Ep. 272 Understanding Women’s Health: Answering Your FAQs

I am honored to have Dr. Stephanie Estima back on the show today! (She was with me before in 2020, on Episode 123.)

Dr. Estima is an exceptionally well-read and well-versed individual! She is an expert on female metabolism and body composition, the author of a fantastic resource called the Betty Body, and the host of an incredible podcast called The Better Podcast. 

Dr. Estima is one of my favorite voices in the health and wellness space! She and I dive into an Ask Me Anything format today. We speak at length about the ideal percentage of body fat for perimenopause and menopause, thyroid health, the impact of diastasis, and weight training based on that core imbalance. We discuss the Gardasil vaccine, optimal nutrients, Hashimoto’s, period cramps, and general PMS symptoms- particularly with inter-uterine devices. We also get into sleep basics, supplement support, the role of parasympathetic days and hormesis, and talk about load management and optimization. 

I know you will love today’s conversation with Dr. Stephanie Estima!

“Iodine is one of those Goldilocks things where we don’t want too little and we don’t want too much. We want it just right.”

– Dr. Stephanie Estima

IN THIS EPISODE YOU WILL LEARN:

• What is diastasis recti, and how do you treat it?
• Dr. Estima dives into pelvic floor rehabilitation.
• The mortality risk versus the benefit of the Gardasil vaccine.
• What causes low Oestrogen?
• What happens when you have low estradiol?
• Why patients often tend to be confused about what they should be doing.
• Stress management in autoimmune diseases.
• What hormones can be the most impactful on body fat?
• How women can overcome insulin resistance.
• The side effects of the copper IUD.
• How to support undisturbed sleep. 
• How to get the best sleep of your cycle in the luteal phase. 
• How to eat to support the luteal phase.
• How to optimize your load management

Connect with Cynthia Thurlow

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Check out Cynthia’s website

Connect with Dr. Stephanie Estima

• On Instagram 
• On her weekly podcast, Better! With Dr. Stephanie, where she explores the human potential, hormones, metabolism, and a life well-lived.
• Get a copy of Dr. Stephanie Estima’s #1 bestselling book, The Betty Body: A Geeky Goddess’ Guide to Intuitive Eating, Balanced Hormones, and Transformative Sex

Episode 123 – Menstruation, Muscle, Maternity, & Metabolism: What Every Woman Should Know with Dr. Stephanie Estima

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 had the honor of reconnecting with one of my favorite voices in the health and wellness space, Dr. Stephanie Estima. She joined me in 2020 with Episode 123. And today, we dove deep into an Ask Me Anything format, speaking at great length about the ideal percentage of body fat for perimenopause and menopause, thyroid health, the impact of diastasis as well as weight training based on this core imbalance, Gardasil vaccine, optimal nutrients, Hashimoto’s, period cramps and general PMS symptoms, especially with intrauterine devices, sleep basics, supplement support, the role of parasympathetic days, hormesis, load management and optimization.
Dr. Estima is an incredibly well-read, well-versed individual. Her expertise is in female metabolism, body composition, and she is the author of a fantastic resource called The Betty Body and the host of an incredible podcast called The Better! Podcast. I know you will enjoy this conversation as much as I did recording it.
Thank you for coming back to the podcast. And for listeners, in my intro, I linked the last podcast that I did on Everyday Wellness with Dr. Estima. And so, it’s so good to have you back.
Stephanie Estima: Oh, I’m just thrilled to be here. Just as we were saying, I think that the respect that we have for each other is mutual, reciprocal, and yeah, very excited to dive in into today. I’ve been doing these AMAs with Mindy Pelz, is a colleague who you know very well, and I was like, “I think we need to expand this to–” I think it’s also very exemplary to have and I know this is not the point of the podcast, but just women supporting women.
Cynthia Thurlow: Yes.
Stephanie Estima: Sometimes, I think there’s like, “Oh, is there a rivalry? They’re both talking about fasting.” It’s like, there’s no rivalry. We’re here. The more people that are shouting from the [laughs] top of the rooftops, the more people will hear us together. I can only yell so loud, [Cynthia laughs] and you can only yell so loud, and then together, we can amplify each other’s voices and our messages collectively.
Cynthia Thurlow: Absolutely. I think there’s so much of this mindset of abundance in our communities. To me, I say all the time, irrespective of whose book you buy, but these messages are all about empowering and inspiring women to really understand their physiology, understand their body, so that they can help navigate whatever stage of life they’re in. I think that that’s so important. It’s interesting to me that I have a monthly group. I think you have a monthly group. And so, sometimes, they’ll say, “Oh, I didn’t know that you knew this person.” And I was like, “Yes.” It’s nice to know that there are a lot of very heart-centered, heart-directed individuals in the health and wellness space that are really looking to share information and just keep things really real. When you do your AMAs and your Insta stories and you’re like, “My form isn’t perfect here and don’t use it as an example.” But I’m like, “Same thing with me.” Sometimes, I get it right and sometimes, I don’t, but it’s important to share all of those perspectives, so people know that we’re human beings as well.
Stephanie Estima: Absolutely, yes. Please don’t judge my lunges. My quads are not as strong as my glutes. Working on it, working on it, but I’m still going to show you the progress, anyway.
Cynthia Thurlow: No, I love it. Well, our very first question is from Nelly. And Nelly said, “I have diastasis recti, but I want to start weight training for the first time. Any advice?” So, for listeners to understand this is a separation of your abdominal muscles, common to see this after pregnancy. I had this. Sometimes, you could work around it with targeted physical therapy. But what are your thoughts when a woman comes to you and they already have had this diagnosed, how do they navigate weight training for the first time?
Stephanie Estima: I’m so happy that this question came in. I used to see this a lot in the clinic and didn’t know that you had diastasis recti. But often, you only know about it after you’ve given birth. It obviously develops during pregnancy, but because the abdomen is so stretched throughout the pregnancy, we only really see it afterwards. So, this is diagnosed, as you mentioned, physical therapist, a chiropractor, any type of body worker, osteopath, massage therapist, if they’re familiar with it. And so, just by way of signs and symptoms for any of the moms that are listening here, it’s basically almost like a visible coning or pooching, let’s say, of the abdomen or the abdominal muscles when you are flexing them. So, it’s usually right around the belly button, either immediately right above or immediately right below. If you palpate or push into the belly button, it feels like soft jelly like when this should be a hard end feel there. The separation itself isn’t painful, but some of the knock-on effects like pain during sex, or not being able to pick up the baby, or pick up laundry, or pick up heavy items, there can be a feeling of instability and potentially pain there as well.
What I would typically do for patients here is, first, to recognize what you can’t or let’s say, what you shouldn’t be doing. So, I understand that this question is, I want to start weight training. Generally, what we want to do first is rehabilitate the separation in the abdomen. So, I wouldn’t recommend, so things like squats and lunges and crunches and anything where you’re like a push up or any type of pushing motion where there’s an increase in abdominal pressure. So, we’ve all seen like– I don’t have one yet, but the belts that people wear during squatting or lunging that kind of thing, because what’s happening is they’re putting a lot of abdominal pressure against the belt, let’s say, as they’re coming down into the squat. This is a big no-no for women with diastasis recti. Unfortunately, the answer here is like, no weight training, no load bearing until we can actually strengthen it.
So, one of the things I would love to do in clinic and I still recommend it is something called hypopressives. If you think about almost like sucking in your stomach as much as you can and holding it, this is activating some of the deep muscles of the abdominal musculature. So, instead of, let’s say, the rectus abdominus, you’re activating the transverse abdominus, some of these deeper muscles of the core to help provide some stability there, things like pelvic tilt, glute bridge, bird dogs, that’s like you’re on all fours. And then if you’re watching this on video, it’d be like one arm is extending and then the opposite leg is extending. And then again, you’re trying to counteract the forces of gravity and your center of mass through some of these deeper abdominal muscles. But weight training is a contraindication to this, because you will make it worse. Because what’s happening is you have this weakness between some of the connective tissue of each side of the abdominis recti generally, is the muscle group that’s affected.
