OT Pioneers: Intro to Pelvic Floor Therapy for Occupational Therapists
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Pelvic OTPs United -- Lindsey's off-line interactive community for $39 a month!
Inside Pelvic OTPs United you'll find:
...
OT Pioneers: Intro to Pelvic Floor Therapy for Occupational Therapists
____________________________________________________________________________________________
Pelvic OTPs United -- Lindsey's off-line interactive community for $39 a month!
Inside Pelvic OTPs United you'll find:
...
--Transcript--
Lindsey Vestal: (00:00)
I am so honored to welcome a personal friend and certified women's health coach writer, speaker, mentor, and creator of fix your period. A series of programs that empower women and mens trader to reclaim their hormone health, using a method that combines evidence based info with simplicity and SAS. Yep. I am talking about the one, the only Nicole Jardim her work has impacted the lives of tens of thousands of people around the world in effectively addressing a wide variety of period problems, such as PMs, irregular periods, P C O S painful and heavy periods, missing periods. And more. The thing I love about Nicole is that she treats women and mens by addressing the root cause of what's going on in their bodies and minds. She passionately believes that the fundamentals for healing, any hormonal imbalance lie in an approach that addresses the unique physiology of every person.
(01:04)
I don't know about you, but this is absolutely essential to reclaim and maintain optimal health and vitality at any age. It is my absolute pleasure to welcome Nicole. On today's episode, new and seasoned OTs, our finding their calling in pelvic health after all what's more ADL than sex, peeing and poop, but here's the question. What does it take to become a successful fulfilled and thriving OT in pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions and this podcast will give you the answers. We are inspired OTs. We are out of the box OTs. We are pelvic health OTs. I'm your host Lindsay Vestal, and welcome to the OTs and pelvic health podcast. Nicole, I am thrilled to have you on the OTs for pelvic health podcast.
Nicole Jardim: (02:08)
Thank you so much, Lindsay. It is so great to be here with you. I'm just as thrilled as you are.
Lindsey Vestal: (02:14)
Oh my gosh. This conversation has been a long time coming and I am so thrilled to have this container to talk about. I'm gonna focus on sort of like what your jam is and what I continually learn so much from you about which is hormones. <laugh>, uh, your book fix your period has been like a Bible for me. And so many of the OTs I support, uh, your podcast. I've, I've been, you know, listening to it for years. Your blog. I could go on and on I'm
Nicole Jardim: (02:44)
Right now. So
Lindsey Vestal: (02:45)
Without further ado, I'm just gonna, we're just gonna get right into it because I am, I've got so many questions
Nicole Jardim: (02:51)
Queued up for you. <laugh> okay, great. I am so excited. Thank you for all those kind words. I mean, I I'm truly grateful for anyone who supports my work. I'm just always blown away by it. I'm like, really? You like me? That's so awesome. Oh
Lindsey Vestal: (03:02)
My God. No, there's this, you're having conversations, groundbreaking conversations that we need more of in the world. So I am internally grateful. Thank you. So we're gonna hit the ground running here and yeah, I mean, we gotta start with, we gotta start with menstrual cycle. We gotta start with hormonal issues. So what I would love to know is when we're looking, when we're trying to figure out hormonal issues, right, mm-hmm, <affirmative>, I've often learned from you that the menstrual cycle is a great starting point. So can you tell us a little bit, how does hormonal imbalances show up as period symptoms?
Nicole Jardim: (03:38)
Oh my gosh. Yes, absolutely. I think the thing for us to remember is, and we're gonna talk about this is the fact that there's this hormonal hierarchy, right? And I talked about this in my book and I felt like it was an easy way to explain that everything is interconnected. All of our hormones are talking to each other pretty much all day, every day. Uh, no hormone exists in a vacuum. It's not like we just have estrogen dominance or we have high testosterone or low progesterone for no reason, right? They're all having a conversation and they're all influencing each other in a major way. And so the menstrual cycle is a great way to see when there are hormonal imbalances. But what so many of us don't realize is that hormonal imbalances start at the top of the hierarchy and that's with cortisol and insulin cortisol, being the stress, hormone, insulin, being the blood sugar hormone.
(04:30)
And when you think about those two hormones, I want everyone to think about what comes to mind and, you know, you think about mental and emotional stress. You think about what you're eating that might be causing your blood sugar to go a little haywire. And then you think about our modern world and how ubiquitous both of those things are. And the fact that not only are they so ubiquitous it's that we have now normalized so much of it as well. So when you think about what our stress, for instance, and the fact that we're all stressed and kids now are stressed and things that we never imagined like 30, 40 years ago are, are happening to us on, you know, in what feels like in an unprecedented way. So we're, you know, we're, we're kind of all maxed out and so we've, but we have completely normalized this, right?
