In this enlightening video, Dr. Jill Carnahan interviews Dr. Jolene Brighten, a leading expert in hormone health, on her new book “Is This Normal?” This book is a comprehensive guide that covers everything you need to know about hormone balance from PCOS to menopause and beyond.
Key Points
- PCOS is a common condition causing irregular cycles, infertility and weight gain. Here’s key symptoms and what you can do to reverse your symptoms of PCOS
- Why men and women’s sexual response and function and libido are more similar than you think and what women can do about low libido or painful sex.
- How does perimenopause, menopause and post-menopause affect a women’s hormones and cardiovascular risk and tips to optimize vitality and sexuality after menopause.
Related Products
- DIM Plus: https://www.drjillhealth.com/dimplus
- 60 Hormone Essentials: https://www.drjillhealth.com/he120
- Hormone Essentials Plus: https://www.drjillhealth.com/hep120
- PMS Balance: https://www.drjillhealth.com/pmsbal
The Guest – Dr. Jolene Brighten
https://drbrighten.com and https://drbrighten.com/is-this-normal/
Dr. Jolene Brighten is a hormone expert, nutrition scientist, and thought leader in women’s medicine. She is board certified in naturopathic endocrinology and trained in clinical sexology. Dr. Brighten is the author of Is This Normal, a non-judgemental guide to creating hormone balance, eliminating unwanted symptoms, and building the sexual desire you crave. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones through her website and social medical channels. Dr. Brighten is an international speaker, clinical educator, and medical advisor within the tech community.
Dr. Jill
Dr. Jill Carnahan is Your Functional Medicine Expert® dually board certified in Family Medicine for ten years and in Integrative Holistic Medicine since 2015. She is the Medical Director of Flatiron Functional Medicine, a widely sought-after practice with a broad range of clinical services including functional medical protocols, nutritional consultations, chiropractic therapy, naturopathic medicine, acupuncture, and massage therapy. As a survivor of breast cancer, Crohn’s disease, and toxic mold illness she brings a unique perspective to treating patients in the midst of complex and chronic illness. Her clinic specializes in searching for the underlying triggers that contribute to illness through cutting-edge lab testing and tailoring the intervention to specific needs.
A popular inspirational speaker and prolific writer, she shares her knowledge of hope, health, and healing live on stage and through newsletters, articles, books, and social media posts! People relate to Dr. Jill’s science-backed opinions delivered with authenticity, love and humor. She is known for inspiring her audience to thrive even in the midst of difficulties.
Featured in Shape Magazine, Parade, Forbes, MindBodyGreen, First for Women, Townsend Newsletter, and The Huffington Post as well as seen on NBC News and Health segments with Joan Lunden, Dr. Jill is a media must-have. Her YouTube channel and podcast features live interviews with the healthcare world’s most respected names.
The Podcast
The Video
The Transcript
156: Dr. Jill interviews Dr. Jolene Brighten on everything you need to know about Hormone Balance!
Dr. Jill 0:12
Well, hello, everybody. It's another episode of Dr. Jill Live. I'm with a wonderful—I say old—friend, but neither of us is old. It's that we've known each other for a long time, right? We won't go there. But I'm so excited to be here with Dr. Jolene Brighten. I'll introduce her in just a second. We're going to talk about her new book, Is This Normal? And we're going to dive into some really practical questions and things. I love the cover. I love the texture. I want to be sure to have it because my hair almost matches your book.
Dr. Jolene Brighten 0:43
I know. Your hair's on fire, like, for real.
Dr. Jill 0:47
So I'm super excited to have you here, Dr. Brighten. Welcome to the show.
Dr. Jolene Brighten 0:51
Thanks so much for having me. It's so good to see you. I feel like, post-pandemic, just seeing people is always such a treat.
Dr. Jill 0:59
Isn't it? I know. Even in my office, patients are starting to come in, and I'm like, “Can I hug you?” You've got to ask, “Can I touch?” It's so lovely to have that in-person connection. I know conferences are starting to come back. And lately, they've been full of people. People are excited to be in person.
Dr. Jill 1:17
Well, let me introduce you, and then we'll dive right into this topic. I titled it “Hormone Balance for Women,” especially PCOS, menopause, and all things hormones. So we're going to dive in. Dr. Jolene Brighten is a hormone expert, nutrition scientist, and thought leader in women's medicine. She's board certified in naturopathic endocrinology and trained in clinical sexology. Dr. Brighten is the author of Is This Normal? a non-judgmental guide to creating hormone balance, eliminating unwanted symptoms, and building the sexual desire you crave.
Dr. Jill 1:48
A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones through her website and social media channels. She's an international speaker, clinical educator, and medical advisor within the tech community. I am so happy to be here with you. Talk about a topic that everybody has questions about!
Dr. Jolene Brighten 0:51
Oh yes. I can't wait to dive in. I mean, between PCOS, perimenopause, and menopause woes, there's a whole abyss out there, right? There's a big hole of information. Then there's a whole lot of misinformation as well.
Dr. Jill 2:25
Yes. I think what's happened is that in medicine, first of all, as medical doctors, we are not well trained on women's health, women's hormones, and some of these things. Now, I've become kind of a hormonal expert, an endocrine expert, in my little field as well. Especially with nutrients and herbs, and just even what's normal and what's not normal—which we're going to dive into today—a lot of that education was outside of medical school. And I say that because when you go to your doctor—especially the classical, allopathically trained doctor—you're going to get a blank stare or [something] like: “Uh, maybe you need an antidepressant,” [and] these [types of] things that are really insulting to women. Even now, there is not the kind of education that we need. So this is such a needed resource.
