Perimenopause, Blood Sugars, GLP-1 Agonists and Weight Gain with Jennifer Pfleghaar, DO

Perimenopause, Blood Sugars, GLP-1 Agonists and Weight Gain with Jennifer Pfleghaar, DO

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Hey everybody, welcome back to the EnergyMD Podcast where we help you resolve your long COVID and chronic fatigue syndrome naturally so that you can get back to living your best life. So very excited today because we're going to be learning a little bit about perimenopause, blood sugar issues, and some of the latest approaches to resolving them from my friend, Dr. Jen Pfleghaar. So let's learn a little bit about her.

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So she is a double board certified physician in emergency and integrative medicine who helps people heal by getting to the root cause. A graduate of Lake Erie College of Osteopathic Medicine and fellowship trained at Andrew Weill Center for Integrative Medicine. She's passionate about aligning body, mind and spirit with God's design. After overcoming Hashimoto's herself, Dr. Jen founded Healthy by Dr. Jen and now empowers others through her virtual practice, bestselling book Eat, Sleep, Move, Breathe.

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and her podcast, the Integrative Health Podcast with Dr. Jen. She lives in Tennessee with her husband, four kids, and a lively flock of chickens. Dr. Jen, thanks so much for joining me today. Thank you so much. Glad to be here. Yeah. So let's start off a little bit. I always like to start off with some definitions. So we're going to be talking about uh perimenopause, hormonal shifts, blood sugars, cortisol.

01:28

How do we define perimenopause? Yeah, it's the time before you're in menopause. So it's that pre time that really a lot of women are just kind of left there uh before menopause. menopause is the definition of one year without a menstrual cycle. So you don't just go from, you know, having normal healthy periods, having babies right to menopause. There's this time in between that women are really lost and

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they start having symptoms that they don't know where it's coming from. They don't feel like themselves. You know, their energy is different. Sometimes they can get anxiety. They don't sleep as well. gain weight. I mean, the list goes on and on and they go to their doctor and they're like, okay, well, we're not going to check your hormones, but we'll give you birth control or an antidepressant. And we see this a lot when doctors aren't looking at root cause. So the perimenopause time,

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We're seeing it younger and younger. We see it like people starting to show symptoms earlier and earlier because what it is is we get this decline of progesterone and then really erratic highs and lows of estradiol. So overall we see a big discrepancy between estradiol and progesterone almost like an estrogen dominance. So they can start having shortened cycles, uh you know, and start having all those other symptoms that I spoke about and that's kind of

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what we say, oh, you're, you're in perimenopause. Like it's starting, we're starting to see those hormone shifts. They're starting to become a problem. So we can work, you know, with lifestyle, with supplements, with sometimes bioidentical hormones to help improve their quality of life while in perimenopause. And then we know in menopause, we can definitely do hormonal therapy, supplements, mind, body, all the things. So definitely for women, it's a time where they feel just

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out of sorts, but they don't have to. They can feel calm and collected all the way through. Nice. And like you said, it doesn't happen overnight. mean, how soon before menopause are these hormones starting to dip? Um, 10 years before some people are more a couple of years before it really depends on the person. And a good, a good thing that you could do is ask your aunts, ask

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Siblings ask your mother is more important mother and siblings. When did they go through menopause? And then you can kind of narrow it down. But I have seen women go into early menopause due to a really stressful situation or event because that can really drive down our hormones and your ovaries just shut down. So that that can happen too. And I think of perimenopause like like ovens. You're not your oven is not going to preheat to bake at the same time as your neighbors or your parents.

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So we can't just say, okay, it's all the same, you know, and that's what we try to do in conventional medicine. And that's why integrative and functional medicine is so good. Cause we look at personalized person because we all have different ovens that are all going to preheat differently. Yeah. When you're talking about stressors, you know, the people in our community, people with long COVID, chronic fatigue syndrome, not only have they had mental or emotional stressors, nervous system dysfunction,

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but they've got heavy metals and chemicals and molds and infections and all of those things would potentially make them have a perimenopause or even menopause earlier than other people, right? Yeah. And you hit the nail, like what you said about long haul that we're seeing a lot more stress, a lot of tanking hormones, DHEA super low in patients testing pre and post COVID, like in my patients that have just been in my practice. So that can definitely cause it.

05:16

emotional stress for sure. I think perimenopause, it's just a really tough spot for women. Their hormones are changing, so they're getting more symptoms like stress, anxiety, depression, more PMS-like symptoms. So they have that. Plus, they're caring for young kids. They're running their kids to all the travel sports. Plus, they have aging parents that they have to worry about. Plus, a lot of them work.

