Is it Perimenopause? with Dr. Jolene Brighten

Today on Midlife conversations, I've got Dr. Jolene Brighton. She's a hormone expert, nutrition scientist, and a thought leader in women's medicine. She is a board certified naturopathic endocrinologist. I love that combination. And trained in clinical sexology. I'm dying to know what that is. Thank you so much for being here today.

Yeah, thanks so much for having me.

I'm so intrigued by you. First of all, the name of your book Is this Normal? Like, I have so many questions. We were talking a little bit before I hit record. And I want to start with this question because I think some women are embarrassed to ask this and I. And I want to just kind of get it out of the gate, the difference between perimenopause and menopause, because I think a lot of people don't understand that. And how do we know when we are in one of those.

Yeah, okay. So don't be embarrassed if this is you, because I actually, I'm an international speaker. I'm on stages all over the world. And I will run into clinicians who use perimenopause and menopause interchangeably. These are people who are licensed medical providers.

Yeah.

And so there is a subset of the medical community who gets this confused. And also, if you're like browsing the Internet, you will also find they get used interchangeably, but they are distinct and they are different. So perimenopause is really the prelude to menopause. And we understand that menopause, it is acceptable to be in menopause at age 45, and it is acceptable for, to begin perimenopause 10 years before that. So if you're listening right now and you're like, is that why, like, 37 was so hard? Maybe. So we can start perimenopause at age 35 and it can take about 10 years before you reach menopause. We can certainly go into the signs and the symptoms. But I want to just define perimenopause. Yes. So perimenopause is coming before menopause. We diagnose menopause. It is a one day event. So here's the other thing. People will be like, oh, I'm menopausal. Well, you get diagnosed with menopause when you've had 12 consecutive months of no period and you are 45 or older if you're younger. So let's say you are 38. That's not menopause. There's something else going on. We have to, we have to investigate that. So at 45 or older, 12 consecutive months of no period, you are now menopausal. The next day, you are postmenopausal.

Wow. So that's really good to know because some women are saying that they're menopausal, but they're still getting just dysregulated periods. So they're still. They're perimenopause. So if you're getting any period within the year, you're actually still perimenopause. Now, my other question is, if you get regular periods, are you perimenopausal?

Like, if you're 50, can be. Yeah. Okay, so this is an excellent question because people often think they're like, it's all about the estrogen in the beginning. And so let's, like, let's talk through this. So with perimenopause, we start to have changes that don't always show up as the period. That's the obvious one. But it can be things like we start having brain fog. We start noticing we're having trouble sleeping at night. It's especially worse before you get your period. You're having hot flashes, night sweats. Most people are like, oh, yeah, that one I'm familiar with. But maybe having itchy ears, itchy skin, noticing more fine lines and wrinkles, droopy breasts, like these are all signs that hormones are diminishing. So with perimenopause, the late stage of perimenopause is when we start to see the period problems. Periods are getting really long and heavy or they're becoming irregular. This is all due to the problems with ovulation. Now, I say problems with ovulation because it is a problem when you can't ovulate because you can't get progesterone and you'll feel bad. So progesterone is helping with GABA in our brain. That helps us feel nice and calm, chill, in love with our life. We don't want to. I call the emotion murdery. You don't feel murdery on your period. Yeah. So when progesterone begins its decline, it is because the ovaries are beginning their decline in our reproductive phase of our life. And so it's. Once we start to have anovulatory cycles, we're not ovulating regularly. Then we see the periods are less regular. Ovulation, as I talk about, is this normal? Is what starts the cycle. The period is what follows ovulation. So whatever's going on with ovulation is going to affect your period. So I think it's just really important to understand. You can have signs and symptoms of perimenopause starting, you know, five, seven years. I mean, before you ever start to notice that, like, yeah, my cycles are getting longer. So they used to be like, you know, 25 days, now they're 30 or they were 30 days and now they're 34, 39, starting to extend. And then you start to see the heavier periods because if progesterone isn't getting up to the right amount in the luteal phase. So let's break this down for everybody. We first ovulate, then we move into the luteal phase. That is where progesterone should take the lead. Estrogen is still present, but if progesterone can't get up to a sufficient amount, estrogen is unchecked. Now estrogen is making your breast tender.