Dr. Jill 3:05
If you guys don't have a copy, go out right now and get your copy. What I love about this book and what you did—and I want to talk about how you got to write this book—is that it's so practical. You could just almost flip to any chapter, any place, and be like, “Oh, okay, here are some questions: ‘Are my hormones normal?' ‘Is my menstrual cycle normal?'” And you've got it so well laid out. You can read through it, and it's amazing that way. Or you can flip to different topics and things. You've got checklists, you've got sidebars, and you've got recipes and plans at the end. Clearly, there's a need for this information. But how did you go about deciding on this book?
Dr. Jolene Brighten 3:44
It just became so clear as I wrote Beyond the Pill. And to your point, you go to the doctor; you're complaining, and you're like, “I have period problems.” Your doctor says to you, “Well, do you want to have a baby?” You say no; they say, “Here's the pill.” And you find yourself on that [pill] because you don't understand what's normal for you and what's not. The majority of things that we face as women we don't have to go to the doctor for, or our doctor doesn't even understand them. They don't even know about them, especially all of the information about sexual health that I talk about in there. These are things that once I made “Ask Dr. Brighten” on Instagram anonymous, people were like, “Well, let me tell you the hush-hush, that I would never say to my doctor” or [things] “my doctor shamed me about.” So that was a big reason for that.
Dr. Jolene Brighten 4:33
The other thing I want to say is that we're talking about menopause as well. So if you are in your reproductive years, they're going to say to you, “Take the pill.” If you are in your later reproductive years, really edging towards menopause, and you're having heavy, painful periods, they're going to say, “Just remove your uterus.” And if you're having mood symptoms, we know that once we get into our 40s and above, women in the United States are the biggest recipients of antidepressants, anti-anxiety medications, and things that come with really heavy side effects that are very often not discussed.
Dr. Jolene Brighten 5:07
We saw just a few years ago that women in their 40s were dying at a higher rate because doctors were prescribing benzodiazepines without telling them that Rosé All Day and benzos don't go together, or a little mommy nightcap and benzos don't go together. So we see that it's really limited in what women are offered.
Dr. Jolene Brighten 5:30
I wanted to start the conversation about: What is and isn't normal when it comes to your vagina, your breasts, and your hormones? How do we understand our normal? And then [I] give you a plan for taking action so that you can fast-track your healing. Even if you need a doctor or go to a doctor, you will have the language, expertise, and foundation that support your body so that you can heal quicker.
Dr. Jill 5:55
I love it, and it's so needed. And like we started this conversation, the traditional allopath is going to say, “This is dysfunction.” But in the realm of normal, what is normal? And what's optimal? Say a woman in menopause has vaginal dryness and wants to have better sex without pain. The doctor doesn't always have a good solution for that. The pill is not going to help in many of these cases; it may make things worse. Let's talk about that real quick, because whether you have PCOS, you're perimenopausal, or you're postmenopausal—typically not postmenopausal—a lot of these younger women are getting offered the pill. Why is that a problem for some issues and not always a good idea?
Dr. Jolene Brighten 6:34
Yes. Well, the problem with using the pill for every single lady's part problem or hormone problem is that the question isn't being asked: Why do you have those symptoms? That is in part leading to the misdiagnosis or delayed diagnosis of very serious conditions like polycystic ovarian syndrome, hypothyroidism, and fibroids. The list is pretty broad in terms of—endometriosis being another one—what gets overlooked, dismissed, or doesn't get the attention it deserves.
Dr. Jolene Brighten 7:05
Now, the pill is a tool. We can certainly use that tool to manage symptoms. That's what I think is an important part of the conversation. Often, doctors will say, [using] PCOS as an example, “Just take the pill; that will fix your period.” In fact, what is going on with PCOS is that, [although] we have an ovulatory cycle, we're not having ovulation, or it's irregular ovulation. Ovulation precedes menstruation, so if you don't see a period, we've got upstream issues with ovulation. The pill suppresses ovulation. Fantastic if you don't want a baby. Like, love that if you do not want to become pregnant. But in terms of fixing periods in a condition where ovulation is the issue, how can a drug that suppresses ovulation fix that? It can't.
Dr. Jolene Brighten 7:57
So then women come off the pill. One thing that will happen is that they'll often look back and say, “The pill caused me to be infertile,” when in fact, the pill was masking all the ways your body was telling you: We're about to have fertility problems in our future. And it wasn't the pill per se that caused you to become infertile; it's that nobody worked you out for PCOS. PCOS, which is one of the top reasons why women struggle with fertility—no one understood that was the cause. No one talked to you about it. No one talked about the fact that there are insulin issues—about 70% of women with PCOS have insulin issues—and there's inflammation going on as well. Those are bad for fertility, but also cardiovascular disease, dementia, and all of these things.
Dr. Jolene Brighten 8:40
So that's the problem with the pill: When we give it without a discussion, when we give it without informed consent, and when we give it without actually asking, “Why does this patient have these symptoms?” Certainly, for some people, the pill can help with acne. For some people, it helps with hair loss. For some people, it makes hair loss worse. For some people, it does help them get relief from their period or PMDD. If people are not familiar with that, I always say: Take PMS [and] now amplify it by a million—it's the worst it could possibly be—and then stretch it out for two weeks out of the month or six months out of the year, and you've arrived at PMDD. Some people are absolutely helped by taking the pill, but that is not the end of the discussion.
Dr. Jolene Brighten 9:25
And to your point about perimenopause, we have a lot better ways to treat perimenopause and to help with those symptoms. We don't have a whole lot of research supporting pill use as having the same benefits as bioidentical hormones or hormone replacement therapy in perimenopause. In fact, there was just a headline that came out, and it was like, “These hormones [inaudible 9:48-55] these hormone replacement therapies. I'm a doctor, so everything is very nuanced, so I'm trying to be like, “you could” or “maybe.” The headline was like: You're going to get that. And when you actually looked at the research, they were using progestin. The majority of people were using progestin.
