Perimenopause isn't just a buzzword it's the missing vocabulary that finally explains why your body feels like it's betraying you in your late 30s and 40s.

This conversation with Dr. Jackie Piasta explored why perimenopause has become such a powerful word for women finally finding answers to years of unexplained symptoms. We discussed the complex hormonal orchestra that begins breaking down in the late 30s and early 40s, creating a cascade of physical and emotional changes that often leave women feeling like they're "not themselves."

The physiology behind perimenopause involves the ovaries becoming less responsive to brain signals, leading to missed ovulations and progesterone deficiency. This creates what's often called "estrogen dominance" though we prefer the term "progesterone deficiency" to avoid vilifying estrogen. The result is unpredictable cycles, mood changes, brain fog, sleep disruption, and metabolic shifts.

A major revelation emerged around hormone testing it's largely unhelpful during active perimenopause with regular cycles, since hormones fluctuate daily. However, testing can provide validation for women experiencing significant cycle disruptions, even if it doesn't change treatment plans. The key is understanding when testing makes sense versus when it's a waste of money.

The conversation highlighted how perimenopause accelerates metabolic dysfunction, with cholesterol, blood sugar, and liver enzymes often rising for the first time. Dr. Piasta introduced the "red wine sign" when alcohol tolerance suddenly disappears as an early warning that metabolic changes are happening throughout the body.

Treatment approaches vary based on individual needs, considering contraception requirements, cycle regulation, and symptom management. Both birth control pills and menopausal hormone therapy have roles in perimenopause care, often used together with IUDs providing contraception while hormones address symptoms. The goal is having more tools in the toolbox, not fewer.

Highlights:

• Why perimenopause is a "power word," not just medical jargon.
• When to test hormones (and when not to waste your money).
• Metabolic changes that accelerate during perimenopause.
• Birth control pills vs. menopausal hormone therapy approaches.
• When your body stops processing alcohol.
• Weight gain and metabolic dysfunction solutions.
• Treatment strategies for the "sandwich generation".

If this episode gave you new perspective on perimenopause and metabolic health, help other women find this conversation by subscribing to the channel and leaving a review on Apple Podcasts. Your reviews help more women discover these important discussions about taking control of their healthcare choices.

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GSM Collective

The GSM Collective - Chicago Boutique concierge gynecology practice Led by Dr. Sameena Rahman, specialist in sexual medicine & menopause Unrushed appointments in a beautiful, private setting Personalized care for women's health, hormones, and pelvic floor issues Multiple membership options available Ready for personalized women's healthcare? Visit our Chicago office today.

GSM Collective

She takes it over from there. So she edits both this and that. So. Good, OK.

So nice.

Yeah, awesome.

Okay, all right. So this is gonna be post intro. All right, y'all. we're diving deep into perimenopausal years today. What's real, what's often dismissed, how we can thrive instead of just survive, whether in your 30s or 40s or beyond. This conversation is for you. And I'm super excited to have my friend and Menopasi, I know Heather calls it Menopals now.

My menopal Jackie Fiesta here, who is amazing. We met a few years ago, virtually, and then in real life. And she's very outspoken on all the socials, as you saw in my intro on her. And we're going to get right into it. Jackie, welcome to Guide O Girl for Sex, Drugs, and Hormones.

Thanks, I'm so excited to be here. Thank you for having me.

Thanks for making time for me. I know that you just moved places and by the time this airs, it's gonna be perimenopause awareness month. So I thought, who better to talk about it than the peri princess herself?

course.

That's the first I've ever heard of that, but I kind of love it. Love it.

Right? I love anything that gives us royalty. So.

I know right now it's certainly perimenopause is having a moment right now and I'm all for it. So let's go.

Yeah. It's interesting because I posted recently that I had, because whatever, I saw, you know, legislation and all the stuff that goes through. So I got something in the mail from our governor of Illinois and it was like, girl, I should have brought it, I did a reel on it. And it was like, hear ye, hear ye, because X number of women in Illinois are going through perimenopause. And because we don't advocate, we have now declared it in the state of Illinois, September is perimenopause awareness month.

How nice.

And it was from Governor Pritzker. And I was like, I guess like, yeah, let's just like.

Yeah, that's fantastic. Now I think it's really interesting, not just to jump right in, but so often one of the myths I hear so often times women are told, perimenopause is just a buzzword these days. And I always tell people, I'm like, it's not, yeah, sure, it's a buzzword. Let's use that to our advantage. It's finally, for the first time in forever, women finally have a vocabulary word to put towards all the things that they've been experiencing through these,

mid to late 30s, early to mid 40s and beyond. And, you know, it's a whole, you know, string of symptoms and we haven't really been able to connect the dots. And so finally, this word perimenopause, my gosh, could this be it? And, you know, there's an argument to say, you know, we don't want to blame everything on perimenopause. We certainly as clinicians, we want to do our due diligence and make sure that we're not missing anything. But I think it's very empowering for women to finally have that word.

Yeah. Yeah.

And unfortunately, there's still the other side of the coin, which is the fact of the medical gas lighting and saying, it's a buzzword. But I think we're going to turn that into a power word and say, yeah, it is a buzzword.

was then.

Yeah. Yes.

