Let's Explore Perimenopause

Welcome to the Balanced Body Podcast, where Sherri Griggs, owner of Balanced Body Health and Wellness in Omaha, talks to us about health, wellness, and balancing hormones. We are back with Sherri Griggs, owner of Balanced Body Medical here in Omaha, the hormone expert extraordinaire. It's what I like to call it.

Yes. And some people even call me the MacGyver of hormones because I can figure it out.

Oh my God. Yes. Just give you a, give you a hairpin. And what is those hooks that you use for climbing? And then you'll, you'll be able to finagle some sort of self-defense against our hormones.

That's right. Yeah, that's it. Carabiner. Yep. So just like we were talking about the patient, um, before we started recording that said, you fixed me. No one else has been able to fix me, right? And it was just— you know what? It just— as she said, you know, you worked really, really hard and you did everything you could and now I feel great and life is good. And honestly, guys, I had not been used to that from her. From her, there was always something that wasn't right.

Mm-hmm.

And to have her say everything is great, believe it or not, No, no comments here. Left me speechless.

That is quite an endorsement right there.

It really is. And, and, you know, today one of the things I'd like to talk about, if we could, is perimenopause.

I think that's a great idea.

Yeah. What is that?

Right. So that is the period, the time prior to a woman going into menopause, right? And menopause is— the medical community states if you have not had a period for 12 straight months, you're in menopause. So, if you don't have a period for 9 months and then you have one, you start over. It starts over.

Wow.

So, peri, meaning like around, it is around menopause time. It can last up to 4 years. And the ovaries work sometimes and other times they don't. And it's really related mostly at that point to estrogen. Okay?

Oh.

We know we have those 4 hormones we've talked about: estrogen, progesterone, testosterone, and DHEA, right?

Mm-hmm.

As a reminder, DHEA being one of our androgens that also helps our adrenal glands.

Testosterone.

Everyone knows what testosterone is, right? For women, testosterone is muscles— muscle, it's strength. It helps prevent osteoporosis. And one of the more important ones is helps prevent incontinence because it keeps those pelvic floor muscles strong. Progesterone is our relaxation hormone. Helps reduce anxiety. Helps people sleep. So that's why you'll have, as somebody said to me earlier, they're like, oh, I always just thought it was after I had my last baby I couldn't sleep because I was used to being awake all the time. Woke up when the kids got older. Well, the timing was that progesterone starts to leave us about age 35 and women start having trouble sleeping. And they attributed a lot of them to, that's just because I've been used to getting up so much with kids. Or they start to experience anxiety, but they don't know why. That's our progesterone. And then our very last hormone, and usually the one that leaves us last, is our estrogen. And estrogen, that's our anti-inflammatory hormone. So you start to have aches and pains in your joints. That's our lubricating hormone. Hair starts to get dry, sometimes fall out, face gets dry down the road, vaginal dryness. And that's also what helps protect our cardiovascular system because the anti-inflammatory effect helps protect us from dementia and helps also prevent osteoporosis and some incontinence. Because if you have vaginal atrophy where the vagina, I always say the grape becomes a raisin, right? It kind of shrivels up. Then there's not as much support for the urethra and we start to have incontinence.

I've got a friend that her skin is like a lot more fragile and stuff. Would that be because of like the estrogen and stuff?

Most likely. I mean, there are some other disease processes like low thyroid, diabetes, things like that can cause fragile skin. But estrogen is when you start to see the dry, really fine lines. What I see in my ladies is they come in and they have these real fine— because like the thinner skin lines. And then when they come back after they've started it, I see them, I'm like, Whoa, you look totally different. And their complaint tends to be, and now I have to wash my hair more. Thanks a lot.

A problem that they wish they had before they met you.

Right, right. So you still have to, you know, you get a little bit more lubrication in your body everywhere. And so yes, That's why you'll, you know, for instance, I always say my, like, my grandmother always really had smooth skin even when she was like 80-something. But that's oily skin. People have oily skin will have less wrinkles. But normal people who have normal skin, the lack of estrogen will affect them even more because they lose that.

