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The Relationship Between Adrenals, Perimenopause, and Thyroid Health

On Friday March 5th I interviewed Dr. Amy Day, founder and CEO of the Women’s Vitality Center, and below is the written transcript. If you would prefer to watch the interview you can access it by clicking here [1]:

Here is the transcript:

Dr. Eric:

Hello, everyone. Hope everyone is having a wonderful Friday so far. With me today is Dr. Amy Day. Dr. Amy has been at the forefront of the natural woman’s health movement since 2004 after receiving the fourth ND license in a State of California. So while she was in naturopathic medical school, struggles with her own women’s health issues fueled by Dr. Amy’s passion. So pretty much in short, Dr. Amy’s a hormone expert, so that’s why we’re going to chat about adrenal health, perimenopause, and we’ll also be answering some of your questions later on. She’s the founder and CEO of the Women’s Vitality Center. She specializes in helping busy professional women struggling with perimenopause to balance their hormones. A big part of that is also balancing their adrenals, which we’ll get into. Welcome, Dr. Amy, thanks for getting together for this interview.

Dr. Amy:

Absolutely. It’s an honor to be here, and it’s really been fun to connect with you and get to know you and all the amazing thyroid work that you do. It’s so important how all these different hormones interconnect with each other, and I’m excited to have a conversation about it today. Thank you for having me.

Dr. Eric:

You are very welcome, I’m excited as well. Why don’t we just jump into the adrenals. We’re going to, again, talk about adrenals and perimenopause, and I think Dr. Amy might’ve froze there. Dr. Amy, are you still with us here?

Dr. Amy:

I’m still here.

Dr. Eric:

Okay, as long as we can hear you, so your screen’s freezing a little bit.

Dr. Amy:

Okay.

Dr. Eric:

But no worries. We’re going to start talking about adrenal health, and then we’ll make our way into perimenopause. Can you tell the viewers why the adrenals are so important for our health?

Dr. Amy:

Yeah, so adrenals, many people have heard of them and many people have not. So just to take a little step back of like what are the adrenals? What are we even talking about? The adrenals are a part of our endocrine or hormone system that they have many functions. But one of their main functions is to help us to respond to stress. They’re little glands that sit on top of your kidneys in the middle of your back, they’re like little hats that sit on top of your kidneys and they produce cortisol, which is your main stress response hormone. They also produce a host of other hormones, but that’s one of the big roles for the adrenals. This all has to do with how do you respond to stress? Stress is going to happen in life, so how is that working for you physiologically to be able to respond to that stress?

Dr. Eric:

Thank you for that explanation. Why do so many people have adrenal problems? At least, I see a lot of adrenal problems in my practice and I assume you do as well?

Dr. Amy:

Yeah, absolutely. It’s interesting what we consider to be an adrenal problem. In conventional medicine, there’s this black and white picture of everything’s completely fine, or you’re in a completely diseased state of the adrenals. What we see in more functional medicine, natural medicine practices is everything in between, where the adrenal glands are just having dysfunction related to the chronic stress that we tend to accumulate in our lives. Whether it’s big, short-term stresses that are going on or all the little things that add up over time and are going on for a longer time, that accumulation of stress can make it so that the adrenal system is just not able to completely respond as adequately.

One other thing to mention about what the adrenals do for us, there’s a stress response in the sense of like, in the moment, there’s a stressful thing going on and you get your blood sugar up and your heart pumping and your eyes dilate and your muscles are stronger. You’re flooding your system with blood sugar to be able to fight or flight, so there’s that acute stress response. Then there’s also a role, a really important role that the adrenals do for us, which is regulating the circadian rhythm or our 24-hour clock. Your adrenals produce cortisol for you first thing in the morning, that’s part of your get up and go.

Then those higher levels taper off over the course of the day and drop at nighttime, so regulating that night/day rhythm is another really important thing that the adrenals do. When we’re in chronic stress situations, when our schedules are irregular, when we have an acute issue of something going on, either emotional or physical, any of those things can contribute to the challenge of the adrenal glands.

Dr. Eric:

Okay, great. It’s important what you just said, as it’s not just emotional stressors, but physical stressors, and lack of sleep also have a huge impact on adrenal health. You also mentioned difference between acute stressors and chronic stressors. When someone is in acute stress, the adrenals do a pretty good job of adapting to acute stress, so you’re more concerned about the chronic stress, correct?

Dr. Amy:

Yeah, either the buildup of the chronic stress or the long-term impact of the acute stresses when they happen. Some people, they’ve never been well since some big thing happened in their life or to their bodies or something, and then it’s the long-term consequences coming from that. Because that resiliency wasn’t there to be able to bounce back. That’s how acute stress can turn into a long-term issue or the chronic stress, that’s the every day grind of all the demands in our lives and the get up and go, and the deadlines, and the world that we live in, and the issues that different people face that are just constant drains on our system.

Dr. Eric:

Yeah, and of course it’s only been increased over the last year for a lot of people with everything going on. But even before last year there’s always been stressors, there’s always going to be stressors, and that’s why we want to try to do everything to improve our stress handling skills. We could talk more about that. But I want to talk about, of course, thyroid and adrenals. As far as stress, stress affects adrenals, so what is impact that chronic stress has on thyroid?

Dr. Amy:

I’ll make a couple comments, but I’d love to hear from you, so there’s connection.

Dr. Eric:

Sure.

Dr. Amy:

So often we see when people are having thyroid problems, that there is an adrenal aspect to that also, or it could be vice versa. I see it a lot in practice and we know that in order for the thyroid to function optimally, that the adrenals need to be functioning optimally as well. But I turn it to you, I would love to hear your perspective actually on how that relationship is between the adrenals and the thyroid.

Dr. Eric:

Sure. There’s a few different ways. Especially, when someone is dealing with a chronic stress and high cortisol. T4, as you know, converts into T3, which is the active form of thyroid hormone. Most of this takes place in the liver, some of it takes place in the gut, I think approximately 60% in the liver, 20% in the gut. Those could have an impact on thyroid health. But also when someone has stressed out adrenals, that could affect conversion of T4 to T3, especially when they have high cortisol levels. So a lot of times we’ll see, or I’ll see normal T4 and low T3.

