Today I am honored to connect with a friend and fellow nurse practitioner, Marcelle Pick! Marcelle is passionate about transforming how women experience healthcare through an integrative approach. She has successfully treated thousands of women through her unique approach to wellness.
Marcelle is currently a faculty member of The Institute of Functional Medicine and has served as a Medical Advisor to Healthy Living Magazine. She has written countless articles and multiple books, including Is It Me or My Hormones?
I always think of Marcelle as a pioneer in the women’s health/nurse practitioner space. In this episode, we dive into her background and the impact of the Women’s Health Initiative. We discuss the limitations of the traditional allopathic model regarding hormones, common misconceptions about adrenal health, perimenopause, and menopause, adverse childhood events and adrenal health, how lifestyle affects our sex hormones, fibroids, endometriosis, PMS, PMDD, and contraception for perimenopause. We speak about endocrine disruptors, mold, and micro toxins. We also get into ways to think about hormone replacement therapy and ways to address intimacy and low libido.
I love connecting with other nurses and nurse practitioners! I hope you will love today’s conversation with Marcelle as much as I did!
IN THIS EPISODE YOU WILL LEARN:
Marcelle was part of the first all-women practice in the country.
How the Women’s Health Initiative has impacted health care for women.
The limitations of the traditional allopathic model, particularly in terms of perimenopause, menopause, and hormones.
The less common labs that Marcelle likes to look at for her patients.
Marcelle shares her approach to unraveling the symptoms of perimenopause.
Some unique ways in which Marcelle deals with problems like fibroids and endometriosis.
How childhood trauma could lead to adrenal and autoimmune issues, weight-loss resistance, and various other health problems.
Many of the things Marcelle recommended for treating PMS and PMDD back in the day (1985) have now become the standard of care.
Contraceptive options for women in perimenopause.
The impact of stress on adrenal function during perimenopause and menopause.
Marcelle dives into liver health and detoxification, chemicals and other factors that could impact our health, and changes we can make to avoid problems and feel better.
What Marcelle does to help women with low libido.
Bio:
Marcelle Pick, OB/GYN, NP, is passionate about transforming the way women experience healthcare through an integrative approach. She co-founded the world-renowned Women to Women Clinic in 1983 with the vision to not only treat illness but also help support her patients in pro-actively making healthier choices to prevent disease. She has successfully treated thousands of individuals through her unique approach to wellness.
In 2001, Marcelle created MarcellePick.com with the goal to be able to reach, inspire, and educate even more women worldwide – her website offers informative articles on women’s health issues and at-home solutions to some of the most troublesome symptoms they experience today.
Marcelle discovered Functional Medicine early on in her career and was honored to be among the first to be certified as a Functional Medicine Practitioner. In addition, she holds a BS in Nursing from the University of New Hampshire School of Nursing, a BA in Psychology from the University of New Hampshire, and her MS in Nursing from Boston College-Harvard Medical School. She is certified as an OB/GYN Nurse Practitioner and a Pediatric Nurse Practitioner and is a member of the American Nurses Association and the American Nurse Practitioner Association.
Marcelle is currently a faculty member of The Institute of Functional Medicine and has served as a Medical Advisor to Healthy Living Magazine, writes a weekly newsletter for MarcellePick.com, and lectures on a variety of topics including weight loss resistance, infertility, stress & illness, and adrenal dysfunction. She is the author of The Core Balance Diet, Is It Me or My Adrenals? and Is It Me or My Hormones?. She has appeared on Dr. Oz, FOX, and ABC and has been featured in Glamour Magazine, ELLE Magazine, and Women’s World Magazine. Marcelle’s PBS show, Is It Me or My Hormones? is a favorite among viewers.
“We know now that the microbiome of the uterus is impacted with regards to having menses. We know that the food that we eat can impact that inflammatory cascade too.”
