On this episode of the Less Stressed Life, we're continuing our September focus on perimenopause with Dr. Carrie Jones, who is back to break down what actually happens to our hormones during the perimenopause transition and why symptoms aren't always as straightforward as they seem.

We talk about the stages of perimenopause, early symptoms, hormone testing, and why fatigue or changing hormones may be related to perimenopause, something else, or both. Carrie also explains how declining estrogen can affect insulin resistance, body composition, belly fat, cholesterol, and blood pressure, plus how to know when HRT (hormone replacement therapy) may make sense, why HRT isn't one size fits all, and the foundational pieces that still matter throughout the transition.

Check out Carrie's other episode, #93 Hormone Testing & Stress Hormones - https://www.buzzsprout.com/775589/episodes/2394305

KEY TAKEAWAYS:
🧬 The different stages of perimenopause
😴 Why fatigue isn't always just a hormone issue
🧪 What FSH, estrogen & progesterone testing can tell you
🍎 Why body composition & belly fat can change
🩸 How estrogen impacts glucose, insulin & cardiovascular health
💊 When HRT (hormone replacement therapy) may make sense
🧠 Why foundations still matter with or without HRT

FREE PERIMENOPAUSE EBOOK:
Not sure which stage of perimenopause you're in? Grab Carrie's free guide here: https://www.drcarriejones.com/stages

ABOUT GUEST:
Carrie Jones, ND, FABNE, MPH, MSCP is an internationally recognized speaker, consultant, author and educator on women's health and hormones with over 20 years in the industry. Dubbed the “Queen of Hormones” in functional medicine, Dr. Jones is a Naturopathic Physician who completed a two-year residency focused on women's health and endocrinology. She earned her Master of Public Health (MPH), became one of the first to be board certified through the American Board of Naturopathic Endocrinology (FABNE), and is a Menopause Society Certified Practitioner (MSCP). She was the first Medical Director for Precision Analytical (the DUTCH Test), the first Head of Medical Education at Rupa Health (a Fullscript Company) and served on Under Armour’s Human Performance Council. She regularly consults and educates for several women’s health, supplement, and lab-focused companies. Dr. Jones co-hosted the highly popular Root Cause Medicine Podcast, which has over 10 million downloads and now hosts her own podcast, Hello Hormones.

WHERE TO FIND GUEST:
Website: https://www.drcarriejones.com/
YouTube: https://www.youtube.com/@drcarriejones
Instagram: https://www.instagram.com/dr.carriejones
Podcast: Hello Hormones with Dr. Carrie Jones find on Apple or Spotify

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❤️ Do your best and leave the rest

WHERE TO FIND CHRISTA:
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Instagram: @anti.inflammatory.nutritionist
Podcast Instagram: @lessstressedlife
YouTube: https://www.youtube.com/@lessstressedlife
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❓Questions for Christa? Submit them here: https://www.christabiegler.com/questions

TRANSCRIPT:

[00:00:00] Dr. Carrie Jones: when we go through perimenopause, our hormones shift, but estradiol, which is our primary estrogen, is a big one. And when we have lower lows or consistent low levels of estradiol, this has a domino effect through the whole body in our cardiometabolic system.

[00:00:14] Dr. Carrie Jones: So it can make us have higher glucose and be more insulin resistant.

[00:00:21] Christa Biegler, RD: I'm your host, Christa Biegler, and I'm going to guess we have at least one thing in common, that we're both in pursuit of a less stressed life. On this show, I'll be interviewing experts and sharing clinical pearls from my years of practice to support high-performing, health-savvy women in pursuit of abundance and a less stressed life.

[00:00:50] Christa Biegler, RD: One of my beliefs is that we always have options for getting the results we want, so let's see what's out there together

[00:01:08] Christa Biegler, RD: Today on the Less Stressed Life we have back Carrie Jones. First time since, I just looked, since episode 93 in 2020. Maybe she was here- Whoa ... since then, but that was the first one that popped up. I know, it's so weird. I'm having a lot of fun.

[00:01:20] Dr. Carrie Jones: That's been a minute, yeah.

[00:01:21] Christa Biegler, RD: I know. I'm having fun looking back on history, when was the last time you were here?

[00:01:26] Christa Biegler, RD: We're actually having a good time because it's the ninth year of the podcast, and so one thing I like to do is check in with people on like what's changed from then to now. So we'll see if that plays in today. Ooh. Even though we have slated to talk perimenopause, so we'll see. So Carrie Jones is an internationally recognized speaker, consultant, author, and educator on women's health and hormones with over 20 years in the industry.

[00:01:46] Christa Biegler, RD: Dubbed the Queen of Hormones and Functional Medicine, Dr. Jones is a naturopathic physician who completed a two-year residency focused on women's health and endocrinology. She earned her Master of Public Health, became one of the first to be board certified through the American Board of Naturopathic Endocrinology, and is a Menopause Society certified practitioner.

[00:02:05] Christa Biegler, RD: She was the first medical director for Precision Analytical, makers of the Dutch Test, the first head of medical education at Rupa Health, a full-script company, and served Under Armour's Human Performance Council. She regularly consults and educates for several women's health supplement and lab-focused companies.

[00:02:20] Christa Biegler, RD: She co-hosted the highly popular Root Cause Medicine podcast, which over, has over 10 million downloads, and now hosts her own podcast, Hello Hormones. Welcome back, Dr. Jones.

[00:02:29] Dr. Carrie Jones: I'm very excited to be back. It's so nice to see you.

[00:02:32] Christa Biegler, RD: Yeah, it's so nice to see you. And today we're talking about one of your favorite topics.

[00:02:36] Christa Biegler, RD: Yeah. But I was just peeking back, taking us back six and a half years ago. Wow. It was January 2020 is when the episode came out, and we talked all about one of my favorite topics, which I think totally plays into today's topic. We talked all about stress hormones, and specifically cortisol, at length.

[00:02:56] Christa Biegler, RD: So you know-

[00:02:58] Dr. Carrie Jones: And yet here we are still talking. Still stressed. Still just,

[00:03:01] Christa Biegler, RD: still talking about the same things overall. Now, in the last year or two, some things have shifted for you, right? Since I last talked to you, you were with Dutch, and then you were with Rupa Health. And I talked to you actually since I was on the Root Cause Medicine podcast with Rupa Health.

[00:03:16] Christa Biegler, RD: Yep. But in recent, Now all the years are like blending together. In the last year or two or so, you've started to talk a lot about perimenopause online, and is it just the glasses that we're looking through? Are we all seeing perimenopause all the time? Is it just us that are in perimenopause?

[00:03:33] Christa Biegler, RD: Is everything perimenopause? Tell us a little bit about your transition over the last few years and the shift and what's been going on in your life.

[00:03:41] Dr. Carrie Jones: What's funny is I have been talking about perimenopause forever. So when I was a medical student, my main attending was in perimenopause.

[00:03:47] Dr. Carrie Jones: She was in her 40s and struggling, and so I got to see that up close and personal. I, of course, was in my 20s, and I lectured a lot about perimenopause. When you're a lot younger in practice and education and whatnot, you talk about everything, fertility and PCOS- ... which is now PMOS, and all sorts of things.

[00:04:05] Dr. Carrie Jones: Hormones at large, stress, all the things. And then when you're solidly in perimenopause, 'cause I'm 49 at the time of us recording this. Still cycling, but definitely perimenopausal, and- The amount of women who just said, "How are you doing it? What do you do? I don't understand it." So I started making the big pivot a couple years ago where I decided, I think the other things are very important, hormones, fertility, PCOS, PMOS, but really I think what women needed was perimenopause.

[00:04:37] Dr. Carrie Jones: And then it exploded. Everybody is talking about perimenopause. And I think it's with good reason, and I've been saying this for a long time. We learn in school-

[00:04:47] Dr. Carrie Jones: And when we're young, middle school, elementary school, we learn the basics, the birds and the bees.

