Doctor Shares: How to Navigate Perimenopause Hormone Shifts with Dr. Carrie Jones

If you are a woman between the ages of 35 and 50 and you are waking up at 3am with racing heart anxiety or experiencing more weight gain that your doctor is telling you is just because of aging, then you are likely being misled. When we're talking about the problem, there may be a specific hormone imbalance that is leading to these symptoms. Today we have Dr. Carrie Jones, who's a naturopathic doctor, a Menopause Society certified practitioner, and the expert who ran the science for the Dutch test. To cut through the confusion and dive into hormone health, she's going to reveal the one simple hormone fix that actually improves your 3am waking and insomnia. Whether there's any legitimacy to various viral wellness trends like lymphatic drainage and seed cycling, and why HRT is protective for your brain and your heart, and the truth about bioidentical hormones, it is a huge pleasure to welcome Dr. Carrie Jones to the show. Let's dive in, Dr. Jones. Many women are experiencing new anxiety or 3am waking, and they think that it might just be stress. What specific hormone shifts are happening underneath the surface that's contributing to these symptoms, especially at the onset of perimenopause?

Well, it definitely could be stress. There are a lot of women really stressed out right now. But what happens is we have a brain hormone called gaba. G A B A gaba. It's our inhibitory, relaxing, calming, everything's gonna be okay hormone. And unfortunately, it declines with age. So in humans, it starts to decline, decline, decline. But when women, they get hit harder because our hormone progesterone, when progesterone breaks down, it can also support gaba. So we have been sort of doubly supported in this calm, inhibitory sleep relaxation hormone for many, many years. And then in perimenopause, we don't make it like we used to. So we don't. We're not making GABA like we used to. We don't make progesterone like we used to. And all of a sudden we're like, ah, I maxed out, I'm burned out, I'm stressed out, I'm anxious. And it hits hard at 3am, 4am, 2am for a lot of women.

And when you think about that being a specific issue for a lot of women, what's the single most effective non HRT intervention that a woman could implement in order to improve those symptoms?

So she doesn't want to do hrt, which is fine. Then we do actually a lot to focus on just sleep hygiene. So I know you said, like the number one thing. It number one thing depends on if we can figure out maybe what they're doing. So, for example, I just consulted on a case where a woman was having a glass of wine every night. I was like, no more glasses of wine. Stop wine. That is absolutely keeping you up. I have other cases I've consulted on where women are up late, they get their second wind, they're working, or they're watching something really stimulatory. Everyone seems to be into like murder mystery podcasts and like exciting things. And I'm like, okay, not, don't do that. Let's not do that for other women. It's more herbal based or it's more nutrient based. Where I'm like, I think we truly need some calm here. I think we need some magnesium or I think we need some herbs like skull cap or passion flower or milky oats. Like things that are very calming and helpful to the nervous system. Maybe somebody sleeps with somebody who's mouth breathing or snoring or keeping them awake all night. So you can see by focusing on these, all these other aspects of sleep. Is progesterone helpful? Of course, for sure. But if you don't want to do that or it's not the right time for you, we have a lot of other options as well. And we have a lot of options to support gaba. Even some of those herbs that I mentioned. GABA itself comes as a supplement that we can use to take before bed and support a good night's sleep.

Yeah, I wanted to start with a non HRT intervention because I do want to get into hrt, but I think that with so much emphasis on HRT right now, I like, want to keep drawing people, especially like women who are going to their doctor trying to just jump on hormones to say, like, let's also expand the toolbox to thinking about other ways that, you know, you want.

To be thinking, oh, my gosh, yes. And the good thing is, like I said, there's so much even, even tea, you know, even women. I mean, everyone knows chamomile tea. But even getting deeper in, such as holy basil tea or even the, you know, going further with the full on sleepy time tea as opposed to chamomile by itself. One, it's a relaxing nighttime activity you can do. And two, the things inside it are genuinely calming, relaxing and soothing to the system. But if you need like the next level up, that's where we get into the true herb that, that the true mineral, like magnesium, taking it before bed, people asking about Melatonin. Should I take melatonin? I'm like, believe it or not, melatonin production goes down as we get older also. So for some women, doing like a half a milligram of melatonin an hour or two before bed is the, like, thing that helps so much with their sleep cycle. So we have a lot of options that are not specifically hrt.

And I think that when it comes to the supplements, that there are so many options that are available, like doing a magnesium GABA blend, even since there's a lot of combo products that exist, or a low dose of melatonin. And if one thing doesn't work for you, it doesn't mean that you should just give up on all supplements because it likely means that you need to figure out what works best for you. Would you agree?

Oh, 100%. And I love, actually I'm a fan of the blended. I understand why people like single dose. You know, some. Some women are sensitive bunnies, and so they need one ingredient so they know if it's working or not. And others are like, no, knock me out. Like, give me the blend of five things. And the reason the blend is there is because we need to reduce cortisol. Cortisol. We need to get you in a calm state of mind. We need to help relax you. And we can do this through various aspects. And that's why, you know, a blend might have five things in it, because maybe two things reduce cortisol. Two things are known to help, you know, with resiliency or make you feel less frazzled. Maybe something is magnesium. You know, like, so we, we get these nice blends that cover a few different angles of why you're not sleeping.