(05:17)
We've normalized this busyness, this constant go go going, uh, we've normalized, not taking a break, not sleeping properly, not resting. And that has had really detrimental effects on our menstrual cycles and our fertility. And then on the other side of that, we have insulin, the blood sugar hormone. Uh, we have normalized, um, drinking coffee, for instance, first thing in the morning before eating anything just so that we can get going. We've normalized, like not sleeping enough, you know, just getting four or five hours a night of sleep. Uh, we've normalized eating tons of sugar, particularly children, sorry, I'm gonna say it. <laugh> no judgment, but it, it definitely is a, a problem. And I see it over and over again in my clients, who've been eating like that since, you know, they were kids and now they have massive health issues related to their hormones and their cycles.
(06:07)
So we have these inherent problems and there's this trickle down effect, right? So those two queen B hormones, as I call them, have an impact on our thyroid. Uh, they have an impact on our menstrual cycle hormones, our estrogen testosterone, progesterone, um, our melatonin, which is our sleep hormone. So we end up with this, this like cascading effect down to our menstrual cycles. And so the problem is, is that if you are having menstrual cycle issues, that is a very good sign of hormone imbalance, but it's not necessarily just your sex hormones, right. It's those other hormones as well. Cuz they're the ones that I think have the, the biggest impact on our bodies. So it's, it's kind of multifaceted, but hopefully that helps explain that. It's not just like progesterone for instance.
Lindsey Vestal: (06:56)
Wait a second. So are you saying that those glorified queen bees, which is the insulin and the cortisol are tho are those are also hormones?
Nicole Jardim: (07:04)
Oh hell yes. Oh yes, yes, yes they are. And so that's a thing that I think is again, so fascinating, right? Is that we don't really talk about their impact on the body. Right? We're just, we talk about cortisol as being the stress hormone and, and you know, our body, basically when we're under stress, the adrenal glands release cortisol, they also release other stress hormones like epinephrine and no epinephrine and D H E a, uh, and, but cortisol is, is the most well known one. And so it's not only utilized at, for stress, like when your body is stressed, it's actually part of our whole circadian rhythm as well. So when we're functioning normally and optimally cortisol rises to its highest peak early in the morning when we wake up and then, you know, kind of tapers off slowly throughout the date, and then it reaches its low, uh, you know, after midnight. And then, you know, we go up and down and up and down, depending on our, our light exposure and our darkness exposure. And of course our stressors as well. Um, and then insulin as well, same thing it's released by the pancreas when we eat food to, um, shuttle glucose to ourselves so that we have energy to think and to function and to do all the things. So yeah, like they are, and they're just, and they're so critically important, but they're often just sort of not even paid attention to is what I feel like,
Lindsey Vestal: (08:27)
No, you're right. Because we, we think about the sex hormones. Most, I, at least that's what I feel like is out there in, in, in media. Right. And the thing that's amazing that you just brought to my attention was like the, how we do glorify the overstressed overworked, culture of coffee, and always being busy. So it's not just that it's, we've normalized it. We actually put it on a pedestal in many ways, not realizing that it's the fastest road to burnout and mental, mental health issues, physical health issues. And so then we're wondering why when our body, you know, finally gets our attention and says, Hey, come on. There's something, there's something we need to do different. We wonder why. And so I actually am so glad you went there and talked about kids because that's that opportunity to really start educating from the beginning, whether we have children or not, whether we work with children because it's, it starts from those habits. So early on,
Nicole Jardim: (09:26)
So early, I couldn't agree with you more. And I think that we think that kids are super resilient, which they are. There's no doubt about that, but I, you know, I, I'll never forget looking at a video many years ago when this sort of first became or came onto my radar, where there was, you know, I, I was aware of the dyes that are in children's foods and the share amount of sugar and the preservatives and all of these things that are in kids' foods, particularly in the us that don't necessarily exist in, in other countries with stricter regulations around ingredients, in food. And I watched this video of, um, children after they had been fed sugar and they were all melting down and losing their minds. And they were like little, small, crazy people running around. It was on a playground or something like that.
(10:14)
And people were crying and they were just losing it. And, and I was thinking, wow, you know, if you've ever witnessed that, that is a blood sugar high and then a blood sugar crash. And it happens to us adults too. We just know how to handle it in a social situation, a lot better <laugh> than kids do. Although I think if we all acted that way, we would probably bring much more attention to the problem of, you know, blood sugar dysregulation and how it impacts pretty much everything in our bodies. And truly is the, to me, the crux of the chronic disease issue that we are facing in the us and the world, really,
Lindsey Vestal: (10:52)
That is, that is fascinating. That is fascinating. So I wanna bring it back a little bit to the sex hormones. Um, yes. Now that we've expanded our view and, and learned a little bit more beyond them, just because I think we always hear so much about estrogen and I feel like it's also become very wide known that, you know, we couldn't be estrogen dominant and I'd love to know Nicole, if you could tell us a little bit more about what that means for our bodies, what symptoms we would have if we were experiencing estrogen dominance.
