We have been inundated with so many messages in society that it takes. It takes work our entire lifetime to like really undo that.
Welcome to the high performance health podcast with your host Angela Foster. The show where we talk about everything you need to break through limits and achieve a high performance, mind, body and lifestyle.
Hi friends I am so excited today is our 200th episode here on the High Performance health podcast. And I am so grateful to all you lovely listeners. I couldn't have done it without you. Thank you so much for listening and supporting the show. It's been such an incredible journey and I can't quite believe we've got to 200 episodes and to celebrate. I have an amazing guest for you today. My guest is Dr. Jolene Brighton. Dr. Jolene is a women's hormone expert and prominent leader in women's medicine. We actually met at the Health optimization summit in London last May. It was wonderful to meet Dr. joley and she's absolutely lovely and so super knowledgeable about everything to do with hormones. I loved her first book Beyond the pill, it's absolutely brilliant if you haven't read it and she has a new book, which you can preorder that is coming out in April next year called Is this normal judgement free Straight Talk about your body. And that's exactly what we dive into in this week's episode everything to do with sex hormones, periods and everything else that you've ever wanted to know about hormones. So without further delay, let me introduce you now to the lovely Dr. Jolene Brighton.
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So Dr. Jolene, it is so amazing to have you on the show. We met back in London in May. I know it's taken us a little bit of time to get this in the calendar. I've been really looking forward to it. So welcome to the show. Yes, I'm
so glad that we made this happen, especially after connecting for people who don't know there's an awesome health optimization summit in London that we got to connect and you were speaking. And then we also had a panel together. So it was a good time. Yeah, it
was it was really fun. And it was nice to meet you in person. So I'm really excited. You have to have a new book coming out next year. Is this normal? I have your book here beyond the pill, which I just think it's a brilliant book. So I can't wait for the next one. I guess a really good place to start is you're different to most doctors, right? Most medical doctors seem to prescribe the pill for anything and everything. What kind of inspired you to write this and go down this whole rabbit hole of how the pill really impacts women?
Well, you know it's a two part in the I have my personal story and my personal journey with the pill which I talked about in beyond the pill, which was like, amazing because like those like horrifically, over a week long periods went away. But also not so immediate, amazing because the nonstop yeast infections could never be clear. But you know, I had that journey, I think, just about everyone has a pill story. I every time my book comes up, and I'm at a party or a conference, people are like, let me tell you my story. And it was really my patients who inspired this, because so many of them came to me, quite frankly, got the team's being the doctor, who was diagnosing PCOS in like the 38 year old female who was now trying to get pregnant, or the one to discover that she'd actually been struggling with hypothyroidism all along. And these different reasons that women are put on the pill, without any question of why. And that's what it really comes down to is, do I want access for the pill? Do I want women to have the option do I want to support women on the pill, absolutely, and beyond the pill does not. And at the same time, I want to give them solutions beyond the pill, because I know you can go to any doctor, and you can be offered birth control pill, like it's a, you know, fill in the blank, whatever the hormone, like symptoms are down there issue, we've got the pill, even sometimes when women are like what like to get pregnant and the doctors like we'll just go on pill, because that's going to reset your cycle so that you can get pregnant. We don't actually don't have any evidence of that. But you know, I think it's really frustrating as a patient as a woman, but also as a doctor to see how many women are prescribed a pill for symptoms that have a pause, and they're given no other solution. And they're told things like, you know, just one pill. And if you want to have a baby, then we'll deal with it later down the line, except on most of these women are also told as soon as you come off the pill, you'll be able to get pregnant immediately. And sure, if you're putting a 14 year old on the pill, that could be true. But when we consider them, the pill is also used to delay fertility and to control our reproductive health, that some women are waiting decades. And in that decade's time, there are these conditions that are developing that are willing that nobody has actually addressed. And so this book, beyond the pill is all about really helping you make the best decision for yourself understanding the pros and cons of the pill, understanding what your other options are, and helping you make that decision that you really feel like yours. You're not a doctor telling you, you have to do this because I told you so.
So really empowering women and also teenagers, right? Because as you were saying there, and that's very, you know, similar to what happened to me, is I think I'd only started my period like a year before and they were so disruptive. And it turned out I had PCOS. But they it was almost immediate. Let's just put you on the pill because we're worried about your bone density. That was that was what I was very quick.
And then here we are decades later ring like actually, we don't think it protects your bones like it. Because we never had really great evidence in doing that. It was really just a theory. And then rather than so can we talk about PCOS? Because that is a yeah, really prominent condition that women are past the pill and it delays diagnosis. You know, with PCOS and endometriosis, we look at women having delayed diagnosis by decades sometimes, PCOS women, they take about two to three doctors before they get someone to listen to actually run some paths. And we picked you on so the name is polycystic ovarian syndrome. But there's not only cysts on the ovaries and we know they're not really cysts to begin with are actually follicles which is your ovaries trying really, really hard to ovulate like they want to perform correctly. They're like we know what we're supposed to do. And we're trying so hard but we just can't get there. So there's not only cysts on the ovaries, but what there is a you know, very predominant it's about 70% of women with PCOS is the estimate current insulin resistance. So what we're looking at is a is an endocrine, you know, condition in the sense that yes, we have testosterone issues, it's elevated. We have issues with progesterone oestrogen with insulin, but there's also this metabolic component in that it can be inflammatory, we can see cardiovascular disease, we can also see mental health health issues. It is not just a ovaries, uterus, female reproductive tract condition, and yet it's treated that way. And to me that's a huge disservice. Because now what what doctors do is they put women on the pill and they say their I fix your period. Now you have a regular period, we can talk about the Fragile X like not actually a period from a menstrual cycle in more detail. But what's problematic is that that missing period was the red flag. That was your vital sign throwing a red flag with a flare if you will, and saying there is a problem here. rather than digging deeper and trusting that you're being put on a medication that masks the symptom, and yes, while it can get the endometrial lining shed, which is really important, if you will years without having a period, yet you have oestrogen stimulation, you can have endometrial hyperplasia, so it builds up the uterine lining, and that could turn into endometrial cancer, if that goes on for years. And so yes, there is not like, okay, we can help with that. And yet, it's not helping with all of these other aspects of PCOS. And in addition, because we know that the pill can be inflammatory for some people that there can be additional cardiovascular issues. This is a population we're not even really studied to understand what is the long term cardiometabolic risk of putting them on the pill and not actually addressing all of those components?
Do you know I'm so glad you said that because I when I was prescribed it at around 15 When I got to uni, and I was in law school, I came off it to see Well Hang on, I've barely had any periods am I going to have one? I want a full 12 months, no periods at all. So it was like, let's just put you back on the pill. But then when I later in my late 20s thought about starting a family, I came off the pill, and I couldn't get pregnant because I just wasn't having periods. And initially it was exactly as you said, I saw various different doctors. They told me my bloodwork was fine. Turned out later, it wasn't fine. They've overlooked it. Then I had scan they saw the cysts and ended up having to have ovarian drilling, they found out I had endometriosis. But it was a long time if that was my own research that led me down the rabbit hole of actually there's a metabolic component. I've had blood sugar test, they were like your blood sugar's crazy. Did you eat before you have this, you know, all these different things. And I started to try and like research and fix it myself. And all that time. Even with the pillars, all these cysts have been building up. And there's problems going on in the endometriosis. So it wasn't a solution. And it was putting my kind of metabolic health at risk, right. And as you say, I wasn't given any guidance on this. And I'm so glad that you raised that because actually put on a personal level, I found PCOS takes work right, I have to work at controlling my blood sugar, I have to work at controlling the acne that I get, and things like that. And I did end up with severe postnatal depression, actually, interestingly, and then clinical depression afterwards. And no one really tells you about any of these risks from pill use from PCOS from anything else.