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So it's so much and I just don't think our body's designed for that and we definitely need help, but the stress for sure can drive your body into hormone problems. So when we look at stress in particular, that's cortisol. So we can have elevated cortisol levels for a time and then eventually our adrenals are like, whoa, I'm just gonna take a nap. But when we have that high cortisol, that can really drive down progesterone and...

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like I spoke about earlier, progesterone is what is declining, like heading down. So if we're driving that down even further, we're gonna have even more symptoms. And then cortisol, if we're really stressed all the time or having these stressors throughout the day, that can affect our blood sugar. And if we're not having good blood sugar balance, well, we're gonna gain weight, we're gonna have metabolic problems, we're gonna have fatigue, and...

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and that is even driving it further. So a lot of different stressors that we encounter that we have to deal with and you can, and you can feel good. So it's not as uh miserable as making it sound. Right. But it does require attention. And you know, if you're listening to this and your mom, you know, got, went into menopause at 50.

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And you're at 40 and you're starting to notice new symptoms that you haven't had before, like fatigue and weight gain and all these things that Dr. Jen has just mentioned. It's time to get your hormones checked. Right. Would you agree with that, Jen? people just, they're, they're, they're like, Oh no, this couldn't possibly be related to my hormones. Cause menopause is 10 years away. Right. But this is like, when you start to get symptoms, you have to pay attention. Yes. And it's a beautiful time to start paying attention and

07:31

Really intuitively, I have so many women that come to me and they're like, I know it's my hormones, but they go to their conventional doctor. They're, they're told, oh, we can't check your hormone labs. It's not going to tell us anything. And they're gaslit, right? And they, they come to me and I'm like, yes, we are going to, to check. Um, sometimes we'll do saliva hormone testing and then we'll get the cortisol right there. Sometimes we'll start out with blood work. If their insurance will cover it. So a lot of different things that we can do, but for sure I like to catch.

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some sort of hormonal lab work at day 19 to 21 of their cycle. We have it fasting, because we also grab a fasting glucose and insulin to look at their home IR score to make sure that they are not heading towards insulin resistance. We're going to check a full thyroid panel along with the hormones, because that's related to energy and fatigue and all of that. And really looking at estradiol and progesterone during that day 19 to 21, because we want the ratio.

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to be appropriate. They shouldn't have really high estradiol and then tanked progesterone. That's showing a problem. And that progesterone, that luteal phase progesterone decline is where we're really seeing a lot of symptoms. And you can ask a lot of women, they feel good their follicular phase, which is the first half of their cycle. So day one is first day of bleeding to ovulation, day 14, 15, and then they start to like spiral days.

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14 through 28 until they get their next cycle. And that is where we can really optimize progesterone through reducing stress, balancing blood sugar, making sure we're doing cycle syncing, which we can talk about later. We're optimizing that progesterone with supplements like Phytex or Chase Treeberry. And then sometimes we're using a little bit of extended release progesterone from a compounding pharmacy during that luteal phase helps with sleep also.

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So, so we're going to see, cause we're going to check labs and we're going to test and not guess. And that's really helpful to these women. And, and then they feel empowered because they're working with their cycle. Um, know, me personally, I'm in perimenopause and I'm like, it's so nice to have a cycle because you, it's just awesome. Like God gave us this awesome menstrual cycle and we, we feel different at different times and we were more creative sometimes than others. And sometimes we're.

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more inward and we can journal. So I think teaching women in this space to really just be proud of that and really work with it instead of against it, because I will tell you, there's so many women in perimenopause that are on synthetic hormones and it's shutting all that down and clogging up the liver and causing more harm than good. uh

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I don't know if you see, probably see a lot of women that are on like an IUD or something and very difficult, you know, to get them off of it because you're like, you're going to feel better. Let's try some other protection, like from your husband or something, if they're trying not to get pregnant. And we work through that because really synthetic hormones don't really have a good place for women when we're talking about women's health and longevity and safety. Yeah, so

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If somebody is, how does somebody know if they're on synthetic hormone? What are some of the brands that they, that they would potentially be on? Yeah. So usually they're called conjugated equine estrogen. So C E E's you look at that. Um, and then progestins. So instead of progesterone, it will tell it, say progestin. So you need to make sure it's, if it doesn't say estra dial, that's it. Or progesterone. That's it. Then it's synthetic.

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And it's really kind of scary because a couple of years ago, an OB-GYN was giving just a small Ohio, Northwest Ohio, a lecture. And she literally told this room full of doctors that synthetic estrogens were the same and did the same mechanism of action as the actual hormone estradiol. And I like freaked out. I looked around me and I'm like, do not take notes on this. That is not correct. Because unfortunately, ACOG, they...

