Episode Highlights With Emily
- Why perimenopause isn’t a problem but a clue and what the data actually says
- Symptom treating vs dialing in and extending positive physiology
- Why she doesn’t even like to use the word perimenopause
- Estrogen is lowest on day 1 of the cycle
- What hormones fluctuate and when in a monthly cycle
- How monthly hormone fluctuations affect every aspect of health for women
- Some things we don’t understand about our cycle
- Cancer protective parts of the cycle and why most breast cancer occurs after menopause
- One study on breast cancer and the timing of surgery found affecting the lower chance of recurrence
- The real role of progesterone and why this is so important to understand
- Why women see metabolic and circadian changes in perimenopause and menopause
- New tools for tracking cycle and hormones at home
- Her take on HRT and how to navigate it in a rhythmic and cyclic way
- Follow Emily on Facebook and Aurelia Women's Health on Facebook
- Follow Emily on Instagram and Aurelia Women's Health on Instagram
- Inito Hormone Tracker
- Mira Max Fertility Monitor
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
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with any order. Hello and welcome to the Wellness Mama Podcast.
I'm Katie from wellnesswama dot com and I am here
today with Emily Sadrey to talk about how perimenopods isn't
the problem, it's a clue, and understanding the cyclic approach
to hormones, health and vitality. She has so much practical
(04:12):
information in this episode. Emily is a double board certified
Women's Health nurse practitioner and certified nurse midwife. She hails
from New York City and obtained her graduate education at
the University of Pennsylvania. She was drawn to midwiffree, which
means with women or to stand in front of, because
it was practice rooted in relationships, and she believes that
(04:33):
women need across their lifespans someone to walk alongside them,
not to tell them what to do. She practiced in
conventional medical settings for a decade before founding a really
a health in twenty twenty one, which I will link
to in the show notes, and she gives a lot
of really practical wisdom in this episode about perimenopause and
why she doesn't even like that word. So let's jump in. Emily, Welcome,
(04:56):
Thank you for being here.
Speaker 1 (04:57):
Thanks so much for having me, Katie. It's a real pleasure.
I feel like I've known you for so long as
I'm sure that many of your listeners do, and it's
a real honor to be here. So thanks for having me. Well,
I'm excited to learn from you.
Speaker 2 (05:09):
I feel like our topics are going to be very
relevant to a lot of people listening, and in the
span of two episodes, we're going to get to go
deep on two particular topics. And in this first one,
I would love to deep dive on the topic of perimenopause.
I know I get a lot of questions about this.
This is a phase I will also eventually be moving into,
so I've been researching it quite a bit, and I
love what I've read from your approach and your work
(05:30):
already on this and would love to learn more deeply
from you, And in particular, you've said that perimenopause isn't
a problem, it's a clue, and I would love to
start there as a foundation for this conversation because I
feel like, often, especially in the realm of women's health,
so many things are framed as a problem. Women often
feel like something's wrong with them or something's broken, And
I love the way that you shine light on this topic.
Speaker 1 (05:53):
Yeah, I think that even in the natural health space,
we have a tendency to sort of conceptualize everything through
the lens of like what a woman is doing wrong.
You know, it's really interesting if you look back to
two thousand and two, and I'm sure that other guests
of yours have talked about the WHI the Women's Health
Initiative studies, So I'm not going to go in depth
about that study and kind of how it changed our
(06:14):
opinion and stance on the hormones. Is a medical community,
even the natural health community at the time, you know,
began really demonizing estrogen, and we began to at that
time more than any really talk about perimenopause in terms
of how we need to sort of be better, how
estrogen is this demon that we need to detoxify better
(06:37):
and anything that was wrong was related to estrogen dominance, right,
And that sort of still stays with us today in
the sense that on the sort of natural, more integrative side,
I think there's still some confusion about the role of
estrogen and about declining estrogen and what that is a
catalyst for in the body. And on the traditional medical side,
(06:57):
there is still an over emphasis on this symptom management,
as you've said, and you know, the last most updated
guidelines from the Menopause Society in the in the North
North America, the US that's our governing body, really still
emphasize that our approach to this phase of life, which
I really think of as just part of the trajectory
(07:18):
of aging and as so many things are. Because most
of the medical model is like a male lens. If
it's female, it's like it has to be kind of different,
but it's not. Instead of talking about as a physiologic change,
we're pathologizing it and saying, like, we'll just treat the symptoms.
I think if you take a more longevity or even
like a biohacking approach to thinking about aging for females,
(07:41):
if you think about how we approach the rest of
the body, like you talk about this in terms of
metabolic health, or you could talk about it in terms
of you know, really any aspect of the body we
are working to not we know that aging is inevitable,
but there are lots of ways that we can kind
of intervene to slow say telamar shortening. Right, the actual
physiological does that occur as we just get older. When
(08:03):
it comes to the endocrine system into hormones, the ovaries
are aging and that is a systemic issue because there
are receptors for estrogen on every cell in the body
except for the red blood cell. So it's not so
much that we need to worry about making a person comfortable.
Of course I want people to be comfortable, but if
we're just taking the approach of like just give a
(08:24):
little bit of hormone or maybe a little bit of
ostwoganda or a little bit of lack cohash or whatever
you want to treat someone with on any side of
the spectrum, we're really missing an opportunity to dial in
and say, is there anything that can be done to
kind of extend positive physiology and positive physiologic sort of
(08:46):
processes in the body by assessing really well and then
intervening to first I would say in very early perimenopause
or really like any amount of overhere and aging. I
don't even like to use the word perimenopause anymore because
again it makes people feel like are they in it
or not? And it's like, in reality, we're always on
this trajectory of our ovaries being dynamic and aging right
(09:07):
from the beginning, Right we are in utero, when we're
in our mother's womb, we have a lot of follicles, right,
and then we have less by the time we're born.
Then we have less by the time we're menstruating, and
then we have less by the time we're thirty and
thirty five and so on and so forth. So it's
really just this, it's the lifespan. It's the female life span.
And so if we're just taking this again, symptom based
approach and saying, well, you're in perimenopause now, so now
(09:30):
you get to have, say, birth control because that will
suppress your symptoms, or you get to have a low
dos estrogen patch because that will suppress your symptoms. We're
really missing this broader scope of saying, let's see your
health through the lens of your ovarian function, and what
can we do to optimize that earlier on? Much in
(09:51):
the same way that we want to optimize fertility. Right,
menopause is really just the cessation of fertility, that's all
that it is. So in the same way that we
can optimize fertility, we can demize ovarian function as the
age for someone like your age or my age, where
we're sort of post child bearing, but we're not necessarily
in the depths and the throes of like right at
(10:11):
that end of ovarian function, right, we're somewhere in the middle.
What can we do to optimize it first, and then
how can we augment it if our physiologic reserves are
just no longer there.
Speaker 2 (10:23):
I love that reframe and the idea of being aware
of this earlier, not framing it as a problem.
Speaker 1 (10:28):
And I feel like even that lens.
Speaker 2 (10:30):
Of looking at how do we support ovarian function in
each phase and not kind of demonizing one or making
it a demarcation point of this is now perimenopause feels
so much more empowering and I feel like it's not
usually talked about in this way. So can you explain
a little bit more on like the hormone side, what's
happening with our hormones in the normal physiological function of
our ovaries, And then from understanding that, what are some
(10:53):
of the ways we can begin to be aware of
and start supporting our ovarian function at any age.
Speaker 1 (10:59):
Yes, yeah, no, I love that. And I know that
you're a big fan of circadian rhythm, so your listeners
will appreciate that. You know, we each also as females,
have an additional rhythm, which is our Infhrydian rhythm, right,
So this is our rhythm of hormones that is dictated
by our hypothalamic, pituitary ovarian axis. So it all begins
in the brain with the hypothalamus and the pituitary, which
(11:21):
are kind of like air traffic control. They survey surveil
the body. They are aware of what's happening in terms
of levels but unlike the thyroid hormone. We're say, adrenals
that have a daily rhythm, right, our ovarian hormones have
a monthly rhythm. Right, Some people, you know, kind of
equate it to like the lunar cycle. Now, evolutionarily speaking,
(11:42):
I don't think that every woman needs to cycle with
the moon, because it wouldn't make any sense if everyone
was always fertile at the very same time terms of
like populating the earth. So you know, I think that
there are light reasons why that may happen, but don't
I don't encourage people to like sync your cycle with
the moon that it's absolutely necessary. But what is happening
is that FSH which it stands for follicle stimulating hormone
(12:05):
on day one of your cycle, when you get your
period right, is starting to climb. It's starting to rise,
and that is responsible for releasing esterdile or estrogen from
your ovarias. Estrogen is at the lowest at day one
of your cycle, so when you're bleeding, it begins to
rise around day five. And we're going to frame everything
in in the context of a twenty eight day cycle,
(12:25):
but for many women that might be twenty seven thirty two,
so you can extrapolate from there. So from day five
to say day twelve, estrogen is on the rise, peaking
one time in the beginning of the cycle in the
follicular phase that's the first half prior to ovulation, peaking
one time about two days before ovulation. When estrodyle peaks
to its highest level that it has at any point
(12:47):
in the cycle for the most part, it will then
trigger the release of lutinizing hormone from the brain. Okay,
so this beautiful ebb and flow, and you should we
should link a picture of it in the show notes
because if you've never seen it, like I think, you know,
you really kind of understand it. If you see it,
LAH is released. This is what you test if you're
doing ovulation predictor tests, right, because this is the hormone
from the brain that triggers the release of an egg
(13:09):
from the ovary. So LH surges, a follicle is released,
and then what's left behind in the ovary is called
the corpus lutium and that is sort of a temporary
endocrine gland that secretes progesterone for about twelve to fourteen
days and then as no pregnancy occurs from about day
twenty one to twenty eight, estrogen and progesterone start to decline,
(13:30):
and then the whole cycle starts again. When they get
to their lowest level, it triggers the release of the
uterine lining, and then it starts again. Now, this is important,
and many of you might understand it in the context
of fertility or the context of your period, right if
you've done any fertility awareness method, if you've just tracked
your cycle for your own kind of health understanding. And
what I didn't understand and was not taught in my
(13:52):
ide league education, just wildly surprising, was that like this
physiologic process, this rhythm is actually responsible for health in
all areas of the body and all systems of the body.
