09: Thriving in Perimenopause

Persistent symptoms like fatigue, weight gain, multiple chemical sensitivities and brain fog are keeping you down. Ignoring the root cause means the problem won't go away, and it might even get worse. The root cause reset helps you identify and address the true source of your health issues. Join today at thyroidfarmises.com/reset. Hello and welcome. I'm here with Dr. Christine Maren. We're going to be talking about thriving in parimenopause. I'm Dr. Isabella Wensier thyroid pharmacist, and this is actually a sneak peak of the thyroid pharmacist healing conversations podcast with Dr. Maren as my guest. Today we're going to be talking about thriving in parimenopause, and I have Dr. Christine Maren here with us. She's a board certified physician and founder of a functional medicine practice specializing in women's health and hormones. Her transformative work addresses root causes, optimizes hormones and builds lasting resilience. Having navigated her own health challenges with pregnancy and now parimenopause, she understands how overwhelming hormonal symptoms can feel. Her comprehensive approach combines conventional and functional medicine expertise to help women feel energized, clear-headed, and competent again. Board certified by ABFM, an IFM certified. She serves patients virtually across Colorado, Michigan, and Texas. Welcome Dr. Maren. How are you doing today? I'm awesome. Thanks so much for having me. It's so, so great to have you. I have to say, so I've known you maybe for about 10 years now, and we got a chance to meet. We had our babies year third, and my first around the same time. I think they were born like one day apart, and this was when I happened to live in Boulder, and you've just always been such a source of wisdom and inspiration for me in the early motherhood years. So I really, really appreciate you for that. Thank you. And now your source of inspiration and wisdom for me through parimenopause. So this is something I posted the meme the other day. It was like, just when you think you have thyroid health and Hashimoto's figured out, it comes parimenopause to knock you off of your throne. And this was certainly something that happened to me. I was like, oh my goodness, I know what I'm doing. I feel great, and all of a sudden I turned 38. My menstrual cycles started to change. I started having insomnia or irritability, anxiety. I woke up like 20 pounds heavier. What the heck? I feel like a lot of us have these personal stories that make us passionate about going deeper into health. And you have yours as well with thyroid, with pregnancy, with parimenopause. Can you share a little bit more about your stories? Oh my gosh, there's like so much. Where do we start? But I'll keep it brief. I mean, my, you know, I dove into functional medicine head first because I was having recurrent pregnancy loss. And, you know, I knew something was wrong. I had symptoms, which told me something was wrong. You know, but that just like it leads to a lot of different things. It's like this bonfire and you start pulling out the logs and the fire and you're like, oh, I got to address my gut health. Oh, okay. So we've got Hashimoto's and there's some hypothyroidism and low progesterone and and there is this mold story and there is root canal. You know, there's all this kind of stuff going on, which really let me investigate a lot and has let me help other patients because they really get it now. And I've done so much research just for myself. But yeah, I mean, I experienced something similar to you. Like one day I woke up and I think COVID happened. And so I wasn't ever wearing jeans, right? Like you just I just wore like, I don't know, yoga pants for like a year and a half. And then one day I got dressed. And I was like, I feel like sausage in my clothes. Like they don't fit anymore. I'm not like massively overweight, but I want to wear my clothes. I want to go shopping in my own closet. And it just kind of crept up. But same thing with you, I was like waking up a lot at night and I used to be like an amazing sleeper. And I, you know, my sleep was just not the same. I just, it's sort of all coincided with some hard stuff that was going on in my personal life. My daughter flooded our house. We had to move, did a remodel that was unexpected. It was a lot. And you know, it was kind of like everything came together at the same time. And I was like enough. I have to, I really started working on a nervous system more than anything. I'm like, I know that's the place to start. And that just, you know, you pill back the layers of the onion and you get to your core. And there was a lot. Yeah, it's interesting. I don't know if it just, it happened to be 2020 for me where it was a really tough year. I think for, for all of the entire planet, it was a really, really tough year. But definitely for having young children at home and trying to figure out what was going on. And I also happen to be like 38 around that time. So that's sort of an age when you are likely to go into perimenopause. What are your thoughts about that? Do you think stress can bring on worsen perimenopause? Or maybe perhaps bring it on a little bit earlier? I do. Yeah, for sure. I mean, there's some degree of HPA access dysfunction. And I think a lot of the women I work with are these very high achieving badass women who get things done. They've got big jobs. They have kids, you know, they're balancing a lot and they're able to multitask and do a lot just like I am. And they ask a lot of themselves. And I think eventually, you know, I think perimenopause is a time when all those things that we've been asking of ourselves, like we've been multitasking like queens, like doing so much and all of a sudden it's like, wait a sec. Like, I'm not as resilient. I can't do all this stuff. And there's a lot of different things that'll bring on perimenopause and menopause early, like reasons why women will go through it on their earlier side. For those listening, like perimenopause happens seven to ten years before menopause, you know, the average age of menopause is 51. So 45 to 55 is really normal age to go through menopause, which means 35 to 45 is a really normal age to start going through perimenopause. And, you know, in my late 30s, I think we both probably track our cycles a lot, which I totally encourage you to do, ladies. And I didn't really even understand at that time in my life that like, oh, this 26 day cycle, that's perimenopause. Like, your cycle's getting shorter, like that's what that is. And for me, it was definitely on the estrogen deficient side. I see some women who have these big spikes in estrogen. You know, some chaos happening. But for me, it was just kind of low. Like, my hormones were just low. And I see that a lot in like the high achieving female who pushes on. It's so interesting. I know I feel like a few years ago, people knew about like, fertility, motherhood. And then it was just menopause. And now we have so much more awareness about this, this other time period in our lives, perimenopause, right? And so how do you diagnose it? Because I feel like some people will say like, you're 21 and your period is too short. Do you have perimenopause? And then some people are like, it's like the last year before many menopause. You know, there's just so much information out there about what it is and what it is. And could you tell us how do you get your in it, right? Yeah. So it's like, it is a clinical diagnosis. I do think, and I draw labs myself all the time. And I think that's important. Like, get labs. Make sure it's not hypothyroidism. It's not. And it might also be, right? Like it can be perimenopause and hypothyroidism. And just again, I think that perimenopause decreases our resilience. And so if it's, if that's the thing that like, clued you into some other health issues, then like, all right, it can be this and that. But you know, look at your nutrient levels. Are you iron deficient? Do hypothyroidism? Do you hashmotos? Like, do an investigation? And I do look at labs for hormones. Now estrogen fluctuates a lot. I like to get day three to five labs in my patients. And you can look at things like LH and FSH. Those aren't going to really go high until you're in menopause. So, you know, they don't diagnose perimenopause, but it's, it's good feedback. If you have your regular