In this podcast episode, host JJ Virgin interviews a clinician (Speaker D) who is also a breast‑cancer survivor about how to incorporate herbal medicine and botanicals into perimenopause and menopause care. The conversation begins with a brief sponsor segment and then moves into a patient‑centered discussion of the therapeutic alliance, emphasizing listening to the individual’s needs and shared decision‑making. The clinician outlines a step‑wise approach: starting with herbs when patients are not ready for hormone replacement therapy (HRT) or have contraindications (e.g., breast cancer, clotting disorders). Specific adaptogens—ashwagandha (sedating, nighttime) and rhodiola (activating, daytime)—are highlighted for nervous‑system regulation and sleep, with notes on timing, dosage, and the importance of certified extracts. Sleep‑supporting botanicals such as valerian, saffron, and passionflower are discussed, along with lifestyle factors (cortisol, alcohol, blood‑sugar) that affect sleep quality. For insulin resistance, the clinician recommends berberine, aged garlic (kialic acid), a specific hops extract (CalaCurb) acting like GLP‑1, plant sterols, and especially dietary fiber, providing a cheat‑sheet tool for tracking soluble vs. insoluble fiber. The dialogue then shifts to phytoestrogens and selective estrogen receptor modulators (SERMs), explaining how they can target hot flashes, night sweats, and other vasomotor symptoms while avoiding uterine or breast proliferation. Hot flashes are framed as a red‑flag for cardiovascular disease and dementia, urging clinicians to treat rather than dismiss them. Practical resources—including a cheat‑sheet for fiber, the clinician’s book Menopause Boot Camp, and show‑note links—are promised to listeners. Throughout, the tone is conversational yet instructional, with a supportive, cautiously optimistic sentiment toward botanical interventions despite limited data compared to pharmaceuticals.
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So someone listening to this who's like, "All right, this is interesting," or someone coming to you as a patient, how do you integrate in the plant piece of this, the herbal medicine, into what they're doing?
It's listening to the patient. I think because I have this reputation in my community for being open-minded and for doing these kinds of things while still practicing in a totally conventional manner and using hormone replacement therapy, which I take hormones, okay?
Me too, don't fucking run from me.
Right, exactly. So it depends on the person, and I think that's really what the therapeutic alliance is, right? Where are they? A lot of my patients, and especially now where people are much more educated and learning about perimenopause and how this all starts, a lot of them are curious and they want to prevent chronic disease, which I'm so excited about. What an opportunity to work with somebody at 37 who's thinking about this rather than 57 when they're in it.
When you're unfrying the egg.
Right, exactly, exactly. You can't, which you cannot do. Sometimes we start with herbal and botanicals first because they're not quite ready or they're curious or they have a symptom that is actually maybe going to respond better to the herb. A lot of our nervous system issues respond really, really well to things like ashwagandha or rhodiola adaptogens. They're really powerful. The sleep issues that people are starting to have sometimes, the botanicals are a more gentle entrance point for them. And the thing is that a lot of these, most of these are actually very amenable to work with the hormones. So there's lots of plant estrogen-like molecules out there. They can work very well for certain things like hot flashes or vasomotor symptoms. One of my favorites is a very specific form of Siberian rhubarb, and we know that it acts like a selective estrogen receptor modulator. So it's activating in places that you want, brain and bone, and not activating proliferation in places like the uterus or the breast. We don't have the best data in the world, but we have some data. So super, super interesting. And I can fine-tune based on what's going on with her. And then if we're layering in hormones, we are. And look, I'm a breast cancer survivor. Some of my patients are in treatment. They cannot be using hormones at that time, or they choose not to usually. I mean, they can do whatever they want, actually. That's what shared decision-making is. Or maybe they have another reason why they can't. Maybe they've had a stroke or a blood clot clot. So maybe they can't use hormones. And these can be really, really, really helpful for modulating not only symptoms, but potentially for impacting long-term health issues like insulin resistance or bone health or brain health or gut health or cardiometabolic profiles. Again, they're not— we don't have the same level of data as we do for a lot of our pharma stuff. But we have a lot of data to support their use and their safety.
Yeah, and I think that's the most important. There's safety data. We need your book, clearly. Because I see this seems very, very relevant for a woman entering perimenopause and menopause. Like, there's so many things they can do. But for someone, let's go back over to nervous system. And I'd like to dig a little deeper into ashwagandha and rhodiola. So for someone, because I mean, what woman isn't in a little bit of sympathetic overdrive?
