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Child: Welcome to my mommy’s podcast!
Katie: Hello, and welcome to the Wellness Mama podcast. I’m Katie from wellnessmama.com and I am back today with Dr. Deb Matthew to dive deeper on the topic of hormones. If you missed our first episode together, we talked about testosterone and a lot of the myths and misconceptions around this, especially for women.
And in this episode, she’s back to dive deep into other hormones and how they relate, and especially a lot of the controversy surrounding hormone testing for women and what to know if you decide to go that route and how to navigate those conversations. with your doctor. Dr. Deb is known as the happy hormone expert, and you will see why in this episode where she explains the interplay of estrogen, progesterone, testosterone, thyroid hormones, and so much more.
Dr. Deb, welcome back. Thanks for being here again.
Deb: Oh, I’m so glad to be here.
Katie: Well, we had an awesome conversation recently about testosterone for women, especially, and I’ll make sure that one is linked in the show notes.
If you guys haven’t heard it, I learned so much in that conversation. And in this conversation, I would love to expand and dive into the other hormones we need to know about and be aware of, understanding when testing is appropriate and what to look for and also if or when there’s a time for replacement.
I guess to start, it’s an easy jumping in point for the conversation is maybe some broad knowledge on when do we need to start to be aware of that or consider testing and or are there things that point to, it might be a good idea to get tested.
Deb: Yeah. Well, I think that a lot of women don’t feel good. And we’ve got our list, we’re tired, we’re not sleeping, we’re bloated, we’ve got brain fog, we’re irritable, anxious. Like we’ve got a laundry list of symptoms and sometimes it can be really difficult to know, is it my hormones? Like, you know, maybe it’s just me.
Maybe it’s my circumstances. Maybe it’s my stress. And one of the clues that your symptoms really could be hormonally related is if it’s cyclic. Like if it gets worse going into your period. If your family feels like hormone hostages and they have to walk on eggshells because they’re not too sure if mom is going to blow in that week before a period. And then if you feel better after your period, and that’s the good week, that week after your period, you’re chopping the broccoli, you’re cleaning out your closets, you’re going to the gym. If you see that change, that’s a really important clue that hormones could be playing a role in what you’re doing.
But sometimes it’s confusing, isn’t it? Like, we’re just not really sure. And so, if you’re not feeling good, that’s a really good time to think about having your hormones tested. I sometimes get asked, like, should every woman get her hormones tested just to know for the baseline? And I’m not sure that that’s really necessary for everybody.
If you’re healthy and well, our hormones fluctuate over the month. It’s actually complicated to measure hormones, it’s not so straightforward. So I’m not sure that every woman needs to have her baseline tested if she’s doing well and feeling healthy. But once things are starting to go downhill or, you know, go off the rails a little bit, that would be a really important time to have things looked at. And some of the really important hormones that we want to talk about are estrogen and progesterone, which of course are the ones that go up and down over the menstrual cycle. And estrogen is the one that makes our uterine lining thicken and grow so that there’s a period at the end of the month when we shed our lining.
So if you’re still having a regular period and if your periods are sort of normal flow, that’s sort of a clue that probably your estrogen is okay. If you’re having really heavy periods, if your periods are coming more frequently, if you have a lot of PMS symptoms that are physical, like a lot of fluid retention, you’re gaining like five or 10 pounds before your period and then after your period, you shed all of that water weight. Those can be… and breast tenderness, those can be symptoms that you have too much estrogen. But a really common thing that we see, especially in women over 35 is lower progesterone. And progesterone is the one that tells our uterine lining to stop growing so that it’s not so thick and therefore it keeps our periods from becoming too heavy. It helps to regulate our cycles.
So if your cycles have started to become irregular, especially if they’re coming closer together, you know, instead of 28 days now, they’re 25 or 23 or 21. If you’re having more anxiety or irritability, like you’re just losing it with your kids and you find yourself shrieking at them over the silliest little things and then you feel like the worst mom ever. If you are waking up in the middle of the night, these can all be signs of low progesterone. And commonly in the beginning, it starts off that it’s the week before your period, but it can kind of get more than that. And sometimes women end up, they only have one good week a month. And then eventually it just kind of you lose that, you just feel that way all the time in some cases. So progesterone is the calming hormone. Really important for sleep. Really important for anxiety. Really important to keep your mood calm and helps to prevent the night sweats. A lot of women don’t notice that their sleeplessness and night sweats get worse that week before your period.