Yeah, I think that's great. And can you explain the connection between cortisol and your sex hormones? Because I think that a lot of women just think that it is a sex hormone issue that they're experiencing and don't tie the potential correlation to imbalances in cortisol.

So cortisol is one of our stress hormones, but it actually does a ton in the body. We can't live without cortisol. When cortisol goes up, it increases our blood sugar for survival. It helps reduce inflammation. Like, it's really helpful. The problem is when it's chron up, then the body goes fight or flight. Clearly we're fighting a dragon or a tiger. I'm going to have to shift a bunch of things to, to make this fight happen. So when cortisol is chronically high, reproduction is not the priority. And even though a lot of women at this age are not looking for reproduction, the body doesn't know any better. And so it's like, why would I make estrogen? Why would I make progesterone? Why would I make testosterone? Right now you need to fight the tiger, and that's the priority. So we get this pivotal in high cortisol states of, oh, we're not going to make those sex hormones right now. We're going to focus on the stress state that's happening. And so women will say, my PMS is worse, my periods are irregular, my perimenopause symptoms are bad, my, my periods are heavy. You know, they suddenly get all these things, or if they're trying to get pregnant, because for sure, women in their 40s are trying to get pregnant, they'll be like, I'm really struggling to get pregnant. I bet it's age. I'm like, I don't know if it's age or if it's the fact that that's not the focus. Your body's focused on this chronic high cortisol state. And not only sex hormones. High cortisol can affect, as I said, blood sugar and insulin and thyroid, and the list goes on.

And as women go through perimenopause and menopause, it becomes harder for them to manage all the stressors that they've had in their life. Where a lot of women will say, I haven't actually increased any stress that I'm experiencing, but I feel like I can't manage the level of stress that I used to be able to manage. Can you explain why that is?

Yeah, I think a big one, honestly, is the. That hormone I mentioned in the beginning, gaba. So gaba, being our calming, relaxing inhibitory, it is one of a few hormones that also puts us into what we call a parasympathetic state. So our relax, our, you know, digest our rest and digest or calm our heel state, as opposed to fight or flight. And so when we don't have gaba, we don't have this much of this other hormone called oxytocin, then the body struggles with recovery, right? It struggles with repair, it struggles with, I'm fine, this is fine, I can totally handle this. That mantra that we used to have when we were younger of, I got this, ain't no thang, is suddenly like, I don't got this. I'm anxious, it's too much, I'm overwhelmed, I'm burned out. I don't know that I can do this. So we get this instability of what we used to be able to handle is suddenly perceived as a much bigger mountain once we get into perimenopause. And honestly, demands do go up or they shift. You know, when women get into perimenopause, their body's changing, which they feel they don't have a lot of control over, and that's scary. Their children are getting older, or maybe they're trying to get pregnant for the same first time. Their parents are aging. They're usually at the pinnacle of their career and heading into the next decade where they're sort of on top of their game. Like, on top. Top is the expert of their game. Marriages are starting, marriages are collapsing. You know, it's. There's a lot. Health issues come up more readily because we're just aging more in the body. And so it can absolutely be a lot and feel a lot in the body.

Yeah, that's a good point. To tie in those life factors that are happening at the same time. A lot of people refer to this time in life, perimenopause, as the zone of chaos when it comes to our hormones. And I'd love for you to explain the three stages that you break perimenopause down into or maybe even start with. Why do the explain it as the zone of chaos? And what are the three stages that you've identified for perimenopause?

So I. I think the zone of chaos is like the most perfect description. There was a researcher, Lisa Moscone, and she described it as like living through a remodel. So if anyone's ever remodeled any part of their house or their whole house, but you still live there, like, that's what it sort of feels like. Everything's changing, but you can't do anything. You can't leave and go, you know, live in an Airbnb for a while. And so what happens is with your menstrual cycle, it's a pretty set roller coaster. So the roller coaster you get on in your period, and then it goes up and then it goes down. You have a loop de loop, and that's ovulation. And then it goes up and down again, and then we start all over. You get your period, if you're not pregnant, move on. In perimenopause, the roller coaster can go off the track and on can get back on the track. So you may have a few normal cycles, and then you may feel completely off the track, like you're on a totally different roller coaster track. And that can happen for a while, and then you can get back on your normal track again. You're like, okay, what the heck happened? So it feels very chaotic because you've been used to a particular roller coaster track for decades and all of a sudden it's changing. Eventually the track will flatten out and you will lose your period and then you will move into menopause, which is when you go 12 consecutive months with no period, and then congratulations, the next day you're considered postmenopausal. Now you said the three stages. There is a group, a workshop that happened called the straw workshop. And we often use these stages for research based purposes when they're trying to classify where a woman would sit in a research study. So we have early perimenopause. And the definition of this I don't fully agree with it, but I understand it's for research purposes. The definition is if your period is changed by stage seven days. So if you used to be a 28 day girly and now you're a 21 day girly, congratulations, you're considered early perimenopause. What's interesting though is most women don't get cycle changes at first. They get sleep changes, they get mood changes, they don't get the cycle changes until we move more to through perimenopause. Then they call it late stage perimenopause, which is where you've skipped two cycles in a row or 60 days. Once you've skipped two cycles or gone 60 days, congratulations, you're considered late stage perimenopause. Neither stage accounts for symptoms or your age or anything like that. And then once you've gone 12 months, no period, then you are considered menopausal. You walk through that door and on the 13th month you're post menopausal. So I argue that there are a lot more benchmarks along the way, especially as it relates to what symptoms are you having? Are you starting to skip cycles yet? How old are you? Like what's going on? And then. Or have you had a hysterectomy? Do you have an iud? Have you had an ablation? There are women who go, I don't cycle at all because I had an ablation, or I had a hysterectomy, but I still have my ovaries. How do I classify myself? And so I feel for research purposes, I understand why they created it, but I'm like, oh, we are so much more complex than that. We have a lot more options we should have. Why want the whole Crayola box, not just three?

