Struggling with Sleep & Anxiety? Are Low Progesterone Symptoms to Blame | Dr. Carrie Jones

Dr. Jones: [00:00:00] and estrogen and progesterone affect all 12. one of which goes up to the brain and helps to activate, stimulate GABA. Think of it like your brake system. As humans age, their GABA production goes down. Women in particular, essentially, get screwed. 

Dr. Brighten: I don't want everyone to think like, Oh, there's something wrong with me.

But I do want to talk about like, What are the ways that this shows up? That people are maybe seeing that they've got this low GABA issue. 

Narrator 2: Isn't just an expert in women's health, she's a global phenomenon known as the Queen of Hormones. With over 20 years of groundbreaking experience, 

Narrator: she's a board certified naturopathic endocrinologist, advisor to menopause, and a driving force in redefining hormone care.

Narrator 2: As the co host of the wildly popular Root Cause Medicine podcast, boasting over 10 [00:01:00] million downloads and chief medical officer at New Ethics Formulations, 

Narrator: Dr. Jones is on a mission to empower women worldwide to take control of their health and hormones like never before. 

Dr. Jones: So we get this nice bonus of GABA every month in our cycle in the luteal phase.

Well, guess what? Guess who's not making as much progesterone as they used to consistently. It's those women. 

Dr. Brighten: So with GABA, like, what can you do about it? If your GABA is low, your GABA is tanking the research studies, like you're old, but what can we actually do about it? 

Dr. Jones: The good thing is. 

Dr. Brighten: 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.

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Don't forget to subscribe, leave a comment, or share this with a friend because it helps this podcast get out to everyone who needs it. Alright, let's dive in. Dr. Keri Jones, you ready to talk some hormones? I am always ready to talk hormones. Always and forever. Yes. We are going to talk about a very special chemical today known as GABA.

Dr. Jones: We are, and it doesn't get talked about a lot, which is [00:03:00] why when we were talking about doing this podcast, you're like, what would you like to talk about? I'm like, GABA. GABA is our inhibitory neurotransmitter in our brain. Think of it like your brake system. And I find that a lot of women don't have as much as they used to.

And in fact, I read a paper very recently that said, as humans age, their GABA production goes down. And 

Dr. Brighten: in 

Dr. Jones: it, the authors actually said, Women, in particular, essentially get screwed because they don't have the GABA because of their progesterone. 

Dr. Brighten: And so 

Dr. Jones: for everyone who's listening and is thinking, well, what does that mean?

Think of break for anxiety. Think of break for the break on your mouth filter. Think of break, think of break of like your brain going a million miles an hour. Like we need GABA to stop, to slow, to calm, and it's a balance with other neurotransmitters. so much. But when we just lose that break system, we feel 

Dr. Brighten: it.

Mm hmm. So when typically do people notice the decline of GABA? 

Dr. Jones: In 

Dr. Brighten: women 

Dr. Jones: in [00:04:00] particular, we definitely start to see that go down probably around their early 40s. Mm hmm. Most consistently. Now, when women make progesterone, when they ovulate, of course, they make progesterone and then progesterone can turn into other hormones, one of which goes up to the brain and helps to activate, stimulate GABA.

So we get this nice bonus of GABA. Every month in our cycle in the luteal phase. Well, guess what? Guess who's not making as much progesterone as they used to. Consistently. It's those women probably starting in their early forties. Definitely by their mid to late forties and into their fifties, assuming they still have their ovaries.

That, that, you get the loss of benefit from the progesterone, but one of those losses is the loss of GABA. 

Dr. Brighten: How does that show up? So we've got the anxiety piece, we've got the loss of the mouth filter, which I just laugh perimenopausal women can relate to it. It's, you know, it's, um, I do want to say there's these things seen as like kind of like dysfunction in [00:05:00] perimenopause that actually in my 20s and 30s, I always respected like when I had patients who were in perimenopause and they're like, I just don't care anymore.

I say what I think. And I'm like, I aspire, I aspire. Um, so I don't want everyone to think like, Oh, there's something wrong with me. But I do want to talk about like, what are the ways that this shows up that people are maybe seeing that they've got this low GABA issue 

Dr. Jones: and even going. Sticking with that same theme.

I'm like, I'm going to say what I want and I don't care. I'm, I'm with you. I'm like power girl. Like, absolutely. Don't you probably have been a people pleaser. You've probably been stressed out. You probably have 6, 000 things on your to do list. You're carrying the load and now you're coming into your own.

You're becoming this whole new person. It's a whole new transition, right? Say what you think. But we all know sometimes we say things that we shouldn't have. Sometimes we go a little too far, that pendulum swings a little too much, and we're like, I wish I had filtered that. Yeah. I wish I [00:06:00] had, you know, like, thought about that before I actually said it.

And so a big suspicion of mine is the lack of GABA, the lack of the brake system going, hey, like, let's not do that. Mm hmm. That is why we sort of just say whatever we feel and say whatever we think and, and don't really care. Yeah. But we also think about things like anxiety, as I mentioned, but we can also see it in impatience, anger, irritability.

So we think of GABA more as our anti anxiety, a big one for anti anxiety, but I also see anxiety show up for women as anger. I see it show up, like, quick triggered, quick to be irritable, quick to point out the negative. I can see that and I'm like, ooh, I bet that is GABA. Now on top of that, think sleep.

GABA is calming. So how many women going through their 40s and 50s in this whole transition start to say, I can't sleep anymore. I wake up at 3am, I can't fall asleep, I can't stay asleep, I'm irritable, I'm impatient, my anxiety's through the roof. There's a [00:07:00] Big orchestration of hormones here. But the more I dive into that neurotransmitter GABA, I'm like up.

That's a big key factor. So with GABA, what role is it playing specifically with sleep? Calming. Mm hmm. It's a big one for calming. And there is some research to show that GABA plays a role in both REM and deep sleep. Okay. And so when, for those people who maybe are wearing sleeping masks, something a wearable, a watch or a ring, or they have something where they're tracking their REM, tracking their deep sleep.

