Perimenopause to Menopause: Decoding the Differences
featuring Esther Blum, MS, RD, CDN, CNS
Audio Only:
Episode 79
Published October 29, 2024
In this conversation, Dr. Jaclyn Smeaton and Esther Blum delve into the complexities of perimenopause and menopause, discussing the myriad symptoms women experience, the medical community's understanding of these transitions, and the importance of early intervention and personalized care.
Esther and Dr. Smeaton also explore:
- The physiological changes that occur during perimenopause and menopause
- The role of hormones like estrogen and progesterone
- How early intervention with hormones can optimize quality of life
- How lifestyle factors can impact women’s health during this time
- The importance of women advocating for themselves and seeking knowledgeable healthcare providers
Key Moments
00:00 Understanding Perimenopause: A Hidden Transition
03:12 Menopause vs. Perimenopause: Defining the Terms
06:07 The Diversity of Symptoms: Beyond Hot Flashes
08:56 The Medical Community's Knowledge Gap
12:03 Navigating Hormone Replacement Therapy
14:58 Physiological Changes: The Second Puberty
18:02 The Role of Estrogen and Progesterone
20:56 Factors Influencing Perimenopause Experiences
23:56 The Importance of Gut Health
27:13 Lifestyle Changes: Nutrition and Exercise
30:03 When to Seek Help: Recognizing Symptoms
33:07 Empowerment Through Knowledge and Support
Jaclyn (00:02.066)
So Esther, we're so happy to have you today. We always have so much fun when we get to connect on the podcast.
Esther (00:07.04)
We do. Thanks for having me back, actually. I really appreciate it.
Jaclyn (00:10.664)
Absolutely. And today we get to talk about something that actually is the biggest reason that people order the Dutch test, which is perimenopause. That was a surprise to me, but when we surveyed customers, that came back as a top condition that they utilize a Dutch test for. And it makes a lot of sense because it's kind of this confusing, murky, uncomfortable time.
Esther (00:31.758)
Yeah, it's totally murky. I'm in it myself and I appreciate everything that my own patients go through. And 60 to 70 % of the people I do see are in perimenopause and do want the information. They do want to understand what's going on in their body. They go to their doctors and a lot of women go from childbirth right into perimenopause without realizing it because it can start mid 30s.
Jaclyn (00:59.826)
Wow, I never thought about that. Yeah.
Esther (01:01.248)
Yeah, it's really amazing because women have choices to have children later in life, or maybe they don't meet their partner till later. so they have children later and then all of a sudden, you you can be nursing or pregnant and then stop being, stop nursing or stop being pregnant and have hot flashes, have vaginal dryness, have, you know, a real dip in progesterone and depression and anxiety and night sweats and all these things, and really have no clue that you're in perimenopause. so women are going to their doctors and their symptoms are really getting missed. Their symptoms are, or being missed, diagnosed. And so the Dutch is great because it's why I use it because I'm like, I don't really care what you think it is or isn't. Let's just open the hood and look underneath and see what exactly is happening during this time.
Jaclyn (01:37.958)
Mmm.
Jaclyn (01:56.232)
Awesome. So let's start with just defining the difference between menopause and perimenopause because menopause is like a clear medical definition. Perimenopause is like the 10 years that lead up to it and all the symptoms, right? So let's talk about that. What is menopause officially?
Esther (02:06.862)
you
Esther (02:13.036)
Menopause is officially 12 consecutive months without a menstrual cycle. So let's say you go for six months, eight months, 10 months without a period, and then you get one, you have to start the countdown clock all over again. Perimenopause is the 10, sometimes 15 years leading up to it, mostly 10, where we can still have the same symptoms and the symptoms don't necessarily go away.
during menopause, by the way, without being treated for it. So we see everything, you know, the garden variety of hot flashes, changes in mental status like brain fog, irritability, depression, anxiety. We can also want to divorce our spouses. That's not uncommon. Hot flashes, itchiness, vaginal dryness, nerve, what are called zaps, itchy ears.
are some lesser known as vertigo, lesser known as joint aches and pains, insomnia, weight gain, higher cortisol levels, higher, you know, this isn't defined as like menopausal symptoms, but I do see also an increase in blood sugar and insulin, increase in cholesterol markers and plaque in the arteries. So there's so many, so many symptoms that
Jaclyn (03:28.252)
Thank
Esther (03:38.55)
I think it's between 60 and 80 different symptoms that can be classified as perimenopause.
Jaclyn (03:43.568)
I love that you're raising kind of the diversity of symptoms that women come in with because traditionally we think about hot flashes and vaginal dryness and really that's kind of all, right? So it is commonly missed because if you don't have those symptoms or if you have a lot of others, they can sometimes be dismissed as not a problem or just part of aging or you know, how else do you hear these things redefined when you talk to your patients?
