Recently I interviewed Dr. Betty Murray, and we talked about the world of hormones, discussing everything from progesterone and its role in women’s health to postpartum thyroiditis. If you would prefer to listen the interview you can access it by Clicking Here.
Dr. Eric Osansky:
I am very excited to chat with today’s guest, Betty Murray. We are going to be talking about hormones with a focus on progesterone, and we will also be talking about post-partum thyroiditis a little bit.
I am going to dive into Betty’s bio: She is a nutrition expert, Ph. D., researcher, certified functional medicine practitioner, and speaker. Betty helps women over 40 harness their hormones to lose weight, optimize sleep, restore energy, and thrive. During her research for her Ph. D., Betty made several key discoveries that led to hormone and metabolic imbalances that plague women over 40. Restoring balance to these key metabolic and hormone pathways is the basis of her hormone reset program. This program has helped her, and hundreds of clients lose weight easily, reduce hot flashes, restore sleep, and turn up their energy without living on a diet of deprivation.
She is also the host of The Menopause Mastery podcast and the founder and CEO of Living Well Dallas Functional Medicine Center. She is a frequently featured nutrition expert on FOX News Broadcasting, CW 33, NBC, and CBS. Thank you so much for joining us, Betty.
Dr. Betty Murray:
Thank you for having me.
You’re welcome. I’m excited to chat with you about progesterone. Before we do that, let’s get a little bit more into your background. What led to you starting to talk about hormones? It sounds like you had your own hormone journey.
I would love to say I didn’t. The truth is, especially for women, none of us get a pass on menopause. It’s going to happen whether we like it or not. My hormone journey actually started after my functional medicine journey. I really came to the functional medicine and functional nutrition realm from my own diagnosis of colitis and later on Celiac. It was me searching for ways to fix those autoimmune conditions and also repair my digestive disorder. I fell in love with it and obviously found a way to take care of that and also get rid of my symptoms. I can’t call it “cured,” but I have been without symptoms for over 18 years.
When I entered into the very last part of my 30s, and my early 40s in particular, it was like something radically changed in my health. Everything that had worked for me before stopped working. I started getting acne on my chin. I started gaining weight despite eating a low carb, high protein diet; doing high intensity interval exercise; having adequate rest periods. All of those things that we tell everybody, particularly people in my profession, to do.
It led me on this journey. I was diagnosed as hypothyroid. I am not actually Hashimoto’s. I have subclinical conversion issues. I was put on thyroid medication. We played with that for a long time, trying to figure out what was going on. I was told that I had all of these different problems. “Maybe you have adrenal fatigue. Maybe you have this or that.”
Basically, my entire 40s, I felt like I was in this endless fight with my hormones. It actually was what led me back for my Ph. D. I was also having all the other things you associate with perimenopause: PMS, mood swings, sleep problems, heavy periods, too frequent periods. When I got into that Ph. D. program, I really started digging and looking at the metabolic effect of these hormones, not the stuff everybody was talking about, but the things that aren’t being talked about, what’s happening inside the powerhouses of your cells and other things. I was able to reverse a lot of those symptoms as I went into menopause. I can say now at 53, going on 54, I feel better than I did at 35 and have a better harness on my hormones.
There is so much that has been missing in the medical community. Anybody that listens to my podcast knows I am pretty angry about the gaslighting of women’s health and the prepared ignorance of let’s not talk about what’s really going to happen in this perimenopausal season to menopause. For some women, that starts in their 30s because that’s where you start to see fertility challenges. We don’t talk a lot about what’s happening.
That’s why I’m on this soapbox now. My transition into menopause started in my late 30s and took over a decade, and it was really uncomfortable. I was already an expert in a lot of these things. I hate to say it, but it’s because I had such a horrible perimenopause that I’m here today talking about hormones.
That’s common, but common isn’t normal. When women have these extreme symptoms like hot flashes and night sweats, a lot of people conclude, “It’s normal. It’s perimenopause, post-menopause.” Your goal is to help women not have those symptoms; even though they’re very common, they aren’t normal.
Right. That’s true.