And lumpy and you're dominance typically, is that like that's creating estrogen dominance?

Yeah, that's what people and what the research has defined as estrogen dominance is this state of relatively there is more estrogen than there should be in that phase of the cycle relative to the progesterone. And so it isn't always necessarily that people will be like, oh, it's because you're making more estrogen. There are cases where you could do that, but it is most often because you're not making enough progesterone to challenge estrogen in perimenopause.

That's an interesting thing you said, because I'm someone who tested estrogen dominant, but I was also having hot flashes, which is so, so. And I was like, how can that be? But oh, absolutely, yeah, you're saying that actually makes sense because you still could be not producing enough progesterone and still not producing enough estrogen. Is that correct? Did I say that right?

Yes. So you can. So what happens in perimenopause is that we begin the progesterone decline. It is estrogen that declines later in perimenopause when you're entering into menopause. So that is a very common time to see what is, quote, estrogen dominant symptoms. Those symptoms of estrogen excess and we can have hot flashes is all about estrogen interplaying with the brain. Same with things like migraines. If you start to develop new migraines, and especially if it's like right before your period, that sometimes is because estrogen was up and then the drop in estrogen has now triggered a change in neurotransmitters, a change in the Brain that is now triggering migraines. And so you're like, I've gone through my whole life and I've been fine and now I am getting headaches. Why am I getting migraines? And that can be part of it.

Makes sense. Okay. You said something that I kind of giggled at in my head because I'm like, wait a minute, I've had that for years. I didn't know what that was. Itchy ears. What is that? Yeah, I always have itchy years.

Yeah. Okay, so let's for. Let me say that itching of the skin can be a lot of things, right? Like, what products are we using? What are we laundering our pillowcase with? Like, there can be a lot of factors. Do you have eczema? Do you have psoriasis? So I want people to keep that in mind. It's not always just your hormones. Hormones are part of what we would investigate. So as estrogen starts to come down, we're not lubricated as much. And I'm not just talking about your vagina. I'm also talking about your skin and your skin being hydrated also, you know, your joints. So noticing joint pain, aches in your body, that can be an estrogen symptom of estrogen being too low. It also can be a thyroid symptom. So this is important to keep in mind as well.

Okay, so when do you. This might be jumping ahead a bit, but I'm really curious. Like, I think in our society, we automatically go to fix things. Like, how do we fix it? How do we fix it? How much is, like, this is normal, we should embrace or how much should we actually be going? We should look at hormone replacement. We should do bioidenticals or like, where is the line on that? And where do you stand on that?

I love that you are jumping ahead. This is totally jumping ahead. But this is why everyone wants to know right away. And they're going to be commenting like, thank you. Thank you for just getting there. So here's the thing. We have been told that we should just put up with a lot because we were born with ovaries. That we should put up with painful periods, heavy periods, having these uncomfortable changes of perimenopause, or these signs of major dysfunction. So I want people listening to understand that if you are having changes in your brain, noticing brain fog, you're noticing mood changes, you are noticing that, like, I used to be so sharp I can remember anything. Now I'm struggling. This is. This is very problematic. And this is one of the things That I take really big issue when doctors are like, no, menopause is natural, therefore we shouldn't bother with any hormone replacement therapy. Well, if we know that these changes may be early signs of dementia, to which over 60% of the dementia population was born with ovaries, then friend. So I have big issue with doctors who are like, menopause is natural, therefore you don't need hormone replacement therapy. Embrace it, just transition. And they do a lot of fear mongering as well about like, well, there's all these other risks except that if we know that you are having cognitive changes right now, and those cognitive changes can be early signs of dementia, to which if you were born with ovaries, 60 plus percent of the dementia population, they are women. You have to understand that if we can come in with hormone replacement therapy and save some brains, why wouldn't we do that? So it's so much bigger than a conversation of like just anti aging and looking young and feeling young. I mean, that's great. We all want that we should be healthy in our bodies for as long as possible. But the absence of these hormones have a detrimental effect on our brain, our bones, our cardiovascular system overall makes sense.

Now do you, and you, do you feel it's okay to really whenever you're having these things happening, so whether you're in perimenopause or menopause, it's okay to start that.

