Landy Peek (00:00)
Welcome to the Landy Peak Podcast. I'm your host and friend, Landy Peak, and I am thrilled to have you join me. In each episode, we will explore what makes life truly fulfilling. Happiness, deep connections, and self-discovery. Together, we'll uncover that happiness is not a destination, but a way of living. Now, let's dive into today's episode.
Landy Peek (00:31)
today we have Dr. Ashley Schrader with us. She's a board certified family nurse practitioner and an IFM certified practitioner dedicated to seeing the whole person rather than just a checklist. After feeling frustrated with the impersonal nature of conventional healthcare, Ashley transitioned to functional medicine, focusing on root causes instead of just symptoms. Passionate about
gut health and hormone health. She understands their connection to mental wellbeing. As a registered yoga teacher, she emphasizes the importance of holistic health. Ashley's own health journey adds a personal touch to her insights. So settle in as we explore healing from the inside out with someone who truly gets it. Ashley, thank you so much for joining us. I am so excited to have you here. Thank you. I'm so happy to be here.
So tell us just a little bit about yourself in your own words so listeners can get to know you. Yeah, sure. So I am a nurse practitioner. I actually made a career change to becoming a nurse practitioner back in my 20s. I used to work in consulting. So a completely different field, felt so disconnected from the impact that I was having. I started teaching yoga in a shelter and felt really connected to the impact that I was having.
and was really inspired by that experience. I had a bike accident and ended up in the hospital. I used to live in Washington, DC in the city and I biked everywhere. And so I was in one of those bike lanes and one of the cars that was parked on the side of the road, the driver had opened her door as I was like in the bike lane. And so tumbled over. I wasn't seriously injured, but I had to go to the hospital and get checked out. was my first time ever feeling
what it was like to be a patient. And so this was all around that time I was teaching yoga and really kind of questioning my purpose and what it was that I wanted to do with my time. And so I was really inspired by that first experience being so vulnerable as a patient. And that was what kind of led me to becoming a nurse and then a nurse practitioner. And so as I...
transition from nurse to nurse practitioner. I was super burned out from working in a really gritty ED in like the inner city of Washington, DC. And I had developed autoimmune disease. I just really had the full experience of what it's like to go through our healthcare system with chronic symptoms and to kind of feel rejected. Like I was doing everything right and
That experience really is what inspired me to this role, which is functional medicine practitioner. And I really, I love what I do. It is, I'm always looking, I'm like an investigator. I'm looking for root cause, contributing factors, triggering, mediating factors that are contributing to symptoms and restoring, that's why we call it functional medicine, restoring function for my clients.
my gosh, that's incredible. A lot in one. Yeah, but I love getting the human side of people and being able to go, okay, she gets this. She understands what it's like. And you're also taking that personal and adding on the professional knowledge that you have to really meet clients where they are. Yeah, exactly. Yeah. And that makes it so much more meaningful to me, I think just because I've
experienced it. really, I feel connected to the impact that I'm having and the people that I'm serving and, and they inspire me and their resilience and how they approach their, their processes, their chronic symptoms. And so, you know, it's really been a synergistic, beneficial relationship that I've had with my clients. Yeah. So how did you end up specializing around perimenopause and burnout?
from going from nursing in a bike accident to this very specialized area that is so needed and not talked about. Yeah. So I was in my thirties and I had no idea that perimenopause started in our thirties. I worked in healthcare. I considered myself informed at the time.
I was a new nurse practitioner and I just didn't think that any of the symptoms that I was having at that time could be related to perimenopause, but they were. I was having really heavy periods, severe insomnia. Like I just would not sleep for days, ringing in my ears, like strange neurologic symptoms and anxiety. you know, it's like all these random symptoms. And if you were to go to your...
in most, many conventional settings, you go to your primary care provider and you tell them these things, they're going to like, and this is what happened to me at least, just like kind of shut you down. Like they'll give you some, like maybe a handout on sleep hygiene, like kind of what we were talking about earlier, and then maybe offer up an antidepressant and then send you on your way. really, are they going, many times they're not even gonna bring up the idea of perimenopause. I don't even think that healthcare providers are educated that
we start to develop these symptoms as early as our thirties. And so for me, going through that experience, feeling lost, trying to piece the puzzle together. randomly learned about functional medicine on a pod. Like it was actually a more conventional healthcare podcast called the Curbsiders. And they had a functional medicine provider as a guest speaker on that day. And when I heard it, it was just like,
choir was singing, I was like, this is exactly what I want. This holds the answers for this is what I've been looking for. That makes so much sense. This is the way healthcare should be. And so through that experience, I just learned more. found a position at a functional medicine clinic. I trained myself. I became certified in functional. It took, it takes years and years to do all this stuff, but.
I just put myself out there to learn as much as I could from some really brilliant people. because I'm still perimenopausal, I'm in my forties and you know, it's never, we're never like fully healed, right? Like it's always a work in progress. And so I still have intermittent insomnia sometimes and I still know the struggle. And so I still feel really passionate about the topic because I,
I faced with it every day. Right? my gosh. I'm so with you. And I had no idea what was going on. Having similar symptoms, know, reoccurring migraines that I'd had when I was a teen and I disappeared and all of a sudden I have migraines again, insomnia, so many different symptoms. I'm also a pelvic health occupational therapist. So I'm working with women and it was over my head. I never connected the dots.
that what was happening with me was actually paramenopause because I thought, menopause, that's like in your 50s and 60s, like so far away, that's not what I'm dealing with. And so going on this search to try to figure out what was going on and why I was having the emotional slumps and really figuring out how to get support. And it's not always easy because a lot of times providers are brushing it off and not connecting the dots. And
I lucked into a provider that was able to connect the dots and support me and say, this is what it is. And my gosh, like light bulb moment. It's amazing. But for a lot of women, peri-manipause is such a mystery. Yeah. And you break it down for us. What are some of the common signs that somebody might be entering this stage? So our listeners can really get a feel if this is something that they are struggling with. Sure.
So it's interesting, the way that perimenopause looks really changes over time, the closer that we get to menopause. Early perimenopause, we're actually symptomatic of higher estrogen levels. So our brain starts sending a stronger signal. There's a hormone called follicle stimulating hormone. Our brain starts to push that hormone up a little bit more, a little bit more, because we need to stimulate the ovaries a little bit more to make adequate estrogen.