Let’s dive into progesterone and talk about why. If you could discuss why so many women have, I guess it’s not only progesterone deficiencies, but hormone deficiencies overall, with an emphasis on progesterone.
Certainly. All of our hormones are like a symphony. In a symphony, you will have the director of the show who will decide what the ambiance is of the actual experience. What experience do they want to have? That is your hypothalamus.
Then you have your pituitary. That’s in the brain. The pituitary is the conductor. It will talk to the symphony and tell the wind section what it needs to play, the brass section to play what it needs to play, and the percussion to do what they need to do.
The hypothalamus and the pituitary are constantly getting information not only from what we think, what we eat, what we do, but from our senses, the chemicals we get exposed to. I think a lot of the dysregulation we see comes from this onslaught of what’s happening at the pituitary and hypothalamus. Our environment is so much more toxic, and there is so much more going on today than there was even 50 years ago.
But what’s really happening is the downstream effect. When you look at those different parts of our endocrine system, we have our thyroid, our adrenal glands, our ovaries that produce our sex hormones, and we even have the pancreas that’s producing insulin. Those are all the different parts of that symphony.
The truth is, I like to look at it this way. My research bears this out. The most primary hormones that get precedent over everything else outside of your metabolic hormones like insulin, because we have to be able to shuttle glucose into our cells, and that’s what insulin does, or we wouldn’t survive.
When you step outside of that very basic need, the adrenals are your canary. They are helping your body understand: Are you under stress or not? Are you in fear or flight? Do you need to fight for your life?
When we look at our sex hormones, our sex hormones are luxuries. Progesterone and estrogen, they’re for when the world is safe and happy, and procreation and continuing the species is awesome. If our adrenals are constantly sending out this gigantic stress response, the world’s not safe, I’m starving on the Serengeti, it will alter those sex hormones.
The big thing that people need to know is that all of these hormones play together. Unfortunately, particularly in the conventional world, they get parsed out into these individual hormones. My endocrinologist only does thyroid. My gynecologist will help me with my sex hormones. I gotta break it to you, they’re a surgeon, not a hormone expert, in most cases. We don’t look at them as this grouping of an orchestra that are playing together.
When we look at the sex hormones, it really is the combination between our three different estrogens that fluctuate throughout the course of the month and a pituitary hormone that instructs the ovaries to get ready, pop the egg out, shoot it out so that it can end up in the fallopian tube, and hopefully by the time it gets to your uterus, we get implantation because we have a combination of the sperm and egg. Progesterone helps prepare the uterus for implantation for growth of the fetus.
It’s that combination of those hormones that fluctuate throughout our month that make up the female hormonal cycle. For most people, it’s somewhere between 24-28 days, up until about 34ish would be a normal cycle. Some people are longer, and some people are shorter. We can get into why that may be.
Progesterone is a really important hormone for fertility. At a minimum, if we do not have enough progesterone, the uterine lining is not prepared to carry a fetus. It is more likely that we will have miscarriage, for instance, as one of the major things.
I’m glad you mentioned the hypothalamus and pituitary because I commonly say that you need to have healthy adrenals in order to have healthy sex hormones. Same thing with the thyroid. Even though a lot of cases are autoimmune, you still have that communication, the HPA axis, and the HPT (hypothalamic pituitary thyroid) and HPG axis. It sounds like that’s one of the areas you focus on when it comes to improving health of the hormones as well, is making sure the person does have healthy adrenals.
Absolutely. The adrenals are responsible for the vast majority of progesterone production. We do get some from the ovaries. In my case, my ovaries are gone. They have petered out. I don’t have any. It would just be the adrenals.
That peripheral adrenal progesterone production, the adrenals make progesterone. That can be pulled through a pathway to make cortisol. If I’m under stress, and my body’s depending mostly on that adrenal production of progesterone, I may actually be using it as substrate to make cortisol to continue that stress response.
I don’t work specifically in fertility, but I have helped lots of people get pregnant. My populations skew a little bit older, not that I haven’t done it. When I have worked with women who are struggling to get pregnant, who have no major definable problems with egg quality and other things, nine times out of ten, it’s probably because they are so stressed, and the concept of trying to get pregnant is stressing them out, that they are probably making their own progesterone somewhat deficient.