Again, this might be related to problems with the liver, or it might be related to problems with the gut.  So it’s not only adrenals, but adrenals can play a big role. Then chronic stress, for those with Graves and Hashimoto’s, chronic stress causes dysregulation of the immune system, which is a pro-inflammatory state. That could also be a contributing factor, or potentially, a trigger of thyroid autoimmunity. Then another way is there’s what’s called Secretory IgA, which lines in mucosal surfaces of the body, and chronic stress will typically decrease Secretory IgA. That’s a protective barrier, so when you have a decrease in Secretory IgA, it can make you more susceptible to, let’s say, infections, for example.

So those are three different ways in which problems with adrenals can affect thyroid.  One directly affects thyroid, the other ways affect the immune system. But, yeah, I definitely see a lot of that in my practice as well. How about sex hormones? Because, again, we’re going to talk about perimenopause, so do you want to talk a little bit about the impact of stress and adrenals on sex hormones?

Dr. Amy:

Yeah, definitely. I love the points that you just made too, it just speaks to whether we’re thinking of it as an adrenal problem or thinking of it as a thyroid or thinking of it as a sex hormone imbalance, wherever it’s showing up like that, just recognizing that the stresses are showing up in our bodies in all these ways. I feel like in our society, it’s become so normal to just be experiencing stress all the time, and that idea of really recognizing it’s having a huge impact in the idea of how stress is, basically, is detrimental to our physiology as smoking is which we pretty broadly now know most people don’t want to be doing that to their bodies. And yet, we have a lot of stress in our lives and there’s a lot of reasons for that, so it can be challenging.

But, anyway, thank you for pointing out those different aspects of how the adrenals are impacting the thyroid, for sure. The impact on the sex hormones, so the adrenal glands, I mentioned earlier, they produce cortisol. They also produce a host of other hormones. They are actually capable of producing estrogen and progesterone too. So part of what happens in perimenopause is that your ovarian production of estrogen and progesterone start to change. First, women tend to start producing less progesterone and still have the estrogen on board. But then later through the perimenopausal transition and into menopause, then having low levels of both progesterone and estrogen is a typical course for that.

The adrenals are able to produce some estrogen and progesterone, which can help to fill in the gaps, if you will. Stabilizing during perimenopause when the hormones are just on this roller coaster of crazy ups and downs that can be stabilized out, and then postmenopausally, that the adrenals can contribute to the hormones that are missing at that time.

Dr. Eric:

All right. One thing also I’ll mention is that… I don’t want to get too much into the hormone pathway, but it all starts with cholesterol. You, of course, you need healthy cholesterol. If you’re taking something like a statin then that can also affect sex hormones. Then cholesterol turns into pregnenolone, and then it separates into two different pathways. The body will always prioritize the production of cortisol at the expense of the sex hormones. Which makes sense, if you’re in a stressed out situation, you’re probably not going to want to have sex… Like an example of going back to the caveman years where if a caveman was being chased by a lion, or I guess that could happen today too maybe, being chased by a bear or something, you’re not going to want to have sex while being chased by the bear.

You’re going to think about just the fight or flight reaction, so the body’s going to always prioritize cortisol. But the problem, again, as we’re discussing, everybody’s in a chronic state of stress and so they’ll always be pumping out cortisol. That’s going to sacrifice the sex hormones, DHEA is going to be on the lower side, testosterone, the estrogens. You might not see all the hormones low because it takes time for that to happen. We’ll talk about the testing as well, especially, more so with the adrenals. But, yeah, why don’t we jump into perimenopause and talk about… or why don’t we talk about, maybe, talk about testing a little bit and lead into that? Because you do recommend testing the adrenals, is that correct?

Dr. Amy:

I do. It’s interesting, a lot of women will start experiencing some changes. They’re in their late 30s, going through their 40s. For some women, it’s not until their late 40s that it’s really starting to kick in anyway. But just what perimenopause usually starts with is subtle or sometimes not so subtle. But sometimes we’re like not sure, “Is this perimenopause? What’s going on? I’m a little hotter than usual, or my period came late, or I’m snapping at people more often.” No, it’s just because the people are really annoying now, or maybe my hormones are changing. That’s all the different changes that can happen, and we start putting the pieces together like something’s going on here. A lot of women are coming with the question of like, “I want to get my hormones tested. I want to see what’s going on.”

Something that I think is important to know is that there can absolutely be value in testing the ovarian hormones, the estrogen, progesterone, the testosterone…actually measuring and looking at those. But very often the estrogen and progesterone are shifting and changing day by day, and even from one cycle to the next. Timing that testing and really interpreting it can be a little tricky. You can definitely get useful information from it. But most conventional doctors, when I’ve had patients say they went to their doctor, they asked for testing, and the doctor says, “We don’t do any testing.” I think it’s important to know that there can be useful testing to be done. But the first layer of testing that I always recommend is a general screening blood test and adrenal test.

In the general screening blood tests, and that this is going to be… you mentioned a minute ago the sex hormones and adrenal hormones are made from cholesterol. Are you getting enough good fats in? Do you have cholesterol? We’ve been told for heart health reasons, you don’t want high cholesterol, you want to keep your cholesterol really low. But you actually need enough and you want to be getting in those good fats and having that cholesterol as the precursor to your hormones. Screening things like cholesterol, heart health markers, your blood sugar regulation markers, nutrient levels. Things that might explain if you’re feeling tired, if there are things going on in your body that you want to check in on. Thyroid, of course, really important to do a really thorough screening.

Even if you’ve had thyroid testing done before, this is a time in life where because everything’s up and moving and changing a little bit, this is a time where it can show up, even if you’ve been normal in the past. A really good thorough thyroid screen, which I can leave you to chat about. Then the adrenal testing is in looking at your cortisol over the course of the day to see how your production is doing for the adrenal glands, the cortisol, and the DHEA can be really important to look at. That you’re going to get more useful information out of as a first layer, and usually addressing those, the nutrition and the thyroid and the adrenal and the blood sugar regulation, that will create a foundation of stability that helps to decrease the wildness of the up and down roller coaster that perimenopause can be.

Dr. Eric:

All right, thank you for that. With regards to adrenal testing then, I know we chatted a little bit before this interview, so I know, just like I do, you do saliva testing and you also do some DUTCH testing. We’re not going to get too much into the dried urine testing because it is a pretty in-depth test. I guess I could ask you, we both know the answer to this, but of course we’re testing the viewers. Why would you want to do a saliva test, or dried urine test and not just test morning cortisol in the blood?

