Ep. 279 Is this Normal? Understanding Sex, Hormones, Periods and More with Dr. Jolene Brighten

In a world where human sexuality often remains shrouded in silence and misinformation, I had the incredible opportunity to engage in a thought-provoking conversation with the esteemed Dr. Jolene Brighton! 

Renowned as a hormone expert, nutrition scientist, and thought leader in women’s medicine, Dr. Brighton’s expertise spans multiple disciplines, including naturopathic endocrinology and clinical sexology. With her recent book, Is This Normal, she offers a non-judgmental guide to achieving hormone balance, eliminating unwanted symptoms, and nurturing the sexual desire we all crave. 

In this enlightening discussion, we explore the cultural factors fueling ignorance around sexuality, the origins of hormone imbalances, the significant impact of lifestyle choices on our hormones, and the often-overlooked role of detoxification. We also delve into the profound implications of oral contraceptives and synthetic hormones on our health and intriguing topics such as PCOS, PMDD, and PMS. 

With so many questions to explore, this is the first in a series of two podcasts that promise to provide invaluable insights for women at every stage of life. Join me as we embark on this journey to unravel the mysteries of our bodies and empower ourselves with knowledge from Dr. Jolene Brighton’s remarkable book, Is This Normal.

“There are these natural urges- this desire, and we’re left to feel not only shamed about it but also that we should have this extreme willpower and self-control.”

– Dr. Jolene Brighten

IN THIS EPISODE YOU WILL LEARN:

• How shame impacts the libido and sexuality of women.
• Why sex education should include the concept of consent.
• The impact of coming off oral contraceptives.
• Changing the narrative for all women.
• Why do women need more time to get aroused?
• The mind-body connection.
• How hormones and menopause influence women’s sexuality.
• Everything we do in our 20s and 30s affects our transition into perimenopause and beyond.
• How to avoid endocrine disruptors.
• Dr. Brighten discusses her 28-day detox program.
• Some important differentiators between PMS and PMDD

Bio: Dr. Jolene Brighten

Dr. Jolene Brighten is a hormone expert, nutrition scientist, and thought leader in women’s medicine. She is board certified in naturopathic endocrinology and trained in clinical sexology. Dr. Brighten is the author of Is This Normal, a non-judgemental guide to creating hormone balance, eliminating unwanted symptoms, and building the sexual desire you crave. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones through her website and social medical channels. Dr. Brighten is an international speaker, clinical educator, and medical advisor within the tech community.

Connect with Cynthia Thurlow

• Follow on Twitter, Instagram & LinkedIn
• Check out Cynthia’s website

Connect with Dr. Jolene Brighten

• On her website
• Find Dr. Brighton on social media: @Dr. Jolene Brighten
• Order your copy of Is This Normal
• Order Dr. Brighten’s digital cookbook 

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 are 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 Dr. Jolene Brighten. She is a hormone expert, nutrition scientist, and thought leader in women’s medicine. She is also board certified in naturopathic endocrinology and trained in clinical sexology, and the author of the recent book Is This Normal? which she refers to as a nonjudgmental guide to creating hormone balance, eliminating unwanted symptoms, and building the sexual desire you crave. Today, we had an enlightening conversation, speaking at great length about a variety of topics including what drives our culture of ignorance around human sexuality, orgasms, becoming cliterate, the origins of hormone imbalances, how lifestyle impacts our hormones quite significantly, especially north of 35, the role of detoxification, the impact of oral contraceptives and synthetic hormones on our health, PCOS, PMDD, PMS and a variety of other interesting questions. This is the first of two podcasts as there are so many amazing discussions that we can have that will be of great interest. I truly believe this book, Is This Normal? is a great reference for women, irrespective of what life stage they are in. I hope you will enjoy this conversation as much as I did recording it.

Dr. Brighten, so good to connect with you. I’m a huge fan of your work and I really enjoyed reading your most recent book.

Dr. Jolene Brighten: Oh, well, thank you so much. And I’m so glad our mutual friend Dr. Tony Youn was so kind to introduce us because I’m so happy to connect.

Cynthia Thurlow: Yeah. I had to chuckle because I know when you have a large social media account, like sending a DM is a joke. I tell people all the time that’s the worst way to try to message with me. [Jolene laughs] I was glad I was able to circumvent [laughs] trying to send a direct message on Instagram. But let’s start the conversation, I feel like even as a clinician myself, there’s a great deal of ignorance and a lack of information about our sexuality and what do you think that really stems from? Because even if we as healthcare practitioners feel uncomfortable talking about sex with our patients, what does that say? What does that speak to?

Dr. Jolene Brighten: You know, I love that this is where you start the conversation, because the fact that people know so little about their sexual health is in part due to healthcare practitioners not making it a priority. A large reason for this is that pleasure, especially for women, is seen as something that’s like extra. Like, “Yay, if you’ve got it. If you can have an orgasm, if you have a libido, you’re winning. Good job.” But if you’re not going to die from it and this is really problematic. Even the World Health Organization has said that pleasure is a very important and key aspect of health and yet we haven’t really seen that make its way into clinical practice. And to be fair, doctors are humans, practitioners are humans, and humans have their own baggage, their own shame. All the stuff that any one of us needs to unpack, your provider does as well and it’s not necessarily something that is taught in their education. Like very serious and important things are taught to them. But your ability to have a healthy and robust sex life in the way that you would like it to be, that isn’t like the priority in terms of med school curriculum.

Cynthia Thurlow: Yeah. It’s interesting because even as a nurse and then later a nurse practitioner, we’re kind of designed from a different model of care and kind of the way we interact with our patients. And in cardiology, which is where the bulk of my clinical experience is, I used to call it the hand on the door question, that I would be in an exam room talking to a patient and they would work up the courage-

Dr. Jolene Brighten: Yeah.

Cynthia Thurlow: -because that’s what it is to have that conversation with me. And I would always sit back down because I thought if it’s taken 20 minutes in a cardiology exam room for them to feel comfortable, then I really need to lean into this opportunity. And then more often than not, I was referring them to a GYN or a midwife, or someone that would be able to address their needs at a different level. And I think that even now that I have teenagers starting to have some more serious conversations with them and they’re not yet sexually active, but at some point, they will be. And when I was reading in the book according to the CDC, the average age for first heterosexual experience is 17. So, okay, sobering for those of us that have teenagers, but very realistic hoping that this generation or younger generations are going to be raised understanding that it’s healthy, it’s normal to have these urges and to not feel ashamed. I think or I know, in fact, when I reflect back on friends of mine from high school and college, people who just had so much shame about their bodies, about pleasure, about having sex, about wanting to have sex, or having that urge to have sex. And so, I’m hoping books like yourself and the content that you’re putting out is going to get women in particular more comfortable asking these questions and kind of getting their conversation started with their providers as well.

Dr. Jolene Brighten: Yeah. Well, you bring up an excellent point that there’re these urges, this desire, and we’re left to feel not only shamed about it, but also that we should have this extreme willpower and self-control. And we think about how many ways this really permeates our culture as it relates to diet and culture as well, that everything comes back to like, “You just need to have willpower and self-control.” And yet these things are natural urges, I talk about in the book, having increased cravings, for example, during your luteal phase. So that’s the second part of your cycle, following ovulation before menstruation, having increased cravings, finding yourself wanting more carbohydrates. Society would tell you that as a woman, you lack willpower, like, you just need to control it. And yet progesterone is like, “No, you need to eat more calories because this is what your body needs.” And so, I think if we stand back and we start to just meet our body with curiosity of these urges, these sensations, these signals from our body, they’re not coming up because we lack willpower. They’re coming up because hormones, because of context of situations and we really need to invite the individual to have curiosity more than shame.

