Today, I am thrilled to speak with Dr. Carrie Jones to delve into the concept of the "middle pause," which refers to the transition from perimenopause to menopause. We’ll examine how lifestyle habits that were effective in women's 20s and 30s may lose their efficacy during this phase. Dr. Jones emphasizes the reduced capacity to "burn the candle at both ends" and the transition from people-pleasing to more straightforward communication. We’ll cover the behavioral impacts of hormonal changes, the significance of hormone replacement therapy (HRT), and the importance of adrenal health. We both stress the need for women to seek supportive healthcare providers and embrace this transitional period. Tune in!
IN THIS EPISODE YOU WILL LEARN:
The concept of "middle pause," encompassing perimenopause and menopause
Changes in lifestyle habits and their effectiveness during this transitional phase
Decline of people-pleasing tendencies and the shift toward direct communication
Impact of hormonal changes on behavior and emotional responses
Understanding physiological changes, including hormonal imbalances
Hormone replacement therapy (HRT) and its effects on mood and well-being
Relationship dynamics and challenges faced by women during this transition
Self-advocacy and finding supportive healthcare providers
Connection between hormonal changes and food sensitivities or allergies
Education and awareness regarding health and wellness during aging
Bio: Dr. Carrie Jones
Dr. Carrie Jones is an internationally recognized speaker, consultant, author, and educator on the topic of women's health and hormones with over 20 years in the industry. Dubbed the “Queen of Hormones,” Dr. Jones is a Naturopathic Physician who did her 2-year residency focused on women's health and endocrinology. She went on to get her Master of Public Health (MPH), was one of the first to become board-certified through the American Board of Naturopathic Endocrinology (FABNE), and is a Menopause Society Certified Practitioner (MSCP). She was the first Medical Director for Precision Analytical (the DUTCH Test) and the first Head of Medical Education at Rupa Health. She co-hosts the highly popular show, the Root Cause Medicine Podcast which has over 10 million downloads. She is the Clinical Expert for the Lifestyle Matrix Resource Center, was on Under Armour’s Human Performance Council, and is an advisor for MetaPause. Currently, she is the Chief Medical Officer at NuEthix Formulations.
“The people pleasing is gone. I think you can say things in a direct manner without being offensive, but for reformed people pleasers, it’s a sign of growth.”
-Dr. Carrie Jones
Connect with Cynthia Thurlow
Follow on Twitter
Check out Cynthia’s website
Submit your questions to support@cynthiathurlow.com
Connect with Dr. Carrie Jones
Transcript:
Cynthia Thurlow: [00:00:02] 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.
[00:00:29] Today, I had the honor of reconnecting with Dr. Carrie Jones, who is a fan favorite as well as a personal fan favorite of my own. She is a naturopathic doctor who focuses in on perimenopause and menopause. Today, we spoke about what no longer serves us in perimenopause and beyond, the impact of the decline of GABA in our brains, the role of estrogen and its interplay with serotonin production, the impact of weight loss resistance, how our adrenals have to better supported in this transitional period in our lives, advocacy, the role of histamine, mast cells and hives, the impact of alcohol red flags and the role of trauma. I know you will find this, as always, to be an invaluable conversation with Dr. Jones.
[00:01:18] As I was connecting with you earlier in the week, getting a sense of what's the litmus test of things that you're seeing and discussing, it became very apparent to me that talking around what is no longer serving us on any level during this middle pause, that's my new catchphrase. Instead of saying perimenopause and menopause, middle pause, during these middle pause years from you as a clinician with when you were working directly with patients and now connecting and educating hundreds, if not thousands of individuals, what are some of the key themes around lifestyle measures that are no longer working for us? Maybe work for us in our 20s and 30s, but kind of serendipitously, as we are navigating this middle pause transition, all of a sudden there's big glaring headlines of guess what no longer works for you.
Dr. Carrie Jones: [00:02:12] [laughs] A big one is burning the candle at both ends. Another big one are my people pleasers and my perfectionists who honestly did. It's what got them through probably their teens, 20s, 30s, and probably got them to the top of the heap. It's probably what helped them survive, fit and grow in a family if that's what they did, or workforce if that's what they did. And now they just did it with gumption and grit and force. And now they hit their middle pause. I love that. And they're feeling it. [Cynthia laughs] They're like, “Wait a minute.” I either need to make some changes or they're getting forced into these changes. And in fact, some friends and I were texting yesterday who were about the same age, late 40s to early 50s, and we were all laughing at how we don't have that people pleaser emotion anymore. Now it's just pure sarcasm and irritation.
[laughter]
[00:03:01] We're like, “When did this happen? When did the switch happen that we just sort of shrug our shoulders and we're like, ‘Eh, we don't care, whatever.’”? [laughs]
Cynthia Thurlow: [00:03:07] Well, I can tell you I have three dogs that get groomed because they're doodles. And we had a very gentle groomer, meaning personality wise, very gentle, I suspected might be on the spectrum. And I have many family members who are on the spectrum. So, I'm like very attuned to that. And I was like, “Okay, I have to be really careful about how I communicate and essentially, I got fired because I gave her feedback, which was like, “My dog was a little uneven. Do you mind clipping his nails more?” And then it was like, “She's no longer comfortable grooming your dog.” And so, I got on the phone with the owner, who was lovely, and the woman said within five minutes she was like, “Oh no, that's not a good fit for you. You need someone that can handle straightforward directness.”
[00:03:49] And she said, “That's not a bad thing. But some people are so taken aback by being direct. And I said, “Well, I'm like a middle-aged woman.” There's no other way to be.
Dr. Carrie Jones: [00:03:57] Right? Is there an option?
Cynthia Thurlow: [00:03:59] Yes. I was like, “The people pleasing is gone.” And I'm like, “I think you can say things in a direct manner without being offensive.” But I think for a lot of people that have been reformed people pleasers that tendency to feel like you're always playing to someone else, “Oh, I want this person to like me, so I want to make sure they're happy” and in some ways negating our own needs and our own desire to be happy. And so, I think saying I'm a reformed people pleaser is a sign of growth. So, when you're talking to your girlfriends about, we're still sensitive and thoughtful in our delivery, but we find it very important to communicate in a very direct and effective manner as opposed to where we were 10 years ago.