Dr. Jolene Brighten 10:10
Progestin is the fake hormone that wants to be progesterone but can't be progesterone [and] that we know is problematic. Progesterone nourishes the brain and the nervous system. It helps with the myelin sheath, which is the way that we run and fire our neurons, our thoughts, [and our] whole ability to talk. Like, thank you, myelin sheath. Progestin does not have those same benefits. And if everybody would just chill on trying to regulate the pill and we could have real conversations about it, I think we would get more research and a deeper exploration that would tell us that there are in fact problems with progestin.
Dr. Jolene Brighten 10:47
We see this by way of the research that shows us that some people experience mood symptoms, especially teens, when they're on contraceptives that have progestin or are progestin-only. And that's important to understand. So if we know this in a younger population… And your mood is not separate from your brain. Sometimes doctors are like, “This is two different things. And I'm like: “No, no, no, no, no. This is the same same.” If we know that in a younger population, it should be no surprise that we see dysfunction that's induced by a medication if we're using progestin in an older demographic.
Dr. Jolene Brighten 11:22
Now, we need a whole lot more research to understand all of the nuances of this, but I just want to say, as I use the term ‘dysfunction,' love it when there's a medication that comes in and makes you feel dysfunctional. Don't love it when we're having a physiological adaptation that is normal, that is a response to our environment. And I just want to say that because we're going to talk about vaginal dryness and pain with sex, and that often gets termed as “sexual dysfunction.” And I'm like: “Well, it's actually physiological adaptation. You don't want to have sex because it hurts. That's normal.”
Dr. Jill 11:59
Yes. Right at the moment you said the headline, which is the one I know is out there, you cut out. I want to make sure people heard that. I think it was the risk of Alzheimer's or dementia with the hormones, right? The one that just came out?
Dr. Jolene Brighten 6:34
Absolutely.
Dr. Jill 12:12
And just like you, I read that, like, “Wait, this is literally our Bredesen group, which is all about dementia treatment.” I was like, “This is progestin! This is not progesterone.” So I love that you made the distinction because, with mental health too, we're finding that real hormones have been shown to benefit aging brains—so that is absolutely clear—but not synthetic. So let's go back to PCOS. You are an expert in PCOS. I love that you talk about this because it is absolutely increasing in incidence. You gave some symptoms, but let's just frame it. What might a woman who has PCOS experience? How might they know? And then what are some ways to look at that besides giving them the pill?
Dr. Jolene Brighten 12:51
Okay, so there is a criterion that has to be met with PCOS. These are the big ones: Number one is polycystic ovarian syndrome. People think you're going to have lots of cysts. This is not only always true, but it is part of the criteria. In fact, what medicine once thought, “Oh, you have a bunch of cysts in your ovaries,” are actually follicles that are developing. Through our cycle, we develop follicles, and this is where the egg is housed. Then, as you get closer to ovulation, there can be only one. One wins, and estrogen, LH, and the whole hormone symphony is like: Choose your champion and let's release it. With PCOS, because we're not getting that same level of brain hormones and ovarian hormones, what we see is that there are a lot of follicles trying to win the race. That's what will be termed the ‘pearl necklace,' the appearance of a strand of pearls of a bunch of cysts in the ovaries. They're not actually cysts; your little ovaries are trying so hard to get an egg ready and get to ovulation.
Dr. Jolene Brighten 13:57
So that's one of the three criteria. Now, you only need two, and the other two are high androgens, which don't have to be diagnosed via blood work; this can be a clinical diagnosis. You can have hirsutism, [which is] hair growth on the chin, chest, or abdomen. I often get people who are like, “Or it's just your ethnicity.” And I'm like: “Listen, I'm a Latina, and I'm going to tell you, this is not an ethnicity thing.” You have very dark, coarse, thick hair, and it is showing up like a beard around your areola, [in] what people call the ‘happy trail,' or even extending down your thighs. It is to the point where you're like, “I notice, and this is problematic.”
Dr. Jolene Brighten 14:40
Now, you may not always have hirsutism. Maybe what you experienced instead was hair loss on your head. It starts with a miniaturization of the follicle. So, DHT, which is the type of androgen that's causing our follicle to get really small. Your strands of hair—I think about 1980s Superman, and they're like, “Ooh, here's his strand of hair holding up this big weight;” I just dated myself, but that's okay—are getting weaker and thinner. It's not Superman anymore. That can be a sign of excess androgens—what most people think of as testosterone. Oily skin and acne are two other really big ones. That is the second of the three criteria.
Dr. Jolene Brighten 15:23
And then the third is, “Where is your period?” Or your period shows up, but it's super unpredictable or it's going beyond 45 days. That is due to ovulatory issues. So, we have irregular ovulation or a lack of ovulation. These are the things we're looking for with PCOS to make the diagnosis. Again, you need two out of three. It is a diagnosis of exclusion, which means that if you just have an irregular period showing up, you need to make sure it's not hypothyroidism and that there's not something else going on.
Dr. Jolene Brighten 15:53
Now, things not talked about with PCOS that aren't part of the diagnosis are that you can have high insulin levels. You might notice that you have blood sugar dysregulation or that you have dark, velvety skin—I talk about this in Is This Normal?—that's showing up maybe on the back of your neck or in a fold. You're seeing this dark, velvety skin or skin tags that can be a sign of insulin resistance taking place. You may also notice that you have mood symptoms, so anxiety and depression are very common among women with PCOS [and are] often overlooked. Often, [this is] not something their doctor even talks to them about when they get the diagnosis.
