← The Thyroid (and Hormone) Fixer Podcast: Thyropause, Menopause, Metabolism and How to Fix It
The Thyroid (and Hormone) Fixer Podcast: Thyropause, Menopause, Metabolism and How to Fix It
547. The Perimenopause "Glass Ceiling" and ALL About Peri with Dr. Amy Killen
00:39:33
Loading summary
Transcript95 lines
- [00:00]
Dr. Amy
Welcome to the Thyroid Fixer podcast. I'm your host, Dr. Amy, and we're diving deep into the world of hormones, especially for all you fierce women in perimenopause and menopause and anyone dealing with hypothyroidism. If you're struggling with weight gain, you feel like shedding those pounds is an impossible feat. If you're dealing with plummeting energy levels, gut wrenching fatigue, or a libido that seems to have left town, then you're in the right place. And don't even get me started on the hair loss if these symptoms are sounding all too familiar. You sound tribe welcome. Because my goal is to educate, empower and shake up your world. I want you to embrace every inch of that badass woman that you truly are. So if you're ready to dive in and fix things, let's get started. So this is something crazy that I learned about electrolytes that I did not know before. Low sodium diets, you know, when you cut back on your salt, can actually contribute to insulin resistance. So number one, we don't want that. We know that that is going to definitely increase our weight. Low potassium status suppresses your growth hormone, your anti aging hormone, and that even just having low thyroid function disrupt your electrolyte excretion. So, I mean, if your magnesium is low, we know that that's going to interfere with thyroid T4 to T3 conversion. Now you have this whole electrolyte excretion issues that you're pushing out more electrolytes, but you need to keep them in for that conversion. I'm telling you, the data is crazy on the importance of electrolytes. So I use the OG of electrolyte powders, element number one, because they taste absolutely freaking amazing. I want to use probably too many packets in a day, quite honestly, because I keep putting them in my water because they taste that good. But of course, I also know that I'm getting my balance of electrolytes and in the summer I need more. Even in the winter when I'm skiing and snowboarding, I'm sweating that all out. You need more. So if you want to try some of these amazing, just amazing electrolytes and actually feel the difference, I mean, you will feel the difference. You'll feel more energized. You, you won't cramp up and you will get better sleep with this as well. I'm telling you. Definitely better sleep. Go to drink lmnt.com so spell out drink D R I N K L M N T.com/thyroid. And this is going to save you some money. You can get the sample box, you can try all the different flavors. My absolute favorite. Just side note, grapefruit and orange. Drinklementi.com thyroid. Are you absolutely frustrated with working with doctors that keep telling you that you're normal and everything is fine, or are you frustrated with going the functional medicine or integrative medicine route and you're still not getting optimized? Maybe because they're focusing on other things other than the thyroid and hormones or they're not a thyroid and hormone expert. Listen, just because you go to a functional medicine practitioner, it does not mean they know what they're doing with your thyroid and with your hormones. They might tell you they do, but the reality is if you claim to be good at everything, you're really good at nothing. That is why we focus on thyroid and hormones now. Yes. What else is involved in thyroid and hormones? You got insulin, you got your adrenals, you got cortisol. Of course the gut is important. Of course it is nutrient deficiencies, all the things. But we look at all of that and the bottom line is you could do all the gut healing protocols, detoxes, adrenal fairy dust sprinkling that you want to do. And if your thyroid is in the toilet, if you're not being treated properly, if your free T3 is low, if your reverse T3 is high, if your hormones are in the tank, then it doesn't matter, you're going to be wasting your time, you're going to be wasting money, you're going to be throwing a bunch of supplements at it, just getting more and more frustrated and getting supplement fatig week. You need to work with people that will hold your hand, actually care about you, ask you how you're feeling, not have a cap on any kind of dosing. Oh, that drives me crazy too. All those docs out there that say, well, you can't go above XYZ dose of T3. That is complete BS. Do not listen to them. Or doctors that tell you the hormones cause cancer. No, no, do not listen. We can get you to optimization land where you feel amazing, where you're not gaining weight, looking sideways at a brownie, where you have consistent energy through the day, your hair is not falling out, and yes, you actually poop and detox every single day. That is a win. So you're going to want to book a call with my team. And this is totally free. And this is where we go over, hey, what have you tried, what has worked, what hasn't Worked. Where are you at on the frustration spectrum?
- [05:09]
Dr. Amy Kellen
And.
- [05:09]
Dr. Amy
And here's how we can help. And we are going to tailor a program for you and your needs to get you to optimization land, because I always talk about it. It's a beautiful place to live, and I invite you all to join me there. Because in optimization land, you are confident and strong. You want to go out, your brain works, you have energy, you have motivation, and you feel so good every time you get dressed. Oh, and you have a libido. It's a beautiful place to live. So I'm going to invite you to click the link below. We always put it in the show notes how to work with us. So you're going to book a free call, no obligation. We're just going to go over everything with you and at least you'll have some guidelines and know what your next steps should be if you really want to get optimized. We got you. We've been doing this long enough. You're not a tough case. I always say that. But it is time to put you first. Because like I say, we only have so much time on this planet. Let's live it in optimization land because you deserve to be the badass human that you're meant to be. So I look forward to seeing you in one of our programs so we can help you level up and bring you into optimization land. All right, my perimenopausal ladies, you know, we've kind of left you out. You know, we talk about you when we're talking about hormones, but menopausal women have been getting so much more attention. And listen, I'm thrilled about it. There are 5,000 menopause books out. Halle Berry's talking about, Oprah's talking about it. We're getting focus finally on women's health and menopause. But what about that time right before? What about that really confusing time called perimenopause, that we don't know when it starts, we don't know when it ends, we don't. We don't know what to do during it. So that's why I'm bringing on a very special guest, Dr. Amy Kellen. And if you've not heard her, listen, Amy, I follow you on social, and I gotta say, every time I watch you, I'm like, she's so much like me. So this woman is blunt, she's funny, and she's gonna break it down for us today. So if you haven't followed her yet on social, of course we'll talk about at the End. Put everything in the show notes. But you gotta follow Dr. Killen because she's just amazing at the information she puts out there, and she does it with such great humor. So I love it. So, Amy, welcome to the show.
