Learn The Real Deal About Bioidentical HRT In Perimenopause with Jill Chmielewski
Today we’re chatting about one of my favorite topics, perimenopause. This time of a woman’s life can be so confusing and often times dreaded. I am here to change that, and so is my guest for today’s episode.
Jill Chmielewski is a registered nurse, certified health coach advocate for aging women, and a mom of four who is on a mission to change the way we approach menopause and aging.
What we discuss:
✨What is going on with hormones during perimenopause?
✨How Jill helps women who have trouble sleeping during this time in their life
✨How to approach Hormone Replacement Therapy for Women
✨What hormone balance looks like for women with fibroids
✨And a lot more on how to navigate this time in your life!
If you are struggling to understand your midlife body and hormones then this episode is for you! It is possible to feel healthy, strong, and vibrant during midlife and beyond, we just need a little guidance. After you listen, check out Jill’s many resources: The Peri to Menopause Roadmap, The Beginner’s Guide to Hormone Replacement Therapy, and Pausing Together
Jill Chmielewski is a Registered Nurse, Certified Health Coach, advocate for aging women, and mom of four who is on a mission to change the way we approach menopause and aging. She helps midlife women break free from the mainstream way of thinking where disease and decline are accepted as an inevitable part of aging ~ and embrace the notion that it’s absolutely possible to feel vibrant, happy, healthy, balanced, and strong through midlife and beyond.
Jill believes that education is the key to helping women understand their bodies, manage their health, and advocate for themselves as they age. Jill created The Peri to Menopause Roadmap and The Beginner’s Guide to Hormone Replacement Therapy to help women navigate the wild ride from perimenopause through menopause and beyond. In early 2022, she launched Pausing Together, an online community for women to connect, learn, and open up discussions on topics that affect “PAUSAL” women (available on Apple and Google).
Jill has been called upon as a “pausal” guest expert on Women’s Health Unplugged, The Period Party Podcast, The Forever Chic podcast, the Paloma Health Speaker Series, Corporate Wellness Partnership’s “Uncomfortable Conversations” Series, and The Dr. Louise Newson Podcast.
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Christine Garvin 0:02
Hey, everyone, welcome to this week’s episode of hormonally speaking, this week, I get to talk about one of my favorite areas to talk about, if you’ve been listening to the podcast for a while, you know that and that is Peri menopause. And the reason that I like to talk about that so much was is, of course I’m in that period of my life. But also, so many of my clients are in this place in their life. And there’s so much confusion about this time of life. And also just we’ve not been taught much about it, right? We go into this not knowing what to expect, when to expect things to happen.
I’m excited to talk to today’s guest Jill Chmielewski , who is a registered nurse, certified health coach advocate for aging women, and a mom of four who is on a mission to change the way we approach menopause and aging. She helps midlife women break free from mainstream way of thinking where disease and decline are accepted as an inevitable part of aging and embrace the notion that it is absolutely possible to feel vibrant, healthy, happy, balanced and strong through midlife and beyond. Jill believes that education is the key to helping women understand their bodies manage their health and advocate for themselves as they age. Joe created the parry to menopause roadmap and the beginner’s guide to hormone replacement therapy to help women navigate the wild ride from perimenopause through menopause and beyond. In early 20 to 2022. She launched pausing together an online community for women to connect, learn and open up discussions on topics that affect puzzle women. And that is available on Apple and Google. Jill has been called upon as a puzzle guest expert on women’s health unplugged the period party podcast the Forever Schick podcast. The Paloma health Speaker Series, corporate wellness partnerships, uncomfortable conversation series, and the Dr. Louise Newsome podcast. Welcome, Jill. Oh, that
Jill Chmielewski 2:17
was so fun. Thank you. I’m so excited to be here.
Christine Garvin 2:20
I’m so happy that you’re here. That’s like, that’s so great. All the things that you are doing in creating for women at this stage of their life, which we know is crazy time.
Jill Chmielewski 2:33
Confusing. Probably the best word right. But
Christine Garvin 2:36
it that way, right this puzzle time. I like that you identify it that way. So let’s start off with what that is for women that aren’t you know, in the know yet.
Jill Chmielewski 2:45
Yeah. And the reason I say puzzles because I think we’ve always thought about menopause is this like finale like this one day, I wake up, I just no longer have a period done, everything is done. And I move on with my life. And I think paazl is just sort of, you know, compasses these years, which start really for most women in their 30s Believe it or not, mid 30s, late 30s Some women early 40s. And they never really end it’s like you have perimenopause, which is that time leading up to menopause where we have hormonal changes, but really the hormones peak in our 20s. So if you think about it, if we peak in our 20s Unless we get pregnant, you know, our rooms are sort of on this slow. I hate to say it this little bit of a trajectory downward. And then in perimenopause, mid 30s, late 30s, early 40s, there’s that more sort of accelerated change in hormones. And that continues until menopause, when we have really, you know, we have low hormones, yeah, but they’re probably still not even rock rock bottom yet that will continue so that postmenopausal time we’re still continuing to lose hormones, you know, until we really do sort of hit that rock bottom. And I say that not in a negative way. But just for women to know that they’re really we’re not squeezing out hormones anymore like we used to.
Christine Garvin 3:59
Yeah, absolutely. And, you know, I know this is sort of a big debate around that when perimenopause starts, right, because so often, I mean, I feel like allopathic doctors often don’t even think about the pre menopausal time, or they’re like, oh, that’s the two years before you go into menopause. When in reality, you know, I think, Well, it’s funny that they say it’s harder to get pregnant post 35. Yeah. Because your progesterone is naturally starting to decline at that point. Right. So right, why they don’t delineate that as this time where it’s, you know, your things are changing, like especially you’re in that that period. Yeah,
Jill Chmielewski 4:40
yeah, they do that and they overlap, like you said, so it’s like the reproductive years and perimenopause overlap for a while. So it is really confusing and I think there’s so many symptoms of perimenopause that are attributed to other things, but they’re really come back to the physiology of the body what our hormones do and when they start to change. We start to see changes. And sometimes they’re super, super subtle. And they’re like little whispers that you almost don’t even know that it’s, you don’t pay attention. And then all of a sudden, you’re like, wait, something really does feel a little bit more different. But it’s such a vague symptom that could be attributed to so many other things. So I think doctors tend to miss them. You know, a lot of times good point.