Cynthia Thurlow: Well, and I think that although I have all boys, I think it’s so important, I think, about my nieces, who are obviously young and still at the stage that they’re teenagers themselves, but hoping that this generation can actually open up that conversation. And to your point, a lot of what I talk about is metabolic health and fasting, and encouraging women to stop over fasting right before their menstrual cycle. They’ll say, “Oh my gosh, I can barely get through a 13-hour fast.” And I would say, “Where are you in your cycle?”

Dr. Jolene Brighten: Totally.

Cynthia Thurlow: Inevitably, it’s five to seven days before their menstrual cycle and they’re trying to suppress all of these normal physiologic urges to have more carbohydrate, to eat more frequently. And I think the more that we understand about our cycles themselves, the better off we will be throughout our lifetime. Not just at the stage of life where I am, where my kids are going, they’re in the throes of puberty. And I’m kind of on the other side helping them understand that these things that we’re drawn to or these behaviors that we whether it’s having an increase in libido in the middle of your cycle just prior to ovulation, these are normal things that happen. This is not you not having control of yourself.

Dr. Jolene Brighten: Yeah. Absolutely. How many boys do you have?

Cynthia Thurlow: I have two teenage boys.

Dr. Jolene Brighten: How old are they?

Cynthia Thurlow: 17 and 15.

Dr. Jolene Brighten: Oh, wow. Yeah, so I have two boys. I have a 10-year-old and I have a 2-year-old. [laughs] There’s quite a gap there. [Cynthia laughs]

Cynthia Thurlow: [laughs] Yeah. That’s such a fun stage.

Dr. Jolene Brighten: Yeah. It’s a very interesting dynamic to watch these two interact. But I think something I talk about in the book that I’m really passionate about is consent and being moms of boys this is something I talk about all the time, is that I think we’ll see a lot on social media of women saying like, “Men are just trash.” And then they’re predators and this and that, and it’s like, “Okay, they’re always these people.” People altogether can be trash we can admit that of any gender. However, so often I think men are unknowing perpetrators of trauma because no one taught them consent. And I’ve been asked on previous interviews, like, “If there was one thing you change about sex ed in the United States, what would it be?” And I’d say, number one is talk about consent. Get everybody on the same page about consent because the CDC recently came out with a report showing that teenage girls have the highest rates of depression they’ve ever had.

Their mental health is really struggling. And the CDC’s answer to that was one of the recommendations is to teach women more about how to navigate sexual relationships, sexual encounters. And I sat back and I was actually really angry at first. I still am angry because to put that on a girl, a young teenage girl, and say, this is solely your responsibility and to negate the fact that sometimes trauma happens and it is an accident. There are times that when I’m lecturing, I will be in conversation talking about consent and then having this light bulb moment where they’re like, I never knew about the enthusiastic part. I never knew that consent took enthusiastic into consideration. I thought if she said yes and even if it was nah, all right, that was consent. And in fact, it’s not. And there’s probably going to be regret at the end and possibly trauma, and that was never the intention altogether. But there’re those myths, and that’s what really the book is busting, is so many myths, but the myths like, “Oh, men are from Mars and women are from Venus, so they just communicate completely differently and they cannot understand each other.” And I’m like, but have we ever tried in their formative years to educate them so that they can navigate this successfully?

Cynthia Thurlow: Well. It’s interesting because the concept of consent is something that we are discussing with our boys just to kind of reinforce that no means no. And you have to pursue them like I’m a total realist, but also in my mind, I think of my kids back and being elementary school age or preschool age. So, the fact that we’re at this point where we really have to have these conversations. What’s interesting is when I ask them, what are you learning in sex ed in school?

Dr. Jolene Brighten: Oh, yeah.

Cynthia Thurlow: The bare bone basics. It probably hasn’t changed much since I was in sex ed in the 80s and it’s a lot of focus on this is menstruation, this is what we do. Talking about STDs or STIs, I think they’re now called STIs. There’s not a lot of conversation about the consent process. So, I agree with you wholeheartedly that has to be part of educating both men and women or young men and women that these conversations have to be had to make sure that everyone’s literally in agreement about whatever activity they’re engaging in.

Dr. Jolene Brighten: Absolutely. And the whole consent conversation, I think when we look to the Netherlands, for example, the Dutch, they’re definitely winning when it comes to outcomes. And what I mean by outcomes, I discuss these in the book, is people are happy the first time they have sex. Their first sexual encounter. They’re like, “This was a good time.” In the US it’s regret. Its majority is they’re stating, I feel regret. And there’s a lot more to it, like lower incidence of pregnancy, lower incidence of STI. So really all of the metrics for which we measure like, successful outcomes and they teach sex ed starting in kindergarten. And people, whenever I say this are like, “That’s so inappropriate.” If you teach them about sex, they’ll have sex. And I’m like, “Well, hold up.” Sex ed is not just putting a penis in a vagina. Okay? So firstly, we back that up. Sex education is about your reproductive health. It’s about hormones. But in kindergarten, it’s about naming the body parts correctly and understanding consent. And this is so simple to do with a toddler. You ask your toddler, can I give you a hug? They say, “No.” You say, “Okay, that’s your body.” You say, “Do you want to give grandma a hug?” They say, “No.” No coercion happens. Grandma’s like, “Oh, I’m sad. Oh, I’ll give you a lollipop.” That’s coercion. No, we don’t do that. We don’t bribe. Then this is how we keep children safe. And so, when I explain it to people, then they’re like, light bulb moment. Oh my gosh, why are we not doing this? And I’m like, “It’s a fantastic question.” Because we can teach our children these things to keep them safe.

And what they’re doing is they’re just layering education so that when you’re getting to the years when menstruation can be coming on, so it could come on as early as eight years old. The average girl is going to start her period, what we call menarche at 12 years of age. There are the conversations happening prior to that. I know a lot of people are like, “Well, once she gets her period, then we’ll have that conversation.” And I’m like, “Periods are kind of traumatic.” [Cynthia, laughs] The first time you get that, then you’re like, that hurt and there’s blood and it’s confusing. So, it’s better to have that conversation before. And I also pose to people things like, wouldn’t you have rather someone talk to you about painful periods and what you can do about them before you had them? There’re so many things in my book. So, I have a whole cycle symptom relief chart, which is basically you’ve got this symptom, so cramps, for example, here is the lifestyle, here is the supplement protocol that you can utilize. And here are the foods that you can incorporate to help with menstrual cramps. What if you knew that ahead of time and you could just incorporate those foods? What if you knew that ahead of time so that when you did have cramps. You didn’t have to schedule with a doctor and wait for like six months to see like, “Oh, can I get in? Can I get help?” And I’m using cramps, but this could be migraines, this could be acne, this could be any of the things I discussed in my book. Wouldn’t it better if you knew, if you had the resources ahead of time so you knew what you could do at home?

Cynthia Thurlow: Well. I think for so many of us, I was certainly part of a generation. Your first book is talking about oral contraceptives and the impact of coming off of them and the net impact on our health just in general. And I was one of those people in the early 1990s put on the oral contraceptives because I had irregular cycles, I had mild PCOS. So just putting that out there and so, yes, it fixed the problem, but it didn’t fix the problem. And so now, [chuckles] fully understanding the net impact of being on oral contraceptives for a long period of time and now kind of using your work as a great example you know referring people and saying, if you’re not understanding what I’m saying, then here’s a great book on this resource. But helping people really understand the concept of fully informed consent, if they are consenting to take medications to fix a problem that could better served with a little bit of lifestyle changes and some supplementation and some nutritional changes, I think that’s a huge impact.

Now, if you have to go on a medication, there’s no shame in that. But I just think it’s so helpful to know these resources are available now. And too bad they weren’t many years ago because I think there are many of us in my generation that are like, “I had no idea that biting differently or focusing in on more restorative therapies in the luteal phase and understanding that I can really get away with a little bit more intense activity in my follicular phase.” And just understanding that throughout the menstrual cycle, women that are still in their peak fertile years and even in perimenopause in many instances, if you make these adjustments, it can make a huge net impact on the way you perceive the world and yourself.

