Helping Clients With Brain Fog, Anxiety, and Mood Changes in Perimenopause & Menopause

Dr. Jessica Drummond 00:00:03 Hi and welcome to the Integrative Women’s Health Podcast. I’m your host, Doctor Jessica Drummond, and I am so thrilled to have you here. As we dive into today’s episode, as always innovating and integrating in the world of women’s health. And just as a reminder, the content in this podcast episode is no substitute for medical advice, diagnosis, or treatment from your medical or licensed health care team. While myself and many of my guests are licensed healthcare professionals, we are not your licensed healthcare professionals, so you want to get advice on your unique circumstances. Diagnostic recommendations treatment recommendations from your home medical team. Enjoy the episode. Let’s innovate and integrate together. Hi there, and welcome back to the Integrative Women’s Health Podcast. I’m your host, doctor Jessica Drummond. And today we’re going to talk about helping clients with brain fog, anxiety and mood changes in perimenopause and menopause. We’re going to talk about why brain fog matters. This kind of generic term is very important for showing us that, you know, perimenopause and menopause aren’t just about hot flashes, night sweats or regular periods, but up to two thirds of women report memory lapses, difficulty concentrating, and sort of a mental fuzziness, which is related to cognitive endurance, memory, the ability to keep multiple things in your mind at once.

Dr. Jessica Drummond 00:01:53 And in fact, longitudinal studies show that verbal learning and memory decline from pre to perimenopause happens in recent research is suggesting that there are deficits in processing speed, inattention and working memory where you’re holding multiple things in your mind at once. Drops in estrogen can reduce brain blood flow and neuroplasticity, while fluctuating and particularly lowered, progesterone affects the brain’s calming Gaba pathways, which results in sleep problems. And when your clients are under chronic stress, these issues are amplified. So today, I’m going to walk you through a case study of a 46 year old woman. We’re going to call her Jamie. She is not a case study of one person that’s been in my practice, but she’s like a summary of many similar women who have walked through the doors of our practice and also the practices of our students who I think you will recognize either in yourself or in many of your clients, or both. She presents with brain fog, anxiety, and mood instability. During this perimenopausal transition, she actually thinks of this mood instability as pure rage.

Dr. Jessica Drummond 00:03:13 She suspects that she may have low progesterone. She also has a history of concussion from a ski accident, neuroinflammation from a Covid 19 infection six months ago, and migraines before her period every month, which has been happening now for about 3 or 4 years. She also is under a significant amount of chronic work and family stress work that working mom stress. We’ll get into it. She feels anxiety and rage that feels new, but she’s not really sure if it’s because of perimenopause or it’s because she is now the working mom of a teenage boy and a daughter with a hefty private school college tuition bill. Or maybe it’s just because her hormones are out of whack. And the other thing that’s so interesting about this client is sometimes she feels perfectly normal. There are days where she feels fine, and she’s not really sure if she can pinpoint her mood changes and her cognitive changes to a particular time in her cycle that makes her feel even crazier. So speaking of her cycle, she’s still bleeding pretty much every month, but the timing of her cycles is fluctuating just a little bit.

Dr. Jessica Drummond 00:04:32 Often her periods are every 24 or 25 days, but sometimes she’ll go 40 days without a period, and that might only be in the last three years. It’s been, you know, 5 or 6 times. She has not been on hormonal, hormonal birth control for a decade since her husband got a vasectomy after their youngest son was born. So we’re going to explore why these symptoms occur and how you’re going to, as the practitioner, track what’s going on when there’s all this complexity. Right. It’s not just perimenopause in a vacuum. You’re going to learn how to apply the integrative Women’s Health institutes, maps, frameworks. These are all the frameworks that we teach in our Perimenopause and Menopause Conference in Complexity program. And you’re also going to learn our seven step system. We’re going to apply these two things in this case to help this client reduce her migraines, restore her cognitive clarity and her emotional balance. So let’s get into where to start. First you need to think about the root causes. And one of the things we’re going to get into, we’re going to get a little nerdy at the beginning of this conversation, because I want you to understand the hormonal fluctuations and the cognitive challenges that in the research have been linked.