Yeah, it's A good point. Can you talk about how a woman would know that they're entering perimenopause? What are the most common telltale symptoms that women will likely experience? Since it is so symptom based, there's.

No test to determine perimenopause. We would just as you said, we use symptoms and age. So if you're about that age, so late 30s into your 50s, and you are starting to experience hormonal changes, so early perimenopause, we tend to see the brain fog kicks in some, the sleep issues start, the mood issues start. Women may notice some weight gain, maybe some joint pain or muscle pain that comes and goes. The hot flashes, the night sweats, the vaginal symptoms, they don't usually come until a little later when estrogen drops because progesterone drops first. So this is where we start to see heavier periods, worse pms, can't sleep. Now it's getting chalked up to, well, that's just, you know, that's just your period. That's just hormones. And it is, but it is, it is your body shifting through perimenopause. And then as you move through and you skip more cycles, and you skip more cycles, you're losing that estrogen and that's when you feel things start to dry out. So the women will say, my skin is changing, my hair is changing, my joints are changing. Everything feels sort of dry. Except I'm having night sweats, like, make it make sense. I'm like, I know it's all this hormone shift.

And then what are some other signs that are less commonly talked about because there's so many, But I feel like we could hit on maybe some that women don't necessarily correlate with perimenopause.

One, when it comes to pain, we often, we know frozen shoulder. So frozen shoulder is very much associated with perimenopause. But what we forget is that women will get other joint and muscle pains. So they'll get this like weird hip pain that happens out of nowhere and seems to be lingering or big toe pain. I was on a meeting recently and all the women were in their late 40s and 50s, and one person said, is anyone else having big toe pain? And like every other woman was like, yeah, what? That's so weird. And you know, nobody's damaged their toe. It's not from bad shoes. It's just one of those weird symptoms. So the, the muscle pain and joint pain, it's, it's called musculoskeletal syndrome of menopause. But it doesn't just happen in the shoulder. It can happen all over. Then we can get weird symptoms like itchy ears. Itchy ears that come and go. That was a symptom for me early on. I was like, what is. What is wrong with my ears? And then I realized as hormones were going up and down, it was affecting my inner ear canal and earwax and the whole thing. Phantom smells. So smelling electrical, burning wire, cigarette smoke. For me, it was sewer smell, which was lovely. I have met a few women who smell cinnamon, so they're lucky. They get a lovely smell. Yeah. And this smells, right? Like. Like if you've ever been pregnant and get weird smells, it's very similar. Women will say, but then you can get mouth things. So gingivitis, inflamed tongue, burning tongue. You can get weird zaps and sensations in your arms and legs that feel awful and out of nowhere. So you can see, we hear about the main things, can't sleep, hot flashes, night sweats. But these other symptoms because of the shifting hormones really can play a role, even digestive things. Women will say, I have heartburn. All of a sudden, I'm like, I know hormones play a role there. Although I'm gassy all the time, like out of nowhere. I didn't travel, I didn't do anything. I didn't, you know, I haven't tried anything different. It's not a worm. Like, I don't know what I did. I'm like, oh, it's totally possible. You're shifting estrogen and shifting progesterone has weakened your intestines, and as a result, you feel gassier.

So what will happen is usually a change in the gut microbiome composition in addition to changes in the lining of the gut. Is that correct?

Yes. In fact, the change in the estrogen, particularly, and progesterone will shift not only we have a. We have a thick, like, almost like a snotty layer. It's called the mucin layer, and it traps bacteria and bad things that come. Anything you eat, breathe, drink or swallow that, you know, gets. Goes along. It's like attached to a vegetable, or you breathe it in the air, it'll get trapped in the mucus layer so that you can get rid of it and it won't get absorbed. That can thin out. And then in our intestines, we have these things called tight junctions. They're almost like a gate on a fence, and they should stay closed when they're closed. And then there's, you know, a secret password. And when they Open. Only certain things can come through. Like magnesium should come through and amino acids should come through. Things you need should come through. But bad things like a parasite or a worm or you know, you're some, you know, the person who sneezed next to you like their germs should not come through. But if your gate gets rickety and your gate gets, starts missing in some boards and it doesn't lock anymore, then that's what we call leaky gut. Your gates are swinging open and allowing things to float through that shouldn't. That pisses off your immune system. And now your immune system has to come and investigate and often attacks. And when you have an immune system that's mad, you get this low level inflammation all the time. So women go, I feel bloated, I feel gassy, I have constipation. I feel like foods I used to be able to eat, I can't eat anymore. And they always caveat it with out of nowhere. Right? I didn't change anything. I'm like, I know, I know you didn't. Your body's changing, but you didn't change anything. I know.