- [07:30]
Dr. Amy Kellen
I have a good time on social media. It's not always well received, but I have a great time, so.
- [07:35]
Dr. Amy
Well, you know, people don't like it. They don't have to look. Scroll on, scroll on. Yes. But, you know, I mean, the way that you bring information to the masses, I think is on point because we need some humor when we're talking about hormones. We need some humor when our vagina is drying up and we're. We're hot flashing and we don't know what to do. So I appreciate that, and I'm sure the women do, too.
- [07:56]
Dr. Amy Kellen
Thank you. Thank you. Well, I'm excited to talk about perimenopause, because I agree it is. It's one of those things that doesn't get talked about as much. In fact, I was just responding to a video I saw of a woman saying that perimenopause wasn't real. It was all a marketing. It was all a marketing term that was invented in the 1980s to sell hormones.
- [08:14]
Dr. Amy
Oh, my. What is this woman, 25, like, has she gone through the loss of hormones?
- [08:18]
Dr. Amy Kellen
No. Yeah, it was. So. I mean, she's like. She looks like she's about 40. I think she just tried to sell something else. I'm not sure, but I probably. I had a good rebuttal coming for her soon.
- [08:27]
Dr. Amy
That's good. That's good. I want to watch that happen. So. But we do see a lot of that out there, that there are many practitioners. Recently you commented on this, and then I. I had a side comment with a group of women about this one practitioner in particular, who is a male who basically is standing on stages saying, y' all don't need hormones. Just fix the cell. And it's like, okay, I. I get it that there can be cell issues, but if you have not been in a woman's shoes and you have not lost those hormones as we age, you can't be up there telling women to avoid hormones. You just can't.
- [09:02]
Dr. Amy Kellen
Yeah. Well, I think that there's always a thread of truth in all of these different people who have opinions about midlife women. Certainly, we do have to pay attention to lifestyle. Certainly we have to dial that in. We do have to pay attention to our mitochondrial health and our. You know, all the things. Like those are all important. So I think that hormones are not going to solve all your problems. But I also think that they're part of the conversation that every woman deserves to have with her doctor. And unfortunately, 95% of women are not able to because their doctors either don't understand it or have some misinformation about these, you know, midlife hormones.
- [09:35]
Dr. Amy
That's so true. That's so true. Okay, we'll get to hormones. We're going to bring those in perimenopause. Let's just start at the beginning. When does a woman know that she is in perimenopause? Do we look at labs or do, do we go by symptoms?
- [09:49]
Dr. Amy Kellen
Symptoms are more reliable. And I, I am a fan of lab testing. For sure. Even in the normal cycle, you're estrogen and progesterone are going up and down depending on kind of where you are in the cycle. But at least then we could test on a certain day and say, okay, we expect progesterone to be in this range, you know, but you're not, or whatever. The problem with perimenopause is the cycles can become erratic and you're also not always ovulating. So now, you know, your estrogen may be 20 or 30% higher some days, and then it crashes down other days. Progesterone's not playing by the rules. And so when, if we check those hormones during perimenopause, we may get various degrees of craziness, but really what tells us that you're in it usually is symptoms.
- [10:31]
Dr. Amy
Okay, so what are those symptoms? What can a woman look out for where she knows? Yeah, she might be entering that stage.
- [10:39]
Dr. Amy Kellen
Yeah. So I mean, usually it's about between two and ten years before menopause. So that can be a pretty wide range of time. There. There are about 30 different symptoms. And I just did a post on this, and I had everyone just comment on their, their symptoms that they were having. That's the first symptom of perimenopause for me. It was Jo. Body pain, waking up in the morning. I'm 49. Waking up in the morning with just like, I felt like I did a seriously hard workout the day before, but like, I had, you know, I hadn't every day it was like that. So that's a pretty common one. Body pain, difficulty sleeping is very common. Anxiety, panic attacks because of progesterone going down. Certainly vaginal dryness, loss of libido, weight gain. It could be weird stuff though, too, like itchy skin or dry eyes or, you know, it's all over the map. Which is what makes it so difficult.
- [11:25]
Dr. Amy
Well, yeah, I mean, it sounds like that it is all over the map. So it's like, whoa, I have every symptom in the world. It could be perimenopause, it could be thyroid, it could be loss of. It could be all these different things.
- [11:36]
Dr. Amy Kellen
Yes.
- [11:37]
Dr. Amy
Okay. So woman has set of symptoms. And it's funny, I always say the first sign of the loss of progesterone is when your significant other people around you say, why are you being so bitchy all of a sudden? And it seems like that's the first. But it's very interesting that you got the joint pain, because isn't that us more associated with the loss of estrogen? So it'd be more down the road in menopause?
