59. Start Feeling Like Yourself Again: Health, Happiness, and All Things Hormones with Brookes Vaughan

This podcast was transcribed using Rev.com. Please forgive any typos or errors.

Brittany: Hi friends. Welcome to the Life with Loverly podcast. I'm Brittany, a wife, mom, and lifestyle entrepreneur here to help you discover your best daily style and encourage you to try new things when getting dressed each day. I took a tiny following on social media and turned it into a community of over 1 million amazing women. And I am so glad you're here. I'll be sharing my heart with you beyond the 15 seconds on Instagram. So we'll be diving into things like personal growth, friendships, motherhood, marriage, and of course the business of blogging. Really, this space is here to serve as your go-to resource to building a life you adore while sprinkling some kindness to others along the way. Grab an iced coffee and let's do life together. I'm Brittany and this is The Life with Loverly podcast.

Brittany: Hi friends. Welcome back to the Life with Loverly podcast. I am so excited for today's episode. We have a guest in studio. Hi 

Brookes, how are you?

Brookes: Hello. I'm good, how are you? Thanks for having me!

Brittany: Of course! So I'm really excited because when we came up with the concept of having a podcast studio, part of it was so that 

Nichelle and I could be in here recording in a space that we love, but I also wanted to be able to invite local guests to come and have the interview in person, which I feel like is really fun. So Brooks is our first in-person guest!

Brookes: I'm so honored and it's beautiful. Love it

Brittany: Thank you. Yeah, so we've, she's been watching all the behind the scenes of what is really happening. We've actually joked a few times about, let's put a camera going the opposite way so you guys can see how much is happening behind the scenes. Yeah. Anyways, I'm so excited to have Brooks here. She is from the Women's Health Company. Can you tell us a little bit about your background and what the Women's Health Company is for our listeners who might not know who you are?

Brookes: Sure. Also, I have to tell you this, I was doing a podcast before I had my little girl, and then I kind of stopped it for a while talking about women's health. And this is so impressive because I was in my closet with the little cheap microphone that I got from Amazon. So this is amazing. Listen, I feel like I have arrived.

Brittany: You can really start a podcast anywhere.

Brookes: You can. You can, but this is way better. The sound quality is going to be way better. But like you said, I'm Brooks Vaughn. I am a women's health nurse practitioner. I'm from South Georgia, if you can't tell. Yes, it's my accent. And I went to undergrad at UGA, met my husband, Skyler here in Athens. I graduated from here and then moved to Nashville for grad school. I went to Vandy, got my degree as a women's health MP. Then we moved to Charlotte for my husbands job and I worked at an obgyn clinic there. Long story short, we felt like the Lord was calling us back to Athens after we had been in Charlotte for about seven years. And just at the point when we moved back, I loved my job, but I was seeing upwards of 30 to 40 patients in a day. And I always felt like I could not get to the depth of what I wanted to with my patients.

I felt like we were doing our best, I was doing my best, but I couldn't get to the root cause I didn't have time to spend to really educate my patients. And if I did, I was getting home at nine o'clock at night. And so my dream was always to have a space where I could really dive deeper and educate and equip and encourage women. My little slogan is "educate, equip and encourage women to live healthy, whole and holy lives." And so the women's health company kind of started out as an online just little fun Instagram account is my passion to that. And then it has sort of evolved over time into opening a clinic this hopefully early fall that's going to primarily focus on hormone health and whole health for women. So little bit of education, little bit of women, motherhood and marriage and a little bit of faith. All the things.

Brittany: I've really enjoyed following along on your Instagram, Kalen Ashford actually is who connected us. And for those of you who've listened to the podcast, Kalen has been on here a few times. She's my skin girl

Brookes: Oh me too girl

Brittany: Queen.

Brookes: She's amazing.

Brittany: But she connected me with your Instagram last year, I think. And I feel like there's just been so many tips and tricks and just things that I've learned that I'm like, "oh, okay," you're talking about things that all women want to know, and it's almost like questions you really need to ask your doctor, but you don't have time in an appointment or you really need those answers between appointments. So I feel like there's been so much great information from your Instagram account, which we will leave in the show notes as well and tell you how to find Brooks at the end of the episode. So let's get into hormones. Cause I feel like this is a great place to start. I know there's women of all different ages who listen to the podcast. I personally want to start with thyroid because I myself have hypothyroidism and it's been something I've just lived with for the past probably 12 years or so now. But we hear about these thyroid issues all the time. It feels like a little confusing maybe to people who aren't super familiar with even where your thyroid is on your body.

Can you give us a little bit of a breakdown on your thyroid and kind of what these symptoms are and just maybe some tips?

Brookes: Yeah, absolutely. No, I am the same way. I had, I was diagnosed with hypothyroidism right before I started trying to have my little girl. And so have treated was treating my, well, I wasn't treating, my doctor was treating my thyroid disorder throughout my pregnancy. And it impacts so much of how you feel. My whole family, my mom, my aunt, cousins, grandmother, they all have hypothyroidism. So it can run in families, it can be hereditary. But in a nutshell, your thyroid is a gland sort of in your neck, in your throat that produces primarily two thyroid hormones. One is called t3, which is thyronine, and the other is t4, which is thyroxin. What a lot of people, when we have our thyroid tested, we're actually having a blood test that's testing our brain. So we have a gland, the pituitary gland that communicates to the thyroid gland and it releases a hormone called thyroid stimulating hormone.

