symptoms of perimenopause

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Night sweats, brain fog, fatigue, joint pain, irregular cycles…these are all symptoms of perimenopause.

As you probably know by now, perimenopause is the hormonal transition period leading to menopause. Typically, this starts in a woman’s late 30s, continues through your 40s, and even into your early 50s – basically until you hit menopause. If you’re in this transition and noticing some extremely frustrating perimenopause symptoms, you’re not alone!

Unlike different periods of a woman’s hormonal journey, most women feel clueless about perimenopause and what changes to expect, especially around hormone replacement therapy.

I’m hoping that today’s episode will give you clarity about what’s going on during perimenopause, so you don’t feel so out of sorts AND share with you new options to help you get perimenopause symptom release.

Joining me to talk about all things perimenopause (plus discussing whether hormone replacement therapy is safe) is Dr. Carrie Jones.

Carrie Jones, ND, FABNE, MPH is an internationally recognized speaker, consultant, and educator on the topic of women's health and hormones with over 20 years in the industry.

Dubbed the “Queen of Hormones,” Dr. Jones is a Naturopathic Physician who did her 2-year residency focused on women's health and endocrinology. She went on to get her Master of Public Health and was one of the first to become board certified through the American Board of Naturopathic Endocrinology. She was the first Medical Director for Precision Analytical (the DUTCH Test) and the first Head of Medical Education at Rupa Health.

She co-hosts the highly popular show, the Root Cause Medicine Podcast, which has over 7 million downloads. She is the Clinical Expert for the Lifestyle Matrix Resource Center, was on Under Armour’s Human Performance Council, works with the new League One Volleyball (LOVB) organization, and is an advisor to Metapause. Currently, she is the Chief Medical Officer at NuEthix Formulations and Head of Medical Education at Metabolic Mentor University.

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In This Episode:

  • Surprising symptoms of perimenopause
  • When do perimenopause symptoms stop?
  • How perimenopause majorly impacts your brain
  • Weird symptoms of perimenopause (no one talks about)
  • Which hormones are affected by the symptoms of perimenopause?
  • Liver detox and perimenopause symptoms
  • Big reason for perimenopause sleep problems
  • Is female hormone replacement therapy safe for perimenopause treatment?
  • Perimenopause test options
  • Simple lifestyle changes to make the perimenopause transition easier


“By understanding that this whole brain shift is part of our transition, it helps us really understand it's not just about losing our period or irregular periods or the ovaries or reproduction. In fact, it's way more global than that. It affects all of our systems, but the brain is the big one that gets affected first.”

“If you are in your 40s and you're starting to notice some of these symptoms, cycle changes, it's shorter, it's longer, you're noticing hot flashes, night sweats, sleep issues, the brain stuff, all the things that maybe are consistent or come and go. Congratulations, you're perimenopausal. It's the transition time.”


Find Dr. Jones online | Instagram | Tiktok

FREE Hormones 101 Cheat Sheet

Healthy Skin Show ep. 323: SNEAKY Perimenopause Symptoms + Signs (No One Talks About) w/ Dena Norton, RD

Healthy Skin Show ep. 072: Sex Hormone-Skin Rash Connection w/ Dr. Carrie Jones

No need to fear menopause hormone drugs, finds major women’s health study — The Washington Post


345: Why Brain Symptoms of Perimenopause Are Your Biggest Problem w/ Dr. Carrie Jones  {FULL TRANSCRIPT}

Jennifer Fugo (00:26.545)
Dr. Jones, thank you so much for being here. I'm excited to have you back on the show. It's been a while, but I think we have a lot to talk about today, especially in terms of hormones and, well, perimenopause and this whole weird gap, I feel like, in our hormone history and hormone experience that women have that we don't really get to talk about until now. Everybody is talking about it. You're talking about it. So thank you so much for being here and sharing your wisdom with us.

Dr. Carrie Jones (00:55.954)
Oh, I so appreciate it, I always love talking with you. Thanks for having me back.

