In this episode of Next Level Human Podcast, Dr. Jade welcomes Esther Blum. Esther is a bestselling author, integrative dietitian, and menopause expert. Over the last 27 years, Esther has helped thousands of women master menopause through nutrition and hormonal balance. Esther explains the idea of perimenopause, its causes and symptoms, and how women can start identifying if they are going through this change.
Esther explains some of the signs of someone going through perimenopause such as menstrual irregularity, sleep problems, and mood changes. Most of the symptoms can be avoided or at least diminished with proper nutrition, healthy habits, supplements, and specific hormone replacement therapies. Esther dives deep into the good practices of all of these aspects, including her new book on this matter ‘See ya later, Ovulator!’
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Podcast Intro: [00:14] welcome to the Next Level Human Podcast. As a human, you have a job to do. In fact, you have four jobs; to earn and manage money, to attain and maintain health and fitness, to build and sustain personal relationships, to find meaning and make a difference. None of these jobs are taught in school and that is what this podcast is designed to do. To educate us all on living our most fulfilled lives through the mastery of these four jobs. I'm your host, Dr. Jade Teta and I believe we are here living this life for three reasons and three reasons only; to learn, to teach and to love. In this podcast, I will be learning, teaching, and loving right along with you. I'm grateful to have your company; here is to our next level.
All right, welcome to the show, everybody. This one is an exciting one, because I have one of my oldest friends in the industry here with me and more than a friend. Esther Blum, who has a new book out I will tell you about here in a minute is has been, you know, was my muse and my mentor. And you know, someone who got me into the publishing world was going back to 2009, I guess, you know, when I released my first book, and I'll give you guys a brief story that I'm going to introduce one of my closest friends and dearest friends in this industry for you, then we're going to talk about her new book. But when I was trying to put out my book, I was on a conference call with a company called designs for health. And Esther happened to be on that show as well. And it was one of the first times I spoke to practitioners about some of the work that I was doing. She came on on the q&a session and was just like, Do you have a book and I was like, Well, you know, I'm trying to get a book. But you know, it's tough, because I don't really know how to maneuver in this industry and this and that. And she's basically like, I'm gonna get your number, you're in luck, I'm gonna help you out. Long story short, she hooked me up with my agent, she's responsible for me getting my first book published. And we've been super tight ever since. One of the interesting things about us is she has helped me through some of my difficult times, both in the physical realm and psychological realm. And I've done the same for her. And we've been super close friends. And we've also been practitioners for each other, et cetera. And Esther has written a book that I am incredibly excited about, because you all know that I do female work, which Esther and I laugh about, you all laugh about the fact that I'm the one who's been doing this work. And I've been waiting for her to put this out for a long time. And so she has a new book out called See you later oscillator. And the subtitle is mastering menopause with nutrition hormones and self advocacy. So as to thank you so much for being here. It's super exciting that you and I get to hang out. We were just talking before we popped on, it's like, this is gonna be fun, because we haven't talked in months and months. Congratulations on the new book. Welcome to the show. And I love you.
Thank you, oh, my god, date, I love you. And for those of you who don't know, Jade wrote the foreword for this book, which is really full circle, I was like, there is no one else who can possibly do this forward except for Jade. So the man who laughs at himself or having a woman's name, it's only appropriate that he writes the foreword for this book.
I'll tell you, I'll tell you a funny, I'll tell you a funny story about what happened to me recently, this is gonna get a little bit off topic. But it doesn't want me to share this, because it's really interesting. I just did a psychedelic experience with LSD. You and I haven't talked about this yet. And one of the things that happened to me is, I found myself surrounded by my female ancestors. And I had to it was really, really interesting. I found myself surrounded by my female ancestors, my grandmothers and great grandmothers. And there was this huge amount of sadness, sort of in this state that I was in about. Women feeling sort of suppressed and feeling like they didn't have dreams of their own and feeling. And I had this sense of like, oh my gosh, maybe this is partly why I went into this work and was drawn into this work. And I've always gotten along better with women, despite the fact that I'm a very manly looking man, and I've always been closer with women. But it's really interesting because from my perspective, you and I have talked about this for a while that it's like, this is how bad the industry is. One of the things I said net forward is that unfortunately, there is not much research being done on women still, it's still drastically misunderstood and it's very difficult to find a female expert who not only lives as a female goes through these female issues, but he's also an expert in helping females uncover this stuff. So I'm really excited that you wrote this book. Let's get kind of started into it. I want to I want to kind of just hear from you why this book? Why now? You've done everything in nutrition written tons of books, amazing books, but what made you want to get this book done now and why it was so important, pure and
Can I swear on this podcast?
Absolutely. We love it when you swear
It is so fucking egregious, like how women are so gaslit. During their time through hormonal changes, women are put on the pill, when their periods are irregular when they're adolescents. They are then given an IUD or more pill, more contraceptive birth control after childbirth. And then when they're going through menopause Doctor scare the crap out of them. And either say, Here's more pill an IUD or we can't prescribe you hormones, because that's an off label use. And like you have got to be kidding me. So I said, You know what, this book literally rose from the ashes. I was talking to my publicist, I had done a podcast tour. And I was like, you know, this book would have this tour would have been so much better the book he was like, so write a buck like Da. And so I sat down that night with a legal pad and had the outline in five minutes. I was like, here it is, because I've been treating these women for years. It was all you know, just right there where I had done my due diligence, I had listened to my you know, 100 hours of lectures and read the articles and women are so criminally underserved and not given the tools to get through menopause, even though there's going to be 1.2 billion women in menopause by 2030. And all they're given is either a prescription for the pill, or an IUD or kind of told like good luck with that, that's just menopause, you've got to suck it up. So that to me was unacceptable. So I decided to open the kimono on my practice and say this is exactly what I do in practice. These are the tools that in the tests that you need to have when you're going through perimenopause and menopause. And here are all the research days that you can take to your doctor who gaslights you because I got so many stellar research studies in there on the benefits of hormone, because he has me on hormone replacement therapy.
Yeah, let's talk about that a minute if we can, because this is a controversial area, right, a lot of menopausal women will be, you know, reticent or you know, if not even downright terrified, especially if they have, you know, cancers in their family, breast cancer, uterine cancer, things like that, or they have had that themselves there. You know, hormone replacement therapy for women is very controversial. And a lot of people are afraid of it. So the question is, should they be and what should they they know about this? What can you know, we say about this now, definitively from your perspective, after, you know, just, you know, finishing all the research and putting it down in this book.
