Troubles of perimenopause & the hierarchy of healing

Hello gorgeous,

this episode was recorded in the spur of the moment, as I'm driving home from dropping my son to his cricket match.

If you want to ditch the myriad of symptoms that derail your good days as you go through perimenopause, you need the right approach.

There's a "hierarchy of healing" that allow you to fix the vast majority of uncomfortable symptoms and reduce the risk of chronic illness in the future.

Your gut is the gateway to resolving so many issues you experience with your hair, skin, waistline, mood, energy, sleep!
Fix your gut first, then tackle your hormones to avoid a yo-yo effect of symptoms returning time and time again.

Learn to recognise how you trigger symptoms with lifestyle choices and nutrition.
Then resolve the symptoms with the approach that works for you.
Let me talk you through this in this episode.
If you want, you can then reach out for your personalised journey through perimenopause.
It can be a graceful journey for you!

In best health,
Dr Kirstey Holland

The information shared in this podcast does not substitute working with your primary health care provider; it is general in nature and not considered personalised advice.

Visit us online for more information or if you wish to work with Dr Holland.
thehollandclinic.com

For your daily dose of women's health related info and ideas on how to gracefully live through health and wellbeing transitions your body experiences, visit our Instagram
instagram.com/thehollandclinic

Transcript

Dr Kirstey Holland: 0:03

Good morning, gorgeous. I have just dropped my son off. He's off to cricket for the day and I have been having, um, a huge amount of inquiries coming in about our program I'm so delighted to tell you that our program has been nominated as program of the year 2023 2024. And um, my program is called Rescue You from the Rollercoaster of Perimenopause. And um, this is my third decade in clinical practice treating perimenopausal women. Um, but I am pretty aware of the fact that suddenly the conversation is louder and prouder than ever before. So I'm absolutely delighted that this is actually the case. Perimenopausal and menopausal women are finally, um, you know, getting the voice and getting the, um, the exposure that they need in order to get the help that they so desperately need. I'm here to tell you that everything that I do is based in the research, scientific evidence, and cutting edge, um, at that. The ZOE PREDICT trial, was a beautiful seminal paper that came out about 12 months ago, talking about the fact that, perimenopausal women struggle with metabolism, and therefore an increase in weight, particularly around the middle, and that they are definitely in this energy crisis. The words are different, um, these are my words, not their words, but the meaning is the same. And, the trial also showed that, that, women are struggling with immunity and they're struggling with gut health. So there was a huge correlation between perimenopause and a decreased, um, level of gut health in perimenopausal women. So it's no surprise and no mistake that my program Rescue You from the Rollercoaster of Perimenopause, which is a three part program, starts with repair. And in repair, we repair exactly that we repair your gut. We repair your microbiome. We repair your metabolism. We repair your immune system because 80 to 90 percent of your immune system resides in your gut. There is this incredible part of your gastrointestinal tract called secretory IGA and is, it's the thick sticky biofilm and um, it's this beautiful mucous membrane layer that should be there to protect the inner lining of your gastrointestinal tract and it's within secretory IGA. That, um, you know, 80 percent of your immune system resides and also 80 percent of your feel good hormones are produced in the gastrointestinal tract. So, if you are having any mood issues, anxiety, or depression, and you have an inflammation in your gastrointestinal tract, the two are related. These are not two separate entities. They're absolutely related. Absolutely. Related. If you have an inflammation in the gut, you quite often have an inflammation in the mood and the mind. So it is absolutely imperative in perimenopause to focus on the hierarchy of healing. So when it, when it comes to the hierarchy of healing, we can't just dive in and rebalance the hormones first. If you have a dysbiotic gut or a gut integrity issue or a leaky gut presentation. So we absolutely need to focus on healing, sealing and repairing your gut first. A lot of the time we actually need to identify individualized food triggers. So many women in my clinic have food triggers that create a dysbiosis in the gastrointestinal tract and actually punch holes in that beautiful gut lining, you know, that gorgeous plumbing. And whenever I'm talking about the gastrointestinal tract, I'm actually talking about eyes, ears, nose, throat, large intestine, small intestine, liver, anus, and vagina. The microbiome is everywhere. The microbiome of your girly bits is attached to and connected to, although intricately different, um, but part of your generalized microbiome. So your scalp has a microbiome, your skin