Yes. This is a big one. Is seeing like the rise in food sensitivities and food reactions that, that people weren't experiencing and women who were able to previously tolerate foods like gluten or dairy. You know, two of the most common triggers that we see until a certain point where they're like, oh my gosh, all of a sudden these foods are causing so many symptoms for me.

Yeah, it's almost like the bucket overflows. Like maybe they, you know, they be, maybe they were careful when they were younger. They like, I know I can't, you know, I can only have one mocha a day or I have to be careful with ice cream, or I only do yogurt a few times a week. They're aware of their bucket, of how much dairy they could have, but then it seems they hit perimenopause and they go, oh, the bucket got smaller. Like, I can't hardly have dairy anymore, otherwise it overflows. And I feel terrible. Like, I know this, this definitely can happen. Now the good thing is there's things we can do but like, it's commonly, it commonly happens.

That's a great analogy. And there are, I mean, I want to talk about hormone replacement therapy in a second. But I think too, like, what we see is that oftentimes women are kind of like jumping to that and skipping the basics around, like an anti inflammatory diet and blood sugar balance and things that even if you're eating healthy that you really have to double down on in order to see those symptom improvements. Would you agree?

A hundred percent. In fact, I would say more than double down. Like quadruple down. Like you have to protect your sleep hygiene, you have to protect your stress management and boundaries, you have to protect the things you were eating that you could get away with and in the routines and habits and you know, maybe the naughty things you would do here and there, you suddenly find you have to double down on and like, or triple down on and like not do those things anymore. The alcohol you used to be able to drink, now you can't, you can't sleep, messes your blood sugar up, gives you hot flashes. And I would totally agree. HRT hormone therapy can help significantly a lot of things, but it's single handedly is not superwoman. Like, it can't just come in and be like, let me fix everything so you can maintain your old ways.

Yes, I, I couldn't agree more. Okay, so before we go there, I want to talk about wellness trends that are very hot right now that are, you know, on social media and things promising a lot of hormone health benefits. And I want to get your professional take on is this a fad or is this something that actually can help people? So the first one is lymphatic drainage. Does the lymphatic system actually play a significant role in helping with hormone health? And does the role of lymphatic drainage support factor into supporting hormone health?

So the answer to your first question is yes. So in fact, I read an article this year that talked about the influence of the lymphatic health in the ovary itself, such as our ovaries have such a complex network of lymph through there that it even carries progesterone. It's important for playing a port in part in ovulation. The, the space around the follicles, we're so focused on the follicles because that's what has the egg and makes the cells that make hormones. But the space around it contains all sorts of lymph and it's really quite active as well. And so if it gets stuck, if it gets sludgy, then it's going, it's going to contribute to issues. So yes, lymphatic movement and, and is super important for ovarian health. And then I don't know that there are outright research to say, you know, go get lymphatic massage. We've like before and after ovarian testing, I Haven't seen that. But I am a huge fan, I should say, of lymphatic testing or lymphatic massage myself. Huge. Whether you do it on yourself or whether I have a lymphatic massage therapist that I see, you know, periodically through the year, I notice a massive difference in just water retention and inflammation, pain, just places that feel stuck. So anecdotally, big fan of the. The fascial movement. And then in the research, they're showing, like, there's a lot of lymph down there in the ovaries that we don't think about.

I didn't even realize that. That's so interesting. So what are your. Outside of lymphatic massage? Is there. Are there any other forms that you really are a fan of?

So I have a vibrate plate, which I'm not even like, sponsored by it or anything. I bought it a long time ago. And I. I'm out there on my vibrate plate quite often to like, get my jiggle on and shake it all down. So I do. I do a little bit of lymphatic work before I get on. And that's probably between the lymphatic work myself and then getting on the vibrate plate. It's amazing. I also have a rebounder. I've been rebounding. I couldn't even tell you how long I've been rebounding. 20 years at this point. A rebounder, for those who don't know, is a mini trampoline kind of specific for lymphatic work? And yes, I got into rebounding when it was not cool and not trendy. I bought it off an infomercial. I'm not kidding. 20 years ago. I've since replaced it twice. But I also love to rebound. So I rebound and I have a little vibrate plate next to it. So I. I am all sorts of sexy when I'm doing my lymphatic work.

So what's the protocol? You do like one and then the other. You do them. You stack it?

If I have the time, I stack it, yes. So I'll usually rebound for a song or two, nothing crazy. And then I will get my vibrate plate is that has nine minute intervals. So then I'll do nine minutes on the vibrate plate and then if I have a lot of time, I'll do it like twice in a day. So vibrate plate in the morning and then vibrate plate in the evening. Usually it's just one a day, though, most of the time.

Okay.

Wow.

I'm only doing five minutes. So I feel like I need to step up my game.

Well, mine is set for nine minutes. I don't know. So I just, no matter what, I do the nine minute cycle and then get, get the shake on and then, and then it turns off.

Okay, this is amazing. Okay, next trend. Castor oil packs. Are they helpful or are they a fad?