Esther (04:12.526)
Yeah, well, and also I'll say, you know, a doctor will say, well, you're not 51, so you can't be in menopause, as if our bodies are exactly on that clock. I have women in their late 20s to late 30s who've gone through full blown menopause. And then I have ladies who are in their mid to late 50s just going through menopause. So there's no specific timeline. I wish it was a switch. But I'm sorry, what was your question about
Jaclyn (04:42.59)
just like I feel like when we talk to when I talk to women in perimenopause, a lot of them are surprised to be acknowledged for some of those. I want to say like softer or like fringe symptoms, but things outside of the traditional hot flashes, libido change, vaginal dryness. I think sometimes it's really affirming for women to hear like, no, this is actually a really common experience in perimenopause to have the brain fog, to have mood changes, etc.
Esther (04:43.22)
What are some of the other?
Esther (04:57.56)
Yeah.
Esther (05:09.186)
Yeah, it really is. And you know, the thing is we're not educated on it at all. I mean, my doctor certainly never educated me. I was the one coming in and saying, yes, I've, my progesterone's really low. I'm starting to take it. I'm not sleeping so well. She just looked at me and said, okay, but never educated me and said, hey, you know what? you're approaching your forties. You're approaching your fifties. Here's what you can expect, the next five years, 10 years. I even went to the GYN office. It was the night before Thanksgiving a couple years ago, and I had a left ovarian cyst that ruptured. So if any of you have had that, you can imagine the pain is like childbirth. Like I was crying. I was like, do I go to the ER? my God, I'm so much pain. So I go for my ultrasound and they say, we have to test you for chlamydia.
I was like, try again. What other options? I said, I don't think I have chlamydia. I work at home all day. So does my husband. We're in a happy marriage. How about asking me that? So then they were like, you're on hormones. Did know you have an increased risk of breast cancer? I was like, okay, next. So they offered me, then they offered me the birth control pill or told me to take Advil 10 days before or 10 days after. Now, fortunately for me,
Jaclyn (06:17.177)
Right.
Jaclyn (06:24.54)
Yeah.
Esther (06:34.286)
One of my dear friends is Amy Ropp, who's a fertility acupuncturist. She was like, don't worry, I've got vats of my special castor oil mix. Just rub that into the cyst every night. And the pain never came back after that. So I was like, or, you know, the other option the doctor told me was that I could have a hysterectomy. So it was crazy. Well, the fact is I…
Jaclyn (06:54.022)
Wow, that seems pretty severe.
Esther (06:58.062)
I wrote that conversation when I wrote See It Later, Avi Later, I said, when you go to your doctor, this is the conversations you're going to have. So it shouldn't have surprised me that I had it with the practice that I went to as well.
Jaclyn (07:11.634)
Well, it is interesting because when we look, we've talked with like several OB-GYNs on the podcast and just in, you know, networking and all the conferences we go to and they don't even get a single hour on menopause really in their residency or in their training. I mean, I can pat ourselves on the back as naturopathic physicians. We did get one hour of menopause training, which makes you like a true expert, as you know, right? No, I'm kidding. There's so much to learn.
Esther (07:16.931)
Yeah.
Jaclyn (07:39.528)
There's so much data and research to understand and experience to be gained, even a general provider or even an OB-GYN, unless they're doing it all the time and unless they're paying attention to the research, it's really easy to not know.
Esther (07:56.504)
I'm shocked that you as a naturopath did not learn about it. That I'm really shocked about.
Jaclyn (08:00.188)
Well, we did. We did learn about it. But remember that you have one semester to learn everything in gynecology. So you have to cover everything for the reproductive years and perian postmenopause. So even when it came to things like hormone replacement therapy, I I went to med school when the WHO was published. So we, of course, learned the risks of hormone replacement therapy at that time and the approach of
Esther (08:09.122)
I see. my gosh.
and
Yeah.
Jaclyn (08:27.432)
I'm saying that because things have changed for those of you that are listening. Things have changed and that study was kind of flawed in its interpretation and its media exposure especially. But we learned about what hormones to replace, some general protocols, but mostly we learned keep women on hormones for as short a time as possible, the lowest dose possible. And now things have really shifted in approach, which is, mean, that's what happens with science, right? We learn more.
And now there's so much more attention paid to women's health, particularly perimenopause and menopause, where we really didn't have much research before. So it's getting better.
Esther (09:04.662)
Yeah. And the good news is, you know, I was talking to Kelly Casperson about this and she said, now Matt, because I said, well, when is it going to change in medical schools? Because we really have to start from the top down. I mean, I teach my clients, I'm like, change begins with us. Don't expect or wait for the system to change. You're going to be waiting 20 years. However, however,
Jaclyn (09:16.316)
Yeah.
Esther (09:27.458)
So I was talking about this with Kelly and she was like, medical schools now, they no longer teach that hormones cause cancer. So that's a win. And about a week is given to menopause care, which I'll take it. I mean, I'll take something to just start normalizing some standards of care so that a woman, when she goes to her annual checkup, be it her primary care physician or her GYN. You know, we've got two entry points to medical care as females. they say, they look at your biological age and say, how are you feeling? Are you having any brain fog? Are you having changes in libido? Are you having hot flashes and vaginal dryness? Even if they don't go into the 20 other symptoms, at least if they open up the conversation around it, we're winning the game.