If we just let up off the wheel a little bit and let go, I always tell them, “I need you to go on vacation. Chill out. Play around with each other like rabbits. Come home.” Chances are, we might be lucky, especially if it’s around that ovulation time period. We may be shortchanging our progesterone just because we have some of that substrate from the adrenals being used to make cortisol.
You alluded earlier that doctors have their own focuses, and they never will talk about adrenals when it comes to problems with the sex hormones. It’s great that there are practitioners like yourself and myself. As you mentioned, the body will always prioritize cortisol over the sex hormones. If someone’s in a chronically stressed state, there really is no way around that. You could take bioidentical hormones, but that’s not fixing the problem. There is a time and place for bioidentical hormones. I don’t know what your perspective is on that. I’m not against them. But it frustrates me that when that’s all they do. You go to someone who prescribes bioidentical hormones, and they don’t do anything from a diet and lifestyle perspective; all they do is give the hormones.
There has been an explosion of doctors who have their toes in the water of maybe looking at things slightly more holistically in most positions. Obviously, I am a Ph. D, not an M.D. D.O., or N.D. That’s the beauty of my world. I will just talk about the research. What does it mean? How does it apply to you? I have no vested interest because I am not prescribing. But I have clinician prescribers in my office who work with me.
I think they have their place, but you will never get really good physiological function if you are just throwing hormones in, and you don’t correct some of those underlying diet and lifestyle pieces that will keep driving that adrenal function. Believe me, I was the first to go, “I’ll sleep when I’m dead. I want to find a pill to make up for what I don’t want to do because I’m a type A, FOMO person.” I just want to do more. It’s my nature.
The truth is, I protect my sleep like nobody’s business. I make sure I relax and meditate and exercise appropriately because that is what is keeping me young as I age. We have to do those other pieces. Hormones are part of it, but they aren’t the only part of it.
Also in my case, I was given all kinds of hormones. I was still 35 pounds overweight as a practicing nutritionist and ex-body builder. Obviously, if it was just a hormone problem, that would have fixed it, and it wasn’t.
You took bioidentical hormones in the past?
Oh yeah. In a complete disclosure, I am menopausal now, and I am absolutely on bioidentical hormones now. Throwing in thyroid medication and progesterone because it was obvious that I was estrogen-dominant, it helped a little bit, but it wasn’t correcting some of the underlying damage that had really happened. It was a pick apart treatment process that didn’t work very well.
You’re on bioidentical hormones now, and you were in the past. The difference is in the past, that’s all you were doing, and you weren’t doing anything to improve your health otherwise, or at least optimize your health. You have been doing this for quite a while.
What are some of the common symptoms of progesterone deficiency?
For a lot of women, this can start even in their 30s. The first thing is, like we were talking about fertility, if someone has infertility issues, there is a high probability it’s a low progesterone level in the second half of the cycle. That’s an easy thing to look at. Depending on who we are genetically, we may not make very much. There are metabolic disorders like polycystic ovarian syndrome (PCOS) that is defined by a lack of progesterone production because of problems with the pituitary.
When we look at the symptoms, I would say the big ones that start to show up are things like sleep. Progesterone has a powerful effect for one of the receptors in our brain for a neurotransmitter called GABA. GABA is our major anti-anxiety neurotransmitter. It’s what also helps keep us asleep. Often, as progesterone levels decline, the sleep starts to get pretty sketchy. That was a significant problem for me. My sleep was very sketchy. Insomnia, interrupted sleep, that would absolutely be one of the symptoms.
Then you can look at some of the other things. A lot of the other symptoms can be things like fibroids, fibrocystic breast disease, heavy periods, clotty periods, periods that become more frequent. Anything that has to do with abnormal periods can be part of that.
If you look at even mood issues, estrogen and progesterone, this is where you start to get into a sketchy game. Either one of them being way too high relative to the other or way too low relative to the other, you can also see some pretty significant mood issues. If someone gets to the second half of their cycle, let’s say the 10 days before their period, and they’re raging mad, irritable, weepy, angry, all of those things, it may very well be because progesterone is deficient.