Jennifer Fugo (00:59.344)
So one of the things that I have learned from you on your Instagram specifically, is that a lot of perimenopause symptoms that us women who are perimenopausal start to experience are these brain symptoms. So can you talk to us a little bit about what are some of these surprising signs of perimenopause that you think we should actually know more about, instead of just like the menopause signs that everybody fixates on?

Dr. Carrie Jones (01:31.762)
That is the truth. In fact, I was talking with Andrea Donsky of a company called Morphus, and they survey thousands of women to understand their signs and symptoms better. And they have correlated that there are over 100. But when they looked at the top 10 symptoms, nine of them had to do with the brain. The only one that didn't have to do with the brain was joint pain. Everything else from like fatigue, to mood, to cycle changes, everything, brain fog, memory issues, feeling more stressed than usual, had to do with the brain. And then I got to interview Dr. Lisa Mosconi, who wrote The Menopause Brain, and she talked a lot about this transition that women go through in their 40s, late 30s, and through their 40s and maybe even to their 50s, how this big transition is sort of a rewiring in the brain.

And because everything starts in the brain, women experience it. And so when they decide, gosh, I might be in perimenopause, is this what perimenopause is? They'll start to notice, oh my gosh, I'm having hot flashes and night sweats, which starts in the brain. I'm feeling more tired than usual, which starts in the brain. I can't handle stress like I used to, starts in the brain. I'm either more depressed, less motivated, my ADHD is worse, or I think I have ADHD for the first time in my life. They can't sleep. A lot of this starts in the brain. Their hunger goes up, they don't feel as full when they eat food, that satiety hormone, the trigger, one of the big triggers, starts in the brain. So by understanding that this whole brain shift is part of our transition, it helps us really understand it's not just about losing our period or irregular periods or, you know, the ovaries or reproduction. In fact, it's way more global than that. It affects all of our systems, but the brain is the big one that gets affected first.

Jennifer Fugo (03:28.78)
And does this go on forever? I have to ask, does it? Is this like a forever brain situation that you sort of lose this sense of who you are? Is it just a decline, a steady decline down?

Dr. Carrie Jones (03:43.986)
And that's steady. Thankfully for a lot of women, the perimenopausal transition is roughly five to 10 years. However, as Dr. Mosconi describes in her analogy, it's like when you remodel your house, like a whole house remodel, but you're living in it. So it's going to be great on the other end. She describes it as the brain's getting leaner and meaner. So we unplug and move around things that we don't need anymore because, specifically reproduction, reproductive things, period things, cycle things are being eliminated to make room for and way for the new transition we are in life. And as anyone who's ever seen a remodel or lived through a remodel, even a smaller remodel, a bathroom remodel, it's kind of a pain and it's tough to live through. But on the other end, you're super happy. You love your kitchen, you love your bathroom, you love how the house turned out, et cetera. And it's the same for us. So it's not forever. It does get better. There are a lot of things we can do, but it definitely can affect us off and on for several years.

Jennifer Fugo (04:44.138)
And just since you're going through this and you're being very open and honest with everyone publicly, so it's not like I'm sharing some weird information, but what has been one of the weirdest symptoms of perimenopause or experiences of perimenopause that you've had so far?

Dr. Carrie Jones (04:58.418)
So far, two things come to mind. So I wasn't expecting the brain fog to hit like it did. And for brain fog, mine is sort of memory glitches. I'm going to do something, I'll decide, oh, I need to look that up on my computer or my phone, and I will pick up my phone and think, I'm gonna look up, what was I gonna do? Or I'll be telling a story and I mention my neighbor who I've lived next to for five, six years and I'm like, what's his name again? Like what the heck? And that's really annoying because I am a go-getter, type A, multitasking, great memory, which I'm sure a lot of your listeners are. And all of a sudden you go, what just happened? Was there a glitch in the matrix? It'll come back. I'll think of my neighbor's name. I'll remember what I'm going to look up. But I didn't used to have that.