When we can see women who don't have a lot of progesterone as they get into their luteal phase, but maybe they don't ovulate, their sleep tends to be worse. The REM goes down, their deep sleep goes down. They don't wake as refreshed. They're waking at 3am. Yeah. If we can get that GABA support back, they tend to report, Oh my gosh, thankfully I can sleep through the night again.

I'm doing so much better. Where are my, my wearables are showing that. This is working. 

Dr. Brighten: Do you typically test for GABA and you know the the metabolites or are you going more off the symptoms going 

Dr. Jones: more off the symptoms? And because I [00:08:00] will often test somebody's progesterone, it depends on the person and it depends where they are.

Let's say in their perimenopausal journal journey, but we know women in their early forties or maybe in the early stages of their journey still usually have regular cycles. So if I check their progesterone and it's really pretty low. And they're reporting a lot of these symptoms. I'm like, I know this is impacting GABA.

I know this is a problem. 

Dr. Brighten: Yeah. There's a very specific time in your cycle. You need to test progesterone. I want to talk about that because I will see people who are like, Oh, my doctor tested my progesterone and it was like nothing. And I'm like, when did they test it? They're like, Oh, I don't know. It was like a couple of days after my period.

I'm like, 

Dr. Jones: Yeah, on Tuesday at 2, when I had a chance to go to the lab, I'm like, I know, it's 

Dr. Brighten: such a waste of their money. In the U. S., like, labs are not cheap if your insurance isn't covering this. It can be quite a pricey test. So let's talk about, like, most bang for your buck, when are you going to test progesterone?

Dr. Jones: If you have a 28 day cycle, [00:09:00] and you, we think you ovulate, ideally, you're going to test somewhere between days 19, 20, 21, maybe 22. So you have a window, it's not like you are tied to one day or one part of the morning. You've got a little window there, so 22. Keep in mind the first day of your period is day one, so that's how we count.

Count, you get your period, that's one, count forward, that's when you would get a blood draw or do some sort of test. So even if you're listening to this and your doctor says, cool, we'll test your hormones, Go to the lab today. Make sure you check your app or however you're tracking your cycle and say, actually, I'm on day 11.

I'm going to come back in a week. I'm going to wait and come back at this prime time. Now, if you're listening to this and you're like, well, my cycles are more like 24 days, then we just adjust down by about four days. Ideally, we're trying to test about five to seven days after ovulation. So I know some women are tracking their ovulation, they're doing at home tests, they're watching their temperature, maybe they're trying to get pregnant even in their [00:10:00] 40s.

And so if you know when you ovulate, then five to seven days later we test. And that applies as well if you're a late girl. So let's say you're listening and you think, well, I get my period every 35 days. I'm not 28. Yeah. No problem. Adjust up seven days. You just move your collection to Whether you're below or above 28 days.

Dr. Brighten: Mm hmm. Somebody who is irregular, so like a PCOS picture, what do you recommend there? 

Dr. Jones: If somebody is really irregular, I usually actually don't check their, uh, hormones. Yeah. Other than, I should say, let me clarify, uh, because there are over 50 hormones. I don't check their estrogen and progesterone usually.

I'll look at other hormones, testosterone, DHEAS. things like that. But in that case, then I don't and I base most off of symptoms. 

Dr. Brighten: Yeah. And that's, you know, something that we've done for a long time in terms of perimenopause, menopausal management is to look at the patient's symptoms along with, you know, giving HRT as well.

And I [00:11:00] just don't think we're at a point where the labs have that much value. And so it's the one time when a doctor will say hormones are all over the place. I'm not going to test them is in that late phase perimenopause. Like when you're getting towards menopause and you know, you're a few years out.

Yeah. Estrogens all over the place. Progesterone is going to be in the tank. We know it from your symptoms. So I just want people to understand because I think they, a lot of times people are like, no, I should get my labs when it comes to the sex hormones. They can get it. so squirrelly at that point. And so if your cycles have already become irregular, it's probably not worth it.

It's not. Yeah. 

Dr. Jones: Yeah. And the guidelines say that the guidelines say, don't test, go off of symptoms, age, et cetera. However, like I said, if you still are getting regular cycles, I, lots of women in their late thirties, forties, who say, I'm clockwork still. Could I get my hormones tested? You 

Dr. Brighten: can, 

Dr. Jones: but I have other women that go, well, I got my period every two weeks.

Then I skipped three [00:12:00] months. Then I got my period back. I'm like, okay, no, we don't need to test you. Not, not the estrogen and progesterone. 

Dr. Brighten: No, no. And we, there's certainly other things that we can be testing, you know, as we're having this conversation, I, I think I DM'd you on Instagram late, or maybe we were texting and I was like, when I learned that you were pregnant, That there were OB GYNs out there saying they were never trained.

They had like a class on menopause. They weren't trained in HRT and I was like, we were trained in perimenopause and HRT. Like we were trained in all it, like I, you and I have been doing this for well over a decade. I was just gobsmacked. I was like, what do you mean? And I had this moment where I was like, and the ones who were saying this, mad respect to them because they were very humble in talking about how like, I remember seeing one of them saying like we've called ourselves hormone experts and I've only come to realize we absolutely do not know anything about hormones because we're literally just trained to help people get pregnant deliver babies and put them on the pill and I was like Whoa, like [00:13:00] this explains so much, so much of patient interactions, so many of my interactions as 

well.

Dr. Jones: Yeah. My own OBGYN's office, there is a physician assistant there who doesn't do, to his credit, doesn't, he does other family medicine, internal primary care. And I had to go see him once my OB was not available for something not OB GYN related at all. And he said, what do you do? And I said, well, I'm a women's health and hormone doctor.

He goes, I don't touch hormones. I don't do hormones. Yeah. I said, I'm sorry, I'm sorry, what? He goes, no, I don't do hormones. I don't do hormones. How can you be a family doctor, general practice, I said, no hormones, thyroid, glucose, insulin, testosterone. He was like, no, no, I refer out for all that. 

Dr. Brighten: Yeah. Well, at least he's referring.

Dr. Jones: At least he's referring. But I thought, oh my goodness, it's such a mainstay. It's such a primary part of being human, male or female, our hormones are what, you know, drive us. They make the world go round for us. And he, he said, So no, I don't, that's not part of my wheelhouse. 

