Today I am honored to connect with a friend and fellow nurse practitioner, Marcelle Pick! Marcelle is passionate about transforming how women experience healthcare through an integrative approach. She has successfully treated thousands of women through her unique approach to wellness.
Marcelle is currently a faculty member of The Institute of Functional Medicine and has served as a Medical Advisor to Healthy Living Magazine. She has written countless articles and multiple books, including Is It Me or My Hormones?
I always think of Marcelle as a pioneer in the women’s health/nurse practitioner space. In this episode, we dive into her background and the impact of the Women’s Health Initiative. We discuss the limitations of the traditional allopathic model regarding hormones, common misconceptions about adrenal health, perimenopause, and menopause, adverse childhood events and adrenal health, how lifestyle affects our sex hormones, fibroids, endometriosis, PMS, PMDD, and contraception for perimenopause. We speak about endocrine disruptors, mold, and micro toxins. We also get into ways to think about hormone replacement therapy and ways to address intimacy and low libido.
I love connecting with other nurses and nurse practitioners! I hope you will love today’s conversation with Marcelle as much as I did!
“When women have had a lot of stress, we have high amounts of reverse T3. So the body is behaving as if it doesn’t have enough thyroid.”
– Marcelle Pick
IN THIS EPISODE YOU WILL LEARN
- Marcelle was part of the first all-women practice in the country.
- How the Women’s Health Initiative has impacted health care for women.
- The limitations of the traditional allopathic model, particularly in terms of perimenopause, menopause, and hormones.
- The less common labs that Marcelle likes to look at for her patients.
- Marcelle shares her approach to unraveling the symptoms of perimenopause.
- Some unique ways in which Marcelle deals with problems like fibroids and endometriosis.
- How childhood trauma could lead to adrenal and autoimmune issues, weight-loss resistance, and various other health problems.
- Many of the things Marcelle recommended for treating PMS and PMDD back in the day (1985) have now become the standard of care.
- Contraceptive options for women in perimenopause.
- The impact of stress on adrenal function during perimenopause and menopause.
- Marcelle dives into liver health and detoxification, chemicals and other factors that could impact our health, and changes we can make to avoid problems and feel better.
- What Marcelle does to help women with low libido.
Marcelle Pick, OB/GYN, NP, is passionate about transforming the way women experience healthcare through an integrative approach. She co-founded the world-renowned Women to Women Clinic in 1983 with the vision to not only treat illness but also help support her patients in pro-actively making healthier choices to prevent disease. She has successfully treated thousands of individuals through her unique approach to wellness.
In 2001, Marcelle created MarcellePick.com with the goal to be able to reach, inspire, and educate even more women worldwide – her website offers informative articles on women’s health issues and at-home solutions to some of the most troublesome symptoms they experience today.
Marcelle discovered Functional Medicine early on in her career and was honored to be among the first to be certified as a Functional Medicine Practitioner. In addition, she holds a BS in Nursing from the University of New Hampshire School of Nursing, a BA in Psychology from the University of New Hampshire, and her MS in Nursing from Boston College-Harvard Medical School. She is certified as an OB/GYN Nurse Practitioner and a Pediatric Nurse Practitioner and is a member of the American Nurses Association and the American Nurse Practitioner Association.
Marcelle is currently a faculty member of The Institute of Functional Medicine and has served as a Medical Advisor to Healthy Living Magazine, writes a weekly newsletter for MarcellePick.com, and lectures on a variety of topics including weight loss resistance, infertility, stress & illness, and adrenal dysfunction. She is the author of The Core Balance Diet, Is It Me or My Adrenals? and Is It Me or My Hormones. She has appeared on Dr. Oz, FOX, and ABC and has been featured in Glamour Magazine, ELLE Magazine, and Woman’s World Magazine. Marcelle’s PBS show, Is It Me or My Hormones, is a favorite among viewers.
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All of Marcelle’s books are available on Amazon
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 had the honor of connecting with a good friend and nurse practitioner, Marcelle Pick. She’s passionate about transforming the way women experience healthcare through an integrative approach. She has successfully treated thousands of women through her unique approach to wellness. She is a faculty member at the Institute of Functional Medicine and has served as a medical advisor to Healthy Living Magazine, has written countless articles and multiple books including Is It Me or My Hormones? Today, we dove deep into her background and the impact of the Women’s Health Initiative. We spoke about the limitations of a traditional allopathic model as it pertains to hormones, common misconceptions about adrenal health and perimenopause and menopause, the role of adverse childhood events and adrenal health, the impact of lifestyle on our sex hormones, fibroids, endometriosis, PMS, PMDD, contraception for perimenopause. The impact of endocrine disruptors as well as mold and mycotoxin, ways to think about hormone replacement therapy as well as ways to address intimacy and low libido. I hope you will love this conversation with Marcelle as much as I did. I really love connecting with other nurses and nurse practitioners, and I know you’ll find this information to be invaluable.
Well, Marcelle, it is such an honor to have you on today. I’ve been so excited for our conversation.
Marcelle Pick: So am I. I’ve wanted to do this for a long time with you. So, I’m here.
Cynthia Thurlow: Absolutely. Let listeners know a bit about your background because I really think of you as a pioneer in the women’s health nurse practitioner space. As were talking about before we started to record, I’ve generally genuinely had trouble bringing NPs on as experts. I want to kind of change the narrative about how nurse practitioners can offer just incredible level of care. You’ve really been able to kind of witness what’s happened over the last 20, 25 years with the Women’s Health Initiative, how that impacted bioidentical and even hormonal replacement therapies, the net impact on women and women’s care. Now we’re coming back around, and I’m feeling grateful and perhaps hopeful that the narrative is changing again.
Marcelle Pick: Yeah. So, it’s interesting. When I went to graduate school, I went to a combined program with Harvard Men and Boston College, and I was very intentional about that because I knew if I had the creds, no one could say anything to me when I really was starting as a nurse practitioner back when very few nurse practitioners were identified.
In 1985, we actually started Women to Women, and I actually started it two years before. That’s why I kept the name. And two of the physicians and a nurse practitioner joined the practice, the first all-women’s practice in the country. So, we had to get attorneys from Colorado because we had different licenses to make sure that we can kind of be equal partners, it was really quite the affair. And we bought this huge Victorian home. I went into debt numbers I could hardly even speak at that time.