-Marcelle Pick
Connect with Cynthia Thurlow
Check out Cynthia’s website
Connect with Marcelle Pick
All of Marcelle’s books are available on Amazon
Transcript:
Cynthia Thurlow: Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
Today, I had the honor of connecting with a good friend and nurse practitioner, Marcelle Pick. She's passionate about transforming the way women experience healthcare through an integrative approach. She has successfully treated thousands of women through her unique approach to wellness. She is a faculty member at the Institute of Functional Medicine and has served as a medical advisor to Healthy Living Magazine, has written countless articles and multiple books including Is It Me or My Hormones? Today, we dove deep into her background and the impact of the Women's Health Initiative. We spoke about the limitations of a traditional allopathic model as it pertains to hormones, common misconceptions about adrenal health and perimenopause and menopause, the role of adverse childhood events and adrenal health, the impact of lifestyle on our sex hormones, fibroids, endometriosis, PMS, PMDD, contraception for perimenopause. The impact of endocrine disruptors as well as mold and mycotoxin, ways to think about hormone replacement therapy as well as ways to address intimacy and low libido. I hope you will love this conversation with Marcelle as much as I did. I really love connecting with other nurses and nurse practitioners, and I know you'll find this information to be invaluable.
Well, Marcelle, it is such an honor to have you on today. I've been so excited for our conversation.
Marcelle Pick: So am I. I've wanted to do this for a long time with you. So, I'm here.
Cynthia Thurlow: Absolutely. Let listeners know a bit about your background because I really think of you as a pioneer in the women's health nurse practitioner space. As were talking about before we started to record, I've generally genuinely had trouble bringing NPs on as experts. I want to kind of change the narrative about how nurse practitioners can offer just incredible level of care. You've really been able to kind of witness what's happened over the last 20, 25 years with the Women's Health Initiative, how that impacted bioidentical and even hormonal replacement therapies, the net impact on women and women's care. Now we're coming back around, and I'm feeling grateful and perhaps hopeful that the narrative is changing again.
Marcelle Pick: Yeah. So, it's interesting. When I went to graduate school, I went to a combined program with Harvard Men and Boston College, and I was very intentional about that because I knew if I had the creds, no one could say anything to me when I really was starting as a nurse practitioner back when very few nurse practitioners were identified.
In 1985, we actually started Women to Women, and I actually started it two years before. That's why I kept the name. And two of the physicians and a nurse practitioner joined the practice, the first all-women's practice in the country. So, we had to get attorneys from Colorado because we had different licenses to make sure that we can kind of be equal partners, it was really quite the affair. And we bought this huge Victorian home. I went into debt numbers I could hardly even speak at that time.
But we all really knew back then that we wanted to make a difference and have women become their own midwives, to know about their body so well that they could start having a voice and ask questions. I didn't think about it at the time. I was terrified, I was a baby, I was young, just got married, and was like, "Oh, my God, what am I doing?" But we did a great job and we really grew very very quickly.
Cynthia Thurlow: I bet. Well, I think it's interesting that the kind of traditional prevailing allopathic medical model is that women are these kinds of silent conduits to contraception and pregnancy and the postpartum period. God forbid, we talk about aging women, perimenopause, and menopause. I think for those of us that have navigated both as clinicians and also as patients ourselves, we just realize there are glaring disparities in the way that conventional Western medicine, the model really looks at wellness and healthcare and preventative care as it pertains specifically to women's health.
Marcelle Pick: Oh, it's so funny when we started the practice, is all of the docs around that were mostly all men practices in my area that were no all women, they said to us, you're never going to be busy. No one's going to want to go to all women. The people that put ourselves in because at the time we had paper charts, they had to keep coming back because we were so busy so fast. So, it was really interesting. We got actually a national reputation at the time because of who were and what was going on with Chris Northrop's book and so on so. It was hysterical. I wanted to kind of jump from the rooftops and go, "Ah, we were right, you were wrong," but we didn't do that. We just really enjoyed how many people were able to help.
Cynthia Thurlow: Yeah. That's really what it comes down to. I think certainly as a middle-aged woman myself, I definitely look for a type of medical provider. Certainly, when it comes to preventative care, GYN care because the years of me having children are many years behind me, it's really important for me to feel very comfortable with the provider I'm working with. There's just a degree of camaraderie with other women. They understand we have the same parts. We've been through very similar circumstances in many ways. I am not at all surprised that you all had such incredible success.
Now, in terms of that trajectory that uou preceded the Women's Health Initiative, you were practicing before then. What was that like as a practitioner? To see the results from the Women's Health Initiative or the WHI as it's more commonly referred to. The downward effect of how that impacted the care that you were delivering and people's comfort talking about hormonal replacement therapy, women asking for hormonal replacement therapy, I would imagine that was really impactful.