Dr. Jessica Drummond 00:05:56 Now, here’s a huge challenge that we have. We don’t have a ton of research on how HRT, or how the hormone fluctuations of estrogen and progesterone and testosterone directly affect the brain. But I’m going to tell you about what we have. So during perimenopause, estrogen levels fluctuate erratically. Studies show that women in the perimenopause transition report frequent brain fog symptoms like forgetfulness, difficulty concentrating, and trouble making decisions. Reduced estrogen slows neural processing. And very importantly, especially when we combine it with Covid 19, infection decreases cerebral blood flow. And we have the underlying estrogen withdrawal hypothesis for migraines that maybe when your clients used to just have migraines in that, you know, day or two before her cycle. Now they’re starting to happen. Like in Jamie’s case. Just around ovulation. Or the maybe ovulation of perimenopause. Not always actual ovulation. Just like a quick estrogen jump and then drop. Or a low estrogen jump and then drop. Or perhaps even more days before her cycle, as sometimes estrogen levels are quite low in perimenopause, but they really can fluctuate.

Dr. Jessica Drummond 00:07:16 So sometimes they’re very high and then a drop can make those migraines worse. So let’s go a little deeper into the impacts of fluctuating and then ultimately reduced estrogen on the brain. Let’s talk about the receptors. So classical estrogen receptors estrogen receptor A and estrogen receptor. Well a alpha and beta A and B are found in brain regions that support memory and executive function, such as the hippocampus the medial prefrontal cortex, the basal forebrain, and the striatum. Estradiol modulates synaptic plasticity, the ability to build more neural connections by stimulating BDNF, which is otherwise which is the shorthand for brain derived neurotrophic factor. It also influences estrogen, also influences dendritic spine formation, synaptic organization, and cholinergic signaling. When you have decreases in estrogen, you actually have decreased brain activity at a neuronal level. We also see increased estrogen receptor density. So in the first in vitro Pet scan study to image brain estrogen receptor density, they scanned 54 healthy women. 18 of these were premenopausal, 18 were perimenopausal, and 18 were postmenopausal. They used a Florent, they used a fluorinated estradiol tracer.

Dr. Jessica Drummond 00:08:45 And they found that estrogen receptor density progressively increases across the menopausal stages. So it’s less density and pre and perimenopausal compared to post menopausal. And it’s progressively increases over time independent of age and independent of circulating estrogen levels, which is really interesting. Higher estrogen density, estrogen receptor density in the hippocampus, amygdala, posterior cingulate cortex and frontal cortex were associated with poor memory performance and increased mood and cognitive symptoms. What the authors are guessing about why this is, is that the brain is trying to compensate for failing or failing or falling estrogen levels over time, but there’s still some question marks around that because it wasn’t necessarily directly in alignment with lower estrogen levels, it was just changes through the menopausal cycle. So it could be other hormones. There could be other reasons for this. A 2025 review from the Menopause Society highlighted that elevated estrogen receptor density is seen during the menopausal transition, and may represent an adaptive mechanism linked to actually worse memory outcomes. This review also noted that gray matter volume in the frontal and temporal cortices and the hippocampus decreases during perimenopause, but then whether or not you’re using hormone therapy may recover post-menopausal.

Dr. Jessica Drummond 00:10:18 So a lot of times women who have mild to no symptoms in perimenopause and don’t get treatment, but then they just continue that transition, feel better postmenopausal. But again their symptoms were mild in the first place. Sometimes even if they didn’t get treated anyway, they’re going to feel better. And we do see some reasons for that. Structural and functional brain changes, gray matter and amygdala volume change. In fact, there was a cross-sectional MRI study compared 54 early menopausal women with 54 premenopausal controls, and the early menopausal participants in perimenopause had smaller bilateral amygdala volumes, higher FSH hormone levels, more depressive symptoms, and poor working memory, and executive and executive function. Decreased amygdala volume correlated with lower working memory accuracy and slower executive function. But you know, this data is limited. This study was observational and not randomized. So, you know, the data we have is not that much and it’s not that strong. But there are these trends that we’re starting to see in the areas of the brain around cognition and memory.

