In this episode, I’m joined by Elizabeth Katzman from Strong Choices to talk all things perimenopause, hormone health, and the truth about HRT. We unpack the confusion around birth control, hormone testing, mitochondrial health, and why your body needs more than a one-size-fits-all approach. Whether you're in your late 30s, navigating perimenopause, or supporting someone who is, this conversation will help you understand what’s really happening in your body and how to advocate for the support you deserve.
ABOUT DR. JANE’S PRACTICE:
Dr. Jane is a Naturopathic Doctor and a Natural Fertility Expert. She and her team of expert practitioners help couples navigate infertility for 1+ years, get to the root cause of their struggles, heal, and bring healthy babies home.
After having a family member struggle with infertility and experiencing a miscarriage herself, Dr. Jane realized how little support and education women receive. She is on a mission to change that. Since 2020, she has dedicated her practice to fertility, where she and her practitioners work with couples 1:1, running functional lab work, customizing treatment plans and providing her couples with the support they need to get pregnant, have a stress free pregnancy and a healthy baby.
Understanding hormonal changes is crucial for women.
Testing is essential for effective hormonal treatment.
Nutrition plays a key role in managing hormones.
Stress management is vital for hormonal balance.
Women often underestimate their ability to monitor fertility.
The messaging around menopause can be misleading.
Bone health is critical for women, especially during menopause.
About My Guest
As a lawyer, I didn't think I would end up devoting years of my life uncovering how to be a healthy, fully functioning human being. Yet, within my family we've tackled mold illness, thyroid disease (Hashimoto), parasites, heavy metal toxicity, leaky gut, and more-all without traditional medicine (although it has its place when needed). Just when I thought I had it all figured out, in came perimenopause! I realized it was time to get back to work to heal myself!
Pregnancy is a natural process, so if it’s not happening or it’s not sticking, something is missing. Join Dr. Jane, a naturopathic doctor and a natural fertility expert, every Tuesday at 9am for insightful case studies, expert interviews and practical tips on optimizing your fertility naturally.
If you’ve struggling with infertility, pregnancy loss, women’s health issues or just want to be proactive and prepare yourself for the next big chapter in your life… this show is for you.
Individualized care is essential for effective treatment of chronic fertility issues.
Transcripts
Jane Levesque (:
Hi guys, welcome to another episode of Natural Fertility with Dr. Jane. Today we're gonna switch gears and we're gonna talk to Elizabeth, who is a functional diagnostic nutrition practitioner and she actually specializes in paramentopause and menopause and supporting women through that fun journey. Thank you so much for being here, Elizabeth.
Elizabeth (:
Thank you. know you said call you Jane, but I'm feeling so inclined to call you Dr. Jane.
Jane Levesque (:
Okay.
It's, know, whatever rolls off the tongue easier is what I say. How did you find me? actually didn't ask you, was this, did you find me on social media?
Elizabeth (:
Yes, yeah, I had I had heard about you for a while and yeah, I found you on social media and your podcast. Yeah. Yeah, think social media is a two sided coin for sure. But there
Jane Levesque (:
I love how that works out because that's how it's supposed to work out, but then you never know what you're going to find on social media. And lately I've been meeting more and more people and I'm like, this is great because this is actually what it should be.
Elizabeth (:
There's a lot of junk, everyone knows that, but there's a lot of great women trying to get, like yourself, trying to get the message out. And it's very helpful because people really don't know where to go. I think the question is like, how does something like that
Jane Levesque (:
Yep, I do find it's helpful. My first question to you, and obviously let's talk about who you are, but my first question to you is how does somebody go from being a lawyer to being a functional diagnostic nutrition practitioner? Because I love hearing those stories. think if we can, the analytical brain, when you pull it to the holistic side, because there's still this like, the holistic is woo-woo medicine, and I don't see it a lot by the time people get to me.
But I do think that that is a message that conventional is, you know, science based and then holistic is more woo woo. So somebody who's coming from a very logic based career into the dark side, if you will, tell us how you came to that.
Elizabeth (:
I mean, guess, especially when I started doing all of this, was very woo-woo. Now everything's becoming more mainstream. But at the time, I was definitely considered odd. You know, I was concerned about changing meters on
Jane Levesque (:
Yeah. I love odd people.
Elizabeth (:
homes and and why and Wi-Fi and all of it and mold and all of the things back when everyone thought that that was very strange strange things to be concerned about. I've always been interested in health and wellness as a kid. I was always and then when I got into college, I had to make a choice between law school or pre-med and for some reason I just felt like medical school seemed like way too long even though it's
a year longer than law school. When you're young, you feel old for some reason. Looking back at... Yes. Well, my current 18-year-old, he's a freshman and he's pre-med. And this is the...
Jane Levesque (:
Yes, yeah, yeah, yeah, it's funny. I wish now, I mean, you said you have children and now you can be like, you have all the time in the world. And yet at 17, you feel like you have to make a decision, right, of, or 18, whatever, to, what is my career going to be? And I'm like, how crazy is that? And we make 18 year olds decide that.
Elizabeth (:
constant conversation of like, trust me, you have plenty of time. I know it seems like eight years is the end of the world, but it flies by and it's worth it. And so when I was done with law school, I did enjoy practicing law for a number of years, but was still very much engaged in staying knowledgeable about health and wellness, although I looked at it a little differently. As soon as I had children, though, there was a huge shift. My two
children that are now in January, they'll be 19 and 17. So this is quite a few years ago. They were getting ear infections when they were two, three years old and constantly being put on antibiotics. And I just in my gut knew that was wrong. So I did some research and back then it was much more difficult to do research. And I do think that's where a law degree comes in handy. Cause it's a lot of what the education is, is figuring out how to research and sift through and find, you know, conclusions.
And it appeared that eating dairy was correlated with ear infections. So we cut out the dairy. They never got another ear infection. And I was like, OK, I need to be the CEO of our health. I mean, I just really was outsourcing all of my authority to a doctor that I really didn't know. And I didn't know where they were getting their training. And I just listened blindly. So I went back to school for nutrition and health coaching. And I found some really great
Jane Levesque (:
wild.
