← Extend Podcast with Darshan Shah, MD
Extend Podcast with Darshan Shah, MD
170. Dr. Sonya Jensen: The Hormone-Trauma Connection: Why Midlife Symptoms Are Not Just Physical
00:57:11
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- [00:03]
A
Welcome to xtend with me, Dr. Darshan Shah. A podcast dedicated to cutting edge science research tools and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results. When it comes to your health span, we are living in a new era where we are creating a new healthcare system no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world renowned experts offering you a step by step guide to proactively avoid disease and most importantly, extend your health span. You've done the labs, you've adjusted your diet, and you've tracked your cycle and read everything there is to read about perimenopause, but you're still not feeling right. Conventional medicine tends to treat hormonal imbalances as a chemistry problem, something to be corrected with lab work or looking at the right protocol of hormone replacement therapy. But the disruption isn't starting in your hormones, it starts elsewhere. And we know this because functional medicine teaches us that every part of our biology is connected. Dr. Sonia Jensen is a naturopathic physician whose clinical work sits at the intersection of cell biology, hormone medicine, nervous system regulation, and the emotional and generational patterns that quietly shape a woman's physiology through the HER method, her hormonal, emotional and relational method, she helps women decode what their bodies are actually trying to say and not just silence the symptoms with hormone replacement therapy. In this conversation, we're going to explore the direct biological link between between mental and emotional health and hormone function and why grief and perimenopause are more connected than any clinicians really acknowledge. And other stress patterns that we inherit drive hormonal chaos that no supplement or product has ever been able to touch. If you've ever felt like you've done everything right, you've taken your medications, you're doing all the things, but your hormones still don't cooperate, this episode is going to reframe where you've been looking. Let's dive into it with Sonja Jensen. Hey everyone, before we dive into today's episode, I want to talk about something that you hear me talk a lot about your biomarkers. And I want to tell you how I'm approaching this situation right now with all of the patients that are calling me from listening to this podcast. So what happens is every day patients are writing to me saying they feel exhausted, they can't lose weight, they're having brain fog. And they see their doctor and the doctor tells them all their blood work is normal. But the problem is this doctor usually is only checking about 10 to 15 biomarkers that only tell you if you have a disease developing. Meanwhile, your body has 160 different systems that are running. And all of these have blood tests that we can test on how effective they're working for you every single day. So if someone is not close to one of my clinics, one of my next health clinics, then I tell them go to their local laboratory and get on Function Health. Function Health gives you access to 160 different biomarkers, the same kind of comprehensive testing that we do at all of our nex health clinics. Health. And if you tried to get this on your own through your regular doctor, it can cost you thousands of dollars. Hormones, inflammation, toxins, nutrient levels, they're all tracked over time in this one platform called Function Health. They could even help you get an MRI scan or a CT scan if you want one. So what I love most about this company is that they don't have a crazy incentive to do this. Function doesn't push supplements, they don't have pharmaceuticals they're trying to get you to take. You're just getting the data and you're getting insights from the data and you can bring this data to a clinic like. And we then have the information that we need to tell you how to improve your health. Membership is now only $365 a year. Literally, it's just a dollar a day. And right now, if you're one of my listeners, you can get a $25 credit towards the membership. You just go to the link in the bio or go to functionhealth.com DrShaw and use the code DrShaw25 for a $25 credit towards your membership. Doctor Jensen, welcome to the the extend podcast is so exciting to have you here.
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B
Oh, thank you for having me here.
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A
Yeah. So you recently had a book come out called heal your hormones and has a little bit of a different take on hormones for women. Right?
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B
Yeah. It's all about reclaiming yourself and connecting the dots between hormonal chaos, emotional overload, relationship pain, all the things that we experience every day.
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A
Yeah. And you have an interesting premise that those things are all connected. Right. It's like the what's going on in your brain is connected to what's going on in your biology. Can you talk a Little bit more about that.
- [04:57]
B
Yeah. I think part of it comes from my training as a naturopathic doctor and just looking at the whole system always. And from my own story, too, through healing my hormones and understanding that the trauma and the stories that I was carrying from my childhood was really framing how my body was operating in this world. And the more I worked with women, the more I started to see that same story show up. That we could eat the right way, we could take all the supplements, we could do the right things, but yet healing wasn't actually happening. She was still stuck. And so it really isn't until we started to dive into this emotional piece and understanding that and how that reframes her biology, which then it's almost like this circular thing, this chicken and egg thing.
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A
Right.
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B
Where is it the hormones that are causing it? Is it the low progesterone causing anxiety, or is it the like being in fear and hypervigilant all the time, that's decreasing the progesterone that's then causing anxiety? So I just see so much of it in my practice.
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A
So you're seeing many women that come to you maybe for, like, hormone replacement therapy, and they're not, despite getting on hormone replacement therapy, they're still suffering, Is that what you're saying?
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B
Yeah, like, they'll come in for various symptoms, whether it's insomnia or irregular cycles, infertility, pcos, all the various things. So we look at what's going on in the physical realm and we start to shift things. But then you start to realize that until we actually change her nervous system and how it's responding to her environment, her hormones are still going to continue to operate in the same pattern that they've been stuck in for a long time. And so she comes in wanting one thing, like maybe a nutrition plan or herbs or bhrt. Like, I use a lot of bioidentical hormones. And then she's walking out thinking, oh, I got to rethink the personalities I've been carrying, the identities I've been carrying just to survive the world that I live in.
- [06:51]
A
And what does that change as a woman? Ages their, like, personality to deal with the world? Like, how does. How does that work? Like, why is there a shift somehow during this time of life and how stress and emotions show up?