Marcelle Pick: Oh, absolutely. What was so interesting, though, is that years before we were already using bioidentical hormones. I didn't feel that many of the pieces to the puzzle when you actually looked at the study itself impacted my patient population. The part was difficult is that people were scared, and every single provider around us was saying, absolutely not. It's dangerous. You shouldn't be doing it. But mind you, we opened at 85, so we had years of experience behind us and we were using what was available at the time. As time went on, I started using more troches and melts and now we have patches too. I was using different combinations including creams and using compounding pharmacies. There are many more compounding pharmacies now than they were back in the day. It was Women's International Pharmacy, I think it was the only one that people were using. We looked at the Women's Health Initiative and the unfortunate part about that is that even to this day, a lot of people are not understanding that many of the women that were in the study were actually ten years post menopause.
When you have those receptors that are quiet and then we rev them back up, there's going to be a very different set of circumstances that come out in adverse results than if you're putting somebody that's got hormones still present to some degree, and you're putting them on hormones. But our culture still has not adapted that concept. If we look at all the research now, and there are tons of it because as I teach for the Institute of Functional Medicine, The Hormone Module, we're always every single year updating our data on what do we know about hormones.
There are so many articles now and published double-blind studies showing that what we thought was true of all women in 2001 is not true of menopausal women. So that's refreshing and wonderful to know. However, the general public hasn't pulled that together yet.
Cynthia Thurlow: No, and it's interesting. My mom was here for Christmas and as you can well imagine, she's a retired nurse and she was an executive before she retired. We had a conversation about who I was interviewing today. I mentioned Marcelle is a friend and an NP. I said she was really a pioneer in women's health. We've had conversations about hormone replacement therapy and my mom said, "Your legacy is to ensure that the tides shift." She said, "My sister," so I have five aunts in totality, "All of them were either put on hormones and taken off, or just never were on hormones." They talk very openly about the degree of osteoporosis and the vaginal atrophy, and in some instances chronic inflammation, oxidative stress, they're insulin resistant, and you can be thin and still be insulin resistant, and just a recognition that they understand that their neurocognitive status has changed significantly. And they talk openly about this, so I'm not sharing anything that they would be uncomfortable sharing, but it makes me realize why it's even more important that we get good information out there, so that women don't fear taking hormones if that's the right choice for them and that clinicians don't fear prescribing hormones for appropriate patients.
Marcelle Pick: Yeah, and I think that's where the question comes in, is, do they have a family history of breast cancer? What are their cardiovascular risk factors? You really look at are they a green light, yellow light, or red light? And that you make a decision together. Every year when I would see patients in my practice, we would be going over the symptoms and I would have them sign a consent. Most of the time, people would say, don't you ever take me off these. Don't you ever. Because at times I would say, look, let's just take a little break and see how you feel, then you can make a decision based on what you want to do. Sure enough, most of them came back and said, never again. That's the hard, hard part for me about all these women that were on higher doses than I ever put people on of, not bioidentical hormones, Prempro.
They were taken off cold turkey and they suffered so badly. They really, really did. We didn't have any ability to be-- they did in my practice, but very few people would say, look, let's do something a little different, and kind of hold it back down again. Because when I did blood work on these women, their numbers were sky high. We're talking sky high, because their dosages were way out of sync. You take those women off hormones, they couldn't think clearly, they were moody, they were irritable. It was horrible for them. So, no, I'm definitely going to always be on their rampages saying, "Look, they need to have choices. Let's talk about what's really good for them."
Cynthia Thurlow: Yeah. I think that's really important is this whole patient empowerment. Like, thinking back to the years when myself and all my friends were put on oral contraceptives to help control our menstrual cycles. We were never given fully informed consent. We didn't really understand what low estradiol levels would potentially do to our bones. We didn't fully understand what that could do at that low of a state of hormones for such a long period of time to control our symptoms. For the same reason we have to fully inform all of our patients when we're working with them to really understand if you choose not to take hormones, that's okay, but understand that these are the potential side effects that can come from that. Now, when we're looking at a traditional, both of us are both dual-trained, traditional allopathic medicine. What are some of the limitations of the traditional view of perimenopause and menopause from the lens of that traditional kind of trajectory? We're really focusing on symptoms as opposed to root cause management, which really does as a tremendous disservice as women.