Dr. Carrie Jones: [00:04:42] What's interesting is that I recently read an article, I believe it was more a review opinion piece in a journal article and the authors were saying, “You know we have an inhibitory neurotransmitter in our brain. GABA and GABA's our brake system. Like, we have a gas system, and then we have a brake system like a car. So, GABA helps us slam on the brakes when we need to, which is fantastic. But the authors were saying, “This declines with age for everybody. It doesn't matter who you are.” Over time, sadly, we lose the GABA. And in the article, they state women lose it more because of our loss of progesterone. And when progesterone breaks down in a good way, then it also helps stimulate GABA. So, we get this double break system, which probably is a good thing in our early years. It allows us to maybe remain calm and handle the things and truly burn the candle at both ends and be the people pleaser, which I understand, that can be a traumatic response, but also it can be just a survival of dealing with rowdy kids or rowdy job or what have you. Like, we have to have the ability to hit the brakes, but as we get older, we lose that. So not only do we lose it for age, we lose it because of our hormones. And as I'm reading this article, I thought of this very thing where we lose the brake system on our mouth and we think of a younger, maybe your mother, your aunt, your grandmother, your neighbor. And you were like, “Man, they just have no filter.”
[00:06:04] They just have no break on their mouth. And now that I'm there, like, “Yep, same same” samesies. There goes my break. It's all gas. I can be thoughtful. I can be empathetic. I can be warned. “Hey, Carrie, watch your mouth in this setting, okay, fine, I'll be professional.” However, I absolutely see it. I can see the decline on my brake system all over the place. But essentially, what comes out of my mouth. [laughs]
Cynthia Thurlow: [00:06:28] Yeah, my kids will look at me. They'll see a look on my face. They're like, “Don't do it.” [Dr. Carrie Jones laughs] I'm like, “I need to give them feedback.” They're like, “No, you don't.” I'm like, “Yes, I do.” They're like, “No, you don't.” They're like, “you're so embarrassing.” And I do it in a way that's kind and thoughtful. But I'm like, “I'm a small business owner myself and I think it might be helpful if you X, Y, or Z.” And my kids are always like, “God, you're so embarrassing.” But I think in many ways, it alleviates so much pressure. Whereas when I was younger, I might have felt because I was a people pleaser, I wasn't really going to speak up for myself the way that I needed to. And so now I show up very authentically.
[00:07:04] But I can definitely distinguish when I'm not being thoughtful about my approach to things. I definitely feel like this loss of inhibition in many ways is beneficial. It's very freeing-- [crosstalk]
Dr. Carrie Jones: [00:07:18] It's very freeing.
Cynthia Thurlow: [00:07:20] My grandmother and her sister. So, this is my grandmother, my great aunt and another great aunt, [laughs] we would have family reunions and my family thought it was funny if everyone had a T-shirt and my grandmother and two great aunts, they love the color purple? I don't know what it is about older women in purple-- [crosstalk]
Dr. Carrie Jones: [00:07:38] Seriously.
Cynthia Thurlow: [00:07:39] But they all had these purple shirts and it said outrageous older women. And they were so proud of these shirts and they would wear them and they would show up at this whatever reunion we were having and they were so proud of their purple shirts. And they would say all the time, like, “We can get away with anything.” Like when a 70-plus-year-old person speaks, no one thinks anything of it. They're like, “Oh, they're 70 plus years old, they can say whatever they want.” They're like, “This is exactly how we feel for so many years we had to subjugate our opinions and the way that we felt about things being deferential, some of it was generational,” but for them I can now fully appreciate, as a 53-year-old woman, I can now fully appreciate how freeing that must have been for them, especially in the years that they grew up within. Women in many ways were not given a voice.
Dr. Carrie Jones: [00:08:30] Yeah. Oh, absolutely. And I saw it in my patients, I'm sure a lot of people listening are totally laughing, chuckling along, thinking of things that they've said, realizing their brake system, their inhibition system is gone as well or on a very quick decline. [laughs] And they're finding that they're saying things now. On the one hand it's very freeing and on the other hand, it can be very shocking for people who are finding their voice for the first time. It can be very shocking for partnerships, marriages, businesses who were like, “Who are you? Where did this come from? This isn't the small, meek, quiet person you used to be, you need to change that, you need to go back, you need to rethink what you're doing right now.” And I'm like, “Nope” [laughs] no--
Cynthia Thurlow: [00:09:08] You're right, because it can change dynamics within relationships-
Dr. Carrie Jones: [00:09:11] It can change dynamics.
Cynthia Thurlow: [00:09:13] -especially, you know, someone said to me, it might have been Mindy Pelz when she was on the podcast that she felt like a lot of the middle age divorces that occurred were really a byproduct by these hormonal neurotransmitter changes when you had a partner that maybe didn't understand or perhaps wasn't as compassionate as they could have been as your brain is trying to recalibrate navigating this middle pause transition, do you feel like women that are taking oral progesterone and/or plus/minus adaptogenic herbs or GABA or L theanine tend to navigate this timeframe and being better off as opposed to individuals? And this is not judgmental when I say this, like some people just do not want to consider HRT.
[00:09:56] But fully appreciating and understanding the net impact that hormone replacement therapy can have on the brake system, the loss of inhibition, [Carrie Jones laughs] helping to find your balance again if that's even such a word. I always say, like, balance is elusive. Let's be honest. But did you see that your patients that were taking hormone replacement therapy or being thoughtful about supplementation hadn't kind of navigated those changes a bit better?
Dr. Carrie Jones: [00:10:22] I did, observationally, anecdotally, I saw it all the time. Especially women who got right on it, assuming they were a candidate tended to do much better. Estrogen plays such a big role in serotonin, in dopamine and in oxytocin. Even in our sleep, how we do and don't sleep. Progesterone is often associated with sleep, which is true, but estrogen also plays a big role. So, if your brain hormones are doing well, if your hormone of bonding and love, oxytocin, is filled up, if you've been sleeping, you're sleeping through the night. I got a text from a friend of mine yesterday in her 40s who said, I wake up every night at 02:00 AM what is this about? She's early 40s. So, we were all like, “Oh yes”
Cynthia Thurlow: [00:11:06] Welcome to the club.