Now, okay, I, I overanalyze and overthink everything way too much. When I was getting ready to have my baby, I wanted like a run-through as to exactly what to expect when I get to the hospital. I get to the car, I pull up, then what? How does that work for premenopause slash menopause? How does all of that— what, what's gonna happen? Because I imagine for people it works differently, on everybody it shows up differently, but generally, how does all that go?

Good question. And that's when definitely that start That's perimenopause, right? Before you get into perimenopause. But what starts happening? What women tend to notice the most is the sleep issue. You might fall asleep, but you find yourself, you wake up at 3 o'clock in the morning, or you have monkey brain where you just can't stop thinking about everything. You can't fall asleep. I remember when I had that, I'd write notes and I thought there was something wrong. It was lack of progesterone, right? I didn't have enough progesterone. So that's really one of the first Signs and symptoms that they'll start to notice. Like you said, Heather, everybody's different. Then they start to notice their energy. They just don't have the energy they used to have and the drive they used to have. That's you losing your testosterone. People that work out a lot are like, I am working out, but I, I'm not as strong as I used to be, or I can't build muscle like I used to build. So they start to notice that. So those are some of the, some of the first things you start to notice. When you start to then lose— so if they haven't seen somebody by then, these things just keep piling on. Now they start having heavy periods because progesterone helps manage the thickness, the lining of the uterus. So as you lose progesterone, the lining becomes thicker and they have heavier periods. Some of them start to have Fibroids or clots. So putting that progesterone back can help take care of some of that. Traditional medicine has started putting in IUDs with progestin, and that helps, but that doesn't fix the anxiety or the sleep or any of the other stuff. It might help with the heavy periods, but it doesn't do anything else because it's such a small amount of a synthetic progestin. That it really stays very local. That's the beginning.

Okay.

Then there's estrogen. Then there's the month that your ovaries decide not to put any out or they put only a little bit out and that's the sputtering. Sometimes they work, sometimes they don't. That's hard to manage. I have to give my ladies their estrogen topically so they can control when they use it. And they will say things like, or I will tell them, we will— if you can guess your cycle, if you know your cycle, you can use so much during days 1 through 14 and so much days 15 through 28, that kind of thing. But the problem is the cycle doesn't stay regular. a regular cycle, it requires the ovaries to do everything the same way every month, and that doesn't happen.

Well, because you had said that, um, through perimenopause that you'll, you'll notice that you kind of stop having your period and it might be months. So is that why you're talking about how it's kind of like you have to You said it very specifically, and I don't want to misquote. You said like you have to know your cycle and you have to know kind of where you are. So if you think that you're starting to get your period and you haven't for that sort of sputtering period, that you change your dosage?

Stay on it. Then you stay on it because obviously your ovaries didn't spit out any estrogen that month. Right. So I had a patient come in and she's like, this makes no sense. I had it here and I was able to use the estrogen for these 2 weeks. And then all of a sudden I got breast tenderness. Or nipple tenderness. That's a sign of too much estrogen. So, I tell her, when you get that, stop using it.

Hmm.

So, she kept track of how long she stopped using it. She said, I was able to go not the 14 days but only 10 days and then I needed it again. So, that tells me that her ovaries did not work for that whole time period as they should have. So, she had to supplement it because then she started getting hot flashes. So then she supplements that estrogen till all of a sudden she gets the tenderness and she goes off of it until she gets a hot flash, then she goes back on it because it needs to be used every day. It doesn't stay in your system when you do a topical like that for a long period of time. It just— and, and that was her frustration, was that she's like, I'm tracking this and there's no order to it. Right.

Oh no.

Perimenopause. Welcome to perimenopause.

Now, I guess this is a silly question coming from me, so if it is, please tell me. But I don't know why I thought this, but I assumed when you were saying that the ovaries will spit out estrogen for, you know, your body as you're going, that it would be kind of doing it in an even keel. Does it happen mostly right after your period, like a kind of a boost from them, or is it different per person, or is it like you constantly are getting estrogen from your ovaries as you're going? Like, how does, how does it work? Because you're saying that it kind of— the ovaries aren't spitting it out and then you don't have your period. Now I have this image in my head where it's like after your period they just do a shot of estrogen in your body and then kind of maintain or something. I don't know, I don't know, I don't know why I'm thinking this.