has a microbiome, your gastrointestinal tract, of course, has a microbiome, your gut has a microbiome, and so does your vagina. So it is absolutely imperative to keep the microbiome healthy. In my clinic, I start with the gut at every point in time. There is no point in having a toxic load or an unbeneficial detoxification capacity when you are trying to balance hormones. So balancing hormones comes next. So in repair... We repair your metabolism. We repair your gut. We also repair your ability to access energy. So the mitochondria comes into this repair program too. And what we need to do is we need to get ourselves into a fat burn and out of a fat store state. So because There is a correlation and a link between perimenopause and high glucose levels, high blood glucose levels, which then lead to an insulin resistance. What this means is we're actually not able to access the energy from our food. In order to think, in order to move, in order to feel vibrant, and in order to feel like we've got the energy that we need to get throughout the day. So, we need to fix this energy crisis, and we need to get ourselves into a fat burn and out of a fat store state. We need to increase our fiber intake, so that we have a beautiful gastrointestinal tract lining, and so that our... gut microbes, the beneficial gut microbes, actually have something to feed on. If your beneficial gut microbes are not receiving enough food, so I always say to my patients, please, in every single meal, make sure you're feeding your microbiome. Because if your microbiome doesn't have the food that it needs to flourish, They will start to eat your secretory IGA, that beautiful, thick jelly like substance that I was talking about before that impacts your immutability and also your mood. So your gut is related to your mood. It is related to your immunity. If you're having any, any signs and symptoms on the skin in traditional Chinese medicine, there is an internal and an external relationship between your large intestine and your skin. Your skin is also a detoxification mechanism. So If you're not able to get rid of the toxicity through the large intestine and the liver, it'll come out in the skin. So if you're having any kind of, you know, skin reactions, that can also be due to a dysbiotic microbiome and your detoxification pathway's not working efficiently. Now, your detoxification pathways can very easily get clogged up. And don't forget the fact that we're actually paleolithic beings. Our physiology has not changed. Your physiology is exactly the same as your hunter gatherer ancestors. Although our lifestyles have changed significantly, your ancestors were not eating processed food and we're not taking in copious amounts of alcohol. They didn't have the ability to eat food from a packet or a box like we do these days. So if your liver is congested and don't forget, your liver will always prioritize toxins first. If your liver is congested and you're detoxifying all the food like substances and the alcohol first, you're going to have a backup of oestrogen not being able to detoxify through the large intestine and the liver. And then, what happens with oestrogen is we need to use it and then we need to lose it. If we have oestrogen moving through the system again once it's already been used, we can have an oestrogenic overload. When we have an estrogen excess presentation, we can quite often also have additional belly fat. So, it's a complex picture. We need to focus on the microbiome. We need to focus on detoxification. We need to focus on healing, sealing, and repairing your gut. But we also need to make sure that you can detoxify and eliminate the estrogens that you have used when you no longer need them. So, back to repair. We need to repair your gastrointestinal tract. We need to repair your metabolism, the energy crisis, your mood, absolutely your sleep. I have so many perimenopausal women coming into the clinic who cannot sleep. When you can't sleep, melatonin is too low. And if melatonin is too low, cortisol is too high. And this is part of the insulin resistance and the weight gain resistance piece. So, when insulin is, when you have insulin resistance. Because you have, okay, so let's go back. You're not sleeping, so if melatonin is not high enough, cortisol is too high. Cortisol is your stress hormone. So when cortisol is too high during the night, you can actually have blood sugar spikes. And it can be these blood sugar spikes that wake you through the night. So somewhere between 1 and 3 a. m. in the morning is liver time. If you're having a blood sugar spike or you're having difficulty detoxifying, you're waking between 1 and 3 a. m. Your liver is unhappy and you have a potential blood sugar spike. We need to keep your blood glucose stable so that we don't have this high blood glucose overnight. Because if we have the high blood glucose overnight and the high cortisol, you literally wake up feeling like you've been run over by a bus. So, if cortisol is high and melatonin is too low at night, your circadian rhythm is disrupted. Every single cell in your body has a circadian rhythm. Every single cell in your body wants to operate when the sun comes up in the morning and go to