The second weird thing that happened are phantom smells. Phantom smells. So Dr. LaKeischa McMillan is an OBGYN who specializes in perimenopause and menopause. And about a year or two ago she said to me, have you had phantom smells yet? And I was like, what? No, what's that? So it's weird smells, often they're bad, like cigarette smoke, burning wire. For me, it was like sort of a sewer smell that would come on and nobody else can smell it, and then it will go away. But it'll freak you out if you feel like you're smelling something burning, of course, you're going to go search your house and look for something burning. If you feel like you're smelling cigarette smoke, you're going to try to move away from it or find the source of it, or figure out where is it coming from, especially if it's in your house, in your car, etcetera. And then it goes away. And when I looked up the research on phantom smells, it's reported by a lot of women. They think they're going crazy, understandably. And it seems to have to do with the decline in estrogen, estradiol, and our olfactory bulb, which is our smelling sense, essentially, in our brain. And that does seem to go away. I've asked a lot of menopausal, post-menopausal women, did it go away? And they're like, oh yeah, it goes away. But it is annoying for those years. You just have to recognize it's not cigarette smoke, or the sewer's clogged up, or something like that. But you do check every time because you're just not sure.

Jennifer Fugo (07:10.055)
That must be slightly unnerving, I would say. I haven't had that experience yet, but I can imagine you're like, what on earth is going on?

Dr. Carrie Jones (07:18.514)
Yes, I was in the bathroom when I first smelled the sewer smell, which makes sense. I thought, oh my gosh, called my husband in, I was like, oh, something's wrong with our sink, I can smell sewer. And my husband, who is an intelligent man, was like, honey, I don't smell anything. And I'm like, no, smell harder. Get your nose down there. He's like, honey, I don't smell anything. And I thought, oh my gosh, maybe something's wrong with him. Maybe his nose is broken.

And then I was shopping, I was at Target and I smelled it again and I thought, nope, nope, it's me. It's just me. And it doesn't happen often, but I have had it a couple of times since that initial time. And it lasts 10 seconds, 15 seconds, and then it goes away. And some people have commented, suggested, you know, maybe we're becoming, like the rewiring, we're becoming more astute. Maybe there is a sewer smell. And because of our rewiring, we are able to smell it better. You and I were talking before, some smells could be due to mold or could be due to nasal stuff, rhinitis, sinusitis, fungal stuff, which is absolutely true. Our sinuses, our mucous membranes can dry out with the decline in estrogen. So it is possible we are developing superhuman smelling sense as we get older. That has not quite been studied yet though.

Jennifer Fugo (08:39.205)
Fair enough. I have to ask you, because I think this is worthwhile to ask. You've mentioned, actually, postmenopausal, and yet we're talking about premenopausal and perimenopause. What is the difference? Because I always think of it as this 12-month period where you stop having a menstrual cycle, but that, as you pointed out before we started, doesn't necessarily make sense for everyone. So what do you think that definition should maybe look more like? And what are you reading now about that?

Dr. Carrie Jones (09:18.802)
The current definition of perimenopause is the transition state leading up to menopause that generally starts late 30s, through your 40s, into your early 50s. The average age of menopause onset is 51 in the United States and a lot of countries. So if you are in your 40s and you're starting to notice some of these symptoms of perinemopause, cycle changes, it's shorter, it's longer, you're noticing hot flashes, night sweats, sleep issues, the brain stuff, all the things that maybe are consistent or come and go. Congratulations, you're perimenopausal. It's the transition time. When you've gone 12 consecutive months with no period, assuming you still have your uterus, you've gone 12 consecutive months, no period, you are considered menopausal. On the 13th month, you're considered postmenopausal. You're actually only menopausal for about one day, the 12-month day, oddly enough. But we do tend to interchange the words menopause, postmenopause, because you can still be symptomatic once your periods have stopped. If you're listening to this and you're like, yes, I'm at 14 months, no period, but Carrie, I'm having terrible symptoms, you're still considered, actually you're considered postmenopausal, because everything has to do with your period. But yes, you can still have symptoms.

What I'm reading, what some researchers are proposing, is that we redefine the definition around the ovaries, the stopping or cessation of the ovaries, because that then implies it's more of a systemic transition. It is involving the ovaries, which are a gland, of course, an organ, and the stopping of the decline in the estradiol and progesterone is affecting everything from your brain down to the tips of your toes. And I like that better instead of just focusing everything around reproduction, for you go 12 months, no period, you are no longer able to reproduce, therefore you're now considered menopausal. When we know as women we are way more than our reproductive abilities and it is affecting way more systems than just whether or not we can become pregnant.