Nicole Jardim: (11:22)
Oh yes. Oh my gosh. Okay. So this is such a great question and I love it so much because estrogen dominance or estrogen excess or high estrogen is very confusing to a lot of women. I hear this all the time. They're also confused and I get it because when you think of that, you just think, oh, that just means high estrogen. Yeah. And, but that's all I know. Right. And so the idea here with estrogen dominant, so everyone understands is that estrogen dominance really just means that estrogen is high in relation to progesterone it's sister hormone. And so think of estrogen as your builder hormone, right. I, I kind of, I like to joke that estrogen is the hormone that builds the house and progesterone is the hormone that comes in and decorates the house. And we all love progesterone cuz who doesn't love decorating, but estrogen really is the builder hormone in that it's going to stimulate the uterine lining to grow and then progesterone comes in and just sort of makes it nice and fluffy for a potential fertilized egg.
(12:21)
And when you think about estrogen, um, there are multiple scenarios and I think that's the, or when you think, sorry, I'll say this again. When you think of excess estrogen or high estrogen or estrogen dominance, I feel like there are multiple scenarios that we have to consider. Right. And so, um, the first thing is that estrogen is, um, it can be high. Like it can actually be high by itself. And, uh, and if progesterone is normal, um, that still means that you're in an estrogen dominant state. And so you could also have low estrogen, but even lower progesterone. And you're still in an, an estrogen dominant state. So you can be high estrogen or low estrogen. You could have normal estrogen and low progesterone and all of this still means estrogen dominance technically. Um, but I feel like we, I, I kind of sometimes think, wow, should we, should we be moving away from this terminology because it is so confusing and just really focus again on those bigger hormones, right?
(13:27)
Because you can be in this estrogen dominant state and it doesn't necessarily change what you have to do in order to get these hormones back into balance. Uh, so ultimately, um, with that, with the estrogen dominant situation, I just feel like we still have to work on our cortisol and our stress issues. And we still have to work on balancing our blood sugar and supporting our insulin production. Um, and you know, we still have to work on probably our gut health and all these other things, our nutrition. So it, I just don't want everyone to get too confused about that. And too hung up on the fact that there, you know, there is this, this estrogen progesterone, uh, Seesaw type thing that's happening in our bodies. Um, I think the other thing too, to consider as well, and this again, is, you know, in, when you're looking at this bigger picture of estrogen and progesterone and all these other hormones is the man made chemicals that we're exposed to.
(14:27)
They're so perverse in our environment, they can be found everywhere. And many of these chemicals mimic estrogen in the body at the estrogen receptor site. And so this can cause an artificial rise in overall estrogen levels. And so this is a situation where estrogen is also potentially dominant over progesterone. So we really do require a multifaceted approach. I think hormone testing can be really helpful in, in this instance to see what is happening in the body. Um, so yeah, that's kind of what's going on with estrogen and progesterone and in that, when you're thinking of that estrogen dominance situation,
Lindsey Vestal: (15:03)
What I hear you saying Nicole to me is so OT, because what you're really talking, talking about is a holistic picture. You're talking about taking a step away from, oh, I've been told I have excess estrogen and going, well, we're gonna take a look at some of the other players involved here and look at it at the big picture that it actually is. And then we're starting to, you know, prioritize, is it, you know, is it gut health is, you know, what's the interplay of manmade chemicals. Like we're really looking at it in this, you know, much more holistic lifestyle behavior way, which can be so life changing and beautiful to embrace. But I would imagine also a little bit overwhelming for people who are just starting down this journey.
Nicole Jardim: (15:47)
Oh, I could not agree with you more. And I think that, that's why I like to move away from these, from nitpicking, these hormonal imbalances, right? Because then women are like, well, is it estrogen dominance? Is it progesterone efficiency? And I wanna say that the symptoms of high estrogen and low progesterone are essentially the same. Right. So I would say that one of the things I've noticed, um, is more of an exacerbation of conditions influenced by estrogen like uterine fibroids, endometriosis, and adenomyosis, as well as breast pain and swelling. Um, you might notice those things if you're in a more estrogen dominant situation, meaning your estrogen is high or it's elevated due to like the manmade chemicals or, um, it's elevated due to insufficient breakdown of estrogen in the gut or the liver. So, you know, there's, there's multiple facets, but if we move away from labeling these hormonal imbalances and just really, like you said, zooming out and taking step one and just building on those steps for healing, like we start with the food and then we look at our mental, emotional stress.
