What Is Perimenopause? Perimenopause Symptoms and Solutions Explained

Dr. Brighten: [00:00:00] Menopause. That is going to be the 12 consecutive months. Boom. No period. We say you're in menopause. Next day, you're postmenopausal. But what about perimenopause? Perimenopause is more than just hot flashes. In fact, it's roughly over 35 different symptoms that women experience as they enter into this phase of life.

But I want you to know that it is acceptable to experience perimenopausal symptoms. seven to 10 years prior to menopause. So if you're listening to this right now, and you're in your mid thirties, I want you to know that welcome back to the Dr. Brighten Show. I'm your host, Dr. Jolene Brighten. I'm board certified in naturopathic endocrinology, a nutrition scientist, a certified sex counselor, and a certified menopause specialist.

As always, I'm bringing you the latest, most up to date information to help you take charge of your health and take back your hormones. If you enjoy [00:01:00] this kind of information, I invite you to visit my website, DrBrighten. com, where I have a ton of free resources for you, including a newsletter that brings you some of the best information, including updates on this podcast.

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Perimenopause is more than just hot flashes. In fact, it's roughly over 35 different symptoms that women experience [00:02:00] as they enter into this phase of life. That can look like loss of libido. Brain fog, inability to concentrate or focus, a surge in ADHD symptoms or autism symptoms, feeling like you just can't fall asleep, or even if you can fall asleep, you cannot stay asleep, so struggling with sleep disturbance.

Yes, you can have hot flashes. Yes, you can have night sweats, but you may also have cold flashes, itchy ears. You may experience itchy skin all over, especially at the base of your scalp. You may also have other odd symptoms like burning tongue or experience joint pain. And so when you go to your doctor and they say, you just need to exercise more because you're increasing your visceral adiposity or you're burning.

belly fat because that can also be a symptom of perimenopause and menopause. You may not be able to exercise because your joints are achy, your muscles hurt, you feel awful when you go to the gym, you're not feeling [00:03:00] any better, and you're lacking motivation because estrogen and dopamine are besties and dopamine's all about that reward.

And so I want you to understand as we embark in this episode all about perimenopause. It's not just about reproductive health. It's not just about hot flashes. It is so much more. And my aim today is to give you practical tools, things that you can actually implement to start feeling better and to navigate this journey.

Now to do that, we first got to define like, what is perimenopause? I think this is something that, like, so many topics that I've addressed during my career that so many women didn't get information about until they arrived there, and they didn't necessarily get that information right away. They often were gaslit, you're just getting old, it's just the way it is, or, you know, it's not that bad, or, you know, this is just part of being a woman, suck it up, grit your teeth, get through it.

And so we got to talk about. What is perimenopause? And I'm going [00:04:00] to take you through several phases of perimenopause today as a way for you to understand it. And there is not a really great consensus on the phases of perimenopause. There are some people who say there's four phases of perimenopause.

There are other people who say No, no, no. There's two phases of perimenopause. Then when you're in that countdown to menopause, there's menopause and then postmenopause. And it gets really confusing. I'm going to use a definition today of taking you through four layers of perimenopause. I'm going to take you through the phases in that way because I think it's a little bit easier to understand from your own perspective.

So you living in your body. So I care a lot less about like, is this accurate in terms of like what the menopause society says or what, you know, you maybe your OB GYN says and more about your experience so that you can approach perimenopause from, you know, basically an understanding that helps you know what tools to implement, what to be doing to fill your best.

[00:05:00] Okay, so these definitions are well accepted that I'm going to share right now. Menopause. What is that? People will say, oh, you know, I'm experiencing menopause, but they're still having periods. Um, or they'll say I'm experiencing menopause, but they haven't had a period in five years. So let's talk about what are the true definitions of these from a medical perspective.

So number one is. Menopause is simply the anniversary of 12 consecutive missing periods. 12 months. Count it down. Haven't seen a period? Welcome to menopause. Tomorrow, you are post menopause. So menopause is just a bucket term that a lot of things fall into, but I want you to understand clinically speaking the way that we diagnose menopause is you are over age 45 and it has been 12 consecutive months of no period.

Now if you're under age 45, you may still go into menopause. However, We don't just accept that as menopause. We have to investigate what's going on. If your period goes missing for an [00:06:00] extended period of time, let's say you're 40, we have to understand, is this actually menopause? Is this primary ovarian insufficiency?

Which is when the ovaries give out sooner than they should. And that can be linked to autoimmune disease, other conditions that must be investigated. That's why we want to know, is it just menopause or is it something else? So we don't miss something. For example, to take a little tangent. You're going to notice I do this a lot, but it's because I want to make sure that I cover as many details as possible for you.

So primary ovarian insufficiency, that is something that we don't totally know why everybody who experiences that actually does experience it. But some people will be positive for 21 hydroxylase antibodies. Those are the antibodies, so an autoimmune condition is when antibodies flag your tissue for destruction, in this case, your adrenal glands.

The immune system attacks it, now we end up with Addison's disease, we can go into an Addisonian crisis, that's life threatening, you're gonna go to the hospital, [00:07:00] you're not making sufficient cortisol, you can't live without that. So I want you to understand, this is why definitions, terminology, and diagnosis are so important.

Diagnosing appropriately is so important so that we don't miss things. I always want to know what's happening right now, but also investigate what might be coming down the pipeline for my patients. Okay, so menopause. That is going to be the 12 consecutive months. Boom. No period. We say you're in menopause.

Next day, you're post menopausal. But what about perimenopause? Perimenopause is basically the lead up to menopause, and we're going to talk about what's going on with the hormones and like, why does this even happen? But I want you to know that it is acceptable to experience penury menopausal symptoms seven to ten years prior to menopause.

to menopause. So that means if 45 is normal to enter menopause, by the way, the average woman's gonna hit menopause in the United States at about 51, but if it's 45, [00:08:00] let's say, then 35 It's completely acceptable to start experiencing perimenopause changes. So all of those things that I just described to you, the brain fog, the fatigue, the insomnia, however, we shouldn't just accept it, okay?

It is acceptable as a normal physiological change, but we should do things because you deserve the right to thrive, to feel your best, always and forever. And that's our aim. Uh, just because something's normal doesn't mean we should accept feeling awful or not have the quality of life that we deserve. I mean, that's what's so mind blowing, earth shattering, if you will, as a woman, not just as a clinician, but as a woman, when I consider that women are spending roughly 20 percent or more of their life in the worst health.

Hear me again, they spend 20 percent or more of their life in the worst health condition of their life. They fill. They're worse. They function at their worst. And that is something that we can prevent. [00:09:00] And that is something that I don't want anyone to harp on. Like that is something where we can, we can create change.

You can create change at home. You can create change right now. I'm talking about these things today. So I want you to understand that so much of society is doom and gloom about menopause. I do not take that perspective. I do not believe that menopause is now the womp womp period of your life.

Everything's downhill. You don't have reproductive capacity. Therefore you have no value. That's a lie. That's a lie. Women in menopause, they're our wise women. They have so much value, they have so much to offer. And after sending over a decade managing menopause in patients, I have to tell you, those are some of my favorite patients.

They are. They are just filled with so much life and a wealth of knowledge. So. While I will talk about the statistics, I will talk about the things that are like, Oh, that's, that sucks. This is the current state of where we're at. I don't ever want you to take the perspective that like menopause is just the worst and we just [00:10:00] are going to live in the worst.

We're not. You're here. I'm here. We're in this together. Okay, so if you're listening to this right now and you're in your mid 30s, I want you to know that you may be experiencing perimenopausal symptoms, but that doesn't mean that there's no hope. The ovaries are still functioning, but I want to talk to you about like what is actually going on.

We, our current understanding in science is that we are born with all the eggs that we are ever going to have. We basically have this savings account. And every month that you ovulate, you are losing many eggs. You ovulate one egg until like later perimenopause, then we might get some whoops of like double egg is ovulated.

That's why women in perimenopause in their 40s have a higher incidence of conceiving twins. Now, every month, you're just out there spending it. You're just like, you know, like mid cycle, you go on a shopping spree. And that checking account is just basically putting [00:11:00] those eggs out. Whether you are on the pill, you are, you know, taking any kind of medication, no matter what you're doing, I just want you to know every single month you are losing these eggs.