sleep when the sun goes down at night. When you do not sleep properly, your cleaning mechanism in your brain doesn't work quite as well. So your glymphatic system. which is not the lymphatic system starting with an L, it's the glymphatic system starting with a G, is not optimal. So what that means is that your brain doesn't get cleaned overnight. So this is one of the things that can end up leading to Alzheimer's and dementia, right? When our brains don't get the clean out that they need. We've got this high blood glucose, we've got this high cortisol, basically this is prediabetes type 2, so that it is so imperative that we test HbA1c. Which is a three month recording of your blood glucose levels as well as your insulin resistance. We need to test insulin, fasting insulin, so that we know that your blood glucose is okay. This is so important in perimenopause and menopause. So here we go. Our melatonin is too low at night and our cortisol is too high. And then what I'm seeing in the clinic is that your CAR, your cortisol awakening response, can either be too low or too high, depending on where you are in your chronic stress experience. So, how long have you been over scheduled for? How stressed have you been for how long? And that will, that, you know, your cortisol, or your cortisol awakening response will depend on that. Initially, women are in fight or flight when they're stressed, initially, like in an acute phase, and quite often that's when we see cortisol to be high. And don't get me wrong, we absolutely need cortisol. Cortisol is, um, cortisol is imperative for life. Like we need to be able to stand up for ourselves and we need to be able to run for our lives and we need to be able to fight for our lives. But again, your beautiful paleolithic ancient body doesn't know the difference between a tiger at the cave and an alarm or false lighting or a traffic jam. So if your system thinks that you're running from a tiger in the cave every single day of your life, eventually fight or flight turns into rollover play dead. You just do not have the energy. To fight or stand up for yourself or run anymore and you've got like this rollover play dead Presentation where you like literally please I just want to roll over play dead. I just want to get back underneath the covers I've woken up My stress and my my energy levels do not recover with sleep You know that you need to take care of your adrenals and your stress levels if you wake in the morning and you're not refreshed This means you're not recovering with a full night's sleep. This leads me into talking about the connection between your adrenals and your thyroid. Now, this is still everything that we're detailing and taking care of in our repair program because we have to make sure that our adrenals are working optimally. We need adaptogens, things like rhodiola and withania. In my clinic, if you are stressed and tired, I use rhodiola, for example, as one of the adaptogenic botanical medications. If you are stressed and wired, I use a beautiful blend of with Thania, like so many different kinds of with Thania really help women who are stressed and wired, relax and rebalance their circadian rhythms so that they don't have a circadian rhythm disruption so that your body knows when it's morning, that it knows when it's nighttime, your body then knows when to ovulate, right? And you're not hungry at strange times of the day. Having a balanced circadian rhythm also helps to balance your leptin and your ghrelin, which is your hunger response. Have you ever noticed that after a really bad night's sleep, you're stressed that day, but you're also super hungry? So our hunger, our leptin and our ghrelin, ghrelin is the hormone that makes you pick up the fork and eat, leptin is the hormone that makes you put that down. Ghrelin and leptin are completely disrupted if you have a circadian rhythm disruption. And then what do we do? Of course, we go for the drug like food substances. And this is no shaming. I'm a recovering food addict, so I know all about drug like food substances. So, you know, we go for the things that give us the hit, the quick hit. You know, the sugar or the dairy or the white flour, you name it. And then unfortunately the unbeneficial bacteria in your microbiome or your gastrointestinal tract feed on sugar and they are delighted. and they cause all sorts of trouble by disrupting your microbiome and potentially creating a leaky gut presentation or a gut intestinal permeability issue. Right, so that's, your GP would rather talk to you about a gut permeability integrity issue. Um, our GPs and our allopathic practitioners don't like the terminology leaky gut presentation, so just use the right terminology for them so that they take you seriously. Um, yeah, and then once we have that, we basically have inflammatory cytokines. Um, coming out of the gut into the bloodstream, attacking our joints and attacking our mood and attacking our mind. So again, if you have an inflammation in the gut, you have an inflammation in the mood and the mind. So again, going back to the adrenals and then the thyroid connection. Think about the wording, you know, it's called perimenopause. It's an invitation for you to pause, but