Well, when we send that stronger signal, we'll end up getting more surges of estrogen. So the estrogen actually goes higher and higher and higher. And so the symptoms, well, some folks will call this estrogen dominance, but the symptoms of that higher estrogen tend to manifest like what you've described. So especially migraines, you can have breast tenderness, really severe irritability.
weight gain, lots of water retention, lots of bloating. Just think like PMS on steroids. It's really, really uncomfortable. And what can really make that worse is if you're really stressed. what a lot of people don't know is that the enzyme that breaks down estrogen also breaks down our stress neurotransmitters, like norepinephrine, like adrenaline type neurotransmitters.
So if we've got a lot of estrogen already going down that pathway, trying to using up a lot of that enzyme, our stress hormones will inevitably that pipeline gets a little bit sluggish and it's kind of full. And so we're not able to get all that estrogen, those stress neurotransmitters through that pipeline. And so we start to back up with metabolites of estrogen or stress hormones or stress neurotransmitters. And then that really can exacerbate things like insomnia and anxiety.
like we, you know, we hear a lot about like palpitations or just like waking up at two in the morning and not being able to sleep. It's really common in early perimenopause because of that, that, that, that it's like biochemistry. It's, got a lot of estrogen. And then if we're, especially if we're stressed and we're making more adrenaline, it's going to build up and we're going to feel more of it physiologically. So, it tends to be, more related to high estrogen there in the beginning.
Also, if we're really stressed, we may not ovulate. We may not make progesterone. So that's the only way that we make progesterone is through ovulation. There's no other way. And so our reproductive system is really sensitive to the signals of stress. So if we've got a lot of stress, our body's like, okay, reproductive system, we're not gonna get pregnant right now, a danger, we're gonna shut down, no ovulation this month.
And so if we don't make progesterone, which has kind of like a calming impact on the nervous system, it stimulates, if you've ever heard of GABA receptors in the brain, calming, relaxing neurotransmitter, if we don't have that adequate progesterone to balance out kind of that excitatory impact of estrogen, then again, those symptoms are even more exacerbated.
progesterone is another really important part of what's happening, especially early in perimenopause. it's different because as we shift towards later perimenopause, we're getting a lot closer to menopause, it becomes more of an estrogen deficiency type of syndrome. So we'll see more of like the weight gain.
Estrogen is an anabolic hormone. So it helps us like build muscle. And so we might see changes in body composition with less estrogen, like less muscle mass. There are probably, well, there will be some changes to connective tissue. Some people will have bone density changes even before they go through menopause, like we'll start to drop and lose our bone density.
And so, and then of course, all the symptoms I mentioned before could happen. I mean, it's such a wide variety and something that's been studied a lot more recently is the impacts of that low estrogen on cognitive function. And so we see a lot of like the brain fog, the short-term memory loss, the poor working memory. You if you just can't like remember people's names when you meet them.
and trouble focusing. A lot of women don't get, like have had ADHD their whole life, but their coping mechanisms stop working in menopause. And then because of all these changes related to hormones. And so when they hit menopause and they don't have estrogen, they actually need to get on medication for it because they've lost that ability to kind of cope without having like the support of hormones.
And then we have like the dementia risk, of course, that there's a concern with as well. it's different and it changes over time. And it really is so unique to every individual. Like what I'm speaking in is generalizations. And so it's very unique to each individual. the other thing I do wanna mention that just popped in my head is body pain. And I see this a lot in my practice is like body aches, stiffness, feeling like you...
It's almost like an autoimmune type disease in nature and joint pain, not recovering well from workouts. That's a really common one in both early pre perimenopause and then later perimenopause too. my goodness. Such a wealth of information. There's so many places that I'm like, I want go there and I want to go there. So brain fog. because I think that's
an area that is not talked about. And I'm hearing so many of my friends, clients, who are now talking about that link of, my gosh, I'm now thinking I have ADHD, where I never really recognized it. And I am having memory changes. Can you talk a little bit about what's going on with our brain during perimenopause? Sure. one process that occurs when we lose estrogen is neuroinflammation.
So estrogen has this kind of like anti-inflammatory impact on the brain. So the more neuroinflammation that there is, the more brain fog is like a classic symptom of neuroinflammation. So we have lots of inflammatory cytokines, like white blood cells that get upregulated in that process. Basically the parts of our immune system that are supposed to tone down inflammation don't work as well.
and then the parts of our immune system that drive up inflammation, they're on overdrive. And that process is happening in the brain and it gets messy. Like it's not super clean. And so that really can impact our ability to think clearly, to have clarity. A lot of times as well, there are underlying nutrient deficiencies that are also contributing to that issue that are just, it's now, again, like I said, without the hormones there,
where it's really hard to overcome those cognitive changes without like, repletion of the nutrient deficiencies. So zinc, copper, really important for brain health. Iron, it's a really common one that gets missed. Like, because what I see is a normal complete blood count, like your red blood cells look good with your primary care. So they're like, you don't have iron deficiency, no problem.
However, if we check a ferritin on you, which is a real, a much better indicator of your iron stores and your iron status, it's super depleted. And women are just really good at compensating for iron deficiency. So we'll have, we won't have anemia, like we won't have low red blood cells, but we will have really low iron. And we need iron for like the very basic process of like generating energy, ATP, like what we learned about in high school biology.
We need iron every step along the way to make energy. And our brain is so sensitive to the loss of that energy. And if we don't have the iron, the fuel is not as clean. Just think of it like an engine. The fuel is not as clean that's going into that energy production. And again, it gets dirty, a lot of oxidative stress. And that again, contributes to neuroinflammation and brain fog. thank you.
