Ep. 220 A Detailed Guide to Healthy Hormones with Dr. Lara Briden

I am excited to connect with Dr. Lara Briden today! She is one of my favorite naturopathic doctors and the author of the bestselling books Period Repair Manual and Hormone Repair Manual. She has 25 years of experience in women’s health, and she currently has consulting rooms in Christchurch, New Zealand, where she treats women with PCOS, PMS, endometriosis, perimenopause, and many other hormone- and period-related health problems.

Dr. Briden is a wealth of information! She brings a fresh perspective and a positive voice to the health and wellness space, and I often recommend her book, Hormone Repair Manual, to my clients and patients. 

Today, she and I dive into her background as an evolutionary biologist and discuss how she became passionate about supporting women and advocating for them throughout their lifetime. We talk about perspectives on aging, what the second puberty (perimenopause) is, and the impact of histamine, mass-cell granulation, and estrogen. We discuss fat redistribution in middle age and the loss of insulin sensitivity. We speak about how using alcohol impacts brain health, sleep, the gut microbiome, appetite, cravings, and hinders estrogen metabolism. We also touch on ways to address dysfunctional uterine bleeding in middle age and explain how to advocate for your health, how middle age impacts the nervous system, and the role of inflammatory foods, including dairy. 

I hope you enjoy our discussion as much as I did! Stay tuned for more!

“We use the word menopause broadly as an umbrella term for the whole process, but actually, perimenopause and menopause are quite different.”

       – Dr. Lara Briden

        IN THIS EPISODE YOU WILL LEARN:

• Dr. Briden talks about her background as an evolutionary biologist and how she changed her career and became an advocate for women’s health.
• Many women fear the process of aging. Dr. Briden and I talk about women’s mindsets and their perspectives on aging. 
• Why is there so little awareness about perimenopause?
• Dr. Briden defines menopause and discusses the timeframe in which some women experience perimenopause symptoms.
• How can ongoing hormonal fluctuations during perimenopause, or second puberty, increase the likelihood of women having issues with a histamine response?
• Dr. Briden talks about fat redistribution in middle age and explains why women need to stay on top of it from a metabolic perspective.
• How can our modern-day lifestyle make the metabolic shift women experience in menopause even more challenging?
• Dr. Briden talks about natural treatments and hormone therapies to lighten the flow of the extremely heavy periods that some women experience during perimenopause.
• Dr. Briden discusses the connection between cow dairy and an inflammatory reaction in some people.
• Women need to understand what happens in their bodies when they have either a partial or a full hysterectomy.
• Dr. Briden talks about estrogen and brain health.
• How does alcohol affect the body?
• What are the best options with the fewest side effects for hormone therapy for women? 

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• Dr. Briden’s blog 

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Transcript

Cynthia Thurlow: Welcome to Everyday Wellness Podcast. I’m your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent, is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

Today, I connected with Dr. Lara Briden. She is absolutely one of my favorite naturopathic doctors and author of two bestselling books including the Hormone Repair Manual, which is a must read for all middle-aged women. She has over 25 years’ experience in women’s health and is currently Consulting Rooms in New Zealand, where she treats women with PCOS, PMS, endometriosis, perimenopause, and many other hormone, and period-related health problems. We dove deep into her background as an evolutionary biologist, what got her interested and passionate about helping and supporting women throughout their lifetime. We talked about perspectives on aging, what exactly is the second puberty, perimenopause, the impact of histamine and mast cell granulation on estrogen, fat redistribution in middle age, and the loss of insulin sensitivity. 

We spoke at length on the impact of using alcohol, how it impacts sleep, brain health, the gut microbiome, appetite, cravings, and impairs estrogen metabolism. We did touch on the net impact of ways to address dysfunctional uterine bleeding in middle age, including the use of synthetic hormones, IUDs, ablations, partial and full hysterectomies, how to advocate for your health, the impact of middle age on our nervous system or mitochondria, and the role of inflammatory foods including things like dairy. I hope you will enjoy this discussion as much as I did. Dr. Briden is a wealth of information and really a positive voice in the health and wellness space. 

Dr. Briden, it’s so exciting to connect with you. I’m so glad that we ended up in the same hemisphere, so that we weren’t having so many challenges with coordinating calendars with you being in New Zealand.

Lara Briden: Exactly. I’m in Canada for the summer, so that worked out well.

Cynthia Thurlow: Absolutely, absolutely. I think you have such an interesting background. Did you know that you wanted to be a physician at some point, because you started off as an evolutionary biologist, which I found so fascinating? I dove down a complete rabbit hole. But I would love to hear a little bit about your background and how you got to where you are really a big women’s health advocate.

Lara Briden: Yeah. Oh, okay. Yes, so, I started out as a biologist studying evolutionary biology, I worked in the field, I published a peer-reviewed paper about sex differences and foraging behavior, which is prescient of what came later. I was planning to be an academic, actually, a research biologist. And then in my early to mid-20s, I just veered off. I decided I wanted to work with people. I was still very curious about biology and how the body works, and I felt naturopathic medicine was a good fit for that which it has been. Because a lot of it’s about what the body can do for itself using nutrition to work with the hormonal system rather than against it. So, yeah, that was about 25 years ago. Now, I changed careers and went into naturopathic medicine and then just starting out in general practice, I worked a lot with women and that’s how that was the beginning of my passion for women’s health, because women’s physiology responds so well to some fairly simple interventions, sometimes. I’m sure men’s health does as well, but I have less experience with men. 

Cynthia Thurlow: I’m so glad that you made that pivot in your life, because you have such a fresh perspective and your book, the Hormone Repair Manual, I recommend regularly to my patients and clients. And so, one of the things that struck me about the book that was different than a lot of other books talking about perimenopause, and menopause, and aging was really addressing the mindset and the perspectives on aging. Because I think for so many women, they have this tremendous fear of the process of aging, how their bodies change, how they interact differently with their environment. I love that the message is about aging is allowed. There was one quote that you use in the book, “With attribution that you don’t owe your prettiness to anyone.” As a woman that my parents really valued prettiness, and being polished, and being professional. 

I think that in many ways, women get so caught up in the physicality of their lives that they may not per se work on the inside work, which I think is so much more important. I have colleagues and friends that are navigating middle age easier than others. And I think in a lot of ways, the expectations, the external validation expectations of women and the physicality of being a woman can make it a very confusing time. And so, this was a part of your book that really resonated with me because especially here in the United States, women aren’t supposed to age. That’s the message.

Lara Briden: I know.

Cynthia Thurlow: Men can be a wrinkled old prune-

Lara Briden: [laughs] 

Cynthia Thurlow: -but women are supposed to look 25 years old for the rest of their lives. Who wants that that kind of pressure? But that is definitely the message I think a lot of women receive.