Christine Garvin 5:19
Yeah, absolutely. So let’s talk through what the hormonal changes are looking like. And then what some of those whispers might be and what other areas you know, women should really pay attention to as they age.
Jill Chmielewski 5:33
Yeah, yeah. So I would say like mid 30s. Again, it’s a little tough to say the timing because the world has become as you know, a lot more toxic, lots more chemicals, a lot of endocrine, what we say endocrine disrupting chemicals, which just means hormone disrupting chemicals, as you know. And those two can sort of play into some of the reasons why maybe women even start perimenopause earlier. So but if we were to really kind of maybe generally speaking, say maybe mid 30s, you may find that you’re having a cycle or two per year that you’re not ovulating. And that, you know, we only make robust amounts of progesterone when we ovulate. So mid 30s, we may have a couple of cycles where progesterone is really low. But then some cycles were very robust. So it’s sort of like a spotty Wi Fi. I think like there’s a little bit of this, like communication, that’s, you know, the brain is telling the ovaries to do something, and it’s like, you know, something once in a while not really responding very well. And then we’ll start to see over time, estrogen starts to fluctuate, so it’s not like this rapid just downward spiral. It’s up, it’s down, it’s up, it’s down. And I think that’s probably where the symptoms get really confusing. Because you you’re almost like, inclined to maybe make an appointment with your doctor or you want to go seek help. But maybe one cycle was like a great cycle. And you’re like, No, no, no, okay, actually, I’m okay. Again. Yeah. But it’s really going up, it’s going down, it’s going up. It could be I mean, it’s all over. It’s like a, it can be erratic with no rhyme or reason. So we have these like years of fluctuating estrogen before, as we say, usually the couple of years before menopause, then estrogen starts to take that sort of like nosedive downward and sort of meeting progesterone, where it’s at. And there’s other hormones, too, we see thyroid hormone often changing during this time, I see. Testosterone is also going down that peaks in her 20s, typically, which women don’t think about, but we have a lot of testosterone, and we need it. Yes, we do. That’s going down and just think of it as like the like the I guess it’s the forearms memory, mood, motivation, and muscle. So if that’s data is changing, we start to see those things change. So we’re kind of getting this big, broad, you know, series of hormonal changes all a little bit at different times, and a little bit different for every woman. So it’s, it’s a little confusing, but that’s sort of the general overview.
Christine Garvin 7:59
Yeah. And I like to, you know, point out that I’ve had clients who are even 48 4950, right, which is 50, or 51, is the average age that women go into menopause, and will test their hormones and their estrogen will still be like crazy high. But like you said, it’s good to just been that month, and then next month, it’s crash, you know, but I think so often women think, Oh, my estrogen is just going, you know, way down by mid 45, or whatever. And in some cases, that’s true. But a lot of times, that’s not necessarily the case that estrogen is just like, all over the place for a lot longer than we think.
Jill Chmielewski 8:38
Yes, absolutely. And then the magic, I mean, I think we get so caught up in the period, like, Okay, I no longer had a period, but it’s really estrogen is what builds the uterine lining. So if estrogen that month was really low, you may not get a period, but then maybe the next month, you have just enough estrogen so that you’ve got a uterine lining, so you’re going to share that uterine lining. So that’s where it’s like, what is going on with my body? This major confusion? Yeah, yeah, that’s absolutely.
Christine Garvin 9:03
So as women, you know, start to embark let’s start with in their 30s When things start to change, what are some of the things that they can do to support their bodies at that point?
Jill Chmielewski 9:16
Yeah, I mean, nutrients. I mean, it’s kind of always I feel like every stage it’s kind of that same foundational pieces of health, which I know no one wants to foundation. I don’t want to do that. Right. Like it doesn’t help but it does. So, but the hard thing about perimenopause, so sleep is going to be huge. Always. I would say stress is probably probably the number one that’s really going to disrupt that hormonal rhythm in the body. Sleep is that is a hard one because we’re telling women we want them to get sleep yet when progesterone is going down. They can’t. They can’t sleep, you know, and when estrogen is fluctuating, they can’t sleep. So so that’s where again, this is where hormone replacement can really shine. So that’s something women can do Eve I’m in their 30s. But if we’re looking at foundational things, it’s the sleep, it’s the stress, it’s the movement, but in a way that really works for your body. I mean, we have to think about building muscle, we’re going to be losing it at an accelerated pace. So those like, you know, and I’m not knocking, like an orange theory, but it’s like, we can’t necessarily it’s not necessarily good. We’re stressed all day to go bananas, you know, for an hour with our cardio that really crosses. Exactly, even though we want to right, yeah, yeah, um, you know, I think there has been, and I just think, pausing, that’s why part of the reason for even, you know, the membership community that I have called pausing together as we are in this 24/7 mentality, and in our 30s, when, you know, a lot of us have kids, or it’s our career, or it’s both, there’s a lot going on, it’s like that high production time. And I know, it’s like, we don’t want to be told to not produce because that’s our society. But that’s the time in our 30s to kind of say, you know, is this working is, am I getting some little subtle whispers that are making me like, my body’s changing a little do I need to adjust a little bit and start thinking about, you know, not these massive changes, but are there’s like, just some little tweaks here and there that we can do, whether it means getting a little more sleep or saying no to an outing on the weekend, because you do need your sleep or, you know, not staying up till all hours of the night or drinking as much as you’re used to, or whatever it is anything foundationally that is going to support the body. That’s where we really want to start.