It's not just it doesn't just serve the purpose of
like changing your uterilning. And we know this because we
know that we feel different, right, we know that we've
(14:14):
heard things like, you know it's better to fast in
certain parts of the cycle. So we understand so sort
of how it impacts our metabolism, our mood, maybe our
sweeping be our energy. But beneath the surface, there are
a cascade of things that are triggered by these undulating
levels of hormones and rhythms.
Speaker 2 (14:34):
Yeah, this is so fascinating, And I've tracked my cycle
now for over twenty years and it's given me some
fascinating insight. I've also used that for planning pregnancies and
avoiding pregnancies.
Speaker 1 (14:44):
One thing I used to frustrate me was in my
order ring data.
Speaker 2 (14:47):
In my luteal phase, I would always have lower readiness scores,
and I used to kind of get angry and ping
them and say, like, of course, temperature rises in the
second half of the cycle. Why am I getting dinged
for this? And then I realized, like, actually, if I
look at the data as as a whole, my readiness
is somewhat lower in my luteal phase, my resting heart
race is a little bit higher, my sleep is not
quite as good at certain points. And so it was
(15:08):
actually accurately giving me insight there. And I was getting
annoyed because I thought they were just honing in on temperature.
But to your point, this affects so many areas of health,
which I find so fascinating, especially if we track it.
We get that insight kind of on a day to
day basis, and can then like tweak based on the
data and based on how we feel to make those changes.
And I know we also hear a lot about progesterone
(15:30):
and progesterone changes kind of being the first sign of perimenopause,
and you touched on it briefly, but I feel like
that one gets so much attention. I would love your
take on progesterone and what to know about that.
Speaker 1 (15:41):
Yeah. Now, I was actually thinking while you're talking that
some of the things that we don't understand about, you know,
the cycle is there are things built in here that
are cancer protective for women.
Speaker 2 (15:51):
Right.
Speaker 1 (15:51):
This is why most incidents of breast cancer happens after
the age of fifty for women, because it's when this dynamic,
very protective cycle falls apart completely. And one of the
roles of progesterone in the liuvial phase is to stimulate
the production of tumor supressor gene. And one of the
roles of estrogen, right is to be a growth factor.
(16:12):
It's how we grow and recycle the internal lining of
our blood vessels. Right, It's think about when you're building
up uterine lining, you're actually growing new blood vessels. So
that's just not happening, and the uterus is happening everywhere.
So we're recycling our blood vessels, we're creating growth factors,
we're creating new stem cells, and then that growth needs
to be balanced right, very much in like a Yin
yang kind of way, by the yin of progesterone, which
(16:34):
says like, calm down, let me do some checks, let
me kind of survey the body, let me like, you know,
look at everything. And there's actually a study that shows
that for women who have breast cancer, if they're surgery
for removal of a suspicious or malignant lump, rather is
done right at that juncture after ovulation, before the surge
of progesterone, they actually have a lower chance of recurrence
(16:58):
because of that protected nature of progests. So progesterone is
not just protective for the uterine lning which we hear about, right, progesterone,
you know, we will get robust amounts of progesterone when
we have healthy robust ovulation, right, and healthy robust ovulation
starts well before day fourteen, day fifteen of the cycle.
It starts back when we get that estradyal peak. So
(17:19):
what many people don't understand is that as perimenopause, you know,
if you want to call it that starts to set in.
It's the whole cycle is falling apart because ovarying health
is falling apart. So even though we kind of conceptualize
it as like progesterone is decreasing, many people begin with
a progesterone supplementation in perimenopause because of sort of lack
(17:40):
of robust progesterone secretion. It's really due to that lack
of peak of estradyl two days before evulation that we're
seeing these impacts because when esterdyl is peaking between day
five and twelve, it's recruiting healthier follicles, right, And the healthier,
more robust follicle you get, the better progesterone production you're
going to get. So it's really like I don't like
(18:01):
to think of like a lot of people say perimenopause
is a period re of estrogen excess and a regularity
and insufficient progesterone. I think that it's a little bit
more nuanced than that. Certainly from a symptom based perspective,
some people will benefit from very very early in perimenopause
doing things that support progesterone secretion like vitex, vitamin C
and other antioxidants. Obviously stress support because there's a relationship
(18:24):
between the formation of cortisol and sort of your ability
to produce progesterone. But we also want to, you know,
think about at what point are we sort of missing
out on the opportunity to really work with estrogen, because estrogen,
from systemic perspective and from a chronic disease risk factor
(18:46):
like perspective, is I would say, more more important than
even then progesterone.
Speaker 2 (18:53):
Yeah, I love that idea that it's more nuanced than
that versus a single solution, especially because it feels like
often those solutions are not done cyclically, so they're not
kind of lining up with what the body naturally does.
So I love that you explained it like that. I
also know, another big topic when it comes to perimenopause
and menopause is the metabolic changes, the increase in visceral fat,
(19:14):
the metabolism shifts. How often already about ninety percent of
people have some barker of metabolic dysfunction, and often for women,
this number goes up in those phases of life. So
can you talk about what's happening? Why do women seem
to experience this sort of like metabolic coming undone often
during perimenopause and menopause.
Speaker 1 (19:33):
Yeah, I love that coming undone. I say fall apart
or coming undone, because that's what it feels like, I
think to women. And we also know there's such a
relationship between you know, our stress, our sleep, you know
how all of these other habits, and we're kind of
coming to a peak time by the time we're in
our mid forties of like really holding it all right,
Like I'm about to be forty four this year, I
(19:55):
have aging parents, I have little kids. Right, many of
the people that we work with it's the same situation.
It's like the amount that you're holding is growing as
just as the capacity in the reserves seem to be decreasing.
So you've got this like perfect storm. And then estrogen
is subtly on suddenly or not so subtly on the
decline in the background, which affects metabolic health in many
(20:15):
different ways on the surface level. Right, I think that
it's practical to think about how when estrogen declines, our
circadian rhythm can begin to fall apart, because estrogen really
governs the super chismatic nucleus in the brain, and so
it decreases our ability to really respond in our brains
to the signals of the sun. And so that may
be subtle at first, but it shows up as like
(20:38):
waking up at three or four in the morning, having
a cordisol spike in the morning. It shows up as
having less resilience to things that also disrupt cordisol, like alcohol.
So women will drink an alcoholic beverage and then they
find that they're waking up at three o'clock in the morning,
and that's because alcohol initially will tank cordisol, and then
because that also works by feedback loop, we'll get a
spike around three or four in the morning. And that
(20:59):
can happen without alcohol too. And people will say, I
think it's just because of all the stress, and I'm
ruminating about the stress, But there's again a physiologic component
to your ability to manage the stress. Right, They work
hand in hand, And I don't want to overemphasize that.
You know, stress of management, of course, is important, and
you talk so much about this on this podcast, and
I think anyone in the wellness space hears about that
so much, and it's important. But we also don't want
(21:21):
to oversimplify and also get into a tendency of kind
of blaming people because I meet so many women who
are just like feel so bereft because they feel like
I'm doing everything for my sweep and I'm doing everything
for my stress, and I just like can't nail it.
And that may be because of the loss of resilience
just inherent and losing estrogen, we also lose the ability
(21:42):
to regulate the vagus nerve, so we lose pairasympathetic tone.
So that means that if you have a stressful event,
like I always say, maybe your kid walked in and
like knocked your favorite glass on the floor and it shattered,
and like it's a small thing, it because a brief
sympathetic but we should realistically be able to recover from that.