Dr. Carrie Jones: [00:11:06] Welcome to the club, sweetie, mm-hmm. And so, when I had patients, and I see it in the comments on social media all the time. All the time, women are like, “Oh my gosh, I finally bit the bullet, went on hormones. Best decision ever. I'm a nicer person. I have a better time in life. I feel more connected, I feel more like myself.” If I had a penny for every time somebody said I feel more like myself, I'd still be a millionaire. I see it all the time. And by more yourself can still include the authentic you. It doesn't mean you're still not setting boundaries or not saying no or back to being a people pleaser, but just comfortable in your own body again and feeling confident. And I would see the decline in that and that would translate to relationships.
[00:11:50] I had a lot of women in their 40s and their 50s who would come in, “I hate my spouse, I hate my significant other, I hate my kids, I hate my job, I hate my boss, I hate everything, I want to quit and run away.” And I remember I had a patient who was in her mid-40s and her husband, I saw him as well off and on. Just from an outside observation, they didn't have a great marriage. I mean, in short, she could have done better. He just didn't bring it to the table. And she was a go getter and she was funny and she was all the things, but she had married him and stayed committed. And then she hit her 40s and she went, “Screw this. I'm not doing this anymore.”
[00:12:29] And he wasn't willing to change and he didn't want to go to therapy and he didn't think anything was wrong. So, she kept coming in for years. “I have low libido. I have low libido. I have low libido.” And then eventually she came in one day and she said, “Turns out I don't have low libido.” I'm getting divorced. [Cynthia laughs] I'm the happiest I've ever been. I have a great libido. And I was like that. And I was young. I was probably in my early 30s at the time and far from perimenopause and it was a real eye-opening teaching moment. My patients taught me a lot. Just like, sure, your patients taught you a lot. And I was like, “Yeah, you had been trying really hard. You'd been putting your relationship first. You've been trying to people please with somebody who wasn't willing to take accountability or do this. It wasn't you with this libido.
[00:13:11] Now, that's not everybody's libido experience. I totally understand that. But I would see these trends in some relationships where she would come in and just go, we're done. we separated, we're done, I filed for divorce. And oftentimes, she would flourish. She would be a happy little bird. And I think she just found her voice and her authenticity and wasn't willing to settle for some of this. The relationships I saw where they were both willing to work on it, both willing to take accountability, went and saw marital counseling. He could understand. I did have husbands who would come in and go, “Dr. Jones, just tell me what's happening with her. [Cynthia laughs] What is going on? How can I support her? How can I do this?” They would do well, but in a lot of cases-- [crosstalk]
Cynthia Thurlow: [00:13:54] It makes so much sense.
Dr. Carrie Jones: [00:13:54] It does, it does. We almost need that coaching at a young age as well. And if you get a partner later in life, you need to be aware that perimenopause, whether you're both in perimenopause or you're with a male partner, then they need to understand what's going on for the whole family dynamic.
Cynthia Thurlow: [00:14:13] And I think that if you have a spouse that wants to understand what's going on with you, physiologically, it helps explain a lot of behaviors. Like, I can tell, that irritability. Even though I'm on HRT, I have moments. And let me be clear, writing this book has not been easy.
Dr. Carrie Jones: [00:14:32] I bet. [laughs]
Cynthia Thurlow: [00:14:34] Multiplicity of issues notwithstanding all the stuff going on in my personal life simultaneously. But my husband would look at me and he would say, “Is this the day you skipped your progesterone? [Carrie Jones laughs] I take one night off a week and I would just look at him and I was like, “Is it obvious?” And he was like, “Yes.”
Dr. Carrie Jones: [00:14:51] [laughs] Little bit.
Cynthia Thurlow: [00:14:51] Yes, yes, you're not normally so irritable. I'm like, “Well, yes.” And so, let's talk a little bit around the role of estrogen with these neurotransmitters, because I think this is particularly interesting because I think that people think solely about dopamine as this pleasure-seeking hormone, that serotonin is just about mood, that oxytocin is just about orgasms. And there's so much more to this actually, oxytocin is also a hormone.
[00:15:20] But the point of what I'm making is that estrogen really is kind of the queen bee. And when we have fluctuating and then faltering levels of estrogen, it impacts things so profoundly. And I feel like in many ways we tend to focus on the big things like heart disease and bone health and immune function. And yet there's subtleties to estrogen that I think are really important for people to understand.
Dr. Carrie Jones: [00:15:45] When it comes to serotonin, is probably my most favorite description of mood and there's thankfully now a lot of research being done around, oh, my goodness, a lot of women are hitting their 40s and 50s and getting diagnosed with major depressive disorder or maybe they had major depressive disorder, it was very well under control. And then they hit their 40s and 50s and it's not so much in control anymore. Do you think hormones are involved? I'm like “Yes, yes hormones are involved.” The answer is yes, give me the money for studies. Yes, I'll just tell you right now. So, here's the example with serotonin. So, to make serotonin in your body it comes from tryptophan. Think of Turkey, remember everyone thinks of tryptophan, coming out of Turkey.
[00:16:26] So, tryptophan turns into something called 5-HTP, which is just like the supplement but you make it in your body as well. 5-HTP then turns into serotonin. Now to get from tryptophan to 5-HTP, it's a very, very, very controlled step. It's like CIA level controlled. You can't just random willy nilly turn into 5-HTP. The trigger for that is an enzyme and that enzyme is created at the direction of estradiol. So, if your estradiol is low, then you're not going to get the trigger, the secret phone call to tell tryptophan, okay now is okay now turn into 5-HTP. Because once you become 5-HTP you can just like shimmy on down to serotonin and things are good. Unfortunately, you can have an opposite effect with high estradiol.
[00:17:11] So, some people say, well in perimenopause it's fluctuating levels. Where we shoot up really high, we drop down really low, we can't really control it, my mood is a mess. Like yes, the body is this built in system where if it's low, you don't make great levels of serotonin and if it's high, you don't make great levels of serotonin. Because tryptophan can actually go a different route. It can take a different path in the woods and it goes down another pathway that starts with a K. It's called the kynurenine pathway. And the point of that is to make NAD, which is a very, very potent antioxidant, very good for the body. We like the kynurenine pathway. It's a survival, reduce inflammation, help you with all the things pathway. But one of the triggers to activate that pathway can be a perceived excess level of estradiol.