So we're losing eggs, losing eggs, losing eggs. As we get closer to our 40s, that savings account is very depleted. And the shopping sprees are going to happen less frequently. That's a bummer. I don't like that. But what's gonna happen is that as you run under the eggs, you ovulate less frequently. Now, the ovaries are running out of eggs, but the brain doesn't care.

The brain is like, do. So there's a hormone called follicle stimulating hormone. Remember this because we're going to talk about testing with perimenopause and how we test hormones. Now, FSH, follicle stimulating hormone, that says to the brain at the beginning of the cycle, even while you're still bleeding.

That's why it's called the follicular phase. Because, yeah, you're having a period, but the ovaries are getting an egg ready. It says, get those eggs ready. Now, when the [00:12:00] ovaries are like, I'm retiring. I don't really care what you have to say, FSH. FSH is like a mad boss and is like, I'm gonna scream at you.

Now FSH is going into the double digits. So maybe it's like 25. It's shooting off. It's a higher number because it's screaming at the ovaries to do their job. And the ovaries don't care. They're going into retirement. They're like, we're done here. So I don't have to listen to you. Now, ovulation, instead of being predictable, unless you have PCOS, it'll be less predictable.

Uh, so ovulation, instead of it being predictable, it now becomes less predictable. So we're not ovulating every month. Now periods can start to become irregular and that continues on until we ovulate less and less and less. That means periods come less frequently. So days between comes more and more and more.

And then we stop. The ovaries are like, I'm in retirement. I'm living my best life. I will be in Cabo. See you later. And then at that point, you're no longer getting periods. We're entering into menopause. Now, what's a [00:13:00] key thing to know is that the ovaries, as they're getting an egg ready, they're producing estrogens.

The beginning of the cycle, they're producing lots of estrogen. Estrogen spikes mid cycle. That's what tells the brain already the egg has been chosen. And then. The brain secretes LH, luteinizing hormone, it pulses that, you ovulate, and then the magic thing happens. After you ovulate, there is a temporary endoconstructor known as the corpus luteum, and that is what makes progesterone.

The only way to progesterone is through ovulation. Okay, now progesterone takes over in the luteal phase, it helps us feel less anxious, it helps us feel connected to our community, to our family, in fact being connected to community and family helps our progesterone levels. It also helps us sleep. It stimulates GABA in our brain, and GABA isn't, so melatonin's like, go to sleep, and GABA's like, stay asleep.

So can you imagine what hormone is messing with us when we can't stay asleep and perimenopause? It's progesterone. And what did I just explain to you? [00:14:00] Ovulation is going to be the first thing to go. And if ovulation is the first thing to go, then progesterone is the first thing to go. And what are the first symptoms of perimenopause we might find?

Inability to stay asleep. Increased PMS. Like, God, if my partner breathes wrong, I'mma be down their throat. Or the chewing out loud. Those are definitely two things that can trigger us. So PMS, feeling rage sometimes. But the big things is that, that PMS picture which could be like breast tenderness, that could be ragey, that can be insomnia, it can be anxiety.

It can feel, uh, you can feel agitated. And, uh, And then, uh, Maybe in your 30s this started a couple days before your period. We don't worry about that, but now as you enter into like mid 30s, into your 40s, now we're looking at that being more like five days, maybe seven days. Now progesterone peaks typically.

So we ovulate, progesterone is going to peak around five to seven days later. And so you might get like those peaks, but then the drop [00:15:00] off, the ovary can't keep going. And then as we get further and further, closer and closer to menopause, there's less of that progesterone production, the ovaries just can't do its job.

And so now we're feeling more and more of those symptoms. We're talking about this right now from an ovulation and a menstruation perspective, right? I defined menopause based on a period, but not everybody has a uterus and not everybody gets a period. So let's talk about some different, different ways to gauge that.

So I wanna get into the phases of perimenopause, but I wanna talk about how do I know? If I'm in perimenopause, I've kind of danced around giving you all these symptoms, but let's get into some nitty gritty. Let's get into specifics about what we can be looking for. And so pay attention if you don't have a uterus, if you are not menstruating regularly.

Hi PCOS, looking at you. Sometimes Hashimoto's, uh, functional hypothalamic amenorrhea. There's a lot of reasons that you might not have a regular period. So let's get into what else are we looking for? So I talked to you about FSH. [00:16:00] Follicle stimulating hormone is going to rise about, you know, days two, three, four of the cycle.

That's when it's going to really ramp up to talk to the ovaries. Now I want you to understand that estrogen and FSH and LH, like, they can be happening during different times of your cycle, but the day we are going to test FSH, you're going is going to be roughly day 3 of your cycle. So you do 2, 3, 4. If you don't have a cycle, we may just take a random reading.

Then we may just test to see where is FSH at. Now, with FSH, So, we understand that as those levels get higher, that signals that we are possibly in perimenopause. However, we have to do consecutive readings. We have to take it again a couple months later and because it might be normal a few months later and that's normal in perimenopause.

So what are we trying to do here with FSH? We're actually trying to catch like how close are we to menopause or are we in menopause if we don't have a [00:17:00] uterus but we still have ovaries perhaps. If you've had your ovaries removed. you are in menopause. So if you had a bilateral oophorectomy, you are in menopause.

So you don't have to play any guessing with that. But if you only had your uterus removed, then those ovaries, they may still be working. So what's the ideal range for FSH? Below 10. And once we get to 20 consistently, Friend, we are in perimenopause. We are, and we may even be in menopause, especially when it gets higher than 20 and it is consistently at that level.

Now, I want you to understand that there is no great test and I probably should have started there for perimenopause. Um, so if your doctor is like, Oh, we're not going to test it because it changes all the time. I mean, that's true. FSH, like I said, one month normal, next month, not normal, next month, not normal, next month normal.

Like that. That. can be a normal pattern for [00:18:00] perimenopause, which is, oh, just, you know, exhausting when you're trying to catch it, right? When you're like, I just want to know. I just want the numbers. So there is no great test. That doesn't mean that we shouldn't test, but If you are experiencing symptoms and you are mid 30s or older, that's a pretty good sign.

So I want you to understand, I think especially because we live in the United States, we have to talk about the fact that healthcare is not accessible. Healthcare is not affordable. It's not practical for everybody to be going to the lab month after month. And so understand that your symptoms, your knowledge of living in your body, is some of the most powerful data that we have.

If you meet with the doctor and they don't care about your symptoms, go to a different doctor. Because they should know, anybody who is an expert in hormones, perimenopause, or menopause, they should know that symptoms really guide so much of the treatment. So I just want you to understand, as I keep going through the labs here, nothing is tried and true and great until you're like full blown into [00:19:00] menopause and then we're like, okay, now we've got these lab levels.

Okay. So your Dr. May also, or your practitioner, 'cause maybe you have a nurse practitioner or a pa, someone else you're meeting with. They also may wanna pull an estradiol E two. That's the predominant hormone through our cyclical years. When you're pregnant, it's Estriol or E three. And when you are post menopause, it's ESTRO E one.

Now they'll wanna look at estradiol with that FSH to see. Okay, FSH is a brain hormone. Great to know. How do the ovaries respond? Now, if the ovaries are not producing sufficient levels of estradiol, that's also a sign. If FSH is up, estradiol is down, ovaries are on their way out. But I want you to understand this about perimenopause.

Progesterone goes first. That's why that's typically the first hormone we'll use in hormone replacement therapy to get symptoms under control to get you sleeping and get you less anxious and you know, not wanting to scream at people on the highway [00:20:00] or maybe in the boardroom, like wherever it happens. So progesterone goes first.

That means estrogen is left unchallenged. So estrogen. Might also look fine in your follicular phase, but we may also want if we if you are ovulating Then we might want to measure it days five to seven post ovulation If it's a 28 day cycle we typically say 19 to 21 days. Not everybody has a 28 day cycle so we might have to fine tune that for the individual.

But we may want to look at estradiol and look at progesterone because you may have significant symptoms of high cholesterol. estrogen happening during that luteal phase due to the fact that progesterone is not challenging it. So during perimenopause, it's not unusual to see a roller coaster of estrogen.