No, they really don't. And, you know, what you brought up is? So they told your labs are normal. So that's a really big problem, right? Because doctors are trained for is it disease? Or is it not? Because it's disease, then I know the algorithm of what pill or what, you know, surgery or what higher level intervention? And if it's not, then they're like, Okay, watch and wait, like, you know, come back with normal whatever it you know, it's it's not a look of isn't optimum. And what can I do to optimise that because optimising health and optimal levels. That's nutrition and lifestyle. That is not where doctors expertise line, and actually seeing a new wave of doctors in the United States saying like, well, all doctors are trained in lifestyle medicine, and then we can sell and they're like, well, we tell you to sleep and we tell you like 10 per size, and then they do teach, do you do refer? Do you do anything that actually enables the patient to do that? Because you're just saying it's not enough for people. But the other point is, is that there is a lot of resistance and I'm sure it happens in you know the UK because it's socialised medicine, to actually testing and working up like a 20 Something population something like doing a fasting insulin a haemoglobin a one C looking at your cholesterol, if you have a diagnosis of PCOS, we should be looking at all of that regardless of your age, because we need to get the baseline and we need to track like, if you are you know, 20 Let's get your baseline because it 30 If things are off, like we can say this was your normal rather than your doctor saying this is the way it always was because you have PCOS kind of situation. But doctors are so reluctant to do that. Because they're taught again, it's we're waiting for disease, like let's wait for disease, and then we can diagnose and then we can treat my role is to just encourage you to never get that diagnosis. But that is like can we just never get that diagnosis. If I've seen that like things. So PCOS, yes, we want that diagnosis. But I don't want to diagnose hyperlipidemia which is elevated cholesterol. I don't want to you know, have to get you down that cardio metabolic pathway and then be like now now we need big guns. We need a cardiologist we've got to come in. I would rather say to you, okay, let's increase the fibre in your diet. Let's make sure that we're getting those healthy fats in and as you said PCOS is work and this is something that I think some of the worst language that ever happens in the PCOS community is when a woman says I cured myself PCUs for I will see sometimes non licenced health care practitioners who are allies, who I think like, like health coach is amazing. We like there's a need for health coaches because doctors, nurses, I mean, PA, they can't do it all. They can't do it all. Patients need that extra support. But sometimes people don't understand that fear is the absence of disease and no longer needing to think about or treat that or do anything with it like it's sure it's done. We are moving on. And when it comes to PCOS is a lifelong condition. So just like I have Hashimotos, that's a lifelong condition. Did I put my antibodies in remission? Yes, will it always have to be diligent about my stress about my sleep about what I eat? Yes, all of that. And the same is true for PCOS. It is a chronic condition. And we find, you can put the symptoms in remission, you can make it impossible for your doctor to ever reach the criteria to diagnose it again, because of the work and effort that you're putting in. But it will always take work and effort on your part, which I think sometimes feels unfair patients are like, That's so unfair, my friends can do X, Y, and Z. And these are usually my younger patients. I'm like, Yeah, wait till they're 40. And they can't do XY and Z anymore. And they're regretting they're looking back in retrospect, and being like, I should not have lived that hard. That's my nice way of saying that, like, you know, what I call it the metabolic obscenities, where you're literally cussing at your body by choices you make, like binge drinking and partying all night. Like, look, I'm not judging or finger wagging, if anybody will, like consecutive years of that, and that is going to prematurely age your body. Yes, you will see it on your skin. But more importantly, we will see it at a cellular level, and there will be dysfunction. And so in some ways, you know, I think a way to look at a chronic condition like PCOS is that you've now been given this opportunity, your body is going to signal to you faster than other people's bodies that you can become in tune with. And you can really start to build that user manual for yourself, that helps you thrive
very much. So that's exactly what I found. It's, I wouldn't say it's a gift. But as you say, it helps you focus on the areas that need focusing, and I have managed to get my cycle, very regular. But I know that if I stray off course, very quickly, the acne is going to show me if I put a CGM on me, I'm gonna see, you know, different, different results. And you know, I
don't know, the CGM is a continuous glucose continuous glucose monitor. Yeah, that is a very awesome tool for PCOS. I just wanted to say that I love that you're using that and you bring that up. I think we're finally seeing doctors starting to accept that for years. I mean, I've had doctors be like, That's frivolous. And what you do not you're making your patient neurotic. And I'm like, button the patient. Have a hypoglycemic response to ground nice that is paired, or excuse me, hyperglycaemic response, like too much blood sugar, to brown rice that is paired with protein and fat and all that, right? It shouldn't, it shouldn't happen based on what we know. But they are and it's what's true for them. And if you can figure that out for yourself, then you can control your blood sugar so much better. And it isn't about becoming neurotic. It's about becoming informed. So that every time you make that decision, it's an informed decision. Like, we know, there's certain things I think a lot of us that, like if I eat this, or I do this, like I'm not going to feel great, but you still chose to do it. And that I think is really empowering to say, I know this isn't gonna make me feel great, but like, I'm gonna really enjoy it in the moment and whatever it is, but you know what you're doing and you're not lost in that, like, why am I doing this way?
Yeah, that's so true. And I think the more I find like with a CGM, as you say, it's like empowering you to make different choices because you can see in real time rather than kind of obsessing with it, you can see what's happening. One thing I want you to you made a really good point around and I think more women need to be aware of this just sticking with PCOS PCOS for a moment, is it is a lifelong condition. Right? So this is going to continue beyond menopause. It doesn't just all go away. I remember a doctor a doctor saying to me recently, it was like, Oh my gosh, for you with PCOS and endometriosis. By the time you get to menopause, it's just going to be a huge relief.
I feel like I want to see for magic wands, like, I love this. I love this idea for all of
us. I know. But what was so beyond that, okay, women post menopause that have PCOS, they still need to pay attention to their metabolic health to their cardiovascular health. Can you just explain a bit more because I think it's so important that women listening who have this condition realise this,
you know, and this is the part where I say like, no matter how old you are, please listen, because at some point, you will make it to menopause. At least we hope so because that means you've lived long enough. I get so many times women in their 20s and 30s. Like that doesn't apply me. It's called me Okay, it will apply to at some point. It's a natural progression of our life process. So we've got this lovely hormone called oestrogen which everyone likes to vilify, but it's super protective, our cardiovascular health. And in addition, we have progesterone. And progesterone is very protective of brain health. So both of these hormones are great for brain health for bone health or breast health for cardiovascular health. So long as they're all in balance. What happens is that as you progress in perimenopause, we see that there there goes to rise and Abila Tory cycles. So maybe you still have a cycle, but you don't ovulate or you start missing cycle because the ovaries are kind of dumb, they're over. They are like, Yeah, we did the we did the like phase of where you know, there was baby making potential. And now we're moving on from that. And turn in a pass can be, quite frankly, can be a decade of health for some women. But it doesn't have to be in this is where what you do in your 20s and 30s can make like such a difference. And there's time to course bras even when you get into perimenopause, if you start having significant symptoms, but it's not progesterone defined, we will start to see anxiety come up, sleep gets disrupted as a prevent presented at the Health optimization Summit. And in my new book is this normal, I have like a whole diagram and I go through this whole thing like, if you are not sleeping, here's how your insulin is going to rise and your ovaries are going to become even more dysfunctional and your inflammation is going to increase. So just by way of progesterone not being available, what's metabolites to stimulate and help GABA in the brain so that we not just fell asleep, but we stay asleep, staying asleep art and the getting the deep restorative sleep that can be really problematic. That sleep disruption will compound the already, you know train that is headed towards cardiometabolic issue. So, you know, we see with men, you know them having cardiovascular issues in their 40s 50s women were matched in terms of our risk once we go through menopause, and we no longer have these hormones. And as we talked about, you know, one thing I think is really important that we didn't talk about is that with PCOS, you're not ovulating regularly. So it can be lack of ovulation or it's like in spurts so maybe over your period every four to six months kind of thing. That is one of the criteria for diagnosing PCOS. What's interesting that I have found the research is that your libido can really suffer. So there has been research done looking at sexual desire sexual pleasure, like do you actually enjoy sex? Do you want to have sex, and it is tied in to ovulation and it's interesting because they corrected for other things and they found with PCOS that you're not ovulating, that can negatively impact your sex life. So we get into perimenopause. Now we're going to ovulate regularly that can affect our sex life costs, like we can have weight gain all these other issues coming up and then we enter into menopause. Now we no longer ovulate. We have vaginal dryness coming up. And let's just like not overlook the fact that if you have cardio metabolic issues, your blood vessels are impacted. That's going to impact blood flow down there. And there is actual research looking at how blood sugar dysregulation and cardiovascular issues now, let me say there's plenty of research if you have a penis, they have done plethora of research, you have a clitoris little bit less, but there is research showing the same impact, which makes sense, because these are the same tissues, the clitoris and the penis, they started out the same in utero. And it's just a matter of having a Y chromosome and some hormones and through testosterone mainly that differentiates all of that. So I bring this on because in medicine, women's sexual health is not prioritised. But we know that women's sexual health mean it's an aspect of health. The World Health Organisation actually is like we need to have a pleasure mission, because that's how important sexual health is. And this is not only often overlooked in all women's health, but when you get to menopause, and you start having pain with science, and you're having these issues, if if you're a man and you start having sexual dysfunction, they're like, let's work you up. Make sure you don't have cardiovascular issues. If you're a woman, they're like, have some wine, get some lube lay there. It'll it'll work itself out kind of situation. drugs don't work so well on us because we have to get into this in Is this normal, just our sexual desire. What people call libido is so complex, that you can't really make a drug that's going to be a complete game changer. But at the same time, like your menstrual cycle and like your period was a sign in your fertile years that there could be a problem, your sexual health and your lack of desire your inability We're down. Payment sense all of these kinds of things. At every point in your life can be a sign that there's an issue and certainly in the perimenopause and menopausal phase, these could point to cardiovascular issues.