Yeah, and by the way, for everyone listening, I'm going through it myself, I'm in the weeds with you. So I'm living proof that you can do it. But yes, a bit of historical perspective. You know, there was a study that came out years ago called the Women's Health Initiative that use the urine of pregnant courses as hormone replacement therapy for women in menopause. And I don't know about you, Jade, but to me, that's not exactly physiological compatible, physiologically compatible with a woman's biochemistry, so. And the data on top of that was flubbed. So the study came out scared the crap out of women and doctors and they said, hormones, cause cancer hormones are going to put you at risk for blood clots and heart disease and all sorts of scary statistics. So doctors, we're not giving women any hormone replacement therapy, even though women have phenomenal changes in their bodies during perimenopause and menopause, which can last up to 10 years. So, you know, women are having vaginal dryness, they're having mental health changes, like severe anxiety and depression. They're gaining weight, they're insulin resistance, they have insomnia, no libido, they just don't recognize their bodies, and they're really irritable. And by the way, I myself have had a lot of these symptoms myself, so I get where you're all at. And so, in 2017, the end again, in 2022, the North American menopause society, said, You know what, this just doesn't really seem right. Somebody went back, God bless him. Somebody went back and looked at that data from the women his health initiative and said, this data is not correct. Not only is it not correct, but actually there are benefits to starting hormone replacement therapy, you can start it in perimenopause, you can continue, after menopause, you can continue for at least 10 years after menopause. And by the way, you can probably continue longer than that as long as your doctor says it's okay. And you're under the care of a physician. So, but the problem is now doctors offices and their medical pamphlets have still not been updated. That being said, I have many women in my practice, who are cancer survivors, and their doctors say to them, you know, you have gone through cancer treatment, but your risk of cancer is actually still very low, and the benefits of hormones are going to outweigh those risks, and still put them on hormone replacement therapy. And there's many different kinds of replacement that you can do that are beneficial. So my goal is not, I'm not here to say you must absolutely take hormones, I'm here to give you the options to make the most empowered choice that you can for your body and what's right for you.
Yeah, and what I know about you is that you're, you're just like me, you're someone who's going to do all the lifestyle stuff first. And you know, really lead with that. But you know, in this case, hormones become a big part of the puzzle. And I think that a lot of women don't understand how powerful they can be one, one thing I want to just kind of go back to briefly because I think it'd be useful for the listener to understand. So when you said the data was flubbed, what exactly does that mean, in terms of because, you know, some people might say, Oh, this is conspiracy theory, they, you know, they, you know, they purposely flood the data, was it, you know, it could be that the data was misinterpreted, it could be that the media, you know, got the data wrong, you know, so what's the story there, just so people can understand a little bit about, because, you know, if I'm a woman, and I'm listening to this, I'm like, This is so confusing. It's so frustrating. How, you know why they were really scared of this for so long. What actually happened? Was it you know, the pharmaceutical companies, because obviously, they wouldn't want the data to be bad because they're trying to sell hormone replacement therapy. So what actually happened there? I'm just curious for myself.
Yeah, so in grad school and an undergrad, my both my degrees were in clinical nutrition. And we spent a lot of time analyzing data from clinical research studies, and a lot has to go right to make studies valid and to make data statistically significant. So in these studies, the data was not interpreted correctly by I don't know if it was the statistician. I don't know if it was the clinician, I don't know if they ran different models. But somebody went and re looked at the data and the results and course corrected for those results. So I, I wish I could tell you I was earning money from these hormone companies, I'm certainly not and there's not a lot of money to be made in bio identical hormone replenishment. There is money to be made in traditional, you know, drug company, standard hormone replacement therapy. I mean, I think venture capitalists have estimated the menopause market to be worth something like $60 billion right now, as we record this in 2022. So it's it is an untapped market of women and companies would be very smart to start speaking to that, to start treating women with dignity and respect. Every woman deserves exquisite menopause care, and to start giving women the tools they need, because by the way, and what's interesting too, is Jade. The more podcasts I do, the more letters and emails I get an Instagram messages from men who are like, Thank you, you have described my wife now we can get her help. You know, it's like men are trying to help their partners and spouses to get through this because it's rough. And I joke like, whoever designed women to go through menopause while they have teenagers in the house and aging parents has like when sick fucked up. Yeah, no, it is hard. It is like, Oh my God, thank God for progesterone. That is what enables my 15 year old to still reside in my home.
Let's go through that really quickly. So let's, you know, we kind of talked a little bit about hormones. We'll come back to that a little bit. But why don't we talk a little bit about if a woman is listening to this and you know, she's in her let's say late 30s up to late 40s and is starting to have some symptoms or feeling a little different. Let's walk through a little bit about what she may be experiencing and how she might want to track this down to see if she is in perimenopause or approaching menopause. What are the signs What are the symptoms? One of the things that she's going to be going through and feeling in our body.
Yeah, a really simple way to kind of start. You know, getting hip to being in perimenopause is paying attention to what your cycles are like. You know, cycles are the fifth vital sign your menstrual cycle, and that the irregularity is a really big sign, if you start if you notice that they're shortening, if you notice that they're lengthening, if you notice that every other month is walking, maybe one of them is doing a different thing than the other one, but the shorter one month is longer. If you're bleeding gets a lot heavier. If you are, you know, using a tampon every 45 minutes plus a pad, you're searching, you're passing very heavy cloth heavy bleeding. Or if you're kind of like gently fading away into the good night, you know, just anything that is not consistent for you is a big sign. Also, if you notice, like your PMS used to be, you know, five days before your cycle or three days. And now all of a sudden, it's like going to like 10 days. And then two weeks, you know, if you notice it's really spreading out. If you notice that you're experiencing more rage as your estrogen like surges, and your estrogen can search up to 30%. On any given day, it can vary. So there's a lot of roller coaster action going on. If the sleep quality changes, you notice you know your sleep is far less restful, you're waking up throughout the night. All of those are really good indicators that you are in perimenopause. But they also things like joint aches and pains, which come with a drop in progesterone, thyroid changes are another great indicator that something's cooking. So you definitely want to start testing during that time. And this is where women are always turned away by their doctors, the doctors say I'm not gonna bother testing you, you're in perimenopause, your estrogen is be all over the place. There's no point, that's actually not true, it's actually a great time to establish your baseline and start to potentially bring in some hormones at that time to kind of smooth out the bumps. So this is the time where a lot of times the doctor will say take the pill, let's just throw an IUD in there because it will to a point kind of tamp down your estrogen. And it's it's going to also suppress ovulation, which you don't really need to ovulate at this point anyway. But the problem is that your progesterone is already declining during this time. And progesterone is kind of that real chill out hormone takes the edge off, and it also opposes estrogen. So in its absence, if you're in a place where it's already lowering, and then you take the pill, it's going to further drive it down, worsen mental health changes contribute to anxiety and depression potentially and won't get to the root of the problem, which is really a progesterone deficiency. And bio identical hormone hits those GABA receptors in the brain, whereas synthetic progesterone or progestin will not. So if you really want to offset the anxiety and depression and you want to offset the anxiety and the mood swings and those heavy, heavy periods, it's a great time to bring in some bioidentical progesterone at that time.