If you are going into the squats and the lunges and the chest presses and anything where you are bearing down or there’s any type of increase in abdominal pressure, you’re going to make it worse. So, the rehab is important prior to doing that. So, I would see a physical therapist, see your chiropractor, particularly physical therapists and chiropractors who have specialty training in pregnancy, postpartum, usually pediatrics as well. They all go hand in terms of the course material. So, if you have a physical therapist, let’s say, a pelvic floor physical therapist, they’ve taken extra training, extra courses in terms of how to understand because the pelvic floor, again, part of the core, they’re going to be able to direct you. Same with chiropractors who have had specialty training in perinatal care.
Then I would say also, you can google, YouTube, let’s say, for hypopressives. They’re so simple, but they’re so effective. I would even say, even if you don’t have diastasis recti and you want to improve core function and that sort of neuromuscular connection to the core, these hypopressive activities are my favorite. So, that’s where I would start. I’ve seen enough women to know that have had this problem postnatally, the hypopressives are, like, they’re the special sauce for rehab.
Cynthia Thurlow: I learned a new word this afternoon. This is super exciting. I think for a lot of listeners, because we do have listeners outside the United States and Canada that it is the standard of care postpartum for women to do pelvic floor rehab. And yet, here in the United States, by the time someone gets to a pelvic floor specialist, they probably have gone through quite a bit, whether or not it’s been from the diastasis or incontinence or other weakening of the pelvic floor muscles. I’ve had so many girlfriends who’ve had very large vaginal deliveries or long, prolonged labors that end up with quite a bit of pelvic floor dysfunction. Just to know, if you are listening to this podcast, there are ways to address these things as you mentioned, pelvic floor specialists, which can include physical therapists, chiropractors, you don’t have to suffer.
I’m so glad this question was answered, because what I see a lot online are well-meaning people showing women that, “Oh, yeah, you should be doing crunches to help repair your diastasis.” From what you are explaining, that’s actually going to exacerbate things.
Stephanie Estima: It will make it work. I think it’s part of a larger conversation around like, “Okay, I’ve had the baby. Now I got to get my pre-baby body back. I got to jump back into–” It’s like, you’ve just made a human. Can we be loving and can you give yourself some grace and allow yourself to heal? I had two children within two years of each other. First baby was 8.3 pounds, second baby, 9.1 pounds. I didn’t walk. [laughs] I didn’t walk after that second one. I had trouble walking. It was a big baby. I always like prehab. I like pre-habilitation, but if you haven’t done that, then take the time to do the rehabilitation. Get yourself back to a place of strength and stability, so that when you are ready for the weights, which I guarantee that you will be, because your body is amazing and it has an infinite capacity for healing that you’re not going to injure yourself and slow it down. Because by the time you get there, you’re just want to go.
If you get injured, this is going to be so disheartening, so disappointing. At some point, you’re going to have to stop and do the rehab anyway. So, do it first, do it properly, get it out of the way, so that you develop that core stability, strength, and neuromuscular connection to the core, pelvic floor, which is basically diaphragm, like, the core is diaphragm to pelvic floor and then have a blast in the gym doing all the other things that make you happy.
Cynthia Thurlow: Yeah. I think that’s so important. I think that there’s a lack of understanding for what happens to our bodies in the postpartum stage that there’s so much pressure on women, whether it’s self-imposed or externally to return to a particular state of being really quickly, because we see people on social media or celebrities that have a full-time chef and a personal trainer who probably lives with them and they probably have help.
Stephanie Estima: They’re starving.
Cynthia Thurlow: They’re starving themselves to get back to this pre-pregnancy body, which I loved the whole time when I was breastfeeding, and I was not working, and I was in that maternity leave time period, and I savored so much of that connection with my babies and bonding and all of those things, and that’s what we should be focused on is just savoring that time, that special time that you get in that postpartum period. But I think we can get detracted from what the most important things are very easily.
Stephanie Estima: Yeah, agreed.
Cynthia Thurlow: Next. Really great question. “What are your thoughts on the Gardasil vaccine? Are we culturally conditioned to think we should get every vaccine? It’s hard to find unbiased information.” This is from Stephanie.
Stephanie Estima: Well, woman with the best name ever, Stephanie.
[laughter]
Stephanie Estima: This is a good question. All right, so, I’m going to say that, like everything in healthcare, you have to assess your individual risk. So, that means your age, that means your chromosomal sex, that means your metabolic health, that means the likelihood of catching the disease, like, the wild type, let’s say, and you have to weigh the benefits and risks against catching the wild type, what’s the mortality risk there versus being inoculated or artificially inoculated with a vaccine. So, with the Gardasil vaccine, specifically, we’re talking about human papillomavirus. I can’t speak for everyone. I’m going to speak for myself and say that I remember when I was at my OB, my checkup, and we were talking and I said to her, “Okay, so, what are the risks for me–?” Because she was recommending that I get this shot. I said, “What are the risks for me in terms of this turning into cervical cancer?” Let’s say, if I have HPV turning into cervical cancer. She just deadpanned looked me in the face and she’s like, “4%.” I was like, “All right, so 96%.” [giggles] I have a 96% chance that this is not going to turn into a malignant, potentially fatal disease.
So, for me, that choice was very easy. It’s like 4%, 96%. I’m going to go with the 96%. I also am taking into account my own genetics, I’m taking into account my health, all of that kind of thing. How many sexual partners I’ve had, not the most exciting in that category. [laughs] Only had a few. My risk is very low. We’ll say it that way. So, for me, it was a really easy choice. Where I think we go wrong and I think to Stephanie’s point, this listener’s point, is that and we’ve seen this in recent years with the pandemic is that it seems like the narrative has shifted from let’s talk about your individual risk, let’s talk about your genetics, let’s talk about how this might either positively or negatively impact you to, everybody needs it bar none, there’s no other way to stay healthy. That’s where I myself will push back a little bit and say, “Hey, consensus medicine isn’t medicine. That’s just everybody agreeing, so everybody can keep their license.” So, we want to think about individual risk, and we want to think about cost benefit. So, if I get it, what is the cost and what’s the benefit? And if I don’t get it, what’s the cost and what’s the benefit? You have to be able to weigh that out.
I’m very blessed that my team, I have a very open and honest conversation with my medical team, and they’re very open to, let’s say, alternatives that they may not have been, let’s say, exposed to or have not with the mass popu– I’m always bringing in studies and things like that. So, I’m that patient. I’m very blessed that I can have– There’s a dialogue. It’s not a monologue with my healthcare providers, but that’s also part of the reason why I do the work that I do is to help other women be able to go in and feel empowered to say, “Hey, can we have a conversation about risk?” Like, I want you to be able to talk to me about what are some of the real risks here and what are some of the real benefits.
I think that being a guest on your show before and also listening to your podcast, I know that you’re also a beacon for informed consent as well, and that’s the definition of what I’m describing here. Informed consent is having a good understanding of the benefits as well as the risks, and then the patient makes an informed decision because she knows or he knows all the benefits, all the risks, and then what is best for him or her.
Cynthia Thurlow: I can’t think of a more thoughtful response, Stephanie, in all honesty. I knew that if I asked this question that had been posed by our listeners and followers that you would have an incredibly well thought out, respectful response. Probably, something the listeners don’t know is that when I trained at Hopkins many years ago, my GYN was one of the researchers, Dr. Cornelia Trimble, she was one of the researchers working with NIH on these vaccines. And at that time, the thought process was, “This is going to save a lot of lives.” What I think is really interesting is, if you look at cervical cancer in relationship to other types of cancers, it tends to be a very slow growing cancer.