And what do you suggest for women that are struggling with that? Because as you say, right, if there's reduced blood flow in one area is happening in other areas, it should be alarm bells ringing. What's the best way around this? Like? Do you think that? It also when we're looking at bioidentical hormone therapy? Do you think that women can I mean, years ago, we transitioned through menopause? We didn't have anything, right? Do you think that women can make that transition? Or do you think that in the majority, if not all cases, women are going to need some support, Have things changed, because there's so many toxins that were exposed to oestrogen stores, all these different things, I'm just curious as to your view around seeing a woman make that transmission transition in the most healthy way.
So there was once upon a time where I was a new doctor, and, you know, being, you know, being just in health and everything I was like, I wouldn't use but I would have done both. And I will just transition naturally, the amount of cognitive decline that we see in women, I have to say, like, sexual health is important. You know, bone health is important, only things are important. What's really scares me. This is personally what I want to avoid is becoming not 66%. That is women who have dementia. And what we see is that it is linked to our pheromones. And so with that in mind, is it possible to transition into menopause, not use hormones, and live, you know, with your life and be happy? Yeah, in a lot of cases, you know, you can, but when we're talking about optimization, and we're talking about quality of life, I just don't want to be in my 80s, wishing that in my 50s, I'd use some hormone replacement therapy so that I could maintain my memories, my personality, still know who my children are, like, I'm getting kind of emotional here. But it's those kinds of things that we're not talking about what we see online. So one, there's a lot of really old research that wasn't done so well. That scared everybody away from bioidentical hormones and actually, like, Okay, you're all gonna get cancer or, you know, you're, it's, it's, you know, that's, I think the biggest scare is that everyone's gonna get cancer. And you know, sometimes when we look at these studies, like when they're using nurses, when you use people who don't have consistent sleep, they're already at higher risk of cancer because of their melatonin disruption, and other reasons. Like I could talk about, like, why we should make them sleep. And people always like, oh, sleep, that's nothing new. I'm like, yeah, and yet, it's so vital. So with that, um, what we like, what I think that there's been a little bit of pushback from some women, you know, who deem themselves feminists who have really viewed violent articles as like trying to hold on to youth or anti ageing, is it anti ageing is a bad thing. Um, I think the way that word gets used, it's not like we're trying to never age bigots that we are trying to sustainably age like, not rapidly age. And you're right, there's a lot of different things in the environment. Um, when so like, they'll run person who does brilliant, he's a doctor does brilliant research and Alzheimer's, when you hear functional medicine physicians who focus in neurology, or even, you know, really, in chronic disease, when we talk about chronic disease, there's this analogy of basically having like a sick or like a colander, right? Somebody that you wash your vegetables, and you've got all these holes in it. That's what we want to go in and patch with chronic disease. That's what we want to patch with old timers and these kinds of things. And there might be 40 holes, and you get to like 30, and you're way better off because of it. Because let's face it, there's a lot you cannot control. We cannot control these plastics that not persist. These chemicals that not persist are ubiquitous in our environment. You know, the same chemicals brought to you by doctors who said, don't worry about it, because there was no research to show they're bad. And now here I am as a grown adult being like, wow, why do we have to keep doing dumb? Why do we have to keep waiting until things are so bad to finally like say, oh, yeah, maybe we should be cautious about it. So that's just so let's say that while identical hormones are not going to be everything, I will say to patients that feel like they're everything because they have been doing all the diet lifestyle, like they feel like they've been doing everything right. And then the bioidenticals are really like you know, that one key that turns the lock and opens the door for what they were trying to achieve. But you know, I don't want to also be the person who's like just everybody bioidenticals and you'll feel so amazing because again, there are all these other holes, right? All these other aspects that we have have to be looking at as well. And certainly when it comes to so we were talking about, like sexual health. And you know, I alluded to payments, that vaginal atrophy is something that isn't just going to affect your sex life. So there's thinning of the tissue becomes friable patients who they just they go to the bathroom, they wipe and there's blood, because they can wipe with tissue because the tissue with paper because the tissue is just that sensitive, it becomes very inflamed rather than someone who who can't sink who can't look, I want anyone if you've ever had a yeast infection, just to imagine that being every day for the rest of your life like that. What really pisses me off about that is that there's this dismissal is it like that's not a big deal? Do you undistracted that leaves that woman? Do you know how much energy that is taking to be in that discomfort? And that means she's not showing up for her community, her friends, her family, or giving her gifts to this world in the way that she could be? Because now she's struggling with something that she shouldn't even have to struggle with. And then that's not to mention that like, maybe she doesn't film. You know, what society has told women, right? We're supposed to be sexual creatures, but like only in the right context kind of thing. But like, eat no matter how progressive we think we are. We have been inundated with so many messages in society that it takes, it takes work our entire lifetime to like really undo that. So there's the psychological aspect of all of that. And then as we were talking about with like clitoral bloodflow one of the best things we can do and use it. We talk about user lose it with nurses all the time. It's the same way with your clitoris and your orgasms. If you're not having that stimulation and using it regularly. You can lose the ability to orgasm you can develop clitoral atrophy. It's there's like this whole movement that's anti masturbation. It's really on the rise out there. And yeah, this is something we've got like FDA approved devices for helping women maintain clitoral health. Because it is it's a very important tissue like down there altogether is a very important issue. And sometimes it is maturation is a prescription that we're writing dependent, like if this woman in a partnership, why should she like have to risk vaginal issues? Why should we have to risk you know, issues with the clitoris because somebody else is telling you about like masturbation as well. Like I'm like I'm literally writing you a prescription for this because it's important and as we talked about, you know, so if it is a cardio metabolic issue, we want to get that work done we've got to get labs we can't like we can't just go based off of what you can't see your heart health I wish you could see it that easily. So we want to be looking like I said the fasting insulin the haemoglobin, anyone see, you may want to do continuous glucose monitoring, we want to look at the hscrp, which is a highly sensitive C reactive protein to see where things that you may need advanced testing beyond a lipid panel to look out, like what are these? What are these other risk factors that you have? And you know, it's something that I'm certainly as you get into perimenopausal years, which is, you know, technically starts at age 35 to get regular EKGs and, you know, talking to your doctor about like, should I have an echocardiogram and getting near these tests? Because the reality is, is that when you know, the who else was on the panel with us was Dr. Amy Kailyn. And I'm reminded of a story recently where her best friend had a heart attack and she was like she was a yoga teacher she did she was like picture of health and she had a heart attack. And you know, Amy and her posts that she was shared on Instagram said like get your EKG get all of that I'm like yes me annually getting all of that stuff because I'm like, I would rather see what's coming on the road ahead and take a detour then arrive at the destination and look back and say Damn it, it was there in the map the whole time.