- [12:02]
Dr. Amy Kellen
Yeah, yeah, you would think that. So usually in early perimenopause, like you're saying early perimenopause, usually progesterone has got starting to go down, but estrogen's still relatively high. And it's that discrepancy between estrogen and progesterone that causes a lot of symptoms. And then as you get closer to menopause, sort of late perimenopause is when both estrogen and progesterone are going down. And that's. You'll have symptoms of low estrogen as well. So you're totally right on. But I think this just kind of tells us that unfortunately not all women read the rulebook in terms of symptoms and when they happen.
- [12:34]
Dr. Amy
That is true. That it's true. So progesterone really is the first hormone to tank, or would it be testosterone? Are they neck and neck?
- [12:42]
Dr. Amy Kellen
Yeah, well, testosterone is going down gradually, starting at about age 25 or 30 for both men and women. So it's kind of a slow march downward. It doesn't fall off a cliff, though, during, you know, at age 45 or 50, like estrogen and progesterone do. So some women, for, you know, they are 30 years old and have low testosterone, especially if they're taking birth control or something, and they benefit from testosterone. Some women never need testosterone because their body makes enough of it. So testosterone is a little different in the way that it behaves. So it could be either progesterone or testosterone could be the first ones that go down.
- [13:14]
Dr. Amy
Okay. And then the symptoms of the declining testosterone, what will women notice there?
- [13:20]
Dr. Amy Kellen
The biggest thing I see is lack of motivation. That is something that isn't talked about a lot, but, like lack of motivation to get off the couch and go to the gym or to like, go out with your friends, you know, to do something that requires some effort. But also we see, you know, lack of libido, difficulty with arousal and orgasm, sexual kind of stuff. We'll certainly see difficulty forming muscle and difficulty burning fat because that's, you know, anabolic hormone. But, you know, even brain fog or depression, like, there's so many things that testosterone can also be associated with. So it's, it is a little tricky sometimes to figure out. Luckily, we can test testosterone pretty easily. It's relatively stable throughout the month. So that is one hormone that I check. And the other thing, I always get labs, because you still do want to rule out everything else. Make sure the thyroid is okay, make sure that all your other, your lipids and your everything else is okay because those things will also be affected oftentimes during this transition.
- [14:11]
Dr. Amy
Okay, so where do you like to see a woman's total and free testosterone? What is optimal for you?
- [14:17]
Dr. Amy Kellen
So in general, I pay more attention to free testosterone than I do total. I like it to be kind of middle to upper end of the reference range for her lab. And people always say, well, what's the reference range for my lab? But unfortunately, especially with free testosterone, there's a lot of variability between labs. So the easiest way to do this is to Google whatever your Lab name is, LabCorp, and then just say, you know, testosterone reference range for women, and then you'll get what that range is. And generally kind of being towards the upper end is usually better.
- [14:47]
Dr. Amy
I say too, I love that. Okay, beautiful. I say, yeah, at least halfway, if not that upper, upper half. I love that. Now, progesterone. Okay, so we normally, and correct me if I'm wrong, we normally test progesterone in a cycling woman. Is 19, 20, 21 of her cycle in that luteal phase.
- [15:05]
Dr. Amy Kellen
Yes.
- [15:06]
Dr. Amy
Where do you like to see the progesterone level of a basically a non perimenopausal woman? Where is that hardy number? And then what will we start to see as a woman goes into perimenopause? What will those numbers do?
- [15:20]
Dr. Amy Kellen
So, you know, the women, women's progesterone is usually between about 5 and 25 nanograms per liter, but about 25 is usually the top and then it kind of goes down. Everyone's a little different. And certainly the labs also have changed how they're measuring progesterone. So we have new assays that are a lot more specific, which makes it difficult. But, you know, somewhere in the upper 15 to 20, 20, 25 somewhere in there is ideal. You're at like 5 in the mid luteal phase. That's definitely not high enough.
- [15:50]
Dr. Amy
Okay. That's where I was going. Because there are so many times where I will look at a woman's labs and she's cycling regularly, you know, every 28 days looks great. But we look at the progesterone, I'm like, you know, this is only like a three, a five, maybe seven. It's just not, it's not good enough for me right here. So I love getting your opinion on this too, because this is your jam. Yeah.
- [16:14]
Dr. Amy Kellen
And we see low progesterone, you know, certainly in cycling women, certainly, you know, even 25 year old, 30 year olds, you know, because progesterone is so sensitive, sensitive to other things. It's sensitive to stress, it's sensitive to if you're over training. There's all these other things. Obviously polycystic ovarian syndrome, they don't make enough progesterone. So there's a lot of things that can contribute, both lifestyle factors as well as other things to low progesterone. And you know, you can cause symptoms, it can cause pms, but it can also cause infertility if you have low progesterone. So I think it is worth checking, especially if you're having symptoms, you know, even in cycling women.
- [16:48]
Dr. Amy
Now I'm going to pick your brain on HRT and the use of, and when we started and all of that. But when you're looking at that progesterone level of a cycling woman, or even, I'm sorry, even a progesterone level of a perimenopausal woman where her cycles are all over the place, she has two in one month, then she skips three months, then she has another one. So when you're looking at that number, when it starts to decline at, I guess, at what point do you say, okay, timeout, it's time to bring in some progesterone hormones, a bioidentical progesterone into your body.