Dr. Jolene Brighten: Absolutely. I want to talk a little more about PCOS because I think you raised an interesting point. But I do just want to dovetail on what you’re saying is that, so often I think we go through life wondering what’s wrong with us? Why is it that before my period I can’t push that my body must be the problem, my hormones must be the problem. Like my activity levels aren’t the same or back to the cravings, why do I have these cravings? or why is it that certain times of my cycle, my skin isn’t looking the way that I wish it would look? I’m like, “What is wrong with me?” And that, I think, is really problematic because so much of medicine. This is, again, I feel like we’re going to be pointing the finger at medicine [Cynthia laughs] a lot today. But this is, once again, where medicine is like the male body is the standard by which we compare everything to. So, if you’ve got this stuff going on over here, there is something wrong with you. And that is how many of us ended up on the pill. I had very long, heavy periods. I bled for more than seven days. I was in so, so much pain. My doctor was like, “This could be endometriosis.” It was not endometriosis, [chuckles] but it was definitely so painful. But, I mean, 17, they’re not going to go do exploratory surgery.

So lucky to have a doctor who was not willing to do that in my pelvis. But I got put on the pill. It was a total game changer for me, but it never fixed anything because when I came off the pill, all the problems were back and then some so, so much worse. But when I took the pill, I felt like I’m in control of my body now. I’m not at the mercy of my cycle. I will bleed when I want to bleed. I will be the boss of my body. I’m not going to blame my teenage or 20 something year old self for what it didn’t know. But I’m really remiss for the way that I was taught, and it’s how I teach things differently about hormones is that they’re really meant to give you superpowers. And when you start to work and operate with them, oh, my gosh, you’re like men you could never, you only wish– You only wish you could have these superpowers. But to your point of PCOS, so people don’t know what that is. It’s polycystic ovarian syndrome. And while the name suggests that there are cysts on the ovaries, there’s not in fact, they’re follicles. They’re little follicles trying so so hard to ovulate every single month. But those don’t always exist in everyone. What does exist in the majority of people is excess androgens and sometimes that’s very pronounced. Maybe it’ll be mild with oily skin, or maybe it’s very pronounced with acne, hirsutism, hair growth on the chin, chest, abdomen that you do not want, hair loss on your head. Feeling ragey at times can definitely be a sign of that and when you have all these other symptoms and in addition to that there will be anovulatory cycles, lack of ovulation or it’s irregular, which is why we have irregular periods.

Now, why I wanted to come back to your point of how you said the pill fixed but didn’t fix. They gave you the pill to make your body bleed. There is a time and the place for that. It’s not the first line therapy by any means, but they’ll tell you, “Oh, it fixed it.” But what does the pill do? The pill’s primary mechanism of action to prevent pregnancy is to prevent ovulation. So, if you have a condition where the entire issue really the crux of it, when we’re talking about the period, the menstrual cycle, the reproductive hormones, is that you fail to ovulate. How is giving you a medication that suppresses ovulation fixing a condition where you fail to ovulate? Logically, it makes no sense. And I have to say that when Beyond the Pill came out, I got tons and tons of pushback from gynecologists, people so big mad at me that I would even dare to even criticize the pill or the way it was being used. And because we don’t want to lose access to the pill, I get that. And at the same time, it’s like, that’s all they were using. And if that’s all you’ve been doing and it’s been working for you as a doctor, it’s pretty inconvenient for another doctor to say, “Try harder. I bet you could do better.” And yet now we’ve seen the conversation really shift. So, Beyond the Pill came out in 2019 and I have now seen the same gynecologist who completely hated me and came after me on social media now saying, “Yes, we admit that the pill does not fix your PCOS.” And I’m like, “Baby, you might hate me, but that was the goal all along.” Let’s just change the narrative, get honest with our patients and do better by them.

That is all I ever wanted. And I feel like we’re moving in the right direction, and that is not because of me. So, we’re clear to everyone listening, it is because of people who are listening right now. It is because of patients going to their doctor. They get educated and they demand better and that’s what I set out to do with Is This Normal? And, like, “Let’s make the net even bigger.” Let’s put the medicine into women’s hands so that they can take control of their hormones. Because the majority of healing, as you know, happens at home and not in the doctor’s office. But I put so many checklists and so how do you know if you have PCOS? Do this checklist. Is it endometriosis? Do this checklist. Those checklists are in there so that you can have a sense of what’s going on with your body, but so you also have the exact data to bring to your doctors that you can advocate for yourself.

Cynthia Thurlow: No, and I think it’s so important and let me be clear. I think your work is changing the narrative for all women. And I think that it’s such a blessing and such a gift. And I feel so grateful that you are able to share this information in a way that it’s tangible. Like, I have my husband and this is something the listeners will laugh about. So, I’m in my car and I have a brand-new car, and I’m like, joining 2023 and so, I’m streaming my podcast. I’m listening to you with Shawn Stevenson. And my kids are in the backseat, and they see the title of this podcast, and they’re like, “Mom.” [Jolene laughs] I said, “I’m doing research. I’m interviewing this doctor [chuckles] this coming week.” And they were like, “Why are you talking about these things?” And I said, “Because women need to talk about these things without shame or feeling uncomfortable.”

Dr. Jolene Brighten: Yeah.

Cynthia Thurlow: And I said, you need to be able to talk about these things. So, they think I’m the most embarrassing person in the world, which is what they told me the other day. But let’s pivot a little bit.

Dr. Jolene Brighten: I just want to say I probably got you be. I have my cliterate necklace on. We have these at drbrighten.com and I got them sent to my house a bunch of them. And my son was like, I want a cliterate necklace. I want that. And I was like, “Do you know what the clitoris is?” And he’s like, “Yeah, it’s some body part or something, right?” And I’m like, “Yeah, okay, went over this.” Let me get my book out. The book has three clitoris diagrams. So, you’ll see three clitoral diagrams more anatomically correct than the average medical textbook. Because I was like, “If medicine is not going to do it, I can’t wait around 20 years for medicine to get it together.” Women should know the anatomy of the clitoris. I actually commissioned an artist to put drawings in the book. And so, I show it to my son, and he’s like, “Well, what is the clitoris for?” And I’m like, you remember we talked about it’s just for pleasure, that’s it? And he’s like pleasure. I’m like, “Yeah, orgasms.” And he’s like, I do not want a clitoris necklace or cliterate necklace.” [laughs] And I just started laughing. But it’s so funny to me that we’ve gone over this before, and yet he’s like, “What?” And he’s 10 and he doesn’t know anything about– that age. He doesn’t know anything about orgasms but it is something that when he asks questions, I give him the honest answers around things. So, he definitely was just like, “You just wear that around? I’m like, I do friend and we start conversations, and I educate people, and I love it. [chuckles]

Cynthia Thurlow: No, I think it’s fantastic. And I love that you’re having those conversations with him. So, getting cliterate so let’s talk about what this is. You talk about it in the book.

Dr. Jolene Brighten: Yeah.

Cynthia Thurlow: You do have these great diagrams. And I had to laugh. I actually pulled out my text from nursing school because we had these big anatomy and physiology books.

Dr. Jolene Brighten: Good old netter, dusting off the netter. [laughs]

Cynthia Thurlow: Sure enough, there is no mention of the clitoris. And when you look at it anatomically in the illustration that’s in the book, comparing it to a penis, you start to understand there’re a lot more similarities than people are aware of.

Dr. Jolene Brighten: Yeah. Well, [laughs] when you think about the medical textbooks are just like, let us just give page after page after page to the penis. And how do we learn about female reproductive health? There’s a lot going on down there. We learn about it. You get the vulva, you get the ovaries, you get the uterus and then you get like real estate to babies. But there’s not this like, here is the clitoris and here’s what it looks like. And this is so important for people to know. We’re both healthcare providers and we our training is not that different from the training today. They are not training about the full scope of clitoral anatomy. And doctors are doing surgeries essentially blind, not understanding that anatomy. And in addition, you still have doctors who are saying things like, “There’s no nerve endings in the cervix and so you shouldn’t ever have pain with that.” Yet women are like, “But I can have a cervical orgasm and my IUD hurt really bad.” And so just for people to understand, there is a huge gap in what’s being taught in women’s medicine.