It's a lot. So I would say deficiencies are really common. And sometimes that even tells us like it's from a functional medicine provider. always like, well, what, why are you, why are you deficient? Like what is, is there a malabsor, is it a diet issue or is there a malabsorption issue, a gut health issue? So many things to rule out. Can you talk about your thought process when you have a client come in describing all of the things around perimenopause and you're thinking that there's something going on with nutrients or gut health or
Because the nutrients are things that I hadn't thought about. As you're talking, I'm like, okay, so I did get blood work and it was all check, check, check, but nobody talked about all of the different nutrients. We talked about hormones. But I wanna learn more about that. So what is your thought process as somebody comes in and they're sharing that they're struggling? Yeah, so for anybody that has cognitive symptoms, fatigue, that's also to me a cognitive symptom.
fibromyalgia, chronic pain issues, I want to make sure all of their nutrient levels are dialed in. So the most important nutrients for those processes that we're looking at are B12, magnesium, the zinc, the copper, your omega-3s. You can actually check your omega-3s at LabCorp or Quest. It's a simple blood draw. But it's so important because it's...
really critical for our brain health to have adequate omega-3 fatty acids. Let's see iodine. Iodine deficiency is really common. We need iodine to make thyroid hormone, thyroid hormone. We have thyroid hormone receptors all over our brain, pretty much all over every organ system in our body. So
Yeah, those are the big ones. And then if somebody's got something, I'll go a little deeper if I think that there's an issue with like B2 or B6, those are some other important ones for brain health. Yeah. so as we're kind of on this topic, if we're listening at home and we're going, okay, I'm struggling with this, there might be some nutrient things going on. What can the listener at home do? Where can they go? Where do they look? How do they take that first step?
around getting that nutrient focus. Yeah. So all of those tests that I just mentioned, they are available at your local lab. They're very simple. They're not crazy expensive. If there is chronic, if you have some of these chronic symptoms, many times insurance will cover this type of workup.
It's difficult and I really feel for being a former primary care provider myself, I really feel for those folks because they really have limited time. They've got like less than 15 minutes to get through a lot of things, make sure you're doing your preventative care, make sure your cholesterol is okay, like lots of really important stuff that they're doing that takes a lot of time. And so they may not be able to order the types of labs that I'm talking about simply because of a lack of time.
So what you would want to look for is a functional medicine provider. A functional medicine provider is somebody who's trained, look for somebody that's certified, who's trained in this thought process. So going a bit deeper and really trying to understand what's underlying the symptoms. And so the organization that's kind of the gold standard of training is called the Institute for Functional Medicine. They are all over the globe.
There are certified practitioners all over the country, all over the world, and they have a wonderful directory where you can put in your zip code, put in your insurance, and locate somebody that's in your local area or in your state. And that's, I'd say, the best way to find a practitioner who's knowledgeable in this approach and who understands that it's going to take some extra time to
go through some extra lab work to get to the bottom of things. that's a great resource to use. I think there's a lot of misconceptions about perimenopause. Can you talk about what are the most common misconceptions that you see and clear things up for us? Sure.
one common misconception is that hormone therapy has no role in treating perimenopause until a year after your last period until you're officially menopausal. So the more and more evidence that comes out about hormone replacement therapy, especially in the prevention of some chronic diseases, most importantly, osteoporosis, one of the biggest killers of women over 60,
is that hormone therapy should be started before that drop in hormones, that complete estrogen deficiency that happens at the onset of menopause. We lose over 30 % of our bone density within that first three years of menopause. it really is so tough to get that back. It's really tough. There's no good medication.
Hormone therapy is not going to bring it all the way back. Strength training, it's just really, I want to get the word out there about this because bone density is just so important. And so what we know is that if we initiate some lower dose estrogen a few years earlier, we're actually going to really offset that sudden decline in bone density that happens at menopause.
for, and this is unique to each individual. you'll want to, folks will want to talk to their primary care or somebody that's trusted and understands hormone therapy about this. But oftentimes what I'll see is, or what I'll recommend is starting progesterone first and seeing how you do with that progesterone is just such a wonderful hormone for alleviating some of those symptoms we were talking about related to perimenopause.
mood issues, insomnia. It really can help balance out higher estrogen early in perimenopause. And then later it can really just help alleviate like hot flashes, nights, like those kinds of really uncomfortable symptoms that can occur as we move further into perimenopause.
So many times I'll because estrogen is kind of like foundational, especially if you have a uterus and you're going to go on hormone therapy, you have to have progesterone on board to protect your uterus. That's just part of it. So just to make sure that you can tolerate it okay, that we have an effective dose for you before bringing on the estrogen. That's typically what I'll do is start with progesterone and then
you're doing well with it, you're getting some symptomatic relief and then we can bring in estrogen and what's become more and more of the gold standard now is like a topical estrogen, usually in the form of a patch, that's what's FDA approved. And so that is something that you could start at a very low dose of again, before the complete loss of your periods for a year, you can start it years earlier to really prevent that like, because you're really, your estrogen does
decline quite significantly as you get closer to menopause. So that bone loss is happening at that time. Now, not everybody is a candidate for hormone therapy. So I don't want to make it seem like that's the only thing, but that's something that is just such a common misconception. And it's out there. Like I'm not going to give you any hormones until you're one year post-menopausal. It's like, there's so much damage that happens to cardio metabolic health, like your vasculature.
and your bone density, it's really important to think about what your options are. And one resource that I'd recommend too is there's a book called estrogen matters. And it's actually written by an oncologist who has a very, used to be an oncologist. So think about the way they view hormone replacement therapy. was, his wife had cancer, she had to go.
like get a full hysterectomy. and she was just miserable with the menopausal symptoms. she was like, screw you, I'm going on hormone therapy. and so she did it. And, he was so fascinated by it. Cause she got so much relief from it. He actually just went into the research and he found, he discovered like, there's no increased risk of breast cancer with hormone replacement therapy. my goodness. We've been like,
the media has been kind of lying about this and really not telling the real story here. And then it became his life's work. And so that book, Estrogen Matters is kind of a culmination of all of the literature he's pulled together. He's now a researcher on hormone therapy in breast cancer survivors, in women with like BRCA mutations. So...
There's just so much to, I think before you start hormone therapy, it's really important to understand what you're, what you're put like the risks, the benefits, what you want to feel good about what you're putting in your body. You don't want there to be any fear or anxiety around it. And so being informed is the best way to do that. I think it is such a, and I'm so glad you're bringing this to light because this is one of the things that I had heard is a hormone replacement therapy increases your risk of breast cancer.
And so that was like, ooh, this is big. And so my provider had said, let's try some hormone that I like.
Landy Peek (26:29)
I don't know about that.
Landy Peek (26:30)
So definitely being informed and understanding, but can you help around kind of that in a deeper way, the misconceptions around hormone replacement therapy, because
until I started it. I had no idea to start it ahead of time. I just lucked into a practitioner that's like, let's try this progesterone with life changing. And then noticing as I progressed in perimenopause a couple years later, needing to add a little bit different as I kept progesterone and then added some testosterone because I was having that huge dive into like, I cannot move off the couch. I have no energy, testosterone. I like, I feel like me again.