Dr. Jessica Drummond 00:11:35 In a multimodality imaging study, a larger study of 161 women 30 premenopausal, 57 perimenopausal and 74 postmenopausal. And they looked at MRIs, Pet scans, and arterial spin labeling measures. The Perimenopausal women showed lower gray matter volume in the temporal and percutaneous regions and reduced cerebral glucose metabolism compared with premenopausal controls. Postmenopausal women had higher cerebral blood flow in some frontal and temporal regions compared to the perimenopausal women, suggesting that this can shift and recover post menopause in some women. But again, these are women that have not necessarily had Covid infections or concussion like Jaime or Case. Additionally, post menopause, gray matter can recover in some regions, indicating that the brain adapts to this new hormonal milieu. you again? This was an observational study with no randomization. So when we think about our client and the impacts of just the perimenopausal shifts, not to mention the the issues of her, you know, past concussion, neuroinflammation, blood flow. These issues are significant for her. So there was another study done looking at the amplitude of low frequency fluctuation.

Dr. Jessica Drummond 00:13:09 Alf, they looked at perimenopausal women 45 to 55 and then younger premenopausal controls. And they measured their resting state fMRI activity. The researchers found altered Alf values in the frontal regions and correlation between sex hormone levels and brain activity, suggesting the perimenopause affects intrinsic neural activity. Again, this was a cross-sectional study and non randomized. So the generalizability is limited. Cognitive symptoms like brain fog. What is the prevalence in this population of perimenopausal women like Jamie. Well Narrative Reviews reports that up to two thirds of the women in the Perimenopausal transition 66% experienced brain fog symptoms such as forgetfulness, difficulty concentrating and trouble making decisions. A 2012 study of 75 women, ages 40 to 60 found that memory complaints were associated with deficits in working memory on testing. Also, deficits in attention and 33 one third to two thirds 66% reported forgetfulness. So this brain fog is not just like, you know, it’s not nothing. I think it’s a symptom we really have to pay attention to when women describe this symptom, because recent review articles emphasize that cognitive domains affected include attention.

Dr. Jessica Drummond 00:14:48 And these are on neuro neural testing, working memory, verbal verbal memory, and processing speed. Think about your high level executive women, your women who are teachers, your women who are physicians, your women who are health professionals, attorneys. You know, their cognition and their ability to jump around and stay focused has to be sharp. Longitudinal data from the Swann study showed that modest declines in processing speed and verbal memory occur during late perimenopause, but fortunately, again, we see a lot of recovery in menopause. Whether someone is treated or not. I do think, though, that we have to start looking at these questions more deliberately with randomized controlled trials, we have very little. A study from the 1990s looked at fMRI crossover, an fMRI crossover study. Just ten perimenopausal women received estrogen or placebo for three weeks, and they found increased prefrontal brain activation during memory tasks when they were on the estrogen, although the memory performance effects were inconsistent. We also want to be thinking about cerebral blood flow, especially in the capacity of long Covid, because we know long Covid is such a vascular disease and blood flow is so important to neural processing.

Dr. Jessica Drummond 00:16:14 Estrogen binds to the endothelial receptors in the brain’s blood vessels and stimulates nitric oxide release, which increases blood flow and vasodilation blood flow to the brain. You know what else does that breathwork Right. So we have lots of tools here. And also estrogen being attached to that epithelial lining increases anti-inflammatory and neurotrophic effects. So as estrogen declines, cerebral perfusion may decrease relating to fatigue and brain fog. In a 2021 Nature Scientific Reports paper published by a team led by doctor Lisa mosconi. Perimenopausal women have lower cerebral glucose metabolism and lower cerebral blood flow in their temporal and parietal cortices compared to premenopausal women in their study. Many of the changes of perimenopause improved closer to baseline once they got to the postmenopausal timeframe. We also have a few small trials that have measured cerebral blood blood flow changes directly related to hormone therapy, for example. There was a study cited in an Alf paper, a prior Alf paper. Alf paper. And we talked about amplitude of low frequency fluctuation. And this citation reported that perimenopausal women receiving estrogen therapy had an increased resting state cerebral blood flow compared with those not receiving the estrogen therapy.

Dr. Jessica Drummond 00:17:57 Another small end of ten crossover randomised controlled trial found that combined estrogen progestin therapy increased prefrontal blood flow and activation during memory tasks, so the data is scarce and tiny. But there is a trend seeing that estrogen therapy may be really helpful to improving that cerebral blood flow through vasodilation, Then through metabolic supports, etc.. Let’s talk real quickly about testosterone. Effect on memory and cognition. This has been studied even less than an estrogen, and the results are mixed. In observational studies of healthy older adults, in 2010, a prospective cohort of 521 over adult older adults 64 to 94, 51% of them were women. Measured serum testosterone and followed their cognitive change over two years in men. Lower testosterone predicted a sharper cognitive decline, whereas women who declined cognitively actually tended to have higher free testosterone levels. High testosterone was not protective in this study and might even be detrimental for women, so we don’t necessarily see testosterone as a cognitive magic bullet. Although it does, it is helpful for libido and when some of the data got a bit more specific when they looked at a cross-section.