I think they're helpful. So I have been using castor oils since 1999. That's when I first learned about it. Castor oil in itself is topically is anti inflammatory. Be careful. If you take it internally, that was what used back in the day. Great grandma would use, you know, castor oil as on a spoon to get rid of worms and parasites and things. So be very careful internally. But externally it's been shown to be quite anti inflammatory and it even I swipe castor oil on eyelashes and eyebrows to help encourage hair growth. If I'm going through phases of hair loss like at the my temples, then I will apply castor oil, sleep in it overnight, shampoo it out the next morning. Castor oil is thick. You do have to be careful, it can stain. But I am a huge fan of castor oil personally. Now there's not human studies, unfortunately on castor oil, I couldn't tell you. You know, here's before and afters of all these studies. But again, since having used it 26 years at this point and used it with a lot of people, I have a lot of great anecdotal feedback. It is an oil, it has to be in a glass bottle.

And the idea behind, do you have a brand that you like?

Queen of the Thrones is probably my favorite.

Okay. And then the idea behind it is that the castor oil packs help with clearing estrogen. Is that right?

All sorts of things. So when you apply it on the belly and around the liver area, it's the idea behind it is it's being anti inflammatory. It helps with digestion, helps with detoxification. And remember, we detoxify lots of stuff, not just estrogen, but definitely it's good for like when you feel bloated. If you feel like you ate something, like you're just feeling like, ugh, I shouldn't have eaten all that. Rubbing castor oil all over the belly can be really nice and soothing. Externally. Again externally.

Externally. And then the next one are adrenal mocktails. So the combination of sea salt and vitamin C and coconut water to get the potassium, there's a lot of adrenal mocktails that are trending. Do you think this is helpful or not helpful.

I will be honest. I have never gotten into, nor did I ever do the adrenal mocktails. I've known about them for a very long time. I know people. That's how they start their day. And they seem to really like them. I personally have never gotten into it.

Okay, do you do it?

We've.

We've used them on some clients that have, like, a lot of autoimmune issues where it seems like there's a lot of central nervous system dysregulation, there may be, like, undernourished. And rather than most people having issues with eating too much sugar and eating too many carbs, that they may actually need more in order to support their central nervous system. But outside of that, I've. I've never seen it to be like, something that's massively beneficial. Yeah.

Yeah. I mean, I like. Again, I like electrolytes. I like. And I like potassium heavy electrolytes as opposed to maybe all the super sodium heavy ones with very little potassium. So I do like potential. Yeah.

So what are. What's your favorite brand that has more potassium?

I have two. One is called New Ethics, New Lights, and the other is Seeking Health.

Okay, that's good.

Those are my two. They have a. They have more potassium than some of the other favorite brands out there. A lot more potassium.

So, yeah, the. The electrolytes, the very, very popular ones on the market right now, they have 500 milligrams to a thousand of. Of sodium and then not very much potassium. And it does create a stronger sodium. Sodium to potassium ratio, essentially.

Yeah. And I have. I had a friend and I were talking about this recently. She had struggled with a lot of burnout and hedonia, and she was like the perfect person to need a lot of sodium, a lot of hpa, sort of adrenal collapse. And she did great with all that sodium. And I was like, absolutely. Then they're for you. And the. The popular ones in the market were originally designed for heavy crossfitters. Right. Heavy triathleters. I mean, heavy exercisers that need all that sodium, of course, but the average person, I would argue, needs more potassium, not more than sodium, but, like, higher levels of potassium.

Agreed, agreed. I think potassium is definitely does not get the recognition that it. That it really needs.

Yeah, I agree with you.

And then what about seed cycling?

Seed cycling? There's no research on seed cycling. Oh, that's not true. I think there's one article that came out this year on seed cycling. It didn't have. There were some issues with the article. But having said that, I learned again. So I learned about castor oil and seed cycling at the same time in 1999. So anecdotally, a lot of women love seed cycling. A lot of women found a lot of relief. And even if it's not so much that it's going to magically fix your hormones, the seeds can provide good fiber and diversity into your diet. So if somebody says to me, I'm gonna do seed cycling, I'm like, go for it. Or there's companies out there that provide the seed cycling for you. And I'm like, absolutely, let's make it easy. Do it. Let's see what happens.

So seed cycling, for anyone that's not familiar, is when you eat specific types of seeds at the first half versus the second half of your cycle to help with regulating your cycle because of some of the nutrients that are in the seeds.

Yeah. Like ch, flax and sunflower and chia and pumpkin and. And you vary them. Yeah, you grind them first. Because sometimes people, I don't know if you've noticed, sometimes people hear like, oh, flax seeds are helpful. So they'll eat straight flax seeds. And the body can't break those down. You have to grind them.

Very, very good tip. So of these wellness trends, I think that it sounds like some of them can be really helpful, but also in people who are like, I just don't know where to start. What should I. What should my first step be? We don't want to overlook the basics of the importance of optimizing what we about stress, sleep, nutrition, blood sugar, balanced meals, all those sorts of things before then. You know, sometimes I think that people are like majoring in the minors and we gotta, like, pull them out of the weeds.

I love that. Yes, I would totally agree with you. Totally agree. And I'm sure you've seen the posts and the memes and the jokes on social media where people are like doing all this stuff as a full time job. And I have a full time job, like, oh, yeah, no you don't. I mean, vibration plate and you know, lymphatic massage and castor. Those are great additions. They're like jewelry. They can be super helpful, complement a whole outfit pulled together. But if you're not wearing a shirt or pants, like, we have a problem.

Oh, that's a great analogy. I love that one. Okay, and then let's talk about alcohol. You've already started to say that a lot of women will report that alcohol starts to affect them more negatively or more dramatically as they shift into perimenopause. Can you explain why that is?