Just watching as I progress, how we're adding in different things is really changing how I feel because the hormone drop like tanked me. Exactly. But I did have that worry and the fear of, what am I doing? Is this going to come back to bite me in the end because I'm asking for instant relief? Mm-hmm. that's inception. And really reassure people that this does have
benefits and it's changing because as I started digging and my provider's giving me information about, okay, so this is changing bone density. This is changing and preventing things that I had not even thought about. Yeah, yes. Especially, touched on this a little bit, but like the cardiovascular health, like if you watch, for many women, if you watch their labs,
from pre-peri into post-menopause, their lipids do this, their A1C does this, like it all just pops up at the moment when we start to really get into estrogen deficiency. It's a complete change in metabolic health and cardiovascular health. And that risk of cardiovascular disease and diabetes really starts to take off at that once we go through menopause. so what we're learning now is if we don't,
initiate that hormone therapy early, then we're actually, if we wait too long, we're actually gonna cause some harm by starting estrogen too late, like five to 10 years outside of that onset. Now it's definitely, that's not the case for everybody, but for some people there can really be increased risk of like blood clots, things like that if we start it too late. Whereas if we start it earlier,
There's much, we actually can offset those changes in lipids and reduce the risk of developing insulin resistance. And so I don't think people put the two together. I think people think here, estrogen, this is a common misconception. They think like blood clots. And so they just automatically think it's like bad for your cardiovascular system, but it's the opposite. It's actually, estrogen is really...
important for how our blood vessels expand and contract. It's really important for how we regulate our blood pressure. And so if we don't have that ability to kind of dilate and constrict our blood vessels in a healthy way, that contributes to atherosclerosis. Estrogen is really important for lipid metabolism. And so if we don't have enough, then we're going, we are going to develop higher cholesterol. And then also
with estrogen deficiency, insulin resistance, which means like your insulin receptor that's kind of sitting on your cell membrane just doesn't work as well. kind of like not, it's not open for business. So your insulin tries to kind of land on that receptor and doc and it can cause the receptors not very healthy. So then the insulin is just kind of floating around and that's really inflammatory to the brain, to the liver.
And insulin is a fat storage hormone too. So that's one of the biggest causes of weight gain in menopause is that as well. And so as it relates to hormone therapy, yes, the bone density I think is so critical. We're thinking about mortality risk as we get older. I think people think like breast cancer is the big thing that's gonna kill us all, but it's actually not true. Like our biggest risks are cardiovascular disease, osteoporosis and dementia.
Breast cancer is not anywhere close. And so we've really got to think about what are we most at risk for as we age when we're thinking about risk versus benefit in terms of hormone therapy. There's just so much information in my brain just going like, my gosh,
I have to pick it and choose like what I actually want to share. there's so many different pieces and I'm picking up the dementia and the different risks that we're not thinking about because we are, breast cancer is what we need to be aware of and breast cancer is what we're looking for and cancer in general is something that we should be hyper aware of. Of course.
but there is so much more that you're tapping into. So how do we mitigate risk around dementia? How do we, you talked a little bit about bone density and lipids, but what should we be thinking when we're looking at the risks of the future? there are things other than hormone therapy too that will offset some of these
chronic disease risks. So a great resource when it comes to bone density is Stacy Sim. She's a PhD researcher who specializes in how our physiology changes. And all the studies have been in men up to now. She's really pioneered a whole new frontier in the research world about
how women's bodies change in each stage, peri and post menopause and how training needs to shift at each stage. And so she's developed this concept of polarized training where we're lifting really heavy. that's of course, a lot of that is for bone density stimulating that bone building activity. And then there's the other end of the spectrum which is getting the heart rate up like
It doesn't have to be a lot, like five times, max 10 times for just 15 seconds to 30 seconds at a time. So these little like sprint like intervals where we're getting really high heart rate, kind of out of breath, like can't go any longer. those are kind of like two opposite ends of the spectrum of training and.
What our bodies don't do as well with in perimenopause, it's possible to do this, because I work with a lot of endurance athletes, but you just have to be careful, is endurance training. So long distance running, being stuck in this zone two, zone three activity for long hours and hours at a time, which I think is a misconception, because I think a lot of us that grew up in the 80s and 90s
we're taught that like, okay, get on that treadmill and like run for three hours, like go burn it, go burn off your calories. And that's really not the way to look at it. It's actually so different. And what we're trying to do too with that strength training is change and improve the health of our insulin, going back to insulin, really improve the health of our insulin receptors. The healthier that they are, the healthier our brain is. I don't know if you've heard of
Type three diabetes now. It's insulin resistance happening in the brain.
So it's basically, dementia.
and so, we're particularly vulnerable to that, in menopause because of the loss of estrogen, and then the loss of insulin sensitivity, but we can preserve some of that with that heavier weightlifting. so I love Stacey Sim. She does, she provides tons of free resources and,
I use a lot of her research to help guide my recommendations for my clients. So that's a big one. And then in terms of brain health, so I'm really passionate about brain health. My mom had ALS. It's a brain disease. We think of it as like a body disease, but it happens in the brain. because of what she went through, I learned that I have a genetic risk for predisposition for ALS.
And so I really have dived into brain health, like what to do, what we need to kind of keep optimal to keep our brains the best that we possibly can. And so something that's really foundational to that is your gut, your microbiome. our microbiome makes most of our neurotransmitters are really important for cognitive function. dopamine, GABA, serotonin,
it's actually, they're all made in the gut. And then there's this bi-directional communication highway between the gut and the brain via the vagus nerve. And so, that's kind of how we regulate our gut really does regulate our mood, our cravings, our ability to focus our ability to like our energy level, like it's really all connected. I believe that the gut and the brain are like one unit really do. And so, that's kind of like number one.
We wanna make sure you have a healthy microbiome that you're digesting your macronutrients well. You can test this for this in a stool test. So a stool test will tell you how well you're breaking down and absorbing fats, proteins, and how's your pancreas doing. It's all really important for making sure we're assimilating the nutrients from our food.
And then a stool test can also tell you about your microbiome, what the balance looks like there. Are you missing any species that are really important? The microbiome is responsible for making a compound called short chain fatty acids. And these interact directly with our, again, the vagus nerve, our nervous system, our blood brain barrier for like basically regulating the health of our brain.
