Debunking Menopause Myths with Dr. Sara Gottfried

Welcome to our course this is a totally new way of thinking about perimenopause and menopause you're in the right place if you have symptoms maybe you're 35 40 45 50 55 if you have symptoms that are starting related to perimenopause or menopause or if you just want to see what's the big deal how do I get prepared for it how can I increase my awareness and my knowledge you're in the right place too you know I went to Harvard Medical School I went to MIT I did my residency training at the University of California San Francisco but what really has helped me prepare for this course is being a female and struggling with some of the symptoms that many of us experience through perimenopause menopause and a lot of that starts in your 30s sometimes as early as your early 20s so we're gonna get into the details today we're going to talk about all the different issues that you might be facing in perimenopause and menopause and I'm just so delighted that you're here I want to talk a little bit about my personal experience with perimenopause because I felt like nothing prepared me nothing got me ready for this dramatic change that occurred so I'm 55 now I'm still cycling the average age for menopause is about 51 to 52 and my symptoms began when I was about 35. so that's when my period started to get a little closer together instead of every 28 days there were about every 25 days 26 24. I had a lot more pre-menstrual syndrome I had this feeling of just being overwhelmed I just couldn't cope with kind of what was coming down the pike at me in terms of life I had one kid and I really struggled with motherhood I remember driving home from working in the clinic I'd work about a 10 hour day and I would just sit in the driveway and just prepare myself kind of brace myself to walk into my home and to show up for my husband and my baby at that time I just really I felt like I was struggling and I didn't know why I went to my doctor I explained what was going on with my periods with my stress levels I was struggling also with weight at that point and my doctor didn't offer me much he suggested that I consider exercising more eating less and maybe take an antidepressant and that did not feel right to me that did not feel right so that's what started me on the path of really looking at the hormones of perimenopause and menopause so that I could prepare myself better but also help my patients my patients that were struggling in the way that I was struggling and they weren't finding answers from their primary care physicians so as I got a little deeper into perimenopause as I turned 40 and then 45 and then 50 my symptoms started to shift so my periods got even closer together every 22 days every 21 days but I also started to notice other changes I had night sweats the week before my period I had issues with my blood sugar and my doctors seemed totally unconcerned I was concerned I didn't like that my fasting glucose kept climbing every year and then I would say after 50 that's when I started to have some memory issues so I just couldn't remember things the way that I once used to be able to I used to have a mind like a steel trap I used to be able to you know remember every single word in a sentence that I wanted to and I realized I had to reach a little bit more so if you're struggling with any of these symptoms I just want to reassure you that you are in the right place we are going to talk about the root causes of the symptoms why do they occur because when you really understand the mechanism when you understand what's going on with you biologically that allows you to really be set up for the kind of solutions that are going to help you in a major way solutions that are sustainable that are natural that are really going to work with your body to get you back into hormonal Harmony the good news is that you don't have to be a passive bystander to all of these changes that are coming down the pike for you so whether you're 30 or 35 40 45 50 or even older you can be empowered to deal with some of these symptoms that you're struggling with and to really step into the role of Citizen scientists so that you can figure out okay here's what's going on here's the root cause here's what I'm going to do about it I'm going to be sharing with you a three-step got freed protocol where where you use lifestyle tweaks lifestyle redesign as a first part of the protocol second part is to use Herbal allies third part of the protocol is to use bioidentical hormones when they're needed to address your symptoms it's a crash course on your hormones the estrogen progesterone testosterone that's at the root of the symptoms that you're experiencing but also the secondary hormones things like cortisol thyroid insulin how those can really affect the way that your brain functions the way that your body functions your weight on the bathroom scale the amount of energy you have to face the day the symptoms you might have related to sex drive or vaginal dryness we're going to get into the details you're going to learn the ecosystem a central part of the story with perimenopause and menopause is the role of the female brain the brain goes through an energy crisis this begins right around age 40. so you may have noticed this it could be that you walk into a room and you can't remember why you can't remember that word on the tip of your tongue you keep losing your phone or your keys this is the female brain in crisis the female brain and the way it utilizes glucose changes up until