I agree, like I think so many patients come in, you know, late thirties, early forties and they're like, I mean, I'm just reading so much. Everything's coming up on my Instagram for you about perimenopause and supplements and this and that. So like, is everything just perimenopause now? And I'm like, well, yes and no, because we know that, you know, women at this juncture in their life have everything hitting them at once from a stress perspective, you know, pivoting and jobs, you know, people are getting divorced. People are like, you know, losing loved ones, people, you know, all these stress,

Mm-hmm.

Yeah.

stressful things that we carry the burden of and then all of sudden, you know, throwing hormonal flux and it's like a real shit show.

Oh, 100%. And most of us are not starting at a good baseline hormonally. Either we've been hormonally suppressed for a good, you know, better part of a decade or two decades with broken toe pills and I'm not sliding those. I utilize them in my clinic often. I think they're a fantastic tool. But you know, we've either lived multiple decades not really knowing what our hormones are or we are already in a very stressed state. And so we add more stress to that.

it's not pretty oftentimes. you know, I think that's why we find so many women really looking for those extra layers of support in this time and eagerly seeking, you know, answers and validation for this word we say is perimenopause.

Yep. Yeah.

No, there's some, think there's a psych term called affect labeling, which once you identify the name of something, your symptoms can automatically feel like either more in control or less, you know, like you can actually, there's some peace in knowing, right? Like even when people come, all these different, you know, they've never been diagnosed with like PGAID or pyramid, whatever. And all of a sudden there's like, there's, this is not just all in my head. Like there's something that can be said about, yeah. And so,

Sure.

Yeah.

I was fine. That's very empowering for most patients. So tell me a little bit about your journey, Jackie. Like, I mean, obviously I know a lot of it, like tell our listeners a little journey.

Totally.

Yeah, I mean, how far do we want to go back? feel like I grew up in the crib of women's health. My mom is an infertility specialist. And so I grew up, you know, sneaking into infertility labs before that was even like a really common verbiage. People, you know, I was like the weird kid at school that was like, my mom makes test tube babies when we still call them that. So from a very young age, I really knew that, you know, I loved medicine. loved like clinical care. I loved taking care of patients.

you

loved like the science of the infertility lab, but I really needed that human connection, which you don't really get in a lab. And so I actually, for the longest time, wanted to be a guidance counselor. And then my mom told me that she was like, guidance counselors don't make enough money, so you can't be that. And so again, that sort of that generation of pressure from the parents. So I wanted to be a psychiatrist.

you

Yeah.

And then somehow I managed to wind myself up into the nurse practitioner profession. I mean, was mainly off of seeing the nurse practitioners working through my mom's IVF clinics and seeing kind of that role. And then I always wanted to be an IVF nurse practitioner, but I married an Air Force pilot and they sent us to small little cities across Texas. And there was never an infertility clinic within

know, driving distance that I could work at. sort of as a fall back, I guess I'll say I went into just regular OB-GYN and practiced for years, you know, gaslighting women through menopause and perimenopause experience. We were never really taught anything. We had like four slides in a lecture on the Women's Health Initiative trial and we were scared to death to prescribe anything.

As we all know.

And there wasn't a ton of also like support and educational support and prescribing, non-hormonal things either. Maybe I just sort of, you know, steered away from it. I also graduated in M.P. school at a very young age. I mean, I was 24 years old. was a baby. And so all that to say, you know, I just sort of fell again. I sort of fell. I was in the right place at the right time.

Yeah.

We had moved cities, I was desperate for a job as an NP and a gynecologist needed somebody to help her manage hormones. And I thought it was crazy. I was like, this isn't saying people don't do this. Nobody gives hormones. And sort of the rest is history. I sort of say like, once you sit down and you really have an authentic discussion about hormones with people who know what they're talking about, it's sort of addictive a little bit. When you start to like the clicking the...

pieces together. that's it, you know, Fast and Furious. I've been an MP for 15 years now and always in women's health and I love it.

Yeah, awesome. And then I know sometimes you talk about even your own journey in this space personally. Like, I don't know how much you want to share and what kind of symptoms you have experienced. really, we have this whole sort of movement with millennial pause or millennials going through menopause.

Yeah.

Yeah, sure.

Yeah, yeah, so I'm definitely your token millennial. I think what we're also starting to hear a little bit more about too is this whole phenomenon of postpartum, sort of just sort of, yeah, going from, yeah, just kind of stepping one foot into, yeah, one foot out of the postpartum pool and one foot into the perimenopause pool.

Yes.

going from post-partum interference.

That might not have been my experience exactly, but I distinctly remember starting to experience night sweating at 36. And mood changes, libido changes, and of course, like we said, there's a lot of other factors there. There was no reason why I should be having night sweating. I mean, no reason. And I had already had some other things worked up and

started on some micronized progesterone and it was totally like changing for me. mean, like the night sweats went away, the sleep, the insomnia went away, the moodiness and a lot of the anxiety throughout the day went away. And I very much believe in a multimodal approach and being very transparent. I mean, I've been on an SSRI, an antidepressant for many years and you know, that's why I knew it wasn't that. like, well, why am I still having this? And so,

there, you know, that was a couple of years ago now, but I mean, for me, it was the night's fests. I was like, this is out of the blue, what the heck is going on? So again, I think, you know, had I not have been in this space and been a healthcare professional, I probably would have just brushed it off and dealt with it and not known, but you know, I have the good fortune of this knowledge base and

Yeah.

Hopefully just advocating for younger women. Like if you feel like something is off in your body and you really looked into kind of the other reasons why, like, I didn't know I didn't have cancer. That's why I wasn't having, you know, wasn't having night sweats because of that or diabetes. Then let's, know, what common things happen commonly in peri-menopause happens to all women. So.