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B
Yeah, I think we do it on a subconscious level when we're young. So depending on our upbringing, cultural, societal, all of that, and family and how we feel like we need to operate to belong or to be loved or to be seen so we might, you know, put on that personality of people pleasing, or we might put on that personality of that, like, type A performer so that I get the attention that I need or the praise that I need. Or maybe we went through a real trauma and we completely shut ourselves down so that we wouldn't be seen. So I think we carry these throughout our adulthood. And then come perimenopause, when the armor that we had from our hormones, because we're just able. We have this capacity. Right. To just go through life. And then all of a sudden, you know, we're going through different stages. Maybe we're becoming a mom and our hormones are changing. Maybe now we're going through perimenopause, and all of a sudden there's that veil that starts to go away and you're like, oh, I'm still operating in this operating system and it's not working for me anymore. My body's starting to scream at me. And so I think we become more aware as we're. As we age with life experience that I don't think I'm operating the way I'm supposed to or not even supposed to have. I'm not expressing who I actually am. I'm expressing what society told me to be. And so I think that's where it starts to change for women.
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A
Yeah, you said something really interesting there. Like the hormones are the armor. Right. And then as those hormones decline, that armor fades. And then it seems like that kind of exposes these emotions. Right. Some more.
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B
Yeah, yeah. So as your estrogen's declining, you might not be accessing joy as much as you were before, or, you know, serotonin isn't working like it normally does. And so, you know, progesterone goes down. All of a sudden we're feeling really anxious. We have fears that we never had before, or maybe we had them, but they were masked. And so as the hormones are starting to decline, then these emotions are starting to come up. And I think it's actually just unveiling what's always been there, but now we're hyper focusing on it because the hormones aren't there to kind of mask everything.
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A
Right, right. You know, I see a lot of women come in. You know, they usually are dealing with the symptoms of perimenopause. These kind of, you know, I'm putting in air quotes dealing with it. Right. Because they feel like it's a normal part of life. But then the one symptom that brings them in to really start taking treatment is actually anxiety. They're feeling like, very anxious all the time. And they notice that their resilience to anxious situations is really diminished. Do you see that a lot?
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B
Oh, all the time. I even saw it in myself. And, you know, I'm quote, unquote, doing all the right things since being, I would say more so like late 20s, you know, 20s. We live a different life and you learn. And I started, you know, doing all the right things, working on my traumas, you know, went through my own story in my late 20s. And here I am, you know, especially when I turned 42. But then really 45 was the year where everything started to come back to surface. And I was like, I thought I dealt with all of this and I'm not an anxious person. And now, you know, not knowing where my 14 year old creates anxiety inside of me. Flying without my kids creates anxiety inside of me. So I'm like, you know, these women that maybe don't have the same tools as I do, or awareness that no wonder they're suffering. No wonder they're feeling like, not themselves anymore or feeling out of control. And I had one woman where her son said to her, you know, I don't know which mom I'm getting every day. And that's what brought her in.
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A
Yeah, yeah. And I'm sure it's like, it's really disconcerting to the moms themselves that they hear this from their kids. Right. It's just they don't know who they're going to be from day to day.
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B
Oh, I know. And, you know, sometimes I see it in my kids because as a woman, you can feel it. You can feel yourself spiraling and you know what you're about to say, don't say it, but it just comes out. And I can feel like, because my, my two boys have such different personalities. My oldest one, I can kind of see him retreating and. Okay, I got to give her some space. The. The youngest, I was like, what other button can I push? What else can I bring up in this moment? And so there's so much discernment as a mom or just as a woman that you need to understand. Okay, is it my hormones? Where am I in my cycle? Like, what's going on? Or is it the actual situation and experience that needs to need some dealing with?
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A
I see. So for women that are experiencing symptoms, right, anxiety, fear, what are some of the symptoms that they're feeling and how does that kind of tie into stress?
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B
Yeah. So, you know, they might just be feeling like they don't want to be social anymore. They're yeah, they're isolating themselves. They're feeling like they don't want to try anything new. They just are not feeling, like, comfortable in their skin like they used to. Like, that's really changing. Their relationships are changing. There's, you know, tension maybe with them and their partners, them and their kids, their colleagues, their friends. Like, things are just subtly changing in their world. And symptom wise, that might translate to gut issues, that might even translate into insomnia and not sleeping. And so when they come in with all of this, the first thing I ask them is, like, what is your relationship to stress? You know, like, how have you managed stress up till today? Are you someone that just pushes through, pick up your socks and just keep going? Do you express yourself or are you used to repressing things and just quieting and dealing with it on your own? And most often women will say, well, I just deal with it. And so my response to that is, well, your body's been dealing with it and now it's done. And that's why we're feeling everything that we're feeling. And that's what gets us talking about her story from before or childhood or even generational, like, what she's learned and observed. So it takes us down this path of, like, what is her stress resilience or what has it been and why has it shifted now?
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A
And what are some of the tools that someone who's feeling like stress may be the root cause of their symptoms?
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B
Yeah.
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A
To overcome those stresses.
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B
Yeah. I think it's important to meet people where they are today. Right. If I tell them to do an hour of yoga and then an hour of meditation, and then, you know, they're going to be like, well, I got to take my kids to hockey, then I got to do this and this and this. So that's not possible. And so I try to bring in little micro moments throughout the day for them of, like, first recognizing, like, okay, what does my nervous system actually feel like? When are these anxious moments showing up for me? So just pausing and asking yourself a question can be helpful asking yourself, like, does this actually belong to me? Or is this somebody else's that I'm carrying? What does this fear or anxiety? What is it trying to tell me? Like, what am I missing here? So just that pause. It's kind of like that Viktor Frankl quote, you know, like the. The freedom lies between the stimulus and the response.
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A
Yes.
