Kim Vopni (00:01.096)
Dr. Carrie Jones, we know a lot of people in the same realm who have wanted us to connect and we're finally doing it today. So thank you for being here. And and we're gonna talk about a whole bunch of perimenopause topics that I wish I had known. I guess mine is about it's almost probably twelve to fourteen years ago when mine started, but I didn't know the term perimenopause. I didn't know what the heck was happening. I had all these weird, crazy symptoms and I
I think instinctively knew that I had something hormonal going on, but everything was quote unquote normal when I went to my medical doctor. And that sort of put me on this path of I had heard of naturopaths. I'd used it a little bit. I remember my family doctor way back in the day. She had recommended naturopaths to me and so I had dabbled, but then that really was kind of put me on the trajectory of trying to figure this whole thing out. And I wish that there had been
kind of the Bible or people like you or more information and resources. Now there's a plethora, but I know that can also work the opposite where you start to get very overwhelmed with things. But I guess maybe just start out, who are you? What got you into this field and and what brought you to this perimenopause space and speaking so passionately about it.
Dr. Carrie (01:08.142)
Mm-hmm.
Dr. Carrie (01:11.756)
Yeah.
Dr. Carrie (01:20.504)
First of all, thanks for having me. Like I I had said before, our friends will be very proud that we're we are together. I have been a doctor for 21 years. I knew I wanted to be in women's health and hormones from the very beginning. Hormones made a lot of sense to me. It helped me significantly that I was hormonal. So then I could explain what was going on with me and my symptoms and what was happening back in medical school when I was in my twenties. I had an amazing mentor.
Kim Vopni (01:25.758)
Dr. Carrie (01:48.505)
Who was in her 40s at the time when the big research article came out, the Women's Health Initiative in 2002, that said essentially, hormones cause cancer, stop your hormones. And my mentor went, we'll be careful, but we're gonna continue to prescribe hormones. And I feel very lucky that I then was in full-time private practice for many years, saw lots of women, a lot of patients to help them with their hormones. And I would have women
Extremely intelligent women, women who'd had multiple children, and they're like, I'm not really sure how this works. Like, I don't really know how I got pregnant. I'm not really sure what this symptom is. I'm not really sure what the word progesterone is. And I spent a lot of time explaining women's physiology, women's anatomy, and I loved it, but it was also very sad that we didn't get any of this in elementary school or middle school or high school or university or anything.
And so that's what I've just done my whole life is is hormone education. And of course, hormones have gotten older as I've gotten older. So now that I am I am perimenopausal, I've been I'm 49. I will I've been perimenopausal since I was forty-four. That's when I had my first symptom. I had a really brilliant idea. And I was sitting right here at my desk in the same background and everything. And I thought, it's a brilliant idea. I'm gonna open that tab on my computer. And the time it took me to move my finger to my computer.
on my mouse pad and opened the tab. I had no idea what the idea was. I do remember to this day it was a brilliant idea, but I don't know what it was. And I thought, I'm I bet that's a first symptom. And then it moved into insomnia. And then it moved into I couldn't not that I drank a lot of wine by any stretch, but like I couldn't even handle a glass of wine and all the things that my patients would tell me back in the day when I was a young pup and they were older and they were like, you just wait.
Kim Vopni (03:18.463)
Yeah.
Dr. Carrie (03:38.978)
And then I went through it, you know, and I was like, let's let's pivot and start talking about this because I'm real world experiencing it with everybody else.
Kim Vopni (03:48.05)
Yeah. Yep. I was that I I would say I s I that's one of the things I still actually struggle with, even though I have I've learnt a lot. I've had, you know, I'm I'm on hormone therapy, all the things I've done lots to optimize my health, but focus and attention and memory has somet is something that I still regularly struggle with. The the weird ones that I had, I had I would get weird rashes for no reason on my body, still have the right
Dr. Carrie (04:12.18)
yeah. Mm-hmm.
Kim Vopni (04:16.665)
Ear itch, only the right ear is itchy. the more st I never really had hot flashes until I was post menopause, so that didn't show up until later, but I had constipation. I would get, every once in a while, I would get one part of my lip would get really fat for again, no reason. I started having heart palpitations, I couldn't sleep, I got anxiety that really floored me. I I had never experienced that before. And constipation.
Dr. Carrie (04:17.336)
Yep.
Dr. Carrie (04:25.505)
Mm-hmm.
Dr. Carrie (04:45.942)
Mm-hmm. Yeah.
Kim Vopni (04:46.393)
libido, blah blah blah, like all the things. And and now I still still have a few of them, but fast forward, like again, that was like 14 ish years ago, now four years postmenopause, and grateful for the information, grateful for people like you. For other people that are now in this space, one thing that, you know, there's no test for perimenopause. There's, there's, you could argue, like
Yeah, they test maybe one FSH for are you in your menopause, but they also look at your your periods. Have you gone a year without them? Where do you sit with regards to testing recommendations? When should they have them? Should they have them? And in perimenopause, there's the conversation around if you are gonna test to do it at a certain time within your menstrual cycle, which is often fluctuating. So how do we navigate that?