Dr. Jessica Drummond 00:19:31 A cross-sectional study in 2024 of women with the ApoE four gene, who had significantly increased risk genetically of Alzheimer’s disease, people with those women with low testosterone were linked to worse global cognition, processing speed and verbal memory. But again, just in those women who also have the ApoE4 high risk genetic allele, there were no associations at all between testosterone and cognitive health in women without the high risk allele or in men without the high risk allele either. So the authors of that study concluded that low testosterone might be a modifiable risk factor for cognitive impairment, but it’s most important in genetically susceptible people and maybe only important in genetically susceptible people. There are another small group of studies done, such as a cross-sectional analysis involving 521 participants that reported that optimal, quote unquote testosterone levels were associated with slightly better many mental state examination scores at baseline. But it found no evidence that raising testosterone levels would prevent that cognitive decline in either men or women. So if someone has naturally higher testosterone, that may be helpful for brains. But we don’t have great evidence that adding testosterone increases cognition.

Dr. Jessica Drummond 00:21:12 There is one dose response trial in hysterectomy sized women 24 week double blind trial randomized 46 hysterectomy Hysterectomies. Women. Women who have undergone hysterectomy with low baseline testosterone to placebo, or weekly injections of 3 to 25mg of testosterone. Cognitive performance was assessed with tests of visuospatial ability, verbal memory, fluency, and executive function. Again, that executive function and memory really bothers women. That’s so frustrating for women that are spinning so many plates. Unfortunately, no dose dependent improvements were observed. Changes in any cognitive cognitive domain were not related to increases in total or free testosterone. The authors noted that short term testosterone therapy neither improved or worsened cognition in general in this study. You know, we do have anecdotal reports that women feel better cognitively with transdermal testosterone, and there are some very small trials. So that study was not done in transdermal. There are some very small trials of less than 30 women that have reported modest benefits of transdermal testosterone on verbal learning and memory, but these studies are pretty short that are between 8 and 10 weeks long, and they’re often open label or crossover designs, limiting our ability to generalize them.

Dr. Jessica Drummond 00:22:49 So while low testosterone has been associated with cognitive decline in observational studies, particularly in women with the ApoE four E high risk genetic allele for Alzheimer’s disease in these genetically at risk women, randomized controlled trials have largely failed to demonstrate any cognitive benefits of testosterone in either men or women. The current evidence just does not support prescribing it for that, only that goal to improve working memory. Focus. Juggling all the plates. Executive function. There are anecdotal reports as such, and we absolutely need a lot more research before we can make a definitive call on that. But I think it’s important for us to recognize that the data is limited. Now, one thing we do have more data on is the calming role of progesterone and its neuro steroid metabolite, Alo pregnenolone. This directly modulates Gabaa receptors in the brain, and by promoting Gabba Gabba activity, alo pregnenolone produces an anti-anxiety and calming effect similar to benzodiazepines. The decreased alpha pregnenolone is linked with depression, and exogenous progestins can impair working memory. So for Jaimie, if we find And low progesterone that could be contributing to her anxiety, her insomnia, and her mood instability.

Dr. Jessica Drummond 00:24:27 Spoiler alert we are going to see a little bit of that mood. And neuropsychiatric symptoms can be related to progesterone and its, and the impacts of those depleted neuro steroid metabolites such as Ella pregnenolone because they are so important to Gaba activation. This is such a calming effect for women that, hey, if you think about being in Jamie’s shoes, right, getting up in the morning, your day has already started off stress. Your teenager is sulking. You’re late for a work presentation, right? There’s a lot going on. A 2019 review noted that lower progesterone and alo pregnenolone during perimenopause correlate with anxiety and depressive mood, supporting the observation that many women report these kind of mood swings between anxious and depressed, kind of stuck in fight or flight, stuck in freeze. This is all related. We also want to be thinking about, in this case, the concussion impact of this, this history of concussion during a ski accident. Concussion outcomes differ by menstrual cycle phase. A scoping review found that withdrawal of elevated progesterone during the luteal phase may actually lead to worse post-concussion symptoms.