Yeah.

Yeah, long, long, long, long, long, long, long, long, long, long, long, long, long, long, long, long, long, long, long, long, long, long,

Yeah.

They're definitely patients, if I start talking about perimenopause in their late 30s, just like, hey, heads up, we give peritalks. mean, we give puberty talks, we should give a peritalk. This might come for you in the next 10 years. You know, they're like, what are you talking about? haven't had babies yet, you know? And then other patients who are like, you know, I just wanted validation and he told me I was too young or she told me I was too young. And so I think it's a fine balance with some of our patients, but I'm sure you're...

Yeah, I think that, you know, that's that ownership piece, right? And being able to put a name to a face. And it's very, I agree with you, it can be very empowering. At least I found that in my practice. It's not like that for everybody, but I think it's very, very helpful to have something where you can really tie up those loose ends for sure.

Absolutely. Let's talk a little bit about like what are you think like the most common symptoms that you know you're seeing in your clinical space and perimenopause. What age ranges are you seeing? You know let's talk about some of that.

Yeah.

Yeah, I think that's great. you know, we've always really leaned on this notion of regular cycles and then the hot flashes and the night sweats, still technically according to the literature is the most common sort of manifestation of perimenopause or presentation, should I say. But really I find oftentimes it's the mood changes, tons of mood changes. Like, I'm just so anxious to drive.

I like to pick my kid up from school or, you know, rant on fears all of a sudden that pop up or anxiety. Yeah, right. Brain fog is a huge one, like feeling like you have ADD and maybe we do, maybe we don't, but kind of feeling like that. Can't find names, can't find words, forgetting things. Libido is a big one. think more women are becoming more...

Yeah.

they kept flying.

forthright and willing to share their challenges in the bedroom. And weight, I see that a lot too. A lot of women complain, I'm not doing anything different and I just keep gaining weight. So I think those are the big ones. I'm probably missing one or two, but sleep is a big one too. A lot of times those are subtle temperature fluctuations and they might not be like a full night's sweat. Sleep disruptions, mood changes, cognitive brain fog.

and weight, I would say, probably the most common ones I see in the women that cross my path.

Yeah. And I mean, we've talked about this before on this on this program, our podcast. Sorry. But.

Tell us, let's talk about, you know, the physiology of perimenopause and why it's so complex. I'm sure people have, you know, kind of heard different people talk about the chaos around it and what happened from, you know, logic perspective. But I always like to review that with the people listening, because maybe they didn't listen to the other ones and they need to know why is this happening?

Sure. Yeah.

Yeah, no, I think it's really important to kind of understand that that physiology piece of what's actually going on in your body. So if we're just going to kind of try to at least sum out kind of the hormonal as far as I know we're kind of trying to move away from the sex hormone. I'm so like ingrained in me, but our gendered hormones, right. And so our menstrual cycle relies on sort of this perfect orchestra.

of the notes and the timing and the instruments coming in when they're meant to come in in order to create this beautiful symphony of what is a normal menstrual cycle and what is typical fertility. And so each month we get the pituitary glands and signal down to the ovary to prepare the uterus and the ovary for potentially ovulation. And then hormone levels rise to the occasion.

We ovulate and then we either get pregnant or we don't and the body senses the continuation of the pregnancy hormones or it senses that those are not there. And so then we have what is what we know of us as our menstrual cycle. And this all is a perfectly choreographed dance between the brain and the ovaries and that really kind of simplistic terms. so.

the universe and everything.

As we age and we see the natural decline in the functionality of our ovaries and then also the health of and the number of eggs and follicles that we have in our ovaries, the ovary becomes less responsive to the signals from the brain. And so we oftentimes don't ovulate. And that's why a lot of women start feeling like progesterone helps them so much because the main production of progesterone in our body is from ovulation. And oftentimes that's the first hormone to go in perimenopause.

That is also where sort of this slang term estrogen dominance has been born from as we stop ovulating. So then naturally we become estrogen dominant because estrogen happens first in the menstrual cycle. And then we don't ovulate. And then when we don't ovulate, we start getting these things called loop cycles. And these are the women that start saying, my God, I had a period in 14 days or 12 days or 10 days. And so we sort of get this confusion, but the uterus doesn't really know what role it plays anymore.

Is it there to support pregnancy or is it there to, you know, have a period? What's going on? And so really the wires are crossing left and right. there's, our hormones work in more than our ovaries and our uterus. And so I hate to sort of just simplify it down to that, but it is a useful way to look at it when you're really just trying to understand what's happening to your body. Of course, there's other things happening. Those hormones work in our brain and that's why we see a lot of like the mood changes and the...

out there.

Yeah.

the cognitive, the front like the executive functioning changes and the memory changes. But that's what's happening. And that's why so much of our definition has relied on this notion of the periods, right? So essentially you're running out of eggs. You don't have any more eggs for fertility. The ovary is saying, cool, like we're not coming to work anymore. And now you're sort of left with this mismatch.

It is a little bit of a roller coaster or a lot of bit of a roller coaster for women. Just, you know, everybody's different and how they experience it. Some people have very mild symptoms and some people have very, very debilitating symptoms, but it's all about sort of this pattern of hormone timing that sort of gets off.

Yeah, absolutely. it's, you know, rather than saying estrogen dominance, think most of us like to say that there's like a progesterone deficiency in your forties that happens and then right there's like that miss.