(22:02):
But if you're feeling like that, just like you can't
shake that physically, that's lack of dynamic para sympathetic tone, right,
And estrogen also impacts that ability. So you have all
these factors that dysregulate stress, and I think that that
absolutely plays a role in the way that our metabolism
is regulated. Particularly we know that gluconeogenesis, which is the
process by which our liver sort of keeps glucose levels high.
(22:26):
And this is something that's very much regulated by stress,
and some people are genetically a little bit more prone
to doing this. I'm someone that's very prone to kind
of keeping glucose levels higher than I actually need them.
Like before, you know, I really could have understood this work.
I just sort of lived in like a high nineties,
low one hundredth place despite lots of dietary changes, and
(22:48):
it was a very physiologic response to stress. So that
will often worsen for women in perimenopause, meaning that like
their increased cord is all is creating is making their
liver kind of unloads stored glucose. Keeping their glucose levels
higher is if they would be kind of ready to
run or exert heavily physically, but it's you know, we're
obviously mostly not doing that. We're sitting at our computers. Additionally, estrogen,
(23:11):
just at the cellular level helps improve insulin sensitivity, meaning
that it changes cellular signalings. So when insulin comes to
the cell, the cell is more receptive to insulin moving
glucose into the cell. We won't glucose in the cell
not outside of the cells, because when it's in the
extracellular space, right, glucose can do all kinds of damage
to the body. We want it in the cell where
(23:33):
it can be used up and converted into atp SO,
which is our energy form, our cellular energy. So the
other thing that it does is it just seems to
deposit more abdominal fat, and we see that with cortisol
patterning too, So I think that we haven't fully elucidated
like how much of that is driven by estrogen's unraveling
of cortisol balance and how much is directly related to
(23:55):
just the loss of estrogen in itself. I think it's
probably a combination of the two. But if you you
are like, am I sort of moving toward that place
where I should be thinking about what can I be
doing to either optimize my indigenous production of hormones or
potentially supplement the initial symptoms that people are going to
experience often are like, I haven't changed anything in my
diet or exercise routine, but I just noticed that, like
(24:18):
around my waist, I have more belly fat, and that
obviously feels really demoralizing and frustrating to women. And number two,
I would say it's the psychological shifts, the feeling like
I just have more baseline anxiety. I feel like I
can't multitask or tolerate things the way that I used to,
and little glimmers of brain fog. Right, brain fog is
(24:39):
a really important symptom to pay attention to, Like if
you've ever been driving a route that you drive all
the time and you just miss your turn right, or
you're like in mid sentence, like on this podcast, and
you're like I can't remember the word that I was
going to say, like something that you say all the time,
those little things that you know. I think we have
a cultural tendency to just sort of like shrug off.
(25:00):
And I think if many of us who are sort
of millennials or young gen xers, when we think back
to our childhoods, it was just very socially and culturally
normal for women in their forties to just take on
a different appearance. They were more fluffy, right, they were
kind of more cranky, and this was like an archetype
that was very generally accepted. And I actually thought, I
(25:21):
remember having thoughts as as a small child at like
thirteen fourteen that like, once you have kids and you
get to be forty, you just end up kind of
being fatter and crankier. Like that's just a natural physiologic progression.
And that's like wildly amazing to me that as a
small child I had that impression, And thank goodness that
I live in the age that we live in now,
(25:43):
where I think age is so much more we know,
we know that age is actually like a chemical biologic thing,
not so much a chronologic thing. Right, you have your
chronologic age, but there's so much that you can do
to impact your physiologic age. And that's really what we're
talking about. It's like, how can you support or your
body to stay within this rhythm for as long as
(26:03):
possible producing hormones in the best way possible at the
best levels and the best rhythm, Or when that is
no longer available, how can we then augment to reproduce
that rhythm. If you're a candidate for that and you're
interested in kind of being all in on this hormone journey,
that's an option too. Either way, we have so much
more ability to modify our outcomes. Does that make sense?
Speaker 2 (26:28):
It does? And I like that you talked about at
the beginning of that kind of losing our sensitivity to light,
which to me indicates that this becomes a very important
factor to be intentional about as we get older. I
think it's wildly important at any phase of life actually,
and even in my kids. I see massive circadian changes
when we get the light exposure piece right. But at
the end of the day, I feel like humans are
(26:49):
solar powered, and so perhaps for women in this phase
of life, it's a little bit more intentionality about our
light patterns and our exposure to natural light and getting
enough of it, and how we know that increases our
nutrient of it affects our circadian rhythm. There's so many
benefits there, and I know it also gets tougher that
when we have teenage kids and aging parents and all
the demands on our time. And I love the way
(27:11):
you kind of explain the first principles of this idea
and really take like that ten thousand foot view and
then dial into the specifics that we could do. This
episode is brought to you by Native Path and in particular,
something I have been experimenting with and really really loving lately.
And here's what you need to understand. A lot of
(27:33):
us think calcium is important for our health, especially for
our bone. But is this actually true bad news? It
turns out maybe not, or at least there's more nuance here.
One of the largest bone house studies ever conducted followed
thousands of women taking calcium and oral vitamin D daily
and the results were surprising, but not in the way
you would think. They saw no significant reduction in their
(27:54):
risk of fractures, and they saw no improved bone density.
So all those calcium pills might not be doing what
we think, and it turns out they might actually be counterproductive.
But here's where it gets interesting. A brand new study
found that women who did one thing every morning consistently
for six months gained seven percent bone density, which is massive.
This is the same amount of bone mass the average
(28:15):
person loses over the course of five years after a
certain age. So what did they do. It was not
a medication or even a workout. Came down to one
simple thing added to their morning routine. And that's why
a lot of people, especially people over fifty, are making
this one simple change and seeing massive results. I'm sure
you're probably curious what it is, and it's a particular
(28:37):
protein from one of my favorite brands called Native path
and they're offering all of you up to forty five
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(28:59):
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Mama and see why people are adding this to the
routine with amazing results. This podcast is brought to you
by Element and this is a company you might have
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(29:20):
products because proper hydration leads to better sleep, it sharpens focus,
it improves energy, and so much more. But hydration is
not about just drinking water, because being optimately hydrated a
state called U hydration, is about optimizing your body's fluid ratios.
And this fluid balance depends on many factors, including the
intake and excretion of electrolytes, which many people don't get
(29:43):
the right amounts of electrolytes are charged minerals that conduct
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(30:07):
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get our electrolytes dialed in. We have more steady energy,
improved cognitive function, suffer fewer headaches and muscle cramps. We
can perform better for longer, and especially the support fasting
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kidneys to release sodium, So replacing that loss sodium with
(30:28):
electrolytes can help you feel good on the fast. Since
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So much more.
Speaker 2 (30:44):
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(31:07):
will receive a free sample pack with any order. I'm
curious for women who are tracking their cycle and as
I have for so long, how can we tell when
these things are starting to shift, when supporting ovulation isn't
enough anymore, or when we like what signs should we
watch out for and what do we do when we
start noticing changes?
Speaker 1 (31:27):
Yeah, it's such a good question. And for any of
you out there, I know there's lots of you who
are cycle temp tracking, So maybe doing it with an
aura or a thermometer and using an app like Natural
Cycles or all the other ones that are out there,
which I've also been doing forever and love it and
love having twenty years of historical data on myself. Another
tool that's really cool, And I don't know if you've
(31:48):
done this at all yourself, Katie. There's a couple of
urinary hormone trackers now out there, the mirror monitor, the
anido monitor, that you can really kind of combine your
self knowledge and monitoring with these tools where you would
just actually pianistick kind of like a pregnancy test or
an ovulation test, and then you stick it into this
little device that sinks with your phone and you can
get your estrogen, LH and progesterone levels every day, which
(32:11):
is super cool because sometimes temperature, which is the core
measure in traditional fertility awareness, in addition to cervical mucus,
you know, cervical position, et cetera. Those are other, you know,
fertility markers that you can be aware of. It's really
cool to be able to dial in to the hormones.
It's kind of like having your own Dutch test at home. So,
(32:33):
and those are really affordable, especially the anidos, so I
definitely recommend checking those out. But the things that you
may begin to see, Number one, if you're only temp tracking,
it's very possible that you'll see a shorter amount of
time that your temp remains elevated. You may also see
that the temp elevation is not as significant. So if
(32:55):
it used to be a degree to a you know,
one point two degrees, it may be like point six
or point eight or point four, right, And of course
there are other things that impact this thyraid health and
thyroid sufficiency, which is something that I really encourage everyone
to have an in depth thyroid assessment annually, especially as
(33:16):
we're moving through ovarian aging, so really starting at thirty
thirty five, an annual complete thyroid evaluation is super important
because a lot of the symptoms and people think like, oh,
it's got to be my hormones, because that's become so buzzy,
and they're convinced that it's that. It's like we actually
correct the thyroid and then all of a sudden, progesterone
production becomes robust again and temperature stays elevated in a
(33:38):
beautiful way. If you're monitoring with an anido or a mirah,
what you might see is that there's a little bit
more of like a chitty chitty bang bang quality, like
a kind of colunking happening in that follicular phase when
estrogen should be on a consistent rise to like you
know that the roller coaster. How there's like the one
really steepeeled hill at the very beginning that like clink clink,
(34:00):
clinks up all the way. That's how our cycle should be.