Dr. Carrie (05:35.479)
Yeah. I am a big fan of testing, but I completely understand that because of that wild fluctuation, it can be hard to pin down when to test, but specifically estrogen and progesterone. When we talk about hormone testing, that's usually what people mean. I want my estrogen and progesterone testing. Forgetting we have so many other hormones. Thyroid hormone, even insulin, vitamin D is a hormone, even though it says the word vitamin in front of it.
We have other things that we can look at that play a huge role and how we feel and how we manage perimenopause. In the start of perimenopause, most women still have regular cycles. And the even that whole early stage, you are pretty classic and that the hot flashes didn't come until later. In fact, the early symptoms of perimenopause are usually the ones you defined. Like I'm tired, I can't focus, me, I'm for I like I I'm think I'm a smart person and then I just forget things. I don't
know where that word went or why I couldn't think of my neighbor's name who I've lived next to for eight years. anxiety is a big one. Anxiety, depression, and rage, irritability. Those are big ones that happen in the beginning. But women are confused because they still get their period month after month if they're not on any kind of birth control. And so they're like, well, I can't be perimenopausal because I'm still regular. And sometimes their OBGI will say their OBGYN, like, you can't be perimenopausal yet, you still get a period. Like
you're you're still pr reproductive. And I'm like, no, no, no, no, that's not how it works. So in that early stage where you do still get a period, I will test women's estrogen and progesterone, in particular their estrodiol and progesterone, estrodiol being our main estrogen. And I prefer to test it five to seven days after ovulation because even in that early perimenopause, women are still often ovulating, which means release the egg, which is why women still get pregnant in their 40s.
Because they're still releasing the egg and they're like, wait, I was confused. I thought I was in my forties. Like, isn't that over yet? I'm like, it's not over till it's over. No. And so we can test them. Once you start to get irregular, once women start to tell me I'm skipping cycles, I skipped two months. I went forty-five days. I had two periods in the same month. I just got this question yesterday. Dr. Carey, I had two periods in the month of September. Is that normal? I'm like, well, common.
Kim Vopni (07:34.173)
Yeah.
Dr. Carrie (07:57.71)
Common. I'm not saying it's fair or fun, but it is common and you might start skipping as well. Then I'm like, let's scratch the estrogen and progesterone. I know your progesterone is low. I know your estrogen is all over the board, but I'm still curious about your other things. Thyroid, for example, your nutrients, your cardiometabolic markers. So I test, but I test strategically depending on where you are.
what you tell me, and this is all assuming somebody still gets a period. If you say to me I've had a partial hysterectomy, I've had an ablation, I have the progestin IUD, they probably they're not gonna bleed. So they are like, I don't even know if my ovaries work. We go by symptoms and we do use that FSH test, that follicle stimulating hormone test to see, have you crossed the menopausal threshold yet? Like how are you doing here? And then we we kind of backtrack using that.
Kim Vopni (08:53.691)
So with testing, do you recommend saliva, blood, and or the Dutch test or or a urine metabolite test?
Dr. Carrie (08:59.662)
or Yeah, so it depends it depends. So I don't often use saliva. I used to use saliva a lot in the beginning of my career, and I pivoted pretty much entirely to blood testing and urine testing of some sort. I will still use saliva if I'm doing a very specific cortisol test called a cortisol awakening response, which
Basically this means if you come to me and tell me that all your symptoms are way worse on waking when you wake up in the morning. Not so much just in the morning, like before noon, but like on waking carry, I'm a disaster, I'm exhausted, all these symptoms are t then I then I'm like, okay, this specialty cortisol test might be really helpful for us. Otherwise, I default to blood testing and I default to urine testing. Now with urine testing, we can do something like the Dutch test, which
For everyone listening, it's an acronym, Dried Urine Test for Comprehensive Hormones. And basically it gives us your hormones and then where do they go? Like where does your estrogen go? How does it break down? How does your testosterone break down? What is your cortisol doing through the day? So it's a very in-depth hormone test. But there's a newer test as well. We call it longitudinal hormone testing, where we do an at-home urine test every day. And the the results are you get right there in your bathroom. It's basically you
Urinate, dip a stick in there, kind of like a pregnancy test, plug it into the little machine. It's about the size of a like softball. And then within 16 minutes, you get estrogen, progesterone, LH, and FSH. and there's a company called Mira, and they do that. And so I like that because some perimetopausal women are like, well, I'm like between 24 and 45 days. Sometimes I get half flashes and then they go away, and I'm like the complete opposite. I'm very cold.
I'm back to my old self. Then I get PMS. I'm like, okay, okay, okay. I need to see, let's look at your hormones every day and let's see how how wild and out they are, as opposed to a one-time blood draw or a one-time Dutch test. But I but I can layer in what I need depending on do I need to know where your estrogen's going? Am I putting you on estrogen? And I'd like to know how your body detoxes it. What is your cortisol doing? How's your stress? Am I looking at thyroid? Well, that's a blood test. Am I looking at glucose? Well, that's a blood test.