pre-menopause through say age 35 most of us are using glucose almost exclusively as a fuel for the brain but what happens around 40 is that the female brain starts to shift the mitochondria the PowerHouse is inside of your cells can no longer use glucose the way that it once did so the result is kind of this slowdown this low brain energy State and when I describe that to patients in my office they get it they're like oh my gosh Dr G I totally have that what do I do I've been taking care of women through perimenopausal menopause for about 30 years and what I find time and again is that women really struggle with symptoms they haven't had a lot of information or education about what to expect as they turn 35 and older and start to experience some of the symptoms of perimenopause and menopause and so that's what we're going to do with this course we're really going to increase your awareness your understanding your knowledge base so that you can face your symptoms you can face the root cause of your symptoms and you have a long list of solutions that are sustaining able that are really effective and evidence-based so that you can feel your best through the transition of perimenopause and menopause what I find talking to women is that there's a lot of misinformation there's a lot of myths out there about what you're up against in perimenopause and menopause one of the things I thought myself when I was in my 20s and 30s was that menopause was a cliff I'd fall off of around age 50 and I didn't really have to worry about it until then but the truth is your hormones start to change sometimes in subtle ways sometimes in dramatic ways beginning much earlier so that can be in your late 20s especially with testosterone and DHEA it can be around 35 to 40 as you begin to run out of right bags with progesterone declining and then in your 40s you might notice that your estrogen begins to decline so those are some of the changes that occur much sooner than the average age of menopause in fact a lot of us go through perimenopausal symptoms for 10 years in my case 20 years before the onset of menopause there's other people who are really well prepared super aware about the changes that are occurring they're on top of their hormones and they often struggle with symptoms for a much shorter duration maybe just a few months and what we want is for you to have choice to really have a lot of awareness and knowledge about how to deal with these symptoms that you're experiencing so that you can have the best transition ever another thing I hear from my patients is that they go to their doctor with symptoms of perimenopause maybe it's I can't sleep anymore or I'm a total at home I just am yelling at my children I don't know why I feel so irritable I'm more moody or I don't have energy like I used to or I'm so hot all the time I'm having these hot flashes power surges I've got night sweats I've lost my sense of humor I've lost my sex drive it is missing in action I don't even know if I want to find it so they take those symptoms to their doctor and often their doctor is not very helpful their doctor says something like you're getting older you're 42 you're 45 you're just getting older this is how it is accept it get used to it and I just want to say no that's not right it's not accurate there's so much that you can do so that this time really supports you and it does what I think it's meant to do which is to help us transition from kind of those householder years that we have through our 20s and 30s you know some of us are working on Career some of us are working on families some of us are doing all of the above it's a time to shift from especially 40 to 65 to shift from that householder role to more of a role of connecting to your purpose connecting to your mission it's almost an initiation I think of perimenopauseative menopause as an initiation a time to step back from dominant culture and to really understand am I living life on my own terms am I still controlled by my mother's script or my father's script or am I living my life in a way that is completely aligned with what it is that I want so perimenopause is known as you know the period of time around menopause so it can last a few months it can last a few decades depending on how attuned you are to the symptoms but what's happening behind the scenes is that your ovaries if you still have them are producing less and less of the sex hormones progesterone first and then estrogen and then for some of us testosterone so you're producing less sex hormones and once you drop below a certain threshold that's when symptoms can begin those can be physical symptoms it could be breast tenderness it could be that fibroids are growing in your uterus you've got heavier bleeding it can also be emotional symptoms more irritability more premenstrual syndrome more premenstrual dysphoric disorder so there's a lot of different symptoms that can result from perimenopause and they can also vary Woman to Woman menopause is when you go a full year without a period so really menopause is just one day it's when you have your one year anniversary and hopefully you throw yourself a menopause party so menopause is really a biological construct a year without a period or if you've had say a hysterectomy it's when you go uh with a an FSH a follicle stimulating hormone level that's greater than 25 or 35. so menopause is a biological construct but it's also a socio-cultural construct and I think this is super important because I remember when my mother was going through