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Their stuff is like really rough. It's really outdated because it's based on studies from drug companies and the influence of drug companies where compounding pharmacies, you know, no one's making money off of that because it doesn't have a patent. It's not a medication from a pharmaceutical company. So we, and this goes back to the women's health initiative where they used estradiol, but progestin synthetic progesterone, which has

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different effects on the body at actually opposite of what natural bioidentical progesterone would do. So it's like not a locking key, right? It's not bioidentical. You're not going in and unlocking it, opening the door smoothly. You're getting in the door, but using a crowbar, you are ramming your way in there and it's having bad effects, right? It's like a robber getting in. It's not doing good things. So when we hear about

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hormones being bad or dangerous. Bioidentical, if used correctly, are good, but also now I'm seeing a surge of everyone's a hormone expert without any training. Every med spa is pumping people with pellets, which are dangerous. And, you know, so, so we also have to be careful because I don't know if you've noticed this, but we're, almost seeing because of the last four years and what it's brought, you know,

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we're seeing a lot of like counterfeit, integrative and functional practitioners and they don't have training, but they're just using that to bring people in. But they're using it as the same way as conventional medicine, like so many supplements, so many, you know, bio-adventure hormones and they're doing harm because they just, they don't know the root cause like you do. You work on the root cause like I do. So I just beware about that because I know it's such a trendy topic, what we're talking about, but you still have to use major discernment.

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about it. Yeah. Yeah. And even, you know, even physicians who claim that they are, are able to prescribe hormones. Like you said, hormone expert. So how does somebody know whether or not they're, they're trained appropriately? You know, if they go to two people's websites and they're both physicians and they say they're trained in, I mean, would, if somebody's trained in functional medicine, is that good enough? Or what do think? It depends. It depends if they had a mentorship, if

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You know, if they just went on a cruise to learn about hormones for a weekend, that's not enough. So I not only did an integrated medicine fellowship and I'm board certified. did an extra certification through Dr. Pam Smith, who's like the goat of hormones in my mentor. So, um, you know, you have to ask them about their training and look at it. A lot of people that say they're hormone experts, it's literally just a marketing ploy and they don't even have any education at their self-taught, which

14:32

Yes, I think people are very intelligent and can learn things, but also you need a mentor in hormones because it can be done wrong. And someone that has seen, you know, thousands of patients that are mentoring you is better than just taking, you know, a course and stuff. So there's also like a lot of different opinions out there in hormones. I know some are doing mimicking cycles and perimenopause. Like for me, it's just common sense to be smart about things.

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and not do harm first, okay? uh I am very conservative when it comes to hormone replacement and my patients know that and I test and don't guess and we start really slow and then go up because if you're overdosed on hormones like especially estradiol and especially testosterone coming off of those and getting into a normal physiological dose instead of super physiological, I mean, it's gonna suck, right? I've had...

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women come to me on really menopausal women, really high doses of estradiol. And I'm like, look, we got to back this down because you're not going to be able to detoxify all of that estrogen you're getting. The reason why you're getting hot flashes and you're not into sex is not from estradiol because you are way overdosed. It's because of cortisol. And this is what I see. I just had to have a talk with a patient today. She was seeing... um

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her midwife and getting testosterone and never didn't tell me. And I'm like, you are on a really high dose of testosterone and I can't believe you didn't tell me. And I was just like, not gonna be mad. And I was just like, okay, well, we're gonna test this and I would bet money that you're overdosed and we're gonna get you on the right dose. And if you, you know, if you're not having sexual interests, well, then we'll do a peptide like PT 141 in her nasal with some oxytocin or we'll do some screen cream directly to.

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The lady part, so I mean, this is where I kind of went back to you have to be careful because some of these things are just being used like medications, like the more the better and just pour it over top where we're not working on like the root causes. And I know it's hard. I know it's hard to have these conversations with patients like, hey, like, I don't think this is a hormone or thyroid problem. I think it's a stress problem or a limbic system problem.

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or you know, like it is not a fun talk to have with patients like that. They have to do work and not just take a pill or a supplement. Right. I mean, you feel that and this is what I'm seeing in hormones. So you definitely have to check their testing. And I was horrified. I went on, I was listening to a webinar one day and they had uh someone med spa with like a physician assistant with lots of followers. And she was telling other practitioners to dose off of

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symptoms how they feel to dose hormones off of that and I mean doesn't that terrify you that I'm like Whoo, we got a we got a real this in this is real real consequences that can happen. So so yeah, we have to be very careful Especially just with the popularity around perimenopause and menopause right now. We have to do no harm. We have to keep patients safe Nice. I'm gonna play devil's advocate on that

17:52

Okay, so just for discussion. So if somebody is menopausal, perimenopausal, they're starting to get hot flashes, they've got some vaginal dryness, you know, there's a strong likelihood that they've got low estrogen. Is it possible that that could be something else? Yeah, so I love that you brought this up. So perimenopause, I am not a big fan because of my training and my mentor.