And thyroid stimulating hormone is what stimulates the thyroid to produce thyroxin and t3. So when the hypothalamus and the pituitary are realizing that the thyroid is underactive, so the thyroid itself is not doing what it needs to do, the brain produces a lot of T s H. And so that's where it gets really confusing. So you can have high T S H, but you're low thyroid, if that makes sense. So you have hypothyroidism, which that's the most common thyroid disorder is hypothyroidism. And the cause of hypothyroidism, really, there are lots, and it varies from person to person. There can be an autoimmune cause of thyroid disorder. We call that Hashimotos, a simple blood test to look for Thyroid antibodies can tell us if the immune source or if the immune system is the source of your thyroid disorder in other countries especially. But we see this a lot now.

I see this a lot in my office too, but nutrient deficiencies can impact the thyroid, especially selenium, iodine, zinc, vitamin D even plays a role in thyroid disorder. So in other countries where there are specifically iodine deficiencies, you really see patients and people with something called a goiter, which can be the culprit of a thyroid disorder. It can be hereditary, and sometimes a thyroid just tanks, it just runs out. And some women can have cysts on their thyroid. So it's important when we're diagnosing a thyroid disorder, I really like to look at all of the thyroid hormones. I like to look at a tsh, but I also like to look at free and total T3 and T4 and thyroid antibodies, especially if we see some variations with thyroid hormones. But you asked about symptoms. So symptoms of a low or an underactive thyroid, which is what we call hypothyroidism, oftentimes can be always feeling cold, not sweating, which is interesting.

A lot of people don't realize that they may have trouble sweating if they have, especially Hashimotos, which is the autoimmune form of hypothyroidism, a slowed metabolism. A lot of women will notice weight gain, that's kind of unexplained, hair loss, dry skin, brittle nails, insomnia. Those are kind of the primary ones. Lack of energy, the opposite. The flip side of that is hyperthyroidism and some patients can have hyperthyroidism and then develop hypothyroidism, which is interesting. But usually with hyperthyroidism, we see a lot of hot flashes, night sweats, sometimes we see that with hypo. It just kind of depends on the person feeling really anxious, jittery, heart palpitations, your eyes can start to bulge a little bit with hyperthyroidism, and that's when we see a high or a low T S H and high thyroid hormones, T3 and t4. So

Brittany: It is kind of confusing. And I feel like when I was going and getting diagnosed, that wasn't the first thing that my doctor looked at was, and I felt like for so long I was just like, something's off. I just feel weird. And it kind of felt like it took me a long time to get to the place that there was a thyroid problem, which I imagine, which is the stress of the world, and some of these symptoms can be other things too.

Brookes: I was having a conversation with a good friend of mine who has Hashimotos, and she had just had her second baby and she said, I just could not get going in the morning. I would drink coffee all day and it would do nothing for me. And she said, I went to my doctor and I loved my doctor, but she said, she just looked at me and she was like, honey, you've got two kids. That's it. You're tired. And she was like, but that, there's more to it. I know there's more to it. And ultimately she definitely has a thyroid disorder, but it can become dismissed I think, in this stage of life that we're in because of being a mom and working and the stresses of life. So yeah, it's worth pushing, I think for testing if you feel like something's off.

Brittany: I feel like one thing I've learned too, just in this, I'm 34 and I feel like I've had kids, I've had medical things, but it's really being an advocate for my own health. And then if something doesn't feel right, continuing to question or getting second opinions, but that is almost a full-time job in itself.

Brookes: It Is. And it can get confusing. I have felt that way. Even just having a little one I've really made me a lot more, I guess vocal about, "okay, no, I really want this, or I really ask that we can." And I think if I'm doing this for her, I should be able to do it for myself too.

Brittany: And sometimes it feels kind of hard. So I mean, for me, I'm on a levothyroxine, but is will I have to be on that for the rest of my life or are there alternative options or what's the solution?

Brookes: Great question. So it depends on the person to be honest with you. And the thyroid can wake back up in some people if the cause may be a transient thing. I've seen it after covid, a lot of women, after what happened to me, I had covid and interestingly enough, I never had respiratory symptoms while I had covid, my neck hurt the entire time. And then about a week later I started having symptoms of hyperthyroidism. So hot flashes, night sweats, heart palpitations, and then my thyroid tanked. And so it's kind of like a viral, post-viral thing. We see that after pregnancy sometimes if we can pinpoint certain nutrient deficiencies and we replace those, sometimes we'll see the thyroid wake back up. But in some women, it's kind of like the ovaries. When we go through menopause, the ovaries bite the dust, and so sometimes the thyroid does bite the dust and it can require lifelong medication. And that's the majority of a lot of people that I see. It doesn't mean that I still work with patients and I say, let's look at blood work, let's see if there are any nutrient deficiencies, and there are some really great supplements and targeted nutrition that can help. And we just monitor the thyroid over time. And in some patients we can come off of it, but not always.

