 Well, hello everybody. It's another episode of Dr. Jill live. I'm with a wonderful as a old friend, but neither one of us are old. It's that we for a long time, right? We won't go there, but I'm so excited to be here with Dr. Jolene Brighton. I'll introduce her in just a second. We're gonna talk about her new book. Is this normal? And we're gonna dive into some really practical questions and things. I love the cover, love the texture. So and I wanted to be sure to have it because my hair almost matches your book. I know your hair is on fire, like for real. So super excited to have you here, Dr. Brighton. Welcome to the show. Thanks so much for having me. It's so good to see you. I feel like post pandemic, like seeing people, like just seeing people. It's always like such a treat. Isn't it? I know even in my office patients are starting to come in and like, can I hug you? Like, can I ask? Can I touch? But it's so lovely to have that in person connection and same with, I know conferences are starting to come back and lately they've been full of people. People are excited to be in person. Well, let me introduce you and then we'll dive right into this topic. I titled it hormone balance for women, especially PCOS menopause and all things hormones. So we're going to dive in. Dr. Jolene Brighton is a hormone expert, nutrition scientist and thought leader in women's medicine. She's board certified in naturopathic endocrinology and trained in clinical sexology. Dr. Brighton is the author of Business Normal, a non-judgmental guide to creating hormone balance, eliminating unwanted symptoms and building a sexual desire you crave. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighton empowers women worldwide to take control of their health and their hormones through her website and social media channels. She's an international speaker, clinical educator and medical advisor within the tech community. I am so happy to be here with you. Talk about a topic that everybody has questions about. Oh, yeah. I can't wait to dive in. I mean, between PCOS, perimenopause, menopause, woes, there's a whole lot of like abyss out there, right? There's a big hole of information, then there's a whole lot of misinformation as well. Yeah, I think what's happened is in medicine, first of all, as medical doctors, we are not well trained on women's health, women's hormones and some of these things. Now, I've become kind of a hormonal expert and endocrine expert in my little field as well, but it's a lot of the education, especially with nutrients and herbs and just even what's normal, what's not normal, which we're going to dive into today. A lot of that education was outside of medical school. And I say that because you go to your doctor, especially the classical allopathic trained doc, you're going to get blank stare or like, maybe you need an antidepressant. Like these things that are really insulting to women, because now, even now, there is not the kind of education that we need. So this is such a needed resource. If you guys don't have a copy, go out right now and get your copy. It is just chock full. And what I love about this book, what you did, and I want to talk about how you got to write this book, is it's so practical, you could just almost flip to any chapter, any place and be like, oh, okay, here's some questions, are my hormones normal? Is menstrual cycle normal? And you got it so well laid out to just be like, you can read through it and it's amazing that way, or you can kind of flip to different topics and things. You've got checklist, you've got sidebars, you've got recipes and plans at the end. Tell us though, how did you, I mean, clearly there's a need for this information, but how did you go about deciding on this book? Oh, you know, it just became so clear as I wrote beyond the pill, that the reason that we find ourselves and to your point, you go to the doctor. The doctor says, you know, okay, you're complaining, you're like, I have period problems. Your doctor says to you, well, do you want to have a baby? You say no, they say here's the pill. And you find yourself on that because you don't understand what's normal for you and what's not. And the majority of things that we face as women, like we don't have to go to the doctor for or our doctor doesn't even understand it. They don't even know about it. And especially all of the information about sexual health that I talk about in there. These are things that ones I made ask Dr. Brighton on Instagram anonymous that people were like, let me tell you the hush hush that I would never say to my doctor or my doctor shamed me about. And so that was a big reason for that. And then, you know, the other thing I want to say is that you were talking, we're talking about menopause as well. So if you are in your reproductive years, they're going to say to you, take the pill. If you are in your later reproductive years really edging towards menopause and you're having heavy periods, painful periods, they're going to say just remove your uterus. And if you're having mood symptoms, we know that once we get into our forties and above women in the United States are the biggest recipients of antidepressants, anti anxiety medications and things that come with really heavy side effects that are very often not discussed. I mean, we saw just a few years ago that women in their forties were dying at a higher rate because doctors were prescribing benzodiazepines and not telling them that rose all day and benzos don't go together or a little not mommy nightcap and benzos don't go together. And so we see it's really limited in what women are offered. And so I wanted to start the conversation about what is and is it normal when it comes to your vagina, your breasts, your hormones, how do we understand our normal and then give you a plan on taking action so that you can fast track your healing. So even if you need a doctor, you go to a doctor, you will have the language, the expertise, but also the foundation that supports your body so that you can heal quicker. Love it and so needed and like we started this conversation, the traditional alipath is going to say, this is dysfunction, but they're in the realm of normal what is normal. And what's not like, say a woman in their menopause is