[00:04:51] Dr. Carrie Jones: If you don't wanna get pregnant, don't put the P in the V, and that's about it. We don't learn anything about perimenopause. Our grandmothers didn't teach us. Most of our mothers didn't teach us. And so now that it's all over the place, I'm very excited about it. So for me personally, what's changed is I'm six and a half years more into perimenopause.

[00:05:06] Dr. Carrie Jones: Mm-hmm. I do a lot of education. I work with multiple companies, which has been really fantastic because all of them have a hormone basis. And a lot of them also have an angle with perimenopause or menopause, and so it's just been a really great transition from just working with the Dutch test or just working with Rupa that now I get to expand and really help a lot of companies that are getting into this space just expand their offerings and their education.

[00:05:39] Christa Biegler, RD: You were just mentioning how I think we're just the first generation that's really bringing a light to this, and I was thinking as you were describing that, before We were talking a lot about perimenopause. It felt like there was fertility years and menopause years- Yeah ... and there was no in between.

[00:05:55] Christa Biegler, RD: But it's actually a long in between- ... for a lot of people. most of a decade or a full decade, or maybe even more overall. And I know you talk about there's a lot to unpack with perimenopause potentially, but I see that you're talking about it from the lens of stages, which I- Yeah

[00:06:11] Christa Biegler, RD: haven't really heard anyone else talk about perimenopause from stages. And if anything, what is interesting to me as I chew on all of this as well, as a newer 40-year-old, is some people at 35... thought process is like it's very interesting because sometimes at 35-ish, people are blaming, "Is this hormones?"

[00:06:30] Christa Biegler, RD: And typically, it could start then, right? But it's like, what, how do people really know? So let's unpack the concept of stages of perimenopause. Are there stages? Did Dr. Jones coin these stages based on- No. ... what she saw? Tell us about the stages of perimenopause in general, and then we'll maybe go into the individuals.

[00:06:47] Dr. Carrie Jones: I did not coin it, but I definitely feel that we need more than just two stages. So a, a workshop occurred, and researchers said, "Hey, for research purposes, and we have women in our research programs, we need to classify them." Pre-menopausal, perimenopausal, menopausal. Okay, cool. And then in perimenopause, where are they?

[00:07:05] Dr. Carrie Jones: Because somebody who's just starting out is very different from somebody who is "I've skipped eight periods and I'm really close." That- that's very different physiology. So the STRAW workshop is what it was called, and they said stage one are women whose periods shift by seven days. Now, keep in mind, the researchers are like, "We need to classify for our study so we can determine."

[00:07:28] Dr. Carrie Jones: So your- cycle is shifted by seven days, so you used to be a 28-day girl, now you're a 35-day girl or - now you're a 21-day girl. the late stage or second stage is when you've shifted by 60 days. You skipped two cycles, now you're considered late stage. Where I have an issue with it and where I've been talking about this a lot is, first of all, I feel like there's some middle in-between stage.

[00:07:48] Dr. Carrie Jones: How do we go from just missing seven days days- ... and nothing in between? And the second thing is everybody's basing this around the menstrual cycle, which I understand for research they have to have one north star, but a lot of women have an IUD or they've had an ablation or a partial hysterectomy and they don't get a cycle.

[00:08:06] Dr. Carrie Jones: Or a lot of women are going, "I still get a regular period and I still have a lot of symptoms, so where do I fall?" And I notice that in myself. My cycles have gotten shorter, three or four days shorter, but not seven. I've missed seven, eight, up to 14 days like once or twice in the last couple of years, so I'm classified as stage one.

[00:08:29] Dr. Carrie Jones: But I haven't skipped 60 days yet, and I'm 49 years old. So I use the stages as like a rough navigation for women. Are you having symptoms? Have you noticed your cycle started to change at all? Couple days here, a couple days there. Or are you on the other side? You are skipping cycles. You've had two cycles in a month where you're in the very erratic stages of I carry, I skip four months, and then my period came back regular.

[00:08:55] Dr. Carrie Jones: Then I got two periods in a month, then it came back regular. It's like I can never count on it. I'm like, "Oh, that's definitely more like late stage." Or are you in that in-between where you're like I skipped like seven days, a week to two weeks, but I have all these symptoms."

[00:09:07] Dr. Carrie Jones: Like- ... "I'm not really sure where I fall." I'm like, "Yeah, you're in the middle. You're like transitioning through." But I will say not everything is perimenopause just in general, and I love that you said that originally and then said, Freshly40- is it just hormones or is it perimenopause?

[00:09:21] Dr. Carrie Jones: Now, I have two sides to this coin. One is I met a woman who was 44, and she started perimenopause at 38, and she said, "But by 44, my periods had stopped, and I was menopausal." And every woman in her family went through earlier menopause, her mom her aunts, her older sister. So she said, "Yeah, it made sense for me.

[00:09:40] Dr. Carrie Jones: At 38 I was having perimenopausal symptoms because six years later my period stopped and there I went through menopause." Whereas other women, me for example, if I was having hormonal symptoms in my 30s, not perimenopause. Hormonal for sure, you can be hormonal at any age, absolutely. But perimenopause, no, because I am most likely due to my family genetics not going to go through into my early 50s, so I didn't start at my 30s.

[00:10:05] Dr. Carrie Jones: Mine was stress and, nutrition and life and all the other things that get in the way.

[00:10:10] Christa Biegler, RD: Yeah, I think it's really lovely when we're able to use a story, and it's always more special when we can use our own story. I think it feels nicer to question perimenopause than to say it's maybe stress and my nutrition and the other pieces as well.

[00:10:25] Christa Biegler, RD: But it really does ... I guess the question that sets you up for is how does someone, if they are s- having symptoms, how are they to differentiate between what are the early signs of perimenopause? And that's really where to bucket it, right? And I agree with you, is that very often because it's popular and talked about, it's like, "Oh, it's hormones," and I agree that it could be, and also all these other systems- Yeah

[00:10:47] Christa Biegler, RD: need to operate as well. So earliest signs of perimenopause that you see most commonly.

[00:10:53] Dr. Carrie Jones: you ready for this? Yeah. So there is a researcher in Canada, Andrea Donsky from Morpheus, and She'd surveyed thousands of women, and the number one symptom over 103 signs and symptoms, the number one symptom is fatigue

[00:11:05] Christa Biegler, RD: Oh, sweet

[00:11:05] Dr. Carrie Jones: Right, exactly, which could be a million things.

[00:11:07] Dr. Carrie Jones: Yeah. And that's where women are like, "Okay," "what am I looking for?" I said, "Okay, what I have found is when women are going am I perimenopausal or is it something else?" I'm like we have to rule out the something else." And I don't mean rule out like it's a disease or a condition or a cancer or anything like that but it might be.

[00:11:22] Christa Biegler, RD: Are you low in B12?

[00:11:23] Dr. Carrie Jones: Yeah, exactly. Do you have a thyroid issue?... Are in vitamin D? When was the last time you hydrated? Are you getting any sleep? Are you living- Yeah ... off caffeine? And, like, how is your stress? Just- ... all these things where suddenly women start to go, I guess that does make sense. You're right." But it's easier to say, "Oh my gosh, am I perimenopausal? I think I'm perimenopausal." "I guess I'm just perimenopausal. I'll go on hormones." I am not opposed to hormones at all, but I don't want anything else missed. I don't wanna miss if you have low iron.

[00:11:47] Dr. Carrie Jones: If you have low iron, going on hormones is not gonna help it, but you are gonna be really fatigued. And you're probably gonna lose your hair. And you're probably gonna struggle with temperature regulation because more on the side of the cold aspect, but some women in perimenopause get cold flashes, not hot flashes.

[00:12:01] Dr. Carrie Jones: So this is why I'm like a proper workup is so important to determine ... And guess what? You might have both. You may be perimenopausal, you may come to me and we run some hormone markers on you based on maybe if you know your family history, your cycle changes, the things you're ha- I'm like, "Oh, that does sound like perimenopause.