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to prescribe estradiol during perimenopause because we are having fluctuations of estradiol where it can be, yes, really low and you don't feel like cognitively you're getting help and like all this stuff, you just have, you miss that multitasking of estradiol, but then you could have a surge, you know, the next day, like really high. So we don't want to add estradiol on these surges that could be dangerous, but I will say, you know, everything depends on the patient. If they're having like,

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one cycle a year for three years. Yes, like we're gonna talk about it and we're gonna do some testing and figure that out and check their FSH. But we just have to be careful. um What I ask my women that are like trending towards late perimenopause, right? Within a couple of years, we think it's getting closer, their cycles are getting waist-based out or just talking to them, even if they're in middle or early perimenopause, just talking about...

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How's your vaginal area doing? Are you having vaginal dryness? Are you having urinary tract infections? Like what's going on down there? Is sex still the same? And if they're like, yeah, it's different, it feels different, stuff's dry, it's not enjoyable with sex, then we do some Estriol, which is a weaker estrogen, and we do that topically down there. Also for the face, so we start to see sagging skin, so we can do a little bit of a retinal.

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plus Estrel on the face, you know, a pea size amount, just a really little bit. And we'll check and make sure that they're not getting too much of this absorbed or not using too much. uh What has happened to a patient in the past is they bought some Estradial and Estrel lotion online. uh Cause some podcasts said that, you know, estrogen helps with saggy skin. And, you know, I know they're talking about that on TikTok and stuff, but she put like pumps all over her body and she was getting

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She was in toxic levels, like really high levels. And I say not that estrogen is toxic, but if we are not having progesterone up there to match it and be protective to the breast and the endometrium, then, and we're not getting rid of the toxic metabolites properly, it can be toxic. So her estradiol was high, her esterol was high, and her estrone was high. So estrone is uh another estrogen that doesn't really do much good in the body. So we really...

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don't want that to be high, that tends to go towards toxic metabolites of estrogen. and it was kind of scary, uh she didn't tell me that she was doing this and I got her labs and I'm like, something is off. And then she told me and I'm like, okay, we got to get off. I can't determine the amount of damage you did. I don't know, right? So this stuff we shouldn't mess around with, but beautiful results with women using some Estrel vaginal cream.

21:08

Compounding pharmacies can put some probiotics in there. They can put DHEA in there to help out a little bit more in the bedroom. lots of different things, cause that, that is important. And it's important for men, you know, to, to realize that things are changing in perimenopause. You just need to talk about it with your wife and also like give her a lot of grace during this time and everywhere, right? In the bedroom, the mood, like all the things. Right. Absolutely. Yeah. That's

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Yeah, especially, you know, when I hear couples talking about how sex is a, it's kind of a defining thing in their relationship. And then all of a sudden sex charts changing and a lot of couples don't talk, you know, and so then it becomes more challenging and then there's more upset. And then, um, I don't know if, if divorce is very high during that time period, but I think unfortunately it is. It is. And it's so interesting because

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The more also I realized that perimenopause like how many women are just suffering like during that time and that's the majority of patients I see are perimenopausal because they are struggling and they might not look like it on the outside, but they are and you can ask like if someone is divorced to just be like, hey, like.

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When did it happen? Was the woman in their 40s or early 50s? And it's always, yes, it's always then. And you hear, oh, she went crazy or blah, blah. And I'm like, no, it's just imbalanced hormones. And this is the thing, should we, with long haul and with chronic fatigue like you work with and with hormones, was this intended to be like this? Is this how the world was supposed to be? No, we live in a fallen world.

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We have so many chemicals. We have so many heavy metals. have, you know, like all these external toxins, stressors, you know, constant notifications on our phones, like driving a stressful, like all these things that weren't really supposed to be there. So, so this is why, like, this is why we have to fight back. This is why we have to work on it and do better and yeah, like save marriages and relationships and just.

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women feel good. Like they shouldn't be, you know, have horrible periods in perimenopause, which can happen because you sometimes get that estradiol surge and it's worse and imbalanced and you know, they're out for days, right? On the couch or something. It's like this, it's not the way it should be because our hormones, you know, how we think, our immune system, a lot of things are determined by our hormones. So balancing them.

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is definitely part of the plan for feeling well. I recently heard a practitioner say that if you use a vaginal suppository or some sort of vaginal cream that it's localized and not systemic. Is that accurate? You're really trying to make me feel crazy, aren't you? I hope they're not prescribing hormone. but yeah.