Dr. Jessica Drummond 00:25:49 Now, often, you know, if your clients have this in your in their history, they’re not going to remember exactly where they were in their cycle when it comes to when they have the concussion. But it’s important to think about if you if the person has very recently had the concussion or she can remember for some reason, if it was in the luteal, especially late luteal phase, that concussion could have primed To Jamie to have this neuroinflammation Achilles heel, if you will. And now that she has declining hormones, that’s amplifying her symptoms and what might have been mild before, pretty manageable or maybe only happening like a day or two in her cycle. It’s a lot more unpredictable. And we’ll look at a few reasons why a little bit later, and it can be a lot more severe then. So we’re now we’ve got low estrogen or fluctuating estrogen, low progesterone, potentially a low testosterone. History of concussion and neural priming. Then she had her third Covid infection six months ago. Long Covid involves immune dysregulation, cytokine storms, chronic inflammation, prolonged immune activation and that directly can trigger brain fog and cognitive fatigue.

Dr. Jessica Drummond 00:27:10 But also it’s a vascular disease, right. So micro clot formation do due to abnormal coagulation can further disrupt that lovely blood flow to the brain, and women are more susceptible to long Covid, possibly due to stronger innate immune responses and sex specific differences in stress hormone interactions. So how cognitive interacts with changes in stress hormones and changes in estrogen, progesterone, testosterone for women in perimenopause, the risk of long Covid after each infection, and those those risks are cumulative. In fact, for anyone after a third infection, the risk of long Covid is 40%. After the first infection, it’s only between 10 and 20%. Then you layer on perimenopause, where the risk is 45% higher than in men with the same number of infections. In fact, perimenopausal women are the highest risk group of anyone for long Covid and a very common presentation of long Covid is known as neuro Pasc, which is characterized so neuro post-acute SARS-CoV-2 characterized by brain fog, fatigue, mood and cognitive symptoms. So, you know, this layer is right on top of those perimenopausal symptoms.

Dr. Jessica Drummond 00:28:30 For Jamie, her six months ago third Covid infection triggered what could now be persistent neuroinflammation layered on top of her hormonal changes and her concussion history, which primed that kind of Achilles heel of brain inflammation. Plus, she has something else going on. An impaired intestinal barrier will often show allow luminal toxins so toxins from the inside of the lining of the gut to out into the circulation, such as LPs or lipopolysaccharide toxicity and antigens to enter the bloodstream, triggering these further kind of systemic chronic immune inflammatory responses. And animal studies strongly suggest that psychosocial stress 46 year old working mom, anybody, right like Jamie is enduring. Increases intestinal permeability via mast cell dependent mechanisms. So although human evidence is limited, this chronic work stress and family stress, you know, navigating the challenges with her teenage son, the financial pressures of paying for her daughter’s education, being the breadwinner, having a busy working job, you know, day to day stressors. We talk a little bit more about what happened in her job at the same time as her Covid infection, so sometimes it’s hard to tease things apart can absolutely contribute to leaky gut, systemic inflammation and mood symptoms because there’s direct communication between the gut microbiome and the brain via the gut microbiome and the vagus nerve and the circulation.

Dr. Jessica Drummond 00:30:17 So Jamie’s having GI symptoms bloating after eating like sweet potato chips, bladder burning, and much more severe headaches even with like a half glass of wine. These hint at gut immune imbalances that are commonly related to MCAS, which can be triggered by stress very commonly triggered by the immune dysregulation incited by Covid infection. MCAS is mast cell activation syndrome, characterized by kind of allergic symptoms, chronic burning, and sometimes adding estrogen. HRT before addressing this, MCAS immune dysfunction can make symptoms worse since estrogen actually can directly trigger mast cell granulation even though it’s generally Inflammatory. All right, so let’s get right into Jamie’s case. I want to reiterate a bit for you and see how all of this applies to her. Again, meet Jamie. She’s our 46 year old married marketing executive and mother of a college aged daughter, a teenage son and a son in sixth grade. She reports the following cognitive symptoms brain fog. Difficulty finding words. Forgetting tasks at work. She says things to me like I just can’t hold multiple things in my brain anymore.