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B
So if I can get her to just, like, increase that pause so she can take a breath and just do something different that's like first step and then other tools. It's, you know, your brain likes routine because it's a predictor. So if her eating's all over the place, it's like, how do we bring more predictability to your nutrition? How do we bring more predictability to your day so you're not stuck in like hyper vigilance? I might give her herbs like nervines, like lemon balm and ashwagandha, like holy basil. Lots of tools physically. But I do think the pattern disruption is probably the most important piece.
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A
Ah, really? Okay, so is there like an optimal protocol? How often to interrupt the stressful day?
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B
Oh, geez. Every day. I would say every day, all day. It's just.
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A
But that's every couple hours. Every once or twice a day. Lunchtime.
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B
Yeah, I would say first thing in the morning. So you can start your day from that space of like resilience and just energy and like knowing, creating an intention. And then before bed. And so those can be like solid times in your day where you're putting intention into it. And then throughout the day, I would say just notice your responses. Like notice the anxiety, notice your body. Like, what is it trying to tell you in those times?
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A
Yeah, yeah. What about that emotion of anger that comes up?
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B
I love anger.
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A
Talk about that.
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B
Yeah, it's. I think anger is action oriented emotion. So when I work with a woman that's angry, I'm like, okay, she's ready, she's ready to heal, she's ready to express, she's ready to finally shake this out of her body. It's the women that are in sadness that I feel take longer. Women that are stuck in grief, women that, you know, have that feeling of isolation and loneliness. So with anger, I think it's showing up because it's been suppressed for so long. And anger in itself, you know, we carry so much resentment when we're not being ourselves, when we have those personalities that we've put on throughout our lifetime. Maybe we're saying yes to too many things and not putting ourselves first. So now we're carrying resentment. And then that resentment boils over many years. And what I've seen happen, and now they're actually showing that this is an actual thing where resentment, you know, can boil into changes in your cortisol levels and anger actually increases interleukin 6, which is a pro inflammatory cytokine. So it's creating inflammation. And how that translates to a woman, what I've seen is like endometriosis, fibroids, cysts, because she's carrying so much, she's not able to let go. So I think this perimenopausal rage that shows up is because they're just done, like, done not speaking their truth. And now it's time to speak it. But we just need a, maybe a better way to speak it. Have a little bit of a filter or some sort of tool, maybe it's punching a pillow, I don't know. But different for everyone.
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A
Yeah. You mentioned a few times dealing with grief. What type of grief are you talking about? And how does one get over? How does one emotionally process grief?
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B
Yeah, grief, I think, is an emotion we don't talk about enough. I think we feel it throughout our life on a subconscious level too. So a young woman that's maybe going into puberty is going to grieve her, like, childhood. A woman that's pregnant is grieving her body and grieving the life that she had when she's getting, you know, her body's changing. A woman in perimenopause is going to grieve her reproductive years. And I think this time of life is such a reflective period that we start to see what could have been or the choices we didn't make or the opportunities we didn't take. And so we sit in a lot of grief with that and also think when we're in that middle age stage, we may have elderly parents, we may have kids that are growing up and leaving. So I think grief is showing up on so many different layers and levels that we're not given really the tools to access it and, like, sit with it. There was a quote that I saw in front of a church one day, and it said, grief is just love that has no place to go. And so I think grief is actually a reminder of like, the beauty in life, like the love that we lost and all that experiences that we shared. So I think the key is to start creating a different relationship with these emotions.
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A
Yeah, definitely. That's such a beautiful quote.
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B
Yeah, it's one that like, sits with me all the time. Yeah, it's a really beautiful quote.
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A
Yeah. So I, I thought you were meaning grief of like, losing somebody, but it sounds like just loss of just that time period in life can be grieved too.
- [19:18]
B
Absolutely. Loss of identity, you know, so a lot of us women, and I can speak for myself, we think we're multitaskers for most of our life. And all of a sudden perimenopause hits like, no, no, I can do this one task, then I'm gonna Move on to the next. So at this moment of like, oh, now I know how my husband feels all the time. Yeah. So I think there's this. Yeah. Grief of identity. It's like you just don't have the same energy or whatever it is, even though. Yes, we can access that energy, but it's just different.
- [19:46]
A
Yeah, absolutely. You know, we talk a lot about traumas on this podcast. And, you know, there's significant traumas that occur sometimes in people's life, but also, some people don't realize, but there's smaller traumas that can occur throughout life, and those also can affect. From my vantage point, I see it definitely helping people improve their HRV and their sympathetic nervous system balance when they're able to process some of these traumas. Right. And you're saying that these also can tie into hormonal regulation.
- [20:18]
B
Yeah. So when we go through a trauma, we're changing our physiology. We're teaching our nervous system that it's not safe and to be hypervigilant so that we're not in this experience again. And even with the micro traumas, you know, that can be a child trying to get their parents attention and not getting it and then feeling like they're not worthy or not enough or whatever that might be, it's creating the same changes in their nervous system and hormonal system by increasing that cortisol and then downregulating the sex hormones. So, yeah, that pattern disruption with, like, increasing the HRV working on your vagus nerve, working on the nervous system, it just changes our reaction to the trauma because it's often not the actual experience itself. It's how the body responded to it and what it did with that information. And so that pattern disruption, I feel like with macro and micro traumas is key to actually healing and then retraining the hormonal system that it doesn't have to be so overreactive with that knowledge that it's been carrying for so long.
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A
Yeah. It's another way that, you know, the human mind is so connected to our physiology that we don't recognize a lot of times. And, you know, this brain body connection is. Is. It's real.
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B
Yeah.
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A
But it's also so much more significant that we've given a credence to in, like, medicine. Right.
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B
Yeah.
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A
You know, I think also, like, this also ties into, like, gut health and mental health as well. Like, they're so interconnected, Right?