Lara Briden: It is. I think I say in the book, “I feared the loss of prettiness.” I guess it depends on how pretty you were to start with, I think somehow this goes, but fear that– I guess, a lot invisibility or this loss of attention from men. But then I don’t know about you, but once you actually get here, it’s like, “Oh, actually, that’s fine. I don’t miss that. I don’t need that. Life is short. We’ve got lots of other things to worry about and relationships.” There’s still I think we fear this loss of sexiness, I guess, or loss of being a sexual being, but that doesn’t happen. As we’re still sexual in our 50s and 60s and beyond if we want to be. It doesn’t have to look a certain way or fit into a certain box. At the end of the day, the truth is, for anyone, I guess, this applies to women who are straight, but I guess, women who are in same sex relationships might have a similar experience, I think men care less about looks than we think they do. 

Cynthia Thurlow: No, I agree with you.

Lara Briden: Honestly, because they’re aging, too, and a lot of it’s about heart connection, and companionship, and I don’t know, maybe we’re veering off topic here. But sex, it doesn’t rely so much on prettiness the way we thought it did. It really doesn’t know. 

Cynthia Thurlow: I agree with you. There’s some degree of confidence, I know that you talk about as women are losing estrogen, they stop being people pleasers and I am a reformed people pleaser. 

Lara Briden: Yeah. 

Cynthia Thurlow: I was talking about this in a book and I was saying, “Dr. Briden does this amazing discussion about the aging process” and that really resonated. I’m like, “Well, maybe that’s why in my mid-40s, I started creating more boundaries, I started getting more clear about what was important and not feeling like I had to appease others that I really need to focus in on my family and what was healthiest.” I’m very grateful that my husband loves me at 50, the same way he loved me at 30. In fact, I do agree with you 100% that our perception of what men are looking for and want, I think, ultimately, healthy committed adults irrespective of what our relationships look like, really are looking for a partner that’s going to be able to support them and love them irrespective of the amount of wrinkles or pounds or any of the things that we get so fixated on that really don’t matter. Because true heart connection. Even if it’s in friendships, is really based on a sense of togetherness that is so much more than the external trappings of whether it’s Hollywood or print magazines. Does anyone even read magazines anymore? That’s one of the things I was saying to my kids. The other day, I was like, “I can’t remember the last time I read a magazine.” I read lots of books, I listen to books, I don’t even look at magazines. But I think for many, many people, they’re pleasantly surprised that navigating middle age is not what they expected it to be pleasantly.

Lara Briden: Absolutely. Maybe this is overstating it, but it’s a little bit joining the party. I feel like because I’m 52. My last period is a year behind me and I definitely feel this surge in confidence. But my patients talked about it and I never really understood. I think it’s a little passage in the book where maybe eight or so years ago, I was walking with my sister and she’s like, “Look at all those women in their 50s, how much fun they’re having.” I’m like, “Yeah I hadn’t really noticed them because they’re invisible.” But then once you get here, it’s like, “Oh, wow. So, this is what this is about. It was nothing to be afraid of.”

Cynthia Thurlow: Yeah, absolutely. I think sending that message to women, because I’m sure much like you, you get messages from women asking questions and there’s so much fear. I remember fearing turning 40.

Lara Briden: Yeah.

Cynthia Thurlow: I didn’t care as much about turning 50. It wasn’t such a big deal. But I remember my late 30s being so passively fearful of turning 40 and then I’ve realized, “My 40s were so empowering” and so, liberating in a lot of ways for many women. What I think is important and what I wish I had known more about and why I think your book and your work is so important is even as a nurse practitioner, no one ever talked to me about perimenopause. I didn’t learn about it in school. I trained arguably at one of the best medical institutions here in the US. No one talked to me about it. My mom never talked to me about it. Most of our girlfriends, it was almost like this silent shared experience that no one wanted to talk about. And so, why do you feel or why do you think that there’s such little awareness about second puberty or perimenopause? Because I feel there’s a lot of focus on younger women. Contraception, pregnancy, postpartum, and then it’s almost like women go out to pasture and they become that invisible entity. But yet, women spend 40% of their lifetime in menopause. So, why are we not being more proactive as clinicians?

Lara Briden: Yeah. Well, a couple things to say. I guess, I think part of it is the stigma, which we were talking about before. I think women don’t want to think that that’s what’s happening. And also, I think it’s the lack of interest from researchers. No, certainly, there have been some researchers who are very interested. So, we can talk about some of those today. But that just hasn’t been on the radar like so many things in women’s health. And also, some of it, the confusion has to do with semantics or the words. I might just define how I see it, because we use the word menopause to broadly as an umbrella term for the whole process. But actually, perimenopause and menopause are quite different. We’ll put it this way. My experience clinically and reading the research is, if women are going to have symptoms and not all women do, so that’s important to acknowledge. Some women just don’t notice anything in which case, I think it’s important not to overmedicalize something. That is just a normal transition and nothing to worry about. Although, it still is a critical window to help, we can talk about that critical moment in time really for health.

But perimenopause, most women, if they’re going to experience symptoms, experience them anywhere between three to seven, maybe up to as long as up to 10 years before the final period and then the year or two after the final period. So, that whole timeframe is called perimenopausal. Perimenopause officially includes up until one year after the final period. You don’t know when that’s going to be, because you’re always thinking, “Was that my final period? Oh, no, was that my final period?” That final phase of perimenopause can drag on for a while. And then, depending on how you want to define it– The way I define it is menopause is the life phase that begins one year after the final period. That’s the definition used by reproductive endocrinologist, Jerilynn Prior, who helped me with both books. I feel like obviously, she’s my mentor. I feel like her take on the whole thing is very interesting. 

Menopause is arguably depending on how you define it. That is a relatively easy time. There’s a quote from Jerilynn Prior where she says, “Women need to know that the turbulent time of perimenopause ends in a kinder and calmer phase of life called menopause.” That phase of life called menopause is sometimes referred to as post menopause. Most of the research suggests that’s usually a pretty easy time. We have to be careful, because I think people talking about menopause being symptomatic. They’re really referring to perimenopause and maybe they’re just a year or two. You don’t want to give the impression that this is how you’re always going to be now. If you’re having night sweats, and mood swings, and anxiety, and migraines that we can talk about some of the symptoms of perimenopause. Those aren’t going to– Even if you did nothing, they wouldn’t continue forever. But of course, there are lots of ways to feel better.

Cynthia Thurlow: But I think it’s so important for women to understand. As you said that it can be this trajectory from the beginning stages, late 30s, early 40s, up until menopause. I almost feel in my own experience as a clinician that what I typically see is, the better women are taking care of themselves, the less symptoms they experience. Here in the United States, we have rampant metabolic inflexibility, we have growing populations of people that are just very metabolically unhealthy. I know a lot of the research that I’ve looked at, because it seems for a lot of people, it starts with these vasomotor symptoms. They’re having a lot of night sweats, they’re getting sweats during the day, people are gaining weight and they’re really frustrated along with other symptoms, breast tenderness and very heavy menstrual cycles. And so, understanding that this is a temporary timeframe that there are so many options that they can work with. 