But we all really knew back then that we wanted to make a difference and have women become their own midwives, to know about their body so well that they could start having a voice and ask questions. I didn’t think about it at the time. I was terrified, I was a baby, I was young, just got married, and was like, “Oh, my God, what am I doing?” But we did a great job and we really grew very very quickly.
Cynthia Thurlow: I bet. Well, I think it’s interesting that the kind of traditional prevailing allopathic medical model is that women are these kinds of silent conduits to contraception and pregnancy and the postpartum period. God forbid, we talk about aging women, perimenopause, and menopause. I think for those of us that have navigated both as clinicians and also as patients ourselves, we just realize there are glaring disparities in the way that conventional Western medicine, the model really looks at wellness and healthcare and preventative care as it pertains specifically to women’s health.
Marcelle Pick: Oh, it’s so funny when we started the practice, is all of the docs around that were mostly all men practices in my area that were no all women, they said to us, you’re never going to be busy. No one’s going to want to go to all women. The people that put ourselves in because at the time we had paper charts, they had to keep coming back because we were so busy so fast. So, it was really interesting. We got actually a national reputation at the time because of who were and what was going on with Chris Northrop’s book and so on so. It was hysterical. I wanted to kind of jump from the rooftops and go, “Ah, we were right, you were wrong,” but we didn’t do that. We just really enjoyed how many people were able to help.
Cynthia Thurlow: Yeah. That’s really what it comes down to. I think certainly as a middle-aged woman myself, I definitely look for a type of medical provider. Certainly, when it comes to preventative care, GYN care because the years of me having children are many years behind me, it’s really important for me to feel very comfortable with the provider I’m working with. There’s just a degree of camaraderie with other women. They understand we have the same parts. We’ve been through very similar circumstances in many ways. I am not at all surprised that you all had such incredible success.
Now, in terms of that trajectory that uou preceded the Women’s Health Initiative, you were practicing before then. What was that like as a practitioner? To see the results from the Women’s Health Initiative or the WHI as it’s more commonly referred to. The downward effect of how that impacted the care that you were delivering and people’s comfort talking about hormonal replacement therapy, women asking for hormonal replacement therapy, I would imagine that was really impactful.
Marcelle Pick: Oh, absolutely. What was so interesting, though, is that years before we were already using bioidentical hormones. I didn’t feel that many of the pieces to the puzzle when you actually looked at the study itself impacted my patient population. The part was difficult is that people were scared, and every single provider around us was saying, absolutely not. It’s dangerous. You shouldn’t be doing it. But mind you, we opened at 85, so we had years of experience behind us and we were using what was available at the time. As time went on, I started using more troches and melts and now we have patches too. I was using different combinations including creams and using compounding pharmacies. There are many more compounding pharmacies now than they were back in the day. It was Women’s International Pharmacy, I think it was the only one that people were using. We looked at the Women’s Health Initiative and the unfortunate part about that is that even to this day, a lot of people are not understanding that many of the women that were in the study were actually ten years post menopause.
When you have those receptors that are quiet and then we rev them back up, there’s going to be a very different set of circumstances that come out in adverse results than if you’re putting somebody that’s got hormones still present to some degree, and you’re putting them on hormones. But our culture still has not adapted that concept. If we look at all the research now, and there are tons of it because as I teach for the Institute of Functional Medicine, The Hormone Module, we’re always every single year updating our data on what do we know about hormones.
There are so many articles now and published double-blind studies showing that what we thought was true of all women in 2001 is not true of menopausal women. So that’s refreshing and wonderful to know. However, the general public hasn’t pulled that together yet.
Cynthia Thurlow: No, and it’s interesting. My mom was here for Christmas and as you can well imagine, she’s a retired nurse and she was an executive before she retired. We had a conversation about who I was interviewing today. I mentioned Marcelle is a friend and an NP. I said she was really a pioneer in women’s health. We’ve had conversations about hormone replacement therapy and my mom said, “Your legacy is to ensure that the tides shift.” She said, “My sister,” so I have five aunts in totality, “All of them were either put on hormones and taken off, or just never were on hormones.” They talk very openly about the degree of osteoporosis and the vaginal atrophy, and in some instances chronic inflammation, oxidative stress, they’re insulin resistant, and you can be thin and still be insulin resistant, and just a recognition that they understand that their neurocognitive status has changed significantly. And they talk openly about this, so I’m not sharing anything that they would be uncomfortable sharing, but it makes me realize why it’s even more important that we get good information out there, so that women don’t fear taking hormones if that’s the right choice for them and that clinicians don’t fear prescribing hormones for appropriate patients.
Marcelle Pick: Yeah, and I think that’s where the question comes in, is, do they have a family history of breast cancer? What are their cardiovascular risk factors? You really look at are they a green light, yellow light, or red light? And that you make a decision together. Every year when I would see patients in my practice, we would be going over the symptoms and I would have them sign a consent. Most of the time, people would say, don’t you ever take me off these. Don’t you ever. Because at times I would say, look, let’s just take a little break and see how you feel, then you can make a decision based on what you want to do. Sure enough, most of them came back and said, never again. That’s the hard, hard part for me about all these women that were on higher doses than I ever put people on of, not bioidentical hormones, Prempro.
They were taken off cold turkey and they suffered so badly. They really, really did. We didn’t have any ability to be– they did in my practice, but very few people would say, look, let’s do something a little different, and kind of hold it back down again. Because when I did blood work on these women, their numbers were sky high. We’re talking sky high, because their dosages were way out of sync. You take those women off hormones, they couldn’t think clearly, they were moody, they were irritable. It was horrible for them. So, no, I’m definitely going to always be on their rampages saying, “Look, they need to have choices. Let’s talk about what’s really good for them.”