[00:17:55] So, you're shooting way up and the body says “Oh lot of estradiol, let's go down and make NAD.” So, once again, you're not getting the serotonin production you might want. Which is why women in part can report, “Hey, leading up to PMS or I've skipped my period a couple months, my mood is not good, full stop period, what's going on?” And that's just serotonin. Estrogen has a role, like as I said, in dopamine and oxytocin. So, now imagine at the same time, all the neurotransmitters are getting affected, not only serotonin, but dopamine. So, now you're feeling blue, not feeling connected, you're surely not motivated, you don't care, and you've got this sarcastic mouth on you. [Cynthia laughs]
[00:18:37] So, it can be a real challenge. And then you go to your practitioner and your practitioner says, here's an anti-anxiety or here's an antidepressant, try cognitive behavioral therapy. And I'm not against therapy at all, but if we back up and go “Oh, you know what, you're in your 40s, you're in your 50s or older. These hormones play a key role in how your brain and your mood subsequently functions.”
Cynthia Thurlow: [00:19:06] Yeah, it's so interesting because all those little intricacies of that pathway from tryptophan, the 5-HTP to serotonin, I think a lot of people forget or maybe practitioners. It's been a long time since we've done biochemistry to understand how that pathway works. And what I find fascinating is estrogen, in terms of, mitochondrial function. So, there's just so many things that are happening that can contribute to feeling sad, feeling unmotivated. It may not be just estrogen. It could also be testosterone because that's executive function. And sometimes women will say, “Oh it is because my body composition has changed, so it has to be a low testosterone issue.” And I'm like, “Well, you also told me you want to go to the gym, but you're not motivated to go to the gym.
[00:19:57] And so, helping women tease out, it's not just libido, it's not just changes in body composition like so many of these hormones. We think it's one or two things that are a sign that a hormone is not functioning at an optimal level and there's so much more to that. When you think about testosterone. So not every woman in menopause or for perimenopause for that matter has low testosterone.
Dr. Carrie Jones: [00:20:18] Right.
Cynthia Thurlow: [00:20:19] I happen to be one of those that has low testosterone, which explains a lot. It's hard to put muscle on even with HRT. Having said that, when you were working directly with patients and you were thinking that maybe testosterone was playing a role in their symptoms, what were some of the things you were looking for beyond the obvious, I suddenly feel like I've gained a tire around my abdomen, I have no libido, which, as we both know, can be multifactorial. It can be way beyond just the low testosterone. It can be contributed to by multiple other issues.
Dr. Carrie Jones: [00:20:54] What's interesting, I'll start with, you said the tire around the waist, because now, just as a little aside, there's a lot of factors that go into weight gain in perimenopause, post menopause. Testosterone relative to estradiol is one of them. And so, I've been reading these papers where they say, “Hey, on top of blood sugar, you know, metabolic syndrome, insulin, the way you do or don't break down fat, how you do or don't store fat, etc., etc., etc., testosterone, to your point, doesn't always decline naturally as a woman moves through menopause.” It does decline with age, but it doesn't suddenly, rapid fire decline as she hits the perimenopausal, menopausal range. It might. Somebody may be like, no, no, mine fell hard, like that can happen. But in general, it just declines with age, but not necessarily menopause.
[00:21:42] So, what can happen is, though, women are cruising along and their testosterone's okay, but their estradiol falls faster because that's expected when she starts skipping periods. And now we get an imbalance between the body's perception of how much testosterone you have floating around and how much estradiol you are floating around. And when you have this perceived imbalance, the receptors that accept that, take in testosterone, they're kind of located around the midsection. We call it an android appearance or apple shape. So, what do women say? I get a spare tire. I've suddenly turned into an apple, my legs and my arms have thinned out, but I'm not thin in the middle anymore, what's going on? And that imbalance between testosterone and estrogen can be a contributing factor.
[00:22:26] So, in many cases, even if somebody says, “Oh, my gosh, my libido is terrible, I can't put on muscle, I have low energy.” It's got to be testosterone. I read a book, saw it on social media, give me testosterone. I actually test, which I know is for some reason taboo, not to test hormones, but I will see what is their testosterone level at, because I want to know if really, it's an imbalance in this testosterone, estrogen. Do we actually need to talk-- have the conversation around estrogen and progesterone first, if they're not on it before we consider testosterone. But what I will say about testosterone is I had a neighbor who said she calls testosterone her battery pack. She said, “When I get my testosterone, I'm using it regularly.”
[00:23:06] She said, I motor up, my brain motor's up, my energy motor's up, my motivation motor's up. Everything just powers on. And I thought that's the greatest way to describe it for the women where it truly does make an impact, even it helps support, of course, like bone health. So, my osteopenic, my osteoporotic woman, obviously I'm looking at other hormones, estrogen and progesterone. But even testosterone plays a big role there. So, I'm excited for as more and more research comes out on testosterone because it's largely considered, “Just a male hormone,” how important it is can be for us to see these things. But I test testosterone, see where we're at.
Cynthia Thurlow: [00:23:43] Well, I think it's important because I have had patients who've come to me that have been working with other practitioners and they'll say to me, “I know my testosterone's low because I'm exhausted.” And I'm like, “Okay, well let's test.” Their testosterone is fine, it's their cortisol.
Dr. Carrie Jones: [00:23:57] Yes.
Cynthia Thurlow: [00:23:57] That is really low. And it explains all of the symptoms they are experiencing. So, it's usually not just one thing, but I think one big theme that I think is important for patients to understand is what's going on with the adrenals in perimenopause. Because I think this is those coping mechanisms that you were alluding to at the beginning, like the get up and go get shit done-
Dr. Carrie Jones: [00:24:22] Yeah.
Cynthia Thurlow: [00:24:23] in your teens, 20s and 30s, served me very well, very very well as a type A high achieving person, did not serve me well in my 40s because don't sleep enough, over exercise, put myself under so much stress getting things done, wanting to appear in many ways, I don't think it was so much that I wanted to appear perfect. I helped myself to high standards.
Dr. Carrie Jones: [00:24:46] Yes. Yep.
Cynthia Thurlow: [00:24:46] Let's talk about what is going on with the adrenals as we are navigating middle age because this is such an important overarching concept for everyone to understand. Because we always need to be doing things to nourish our adrenal glands.
Dr. Carrie Jones: [00:25:03] Yes. And which is part of I'm sure a lot of people have heard, former guests and social media, the nervous system. This is your nervous system and it starts in the brain. So, we have two parts of our brain, the hypothalamus and the pituitary. And they are what-- the hypothalamus takes in all the input from everything happening in your life. How much sleep you've had, how much you have or haven't had to eat, how much caffeine you've taken in, what you've been exposed to that day, what your schedule looks like, if you've been fighting with somebody or not, like that hypothalamus takes all of that in and then dictates down to the pituitary in your brain. And then that goes down to the adrenal glands and says, make cortisol or you can even make adrenaline, which is epinephrine, noradrenaline, which is norepinephrine.