Brittany: Yeah, it's interesting because I feel like there was a period of time I was in between doctors and my prescription had run out and I kept just being like, oh, I'll make an appointment. I'll make an appointment. And I probably went three months without taking my thyroid medicine. And it was crazy to see just my hair thinned out. My skin got really bad. This was right at the, I would say we ended up doing I V F to get pregnant, but this was probably at the beginning of our trying to get pregnant. I always look back and I'm like, I wonder how that played a role in our fertility journey because I know that can cause some issues.

Brookes: It definitely can.

Brittany: And then as soon as I got back on it just, things just started. And I mean, I'm not proud of that, but think of how many times people

Brookes: Absolutely

Brittany: Use a doctor's appointment or to reschedule. It takes months and

Brookes: It does it. It definitely does. And the good thing about thyroid medication, like Levothyroxine and Synthroid is the name brand. We have so much good data on its safety and it is category A for pregnancy. Tylenol is not even category A for pregnancy. And so I am pretty quick in women who are trying to get pregnant or pregnant, we know that optimal is not the same as normal. The lab for A TsH, the lab considers normal 0.45 to 4.5. There is so much data now that has shown the importance of, especially for fertility in pregnancy, keeping your tsH under 2.5. And so I'm pretty quick in patients who are trying to get pregnant to say, I think even if it's just for the time being while you're pregnant and trying to get pregnant, let's treat you. Because we know so much now about its importance with ovulation, Pregnancy implantation and sustaining a pregnancy. We know that early on thyroid hormone is super important for baby's brain and neurological development. And so this is just a side note, but from a preconception standpoint, that's why I really advocate for all women who are considering getting pregnant within a two years even, right? To have their thyroid tested because it plays such a role and it needs to be monitored and managed. If it's suboptimal, even if it's not crazy high or crazy abnormal it plays a role.

Brittany: That's great advice. I mean, truly, I think if you take away anything from listening to this podcast, it's just it doesn't hurt to get the extra blood panel drawn and just to check your levels if this is where you are in the season of life or if you're experiencing any of these symptoms too. I know once I got some things kind of sorted out and figured out, I just, quality of life even felt so much better.

Brookes: Yes, absolutely. Even your digestion. I find that's another symptom that a lot of women will have with hypothyroidism is bloating and constipation and things. Just everything slows down. And so treatment can really play a role treatment. And I love, I will say selenium, zinc, iodine and vitamin D are some of my primary things that I really focus on with nutrition for supporting the thyroid. And you can get a lot of that in your diet two Brazil nuts a day gives you all of the selenium that you need. This sounds weird, a lot of people are like, "oh, that sounds gross," but the seaweed chips that they carry at Trader Joe's and Costco have a ton of iodine. And then obviously a lot of times I will recommend a supplement that has contains all of those or targeted if we needed to.

Brittany: Do you have a suggested multivitamin or supplement that you're like, this is a great place to start?

Brookes: I get asked that a lot and there are so many, I mean, really, there are so many good ones, and I do like to tailor based on where you are in life and what we need to do based on what your blood work shows. But in general, third party testing is important, okay? Because supplements aren't necessarily FDA regulated. They're monitored, but they're not regulated like medications are. And so I think it was back a couple years ago, maybe five or six years ago, the New York surgeon general pushed or pulled, not pushed, pulled I think hundreds of supplements from drug stores and vitamin stores. And they found that over 90% of those supplements didn't have what they said they did on the label. They tested 'em, and that was really eye-opening, right? And so third party testing is important because that just means that the company has obtained from a third party, they've come in, they've tested their supplements, and what they say is on the label is what you're taking.

So two brands that I my go-to in my practice are Thorne. T H O R N E and Pure Encapsulations. And they both have just good basic multivitamins and prenatals. Some other third party tested ones that you can get over the counter pretty easily. Mary Ruth's has a really good prenatal and they have good, I use their multivitamin for Walker Ann for my daughter, just their liquid. And a lot of women who are trying to get pregnant and pregnant have a hard time with a capsule or a tablet, and so their liquid is typically what I recommend over a gummy for most women if you can't having nausea. But those are just in general, those are sort of my two that I just go to a lot. And then I really like to sit down and kind of tailor. I love blood work, I love to check vitamin D and B12 and iron and some of those things to see what patients need and then tailor supplements based on that. Most of the time, most women can really get what they need in their diet, but we're in America, none of us have perfect diets, and so I find that a good multivitamin or a prenatal just fills in the gaps.

Brittany: We really like Mary Ruth's for, they have a great kids's probiotic that my girls take every morning. I'm on their subscription service, so don't even have to worry about it. It comes in, it's great. They love it.

I love to look for some of her vitamins for myself as well.

Brookes: She's got a good magnesium too at night that a lot of people take. So yeah, they've got some good ones.

Brittany: I feel like off air I'm going to be like, let's do all the things.

Brookes: Come on, we'll do it.

Brittany: Okay. Kind of switching gears from the thyroid, a ton of this information has been so helpful, but I know a lot of what you talk about is also vaginal health and we're really getting into some good conversations.