Now, to your point of becoming cliterate, there is actually Ian Kerner wrote a book, She Comes First. He came up with the term cliterate. I name him in my book because it’s just so brilliant because that is really what is missing. It’s missing in medicine, but it’s also missing in the bedroom as well of people having an understanding of just how vast the structure is and the fact that it’s only made for pleasure. So, you look at in the book, I did homologous drawings side by side. There’s a clitoris and there’s a penis. And I show how from embryological development we have the same tissues, but they just showed up differently depending on both the chromosomes and their response to hormones. So, this is important for people to understand. In the book, I’m like, look, we’re going to use XX and XY because it’s simple. But no, it’s way more complicated than this. XX gets the clitoris, XY gets the penis. And the penis is less sensitive than the clitoris because it also has the job of carrying out ejaculate and urine and it is on the outside. [laughs] It is not [?] if you were walking around with that tissue on the outside, can’t really be as sensitive. And so, with that, we’ve got these same tissues going on and I show them side by side. I also show how we differentiate.

Now, what happens is that during pregnancy there is a testosterone wash as it’s called. And if you have a Y chromosome and it has the genes to respond, it responds to that and you differentiate to a penis. You can be XY but not respond to that wash and end up with female genitalia but still have XY, your chromosomes are showing up male. So, it’s important for people to understand that it is far far more complicated than the average biology teacher is teaching. But it is important to understand that these tissues are the same. And if we can understand that stimulating a penis is the way to an orgasm, then it’s not so hard to make the leap that stimulating the clitoris is the way to an orgasm. And for people to not get so upset when they hear that only about 18% of women can have an orgasm vaginally and understand that sometimes you will have a vaginal orgasm when you’re simultaneously stimulating the clitoris and that’s fantastic. But if you are someone who’s like, “I’m not having orgasms with penetration, which maybe even sex ed told you that was the way, it is not, in fact the way.” The way is the clitoris that is the primary way to orgasm. However, there’re a lot of other ways people get there, which I go through in the book.

Cynthia Thurlow: Yeah. I think it’s really interesting. And like I said, I’ve been looking through the book and referencing the book, and my teenagers have been kind of rolling their eyes and they see me because Dr. Brighten’s book is bright pink. It’s hard to miss. [Jolene laughs] It’s been coming everywhere with me as I’ve been trying to make sure I finish it before our discussion today. And I just think building that awareness allows people to understand, like, “Oh, I kind of get it.” That makes a lot more sense anatomically why women may need a little bit more time and we can certainly dive into this, that women sometimes need a bit more time to get aroused versus men. Seemingly, it’s like they breathe and they’re ready to go, and women just don’t operate that way or at least most of the women I talk to. Certainly, you have greater experience in this area. Has that been your experience as well?

Dr. Jolene Brighten: Oh, absolutely.

Cynthia Thurlow: Women generally, it’s like a slow boil. It’s like, let things boil for a while and then we’ll be ready. But no, it’s not an instantaneous connection.

Dr. Jolene Brighten: Yeah. Well, and it’s so interesting because whenever I talk about this on social media, I always love the women who jump in and they’re like, “I can give myself an orgasm in like, two minutes, three minutes, four minutes.” And the women who are timing themselves, I’m like, “You little biohackers. I love you.” You’re like, “I want my own data.” [laughter]

Cynthia Thurlow: I want to be efficient.

Dr. Jolene Brighten: Yeah. Well, and there is something to be said about the mind body connection, right when you’re touching your own body. So, if you are doing abdominal exercises, actually touching your fingertips on your abdomen helps the nervous system connect even more, and you can engage more fully. It is the same thing when you’re touching your own body. So, yes, and you also know you’re getting instant feedback, what’s good, what’s working. When you’re in a partnered relationship, it does take longer. And so, I go through this, there’s a whole chapter on orgasms, and I talk about how it can take 20 minutes for, like, arousal and sometimes another 20 minutes for a woman to have an orgasm and that is normal. That is completely normal. Because when the clitoris is being stimulated, you have to be giving feedback. And maybe it’s talking, maybe it’s moaning, maybe it’s moving in a certain way.

You have to be giving feedback in order to tell your partner, do more of that, I like that and so there’s like a little bit of a delay it’s not as instant of like, brain says, “Yes, okay body keep doing what you’re doing. And so, these things are also normal. So, as I talk about in the book, one of the things that can keep you from having an orgasm is worrying about, are you taking too long to orgasm? And this is again something that society shows us and I talk about this in the book, like, the things that we see, it’s always this spontaneous desire. Like you’re just instantly in the mood and then you’re just instantly orgasming. And it just doesn’t work that way in the average bedroom. And I think that a lot of us go through our early years being like, “What’s wrong with me trying to be more performative.”

Even and I don’t say that in a negative way. So, people understand faking orgasms. Roughly 86% of women report doing that. And whenever I talk about this, people will mostly men are like, “Women are so deceitful. They’re such liars.” I mean, they are deceitful. It’s called altruistic deceit. She wants you to feel so good about yourself and your ego. She’s tending to more than just sex and pleasure. She’s also tending to your self-esteem. So, if she knows she’s not going to get there, she’ll still fake it because she doesn’t want you to fill the weight of what society has told you. Being like, you should be a master in the bedroom and a stallion and all of these things. It is altruistic deceit. She is bypassing her own pleasure in order to make sure that your ego is protected. And boy, is that sobering for people to hear. Other reasons women fake it is they do want it to be over. Oftentimes it’s due to pain, which is like, can we blame you? But they’re like, “I don’t want to kill it for my partner.” So again, it’s very much thinking about their partner. And as much as the narrative exists out there that men don’t care about women or men just want to get off, I see all of these things. It’s really not true when you speak to men in committed relationships or partnered relationships, and even in non-monogamous relationships. Men want to bring pleasure to their partner.

And we’re speaking– I should clarify, we’re speaking primarily about heterosexual relationships because these are the members who have opposite parts. And when men are not educated about the clitoris, it makes it a lot harder for them to be able to provide that pleasure to their partner. And maybe their partner doesn’t yet know how to give that feedback. This is where I will say society gets a lot of things wrong. Okay, but here’s a big one, telling women that sex is like it’s going downhill, like in perimenopause and menopause, that your sex life is over. Society likes to sometimes send it out there like you’re not that young vixen anymore blah, blah I’m like. If you are ever a vixen friend, it is usually in your 40s, 50s and beyond that women are reporting that they’re having greater pleasure. And a big reason for that is because they know their body, they know how to communicate, and they also understand that their needs are as important as their partners as well. And they enter into sexual relationships with a much greater sense of maturity from the perspective of they know it’s more than just orgasms. There is more to be had in this.

Cynthia Thurlow: I think that’s such an important kind of point and distinction to make. And I do find in conversations with my really close girlfriends, they’ll say some of us are at the stage where we’re no longer getting a menstrual cycle. So, there’s no concern about pregnancy so–

Dr. Jolene Brighten: Oh, yeah.

Cynthia Thurlow: –that allows them to enjoy sex so much more because they don’t have to worry about that pregnancy that they weren’t anticipating or weren’t expecting.

Dr. Jolene Brighten: Totally.

Cynthia Thurlow: I think the other thing that I’m finding in my kind of age group is that as women– and then obviously perimenopause, there’s these incredible fluctuations of estradiol throughout that period.