- [17:23]
Dr. Amy Kellen
So if, if she's in perimenopause and is having irregular periods, I don't even wait for the number. I think that if you have the symptoms and you're in perimenopause, we can start progesterone. And the reason I say that is because the number might be 21 day, but it also could be three the next day. Like there's, there's not a lot of rhyme and reason. And so using a single lab test to say that you do or don't need hormones in perimenopause. I think it's. You're leaving out a lot of women who could benefit from progesterone.
- [17:51]
Dr. Amy
Yeah, I completely agree. Okay, wait. Now I have to stay on the HRT topic because this is too good. So you're 100% right. And I think too many doctors, well, especially conventional, as we know, will say, well, you don't need hormones right now because you haven't stopped your cycle for 12 months. Once you are 12 months in into menopause, then maybe we can talk. And then normally they're talking about progestins anyway, so. So I love hearing from you that we can start progesterone just based on symptoms. Now, let's say we start that. Do you like to cycle the progesterone if a woman is still cycling, or what are your thoughts on using it every day of the month?
- [18:32]
Dr. Amy Kellen
Yeah, great question in general, and everyone's different if. If the woman is cycling regularly. I generally will cycle the progesterone because we want to just mimic. We want to kind of support her own production and just mimic it. So essentially giving it, like, during the luteal phase. So maybe day 14 to 28 of her cycle. I will say that with a caveat, which is that some women love progesterone so much, they get on it, they're sleeping well, their anxiety is better, their migraines are better, they feel great. And sometimes we'll do a daily progesterone, but then we'll increase the dose during that luteal phase. So maybe it's 100 milligrams on day one to whatever, 14, and then we increase it to 200 the second half. So we still have a cycle going, but she's getting a little progesterone every day. So there's a couple of ways to do it.
- [19:16]
Dr. Amy
Okay. Yeah. And when you have women that love the effect on their sleep, it's so hard to tell them to take a break. Now, is there anything to the. Because I've heard some practitioners talk about taking a hormone holiday from progesterone, even if it is two days out of the month or, you know, take a hormone holiday just on the weekend. Is there something to that? Because that seems like a very big debate in. In this perimenopause, menopause, hormone space.
- [19:42]
Dr. Amy Kellen
Yeah, well, there is a lot of debate, and there are some practitioners certainly who believe, you know, very, very strongly that you should be cycling progesterone even in menopause. That there's the receptors. And you know all these things.
- [19:53]
Dr. Amy
Right.
- [19:53]
Dr. Amy Kellen
The truth of the answer is we don't know there. We don't have any comparison, like good comparison studies that tell us in menopausal women that you should or shouldn't cycle or that the receptors need a break or don't need a break. So I think it makes sense, if you're gonna take a break, it makes sense to take it during when you start your period, because progesterone falling is the signal to your body that it's time to shed the uterine lining. So if you want to mimic nature, then stopping progesterone during your period is probably the most important time to stop it. But again, some people do find not stopping it.
- [20:26]
Dr. Amy
Okay, now what about those poor women that are getting two cycles a month? What do you do? Do you just tell them, okay, for that second one, go ahead and just carry the progesterone all the way through, or do you have them stop it again?
- [20:38]
Dr. Amy Kellen
It's kind of a trial and error. I mean, people, you know, I'll just put them on progesterone every day. Like, if you're having a lot of irregular cycles, just crazy irregular, whether it's because of perimenopause or PCOS or anything like that, then I'll just usually just do a daily progesterone and just, like, not pretend like I'm even trying to get, you know, get it back on track that way and that. But if we can get it back on track, certainly. Certainly we will. It's just not always possible. And it's so hard for women. Like, it's hard for me. And I, you know, I'm. I know all this stuff to just to be like, well, what day of the month is it? And am I supposed to take it or not take it? And, you know, like, what's the dose? So I try to keep it as simple as I can so that they actually, you know, take the medicine.
- [21:17]
Dr. Amy
Yeah, yeah. And then when you're. When you're brain foggy and you're not sleeping, then simple is better anyway. Simple is better.
- [21:24]
Dr. Amy Kellen
Exactly.
- [21:25]
Dr. Amy
Now, I'm just gonna take a little bit of a turn off the road here, because since we're talking about hormones and the receptors, what popped into my mind, and I heard you talking on a friend of mine's podcast, Stephanie Estima, and you. You were talking about something that comes up in my practice, a decent amount of time, at least enough to have this discussion. When a woman is in menopause and she is 10 years plus without hormones. But she wants to start on the hormones. What can she expect? So basically I would love to know from you, the protection, like is she getting any of that bone, brain, breast, heart protection 10 years after? Can we at least give her symptom relief if we start hormones 10, 20 years down the road? And what do we have to be aware of when we start those hormones? Because those receptors are so they're basically dried up, but they're also kind of like sponges and they over absorb is completely not the right medical term whatsoever. But I, I see these women over respond to the hormones.
- [22:31]
Dr. Amy Kellen
Yeah, I mean, I think the first question is, can women take hormones if they're more than 10 years out from menopause onset? Because you know, the classic teaching was that they probably shouldn't because there's too much risk.
- [22:41]
Dr. Amy
Yep.
- [22:42]
Dr. Amy Kellen
That I think has gone out the door. I mean the increased risk came from starting synthetic hormones, you know, progestin and Premarin, more than 10 years from menopause onset. And that did have some problems. But the hormones we use now, the bioidentical hormones, there's not a lot of increased risk, especially if it's transdermal estrogen. Now, as far as benefit goes, the systems that are still very responsive to hormones are your bones and your pelvic floor, for sure. So those things we definitely still see benefits with hormones, even if you're 65 or 70. The systems that maybe aren't as responsive to late start hormones, at least per the studies so far, are the cardiovascular system and probably the brain. The dementia benefits we know at the heart, we know for sure that if you start hormones more than 10 years from menopause onset, or once cardiovascular disease has started, like you already have atherosclerosis, you already have plaque in your arteries if you do that. We're not going to prevent or further prevent heart disease to any degree by starting hormones in those women. So it is important to know and it's important to start early if you can. But obviously a lot of women unfortunately miss that window.