having vaginal dryness and wants to have better sex without pain. The doctor doesn't always have a good solution for that. And again, the pill is not going to help in many of these cases that may make things worse. Let's talk about that real quick because whether you have POS or your perimenopausal, or your postmenopausal, typically not postmenopausal, but a lot of these younger women are getting out for the pill. Why is the problem for some issues and not always a good idea. Yeah, well the problem with using the pill for every single lady part problem or hormone problem is that the question isn't being asked, why do you have those symptoms. That is in part leading to the misdiagnosis or delayed diagnosis of very serious conditions like polycystic ovarian syndrome, hypothyroidism, fibroids and the list is pretty broad in terms of endometriosis being another one of what gets overlooked or dismissed or doesn't get the attention it deserves. Now, the pill is a tool. We can certainly use that tool to manage symptoms, and that's what I think is important part of the conversation. Often doctors will say, so PCOS as an example, just take the pill that will fix your period. In fact, what is going on with PCOS is that we have an ovulatory cycle so we're not, we're not having ovulation, or it's a regular ovulation. Ovulation precedes menstruation. So if you don't see a period, we've got upstream issues with ovulation. The pill suppresses ovulation. Fantastic if you don't want to baby like love that if you do not want to become pregnant. But in terms of fixing periods in a condition where ovulation is the issue, how can a drug that suppresses ovulation fix that it can't. And then women come off of the pill. And one thing that will happen is they'll often look back and say the pill caused me to be infertile, when in fact the pill was masking all the ways your body was telling you we're about to have fertility problems in our future. And it wasn't the pill per saying that caused you to become infertile. It's that nobody worked you out for the PCOS. Nobody understood that PCOS, which is one of the top reasons why women struggle with fertility. So that was the cause. No one talked to you about it. No one talked about the fact that there is insulin issues, about 70% of women with PCOS have insulin issues, and there's inflammation going on as well. Those are also bad for fertility, but also cardiovascular disease, dementia, all of these things. So that's the problem with the pill. When we give it without a discussion, when we give it without an informed consent, and when we give it without actually asking why does this patient have these symptoms. Because certainly for some people, the pill can help with acne. It can help with some people it helps with hair loss, some people it makes hair loss worse. Some people it does help them get relief from their period or PMDD, which if people are not familiar with that. Now we say take PMS now amplify it by a million. It's the worst it could possibly be and then stretch it out for two weeks out of the month or six months out of the year, and you've arrived at PMDD. Some people are absolutely helped by taking the pill, but that is not the end of the discussion. And to your point about perimenopause, we don't, we have a lot better ways right to treat perimenopause and to help with those symptoms. We don't have a whole lot of research supporting pill use as having the same benefits as bioidentical hormones or hormone replacement therapy and perimenopause. In fact, there was just a headline that came out and it was like, oh, you know, these hormones, these hormone replacement they could put like, and I'm a doctor, so I'm like, everything is very, you know, I'm trying to be like, you could remain. No, the headline was like, you're going to get that. And when you actually looked at the research, they were using progestin. The majority of people were using progestin. Progestin is the fake hormone that wants to be progesterone, but can't be progesterone that we know is problematic. Progesterone nourishes the brain, the nervous system, it helps with the myelin sheath, which is like the way that we run and fire our neurons, our thoughts, the whole ability to talk like, thank you, myelin sheath. Progestin does not have those same benefits. And if everybody would just like chill on trying to regulate the pill and we could have real conversations about it. I think we would get more research and a deeper exploration that would tell us that there are in fact problems with progestin. And we see this by way of the research that shows us that some people experience mood symptoms, especially teens. When they're on contraceptives that have progestin, or are progestin only. And that's important to understand. So if we know this in a younger population, like, and your mood is not separate from your brain. Sometimes doctors are like, there's two different things and I'm like, no, no, no, no. This is the same thing. If we know that in a younger population, it should be no surprise that we see dysfunction, right, that's induced by a medication. If we're using that progestin in an older demographic. Now we need a whole lot more research to understand all of the nuance of this. But, you know, just want to say, as I use the term dysfunction, love it when there's a medication that comes in and makes you feel dysfunctional don't love it when you're having a physiological adaptation that is normal that is a response to our environment. And I just want to say that because we're going to talk about vaginal dryness and pain pain with sex, and that often gets termed as like sexual dysfunction and I'm like, well, it's actually physiological adaptation, like you don't want to have sex, because it hurts. That's normal. Yes. Yes, what a great and right in the moment you said the headline which is the one I know is out there, I think in it you cut out I want to make sure people heard that I think it was the risk of Alzheimer's dementia with the hormones right the one that just came in and just like you I read that like, wait, this is literally our brothers and group which is all about dementia treatment was like, this is progestin. This is not progesterone. So I love that you mean distinction. Because with mental