Christine Garvin 11:27
Yeah. And I know it’s hard for a lot of women, I went through this myself, I see it with clients, you know, what you just brought up the drinking the alcohol, and how that really starts to impact your body so much more as your hormones start to fluctuate, and particularly with sleep will just rob you of that sleep,
Jill Chmielewski 11:47
Christine Garvin 11:47
It’s like, even if you think, Oh, I drink a glass of wine to help me go to sleep, half the time you’re waking up at 2am or 3am, or 4am. Because of that, you know, I know that that’s, that’s a tough one. But it you will be very thankful to yourself in your 40s if you start to come back from this promise you because I know post 40 It’s a completely different world trying to drink alcohol,
Jill Chmielewski 12:11
isn’t it? It totally is. I mean, along with the alcohol, the food, which I didn’t touch on, but the nutrition because I think we kind of look at this, like, oh yes, nutrition, I should eat better, but thinking about the way that hormones work and the way that they you know, they signal to receptor. So for your listeners, it’s, it’s like a little satellite dish sitting in the cell waiting for a signal. And they need nutrients to help that communication so that that hormone can signal and if we don’t have our vitamins and our nutrients, or minerals, all those things there, the signal may not be sent. So we can actually help to improve the signal, if we can get some good nutrition onboard. And along with that is eating very well like in terms of slowing it down chewing thoroughly. We can’t digest food if we’re just going to swallow it whole. So we really want to just this is where it’s like that slowing down just a little bit. It will go a long way to really help us Yeah,
Christine Garvin 13:06
absolutely. I try and always let my clients know one of the best ways that you can help your digestion is taking three deep breaths before you eat, right? Because it we’re just in our sympathetic nervous system all the time running around, and then we’re trying to eat and not digesting well. And it’s like, for everything in your body that runs in your body, including your hormones, you need good nutrients, and you need to be absorbing those nutrients otherwise, and I couldn’t get anywhere.
Jill Chmielewski 13:31
No, no. So we do all that hard work cooking or preparing. And it’s like for nothing you know, so it’s just makes sense. three deep breaths. It’s no big deal. And you feel so different. It’s like everybody knows when you take them. You’re like, wow, you just feel like you just calmed. You can feel this calmness come over your body.
Christine Garvin 13:47
Yes, absolutely. Yeah. So let’s speak a little bit more to the sleep because I know that that’s a big issue for so many women. And absolutely, you know, the progesterone, particularly the oral progesterone, if you’re at that point where your progesterone is really low that oral progesterone can be helpful for a lot of women. What other things before say their progesterone is not that low yet. Or you know, they’re not ready to go on hormone replacement therapy. What would you recommend that they start with?
Jill Chmielewski 14:16
I mean, I honestly I feel like starting with the like looking at your day because I think if you think you’re going to be bananas all day and then your body is just going to very peacefully, you know, go down at night. It’s like thinking about how we would if you have had little kids before there’s a process like getting into a bedtime ritual setting yourself up so that you can fall asleep so you don’t have this like a million things running around in your head. Caffeine I think is really big for women that they don’t always connect. I’ve done it myself and I think we don’t realize how many things caffeine is in which, you know, coffee actually has really does have some health benefits. But if you’re having it at three o’clock to get through the afternoon slump, it’s really going to take its toll in terms of trying to fall asleep at night. So, you know, melatonin for some women like there are things that go back to nutrients. There are some supplements that can be helpful with sleep, there’s some herbs that can be helpful with sleep, but it really depends on the woman, melatonin, teeny, teeny, teeny tiny amounts is really all people need and could experiment with to see if it helps them a little bit, right? Um, you know, you want to just be mindful, because we don’t actually make that much melatonin. So when people are taking 10 five milligrams in the morning, you know, we want to be mindful of that. And again, you know, there’s other herbs and things like that sugar too, just thinking about like sugar before bed, just being mindful of that, like nighttime routine and what you’re doing before that so that you set yourself up for better sleep. You know, I try to avoid a lot of the, you know, I think trying to avoid some of the medications if possible, we just know that the sleep hypnotics sometimes you need it, you know, sometimes there are times for everything. But I think we just want to be thinking about like physiologically what’s happening in the body and addressing right, the root cause whatever that is. Yeah,
Christine Garvin 16:05
absolutely. Okay, so now women are moving into their 40s. What are some of the things because you know, things I’d say? This is very much averaging. But like 4344 often is when you start to see some bigger changes. It’s not maybe as much of a whisper
Jill Chmielewski 16:24
yes, that it was a loud scream. And we say, yeah, yeah. So fatigue is a big one. And that is even a big one. In perimenopause early on in like mid to late 30s, we’ll see fatigue, which gets attributed to a lot of other things. Anxiety, because estrogen is up, progesterone is down, we’ll see anxiety really creeping in, even in women who never experienced anxiety before, and they’re like, I have never been an anxious person. But this estrogen up without progesterone balancing it out really makes a difference. So that’s a big one. We’ll see some time, a lot of times, we’ll start to see some changes in your period. So not every woman will see that, especially in their 30s Right out of the gate, you know, because you can still have a period. And if you don’t ovulate, right, I mean, women need to know that all waves Yeah. But oftentimes women will see their periods can be shorter, they can be longer, they can be heavier, they can be lighter, you can skip, you can get to nine months without a period. And now you’ve got a period again, so that clock resets because menopause is really 12 months, without consistently without a period. So there’s just so much fluctuation happening, um, weight gain, that’s where we really see weight gain heat up. And I think most of the studies show it’s in the years before menopause, where women are apt to gain the most weight. And it’s interesting. Yeah, it’s not just the NA, you know, it’s not just the weight. It’s the body composition changes, which are really hard to see for women, right? Oh, so absolutely. Yes, skin changes, vaginal changes, even maybe, maybe more uncomfortable. Sex, maybe, maybe more yeast infections mean, the pH of the vagina changes as hormones change. So these are the kinds of things where I’m gonna say, you know, I just didn’t, I’m things are changing down there. But I don’t know exactly what it is. So that’s where we get those kind of heavy hitter physiological symptoms. Although, you know, it’s interesting about 75% of women experience symptoms, and 25%. Don’t
Christine Garvin 18:17
which, Wow, am I surprised I said, Hi.
Jill Chmielewski 18:20
And we always sort of say the women who experienced symptoms are the lucky ones, because you want to be thinking about this, that we’re all having the same physiologic things are happening behind the scene. So when hormones change in our 40s, we’re going to start to have Beaumont muscles, like all these things are happening, right? But if you don’t have symptoms, you may not be a cluing into it. So even though sure your listeners are not excited about those changes. It’s a good thing. We need to be paying attention.
Christine Garvin 18:50
Yeah, absolutely. Yeah. So what are some of the things around that age? You know, I mean, obviously, you know, things you already talked about in your 30s are important to continue to do or if you haven’t started to do that at that point. But yeah, above and beyond that, what what should people be doing?