But also the thing is, yeah, when we go to the doctor's office, right, we really need to dedicate sessions specifically to ask for hormones. We can't expect that the medical system now has 10 minutes allocated per visit, be it a pap smear or a checkup. So if you're interested in MennoCare, my advice is to get a separate appointment just for that, to ask about it.
Jaclyn (10:21.392)
absolutely.
Esther (10:50.068)
ask about hormones if that's something you want to explore and take on. Don't do it while you're getting a pap smear or don't do it, you know, while your blood pressure is being taken. It's got to be a separate visit and you've got to tell your doctor, I want to follow up with you on this. I want to get regular care, but I do need care on this. There are FDA approved hormones. I'd like to give those a try. So then you establish that you're partnering, you want to have guidance, you want to have support versus know, it's the last minute of your consultation. You're still in your gown undressed and you're like, can I have some hormones now? And then you want to walk out the door because your providers are going to want to make sure that you're being followed up with too. It is a partnership. know, doctors are not inherently evil. They go into this wanting to heal and help, but you know, we have to, we have to partner with them as well.
Jaclyn (11:34.29)
Mm-hmm.
Jaclyn (11:45.148)
I love that and thank you for talking about that kind of soft skill approach. We always call those door knob conversations. like after you've spent, you know, for a naturopath, we'll spend 30 minutes or whatever in a visit. And as we're about to leave, you have your hand on the door and the patient's like, there's just one more thing. And it was really the thing that they wanted to talk about that whole time, but they were too embarrassed to ask or didn't know how to bring up, whatever. So it's great to think about that. And it is really a partnership. And we talk about this all the time when we talk about hormone replacement therapy.
Esther (11:51.17)
Yeah.
Esther (12:03.768)
Yeah. Yeah. Yeah.
Jaclyn (12:14.716)
Well, one, there's a wide variety of options for menopause care, not only hormone replacement therapy. There's so many lifestyle things. There's herbs and nutrients that can be used. can maybe talk about some of those. And then there's hormone replacement therapy. And when you get into HRT, we really do need to do an individualized assessment of every patient to determine whether they're a safe and best approach for a patient. And then which approach in that hormone realm is best suited for the patient.
Esther (12:23.436)
Hmm.
Jaclyn (12:44.572)
which route of administration, which dose, et cetera. So it's definitely not something that can be a quick prescription on the way out. I completely agree. So can we talk a little bit about perimenopause to menopause and what's happening physiologically? I I kind of think about it as like a second puberty, like the first time wasn't bad enough. We get to go through it at the other end of our reproductive years and...
Esther (12:52.236)
Yes. Yes.
Esther (13:02.542)
And I know. Yeah, we're backing out of puberty basically. Well, it's brutal. For me, the progesterone decline really hit the hardest. So for a lot of women, we lose progesterone first because our body doesn't need our levels to be so robust. saying, you don't really need to keep ovulating. We don't really want you to get pregnant after a certain point.
Jaclyn (13:10.979)
gosh, it's brutal.
Esther (13:34.842)
After a certain biological age, so your progesterone production declines. You also need to understand the thing people forget to address is midlife. Okay? We've got aging, ailing, and or dying parents. And if we have children, a lot of them are teenagers. And you're trying to launch them to college and get them to not crash their car, get speeding tickets all the time. And then...if you've been a career woman, this is probably the time your career is really peaking because you've been doing this for 30 years or so. So, you know, we have all these stressors that can put us in fight or flight, and that is also going to tank our progesterone, right? It's, really, start from the top down. So we have feedback, mechanisms and feedback loops that tell your brain will tell your ovaries, don't release an egg this month, don't ovulate and does it by lowering your progesterone. So when that happens, we start to get crime scene periods, right? Massive blood clots, heavy, heavy. You're like, my God, this is a scene out of John Gotti movie. Or of course, like I'll never forget the time I was wearing, you know, very light tan pants.
New York City, I was like sofa shopping and I looked down and I was like, we've got a situation here. And my bestie was with me. yeah. I was sitting on a buttered leather, a butter yellow leather couch and I looked down. Thank God nothing got on the couch, but like my bestie gave me her sweater and we were riding the subway home with our husbands and they were just shaking their heads. like, what is it with you girls? I was like, I had no idea. I don't know. So,
Jaclyn (14:58.306)
- Then you were clothes shopping.
Jaclyn (15:17.49)
Yeah
Esther (15:22.499)
So, yeah. So when our progesterone levels tank, you know, we can get really wicked cramping, very, very heavy bleeding, also insomnia, or that second half of the cycle, we are jackal. The first half we're hide and we're like, all right, I'm pretty happy. I'm pretty chill. I'm feeling good. And then the second half sits and you're like, who are you? I hate you. And like the devil takes over.