Brookes: TMI

Brittany: Not tmi, but it's the questions that we all have.

So let's talk about vaginal microbiome and what that is and how we can keep it healthy.

Brookes: Perfect. It's funny because people always will say, is this T M I? And I'm like, listen, you don't see the behind the scenes. This is the conversation that I'm having all day every day. So nothing is tmi to me. My poor husband, the things he hears me talking about with my friends, he's like...

But the vaginal microbiome is basically just the vagina is a micro ecosystem in a sense. We have a lot of good bacteria, we call it flora that makes up the vaginal microbiome, and particularly the primary healthy bacteria of the vagina is lactose bacilli, which is very common in probiotics that we take. And what it does is it helps keep the vagina acidic from a pH standpoint. It helps fight off bacteria, yeast, all those things. And actually the vaginal microbiome, there's a lot of data now on its importance with fertility and pregnancy. We know that when it can become disrupted, there's heard of bacterial vaginosis or BV that's a bacterial infection. We know that BV can be a culprit of preterm labor. So we're learning how important the vaginal microbiome is. It's interesting because a lot of people ask me, should I put apple cider vinegar in there?

And all these things? I'm like, Nope, nothing. It is self-cleaning really and truly it is it, I usually recommend nothing, not even soap, because soap is very basic and your vagina needs to be acidic. You always tell patients, wash your labia, but you don't need to get soap up inside in there because it can burn and it can create an infection. And there are things that can sort of change our pH and change vaginal odor and those sorts of things. Usually a change in pH is what creates odor. So when the vagina goes from being acidic to basic is when we get an odor, obviously soap, douching, even feminine washes like Vigil and Summers Eve can change the pH. And so I usually recommend staying away from those semen TMIi probably, but it is very basic, and a lot of women will come in and they'll have a bacterial infection or something that seems like a bacterial infection after intimacy, and it's because the vaginal flora has been disrupted. And so for things that, oh, antibiotics, can disrupt the vaginal flora because they wipe out all of the good bacteria. So now you're vulnerable to anything else to bacteria, yeast, fungal infections, things like that.

Brittany: So I feel like anytime I'm on an antibiotic, I'm like, just go ahead and write me A diflucan, just better safe than sorry. But I always wonder if antibiotics are doing that to my body. What is it doing to my daughter when they have an ear infection or something?

Brookes: I know it's hard to, and that is when I do recommend when you're on an antibiotic, I definitely recommend taking a probiotic and eating probiotics to restore the good bacteria, especially lactobacilli. So looking for an antibiotic that has lactobacilli. And at Mary Ruth's, I'll be honest with you, when I was nursing walker in, I used that one in on one called Claire Labs, but I love the actual strains of probiotics, so I just take hers if I ever need it, but obviously they have adult versions as well. But taking a probiotic, eating like keefer sauerkraut, yogurt, things like that when you are on an antibiotic can be very helpful. And just in general, and there's one over-the-counter product that I do recommend, well, I say one there are two. One is something called refresh, R E P H R E S H. You can get it from Target, and it is really good for just reac, acidifying the vagina, especially if you're noticing at the onset of an odor or something.

It just seems like it's a little off. I usually recommend trying that. And then sometimes there is a supplement that you can also get from Target. There's a company called Love Wellness, and they have something called boric acid, and it's an acid. It sounds kind of like strong. Yes. And they're like, oh gosh, you don't want to take it orally, but one tablet. There have been some studies that have looked at boric acid at killing certain fungal infections. There's a yeast called Candida Glabrata boric acid kills, and then there's some evidence that vitamin C works as well. We have yet to come up with vitamin C vaginal suppositories. Yes. So maybe that's going to be on the horizon. If somebody knows about one, let me know, because those are other things, but normally I just say nothing in your vagina. This is a little trick that I give behind the scenes a lot. Mom, I hope you're not listening, but after intercourse, if you have had unprotected intercourse, I tell my patients, put a tampon in for like, oh, 10 minutes. Don't leave it in for long because then it's doing the opposite effect, but just for a few minutes to get all that out. And it works, I swear by it.

Brittany: That's just a great Idea.

Brookes: I've had people who keep coming for recurrent infections, and I had a patient recently, she came back and she was like, that one tampon trick worked miracles. She's like, it's been a year since I've had an infection. Oh my gosh, it works.

Brittany: Wow. Okay, so while we're on the topic of vagina's fluid and discharge, what is normal, what is not? I feel like summer is coming and I also feel like pregnancy sometimes there you see a change in what your discharge can look like. Yes. And even I feel like some of this conversation will kind of piggyback off of a previous podcast with the Birds and the Bees, but also talking to our kids about, "okay, this is what's going to happen and this is what this means."