Cynthia Thurlow: Yeah. I think that’s really important is this whole patient empowerment. Like, thinking back to the years when myself and all my friends were put on oral contraceptives to help control our menstrual cycles. We were never given fully informed consent. We didn’t really understand what low estradiol levels would potentially do to our bones. We didn’t fully understand what that could do at that low of a state of hormones for such a long period of time to control our symptoms. For the same reason we have to fully inform all of our patients when we’re working with them to really understand if you choose not to take hormones, that’s okay, but understand that these are the potential side effects that can come from that. Now, when we’re looking at a traditional, both of us are both dual-trained, traditional allopathic medicine. What are some of the limitations of the traditional view of perimenopause and menopause from the lens of that traditional kind of trajectory? We’re really focusing on symptoms as opposed to root cause management, which really does as a tremendous disservice as women.
Marcelle Pick: One of the things that I love about functional medicine is we’re trying to look at the cause of the cause. If somebody is having hot flashes, they’re not always going to be there for the same reason. When I see somebody coming into my office and they’re having perimenopausal symptoms, I’m on high alert as “How do I get this woman back to feeling normal.” I don’t feel like myself, I feel like somebody else has invaded my body, I’ve gained all this weight. I can’t think clearly, I’m crying all the time, I can’t sleep, and I’m having sweats or the biggest thing I’m seeing now is anxiety. Anxiety that’s coming from the bottom of their soul. For me, I need to try to figure out where that’s coming from and around perimenopause what I say to women is, look, “Perimenopause is this amazing journey of self-discovery. Who am I? What am I going to be for the second half of my life? And how do I get there?
And it’s not with an antidepressant. It’s really more self-reflection. A lot of women have a lot of issues that they hadn’t thought about for years that have been under the carpet that kind of come to the surface. I was like, “Okay, so let’s kind of look at that.” What can I do also to look at your adrenal function? What do I need to do to help with sleep? Why are you not sleeping? The anxiety may be coming from high cortisol production because in perimenopause estrogen is an anti-inflammatory. It keeps everything at bay a little bit. When you’re hitting perimenopause and menopause and it’s not there anymore, “It’s going to like oh my God, what happened to me?” It’s truly doing what you said is, let’s kind of really unpack what created the problem, and treat that instead of treating with an antidepressant. Sure, it’ll take the symptoms away for a bit. That’s not the root cause of what’s going on.
Cynthia Thurlow: Yeah. It’s interesting, even my own perspectives as a perimenopausal woman, I just happen to have my menstrual cycle. My first day of my menstrual cycle when I was seeing– for my annual exam with my GYN, she was like, “Oh my gosh, your period is so heavy.” I said, “Well, I’ve been telling you that I’ve been dealing with this.” And she’s like, “Okay, we will fix this. We’re going to put you on oral contraceptives. If that isn’t what you’re interested in, we’ll give you an IUD. Next step up would be an ablation. And you know what? You’re done having kids, so let’s just do a hysterectomy.” And I was like, time out. I don’t want any of the above. One gave me migraines. There’s no way I’m having an IUD. I don’t want a surgical procedure if I don’t absolutely need it. I feel like that’s my perception that’s the prevailing way of dealing with perimenopause is, “Oh, these things are going to fix the problem and they really don’t fix the problem.”
What I find really interesting is if we talk about some of the physiologic changes that are occurring in our bodies as we’re transitioning into perimenopause the 10 to 15 years preceding menopause, it can be precipitated by, suddenly you’re not sleeping well or you have more anxiety or depression or your cycles get very heavy, but not realizing that it’s these hormonal changes that are driving a lot of the symptoms we’re experiencing. If we don’t address that that can be problematic.
In your book, you talk a lot about some of the labs, kind of the traditional allopathic labs. There aren’t enough labs done often enough to be able to get a sense for what’s going on. If you come in with a typical perimenopause case, not sleeping, more anxiety, what are some of the labs like, less common labs per se, maybe from the lens of the functional perspective that you’ll be looking at in addition to things like the DUTCH, to get a sense for what’s really going on with this female?
Marcelle Pick: Yeah, great question. So, as I mentioned in my book, adrenals trump hormones and adrenals trump thyroid. I’m always going to be doing an evaluation of cortisol production, doing a saliva profile to look at the level when they wake up, 30 minutes later, noon, afternoon, and the evening. And this is my bias. I like another company besides DUTCH for that. I think they’re more specific to the symptoms that I see in my patients. In addition to that, I’m going to do a full panel of thyroid testing because that’s when we see most women have thyroid issues. I’m going to do a TSH, free T3, free T4, total T3, thyroid antibodies, and reverse T3. The reason that’s so important is because when people have an enormous amount of stress, we’ll do normally a TSH, and oftentimes a T4. But what they’re not looking at is how much active thyroid do they have, how much active T3 do they have. When they’ve had a lot of stress for many different reasons because there’s a lot going on in the world right now. We have high amounts of reverse T3. The body is behaving as though it doesn’t have enough thyroid. So, I always do that as well.
I’m going to do the standard test, but I’m also going to look to see what their hormonal levels are, depending upon what they want to do. If they say, Marcelle, I don’t want to intervene with any hormones, then I might not do that testing. But most are curious what’s going on in my body. The conventional approach is your hormones are going up and down all day, it doesn’t matter. Well, that’s not completely true. That is if we’re specific about when we do hormone testing, like on day seven for estrogen levels, estradiol, and estriol. I don’t do estrone generally. On day about 22 of a cycle, if they’re still having cycles, I’m going to be looking at progesterone levels, DHEA-S doesn’t matter, FSH/LH I might do around day three if I’m wondering where their numbers are for menopause? I’m going to be more specific to that patient as to what they’re wanting and then we’re going to really start to unravel things. But here’s the other thing that’s interesting and that is I’m going to do a gut evaluation because the gut is so important, certainly for serotonin production, two-thirds of serotonin is produced in the gut. If they’re stressed out, that’s going to affect serotonin, which is going to have an impact on brain function. And round and round the circle goes. Also, the food that they’re eating and how much stress do they have there in their lives on a scale of one to ten.
All of those seem to really have kind of a symphony in perimenopause. It’s kind of this climactic time in which so much happens and it’s really unraveling that. I’ve used progesterone for years and years and years and years instead of oral contraceptives. Here’s something really interesting and that is that we know now that the microbiome of the uterus is impacted with regards to heavy menses. We know that certainly the food that we eat can actually impact that inflammatory cascade too. We know that the vagina and the uterus have the microbiome. As we shift that microbiome, it also very much contributes to that menstrual shedding and menstrual bleeding the heavy periods as well. That’s pretty new information and pretty exciting. We can actually predict from the microbiome of the uterus if somebody’s going to have cramps. We can predict, this is going to really sound crazy, from the microbiome of the vagina if they have freckles or not. They did an enormous study kind of looking at how can we really understand things now that can shift, obviously, as we change the microbiome as well. It was kind of interesting stuff that’s coming down the pike.
