I was listening to the Resetter Podcast by Dr. Mindy Pelz (you may have heard of her book “Fast Like a Girl”) and she was interviewing one of my favorite doctors - Dr. Carrie Jones (she is a hormone expert Queen!). The interview is amazing and if you haven’t listened to it, please do.
They talked about many important topics regarding hormonal health through the lens of metabolic health, but one thing that I wanted to highlight is Dr. Carrie Jones (who used to be the medical director at Precision Analytical - the maker of the dried urine hormone test called the DUTCH test) spoke about how she saw, over and over in the thousands of lab results she reviewed, the impact of stress and sleep during perimenopause. Stress has a MASSIVE impact on your hormones. So let’s get into a few examples of how this impacts symptoms during perimenopause and menopause.
At the School of Applied Functional Medicine, I learned how all our hormones act like a giant soup in our body. They all balance (or imbalance) each other. So you can’t look at progesterone and estrogen or testosterone (which by the way women also have and need - it’s not JUST a male hormone) in isolation. You also have to consider cortisol (the main stress hormone which is also a “master” hormone), insulin, and thyroid hormone to name a few, because changes in the level of any one affect all the others.
Chronic stress is a state that increases your cortisol production (and overtime, if the stress is sustained, it can also lead to very low cortisol levels in the body which is also concerning). High cortisol elevates your blood sugar (no matter how healthy your diet is, by the way) because your body is preparing for its fight or flight stress response which requires blood sugar to be pumped into your muscles to prepare your body to react to danger. Your body responds to raised blood glucose by releasing insulin to allow that glucose to enter your cells for the production of energy. However, if your muscles don’t actually utilize that raised glucose (to do something like sprint, fight, hide, lift weights, etc), and your body continually experiences high blood glucose and insulin spikes (perhaps due to periods of high stress occurring regularly), it can lead to a state of insulin resistance where your cells ultimately a less able to utilize the glucose for energy production. Sustained high insulin can also lead to many complications such as hardening of your arteries, as well as towards metabolic dysfunction - prediabetes, diabetes, heart disease.
But that’s not all… high cortisol also impacts your other hormones in a myriad of ways. It can lead to LOWER production of progesterone, estrogen and testosterone. When you are in early perimenopause, your body already is naturally slowing down its production of progesterone which can lead to a state of estrogen dominance that comes along with its own set of not-so-fun symptoms (think bad PMS symptoms like stronger cramps, heavier bleeding and clotting during your period, mood swings, bloating). Then in later perimenopause, your estrogen production also starts to naturally taper down. Add to it this high cortisol impact and BOOM - symptoms can start to hit you a whole lot harder leaving you pretty miserable.
High cortisol can also impact your production of active thyroid hormone which in turn can slow down your basal metabolic rate (hampering your ability to burn fat, for example), leading to weight gain especially in the abdomen and face. It can also lead to feeling exhausted, heart palpitations, increased anxiety, high blood pressure, difficulty sleeping, increased brain fog, susceptibility to infection, lower sex drive, constipation, bloating, and changes to your skin (just a few symptoms, right?!).
So, what should we do about it? First, it’s important to work with your doctor to get your hormone levels tested (don’t guess). One of the best tests on the market today is called the DUTCH test made by Precision Analytical. It is a dried urine hormone test that gives you a complete picture of all your hormones. It also has a saliva component which is a great way to test your cortisol levels throughout the course of a day (multiple saliva tubes at precise times throughout the day can give you a good sense of what your cortisol curve looks like -- and there are “normal” patterns that your cortisol is supposed to follow over the course of 24 hours). I’m a big fan of the DUTCH test because not only does it give you a complete picture of your hormones, it also shows you the metabolites of each hormone, and how you are processing, clearing (or not if the case may be) each one and down which detoxification pathways (some pathways are more protective and beneficial than others). If your doctor insists on using blood labs instead, you will usually want to have these labs run around days 19-21 of a regular 28 day cycle to get a snapshot of the “normal” ebbs and flows of your hormones.
Next, once you have a good picture of what your hormones are doing, you can work with a functional practitioner to balance out what is suboptimal. As a functional medicine health coach, my approach for this work is always multi-pronged. If your cortisol is suboptimally high during certain points of the day, we would address your sources of stress and your perceived levels of stress. We would add in stress-mitigating actions throughout your daily routine, and we would work on lifestyle habits like meditation, mindful breathing, yoga, or journaling to name a few. We would also consider using certain supplements that can help lower (or boost if need be) cortisol called adaptogens. We would consider your diet in careful detail and utilize food as both nutrition and medicine. We would also look at how you are moving throughout your day and adjust your forms of exercise as necessary (not all exercise is created equal)! Other lifestyle habits like sleep, electronic usage, and hydration are also important to take into consideration.
Yes, we all have stress in our lives, but how we deal with it is what can set your body up for success, or for a harder time, especially during the perimenopausal, menopausal and postmenopausal years. If you think you might be struggling with any of the above and want to take the next step in feeling healthier, stronger and more in control of your health, contact Payal by emailing payal@arorawellness.com.