterwards.
Well, even OB GYNs.
Yeah.
People are like, oh, I'll justgo to my ob.
I'm like.
Uh, depends on when they trainedand how, depends on when they
trained and where they trainedand how good that that program
was at doing it.
And it's like you have to have amentor that really was good.
Like that's, it's, it's kind ofinteresting, like who you

(01:10:58):
mentored with, like who taughtyou when you were in training
makes a difference as to whatyou learned.
There's just, there's enoughstuff coming out.
We need to be talking about itlearning because if we're
working with, if we're workingwith anybody from the ages of 35
to 55, yeah.
Yeah.
It.
We need to Yeah.
Be aware.
Yeah.
I mean, because people, andthere's s they're suffering.

(01:11:19):
Yeah.
Yeah.
I will say too, that there's alittle bit of an art to it too,
like of for sure, you know, kindof figuring out what's gonna
work for people.
Um, but you know, there's some,you know what I told the person
that's working with me right nowwho, who really wasn't taught
much.
I was like, here's some basics.
Like, just, just start, youknow, you can at least get
somebody started and then ifthey're not responding the way

(01:11:41):
that you think they should, youknow, you can have'em, see
somebody who has moreexperience, but the, the vast
majority of people, if you, ifyou kind of know the process,
you can at least get'em somethings to get'em a little bit of
help and, and get'em feelingbetter.
So, totally.
Yeah.
I mean, there's more and moreresources out to, even if you
just validate what they're goingthrough, just validate that,
please.

(01:12:01):
Stop telling people that they'retoo early to be in
perimenopause.
Right, right.
Because I was told that a fewtimes and I was like, please
just stop.
I, I just, I I don't want tohear that.
Yeah.
I know.
I've tried all of the things Idid.
I'm a huge advocate for holistichealing, but I'm also like,
there's medications that weneed.
Absolutely.
I'm the same way I use.

(01:12:23):
A very integrative approach.
I write prescriptions.
I love to not writeprescriptions, but I wanna do
what the person feels is bestfor them.
Yeah.
And it's gonna be very differentfor different people.
Mm-hmm.
And it takes, I am lucky to havethe luxury in my practice, to
have time to talk with people.
Yeah.
I've been in a practice whereyou saw 25 or 30 people a day

(01:12:46):
exhaust, you had exhaust 10minutes to do all of the stuff.
Look at their blood pressure,you know, look at their lab
work, you know, do the exam,refill the prescriptions, like
do all the stuff that you'retotally out of time.
You don't have time to sit andhave this nuanced discussion
about their symptoms whenthey're happening.
All of that.
And, and that's, you know,unfortunately a huge fault in

(01:13:08):
our medical system.
And I really feel bad for peoplethat.
Don't have time to sit and talkwith their, you know, provider
about what's going on.
Um, but that's why I said if youcan track and come in with some
very specific, I think the moredata points Yeah.
I'm like data, data, data, data,data, exactly.
Right.
You track your periods, trackyour symptoms, come in with very
specific things, this is what'shappening.

(01:13:30):
Then you've really helped themhone in on what they need to do
to help you.
But, but then also too, justlike say somebody does have that
practitioner, that's 15 minuteappointment, you know, like you
said, like go in with that.
And then if, if somebody'slistening is that practitioner
that has 15 minute appointments,then you tell that patient to do
this.
So then when they come back,right, you've got another 15

(01:13:52):
minutes.
Right?
Yeah.
So at least they're going awaywith more frequent something
validating them.
Mm-hmm.
Hey, this is real.
And if you can't help.
There's somebody else.
And that doesn't mean we're badpractitioners.
No.
It just means that we're puttingour ego to the side Yep.
To say, Hey, I actually thinksomebody else can help you with
this.
Mm-hmm.
This is probably what it is.

(01:14:12):
And then they get to go withthat information.
Even knowing, I was just talkingto somebody the other day, they
were saying like, oh, mypractitioner mentioned I might
be in perimenopause.
And it started to make sense andthey didn't know where to go
after that.
Mm-hmm.
But at least they got thatinformation.
Yes.
And you're like, oh, I'm notJust so they're validated outta
control.
Totally.
Like my brain is not outtacontrol.
There's actually somethingchemical happening here.

(01:14:33):
We had another patient who'sabout the same age as me.
She's super sweet.
Um, uh, she walked in the otherday, she was working with
Arista, and I was like.
Hey, how you doing?
I'm like, I'm great.
I'm a progesterone.
She's like, what?
I thought I was crazy.
We're the same age and you're onit.
Oh my gosh, I feel so validated.

(01:14:54):
I'm like, yeah.
Yeah.
And even when I posted it, Iposted it on my Instagram story
and I was like, you know,welcome to perimenopause.
And it was just message aftermessage after message.
Oh my God, thank you for sayingthat.
I'm not crazy.
'cause I think it's the youngerpeople that are like, am I
crazy?
Mm-hmm.
It's the people in theirthirties mm-hmm.

(01:15:14):
That I'm noticing.
They're like, am I crazy?
Yeah.
I'm, I'm, I'm in my thirties.
And I'm like, no, you're not.
You're really not.
Yeah.
And those were the messages thatwere coming through was, thank
you for sharing that.
Mm-hmm.
I've been validated.
It's not telling people to sharestuff on social media.
Maybe it's just we are openlytalking about it with our
friends.
Absolutely.
Or somebody that you trust.
Um, I just did it so.

(01:15:35):
Openly because I'm in thisprofession.
Mm-hmm.
And I know I've done enough workwhere I could share my stuff and
I'm okay with criticism ifsomebody wants to say something.
So I feel more comfortablesharing it that way.
But not everybody does.
But the more we can kind ofnormalize it.
Mm-hmm.
Especially, I think in that 30to 35 to 40 range, you know, I

(01:15:56):
think it's, it's tough'causethey struggle.
Mm-hmm.
They really do.
Yeah.
And I'm one of those people.
Yeah.
And I, I feel for people.
Mm-hmm.
Absolutely.
But.
Yeah.
Yeah.
Well, this was such a lovelydiscussion.
Yeah.
There's so much more.
You could, we could probablytalk for hours, but I know we
totally could.
We'll have some other topics totalk about.
So thank you so much.

(01:16:17):
This was incredible.
Good luck to everybody out thereand your blindfolded, hormonal
rollercoaster you're gonna, butnow they have more information
with your incredible brain.
I'm like, oh my gosh.
I need to just shadow youforever.
Um, and so you're not taking onnew clients now, but I could
still say, so you're atResilient Health.
Mm-hmm.
And so there's otherpractitioners that, and, uh,

(01:16:40):
physicians that work with youthat can practice similarly.
Yeah.
We are all, we are actuallylooking for a new physician
because we are all quite busyright now.
Yeah.
But yeah, we do because it makessense why you are.
So maybe they'll have an openingwith another physician.
Mm-hmm.
But if you are a physicianlistening, I would definitely
check out their practice.
Please.
Because they, it's a great placeto work.
Yes.

(01:17:01):
Yes.
So, all right.
Well, thank you.
Thank you so much for having me.
Thank you so much for listeningto my podcast.
It would be a huge help if youcould subscribe and rate the
podcast.
It helps us reach more peopleand make a bigger impact.
I would also love it if youcould join my email list, which
is LinkedIn, the caption forpodcast updates, upcoming offers

(01:17:22):
and events.
You can also find me on TikTok,YouTube and Instagram at Dr.
Mary pt.
Thanks again.

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Episode 54: Perimenopause Isn’t a Diagnosis, It’s a Midlife Shift with Dr. Theresa Pugh

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