Dr. Jolene Brighten 16:36
As you can imagine, if you are not ovulating regularly, [you may have] infertility. So inability to conceive is another way. And it might be the first time you come off the pill that you start paying attention to that, and you're like, “Something is going on here.” The last thing I'll say is weight gain. This is weight gain that, no matter what you do, you can't seem to get off. Maybe you're somebody who's like: “I've been strength training, and I'm very strong, but I'm noticing, especially around my midsection, that I'm starting to gain weight.” And as you know, you go to the doctor as a woman, if you complain about weight, they're like, “Eat less, move more.” I actually said in Is This Normal? that is some dietary dogma that never should have been in women's medicine because it is such a disservice and such a tool of dismissal.
Dr. Jill 17:29
Yes.
Dr. Jill (pre-recording) 17:29
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Dr. Jill 18:25
Yes. I love that you say that. And this goes for PCOS but also menopause, right?—because when we have cortisol and insulin that are higher than our normal hormones, or… In fact, I just saw a diagram, [which] might have even been from you, where the cortisol-insulin high, testosterone medium, and estrogen-progesterone lower are the classical “I can't lose weight” for both PCOS and menopause. I love that you're saying this because, truly, hormones are much more regulatory on our weight than our diet and exercise. Thank you for framing that. So then women go to their doctor, and the doctor's like, “Okay, you want the pill.” We already framed this, but why would they maybe want to do something different? And what else could they do if they're just diagnosed with PCOS besides going on the pill?
Dr. Jolene Brighten 19:08
Yes. Okay. You can always use the pill. I have patients who are like: “I'm getting married. I need to have clear skin. Like, I need interventions.” So I just want to say that because I think I'm—
Dr. Jill 19:19
Yes. There's no shame around that. I love that.
Dr. Jolene Brighten 19:22
No. And it's really easy for women who have never walked that path to be like, “Just never use the pill.” And it's like, yes, but you're about to memorialize a major life event. For the rest of your life, these photos will live on your wall. If you want to have clear skin, I totally get that. I think it's important for people to understand that you can use the pill and use the nutrition and lifestyle interventions. You can use spironolactone and use nutrition and lifestyle interventions. You can use metformin for your insulin and your blood sugar as a tool while you also build that foundation. Neither of those drugs that I just mentioned has to be with you forever, so you might want to use it. You're like, “Short-term, I just need results, but I'm going to work on all this other stuff because I don't want to be dependent on those.” I do want to say that.
Dr. Jolene Brighten 20:11
Wherever you are in your journey, what I'm going to explain to you you can utilize and employ. Number one is: Build muscle mass. Back when I was doing my master's for nutrition, my research was on sarcopenic obesity. For over 20 years, I've been like: “Build muscle mass, everybody, and eat adequate protein.” Most people are going to need one gram of protein per kilogram of body weight to maintain muscle mass, especially as they get past [the age of] 35. It's super, super important. Your muscle is, in itself, an endocrine tissue. It's going to help with sensitizing insulin. It's going to help with modulating those estrogen and testosterone levels.
Dr. Jolene Brighten 20:55
Although I talked about testosterone, in PCOS, estrogen can also be problematic because estrogen is part of the: Let's get an egg out! But then it never happens, and without ovulation, we don't get progesterone. So estrogen goes on unchallenged, so a lot of what people call estrogen dominance that you'll see. I do have to just share as a side [note]. I had someone on social media saying: “Oh, Dr. Brighten is the one who invented estrogen dominance and invented this term.” I just laughed because I was like, “If you go to PubMed, there's research that says ‘estrogen dominance' that came out before I was born. That was not me. I just happened to be noisy about it.”
Dr. Jolene Brighten 21:35
With that estrogen excess, this is what puts women with PCOS at higher risk for endometrial hyperplasia—the building up of the endometrial lining and then that inability as you shed. You go a year or two of that, you're going to start seeing your risk of endometrial cancer creep up. This is a reason a doctor will say: “This is your only way to prevent endometrial cancer because you have PCOS and you're going to get that!” No. Just because you have PCOS does not mean you will get endometrial cancer. The pill is one tool that can trigger withdrawal bleeding and make the endometrial lining shed. But what's our primary goal? Let's get you to ovulate regularly.
Dr. Jolene Brighten 22:13
So building muscle mass is one thing that we can do. The other thing that we can do is work on our inflammation. With inflammation, that is going to cause chaos for the adrenal glands. It's going to cause chaos for your estrogen-testosterone balance. It is going to cause chaos in terms of your ability to get back to ovulation. When your cells feel that inflammation, they're not filling the hormones. So the receptors actually won't be as accepting to the hormones and you'll lose sensitivity that way as well. That can look like keeping our stress low, exercising, and [making good] dietary choices. So lots of fresh fruits and vegetables.
Dr. Jolene Brighten 22:54
And I don't care that you have PCOS; eating fruits is going to provide you with so many antioxidants. It's going to provide you with a lot of things that are supportive, not just for your overall health but [also for] your ovarian health. I always tell patients: Look at berries. Do berries not look like an ovary? It reminds me of PCOS ovaries. It's trying to ovulate. And we know that the antioxidants in berries are super beneficial for our ovaries, so make sure that you're getting fresh fruits and vegetables in as often as possible.
Dr. Jolene Brighten 23:24
If you've got to do frozen, you've got to do frozen. Like, that happens. Where I'm at right now, the only way to get organic broccoli, which I eat a lot of, is frozen. And you know what? I'm still going to get the DIM. I'm still going to get the sulforaphane. I'm still going to get the nutrients. By eating all those fruits and vegetables, you're not only going to deliver nutrients and build a nutrient-dense diet, [but] you're also going to be increasing your fiber. We want to aim for at least 25 grams of fiber. We know from the research. Even if you don't have PCOS, please listen up, if you struggle with your weight at all: 25 grams of fiber every day. Less than 25 grams of added sugar every day. Okay, so less is better with the sugar.