Elizabeth (:
holistic practitioners. actually found it through, because again, the internet was not really a thing then. I had Suzanne Sommer's book and I looked in the back of it and she recommended doctors in each state. And I found Dr. Brownstein in Michigan, who is an amazing physician. And through him and a lot of people got very educated. And then I wanted to take it a step further. I really didn't want to then go through a middleman and have to ask permission to order labs. And then I found the FDN program.
Jane Levesque (:
Mm-hmm.
Elizabeth (:
There was a pretty robust training. At the time it was less hormones. I mean, you did get an overview, but it was a lot of gut, liver health and all of that. And then we got quite sick with mold where, you know, to the point where my kids missed six months of school. That was really a crash course in mold. I had Hashimoto's for a minute because of it. I was nursing my fourth child. So I felt like through each and then I had around a
Jane Levesque (:
well.
Elizabeth (:
parasites because we fostered a lot animals and not that you need to foster animals because I see Parasites with women all the time. So as things sort of happened in my life, it grew my knowledge base because every time I was not willing to go to a doctor and say tell me the answer I had to figure it out for myself. And so I'm almost 52 when I was around 43 to 45. I started feeling changes.
I kind of eliminated all the usual suspects and realized it was hormonally based. And that's when I went back then again, you know, went back to A4M, got my certifications, did Dr. Kharrazian's courses. I did a lot of courses and mentorships and it took me a few years to put all the pieces together because there's a lot of conflicting information in the hormone space. So I can't even imagine how the average woman would make a decision about
Jane Levesque (:
Yes.
Elizabeth (:
What is the right way to do HRT? Should they, shouldn't they, when? What's the order? So yeah, and all of- think it was also a great asset. What is the idea? I think healthy because you're realizing that I am.
Jane Levesque (:
And you know, the community, see that all the time. Something that you said I think is really powerful to outline is that you wanted to be a CEO of your own health because you're realizing that I am making my decisions based on someone else's opinion about me from like a 10 minute appointment. And it's like, how crazy is that that we spent? And I had a couple that I just chatted to, they had five rounds of IVF and they're literally are like just kind of following these little
I should do this and I should do that. And it's these doctors that have known them for 20, 30 minutes, maybe 60 minutes at most, and they're making life-changing decisions. And it's very, like, it's a good reflection to go, maybe there's something more to this than just listening to this doctor. You know, I think that's really empowering to hear.
Elizabeth (:
Yeah, because you can't, I mean.
But listen, traditional doctors, just unless they have a curiosity and they go on to functional training on their own, they're just not going to have all the information. like I was saying yesterday, I did the radio frequency microneedling for my vagina. And when I was waiting in the waiting room, so I went to an OB's office to do it. Not my OB, but I went there because they offer these vaginal rejuvenation services.
and they had videos in the lobby explaining services. And one of them was how amazing Oblations are and how no big deal and yay, you don't get a period after it for most women and everyone loves that. And I just thought, whoa, like this is the message you're getting in the waiting room. I mean, I always say a period is just the greatest gift and it's such a great report card for overall health and
If you are, you know, an early and mid peri-menopausal still cycling, it's a great indicator of where you're at, what your needs are. So, you know, the messaging is very conflicting everywhere. I...
Jane Levesque (:
Thank
Yeah, you want to a period as long as possible. And I always say, like, I don't care if you want to be pregnant or not, you should maintain, you should try to optimize and maintain the function of your ovaries for as long as possible because it's a sign of healthy aging and healthy hormone production. And when we introduce HRT, we're introducing HRT to maintain the receptors and the hormones that keep us alive and, you know, experiencing our skin, our libido, our metabolism, our bone health, our like,
mental, health, literally like everything is connected to hormones in some way, or form. But it's like our ovaries make those little hormones, know, the sex hormones, obviously not all of them, but it's a, yeah, the message is, and now we'll talk about that, the perimenopause where, hey, just go on birth control and you're doing HRT now.
Elizabeth (:
Yeah, and I think a lot of the messaging, especially when you're talking about from an obese perspective, their focus really is just fertility and babies and that kind of thing. So they don't really think of.
hormones outside of that. if you're done with your baby making years, then do an ablation and get rid of the issues. Hysterectomy, who cares? You'll be fine. You don't need it. You're not having any more babies. And then yeah, if you don't want to get pregnant, it's a perfect time. You're in period menopause. Take the birth control pill. It's going to override all of the chaos. And you know, people think it's regulating their menstrual cycle and really it's just taking it away.
Jane Levesque (:
Mm-hmm.
Elizabeth (:
It's a withdrawal bleed. It's not a menstrual cycle. So it's very confusing. yeah, so if we, the pill is not something I recommend for, that's a big reason because you really don't know what your cycle is. You don't know if you're between the ages of 40 and 50 and you're taking the birth control pill, you have no idea. Are you early perimenopause, mid, late? Are you even done? We don't know. We don't know where you are.
So you could be losing a lot of bone mass, losing optimal function of your brain, setting yourself up for cardiovascular. So, know, all of the silent killers are really going under the radar because you are thinking you have a very regular cycle because it's being, it's synthetically derived.
Jane Levesque (:
Yeah, and I mean, I'll fill it in for my listeners who are in fertility space. It's also like, if you go in, most women get put on birth control.
couple years after they started their period and the hope is that at least two to three years, so then the brain and the ovaries, you know, make a connection. But then you go on birth control for 15, 20 years, 10 to 20 years. And then it's like, you're just expected to then get pregnant. You're like, but your ovaries have been shut down and the brain hasn't been communicating to them for the last 10 or 20 years. So we have these like unrealistic expectations on the body. And so getting a little bit more of this eye opening experience of like, there is a side effect.
Elizabeth (:
I'm sure they started their career. and not always at least.