You can even get the acne, particularly along the cheek line and the chin, as a sign of abnormal hormones and relative estrogen dominance relative to progesterone. Those are some very basic, easy symptoms that could be a sign something is off.
Sticking on the topic of estrogen. Talk about both progesterone and estrogen. If someone has too much estrogen, that could be considered an estrogen dominant condition. Even if they have normal estrogen but low progesterone, that also is considered estrogen dominance as well, correct?
Exactly. It really is the relative relationship between these hormones that sets up a lot of those symptoms. When they get wildly out of balance to each other, it’s almost natural. Natural isn’t ideal, but it’s almost natural for most women to experience some of that as they get into that menopausal timeline as they start moving toward menopause. Progesterone declines long before estrogen does.
Is there any concerns with too much progesterone, which I assume doesn’t really happen unless someone is taking progesterone? There are concerns if someone has excess estrogen. If someone takes a progesterone cream, and they’re taking more than they need to take, is there any concern with that?
When you look at the studies out there, we don’t generally see a lot of occasions with a wild increase of progesterone relative to estrogen. When we get into the scenario where progesterone levels might be problematic, could be things like post-partum depression. Progesterone levels, when we’re pregnant, particularly those last two trimesters, they’re off the chart. If progesterone is way too high, you will see things like water retention.
I have not been pregnant—I am child free—but anyone who has been pregnant, when they get to the last half of their pregnancy, they will feel like they are water-logged. Excess progesterone can cause edemas, water retention, things like that. If somebody was supplementing or had a scenario where their progesterone was peaking more than their estrogen, they may get more water retention, fluid retention.
If we look at the overall mood scenario, PMDD, which is a much more severe form of PMS, it’s basically premenstrual disorder. It is a diagnosis. It is a label. But it is when the second half of the cycle results in some pretty significant psychological problems. It has been implicated in women doing acts of violence. There is some literature out there showing that it may be a brain reaction to that wild change in progesterone. The brain is responding adversely to it. We don’t know for sure, but it seems like it may be that. Post-partum and PMDD may be associated with these wild shifts in progesterone levels.
If we look at a woman supplementing with progesterone, and maybe she is getting more than what she needs, usually you will get weird things like breast swelling or tenderness. If you have too little, you can also have that. You can track it to the intake.
What’s interesting is when you look at the supplementation with progesterone, there is good literature out there showing that it’s quite effective as a sleep aid, particularly in women much past menopause. It has positive effects, too.
When it comes to determining how much progesterone someone would need, that’s where testing comes into play. That’s where I want to talk about hormone testing, focusing on progesterone, but feel free to talk about some of the other hormones. Do you have a favorite test, whether it’s blood testing or dried urine testing? These days, a lot of practitioners are doing that.
There is advantages and drawbacks to all of them. Serum testing is less ideal, for multiple reasons. It’s ideal because it’s easy. You probably will run other labs, so it’s easy to throw them on top. You will blood draw for your metabolic panel or your other things you might be looking at.
When you’re looking at sex hormones in blood, all our hormones have binding proteins. Those binding proteins, think of them as a taxicab that pick up the hormone, drive it around, and drop it off at whatever target place it needs to do its job. When you look in blood, you can’t distinguish between how many of your hormones are in the car and how many are outside. You could falsely be dosing inappropriately because you can’t tell how many are free. The free hormone is the important hormone. That’s where it’s available to do its own work. Those binding globulins can tie them up. It’s a less favorable one.
The other thing is progesterone is very fast from production to tissue, so it basically gets made and used very quickly. You could easily dose improperly if you are looking at blood alone. But sometimes, we do what I call quick and dirty bloodwork to see what’s happening. We are already getting a bunch of other things. Especially if insurance might pay for it, it might be worthy to check.
Saliva can show you the free amounts. It’s a pretty good judge of progesterone although it can often project really high salivary levels of progesterone when it may not be that physiologically high. It has some advantages.
Personally, I prefer either the dried urine spot, the Dutch test, or a 24-hour urine test for hormone metabolism. Both of them test the same things, except the dried spot can also give me the cortisol rhythm throughout the day because you are getting multiple tests throughout the day to see what your adrenals are doing.