cycles, like it could also be PCOS. You want to look at your testosterone levels. Are they low or are they high? Look at your androgens like DHA. But I like to look at an estradial level in day three to five. And if I see it's pretty low, that can clue me in that like, all right, we're getting there. Washing cycles. So are your cycles getting shorter? That's typically what I see in like the early perimenopause is cycles start to get shorter. And then when we get closer to menopause, they start to space out for most women. And so it'll be more irregular. So, you know, you might have a cycle on day 35. And then you skip one. And then you're like, I don't know, three months ago. Like, I had a cycle. But that's typically later. So, you know, in that later side of things too, that's when a lot of women start to experience hot flashes, sometimes palpitations, hot flashes are pretty much like that's telling you you're in manopause. You don't get hot flashes for a lot of other reasons. But not everybody in menopause or perimenopause gets hot flashes. So it's not like you have to have those to mean that you're in perimenopause or menopause. You know, the irritability piece, if you're just not feeling like you're so. You're not sleeping as well. You have a shorter fuse. A lot of people complain about brain fog. They're just not as sharp as they used to be. I'd say more than 50% of women who go through parry monopause are like I don't know, like 5 or 10 pounds heavier for no reason at all because things shift a lot with our metabolism So in reality it really is mostly a clinical diagnosis But there's a lot of supported Supportive evidence that you can get. It's not like there's this funny like Comedian on Instagram and she's like how do you know what your hormones are doing? Nobody knows what your hormones are doing like you can test. They're not perfect You need to know when to test. I like to get more than one day like so I'll get day three to five labs and then Depending on the patient. I'll get them done in the luteal phase, which is after ovulation as well Just to see some women we've got these like high estrogen low high low and it's very chaotic And so they feel this like estrogen sort of Dominance or progesterone deficiency symptoms and some women like me Experience more just like low levels throughout and that may or may not come with low libido or painful intercourse or things like that Yeah, it's a lot of different symptoms that can happen and I feel like I Don't know I feel like I just didn't know it until it really hit me I sort of it was in the back of my mind But it's just until it happened. I was like wow. This is quite impactful now I know what people are talking about Is this like something that is just a normal part of aging? I feel like for a while I was like okay, well, I'm just getting older. I'm just gonna turn 40 so I'm just not gonna wear my cute stuff And this is kind of what it happens and then of course I saw you and just Thriving and paramedic pause and I just was like so inspired. I'm like it doesn't have to be this way Can you tell us a little bit more about that like are we just destined just to Deal with this right no. I mean like metaphors is inevitable, but Suffering through it isn't I really believe it's like a time where we can feel more like ourselves and I will say You know if you look at psychology there's these like phases that a woman goes through so that initial phase is the maiden phase And then whether or not you decide to have children It's called this it's like the mother the maiden the mother and then this like phase that we're entering when we go into Metapause this wise Cron and sometimes that term Cron doesn't have a great connotation. I don't work it. Yeah But I would encourage you to like change your Your thoughts around that it's this time when we can like harness all this strength all of this wisdom We've gathered all of this education. We've gathered over our lives and transform into this like Version of ourselves whoever it is that we want to be but feel more like we really are like the person We really are and focus our energy a little bit more on ourselves I mean we've been taking care of people like as women We've been taking care of people our whole lives. I mean, it's culturally in there It's our hormones are actually part of that you know when we have more estrogen It makes us more like a caregiver. So yeah, I think it's a great time to take care of you I Feel like we should have redeemed it like the wise woman phase. Let's do it like we don't need to call her a Cron, but she's like the wise Woman who knows herself and knows what she wants and You know, it's like all that experience like for me it feels like oh full circle this feels so full circle Like all of these experiences prepared me for this what I'm doing now and It's just a really beautiful thing to witness. I think if you can get to that point, but If you have really your hormones all over the place it makes it hard and you don't need to suffer through it There's so many great options that are low risk and actually have a lot of benefit Absolutely, so when I was in pharmacy school. I remember the Study came out in 2002 the Women's Health Initiative study and we were like I was a pharmacy intern and I just remember like dispensing hormones for hormone replacement therapy like left and right and then all of a sudden that kind of came to a stop because they were some Information linking hormone replacement therapy to breast cancer. Can you tell us more about Perhaps what that study was and what it got wrong and since that time I know it's been yeah We walked back on that a lot. We had a reanalysis come out like a decade afterward But that initial study was so heavily publicized. It was kind of like a media blitz like it was on the front of time magazine and like Estrogen causes breast cancer and everybody just Went off their estrogen. Yep, and the study wasn't even designed to look at breast cancer It was designed to measure cardiovascular risk and so when you don't design a study for that specific reason You're not doing mammograms on on women who enter the study and you know We were looking at a wide age gap and it was 55 to 75 and like those risks are really different You know if you're 55 versus you're 75 and the placebo arm of that group had an artificially low rate of breast cancer They call that the healthy population selection something like that So it made it look like there was a slight increased relative risk but Like we've gotten get back and reanalyzed those all those studies all that data has been reanalyzed and found that Oh the estrogen only arm actually had less breast cancer So now the thought is like oh well that estrogen might have been protective But during that reanalysis there just wasn't the same media blitz like it's not the same headline when you're like Guess what? Estrogen doesn't cause breast cancer. We're sorry. We said that. Yeah, so there's a lot of problems with that study for sure I will say like that data did show a reduction in colon cancer and reduction in type 2 diabetes I mean there were some good things you know There's some data that came out of that that can be useful But the other piece that's important to know is what was studied so it was like generation one of HRT so Premarin is conjugated equine estrogen. It comes from Horse urine so it's like not even the estrogen that the horse uses is like what they pee off and honestly, I think Premarin's better than nothing but now we use body identical or bio identical estradial and If you use that transdermally, which is what most providers prescribe so meaning like a jellic cream a patch Even there's like vaginal rings Those don't increase your risk of blood clot If it's transdermal if it's oral it does have a slightly increased risk But as you know, it's like we're so unfair with bio identical hormones when Anybody can get a birth control pill right like it's so easy like here But it's just important to remember The type of hormone matters whether it's a synthetic derivative of a hormone or the actual body identical hormone matters a lot in terms of risk and benefits Yeah, it's so interesting. I remember learning um so Premarin it was pregnant mayor Mairs for n because a mayor is the female horse apparently right and so I remember learning it that way and It just makes so much sense