Marcelle Pick: One of the things that I love about functional medicine is we're trying to look at the cause of the cause. If somebody is having hot flashes, they're not always going to be there for the same reason. When I see somebody coming into my office and they're having perimenopausal symptoms, I'm on high alert as "How do I get this woman back to feeling normal." I don't feel like myself, I feel like somebody else has invaded my body, I've gained all this weight. I can't think clearly, I'm crying all the time, I can't sleep, and I'm having sweats or the biggest thing I'm seeing now is anxiety. Anxiety that's coming from the bottom of their soul. For me, I need to try to figure out where that's coming from and around perimenopause what I say to women is, look, "Perimenopause is this amazing journey of self-discovery. Who am I? What am I going to be for the second half of my life? And how do I get there?
And it's not with an antidepressant. It's really more self-reflection. A lot of women have a lot of issues that they hadn't thought about for years that have been under the carpet that kind of come to the surface. I was like, "Okay, so let's kind of look at that." What can I do also to look at your adrenal function? What do I need to do to help with sleep? Why are you not sleeping? The anxiety may be coming from high cortisol production because in perimenopause estrogen is an anti-inflammatory. It keeps everything at bay a little bit. When you're hitting perimenopause and menopause and it's not there anymore, "It's going to like oh my God, what happened to me?" It's truly doing what you said is, let's kind of really unpack what created the problem, and treat that instead of treating with an antidepressant. Sure, it'll take the symptoms away for a bit. That's not the root cause of what's going on.
Cynthia Thurlow: Yeah. It's interesting, even my own perspectives as a perimenopausal woman, I just happen to have my menstrual cycle. My first day of my menstrual cycle when I was seeing-- for my annual exam with my GYN, she was like, "Oh my gosh, your period is so heavy." I said, "Well, I've been telling you that I've been dealing with this." And she's like, "Okay, we will fix this. We're going to put you on oral contraceptives. If that isn't what you're interested in, we'll give you an IUD. Next step up would be an ablation. And you know what? You're done having kids, so let's just do a hysterectomy." And I was like, time out. I don't want any of the above. One gave me migraines. There's no way I'm having an IUD. I don't want a surgical procedure if I don't absolutely need it. I feel like that's my perception that's the prevailing way of dealing with perimenopause is, "Oh, these things are going to fix the problem and they really don't fix the problem."
What I find really interesting is if we talk about some of the physiologic changes that are occurring in our bodies as we're transitioning into perimenopause the 10 to 15 years preceding menopause, it can be precipitated by, suddenly you're not sleeping well or you have more anxiety or depression or your cycles get very heavy, but not realizing that it's these hormonal changes that are driving a lot of the symptoms we're experiencing. If we don't address that that can be problematic.
In your book, you talk a lot about some of the labs, kind of the traditional allopathic labs. There aren't enough labs done often enough to be able to get a sense for what's going on. If you come in with a typical perimenopause case, not sleeping, more anxiety, what are some of the labs like, less common labs per se, maybe from the lens of the functional perspective that you'll be looking at in addition to things like the DUTCH, to get a sense for what's really going on with this female?
Marcelle Pick: Yeah, great question. So, as I mentioned in my book, adrenals trump hormones and adrenals trump thyroid. I'm always going to be doing an evaluation of cortisol production, doing a saliva profile to look at the level when they wake up, 30 minutes later, noon, afternoon, and the evening. And this is my bias. I like another company besides DUTCH for that. I think they're more specific to the symptoms that I see in my patients. In addition to that, I'm going to do a full panel of thyroid testing because that's when we see most women have thyroid issues. I'm going to do a TSH, free T3, free T4, total T3, thyroid antibodies, and reverse T3. The reason that's so important is because when people have an enormous amount of stress, we'll do normally a TSH, and oftentimes a T4. But what they're not looking at is how much active thyroid do they have, how much active T3 do they have. When they've had a lot of stress for many different reasons because there's a lot going on in the world right now. We have high amounts of reverse T3. The body is behaving as though it doesn't have enough thyroid. So, I always do that as well.