- [23:49]
Dr. Amy
Right, right. And they do. I mean there's been so much misinformation out there for years, but at least they know that there's, there's something, there's going to be some benefit they get out of it. I feel so much stronger in my workouts and I legit feel like I recover quicker from my workouts because I am now using every single day mito pure. So when I dive into what does mitopure do? How is this actually helping me. And sometimes I won't even look at what a supplement does. I'll just use it because I want to actually experiment, experience the results and then go back and say okay, here's what I feel, here's what I notice. How is it doing it? So after feeling stronger, noticing that I'm recovering so much faster and especially with Hashimoto's hypothyroidism, you know your recovery is much lower than everyone else's with regular use, I started to see and feel the difference in my energy levels and in my workouts. So I was stronger, I had more endurance where I would normally, let's say poop out at burpee number 10, I was actually able to do burpee number 20 and not feel like I was dying. So the endurance is up. And the other thing I noticed when I dove into the literature on might appear is that it really does deliver double digit increases in muscle strength. And guess what? Endurance without actually changing your exercise. So total win. Complete and total win. It's working at cellular renewal, it's working on your mitochondrial health. But most of all for me, what I noticed immediately, better energy, steady through the day, strength, power, resiliency, better workouts, better recovery. Absolutely amazing. So if you want the most out of your workout because it's hard enough to get to the gym, so if you actually want the most out of your workout and you want your muscles to get the most out of your workout, then you gotta go and grab some might appear. So timeline that makes might appear they're offering a 10 off your order. So you're gonna go to timeline.com forward/doctor Amy D R A M I E and you're gonna use the code Dr. Amy and that's it. 10% off. You gotta try it. So again, timeline T I M E l I n e.com forward slash dash r a m I e. That's gonna get you 10% off your order. Write me after, let me know how your workouts are. You are going to thank me. Now what have you found? When you start hormones on those type of women that have been so deficient for so long, how do you see them respond? Do you see hyper response or the slow to respond?
- [26:47]
Dr. Amy Kellen
Yeah, no, they can definitely be. I usually start the dose lower than I would for anyone else because they are going, you know, their, their body, their bodies are just not used to these hormones. You know, for instance, you can have certainly have vaginal bleeding and that's fairly common. Starting you start estrogen later on, all of A sudden you've got this 65 year old and she's bleeding and she. I know everyone's freaked out because she's bleeding, which I understand, but that's your kind of just. You're igniting or, you know, turning on some of those receptors that haven't been on for all that time. So I do start and I go slower with the women who have been off hormones for a long time. Yeah, just like you said.
- [27:21]
Dr. Amy
Yeah, exactly, exactly. Okay. I had to go there. I had to get your take on that. Now we'll take it back on the road to perimenopause. Now, you talk about a perimenopausal glass ceiling. I've never heard that term before. You gotta break that down for me.
- [27:36]
Dr. Amy Kellen
Yeah, I mean, I don't even know if it's a real term, first of all, but I did a talk about this because I was talking to a friend of mine, Carla Vetrone, who has the same. This. This company, and she was talking about how in the kind of corporate America, she said she's in New York, that she feels like that perimenopause is really contributing to this glass ceiling that women have. So I started doing some research on it. And. And I. I do think that there's something there. I mean, we know in perimenopause that, you know, the brain, essentially your brain energy dims by about 30% as you're going through perimenopause. And so, like, you're trying to do the same things you could before, but now you've got difficulty concentrating. I can't find words and I can't focus for very long, and I'm distracted easily. So from that. And then you also lose testosterone, which I think is very problematic, especially for women who are in leadership positions. You know, testosterone gives you the confidence, it gives you motivation, it gives you assertiveness. And all of a sudden that goes out the door. And it's like you can't make decisions very quickly and you're unsure of yourself and, you know, your leadership style completely changes. So we know that, like, you know, I don't have the numbers on top of my head, but it's like 30% or something of women kind of step back from their job. They don't necessarily leave it, but they step back from challenges and new clients and leadership positions during that kind of menopause transition.
- [28:52]
Dr. Amy
Yeah, I know. And that's so sad because these are powerful, badass women. You almost see them diminish. Now, let's say those women were to catch themselves and start on hormones early. When would they start to see that motivation and that brain shift occur?
- [29:10]
Dr. Amy Kellen
How long does that take on testosterone? I mean, can be as early as a few weeks. I tell people to give it at least three months with testosterone for the motivation, assertiveness, that kind of stuff. Certainly estrogen is going to also help turn that light bulb back on. That's really important. But any of these changes can sometimes take a few months. You got to kind of like give it some time, let it settle, and then be ready to make adjustments to either your dose or your route, your delivery system. Because this is more of an art. It's an art and a science, I guess, but everyone responds differently. And so what works for your sister or your mother may not work for you. So you have to be ready to be like, okay, I'm going to go on this multi year exploration of trying to feel as good as I can with, you know, the hormones and everything else that you're doing now.