As scary, isn't it but these tests are not run kind of routinely that often as well. You see I'm here I had a friend his sister very recently in similar in her early 50s. Super healthy, massive on walking, doesn't walk doesn't drink exercises regularly. It's really healthy. All of a sudden gets a headache gets prescribed a migraine pill, but instead actually she has a double block up to the brain. And now she recognise anyone nothing. And
it is it's really frightening. It's so frustrating because I talk about this in my book is this normal? The rate which I wish I would have been a whole chapter honestly, on gaslighting women, but the rate at which were dismissed and it's a whole section we're talking about paying with someone, and how it's not taken seriously paying respects not taken seriously. They don't even take our headaches seriously, which can be a migraine or could be a stroke. I talk about that and be on the pill as well, because the number of parents I've had, and rightly so I get all these doctors who are like, don't talk about the stroke risk, don't talk to him about fonts, because you'll scare women away from taking the pill so that I say, bullshit, bullshit that you think you get to withhold information from women, and you get to decide what your information will scare them or not scare them, they deserve all the information. Because too often, these women are never told about the risk of a pot of what to look out for. And I hear from parents who have lost their daughters because their daughter went to the ER, shortness of breath while they had a pulmonary embolism that they had to go back to the ER several times where they died in their bed because their doctor was like never even asked about the pills. Same with the stroke. They're told that they have a headache. Well, yeah, they had a headache. But then they started noticing that they were having vision change in one eye. And that, you know, when they were talking, they were like some of them a little bit funny, but because their doctor told them there's nothing wrong. And they didn't even ask them about the pill. They just ignore it. And now like they are either disabled or they're dead, and we are not seeing this at like an exponential rate where it's like our crisis, I want people to understand that. It's not like we're like, Oh, my God, like this is like, you know, something no doctor is talking about and all these people are dying. No, but you know, we're not seeing it's not like this huge, huge risk. And yet, it is a risk. We do need to talk about it. Women do need to be informed, especially because odds are they will encounter a provider who is going to dismiss them and gaslight them and send them on their way. And every woman needs to know if she's on pill or she's on hormone replacement therapy, or if she just doesn't feel things are right, right, that she needs to advocate for herself, but always disclose those hormones to your provider. And that is so much easier said than done. Because when you're in the acute state, especially like if you are having like the worst headache of your life, like how do you recall that? And why is it on you as a patient to have to remember to tell your doctor that you're on the pill because they just didn't ask or to tell your doctor that, hey, I'm scared, this might be a clot I, you know, this is something that I've had patients who come to me and they're like, I told my doctor scares clot, they dismiss me, it wasn't until I pitched this huge fit. And I was screaming in there, but they were like, Fine, you're gonna be hysterical about it. Because like, you know, we're still using that word, then we're going to work it out. And lo and behold, it's not just, it's just not it's not just quiet. I mean, there's so many conditions where it isn't until you go there and you are the messy patient that like you don't want to be you don't want to be that person to lose it, you lose it, and then your doctor listens. And then finally it's like, oh, lo and behold, if endometriosis you have fibroids, oh, you had ovarian cysts that was gonna be like, probably be very unfortunate. There are just so many cases like this that should just never exist. Like because it's as simple as just listening to your patient. And we don't have a system that holds space for that.
No, we don't do right. Do you think that all these hormonal problems that women are experiencing? Do you think they've got more prevalent? Do you think we've got better at diagnosing them? Like what do you think's going going on?
So, one, we can't ignore that the environment is way worse off than it was and even just in our lifetime, right. And I think it's really funny that there, there's providers out there that can acknowledge the climate change issues, and the major issues that we're facing in the environment, but they will not acknowledge that those production impact women and impact Orleans but probably listening, like just think for a second that like your body, your body can, you know is is designed to create life to grow life. And like it doesn't always work that way. And you want to know how much that but to do that to be set up in that you have to be super in tune with the environment. So if we get overstressed if there's a famine, you know, there's different things going on. We received those signals our hormones shift or change. Now put us in an environment where you're getting endocrine disruptors coming in there is loss of community there is no more tribe no more family no more you know, there's just not that. I mean, I don't know how it is in the UK. We still see that like in Italy and in Spain and other countries. There still is this like there's multi generational households there is still this like supportive family unit. We do not see that in United
Kingdom so much in the UK either. Now, unfortunately, everyone's like spread out and travel.
Yeah. So who does it? Who does the burden of holding everything to managing a household to doing all the tasks every it falls on women, even though like, and then people will be like, no, like, we've thought and feminism and get to work. And on the seventh get, like all of my female colleagues, we just talk about how much we need wives like we just need, we need to. We need why, because we still have to do so much of it. And it's not to say that's not a dig on my husband, just for everybody listening. It's just there is still this like caretaking and this tendency that we have as women get it doesn't mean we should it should all be on us to do that. So we start to look at all of these things. And of course, that is all going to negatively impact us. I mean, we there is some research that shows that being in community around ovulation and following ovulation actually helps your progesterone levels. What is that? That is a signal from the environment saying, Should we have a baby, there are people here that will support us, protect us help us like, and these are things that get overlooked all in the name like independence, right? independent woman, yes. But also the United States is set up to be like, it be being an individual over collective like no matter what, no matter what the cost, and the cost is women's health. That is what the cost has become. So when you look at like, and that's just to say that, like I don't, I think so often in the wellness space, there is a very myopic perspective to be like, it is the food that we're eating, and it's environmental toxins, but it is so so much more than that, like it, it really takes a team of health practitioners to help an individual and all of that. Now, in terms of like, you know, are we diagnosing it better? I think that we are in an internet age where, and I will say there, there's a lot of doctors who are like women should stay off the internet, because they become type of contracts and all this stuff. You know, there are so many women who are figuring out that they're autistic, or they have ADHD, or that they have other issues, from the information on the internet. And then they seek out the provider and they can go to them and they can get help. How do people even go to the doctor if we're not giving them that information? So I think that there's a lot more I mean, you have a podcast, podcast when I was growing up, like what I wouldn't give in to be going through puberty and have podcasts and blog posts, and books and all of this information. Like I have the Dewey Decimal System in the library looking at stuff from like the 70s, that really was just not not it. So there's that piece, and then there is the peace, that women are more empowered to take care of their selves to speak up for themselves. I mean, you know, back in was like the 50s 60s. We had like the valium age of moms of moms who were like, This is something's wrong, I can't do it all this life, like and never just like medicate them medicate them, right. And so we're seeing more and more patients, I think that are very cautious when their doctor offers them the medication that will basically subdue them. They're also being like, wait a minute, I've had enough information now to know to ask more questions. So it's not a simple answer, like I can give a simple answer. I would love to and it's always the question like, you know, is it that, you know, the environment has changed so much? And that we're seeing more of it? Or is it you know, are we just more educated? Like, what is it? And I think it is we are more educated, but also, we we've seen shifts happening in every aspect of our life that will absolutely throw off the endocrine system, throw off your diamonds.