Jaclyn (15:46.856)
That's so relatable. mean, I honestly, mean, I'm 44, so I'm like at very early stages, but I have seen change. And for me, the biggest thing is like, there's always a couple of days every month where I'm ready to like uproot my life, you know, move, leave, whatever. And then I'm like, just don't make any decisions for three days. And every time I'm like, hey, there we go. There's my cycle. I feel great again. You know, it's...
Esther (15:52.642)
What?
Esther (16:12.472)
There we go.
Jaclyn (16:14.364)
that PMS I'd never experienced before as well as wild.
Esther (16:16.75)
yeah. It's wild. It's wild. I I joke with my teenage sonny, 17, now I'm like, know the reason why you live in my house is because I take progesterone. Otherwise you'd be back in the shed in the woods. So yeah. you know, really making sure that your progesterone is optimized is a fantastic way to transition from perimenopause to menopause. In the early parts of perimenopause, it's really, there's some
Jaclyn (16:26.837)
Hahaha
Esther (16:45.688)
great things you can do to support. mean, maca and chaste tree can really support your adrenal function, can really eke out a robust production of progesterone from the ovaries. So you feel so much better. You you could take it the second half of the month, but I really recommend just taking it all month long to really support optimal progesterone levels.
As you get later and later, and you'll know when those stop working and your symptoms are back, then we recommend women introduce progesterone the second half of their cycle when it all starts to hit the fan and then really end stage perimenopause where your periods are super irregular and not coming with any rhyme or reason, then you could take progesterone all month long.
Jaclyn (17:38.022)
Now, it is interesting. think it's really helpful for women to kind of understand the common sequence. Now, perimenopause can be so diverse, but typically, like the hot flashes and vaginal dryness are later in perimenopause, from my experience with patients. The earlier signs are the kind of mood changes, cognitive changes, heavy bleeds, and those are more progesterone. Like progesterone will, the decline of progesterone is the first thing that
Esther (18:02.178)
Yes.
Yes.
Jaclyn (18:05.818)
women experience and that happens physiologically because that's kind of a slow gradual decline into menopause versus estrogen. Let's talk about estrogen.
Esther (18:11.075)
Yeah.
Esther (18:15.402)
Estrogen levels can fluctuate up to 30 % on any given day. And this is why most practitioners do not want to test prior, because they're like, it's going to be crazy from one month to the next. And we really don't want to test. It could be crazy from one day to the next. And this is harder to control and regulate. But again, this is why I, you know,
Jaclyn (18:16.584)
It's a bit of a roller coaster.
Esther (18:44.994)
You're preaching to the choir. I'm a fan of the Dutch because A, I like to look at how estrogen is moving through your liver and also your gut. And if it's not moving through well, if it's getting backed up, if the sink isn't draining, then you can have more of an impact emotionally. You can feel, you know, more weepy, more irritable, more breast tenderness, more bloating, you know, a lot of fluid fluctuations and water retention versus supporting your detox pathways, maybe whether it's phase one or phase two, you know, it depends on which pathways you need supported. For some women it's glutathione and taurine. other women it's, choline, a trimethylglycine. Other women need cruciferous concentrates and really eating a good amount of cruciferous vegetables and fiber flaxseed and chia as well. So that is really individualized. But the progesterone, again, you'll see, you'll know, and later marry perimenopause when it's really time to bring it in is when you are having hot flashes, when you're taking progesterone and still not sleeping well, progesterone will help you fall asleep, but estrogen helps you stay asleep.
It's really getting the ratio right. Also, if you're having migraines, I have seen very successful treatment of migraines when the ratio of estrogen to progesterone is right for your body. I don't have an exact number of what that is. It's very, it's trial and error and it is individualized, but that also helps too. And so when you quell your hot flashes, when you're using vaginal estrogen as well, and that's helping, you know, that's how you know.
Jaclyn (20:11.848)
Yeah.
Esther (20:40.194)
that you did the right thing by bringing it in. And I do look at the Dutch, but I also look at blood work concurrently to really verify and optimize recommendations. I can't prescribe, but I can say, here's what you can ask your doctor about. And then they work with, I always refer out that would, it's outside my scope to provide, but I can certainly suggest and recommend.
Jaclyn (20:56.786)
Mm-hmm.
Jaclyn (21:05.256)
love that you kind of bring up the variation too in estrogen. I think that's one of the challenging things because it is truly difficult to test when you're in perimenopause. Postmenopausal hormones become a lot more stable. But in perimenopause, you're right. I mean, you have this variation within the day, which the Dutch can overcome that 30 % variation from hour to hour like you talk about. But there is also the day-to-day variation that can be pretty significant.
Esther (21:08.462)
and
Esther (21:14.808)
Yeah.
Esther (21:29.656)
Yeah.
Jaclyn (21:33.96)
which is another thing that I think is great to bring up because sometimes women will get on estrogen therapy and they'll feel really great if they're in perimenopause, but then they'll feel terrible because they start to have signs of estrogen excess. And that can be because all of a sudden their ovaries are secreting estrogen and that extra amount is too much for a period of time. So it can be very difficult to treat in perimenopause versus in menopause when things are stable.