I always focus on food-based options, lifestyle modifications as a primary level of, this is what everyone should be doing. Investigating our relationships with certain types of inflammatory foods and alcohol in particular seems to be a big player in this. It was interesting I just returned from a business event and ironically enough, most if not all of the clinicians that I was attending dinners with and interacting with, almost all of them don’t drink alcohol as one example. And for many of them just saying, “It doesn’t make me feel good.” I jokingly talk about the fact that I was never much of a drinker to begin with. But during the pandemic and having two years of not really doing as much socializing as we normally did, I said to my husband, “The only thing that I notice when I drink alcohol, it wrecks my sleep and I get hot flashes. Otherwise, I don’t,” because I preserve my sleep so, I make such a huge emphasis on sleep quality and enough REM and deep sleep, etc., that I just said I’m now so protective of my sleep. I’m not willing to engage in that. But I love that you mentioned it’s this temporary process.

And so, one of the things that really again resonated with me in your book was talking about as we’re having these hormonal fluctuations and I don’t want to oversimplify things and say, “It’s just about low progesterone and fluctuating amounts of estrogen.” One thing that I’ve been seeing with greater frequency in many women is a degree of all of a sudden, they have histamine response issues, all of a sudden, they’re getting hives, and mast cell granulation, and how this can be heavily influenced by these fluctuations in estrogen. And so, I got a lot of questions about this specifically. I’m curious if you can unpack this for us that how these hormonal fluctuations are ongoing during perimenopause can lend us to the propensity, the likelihood that we can have issues with histamine response.

Lara Briden: Yeah, so, let’s talk about just broad strokes hormonally what’s happening and you just said it already, but I’ll repeat it. This is second puberty. It’s quite analogous to first puberty. And that first puberty is a time when our estrogen kicks in. We’re quite sensitive to it and takes a lot to ovulate so well to make progesterone. So, that’s why young girls, well, teenagers sometimes can have very heavy periods. That’s a mirror situation of the heavy periods that can happen in our 40s when we lose progesterone first, because we just started having cycles where we don’t ovulate or don’t have as good a luteal phase, we’re just making less progesterone overall. At the same time in our 40s, estrogen, it becomes uncontrolled basically. It starts spiking up to three times higher than it ever was before and that’s a challenging situation. 

Because of course, it’s not going high and staying high. That wouldn’t be nice either. But it’s going up and down and up and down. And so, when it spikes up, that’s where potentially, especially if you have an underlying immune system that is sensitive to that thing. That’s when some women can get a mast cell reaction like high histamine stimulated by estrogen essentially, and not calmed by progesterone, because progesterone normally has an anti-histamine effect. We can definitely get this histamine and that can contribute to breast pain, that can make periods heavier. Actually, histamines play a role in that. Certainly, anxiety, insomnia. It’s not the only reason for those symptoms, but it’s contributing. 

And so, typically, symptoms will be around ovulation time if you’re still ovulating and/or premenstrual, and one easy, just almost diagnostic technique. I do talk about in the book and I’ve written about it since then, you can just try some antihistamines. It’s not necessarily your longest-term sleep solution you’re going to want to use but at least it gives some insights like, “Oh, yes, an antihistamine switched off these headaches or migraines, calmed me down.” And when you have that insight and then you can look at nutritional strategies, and diet and gut strategies, and supplements to calm histamine as well. So, that can be quite helpful. I’ll just say one thing that antihistamines, they’re fine, it’s fine to use them for a few years or short term. They can potentially contribute to weight gain. So, that’s another just tricky aspect of that. Of course, in our 40s, there is already a time when we are having a fat redistribution. Weight gain is not even precise enough to describe what’s going on. We’re losing fat from our bums, potentially, and putting it on our waists and on our belly. This is a fat redistribution. It’s really clear in the research that this happens. 

In part, you’re losing estrogen and progesterone, so you’re losing their metabolic benefits. And then also, this is something that I think is quite interesting. Because we’re losing estrogen and progesterone, testosterone starts to shine through. Because both estrogen and progesterone have an anti-testosterone or an anti-androgen effect. And testosterone in women, where excess levels of testosterone in women causes weight gain around the middle. That’s actually the PCOS situation. There is analogous thing going on between polycystic ovary syndrome and perimenopause, if your readers or listeners are familiar with PCOS. We have that challenge as well. What the research shows, you probably know this, but actually the weight gain around the middle is most profound during our perimenopause, late 40s, early 50s. And then settles down, potentially, which gives us hope as well. If we’re noticing this change in body shape, it won’t always just continue like this indefinitely. But we would do not just for cosmetic reasons, or stigma, or beauty, or anything we talked about the beginning. For very true health metabolic reasons, we do want to try to get, maybe not eliminate the change in body shape, because I think we’re always going to get some thickening around the waist. But just stay on top of that from a metabolic perspective knowing that that can increase the risk of insulin resistance, which is long term has many risks. We could talk about that a little bit if you want. That shift insulin resistance and why that’s what I call in the book a critical window.

Cynthia Thurlow: No, and I think it’s important because really understanding that estrogen has this beautiful insulin sensitizing aspects. And for so many of these women, women that maybe have been CrossFit athletes at some point that then lean into overexercising that they think a little bit of exercise is good, then they’re going to add in some fasting, then they’re not going to sleep. And just understanding that as we are getting these fluctuations of estrogen and I know that we’ll talk about brain health, but insulin resistance, I think this is really when women are most at risk. If we are going to become insulin resistant and ultimately diabetic, this is that window that we really have to– And that’s why I talk about the lifestyle so much. This is really when we have to lean into foods that inflame our bodies and why our sleep is so important. And so, I would love for you to talk about this whole inflammatory process that’s ongoing that is making us more susceptible. And then I’m hoping at some point, we’ll talk a little bit about HRT, because I just came back from this event. During the Q&A, I was asked probably 10 times my thoughts on HRT and so, it was surprising that they’re still, at least, here in the United States, because of the Women’s Health Initiative, there is still this fear by clinicians, fear by patients to actually take hormonal replacement therapy. And yet, my hope and my intent is always to help educate women, so that they can have a conversation with their doctors, their healthcare professionals in a way that will be most beneficial for them.

Lara Briden: Sure. Yeah, then we definitely talk about hormone therapy. But first, just speaking to your question about this loss of insulin sensitivity, the way I see it actually is, just to frame it a little differently. This is my view as an evolutionary biologist. We evolved to do this. This is very clear now in the research that through several lines of evidence. But menopause is not an accident of living too long. Arguably, even as humans, both male and female, a longer human lifespan may have evolved due to positive selection pressure on women’s post reproductive years. Prehistorically, women in their 50s, 60s had been very important for groups of humans and that’s just a fact. We still know that in modern day forage of peoples. We’re meant to do this. We’re meant to be healthy through that time, by meant to I mean we physiologically have the capacity to be healthy. 