The more short-chain fatty acids that we make typically the better. again, measurable in a stool test. So that's really important and foundational for really understanding what you can do to improve your brain health. So usually we'll start there. And then also going back to what we were talking about before in terms of the nutrient deficiencies, that's really, really important as well.
there are some online kind of brain games and assessments that you could do. There's actually something called a cognoscopy. Have you heard of this? It's like a colonoscopy for your brain. And it's basically kind of a lot of what I'm talking about, checking some biomarkers that are related to brain health, checking for like doing a little mental exam.
There are nutrient labs, vitamin D is one I think I missed too. So simple vitamin D, but really important for your brain health. And so kind of like a combination of those things. And then of course hormones, like do we have normal or optimal? That's one thing too, levels of testosterone, estrogen, progesterone. So, and really it's frustrating because like, let's say our...
a provider will check our hormone levels and we'll be in the normal range. But it's we're nowhere, yes, we're in the normal range for perimenopause with an estrogen of zero, but that's like, no, that's not optimal, that's not ideal. And so working with a provider who really understands those optimal ranges can be really helpful too, and just kind of guiding your plan and making sure that you're kind of set up for success as you move into menopause.
really huge to highlight normal versus optimal. Because that is a real like light bulbs going off in my head around. Okay, so a lot of us are hitting those normal ranges, but normal isn't feeling good. Normal isn't optimal for where we want to be. Yes, those reference ranges are built off of their reflection of our population, number one, which is not healthy. And number two, it's giving you a picture of like
98 % of the population. So think about that. that you want to be in that reference range? I don't think so. a testosterone, the, that a normal free testosterone for a woman is down to zero in that reference range, which in lab corp and quest, is, what are you saying? So you're saying it's normal for women to just not have testosterone. have so much more testosterone. We're supposed to have so much more testosterone in our bodies than estrogen.
It's, and we don't think about testosterone like that. think estrogen is the dominant hormone, but testosterone is the dominant hormone is critical for so many processes in our body. So many organ systems. So yeah, it's really tough to see that. Like you'll, you'll get the reference, the labs back and you'll see, my, okay. I'm normal. My free testosterone zero, my total testosterone. think even two is normal for,
a female who is like in, think, I don't even think they do it by age group still, which is so wild to me, but I would like it, for example, for me, a normal, an optimal testosterone would be like between 40 to 60, somewhere like in the upper end of it. And that's even a little bit above the upper end of the standard reference range at like lab corp. Whereas two would also be considered normal, which is bizarre and too low.
like you'll definitely, like most people would be symptomatic at that level. Okay. So I want to just like go back to that because then there's difference. So you're saying that normal testosterone, what if you get lab work and it comes up, this is quote unquote normal is like zero to two. Yeah. So no, they're the normal reference range. Let's say it's typically like two for a total testosterone level is like from two
to 35 or 40, so like really wide. And the upper end of the reference range is actually pretty low still. Yeah. Yes. Okay. So thank you for correcting. So zero to 35, but then you're saying optimal so that we're feeling really is 40 to 60. But you have the charts of normal. High level of normal and still not feeling good.
Exactly, exactly. Yes. And, you know, there's a lot of variation in there for each person. Some people feel excellent at 60 and some people feel excellent at 30. And so each person is going to be unique in how they respond to testosterone therapy. symptomatic, just so I can describe what that is like, low testosterone. You know, we commonly think of the sexual
symptoms, so low libido, like horror arousal, trouble having an orgasm, but really it impacts our cognitive function, our brain health, our bone health, our insulin sensitivity, our metabolic health, our ability to build muscle and recover after exercise. Of course, we think about that from the male perspective, but it's actually really important for women.
too, for our ability to build muscle. It's again, another anabolic hormone that we need for bone and muscle building activity. And in this setting of stress, testosterone is the most vulnerable hormone when we undergo especially chronic stress. there's something called the pregnenolone steel where our body...
will sense the stressor and will steal testosterone resources towards making stress hormone pregnant alone. So our body will take those resources from testosterone and bring them over to pregnant alone, which is just an upstream of like your stress hormones. And so we'll often see in somebody with chronic stress, that one takes a dip first, like your testosterone will drop before anything else does, before we even see like you.
lose your progesterone production, will see the testosterone drop first. And so it's common, especially in perimenopause with the stress of perimenopause and just the stress of like, you know, being in your 40s and 50s, I will see a real sharp decline in testosterone. And it can really be difficult for folks. like you were saying, it can be such a wonderful therapy.
when it's used the right way at alleviating those symptoms. It really can be, it was huge. And it wasn't one that I thought about. I thought when we started talking about hormone replacement, like I'm gonna get estrogen. Yeah. Okay, here's progesterone. I'm like, okay, that makes sense when she started me on progesterone because like I connect that as female hormones that are going to complete with perimenopause and menopause. I hadn't.
ever thought testosterone. And so when she said, let's try testosterone, I'm like, what? Why? And it was huge night and day and like energy and brain clarity and feeling good. But it wasn't one that I was, that wasn't even in my sphere of knowledge. And it's so huge. Wonderful that, yeah, you have a provider that like that.
It's important to get these hormones checked, even if you're on birth control, because what birth control, especially estrogen containing birth control does is it, because of the high, it's synthetic estrogen, it's really high, high dose synthetic estrogen. So your body is like, oh, I need to make binding proteins, make really high levels of binding proteins to bind up all this estrogen. a normal...
For example, sex hormone binding globulin, which is one of those proteins, is typically around like 70, 80. And when you're on birth control, that shoots up into the 200s. binding proteins so high, it doesn't just bind with that estrogen from the birth control. It also binds up with your free testosterone. So it will tank your testosterone like to zero. And it's really, it's almost always zero. And women on estrogen containing birth control, when you check those labs. And so,
It's common for women to be on these oral contraceptives throughout perimenopause. And a lot of times they're used for treatment for these perimenopausal symptoms, even though we're not getting like the longevity benefit from them. But I'll often see in these women's severe symptoms of low testosterone and low estrogen, because you're not making any endogenous estrogen when you're suppressing it from the birth control pill.