that obviously like we would do better with bio identical hormones that our bodies Normally respond to that they would bind the receptors. They're supposed to be binding versus that other types of receptors and You know, it's interesting you say that because I feel like yes the bio identical hormones It's like oh my gosh bio identical hormones, but birth control Like there's so many women and perimenopause that are put on birth control. Oh my gosh That's like my pet peeve like put me on a soapbox like stop They're you don't get contraception with HRT So I think that's important and women and perimenopause probably don't want to get pregnant so that is an issue If you want to know my favorite form of birth control it's a vasectomy right after that like an iUD is not the worst thing in the world but I would bar prefer it to birth control pills because One thing I didn't mention in the whi But it's similar in some ways to birth control pill is the type of progesterone that's used and it's a synthetic progestin And those have very different risks than that body identical progesterone like if you're at home and you're taking progesterone It should say like micronized progesterone or you can get it from a compounding pharmacy and it's also progesterone But you really want that bio identical progesterone There is some data that the synthetic progestin Maybe does play a risk in breast cancer. There's a French study that looked at that So I stay far away from progestins, but it's complicated because Medroxy progesterone acetate is a synthetic progestin, but it sounds like a progesterone so I stay away from a proxy progesterone acetate And I really favor micronized progesterone But when it comes to birth control pills, it's like a similar thing We have this synthetic derivative of an estrogen Which we can't actually measure in your blood It's a high enough dose that it shuts your ovaries down so you no longer make this magical hormone called estradial Instead you're replacing it with this fake estrogen from the birth control pill Which also increases your risk of blood clot And while that's not a super common side effect. It's a more serious side effect It's common enough. Like I have women every time I speak some woman comes up to me and says I was put on birth control when I was 40 years old and I had clot and I have a small stroke because of it Like I hear that story often enough To just like ring the bell on that like stop using birth control pills in older women I mean younger women have less risk of blood clots and so you know, they tend to tolerate it a little better Which I think is part of the reason Why women are like okay, sure, I'll take it again. I you know took it before but there's other side effects mood libido So like many women in this phase have this disconnect with their sexuality. And I think like that is part of our health. And having this really like sucky libido on birth control pills, it's like that's not what we're going for here. Yeah, I agree with you. And I would say even for younger women, so new studies have come out with Draspheranone, which is the active ingredient in Yaz and Yasmine. And that can increase the risk of irritable bowel syndrome. And then there are increased risks of thyroid disorders. Me, what I thought was really, really interesting with birth control is that can actually alter your preference for mates. And that's what is really important here in your 20s and dating. And you like, you know, yeah, totally. I agree. I mean, yes, it is not my favorite medication. I'm all for like reproductive freedom, but it is not what I would choose. And certainly not what I will encourage my children to choose when they get to be adults. Yeah. And definitely, you know, the risks, I know I feel like I learned that in pharmacy school where it was like after a certain age, you just don't utilize birth control pills because of the increased risk of blood clots. But yet so many women, it's just hand people like candy, right? It really is. And like, also if you think of it, a lot of women are told, I hear this story too. I can't go on transdermal estrogen because I have factor five light in. I'm like, did you take birth control pills? Yes, did you take, have a blood clot? No. Like I think transdermal estradiol is probably fine for that patient. But we have such scrutiny around using hormones and HRT and paramanopause and menopause. You don't screen anybody for that stuff when you put you on a birth control pill. I mean, I would argue that you really should. So if you're going to take a birth control pill, you should see, do you have any blood clotting issue? There's a really high percentage of the population that has factor five light in, which is a blood clotting problem. I mean, it increases your risk of blood clotting, you know that. Are you constantly battling fatigue, brain fog, weight gain, or multiple chemical sensitivities without knowing why? These symptoms are often linked to a deeper underlying health issue that relates to having toxins that can create a backlog in the liver. Ignoring this root cause can leave us feeling frustrated and stuck, unable to move forward, no matter what we do. The root cause reset program is designed to help you clear that toxic backlog in a super, super gentle way with expert guidance, targeted strategies, and practical tools you can use in your home today. You'll finally address what's holding you back. Thousands have transformed their health with this program sometimes in just two weeks, and now it's your turn. Enroll at thyroidfarmacist.com/reset. Yeah, thanks for clarifying that I was going to talk about that for people listening what that might mean. Yeah, it's very interesting. I hope that more awareness becomes available about utilizing bioidentical hormones. Do you think women need to be fully in menopause before they benefit from those? What are your thoughts on starting that? Do you start people with like, "vitax? Do you prefer topical? Do you prefer oral? Can people eat a whole bunch of yams? Get their progesterone? Should they be eating soy? What are your thoughts? I know there's, when you're on Instagram, which we both are, I know there's so much advice about like, if you eat this, this will normalize the estrogen and would love to eat your thoughts. I mean, I think the lifestyle piece is always central, right? You can't like supplement or medicate your way out of a crappy lifestyle. So, you know, alcohol and sugar and like, refined foods, all of that stuff is important. You're going to tolerate it less well when you get older and when you get into this phase of your life most likely. So all of that stuff is foundational. Like in my practice, I always say there's like these five foundational health habits, which is low-tox living, a protein centric, high protein, whole foods nutrition, good quality sleep, which often gets, you know, that's a loop where like, progesterone and things like that can help. Mindset. Giving yourself lots of self-compassion and love and strength training. Building muscle can be super important. So all of those things are great, but ultimately they're not a reason to avoid hormones. Like we replace our thyroid hormone when our thyroid labs are off. Why can't we supplement with estradiol or progesterone if those are low? And so typically in paramanopause, the first thing I'll start is progesterone, not always though. But a lot of women love progesterone. It can help a lot with anxiety. It can help with sleep. It'll feel a lot more calm for women who have high estrogen. It can really balance that out because estrogen and progesterone are very Yin Yang. So I don't think estrogen is like a bad thing. It's just really about balancing it if you have a lot of it. Part of that discussion also goes into gut health because your gut microbiome metabolizes estrogen and that really depends on your microbiome and your liver and, you know, how things are eliminating. So that's important in terms of that balance. But again, it doesn't mean there's no reason not to use progesterone. If you think about in terms of risk and benefit, like there's very little risk, you know, it's not like we're dealing with something that's going to increase your risk of blood clot or increased your risk of breast cancer or something like that. So I am a huge fan of progesterone. Some women, not all women, do really well