Jennifer Fugo (11:28.448)
That makes a lot more sense, especially as you pointed out, there's women in different scenarios. And if you say, had a hysterectomy, but you still have your ovaries, are you menopausal?

Dr. Carrie Jones (11:41.234)
And I get that question a lot. Carrie, I've had an ablation. I've had my uterus removed. Where do I fall? I don't know. I'm not bleeding. How do I define this? So usually what we do is we can test and see if maybe the ovaries are functioning. Or there is a test called a follicle-stimulating hormone, FSH. It's a blood test. Once it gets above 20, some guidelines say above 30 in the blood on two occasions, some more than one occasion, then we consider you menopausal. And oftentimes women are of an age having perimenopuse symptoms and so they kind of know they're perimenopausal. They're just curious if they're all the way menopausal, postmenopausal, if they still have their ovaries. If a woman has had surgical everything removed, the uterus is gone, the ovaries are gone. The second the surgeon removes the ovaries, you are considered surgical menopause is what we call it. So if you've had this surgery at 35 years old, you went menopausal at 35 years old. If you had it at 23 years old, you're considered menopausal at 23 years old. This is why we need to broaden, change, redefine the definition because it can be really a struggle for women to figure out where they fit and then what do they do.

Jennifer Fugo (13:03.296)
So one thing that I am gathering from all of the things that you've discussed is there's a lot of confusion. I will be honest with you, at 44, I feel like I am currently becoming confused about my own body, which I feel like for 30 years, I was like, okay, we're in sync, I get what's going on here. And now all of a sudden it feels like it's doing its own thing, and I guess I didn't get the message. Why do you think that women seem to be less educated about perimenopause as compared to menopause, or even when we have this onset of our menstrual cycle, or as we move into a more stage of life for childbearing and such? Why are we less educated around this?

Dr. Carrie Jones (13:52.402)
I seem to find in the United States especially, we don't get the education from generations above us. So our mothers, our grandmothers, or aunts or whoever, didn't want to talk about it. Or maybe we saw some worst-case things. We saw depression, we saw that they were having hot flashes, we noticed, as their children, that their moods are really changing, they're gaining weight. You would hear they had high blood pressure or are developing diabetes. But nobody explained, nobody talked about it, and it just sort of was, well, that's natural, women go through menopause, which is true. It's very true. All women are going to go through menopause at some point somehow. So we have these two older generations that didn't want to talk about it. We didn't have social media for a long time, so they had nowhere to look. The only way they had to look was to ask their doctor or the other women in their life, which weren't very helpful.

And then in 2002, we had the Women's Health Initiative, which is the big study that dropped the news on everyone that hormones cause cancer. That is a whole conversation into itself that has largely been proven wrong and retracted. However, from 2002 forward, till very recently, women stopped their hormones, they didn't go on hormones. And because there was very little alternative to offer, there were antidepressant pills, there were sleep pills, it was kind of like, yes, suck it up. We don't have anything to give you. So even if you were searching out help, most of conventional medicine would shrug their shoulders and go, yeah, you're 55, you're 60, you're 42, like, that's what happens. Good luck.

And now that tide is really shifting. New guidelines are coming out. Social media, of course, has completely exploded. We have all this education now at our fingertips. And finally, medicine, and companies, and universities, and those who make the guidelines are opening their eyes and going, oh, wow. Even publishers, the amount of menopause books coming out, perimenopause books coming out is great, like we're trying to make up lost time on the education part to help. Now, the tidal wave of education is still tidal waving, definitely hasn't made its way across all of medical America, but it is slowly starting to roll through. And that's what gets me really excited. But I think that's why so many people don't know. We were never taught this in school. You know, we learned how to not get pregnant. Or if when you were older, if you wanted to get pregnant, that's when you would see your OBGYN. And then there was sort of nothing in between because they don't really have anything to offer you. Not really. And so the management of perimenopause was very confusing to everybody. And that is really changing.