Brookes: Yeah. What's normal and what do you let me know about? So discharge can change throughout your cycle, which is very healthy. That means that if we were looking at your hormone levels throughout a menstrual cycle and somebody who's not on hormonal birth control, we see fluctuations and the consistency of discharge typically, obviously you have your period and then right after your period, a lot of times women will notice just kind of a white milky discharge, which is very normal. Then it can become a little sticky, and then it becomes clear and egg white like. And then after you obvi, that's kind of indicating that you're getting ready to ovulate. And then after ovulation, it becomes sticky again. To prevent it kind of is like your womb closes, you have progesterone that kind of creates just kind of a sticky, and some women will kind of mistaken that for yeast, it can look a little bit like yeast, not always, but so really discharge can take a lot of forms.

Even sometimes watery, especially with pregnancy, a lot of women can just, your glands are, you have lots of stuff going on down there. So a lot of women will just notice a lot more discharge in pregnancy because your vagina is self-cleaning, your cervix, you have a ton of progesterone that you're secreting, which creates thicker discharge, and it's trying to protect your microbiome and the little baby inside of you. So normal can look very different. What I usually recommend to come in for with something that's abnormal would be very clumpy and curd like, like cottage cheese. It's a not beautiful analogy,

Brittany: But

Brookes: That usually can indicate a yeast infection. green to brown can indicate old blood, red, pink. That can all kind of indicate blood. But typically if it's green clumpy or has a very foul fishy type odor, that usually can indicate an infection. But there are a number of things that are normal. It just kind of depends on the person. And a lot of women can notice a lot of discharge if they are constantly washing. And so I'll tell patients who come in, they're like, I just have all this discharge and we check, we look under the microscope and everything's normal, or we run tests. Sometimes I'll do cultures because people will just keep coming in with, and if everything comes back normal, a lot of times it's overdoing it.

Brittany: Yeah because I feel like your body would then be trying to get back to its normal level. And so it's really trying to push out the fragrance and yes,

Brookes: It's self cleaning.

Brittany: So it's just trying to wash it out. It's so interesting how our bodies are just like it is doing all this stuff just while we're sitting here. I know.

Brookes: It's amazing. The more I learn about women's health, the more I'm just like, God, you are so amazing in the way you've created us. Seriously.

Brittany: So interesting intention with literally

Brookes: Everything.

Brittany: It's so true. Okay, so what is estrogen dominance and what are some symptoms that we may be experiencing with estrogen dominance?

Brookes: Good question. So I've been talking a little bit about this on my Instagram account this week. It used to be that it was estrogen dominance was kind of a only naturopath to talk about that. It's woowoo medicine. I remember having a conversation with a doctor a couple years ago, and I asked him what he thought about it, and he was like, yeah, that's not a real thing. But now mean, even if you look on Harvard med or Cleveland Clinic, there's a lot more information about estrogen dominance. And in a nutshell, it's when a woman has too much estrogen, and that can be it. It can get a little tricky when you're having a normal menstrual cycle. You are estrogen dominant in the first part of your cycle and in what we call the follicular phase, because you haven't ovulated yet. And when you ovulate, your ovaries produce progesterone, but early on you aren't you are producing estrogen.

And so women can get a little bit confused if they were to have a blood test and they had their estrogen and progesterone tested in their follicular phase, yeah, that's normal. You want to see estrogen dominance. But what I find is I listen to someone's symptoms and then I'll kind of tailor a hormone test in the luteal phase, which is after someone has ovulated to just see if their levels are within a normal range. The range of estrogen is very, very broad, basically 40 to 400. Don't quote me on that, but depending on the lab that you look at. And so in reality, it's when we have a lot of estrogen and we're not producing enough progesterone or progesterone in general. So in a woman who may not be ovulating, who may have an ovulation, some disorder that's preventing ovulation, but her body is producing estrogen from, you can make estrogen from places other than your ovaries.

Fat tissue can make estrogen. We call something we call false estrogens. Xenoestrogens, I don't know if you've heard of endocrine disruptors. It's a popular term these days. But plastics, b p, a, thalates, things like that can mimic estrogen in our body. And so some women are just getting a lot of that in their system and they're making estrogen from fat tissue, and they're not ovulating, and so they have estrogen, too much estrogen. So symptoms of that can be heavy bleeding, bleeding all the time, a thickened uterine lining. We can see that in some women, fibroids can sometimes be a clue for estrogen dominance, tender breast bloating, fibrocystic breast disease. Those are all things that may clue me in to possibly some estrogen dominance. And then kind of tailor that based on what a woman's symptoms are with blood testing if we decide to do that.

Brittany: Yeah, it's so interesting. I didn't think about it being different depending on when you are in your cycle and testing at different times, I feel like kind of goes back to being an advocate of your health and you really have to, maybe let's test it another time if you really feel like something is off with it.

Brookes: Yeah. And I really believe, I used to do a lot of people ask about Dutch testing and saliva testing, and I used to do a good bit of Dutch testing, and I just found that I can get what I need with blood testing that insurance will cover for the most part. And a lot of times we can tell based on your symptoms and a simple blood test, how things are going.

Brittany: So then on the flip side, progesterone, that's also very important in women.

Brookes: Absolutely.

Brittany: Yeah. I remember when I was pregnant with Collins, I did progesterone shots for 10 weeks as just kind of finishing up I V F. And I remember when I was pregnant with Hazel, we just naturally got pregnant with her, and I was kind of like, wait a second. Is she not set up for success like the other pregnancy was?