testosterone. That can be really helpful. A lot of times in paramanopause, women need more, but it really depends. Not everybody needs testosterone. And so that's really dependent on labs and, you know, clinical presentation. It can help with motivation and libido and brain fog and helping women feel more like themselves. And then estradiol. So for people like me who have low estrogen levels, I love estradiol. Like it's awesome. I use it as a patch. I will sometimes prescribe it as a bring. There's actually a vaginal ring that can be really helpful for women who struggle with vaginal dryness or pain work. And of course, it also helps with urinary continents. So it can help toneify like the pelvic floor. So sometimes I'll use it that way called femurine. But it usually I'll prescribe it transdermal since it does come with an increased risk of blood clot. And if you use it when you're young, it helps more with prevention of brain related issues. It helps more with mood. It's the first line treatment for mood disorders in paramanopause is estrogen and progesterone or HRT. It's not an SSRI. That doesn't mean you can't use an SSRI, but it's like use the hormones. They're safer. You know, this is such an important topic because I feel like this is an age where women might have new onset, mental health issues and mental health challenges. I know for me, it was like, why am I anxious? Like where is this coming from? But other women have had like depression. But all kinds of like really serious mental health disorders where they're put on tons of medications, psychotic medications even where it's like actually, you know, female hormones could be really, really helpful with this, right? Yeah. And I actually think there's not a lot of studies to back this up. But one of the things that happens in my brain is I'm like, what's happening postpartum when women are breastfeeding? We have really low levels of estrogen in that time frame. Like let's talk about that postpartum depression. How much of this is related to low estrogen? And if you're one of those women's any message, please because I want to hear from more of you who had postpartum depression and then go through paramanopause if you have low estrogen levels. If those also trigger similar depressive symptoms, I really wonder about that. But hormones play a really important role in our brain health and our mood and our sleep and our ability to tolerate things and our, you know, what's our, like how short is our fuse kind of depends on what your hormones are doing. Yeah, definitely like the patients and the short fuse has been a thing for me. I know I was always described as a very, very patient person. I feel like that's been a challenge. The other thing has been like that, I guess that whole dopamine pathway where I would just be very focused and all of a sudden I'm like, okay, do I have ADHD? Where did that come from? Right? And there's so like histamine issues. Can you talk about some of these weird functional medicine things that you're seeing and I'm seeing where it's happening to? HD thing is so real. There are so many women who have this underlying like low grade ADD. It's usually like a pre-existing mental health thing like a low grade anxiety. But then you go through paramedics and you're like, no, no, this is now a clinically significant issue for me and I need something. So that happens a lot with patients who have ADD. They say this all the time. Like it got way worse during paramedics. And yes, histamine is such an interesting one because it really can get like thrown off during paramedics. And part of that really has to do with our gut microbiome. So there's really interesting studies that have come out in the last five to ten years looking at the female gut microbiome. And there's a sexual dimorphism, which means that our gut microbiome as a woman starts to look more like the gut microbiome of a male when we're in menopause. Whoa. But the gut microbiome, so back to the estrogen metabolism, piece. It's like, well, it plays into that because we have this thing called the astroballome, which is like the specific unit of the gut microbiome that deals with estrogen metabolism and makes this thing called beta-glucaronidase. And so it affects our hormones too. So it's very bidirectional. The gut affects our hormones and then our hormones affect our gut. So, I mean, there's definitely increased rates, increased severity of IBS for patients who go through manopause, increased like IBD. We know that menopause also is a risk factor for autoimmune disease, just like postpartum is. So these big hormone fluctuations can play a significant role. So like, you know, Hashimoto's for sure. Like we want to look for that during perimenopause and menopause. We want to look for that postpartum. I mean, we should look for it always because it's missed so often. Hire rates of hypothyroidism in menopause. So the heart health issue is like, that's not even a functional medicine thing, but like if you start estrogen on the earlier side, you'll have better cardiac protection because just remember hormones are a lot better at preventing issues and they are at treating. You can't like reverse heart disease with estrogen, but you can prevent it with estrogen. I like that. An ounce of prevention is worth a pound of cure, right? I wanted to talk to you a little bit more about thyroid health. So we do know pregnancy, puberty, perimenopause. These are going to be peak times when we have a higher incidence of hypothyroidism and Hashimoto's and that this time period can also impact Hashimoto's, right? It can also impact thyroid hormones as can like adding in bioidentical hormones. Could you talk us through that process? Like, what are we doing? If we're a thyroid patient, we're going through period menopause. We need to know. Follow your labs closely. Don't like check them once a year. Like I, if you feel like there's big hormonal fluctuations, check your labs more often and use them. I mean, they're a reliable method. They're not perfect, but they are a reliable method of measuring your thyroid hormone. And if you start hormone replacement, make sure you check your thyroid function afterward. So when women get pregnant, we have a really high amount of estrogen on board, and so we make more SHBG, which is sex hormone binding glabulin and TBG, which is thyroid binding glabulin. And so we know that when you're pregnant, if you're on thyroid medication, we're probably going to increase your dose by 25 to 30%. As soon as you're pregnant, that's going to decrease your risk of miscarriage. So the same, they have not the same. A similar kind of scenario happens if you start estradiol, but the level is much lower. So when you're pregnant, your estrogen's like in the thousands, and when you're on estradiol, it's like in maybe a hundred, you know, 75 to 100, something, something like that. So it's not like every woman on HRT is going to need a higher dose, but you should check and make sure, see if you need the higher dose, see what happened there. That would be definitely important. The other thing to know, which is really cool, is estrogen improves your thyroid hormone receptor sensitivity. So it might mean that your thyroid medication works better. You may need a slightly higher dose, but not everybody does. By the way, the other thing that improves your thyroid hormone receptor sensitivity that I always talk about is exercise. So it's like even more reason to strengthen and walk, you know, when you're in a pariamount of costs. I love that. So in Boulder, I have this gorgeous hiking trail next to my house, and I used to go on a lot of walks. And yoga and walks were kind of like my main thing that really kept me fit. Since that time, I moved to Austin, Texas, and all of a sudden, you know, I'm like, wait a minute, I really have to up my game. So now I have a walking treadmill. And then I think you encouraged me to get one of those. I saw you with those weighted vest. Yeah. So a weighted vest, I mean, you know, I wear a 12 pound weighted vest and I tell my patients about 10% of your body weight would be ideal. It just like ups the anti-free walks. It's also really great for bone health. And so I haven't even talked about this with HRT, but one of the things we really want to protect is our bone density. When you get to be older, if you don't have good bone density