(16:55)
And then we're looking at our gut health and our liver detoxification pathways and, you know, and all the, you know, I could go on and on our thyroid what's going on there because your thyroid actually is really influenced by high levels of estrogen, low progesterone in the body. So there's, you know, multiple facets, but ultimately at the end of the day, like what's causing the estrogen progesterone imbalance in the first place. It's the, it's all of the stressors that are in our environment, whether those are physical or mental, emotional stressors, and ultimately what's happening. The reason we're in that estrogen dominant state, low progesterone state is that we're likely our bodies are likely not ovulating consistently. And so when you ovulate consistently, you're producing enough progesterone to balance out the estrogen. Um, granted, like I said, you know, there's environmental chemicals, there's gut and liver issues. So there are multiple factors. But what we have to be looking at is is this person ovulating. And if they're not ovulating or if they're not ovulating consistently, why would that be? And again, we come back to the overarching theme of cortisol and insulin.
Lindsey Vestal: (18:03)
<laugh> I have to do a shameless plug for your book here because <laugh> that little, you know, beautiful summary that you gave us, you really do an incredible job of outlining those steps in a really systematic way. So for anyone feeling overwhelmed in, in some of this conversation, which is really a natural reaction Nicole's book breaks it down in, in such a step by step beautiful way.
Nicole Jardim: (18:27)
Oh, thank you so much for saying that I was, that was really my goal with it. I really, I, I feel I had like 20,000 more words, but then I had to cut them all out <laugh> but I, you know, I really wanted to try and explain what feels or at least what felt to me like really hard concepts back in the day when I was trying to understand this. And I think that one of the biggest problems in women's health is that we're told to just lose weight or we're just getting older, or this is just what postpartum is supposed to be like, or this is just what your period is supposed to be like. And we're kind of sent on our way without any real explanation as to what is going on. And that was a thing that irked me the most in my twenties and thirties, trying to find help for the problems I was dealing with. And so that was why I was like, all right, I'm just gonna write a book that explains all of this in a way that makes sense to people, hopefully. Um, and so they have a place for answers if they are questioning things.
Lindsey Vestal: (19:20)
I love it. I love it. I'll definitely link to your book in the show notes. So you briefly mentioned testing hormones, and this is a, I think this is a really important topic, you know, in pelvic health, we often recommend our clients test their hormones. Um, and so I'd love to hear from you, um, what are the best ways that we can do this? And when in our cycle, is there an optimal time that we should test our hormones?
Nicole Jardim: (19:47)
Yes. There are so many things I could say about hormone testing. Um, I would say the first thing is that there is so much confusion about it. And I've really thought about this a lot over the years after working with a lot of different women from all different backgrounds and, and really trying to, and then of course also talking to so many online as well, and just really trying to come up with a, something that made sense for people. And I would say that there are multiple scenarios. The first is that I feel like a hormonal baseline can be so helpful. And when I say hormonal baseline, I mean, what's going on with your hormones? Like, what's your baseline. And determining that is actually relatively easy to do. The problem is, is that we're working within a system where doctors don't do this. They they're not interested in any of this.
(20:39)
I mean, the majority of them aren't and this isn't to knock all doctors because I get it. Like I get that, this isn't how they're trained. So I, I understand, but I do think that if we have the ranges of these hormones, cuz when you look at your test results, you can see, you know, ranges for them, normal ranges for them. Then obviously there's been studies that have been done on them and they people have used them as, you know, as a gauge for determining what's going on with a person's, um, overall health. So with all of that said, I, I think that you can, you can get basic hormone testing done. And I, I actually have a, a hormone testing cheat sheet that I have on my website because I feel like this should be accessible to everyone. And so I, you know, I recommend a few things.
(21:26)
I think if you are just kind of wanting a baseline and you don't have a lot of help in terms of, uh, you know, your doctor being able to help you out understanding the test results and things like that. Then I would say that you might wanna just go down the root of getting serum or blood testing done. And so blood testing for hormones is old school, very reliable. Um, it'll tell you the basics that you really need to know. And so what I usually suggest is between days three and five of your menstrual cycle. So that's like day three to five of your period. So somewhere within there, you wanna test your FSH and LH that's follicle, stimulating hormone, and that's Lutin hormone. Those two hormones come from your brain. FSH is stimulating the follicles on your ovaries to basically get an egg ready for ovulation.
(22:17)
So you wanna make sure that your brain is communicating with your ovaries and you'll be able to tell that from those two hormones, um, and you wanna make sure it's communicating efficiently, right? And so if those two hormones are high or low in that window, that day three to five window, that can tell you a lot. And I, I don't think I can go into all of it because we don't have tons of time, but, um, I've talked a lot about this on, in my blog, on there, on my website as well as on Instagram as well. So there's a lot of information. And then you also at that time, wanna test estradiol. So that's your most potent form of estrogen in your body, in your cycling years. And that includes perimenopause too, by the way, just so everyone knows you're still cycling during perimenopause times in your forties for, for most of us.