I think, even in ancient times, the biological lifespan of a human was 70, 80. The average of that, the life expectancy is much lower, because so many people used to die as children, sadly, and in childbirth, and infections, and all the hazards, all the ways that it was hard to live to old age, historically. But I think for those individuals who were lucky enough to get through, they live to 70 or 80. We know this from the fossil record now. Just to be clear, menopause even without hormone therapy potentially can be a healthy time. Now, this is where the concept and– I’ll try not to be too technical here, but this is where the concept of evolutionary mismatch comes in. Do you know that? Are you familiar with that? 

Cynthia Thurlow: Yes.

Lara Briden: Yeah. So, this quite profound shift in our physiology that happens when we stopped menstruating in a different time, it would have actually been fine. It would have actually almost been a superpower. We would have actually, in a way arguably, because an estrogen as well as making us more insulin sensitive, it actually increases our energy requirements. Estrogen, it creates quite an expensive metabolism. This is the way I’ve flipped it. Our metabolism goes down when we end our reproductive years. But think about that in a historical perspective. We would have not needed as much food. We would have been given all the starchy carbs to the children, and breastfeeding pregnant women, and reproducing women, and we would have been able to live on a leaner diet, because we’re potentially good at going into ketosis and being metabolically flexible. You can see how in a traditional lifestyle, this would have been fine, this shift in metabolism, if that makes sense. 

But in our modern worlds, there are so many ways that what should be a normal shift in physiology and metabolism becomes really quite challenging. One of the parts is the fact that our food environment is so high calorie, high everything, high carb. Not just that, but the alcohol you referred to. There’s some evidence that exposure to environmental toxins can really add too, and worsen will create essentially symptoms of this transition. I’m pretty confident. Well, we know that modern day forage of people don’t report symptoms of perimenopause. They go through menopause, their period stops, they know about it, they’re happy about it. Generally, it’s not a negative thing. So, certainly, the historic literature doesn’t really talk about symptoms much at all until relatively modern time. So, I think the symptoms are real, 100% I think they’re in large part due to evolutionary mismatch, which a lot of it’s out of our control. It’s not that people are doing something wrong, or eating wrong thing, or anything like that. It’s just the world we live in is not very supportive of this change we have to go through. Does that make sense?

Cynthia Thurlow: No, it does. It makes me think about the cohort of women that go through transition from perimenopause to menopause and then it makes me reflect on the women that are having partial or full hysterectomies during this timeframe. It makes me think back to, gosh, I was probably 42 and happened to have my annual GYN exam on the first day of my period and I was telling my GYN, “I have very heavy periods.”

Lara Briden: Yes.

Cynthia Thurlow: So, she examined me and said, “Oh, my gosh, you do have very heavy periods.” I said, “Well, I wasn’t kidding.” The milieu of options for traditional allopathic medicine runs along the synthetic hormones, an IUD, an ablation or hysterectomy, and she, of course [crosstalk] one with me. And so, I would love to touch on, because I oftentimes receive a great deal of questions across the continuum about women who’ve either electively chosen any of those options that especially a partial hysterectomy, where she still has her ovaries or a full hysterectomy. Many times at which they’re not fully informed about what is going to happen to their bodies and how the normal transition into menopause is disrupted. And so, I think it would be very helpful for listeners to get your perspective, because fully informed consent, I think a lot of people may not have elected for those choices, if they really realized what was happening to their bodies when they had organs removed that impact the hormonal regulation.

Lara Briden: Yeah. Okay. Sure. Speaking to the symptom of the very heavy periods and they can be very heavy.

Cynthia Thurlow: Mm-hmm?

Lara Briden: Just to be clear, the normal, acceptable maximum of menstrual fluid to lose during all the days of the period of the bleed is 80 milliliters. To put that in perspective, that’s the content of two small eggs. That’s what I talk about it now. One egg is like 45 mils or something, so, just picture that. And some women can lose up to, very, very high end. Let’s say, up to 500 mils. The difference would be 80 and 500, right? It can become crazy. Fortunately, most women don’t experience that. Two-thirds of us, our periods just stay the same or lighten. It’s not a universal experience. But I think there’s different risk factors certainly that can put women at risk of those, I call them the crazy heavy periods of perimenopause. It’s a challenging symptom. No question. 

I’ll just list a couple of natural treatments and then we’ll answer your questions about what to do if you’ve had a hysterectomy. There are some period lightening strategies. I have a whole chapter as you saw in Hormone Repair Manual, whole chapter about this actually. Some dietary strategies, often I say, try some time off cow’s dairy, because dairy has such a histamine, actually histamine plays quite a big role in heavy periods. It’s even one study where they used, so interesting, intravaginal antihistamines, a localized antihistamine effect try to lighten flow which I found was super interesting, because the uterine lining is full of mast cells. That’s not to suggest that’s the only cause of heavy periods. 

But then I talk about using certain supplements that can help. It’s obviously important to stay on top of iron and don’t become iron deficient, because being iron deficient makes periods heavier, cruelly. Then you can use real progesterone to lighten flows. This is actually maybe the beginning of our hormone therapy conversation. Because yes, on offer generally has been progestins, which are analogs of progesterone, they are not progesterone. Progesterone is not a generic term like estrogen that can just refer to anything progesterone like at all. Progesterone is our own progesterone that we make or that we can take in the form of the product in the US is called Prometrium. It’s by prescription. It’s body identical, or bioidentical, or natural progesterone. It can lighten flow. You have to take quite a lot of it compared to a progestin. That’s one of the, I guess, downsides to it. It could be a little more. It’s more expensive than progestins. 

But for women, when that’s the right solution, there’re several advantages over progestins. You can actually get some side benefits, neurological benefits from progesterone that progestins just don’t provide. Progesterone is very tranquilizing, so sedating. Actually, you need to take it at bedtime or make you feel very weird during the day, but it can help you sleep. It helps stabilize the nervous system, prevent migraines, improve the body’s ability to cope with stress. Arguably, the bold statement, but it in the show notes, we can put a link to Professor Prior’s blog post about this. But there’s several lines of evidence that suggest that progesterone, real progesterone may reduce the risk of breast cancer, which is pretty important when you consider that most, probably not all, but almost most progestins slightly increase the risk of breast cancer. So, there’s a safety issue around that. Yeah, so, that’s a little blurb on heavy periods. Do you want me to talk about hysterectomy or do want to ask me something about the–?

Cynthia Thurlow: No, I think what’s really interesting for me is, so, I am gluten, grains, and dairy free and in perimenopause, when I went dairy free, my periods got lighter-

Lara Briden: Yes. 