health to we're finding that actual real hormones have been shown to benefit aging brains. So that is absolutely clear, but not synthetic. You are an expert in PCOS I love that you talk about this because it is absolutely increasing incidence. You gave some symptoms but let's just frame it what might someone what what might a woman who has PCOS experience, how might they know. And then what are some ways to look at that besides giving them the pill. So there is a criteria that has to be met with PCOS and so these are the big ones number one is the polycystic ovary and syndrome that people think like you're going to have lots of sis. This is not only always true, but it is part of the criteria. And in fact, what medicine once thought we're like, oh, you have a bunch of cysts in your ovaries are actually follicles that are developing. And it through our cycle, we develop follicles and this is where the egg is housed and then as you get closer to ovulation, there can be only one one that wins and you know estrogen LH as the whole hormone symphony is like choose your champion and let's release it with PCOS because we're not getting that same level of brain hormones and ovarian hormones. What we see is that there's a lot of follicles trying to win the race and so that's what looks like the way will you know be terms like the pearl necklace that appearance of a strand of pearls. So you have a bunch of cysts in the ovaries, not actually sis, your little ovaries trying so hard to get an egg ready and get to ovulation. So that's, that's one of the three criteria now you only need to. And the other two are high androgens, which doesn't have to be diagnosed via blood work this can be a clinical diagnosis so you can have hercetism hair growth on the chin chest abdomen. I often get people who are like, or it's just your ethnicity and I'm like, listen, I'm a Latina and I'm gonna tell you, this is not an ethnicity thing, you have very dark course, thick hair, and it is showing up like a beard around your areola. It is showing up what people call the happy trail or even extending down your thighs. And it is to the point where you're like, I noticed and this is problematic. You may not always have hercetism, maybe what you experience instead is hair loss on your head. Yeah, it starts with a miniaturization of the follicle. So DHT, which is the type of androgen that's causing our follicle to get really small. Your strands of hair they go from like, I think about like 1980s like Superman and they're like, Oh, here's his strand of hair, holding up this like big weight. And I just dated myself, but that's okay. So your hair is getting weaker and thinner and not Superman anymore. That can be a sign of excess androgens and what most people think of as testosterone. So you have oily skin and acne. Those are two other really big ones. So that is the second out of the three criteria. And then the third is where is your period, or your period shows up, but it's super unpredictable. It's going beyond 45 days. That is due to ovulatory issues. So we have irregular ovulation or lack of ovulation. So these are the things we're looking for with PCOS to make the diagnosis. It is a diagnosis of exclusion, which means that if you just have an irregular period showing up, you need to make sure it's not hypothyroidism that it's not something else going on. Now things not talked about with PCOS and that aren't part of the diagnosis is that you can have high insulin levels. So you might notice that you have blood sugar dysregulation or that you're having dark velvety skin. I talk about this and is this normal? It's showing up maybe on the back of your neck or in fold. You're seeing this dark velvety skin or skin tags that can be a sign of insulin resistance taking place. You may also notice that you have mood symptoms. So anxiety, depression, very common among women with PCOS, often overlooked, often not, you know, something their doctor even talks to them about when they get the diagnosis. As you can imagine, if you are not ovulating regularly infertility, so inability to conceive is another way that and it might be the first time you come off the pill that you start paying attention to that. And you're like something, something is going on here. And then the last thing we'll say is waking. And this is waking that no matter what you do, you can't seem to get the weight off. And maybe, you know, you're somebody who's like, I've been strength training, and I'm very strong. But I'm noticing, especially around my midsection, that I'm starting to gain weight. And as you know, you go to the doctor as a woman, if you complain about weight, they're like, eat less, move more. And I'm always like, you know, I actually said, and is this normal? Like that is some dietary dogma that never should have been in women's medicine because it is such, it is such a disservice and such a tool of dismissal. Yeah. Hey, everybody, I just stopped by to let you know that my new book, Unexpected, Finding Resilience through Functional Medicine, Science and Faith is now available for order wherever you purchase books. In this book, I share my own journey of overcoming life-threatening illness and the tools and tips and tricks and hope and resilience I found along the way. This book includes practical advice for things like cancer and Crohn's disease and other autoimmune conditions, infections like Lyme or Epstein Barr and mold and biotoxin-related illness. What I really hope is that as you read this book, you find transformational wisdom for health and healing. If you want to get your own copy, stop by readunexpected.com. There you can also collect your free bonuses. So grab your copy today and begin your own transformational journey through functional medicine in finding resilience. Yeah. I love that you say that because so many women are told or, and this goes for PCOS but also menopause, right? Yeah. Or in fact, I just saw a diagram. It might have been even from you where the cortisol insulin high testosterone medium and estrogen progesterone lower is the classical, I can't lose one for both PCOS and for menopause. So I love that you're saying this because truly the hormones are much more regulatory on our weight than our diet and exercise. So thank you for