Yeah, I don't like the term estrogen dominance because I find that it puts a negative connotation on estrogen. know, don't want to vilify estrogen as such a powerful molecule and hormone in our body. And so when we talk about estrogen dominance, it makes women feel like there's something wrong with estrogen and there isn't. And so I don't, I agree with you. I don't like the term estrogen dominance. I much prefer the term either progesterone deficiency or

and ovulation, means we're not ovulating anymore. So anyways, I guess it's potato, patata, semina, but that's the way we like it, right?

difference in the words that we hear on social media because that's what we see from patients and then they go through and they get all these just testing done that is not needed because they think that they have this estrogen dominance and they go through this elaborate expensive testing that may be offered from people that then want to give other therapies that they're selling.

Certainly, 100%. It's a very mixed, unfortunately the waters have been muddied up for 20 years and it's created a lot of stylistic differences.

Well, I would say, I mean, we all talk about how women's health is such a predatory market because the truth of the matter is, and I've said this many times on the podcast, our medical system is set up to fail women, right? Like we have...

these insurance based models that are really trying to, you know, bottom line, put money into insurance companies and the corporations that hire the professionals that work for them. And at the end of the day, you know, those 50, I know, I would say like, know, gynecologists, unfortunately get vilified a lot because they're expected to see, you know, I was in a practice at some point where I had to see 30 patients a day. And, you know, that's when we all potentially did some of this like unfortunate gas

because A, we didn't learn it, and B, we have like 10 minutes for that patient. And I think that it's an unfortunate thing where, know, I don't even get upset when a patient tells me that she's gone an alternative route because what are they to do? They're trying to find answers on their own half the time, right? And so I think that, you know, just understanding that, you know, our system is rigged to fail women, and that's why so many of us have to work outside of the system.

It's certainly, and it's something that, again, we're not taught to be very good about this. So we tend to shy away from things that we're not confident about and that we don't feel good at. And particularly if we don't have the time to focus on that, it's just easier to sort of kind of brush it to the side, whether we're doing that consciously or subconsciously.

Yeah, I never want to throw any of my colleagues under the bus. think we all are very well-meaning individuals. We wouldn't have gotten into medicine in our respective field if we didn't want to take care of people. And most, I know, know, right? Most, medicine is certainly not the glamorous profession that it maybe once was. it's, you know, most.

you

Most of you follow me.

Most of us are very well-meaning and really want the best and want to try and try to do our best. But of course, you know, we're human at the end of the day. So we're coming with our own baggage and our own issues. So just is what it is.

Well, let's talk about even just being an entrepreneur. You and I are both entrepreneurs in our ways that we're trying to do things. Like, how did you decide to navigate this space? Because it does take a lot of intestinal fortitude to move forward with the idea of working outside of a system that you've previously.

Yeah, well, I won't lie and say that it wasn't without tears because yeah, we are very much, you know, taught within the system of medicine. And again, like I said, going back, most of us are very, are empaths. We want to take care of people. We were taught and trained that, you know, know, took the Hippocratic oaths, did you know harm and to care for all people as best as you can without bias, without stigma, without any of that. so

There is unfortunately the nature of being an entrepreneur and trying to start your practice outside of the insurance-based model is you're not going to be able to take care of everyone anymore. that is something that is difficult to reconcile initially. But at the end of the day, a large part of it was for my own self-preservation and knowing that I can.

do what I, you know, I'm trying to do what I can with my little piece of, you know, piece of the world and try to make an impact in ways that I can and give back in other ways. And but again, yeah, it's not there's not a perfect answer for this. I mean, I think, you know, I still three years in we struggle with it. I practiced menopause medicine for almost seven years within an insurance based model of care. And I was

very, very lucky to be part of a very large OB-GYN office that didn't give me crap for my numbers being not great because I only saw menopause patients. They sort of knew that they wanted that within their practice and there were a lot of concessions that were made for my billables. That's kind of the hard truth of it, right? Is that the other nurse practitioners were more productive.

productive than me, they brought in more money to the clinic and that's probably why a lot of individuals that are still working within the interns based model are not sort of, moving outside of it if that's our only focus because it's just, again, it's a very labor intensive, it takes a lot of time to sit down with somebody and really get into the nitty gritty of menopause and then if you're not, as our good friend, Corinne, then says, if you're not a menopause Barbie and you don't,

you don't respond to the standard doses of hormones to the, you're not a patch princess who gets the middle of the road dose and takes the normal dose of micronized progesterone and it's all sunshine and rainbows. You know, that's fantastic. That can be very easily managed within a 15 minute visit, but not all of us are like that. And so there's just a lot of layers, but I love being an entrepreneur. love, you know, doing things by my own.

Listen.

vain and I love showing my daughters, you they're always griping, mommy, you work so much, you work so much or, you know, the year that they told me that I should be a computer for Halloween really hit close to home. But, you know, I really, my mom was an entrepreneur in her own right and really, you know, built herself up in a very male dominated world and

She's not a physician, she's a laboratory and she's an embryologist. so she really, you know, seeing that really, really inspired me and motivated me to be like, okay, we can do this. Do we have it all? No. Do I do it all right? No. But I try to do the best I can and make the world a better place than it was before I got there. So whether that answers your question, I don't know. I'm just babbling on at this point.

