Thriving Through the Perimenopause Hormone Rollercoaster with Dr. Jen Pfleghaar

Introduction to perimenopause and Dr. Jen 0:00

Hello, welcome to the Thyroid Pharmacists Healing Conversations podcast. Today, I'm joined by Dr. Jen Flegar. We're going to be talking about thriving through the perimenopause hormone roller coaster. we're gonna be getting into some really innovative solutions, we are going help you guys feel better through this time. I know I was just sharing with Dr Jen that before I hit perimenopause, I thought I had things all figured out with Hashimoto's, and then perimentopaus hit and it was kind of like a bus that derailed me.

And I have to really reinvent my wellness routine and get into just way different wellness habits that were still relevant to Hashimoto's, but also modified for perimenopause. And so super excited to bring this episode to you. I'm going to give you a little bit of background about Dr. Jen. She's a double board certified physician in emergency and integrative medicine. medical school at the Lake Erie College of Osteopathic Medicine and training at St. Vincent's Mercy Hospital that her fellowship at The Andrew Weil Center for Integrative Medicine.

She co-authored Eat, Sleep, Move, Breathe, A Guide to Living a Healthier Life and serves on the board of the Invisible Disabilities Association. Her passion for healing isn't just professional, it's personal. So she is one of us. She does have Hashimoto's. And so she dove deep into the world of autoimmune conditions, hormone imbalances, and thyroid health. Now she's on a mission to guide others towards better health And she also has a book on thriving in perimenopause, which I'm so excited that this is going to be available to women around the world so we can care for ourselves and we get the doctor trusted advice on how to deal, how thrive in this life stage.

So welcome, Dr. Janet. It's so great to have you here. Thank you so much for having me. Super excited. So can we get to perimenopause? For people that maybe haven't heard of it, what exactly is periminopaus? I know there's like a few different definitions out there. Some people will say it's a year before you hit menopase. Other people say, it starts at birth, right? So what's the truth out here? Yeah. Well, we know the definition of menopus is one whole year without a cycle. And this can be this can take different different times for different people.

It could be kind of quick. They have irregular periods and then they're without a period or it can drag on. So perimenopause is the time before menopausal. This could anywhere from two years to 10 years. I have a patient right now where it's like going on 20 years and what it is is it the decline of these hormones. it The decline progesterone And it's the decline of estradiol, but also estridiol has erratic roller coaster up and down spikes. And I like to think of perimenopause like like an oven.

OK, so think about you have an oven at your house. You have a oven, say, at you friend's house, your parents' house? They all preheat differently at different times. you can't expect them all to preheated the same time. They're all different ovens. That's like perimenopause. We're all preheating at different times to get ready for menopausal. That can be confusing. Like you were saying, it hits you like a bus, and that's it. You think you have your wellness routine down, your health down. Then you get to your early 30s now.

I'm seeing some women in perimentopose, sometimes late 30's, you feel a mess, you're getting these symptoms that come out of nowhere, or you are gaining weight out nowhere. You're having anxiety, palpitations. So many different symptoms can be from this perimenopause journey. And this is when if we know some tips and tricks, what to do, how our hormones are working, we can glide through this a lot more gently. Yeah, I can say with my experience, i was in my late 30s and I had always been a greyhound.

Like I was always described as somebody that could just eat a ton of food and then I would never gain weight and people were like, ''I don't think you're eating or you know, do you have an eating disorder?'' I'm like have you seen how much I eat? I always had an amazing appetite and just you, know except for some of the times when I have my Hashimoto's diagnosis, my metabolism was amazing, right? And then all of a sudden with perimenopause, I'm not hungry anymore, but the weight's coming on and I am waking up in the middle of the night anxious.

Like, where did that come from, right? I was irritable. My periods are coming more frequently. And I think sometimes when we have hormonal imbalances, doctors and well-meaning people in our lives are like, well, you're just getting older.

What perimenopause is and why symptoms appear 5:15

Of course, You're going to gain weight, of course you are going be more tired, or it's inevitable that as you get older, your sleep just sucks, right? Yeah, all the time. And it is really hard for me Because perimenopause women, they are just gaslit at doctor's offices. Think about perimentopaus. This is where I really believe women are being attacked. We're being attack physically with these hormone changes. Mentally, when we're going to the doctor asking for help, there saying, here's an antidepressant or here is oral birth control, which is not going help our hormones, it's going disrupt them.

And we're spiritually attacked too. I really think we are vulnerable. Sometimes we feel alone because we don't know what's going on and we do not want to share it on Facebook or Instagram that we were struggling. We want everything to look perfect, you know, and it's holding it all together. Some women are working jobs. homeschooling, you know, we have kids, We have all these responsibilities. So this is where the stress of all of that kind of comes out ahead and then comes at the cost of progesterone when we already have declining pro gesterones.

And that's why we're seeing shortening periods. We're seen estrogen dominance like symptoms because we are robbing from that pro-gesteron and we can do things to help with that. But we first have to recognize it. I think that is the biggest thing. You have recognize that I am entering this perimenopause state, the state before menopausal. We all know menopsis. You know, we all what that is. And we know that bioidentical hormones can be really helpful for cardio protective, for our brain health, our heart health for bone health.

So we But what about before? This is where there's a lot of struggling, and I've seen women just, you know, it just brings them to tears sitting in my office. And I also noticed a pattern in this perimenopause that this is when a lots of divorces happen. It was interesting. I was talking to my husband about it. He was taking about a co-worker that was going through a divorce, I'm like, well, let me guess, was she in her like late thirties, early forties because the husband said she had just went crazy.

And it's, I'm like, she was in perimenopause. I am writing this book. This is why I m so passionate about it because I feel like we're being like attacked in so many ways. It's such a busy time for us. I mean, all that we're juggling all the different hats for wearing. So if our hormones are going a little crazy, or, you know, we are gaining weight out of nowhere, and that just makes us feel very stressed and out-of-control, well, were going to kind of deflect that on our families or our spouse because we feel out control of our bodies.

Its very frustrating. Yeah, I think the divorce rates are just such a big concern, and then mothers not enjoying motherhood. I know these days, many women are having children, not in their 20s, they're having in 30s sometimes in 40s. And when you're going through that perimenopause roller coaster, you don't have that same patience. You don't have that same bandwidth for your kids. And unfortunately, I've seen, you know, some of my girlfriends over the years where they're they love their kids, but they are just overwhelmed or they struggle with their husbands.