In the folegular phase, be one big hill at the beginning,
and in perimenopause you might start seeing there's like kind
of a chunkiness, like you go up and there's down
and up and down, and you don't really get that
sufficient peak in the preovulatory phase. And that's really interesting
to watch because what sort of happens is that if
(34:21):
you're tracking your actual hormone levels, what you will find
is that instead of having a high peak on day
twelve and a moderate peak on day twenty one, you'll
see a really big peak in the second half of
the cycle, in the luteal phase instead. And I think
the reason is because FSH is always aware of what's
going on and kind of knows. Your brain knows intuitively
(34:43):
that you never hit that peak that you were trying
to hit preabulation, and then it kind of hits it
in the second half of the cycle, which is why
some people may describe things like what we would maybe
classify as estrogen dominant symptoms in the second half of
the cycle, so like increased breast tenderness, increase PMS, and
theoretically that's related to an imbalance in the amount of
(35:03):
progesterone relative to progesterone in the second half of the cycle.
So if you're having I would say symptoms like you're
feeling a lot of mood and brain and cognitive changes.
You're seeing sleep changes, You're seeing like temperature regulation changes,
so not quite night sweats or hot flashes, but you
feel even more cold, kind of like a thyroid symptom.
(35:25):
Like these can all be signs that this system is
falling apart. And I would say, if you're like up
for the challenge and you're the girl who's got the
CGM and you're doing the TENTP monitoring and all that stuff,
go get yourself and ANITO or a mirra because it
just kind of elevates your awareness of what's really going on.
Speaker 2 (35:44):
I love the availability of all these kinds of tools
now and that we can get this data at home.
I feel like we're living in such an amazing era
for that. And sometimes it's helpful, really helpful to have
people like you could have explained how to use these things,
because often we can get data overwhelmed as well, like
with lab data and genetic day and all this testing
we can do. Knowing how to actually use that to
our advantage kind of becomes a really big factor. And
(36:06):
we've touched on hormones. I'd love to before we end
this episode to talk a little bit about hormone replacement therapy.
I know that's a big topic in these phases of life,
and based on everything that you've said, I'm wondering, is
there a kind of a rhythmic approach to this as
well that more closely mimics the body's natural rhythms and
that is more supportive of ovarian function and health as
long as possible.
Speaker 1 (36:27):
Yeah. So I like to think of hormone replacement therapy
when I very intentionally use the term hormone replacement therapy
versus menaphausal hormone therapy, because in my opinion, we do
not need to be, you know, a year without a
period before we think about using hormones. And there are
lots of indications for hormone replacement therapy, including conditions like
PCOS or primary ovarian insufficiency, things where there's dramatic hormone
(36:49):
insufficiency well before the time that we would think of
it as like traditional ovarian declines. So the way that
I categorize hormone replacement therapy is we've got basic static. Okay,
that's one type. That means that we're giving like a
low dose continuous estrogen every day, and we're giving a
low dose continuous progesterone. The reason that we need to
give progesterone an addition to estrogen, from a very traditional
(37:10):
medical standpoint, is to protect the uterine lining from getting
that growth that I talked about happens between day five
and twelve of the cycle leading up to ovulation, which
would be theoretically preparing the uterus for a pregnancy. In
a traditional approach, we never want the uterine lining to
grow once someone is, you know, relatively menopausal, because if
(37:32):
that goes unchecked and it's not shed with a sufficient period,
it's a risk factor for endometrial cancer. So most hart
when you're hearing about people talk about it in kind
of the menopause, all the menopause glory that's happening on
socials right now. Is that methodology. It's using some type
of transdermal or oral estradil and some type of continuous
progesterone with the same dose every single day. Then I
(37:54):
have the second category which is cyclic, which means also
a low dose static estrogen, usually transdermal, some times oral,
and using progesterone for only twelve or fourteen days a month.
Sometimes this can be effective in perimenopause. Is just sort
of like a top off. A little bit of estrogen
kind of helps your natural rhythm maintain and stay in place.
(38:14):
But it's a little bit of a double edged sword
because with any type of HRT that you use, especially
if you're initiating perimenopause, there's always the risk that the
exogenous hormone supersedes in your endogenous so internal hormone regulation.
So it gives so much feedback to the brain that
(38:34):
your own brain stops stimulating your production of hormones and
you can end up with lower levels than you even
started out with to begin with. The third category would
be called physiologic or rhythmic, So I like to call
it physiologic HRT, and it's a methodology that we've been
doing for several years in our practice that really happened
by accident. I didn't even start my practice to be
a hormone care provider. I started doing functional medicine, and
(38:57):
obviously I had a background in women's help because I'm
a midway and a women's health NP, and I just
had all these women come into my office who were
forty five, forty nine, and I did all of the
things that functional medicine taught me to do with them,
and they would get a little better, but like ultimately,
they wouldn't yet fully better, no matter how many elimination
diets I did with them. And I mean, that's a
(39:18):
whole other topic for another time, But what I discovered
was that women on traditional HRT regimens would often get
initial relief, and that we certainly know that it's effective
for a management of hot flashes, right, which is sort
of a characteristic thing that we think about when we
think menopause. But we know that perimenopause and menopause and
this trajectory of ovarian decline is affecting the cardiovascular system,
(39:41):
it's affecting the bones, it's affecting our immune system and
our ability to sort of monitor and control for uncontrolled
cellular growth right, and gene expression, which is a case
in cancer. It's affecting our NERD transmitters and our mood
and all of these things. And when you take the
approach of let me give the dose that was appropriate
for shutting down hot flashes. That's really all you're doing.
(40:05):
You're not conferring all of the possibility of physiologic benefits.
And so I actually had a patient who was like,
I want to try this methodology, and I was like, Okay,
let's do it. And in physiologic HRT, you're using a
transdermal estrogen generally has to be compounded, and you're using
a delivery method that allows you to give very precise
(40:27):
amounts of cream so that you can give a different
miligram amount every day in the follicular phase of the cycle.
So day one to five is one dose, Day five
and six are a different day six and seven, day seven, eight,
et cetera, up until you do a singular peak on
day twelve with your dose, and then it drops down
just like it would in a normal physiologic cycle of
a cycling woman, and then it surges again for the
(40:49):
luteal phase. And then progesterone is done in a very
similar way, so a smaller amount beginning on day fourteen, larger, larger,
larger up to day twenty one, and then down, down, down,
And I find that this is really nice done in
a sort of at at a very sort of beginning
beginner dose with women who are impairing menopause because their
bodies are already used to cycling. So, you know, a
(41:12):
people who are cycle centric, who are aware of their cycle,
understand how it affects their mood and their behavior and
just sort of their energy. Right, Many women sort of
organize their work life and their productivity and their creative
time versus their kind of bookkeeping time based on where
they are in their cycle, because it makes our brain
feel different, right, and so this is possible to sustain. Now,
(41:36):
there's no clinical research on this methodology, right, There's not
hard evidence, randomized controlled trials, or big systematic reviews of
any sort on this type of approach. However, we do
have a lot of research that really elucidates what happens
when women don't ovulate.
Speaker 2 (41:54):
Right.
Speaker 1 (41:54):
We know that women on birth control, women who are PCOS,
women who are primary or varian insufficiency, women who have
go fall apart earlier than typical have a much higher
risk of chrownic diseases like osteoporosis, cardiovascular disease, diabetes, and depression.
And so essentially, menopause is the breakdown and fall apart
of this very essential internal rhythm, and along with it
(42:18):
comes risk factors in side effects, and a lotos static
approach has you know, some ability to stave off some
of these things. We know that the you know, the
estrogen can reduce the risk of cardiovascular disease, can reduce
the risk of diabetes, that it's effective for improving insulin resistance.
But I guess the question is like how good can
it get if managed really individually? Right? This is like
(42:41):
a very individualized, tailored approach, really dosed per the person,
and it's for the woman who's okay with the monitoring, okay,
with the frequent testing, okay with the maybe occasional ultrasound
to make sure that your body is getting a period
appropriately and shedding a really you know, complete heroine lining.
So it's not for everybody, but it is certainly something
(43:01):
to look more into, and if you're interested in it,
you can go to the Women's Hormone Network dot org,
which we can put in the shows as well, which
is sort of the consortium of providers across the country
who are practicing in this way, and you can learn
more about it amazing.
Speaker 2 (43:14):
I will make sure those are linked in the show notes,
and I know you have specific resources for anybody listening
who wants to continue to follow up. I will make
sure those are linked as well. But where can people
find you and learn more and I deep on their
own health?
Speaker 1 (43:27):
Yeah, I'd love for you to follow me on Instagram
at Emily Sadry Underscore NP and also you can visit
my clinical practice. We're currently licensed in eleven states in
the US. That's Aurelia Health dot org, a U R E.