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Have you ever heard like how like students like in high school like soak a tampon in alcohol and then insert it and then they'll be drunk at school? Have you ever heard that? oh Yes. Like it's a thing. Like look it up. Like are they used to now I think kids just like smoke in the bathrooms like do drugs in front of their teachers. But anyway, so this used to be like a thing, right? So how, oh my gosh, like how would that happen? How would you

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get drunk from a tampon being inserted with alcohol. Oh my goodness, because you absorb stuff through your skin, especially the mucosa, especially the vagina. Like give me a break. And it's crazy, because we know even with IUDs, like that is flawed. Like we know that it's absorbed through the body. So it is, even if you put, remember that patient I said that that was putting the estradiol on their body, on their skin to tighten their skin, she was absorbing it.

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Even with skincare products with parabens and fragrance, we know we're absorbing it. That's why we have to be so careful. So that is not, that is not true. Now, I hope you're the, whoever you heard that from wasn't in functional or integrated medicine. Cause that would be bad. Cause I did have a patient recently that came from a urologist em who, who was going to prescribe her, you know, topical estradiol.

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but not give progesterone. And if you do estradiol, you need progesterone for that protection. Remember that the endometrium and breasts, so it's not estrogen dominance and for protection. So um he probably thought it was just localized too. And this is what happens if we compartmentalize our body also and don't see the body as a whole. So yes, you are gonna absorb that. And that's why I like the estradiol a little bit. Now a caveat to...

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like speaking of vaginal health, uh women that are postpartum uh and breastfeeding that really, cause this happened to me, I needed some, little bit of, I breastfed my kids for so long. I needed a little bit of estradiol topically down there while I was breastfeeding and just a really little bit. And sometimes women will need that support. Cause when you're breastfeeding, your estradiol is suppressed.

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because you are lactating and for long time, that can, you could feel heaviness down there. You could have UTI, same thing, or for intercourse. So that's a caveat like estradiol. Yeah, it's okay, because they're younger. They're having, you know, more steady estradiol as opposed to perimenopause when it's really erratic. So that's like definitely, yes, definitely absorbed most of the times when I prescribe.

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hormones in post post menopause and menopause, it is topical and it is 100 % absorbed. Yeah, I thought so. um And then in terms of um route, you kind of alluded to that. So do you prefer topical? I've heard of patches, um oral progesterone versus topical. Can you talk a little bit about that?

27:35

Yeah, so younger women, do like the topical progesterone if they're having horrible PMS, if they're having cysts, if they're just having a horrible time with their cycle and they're like, my doctor is only saying birth control, a nice luteal phase cream is very nice. So just that second half of the cycle for them. As we start to get in perimenopause, it depends where they're at.

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but usually they're having problems with sleep by then. So then we'll do the oral progesterone and carry that through menopause because that is going to break down and help with sleep, activate the GABA receptors, be more calming, make you almost drowsy. You don't want to take it in the morning. You take it at night. So that's really nice. And then for the estrogen. So estrogens should never be oral. So it's something when we take estrogen,

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it has first passed through the liver. And that is where all the toxic metabolites are created. So if we put it on topically, we bypass that. Now I would get a lot of patients in my practice that were earning on trochies, which is you put it under your tongue and it goes right into your saliva, but you're still swallowing some. So that's increased risk for me. So.

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I tried to, I've tried, I've won that's like hanging onto the trochee for her dear life. And I'm like, we need to switch. But most of the time with absorb absorption, if they're having a problem absorbing the hormone with a cream, they're not rubbing it in for long enough. They're not being patient or it could be a base problem. So that would be the compounding pharmacy where you would make sure they're using like Versabase or something that is going to rub in. Cause you're, you're forcing, you know, a steroid hormone.

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into the skin, so you have to have something that helps that. Testosterone, usually the same and we just compound it right in there with the estrogens, so that's very nice. um You know, there are some people that do testosterone injections, I mean, I don't, I see men and women and they do fine with the cream as long as they're patient because sometimes what the, the excipient of the testosterone, what it's held in when you inject it,

29:53

It's not always good. There is an actual oral testosterone that's new. I'm still trying to shake out to see how everyone's doing with that. It's specifically designed to like not be toxic to the liver when you swallow it. So they've had a lot of studies. It's a pharmaceutical. So we'll see. I'm still waiting a little bit with that. And for men testosterone, since they don't have a vagina, are you recommending that they

30:22

Put it on the anus or testicle. Oh So for women, the cream I'm talking about with the testosterone, they do inner thigh or they do the arm. So the vaginal estrogen, the estriol is just for the perimenopause when they need it. And then menopause, if I get a woman that comes to me and they've never been on hormone replacement, we will do the vaginal to wake up those receptors and then we'll switch them to the whole body cream or do them at the same time.