They get really easily frustrated. and a part of that is progesterone. Now, I remember going through pharmacy school and talking about hormones and hormone replacement therapy, and it's like you hit menopause and then you do some estrogen and if you still have a uterus, you'd use some progeterones, but nobody really talks about how progesterone is the first hormone that plummets and jumps off of the cliff in our mid-30s in many times. Can we talk through progesterone, what it does for us, and maybe some of the signs and symptoms on how that might show up for as emotionally and physically?

Yes. Progesteron is so important. And the reason why in menopause, they would give pro testosterone is to protect the uterus if you still had one. If you didn't have a uterus, oh, you don't get pro gesterones. No, we all need pro gesterone. We have progesterones receptors for a reason. progesterone is protective breast and uterus. Progesteron also is very calming in our mind. So progesterone's broken down in your brain and there's activation of GABA receptors. GABE receptors are what is calming the brain.

Different supplements can help with GABER receptor activations. People take GABAs sometimes. Benzodiazepines are working on the GABA receptors. So progesterone is very important. We need it. In perimetopause, some symptoms that you might notice, and I noticed them personally a couple of years ago, that those two weeks before are the luteal phase, before you start your cycle. You have the follicular phase where estrogen is dominant, starts on first day of bleeding, then that's two week, you have ovulation, Then you have the last two weeks, which is the luteal phase.

This is where progesterone is going to shine and be more dominant compared to estrogen, and that is what we need. What can happen is if this progeterones is plummeting, we have a progesterone deficit during the Luteo phase, this can be for many reasons. Stress can drive pro testosterone lower. Think about female athletes that are pushing themselves to the limits throughout their whole menstrual cycle. They have irregular periods, right? They're not getting regular periods. When we have stress that can affect our hormones, specifically progesterone, cortisol is right down the line in that hormone cascade from pro gesterones.

Sometimes we can deplete or progesterone if we're really producing a lot of cortisol and very stressed. So what you'll notice during that maybe week before you get your ready to get cycle, a couple of things could happen. You could notice your cycle length shortening, so your 28 days every month, but then you noticed you're like 25 and maybe 26, like they're shorting because you have that pro testosterone deficit. you also might notice you are a little bit more Ragey or angry or irritable and luteal phase is nice to to be more emotional and you know, I cry sometimes more and that's okay that we should embrace that.

That's beautiful. But being irritability, ragey over emotional where you're reacting to your kids are snapping at them. Those are warning signs and don't be hard on yourself. just say, hey, I'm going to figure this out. What can I do to optimize my progesterone during the luteal phase? Do I want to try some chaste tree berry? Or am I older where I am just going go and do some bioidentical progeterones? Those are the choices you have to make. I did chastery berry for a little bit, and then I just When I hit 41 and a half, I think is when I started progesterone during my luteal phase.

Now, you don't feel that, that touchiness around your family. Other symptoms that you could have is a lot of anxiety.

Progesterone decline, stress, and hormone imbalance 13:00

You could also have heavier cramping, more PMS symptoms like headache, like I said, the cramps and the bloating, heavier cycles and heavier periods. So all of these things you might be like, wow, I just realized I always had a normal cycle. It was 28 days, it lasted three days. I had maybe a little cramping and now all the sudden you're calling off work because your cramps are so bad and your cycle is so heavy. So we have to dig into why, because there's a lot of reasons. We also have a lots of exposure to xenoestrogens or endocrine disruptors.

So our world is getting more and more toxic. You go to the airport, and they have these new things where you walk by them, they shoot out fragrance. And I'm going like this, trying to get through. endocrine disruptors, which any what an endocrine disruptor means is anything, any chemical that can either bind to that receptor of our hormones or interfere with the receptors action or interfere with how we get rid of them and how break down our hormones. It's a lot. Sometimes we can have this estrogen dominance because we're exposed to all of these things in our environment.

Then you could work on detoxifying your estrogens while also promoting the progesterone. So it's really a balance that it is already out of whack. I am seeing women Late 20s, early 30s with estrogen dominance perimenopause symptoms and it's like, wow, we really have to correct these things now so we can preserve your fertility and your mental health. while they're going through all these changes. So it's very hard though, because I will say you will go to your doctor or maybe talk to friends and a lot of the conventional wisdom that you'll get, which is not wisdom, but it is what they say is go on oral birth control pill.

So when you're going on oral birth control pill, you are taking oral estrogens which then have to get metabolized through the liver and that on its own can cause toxic estrogen and DNA changes. It can affect your fertility, affect you gut health which will further disrupt your hormones. So it's not the answer. And I have seen another thing that is kind of scary, because I've seen a lot of these women, they're put on birth control pills. So say in their 40s, for these perimenopausal symptoms, then they don't even know when they hit menopause.

They're like, well, I just they come to me when their 50. Well, like I'd been on Birth Control for for 10 years. And so I haven't really got a cycle since then. I don' know if I'm in menipause or not. We get them off the birthcontrol, we check some lab work, follicle stimulating hormone and we go from there. So really a lot of dangers in just covering up the symptoms, especially with you being a pharmacist, you know that, unfortunately, that is what we learn in medical school and then pharmacy school.

You get a symptom, a diagnosis, and you treat it with a medication. But that that not what is going to be helpful during perimenopause. Yeah, absolutely. And just to your point with progesterone and how it has effects on the GABA receptor, which is our chill and relax neurotransmitter, I know a lot of moms in perimenopause, they're drinking wine, right? Some of them are taking CBD, some of then are, you know, taking some benzos just try to chill themselves out. I was popping GABAA here, L-theanine and trying to figure out like, What is going on with me?

And actually, it's like a progesterone deficiency. And you get on the progeterrone, and all of a sudden, you don't need the CBD, the wine, The GAVA, You don' need The Benzos. You can you Don't Need the Ambien. you can sleep at night. It's just like the world in front of you transforms. I don't know if some people are saying like perimenopause is having like, it's trending right now, right? And is it, has it always been this apparent? Is it because I'm in my forties that I am aware? I know that there's, I now in 2020, that's when it started for me and there was this global pandemic, high stress time, and so you had alluded to that, there are factors that can sort of make your experience with it worse, potentially bring it on a bit earlier when we think of progesterone declining, you're really gonna notice that if you've got too much estrogen on board, right?