Dr. Jessica Drummond 00:31:41 I used to be so focused, but now I feel so easily distracted, not to mention anxious and rage when I’ve always been such a really calm and focused person. I used to be able to handle a lot as what women will say to me, and they are spending a lot of plates, but this is new. They feel like they can’t handle it. I feel rage usually at my son or husband, when I feel overwhelmed about the mental load of our busy life and all my responsibilities. Occasionally I feel a little bit depressed because I used to be able to handle this. Fortunately, I do have a good group of girlfriends who I connect with at least weekly, who are in the same place. That kind of help me feel like, okay, maybe I’m not crazy because we’re all sort of going through this, but sometimes I feel like my situation is worse or more severe, or I just can’t handle it the way it used to. How are my cycles now? Well, she has Jamie has a regular cycles, migraines, 1 to 2 days before menstruation, and increasingly, sometimes many days even before menstruation.

Dr. Jessica Drummond 00:32:50 She also has them sometimes when she feels like she might be ovulating. But we are using mirror testing, which is a form of hormone testing, and her estrogen three glucuronide, e.g. three metabolite shows just a brief rise and then it crashes again. So she might not always be ovulating. Her progesterone metabolite or PDG level is also increasing, but not as high as it normally would in in, during the luteal phase. And it doesn’t like stay up there. She’s got some luteal defects. So it’s likely that she’s not ovulating or at least not ovulating consistently. Her cycle sometimes are pretty short, showing luteal defects and signs of an ovulation during some months. Some months she has a normal cycle, some months she doesn’t, which is very consistent with perimenopause. Her past medical history is a concussion during a ski accident five years ago, and then her third Covid infection six months ago, when her brain fog and cognitive fatigue and lack of attention really worsened. But that wasn’t the only thing that was happening at that time.

Dr. Jessica Drummond 00:34:03 She didn’t really get much rest or time off to recover from that acute Covid infection, because at that same time, half of her work team was fired and all of a sudden she had double the work for no more pay. Right. That’s a common refrain right now also. So she’s living, you know, so she never really got to fully recover from that acute Covid infection. And it’s turned chronic. And now, six months later, her brain is not handling the stress of all of this caregiving of her son’s caregiving, at work, having a carrying a heavier work load. She takes a lot of trips for work. She’s across time zone. And when she travels, she eats more processed food because there’s just not much healthy to eat at the airport. In the hotel. On her lab findings. She does have low serum progesterone. Diurnal saliva at testing shows low morning cortisol and elevated evening cortisol. Her. She has got dysbiosis on her GI map. She has functionally low vitamin D levels and mild iron deficiency.

Dr. Jessica Drummond 00:35:13 Lisa shows up in your clinic overwhelmed. She wonders if something serious is happening and is feeling really discouraged when she’s kind of feeling she has a brain tumor and her doctor is like, oh, you’re fine, this is just perimenopause. You need some stress management. No, we are here to be that safe space for her, to help her navigate through our seven step system using our maps frameworks. The maps frameworks creates clarity for you, but also for her that there’s a structure around how this healing is going to go. And we have confidence in that structure, and we have the patience to go through that structure over time. So step one as we track what is going on. Can we align her symptoms to anything to her mirror testing, to times in her cycle to increase stress times at work? And we look back at the timeline to when some of these things were initially triggered the concussion, the Covid infection. Maybe we look back at those first two Covid infections. Maybe they were a little bit more mild but triggering some similar things.

Dr. Jessica Drummond 00:36:25 we use mirror hormone monitoring. There are other options as well, but I like this one because we can check daily over time. Her hormone metabolites of estradiol, of LH, of FH and her progesterone metabolites. Those are the core things that we can test right now in perimenopause. So I’m hoping for more soon. normally in a regular cycle, the estrogen metabolites tested by the mirror will be a will get like a surge. There’ll be an LH surge, then an estradiol surge, then ovulation, but in perimenopause. This can be shortened or truncated. And we want to see if especially if that’s correlating with any of her migraines or pain inflammation or the times when she feels just like so much less able to be like on it and focused and, you know, someone she feels like she can rely on. And often brain fog correlates with low progesterone. Spoiler alert. Jamie also has low progesterone at times, especially in the luteal phase. So we also look for in a case like this test for things like inflammation, like the HCP serum ferritin, which in her case was functionally low because of the heavy bleeding of her close menstrual cycles.