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because once you have the estrogen back in the body, it's gonna go everywhere, including down there. So usually they just rub it in in the inner thighs, six days of the week, one off, because you need an off day to help those receptors kind of reset. And then men, um see, this is tough because yeah, like, you know, some apply it right to their testicles, but I can't recommend that because if something would happen, m

31:17

and I would tell them that that would be bad. So we usually just say to the inner thigh with men and same thing, just make sure they're rubbing it in long enough. And most men get good levels with the cream and it's more steady than the shot. This is where for men, it's really interesting to see how this new oral testosterone shakes out. But some like the injections, but then you get that peak in that valley. And I just like,

31:46

more steady. I'm very conservative when it comes to hormones and I want it to be more, more just physiological levels, not super therapeutic on those. I'm not into that with hormones. Yeah. Do you find with men 50 to a hundred milligrams does the job or what do you like? Usually for topical, we just start them out at five milligrams daily and see, and see where it goes. I mean, I like to start

32:14

low and slow, like women, 0.25 milligrams of testosterone. I start them out with, and usually that's enough. I mean, I don't think I have a woman on more than one milligram a day. I mean, they just, we just don't need it. And then we check saliva testing because it's looking at the tissue level. So if we're giving something topically, it doesn't go, it's not passing through the blood. It's not like we're taking it orally and it's going through the blood. It's going directly to the tissues.

32:43

So that's another thing I see a lot is that we'll have women, you know, maybe on a patch by their conventional medicine doctor or maybe on topical where they're rubbing it in and then they're doing blood testing for the estrogen and they're putting them, they're like, it's not getting absorbed. It's not getting absorbed. And they keep putting them on higher and higher doses. And the women might say, yes, I'm having hot flashes still. I can't sleep. But you know, the second most common cause of hot flashes is cortisol being too high.

33:12

You know, we have to, we just have to make sure that we're doing our due diligence when it comes to proper testing, uh proper application of all the different hormones. And do you like testosterone a day off as well per week? That could be, that could be straight through for men. For women, they'll do six days out of seven because it's usually within the bias.

33:37

And even my women in perimenopause, if I'm starting them on a really low testosterone because we've tested and tried all the things and it's still low, uh I will do six days on, one day off. So they're just used to that for when they go into menopause. Gotcha. And so then for the patch, you know, I've heard of patch twice a week. What do you think of that? Is it also not as good as the rhythm that you're discussing where you're of like you're applying it every day? Yeah, I just don't.

34:06

I don't like the pharmaceutical companies. just, don't know. And I had a woman that came to me on the patch and I like using Bi-Est, which is estradiol and Estrel E2 and E3. So I had a patient that came to me and I need to pull up her labs again, her chart and look at it. Cause I'm going to use it for an example. And she had some weird saliva results. Like, like what was in the patch that she said she was on, like wasn't what the labs were.

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reflected. So it that really freaked me out. So I'm like, yeah, I'm just not doing the patch there. And there's also like a big push right now, like show me your patch like hashtag. And I'm like, something's off. Something's really off because why? I don't know. I guess I'm really skeptical just because I've seen so much, know, in the two decades of practicing medicine, like so much kind of

35:03

evil? Like, I don't know. I'm always like, well, what's the real agenda going on? So yeah, so I'm not a big fan of patches personally. Yeah. And this particular patient that I'm thinking of that, you know, I'm not prescribing for, but you know, she's, she's in my program, but I see that this is kind of like what her practitioner is doing is that, you know, she, she got rid of her hot flashes, which was great with the patches and she's kind of been ramping up on them with the idea that

35:31

the higher doses are gonna saturate the tissues and they're gonna eventually help her lose weight. That's a lot of her weight gain, happened during perimenopause is because uh she was uh estrogen deficient. And if she's tolerating higher doses, as long as she's not having side effects of too much estrogen, like uh tender breasts, sensitive nipples, that they're gonna continue to ramp up. What do you think about that?

35:56

I think that is terrifying and find out who that is and I'll send them a copy of my book and Pam Smith's book um No, that is extremely dangerous and they're probably just testing the serum the blood and and not not paying any attention so I will tell you if she's ramped up really high on estradiol and um She needs to come down which is she will she will feel like crap and want to hurt someone

36:23

Um, yeah, cause I've had patients where I'm like, you're overdosed. need to come down and they were not happy with me and, it's, it's bad. And I hope that she's taking progesterone or pro metrium. You're patient. Okay. Good. Cause otherwise that'd be scary. And here's something fun that like you could order is you can order a estrogen urine metabolite test and just see how she's breaking down all those estrogens.

