Podcast Summary: The Thyroid Fixer – Episode 547: The Perimenopause "Glass Ceiling" and All About Peri with Dr. Amy Killen

Introduction

In Episode 547 of The Thyroid Fixer, host Dr. Amie Hornaman delves into the intricate world of perimenopause, its symptoms, and its profound impact on women's health and professional lives. Joined by special guest Dr. Amy Kellen, a renowned expert in hormone health, the episode offers a comprehensive exploration of hormonal changes during perimenopause and actionable strategies to navigate this transitional phase effectively.

Understanding Perimenopause

Dr. Amy Kellen begins by addressing the often-overlooked phase of perimenopause— the transitional period leading up to menopause. She emphasizes that perimenopause typically spans between two to ten years before menopause, presenting a myriad of symptoms that can significantly affect a woman's quality of life.

Dr. Amy Kellen [08:13]: "Perimenopause is one of those things that doesn't get talked about as much... It's a really confusing time."

Key Symptoms of Perimenopause

The discussion highlights approximately 30 different symptoms associated with perimenopause, making diagnosis challenging. Common symptoms include:

• Body Pain and Fatigue: Dr. Kellen shares a post from a listener, Jo, describing waking up with body pain akin to intense workouts without actual exertion.

  Dr. Amy Kellen [10:30]: "Body pain, difficulty sleeping is very common. Anxiety, panic attacks because of progesterone going down."

• Emotional and Cognitive Changes: Anxiety, panic attacks, and brain fog are prevalent due to fluctuating hormone levels.

• Vaginal Dryness and Loss of Libido: These symptoms often stem from declining progesterone and estrogen levels.

• Weight Gain and Metabolic Shifts: Hormonal imbalances can lead to insulin resistance and weight gain, exacerbated by poor electrolyte balance.

Hormonal Fluctuations and Testing

Dr. Kellen emphasizes the importance of symptom-based diagnosis over reliance solely on laboratory tests, especially since hormone levels can be erratic during perimenopause.

Dr. Amy Kellen [09:49]: "Symptoms are more reliable. And I am a fan of lab testing for sure... But what tells us that you're in it usually is symptoms."

Role of Electrolytes in Thyroid Function

Early in the episode, Dr. Amy discusses the critical role of electrolytes in thyroid health, highlighting how low sodium and potassium can disrupt thyroid function and contribute to hypothyroidism symptoms.

Dr. Amy [02:00]: "Low potassium status suppresses your growth hormone, your anti-aging hormone... Magnesium interferes with thyroid T4 to T3 conversion."

Hormone Replacement Therapy (HRT)

A significant portion of the conversation focuses on Hormone Replacement Therapy (HRT), particularly the use of bioidentical hormones to manage perimenopausal symptoms.

Progesterone Therapy

Dr. Kellen advocates for early progesterone supplementation based on symptoms rather than waiting for specific lab results or cessation of menstrual cycles.

Dr. Amy Kellen [17:23]: "If you're in perimenopause and having irregular periods, I don't even wait for the number. I think that if you have the symptoms, we can start progesterone."

Estrogen and Testosterone Supplementation

The discussion extends to the benefits and considerations of estrogen and testosterone therapy:

• Estrogen: Dr. Kellen stresses that estrogen supplementation can begin before menstrual cycles cease, especially to prevent bone loss.

  Dr. Amy Kellen [32:04]: "There's no harm in starting estradiol or an estrogen replacement... The systems still responsive to hormones are your bones and pelvic floor."

• Testosterone: Regular testing of free testosterone is recommended, aiming for levels in the middle to upper reference range to enhance motivation, libido, and cognitive function.

  Dr. Amy Kellen [14:17]: "I like [free testosterone] to be kind of middle to upper end of the reference range for her lab."

Managing HRT Side Effects

Dr. Kellen addresses potential side effects of progesterone therapy, such as paradoxical reactions leading to anxiety or grogginess. She suggests alternative administration methods (e.g., vaginal creams or troches) to mitigate these effects.