menopause and she said to me Sarah I feel like I'm disappearing I feel like there's so much emphasis you know when I read Vogue magazine or when I'm online when I'm watching TV shows there's so much emphasis on a youth culture and once you hit menopause you just start to disappear it's like you're on the sidelines you're more dismissed and I was so sad to hear that from her and I made a vow at that time to just say whoa stop we can't do that hold up we need to really value women as they're going through this experience of perimenopausal menopause we need to support women so that we can take care of ourselves in a whole new way we need to tend and befriend each other so that we can activate oxytocin get that together with estrogen so that you really feel bonded and connected and loved and supported when I was living in Alaska getting ready to go off to Harvard Medical School in Alaska they used to have the stain that if you go to Harvard you have to overcome it to come back into the state so I was thinking about that but I was also thinking about one of my mentors Christian Northrup and Christian Northrup who wrote women's bodies women's wisdom said something really valuable to me she said that when you're in your reproductive years so that's you know from puberty until you stop cycling regularly around 35 40 45 when you're in your reproductive years you have a different level of estrogen and progesterone and testosterone every single day of your cycle those different levels of hormones in some ways force you to be accommodating force you to kind of roll with the punches and sort of put up with all the things that are coming your way it kind of works with those of us with the trauma history and we're people Pleasers so we accommodate accommodate accommodate then when you hit perimenopause and you no longer have this kind of predictable level of hormones each day the hormonal Veil comes off and you start to speak your Truth For the First Time and that's what I get really excited about with perimenopause menopause because it allows us to step into our power and to really make choices about how we want to live our lives to look at things like people pleasing to see how some of these behaviors either are serving us or no longer serve us so the more that we can step into our power understand what's going on with our bodies that allows us to really have the wind at our back I think of these hormones as really supporting us in speaking Our Truth getting radically honest and going through this initiation process what is perimenopause what is menopause I think it's really important to understand that estrogen is the primary starring role of the transition that women experience through middle life so estrogen is a primary regulator of the female body it does a lot of different things at different life stages so it's pretty low when you're first born you get a little estrogen from your mother but when you hit puberty that's when your estrogen levels start to fluctuate quite a bit and so that's when a lot of women will notice the acne the breakouts there you have breast development they've got development of their uterus they get their menstrual period so puberty is a huge change in terms of the female body then there's this relatively stable period of time during your reproductive years so that's usually during your 20s and 30s sometimes into your 40s and then perimenopause hits perimenopause is kind of like puberty in reverse where initially progesterone starts to decline and estrogen fluctuates wildly and then in the second phase estrogen declines and then in menopause you're in a state where estrogen progesterone are low and you may or may not also have low testosterone so the definition of perimenopause is that it's the period of time around menopause so it's typically about the 10 years from say 42 to 52 somewhere in there where you notice some subtle changes usually first with your menstrual cycle but then you can broaden it to include emotional symptoms like irritability mood swings you can have more depression you may notice hot flashes and night sweats you may notice bladder infections decreased sex drive you may notice that your joints are not quite as lubricated as they used to be you might have frozen shoulder or you're stiff in the hips all of these things are related to the changes in estrogen progesterone and testosterone menopause is when you go one year without a period so full stop one year it's just one day in your life menopause is that one year point of no bleeding after that is post-menopause so how do you know if you're in perimenopause I have a lot of women who are in that 35 to 45 year age group and they're just like I don't know is this depression or is it perimenopause how do you tell the difference so I want to go through some of the questions that I have in my book the hormone cure so perimenopause how do you know you're in it well one thing is that say over the last six months you may have noticed that some of your householder responsibilities like going to the grocery store or your chores at home cleaning up around the house you're just a lot less enthusiastic about it in fact um it's really the last thing on your mind you may notice that you want to be more socially isolated you may notice for instance that when you go to a party you can't wait to leave when you have plans you might be thinking I really hope they cancel that is perimenopause very common a lot of women notice that their pants don't fit the same way they can't button their pants they've