Now I agree with you, and you know, I just converted my practice after a decade of working with an insurance-based system. And the only, and you know this, and most of my listeners should as well, that the only reason I could do that is because my husband supported my practice. And he said, last year, he said, you your nonprofit needs to make profit. Like I can't support it. I can't, I'm the one that sees 45 patients or 50 patients in a day, you know, and continue the way I'm going.

Okay.

Yeah, sure.

And also as I entered perimenopause in the last few years, what I realized as we talked about being empaths.

Like I would come home, you know, maybe, you know, I didn't see 30 patients a day, I saw 15 or whatever, and three or four new patients and you come home depleted after hearing their stories of, you know, medical gaslighting or, you know, persistent genital pain and all this stuff. And I'd come home really depleted emotionally. And my kids and my husband were like, what's wrong? And I'm just like, I can't talk right now. Because it does work at all, right? Like it's...

Great. You absorb it all 100 % and it takes, yeah, it's like you ran 15 marathons, mental marathons in one day because not only do we as clinicians have to listen to that and we want to, but we have to internalize it and then we actually have to decide and make clinical judgments in terms of what would be the best. And I'm not complaining, we're so privileged to be able to do this, but

Absolutely.

Yeah, I know my husband's always like, what's up? How's your day honey? I'm like don't talk to me Just sit there quietly next to me and breathe the same air, you know, but But yes again, it's it's it's a it's a very This is a very rewarding space in medicine because you can make such a huge impact on individuals, you know that are really

Yeah. Almost like them.

feeling terrible and it's why I said it's addicting. It's a really, it's a fun space to be in when you're in it. When you see those like instant gratification moments too.

It's true actually, yeah. And I think that's kind of why we all have gelled together in this as well. You the ones that we text each other every day about X,

Yes, yes, 100%. I know I'm like some of my bed, like who are my friends now? Yeah, they're all my like my Instagram doctor friends that I've met. And I'm like, we're all we all just do you know, we have common interests, common things. So yes, that's that's my life now. Right? I love it.

Well, let's get back to the hormones. I actually wanted to talk a little bit about, you know, your thoughts on, know, because everyone wants to get their hormones checked and, you know, I'm on a lot of OB-GYN threads and, you know, that's like the bane of most busy OB-GYN practices, right? They're like, yeah, here I get another request to get my hormones checked and...

Yeah.

yeah.

And I think you probably do it similar to me, explaining patients what the benefit is and then do it because they want to see it. And that's fine too, but let's talk about, you know.

Yeah.

Oh, yeah, I know. This is one of my favorite questions. So I'll make it really simple and easy. If you're on a hormonal birth control pill, you cannot check your hormones. You cannot accurately assess your hormones. So that's out already. Then if you're in perimenopause and you're having regular menstrual cycles, you know, within reason, like every 21 to 35 days you're having a period, don't check your hormones because, or if you check your hormones, you need to check them every single day and then you need to understand

Yeah.

what that means, like the clinical meaning of that when you plot it on a graph and then superimpose it over like the menstrual cycle graph that we all learned about, right? In, yeah, in school, right? Because if you just go to your gynecologist on a Monday and say, want to get my hormones checked and you're having regular menstrual cycles, then it's just going to be whatever that is that day. It's not clinically meaningful or significant.

Yeah.

If you are somebody that is experiencing large fluctuations or gaps in your menstrual cycle or things are just awry, there probably is some utility in perhaps checking the hormone level. If this has been going on for an extended period of time, there can be some potential validation in that, right? So if it's been three to six months without a period, then maybe I'm going to be checking something called an FSH to see if it's just kind of popping up and, you know,

Am I going to necessarily as a clinician act on that or change my treatment plan? Probably not. But as somebody that's living this lived experience and not knowing what the hell is going on in my body, I'm going in and getting that, it may be really validating for me to see that level on a piece of paper. So I kind of split the difference. Again, Samina, both you and I work outside of the insurance based model of care. We've got the time to sit and talk through these options with our patients.

So if you're in period menopause, would say the vast majority of time, I would recommend steering away from hormones, checking your hormones, because it's just, you're just shooting at fish in a barrel really, and you're just, it's a moving target. But if things are really spacing out, you're really skipping your periods and you're getting lapses, maybe we can check some hormone levels to add some validity to, if that's something that you want. That's a shared decision making, right?

But now it's very uncommon for insurance companies to also pay for these tests. So you have to be on the lookout for potentially footing that bill as the patient. And then, so that's my long story. If you're on birth control pills, don't do it. If you're in perimenopause and having normal menstrual cycles, don't do it unless you're going to do it every single day. And then that's meaningful to you. And if you're in perimenopause and you're really having gaps, then perhaps a test might be.

helpful for you, not necessarily for your clinician. Does that make sense? What are your thoughts? I don't know.

Right. And then we have, yeah, yeah, no, I totally agree with you. And then you have those clinical scenarios that we always talk about, like someone has a marine IUD and we don't know what's happening with their cycle or someone who's had a history.

Right. No. And yeah, if you have a marina IUD and you really think things are wonky weird, then yeah, why not grab me. Me getting a blood level is no sweat off my back. I mean, again, it's there's all different arguments of that now. people are going to ask, well, what about the Dutch test? What about the urine, you know, test all the things.