It's a wild ride. I feel like, you know, if you've ever been to like the fair and they, you're on a roller coaster and they play like [00:21:00] heavy metal music, like that's literally like what it feels like is happening to your nervous system through all that. You're just like, ah, so, uh, that's my best heavy metal.

Impersonation. Uh, so there can be these ups and downs of estrogen, but estrogen can be really aggravating when left unchecked. So a lot of people will refer to this as estrogen dominance. It's a relative estrogen dominance relative to progesterone. In the research, it's hyperestrogenism, so high estrogen levels.

You know, if you're experiencing this, you're like, I don't care what you call it, just fix it. That's it. That's all I want it to be. But I just want you to know, uh, you know, from my perspective, I think it's perfectly fine if patients use whatever language they're comfortable with. And as providers, we refine that.

We don't judge them for it. We refine that. It's the same as if somebody says, I have a hormone imbalance. Like, that's not wrong. That's their experience. It's their best guess of living in their body. And as practitioners, we say, Tell me more about [00:22:00] that because it's our job to figure out like, is it estrogen and progesterone?

Is it hypothyroidism? Is it, uh, you know, high levels of insulin? We've got insulin resistance. It's a provider's job to figure that out. Okay. All right. Let's get back to the labs. Okay. So we talked about FSH. Okay. All right. so much. We talked about estradiol. I want to talk about something that if you've ever been on a fertility journey or maybe you saw the New Girl episode where they were like checking like how many, how many eggs do I have in my savings account is anti malarian hormone or AMH.

Now AMH is typically used when somebody is going to go through IVF as a predictor of like how many eggs can we get in an egg retrieval. It's going to tell us an estimate of like how much do you still have in your savings account and AMH over one. is really great if you're in your 40s. Um, and we want to look at this AMH, not in everybody, but certainly someone who is like, what's, I still want to get pregnant.

Just so you know, if your AMH is low, you may [00:23:00] still conceive naturally. It's not. It's not going to, you know, have a bearing on that. Again, it's utility comes in IVF, how many eggs might we be able to retrieve. PCOS, by the way, women with PCOS tend to have elevated levels of AMH. And so you might have an AMH of like 2 in your 40s and maybe, and that's, that's wild, that's high, right?

Um, and that's something that, uh, and, and, you know, I should say like it, we're probably like more like 1. 5, but. It may be high, and then your provider's like, you have tons of eggs, but the eggs might not be the best quality, uh, and, you know, it may not totally be predictive of when you'll go into menopause.

But AMH is pretty telling about the ovarian reserve. So with AMH, it doesn't always necessarily mean that menopause is right around the corner, but, you know, if your AMH is like 2, it's like, sister, we are getting close. When you're getting close and odds are you're, you're going to be in [00:24:00] menopause very soon.

There's another thing that we can do. So AMH can be done at any point in your cycle. Um, an AFC, an antral follicle count that needs to be usually, you know, what's great is it's usually around day two, three, four of your cycle. Uh, if we can get you to go in and just get your blood drawn and do this, it's an ultrasound procedure.

where we can actually look at how many follicles you're recruiting. And so if what we see is that there's only a couple of follicles, these are the egg potential, the potential winner. It's like, um, not a sports person, but this is what I imagine. Like you send a bunch of, um, athletes in and they go into a trial, but there can only be one winner.

And that's kind of what the, the ovaries are like. So, um, yeah. You know, when you're young and you're healthy, you may be recruiting like a dozen follicles to choose one. And as you get closer to menopause, which doesn't mean you're not healthy. It just means that you are naturally losing those egg stores.

You may only have a few follicles. So we're getting very, [00:25:00] very close to menopause. Again, Nothing is completely accurate and predictable, um, you know, these, these labs in terms of saying like, yes, most definitely, um, until we see those FSH, you know, that FSH soaring well above into those double digits, and you haven't had a period, but you're like, oh, I don't have a uterus, that's okay.

FSH is soaring and you're just like, yeah, I've been having hot flashes, night sweats, like I'm feeling the things are happening. We don't have to wait to bring in hormone replacement therapy if that's the direction that you are choosing to go and that's an indication for you. Now tracking your cycles, very, very important because we're going to talk about these phases and with the phases of perimenopause, that can be very telling of what's going on.

We're going to talk about phases of perimenopause. And so keep these in your head where you're at. And we're going to talk about things that you can specifically do to support yourself right now. Now, [00:26:00] as I said before, if you do not have a uterus, none of the period parameters are going to be helpful.

Instead, we're going to follow your symptoms. I'm going to go through a list of symptoms for you to kind of jot down as you track your cycles, things to be thinking about. Um, and the labs that I talked about previously, we can try to use those. to try to dial in where things are at. But I can't emphasize this enough.

Knowing your body, knowing your symptoms, and making a note. Whether you have a app that tracks your period, or you have old school calendar, or you just want to keep a little like period diary, whatever it is. Having that information in front of you is so powerful for you to be able to advocate to yourself with your doctor.

If your doctor's like, this isn't a big deal, and you're like, checks, notes, it is a big deal. It's very, very hard to be gaslit. if you have the data right in front of you. So definitely tracking things. Now let's break it down and I want you just to pay attention. Where might you be? Okay, so I told you I was going to tell you about four phases.[00:27:00] 

Phase, so the first phase is that very early perimenopause. And This is when periods are still regular, but you start having those symptoms of sleep disturbance, of anxiety. So like I was talking about when the progesterone starts to dip out, and this is happening usually in our mid 30s, late 30s, maybe even early 40s.

So just because perimenopause can last 10 years for some people doesn't mean it won't be four years for you, okay? We care more about what your normal is, what your experience is in delivering the best care for you. So in that very early perimenopause, that's when I never really had PMS and now it's starting to be a problem.

I'm starting to have these sleep issues. And then we move into the second phase of early perimenopause. Now this is characterized by the periods starting to get irregular. They're off. Your cycle can be off by seven days. sometimes a little bit more. So in that instance, the 28 day cycle is maybe now a 21 day cycle.

That's a [00:28:00] sign that progesterone is definitely failing. And you know, at this point, we might bring in progesterone and get a little extension to that cycle. Some people are able to get back to the 28 days. Some people are like, I can get to 26 now. But the thing we're most interested in is like, Are you sleeping?

Are you less anxious? Do you not feel at the mercy of stress? Are you feeling a little more like you did before? A little more like yourself? So, it's not, I just want to be like crystal on this, crystal clear. We, our, our aim is not to make you feel like you're 20. And maybe you're like, I would never want to be 20 again.

I don't want anyone to be under the impression that you need to look like you're 20, feel like you're 20, any of that. What I want is you to feel your best at that moment where you're like, I feel really good. I'm living my life in the way that I want to live it. Okay. So with that being said, we, you know, I've alluded to progesterone therapy.

I [00:29:00] want to, we'll talk a little bit about hormone replacement therapy in this episode. I do feel like it is something that I need to dedicate a whole episode to. And, uh, as always, I'm a doctor, but I'm not your doctor. So any of these things that I talk about today, you need to discuss with your doctor, especially if they require a prescription.

Don't be going and getting stuff off the internet. The internet can be a scary and dangerous place. Okay. Alright, so, very early perimenopause into the early perimenopause. And so, very early, we're not seeing period cycle changes, but we are seeing symptom changes. Now. As we get into early perimenopause, we've got changes of like seven days or more in our cycle.

So day one is the first day you bleed, the next period to the next period, that's what we're counting as a cycle. And I use 28 days because that's the parameter, that's the, that's how we teach about it. But if you've read my book, Is This Normal?, then you know 28 days is not actually the norm for everyone.

It might be your normal, but if you're more like, you know, 25 day cycles or 34 day cycles, that's not, [00:30:00] Abnormal. Okay. So you want to look at your cycle and is it, you know, something where like it's, it's coming sooner. So from the 28 day perspective, is it coming more like 21 days or is it more than that? Is it coming more like 40 days?

So in, you know what the crazy thing is, is that as you get closer to menopause, it can be either or. Uh, and so we go from the very early to the early. Now we enter into the Late perimenopause transition, late perimenopause transition. Now the cycles are 60 days apart or more. So now we're jumping months.