Cynthia Thurlow: Well, and it’s interesting because very likely when you and I initially trained, the gut microbiome seemed way far off. But now we talk about the oral microbiome, the gut, the vagina, the uterus. I mean, it’s amazing to understand that there are all these microbial products that go on– viruses, bacteria that are designed to be there, but differentiating that it can lead to more inflammation, less inflammation, more likelihood to skin changes, the freckle thing is fascinating.
Marcelle Pick: I’m not fascinated at that? I was just like, are you kidding me? [laughs]
Cynthia Thurlow: Yeah, someone paid for a study to figure that out, which is fascinating. But when we’re talking about heavy menstrual cycles so obviously not unique per se to perimenopausal women, but women that are prone to fibroids or endometriosis, what are some of the unique ways that you look at these problems? Got a lot of questions about this because the standard medical care– fibroids, they either get a myomectomy or they’ll go in and they’ll get oral contraceptives. Endometriosis can be very extensive. It can be mild and be very extensive. For many of these women, it’s been my clinical experience, a lot of emotional components to it, which is probably completely related to the fact that they’re dealing with some chronic pain issues.
Marcelle Pick: Well, it’s kind of hard to know the chicken or the egg in that case. What I find is when I was in practice for many, many years, 37 years, that so many women that had endo were high achievers, even though that’s not a standard thing and expected a lot of themselves when I kind of looked back at their story, they oftentimes had a fair amount of, I don’t know if I’d call it trauma, I think that’s a heavy word prior to that adolescent time. We’re starting to understand a little more about endo. That may be an autoimmune reaction, in which case when you have those endometrial cells that are sloughing back into the abdomen, the body doesn’t have the ability to actually phagocytose those cells, which may be part of the immune system.
We also know that women that have endo almost always, always have Candida. That gets back to the gut microbiome. I’ve never seen somebody to date that I had that I treated for endo that didn’t have overgrowth of Candida. We also know that there’s a high number of those women that have high dioxin levels. And the association between endo and high dioxin is also present. When you’re working with someone or me, I’m going to be looking at all those pieces to the equation so I can really see if I can help them look at what for them is that contributing factor. I had such an interesting case many years ago. I actually wrote her up. It was Women’s Health magazine interviewed me for her. At the time I saw her, she was 32 and she had seven years of IVF, she had one child and she was getting ready to have a hysterectomy for endometriosis because she had excruciating pain and she couldn’t be with her son.
I said, pkay, but you’ve got to cancel the hyst by next week, I can’t, what can I do? Indeed, we did the whole evaluation. We looked at her gut, we looked at her adrenals, food sensitivity. She did have yeast and a parasite. We treated all that. I also had her go to Al-Anon because she had a huge family history of alcoholism. I said to her when she came back to see me because her score of how many symptoms she had, so much, much better and she wasn’t having pain anymore, and she was all happy. I said, you really should think about birth control. And she’s like, give me a break.
I’ve got half an ovary on one side and a blocked tube on the other because they took one of the tubes out and she goes no way. She got pregnant, so she had a baby. That’s why we wrote her up in the magazine because she did all the pieces and really started to understand the connections. So for me, it wasn’t just about– “Yes, it’s emotional, horrible when you have endo, but what created some of that to begin with? And that’s where I always go. “If you don’t deal with your story, your story will deal with you,” is kind of a metaphor I use a lot. It was a combination of all that. It’s not the first time I saw that in my practice. I actually saw it quite often. It’s looking at all the pieces to the puzzle for her what contributed to that. The good news is we can do something about it. The bad news is the traditional way of dealing with it doesn’t always work.
Cynthia Thurlow: Yeah. I can imagine.
Marcelle Pick: It will help you get pregnant, but it doesn’t always help the pain or cramps.
Cynthia Thurlow: Yeah. I’m so grateful that she met you and avoided having a hysterectomy. I mean, that’s such a severe surgery to have at such a young age. I do hear over and over and over again, people will send us messages. They’ll say, what are my options? And I’m like, we’re not-
Marcelle Pick: Of course.
Cynthia Thurlow: -your treating doctor or nurse practitioner, but here are some resources, discuss them with your healthcare practitioner. What about for women that have debilitating PMS or PMDD, which is the really severe form of PMS that I think for a lot of practitioners, they think of, “Oh, this is just what every woman goes through.” The one thing I want to interject was I only had PMS when I was taking oral contraceptives. When I wasn’t taking oral contraceptives, I had no PMS. It’s like, how many thousands and thousands of women every month they have debilitating PMS and it’s actually a byproduct of the contraceptives that they’re taking.
Marcelle Pick: It certainly can be and my experience is that many times because the progestogen that’s in the pill is not the same as we produce, which is called progesterone, and many times, if somebody is already progesterone deficient, getting them on the pill makes the progesterone deficiency worse. So, the symptoms are pretty intense. When I’ve had people on birth control pills, I’d always use progesterone cream days 7 through 21 of the pill packet or if they were using a ring, I would kind of shift it as well in the same format.
In my experiences interestingly enough, I mean, back in the day in 1983, we only had progesterone suppositories to treat women with, but I was using them back then through a compounding pharmacy with amazing results for PMS and PMDD as well. But there were times I would use a higher dosage. I mean, there were times for some people I had them on 400 milligrams a day and I changed it from day 7, then I increased the dose on 10 and I increased the dose on 14.
Again, I was monitoring the levels very carefully because progesterone can actually increase estrogen levels. But the results were night and day. What everybody would say to me is “That black cloud is gone, the veil is gone.” I feel back to normal. For many of those women, they would say I’ve got one good week a month, I can’t live this way anymore. For me it was devastating for these people. It was really nice to be able to give them an option back in the day, even though I was kind of herald in the community as, “Oh my God, she’s really kind of gone out to lunch.” The irony is now is many of the things we recommended back then weren’t standard of care. I was using probiotics back then and now it’s standard of care. Even most gastroenterology offices are using it. It’s interesting if you follow the literature with regard to what they’re doing in Ph.D. clinics, that’s where you really gather the data. It takes a lot longer for the double-blind studies to come up and they’re usually medicine oriented anyway.