Jane Levesque (:
to every medication that you take. And don't get me wrong, sometimes those side effects are worth it because you need, right, whether it's an antibiotic or something to be inflammatory, like you need it to control a process that the body is not managing, but long term you should be thinking about, what is this doing long term? And if I need this long term, then maybe something is wrong, you know?
Elizabeth (:
Yeah, and I do love that part of the conversation about your brain and your ovaries we
they need to be trained and given time to connect. you know, a lot of the women I work with have teenage daughters and daughters in their twenties who are also on the pill. And, you know, if you put a girl who's 14, 15, 16, 17 on birth control, you haven't given their brain and ovaries a chance to establish a relationship. It's like, it may not be the most comfortable thing and it's a little chaotic, but give it time. know, support your body with nutrition and exercise and all of the, you know,
all the supplements that you might need, get rid of the ultra processed foods, like give your body a chance to function rather than just rob it of its ability. I do have a question and other cash powers. Is the HRC, it's a lot of information, but actually, you have to start to yourself if you realize or.
Jane Levesque (:
Yeah, I do love what you said about like, got a crash course in mold when you lived in mold, because this like, this will connect to the HRT. It's really hard. There's a lot of conflicting information, but.
when you actually start getting good at HRTs when you're in that phase and you have to start to support yourself and you realize or you watch maybe your mom, like I remember I watched my mom when I was early twenties go through menopause and the things that she was put on, synthetic hormone just made her nuts. And so then you go, oh, I don't want to, you know, I don't want to do that. HRT is bad. And now here I am, you know, 39 year old learning about HRT, obviously how it fits in with fertility, but then for overall
health for the woman, bone mass, metabolic health, like brain health, you talked about that. Literally any disease is going to be connected to hormones in some way, shape or form, but the crash course is going through it, you know?
Elizabeth (:
Yeah, and also back to the mold thing. It's like, you know, HRT and we can talk about the more specifics of it, but it also isn't a magic bullet, which is one of the reasons why I say like I looked at was it a mold exposure? Was it parasites? Was it like toxins? Any of the usual suspects?
Jane Levesque (:
Yes.
Elizabeth (:
because you could have those exposures and not realize it and you start HRT and you're not feeling better and maybe you're even feeling worse. And I do notice this a lot in the, there are some really big influencers out there that are traditional MDs, but they talk a lot about HRT. And so I think they come across as more functional, but they're not at all. And they also have sort of large,
venture capital backed platforms where you can buy things online and there's not a thorough check of the human being. And so if you, I was listening to a podcast with one and the question was, know, I'm on estrogen, I'm taking this, I'm taking that, but I'm still, have brain fog and I'm this and that. She's listing all the symptoms of mold. And the doctor said, you just need to up your estrogen. Like without even knowing anything. And I just thought,
Jane Levesque (:
You have to the money, right? You always have to follow the money.
Elizabeth (:
Yes. Yeah, yeah. And you have to look at it all. But for me, it was really, I had anxiety and the only time, that was my indication that I was in perimenopause. For a lot of women, it's anxiety because we lose our progesterone. But it felt very similar to when I had a mold exposure. It felt very similar to when I had parasites or
before I quit eating gluten. So, you know, once I ruled those things out and then did a thorough look at my hormones, it was clear that, you know, my progesterone wasn't nothing, but it clearly wasn't enough to... It wasn't good. And that's another thing. It's like there's no... It has to be this number or you're not going to feel well. It's completely person to person dependent, which is why it's really hard to give exact ranges and...
Jane Levesque (:
It was good.
Elizabeth (:
because every woman's receptor function is different. Every woman's liver is different and gut and how they metabolize things quicker, slower. it's nice that there are online resources and platforms to get HRT. But if you're not working with someone who is willing to take the time to dial in on you specifically, you're pretty much just gonna get put on a patch and you're gonna get.
nightly 102 milligram progesterone and that's supposed to just do it and then if you're not feeling great maybe you just up it. It's it's pretty cookie cutter and it's it's robbing women of feeling their best and that can be quite frustrating when they feel like okay I'm on the cutting edge I'm like I'm down with HRT I'm gonna do it and then they go to someone that doesn't want to spend the time and they're they're not going to get the most out of it at all.
Jane Levesque (:
Yeah, I'm glad you're bringing that up because it's not cookie cutter at all. It's very much individual and you should be tested frequently, especially at the beginning, probably every three months to get an assessment versus like every couple times a year for sure you want to be looking because the body is going to be changing.
Elizabeth (:
Yeah, changes really quickly. Some things that I like for women to look at that are pretty simple is trying a continuous glucose monitor periodically.
So starting from probably late thirties, you just wear it for two weeks, maybe do it every six months or so, because that's one of the soonest indicators is when you're unable to manage glucose the way that you used to. You used to be able to wake up in the morning and have a banana and a cup of coffee. Now all of a sudden your cortisol is through the roof. You feel awful. Your glucose is through the roof and it's not coming back down. That's a good indicator that you can look at over time.
know, cholesterol, looking at your lipids, your lipids are gonna be increasing. So again, when you hear a lot of these MD influencers say it's the zone of chaos, don't even bother testing, just go to my website and take hormones. You know, there's a lot more you can look at besides just hormones. So, you know, your lipids, your blood sugar, if you wear any kind of wearables, you can look at your sleep, how that's being affected.
But it's definitely a time in life where it's time to start paying attention. So if you're the type of woman that is used to working a million hours a day and taking care of the kids and having a glass of, yeah, yeah, yeah, overtraining and having a glass of wine at night and all of the things. Also, know, alcohol intolerance then will increase. But a lot of women want to ignore that because they're, you know, that glass of wine has really become more of a pacifier and it can be hard to give up.
Jane Levesque (:
It's draining.