Yeah, well, Well, they cycle. So it's like a cycle and you've got, you know, your— they call the luteal phase and the follicular phase. And all of these different phases are so many days before and after the actual period. So that's when there's ovulation and egg is released. And I'm not going to get too technical about it, but different amounts of estrogen, your body is secreting different amounts of estrogen and generally progesterone.

Okay.

According to that cycle, right? So the uterus, it gets the lining and the estrogen helps us get that lining. And that way, it's ready for the egg. So when there's ovulation, then the egg can implant into a good lining so that the baby can be nourished. So through that cycle, different amounts of estrogen is released.

Okay.

Mm-hmm. So what happens in perimenopause is maybe not enough is released or too much is released. Well, not so much too much. I shouldn't say that because you end up with the heavier lining because there's not enough progesterone to balance it out. You get estrogen dominance, it's called. So the right amount's released, not enough is released, nothing is released. And each month it's different. So when we check a lady's hormones, And I have somebody that comes in and they're great estrogen level, but they tell me they have hot flashes.

That's—

That was one moment in time. We try to do it days 19 through 21. They might not know when 19 through 21 of the cycle is because they're perimenopausal or they already have an IUD in. So just because they had enough at that moment Like the example I gave where she goes on it and off it, on and off it, doesn't mean that next month on that same day, if we knew her cycle, she has enough or has any. So it's a very complicated time. There are a lot of practitioners that do not treat peri— during perimenopause.

Mm-hmm.

Or at least they will do— they'll do testosterone pellets for people, but they won't Give them estrogen because they— one, you can't use a pellet because that's a constant supply. And the month that the ovaries work right, the patient's gonna hate you because they're gonna be miserable.

Mm-hmm.

They're gonna have swollen, uncomfortable, painful breasts. They're gonna be miserable. So they have to be able to control it. And it, it's a matter of letting the patient know, hey, I can't fix perimenopause, right? I can't take all your symptoms away because I have no way to know what your body's going to do. So I can replace their— yeah, go ahead, John.

Oh, I was just gonna say, but it sounds as if, like, as painful as this process is, especially for that example that you gave where, you know, she was using the, she was using the creams or the topicals and then kind of pulled herself off and then put it on. Maybe she was having way less swings than her perimenopause would've normally had because she was able to kind of control it and bring— I'm thinking of like a cosine. Do you remember in math where it was like the wave, the wavelengths?

Yeah.

Almost like the, the, um, the cycles that you're talking about, but like it's a tighter wavelength, so you're able to control it a little bit better. So while it is uncomfortable on the, you know, too much estrogen side and the not enough estrogen side, you're at least able to kind of manage and get yourself back up to a A ledge, if you will. Am I wrong on that?

No, no, you're correct. Because if she did not have help with this when she— after she had that first hot flash and now she uses her estrogen, she doesn't have any more. If she didn't have help with this, she would be having hot flashes and discomfort for days, days, maybe a couple months. But instead, we're able to help her out by giving her that estrogen. Now, if her ovaries decide to start producing estrogen that day and she's given herself some and she gets some breast discomfort, it's short, it's done, because the next day she won't have that discomfort because she didn't give herself any more estrogen. It's very short-lived topical. I use cruelty-free organic jojoba oil, so it's clean. There aren't any toxins in it to add to our toxin level, which can also mess with your hormones. So, but that definitely makes it an easier, as you're saying, John, she's not having the huge swings because she has control over it.

That's so cool. I mean, to me, that sounds like you're bringing something from like a, you know, a bad place into just a much better manageable From that. And by the way, because of your suggestion about jojoba oil, I went and got some and it's so good. I love it.