Okay, so let me just repeat what I heard and tell me if I got this right for everyone. And I just like to repeat so people can be can kind of get it. So all right, so you're beginning to have symptoms, you're relatively consistent in menses, and all of a sudden, something changes, it can become shorter menstrual cycles, or longer menstrual cycles or difference in bleeding, either lighter bleeds or heavier bleeds, but something is changing there. And you're also beginning to see changes in mood, perhaps, that where it was like one week before the menstrual cycle where you're getting some mood changes. Now you're getting it for two weeks now. So it's like double where you're not feeling good. And one of the mechanisms here it sounds like you're describing is this fall in progesterone. So this discrepancy between estrogen and progesterone is getting wider. And it sounds like estrogen is being pretty volatile at the same time, too. So sometimes it's high, sometimes it's low. And you can kind of feel a little bit crazy with that where at times you might feel normal. Other times you might feel crazy. Sometimes you might feel anxiety, sometimes you might feel depression. And this idea of the falling progesterone seems like what you're pointing towards women to sort of look at and that if you go on just your typical birth control or something like that, it's not necessarily going to solve this particular problem. So what are the solutions? I think a lot of people will be like, Well, do you even need hormones at all? So if you've seen people who just through changes of diet and supplements can get away with that for time and then go into the hormones? So let's walk through and say what would you say are the first changes that a woman might want to make when they're starting to experience this. And then when would they want to be thinking about hormones and which one and it sounds like as a hint and you know that you're pointing to essentially, progesterone alone might be the best thing to do in perimenopause. But I'm curious where you start?
Yes, absolutely. And you can't out hormone your lifestyle choices. If you're still drinking a lot and staying up really late and not taking great care of your body, then no amount of hormones or supplements will save you you've got to really have a nice solid foundation to work in conjunction with hormone replenishment and hormones are a piece of the pie. They're not the whole pie. So you want to start with really great self care because nothing bottoms out your progesterone, like a tremendous amount of stress. So I always say make it to don't list right, stop taking on so many things. The word no is really a complete sentence in and of itself. So if you're serving on a million and I see this in my clients, right, there's always serving on school boards. They're volunteering for committees at work, stop, quit the committee's get extricate yourself from commitments that are really going to take free downtime away from yourself. Make sure that you're getting outside in the morning, you know, nothing de stresses you like a good walk outside, take the dog out, go sit outside, you know, with hot beverage in the morning, just get that light in your brain to start regulating your circadian rhythm and lower your cortisol. I mean, Jade, you taught me how important walking was. I'm a recovering marathoner, right so and like to go to walking and have that be my happy place. I'm like, wow, this is kind of wild. But it really makes a huge difference if you're if you're super depleted, or if you're just overly stressed and burning the candle at both ends, walking is key. Next, you want make sure that you really optimize your protein intake. Because this is a time where you really lose muscle mass while your hormones are in decline, your progesterone, estrogen and testosterone can all decline. So getting optimal protein, this works out to be on average four to six ounces at a meal, three meals a day, or if you're intermittent fasting, you're doing two meals a day, you want to get you know six to eight ounces of protein at those two meals. getting good sleep, you know, putting your phone on Do Not Disturb not not really going on your phone at night, just reading a book meditating, you know, simple strategies to just have quiet time is key. Alcohol also and caffeine can be this is a time when you're going to tolerate them less. So you want to revisit those habits. And then yes, there are wonderful herbs that you can try to really support your adrenals because during perimenopause, and especially in menopause, your ovaries are winding down, their production of hormones and your adrenals are going to pick up the slack. So you want to give your adrenals some nice support and kind of give your ovaries that little robust final push. So Chase to your vytex is a wonderful herb to help Bob progesterone. I also love maca, it's ma si a that also is great. If you're starting to hot flash, there's a lot of clinical research, I believe it's 83% effective rate, effective efficacy with using market and decreasing hot flashes. So those are great lifestyle choices. And honestly giving up caffeine and alcohol like really helped with sleep and hot flashes in a huge way. So those are starting points. That's what I do and testing and not guessing. That's the other thing too. As I like to test I run the Dutch and the GI MAP test because that is going to tell me how hormones are moving through you know if if we need to support your liver or your gut in eliminating the excess estrogen that may be hanging around and not moving through you. So I like to test and don't gas and I like to use additional supplements if need be A B complex is really good at methylating and detoxing your hormones. broccoli sprout concentrates also are really good for getting your liver to kind of clean up the extra estrogen. And last but not least, is fiber like chia and flax seeds. You know putting those on your yogurt or in a smoothie, or mixed with some applesauce. Those can help bind extra estrogens and pull them out. And you may think, Well why are you telling me to get rid of estrogen if I'm going to end up replacing it but the key is to balance if your estrogen dominant and your progesterone is low. Then the key is to kind of get your progesterone to come up and just clean up the excess estrogens floating around so you can get into had her doubts throughout the process.