We're not talking weeks. We're jumping months. Now, as you can imagine, we got low progesterone happening in the very early and then it's getting worse in the early. And then as we get into that late perimenopause, that is, uh, so the late perimenopause transition, is really where we see symptoms start [00:31:00] to get a lot worse.

And that's where we really start to feel the progesterone. And now we might start feeling the estrogen as well. With estrogen being low, we might be like, wait, what's happening to my skin? I look like I am getting more fine line wrinkles. And you might be like, that's vain. Okay. Yeah. Okay. You know, I just want to give you permission, but like, you can worry about that stuff.

Uh, when it comes to like worrying about aging and weight, people are often like, You're so judgy about if you worry about it, but also judgy if you are getting older. It's just such a weird place to be as a woman. Whatever is true for you and whatever you are feeling, I just want you to honor that, okay?

But when we start to see the fine lines and wrinkles, what is really going on? Why do we even bring that up? Because that's a symptom of estrogen going low and collagen starting to get, you know, not, it doesn't have the same integrity. It can be broken down. It's not being replenished the same. Um, that means we start to compromise the integrity of our skin.

When we enter into menopause in that like first five years, we lose about 30 percent of our [00:32:00] collagen, which is why people feel like they age so rapidly and. I want you to know that if you care about how you look and you're worried about that, I care too, okay? But as a doctor, I care about like, well, what does this mean in terms of like injury and the barrier and the protective mechanism of this skin?

So that can be a sign of estrogen declining. Our breasts can also droop. We can feel achy joints. We can feel achy muscles like they don't recover, more brain fog. This is where my ADHD and autism friends and patients, they. really start to feel symptoms are starting to creep in. Now we make the transition.

We're, we're going from late perimenopause transition to late perimenopause. What is that? Now you don't have any clue when your period's gonna come. Maybe it's already counting down. You're like, and you know what's really lame is that you can count down and you can be like, Tuck, I'm at like 9 months, 10 months of no period, [00:33:00] I'm about to be in menopause.

Like woo, such a relief to know what is going on. And then you might get a period and the clock starts all over again. That can definitely be happening in late perimenopause. Now late perimenopause though is typically that final stretch, that 12 month countdown before you get to your period. But if you're like, yeah, I felt, I felt.

all of this and then I got my period again and then I had to start counting down again, you may still be in that late perimenopause. Now, this, these four phases, I just want you to mark where you're at because I am going to give you some tips, some things that we can talk about. I've already alluded a little bit to the hormones, um, but I want to just remind you that Your experience may look a little bit different and that doesn't mean there's anything wrong with you.

Okay. Um, and I also want you to understand you may have had lab testing and everything looked perfectly [00:34:00] fine and normal, but yet you are feeling like you're in that late perimenopause transition and you're like, what is happening again? Again, because we can test, retest, and still find normal. normal parameters.

That's the worst. That is like one of the few times when you're like, I don't feel normal and your labs can look normal. But again, we honor your symptoms. So we want to be tracking all of that. And if you are somebody who has had a hysterectomy, you don't have a uterus, and I defined all of that. The, the menopause, or excuse me, the perimenopause transition based on cycles, that's, that's where we define things from.

I want you to understand that your symptoms really matter, but it can be a little harder sometimes to dial in where you're at, but that doesn't mean we can't support you. Okay, so here's the questions that I ask my patients that I would have you ask yourself. Do you rage before your period or [00:35:00] cyclically?

So if you don't have a period, is it cyclically happening where you're just like, Oh, I'm like crawling out of my skin or like the littlest things are just like driving me insane. Or maybe you have a lot more sensory sensitivity. Very common in the neurodivergent community who are in perimenopause. By the way, there's no new onset of ADHD or autism in perimenopause.

It is just the inability to mask coupled with the hormones that supported you that had your back not being there, not operating in the same way. And so you may find that you can't wear the same clothing anymore. The wet hair on your back is driving you insane. The buzzing of the light, can not everybody hear that right now?

It's, it's getting under my skin and your nervous system might feel raw. So ask yourself, are these things happening cyclically? By the way, for my ADHD and autistic peeps, these are there really all the time, and they heighten cyclically. [00:36:00] It's not, so if you're just like, yeah, no, cyclically it does get really bad, but the rest of the time I'm like totally fine, totally functioning, not even worrying about this stuff.

It's, you know, I don't want anybody to be like, You know, panicking right now over it, but just to have that understanding of like, if you are neurodivergent, it's there all the time. It's worse usually before your period, and if you don't have a period cyclically, it's hitting you. Okay. So what else can we ask ourselves?

Are we cyclically having headaches and migraines? They might happen every couple of weeks or so, so migraines and headaches can be happening around ovulation. Okay. And before you menstruate with the changes of estrogen happening. So I just want you to understand that, um, the headaches and the migraines, you have to keep a journal because they may be fluctuating twice in a cycle.

And that's normal to see, but is it happening cyclically? It's not just like, Oh, I didn't get enough sleep. Now I have a headache. You have to keep a headache [00:37:00] journal. Am I experiencing breast tenderness like when I was a teen? Or am I breaking out like I was a teen? Some people call perimenopause like the second puberty and that's fair.

It's not fair. It's lame. We shouldn't have to go through that twice in our life, but it can sure feel like it because you know, in puberty, your hormones are just like figuring out how to operate and your androgens might be surging. So we think about testosterone that now we're getting oily skin, we're getting acne.

In your late perimenopause, so some women lose testosterone, but not everybody does. Um, some women retain testosterone, but lose estrogen from keeping it in check. And now they've got oily skin, they've got acne. Are you losing your hair? Are you getting miniaturization of the follicle? That is the strands of your hair are getting much thinner.

We see this a lot in PCOS, but it can happen. if you have elevation of DHT, dihydrotestosterone, which is a potent form of testosterone, and that can cause [00:38:00] irreversible hair loss. So that means take a trip to your derm, and that may be something where you use topical rosemary solution. I actually have an article on drbrayton.

com all about testosterone, menopause, and hair loss. So things like saw palmetto might help, orally minoxidil might help. tropical rosemary oil, doing scalp massages, doing light therapy. I talked through the specifics in that article. There's a little bit of a tangent there, but anytime I bring up hair loss, I know somebody gets anxiety and I'm like, I just have to say some things to help mitigate that.

Okay, so are we breaking out? Are we experiencing hair loss? Are we experiencing breast tenderness? Are you having hot flashes, night sweats, cold sweats? How often do you have hot flashes? How often do they last? Do the hot flashes interrupt what you're doing? So maybe you're in the middle of lecturing and you're like, I can't, I can't stop the world.

Um, maybe you're at the grocery store and you're [00:39:00] picking something up. You have a hot flash and you're just like, I just need a minute. I gotta take a breather. That is a severe hot flash. That is definitely something to make note of because that is somebody who needs an intervention, who needs, and this is usually going to be a pharmaceutical intervention, whether it's a bioidentical hormone or, you know, in some places or some cases we use SSRIs, SNRIs.

There's other, other things that we can consider, but if you have severe hot flashes that interrupt what you're doing, you have to stop what you're doing, that is a severe hot flash. So, When I'm talking about all of this, I want you to understand it's not just like, yes or no, do I have it? How does it affect you?

How does it affect your life? If your headaches mean that you got a migraine so bad you're down for three days, we got to support you. Why is this important? Again, this is how you advocate to your doctor. They can be really dismissive. So, uh, having heavy periods, so when you go so long without, um, a period in, you know, that, these phases, so as you get to that like 60 [00:40:00] days, for example, of not having a period, estrogen's been there stimulating the tissue, progesterone hasn't been balancing it, now you get a period and you're just like, oh my gosh, this is like a scene out of Carrie, like there's so much blood.

How much blood? Are you bleeding through a pad and a tampon every hour? Write that down. We need to know that. That's not normal. Are you having clots bigger than a quarter? Not normal. Could be a sign of fibroids. I, this is actually, I have checklists about this in my book. Is this normal? Because, um, too often are women told at every stage of this life that like heavy bleeding and cramps are just normal.

We need to investigate some of these things that are going on because, um, it might just be that like, oh, the endometrium is building up a lot, but it might be that you've developed fibroids, or that you actually have endometriosis that hasn't been caught, which is actually really normal, unfortunately, in the United States for endo to go missed.