Cynthia Thurlow: -and I lost the five pounds of fluff that seemed to be– I was incapable of losing. I’d done all of the things. And so, I know that for many people, they have a love and appreciation for dairy. I know it can also be very addicting. And so, if anyone’s experiencing dysfunctional uterine bleeding or has very heavy periods, it’s really something to consider and I find it absolutely fascinating that reading your book put those two things together for me and I started to reflect back, “Oh, when would I go dairy free? Oh, yeah, that’s when my periods got lighter.” Not realizing there was this interrelationship between really looking at some of the important aspects that are specific to dairy and how that can impact balancing our hormones. I had never even considered that. It’s utterly fascinating that I’m now making these connections. And certainly, hopefully, listeners are as well. If they’d been on the fence about going dairy free or doing a trial of being dairy free, I think it can be quite significant.

Lara Briden: Let’s talk about that for a minute. Yes. So, I’m through my lens, the problem with cow’s dairy is A1 casein. It’s a very specific molecule that depending on the individual, the person who’s eating it may or may not form an inflammatory compound called BCM-7. Not everyone does that. Dairy, it’s about one in three of us, I think, who get an inflammatory reaction to normal cow’s dairy. Then two out of three who don’t get that inflammatory reaction are scratching their heads going, “What’s the big deal? Dairy is fine.” That’s obviously why the research is a little bit confused, too, because I think I will say, for a lot of people cow’s dairy is fine and not inflammatory. But for those of us who it is inflammatory, it’s a big deal. Actually, it can make a huge difference to health. And fortunately, some of the research is starting to tease that apart. The devil is in the details always. 

At Deakin University, the foods and moods center there, at least they have been. I hope, it’s still ongoing. A study into removing A1 casein for premenstrual mood symptoms and looking at A1 versus A2 dairy. I spoke to the researcher and he said, “Yeah, they’re actually going to be checking for BCM-7 in the urine. Just to give an example of how precise you have to be. Removing dairy is only an effective intervention for those people who are reacting to it. It’s not an allergy. It’s actually just this formation of an inflammatory compound. This maybe a little technical, but I guess, what I would say is, it’s worth trying it. For most people, they can probably still have goat and sheep and other forms of dairy that doesn’t have A1 casein. Down under in Australia, New Zealand, they call that A2 dairy. You can get that in the States now, I think.

Cynthia Thurlow: Yeah, you can get some A2 milk. Because I’ve seen it and I’ve actually thought about it.

Lara Briden: Yeah.

Cynthia Thurlow: I have a very pro-dairy family and I’m the weird one that doesn’t. And so, I’ve talked to them about, “Maybe we should try this just to see,” because if I have a genetic susceptibility, probably, one of the two of my offspring do as well. 

Lara Briden: Or, you should just switch to A2. There’s no reason not to apart from it sometimes a little bit more expensive. But it still has all the other nutritional benefits of normal dairy. The other thing is butter. Butter has very little casein in general. The other thing that doesn’t have much casein is ricotta. 

Cynthia Thurlow: Interesting.

Lara Briden: Sometimes with my patients, the ricotta’s popular. Yeah, it would be totally dairy free usually. But avoiding normal A1 casein can be a game changer for some. For some people, it’s very dramatic, actually, which in terms of periods, and mood, and even metabolism to some extent.

Cynthia Thurlow: No, and definitely for myself, I always say the N of 1 is so powerful. And so, when we’re considering, if there’s a woman who is trying to navigate the trajectory of perimenopause and maybe her provider offers synthetic hormones versus an IUD versus an ablation versus looking at a hysterectomy, when you’re working with your patients, I would imagine, you’re not offering synthetic oral contraceptive and that’s a whole separate tangential conversation, because I see women in their mid-50s, who are still taking oral contraceptives which is a whole separate rabbit hole.

Lara Briden: Well, I talk about that in my book.

Cynthia Thurlow: Yeah.

Lara Briden: Because just to be clear, the pill is a high dose hormone therapy, which is a whole other question itself. But yes, certainly by your 50s, why not switch to a lower dose body identical natural hormone therapy, which is the standard these days. Why take those contraceptive drugs when they’re riskier than modern hormone therapy and not as nice in any way? And also, just to be clear, the withdrawal bleeds you have from the contraceptive pill are not periods. So, you can easily go into menopause while you’re taking the pill and not know it, because you’re having these drug bleeds like pill bleeds. So, yeah, I have a section in my book about that. 

Most of my patients get success, in terms of heavy periods with progesterone, real progesterone, not all to be fair, obviously it’s individual. Many patients would do a combination of dairy free, maybe the supplement calcium, natural progesterone, and getting through till menopause, right? Because it’s only usually a few years of those heavy periods. You just have to get through. Some of my patients end up having a hormonal IUD, if it’s just too hard. Because it can be a lot of work, a lot of stuff to take, if you are just taking iron. If you’ve been dealing with very heavy periods, it can be a full-time job trying to manage that. I totally get why some women would feel better on a hormonal IUD. 

The interesting thing about the hormonal IUD, so just to be clear, there’s no progesterone in it. It’s levonorgestrel, it’s a progestin. It’s actually one of the androgenic progestin. That’s why it can worsen the perimenopausal weight gain that we’ve talked about. Not in every case, but it’s mostly local, but you get some systemic effect from it. But it doesn’t shut down the ovaries or overrides ovarian– The hormonal process the way the pill would, for example. Just to be clear, you can have the hormonal IUD, plus take progesterone for migraines and sleep and other things. It’s not an either or necessarily an either-or situation. You can do both.

Cynthia Thurlow: I think it’s really interesting, because a lot of these options are left and there’s no judgement in what people decide to do. What I typically see is, even if it’s a progestin IUD, or it’s an ablation per se, or they get a partial hysterectomy, it may not fix the symptoms per se. If they are still having higher levels of estrogen and if we do testing, here in the United States we use the DUTCH. I’m not sure if that’s a test that you like or use with your inpatients. But if we look at blood values and we examine how their estrogen metabolism is going, I’ve just come to see and find and certainly, I’m not a GYN myself, but I just sometimes see that the symptoms may be addressed, but it doesn’t necessarily fix the root cause of the issue, which is this relative estrogen dominance. I say relative because we know in perimenopause, they get fluctuating. Sometimes, it can be high, sometimes it can be low, and it may fluctuate during that perimenopausal period. 

Now, when you have patients that are at the point where maybe for several different reasons, they go on to have a partial or a full hysterectomy. Can we speak to what is happening in the body? I know that based on what I’ve looked at research wise, sometimes, women are not fully informed when they have a full hysterectomy that they in the next day may feel completely different with the loss of hormonal regulation that’s ongoing with removing of the ovaries and their uterus, etc.