Jill Chmielewski 19:06
Yeah, I you know, we so we always go back to the foundational things. I really feel like at that point, and really, even when women are younger, seeking out help getting a menopause practitioner, and when I found out he meant that as somebody who really not someone who do like a weekend seminar on menopause, someone who understands it, because, you know, we are losing hormones and women, you know, used to we used to not live past 50 years of age, so write in like the year 1900 I think the average life expectancy was 50. Well, menopause is 51. So it wasn’t a big deal. But now we have like artificially extended people’s lives, like we have all of these things that people can do to live longer, right? But we’re gonna live like 3040 50 years or so half half of the live or less. So yeah, this is where hormones I’m a big proponent of optimizing hormones. And, you know, if the lifestyle pieces aren’t doing it, yeah, you’ve got to go back to the physiology and go back to the root cause and say, You know what, maybe bringing in a little bit of hormone replacement is gonna go a long way to helping to not just alleviate symptoms, but to protect the body systemically. So we’re kind of get like killing two birds with one stone. And it takes a while to find a practitioner. So in their 40s or late 30s, that’s the time to start seeking someone really help you. Yeah. And support your body in that way.
Christine Garvin 20:30
I’m really glad you brought that up. Because I think that does happen, right? That women are 48 or 49. Before they’re like, Okay, I really, really need help. And then it can be really tough to find that support that they need. You’re already sort of past this point. I do want to talk now about hormone replacement therapy, because I mean, we’ve definitely talked about it on the podcast before. I’m definitely a proponent of a two for the, the bone, the heart. And what’s the other one on this blood vessels? Yeah, yeah. And the memory, you know, right now, I know as I’m getting ready to start my period right now. But yeah, I mean, if we’re looking, you know, postmenopausal or menopause years, as some people call it, you know, these, these are the three huge issues, right for women is that mean, osteoporosis is rampant, right. I mean, majority of women will have osteopenia or osteoporosis. I mean, dementia is huge for women, and then heart diseases for women, that’s, you know, just starting to be talked about more now. So, so yeah, let’s talk hormone replacement therapy.
Jill Chmielewski 21:39
Yeah. So, you know, I think there’s been this fear of hormone replacement therapy. And I won’t go into all the details, but it’s because of the study the whi which was done in prematurely stopped in 2002, who, you know, where it was really falsely sort of put out there that hormones cause breast cancer. And, you know, very quickly, there was a reanalysis done, and it was, and even at the time, it was statistically insignificant, but that’s not what was communicated ah, dry. So, you know, it makes me crazy to trust me, it’s like, there’s
Christine Garvin 22:08
doctors that still say that to this day, this day.
Jill Chmielewski 22:11
So I think women have been fearful of hormones for such a long time. But we go if you go, this is where we’re, you were saying to with education, you and I were talking before the show, understanding your body is really will go a long way to help you in this time, because we’re OPT, all we’re looking at doing is optimizing hormones. And we don’t you know, hormones are measured in parts per million parts per billion parts per trillion. So when we’re talking about hormone replacement, we’re not slathering, you know, like that’s in that’s in jars of cream on our body, it’s an even in the creams is 1% to 3% is the hormone the other 97 to 99% is the base. So right, we’re talking about bringing in estrogen, we’re talking about bringing in progesterone, which are both very important for bones. Very important for blood vessels, very important for the brain, all the things you just said, for muscles too, because women lose bones, they lose muscle, then they fall in osteo, product, bone or bones with osteopenia, then they break a bone, then they end up needing going be not becoming independent, like we’re now you know, and I’ve seen it firsthand recently, in my own family with my mother, and on a nursing home, no one wants to go there, no one wants to be having bladder control issues, all of these things that happen when we lose muscle, like in our pelvic floor, too. So we want to be thinking long term. And we want to be thinking short term too. So I always think about it as like kind of replacing as you go. So as it’s going down. Don’t wait until you’re now 50, or whatever, three years past menopause, there’s been this sort of slow trajectory down from our 20s, not to say to replace in our 20s. But there’s a certain point where we really especially when you’re feeling those symptoms, yeah, we really want to start, we want to make sure we don’t lose those protections of the blood vessels. We want them to stay flexible and smooth. And as soon as that estrogen goes down, he becomes stiff and sticky, you know, and so we want to make sure we’re really doing what we can to support the body. So hormone replacement is I think, you know, it will probably it is coming back. We’re having more conversations again about it. But I think there’s been more and more research put out there finally, that is vindicated estrogen. We all have lots of hormones flowing through our body when we’re pregnant. We’re most of us not getting breast cancer when we’re pregnant. So we’re thinking about what these hormones are actually doing in the body.
Christine Garvin 24:28
Right? Absolutely. So I have a maybe tricky or sticky question for you. Just thinking about myself so you know I had fibroids I had a fibroid misshapen and all of that. And so you know, I test my hormones pretty consistently and you know, I definitely tend towards that higher estrogen and favoring at different points, the 16 Oh H pathway or the four h pathway, right? So I’ve always been Even in the times after where I had been doing some work, I was still estrogen dominant. Just recently, I was for the first time not estrogen dominant, which is great. But it was also like, lose my estrogen a little too low now. Right. So it’s it was still and I it was a Dutch test, it was still in cycling range, but there’s a lower end. Right. So my question is, you know, because I continue to take dim and other, you know, supports for my phase one and phase two, liver detox. But this is a tricky area, right? Because I don’t want my estrogen to go down too much. So in a situation like this, what what would you sort of recommend or? Yeah,
Jill Chmielewski 25:42
I mean, I know, again, it goes back to optimizing. And I think just thinking about you want the balance? Like, it’s not just, I think, thinking about the hormone, maybe, you know, hormones receptor function, how can we make sure those receptors are functioning well, that we’re detoxing the hormones, getting them out of? And then pooping, of course, to get them out of the body? So there’s this whole process that needs to happen? Yeah, um, it took, you know, it depends, I mean, cruciferous vegetables, as you know, I mean, this is the whole rationale behind them. They’re very, very supportive with liver health. So I think anything you could do to support the liver, you want to be doing right, and to support those pathways, obviously. But we do need hormones, and even in women who have had fibroids, yeah, we it’s a unique case by case basis. And you go and you, you know, it’s low, like we talked about earlier, low and slow, whatever you’re doing, even when you’re bringing replacement on as well, yeah, you can do dim, but I would say, you know, you want to be thinking about, like pay attention to symptoms, how are you doing, you know, and if you’re feeling, you’re starting to feel some of those low estrogen symptoms, maybe you’re switching off of something like dim, I mean, it’s something that I usually don’t recommend taking it permanently, or any supplements. So if you can do just more of the foods that will work sort of in synergy with each other to help support the liver, you you may end up with that really nice, beautiful balance and those pathways are, you know, going in the direction that you want them to. Right. I don’t know if that answers your question, or Yeah,
Christine Garvin 27:09
I think, you know, it’s it is one of those sorts of tough cases, because I definitely agree with you have not longterm any. Usually I tell my clients, you know, not longer than three months. Yeah, without retesting, to see, you know, I’ve gone on and off of it, I do tend to have those best high estrogen symptoms if I go off of it, which isn’t part of the problem. But I do want her in a case like mine, if it’s actually worth testing, you know, yeah, every two or three months to kind of see because that could have been an anomaly that month, really? Would the you know, I mean, 43. And to see if it’s like, okay, am I having overall low estrogen now or lowered estrogen? Or was it kind of that time and, okay, now it’s back up, you know, and so I can release? Yeah, based off of that.