framing that. So then women go to their doctor and docs like, okay, you wanted the pill. Why would they maybe not want to we already framed this, but why would they maybe want to do something different? And what else could they do if they're just diagnosed with PCOS besides going on the pill? Yeah. Okay. So I mean, you can always use the pill, especially like I have patients who are like, I'm getting married. I need to have. Yeah. Like I need interventions. And so I just want to say that because I think I'm. I love that. And it's really easy for women who have never walked that path to be like just never use the pill. And it's like, yeah, but you're about to memorialize and a life event, major life event for the rest of your life. These photos will live on your wall if you want to have clear skin, like totally get that. I think it's important for people to understand you can use the pill and use the nutrition and lifestyle interventions. You can use spironolactone and use the nutrition lifestyle interventions. You can use metformin for your insulin and your blood sugar as a tool. Well, you also build that foundation. And neither of those drugs that I just mentioned have to be with you forever. Yeah. And so you might want to use it. You're like short term. I just need the results. And now I want, but I'm going to work on all this other stuff because I don't want to be dependent on those. So I do want to say that. So if wherever you are and you're joining what I'm going to explain to you, you can utilize an employee. So number one is build muscle mass. I think so back when I was in my master's for nutrition. My research was on sarcopenic obesity. So for over 20 years, I've been like build muscle mass everybody and eat adequate protein. Most people are going to need more like one gram per kilogram of body weight of protein to maintain muscle mass, especially as you get past 35. Super, super important. Now your muscle is in itself an endocrine tissue. It's going to help with sensitizing to insulin. It's going to help with modulating those estrogen and testosterone levels. So although I talked about testosterone in PCOS estrogen can also be problematic because estrogen is part of the let's get an egg out. But then it never happens. And without ovulation, we don't get progesterone. So estrogen goes on unchallenged. So a lot of what people call estrogen dominance that you will see I do have to share it as a side. I had someone on social media saying, Oh, Dr. Brighton is the one who invented estrogen dominance and invented this term. And I just laughed because I was like, if you go to PubMed, there's research that says estrogen dominance that came out before I was born. I was not named. I just happened to be noisy about it. So with that estrogen access. This is what puts women with PCOS at higher risk for endometrial hyperplasia, building up of the endometrial lining. And then that inability is shed you go a year or two of that you're going to start seeing your risk of endometrial cancer creep up. This is a reason a doctor will say, This is your only way to prevent endometrial cancer because you have PCOS and you're going to get that. No, just because you have PCOS does not mean you will get endometrial cancer and the pill is one tool that can trigger withdrawal bleed, make the endometrial lining shed. But what's our primary goal? Let's get you to ovulating regularly. So building muscle mass is one thing that we can do. The other thing that we can do is work on our inflammation. So with inflammation, that is going to cause chaos for the adrenal glands is going to cause chaos for your estrogen testosterone balance. It is going to cause chaos in terms of your ability to get back to ovulation. And when your cells feel about inflammation, they're not filling the hormones. So the receptors actually won't be as accepting to the hormones and you'll lose sensitivity that way as well. So that can look like, you know, keeping our stress low doing our exercise, but also our dietary choices. So lots of fresh fruits and vegetables and I don't care that you have PCOS eating fruits are going to, it's going to provide you with so many antioxidants. It's going to provide you with a lot of things that are supportive, not just for your overall health, but your ovarian health. I always tell patients like, look at berries. Do berries not look like an ovary? Like really trying to like it reminds me of PCOS. And we know those antioxidants that are in berries are super beneficial for our ovaries. So making sure that you're getting fresh fruits and vegetables in as often as possible. You got to do frozen. You got to do frozen. Like that happens. I'm like, I'm like, I'm where I'm at right now. The only way to get organic broccoli, which I eat a lot of is frozen. And you know what? I'm still going to get the dim. I'm still going to get the sulforaphane. I'm still going to get the nutrients. So in eating all those fruits and vegetables, you're not only going to deliver nutrients and building a nutrient dense diet. You're also going to be increasing your fiber. So we want to aim for at least 25 grams of fiber. We know from the research. So even if you don't have PCOS, please listen up. If you struggle with your weight at all, 25 grams of fiber every day, less than 25 grams added sugar every day. Okay, so less. You want to get that fiber up and tending to your gut microbiome. So there's been research showing that microbial diversity in the gut. People who have lots of critters in there and that lots of different kind, they have lower incidences of belly fat and it's easier for them to ditch the belly fat. Now, why does this matter? For people listening, we're not talking about aesthetics. We're talking about visceral adiposity. When I say belly fat, we're talking about fat packing around your organs. It is pro inflammatory. It hates you being sensitive to insulin because it just wants you to basically plump up those cells as much as possible. And that is the big risk for everybody in terms of cardiovascular and metabolic disease. So for everybody, tend to your gut health. Eating all that fiber is going to help. You may want to take a quality probiotic and decreasing that sugar is definitely going to be helpful. And I know that the anti