Dr. Jolene Brighten: Yeah. We should talk hormones. [laughter]

Cynthia Thurlow: Yes. And then as we’re kind of heading towards into menopause for many women, like that loss of estrogen, all of a sudden, they’re like, “I’m losing my people pleasing skills.” Like, I don’t want to be so accommodating. I want to be clear and more intentional about what I need, what I want, how I want it, when I want it. And so, it’s been funny for my girlfriends, many of whom are not clinicians just to say that arbitrary. They’re like, “Oh, you know what’s really great is I’m so clear about what I want in the bedroom.” Whereas before I was kind of like, “Well, whatever you want.” And now they’re like, “Nope, I don’t want to do that. I want to do this.”

Dr. Jolene Brighten: Yeah.

Cynthia Thurlow: And I think that being your own best advocate, I think is very helpful, a great pivot into talking about hormones because as we both know, that’s at the basis of everything. And so, when you’re speaking to women, and I would say most of my women are 35 and above, so they may not yet be in perimenopause, but we go all the way up into menopause. What are some of the more common signs that you see clinically when their hormones are not properly balanced? Like, I know it’s like a seesaw, our body’s desperately trying to find some degree of balance. But what are some of the most common signs you’re seeing in this age group in particular?

Dr. Jolene Brighten: Sure. So, when we’re talking about 35, mid 30s, it might surprise people that the first place I would go is thyroid. But that’s because starting at that age, that’s when we see higher incidences of hypothyroidism, specifically. And so, things that we are told are normal because we’re just getting old. And I’m like, “Man, if you want to get backhanded, call a 35-year-old old.” [Cynthia laughs] Because I mean, if you’re pregnant, it’s a geriatric pregnancy. I’m like just because reproductively speaking, the uterus is like getting up there in age, that doesn’t mean she is. We live a very long time compared to our ancestors. So, starting at 35 we can see that there can be an onset of fatigue, maybe having brain fog, weight gain, having hair loss. Sometimes providers are like, “This is just part of aging.” Like welcome to your mid-30s. I’m like, “That is so young.” It is so young. Sometimes, I’m like what are you, like 14 in your brain? Because here I am at 42 and I’m like I remember being 14, thinking 30 was old and then getting in my 30s and being like I don’t even feel like I’ve started yet. I’m 42 and I’m like sometimes I don’t realize that I’m in the 40s because we have this mindset in society that as women this is somehow old. So certainly, if you’re experiencing any symptoms that your doctor says like you’re old unless you’re like 70 plus, I don’t want to hear that. I don’t want to hear that.

There are things that start to go in life, but brain fog, never acceptable. Fatigue where you can’t get out of bed no matter how much you sleep, never acceptable. But the other thing that can happen with hypothyroidism is we can start to experience irregular periods. Without sufficient thyroid hormone, we don’t stimulate the follicles in the ovaries to mature and ovulate. Without ovulation there is no progesterone, without progesterone there is no luteal phase, and without a luteal phase there’s no drop in progesterone which triggers the menstrual cycle, the bleed, the start of the menstrual cycle is what I was going to say. Really the start of the menstrual cycle is ovulation, but we teach it from menstruation because that is so much easier to understand and dial in for most people. So, it’s really important to understand that this could be a thyroid problem because at 35 you may very well be in perimenopause. So, is acceptable to go through menopause at age 45? It is acceptable to start perimenopause 10 years prior so at 35 it could be perimenopause. But early perimenopause does not begin with irregular periods. It begins with other symptoms. I have a whole checklist in the book about perimenopause, but it begins with other symptoms usually.

Sometimes we can see that PMS is getting worse. We’re starting to feel like, “I’m a little hot at night.” So am I starting to have symptoms of hot flashes arise, starting to have anxiety, starting to experience symptoms where you’re feeling like, “I’m just not myself, like something is off and you can’t put your finger on it.” And so, with that, your doctor may jump and say, “Oh, this is perimenopause” and not check your thyroid. They should be checking your thyroid. In fact, I advocate for a full thyroid panel annually and that would be a TSH, which is a brain hormone that talks to the thyroid, free T4 that’s how the thyroid responds, free T3, that’s the active thyroid hormone that’s responsible for your menses, your mood, your metabolism, your motility in your gut. And also looking at TPO and thyroglobulin antibodies. Just because those antibodies are negative once doesn’t mean they’ll be negative in the future, okay. They have to be retested and we should be screening because antibodies happen first, hypothyroidism happens second. If we see antibodies, we can intervene so that you don’t end up on a medication. And why I bring up the antibodies so people know Hashimoto’s is an autoimmune disease. It is the most common cause of hypothyroidism in the United States and it is the most common autoimmune disease among women. So, it is worth screening. So that is one of the places at 35 that I start thinking about. And as I talk about in the book, we have a pyramid in the book and it’s a hormone hierarchy. And the base of that is going to be our adrenal glands and insulin above that is going to be thyroid.

And at the very tippy top, that’s going to be our sex hormones, our ovarian hormones. And it’s important for people to understand that when we’ve been burning it at both ends through our 20s, that is hitting our adrenal glands. And in our 30s, if you notice that you can’t drink alcohol and be okay the next day like you used to in your 20s, that is normal to have that change in that experience. But also understand that all of those habits of your 20s, they’re really impacting that base layer. And so, I just bring that up because it is really sobering at times to realize that we can’t live like were in our 20s. And honestly, we should have never lived like we were in our 20s. [Cynthia laughs] If I could tell my younger self that like, “Friend, get the sleep, do that.” I was fortunate enough to go through my nutrition education in my early 20s that I made a joke about the other day getting my AMH ran. So, I’m 42, my anti-Müllerian hormone is looking closer to someone in their 30s. So, I’ve got good egg reserve, my hormones are great, don’t have signs and symptoms of perimenopause. I was talking to my doctor about this and she’s like, “You’re just one of the lucky ones.” And I was like or I have been working hard for the last 20 years to do the opposite of what our modern culture tells us to do. And I’m like instead of telling people like, “Oh, you’re just lucky.” And listen, if you got six pack abs genetically, yeah, you won there. If you are into that, yes, you are lucky you got those genetics. But in terms of how people take care of their health, instead of telling people like, “Oh, you’re just lucky.” How about we say, “Hey, good work.” Because I know that this took effort all of these years to be the outlier in terms of what the standard is.

Cynthia Thurlow: Yeah. And it’s interesting because I think on a lot of different levels that we are conditioned to work harder, sleep less, do those really intense workouts. I mean, I am a classic example of someone who had a very– even though I work part time, very stressful job as an NP, working for this big cardiology group. And at the time, the NPs–

Dr. Jolene Brighten: Let me just say nurses have it worse, like of all healthcare providers when it comes to how it hits your health. I think just as everybody listen to what she’s going to say right now, but as a doctor, I think we do not respect enough how hard nurses work and what they have to go through. So, continue on.

Cynthia Thurlow: Thank you.

Dr. Jolene Brighten: Really want people to hear that.

Cynthia Thurlow: Thank you. No, so the nurse practitioner service covered seven hospitals with the docs. And at the time in cardiology, some of these hospitals did not have Cath labs which meant if someone came in with an acute MI or acute heart attack, sometimes we’re calling in the choppers to send them to other hospitals.

Dr. Jolene Brighten: Yeah.

Cynthia Thurlow: And at the time I had a child at 34, one at 36. I went back to work. I remember I would literally just pump. I didn’t even have time to eat because I was so busy that I would find a room and a sympathetic nurse that would watch a door so I could pump and I would eat a protein bar, which is disgusting to think about. I didn’t eat enough food and had this super stressful job.

Dr. Jolene Brighten: Protein bars have come a long way, but man, I know what you’re saying back in the day man.