Or you might have developed adenomyosis. Like, we need to know what's going on and we shouldn't accept these things as [00:41:00] normal. Okay, so, uh, we've talked about skin, we've talked about periods, we've talked about headaches, but wait! There's more. Sleepless nights. What does it look like? Are you having trouble falling asleep?

How long does that take you on average? If you wear any kind of data tracking device like an Oura Ring or, um, you know, an Apple Watch or anything like that, it will tell you. Latency. Did it take you like 45 minutes or more? That's a long time. We might need to get some help here. We're going to talk about some things to help sleep today.

We'll get there. Uh, are you waking? What time are you waking? If you meet me with a Chinese medicine practitioner, they want to know what time you're waking. 2 to 4 a. m. is most common, uh, that I hear among perimenopause women. And, you know, Honestly, it's not just about hormones, but that's usually a time where it's like we need liver support.

Do you have trouble falling asleep, staying asleep, and having hot flashes when you drink wine or any form of alcohol? Uh, yeah. Welcome to your [00:42:00] 40s. Uh, but that's important to know. It's good data to track. It's wah wah sometimes when you're like, I just wanted to have a glass of champagne, and it wrecks your sleep.

And that's no fun. Uh, I do, I want to honor that, you know? Alcohol in no form is good for us, but also it might be a celebratory thing for you. And, you know. Sometimes we do things that are not great for our health, but they are great for our soul. And I'm not here to judge you about those things, but we wanna track that, like what is going on, what makes things worse?

So you can talk to your provider about that. So we talked about the sleep. Are you having the itching, ears ringing in your ears? Burning tongue syndrome, uh, you know, are you experiencing anything? Anything that you're like, I haven't had that before. Make note of it. These can all be signs of perimenopause and.

Again, there's lots of things that we can do to help that. Okay, so we talked about what was happening in perimenopause. We're running out of eggs and because we're no longer able to ovulate as frequently, [00:43:00] we don't make progesterone. Even when we can ovulate, maybe that corpus luteum doesn't do the best job.

Um, and that comes down to progesterone. Okay, so I do want to talk specifically In these phases, what can we be doing? So in very early perimenopause, we can still support progesterone production. And sometimes we can be very successful in that. So we can still help our ovaries make enough progesterone that we don't necessarily need progesterone replacement therapy at that point.

And how can we do that? Um, certainly through diet, lifestyle, supplementation, uh, I'm, you know, I'm going to be honest with you that I do not believe that you can out supplement a poor diet and lifestyle. But also at this phase of life, we need supplements. And this is pretty well understood that like, you know, things like calcium, like we're going to need more of that.

Calcium can also help with PMS, but it's also going to help with your bone health. So [00:44:00] there are going to be supplements, but. It doesn't mean like everything's going to work for you, right? You have to evaluate what is true for you. I will always invite you to do that, to sit through the lens of your eyes and ears, and listen to, and take in this information of what might be helpful, and then be your own little scientist, your own little N of one, because that's the data that matters most to you, is what actually helps you, what is true for you.

I'm gonna probably talk about stress reduction and sleep in every single episode that you uh, ever hear from me. I just want to admit that now, and it might feel redundant, but these are really foundational things that we have to do for our hormones. So, you know, I actually, I'm going to say this, at DrBrain.

com I've got several articles about stress and about sleep and about things that you can do for that, because I really want to get into like specifically what's going to help progesterone, what's going to help estrogen, but what I do want to say is that the brain has a mechanism that if you are under high stress, it will choose survival.

over [00:45:00] procreation. And what does that look like? That looks like dampening progesterone. Choosing cortisol production over progesterone production. And as you do that, that's when we can start to get worsening of those PMS symptoms, of those low progesterone symptoms we discussed. So we have to, we have to address the stress.

Not all stress can we control, but we can control how we process, how we deal with stress. So maybe you want to journal. Maybe you do want to join yoga. Maybe you are someone who can meditate. Maybe you're someone who needs to go for walks. Maybe you're someone who needs to definitely do yoga. ditch that person in your life and not let them have access to you anymore.

Really evaluate your stress and know that, like, stress, when you can really tackle that and really start to address that, that's going to be one of the biggest things that can shift your hormones for the better. Not just your hormones, but your cardiovascular health, like all of your health. Okay, that's what I'm going to say about stress.

It is important. So what else can help? This is where we want to come in. We want to support progesterone production because that's going to stimulate GABA in your brain. Keep you chill. [00:46:00] Keep you happy. Keep you calm. Keep you sleeping. What can help, okay, for, for affecting progesterone? Vitamin C. Vitamin C is something that we want to include in our diet.

It can look like things like strawberries, bell peppers, certainly all the citrus fruit. Maybe you're adding a little lemon to your tea every day, like different ways that you can start to incorporate these foods that have vitamin C can help support progesterone production. But odds are you're going to have to supplement as well.

So how much? With vitamin C, maybe looking at needing to come bring in a couple hundred milligrams, but most people are going to do better with like 500 to a thousand milligrams. I do want to say that there are protocols sometimes that people use a high dose, like 4, 000 milligrams. Do that in divided doses.

So a thousand milligrams four times a day is a lot better than 4, 000 milligrams all at once. That can cause diarrhea. We don't want that. We [00:47:00] also know that Vitex, which is an herb that has been used in many, many women's medicine practices, like very, like, you know, not just, uh, I want to say it's like not just naturopathic and functional medicine and all that, but like Vitex has been used in many cultures historically to support.

ovarian function, how the brain talks to the ovaries, and how that helps with progesterone production. Vitex is going to work a lot better in the early stages of perimenopause than it is when you're counting down to menopause. And the reason for that is because it's helping the ovaries function. I have no magical wand that I can wave when we get into the very late perimenopause days of like, counting down, like, we're, we're coming, you know, in the homestretch to menopause, there's nothing I can do to get your ovaries to work again, and oh my gosh, I wish I could.

I might be able to in the future, as the clinical trials around rampant myosin and some of these other things [00:48:00] that are, you know, being studied, But as of right now, there's nothing I can do. And there's nothing that you can do to make your ovaries work again. But in these early stages of perimenopause, we certainly can.

We can support their function and help optimize their function. With Vitex, we're looking at about 200 milligrams. I also like to look at selenium. Selenium in the diet or supplementation, we want to be hitting around 200 milligrams total. So if you're somebody who's mowing down Brazil nuts, which is a great source of selenium, you may not need to supplement.

But, uh, selenium can help with ovarian function and with thyroid function. It's a very important mineral. Uh, it also, I mean, it helps, there's, I could go, I could do a whole episode on selenium, but let me just say this. We want to be looking at selenium in our diet first and supplements second. So, because you might only need like 20 milligrams, 50 milligrams of selenium in a supplement because you're eating fish like [00:49:00] most days of the week.

Great source of selenium or you are eating those Brazil nuts. Know that. We don't know how much is actually in your Brazil nuts because it depends on the soil quality in which they were grown. And we don't have that information, that data. So, um, sometimes people are like, um, just eat three Brazil nuts a day and that's all the selenium you need, maybe, but we don't actually know for certain.

And, uh, well selenium's good. Well many of these things are good. More doesn't mean that it's better. So Vitex, selenium, vitamin C, vitamin B six, vitamin B six. is really helpful for estrogen metabolism and for progesterone. And so it can be really helpful for some people when it comes to those PMS symptoms.

With vitamin B6, we want to look for 25 to 50 milligrams and taking that in on a daily basis. And that may even be in addition to what you're already eating. Now [00:50:00] with vitamin B6, it's water soluble. You pee it out if there's too much of it. However, Some people who have done levels of like 200 milligrams a day for a very long period of time, sometimes, you know, it takes as much as a year, can have paresthesia.

So they get numbness and tingling in their fingers and toes. As soon as you stop, it works its way out of the system. That goes away. It's reversible. But I just want you to be mindful of it because I've never seen it clinically, but there's always that one person on the internet that's like, I did 10 milligrams of B6 and I had this and it's, and you know, they're like, so like no one should supplement with B6.

That's what's true for them. I don't know what their diet was like. I don't know if they checked all the supplements in their cupboard and really had only 10 milligrams or if there was more going on. So, uh, but I just bring it up because I like you to be aware of like what to look out for, just in case.