diet culture, they're going a little too far in my opinion, some of them where they're like anyone who talks about sugar is like, you know, part of the problem and I'm like friend, am I supposed to ignore all the research? Am I supposed to lie to you because like the diet industry lied to you like no, we're going to tell the truth and you're going to view this through the lens of what's true for me. And just like I say, and is this normal? We're going to have our cake and our balanced hormones to because, you know, as you and I were talking, I was just in Paris, I very much adopt the French way of living in terms of pleasure is necessary for a balanced happy life. Okay, we talked about diet. We talked about exercise. The last thing I want to say is sleep. If you are not getting quality sleep, then I don't care how good you eat it is going to be an uphill battle. So there, the piece I want to talk about in is this normal I have a whole diagram, you can see the insulin resistance, the inflammation, the an ovulatory cycle so not ovulating, all of that can occur if you're not sleeping well. You want to hone in on melatonin. Melatonin, everybody's like great sleep hormone, don't get jet lag, it protects your ovaries. If you are struggling with infertility, and you are 35 plus in my clinic, we're going to bring melatonin in as a way to support ovarian. Melatonin is an antioxidant. It also protects the brain. Now, in terms of research of like, oh, do we have great research on like if you take melatonin long term or any, no, we don't. But what we do know is that melatonin is so potent of an antioxidant that those people who are night shift workers who have low levels of melatonin, they have higher incidences of cancer, ovarian dysfunction, brain disease, all of these things. And so with PCOS, with perimenopause, with every woman on this planet, protect your ovaries by getting good sleep. And the things that you do to protect your ovaries are actually going to protect you for longevity. And I don't know about you. I'd love to hear your opinion. But I'm very much of the mindset that if David Sinclair can be out there saying like, hey, based on my research, we don't have to die and ourselves should live longer and they can remember, then our ovaries should be able to as well. And it makes no sense why it is that we live so much longer than even generations ago, but that we are still going through menopause and struggling with perimenopause when we do, we should be able to extend that lifetime. And I'm convinced it comes down to all the things that we do to support our mitochondria and that every biohacker or health optimization person or longevity expert, you know, whatever people are calling themselves these days, they're all talking about the same stuff to like make yourselves work and go the distance. We should be able to do that with our ovaries as well. Amen, sister. I'm just sitting here nodding and smiling so big because you've just given us a such a depth of wealth of knowledge and what I love is you always bring the practical tips to and also like, yeah, a little sugar is okay, but really, really do watch this thing like it is important. Glycemic index has everything to do with diabetes, heart disease, obesity and cancer risk. So it's very real we can't ignore that but also pleasure is important. So I love that. One thought I had when you're talking about diversity of diet and the microbiome and all these things you know I love the gut and recently I've been doing research on nitric oxide and some of the codes for that loss of hormones loss of nitric oxide are really the core of aging. Well, nitric oxide is rich in things like leafy greens and beats and beetroot and all this nitric oxide is all about great sex right it is. Yes. Okay, so I was so glad you're saying this because I'm like, if you are struggling with an erection whether it's your clitoris or your penis friend, you are aging too fast we've got metabolic issues got cardiovascular issues. I actually, in London I was at the health optimization summit, and they were like talk about optimizing your hormones and your sexual health and people were really shocked that I was so much time on insulin I was like, let's talk about insulin because insulin resistance hates your clitoris. Yes, yes, no this and here's the fact I bet I just read this I did not know this till literally Sunday night I'm doing the research to do a presentation on nitric oxide. Hemoglobin A1C is that goes out that literally binds free nitric oxide, not nitric oxide. I didn't know that. I know me neither. Oh my God that makes so much sense. So basically an insulin and basically it creates more insulin resistance because the receptors and because of blood flow so just so those of you don't know we're getting excited about this nitric oxide nitric oxide is naturally made by your body it's made from fruits and vegetables. You can now take pills and things that are like beet juice that's great but truly food is a source of nitrates which are converted in your microbiome in your mouth to nitrites, which then your body uses to convert to nitric oxide nitric oxide is a vasodilator opens blood flow to the brain to the heart to the penis to the clitoris like to the all the organs where we need this so men and women especially as we age most of the time, and especially if you're a man out there we're not really talking to men today but if you're a man you're listening, and your Viagra isn't working anymore. That means you don't have enough nitric oxide because that works based on the fact that you have nitric oxide and same with women so this is such a core. And like I said I was reading about the metabolic dysfunction with low nitric oxide and it involves the fact that higher A1C is going to bind that up. If your A1C is like eight or you're totally diabetic, you're going to have sexual dysfunction because you're binding up the nitric oxide. And let's just like I want to just double tail on that and saying, we have recognized for decades that cardiometabolic issues lead to sexual dysfunction, erectile dysfunction in men. Well accepted medicine resisted this concept in women, being like it has no bearing it doesn't it doesn't relate. The reason is, is because the doctors are so poorly trained