I, those women too, even though they're on hormones, they're, not getting the therapeutic benefit of a lot of these really important, anabolic endogenous, which means just coming from you hormones. my goodness. That's an aha moment because we're talking about hormones and hormones and it's so easy to think, well I'm on birth control. And I had friends and clients who have said, well, my provider said, well, we can just try birth control, but
you're saying that's really missing out on all of the benefits of looking at and seeing what kind of hormones specific for perimenopods and menopods we need to be adding in. Exactly. Yep, exactly. We're not getting, well, we're losing the testosterone because it's really the free testosterone that matters when it comes to what's like...
usable, but for your cells. So your cells can't use bound up testosterone. It's not, it doesn't work that way. They can only use the free and you have zero free when you're on an estrogen almost always, like I will tell you, cause I check it so many times. and, the estrogen. Yeah. If you check somebody's estrogen, who's on oral birth control, it's zero. Like they always will have zero. So the birth control pill with that synthetic estrogen, that doesn't build bones and
that doesn't have the anti-inflammatory impacts on the brain. it masks potential issues with period. A lot of times those birth controls are just taken continuously. So it's really masking other things that could be going on too, because we're not able to measure the health of the menstrual cycle because we can't assess it because it's not happening.
Yeah, it's truly tricky, but a lot of the, you know, at the same time, those medications can be so helpful, you know, for people with migraines or acne, but, you know, ultimately with those types of symptoms, ideally rather, birth control can be a great band-aid, but rather than being on it for, you know, decades, we're really trying to work out what's causing the migraines and the acne.
going back to like you talked about at the beginning, going back to that root cause. Exactly, exactly. Yes, exactly. And that is so huge for people. we do a lot of band-aiding, a lot of masking, but it takes that time and that energy to go down to the root cause. And that's really what is going to shift and change our lives versus this band-aid masking approach. Exactly.
I do this a lot in, work with a lot of like active, women who are training for races and, they'll, be on these birth controls and they, have no testosterone and they're doing these really hard, long workouts without having the benefit of the hormone testosterone is they're just depleted. that being in that low hormone state is a stressor on your, in trying to train.
is a stressor, it's really hard on the rest of the endocrine system. So we'll often see some changes in the thyroid. We'll see some changes in adrenal hormones because the whole axis is just kind of starting to shift. a lot of times those folks are on birth control because of like migraine issue or something. And so we'll really work on...
getting at what's probably contributing to the migraines. Usually there's some nutrient deficiencies or something going on in the gut, maybe like a sensitivity or something like that. And then once we fix that, then we take away the birth control and then they can make their own estrogen and their own testosterone again. And really it just is such a huge shift in terms of what's happening in their endocrine system.
in a really positive, powerful way. Yeah, it changes their training. Yeah, I bet. And again, things I had never even thought of as we were going through. So you talk about stress and you talked about stress just a little bit ago on what's going on internally, stress inside of the body, but also there's outside stress. Can you talk a little bit about what stress and burnout and how that plays and connects in with perimenopause?
Sure. many times like what will happen is kind of like what the same kind of mechanism we were talking about before with ADHD, for example, like we'll have these coping mechanisms for like stress or for like our focus. Like we've had these built-in coping mechanisms that we've been using since our teens that have kind of gotten us to where we are now.
but then because of the huge, like seismic shifts that are happening in the endocrine system related to perimenopause, those coping mechanisms that we were using before, don't necessarily work. for example, and I'm going to talk about coping mechanisms. I'm thinking like not super healthy coping mechanisms. Like, for example, like just, with stress, like using intense exercise to like manage stress or like that, that
tendency to like push harder and like grind and just push your way through. Um, that's so common. And so, uh, that, it's just, it's so common in women, especially like, you know, women who are kind of moms, they have a lot on their plates and, maybe they're working too. And they've just got all this stuff that they've got to manage. Um, they'll just push through and then, and then what takes, um, you know, the back seat is, uh, tie like time for.
themselves, which I know you, I know you and you're, yeah. Go and it was a conscious effort for me to bring that in. it is, it is the first, we are the first, thing to be pushed in the back as we focus on work, as we focus on kids, as we focus on everything else in our life. And it's like, well, you know, I'll just slip by. I'll decrease my, you know, amount of sleep that I get, you know, I'm just going to get her up earlier. That was my.
biggest thing is like, I'm just gonna get up earlier. And then you're staying up later. And then I'm like, this little bit of sleep, exhausted. And then I'm downing coffee. but it worked in my 20s. Like, can still do that and still be functional. But in my 40s, I don't feel okay when I do that. Yes, that was it. That's exactly it. Exactly it. And
And we really don't, like what you were, I love what you talk about in your podcast too, just about like hobbies and the importance of that and the importance of just activating that side of our brain and like turning on our parasympathetic nervous system in that way. In a way that's not like, for example, like a lot of hobbies that we do are like actually something that like is productive. You know what I mean?
to be able to kind of shift that narrative in your mind and think about what could I do that's like just a hobby, like for fun, like just be creative and like do something that's just for me. really don't, women are just, I hate to generalize, but I just, we've been through it and so we know and I see it all the time. there's a lot of research coming out about women and why they are
at higher, like why they just have like two thirds of the autoimmune disease, you know, in the country, why we're just so susceptible to it. And it's this tendency to take on so much, like to, and to like, to allow ourselves, like to basically give everything, we just allow ourselves to be depleted because this is just, it's a tendency and it may be just how we were.
raised and we saw it in our own mothers. I mean, I think there are lots of things that contribute to why it is the way it is, but that's one of the underlying causes of autoimmunity. And it's so fascinating, but it really, it's an emotional, spiritual, like psychological thing, but it really has an impact on what's happening in your lab.
like you can see it in the numbers and how we can become so depleted in our hormones from this like tendency to just like give it all, like just, you know, give up all of our energy and not allow time for ourselves. And so, yeah, things that carried us through the twenties and maybe some of our thirties it's not going to cut it in perimenopause. So,
And I think there's something like, okay, I can give myself some time. There's something about that that is like so calming and just reassuring that that's okay to do when you have advocates like you out there saying that it's okay. It's so powerful. It's that permission that I can do something for me.
And it is a huge mental shift in that mindset shift in, okay, I'm gonna slow down and away, but I'm not gonna just push, push, push. I'm gonna be more choosy about what I accept. I'm gonna say no more. I'm gonna really focus on what builds me up and what are the things that I can do that feel creative and fun. Cause most of my creativity vanished when I had kids because
All that time for hobby is now kids And so I let it go. And then I did choose the things that, you know, like I was running six miles a day and I was all of those things. Yoga was a thing that was fun. Now it became like cramming in at 5 a.m. so that I can get my workout out. I'm totally guilty of that too. Where it was this enjoyable thing. This was something that I did on my Sunday mornings in a class.