Now, the other component of this very early perimenopause is supporting estrogen metabolism. So, I told you vitamin V6 can [00:51:00] help. Calcium D glucarate can help especially in the gut. So those little gut bacteria, they make something called beta glucuronidase that could reactivate your estrogen, put it back into circulation, and that calcium D glucarate can help dampen that and can help the body get the estrogen out that it no longer needs.

Now before it ever gets to your gut, it's got to go through the liver. And we know a couple things can help in the liver, DIM and sulforaphane. Now with DIM, more is definitely not better than when you're in perimenopause. And so if you're in early perimenopause, you might do well with 50 to 100 milligrams.

As you get into that late perimenopause, you might have to drop back to 50 milligrams, maybe 25. maybe take it out altogether. And that's because DIM is going to push phase one estrogen metabolism and we never want to drop estrogen too low in, in this. And so I bring this up because, um, on certain websites, uh, [00:52:00] that a lot of people buy things from, uh, they will have like DIM 600 milligrams.

That's way too much DIM. That is way too much. You're going to end up with headaches. You're going to end up with low estrogen symptoms. You're going to feel awful. So way too much. Do not go that route with DIM. That 50 to 100 milligrams is usually a sweet spot, but you want to couple that with sulforaphane and other phase two, that is in the liver, other phase two molecules to help with that metabolism so that we don't feel worse.

Now places where you can get this cruciferous vegetable, so whether or not you take these as a supplement. I recommend you eat cruciferous vegetables and broccoli sprouts. Broccoli sprouts, a couple of tablespoons rivals like two pounds of like broccoli in terms of its protection, helping with that estrogen, but also helping with its protection.

And there's been research on cancer. Uh, and how well we can protect ourselves from cancer with eating in this way. Does this mean [00:53:00] all you need to do is eat broccoli sprouts and you'll never get cancer? No. Cancer is multifactorial and there's lots of things going on, but I'm like every little step you can take towards health, that's a win.

And this is one of those easy wins to be including. So you can be supplementing with these things or you can be eating them in your diet. Why do we want to support that estrogen metabolism? Because progesterone is dipping low. And so in that luteal phase, that's where we're going to have like estrogen and progesterone challenging each other.

I want to switch gears a little bit and talk about things that specifically will support estrogen and then we'll come back to the phases of, of perimenopause. So we, we already covered the very early, but when it comes to estrogen, again, we're going to rely on the ovaries for this. Once you enter into menopause, your adrenal glands are going to produce DHEA.

DHEA will get converted into testosterone and estrogen. And this is [00:54:00] why the stress reduction piece, I was like, I have to talk about this, uh, because we have to take care of those adrenal glands. They're going to be what we lean on once the ovaries, which are designed to give out, do in fact give out. When estrogen dips, so does dopamine and serotonin.

There goes our motivation, there goes our happiness, there goes a lot of our mood. And so why is this so important? Well, women who are in perimenopause have the highest diagnosis rate of anxiety and depression when we look at cohorts. And with that, they're getting prescribed. Mood altering medications, which may be necessary, but they're getting that instead of a thorough evaluation and looking at do they need estrogen.

Now I want you to make your own estrogen for as long as possible, so let's talk about how to support that, but estrogen often gets vilified. It's a very, very important hormone. It is not a villain. Feels like a villain when it's out of balance with progesterone, but it is not a villain. In [00:55:00] addition to supporting our mood, estrogen also supports our collagen.

So I talked about the skin, but also the collagen in your joints. It supports your joints. It supports your muscles. It's so important. And whenever we talk about building muscle, which is so important, It's very, very important for your perimenopause and menopause journey. So often people think about testosterone.

It's the same with our libido. However, estrogen is crucial for your libido and for your, your overall gym goals. I could just say that as a, as a broad stroke, but for building muscle and for maintaining your bone health. And when it comes to fitness. I actually, I want to read this, this little excerpt from this study that came out to you because I think it's, it's just so important.

So there's a recent study that's titled the musculoskeletal syndrome of menopause. And thank you, Dr. Vonda Wright and her colleagues for putting this out because it's super, super important. But I want you to understand just how important your estrogen is [00:56:00] when it comes to your musculoskeletal health.

More than 70%. This is pertaining to those going through menopause, will experience musculoskeletal symptoms. Okay, 70%. You're going to have bone, muscle, joint issues, and 25 percent will be disabled, 25%, will be disabled by them through the transition from perimenopause to postmenopause. So those years of having those symptoms and then going into that postmenopausal time, 25 percent will be debilitated, but we can intervene.

We can do things to help with that. So in addition to estrogen helping with recruiting stem cells, helping our muscle mass, helping our libido as we talked about, it's also anti inflammatory. And that is why we see more autoimmune disease rises as people make the perimenopause to menopause transition and ultimately enter postmenopause.

This is why we see [00:57:00] More joint pain, more achiness, just overall feeling icky. This can be because of estrogen. So what can we be doing? Number one is omega 3 fatty acids. Getting on a combination of EPA, which is anti inflammatory, and DHA, which is going to protect your brain, of 1, 000 to 2, 000 milligrams and taking that every single day.

That is in addition to eating fatty fish, mackerel, sardines. Salmon, you might be like, ick, friend, trust. They are not only going to have your omega 3 fatty acids, but they're very nutrient dense as well. So this is not only anti inflammatory, but it can be neuroprotective as well. When you're looking for an omega 3 fatty acid, I cannot emphasize this enough.

You want quality. You do not want, I got a thousand capsules for like ten dollars. They're not required to actually test these. The [00:58:00] FDA doesn't require supplements to have what they put on the label actually in the supplement. And with these fish oils, they can be cut with other things. They can also have contaminants.

So we want to look for Third party tested. We want high quality fish oil from a company that you trust and that they are actually filtering it. They're treating it. They're processing it in a way that removes PCBs and other things that we don't want in there. Okay. This is something that I am very, very passionate about.

It's, you know, I am the founder of Dr. Brighten Essentials. We third party test, we do all of this because I take these things, children, my husband, my friends, my customers, my people take these from us and they trust us and I, as somebody who's been in the nutrition industry for two decades, I do not mess around.

So omega 3 fatty acids, great as long as they are quality and these can really, really benefit you for the long run. They are, once you get into perimenopause, these are a daily practice. When it comes to eating. I talked about how important [00:59:00] diet is. We want to be more in line with the Mediterranean diet.

We want to be looking at getting quality protein. at every single meal, at least 30 grams every day and more fiber coming in. Women need to be getting at least 25 grams of fiber in the United States. It's like on average like 12. We need fiber. It not only is going to support the microbiome, which by the way, when estrogen dips, so does your microbial diversity in your gut.

And we know microbial diversity is associated with so many positive health outcomes, but also We see a link between fiber consumption and belly fat accumulation. Now once you get into that phase where estrogen drops and then postmenopause when estrogen is essentially gone, belly fat begins to accumulate.

This is visceral adiposity. So when we say belly fat, we're talking about the fat that packs around your organs that makes you metabolically unstable. It is a risk [01:00:00] factor for type 2 diabetes, for poor cardiovascular outcomes. So cardiovascular disease, we want to avoid this. Fiber is one way that we can avoid this.

25 grams of fiber every day. Keep your added sugar to less than 25 grams every day. Now, I say this so many times and maybe it's like played out, but like I've spent, I've lived in Paris for a period of time and there's one thing that I ever took away from the French that I do think they do better than anywhere else that I have been and that is pleasure.

They are like pleasure, you need pleasure in your life. So I'm not saying don't ever eat cake, but what I am saying is check the labels. Because if you're eating yogurt and you're like, this yogurt is a great source of protein, but it has 16 grams of sugar, now we can't have the cake. That's lame. We wasted it on that yogurt.

So check the labels, less than 25 grams of added sugar, 25 grams of fiber. Some people do better with more, but more sometimes drops our estrogen too much. And we want to get that 30 grams of protein by the very bottom [01:01:00] limit. We want to hit that 25, but we want to have more protein coming in and you need more protein as you age because you lose muscle mass.

This is what when I was working my master's, uh, nutrition, I was studying sarcopenic obesity 20 years ago, so long ago. Guess what? The science still holds true. We lose muscle as we age and we need more protein and we need more resistance training for that. So these are things that can help with your estrogen, but they're also going to help with your health overall.