Jill Chmielewski 28:00
Well, and the other thing to think about, you know, so I don’t recommend testing hormones during perimenopause. Oh, okay. Yeah, went up, down, down, up, down. So you’re going to have I mean, the problem is, then if you are you feel symptoms, you’re like, I don’t know what’s going on. And I think we are so like tied to data points sometimes. Yeah. But all of these things are happening. And the thing about the highs and lows within perimenopause that women have to understand is, that’s really the brain trying to cue the ovaries to produce and so you can have even greater estrogen dominance. And then these great falls in estrogen. Because the brain is telling the ovaries produce produce produces trying to produce produces really high, then it drops again, and this is where it’s going to seem counterintuitive, but this is where bringing in some estrogen replacement. I know that seems odd, but it’s going to calm the brain down. So it’s not screaming at the ovary. Yeah, get this very low level estrogen.
Christine Garvin 28:55
Yeah. So typically, we
Jill Chmielewski 28:57
say until you’re actually post, you know, post menopause and you’re trying to follow up on let’s say, hormone replacement therapy, to sort of check levels. Don’t test during perimenopause, it’s too all over the place. You’re not going to have a very valid, you know, I guess result and your treatment is going to be based on that one moment.
Christine Garvin 29:17
Right. Time. Yeah. Yeah.
Jill Chmielewski 29:20
Christine Garvin 29:22
So then when you work with someone, you would go more based on those symptoms. If you’re like, Okay, these low estrogen symptoms are here. We’re gonna try that estrogen.
Jill Chmielewski 29:33
Yes, yeah. And you start very, very low. And so I work with a doctor, Dr. Rosen sweet, who has actually a line of organic Okay, they’re all getting hormones and organic oils and it comes in like a dropper bottle and what I love about it is for someone especially in perimenopause, you know, you’re rubbing so estrogen goes on your wrist, you’re literally tipping the bottle. So if you picture like an essential oil bottle, it’s a drop. You can put a drop on your wrist, rub them together. Um, it’s a super low dose of the lowest dose, I think it’s like point four, four milligrams, okay.
Christine Garvin 30:04
And as I master dial, it’s a bias. So it’s the
Jill Chmielewski 30:08
combination of the two. And so you can titrate the beauty of them is, if you’re having a month, especially if you’re tuning into your body, usually in perimenopause, you’re going to probably can stay on the lower ends, you might be using a drop in the morning a drop at night, maybe it’s just a drop at night to help you sleep. But if you’re having a high cycle, a lot of times women know that they’re having this kind of estrogen dominance cycle, maybe if they’re feeling it sounds like you kind of know when things are happening. You can titrate accordingly to what your body needs, which is I think the beauty sometimes in in HRT that has like dosing capability where they’re not just giving you one, here’s your prescription, take it every day, right? We don’t want to be all over the map. But when you can titrate in that way, where it’s just a tiny, tiny amount. It keeps you level, you’ll know in about a week or so you can say okay, we usually when we’re even titrating, some into hormone replacement therapy, we usually say a drop in the morning, a drop at night or a drop at night, in a week, like see how you feel you’re going to know if are you sleeping through the night? Are you feeling better? Do you feel like you’re more level are all of the things kind of falling into place? No more hot flashes, you know, maybe no more joint pain, whatever you’re experiencing? And if you’re not, then we usually say okay, go up to the next, you know, Okay, the next week go up a little. So there’s so much it’s not difficult. But there’s so much I guess personalization really, with all of this, that it really helps to work with someone who really knows their stuff.
Christine Garvin 31:35
Yeah, absolutely. Yeah. Do you often start women on progesterone first, or alongside the estrogen?
Jill Chmielewski 31:43
Always progesterone with estrogen, no matter what, even if you have a uterus for the women out there, because we need both hormones, and they really do much better. And when they’re balanced with one another. Progesterone makes estrogen receptors more sensitive as well. So, you know, if we don’t bring progesterone on sometimes women will start estrogen. And over time, they’re like, you know, not having that same effect anymore. Yeah. When these hormones are, so they’re like a family and they really need to be working together. Well, not all families work well together. I guess that’s true of our hormones do they don’t always work well together. But in a really like Zen family, that’s we want those hormones to be estrogen and progesterone always together? Yeah, absolutely.
Christine Garvin 32:23
Yeah. That’s awesome. What so I assume with testosterone to that ego based on symptoms in bringing that in.
Jill Chmielewski 32:33
Yeah. So testosterone, oftentimes, we typically will find that women testosterone will continue to go down through perimenopause, sometimes you’ll have a little bit of an upper lip. And that’s just the body trying to make the the brain you know, the brain trying to make the body like make some more estrogen. Yeah, because we make estrogen from testosterone. So sometimes women will say, I’m starting to get, you know, like a few like rogue hairs or oily or skin or something’s happening, they may have a little tick up in testosterone. But we typically find within about three years of menopause, most women have rock rock, rock bottom testosterone. So oftentimes, we’re starting that to earlier on before we get to that point where we are right, we don’t want to get to the place of rock bottom. So earlier is typically better. And then what about DHEA? Yeah, DHEA is well, I mean, I so I use the menopause method hormones. And so my bottle is actually testosterone combined with DHEA. They’re all in one. For a lot of women. Again, it’s just it’s sort of that helper hormone. I mean, hormones are made from DHEA. So for women, you definitely want to work with someone on that I because DHEA is also available over the counter. I’m really, I’ve seen women taking like 1020 milligrams of DHA. And I’m like, what? Yeah, that’s crazy. Yeah, yeah, I really want to go low and slow with DHEA, too, I think with all the hormones, but I think DHEA is can be extremely helpful.
