Jennifer Smith: Welcome to You're Not Crazy. It's perimenopause. If you're a woman over 40 and feeling more anxious, not sleeping well or disconnected from your body, this podcast is for you. I'm your host, Jenny Smith, functional medicine health coach here to help you understand what the heck is happening in perimenopause. Each week we're diving into real life conversations about how our changing hormones impact anxiety, sleep and stress. and I'll share simple strategies to help you feel normal again. So grab a cup of tea or beverage of choice, get comfy and let's dive in. Welcome back to you're not crazy. It's perimenopause. I'm Jenny and thank you so much for joining me today. Today we are talking about something that I am very familiar with. Want to take you back in time. 1997, I was 21 years old, a full time college student. I was working part time and my parents were going through a pretty nasty divorce. At this time I was gaining a lot of weight. I looked back at pictures and I was very puffy, very, very puffy in the face. I just looked swollen despite not doing anything different. I was very depressed and just feeling like ⁓ a sense of dread, like just really blue. And I chalked it up to my parents were going through a divorce. It was really sad after 26 years marriage. I was 21 years old. My parents who I looked up to never thought that our family would separate like that, regardless of my age, even though I was an adult, it was very traumatic for me. It was a really hard time in my life. I was also really tired all the time and I just thought, okay, well I'm doing a lot. Like I'm in school full time, I'm working part-time hours. I was not taking care of myself. I can tell you that right now. I mean, I was a college student. eat fast food all the time. I didn't sleep very well. I was drinking a lot on the weekends and sometimes during the week at Taco Tuesday, Sunday Fun Day. You know, it just was a lot of things that I was doing that were, I would say pretty common for college students, but also because I was going through so much that it was a coping mechanism for me. And I just, I just kept thinking, okay, well this is all happening because of everything going on in my life. Then I had a really crazy abnormal symptom that scared the bejesus out of me. And what happened was I was starting to have discharge in my breasts. Like it was like I was lactating. And if I squeezed my boobs, was like, it was not, I wouldn't even say it was like milk, but it was almost like I was lactating. And I'm like, what the heck is going on with me? I was like mortified. I was scared. I was barely talking to my mom at this time because I was so angry with her because of everything that had happened with my parents. I went to my doctor and I told him like, I'm lactating and I'm not pregnant. There's no way I'm pregnant. He was like, ding, ding, ding, ding, ding. And I love this doctor because it's almost like he knew as soon as I told him that this is what is happening to me, he knew and he tested my thyroid and he's like, you are dealing with hypothyroidism. And I had talked to my dad about it. I remember telling him that, you know, my doctor has diagnosed me with hypothyroidism. I think my aunts on my dad's side of the family had it and my mom had it. like it was, in our family and my doctor was like, you'll, you'll need to take medication to manage this for the rest of your life. This is why you're gaining weight. This is why you're puffy. This is why you're lactating. This is why you feel depressed. Even though you have valid reason to be depressed, your life has been turned upside down with your parents going through this ugly divorce. So it was just a really crazy time and my dad's like, okay, if you're gonna be on medication for the rest of your life, you need to go see an endocrinologist. So I did and got a second opinion and this endocrinologist said, if you were a 40 year old, now mind you, was 21. He said, if you were a 40 year old, your thyroid labs are so low that you wouldn't be able to get out of bed. That's how low they were. So he's like, you absolutely need medication. so medication, I started taking. and it helped. I felt better. I stopped lactating. I started losing weight. I lost the puffiness, but no one, and I mean not one of them, the endocrinologist or my practitioner said, Hey, there might be some lifestyle things going on right now. Your stress might be contributing to what's going on with you. And our thyroid is deeply, deeply sensitive and impacted by our stress. So today we are going to be talking about something that gets missed all the time with perimenopausal women is thyroid. And we, you know, this is what I see over and over again, is women are feeling just a lot of horrible symptoms and they're, they're going to their doctors and they're running their labs and they tell them your labs are normal. Everything seems fine. I'm going to talk to you today about how your thyroid changes during perimenopause. what the symptoms are and how it can overlap with our hormonal changes and the testing that you actually want to ask for to determine how your thyroid is functioning. And our thyroid matters so much and it matters because it is our body's metabolic control center. It impacts your energy, your brain, which is what it was doing to me. It was, it was telling my brain that I was pregnant and to start producing milk, you know, and it just, it's just so wild how our thyroid hormone can make those changes in our body. Like it's just, it's crazy. So it impacts your mood, your weight, your hair and your skin. You can lose your hair, especially like around your eyebrows, like the outer edges of your eyebrows. You start to have really