What else can help? Turmeric can help with belly fat and it can help with inflammation. And I love turmeric. I, you know, it's something that in Ayurveda, they have used ever. I always love when it's like something is like old school wisdom of a medicine that's been around forever. You know, because like, you know, to be real in the United States, our, our medicines like a baby and like Ayurveda and Chinese medicine, they're like grandfathers, grandmothers, uh, I like grandmother, but I won't go with [01:02:00] that.

Uh, so they're just like, they've, they've been around for a while. And turmeric is something that is so easy to incorporate in your diet. And you may even want to consider a supplement. And there was an interesting randomized control trial, I want to read this to you. In one randomized control trial, curcumin, that's the active constituent of turmeric, curcumin of 500 milligrams, significantly reduced hot flashes in four weeks.

Say what? Now, unlikely, the severe hot flashes that I mentioned, is turmeric going to be enough? So if you're like, Dr. Brighton, I am drinking the turmeric, I'm eating the turmeric, I'm doing all the turmeric, and it's not helping, you, it is helping, but not to the degree that you need. Okay? So you have not done anything wrong.

It's not you. You just may need more support. Okay. So in this study, they also looked at vitamin E of 200 IUs a day. Vitamin E, why bring that up is because that can help support estrogen production in the ovaries as well. So [01:03:00] they looked at. Vitamin E 200, I used a day and found that after 8 weeks, there was a significant reduction in hot flashes.

So, turmeric will get you there sooner, vitamin E can help as well, but remember, once we get to where the ovaries stop making estrogen, the vitamin E might not be enough, and that doesn't mean you did anything wrong or that you're broken, you just might need a little more intervention. Now, a few other supplements I want to recommend, creatine.

Three to five grams a day is what we're looking at. Some people do a loading dose. If you're going to do something like that, you're going to talk to a doctor first, okay? But why I love this supplement, it not only helps with the energy production, so you work, you're not like you, you drink it and you have it and then your next workout, you're like, I have more energy.

I'm going harder. Like what's going on? It makes you more successful in the gym, but it's also great for your brain health. If you have ADHD or autism, creatine's your friend. I love it. Uh, so it also has cognitive benefits as well. When it comes to exercise, now I've talked a lot about exercise. You have to be strength [01:04:00] training, some kind of resistance training.

So starting with body weight, fantastic. Adding a weighted vest. I was actually sharing with somebody that https: otter. ai I always have like looked to the women who have walked the road before me and if they're like, they're doing something and they're like, this is helping me, I'm like, then maybe I should do this.

So I used to teach a group fitness class, um, a senior citizen group fitness class, that's what it's called. And, uh, so many women were like, started coming in and weighted vests. And I was like in my late 20s and I was like, tell me more about this. And they're like, my doctor says it'll help like keep my bone mass.

And they were all being recommended this only after osteopenia was found. And I was like, oh my gosh, like if this can, if this can make it so I never have osteopenia, then that's, I'm going to do that. Sign me up. So weighted vests walking around your house while you're, I don't care if you're 35, like put it on.

Walk around your house while you're picking up like maybe you're picking up kids toys picking up laundry Like you can just wear it even if you wear it for like 20 minutes It's [01:05:00] going to help but we want to have resistance training as well. And so Definitely lifting weights and we want to be working on at least 150 minutes a week It doesn't have to happen all at once But we do want three days of strength training and meeting with a personal trainer can help you feel more confident If you're having, if you've had an injury, you are like, oh, I just don't feel confident all the, uh, physical therapist can help with making sure you're recruiting the right muscles, that you're balancing things, and that you are most successful.

Lifting weights is one of the most important things that you can be doing to optimize your health at any stage of life, but certainly in perimenopause and menopause. So we've got to have the protein coming in, the creatine can help, but we've got to be strength training. And I would say going for walks regularly is also fantastic because it helps with your stress.

The cross body action of your arms and legs, that's going to help dissipate your stress levels and you can get yourself to a heart rate where you are in [01:06:00] that fat burning zone. We want to have moments where we are. challenging our cardiovascular system and our lung capacity, so that's got to be worked in as well.

We also need to be working on our flexibility. All of this is so important and it can feel so overwhelming, but if nothing else, if you're like, where do I start? I would start stretching and strength training. And you can stretch before, strength train, stretch after. You've already mastered flexibility and strength training.

Now I mentioned calcium before. With calcium we may be looking at just bringing more calcium into our diet. Vegetables are actually a great source of calcium, better than dairy in some instances. Like Chinese cabbage has a lot of bioavailable calcium in it. But we also need to have vitamin D3 and K2. Get out in the sun.

Please get out in the sun. Expose yourself to the sun when we don't have a high UV index. However, most of us are supplementing with vitamin D3, K2, because we don't get out in the sun enough where we live in a place where like there isn't enough sun to get out into. [01:07:00] If you are supplementing with vitamin D3, you do want to have K2 with that as well.

And that is so that it keeps the calcium in the bones and not In your arteries, not in your blood vessels. That's a very good thing. So I've talked about some other supplements, I've talked about, you know, just things holistically that you should be doing for your health, and I want to come back to those stages of perimenopause and really guide you.

Okay. Early perimenopause. This is that two punch combo of progesterone not rising enough and estrogen playing, being like the Loki of your body, playing tricks on you, uh, and really challenging, uh, your system because it's left to stimulate those tissues. So one cycle you have breast pain, next cycle you have hot flashes, maybe one cycle you wake up drenched in sweat, three cycles go by, then it happens again.

This is the roller coaster ride of estrogen. We still want to support progesterone best we can, lifestyle and supplements, but now we [01:08:00] want to start considering progesterone hormone replacement therapy. That may look like a hundred milligrams to 200 milligrams of an oral micronized progesterone in the evening.

You can get that compounded as a bioidentical, but also prometrium is a bioidentical progesterone and some insurance plans cover this in the United States so that it's quite affordable. You take that every night or your doctor might say since you are still having a period, we're gonna take it for a certain time during your cycle, they can really guide you on that.

That should help you feel, you have an easier time falling asleep, staying asleep, feeling less anxious. There are people and I this is why I need to do a full episode on HRT if you want a full episode of HRT Please let me know leave me a comment So I know this is something you're interested in because I'm like, I think this is a good idea But maybe you're like maybe you don't I don't know you're gonna have to let me know so with progesterone [01:09:00] that You know, taking that oral progesterone, that works for a lot of people, but some people don't tolerate progesterone well, and so you may have a paradoxical effect to it.

And so we do need to talk in more detail about when progesterone doesn't work. Okay, now we go into the late perimenopause, but I want to talk about oral contraceptive pills because at this point, as we enter into the late perimenopause, you might be offered the pill. You may have been already offered it before.

When progesterone starts to be problematic, your doctor might recommend the pill. So is the pill the best treatment for perimenopause? No, it's not. However, there are roughly three times that we would consider using the pill in perimenopause. But I want you to understand when it comes to bioidentical hormone replacement therapy, what we use for menopause is [01:10:00] such a fraction of what the pill is designed for.

The pill It's so many hormones, it comes in, it floods your system, it stops the brain, FSHLH, you're out from talking to the ovaries, okay? Now, if you cannot, will not, do not want to get pregnant, that can't happen, and you absolutely are like, the pill is what's right for me in this, then we would use the pill for contraceptive purposes, not for perimenopause symptom management.

We can do it so much better using progesterone, estrogen, and maybe even testosterone. Now, and as I say testosterone, that's a big reason why I'm like, the pill is like one of the worst things you can do to a woman in perimenopause. You take somebody who has no libido, who's lacking motivation, that you're telling them to build muscle mass, and you put them on a medication that stops their ovaries from making testosterone and then raises.

sex hormone binding globulin, a protein that grabs onto their testosterone. And now you just made that, all of that so difficult, okay? And that is, um, libido is one of the, [01:11:00] one of the top complaints up there that I hear from patients. Like, there's several, right? It's not just libido, but a lot of women struggle with libido and perimenopause, so the pill is absolutely the worst thing you can do.