[00:12:17] Dr. Carrie Jones: It's looking like that. And oh, by the way, oh, by the way, you're also low iron, low B12." "You do have a thyroid problem," et cetera, et cetera. They overlap, and that's what I want women to really take home is that it could be perimenopause, it could be something else, it could be both. Yeah. But you have to get evaluated.

[00:12:33] Christa Biegler, RD: Yeah. There's lots of things that could be optimized overall. I think one of the tricky parts for people is that they get dismissed about this a lot- Yes ... there's no clear roadmap for here's what we should do we're evaluating perimenopause. So if someone wants to rule out is it perimenopause, I don't even know if there's clear parameters on here this is going down piece, little by little. So if someone is- Yeah ... evaluating their sex hormones or other markers to look at perimenopause, how, aside from symptoms- fatigue, yes. What the most common symptom that especially a high performing person or a person who's very used to doing things What I've noticed is they don't even like to say fatigue, right? Oh, yeah. It's just like we may define it as different ways. "Oh, I have trouble waking up," or, there's so many little tiny- Yeah

[00:13:20] Christa Biegler, RD: nuances to that. Okay. So first of all, do we have any standards for-

[00:13:25] Dr. Carrie Jones: None. No? No. And because perimenopause is a transition state like puberty, we don't have to diagnose puberty. It's not a disease. It's something we all go through if you still have ovaries. If you've had your ovaries removed, that's a different story.

[00:13:39] Dr. Carrie Jones: You're considered it's immediate surgical menopause. But if you go through perimenopause, we can test your hormones. If you're still cycling regularly but very symptomatic, I can look at your progesterone, your estrogens, your testosterone, DHEAS. But markers, there are other markers. There's a marker called FSH, follicle-stimulating hormone, and it tends to rise, start to rise about four to six years Like before you go through menopause.

[00:14:06] Dr. Carrie Jones: Now, that's not 10 years, 'cause some women take 10 years to go through perimenopause, but it might give me an idea if I start to notice your FSH creeping up. I'll give you example, me, for example. FSH should be in the single digits, so one through nine when you get a blood draw, or you do the at home urine test.

[00:14:25] Dr. Carrie Jones: But if it starts creeping up in the double digits, 11, 12, 13, 14, 15, et cetera, you're like, "Hmm." this is a hormone that goes from your brain to your ovaries, and it should be a very easy text message. Brain sends out the FSH down to the ovaries, the follicles in your ovaries, and says, "Do the thing, make the hormone.

[00:14:41] Dr. Carrie Jones: Grow the follicle." The follicle's like, "Got your message, cool. No problem." Sends the check mark emoji. Off you make hormone, your follicle grows. But what happens is as we get older, the brain tells the ovary, "Do the thing," the message is left Like it's just not got like before, and so then it sends it again, and then it sends it again, and this time it uses the loud effect.

[00:15:03] Dr. Carrie Jones: So your FSH starts climbing. Once your FSH is above 30 on more than one occasion- ... and you've been skipping your cycle, you've gone 12 months no period, then we're like, "Oh, you're post-menopausal. You've crossed the doorway of menopause into the other side." Now, we don't use FSH alone. We use the 12 months no cycle for determining menopause, but some women, again, don't have a cycle, they're not really sure, like it's hard to tell if you have an IUD, things like that.

[00:15:30] Dr. Carrie Jones: For other women, we do track their FSH over time if they're curious, and I can see the trend of it going up. So I got my blood drawn, gosh, I think it was two months ago, for a particular like research project for fun that I was a part of, and my FSH, 'cause you test it ideally on days two or three of your cycle, two, three, four of your cycle.

[00:15:51] Dr. Carrie Jones: It was 22, and I was like, "That's in the double digits, like what the heck?" Now, I still get my period regularly every month, but it's getting harder and harder. My brain and my ovaries are like yelling at each other. Yeah. So I already know 'cause I'm symptomatic in my age, but I also know because of this blood work.

[00:16:07] Christa Biegler, RD: Yeah. I was curious if there's no baseline, I was wondering is there really a problem if there's no baseline, but with your story it kinda sounds like no, not really, right? It's

[00:16:15] Dr. Carrie Jones: just an issue. Not really, no. And again, when somebody says to me, "How do I know?" I'm like we take your age into account. We take your symptoms and your cycle into account."

[00:16:24] Dr. Carrie Jones: I ask about your family history, do you know when your mom or your grandmother, the women in your family, aunts, do you have an older sister? And we take that information, and if it sounds about right, if you're in your 40s early 50s, and you're like, "Oh yeah, I'm symptomatic. I'm on track with the women in my family," yeah, you're perimenopausal.

[00:16:42] Dr. Carrie Jones: The harder part, the more gray area, and I mean gray in the best way, is when they're in their 30s.

[00:16:48] Dr. Carrie Jones: And we're seeing this more and more on social media where women are identifying at 31, 33, 35. They have very low hormone. Yeah. Their cycles are irregular. Yeah. And they're like, "I knew it. It's perimenopause, I'm over, I'm done."

[00:17:00] Dr. Carrie Jones: I doubt it. Yeah. Maybe, but like- Or- ... I would imagine it's something else that Yeah ... that somebody's just not working up, or you got what I would call a lazy classification of, "Yeah, sounds like perimenopause. That's what you have." Yeah. And then no workup was done.

[00:17:14] Dr. Carrie Jones: And unfortunately we see this all the time in women's health where- No workup is done.

[00:17:19] Christa Biegler, RD: Yeah, it does

[00:17:19] Dr. Carrie Jones: make- We're left to think for ourselves ...

[00:17:21] Christa Biegler, RD: it makes sense, 'cause if I hear that, I immediately think, "Oh, your adrenals are probably not-" Yeah ... functioning very well. Yeah. And so that becomes the priority, so your body's not gonna make any other hormones.

[00:17:30] Christa Biegler, RD: And maybe even low intake because high-stress, busy life, whatever, and so you're not gonna have the backbone to make it, and that would probably get missed no matter what conventionally. I even see it.

[00:17:40] Dr. Carrie Jones: There's no- I'm sure you see this too. Yeah. Yeah. Oh, yeah, I was gonna say- There's- ... you probably see it in somebody in their 40s.

[00:17:45] Dr. Carrie Jones: Oh, yeah, for sure. I've had women 40 to 45 who are like I'm in my 40s. It must be perimenopause," and the whole time they had a blazing thyroid problem.

[00:17:51] Dr. Carrie Jones: Yeah. Or a blazing adrenal, a hypothalamic pituitary adrenal issue-

[00:17:55] Dr. Carrie Jones: Which is- ... that was showing up ...

[00:17:56] Christa Biegler, RD: which is just not going to be checked.

[00:17:58] Christa Biegler, RD: I just don't think- Yeah ... we have very good conventional assessment for anything- Yeah ... related to adrenal, and usually I think that the thyroid is in... It's usually like, a bit I'm trying to say it gently. It's more of a mess if it's showing up on blood work, right? It's like there are signs before it shows up on blood work- Yep

[00:18:14] Christa Biegler, RD: for a long time typically. And when in doubt, we can always support those things, 'cause we all have them. They are essential. We all have those organ- Yeah ... systems, those hormones, and they're priorities before sex hormones. And that's a thing I always come back to whenever I'm discerning symptoms as well.

[00:18:31] Dr. Carrie Jones: Oh.

[00:18:31] Dr. Carrie Jones: Yeah ...

[00:18:32] Christa Biegler, RD: so FSH and then also DHEAS, don't you... Do you see that rising as well?

[00:18:37] Dr. Carrie Jones: It depends on the person. So S means sulfate, and if somebody has a lot of inflammation, that will block the S getting put on, sulfation. So they could have a fake-out, which means they'll have a lot of DHEA-

[00:18:48] Dr. Carrie Jones: But their DHEAS will drop down because the inflammation has gotten in the way, and they can't put that little S on.