And now I'm doing it in my basement before the kids get up, hoping that they don't wake up too early so I can finish the video. And if I do, like at least get through so Shavasana goes out the window, cause at least I finished the main stuff and forget Shavasana cause like I don't have time for that. And it wasn't building me up. I wasn't feeling good. I was really just push, push, push until I had no energy.
And then it's like, now I have to go see somebody because, I don't know what to do. Singing is this huge problem, but not looking at what I can do in my own life to start shifting that and really prioritizing and noticing that there is that shift in happiness in that we're now shifting in our 40s from this do, do, do to really that legacy and giving back. And that is a shift in how we're viewing the world. Wow. Huge.
about it. We just can't push it until, and women, we push until we literally can't push anymore. And then it's like, okay, we're collapsing and now it's time to get help. And I love this conversation because you're saying how important it is to be looking at our hormones and looking at our symptoms early on, not just waiting until we don't have periods anymore, not just waiting until we literally can't function anymore. Once we have it,
autoimmune disease and all of this stuff that just adds up that we just start taking on. It's like, okay, here's one more thing and one more thing. Really shifting to let's look like right now when things are mild, when we're in the space of I'm uncomfortable, but I can still function, let's start having conversations now because we're gonna change our outcomes later on. So, yes, so well said. And it's so much easier to kind of correct the course.
earlier on than getting to the point, like you said, of complete burnout and autoimmunity and just depletion of hormones. It's tough to come back from that. takes a long time and a lot of work. And it's not just like put the hormones back in and everything's fixed. It's complex. So yeah, this is exactly the point. Yes, I'm trying to get across it. The earlier, the better.
The symptoms that we tend to brush off, like we're just not sleeping as well, we're a little foggy in the brain, we're a little tired, that we just kind of are not recognized by conventional medicine as like legitimate symptoms. Those are real and that's your body. Your body is telling you something. Your body is speaking to you. And so even those symptoms that you may brush off and that your provider may brush off,
Listen, it's so important to listen now, yeah. It really is. And I know for me, because I have younger kids, I was blaming sleep on kids, on dogs, on, I would hear a sound and then I would be up and my son talks in his sleep. So like, I hear it and then I have to wake up and I'd be like, does he need something? No, he's just talking to sleep. But then I couldn't go back. And so I was tired and I was saying, okay, the fatigue is definitely due to
I'm waking up with him and typically, you I could hear and then go right back to sleep. But with this perimenopause starting, I'd be up and it's like two o'clock in the morning and I blame it on him, but it was really what was going on in my own body. And I just wasn't connecting the dots. And so there are so many things that we do brush off of it's not that bad. And once I started looking at it, I'm like,
this goes in a cycle here and something else in my body goes in a cycle here. it's like, my sleep is not, it's not consistently disturbed. It's only disturbed a certain time of month. I can't go back to sleep. So it took some really detective work at introspection where I'm looking at, oh wait, let's not just brush this off. Let's look for patterns. And as I was started to see the patterns, it's like, oh, maybe this is something more. Yes.
you're so spot on. Yeah. And that was something, yeah, I didn't bring that up, but that's so true. The times that symptoms can really, it's different for everyone, but a really common time for those types of symptoms to flare up is that week before your period starts, right? Like the usual, the old PMS window now becomes like the severe, like insomnia anxiety window. And it's as wild highs and lows, those fluctuations.
the absolute levels of the hormones that's triggering that. And so that's a great point too, just kind of tracking and seeing if things are cyclical like that can be really helpful in guiding your conversation with your provider. It was aha moments. And I'm big into like, I tell all my clients, we're looking at, putting our detective hats on and we're looking at things, but I wasn't doing it with myself because it's too easy to brush off. And I wasn't spending that focus time on me.
I was really focused on everybody else. And so it was that internal shift. So let's talk about sex in perimenopause because there are some changes that happen. And I think a lot of it just gets brushed off. Yes. So
really a really common early symptom in perimenopause is low libido and actually have changes related to lower estrogen and it can be cyclical too in the vaginal tissue which can cause vaginal dryness, pain with sex. So a lot, yeah, there are physiologic things that are happening, but there's also, it's not just like in the pelvic area, it's also in the brain. And so
we think about testosterone is the driving hormone behind libido, but estrogen is really important for that too. And so, it can be, it's, it's, it can be an imbalance of things. high, high, really high estrogen can kill libido. of course, low, low testosterone can also kill libido. for anybody who is having pain with sex in the like outer area. So there are two different types of.
pain with sex that we talk about. And so there's the deep one, you you feel it deep inside and usually there's something structural related to that. But then there's the intraoidal, which is like on the outside, like vaginal pain, usually related to dryness or like just tightening of the tissue. And that is usually related to estrogen deficiency and it responds so well to topical estrogen. So.
we can give like micro doses of topical estrogen a couple of times a week and alleviate those symptoms. it's, it's anybody can take that. anybody can be on that, can be on that. I've seen women do really well with it who are younger in their early thirties, but they're on birth control and they have issues with the estrogen deficiency from birth control. They respond so well to that.
And along with the sexual symptoms too that are happening down there, urinary symptoms, urinary frequency, your frequent UTIs, it's so surprising to me. can be such a simple fix a couple of times a week, insert this estradiol cream. It's a very low dose. It's not systemically absorbed. And we can virtually like take away these recurrent UTIs that can happen as we move deeper into menopause.
That's one therapy that's super cheap. And I highly recommend it anybody who's having any type of like vaginal dryness or urinary symptoms related to like an estrogen deficiency can work wonders. Thank you for bringing in the urinary incontinence and urgency and UTIs because that I think is a missing link where a lot of us are not connecting the changes in our bodies.
but also that there's vaginal dryness that can go in and we just chalk it up as like, ooh, this is a nuisance. And tell them it's really bad. And then it's like, okay, we need to seek out some kind of help. I love hearing that even women with birth control who are not necessarily thinking perimenopods can have benefits from a little bit of the estrogial. It's so powerful. So it is something that's like FDA approved from the regular
from a regular pharmacy, it's usually covered by insurance. And then just think about the benefit, the other benefits, the ancillary benefits, like, okay, you're not gonna have you frequent recurrent UTIs, so you don't have to go on antibiotics. So your gut's healthier. So your brain is healthier. Like all those things all matter. And it really can be a slippery slope. I've seen it so many times with these women who are post-menopausal with these recurrent UTIs that would benefit so much just from a little bit of topical estradiol. Yeah.