Because that gets out of balance for you and then you can really start noticing the symptoms. What are some of these things in our environment or perhaps in day-to-day lives that you think, and what do you thing? Is perimenopause more common now or is this just something that we're finally talking about? I think the environment has made it worse, has really made the progesterone deficient with regards to high estrogens. Even glyphosate can affect estrogen receptors. And I know where I was practicing before I moved to Tennessee and Ohio in the Midwest, I mean, glyphosate on everything in the rain.

You know, you can't get away from it. They're spraying it, so that's affecting gut health, affecting how estrogen works in body and all of the xenoestrogens, fragrance and everything. All our food is wrapped in plastic. many issues from that. And I also think that with the pandemic in 2020, that there is a lot of stress and also the spike proteins. I think a lots of those probably accelerated to the stress on our bodies. We're getting rid of this thing that probably shouldn't have existed and now we're dealing with consequences from them.

Stress can absolutely accelerate the transition to menopause and really kind of put you into early menopause sometimes. So we are seeing that where there's patients with acute stress, stressful situations, or even stress on the body through stealth infections. Maybe you're living in a moldy home and that's going to act as an endocrine disruptor also because you are not able to detoxify estrogen like you should because your liver is dealing with all these mycotoxins. To your point about drinking wine to go to sleep, If your liver sees wine, it is going to stop everything else and it's going get rid of that toxic alcohol and put breaking down your estrogens on the back burner.

This is a problem with women and especially in perimenopause. You're more stressed. Since the pandemic, we've drank more alcohol as the country in the United States. And if you're trying to just deal with your symptoms and cover them up, If sleep is a problem, if anxiety is the problem yet, you're going to use a depressant to get rid of that feeling that you have. That's the last thing you want to do in perimenopause because then you are not going be detoxifying your estrogens you making easily or well.

Then that's going make the balance between estrogen progesterone even worse. Things that deplete progeterones, we can talk about blood sugar balance. If our blood sugar is really out of whack, that's going to be stressful on the body. If we're having big spikes of blood, sugar all the time, all day, That can affect your hormones also. Also, if we stress that can effect our Blood sugar. It kind of goes both ways and I've seen it both Ways with my female patients. So a lot of times a continuous glucose monitor can help with that.

You want it to be nice and smooth, your blood sugar, you don't want these big spikes that's like pounding on the doors when you have insulin released in your body trying to get glucose into the cells. If you just, basically it's crying wolf every time, eventually those cells are just not gonna listen and they get insulin resistant. and insulin resistance, that can be really hard in perimenopause. As we are declining in our estradiol, which helps with insulin sensitivity, or it's spiking up and down, we could be gaining this weight from this insulin resistant.

So you're eating the same, but you are becoming more insulin-resistant. And this is where really balancing those hormones cortisol included, which is our stress hormone, can really be helpful in perimenopause. We don't always think about that. I was reading a book last night in the bathtub, trying to relax, and it was really interesting talking about being busy versus being hurried and how that is for our soul. He was saying how busy is okay. Like, I have four kids, like I'm going to be busy. And I do explain this to people.

Well, we're busy, And we just moved and I have a business and my husband works. But are we hurried? Are you rushing through everything? are you not even enjoying the time with your kids? You're just going through the motions. And that's stress, like feeling hurrid all the times. Our soul is not feeling any rest and we're not getting rest. That can contribute. Sleep too, as our hormones are fluctuating, we can definitely have less restful sleep. If we're not getting rest full sleep and good deep sleep, and quality sleep then that is stressful for our body.

Then the next day, if we are unrested, were going to crave carbohydrates. We know that if were not rested, are going make bad food choices, then just goes through a vicious cycle. So it can be really hard during perimenopause when you have all these moving parts, and then you're not getting enough progesterone. Sometimes just giving a nice luteal phase pro testosterone, if you are in the thick of things with perimanopaus, can just be enough to smooth everything out. I've noticed this with patients with other things going on, like kashimoto's.

like a gut dysbiosis, like chronic mold or chronic Lyme, that if we balance that progesterone, then they're just in a better state. Their body in general is less inflammatory, it's less stressed, but then we can work on those other things. So that can be really helpful also. Yeah, sometimes having a prescription on board or a hormonal support makes things a lot easier. I know one of the things I noticed was my executive function was always very, very good, I guess, for lack of a better reason. when I had, you know, when the throws of Hashimoto's, of course, that changed, and then I got myself into remission, got everything optimized.

And I'm like, okay, productive human again, right? And then with perimenopause, all of a sudden, I am like leaving a mess here, walking into rooms, then, like okay.

Environmental toxins, blood sugar, and liver support 25:00

thyroid function is looking good, what else is going on? And getting on Vitex, you know, Chase Tree, I was like, oh my gosh, like I'm like normal again, and I feel amazing again. And then you could put in the things in place that maybe were overwhelming because there are some of those lifestyle changes. For a lot of women, myself included, it was a little more protein and a bit more fiber than I was used to eating to really help to manage my weight and doing more weight-bearing exercise versus just my walks and yoga and hiking that I did prior.

A lot times, you might know what you need to do, but you may lack that motivation and perimenopause. Progesterone is so amazing for brain health. And so Vitex can also help support some of that dopamine and just get things balanced so your brain feels like you again, right? Yeah, absolutely. And I will say it's a good idea to test your levels. When we're looking at progesterone, you want to check it on day 19 to 21. That's where it is going to be at its peak. So it would be a great idea if you're listening out there and you are like, well, I don't know even what my hormones are.

definitely a good idea to check. You can just check serum blood work. So that would be you just go to your doctor, you can get it through insurance. Once I start having patients on topical hormones, I do switch to saliva testing, and that's through a functional lab company. This is more for anyone listening out there in menopause. When we put on a topically estriol and estradiol, If you check serum, it's not going to reflect the tissue levels and you will be overdosed. I see this all the time in my office.

The saliva levels are going give the actual tissue level so you know what your body is actually getting and what it is doing. So that's what I track on topical hormones. Now with progesterone, I usually do topically pro-gesteroin for younger women and then I switch to the oral There have been my mentor, she said that there's a little bit more breast protection in giving oral progesterone as we get older. And oral Progesteron helps with sleep because we're getting conversion to allopregnenolone and then that's giving the brain calmness.