The reason why hormone testing in urine, I think is advantageous is you’re getting free levels. We are picking up the free levels of the hormones. We can see if it’s adequate or not for age. Is it a physiological range that is known to help things like bone mineral density and osteoporosis and all those other pieces?
We can also see the metabolites. Once we’ve made these hormones, they do their job, and they get sent to the liver to get packaged up to get thrown out. That packaging process is a multi-step process that is driven by our genetics, can be interfered with by toxins, and have some limited capacity potentially in different people. The dried urine test and 24-hour urine test shows us those processes at each step of the way. You can really see once I get my hormone to the liver, can I wrap it in the three different wrappers I need to, so I can throw it out in the trash? Every single one of those steps has to be done in order with the right ingredients at the right time, or you can’t get rid of those hormones.
Those tests are better to judge adequacy and what happens after you use it. I like them. They are obviously more expensive usually than bloodwork. Maybe not. If you’re paying for bloodwork with LabCorps or Quest out of pocket, sometimes those can be very expensive, whereas this test gives us more data.
I agree. There is a lot of different advantages to doing a test like the Dutch test. One thing I like is when looking at post-menopausal women, it gives that post-menopausal range. If you do a blood test, and someone’s progesterone is 0, the lab considers it to be perfectly fine.
If progesterone and estrogen levels are nonexistent, it’s okay. The Dutch gives the pre-menopausal range and the post-menopausal range. I like that. For cycling women, there is a cycle mapping opt-in as well, so you can look at it throughout your cycle. I like the Dutch test as well.
You also mentioned the hormone metabolism. When it comes to estrogen, do you see a lot of people with elevated 4-OH and 16-OH metabolites?
Absolutely. I am an open book online. I have played my entire review of my own genetics as a podcast. If anybody wants to know what genetics means, you can listen to my podcast and hear my own personal genetics.
I am heavily mutated in that pathway, so I have two mutations on that CY1P1B1 gene, which for anybody who doesn’t know what that is, that’s a less favorable estrogen metabolism pathway. It makes a toxic metabolite called 4 hydroxy estrone. I am on hormones, but I watch what my hormones are doing by using the Dutch test. I use nutrition to modulate it because I want the positive effects of hormones to keep me healthy in all those other things, but I want to make sure I get them to the trash.
I do see a lot of people with very high levels, particularly of 4 hydroxy, or the propensity to have high levels, and we do a bunch of things to bring them down, myself included. I use myself as a lab rat of one all the time, to see what happens if we do this on this pathway?
I might have to get you back one day to talk about genetics and methylation and all that fun stuff.
What are some ways to increase progesterone? Obviously, there is bioidentical hormones, which you’re taking. I want you to talk more about that. One question also when it comes to that is taking it during post-menopause. Do you think that every woman in post-menopause should take hormones? If not, should everyone with a hysterectomy take bioidentical hormones? If you could talk a little bit about the botanicals, herbs such as vitex/ chasteberry.
Sure. I’ll start at the younger end of the spectrum. Let’s say it’s a woman in their late 30s. Maybe they’re like me, and they woke up one day and feel like they’re in puberty again. Something went wrong. In those cases, where maybe their progesterone isn’t peaking quite where it’s supposed to be, because progesterone declines long before estrogen, that is a perfect time to use things like chasteberry, vitex, or vitex dong quai, even things like maca. Those herbs have been shown to modulate some of these pathways and favorably push toward progesterone, relative to estrogen. Sometimes, we can get some improvement in our hormones just by putting some things in there that swing that spectrum a little back toward progesterone. I use those quite a bit in my practice.
Now, as somebody moves into that 40s spectrum, chances are the progesterone is declining pretty quickly. There are some over the counter versions of progesterone that are topical and made from sweet Mexican yams. Most of the time, you’re looking at a biological effect of about a 20mg dose of progesterone with something like that. Those might work a little bit in that very early time period. You might stack that on top of some of the herbals.
As you start to get into the real loss of progesterone, that is where you start getting into prescriptive needs. Progesterone can really be given in two ways that I’ll focus on. It can be given as a cream or an oil, but a topical delivery, and it absorbs very easily subcutaneously. Lots of things absorb through your skin, everything really. When you are starting to get to those doses, most of the prescriptive doses will be 100-200mg.