Dr. Amy Kellen [34:11]: "If you give it a non-oral form, like vaginal progesterone, people tend to do better."

The Perimenopause "Glass Ceiling"

One of the standout topics is the concept of the perimenopause "glass ceiling," introduced by Dr. Kellen to describe how hormonal changes can impede women's professional advancement.

Impact on Professional Life

Dr. Kellen explains that hormonal fluctuations during perimenopause can lead to decreased cognitive function, reduced motivation, and lowered assertiveness, all of which can hinder career progression.

Dr. Amy Kellen [27:36]: "Your brain energy dims by about 30%... Testosterone gives you the confidence, it gives you motivation, it gives you assertiveness."

Consequences

These hormonal shifts may cause women to step back from challenges, new responsibilities, and leadership roles, effectively creating a "glass ceiling" that restricts their professional growth.

Dr. Amy Kellen [28:52]: "We know that perimenopause can contribute to the glass ceiling women have."

Overcoming the Glass Ceiling

Dr. Kellen suggests that early hormone optimization, particularly with testosterone and estrogen, can help mitigate these professional setbacks by restoring cognitive and motivational faculties.

Dr. Amy Kellen [29:10]: "Any of these changes can sometimes take a few months... it's an art and a science."

The "Queen Phase" of Perimenopause

Dr. Kellen introduces the concept of the "Queen Phase," a stage where women reclaim their strength and autonomy after hormonal declines.

Definition and Significance

The "Queen Phase" symbolizes a period of self-empowerment where women no longer rely solely on hormonal protection but actively engage in practices like strength training to maintain bone density and overall health.

Dr. Amy Kellen [41:05]: "When you're putting on your crown... you're gonna do it yourself."

Emotional Transformation

This phase also involves emotional liberation, where women feel less concerned about societal expectations and more confident in their self-worth.

Dr. Amy Kellen [42:50]: "All of a sudden you just don't care as much about all that stuff, which is great."

Practical Advice for Navigating Perimenopause

Early Intervention

Dr. Hornaman and Dr. Kellen advocate for early recognition and intervention to manage perimenopausal symptoms effectively, emphasizing the importance of working with knowledgeable healthcare providers.

Dr. Amy Kellen [43:21]: "Find someone who's kind of like your co-pilot that helps you to know what's happening."

Tailored Hormone Therapy

Hormone therapy should be personalized, considering each woman's unique hormonal profile and symptomatology. Regular monitoring and adjustments are crucial for optimal outcomes.

Support Systems

Building a strong support network, including medical professionals and community resources, is essential for navigating the complexities of perimenopause.

Dr. Amy Kellen [44:03]: "You're not losing your mind, you don't need to kick all the kids out and your husband too."

Conclusion and Resources

The episode wraps up with Dr. Kellen sharing her platforms and resources for listeners seeking further information and support in managing perimenopause.

Dr. Amy Kellen [44:28]: "My website is doctoramykillen.com... Follow me on Instagram @DoctorAmyKillen."

Dr. Hornaman reiterates the importance of understanding perimenopause and encourages listeners to seek professional guidance to transition smoothly through this life stage.

Notable Quotes

• Dr. Amy [00:00]: "If you're ready to dive in and fix things, let's get started."

• Dr. Amy Kellen [09:35]: "95% of women are not able to [discuss hormones with their doctors] because their doctors either don't understand it or have some misinformation."

• Dr. Amy [19:16]: "Every day of the month. There's a couple of ways to do it."

• Dr. Amy Kellen [33:05]: "There's so much like those things should be a pair."

Final Thoughts

Episode 547 of The Thyroid Fixer offers invaluable insights into perimenopause, highlighting the intricate balance of hormones and their far-reaching effects on women's health and professional lives. With expert guidance from Dr. Amy Kellen, listeners are equipped with the knowledge and tools necessary to navigate this transitional phase with confidence and empowerment.

For more information and resources discussed in this episode, visit the show notes or follow Dr. Amy Kellen on her various platforms.