So you don't want to take oral, progesterone in the morning because you will be sleepy. So progesterone is great, but we still want to test and not guess. So you want Maybe sometimes we'll just work on detoxing the estrogen. Sometimes I'll get patients where their progesterone level is actually okay, but their estradiol level's really, really high. We just need to bring it back into balance and look at their symptoms and see if they're having estrogen dominance symptoms. Because if there are, even with an adequate pro testosterone, we need make sure we're getting rid of the estrogens properly through our liver and through out gut.

One of the things that I noticed that was a really big game changer for a lot of my symptoms was liver support. And fiber also helps because it helps us to get rid of some of that excess estrogen. Do you have specific things you use to support liver? I love liver. So estrogen is going through phase one and phase two detoxification and then goes out through the gut. and through an enzyme called beta-glucuronidase. If it's overactive, you can keep recycling those estrogens. At that end, we want to have good gut health and calcium deglucurate can help with that.

That's where the fiber can also come in and help get the stool going through because we need to make sure we're pooping it all out. Phase 1 and phase 2, that can be supportive with supplements like I3C and DIM, and you can actually get those components in broccoli sprouts. So a lot of broccoli sprouts are really good for hormone health. Milk thistle is going to be good. You could use artichoke root, dandelion. Um, you could also use castor oil packs, anything to support the liver. And then a big one is NAC or glutathione.

So those are really important for phase two. So good liver support, especially because our livers are overburdened by all the toxins in our world. And, you know, to go back, like, is perimenopause just being talked about more? Well, maybe it's just we're more symptomatic because 50 years ago, 100 years, ago we didn't have as much stuff as many chemicals and pesticides and herbicides and glyphosate. And so it's a lot harder on our bodies and it is a much harder in our hormones. So we have to be proactive.

I take liver support every day and I will take it all the time. It is just that important. Then, of course, not trying to go against your liver, right? So having clean products in the house that you cook with that, you're putting on your body and avoiding glyphosate sprayed oats and grain and all of that. So really making sure that your input is, is good also. And of course, alcohol. Yeah, it's been so interesting. I know when I first started working with clients with Hashimoto's, I had them with like multiple chemical sensitivities and a lot of them just weren't really getting better with the recommendations and sometimes the testing took a while and it got to the point where I was working them for months and they just aren't getting really better.

They would try a vitamin and they were like, this made me feel worse. I didn't feel anything. That's when I came across liver support and working with that for just two weeks helped to clear up so many people's symptoms. Back in the day, I thought it was like a one and done deal where maybe you need to repeat it once a year, once every few years. But then a lot of people were, hey, i feel really good on this. What can I stay on it? And I was kind of like, I don't know about that. But then with myself and my own perimenopause journey, and I also had some mold exposure, two weeks isn't enough.

You need to be really actively supporting your liver detox pathways and really make over your personal care routine, because there's just so much that we can become more sensitive to. I know we mentioned alcohol, I know caffeine, i used to be able to sleep after chugging caffeine and all of a sudden it's like 301 and if I have a cup of tea then I can't sleep the whole night and then also anything that could stimulate or support estrogen so any kind of even adaptogens that have some estrogenic activity these are all things that can be really really impactful when you have perimenopause where maybe you didn't really think they were relevant in your 20s or earlier 30s.

It's just been very fascinating. Yeah, it really is. And we need to start thinking about the stuff in our 20's or 30's, like ladies out there, they need too. They need be aware of it because that is when, you know, the concern like breast cancer, one in three women are diagnosed with breast and that prevention starts in their 20. You know, and your thirties and forties. Yes, you can still make a difference and you still support your body, but we should be thinking about this and telling these things to women in their twenties.

And that's what's frustrating is, there's not enough prevention. Detection is not good enough. But yeah, like drinking alcohol, you know, think of all these college students, they're drinking out alcohol eating pizza with glyphosate in it on oral birth control. I mean, their hormones are are trashed and then their gut health gets trash and they get an autoimmune disease or, it's so hard to watch, especially when I've been through that. Right. put on oral birth control to regulate my period. I had a mold exposure in childhood.

Um, I drank beer in college, you know, all of these things you look back and you're like, Oh, like if, if I only would have known or someone would've told me. So that's why it's really important to start thinking about these. And with estrogen detox, so you can actually get an estrogen metabolite test. where you look at your urine metabolites and how you go down the pathways of estrogen detoxification. And that is the 2-methoxy pathway, which is a good pathway. That's how we want to detoxify our estrogens.

Then there's 16-hydroxy-pathway, it's okay. We don't really want go to down that road too much. But then there is road we really don' t want down, the 4-methoxy pathway and that can create DNA damage. And that is scary. We don't want to go down that pathway too hard. But genetically, some of us do. So what do we do? Well, we want, first of all, not do things that tie up our liver, like take pharmaceutical drugs we don t need or drink alcohol or everything we were talking about. Then you also want t support that good pathway.

Think about driving in a car, and you're going to go down the good road instead of the bad road. So we can gently steer our body that way, but it's really eye-opening if you do get one of those urine metabolite estrogen tests because I got one and I really, not that I would drink a lot, It's a special occasion because I know that it's important for me and for my children. For me to be healthy and to metabolize my estrogens properly. It can be life-changing when you see something on paper. It's one thing to know that drinking isn't good for you, but sometimes when see on a lab test, that can very confirming.

Is it the ditch test that you like to use for these metabolites or is there another test you utilize? Yeah, you can use that one. So I utilize the RTs, their estrogen urine estrogen metabolites, because they use them for my saliva testing. Because that's the women that I have on bioidentical hormones. I check their saliva also, but and you don't have to spend like 1000s of dollars a year on this. It is an expensive test. it's a couple of hundred dollars you Can use your HSA but just get it if you just Get it once because then you could be like, oh, like I don't, you know, I go down hard both pathways, which is what I do, and some people, their genetics, it's perfect.

Like how they go, about 80% is down to the good pathway and then a couple percent down 16-hydroxy. It's like, your genetics are great, but those women can get breast cancer too. I've seen that also. And, oh my goodness, a patient that I have, I really think her root cause of her breast cancer at a younger age was stress. So once again, ladies, if you are type A, join the recovering type a group with me. Me too. Oh, good. Yay. We should start a club. You really should. And you really, like I said, don't be hurried all the time.