That can be given orally as well. What’s interesting about oral progesterone is when you give it in a powder form that you have in a capsule, it’s poorly absorbed and utilized. Progesterone, in order for it to be adequately used, it has to be in an micellized form. It has to be micronized. When they micronize that progesterone, they make that fat soluble hormone water soluble, so you can absorb it.
When you look at the clinical studies of the efficacy of a topical progesterone compared to a micronized progesterone orally, the oral works better if sleep is an issue. If a woman can’t sleep, they have insomnia, or it’s really interrupted, my general recommendation is to go to an oral. Oral progesterone has no real concerns with liver metabolism and toxic metabolites.
Estrogen does. That’s what we were talking about before. You don’t really want to take an oral estrogen because it has to go through a first pass through the liver before you can use it.
Years ago, when Premarin was one of the only things available on the market, it has a lot of history of safe use. It really does. I know in the functional medicine community, we are very anti-Premarin. It’s because it’s got 17 different estrogens, and humans only have three. However, there is over 50 years of history, and there is low risk, even with Premarin.
Today, we have a much more eloquent and bioidentical, which means exactly like what our body makes, way to give estrogen. The woman who may need progesterone as they go through their 40s is often going to start needing estrogen somewhere before they get to the end. The cliff dive of menopause. Estrogen is better given topically. There are some utilizations of pellets, which are subcutaneous fat and muscle application, where your body is metabolizing it through the tissues. It’s a more efficient way to give it. Estrogen topically means it’s going to hit your blood supply, get used, and then it ends up in the liver, so it doesn’t go through first pass liver.
I believe personally that regardless of whether a woman has a uterus or not, years ago, doctors would not prescribe any progesterone if a woman had gone through a hysterectomy. They thought progesterone’s only need was to protect the uterus from excess estrogen increasing the lining of the uterus and causing estrogen bleeding. But we now know progesterone has a huge impact on the body and the brain. It’s necessary way beyond the uterus.
I am of the mindset that you replace both. You take them to physiological dose. Not just my hot flashes got better, but you want them to produce their physiological effect, so you get the bone protection, brain protection, heart protection, mood protection, and other things. I believe in doing both.
On the other side of that equation, I also believe women should be on testosterone therapy, even though the FDA has not approved testosterone therapy for women. Every woman listening, we make 3-4x the amount of testosterone on any given day than the highest level of our estrogen at its absolute highest. It is an important hormone for women. It’s just never been looked at because there was an extraordinary male bias in the science and research community that drove everybody to push that hormones were unsafe, and definitely they thought women didn’t need testosterone.
What form should women take?
Same thing. Really topically. Topically or a pellet, something where it’s absorbing through the tissues instead of going through the liver.
You take topical estrogen, topical testosterone, and do you take topical progesterone orally? For progesterone, oral is better for sleep.
Okay. I didn’t know that. Does topical progesterone help at all if someone has sleep issues?
It doesn’t seem to be as powerful. Everybody always thinks of progesterone as something for the uterus. It’s to protect the uterus from excess estrogen, or it’s to get the uterus ready for fertility. Progesterone has these effects, like the holding of the receptor for GABA, so it has a calming effect. It also has a calming effect on levels of dopamine and the NMDA receptor in the brain, so it has a modulating mood effect on its own. Progesterone acts a little bit as an analgesic, so it has a painkilling side to it, too. It has all these multifaceted pieces to it that we would benefit from.
If someone has a hysterectomy, it sounds like in just about all cases, if not all cases, you would recommend all three hormones?
Absolutely. The thing is, you could get things like a little bit of hair loss, but you can get hair loss from too little testosterone and too much testosterone. You can get hair loss from the loss of progesterone and estrogen. That’s where testing, like the Dutch test, comes in. Even if you’re on these hormones, you can see that’s going to happen, and you can put things in to stop it.
I have a tendency for hair loss with testosterone therapy, and if I am not protecting against that based on my genetics. I can put things in like stinging nettle and saw palmetto that push away from the production of a hormone called di-hydro testosterone or DHT, which causes hair loss. There is a lot that can be done to watch and modulate, so we get the best effect of the hormones and reduce the side effects that may be from them.