[00:18:54] Dr. Carrie Jones: So then it becomes a matter of why are you so inflamed? What's going on? Is it a bacteria, virus, a mold? Is it something with your gut? Is it something with the food you're eating? Is it, a metabolic issue? Is it from excessive visceral adipose tissue, which is quite inflammatory?

[00:19:07] Dr. Carrie Jones: There's a whole lot of reasons for inflammation. So then again if somebody is just tracking DHEAS and they're like, "Oh my gosh, it went down. Look at me," I'm like, "Oh, yay, I hope you're less stressed, and also are you inflamed?" What, now what's going on? Yeah.

[00:19:21] Christa Biegler, RD: Yeah, for sure.

[00:19:22] Christa Biegler, RD: Okay, and I heard you talk about checking on days two through five. I just had Jolene Brighten on, and . i know that's what she says as well. And then some people still test post-ovulation as well. Is there- Any issue with either one?

[00:19:35] Dr. Carrie Jones: No. Yeah, you can test

[00:19:36] Dr. Carrie Jones: Ideally it's between two, three, four, and five because that's when it is actually the most active. It's follicle- ... stimulating hormone, so when are you trying to stimulate a follicle? On those days. In the early follicular part of your, phase of your cycle. So that's when ideally we want it.

[00:19:50] Dr. Carrie Jones: However, what's really cool is, like I said, we have at home urine tests now that you can just, pee on a stick, get the result. And so a lot of women are doing tracking every day of their cycle- ... so they're getting information about themselves every day. So I have a ... I do a lot of consulting. I have a lot of women that will show me "Okay, here's my FSH through my cycle."

[00:20:10] Dr. Carrie Jones: And it's very cool to see it may stay nice and low because their estrogen is very healthy and cycles n- regularly. It may bounce around like a rollercoaster because estrogen's up, estrogen's down. Estrogen's quite suppressive to FSH. So if somebody's has a low estrogen cycle, their FSH may be a lot higher, but if their next cycle is back to normal and their estrogen's where it should be, their FSH can drop down.

[00:20:34] Dr. Carrie Jones: So I do like watching FSH through the cycle- ... depending on the woman, and honestly what are we going after? 'Cause interestingly, it has the name follicle-stimulating hormone, but we have as, as women FSH receptors all over our body. We have them in our brain, we have them in our bones, we have them in our fat tissue.

[00:20:51] Dr. Carrie Jones: It's not a one-trick pony. It does ... As a hormone, it does a whole lot more than we think.

[00:20:55] Christa Biegler, RD: Yeah, like many things.

[00:20:57] Christa Biegler, RD: Any other lab red flags you would look at before going on to other symptoms and assessment?

[00:21:04] Dr. Carrie Jones: In determining if somebody is perimenopausal?

[00:21:06] Christa Biegler, RD: Sure, yeah, or transitioning.

[00:21:08] Dr. Carrie Jones: Yeah, and again, as I said, the great thing about where we are now is that we have so much at home access where women can just take control of their health and test for themselves.

[00:21:16] Dr. Carrie Jones: So I am really appreciating some of these at home everyday urine tests that you can do and s- get your hormonal feedback. Why do I like this? Because I will have women that say to me, "I feel like I'm perimenopausal," and then I'll get to track back and see their last couple of cycles on this graph, and I'm like there's your estrogen, there's your progesterone," so I can watch the trends of oh gosh, you are not ovulating like you should. Your LH, luteinizing hormone, that's the signal to ovulate, is not as spiky as it should be, and as a result, your progesterone's not as high as it should be. So I can start watching these trends. Now, does that mean automatically you're perimenopausal?

[00:21:51] Dr. Carrie Jones: No, 'cause a lot of things get in the way of ovulation, but it does help me, especially when women are like, "I'm so symptomatic. I'm having all these symptoms. Hot flashes and night sweats and brain fog and my joints hurt, but I do still get a period. How is that possible?" And then I see through the graph through the whole month you make enough estrogen to get a period, like to trigger all the things, but it's not great.

[00:22:11] Dr. Carrie Jones: You have more lows than normals and highs, and as a result, that's why you're having these symptoms. So I do appreciate what- is coming out in the ability for us to track ourselves and look at ourselves and start to see is this a hormone issue because they're responding to stress or thyroid or nutrients?

[00:22:30] Dr. Carrie Jones: Or is this a hormone issue because we are truly running out of follicles and the communication's not there like it used to?

[00:22:36] Christa Biegler, RD: Yeah. It is pretty fun that we are having more at home testing options. I see this pop up all the time with sleep apnea or whatnot, and I haven't tested everything.

[00:22:46] Christa Biegler, RD: Yeah. And this makes a lot of sense that you would appreciate this because I feel since you start, one of your earlier things a couple of positions ago was- ... a Dutch test, right? Yeah. And there was a lot of urine testing, and it makes sense that you would tune into some.

[00:22:58] Christa Biegler, RD: There was a company that sent me a meter called Inito, I think.

[00:23:03] Dr. Carrie Jones: Yeah.

[00:23:03] Christa Biegler, RD: That was one of them. What are ...

[00:23:04] Dr. Carrie Jones: Is there any other- Mira. Mira's the other one. That's who I work with. In full disclosure, I do a lot of education. I got their machine a while ago 'cause I thought, "This is the coolest thing in the whole world," and all the

[00:23:13] Dr. Carrie Jones: Inito, Mira, they were looking at fertility- ... and tracking your cycle the whole month in order to get pregnant, which is great, fantastic, noble, very important, ' and even perimenopausal women are looking to get pregnant. But I was like, hold on, where I am in my 40s, what's going on? So I started testing myself, and even though at the time I would get all these cute little fertility pop-ups like, "Now's the time to try," I'm like, "Oh, sweetie no." I just wanna see what my hormones are doing. And I could see very clearly my progesterone. I would not take my own progesterone replacement to see what I was doing, like in a month, and like, how much do I really make?

[00:23:48] Dr. Carrie Jones: And it was not great. Let's put it that way. So anyway, then I started reaching out to the company like, " you guys, why fertility? All my perimenopausal friends wanna know what's up," especially, the data trackers. And so I love that there's the ability out there now.

[00:24:02] Christa Biegler, RD: Yeah. With it. I've had an Inito in the closet for quite a while, and I remember that was the exact reason why I wanted it was for that very reason- Yeah

[00:24:10] Christa Biegler, RD: was to test in that way, and then I apparently- Yeah, and you don't

[00:24:13] Dr. Carrie Jones: have to test them ... got it thrown by the

[00:24:14] Christa Biegler, RD: wayside.

[00:24:15] Dr. Carrie Jones: Every ... It sits in the closet. The nice thing I tell women, 'cause sometimes they're like I'm not trying to get pregnant, so how long do I do this?" I'm like do it for a couple months."

[00:24:22] Dr. Carrie Jones: "Or do it for one month and let's see where you're at. Or if you're feeling great, don't. And if you feel very symptomatic," 'cause which can happen in perimenopause, you get these, weeks or months where you're back to what you think is baseline or normal, and then all of a sudden you're like, "Nope, everything's changed.

[00:24:37] Dr. Carrie Jones: What's going on?" I'm like I can tell you in real time if you'd like to see. We just test and look." And again, it's not for every woman. I don't need every woman to do this test. Not every woman wants to do the at home test, but for women who are like, "Why? Why didn't I have this symptom and now I do have this symptom?"

[00:24:54] Dr. Carrie Jones: Or, "Why did it go away and two months later it's back?" I'm like "Well, I let's see what your hormones are doing. And it's been, the nerd in me has been completely fascinated to see all these different charts where women are like, "I get my migraine right here," or "Oh, my gosh," "This is the hot flashes."