thinning hair around there. That's like clear indication of a thyroid disorder. It impacts your digestion and your tolerance to stress. you're highly stressed, it will impact your thyroid. So even if your thyroid is off a little bit, you will feel it. Now let's layer on perimenopause on top of that when your hormones are already fluctuating and it can feel like everything is unraveling all at once and you feel just terrible. So This is where it can get really confusing because the symptoms do overlap and the symptom of thyroid dysfunction and perimenopause, they look very similar. So things like fatigue, brain fog, weight gain, anxiety or depression, poor sleep, thinning hair, feeling cold all the time. All of that can be easily convinced that it's your hormones and perimenopause. And sometimes the thyroid isn't even looked at. But your thyroid is a big part of this picture because when your hormones shift, your stress increases. Now remember our stress tolerance gets lower when our hormones drop and our hormones fluctuate. So that's why we can't handle stress like we used to. And when that happens, we get systemic inflammation in our body and that will trigger our immune system. And then when that gets triggered, then our thyroid becomes a target. So it affects our thyroid, which is a hormone. So there's a lot of hormones involved that can be very complex. And this is why it's really important to be working with a practitioner that can test you correctly. So, you know, you get a big picture, you know what's going on. Let me just explain a little bit of what happens when we go to our doctors and we're frustrated because they run our labs and they say, everything looks fine, you know, you're tired because you're a mom or you're tired because you have a stressful job or this is what happens when we get older. We start to feel these things like we start to feel this way. And that is a bunch of bullshit ladies because we shouldn't be feeling like crap after 40. Despite what people say, it's not typical and it's not something that we should just accept as, well, I guess I'm getting older. So I'm just going to feel like crap for the rest of my life. Absolutely not. Most primary care providers, if you say that you want to have your thyroid panel done, they're going to run one marker and that is the TSH, which is the thyroid stimulating hormone, which is what they ran for me in my twenties. I doubt they did a full thyroid panel. So even then it was probably so bad that they knew that I had hypothyroidism. If your TSH falls within a normal range, you're going to be told that your thyroid's fine. But the TSH is just one signal. It is the signal from your brain to your thyroid. It doesn't tell you how much your thyroid hormone you're producing. It doesn't tell you how well your body is converting it. And it doesn't tell you how it's being used at the cellular level. So you can have a normal, and I'm putting quotations here, a normal TSH and feel completely off. So normal and optimal are two different ranges and functional medicine has a smaller window of an optimal range where conventional medicine are, you know, everyday allopathic doctor insurance providers. They have a wider range of normal. And when you go to a functional medicine practitioner, they have a more narrow range of what's normal because you want to be optimal. Normal is like, All right, but we want to be optimal. How can we get everything working at an optimal level? And so let me show you an example of that. A standard reference range of TSH is 0.45 to 4.12 milli-international units per liter. Optimal reference range is 0.5 to 2.5. milli international units per liter. That's a huge difference. Standard reference is very different from optimal. So that's why you want to make sure that whatever your results are, that you are in an optimal reference range. And this is something that I do talk about with my clients is what that optimal looks like in a functional medicine lens versus what is being identified in our conventional medicine guidance. with our doctors and what they're looking at. Let's talk about what we want to test outside of just TSH because we need to have the comprehensive full thyroid panel to know what's happening. We want to look deeper. So here are the markers that are going to give you a complete picture. So your TSH you want to have done because this is signaling from your brain to your thyroid, the hormone of what's happening. Like this is telling your brain to talk to your thyroid. to start functioning. Then you wanna do a free T4. This is the storage form of your thyroid hormone. A free T3 is the active form. This is what your body actually uses. T3 is what your body actually uses. And it's usually converted in the liver. So if your liver is sluggish and not functioning well, and you are taking a medication for TSH, it's not gonna get converted and you're still gonna feel awful. Then you want to have a reverse T3 ran because depending on the number, it can block thyroid function. And this usually happens when your stress levels are high. And then last but not least, and probably most importantly is you want to have the thyroid antibodies run like a TPO or like a TPO and a TGAB. Those are the tests that are going to test your thyroid antibodies. And this will tell us if there's an autoimmune component, like Hashimoto's, which is very common in women, especially as women get older, they start to develop more autoimmune conditions. so Hashimoto's is often under diagnosed. Most practitioners are not running thyroid antibodies. So that's the comprehensive full thyroid panel. And you want to make sure that you're working with someone who is very educated and well versed