L I A Health dot sorry dot com dot org
or my website Emilysadry dot com. And if you go
to Emilysadry dot com back slush well in this MoMA,
(43:47):
we have some resources for you and have some information
about our programs.
Speaker 2 (43:52):
Amazing Well, those will all be linked and I feel
like this was such a comprehensive and helpful episode. We
got through so much and a short amount of time,
and I will make sure there are relevant links for
all of you listening on the go. Those are all
at Wellnessmama dot com. Emily for this episode, thank you
so much for your time and for all that you've shared,
and you guys stay tuned for another round that will
go deep on mental health and GLPAS that Emily, thank
(44:13):
you so much for the time today.
Speaker 1 (44:14):
Thank you Katie, it's been a pleasure.
Speaker 2 (44:17):
And thank you for listening, and I hope you will
join me again on the next episode of the Wellness
Mama podcast. If you're enjoying these interviews, would you please
take two minutes to leave a rating or review on
iTunes for me. Doing this helps more people to find
the podcast, which means even more moms and families can
benefit from the information. I really appreciate your time and
(44:37):
thanks as always for listening.
Well on for My Body's podcast.
Speaker 2 (00:04):
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ratios and this fluid balance depends on many factors, including
the intake and excretion of electrolytes, which many people don't get.
The right amounts of electrolytes are charged minerals that conduct
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status by balancing fluids inside and outside of ourselves. Element
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hundred milligrams of sodium, two hundred milligrams of potassium, and
sixty milligrams of magnesium with no sugar. Since electrolytes are
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improved cognitive function, suffer fewer headaches and muscle cramps. We
(02:59):
can reform better for longer, and especially the support fasting
or low carb diet because when we stop eating carbs,
like during a fast, the absence of insulin allows the
kidneys to release sodium to Replacing that loss sodium with
electrolytes can help you feel good on the fast. Since
Element is zero sugar, it also doesn't break up fast.
Electrolytes are also important for maintaining blood pressure, regulating digestion,
(03:21):
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(03:49):
at that link you will receive a free sample pack
with any order. Hello and welcome to the Wellness Mama Podcast.
I'm Katie from wellnesswama dot com and I am here
today with Emily Sadrey to talk about how perimenopods isn't
the problem, it's a clue, and understanding the cyclic approach
to hormones, health and vitality. She has so much practical
(04:12):
information in this episode. Emily is a double board certified
Women's Health nurse practitioner and certified nurse midwife. She hails
from New York City and obtained her graduate education at
the University of Pennsylvania. She was drawn to midwiffree, which
means with women or to stand in front of, because
it was practice rooted in relationships, and she believes that
(04:33):
women need across their lifespans someone to walk alongside them,
not to tell them what to do. She practiced in
conventional medical settings for a decade before founding a really
a health in twenty twenty one, which I will link
to in the show notes, and she gives a lot
of really practical wisdom in this episode about perimenopause and
why she doesn't even like that word. So let's jump in. Emily, Welcome,
(04:56):
Thank you for being here.
Speaker 1 (04:57):
Thanks so much for having me, Katie. It's a real pleasure.
I feel like I've known you for so long as
I'm sure that many of your listeners do, and it's
a real honor to be here. So thanks for having me. Well,
I'm excited to learn from you.
Speaker 2 (05:09):
I feel like our topics are going to be very
relevant to a lot of people listening, and in the
span of two episodes, we're going to get to go
deep on two particular topics. And in this first one,
I would love to deep dive on the topic of perimenopause.
I know I get a lot of questions about this.
This is a phase I will also eventually be moving into,
so I've been researching it quite a bit, and I
love what I've read from your approach and your work
(05:30):
already on this and would love to learn more deeply
from you, And in particular, you've said that perimenopause isn't
a problem, it's a clue, and I would love to
start there as a foundation for this conversation because I
feel like, often, especially in the realm of women's health,
so many things are framed as a problem. Women often
feel like something's wrong with them or something's broken, And
I love the way that you shine light on this topic.
Speaker 1 (05:53):
Yeah, I think that even in the natural health space,
we have a tendency to sort of conceptualize everything through
the lens of like what a woman is doing wrong.
You know, it's really interesting if you look back to
two thousand and two, and I'm sure that other guests
of yours have talked about the WHI the Women's Health
Initiative studies, So I'm not going to go in depth
about that study and kind of how it changed our
(06:14):
opinion and stance on the hormones. Is a medical community,
even the natural health community at the time, you know,
began really demonizing estrogen, and we began to at that
time more than any really talk about perimenopause in terms
of how we need to sort of be better, how
estrogen is this demon that we need to detoxify better
(06:37):
and anything that was wrong was related to estrogen dominance, right,
And that sort of still stays with us today in
the sense that on the sort of natural, more integrative side,
I think there's still some confusion about the role of
estrogen and about declining estrogen and what that is a
catalyst for in the body. And on the traditional medical side,
(06:57):
there is still an over emphasis on this symptom management,
as you've said, and you know, the last most updated
guidelines from the Menopause Society in the in the North
North America, the US that's our governing body, really still
emphasize that our approach to this phase of life, which
I really think of as just part of the trajectory
(07:18):
of aging and as so many things are. Because most
of the medical model is like a male lens. If
it's female, it's like it has to be kind of different,
but it's not. Instead of talking about as a physiologic change,
we're pathologizing it and saying, like, we'll just treat the symptoms.
I think if you take a more longevity or even
like a biohacking approach to thinking about aging for females,
(07:41):
if you think about how we approach the rest of
the body, like you talk about this in terms of
metabolic health, or you could talk about it in terms
of you know, really any aspect of the body we
are working to not we know that aging is inevitable,
but there are lots of ways that we can kind
of intervene to slow say telamar shortening. Right, the actual
physiological does that occur as we just get older. When
(08:03):
it comes to the endocrine system into hormones, the ovaries
are aging and that is a systemic issue because there
are receptors for estrogen on every cell in the body
except for the red blood cell. So it's not so
much that we need to worry about making a person comfortable.
Of course I want people to be comfortable, but if
we're just taking the approach of like just give a
(08:24):
little bit of hormone or maybe a little bit of
ostwoganda or a little bit of lack cohash or whatever
you want to treat someone with on any side of
the spectrum, we're really missing an opportunity to dial in
and say, is there anything that can be done to
kind of extend positive physiology and positive physiologic sort of
(08:46):
processes in the body by assessing really well and then
intervening to first I would say in very early perimenopause
or really like any amount of overhere and aging. I
don't even like to use the word perimenopause anymore because
again it makes people feel like are they in it
or not? And it's like, in reality, we're always on
this trajectory of our ovaries being dynamic and aging right
(09:07):
from the beginning, Right we are in utero, when we're
in our mother's womb, we have a lot of follicles, right,
and then we have less by the time we're born.
Then we have less by the time we're menstruating, and
then we have less by the time we're thirty and
thirty five and so on and so forth. So it's
really just this, it's the lifespan. It's the female life span.
And so if we're just taking this again, symptom based
approach and saying, well, you're in perimenopause now, so now
(09:30):
you get to have, say, birth control because that will
suppress your symptoms, or you get to have a low
dos estrogen patch because that will suppress your symptoms. We're
really missing this broader scope of saying, let's see your
health through the lens of your ovarian function, and what
can we do to optimize that earlier on? Much in
(09:51):
the same way that we want to optimize fertility. Right,
menopause is really just the cessation of fertility, that's all
that it is. So in the same way that we
can optimize fertility, we can demize ovarian function as the
age for someone like your age or my age, where
we're sort of post child bearing, but we're not necessarily
in the depths and the throes of like right at
(10:11):
that end of ovarian function, right, we're somewhere in the middle.
What can we do to optimize it first, and then
how can we augment it if our physiologic reserves are
just no longer there.
Speaker 2 (10:23):
I love that reframe and the idea of being aware
of this earlier, not framing it as a problem.
Speaker 1 (10:28):
And I feel like even that lens.
Speaker 2 (10:30):
Of looking at how do we support ovarian function in
each phase and not kind of demonizing one or making
it a demarcation point of this is now perimenopause feels
so much more empowering and I feel like it's not
usually talked about in this way. So can you explain
a little bit more on like the hormone side, what's
happening with our hormones in the normal physiological function of
our ovaries, And then from understanding that, what are some
(10:53):
of the ways we can begin to be aware of
and start supporting our ovarian function at any age.