- [29:56]
Dr. Amy
You're a proponent of starting the hormones early, like before you lose your cycles, before the symptoms take over your body, right?
- [30:04]
Dr. Amy Kellen
I am, yeah, I am, I think progesterone for sure. Early testosterone, if you need it, and then estrogen. We used to say you got to wait till you've, you know, you're 12 months from periods, like you just said. But, you know, we also know that the bone loss, for instance, that happens in perimenopause can happen, you know, two years before you have your periods become irregular. And so if we're trying to prevent some of these things that from happening, like bone loss, then it makes sense to potentially start even estrogen a little bit earlier.
- [30:32]
Dr. Amy
That, that's a great point. Now when would you actually start the estrogen? Are you looking there at symptoms or DEXA scan for their bone, or are you looking at labs and actually looking at that, that FSH and the estradiol number? And at what point do you say, okay, I get it, that your cycles haven't stopped, but it's time here, it's time to add in the E. There's.
- [30:56]
Dr. Amy Kellen
A couple of, a couple of ways to look at it. There's a couple of tests. So certainly fsh, that'll start to go up. You know, as you're getting closer to menopause, that's your brain, it starts to yell louder at your ovaries that we need to make estrogen. So that starts to trend up and that is something you can follow. I also like tests like the glycanage test, which is a test that is, is it's essentially measuring a special kind of inflammation attached to your immune cells. And we see that glycan age go up like significantly. Like Maybe you age 10 years on that test in a six month period when estrogen overall has started to drop, even if there's some fluctuation during certain times of the month. And then there's also an interesting. I'm actually an advisor for a company called Timeless Biotech and they actually have, they're coming to market pretty soon with a menopause predictor that essentially uses AI and a couple of different basic labs to predict when you'll be going into menopause. And they can predict it out 12 years into the future. So that's something else. You know, it's not expensive. Maybe you're 35 and you're like, I have no idea if it's going to be like 2 years or 15 years. So apps like that could be helpful as well or platforms.
- [32:04]
Dr. Amy
Okay, interesting. So there's just for the listeners, there is no harm in starting estradiol or an estrogen replacement. Bioidentical hormone replacement. Maybe you do a bias estradiol. There's no harm in starting that before your cycles stop.
- [32:21]
Dr. Amy Kellen
That is correct. There's no harm. The only caveat is to know that your endogenous what you make estrogen Production is about 20 to 30% higher in early perimenopause than it was when you were in pre menopause. Your mate, you know, the peaks are higher. Maybe before your estrogen would peak at 400 and now it's peaking at 800. And so we don't want to give you a lot of estrogen on top of that. If you already have too much estrogen, wait until the symptoms are telling us this as well as maybe some of those lab tests.
- [32:53]
Dr. Amy
Yeah, yeah, absolutely. Yeah. Because a woman could go into a pretty significant estrogen dominance day because of the low progesterone as she is moving through perimenopause into menopause.
- [33:06]
Dr. Amy Kellen
Absolutely. And a lot of the symptoms that we think of like hot flashes for instance, that can be from. It's not always low estrogen, it could just be chaotic estrogen. So changes in estrogen. So usually we start with progesterone because oftentimes that actually will help with even things like hot flashes in perimenopause. Because it's not all about the estrogen.
- [33:24]
Dr. Amy
Yeah, exactly. And a lot of women don't know that either. That progesterone can actually help with the menopausal quote unquote symptoms.
- [33:33]
Dr. Amy Kellen
Yes.
- [33:33]
Dr. Amy
That they automatically. They immediately tie hot flashes or vaginal dryness to low estrogen. It's like we've been taught that we have that in our minds, but not realizing that progesterone plays such a significant role as well.
- [33:46]
Dr. Amy Kellen
Yeah, And I love. Progesterone is so safe. Like, I love it. It's such a great, it's such a great medication. It's extremely safe. It's calming. Not everyone loves it. Certainly there's, you know, 10% of women or so who don't love it. But in general, I think it's such a great medication.
- [33:59]
Dr. Amy
Now, do you ever find with progesterone that some women don't do well on the oral? There's that. That small percentage that they get almost the opposite reaction. They'll get anxious and, and just not tolerate the oral?
- [34:11]
Dr. Amy Kellen
Yeah, absolutely. 10 to about 10% of women will have either a paradoxical progesterone response, which is essentially instead of being calming and helping with sleep, it causes excitation and anxiety and they can't sleep. That's one way, one thing that happens and then the other thing that happens is that some women are just very sensitive to the progesterone. So like instead them a little bit sleepy, they're waking up groggy the next day and they're like, you know, depressed and all of those things. So either of those though, if we give it a non oral form so you don't make the metabolites that then go to your brain, like a vaginal progesterone, for instance, or a trochee under the, under the tongue. People tend to do better.
- [34:48]
Dr. Amy
Okay, that was going to be my next question. Is then the option for those individuals that respond that way, Cream, troche, vaginal, all of that, that. Now why is that? Why is that what happens with the brain? Because I want my listeners to understand this. What happens with the brain when someone does not tolerate progesterone orally? They have that paradoxical effect.