Well, I will say this. I just had a patient in here earlier today and she had gone online and she was suffering from vaginal dryness. Now, she had had her uterus removed at the age of 40, 5. Kept her ovaries. When the uterus is removed, 50% of the time the ovaries quit working anyway. My— what I believe for her to have vaginal dryness, that tends to be one of the last symptoms. Okay, you need to be without estrogen a while before that. That's not one of the first symptoms you have, right? So what I believe is that her ovaries probably quit working shortly after the uterus was removed. She was one of those people that— some women don't have hot flashes when they go through menopause. And that's where these people, you know, don't seek hormone replacement and then later on end up with the osteoporosis, cardiovascular disease, potentially dementia, you know, the vaginal dryness. They end up with some of this other stuff because they didn't think— They needed it because they never had a hot flash.

Oh my gosh.

So she really didn't, but she had terrible vaginal dryness. She went online and they prescribed her estradiol. So estrogen is the catch-all name for the 3 types of estrogen we have, which is estrone, estradiol, and estriol. We know estriol is what you use for vaginal dryness. The body can take estradiol and convert it to estriol. There are 2 schools of thought. You will have some specialists who feel very strongly that we do not need to give women estriol. The body naturally will convert it if it's needed. But it's not always true. So in this lady's case, she was using a very low dose twice a week. And seeing nothing. I said, well, because you need estriol. They didn't give you the estriol. I'm going to give you a mix because we're going to protect your bones. We're going to get rid of your vaginal dryness. I'm going to tell you that within a week you're going to notice a difference, and within 2 to 3 weeks it should be completely gone. So she'd had this a couple of weeks and noticed nothing. But one of the things she said was that her and her husband perform oral sex, and he said even after she washes this cream off, it tastes horrible. So we put some lube oil on our hand and tasted it. It doesn't taste horrible. Oh my gosh. But let's try it.

Yeah.

And it didn't taste horrible. So, you know, so even if, you know, the 45 minutes that the hormones have absorbed, right? Because I don't have people putting it all over their arms and legs and things like that, like most practitioners do. I have the women use it on their labia. 45 minutes, it's absorbed. She can wash it off. But if there's any left, it doesn't taste horrible. There you go. So a new benefit to the whole oil.

I, I didn't even know. I'm gonna have to taste mine just to see.

Oh my gosh, Jonathan, they're chugging it down.

Right. Good.

I don't know about it internally, but, you know, the thing about it is there aren't any solvents in it to make it absorb. And that, you know, I believe he said it tasted metallic. So I'm not sure what might have been in that cream to get it to absorb in her body. But if that isn't a testimonial for why you don't want to use creams, I don't know what is.

Yeah. Yeah.

Right. And another symptom that can come along with this is constantly fighting vaginosis, vaginitis issues, bacterial vaginitis, which is just an overgrowth of our normal bacteria, an imbalance. And then also, um, what other— and urinary tract infections, because things have just— they're imbalanced because that's not an area that is supposed to be dry.

Huh.

So she's suffering from a lot of other symptoms. So my belief is that she probably lost her estrogen years ago but didn't know it because she didn't have any other symptoms. And she works out and she eats really clean. So she didn't have the estrogen dominance, which is where you put the weight around the middle. That's where a lot of women will notice it. They're like, oh my God, I'm putting weight around the middle. I'm eating the same. I'm working out the way I do. Why is this happening? Estrogen dominance.

Hmm.

Need that progesterone back.

Now, this is for women. Do men do like the same thing? I mean, obviously not as complicated, but do they go through like a menopause, premenopausal area phase?

This is a good question. It's andropause. They call it andropause, which it should be the other way— menopause, men, you know, andropause. And what happens to men is when they start to lose their testosterone, and they do, and we're finding it in younger and younger men all the time, which is a little bit scary. Why, why do we have 30-year-olds that are low on testosterone? What are we doing, right?

Hmm.

Hmm. There he is. It's, you know, hormones in our food and our water or whatever. Don't know. Um, but men will get low testosterone, low energy. So the— I believe, you know, the common thought process is, well, erectile dysfunction, I'm low on testosterone. But this— it's not always true. Symptoms can start before that of fatigue, lack of energy, depression, elevated cholesterol, elevated blood sugar. Those are all— those are all can be symptoms of low testosterone in a man. Traditional medicine says you're okay as long as you're above 200 for a reading of testosterone. A majority of men start feeling symptoms when they get below 500.