Esther (22:01.997)
Hmm.
Jaclyn (22:03.688)
it's much more easy to find a comfortable dose. So if you're a patient, it's not your provider doing something wrong. It's that your body is probably still in flux through that time. I don't know if you've experienced that, but one great analogy I heard, which I love to share, is that the ovaries in perimenopause are a bit like a ketchup bottle when you're on the very last serving. Isn't that so funny? It's like you shake it and nothing comes out and nothing comes out and then all of a sudden, like, yeah, it's like.
Esther (22:14.274)
That's right.
Jaclyn (22:33.426)
catch up everywhere all over your hot dog. And that's a lot about what the ovaries do and it's because they're getting signals from the brain and sometimes things don't click and then sometimes they do. Or you might get a cycle where you ovulate or you you get a follicle, a dominant follicle that gets made and surges estrogen. So it can be so unpredictable. And so just keep that in mind if you're feeling frustrated because you're like, I felt great for a couple of months and now I don't.
Esther (22:36.184)
Aww.
Esther (22:51.81)
Yeah.
Esther (22:57.902)
Yes. And this, I can tell you this has happened to me. I work with my doctor on it. I started off at higher doses. Then I had to drop down to lower doses because my estrogen was too high. mean, I had my Goldilocks moments. We dropped down. Then I started feeling really crummy, like the dead lady in the bathtub in The Shining kind of crummy. And then we bumped it up. And just this month, I was like, my
Jaclyn (23:19.847)
Yeah
Esther (23:26.412)
like I finally have had a month of just not feeling dead. It's like the period flu, but 24-7 all the time. So it does, it is trial and error and you have to be patient and expect that the wheels are going to come off the bus. It's not linear. Your body does what it wants when it wants to. I can tell my ovaries to, you know, piss off, but they're still going to do what they want to do when they want to do it. So
Jaclyn (23:34.492)
Hmm
Esther (23:56.044)
Yeah, and my cycles could be 40 days, 60 days, 20 days. There's still no rhyme or reason, but it does get better. And adding in testosterone, adding in vaginal estrogen if needed, all those things also make a huge impact on energy, cognition, mood, focus, libido. All of those things are wonderful too.
Jaclyn (24:21.681)
So can we talk a little bit about some of the influencing factors? Like, why is it that some women have a harder time with perimenopause and menopause and others experience very few symptoms? Or they have this prolonged perimenopausal period versus a short perimenopausal period. Do we have any understanding of what influences that?
Esther (24:26.399)
Thank
Esther (24:41.25)
Yeah. Well, first of all, we're seeing perimenopause earlier and earlier. And if you look at the volume of endocrine disruptors in our environment and our stress, that can absolutely lead to a more premature ovarian failure, just because if you're in a chronic flight or fright state, and that can absolutely impact if your fight or flight state is from current versus past events. For instance, there is hardcore evidence that women of color lower socioeconomic status, women who've experienced trauma with a capital T, all of that can also lead to earlier perimenopause and more difficult perimenopause. We know that, you know, during perimenopause, as the ovarian party winds down, the adrenals really have to pick up the slack, start to step in for hormone support. And so, the worse our cortisol levels are, the more rock bottom they are from chronic stress and burnout. will certainly make your symptoms feel worse. It will make you feel more fatigued, more draggy, make your symptoms worse, could make your hot flashes work as well. And also, yes.
Jaclyn (25:57.0)
So I want to let's stop and double-click on that because I think that's like such a cool point to bring up. I love how you call it the ovarian party. As the ovarian party is winding down, I'm going to take that phrase. Thank you very much. But – so typically in a cycling female, the ovaries are producing estrogen. The granulosa cells are producing estrogen as follicles mature and then you – that trans – you know, gets transmuted into the corpus luteum which makes progesterone in the second half of the cycle. But what you're saying is that
Esther (26:04.829)
That's the oppiering part.
Jaclyn (26:26.618)
as that slows down, the adrenals have to take over. And that's like real science. It's basically that the only estrogen you make is through – it starts with DHEA production in the adrenal glands. That's what you're getting at here, right?
Esther (26:40.63)
Yes, thank you. Yes.
Jaclyn (26:42.96)
Yeah, so the adrenal glands make DHEA and then that gets converted to a variety of hormones, but eventually to testosterone and then to estradiol from testosterone. it is, it's really, really important because it's the only source. It's like the only well. I'm trying to think of a good analogy, but like, you know, you have to kind of dip into your secondary well because the first well is run dry to really have the influence that you need. So yeah, if the adrenal glands aren't if they've been taxed through chronic stress for a long period of time, there might be disruption in the communication along that pathway. And definitely when you make cortisol, you make DHEA. They're both stimulated by ACTH. So I can make a big difference there.