Yeah, I couldn't agree more. And it's interesting isn't because when you talk about the stress there, and their lack of community, like a lot of women now, and I think there's, you know, I tend to cycle my fitness, for example, around my menstrual cycle. And I think there's really good evidence and things for that. But I think a lot of women overlook and they go, Oh, well, I shouldn't be doing high intensity work in the luteal phase, completely forgetting that they're so highly stressed. And the psychological stress is having so much more of an impact on their hormones than the 20 Minute hit session that they did in the gym. Because as you say, particularly as parents, and I think when you're working as a mom, you've got your kids. It's very difficult as well, I think without being kind of rude to men, I think often they just don't always quite get when your child is under pressure, right? So they're like, it'll be fine. The classic husbands responses will be fine, you know, quite often, and actually, the kids need your help. And so I think as the primary caregiver, we are under so much pressure. I wanted to ask you, oh, sorry, got,
oh, I was just gonna say, you know, to that point with men, because I'm raising two boys. It's also recognising that like, there are patterns that they've been taught, they have to say it's fine, right because they get to have like a Anger and happiness, what other emotions do they get to have? So that response? I think it's like, that's really annoying. Okay, I'm just gonna say it like, it's really annoying. I have I have worked on this for years, because it'll be like, it'll be fine. And I'm like, What will make it fine? I don't know, it'll be fine. It'll be fine. And I'm like, No, it's not fine. Why don't we like actually name what it is and go through that. And I think being long, that's been something that like really focusing on on like, mainly emotions work through that. So I just want to say to women, like all is not lost, we do have an opportunity to help a future generation be better off than us. And also to recognise that like that, it's going to be fine. It's sometimes a stress response. And someone who doesn't know how to name emotions or process or deal with it, because they were never taught and as much pressure as we get in society in all the ways we can go on and on about, men also get a pressure of like, you know, and they also get a pass, right? They get a pressure and a pass, and it's not serving any of us.
It is it really surprises me. I have two boys and a girl, as my boys telling me a little while back that their prep school, they were told, Don't cry, boys shouldn't cry, just thinking, Oh, my God, like, really, in the modern age actually saying this to our boys that they can't, you know, they've got to suppress their feelings. I mean, it is. Yeah, it's crazy. So I wanted to ask you before we kind of go back a little bit to the younger population, when you were talking there about menopause and the impact on Cardiometabolic Health and also on neurological health. What is the right time I know a lot of women listening to this will be having in their mind. When is the time that I need to go see my doctor about getting hormone replacement therapy and how do I know when I've reached that point?
Well, okay, so firstly, we can use bioidentical progesterone in the perimenopausal phase to help with symptoms. Topical can be nice, but oil is actually we're going to get the metabolites, they're going to help with the anxiety. We, when you have projects from you love your family, you love your people like a lot more and when you don't, you're like why are they eating with the mountain folk? Like why can't they stop breathing like that kind of irritability habit. And so I just it's not normal to feel that way. But it is normal if you don't have enough progesterone going on. So we can use that in managing Peri menopausal symptoms. So we can go off symptoms. There's a lot of markers who go off symptoms. We can also test about five to seven days after ovulation. But if you are in perimenopause, and you're not ovulating regularly, and you can't sleep, you can't so you have difficulty falling asleep staying asleep. You're finding that maybe you're feeling puffier like you're having some fluid retention, you're feeling really irritable, you're having anxiety. That's the time when we can use progesterone bioidentical progesterone therapy and that can be helpful when it comes to like, when is it that I should start oestrogen? So this is often like, let me let me just breathe in to the fact that it does make me angry. I'm gonna name that emotion. There is there when doctors are like, Oh, your periods are regular, like just have the pill. What's much like the pill was used, okay. The Pill was developed for young populations who don't want to get pregnant and it really was developed to be used for like three years facing a pregnancy. Here we are like decades on end of using the pill. And they will put women on the pill. You don't need more oestrogen. And you don't need more oestrogen and that pays like you're doing the oestrogen thing it's a progesterone issue that we often see a rise in perimenopause. Then doctors are like oh just like take you know you just stay on the pill not will help with menopause. Never Okay, as a hormone doctor, I would never recommend oral oestrogen. Never the you have to use a higher dose. The risks are much higher. You're already somebody that's moving into a higher risk of cardio metabolic issues. Now I'm giving you oral oestrogen. No I don't think so. Like that's that's a bad idea. And it's because doctors are told like the pill is so safe and a hormone replacement therapy is so dangerous and I'm like can you just please like read updated research because you're wrong. Like you're just absolutely wrong like and so the time to be thinking about like going on oestrogen therapy. What So firstly, what is menopause? Everybody actually menopause is this like long it menopause is a day. Okay? So you don't have a period for 12 consecutive months. Welcome to menopause tomorrow. You are postmenopausal. That is the time that we want to the so that would be the time that I'd say get in conversation like when you're getting to that six to nine month mark with your doctor about what does it look like to go on hormone replacement therapy? What labs do I need to get done for you to be comfortable with this? and be thinking about starting that therapy. Most providers are going to want to start you within five years of you going into menopause. That is really where we do see the benefit. And I talked about dementia, talk about all these other things. There's new research coming out showing that mortality, okay? Mortality rates are like very, there's, it's a sad outlook once we lose our hormones, even worse, if you have like a hysterectomy, in your 30s and it's an oophorectomy. They take your ovaries and you don't get hormone replacement therapy. So if you lose your ovaries or your ovaries are losing the ability to produce hormone, that is a time to consider hormone replacement therapy. And when it comes to what about like, you know, women start to get scared about like, what about, you know oestrogen and breast cancer? Remember, you're going to be doing your screening mammograms like that needs to be happening anyways, you should know your family history. So now's the time to start figuring out your family history. And remember things like broccoli sprouts. So getting a sole source of sulforaphane dem coming in from your Crucis cruciferous vegetables. Eating your you know, eating a wide variety of plants is going to help you get magnesium honestly probably need to take magnesium because we all do. But getting magnesium in making sure that you are taking in the nutrients that's going to help your liver properly run oestrogen detox pathways to get healthier metabolites. So we want less of the four and 16 hydroxy. If you if you're into the nerdy stuff, there's a whole liver chapter and beyond the pill that like takes you through all of this. I spared you Is this normal? I was like let me just give you the brief highlight. But like here's what to do what will be less nerdy here for a second and other nerdy stuff to talk about. But we want to be more than that two hydroxy as strong. So we want to be protecting methylation, we want to be protecting our livers ability to run so like what was the number one thing like in protecting your liver, let's cut out alcohol. If you want hot flashes, if you'd like hot flashes, it'd be like waking up drenched in sweat. continue drinking, by all means. And that doesn't mean you can never have all gall. But you know Doctor brain.com, I have a whole article with research cited about what alcohol does to your hormones. And it's not good and it's not fair. It's not fair to say that. So there are lots of things that you can do lifestyle wise that you should be doing lifestyle wise, whether or not you choose hormone replacement therapy to lower your risk factors. And we know when we have those in place again, let's go back to that sieve. We have plugged holes that is going to make it so that your body can really be optimised.
And what about the difference between that's super helpful. What about the difference between oestrogen patches and pellets?
Yes, so I couldn't not a big fan of pellets. It's been then there's going to be some doctors in the comments that lay back all they do. And they're just like, it's the best thing ever. And it's like cool. Maybe you find the right people for that. But I see a lot of patients that get pellets and they it's just problematic for them. Like especially, you know, getting that bolus of oestrogen, there's patches, there are creams. I mean, these days, I mean, even in like the last like 15 years, I've really seen a lot, a lot more accessibility to hormone replacement therapy. And most people's insurance is going to cover like getting a patch, or getting an oral progesterone. It's a biochemical like prometrium and being able to take that orally. And so it's about what is fine. What like what are you going to be consistent with what is the easiest thing for you. And you know, some people will choose pellets, but the thing about pallets is that it's really hard to dial in what your specific needs are, in the end, get it right the first time. So just understand that and I would work with somebody who is trained in hormone replacement therapy and can talk you through your pros and cons. A lot of times I will say not a lot of time, but I do come across doctors that all they do is pellets and they're very biassed with pallets and they only recommend pallets and I'm like how can you be meeting the individual at their level and really doing what's right by them if you are bringing this bias that like everybody should just use pellets like no matter what.