Cynthia Thurlow: Yeah, it’s really interesting because you were way ahead of the curve and a lot of what you’re sharing now makes so much sense. As a woman who had thin phenotype PCOS, it makes complete sense why when I was taking oral contraceptives with a luteal phase defect where my progesterone levels endogenously were too low, why it made the PMS, why it really magnified all of that. Now we got a lot of questions about what are your traditional recommendations, again generalization for women in perimenopause who are done having their families, but don’t want to run the risk of getting pregnant prior to menopause. Do you have favorite contraceptive options? What are your favorite ones that you’d like to use?
Marcelle Pick: I did a whole presentation on that for IFM and I think my favorite one is probably the NuvaRing. I always add progesterone with that as well because you do not want to get pregnant, if you don’t want to get pregnant. You don’t want to put yourself in that position and using something like a NuvaRing and really adding to it than progesterone but also looking at adrenal function and also at nutrition, making sure that the sugar amount is down and all that kind of stuff so you can feel your optimum.
People have asked me the pill, it’s hormones and I’m thinking, you know what? I’d rather them be on that than get pregnant if they don’t want to be. We need to have some ability to be able to have control. You still want to be sexually active. You don’t want to have a tubal ligation or your partner have a vasectomy, then my favorite is probably the NuvaRing. You don’t have to mess with every night. You put it in, you take it out, and using it in combination with oftentimes V Vitamins because they can deplete the vitamin stores and then using progesterone cream with it is probably my favorite.
Cynthia Thurlow: I love that. It’s something that is respectful of the fact that women are looking for dedicated, reliable contraceptives, but also understanding that there’s no shame. In fact, I am working with an NP right now who is on oral contraceptives in perimenopause and just said listen, I can’t get pregnant at this stage of the game. I’m older than I would want to be as to have another child and I just need somebody to be reliable until I go into menopause.
Marcelle Pick: Absolutely.
Cynthia Thurlow: Yeah. You’ve alluded to multiple times adrenal health and I interviewed Dr. Kyle Gillett earlier this year and he used a term I’d never heard of before, but it makes complete sense, adrenal pause. Understanding that our adrenals take a little bit of a hit transitioning into middle age and the importance of understanding what our adrenal glands are doing as our ovaries are producing less progesterone would be helpful for listeners to have that reinforced because this is why we become a little less stress resilient. This is why the lifestyle piece becomes critically important in perimenopause and menopause.
Marcelle Pick: Again, we don’t have estrogen to kind of cover things up, if you will. And it’s really a great masker. Adrenal function is interesting because before menopause 15% of our hormones are produced by our adrenal glands, post menopause, about 30% are. They’re having additional need for the production of more hormones and if they’ve already been maxed out because of stress and the urine fight-flight a lot. It’s interesting because when I talk to people a lot, I don’t really have a lot of stress. The question I ask is, well, how much negative self-talk do you have? Of course, it’s like [Cynthia laughs] stress right there or how much stress did you have as a kid? What was your what I call ACE score, which is adverse childhood event score and if it’s right up there, then you may be having this kind of verbiage going on in your head that is contributing to cortisol being produced in every situation.
If you’re an over pleaser or if you are someone who always thinks you’re wrong, or if you’re someone that just doesn’t have good self-esteem, all of which gets magnified in menopause, then that’s going to come up as an issue too, which is going to produce more c. The interesting thing is that cholesterol makes cortisol. If you’re on a cholesterol-lowering drug that can contribute to this whole cascade of events that go on that are not really healthy for you.
In and of itself, if we have too much requirement for cortisol, it will go to cortisol at the expense of estrogen, progesterone, testosterone, and DHEA. There’s an enzyme called 17, 20 lyase that blocks that conversion. And what does that mean? Well, it means that we don’t have as much progesterone because that’s a thing that goes down first, and then it’s estrogen and certainly testosterone as well.
That all contributes then to the body trying so hard to produce those hormones and it can’t. And we’re then more in fight-flight. We have more anxiety that sense of adrenaline going up and we can’t sleep, and that’s because oftentimes cortisol is up at night and we’ve got too much cortisol production and we don’t have enough melatonin sometimes as well. It’s a cascade of events that go on. I call it adrenal dysfunction. You can call it adrenal pause. I mean, all those names are great. I’m not a great fan of the adrenal fatigue concept and I write that in my book because I think that’s what’s gotten us in trouble in the conventional world. Adrenal fatigue, are you serious? but it is a reality.
If you look at the bell-shaped curve, most people don’t have Addison’s, which is too low, most people don’t have Cushing’s, which is too high. They fall within the ends of those curves with very significant symptoms. There’re degrees to adrenal dysfunction as well depending upon how long it’s been going on. Our body is not meant to be in fight-flight all the time. Thousands of years ago, we’re going to be chased by a tiger. We either got eaten or we went back and kind of life was back to normal. That isn’t the case anymore with all the social media stuff, all the news, the computers, our lives, the COVID and pandemic, and everything like that. We really have to find ways ourselves to not decrease the stress per se, but to find that parasympathetic kind of pause, if you will so that we’re not on high alert all the time.
Cynthia Thurlow: It’s so true because if the last nearly three years has shown us anything, it’s chronic debilitating sympathetic dominance, that fight or flight. If that’s chronically activated, your amygdala, which is your lizard brain, will override your prefrontal cortex, which is your thinking brain. People don’t say or do things they would otherwise normally do under normal circumstances. It explains why a fear-driven mentality can impact people pretty significantly. Understanding there are things we can do, that’s always the message that I know you and I always want people to understand that in middle age, perimenopause, and menopause, you have to do more to invite that parasympathetic whether it’s meditation, connection to nature, getting sunlight in the morning, slowing down, saying no more often. I know that’s been a work in progress for me, especially coming off of a book launch, having more downtime, taking a nap, doing those kinds of things really has value beyond the perception that we want to be busy all the time. I think that Rushing Woman’s Syndrome that you hear used in the vernacular is really problematic.