Jennifer Fugo (16:34.491)
So in terms of our hormones, and are we talking mostly about sex hormones in regards to perimenopause, but not only just that, which hormones do we really need to care about here for perimenopause test?

Dr. Carrie Jones (16:46.994)
Yes, so usually what we're talking about when we talk about hormones, we're talking about estrogen, estradiol in particular, which is known as E2, and we're talking about progesterone. Now, we have other hormones that can be affected, of course. We have androgen hormones, testosterone, we have DHEA that can be affected. Believe it or not, our thyroid can be affected at this transition. So I really encourage women, if it's been a hot minute, go ask for a full thyroid panel, even if it was normal five years ago, it may not be now. This transition affects the thyroid hormone production.

Things like our insulin and our glucose, these markers we don't even think about, can start to go up. We become more insulin-resistant, we become more pre-diabetic, because of this shift. Our cholesterol markers start to go up due to the decline in hormones. We noticed that the LDL cholesterol tends to go up, HDL cholesterol goes down, triglycerides go up, and it can seem out of nowhere. I have talked to more practitioners, health practitioners in the field who go, Carrie, I had great numbers last year, and I'm that much further along in this perimenopausal transition, or maybe they're now fully menopausal, and poof, their numbers have gotten worse. I'm like, I know, I'm so glad you tested. So when we talk about hormones for sure, usually they mean estradiol and progesterone because those are made predominantly out of the ovaries, and that's our focus with the definition. However, because it is a global effect on every single system, a lot of other markers get affected as well.

Jennifer Fugo (28:40.525)
It's interesting, when I was in my 30s and maybe like right around the 40-year, I was like, I gotta make sure that I'm always supporting liver detox, it helps support my hormones. I really did truly find that it almost entirely eliminated any PMS issues at all. Do you find in research or your experience that even in the perimenopause state and transitioning into postmenopausal that we still should be focused on supporting liver detox?

Dr. Carrie Jones (29:11.762)
I do, and I say this because in the perimenopausal state, before your estradiol goes down, usually it wildly swings up and down. So in your cycling years, when you had a period that was really consistent, you were on a very controlled roller coaster. Your estrogen goes up, your estrogen goes down, your estrogen goes up, not quite as high, and then back down again. And it's very controlled month after month, or it should be. In perimenopause, the roller coaster seems to go off the rail and do what it wants. So some days it's twice as high as you would have thought, some days it's bottomed out, and then it starts over again. And because we're having these wild swings, the high days are going through the liver. And so it is nice to still have liver support and support the estrogen craziness that's happened.

Now, also remember, though, in your 40s and 50s, that's your fourth and fifth decade of experiencing life. So chemical, toxicant exposure, alcohol, medications going through the liver, we still want to support the liver's ability to handle that. If I live in an area that has a lot of wildfires, and we're coming up on summer season at this interview, years ago I bought air filters, air purifiers, because I know that air quality, air pollution is a huge deal. And other people have water quality issues. You know, other people, it's it's plastics, it's fragrance, it's it's the chemicals in our skincare, that are not good for us, the parabens, the phthalates, etc. And all of that has to go through the liver. So why stop supporting the liver just because we're going through this transition? If anything, the transition is going to impact the liver. Women are more at risk for gallbladder disease at this age. They're more at risk for fatty liver at this age. So we absolutely need to keep supporting the liver, which does include even cutting out or really cutting down on alcohol, which is hard for a lot of women to hear.

Jennifer Fugo (31:00.522)
And that also impacts your sleep as well. So what the heck is up with all of the sleep issues?

Dr. Carrie Jones (31:03.762)
Oh, so much. Couple things, so the change in progesterone is usually the first thing. So progesterone is calming, soothing, relaxing, plays a role in sleep and women notice that they can't fall asleep or they wake up at the dreaded 2 am, 3 am, and they can't fall back asleep. Estrogen as well plays a role in sleep, in I believe our REM sleep, and estrogen plays a role in our melatonin production. And so between those two, just looking at those two, obviously a lot of other things go through sleep, but remember, your brain is also remodeling. So when the center for, OK, let's go to sleep and stay asleep is getting all these mixed crazy signals all the time because the hormones are there, the hormones are not. And so as a result, unfortunately, we don't sleep as well as we used to when we were younger.