Meaning, if you’re getting Pap smears on regular intervals based on, again, your own bio individual needs, and what stage of life you’re in, etc., this tends to be something that is caught pretty readily and pretty easily and often. [crosstalk] Yes. And so, again, to Stephanie’s point, looking at your individual needs, looking at the cost benefit analysis, talking openly with your healthcare practitioner and deciding if it’s the right decision for you. So many good questions.
Stephanie Estima: There were so many good questions.
Cynthia Thurlow: [laughs]
Stephanie Estima: There were amazing questions. Your assistant sent them to me last night and I was like, “Wow, we’re going to have a good conversation.”
Cynthia Thurlow: Absolutely. So, I have to say bravo to the listeners and to Stephanie’s listeners as well that we got so many well thought out. I could tell people were thoughtfully asking these questions. Okay, we’re pivoting a little bit to, what recommendations would you have for a Hashimoto’s patient that is trying to naturally balance hormones but still has low estrogen? And Brittany is childbearing years in her 30s with symptoms affecting hair, skin, and nails with normal thyroid panels.
Stephanie Estima: Yeah, I read this one and I had so many questions. [Cynthia laughs] I was like, “What do you mean by normal thyroid panels?” [Cynthia laughs] You have Hashimoto’s and you have normal thyroid panels. Okay, so to expand on what I’m talking about, so, I’m not sure what labs she’s looking at. When she says normal thyroid panels, I’m hoping that she’s obviously including TSH, which is thyroid stimulating hormone, maybe she’s looking at her T3 and her T4 levels. A full thyroid panel is also going to look at reverse T3, which tends to be a little bit higher in our Hashi’s patients, and also maybe even looking at the ratio of T3 to reverse T3, we want to look at that. And then, of course, the autoantibodies, so the TPOs and the antibodies as well. So, those are the two antibodies that are an autoantibody. When I say, same as antibody it just means self-directed.
Are those normal too? That was my question. When you say normal, because so many times when you go to, we’ll say, a traditional allopathic physician for thyroid specifically, I hear this all the time, I’m sure you hear this all the time, Cynthia, that most women have to fight to get an extended or full thyroid panel. Many doctors who are not educated fully, let’s say, on lab diagnosis or even just thyroid function will just look at TSH, T3, T4. Maybe they’ll look at free T4, free T3 as well, but the reverse T3, the autoantibodies, they’re not really looking at. So, I’m going to assume that she doesn’t necessarily have access to her autoantibodies potentially. I’ll say that thyroid generally, when we’re thinking about healing the thyroid, I think there’s another question in there around like, “Can I fully heal my thyroid or get off my dependency or something like that with lifestyle interventions alone?” But I would say, when I’ve cared for, I’ve seen a lot of Hashi’s patients.
There’re two main verticals that I look at. One is their conversion. So, the thyroid is going to produce mainly like 93-ish percent of inactive thyroid. It produces something called T4, which does nothing in the body. It’s inert. We need to actually cleave one of those bonds to make it T3. But that conversion from T4 to T3, T3 is the active thyroid hormone. That’s the thing that’s actively helping the cells, take substrate up and produce ATP is done in the liver, it’s done in the heart, it’s done in the skeletal muscle, it’s done peripherally, okay? So, the liver is actually where I will usually zone, like, zoom into, because where 60% of the conversion in the body happens is in the liver. So, we want to be looking at optimizing this woman’s liver detoxification pathways. And of course, thyroid and estrogen, they’re besties, right? When we have low thyroid, we tend to also have either low estrogen or estrogen goes unchecked. In the liver, when we are optimizing liver detoxification is where we can also very positively influence estrogen metabolism as well. So, I would be looking at liver detoxification.
I don’t know, how detailed you want to go here, Cynthia, but I would say there’re three main parts to detoxification. There’s hydroxylation, conjugation, and elimination. So, hydroxylation is just a fancy word for sticking an OH group [laughs] metabolite, okay?
Cynthia Thurlow: [laughs]
Stephanie Estima: Conjugation is how we eliminate. There’re different areas, different enzymes. There’s COMT, there’s [unintelligible 00:21:36]. We won’t go there, but we can influence it with sulforaphanes, which are compounds from green leafy vegetables. And then there’s elimination in the gut. So, do we have the appropriate amount of species in the gut, either the microbiome? It’s primarily the microbiome, but there’s also the [unintelligible [00:21:50] and other kingdoms in the gut that are allowing for the estrogen to be appropriately metabolized. I’m sure you’ve talked about the estrobolome on the show before, which is the species in the gut that are specifically involved in metabolizing estrogen. And of course, the golden rule of estrogen, use it and then lose it. So, we want the gut to be able to get rid of it and not to de-conjugate it, so that it comes back into the system and circulates. Now, when we’re talking about low estrogen, I think she said low estrogen,-
Cynthia Thurlow: Yes.
Stephanie Estima: -particularly. Okay. So, what are some of the things that causes low estrogen? One is age, which I don’t think she was in her 30s.
Cynthia Thurlow: Yeah. Childbearing years, 30s.
Stephanie Estima: Okay.
Cynthia Thurlow: So, I’m assuming early mid.
Stephanie Estima: Yeah. So, age here, you shouldn’t have low estrogen in your 30s. If anything, most women are dealing with an excess or an abundance of. Other things we want to think about with low estrogen are eating disorders or a history of eating disorders. So, things like anorexia and bulimia where you’re essentially depriving your body of certainly calories, but of course, in those calories are nutrients that are going to help keep your hormone levels balanced. She also might be dealing with POI or primary ovarian insufficiency, which is kind of what happens to women in perimenopause in their 40s, but this, where we see these fluctuating hormonal levels, we see hot flashes, we see low levels of hormones like estrogen, but with POI, we’re actually seeing it prior to 40. So, there might be something there either genetically determined, stress determined as well from her history that might be something to explore.
A couple of other things that, I put on my DDX hat. I’m like, “What are my differential [Cynthia laughs] diagnoses? What are all the things that can happen?” So, the other obviously things like, I don’t think she mentioned this, but chemotherapy. Medications can also affect estrogens essentially as well. So, chemotherapy can damage the ovaries, you know oophorectomies, I don’t think she mentioned that, but just for completion for the answer for your listeners. And then the other thing I was alluding to it, but hypothalamic amenorrhea. I call this like the deadly triad. If she’s exercising too much, she’s overly restricting her calories and she’s fasting too aggressively, we can run into this HA, this hypothalamic amenorrhea, where the pituitary gland essentially– You’re basically not getting enough nutrients and your brain is not going to be releasing enough of the hormones that are going to essentially cascade down in the production of estrogen, like, there’s too much cortisol.
So, those would be like which puzzle piece best fits her clinical picture and then we might explore from there. But often, when we have thyroid dysfunction, more often than not we’re going to have estrogen dysfunction as well. So, in her case, she’s already displaying that. So, I would want to first understand what’s the full picture for the thyroid? Because I don’t think we fully know that. If she said her labs are normal, but she Hashimoto’s thyroiditis, those two are almost competing answers. It’s almost an oxymoron, like, that doesn’t really go. Then what might be some secondary or tertiary reasons why estrogen might be low. So, the POI, the hypothalamic amenorrhea, history of eating disorders, excessive cardio, excessive caloric restriction, all the things.
Cynthia Thurlow: I’m so glad you brought up the triad, because I speak to this triad often to the point where it’s now become a daily conversation, because I’m sure you see these women as well. It’s like it starts as a well-meaning habit of fasting and exercise, and then all of a sudden, it’s this role of hormetic stress. It can just be like a train that’s out of control. All of a sudden, they don’t know how to get ahead of it.
Stephanie Estima: Yeah.