and you fall like off a chair or something, like not a big significant trauma and you break something, that's a sign that you don't have great bone quality. And it's super common. I would say the majority of my patients who get bone density scans, you know, show low bone density. It's female patients not so much males, but estrogen can help with that. So so can wearing a weighted vest and lifting weights and all that kind of stuff. So I love to wear my weighted vest. Like I just, you know, if I go for a walk with my dogs, it's just like, you know, if you were to wear ankle weights or like, like, weights or whatever, it's just more comfortable. So yeah, I love, I love a weighted vest. It also helps with your core and your stability, which are things you want to work on. So you can age really well and do whatever you want. Like that's part of the reason I do all this is like when I'm 65, I still want to be skiing. When I'm 85, I'm going to be hiking. Like, I have no plan on not doing any of that stuff. I feel like one of the things that I really learned is just like how important muscle building is when you are in parimenopause. I know I did like one of those calculators for your BMI and to, you know, for your optimal, like, caloric intake. Here's a whole thing about like calories in equals you basically like if you want to lose weight, just eat less and exercise more, but it gets a bit tricky when we're older because if we have a thyroid condition, that means we're not going to be burning as many calories that rest. And then if we have like not enough muscles on board, that also leads us to have, I guess, lower ability to burn calories. And so we could be eating the same amount of food and doing the same amount of exercise, but just and also just getting older, this can really lead to us putting on weight out of nowhere. 100%. Yep. Yeah. I mean, muscle mass is like your best friend as you age. It's a long devity organ. It lets you, like, it takes stress off of your joints even. I mean, for me personally, when I started lifting again, I used to have IT band issues and some stuff at my knees and that's like, I don't even know it's there anymore. And the biggest difference was not stretching and massage and getting brolfing and like all these things I had been doing for so long, it was lifting weights and strengthening my glutes and my quads and all these supportive muscle groups. So it helps a lot with just structural integrity of your body, but it's also like helps with insulin sensitivity. So if you're thinking about blood sugar issues, like the best thing you can do is get more muscle and it helps with metabolism. Like you mentioned, like the best thing you can do for your metabolism is get more muscle. If I skip a meal now, I am screwed because my metabolism is so different. And I just can't, like, I don't have that option anymore. Can you can you give us perhaps like a place to start and maybe a place to get to if somebody maybe hasn't been doing enough exercise? It can be quite challenging when you have thyroid fatigue that really start and sometimes too much exercise at once can be quite overwhelming. Can you give us maybe a place to start or some suggestions for people that are like, okay, I need to build muscle. How do I do it? Yeah. And I would say to don't push yourself too hard, like yes, push yourself, but listen, like if you work out and the next day you feel terrible, you have gone too far. You have crossed that threshold. So everybody has a different threshold. So you do want to push yourself, but you don't want to push yourself so hard that you crossed the threshold and the next day you have no reserve. And so it really depends on like obviously optimize your thyroid function, optimize your hormones, I'm a big fan of that, but a good place to start. So I try to keep it really simple with the rule of threes. So 30 grams of protein three times a day, 30 grams of fiber a day, which is a lot. It's harder to hit than you think. Three walks a week for 30 minutes a day. And if you can wear a weighted vest awesome and maybe you start there and if 30 minutes is too long, like maybe you start with 15 minutes, whatever it is, it just depends on your threshold. And if you can do three days of strength training amazing, even if it's just like a 20 minute kind of thing where you're just lifting up some like lifting weights and getting into the routine of things. I honestly think like for most people is just getting started, that is the hardest part. But if you can get your butt doing the thing, make a goal, that's great. And I think the biggest deal is like mindset, how do you feel about yourself when you're doing this thing and why are you doing it? Like figure out your why, why do you want to do this thing? What's your goal? Have a goal that's all around you, not around like I'm doing this. So my husband will like think I'm hot or whatever. I don't know. You know, so like do it for yourself. Why do you want this goal? Write it down and really focus like I think the biggest place to start his mindset. Like that's where I started. I didn't just go to the gym one day. I just I used to go to the gym all the time. That was like my jam, but you know, three kids in a practice and like four moves later, I wasn't part of my daily habit. But you will start to feel really good once you get into the habit. But it's really it's just getting started that is the hardest. But I would say if you're somebody who has like mitochondrial dysfunction, a lot of thyroid fatigue outside of like really optimizing your medication and your supplementation and your nutrition, and all that kind of stuff. Listen to your body. Like you do want to push when you exercise, but don't do it from a place of punishment. Don't do it from a place of like that self, if you feel yourself having that like self-critical voice, I would really like step back and think about like, how do you give yourself more compassion and love? And anytime when I'm lifting and I'm like, like probably people in the gym hear me 'cause my headphones are really loud. I'm like listening to music and I'll be like, self-respect, don't know. You know, but I totally do it from this place of like self-respect. Like when the lift gets hard, I literally say, I'm doing this out of self-respect. 'Cause I know it's good for me and it makes me feel better and it makes me feel more confident and stronger and I fit back into all my clothes again. - I love that. I love that incentive. I think for me, it's always like few clothes. So for me, it's like ooh, and then I get to wear this really fun dress and then I get to wear this. And definitely music always, always help. - 100% and listen to like good music. Like I have this mix, I'm gonna have to share with you. But it's really like, I think Spotify classes it, classifies it as female empowerment music. - I love that. - But it's a little bit like hip hop, ish. It's really great. I love it. I'm gonna share it with you. - Thank you so much for that. I would love that. And I'll try to put it in the show notes if I figure out how to make that music. You mentioned two things I wanna ask you a little bit more about. I really learned about the role of fiber. And like it's, it wasn't really a big, as big of a deal in my 20s and 30s. But then once you get into Perry Manipaz, why is fiber such a big goal? And how do we get enough of it? 