Brookes: Yeah. Yeah.

Brittany: But yeah. So on the flip side, tell us a little bit about why's so important

Brookes: So it's interesting, the word progesterone literally means to support a pregnancy. So pro means pro just is gestation. And so an own is what we put at the end of steroid hormones or hormone. So progesterone basically means a hormone to support a pregnancy, but it plays a role, a huge role just in how women feel and operate on a daily basis anyway. So progesterone is produced by the ovaries after you've ovulated, when you ovulate you, the follicle that ruptured, that released an egg creates something called a corpus that produces progesterone. And the last half of your cycle, if you get pregnant, eventually the placenta kicks in and the placenta starts to produce the progesterone. But progesterone plays a large role. A lot of women don't realize how much of a role it plays in our mood. And it's important in general for fertility. You cannot get pregnant if you don't have progesterone.

You can't sustain a pregnancy if you don't have progesterone. But in women who become perimenopausal and who are all over the place with hormones, progesterone and estrogen can fluctuate greatly and send women for a tailspin mood wise and all of those things. And so an interesting fun fact about progesterone too is it acts on the GABA and serotonin receptors in our brains. And so I'll ask a lot of patients who are coming in with perimenopausal symptoms or who are on hormone replacement therapy and they're on a synthetic form of progesterone, and they're like, "ah, my moods are all over the place." A lot of times I'll ask patients, how did you feel when you were pregnant? Really, once you got through the sickness, how were you? And a lot of women will say, "I felt really good." Some women will say, "I felt really depressed."

And sometimes that's high progesterone in the way their body is responding to it. But a lot of women will say, I felt great. And so natural progesterone from the ovaries and bioidentical progesterone, that's identical to what the body makes usually from plants. It acts like a really good lock and key on a cell receptor. So hormones are chemical messengers, and they travel through the bloodstream and they fit on a cell receptor like a lock and a key, and they open it and tell it what to do. And so progesterone does a lot when it comes to sleep regulation, mood regulation, and stabilizing the luteal phase. So you'll see women who have a really short luteal phase or really short periods, a lot of times that's a progesterone issue. But this is just a fun little side note a lot of times, and not in everybody, but in some women who have taken birth control pills with synthetic progesterone or who are taking hormone replacement therapy with synthetic progesterone, it doesn't act the same.

So it can, and like I said, and not in everybody, some women do great with synthetic progesterone, but a lot of women will say that they have a lot of mood swings, depression and anxiety. And so a lot of people are like, I'm confused if progesterone made me feel crazy, why are you telling me it's important? And it's really the type, so right synthetic can almost fit a poor lock and key. If you've ever tried to put a key into an old lock, it can be very annoying. And so it depends on the type of progesterone. Yeah.

Brittany: So would you say there's correlation to how sometimes after people have babies and then there might be some postpartum depression?

Brookes: Absolutely.

Brittany: Maybe the levels have shifted from that being great during pregnancy and then now, you know what I mean? To me, that was kind of the first thing I thought. I'm like, okay, hold on.

Brookes: Yep. Yes. And it's sad to me that we haven't gotten to this point with medicine where we, it's just common knowledge that we know this. I actually was talking to a patient the other day who two completely different scenarios. She first baby had her baby. She said I was fine during pregnancy. I felt great. Then I had my baby, and she went into a postpartum psychosis. She was like, I had to be hospitalized. I was put on high doses of anti-psychotic medications, antidepressants. And she said, I was scared to death to have a second baby because of what I went through with that first. And she's like, I'd never had any of these issues in my whole life. And everybody just chalked it up to postpartum psychosis. And they put me on all these high doses of medications. And she said, finally, she found a gynecologist who listened to her, and she was like, I just need a good game plan.

And the gynecologist said, okay, this is off-label, because this is not, it's sad to me because I'm like, this is healthy. This has got to be safer than anti-psychotic medications. But she immediately started progesterone supplementation after pregnancy with her second baby, no issues whatsoever. And we know that progesterone is really what the culprit of most of the initial mood disorders can be with postpartum depression. And honestly, estrogen too. Estrogen plays a huge role in brain function and mood. And you have all of these hormones when you're pregnant, you have more than you will ever have at any other time in your life. And then as soon as you the placenta, it tanks. And so that's why almost 90, over 90% of women have postpartum blues within the first week. And then we're learning that an increasing number, it's being more and more talked about. And so the numbers are going up. The prevalence of postpartum depression is a lot higher than we once thought. And so I'm a huge advocate for yes, we know hormones play a role, so we need to really start studying its impact on maternal mental health.

Brittany: So you've said the word perimenopause a few times, but what does that exactly mean? And what stage of life is that happening?