So it really depends on your family history, your personal history, what is going on with your symptoms. Generally in perimenopause, the place that we start is with bioidentical progesterone and using oral progesterone. And the reason for that is because that is what affects the brain in terms of helping with symptoms like anxiety, sleeplessness, feeling agitated the week before your period, sometimes two weeks before your period. And then as perimenopause continues on, that's where we start looking at, is this a time to bring in estrogen? Should we be bringing estrogen on top of that? And there's a lot of providers who are like, if you've lost your uterus, there's no need for progesterone. However, progesterone also has an effect on our cardiovascular system, on our musculoskeletal, our bone system and also our brain. So it depends on the symptoms that you're presenting with. And then of course, when it comes to testosterone, that's a big controversial one where doctors are like, there's no reason for women to have testosterone sometimes. And that's absolutely not true. We also need testosterone as well. And that is something where we want to look at symptoms, but we also want to test and understand the pathway. So with testosterone, if I give that to you and an enzyme called 5 alpha reductase is upregulated, you are converting testosterone to DHT. You're probably going to lose your hair if I start you on that without checking that system first. And so we might want to do a lower dose or fine tune it for you.

That's so interesting because there are women that say they're losing their hair and they're on hormone replacement and I don't know, they're connecting that. That's such an interesting correlation. I love that you just said that. What about the. When doctors just say, you know what, just let's just put you back on synthetic birth control pills. Let's just. All the symptoms will go away. What are your thoughts around that?

I am not a fan of using birth control in perimenopause because it's just, you know, it's putting more estrogen on a system that actually needs progesterone in the beginning and you are not getting progesterone, you're getting progestin. So you don't get the same benefits as progesterone. That I was just saying like, you know, for brain health. In the same way that your natural hormones are providing or we can provide with bioidenticals, we also know for some people they can have adverse mood symptoms when it comes to starting birth control. And if you're in perimenopause and you're already struggling with depression, anxiety, adding birth control on top of that may make things worse. And so we have to counsel on that just to be aware of how does this affect the individual overall? The other issue I take with birth control is that, you know, it's. I'm going to say it is great because you can get pregnant in perimenopause. In some cases, it is great if you don't want to get pregnant. I don't think it's the best way to really offer a very individualized approach to hormones.

Yeah, that makes sense. What about your thoughts difference between bioidentical and. And regular hrt? I'm personally on bioidentical just because I was told it's more natural. I don't. And then I hear that what I'm taking maybe is not strong enough. So I get very confused. I'm sure my audience is also confused. What is your thought? What are your thoughts on the two and the differences yeah.

Okay. So when it comes to bioidentical, something like prometrium, which is bioidentical, progesterone is actually a pharmaceutical. You can get it for prescription. It's, you know, depending on your pharmacy, like dollars a month. And that is really the choice there. When we look at the non bioidentical, the synthetic sources of progesterone, those are the ones that have been so problematic. Though adding these progestins have been problematic in the research in terms of cancer risk and not really giving the benefits that outweigh the risk when it comes to estrogen. There are lots of options out there. I do think bioidentical. Bioidentical is as most closely matched to your own hormones as possible. And I much prefer that when it comes to something like birth control, for example, it's just important for people to be aware that the reason why they use progestins, a big reason, is because you can patent that. You can't patent anything that is natural, which means that it's usually cheaper.

That makes sense. Okay, so I use biased and that for me has stopped Hot flashes. Like I don't have an issue with it. But then I get confused. Scrolling social like I'm sure many people listening do, where I'll see an expert say bias is junk. It doesn't do anything like I'm help us with that too. It does. I mean, is bias okay? Is it really not enough?

Yeah. So this is definitely something that you know when it comes to bioidenticals, working with a provider. Well, when it comes to any hormone therapy, making sure you're working with a provider who's going to understand your body, be monitoring your symptoms, testing levels and perimenopause. There is some testing of hormones we can do, but you know, for example, follicle stimulating hormone fsh. Doctors will say, oh, you can test that if it's high, you're in perimenopause. Well, one month it might be high, the next month it might.

That's me. That's exactly me. Like some months it's not. And I'm like, I get all confused. Yes, so normal.