Elizabeth (:
But also, drinking alcohol and HRT is a big no-no, because your liver is going to prioritize those toxins first and metabolize them before your hormones. And so for a lot of people, they'll just do it anyway. I won't do that with my clients. If you don't want to give up alcohol, I really can't work with you because it's too dangerous. Estrogen doesn't increase your risk of
breast cancer, if you pair it with alcohol, know, alcohol increases your risk of breast cancer. So
Jane Levesque (:
Yeah, because then that estrogen is hanging around and how your body's metabolizing that estrogen changes. yeah, think it's, mean, you correct me if I'm wrong, but you probably are getting people like.
let's figure out your liver function, let's figure out your gut function, and let's figure out why you need that alcohol in the first place. You know, I don't want people to feel bad because a lot of the times when I have someone who's using it as a pacifier, like they are genuinely using it to soothe themselves because their nervous system is regulated. So then it's like, how can we create more regulation in the nervous system? And yes, sometimes it was the hormones that they need, but there's a lot of tools that we can use as practitioners. So then it doesn't become as big of a crutch. And you actually don't want it because you realize
is how much chaos it creates in the system.
Elizabeth (:
Yeah, and also a lot of times that's really, you know, a progesterone deficiency and you're trying to calm your nervous system down. if someone, I mean, this is a time where we do have to be working a little harder and I know a lot of women don't want to hear it. It is a pain in the butt to make time for meditation and grounding in that stuff. Honestly, it only takes 10 minutes, but it can be a real turnoff to people. But sometimes just a little progesterone can help get you more in that relaxed mindset.
And so, you know, if you're still ovulating, you are making your own progesterone, but it doesn't mean you're making enough. So in that second half of the cycle, it is a very safe hormone. If you want to add 100 or 200 milligrams to that second half of the cycle to help calm you down, it can be, you know, really life-changing for women. You know, you don't want to add it in early in the cycle and cut off your own ovulation cycle. If you have too much at the beginning, you won't ovulate.
Jane Levesque (:
Yes.
Elizabeth (:
And I see a lot of women who have a consistent period, but they're not ovulating. So I think a lot of women don't understand that you could still have a regular cycle, but doesn't mean you have any progesterone. Especially in that period, or maybe you ovulate one month and not the other.
Jane Levesque (:
Yes.
Jane Levesque (:
Yep.
That's where the testing is really important because you could see it. You could see, I love what you said about the glucose monitor because there's early signs and I have a question to you, but I wanted to like kind of close the loop of one of the signs of this kind of perimenopause that I think we're not taught and aware because I wasn't up until, you know, a year ago when I drove into the HRT more is that it is, you're going to start having more difficulty managing your blood sugar. You are going to start noticing more anxiety in that second half of the cycle or rage or depression or some kind of
Elizabeth (:
I'm
Jane Levesque (:
mood thing because that progesterone is not there and that cholesterol is going to be coming up because in order to make hormones you need liver function and good mitochondrial function and as your hormones are going down the body's like let me make more cholesterol so then you can make hormones but then your liver is struggling your mitochondria is struggling this is what the mold and so then you're not making it you know you're not making the hormones so then the body upregulates the cholesterol more and then you have conventional
Elizabeth (:
up because the orders may hold until the first option is in the third row function. And so that is all the way down. By the way, I'm getting a lot of material. maybe they hold, but then they reversed from the extensor is where it happens to be. And so they are not making it. And they're not making it. then I'll regulate the cholesterol. And I'll make sure that doctor's kind handling it.
Jane Levesque (:
coming in and going, let's get rid of this cholesterol. And it's like, no, no, no, let's not get rid of the cholesterol. Let's fix the liver and the mitochondrial functions so that we can make the hormones. But those are like early signs that I think most people do not know about. And they're just written off as whatever, like, you're just getting older. But it's actually like the paramedicopausal changes that are starting.
Elizabeth (:
Yeah, and when we start losing our estrogen, we start losing our mitochondrial function. you know, that's like the earlier
Jane Levesque (:
in negative cycle.
Elizabeth (:
Yeah, it's an awful cycle and you know, it's funny. I'll see women with red light masks on their face, which is great. But it's like if you're going to invest the money and time into that get a red light panel because then you can have it over your ovaries. That's going to help your mitochondrial functioning in the ovaries and your thyroid and your breasts and your brain for the time and money. I just think it's such a waste when I see women with it, you know, only on their face just sit.
Jane Levesque (:
I know.
Elizabeth (:
But yeah, mitochondrial function is huge, which is why I am a biohacker. I like all of this stuff. But it doesn't have to be expensive. You can walk on the grass and get sunlight at the right times of day. you can not go to bed on time. again, the drinking just zaps our mitochondria for days.
Jane Levesque (:
You could just go outside and get fresh sunlight.
Jane Levesque (:
Yep, go to bed on time.
Jane Levesque (:
Yeah. Tell me what is the age you're seeing, you know, that women are needing to start?
Elizabeth (:
That's actually like,
Jane Levesque (:
HRT or some kind of hormone support like the paramedicine, how are you identifying that and kind of the progression of the support because that has been a big like a hot moment for me that it's not just one year before your period stops and you start to experience estrogen chaos if you will and the dysregulation and the hot flashes and the weight gain and blah that's actually like 10 years before that you could have been doing stuff to support.
Elizabeth (:
I do see it in women in their late 30s. The classic age is sort of mid 40s. Most women by 45 are experiencing weight gain, anxiety, changes in sleep. That's sort of the classic age because you know, I mean the average age of menopause when you stop having a cycle for a year is 51 and generally starts five to 10 years before that.
There's very few women I see their blood work in there when they're around 45 that is normal. Usually the cholesterol is going up, the progesterone is pretty low. that tend, they said, know, hair loss, thyroid issues escalate because without progesterone, you know, we aren't able to convert T4 to T3, we're losing out on that ability. So Hashimoto's goes through the roof, which is another reason why I can't stand the pill at that time because
The pill alone increases our risk almost 300 % of Hashimoto's. So you're taking that at time in your life where your thyroid is already compromised. Not a great idea as well as oral estrogen, especially oral synthetic estrogen that's in a birth control pill increases our risk of cardiovascular issues like blood clots. And those risks again are increasing at that time of life as well. So why would we want to compound that?