Cynthia Thurlow: Yeah, I would like drink water and eat protein bars. But why I’m sharing this is stressful job, not enough sleep. My husband did a lot of international travel. We didn’t have local family to help us, even though we had a wonderful woman who helped us with the boys. I didn’t have someone who was like at the ready all the time. And so, when I transitioned from my late 30s into my early 40s, I hit that wall. That wall of perimenopause that changed everything for me. It was like I was overexercising. I wasn’t purposely not eating enough food, but just taking care of little people, sometimes you don’t think about yourself. And so, I went to see my Gyn and I remember saying to her. I’ve got these really heavy menstrual cycles, and I just happened to start the day I had this exam. And so, she does this internal exam, and she goes, “Whoa, you have really heavy periods.” And I said, “I was just telling you that.” She was like, “Oh, you can fix this.” We can give you oral contraceptives. If you don’t want to do that, we’ll just put an IUD in or maybe just an ablation and you’ve already told me you’re done having kids.

Dr. Jolene Brighten: Oh my God. Yeah.

Cynthia Thurlow: Just do a hysterectomy. And I was like, “Time out, no way to everything.” And for me, it was traditional allopathic trained provider all of a sudden trying to rethink the way I was living my life.

Dr. Jolene Brighten: Yeah.

Cynthia Thurlow: And I think for a lot of women, it’s not until they hit that wall. So, bravo to you. At 42, I was really starting to feel it. But you’re right, all the things we do in our 20s and 30s definitely impact the way that we make that transition into perimenopause and beyond.

Dr. Jolene Brighten: Which is not fair, this is not fair [laughs] because even though I was eating really well, I have always been someone who is aimed and I don’t hit it right every day for people to understand. But I will never forget this study. Sitting in nutrition in one of my classes, and we’re talking about just the food pyramid, what a joke it is, and how it was based on lobbying. It’s really important for people to understand it’s based on lobbying, not science. And when they said the studies consistently show that eating seven to nine servings of vegetables and fruits a day, and I always start with vegetables. We always say fruits and vegetables, but it’s like one to two servings of fruit, the rest should be vegetables. But that is what has been shown to increase longevity, to improve cancer risk. So, reducing cancer risk, just all of these markers. I remember sitting there and I was like, “I will do this. This will be my goal. This will be the thing.” And so that’s something that has made a tremendous difference in my life and my health, is because at very young age, I was afforded this information and an instructor who told the truth. And when I heard those words, I was like when I went and read the study and I was like, “All in on this.” And so, I say this, that vegetables have been in my saving grace. But I also, I mean, I went to med school, I thought, like, I didn’t know, I didn’t think it was okay. I knew it wasn’t okay to start drinking coffee at like 8 o’clock at night that I had to study. And I would stay up and I would study. And then I had to work through college. And so, I’m like getting up and teaching group fitness classes at 5 o’clock in the morning.

So going on sometimes four or five hours of sleep and then going to school, going to rotation– all of it. And I look back and I’m like, firstly, like, amazing body, like applaud all around that you didn’t die and that you were able to do all of that. But also, I’m like, man, it had to be done. As I look back, there was no other way, but there was hell to pay at moments in my life, [laughs] sure, because of this. And so, I think you telling that story is so important because it’s important for people to understand that we don’t know what we don’t know. And we also can acquire new knowledge. We can shift and we can change, but sometimes we’re just surviving and doing the best we can. And I think motherhood is like probably the place that unfortunately in the United States that so many women find themselves in that survival mode. And I definitely was the same with my son, having him going back to work in the clinic like six weeks later, living basically on collagen and tea during the day because I didn’t have time to pee because I had to pump and I couldn’t eat. And it was so much, so I do appreciate you sharing all of that and I think it’s just so important that we don’t judge our past selves because we would have made better choices had we had the opportunity, the access or even the knowledge to do those things. But also, that we don’t judge each other because we never understand where somebody else is at in their life. And I think that is part of, as we talked earlier, about shame. That happens a lot with hormones where people will say like, “Oh my God, I can’t believe that you would ever drink out of a plastic water bottle.” And shame someone for it but they might not understand that’s the only access to water someone’s had in that day. Like, maybe they’re traveling and that’s the only way they got water. Being dehydrated is going to be worse than a one-time BPA exposure. And as much as I’d like to see the ocean not take on another plastic water bottle, I also know that when you become dehydrated, your adrenal glands are going to become stressed, your brain is not going to function as well. Your entire hormone system is going to fill the pool of dehydration. And I don’t think people really even understand that sometimes we have to make these kinds of choices. And what might seem like not the best choice, actually, is because dehydration, lack of sleep, these things that we kind of take for granted because we just do them, they are really detrimental to our hormones and they can absolutely be at the root of why you continually have hormonal symptoms or you feel like you’re not getting better with those.

Cynthia Thurlow: Yeah. Thank you for that. I think that one thing. And I’m sure you and your team navigate this as well. Sometimes I’ll have people shame a post that we put on social media. And my standard response is I meet people where they are.

Dr. Jolene Brighten: Yeah.

Cynthia Thurlow: And the concept of good, better, best, I think, is really important for people to understand you’re doing the best that you can on that day, because it is so easy for us to judge one another and to shame ourselves and feel guilty. I was raised Catholic, and I always say, like, “The Catholic genetic pool is just all about guilt.” And it’s taken lots of years of therapy to work beyond that.

Dr. Jolene Brighten: Yeah.

Cynthia Thurlow: So, I always say there should be no guilt. But occasionally people will comment and I will say to them, are you suggesting that I should shame someone because they’re not doing exactly what I’m doing? That’s not the right place to come from. You mentioned something that I think is really important when we’re talking about exposure to plastic. And so obviously, for each one of us, we have to maintain our sanity. We all have budgets.

Dr. Jolene Brighten: Yeah.

Cynthia Thurlow: We may not be able to replace everything. Let’s talk a little bit about some of the detrimental things that happen when we are exposed to endocrine disrupting chemicals so that people can better understand that plastic is not benign. I don’t want anyone to walk away from this and feel like they have to stress excessively but knowledge is power. And you do a really good job in the book talking about this and how it impacts not just women, but also men as well.

Dr. Jolene Brighten: There’s so much that had to get cut out of the book. It’s a giant book. And so, people are not intimidated because definitely people are like, “I don’t know if I want this book. It’s so big.” I’m like-

Cynthia Thurlow: You want this book?

Dr. Jolene Brighten: -I write it so you get in and get out. Like, you just get what you need and the rest is there when you need it. But by no means do you have to read it front to back, although you did, [Cynthia laughs] and many people have but I just want people to understand that. But this was one of the things that we had to really pare down this section. And I could have written an entire chapter just about endocrine disruptor. So endocrine disruptors, I mean, the name says exactly what they do. These are chemicals that disrupt your hormones and they do things like altering your DNA by mimicking estrogen. So, the DNA in your cell, they alter how it performs by mimicking estrogen, they can increase free radicals in your ovaries. They have been shown to alter how you produce hormones in your ovaries. They also can impact your egg quality. So, we hear things like, “You’re born with all your eggs and that’s it. There’s nothing you can do.” There’s so much you can, so much you can do to maintain your egg quality. And avoiding endocrine disruptors is one of those.

It really took studies coming out on men’s semen. And let me just for everybody, like, I’m not here to scare you, but men today have about 50% of the amount of sperm that their grandfathers did. We are in a reproductive crisis. And I don’t say that to scare you, but nobody’s talking about it except for reproductive endocrinologists who are doing the IVF procedures and the epidemiologists and other researchers who are pulling this up. And then you’re seeing other doctors chime in and say, “It’s not that big of a deal. It doesn’t take that much sperm to get pregnant. Oh, we have all these technologies.” Shanna Swan, who’s one of the researchers, it really struck me when she said, “If we ever considered this, humans would absolutely be on the endangered species list, because that’s where we’re at with our reproductive health.” And this is in part because of lifestyle. Yes, obesity is problematic, but endocrine disruptors can also be driving force behind obesity. Yes, smoking is bad. Air pollution is bad. Pollution, forever chemicals out there, that’s all bad. But what are forever chemicals these are endocrine disruptors. And this is what she primarily points towards. This is what we’ve seen change. It can alter testosterone in both men and women, make it so that you can’t utilize it. So even if you don’t want a baby, there goes your libido, there goes your ability to regulate your immune system, because testosterone is involved in that as well. And for women, testosterone is also part of our mood, why we set boundaries, why we wake up, we kick ass, we feel so alive in our bodies sometimes. That is in part thanks to testosterone. So, I think it is really important for people to start to evaluate and consider what is in their environment.