I'm going to do the standard test, but I'm also going to look to see what their hormonal levels are, depending upon what they want to do. If they say, Marcelle, I don't want to intervene with any hormones, then I might not do that testing. But most are curious what's going on in my body. The conventional approach is your hormones are going up and down all day, it doesn't matter. Well, that's not completely true. That is if we're specific about when we do hormone testing, like on day seven for estrogen levels, estradiol, and estriol. I don't do estrone generally. On day about 22 of a cycle, if they're still having cycles, I'm going to be looking at progesterone levels, DHEA-S doesn't matter, FSH/LH I might do around day three if I'm wondering where their numbers are for menopause? I'm going to be more specific to that patient as to what they're wanting and then we're going to really start to unravel things. But here's the other thing that's interesting and that is I'm going to do a gut evaluation because the gut is so important, certainly for serotonin production, two-thirds of serotonin is produced in the gut. If they're stressed out, that's going to affect serotonin, which is going to have an impact on brain function. And round and round the circle goes. Also, the food that they're eating and how much stress do they have there in their lives on a scale of one to ten.
All of those seem to really have kind of a symphony in perimenopause. It's kind of this climactic time in which so much happens and it's really unraveling that. I've used progesterone for years and years and years and years instead of oral contraceptives. Here's something really interesting and that is that we know now that the microbiome of the uterus is impacted with regards to heavy menses. We know that certainly the food that we eat can actually impact that inflammatory cascade too. We know that the vagina and the uterus have the microbiome. As we shift that microbiome, it also very much contributes to that menstrual shedding and menstrual bleeding the heavy periods as well. That's pretty new information and pretty exciting. We can actually predict from the microbiome of the uterus if somebody's going to have cramps. We can predict, this is going to really sound crazy, from the microbiome of the vagina if they have freckles or not. They did an enormous study kind of looking at how can we really understand things now that can shift, obviously, as we change the microbiome as well. It was kind of interesting stuff that's coming down the pike.
Cynthia Thurlow: Well, and it's interesting because very likely when you and I initially trained, the gut microbiome seemed way far off. But now we talk about the oral microbiome, the gut, the vagina, the uterus. I mean, it's amazing to understand that there are all these microbial products that go on-- viruses, bacteria that are designed to be there, but differentiating that it can lead to more inflammation, less inflammation, more likelihood to skin changes, the freckle thing is fascinating.
Marcelle Pick: I'm not fascinated at that? I was just like, are you kidding me? [laughs]
Cynthia Thurlow: Yeah, someone paid for a study to figure that out, which is fascinating. But when we're talking about heavy menstrual cycles so obviously not unique per se to perimenopausal women, but women that are prone to fibroids or endometriosis, what are some of the unique ways that you look at these problems? Got a lot of questions about this because the standard medical care-- fibroids, they either get a myomectomy or they'll go in and they'll get oral contraceptives. Endometriosis can be very extensive. It can be mild and be very extensive. For many of these women, it's been my clinical experience, a lot of emotional components to it, which is probably completely related to the fact that they're dealing with some chronic pain issues.
Marcelle Pick: Well, it's kind of hard to know the chicken or the egg in that case. What I find is when I was in practice for many, many years, 37 years, that so many women that had endo were high achievers, even though that's not a standard thing and expected a lot of themselves when I kind of looked back at their story, they oftentimes had a fair amount of, I don't know if I'd call it trauma, I think that's a heavy word prior to that adolescent time. We're starting to understand a little more about endo. That may be an autoimmune reaction, in which case when you have those endometrial cells that are sloughing back into the abdomen, the body doesn't have the ability to actually phagocytose those cells, which may be part of the immune system.
We also know that women that have endo almost always, always have Candida. That gets back to the gut microbiome. I've never seen somebody to date that I had that I treated for endo that didn't have overgrowth of Candida. We also know that there's a high number of those women that have high dioxin levels. And the association between endo and high dioxin is also present. When you're working with someone or me, I'm going to be looking at all those pieces to the equation so I can really see if I can help them look at what for them is that contributing factor. I had such an interesting case many years ago. I actually wrote her up. It was Women's Health magazine interviewed me for her. At the time I saw her, she was 32 and she had seven years of IVF, she had one child and she was getting ready to have a hysterectomy for endometriosis because she had excruciating pain and she couldn't be with her son.