unfortunately a lot of the time we also experience adrenal and thyropause. Right, so you can, it's so often, it's so common for perimenopausal women, all women in their 40s, to be diagnosed with a thyroid condition. Um, I see Hashimoto's thyroiditis in my clinic all the time. So it is so important to know how to test, what to test, and when to test. You need a full thyroid panel. I don't know why it's so difficult to get the testing that we need in this country, but unfortunately it is. So, you need to test your thyroid, you need to test your adrenals, you need to know what your cortisol awakening response is doing, and you absolutely need to know what your thyroid stimulating hormone is doing. You need to know TS, you need to know T3, T4, reverse T3, and you need to test both thyroid antibodies. I cannot tell you how many times. I've had a woman come into my clinic going, Oh, my doctor's tested my thyroid and everything is fine. Your doctor's tested your thyroid stimulating hormone and it is fine. And so many women have a thyroid stimulating hormone well within range, right? Well within range. Thyroid stimulating hormone ranges are huge, um, uh, in my opinion. You know, 0. 5 to 4 is actually a huge range. But, uh, you want your thyroid stimulating hormone at about 1. 5 or 2. You really don't want it any higher than that. To me, as a functional medical practitioner, if you have thyroid stimulating hormone, two or above, you're a candidate for hypothyroidism. Hypothyroidism makes you feel exhausted, you tend to hold on to weight, you can't seem to lose weight, you struggle with weight loss resistance, you're puffy, you're really puffy. So it doesn't actually, it isn't actually about the kilograms, but you literally feel like you can't get rid of that fluid retention. And again, quite often, um, You know, your energy levels are not recovered through sleep or rest, so you still feel absolutely exhausted on waking. Um, so yes, so thyroid and adrenals absolutely imperative, and then we need to get you into this fat burn as opposed to a fat store state, so that your mitochondria can work extremely well. The mitochondria is the energy room of the cell. From the age of 35 onwards, our coenzyme Q10 can deplete quite significantly. Coenzyme Q10 or Ubiquinol is gold standard fuel for your mitochondria. So, once you start to support your mitochondria and you have beautiful mitochondrial uncoupling, you can actually access that energy level again. And you need to, look, perimenopause, there's never been a time in your life where you have been more inflamed with less energy. Progesterone is going MIA, she's cool, calm, collected, and she sleeps. Progesterone also modulates the immune system and she modulates estrogen. So without progesterone, estrogen starts to rollercoaster. So that's where we feel like we're really on this crazy rollercoaster ride. One minute we're exhausted, the next minute we're snappy, the next minute we've got mum aggro and relationship aggro. You know, we've got dragon woman coming out screaming at everyone, you know, and then she feels really bad and really ashamed for it. And that's also because. You don't have the reserve or the nourishment that your adrenals need, and your adrenals are starting to take on some of the workload from the ovary, right? And if you've had a high ACE score, you've been under or overscheduled or overstressed for far too long, your adrenals are already exhausted and they're like, are you kidding me? You now want me to do the job of the ovary as well as your fight and flight and like keeping you alive? No, I'm sorry. No, I'm done. And that's when women start to feel that real burnout, you know, because the, the adrenals can't take on any more. They're done. They're dusted. They've, they've, they've been going for far too long. So then you have this adrenal pause. And then unfortunately, due to the fact that the hypothalamus, pituitary, adrenal and thyroid access is all in communication with one another, your thyroid starts to feel exhausted too. Because if there's something going on in the adrenals, there's something going on in your thyroid. So, that is repair. We need to repair your gut. We need to repair your immune system. We need to repair your mood. We need to repair your mind. We need to repair your sleep. We need to repair your metabolism so that you can access fuel from your food. And once your body has a nutrient dense, rich blood supply, and you are able to access the energy that you really need, you've got stable blood glucose levels and you don't have insulin resistance anymore. Right? You don't have this pre type 2 diabetes. You don't have high HbA1c. And, um, you are moving towards vitality again. You will seriously have the energy to do what it is that you want to do in your life. You will be able to serve the people that you love with such incredible abundance. You will have the ability to chase the joy. And that is the first step in your hierarchy of healing. Once you have an incredible roadmap, you know how to heal, seal and repair your gut. Um, you can rebalance those hormones and you can absolutely Make this perimenopausal and menopausal experience far more graceful, and that's just part