So if you’re having night sweats and you don’t always sleep through the night and you haven’t made that connection, sort of pay attention because you’ll find that really commonly it’s that week before your period. So we want to look at estrogen and progesterone. We want to look at testosterone, which that’s what we talked about last time.
It’s really important for women too. And if our testosterone goes down, there can be other reasons besides just sort of perimenopause, but it can cause low libido, vaginal dryness, loss of muscle tone, muscle mass, but also it just makes us feel sort of flat and unmotivated and just sort of ho hum. And we just don’t feel like ourselves. Another one that’s really important is cortisol, which is our stress hormone and cortisol goes up to help us cope with stress, which is great in the short term. But when we have chronic stress in our lives, it can end up being chronically elevated. And then we’re just sort of always in that fight or flight response.
We don’t feel good. And really importantly cortisol is a regulating hormone. So it regulates all the other hormones, and it just makes all the other potential hormone symptoms that muchworse. And thyroid is all tied into this too, because thyroid sets our metabolic rate, it gives us energy, it makes our skin, hair, and nails grow, keeps our brain sharp, it’s also really important for libido. So if you have no libido, it could be low testosterone, it could be a problem with cortisol. And it could be that your thyroid is the problem and you can have all of those at the same time because they’re tied together. If you have a cortisol problem, it shuts down the other hormones.
So you don’t make as much progesterone and you have more PMS. It shuts down testosterone. So you don’t feel like doing things and you have no libido and it interferes with how your thyroid works. So now you’re tired and gaining weight and you’re constipated and you’re cold. So there’s a lot of interconnection. Another really important interconnection is if you have what we call estrogen dominance, which means that you’re still producing estrogen, maybe even you’ve got too much estrogen in your system, and there’s not enough progesterone to balance the estrogen out, when that happens, that estrogen dominance pattern, that goes along with the heavier periods, more PMS, anxiety, irritability. When that happens, it also interferes with how your thyroid functions. And so now if your thyroid’s not doing a great job, thyroid can cause menstrual problems and irritability and sleeplessness. And so they just kind of all compound together. And so I think it’s important to think about our hormones as this complex tapestry, where each hormone is important for how the other hormone works.
And if one of them is out of whack, the other ones start to go out of whack too. And so it’s important for us to look at all of them together, because at the end of the day, it’s often that we don’t find like one hormone is completely off the deep end. What we often find is that each hormone is just a little bit out of kilter, so they all might even technically be in the normal range.
But if one of them is kind of high normal and the other one is kind of low normal, you don’t feel right. And when you don’t feel right and you go to your doctor and you try to put it into words: I’m tired all the time, I have no motivation. I don’t feel like doing things. This doesn’t feel like me.
This is not normal. I don’t feel like myself. That’s got Prozac written all over it, right? I mean, the only thing that we were really trained in medical school to do if you don’t feel good is to give you antidepressants, anxiety pills, sleeping pills. If your periods are not going great, we give you birth control pills. But the problem is that those are not really treating the real problem and if we can get your hormones back in balance, you can feel so much better.
Katie: That makes sense. And it makes sense to pay attention to not just like the normal lab ranges like we talked about in the last episode, but to know how they interact together and kind of the optimal versus just normal, which I hate that word in a medical context. I’m also curious, is there any value to women, say like in our early 30s, getting a baseline test, not as a way to like pin, if you know, maybe she feels great, maybe she’s not concerned.
But to get a baseline to know for later, like these were ranges where I did feel really good to maybe that’s kind of my body’s natural point. Or is that sort of opening a Pandora’s box that we don’t need yet at that age?
Deb: You know, I, I guess I would say I don’t tell all women, okay, you’ve hit age 30, go get your baseline hormone levels done. So I don’t think everybody needs to have their hormone levels done. I think it’s, I think it’s nice information. I mean, I think it’s great for anybody who would like to have it done, to have it done just to know. I think that’s totally fine. But I don’t think we need to tell all women that they really need to, because our hormones are cycling, they’re changing a lot day to day. So a one time hormone test is only a piece of information. It’s not the be all and end all of how your body’s hormones are functioning.