got more belly fat than they used to because one of the changes happening behind the scenes is the way that estrogen is talking to insulin so the distribution of fat which starts to deposit fat at puberty right at the breast and at the hips that starts to reverse and so instead you get more fat deposited at the waist so this is not just an issue of not fitting into your pants it actually represents a metabolic crisis for many of us so unless you're not on top of it unless you're not you know checking your labs and staying on top of things like your fasting glucose and your hemoglobin A1c levels and what's happening when you eat carbohydrates this can lead to some weight gain and some fat gain especially after the age of 40. a lot of women describe to me emotional instability they just find that they are crying at work they are yelling at their kids and they just feel like their emotions are much more Amplified than what they were 10 or 15 years ago many women describe to me that they are just sick of exercising they feel like it does nothing anyway so why bother with exercise they're too tired anyway to do it so your fondness for exercise might change as a result of perimenopause you might notice difficulty sleeping so in the first phase of perimenopause when your ovaries are making less progesterone what you may notice is that you don't sleep all the way through the night the way that you once did you may notice more anxiety you may feel like those periods are getting closer together and closer together all of these are low progesterone symptoms and that is the first half of perimenopause second half is low estrogen but it's it's valuable to kind of separate these symptoms so you know the root cause you may be waking up sweaty in the middle of the night you may be feeling like oh my gosh I have to change my sheets again I have to change my nightgown maybe I need to change my partner very common and very menopause you may notice more wrinkles so estrogen one of its jobs is to kind of gird the skin of your face to keep you from getting wrinkly so you may notice more wrinkles here and here and you know that's that's part of the decline in estrogen you might notice that you are less interested in grooming so it's it's so fun for me because I'm going through perimenopause at the same time that my daughters are well into puberty and I can tell you my 17 year old cares so much about what she looks like when she walks out the door so she's like impeccably groomed her makeup is perfect her hair is flawless and then I'm in the kitchen working at the table wondering when did I last wash my hair I'm not really sure so that interest in grooming habits comes from the increase in estrogen together with the connection to oxytocin makes you care about your girlfriends when you're a teenager it makes you care about how you look uh it makes you care about attractiveness and then you kind of get the reverse once you hit 40. so your menstrual cycle might become totally unpredictable you may not know if when it's going to come if it's going to be heavy or light if it's going to be spotting or flooding or somewhere in between very common in perimenopause you may notice that you care more about chocolate or alcohol than you do about sex so that's very common for for us who are going through perimenopausal menopause and uh you know there are some folks who just feel like why do I want to keep doing this like maybe the shop is closed so sex drive is about 70 hormonal and definitely the hormonal changes to perimenopauseam menopause can make your libido take a hit the other thing that I see women do as they go through perimenopause of menopause is that they they feel like some of the lifestyle changes that they need to do to survive perimenopausal menopause to thrive through perimenopause and menopause things like stop eating sugar no more packaged Foods no more processed foods exercise more lift heavy weights do some meditation every single morning they feel like that sounds totally overwhelming I just can't even imagine fitting that into my life that is a symptom of perimenopause so I just want to tell you that if you're feeling less gung-ho about Behavior change that is part of the symptoms of perimenopause menopause and the good news is we've got your back we've got solutions that are going to be palatable that you can start to make in you know small ways because we know that these baby steps that you take some of the solutions that we're talking about in the course when you take these baby steps and you start to aggregate them over time they add up to Major transformation and that's what I want for you as you make your way through perimenopause and menopause we've talked about estrogen progesterone and testosterone and how they're really the central story of perimenopause but I think it's important to realize that hormones don't exist in a vacuum so there's really this whole Orchestra of your hormonal system and there's three hormones in particular that I think are important to pay attention to so estrogen cortisol and thyroid we've talked about estrogen already it's the primary regulator of the female body it's in relationship with progesterone I think of them as Tango Partners so you want them to be in really good balance where one doesn't dominate over the other so you want balance between estrogen and progesterone but estrogen also crosstalks with thyroid hormone thyroid determines the speed of your metabolism it's like your gas pedal and it it decides how fast or slow you burn calories