Yes. So our liver changes, of course, as we get older and impacts the enzymes that break down our alcohol. And as a result, when we drink, no matter what it is, a lot of women will say, I feel more hungover. I feel hot flashes, night sweats. I feel I'm awake all night long. My heart races. I hear that one all the time. My brain just doesn't function very well like it used to because the, the liver is just, you know, it's not a, it's not a 20 year old liver anymore and your hormones are shifting and so it's going to struggle to break it all down. And what's interesting is when I was in full time practice, I would have all these women in their 40s go, you just wait. You just wait. When you turn 45, you won't be able to drink wine anymore. And I was like, that's ridiculous. Nope, they were right. I rarely drink because I get all the symptoms. You know, feel terrible, don't sleep, heart races. Even if I do one glass of wine and people will argue with me. They will say, well, are you drinking organic biodynamic wine? You know, like that will make a difference. I'm like, it doesn't. It's still alcohol. Yes, it's cleaner, but it's definitely still alcohol. You have to process or I will have the blood sugar. Experts will say, well, I do tequila on the rocks because tequila doesn't impact my, my glucose. And I'll go, okay, but it's still alcohol. It's still tequila. You still have to break it down and it can still cause problems.

So true. Okay, and then let's shift gears to hormone replacement therapy. We talked about how hormone replacement therapy can be beneficial. A lot of women, I think, still correlate hot flashes with hormone replacement therapy. But can you expand upon how hormone replacement therapy can be beneficial and supportive for our brain, for our hearts, and so many other areas that a lot of women don't recognize.

And it makes sense. Women associate hot flashes with hormone therapy. That is what it's FDA approved for. So it's FDA approved for vasomotor symptoms, which is a fancy word for hot flashes and night sweats. And it's, it's approved for bone health, preventing osteoporosis. And so those are two big ones that we hear all the time. But the changes in perimenopause impact every single system in the body. All 12 systems can show up with symptoms or decline with the change of these hormones if not addressed. And we know off label by giving hormones that a lot of women report significant improvement. As I mentioned earlier, joint muscle stuff, brain stuff, mood, even feeling more connected, feeling less rage fill, feeling happier. Sleep, progesterone and estrogen play a role in sleep, vaginal symptoms, nervous system, microbiome. I mean really, these hormones can impact every system and I think see it. I'm sure you do too in your own clients, but in the comments in the DMS and the feedback from women who go, I used to, I used to feel terrible. I used to feel like I was falling apart. I was you having all these symptoms. And once I course corrected a lot of all the basics and got on hormones, it's, I feel so much better. My, my life is so much more improved. And so I think women don't realize, oh my gosh, I'm also having brain fog or I'm also feeling rageful, or I'm also having all these digestive issues. You just mentioned, I didn't put two and two together. That that's possibly part of perimenopause. And as a result, hormones, if you're a candidate, might also make a really big difference for you.

Yes, I completely agree. I've seen so many benefits from women who transform how they feel with getting on the right dose. And when it comes to women who are interested in exploring this conversation and are thinking about hormone replacement therapy versus bioidentical hormones, what is your stance on the differences between the two? And are bioidentical hormones a better route to go, in your opinion?

So bioidentical is just a fancy word for hormones that look like the hormone in your body. So if you go on progesterone, it looks like the progesterone in your body. If you go on testosterone, it looks like the testosterone in your body. Then we have the synthetic form. So we have synthetic estrogen, we have synthetic progesterone where it looks kind of similar, but not really similar enough. It'll bind to the receptor and help, but also does a whole lot of other things and can come with a host of other side effects. Women are familiar with a lot of this, like the birth control pill. The birth control pill is synthetic estrogen and synthetic progesterone. The progestin, iud. Progestin is a synthetic progesterone. And then of course we have options for menopause as well. In my experience and based on the research, the bioidentical definitely comes with way less risks and way less side effects, it doesn't mean it's zero side effects, but definitely way less side effects. So, for example, with the progestin, which is a synthetic progesterone, this progestin is in the research, what is being attributed to the few extra cases of breast cancer as opposed to progesterone, like the kind you have in your body, doesn't seem to have an increased risk of breast cancer. Now, women can develop breast cancer and have never done hormones, they've never been on the pill, never had an iud, never did hormones ever, and unfortunately, God forbid, develop breast cancer. But I mean, in the, in the grand scheme of breast cancer development, it's progestins, few extra cases, progesterone seems not to have that risk. And so just by understanding this even clot risk we have, if you swallow estrogen and it's synthetic, you have a higher clot risk than if you swallow estrogen and it's bioidentical, you still have a clot risk. It doesn't seem to be quite as high as with the synthetic. So even that has some, you know, varying level, same risk, clot, just like, how much risk.

So for women who are going to, let's say a traditional OB GYN who are having conversations around hormone replacement therapy, their doctor is more progressive and is, you know, saying that this could be a beneficial route, but are saying that they have to go on a synthetic hormone for their hormone replacement therapy protocol. Can you explain why that happens?