Right.
I mean, who's— so what are some of the things that she could look at here?
Well, I mean, first of all, some of it is timing and where you're at. Where you take it in the day. Ashwagandha can be a little more sedating. And again, remembering that it can take some time for these things to get into your system and work. So ashwagandha, I would say for most people, I would start with trying to take it at night. And it really can help with sleep as well because it can kind of downregulate the nervous system and it can interact with GABA receptors and help relax, right? Rhodiola is a little more activating and it can be a little more beneficial like maybe earlier in the day. You know, this is like, these are broad strokes, broad brushstrokes we're painting in. So those are two things I would just think about. But adaptogens are really interesting 'cause they are, their goal is to get you back to homeostasis, which sounds really weird in Western medicine. It's like, well, how could it do both? But it does because as I mentioned with plants, there's synergy and they're activating more than one pathway at the same time. So those are two that are actually really well tolerated and very effective. I think understanding like the dosage and you're getting the right extract and that it's a certified product, things like that that is very, very helpful. I see a lot of anxiety in perimenopause, a big uptick. And we also know anybody who's had any kind of hormone-mediated mood disorder, so maybe around puberty, for sure if they've had pregnancy-related anxiety or depression, they're almost certainly gonna have an uptick in those symptoms again in perimenopause. And we see like up to 40% of women have some kind of mood symptom. So really targeting that nervous system regulation is so important. I mean, game-changing. And sleep, regulating sleep. If you don't sleep, I could dip you in all the hormones and you're just, you're not gonna get better.
Well, it's a massive problem.
Yeah.
Let's be honest. Yeah. During perimenopause. So beyond the ashwagandha, are there other things that you like for sleep?
It depends on what you're trying to do. I mean, valerian is really powerful. I would be careful with it because it can make you very groggy in the morning, but it is really good at inducing sleep. Sleep. Saffron and passionflower also have some efficacy. I think it depends on what the issue, right? Is it falling asleep? Is it staying asleep? Honestly, most of my patients, it's staying asleep. But also looking at things like blood sugar and activity level, right? If you're super, super active later in the day, you're going to have— your cortisol is going to be up. You're going to have a harder time going to sleep. If you're drinking alcohol, I feel like I shouldn't have to say this, but I have to say it. Like, sure, it's going to make you fall asleep. You are not going to have a good sleep. For a million reasons. It's not good for your brain and it's definitely not good for your blood sugar. So understanding insulin resistance is also climbing at this time of life. And insulin resistance and glucose metabolism actually play a big role in our sleep. So it's kind of hard to nail it all on just like one, but I think passionflower and saffron are ones that people don't think about and they're great.
And saffron also can be used for mood disorders. Yes, for sure.
A lot of the things, anything that works on the HPA, HP ovarian axis in this case, is gonna help with mood and with sleep. So you see a lot of crossover here and you can layer these as well.
Now, of course, the other big issue, and you mentioned it, is all of the, we're starting to get more insulin resistant. So we've got blood sugar issues. Are there some things you like to use for that?
Yeah, I mean, these herbs are not as great, but I like 'em. I mean, it depends on how, bigger issue is berberine actually has plenty of data to support its use. I think that we're seeing some newer ones coming online and some of the older ones, like, look, there was a kialic acid, which is aged garlic, and it's a very specific thing, was having its moment for a while there.
I cannot take that stuff.
Yeah, I don't think it works that well. There's some really interesting work with a very specific hops that really is acting like a GLP-1. I mean, it's not in the same long-acting way.
Oh, is that the CalaCurb?
Yes. And honestly, the data is really fascinating. It's very interesting. So, those are some of the ones. I know I'm leaving something out. I can see my slide and I'm just like blanking on what that was. But these are some that I reach for. There's plant sterols, which is going to be more for your cholesterol, and fiber. I mean, really, like, you don't have to get fancy. Like, people need— people don't get enough fiber. It could be as basic as that.
Well, when you look at fiber, because there's different types of fiber, how do you recommend doing this for your patients? I mean, it's such a basic that the reality is the majority of people are getting a third of what they need.