it's involved in inside your cells with how fast you're making biochemical products cortisol is so essential it's really the most essential hormone out of all the ones that we're talking about in fact I had someone on a podcast say oh it's like Michael cortisol Leone cortisol is kind of like the the highest priority because you can live without estrogen you can live without progesterone testosterone but you really need cortisol you need thyroid too but you definitely need cortisol it's involved in so many different things it controls your blood sugar it's involved in your ability to have a stress response fight flight freeze it's also involved in your response to your immune system's responsive modulates the immune system so these three hormones estrogen cortisol thyroid they all crosstalk and you want them working on your side you want them supporting you so yes we're going to pay a lot of attention to estrogen progesterone and testosterone but I want you to realize that there's this larger orchestra that includes estrogen thyroid and cortisol and the way that they work together so we've defined perimenopause we've got a sense of some of the hormonal changes that are underpinning the symptoms that you might be experiencing and I want you to pay attention to these Triads so estrogen progesterone testosterone but also estrogen cortisol and thyroid so we want to be thinking about how they're working together and when they're not working together how that's going to trigger symptoms for you let's talk about some of the hormonal changes that occur during perimenopause and menopause so I want to show you a figure there's a really helpful illustration that we're sharing with you that shows the symptoms as a function of time and what I'd like for you to do is to to see between the age 50 and age 55 there's a dotted line that says last period so we know the average age for menopause in the United States is around 51 to 52. and if you take that dotted line and bring it up to the top of the figure what you'll see is the symptoms to the left that are associated with perimenopause that includes weight gain fibroids more cramping breast tenderness irritability more hunger insomnia vaginal dryness loss of libido and then there are the symptoms that tend to happen towards the end of perimenopause and into menopause and that includes hot flashes night sweats breast cancer depression heart disease more vaginal discomfort osteoporosis incontinence what I want you to notice is that a lot of these symptoms especially the mood swings hot flashes night sweats low libido insomnia these are coming from the brain coming from the brain so a lot of us are thinking perimenopause and menopause it's all about my ovaries no what's happening is that there are changes occurring in the female brain and they're driving a lot of your symptoms of perimenopause and menopause in functional medicine we use a systems biology approach and I think it's valuable to spend a moment quick science moment on the systems biology of what's happening in perimenopause and menopause so the systems biology of your body in pre-menopause is working pretty well for those of us who have regular periods every 28 to 30 days you've got you know these changes in your estrogen progesterone and testosterone each day testosterone tends to Peak around day 14 estrogen Peaks around day 12 progesterone Peaks around day 21 or 22. so these are kind of the normal cycle of your hormones and then the control system stops working so well in a systems approach to hormones you really want to start at the top which is the female brain the parts of the brain that control your hormones are called the hypothalamus and the pituitary so these two parts of your brain are involved in controlling your levels of hormones and what happens is that once you start to run out of ripe eggs in your ovaries the message the feedback loop between your brain and your ovaries starts to falter so it doesn't work the way that it once did you can think of the hypothalamus and the pituitary as kind of the boss of your endocrine organs and the rest of your body so certainly your ovaries but also your thyroid gland also your adrenal glands which are the place where you make most of your sex hormones including cortisol pregnenolone DHEA so the control system starts to get wonky typically sometime between 35 and 45. the other thing that you want to keep in mind is that if you're someone who's experienced a fair amount of trauma either as a child or as an adult that can really disrupt your stress response system and it can disrupt the control system for your hormones so what I see time and time again is women who've experienced significant trauma maybe they've got an elevated a score adverse childhood experiences and they have a rockier time going through perimenopause and menopause so we want to be thinking about those Triads estrogen progesterone testosterone we also want to be thinking about the crosstalk between estrogen cortisol and thyroid and how the control system can sometimes be jacked up before you even enter perimenopause and if it is it can make the process the transition even rockier a lot of women wonder if they can do some testing blood testing to see where they are and the answer is yes and if you get told by your clinician that you can't tell that hormones fluctuate too much and it's not worth measuring them I would recommend that you find a more collaborative clinician to work with so hormone tests really give you a lot of information through perimenopausal