Dr. Carrie (11:21.697)
So depending what I need, I can pull. I don't do all of them all at once.
Kim Vopni (11:26.759)
Got it. Yeah. I just was at a at a conference and Mira had a table there. It's I have heard about them but I hadn't actually seen them in real life. It's a it's a really I I love the innovation and the progress the the prog progression, I guess is the right word, but the the innovation in the space of us being able to be in charge of our health and our health data. and then, you know, it just it just opens up so many possibilities and takes a barrier of
appointment times and wait times and all of the stuff. And then of course, obviously practitioners like yourself to help us evaluate. But you you talked about so the the h where the ho say estrogen or hormones are going in the body. So this is, as you said, the how it's being metabolized and if there is, you know, put some people say detox pathways. So there's three pathways. Can you talk a little bit about why it's important to know where your estrogen is going or how we are metabolizing it.
Dr. Carrie (12:20.641)
You know, one time on social media, well, I've done it a couple of times. I'll post a poll, you know, on Instagram stories. I'll post a poll. Like, how long do you think estrogen lives in your body? And I'll I'll put up like a couple minutes, you know, a day, a week, forever. And the number of people who click forever, I'm like, forever. Like, you mean the estrogen I made in puberty I still have circulating? No, no, no, no, it's not it doesn't work that way. Your body will make and use estrogen and then break it down really pretty quickly. And we call this metabolism.
Is is the act of breaking down. Now we often think of metabolism like, I need to rev up my metabolism to lose weight. But when we think in science, the grander word for metabolism is how do we break this down? So estrogen goes through three phases of metabolism or the detoxification. The first phase predominantly happens in the liver. Not always. You can ha you can do this in other places. Even the breast tissue allows you to start the detoxification process.
And this phase, believe it or not, is iron dependent. And because it's iron dependent, so many women who struggle with iron deficiency really can get stuck in this phase. And as estrogen goes through this phase one, it then has three more doors it can choose from. Some of these doors are better than others. So one of the doors is actually really quite protective. And the other door is potentially damaging to the genes. It's what we call genotoxic.
So we don't we d we don't have a choice. The body designed us this way, but we don't want to prefer this pathway. Now, after we go through these doors on the other side, and for some of these, we have to either get we need to get neutralized. Because eventually the end goal is to get rid of it, which is either through the kidneys and the urine or through the bile and intestines in your stool. So we have to make it water soluble. So the second stage is let's make it neutral and let's make you water soluble. And these are fancy words, methylation.
Sulfation, glucaronidation, but really important for us to know as clinicians, we can look at them in real time on in urine testing, like the Dutch test. I can get some information on genetics if you happen to have your genetic report. A lot of people love their genetics. And then the third step is how is your how are your kidneys? How how is your intestinal tract? Do you have a gallbladder? Like what is your bile doing? Do you have constipation? What's going on in the GI? Have you
Dr. Carrie (14:41.08)
Traveled and you've picked up a parasite. Do you have small intestinal bacterial overgrowth? So you can see in this three-step process, it's really helpful for us to evaluate because what I don't want is for your estrogen to only get so far and then get reabsorbed back in the body. And I don't want it to be go down the path of DNA damage and increase the risk for DNA damage. Like we don't want that. So by seeing how these pathways are, I can use diet and nutrition and supplements.
To help guide it ahead of time before I even start to talk to you about, hey, are you do you are you interested in going on hormones? Are you considering estrogen? Or even somebody who's younger who gets a lot of estrogenic symptoms, sore tender breasts, big time PMS, fibroids, polyps, heavy periods, that inability to clear estrogen well seems to be linked to this, because it just gets reabsorbed again.
Kim Vopni (15:37.819)
You said a couple things that that struck me. One, the first pass with or sorry, I think you said the second pass that dependent on iron? Was it the first pass or the second? First. Okay. So the first pass reliant on on iron. And then I think about the people like myself who I had murder scene periods and I was so low in my my iron ferritin and so
Dr. Carrie (15:47.064)
First pass. The first pass, yeah.
Dr. Carrie (16:02.061)
Yeah.
Kim Vopni (16:03.602)
Nobody told me at the time that I should potentially be supplementing or doing other things to increase my iron as that would help with the detoxification that first pass. That was interesting.
Dr. Carrie (16:12.226)
Yeah. Isn't that wild? And and two in here in the States, two societies have changed their ferritin cost. So ferritin is a fancy word for iron storage, like an iron warehouse. How much iron do you have stored in the racks of your warehouse? And the range in the US is huge. It's like fifteen all the way up to a hundred and fifty, sometimes two hundred. So if you're at sixteen or fifteen, they're like, Well, you're on the lower end, but we'll just keep an eye on it. Stupid. So stupid and so low.