Brookes: That's a good question. Yes. Hopefully that makes sense. So it's really funny that I was thinking about this the other day. I say this a lot. There are five P's to women's health. There's puberty, pregnancy, postpartum, perimenopause, and then the pause, which is menopause. And then the sixth is, I say five, six is vitamin P or Prozac, which is what a lot of people are given to treat a lot of these symptoms. And then there's nothing wrong with Prozac, don't get me wrong. I prescribe it. But a lot of times, hormonal, these hormonal things can happen all at the same time. A woman can be pregnant, go through postpartum and be perimenopausal all at the same time. So perimenopause just means around menopause. Okay? Peri means around minnow means monthly pause means stop. So menopause means stop the monthly. But it really scientifically is when the ovaries bite the dust and they're not producing hormones anymore, they're not causing us to ovulate and have a regular monthly cycle.

And a woman who's not on hormones or hormonal birth control, it would be when she's gone a full year without a period, peri can start 10 plus years prior to actual menopause. And it just basically means that the ovaries are getting closer to reaching their expiration date. And so we can see and feel a lot more hormonal fluctuations. And so if we looked at a woman's sex hormones over her lifespan, you think about a teenager, adolescence, puberty, when the ovaries are waking up, you can see some steep rises and fall ebbs and flows with right hormones. I mean, you know how teenage girls can be. We're both going to be in for it one day. My mom says, I just will have coming for me what I probably gave her. But then in our twenties, early thirties, hormones can kind of level out and not be so drastic in the fluctuations.

But as our ovaries are starting to reach their expiration date, we can just start to experience more fluctuations, steeper rises and falls. And that's really hard to pinpoint on a blood test or a saliva test or a urine test or any of that, because it can change drastically by the day. And so we primarily base a lot of it off of symptoms. We can start to see some irregularity with periods, shorter length between periods, longer days of bleeding, shorter, lighter periods, more severe mood fluctuations, more severe pMs, menstrual migraines, lowered libido or sex drive. So a lot of things can start to come into play 10 years prior. The average age of menopause is 51, and a lot of women can start to experience perimenopausal symptoms even in their late thirties, even as early as 35. But that doesn't mean that you're in menopause in full-blown menopause. You're not post-menopausal.

Brittany: Right. So I guess how can progesterone play a part in some of the, is there still a correlation there? Is that something, if somebody was having these, maybe experiencing some of these things, they were getting close to be in perimenopause, but maybe their progesterone levels were not good?

Brookes: Good question. So what happens as our ovaries age is our egg quality can decline. And so we can have suboptimal progesterone. And it's also very controversial. We know that you've ovulated, if your progesterone levels are above three, a lot of fertility doctors to see them above 10 for optimal fertilization, implantation, all of the things that come along with pregnancy. And so in general, what can start to happen in a woman who her egg quality may be declining is that progesterone can just be very low, or it can just, we can see her uterine lining become less stable. So she'll have shorter luteal phases. So progesterone in some women, and like I said, it kind of depends on the person. In some women, we will supplement with progesterone. I like to get to the root cause. So sometimes there's other things that a thyroid disorder in general can cause issues with progesterone, cortisol being out of whack can cause issues with ovulation, which causes issues with progesterone.

Malnutrition can cause issues with ovulation, which can cause issues with progesterone. And so it really varies, depends on the person. I do have patients in perimenopause who we start on hormone replacement therapy. We're not shutting down ovulation. We're just kind of supporting what the body's naturally doing. In some women, they prefer just the bioidentical prometrium or progesterone that I usually in women who are experiencing severe perimenopausal symptoms. And we suspect that with irregular periods and mood fluctuations and all of those things, and we've ruled out thyroid disorder and all those other complications that can maybe mimic perimenopause. That's another thing. Perimenopause is a diagnosis of exclusion, meaning we rule out other things. But a lot of times we will do hormone replacement therapy with estrogen and progesterone because it's a dance. So

Brittany: It's so interesting. I even feel like so much about what we're talking about right now. I wish I would've known earlier in my twenties when I was going to the doctor. I'm like, I feel weird. I don't know what's going on. Yeah, I, but I just didn't have the knowledge to ask the right questions or dig a little bit further. So I hope this has been valuable, or I just think these are all so many things that I just wish I would've known about sooner. Yeah,

Brookes: Me too. And it's interesting. I see a lot of college students, and I'm amazed at how they're taking control of their health because I'm like, when I was your age, I did not care about, I didn't know people would ask if somebody asked me when my last period was, I'm like, I don't know. I dunno. And they come in and they, they're listening to their bodies and they're, it's just really encouraging. And that's, I think, the beauty of having more knowledge at our fingertips because you can take charge of your health earlier.

Brittany: Absolutely. I want to get into pregnancy before we wrap up, just because I think there's some great takeaways that we can talk about too here. So obviously we know that there are some connections between the thyroid and getting pregnant. So if somebody was maybe having trouble getting pregnant, would you say that would be a great first place to start?

Brookes: Yes, absolutely. Yeah, absolutely. Thyroid, and then I recommend there are some targeted blood work labs that you can do based on where you are in your cycle. That can be also beneficial if you're having trouble getting pregnant, even nutrient deficiencies play a role in pregnancy as simple as B vitamins and vitamin D deficiencies can play a role. So that is where, that's the first place to start, and then you can move forward from there to do further testing.

Brittany: What about getting off the pill and wanting to get pregnant? I know, so I've read things where it's like, oh, being on birth control can hinder you from getting pregnant. And then some people get off the pill and they're pregnant the next month. What should people know about if they are on birth control coming off and just what that process looks like related to pregnancy?