Lara Briden: Yeah, so, let’s talk about that briefly. Well, of course, removing only the uterus and not the ovaries should not have a huge effect on hormones. Officially, it has no effect on hormones. But there has been documented a decrease in progesterone production from that. I think just because the ovaries, they’re affected by the loss of structurally and potentially some change in blood supply once the uterus is gone. I talk about this in my book, the one thing I’ve found that can happen is, let’s say, you do have partial hysterectomy. 

Uterus removed, but ovaries left while you’re still in the throes of perimenopause, what can be confusing is, you can have these, for example, quite intense premenstrual symptoms, but not know what’s going on because there’s no bleed to give you the sense of timing. I tell a lot of my patients, “You’re still cycling obviously. You’re still having ovulation, migraines, and then mood, and breast swelling.” Yeah, removing the uterus doesn’t change any of that process. And so, that’s one thing to understand. You can obviously then still use all the treatments that some of them that we’ve talked about to help to stabilize estrogen, you can still take progesterone even though you don’t have a uterus, which goes against the standard, but this is why I’m talking about real progesterone, Prometrium has many other benefits besides just thinning the uterine lining. 

But then just to speak here, yeah, having your ovaries out, now that is a whole other thing. That is actually what a serious thing to have done. Not to overstate, not to be too dramatic, but we have maybe this sense that, “Well, ovaries, we don’t need them after menopause.” Actually, they do. They still produce androgens, which we do need because I was speaking how testosterone can cause weight gain. But just to be clear, we need some level of testosterone and androgens. They’re beneficial for general health, for mood, for bones as a sweet spot. And of course, after menopause, androgens are how we make estrogen peripherally. This is very clear in the research. Actually, women menopausal into their 50s and 60s, their general health can be impacted quite a lot by losing their ovaries, unfortunately. And it actually in correlates with increased risk of heart disease, and dementia, and other things like that, which can be helped by taking hormone therapy, but not entirely mitigated. Actually, I think part of it is because we do get this baseline androgen-estrogen production from our ovaries. 

We

the ovaries, we still need them. And I appreciate maybe there’s some people listening who had no choice because of cancer risk or something like that they had to have their ovaries out. So that can be the situation, even though doctors are trying to do at less than– They used to just whip them out with really no thought about what that might be. But modern day, they’re pretty conservative, most doctors and will only remove them if there’s a clear risk. Yeah, in most cases, if the ovaries have been removed, unless there’s a strong reason not to, you would almost always want to take some estrogen therapy at that point. I would argue estrogen and progesterone again, because that’s yeah, can be quite a shock to the system. It’s castration. It’s different than menopause to lose your ovaries.

Cynthia Thurlow: No. I think it’s so important for women to understand to have a full clinical sense of what’s going to happen. My mom, because of some risk factors had both her ovaries and uterus removed. I don’t think it dawned on her, even though she’s a nurse that several years later, all of a sudden, she’s starting to see some cognitive deficits and she’s starting to– She’s osteoporotic, significantly osteoporotic. She assumed as I think many women do that because she was using intravaginal estrogen that that would protect her bones and protect her brain. And so, one of the things that I have found so interesting and I know that you mentioned Dr. Lisa Mosconi in the book. 

Lara Briden: Yeah.

Cynthia Thurlow: In her book, XX Brain is a book I talk about all the time. I think it’s really important for women to understand that these hormones if we don’t have enough of them, there’s a lot of estradiol and progesterone signaling in the brain that when we go into menopause that can be impacted significantly. I know you do a really beautiful job talking about brain health and why it’s so important that we are cognizant of how to support our brains, and support the HPA axis, and getting more into the parasympathetic because our bodies really lean towards this inflammatory sympathetic dominant existence. And certainly, here in the United States, where it’s 24/7, we have access to anything. It’s hedonistic, get what you want at any time of the day or night, and that includes food. 

We have something called Uber Eats here, which is a terrible [crosstalk] DoorDash. Terrible concept. But I just start to reflect on the net impact on cognition, increasing rates of Alzheimer’s, just really thinking thoughtfully, so that women can make decisions based on education, inspiration, and empowerment. So, they’re not getting to a point where they’re 20 years into menopause and they’re realizing they can’t necessarily reverse what has already happened.

Lara Briden: Okay, let’s talk about estrogen and the brain and some of Lisa Mosconi’s work and another researcher, Roberta Brinton who I do quote in the book. First of all, just to you mentioned vaginal estrogen. Vaginal estrogen is amazing. It’s awesome. I pretty much everyone should– Well, if you’re at all inclined, use that for just vaginal health and lubrication. It’s very safe and easy, but it doesn’t offer systemic estrogen support. It doesn’t. To the point that actually, one thing about vaginal estrogen is, it’s now widely and officially considered to be safe, even with a history of breast cancer. So, that’s important to know. Because the experts and scientists have looked at this and they’ve decided, “No, there’s just such minimal systemic estrogen coming from that, but it can be used.” Yeah, so vaginal estrogen isn’t going to do anything for bones or brain health.

In terms of brain health, yeah, because the brain loves estrogen. There’s no question. The brain loves estradiol. It does a lot of things, but mainly what Lisa Mosconi, it’s on her research, they talk about the energetic system of the brain and how– For example, the mitochondria, everywhere in the body, including in the brain, love estradiol. They just can’t get enough of it. And so, that enhances insulin sensitivity, that enhances brain energy. This is where, in there, Mosconi and Roberta Brinton research, hopefully, I’m quoting it right. One of the things they found is that, with the eventual drop in estrogen with the menopause transition, keeping in mind in the earliest, because of the earlier phases of perimenopause. It’s actually spiking up really high and then dropping down and that drop can cause symptoms as well. 

But eventually, obviously, we do get to a lower level than we had when we were in our reproductive years, not zero. Our serum levels are about 10% of what they were. And then of course, we make estrogen locally in cells. So, that’s really important. If our cells are healthy, we can make enough estradiol locally in our cells to provide the body with what it needs. Because obviously, estrogen is important for men and children and everyone. We’ve all got this baseline level of estrogen. But what happens is, it’s the calibration, it’s the adjustment. What they found in their research is that with the eventual drop in estrogen, especially in those early months or years of that transition, there’s up to a 25% drop in brain energy measurable on scans. They can see the brain lighting up. That’s a little frightening, obviously, for all of us who have to go through this process. It’s like, “Ouch, that’s real.” This is the cognitive symptoms that we can get during perimenopause transition, I think the example I use in my book is, I forgot where I parked my car one day, not permanently, but I’ve just gotten have this real muddled moment of what is going on. So, that’s a known thing and that is from—

Essentially, physiologically what’s going on, reduction in estradiol, our brain cannot access glucose for energy the way that used to be able to. It still can, obviously, but not to the extent. We don’t have that insulin sensitizing superpower of estradiol that we had when we were in our reproductive years. The brain has really no choice but to become metabolically flexible. Well, it needs to become metabolically flexible to access more ketones to compensate for this reduced ability to turn glucose into energy. Now, just circling back to what we said at the beginning. Prehistorically and with more traditional diet, lifestyle, low insulin resistance, those individuals probably make sense to you like, they were more metabolically flexible. Their brains potentially during this process would have been like, “Oh, okay, well, I’m going to have to use more ketones for energy” and they could do that. But because of, again, this evolutionary mismatch and a lot of us tending to insulin resistance for a combination of reasons, some of which are outside our control, the brain is really struggling. 