So it's more than just losing our monthly report card. We're actually putting ourselves at more risk for cardiovascular issues, and thyroid issues. The pill in and of itself does cause leaky gut. We deplete the bifidobacteria. So then in our vagina as well, which is why you have women dying of Euro sepsis later in life and it's just never talked about. have a recurrent UTIs that
aren't treated well with antibiotics, should be treated with vaginal estrogen, know, systemic hopefully as well, but vaginal for sure. And women are dying. sorry.
Jane Levesque (:
Yeah. I have a 76 year old client and she's just a mom of...
a couple that I'm working with. so sometimes I'll take on it. Estrogen, vaginal estrogen is how we got her UTIs under control. Cause it was just like, you need to be doing this. And she was kind of doing it, right. And we're trying to get her on the HRT, but at 76, when she hasn't been, there's a lot of stuff that we're doing some prep work before introducing really low doses, but it's amazing. Cause and again, like she has a lot of osteoporosis and bone loss and it's just kind of blamed on old age.
Elizabeth (:
There's a lot of stuff we're doing somewhere before the case of Joe Johnson, but it's amazing. think been a lot of us that have lost it, and it's just been a lot of mean, it's just been a lot of work. work. mean, mean, just been a work. it's just been a work. I mean, just mean, lot work. I mean, it's just a mean, it's just lot I mean, it's just been a lot work. mean, just of
Jane Levesque (:
versus it's like no the estrogen hasn't been there the you know and yes there's been all deficiencies and all that kind of stuff but the hormones are play a really big role.
Elizabeth (:
of your last cycle, you know, within if you've spent a year since you've had a cycle, then within 10 years of that, you want to start HRT because without the estrogen, then you build up calcified plaques. And then if you're adding in estrogen, you can loosen those plaques and that can cause a cardiovascular event. So for a woman over 10 years out, it's a good idea to do like a CIMT and know, an ultrasound on your carotid to take a look.
And if that looks good, you're probably pretty good. If it looks bad, you might want to do something like a clearly it does have radiation. So I don't love those. if it's if it's a difficult. Yeah.
Jane Levesque (:
Proteolytic enzymes are also great, right? Like there's understanding, there's lots. I actually, so I know you said five to 10 years, I actually, because I'm testing women who are in their 30s. So I see it's 10 to 15 years before the menopause that they usually need, but that support is so different than when she's 45 versus when she's 50. So at 35, I see that most women need some kind of progesterone and whether that's a herbal or homeopathic or a little bit of,
Elizabeth (:
Yeah. Yeah.
Jane Levesque (:
you know, bioidentical because when that hormone goes down, the receptors turn off because they're like, yeah, we don't need it. And so then by the time the progesterone is really low, those receptors have been shut down and now we need to revamp and do they turn back on? We don't know. Like that there's a lot of stuff that we still don't know because I see it in practice, but like, there studies showing it yet? No. So, you know, are we catching up? Probably.
because I don't believe anything in the body just like dies off and doesn't function again. it definitely does, like if you don't use it, you lose it. That's for sure a thing that happens.
Elizabeth (:
Yeah. other issue with the pill too, because they're synthetic.
hormones, bind more strongly to the receptors. And so a woman who has a long history of being on birth control, then their body may not be that receptive to bioidentical progesterone. So you feel like, it's going to make them feel better. Sometimes it makes them feel worse because their receptors are a mess. So they've got to, you know, do some receptor detox, some niacin, some saunas, clean their gut out, like, you know, get their body working again. But yeah, I mean, honestly, even
there's teenage girls who I've seen through their moms that they need a little progesterone.
Jane Levesque (:
Yeah, that's a very sad reality, it's true like women with premature ovarian insufficiency, right? In 20, you have to hit HRT because the ovaries never turned on or turned on and very quickly burnt out, if you will. So that is a sad reality that's happening as well. I did want to ask you, because I have a couple of women that I'm thinking about who...
it's not birth control, it's birth control, but it's the IUDs as opposed to the pill. What are you seeing in terms of, you know, the benefit, the effect? Is it as bad as the OCPs, as the oral contraceptives? Is it different? it?
Elizabeth (:
I mean, you know, well, there's the copper ones, which people think of as being a little better. It's still a foreign object in your body that, you know, is inflammatory that your body can respond against. It still has to balance out with zinc and, you know, it
It is problematic in some ways. So are there people that feel fine on it and do find sure there always are, but do I think it's great? No, I don't recommend it. The progestin IUDs are again, a synthetic progestin. So you're not supporting your bones. You're not supporting your brain and you're blocking your progesterone receptors with a synthetic progestin. So you're really missing out on all the wonderful benefits of
your own body's production of progesterone or a bioidentical if you wanted to take that instead. I also think that women are just always underestimated with their ability to monitor their fertility. So if you don't want to get pregnant, especially women in perimenopause, most of them are done having their kids and don't want to. And so they do like the idea of a birth control. But in reality, there are not that many days in the month that we
can get pregnant and we can figure that out. There are ways to figure out what day is your fertile rather than sticking in a device that's going to give you a synthetic progestin every day of the year. Yeah. Yeah.
Jane Levesque (:
Yep.
Jane Levesque (:
Yeah, think, you know, it's, have you heard of I'm on the birth control because it helps to prevent cancer?
Can we talk about that? Because I think it's really difficult to, I agree. don't like the, I was actually in a copper AED when I was young because it was not hormonal. It's great. I did bleed more, but then now I look at copper, say, in plasmin ratios. And that's one of the reasons that women won't be able to conceive. And one of the reasons they'll have a lot of neurological symptoms because that copper is so inflammatory and it leads into estrogen.
Elizabeth (:
I was actually.
Jane Levesque (:
and not the good kind, then now I'm like, yeah, we don't want that imbalance. Like it's quite significant for a lot of women.