Speaker 1 (10:59):
Yes, yeah, no, I love that. And I know that
you're a big fan of circadian rhythm, so your listeners
will appreciate that. You know, we each also as females,
have an additional rhythm, which is our Infhrydian rhythm, right,
So this is our rhythm of hormones that is dictated
by our hypothalamic, pituitary ovarian axis. So it all begins
in the brain with the hypothalamus and the pituitary, which
(11:21):
are kind of like air traffic control. They survey surveil
the body. They are aware of what's happening in terms
of levels but unlike the thyroid hormone. We're say, adrenals
that have a daily rhythm, right, our ovarian hormones have
a monthly rhythm. Right, Some people, you know, kind of
equate it to like the lunar cycle. Now, evolutionarily speaking,
(11:42):
I don't think that every woman needs to cycle with
the moon, because it wouldn't make any sense if everyone
was always fertile at the very same time terms of
like populating the earth. So you know, I think that
there are light reasons why that may happen, but don't
I don't encourage people to like sync your cycle with
the moon that it's absolutely necessary. But what is happening
is that FSH which it stands for follicle stimulating hormone
(12:05):
on day one of your cycle, when you get your
period right, is starting to climb. It's starting to rise,
and that is responsible for releasing esterdile or estrogen from
your ovarias. Estrogen is at the lowest at day one
of your cycle, so when you're bleeding, it begins to
rise around day five. And we're going to frame everything
in in the context of a twenty eight day cycle,
(12:25):
but for many women that might be twenty seven thirty two,
so you can extrapolate from there. So from day five
to say day twelve, estrogen is on the rise, peaking
one time in the beginning of the cycle in the
follicular phase that's the first half prior to ovulation, peaking
one time about two days before ovulation. When estrodyle peaks
to its highest level that it has at any point
(12:47):
in the cycle for the most part, it will then
trigger the release of lutinizing hormone from the brain. Okay,
so this beautiful ebb and flow, and you should we
should link a picture of it in the show notes
because if you've never seen it, like I think, you know,
you really kind of understand it. If you see it,
LAH is released. This is what you test if you're
doing ovulation predictor tests, right, because this is the hormone
from the brain that triggers the release of an egg
(13:09):
from the ovary. So LH surges, a follicle is released,
and then what's left behind in the ovary is called
the corpus lutium and that is sort of a temporary
endocrine gland that secretes progesterone for about twelve to fourteen
days and then as no pregnancy occurs from about day
twenty one to twenty eight, estrogen and progesterone start to decline,
(13:30):
and then the whole cycle starts again. When they get
to their lowest level, it triggers the release of the
uterine lining, and then it starts again. Now, this is important,
and many of you might understand it in the context
of fertility or the context of your period, right if
you've done any fertility awareness method, if you've just tracked
your cycle for your own kind of health understanding. And
what I didn't understand and was not taught in my
(13:52):
ide league education, just wildly surprising, was that like this
physiologic process, this rhythm is actually responsible for health in
all areas of the body and all systems of the body.
It's not just it doesn't just serve the purpose of
like changing your uterilning. And we know this because we
know that we feel different, right, we know that we've
(14:14):
heard things like, you know it's better to fast in
certain parts of the cycle. So we understand so sort
of how it impacts our metabolism, our mood, maybe our
sweeping be our energy. But beneath the surface, there are
a cascade of things that are triggered by these undulating
levels of hormones and rhythms.
Speaker 2 (14:34):
Yeah, this is so fascinating, And I've tracked my cycle
now for over twenty years and it's given me some
fascinating insight. I've also used that for planning pregnancies and
avoiding pregnancies.
Speaker 1 (14:44):
One thing I used to frustrate me was in my
order ring data.
Speaker 2 (14:47):
In my luteal phase, I would always have lower readiness scores,
and I used to kind of get angry and ping
them and say, like, of course, temperature rises in the
second half of the cycle. Why am I getting dinged
for this? And then I realized, like, actually, if I
look at the data as as a whole, my readiness
is somewhat lower in my luteal phase, my resting heart
race is a little bit higher, my sleep is not
quite as good at certain points. And so it was
(15:08):
actually accurately giving me insight there. And I was getting
annoyed because I thought they were just honing in on temperature.
But to your point, this affects so many areas of health,
which I find so fascinating, especially if we track it.
We get that insight kind of on a day to
day basis, and can then like tweak based on the
data and based on how we feel to make those changes.
And I know we also hear a lot about progesterone
(15:30):
and progesterone changes kind of being the first sign of perimenopause,
and you touched on it briefly, but I feel like
that one gets so much attention. I would love your
take on progesterone and what to know about that.
Speaker 1 (15:41):
Yeah. Now, I was actually thinking while you're talking that
some of the things that we don't understand about, you know,
the cycle is there are things built in here that
are cancer protective for women.
Speaker 2 (15:51):
Right.
Speaker 1 (15:51):
This is why most incidents of breast cancer happens after
the age of fifty for women, because it's when this dynamic,
very protective cycle falls apart completely. And one of the
roles of progesterone in the liuvial phase is to stimulate
the production of tumor supressor gene. And one of the
roles of estrogen, right is to be a growth factor.
(16:12):
It's how we grow and recycle the internal lining of
our blood vessels. Right, It's think about when you're building
up uterine lining, you're actually growing new blood vessels. So
that's just not happening, and the uterus is happening everywhere.
So we're recycling our blood vessels, we're creating growth factors,
we're creating new stem cells, and then that growth needs
to be balanced right, very much in like a Yin
yang kind of way, by the yin of progesterone, which
(16:34):
says like, calm down, let me do some checks, let
me kind of survey the body, let me like, you know,
look at everything. And there's actually a study that shows
that for women who have breast cancer, if they're surgery
for removal of a suspicious or malignant lump, rather is
done right at that juncture after ovulation, before the surge
of progesterone, they actually have a lower chance of recurrence
(16:58):
because of that protected nature of progests. So progesterone is
not just protective for the uterine lning which we hear about, right, progesterone,
you know, we will get robust amounts of progesterone when
we have healthy robust ovulation, right, and healthy robust ovulation
starts well before day fourteen, day fifteen of the cycle.
It starts back when we get that estradyal peak. So
(17:19):
what many people don't understand is that as perimenopause, you know,
if you want to call it that starts to set in.
It's the whole cycle is falling apart because ovarying health
is falling apart. So even though we kind of conceptualize
it as like progesterone is decreasing, many people begin with
a progesterone supplementation in perimenopause because of sort of lack
(17:40):
of robust progesterone secretion. It's really due to that lack
of peak of estradyl two days before evulation that we're
seeing these impacts because when esterdyl is peaking between day
five and twelve, it's recruiting healthier follicles, right, And the healthier,
more robust follicle you get, the better progesterone production you're
going to get. So it's really like I don't like
(18:01):
to think of like a lot of people say perimenopause
is a period re of estrogen excess and a regularity
and insufficient progesterone. I think that it's a little bit
more nuanced than that. Certainly from a symptom based perspective,
some people will benefit from very very early in perimenopause
doing things that support progesterone secretion like vitex, vitamin C
and other antioxidants. Obviously stress support because there's a relationship
(18:24):
between the formation of cortisol and sort of your ability
to produce progesterone. But we also want to, you know,
think about at what point are we sort of missing
out on the opportunity to really work with estrogen, because estrogen,
from systemic perspective and from a chronic disease risk factor
(18:46):
like perspective, is I would say, more more important than
even then progesterone.
Speaker 2 (18:53):
Yeah, I love that idea that it's more nuanced than
that versus a single solution, especially because it feels like
often those solutions are not done cyclically, so they're not
kind of lining up with what the body naturally does.
So I love that you explained it like that. I
also know, another big topic when it comes to perimenopause
and menopause is the metabolic changes, the increase in visceral fat,
(19:14):
the metabolism shifts. How often already about ninety percent of
people have some barker of metabolic dysfunction, and often for women,
this number goes up in those phases of life. So
can you talk about what's happening? Why do women seem
to experience this sort of like metabolic coming undone often
during perimenopause and menopause.
Speaker 1 (19:33):
Yeah, I love that coming undone. I say fall apart
or coming undone, because that's what it feels like, I
think to women. And we also know there's such a
relationship between you know, our stress, our sleep, you know
how all of these other habits, and we're kind of
coming to a peak time by the time we're in
our mid forties of like really holding it all right,
Like I'm about to be forty four this year, I
(19:55):
have aging parents, I have little kids. Right, many of
the people that we work with it's the same situation.
It's like the amount that you're holding is growing as
just as the capacity in the reserves seem to be decreasing.
So you've got this like perfect storm. And then estrogen
is subtly on suddenly or not so subtly on the
decline in the background, which affects metabolic health in many
(20:15):
different ways on the surface level. Right, I think that
it's practical to think about how when estrogen declines, our
circadian rhythm can begin to fall apart, because estrogen really
governs the super chismatic nucleus in the brain, and so
it decreases our ability to really respond in our brains
to the signals of the sun. And so that may
be subtle at first, but it shows up as like
(20:38):
waking up at three or four in the morning, having
a cordisol spike in the morning. It shows up as
having less resilience to things that also disrupt cordisol, like alcohol.
So women will drink an alcoholic beverage and then they
find that they're waking up at three o'clock in the morning,
and that's because alcohol initially will tank cordisol, and then
because that also works by feedback loop, we'll get a
spike around three or four in the morning. And that
(20:59):
can happen without alcohol too. And people will say, I
think it's just because of all the stress, and I'm
ruminating about the stress, But there's again a physiologic component
to your ability to manage the stress. Right, They work
hand in hand, And I don't want to overemphasize that.
