#127: What is Perimenopause

Hey beautiful, it's Dr. Tabatha.

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Hi, I'm Dr. Tabatha, the Gutsy Gynecologist. I'm a triple board-certified OB-GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey, and I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyn health and your overall And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more Band-Aid medicine, ladies. We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. And I want to be your gutsy gynecologist. So welcome. All right, ladies. So today I want to talk about what the heck is perimenopause, right? So we hear this term a lot, but it's not really well understood because when I went to medical school back in the day, you know, it was described as this 3 to 5 year transition period where your progesterone and estrogen levels start to decline. They call it Symptoms of hormone deprivation beginning, because menopause is the literal definition of an entire year without a period, usually brought on by the natural decline of ovarian function. Sometimes it's surgical, right? We remove your ovaries during surgery and you come out of the operating room and you are in menopause because your body is no longer producing reproductive levels of estrogen and progesterone. So. There's a whole transition period before those ovaries stop making reproductive levels of hormones. And like I said, I was taught it was 3 to 5 years and that it should be a mild transition— start having hot flashes, night sweats, mood swings— and then you stop having your periods. But I will tell you, over the past 20 years, I have continued to watch this steady, steady increase in symptoms that are occurring longer and longer before menopause. So it used to be these symptoms started around 47, 48 because the average age of menopause is 51. Now I'm constantly seeing perimenopausal symptoms actually beginning in the mid to late 30s. So 10 to 15 years before we stop having our periods, we are having symptoms of perimenopause, you know. And so we could either say, yeah, perimenopause is lasting 10 to 15 years, or we could look at it like we're having hormone imbalances for other reasons long, well before our natural transition into menopause. So that's really what's going on is you can call it whatever you want. We call it perimenopause because it's easy for women to understand, but essentially your ovaries are having trouble making their balanced levels of reproductive hormones because of all of the outside turmoil going on from the foods that we're eating to our chronic physical stressors, our emotional, mental stressors, our environment. Environmental toxic burdens, so many things, our nutrient deficiencies. These are all making it really hard for our brain and our ovaries to have this discussion and to keep your levels balanced in and in harmony the way they're supposed to cycle every month. So what does that look like? It looks like Anxiety, depression, so lots of mood swings. It looks like lack of energy, fatigue, headaches before your period, the onset of heavier periods, cramps, bad PMS, breast tenderness, all of these things. You know, some women will find they can no longer sleep through the night. They're waking up at 2 or 3 in the morning. They're having trouble with their digestive system. Everything's kind of slowing down. They're feeling more bloated. Especially right before the period. So all of these things, just because it's common and we're all suffering, you know, with each other through it, it doesn't mean it's normal. So you really shouldn't be having these struggles, especially if you're still in your 30s or in your early to mid-40s. That means you have a hormone imbalance. And so I love supporting women getting back into hormonal balance because you totally can. You just have to figure out what is causing the imbalance, right? So I always say, unless you are just naturally going into menopause, say you're 50 years old and your ovaries literally are declining because you are running out of eggs and you're no longer ovulating every month, that's a normal physiologic process. If that's not the reason, then there is a root cause issue driving this hormonal imbalance. And that's what you want to figure out and work on because that is what most of us are suffering from, are these root cause imbalances. And it's almost always diet and lifestyle related. So I know you guys get sick of hearing me say that, but the amazing thing is That means it's fixable. That means we have control over how we feel and we can do something about it, right? So I would love to see women really focus on cleaning up their diet, getting rid of the inflammatory foods. Some of the biggest inflammatory foods are things like salad dressings. They're full of inflammatory oils that cause a lot of omega-6 production, which is very inflammatory. So you really want to focus on swapping out cheap, nasty salad dressings for clean, whole, healthy oils like organic olive oil and avocado oil. MCT oil, I love. It doesn't have any flavor. You can put it on your salad. You can put a little balsamic vinaigrette on it. And MCT oil literally goes right into your cells. And helps you produce energy. So it's a great energy boost. It helps your brain function so much. Oh my gosh, it's fabulous. So start thinking about how can I swap out inflammatory oils, all those seed oils, vegetable oil, canola oil, sunflower oil. Get those out of your life. If they're in your salad dressings, they're in your cooking, you know, repertoire. Swap them out with good, healthy oils. Gluten. Gluten is a main inflammatory driver for a lot of women. I mean, honestly, men seem to handle gluten a lot better than women, but there are men who have an immune reaction to it as well. But a lot of women do better when they don't eat gluten because it does trigger an inflammatory response in your gut. Your IgA levels and your IgG levels go up. They just start attacking gluten. It has been so genetically modified over the decades that our body doesn't even recognize it. It thinks it's a foreign, you know, protein, and so it attacks. So getting rid of that can be super helpful. Sugar. Sugar is a huge inflammatory driver. There's so much sugar in our food in this day and age, and that just drives inflammation. So sugar causes brain fog. It makes us feel Loaded, it zaps our energy. It wipes us out. I know for me, if I eat any kind of