Katie: That makes sense. Okay, and I love that you also brought thyroid into this. Cause I think that’s obviously an issue for a lot of women and that there’s a lot of kind of misinformation or just not super great direction related to thyroid thyroid testing as well. I guess if a woman is like wondering if she has issues or her hormones are out of balance, what do you recommend at that point, as far as what testing to look for, what kind of ranges are we wanting to be in and anything to know going into that process?
Deb: So this is actually a really challenging topic to talk about because in medical school, we are not taught about any of this stuff that we’re talking about. In fact, I would tell you that I learned first about how progesterone is the one that’s calming and it creates the irritability and anxiety and sleeplessness, because I read a book written by Suzanne Sommers.
You remember like the thigh master lady. And I was reading about the women in the book and they had all the symptoms just like I did. And then I read about how much better they felt when they got their hormones balanced and that completely blew my mind because there was nothing about that in medical school.
I just knew that progesterone was one of the things in birth control pills that had to do with your uterine lining. I had no idea that the part of our body that had the most progesterone receptors is in our brain. So when you go to see your regular family doctor, your gynecologist, if you march in the door and say, Hey, heard this podcast, I’d love to get my hormone levels tested. That’s just not what they do. And so a lot of women are told, we don’t do that, you’re too young to have a hormone problem, hormone testing is not valid, like, they just really get shut down. If your doctor is willing to measure something for you, typically what they’ll measure is a TSH, Thyroid stimulating hormone.
That’s the screening test for thyroid. If you’re full blown hypothyroid or hyperthyroid, it’ll be abnormal, but there’s so much in between there that gets missed on the screening test. Sometimes they’ll measure a test for you called FSH follicle stimulating hormone. And this is a test that kind of tells us if your ovaries are still going strong or if they’re starting to peter out. That can be important if you’re interested in fertility. Because we want your FSH level to be low, meaning strong ovaries if you’re wanting to start a family. But even if it’s starting to go up, it doesn’t really tell you what your hormone levels are. It just tells you that your ovaries are starting to tippy toe towards perimenopause.
But those are really the only two tests that doctors will sort of even sort of commonly entertain. What I like to do when people come in to see me and doctors who practice like me is we want to look at all of these different hormones. And we have three, four I guess main ways that we can test for hormones.
We can do just a regular blood test, like everybody’s used to. There are also tests called blood spot tests where you just prick your finger. And we put little drops of blood on a filter paper and then the paper gets mailed into the lab. So those are very similar. We have saliva testing that we can do, and we have urine testing. The message that I would love to give today is that all of those tests have pros and cons. They all have validity. Each one of them has circumstances where they may be better than the other one. But there’s no one right answer. And I spend a lot of time teaching other practitioners and talking, you know, lecturing about which test is best.
And the reality is there is no one right answer. So if you hear somebody talk or you hear me talk and you decide, I really want test A, and you go in to see your practitioner and you sort of say, I want test A and they really want to recommend test B. It doesn’t mean that they don’t know what they’re doing or that they’re wrong.
It’s just, there are different ways that we can do this. And for each woman, we try to decide which is going to be the best test for you. And also doctors have to be good at being able to analyze the test results and understand and make sense of them and use those test results in a meaningful way to help you. And so sometimes doctors get really good at utilizing this test or really good at utilizing that test. And I think at the end of the day, you’re probably best to go with whichever test your doctor, or your practitioner, whoever you’re working with, is the most familiar with the most comfortable with then you’re the one that they get the best results.
Tests are only tools, but having said that, I’d love to give some information about the pros and cons of the different tests so that women know, because unfortunately, when we’re talking about hormones, we all have to be our own advocate. This isn’t part of standard of care medicine. You can’t just walk into your doctor and get a quick prescription for something to fix this. So I think it’s important to know. So blood work can be okay. Especially if you’re not on any kind of hormone therapy, we’re just going in to measure what you’re naturally producing. Blood work can be okay. What really matters is the timing of the test, because frequently if you’re going to just your regular doctor, they will have you do the test when you’re on your period or within the first few days of your cycle, like day one through five of your cycle. And the reason for that is you’re typically only measuring the FSH, that follicle stimulating hormone. And that one spikes way up at ovulation. That’s part of what triggers ovulation. So we don’t want to do it in the middle of the cycle, otherwise it’s going to look high, but it’s not perimenopause, it’s just ovulation. So if you’re on your period, we know you’re not ovulating right now. So that’s usually where they tell you to go. But if we’re measuring the rest of your hormones, that’s not the right time because our hormones change over our cycle.