in clitoral anatomy. In fact, is this normal has three diagrams of the clitoris because the average medical textbook the majority of medical textbooks don't even have one that is actually representative and I actually, I had an artist draw all these up for me. And I had them do a cross section, showing like the corpus cavernosa and all of that my editor was like gone too far like. But what I was showing is that if I took a cross section and a cross section of the clitoris it is the exact same tissue, because that was embryos, it was the same same. Testosterone came in and the penis is the one that differentiated from the clitoris clitoris is always what it was planned and and testosterone and a gene on the y chromosome. They decided otherwise and they went pita so it is mind boggling to me why medicine when I even still get people who push back on the medicine regards this is like this is true this is fact for men, but women who the same exact tissue who are saying I'm losing a little bit of sexual sensitivity it's hard to orgasm doctors like you're just getting older it's the way it is and I'm like, okay, sexual function pleasure, super important, but I've got alarms in my head because if you're saying that to me I'm like, where's your insulin, where is your blood sugar, because if your clitoris is filling that effect, your eyes, your kidneys, your fingertips like your heart, all of these other tissues are going to start feeling that effect as well. And where it may show up first is that place of your body, and that may be the first place that you, you tune into because so many other things were told are normal, like, you're starting to get old and your vision is changing. Okay, true, I just change as we age. However, those can also be signs of serious cardiometabolic issues. Yes. Yes, so just to repeat for those of you listening men are women and again probably right now majority of the artists women but if you're having to live with men, or they know men. Yeah. Either way though, if you're having sexual dysfunction, like Dr. Joellen Brighton said she said, if this is a sign that there could be a vascular cardiovascular issue it's literally the very first clue a lot of times for endothelial dysfunction or vascular dysfunction. So there's a way bigger importance than just sex here, although that is important, right. It could be your health. Let's talk about menopause of women. I'm one. I had briefly tell you so I had chemo at 25 for breast cancer my period stopped for two years my poor ovaries back then but then they started and then I had undiagnosed celiac and anemia and I stopped my periods amenorrhea because I was undiagnosed celiac for two years in my 30, and then they came back and my I'm just like so happy with my little ovaries because they have just like fought and fought and fought, but then when I turned about 45 they started sputtering outside I don't know that's kind of early but not super early considering what I've been through. So I am in was I'm not afraid to say that but let's talk to those women out there. What's average age what symptoms and then what do these women do about it because a lot of doctors don't know how to console them, and it doesn't mean you're you have to have vaginal dryness or poor sex or poor libido or poor functional function or poor sleep. Let's talk about these women in menopause. Yeah, we would never accept that for men. This is what just really chafes me is that when you look at how women are treated, and it is changing but it's only people are like so much has changed in medicine I'm like only in the last couple years because a hell of a lot of celebrities, we're like we're not going to be quiet about this, we're going to start organizations we're going to get loud. We're going to like make our own networks and I'm like, man, like, you see what the Kardashians do and then you see what these other celebrities do and I'm like, I feel so spider man with great power becomes great responsibility. Look at this change you can make because like you and I we're shouting it all day in the western medicines like whatever women suck it up. Let's talk about it though because when when we talk about menopause like what exactly are we talking about what's Perry menopause so it is normal to go through menopause at age 45 that's the youngest accepted age and the average woman is going through it about 51. Okay, however, Perry menopause can start seven to 10 years in advance. And so that means you might be 35 and you're starting to experience symptoms of hot flashes. The regular periods and the periods stretching out beyond like seven days or more like being long, or, you know, going, going be like used to be like 28 days and now you're like 35. It's happening more the tail end of Perry menopause in the early Perry menopause. This is where like the hot flashes start to come up mood symptoms. So as our hormones change, they it's changing in the brain as well. We might notice weight gain loss of muscle mass. We might notice that now we're starting to get like hair growing in places and unlike the PCOS picture that was happening much earlier on the acne. That's so lame like who wants to 40 with acne. I just laugh about it because I went through that and I shared it online just a couple weeks ago. Thanks to like the hormones that I'm using. So with that, there's this collection of signs and things with Perry menopause itchy skin as estrogen starts to decline. When we get to menopause menopause is a one day event. It arrives 12 months 12 consecutive months of no bleed. So no ovulation no bleed. You are now menopause tomorrow the next day you are now post menopausal. Now with the hormones, people always think like estrogen is so problematic and estrogen is where we need to start. I sometimes see people saying like Perry menopause, you should start estrogen now and I'm like hold up. So this is where it can look more and more like that PCOS picture that we talked about before it's not PCOS just so we're clear, but since people already heard that just to link back in in that when ovulation becomes more irregular, progesterone production becomes more regular because the only way to progesterone is to ovulation. And so estrogen is unchallenged. As you're becoming irregular in