Dr. Jolene Brighten 24:07
You want to get that fiber up and tending to your gut microbiome. There's been research showing that with microbial diversity in the gut, people who have lots of critters in there and lots of different kinds have lower incidences of belly fat, it's easier for them to ditch the belly fat. Now, why does this matter? For people listening, we're not talking about aesthetics. We're talking about visceral adiposity. When I say belly fat, we're talking about fat packing around your organs. It is pro-inflammatory. It hates you being sensitive to insulin because it just wants you to basically plump up those cells as much as possible. And that is the big risk for everybody in terms of cardiovascular and metabolic disease. So for everybody, tend to your gut health. Eating all that fiber is going to help.
Dr. Jolene Brighten 24:57
You may want to take a quality probiotic, and decreasing that sugar is definitely going to be helpful. And I know that in the anti-diet culture, some of them are going a little too far, in my opinion, where they're like, “Anyone who talks about sugar is part of the problem.” And I'm like: “Friend, am I supposed to ignore all the research? Am I supposed to lie to you because the diet industry lied to you?” Like, no. We're going to tell the truth, and you're going to view this through the lens of what's true for me. And just like I say in Is This Normal? we're going to have our cake and our balanced hormones too. You and I were talking; I was just in Paris. I very much adopt the French way of living in terms of: Pleasure is necessary for a balanced, happy life.
Dr. Jolene Brighten 25:39
Okay, we talked about diet; we talked about exercise. The last thing I want to say is sleep. If you are not getting quality sleep, then I don't care how good you eat, it is going to be an uphill battle. So the piece I want to talk about is in Is This Normal? I have a whole diagram. You can see the insulin resistance, the inflammation, and the anovulatory cycle—so, not ovulating. All of that can occur if you're not sleeping well.
Dr. Jolene Brighten 26:01
You want to hone in on melatonin. Melatonin—everybody is like, “Great, sleep hormone, don't get jet lag”—protects your ovaries. If you are struggling with infertility and you are 35-plus in my clinic, we're going to bring melatonin in as a way to support ovarian health. Melatonin is an antioxidant. It also protects the brain. Now, in terms of research, like, “Oh, do we have great research on if we take melatonin long-term or anything?” No, we don't. But what we do know is that melatonin is such a potent antioxidant that people who are night shift workers and have low levels of melatonin have higher incidences of cancer, ovarian dysfunction, brain disease, and all of these things.
Dr. Jolene Brighten 26:47
So with PCOS, with perimenopause, and with every woman on this planet, protect your ovaries by getting good sleep. The things that you do to protect your ovaries are actually going to protect you for longevity. And I don't know about you—I'd love to hear your opinion—but I'm very much of the mindset that if David Sinclair can be out there saying, like: Hey, based on my research, we don't have to die and our cells should live longer and they can remember, then our ovaries should be able to as well. And it makes no sense why we live so much longer than even generations ago but are still going through menopause and struggling with perimenopause when we do. We should be able to extend that lifetime. And I'm convinced that it comes down to all of the things that we do to support our mitochondria. Every biohacker, health optimization person, or longevity expert—whatever people are calling themselves these days—is all talking about the same stuff: To make your cells work and go the distance. We should be able to do that with our ovaries as well.
Dr. Jill 27:51
Amen, sister! I'm just sitting here nodding and smiling so big because you've just given us such depth and wealth of knowledge. What I love is that you always bring practical tips too. Also, yes, a little sugar is okay, but really, really do watch this thing. It is important. The glycemic index has everything to do with diabetes, heart disease, obesity, and cancer risk. So it's very real; we can't ignore that. But pleasure is also important. So I love that.
Dr. Jill 28:17
One thought I had when you were talking about diversity in the diet, the microbiome, and all these things. You know that I love the gut. Recently, I've been doing research on nitric oxide. And some of the quotes were that loss of hormones and loss of nitric oxide are really the core of aging. Well, nitric oxide is rich in things like leafy greens, beets, beetroot, and all this. Nitric oxide is all about great sex, right?
Dr. Jolene Brighten 28:36
Yes! Okay, so I'm so glad you're saying this, because I'm like: If you are struggling with an erection, whether it's your clitoris or your penis, friend, you are aging too fast. We've got metabolic issues; we've got cardiovascular issues. In London, I was at the Health Optimization Summit, and they were like, “Talk about optimizing your hormones and your sexual health.” And people were really shocked that I spent so much time on insulin. I was like, “Let's talk about insulin because insulin resistance hates your clitoris.”
Dr. Jill 29:03
Yes, yes! And here's the fact, I just read this; I did not know this until literally Sunday night. I'm doing the research to do a presentation on nitric oxide and hemoglobin A1C, as that goes out that literally binds free nitric oxide.
Dr. Jolene Brighten 29:17
I didn't know that.
Dr. Jill 29:18
I know. Me neither.
Dr. Jolene Brighten 29:19
Oh my God, that makes so much sense!
Dr. Jill 29:20
Doesn't it? Basically, it creates more insulin resistance because of the receptors and the blood flow. So for those of you who don't know, we're getting excited about this nitric oxide. Nitric oxide is naturally made by your body; it's made from fruits and vegetables. You can now take pills and things that are like beet juice. That's great, but truly, food is a source of nitrates, which are converted in your microbiome and in your mouth to nitrites, which your body then uses to convert to nitric oxide.