You know, just really slow down. I would 10 out of 10 recommend moving to Tennessee and getting a bunch of chickens. Oh, I'm just kidding. But I might have a little chicken problem, but taking care of chicken, it's very, very calming and relaxing, and I will say, so just find ways. even just unplugging and reading books with your children. If your kids, no matter what age, ask you to read a book with them, you sit down and you do it because that forces you slow down, and just enjoy. I know you, Dr.

Vagus nerve support and nervous system healing 37:30

Roosevelt, wear a lot of different hats and could probably fill your schedule all day long with doing stuff. for someone or for your business, but you can't. I've done it. It's not good. it's Not making anyone happy. The fast road to burnout for sure. You go through and you don't make time for yourself and You don' make for the things that bring you joy and really fill your cup when you're just in that, I guess, high performance and I think You know, we're told to be boss babes and have side hustles and all of these things.

And I don't think it's great for most people in the long term. Sure, for a few months here and there, maybe you need to get through a big project, you to go through school or write up a book, but you really do need that time for yourself. I'm glad you mentioned ZRT Lab, I really, really love them. They've got fantastic tests. tests, the saliva tests for people because to your point, a lot of times people with Hashimoto's are going to have burnout and they're going have that adrenal dysfunction, low cortisol.

We talked a little bit about chronic stress and how that can dysregulate hormones, how trauma can do that. I was hoping you could tell us a bit more about the vagus nerve and support people in that kind of healing path. Yes, that is such a great one. I'm glad you brought that up. So vagal nerve stimulation is really important. That is the parasympathetic. We have the sympathetic fight or flight, running away from a tiger. And I feel great that God gave us that ability. You know, when you have superhuman strength and you pick up a car, you run real fast after your kid.

Oh, I felt like this one, we were stuck in like a possible tornado situation when we're camping and we are running to the storm shelter. I was like, oh, you know, Oh my goodness, was wearing a continuous glucose monitor. My blood glucose, it went up to like 250. It was the highest it had ever, ever been. And, you know, those nasty crumble cookies. No, I'm just, no judgment, but those are just sugar. Don't, don't do that. That is a fad I do not like. But anyway, so stress and blood sugar is terrible.

So I wish then I would have had a vagal nerve stimulator to zap on me. So the vagal nerve, it's going to kind of put the brakes on things. So that is the balance, that's rest and digest. A lot of people with chronic constipation, they have vaginal nerve issues. Maybe they've had trauma during childhood or even a car accident or, you know, a lot things can be triggering trauma wise and our body keeps the score for that. You can stimulate that by talking, humming, singing, their vagal nerve runs right down your neck so you can actually feel when you talk like there's vibration going on right there.

Things like grounding, things like meditation, prayer, that can help reset the body. I really like using a vaginal nerve stimulator. i've been consistently using it the last couple of months and i really liked it i'll use it before sleep and you just i put on the right side because that's where the most vagus nerve fibers are going to be and put it there and it's just two minutes and done. I recommend that to my patients that are stressed or dealing with constipation. Have you tried a vagal nerve stimulator?

Do you like it? I think I got the pulsetto and I used it a little bit. Is there one that you like? I have a lot of, full disclosure, I've had a lots of gadgets. There's like a waiting list for when they'll get tried. And I haven't tried those before, but I had some clients with really good results. Do you have one you really like using? It's really small. I travel with it. The last few times I've flown, I put it in my carry on because I was like, well, if something happens, this would actually be a really good solution to trigger the vagal nerve.

Um, the, The gentleman that created the true Vega product is really interesting in his book. He talks about how they used to stop asthma attacks by vagal nerve stimulation. So it's really cool because you think about it. It's going to, instead of bronchoconstrict, which is an asthma, it is going bronchodially because it has that parasympathetic tone on there. similar to a racing heart, if we apply parasympathetic support, that is going to put the brakes on the heart rate. So there's a lot of cool books like the Polyvagal Theory is really good.

It's very dense. it will be a good book to read before bed just to get you off to sleep. I remember I would read it and I'm like, I can only read 10 minutes of this. It's making me so sleepy. And then the body keeps the score is great. So that's in that ties into perimenopause. Because if you are if your operating in a fight or flight in sympathetic tone, that is going to push the cortisol that it's going. To run your hormones ragged and you're going through peri-menopausal earlier. You're gonna have more trouble with it.

So it can really be a factor, especially post pandemic. I think we all have a little bit of trauma and trauma can affect that sympathetic parasympathetic balance. It's been hard to watch honestly how much trauma people have over the past four to five years. Yeah, I agree with you with so many people going through such trauma. And I've seen people, just get really divided about their politics or that some of the choices they made, where I'd seen, people who disowned their siblings or family members.

We can agree to disagree and still appreciate the humanity in one another. There's not a single person in this world where i agree And it's just been very devastating to see people doing that, and I feel like a lot of that is coming from unresolved trauma, some of the fear of survival. I'm going to have to try Truvaga now. Now you just gave me another gadget to use. Two minutes a day, is that all you really need to do it for? I use it twice a day, but one time a is better than none because some days I won't use that.

And but, you know, honestly, like the biggest game changer for me has been giving up control and just knowing like God is in control for I think the politics, all of that, it's like, what can we even do? Fighting on the internet with someone or your siblings or family, that's not going to help. And ultimately, we're not in control. So we can just surrender and live with peace and not have that anxiety. That goes back to trying to multitask and be boss lady and all of this and we're having the world like tell us all these things and it's not serving us or our family and I really like about a year ago I wanted to focus on my family, my husband and make sure everything is good at home first And then, you know, make sure I have that down and then go out and do the boss babe and to the other things.

But if you find that those things, they're not even bringing you joy. They're bringing new anxiety and you're bring it home. That is just going to disrupt everything. And I think that there's a lot of pressure on women right now to kind of do everything and the economy's hard, you know, it seems like both parents have to work and it's just a lots. So you really have sit down with your family. come up with a game plan so your health isn't suffering because I'm seeing it so much with women. They're just very stressed, very anxious and not happy.

And then coping with things like alcohol or being despondent on their phone, away from family, all that stuff. So we really just have to go back to what's important and what TikTok or Instagram telling us is important. but what we know is at the center, you know, our family and God and keeping that part really, really tight and running well, and then we can go out and do other things. Yeah, I'm a big believer of, like, health starts in the home, so you want to make sure that You have a good relationship with your family, that you have good a relationship your God or a higher power that believe in and that your taking care of yourself before you try to take over the world.