Cynthia Thurlow: When I read this question, I kept thinking, “Is she on oral contraceptives?” Because when we talk about this concept of informed consent, well-meaning practitioners, many years ago I was started on oral contraceptives, very likely because I had mild thin phenotype PCOS and wasn’t having regular cycles. No, this will help fix it. If you miss opportunities to have– When you’re in your peak bone building years and your estrogen is so suppressed, the net impact of that– So, when I was reading this, I was reading it from that lens thinking maybe this is a young woman who has been on oral contraceptives and could be in this low estradiol state. But I think that from what both of us are alluding to Brittany, a little bit more information. You may know that maybe your antibody numbers are negative and you’re stable on medication, but we don’t have enough information to be able to completely flesh out the answer, but this certainly will give you some directions to move into to get a better sense of what the next step should be.
Tying into our thyroid question, this is from Jessica. “You are both a wealth of knowledge. Thank you. I’ve learned so much from your podcast and books. My question is regarding low iodine. I have Hashimoto’s and hypothyroidism. It is under control and my numbers look great. However, my iodine came back on the low end. I cannot eat seafood. It makes me physically ill. My integrative doc put me on iodine supplements and I’ve read that it can cause more harm than good. Could I supplement with kelp supplements or would that be similar to the iodine supplement? I’m struggling with where to go from here to tackle this. Thank you so much.”
Stephanie Estima: The short answer is yes.
Cynthia Thurlow: [laughs]
Stephanie Estima: I think she can certainly try kelp supplementation. I think iodine is one of those goldilocks. We don’t want too little, we don’t want too much, we want it just right. So, you can certainly overdo it. I would say, I don’t know where she lives, but chances are she’s probably getting enough iodine from her salt, even just regular old table salt. But Himalayan salt and the super special flakes and all the kind of gourmet salts, those are also very good sources of iodine, we’ll say. But sure, she can try kelp supplements. I think that that would be wonderful. I think anytime you have low thyroid function, considering iodine supplementation is wise, but you have to be monitoring that with your primary healthcare provider because you can completely overdo it. And then we have other issues that can pop up with too much iodine as well. So, yeah, the short answer is try the kelp.
Part of healthcare is, there’s a science to it, but there’s also an art. We can understand the mechanisms and we can say, “Okay and iodine and L-tyrosine, we can talk about all of these different mechanisms, but at the end of the day, there has to be an element of play and experimentation and creativity that is infused into our patient care to see what works because of this little thing called bio individuality. It’s maybe theme so far in some of these questions that have been coming up, but we want to be thinking about how do you individually respond to it. The iodine supplements might be fine. Maybe her fear around it is that she may be overdoing it. So, you want to make sure that you and your functional medicine provider, it looks like our integrative doc are monitoring your Iodine levels. And then if that isn’t working for you, then maybe you can try something like a kelp supplement. I think that’s absolutely, yes.
Cynthia Thurlow: Well, and it’s interesting, because I feel as if iodine as a topic in the functional and integrative medicine space, it tends to be one camp or another.
Stephanie Estima: It’s so true.
Cynthia Thurlow: Pro-iodine, anti-iodine,-
Stephanie Estima: Yes, it’s so true.
Cynthia Thurlow: -and there’s no in between. So, is it any surprise that patients are confused as to what they should be doing?
Stephanie Estima: Yeah, it’s so true. You see that with a few different verticals in health. You see that with hormone replacement therapy. So, estrogens either the devil or it’s the best. Testosterones either the devil or it’s the best. You see it with cholesterol, you see it with certainly, how to treat them– Is it desiccated thyroid? Is it T3 hormone? What are we doing, Synthroid, Levo-? So, yeah, there’s certainly quite a bit of debate, and there’re lots of different ways, lots of different roads to Rome. So, I would say, feel free to have the flexibility of thought to experiment. What you measure, you manage. So, measure your iodine levels, watch your thyroid, and see how you respond to some of the different stimuli that you’re playing with.
Cynthia Thurlow: Yeah, and it’s interesting. I think that it’s been my clinical experience. Now, I have well-controlled Hashimoto’s negative antibodies. I’m on compounded T4 and T3. I talk about this a lot. It’s interesting. I’m seeing a new functional medicine provider who is the best listener I’ve ever worked with. And so, he’s very thoughtful. We had this long conversation about iodine, and he said, “I just want you to try the drops. Just try them.” And so, right now, I’m doing fine. We’re monitoring my levels, and actually, my iodine has improved. But I do know, if there’s a hesitancy, if someone doesn’t intrinsically feel that supplementation is the way to go, I think food-based sources are certainly reasonable. Just make sure, if you’re having kelp or having seaweed that you’re sourcing it from a place where there’s less contamination. There are definitely resources we can include in the show notes, but that’s the one thing I would say is just try to make sure you’re not having it harvested from outside of Japan or that part of Asia where there’s still quite a bit of radiation from Fukushima.
Stephanie Estima: Okay, that’s a really good point.
Cynthia Thurlow: Yeah. But that’s the rabbit hole that I go down. It’s like, “Okay, if I’m going to think about it, then I–” It’s like, I go down this massive rabbit hole and then I’m like, “I need to find my way back.” Okay, this is the last question about thyroid, but again, such thoughtful questions. This is from Maria. “Can you reverse your need for thyroid medication with diet alone?”
Stephanie Estima: Diet alone. So, I’ve seen lots, I’ve worked with lots of women who have reduced their need for thyroid medication from diet. Well, it’s not just diet. I’ve seen a whole lifestyle overhaul. So, we are looking at stress management. The other thing I’ll say and I actually would love to know what your thoughts are on this as well. I often find autoimmune diseases as a general category. So, within that, of course, we’re including Hashimoto’s thyroiditis. I would say that there is an element of– How will I say it? Sympathetic dominance and trauma or stress that is still leaving a residue on the system. When most women who have any type of autoimmune disease, there usually has been a difficult upbringing, there’s been a difficult relationship, let’s say, with a mother, a father, an ex-husband, an ex-partner, something like that, where they’re naturally just a little bit more on edge.
When you really get into it, there’s a couple of questions that I’ll ask, like, when you walk into a room, are you just planning, like, are you looking where all the windows are and the exits? Are you planning your exit when you walk into a room? That kind of level of more frenetic way of being, I’ll say. It’s with most of my autoimmune. So, it’s not just Hashimoto’s, but I’ve noticed this with my MS patients, worked with some lupus patients as well, where it’s the same thing, where there’s been some really strong stress signal at some point in the life where their response to it has been to completely internalize it, because maybe they were too young or they didn’t have the skills or the tools at the time to figure out how to deal with it. And so, that leaves the system always revving. So, if we think about the proverbial car, the foot’s always on the gas, it’s always on the sympathetic, we’re always in drive mode.
So, I say that because, yes, you can completely reduce your dependence off of medication, but it’s hard work because one of the levers that needs to be, we’ll say, pulled well and into position is the stress management piece. So, really understanding what your triggers or what activates you, what gets you going or nervous or anxious and working on that. That’s actually the hard work because I can give you the diet and I can give you the exercises and I’m going to tell you to lift heavy, and all of those things which someone with Hashimoto’s can probably punch out relatively easily. But it’s the stress piece. Looking back in the history of that usually woman’s life, although men, I have worked with men as well, but it happens, I think eight times more frequently in women. Generally, autoimmune disease is like 8 to 10 more times more frequent in women. So, there’s been some kind of unresolved trauma or stressor where the individual, maybe at the time didn’t have the skills to process the stimulus.
So, yes, you can, but it’s a lot of work. But it’s worthy work. You are worth investing in. So, is it worth the introspection and the unraveling of some of these stories and belief structures that these neural networks that we’ve created? Absolutely. Absolutely worth the time. You’re absolutely worth the effort. Is it easy? No. But have I seen it happen? Hundreds of times.