Now, are they a little more stable? Because like women go through cycles, do men have as fluctuating of a cycle, or are they kind of more steady?

They're more steady. They don't cycle because they don't really have anything right to cycle or a reason to cycle. So they're more steady. There are things they can do to increase it. If they work out more, the more you work out, the more it can help bump your testosterone up. So there's activities Things that they can do, but it's not cyclical. It's lifestyle that can change their levels.

Okay.

And not necessarily dramatically, but definitely. They also can start having issues with their memory. And as I said, depression and moods. And eventually, then there will be the erectile dysfunction. And not necessarily that, you know, they can't get an erection, but maybe it's not as hard as it used to be, or it's something that, um, it just, it doesn't stay up as long as it used to, or, you know, as opposed to the, it doesn't work at all. Doesn't work at all, that generally is a circulation issue more than a testosterone issue. But that's a whole nother— that would be a whole nother podcast, right? Yeah.

We should talk about circulation issues because I hear that all the time from doctors, you know, Every time I talk to a doctor.

Yep.

Oh, yeah. Well, we have something here, precursor to help your body make nitric oxide that helps your circulation, lowers your blood pressure. Yeah. Makes wound healing quicker and circulate more blood everywhere.

Interesting.

So that is part of treatment. Yeah.

So just like we normally say, When it, when it comes to all this, obviously it's person by person because you know how your body works. And if you notice a change, it might not be the sort of main change that everybody else notices or talks about.

Right.

But, but it seems like that when, when we're talking about, um, you know, both of these symptoms for perimenopause, menopause, or Uh, you said andropause for boys?

Andropause.

Andropause. That it's just like there's something there that is making you just feel different, and it's something that you can't explain.

And it is exactly that. You go to the doctor, the doctor says your labs are fine, there's nothing wrong with you, right? But you don't feel fine. You don't feel good, and you know you don't feel good. So one of the things I say is I check all the hormones, right? Not just some of them, all of them, and in detail. Not just the main, is your thyroid working? It's, is it working and is it working properly and is it optimized?

Mm-hmm.

Right? Are you— are, you know, patients that come and they say, well, so-and-so is giving me my estrogen and my estradiol level is fine, But I'm still having hot flashes. Fine is defined as it could be a number from 2 to 5, and if you're at 2.2, they're going to tell you you're fine, right? Your number comes in like your free T3, your— one of your thyroid numbers comes in at 2.2, your doctor's going to say you're fine if they check that one. Most of the time they don't, but that's the one we use. They don't check, but if they did, You're fine. But really, you don't start to feel good until you get up to 3.5. So it's optimizing.

It seems like such a small change too, because the number is just like 1 or 2 off, whereas— and I hate to compare, but, you know, you were saying that testosterone readings for men can be like 200 to 500. It seems like such a— it just seems like such a disparity among all the, all the hormones, the number checking.

And it is, and it's different for men and women. But the thing is that, like I said, if the man is above— maybe 300 is the number, not 200, I'd have to look at the normals— but if, if he's above— because I'm looking at getting my guys up 900 to 1,200. For a level.

Oh my gosh. So if you're at 200, huh, and you need to get— if you're at 200 and you need to be at 1,200 is your normal, then you're off by what seems like a lot, but it could be— I mean, I don't know, you tell me, is 1,000 a lot difference?

You're gonna feel like absolute crud, but you get up to— you get up there like in the 1,200, you're gonna be on top of the world.

Huh.

You're going to have energy. You're not going to have the humdrums. You're going to have drive. I have one of my patients, he knows every time. He goes, I'm dropping. I know I'm dropping. I can tell I'm dropping. I have another fellow practitioner I work with and he says, I'm dropping. I'm having trouble sleeping.

Hmm.