Dr. Brighten: Honestly, every [00:14:00] single provider who ever sees a female patient should know enough to screen their symptoms and make sure they get the help they need because, so as you talk about GABA, as you talk about progesterone, as we're talking about these hormones, they can show up in any other ways, right?

So there's brain function, cardiovascular health, there's bone density, there's gastrointestinal health, there's so many ways these hormonal issues can show up in different systems of the body. And sometimes you're with a doctor who's just chasing your IBS when it's actually low estrogen. 

Dr. Jones: Oh my gosh, I've read quote after quote and study after study that says humans have 12 systems of the body, and estrogen and progesterone affect all 12.

Which means at any age, at any stage of your life, estrogens higher than they should be, lower than they should be, progesterone the same, can impact these symptoms. Which, just as you gave the example, you go to your practitioner, you have IBS, especially since we're in that perimenopausal time zone that we're talking about.

Let's say you go and go, my IBS is getting worse, I don't understand. Turns out you're 48, [00:15:00] you're starting to skip cycles, that change in estrogen plays such a role in the GI tract, but they're looking like, oh, we're just going to refer you to gastroenterology. Well, gastroenterology has no idea. They'll do a colonoscopy.

They'll check you for the big stuff and they'll go, it's just IBS. I don't know. I don't know why it's getting worse. 

Dr. Brighten: Yeah. Estrogen plays such a big role. Absolutely. I love that you bring that up because there is not a time in a woman's life where getting the diagnosis of IBS with no thorough workup isn't doing you dirty.

We know that IBS is a very common diagnosis that women are handed that they never get their endometriosis diagnosis. Like we see this. So many instances of this. So I think that's a really important take home for people is if you're having gut issues. Check on your hormones. I want to go back to the GABA piece.

We took a little tangent. We're going to come back. Love it. So with GABA, like, what can you do about it? If your GABA is low, your GABA is tanking. The research study is like, you're old, but what can we actually do about it? 

Dr. Jones: The good thing [00:16:00] is, as we said, progesterone, when it breaks down, one of the things it breaks down to goes up to the brain and helps improve GABA.

So if you're listening to this and you don't have a lot of progesterone, no matter what your age, let's say you have PCOS and you haven't cycled in a long while, therefore you've You may feel and understand that these symptoms apply to you as well, just as somebody who is going through the perimenopausal menopausal journey.

So getting your progesterone back on track, however that looks, and even if you're taking progesterone, progesterone that you swallow when you Take the pill and it goes down to your liver when that breaks apart. One of those things that breaks apart to goes up to your brain and helps activate GABA. This is why so many women start oral progesterone.

Now, when I say the pill, I mean like a capsule. I don't mean the birth control pill. Yeah. When I should clarify, we'll get into that in a minute. But yeah, I should clarify a capsule that you swallow, um, as opposed to a cream or a vaginal or something like that. So. The capsule progesterone has been shown to be really helpful at supporting [00:17:00] the GABA system in the brain.

You can also take the supplement GABA. Now there is some caveat to that. Some people feel GABA as a molecule is really big and should not cross up into the brain. You have a blood brain barrier up there, like a gate system that keeps things out that shouldn't cross. So GABA allegedly is too big to cross.

Sadly, some people have what we call a leaky blood brain barrier. Just like you can have leaky gut, leaky skin. So you take GABA and you feel amazing. It may indicate something around about your blood brain barrier, but I've also read research that says when you swallow a GABA capsule, it talks to the nervous system in your GI tract and the GI tract moves through a nerve called the vagus nerve and says, Hey, And so it's more of a communication support with GABA.

And lastly, one of the other big common ones is a product called L theanine. L theanine is very calming without inducing drowsiness. So it's okay to take in the day. But it's also very supportive to the GABA system. So [00:18:00] that's just three examples of how, you know, relatively pretty safe. Relatively pretty common.

Relatively pretty researched ways that we can support GABA as we get older. 

Dr. Brighten: Yeah, I had a, I'm going to just share with you that I had an embryo transfer and they will often recommend Valium so that you're chilled, you're calm. And I was like, I see your volume and I raise you L theanine. Just because I don't ever like, I'm a rapid metabolizer.

So if I'm going to, if there's going to be side effects, I'm going to get them. So, uh, with that, I went with L theanine. I just love L theanine. How do you feel about passionflower? 

Dr. Jones: Love passion flower. That's another favorite. We get into the herbs. Passion flower is a huge one. It's been studied for a long while.

Um, it, that is a little bit more drowsy inducing as opposed to L theanine, um, but you'll find passion flowers and teas. You can take it as a supplement. You can take it as a tincture and that That also will help stimulate the GABA system. 

Dr. Brighten: Mm hmm. Yep. You specifically said oral progesterone. That's going to help with the anxiety.

That's going to help with sleep. [00:19:00] There are a lot of people taking to Amazon because they're desperate. I don't want to shame them. I don't want them to feel bad, but a lot of people taking to Amazon, um, or even somebody was going viral on Tik TOK with wild yam. Talk to us about that. 

Dr. Jones: The problem with wild yam, when you make progesterone.

As a pharmaceutical or a supplement, they can utilize wild yam and in a lab, they will convert it into progesterone. And it's something our bodies don't have the ability to do. To make that conversion. Yeah, so wild yam in and of itself can be converted in a lab synthetically in a good way though To progesterone so but wild yam is an herb may still have beneficial effects But it is not a one to one It's not like I use this wild yam cream The factory is gonna magically turn it into progesterone and I'm gonna get progesterone out of it.

Dr. Brighten: Yeah, 

Dr. Jones: unfortunately 

Dr. Brighten: Yeah, and I think that's important for people to understand is that your body doesn't have the [00:20:00] capacity to actually be able to generate progesterone from that. And there, you know, I'm always careful with like placebo, but I want people to under, like just saying like, Oh, it's placebo, but I want people to understand the link.

There have been studies that show even the pharmaceuticals we use, so many of them have a placebo effect. And so it may very well be that you are using wild yam cream. And you're like, oh, I'm feeling better and it may very well be placebo. And to me, I'm always like, more power to you. If your brain can make you feel better by like believing that, but like maybe somebody could just get you like some cheaper lotion and you could do it that way.