(23:03)
Uh, so you would wanna test those three hormones, your estradiol, uh, is that estrogen, right? So you wanna see where that's at because it can have an influence on FSH and how it's functioning. So you just wanna make sure it's not too high or too low during that time. And then, um, when you get to ovulation again, you can kind of test your hormones at that time of the cycle as well. Again, like there are normal ranges on your test results for each phase of your cycle. So that early follicular phase, the days three to five, like I mentioned, the ovulation and then the Lal phase. So that is post ovulation and that's a time you really wanna test progesterone. And I also recommend testing estradiol at that time too, to see what's going on with it. And so you really we've been told to test on day 21, right?
(23:55)
I'm sure if you're listening, you've heard that before, test your progesterone on day 21. The problem with that is that it's a very outdated way of thinking of progesterone because hardly anybody <laugh> ovulates on day 14 consistently every single month. And so if you're ovulating on day 14, they say, test your progesterone on day 21, 7 days post ovation. And so that's very confusing to people because some of us don't ovulate until day 21. Some of us ovulate, even later, if we have a condition like P C O S for instance. So it's really important for us to kind of have an idea of when we're ovulating. I recommend using a basal thermometer. Um, I've talked about this extensively online and in my book, and the idea is you're taking your temperature every morning so that you can see when your temperature goes up and that's when you've ovulated again, you don't necessarily need to do that.
(24:46)
You can also observe your cervical fluid changes like that. Very wet consistently consistency, cervical fluid actually indicates that ovulation is approaching. And then when it dries up or gets sticky or tacky, it means ovulation is likely occurred. And so you can base your ovulation window on those symptoms and then count like five to seven days post those, those symptoms that time in your cycle and then measure your progesterone then. Um, and so that's what I would say to anyone who is curious about that, that will give you a, an adequate or an like basically, um, a level of progesterone that shows that you have ovulated or not ovulated. And that's kind of what we wanna see. And so that way, like you can measure these hormones and have an idea of whether your brain's communicating with your ovaries, if it's doing it properly. And if you've ovulated in that cycle.
(25:39)
And then, you know, I think the other thing to consider too with hormone testing is that there is, you know, we're all unique and so we might need different things, but it doesn't change the outcome. And I know we all wanna do testing because testing is really glorified and, and everybody sings its praises. And I think that testing is amazing, but I also recognize that not everyone can get testing done for various reasons, or they just don't have access to the kind of testing that a lot of people talk about things like the Dutch test, which is a dried urine hormone test. And so I just think it's important for us to remember that it doesn't change what we will have to do in order to get our hormones under control. And that's the hard part. I think that that's the challenging part for a lot of us,
Lindsey Vestal: (26:23)
Excuse the interruption. It's Lindsay here. I just wanna pop in and let you know that I am so jazzed up that the very first OTs and pelvic health virtual summit is happening October 1st and October 2nd, 2022, head over to www OTs and pelvic health.com to learn more. I hope you join us. It's gonna freaking rock. So what would you recommend for people? So the Dutch test is something that, that I talk a lot about, but you're right. It, it may not be available or accessible to everybody. So what do you do? What do you recommend for, for people who, you know, would like some information, should they, should they just be looking to their body for signs and symbols and then go from there? Like, what are your, what are your recommendations for that situation?
Nicole Jardim: (27:11)
Well, I think it's a combination of things. I, I think that you can definitely ask your doctor for the testing. I feel like more and more doctors are open to doing testing, especially when you walk in there with confidence, <laugh> and ask and say, this is what I would like to have tested. And here's why, um, so I think that that's important. I will add on to the hormones. I just mentioned, I think that, uh, testing your androgens, like your free and total testosterone, your D H E a, uh, dihydro, testosterone or DHT, particularly if you have symptoms of androgen excess, right? So that's hair growth on your face or hair loss on your head, or you've put on weight and you don't know why, and you can't lose it, no matter what you're doing, those are, are signs and symptoms of, of androgen excess as well as oily skin and acne and things like that.
(27:57)
Um, so I would, I would certainly add on those two and possibly sex hormone, binding globulin, S H B G. And so that's a hormone that binds to estrogen and testosterone and technically lowers them. So you wanna know what's going on with your S H B G depending on the symptoms you're experiencing. Uh, and so I would recommend that as a first step to people, uh, if, you know, they don't, they can't either can't afford a Dutch test or they, you know, that's, they don't have a practitioner who's trained to understand the Dutch test because that's the thing I've seen this so many times I have clients come to me, they've spent a thousand dollars on testing, but they don't have anyone to actually interpret the test. And they didn't realize that the tests were not easy to understand. And, um, and so I think that we, we tend to jump the gun a little bit and jump to step four or five when really we're at step one with that said, the Dutch test is obviously incredibly comprehensive.