'Cause 30 grams is a lot, a lot, right? - Yeah. So I'm gonna tell you something. It's gonna blow your mind. Like this literally, I was like so resistant to this. But if you are active, if you're lifting weights, if you have a lot of muscle mass, or you're trying to build muscle, increasing your carbs and decreasing your fat might be the key. And this happens in a lot of our patients who are trying to lose weight. Like we have a lot of women in Perry Manipaz who wanna lose weight. And most of the time, I'm telling them, 'cause a lot of our patients are on more paleo style diet. If you start tracking what you're eating, I can almost promise you, if you're paleo, that you're eating way more fat than you think, which is very calorically dense. And I'm by no means an advocate of a low fat diet. Low fat diet was just like high sugar, high processed foods, it destroyed us all. Forget it. We're not, this is not the low fat craze. But it is watching the amount of fat you get in all of your meals and increasing your carbs because usually the carbs are the things that have fiber. Now avocados, an exception. Avocado has a good amount of fiber and it's fat. But I eat oatmeal now, which is like, I don't know, if you knew me three years ago, I would have never touched oats. And I'm completely gluten free. But I do like oats with chia and that's a great source of fiber. But fresh fruits, fresh vegetables, and even grains, if you do okay with grains, can be great sources of fiber. I always say with carbs, they should be high in fiber. You want your carbs to be a source of fiber that makes them complex carbs, not simple carbs. I do eat some simple carbs sometimes now, which I never used to do. Like the idea of like eating a piece of bread, but if I don't eat, like I have to get enough carbs in my body to support my blood sugar, otherwise it's gonna dip now because I have more muscle mass. So I think, you know, the key to getting more fiber is eating fresh fruits, not dried fruits, fresh fruits, not fruit juice, fresh fruits, whole fresh fruit, and then fresh vegetables. Every single meal try to do some fresh fruits, some fresh vegetables. Not only does it have fiber, they also come with antioxidants and phytonutrients. But gone are the days when I tell patients like not to eat, you know, an apple or whatever. Like I think there's so many people out there who are conditioned to be really afraid of blood sugar spikes if they eat a piece of fruit. And you might want to pair your fruit with something, like a handful of almonds, but just like the idea of doing like a lot of nut butter. Like people would be doing like a couple tablespoons of nut butter, but like that really adds up in terms of caloric density. - Yeah, nuts and seeds, I feel like were my worst 'cause I would snack on those and then I would look at, I don't know, it was the sunflower seeds and I was like holy cow, like I just ate a handful of these and it's like so many calories. And yeah, I believe, and for my understanding, fiber is amazing because it helps to clear out a lot of toxins and also some of those toxic metabolites that our hormones can make. And it might not be as relevant when we're younger, but as we get a bit older, that is when we need to switch it up. And I feel like nutrition is a science and an art and there are therapeutic diets where perhaps if you are newly diagnosed with hashinotos, maybe you need to do this type of diet for a little while. If you're in parimenopause, you might want to switch things up. And it's like sort of like, it's the same things that you're doing aren't getting you the same results then you need to change what you're doing. I know for myself for a while, I'm like, but I'm doing the same thing, why? Why, everything happening this way? And it's like, okay, well, you need to change the things you're doing to get, you know, get a different help. - You want a different point. And I mean, back to the gut microbiome piece, like the number one thing we can do for our gut microbiome is eat fiber. - Yes. - And for the people who are like, do have blood sugar issues, you know, resistant starch is like a great way to get fiber and prebiotics, which is literally just like cooked and cooled stuff. So it's like cooked and cooled beans, cooked and cooled grains, cooked and cooled rice. I'll do like my favorite carbs are potatoes, rice often leftover, like I'll make extra cooked and cooled potatoes or a great source of resistant starch. And like green bananas, things like that. So yeah, fiber is super important for your gut microbiome. And just remember, your gut microbiome's changing when your hormones are changing. - I love that. I've loved using resistant starch and butorate as well as like aloe to help like recover some gut health. I feel like it works really, really well for me personally when I started to add a lot more fiber. I feel like my skin cleared up. I had this like chin acne that would pop up every now and then I was like, what the heck? It's just fiber really, really helped with that. - Yeah, it probably helped. Yeah, see it's like helped with your hormones. Yeah, the acne piece is so interesting too in paramanopause. Yeah, that's like a whole other. - One extra gets what we didn't ask for, right? So we talked about lifestyle changes. We talked about hormone replacement therapy. We didn't talk a lot about supplements or some of the other therapies. Do you have some time to maybe get into those, the things that you like to utilize in your approach to paramanopause? - Yeah, I mean, the basic stuff is always important. Like a good methylated B complex, a vitamin D3 K2. We want to think about bone health. K2 is really important. I don't put people on calcium at this age. It's really generally not something I recommend. But methylated B complex D3 K2 magnesium, fish oil. Like those are very basics. A probiotic can be super helpful. I'm a big fan of spore-formed probiotics. Not every probiotic, I would say if you're a woman in paramanopause and you take a probiotic and you feel like, oh man, this may be more bloated or whatever, it's maybe a sign of SIBO. Like sometimes different kinds of probiotics aren't actually what you need. Same with fermented foods, right? It's like what everybody does. Fermented foods and probiotics and you're like, "Good, worsens the histamine stuff." So it listened to what happens and used that as a clue to what's going on. But yeah, those are the basics, I think, when it comes to paramanopause, I really like creatine. I mean, even outside of paramanopause, but I use creatine when I left all the time. And it's super easy to use, super simple. I also use collagen. I think collagen's great for hair scale skin nails and gut. It's also good for bone health. So I personally do collagen. Like after my workout, I'll do a protein shake with collagen in it, but just FYI, I don't think collagen counts toward your protein macros. It's just like a little added bonus. I do a different kind of plant-based protein personally. So I'll do like three scoops of that plus collagen and I'll do creatine when I work out in my water bottle. So those are some big ones. Like I used to use a lot more chase tree than I used now. Sometimes I'll use it. Sometimes I'll use dim. So for women who are on estrogen, dim can help you metabolize your estrogen in a more favorable way. But I generally don't use it unless women are taking estrogen in this age group. So if women really have more estrogen, then they need, and they're having these like fluctuations, high low, high low, which is characteristic of a lot of women in paramanopause. That's when I try to balance it with progesterone versus depleting estrogen because dim will make you get rid of your estrogen or process it a little bit more quickly. I'll use dim and women who are on estrogen. Actually, when I started HRT, I had some pimples, like literally for the first time in my life around my jawline, and dim helped, because it just helped with that estrogen processing. But it's like any imbalance can cause acne. It could be from progesterone. I've seen it from progesterone. It could be from. It could be from testosterone, like it's kind of hard to know. But yeah, so those are some of the big ones. Let me think of what else? Like I literally have all my supplements behind me. I'll use digestive enzymes, that's another one. So as we age, we tend to have more increased rates of something called PEI or pancreatic acochron insufficiency. So using like some digestive enzyme to help your pancreatic alastase can be helpful. If people struggle with like fat malabsorption, I'll use like ox bile or something to help with that. I really like bitters too, just to help with like good, good healthy digestion. I mean, you could take a fiber or a prebiotic supplement as well. I don't use that as much just because I try to aim for food as the main one. I mean, in my patients, it's like, what's your blood work say? Like do you need more iron? Do you need more B2? Sometimes, you know, patients have a high homocysteine. It's like, I'll use more B2 or more B12 or, you know, like a folate Lawsinge or whatever it is. But it really is, it's nice to have some actual data. So you're not shooting in the dark. Because when you're shooting in the dark, I think when it comes to supplementation, it's like, you can just take stuff and the majority of