Cynthia Thurlow: It’s really encouraging. I think for listeners if they’re following what Stephanie is referring to, so adverse childhood events, we know that if you have a great deal of adverse childhood events. You are at greater risk for not only autoimmune conditions, but also weight loss resistance. I don’t know that we fully understand that mechanism, but last year, I had the honor of connecting with Dr. Gabor Maté. I’ve been very open about the degree of abuse I dealt with as a child and young adult. In my training, it was like Trauma. And so, I didn’t experience Trauma, so I didn’t recognize trauma for what it was. And so, trauma is a wound. But those of us that have experienced quite a bit of trauma as young people are more at risk for autoimmune conditions. So, I’ve had several throughout my lifetime.
But I think it brings up such a good point of this revved up autonomic nervous system in the direction of the sympathetic response. You may feel calm, but your body doesn’t perceive that you’re safe. And so, this chronic activation of the sympathetic nervous system can really impact our health in pretty profound ways. So, if nothing else, this lifestyle piece, if you have an autoimmune condition, it’s so important to get a hold of, and as easy as it would be to say, five minutes of meditation once a week will help with that. It’s really doing that deep inner work that can really get you to a point where you could be in remission. It’s always my hope that people don’t need to be on medication. I did that. I did all the work, all the lifestyle piece. Still need a little bit of medication and that’s okay. If you need to be on medication, that’s okay. But absolutely, the lifestyle piece really needs to be better and more proactively addressed, because it’s very easy to prescribe a medication. It’s a whole lot harder to make all those lifestyle changes. I know that they’re challenging to do. They’re not meant to be easy, but over time, the net benefits can really just be amplified.
Stephanie Estima: Well, first of all, thank you so much for sharing with your audience your experiences, because I think it’s very easy to look at someone who’s as accomplished as you are, and put together, and well-spoken, and all the accolades that you have, and almost puts you up on a pedestal, like, she can’t even be human. She just must be this Wonder Woman that’s puts her mind to something gets it done and gets it done. This is one of my favorite quotes from Ted Lasso. First, “The truth will set you free, but first it will piss you off.”
Cynthia Thurlow: [laughs]
Stephanie Estima: That’s the first thing. I think when you do that, when you are so open and honest and transparent with your community, it allows for introspection on the listener side to say, “Oh, okay, so, Cynthia is describing this scenario that maybe is there anything in that story that sounds like me?” It gives other people permission to also explore their own past and how their past might have some of that residue, let’s say, that’s showing up in the present. I just want to applaud you for that, because I think that it’s really difficult when you have the audience and the platform that you do to be real. We see this. You and I see this, right? You see big platform people and they look very scripted, and they have the talking points that they have, and they have the talking points that they have, and they never go off of that script that they’ve been given or that they’re telling to the world. So, I think that that’s so admirable that you’re doing that.
I can tell you, I’ve talked similarly. I don’t talk about it a ton, but I’ve talked a little bit about it on the podcast. I’m a slow learner, so I am still [Cynthia laughs] coming into my own comfort around talking about some of these things. But what’s been incredibly helpful for me is, like, psilocybins and mushrooms, and I’ve explored some other psychedelics that I’ve talked about on the show. But mushrooms, I find, are gentle and loving, and they just do– they’re wonderful for me. So, I found that to be very, very helpful in me having, we’ll say safety, to explore some of those memories and look at the memory.
One of the things that I’ve talked about is and I’ve heard this, I can’t remember where I heard it and I wish I could remember, but it’s almost like you go from being an actor in the play to being in the audience. So, instead of mom or dad or scary gentleman in the alleyway, whatever, and all of those things are happening to you, now you can remove yourself and you’re a third person and you’re like, “Oh, okay, I see that the father. This is how he was raised, and these were some of his belief systems, and that’s why he was reacting to her in the way that he did,” that kind of thing. So, I’ve moved from being more like first person for things happening to me to being able to see the entire play, and all the actors, and all the drivers. That’s what, I will say, psychedelics has really helped me with that, because it was very difficult for me before that. It’s always my fault. I was the reason why I couldn’t keep my marriage together. I didn’t do enough for all the things versus looking at the totality of the scenario and being able to look at everyone’s contribution to the problem.
Cynthia Thurlow: Well, I think all of our journeys are so important and impactful. Thank you for– I receive your kind words and also reflect back on you the work that you have done to get yourself into a more compassionate view of yourself. I think that so much of our experiences, they are what they are, but I think it reflect a great deal on Gabor’s book, because for me, I was ready to do the work. I’d been in therapy, I’d done Reiki work, I’d done all this energy work, I was ready to read that book. I walked away with a degree of profound compassion for my parents and the recognition that so many of us sometimes are just doing the very best we can.
Stephanie Estima: Right.
Cynthia Thurlow: And that’s okay.
Stephanie Estima: Right.
Cynthia Thurlow: But anyway.
Stephanie Estima: Well said.
Cynthia Thurlow: Yes.
Stephanie Estima: Are we all just doing the best that–? My kids, someday they’re going to be on a couch talking about-
Cynthia Thurlow: All the time. [laughs]
Stephanie Estima: -my mother, my high-achieving, driven, type A mother and this is what she did to me. It’s going to happen too.
Cynthia Thurlow: Exactly. Although it’s interesting, I’m in a place where my 17-year-old has his first girlfriend and she’s absolutely lovely. Last night, we met her parents and they are absolutely lovely. This young woman’s mother and I were having this really nice conversation and I said, “I am so grateful that I get to see the wonderful young man. My husband and I have impressed upon him healthy relationships, and communication, and growing up in a loving, quiet, peaceful home, because I get to see the amazing young man he is, and he’s dating your daughter, who is equally wonderful and lovely.” And I just said, “I’m just so at peace.”
I know a lot of parents get stressed when their kids start dating, and yet, I’m completely at peace, because I can look objectively at this young couple that they communicate really well, they’re respectful of one another, very clearly they care about each other enormously. Sometimes, I think we forget how much we imprint upon our children. But for me, being able to feel at peace and very, very grateful that I’m like, “Okay, I can look and see that we’ve done a lot of the work and I can see this in my children.” And so, I just want to close that loop. Okay. Yeah.
Stephanie Estima: I love that mom brag. I love it, I love it, I love it. That’s great.
Cynthia Thurlow: Well, no, but it’s one of those things that I think I don’t talk a lot about the kids on the podcast, because they’re now teenagers and everything I do is embarrassing and I’m embarrassed. It’s just what normal teenagers think of their parents.
Stephanie Estima: For sure.
Cynthia Thurlow: So, I always tell them, “I’m very respectful of your privacy,” but this is one of those things I can say objectively, I’m very proud of the young man that he’s been.
Stephanie Estima: They end up dating what they see at home, right? So, I say this in a loving way. Like, that’s such an awesome mom brag. First of all, I don’t think women brag about themselves. That’s one thing.
Cynthia Thurlow: [laughs]
Stephanie Estima: So, I’m so proud that you did that. The other thing is your son, their first relationship with the opposite sex is you. So, if you are doing the work and you are modeling what it’s like to be an adult female who sometimes makes mistakes, and can recognize those mistakes, and have conversations about those mistakes, and it’s not a totalitarian like because I said so, that’s why. If you’re wrong, you never apologize. One of the things that we do in my family is, “Can I get a redo?” [giggles]
Cynthia Thurlow: Oh.
Stephanie Estima: Like, “I messed up or mommy’s really tired or I misinterpreted the situation entirely. Can we get a redo?” And so, they do that now too. They’re like, “Mom, can I get a redo? I know that I hit my brother or whatever it is, but can I get a redo?” [Cynthia giggles] Then there’s like some hugging. So, I think that the success that you’re going to see now with your son is in part because of the work that you and your husband have also put into yourselves and your own dedication to growth as well.