You know, here's my take on that. To each his own. If you are a naturopathic girly and you want to get your urine hormones tested and you want to see the way that your body is changing all your hormones through the thing and that's you, great. Do I do urine tests in my clinic? Absolutely not. I don't run them. I don't use them. Do I have colleagues that do and swear by them? Yes. And I can respect it, although I feel like there's very little

evidence behind them. Will they in 10 years, maybe we get more precision medicine models and we can see it, maybe. But right now it's just not something that I utilize in my practice. For me, it just over complicates things.

Yeah, I agree. And I agree there's not enough evidence to support it at this juncture. I totally agree. And looking past sort of like your menstrual cycle and reproductive, let's talk a little bit about metabolic changes that happen. Because we talked about weight gain being one of the biggest things we hear about. Let's talk about now.

Yeah.

Yeah.

And that's why we try, you know, we all met this weekend to kind of like, we don't need to call these things sex hormones anymore because we know they're neuroendocrine metabolic hormones.

Yeah, they function in every tissue in the body, every, know, it's, super, I mean, there's so much more than just your reproductive organs for sure. So yeah, the metabolic changes associated with perimenopause. the thing that we have to understand is the thing that we're not maybe the best about in current medical, like the way that the culture is in medicine is we're a little bit more reactionary than we are.

preventative as much as we want to say, we have preventative medicine models. We just aren't. And I think it's just because time and we're pinched, right? And we just, we can't. And so, and so here's my take on this. We really need to shift our focus in perimenopause and stop telling women they're too young for perimenopause and stop, you know, brushing them off because all of the accelerations in our physiology

or sort of the negative happen in perimenopause. It tend to actually settle down a little bit once we've crossed over in the menopause, but it's actually perimenopause where we're seeing this acceleration. And so what happens and oftentimes what I'll hear in my practice is a patient say, okay, I went to my primary care doctor and my cholesterol panel for the first time ever in my life went up.

or my hemoglobin A1C, which is an average kind of calculation of your blood sugars over the last three months, is up. Or my fasting blood sugar is up. Or my liver enzymes are up. You know, none of these have ever been abnormal in my life and this is up. And so what's happening is we're, yeah, everything's the same, You know, doing everything the same and things are changing. So what we see is a, we see a rapid acceleration in the perimenopausal years, usually the late.

And my exercise. Yeah.

perimenopausal years. So that's where we get insulin resistance, metabolic dysfunction, a change in the way our body is processing and metabolizing energy, largely because we see estrogen's light dimming. And estrogen plays a massive role in the function of our pancreas and how insulin is accessed by ourselves. And so we see that. We see changes in the thickness

of our arteries, we see changes in the cholesterol levels. And so if you're a woman listening to this and you're like, yeah, I mean, my cholesterol shot up 20 points for no reason, you're not, you know, you're not crazy. You're not doing anything wrong. It's literally your body is having changes. Um, the good news is, is that this does tend to settle down a little bit as we, like I said, as we get into menopause, but unfortunately then the aging process takes over and then we start just

you know, moving into these chronic diseases. So I think it's really important for us not to have sort of, not to be alarmist about this, but sort of just be smart about it and know that, okay, this is the time where these things are really starting to rev up and we are oftentimes gonna have to be a little bit more proactive and kind of

Mm-hmm.

notice this and make some changes because this is what's happening. sometimes that will equate about, think of weight, the data says, I mean, like five to 10 pounds of true weight gain. Of course, everybody's different. I have some women that have gained way more than that. Some women that slide through with no weight gain, but I think on average it's about five to 10 pounds of weight. And so I think this is why we're seeing all this, talk about weight bearing exercises and how do we

you know, walking 7,000 steps a day, you know, trying to meet all these minimums so that we can keep up with these metabolic slowdowns that are really happening. Slow, yeah. Yeah.

that and our bone density and muscle mass.

Right. Right. And so we're, you know, much of the bone that we are losing is the accelerations is also happening in perimenopause. to this, you know, thanks. Yay. Right. But, you know, it's not all, not all hope is lost. You know, that's the thing is like, you want, we want to put a positive spin on everything. It's like,

Yay!

I think one thing I will say is as soon as you are, and this might not resonate for everybody, Smeena, I know you're a dry girly, but for me who loves their red wine, for me it's like as soon as you recognize that your body can't process alcohol like it used to, for me that's what resonates with me, because I like my glass of wine, for you it probably would be something else, but a lot of women will recognize like, my God, I can't process alcohol like I used to, it feels awful.

That's a warning sign. That's happening metabolically all throughout your body. And so what?

Yeah, they should call it red wine sign. They should call it the red wine sign.

Yeah, I should. You guys should coin that. That's how I'm going to get rich, Samina. No, I think, you know, us just recognizing it and then what are like little shifts we can do? I we don't necessarily have to do anything massive, but what are little shifts that we can do to start kind of adding ourselves to the list, our list of important things that we need to get done? Because again, there's another problem about this time in our lives is oftentimes we're busy trying to solve everybody else's problems, right?

We're dealing with the kids' problems, the husband's problems, the parents' problems, our work loads. And oftentimes we forget that we also need that time and attention as well.

Yeah. It's so true because the patients are all looking at me like, God, you've given me so much to do now. I'm sorry.

It is, but you know what, a little shift in the change from instead of parking in the front of the target parking lot, if you go park in the back of the target parking lot, like little minimal changes like that. know, if you work on the third floor of a building, take the stairs, not the elevator, you know, just stupid little changes. As soon as you pull into the drive-over and you get home, take 20 minutes, grab your phone and earbuds and go on a power walk. I don't care. Nobody's allowed to talk to you. That's your time. It doesn't have to be these massive muscle movements.

in order to make good positive changes in your life that are actually going to lead to these positive changes. So if it feels insurmountable, try to, it's like how do you eat an elephant one bite at a time? So just do little things that you can stomach until maybe you're able to carve more time out.