That's why there is no test, there's no lab test to diagnose perimenopause. It is, are you of the right age and do you have the collection of signs and symptoms that you are in fact in perimenopause? So when it comes to hormone replacement therapy, it is important. You know, there's a lot of ways to try to get things over the Counter, even like dhea. And with that, I'm like, it is much better if you're being prescribed and monitored by a doctor because you want to make sure that you are getting one, the standard dose. And this is what's been kind of an issue with compounding pharmacies is that with compounding pharmacies, the question is always, do all of them have the technology to mix everything? So you're getting the same dose every day. If you're not, then the problem is, is that you could end up with more hot flashes or one day you're getting much higher estrogen. And once the one day you're much lower estrogen. So whatever hormone replacement therapy you're choosing, I really encourage you to be under the care of a provider who's monitoring it. People on the Internet will say, this is, you know, this is not good for you. This is like what's best for you. How do they know? Do they know you? Do they live in your body? Have they asked you all the questions?

Okay, now I have a weird maybe question, but it's a personal thing. I navigated. So I'm just wondering your thoughts from the expert side on this. So I went down having all the periodontic perio, sorry, perimenopause symptoms and being really into bioidentical hormones. And I started, I had the hot flashes. I was navigating that, all that. And then me cleaning up my gut health actually helped alleviate a lot of things too. So in my mind, what I started thinking, well, should we be doing something like that first before navigating the hormones? Is that just something that should be coupling it? Where do you stand on that? And like, what should people be doing, if anything, before they go down the road of hormone testing and replacing?

Yeah, okay. So absolutely, you bring up a great point. Like, your gut health is going to be crucial for your hormones overall. And starting bioidenticals is no exception. So why is this? So we start upstream that when you have your own natural hormones and it's time to get rid of them, you're going to detox that through your liver. If you're using bioidenticals, just by the way, everyone, no oral estrogen, we don't use that. The clot risk is really high when you start oral estrogen in comparison to a topical estrogen. Another reason why I'm not a fan of the pill during this phase of life. So with that, this estrogen is going to go through the liver and then once it's processed through the liver, phase One, phase two, liver detox. It is going to go into the gut and into the urine, so feces and urine to get moved out. So drink your water, everyone. But also your gut has something called the strobilone. And the estrobolone is how your gut interacts with your estrogen. It's part of how we keep the right amount of estrogen levels and we also keep moving things out. If you have something called dysbiosis, which is an imbalance in the flora, it isn't that you have like bad pathogenic causing disease, gut bugs, it is an imbalance in the flora, you're going to have a higher amount. So with that dysbiosis, we can have an elevation in the enzyme called beta glucuronidase. And beta glucuronidase has an important role of reactivating your estrogen and putting it back into circulation. However, if there's too much of it, we can be putting too much estrogen back into circulation, and that can be problematic. We also understand that when it comes to perimenopause, menopause, that is a higher risk moment of someone's life to develop autoimmune disease. So anytime we have hormonal transitions, like getting pregnant, having a baby, getting our period the first time, having major stressful events, which shifts the hormones as well, and then perimenopause and menopause, that can predispose us to getting autoimmunity.

Okay.

If we already have the genetics and we are experiencing gut dysbiosis, this is our current understanding of automatic. And so women are at much higher risk of autoimmunity than our male counterparts. And so this is just important to understand as well that your gut health is one way that you can safeguard against that. The other thing that's interesting about gut health is that it has been found in the research that more microbial diversity, so not just more gut bugs, but lots of different kinds of gut bugs, is associated with lower levels of visceral adiposity or belly fat.

Yeah.

And while everybody talks about belly fat, you know, the layperson is like, I don't want belly fat because of bathing suits or jeans or whatever. Understand that as a doctor, I don't want you to have belly fat because that's the fat packing around your organs that is most associated with. With increases in cardiometabolic risks. So, like diabetes and heart disease. And so how do we have visceral fat?

Right? Is that what you're talking about?

Visceral fat? Exactly. And so how do we have more diversity of our microbiome, diversity of the fiber we eat. So not just a matter of, like, just get your 25 grams every day. I talk about this and is this normal? Like, if you have ovaries, you need to be aiming for 25 grams of fiber every day. Most people are.

And with the trendy diets, they're not doing that. Because with people doing keto or Carnivore, they're not doing that.

That. I know, I know. And that is something I had a podcast I was on, they were like, what would you never do? And I'm like, I don't have a lot of nevers because I just feel like I'm always holding out for more science. But Carnivore is one that I'm like, yeah, no, I'll never do that, because I really like my plants.