I said, pkay, but you've got to cancel the hyst by next week, I can't, what can I do? Indeed, we did the whole evaluation. We looked at her gut, we looked at her adrenals, food sensitivity. She did have yeast and a parasite. We treated all that. I also had her go to Al-Anon because she had a huge family history of alcoholism. I said to her when she came back to see me because her score of how many symptoms she had, so much, much better and she wasn't having pain anymore, and she was all happy. I said, you really should think about birth control. And she's like, give me a break.
I've got half an ovary on one side and a blocked tube on the other because they took one of the tubes out and she goes no way. She got pregnant, so she had a baby. That's why we wrote her up in the magazine because she did all the pieces and really started to understand the connections. So for me, it wasn't just about-- "Yes, it's emotional, horrible when you have endo, but what created some of that to begin with? And that's where I always go. "If you don't deal with your story, your story will deal with you," is kind of a metaphor I use a lot. It was a combination of all that. It's not the first time I saw that in my practice. I actually saw it quite often. It's looking at all the pieces to the puzzle for her what contributed to that. The good news is we can do something about it. The bad news is the traditional way of dealing with it doesn't always work.
Cynthia Thurlow: Yeah. I can imagine.
Marcelle Pick: It will help you get pregnant, but it doesn't always help the pain or cramps.
Cynthia Thurlow: Yeah. I'm so grateful that she met you and avoided having a hysterectomy. I mean, that's such a severe surgery to have at such a young age. I do hear over and over and over again, people will send us messages. They'll say, what are my options? And I'm like, we're not-
Marcelle Pick: Of course.
Cynthia Thurlow: -your treating doctor or nurse practitioner, but here are some resources, discuss them with your healthcare practitioner. What about for women that have debilitating PMS or PMDD, which is the really severe form of PMS that I think for a lot of practitioners, they think of, "Oh, this is just what every woman goes through." The one thing I want to interject was I only had PMS when I was taking oral contraceptives. When I wasn't taking oral contraceptives, I had no PMS. It's like, how many thousands and thousands of women every month they have debilitating PMS and it's actually a byproduct of the contraceptives that they're taking.
Marcelle Pick: It certainly can be and my experience is that many times because the progestogen that's in the pill is not the same as we produce, which is called progesterone, and many times, if somebody is already progesterone deficient, getting them on the pill makes the progesterone deficiency worse. So, the symptoms are pretty intense. When I've had people on birth control pills, I'd always use progesterone cream days 7 through 21 of the pill packet or if they were using a ring, I would kind of shift it as well in the same format.
In my experiences interestingly enough, I mean, back in the day in 1983, we only had progesterone suppositories to treat women with, but I was using them back then through a compounding pharmacy with amazing results for PMS and PMDD as well. But there were times I would use a higher dosage. I mean, there were times for some people I had them on 400 milligrams a day and I changed it from day 7, then I increased the dose on 10 and I increased the dose on 14.
Again, I was monitoring the levels very carefully because progesterone can actually increase estrogen levels. But the results were night and day. What everybody would say to me is "That black cloud is gone, the veil is gone." I feel back to normal. For many of those women, they would say I've got one good week a month, I can't live this way anymore. For me it was devastating for these people. It was really nice to be able to give them an option back in the day, even though I was kind of herald in the community as, "Oh my God, she's really kind of gone out to lunch." The irony is now is many of the things we recommended back then weren’t standard of care. I was using probiotics back then and now it's standard of care. Even most gastroenterology offices are using it. It's interesting if you follow the literature with regard to what they're doing in Ph.D. clinics, that's where you really gather the data. It takes a lot longer for the double-blind studies to come up and they're usually medicine oriented anyway.
Cynthia Thurlow: Yeah, it's really interesting because you were way ahead of the curve and a lot of what you're sharing now makes so much sense. As a woman who had thin phenotype PCOS, it makes complete sense why when I was taking oral contraceptives with a luteal phase defect where my progesterone levels endogenously were too low, why it made the PMS, why it really magnified all of that. Now we got a lot of questions about what are your traditional recommendations, again generalization for women in perimenopause who are done having their families, but don't want to run the risk of getting pregnant prior to menopause. Do you have favorite contraceptive options? What are your favorite ones that you'd like to use?