Dr. Amy:

Yeah, good question. Let’s see, so because of the fact that the adrenals are regulating your circadian rhythm and that 24-hour clock, your cortisol changes throughout the day. It’s a lot like when we’re testing estrogen and progesterone and a woman having a cycle, it matters what day of the cycle we test on because the levels are changing. A level on one day might look low and other then it might be high, but it’s the same number. You have to know what you’re looking at, and the way that cortisol has its cycle in a day, we produce more cortisol first thing in the morning, and then it tapers off as you go through the day and drops at nighttime to help you wind down and go to sleep.

You need to look at that pattern. By looking at only one data point, you’re really not getting a full picture of how the adrenals are responding over the course of the day. Then a blood level is a very short-term, that’s just the amount that’s circulating right in that instant. For some people getting their blood drawn is a stressful experience.

Dr. Eric:

Yeah, I was going to bring that up. I’m glad you did.

Dr. Amy:

In order to get a blood draw, unless you happen to have a partner or someone in your home who’s a venipuncturist, usually, you have to be up and get ready and get out the door and go somewhere to get your blood drawn. Your cortisol peaks about 15 to 20 minutes after you first wake up. So getting that awakening response and getting a sense of what’s happening right away in the morning is more indicative of your cortisol level. There are several factors that make a home test kit, and there’s pros and cons to saliva or a dried urine testing.

But both of those give you the opportunity to test at home and look at four different points, at least, over the course of a day and map out that pattern that gives you an idea. It’s not just am I high, am I low, it’s what’s the pattern over the day? Is what really is what we’re looking for.

Dr. Eric:

Yep, correct.

Dr. Amy:

Did I get all your points? Did you have anything to add?

Dr. Eric:

I think you hit it all with regards to, especially, cortisol. As you mentioned, there’s no perfect test, and a big potential drawback of the blood test is, like you said, a lot of people… even if they’re not stressed out, going to the lab, just getting the blood draw itself for some people, they might not perceive it as being stressful. I know it does come down to the perception when it comes to stress a lot of times. But that’s also important to mention, even when doing a home test. Like saliva or dried urine, you want to collect it on a regular day, and ideally, a lot of people will do it on a weekend just because it’s hard to do during a work day.

But the point is if you have an abnormally stressful day, so if you’re collecting it and you have an argument with your spouse before the collection, or have a headache. I’ve had a lot of people with different patterns, but I remember one specific situation where someone did their saliva test and I saw that it was elevated around lunchtime and they were mentioning that they were studying for an exam and they were stressed out because of the exam. Again, even though the home tests aren’t perfect, and that’s why if I see some crazy findings, I usually ask the person, “Did anything unusual happen that day?”

But, yeah, it’s the same exact reason I’ve been doing saliva testing all these years, and more recently on some people I’ve done dried urine testing. If you’re just focusing on adrenals, I think saliva testing or dried urine testing is fine to do. Yeah, just for that circadian rhythm, so you could see it throughout the day, first thing in the morning and then last thing at the end of the day. Then a couple of samples in between. Thanks for that explanation.

Dr. Amy:

Yeah, should we talk a little bit about the patterns and what that can mean?

Dr. Eric:

Yeah, I think that’s a good idea because also some people wonder why test the adrenals? We’ll get into the patterns and that’s a big reason why. But, yeah, if everybody’s stressed out, why don’t we just assume people have adrenal problems and not do the testing. It’s because different people have different patterns. I’ll let you take over and talk about some of the different patterns.

Dr. Amy:

Yeah. It’s interesting that you put it that way because you’re right, there is this idea that like I know I’m stressed, I know that’s part of it, so why does it matter? What’s going to change based on the numbers or the patterns? To some extent, it’s a valid point to make. If you’re really watching your budget or really trying to just take the most streamlined approach to what you’re doing for your health, if you’re willing to make some lifestyle changes and you don’t necessarily need that data to prove it to you, it’s a lot of the things that help to restore adrenal function are safe and appropriate to do regardless of exactly what your numbers or your pattern really is.

There’s some truth in there, but you can get more specific if you know exactly what’s going on in your own physiology. You can put your effort more focused on the things that your body particularly needs. If you know better where you’re starting from, and the truth of the matter is that for most people actually seeing it on paper is just so, or on the screen if you’re looking at electronic results, it’s validating for one thing. Your other doctors have probably told you, “Everything’s fine. There’s no reason for you to be so exhausted. It’s all in your head,” or whatever. That validation of like, “Yes, there is a real thing going on with you here.”

It gives you a baseline that you can compare to in the future too. You can see, “Okay, I’ve made it this far in my progress at three months or six months,” and you know how to monitor that too. There’s three basic patterns that I usually tend to find.  Of course, every individual is unique and there can be nuances in this. But there’s the people who just like run high. The normal slope might be like this, and they’re just across the top of the chart like this. This is someone who’s probably experiencing anxiety, wakes up in the morning, early on, ready to go, jumps into everything, like, go, go, go, go, go. Mail them in, and ends the day still just powered through and all that.

So some people just run high. Some people run low. This is so hard to get up and get going in the morning that maybe the alarm goes off and you snooze it six times, and you’re dragging yourself out of bed. And try to pry your eyes open and maybe feeling like you have to have caffeine or sugar to get your engine running and get yourself going as you go through the day dragging, foggy thinking, hard to do your work. You get to the end of the day and just like, “Ugh, it’s so just been bottomed out all day long.” Then the other third pattern that’s probably the most common that I see, because it’s the in between point, is a reverse curve. Where you’re tired in the morning, you’re trying to get going. It takes a little while to get it all going and all of that.

You’re tired through the day, a little foggy, maybe some ups and downs. If you’ve got something exciting you’re working on, and then you get to the end of the night. The classic description of this is wired tired, where you get to the end of the night and you’re wishing you could sleep, but boing, everything turns on. Your eyes are wide open and you’re so productive and you’re getting your stuff done, and you’re doing all these things. You finally have this burst of energy and this time maybe late at night, and then you end up going to bed late, and then the next morning you’re tired and the whole pattern keeps repeating too, so the reverse curve. Usually, the order of things over a person’s lifetime is that we can run high, high, high, and go like that for a while.

Then the system starts dysregulating and flips, and then ultimately burnout is that low, just I can’t even mount that response anymore. That’s what we’re looking for on the test results is where are you in at different times of the day to show where you need to focus the most on to help correct the curve and help support the adrenals.