Jennifer Fugo (31:50.185)
I also find that I'm so much warmer. So the room, my husband, like, wants to choke me at this point. I say it lovingly, but he's like, it's too cold in here. Can you close the window? And I'm like, no. We no longer have a heavy comforter, I can't do that. It's okay. I'm adjusting, but it's like, I am one of those people that went from freezing cold hands and feet, he's like, what, did you die? Like your hands are so cold. Now I'm like, I'm warm all the time, and I just have leaned into it, it's okay, but it is what it is.

So, you know, where I'm at right now and I think many listeners are as well is this idea of hormone replacement therapy (perimenopause HRT) for perimenopause treatment. And there has been, for years as you kind of alluded to earlier, that there's all these risks, and they could cause cancer, and maybe we should not use this. Do you feel like the risks of using hormone replacement therapy for menopause and perimenopause treatment are valid, or do you think we should actually reconsider the use of this and be a little more open to it?

Dr. Carrie Jones (32:58.962)
Actually, so that was the Women's Health Initiative from 2002. That's the one that made the cover of all the news and the magazines that, you know, quote-unquote, hormones cause cancer. And since that time, there are a lot of authors on that original study, a lot, and a lot of them, even including the main author, they have done research since that time and have come out and talked about how the main outcomes published in the media have actually, they're not true. Like they've actually been debunked since that time.

In fact, in that original study, which did not make the news at all, in that original study, they had two sections. They had a combination of estrogen and a progestin, which is different than progesterone, and they had an estrogen-only arm. So if you didn't have a uterus, if you'd had a hysterectomy, you were in the estrogen-only arm. At the time of the news and everything that, quote-unquote, hormones cause cancer, it turned out the estrogen-only arm didn't have an increase of cancer. Estrogen in that arm didn't have an increase in cancer. They continued that arm for many years later and found that still, it did not have an increase in cancer. That did not make the news. What they said was hormones cause cancer and in the combination estrogen-progestin we had an increase in cancer.

Since that time we've now realized, and there's a group if you're listening from the UK, NICE, N-I-C-E, which is the National Institute of something something, they have these wonderful graphics to show the small percent increase if you're doing a combination estrogen-progestin and the risk of breast cancer. Which is different than if you are on estrogen alone, maybe you've had a hysterectomy, or estrogen and progesterone, which is very different. And there's a great book called Estrogen Matters, and on Instagram, they have a page, @estrogen_matters, and they go through this and it's very educational to help people understand where we were and where we've come, where we're at right now.

Dr. Carrie Jones (35:26.418)
Now there are some risks with estrogen, for example if you swallow estrogen, if you take it as a pill, you have a slight increased risk for stroke or clotting, so we don't generally use swallowed estrogen as perimenopause HRT. Usually we do a patch or topical, or there's also options out there, depending if you get it at your pharmacy or at a compounding pharmacy. And then for progesterone, we want to make sure it's progesterone. So if you get it at a pharmacy, the trademark name is called Prometrium. You do have to be careful, it does have peanut oil in it. So if you're a peanut allergic, don't take it. It does have some food dye in there, I don't know why, but there you go. And if you can't do that, then you can get it compounded at a compounding pharmacy and then they can do it as a pill, cream, a vaginal. There's a lot of options if you can't do what's commercially available.

And you often hear the word body identical or bioidentical hormone replacement therapy for this. And the reason they use those terms is because the progesterone in the trademark name, Prometrium, looks like the progesterone in your body. That's why they call it that. Whereas progestin doesn't. It doesn't look like the progesterone in your body. But it's close-ish and it does other things. So it can bind to a whole bunch of receptors. And that's one of the problems that came out of it.