Yeah, something I've seen more used with a US client side counter to the pellets rather than Yeah, okay. So interesting. And with progesterone, have you found some people don't tolerate it well,
so I will say that okay, one you if you go too high and progesterone, you your breasts recover going to swell. Yeah, generally patients don't complain about the size. They complain about the tenderness. You'll find that you're really groggy waking up in the morning. So you wake up feeling super groggy, and you make cry a lot more. Those are some big signs with oral progesterone being too high. There are compounding pharmacies where we can actually play with the dose and come down. Some people are much more sensitive. People who have a history of PMDD sometimes do not respond as well to progesterone therapy. Their brain is just different in how it utilises progesterone. And that's like very just say that very preliminary research and what I'm citing there with that, and it's not always true across the board, but if you have a history of PMDD, which is it's much, much more severe than PMS. So that's usually going to be like 10 plus days out of your cycle where you are having extreme physical and mental emotional symptoms going on. You want to convey that to your doctor. I have had patients where like 50 milligrammes of oral progesterone sweetspot, that's it, do the standard, like 200 milligrammes that a lot of people take and no two, they are crying, they're actually feeling more irritable, they're like, I'm, I'm feeling, you know, not completely within my body within my mind, and then it's not saying it's psychosis, it's just feeling like, my emotions are in charge here and I can't stop crying.
It's interesting what you're saying there about progesterone and in perimenopause and oestrogen around the time of or post menopause because I found like a lot of doctors here in the UK, they're always prescribing the two together, and it's while women are still having periods in their 40s. But I know Dr. Laura Bryden. She's also a fan of just progesterone therapy only and I think it's, is it I think it's down to awareness that more doctors just need to be educated on using it.
So progesterone, okay, so here's, like progesterone is just kind of like an unsung hero and women's health. And the problem with progesterone is that it's used interchangeably with progestin, which is the synthetic stuff you find in the pill. And progestin doesn't have the same benefits for brain health that progesterone does have, actually doesn't have the same benefits like overall as far as we know right now in the current research. And so doctors because the pill, right, this is what they're trained in there like oestrogen progesterone always go together. Then there's the camp. That's like, you only ever get progesterone when there's a uterus present. If there's no uterus present, then we don't even worry about it because oestrogen is just so important. And oestrogen is important, and yet so as progesterone, these are you'll also often see, so if you want to take your testosterone like put you on the pill, okay, so the pill is going to shut down. Ovarian hormone production, this is how it's working. It's working at the brain level, to shut down the brain talking to the ovaries. Now the ovaries aren't going to produce their hormones, you're not going to cycle therefore you will not ovulate. Yeah, you know, baby, that's all we want, right? Except you're also not going to make testosterone at the levels you mean and it's going to cause your liver to produce more sex hormone binding globulin, which is going to bind up your testosterone. Now we've got libido issues. Well, who cares right women women don't like sex anyways, women don't have libidos anyways, we're not interested in sex anyways, right? Thanks. Purity culture for invading medicine. No, that's not true. So now we've got low testosterone. That's problematic because what happens in perimenopause is we start seeing these metabolic shifts where women are gaining weight definitely starts happening postmenopausal. We need that testosterone to maintain our muscle mass. Muscle mass is a very, very important endocrine organ and is an organ of longevity. We want to build muscle mass because that's going to that's going to help with bone mass as well. So testosterone is absolutely essential. You don't have enough testosterone, well, you're going to feel unmotivated, you're going to find you probably cry more. This is where hormones get their crossover and it gets complicated. You're just going to find that your low energy, what does this start looking like starts looking like depression, when it's actually a testosterone issue. So you're giving women in perimenopause and menopause the pill. Now you're giving them this extra oestrogen, some progestin, you're also putting them at higher risk for some of the side effects of the pill and you're taking their testosterone like, What good are you doing here? You're really not. So in perimenopause, we want to be looking at like the progesterone. Is there a time and place for oestrogen? Absolutely, it's very individualised. When do we know that? Like, I can speak generally that oestrogen is going to be needed. When those ovaries are done. That's when oestrogen is going to be needed. And if you start having like hot flashes, vaginal dryness, like you start having issues, sometimes we'll use a topical oestrogen or topical DHEA vaginally like on the vulva and that's to help the tissue and that can help mitigate the symptoms a little bit. So there's there's a lot of like bio individuality that happens here, but oestrogen, really, it's when the ovaries are done. We're going to need oestrogen. And the problem with coming in now if you come up with a pill, that's completely different, but if you come in with oestrogen and then what happens women start getting really heavy periods. Okay? We've done too much with oestrogen now and now doctors are like, Oh, well, what do I usually use for that, like you need the pill, I can do ablation, we might do a hysterectomy. Like, that's when things can really start escalating. And so, you know, we didn't even talk about testosterone replacement therapy, but I think it's really important in women's health. And it is a very, like testosterone is one of the terms we really have to dial in, I usually start low and slow and go up with it. Because if you go too high, or your, your enzymes are upregulated, like inflammation can do that alone. And I actually I talk all about this and is this normal, in how that takes that testosterone into DHT. That is a form of testosterone that's gonna make you lose the hair on your head. And you might start getting chin hairs, which also sucks, but not as bad as losing all of your hair. And having hot flashes and feeling like you just like don't enjoy life anymore. All of that compounded together. So testosterone, really, really important women's health, super overlooked thing with progesterone and your average doctor that you talk to. And I know this because I lecture and medical conferences, and how often doctors come up to me afterwards and say, I never really understood the difference between progesterone and progestin. And I'm putting molecules up on a slide showing the difference. And they're like, I've been told us the same, I was told in medical school is the same. I was told by the pharmaceutical rep who came into my office and told me to prescribe more of this than it was the same I've been told and continuing medical education. And then this is the first time that I'm actually seeing that it's not the same. And I'm seeing the research that says it's not the same isn't necessary in the pill. Yes, we have to have that there to oppose oestrogen. And most doctors recognise that that's important. But the reason why it's progestin is not progesterone is you cannot pass a natural substance. And in the United States, one of the biggest things that we have is patents. So progestin it was actually made in Mexico, in a lab in Mexico, and then it was brought into the pill formulations. And that allowed them to patent these drugs. And so to understand that, like, it wasn't put in there, because it was like the best thing. It was the thing that allowed for a return on investment from the pharmaceutical companies who for the first time in history, got to give a drug to somebody who never had a diagnosis, all they had to do was be born with a set of ovaries.
Scary, so scary. When you're looking at that school. When you're looking at this, and you're testing women. I know you talk about the Dutch test, actually, in your work. I often look at that. You can see variances as well, though, when you compare the Dutch test to when you're looking at serum testing, in terms of levels, like oestrogen can look good on one and then not in the other. And you just explain a bit about that and what you what you tend to use in terms of like prescribing those bioidenticals and what women should be talking to their doctor about in terms of testing.