- [21:49]
B
Yeah. Like, how we digest food is a reflection of how we digest life. Yeah. And so I think most of us even, like, you know, those listening can look back at a time of like feeling nervous or feeling something and it's like reflecting in their gut or feeling angry and feeling upset and all of a sudden there's constipation or something, or, you know, the opposite. So there's such a connection because serotonin is produced in the gut and that's our like happy neurotransmitter.
- [22:18]
A
Right, Exactly. And you know, going back to traumas, like you also mentioned earlier, like generational traumas and also just generational programming, I'm, you know, one of the things that's just massively mind blowing to me is that the traumas your mom and her mom experienced get passed down and your dad and your dad experience get passed down through methylation changes in our DNA. And so it might not just be our life that we are trying to heal from, it's also our parents and our grandparents lives.
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B
Yeah, yeah. I don't know if you've seen, if you've looked at Rachel Yehuda's work. I quote her all the time. She's done a lot of Holocaust studies and generational studies to see the impact of their trauma on their offspring. And adrenal insufficiency was across the board. And then grandchildren, they saw metabolic changes. And so that's a real thing. Even looking at my own South Asian lineage too, with like colonization and the famines and the changes it created in our like pancreas and our ability to just mobilize glucose. Like there's so much that happened on the metabolic side, but also just like the worthiness side and like the other things that, you know, the stories that we're carrying too, our ancestors were carrying that got passed down. So I think the generational piece is. It's huge, especially because we didn't start it. So now we're carrying somebody else's story. So that doesn't mean we can't change it. But I think it's important to understand our lineage and understand the habits that got passed down because of it, so that we can start to change those habits for the generation forward.
- [23:54]
A
Right. And that's why it's like, you know, it's so important to know your history just of your family, of your culture. And I think there's been like this connection that we've been struggling to make. I mean, we know there's genes that you can see, the SNPs that you can measure, like BRCA, for example, that you have a family history of breast cancer, but there's so much as passed down in family history that we just can't find the SNPs or you think that there are so many SNPs that was hard to put it together. But then there's this other layer of complexity of what genes are turned on and off that also get passed down. So I think my mind is just in a place where it's like, okay, we can take a look at your genetics, but it really doesn't tell the full story. What really tells a story is a history of your culture, the history of your family, et cetera. Right, yeah.
- [24:42]
B
The epigenetics, the environment that the genes were in and why they decided to turn on and off and what I think that does. It actually puts us in the driver's seat. It tells us that we can have control, that we can make changes if we change our environment and how we're responding to it as well. So I think that's actually a really good way of looking at it, because we can get stuck in that, like, oh, mom had it, grandma had it. That means I'm going to have it.
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A
Right. I don't know if you want to go here or not, but this is a big topic in Vancouver, where you're from, is the use of psychedelics.
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B
Oh, yeah, yeah. It is.
- [25:15]
A
Unpacking, trauma, I think, also anxieties and, you know, stress. From where I sit in Los Angeles, to access these psychedelics, it's more difficult. You have to travel somewhere or you get them underground. I think you can get it from the store down the street right now in Vancouver. So how is that affecting your practice?
- [25:37]
B
It's still pretty regulated, from what I understand. And I have a different relationship with that whole world because coming from, like, my yogic background, I also did a lot of shamanic traditional training, too. And so I just have a lot of reverence for that medicine. And I think what happens to us in the west is that we take something and we run with it, and then we think everybody needs it.
- [25:59]
A
Exactly.
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B
So the relationship I have with that kind of medicine is like, the medicine actually calls you, you know, when you're ready to actually sit with that medicine, and then it does the work that it needs to. And I think it has to be done in a very sacred way and in a very safe way where, like, you subconsciously feel safe enough to let go. So, yeah, I mean, ketamine's been used a lot here for, like, depression and things like that. And, you know, I have a few patients that have gone to the clinics, and it's done some work, but then I also see them cycling right back. And so for me, it's like, do we go for this quicker fix that will work on the subconscious without us knowing, or do we do the deep work? Because I think as a society, we're uncomfortable with discomfort or feeling sad or feeling emotion because we haven't been taught how to. And then we're in this place of, like, we don't know what to do because we've done it all. And that feels like the last thing. So I'm not against or pro or anything. I think it's always individual of what people need to support themselves. And if it works for you, I think that's great. I think the challenge is when people are doing it in this way of, like, I don't even know how to frame it. Like a trend. Yeah, yeah.
- [27:17]
A
Like recreationally, or they. Everyone's just like, yeah, like a trend. Exactly. You know, right now, it's like in Los Angeles is definitely the thing. Like, you start with psilocybin and then you go to mdma, and then you do a journey with, like, ayahuasca, and then you to another. You know, it's. It's like this thing that everyone's trying everything, right? And a lot of times, you know, because there's so much demand, you can't find someone who's trained like you are in the ancient traditions of how to use this correctly. And so sometimes there's bad experiences or people just ending up using it with no guidance whatsoever. And I think that can be dangerous.
- [27:55]
B
Doesn't it make you wonder, though, why we're so desperate for this kind of solution? You know, like, when I think back to just, again, coming from the yoga community, you hear about all the different challenges that the west faced with different teachers coming from the east. And, you know, we all know the stories and stuff. And I think when people are in this, like, desperate place of wanting to belong and wanting to heal and all of that, it's so easy to gravitate towards something shiny that looks like it's going to heal everything. And so it always makes me wonder, like, why are we still stuck in that cycle when we know so much, when there's so much information, there's so much support now that, like, why are we still here as. As humans? And what's that bottom missing link? And I always go back to community. I think from the beginning, we just haven't been set right. I mean, I'm lucky. And I don't know if you have the same experience in your family. Being from an Indian family, you're just, you're plopped into a big community. Right. It has its pros and cons, but I've never felt alone. Like I've always known there is someone that I'm going to be able to lean on. And I think the loneliness, the lack of support that people feel is making us like desperate for something.