Marcelle Pick: Oh, no question about it. I think unfortunately we’re also very good at multitasking. When we’re good at it and it becomes behavior and then there’s perimenopause, there’s alot of kind of questions about things, about yourself and you stay busy to maybe not deal with that too, so it gets complicated. It’s being willing to kind of sit with the anxiety to some degree also to find out what is this about, what is this telling me? Because their bodies are unbelievably infinitely wise and if we just learn to listen to some of those pieces, we can also gain such incredible information. In addition to the hormones and the adrenals and gut microbiome and all those pieces together, it’s a network that we really need to look at to be able to help people feel better.
Cynthia Thurlow: Absolutely. I’m glad that you brought up the ACE scores, so adverse childhood events. The more I’m looking at the research, the more I’m realizing that men and women, if you undergo a lot of childhood trauma, it can set you up for not only a significant likelihood of developing autoimmune disorders but also weight loss resistance. The latest studies that I was looking at was showing the interrelationship of this chronic inflammation, oxidative stress, chronic stress at an early age that can really set you up for quite a bit of health problems moving forward.
Marcelle Pick: Yeah. I guess the thing that I really want to reiterate here is that what’s so important to know is just because you had a lot of stress as a kid does not mean you can’t get over it. Nor does it mean you have to go through all of the stress over and over again. It doesn’t have to happen. It is very important to recognize that if you grew up in a home in which there was a lot of anger, perhaps nothing ever happened, but there was a huge amount of anger. A lot of those women become perfectionists. That doesn’t work very well in the world for us in medicine, thank God but what I mean. All of that we carry forward until we start to understand ourselves. It’s not a bad thing, but it is a very important piece to recognize.
One of the books, my first book that I wrote is basically on weight loss resistance, again, I was way before my time. As our issues are in our tissues, that was the last chapter in my book looking at what are the emotional pieces that are staying connected to us. It really behooves us to understand it, to do some self-reflection. Because I promise you, it is directly related to heart disease, to cancer, to early retirement, to disabilities, to heart disease, i’s everything and also metastatic changes. The most recent research is astounding when it comes to that and it is oxidative stress and stress. I just urge people, if it is true, they can go and look at the ACE score themselves and also the resilience score. And see is it high? Okay, so now that’s okay and I do that. I have an adrenal program, a six-week program. The first thing I ask people is, what’s your ACE score? We can kind of know where we’re headed with this, because that’s the thing I see keeping people in adrenal issues is that they’re not dealing with that trauma.
Cynthia Thurlow: Yeah. I’m so grateful that you have been laying the groundwork for doing this work and it’s interesting. I just interviewed a good friend of ours, Dr. Joan Rosenberg, and we were talking about childhood trauma and just things that we grew up in. She said, “If you have the capacity to think, you have the capacity to change.” I just want to make sure I close that loop and offer her up that even if you grew up in a less-than-harmonious environment as a child, you absolutely positively don’t have to let that be your destiny. Now, a lot of questions came in talking about liver health detoxification, which I know for us both, we understand this complex interrelationship, in particular, of estrogen and detoxification in the body. Let’s talk about that, a little bit touch on liver health detoxification because I think that people need to understand and this is where the allopathic and functional models really differentiate.
If you’re seeing a traditionally trained allopathic medicine provider and you’re in menopause or perimenopause, you may just get hormones right out of the block. But you and I are really looking at layers of items in terms of lifestyle and detoxification before we even consider adding in hormonal therapies.
Marcelle Pick: So, it’s interesting. There’re two pieces that I think about with that and one of them is there’s layers of how we detoxify our hormones estrogen. There’s kind of “The good, the bad, and the ugly,” as I wrote about in my book. In addition to that some people what I call pathologic detoxifiers and that’s really helpful then to know their genetic profile because if you have– we have the liver that has a phase 1 and a phase 2 component. Phase 1, we actually make things biologically more active, so they actually be more problematic for us if we will. We have a phase 2 that gets it out really fast. So, some people have a very active phase 1, very, very quickly, much faster than others and a slow phase 2. That would be the person that goes into Home Depot and goes, “Oh, my God, can’t you smell it in here?” Or the person that’s super reactive to perfumes or the person that just says, “I’m so sensitive to smells.”
They’re usually the ones that activate it very quickly and can’t get it out of their system. I’d be more inclined to want to know that as well as their ACE score, as well as how their body is metabolizing that estrogen, is it going down the pathway of “The good, the bad, and the ugly”, because the good news is we can do something about it. We add fish oil, we change their diet, less sugar, more protein in their diet, flaxseed oil and then we add either I3C indole-3-carbinol or we do something called DIM. And this controversy is DIM better or I3C better, it’s like let’s see what works to get that and the beautiful part is we can change that. That’s easy to change. What’s a little harder to change is phase 1, phase 2 issues because you just generally need some additional support, perhaps even including acupuncture or something like that to really facilitate that.
Cynthia Thurlow: It’s really interesting. We take the concept of detoxification for granted. We poop, we breathe, we sweat, we urinate and it’s far more complicated than that. The more that I know, the more I’m humbly looking at my body and saying, wow, like, we just assume if we poop every day that everything’s functioning optimally. And what can happen? For some people you mentioned “The good, the bad, and the ugly” talking about these metabolites that we look out on the DUTCH. But for some people, they don’t get this proper detoxification of estrogen, they recirculate it, but because they’re having a bowel movement every day, they assume that they’re ridding themselves of excess hormones and that may indeed not be the case.
Marcelle Pick: Absolutely. That’s why it’s so helpful to get these additional tests, like the DUTCH test or even the stool test. Because if you see a stool test and they have a high level of what we call beta-glucuronidase, we know that those are people that more than likely have got recirculation of the estrogens, which can certainly be problematic. And without even being on hormones it can be problematic, especially if you have increased adipose tissue, then you’ve got more estrogen stored in the tissue and that can be even more of an issue. The beautiful part that we’re talking about is that we just need to have our people see people that know how to kind of interpret this for them, so that we can really get them on the other side and truly go into their 80s and 90s gracefully and feel and look amazing. Because I really do believe that that’s possible, but we have to be a little bit more careful about looking at what’s underlying the issues.