So in the first, while you’re on your period, your estrogen and progesterone levels are going to be really low. It doesn’t mean that you have low hormone levels or that you’re in early menopause or any of that. They’re supposed to be low when you’re on your period. The week after your period, your estrogen level goes up a tiny bit, but your progesterone level is still going to be low. And then around the two week mark, in the middle of your cycle, that’s when you ovulate, estrogen is going to spike way up. And it doesn’t mean that you have too much estrogen, it just means that you’re ovulating. And then once you’ve ovulated, your ovary is going to start to make progesterone in the little place that released the egg. And so after you ovulate, now you’re going to make a whole bunch of progesterone for the two weeks leading to your period. And then when it’s time for your period to start, the estrogen and progesterone are going to plummet and that’s what triggers the shedding of your lining. So if you get your blood work done at the wrong time in your cycle, you’re going to get these results that are totally different.
And I shouldn’t say the wrong time, but depending on where you are in your cycle, we’re going to get extremely different results. So that’s why we can’t just look on a lab test and say, Oh, your estrogen level was this, or your progesterone level was that. Therefore we know exactly what’s wrong. Because we have to take the context into account. This is why a lot of healthcare practitioners, a lot of doctors will refuse to measure hormone levels because in their mind, first of all, they weren’t taught to do it so it’s not like a normal thing to dout . Bin their mind, they’re thinking, Well, you’re here today on a random Tuesday afternoon in my office, but I can order your hormone levels today, but they’re just going to be different next week.
And they’re going to be different the week after that, so it’s meaningless. So there’s no need to measure your hormone levels. Here’s my take on that. Your blood sugar changes minute by minute in the day, depending on what you ate, when you last ate, but we don’t say we can’t measure your blood sugar because it changes.
We just put it into context. We asked you to go fasting or we do it, when you’re pregnant, you have to drink that nasty sugary stuff, right? To see if your blood pressure spikes. We just put it into context. The same thing is true for your blood pressure. If you are all stressed out over something, like if you’re late to your doctor’s appointment, you’re stuck in traffic and you’re rushed getting there, or you’re nervous because you’re waiting for test results and you’re kind of scared, those kinds of things are going to make your blood pressure be high. Or if you exercise that naturally your blood pressure goes up to help you exercise
So we know that your blood pressure is going to change minute by minute over the day depending on what’s going on, but we don’t say we can’t measure your blood pressure because it changes. We just put it into context. So that’s how I feel about hormones is we just have to put it into context. But it is very important to make sure that you’re going at the right time. So for women who have regular 28 day cycles, we have them go about a week before their period, which is roughly day 19 to 21 of a 28 day cycle. And it’s roughly halfway between when you ovulate around day 14 and when your period starts around day 28. So regardless of whether we’re talking about blood testing, saliva testing, urine testing, the timing really matters. It’s really tricky, though, for women who don’t have a period, maybe they had a partial hysterectomy, so they don’t have a uterus, but they still have their ovaries, but they’re not having a period.
So we don’t know, their ovaries are still cycling and doing what they’re doing, but we don’t know what’s going on. Or a lot of women who get an IUD, that they don’t often get a period or just every once in a while they get some really, you know, small amount of spotting, but there’s no regularity to it. Or sometimes women have had an ablation, which is a treatment where we treat the lining of the uterus to sort of create scarring so that you don’t bleed anymore and then we don’t know. And that’s really important because the women who had to have the partial hysterectomy or had to have the ablation, often these are women who had hormone problems, which is why they were having like excessive bleeding that caused them to need those treatments in the first place. So we really do want to know what’s going on with hormones because the treatments can make it so you don’t have to deal with the heavy bleeding, but it didn’t fix, didn’t do anything really to the hormone issues. So we don’t know where you are in your cycle and that makes it really difficult to interpret. It doesn’t mean we can’t measure your hormone levels. Sometimes I even do it two weeks apart, like we’ll do it now and then we’ll do it two weeks later just to kind of see what we get because it should be very different.