It's the way that they were trained. So for the longest time they were under the perception that they didn't have any other option other than the synthetic. So it was very common for OBGYN to say you need to be on the birth control pill until you're 51 or 52. And then we can figure it out from there. And to this day, they still have that perception of, well, we only have these few options or they don't feel comfortable or know how to prescribe the bioidentical. So they just don't. They default to, to the, the old way of using the synthetic option. My own primary care doctor, when I went and saw her, said to me, why aren't you on the birth control pill? You need to be on the birth control pill until you're 51. And I was like, I don't think so. And why until I'm 51? And she goes, well, that's what the average age of menopause is. And I was like, well, it doesn't mean that's my age. What, what like, what the what? But that's what she had been taught, that women go on the birth control pill until they're 51. That's the average age of menopause. And then she's like, then. Then we'll talk about what we could do next. It's like, wow, thank you. But no.

Yeah, yeah. It's so funny that she had no context of who she was speaking to.

She did not. I had to. I even reminded. I was like, well, you know, I do this for a living. And she was like. She was like, oh, yeah, that' I remember. Yeah.

That's interesting. And so do you feel that you personally, like, would you. You would choose a bioidentical over a synthetic form?

Yes. The only time I would choose synthetic, and I do. I like women to know, is that if. So synthetic progestin is used if you ever develop hyperplasia. So hyperplasia is a thickening of the uterus where the inside gets, like, Creates heavy periods, usually a lot of bleeding. And that can result in potentially an increased risk for things like uterine cancer. So if you've ever been told you have hyperplasia, they will often put you on a progestin because it will quickly reverse the situation. And I'm all about that. Let's reverse that situation quickly and then address it from there. And that's about it. Otherwise, I only prescribe bioidentical when it comes to a perimenopausal woman. Now, I will say if a perimenopausal or menopausal, but if a perimenopausal woman says to me, I don't want to be pregnant, I'm on the birth control pill. I love my birth control pill. Can I stay on it? I will support her. I'm not against these options. I'm glad we have all sorts of options. I will keep her on the pill if that's what makes her happy. And, like, I'm good with it and she's good with it. But if she's brand new to me, or if she says, I've never been on hormones, I'm 46, I'm ready, then it's going to be bioidentical. It's going to be progesterone, estradiol, testosterone, like the real thing.

So helpful. And when it comes to lab testing, you know lab testing better than most people on the planet when it comes to hormone health, especially as the medical director of Dutch, the first medical director that helped so much with building their hormone testing. Where do you find it to be most beneficial for women to start with hormone testing.

Yes. So first of all, we have over 50 hormones in the body. So sometimes women will go, I want all my hormones tested. And I'm like, that could include thyroid, that like vitamin D is a hormone and insulin. But what they usually mean is estrogen, progesterone, testosterone, et cetera. So she's pretty early into her perimenopause years and she's still cycling pretty regularly and still ovulates then. I am a huge fan of like, let's test, I want to see where you're at. Let's see what, what we're doing. And that could include a one day test, meaning go get a blood draw or maybe do a Dutch test, do a urine test or even a saliva test on that day and see what's happening. But if she's really irregular, if she says, you know, I like didn't have a period for three months and then I got a period twice in a month and then I'm back, you know, I'm like, oh, we can actually skip the estrogen progesterone part because you're so irregular. It's not worth it. Now some women have gotten into the at home everyday tests that are now available. So there's companies like Mira is an example where you can essentially kind of like a pregnancy test. You pee on a stick or pee in a little cup dip, dip it in and then get your estrogen progesterone metabolite results. Two other hormones called LH and fsh. And so even women with irregular cycles are loving that test because they can see the chaos that's happening. How often they're high, how often they're low, what's working, what's not, and then address it accordingly. So we've come a long way in the testing realm when it comes to hormones. It doesn't have to just be a blood draw. We have a lot of other options.

Yeah. Which is so helpful and sometimes more accurate.

Yes.

Would you say?

Yeah, depending what you're looking for. Yeah.

One caveat is that a company like Mira is very expensive. I used Mira for a while because of trying to figure out my cycles before I got pregnant. And it is a more expensive route to go down. That probably doesn't need to be the first place that most women are starting. Would you agree with that?

No. Yeah, we're back to the foundations. Like if you haven't had blood work done in five, 10 years, oh my gosh, we're just going to start there. Like I'M going to look at your thyroid. We'll start with your vitamin D, your glucose, your electrolyte. You know, we'll start with some of your basics. Let's get a cholesterol on you. Like, let's, let's start to look in those first versus much like we said earlier, don't jump. What did you say? Don't major in the minors. Like, let's, let's not jump straight to the jewelry. If you've never even had your glucose or cholesterol or, you know, some of these other keynotes tested first, we will start there. And it's not uncommon for women to go so many years without having a blood test done. You know, like, they feel good, they don't need to. They haven't seen a doctor in a while, so they forget. And then they turn perimenopausal and things come up.

And I, I really am such an advocate of women getting annual lab work done. I'm sure you are too. But even before these changes so that you understand what your baseline looks like, having a baseline when you're not having symptoms is like such an amazing gift.