I know it's challenging for women that are in that state where they have children and maybe aging parents, right? because you feel stretched in so many different directions trying to care for your young children and your aging parents and trying do the work thing. And I think it's a perfect recipe for going into that burnout stress response and then you end up getting into early menopause and perimenopausal. I love that we talked about parasympathetic because that can be a really healing state when we're constantly rushed and going from thing to thing.

It's like we don't have that opportunity to get into that.

Cycle syncing for exercise, fasting, and energy 47:30

My favorite is like Epsom salt baths. I know my, um, my husband for a while would be like, how long can you stay in there? I'm like as long as I need to. I have it so hot because sometimes I'll be, like we have a huge tub and I m like do you want to come in? My husband, he's like it's so h t, I am like yeah, because then I sweat and i detox and am in the epsom salt, detoxing with magnesium, it s like a two for one because that we don't have our sauna set up here yet. And and I think I need to clean it.

It's really gross and sweaty. So but but yeah, Epson salt baths and i have a like red lights all throughout my home like put in red bulbs and have one right above my tub so it's like I have the mood set there because you also want to you know avoid blue light at night for your circadian rhythm and So you release melatonin so you sleep well. So there's so many things because I know I would work up on my computer with patient charts until midnight looking at that blue light. I mean, I have blue like blockers on, but it's still not good.

We all need to have our boundaries and make sure that we're putting our health first because that is the most important thing with with perimenopause and taking care of your family. You need to be healthy for them. I have red light bulbs in my house, too. My house probably looks really weird at night. And I love it because one of the chicken heat lamps we have is red. So I'm like, oh, they're little biohacker chickens. They don't know it, but they are. Then you can get soy-free eggs, and you know what kind of feed they were getting, so you that your eggs are absolutely healthy.

We didn't get a chance to talk about cycle syncing. Can we get into that a little bit? And can you let us know what that is and how women in perimenopause can benefit from that? Yes, absolutely. I love cycle thinking for ladies of all ages, for women. It's really cool to be in tune with your cycle. And we talked a bit about what the cycle was earlier. So with cycle-syncing, we use those hormones to our advantage. you know, how they work in our body and what we should do from eating to working out even when to take pictures, family pictures.

So that follicular phase where that estrogen is dominant, this is where I tell women that they can do their fasting. If they want to fast, it's the best time to do it. if they wanna do low carb, its the time do do. They're gonna do better at it. If you tell someone to start a fast or a new diet like, oh, I want you to put on a therapeutic carnivore diet, start during the week before your cycle. No, that would be terrible because that is going to stress out the body more. Now, during a follicular phase, we are more because of estrogen insulin sensitive.

Okay, so we could handle more carbs here if we wanted to. We're more insulin-sensitive, but during the luteal phase, we're unresistant to stress. So we do require a little bit more carb there. we have higher metabolic rate because our body is getting ready to to implant if an egg was fertilized. So we can have a little bit more carbs there, but we don't want to stress the body out and do any extreme fasting there. That is going to drive the cortisol up and then at the cost of our progesterone. so that follicular phase that first two weeks of the cycle try to do you know your intermittent fasting here your longer fast you could do low carb if you're going to try carnivore or a new diet or something that You want to try to incorporate more protein in, and you've never done it before.

Well, do it then. Do the hard things then, so you're not going to fail at it. Also, working out. We know the luteal phase, the second half of the cycle, where progesterone is more dominant. we are more prone as women to injuries. There's a really cool study that they did in professional soccer players in Europe, and they noticed more muscle injury and other studies have showed more likely to get an ACL tear during that luteal phase. I tell my women, yeah, it's really interesting. So I've even had a patient that tore her ACL and I'm like, where were you on your cycle?

It was during a soccer game, so she wasn't trying to not follow the rules of cycle syncing, but it was during her luteal phase and she tore her ACL. So we're more likely to injury. What does that mean? I tell my women patients that this is where you want to do more mobility. You can do walking with an incline with a weighted vest. Because you should lift weights all the time. We should always be lifting weights in perimenopause because we need to preserve our muscle, which is a longevity organ, and sensitivity.

So what we want to do is lift, but lift higher reps, lower weights. The follicular phase, this is where you're going for your PRs. This is your squat, you are adding on a bunch of weight. You're gonna hit it hard, low reps high weights, because when we're adding more weights and we are really pushing ourselves, we we're more prone to injury, right? So that's when you want to do it. Go for your personal records. This is where you wanna work on your VO2 max and do sprint workouts. So this is when I do sprints on the treadmill during my follicular phase.

And once again, you feel better doing it, You feel really good. They've also looked at studies with performance and women feel and perform better during the follicular phase So it's really interesting when you see women, when they're entering perimenopause, they are doing the HIIT workouts all throughout their cycle, every day, too much. They're not losing weight.They're doing tons of cardio. And they were like, why? Why is this happening? Because they theyre fighting against their body. Their causing extreme cortisol.

you know, stress on their body, extreme spikes, their protesterones tanking, they're actually losing muscle because their bodies are so stressed and cortisol is going to eat up muscle, it's catabolic, we call it. So we need to balance that and if you want to do HIIT workout sprints, just do it during your follicular phase, chill out during luteal phase. Lift weights throughout the whole cycle and you're not going look like a man if your lift weights. You can lift super heavy, like I've been lifting super-heavy for the last three, four years I do not look like a man.

I mean, now if you're taking steroids like testosterone, you know, then you might look a like man, but you are not going to look man okay. So that's something that I really like to tell women. Also just kind of fun like when you ovulate day like 14, 15, that is when your glowing. That's when want to schedule a podcast, get family pictures, you know, all the things because your testosterone is peaking there. And that's is you want be intimate with your spouse and make more children. So that beautiful how God made our cycle.

So if we're, you know, sinking our cycles, thinking our activities, our thinking, all of that to our Cycle, we are not going to be fighting against nature or our body. And we will see improvements in our weight, in out mood, because I talked about diet and exercise and those are the two big things that Sometimes during perimenopause, we're doing the same exact thing, eating the the working out, but you're gaining weight because before you were younger, your body was a little bit more resilient. As we age, We get less insulin sensitive.

Our hormones are declining, our growth hormones declining. Everything's declining so to be anti-aging, replenish the hormones when appropriately. We also were smarter about how we operate so then we can really age gracefully. It's cycle thinking is so fascinating and I've just discovered it a couple of years ago and it's been really interesting because my husband, for example, he would be able to study every single day for one hour a day if he had to I would get it done, you know, in two weeks and but I'd have to do it at a very specific time.