With perimenopause, if someone is at the beginning stages, I am trying to figure out when it comes to the herbs. Do you use chaste tree or maca or dong quai more in pre-menopause before they hit perimenopause and post-menopause? Or which stage? Do you combine the two bioidentical hormones along with the botanicals?
I definitely use the botanicals in perimenopause, especially somebody who is early on and doesn’t necessarily need hormones. I use them with hormones. Because those herbs shift those hormone pathways a little bit, they have some positive effect on how you detox your estrogens. Often, you can put them together with some of the other nutritional compounds that make it easier for you to get your estrogen down the cleaner pathways.
Foods like the brassica family and broccoli and brussels sprouts and kale. Berries. Even caffeine, which has been vindicated and helps you make cleaner estrogen. Rosemary extract. Thyroxine helps you get a cleaner pathway for estrogen detox. Adding nutrients like that can help also improve the estrogen detox. Indole-3-carbinol, DIM, even citrus bioflavonoids and hops can help you make cleaner estrogen pathways.
Often, you can combine those with those herbs in particularly someone who might be starting on hormone therapy to make that cleaning pathway really clean. Everything is moving in the right direction. I use them all the time, and I use them all the way through menopause.
Very cool. I want to spend a few minutes on postpartum thyroiditis. Before we talk about that, is there anything else I should have asked you about progesterone that I didn’t ask you? I’m sure there is a lot more you could talk about, but anything urgent?
No, I got to hit on the big ones. If every woman listening to this walks away and says, “Huh, maybe I need to explore this because it might be a bigger deal,” especially if you are in the age range where it makes sense to look at it, then I have probably done my job.
Very good. Let’s spend a few minutes on postpartum thyroiditis. I know you have a lot of experience with that. I want you to focus on the management, but also, I don’t know if you want to talk about what postpartum thyroiditis is and how frequently you see it in your practice.
I do see postpartum thyroiditis even though I don’t necessarily work with people on the fertility side. Postpartum thyroiditis is a pregnancy-induced Hashimoto’s with antithyroid peroxidase antibodies. What I have found, and you can probably speak to this as well, is that often, this is a subclinical Hashimoto’s. The antibodies were already present before pregnancy. It’s the hormone changes that radically shift what’s happening in the pregnancy itself, and that’s the ensuing inflammatory response.
I like to think about it this way: When we’re pregnant, one whole side of our immune system takes a nap. Otherwise, if it was paying attention, it would kill the fetus. We have a foreign entity in our body. A lot of it is this inflammatory response of those hormones shifting, the reduction in progesterone, the increase in estrogen relative to it, the turning back on of that immune system, and also the increase in prolactin, because prolactin is immune stimulating. Prolactin is the hormone that brings in breast milk. All of those things are just right for an opportunity for thyroiditis postpartum.
How do you manage it? I know that’s not your focus, but when you do see someone with postpartum thyroiditis, what do you do to help manage the symptoms?
If we look in the research, there is some pretty good research that nutritional selenium, adequate levels of selenium and taking supplemental selenium, both even pre-pregnancy. If somebody is like, “Hey, I know I have antibodies, but I am not fully Hashimoto’s,” or “Maybe I am Hashimoto’s, and I don’t want to have a thyroid storm afterwards,” we can use preventative selenium. If someone is experiencing that, using appropriate selenium from that.
I also look at the usual anti-inflammatory things. Taking your inflammatory foods out. Particularly gluten, even if you aren’t Celiac, even if you’re not sure you’re gluten-sensitive. Remove that immune stimulating food because it does poke holes in our intestinal walls. It can increase this immune response, even if somebody is not Celiac.
I also look at some other really inflammatory foods: sugar, dairy, processed foods. In some people, we might even remove grains for a period of time because they tend to be more immune stimulating.
I often look at the amount of iodine, whether it’s too much or too little. On either side, if it’s too much or too little, you can see an increase in thyroiditis. You may agree or disagree with me, but there has been this prevailing story in functional medicine that was started by a particular physician or researcher. Everyone who had thyroid problems really needed physiological doses of iodine.