Dr. Jessica Drummond 00:37:48 Low vitamin D and we talked about low serum I mean, low saliva, cortisol in the morning and high at night, making it harder for her to really calm down and feel calmer and fall asleep. You can also use neurocognitive and assessment tools if you don’t have access to other kinds of testing, or in concert with access to other kinds of testing. You know, we talk all about these in the maps. It’s up to each practitioner. Things like and then also, let’s say you’re a physical therapist, you might want to look at vestibular function balance. because low progesterone can worsen these post-concussion symptoms. So we want to know the phase of the cycle when we’re doing these tests as well. I think it’s important to look at GI symptoms because the gut and the brain are so connected. In her case, the gut dysbiosis is present primarily due to low beneficial and commensal series species like Occur Mantia and Bifidobacterium longa. She is a history of doing harsh bacterial, antibacterial killing antimicrobial herb protocols because she went to work with a naturopath once or twice, but then stayed on antimicrobial herbs without really a whole plan around that for over a year consistently, which helped her feel better at first and kind of helped her be able to tolerate eat more foods without as many symptoms.

Dr. Jessica Drummond 00:39:28 But, you know, over time, she’s just killing off her supportive bacteria. She also had a history of at least five bouts of antibiotics in elementary school due to chronic ear infections. And we see this a lot in our practice that like when clients are on the kind of practitioner practitioner roadshow and they’re seeing a practitioner like, what’s the protocol that’s going to heal me? They sometimes do that protocol, but then don’t stick with that practitioner for the long term to really support. And this is what I see so often with clients who come to us, who have already been to amazing, well known, famous functional medicine physicians or, you know, Mayo Clinic, like teaching hospitals that are amazing. They are really good. But the perspective is like, we just have to find the perfect protocol. If this doesn’t work right now, go to the next person. Maybe they have the magic wand. And the reality is that we have to start with foundations of day to day health behavior change. So for example, this client’s not exercising at all.

Dr. Jessica Drummond 00:40:34 She is so fatigued from her last Covid infection that when she comes home from work, crashes after having a fight in the car with her sons, driving them all over town for their sports practices. Finishing their homework, they grab some chick fil A on the way home, and then she crashes. Maybe she scrolls. Maybe she watches Netflix. But there’s no calming wine down routine. There’s no morning routine. And because she likely has MCAS and maybe even mild me CFS from the long Covid starting low with exercise is key. But that can be so powerful as a nervous system regulator. We can utilize the things that help our clients heal. As these. Step one nervous system. Regulation. Slow flow. Yoga. Ten minute walks in a neighborhood path near some trees. Right. Avoiding obviously any high impact exercise right now or like risk of falling you know, no skiing. No like cycling with this concussion history. But is your client getting up in the morning and regulating her nervous system, starting with things like morning sunlight exposure.

Dr. Jessica Drummond 00:41:50 Regular bedtimes. Regular wake up times. Turning off all the screens by 6 p.m.. In this case, we’ve got a brain to heal. We can’t be scrolling and on Netflix till eight 910 11:12 p.m.. So let’s start with collaborating with Jamie on her morning routine. This is going to be really challenging because she likes to be in control of everything. Before picking up her phone or even talking with any of her family, she’s going to grab a full glass of water and go outside and sit and either breathe or do a little movement, yoga, mobility, take a little walk or just breathe. Just listen to a visualization. Do some mindfulness meditation. Then we have so many tools we teach you in our Perimenopause and Menopause program to help your client set up with complete ease a morning breakfast routine, including we’re going to teach you how to build her a customized AI agent assistant to build out her meal plan, her grocery list, her meal prep, her breakfast routine, and then you know what she’s going to learn from you and you’re going to learn together is how to delegate some of those things.

Dr. Jessica Drummond 00:43:07 So, for example, with Jamie, her husband is now going to step in. He does the complete morning routine with his boys. He sets the tone of the day with music, with activity. She’s out walking. She doesn’t see them. She’s in the backyard. Wherever she is. She does not even see her husband and kids. Maybe her husband runs in for a quick kiss before he takes them to school. She’ll see them later. He sets the tone right. Let’s learn to delegate. And because step one of our seven step system here at the Integrative Women’s Health Institute is nervous system regulation. This is a long term and patient process, a confident process for us as practitioners and women who often ourselves, are healing and yet without dedication to a calming, soothing, whether it’s nourishment, morning routine, journaling. There are thousands of options that you’re going to learn nothing when the nervous system is not in a mode of safety. The perfect supplement stack will not work. The perfect HRT stack will not work, the perfect MCAS therapies will not work.