Dr. Eric:

All right, wonderful. Also, we want to let viewers know that we’ll be answering questions soon, so if you have questions for Dr. Amy or myself, just type in the chat and we will get to them. You made some good points, so when I was dealing with Graves’ disease, at that point, I knew stress was a factor, but I honestly didn’t think my adrenals were too bad. I was one that needed validation to get the testing. But I will say this, you can’t always go by symptoms because someone listening might say, “Well, I’m fatigued all day, so I know my adrenals are low.”

But sometimes that’s not the case, sometimes someone will be fatigued yet they might have an elevated cortisol levels. In my situation, I didn’t feel fatigued yet everything was low. I had low cortisol, low morning cortisol, low DHEA. Pretty much everything was low on the test and I felt fine, and probably a big part of that is because with hyperthyroidism you get the increased metabolism so that was offsetting it to some extent. But, yeah, so if I had to guess before that, I would have guessed that either my adrenals were normal, because again, I was in denial, or I would have said if they were out of balance, I would have guessed they might’ve been on the higher side. I would have never guessed they would have been low. That could, to some extent, dictate the treatments.

Obviously, you could, regardless of whether or not you do adrenal testing, you could eat well, you could do meditation, yoga. It’s not like you can’t do anything, but for certain adrenal patterns, you might want to. In my case, again, my adrenals were low, so I took licorice root to help with lower cortisol. If someone has elevated cortisol, they might take phosphatidylserine. You might have other suggestions, and those are just some general… Well, not general, but general based on the pattern. Licorice I would say, if you have high blood pressure, you would not want to take it. Be careful with certain herbs and supplements. But let’s go ahead now and talk about perimenopause.

Dr. Amy:

I just have one other question on testing before we go ahead.

Dr. Eric:

Oh, yeah, sure.

Dr. Amy:

Can you walk us through what you would recommend screen? Because you’re talking about screening is important, right? You can’t always tell based on your symptoms. Your energy could be high or low for so many different reasons, so the screening and looking at these different pieces and figuring out, “Okay, which of these is the biggest factor for this person?” What do you recommend for thyroid screening?

Dr. Eric:

Yeah, so thyroid definitely, of course, TSH or our friend thyroid stimulating hormone, which probably is one of the least important. I still pay attention to it, but a lot of doctors, that’s all they do, is TSH. TSH, I like looking at the free hormones, free T3, free T4. If someone wants to do a full panel where they’re looking also at the total T4, total T3, that’s fine too. But, usually, I stick with TSH, free T3, free T4, thyroid antibodies. It also depends on the presentation of the person. If someone comes in, what I’m suspecting to be Hashimoto’s usually it’ll be antithyroglobulin antibodies and thyroid peroxidase antibodies. If they have Graves, the antibodies specific for Graves are TSI, thyroid stimulating immunoglobulins, which is a type of TSH receptor antibody.

There’s also reverse T3 that could also play a role in conversion. A lot of times you’ll see reverse T3 high if someone has a problem converting T4, T3. The only thing is in hyperthyroidism, I used to do it on all my patients, but in hyperthyroidism, most people have everything high, including reverse T3. I usually don’t recommend it anymore for my hyperthyroid patients. From a thyroid perspective, that’s what I write. Then, of course, the basics like CBC with differential and all. But you just asked about thyroid, but there’s other blood tests. Are those what you do?

Dr. Amy:

Yeah, that’s what I do. The reverse T3, that’s interesting to make that point that you just did. I usually do like to look at it at least on a first layer screening. Because more often the people that I’m interacting with are tired and fatigued, and I’m worried about that conversion or if the adrenals where they got to the liver are playing into that. But it makes a lot of sense if someone is hyper, they’re just going to be high across the board. You’re not really looking at conversion in that instance, it’s more just like everything’s just high for the T3, T4, reverse T3, all of it.

Dr. Eric:

Exactly. All right, so why don’t you talk about perimenopause? What’s the difference between menopause and perimenopause?

Dr. Amy:

Yeah, good, good, good. The technical definition of menopause is when it has been a full year since your last period. It’s defined that way because in the time leading up to menopause, sometimes women will go a long time in between the periods, but then it’ll still come. It’ll be, instead of a month, it’ll be two or three months or five or six months even. Then it might stretch out to like seven or eight months in between periods. But once you’ve gone a full year, it’s pretty unlikely that you’re going to get another period again after that. That’s long enough to say like, “Yeah, your body is done with having periods.” It’s a defining moment, it’s a single day, it’s been exactly a year since you had a period.

I always like to joke and recommend like throw yourself a menopause party on that day. It’s been a year. Then after that day is technically referred to as postmenopause, and then what we’re talking about, especially today, here today is the whole transitional period leading up to the actual moment of menopause when it’s been a year since that last period. There’s a whole stage of life, of transition, and I like to give the visual of thinking about your menstruating years as a bell curve. When you have puberty, when you’re in puberty, when you’re a young teen, unfortunately, it’s happening earlier these days, but usually a young teen first period to start the menstruating years. There’s an on-ramp and we call that puberty and that’s the whole teenage timeframe of body changes and moodiness and questioning who am I really anyway? Like refiguring your life and feeling awkward and having these changes going on.

Then as we get into the 20s and 30s, there’s more stability, and more like the top of that bell curve. For most women, there’s always exceptions. But just in the normal curve of things is pretty regular cycles, and usually, this is the more fertile years and just more stability and regularity in the menstrual cycle. Then there’s the downside of the bell curve. As we taper down, it’s basically what I like to help people think about perimenopause. It’s like puberty in reverse, so it’s a very similar experience where your body is changing and things are going on and you might be feeling moody and all those kinds of things. But the beauty of perimenopause is that you’re older and wiser and hopefully have more resourced in your life and in your experience and in connections and how you can get help if you need it too.

It’s not a disease, it’s not something that needs to be overly medicalized. But it’s a natural life transition and it can be a little ambiguous to define as puberty can be too. At what age does puberty end? There’s no real exact notion to that. When does perimenopause begin is a little loose like that also. As soon as there’s some shifts or changes or things that just aren’t as stable as they had been before, that’s probably the beginning of perimenopause. It can last five, up to 10 even years. It doesn’t mean that you’re going to be menopausal in any moment here, it’s just it’s a phase, it’s a transitional time. There’s a lot that you can do to help support the journey through it all.