people, like me and a methylated B complex official magnesium and D3K2. But like, it's nice to have some data and know how to personalize, you know, your supplements so that you know exactly what you're getting. Because like iron, for instance, some women need iron and some women don't. Some people have too much iron. You know, sometimes zinc is another big one I'll use. Sometimes I'll use selenium and an acetol. Like, you know, we have so many tools. And it just really, that's like where it's like, I don't like to shoot in the dark. I want to know what's happening. And if I have a patient with a lot of blood sugar issues, probably going to use an acetol. And if our burberry, in burbrines, great one too. But it, yeah, it just really depends on the person. I love that you have such a huge toolbox of things that can be utilized to help various symptoms or struggles that people are having with. So you mentioned testing. You do testing of hormones, blood work for that. And do you do any kind of like fancy functional medicine tests for nutrients? Or do you do blood work for that as well? Mostly for nutrients, I'll rely on blood work. Most of my patients will do a really comprehensive blood panel. And then we'll do, I like organic acid testing, stool testing, cebobrath testing. Sometimes I'll do the Dutch urine test for comprehensive hormones. But I honestly rely on it less now than I used to. Typically for perimenopause symptoms, I would rather just check your blood work. Like, four separate times versus having a one moment in time comprehensive lab. Now, I still use that test. And I especially like it when somebody is on hormones so that we can see the balance. And we can see phase one and phase two of estrogen detoxification. The stool test lets me see phase three of estrogen detoxification, which has to do with beta glucoronidase. And then of course, we'll just talk like, are you having a bowel movement every day? That's really important back to fiber. Like, you should poop every day. And fiber will help. But, yeah, so those are like the big labs. The big labs, OAT helps me understand nutrients. So I can see from that if somebody needs more B2 or B12 or folate or coq10 or carnitine or glutathione or whatever it might be. And I do lots of fancy functional medicine testing depending on the patient. Like, if we need to look at mold or heavy metals or things like that, we can always. Yeah, I like tests for the oral microbiome and all sorts of stuff. That's really great. And I feel like you have such a large toolkit because different people might have, might have parimenopause, right? But there may be some additional drivers in their lives. For example, having mycotoxin exposure might make their parimenopause symptoms worse. Or if they're nutrient deficient in something that can make their insulin resistance worse, right? And so really dialing things in versus just being like, okay, everybody get on this hormone plan. Or everybody just, you know, this, this is a lot of sense because then you can really dial things in for people because I feel like. A lot of things may be come to surface during parimenopause that were perhaps there and we were just. I don't know, dealing with 100%. We had more resilience. Yeah, like in parimenopause, it's like you just strip away that layer of resilience. And you kind of like things kind of come to, you know, you can only like ignore it for so long. And that's why I love functional medicine and like I love this approach that I get with patients. And it's like great hormone optimization, but we don't stop there because we're going to look at your gut health and your nutrient levels and like toxin exposures and all this other stuff. Because it really does make a difference. I mean, I thought I was trying to come up with a way to just have a parimenopause program. I just optimized hormones, but at the end of the day, every time I do blood work and all these labs on patients, I find something. You know, there's some fungal overgrowth in your gut where there's bacterial overgrowth or there's Hashimoto's that you didn't know about or there's always something. So having a really comprehensive approach and a big toolbox is kind of awesome. Yeah, I really appreciate that about you. I'm going to ask you some rapid fire questions, but I would also love for you to tell people where they can find you and learn more about your work. Or if you have any kind of links that you wanted to share with us or then I could share in the show notes. We're going to share my playlist with you all. Amazing. You should totally listen to it with me. Find me at Dr. Christine Marin on Instagram. This is mostly where I am. I'm also on Facebook and my website, Dr. Christine Marin. Fantastic. I have a few questions. Are you taking new patients and how can I become your patient? Do you see people virtually? Yes. So I see patients virtually in Colorado, Michigan and Texas. Those are all states where I'm licensed. I'm a fully licensed physician in all three. So just head to the website. I do hope to expand that. I'm not telling medicine laws. We're working on it right now actually, but telling medicine laws are a little bit archaic. But yes, I see all my patients virtually one state at a time, right? It's a lot to manage all the different licenses. Yeah, pharmacy licenses are similar. So it's like one country, but the rules and different. Is a weighted vest safe for us to your parosis patients such a great question. I would say for sure it'd be awesome. When I have a patient with osteoporosis, there's like a few things. I'm like weighted vest, strength training, creatin, collagen, D3K2, magnesium. You can also do some other stuff like tertiary juice might help. There's a few other like kind of things that you can do for that, but hormones are the biggest deal. Like estrogen, progesterone, testosterone, optimize them all. That is super important for bone health. I think a weighted vest is totally safe. Amazing. Thanks so much for that weight bearing exercise. It's like so great for osteoporosis, right? I tend to be estrogen dominant with almost non-existent testosterone or progesterone. Any thoughts on that? Yeah, I would love to give you testosterone and progesterone. I mean, it's, yeah, it's like just replace them. Like you don't have to suffer progesterone, micraniased progesterone at the regular pharmacy or you can get it compounded. Don't use medroxyprogestero and acetate. And if you're cycling regularly, you could just use it in the second half of your cycle. If it's really helpful, you could use it for the whole cycle. And for women who have irregular cycles, just use it all the time every night. But it will make you sleepy, so it's something you want to use at that time. And the thing with estrogen dominance, it could be simply because you're progesterone deficient. And then you'd need more progesterone or you could have just like way too much estrogen. And so you would want to clear that out or you could have like a combination of both. So there might be few different patterns to think about. Is that, is that right? Yeah, I mean, I usually say it's progesterone deficiency. It's probably like the estrogen dominance is really just progesterone deficiency. But yes, there is this element of like gut health. How do you metabolize your progesterone? This is where it's like, depending on how high it is, like you could try something like dim detox because it's got dim and calcium deglucrate and some liver support. But generally with a patient like that, I would just first start with progesterone like fiber. And make sure, I don't know if you go to the bathroom every day, you should poop every day. Make sure you're supporting your liver, stop drinking alcohol or minimize it. Because that will definitely impact some of that and how you metabolize things like estrogen and other. Any kind of toxin really. This next question is kind of interesting and I have an opinion on this. I'm not sure if it's from the United States, but is it safe to get over the counter medicine for low test testosterone? You know, in the US, we don't really have over the counter medicine for low test testosterone. I mean in other countries, I would work with the physician on that. Like, you don't want to mess around with that, right? Yeah, I would say don't mess around with that. You don't really know what you're getting. I