That's incredible. Thank you so much for sharing. if you could give one piece of advice to the women who are listening, going through perimenopause, what would it be? So I would say, because I'm a healthcare provider, I really, do, and I'm a patient, I really understand.
how important it is to find a provider that listens. that's by far the most important thing. Find somebody that you feel comfortable talking about sex with, somebody that you can share that you have brain fog with that you don't think is gonna like roll their eyes at you. Somebody who's not going to like act annoyed that you like learned something on.
chat, GBT or Google or something like, you you really, we need to be as healthcare providers. It's time to like be open to patients, educating themselves and to help guide their conversations that they're having with the internet and social media instead of just making it like making them feel bad for it. And so I think just having somebody who's going to listen in a nonjudgmental way, who's willing to help you tackle some of these problems is so important. So
Yeah, that's the big one. Find a provider who will listen. Yeah. I think that is huge for anything that we're looking for. Find a provider that will listen, especially around this topic. And I love that you brought up someone who is open to talking about what you saw on social media. Because often those are the little clues that we're like, my gosh, there is something out there. Let's go dive in here. It's the first time we may have seen or heard anything around this. And so we take it.
And if we feel shamed for bringing in and saying, okay, this is what, my gosh, yes, I saw it in Instagram or I saw it on TikTok. And then we shut down the conversation. But if you can use that as a jumping point of like, ooh, I heard about this. And then we have a provider that can really go in and have the knowledge to support us around it. That is life-changing. Yeah, I completely agree. Yep. And I've had so many folks...
when they bring it up to me, because they've had bad experiences like that in the past, they're always like kind of cringing, like waiting for me, like, oh, I got this on Instagram. And I'm like, it's okay, let's talk about it. And I think that's, you know, that's the direction we're headed. I think there's a, a younger generation of healthcare providers that are more open to have these conversations, but.
You know, speaking of just being proactive about things, now's the time, like even if you're not having the menopausal or perimenopausal symptoms, now's the time to start going out there and finding the right provider. Like try a few different providers and see who's a good fit so that you're ready when symptoms do arise. And I think that's huge. Try a few providers and see who fits. We do often go with a provider and we feel like we're locked in.
because we chose this person. It's like even personalities don't match. But there are, mean, just like friendships, there are different personalities and different ideas and different thoughts. And you do want someone that you can talk to about the nitty gritty stuff, about sex, about the things that are coming up. If you can't say I'm having pain with sex to the provider, it's not your right provider. Exactly. Well said. Yeah, that's a good rule.
then this isn't somebody that's going to be open and you're going to be able to share all of the things that are going on. Exactly. Exactly. Before we are done, are there any last pieces of advice or words of wisdom that you would like to share Yeah. when it comes to hormones, perimenopause, menopause, knowledge is your power. So
getting informed, again, being proactive, learning now, finding, it's okay to learn on social media. So maybe finding some providers that you like, that are trusted and aren't using like scare tactics. There are some great providers out there that like, I don't know you've heard of the Menoposse. Yeah, they're wonderful. So anybody in that group is great and they're so, it's fun, great place to learn, but that book, Estrogen Matters is also another great way to just inform yourself.
Again, because if you do choose to go down that path of hormone replacement therapy, you want to feel good, you know, and happy, like confident that you made the right choice about what you're putting in your body. Cause that the placebo and nocebo effect are real. we, you know, we really, our mind can really impact the way that these compounds interact in our body too. So you definitely want to feel informed on it. Absolutely.
And if people would love to connect with you and have you as a resource in their lives, what is the best way to connect with you? Sure. So I am on social, on Instagram. So I'm Ashley Schrader underscore NP. am, I have a website, risefxmed.com. You can sign up. always putting out really informative content and emails.
So feel free to sign up there. I'm seeing, right now I'm taking clients that are in certain states. So I'm in like the DC, Washington DC area, Maryland, Virginia, Massachusetts, Florida. And I will be in Colorado very soon. And next year I'll be in the Pacific Northwest. So Idaho, Washington and Oregon. And
I'm developing some programs too around perimenopause. So those will be available to anyone once I launch those, I'll be announcing it in my email, on my social media. So yeah, come find me there and engage with me there. And yeah, I hope to meet some folks out of this. my gosh. Thank you. Thank you. So all of your information will be down in the show notes so people can easily find you. I am so grateful for you sitting down and having this conversation today. It has been incredible for me. So many aha moments, little nuggets I'm taking away.
light bulbs going off in my head. I just wanna thank you for being here, but also for being an advocate and a voice for women and really sharing this information because it is such an under-talked about topic. And I really appreciate you being out there helping women. Thank you so much. I really enjoy talking with you. I love your podcast too. Like it's been inspiring for me to devote some more of my own time to myself. So thank you too.
thank you. I really appreciate that.
Landy Peek (1:10:37)
my goodness, this conversation was so incredibly powerful and eye-opening for me, and I truly hope it was the same for you. If you are struggling, please get the help that you need reaching out to somebody like Ashley to really be able to support you in a way that you are needing. And if you know someone who may be struggling,
who may be in that agent space of perimenopause, who is feeling all of the different things that come with our hormone shifts, share this episode. Let's make huge changes together. And because I think every adult human should hear, I love you and I like you and you were smart.
and kind and brave. And you can do this. And you've got this thing called life. And you are making a difference in someone's life just by existing. Thank you so much for being part of mine. I wish you all the happiness that today brings. We'll talk to you on the next episode.
Landy Peek (1:11:55)
Hey, before you go, just a little bit of legal. This podcast is designed for educational purposes only. It is not to replace any expert advice from your doctors, therapists, coaches, or any other professional that you would work with. It's just a chat with a friend, me, where we get curious about ideas, thoughts, and things that are going on in our lives. And
As we're talking about friends, if you know someone who would benefit from the conversation today, please share because I think the more that we open up these conversations, the more benefit we all get. until next time, give yourself a big hug from me and stay curious because that's the fun in this world.