Christine Garvin 33:57
Do you think that’s enough? In certain situations, to not have to do testosterone? Or
Jill Chmielewski 34:03
I think early on, it could be enough if the body is good at producing if their body is really able to do sort of like the raw materials for the body? Can the body do what it’s, you know, it designed to do, but you know, our body sometimes doesn’t do that. So sometimes, it’s not enough, I guess, in my experience, and in seeing testing and working with women over the years, I haven’t seen a woman you know, who has just DHEA, who still has great testosterone a few years after menopause, and yeah, I see. I see the mid the needle moving a lot more quickly with testosterone goes down. Yeah, then DHEA alone, but it depends on the woman. Right, right. Yeah.
Christine Garvin 34:39
So let’s talk a little bit about the different forms. Yeah, because I know that you know, each hormone sort of has multiple forms, you can take it and that some will work better for some women and others will work better for other women. Yeah. So let’s start with progesterone and talk about this forms. Yeah, you
Jill Chmielewski 35:00
So progesterone and we should definitely make the clarification progesterone is not the same as progestin. Yes, or a project progestogen, which is another word. There’s like all these words that everyone’s confused about anything
Christine Garvin 35:13
that birth control pills, is not truly progesterone. Yeah,
Jill Chmielewski 35:17
it isn’t. And there’s really such different molecules progesterone made in the body versus progestin. I mean, almost like opposite effects, aside from the fact that the both will control the lining of the period or the lining of the uterus, if you will. Yeah, progesterone, we typically recommend everyone’s different, but we typically recommend oral micronized progesterone, you know, I am a fan of compounding pharmacies, because you can start low you can start you can make any dose for any woman, I mean, there’s so much variability that you can do there. Um, typically we’re taking oral micronized progesterone at night, you may start a woman on 50 milligrams, maybe, then 275, up to 100. Some women need to go up to 200. But oral is typically what we’re going to need to protect the body to do all those like systemic functions that are that progesterone does, and protect the uterine lining so that we don’t have a uterus growing out of control. You know, oral is the only one that that we know of, I mean, there are people experiment, there is topical progesterone, which can be very good as well. It doesn’t tend to have those same like sleep and like anti anxiety benefits, although some women will say I use progesterone on my skin, and I actually feel I feel better. So
Christine Garvin 36:32
the body is fascinating, high
Jill Chmielewski 36:33
like nothing stays in one spot. So we know things can crossover. But we know that oral progesterone for most women is going to be the gold standard was sleep and then also with protecting the lining of the uterus.
Christine Garvin 36:44
Mm hmm. Gotcha. And so let’s talk about estrogen. So estrogen is
Jill Chmielewski 36:49
Yeah, a little more complicated only because so estrogen we we want to stay away from oral estrogen at all costs. There’s exceptions to every role, as we always say, but we know that oral estrogen increases clotting factors. So women know that who were on well should know that should be part of their informed consent. If they’re on the birth control pill. It can increase clotting factors, it’s very hard on the liver, it increases something called sex hormone binding globulin, or sh BG, which tends to decrease testosterone. So there’s a lot of not so great things with oral estrogen, which would there’s no need for us to use it because we have like this beautiful availability of topical estrogen, which is what we want to use right in topical form again, and for women that are listening, it’s just we’re typically rubbing it, there’s different places you can rub it, but oftentimes, it’s on our wrist is where we’ll put it. But there’s a couple of forms of that too. There’s also the patch, I’m not, you know, the patch is fine. I tend to like the compounded because I like that there’s not a lot of funky other ingredients that are added to the creams typically, or the oil or the gel or whatever you’re using. And there’s a little more control over dosing, you can titrate to your unique dose when you’re doing like a cream or something topically. But there’s two types of estrogen for the skin, we can do estradiol, which is just one type of estrogen, or we can use biased which I was talking about earlier, which is two estrogens, which one is called estriol, and one is called estradiol. And the reason we go with bias and the reason a lot of us I think our fans more of biased is because of the we know that there’s more estrogen in the body than there is estradiol and testosterone combined. So we want to copy nature. But we know by using bias we’re doing more work sort of producing or giving the body estrogen in a similar way that the body would have estrogen in the body as three all signals what they call like the beta receptor, estrogen beta receptor, which is more of like that calming anti proliferative kind of effect where estradiol signals the Alpha receptor, which is a little more like alpha, you know, like a more aggressive, a little bit more proliferative. So, when we’re trying to avoid things like you know, black breast glandular proliferation, which we get every cycle anyway, their own hormones, right, biased is nice, because it has that balance where we’re not going to be overly, you know, signaling certain receptors to to proliferate. So yeah, I like biased, more than I like to sort of single estrogen alone. But I mean, if you if that’s all you have available, estradiol can still be a really great option. Gotcha. Yeah, a lot
Christine Garvin 39:29
of sense. For both progesterone, I mean, I’ve probably heard this more often with progesterone, but also with estrogen or bias. If a woman decides to use it vaginally, is that going to just impact the vaginal tissues? Or is it going to go systemic?
Jill Chmielewski 39:48
Yeah, it’s so interesting. There’s I feel like there’s still so much out there. I mean, nothing stays in the vagina. So I feel like it’s going to go further. will oftentimes Names use a certain type of estrogen estriol for vaginal people who have like really vaginal dryness, vaginal issues. Because you think about when we’re in pregnancy, we produce most like a tons and tons of extra on getting the body ready to deliver babies. So it’s really working on that vaginal tissue. So oftentimes we’ll use STL. They do, you can put them obviously in vaginally, usually we’re not using. Usually, if we’re going to deliver it for systemic effect, we’re going to put it on the skin, we just have to look because vaginal absorption is usually a lot greater than on the skin. So we want to make sure with our dosing we’re being very mindful, get it? Yeah. And progesterone to mean some women actually, there’s some women who will take oral progesterone, and it doesn’t do what it should do, right to protect the uterine lining. So in that case, sometimes vaginal progesterone can be better. And that may be a better option for women. I haven’t seen it used, I guess, I would say typically, it’s not used as like the systemic delivery. Long term. Plus women don’t really want to be like every night or twice a day with the estrogen. So on your skin, it’s like part of your skin ritual, I feel like vaginally is a lot to ask unless we’re really more therapeutically trying to do something right. Lowering the vagina. Yeah, absolutely. That makes
Christine Garvin 41:20
sense. One more quick question about progesterone before we go on to the forms of testosterone? Yeah. You know, with progesterone and adrenals. So I’ve seen this actually with a couple of clients who will go on that oral progesterone. And they will be like doing at night, right, which is the total opposite of what it should be doing. Yes. So do you see this happen sometimes with when their their adrenals are dysregulated, that the oral progesterone, you know, either because of the levels or just getting that progesterone and when the cortisol is dysregulated? Do you see that happening?