think you can get like some gray market, like black market testosterone on some sites probably, which I would stay away from with testosterone, different women tolerate it differently. If you start testosterone and you go too high too fast, a lot of times people will get acne or hair loss. That is a risk. It depends on this enzyme called bivaltheroductase activity, which is a reason I do that Dutch test. But you could just start with a I I prescribe a topical testosterone gel or cream and you know, slowly tight trade up and you can use your labs for that lab values aren't perfect, but they can help. You want to check your testosterone before you start though, like you definitely want a baseline level. Do you ever recommend supplements maybe in the beginning stages of perimenopause instead of utilizing hormones? I tell my patients like this isn't a dictatorship like I take feedback so this is your plan that mine I'm just here to guide you so if I have a patient who really doesn't want to take hormones yeah sometimes we'll use supplementation so one of the over-the-counter testosterone question might have been referring to DHA sometimes we'll use DHA as a precursor to testosterone you have to be careful with it because it can cause hair loss and acne in certain people most people tolerate it well most women many women at a lower dose but if you go too high it can cause side effects so in a patient who is perimenopausal who doesn't want to take hormones I would work on all the other foundational health stuff probably do like depending on labs it really you know for DHA's low or her testosterone's low I would try that not all women make testosterone from DHA but many do just when it's like it just depends kind of thing chase tree could potentially be helpful that's vi-tex is another means of vi-tex yeah love that those are some great suggestions so let's see and thank you so much for being here with us few rapid fire questions for Dr. Christine what the wellness hack you refused to participate in cold lunch I'm with you on that a lot a lot of thyroid girlies are just you know that's not on our list right I am not watching I don't know I'll go on the sauna yeah I'm like I will modify a cold plunge by making it a hot bath with ex-insolves like that's my version of it and totally the most outlandish thing you've ever tried for your health oh well it probably is related to mold exposure and this is not a fun experiment or one that I took very lightly at all but we'd mold exposure which is part of my health history and part of my like really health trauma honestly like mold causes a lot of PTSD and like we had to get rid of like a lot and when our house flooded if it was wet it was gone like normally what happens is insurance companies are like dry it with fan no so basically we ripped our house apart that was kind of outlandish and you don't want to take the risk because you know how bad you felt when you were deep that you were just like no stuff is important it's important enough to mess with my health and my family's health yeah totally it's not when I take lightly at all of course it's a big deal but yeah I'm sorry that you went through that and I'm so glad that you're on the other side and you also help a lot of people we didn't talk too much about that today but you help a lot of people with mold toxicity as well yeah if you had to live on one healing food forever what would it be oh my gosh this is gonna make my right hand woman's man the laugh chicken right chicken fair enough really good quality chicken but I am a protein girl now and I like my muscles and I need chicken to preserve them love it and you've had an amazing photo shoot of all the progress that you've been making that you were sharing with yeah fun and you're I will be in strong magazine soon so that's it was really fun shoot and yeah just like seeing the photos is like whoa wild I'll send you some fun ones later congratulations I'm so proud of you thank you rooting for you okay your biggest moment on your healing journey okay here's one part of my healing journey was like root canals like trust me I've been through like so much stuff right so that was like the beginning of my demise was really these like two root canals I had and I later had them extracted and had them replaced with zirconia implants and crowns but the biggest oops was when a peridonist told me to add like a couple drops of bleach to my water pick and I neglected like then I did a GPL Tox test so I do this test to look at like Toxin markers for like you know all the things my perchlorate levels were like through the roof and I was like what is that about I mean I don't even I don't like clean my house with bleach like I have all this like holistic stuff and it's because your mouth absorbs stuff it absorbs everything you know so I was getting exposed to like a ton of perchlorate terrible right oh my god wow yeah I feel like you and I have had conversations about dentistry and they haven't been that we haven't been super excited about some of the things that happen what supplement the cake supplement police medication police came to your house and we're like we're rating all of your stuff but you can keep one thing what would it be okay it's probably one most people have never heard of but it's called hu 58 and it's from microbiome labs so they have my favorite some of my favorite got supplements so mega-sport biotic is one that I think a lot of people probably heard of and they make this one called hu 58 that's like a more antimicrobial probiotic so I really like it or can I have to yes yes of course mega-ig 2000 I would keep that as well so like a serum derived immunoglobulin or SBI protect I like those both and mine like I'm all about like the gut like a lot of my journey has all been like gut health, SIBO, IBS all that stuff I think you introduced me to SBI serum based in uniblobulin my husband was diagnosed with ulcerated colitis and that was one of the things that got him in remission I have that in my house all the time my son had the stomach flu and we used SBI bullardi and what was the throw so fran and it was like okay it like stopped in its trough it's it's in full stuff so mega-ig 2000 an SBI protector really like basically the same thing they both come from the same supplier and they're both yeah yeah it's it's like it supports your immune system and your gut immune system unlike the lost run but without like a theory so I want to check out hu 58 that's not on my radar but I'm like add to heart do you have a guilty pleasure that maybe is in doctor approved people would see you out the where and be like is that doctor Christine Marin oh yeah nails it's called my name I have these two yeah I love it yes I am like I'm an 80 20 kind of girl you know it's like I I try to have just balance in my life you know I think I've taken my health too far and been at the point of hypervigilance and that was related to the mold and like just it really created like hypervigilance and PTSD and I'm like I got to fix my nervous system like this sucks like my kid would spill a glass of water and it like you know I'd be like freaking out so anyways I really live in a place of like yeah I try to have some moderation and I really like having my nails done lately I love it next time we see each other let's get a man he will go get our nails done last time I was at the nail salon I actually ran into Jill Carney and I was like this is so funny let's not take a picture though but we were both getting our nails done I think she was getting pretty good yeah black male photos right I love it thank you so much for taking the time to send this afternoon with us to answer some questions to tell us how to thrive in parry menopause I really really love the inspiration that you bring to so many women I hope that you write a book I'm so so excited for everybody listening I hope this has been a healing conversation please make sure you check out Dr. Christine Marin on Instagram and Facebook and her website so I'm a huge fan and hopefully this has been a healing conversation for you thank you so much for having me it literally is one of my favorite things talk to them are you tired of managing symptoms without results don't let unresolved health issues control your life join the root cause reset program at thyroidfarmises.com slash reset and get to the root of the problem