- [29:12]
A
Yeah, I fully agree. I think, you know, we're lucky. Like you said, most South Asian communities are very tight and the families are even tighter. Right. So you end up becoming best friends with your cousins and each other all the time and then that's part of a larger community and then there's the temple that you go to and it's all, it's all such a part of life that you grow up with. And there's a lot of gossip, but
- [29:36]
B
yeah, there's definitely the other side to it.
- [29:40]
A
Right. But there's also a huge positive benefit to that that you never feel alone. And I would say, you know, as my parents, I watch my parents grow. They're still grow old. I mean, they're in their 80s now. They have a very tight knit community still and that's what's keeping them alive. You know, they're not necessarily the healthiest people that they tell me they go to the gym, but I don't think they really do. But they're so mentally and physically healthy because of, I really believe, their community.
- [30:10]
B
Oh, for sure, yeah, yeah, I see it in mine too.
- [30:14]
A
Yeah. Right. And you, that's a Harvard study. Right. I mean the number one thing that kept people healthy for the longest period of time and kept them alive was really a level of friendships and community they had.
- [30:25]
B
Yeah, it's everything. It's funny, like growing up, you know, we'd be like, oh, another wedding, another this, another or that. And I'm like, oh, I get it now because it's in those spaces and in those times where you're coming together with your community and that's what like is still getting carried forward. And that is what's keeping them going. It's keeping them busy, it's keeping them on purpose. It's giving them motivation to like do something every day. So, so important.
- [30:49]
A
Yeah. And I also think like the gossip maybe serves a purpose too because it's kind of like this mental chess game they have to play every day, deal with.
- [30:57]
B
Yeah, it keeps you sharp.
- [30:59]
A
Exactly, exactly. But you know, I do think like, you know, you mentioned loneliness and retreating into like your own shell or bubble. I think, you know, it happens a lot around perimenopause. Why is that?
- [31:13]
B
Yeah, I think it's because we feel like we're not recognizing who we are anymore. Like, our body's changing, our personality is starting to shift a little bit. It's almost, like, scary to go out into the world because we don't know how we're going to respond or our body's going to respond. A lot of women are having difficulties with their cyc at that time, whether they're, like, heavier. So they're isolating themselves during that time. So when you're not feeling good in your body, it's really hard to show up in the world. And it's almost easier just to isolate because we're feeling so many different emotions. And, you know, a lot of women are put on antidepressants in perimenopause, and I think it's the estrogen and the testosterone, like the low amount of hormones. And so when they're feeling that way, there's no motivation to go to the work, to go to the gym. There's no motivation to go get help. Like, there just isn't that. We know what we need to do, but we don't have the energy or the drive to do it. So I think it's just easier to isolate because we feel alone, even though. So that's why I think, like, these conversations are so great that women can hear that. Wait, no, like, I'm. You're not alone. Like, so many of us go through this. It just manifests maybe in a different way for each woman.
- [32:24]
A
Yeah, absolutely. And so, you know, I think about this kind of retreat and this isolation that occurs because you're not feeling like you know yourself anymore almost. Right. And then I think sometimes people seek out hormone replacement therapy, as, you know, I'm putting in air quotes, again, a cure to this. But my question to you is, like, does the emotional and mental work come first or the hormone replacement therapy come first? Like, how do you sequence these things in your practice?
- [32:55]
B
Yeah, it's a good question. I created this thing called the hierarchy of hormone hormonal healing. And on the bottom, I did put physical as being, like, the number one. So it's, again, it's so dependent on the woman's story. And if she's feeling so rough, where she does have no motivation, she's feeling anxious all the time. Like, there's all these things going on. I feel like the best thing to do for her is to give her quick support, whether that's me supporting her adrenals with herbs or Things that she can take, or it's bhrt, it's progesterone, it's estrogen or testosterone to get her feeling good, to give her that motivation to make better choices with her food, to make better choices with, like the going to the gym or going for a walk or doing the things that she needs to do. And then there's energy to look at the patterns. So the women that just want to take hormones, because I have those in my practice too, they're like, I don't want to do anything. This is all I want. I heard this, this, and this on a podcast. So I want this will do that. But then eventually they'll realize six months later, like, oh, yeah, I perked up, but then I'm going back down. I'm hitting a plateau. But the women that are doing the lifestyle things, plus the hormones, even better. But then even them, they're like, oh, okay, there's something about a year later, I'm still, I'm still stuck. I'm still stuck in this relationship. I'm still stuck and thinking the way I did before. So then we do that deeper work. So what I have found the easiest way to get to the emotional piece, because it's so deeply imprinted, is to do the physical first.
- [34:26]
A
Yeah, that makes a lot of sense. And at least it gives them sometimes a quick win. That I think, you know, is a positive reinforcement that now it, now they have some space to do the emotional work, you know, And I, I, it's an analogy to me. Like, I see this work, you know, and it's kind of a little bit counterintuitive. Sometimes I think people are like, oh, I just want to do everything naturally first before I start taking something. But in the GLP one world where we're prescribing these weight loss peptides, you know, there's a lot of talk about, like, do the work first, then take the peptide. I mean, that sounds great, but many times people need that quick win. So they have the, they reduce the food noise, they get the quick win. They have the space now to do the work. And that's why I think a lot of people fail their peptides, is because no one talks about doing the work, about reframing their relationship with food, about stopping the ultra process, increasing protein, and then they gain the way back. Right? And I think the same occurs with hormones, is that you get, if you have a quick win now it's time to do the emotional work, do the physical work, and get into a better place. So there's always this synergy between the hormonal treatment and your lifestyle.