Even things like glucose, you know, if you, and cholesterol, you don't tend to feel those. So if you're getting a lab draw every year in your 30s or even every other year and you watch your cholesterol, stay really pretty good. Stay pretty good. Stay pretty good. Amazing. But then what happens at you hit your 40s, and as you hit your 40s and especially into your 50s, you may notice your cholesterol goes way up. It's not uncommon that when estrogen goes down, cholesterol goes up, but you don't feel that. You don't feel your cholesterol go up. And so you're identifying as a low cholesterol person. Like, I've always had low cholesterol. I'm great. And then all of a sudden you miss the fact that it went up and that cardiometabolic disease is the number one killer of humans. I don't want to miss that in somebody. I don't want to miss pre diabetes in somebody. Because you'd always had low glucose, so you skipped it for a while. I want to know what your glucose is doing pretty much every year. I agree with you.

And the sooner you intervene, the easier it is to reverse.

Yes, yes. It's, I mean, it's the whole basis behind, behind prevention. Right.

And I was actually just at a talk that Dr. Hyman was giving, talking about how a car, like we have a Dashboard on our car where we understand our tire pressure and our oil and our gas. And why would you not want to have that on your body? To be able to be proactive in the decisions that you're making, to be able to prevent disease so much earlier that we're in an age where this exists. The ability for us to be able to make very calculated decisions on our nutrition, lifestyle supplements, medications, so that you can get so many years in advance of the major killers that will extends lifespan and just overall human optimization.

Yes, 100%, unfortunately, like we all know someone, right? We all know somebody who's either health declined very rapidly or sudden, maybe is sadly no longer with us. And when we look back, we're like, man, if we only knew, or if we'd only done, if we'd only tried, if only they'd, you know. And again, everything's an if. We don't know for sure. But when it comes to that health thing and prevention, if we could have Learned in our 30s how to prevent something our 40s as opposed to it, just like slamming into us in our 60s, it's so much easier to address it younger than it is older.

So true. And when it comes to glucose, you mentioning glucose, a lot of the work that I do is helping people to, to improve their nutrition around blood sugar stability. Can you explain how blood sugar is the foundation of hormone health?

Oh my gosh, yes. And unfortunately goes off the rails as women get into perimenopause because the change in hormones can make her insulin resistant and so therefore her glucose goes up, her triglycerides go up and then we have all sorts of issues. So I said already cardiometabolic disease, I mean specifically, it's heart disease is the number one killer of humans. But we can add that metabolic overlay pretty closely up there. And when our blood sugar is all over the place, that ties into one in particular, cortisol. So our stress, stress response, because cortisol's job is to increase glucose. So you may have high glucose not entirely because of your diet, but because you know, you're burning the candles at both ends and have high cortisol all the time, that will increase glucose. And that glucose impacts our brain, our tissues, our bones, like absolutely everything when you are your glucose is going up or you're becoming more insulin resistant. And so as a result that can end up in miscommunication back to the brain and therefore miscommunication in the firing of estrogen, progesterone, testosterone, etc, plus you feel terrible. Women are like I'm hangry, I'm hungry, I have brain fog. It must be hormones. Well, it might not be hormones. It might be a blood sugar issue. High or low weight gain around the middle, everyone's like, oh, it's cortisol, might be insulin. And so by understanding glucose, even anxiety, the amount of people I know whose anxiety is triggered by blood sugar swings, huge. Can't sleep, glucose is a mess. Huge. So just something as simple as understanding your blood sugar and getting that straightened out could impact so much.

Could not agree more. Thank you for breaking that down. So if someone is watching this, thinking, what is the first place that I can start? What is one key intervention that I can take away from today's episode? What would you call out as that intervention?

My first sleep. Protect your sleep. That is probably the first thing because you heal and repair and rest and recover in sleep. So if you're only getting six hours a night, four hours a night, if you're waking every couple of hours, you. It's going to impact not only that day, you're going to be in a sleep deficit, but then, like a domino effect all the days to come. So definitely, first and foremost start with. To me, start with the sleep aspect.

And if you're a woman that's having a difficult time sleeping, I think that the work has to be done in understanding that that is a sign. Right? It's like a symptom that's happening from something else happening underneath the surface. And better using that to say, to pay attention and say, like, what can I learn from this? And what imbalances are happening that I can lean into to be able to support my physiology?

And it will help so many other areas, too. So, for example, if you're waking up in the middle of the night because of blood sugar issues, then. Well, we talked about blood sugar then. Now you know you're gonna protect your sleep, but you're gonna focus on your blood sugar. If it's because of alcohol, we've talked about that too. So we're gonna protect your sleep by addressing alcohol. If it's because of stress, we've talked about that. So now you're gonna protect your sleep by working on stress. Is it hormones? Is it estrogen and progesterone? You know, so now you can see so many things funnel into a good or a bad night's sleep, but we've talked about a lot of that. It. We've given a lot of practical, tactical suggestions. So we're not leaving you hanging.

We're not leaving you hanging, Dr. Jones, you are such an incredible naturopathic doctor and just such a pioneer in the space of female hormone health. I'd love for everyone to learn how they can get access to all of the incredible information that you're putting out in the world. Can you share where people can find you?

Absolutely. So you can find. Well, I'm all over social media so I am on Instagram, I'm @Doctor Carrie Jones. I am on YouTube @DRCary Jones, my website, which is Dr. Carrie Jones. And I actually have a number of free ebooks on there including a lab checklist that you can print have for free that you can talk to your provider about that breaks it up into foundational basic labs and more advanced labs to explain it to you. And then I have a podcast, hello hormones with Dr. Carrie Jones.

Amazing. Thank you so much for being here and we'll see you next time.

Thank you for having me.