And recently I shared this meme that was just brilliant. extraverted you make the plans, but the introverted shows up. And a lot of times I think that's so relevant for many women where they just feel their most bubbly, extroverted when they are, you know, ovulating and then when their menstruating, they go back, right? A lot of the health advice, a lot the business advice whatever out there is very much tailored to men who essentially have the same hormones throughout each day where for us this is so empowering because if you're right before your period you don't feel like doing a high intensity exercise, you might feel bad about yourself and then you can kind of fall off the wagon.

You're like, I missed a day or I miss a week. What's the point? And you are not seeing results. But when you so empowered with knowing like actually, I'm going to do this in these two weeks, then I am going do a hot photo shoot and spend time with my husband and do some things with girlfriends. Then it's going be time to maybe lift some weights, maybe do yoga, and then have some time where I will chill and be in my woman cave and not really do anything and just understanding your cycle, where you are and what that means.

Such a game changer for I mean, just for women. I'm such a big proponent and such big fan of this. And I'm like, I am late luteal phase. I notice, too, on Instagram, my Instagram stories, when I m late, lutial phase, just I s spicy. Sometimes I' m just a little snarky, and I will maybe not have as good of a filter. And i joke about that because I''m like oh, i'm late Lutale phase that's why I like going off on tangents about random things. But I think you could teach your son about it. I'm excited for our boys to have girlfriends and wives and really be in tune with their cycle.

And then they probably would have a lot less arguments. Frustration, so it's really fun to embrace this. And like you said, not beat yourself up. If I'm craving a bunch of popcorn or just want more carbs or even more food during my luteal phase, it is okay. I am not going to shame myself. You are not gonna gain 20 pounds in two weeks. What you do is you rein it in during your follicular phase you do a 36-hour fast, you maybe do keto for a couple days, or you're metabolically flexible. You can go back and forth.

So yeah, don't beat yourself up over it because that's going to stress you out and that can affect your progesterone. And then we're back at square one. Please don t compare yourself to Instagram influencers or Don't compare yourself to anyone. No one is doing what you're doing and you are doing a great job. So it's, I think that's women are just, we just have a lot, a of external pressures nowadays that weren't there, that didn't used to be there.

Peptides for hormones, gut health, and libido 59:30

Yeah, absolutely. I think it's exciting to be in this day and age because like you said, I'm excited for my son. He understands what a menstrual cycle is even though he's only seven, right? My husband's super empowered so he understands that sometimes Isabella might make a lot of plans and sometimes she might not want to go out and see anybody and he understand these things where I feel like my father's generation oblivious right and they don't realize that and all of the recommendations out there are okay you should do this and there for fasting or for work and productivity whatever they are for men right.

And so doing this is empowering. One other exciting innovation in these days and age that I'm excited to watch and learn about is the use of peptides. Now, these have been transforming healthcare anywhere from children's health to gut health, to autoimmune health. to women's hormones. I would love to know how you're utilizing peptide for women. Yeah, I've been using peptides for quite a while. They're kind of like a buzzword now, which is great. I love that they're getting more attention, more people are utilizing them.

There are a bunch that I used to use, and the FDA has them on this category 2B where you can't get them from compounding pharmacies. I utilize compounding pharmacies where they get checks from the FDA. It's a regulated compound pharmacy. I know my compound pharmacist, and that's where I get these different peptides for patients. There's also a lot of oral peptide and there's certain brands that are actually really good and high quality. The oral supplement companies that I recommend to patients, I know the owners.

I have their phone numbers.I talk with them. It's good quality. You definitely want to make sure you're working with a provider that knows peptides, knows the peptide world, and that you are getting it from a good place, especially with the injectables. A lot of the people are now getting them from China because they can't get them now from their compounding pharmacies. And they could be not what they say they are. They could have LPS in it, like a polysaccharide, which could cause a lot of inflammation in the body and the gut.

So you have to be careful because you're injecting this. Some of my favorite for perimenopause women, I do want to talk about GLP-1s. GLPs are semiglutide and then GLPS-GIPs is terzapatide. And these work really well for women that are kind of stuck, that they are insulin resistant for whatever reason. It could be stress, it could from bad dietary habits. And they've tried all the things. We've try all hacks. They lift weights, they tried berberine, They've trying to reduce their stress even though that's always something that their working on.

But sometimes they can just kinda move the needle. and working so many different ways. Working on feeling satisfied, working on delayed emptying of the gastric muscle, but also working brain inflammation and generalized body inflammation. Sometimes it's more than just losing weight when we're prescribing these peptides and using them. So my patients, though, we do really low doses and short amount of times. If I have patients on it for longer than a few months, they're usually on a small, a micro dose, and it's usually for inflammation.

The other thing about GLP-1s, you should not look like you're on ozempic or monjaro. You should NOT look that. If you look like you lost a lot of weight or you're taking one of these, you are doing it the wrong way. You're working with someone that doesn't know what they're doing. It should be a gradual weight loss where you maintaining muscle. So I have my patients and I'm like, okay. it's time to go on this," or they ask to on it. I'm like, okay, you have to have 120 grams of protein a day. You have the drink lots of water, take your creatine, lift your weights.

They have do all these things. Sometimes I pair it with an oral peptide called PeptiStrong, which helps maintain muscle when they're on a GLP-1. So sometimes that one is helpful too. You can also pair a GLP-1 with a growth hormone secretagogue. So there are peptides, ipamoralin, CJC-1295-semimoraline. Those are different growth hormones secretagogues. You could inject them up to three times a day, but usually my patients just inject before bedtime on an empty stomach, and that goes with your natural growth hormon releasing rhythm of your body.

Then that can be helpful because they're going to the gym, They have this growth hormone secreted on board with the once weekly GLP1, so they work synergistically. There's an oral peptide 5-amino-1mq that works within the cell, that it works with cells like energy house. That one also has a little bit of lipolysis and really good for energy. Sometimes that one's good to pair too. And then gut health and healing. So with thyroid Hashimoto's, weight gain is a problem. A lot of women in perimenopause, they are postpartum and they have Hashimoto's or they thyroid problems or got health.