Now the American Society for Hematology has said, hey, menstruating women need to be at least 30. And the American Gastroinological Society said, if you have a history of anemia or you're anemic, you need to be at least 45. And so that's a big gap. A lot of women have written in, I rate, like I was, I was nine. I was 11. Like I was 16, you know, I was told I was fine. I was told I was fine at 24. And yet,
Even the hematology society says I really need to be above thirty. It make a huge difference in health.
Kim Vopni (17:12.508)
Yeah. Yeah. Yeah. The other one that struck me was the the poop passage. so the binding everything up and getting it out. And this was another big haf for me and the when I learned about I I read a book and it had a questionnaire about many different things and it would help you understand are you estrogen dominant, are you deficient in this? Are you hypothyroid? And I kept
ticking off hypothyroid and then that led me down the path of Hashimoto's and that whole thing. And I just at the time said, why why are we not having a baseline for hormone testing and for thyroid testing? Because again, in my situation it was I had the heavy bleeding, I had the constipation. So none of that detoxification really was happening very, very well. And probably was part of the reason why I felt so terrible, because I couldn't couldn't I wasn't detox detoxing that estrogen. And
Dr. Carrie (17:48.536)
Mm-hmm.
Dr. Carrie (18:02.124)
Mm-hmm.
Kim Vopni (18:06.472)
Then when you're in the phase of you don't have the progesterone, so you were going to be in that quote unquote estrogen dominant phase and you're not getting it out, you know, it's just like so many little aha moments that I'm having having now, you know, fourteen years later.
Dr. Carrie (18:19.598)
Yeah. And thyroid is a big one, especially because most clinicians will run a TSH, thyroid stimulating hormone. But really the most active hormone is our free T three. This this this week and last week, I have talked to two different endocrinologists who are very, very functional, very integrated, very holistic, but fully practicing endocrinologists. And they were like, we run a free T three because I keep s I keep saying to my chat GPT, I mean, don't judge me.
But I'm like, free T3 makes the cell go round. Like it's it's the active ingredient that really gets in there and helps power, you know, independent of the mitochondria and ATP. Free T3 is a big one. And Chat GPT is like, well, that's a little, that's a little simplistic, Carrie, but I know what you mean. And so I said that to these endocrinologists, and they're like, no, no, we feel the same way. We feel if somebody's free T3 is borderline low or low, they're really gonna struggle at a cellular level. Even their mitochondria, their ability to make
Hormone, their ability to feel and look good, the way their digestion works, their hair grows, their skin recovers. Everything can fall apart if that's borderline low or outright low. And yet, most clinicians don't run it. They just stay at the top at TSH and they think that's good enough. And kind of like the iron story, like women are getting missed once again. Like, great, I'm glad my TSH is normal, but it doesn't mean my T3 will be normal as well.
Kim Vopni (19:46.483)
Yeah. Yeah. Yeah. And that was exactly me. I I was the one that had to go and ask, even even when I went to a naturopath, I was the one that still had to ask, could I have the testing to have the reverse T three, have the the total T three, you know, all all the things and the antibodies. And that is something that I I encourage all women to do. So in you you mentioned some other things about w it what you're looking for in the testing and one of the other things was was minerals. What
Dr. Carrie (19:57.817)
Yeah.
Dr. Carrie (20:01.56)
Yeah.
Dr. Carrie (20:09.774)
Mm-hmm.
Kim Vopni (20:13.554)
Why is that important? What are you looking for in particular with regards to, you know, is it you're looking for things that are too much, too little?
Dr. Carrie (20:21.304)
Too little. It's really unfortunately very common that I think a lot of women are mineral depleted. And in particular, magnesium is a big one. Magnesium is active in over 600 enzymatic reactions in the body, which means to get your body from point A to point B, magnesium is usually the cofactor that helps make that happen. And in the scheme the grand scheme of detoxification, one of the ways we do it is called methylation. And the name of the enzyme that comes from a gene is called C O T.
Some people shorten it to Compt. Some people, it's catechol O methyl transferase. If you are into genetics as well, it's on every genetic report. People love to test it. Now COMT is magnesium dependent. We we have to have magnesium to do that. And COMT not only detoxifies and helps estrogen get broken down or or neutralized really, but it does so many other actions in the body. Even like breaking down your dopamine, your adrenaline, your noradrenaline.
Like it's really, really helpful and and if you're depleted in magnesium, you don't get it in, you have a lot of digestive things, you can't absorb it, you have loose stools, you just end up pooping it out, you know, like we don't get it in our soils, then you're gonna struggle in all these aspects, detoxification being one of them.
Kim Vopni (21:40.319)
When you are testing for and looking at that in particular, a lot of people highlight magnesium as a lot of people being deficient in it. When when you look at magnesium supplementation, there's so many different types. And so when you're looking on a test, is there one type of magnesium that we're looking at or is it overall all the different types of magnesium in the body? And then how would you then support the person? What type what type are they typically most deficient in?
Dr. Carrie (21:47.214)
Mm-hmm.