Yeah, and it's really interesting because this, this idea of estrogen dominance is a tricky one. In the medical world, a lot of conventional doctors are not aware of it or poopoo it or downright deny it, those of us in the functional medicine field have been very much up on estrogen dominance and what it entails. And I'm just going to go through this really quickly and tell me if I get any of it wrong just for the listener. But in when we talk about estrogen dominance, there's several different ways to do this. And when you come into perimenopause, you're essentially not ovulating at times. And so if you listen to what Esther was saying, if you're not ovulating, you're not producing progesterone that creates estrogen without progesterone. So that's a form of estrogen dominance, if you're also listening to what Esther is saying, and correct me if I'm wrong here as to but when you when you're stressed, stress seems to have an impact first on progesterone and then later estrogen if you really get stressed, but stress can seem to put you in this estrogen dominance state as well add on to that the fact that we have lots of exogenous estrogens in the environment, phthalates, you know, bisphenols, all of these kinds of things, chemicals of industry, these things can become, you know, make a woman perhaps more estrogen dominant. Then there's, you know, another piece here where Esther was essentially educating us on detoxification of estrogens and how you go through phase one and phase two in the liver. And then phase three, which is essentially the digestive tract. So you put these things out, they can also get research circulated into the system reabsorbed. That's a form of estrogen dominance. And there's actually one more form where it's, if as testosterone can then be aromatize, this, this happens in some women not all into estrogen as well. And this is another potential source of estrogen dominance. So this this idea of this discrepancy, and I love the way you described it, Esther, between estrogen and progesterone getting into this Goldilocks zone, progesterone, typically, there's lots of things that can reduce progesterone, not a whole lot of things that can raise it. And there's lots of things that can raise estrogen, not a whole lot of things that can lower it. And so it's very easy to move into this estrogen dominance state. And we shouldn't get too caught up on the terminology, just understand there's a discrepancy between estrogen and progesterone. And that needs to be fixed, which I guess brings me to my next question, because obviously women are going to be listening to you and essentially saying, okay, great, reduce stress, make sure I increase my protein, as as progesterone and estrogen change, it will change things in the brain, but they have to do with hunger and cravings. So holding on the muscle mass, yes. And also controlling hunger and cravings with protein, but then the sleep thing and all of that, you know, a lot of women are just like, I can't like, no matter what I do, I'm not going to be able to sleep I wake up now, you know, hot night, my mind is running crazy. And I guess this is where you would say what because I know you have an approach where in perimenopause, there's, if we move into hormones, there's something that you're going to do probably in perimenopause, and then something you're going to do once you hit menopause are going to post menopause. So what would then be your approach hormone wise? And let's just remember what Esther shared with all of us. You can't what how'd you put it, I love the way he put he can't out hormone, a bad lifestyle. So if you don't have this lifestyle stuff in control, the hormones may not have as much of an impact. And so now that we've kind of covered the base sort of lifestyle stuff, and now we're into the hormone realm, what comes first walk us through a little bit, and I guess, you know, maybe we could start a testing if you want and how to unravel that. Or maybe we just go in and say, Okay, here's where to start with hormones.
Yeah, well, yeah, the testing, I always like to test and don't guess don't just go to your doctor and take me hormones now without even looking to see whether you're a candidate. But caffeine and alcohol this is where I will say you're gonna see a huge improvement in your sleep when you cut those two out. And most people are horrified and throw shade at me for that, but I'm telling you, it's it's rough in the beginning. But when you cut them out, your energy's actually so much better because you're going to be sleeping better. That being said, if you're already doing those things like me, I'm not big on booze and I do not touch caffeine. My son saw me he's like, if I take a sip of anything caffeinated, he's like Mom, you're gonna be up for like the next three days straight. So definitely avoid those things if you want to improve your sleep. But after that, yes. If you are willing to do some testing, you're probably gonna see you're a candidate for some bioidentical progesterone and progesterone really hits up those calming neurotransmitters in the brain quiets the brain. So after you do your nightly meditation, which is also important for lowering overnight cortisol. You can bring in either a trophy which is a dissolvable tablet under the tongue. Or you could take a bio identical progesterone called parametrium. Now the difference between the two is that parametrium, because you're taking it orally it has to go, it has to go through the digestive tract and the liver in order to be processed through your body, whereas a trophy goes right into the bloodstream for absorption, so it's a quicker delivery system. But I like it too, because you can really customize and titrate the dose up beautifully. So with those things, that's usually a great starting point. But then you also want to look at maybe taking some calming nutrients that are going to quiet the nervous system. You know, magnesium glycinate, is a type of magnesium that is specific to targeting anxiety. So I'd love to have people take magnesium, and I certainly love adaptogenic herbs, things like ashwagandha, Saundra rhodiola, holy basil, that's kind of a really nice combination to support your adrenals support your blood sugar, and getting in that protein throughout the day will also stabilize your blood sugar, a lot of us are waking up because we become more insulin resistant through perimenopause through the decline in estrogen and progesterone. So by just popping, you know, a lot of protein throughout the day, you're going to course correct that beautifully. That's why the lifestyle piece is so key.
Yeah, yeah. So let's just to because a lot of people who are a little bit older in the hormone piece would be thinking about Oh, I thought you do like a progesterone cream or sort of a patch. And so we don't typically do that anymore. I don't know if you want to mention that. It's uh, but that's, that's one thing. So we are doing oral progesterone is and primarily under the tongue to get into the bloodstream faster is what you recommend. And this tell us what, what will people notice, you know, sort of right away with this? Is it an immediate kind of thing that you start to see? Does it take some time? Curious the effects that it has?
It's pretty quick. I mean, it takes about three months for your tissues to fully saturate with the targeted to their targeted receptor sites and really get absorbed and into your body. But people can notice, you know, within days to a couple of weeks, you know, some people's complain and say, Wow, I'm actually too groggy and we have to cut back the dose, but most people notice immediately an improvement in sleep. And to your point, though, Jade, you know, for, you know, before I was really working primarily with menopausal women, I worked with left menstruating women who are earlier and they're just having more regularity in their cycles. And those women actually, we did do topical progesterone, I'll use some drops, I'll use liquid drops or and it's just a very low dose, it's like 30 to 40 milligrams, whereas for Peri and postmenopausal one to 200 milligrams is great. Now what happens if you're listening to this and you say, but I've had a hysterectomy or a partial hysterectomy, very few doctors at that point are going to prescribe progesterone however, you can actually use it vaginally. At that point, it is indicated and you know that the vaginal walls are so highly receptive to progesterone and to estrogen and testosterone, like it's a great way to replenish hormones. So I tell my ladies like I'm pretty much going to shove it in every possible orifice that I can in your body to get absorption. But you know, there's also a double benefit of using vaginal hormones and that is to prevent and especially estrogen that is to prevent atrophy, bladder dysfunction, urgency, incontinence, dryness, you know, vaginal estrogen really course corrects there, even if you've had a history of cancer. It stays very localized the blood has been tears clinical research or studies in my books to show that vaginal hormones stay localized, they don't raise the circulating levels in the bloodstream. So it's another great delivery system for women.