[00:25:11] Dr. Carrie Jones: I'm like, "Oh, I can see in real time what's actually happening with some of these hormones." Yeah,

[00:25:15] Christa Biegler, RD: that's fun.

[00:25:16] Dr. Carrie Jones: This is what's happening.

[00:25:18] Christa Biegler, RD: Yeah. That really is a lot more rewarding if you are able to find that information- Yeah ... or you're able to grab that data, because when you go in and do a one-time blood test, it's like you're sometimes

[00:25:30] Christa Biegler, RD: There's lots of possibilities- Yeah ... for that day and time, right? Yeah. That may impact how it looks. And so if at first your labs don't look or if they look funky, it is okay to always recheck, right? So it's- Always ... it's just kinda

[00:25:44] Dr. Carrie Jones: nice

[00:25:44] Christa Biegler, RD: to- Oh,

[00:25:44] Dr. Carrie Jones: yeah ... to- Even in a a Dutch test. Dutch test is a single day test and gives you a ton of information, but even years ago I would say to people, "It's just a one-day test."

[00:25:53] Dr. Carrie Jones: In fact, it's a one day in that moment, it's not even a one ... Yeah. A blood test is not a one-day test. It's you got a blood draw, and your progesterone at that exact second when the needle went in your arm is what your progesterone is. It doesn't mean that was your progesterone an hour ago, and it doesn't mean that's what your progesterone's going to be in an hour.

[00:26:11] Dr. Carrie Jones: 'Cause I think what we never get taught is hormones are made on a pulse system, so it's not like a garden hose. It's not "Okay, turn on the hose and let's make progesterone," it just sprays out all over your body. It doesn't work like that. It's the brain sends a pulse like Morse code, and then some progesterone is made.

[00:26:27] Dr. Carrie Jones: And then it gets used and it goes down, and then a pulse is sent again, and then it gets made and it gets used and it goes down. And so it's this sort of this like- Up and down, you know- Yeah ... throughout the day depending when the pulse is. So if you got a low progesterone blood draw, doesn't always mean it's low.

[00:26:42] Dr. Carrie Jones: It could just have meant you didn't get a pulse yet. You didn't make it.

[00:26:45] Christa Biegler, RD: No. Yeah. People are gonna wanna know, Carrie, how do I help my brain send more pulses?

[00:26:51] Dr. Carrie Jones: I know. - You hit it on the head earlier, pun intended. So hormones are the first to react, they're very dramatic, and they're the last to heal.

[00:27:01] Dr. Carrie Jones: Because making a hormone requires a lot of energy in the body, and it, survival is prioritized over the production of hormones, right? Your body is like, ooh, if you're stressed or if you feel threatened or if you don't feel safe or if you have a lot going on to the point where the brain registers it and says, "Now is not a good time to make a hormone or not to, good time not to ovulate.

[00:27:22] Dr. Carrie Jones: I'm gonna delay the period. I'm gonna make the period come shorter. I'm gonna make the period heavier." Whatever it is, the focus is always gonna be on survival. So how do I protect your heart? How do I protect your brain? How do I get your skeletal muscles ready to fight or flight? And so when somebody says, "How do I get my pulses back?"

[00:27:38] Dr. Carrie Jones: I'm like we have to address the ecosystem that's sending the negati- the negativity up to the brain that it's not safe, there's a lot of stress, you're missing certain nutrients, the timing is off." We have to course correct all of those things, and then the brain goes, "Okay, cool. I've checked all those boxes.

[00:27:57] Dr. Carrie Jones: We're good enough to make a hormone. That's fine." 'Cause you can still get your period stressed as all get out. But you're not, the actual level of production of your hormone is probably not that great. So women will start to say I get my period still, but my PMS is wretched. My cramps are bad."

[00:28:13] Dr. Carrie Jones: Or, "I got a migraine this month, and I haven't had a migraine in several months. Like, why?" Or, whatever it is, "My PMDD was the worst this month." Because you get enough hormone to make, go through the cycle and make a period, but it's not at adequate levels that you were hoping for.

[00:28:29] Christa Biegler, RD: Yeah.

[00:28:30] Dr. Carrie Jones: That's we go back to let's address everything else we talked about, right? All the other glands, and nutrients, and nutrition, and sleep, and hydration, and stress management, and gut health, 'cause that all feeds into the brain.

[00:28:43] Christa Biegler, RD: Yeah. And the good news is there's lots of opportunities to try to improve. Tons.

[00:28:47] Christa Biegler, RD: It's- Tons ... it's not like you're stuck in a certain place. I wanna talk a little bit about ... there are definitely certain things that start to happen in the body. We have talked- Yes ... a little bit here and there. We've talked about cardiometabolic stuff, et cetera, so we can run through some of that.

[00:29:02] Christa Biegler, RD: But I think Aside from fatigue, I feel like the other very common argument and complaint that I hear from people is weight gain.

[00:29:11] Christa Biegler, RD: So let's talk about what are the mechanisms that happen in the body, related or not related to perimenopause, that might be ... if you have so many women saying this around that time- it's like, what are all the mechanisms that may or may not be impacting this?

[00:29:27] Dr. Carrie Jones: So many. So when we go through perimenopause, our hormones shift, but estrogen, estradiol, which is our primary estrogen, is a big one. And when we have lower lows or consistent low levels of estradiol, this has a domino effect through the whole body in our cardiometabolic system.

[00:29:44] Dr. Carrie Jones: So it can make us have higher glucose and be more insulin resistant.

[00:29:51] Dr. Carrie Jones: When we have lower estrogen, Our body can perceive us as having higher what we call androgens or testosterone hormones. And it's a kind of a ratio where the body's like, "Oh no, estrogen's dropping down. I feel like I have all this testosterone."

[00:30:06] Dr. Carrie Jones: And what happens when we have this perception in our body is that we get more apple shaped as opposed to pear shaped. So then women go my weight on the scale hasn't changed, but my pants are tight. I'm getting this belly and I haven't had this belly before." Our actual physique changes.

[00:30:21] Dr. Carrie Jones: The ability for us to break down fat and release the fatty acids in our fat, and then burn those fatty acids as fuel in a sense, goes way down. In fact, it's harder... the fat factory that's supposed to take care of those fatty acids isn't as effective as it used to be. So now we have this big buildup of fatty acids on the one side of the factory, and the body goes we can't have this, so we need to put them somewhere."

[00:30:45] Dr. Carrie Jones: And so where does it go? In the visceral fat around the middle again. And the list goes on. Like, where we deposit fat, how we do or don't, in a sense burn fat. Our hunger and craving signals all change. A lot of women will say to me, "I have so much food noise. I didn't know what food noise is.

[00:31:01] Dr. Carrie Jones: I now know what food noise is. I'm hungry all the time. My normal meals don't fill me up. I feel like I have to eat twice as much just to get that signal to stop that I'm not hungry." And the change in estrogen, unfortunately, takes the brake off of all our hunger signals of like, "Go ahead and eat," you need to eat more."

[00:31:20] Dr. Carrie Jones: And, we hear a lot growing up about calories in and calories out, and part of it can be true. If your exercise and movement's gone way down because you're stressed out and you're tired, you don't have time for it, and your hunger signals have gone way up, so you're eating more and snacking more, that's gonna contribute and cause problems.

[00:31:40] Dr. Carrie Jones: But this is what gets me with, for women. Women are like, "Yeah I know that, and I've been making changes. I've cut some calories, I've started working out, and No movement is happening like I would see in my 20s and 30s." Yeah. 'Cause now what happens is we added on all the other layers on how you manage glucose, how you manage insulin, how you manage inflammation, and where you have fat deposition, and on.

[00:32:00] Dr. Carrie Jones: And so when I- See on especially social media when people tell women, "It's just calories in, calories out," I'm like, "Just? No, it's so much deeper and wider than that." And I will also see quotes of oh, the average woman in perimenopause gains five to 10 pounds, and then the comments section just blows up.