Oh, but, um, you brought up the pill. Now the pill, has progestin and I see a lot of, uh, providers who will be like, Oh, perimenopause, menopause. Let me just put you on the pill. Let me give you some progestin. Talk about why that's a problem. 

Dr. Jones: It's a, it's what's so interesting. So years ago, my old OBGYN. So when I was in my thirties at the time, she was in her [00:21:00] forties.

And I said, We're talking hormones. She knew what I did. She was great, very supportive. And I said, what are you doing to support the fact that you're in your 40s and perimenopausal? She said, the birth control pill. What else would I do? 

Dr. Brighten: Yeah. 

Dr. Jones: And I went, Oh, Oh, well there's, there's a whole lot of other options out there.

And the birth control pill was really designed for younger women and specifically for birth control. And are you sure you want to be on that? Temporary. Are you sure you want to be on that at 46 or 48 years old, however she was? And she goes, yeah. Well, what else would I do? And it's working, so I'm going to keep taking it.

And I thought, this is the message. This is the message that's out there. And of course, it's the message that's continued to be perpetuated, which is, why would you do any kind of other, like bioidentical estrogen, progesterone, which there are pharmacy, pharmaceutical FDA approved versions out there.

Absolutely. They're covered 

Dr. Brighten: by insurance. People 

Dr. Jones: misconstrue that as well, that we say bioidentical, like it's this weird woo woo witchy thing. And I'm like. It's literally at a Walgreens or a Kroger or a Costco, like you can get [00:22:00] it, cover it often just as you said. So the birth control pill, I, the, I have, and I'm assuming you do as well.

That is never my first go to when somebody is going through perimenopause and says, what do I do for all of these symptoms? Because what's actually FDA approved in all these, in estradiol, in progesterone, you know, the, the, the pill's not listed. It's these other things that we. Yeah, want to lean on instead 

Dr. Brighten: there are only three times that I consider the pill in a perimenopause person that is one Contraceptive totally they're like I don't want to get pregnant and this is what I feel like is best for me Number two is in PMDD cases that do respond well to that.

Not all of them do it's such a lie that women are told Like oh if you have PMDD then like we just give you the pill because progestin can actually make the brain go wild and some people I'm one of those people like you want to see me angry and depressed Give me progestin. Uh, but the third is disordered uterine bleeding, like what, you know, once things have been ruled out, right?

Because disordered [00:23:00] uterine bleeding is always endometrial cancer until proven otherwise. But if you have to get that under control because someone's becoming anemic and you're like, we just have to stop you from bleeding, no matter what, because the risk is too high. That's about it. But. It was interesting because I had a conversation and I'll link it with Dr.

Amy Killen and she made such a good point that we spend our entire like we tell women Through their whole youth the pill is safe. The pill is safe. It's safe. Why would you question it? There's nothing wrong with it It's perfect Be grateful you have it. And then once you get to menopause and you start asking about hormone replacement therapy, suddenly it's the most dangerous thing you could think.

Suddenly it's like, Oh my God, are you trying to kill yourself? You're trying to get breast 

Dr. Jones: cancer. 

Dr. Brighten: However, they're fine to continue to prescribe you the pill, which is so much more estrogen than what we would give when it comes to hormone replacement therapy and the progestin is highly suspect. in being associated with breast cancer.

Absolutely. And so that, I've always found wild. But when Amy [00:24:00] made that point, I was like, only God. We literally gaslight women in every capacity possible and even to tell them that like, Oh, your topical estrogen would be so dangerous, but continue the pill. And it's like, wait a minute here. Right. So talk about why topical estrogen is not as big of an issue for some people than oral estrogen.

Dr. Jones: When they were looking at the research on oral estrogen, so when you swallow estrogen as a capsule, again, everything goes to the liver, everything you eat, breathe, drink or swallow goes to your liver, so always thank your liver, it's on your right hand side under your right rib cage in case you don't know.

Praise it! Give a little, give a little love to our liver. So, when it goes to the liver and it can break apart into some components, research has shown that there is a slight increase for some women, that it can increase blood clots. Yeah. So, we have something called a thromboembolism, um, and the risk for stroke.

And so, we want to be really careful. And it's often not the first choice to go with oral [00:25:00] estrogen because of the cardiovascular risk. We already know women have an increased cardiovascular risk just by the act of going through this whole transition. Just humans aging, unfortunately, but especially women because of the loss of estrogen.

So then to add in the oral estrogen on top of it. And you've got this slight increased risk. A lot of practitioners are like, Ooh, I don't want that. What doesn't have the risk though, and which has been proven, is the topical estradiol. So often you'll see this as the topical creams, or you'll see it as the patch, um, or vaginal, and going that route instead.

It's only the swallowed route that is the risk. has that slight increased risk. 

Dr. Brighten: Yeah. Well, and what's so important about that is that not everybody knows that they're at risk for a clot. Right. Like I, I talked about this in Beyond the Pill, like while it's like a mild risk and it's low, like a stroke is not a mild event to have.

Like we can screen for factor V Leiden, like MTHFR is something that comes in a warning in [00:26:00] Canada. Um, there's different genetic mutations that we can have. I actually didn't know I had one until I was on a fertility journey and I got a more thorough workup. It's a random gene I'm heterozygous for and they're like, oh, yup, like if we're gonna do any estrogen, you have to be on low weight molecular heparin because of the clotting risk.

And I'm like, wow, I did the pill for 10 years and I didn't know that, but I did it. In my twenties. Right. Which is very different than doing it in your fifties. Right, 

Dr. Jones: right. Oh, absolutely. Absolutely. And I want to go back because you mentioned PMDD and I think that is so important to talk about. Yeah.

Because I think a lot of perimenopausal women hit their forties and fifties and think, oh my gosh, is this PMDD? What is going on? Somebody mentioned that their PMS is ten times worse. Yeah. Recently I was reading this article because in perimenopause perimenopause. As you move through the stages, your estrogen really swings.