And let's get back to the show. Yeah, and you know, so let's go into this then when to start adding, you know, estrogen, perhaps systemically and or perhaps just vaginally So when would a person begin to say okay, I've been taking progesterone and it sounds like what you're educating us on is progesterone is highly indicated highly effective in perimenopause. Right, and then menopause comes and by the way, for the listener, menopause is a tricky sort of thing in medicine, because when we talk about it really two ways in functional medicine, it really is just a point in time from a medicine standpoint, right? It's like it's that point in time where FSH has a particular number and or you haven't had menses for, you know, a year. And so it's really defined as like a moment in time, however, in functional medicine will oftentimes look and be like, well, it's also somewhat of a different hormonal state. Because as you listen to Esther, she's talking about, you know, progesterone is low. Estrogen is sort of volatile and perimenopause, but then it gets to a point where they both fall. And so typically, we might think about at least I do, and I want to see if you do to Esther, in terms of when I think of menopause. Yes, it's just a clinical diagnosis a moment in time, but I also tend to think, Okay, at this point, and this is probably why the test don't guess thing is so important because you don't necessarily know where a woman would be with their estrogen and progesterone. But typically when I think of the distinction between perimenopause and menopause, I'm thinking okay, perimenopause, progesterone, low estrogen volatile, sometimes high, sometimes low menopause, estrogen low and progesterone low. So I would imagine, then there's a new sort of perhaps formula for hormones as you move into that estrogen low and progesterone low. And I'm wondering how you handle that.
Yes. So estrogen, you know, once it's indicated, and by the way, that's another great aid for sleep is progesterone is going to help you fall asleep. And estrogen often helps you stay asleep. So some doctors I've seen some doctors just do a little biassed cream, which is 50%, estriol, 50%, extra dial. But a lot of doctors will use a straight up patch that you can wear, you wear three days straight, it's tiny, it's like an inch in diameter, and you change it every three days, you can wear it in the shower, you can wear it swimming. So that's just a nice consistent delivery system. There are some doctors that will give pellets and I do not recommend pellets. And here is why because a it's a surgical procedure, you actually have to have an incision done. There's a tiny tunnel dug into your tush, and the pellets are inserted, and then you're closed up. So what happens is you can't really regulate the release and the delivery system in the pellets. And there is no clinical research done on pellets. And I look at the lab tests of women who have pellets and their levels are sky high, like out of range every time. And what happens is the levels are jacked up so high that when they start to decline, even though they're still way higher than the baseline, you can feel withdrawal, you can start to feel as crummy as you felt before you went on them. So women feel great initially, or I've had loved women say I feel horrible, like I've gained 10 pounds, I'm so irritable. And now I just have to sit and wait for these to flush out. So I prefer a gentler low dose, the dose in bio identical hormone replenishment is a fifth of the dose of a contraceptive birth control pill. These are low doses, we're not trying to get you to ovulate. We're not bringing your period back holla freakin lujah for that, and we're just getting you to the level you need to prevent osteoporosis. Because bone loss is highly associated with estrogen loss. We're preventing heart disease, and we're preventing cognitive decline and Jade when I did the research for this, I was so angry at like looking at all the Alzheimer's prevention research and all the cognitive benefits that hormones offer testosterone, progesterone and estrogen and I thought this is criminal women are criminally underserved. They deserve this knowledge. You know, we have the opportunity to not lose our minds in menopause to be great contributor to contributing members of society until you know, we no longer are on this heavenly Earth. So there is no reason why women cannot benefit and testosterone you will see like if you looked up in the prescription manuals, I don't know if this is the pharmacist writing this, you know, there's still all sorts of warning labels on hormones if they're going to cause blood clots and heart disease, which is not true. But also for testosterone. It's an off label use if it's written for women and less the doctor sees the benefit, which is just ridiculous to me. Because testosterone helps bring back a woman's libido it helps prevent losing muscle. I mean, it's so critical and important and 10 different women have said in the last week alone, her to get it grow facial hair on testosterone, I'm like, Dude, you would have to be taking so much testosterone, like you're not Arnold Schwarzenegger, you're not Michael Phelps or not, not that Michael Phelps took testosterone, but you know, you you have to take so much. I'm like, It's laughable, you're on a micro dose practically. So you're not none of that's going to happen for you.
Yeah, and you know, it's interesting a couple things that I'll just add to this discussion and tell me if you if you've got this if I'm getting any of this wrong as to but one of the things you may have noticed is so moving into menopause esters now talking about Okay, now we're talking estrogen, more about estrogen therapies and maybe estrogen plus progesterone. So I want to know, when you do both, and when perhaps not, but we might have noticed that things have come a long way and understanding how to deliver these hormones. And so one of the things that maybe you didn't catch, but you want to be aware of when talking to your physician is typically we do progesterone orally, right? We used to do progesterone creams now we typically do it orally, but we typically do estrogen through patches and creams and that's partly because of what happens when you take estrogen orally and some of the factors that are created In the liver, it's a small risk, but there is more of a clotting risk of estrogen is taken orally. That's why we do it the way that we do. And what's cool about that is that the, you know, esters pointing out to us that that research on this has come a long way. It's not like we're not an 80s anymore, right? We're not in the 90s. Like a lot of people are still talking about hormones in the way that they were talking about them, you know. And so I love the way you're educating on sort of the bioidenticals, the different delivery systems, when to use them how to test and how impactful they could be. And one of the things that I want to ask you about testosterone. Oftentimes, when I think about testosterone, in women, you're kind of getting a two for one there, right, because aromatase and testosterone going aromatizing into estrogen, it was something that I wasn't that high on for a long time. For women being a man, not this is the downside of being a man doing female work, because I don't, you don't get to feel these things, right. So I get to I have to be educated by people like Esther to be like, here's what it's like, here's the kind of thing you want to be thinking about. But then once you start using testosterone, in women, it can be pretty powerful when it's indicated. And you're kind of getting sort of a two for one there. One of the things I've seen, at least in testing is that not only does testosterone sort of come up, again, not to the levels that you would be concerned about, but you also see estrogen get a bump as well, you're kind of getting a two for one there. And I think that's part of the reason why it can be a pretty powerful thing. But I'm curious how you see that as well. And if you've seen sort of estrogen oftentimes come up a little bit as well. If you're giving testosterone and maybe even educate us on when would testosterone be the you know, indicator? Because I think a lot of women would be like, Okay, so when would I even want to take that, you know, I mean? So I'm just curious about that piece.