Jill Chmielewski 42:02
You know what I have? And I don’t know if I can say I’ve always seen it tied to the adrenals. Although it tends to be the women that are really, really stressed out or have had those kinds of like stressful, stressful lives. There are some women, though, that just need much lower doses. Like there are women that are very sensitive to progesterone, which is, in a way strange when you think about it, because we make it every month if we’re having right if we’re if we’re ovulating. So that’s where like a compounding firms that we might say go down to like 25 milligrams, you can actually make a 25 milligram tab and do something like that or experiment with it. Maybe maybe before bed isn’t the right time, for most women it is. But for some women, it’s not. And maybe before bed is not really the right time, right? We want to be working on those adrenals. I mean, if the body’s in this stressful state, and cortisol is high, and you’ve got this chronically highest cortisol or or chronically low, it’s flatline. Now, because we’ve been so stressed for so long, we want to be working on that as well. What’s interesting, though, is having low hormones is stressful for the body. So it’s this fine line, because, right? We want to we want to do these things. We want to support people, maybe with HRT, and we know not having hormones balanced, and row in optimal is stressful. Yeah. So then we kick out more cortisol. So it’s really this. I mean, this is where we go back to and I say this all the time. You know, working with a practitioner, who is like, this is what they do, like they don’t just sort of on the side, like this is what they do. And it’s you know, for a lot of women, they’re thinking it’s going to be their GYN. And it’s not because that’s not how they’re trained. It’s not at fault on them. It’s just not the training that they get.
Christine Garvin 43:37
Absolutely. Yeah, I just had Dr. Tabitha Barbara on recently. And you know, I think she did such a good job of explaining, you know, what they learned in medical school was medication using birth control, and, you know, to regulate periods and surgery. I mean, and that’s the training, right? They she said, they learned as much as the family doctor does about actual hormones, and about the endocrine system. It’s like, all the learning that she did about that was, you know, after she’d already been a doctor for a long time. So, yeah, to always remind people that Yeah, unfortunately, if you go to your doctor with these hormone issues, they’re probably going to want to put you on birth control.
Jill Chmielewski 44:17
That’s probably, which is not what we want them to be doing, you know, unless that’s what we’re seeking out for whatever reason, right? There was there was actually like an article, I think it was in 2018, in AARP, the magazine, and it was looking at like a Johns Hopkins survey and it was, I think they said, less than 20% of OBGYN medical residency programs, even offer a course in menopause. And if there is one, it’s an elective, which it’s like, half of the population is women. So half of the population is going to go through menopause. And it almost is like that’s more I mean, not half the population is not necessarily going to want to get pregnant, right half the population is going to go through menopause. So we really Need to be stepping up our game in terms of, you know, women? I think we are I think we’re starting to shout a little louder and saying yeah, no, we need some help here. Yeah. But that’s we’re shopping around for a practitioner. It’s like the earlier the better because even if you’re not having symptoms now, you will at some point, and even if you don’t, like we said 25% of women maybe don’t have really obvious symptoms, those physiologic changes, bone changes, you know, the brain, the blood vessels, all of those things are happening anyway. So you want to have someone that really understands a menopausal woman’s body
Christine Garvin 45:32
100% Yeah, I want to come back to that in a minute. Let’s finish up with testosterone. What are the forms there?
Jill Chmielewski 45:38
Yeah, we really only recommend topical there are pellets I know the pellet people out there big. Yeah, again, we know we always say we never say never, we never say never, but they’re really Yeah, they’re really high doses and I think women sometimes especially if their testosterone has been low and they use pellets they’re like
Christine Garvin 45:58
Jill Chmielewski 45:59
Oh my gosh, this is amazing. I feel so great. And they’re just like you know, just but until
Christine Garvin 46:05
they actually pumps out the you know, other not so
Jill Chmielewski 46:09
yeah. And then we rate it raises sex hormone binding globulin that that what we talked about earlier, sh BG, which can be measured on lab work. And then it’s going to lock up testosterone, it can lock up estrogen so it can it can muck with all the hormones anyway. We tend to see Yeah, within that cycle, because I think you can get them replaced. It’s like every four months or so for women. You have to you know, there’s surgically I mean, it’s not surgery surgery, but you are surgically going under the skin every time Yeah. We really the better way to do it is topical, it’s simple. You again you’re applying it to you know, I use it like I just put it right on my sofa ICIC Dr. Rosen sweet. And he always says put it kind of like over your ovary like where you have to put it over your ovary but kind of like picking another spot to put something. The abdomen is a good place. We want to put it on the skin where we don’t typically grow hair because you can grow more hair wherever you are. Putting testosterone. Okay, yeah, so we want to make sure we’re avoiding spots. So women are
Christine Garvin 47:05
like putting it on there.
Jill Chmielewski 47:08
I know they’re always like, right here. My forehead, please. Right. Don’t put it above your lip. Yeah. Your chin right here. No, we don’t want to do that. So yeah, so topical is beautiful. And it’s just again, it’s a dropper to you know, if you’re using an oil, it’s the cream. You know, women can go to the compounding pharmacies can mix, we’d recommend keeping the hormones separate. But if someone is like, it’s too much for me to think about, you know, they can mix them together. So there’s a lot of really cool ways we usually recommend testosterone in the morning though, because it can be energizing. If you think about testosterone. Yep. So testosterone before bed is probably not something that we want to be. Yeah, it’s a morning. That’s a morning ritual. Yeah. And I think the pellets of avoiding them, for most people is really probably a much better option.