in the thyroid and to be able to look at your thyroid lab results and numbers and be able to tell you how it's functioning. So just to recap, that's a TSH, a free T4, a free T3, a reverse T3 and thyroid antibodies. So once you have the results of a comprehensive thyroid panel, then you can have a game plan of what you're going to do. Let's talk about why our thyroid is impacted in perimenopause. Now once women enter perimenopause, they are more likely to develop a thyroid disorder. And let's connect the dots here. In perimenopause, your estrogen's fluctuating, your progesterone's declining, your cortisol is often elevated. This is your stress hormone. All of that impacts your thyroid. High stress can reduce the conversion of T4 to T3. Now remember T3 is the active form. That's what we are using. And if you were under a lot of stress, which is what I was under, When I was a full-time college student working part-time, my parents were going through a nasty divorce. I was eating like crap. I was drinking too much alcohol. I was under a lot of stress. And that is probably why I was struggling with hypothyroidism. Again, high stress can reduce the conversion of T4 to T3. Another reason is your blood sugars, like your blood sugar swings. If you are having a lot of high, low blood sugars going on, that's going to stress your system out. This is why I really talk about balancing your blood sugar. If you go back and listen to my previous episodes about how we can support our hormones and our body, I am always talking about blood sugar. Blood sugar is so important in keeping our hormones balanced. If you're dealing with any kind of inflammation, toxin exposure, stress, ⁓ inflammation from the food you're eating, inflammation from not sleeping well, All of that can impact your thyroid function and autoimmune conditions become more common as we age. We are just more susceptible to it based on, you know, everything that's happening in this phase of life. And depending on our own circumstances, a lot of women develop autoimmune conditions due to past traumas or even current traumas. And so it's all connected. It's not just, ⁓ I have hypothyroidism. So You know, it runs in my family. I'm just going to be on medication for the rest of my life. And I really wish like back then I didn't, I was not nearly as involved in my health as I am now. And probably because I was 20 and when you're 20, you are invincible. You don't think about getting older. You don't think about aging well. So I was like, okay, doc, you tell me I have to be on medication for the rest of my life. I'm going to believe you. All right, okay, well, I'm gonna have to take these medications for the rest of my life. And it wasn't until I went to my functional medicine doctor where she shared with me, like, you can probably get off your medications. We just have to make sure that we're dialing in on nutrition and making sure we're managing our stress and minimizing toxin exposure. As much as I really valued her belief in that I don't have to be on medication, I... do genuinely feel like I have done so much damage to my thyroid that it would take a miracle to be able to get it functioning on its own without medication at this point. But I do believe that it is reversible and it's something that we can take care of if we know what we're doing versus just taking medication for it forever. My last episode, episode eight, we talked about should you test your hormones? And the question is when to consider thyroid testing. You want to consider thyroid testing if you are over 40 and have a pulse. Like we all should have a comprehensive full thyroid panel regardless because it's just so common, especially as we get older. You definitely want to have a full comprehensive thyroid panel if you're exhausted, no matter how much sleep you get, you're gaining weight without changing anything. You feel cold when others don't. Like it's, you're feeling cold, but it's abnormal for you to feel cold because it's hot out, but you feel cold. That is a sign. That's a symptom that something's going on with your thyroid. You have brain fog that is very alarming. That is something that I have struggled with throughout like my life due to my thyroid issues. And because it's connected, like it's a big part of our brain health. your hair is thinning again, especially around the outer edges of your eyebrows. And you just feel like your body is slowed down and you're not really sure. So it's in addition to if you're going to have your, your sex hormones done like estradiol, progesterone, testosterone, it's a good idea to have your thyroid panel done a full comprehensive thyroid. And you want to let your provider know that that you want a full comprehensive thyroid panel run, not just the TSH that practitioner is not willing to do it, then you need to find someone that knows what they're doing with thyroid health and have that run. Endocrinologists will do a full thyroid panel, functional medicine practitioners, naturopathic doctors, they will all do a full thyroid panel. That answers your questions with thyroid health. What does it look like? How is it connected with perimenopausal hormone fluctuations and decline? And what can we do about it? Let's just say we are dealing with a thyroid disorder and it's, need to spend some time nurturing our thyroid. What are some things that we can do? Testing is a helpful tool in determining where we are. And medication is very helpful. Now that is something that has absolutely a hundred percent helped me. I don't recommend anyone ever getting off their thyroid medication unless they are working with a provider that says it's safe to do so because it will lead to serious, serious health