[00:25:45] And there's a different layer that does make testosterone and makes also DHEAs, some androgen hormones. So, depending what you need, the brain dictates everything, goes down to the adrenals. Once the ovaries are done, you still can make some testosterone out of your ovaries, but you also make testosterone, as I said, out of your adrenal glands. So, if you have been burning the candle at both ends, if you have been really stressing out that nervous system, if boundaries have been a struggle for you, you've been people pleasing, you haven't been saying no. And I'm not saying this to blame anyone. What I'm saying is we tend to have the realization as we go through perimenopause of like, “Wait a damn minute.” Like, hold on, “This isn't working for me anymore.”
[00:26:27] And so what happens is the system, the HPA axis is what we call it, the nervous system says, I'm not as good as I used to be. I'm having a hard time keeping up. The brain is trying to protect you, so it might even downregulate your cortisol. You might find yourself really just burned out, low cortisol. Because the brain's like, “Girl, stop, rest. Take a break. We need to survive for a minute. We need to be more resilient.” But I don't even have the reserves to give you resiliency. And so, what I find is that a lot of women actually slide in sideways to perimenopause, and then they're like, “I used to be so good, right? I used to be so good in my 30s, and now I'm completely burned out.”
[00:27:07] They're comparing themselves to their younger years and all the energy they had and all the ability they had. Like, yeah, your system is actively trying to get you to slow down, rest and heal, and we don't as humans, we keep pushing, pushing, pushing. But what that translates to when we have this nervous system that's screaming for help is that it shows up in other areas of the body. Our hot flashes and night sweats are worse. Our sleep doesn't work as well. We tend to gain weight. Our skin gets thinner and looks older and drier. Our hair starts to fall out and get thinner. We're tired, that affects our mood, so now we're grumpy or we're irritated or we're anxious. It can affect our periods. If you were ovulating, which can still happen in perimenopause, maybe you find you're ovulating less.
[00:27:52] Is it age? Is it stress? We don't quite know yet. And so, all these downstream symptoms can happen when the nervous system's like, please stop, stop and take a break just for a minute. Take a breath.
Cynthia Thurlow: [00:28:05] Well, and I find a lot of the women that course correct and back off on the intensity of exercise, get more sleep, adjust their diets, do the right types of exercise, ensure they are surrounded by healthy relationships as much as possible. Maybe they change their job. I mean, there's so many layered components to this. I think those women can go on to course correct and thrive through the rest of perimenopause. And I speak from personal experience because I did everything wrong. I didn't know any better. [Dr. Carrie Jones laughs] No one prepared me for perimenopause. I kind of hit it like a wall. And I remember there was an entire year in my 40s, that all I did was walk.
[00:28:44] I went from doing 05:00 AM intense conditioning classes and spin classes to just walking for an entire year because that was as much physical activity as my body would allow me to do. And I think for so many women listening, because these women end up in our programs and we interact with them. So, I know there's a lot of us out there that course correction can set you up for success throughout the rest of your middle ages and beyond. And I think that in many ways there's this thought process, “Oh, you're being punished, you're doing something wrong. And really, the word ‘pause’ whether we associate it with middle pause, perimenopause, menopause, thyroid pause, adrenal pause, whatever terminology we want to use, the word ‘pause’ needs to be the emphasis.
Dr. Carrie Jones: [00:29:31] Yeah.
Cynthia Thurlow: [00:29:31] We're designed to course correct at some point in our adult lifetime. And if we're smart and we lean into that, it really can have some significant and profound impact.
Dr. Carrie Jones: [00:29:41] Glinda, the Good Witch says, “You've had the power all along, my dear.” And I say that a lot, because in perimenopause it's exactly that. Once women get this education, which should have been there all along, but we're getting there. Once women understand, once women listen to your podcast, they go, wait a damn minute, [laughs] I am going to make changes. Either they don't have a choice, their body is forcing them to, or they've listened early enough where they can go, “Okay, let's start making some changes.” I'm done with the way this is going, and I'm going to do better. And they truly take their power back and I fully agree. It just makes it the rest of this whole transition into their next decades so much easier, so much better. Don't give your power away, definitely take it back, claim it, make some of these changes as best that you can.
Cynthia Thurlow: [00:30:32] Yeah. And it's interesting, as I been writing my book, like, really being in the research to see who are the people having the most symptoms in perimenopause and menopause and there are consistent themes. Some of things we have no control over, however many things we do and what I found interesting was looking at the research, having a supportive partner. Now, it doesn't necessarily have to be someone you're married to. It could be your best friend. But that partnership or having someone, I think about, I have three dogs, so I look like a total crazy person. Because now I have teenagers who, depending on their mood, they want to hug mom. They want to just fist bump mom. I mean, it's very different.
[00:31:10] But I think for so many people, having a supportive partner, as I know you alluded to earlier, that can make a huge difference. Having someone that you feel like, understands, is compassionate and empathetic. That includes your healthcare provider.
Dr. Carrie Jones: [00:31:23] Yeah.
Cynthia Thurlow: [00:31:23] When you were working with patients or you were connecting with a friend that doesn't live locally, where you can make a direct referral, what are some of the things that you think are really important? If women are looking for a new provider, new practitioner, I don't think it necessarily needs to be a certain amount of letters after their name. Obviously, you want someone licensed, that's clear. But how does someone vet a provider to work with? someone that's going to be able to support their needs and be in alignment whether they want to talk about HRT, whether they want to focus on lifestyle, how do they navigate making choices about who to work with?
Dr. Carrie Jones: [00:32:01] What's interesting is I have a little bit of different take on this because, we see online where like, “Oh, if you're not a menopause society certified practitioner, you know nothing.” I'm like, “Well that's not true at all.” They're a great society. But at the same time there have been practitioners who've been prescribing hormones for a very long time. They just haven't made the news or it hasn't been very popular. So, the way I go about it is this. I'm like “First and foremost, ask your community, ask your Facebook groups, ask the soccer moms that you're with every day, ask people at the school if you have kids. Like ask your bestie, ask your sister, ask people at work. Ask, ask, ask.” Then I'm a huge believer in reviews.