Oh yeah. First of all, people have to track what they're doing, right? Because I'm going to tell you something. When I talk about fiber just generically, I mean, are you talking about soluble fiber? Are you talking about insoluble fiber? And they all say to me, especially my— I have a very a very educated demographic and very health-focused demographic, right? And they are all telling me about vegetables, which are amazing. Absolutely, you need to eat vegetables. You're not getting nearly as much fiber in your fruits and vegetables as you think you are.
That arugula just did not crank up your fiber intake.
No, it really didn't. So the first thing I do is have them kind of look at what they're doing. I actually have a cheat sheet, JJ, that I send them because some people like lentils and some people, you know, like chia pudding. I don't know.
Maybe we can include the cheat sheets.
Oh my God, absolutely.
I'm voluntolding that we will gift the cheat sheet to the audience.
Absolutely.
Cool. Yeah, so there's— and some of my patients are vegan and some of them are, you know, whatever. So I think helping them make selections and understanding like 25 to 30 grams if you can do it, but I have a hard time with it. It's like a freaking full-time job.
I know, I track it every day too. I'm like, I'm a big tracker, but I love—
it's so important. I can weigh with my 2 devices.
You know, like everything.
Yeah.
But fiber especially, that is like that 10 grams per meal.
Yep, yep, exactly. Divide it up. Divide it up.
Although I will brag a bit. I've already gotten 20 grams in.
Of course you have. Just so you know, it's like noon, you guys.
I haven't had lunch yet though.
And a lot of this is actually the perimenopause and menopause stuff that I talk about botanically is a lot of it is actually in my book, Menopause Boot Camp, because I focused a lot on stuff that people just were not talking about yet. And people still are not talking about this enough. So we're gonna keep bringing it to the forefront.
And we will, what we're gonna do is we're gonna put that in the show notes. Amazing. Because we did your interview on that. That was a while ago.
Yes, yes.
So we did that interview.
It was 4 years ago.
4 years ago.
Yes. Wow.
Yeah.
All right. Crazy times. So other things for people that they can use here. We talked about things for mood. Yeah. We talked about things for sleep and blood sugar. But what about just, you know, hormonal symptoms?
Yeah, I mean, so again, some of these phytoestrogens and some of these SERMs are actually really interesting.
What's a SERM?
So SERM is a selective estrogen receptor modulator. So it is selectively turning on or off estrogen receptors in different areas because estrogen acts all over the body, right? It is not just, you know, in your uterus or your ovary. It's in your bones, it's in your brain, it's in your heart, it's in your liver, it's in your muscles. It's everywhere. So we want to be careful that we are targeting the areas that are causing us a problem. So if you're having hot flashes and night sweats, that's coming from the brain actually. And is, by the way, a big red flag for cardiovascular disease and dementia. What? Yeah. Yeah, that is a signal.
I have never heard this.
Yes, severe hot flashes are a signal.
Okay, so if you have severe hot flashes, but then you control them—
It's probably having a positive impact.
Okay, so it's like, it's not just that—
They're not benign, they're not just a joke. They're not just like a funny meme.
Why is that a big risk factor?
Because it's having an imp— because part of what's happening is it's originating in the thermoregulatory center in your brain, but it's having an impact actually on the vascular system as well, which is where the hot flush is kind of being acted out. So we know that it's related to reactivity and then more issues like you're losing nitrous oxide, which helps to relax the blood vessels. And you're also having an impact on the endothelial lining, the lining of the vascular tree of all those vessels, which of course is going to— you have more inflammation. So, okay. And then the inflammation is—
yeah.
And you know, I'll tell you something.
So should you be rude or what should you do?
Well, I mean, you should— here's the thing. You should not grin and bear it. You should treat your hot flashes. So whether you're using—
No suffering.
Yeah, suffering is like, not only is it like unnecessary, you're not getting a gold star for it and it's harming you. So I really want people to know, yeah, a hot flash is not just a funny joke and like, oh, get a fan. I mean, get a fan if you need it, but like take care of that. And if your clinician does not understand that this is a signal for your longevity, we gotta find you another doctor, okay? We just really do. So look, black cohosh, which is much maligned and does not act as an estrogen, works pretty well. Very specifically, Rummifemin. The Germans are always on it. They're really good with plants. But 50% reduction in hot flashes. Wow. Yeah.