Yeah, so it's something that you'll find a lot of providers and even pharmacists, when you talk to them, they don't necessarily hang as much on testing as they do symptoms. And I think that is because we just like serum testing hasn't always been the best in terms of catching this. With the Dutch test. If you're on bioidentical progesterone, it's not really going to tell us much with that. And in fact, like, we really have to go offset symptoms with progesterone. Why I like to run the Dutch test is I want to see the metabolites. I want to see what you're doing with your oestrogen. And I think so a lot of times you know, the Dutch test is going to be that five to seven days after ovulation with a lot of doctors say day 19 to 22 of your cycle. But as we talked before we even started recordings that not a lot of people are actually having 28 days cycles. So keep that in mind. It really needs to be five to seven days after ovulation. That is when your natural progesterone will be at its highest and that we'll be able to look at all of that. But when it comes to the bioidenticals like I said the Dutch test isn't and then we were at that for the progesterone. The metabolites, however, with oestrogen are super, super helpful. Because if you are pushing everything into 16 hydroxy s Joan, I know that your breasts are probably going to get lumpy and bumpy and swelling if if we start giving you oestrogen if we're not addressing that pathway, if it's the four hydroxy Ostrom we could have a problem with DNA damage, and if we have problem with DNA damage that equates to cancer in the future. That's problematic. So we want to be looking at like how can we come in how can we intervene? The other thing I like about the channel we haven't even talked about this right we just didn't turn it over. It's over it's over a lot love them like love the hormones from them. However, your adrenals are everything when you go into menopause. This is why I'm like sleep, legs up dying and saying all of that because you know I actually put I talked about this pyramid so much and I put it in Is this normal? The foundation of your hormone period is or your pyramid. Let me say my words, right is your adrenal glands and insulin and if those two things are not right, we expect your thyroid hormone and Your sex hormones, those are not going to be right either. And that is your foundation in healing. Your hormones are good. That is your foundation for having great hormones through your whole life. Once you are menopause, the adrenal glands are going to produce DHEA. There's a big significant portion of our testosterone coming from our adrenal glands. DHEA can be make testosterone, but then it can also go into oestrogen. So you're not done just because your ovaries are done. You're not done with all of your tissues making oestrogen when we know like, bone cells, fat cells, like they're gonna make oestrogen, too. But your adrenal glands, we really need to understand where stress is out. Because like, I can be giving you bioidentical hormones. And let's say I'm like, oh, yeah, your anxiety is bad. And like you're having, you're having this night waking and all that stuff. But I'm not looking at your cortisol. I'm not looking at your cortisone. I'm not looking at your epinephrine, norepinephrine output, like, I need to see that because that's a big piece of the puzzle. I can't do that on serum. You know, if I think you have Addison's disease, I'm going to be like, Oh, which is like, adrenal insufficiency, and that I'm going to be like, let's run, you know, all of these markers. But otherwise, I can't really do this for point throughout the day, how are you looking the ducks now? Has the cortisol response, like when you wake up? Is your cortisol spiking the way it should? That pattern, especially if you're a mom, or if you're an attorney, by the number of attorneys, like they're just not patterns tend to get thrown off? Okay. So like, anyone who's gone through grad school, like you have a pattern of a college student for so long that you've been up at night, studying, and skimping on sleep and all that if you are a mom, you have a baby, that's like night, wait, no, wait, you're not supposed to sleep like that baby, like come on what the baby is, but I'm not supposed to write and say this is I know, I'm a 17 month old. And so with that, when we can see is that cortisol is not spiking in the morning, and it's actually coming up in the evening. Well, maybe it's a progesterone issue, or maybe it's actually your cortisol is an issue. Maybe it's a testosterone issue with energy in the morning, maybe it's a cortisol issue. Or maybe it's a cortisol, thyroid and testosterone issue, because spoiler hormones are rarely just one thing. And so that's why I like to look at that because I want to see the whole panel that doesn't do thyroid, so I'm gonna have to do serum anyways. And it's not always economical for everybody to do a Dutch panel. So you know, and it may be something that like, their insurance isn't going to cover bioidentical. So I'm like, Okay, what basis do we need to cover with serum work that we can get with that, and then we can do the best we can with meeting people where we're at, because, honestly, like, like, I hate that finances have to be part of like dictating how we do medicine. And yet, it's a very real reality of some things, we have to consider that like this, this is just not economical for people to do a Dodge panel, get on bio identical do all of that. And people still deserve to feel amazing and live a really healthy and full life.
Which is a shame when you think about it when you're looking at those pathways, right? And you can see the four Oh H and if that could cause or is causing DNA damage and predisposing them to cancer think how much money you're saving further down the line in terms of treating that patient. But it's the same in the UK, it's not paid for one question I had was on the 16 Oh, H pathway, right? There's a it's kind of like a Goldilocks effect, right? You want it to be within a certain range because it impacts bone density. What happens when that is low? Because sometimes what I'll see on the dash is actually all the levels just look really no.
You have to start looking at like, it's usually a question of supplementation, right? So people hear things like, like I just said, dim is helpful. So fear Fein is helpful. Where do they start though? I started with food. And I will say that I have a supplement line for women's health that I formulated. But I will always start with food first. And what I often find is that there's a supplementation issue where people are like, well, if a little is good, then more is better. And we have to start looking at like, what things are they taking? And also like, depending on the supplement company, what things are they thinking they're taking, but like, maybe isn't actually in there and is it something else that we have to look at? Like are they overdoing it? Dem is one that like, I don't recommend patients going over 100 milligrammes and it is something that I'll say I was shocked that I was getting people so I do a weekly asked Dr. Breaking on Instagram, and there were people who like I take them and now I'm having hot flashes, I took them and I like got me period early. I took Jim and I, you know, had migraines or headaches and I'm like, What is going on? I'm like, Alright, where are y'all getting your gym from? What's going on? Oh, my God, Amazon selling like, you know, 500 plus milligrammes like some of them saying like, take two cops a day. And really marketing its marketing more towards like the people who have oestrogen positive cancer, or the receptors are positive. And so with that, I'm People are just overdoing it and they're like, Yeah, I saw your supplement at 100 milligrammes, and so I figured like I was in must be better, and I'm like, you just tanked your oestrogen like you just like we're just like, it's like the I Love Lucy and the Chocolate Factory conveyor belt and they can't keep like the chocolates just like going through, like you just pushed it right through and your body's like, wait, I want that, like, some of that. And so that is something that I often that's one of the first places I will look when I start seeing because you do want the right and it you're right, it's a Goldilocks up, but like there needs to be balanced with that. And so supplementation is like the first area I start to look at, like, are we overdoing it with something and maybe you're not even overdoing it? You know, like, like, it's like, well, that's the standard. But for you, your body, your genetics, things that medicine doesn't even understand yet. It's too much.
And if they're not supplementing, would you worry about it or not so much if they're not?
Yeah, if they're not supplementing, it's the kind of thing that I will. So I usually will run a touch panel in like six to 12 months later. And then we'll do a recheck and see like, are we stuck? Is this problem persisting? Generally, it's not as we work on things. But I will say I think that is something that people don't do enough is they don't follow up and they monitor like, what is actually going on there. And we have to remember that labs are always one snapshot in time. So they're not always the full story of like the entirety of your life, right. So sometimes, we will see a TSH, so thyroid stimulating hormone of like for like, I don't want to see that about 2.5. I actually had a patient with this recently. And when I was like, Well, what's going on? And they're just like, my, I've been supporting my friend, like, her daughter just passed away. And I'm like, How close were you very close? Okay, losing a child. Losing a child is bullshit. I just don't think it's fair. And I don't think it's right in this world. And I think it takes a tremendous toll. And she, you know, she was like, Don't I need thyroid medication when this one thyroid medication? And I said, you know, I do not have this major stressor, I would be considering, like, do we need thyroid medication? And I told her, like, I would just like to support you support your stress support all in this? Because what's being hit on this foundation is her adrenal glands right now. And so we went ahead and we retested in three months, we monitored her symptoms. So so everybody knows, if I went with a medication, it's going to take six to eight weeks for the pituitary to adjust for me to know how that medication has been affected. But TSH does switch. So when you're looking at diet, lifestyle therapies, you want to be thinking the same thing is, it's going to be about eight weeks, but like, does everybody just start everything like day one. Now, it usually takes a couple of weeks to get into it. So three months is a good time for usually reevaluate. And we reevaluated and our TSH was fine. Everything looked great on her thyroid panel. And so that's just a lesson of just remembering that if you see a lab and things are off, we don't always have to react right away. Sometimes it's a matter of just going back to the basics supporting the person and retesting and again, being cautious that we're not jumping in with too many interventions. Because we don't want to, you know, we don't want to necessarily treat every little thing that we see on the lab, we want to treat that person in their entirety. Does that make sense? Uh, totally.