I see just as many people who may have thyroiditis, postpartum and/or an uptick in Hashimoto’s antibodies, and some of it is probably being driven by too much iodine. Yes, if we don’t have enough, and our soil is depleted, but chances are, people are eating foods with iodine in it. The relative risk of somebody being severely iodine deficient is probably not what’s being promoted out there. I very much believe in doing an iodine to creatinine ratio, really looking at that and adjusting the diet to increase or decrease that iodine level.
I agree that you want to be cautious with iodine. I was on the iodine bandwagon years ago, just as far as the higher dose of iodine, and realized that that’s not a good idea for a lot of people with Hashimoto’s and Graves’. That being said, if someone is pregnant, they probably want to take a prenatal that has iodine, but just a smaller amount of iodine. You don’t want to go to the other extreme, where you are completely restricting iodine during pregnancy because iodine is important for the development of the fetus, especially the brain.
I agree as far as taking separate iodine supplements during pregnancy. That could be a contributing factor.
That’s good advice with selenium. A lot of people don’t know that they have Hashimoto’s during pregnancy. If someone does know that they have it, they could take the proper precautions. I guess it’s a good argument for anyone to try to eat a healthy anti-inflammatory diet, do things to manage stress.
Also, it sounds like you agree. Some people talk about birth as being a trigger, but it’s almost like the straw that broke the camel’s back. The person had the antibodies prior. It’s not like the birth caused Hashimoto’s. As you know, it takes years for that process to develop.
Anything else that you wanted to talk about with postpartum thyroiditis? I know there is probably not a lot to talk about, but I wanted you to give an overview.
I think we should be testing for these things before we think it’s a problem. You’re going to develop Hashimoto’s over time. It’s not something new.
The other thing people need to realize is when we look at lab reference ranges, and some of them may vary by lab, they didn’t go out and get 1,000 of the healthiest people on the planet and go, “What’s the perfect range?” They picked 1,000 random, probably medical students who were sleep-deprived, sick, and tired, and did theirs. Maybe someone got lucky, and they looked for antibodies. They are just slightly below diagnostic criteria. I always look at those things, and they’re like, “Oh, you’re fine.”
You shouldn’t be creating antibodies to your own body parts. If you are skirting the high side of normal, something’s brewing. If I know that, I can take proactive steps. Just because somebody is in the reference range doesn’t necessarily mean that won’t progress to something later on. It may not, but it may. It’s important to look at it as the N of 1, that person, and what’s the likelihood for that to increase?
I agree. You want to look at the optimal ranges. The problem is that most of the time, they will just do a thyroid panel. Many times, just a TSH. If the TSH is on the higher side, but within the range, they won’t look any further. They should be doing predictive antibody testing, where they look at the thyroid antibodies, especially the thyroid peroxidase and antithyroid globulin antibodies, even if the TSH is within range, because it takes time for that process to develop, where the TSH becomes out of range.
That’s a good point, all pregnant women, the argument for them to have the thyroid panel as well as antibodies. I don’t think it will happen anytime soon in conventional medicine, but in the functional medicine world, probably a good idea.
Where can people find out more about you, Betty?
Obviously, you can listen to Menopause Mastery. I have some men who follow me. Even if you’re not in menopause, we’re talking about this trajectory time period, as these hormones change. You can follow me there.
You can find me at BettyMurray.com. On that website, you can get to a What’s Your Hormone Type quiz. It’s a questionnaire that takes about 2-3 minutes. It will help walk through a bunch of symptoms and help you figure out what hormone imbalance you may have. You can figure out if your adrenals are fried, if your sex hormones are causing a problem, if it’s thyroid, if it’s your metabolic hormones. It helps distinguish that, and it has its own personalized report that comes from your questions.
Check out Betty’s podcast as well as her quiz. Thank you so much for chatting about hormones, especially progesterone, even though you also spoke a good amount about estrogen and a little bit about testosterone, as well as postpartum thyroiditis. You shared a wealth of information, and it was a pleasure having this conversation.
Thank you, Dr. Eric. It was really fun being on.