Dr. Carrie (22:06.734)
So the good thing is magnesium is magnesium. Thank goodness. So when we do a magnesium on a test, most often we do what's called an RBC magnesium. But the thing about magnesium is it's it's intracellular. It's in the cells. So picture your neighborhood. And if I were to count all the people walking around your neighborhood, that's outside the cell. Whereas I would have no idea how many people were in their houses. That's magnesium. So if I count what's outside versus what's inside, could be very, very different story.
So a lot of times with people, I'm like, I may not even test because I just may put you on magnesium. Now, magnesium often has a second, like a last name, like magnesium malate, magnesium glycinate, magnesium citrate. And that second word just helps it either get absorbed a little better, not have as many GI effects, maybe help other areas of the body, like magnesium glycinate with a G.
Glycine is calming, it's soothing, it's relaxing, and it also doesn't tend to cause the loose stool diarrhea effect. So a lot of people like their magnesium glycinate as a form. They take it at night, they don't get the loose stools, they feel better. If you have a history of constipation, you may be told to take magnesium citrate. That will help move things through, but it will still give you magnesium. We have others like oratate, which may be meet more cardiovascular leaning.
malate, which is similar also from muscles. So there's all these different forms of magnesium. But thankfully, in the end, all of them are magnesium. Some just absorb better than others. Like magnesium glycinate absorbs better than others.
Kim Vopni (23:41.823)
Got it. Okay. That makes sense. How would you obviously everybody who's listening would would go get a test and test results are going to be different. So we we can't necessarily say, tell everybody, these are all the things that you should do. But there are things that we could potentially do generically that could help us ease this
this transition period that we're in. What would you say are your top three to five recommendations for how people can optimize their overall health so this transition becomes a little bit easier?
Dr. Carrie (24:15.661)
No, the good thing is a lot of it it's boring, which is why nobody likes to do it. But I'll give you the science behind it. So it's even things such as like, you know, we hear all the time on social media, eat enough protein, eat enough protein. Remember when protein breaks down, those are your amino acids, those are your building blocks to life. So if you don't get enough protein, you're not getting enough of what we call the building blocks to life. So make sure you're getting enough protein at every meal. Even things like fiber. If you now I understand not everybody can start out with a lot of fiber if they have a lot of GI digested things they're working on or upset.
But if you can increase your fiber, I would highly recommend increasing your fiber, whether that's through complex carbohydrates, you know, vegetables, root vegetables, or even adding in a fiber supplement. So, so helpful because the digestive track really changes, unfortunately, for the worse, for a lot of women at this stage of the game. Speaking of which, easy digestive things are like chew your food, which sounds crazy.
But the amount of people that I find don't like they chew once, twice, three times, and then immediately swallow. Well, your digestive tract is changing for the worse, potentially because of your changing hormones. So the more you can chew to break down your foods, the easier it is for you to assimilate and absorb your foods. Even adding in a little lemon juice and water before you eat, or apple cider vinegar with the mother. Some people like digestive enzymes with their meals or like papaya, little papaya enzymes.
before meals just to help you break it down and assimilate it that part better. Then we get into hydration. Like when was the last time you actually counted your water? Some people are fantastic. They live their life. They have 1400 Stanley cups and all these water bottles and they drink all of them. And others are like, man, it's mid afternoon and I haven't had a glass of water yet, but you have had coffee. So go back and drink some water. Make sure that you are hydrated. Then there's alcohol.
How much alcohol are you drinking? Because alcohol is quite the bully and really can take a, you know, take its toll on the liver and can really inhibit estrogen detoxification. Like it gets in the way. It uses up resources. It creates toxins. It makes you feel like crap. And a lot of women going through perimetopause will just straight up tell you man, when I drink alcohol now, when I have that glass of wine, I can't sleep. My heart races. I get hot flashes. I feel terrible. I used to be able to put it down.
Dr. Carrie (26:37.879)
And now I can't anymore. I'm like, I know. Because the enzymes in our liver are changing. They're they're they are also, you know, responsive to hormone changes. They're also getting older and they just can't handle alcohol like they used to. And then it becomes to diversity of foods. Make sure you're not eating the same thing every day, all the time. Like, you know, you're going through this transition, so shake it up a little bit. Change what vegetables, eat what's in season, rotate your fruits around. If you only ever eat chicken.
Try something new. Try turkey, right? Like, try, you know, try beef if you can. If you only eat beef, then like let's try turkey. Even dark turkey. You know, either let's let's chicken or dark chicken. Let's get it. If you eat meat, of course. I understand not everybody does. But if you're thinking to yourself, gosh, yeah, I pretty much only eat chicken. That's the only thing I have. I'm like, we let's rotate around. It'll your digestive tract will really appreciate it. Your microbiome will wants diversity. And as we get older, it's not as diverse as it used to be.
So I hit these I hit these like high points of diet and hydration and alcohol and people roll their eyes at me. They're like, that's boring. Is there a supplement for that? Like, well, technically, yes, there's a fiber supplement, but like, come on. When we dial in on these things, this is when it can help our detoxification, metabolism, you know, our energy, our again, the as the absorption of these vitamins and nutrients that our body uses.