[00:32:39] So, even if you're like, “Well, I have nobody to ask,” just search menopause doctor near me or menopause practitioner near me or hormone replacement therapy near me and read the Google reviews, read the clinic reviews over and over. And then the other thing you can do, and a lot of cities have this, is to call the pharmacies. Now I call compounding pharmacies whether or not you're going to get your hormone from a compounding pharmacy. The compounding pharmacists are brilliant at knowing who's good in the area because that's who's calling in if it needs to be some sort of HRT that has to be specialty made. So, call the pharmacist. “Hi, can you give me a list of three or five in the area that you really like, here is what I'm looking for.”
[00:33:21] The compounding pharmacies know what's up. Then when I call the clinic-- when I first moved here and I had to call the clinic for, oh no, when I switched insurances, I did get a new clinic just for the GYN part. And so, I talking to the front desk. “Hi, I like to establish care” but it was a big clinic, there were 30 practitioners there and I was like, “So” [Cynthia laughs] in my 40s, [laughs] I'm looking like I'm really straightforward, I'm very holistic, I didn't say I was a doctor, I was just like very holistic. Who would you recommend? Like who do you think good at communication, cool with holistic, good with hormones or at least understands hormones somewhat to do my Paps. And the front desk is like, “Oh girl, you need this doctor.” [Cynthia laughs] I was perfect. Sign me up, [laughs] get me an appointment.
[00:34:14] And so that's how I go about it between community, compounding pharmacy for it to see who they recommend, read reviews like crazy and then ask the front desk and be very direct with the front desk, “What are you looking for? And do they have that at that clinic? Is that possible?” Even if you've read the clinic page and the page is beautiful and it looks like they have all the things, still ask the front desk, still say, especially if it's a multi practitioner clinic, here's what I'm looking for.
Cynthia Thurlow: [00:34:39] When I worked for this large cardiology group, a lot of my job, especially with hospital follow ups, was figuring out which provider am I going to send this patient to that is going to benefit both of them. Because you have some providers who are very cut and dry and they don't want to take a lot of extra time to talk. And there are people for that particular provider's personality. And then I would have my warm and fuzzy docs. And yes, they do exist in cardiology, they are not unicorns. But I knew I had to be judicious because I would sometimes get in trouble if I sent too many people to one person. So, I would have to be very judicious. And I would sometimes just ask patients, what's specifically are you looking for?
[00:35:18] To your point about you being direct and saying these are the characteristics of a provider that I am looking for. And to touch one of your first comments that you made, I was ready to take the North American Menopause Society test because I was like,-
Dr. Carrie Jones: [00:35:30] I took it.
Cynthia Thurlow: [00:35:30] “Oh, I should do this.” And then like five of my friends took it and they said they're still not focused on HRT, they're still focused on lifestyle measures, they're still super conservative. And so, I was like, “Maybe I won't take it.” So, for anyone that's listening, I could sit for that exam. I just have gone back and forth. And so, the one thing I have found is when I have clients that live outside of my state, I would direct everyone to that website as a resource.
[00:36:01] And I came to find there was tremendous variation in practitioners and a lot of them were like, “Sorry, you're five years into menopause, I'm not prescribing HRT.” That happened so many times after telling patients, “You just need a little bit more of a workup before HRT is considered. You are such a healthy 60-year-old, why should you not have this under consideration?” That I decided that I needed to stop doing that because I was just fighting that they were being told no so frequently, just by virtue of the fact that they were eight years into menopause, ten years into menopause, and these were active, healthy females. So, I think the due diligence piece is really on us as consumers. And you've given so many great tips on that that I think are really helpful.
[00:36:44] One thing that I thought would be interesting to talk about, because I don't think we've talked about it much on the podcast. A lot of women notice in perimenopause that they start getting more histamine responses. They suddenly have hives. They're in the midst of something stressful. And someone said to me the other day, “Oh, I've suddenly developed a lot of food allergies.” I was like, “It probably isn't allergies,” but let's talk about this because I went through this myself. I'd never had hives before in my entire life and I was going through a lot of stress. And one day I started breaking out into hives. And it had a lot to do with what I was eating, but also I was not on the right formulation of HRT. So, let's unpack why this happens.
Dr. Carrie Jones: [00:37:26] And it's a very unfortunate symptom that can happen. I often tease, joke that I don't want to be the goddess of the world. [Cynthia laughs] That seems like a big job. But I would like to be the goddess of us, of the female body. I would make some changes, some of these symptoms, like this one. Why do we need itchy ears? Do we really, you know, some of these things, we just press a button, oh, and now I'm menopausal, button pressed. So, histamine is under the control of course, the immune system. And the immune system is very under control or very, I should say, partnered with estrogen in particular, estradiol. And so, I found especially in maybe the cycling years.
[00:38:06] And in perimenopause, when you are having the wild swings of estrogen, that estrogen, estradiol slows the breakdown of histamine. And it can also trigger what's called a mast cell to go ahead and release histamine. So, it can increase your release of the freaking molecule that's causing the problem. And then it stays in your system so you can't break it down. And now all of a sudden, you're like, “Where did these new allergies come from? Why am I stuffy or sniffy all the time? Why is my asthma bad? Why do I have welts? Why do I scratch my skin?” And it raises wet red. It didn't used to do that. So, estrogen plays a role there on top of it. And as you know very, very well, estrogen and progesterone play a huge role in gut health.
[00:38:47] And as estrogen and progesterone decline, we lose what's called gut integrity. So, your intestinal tract is literally one cell thick. So, think of it like I think of like a fence. It's a big, giant fence from your mouth all the way down to the other end. And in your fence, you have gates. And these gates are supposed to be true gates. They lock when they're supposed to lock, and they open only when certain foods or nutrients or what are allowed to cross have been given permission. But as we lose estrogen and progesterone, our gates develop holes. They get loose. They get a little too fast and loose, and they let anything through that they shouldn't. And so, we call this leaky gut. It's leaky gates, essentially.
[00:39:28] And because of that decline in estrogen and progesterone, so now things that normally would not have crossed the gate, maybe would have not left your backyard, are suddenly leaving the gate, leaving your backyard and wandering around where they shouldn't be. And that involves the immune system again. Now the immune system's like, “Whoa, you are not supposed to cross out of the intestines. What are you doing here in the bloodstream? I'm going to have to attack you. Sorry.” And so, it goes after it. Now, this can manifest as foods that ever used to react for you before, you would eat something in your whole life, you never reacted. And now that you're finding, like, “What the heck? Every time I eat it now, I'm having this crazy hive or histamine reaction. And it's partly because hormones are changing the gut in a few ways. That's just one way.