Yeah, I do, too.

I don't see myself doing that one. So with that, understand that it's not just like, oh, I am eating my broccoli every day. We want to diversify the fiber. And so this is why, like, I will often share on my social media, like, I will do a yogurt parfait, a Greek yogurt that's going to be high in protein. Friends, please start your every morning with high protein.

Okay?

And then I bring in psyllium husk chia seeds. I am adding, like, cashews in there, making sure that I have, like, fresh ground, either, like, flax seeds or I'm having, like, pumpkin sesame seeds. I am doing as much diversity of fiber as I can to start the day. Because often, as, you know, as a busy person, you can't even control every moment of your day, and you don't know where you're going to end up being like, well, I'm getting a salad and that's pretty good. But I'm, like, not getting as much diversity. And so other things that you people can do is going to ethnic markets. So whether it is like an Asian market, a Mexican market, and looking at different roots plants that they have there that you haven't seen, if you haven't seen them, you haven't eaten them, and your microbiome will be so giddy to get them, because whenever we have that diversity of fiber that is feeding little critters in there that, you know, haven't been getting as much food, and it's signaling that there is such a plethora in the environment. The environment is very safe. Not only does it affect your microbiome, but it also affects your hormones.

Okay, this Is fascinating. Now I want to bring up something because I think if listeners are like me and we go into fix it mode. I just want to ask you about this because I did this wrong. So I had the high beta. I'm going to pronounce it all wrong. The high beta glucuronidate case. Okay. I had it with. With amongst a lot of other things going on in my gut that I didn't know about. And it explained a lot as to why I have an autoimmune. All the things. So then I, because I went on Dr. Google, which I shouldn't have done. I'm like, oh, I'll just take calcium glute. D. Calcium glutamate. Did I pronounce that right?

And I'll do great. Right?

And I was taking dim too. So then what happened was I started getting massive hot flashes. Like around the clock hot flashes, like five an hour. And I'm like, I just thought it was my hormones. But what I know now is I was cleaning out that too quickly. Does that make sense? And I was making estrogen drop. Is that accurate? Because, and I wanted to ask you this because I think we as women go on Google and do this.

So. Yeah. Okay. So firstly, I think you should go on Google and I think you should gather all the information that you have and formulate those into questions that you can ask your provider. I know doctors out there are like, oh, you know, would you learn that from Dr. Google? And it's like, well, they're not learning it from you. Obviously if they were, they wouldn't be relying on.

Good point. Like good point.

I have a whole website like that people find via Google and I link out to all the citations and everything. And I am a very solution oriented individual. So with this I'm curious first, how much dim did you take?

Too much. I was taking dim detox and I was taking. Well, it says to it too. I've. Well now what I take is one and it works, works great. But I was taking too dim and I was taking the glucaronidase. Like I was like over trying, like, oh, I'll just counterfex it.

Yeah, yeah.

And I didn't connect it till later because as soon as I stopped that the hot flashes stopped.

So a lot of dim that's out there is going to be high dose. I mean there's some that people are like dim causing hot flashes. I'm like, what dim were you taking? And I go look it up. They got it on Amazon and it's like, 600 milligrams. And I'm like, oh, I would feel awful if I took that. So. So there is really a trifecta. And when we're looking at estrogen metabolism of three ingredients that I love to put together, this is what's in our balanced women's hormone support. And I formulated this way because I don't want anybody having side effects and because I take it. So with that, it is dim. Now, most people are going to do well with dim. 50 to 100 milligrams.

I'm definitely taking it more than that. So that explains.

I don't. Yeah, and you don't really need to go more than that. Like, more is not better in this instance. So dim is going to help with phase one liver detoxification solution. Calcium D glucarate is also involved in liver detoxification. But there is another. Another thing called sulforaphane. Now, sulforaphane and dim both come from your cruciferous vegetables. If you're someone who's like, I don't want to start with supplements. Start with eating cruciferous vegetables. So arugula, broccoli, cauliflower, kale. Eating those on a daily basis and getting that variety. And if you really want to, like, hack it, broccoli sprouts, they're going to be higher in sulforaphane than any of those other things.