your cycles, your symptoms may be related to estrogen, but at the root of it. It's because of what's going on with progesterone. So if we're going to use hormone replacement therapy progesterone is where we start. DHEA is another consideration, and it's important for everyone to understand this is a anti aging hormone that our dream lands make it starts as decline at 25, which is so lame because for menopause we need it because we turn DHEA into estrogen and testosterone. And so during this time during this phase this Perry menopausal phase like we want to support the ovaries and producing progesterone regularly ovulating doing everything they can when they when they don't got it in them anymore. That's where we look first at progesterone bio identical. I really love oral because it gets metabolized and it's metabolites are what help you sleep. Gabba anxious. And so that insomnia that inability so if you were trackable like I do. So these wearable technologies are great way for you to tune in what's going on. And what I'll say is that if you are tracking your cycle and you're looking at your body temperature and your sleep. And you are in your 40s and you are finding body temperature like body temperature goes up after ovulation because that's what progesterone does, but it's going a lot higher prior to your period and your sleep you have more sleep disturbance. You're not getting as deep sleep you're starting to have those issues. That's a sign that you are in Perry menopause and that you might not even fill it yet you might feel tired in the morning but you're not cluing into what's going on. And that technology may very well be cluing you in and showing you okay this is the pattern and this is what's happening here. But in the menopause this is definitely a time that we should consider hormone replacement therapy so extra diol E2 for the vagina E3 astral that is lovely for vaginal dryness and for anyone who has hesitancy around this because there's a lot of doctors that are like that's just going to give you cancer and it's horrible. So about 60% of more of women go into elder care facilities because of incontinence. They're they're not able to make it to the bathroom on their own they have to have somebody tending to them for that. We can prevent urinary incontinence by getting people with occupational therapists or pelvic floor therapists who work in that area, and making sure that they have hormone stimulation to that tissue. Yes, because estrogen isn't just about great sex the ability to self lubricate estrogen is why you're able to make the glycogen the sugar that feeds the lactobacilli in your vagina that keeps the pH moderated so you don't end up with BV yeast infections and even urinary tract infections. It also helps with the musculature and the tissue of the pelvic floor so that we are less inclined to be heading down the road of vaginal atrophy atrophy so thinning of the tissue and this can be uncomfortable to walk or you wipe with toilet paper after urinating and you bleed. And all of that's going to affect your urinary tract system as well and so that's a reason to consider topical estriol E3 and this is the hormone of pregnancy. It is a weak hormone, it will get its job done down there, but it is a weak hormone estradiol is the one that is a much more potent hormone. And that is one that I'm always like just topical friends because it's when we take it orally that we see the increased risk of clots and the so for everyone to understand anytime estrogen goes up clotting factors follow. This is why the pill pregnancy, any oral estrogen therapy is going to be a risk for a clot so stroke, pulmonary embolism, we don't we don't want to end up that stuff so if you're afraid of that that's something to understand that we don't we don't want to be going the oral route. So we talked a little bit about the estrogen and I don't want to like just to hear a preach from so to speak but testosterone is another therapy that often gets overlooked if you're doing DHA I don't recommend doing testosterone and never recommend doing DHA without knowing your estrogen your testosterone how your enzymes where it's going right. Exactly because you might cause hair loss or you might cause any and you don't want any of that but with testosterone therapy. This is really important for women. A lot of doctors, even doctors doing hormone replacement therapy are like women don't need testosterone and I'm like, we do. Because it's important for our mood. If you find you're crying all the time you lack motivation you can't get up in the morning you're losing muscle mass, you probably have testosterone problems and the libido will also be a problem but notice I didn't start with the libido. Because it's going to be a whole lot of other things going on than just libido if you have low testosterone symptoms. So that was a whole lot of information. The, the other thing I want to say so I shared with you before we started recording. I'm going through IVF treatments, and I noticed during my pregnancies that I always have like great boundaries and I just feel like I always talk about testosterone is like you wake up you kick ass you set boundaries and on this and going through IVF therapy when I watch my I'm not monitoring my blood I watch my estrogen go up and I'm like, you know people always say that like testosterone is like the alpha hormone and I'm like estrogen is the alpha hormone because I didn't tell you like, you know, people had a lot to say about IVF. I'm injecting brain hormones that make my ovaries produce estrogen and build follicles, but my estrogen man, my brain I'm like my brain has never worked so well. Yeah, my life, my ability to just be like no you're not going to talk to me like that instead of being like you know that woman thing. Right, right, right. But like being like, did I do something. Should I attend to this. Is this my fault. I'm just like, no, no, no, no, no, like this is not the way it is. I will not be talked to it will not be treated like that and I'm I just like watch all of this like observing and I'm always like this and a one and I'm like man. That is so much I feel like this is part of the conspiracy of why we why they don't want to give women estrogen. My goodness, we are brilliant. We