Esther (27:20.504)
That's right. That's a huge, huge, huge impact. And also, we have to look at gut function. Having a significant drop and decline in estrogen and progesterone is going to disrupt the gut microbiome. It decreases our production of hydrochloric acid. It can change the epithelial lining of the small intestine. There can be a lot more inflammation there.
So oftentimes, yes, this is why I do stool testing alongside the Dutch. And I've had women whose hot flashes have resolved just by healing inflammation in the gut. And the brain fog disappears, healing inflammation in the gut. We know if we have a leaky gut, we have a leaky brain. So all of those pieces are really important to address. It's not only coming from a change in hormones or adrenal function, it's also coming from a change or disruption in gut function. So the better your gut function in menopause, the better your symptoms and your journey will, or through perimenopause, the better your journey will be as well.
Hey. Yes, I saw she dropped.
Esther (28:45.386)
I still kept going. was like, just keep going. She'll come back.
Esther (28:53.366)
Okay. Yeah, no problem.
Esther (29:00.686)
I mean by 1245. Okay. Okay.
Yes. good. I'm so glad. Good.
Esther (29:20.486)
good. Okay, good. Good, good. Yeah, I'm just looking at my schedule. Yeah, my next call is at one, but I try to just take a little break between calls. Yeah. Yes, yes. Yay. good.
Jaclyn (29:38.773)
Hey, sorry about that. That's never happened.
Esther (29:46.86)
I just kept talking.
Jaclyn (29:48.683)
Good, I figured you're a pro, just rolled with it. Yeah, sorry about that. It just like dropped me out of the internet. I'm in like a co-working space, but I'm here all the time. This has never happened, so don't know what was up.
Jaclyn (30:03.712)
Today is special. I actually like feel really like I'm hungover except it's a parenting hangover. It's not like a fun party night hangover because I had a my little guy was up all night long like vomiting in our bed. I'm like, it's so brutal. He's five.
Esther (30:11.887)
Esther (30:19.028)
It's so brutal. I'm so sorry. I've been there and it's horrible.
Jaclyn (30:23.404)
I don't know what's going on with him, just as an aside. I was away in London last week and while I was gone, the day I left, he fell sick and my husband, in the end, I'm like, take him into urgent care because he was vomiting so much and he had really bad stomach pain. That was the biggest issue. And they gave him Zofran and the vomiting kind of stuff, but he had really severe pain for like five days. And he ended up in the ER and they thought he had appendicitis and he got all worked up and blah, blah.
Esther (30:25.546)
Uh-huh.
Jaclyn (30:48.831)
And then he was fine on Sunday and he's been fine all week. And then last night he was complaining of a stomach ache and then started vomiting again. I'm like, what is going on? But it's probably not norovirus because it's been like nine days now and that usually passes in two to three. So I might end up going back to the ER with him when we get off today because I'm like not sure what's going on. Poor dude. Poor dude. But Angie was like, God, you know, my husband, like this is awful.
Esther (31:02.062)
Esther (31:08.43)
I'm so sorry. So that's so tough.
Jaclyn (31:16.223)
I feel like we partied all night, but it was just the worst party ever. I know it's the worst, yeah. Anyway. it totally is. Parenting hangovers. Let's keep going. All right, so we were talking about... good.
Esther (31:18.506)
Yeah, the worst. The non-alcoholic hangover is the worst.
Esther (31:28.042)
Yeah. Yeah. so sorry. I talked about gut health. Yeah. I just talked about like, the importance of optimizing gut health to also, decrease menopausal symptoms and how like you can clear out brain fog, you can clear out hot flashes, just optimizing gut health. But I didn't get into specifics of how. Okay.
Jaclyn (31:47.659)
Mmm.
Jaclyn (31:52.873)
Okay, that's perfect. I don't think we really need to. All right, let me roll in. Okay, so we've talked about stress and adrenal function. We've talked about gut health. You've also brought up environmental toxicity and the role that that probably has on the timing. Anything else that jumps to mind for you? What about nutrition or exercise?
Esther (32:11.658)
Yeah, I was going to say, you know, diet and, diet, I already said stress management and exercise, you know, will it change the outcome in the onset? No, but can it manage the severity of the symptoms? Absolutely. So first of all, let's start with the exercise piece, which is really my therapy is walking outside twice a day. getting that morning light is a spectrum that's 200 times greater than any indoor light bulb, especially with all the LED bulbs that we're now exposed to on a daily basis, even in our own homes. So getting outside in nature lowers cortisol, regulates your circadian rhythm. For me, it's my greatest antidepressant. It's such a mood elevator. It's so calming. It's restoring. And also, it helps
burn fat. mean, when you're walking six, eight miles a day, you're not going to develop that menpause so easily. Your body will stay much more regulated and not gain all that weight at once. Certainly strength training too, the more muscle mass we have, the leaner we are, the better we manage our insulin, the better we support our bone density and manage longevity. Right? We didn't talk about losing bone mass, peri is a huge sign of perimenopause. It happens in perimenopause. Most people don't realize we lose the largest amount of bone in the last couple of years of perimenopause. So by the time we get into menopause and then your doctor says, you should have a bone scan at age 63. No, you're already far gone by then. So early intervention of estrogen is really key for optimizing bone health and bone density as well.