To make things, build things, clear things, it can make it so much easier. Even magnesium, I didn't even say this, I forgot. When you make energy, most people think cortisol. Like how, you know, I I have I'm tired today. I must have low cortisol. But really, your cellular energy is called ATP. And we made it from our mitochondria, our cellular powerhouses. And ATP, in order to activate it, it needs magnesium. Without magnesium, it's not activated.
And so I'm yes, it helps detoxification of estrogen and all these other things, but like just it cellular energy, you need magnesium. So if you're not absorbing well because you eat like a snake where you just swallow your food whole, and then you eat on the run and you're stressed out and you're underhydrated and over caffeinated and had too much wine last night. And then you're like, my perimetopause sucks. I'm like, I know. I mm-hmm.
Kim Vopni (28:38.386)
Yeah.
Kim Vopni (28:53.62)
Yeah. If there was one thing that I would tell people right off the bat, aside from you know, the testing the hormones and the and the thyroid, I would say stop alcohol. And this was coming from somebody who I I rarely drank. My husband has never seen me drunk. We've been married for almost twenty-five years. We've been together for twenty-eight, like
Dr. Carrie (29:06.713)
Mm-hmm.
Kim Vopni (29:17.424)
I I just have never been a big drinker at all. So I I never thought, it's the alcohol. But as soon as I stopped alcohol, everything that I had been th all the lingering s symptoms as I was kind of getting things in check, everything normalized. And I would have like maybe a glass or two a week, maybe. And it was shocking to me, honestly. And now I you know, I still very rarely even drink at all. I went for years without and now I have it on occasion, I find, but
Dr. Carrie (29:33.871)
Mm-hmm.
Kim Vopni (29:43.4)
But it has to be early in the day, earlier, like not like ten in the morning. I mean like, you know, if I'm going to it's like four o'clock or five. But that was such a big difference. Yeah.
Dr. Carrie (29:44.953)
Yeah.
Dr. Carrie (29:48.496)
I mean maybe sometimes my girlfriend and I were it's a huge difference. My girlfriend and I were out to dinner the other day and we did we didn't drink. We had to lecture the next day. I don't I don't drink, I'm like you. I I I don't drink much at all. I feel terrible when I do. But man, I do love a good glass of wine, but it does not love me back, that's for sure. So my friend and I were joking, we were like, We need to bring back day drinking when like when we were in college or younger.
Kim Vopni (30:07.73)
Yep. Yeah.
Kim Vopni (30:16.626)
Yeah.
Dr. Carrie (30:17.239)
Because at least if I had, I don't know, a mimosa, let's say, you know, at a at a bridal shower, th by the afternoon and like that night, it had worked out like I slept okay. it's not justifying, but you on the rare bridal shower I go to if I have a half a mimosa, I'm like, I'm fine like thank God, I'm okay. If I had that mimosa at six o'clock at night at dinner, I'd be a wreck.
Kim Vopni (30:39.698)
Yeah, yeah. No, it's crazy. The in the in this menopause transition, perimenopause transition, we hear often it's progesterone that is dropping first. And so when you are having the hormone therapy conversation with somebody and we're looking at starting somebody with hormone therapy, do you always start with progesterone first and do you always start with just one at a time, or do you
Like some people have a combo where everything's been compounded together and and put into one, say, cream.
Dr. Carrie (31:15.651)
I d so it depends on the person. So if I have a sensitive bunny, then I will just do one at a time. Because if I do estrogen and progesterone and testosterone or even DHEA and it goes off the rails, then I don't know which one it is. Sometimes I can figure it out based on symptoms, but I'm like, let's just start with one. Usually I start with progesterone because it's true that tends to decline first. I will say though, there is a subset of women whose testosterone declines first. And it's often that woman whose
Like mid to late thirties, has had a has had another child, second child, third child, fourth child, maybe it's her last child, and like everything crashed since then. And oftentimes that testosterone belongs to a family called the androgen family. And they'll, you know, they're like, my gosh, I'm not motivated. I don't have libido. I don't feel like myself. Like, I can't put on muscle. So it's not irregular cycles. It's not hot flashes. It's not necessarily even anxiety, or f they're just like,
I just don't feel myself anymore. And I'm like, that's testosterone. I think we need to look at testosterone. Not all though. That some women me, my testosterone is held steady. I am good with testosterone, but what I did lose was progesterone. Like that that was gone. So I take progesterone. So I think it's important to really evaluate it when did your symptoms start? What was going on in your life? And what were those symptoms? Do I need to give you progesterone? Testosterone? Both.
Kim Vopni (32:17.673)
That was me.
Dr. Carrie (32:40.148)
Or are you far enough along? Some women come to me in perimenopause and she's like, I haven't had a period in six months. So she's not at the twelve month mark, but she is at six months and she's miserable. And I'm like, we need to quickly get you into up roll up into some estrogen here soon. But let's start with progesterone. We'll add in estrogen and then look at testosterone.