Wow. So, he knows. They know because you— you know, the thing is, is when it naturally happens, it drops so slowly you don't realize it. You know, I'm just getting older. I don't have as much energy. I'm just getting older. I don't have as much drive, right? Because over the years, as you lose 2 to 4% per year and it's dropping, but when I bump you up and all of a sudden you feel amazing, you forgot how good it feels to have that energy and drive you used to have. Then it's pretty obvious when it starts to leave you again.

So, it sounds like it's really, really important to listen to your body. I know a lot of times too, like, I, I, I'm just so busy, I don't really even have time to stop and think about what my body is telling me. Um, but this kind of made me, me think maybe I should stop for a little bit and pause and see what's going on there.

It's important because a lot of times people don't realize that something is wrong until it's gotten so bad, right? Because we're so busy, we're doing things, we're not really self-aware. Or we're just going, forget it, it's not a big deal. Or again, the I'm getting older. What's worse is when it's the doctor that says you're just getting older, right? That's the worst. So, you know, I've said this before, you know, people will say, so then why, if our body's supposed to have them, why don't we have them? Well, because we're supposed to be dead by 45, right?

Mm-hmm.

Modern science and modern medicine has kept us alive longer than we used to be.

When you have traumatic events happen in your life, does that affect your hormone balance as well?

Absolutely, because traumatic events cause you to release cortisol. Cortisol is a hormone, but cortisol likes to sit on those receptors, your hormone receptors, and block your other hormones from being in use. So if you've had a traumatic thing happen and Maybe you notice if you're somebody that's still having cycles, your cycle's off, something weird has happened. That receptor can sit there and it can keep your body from using them. So I said cortisol will trump sex every time. So that's why women, if they— even if they're doing testosterone replacement to help with their libido, which it makes a big difference, and it's like, but your testosterone levels are good, why don't you have any drive? Because I have so much stress, cortisol's blocking it.

Now, can those trigger like premenopause or perimenopause and menopause and andropause?

So, can it? Yeah. I mean, I know that anything, any stressor on your body, because we don't realize how complicated our bodies are, can cause changes to happen. I can't say That I've really read any studies or read a lot on. Yes, stress can make you go into like early perimenopause or early menopause. I can't imagine why it wouldn't, right? Because we're throwing our equilibrium off, we're throwing our balance off. But I can't speak expertly on that because I haven't really looked into it much.

Right. Probably not many studies have been done into that either.

I bet there may have been. I have 33 pages of studies about hormones, you guys, that are all within 5 years old.

Oh, wow. So they're making advances on this every single day.

Yes.

Yes.

Yeah. So what I would say, if you have any questions, if you're listening today and have any questions, go to my website, balancedbodymedical.com. Sign up for a free discovery call. No charge to talk to me, and we can find out if there's something that I can help you with. If you are not local, the odds are pretty good I can find you a practitioner who is local that can help you, or you can come visit me in Omaha once a year and I can still help you out, and then the rest can be telehealth. And that's balancedbodymedical.com, and I would be happy to help you.

Well, I think that's wonderful. And Sherri, thank you for discussing not just perimenopause, but also andropause, because andropause, because it— I didn't even think to ask if there was something that was similar for guys. I just figured that's like midlife crisis.

It kind of is, right? Because you don't feel like you used to feel. You don't have that excitement. You're bummed out. You got to do something to get excitement in your life again. Just get some testosterone.

I like how that's the catch-all right there. So, and if you need to hear more about testosterone on its own, because a lot of times I think we all have a mental picture of what testosterone is. And if you haven't heard Sherri go through each and every single one of the hormones, um, singularly and explain it, we have that at the beginning. You can look back at past podcasts and see that. It was so very helpful to talk through and understand that from her because she is the hormone expert extraordinaire here, live and local in Omaha. Yes. So thank you so much, Sherri.

All right. Thank you, guys.

Thank you. It was so good to talk with you.

This has been the Balanced Body Medical Podcast with Sherri Griggs, owner of Balanced Body Health and Wellness. If you're looking to find Sherri, go ahead and look for the website, balancedbodymedical.com. If you're looking for the business and you want to find Sherri at her office, you can find her at—

10815 Elm Street in Rockbrook Plaza. Thank you.