I always think you got to treat the person not the laughs right. Because as you say they're a snapshot in time. Yeah, you've been so generous with your time I have a few questions from my community, if that's okay, before you go, I think you probably cover them in the book when it comes out. So one is around how do you guide college aged kids around the pill conversation? It's so easily around pill prescription because it's so easily prescribed for things like heavy bleeding and cramping. And you know, a lot of teenagers maybe don't have an awareness of things like you feature in the book about how it can even damage your microbiome, it can cause inflammation. How would you have that conversation?
You know? So there's the question of Are you sexually active? So this is sometimes this is where, like, people ask me like, is this normal? Did you like this is like what sat said teachers should say, did you write this for teens? No, I did not. I wrote it for parents. And I really encourage parents to be the reliable source that their kids go to. And that's because sometimes kids will be telling their parents, you know, it's for my heavy periods. And really, it's because they want to be sexually active. That's a different conversation, right? Because if you have, you know, your kid is going off to college and they're going to become sexually active. There's a lot of people who talk about fertility awareness method. It can be fantastic, but the thing is, is that we've got brains that are not fully formed yet. They're not done developing their forms. They're just like not done developing them. I'm gonna have a low enough life experience and hormones are really, really good overtaking the brain at times. And one of those times is around ovulation where you're going to be a lot more in the mood. And so I just say that because infertility awareness meant that work for a team sure, is it going to work for every team? No. And you really, I just see a lot of people talking about this. And I'm like, if we want, especially in the United States, when we've got Roe v. Wade, and all of the issues, then we just got a lot of issues here, let me just say we've got issues, we really have to be aware of this conversation. So maybe the pill is the best thing for them. And we talked to them about, hey, I want to make sure that you are on a multivitamin or prenatal so that we're protecting your nutrient stores. Because, you know, if you're in a dorm, maybe the dorm foods like not the best, maybe we want to get them on a probiotic to support them and talk to them about ways to just, you know, really make sure that they're attending to their health. And then the big red flag like things that you should go to your doctor about if you're having these issues, when even things like you have chronic yeast infection, if you're having things sadly, you should see your doctor about that because it could be a side effect of the pill. So there's that aspect. And there's also the options. So in chapter 13, and beyond the belly give all these options and pros and cons of birth control. So there's IUD. So you could do a copper IUD as, as an alternative, it can lead to endometriosis, not the best option for you. And it can lead to heavier, more painful periods. So something to be aware of already heavy and painful. No, not for you. There's progestin based IUDs you're not going to get any oestrogen from that it is also not localised, that progression will make its way throughout your body. Okay, so and then, you know, there's there's barrier methods. And that is a conversation that I think is not happening enough. It is so reflexive to be like, we don't want to get pregnant, oh, unintended pregnancies, the worst thing in the world. And then it's like pelvic inflammatory disease and infertility. That's a subsequent issue from that. That sucks, too. And we have to talk about barrier methods, like there's a lot of cases of herpes. There's a lot of cases of Gonorrhoea and Chlamydia happening in colleges. And so we have to talk about barrier methods as well. And so that's all like the contraceptive conversation, when it comes to managing heavy periods, painful periods, things like that. There are options, I outline all those and beyond the pill. And that's a conversation that is the individualised level, some women do not have the bandwidth to be like, Okay, I'm going to eat more omega three fatty acids, or bringing omega three fatty acids supplement and bring in like magnesium, that helped, my periods get better. Maybe they just are like, I just need to take the pill and be done with it. And parents, as providers, we need to respect that as well. And so really, I think it's about presenting the options, and then whatever is chosen supporting that person in that, whatever that that might look like for that individual, including if they choose to take the pill, make sure that you're supporting them in being successful with that. And knowing that if it doesn't work for them, there are other pill prescriptions. There are other ways to go about this. They shouldn't just settle.
It's a bit of an experiment, isn't it with the pill like one your friend may be taking the pill that works fine for her and then it doesn't for you. And yeah, it's good to try. Thank you for that answer. The other question was around a couple others around. How long after stopping birth control does it take for things to regulate? And does the pill itself decrease progesterone over the months ahead? While progesterone is made when you ovulate? Right, so
yeah, so if you don't ovulate, you won't have progesterone and it can take some time for ovulation to resume and your periods to come back the whole time you run the bill, that's in a period you stop the pill, you're like, Oh, I had a period. And now I haven't had a period for like three months. You've actually not haven't had a period this entire time. You've had a medication induced withdrawal bleed, right. That's why we give it with PCOS. We're like we need to induce a bleed. That is that is what we're doing here. A period a menstrual cycle period is following ovulation. So the whole time you're on the pill, you're not ovulating. And we don't have studies. We don't actually know what happens if we put you on this it like 12 1314 and then you don't come off of it until like 44 we don't actually know. You know, is there any interruption in the maturation process and the necessary communication cycle of the brain and the ovaries? And so that's just important to understand because if you're coming off in the peri menopausal phase also know that like you're very menopausal. So like you may not be getting a cycle back. But most women what we see so if you have PCOS or you had irregular periods, we will see that usually within six months, the period comes back with if you had a regular cycle it can take three months but at any point If you hit that, you know, three or six month mark, you should go see your doctor and you should definitely get worked up. And if they say just go back on the pill, that's not the answer, you're not ovulating. That's a problem. And they'll be like, who needs ovulation? It's not that big of a deal. And I'm like, there's a lot of research to say. But, you know, just reducing women to just baby making and saying, Well, if you don't want a baby, then who cares? That's this is like a go to move in medicine. So if you are coming on for birth control, I do have a guide at Dr. brighton.com/p b, c s diet. And that is just a guide to help you understand how to eat in a way and really set up a lifestyle so that you can start regularly cycling again and support your body. And you may still need medical intervention. And the good news is, is that if you do you've already set a really good foundation with those practices, so you don't have to wait until that three to six months to do something, you can start doing something about it. And then if it's your period still hasn't come back. You can see your provider about that because if it's PCOS, then it's going to take it's going to take more if it's hypothyroidism, it may take the medication or something else you know coming in. So it's all it's really important just to understand what is going on there so that you're addressing the correct issue.
Amazing, thank you so much. And we'll link to that guide in the in the show notes. I know your book, your new book is going to have all the answers that people need is this normal it's coming out in April next year is that April, April, but you can grab it now. It's available for presale so people can go pre order it you also do your weekly lives please link Dr. Dolan, where can people come and find you your content interact with you? I know that they're gonna want to connect with you after this.
Yeah, so if you go to Dr. brayton.com if you actually want to grab Is this normal now we have a like quickstart guide basically getting into that 20 Day programme and starting to get results now in terms of your love life and your hormone health. To Dr. brighton.com is my main hub and then you can also find me on Instagram Tik Tok and YouTube all at Dr. Jolene Brighton, Dr. Jolene. Well, I should spell her that's not that's a different kind of name, right? It's a Dr J, o l e ne and then last name VRI gh t e n. And you can find me all over social sharing all kinds of information. And yes, we do. The weekly asked Dr. Brayton, which is where so much has been born out of I'm like, is this normal? I'm like, Okay, this is what I get asked all the time and to get 15 seconds on Instagram to answer these questions. So hang on, I'm gonna just like dedicate a whole chapter into going into the deep dive on all of this.
Happiness. Thank you so much for coming on the show. It's been such a pleasure chatting to you. Yeah, and
I hope to see you next year in London
in London and date I look forward to
it. Thanks for listening. Remember to review and subscribe, you can grab the show notes, the resources and highlights of everything Angela mentioned over at Angela Foster performance.com You can also snatch up plenty of other goodies, including the highly helpful Angela recommends page which is a list of everything she personally recommends to optimise your mind, body and lifestyle