- [35:11]
Dr. Amy Kellen
Yes. So when you take any medication by mouth, like you're swallowing a pill, it gonna, it's gonna go through the liver before it gets into your bloodstream. So it's called first past effect. We know about this. Some people think, you know, talk about it being really bad. It's not bad. We just got to understand what's happening. So your progesterone goes through the liver, it gets made into metabolites, and one of those is called allopregnanolone, and that metabolite actually goes to your brain and it acts on your GABA receptor. And, you know, you think about GABA as being like, calming and relaxing and all of those things, which is why for many women, progesterone is so great. It acts on gaba. It's very calming. Some women have a. It's actually. They think it's actually a GABA receptor issue where the receptor reacts the opposite way. So progesterone binds to it, but then the downstream effect is essentially excitation. And oftentimes the women who have that, some of them also had like pmdd, for instance, where they were, you know, have difficulties during the second half of their period of their cycle with anxiety and stress and, you know, dysmorphic disorder. And that we think is probably is also a GABA receptor issue, at least partially.
- [36:21]
Dr. Amy
Okay. And there's nothing that they can do to shift that. They just have to deal with the fact that, okay, you might not get the sleep benefits from the oral progesterone, but you're still getting all of the benefits of progesterone through the cream or the troche.
- [36:35]
Dr. Amy Kellen
Yeah, yeah, exactly. I mean, as far as I know, there's not an easy way to shift that. I have. I haven't found it yet if there is.
- [36:42]
Dr. Amy
Now, what about pregnenolone in perimenopause? Do you use that a lot?
- [36:46]
Dr. Amy Kellen
You know, I don't use it too much, although I think that there. I think there's a use case for it. You know, we think of it as being like the mother hormone. I, I just, I tend to like to play, like, replace like, very specifically the hormones that I can see that are lost. It's same thing with like, dhea, which I, which I do use, but some people will use DHEA to, instead of like testosterone because it gets made into testosterone, but it also can get made into estrogen. So for me personally, if I want to get. If I want you to have testosterone, I'll just give you testosterone. But having said that, I think that there's probably a place for some of these hormones. It's just a little bit tricky to know what your body's going to do with them when we give them to you.
- [37:21]
Dr. Amy
Right. And now I've seen a lot more lately on pregnenolones, protective effect on the body from cancer. And, and I've been listening to, obviously. I mean, gosh, you were actually on stage with me at HOS when I kind of announced. I'm like, yeah, I just, just literally yesterday got a call that I have uterine cancer. But it's cool. We're going to talk about hormones today, but I've obviously been going down this rabbit hole of how protective progesterone is and how protective pregnenolone is. So I've been incorporating more pregnenolone. But I want to come back to you and ask you about progesterone's protective effect on cancer, being anti proliferative. So we talked a lot about the connection with, with the symptoms. And then of course, fertility and infertility and even thyroid and insulin is helped by progesterone. But what about those cancer protecting components of progesterone? Can you talk about that?
- [38:19]
Dr. Amy Kellen
Yeah, There's a lot of debate still in the medical literature. I will say, like, for instance, look, thinking we know that progesterone protects against endometrial cancer, you know, uterine lining cancer. That's, that's not even disputed. But there's a lot of debate on its role in like breast cancer, for instance. I really think that most of the literature points to it as being very protective for, against progesterone. I think of estrogen as being kind of like a construction worker. It's very anabolic. It's building up tissues, it's protecting, it's building, it's building and it's great. But then I think of progesterone as being like the project manager on the scene. It's making sure that estrogen is not building too much or in the wrong places. It's kind of like keeping things in a safe level. And so I use progesterone with all of my women who are in menopause, whether they have a uterus or not. I think it's really important to not just protect the uterus, but also we're going to protect the brain and the heart and all the different things, the breasts. So I think it's important, I think that eventually the sort of more traditional doctors will start doing that, but they haven't yet. The guidelines still don't recommend progesterone unless you have a uterus.
- [39:25]
Dr. Amy
Well, it's wild too, because I had mine taken out and I would never give up, up the calming effects of progesterone, the bone protection, the sleep, the mood, the dot, dot, dot, on and on. It just blows my mind that we're still in this mindset of like, oh, well, you don't have a uterus, so you don't need anything else. Like you don't need that sleep help.
- [39:47]
Dr. Amy Kellen
Or we know that sort of yin and yang relationship between estrogen and progesterone, like, it's very clear, it's very known. And we know that progesterone, you know, even affects the way estrogen binds to the receptor. Like, there's, there's so much like those things should be a pair. And so the idea that we're just going to give one without the other one just because you don't have one organ, I think it's just crazy. It's crazy town.
- [40:10]
Dr. Amy
It is. It's so crazy. And, and I mean, we always talk about, everyone in this space talks about you should never take estrogen unopposed, meaning you don't take estrogen without progesterone. Like, just like you said, they go hand in hand. They're a pair.
- [40:27]
Dr. Amy Kellen
Yeah. The only time that I say that it's okay or that I recommend it is if you're doing like a low dose vaginal estrogen. And in that case, which I recommend every woman if you're over 50, if you're not taking a low dose vaginal estrogen or you know, something else like a DHEA or testosterone to help the pelvic floor. Get that from your doctor, is expensive, inexpensive, it's, it saves lives. But that one, you don't need progesterone because it's, it's a locally acting, it doesn't get in the rest of your body very much. It's a very, very low dose. Right.
- [40:55]
Dr. Amy
It's not going to have those growth promoting properties like an estradio. Yeah, yeah, exactly. Okay, I have to ask you, what is the queen phase of perimenopause?