Yeah, well, you take it, you certainly want to take it when your levels drops. Not everyone needs it, when they first see me because they're in perimenopause, they're not fully menopausal initially. So we keep monitoring it, we keep retesting, and we bring it in when we need to in the form of a transdermal cream, just a topical cream, you know, inside your thighs and your lower abdomen. So could I say, in some people who are estrogen dominant, it's already aromatizing to testosterone, which may be why they don't need it initially. Now that I'm thinking about, I'm like, Well, that makes sense. Because I always wonder why don't women have lower testosterone? Initially, it's probably aromatizing from estrogen. So later on down the line, though, yes, as estrogen continues to decline, then you do bring it in. And it's super, super helpful. And you can give it vaginally, you can also give it topically, so the delivery systems are awesome. And again, like when you're putting a cream on, right, it's you can regulate the dose, you can really work with your compounding pharmacist and your doctor and say, you know, I'm not feeling great on this, or I am feeling great on this because some of this too, as much as I'm an advocate for labs, we also want to see what your symptoms are like, right? Because we're humans, we're not robots, it's not just everyone fits into their tiny boxes. Everyone's unique biochemically. So most women feel good on the protocols I recommend, but some don't. And we have to go back and tweak. So I like to say you know, give yourself some margin of error. Don't always expect to hit it out of the gate. Especially if you start during perimenopause, this is all going to be a moving target. Because you're and this is like me, that's where I am personally at where the dosage I've started out as lower. Now I'm starting to slowly titrate up because I just feel you know, ladies, you know, when the wind blows differently, we know our bodies, and you're like shit, I don't feel so good. My energy is taking my workouts are suffering. So I had a consultation with my doctor and he was like time to titrate up but gently and slowly, right you know, just double your dose and go rogue and do this on your own. You work with your practitioner, you talk about your symptoms, then you keep retesting your levels. The other reason why you want to retest your levels is because your levels need to be at a certain amount to maintain that bone density to offset, you know, risk for chronic disease. So you really want to make sure your tissues are saturated, and that you're getting monitored three, four times a week that you're getting your mammograms that you get ultrasounds if you've had a history of fibroids or you know, you want to make sure that the uterine walls are not thickening on hormones, you know, there's, you want to make sure that you're truly going through every check every checkpoint throughout the process.
And let's talk a little bit about because I think we'd be remiss on this podcast. And we talk a lot a lot about weight loss and things like that. What do these things do in that realm? Because it's kind of controversial right back, you know, I don't know, five or so years ago, I did a deep dive into the research on this. And I'll tell you what I found, because I'm curious if you found something different. One of the things that I found is that with weight loss, in particular, these hormones don't necessarily seem to play a role in weight loss in the way that we thought, but they do seem to reduce middle body fat, you know, they do seem to return the hourglass to women. So that was oftentimes confusing to women, because they're like, Well, wait a second, how am I losing belly fat, if I'm not necessarily sort of losing weight, and I think it goes back to estrogen does have some muscle building potential as well. It is insulin sensitizing. It has many different effects there that would be able to at least change the body shape. So we don't necessarily see in the research a clear cut answer in terms of it driving down weight loss, because that's so tied to lifestyle, but it does seem to change the shape of women to give them back a little bit of their hourglass shape. And I'm wondering if that's what you've seen in the research as well. And you've seen in with the women that you're dealing with, because I think a lot of times people might be like, Oh, it's similar to thyroid hormone, right? It's like, oh, I'm going on thyroid hormone, I'm automatically going to lose weight. But that doesn't always that's not always the case. But it does seem to be with hormones, that they may not necessarily cause you to lose weight, because that's going to be more about the lifestyle stuff as they're educated us on. But they do seem to when you start to take them, regardless of any changes in lifestyle, they do seem to make a difference in belly fat. And I'm wondering if that's what you've seen as well. And anything you have to say there.
Yeah, I feel like the sooner you can introduce hormones, the better your chance at offsetting weight gain to begin with, when it comes to, you know, restoring the hourglass shape that is a partnership with hormones, strength training, which drives insulin right into cells. I mean, hello, Jade, you're the king of strength training and the metabolic effects of lifting weights, walking, fixing your sleep, right? I always think of what you taught me when you're like, how many calories does stress have? How many calories does insomnia have right? And really regulating your diet, you know, protein by day, I always have recommend carbs at night, you're going to be more insulin sensitive at that time, but it's also going to bump up your insulin. So you tamped down cortisol and actually sleep. So all having all of those pieces in place is really key. It's not, it's not the one is that the white knight on the shining horse that are shining? Anyway, the great white, the white horse on the white knight? What's the expression?
I don't know, I've never heard that expression.
Ladies, there's no horse and there's no knight, okay? It's a it's a partnership with all of this. It's always a partnership. So and you know, when you're menopausal, too, it's a great time to really introduce intermittent fasting because a lot of women struggle to do intermittent fasting with a monthly cycle. You know, because the first half of your cycle, you're so much more insulin sensitive, and you're like I could do this I can fast and shorten my eating window and the second half of the cycle. You know, insulin is a roller coaster ride along with your estrogen and progesterone is bottoming out. It's much harder to do fasting then. So but with menopause brings a consistency of or a lack of, you know, the roller coaster ride. That's a great time to do intermittent fasting. And I see tremendous success in my menopausal women in that. But it's another area that's so poorly studied. I mean, Cynthia Thurlow is really the go to for this. But when I wrote cave, women don't get fat. I mean, I looked at 73 studies on intermittent fasting and only 13 Were done are women. They're just the science is not out there because we are a much larger control panel with so many more variables like I like in men's bodies to a light switch. Right. And women it's like the control panel of the cockpit of the airplane. There's many Not to disparage men in any way, but it's just it's a bit simpler. Yeah. In terms of cars versus menopause.
I interviewed Dr., who's a PhD in, you know, metabolism. He specializes in metabolism, but we were talking about, I asked him I said so why do you think that women are underrepresented in the research and He said the same thing he was just basically look, if you look at the studies, there's a lot more variables to control, we, you know, if we're really going to do a good job with it, you know, obviously estrogen and progesterone are impacting things we need to know. Like, ideally, we would want to know what you know, phase of the cycle they're in. And then, you know, each woman is like a fingerprint. So we don't, you know, like one woman might be in the luteal phase and have higher estrogen than, you know, someone else or estrogen is dominating progesterone, and some women may, progesterone might be dominating estrogen. So we each, each woman has this sort of fingerprint, that will impact and research the tool for averages. And so that that just complicates things. And I think women should be aware of that. But as we wind down the time here, I want to talk about something that I think is, you know, to be honest with you just something not a lot of people talk about and it's it's sort of like this, and I'll tell you, this comes from conversation with my mother. This is years back now, when she was going through perimenopause, and I'm, my mom is my best friend, she's my hero, we were very close. And I remember her telling me something along the lines of this, and she was essentially, you know, it's tough because, you know, men as they age, you know, oftentimes become distinguished and, you know, are oftentimes even seen by society as being, you know, better looking or, you know, oh, he's more distinguished, he's more powerful. He's like, you know, the George Clooney effect, let's call it right. And so men don't, aren't necessarily aware of what goes on for women, women in what my mom was explaining to you like my whole life, whether I want it to or not, I've been somewhat evaluated on my personal appearance. And so as I go through perimenopause, and menopause, and my appearance changes, it's almost as if I'm under, you know, undervalued by society. And I think this is something that is really, really difficult. For women, I've seen it not just with my mom, but I've worked with mostly women in my clinical practice. And this is something that underlies a lot of this change. And I think we'd be remiss if we don't talk about this, this difficult psychological state of where essentially these changes, and the way our culture treats women, when they're young versus when they're more mature, is incredibly difficult. And I can't imagine what some women must go through in this change. And I'm wondering how you deal with this, or if you have anything to say about this, because this is something that I think, you know, I just think about it for myself, it will be incredibly, I don't know, disorienting, and or disappointing or depressing in a sense to, you know, sort of, you know, be in this culture that evaluates women on their personal appearance in a very different way than they evaluate men. And then that personal appearance is we all are essentially getting older, and you know, not looking like, you know, hot 20 year old anymore. And I'm wondering how this is impacting, and I'm really wondering if hormones seem to take away some of this, you know, cognitive issue or depression around this change that women often deal with? I'm just wondering, because yeah, it's something that as a man, I think it's been the opposite for me as I've been in my 40s I feel like I'm the ugliest I've ever been in my life. But I get more compliments about like, you know, my physical appearance, which is odd to me. And then I think the women who aren't close to you in my life, are reporting the opposite. And I just wonder what is that about? And it's something that I think we don't talk about, and you have all people I imagine have something to say on this.
First of all, this is why I love you for even being, you know, so insightful around this and bringing it up. There's really two schools of thought. I mean, yes, there is the thought that, you know, a lot of women feel like they lose their value in contributing to society. If they're no longer fertile. They don't feel as sexy about themselves, their bodies are definitely changing. I mean, my mom jokes that the best birth control is gravity. You know, there is all of that but joking aside, you know, I also see and I want to inspire women to say, just wait ladies because we are on the cusp. This is the tipping point mark my words in the next five to 10 years. We are going to change the landscape of menopause not only for ourselves, but for younger generations. There are so many celebrities now that are going through this exact phenomenon that are speaking out that are getting louder that are using their platform to discuss their experiences and they to from the ones I have spoken to and the podcasts I have been on the to have been gaslit not giving great options. I believe that the power lies within each and every one of us. The more we demand better care, the better it will get if every woman walks into her doctor's office, be it with my book or someone else's, with the clinical research studies listed and says, I demand better menopause care, you're not giving me good options. I'm not taking birth control to suppress my hormones, what else do you have, that's going to force doctors to actually do research and change their treatments. Because if you don't, if you're thinking, I'm never going to change the system, we may not change what's taught in medical school, but doctors have every option to go and seek the research and look at it themselves. And they have a duty to you as the patient as the consumer, because medicines a business like any other, they have a duty and a responsibility otherwise, that is lazy medicine and medical negligence. And if you think about that, look at Walmart, Walmart's a great example, they did not have organic foods 10 years ago, most menus now have gluten free options on them, which didn't happen 10 years ago, that was all due to consumer demand. So when we speak up, and if you're uncomfortable speaking up to your doctor, it doesn't feel comfortable. You can say listen, I have these research studies I want to give to you please look them over. Or you can find a new doctor, or bring an advocate with you who's like not afraid to, you know, stand up to someone in a white coat. And you can do it very respectfully. I mean, I have many conversations with colleagues who don't believe in the work I do at all. And we have very civil debates on it. But it's the more you call it into question and use your voice. Use it because I don't know about you all but I am definitely losing my filter with every successive decade. And I plan on using that to fight like hell for every woman out there and to call out just the egregious situation of menopause care now. And you know, if you want to let your hair go silver, if you want to show your wrinkles and lines, do it. I mean, my husband and I were having a great a great date. And we saw like we were looking at around the restaurant and I'm not judging this at all. I was actually in defense of it. But he was like, why are so many people around here seem to have had work done on their face. Right? Like what is up with that? He's like, you don't have wrinkles, and I have a shit ton of wrinkles. Right? I just use good filters when I take photos. But he's like, you don't have wrinkles. i Why would you do that I never, I don't want you to not have wrinkles. Like, that's who you are. That's your face. And it's beautiful, right? And I was like, well, a lot of women feel like that is their empowering choice. They may not want wrinkles, and they may feel better about themselves. Having work done more power to you like however you want to address your menopause, you want to invest in a strength coach, you want to use hormones, you want to use nutrients, you want to get some work done, like do it reclaim your power during this time, because there is no better time than to absolutely be like hello world. I'm here. And this is me and this is what you get. And I think if every woman did that, you we'd be such great leaders for our daughters for future generations, but also just be feel much better about ourselves more confident in our own skin, confident in the bedroom confident at work, you know, and just day to day in our own lives. I think that's really the key is that no one's gonna sit and hand you the confidence. It's really what I've learned the most about writing this book, Jane is that confidence is really an inside job. And no one is going to say, you know, here you go here, there was all this money to take care of yourself. But you know, ask your spouse for partnership, get the care you need be like, Listen, I'm going to need to invest some resources getting better, and it's going to help our marriage, it's going to help. You know, we be happier as a human and be a better mom and wife and all the good things.