So one day or for a couple of days, it may be a lot higher than you [00:27:00] expected. And then, boop, it drops back down low. When estrogen goes up really high, it can actually worsen or increase histamine. Yes. And there's cool research on histamine and PMDD. And so while I understand. The birth control pill on PMDD and for some women it absolutely does, thank God, control it and allow them to live their lives.

Yeah. But I also go back to Maybe we just need to peel apart a few more layers. What if it's the swinging estrogen that's impacting your mast cells and histamine, it's impacting your liver and your ability to break it down. Like, what if it's been histamine the whole time and now we've just put you on the birth control pill, which is this large bolus of ethanol estradiol.

Like, are we sure about this? And so really, instead of being the one stop shop, it cures everything. It's like, well, maybe we need to step back. And really go back to being thorough, like we should be, in evaluating some of these. significant symptoms that [00:28:00] come up during this transition. 

Dr. Brighten: Absolutely agree. And I see your PMDD and histamine and raise you that nearly 50 percent of those with ADHD suffer from PMDD and almost 95 percent of those who are autistic.

And. Those neurodivergent conditions inherently have histamine issues. And so that's what I also take issue with, is where it's quick to jump to PMDD, quick to jump to the pill, and this is part of why it's been something that's been masked, where women now enter their 40s, and now they're getting this diagnosis of ADHD, autism, ADHD, because In part, you can no longer mask, your histamine is completely out of control because the immune system is now doing what the immune system does, which is getting haywire with the hormones, or your child is getting diagnosed.

And then it's the wake up call of like, hold up, You're, you're telling me that like, you know, hearing a sound and [00:29:00] feeling like, you know, my skin is crawling is not normal or that lights making you nauseous and like, I, like, I thought it was normal. Nobody wanted the big light on, like, it's just me. So it is something that I think we need to be careful to jump too quick to the pill.

You're right. Some people, but there, there's this myth that like PMDD, the only treatment is the pill. Absolutely not. Some people do better with it. Like I said, some people the progestin makes them worse and their doctor tells them you can't have progesterone. Progesterone is your problem because in the luteal phase your symptoms are worse, therefore it's progesterone.

When in reality, it can also be linked to GABA. Right. And that their executive function is struggling. Right. 

Dr. Jones: Absolutely. Well, even going back to ADHD as an example with histamine, why are women in their 40s and 50s getting diagnosed more? Maybe it's more awareness. Thankfully, but also you have less of a break system as well.

Yeah. So you gave some great examples. Oh, you mean when I hear that sound, I feel like my skin's crawling into light, bright light, bright lights, too bright. Maybe before, when you were [00:30:00] younger, you had an abundance of a break system. 

Dr. Brighten: And 

Dr. Jones: I don't know this yet. I haven't seen research on it. I'll be so curious as it comes through.

Oh, if we get 

Dr. Brighten: research before our time comes to like meet our maker, I will be shocked. 

Dr. Jones: I know. But if we just think physiologically, if you have more GABA, you may have been able to tolerate it more. 

Dr. Brighten: And once the 

Dr. Jones: GABA starts to go down, you can't. Yeah. And, and on top of it, the changing hormones is of course.

worsening. Histamine is an example and all these other things that are bringing it out. And it feels like it comes out all at once. You know, like it's, it's not like a slow roll. It's like all of a sudden people, women feel hit by a bus 

Dr. Brighten: as they're going through this. So the other component to this is the masking.

Women are not able to mask as effectively. And we know from the research that we do have is that masking is a fast track to burnout [00:31:00] and it certainly can happen in your forties. And so what we're talking about with burnout is this cortisol dysregulation, the whole hypothalamic pituitary adrenal access dysregulated.

Talk about how that affects progesterone and GABA as 

Dr. Jones: well. Oh my gosh. Our whole, our resiliency goes down. Unfortunately, I know there's a lot of talk on social media and at conference and things about resiliency. We need to get more resilient. And I'm like, but when your hormones are just haywire all over the place or, or gone, you're, you're far enough along your stages that you don't really have hormones.

You, you don't have the bounce, the ump, the rebound anymore. And so what can happen is that your cortisol is supposed to go up in the morning and then down at night. And I mean up in a normal physiologic sense. I'm not saying the, to the mountaintops, you know, just a normal amount. But when you get in a stressful situation, you're upset at somebody, you need to fight a tiger, whatever it is, your cortisol goes up and then it should go back down.

But what we find with chronic cortisol, chronic stress. Chronic masking, chronic trying to just [00:32:00] hold it together, trying to just live life, trying to handle your family and your job. And then all of a sudden and aging and getting into your forties and fifties that it becomes we have high cortisol and over time it can become low cortisol.

Cortisol has a negative feedback loop, meaning if it's too high for too long, the brain says that's enough. We're done now. Let's start dropping this down. On top of what happens with women in their forties. Oftentimes it's big transitions in other parts of their life. Maybe it's divorce. Maybe their parents are aging.

Maybe it's a career because they're at the pinnacle of their career. Maybe their kids are getting into big transitions, high school, college beyond. So it's a lot on top of having. maybe probably low cortisol, less resiliency in the whole system. And you've now had 40 or 50 years of all this feedback to your brain.

And it's your brain that dictates how you handle stress and which hormones fire off. So if the brain [00:33:00] is now constantly get even more, I'm stressed out. I'm stressed out. Things are changing. I don't get this. That's the message. Well, that's the message sent to the rest of the body. And what's not important when you're trying to fight a tiger or fight a or survive, ovulation is not important, making hormones at the right time is not important.

That's, that's part of literal survival of the species, but not survival of you as the human. So then women start to say, I'm losing hair. Well that's not important to survival, you know, like to fighting a tiger, they start to report like, my skin is getting dry, it's getting wrinkly, it's getting, feels like it's getting older.

That's not important to survival. My digestion's off. That's not important to survival. It's the heart. It's the lungs. It's the brain. It's the right. So when we put all this together in this big, crazy thought of, oh my gosh, my body is just trying to survive. Yeah. And my hormones are a by product of that.

They get left in the dirt and that's how I feel. And it's not fair. 

Dr. Brighten: You know, it's not fair as you said like people talk about resilience You need to build more [00:34:00] resilience and yet Why is it that we're always asking women to step up and do more and we don't stand back as a society and say? How can we actually support them?