are powerful. We are all the things that this world needs us to be when we have estrogen complacent is not one of them. I love that you say that all my life my sister and I have been prone to PCS I don't think I've been full blown because I didn't have a lot of clinical symptoms but knowing that my testosterone has always been okay. I mean, postmenopausal that has not been my issue but estrogen was the big thing that I noticed and just like you said all of a sudden lack of motivation lack of like clarity planning executive function. That was all I actually realized that's not testosterone because my testosterone was normal. It was right. So I love that because I really realized I'm like wow this estrogen is really important and because of my history of breast cancer I was always more careful. I want to speak to that of course I'm 20 years out so but so many doctors are afraid even with a history of breast cancer now use this under use your you need to talk to your physician about this, but it is safe to replace estrogen in the right cases when you're doing the right forms, even after breast cancer if you're enough years out the study support this. And I don't want to be protective. Yes, yes, especially when you use it with progester or yeah because you're dividing cells and then you're differentiating so I want to say. Oh, sorry, I was going to say the amount you have to use to get symptom relief is so little and it, you know, no shade to Suzanne summers she was trying to she was doing the best you could with the information that she had like we all do. But that whole protocol that people are doing we never mess with that I had people coming to me being like, I want to have my period again and I'm like, you have a period because you ovulate I can't give you any hormones to make you ovulate again like if I could if I discovered that like oh my goodness I can tell in everybody but like you men straight because you ovulate I can't make you ovulate again. So just giving you enough hormones to make your uterus leave like what what are you doing there that's not. That's not in harmony with the way that things were designed so you don't need much I mean right my patients are very very little amounts of estrogen and I'm always surprised at how good they feel like on so little and I'm like if it works for you. Let's go. And you know in the case of auto immunity. We see auto immunity gets a lot worse in menopause as well because we lose that estrogen that helps modulate the immune system. And so with that, that's, you know, and I will say insulin makes us excuse me estrogen makes us sensitive to insulin as well which we know blood sugar regulation ties in to immune system function. But there are women who that are struggling with MS who are struggling with rheumatoid arthritis who are struggling with all these things that I mean rheumatoid arthritis and great disease oftentimes I'll see doctors be like no you can't have any estrogen, but a little right. Done just right and well monitoring that patient can actually help their symptoms immensely and what, what do we really want here, we want quality of life, like we want, we want every single woman in that wise woman phase able to pass on that wisdom, I know I do. Yeah, no great great summary and I've always said here again, because I've had breast cancer I can speak from that perspective, and I don't have to choose but if I had to choose between breast risk and brain risk. It's my brain. So even in that, it's a hard choice right but again, and I'm not we don't have to choose. There are safe ways for post breast cancer patients when they're far enough out with the right topical doses, low doses that are absolutely safe. Of course with your doctors input right being monitored, getting the right testing and having the methylation support that we know protects you against DNA damage that's. You can use the back like full circle to what we were talking about with the pill like you can use the pill, you can use hormone replacement there but you can use these interventions but we have to individualize it and we have to support you beyond that. And that has been such a disservice that modern medicine is done is like here's a pill, it's going to fix everything. Yeah, and I'm sorry friend that I can't give you something to fix everything because like I know that'd be super easy. This is unique every single day that is the major mover in medicine and that's what makes pharmaceutical interventions work better and have less side effects and yes you do have that much power. Love it, what a way to end with the empowerment of women and I love gosh, we could talk a whole other hour, but everybody the big thing is, grab a copy of her new book Dr Brighton this is brilliant it's so great because it's one of those you can keep. It connects to you and literally like reference it when you need help when you have questions if you need dietary but it's all in here, including the diagrams. So, love, love, love it love that you have put out your great work in the world. Where can people find you where can they find the book, give us a little bit of info about you. All right, so Dr Brighton.com DR BRI ghtn.com. That's my main hub where you will find tons of free resources to support your hormones. The book is there as well as all over in bookstores. And you can also find me on social media so at DR Jolene Brighton, whether it's Instagram YouTube Tiktok threads now. I know I'm like, I tagged you the other day, someone was like asking me about mold and I was like, Dr Jill Karnahan. And I was like, thank God she's on threads because I know right when I want to give somebody a resource or referral. If they're not on social media, I'm like, I'm going to give this person your name and then and then they're not going to they're probably not going to search it they need this help now. So cool. Well, everybody go out check a copy get your copy of this book so worth having it next to you. And thank you Dr Brighton for your work in the world. Thank you for your enthusiasm. Thank you for that estrogen power. It's great to talk to you today. Yeah, thank you so much for having me so good seeing you and thank you to your audience for listening to us go off about hormones and how to help yourself.