I took, like, handfuls of those broccoli sprouts because I'm an overachiever with this stuff, which is awesome.

My kids eat them, too. So, like, no, so good.

Like, they really could have a lot of bad bacteria, too. So you have to, like, really be aware of washing them and making sure.

Too, and where you're sourcing them. I know.

I went over. I. I'm like, that overachiever that went and bought. I'm like, oh, okay, I see this on Google. I will eat pounds of broccoli sprouts every day and take off.

Yeah. Yeah. Well, and with broccoli sprouts, you really only need, like, two tablespoons a day, which you'll get the same benefits. Yeah, you'll get the same benefits of that as, like, over two pounds of. Eat broccoli. Like, eating straight broccoli. Don't eat that much broccoli. You will be the stinkiest person in the room, friends. That's true. Don't eat that much broccoli. So we've got our dim sulforaphane best coupled with myrosinate myrosinase, which is going to come from mustard Seed, So you can add, you know, mustard feed into the mix or you can take a supplement that has this and then the calcium D glucarate. And so that is going to help with phase one, phase two metabolism. And the calcium D glucarate is going to help with moving out the last phase in the gut, what some people call phase three, calcium D glucarate. We're going to be looking at more like 300 to 500 milligrams of that sulforaphane. That's usually going to be around like 100 milligrams that you're taking of that. And so we don't want to go really high with the supplements because ideally you're still eating your cruciferous vegetables.

Yeah.

Understand, I think people, you know, I will talk a lot about eating protein because it's great for your blood sugar, it's great for your, you know, insulin levels. It's going to be great for so many things. Especially like I tell if you're over 30, you got to be eating more protein. If you're over 40 is non negotiable. 1 gram per kg of body weight every day. And this is, this is born. So if people are like, where is this coming from? From my master's nutritional research was in sarcopenic obesity. So like 20 years ago, I was studying the effects of not getting enough protein. It's bad. And I knew it was bad then and now more research has come out, it's even worse. But the other thing people have to understand is amino acids are essential to liver detoxification. And so while you know, you'll see all of these like potions and swamp water and that's what they taste like sometimes of things out there where people are like, you have to take this to detox. Detox. Understand, your body is set up to detox. Your liver is very good at it, your whole body's very good at it. If everything is being supplied with what it needs and functioning optimally. So that is drinking enough water, moving your body every day, eating enough fiber, because if you're not pooping, if you're not getting enough, if you're not hydrating enough, if you're not eating a nutrient dense diet to fuel your liver, you're not going to be able to run these pathways efficiently. And so that's where a lot of like the detox fast talk is born out of. And then, you know, doctors like, you don't need to do anything. I'm like, well, you do. Okay, like, and it's not the standard American diet. The doctors are like, just eat a regular diet. I'm like, right, you mean the worst diet in the world. No, don't do that. But it also isn't, like, as extreme as, like, don't eat for five days and just drink, like, milk thistle every day. Really great for hepatocytes or liver cells. Like, excellent. But don't negate the things you can do every day. And especially if you are 40 or older, do not negate your sleep, because you are not just detoxing in your liver, your gut, your kidneys, your brain is also detoxing at night. And it requires that good sleep to move out the. The bad stuff we don't need in our brain so that we can maintain our brain health as well.

So good. Okay. The question I have not asked you yet that I've got to ask you is about sex life. Because that. That is a very common question I get from midlife women. They feel they've lost interest. It's declining. What's wrong with me? Even women that say that, then their doctor put them on testosterone. That's not changing.

Yeah.

What's happening there? And can that actually be fixed? I feel like a lot of doctors are not helpful here.

No, they're not. Because when you look at the training that doctors get in sex, it's as bad as what you get in sex ed as a teen. Like, it is not good. And so, you know, what is your doctor's role? Doctor's role is to help you with any physiological anatomical issues going on and refer you when they meet their limits. The problem is, is they don't always know to refer. So I'm a certified sex counselor. I still will refer to a sex psychologist because. Or psychiatrist because they can work with couples. They can work on the. More of the cognitive issues where I'm looking at, like, what are the very simple behavioral changes, but also the hormones and then looking at, again, do we have structural issues going on? So I will also refer to pelvic floor physical therapy. I just think that should be just standard of care in this country. Like, you know, we're sending women to get paps, like, every three to five years. Why don't we send them to the physical therapist like, once a year, Just make sure their pelvic floor is okay. Especially when you consider one of the top reasons that land women in nursing care, elder care facilities is because of urinary incontinence. Like, we can prevent that. We can have independence. Yes. So that is another aspect of aging which is also related to our hormones that we don't talk about. So it feels like a cruel joke.