But that’s another reason why sometimes doctors will just say, well, there’s no point in measuring your hormone levels because how would we even know how to interpret them? But we can certainly match them up with your symptoms. There’s a lot that we can do. But I think it’s important to know it’s not so simple. And one more thing, and I’m going to take a breath, but one more is if you’re on birth control pills. If you’re on birth control pills, we really can’t accurately measure your estrogen and progesterone levels because what’s in the pill is not real estrogen and progesterone. It is synthetic chemicals that are man made that have never before been found in a woman’s body and what they do is they turn off your hormones and then the hormones are replaced with these synthetic chemicals. And there’s no blood test or urine test or saliva test for those chemicals in our body.
So almost always what happens is if you get the tests done, it’s going to look like your hormone levels are really, really low. But it doesn’t mean you’re in menopause or that there’s a problem. It’s the result of, it’s the expected result of the birth control pills. So if you’re on birth control pills, it’s just not really even worth wasting your time to get your estrogen and progesterone level tested. We can still measure the other hormones though. So it’s not all is lost, but those ones won’t be accurate.
Katie: That was so helpful. And I love that you gave kind of like all of the caveats to know of different hormonal situations so that women can navigate this on their own. And I say often on here, at the end of the day, we have to each be our own primary healthcare provider in taking ownership for our health.
And it seems like the really good doctors and practitioners like you are most excited when they have a woman come in who is in that driver’s seat and very invested ’cause she’s willing to do the things to help improve her health and work with you and then can benefit most from, in this case, your very specific knowledge on hormones.
I’d love advice you have for women for navigating a couple specific topics. Maybe they’ve been through hormone testing or some kind of testing and have been told your labs are normal. Which we now understand might not mean that they’re where you want them to be, but they’re told their labs are normal and not to worry about it.
Or as I was, you know, like, that’s just part of being a woman or being a new mom or they hear those things a lot. Or if your doctor is not on board with hormone testing at all, any advice for navigating either of those situations?
Deb: Yeah. And I want to come back to the urine testing and the saliva testing too. So,this is so common. Like it’s so common and it’s not your doctor’s fault. Like your doctor wants to help you, but we were not trained. They don’t know what they don’t know. I didn’t know. I had no idea. I had all kinds of symptoms and I didn’t know. So if you’re told that your labs are normal, but you feel crappy, it doesn’t mean that you’re normal it just means that your doctor didn’t look in the right place or didn’t didn’t know how to interpret your labs in a way that can help you. And it doesn’t mean that that’s the end for you it doesn’t mean that there’s no hope it doesn’t mean that you are normal and it’s all in your head or this is like your personality flaw or something. It just means that you probably need to find somebody else to help you. So if your doctor isn’t on board with this, if they’re telling you you’re too young, or it’s not your hormones or they won’t test you, whatever the case may be, don’t give up.
Because help is available. You don’t have to put up with feeling this way. It’s just that, just like the doctor’s not looking for the answers in the right place, unfortunately you’re looking for help in the wrong place. Because you’re going to your doctor expecting they’re supposed to be the one that knows how to fix this. And unfortunately in, in most cases, that’s not really true. But don’t give up because you can find people who can help you. And, and what I would say is, when I’m working with somebody, I feel like the most important thing that I do is certainly not writing prescriptions for hormone replacement therapy.
The most important thing that I think that I do is I give women the information that they need, either by understanding their history or interpreting their lab results. And giving them the information that they need in order to take back control of their own health. So that they can keep themselves well and keep themselves out of all of our doctor’s offices as much as possible.
So what I really want them to understand is what’s going on in their body. How is it making them feel? Why is it happening and what can be done about it? Because I feel like, especially when we have hormonal imbalances, a lot of times we feel a little bit out of control, especially with our mood. And that sense of understanding what’s going on, having a sense of control, knowing what you can do to help yourself, I think is really, really important.
Katie: That’s so helpful. Okay, let’s circle back to saliva and urine testing so we don’t leave that open loop.