Dr. Jill 29:44
Nitric oxide is a vasodilator. It opens blood flow to the brain, to the heart, to the penis, to the clitoris, and to all the organs where we need it. So men and women, especially as we age, most of the time… And especially if you're a man out there: We're not really talking to men today, but if you're listening and your Viagra isn't working anymore, that means you don't have enough nitric oxide, because that works based on the fact that you have nitric oxide. And the same with women. So this is such a core. Like I said, I was reading about the metabolic dysfunction with low nitric oxide, and it involves the fact that a higher A1C is going to bind that up. So if your A1C is like eight or you're a totally uncontrolled diabetic, you're going to have sexual dysfunction because you're binding up the nitric oxide.
Dr. Jolene Brighten 30:24
I want to just dovetail on that and say that we have recognized for decades that cardio-metabolic issues lead to sexual dysfunction—erectile dysfunction—in men. Well accepted. Medicine resisted this concept in women, being like: “It has no bearing. It doesn't relate.” The reason is that doctors are so poorly trained in clitoral anatomy. In fact, Is this Normal? has three diagrams of the clitoris because the majority of medical textbooks don't even have one that is actually representative. I had an artist draw these up for me, and I had them do a cross-section showing the corpus cavernosum and all of that. My editor was like, “Gone too far.” [inaudible].
Dr. Jolene Brighten 31:16
But what I was showing is that if I took a cross-section of the penis and a cross-section of the clitoris, it is the exact same tissue. As embryos, it was the same, same until testosterone came in, and the penis is the one that differentiated from the clitoris. All right, the clitoris is always what was planned, and testosterone and a gene on the Y chromosome decided otherwise, and they went penis.
Dr. Jolene Brighten 31:37
So it is mind-boggling to me why medicine—I even still get people who push back on me—regards this as: “This is true. This is a fact for men.” But women who have the same exact tissue are saying, “I'm losing clitoral sensitivity; it's harder to orgasm,” doctors are like: “Hmm. You're just getting older. It's the way it is.” And I'm like, “Okay, sexual function [and] pleasure [are] super important.” But I've got alarms in my head because if you're saying that to me, I'm like: “Where's your insulin at? Where is your blood sugar at?” Because if your clitoris is feeling that effect, your eyes, your kidneys, your fingertips, your heart, and all of these other tissues are going to start feeling that effect as well. But where it may show up first is in that place of your body, and that may be the first place that you tune into because so many other things we're told are normal. Like, you're starting to get old, and your vision is changing. True—eyes change as we age. However, those can also be signs of serious cardiometabolic issues.
Dr. Jill 32:36
Yes. So just to repeat for those of you listening, men or women, and again, probably right now, the majority of the audience is women, but if you're having—
Dr. Jolene Brighten 32:43
Yes. But they live with men or know men, so it's okay.
Dr. Jill 32:47
Either way, though, if you're having sexual dysfunction, like Dr. Jolene Brighton said: This is a sign that there could be a cardiovascular issue; it's literally the very first clue a lot of times for endothelial dysfunction or vascular dysfunction. So there's a way bigger importance than just sex here, although that is important, right? It could be your health.
Dr. Jill 33:08
Let's talk about menopausal women. I'm one. I'll just briefly tell you. I had chemo at 25 for breast cancer. My period stopped for two years—my poor ovaries back then—but then they restarted. Then I had undiagnosed celiac [disease] and anemia, and I stopped my periods—amenorrhea—because I was undiagnosed celiac for two years in my 30s. Then they came back, and I'm just so happy with my little ovaries because they have just fought and fought and fought. But then, when I turned about 45, they started sputtering out. So I don't know; that's kind of early, but not super early considering what I've been through. So I am in menopause; I'm not afraid to say that.
Dr. Jill 33:41
But let's talk to those women out there. What's the average age? What are the symptoms? And then, what do these women do about it?—because a lot of doctors don't know how to counsel them. And it doesn't mean you have to have vaginal dryness, poor sex, poor libido, poor mental function, or poor sleep. Let's talk about these women in menopause.
Dr. Jolene Brighten 33:56
Yes. We would never accept that for men. This is what just really chafes me is that when you look at how women are treated… And it is changing, but it's only… People are like, “So much has changed in medicine.” I'm like, “Only in the last couple of years,” because a hell of a lot of celebrities, we're like: “We're not going to be quiet about this. We're going to start organizations. We're going to get loud. We're going to make our own networks.” And I'm like, “Man, you see what the Kardashians do, and then you see what these other celebrities do.” And I'm like: “I feel so Spider-Man! With great power comes great responsibility. Look at this change you can make!” You and I are shouting it all day, and the rest of medicine is like: “Whatever, women; suck it up.” Let's talk about it, though.
Dr. Jolene Brighten 34:37
When we talk about menopause, what exactly are we talking about? And what's perimenopause? It is normal to go through menopause at age 45. That's the youngest accepted age, and the average woman is going through it at about 51. However, perimenopause can start seven to ten years in advance. That means you might be 35, and you're starting to experience symptoms of hot flashes. Irregular periods and periods stretching out beyond seven days or more, being long—you used to be like 28 days and now you're like 35—that's happening more at the tail end of perimenopause. In early perimenopause, this is where hot flashes start to come up, [as do] mood symptoms. So as our hormones change, it's changing in the brain as well. We might notice weight gain or loss of muscle mass. We might notice that now we're starting to get hair growing in places, unlike the PCOS picture that was happening much earlier on.
Dr. Jolene Brighten 35:40
The acne—that's so lame. Like, who wants to be 40 with acne? I just laugh about it because I went through that, and I shared it online just a couple of weeks ago thanks to the hormones that I'm using. So with that, there's this collection of signs and symptoms with perimenopause. Itchy skin as estrogen starts to decline. When we get to menopause, menopause is a one-day event. It arrives [after] 12 consecutive months of no bleed. So no ovulation, no bleed, you are now [in] menopause. Tomorrow, the next day, you are now post-menopausal.