[00:40:12] The immune system gets involved again and now we have sort of maybe like a sensitivity reaction as opposed to an allergic reaction. But also, the mast cells get involved and out comes histamine. And when you eat foods, let's say leftovers as an example, you love leftovers, you like your leftovers, you bring them to work. Now you're noticing your leftovers are really starting to upset your stomach, you're getting bloated, maybe gassy, you're just feeling, ugh when you eat your leftovers. Well, leftovers, the bacteria in leftovers can divide, which can cause people to have a histamine reaction to the bacteria in the leftovers. It doesn't mean it's bad. It's not like food poisoning bacteria.
[00:40:50] It's just like food that's been sitting, even if you put it in the fridge, can just sort of divide up these bacteria. Now it affects the histamine. And then your gut is supposed to clear that. There's an enzyme called DAO and DAO is supposed to look at that food, histamine and go, “Oh, no, let's break you down. Let's run you through the trash compactor.” Except when you are older and your estrogen is down and just naturally with age, that DAO declines and so that bacteria gets to run free, sets off your histamine again. And now you have food you're sensitive to that you didn't used to be.
[00:41:25] That worsened your immune system and your mast cell histamine in your body on top of the fact that your estrogen changing is just naturally, unfortunately for some women, affecting their allergic symptoms at large in their body. Like, who designed this? I understand biochemically [Cynthia laughs] why it happens, but at the same time, I don't know, I feel like once you hit it, we hit a certain age, we already had to have the babies, whether we have them or not. Like, we had a period, every month that’s what the female body is designed to do. I feel like we deserve a crown or a watch or a certificate, something. [Cynthia laughs] I don't want hives. [laughs] What? Congratulations, you're menopausal now you get hives.
Cynthia Thurlow: [00:42:08] Yeah. No, no. I think the best example I can give from recent memory was my functional med doctor wanted me to do a dairy trial to see if I could tolerate dairy. So, I've been dairy free unless I've gotten it imperceptibly in a meal when I'm eating out. And so, we did a dairy trial and I didn't even eat much. And within 15 minutes my nose got stuffed up, I started to cough, I had some digestive upset. And so, I had told him, this is how much I consume. This is what I ate it with. And he said, “Yeah, no, you're definitely dairy intolerant.” We don't even need to do more testing. Because it was so dramatic so quick, the hives started, everything else started. He's like, “You're just sensitive.”
[00:42:49] So, if you've ever been told that you're sensitive, I'm like, “Not sensitive emotionally, but physically my body is like, Sorry, there's no more sheep's milk, goat's milk, cow's milk dairy in your world.” And so, I'm acquiesced to this at this point after that mini trial, I was like, “I don't need to do more, that was unpleasant.” If you're listening and you experience that, probably might be best to eliminate that particular item if it seems to be driving your symptoms. And the sad thing is, I have some patients, it's just fermented foods that will provoke. Things that we tell patients are healthy to consume. There's fermented vegetables, kombucha, kefir, yogurt, miso, things that are considered to be healthy and they are provoking symptoms.
Dr. Carrie Jones: [00:43:36] Yeah, yeah, unfortunately, or it didn't used to provoke and now it provokes. Now they would love their miso soup or their kimchi or their kombucha and they're like, I just can't do that anymore. Same with alcohol. I've had a number of people who said, “I used to drink alcohol, enjoy my glass of wine.” And now I get such a histamine reaction. My face turns red, my nose gets stuffy, I get the postnasal drip, I don't feel well. Now alcohol is its own separate category and how it affects the body, of course, but from a histamine perspective, wow, that can really set off the mast cells, histamine and create this whole reaction.
Cynthia Thurlow: [00:44:11] Well, not to mention the net impact on people's sleep. I've never been a big drinker, but I, I loved once, maybe twice a month to have a dirty martini. Made me so happy. [Dr. Carrie Jones laughs] It was like my conduit to salt. But what started happening was if I even had half a martini, I knew what was coming. I knew that I would fall asleep, I would wake up, I would get hot flashes, which God bless anyone that experiences that on the regular. Because it was like, I just needed to have that happen a couple times. And I was like, okay, I can't do this. I need to course correct. I need to find something else to do. Do you find that there's any, I don't want to use the word prerequisite because it's not the proper term that I'm trying to think of. But are there any signs when you're talking to a potential patient or you're speaking to providers at an event where you're lecturing?
[00:45:04] And again, Dr. Jones is so funny. She takes things and makes them very accessible, but makes them funny as wonderful analogies. But are there like red flags for you when you're talking to someone? Like, this is someone who's going to struggle to kind of manage their symptoms in perimenopause and menopause. Is this someone who is going to have a tougher time based on signs, symptoms or things about them as an individual that will tell you. This is someone who's going to struggle a whole lot more than the average person?
Dr. Carrie Jones: [00:45:34] The two pop to mind immediately. The first are my canaries in the coal mine, which we need our sensitive patients. They are the ones that alert us to environmental things or they just make things, researchers start to-- view our sensitive patients as like, “Oh, maybe that it is a problem, we should research that.” But they come in and they go, I'm sensitive to everything. I'm sensitive to sense, I'm sensitive to foods, I'm sensitive to just everything in life I've been sensitive. And I hate to say this, but when they tell me this, I'm like, “Ooh, there's a chance perimenopause is going to be harder for you. We're going to have to work harder with you.” And especially because when somebody says, I can't even go down the detergent aisle, I can't handle candles, at Target, I can't be in an Uber when they have the plugin in, I get a headache, I get nauseous, I'm just super sensitive right away. I know it's a liver issue, like right away. When we think of detoxification, it's a two, if not three-step process. So, I know they're coming in through phase one and they're stuck at phase two. And that phase one and phase two can actually be quite toxic. And that's why they feel so sick. And so, I know, right away we have some liver detoxification issues. And because that's so important as women move through perimenopause and menopause, that I'm like, if we don't do anything, you're probably going to suffer more.