(28:51)
I mean, it has that word in its name. <laugh> so it's definitely super comprehensive and can tell us a whole lot, but at the same time, blood testing can tell us a whole lot too. So it just depends on the person's situation, I think, and where they're at in the healing journey. Because like I said, I feel like what tends to happen is we jump to like step four mm-hmm <affirmative> when really we could just start at step one and make it easy for ourselves. And so we've gotten all this expensive testing and it's not necessarily telling us anything that we didn't already know based on the symptoms that we're experiencing. And as a health coach, I'm trained to look at your symptoms to really investigate and figure out what, you know, what might be going on based on all the symptoms you're experiencing. So you could do the blood work, you could do the symptom tracking, you could do the Dutch, you could do all three. It just is so dependent on the particular person and their circumstances. Mm-hmm
Lindsey Vestal: (29:46)
<affirmative> I love that it's client, very client centered. I love that.
Nicole Jardim: (29:50)
<laugh> I try.
Lindsey Vestal: (29:53)
So you mentioned the thyroid, um, and the menstrual cycle. Would you mind diving into a little bit about how the thyroid can contribute to some of the period problems that we're experiencing and how we can address that?
Nicole Jardim: (30:09)
Yes. Okay. So I think the first thing to remember when we're thinking about the thyroid, because I think when you think of the thyroid, you definitely don't think of period problems, but it's, so it plays such a critical role in our menstrual cycle. And so I think the first thing to think about, so everyone just, you know, put on your imaginary, just imagination, hats now, and think of these axises in the body, right? So we have the HPA axis, which is the hypothalamic pituitary adrenal access. And so that's basically your brain and your adrenals. So imagine like a line drawn between your brain and your adrenals, and then another line going back from your adrenals to your brain. And so that's that access, right? Your brain is talking to your adrenals. That's basically how everything functions in the body. And then we have the hypothalamic pituitary thyroid access.
(30:56)
So that's, again, your brain talking to your thyroid and your thyroid then talking to your brain, right? So we've got these feedback loop, feedback loops going, and then we have the hypothalamic pituitary ovarian axis. And so that's, again, your brain talking to your ovaries and your ovaries, then communicating back to your brain. So all these three axises have an obvious commonality, right? They include the hypothalamus and the pituitary. So when you're hypothalamus and pituitary are overburdened by stress, for instance, then there is gonna potentially be dysfunction, not only in the HPA access, but the H P T and the HPO access. And, um, I could talk about what happens to your ovaries next, but basically with the thyroid, there are multiple things, right? Like the effects of thyroid dysfunction are, are, are myriad. There's like a wide range of period and menstrual cycle problems. There's infertility, subfertility, there's pregnancy complications and miscarriage, and there's even postpartum thyroid dysfunction, which really has been on the rise for a long time.
(31:59)
So, um, when we're thinking about hypo and hyperthyroidism, so hypo is when neuro thyroid isn't, isn't working as well as it should. And hyper is when it's overworking, they cause all kinds of problems. And so we're looking at things like heavy periods, long periods, even short menstrual cycles. So cycles that are just shortening in length, um, irregular cycles in frequent periods, you might notice spotting before your period, or at other times in your cycle, you might notice short or even scanty periods, which are like little tiny periods, just spotting and even missing periods. So this is crazy, right? Because again, nobody really even realizes there's this huge connection between the thyroid gland and thyroid hormones and how our ovaries function and ultimately how our menstrual cycle will play out. And so what happens is thyroid hormones support pituitary hormone production. So they influence ovarian function, um, by, you know, grow supporting the growth of ovarian follicles and ultimately ovarian hormone production.
(33:06)
And then they also support healthy levels of something called goad, a Tropin releasing hormone, which is the hormone that comes from the hypothalamus that goes all the way down and talks to the ovaries and like, and has them do what they're supposed to do every single month. And it also influences sex hormone, binding globulin, or H B G, which is the hormone I just mentioned. And so all of this can disrupt ovation if imbalanced. And so when we have, um, irregular cycles, particularly, so when we have irregular ovulation, I find that that's usually a pretty good sign that there's a brewing thyroid problem. And so that's where, you know, we wanna make sure that we're stabilizing the, you know, we're stabilizing all the things I've been talking about, right? Like we wanna really look at our stress. Like I think it becomes, I don't wanna say life or death <laugh> cause that's a little dramatic, but it kind of is that in that you have to decide whether you're gonna stay on the track that you're on right now, burning out, or whether you want to, you know, really take a hard look at what's happening in your life and causing these endocrine lands to be so stressed that they're, they're kind of acting out because what I think the common misconception in our modern reality is that our bodies are broken.
(34:26)
Our bodies are betraying us. Our bodies are rebelling against us. They're doing this thing to us when in fact your body is just responding to a world that is really not conducive to optimal health. And that's a huge problem, obviously, because we all have to live in this world and it has become somewhat inhospitable to so many of us because of how challenging it is, you know, financially the amount of work we have going on the to-do list, you know, taking care of children of parents. If they're aging, I could go on and on and, you know, just, and forget like just like a random life crisis. You know, we, we have a lot of things happening, but I think that the problem is again, is that we've been led to believe that when our body is responding appropriately to these stressors, uh, it's, it's broken and there's something wrong.
(35:12)
When in fact it's actually just responding and it's telling us that something is wrong and we just need to pay attention to it and start to make changes to start to get back to homeostasis. So that's kind of, what's going on. I will say specifically with hypothyroidism, for instance, which is the most prevalent form of thyroid dysfunction. It, it disrupts that ovulatory process starting in the brain and it, what it does is it actually disrupts production of a hormone called prolactin from the pituitary and can raise prolactin, um, causing this elevated prolactin situation. Prolactin is supposed to be high postpartum, right? So when you're breastfeeding, it triggers breast milk production. We do not want high prolactin prior to being pregnant or postpartum because it will absolutely disrupt that ovulatory process. It's how we don't ovulate postpartum. We have high prolactin. So what I see is oftentimes really high prolactin in a lot of women.
(36:13)
And usually when we, when we look deeper, we trace that back to extreme stress, um, a traumatic experience, a severe illness, or a long term illness. And that of course, uh, you know, slows down your thyroid function, raises your prolactin and your body of course understands that this is a stressful situation, that it should not be having a baby in. And so it will, downregulate all of these, you know, all your sex hormones so that you don't get pregnant. Like you don't have the chance of getting pregnant. So really this is a protection mechanism, but we're all like, why is my body doing this to me? So this is, you know, that's one way that I think the thyroid can, can really impact your cycle. I mean, there's more, but I'll stop <laugh>
Lindsey Vestal: (36:56)
Oh my goodness. That was so incredible. And so like refreshingly eloquent. Um, <laugh> because, I mean, we're, we're talking about some heavy stuff here. I mean, it's like alphabet soup, right? When, when we're talking about all these hormones and what I really gleaned really throughout our entire conversation today, but, but really specifically, this, this last question was like, how many times we can misperceive our body, not having our back when in actuality it is a communication tool, right? That, that is kind of saying, Hey, let's like, I'm actually on your side. So for instance, this plac example, right? If we are so incredibly stressed, it is, it is not the optimal time potentially to, to be able to be fertile, uh, to conceive. And so, again, it's this idea of this check-in balance that I feel like is always coming back to managing stress on our mental wellness, mental wellness. I feel like is such the foundation of all forms of health in our body. And it's one of the things that I feel like OTs really do well is that we really consider that whole person, that bio psychosocial approach and how the intersection of the bio of the psycho of the social can all interplay and is capable of giving us information that we have a choice to respond to and potentially change things in our lives that can contribute to that balance of health in all of those aspects.
Nicole Jardim: (38:26)
Yes. Oh my goodness. I could not agree more. And I've talked about this a lot recently, the fact that it feels like a bit of a radical act to be healthy these days. And I was thinking about this because just over the weekend and I actually wrote a post about it because I think that for so long again, we've gotten this message that we just have to adapt to this environment that we've created <laugh>. And it is, I just feel like our brains and our bodies have not caught up and our brains are still living in prehistoric times. Of course, they're, you know, they're very adaptable. There's no doubt about that. But when our brains that when they pick up on danger and they view it as danger, right, cuz they're not viewing your stressful experience driving on the highway or at work, you know, you're 12 hours into your Workday or whatever.
(39:18)
They're not viewing that as, uh, as that particular thing, right? Cuz it's not technically life threatening. They're viewing it as the life-threatening thing that was happening a thousand years ago on the planes of the Seren Getty, right? Like you are your prey and you need to run away. And so when your brain is constantly in this red alert mode, you know, we know what's gonna happen. Right. We know this cascade effect. We've just talked about that. We know that there is, you know, a potential, um, impact on the menstrual cycle over time of these, you know, these accumulate accumulated stressors. And so yeah, like I really think that it requires so many of us to take a hard look at our lives. I really had to look at my life with living in New York and how intense it was. And then writing a book and writing a book is the worst thing that anyone could ever do.
(40:06)
I don't know how people enjoy this thing. <laugh>, it's crazy to me because it was so intense for me. And I remember New York was also so intense and there was just so much going on and there's so much traffic and noise and all these things. And now that I've moved out of that environment, I'm like, whoa, okay. Now I see what I didn't see when I was immersed in the environment. And so I think that sometimes, you know, these are, those are big life changes and I don't expect everyone to just go and like move house by any means. It took me a long time to get there. But I do really believe that for a lot of us, we might have to start doing that, that soul searching and scanning of our lives and figuring out if this is right for us and our overall health
Lindsey Vestal: (40:47)
That's right. And, and it can be life changing, like moving houses or changing jobs, or it could be small little radical acts such as, maybe as you talk about in your book, drinking some water with lemon in the morning, right? Yeah. Instead of that coffee, right. I mean, there's just li we, we can, we can, it runs the gamut for the changes that we can make that have that cumulative effect, which I think is incredibly empowering. Okay. Nicole. So I, this is amazing. I have learned so much. I have one last question for you just to bring it back to the theme of our podcast and you know, you have really immersed yourself and to me, you are, you are my go-to for anything menstrual health and hormones. And I would love if you could share a little bit about in this journey of your discovery of, you know, really supporting menstruating people. What have you learned about the intersection of menstrual health and pelvic floor health throughout your studies?
Nicole Jardim: (41:41)
Oh my gosh, Lindsay, so much, I've learned so much from you <laugh>, I've learned so much. It's incredible. I, you know, it's funny because I definitely was one of those people that never connected the structural with the hormonal, um, for so many years. And I think it was probably because I didn't even realize I had structural issues to begin with, but what has been so amazing to me is sort of my own journey with lower back pain and pelvic issues, like painful sex and things like that when I was, you know, especially when I was in my twenties and I was on the pill again. Right. Like I don't even think people realize that they, they hear things like, oh yeah, I, you know, I, the pill affects your sex drive and it affects, um, how sex feels and it might hurt and vaginal dryness and all of that.
(42:31)
And so when you think about that intersection, I feel like man, if I were to assemble a dream team of people to work with every client of mine, it would certainly involve someone like you because of the tremendous impact that our hormones have on our pelvic floor and that our pelvic floor has on our hormones and just our overall health, our wellbeing and our vitality. And so I would say like some of the number one things that I have learned, or some of the most important things I've learned is that, um, yes, hormones do indeed affect your pelvic health. Uh, when I think about the vaginal tissue and the integrity of that tissue, as well as cervical fluid production, um, sex drive, all of that has an impact or all of those hormones have an impact on those aspects of our pelvic health. And then also two things like exercise and movement and how you're breathing.
(43:30)
Okay. Like I can't even get over that. None of us know how to breathe properly, by the way. <laugh> like, you were the first person that taught me that how to breathe in alignment with your pelvic floor, like who knew. So I feel like that was the biggest revelation for me. And I've, you know, continued to check myself every time I realize I'm not breathing properly and that has totally changed the way I work out as well, because that's the other thing I see. So many women they're lifting weights, they're doing all these things, but they have no idea to take their pelvic floor into account. So yeah, I could go on and on, but I feel like some, those are some of the biggest things that I've learned over the years. Those
Lindsey Vestal: (44:06)
Are the doozies right there, for sure. <laugh> yeah. It all comes back to that foundation of breathing. And then just carrying that into activities of daily living, whether that's exercise or, you know, lifting, lifting a bag of groceries as you walk up your stairs, you name it. It all, it always comes back to that. Okay, Nicole, so you are clearly, <laugh> clearly brilliant and just so lovely and reassuring and so empowering. And so for any OTs who are listening to our podcast today, how, how can they study with you obviously buying your book, listening to your podcast. Fantastic. Are there any other ways that we can study with you?
Nicole Jardim: (44:45)
Yeah, actually I have a certification program, um, and it actually starts in the fall every year. Uh, it's about seven months long. And I, I walk anyone through really like if you're a health coach or you're an OT or a PT or someone who's gotten some sort of, of health and wellness training, then this is a great, um, segue into the women's hormones and menstrual cycle learning that I have just sort of taken from, you know, all kinds of training over the years. And, and then also my experience as well, and, and put together, um, this certification that really teaches you the intricacies of the menstrual cycle and ovulation and the phases of the cycle, as well as all the hormonal aspects of that as well. And then of course, how all of these impact the other parts of your body. So we're talking gut health and the liver, and we're talking the brain and we're talking about the thyroid and pretty much every aspect of our health is covered as it relates to the menstrual cycle and our hormones in general. So yeah, it's, it's starts in the fall and, um, I feel like that's a great way if someone is really interested in learning more about this in depth. Oh,
Lindsey Vestal: (45:57)
Phenomenal. I will definitely link to that in the show notes, as well as all of the other things we have talked about today, Nicole, I, I cannot thank you so much for your generosity, your wisdom, and just, I mean, you're just, you're such a champion for, for women's health everywhere and really trailblazing this information that I hope one day will be so much more mainstream. And I think you are, you are one of the most pivotal people I know making that happen. So thank you for all that you do. And thank you for, for today. I, I cannot tell you how much I've learned.
Nicole Jardim: (46:28)
Oh, thank you so much, Lindsay. Oh my goodness. I hearing you say all of this, it just practically brings tears to my eyes. Thank you for saying all of that. I feel exactly the same about you too. And I'm just so glad that we know each other. And thank you so much for having me on the podcast.
Lindsey Vestal: (46:42)
Thanks for listening to another episode of OTs and pelvic health. If you haven't already hop onto Facebook and join my group OTs for pelvic health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and post it to IG Facebook, wherever you post your stuff and be sure to tag me and let me know why you like this episode. This will help me to create in the future, what you wanna hear more of. Thanks again for listening to the OTs and PE health podcast.