For somebody who is struggling with that. Okay, if you want to prevent pregnancy because ovulation is becoming irregular and you're like, absolutely not, maybe then we choose using the pill. If you have PMDD, which is like a severe, severe, severe, I can't emphasize it enough, form of PMS, and you're neurodivergent, And so, uh, if you have PMDD on its own, just so you know, it's very very common among those with neurodivergent.

So if you're PMDD, we may use it. If you're PMDD and neurodivergent, we may use the pill. And it's because we do need to actually shut down the ovaries and keep a steady state of hormones because those fluctuations can lead somebody, um, to being, having such adverse mood changes that they feel suicidal. I just want to be really clear that you, if you ever have any symptoms of suicide, you should [01:12:00] absolutely contact your provider or your suicide hotline, uh, and that you should not just grit your teeth and bear it and try to go naturally in, in trying to correct things.

You should get support for that. So that's another instance that we might use the pill. We, and that's not to say that if you have PMDD or you're neurodivergent, you are still a candidate for using hormone replacement therapy, the, you know, the kind that we use for some menopause hormone therapy, you're still a candidate, but I just want you to know that maybe the pill is the best option for a short term period of time for you during this transitional period, and there's no shame in using that.

Now the other time that we may consider using the pill is when we have severe uterine bleeding. Okay, so you're, you know, we just took you from one stage where it's like, oh, the cycles are like seven days plus or minus coming, and now we're going into the next phase of the late perimenopause transition, and now they might be 60 days, and now we might have severe bleeding where you end up bleeding for like [01:13:00] two weeks.

We need to work up why, okay? We can't just put you on the pill. Don't let someone just put you on the pill. We have to work up why. Disordered uterine bleeding is endometrial cancer until proven otherwise. This is a saying in medicine for a reason. That's how serious it is to work it up. Don't ignore it.

I'm not trying to scare you, but don't ignore it. We want to work it up. And then we might use the pill because you can't bleed for that long without becoming anemic. You cannot have a life like that. So you may be put on the pill for a period of time to shut everything down, working it up, and then maybe coming off and then considering, do we go a different route with things?

So, if your doctor offers you the pill for any of those reasons in, you know, the, the late perimenopause transition, maybe a little bit before, hey, you know, it's worth considering. If it's just for symptom management, nah, we can do so much better than that. Okay, so now we're in that late perimenopause transition, what can we be doing?

And if you're already here and you're thinking, [01:14:00] great, I'm too late. You're not. There's still so much that you can be doing. So at this point, the low estrogen symptoms are going to start. We may consider estrogen hormone replacement therapy. You may or may not be a candidate. You may or may not want to use it, but it should be a conversation that you have with your provider to get all the information that you need to make the best decision for yourself.

Uh, you, I just want you to know if you're having urinary symptoms, you're having vaginal dryness, anything like that, just about everybody is a candidate for topical estrogen applied to the vagina. No, it's not going to go systemic. We don't worry about much with that. So I just want you to understand that is an option for a lot of people, but you may also need to take, you know, to start a patch or start a cream when it comes to estrogen at this phase.

It depends on your symptoms. Thanks. We don't have to wait for full menopause to start you on estrogen therapy and start supporting you. What we don't want to do is we don't, estrogen is preventative, okay? Estrogen is preventative, it is not a treatment. [01:15:00] So we don't want to get to the place where we've, we've passed where estrogen can help and then start estrogen.

We're not going to go back. So we just want to prevent it all along if we can. Now, if you haven't started your fish oil yet, this is a good time to start fish oil, and this is a good time to start collagen. Getting like 20 grams of collagen in a day. I drink collagen every day now. I just put it in my coffee, I put it into beverages, but starting to bring in collagen that can support your bones and support your skin health and support your joints.

This is the phase where, if you haven't done it yet, let's get that in. I talked about the 25 grams of fiber, non negotiable at this point. If estrogen's going down, we've got to protect ourself against that visceral adiposity. Get the fiber in check. Get the sugar in check. No more added sugar. At this point, if you haven't jumped on the magnesium bandwagon, now is the time.

150 to 300 milligrams is typically what I'm using. It helps with sleep. It helps with anxiety. It helps with like 300 mechanisms in the body. It is super, super amazing. I'm not [01:16:00] saying that It is a treatment for any kind of medical condition. It is an ally. It is supporting what you're doing in your lifestyle.

So getting that magnesium up. Interestingly, there was actually a study that showed that people who had 550 milligrams of magnesium Coming from not just a supplement, but their diet as well, they had brains that appeared younger than their cohorts. So there's a lot going on with magnesium. We need more data on this, but it's super, super promising.

Okay, the countdown has begun. We are in late perimenopause. We are in that 12 month stretch into menopause. This is definitely the time where HRT should be considered. Again, I'm not going to force anyone into HRT, but they should be looking at their symptoms and considering. So at this point, this is definitely when we would bring in vaginal estrogen.

That is to support the pelvic floor, to support the urinary tract system, to prevent vaginal repeat UTIs to prevent [01:17:00] vaginal dryness, to prevent vaginitis, which is painful inflammation of the vagina. We want to prevent vaginal atrophy, tightening, shrinking pain of the vulva vagina. We want to prevent all of that.

Now is the time that no longer can we come in and can we just use Vitex or vitamin C or B6 to support the ovaries. They're, they're on their way out. So now we need to be looking at what can we do to support our bone health, our cardiovascular health, and our mental health. All of it is very, very important.

If at this point your doctor hasn't looked at your insulin, hasn't looked at your hemoglobin A1c, this needs to be done. Because we need to know where you're at right now and if you are at risk of heading into type 2 diabetes or if you are at risk of insulin resistance beginning. And so, just to be clear on that, insulin resistance happens, the cells become resistant, now we head into type 2 diabetes.

So they go hand in hand, but we look at fasting insulin and [01:18:00] we look at hemoglobin A1C, which is what your blood sugar has looked like over the last three months, to really understand what your risk factors are. C reactive protein, a marker of inflammation, that should be checked. Homocysteine, we should start looking at the cholesterol panels and using that to also guide us on HRT.

Once you go into menopause, triglycerides go up, uh, fasting insulin can go up. All of the cardiometabolic markers that we look at for, are we at risk for chronic disease or cardiovascular event. They start to shift to be less favorable. So we want to look at those as I think it also helps lend to the conversation of you deciding whether or not you want to use estrogen hormone replacement therapy.

Now, if you are somebody who is already in that menopause transition, you're like, I'm post menopause by, you know, several years. Is it too late? It's not. You have to talk to your provider about where you're at, though. So, some [01:19:00] people are still following the guidelines that you don't start hormone replacement therapy five years post menopause.

Some people are taking a more individualized approach to the patient. That's what I favor of looking at all of their parameters, looking at their family history, making sure they have all of their screening and that they've really been evaluated to help guide them. I, of course, can't guide you on a podcast.

What I've done here is I provided you the information that you need to make the best decision for yourself to help you really navigate the conversation with your provider to track those symptoms so that you can advocate for yourself. But in order for you to really take that next step in terms of if you're going to go the route of hormone replacement therapy or not.

You have to talk with a provider. I recommend using the Menopause Society. They have a network of providers. You can look there. Um, the other place is the American Association of Naturopathic Physicians. Uh, I was, um, [01:20:00] I was actually shocked to learn that, um, gynecologists weren't trained in menopause. They got very little because I spent years.

Um, and, and I've been prescribing hormone replacement therapy for over a decade. So we are definitely trained differently. And then the other place to look is A4M, which is the Academy for, um, anti aging. Not a great name necessarily if you're like not part of the anti aging crew, but it is something that they do have lots of trainings for providers to know how to prescribe hormone replacement therapy and so they're very well versed on it.

All of these places use the latest science to to train their providers and to make sure that they are up to date on the latest information coming out so that they're not using things. We didn't even talk about the Women's Health Initiative, but anybody who's referencing that, they're not a provider who actually has expertise in this arena.

So with all of that, if this episode was [01:21:00] helpful for you, please share it with someone else that can help. Please remember to like, comment, subscribe. do all the things, uh, if this was helpful at all because that little bit of effort on your part is a great, great amount of help for me in getting this information out to the people who need it.

 

As always, it is a pleasure and an honor to be talking with you, to share this information with you, and to support you on your journey. I'll see you next time. I hope you enjoyed this episode. If this is the kind of content you're into, then I highly recommend checking out this.