- [35:39]
B
Yeah. Well, then you're using those things as actual tools. You're not using it as a thing that's going to fix me. Because now, again, we're giving power to the thing outside of us, but instead you can use it as a tool so that we can start to reclaim and empower ourselves through the choices that we make that are going to help that tool be even more efficient. And then maybe eventually we don't even need that tool, or we use it when we need it, but we become so familiar with ourselves that we can make have that discernment that we need.
- [36:09]
A
Yes, absolutely. I'd love to talk to you a little bit about kind of the specific treatments that you do in your clinic and in your practice for women that come in. So are you. You know, one of the things that I get a lot of questions around is testosterone for women and how does that affect them emotionally? How does that affect their kind of their reactions to the outside environment? And should every woman be on testosterone or not? How do you feel about that?
- [36:38]
B
Yeah, testosterone is an interesting conversation with women because someone will come in with a preconceived notion that it's only for men. And so there's a lot of education around the fact that women need testosterone. We have many receptors in our brain for testosterone, so it's like an antidepressant. We need it for lean muscle, libido, motivation. It gives us that, like, pep in our step for life. And when that's missing, it's often due to low testosterone. So my conversations around testosterone are often connected to, like, insulin and looking at their metabolic health and making sure that we're working on that side there. Does every woman need it? I don't think every woman needs it, but probably could use it as a tool when it's low. And also looking at the stress adrenal side. So if testosterone comes from DHEA and high stress cortisol is going to lower your dhea, then do I want to go up a level and work there and make sure her adrenals are being supported so that her DHEA is supported and she's converting. So this is where I use like the Dutch test or I use hormone testing to kind of educate her on what her testosterone is doing, because I want to see how it's breaking down. Is she someone that is going to actually break it down or make dht, or is she someone that's going to break it down the right way and not grow hair on her chin and then get upset with me because she's on testosterone. So, yeah, I think it's so nuanced when it comes to hormones. And that's always what I try to do, is educate women on that nuance, that every system is connected. And yes, the testosterone, if you take it, might help you in the gym, it's going to help you with motivation. But maybe we don't need to use it for a long period of time or every day. And there's different methods of using it too. So I think it really depends.
- [38:25]
A
Yeah, absolutely. Now, estrogen, obviously, and progesterone are both hormones that women need to be on after menopause. Do you have any thoughts around how you sequence those hormones for women that are coming in in perimenopause? They're coming in with symptoms, but they're still having a period or they, you know. You know, the traditional definition is no period for one year. Maybe they're only three months away from there. How do you sequence the hormone replacement therapy?
- [38:53]
B
Yeah. So for perimenopausal women, yeah, it's tricky because she might be missing periods and all of that, but I'm still looking at how her, sorry, her liver is supporting estrogen detoxification. So if she's a woman that has a history of fibroids or endo or fibrocystic breasts, then I'm probably not going to put her on estradiol right away. I want to make sure her gut and her estrogen detox pathways are working well in her liver. And then if her estradiol is actually low, then I'm going to support her with that. I like biased. I know not a lot of people like biased, but I think the fact that estradiol is a building hormone and estriol kind of keeps estradiol in check, is important for perimenopause especially. So I tend to use those two together or sometimes I will just start them on estriol, depending on what they're coming in with. If it's just vaginal dryness, it might be more an insert of dhea, which is going to help her. So, again, nuanced, but with perimenopause, it's like consistently rechecking every couple months. You know, is this what we're doing, working still? We might have to make adjustments. Whereas post menopause, you could probably put a woman on a protocol for like six months to a year and she might be pretty steady on that. But perimenopause, I'm seeing them at Least six to eight weeks. Every six to eight weeks to make sure she's. She's still okay. And yeah, my first go to hormone would probably be progesterone. A lot of times with perimenopause.
- [40:21]
A
Yeah. Are you using what, mainly oral progesterone for your patients?
- [40:24]
B
Oral. And cream.
- [40:26]
A
And cream, yeah.
- [40:27]
B
Mostly oral, yeah.
- [40:29]
A
Some of the people come into our clinic and they're on the dual patch with the oral, with the estrogen and progesterone as well. And so there's so many different options for women. It's just really finding what's most convenient and what's. I mean, to me, what's going to be the thing you're going to be the most compliant with too, right?
- [40:48]
B
Yes. Yeah. That's huge. Especially with hormones, because they're sensitive. So you miss a day or a couple of days or something gets thrown off, it's going to change your result.
- [40:58]
A
Yeah, yeah, absolutely. I think I'm always kind of wondering how compliant will the person be? Many women now have such incredibly busy lives with lots of travel and lots of responsibilities and. Yeah, I can't tell you the number of times they forget to use their cream or they forget to pack it. And I get the emergency phone call, like, can you call it into Dubai? I don't know how to do that. So sometimes. Sometimes I think, you know, for practitioners, a lot of practitioners listening to this podcast is definitely something to consider is the form that you're giving your.
- [41:32]
B
For sure. Yeah.
- [41:33]
A
Yeah. And then, you know, most of the guests that I've interviewed in this podcast that are in the perimenopause menopause space, they highly recommend vaginal estrogen for women. And you mentioned vaginal dhea. Can you tell us the difference between the two and why you prefer one or the other? Or it's both.
- [41:50]
B
Yeah, I like both. So the only time that I prefer DHEA is when there's a lot of pelvic pain. I've actually used it with vaginismus a lot and it seems to work really well. And with dhea, you're converting to estrogen or testosterone. I feel like then you're kind of getting a little bit of both, depending on what your body needs. So that, to me, is what's been like, the biggest difference maker in terms of pain. I don't know if there's like, actual clinical studies on that or not, but clinically, that's what I've seen. If a woman just has vaginal dryness, the estriol or estradiol is usually enough. But if she's got that plus pelvic pain, whether it's because of endo and inflammation in the area, but I find for her, dhea, for some reason, just works better.