So it's really interesting. The hard part is it still gets perpetuated. If you are on hormones, you may have noticed, and if you go through a conventional pharmacy, Walgreens, Rite Aid, whatever, Kroger, Costco, you may have noticed in the package the insert says, hormones cause cancer, the Women's Health Initiative, blah, blah, blah. And it's really unfortunate because that data is quite outdated now at this point. And that information has not rolled itself across the United States yet either. I do hear of a number o primary care and OBGYNs who'll still quote that or who will say, oh, we can't use hormones because that causes cancer. Now, what is interesting to me, an interesting observation is that these same practitioners have no problem giving the birth control pill, which is ethinylestradiol and a progestin. But they do have a problem with female hormone replacement therapy for women who are struggling in menopause.

Dr. Carrie Jones (37:37.714)
And so when you ask do risks outweigh benefits, I think benefits far, far, far, far, far outweigh risks, knowing that it is a systemic, bodily thing that happens to us. And so female hormone replacement therapy could be a real blessing in disguise for a lot of people. Now, there are a lot of people who don't believe in hormones regardless, or maybe have a history, they can't do hormones for whatever reason, and that's totally fine. But my purpose of this is, if you want hormones, you're considering hormones, and somebody says to you, oh, it causes cancer, hormones cause cancer. They have very outdated information. We've come a long way since then. Thankfully it is getting out across social media and the internet, but it doesn't always make it into a doctor's office.

Jennifer Fugo (38:11.905)
And should we get testing ahead of time to know what we need and how much we need? And then there's like blood testing, saliva testing, urine testing. I'm like, I don't know. What do you suggest for perimenopause test?

Dr. Carrie Jones (38:26.802)
So technically the guidelines, you do not have to have testing to go on hormones in perimenopause or menopause. And you do not have to have testing to be diagnosed as perimenopause or menopause, or be told you are in perimenopause and menopause. Technically you don't have to. However, a lot of practitioners do like testing to get some sort of baseline, maybe even in the other hormones, thyroid, cortisol, insulin, things like that. They're like looking everywhere else to see, or they're doing certain testing to determine how does your estrogen process through your body. So if I'm going to put you, Jen, on estrogen, I still want to know, based on testing, do I need to support your detoxification and how do I support that? And then once you're on hormones, definitely there are a lot of practitioners, not all, but a lot, like to follow up with testing and see where you're at.

And remember, you still have testosterone. You still have DHEA, and those are hormones that are available as well. DHEA is over the counter. Testosterone, there is no FDA-approved testosterone for women, so testosterone is generally compounded. You can't go get a woman's testosterone at Walgreens, Rite Aid, CVS, et cetera. You can only get it at a compounding pharmacy. But it is available. A lot of prescribers still do that. And so when you're looking at these hormones, definitely practitioners will say, I'm still going to test and see what's going on.

Jennifer Fugo (39:56.031)
So interesting. So with all this said, my final question, what simple changes do you think could be most impactful for somebody listening to this who is in the midst, like me, like you, in the midst of perimenopause symptoms? What could we do that would be helpful?

Dr. Carrie Jones (40:14.82)
Oh my gosh, yes, this is the great thing. So, I'm gonna put a pin in hormones, because I am a fan of hormones. I know not everybody is, but I am. But we're gonna put a pin in that, because let's talk about the lifestyle stuff. So when it comes to this perimenopausal transition, you use the word when it comes to feeling hot or warmer all the time, I'm gonna lean into it. So we feel that we need to, you can be annoyed, right? I get annoyed all the time. But I understand what's going on. Now everyone listening understands what's going on and we're going to lean into it. We're going to understand that our body is going through an entire remodel and out the other end, it's going to be better. We're coming through like a phoenix through the fire, literally, and we're going to rise up and it's going to be great. Right? So we're going to have a little mind change around that.

Second, we're going to realize that this time, because of the remodel, remodels are stressful. So we are going to take care of ourself. So you are going to give yourself extra time. You are going to give yourself extra self-care. You're gonna do the extra things as you're going through this to give yourself grace and don't think, oh my gosh, why am I not liking my 30s? What happened to me in this time? It's a whole transition. You're a whole new person. You're gonna give yourself grace. Third, we're gonna get you sleeping better. So whatever it takes to get you sleeping better, whether that's adding in magnesium at night, like magnesium glycinate, drinking sleepy time tea, or both, adding in herbs that are calming, such as passionflower, chamomile, maybe some lavender spray around the room, whatever it takes, we gotta get you sleeping at night.