Jaclyn (33:43.723)
you
Esther (34:05.526)
and strength training really supports that and counteracts bone loss. And then we have diet. So diet is really going to optimize your microbiome, especially fiber. Fiber, again, keeps estrogen in check, binds excess estrogens, acts like a sponge to really mop them up and shuttle them out via your bowel movements, but also
fiber regulates your blood sugar. It's food for your microbiome. It's food for your good bacteria to eat. colors, dark green leafies, reds and blues, all of those foods really support healthy gut microbiome, but also diversity. Like we eat the same chicken on Monday, fish on Tuesday, meat on Wednesday. So your proteins may not vary as much. However, your
produce and your starches can vary a tremendous amount. can have sweet potatoes, white potatoes, which white potatoes cooked and cooled are very high in resistance starch, which is great for the gut. Winter squash, legumes and beans, if you tolerate those. Dark green leafy vegetables, rice and quinoa, if you tolerate those. And then vegetables, unlike just...
Buy one different vegetable a week than you would normally eat. Buy eggplant one week and roast it with some red peppers, put it in tomato sauce over meat. Red apples are in season as we record this, and there's so many different varieties of red apples. So buy different varieties of red apples. You don't have to eat berries year round just because they're available. Give your body a break from eating the same foods all the time.
Jaclyn (35:55.637)
This is great. We're going to have to have you on for like a cooking show because you have a lot of really good ideas. So it's going to be like the next book will be a recipe book and our next podcast will have a kitchen. That'd be so fun. Yeah. And I love that thought of food as medicine and like getting the diversity. You know, anything that adds color or flavor or aroma to a food is usually a phenol containing compound or a flavonoid. It's a nutrient. It's a plant nutrient. So
Esther (35:58.693)
hahahaha
Esther (36:04.91)
Yeah, let's do it.
Esther (36:13.144)
Yeah.
Esther (36:25.475)
Yeah.
Jaclyn (36:25.587)
I call them plant antioxidants instead of antioxidants. And a lot of them don't have names, right? But you want the diversity of that in your diet. And you're right. You get the diversity of micronutrients, but you also get the diversity of fibers. And that's so critical for gut health. I love that you bring that up. So I think my last question for you is, as women start to see these symptoms come up for them, what should they start by doing on their own?
Esther (36:28.814)
Jaclyn (36:52.553)
And you've talked about this, like balance blood sugar, exercise, things like that. And how do they know when they need to go ask someone for help?
Esther (36:59.692)
Yeah. Well, there isn't a woman out there who doesn't know her own body. When every woman who says, you know, I think it's my hormones, you're always right. Because when your monthly cycles either start to shorten or lengthen or just get wonky in terms of flow volume, or again, your moods are so shifted and you just don't recognize yourself or the weight gain starts, you know, that's the minute your feel off schedule an appointment. Don't wait because it doesn't get better without treatment. It doesn't go away. There are women I treat in their seventies and the minute they stop doing all the things, their hot flashes come right back and their vaginal dryness and their skin gets more wrinkled up without all that beautiful estrogen. you know, go right away. Don't wait. I did write, you know, I've whole book called See You Later, Avilare, where I walk you through the tests you have done. I tell you all the blood tests to have done. Look at your inflammatory markers. Look at your insulin levels. Look at your thyroid function. Look at your cardiac risk markers. Start to see, uh-oh, I've never had really high LDL before. I've really never had high homocysteine, and now I do. What's going on?
Jaclyn (38:25.545)
And that's a super common change that we don't talk about a lot like the health medical space, but a lot of women get put on cholesterol lowering medications around this time, but it's very much, it can happen so fast with no dietary change, really just with the hormonal change. So I'm glad you bring that up.
Esther (38:32.045)
Yeah.
Yes.
Esther (38:38.711)
Yes.
Esther (38:42.838)
Yes. And also remember too that birth control pills and antidepressants are not menopause care. They're band-aids, right? Or putting in an IUD or having an ablation for heavy flow. The start is with progesterone. That's what's deficient that's causing a lot of your symptoms, psychological, physiological as well. So, you know, adding in progesterone or as we talked about, chase tree or maca, either way, you may need to go outside your regular doctor's office. You may need to work with a functional medicine practitioner. I do love the Dutch and I love the GI map to help understand and get a really clear window into what's happening. But if you don't want to do all those tests or if they're outside budget, then still work with a hormone literate doctor who's going to say, right, listen, for some doctors, they may just test your blood. Some doctors may just test your symptoms. You should always make sure you're going to get retested, but you know, you can, every state has at least one local compounding pharmacy in every state. So call your local compounding pharmacy and say, can you please hook me up? Who are either your naturopathic physicians, nurse practitioners or hormone literate MDs or GYNs who can prescribe hormones or who can guide me through perimenopause. And so knowledge is power and working with someone really good from the get-go is the greatest investment that you can make in yourself because you will have your quality of life. You will be able to do your job. You will save money from hiring a divorce lawyer.