[00:47:01] The other category of women that I thought of, where the women who come in and are completely burned out, they are just the candle at both ends is already touched, their head is barely above water. And when we talk, they know they need to make changes, but for whatever reason, life, family, job, what have you, circumstance, they can't. They are where they are and they can't make big changes, but they are completely burnt out. They're really struggling. They're also going to have a worst perimenopause, in my experience, because the scaffolding of their body is so worn down. They've gone through their teens, their 20s, their 30s, doing all the things for all the people, for themselves, what have you, or not for themselves. And now they're coming in their 40s going, I'm having all these symptoms.
[00:47:49] I'm like, “I know, I know, I know.” If I had a magic wand, I promise I would wave it. And those are the people I see that probably have a much worse perimenopause. It's not absolute. It's definitely a very much a gray area. But I see it over and over again, especially at conferences when I talk to women who, maybe we check in at the hotel at the same time, and they're like, “Oh, no, I can't have that room. You didn't use proper cleaning. It smells like mold. I'm not able to handle that.” Like, I can smell the detergent on the sheets. Is there a way? Is there a way? Can I move rooms? I can still smell the smoke.” And they're right. I'm not knocking them for anything they're asking for, but I know they're probably struggling with their hormones as well. Just as much as at a conference where somebody says, “I'm completely burned out, Carrie. I'm at my wit's end. I don't know what to do, I feel terrible. I have all these symptoms.” I could have seen that coming.
Cynthia Thurlow: [00:48:36] Yeah. And I would imagine, now that there's emerging research around the role of adverse childhood events and trauma that, the latter patient kind of profile that you were talking about, they are very much the people that kind of fit that particular mold that I think of in perimenopause into menopause that someone who has had a chronically over activated sympathetic nervous system probably their entire lives and not realizing because whether their body perceives it, well, their body does perceive it, but whether they themselves perceive it from like a top down approach, their body feels like they're under constant threat. And so, the gasoline added to the fire of perimenopause could potentially make things so much worse.
[00:49:20] I've had women in programs that we've worked with where I've referred them on to work with trauma specialists because it is so clear that is what is driving a lot of their sympathetic nervous system overload. And let me be clear, we want balance between the autonomic nervous system. We want to have the rest and repose. We want the fight, flight or flee or fawn, which is the other F that goes in there. But helping people differentiate, like a lot of our coping mechanisms that are maladaptive will show up for us in unusual ways in this middle age time in our lives and again, that emphasis on the word pause, like it's a time to reflect, what is serving us, what is not serving us.
[00:50:03] But I'm curious as the trauma-- influence on the autonomic nervous system is that research is coming out. Are you starting to make those connections or we know when you're at events speaking to people.
Dr. Carrie Jones: [00:50:16] Yes, if somebody says it like “This was my upbringing, this was my history, or this is my last marriage,” what have you, we're clearly big and little Ts show up. And if their 20s and their 30s and even early 40s have been a fight in their life, fight to keep their head afloat, fight to keep money coming in, fight to keep food in mouths. I mean, I have a lot of empathy for that. However, because none of us for a very long time were taught much about perimenopause and that they're going to probably slam into it or what's happening. Then they go to their doctor and they're like, “I feel terrible, I'm having all these symptoms.” And immediately, you know, it's like, “Well, you need antianxiety, you need an SSRI, you need the birth control pill.
[00:51:05] You need a blood pressure medication, all of a sudden, seven medications later to manage this. But yet when they draw out their history, I'm like, “Oh, there it is.” There's like we just put the whole puzzle together. Unfortunately, the medical system has done you wrong. And here we are in your 40s or 50s trying to get some help when this has been going on for decades.
Cynthia Thurlow: [00:51:29] Yeah, I think that the one thing it is reaffirmed for me, like where I was headspace wise 10 years ago versus now is very different. And so, when I see women really struggling in perimenopause, I remind them, I'm like, you can course correct, you can change things. You do have control over some stuff, maybe not all things, but aging is a given, suffering is not. And so, I think that, making sure people really understand that, like if you aren't getting help from the provider you're working with now, there is someone out there that is fully qualified to be able to support your needs. Are there any things that are coming up for you? I know when we were together in December, you were talking about the potential of a book coming up, which is so exciting. [Dr. Carrie Jones laughs] What's next new for you? What's new on the horizon in 2025?
Dr. Carrie Jones: [00:52:19] And now I can talk about this openly because I've signed the contract and got the contract back. So yes, I do have a book-- [crosstalk]
Cynthia Thurlow: [00:52:21] Hey congratulations
Dr. Carrie Jones: [00:52:24] Thank you. Coming in 2026. It is on perimenopause. I describe it as like Seventeen Magazine Meets Perimenopause and Humor. I had a lot of friends who said the books on hormones in general or menopause and perimenopause are fantastic, but they're very thick, they're very dense and I don't have the bandwidth for that. We probably have all noticed our society has moved into, quick reel and TikTok clips and that's all we can focus on. And they said, “I just want to know the basics of perimenopause.” In fact, I don't even want to admit that I'm perimenopausal, so I want to see if I'm there or not. And I was like, “Oh, I can write that book, absolutely.”
[00:53:02] Let's keep this very basic and superficial and fun and that's what the book is. And so, I'm very excited for that in 2026. [laughs]
Cynthia Thurlow: [00:53:12] Well, I can't wait to hear more. And of course, anything that we can do to help support you when the book comes out. And you know, my community obviously loves you, so they will be signing up to get copies. Please let listeners know if they've been living underneath the rock and don't know who you are, how to connect with you, how to find you on social media, learn from you. You have an amazing newsletter, you're now on YouTube, which is where I think you particularly shine because you are such a great educator. And you do it again in a way that makes it funny and accessible.
Dr. Carrie Jones: [00:53:40] And it's the wild wild west out there I always say between YouTube and TikTok and I mean, I know they've been around for a while, but to me I'm like, “Oh my gosh, learning curve.” Everything's on my website, which is drcarriejones.com so signing up for the newsletter, courses, classes, blog articles, links to YouTube, everything is on there. I am on Instagram @dr.carriejones and of course on YouTube @drcarrieJones and I have dipped my toe into TikTok. I'm not very consistent there because that is the wild west to me. But it's @drcarriejones.
Cynthia Thurlow: [00:54:15] Awesome. Thank you again, my friend. It's always a pleasure to connect with you.
Dr. Carrie Jones: [00:54:18] Thank you.
Cynthia Thurlow: [00:54:20] If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.
Comments