Cynthia Thurlow: Well, thank you, and I love the redo. I may have to borrow that. But definitely one thing I have consciously done is and because they’re all teenagers, when they don’t want to talk to me, I’m still like, “I’m still going to come in, I’m still going to say goodnight, I may sit on your bed occasionally. We’re going to have a conversation.” And so, understanding that as our kids are getting older, our relationships change, not necessarily in bad ways, but meeting them where they are.
Stephanie Estima: Yeah.
Cynthia Thurlow: I think a lot of people, when they get to the teenage stage, they’re like, “They’re jerks. I don’t want to deal with them.” Yes, they can be a jerk. We can be jerks too, but we have to acknowledge like, “You’re an adult, they’re a child still. You have to meet them where they are and make sure that communication piece is still ongoing.” Okay, this is a question from Elizabeth. “What is the ideal percentage of body fat for perimenopause and menopausal women that bodes the best for an increased health span?” Such a good question.
Stephanie Estima: Such a good question. I think that, first of all, we want to think about– We’ll say it this way. Women are going to have a higher percentage of body fat than our male counterparts do. That’s whether we are in our fertile years, whether we are in perimenopause, which is still considered our fertile years, and then menopausal as well. So, the body has an essential kind of baseline of fat. Like, you need about somewhere between 10% to call it 14% of your body weight is going to be adipose tissue. I would say 14% to call it 24%. So, on the low end, I would think 14% is more like an athlete, sort of a high performing athlete. I would say most women who enjoy fitness and who are lifting weights want that kind of fitness look. You’re probably going to clock in somewhere between 18% and 21%, but then a little bit of padding on either side. So, up to about 24%, I think is wonderful.
Then 14% to 18% height is important there as well, like, how tall are you, and a couple of other factors. But I would say, generally, ideally, you want to keep your body fat under a quarter. We’ll say it that way. So, somewhere between 14% and 24%. The more optimal range, we’ll say, to stick to is somewhere between 18% and 21%, 22%.
Cynthia Thurlow: Yeah, and it’s interesting that there are so many things that impact our body fat percentage throughout our lifetime. Obviously, pregnancy, we’re going to have more body fat, and that is the natural process. For many women, as they’re north of 40, and we’re losing muscle mass and we’re gaining more adipose tissue and understanding the role of sarcopenia and fluctuations in sex hormones. I almost feel like when I really look at what hormones can be the most impactful on body fat, I think a lot about insulin and cortisol and testosterone in particular, because if you’re chronically stressed, lot of themes we’ve been talking about is managing your stress. So, chronically stress, if cortisol is elevated, your blood sugar is elevated correspondingly, your insulin will go up and helping people understand that things like meal frequency and how good or not good your sleep quality is and how you manage your stress.
Do you do chronic cardio or are you lifting weights? Common theme, make sure you are strength training to maintain that muscle mass and build on it. Inflammatory foods that people are consuming. A lot of these things, I think a lot about alcohol. We talk very openly on the podcast about gluten and dairy depending on the individual, and alcohol and sugar and how a lot of these things that seem fairly benign can send that body fat percentage to a degree that many women don’t desire it to be so. So, it’s helping people understand that there’s a lot at play in terms of ideal body fat percentages, which if you are a fitness competitor or an athlete, you’re probably going to be a bit on the leaner side. But I would say most people, if they’ve got a fairly healthy lifestyle, it should be within that range. It’s not at all uncommon for women in the latter stages of perimenopause and early menopause years to put on 5, 10, 15, 20 pounds. Some of that is hormonally mediated and it’s also a reflection of these changes in body fat relative to muscle mass and how that can impact insulin sensitivity and other factors.
But one thing that I do think, not every woman that goes into menopause stops making testosterone. There are about 25% of women that still have vibrant testosterone levels in menopause, which is another reason why not everyone needs more supplementally or compounded testosterone. But helping women understand that sometimes, it’s the loss of testosterone that can change body composition significantly. And so, just keeping that in the back of people’s minds, I think that the conversations around HRT can range from one extreme to another, but since testosterone is not FDA approved per se for women, which I think is problematic, there are compounding pharmacies that can make it. But I was talking to a physician the other day and she was saying that, with the pandemic and all this telemedicine that people have been doing that the FDA is now really cracking down on particular on testosterone prescription. So, it’d be interesting to see how that changes. But I know that hormone piece and lifestyle piece definitely plays quite a significant role in how lean or not lean an individual is at that stage.
Stephanie Estima: Yeah, you brought up two very important points that I think are worth highlighting, which is, the insulin regulation piece and the cortisol piece. So, we’ve been talking a little bit about that through the show, but I would say, naturally, as you mentioned, as we age, we naturally become more insulin resistant as we age. So, if you don’t have strategies to actively overcome that, things like weight training, which where we see insulin resistance actually settling in first, it tends to be in the musculoskeletal system. So, in the muscles, and in the bones, and in the ligaments, we usually can overcome that by one or two sessions of weight training. The muscle becomes orders of magnitude more sensitive. So, the GLUT4, so without getting too geeky, but we have the GLUT4.
The GLUT4 receptor is able to express itself on the surface of the muscle cell much easier, which is a way for it to take glucose passively in to the muscle cell, and then it gets phosphorylated, blah blah, blah, and then it’s used for energy there. So, when we’re weight training, this is a way for us to become better glucose disposal agents. And then the other variable to manipulate in terms of overcoming insulin resistance is to reduce your carbohydrates, either transiently or cyclically. So, we can reduce our carbohydrate intake. Fasting is another way. That’s like total caloric restriction. If we’re bringing everything down, so you’re going to naturally become more insulin sensitive.
So, things like a female centric, maybe ketogenic diet or some healthy and sustainable easy fasting, not like 72 hours. I don’t want someone listening to me like, “That’s it. I’m not going to eat for the next week.” [Cynthia laughs] That’s not takeaway here. That’s not the takeaway. The takeaway is gentle fasting for a woman has been shown to improve insulin sensitization systemically throughout the entire body. So, that’s really important. Then the other piece that you said was the cortisol and the adrenal piece. These are like the first two dominoes that have to be put in check. It’s like the insulin sensitivity and then the cortisol output by the adrenals. So, again, we’ve been talking about it with the trauma and the ACE, the adverse childhood experiences and Trauma, trauma, but certainly, stress management finding something that works for you.
I know we were on another question before, but you said, sometimes, the meditation for 10 minutes doesn’t work. Personally, I’m going to be very open and honest to you. I have a lot of limbic resistance to meditation. I always feel good when I do it, but I do mental jumping jacks in order to get out of it. And I don’t know why. So, I find things like getting out in the sun in the morning and doing a walk. I find that very calming for me. Even just standing outside, taking my slippers off and standing in my backyard, my grass, I find that to be very therapeutic. So, there’re lots of different ways that we can attenuate or pull down our stress response. Meditation, certainly, one of them. Another one that I actually use a lot with clients is yoga nidra or non-sleep deep rest. I have no limbic resistance.
Cynthia Thurlow: Delicious. [laughs]
Stephanie Estima: You just lie down and then listen to something, and it’s like, “There, I’ve done my yoga for the day.” [laughs]
Cynthia Thurlow: Yeah. No, it’s delicious.
Stephanie Estima: Delicious. That’s a great word for it. So, that’s another way that we can think about managing our stress to your point around body fat levels or adipose levels changing as we move into perimenopause and then later on in menopause, those are some really great strategies. I think most women should be thinking about first as a first order of operations.
Cynthia Thurlow: Such a good point. I love that you brought up yoga nidra. I’m in a new city and my previous yoga studio that I love, they would do yoga nidra twice a month, and my husband would jokingly call it my nap time, because I would go and I was like, “You don’t understand. It’s the most wonderful, delicious experience.” I wake up and I’m refreshed and I feel great and I fall asleep easily when I get home. I want to make sure that I’m respectful of your time. So, we’re just going to go over two more questions, and anything we didn’t address in this podcast, I will make sure I address on social media. This is a question from Allie. “Is it normal for period cramps and general PMS symptoms to grow worse with age? I’m 35 and have a copper IUD and I’ve noticed more painful periods and more PMS, tender breasts and irritability in the days leading up to it.”