Dr. Eric:

Okay, so there are no specific tests for perimenopause?

Dr. Amy:

There’s not an exact test for saying that perimenopause has begun. We can start to see FSH and LH start to rise, but it’s not a direct trajectory. When you’re in your menstruating years, usually, LH and FSH will be lower when you’re postmenopause will be higher. But there’s not a direct line. In perimenopause, it can be all over the place, so you could be high one month, low another month. It’s not an accurate way to assess, and your estrogen and progesterone levels can be changing. But, again, there’s no like no number of high or low because they’re changing. Yes, there’s no exact tests that defines you as perimenopause.

Dr. Eric:

Okay, so what’s the most important thing for a woman to do to help herself have a smooth transition through perimenopause?

Dr. Amy:

Yeah, so that’s the first half of our conversation really is the answer to that question. Really hoping that stabilizing that foundation, and that’s addressing the stress boosting the adrenal resiliency, so that stress isn’t having such a big impact. Getting your nutrition on board, your blood sugar regulated, your thyroid really functioning well. All of that builds this foundation that makes it a much smoother ride. There may still be some ups and downs, but I like to joke that without any of that support in place, perimenopause can be like the thrill seeker roller coaster that’s like woo, up and down, it’s scary and really intense.

But with that stable foundation, we can put you on the little kiddie roller coaster. It’s just there may still be some ups and downs, but you can ride with it and have a good time with it. That’s building that foundation and really I’ve seen that all of those factors are important and I’ve just seen again and again, that the adrenals and the stress that underlies all of those is so much of what makes the difference.

Dr. Eric:

All right, all right, very good. Well, I definitely want to leave some time for questions, and then we’ll also talk about your quiz. Dr. Amy has a quiz that she’d like to share. But is there anything else you’d like to add?

Dr. Amy:

I think just the point, I feel like when we talk about stress and the fact that stress can lead to all these other issues that I just want to be careful to say that it’s not that you have to completely remove yourself from stress or from your life in order to be healthy. I think that it can be easy to go into the extreme of like, “Oh, well, I have to completely change everything and stop doing all these things and all of that in order to get stress down.” I really see it more as how to build your resiliency and how to help your body and your physiology be able to be healthy in an environment that has stress going on in it.

Because a lot of the women that I work with are leaders, entrepreneurs, business owners, or have projects that they’re working on. They have their families that they’re supporting and everything. I think it’s really important that women can do the things that they want to do and have their impact and make their difference and it’s important to have your health supporting you to be able to do all those things too, and that is possible. I’ve been through it myself, up and down, where I get so into something and then I get sick and adrenal fatigue or whatever and I have to build back up again and then that. I’ve learned in that process of figuring out the things that help to keep that stability in place while being able to continue pursuing your passions and doing the things that you want to do.

And having your health really making it all possible instead of your health suffering because of all the things that you’re doing. Just wanted to make that point. Stress can be a good thing, it’s about the skills you mentioned before, are stress supporting skills and how we help our physiology to be able to roll with the things that go on in life.

Dr. Eric:

Wow. Thank you for adding that. I am going to put the link to the quiz, but I’d like you to talk about the quiz so people when they see, why should people go ahead and take your quiz? I’m going to recommend, definitely take the quiz.

Here is the link to Dr. Amy’s Quiz:

https://replenishyourenergy.com/quiz​ [2]

Dr. Amy:

Yeah, so the quiz it’s called the why am I so tired quiz. This is something that I just hear from so many women and just being able to get a better understanding about what factors are at play and why you’re feeling so tired all the time and what could be going on that’s going to help you? That idea that stress is inevitable, but if you’re feeling depleted, you’re feeling rundown, you’re feeling the effects of that chronic stress build up, why is it that that’s happening? After you take the quiz, then we’ll talk more also about how to build your resiliency and how to help to get you to a place where you’re having more energy too for all the things that you’re doing.

When you take the quiz, you’ll get your resiliency score, so you’re going to find out how your adrenals are doing and this is just how much of a factor stress is being for you and your particular case. I’ll give you some tips on getting started boosting your energy. I, also, am going to be teaching a workshop later this month called From Fatigued to Fired Up. I’m going to be teaching some surprising strategies in there about the kinds of things that can make the difference to really help make a shift and help to build your resiliency and boost your energy and help you to be able to make your difference and really enjoy your life and do the things that you want to do. But have your health really supporting you in doing that. Start with the quiz and find out why am I so tired? I hope that will be helpful for you.

Dr. Eric:

Great. Then when they complete the quiz, they’ll get information on that masterclass if they want to sign up. Is that correct?

Dr. Amy:

Yeah.

Dr. Eric:

Okay.

Dr. Amy:

Yeah, when you complete the quiz, you’ll get your number. When you click on that, you’ll get some tips, some information of understanding that. At the bottom of that page, there’s a button right there to sign up for the class. Then go through and actually sign up for the class and we’ll make sure that you get your free access to that. If you miss it on that, we’ll send you a follow-up email to make sure that you know when that class is coming. It’s a few weeks from now, but you can reserve your spot now and we’ll send you reminders as it gets closer too.

Dr. Eric:

All right, wonderful. I have it on the screen here. I put it in the chat. Now, it’s not going to go into the Facebook groups, so I’ll have to do that manually, which I’ll do that just because it’s a private group. I’m thinking it’s just going to the page right now, but I also have been displaying it for the last minute or two here. I’ll make sure that I’ll manually put it in the groups, and all right.

Dr. Amy:

If anyone’s listening and didn’t see that typed, it’s just replenishyourenergy.com/quiz. So replenishyourenergy.com/quiz.

Dr. Eric:

All right, cool. Thanks for verbally letting everyone know. Yeah, definitely, sign up for that quiz and as well as the master class. Which again, the masterclass will be later this month, but the quiz you could do right away, or maybe in a few minutes after we answer questions. But, all right, so let’s get to… Stay in your lane. Hello, Dr. E and Dr. A, happy Friday. Thanks for sharing. You are welcome, thanks for attending.

Dr. Amy:

Happy to be here.