Christine Garvin 47:55
I have definitely seen, you know, a couple clients have come to me after they’ve gotten that done. And what’s so hard about that is if it’s too much, you don’t have any recourse until it three, four months later, right when I’ve gotten and that’s the hard part, you know, yeah, it’s not pretty. But so in terms of finding a practitioner, this is this can be the hard part. Right? Yeah. So can you give some advice on how women can go about doing that? Yeah,
Jill Chmielewski 48:25
I, you know, this is probably like, probably the number one question I get is, How do I find someone, especially now in the membership community, we do q&a Is every two weeks with Dr. Rosen’s suite, and we it comes up because we’re talking about hormones and HRT and many things. And I think then women are like, I want to find someone and they’re having so much trouble. I think one of the probably the simplest ways or maybe for everybody is calling your local compounding pharmacy, or one that’s in the area, and saying to the pharmacist, who do you know, who do you work with, that’s really good, and really knows their stuff with hormones, because they’re going to know based on the prescriptions that they receive, if someone knows their stuff or not. If the prescription comes back kind of, you know, wonky, and it doesn’t seem quite right, they’re gonna know, they will know those repeat doctors that are filling prescriptions at the pharmacy over and over and over. So that can be I think, one of the best ways and I’ve feedback from clients and patients over the years is that’s, that’s been a pretty good way to go. There are certain, you know, like IFM Institute for Functional Medicine, they do have hormone training programs on a forum has hormone training program, so you can kind of go to some of these, you know, groups that were that were, you know, they do hormone training, but hormone training that you really trust, right. I think those can be maybe some I would say that’s probably like my top recommendations for sites to go to gently sort of search.
Christine Garvin 49:53
I love a forum that Yeah, right. Yeah. I’ve gone to those conferences. I really yeah, they’re on top of that. Yeah. And they’re on Yeah,
Jill Chmielewski 49:59
they were Willie, I think a lot of them are I mean, sometimes I hear different practitioners talking about things. And I’m like, because I know what I know. Yeah. That one, so I have my like little list that I kind of stay away from, but that is probably your best. But friends sometimes can be helpful too. But shop around and get your questions and when you understand hormones and know what to ask for, to to say, you know, so if they’re recommending a palette and you have learned about palettes, you’ll notice that you know, what are you read their bio, because a lot of times, you know, if you go down that rabbit hole and you start trying to find a practitioner, they’re going to have a website, you can see they’re sort of approach to menopause and what they do, and you’re gonna get a vibe about whether or not they’re really they’re in alignment with what you are also wanting for this time in your life. So you just have to take some time, just like we do for like pediatricians are already do, and we just have to do the research it. Yeah, I will say and I’ve said this, Dr. Rosenstein, I’ve talked about this a lot, you know, kind of back to the family doctor, I mean, you want someone who not just went to that weekend seminar, a foreign but really practices it. So just like if you broke a bone, you can go to you know, a family doctor probably learned in med school, how to set a bone. But do you really want to go that route and want to go an orthopedic doctor, because that’s what they know. And that’s what they do all day, all night. So with menopause, really finding someone that is, you know, that’s all they do. That’s really or that’s the bulk of their practice, I would say that’s really where you want to go. And the other kind of comment on that is you probably will be paying out of pocket. And I hate to say that to women. Because we’re used to this health care system where you know, it’s, it’s, it’s not paid for, but it’s part of insurance,
Christine Garvin 51:40
right? And we pay an exorbitant amount.
Jill Chmielewski 51:43
We do. Yes, exactly that we pay a lot for. But to find someone who’s going to spend we you need more than 10 minutes with them. So you want to sit down with someone for an hour that wants to hear your story, right? It’s not going to be every month that you’re going to see them. But when you start out, you know the first year meeting with them, you’ll maybe get an hour with them, or 45 minutes and then a follow up visit maybe for half an hour, 45 minutes. And then you kind of on smooth sailing, you’re seeing them once a year, maybe twice a year. So just kind of in your mind thinking I’m going to pay out of pocket for this, but it’s going to be worth it because they’re going to really hear my story and what I want we’re going to be in a partnership together.
Christine Garvin 52:17
Right. So important. Are there any doctors that are able to work nationally that you recommend?
Jill Chmielewski 52:25
I you know, it’s all about the if they do telehealth mean there’s tons of menopause Doc’s that will do telehealth visits. I think that’s really cool news. testosterones a little funky because it because of the class of medicines it’s in, there’s a little bit with with licensing and being in the same state and things like that. So that is where things can get tricky. With COVID. There was some wiggle room I think on some of that I don’t remember all of the nuances, but telehealth is a great option. Yeah, sometimes you might have to go to the state. I mean, when I first started, I literally I was going to California for a visit anyway. And that’s how I saw I live in Illinois. I live outside of Chicago. I went to California and as long as you see your practitioner in person for the first visit, to do the right telehealth, okay, yeah, gotcha. So that may be something to think about as well,
Christine Garvin 53:12
because I know some people are listening in a small town. Yeah, there’s just not even an option.
Jill Chmielewski 53:19
No, no, I know telehealth is an option. But you might have to be I think you do have to be in the same state for testosterone prescription. Gotcha,
Christine Garvin 53:27
interesting. So fascinating, right, how they decide who gets I don’t
Jill Chmielewski 53:31
get me started.
Christine Garvin 53:35
Oh, my goodness, this is such an amazing conversation. I could have asked you so many more questions. I’ll probably want to bring you back on about all of this, but tell everybody how they can be in contact with you and more about your membership program?
Jill Chmielewski 53:49
Yeah, no. So it’s, I used to I’m no longer working one on one with patients or clients, I hung up my one to one hat about a year ago, I really wanted to just educate women more broadly in a community but also connect. So I just launched a membership community called pausing together, that would be the very best way to come in. Connect with me, you can ask questions. We’ve got tons of content available for women. And then we do q&a with Dr. Rosen, sweet every two weeks, nice, all the questions that are being asked. And then we have guest experts more and more coming in. I just launched the community this year. So we’re sort of in Build mode, but um, yeah, it’s really fun. You can find it on Apple, you can find it on the Google Play store. Or you can go to my website, which I don’t know if you want to include maybe in the do you include OB in the notes for sure. That’d be great. You can learn more about it there as well. Yeah,
Christine Garvin 54:35
great. Oh, thank you for so freely sharing all this information that so many women really need to know and have that guidepost because you know, it is such a struggle. So
Jill Chmielewski 54:48
So it’s my pleasure. Thank you for having me. I appreciate it.
Christine Garvin 54:51
Absolutely. Okay, you guys. I will see you next time.