One of the research papers and I will quote. I sometimes quote this, I sometimes don’t. I’m not sure how much it scares people but Roberta Brinton, a colleague of Lisa Mosconi, I think I’ve got this right, she had a study where she found that, “If the brain cells can’t access ketones the way they need them during this energy crisis spread over some months, the brain cells will potentially cannibalize the myelin to get ketones.” Myelin is the fatty coating of our brain cells. It’s like, “I need some kind of energy. I’m going to grab that.” For me, that was a very vivid image. I can’t even remember if I put this quote in the book or not, but in my house, one of the quotes is– We usually don’t have dessert, but occasionally do. Sometimes, I’m tempted, but then I’ll say to my husband, “Yeah, I’m not going to have that dessert because I don’t want my brain to eat itself.” That’s the cannibalizing of the myelin which potentially can happen with reduced metabolic inflexibility. 

I don’t want to overstate that. I think there is some wiggle room in this, but a lot of it comes down to just being conscious that this is the tipping point for metabolism. If there’s ever a time to be metabolically flexible and it sounds like your audience knows what I mean by that. If there was ever a time to focus on, it’s now. It’s during this transition with estrogen and of course, estrogen therapy does increase metabolic flexibility. So, that’s true. Whether we need that, you know what, I don’t think every woman needs that. I think it is a real effect. One thing I’d like to see in the research is again, it’s about the devil in the details teasing this apart and making sense of this. When they’re researching, does estrogen therapy reduce the risk of heart disease, for example, reduce the risk of dementia. I think it does, in many ways. I think even more important would be to look at of the participants in the studies who had insulin resistance and who did not. Because I think the really metabolically healthy women who don’t have insulin resistance, they’ve got lots of muscle mass, they’re good, they’re burning ketones, some of the time their brain is healthy. I seriously doubt they need estrogen, the way women who have insulin resistance do in terms of longer term.

Cynthia Thurlow: Yeah, no, that’s a really interesting statement because it makes sense. I have colleagues of mine who are in their 60s are not on HRT, and are so sharp, and just doing so well. They are very metabolically flexible. And so, that seems to be the case that– For me, I take progesterone and that works really well for me. Right now, I’m very metabolically healthy, but that’s much more aligned with bio individuality and really looking at who is metabolically rigorous. There are a couple of things I want to make sure that we touch on, but also being respectful of your health. There are certain aspects of your book that really resonated. And one in particular was talking about alcohol. It’s almost like the elephant in the room. There’s a huge mommy drinking culture. By no means, there’s no judgment in what I’m saying, but I know for me not being someone that drinks alcohol any longer, I do find that can be very triggering for people. 

I try very hard to come to a very objective place to talk about what alcohol does in the body. That one section in particular for me really resonate. In fact, I talked to my team and said, Dr. Lara Briden has this great section talking about the research on what alcohol does to our bodies.” I would love to at least touch briefly on this because I do get a lot of questions. I think many people feel a sense of social pressure to drink and maybe they would prefer not drinking. I would say, “It’s very much a bio individual decision.” But I think for women navigating middle age, sometimes, we have to reflect on some of those habits and I just find for a lot of women that are struggling with weight loss resistance and blood sugar dysregulation that sometimes the alcohol piece is what’s driving a lot of what’s going on.

Lara Briden: All right, so, just to be clear with the research. We used to have this, “Oh, moderate drinking is good for you.” Yeah, that ship has sailed. That’s not a thing pretty much. I talk about that in the book and some of the debunking of that, because that was just bad statistics, basically kind of shoddy. There’s no good amount of it. Alcohol is not healthy in any amount. But some of us can get away with some amount. There’s an amount we can get away with because it’s pleasurable, so I get that. I think for some people depending on where they are in their life and who they are, some amount of alcohol in the week is probably not a big deal. 

For perimenopause, the stakes are higher. Our nervous system is recalibrating. We’ve talked about this, our brain is recalibrating. Alcohol interferes with that. All of us have the experience. You mentioned it earlier, like, affecting sleep and hot flushes. For me, personally, I have this little thing like, I could have this beer with dinner, which I wouldn’t really enjoy, but then I’ll wake up all sweaty at 3 AM. So, actually, I’d rather sleep through the night and not have it. There is the immediate effect on sleep that night, but there’s also, what we know from the research is a longer-term effect. Alcohol can have a negative effect on circadian rhythm. Then one of the challenges of perimenopause is our circadian rhythm is changing. It’s not as robust. It needs a lot more support. It needs that light in the morning, it needs [unintelligible [00:53:47] protein, it needs dark at night, and all the things just to try to keep our circadian rhythm going and alcohol disrupts circadian rhythm. 

The other just fact about alcohol, which is important and it has the breast cancer risk. Not a huge one. All risks, it’s relatively small but moderate alcohol is as risky as modern estrogen therapy in terms of breast cancer risk. Just to put that in perspective, if people are afraid of taking estrogen, well, depending on what– we could talk about the types of estrogen and hormone therapy, but more than probably four or five drinks in a week is a bigger risk than that estrogen would be. That puts it in perspective as well. Yeah, alcohol pretty clearly impairs metabolic flexibility even to a greater extent than I realized actually. Since I’ve written the book. I’ve seen some more research about that. So, it’s not friendly to help in any way. I’m mostly like you. I mostly don’t drink. I do have the occasional drink now that I’m 52, because my last period was like a year and a half ago. I am feeling now, it is starting to, I think, get into that more stable time where I can have a drink and I don’t really notice an effect. But I still prefer to have a robust circadian rhythm and good health going forward. So, I think I’ll stick with mostly not drinking.

Cynthia Thurlow: Yeah, it’s interesting how I always say that. I’m fully adulting now, because my sleep has become such a large focus of how I perceive the world, how I go about my day, etc. Much like yourself, I choose not to drink because my sleep has just become something I really prioritize. Now, when we’re looking at HRT, when we’re looking at hormone replacement therapy, there are so many options. Whether it’s estrogen or progesterone, here in the United States, there’s no FDA-approved testosterone but there are plenty of women that are taking testosterone and we can touch on why that sometimes happens. I always say, “Look upstream if your testosterone is low, looking at the other things that can precipitate that happening.” If we speak from a broad-based perspective, what have you found in clinical practice to be the best tolerated, least side effects options available for women? And certainly, I think this is important because women can then take this information and go to their GYNs or their OBs or whomever they’re seeing and have an ongoing discussion with them about what is going to work best for them.