[00:32:19] Dr. Carrie Jones: Hundreds and hundreds of women who are like, I wish it was only five to 10 pounds." I've gained, and it's often unfortunately exponentially more, ... And I would agree with you, I think weight gain is a very common

[00:32:30] Christa Biegler, RD: It becomes a pretty big motivator because it seems... that's what I see in women is like they're like, "Oh, I like the idea of fixing this, but really what I'm after is to change my body composition."

[00:32:40] Christa Biegler, RD: And your analogies have been on point this entire time, but I do, I really appreciated the one where it's like you become more apple shaped instead of pear shaped. Yeah. Because I have seen that a lot as well, and I think that description is just a nicer service than anyone has given on the show yet, so I appreciate that.

[00:32:59] Christa Biegler, RD: Talking about the reason, the mechanism, what is going on in the body where the ability to break down and burn fatty acids is declining?

[00:33:08] Christa Biegler, RD: I do not know about you, but I feel the change of season is upon us. And for many people, it's back to school or back to work, or for me, it's back to focus. And I wanted to share a few tools that I'm using that might make this transition a little easier for you as well. Now, first of all, if you've got a kiddo that gets stressed or anxious about school or sports and, and/or you just don't like taking supplements by mouth, have you tried this Mag Relief lotion from Jigsaw?

[00:33:35] Christa Biegler, RD: A lot of topical magnesium sprays burn, but this lotion has zero smell, zero burn, and it contains organic oils and my favorite kind of topical magnesium, which is OptiMSM. You can just put some on. Usually it's gonna be legs and feet, but you can put it wherever you want on your body. Put some on after exercise, before bed to help with sleep and stress.

[00:33:55] Christa Biegler, RD: Another type of magnesium that I am adding to my rotation is the Brain Boost from Jigsaw. It's mag threonate, which means that it's the type of magnesium that crosses your blood-brain barrier to help with focus. And in studies, beyond focus, it also helps with deeper sleep, which then helps improve daytime alertness and reduce grouchiness.

[00:34:18] Christa Biegler, RD: So if you have not tried the Brain Boost mag threonate from Jigsaw, it might be helpful for getting back into the swing of things. That's what I'm gonna go ahead and try. And then finally, I am still drinking this very licious Electrolyte Supreme with a splash of sparkling mineral water on repeat. It's kind of like one of those sparkly energy drinks, but better for you because it's a combo of a multivitamin, vitamin B, minerals, and electrolytes without a vitamin flavor at all.

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[00:35:11] Christa Biegler, RD: So if you miss the 15% off code in September, no problem. You can always get 10% off any order anytime with LESSSTRESSED10 as the code. As always, thank you so much for supporting this podcast and using our codes at https://www.jigsawhealth.com/.

[00:35:28] Dr. Carrie Jones: So estrogen plays a big role in that cycle to get it into our mitochondria, to make ATP out the other end. And so when estradiol is low, then we don't have the fuel for that cycle to work, to literally pull the fatty acids in and push it all the way through.

[00:35:45] Dr. Carrie Jones: So speaking of analogies, I give this same analogy a lot. So I live in the Pacific Northwest. We have a lot of timber here. So if you can imagine, you are at a wood mill, and you've got a whole lot of trees on one side that have to go through the mill, and out the other end they become boards or, sawdust or whatever they're gonna do with these trees.

[00:36:02] Dr. Carrie Jones: But now let's pretend that's fat. So you've got a whole bunch of fatty acids on one end trying to go through the mill to break them down and be useful out the other end, but they can't. Estrogen was the key that turned on the power and got that turned the lights on and, supplied the workers, and that's not really happening as much as it used to.

[00:36:19] Dr. Carrie Jones: And so with all those fatty acids on one end, the body goes, "Ugh, we have to put these somewhere. We can't just let them pile up in the parking lot." So it puts it in our visceral adipose. That's the deep fat that's around our organs, and our organs are around our middle. So again, furthers the apple shape as opposed to maybe pushing it lower into a pear shape on the hips, thighs, and booty.

[00:36:42] Christa Biegler, RD: Yeah. Super interesting. I was just reflecting about how I always like to personify the sex hormones, and I would, I used to call estrogen Jekyll and Hyde because- Oh,

[00:36:50] Dr. Carrie Jones: yeah ...

[00:36:51] Christa Biegler, RD: so often before perimenopause, estrogen gets a bad name for all of its symptoms, right? But in perimenopause, the fact that it's low is really a common denominator in a lot of the symptoms overall.

[00:37:03] Christa Biegler, RD: A lot. And I-

[00:37:04] Dr. Carrie Jones: Yes ...

[00:37:04] Christa Biegler, RD: and I think about how if estrogen metabolism sucked Which there's so many options to improve that. But if it sucked then, it makes me wonder how it goes later overall or if we drop off or... I don't know if you've seen any trends, and I wonder also, we're gonna get into a little bit of to hormone or not to hormone, to HRT or to not-

[00:37:23] Christa Biegler, RD: to HRT. That is the question. My goal is always to help my brain stimulate my ovaries . for as long as possible. But, how do you start to make those decisions at the right time, et cetera? Any insights, if you wanna share any insights around maybe your personal journey watching your own sex hormone specific hormones shift and change, how much you saw them change at a time which created symptoms.

[00:37:46] Christa Biegler, RD: Any insights you wanna share about that or estrogen, and then we'll talk a little bit about what do people do? 'Cause we're hearing, people are hearing now I hear that's coming up a lot, so do I just need to go..." They're like what do I do? Do I just go on hormones?" So let's talk a little bit about your journey or-

[00:38:00] Christa Biegler, RD: Anything that you've seen with working with people and looking at data or whatnot related to-

[00:38:04] Dr. Carrie Jones: Yeah ... For mine, my testosterone stayed steady. So testosterone does not automatically decline with perimenopause. It does decline with age, but everybody's testosterone declines differently.

[00:38:15] Dr. Carrie Jones: So I just interviewed this amazing doctor of nurse practitioner, Dr. Terri DeNey, who's excellent in the topic of testosterone, and she was describing women like in their 30s, they've had their second or third kid, and all of a sudden everything kinda drops off, and she was explaining how the loss of testosterone is a big part of that.

[00:38:33] Dr. Carrie Jones: And I was like, "That's so fascinating," because I have not had children-

...

[00:38:37] Dr. Carrie Jones: Did not have children, and my testosterone has stayed steady. Like this whole ... Even at 49 years old, I've what I would consider excellent levels of testosterone. What did fall off, though, was progesterone. Yeah. My progesterone, like I said, I still cycle fairly regularly.

[00:38:51] Dr. Carrie Jones: I do ovulate most months because I track it or I can feel it. , I can tell a difference. But my actual output on the other end of progesterone is not that great, so you know, back to the factory. Like the factory's on and things are coming through, but the output is not that great. So I started progesterone consistently probably at 45, 46 years old.

[00:39:12] Dr. Carrie Jones: My estrogen is always generally and always has been elevated. I am a very, what we would describe estrogen dominant relative to progesterone type girl. I have higher highs with my progesterone, and I'm noticing now at 49 that I am getting ... I probably have like what other people would term as normal levels of estrogen.

[00:39:32] Dr. Carrie Jones: But for me it's a drop 'cause I'm used to a lot of estrogen. And so when people go, "Oh gosh, you're 49. Aren't you on estrogen yet? Oh, you should probably go on estrogen," I'm like not yet. I'm not having hardly, not a lot of low estrogen symptoms. Some of the things come and go, like word recall.

[00:39:49] Dr. Carrie Jones: I'll have itchy ears that come and go. I had a spell of phantom smells. Some funny things. But by and large, I'm just gonna knock on wood here, like hot flashes and night sweats I don't get. The joint pain or musculoskeletal syndrome stuff. I don't have the vulvovaginal things.