Deb: So saliva testing is an okay way to measure hormones. I like it, especially for younger women who are say in their thirties, because what we’re really looking for most likely in that age group is estrogen and progesterone imbalances. The normal range for progesterone on a lot of these saliva tests is looking at women who don’t have symptoms. So in a blood test, the normal range is super broad. And it’s just looking at, you know, the 95 percent of the population lands in this zone. But in the saliva test, it’s more commonly normed for women who feel good. So it’s more likely that it will show if there’s a problem. The other thing that saliva tests are really great for is cortisol because cortisol changes over the day.
We have a circadian rhythm and it’s supposed to be highest in the morning. So you can leap out of bed and get started with your day. And then it’s supposed to go down over the day so that you’re relaxed and calm and you can sleep soundly at night. But what happens to a lot of us is we don’t have enough cortisol in the morning.
So now we need coffee or something to get our brain going so we can get started with our day. And then we’re all wound up and our brain won’t turn off and we can’t sleep at night. And then people go for sleeping pills or melatonin or something to help them go to sleep. But their cortisol circadian rhythm is flipped around backwards. So if all we did was send you to the lab to get a blood test for cortisol, if you go at a different time of the day, you’re going to get a totally different number. So for blood tests, only the eight in the morning one is valid, but we can’t see what happens over the day. So in a saliva test, we can look at what goes on in the day.
We can even look at something called a cortisol awakening response, where we get your saliva the moment that you realize you’re awake. We get it 30 minutes later and then 30 minutes after that and we should see a nice spike, which is the normal circadian pattern. So we get lots more information about cortisol if we do it in a saliva test than in a blood test. And then we have urine testing, it’s often called Dutch testing. And urine testing looks not just at the level of hormones in your system, but it looks at how your body processes the hormones. So for example, estrogen, there’s multiple different kinds of estrogen in our bodies and the estrogen has to get metabolized down these different biochemical processes, down these different pathways. There’s one pathway that actually is protective against breast cancer. And then there’s another pathway that could sort of be helpful towards breast cancer. And so if we can see what pathway you’re going down, there are some natural things that we can do in order to help fix it. Part of it is genetic, but a lot of it is environmental. We especially like this for women who are at higher risk for breast cancer, for whatever reason, or women who have things like fibroids or heavy periods or endometriosis, where we worry that they may not be processing and clearing the estrogen out of their system in a healthy way. And we just can’t get those kinds of things if we’re looking at a blood test or a saliva test. On the other hand, if women are menopausal and we know that their estrogen levels are really low, when we’re looking at these different pathways, the results aren’t going to be accurate if your estrogen level is really low. So there’s sometimes when these tests are much more helpful than others, and that’s why we want to individualize the decision.
There’s no one right test that’s the perfect test in every situation.
Katie: That makes sense, and it’s so good to know that there are options for this, and I would guess a lot of women listening feel a lot more empowered to kind of direct their own decisions related to this and to advocate for themselves and ask questions to help really understand what’s going on. And I know you also have a lot of resources for follow ups for this and a lot more deep learning people can do on your website and with resources you have. So for anyone who wants to learn more and keep going with their education around this topic, where can they find you and where can they find those resources?
Deb: Sure. So my practice is Signature Wellness in Charlotte, North Carolina. And the website is SignatureWellness.org. There’s lots of information on the website. You can follow me at DrDebMatthew on Instagram and Facebook. And I also wrote a book to help women sort of figure out whether their symptoms could be from a hormone problem.
It’s called This Is Not Normal, A Busy Woman’s Guide to Symptoms of Hormone Imbalances. And there’s lots of checklists so that you can see, could it be low progesterone? Is it high estrogen? Is it a cortisol problem? What might it be? There’s some tips to start getting your hormones balanced naturally and also some tips on how to talk to your doctor and even some resources for where to go to find a provider who can help you.
And we’ll put the link to the show notes so you can download a free copy.
Katie: Amazing. Well, Dr. Deb, this has been such a fun conversation as was our first conversation. I will put links to everything you mentioned in the show notes so people can find you and keep learning from you. And I know I learned a lot and I’m going to follow up on some of these points myself. Thank you so much for your time today and for everything you shared and for the obvious passion you have in helping women.
Thank you so much.
Deb: Thank you.
Katie: And thank you for listening and sharing your most valuable resources, your time, your energy and your attention with us today. We’re both so grateful that you did. And I hope that you will join me again on the next episode of the Wellness Mama podcast.
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