Then, because of the blood sugar and insulin, cholesterol thing, and a lot of women tend to gain weight around the midsection at menopause, which is inflammatory, we don't want that, we're gonna start weightlifting. So if you were previously addicted to cardio, or you really like your cardio, we need to start adding in weights. We need to put a little bit more lean muscle on you. We need to increase your protein if you're not getting enough protein in your diet, and build that lean muscle because we're losing it. We're losing the lean muscle as we get older with this shift in hormones and we don't want to lose it. We want it for lowering inflammation, helping our bone health, the weight, everything. So we want to be packing on the muscle as opposed to just cardio. Now I'm a fan of cardio, you know, go for walks, big fan of walks, get those 10,000 steps in or more. You got to put some weight on as well.

Dr. Carrie Jones (42:33.586)
The last thing that happens, and I was talking with, and we mentioned him earlier, we were talking, the two of us, Kiran Krishnan is a microbiologist, and he was saying, you know, when women go through perimenopause and menopause, the decline in estrogen really affects their microbiome. They get more risk for leaky gut, more risk for inflammation. So it doesn't mean you have to test your microbiome, but it does mean you need to support your microbiome more. This might mean adding in specific probiotics. This might mean getting in more fiber. This might mean adding in resistant starch powder to your, whatever you're doing, your smoothie or something, just in some water, your tea, I don't care, your coffee. Whatever it looks like to continue to support your gut is only going to help because the GI tract is a big source of inflammation, unfortunately, as we get older, and we want to maintain that integrity. I want my GI tract working for me, not against me, just because of these hormone changes. And that's the lifestyle stuff.

Obviously, we can layer on phytoestrogens, like genistein from soy, or actual estrogens, hormone therapy, as it fits you. And you can do hormone therapy sort of in an order. For example, I'm only on progesterone. I still cycle every 25 days. So I don't need estrogen yet, but I am on progesterone and I'm probably going to add in DHEA here soon because mine is declining. DHEA does decline with age, unfortunately. I don't need testosterone yet. But you can layer them, you can start with one, see how you do, retest, start with another one, et cetera, et cetera. So those are my big ones.

Jennifer Fugo (44:26.651)
I love that. So with that being said, you have a brand new website. So for everybody who used to go find you in other places, you have your own home now to welcome everyone to, at And you also, because I think this is helpful based on our conversation, you have the Hormones 101 cheat sheet that's available on your website, and just tell everybody why that would be helpful for them.

Dr. Carrie Jones (44:51.218)
I often got the question, what labs do I ask from my doctor, or what labs can I order on my own? And what do they mean? What am I looking for? Why do I care in this transition? Some of these labs have to do with inflammation, or they're what we call metabolic markers. Maybe you've never had them before. And now is the time. Now is the time we keep track of your heart, of your inflammation, of your bones, of your brain, right? All these things, including your hormones. So that's to help women go, alright, I have my sheet. I understand what it's for. I'm gonna ask for it or I'm gonna order it.

Jennifer Fugo (45:25.944)
Awesome. Well, you can get it there and we'll put the links to everything in the show notes. You also have a podcast as well. It's the Root Cause Medicine podcast. Is that correct?

Dr. Carrie Jones (45:33.65)
It is. Yes, I co-host it with another fantastic doctor, Dr. Kate Kresge.

Jennifer Fugo (45:39.16)
Awesome. And you have a YouTube channel, so we'll put a link to everything, your Instagram, your TikTok, et cetera, so everybody can find you wherever you are. I just want to thank you so much, Carrie, for being here, and the generosity that you bring, not only when you come here on the show, but also just online sharing your personal experience, what you're reading and research, just always being so willing to share. I absolutely love that about you and the fact that you don't gatekeep or make the information so difficult or complicated that the regular person, the regular woman, can't actually make sense of it. Because we all need more of that and we all need more of you. So thank you so much for being here. I really appreciate it.

Dr. Carrie Jones (46:25.586)
Thank you!

symptoms of perimenopause