[00:40:04] Dr. Carrie Jones: So I'm not there yet with estrogen, But you can't also compare your perimenopausal journey, if you're listening, to mine. Because I have women, I know tons of women, and they're way younger than me, who are on all the hormones and doing great. And so it's just my family goes through menopause later, in their 50s, and so I'm just shifted up relative to somebody else.

[00:40:24] Dr. Carrie Jones: So that's my current journey with hormones, what I've seen. It's fun to hear s- fun to hear stories, especially from the hormone queen, right? We want

[00:40:29] Christa Biegler, RD: to know her.

[00:40:32] Dr. Carrie Jones: And I'm a little different because I've been tracking for, gosh, two decades now. And when you work for a lab, when I was the medical director at the Dutch test, perk of the job, you got free testing all the time you wanted.

[00:40:42] Dr. Carrie Jones: So I was free testing myself often, so I have all through the years. And even now I do a lot of education for them, and so anytime I want Bless their heart, they send me a free lab test, so and that's not common. I'm fully aware that's quite, different relative to somebody else

[00:40:58] Dr. Carrie Jones: But I love that I can share that with people of "Hey, I know you haven't been able to test often, but I've tested a whole bunch, and here's what I've seen in myself, and here's what I tend to see in women who also have had access to that." Now getting to do the at home every day test, like the Mira, like I said, I got that I think I wanna say two years ago.

[00:41:14] Dr. Carrie Jones: I bought one 'cause I was like, "This I wanna know for me." And so I was ahead of the curve in that even for perimenopausal women, and now women are using those kind of tests and seeing for themselves. And so I think it's a really helpful story to understand because we're getting one very specific story on social media.

[00:41:34] Dr. Carrie Jones: You know- Yeah ... it's like your progesterone's gonna go down, then your estrogen. You should be on all the hormones. Your testosterone's gonna go down. Like everything's a should. Like it's going to, it's going to, it's going to. It's doom and gloom, and I'm like,

[00:41:43] Christa Biegler, RD: I don't think that the insulin resistance gets talked about as much as it should online.

[00:41:48] Christa Biegler, RD: I don't see it get talked about as much as it should.

[00:41:50] Dr. Carrie Jones: The whole cardiometabolic doesn't get talked about. Yes. We hear about heart health in general.

[00:41:55] Dr. Carrie Jones: But behind the scenes, I've had more women come up to me at conferences and say I always had low cholesterol or low blood pressure, and now I have high cholesterol, and now I have high blood pressure."

[00:42:06] Dr. Carrie Jones: And those are things you don't really feel. Yeah. And what can happen is that if you have had low cholesterol and low blood pressure your whole life, and a lot of women identify as this, people are like, "Ugh, I'm so proud. Every time I go to the doctor they can barely find my blood pressure it's so low." So they don't think about it, and then they hit 45 or 50 or 55- Yeah ... and they're like, "No, I've always had low blood pressure. Why is it high? I don't understand." Not realizing estrogen's role in your blood vessels and what it plays for clearance of cholesterol and then flexibility in your arteries. So even heart and blood sugar, the weight gain, the risk for Type 2 diabetes, insulin resistance, metabolic syndrome, like I said, high blood pressure, hypertension, high cholesterol, like We definitely need to talk about that more.

[00:42:51] Dr. Carrie Jones: It's not sexy. No. I get it at all. Yeah. And I think women are like, "That's so common. That's what old people get. That's what my mom had." "I don't wanna talk about that." I know. But you're midlife.

[00:43:01] Christa Biegler, RD: I know.

[00:43:01] Dr. Carrie Jones: When do you think hers started?

[00:43:03] Christa Biegler, RD: Yeah, and not to mention your low adrenal status that no one was testing- Oh, yes

[00:43:08] Christa Biegler, RD: 'cause there was no way to test it is also- Yeah ... a reason your blood pressure was so low no one could find it. Yeah, that's such a good point. It's like, "Hey, by the way, sorry, that's actually not really a good sign." It's actually not great that your cholesterol would've been low. And I know it's a sad thing.

[00:43:22] Christa Biegler, RD: Yeah ... we've applauded it because we're very black and white in medicine very often. . And I think that there's a level of discernment. It's like, okay, am I going to, evaluate my insulin and glucose markers? Yes, I think we all should. Yeah. And then what am I gonna do with it?

[00:43:37] Christa Biegler, RD: There's so many lifestyle things there. And then, with the cardiometabolic things, if your cholesterol's going up ... I've had this conversation with some other colleagues and it's yeah, what it's discerning what do you wanna do about that- ... right? So it's like you said it in different words earlier, it's it's layers, right?

[00:43:54] Christa Biegler, RD: Yeah. At that point. Yeah. And so It's not only anything that wasn't taken care of before we get to take care of now, it's also like a whole new set of layers overall. But I think the way you've shared it with us, these aren't necessarily mysteries, but finding someone to help you navigate it and then also, like, having, gaining the education and understanding your body well enough to know that these things can show up and that there's options for all of them I don't see any way around that personally.

[00:44:22] Dr. Carrie Jones: And e- especially 'cause you mentioned in the way beginning about being like the first generation, and I, unfortunately I say this a lot, the Gen X's and elder millennials, we are literally paving the way. I'm glad it's us, also I'm sorry it's us. I wish- Yeah ... a generation after us would've helped pave faster, but once again, it's up to us- gen X and elder millennials. You know- Yeah ... we're scrappy, we were latchkey kids, we drank out of hoses, we came home when the lights came on. We're gonna figure out perimenopause. And then we're gonna make it easier for the generations after us. But until then, yeah, exactly what you said, it's layers and gonna pull yourself up by your bootstraps and we're gonna figure this out.

[00:45:01] Christa Biegler, RD: This is actually a little serendipitous, I was just thinking about I don't know if there was a second Dutch Fest. I was at the first one.

[00:45:07] Dr. Carrie Jones: Yeah.

[00:45:07] Christa Biegler, RD: And I remember coming away from, there's like a beautiful chart of, I think it was hormone replacement therapy options.

[00:45:15] Dr. Carrie Jones: Yes.

[00:45:15] Christa Biegler, RD: And my takeaway from that whole segment was it's a lot of trial and error.

[00:45:20] Christa Biegler, RD: It's- It's a bit of a Wild West.

[00:45:22] Dr. Carrie Jones: It's like lipstick. And I mean this wholeheartedly, if you go to the store and you're not allowed to try on lipstick, so you're just holding the shade up to your lips, right? And then you're like, "I think this one'll look good." So you go home and you try on the shade and you're like, "Nope, that's so not my shade."

[00:45:34] Dr. Carrie Jones: It's not that you failed lipstick, it's not like you can never put on lipstick again, it just wasn't your shade. Hormones are the same thing. Just because you got put on the patch, the estrogen patch and the progesterone pill, and if you're like, "Hated it," you didn't fail hormones. It's a different route, it's a different dose.

[00:45:49] Dr. Carrie Jones: Maybe there's a lot of inflammation getting in the way of the receptor, so the hormones couldn't even get there in the first place. Maybe it's what you do for a living. You're a swimmer, so maybe the patch is not the best option for you. Maybe you have adhesive allergies, you're very sensitive in your skin, patch is probably not the best idea for you unless we try some other things.

[00:46:04] Dr. Carrie Jones: But if these aren't explained to you, or you didn't know that you have to rub in your gel for like- Beyond what you think. Some of the gels you have to rub and rub, and then rub, wash your hands, and then you have to let it air dry. So there you are standing wherever you rub your gel in, if it's your arm or your thigh or your lower belly, and you're standing there naked like la la waiting for your gel to absorb.

[00:46:23] Dr. Carrie Jones: Most of us have very busy lives. We don't have time for that. So then you're rushing, putting clothes on, washing your hands, doing whatever. And you didn't fail hormones. It's just these little nuance things we have to discuss.