Dr. Eric:

We’ve got someone from Facebook watching. That’s the only downside of StreamYard is if they don’t give permission, then their name doesn’t display. That means they’re in the group if it comes up as Facebook user. “I’ve been the reverse curve for all my adult life, and I was told it was because of my low blood pressure, 120 over 60. I developed Graves five years ago, and it got down to five milligrams after beginning toxics. Are you talking about the medication five milligrams? Because I know a lot of patients take methimazole and five milligrams would be like a low dose. Because I don’t think a blood pressure of like 120 over five, that would be like pretty low.

Dr. Amy:

I think they’re saying that they probably started treatment five years ago. They’ve had improvement, they’ve gotten the medication down.

Dr. Eric:

I’m joking. I’m just cracking an unfunny joke here. What would I do to improve the cortisol? Well, I’ll let you, I could always add, but let’s hear from you, Dr. Amy.

Dr. Amy:

One thing that strikes me is I just want to question and reverse the cause and effect or the chicken and egg part of your first comment of having that reverse curve and saying that was because of low blood pressure. I would actually say that more than likely the imbalanced adrenal function is contributing to your low blood pressure. The adrenals, I mentioned early on, they produce a host of hormones. Cortisol is a big one we talk about that has to do with the stress response, DHEA, another important cortisol hormone. They can produce estrogen and progesterone we talked about. Another hormone that the adrenals are responsible for producing is one called aldosterone, which is more to do with regulating your fluid and electrolytes and regulating the kidneys.

So remember the adrenals are actually located on top of the kidneys and there’s a reason for that. Because they actually do regulate the mechanisms of kidney filtration. When the adrenals are not functioning properly, we tend to lose our electrolytes more easily through the urine. And that can cause us to feel low blood pressure because we don’t have that salt and the electrolytes in the bloodstream to hold the fluid in. Then we can get low blood pressure, and a lot of people with adrenal dysfunction have low blood pressure, feel like you get dizzy. If you stand up too quick, you’re going to get dizzy or faint easily. So really supporting, I’d say, one of the first things if you’re having low blood pressure and you’re needing to support your adrenals would be to make sure you’re getting plenty of electrolytes in.

One thing that I recommend for people to start your day, as long as you don’t have high blood pressure and need to watch your self intake, start your day with a glass of water, with some salt in it. It’s a really nice way to start your day and a little squeeze of lemon if you’re inclined to that. But the salt or the electrolytes, first thing in the morning, help to get the adrenals going and help to make sure that your body has that support for the blood pressure. Electrolytes can make a really big difference, and lots of other things that help to stabilize and flip that curve back to being high in the morning, low at night. There’s a lot to that. But one of the first things when I hear that blood pressure piece would be electrolytes.

Dr. Eric:

Yeah, and you would recommend natural sea salt, for example?

Dr. Amy:

Yeah, so either the natural sea salt, Celtic salt, Himalayan salt, and any of the good quality salts that have some minerals with them too. In terms of the amount, it varies to taste. Usually, when this is going on, people will also actually crave salt too. If you do, the person who wrote this in, if you also notice yourself having cravings for salt through the day, then this would be probably really good for you to do. That you put salt to taste, so it should still taste good. It should be like refreshing. If you feel like you’re drinking ocean water and it’s disgusting, then cut the amount of salt back.

What usually happens over the course of a few months is the same amount of salt that you were craving and wanting suddenly starts tasting too salty, and you can decrease the amount that you’re including in your morning water.

Dr. Eric:

All right, thank you for that, Dr. Amy. We’re going to go another question…

Dr. Amy:

And congrats on the improvement so far with the Graves like just to be able to get down to that really low dose and it’s good progress moving in the right direction. I think addressing the adrenals next could probably be really helpful for you.

Dr. Eric:

Yeah, no, that is true. Five milligrams, low dose. Obviously, once it gets to the point where you don’t need the methimazole, but, yeah, one step at a time.

Dr. Amy:

Are there things that you’ve seen, Dr. Eric, that have made the difference for someone to get off that last little bit? To get them to the place where they really don’t need it?

Dr. Eric:

Yeah, probably too much to discuss here because it’s not just the adrenals. Adrenals do play an important role, and like I said, I had a low cortisol pattern the morning. I didn’t have a reverse curve, meaning my cortisol wasn’t high at night. But I had low morning cortisol, and of course, diet lifestyle factors played a big role. Then other things, I mentioned a licorice root in my case, which again, we can’t give specific recommendations here. Since you have low blood pressure you might be fine with that. But, again, in my case, that helped out, B vitamins, vitamin C. Nutrients overall are obviously important. But there could be other things, of course dragging down the adrenals as well.

It could be stealth infections, and again, not saying that’s the case with the person who just asked a question.  I definitely would follow advice of Dr. Amy, or suggestions that Dr. Amy gave. But try to do everything you can diet lifestyle. But sometimes, actually, a good number of times we do have to dig deeper, especially, if diet and lifestyle isn’t enough. If you’ve been dealing with it for a long time, then you might have to dig deeper. Could be, again, like I said, infections, it could be toxic mold, it could be chemicals, environmental toxins. But, yeah, good job so far getting down to the five milligrams.

Maybe just by improving the adrenal health itself, you might not need to dig deeper, or you might have the answer. As Dr. Amy said, it’s not always just emotional stress. We all deal with stressors, a lot of times we could just do things to improve our perception of stress. Again, blocking out time for stress management, mind, body, medicine. But, as I mentioned, sometimes we do need to dig deeper. All right, we got Claire. Thanks for joining Claire. Claire says, “I love the concept of puberty in reverse.”

Cool, cool. Cool. All right, and then I could answer this. “I have hyperthyroidism, is a good for me to go for surgery?” Again, I can’t give specific recommendations. All I could say is that sometimes surgery is necessary. I can’t say it’s never necessary, but in most cases it should be the last resort. It really depends on the situation.  If someone has thyroid cancer, for example, that might be a situation when surgery is necessary. My goal is to try to work with people to try… just like I did, when I had Graves, I could have opted for radioactive iodine and thyroid surgery. I chose to address the cause of the problem.

Everyone is different and there’s a time and place for surgery, but my goal is to try to minimize people getting the conventional medical treatment. At least, for radioactive iodine and thyroid surgery. A lot of my patients do take the antithyroid medication to be safe, some take an herbal approach, but that’s a completely different topic.