Elizabeth (:
Yeah, and you know, far as cancer risks go, I do find it interesting that a lot of women that say that are they're perfectly fine taking a birth control pill that's completely synthetic. They're completely fine with drinking alcohol that is a carcinogen. And then they are often the ones that are afraid of
HRT because they think it causes cancer when really it's the statistics are very clear that it reduces risk of all-cause mortality including you know the cancer all the cancers that people are concerned about like breast cancer and and even if you were to get breast cancer your survival rates are much better for women who are on HRT and so you know recently the FDA took off the black box warning of estrogen
which is amazing, was a big win, but I also think it's really confusing to women. So I'm very happy that they took it away, because one of the first things I recommend for women in their 30s, even if they don't, especially if they've had children, even if they don't need HRT yet, I love recommending a low dose vaginal estrogen to.
Jane Levesque (:
Big win, yeah.
Elizabeth (:
you know, prevent against UTIs to help their, you know, elasticity and their collagen and prevent prolapse and the muscularity and the whole thing. It's just, think of it as, you know, a facial moisturizer. It's just for your vagina because the same things as our skin starts sagging on our face, the same thing is happening to your vagina and it's not just a cosmetic concern. It's really, you know, to prevent lifelong issues.
Jane Levesque (:
Yes.
Elizabeth (:
So it is one of the things I recommend first and it did come with the black box warning, which was insane. And many women would say, my gosh, it's got like skull and crossbones. I don't think, and why would they listen to me? What am I? I'm a health coach and their doctor is telling them it's dangerous. Okay. So I understand that. So that's a big relief that it's the black box warning has been taken away. But what I hear a lot lately is
The black box warning is just in relationship to estrogen and people don't know what HRT is. So it's any type of hormone replacement. It could be testosterone, could be progesterone, it could be estrogen. It could be injections, it could be oral, it could be topical, it could be placed in your vagina, on your abdomen, on your shoulder. Like there are just so many different forms and ways and concentrations and timing.
Jane Levesque (:
to you.
Elizabeth (:
There's so much involved and I think that a lot of people are like, HRT, no black box wording. It's like a free for all. I'm gonna go get my testosterone pellets in my butt now. So. Yeah. Yeah, which I, should probably, if women are interested in HRT, we should probably talk about the pellet situation because it is very common. It's one of the few forms of.
Jane Levesque (:
Because this influencer is doing it.
Elizabeth (:
hormones where doctors get a financial kickback. It's quite expensive. It's not at all how our body works. Our hormones don't peak and then slowly decline over three months. We have a monthly cycle, not a seasonal cycle. So we don't want our testosterone to go through the roof, not knowing how we're going to respond or feel and then slowly lose it. So
And there are complications. say it's just a little incision and no big deal, people do develop, you know, depending on your genetics and your inflammatory status, people do develop all of it. They act like it's just, it's so cookie cutter, but you can develop keloids and, you know, have a reaction. And the traditional practitioners in these testosterone places are surely not doing Dutch tests to see if you're
Jane Levesque (:
your liver function, your mitochondrial function. Yeah.
Elizabeth (:
heavily DHT to see if your acne is gonna just go through the roof and you're gonna have to live with it for three months. So. It is.
Jane Levesque (:
Or you're push it all down the estrogen pathway that's more problematic and is associated. That's kind of my rules of thumb with HRT is you should do testing and understand where your hormones are at.
You need to personalize it and you need to run a Dutch test or something equivalent. do inside plus by us biotech is very similar. That came out that I've been trying and playing around with, but like, let me see how your body breaks down hormones because there is a genetic component to it, you know, and mitochondrial function. This is something that I learned from my mentor is the mitochondrial function is so important when you're taking HRT, because it's basically the body's ability to use those hormones. And so putting someone on CoQ 10 and good
quality ubiquinol and the right dose and then make sure that they can absorb it is actually detrimental for either the success or the failure of the HRT that they're put on. And it's like, nobody thinks about that. It's because it's not sexy marketing. It's not sexy to be, oh, just put this in your skin and then it's good or just do that and then it's good. It's no, you're going to have to poop in a box, pee in this one, take a bunch of blood. You're going to have to collect this for a month. And then I'm going to
Elizabeth (:
And somebody tells, I can be sure that they can observe it. He's not just against the rituals or just like that or, you know, in some other upsides, he's pretending that they're on it. It's like, what he's doing. He thinks it's a little bit of a fag. Right. Plus, see. So, just take a minute and enjoy the rest of video. You have to know that the live streaming is online so you can face it online. can have time to do the live streaming. important. And I'll leave it as it is once you're there.
Jane Levesque (:
to tell you what to do. And it's like, I've been yelling that from the rooftops for a long time. And now my clients, when they come to me, it's like, hey, this is the approach that I want because I've already done the try this and see what happens. And it actually created a lot of mess. And so my hope is that we continue to educate people and say, HRT is life changing. But if you don't personalize it, it can be life changing not in a good way.
Elizabeth (:
Yeah, and when you mentioned pooping in a box, it's like that's
Like the first question, are you pooping every day? Because if you're not, then adding HRT onto it is not going to be helpful. So let's figure out your gut health and your liver function and make sure that you are going to the bathroom daily before we throw HRT in there that's going to continue to circulate and you're going to have those dominant symptoms. So that happens a lot with people who are on higher doses of the GLP-1s, the Ozempics and that sort of thing, because it slows down their
gum motility and so it's less concerning for the women that are doing the micro doses and aren't having that rapid weight loss and it can actually be helpful for mitochondrial function and all of that. But if they're not doing those properly, I think there's studies that show that GLP-1s and HRT can be quite synergistic. But again, it's the dose, the timing, the right way for that particular person.
So yeah, to listen to.
Jane Levesque (:
And like what else is going into the body? I actually had a client on earlier this week and she's like, I've lost all this weight. I've been doing GLP-1. It's been great. And I'm like, are you eating enough? That was my, like from a fertility standpoint, cause I'm going to look at her nutrient panel and I'm going to look at her ventilation panel and everything is going to be in the red. And so even though she's losing weight, she's so depleted that you can't make hormones when you don't have anything in the body to make hormones. And so there's that.
starvation component of it because the appetite isn't gone and so you're not craving things and you're not eating enough and so then you're not going to be pooping and then of course the motility. Then there's also like is this actually still beneficial for you or do we need to be switching and changing it just because the weight loss is there? I mean there's no like detriment that's happening you know.