Now, the number one place you can control and the number one place that has the biggest impact is your house. So, I just want people to know that this is an easy topic to freak out on. I definitely freak out. I have young children. I’m like what? I have two boys. What is life going to be like for them if they don’t have testosterone that’s problematic for their health as well. And so, I’ve definitely had these moments, and I empathize if you go there too. But let me give you steps. Let me help you not freak out. So, here’s first thing in your house, if it’s got a fragrance, it’s got to go. Glade Plugins, chuck them. I want you to get rid of candles. I don’t care, it’s Yankee Candle season, get rid of them. You can get some essential oils and a diffuser and have that same smell. Or you can just bake some cookies or you can do a simmer pot and simmer pots are amazing because they’re also antimicrobial. So, you can put a pot of water with cloves and you can get some star anise. It’s really beautiful. As well you can get cinnamon sticks, toss those in that can also make your house smell well. And you basically got your own humidifier in your kitchen. Please don’t leave this unattended, but there’re alternatives to this. If you’ve got fragrance in your personal care products, those are so expensive, let’s phase them out. So, let’s take inventory and as you run out, then replace it with something else. And that gives you time to also do the research, because doing the research is super exhausting in the United States that puts all of the burden on the consumer to figure out what’s going to harm them because the FDA is not going to take it off the market until enough people have been harmed. And it’s significant enough, which is how we find ourselves with forever chemicals in our environment that are never going away and are harming us all.

Good news. You have a detox system in your body so you can handle the stuff that you get exposed to outside. So inside, we want to get rid of the fragrance. We want to clean up personal care products. We want to clean up house cleaning products. Degreaser, friend, get a clean degreaser. Not a greenwash degreaser, but one that is not full of all of those really harmful chemicals, because those are really problematic. And these things are also causing DNA damage. I doubt you’re someone listening to this being like, “I don’t care about my hormones.” But in case you are, know that exposure to all of these things is absolutely going to determine when you die. They are going to determine how you die in terms of is it a long, slow, unhealthy process that goes on for years, and they will reduce your longevity. And again, I don’t say this to scare you. There’re lots of research out there, go look up David Sinclair’s books. I think those are a great place to look for longevity. Talk about endocrine disruptors. So, we did a little bit of like, okay, fragrance, you’re right about plastic, and we got to get plastic out of our kitchen. And this is always when people are like, “Oh, God, I have to go to Amazon and buy all of the glass containers. I buy pasta in jars. Anybody who is like, Italian out there, I do agree that homemade pasta, fresh made, the sauce, way better. But if you buy pasta jars or other glass jars, guess what you got? You got a new container to store stuff in or to drink out of if you’re like.

I have plastic cups I can’t afford that, I use a mason jar to drink out of just because I’m like, it’s 32 ounces. And I know that I’m still breastfeeding. If I can get three or four of these in the day, I’ve done my job. I’ve done my job with hydrating. So, you can reuse these glass containers that you come across. I actually saw somebody showing how they save their peanut butter jar lids because those are going to come in plastic containers. Sometimes you can get them in glass and again, you can just save that. But if you do get a plastic one, the plastic lid is still better on top of these jars. So now we’ve got a really economical way. The lid is not going to be coming into contact with food. If you’re like, “Well, I’m just not ready to go there and start replacing stuff. Don’t microwave in plastic. Don’t heat up anything in plastic. Don’t store anything acidic in plastic. That’s when we know things get liberated. So, we’ve covered like personal care products, cleaning supplies, just cleaning up the house a, bit about what’s going on in the kitchen. Just know that I love takeout as much as the next person. But those containers, friends, and that is definitely something that you just have to choose sometimes [chuckles] whether or not you’re going to have takeout and just be educated and informed in the decisions that you make.

And then I just want people to understand that I mentioned there’s this detox system in the 28-day program. I take you through how to really support your body in detoxing through the liver, through the bowels, through the kidneys. I don’t overtly say that. I felt like I beat that one down beyond the pill and really went through the whole detox. And I’m like, “Do people need to know the ins and outs of the science of detox?” No, they just need the tools to do it in a way that works for them and is manageable. And so that you’ll get as part of the 28-day program. There’s certainly so much more in the 28-day program. And if you go to drbrighten.com/itn-resources, you can get the full cookbook. It’s a digital cookbook that goes with Is This Normal? And it’s got four weeks meal plans and those weeks correspond with your menstrual cycle so you can eat in a cyclical fashion. And it’s got, I think, 60 recipes in there to really support you wherever you’re at in building your hormones.

Cynthia Thurlow: I really love that. And I think that for those people that are listening, they’re familiar with the estrobolome, they’re familiar with detoxification and why it’s so important to have a bowel movement at least once or twice a day. But one thing, I would love for you to just briefly touch on is just because you’re having a bowel movement doesn’t mean that you are getting rid of excess estrogen. And for the women that are heading into perimenopause, understanding that this can be a time when we have the greatest fluctuations of estrogen of our entire life, it’s even more important to make sure, and I know you do a beautiful job talking about this in the book. That estrogen dominance period like helping women understand you’ve got to package it up and get rid of it. And even if you’re having a bowel movement every day, it does not per se mean that you are, I would say, don’t assume, make sure you’re doing all the other things to help support your body.

Dr. Jolene Brighten: Yeah. Well, you bring up such a great point about the estrogen dominance piece. It gets called so having those higher levels of estrogen, that’s because, relative to progesterone, estrogen is left unchecked. So, progesterone is down. Why? Because even if we do ovulate, we don’t make as much progesterone or we’re not ovulating. So, if you’re in that year sprint to menopause, you might only be having a period, like every 60 or more days, which means that you’re only ovulating about that frequency. And so, without that progesterone, we do have those higher levels of estrogen, and we know that those estrogen metabolites, there’s 2:16 and 4-hydroxyestrone. And these estrogen metabolites, they are problematic at all periods of our life, but we definitely see more problems in terms of our ability to just repair our DNA and survey the land by the immune system to delete those cancer cells, then we really need to tend to our metabolites at that time. So that’s where we’re talking about the liver aspect of those things. And for anybody who’s just really visual in the book, I put a diagram of the liver, and I have phase 1 here’s the nutrients. Phase 2, here’s the nutrients. And then you go into the back of the book, there’s an appendix, and it’s like, “Oh, magnesium. Okay, I need to eat magnesium.” Here’s the foods that have magnesium. Here’s the signs that your magnesium is too low. So, I put that in there so that you literally can get the information you need in, like, five minutes. So, to your point about the gut, once the liver is packaged, everything out, we want to move it out through the gut. You may be having a bowel movement, but you may have dysbiosis. So, an imbalance of gut flora.

If that’s the case, they may be producing more beta-glucuronidase. This is an enzyme that reactivates your estrogen and puts it back into circulation. This is where nutrients like calcium D-glucarate can come in and be really helpful. But I also think it’s worth considering a probiotic. And if you’re in perimenopause, another reason to tend to your gut health, making sure you get 25 grams of fiber every day, making sure you’re eating soluble fiber. So maybe that’s coming from oats, or maybe it’s coming from plants and things like apples. But you also want to consider probiotic, because it’s been shown that people who have more microbial diversity in their gut, they actually have lower incidences of belly fat. They have an easier time losing weight. Now, for people to understand belly fat, specifically visceral adiposity, that’s the kind we get scared of. We are scared of that. Are your hips, butt, thighs getting a little padding when you get into perimenopause/menopause normal? It’s actually normal to gain a bit of weight because that’s protective as we enter our menopausal years. However, when it’s central adiposity, we get concerned because we’re packing fat around our organs and that is associated with increased risk of diabetes and cardiometabolic disease. So, tending to your gut health that is going to be good for your hormones. It’s good for your vagina as well, and helping support your vaginal ecology and vaginal lubrication, preventing vaginal dryness. So, the estrobolome is a big player in that, as I talk about in the book. But in addition, it can also help with your metabolic health in your body composition and so, it’s definitely worth considering.