one. Part two is rebalance. This is where we rebalance your hormones and rebalance your life and teach you how to live within this beautiful cyclical gorgeous rhythm that the female body was designed to do. Now, even if you're not cycling anymore, I highly recommend, because we're earthlings and we live on planet Earth, And we have a lunar cycle, right? Our menstrual cycle follows the moon. When you're no longer cycling, why not follow the lunar cycle? So, full moon is ovulation. In Rebalance, I teach you exactly how to support yourself according to the lunar cycle. So, for example, between day 1 and day 3 of your cycle, there is never a time in your life where you are more in tune and you are more Intuitive. And then between day three and day seven, you are so creative. This is the creative part of your cycle. This is when you start to dream big. This is when you create. Between day, you know, even between day three and day 14, you are hugely creative, and then when you want to get your message to the masses, you get up on that stage on day 14. When you are ovulating, you are absolutely magnetic. I've walked into parties and, you know, friends of mine and I've gone, Oh, are you ovulating? And they go, Oh my God, how do you know? And I'm like, you look insane. It's when you are your sexiest. It is when you are at your peak. It is when you are absolutely magnetic. So if you have a message that really means something and that you really need to share with people that really need to hear it. Day 14 is your day. Get up on stage and do it. Then if you are editing a book, there is never a time that is better to edit between day 14 and 28 because you are in your luteal phase. There is never a time where you are more critical. So you can use that. You can use that incredible power to edit. And when I say edit, yes, of course, edit your book. Take out the bits that don't work, but also edit your life, take out the mindset that no longer serves you, take out the friendship that no longer serves you and edit the things that no longer serve you. And I'm also here to tell you that because, you know, so many of us are also in relationship with others. This is the time when you want to criticize. This is the time when you want to criticize the people in your life and you want to criticize your relationship and potentially yourself too. I highly recommend that you write down what it is that you want to change and I highly recommend that you don't do it at this point in time. This is not when you give the feedback, you hold onto that information. You use your intelligence and you make sure that you bring your most intelligent self to your biggest challenge or the thing that you want to impact most. So you wait until you are in the first half of your cycle when you're really creative. And ideally you have cocktails and feedback when you're ovulating. Your partner is. far more receptive towards your beautiful feedback and your suggestions when you're ovulating. So I highly recommend that you do that then. So we've got repair, we've got rebalance, and then we've got reclaim. In reclaim, we reclaim your metabolic health and we prevent chronic disease for good. In this incredible trial that I was talking about before, we saw that All of the chronic diseases that 41 million people worldwide die from are preventable. You can turn the ship around at any point in time. Please don't die from type 2 diabetes or Alzheimer's and dementia, you know, which is type 3 diabetes. Please don't die from a cardiovascular disease risk that was preventable. Please do the lifestyle pieces. They are absolutely the hardest pieces to do and women don't want to hear it. You know, so many women just want to take a magic pill or the one thing. So I know that there are so many things out there in the marketing world that work. You know, there's this one pill for menopause and it's going to, you know, stop all of your horrible symptoms. That's never the case and it's never going to work long term. You know, it is unsustainable. It might work for a while. But if you want true sustainable health, you need to do the lifestyle factors. The Mediterranean and the longevity diet have been proven to be absolutely brilliant for perimenopausal women, but again, it's individualized precision care. So, if you want to know what's going on in your gut, I highly recommend the GI 360. It is the best functional test on the planet, in conjunction with the OAT test, I'd say, but I think the GI 360 is absolutely fine for gut health. And then, of course, I use the DUTCH test for, um, hormonal health. So, either the DUTCH Plus or or the dutch cycle mapping or the dutch complete, but we can talk about which one you need in the clinic if this is something that resonates with you. So please repair your gut, repair your metabolism, repair the energy crisis, repair your immune system, repair your mood, your mind, and your sleep. Get all of the functional tests that you need. Get a full blood panel, full thyroid panel, like I said before. and please have a look at the MTHFR gene polymorphism and have a look to see what's going on in your gut and treat your life and your health holistically. So health is not separate. There is no mental