issues. If your thyroid is not functioning well, I mean, it controls everything. It controls so much. You want to make sure that you are working closely with a practitioner that knows what they're doing. I also want to remind you of going back to the basics. Now I am an expert in lifestyle medicine. I am a huge believer or lifestyle habits support our hormones, support our body and support how we feel. If you are just so low and depressed, how are you supporting your body? You need to look at areas like, are you supporting blood sugar? Are you eating enough protein and fiber? Are you getting enough micronutrients? Are you getting enough fruits and vegetables? Are you managing your stress, prioritizing your sleep, especially as we get older? Sleep is gold and we need to protect it and we need to defend it to all ends. We desperately need our sleep for brain health, hormone health, stress health, all of that. And you want to make sure you're moving your body specifically with adding strength training. So important. These are the foundations that I stand by that I truly wholeheartedly believe in that will help support your hormones as well as your thyroid. And this is exactly what I outline in my program, the hormone reset project. We address our blood sugar. We make sure we're stabilizing it. I make sure that you're eating enough protein and that we're managing our stress and we're sleeping well and that we are incorporating movement. Testing is just a tool and it's not a starting point for everyone. So if you cannot get a comprehensive lab panel for whatever reason, which is fairly easy to do now, you can go to a lab testing place and get your own labs run. There is also a company called Function Health. I have a functional medicine doctor, so I get my comprehensive labs done with my functional practitioner. But my husband is a member of Function Health, and he had a full comprehensive lab panel done. I mean, they go deep dive into everything. And the membership is under $400 a year, and you get labs done twice a year with interpretations by medical professionals, medical doctors, and then they also give you lifestyle recommendations, what to do and how to follow up. So you can do, there's things like that where you can get your own labs run without having to rely on your provider. So just know that there are options for you if you want that information. But also you can just start with your lifestyle. If you know that you're not sleeping well, start there. You know you're not eating enough fiber, enough protein and fruits and vegetables, start there. Address your lifestyle and you'll notice a difference in how you're feeling. If there's anything that you take from this episode, it's this. You are allowed to ask questions and you are strongly encouraged to advocate for yourself. You are allowed to feel better than just fine or that your labs are normal, even though you're feeling like crap. You don't have to settle for that. You know your body better than anyone. If you are not feeling comfortable with your practitioner, if they're not working with you trying to get to the bottom of your issues, then you need to find a practitioner who will. And there are plenty of them out there. And sometimes we might have to spend more money out of pocket. But I can tell you that since I've gone to a functional medicine doctor, I have rarely had to go to a doctor. If I need to go to anything, I go to urgent care. And then I have a gynecologist I go to for my regular health screenings like my mammograms and pap smears, things like that. But I have not had to go back to a general practitioner and I'm very healthy. I'm going to be 50 in a couple of months and I don't have high blood pressure. I'm not on statins for cholesterol. I am way out of the pre-diabetic zone now, which I cannot confidently say that that would have happened if I didn't switch gears and change my lifestyle. Sometimes it is worth investing a little bit more in your health now to save you a lot of money down the road and take it from somebody who works with people who are caring for loved ones who are very sick, loved ones who are young in their sixties who are on dialysis because of type two diabetes that has impacted their kidneys and their kidneys are no longer functioning and nobody has really shown them how to reverse the disease and not necessarily cure it because there is no cure, but you can reverse the symptoms and protect your organs and your health and your body with the right lifestyle habits. And so that is my passion. And that's what I love to show women is that you can take control of your health and you don't have to be subjected to medications or well, this is your diagnosis and this is just how it is. Like my doctor told me you have hypothyroidism and you're going to be on medication for the rest of your life. Had I known what I know now, then I would have known that I can certainly turn it around and optimize my thyroid. And at this point, I think because it's been almost 30 years of being on medications, I think it's really something that's probably not practical for me, but just know that lifestyle medicine goes a long way. So I hope that this episode gave you a little clarity around thyroid health, the symptoms, what it does, a comprehensive lab panel, what that looks like, optimal versus normal lab ranges. And if you felt like this episode helped you and you know somebody who's really struggling right now, share it with them. This might be really helpful for them to hear so that you can go into your next doctor's visit more empowered with more information and to ask for what you need. All right. With that said, thank you so much for being here and I'll see you next week.