sugar or processed foods, like I want to take a nap within half an hour. It's that severe. Caffeine can be very draining. Alcohol, you want to keep that one drink, you know, max, and really focus on not only those really healthy oils, but getting enough clean, lean protein from grass-fed beef, free-range Range chicken, all of that good stuff. You want to get cruciferous vegetables like broccoli, Brussels sprouts, cauliflower, bok choy. Those are full of diindolylmethane and indole-3-carbinol, which help you metabolize your estrogens so that your hormones can be balanced. Cruciferous vegetables are amazing. And in that same regard, you can take Dimethyl— Which is diindolylmethane and indole-3-carbinol as a supplement form to help you metabolize your estrogens. That helps with phase 1 in your liver. There's 2 phases in the liver, and sulforaphane from broccoli seed extract can help huge amount with phase 2. So that is in my Energy Lift supplement. So if you take Estrotame and Energy Lift, you're gonna really make some headway on getting rid of those heavy periods, PMS, mood swings, migraines, breast tenderness. All of that can be relieved just by taking those 2 supplements. So it's amazing what you can do when you really start to help support your body's physiologic processes and help get those hormones metabolized and excreted and removed from your body efficiently and replete the vitamins and minerals that you're deficient in. So perimenopause can also look like a time of weight gain, am I right? All of a sudden you're gaining weight around your waist, around your midsection. Like, I hear it all the time. My patients are like, where did this come from? I have never had weight on my belly and now it's there and I can't get rid of it. So that is very much related to too much estrogen compared to progesterone and too much Cortisol from chronic stress. So you want to get your cortisol levels in check by managing your stress. Like start journaling, start processing your feelings, start having gratitude, do deep breathing techniques, meditation, like whatever works for you. Figure that piece of it out and then try to support progesterone either with actual progesterone, which I prescribe to many of my patients during perimenopausal years. You can take it in bioidentical micronized progesterone pill form at bedtime. It helps with sleep and anxiety and keeps estrogen in check. You can do a supplement form like progesterone oil, which gets absorbed on your skin. That's at my store as well. Or if you're in the early phases and you're still ovulating but it's not optimal and you really do want to support that progesterone, sometimes chaste tree is a beautiful way to really support that progesterone production. So that's in my, you know, Progest Lift. That's a nice herbal blend to help support progesterone production. So you want to support progesterone, you want to combat your stress and cortisol production, and then make sure your estrogen is in check because estrogen during perimenopause is like a roller coaster. Normally in your reproductive years, estrogen is Smooth up, up, up, up, up, and then goes back down. And it does that twice during our cycle. During perimenopause, when our ovaries are struggling to produce the amounts of hormones that we need, sometimes it will shoot out a whole bunch of estrogen. You'll have a big spike and then it will drop. And that is where you get those symptoms are from that high, high, high and low, low, low. And it doesn't feel good. And so it's really important to Keep that estrogen in check as much as you can. And like I mentioned, if your estrogens are getting too high, you want to use supplements to metabolize those estrogens and bring them down and eat those cruciferous vegetables. If your estrogen is consistently low, you might need to supplement with something like black cohosh or dong quai. That's what my EstroLift has. But be careful during perimenopause because estrogen does fluctuate a lot. So what I've found, you know, with my patients, the most success is when you really focus on optimizing progesterone to keep estrogen in check and getting that cortisol production in check and making sure you have enough testosterone. If those 3 are in check, Then the estrogen roller coaster doesn't feel so scary. It's not so horrible. So that would be my advice for sure. And if you're not really sure what's going on, we can always test. There are easy ways to test your hormones in blood, in— with urine, with saliva. It depends on your situation, how often you're cycling, how irregular it is. So don't hesitate to reach out to me or a functional practitioner and find out about testing, because that can really be a game changer for women, is to find out what the heck is going on with their hormones, because sometimes it is hard to tell. So I hope that you feel empowered, right? I want you to realize that this transition shouldn't be crazy. It shouldn't be super long. If it is, that's indicative of a hormone imbalance, and there are many things that you can do to get back into balance. So I really want you to focus on getting your vitamins and minerals that you need for your body to do its daily processes, to make your hormones, to metabolize your hormones, to excrete your hormones. I want you to lay off on things that are causing inflammation and driving all of this dysfunction. I really want you to focus on hormone balance. So I hope you got some amazing tips out of this episode. Give me a shout-out. If you thought of somebody while you were listening to this today like, oh my gosh, she totally— this is her, this is what's going on, share this episode with her. Have her reach out to me. There is support, there is help because we women, we need to support each other and lift each other up, right? It's a sisterhood, not a competition. We're all in this together. Like, that's why I do this. I just want you to live your best life. And I know that you can feel amazing, have amazing health and vitality, and be balanced. You don't have to be struggling. You shouldn't be dragging through the day. Having those issues. So let me know if this was helpful. If you're finding value, please hit the subscribe button. 5 stars would be amazing. And just share it with all the women in your life because we're all in this together. Okay, go have an amazing Kick-Ass week. Let me know what else you want to hear about. I am here for you, ladies.