36:48

because if she's going down that bad pathway, the form of oxy pathway, then she's causing like damage to her cells. And what cells are we talking about? Breast, breast cancer. know, mean, we have, well, you know, it's October right now. Yeah, no one talks about, let's look at your estrogen metabolism and fix this. Oh no, we are just, get a mammogram, that's gonna fix it all. No, so yeah, so there.

37:16

there's an issue if she's overdosed on estradiol, and that is not, well, that is not her weight problem. No, this is just crazy. And you have your work cut out for her because it's not, or for you, I mean, because that's only gonna cause her some problems. Yeah, so what do you see as the major cause of weight gain and menopause?

37:40

Well, it's a lot of things. Well, perimenopause and then menopause. So yes, we want our hormones to be balanced. We want that estrogen dominance to come down, right? So focus on liver health, gut health, because that's how we detoxify our estrogen through the liver, through the gut. So if that is not working properly, then we are gonna have a mess. And then bring up that progesterone by working on stress reliefs by Vitex or Chase Treeberry.

38:08

regulating your blood sugar. So a lot of insulin resistance is the root cause too of this weight gain because our body is stressed out. It's going through the season. Now when a woman in perimenopause, like what do they do the moment they're starting to gain weight? They hunker down even more. They're going to do high intensity interval training. They are going to starve themselves and fast.

38:31

So if you do that out of rhythm of your cycle, you are only going to gain weight and mess up your hormones more, like jack them up. So I like to tell women if they're still cycling, like you need to do all this work in perimenopause so you transition to menopause well, right? Because if you are causing a tornado in perimenopause, menopause is gonna be a disaster. So in perimenopause, you're still cycling. Cool, so let's work on things. Let's get metabolically fit.

38:59

that first half of that cycle, the follicular phase, your estradiol is higher. That's the dominant hormone. Like you're, you're kicking butt, like you're multitasking, all this stuff. You're more insulin sensitive during that first half of the cycle because of your dominant hormone. So this is when you can do your sprints. You can do your orange theory, your hits, your crossfit, all of that during those first two weeks. Okay. You can lift really, really heavy and go for like your personal records.

39:27

You know, you're not gonna, you're not as prone to getting hurt in the follicular phase. You can do your fasting here. You can do your keto here. You can do your carnivore. You're like, I'm gonna do carnivore for two weeks. Do it there. You're gonna succeed. You're not gonna stress your body out. You're gonna lean down. You're gonna feel good. So then we go to luteal phase. Luteal phase, we know there's studies on soccer players in Europe that they tear their ACLs. When do they tear them? In luteal phase.

39:56

We know that the hormones that getting us ready to have a baby implant relaxing our ligaments and our joints, we know that progesterone, we're just more prone to injury. So do not do your personal records here. Don't try to, I'm gonna bench 20 more pounds. No, you're not, okay? Still lift because lifting and muscle metabolically is gonna make us more resilient. So still lift, but lift lighter and to fatigue.

40:23

And then go for walks. This is when you could do your weighted vest walks and all that stuff. So more restorative mobility type of workouts during that. Also, if we're doing in the luteal phase, we talked about like cortisol making progesterone less, um the progesterone steel, we call it. If you're doing major HIIT workouts and stressing your body, that is going to affect your progesterone, make you even more feel like that estrogen dominant and imbalanced. And then

40:52

eating wise, this is when I, when I put my patients where I'm like, yeah, we need to do a food elimination or, you know, let's try to do more keto. I'm telling them to start it in their follicular phase and the luteal phase. Once again, we don't want to stress our body out. We actually require more calories during the luteal phase. Cause once again, the body is preparing to have a baby progesterone makes us more insulin resistant. Okay. So if we're like just fighting against nature,

41:21

You're going to have the opposite effect. You are going to balloon out. And I've seen this. I've seen this with women doing intermittent fasting, gain weight. Once we looked at their continuous glucose monitor and adjust it to their cycle, they lost weight just doing that. Um, calming down on the workouts. Like I've had, I had a patient that she trained for a marathon. And once again, she didn't tell me maybe because they know what I'm going to say, but she, she gained weight and her, her hormones were perfect before they got so out of whack.

41:50

They're back to normal now. So that's, that's great. Our body wants to go back to homeostasis, but she had to work to get it back. Um, but she like gained 20 pounds, you know, training for a marathon. So not that we can't do these things, but we need to be like aware of like, where am I at in my cycle? Because we don't want to exacerbate these, symptoms. So the weight gain, can you see how it can get out of control? Like if we're not doing things at the right time, even though we think that we're doing the right things.