Dr. Jolene Brighten 36:17
Now, with the hormones, people always think: “Estrogen is so problematic, and estrogen is where we need to start.” I sometimes see people saying: “You're in perimenopause; you should start estrogen now.” I'm like, “Hold up!” So this is where it can look more and more like that PCOS picture that we talked about before. It's not PCOS, just so we're clear. But since people already heard that, just to link back in, when ovulation becomes more irregular, progesterone production becomes more irregular because the only way to progesterone is through ovulation, so estrogen is unchallenged. As you're becoming irregular in your cycles, your symptoms may be related to estrogen, but at the root of it, it's because of what's going on with progesterone. So if we're going to use hormone replacement therapy, progesterone is where we start.
Dr. Jolene Brighten 37:06
DHEA is another consideration, and it's important for everyone to understand that this is an anti-aging hormone that our adrenal glands make. It starts its decline at 25, which is so lame because once we're in menopause, we need it because we turn DHEA into estrogen and testosterone. During this perimenopausal phase, we want to support the ovaries in producing progesterone regularly, ovulating, and doing everything they can. When they don't have it in them anymore, that's where we look first at bioidentical progesterone. I really love oral because it gets metabolized, and its metabolites are what help you sleep and feel less anxious.
Dr. Jill 37:48
GABA.
Dr. Jolene Brighten 37:49
Exactly. That'll stimulate GABA in the brain. If you wear trackables like I do, these wearable technologies are a great way for you to tune in to what's going on. And what I'll say is that if you are tracking your cycle and you're looking at your body temperature and your sleep and you are in your 40s—your body temperature goes up after ovulation because that's what progesterone does—[your temperature] is going a lot higher prior to your period and your sleep; you have more sleep disturbance. You're not getting as deep sleep. You're starting to have those issues. That's a sign that you are in perimenopause and that you might not even feel it yet. You might feel tired in the morning, but you're not cluing into what's going on. And that technology may very well be cluing you in and showing you, “Okay, this is the pattern, and this is what's happening here.”
Dr. Jolene Brighten 38:40
Now, as you get into menopause, this is definitely a time that we should consider hormone replacement therapy, so estradiol—E2. For the vagina, E3—estriol—is lovely for vaginal dryness. And for anyone who has hesitancy around this—because there are a lot of doctors that are like, “That's just going to give you cancer, and it's horrible”—about 60% or more of women go into elder care facilities because of incontinence. They're not able to make it to the bathroom on their own. They have to have somebody tending to them for that. We can prevent urinary incontinence by getting people with occupational therapists or pelvic floor therapists who work in that area and making sure that they have hormone stimulation to that tissue.
Dr. Jolene Brighten 39:26
Estrogen isn't just about great sex [or] the ability to self-lubricate. Estrogen is why you're able to make glycogen—the sugar that feeds the lactobacilli in your vagina—and keeps the pH moderated so you don't end up with BV, yeast infections, or even urinary tract infections. It also helps with the musculature and the tissue of the pelvic floor so that we are less inclined to be heading down the road of vaginal atrophy, or thinning of the tissue. And [with] this, [it] can be uncomfortable to walk. Or you wipe with toilet paper after urinating, and you bleed. All of that's going to affect your urinary tract system as well. So that's a reason to consider topical estriol—E3.
Dr. Jolene Brighten 40:10
And this is the hormone of pregnancy. It is a weak hormone. It will get its job done down there, but it is a weak hormone. Estradiol is a much more potent hormone, and that is one that I'm always like, “Just topical, friends,” because when we take it orally, we see the increased risk of clots. So, for everyone to understand, anytime estrogen goes up, clotting factors follow. This is why the pill, pregnancy, and any oral estrogen therapy is going to be a risk for a clot. Stroke, pulmonary embolism—we don't want any of that stuff. So if you're afraid of that, that's something to understand that we don't want to go the oral route.
Dr. Jolene Brighten 40:57
So we talked a little bit about estrogen. And I don't want to just sit here and preach from the pulpit, so to speak, but testosterone is another therapy that often gets overlooked. If you're doing DHEA, I don't recommend doing testosterone, and I never recommend doing DHEA without knowing your estrogen, your testosterone, and how your enzymes are functioning.
Dr. Jill 41:15
Where it's going, right?
Dr. Jolene Brighten 41:17
Exactly because you might cause hair loss or acne, and you don't want any of that. But with testosterone therapy, this is really important for women: A lot of doctors, even doctors doing hormone replacement therapy, are like, “Women don't need testosterone.” And I'm like, “Uh, we do.” We do because it's important for our mood. If you find you're crying all the time, you lack motivation, you can't get up in the morning, you're losing muscle mass, you probably have testosterone problems, and the libido will also be a problem. But notice I didn't start with the libido because there's going to be a whole lot of other things going on than just the libido if you have low testosterone symptoms. So that was a whole lot of information.
Dr. Jolene Brighten 41:57
The other thing I want to say, [as] I shared with you before we started recording, [is that] I'm going through IVF treatments. I noticed during my pregnancies that I always have great boundaries. I always talk about testosterone as like: “You wake up, you kick ass, you set boundaries,” and all this. And going through IVF therapy, I'm monitoring my blood; I watch my estrogen go up. People always say that testosterone is the alpha hormone, and I'm like: “Estrogen. Estrogen is the alpha hormone.” People have a lot to say about IVF. I'm injecting brain hormones that make my ovaries produce estrogen and build follicles.