Sometimes it just like we're wiser and then all this.

I know. Well, and that's the thing. Is that why I think it's so important that we maintain our cognitive health is because we are wiser and we have a lot that we can gift to this world. Unfortunately, if we start to lose that cognitive ability, then the world is missing out on really important wisdom for women. So I love that you make that point. Okay, so. So everything that we've talked about sans the hormone replacement therapy is in the second part of is this normal? So I do like to be really transparent. Everyone, this is Normal is not for postmenopausal hormone replacement therapy protocols. But it will help you with your thyroid, your adrenals, everything else. The first section of the book is all about your sexual health. And I dedicated an entire chapter to libido because it's one of the top questions I get no matter what, what age someone is. So if you are in perimenopause or menopause and you're struggling with libido and think like, oh, it's because I'm getting old, because that's what my doctor said. Know that I have like 20 somethings struggling with libido as well. And sometimes they're very similar. Now I would love to say give testosterone and that'll fix everything. I wish it was the answer. It's very rarely the answer alone for a low libido. So if your only symptom is low libido, I map out symptoms of low testosterone. There's actually a whole checklist in is this normal? Never have I ever seen a low testosterone problem present as just low libido. There's usually inability to gain muscle mass or losing muscle mass, changes in your mood. So feeling like I just don't have my kick ass like essence that I used to have, I am feeling sad, I'm crying more easily, I am tired all day. Like these are signs of low testosterone. So very important to understand. Could it be your testosterone? Certainly. But if it is, we've got to understand what else is going on. So as I talk about and is this normal? Insulin can be playing a role, cortisol can be playing a role, your thyroid can be playing a role. And then the big one that like gets missed but can be a big issue is the estrogen decline. So everybody is like men really like sex. They have low, they are, they have high libidos and they have testosterone. Therefore, that must be the answer because medicine and society is always like, here's my men and they're the standard. And then there's women. So just like, same same, right? No. So estrogen, when estrogen is high, if you're still cycling, you get near ovulation. Estrogen is high. Testosterone is also up, but it's estrogen as well that is going to contribute to more sexual fantasies, to more interest in sex, the easier orgasms. Like, so funny because.

Yeah, we've not been told this. This is why I'm hearing of this, that.

Yeah, so as estrogen declines in the later part of perimenopause, we may find that we have vaginal dryness. Certainly something that can happen postmenopausal. But we have vaginal dryness. We have pain with sex. We're starting to have, like, atrophy of the tissue. It's thinning. Maybe you bleed after sex. That's very problematic. That is not considered normal whatsoever. And maybe you're having a harder time achieving an orgasm. Them, for the most part, medicine will say to most of the time is like, use some lube and have some wine. Like, that's it.

Yeah.

These are the answers that I. All the time women are like, my doctor just said, have some wine, get some lube. I'm like, well, lube will help. Lube is good for everybody. We all love lube. Big fan over here. Every part of your cycle, lube, amazing. Alcohol can actually hijack your libido because it is a central nerve system depressant. And so what I mean by basically.

Saying it's in our head when they say that, I feel like, like, oh, yeah, just like calm your brain. But that's not.