Stephanie Estima: All right. So, we got a copper IUD in here. So, first, if there’s a favorite contraception I have, it’s the copper IUD, because we are avoiding some of the hormones, the synthetic hormones that are encapsulated in some of the oral contraceptives, or the Mirena, for example. Just as an interesting note, the way that it works is copper repels sperm. So, as the sperm is swimming, it’s like, “Oh, my God, that’s copper.” It’s literally their kryptonite.
Cynthia Thurlow: [laughs]
Stephanie Estima: So, they will start swimming the other way. Isn’t that so amazing?
Cynthia Thurlow: It is amazing.
Stephanie Estima: Okay. So, just for anyone that’s like, “I wonder how the copper IUD works.” It literally repels the sperm, okay? So, for this woman in particular, one of the side effects that we know with the copper IUD, of course, is that it can increase, at least transiently, the heaviness of your flow. If this is a recent, let’s say, insertion, we know that your menstrual flow, at least be like 50% higher, it can be orders of magnitude more than when you are not using one. So, that can lead to things like anemia. And so, we want to be really mindful of that. That being said, that should level out, okay? So, that shouldn’t continue.
The other thing to be mindful of is that, if you have a copper allergy, this can also create this pro-inflammatory response in the body, which can lead to estrogen dysregulation, which of course is going to lead to heavier bleeding around the time of your menses as well. So, when we think about reactions to the copper IUD, in general, periods that are heavier or longer than usual, which she seems to be describing, lower abdominal cramps or discomfort around ovulation, around period time, but also throughout the cycle, you want to be monitoring that as well. The other thing I want her to– and she may not have put these together, so I’m just including this in my response just to be thorough is, symptoms of pelvic inflammatory disease, essentially like pain during sex, fatigue, abnormal discharge from the vagina, so we want to make sure we want to rule out that those things are not happening. So, if the copper IUD is a recent, let’s say, insertion, then having a heavier flow around her period, transiently, like, four months-ish, that should be it. After that, it should be normal, like, usual. If it’s still heavy, we also have to–
The other things we have to also consider is that there may be perforation. When the IUD was inserted, it was inserted incorrectly. So, we want to make sure that she’s having a conversation with probably the OB who inserted it to have it checked to make sure that it is at least mechanically and anatomically in the right place. And then, if it is and she’s still bleeding heavily, we want to be thinking, maybe she has a copper allergy or maybe this is not the contraceptive for her. My absolute favorite type of contraceptive is fertility awareness method. So, this is basically tracking your basal body temperature, tracking your cervical fluid over the course of the month, and when it’s done correctly, it’s right up there, 98%, 99% effective. I would argue that I like it better than all of the other methods because it forces you to pay attention to what your body is telling you. When are you warmer and can we have a master class in our cervical fluid, please? It’s not just snot that shows up in your underwear.
Cynthia Thurlow: [laughs]
Stephanie Estima: It’s telling you something. It’s saying, “Hey, we have more estrogen. Hey, you’re about to ovulate. It’s sticky and lotionally, egg whitey.” That’s a signal that ovulation is eminent. So, I think that if the copper IUD ends up not being the option for her, I would strongly recommend that she look into FAM as well. That is my favorite way of contraception, if that’s indeed the goal, is that she doesn’t want to get pregnant, she can learn about the rhythms and her own particular cadence. I think that that relationship that she would develop with herself, I hear this time and time again from women who do the fertility awareness method is that, they just feel like they have better agents for themselves, because they know themselves better.
Cynthia Thurlow: Well, I think it’s so important, because in many ways, most medications that are used to impact our reproductive health are designed to control the symptom, and in essence, deconstruct or disconnect our awareness of our bodies. So, I love that you brought up FAM and I agree with you wholeheartedly about the copper IUD. I was thinking when I was reading her question was, I think this requires going to your physician who placed it just to make sure, is it in the right place, did it perforate your uterus? That does happen on occasion. And is this the best option for you? Because the symptoms shouldn’t continue to get worse. They should, over time, get better. I know that for many people, they want to drop the IUD and then they don’t want to think about it again, but it definitely sounds like, this is impacting Allie’s quality of life quite significantly.
Okay, last question. There are so many other good questions and I promise over the weekend, I will get these answered on social media. This is from Magdalena. “What would be a good way to support undisturbed sleep? I tend to wake up between 02:00 AM to 04:00 AM only in the luteal phase of the menstrual cycle. As per the DUTCH test, progesterone is within the range, estrogen is slightly below, testosterone is low, cortisol is good. I have tried melatonin, 5-HTP, inositol, magnesium, phosphoserine, some botanicals to no success.”
Stephanie Estima: I just want to give this girl a hug. [laughs]
Cynthia Thurlow: Yes. It’s not fun.
Stephanie Estima: It’s really not fun.
Cynthia Thurlow: [crosstalk] not fun.
Stephanie Estima: Yeah. So, she sounds like she’s doing a lot of the right things, a lot of the right supplements. She’s gotten the DUTCH test, which I’m a fan of. Without knowing her age, maybe even her chronotype, I think that would be also useful information as well. But I would say, generally, this is how I would think about sleep hygiene is that the best quality of your sleep starts the moment that you wake up. So, sunlight, getting early morning sunlight. We’ve been all taught that blue light is the worst, but when the sun is in a low solar angle in the sky, like 06:00, 07:00, 08:00, maybe even 09:00 in the morning, you’re actually getting quite a bit of blue light through the eyes and up to the suprachiasmatic nucleus in the brain, which is going to set off your circadian rhythm.
Usually, what happens is, once you get that early morning light exposure, there’s this timer that starts right. So, this is 14 to 16 hour-timer that is going to dictate when you’re going to be tired later on. We’re just going to get all the fundamental basics out of the way. So, we got sunlight. Hopefully, she’s also engaging in parasympathetic activity. So, one of the things with theme of what we’ve been talking about today, with some of the super driven, like, my autoimmune ladies that are listening, and even if you don’t have an autoimmune disease, if you are a driven type A personality, I’m going to guess that you don’t often or maybe you don’t like [giggles] or you are not as often as you should taking parasympathetic days.
So, one of my friends, Ben Pakulski says, “Champions don’t take days off, they take parasympathetic days,” which I love. It speaks to my–
Cynthia Thurlow: Fantastic.
Stephanie Estima: Isn’t that great? It speaks to my type A personality like, “Yes, I never have to take a day off.” But also, I’m managing load. So, I am going to go for a walk, maybe instead of berating myself that I didn’t have the hardest hit workout, cardio workout, whatever it was, right? So, “Champions don’t take days off, they take parasympathetic days.” That’s Ben Pakulski, who’s a dear friend of mine and maybe one of the smartest guys that I know. That applies here as well. So, how is she managing her load? If she is in the luteal phase and still pushing the way that she was in her follicular phase, we’re going to see sleep changes. Follicular phase, whether it’s weight training or career or whatever it is, is a time to push. We are more physiologically resistant to things like fasting, to things like the ketogenic diet, to going for PRs in the gym, like, lifting your heaviest weights. It usually happens or the best time or optimal time to do those things is in the first half of your cycle, so bleed week and preovulation.