Dr. Jolene Brighten 42:34
But my estrogen—man, my brain has never worked so well. My ability to just be like, “No, you're not going to talk to me like that” instead of that woman thing. [inaudible]. But being like: “Did I do something?” “Should I tend to this?” “Is this my fault?” I'm just like: “No! No, no, no, no, no!” Like, “This is not the way it is. I will not be talked to or treated like that.” I just watch all of this, like observing. And I'm always like this N of 1. And I'm like: “Man, that is so much. I feel like this is part of the conspiracy of why they don't want to give women estrogen because, my goodness, we are brilliant. We are powerful. We are all the things that this world needs us to be when we have estrogen, and [being] complacent is not one of them.
Dr. Jill 43:20
I love that you say that. All my life, my sister and I have been prone to PCOS. I don't think I've been full-blown because I didn't have a lot of clinical symptoms. But knowing that, my testosterone has always been okay. Even postmenopausal, that has not been my issue, but estrogen was the big thing that I noticed. And just like you said, all of a sudden [I felt a] lack of motivation, clarity, planning, and executive function. I actually realized, “That's not testosterone,” because my testosterone was normal.
Dr. Jolene Brighten 43:43
No, no, totally.
Dr. Jill 43:45
Right? So I love that you say that, because I really realized too, I'm like, “Wow, this estrogen is really important.” And because of my history of breast cancer, I was always more careful. I want to speak to that. Of course, I'm 20 years out. But so many doctors are afraid, even with a history of breast cancer. Now, you need to talk to your physician about this. But it is safe to replace estrogen in the right cases when you're doing transdermal and when you're doing the right forms, even after breast cancer, if you're enough years out. The studies support this.
Dr. Jolene Brighten 44:14
And it can be protective.
Dr. Jill 44:16
Yes. Yes. Especially when you use it with progesterone, because you're dividing cells, and then you're differentiating.
Dr. Jolene Brighten 44:25
The amount you have to use to get symptom relief is so little. No shade to Suzanne Somers. She was doing the best she could with the information that she had, like we all do. But that whole protocol that people were doing, I would never mess with that. I had patients come to me like, “I want to have my period again.” And I'm like: “You have a period because you ovulate. I can't give you any hormones to make you ovulate again.” If I could, if I discovered that, like, oh my goodness! I'd be telling everybody. But you menstruate because you ovulate. I can't make you ovulate again. So just giving you enough hormones to make your uterus bleed—like, what are you doing there? That's not in harmony with the way things were designed.
Dr. Jolene Brighten 45:06
So you don't need much. I have patients on very, very little amounts of estrogen, and I'm always surprised at how good they feel on so little. I'm like, “If it works for you, let's go.” And in the case of autoimmunity, we see that autoimmunity gets a lot worse in menopause as well because we lose that estrogen that helps modulate the immune system. And I will say estrogen makes us sensitive to insulin as well, which we know that blood sugar regulation ties into immune system function. But there are women who are struggling with MS, who are struggling with rheumatoid arthritis, who are struggling with all these things. I mean, rheumatoid arthritis and Graves' disease, oftentimes they'll see doctors be like, “No, you can't have any estrogen.” But a little bit done just right and well monitored in that patient can actually help their symptoms immensely. And what do we really want here? We want quality of life. We want every single woman in that wise woman phase [to be] able to pass on that wisdom. I know I do.
Dr. Jill 46:10
Yes. Great, great summary! Again, because I've had breast cancer, I can speak from that perspective. And I don't have to choose, but if I had to choose between breast risk and brain risk, I'm going to choose my brain.
Dr. Jolene Brighten 46:23
It's a hard choice, right?
Dr. Jill 46:25
Yes. Again, we don't have to choose. There are safe ways for post-breast cancer patients when they're far enough out with the right low topical doses that are absolutely safe, of course with your doctor's input.
Dr. Jolene Brighten 46:38
And being monitored, getting the right testing, and having the methylation support that we know protects you against DNA damage—I think this really comes back full circle to what we were talking about with the pill. You can use the pill, you can use hormone replacement therapy, and you can use these interventions, but we have to individualize them and support you beyond that. And that has been such a disservice that modern medicine has done, like: “Here's a pill; it's going to fix everything!” And I'm sorry, friend, that I can't give you something to fix everything. I know that'd be super easy. But the choices you make every single day are the major movers in medicine. And that's what makes pharmaceutical interventions work better and have less side effects. And yes, you do have that much power.
Dr. Jill 47:23
I love it. What a way to end with the empowerment of women! Gosh, we could talk for a whole other hour, but everybody, the big thing is: Grab a copy of her new book. Dr. Brighten, this is brilliant. It's so great because it's one of those you can keep next to you and literally reference when you need help, have questions, or need a diet. It's all in here, including the diagrams. So I love, love, love it. I love that you have put your great work out into the world. Where can people find you? Where can they find the book? Give us a little bit of info about you.
Dr. Jolene Brighten 47:54
All right, so DrBrighten.com. That's my main hub, where you will find tons of free resources to support your hormones. The book is there as well as all over in bookstores. You can also find me on social media, @DrJoleneBrighten, whether it's Instagram, YouTube, TikTok, or Threads now.
Dr. Jill 48:18
I know, right?
Dr. Jolene Brighten 48:20
I tagged you the other day. Someone was asking me about mold, and I was like, “Uh, Dr. Jill Carnahan is who you need to talk to about this.” And I was like, “Thank God she's on Threads.” I always feel like when I want to give somebody a resource or a referral, if they're not on social media, I'm like: “Uh, I'm going to give this person your name.” And then they're probably not going to search for it, but they need this help now.
Dr. Jill 48:43
Yes. Oh, cool. Well, everybody go out and get a copy of this book. It's so worth having it next to you. And thank you, Dr. Brighten, for your work in the world. Thank you for your enthusiasm. Thank you for that estrogen power. It's great to talk to you today!
Dr. Jolene Brighten 48:57
Yes. Thank you so much for having me. It's so good seeing you. And thank you to your audience for listening to us go off about hormones and how to help yourself!
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