- [42:34]
A
Yeah, for sure. And then another thing that I see a lot that women are sometimes having difficulty talking about, but I do want to bring it to light, is pelvic floor relaxation and urinary problems as well. Right. And so, yeah, talk about that if you don't know.
- [42:49]
B
Well, it's funny because my kids will laugh at me because there's times where I sneeze and I'm crossing my legs. Like, why do you do that? Because I gave birth to you, too. That's why I do that. Yeah. There's actually a real change as estrogen declines. The tone's declining. Right. In your bladder. And so if you have, you know, if you've given birth and if you've ever had a prolapse or there's stress or history of UTIs, there's just more vulnerability in that area. So then there's going to be more relaxation there. So you might have to wear the diapers that you wore when you were young, and now all of a sudden, they're back into your life, and that doesn't feel good. And so the way I go about talking to women about this is pelvic floor strength. So, like, making sure they're seeing a physio that focus on pelvic floor or even like an acupuncturist, an osteopath, too, so that they can look at some structurally how we can support the system. But then I also noticed vaginal estrogen actually does the job pretty well, too.
- [43:49]
A
Yeah, absolutely. And there are some surgical options as well. Like some OB GYNs can do some bladder sling type of procedures.
- [43:57]
B
Yeah.
- [43:57]
A
I've had many women come to me after getting even a tummy tuck to tighten their core muscles. That also fixes some urinary difficulty. Sorry, Urinary incontinence issues as well. Yeah, so. So I think there's a lot of options. And it's really important for women who are listening that may have a issue with this to talk to their doctor about it and ask about the different options and get some opinions. Because you don't have to live with us.
- [44:23]
B
Yeah. It's taking the shame away from the experience that women have. So the more we talk about it, the more we normalize it, or else they just kind of feel like they're dealing with it on its own.
- [44:33]
A
Right. And it's not, you know, it's not normal aging. It's, it's anatomy changes. It's also estrogen. A lack of estrogen causes weakness in that area in the pelvic floor. And these things combine into this issue. But it can be easily reversed with, with, like you said, this entire myriad of options that we have available.
- [44:55]
B
Yeah, for sure. Yeah.
- [44:56]
A
Can we talk a little bit? You know, because I don't think this podcast will be complete unless we talk about the long term benefits of estrogen therapy for women's disease reduction and aging. Can you talk about that a little bit?
- [45:10]
B
Yeah. When you realize how many receptors we have for estrogen everywhere in our body. So that's bone health and especially cardiovascular health. I don't think women really put those two things together. I mean, estrogen is creating flexibility in your arteries. So the more rigid your arteries become, the easier it is for them to get damaged. And so there's those pieces. There's like the memory. I think one of the first symptoms that women start to experience in perimenopause is brain fog or that inability to recall that word to try to describe something or names. But they just kind of think, oh, you know, I'm tired, I'm stressed. That's probably why it's happening. Not realizing that estrogen actually plays a huge role in that. So for longevity, if we don't have this hormone, we're at like, I think the statistic is 50% higher risk when it comes to a cardiovascular event. You know, we're more prone to then falls and breaking something because of the osteoporosis or osteopenia. And those things are huge. If we can't move well, if we can't think well, it's going to change how we're relating to ourselves and also to everyone else in our lives. And the quality of life then starts to decline. So I think estrogen is imperative for quality of life. And it's just important to find the type that you need, the form you need, how long you need it, or how you can use it for long periods of time. And finding the right practitioner that will help you with that. I think it's probably one of the most important things that we need.
- [46:40]
A
I completely agree with you. And so, you know, I think finally in the United States, the Women's Health Initiative study created a black box warning on hormones for women. And that's been removed. And so the conversation has been reopened. But there's only still 9% of women are on hormone replacement therapy that need it. Here and so it's a lot more awareness needs to happen.
- [47:03]
B
Yeah, for sure. And also I think the nuances around using it too. I know there's been, whether it's social media and other places, some people not loving, like the Dutch test or these other ways of understanding how estrogen is metabolized. What I've seen in my practice now, I've been doing hormones specifically since 2012. And I can tell you, just clinically seeing when a woman isn't detoxifying estrogen properly, it does not give her the benefits that we need it to give her later, if we're not doing the work with the liver and the gut. Because then she's still going to be spotting, bleeding, her endometrium is going to be thickening, like she's still going to be holding on. Some women get, like inverted nipples. Like, there's a lot of things that can happen that aren't enjoyable if we're not working with estrogen properly.
- [47:54]
A
Yes. I'm a big fan of the Dutch test, and I think this is an important piece of the puzzle that only the Dutch test can bring you. Right. I don't think there's any other way to really understand how you're detoxifying estrogen without checking the urinary metabolites. Right. And so the Dutch test, for the listeners that don't know what that is, it's a test that's a urine test that can be ordered by any functional practitioner. That's extremely useful in this last little piece of the puzzle. And so if you're struggling with hormone replacement therapy, definitely ask for it. It's a complicated test, it's not easy, and you need specialized training to be able to decipher the results, I think. But I think it's absolutely valuable. Maybe you can talk a little bit about the pathway of detoxification of estrogen. And why is that important? Why do we need to detoxify from a hormone that's natural in our body?