Dr. Amy:

I just wanted to say that I think it’s so awesome, Dr. Eric, that you offer what you do. Because the person who just wrote in probably their endocrinologist has only offered surgery, or very few options. I just think it’s, really, it’s so great that you’re here and that you’re asking this question and looking into this. Because I think it’s really important that in our journey of healthcare and healing, that we have access to options and that you’re presented with like, “Well, you can go this route or you can go this route and here’s these different ways about this.” There’s a time and a place, but Dr. Eric has a lot of really great resources and an amazing approach to giving you another option that you don’t have to go for surgery necessarily. It’s one of the options.

Dr. Eric:

Thanks for that, Dr. Amy. My goal is to try to save people’s thyroid gland. It’s not always possible, but again, too many times the endocrinologist will say, “Someone needs to receive radioactive iodine or thyroid surgery.” Again, sometimes that is the best option, but many times that’s not the case. We have a thank you here, so you are welcome. Thanks for tuning in. Then Melissa here: “Sorry I missed the beginning, what kind of doctor do I need to see to get my adrenals tested? I’ve always had a fight or flight state of reacting situations and battled Graves on and off for the last six years. I know stress is a trigger, but never been tested or tried to cope with stress aside from yoga, meditation, lemon balm, motherwort, and CBD at night. What kind of doctor?” Obviously both Dr. Amy and I, we help people with adrenal problems. But I’ll let you expand on who would be a good option-

Dr. Amy:

Yeah, sure. You’re right to ask the question because not every doctor tends to offer testing for adrenals the way that we’re talking about really looking at that pattern over the day and looking at it more holistically. It’s going to be, I’m a naturopathic doctor, Dr. Eric’s a chiropractor, so an integrative functional medicine. More natural holistic practitioner is who’s going to be able to help you with that. I’ll mention, we do have an online group program that we run where we actually give you access and show you exactly how to order your own adrenal saliva test, and really get into the details of understanding what your results mean and what kinds of things to do to focus on to improve your adrenal function too.

That is something that we teach in our group program, which would be an easier to access lower cost way of getting help, or of course in the private practice of either one of us or a functional integrative naturopathic, holistic alternative, etc., practitioner would be able to help you with that too.

Dr. Eric:

All right. I will also add that probably the person who’s not going to treat your adrenals would be your primary care doctor or your endocrinologist, unfortunately. They might run a morning cortisol, maybe look at DHEA, but they’re usually not going to look at the circadian rhythm of cortisol through the saliva, through dried urine testing. Dr. Amy is right, and again, make sure you not only do the quiz, but her masterclass as well. Because that’s going to also… I don’t know if… It might not talk about testing and all that, but it is going to focus on adrenals, correct?

Dr. Amy:

Yes, it focuses on adrenals and strategies to help. It’s different kinds of strategies, it’s not just eat your protein and go to bed at night. There’s more to it than that. Yes, happy to share more with you.

Dr. Eric:

All right. Well, let’s try to get to a few more questions. We probably won’t be able to get to all of them, but Pili here, “is it recommendable to use the natural clock during perimenopause for those of us who no longer want to take the pill? Will the body temperature readings be too unreliable?” I’ll let you take this one.

Dr. Amy:

I can take that. I’m pretty sure what you’re referring to is for the sake of contraception. So during perimenopause, even though your cycles are irregular, you still can get pregnant. Being careful to prevent pregnancy if you’re not wanting to get pregnant is important to do. Taking temperature readings is one way of natural family planning of like noticing your temperature regulations and using that information to know when you’re ovulating and when you’re fertile, and then when you’re not. But, in perimenopause, you’re right to be concerned about that. It becomes more unreliable because the cycle length can change and it’s a lot harder to be sure of what your pattern is going to be and which days you’re more or less hurdle.

It’s already a less reliable method than some other forms of contraception. If you’re wanting to avoid pregnancy, I would be careful about relying on the temperature reading. But regulating your cycle, doing the things about stabilizing that foundation, whether that’s through adrenal support and then fibroid, blood sugar, getting your nutrition, your sleep patterns, all of that, can help to restore a more normal cycle. Which can be a more dependable pattern also. Hopefully, that helps.

Dr. Eric:

All right, do you have time for a couple of more questions?

Dr. Amy:

I could, yes. I love questions, I’m happy to help.

Dr. Eric:

Okay, because this I know someone asked in the Facebook group, “can perimenopause hormones trigger hyperthyroidism or hypothyroidism?” Do you want to cover it or do you want me to talk about it?

Dr. Amy:

No, you take that one.

Dr. Eric:

Okay, so I mentioned earlier, stress definitely could be a factor, and potentially, a trigger of Graves, Hashimoto’s, and I mentioned how chronic stress could affect the conversion of T4 to T3. So that could lead to low T3, which is the active form of thyroid hormone. As far as perimenopause or imbalances of the sex hormones being a trigger, the short answer I think would be no, in my opinion.  And so they’re not really a trigger. Women have been undergoing perimenopause for quite a long time, and I think we do see a relationship sometimes between hormone fluctuations and thyroid conditions…like postpartum thyroiditis is common. But even in that situation      I don’t look at the birth process as being a trigger, as most women have had the antibodies well before for Hashimoto’s. I haven’t seen it where it directly causes hyperthyroidism or hypothyroidism. But for those with Graves or Hashimoto’s, you might wonder is it a trigger? It might be a factor, but just about everybody will have had the autoantibodies for those conditions develop well before perimenopause. So to me I don’t consider it an actual trigger.

Dr. Amy:

Yeah, I agree. I’d say it’s a time in life where it often shows up and it gets discovered, but it’s not necessarily that the perimenopause is what triggered it. They probably never got screened beforehand or the stress of going through perimenopause is more so the trigger than the perimenopause itself, for example, or other things going on. I would say I see a lot of women, while their hormones are changing, it’s a time where you can have changes in your thyroid or discover those changes too. But with the case of the antibodies, it’s very likely that they’ve actually been around for longer and you just didn’t know it. It’s certainly not every woman who goes through perimenopause gets triggered into a thyroid problem, so it’s not a direct thing, but it can compound and come together.

Dr. Eric:

Yeah, it could be a contributing factor. Again, the stress I think is really big. What we spoke about earlier, not just the hormones, perimenopause, menopause, but let’s see, we got Shirley here, and she says “That would be me”, I guess, something you mentioned earlier. Then here we have Tracy:  “Dr. Amy and Dr. Eric, this is Tracy from New York. My saliva test results on Tuesday, 10:00 AM, 0.34, two…”

Dr. Amy:

This looks like cortisol, I think.