Yeah, okay, well, that. So that actually is a great point because it can be psychological. But let me give you, like two. Two scenarios where it's actually like the pros and cons here. So one is, you know, it can be psychological that maybe you're having body image issues. We know that can put a break on desire, on arousal. It can get you out of arousal. It's a very common one to be spectatoring while you're having sex. Like, you are basically sitting on the sidelines judging yourself is very common and I would say a normal place to go, given the society you've been raised in. And that is something that you can own and you can work on. And I just want to, like, I give a whole exercise in my book around do, like, what things that you can do. But on the flip side, the other thing that happens that's psychological is something that's a break for life. Like someone that's under 35 is the fear of an unintended pregnancy. But once you know you can't get pregnant, that break has been removed. And so now you may find that it is in your head in terms of getting more in the mood, because now you don't have that fear anymore. So there is a psychological component. And in the book I really Marry, the psychological aspect of what puts women out of the mood keeps them from getting in the mood and how to address that and how to do inventory on yourself to know how sensitive. What is called the gas pedal and the brakes. This is the dual control model by Bancroft and Janssen. They talk about, basically. And by the way, there's always somebody who's like, why are we comparing women to cars, friend? This model was made for men, of course, first, right? And then they were like, we should try to understand women and adapt this to women as well. So this transcends genders altogether. And it can be true for anybody that, you know that's, you know, experiencing these issues. But the gas pedal is the go. It's the Hallmark telling you, get the card, get the roses, get the chocolate, get the Marvin Gaye, get the scented candle. That's supposed to put her in the mood. And then your partner may be like, I did all the things right. Why are you not in the mood? And you might be like, you did all the things right. I must be broken. I'm not in the mood. But the reality is, is that none of those things can go if the brakes are engaged. And the breaks can look like being overextended in life. So you're being stressed out. Maybe you're both boss yelled at you that day. Maybe you're. You're struggling with body image because you went to H M and their lights are, like, horrible or some other clothing store. And you're like, I have so much cellulite friends. It's the way they light. They lit the room. Okay.

Like, Nordstrom's is the worst.

Oh, my God. I know. I'm like, do you not want me to buy clothes?

Do you hate me? Like, I think they're. Mark, obviously no marketing, but I'm like, if you just have better lighting, we would spend a lot more money.

Oh, gosh. Yeah, yeah. Oh, yeah.

Like, there's, like, their lighting is the worst.

Maybe we should start that business going in. Like, oh, man, the ROI on that. So. So maybe there's that issue going on and then maybe, like, you know, you are caught between taking care of kids and taking care of elderly parents, and that's zapping your energy. And you try to have a conversation with your partner, and you're like, I need to talk about things. I need to process things. And they're like, yeah, not now. Like, I'm too busy. The game's on. I'll talk to you later. Like, they just sent the signal of like, you're not a priority. I'm not tending to you. I'm not taking care of you. You don't feel supported in this relationship. And so all of these things can be breaks. Later on, they come around and they're like, well, the game's over 91, and you look good, and you're like. And they're rubbing up on you, and you might not even notice it. So the male counterpart is often like, oh, she's withholding sex from me. She's not interested in me. Like, if you were delivering pleasure. Friends, she's not withholding pleasure from herself. Nobody's trying to punish themselves here, okay? But the problem is, is that with all of that. That the static and noise and distraction going on in her brain, she may not even notice your sexual advances. And so we walk around feeling like, I must be broken. Something's going on with me. And reality is, is that we just have to understand ourselves better, how we can work on those breaks and understand that your hormones, as defined by this model, which I love, that these psychology researchers are like, hormones are also breaks which might be being on hormonal birth control. So I'm glad we brought this up because I wanted to bring up my next issue with hormonal birth control, which is, if we know that women in perimenopause may struggle with libido, why would we put them on a drug that women have reported since its inception has tanked their libido? Not true for everyone, but true for enough women that it should give us pause, because even the World Health Organization is like, pleasure is an important aspect of health. And the American medical system is like, well, is it women's pleasure? Meh.

Oh, that's a whole topic. Yeah, that's. But, yeah, good. Valid point there. Valid point. Well, this has been really helpful today. I think it gets so confusing because I feel like all of a sudden, everybody acts like they are a hormone, an expert. Everyone's, you know, and it's confusing on social. Especially social media, because there's so many opinions and so many people saying things, and. And I feel this was very helpful because I feel like you really broke things down, explained it without really judging, like, what else? What people's choices are. So I appreciate that. I'm excited to dive into your book and I want everyone to get it. Is this Normal? Is the name of her book. And this is fascinating. Where can they get this book?

Anywhere that books are sold. Support your indie bookstore if you can. But I also know Amazon's really convenient. So, yes, anywhere the books are sold, you can grab a copy.

Thank you so much. And where do you want them following you on social media? Where's your favorite platform?

Oh, I'd say Instagram is my main, but you can find me pretty much anywhere at Dr. Jolene Brayton, thank you.

So much for today. Thank you.

Yeah, thanks so much for having me.