You know, stress of management, of course, is important, and
you talk so much about this on this podcast, and
I think anyone in the wellness space hears about that
so much, and it's important. But we also don't want
(21:21):
to oversimplify and also get into a tendency of kind
of blaming people because I meet so many women who
are just like feel so bereft because they feel like
I'm doing everything for my sweep and I'm doing everything
for my stress, and I just like can't nail it.
And that may be because of the loss of resilience
just inherent and losing estrogen, we also lose the ability
(21:42):
to regulate the vagus nerve, so we lose pairasympathetic tone.
So that means that if you have a stressful event,
like I always say, maybe your kid walked in and
like knocked your favorite glass on the floor and it shattered,
and like it's a small thing, it because a brief
sympathetic but we should realistically be able to recover from that.
(22:02):
But if you're feeling like that, just like you can't
shake that physically, that's lack of dynamic para sympathetic tone, right,
And estrogen also impacts that ability. So you have all
these factors that dysregulate stress, and I think that that
absolutely plays a role in the way that our metabolism
is regulated. Particularly we know that gluconeogenesis, which is the
process by which our liver sort of keeps glucose levels high.
(22:26):
And this is something that's very much regulated by stress,
and some people are genetically a little bit more prone
to doing this. I'm someone that's very prone to kind
of keeping glucose levels higher than I actually need them.
Like before, you know, I really could have understood this work.
I just sort of lived in like a high nineties,
low one hundredth place despite lots of dietary changes, and
(22:48):
it was a very physiologic response to stress. So that
will often worsen for women in perimenopause, meaning that like
their increased cord is all is creating is making their
liver kind of unloads stored glucose. Keeping their glucose levels
higher is if they would be kind of ready to
run or exert heavily physically, but it's you know, we're
obviously mostly not doing that. We're sitting at our computers. Additionally, estrogen,
(23:11):
just at the cellular level helps improve insulin sensitivity, meaning
that it changes cellular signalings. So when insulin comes to
the cell, the cell is more receptive to insulin moving
glucose into the cell. We won't glucose in the cell
not outside of the cells, because when it's in the
extracellular space, right, glucose can do all kinds of damage
to the body. We want it in the cell where
(23:33):
it can be used up and converted into atp SO,
which is our energy form, our cellular energy. So the
other thing that it does is it just seems to
deposit more abdominal fat, and we see that with cortisol
patterning too, So I think that we haven't fully elucidated
like how much of that is driven by estrogen's unraveling
of cortisol balance and how much is directly related to
(23:55):
just the loss of estrogen in itself. I think it's
probably a combination of the two. But if you you
are like, am I sort of moving toward that place
where I should be thinking about what can I be
doing to either optimize my indigenous production of hormones or
potentially supplement the initial symptoms that people are going to
experience often are like, I haven't changed anything in my
diet or exercise routine, but I just noticed that, like
(24:18):
around my waist, I have more belly fat, and that
obviously feels really demoralizing and frustrating to women. And number two,
I would say it's the psychological shifts, the feeling like
I just have more baseline anxiety. I feel like I
can't multitask or tolerate things the way that I used to,
and little glimmers of brain fog. Right, brain fog is
(24:39):
a really important symptom to pay attention to, Like if
you've ever been driving a route that you drive all
the time and you just miss your turn right, or
you're like in mid sentence, like on this podcast, and
you're like I can't remember the word that I was
going to say, like something that you say all the time,
those little things that you know. I think we have
a cultural tendency to just sort of like shrug off.
(25:00):
And I think if many of us who are sort
of millennials or young gen xers, when we think back
to our childhoods, it was just very socially and culturally
normal for women in their forties to just take on
a different appearance. They were more fluffy, right, they were
kind of more cranky, and this was like an archetype
that was very generally accepted. And I actually thought, I
(25:21):
remember having thoughts as as a small child at like
thirteen fourteen that like, once you have kids and you
get to be forty, you just end up kind of
being fatter and crankier. Like that's just a natural physiologic progression.
And that's like wildly amazing to me that as a
small child I had that impression, And thank goodness that
I live in the age that we live in now,
(25:43):
where I think age is so much more we know,
we know that age is actually like a chemical biologic thing,
not so much a chronologic thing. Right, you have your
chronologic age, but there's so much that you can do
to impact your physiologic age. And that's really what we're
talking about. It's like, how can you support or your
body to stay within this rhythm for as long as
(26:03):
possible producing hormones in the best way possible at the
best levels and the best rhythm, Or when that is
no longer available, how can we then augment to reproduce
that rhythm. If you're a candidate for that and you're
interested in kind of being all in on this hormone journey,
that's an option too. Either way, we have so much
more ability to modify our outcomes. Does that make sense?
Speaker 2 (26:28):
It does? And I like that you talked about at
the beginning of that kind of losing our sensitivity to light,
which to me indicates that this becomes a very important
factor to be intentional about as we get older. I
think it's wildly important at any phase of life actually,
and even in my kids. I see massive circadian changes
when we get the light exposure piece right. But at
the end of the day, I feel like humans are
(26:49):
solar powered, and so perhaps for women in this phase
of life, it's a little bit more intentionality about our
light patterns and our exposure to natural light and getting
enough of it, and how we know that increases our
nutrient of it affects our circadian rhythm. There's so many
benefits there, and I know it also gets tougher that
when we have teenage kids and aging parents and all
the demands on our time. And I love the way
(27:11):
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will receive a free sample pack with any order. I'm
curious for women who are tracking their cycle and as
I have for so long, how can we tell when
these things are starting to shift, when supporting ovulation isn't
enough anymore, or when we like what signs should we
watch out for and what do we do when we
start noticing changes?
Speaker 1 (31:27):
Yeah, it's such a good question. And for any of
you out there, I know there's lots of you who
are cycle temp tracking, So maybe doing it with an
aura or a thermometer and using an app like Natural
Cycles or all the other ones that are out there,
which I've also been doing forever and love it and
love having twenty years of historical data on myself. Another
tool that's really cool, And I don't know if you've
(31:48):
done this at all yourself, Katie. There's a couple of
urinary hormone trackers now out there, the mirror monitor, the
anido monitor, that you can really kind of combine your
self knowledge and monitoring with these tools where you would
just actually pianistick kind of like a pregnancy test or
an ovulation test, and then you stick it into this
little device that sinks with your phone and you can
get your estrogen, LH and progesterone levels every day, which
(32:11):
is super cool because sometimes temperature, which is the core
measure in traditional fertility awareness, in addition to cervical mucus,
you know, cervical position, et cetera. Those are other, you know,
fertility markers that you can be aware of. It's really
cool to be able to dial in to the hormones.
It's kind of like having your own Dutch test at home. So,
(32:33):
and those are really affordable, especially the anidos, so I
definitely recommend checking those out. But the things that you
may begin to see, Number one, if you're only temp tracking,
it's very possible that you'll see a shorter amount of
time that your temp remains elevated. You may also see
that the temp elevation is not as significant. So if
(32:55):
it used to be a degree to a you know,
one point two degrees, it may be like point six
or point eight or point four, right, And of course
there are other things that impact this thyraid health and
thyroid sufficiency, which is something that I really encourage everyone
to have an in depth thyroid assessment annually, especially as
(33:16):
we're moving through ovarian aging, so really starting at thirty
thirty five, an annual complete thyroid evaluation is super important
because a lot of the symptoms and people think like, oh,
it's got to be my hormones, because that's become so buzzy,
and they're convinced that it's that. It's like we actually
correct the thyroid and then all of a sudden, progesterone
production becomes robust again and temperature stays elevated in a
(33:38):
beautiful way. If you're monitoring with an anido or a mirah,
what you might see is that there's a little bit
more of like a chitty chitty bang bang quality, like
a kind of colunking happening in that follicular phase when
estrogen should be on a consistent rise to like you
know that the roller coaster. How there's like the one
really steepeeled hill at the very beginning that like clink clink,
(34:00):
clinks up all the way. That's how our cycle should be.
In the folegular phase, be one big hill at the beginning,
and in perimenopause you might start seeing there's like kind
of a chunkiness, like you go up and there's down
and up and down, and you don't really get that
sufficient peak in the preovulatory phase. And that's really interesting
to watch because what sort of happens is that if
(34:21):
you're tracking your actual hormone levels, what you will find
is that instead of having a high peak on day
twelve and a moderate peak on day twenty one, you'll
see a really big peak in the second half of
the cycle, in the luteal phase instead. And I think
the reason is because FSH is always aware of what's
going on and kind of knows. Your brain knows intuitively
(34:43):
that you never hit that peak that you were trying
to hit preabulation, and then it kind of hits it
in the second half of the cycle, which is why
some people may describe things like what we would maybe
classify as estrogen dominant symptoms in the second half of
the cycle, so like increased breast tenderness, increase PMS, and
theoretically that's related to an imbalance in the amount of
(35:03):
progesterone relative to progesterone in the second half of the cycle.