In the luteal phase, it’s time to slow down a little bit. And so, if she’s still pushing that gas pedal and not the brake, then we’re going to start to see that two to four times that she’s describing when she wakes up is when we actually start to see cortisol start to be dripped into the system. If her adrenals, again, back to the adrenals, are jacked, she’s not taking parasympathetic days and she’s not working on recovery, then her adrenal glands are going to overcompensate. We’re going to overdo the dumping of cortisol. It’s usually two to four in the morning. That’s always the time that I hear women are waking up overnight. And so, we want to be dialing back the hormetic stress, because hormetic stress, if you do it in excess, is a distress. Exercise in and of itself technically a stressor. Blood pressure goes up, thyroid function goes down, immune system transiently goes down as well. Exercise actually sounds pretty scary, if you describe all of the adaptations that happen, and certainly you can overdo it on the exercise as well.
So, if she is in the luteal phase still driving, then that cortisol, of course, is going to affect her progesterone. Progesterone is the call it the star of the show in the luteal phase of the cycle, where it is going to– some of the metabolites like allopregnanolone are going to activate GABA receptors in the brain that chill us out, calm us down, and allow us to have that really restful, quality sleep. And technically, under the influence of progesterone, you should be getting the best sleep of your cycle in the luteal phase. So, if it’s worse for her, that tells me that her load management is off. So, load management in terms of physical load, in terms of chemical load potentially, and in terms of emotional load. So, how can she prioritize parasympathetic activation in the luteal phase of her cycle? That may look like a lot of different things. It could be walking instead of going to Orangetheory, not pooh-poohing Orangetheory, but I’ve seen it enough times. Women love their Orangetheory, they love their F45, they love their HIIT, all the HIIT, all the HIIT, all the time. So, can she go for a walk? Is she able to maybe go for a walk at sunrise or sunset? So, getting either early morning light or second-best time of the day is that sunset light again helps with that circadian reset, some of the hormones and the chemical concoction that allow for a blissful sleep to happen. Other things that I find to be very helpful for sleep is core body temperature manipulation. So, we are talking about sunlight, we are talking about parasympathetic load, but is the room cold?
One of the things I joke about– I posted a couple of maybe weeks ago now, like, what I do with my hair overnight. And someone was like, “Wow, my husband would kill me.” I have mouth tape, woolly socks, and I have this thing in my hair to curl my hair overnight. But woolly socks will– What we want is we want the heat to go away. We want the core body temperature to lower. One of the ways that you can do that is by putting on woolly socks, because your feet are going to warm up. So, you’re going to almost like a snake charmer, you’re going to charm the blood away from the core to warm up your feet. So, that’s another tip as well as core body manipulation. So, if you don’t have woolly socks or you don’t have the inclination to do woolly socks, you might think about taking a really hot shower right before bed or a hot bath. That’s going to also increase your core body temperature in the bath, so that when you get out, you’re going to have this rebound where your core body temperature is going to drop. You actually require that in order to have a good night’s sleep. So, those would be some initial tips that I would say.
But as I’m thinking about her question, the more and more I think about it’s like, what is your load management look like? Are you treating your body moving, and stress managing, and changing maybe the way that you eat to support the luteal phase of the cycle versus your folli– Because she seems to be doing okay in the first half of the cycle, which is designed for a bit more of go-go-go. But the second half we really do have to honor that hormonal milieu and changing of that hormonal composition in the second half of the cycle.
Cynthia Thurlow: What a beautiful explanation I would add to this is, I’m going to assume Magdalena is probably at least late 30s, early 40s. And so, when I’m looking at progesterone levels, we know that one of the first things that really is the hallmark to perimenopause, the 10 to 15 years preceding menopause is this reduction in secretion of progesterone from the ovaries. This is a time when many women start having sleep problems, they feel more anxious, they’re more depressed. It can really be quite profoundly significant preceding that last week of their menstrual cycle. So, getting a good serum lab, a blood lab, days 19 through 21, I think would be helpful for progesterone.
I don’t love the DUTCH for trying to get a sense of what the progesterone levels are. It’s not the best test for that. So, I think that’s one thing that you also mentioned that your estrogen was a little low, your testosterone was a little low. Sometimes, you can see low testosterone in association with low DHEAS in relationship to chronic stress so much to Stephanie’s point about this load management and then really understanding that that lifestyle piece really does have significant improvement. I have some women in perimenopause that do well with transdermal progesterone, even some that take oral progesterone just the week preceding their menstrual cycle, which really can help reset those receptors. It upregulates GABA, it allows for us to be more relaxed.
Then the other piece is you’ve mentioned some very good supplements and it may just be that you are in a position where we just need a little bit more information. I would probably guess that it may be that week you need some progesterone, and that progesterone may be all that you need to have you feeling a whole lot better. I think there’s not enough discussion about the loss of progesterone from the ovaries. Then it then becomes this adrenal. They call it adrenal pause, but it’s almost like this adrenal hiccup. The adrenals are then called in as the backup quarterback. If you’ve got chronic stress already, that’s going to impact the adrenal functioning in terms of optimization quite significantly. So, I think that Stephanie, obviously, gave a phenomenal explanation of things in terms of lifestyle that you can be doing to help improve sleep quality, but I would say a little bit of testing and then consideration to the potentiality of doing a little bit of progesterone the week prior to your menstrual cycle, I think may make a huge difference.
Stephanie Estima: I agree.
Cynthia Thurlow: Well, Stephanie, it has been such a pleasure. Obviously, this will be the first of many AMAs. I did not get to all of your questions in terms of the listeners that have shared with us, and I will get those answered on social media. Please let my listeners know how to connect with you, how to find your amazing podcast, your book, your work. You have an incredible Instagram account that I always find inspiring, and I’m always learning through you. And so, I’m grateful for your contributions to women’s health, and helping navigate the aging process, and do it from a place of empowerment and not fear.
Stephanie Estima: Thank you so much. Yeah, well, I’m 45. So, I’m in perimenopause. I’m right along with you [Cynthia laughs] and I’m trying to figure it out myself. So, I love talking about women who are, how we optimize fertility and then how does that change in perimenopause. And then when I’m in menopause, I’m sure I’m going to be much more interested. I am very interested in menopause now, but I find right now what I’m noticing and I think you are too is that, perimenopausal ladies are forgotten about, aren’t we? They’re just like, “Well, it’s a function of aging. Suck it up buttercup. Here’s a birth control pill or what have you.” So, thank you for the kind words.
You can find me– Every week we have a show. If you’re listening to Cynthia’s show, we are probably in the same place, it’s called Better with Dr. Stephanie. We speak to– a lot of overlap in terms of Cynthia’s guests and mine. I love to talk to fitness experts, nutrition experts, individuals who are what I would consider thought leaders worldwide in terms of what it means to live a well-lived life. So, better bodies, better nutrition, better sex, better families, all the things. So, Better with Dr. Stephanie. The book named after The Better podcast called The Betty Body. So, fans of the show have named themselves Bettys. I love it. It speaks to my vintage heart and [laughs] it’s very similar to the word better. So, it’s called The Betty Body, and we go through cyclical living essentially. So, what normal menstruation looks like, common types of hormonal derangements that we see, estrogen dominance, testosterone or androgen dominance, things like PCOS, Hashimoto’s, that kind of thing. And then how to eat in accordance and train in accordance with your cycle, the importance of orgasms, that kind of thing.
Then Instagram first name, doctor first name, last name. So, @dr.stephanie.estima. It’s basically my diary. [laughs] It’s like, “Here’s the podcast episode and here’s the workout that I did,” [laughs] so that you’ll find me there. I try to post there at least a few times a week. So, you can DM me there, ask questions. I do AMAs, as you were mentioning in my stories as well, because I love to be in service for women who are trying to find answers, because we’re the original biohackers. It’s like I am going to find an answer and I’m going to find a way and I’m going to make it happen. So, here to serve and thank you so much for having me. This has been a blast.
Cynthia Thurlow: Absolutely. Have a great rest of your day.
Stephanie Estima: Thank you.
Cynthia Thurlow: If you love this podcast episode, please leave a rating, and review, subscribe, and tell a friend.