disease that isn't impacted by the gastrointestinal tract. We're now even seeing in the, um, In, in the, in the psychology and the psychiatry textbooks that inflammatory cytokines impact the brain and nutritional deficiencies impact the brain. Of course they do. Of course they do. Health is bio psycho social. But doing the lifestyle pieces are hugely brilliant. You know, get into bed early, get eight hours sleep, you know, wake up and get that beautiful cortisol balanced, you know, get that morning light into your eyes. And, um, turn off the screens at night and listen to your body. You have the most incredible intuition and body wisdom. You just need to know body literacy. You need to understand where you're at in your cycle. You need to understand what your gut is doing. You need to understand what it is that the messages that your body are sending you are saying. You need to understand where your progesterone is at, your estrogen, your cortisol, your testosterone, your atenocannabinolone, your androsterone. You need to know where your cortisol and your melatonin ratio is at. You need to know whether you have micronutrient deficiencies, you know, please take your health into your own hands. You need to care about yourself. We don't necessarily have a health care system that focuses on vitality. Now, our mainstream doctors are great at keeping you alive. But, you know, don't just be alive. Like, I want you to thrive, and particularly during perimenopause, because we need to transition successfully into menopause in order to be vital for good and ensure that we don't actually have any of these chronic diseases. So, repair, rebalance, and reclaim. Rescue you from the rollercoaster of perimenopause and transition successfully. Book your Clarity Call with me if you have any questions. It's a free Clarity Call. Join my green room while it's still free. It's a beautiful place to start. It gives you some ideas about what to test and when to test. Um, yes, I completely understand that so many women come into my clinic and they tell me, you know, on a weekly basis. that the GP say, you know, all your hormones are fluctuating so much. We don't even know, you know, when to test them. Yes, your hormones are fluctuating so much, but we absolutely do know when to test. We know that we need to test estradiol and sex hormone binding, globulin and testosterone and FSH and LH and prolactin between day one and day three of your cycle. And we absolutely know that we need to test. progesterone between day 19 and 22 of your cycle. So if you can get those blood draws, if you can get a full blood analysis, your full thyroid panel, you know, check to see that you've got, you know, adequate B6. B12. D3 is absolutely imperative. I see so many women with such low D3 levels. Every single cell in your body has a D3 receptor. And, you know, if you have Seasonal Affective Disorder, you absolutely need to check your D3. And don't forget that we need K2 to get D3 into the bone to prevent osteopenia and osteoporosis. And, of course, we need to move in a way that we love. And we absolutely need to be eating one gram of net protein per kilogram of body weight. Anyway, that's my little synopsis about my program. I'm so delighted to let you know that I've been nominated as health and wellness coach of the decade by the beautiful you life coaching academy and I've been appointed to a global perimenopausal panel and I'm so delighted to be here. I'm here for you. I had an extremely challenging health journey myself. I was diagnosed with polycystic ovarian syndrome, chronic fatigue syndrome, Hashimoto's thyroiditis, and I was a little girl who was trying to Move away from the pain of her parents divorce and being sent to boarding school by overeating and I'm a recovering food addict. I completely understand what it's like, but I am now 47. I'm in perimenopause. I'm somewhere between a size 10 on a good day and I do not diet, this is a diet free zone. I live a beautiful, beautiful, balanced 80 20 and you can too. You can absolutely live in an incredible body and you can support your biochemistry. Please do not take negligent care as, as the base. You know, you, you can, you can thrive. You can absolutely thrive at this time in your life and I want you to. And, um, you know. I'm busy. I was a single mom for 13 years. I've now found the love of my life. We've spent the last three years together and absolutely cannot wait to marry him. And we have a patchwork family with three teenagers, 16, 17 and 18, two dogs. And believe me, we've got a busy life, but I'm absolutely loving it. I understand how challenging perimenopause can be. I know our children are in challenging phases. I know that our careers are potentially incredibly challenging at this point in time. And we, you know, most of us are mothers and lovers and sisters and, you know, have children and aging parents and all the things, but your health does not need to suffer. And I'm also here to tell you that it's not your fault. Take it easy. Have a beautiful day. I can't wait to meet you on the clarity call. Let me know if you need any help. Shoot me through a question. I would absolutely love to answer you. Take it easy. Have a gorgeous day.