Jaclyn (40:38.311)
you
Esther (40:39.382)
You will improve your relationship with your family and your kids and your friends and you just you will not want to mass murder everybody. You'll be happier mood, sleeping, you know, happy romantic sex without dryness, without pain. You'll have a libido. You don't have to gain a ton of weight or any weight in perimenopause and menopause. So it can actually be an amazing time in your life. But early intervention is really the biggest, biggest, most important step you can take.
Jaclyn (41:10.923)
I love that. You know, I remember in medical school, someone teaching that health is, it's not only the absence of disease, it's like the ability to live with freedom and do what you want and feel your, be your best self. And that's what's resonating for me as you speak is like, you can have that through this time that sometimes feels difficult for women. And I love that that's really the goal that you're talking about is that optimal, beautiful life where you get to really be that full expression of yourself without limitation.
Esther (41:14.734)
and
Esther (41:36.438)
Yes. Yes. And also, again, when you have a team in place that's going to support you, you're going to free up mental real estate. mean, how many of us have been up at two in the morning Googling, like, how do I get rid of my hot flashes? How do I sleep through the night? What's happening to my body right now? I'm 54, right? Versus investing some time and financial resources into just a session or two with a practitioner who's going to meet with you regularly. Once you're once you're out of the moving parts of perimenopause, like you said, like once your hormones are low in menopause, you're stable. It's like, that's when I get the best results with women losing weight and women who have never been able to lose weight or haven't lost weight in 10 years with very stubborn body fat and just absolutely no energy and brain fog. They're like, my God, you brought me back from the dead. Like, is this still possible? Yes, it's totally possible. So, but again, I don't want women waiting 10 years waiting. I want them to address it in real time as it's happening. And you can say, okay, you know what you're doing. I'm going to work with you. I'm going to tell you what my symptoms are. I'm going to check in until my hormones are stable. And then, you know, we'll retest as we go. And then you just move on with your day. You don't even have to think about it. You just are like, all right, I feel good today. Even on crap night sleep, I feel good today because got my hormones, I'm eating my protein, I'm getting my workouts in and, you know, it can really be amazing.
Jaclyn (43:13.931)
That is amazing. Well, thank you so much. It's always so awesome to have you on the podcast. And you mentioned it a couple of times, but Esther's newest book, See You Later, Ovulator, which is absolutely the best title I've ever heard. You can check that out if you want to learn more about her approach to perimenopause and menopause care. where's people's best place to find you on the web?
Esther (43:25.687)
Thank you.
Esther (43:34.787)
Yes, please find me on Instagram at gorgeousester and at estherblum.com. E-S-T-H-E-R-B-L-U-M. We have so many resources there for you. And depending on when this comes out, I'm doing a World Menopause Day event as well that will be recorded and accessible through the site. So we're going to have just…so much to support you with and get you through.
Jaclyn (44:04.491)
Fabulous. All right, well thank you so much. Have a great day.
Esther (44:06.369)
Thanks, Jackie.
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About our speaker
Esther Blum is an Integrative Dietitian and Menopause Expert. In the past 27 years she has helped thousands of women master menopause through nutrition, hormones and self-advocacy.
Esther is the bestselling author of See ya later, Ovulator; Cavewomen Don’t Get Fat; Eat, Drink and Be Gorgeous; Secrets of Gorgeous; and The Eat, Drink, and Be Gorgeous Project.
Widely respected as an industry expert, Esther was voted Best Nutritionist by Manhattan Magazine. She has appeared on Dr. Oz, the Today Show, ABC-TV, and Good Day NY. Esther is an in-demand authority frequently quoted in goop, Well + Good, Forbes, Time Magazine, The New York Post, The Los Angeles Times, In Style, Bazaar, Self, Fitness, Marie Claire, and Cosmo.
Esther received a Bachelor of Science in Clinical Nutrition from Simmons College in Boston and is a graduate of New York University, where she received her Master of Science in Clinical Nutrition. Esther is credentialed as a registered dietitian, a certified dietitian-nutritionist and a Certified Nutrition Specialist (CNS), the certification from the Board for Certification of Nutrition Specialists (BCNS). She is also a member of the American Dietetic Association, Dietitians in Functional Medicine, Nutritionists in Complementary Care, and the Connecticut Dietetic Association.
Show Notes
Learn more about Esther Blum and follow her on Instagram @gorgeousesther.
Check out Esther’s other DUTCH Podcast episode, Finding Comfort in the Menopause Metamorphosis, to hear more tips about transitioning into menopause.
Become a DUTCH Provider to learn more about how the DUTCH Test can help support your patients in the phases of perimenopause and menopause.
Please Note: The contents of this video are for educational and informational purposes only. The information is not to be interpreted as, or mistaken for, clinical advice. Please consult a medical professional or healthcare provider for medical advice, diagnoses, or treatment.
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