Elizabeth (:
It's quite difficult when you don't have an appetite to get enough nutrients and you can't just focus on one nutrient. then, you know,
Jane Levesque (:
Yes.
Elizabeth (:
women will sort of get, because when we were growing up, it was very much like there's this zone diet or there's Atkins diet or there's low fat. It's like people want to pigeon hole when at the end of the day, it's really about balance. So we have to have enough protein for our bones, for our muscle, for our brains to function. We need those aminos and...
We also need a lot of fiber because we got to get that estrogen out. We have to be going to the bathroom. So if you're on something that's suppressing your appetite and your motility, it becomes very difficult to get all of the nutrients we need for all of the reasons. We need, you know, enough colors to be feeding all of the bacteria in our gut for our immune system and for everything else. So me personally, it would be because I just have never had a huge appetite anyway. I can't imagine adding on something like that on top of it. I just know I wouldn't.
be able to eat enough.
Jane Levesque (:
Yeah, it's, I mean, I the point that we're trying to make and we're doing is just like, it's so individualized and so personalized to you and what's going on, not just even what's going on with the hormones, but like what's going on in your life. Because I'll always say, you know, when I meet a woman that's really depleted and her DHEA is really low and I'm like, just gave her some DHEA, you should feel so much better.
and probably progesterone as well. My inclination is going to be to get the progesterone down and get the cortisol because if I just give her the DHEA it's going to keep feeding into that pattern of over driving or not setting boundaries to say yes, yes, yes to all the things. And even though she needs that hormone because she's using it so she hasn't changed the habits of
Elizabeth (:
And
Jane Levesque (:
regulating the nervous system and not just using up every ounce of energy that she gets on somebody else or somebody else instead of keeping some for herself so her body can heal. you don't change that kind of psychological component of it, if you will, then it doesn't fix the issue, you know?
Elizabeth (:
Yeah, and for me, I think, like, kind of like a challenge and I look at them as opportunities. So for me, paring menopause is very much an opportunity to get more in tune with yourself, to give yourself more grace to provide more time for yourself to do the things that are
really going to help your nervous system at the end of the day. It's like that's everything. If you if you are have a dysregulated nervous system and again we need hormones and it's the chicken or the egg and they you know all of it. But I would love women insisting you know well it's menopause it's period menopause and eye roll and it sucks. I would love to have them look at it differently and say like I am older now and I've accomplished a lot and I'm
Jane Levesque (:
Mm-hmm.
Elizabeth (:
Now finally in a stage of my life where I have a much greater understanding of my body and my life and kind of what sets me off and what relaxes me and really get in tune with that and carve out it doesn't have to be a full-on meditation retreat carve out 10 minutes here and there. Some of my women you all just have them lay on their back flat for like 90 seconds a couple times you know doesn't have to be this huge
Jane Levesque (:
Yes. Just lie down. Just lie down.
Elizabeth (:
Lie down, take some deep breaths for 90 seconds here and there. You know, especially also women with babies, you know, they're experienced all that too. So it's like, I always found it so funny to say take a nap when your baby naps. It's like, my gosh, that's when I'm living my life is when my baby's napping. But like, but you can lay down. Yeah. But you can lay down for 90 seconds and do some deep breaths. that...
Jane Levesque (:
I'm green!
Jane Levesque (:
Yes.
Elizabeth (:
goes a long way. I, when I became trained as a somatic coach, I did it through something called the NeuroFit app and all of their sessions are three minutes. And my HRV like tripled and I just would do a couple three minute sessions. Now I don't do them as much, but especially during the training when I was consistent with it. it was crazy how my HRV went through the roof and just
In one day, it's like, it's not like, again, it's not a retreat. It's a little bit goes a long way, especially when you throw in some magnesium.
Jane Levesque (:
Yeah. I do think that's where the data tracking is really important because sometimes you don't notice it immediately. Like, yeah, I feel comfortable, but you don't realize how big of an impact it has. But then you, I'm looking at my aura ring because I can see like when I start a new protocol or when I'm going through a protocol, I'm doing like some killing and I can just see when it kicks off, you know, or when it kicks in and things are, it's like.
motivates you to keep going. It's like, I'm not sure this is really doing anything because you don't feel a drastic change. It's slow, slow, slow. But then all of sudden you're like, yeah, I'm on the other side of it.
Elizabeth (:
communities, we could move people, rest of the city, it's so, so slow to then move that, like, yeah, I'm on the other side of it. I think that tracking is really important because we all have stories that we tell ourselves of, you know, I had a bad night's sleep or a good night's sleep, or I'm stressed or I'm not. And it's like, how do you really know if you're not looking? And I know that some people can, it can be too much.
Jane Levesque (:
Mm-hmm.
Elizabeth (:
information for that. You don't necessarily have to look every night. You could just you could do a wearable for look at it on a Sunday. You don't have to check it every morning and like freak out about it. You can just have a general idea of like or even a little journal. You know okay I quit eating at five o'clock that day. I ate dinner at nine o'clock that day. Like what's you know how does that affect me? It's like you know that's another thing that like intermittent fasting can
Jane Levesque (:
Hmm?
Elizabeth (:
can be helpful or it can be detrimental. A cold plunge is helpful, detrimental. So people will say, well, how do I know? Well, you really have to track. If you want to be doing things like that to help your mitochondrial function, you have to track. Because no one can answer those questions for you. That's where it comes in with getting some autonomy over your.
Jane Levesque (:
Yes.
Elizabeth (:
own health. have to step in and take control and know your body because nobody else can step in and say this is the diet you should be doing. This is I mean in general terms we can kind of say how much protein, much fat, how much fiber but that's generalities. I don't you know know everyone's genetics and metabolism and these things change throughout time. a little bit speaking of metabolism I do like to do also composition
testing not just a DEXA to look at bones, but it is important to start at least in your 30s. I've actually with my son who's 18, have him check, we build most of our bone before 30. So it is a nice idea to check especially teenage girls that under eat and give them a sense of like, okay, we got to prioritize protein and here's why.