So if you're having I would say symptoms like you're
feeling a lot of mood and brain and cognitive changes.
You're seeing sleep changes, You're seeing like temperature regulation changes,
so not quite night sweats or hot flashes, but you
feel even more cold, kind of like a thyroid symptom.
(35:25):
Like these can all be signs that this system is
falling apart. And I would say, if you're like up
for the challenge and you're the girl who's got the
CGM and you're doing the TENTP monitoring and all that stuff,
go get yourself and ANITO or a mirra because it
just kind of elevates your awareness of what's really going on.
Speaker 2 (35:44):
I love the availability of all these kinds of tools
now and that we can get this data at home.
I feel like we're living in such an amazing era
for that. And sometimes it's helpful, really helpful to have
people like you could have explained how to use these things,
because often we can get data overwhelmed as well, like
with lab data and genetic day and all this testing
we can do. Knowing how to actually use that to
our advantage kind of becomes a really big factor. And
(36:06):
we've touched on hormones. I'd love to before we end
this episode to talk a little bit about hormone replacement therapy.
I know that's a big topic in these phases of life,
and based on everything that you've said, I'm wondering, is
there a kind of a rhythmic approach to this as
well that more closely mimics the body's natural rhythms and
that is more supportive of ovarian function and health as
long as possible.
Speaker 1 (36:27):
Yeah. So I like to think of hormone replacement therapy
when I very intentionally use the term hormone replacement therapy
versus menaphausal hormone therapy, because in my opinion, we do
not need to be, you know, a year without a
period before we think about using hormones. And there are
lots of indications for hormone replacement therapy, including conditions like
PCOS or primary ovarian insufficiency, things where there's dramatic hormone
(36:49):
insufficiency well before the time that we would think of
it as like traditional ovarian declines. So the way that
I categorize hormone replacement therapy is we've got basic static. Okay,
that's one type. That means that we're giving like a
low dose continuous estrogen every day, and we're giving a
low dose continuous progesterone. The reason that we need to
give progesterone an addition to estrogen, from a very traditional
(37:10):
medical standpoint, is to protect the uterine lining from getting
that growth that I talked about happens between day five
and twelve of the cycle leading up to ovulation, which
would be theoretically preparing the uterus for a pregnancy. In
a traditional approach, we never want the uterine lining to
grow once someone is, you know, relatively menopausal, because if
(37:32):
that goes unchecked and it's not shed with a sufficient period,
it's a risk factor for endometrial cancer. So most hart
when you're hearing about people talk about it in kind
of the menopause, all the menopause glory that's happening on
socials right now. Is that methodology. It's using some type
of transdermal or oral estradil and some type of continuous
progesterone with the same dose every single day. Then I
(37:54):
have the second category which is cyclic, which means also
a low dose static estrogen, usually transdermal, some times oral,
and using progesterone for only twelve or fourteen days a month.
Sometimes this can be effective in perimenopause. Is just sort
of like a top off. A little bit of estrogen
kind of helps your natural rhythm maintain and stay in place.
(38:14):
But it's a little bit of a double edged sword
because with any type of HRT that you use, especially
if you're initiating perimenopause, there's always the risk that the
exogenous hormone supersedes in your endogenous so internal hormone regulation.
So it gives so much feedback to the brain that
(38:34):
your own brain stops stimulating your production of hormones and
you can end up with lower levels than you even
started out with to begin with. The third category would
be called physiologic or rhythmic, So I like to call
it physiologic HRT, and it's a methodology that we've been
doing for several years in our practice that really happened
by accident. I didn't even start my practice to be
a hormone care provider. I started doing functional medicine, and
(38:57):
obviously I had a background in women's help because I'm
a midway and a women's health NP, and I just
had all these women come into my office who were
forty five, forty nine, and I did all of the
things that functional medicine taught me to do with them,
and they would get a little better, but like ultimately,
they wouldn't yet fully better, no matter how many elimination
diets I did with them. And I mean, that's a
(39:18):
whole other topic for another time, But what I discovered
was that women on traditional HRT regimens would often get
initial relief, and that we certainly know that it's effective
for a management of hot flashes, right, which is sort
of a characteristic thing that we think about when we
think menopause. But we know that perimenopause and menopause and
this trajectory of ovarian decline is affecting the cardiovascular system,
(39:41):
it's affecting the bones, it's affecting our immune system and
our ability to sort of monitor and control for uncontrolled
cellular growth right, and gene expression, which is a case
in cancer. It's affecting our NERD transmitters and our mood
and all of these things. And when you take the
approach of let me give the dose that was appropriate
for shutting down hot flashes. That's really all you're doing.
(40:05):
You're not conferring all of the possibility of physiologic benefits.
And so I actually had a patient who was like,
I want to try this methodology, and I was like, Okay,
let's do it. And in physiologic HRT, you're using a
transdermal estrogen generally has to be compounded, and you're using
a delivery method that allows you to give very precise
(40:27):
amounts of cream so that you can give a different
miligram amount every day in the follicular phase of the cycle.
So day one to five is one dose, Day five
and six are a different day six and seven, day seven, eight,
et cetera, up until you do a singular peak on
day twelve with your dose, and then it drops down
just like it would in a normal physiologic cycle of
a cycling woman, and then it surges again for the
(40:49):
luteal phase. And then progesterone is done in a very
similar way, so a smaller amount beginning on day fourteen, larger, larger,
larger up to day twenty one, and then down, down, down,
And I find that this is really nice done in
a sort of at at a very sort of beginning
beginner dose with women who are impairing menopause because their
bodies are already used to cycling. So, you know, a
(41:12):
people who are cycle centric, who are aware of their cycle,
understand how it affects their mood and their behavior and
just sort of their energy. Right, Many women sort of
organize their work life and their productivity and their creative
time versus their kind of bookkeeping time based on where
they are in their cycle, because it makes our brain
feel different, right, and so this is possible to sustain. Now,
(41:36):
there's no clinical research on this methodology, right, There's not
hard evidence, randomized controlled trials, or big systematic reviews of
any sort on this type of approach. However, we do
have a lot of research that really elucidates what happens
when women don't ovulate.
Speaker 2 (41:54):
Right.
Speaker 1 (41:54):
We know that women on birth control, women who are PCOS,
women who are primary or varian insufficiency, women who have
go fall apart earlier than typical have a much higher
risk of chrownic diseases like osteoporosis, cardiovascular disease, diabetes, and depression.
And so essentially, menopause is the breakdown and fall apart
of this very essential internal rhythm, and along with it
(42:18):
comes risk factors in side effects, and a lotos static
approach has you know, some ability to stave off some
of these things. We know that the you know, the
estrogen can reduce the risk of cardiovascular disease, can reduce
the risk of diabetes, that it's effective for improving insulin resistance.
But I guess the question is like how good can
it get if managed really individually? Right? This is like
(42:41):
a very individualized, tailored approach, really dosed per the person,
and it's for the woman who's okay with the monitoring, okay,
with the frequent testing, okay with the maybe occasional ultrasound
to make sure that your body is getting a period
appropriately and shedding a really you know, complete heroine lining.
So it's not for everybody, but it is certainly something
(43:01):
to look more into, and if you're interested in it,
you can go to the Women's Hormone Network dot org,
which we can put in the shows as well, which
is sort of the consortium of providers across the country
who are practicing in this way, and you can learn
more about it amazing.
Speaker 2 (43:14):
I will make sure those are linked in the show notes,
and I know you have specific resources for anybody listening
who wants to continue to follow up. I will make
sure those are linked as well. But where can people
find you and learn more and I deep on their
own health?
Speaker 1 (43:27):
Yeah, I'd love for you to follow me on Instagram
at Emily Sadry Underscore NP and also you can visit
my clinical practice. We're currently licensed in eleven states in
the US. That's Aurelia Health dot org, a U R E.
L I A Health dot sorry dot com dot org
or my website Emilysadry dot com. And if you go
to Emilysadry dot com back slush well in this MoMA,
(43:47):
we have some resources for you and have some information
about our programs.
Speaker 2 (43:52):
Amazing Well, those will all be linked and I feel
like this was such a comprehensive and helpful episode. We
got through so much and a short amount of time,
and I will make sure there are relevant links for
all of you listening on the go. Those are all
at Wellnessmama dot com. Emily for this episode, thank you
so much for your time and for all that you've shared,
and you guys stay tuned for another round that will
go deep on mental health and GLPAS that Emily, thank
(44:13):
you so much for the time today.
Speaker 1 (44:14):
Thank you Katie, it's been a pleasure.
Speaker 2 (44:17):
And thank you for listening, and I hope you will
join me again on the next episode of the Wellness
Mama podcast. If you're enjoying these interviews, would you please
take two minutes to leave a rating or review on
iTunes for me. Doing this helps more people to find
the podcast, which means even more moms and families can
benefit from the information. I really appreciate your time and
(44:37):
thanks as always for listening.
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