Marcelle Pick: I did a whole presentation on that for IFM and I think my favorite one is probably the NuvaRing. I always add progesterone with that as well because you do not want to get pregnant, if you don't want to get pregnant. You don't want to put yourself in that position and using something like a NuvaRing and really adding to it than progesterone but also looking at adrenal function and also at nutrition, making sure that the sugar amount is down and all that kind of stuff so you can feel your optimum.
People have asked me the pill, it's hormones and I'm thinking, you know what? I'd rather them be on that than get pregnant if they don't want to be. We need to have some ability to be able to have control. You still want to be sexually active. You don't want to have a tubal ligation or your partner have a vasectomy, then my favorite is probably the NuvaRing. You don't have to mess with every night. You put it in, you take it out, and using it in combination with oftentimes V Vitamins because they can deplete the vitamin stores and then using progesterone cream with it is probably my favorite.
Cynthia Thurlow: I love that. It's something that is respectful of the fact that women are looking for dedicated, reliable contraceptives, but also understanding that there's no shame. In fact, I am working with an NP right now who is on oral contraceptives in perimenopause and just said listen, I can't get pregnant at this stage of the game. I'm older than I would want to be as to have another child and I just need somebody to be reliable until I go into menopause.
Marcelle Pick: Absolutely.
Cynthia Thurlow: Yeah. You've alluded to multiple times adrenal health and I interviewed Dr. Kyle Gillett earlier this year and he used a term I'd never heard of before, but it makes complete sense, adrenal pause. Understanding that our adrenals take a little bit of a hit transitioning into middle age and the importance of understanding what our adrenal glands are doing as our ovaries are producing less progesterone would be helpful for listeners to have that reinforced because this is why we become a little less stress resilient. This is why the lifestyle piece becomes critically important in perimenopause and menopause.
Marcelle Pick: Again, we don't have estrogen to kind of cover things up, if you will. And it's really a great masker. Adrenal function is interesting because before menopause 15% of our hormones are produced by our adrenal glands, post menopause, about 30% are. They're having additional need for the production of more hormones and if they've already been maxed out because of stress and the urine fight-flight a lot. It's interesting because when I talk to people a lot, I don't really have a lot of stress. The question I ask is, well, how much negative self-talk do you have? Of course, it's like [Cynthia laughs] stress right there or how much stress did you have as a kid? What was your what I call ACE score, which is adverse childhood event score and if it's right up there, then you may be having this kind of verbiage going on in your head that is contributing to cortisol being produced in every situation.
If you're an over pleaser or if you are someone who always thinks you're wrong, or if you're someone that just doesn't have good self-esteem, all of which gets magnified in menopause, then that's going to come up as an issue too, which is going to produce more c. The interesting thing is that cholesterol makes cortisol. If you're on a cholesterol-lowering drug that can contribute to this whole cascade of events that go on that are not really healthy for you.
In and of itself, if we have too much requirement for cortisol, it will go to cortisol at the expense of estrogen, progesterone, testosterone, and DHEA. There's an enzyme called 17, 20 lyase that blocks that conversion. And what does that mean? Well, it means that we don't have as much progesterone because that's a thing that goes down first, and then it's estrogen and certainly testosterone as well.
That all contributes then to the body trying so hard to produce those hormones and it can't. And we're then more in fight-flight. We have more anxiety that sense of adrenaline going up and we can't sleep, and that's because oftentimes cortisol is up at night and we've got too much cortisol production and we don't have enough melatonin sometimes as well. It's a cascade of events that go on. I call it adrenal dysfunction. You can call it adrenal pause. I mean, all those names are great. I'm not a great fan of the adrenal fatigue concept and I write that in my book because I think that's what's gotten us in trouble in the conventional world. Adrenal fatigue, are you serious? but it is a reality.
If you look at the bell-shaped curve, most people don't have Addison's, which is too low, most people don't have Cushing's, which is too high. They fall within the ends of those curves with very significant symptoms. There're degrees to adrenal dysfunction as well depending upon how long it's been going on. Our body is not meant to be in fight-flight all the time. Thousands of years ago, we're going to be chased by a tiger. We either got eaten or we went back and kind of life was back to normal. That isn't the case anymore with all the social media stuff, all the news, the computers, our lives, the COVID and pandemic, and everything like that. We really have to find ways ourselves to not decrease the stress per se, but to find that parasympathetic kind of pause, if you will so that we're not on high alert all the time.
Cynthia Thurlow: