112. Encore Episode: Hormones 101 – Understanding Perimenopause with Monique Willingham

Big News: Our Midlife Concierge Program Is Launching!

Hi ladies, it’s Dr. Sarah here with something incredibly exciting I’ve been waiting to share. Monique, our amazing nurse practitioner, and I are launching a brand-new Concierge Membership Program exclusively for women in midlife right here in Maryland!

This high-touch, deeply personalized program is designed to support you through every phase of perimenopause, menopause, and beyond. We’re combining the best of functional medicine, Chinese medicine, lifestyle coaching, and bioidentical hormone therapy—plus weekly coaching calls and advanced lab testing—to give you the care and attention you truly deserve.

To celebrate the launch of our concierge membership program, I’m doing a special fan-favorite replay! We're bringing back Monique’s wildly popular episode, Hormones 101. Whether you missed it the first time or want a refresher, it’s the perfect companion to this exciting announcement.

👉 Interested in becoming a founding member? Email us at hello@risingwomanproject.com to learn more or reserve your spot. (Maryland residents only!)

We can't wait to support your midlife journey in a whole new way —and I hope you enjoy this encore episode!

Did you know you can start experiencing perimenopausal symptoms as early as your mid-thirties?
 
 Many women feel confused and alone during perimenopause because the world totally fails to prepare them for it. If you relate to that, you’re in good hands because my guest, Monique Willingham, and I are passionate about helping women understand what’s happening in their bodies during this time.
 
 This episode of Midlife Rise + Thrive will help you understand your hormones and empower you to reclaim your health. Welcome to the Hormones 101 class you never got.
 
 Monique is a Nurse Practitioner who has been practicing in oncology for over 15 years and uses a holistic approach to help patients reduce inflammation and improve energy and mental clarity.
 
 
 In this episode:

• The basic roles of your hormones 
• Why your symptoms might feel inconsistent 
• How to make your hormones happy

 Resources Mentioned:

Visit Monique’s Website: www.remedygreenwellness.com 

Learn About the Midlife Concierge Program: hello@risingwomanproject.com 

Connect with me, Dr. Sara Poldmae:

Website: https://risingwomanproject.com

Instagram:  https://www.instagram.com/drsarapoldmae

Transcript

Sara Poldmae: 0:01

Hi, ladies, it's Dr Sarah here. I have some super exciting news for you. Monique, the nurse practitioner that I work with really closely in my clinics, and I have finally developed a concierge membership program for women in midlife. This will be a high touch in depth approach to your midlife journey. We will be offering everything from functional medicine, Chinese medicine, Lifestyle coaching, bioidentical hormone replacement therapy, Advanced Functional Medicine lab testing. We will be doing weekly coaching calls, everything that you need to navigate through this journey of perimenopause, menopause and beyond, we are so excited to be finally offering you the time and the care that you deserve, and we are launching it super soon. So if you are a woman in Maryland, it is only open to women in Maryland and would like to potentially become a founding member. Email me at hello at rising woman project.com Hello at rising woman project.com we have not officially announced this yet. This is the first announcement. We're putting it out in the universe. So I'm so excited. I hope that you reach out and to celebrate launching our concierge membership program, I've decided to do a fan favorite replay. We're bringing Monique's episode hormones, 101 back to the show. So I hope you enjoy. Let's dig in. Welcome to menopause. Rise and thrive. I am Dr Sarah pulled me and this podcast is your go to guide for navigating perimenopause and menopause. If you are feeling a little overwhelmed, trust me, you are in great company. Each week, I'll bring you expert advice, raw, honest conversations and simple tips to help you stay grounded and maybe even find some humor in the process. Let's rise, thrive and tackle this wild ride together. So happy to be here with you. Monique. Hi. How are you good? Monique has been a guest on the podcast before, and we wanted to sit down together again, since we have been working closely in clinic together and have been learning a great deal from each other, and we've even developed a one of a kind program for women in midlife that we're super excited about. For those of you listening, you can find out more about this program at the tail end of the podcast, I wanted to start by saying that there are so many women that are suffering from perimenopause related symptoms. In fact, Monique, I think you pulled together some mind boggling statistics surrounding this.

Monique Willingham: 2:52

Yes, so there are over 100 million women suffering from perimenopause and menopause symptoms, and unfortunately, only 35% of women between the ages of 40 and 65 know what to expect. So Dr, Sarah and I wanted to help women understand the root cause of why women may not be feeling like themselves, and we want to help empower them to reclaim their health and have them feel like their complaints are not being dismissed.

Sara Poldmae: 3:25

Yes, I had a guest on one of the earlier episodes of the podcast, Jennifer glarson. Was a fascinating episode about hormone replacement therapy, and I remember her saying, if this were men that were suffering in these numbers, we would have figured it out already, and I think is some truth to it, and that's probably why women often feel like their complaints are dismissed. So we thought we would start with Monique giving a little hormones 101, for our listeners, because the more that we work with women, the more that we realized so many women don't understand the role of each of these major players in women's Hormonal Health and knowledge is power. So understanding what each of these hormones does will be helpful in figuring out how to manage our hormones in this time of

Monique Willingham: 4:13

life. Yes. Okay, so when we are talking about hormones, I wanted to talk about the major players, so I thought I would start with the most common symptoms women complain about and relate the symptom to which hormone may be influencing, as well as after I explain the hormone and symptom relationship, we can then move to Dr Sarah, who can explain about some tips on from a functional medicine perspective. So when I start to talk about hormones, they are chemical messengers that start and travel from the brain the ovaries and go to all the other organs in the body. And an analogy to think about are cars on. The highway. And so when we think about estrogen, we can relate estrogen to being a red, fancy, fast car. Okay, so that car is fun. It's a fast driver, it's outgoing, and sometimes it can get a little bit out of control. And then we can think about progesterone on the highway, and that's a gray family ban or station wagon that's very cautious, it's calm, it's more level headed. And then we think about testosterone, which you can relate as an f1 50 truck, and it is muscular and has increased confidence, it can have a little bit of aggressiveness, leadership, and usually the testosterone spikes at the time of ovulation, which is usually around the second week of your menstrual cycle, and that is when your libido is at its highest. And so when we're driving down the highway, we just want to make sure that all of these cars are going at the right speed. There's no congestion, everything's clear, so that we can go from one location to the next in an efficient manner. There are some other hormones as well that can impact the highway, which are insulin, cortisol and thyroid, and we will talk a little bit about them and how they influence our three main hormones. I love that

Sara Poldmae: 6:25

analogy. That's amazing

Monique Willingham: 6:28

that next. So when we are talking about estrogen, those fast racing red cars, those estrogen hormones are usually produced in the ovaries, adrenal glands and then the fat cells. And so the main function of estrogen is being responsible for that reproductive tract, growing and maturing the uterine lining and maturing the eggs. So it is most high, usually at the first phase of our menstrual cycle. Okay, so those first two weeks, estrogen is usually high. And what does estrogen do for us? Well, it can regulate our temperature control center. It can help boost neurotransmitters in our brain to help with our sleep, our mood, our libido, our cognitive function and memory, and it helps preserve our muscles and our bones. Okay? So as we age and as the estrogen levels are changing, we can lose muscle mass. And so as we're looking at our bodies and as they're changing throughout life, we may notice that we have more fat cells around our mid area and the muscle that we had worked so hard to build may be decreasing, and we have to work even harder to build that muscle. Estrogen is also responsible for helping us keep our good cholesterol in check, so it helps with our HDL levels, and it also helps with the moisture of our skin. Okay, so if we think about our skin on our face, and how we have to moisturize, and maybe in our 40s, 50s, it becomes a little bit more dry. It's not as flexible or pliable. We're needing heavier moisturizers. Think about your vaginal health as we're changing. We have more dryness down below again, because our estrogen levels are changing and decreasing. The next car that we talked about was the family van, which is the progesterone. So think of that as your relaxing hormone. It is usually produced during ovulation. So after those first two weeks we're in the center reverse cycle, we start to ovulate, and now progesterone is being secreted, so that is starting to go up. The whole point of progesterone is to build that lining in the uterus area, so that if we were to become pregnant, that uterine lining is ready and healthy. But most of the time we're having irregular cycles, and so we shed that lighting. So with the progesterone, it again helps affect the reproductive tract in the brain. It binds to the receptors to help produce a calming, sedating effect. It helps improve our sleep. It can increase our libido as well. It helps build bone, and it also benefits our cardiovascular system, and it actually enhances our sensitivity to the insulin and thyroid hormones in our body. So when we think about the progesterone hormone, usually in our mid 30s, late 30s, that is actually the first hormone that starts to decrease over time, which can cause difficulty sleeping. It can cause bloating, hot flashes, headache, fatigue, mood changes. So that is the role of the progesterone and. And next, an often overlooked hormone, is the testosterone. So that's produced by the ovaries and the adrenal glands, and again, as I had said earlier, it surges at ovulation, right before the menses, so that helps maintain our muscle mass, our bone strength. Testosterone is what's in charge of our libido and sexual response, and it helps our overall sense of well being, and assists with our brain function. So it influences both stamina and restful sleep, and it, again, is another hormone that has a protective factor against cardiovascular disease, if we want to move to cortisol, and I feel like there's a lot of buzz around the word cortisol. Cortisol is made by our adrenal glands, and it regulates our immune system, stimulates the production of glucose and aids in short term memory. It also helps the body adapt to stress by increasing heart rate, respiration and blood pressure. Insulin is also a hormone that is very, very important during perimenopause, and I think, is often overlooked as well. Insulin is usually stimulated in the pancreas, and it stimulates the cells in the body to take up our glucose and estrogen helps improve our insulin sensitivity. So when estrogen levels are low, we are more prone to becoming insulin resistant, also, which we'll talk about later. Our lifestyle factors worsen the insulin resistance. So when I think of the insulin as if we're thinking about the highway, you can think of it as like your your exit ramps, or your toll booths. When you get to the cell, your insulin is asking to go into the cell to give it the glucose and the energy. And when your cell is full of all glucose, then the cells like, now I'm not letting you in. And so then the insulin gets upset because they're stuck on the highway, they're stuck in the bloodstream, and it starts to kind of back up. When that happens, we have more inflammation in our bodies, and we tend to gain more weight from the inflammation and the higher levels of insulin, and these higher levels lock our abilities to burn fat. It can also increase heavier periods, because it's stimulating the growth of uterine lining and progesterone levels are getting decreased, it can also contribute to worsening brain fog and hot flashes. Last but not least, I think the thyroid hormone, it's a hard connection to explain to our sex hormones, but the point is, with the thyroid hormone, it is important to regulate metabolism, and so as we age, lots of cells, hormones start to change, and sometimes the thyroid hormone is one of them. Actually, one in eight women develop hypothyroidism, and high levels of inflammation in the body is a factor, as well as low estrogen levels, but the symptoms of hypothyroidism is very similar to the symptoms of perimenopause or midlife so it's important, when you're going through all of these changes, changes and experiencing these symptoms, it's important for us to Determine the root cause, right? So drawing thyroid levels and figuring out what's going on with the thyroid standpoint, because if we can alter that or fix that, then ideally those symptoms are not getting worse. So when people have an underactive thyroid, they may experience fatigue, brain fog, forgetfulness, mood swings, weight gain, depression, loss of bone mass. And so those are similar to the perimenopause. And then if you're hyperactive, meaning you have too much of those thyroid hormones, then you can have hot flashes, palpitations, difficulty sleeping. So those are basically the six hormones that are pretty important for our mid length changes,

Sara Poldmae: 14:02

great. So now we've looked at the hormones. What is perimenopause? Perimenopause can start at around the age of 35 and I don't feel like anybody warns us

Unknown: 14:13

about that. I think so. I think people often

Sara Poldmae: 14:17

think menopause 50 year old, that's the basis of it, and there is more conversation going on around it, but I do think that many women don't realize that this can be a good five or 10 year, maybe even longer process. As you said, progesterone starts to decline in her mid 30s, and at least with me, I had my daughter at 31 and I feel like once I recovered from that right around 35 I feel like I did start to notice changes with my sleep, you know. And a lot of women, I think, can resonate with that, and that could be the progesterone levels that started to decline already, but we're not expecting that, because. We still feel young in a lot of ways, and it just kind of takes us by shock. 75% of women in their 40s and 50s experience perimenopausal imbalance symptoms, and these symptoms can go unacknowledged or unrecognized as even being related to our hormones. So things like joint pain or difficulty sleeping, we don't necessarily go right to hormones. When women go to their healthcare providers, they often get dismissed as depressed or just get put on a birth control pill, and that may not be the right direction to go in for a lot of women. So first we really need to look at how a woman is experiencing her change of life. Are there problems with sleep, mood, sexual functioning, hot flashes, night sweats, that interfere with their daily functioning? Is it more that they're experiencing memory or cognitive problems? Are they having palpitations, anxiety, depression, irritability, all of the above is vaginal dryness a problem, or urinary incontinence. Monique, you had a good analogy about a soap dispenser. Maybe you could share that with our

Monique Willingham: 16:11

listeners. Okay, as you explained, once we are late 30s into the 40s, our hormones are beginning to fluctuate and have all these symptoms. So when we say they're fluctuating, they can be decreasing, increasing. They're just imbalanced. And when you think of a soap dispenser and it's almost empty, and when you push the pump, you're like, Oh, that was, you know, that was good, okay, great. Or you push it and, nope, there wasn't any soap that came out, or just a little bit came out. You have to push it again. So every month when we are having our cycles and we don't know what that month is going to bring, sometimes we have higher levels of our hormones and we feel great. Sometimes we are not getting as much soap out of the soap dispenser, and so they're lower, and we're not feeling good, or we're feeling those symptoms of just feeling awe. So it's us going through these cycles and changes, and it's just, how can we manage that better? Because we can't control how much hormone is getting secreted, right? But we can control acknowledging how we're feeling when we're feeling that way. And what can we do, from a holistic functional medicine perspective on how to help ourselves,

Sara Poldmae: 17:27

right? I always think of it as what can we do to make our hormones, quote, unquote, happy. So what can we do on this bumpy highway, this bumpy road, to make it a little bit less bumpy. And so I think one of the biggest things that I see in clinic is sleep disturbances. Sleep is a big one. Without good sleep, your blood sugars are definitely affected, your insulin response, your insulin sensitivity. So if you're not sleeping for weeks in a row, then you most likely are going to have issues with regulating your blood sugars, your stress hormones are affected if you're not sleeping. Developing a consistent sleep routine and getting good quality sleep is huge. Your circadian rhythm is directly in cahoots with your hormones, and we can talk more about how to get better sleep, but one of the first things that you can focus on is getting sunlight first thing in the morning, because it can help to regulate your circadian rhythm and get your sleep back on track. There's a lot that can be done, and I feel like if there are difficulties with sleep, that's one of the best places from a holistic medicine, functional medicine standpoint, that we should start because so much goes on in rest and repair during sleep, and it's just such a big player. And then the next thing is, what are we consuming our diet? We don't mean diet in the sense of, let's lose weight quick and get the fat out of our middle. We mean in the sense of getting high quality nutrient dense foods to become the staples of our diet. We're not saying you can never have a snack that's maybe not of high value, but if we can make 90% of our diet high quality nutrient dense foods, we can give our body what it needs to function at its highest level. In turn, we can work on regulating our blood sugar and insulin response. We don't want you eating pre packaged chemical laden foods, because even if you're cutting calories and meeting your macros when you're utilizing these pre packaged foods, you're also upping the toxic load in your system. And hormones tend to hate that. So definitely getting more clean with your diet, and that can mean different things for different people, but definitely working on what we're taking in. And as a caveat to that, I also want to throw in, from a holistic perspective, what we're taking in, not just for food and water. But what we're taking in from the news and the things that might upset our system from a different perspective,

Monique Willingham: 20:06

yes, yes, I feel like, as you were explaining what the diet, I mean, all of the processed foods, and that's just causing so much inflammation, and just going back to our highway, it's congesting it. It's just taking up space that doesn't need to be that way, which in turn affects and disrupts those cars driving by.

Sara Poldmae: 20:24

Yeah, absolutely, which is, I just love that analogy, because I always try and explain to my midlife women that I'm treating that we just need to clean things up. It doesn't mean that we need to be perfect, but we can't have a sluggish system and then have all these sporadic hormone changes occurring, and expect that our bodies aren't going to give us some signal that things are off balance. So another thing to focus on is movement. So this can mean different things for different women, but making sure that you have an exercise program that you can stay consistent with, I think, something that's going to work for you and your schedule and that isn't adding extra stress to your body, is important. Sometimes during midlife, we want to exercise the way that we did in our 20s, and that may not work just thinking from a perspective like high intensity interval training, if you don't give your body plenty of time to recover the extra stress hormones that are released during that type of exercise could actually be working against you, and all the other things that we're talking about with stress hormones, insulin response, all of that. So working with and getting guidance on a movement program that would be most appropriate for you, and working on building up muscle would be important as

Monique Willingham: 21:44

well. And you know, Sarah, I do remember listening to one of your other podcasts. I can't remember which one I remember you talking it must have been like the exercise and weight training one I remember you talking about how you had shown up to a class and you just weren't feeling it, and you're like, just, I don't want to do this, or I'm just not in the right mindset to go in here, and I'm not going to do this crazy move amount. And so I want women to understand that it's okay to feel and do those things. And if you start to just journal and track your menstrual cycles, you feel like that probably the third or fourth week of your cycle, right when that progesterone is high, estrogen is going down, and you're just, you know, you don't feel like dealing with high intensity workouts. Your brain's not going to respond well to that.

Sara Poldmae: 22:38

Absolutely. Yeah. So different times of the cycle, different types of exercise may be more appropriate. So listening to your cycle if you're still having one is super important. And as we know, once you start going through perimenopause, your cycles can change. But that doesn't mean that your hormones aren't still fluctuating for a few days here, a few days there, so just paying attention for sure is helpful. The next thing is stress reduction techniques. So I've mentioned this in an earlier episode of the podcast, but there's a great book called burnout, I believe is the name of the book, and the author talks about completing stress cycles. So when people come in and talk about stress reduction techniques, it's not necessarily that we're reducing stress, it's that we're reducing our response to stress, or learning how to complete a stress cycle, you'll never be able to get rid of the stressors in your life. There will always be something that if you have children, your children may need, or your children are going through, you may have an aging parent, you may have work deadlines. So it's not about taking the stress and reducing it out of your life. It's more learning skills and tools to help you to complete the stress cycle and tell your body that it is okay, whatever you have been through, or whatever you're thinking about is okay, and creating that relaxation response so that your stress hormones understand where and when they should be reacting. The problem is staying in fight or flight all the time, where we don't calm down in between all the stressors in modern life, there's stressors around almost every corner, and back in the day that was a bear chasing you or a stressor that was a life or death. And now our bodies don't necessarily know the difference, so we stay in this heightened stress response. So learning how to mitigate that stress response is really, really important. Increased stress definitely not so good for your hormones, insulin resistance, all of that. So finding things that work for you, whether they be meditation, acupuncture, you know, anything that you can do to mitigate that stress response is really, really important for. Hormonal Health during midlife, I agree finding a practitioner that works with supplements and herbs that support hormone health can definitely be helpful. I was actually on a Facebook page and felt like I was being a little bit bossy, but there was a lot of advice being thrown out there for a woman that was really struggling with some intense symptoms of perimenopause, and there was a lot a lot of supplements thrown out on there from non medical providers that I just thought, God, Facebook has got to be the number one worst place to go when you're seeking medical advice. I'm pretty scary. So I was on there saying, hey, like, some of these are not, you know, just because something is natural, and I preach this to the choir, a lot people are probably sick of me saying that. But something that's natural is not always safe. There are plenty of poisons that you can find in nature, so finding practitioners that can help you with your particular situation when dealing with hormone health is really, really important, someone that can help you to nourish and heal your gut. If your gut is out of balance, finding someone to help you to support your adrenals if your stress response is out of control, because we talked about earlier, the symptoms each woman experiences can be different and can really be affecting different bodily symptoms. So some women tend towards more neurological symptoms, some women more towards digestive symptoms, some fatigue, some, you know, hot flashes. So we've really got to look at like, where do we start based on the symptoms, but also based on maybe some of the lifestyle things that are out of whack for a woman? So just finding a practitioner that can help you to pinpoint where to start safely is important, and sometimes it can be that medications are the answer. So hormone replacement therapy is not necessarily a terrible idea for some women, if your thyroid is completely out of whack, you may need to medicate for your thyroid issues. So just finding the right practitioners that can guide you through this stage of your life if you're suffering is certainly a key component. And then the last one, and then I'm going to turn it over to Monique in case I forgot something. Oh, back to blood sugars. Though, blood sugar is really important, insulin resistance, continuous glucose monitoring, I think that that's a really huge and underutilized tool. Insurance doesn't necessarily pay for these monitors if you are not diabetic, and I think that is a disservice, because blood sugar issues are related to so much inflammation and chronic disease in our country. And I think some of the numbers we look at are questionable. As far as what we consider as diabetic and pre diabetic, I think we can see the trends towards where a person's heading before they reach those numbers. So just going back to regulating your blood sugars, I think that's really important. And then the last one that I have is community. I think that this is a really big one. If our souls aren't nourished, our bodies will not be healthy. So spending time with people that elevate you, that listen to you and love you and can hear your concerns, and being able to share with people that may be going through symptoms and stressors that are similar is really important, and can just really help make the journey easier, and feeling supported is one of the best things that you can do for your health.

Monique Willingham: 28:36

Yes, I agree with all of your interventions. That's why we work so closely together?

Sara Poldmae: 28:43

Yeah, absolutely. So I'll be doing an outro to explain a little bit more about the program that Monique and I have put together for midlife. But we really enjoy working with patients that are going through perimenopause, and would love to hear what symptoms you're experiencing, and anything that we can help with. If you have questions for us, I will be posting a lot on social media asking for any of your questions, and I will tag Monique in those posts so that she can pipe in as well. But you are not alone. As we said, I'm going to scroll back up. It's 100 million women. Yep,

Monique Willingham: 29:24

exactly, that's that was right. That's

Sara Poldmae: 29:27

100 million women, and most of us don't know what the heck to expect during this time. So exactly, monick and I are both committed to helping you through this process and making this road a little less congested, a little less bumpy, so that you can live your best life. Yep, yep, thank you. Yeah. It was a pleasure having you on Monique. And again, if you have any questions, feel free to contact us. Monique, contact information will be in the show notes, and you know how to contact me.

Unknown: 29:59

Oh. Right, right. Have a good day. Ah, see you later.

Sara Poldmae: 30:04

If you are in Maryland and you are struggling with symptoms of perimenopause and really want to get your health back on track and feel like yourself again, then we have a program for you. I have teamed up with nurse practitioner Monique Willingham, and we have developed a 12 week midlife reset program. It includes so many good things to start you back on track to feeling like yourself again, including a functional medicine evaluation, lab work at the beginning and at the end of the program, individualized treatment plan, core supplement protocol, bi weekly coaching sessions with myself and Monique a personalized treatment plan, including nutrition advice as well as exercise plans, we will get you hooked up with continuous glucose monitoring and an unlimited infrared sauna if you are in the Annapolis area, we will work closely with you, coaching you on lifestyle hacks and techniques, we'll give you guidance on positive mindset, goal setting, sustainable habits. We have so much to offer, and we cannot wait to share it with you. We hope that you'll join us on this journey to getting you feeling better than you ever have. We look forward to seeing you soon you