42:19

If it's working against our body, our body's gonna be like, nope, and like double down and like gain weight. We have seen it. And so how does that differ from menopausal women and weight gain? Yeah. So menopausal, a lot of the times this is more hormonal. We do want some estradiol. We do want progesterone. We might need testosterone there. And our body just came off that stress cycle. So a lot of root cause too of hormone problems is stress.

42:47

We also want to look at the thyroid, of course, because the thyroid as an endocrine organ, it's just assaulted by environmental toxins and aging and oxidative stress and heavy metals. So that is an organ that can like wear down a little bit more. And this is where sometimes I don't know if you use bioregulators a lot, but I love bioregulators for the thyroid just to tap into that biological reserve for the thyroid. And that might starve some of that off, but

43:16

But menopausal women, same thing. um You're gonna wanna look at, you know, pop on a continuous glucose monitor and see what your blood sugar's doing. Sometimes women are just metabolically like a mess. And sometimes just doing cycle syncing will be fine. Sometimes they need berberine. Sometimes they need metformin. And sometimes they need a GLP-1. uh

43:40

and I've seen, um you know, GLP-1 semi-glutide or terzepatide, which is a GLP-1 GIP, this can be helpful to get them over that hump and do a low dose for a couple months, get them more insulin, metabolically flexible, more insulin sensitive, and then they can get off of that. The worst thing that you want to do is get on a high dose GLP-1 from a provider that doesn't.

44:07

know how to do it really that's just trying to make money and jumped on the bandwagon like med spas and stuff is get on one lose lots of weight but most of the weight you're losing is muscle and then you get off of it or you stay on it and you're just a flappy skin and then you can never get off of it because you don't have muscle to help with your insulin sensitivity so you know menopausal women if you're not lifting lift

44:35

Um, if you have tried all the things and then want to try a GLP one, which I mean, so many people are on them and you can get them like candy, stay on a low dose. always tell my women non-negotiables on a GLP one is that they need to lift weights, lift heavy weights. have them take a peptide called pepty strong 2.4 grams. It's from the fava bean. helps retain muscle a little bit.

45:03

I have them take creatine daily, at least five milligrams. You can bump it up to 10 for memory and brain if you want. um And then they have to eat their protein. So healthy fats, yes. You can have carbs, know, check them with your monitor, but usually just luteal phase women need carbs. Like menopausal women, I've seen so many continuous glucose monitors and carbs you just don't do well with. If you want them, have them at the end of the meal.

45:32

after you eat your protein and your fat. But 30 grams of protein per meal, that no matter what, and I tell them, I'm like, if you are on a GLP-1 or if your dose is too high that you're not eating protein and maintaining muscle mass, you're on too high of a dose if you're nauseous and just not eating. This is dangerous. We're gonna ruin metabolism of millions and millions of people in the United States, because everyone is on a GLP-1 incorrectly. It's very scary.

46:02

And then one thing that we've been doing um at my clinic is perimenopausal women that, you know, they, they want to be on the GLP one. They've tried to come off and they're like, Oh, the food noise. And we're still working on habits. And they just, they, they like to be on it. We're just doing it. They're luteal phase that second half of their cycle where they're more insulin resistant. They're having that food noise. They're not making rational good choices. um And that just helps them. And then they.

46:30

then they take a break during their follicular phase. you know, I guess like the whole time I've been talking about like less is better, right? Like we don't need to overdo things and get side effects and all of that. Yeah. Really great stuff. So thank you so much, Dr. Jen for being with me today. So healthy by drjen.com. Is that the best place to send people? Yeah. And if you

46:58

want to get the book, the perimenopause reset, you can go to Dr. Jen book, Dr. Jen book. uh Yeah. And I have some freebies always, you know, on my website protocols and on my platforms, integrative Dr. Mom. So just want to want to help everyone. And if you have any questions, reach out. Awesome. Yeah. We have a looks like peptides for motherhood bonus.

47:28

So we will drop that link as well. But yeah, definitely, you know, if you are interested, you're in perimenopause, if you're menopausal and this spoke to you, please reach out to Dr. Jen and get her help so that you don't have to suffer the way so many women are today. So thanks so much for joining me here today, Dr. Jen, really appreciate you coming on. Thank you, So if you have chronic fatigue, whether it's from long COVID or chronic fatigue syndrome, go ahead and click the link below.

47:57

to watch my latest master class, where I go deep into our four step process that has helped thousands of others resolve their symptoms naturally. After you watch that video, if you're interested in seeing if we're a good fit to work together, you can then get on a free call with me. All right, thanks so much. I'll see you over there.