- [41:05]
Dr. Amy Kellen
I think of the queen phase is essentially when you, when you're, when you lost your own hormones like you lost estrogen, progesterone, those have gone away. That protection that shield that they provided you has gone. And now you have to kind of step into protecting yourself. So you're putting on your, your crown and you're saying, you know what? I'm not going to rely on any, like, I'm not gonna rely on other things to protect me. I'm gonna, I'm gonna do it myself. So it's whether it's taking hormones and getting a prescription, but also, you know, lifting heavy weights and making sure you're building muscle and essentially taking on that protective role for yourself versus relying on, to be already there. Because before we lose those hormones, they're there invisibly protecting us and shielding us. And we don't know it, but, you know, we kind of just have to, we benefit from it. But eventually those hormones go away.
- [41:51]
Dr. Amy
Oh, I love it. Well, and I will even say there is a queen two point. Wait. Dr. Amy, you're not yet in menopause yet, right?
- [41:59]
Dr. Amy Kellen
No, I'm 49. I'm pretty close though. I'm. I'm. My cycles have become sparse. I feel like I'm like basically there, but I'm still. I. I still say I'm in perimenopause.
- [42:08]
Dr. Amy
Okay. So, yeah, I don't know whether this occurs at the age of 50 or if it just occurs in menopause. So whenever you enter. But I'm going to say the Queen Phase 2.0. It's very much what Lisa Moscone talks about where that armor. Because you said armor. So that's what made me think of that. Armor kind of falls down and you literally do not give a shit about anything anymore. You don't care what people think about you. You don't care about going to the grocery store without makeup on. You don't care about the little things that used to bother you maybe in perimenopause. Don't. So that's one thing that you can look forward to. And you can totally coin the queen face 2.0 if you'd like.
- [42:50]
Dr. Amy Kellen
I love that. Yeah, I hear a lot of women talk about that. It's just like all of a sudden you just don't care as much about all that stuff, which is great. I think that's awesome.
- [42:59]
Dr. Amy
Fantastic. So perimenopause is setting you up for that. You know, just like Dr. Amy said, you're getting ready, you're lifting heavy, you're putting yourself first, and then you're just going to move into this other beautiful phase where people are not going to annoy you as much anymore.
- [43:12]
Dr. Amy Kellen
Something to look forward to, care.
- [43:13]
Dr. Amy
I love it. You don't care. You don't care. Is there anything I missed about the beautiful stage of perimenopause that we needed to touch on?
- [43:21]
Dr. Amy Kellen
I think the most important thing is know it's coming. You know, make sure it's. It's hard. It's hard always to find a provider, like medical provider to help you. But I think it's so important to have someone who's kind of like your co pilot that helps you to know what's happening, explains the process, tells you it's going to be chaotic, but eventually it'll settle down because there's so many symptoms. A lot of people will see four, five, six different doctors with all these crazy symptoms. They'll see a cardiologist and a neurologist and a rheumatologist. And it really is all from one thing. So, so finding that person to walk you through it is so important if you can.
- [43:55]
Dr. Amy
And just knowing that you're not crazy, it's just your hormones, you're not losing your mind, you don't need to kick all the kids out and your husband too.
- [44:03]
Dr. Amy Kellen
Exactly, exactly. It may look different for you than, you know, anybody else in your life, and that's okay. And, you know, you will get through it, but hopefully with some support.
- [44:12]
Dr. Amy
Yes, yes, the support is key. So on that topic, Dr. Amy, you do so much, you do so much for so many people. And, and I mean, really, you're a crazy entrepreneur. So where can people find you? All the different websites, what are, what are all you doing these days?
- [44:29]
Dr. Amy Kellen
Yeah, so, I mean, I'm on Instagram, Dr. Amy B. Killen, and that's my kind of primary social media, but I'm on all the other channels too. My website is doctoramykillen.com and I also have on there kind of my links to my different companies. I have a longevity clinic franchise called Humanot Help Health, which we just launched last year and that is Humanot Health.com it's in Austin, Florida currently and we're going to be expanding that. And then I also have a female focused longevity supplement company called Hopbox and that's super fun. It's kind of like all my favorite supplements into one little pack. And that's at Hopbox Life. So those are some of the places that you can find me.
- [45:04]
Dr. Amy
I love it. And we'll put all those links in the show notes of where to find Dr. Amy, but you gotta follow her on Instagram because she's amazing. So I'm just saying thank you. Thank you so much for joining me on here. And just this is a beautiful podcast. Just breaking it down for all my perimenopause ladies out there.
- [45:22]
Dr. Amy Kellen
Yes, thank you so much. This was so fun.
- [45:24]
Dr. Amy
Absolutely. We will see you soon. The information shared on the Thyroid Fixer podcast is intended solely for informational and educational purposes. It is not a substitute for professional medical advice, diagnosis or treatment. Always consult with your physician or other qualified healthcare provider with any questions you may have regarding a medical condition, treatment or before making changes to your healthcare regimen, including medications, supplements or other therapies. Use of the information provided in this podcast does not establish a doctor, patient or client, provide a relationship between you and the host or between you and any other healthcare professionals featured on the show. Any medical opinions or statements made by guests are their own and do not necessarily reflect those of the host or affiliated parties. Statements regarding dietary supplements or health related products mentioned in this podcast have not been evaluated by the fda. These products are not intended to diagnose, treat, cure, or prevent any disease. Some episodes of the Thyroid Fixer podcast may include sponsorships or affiliate links. The host may receive compensation for discussing or promoting certain products or services. Any such sponsorships or affiliations will be clearly disclosed during the episode. All opinions expressed list are those of the hosts or guests and do not necessarily reflect the views of any sponsors. The inclusion of a product or service does not imply endorsement by any healthcare professional featured on this podcast.