Um, so glad to hear you put it that way. Because I've heard this from, you know, again, my mother and other women who are close to me that, you know, have taught me and what I have always come to is like to me, and this, I think is just across the board authenticity, and showing up as we are in whatever way that we choose, right like in whatever work we have done or whatever the things that we do. It's the authenticity that I think is beautiful and sexy for each individual male or female. And I think that our culture, you know, has missed that in a sense. We celebrate individualism in some ways, and then we don't do it in other ways. But to me, it's really the charisma that we show up and the beauty that we have in our hearts in the way that we own ourselves. And I love the way you put that because to me, I would agree, it's like, to me, whether you choose to have work or whether you don't however you choose to show up, I just think that we should be celebrating our uniqueness. And part of you know, this book, and this work is really about helping people be their best in whatever way they, they essentially choose. And, you know, part of me just because as aging is one of these things that I have, you know, switched not I love my 40s Now I'm loving my 50s, right, I'm gonna be like, you know, and I think that if we all just, you know, of course, I'm a man is different things, but we're all aging, we're all getting to this place. And authenticity, to me is the solution to owning and falling in love with ourselves in this way. And so, from my perspective, it's a really cool sort of thing. That's a whole different conversation that I think goes along with this. And I do think though, you know, both hormones are really interesting in this because they do wire brain chemistry a little bit differently, to help with, you know, self esteem, raising serotonin, and, you know, all of these kinds of things. So, I don't know, it's just something that I thought was interesting to cover, because I know it's something on a lot of people's mind, we're kind of talking about a condition of aging that has unfortunately been made out to be a disease, when it's really just a transition, that can be an unbelievably beautiful transition. However, with these hormonal changes, there are some things that Esther is educating us on that can make this transition much better. So you don't have to suffer into what should be a beautiful, you know, time of life. So what are the things would you say as to that you want to make sure that you cover before we end things today that you know, maybe we didn't cover? Or you want the listener to know and then, of course, they're gonna want to know where to get in touch with you, and you know how to follow you.
Yeah. So um, absolutely, you know, know that this is what you're going through is indeed a transition. It is not forever, you are absolutely capable of feeling incredible, being physically strong, emotionally strong, resilient, sleeping through the night, having a good libido, not having incontinence issues, you know, not having hot flashes, feeling really happy and at peace. So all of this is capable. So make sure that you work with a good practitioner, if your practitioner doesn't offer you a lot of solutions, find a new one. Definitely get my book, see you later. You can actually if you and I have a gift for your listeners, if you go to Esther blum.com, forward slash cocktail, you can get my happy hormone cocktail Guide, which will get you started today and get on the priority notification list for my book. But help is out there. And you're not alone. I promise you, none of you are alone. And we're all going through this together. And the more that we normalize menopause, the better it's going to be for everyone. So that's really my goal is just to crack these conversations open without shame or taboo or anything and normalize it and like Yeah, great. This is me what you got, how are you going to get me through this and you will you will get through it and rock it out.
I love that. So just so you all know Esther's name e s t h e r Blum v L u m.com/cocktail. So Esther belongs cocktail that will get you her hormone guide. One of the things I'll say here is that I get asked all the time, you know, I'm always getting DMS, emails all that Jade, can I work with you on menopause and stuff like that? I don't do this work anymore. I'm too involved in my educational things, Esther's who I would send you all to so from my perspective, if you're looking for a practitioner to work with, this is who you should be working with she's absolutely you know, someone that I have sent patients to you know, throughout my career She's someone I trust, implicitly credibly talented person. So make sure you get with her Tell her tell them though, where they can follow you because you are on social media, right? Like we I know you're on where if they want to follow you as well. Where do they get you? And yeah, so tell us where they can find you there.
I'm at gorgeous Esther on Instagram. And, yeah, we're doing a lot of fun stuff around the book release. So I'm really excited. We're gonna do some launch parties. So that'll be really fun. So stay tuned.
Esther on Instagram. estherblum.com Right? Get her, you know her free download Esther blum.com/cocktail. And I love you, my friend. You're just the best. I'm so happy to get this book out. When does the book come out? By the way? So I mean, is it? Can they preorder it now? Like, how does all that work?
Yeah, yes, you can preorder it now on Amazon, it should be in major retailers. 10 four is the release date, which cracks me up like 10 for over an hour? And yes, you can definitely preorder it for sure. And I just, I'm excited for you all to read it. Like I really wrote it. With every one of you listeners in mind. I was like, this is the book I would want. The reason why I write my books is because they're always something that I would I wish somebody wrote for me. So Jade's books were really like the other books that I went to as my resource and Jane, you should all know that like the work I do would never have been possible without Jade he really you started me on the trajectory for hormones, you helped me understand thyroid and just the whole hormone curve and the life cycle and the just so much of the work I do rests on the shoulders of giants like you truly Jade like it's I'm not blowing smoke here, guys. You know, this man is brilliant and listening to his podcast. So I have you to think because you really started this and you inspired me, you know, I had had some chronic illnesses a while back and Jade was like, you know, you're going through this to help other people and I was like, Screw you. Like, really come on. But honestly, it was really the greatest gem and truth bomb anyone has ever dropped on me. So you know it just here we are Brother Love. I love you so much. I'm like, I miss you. I want to see you in person.
Because yeah, we got to hang out. We're gonna try to do this in person. She was going to come down to Asheville to hang out, but it didn't necessarily work out. But yeah, we've been we've it's been crazy, right? We both been students and teachers for each other. And it's just so so amazing. I love you too. And I will stay on the line. Let's talk a little bit but we're going to end the podcast for all you listeners right now. And thank you so much, Esther make sure you check out her book. And I'll talk to you all at the next podcast.