Kim Vopni (33:00.767)
Yeah. Yeah. This the testosterone was the last thing and it really should have been I think the first thing that I that I all of those things. I lost my motivation, my drive. I was always, you know, at the gym, no problem. I if I ever had the motivation to go, I couldn't recover very well. Like it was the classic testosterone conversation, but it was it just wasn't part of the conversation at all. It hardly is now. I mean it's starting to happen a little bit now, but yeah.
Dr. Carrie (33:05.932)
Yes.
Dr. Carrie (33:22.38)
Yeah. Yeah. It's and there's so much pushback. There's so much pushback of like, and it it just it's it's hard for me, having been in practice as long as I was, and prescribed as long as I was. again, I've been prescribing. I graduated medical school in two thousand five and and was like as soon as I got my license, started prescribing. And so I have so much feedback from women who wear testosterone not always but often made a huge difference in those types of symptoms.
So when there's this weird pushback on social media of, well, we shouldn't even lab test it. The lab test, you know, the range is a joke, or we don't have an FDA approved version, so we shouldn't give it to women, or some of the researchers who talk about placebo effect and testosterone, I'm like, I I believe the women. When when I put somebody on testosterone and they feel like a million bucks, things come back, things turn on, they're feeling great, or even half that, even if they're not
Back to like where they were in their 20s, but they're like, I just feel myself again. I just feel better. Like that's gr I believe you. Great.
Kim Vopni (34:27.443)
Yeah, yeah, yeah. With progesterone, would you do you default to cream over tablet or always tablet? What do you prefer?
Dr. Carrie (34:37.283)
I if they're not sleeping and they have a lot of anxiety, I default to the capsule, Prometrium, unless they in the United States our proje pro Prometrium still has peanut oil in it, which is stupid. In other countries, Canada, the UK, like they don't use peanut oil. I don't know why we can't get with the times, but in which case then we can compound it without peanut oil. It also has some f you know, dyes and filler and stuff in there that some women react to, so I'll compound it without all that crap if they're sensitive.
so I tr start that route first, especially if I'm going to add in estrogen, if that's on the plan, because if she has a uterus, the progesterone cream has not been shown to be protective against the risk of thickening of the uterus, which is called hyperplasia. Now, if she doesn't have a uterus or she says to me, I don't want estrogen, but I went to the natural food store and I picked up progesterone cream and I've been using it and I feel better, I'm like, great.
Do you want stay on it? Like if it's working for you, it's working for me. So I can for sure go the cream route if that's the way she'd prefer to go. And some women will go, can you can we get it compounded? Can I add testosterone in? I don't want estrogen or I'm I'm afraid of estrogen or I'm not ready for estrogen. Like, of course. If this is working for you, I wanna use what's what's still working forever. But as long as you realize that, sure, let's try it.
Kim Vopni (36:03.989)
Should women be afraid of estrogen?
Dr. Carrie (36:06.06)
No, no. It is a blanket no. I'm gonna say obviously there are caveats and nuances to that. I was just reading a paper, two big international organizations put out guidelines around heart disease and hormones. And they were like, if you have uncontrolled heart disease, so uncontrolled blood pressure, your cholesterol's through the roof and you're doing nothing about it. If you have a history of blood clot or you're high risk or what have you
Like you can still use hormones, but we prefer you use, like the ideal to use is transdermal. So the patch or a gel, for example, vaginal. Like go that route. Don't swallow it. So if you're swallowing your estrogen, there is an increased risk for what increasing your your blood clotting factor. So that's where we get the increased risk for potential clot, stroke, some of these other things. So we have to be careful on the route as for estrogen. Can women have side effects of estrogen? For sure. I have women that
will go on estrogen. Sometimes it's too much. Sometimes they haven't been on estrogen. They bit like they've haven't had a period in a minute. And all of a sudden they go on all this estrogen and then they're like, my breast tenderness is crazy. I'm like, too much estrogen. Let's help you get rid of it. Let's help with the metabolism. Let's lower the dose or change the route. So it's not that it's this magical pill, but I you shouldn't you shouldn't fear it. And the last thing I'll say is like estrogen single handedly is not the cause of cancer. Like cancer's so complicated.
But yet that paper back in two thousand two was seemed to imply to people estrogen is the problem. And it wasn't even estrogen, it was the progesterin, the synthetic progesterone.
Kim Vopni (37:43.594)
Yep, yep, yep. So kind of coming to the end now, let's say this person we've supported them through their perimenopause, they've now been over a year without a period, they're now officially post menopause or in menopause, whatever terminology we want to use. Do you still recommend testing at any point to continue to look at the metabolism given that they are on hormone therapy? Or what would you change in this scenario, if anything?