- [48:45]
B
Yeah, Well, I think it's because of how much of it is in our environment. So pesticides look like estrogen, phthalates, BPA is just everywhere. And this is why I think it's even important for men to do the Dutch test so we can see if they're actually detoxing it. See, so many young men with gynecomastia. Right. So because there's too much estrogen and it looks the same biochemically as the estrogen that our body makes. So, yes, our body should be able to just detoxify what we make. And if we're taking the right dose, it should be able to do that. But when our systems bombarded with toxins from the environment, the liver is overworked, then we have to look at phase one and phase two detoxification. So you brought up methylation genes before. If we're not methylating, well, that whole process of detoxification isn't efficient. And so the Dutch test will give you clues as to your phase one and phase two estrogen pathway detox and whether your methylation process is working or not. And then you can do the right things to support phase one and phase two. So you can do glutathione, B vitamins, you know, take methyl donors and all of that to help support that detoxification.
- [49:52]
A
Yep, absolutely. I think that, you know, you bring up very important points in this podcast about not ignoring emotional symptoms, not ignoring the past, including your past, your parents, past, the culture you come from, and also, you know, not ignoring the conversations around other symptoms that you might be feeling like urinary incontinence and some of these other ones. And so there's so many important things that the women listening to this podcast should take away from this as far as what's the conversation you need to be having? And so a lot of times these conversations come up at a primary care visit, and the answer is always one of, I hate to say this, not always, many times, one of, like, here's an estrogen patch, see, in three months. Right. Or it's all of that's in your head, like a gaslighting type of a thing. Right?
- [50:52]
B
Yeah.
- [50:52]
A
So what does a person do when they're being told that none of that is true, it's all wrong, or just, here's a patch, come back and see me.
- [50:59]
B
Yeah. This is why it's so important to know thyself. Like, know what's going on in your body and know and have that courage to be able to speak your truth. And if that practitioner isn't listening to you, you go to a different one, because you have every right to be heard. And the patient coming into the clinic now possibly knows more than the doctor sometimes about their condition than the doctor does because of the age of information that we're in. And so as a doctor, I think it's so important to sit with the patient and listen to them. I learn so much from my patients every single day. And so, yeah, if you're with someone that's not listening to you, it's time to find somebody else that will. But that starts with knowing yourself, like, knowing that, you know, throughout my cycle, it's, you know, normal to feel some changes of emotion. But if I'm feeling so sad and so bad about myself in the last half, where I don't want to leave my house, that's not okay. Like, you have every right to live a joyful life, and if something's getting in the way of that and you need to express that to your doctors, we need a space, a safe space for patients to do that. So my advice would be like to first start with you. Become aware, know, listen to these podcasts, like, know what it is that you can arm yourself with in terms of questions with your doctor. And then if that doctor's not supporting you, it's, yeah, time to find another one.
- [52:20]
A
Yeah, I, I, I agree. I agree. Thank you so much for this conversation, Dr. Jensen. If the listeners would like to hear more along this topic, you have an incredible book you just released, right?
- [52:32]
B
Yeah, I do. Yeah. It's called Heal youl Hormones. Reclaim Yourself. So you can get it at heal your hormones book.com if you're interested. Yeah.
- [52:40]
A
And what kind of things will people learn from this book?
- [52:43]
B
So the first half of the book is really about bringing awareness to all these topics about the different emotions, the different hormones, and how the interplay works, the generational pieces. And then the second half is the her method. So that's taking you through that hormonal hierarchy. And there's a quiz in there where you can take that quiz and kind of find out, okay, what's the prominent emotion and hormone that needs support right now? Like, am I the anxious overachiever or the silent struggler or the perfectionist? And then you get protocols that support those different archetypes from mostly things that you can start right away at home. And so there's like a little method, but the whole intent with the book is for people to understand themselves more, for women to just know themselves more. And there's exercises in there that you can do with your partner, so your partner understands your hormonal changes with you. And also just working on those, like inner stressors and traumas and stories that we carry.
- [53:46]
A
I love it. Thank you. Where can people learn more from you on social media or your website? Can you give us that information?
- [53:53]
B
Yeah, you can find me on Instagram. My handle is Dr. Sonia Jensen. And also my website, drsonniajensen.com and are you taking patients? I am, yeah. I'm still, I love my one on ones.
- [54:05]
A
Do you do remote consultations for people outside of The Vancouver area. Right. They can find that at Dr. Sonia Jensen.
- [54:12]
B
Yeah.
- [54:13]
A
Great. Thank you so much for joining us today. I really appreciate you being here.
- [54:17]
B
Oh, thank you for having me.
- [54:18]
A
You're welcome. Thank you for listening to that transformative episode with Dr. Sonja Jensen. Here are my top five learnings from that episode. Number one. Your emotions shape your hormones. Beyond diet and supplements, unaddressed emotional patterns and past traumas significantly influence your hormone balance, often being the root cause of symptoms that persist. Healing requires addressing these deeper emotional layers. Number two, Perimenopause can unveil other hidden issues. Our hormone is actually like armor and that declines during perimenopause. So underlying anxieties, fears and emotional patterns that were previously masked can surface, making it a critical time to address these deeper issues for true well being. Number three. Stress. Resilience is key. Our body's response to stress, not just a stressor itself, dictates hormonal health. Developing tools to increase the pause between stimulus and response and integrating little micro moments of calm in your day can retrain your nervous system. Number four. Anger can be a catalyst for healing. Often suppressed anger is an action oriented emotion that signals a readiness to change. When channeled constructively, it can help women express her truth and release resentment that contributes to inflammation and hormonal imbalance. Number five. Generational trauma impacts biology. The experiences of your ancestors, including traumas, can be passed down through epigenetic changes affecting your current hormonal and metabolic health. Understanding this lineage empowers you to break cycles and foster healing for future generations. Thank you for listening to this episode with Dr. Sonja Jensen. Please forward this to anyone that you think would benefit from hearing about how your hormones and your emotions are so interconnected. Thank you. Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.