It's like be more resilient to stress like we have no nuclear family You have to mother alone like oh now you are I mean, we're in the unique environment generation that's caught between mothering and caretaking of elderly parents. I mean, Gen X is the first generation they believe. So for everybody listening, we go into this slump where we, we feel depressed.

We have this like midlife, right? And then people come back out of that. Gen X is the only one that, that we've seen so far that they're like, we don't think they're going to come out of that. They're going to sleep. Stay there. Well, 

Dr. Jones: that's terrible. 

Dr. Brighten: I think we can change that. I think we 

Dr. Jones: can, too. I think we can 

Dr. Brighten: absolutely change that through these conversations, through women speaking up, through, you know, if hormone replacement therapy is right for you or nutritional supplements and looking at your lifestyle, like other factors that we can do this.

But the thing we've got to stop doing is, you know, Hey, like women just [00:35:00] need to be more resilient, be more resilient. It's like, give us a break. Have we not done enough already? 

Dr. Jones: Do you remember years and years and years ago when boss babe came out as in the hashtag hustle culture, hustle and grind? Oh, I had a hustle t shirt.

Oh my gosh, I was so against it because at the time I happened to work for a hormone lab and I was still. You're like, I see, hashtag boss babe, hormone results and cortisol results and people filling out their questionnaire. Are you stressed? Yes. At what level? A 10. Are you sleeping? Not at all. And I'm like, stop the hustle.

Yeah. Stop the boss, babe. I support you in whatever you do. And at the same time, let's not break your whole body down. And some of these women are feeling it now in their twenties. Yeah. They're feeling already like a 40 or 50 year old young. Mm hmm. Like, whoa, you're too early for this. Yeah. Imagine now what's going to happen in your 40s or 50s.

We have to have this education now for you. I joke all the time, we have preconception care. We did pre perimenopausal care. Absolutely. Like, I need to prep you before you even get [00:36:00] there. Totally. Because 

Dr. Brighten: it's a whole change that you need to be aware of. Absolutely. And there There's so much that you can be doing in your twenties.

This is what's really lame, right? Like there's so much in your teenage years that like sets your bone mass and like sets up so much stuff and you're like, God, could somebody have told my teenage self to like not eat crumb donuts for lunch? Like that was unacceptable. Uh, no. Cause I don't like to be told what to do.

So, uh, my, my husband's in the room right now. He's going to be like, amen to that. She does not like to be told what to do. Uh, but you know, there are a lot of things that you can do. 20s, 30s to set yourself up for success. What are your top things that you would recommend people who are listening now who are like, okay, I haven't hit my one year anniversary of no period and menopause event.

What could I be doing right now to set myself up for success in the perimenopause transition? 

Dr. Jones: So if we're starting early, if you're listening to this and you are either just getting into perimenopause or maybe you're. feeling like you're pretty close. We've got some big things. As I said, all 12 systems of the body [00:37:00] change, but the big ones we think of cardio metabolic.

So heart diabetes. So we're trying to like reduce that risk. We think of brain neurological, right? So we're trying to reduce the risk of dementia and Alzheimer's. We're also trying to reduce the risk of frailty. So bone loss, osteoporosis, break a hip, et cetera. And then of course, we're trying to reduce the risk of cancer.

And in that regard, and at the same time, I want you to have a really wonderful day to day. I want you to be thriving and happy. So we Wait, 

Dr. Brighten: and I also want you to have good sex and not pee your pants when you laugh. A hundred 

Dr. Jones: percent. Yes. A hundred percent. Yes, that goes without saying for sure. So we joke and talk and educate and post about the foundations all the time.

I know they're not sexy, I know they're boring. They never are, but trust your mama's right. Exactly, exactly. It's the getting the good sleep, it's the nutrition, it's the not, getting enough protein. Are you, I joke, we're like houseplants. We're like bougie houseplants. We need enough water, we need really good soil.

We need some sunlight. Hopefully we're by a really [00:38:00] wonderful window. Hopefully the person who, you know, is our community sings to us and plays good music and is happy. So as a houseplant, we can thrive. And it's the same as an adult. I have to tell 

Dr. Brighten: you somebody else on the podcast used that analogy. And I was like, we're a fiddle fig and anybody who has houseplants, I have like over 50 houseplants because I've always been that person.

Uh, but fiddle figs are Seriously the most finicky like you look at them wrong and they're like leaves are gone. I'm dead Like why'd you look at me like that? And so I feel like that, um, this person wasn't talking about it in the context of perimenopause But i'm like some days some days it might be like that.

It's 

Dr. Jones: and we We get, we forget ourself in this transition or the transition and I understand it is so overwhelming and the symptoms seem to come out of nowhere and you've changed nothing yet everything has changed. So you're like, well, I don't even know where to start now. And so it's again, going back to foundations, alcohol, it's, it's your community.

Do you feel safe? Do you have joy? Are you playing? [00:39:00] Are you fulfilled? And then we move up from there. Then I'm like, okay, now we look at your exercise because some people aren't even. doing any movement at all. But when we're looking at exercise, let's start building some skeletal muscle because the skeletal muscle is going to help protect you against bone loss and it's going to help protect you against diabetes type 2, right?

So we want to start building some muscle. Then we can start looking at the nutritional aspect, but maybe you do need to supplement. Maybe you need some lab work at this point. Like, let's see, do you need vitamin D or do you need iron? Do you need B vitamins? Do you need some of these extra nutrient supports to help?

And then we look at. things like HRT, hormone replacement therapy. Are you a candidate? Great. Which ones can we start you on? What are your risk factors? Which one, like, what dose are we starting? What is our goal? There's a lot, of course, as you know, that goes into HRT. But I, if you are a candidate, I am a fan of Moving in that direction of starting it because again, that's what's going to in combination with everything else [00:40:00] This is a 360 approach estrogen alone is not going to save you 

Dr. Brighten: No, 

Dr. Jones: but it is going to be helpful with everything else that you're doing It's like the cherry on the top at helping reduce the risk of all those things and helping you have a great day to day Including how great regular sex because if you don't have a lot of estrogen You're gonna have a probably have a lot of dryness down there 

Dr. Brighten: Totally, totally.