Jane Levesque (:
You got to lift weights and you got to be strong as opposed to just skinny and kind of start changing that language.
Elizabeth (:
Yeah, so I for sure the bone health is important to get, you know, adepts early on. It's very low radiation. If that's a concern, you can take chlorella and iodine beforehand. It is really low though. And then you can look at visceral fat because again, that's something that increases during that, you know, late thirties through the fifties. So you want to stay ahead of that.
It's a big and measure, you everything you can measure your metabolic rate. If you're not eating enough calories, you're going to have a low metabolic rate. So actually, if you want to lose weight, you might want to eat more. I think the whole point is, I agree with all the recommendations for like, he's important work. And it's like, yeah, I'm just taking the reign. But I think it's, think it's important to like,
Jane Levesque (:
Yeah, no, I love data. think that's the whole point is I agree with you because I'll have patients who are like, it's too much, I need to put it back. And it's like, yeah, then just take a break. But I think it's the judgment or like, for example, weight. I remember when I struggled with my weight loss and I was obsessive about my weight and my weight would, what I weighed on the scale would determine the kind of day that I had.
Elizabeth (:
I obsessed about my family and the way that what I did on this scale, I did something that I never did if I had. I wanted to know what different parts of it as a human being would look I don't know if I actually would like to explain. But I mean, I think I seem to know that when I have a bad day, I just have to think about how are decent things going to be morning.
Jane Levesque (:
And it took me a long time to now look at the number and just have it as a piece of data. Like I don't have that same reaction when I look at sleep. Do you know what mean? When I looked at my sleep data, I wouldn't have a bad day because I only got an hour deep sleep and that was an hour and a half. And so it was breaking down the emotional tie that I had to the weight and what I thought it meant versus the actual number. And so to be able to look at the data objectively, but then also like have somebody else that's going to look at it.
Elizabeth (:
I think that's a skill. I think that's skill for us.
Jane Levesque (:
and tell you what it means versus you spiraling. I think that's a skill and I think that's a skill worth learning because you can't hide from it. I have so many patients who are like, I'm healthy. And I'm like, just show me because I don't really believe you. I don't think I believe you. I don't believe you because I think you're lying on purpose. I just think you go to the doctor and the doctor tells you that everything is fine and you don't need anything. And then you just stop listening to your body and then you're 20 pounds
Elizabeth (:
Yeah.
Jane Levesque (:
30, 50 pounds overweight, you have brain fog, your legs under your eyes, and you're still being told that you're fine. And if I look at your data, don't think so. You know, like the body's actually been compensating for a long time and it needs support.
Elizabeth (:
I agree. I was the same way with this scale. It would determine my mood for the day and I would look every day. And it's funny now, it's so different. I, last year I changed the concentration of estrogen I was taking and it wasn't enough. And every day that I stepped on the scale, was a pound heavier. rather, and then when I did a follow-up composition, my visceral fat had increased too.
And it was so interesting looking at it from a different perspective because before it would have put me in a bad mood because I would have felt like I was fat. And now it was just a useful tool that showed me that I was not taking enough estrogen. It was the only thing that had changed. It was a clear indication. So it's like, I'm not going to then my solution to that isn't I'm not going to like get on ozempic. I'm not going to starve myself. I'm not going to
it do extra cardio, what I'm going to do is increase my estrogen and keep doing everything else exactly the same and, and know that it's going to sort itself out. It's just a tool. You know, you don't yeah, I'm not emotionally attached to it. Like I used to be. Yeah. It's super powerful. I'm supposed to process.
Jane Levesque (:
Mm-hmm. Yeah, that's powerful.
Yep. Yeah, it's super powerful. But like, that's to be able to get out of that. I know how long it takes to be able to do that, you know, to go, I trust the process. And I say, like, you know, when I had my 20 pounds that I was carrying, it's like, I know what it took and how long it took and what, and like, if I gained 20 pounds tomorrow, I know exactly what I would do.
And that's because I went through the process and it took me years, know, like five, whatever, however long, don't even remember how long I was struggling with that, but at least a good five, if not 10 years. But it's, you know, I think it's really hard for people to understand that, to be able to trust the process now and the data is super helpful.
Elizabeth (:
It's also another reason why I like the
doing the body composition because you know, I mean, there was a time where I was really trying to put on muscle and so, and I was, and I was gaining weight, but it was muscle. So it's nice to know what that weight is and what your starting point is and, how it changes over time. again, nothing to obsess over, just a frame of reference.
Jane Levesque (:
Mm-hmm, yeah. Thank you so much for being here. Your wealth of knowledge, I'd love to tell people where they can find you and what you're working on and put you on the referral list to help the clients who are not looking to conceive but are looking for support in perimenopause so they can reach out and get the help that they need.
Elizabeth (:
Thank you. My website is strongchoices.com and I post a lot of educational content at strongchoices1 on Instagram. I'm young just wrapped up my book. It's called Sexy Bones.
Jane Levesque (:
I love it.
Elizabeth (:
Trying to gear bone health towards a younger group of people, letting them know what they can do to support themselves and set themselves up for success. So that's circling publishers right now. I'm excited about that. I don't know. I'm hoping by next, like around this time next year. Yeah. Strong choices. Yeah.
Jane Levesque (:
Do you know when this can come in?
Jane Levesque (:
Amazing. Well, thank you so much for being here. It's Strong Bones 1 on Instagram and then Strong Bones, Strong Choices, not Strong, Strong Choices 1 on Instagram. Strong Bones is the name of the book. But thank you so much for being here. I do to all the listeners, if anyone has questions around HRT, I love everything that you brought to the table today. And there's so much more that we could keep talking about it in this way. Like, OK, we'll just cut off the conversation now.
Elizabeth (:
Thank you. Thank you.
Jane Levesque (:
probably three more hours about HRT. So thank you for being out there and getting that very important information out for women's health.