menopause what we know is that in the first phase of perimenopause when progesterone starts to drop if you're still cycling you can measure your progesterone usually on day 21 or 22 and see if it's 10 or higher if it's less than that it means that you're starting to run out of progesterone your progesterone levels are low and it gives you symptoms like a shorter time in between your periods it can make you feel more anxious and it can disrupt your sleep so that's the first phase you can measure progesterone to assess that once estrogen starts to decline in the second half of perimenopause that's where you find that your estradiol levels are not quite what they used to be so they used to Peak around day 12 of your menstrual cycle now it might be 20 or less so you can measure estradiol as a way of checking to see if you're in Phase One or phase two of perimenopause the way that we deal with hormone therapy in terms of women going through these different phases of perimenopause is that typically we just treat with What's missing so in the first half of perimenopause when progesterone is low that's where we want to give a prescription for natural progesterone especially in women who are struggling with sleep because we know from randomized trials that it improves your sleep in the second half of perimenopause when progesterone is low and then estrogen is low you want to treat both of those in people who are a good candidate and then you can use blood testing you can do some additional testing too such as with dried urine you can check cortisol with saliva but you can use blood testing to assess where you are and then also to monitor therapy so if you're starting to notice that this is a lot of information don't worry that's a symptom of perimenopause one of the things I recommend is that you take my questionnaires so we've got a number of questionnaires in the course that you can use to identify which of your hormones are out of balance and that can then allow you to use the got read protocol to address that specific hormone imbalance one of the most common questions I get is what about hormone therapy what could I take during perimenopause versus menopause so if you're feeling somewhat overwhelmed about all the things that we've covered right now I just want to let you know that we're going to go over this multiple times so you may hear it once here and then you're going to hear it again in the future we're going to make sure that you understand this so in the first half of perimenopause when progesterone is low maybe your periods are closer together you're having trouble with sleep you're struggling with anxiety that's when I like to give progesterone so progesterone on its own I don't do that in menopause I only do that in perimenopause the first half of perimenopause if I have someone who's got low estrogen symptoms maybe they've got some memory issues they've got vaginal dryness they're noticing that their mood is not quite what it used to be that's when I add estrogen together with progesterone so that's the second half of perimenopause and that continues into menopause so estrogen plus progesterone in the second half of perimenopause continuing into menopause another question I get is why are we gaining weight and what can we do about it so there is this metabolic crisis that happens after age 40. for me it started around age 35 I just could not lose weight no matter what I tried and there is this entire change that's occurring below the hood where you can see that the way that estrogen and Insulin are talking to each other begins to change so estrogen is not what it used to be you don't have the same levels that you once did you have less progesterone less soothing you're not sleeping as well that then jacks up cortisol the next day if you don't sleep well and it leads to this redistribution of fat in your body so that you have less fat getting deposited at your breasts and your hips more at your belly there's also this change that occurs related to insulin and estrogen where after age 40 you gain about five pounds of fat and lose about five pounds of muscle every 10 years decade after decade so unless you're doing something specific about it to address your insulin to measure your insulin and make sure that you're in a good metabolic state with metabolic flexibility able to burn carbs as well as ketones metabolically healthy with a normal fasting glucose a normal hemoglobin A1c optimal range for your blood testing unless you're doing something really specific about it you may notice that you're gaining weight through this process so the more that you're going to pay attention to your food the way that that is helping to feed your hormones and also keeping your insulin in check that's going to really help you prevent the weight gain that can occur for a lot of us as we go through the transition this is the end of part one you might be feeling like wow that's a lot of information it's a lot of detail quick reminder that we're going to get into all of the details as we get further in the course so that this really makes sense to you and you understand step by step what solutions to put in place

Channel: Commune

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Keywords: wellness, well-being, commune courses, commune, online learning, health, relationships, yoga, online yoga, workout videos, nutrition coaching, spirituality, podcast, mental health, personal development, holistic practices

Id: o370xEw9Tis

Length: 37min 35sec (2255 seconds)

Published: Tue May 16 2023