So progesterone, you brought up the HRT. When is an ideal phase to begin that? Because there's a lot of providers who I, you can tell they're new to HRT who are like, once you're in menopause, then we'll deal with it. What should people be thinking? When do we start, uh, progesterone and in context with estrogen?

Dr. Jones: I am in the, I am firmly in the camp that once your progesterone starts declining, stop ovulating or just stop producing progesterone like you used to, start progesterone. The other camp, just for people who are curious, is don't start any hormones until you've gone 12 consecutive months without a period, [00:41:00] and on the 13th month you're considered postmenopausal and can start hormones.

Why would I let a woman be hormone free for 13 months and suffer a lot of changes for the worst can happen in there. So usually if we start hormones, progesterone is the first thing to start. As you move through the stages of perimenopause, as estrogen is starting to decline, that's usually when I start to add in estrogen at that time.

Hot flashes, night sweats, vaginal dryness, the brain fog, the joint pain, the muscle pain, mood changes. For All these things related to a declining estrogen, headaches, migraines, like, you know what? We should probably start looking at estrogen as part of your plan. And then we can build in as needed testosterone, DHEA, et cetera.

Dr. Brighten: There are providers, I agree with all of that, just so people know, I'm on the same page as you. There are providers, however, that say if you do not have a uterus, you do not need progesterone. 

Dr. Jones: I am not in that camp. I am not in that camp 

Dr. Brighten: either, but go ahead and accept it. 

Dr. Jones: But yeah, this is why [00:42:00] when you are on estrogen and if you have a uterus and you don't do anything out there, like we don't use any progesterone, you have an increased risk of uterine hyperplasia, which essentially is thickness and changes in tissue that could eventually maybe turn into uterine cancer.

Yeah, we don't want that. So then the, this, these are the guidelines and the society said, okay, well if you've had a hysterectomy, a partial hysterectomy, you just had your uterus removed. But you still have your ovaries. Maybe you don't. But you go on estrogen. You do not have to go on progesterone. Mm hmm.

Um, I believe because progesterone receptors are from the top of your head to the tip of your toes and not only centrally located in your uterus, that progesterone has a whole lot of other benefits other than just the uterus. It also really ticks me off those providers regulate or relegate progesterone just to the uterus.

Yes. The only defining thing about us, as far as all these 12 systems, is the [00:43:00] uterus. It's just the baby making container. That's it. Yeah. If you take that out, you don't need progesterone. I'm like, but every, but, hold on. Yeah. We have all these other receptors. I want progesterone to bind to them so that I can be 

Dr. Brighten: happy from my head to my toes.

Totally. I'm with you. Well, I'm like, Progesterone because I, you know, for me personally, I'm like, when it is my time because I want to sleep well and not be anxious. I already have a propensity towards anxiety and estrogen because I want to keep my mind sharp. I don't want to have brain fog. I don't want to have joint pain.

And I, it's not a vanity thing. So I've seen people say like, Oh, HRT is gender affirming care and I'm like, That's not correct. I see what you're trying to do there politically to like advocate. And yet, when it comes to being assigned female at birth and doing hormone replacement therapy, it's not gender affirming.

It's not so that I keep my breasts. I keep my hips. I keep any of this stuff. It's so I keep my mind. So I keep like visceral [00:44:00] adiposity at bay and I don't end up with diabetes. Like it's 

Dr. Jones: Even in the genital urinary syndrome of menopause, which is everything, you know, below the belt, right? It's everything vaginal, vulvar, clitoral, bladder related.

I mean, there are women that end up in the hospital because of recurrent bladder infections or bladder infections that become more systemic and lead to a big problem because they don't have the estrogen. I mean, There's the musculoskeletal syndrome of menopause, which is where they look at the higher propensity for frozen shoulder.

It's for the women who have all the muscle pain that have been told it's fibromyalgia and really it's not enough estrogen. It's all the random joint pain that suddenly shows up where it's not rheumatoid arthritis and it's not fibromyalgia, but nobody can figure it out. You must be getting old. It's just arthritis.

I mean, that can be really debilitating. Yeah. And if when you hear. The stories, and you see the research of women going on HRT, that gets better. Their quality of life improves, the risk [00:45:00] for future chronic disease goes down, the risk for hospitalization goes down, missed work goes down, productivity, all these things.

We look at just outside of what's happening in the body, how it affects the rest of society, their family. I mean, it's just like mind blowing when people say that. Yeah. Cause I'm like, I'm trying to reduce a lot of these risks. I'm trying to maintain a lot of these tissues. I'm trying not to get infections.

I'm, I'm trying not to be in pain. Yeah. What? 

Dr. Brighten: Yeah, it is, it is wild to me. And as you were saying, like, this is something so much more complex because I think people even think like, Oh, well, if you're trying to use it for the vulva and the clitoris and the vagina to maintain that tissue, and they don't realize that.

I mean. The tissue can become so friable that if you just urinate and you wipe, it bleeds, it's painful, it's distractingly painful. You brought up, um, GSM. It's so interesting to [00:46:00] look at some of the surveys where 80 percent of people say the quality of their life, like it has impacted their life, where people are saying that they're no longer interested, not just in their partner, but they don't.

feel comfortable in their own body because walking can feel like you have sandpaper in your vagina like and then as you said like The UTIs that can't be treated because they're now antibiotic resistant I think the lack of estrogen, topical estrogen, to the vulva, vagina, for women, that lack of treatment being offered is why we see so much antibiotic resistance to UTIs now.

Because they give it over and over and over with no regard of what it is. is actually going on. Yeah. And is that the body as it lose as estrogen, it loses the, the first defense, which is the microbes that dwell there and the integrity of the tissue. 

Dr. Jones: Yeah. Oh my gosh. Even something like hot flashes. I was reading a study [00:47:00] on the amount of productivity and thus money loss Yeah.

From women who experience frequent hot flashes or night sweats because it interferes with their day. It interferes with their work. Again, their family. They don't sleep. So they feel terrible the next day. And if you have that recurrently, so you frequent through the day and you have them every day, going to blow up your life and then how you perform in your family.

show up for yourself, your job, et cetera. I mean, they put money values to this because they know how detrimental recurrent frequent hot flashes and night sweats can be. And this has been going on for decades, generations without much education around it, without much support, without much help. And in fact, what we had was highly vilified, which we still have that stigma today.