I love that actually, because I think that's one of the biggest complaints that's after the end. like, oh, wow, so I have to do what? And it's like, just do what you can. We have to give ourselves grace,

yeah!

100%. Some people are very, some people are all or nothing and they really need sort of that tough love of like, they're gonna change everything overnight. But I think for the vast majority of us, we need simple, relatable, digestible things that we can actually, actionable items that we can actually put into practice. I think that's, honestly, Simina, that is why the weighted vest has taken by storm.

Every time I go drive in my neighborhood, there's three or four women out there walking with their weighted vest because it's a simple, easily attainable thing that they could add in to their day to day without massive changes. they can just do maybe what they were already doing or it's a fun new toy that they feel like they're making a positive change.

Yeah.

Yeah.

in their life and I think that's fantastic. It's so fun to see like, okay, let's do this.

my god, the Holderness family just did a bit on the weighted vest. Did you see that?

I mean they are the yeah, they are the funniest they are yeah, but it so Little little things, you know start small work it in rather than try to be way overwhelmed by you know feeling like you need to make period menopause your full-time job, so

Yeah. People always ask you like, well, what's the best form of natural estrogen? Or what's the best way to, you know, survey for colon cancer? And I'm always like, the one that you'll do, right? What good is it for me to prescribe this or send you to get a colonoscopy if you'd rather do a colic or like whatever, you know, we know things are better for some than others, but if you're not going do any of it, like let's figure out what you'll do.

Yes.

Sure, yeah, of course.

Absolutely. Okay, let's talk a little bit. So we talked about all the stuff that's happening to women and to our patients. Where are you in treatment? Like do you, like some people jump to birth control. Let's talk about birth control pills versus menopausal and hormonal therapy and where you're at.

Yeah.

Yeah, so in period menopause, I try to break it down simply and say, the things that we need to look at first are, do you need contraception? And do you need cycle regulation? cycle, so do you have heavy menstrual periods? Those are the things that are really important because too much to many of our dismay, we can still get pregnant into our late 40s. And so we need to account for that. So if you need contraception,

up to 50 % of unwanted pregnancies are between the age of 40 and 45. Yeah.

Yeah, yeah, yes, yes. I know it's crazy. It's a crazy statistic. So all that to say, if you need psychocontrol and you need contraception and you feel like your symptoms are really erratic, let's, sometimes for individuals that really struggle with like premenstrual dysphoric disorder, which is just that rage and that just really horrible moods,

in and around kind of where your cycle would be. A birth control pill might be a really fantastic option for you because it kills all those birds without one stone. It offers that cycle regulation and contraception. And it really is one of the most impactful therapies for premenstrual dysphoric disorder. And so that's kind of, now there's some downsides to a birth control pill. If you have low libido, if you've already got vaginal dryness,

those birth control pill really can sort of shoot yourself in the foot with the birth control pill. So I don't want to dilify it, but it really can do that. So if you've already got some sexual dysfunction, I probably would go elsewhere. And then to that end, you need contraception and you need psycho control, the long acting reversible contraceptives, i.e. the IUDs, can be super great.

I am an IUD girl, I've got one, I just got my second one put in. It can be really, really great. And then you can add, if you want to try menopausal hormones for perimenopause, you can add them on top of an IUD. Often, of course, you need to consult your individual clinician, but generally speaking, they can be utilized together. So that's kind what I try to rule out is what's your birth control needs? What are your period needs? What do we need to manage?

from you know like a gynecologic perspective and then once we've got those things down then we can play quote unquote with utilizing you know our estradiol progesterone and sometimes even testosterone to help with symptoms during this time. I you know patients ask me all the time before they make appointments well what do you prescribe what do you do? I'm like I mean if it can be put on a prescription pad I will you know I have been known to write it before it just depends on what

Yeah.

Again, like kind of what you were saying, what will you do? What works for your day to day? What are your personal needs? But yeah, I mean, is, right, right. And so it's a myth that you can't use menopausal hormones in perimenopause. It's also a myth that, know, birth control is the end all be all for perimenopause. But again, I like to have more tools in my toolbox, not less. So I think it's, again, it's just,

Wait, there's some in the

Everybody is a little bit different. So yeah, so all of it.

What do you do in terms of the weight? Because the weight gain, feel like it's such a big factor for so many people. And I know you often talk about metabolic dysfunction.

Yeah, yeah. so, right. If you're really struggling with weight gain, I would highly encourage, you know, you if you're to see a clinician that is well versed kind of in the obesity medicine. This is this is another sort of little sort of hate the word niche, but for lack there of a better term, like this is a niche that's been carved out in medicine where individuals, including myself, and I really sat and studied up on

weight, metabolic changes, obesity, insulin resistance, and what is actually happening. So when I women come to me and they're struggling with their weight, I want to figure out what is going on in their body. Are they having insulin resistance? Do they have PCOS, polycystic ovarian syndrome? And perhaps maybe they have the form of it where they've been able to largely control their weight and maybe it's just accelerating in perimenopause. I actually just had that in my office yesterday.