Cynthia Thurlow: Yeah. No, such a beautifully articulated conversation and I want to be cognizant of time, but I do want touch on a couple of rapid-fire questions that came in-

Dr. Jolene Brighten: Ooh.

Cynthia Thurlow: -when people knew that were talking. And this is very relevant. I’m not particularly active on TikTok, but I know that you are. Supposedly there’s a 27-year-old female who is in POI, so premature ovarian insufficiency, I think some people were saying she was in menopause. Are you starting to clinically see younger women that are having these long periods of not having periods and thinking it’s completely benign?

Dr. Jolene Brighten: Okay, couple of things that I want to say. So firstly, doctors will call it early menopause, and I would just say get a new doctor. [Cynthia laughs] Because if they’re not saying this is primary ovarian insufficiency and investigating it, it’s a problem. This can sometimes be an early sign of Addison’s disease, which is a rare autoimmune condition, but you can die from that autoimmune condition. This is the true adrenal fatigue. When you actually get adrenal gland destruction and you can go into an Addisonian crisis and this is where you get hospitalized, it’s a very bad thing. That is one of the extremes of what could cause primary ovarian insufficiency, but it could also be autoimmune. We know that once you have one autoimmune disease, once you get that diagnosis, you likely have others. And autoimmune is not a mess around with kind of thing, so definitely needs to be investigated. And if your doctor is just like, “It’s just early menopause.” At 27, go back to school fool. It is not early menopause. [Cynthia, laughs] I ain’t even going to hear that. So, the other thing is that because– medicine has done this real disservice in calling the bleed that comes with the pill a period. And so, they’ll say you don’t need a period when you’re on a pill. But they just say you don’t need your period, it’s fine, and you’re on the pill. So, then women come off the pill or women are not on the pill and they’re like, “Well, I’ve heard that you don’t need your period, it doesn’t matter.” You don’t need a pill bleed. This is true because there’s no ovulation, there’s no growth of the endometrial lining. So, no, you don’t need a pill bleed, but you do need your period. It is a sign of vitality. It is definitely a metric of your overall health. And we know that losing your period at that early of an age, that’s significant increase in morbidity and mortality, like all-cause mortality.

Like, we’re talking about people that are going to have dementia, people are going to have heart attacks at ages far far younger than we would typically see. I have seen, especially in the vegan community, very large accounts saying, “Oh, you only have a period so that you detox.” And if you’re on a vegan diet, you’re so clean that you don’t need a detox that if you lose your period that’s a good sign. You’ve done a good job. That is functional hypothalamic amenorrhea. You have starved your body to the point where you’ve now told it that the environment is so unsafe that it should not put any energy into reproductive health and is very bad. Because what is going to happen is we are going to lose our bone health, our brain health, our heart health and we are not going to come back from that very easily.

Cynthia Thurlow: Thank you. I was stunned when I read this report and I thought to myself, I could not think of a better person to ask this question. Number two, what is butt lightning?

Dr. Jolene Brighten: Butt lightning, the phenomenon where it feels like Zeus himself has shot a bolt of lightning into your anus. [laughs] So, I didn’t come up with the term, proctalgia fugax is actually the medical term, but everybody on social media is like butt lightning, butt lightning. And I was like, “That’s actually a better term for it.” So, this can happen due, most commonly, to elevated prostaglandins. It can be how your uterus is tilted; it can be how you’re wired in terms of your nervous system. And it can also happen during pregnancy because there is so much pressure and so much going on down there. In some instances, it is a sign of endometriosis. So, if you’re also having other symptoms, which I detail in the book, definitely worth getting checked out.

Cynthia Thurlow: Yeah. Last question, and I had a lot of questions about this. Women that are still getting menstrual cycles and are trying to differentiate between “bad PMS versus PMDD.” And interestingly enough, in the book you talk about 90% of women have PMS and only 3 to 8% of women actually have PMDD. So much lower frequency but what are some of the key differentiators for people to look for?

Dr. Jolene Brighten: Oh yeah. So, we could do a whole podcast on just this. [Cynthia laughs] Okay, so with PMDD it’s going to last longer and it’s going to be much more intense. Like you can have suicidal ideation with PMS, you’re not thinking of unaliving yourself with PMDD, that thought might come around. So, with PMDD you’ll have more extreme symptoms, so extreme mood symptoms, extreme physical symptoms. And what is important to understand that I do talk about in the book as well is the link between PMDD and having neurodivergent minds, okay. So, if you are a neurodivergent individual, you may be more likely to be diagnosed with PMDD. So, it’s found that roughly 46% of women with ADHD have PMDD and the estimates for autism is over 90%. So, this is important to understand because you may only get the diagnosis of PMDD, but you may find that they have these same issues throughout your cycle. They’re just more intense before your period. And so, for someone with PMDD, they’ll have sensory issues. So, lots of light, sound, smell, touch, these things are really, really aggravating to them.

If you are having PMDD symptoms and you’re like, when I hear that sound, it feels like somebody’s peeling my skin. And it’s like you hear a sound, but you have a physical symptom or you see something and it makes you want to throw up. These kinds of things can actually be signs that you may be neurodivergent. And why I bring this up is because if you get the diagnosis of PMDD, that is all your doctor is going to see and they are going to be like, “Well, you’re not a little boy, so you can’t have autism or ADHD.” And yet many women are going undiagnosed. The DSM-5 has not been updated. Like, I look at PMDD and I really am like, “It’s looking a lot like autism there.” [laughs] And yet there haven’t been updates to include women. In medical school how I was taught about autism was just so extreme. And even how I see providers talk about it on social media where they’re like, “Oh, don’t do these things because it’s associated with higher incidences of autism and as if autism is this extreme and really bad thing and they’re not even realizing that how many women in their audience are actually autistic?” High masking and what some people would call fully functional, although it’s just like these are people who have figured out how to navigate society. So, I just bring that up because this was another section of the book that I really had to pare down.

Again, I could do like a whole podcast with you just talking about all the nuance of this. There is a checklist in the book to understand, is it PMS or is it PMDD? And I really encourage people if they feel like they’re falling in one or the other, to take that quiz and really evaluate themselves. You have to track the symptoms for a couple of months because with PMDD, they have to be present at least half the year for you to get the diagnosis. And so, if you go to your provider and haven’t tracked it for a couple of months, they might be like, “Well, it’s just probably PMS.” And so, you want to have all of that data dialed in.

Cynthia Thurlow: Well, thank you so much for this incredible discussion. Thank you for the work that you’re doing. Please let listeners know how to connect with you outside of the podcast, how to get access to your newest book, and how to connect with you on TikTok, which is where you are. I mean, I’ve thoroughly enjoyed kind of preparing for this podcast. You keep it real and I think that’s what all of us need.

Dr. Jolene Brighten: Well, thank you. Yeah. I’m all-over social media @drjolenebrighten. My main hub is drbrighten.com, D-R-B-R-I-G-H-T-E-N dotcom. There’re tons of free resources there. Understand that there’re things you can’t say on the Internet or on social media, which is why I wrote a book, [chuckles] because then I get to talk about all of the things that you need to know that doctors should be able to say on the Internet, but that like, Big Daddy Meta doesn’t let us. [laughs]

Cynthia Thurlow: Well, thank you so much again.

Dr. Jolene Brighten: Yeah. Thank you.

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