Dr. Brighten: Yeah. Well, isn't it wild that Um, you and I were prescribing HRT with the women's health initiative still being the looming thing. I don't know about you, [00:48:00] but I had doctors who would tell, you know, we'd be co managing patients and they'd be like, she's going to kill you with that. That's going to kill you that you, you use that.

And the only people that were like actually got it were the pharmacist, like for a very long time. But for a while there, we were like wild, wild west doing this with patients where patients would come to me because they're like, my doctor is offering me nothing. And. I think anybody, I never want to scare people onto HRT or away from HRT.

I think it's a very nuanced conversation for the individual. But in my time of seeing patients who chose not to use HRT, and I remember this one patient who then began. Losing her memory, going into dementia. And who knows if HRT would or wouldn't have helped her, but to see her lose the memory of her life that she built, that for me was like something that I'm like, as a doctor, if I can prevent that in any patient, like, that is absolutely going to be the thing I do, and for myself as well.

Dr. Jones: Well, it's Now, [00:49:00] thank goodness, the conversation is starting to change, but women weren't even given the opportunity to choose if they wanted to go into HRT. Yeah. Because much like you, with, with, uh, my patients, I mean, I have the entire talk with them around HRT. It's, it's not a panacea, 

Dr. Brighten: but 

Dr. Jones: it's pretty great for a lot of things.

Yeah. And there are some risks. It's not perfect. We go over all of that and then it's their decision, but for a lot of women, they weren't even offered the conversation. a little bit, even 10 percent of what I would talk or you would talk with them about. Yeah. And that's what needs to change of like, here are a lot of options we have.

Here's what we know pro and con let's choose what's best for you. And that is just not been on the table forever. It's like, Oh, that's common. That's what happens to women your age. Yeah. Best of luck. Or here's an antidepressant. No shame in antidepressants. But for a lot of women, it didn't work. Yeah. And then it was like, well, I have nothing else for you.

Dr. Brighten: Let's 

Dr. Jones: raise the dose. Let's try a different one. Let's add in an anti anxiety. All right. Let's now add in a sleep [00:50:00] medication. Okay. Let's add in a, and then all of a sudden we're an entire, you know, mini pharmacy. On your, on your countertop. 

Dr. Brighten: I think it was just a decade ago where a study had come out about how middle aged white women were dying at significantly higher rates than had ever been seen because of benzodiazepines and alcohol.

And I remember reading that and being like, Progesterone. Yeah, 

Dr. Jones: progesterone. because they're 

Dr. Brighten: on the benzos because of anxiety and that's not enough to help with their mood and so it's like, you know, rosé all day culture. A lot of people like make fun of women for that and I'm like, they're literally doing anything they can to cope through one of the most challenging periods of your life, especially if you don't have support.

If you have support, it can be a lot smoother of a road. And I think We really have to reflect on that, that medicine, our oath is to first do no harm, and a lot of harm has been done. And we really have to have these [00:51:00] conversations. And I think if we want to bridge the trust with patients, again, doctors have to own this.

They have to own that they got it wrong. That they are now learning and going to do better because I've seen a lot of gaslighting where it's like, well, no, like, you know, like that, that's just like, you know, the way it was and like, it's just very dismissive. And it's like, we have to own that, like, mistakes were made, that study was garbage, um, and, and no more money was allocated after that to actually confirm it.

If that study had come out and said, HRT is the best thing to ever happen. It is perfect. Give it to all women. Everybody would have been lining up to question it, to say, replicate it. Replicate it, do it again, prove it. But in this instance, when it was just withholding something from women, it was like, no.

It was 

Dr. Jones: treated as the gospel, as truth, as, you know, Jesus himself came down and said it causes cancer. And we have to remember, cancer's complicated. We can't single handedly [00:52:00] blame breast cancer. on estrogen, not single handedly, 

Dr. Brighten: and that's what's happened. I want to be fair that like, you know, in the study, like, if the, if things are scary enough, I want people to understand that it's scary enough that that did give people pause for, like, replication, but it was not even designed well to begin with.

Yeah. And the fact that it took an entire, like, probably about, what, two generations going into menopause for them to then say, you know, actually, that was a bad study. We didn't design it right. Why did it take so long? Because it affects ovaries. 

Dr. Jones: The studies in between there, they never made the news. You know, there's, there's some of the researchers in the Women's Health Initiative have gone on to do other research.

And when you go back and read it now, I'm like, why? Why am I just now hearing about this study? Why didn't that make the news? Why didn't anybody come back and be like, oopsies, here's the newest. Why did we have to suddenly wait until, you know, now, very recently for, to get this information, this knowledge, this, this, this [00:53:00] new research that's come back.

Well, we're 

Dr. Brighten: changing all 

Dr. Jones: of that now. We are changing that. And you 

Dr. Brighten: have an entire YouTube channel that I'm going to link to because you provide a lot of education there. And I think. The way that we change this is we have these conversations and if you're listening to this now and you're like, yes, I want to change this, share this with somebody, share this, pass it along, when you spread this information around we can change the entire system.

I always say it's not going to be doctors like you and I who actually change the system, it's going to be the patients who advocate for better, who demand better care that are actually going to change women's health for the better. 

Dr. Jones: 100 percent and I, I tell women it's okay to find somebody. on your team that's different than the team you currently have.

If you like your doctor for primary care, but they're not great at hormones, add your team. Find a doctor who's good at hormones. If you like the person who delivered your baby, but they don't know how hormones work in the stage of the game, totally fine. Yeah, keep them for the guidance [00:54:00] stuff. Find somebody who understands hormones.

Don't feel bad or guilty or, or shame. We just add to the team. You're not cheating on anybody. 

Dr. Brighten: Well, this has been a wonderful conversation. Thank you so much for sharing all of this information for having this conversation with me. I mean, I always love hanging out with you, but I think it's great that we're having a conversation that we recorded so other people can listen in.

Well, I 

 

Dr. Jones: so appreciate you having me on it. I love talking with you always.