Dr. Eric:

Yeah, it’s the four different cortisol levels. Yeah, her first one she didn’t take until 10:00 AM, and then two third. Again, she might have not woken up until around that time, I’m not sure. I don’t know if this is saliva. Oh, yeah, actually she says saliva test results here. I was going to say the units are different from the testing that I’m used to seeing, and probably the same with you. But everything, other than that first one, obviously the first one is the highest, that’s the good news. It is the highest, the other ones are on the lower side. That third and fourth one are undetectable. I don’t know what the range would be for that first one, it depends on the lab. That also might very well, might be on the low side. But, yeah, definitely the other values are all on the lower side. I’m not sure what lab, but yeah, do you have any feedback?

Dr. Amy:

Pretty similar to what you’re saying, different labs have different reference ranges. I would just say look at your results in the normal range. A lot of labs report with a graphic too. You can see the zone on a graphic of what would normal be and then you look at your line compared to that. But like Dr. Eric was saying, the pattern is correct, your highest and then down and then down, so you’re not doing a reverse. But the later numbers for sure, and maybe even that first one are probably low. It’s more of that depleted, like needing to do a lot of restoration to help build back up again. But it’s good that you’re not getting that burst of second wind backwards thing at the end of the night.

Dr. Eric:

All right, thank you. Can you do two more? If you really have to go, I’ll let you go.

Dr. Amy:

No, no, I can do two more, I think.

Dr. Eric:

Okay.

Dr. Amy:

Yep, I’m up for five more minutes, so let’s go!

Dr. Eric:

Okay. Well, let’s do four minutes because I want to also give a minute to wrap up and also give your… so we’ll do like four.. We’ll definitely get you off by four minutes. “Can your adrenals cause pain in that area?”

Dr. Amy:

That’s an interesting question. Not commonly, but I have had some patients who are just really sensitive and really tuned into their bodies and feel like they have some sensation around that. But it’s not typical at all, usually, it’s not something that you’re feeling in your body right in that area. But it’s possible.

Dr. Eric:

Yeah, I would agree. It’s not something that’s common, but, yeah, it’s possible.

Dr. Amy:

Your body is talking to you in some way. But if you’re hurting in that area, I think it’s important to consider what else could be causing that pain. Is it your kidney or…

Dr. Eric:

Kidney, yeah, exactly.

Dr. Amy:

…muscle strain or just something going on with your back?

Dr. Eric:

All right. This might be the last one because it’s a long question. Let’s see. “I was recently diagnosed with Graves. I’ve been one month on Amy Myers protocol, no gluten, dairy, nightshades, eggs, daily curcumin, fish oil, zinc, vitamin Z, probiotic, along with 10 milligrams of methimazole, propranolol. My T3/T4 are back to normal.”

Dr. Eric:

“Liver function tests had gone up. I want to stop methimazole. Someone recommended herbal control my symptoms. Do you have any recommendations?” Okay, so you’re on 10 milligrams of methimazole and the liver function tests, so like AST, ALT have gone up. Maybe due to the methimazole and someone… Yeah. I could cover this. Again, can’t give specific recommendations, but when I was dealing with Graves, I did take bugleweed. I did not take the antithyroid medication. I mentioned earlier how a lot of my patients do take antithyroid medication, such as methimazole or sometimes PTU, or carbimazole if you live overseas. But, yeah, so I took bugleweed, and so that, again, I can’t tell someone to take bugleweed.

Dr. Eric:

My patients I could talk to them about it, but again, I’d say bugleweed and that did a pretty good job with me. The good news is 10 milligrams is still on the low side of methimazole, so you might be okay with making a transition. I will have some patients take methimazole and the bugleweed at the same time, usually, not exactly at the same time, but maybe like an hour or so apart. Again, I can’t tell them to stop taking methimazole as I mentioned. When I was in with Graves, I took five milliliters twice a day of 1:2 extract of bugleweed. But, again, that was my personal situation and I based it on the thyroid blood test. Then there’s motherwort.

Motherwort is more for the symptoms, not really affecting the thyroid, so like propranolol it’s similar to a beta blocker. I took bugleweed and I took motherwort, I actually started with bugleweed but still had some heart palpitations. Instead of taking a beta blocker, essentially, that’s the motherwort. But you want to be careful about abruptly stopping anything. I say let’s wrap it up just because it’s pretty close and I’ve already kept you longer than I promised. Just there’s so many questions and I hate leaving them unanswered. But anyway, register for the masterclass and let me put up one more time that replenishyourenergy.com/quiz​.

Again, I apologize for those that we didn’t get to your questions, but again, thanks for attending. If any questions specific for hyperthyroidism or Hashimoto’s, again, I do these on a regular basis. Not necessarily every single week, even though I think I will be on next week, so stay tuned. Then, again, Dr. Amy, by visiting her quiz, you’ll be on her list as well and you’ll get access to her masterclass. If you have more questions on adrenals, perimenopause, again, definitely fill out the quiz, attend the masterclass. But, again, Dr. Amy, I’d like to thank you again for, not only the answers you gave, but again, going over to make sure we get to some of the questions. Not all of them, but again, we got to a good number of them and appreciate you sharing your thoughts and feedback on adrenal health and perimenopause.

Dr. Amy:

Thank you so much for having me. It’s really fun and happy to answer questions and we’ll do more Q&A at the end of the masterclass too. Check the quiz and hope to stay in touch. Thank you, Dr. Eric, again, for the important work that you do and offering these options in between the nothing or the dramatic really important work. It’s so great that people have options when it comes to their Graves and their Hashi’s, and thank you for having me here today.

Dr. Eric:

All right, you’re welcome. It was a pleasure and maybe we’ll do it again in the future. Again, everyone have a wonderful day, a wonderful rest of your weekend. And same to you, Dr. Amy, have an awesome rest of your Friday and weekend as well.

Dr. Amy:

Thank you, bye.

Dr. Eric:

All right, bye everyone.

During the interview Dr. Day mentioned her “Why Am I SO Tired?” quiz, which you can check out by visiting the following link:

https://replenishyourenergy.com/quiz [3]

She is also having a “From Fatigued to Fired Up” workshop in late March:

https://replenishyourenergy.com/fromfatiguedtofiredup [4]