[00:46:34] Christa Biegler, RD: Yeah, that's super fun. Great analogy again. I think, you know, I feel like I'm in the camp of trying to preserve what's there and support before.

[00:46:45] Christa Biegler, RD: Because once you do HRT, and I'm also pro-hormone-

...

[00:46:49] Christa Biegler, RD: But it's like, you're either on or you're off. It's not like you were like, "I went on for a while and then I came off, and everything was perfect." It's like you're either on or you're off. Yeah. And so I'm through in the phase of let me take data, let me experiment and explore and optimize everything else I can- Yeah

[00:47:04] Christa Biegler, RD: so I can wait to take hormones as long as possible or as late as possible, because if I'm going to use them, then I'll just be on them, right?

[00:47:12] Dr. Carrie Jones: Yeah.

[00:47:12] Christa Biegler, RD: And is there anything you wanna speak to around that? Especially women are hearing about their estrogen. We talked about it being Jekyll or Hyde or, the dominant versus too low. So is there anything you wanna share about supporting our natural processes to make hormones as long as possible? I know we have our genetics and we have, especially looking at your family history and all of those pieces, but anything that you wanna share related to that?

[00:47:34] Dr. Carrie Jones: Yeah, even things like medications, traumas, major stressors, nutrition all of these foundations, all these layers that you've mentioned absolutely play a role. Now, when you go through the doorway of menopause, in a lot of regards, that is chosen for you. You don't come with like an old-school ticker tape that just would like come out of your ear and it's like, "Hey," "Krista's gonna go through at 51."

[00:47:58] Dr. Carrie Jones: You're like, "Fantastic. Yes." Good to know. We don't quite have that technology yet, but if we know generally maybe what your family went through or how old you are when you're having symptoms, when your hormones are starting to change. So no matter what, because the big guns in life the big things we wanna worry about with longevity are things such as your brain, right?

[00:48:15] Dr. Carrie Jones: Neurodegenerative disorder, dementia, Alzheimer's, et cetera. The cardiometabolic. Heart disease is still the number one killer of humans. Estrogen does play a big role. We have cancer, so we wanna make sure in our lifestyle and things we can control since we know a lot of cancer, not all cancer, but a lot of cancer has lifestyle-type factors that contribute to it and can accelerate it or play a role.

[00:48:37] Dr. Carrie Jones: So you know, like we wanna work on those. And then lastly is musculoskeletal. So we don't want you to break a hip. I don't want you to crack a femur. I don't want you to trip and fall and be shuffly and off-balance. I don't want you to have joint pain either. So we look at these four is what's gonna get you like a healthy life.

[00:48:53] Dr. Carrie Jones: I don't know how long you're gonna live, but I would like you to live at a healthy manner, right? So when we're looking at when do we start this, you start it now. You wanna optimize a little bit every day in all these areas of your life so that you can have a better perimenopause, hopefully, and then of course through the rest of your lifespan.

[00:49:11] Dr. Carrie Jones: Because when we think about our grandmothers, for example, or your great aunt or whoever, if they broke a hip, God forbid, if they had heart disease, if they were Type 2 diabetic, if they have had dementia, Alzheimer's or have it, that doesn't just pop up in old age. That starts decades before, and that's the big one that we're really trying to hit home for people- as Grandma didn't break a hip because suddenly at 80 she developed osteoporosis. That started in her 40s and slowly over time eroded at her bones. So let's rewind and start now when you're listening and taking care of your health with like exercise, diet, nutrition, stress, all the things, and then when you're ready for hormones, when you need hormones, like layer them in.

[00:49:54] Dr. Carrie Jones: And what's interesting is when you say like I wanna push off hormones as long as possible, basically we just wanna be as healthy for as long as possible. Like for me, my progesterone was not coming back. I tried the herbs. I take care of... all the things are great, and my poor little follicles were like, "Nope, we're not making this."

[00:50:12] Dr. Carrie Jones: So I went on progesterone. I still make a robust amount of estrogen. I don't need to add in. Even when people go, "You're crazy. You're 49. You're almost 50. You should be on estrogen," I'm like, "Why would I add more to the fire?" I already make a lot. When I stop making so much, when I start skipping cycles, I will happily go on estrogen.

[00:50:30] Dr. Carrie Jones: So it's not a matter of I'm trying to push it out as long as possible, I'm just matching when my physiology is like, "Eh."

[00:50:36] Christa Biegler, RD: Yeah. "

[00:50:37] Dr. Carrie Jones: I don't wanna do this anymore. Th- it was a good ride. I don't wanna make estrogen like I was." I'm like, "All right, cool. No problem. I will start estrogen." But those foundational things you have to have in place because as you and I know, brain health alone is like estrogen's not gonna fix it.

[00:50:51] Dr. Carrie Jones: Estrogen alone is not gonna- solve your joint, your bone issues. As I, jokingly say, if you've been drinking and smoking and straight West Coasting, as Dr. Dre says- ... estrogen's not gonna fix that alone. So we have to think of this very broadly of a 360 approach- Yeah

[00:51:07] Dr. Carrie Jones: and include hormones in there.

[00:51:09] Christa Biegler, RD: Yeah. But hormones are a great buzzword, and they might be a motivating buzzword for us.

[00:51:13] Dr. Carrie Jones: And for a lot of women, they are doing the thing. They're like, "Carrie, I am doing all-" ... "the other foundational lifestyle stuff. I have a great diet. I sleep. I have great community and joy, and I exercise,"

[00:51:24] Dr. Carrie Jones: and it wasn't until I added in the hormones that was really like the cherry on the sundae. And I'm like, "Exactly. But if you had just-" "... done the hormones, if that's all you had done and your life was a train wreck, you might have then called me and said, 'I don't like it. I failed hormones.

[00:51:40] Dr. Carrie Jones: This isn't working.'" Yeah. "I feel worse. I've gained more weight. I'm puffy." It's two sides like I need both sides of the coin together.

[00:51:47] Christa Biegler, RD: Yeah. Yeah. And sometimes, as you mentioned earlier, you might try a hormone dose or a hormone delivery method, and you didn't love it initially. It's... Yeah.

[00:51:55] Christa Biegler, RD: Maybe there may be a different one that you must try as you-

[00:51:58] Dr. Carrie Jones: And it may be great at first-

[00:52:00] Dr. Carrie Jones: And then as you move further into perimenopause or across the threshold of menopause, you may find, "God, I hate this way. I think this way is not working for me anymore," because it's just like anything else in the body.

[00:52:11] Dr. Carrie Jones: Sometimes you have to shift and adapt with how your body's shifting and adapting.

[00:52:15] Christa Biegler, RD: Yeah. Yep, that's a very good point. Carrie, where can people find you online?

[00:52:21] Dr. Carrie Jones: They can find me... Everything is on my website, https://www.drcarriejones.com/, including I have a number of free e-books that talk a lot about perimenopause and estrogen detox and myths and labs and all sorts of things because, of course, I'm sure, there's a lot more questions that will come.

[00:52:37] Dr. Carrie Jones: Yeah. I'm on Instagram at @dr.carriejones. I'm on YouTube at Dr. Carrie Jones, and my podcast, Hello Hormones with Dr. Carrie Jones. Basically if you type in my name you will find me.

[00:52:47] Christa Biegler, RD: Yeah. And maybe a forthcoming book in the early next year, huh? Yeah,

[00:52:50] Dr. Carrie Jones: that's... Let's cross the fingers. The book is written. It's currently in design.

[00:52:53] Dr. Carrie Jones: We have pushed the publication date back once, so hopefully in early 2027 it will be published.

[00:53:01] Christa Biegler, RD: Yeah. Great. It's like a birth of a baby into the world for you- Oh ... with the book, so- No kidding ... congratulations. Yeah.

[00:53:07] Dr. Carrie Jones: Thank you.

[00:53:08] Christa Biegler, RD: So many things. Thanks for coming on today.

[00:53:10] Dr. Carrie Jones: Thank you.