Dr. Carrie (38:11.279)
So again, if if budget allows, I say yes. So if sh if especially if she has any kind of strong family history or you know, she tells me when she was cycling she had horrible PMS and, you know, breast tenderness and really heavy periods. And then and then now she's postmenopausal, so that's all gone. But she's on estrogen, I might let's do you mind? Let's let's do this test and see what your metabolism looks like. Plus I'll get other bonuses. Your testosterone, your DHEA, your cortisol, your met melatonin
Like let's get really well rounded in what's what's going on here. So I will I will do that. Ideally if I can. Is it required? No. For sure not. If somebody is 12 months and she has been holding off and holding off and holding off and finally she's like, I hate it, put me on hormones. But I the the test isn't really in my budget right now. Then I will focus on all right, let's focus on diet, hydration, pooping regularly, bile health. Like what can we do to to help get it out better while you go on the hormone?
Kim Vopni (39:11.793)
Is there ever a place for I think of in perimenopause, dim is often offered for people from a detoxification. So this is I can't say the word. I can never remember how how dyed or blah blah blah. I it's a big mouthful, but yes, you can say it better than I do. But is that could that play a role in somebody who is postmenopause or is that
Dr. Carrie (39:26.828)
yeah, dimethyl. Yes. Yes, yes.
Kim Vopni (39:38.173)
So I think of it as when it somebody's in per in perimenopause, maybe not even on progesterone yet, they would use it to help calm out the that, you know, quote unquote estrogen dominance. But I hear some people who use it postmenopause while they are on HRT and I've always wondered if that's canceling things out or what would be the reason that would happen.
Dr. Carrie (39:56.929)
Yeah. So dim is diandyl methane and it comes from the broccoli kale cauliflower family. Now it's heavily concentrated. You do get some when you eat those foods, but not to the level of a two or three hundred milligram capsule. Very, very different. So what dim does is it works on that first phase of detoxification. It helps pull estrogen out of circulation and pushes it down what we call the more protective pathway. So it's a good thing. It's a great thing.
The problem is if you don't have a lot of estrogen, it can lower I've seen it many times over. It'll lower your estrogen out of circulation. So if you already have low levels, I'll have women go, I started dim and now I'm hot flushing like crazy. I'm like, stop the dim. You've put you've you've pulled the estrogen too low. So I actually prefer I'm okay with dim if you have a lot of estrogen to get rid of. If you are a high estrogen person by default, I am a high estrogen person by default. I have been testing my hormones.
Because I've been in the field for 14 years. So I have 14 years of lab data on myself as a lab rat. And historically I always have high estrogen. Like DIM works really well for me. Somebody else, though, may not. They may just have typical rise and fall of estrogen. They don't get crazy high levels. In fact, they make normal levels of estrogen. It's just low progesterone. So really the problem is a progesterone problem, not an estrogen problem. So I am very careful when I use DIM. Once you're menopausal, I
Personally don't recommend DIM. I don't use a lot of DIM because you're already low. Even if you go on HRT, that means I have to put you on more estrogen to make up for the fact that I've got you on DIM. The only time I will see, I am not an oncologist, I will see my functional integrative oncologists. They will use DIM sometimes as part of their breast cancer protocols, which they should they should. I mean, that's that's their area of expertise. So I'm like, absolutely, you do it. I move on to the other stages instead. I support methylation.
Kim Vopni (41:48.351)
Mm-hmm.
Dr. Carrie (41:53.664)
Sulfation, glucronidation, bile, the digestive tract, the kidneys. So I help the back end of elimination as opposed to the front end once they're menopausal to help just get it out.
Kim Vopni (42:05.781)
Okay. Final question. Is there an age where women would need to stop their homework therapy or is it only good for ten years?
Dr. Carrie (42:15.47)
No. And you will see this all over social media. Women go, I'm gonna die with my hormone therapy in my hand. I'm like, Abs you go, girl, absolutely. No, it you we used to say you could only be on it for, you know, the shortest amount of time, the short the smallest dose. And even the menopause society came out with their guidelines a couple of years ago and they were like, Actually, as long as you reevaluate it, you know, every year
Kim Vopni (42:21.565)
Yeah. Yeah.
Dr. Carrie (42:39.296)
And nothing's really changed, then yeah, you can stay on hormones till the day you die. So no, you don't have to stop it if you don't want to.
Kim Vopni (42:46.599)
Awesome. Awesome. Where can people find you and learn more of the amazing information that you share?
Dr. Carrie (42:52.494)
Yes, if you go to dr carryjones.com/slash estrogen detox, that's my website. And then I have an entire free ebook that really goes into if you're curious a lot more about this estrogen detox, it's all right there, including like what are ideas that you can do to support it, the phase one, the phase two, and the phase three. I am on Instagram at dr.caryjones. I am on YouTube, which is Dr. Carrie Jones. And then I have a podcast, Hello Hormones with Dr. Carrie Jones.
which you will be on as well. So it'll be it'll be you can listen to all of us there again. So that'll be great.
Kim Vopni (43:25.093)
Yeah.
Amazing. Amazing. Thank you so much for all you do and for being here today.
Dr. Carrie (43:32.345)
Thank you.