Yeah.

and what's going on? Is there a nutritional issue? Is there a sedentary issue? What's going on? And so then once we find out the root cause, we can work through what that is. Do we treat this more like a pre-diabetes and like insulin resistance or do we treat it with weight? Weight loss medications, what we call AOMs, anti-obesity medications. So we certainly have a large menu of medications to help with weight and sometimes

Really, it's just getting you sleeping again, getting your nutrition a little bit more honed in and dialed in, moving your body a little bit more. If it's just a little bit of weight gain. But definitely don't let somebody sort of gaslight you into, you just need to eat less and move more. Like let's look into actually what's going on first and then we can determine if that's actually a useful suggestion for you.

Yeah.

Exactly. Because I feel like I've also done a deep dive into the obesity world in terms of studying it. But I think a lot of the medications, not just the GLP ones, but some of the all the medicines that are available have just made a huge difference. I think some of it, especially with the GLPs, that there's so much inflammation that develops in perimenopause with the muon flux and the

Yes.

estrogen going crazy in your system. That's when people really feel like this is controlling some of that.

yeah, for sure. And I love the marriage between perimenopause, menopause, also the obesity medicine world where we really, and obesity medicine doesn't mean that we only can treat people when they have true obesity. And this is again, another preventative medicine. If you've got people that are really saying that their body is changing in spite of their best efforts at trying to remedy it, we've got to listen.

you know, when our patients are saying the smoke alarms are going off, you know, we cannot wait for, you know, the house to be on fire, so to speak. So there are so many, and I love the GLP ones. think they're one of the best, you know, one of the best inventions that we've had in modern medicine. But again, you don't, you don't have to use GLP ones. There's a lot of different options, a lot of meds that have been around for forever and cost next to nothing. And so,

Thank

Again, it's really important to work with somebody that's willing to sit with you and go through the menu of options of what might work for you. But yes, think, again, more tools in the toolbox there. And we've got, there's good lifestyle suggestions, there's supplements sometimes that can be useful. So there's a lot of different ways to go about it.

Absolutely.

Right. And really sometimes I'm like, let's really talk about what you're eating every day because a lot of patients were like, well, no, my, my, I clean. And then you listen, you're like, well, you know, you could like the protein could be, you know, like 30 grams of protein per meal is kind of a hard sell for people. like, you know, it's kind of like taking a deep dive into all of that. Right.

Certainly, 100%. And again, we're coming back to that sandwich generation, but sometimes us moms are just eating the leftovers on our kids' plates. We're just trying to do what we can, right? Yeah, my husband travels for, he's a pilot for a living, so he's gone a lot. he always says, is it girl dinner night? And he's...

Yeah.

joking but usually we're just throwing things together from the refrigerator. So to be, know, Kraft mac and cheese cannot be my, you know, mainstay staple of my diet. So of course, most women, I will say believe women because most women if they're, if they're being vulnerable enough to come and seek out guidance from a health professional, they probably already navigated it as best as they, as they can. you know, we,

Yeah.

Yeah, very true.

Most of us have grown up in diet culture, so we know how to diet. We're pretty damn good at that.

Exactly. Yeah, calorie deficits is not a problem. It's really the...

Yeah, yeah.

Okay, cool. Well, that's awesome, Jackie. think, you know, we've covered a lot of ground here and I want to be cognizant of your time. I started doing this part of my end segments because I like to say the people that listen are like vagilantes. So my husband made me do it. He made it. I was like, oh, they're all vagilantes. Anyway, so I started this thing called a vagilante verdict. So it's kind of like your hot take. So.

I love that, I love it.

Okay.

It's really like your one piece of like straight talk advice that you want women or the clinicians that are out there listening. Cause I feel like I have a lot of clinicians that listen and just for like, you know, their own see me type of thing. What's your vaginolanti verdict on period menopause?

gosh, I know. My vagilante verdict on perimenopause is curiosity is your friend. We are learning so much about what perimenopause looks like and how it's presenting as even in these modern generations. So we keep to know what it is, but I think that we'll find that this will evolve heavily over, you know, through the millennials and through the...

Yeah.

the generation beneath us. And so I think curiosity is your friend here and not really being so dogmatic because yeah.

Yeah.

I love it actually, yeah. That's really cool because I do think that we have to stay curious, we have to stay informed and educated and go to the, up to date on research, which I love that in our little subgroups we're always sending each other journals.

Yeah, have an open mind because I think what we think it is is maybe not the full story. women know their bodies, of course. So that is the cliche, but listen to your body. We know our bodies and be relentless in your pursuit of getting better if you really know that something's off.

Listen.

Yeah, because we always hear that one of the biggest complaint is just not feeling like yourself. so that get into the point.

Yeah, not feeling like myself. So what that's worth,

So try to do the best to feel like yourself. Well, thanks so much, Jackie. I really appreciate you coming on. I mean, this has been a great conversation and a lot of great info for people listening. So I'm so happy to be able to put this out into the world in Dream Paramedic Paws Awareness Month, which is in September, which is the second year that it's...

my God, of course.

Yes, second year and we'll be doing events through Perry and there'll be lots of fun things going on on social media trying to raise awareness and great talks. So keep a lookout for that for sure.

Yeah, that's a great platform for Perry. It's hello Perry or just Perry community. P-E-R-R-Y. All right, thanks again. And so just remember guys, I'm Gyno Girl. I'm here to educate so you could advocate for yourself. Please like and subscribe to my channel and join me on my next episode.