Brookes: So you'll get a different answer probably depending on who you ask. What I truly believe, based on the data and what I've seen in my practice is the pill. It suppresses ovulation, which is how it works as birth control. And it keeps the uterine lining thin. It has been shown, we do know that it can deplete certain things like especially B vitamins and folate, which are crucial early in a pregnancy. What it also can do is it can mask an underlying fertility disorder. So with a pill, either you're not having a period with it or you're having a very regular, consistent monthly withdrawal will bleed, which a lot of people equate that to a period when they're on the pill. And so when they come off, if someone has fertility struggles after the pill, they're like, oh gosh, the pill did this to me.

And what we have found is it's really, and this is what I believe, it's really masking things that may have been under underlying that just don't get addressed early. And it can deplete certain vitamins and so in minerals, and that plays a role in pregnancy early on, and the ability to get pregnant and sustain a pregnancy and the health of a pregnancy. And so my recommendation is, but on the flip side of that, the pill doesn't cause infertility. If that makes sense. So my recommendation to women who are coming off of the pill is start a prenatal vitamin, particularly three months or more before you're coming off of the pill, consider a B complex in addition to the prenatal vitamin just to get added B vitamins. B vitamins are water soluble. So you do basically pee out what you don't need. I don't want people to overdo it too much.

But usually a B complex and a prenatal can be a good way to sort of replenish those things. Have blood testing before preconception testing, is what I call it before you come off of the pill. So we know your thyroid looks good. Yeah. We know your vitamin D levels look good. We know blood sugar, liver and kidney function, all of that looks good. Those are simple, easy tests that insurance covers. Usually vitamin D sometimes costs $25 to $50, which is annoying, but usually everything else is covered by insurance. But I usually recommend not coming off of the pill until you're ready and then starting right away. So doing the work on the backside or on the front end of coming off of the pill with replenishing nutrients, having the blood test, the pill can alter thyroid hormone as well. And so that is another thing.

If a thyroid level is tested and it's off while you're on the pill, coming off of the pill and waiting until your thyroid is regulated before you start trying, because we know it's so important to have a stable low right level of T S H and healthy normal levels of thyroid hormone in your bloodstream before and during an early pregnancy is important. But in general, if you've done the work on the front end, when you stop the pill, you can start trying right away. Because a lot of women, like you said, get pregnant right away. And then sometimes periods can get a little bit irregular as the body is trying to figure out what's going on. And so I usually recommend trying once you come off of it, as long as you've done the work on the front end. And if your periods aren't regulated after three months, then it's time to really see your doctor again and see if there's something else going on.

Brittany: Yeah. It's just so wild. How many things can be related to getting pregnant and something like so small could be off. And I didn't even think about the correlation between birth control and your thyroid, but thinking back to just my own situation, I feel like once I was on the two together for several years, and then once I was off birth control later, I had to change my dosage of my medicine because my thyroid levels had changed. And now I'm like, who? That was probably related.

Brookes: It definitely can be related. The pill has been shown to increase something called sex hormone binding globulin and thyroid hormone binding globulin, which plays a role in what's available for your body to use. Yeah. So it's interesting. Yeah, it's very interesting. So interesting. Fascinating.

Brittany: Everything that's going on inside of our bodies, it's just, it's crazy. It is. Well, this has been so insightful. I've learned so much. I'm ready to book an appointment to come get a workup on.

Brookes: I'm ready to see you.

Brittany: Okay. So tell our listeners where they can find you. If somebody is local and did want to come see you in person and do a workup, where could do that? And then tell us where we can find you online.

Brookes: So I am online on Instagram @The Women's Health Company, and then my website is the women'shealthcompany.com. I will be open, I'm hoping in late June, early or late July, early August for in-person visits in downtown Watkinsville. Awesome. And the address and all of that will be on the website soon. Awesome. I also take virtual patients. I can diagnose, prescribe, treat all across the state of Georgia. So I see patients all across the state of Georgia, virtually. If you are out of state, I can do a coaching, like a coach by coach basis. So I can't prescribe medicine, but I can really dive deeper with what you've already had done and what's going on. So yeah.

Brittany: That's awesome. That's great to know too, just because sometimes I feel like people want to talk to somebody who they feel like aligned with and get a good plan, but if they're not in the state of Georgia, then you can at least kind of help point them in the right direction.

Brookes: Yeah, absolutely.

Brittany: So I love that you offer virtual Yes, as well.

Brookes: I love virtual too. I love in person, and I love virtual either way.

Brittany: There's so many options now. It makes so many good options!

Brookes: So many good options. Covid really actually, truly made telemedicine a really great thing. Yeah. So that's awesome.

Brittany: Yeah. Well, thank you again for joining us and for our listeners on life with Loverly. We are so excited that you're here. We will talk with you soon!

Brittany: Hi, friend. If you're loving the show, will you go find that follow button on your podcast app? This will ensure that you won't miss a single episode. I love having you in this community. Until next time, this season of Life with Loverly is produced by Elizabeth Evans Media Productions.