The peptides that are great for got-health are oral peptides and you can get them as supplements, and that's BPC 157. That's actually derived from our gastric juices. And then I really like KPV, which is a tripeptide, great for gut health with inflammation, also great mold anything with like mast cells and inflammation. And then I love lorazetide. Lorazotide I loved for kids too. Lorzatide is actually going through, I don't know where it's at in the clinical trials, but that will be a medication soon for celiac disease because it helps with tight junctions and zonulin.

So those are three that I, love peptides for calming down gut inflammation and what can make gut health were stress. So I know we keep going back to that, but that's because it's so important. And I with your adrenal book, you go through that a lot too. But personally, we moved about three months ago and it was a a stress on my body and my gut health It got a little off, so I doubled down on peptides on eating, on sleep, fecal nerve stimulation. So these peptide, they're such great tools to be used in conjunction with the basics, with good sleep with eating right.

with meditation and prayer, with movement. That's one thing. I have an online peptide course where I first, because it's for providers or laypeople, that I go through all of those basic health principles because I've seen that peptides will work better when you are at least paying attention to those things. the downsides of peptides are that they are expensive. I mean, really not terribly expensive, but some of the injectable ones are You know, if I could put everyone on a couple of peptides that see me, I would, because there are so many good ones.

Another fun one I like to talk about for women and men is PT 141. And you mix that with a little oxytocin and you could just take it to internasal. So no injections. and intranasal you have less nausea with the PT 141 and that's before intercourse with your spouse. So my husband and I will take it sometimes like just like we'll joke about it or sometimes I'll utilize it in the luteal phase like when I'm like I don't really want to be touched You know, like that's another thing, right? Like sometimes our hormones, our men are designed to want to have sex every day because that is how their hormones are.

And ours is just that ovulation, that peak right there. But it's still good to be intimate. The PT-141, it helps with that. So in-stress is actually a big downer for wanting to horse with your spouse. It's just a fun peptide because the PT-141 helps the arousal and then the oxytocin helps with that comfort, that interplay. And it's the love hormone, oxytocin, and that's what we produce with breastfeeding. In actually giving long hugs, you can produce your own oxygoccin. So those, yeah, I could talk about peptides all day.

I love them and they're really just another great tool in the toolbox for all things. Yeah, those can be really, really fascinating. I've used some internasal oxytocin in the past, and that can a really big game changer. Going into crowds or meeting people for people with social anxiety, that could be a big really game-changer. The lorazetide, I had seen in research many, many moons ago, like 15 years ago. And so I was So excited when I realized it was available so people can actually utilize this now where for the longest time it, was just kind of like a research thing that was maybe going to be approved and maybe become a drug one day.

And now this is available and it can be helpful for intestinal permeability, which is. such a big important factor to address when you have autoimmune disease. You have a store where people can get oral, you had alluded to reputable sources where they can some of the oral peptides, the injectable was we want to make sure we get a prescription from a physician or working with a qualified compounding pharmacy. Yeah, on my website, Healthy by Dr. Jen, I have my favorite oral peptide brands there and some bioregulators too, which is a whole nother thing.

But it's a really fun world for sure. The oxytocin, that's that a good use of it for crowds. I didn't think about that for people with social anxiety.

Book, resources, and rapid-fire closing 1:10:30

like doctors that work a lot with autistic kids and Pans Pandas using oxytocin to just help calm inflammation of the brain. So yeah, really, cool stuff. And this is stuff that you're just walking into your regular doctor and they're going to be like, what are you talking about? There are so many of us using it, using these things and all these strategies and there's research to back it which is great. It's just fascinating. I mean, I saw the research with children not meeting their milestones with crawling, specifically children with a condition known as Prader-Willi, which is expected where they're not going to meet certain milestones and they were using like intranasal oxytocin.

And the kids that received that, they were crawling and meeting their milestones, having better developmental outcomes. And it's just incredible. I wish more people would know about peptides and would about some of these innovative solutions. So I'm really, really grateful for you taking the time to spread the word about these. You have a book. about perimenopause, how to thrive through peri-menopaus, and you include everything that we talked about here in greater detail as well as some other strategies.

Could you tell us more about your book? Yeah, so the book's called The Peri Menopas Reset and if you go to drjennbook.com you can purchase it and there's a bunch of freebies and it's great. It's 28 days through cycle syncing, through all the information and everything I've learned with my patients to get you through perimenopause. But it also is really helpful if you're older, if your through a perimanopausal and in menopas and younger. There's still a lot of good tips in there. Yeah, thank you.

Thank you so much for creating this. I'm so, so excited to get my copy and I cannot wait to read it from from beginning to the end. And I know I'll be having my highlighters and pens going through it. So super, super excited about that. Where can people find you and your work? Do you have a website and social media that you could share with us? Yes, website is healthybydoctorjenn.com. And I hang out mainly on Instagram, Integrative Doctor Mom, so Integrated D-R-M-O-N. I also have a YouTube that I have videos and podcasts on there under Integrate DoctorMom.

So we're going to wrap up soon, but I've got a couple of rapid fire questions for you to put you on the spot. Is there a wellness hack you've refused to participate in? I would say I used to cold plunge all the time, but the past six months have been very stressful on my family, so I stopped doing it. And once we settle down in here a little bit more in Tennessee, I'm going to start plunging again because I feel like my adrenals have reset. but that is something that you have to listen to your body.

You can't just do a hack all the time just because everyone's doing it. I took a break and I'm still on a brake until my body tells me I can do it again. Yeah, thank you for sharing that. That's been a popular answer on this podcast. And I think this can work really, really well if your thyroid is optimized, your adrenals are optimized. Maybe you're going through a lot of hot flashes. It's going to be game changing. But for a lots of times, people might find that little bit of stress too stressful when they are in adrenal dysfunction.

Or if they're still hypothyroid, that's gonna worsen how they feel for sometimes hours if not days if they get extreme cold exposure. But yeah, that's been a very popular answer. What about if the supplement police came to your house and confiscated all of your supplements but let you keep one? What would you? Oh, That would be horrible by the way, right? Magnesium. That's a really good one. If that is like one of those foundational things that can be a Thank you, Dr. Jen, so much. It's been such a pleasure having you here.

We love the opportunity of getting to learn from you. I know everybody listening has really benefited from this conversation. Really appreciate the work you're doing for women with Hashimoto's, women in perimenopause. On behalf of the community, I'm so grateful for you! Thank so you much! It has been a fun conversation, and I appreciate you Thank you. And everybody listening, I hope this has been healing on your journey. Until next time.