Lara Briden: Absolutely. Yeah, let’s dive into this. It’s our finale topic today. It’s a good one. it’s important. One thing, I don’t use the word replacement therapy anymore. Generally, it’s referred to as menopausal hormone therapy, which I think is more appropriate because replacement immediately implies that it’s replacing something–. It’s an abnormal situation and we need to replace it. Actually, the lower hormones of menopause is a normal situation. But just to be clear, it can also cause symptoms for reasons that we’ve spoken about. So yeah, in term of hormone therapy, one very good thing is that we have arrived at bioidentical. It’s hard for me– I’ve been doing this for 25 years. It’s not that long ago. Depending on which country you’re in, only less than 10 years in Australia, actually, but 10 or 15 years depending on which country you’re in. Back then, it was like, “Oh, no natural progesterone is not a thing.” Progestins are fine. There’s no difference between progestins and progesterone. That was the talking point. Anyone advocating for progesterone like I was doing back then, that was considered pseudoscience, basically. 

Here’s an example of how we’ve seen the progression. I didn’t think it would take this long, but it has finally arrived. The official recommendations, the ones that just even came out last week around hormone therapy, all state oral micronized progesterone, real progesterone aka body-identical, bioidentical, natural progesterone is safer than a progestin in terms of breast cancer risk. It has lots of other benefits as we’ve talked about. So, that’s finally here. It took a couple decades, but that’s good. You can now, usually, in the conversation with the doctor, most women are by default now offered bioidentical or natural hormones and that was not the case 20 years ago at all. That also speaks to the old research like the Women’s Health Initiative, those were not bioidentical hormones. We are now comparing apples and oranges. That was a different set of drugs that were being used. Those progestins that were being used were not safe, I would say. 

Usually, you don’t even have to go to a natural doctor or anything like that. Most cases, if you just go to your normal doctor, you’re going usually be prescribed Prometrium or depending on what country you’re in, it goes by different brand names, Utrogestan that’s the real progesterone, plus, a bioidentical body identical estradiol patch or gel. That’s through the skin. Either wear a patch or use the gel, and that’s natural estrogen as well. And so, that’s the mainstay of hormone therapy. I have a blog post myself called a safer type of hormone therapy where I just explained a bit more about the bioidentical, the history of that, and the terminology, and why it was controversial, and how it never should have been. Fortunately, that’s good for women today. We’re getting much better options on offer than what women 20 years ago had, so that’s good. You have to still read the label. Some doctors might still be prescribing the old school Premarin or progestin. You just have to look at it and then ask for what I say to my readers is just then say, “Well, is there a reason that I wasn’t offered the more modern recommendations?”

There may be certain circumstances where the preferable body identical hormones are not the first choice, but for most women it should be. So, that’s clear. And also, we referred earlier, I’m a big fan of using progesterone on its own. You talked about that, Professor Jerilynn Prior advocates real progesterone on its own potentially through perimenopause. Even into menopause can help to relieve night sweats and hot flushes. Often what I’ll say is, maybe do progesterone on its own for a while and then add in estrogen if you need it and add in estrogen patch. And doing it in that order can actually help to tolerate estrogen as well and feel better on estrogen. That’s true, even if you don’t have a uterus. And that’s the more controversial part of what I’m saying. But this is because progesterone’s benefits on the breasts and brain.

Then in terms of hormone therapy, testosterone– Yeah, that’s interesting. I have a reputation of being anti testosterone. I’m not. I acknowledge that testosterone, especially, potentially topically can help with libido. I think that’s a reasonable option if women want to look at that. You just have to be careful, though because testosterone can cause weight gain. Usually, that shouldn’t happen if it’s a low enough dose and it’s in combination with estrogen and progesterone because they have anti-testosterone effect. It’s context dependent, but too much testosterone can cause weight gain for sure. That’s something to be thinking about. 

The other hormone that I wished was more on the radar is DHEA. It was on the radar about 15 or 20 years ago and then went through a couple of clinical trials that just got dropped. And yet, I feel it’s probably, logically– In terms of hormone therapy, I think it’s more logical to take that than testosterone. But the research is not there for it unfortunately, I don’t know, how many of your listeners might be taking DHEA. Yeah. 

Cynthia Thurlow: No, and it’s really helpful to hear your perspective. Again, I think when I talk to women, it is so clear that the Women’s Health Initiative and the resultant information that was shared and the faulty data that was shared has really influenced an entire generation of clinicians and it’s made women in many instances very fearful about menopause therapies. 

Lara Briden: Yes.

Cynthia Thurlow: I’m going to start changing that vernacular 

Lara Briden: Yeah, menopausal hormone therapy. 

Cynthia Thurlow: Yes, I will give you full credit for that. 

Lara Briden: Yeah. 

Cynthia Thurlow: But I think it’s important for us to have those conversations and to sit down with our clinicians and to explain like what our goals are and what we’re looking for. And so, I’m so very grateful for the opportunity to connect with you and that somehow, we both ended up in the same hemisphere during the Summer.

Lara Briden: I know.

Cynthia Thurlow: Please let my listeners know how to connect with you, how to get your amazing books. They’re obviously ones I reference quite frequently. Thank you for all the work that you do. I really have to say that I read a lot. And so, my listeners know this. If I find a book that I’m referencing frequently or it’s causing me to go down a rabbit hole to read more about something, I learned about the supplement touring through you and do now recommend it quite a bit. So, thank you for that. But let my listeners know how to connect with you outside the podcast.

Lara Briden: Oh, okay. Thanks, Cynthia for the feedback and the lovely conversation. Yeah, I’m easy to find. My books are– Well, the book we’ve been talking about is Hormone Repair Manual. That’s for women, 40 plus. My first book is called Period Repair Manual, which is for younger women, essentially, although, there is a chapter on perimenopause. But it’s more for women in their 20s and 30s trying to navigate coming off the pill and all kinds of different challenges. And then my blog is larabriden.com. So, that’s also very easy to find. I have a podcast, which is just me talking like spouting off on different topics. And then all my social media is @larabriden.

Cynthia Thurlow: Awesome. Well, thank you again for your time today. It really has been a pleasure. Like I mentioned, I was doing an Insta story earlier today and I was saying, “I have five pages of notes.” So, literally, I could have continued talking to you for hours on end-

Lara Briden: Oh, yeah?

Cynthia Thurlow: -about so many different topics. Hopefully, we’ll be able to reconnect later in the year or in 2023.

Lara Briden: Yeah. Sounds good. We’ll look for Part 2. Thanks, Cynthia.

Cynthia Thurlow: If you love this podcast episode, please leave a rating and review. Subscribe, and tell a friend.