Cynthia Thurlow: Absolutely. A lot of questions came in about how you go about and again, generalities because you’re not treating anyone that’s listening. When we’re talking about the systematic way that we look at bioidentical hormone replacement, whether it’s starting with progesterone or DHEA, and then moving on the continuum to appropriate types of estrogen, possibly testosterone. I don’t know what your feelings are in this and to tie into that because you mentioned troches, you mentioned lozenges, you talked about patches. I’m seeing a lot of people in the functional space that are doing subcutaneous testosterone. Obviously, pellets are something I know we’re in agreement on, that we don’t love. But there’re lots of different ways to administer hormone therapies and some are more embraced than others.
Marcelle Pick: I’m always going to be looking at the person and I’m going to be perhaps starting them on what my favorite thing would be. Sometimes they say, “I’ll need to be covered by insurance.” Okay, then I can use a patch easily, Minivelle patch, tiny little thing. I usually start at 0.0375, maybe 0.05 depending upon the symptoms. I’ll add progesterone and oftentimes I will add a time-release capsule. There’s controversy around that. The reason I do that is because I want to make damn sure that I’m protecting the endometrium that’s just my [unintelligible [00:42:30] because I’ve seen too many people come in with hyperplasia, which is an overgrowth of too much estrogen in the uterus because they weren’t on and protected enough with the progesterone. I might put it in a troche however. There are times that I will put a combination of the, I might do tri-est; estriol, estradiol and progesterone.
There are people that I will also do DHEA, but more likely I’ll use drops because they do a milligram per drop for that DHEA. Then I work them up to 5 drops twice a day and it works like magic. I will also sometimes put people on testosterone, it depends on what their levels are, but I always test them then to find out and those people I will test at baseline to see where have I shifted them to. And then I’ll look at them. Usually, I do it twice a year. I’ll do blood for some and depends on what kind of hormones I put them on and then I’ll do a urine, so I can look at 2, 4, and 16 of those metabolites in the urine once a year. I usually do it twice-a-year testing. Everybody’s different, but I always do adrenal testing too because if their adrenals are off and they’ve got more stress, it absolutely affects the efficacy of the hormones they are on, even if they haven’t changed forever and they have a lot of stress, I’m looking at these things going, what happened? It’s usually, well, someone died or something happened or something like that. It’s just important to be on top of what’s going on in people’s lives-
Cynthia Thurlow: Absolutely.
Marcelle Pick: -and it really depends on what they like. I’m not a big fan of creams long term. This is my personal bias because I think sometimes they stop being as effective and you have to kind of try and find different places. I can get as much success with the others. Some people use vaginal creams and that’s another option for people that certainly have to be careful with that, though, the absorption vaginally is like 10 times higher.
Cynthia Thurlow: That makes sense. It’s interesting because as we get questions, we have group programs, we get a lot of questions online, as I’m sure you do as well. There’s so much variation in how different people practice that sometimes it’s a sticky wicket, meaning it doesn’t matter what you say because inevitably you’re not the treating provider. You don’t have the option of looking at labs to be able to make determinations about what the best options are for them. I know that pellets can be controversial because for many people there’s wide variability in terms of efficacy, symptoms, etc. During your 30-plus year journey as an NP, were pellets ever a part of your practice?
Marcelle Pick: They weren’t. The reason for that is that when I would do testing on some of these people, and I would do testing not in a conventional lab. I’d do testing in which we’re really looking at what do we know for the differentiation of what those numbers should be for someone who’s menopausal and on hormones. The numbers were sky high. I was thinking, I only need a small amount. We don’t have a lot in our bodies to begin with and it’s an orchestra. I need to make sure that everything’s together. But that testosterone is balanced, the DHEAS is balanced, the estradiols are balanced, and the progesterone is balanced, and obviously cortisol production. My experience has been, when I see people on troches and I mean obviously, people love them because there are people still using them. I haven’t seen that myself. But once you’ve got it in, it’s like if you’ve got a pellet in, it’s going to have to just wear itself out and see what happens.
I can get the same results using less but more balanced, in my opinion. Doing the functional medicine approach, which is looking at all the other contributing factors to what’s their diet like, how much exercise, how much sleep, how happy are they? What was their ACE score, then we can put that all together and generally people feel remarkable.
Cynthia Thurlow: I bet, and you’ve touched on it, but let’s expand on this a little bit more. You mentioned things that can contribute. It’s a lot of its lifestyle, but I think for many people, they don’t recognize that chemicals we’re exposed to are in our environment, our personal care products, and our food can have a negative net impact on our hormones. You talked about the symphony. They can make this symphony go from being a beautiful melodious sound to being a disaster. Over the last 30-plus years, you’re probably seeing greater awareness about estrogen-mimicking chemicals and endocrine disruptors and how these can impact our health. I speak quite a bit about how some of these can actually impact insulin resistance and vis-à-vis also related to the inflammatory nature of adipose tissue or fat tissue, which is a highly sophisticated organ. Many people don’t understand, it’s not just fat, it is far more sophisticated than that. What have been some of the things that have been allotted a great deal of improvement in your patient population by making some of these changes?
Marcelle Pick: I think when you look at health overall, from skin rashes to mood to how often people get sick to the immune system, all of that can be greatly changed by looking at what those issues are. Do they have a mold issue? Have they ever been exposed to a lot of molds? How many things do they put on their face? The average newborn has 247 chemicals in its cord blood. The average baby that’s being breastfed and this is old data, 150 different chemicals. Do I suggest you stop breastfeeding? Absolutely not, of course not, I would never do that. However, we have to understand that there’s more childhood cancers than ever before in our history. Why is that? I think a lot of times we don’t think of it. We put something on your skin or we’re not paying attention to preservatives, or we’re not kind of acknowledging that these things have an impact and it’s enormous.
When I was first in practice, we were talking about organics. Chris Northrup and I were both [unintelligible [00:48:09] at the time, and we’re very conscientious of kind of the food that we eat. As time kind of moved on, we started to realize protein was probably more essential. But we’ve been talking about all of these pieces for a very long time. Back in the day, we were talking about organics and there was no research, no literature. It doesn’t make a difference. Now we have the data to show it makes an enormous difference because if it’s conventionally grown, oftentimes they’re using pesticides on it. That doesn’t create something called hormesis, which is the plant becomes resistant to the bugs on its own and you are able to actually take that in. We know that the nutrient status of those foods is much higher. Now, do you always have to buy organically? No. You can go on the Environmental Working Group and you can look at what foods would better, what we call the clean fifteen and the dirty twelve because they change every year.
But they also have information about what skincare products can you use? What about sunblock? What about all the things that we’re using that actually can make us really unhealthy and we’ve been exposed to so many– You can go outside. There was a study done in Maine and they looked to see there’s no problem here, we were so pristine and so on. They looked at the legislators and they looked at hair and blood from 17-year-old, 18-year-olds all the way up until their 80s. There was not one person that didn’t have at least 15 to 30 exposures. We know that it is true in us. Okay, so don’t get scared by it. But then what can we do to detox our system? How can we support the liver? How can we be more mindful of how much alcohol consuming or toxic relationships that contribute to?
It’s all of these things that we’ve beautifully talked about today that contribute to our ill health and stopping those things. The beautiful part is they did a big study in Europe of 70-year-olds and looked to see if they changed their diet and got them on nutrients. Did it make any difference in their outcome? Yes, it increased their life expectancy by five years. That’s a big deal. If we change and we’re more mindful of even when you build a new house with a lot off-chemicals that are going off, off-gassing we call that, that can be problematic for a long time. When we built this house that I’m in now, we put wall-to-wall carpeting in the room that I had my children in and my son developed ulcers on his eyes and we took the carpet out the next day. Some kids are just more sensitive. It was my stupidity of like, why would I do that? I knew better back then. It was a long time ago. It is those things that we really really have reactions to that can contribute to people feeling much healthier if we start to understand it.
Cynthia Thurlow: It’s so important because really looking comprehensively at all of the factors that can impact our health, not just the low-lying fruit, but understanding all these subtleties can have a huge impact. A couple more questions. I got a lot of questions about libido, which I know that you’re going to mention that libido is more than just hormonal fluctuations. There are so many contributors. If you’re dealing with a woman that is perimenopausal or menopausal and the libido is a byproduct of painful sex, dryness, etc., what are some of the things you start with other than diagnostic testing?
Marcelle Pick: I love this question [Cynthia laughs] because here’s the thing. In my practice, I would say about 60% of my patients over 60 were not sexually active anymore. I would always ask the question, what’s up? What’s going on? Well, we’re both okay with it. I can pretty much guarantee you hormonally that’s absolutely a piece to the puzzle. But when women have vaginal dryness, who would want to have sex? Thank you very much. When you feel like you have knives in vagina, forget it, no way, not going to happen. I always talk about a happy vagina. I want women to have a happy, happy, happy vagina. It’s easy to treat because we can use– I use estriol cream and sometimes I’ll put DHEA in it. Sometimes I’ll just use DHEA vaginal cream and that symptom can go away in a week. That’s an absolute ridiculous issue that any woman should have to have.
We know that estriol in particular doesn’t go back upstream. Even around here, many of my patients whose oncologists are fine with them being on estriol. Now, other than that, we have some differences between men and women and the men oftentimes feel loved when they’re having sex. Women need to feel loved to have sex. It’s quite different and conversation and really understanding that for women foreplay starts in the morning. Hey, babe, do you want me to take the trash out for you? What else can I do for you today? And man it’s like, “Hey, honey, you look really good right now.” You’re thinking, what are you talking about? I’ve got all these things to do for today. I’m not there. It’s finding that balance between the two and really learning to communicate and understanding that we do think differently. Men and women do really think differently. It’s not bad or good. It’s many times men compartmentalize.
We need to have conversations and learn how to kind of have that conversation as they do with us and really kind of know those pieces. And also, what’s their sexual appetite? What’s your sexual appetite? If the pie in the sky was there, what would it be like? What would this situation be? If you’ve got small children, it’s kind of like sex? How do you spell that again? [Cynthia laughs] It’s very different, so different times in our lives. Perimenopause oftentimes for many is these kids are gone, they’re in college or they’re away and you’ve got more freedom. But then they have to reconnect and find out who are we now as we’ve come to this time. I can’t stress enough how important that connection is, in addition to finding out adrenal levels, in addition to finding out hormonal levels. But the first thing we do is we make the vagina happy and we use vaginal cream because it really helps.
Cynthia Thurlow: Now, I think that’s really important. I recall many years ago when I was a baby nurse practitioner and this is at the advent of Viagra. I had patients, in conjunction with their cardiologists, that we would start them on Viagra, and I would have angry women banging on my door wanting to know why they had to start having sex with their husbands because they hadn’t had to do that service for “15 or 20 years.” So, making sure that we’re aligned with our partners, we’re having those conversations. First and foremost, as you said, making sure we have a happy vagina, because if that’s not happy, then nothing else is really going to come to fruition. Now, Marcelle, I could talk to you for hours. This is just one snippet of conversation. Please let my listeners know how to connect with you if they’d like to work with you, do one of your programs, purchase your books, find you on social media. How can they do that?
Marcelle Pick: So, I’m not a social media queen, probably because I’m too old, but I’m getting ready to ask somebody to do that. Oh, yeah, yeah, yeah. But they can go to marcellepick.com. I have probably almost 2000 articles that I’ve written since literally 2001 about functional medicine. All my books are on Amazon. You can just type my name and you can see the three books that I’ve written. The Core Balance Diet, Is It Me or My Adrenals? Is It Me or My Hormones? And I also have a very successful weight loss program. Most of my people lose 20 pounds in six weeks with the homeopathic drops that I use and 70% keep it off long term. So, that’s really part of my dream. Next year, I’m also going to do something called the Afterglow Program, which is going to be a year-long program with me. Looking at three months of adrenal, three months of digestion, three months of hormones, and then three months of emotions and ACE score kind of information. I’m looking forward to starting that next year.
Cynthia Thurlow: I love it. Well, thank you again, my friend. It’s been a pleasure. I know it’ll be the first of many conversations we’ll have.
Marcelle Pick: Sounds good to me.
Cynthia Thurlow: If you love this podcast episode, please leave a rating and review, subscribe, and tell a friend.