Dr. Jessica Drummond 00:44:22 Now these will work powerfully. They will build on top of that nervous system regulation for your client. But your client can be eating the perfect diet can be taking all the right things. Nervous system regulation must be in the mix. Mix. It is step one. If I have any magic bullets, it’s nervous system regulation. Now, the good news is that even taking that supplement stack, you know, putting that hormone patch on how your client eats, how your client breathes, what your client eats, how stable her blood sugar is during the day. So many tools that we teach you inside of our perimenopause and menopause certificate program. Confidence in complexity. We can use the same tools that are the tools for biochemical, cellular, and physiologic healing. Also can function as nervous system regulators when used in a certain way. So, you know, wrapped in confidence and commitment over the long term. All right. So step two is we’re now going to collaborate with our client on her goals. For Jamie her goal was clear.

Dr. Jessica Drummond 00:45:34 She’s like I want my brain back. No more brain fog. I want to be able to I want to feel like myself. I want to be able to think clearly and flexibly. I want to show up at meeting some presentations and not forget everything. I don’t want to be like deer in headlights on the spot when I come home from work. I don’t want to be daily screaming at my teenage son or my husband for having this teenage son. I don’t want to be Reiji. I want to not feel anxious every second. I’m ready to feel calm and focus. I want my brain back. Okay, so in step three, she’s going to begin to collect data on her heart rate variability, her stress scores. We’re going to use wearables. We’ve already discussed some of the results of her Mira Daly hormone testing. In this case, we use that for about 3 to 6 months. And some basic functional lab testing to look at her baseline of her gut microbiome, of her inflammatory markers, of her nutrient sufficiency, like vitamin D.

Dr. Jessica Drummond 00:46:35 We don’t need a ton of data collection because we really slow down. Own. We don’t need a ton of raw numbers right now. Although if she’s really a data driven person, totally fine. Because the thing is, we have taken a moment to slowly and patiently held space with our brilliant coaching skills that you’re going to have after you complete this program. You, as a practitioner, are ready to hold space and listen to her full story and keep her regulated over a long period of time, months to years to so we can get deep root cause cellular healing. You have to trust yourself. She has to trust you. And then we have to talk about her beliefs around her own healing. Then in steps four and five, we’re going to start with those priority foundations, right? What are her day to day health behaviors? A change in her morning routine and her breakfast routine feel non-negotiable, with her husband taking the lead to get the boys successfully off to school. They’re not always going to be happy, but he’s going to set a calm, happy tone, joking around a little with them.

Dr. Jessica Drummond 00:47:51 Her older son might still skulk through it for the sulk through it for the next 2 or 3 months. This is no longer a problem, and her being wet, ready and willing and able to accept that that she doesn’t even know what’s happening. First thing in the morning. She just knows that her son is making it to school, and she’s building trust that she can trust herself to delegate and that her husband can handle it. She’s out on her morning walk and her thoughts start to be concentrated. She starts to soothe those energy leaks of her own energy. And while she doesn’t change all of her nutrition right away, and she still has an occasional glass of wine on the weekends. Breakfast is her non-negotiable first shift to an anti-inflammatory, Mediterranean style nutrition protocol. And again, I’m going to teach you exactly how to build her a customized AI agent that will do this kind of work for her, and then she can delegate some of the execution. Learning how to delegate is going to keep her on track to 90%.

Dr. Jessica Drummond 00:49:04 Avoid alcohol, sugar, processed foods, especially when she’s traveling. She’s going to start committing herself to adding nutrition with her own travel snacks, and she’s going to show a commitment to protecting her immune system. We don’t we don’t want a fourth Covid infection. She’s wearing an evidence based N95 mask and using evidence based nasal sprays to reduce her risk for that fourth Covid infection. We want to make sure that she’s using a well fitted mask. Not just kind of like an old cloth mask or whatever. We know that doesn’t work. having a fourth Covid infection would be one of the most harmful things that could happen to her in this phase. So. And then in a few months, she’ll be ready. And her physiology, her nervous system, her subconscious will be ready for more refined supplement stocks, more anti-inflammatory strategies, more tools and strategies, including pharmaceutical and non-pharmaceutical mass self stabilizing and immune supportive nutrition strategies. She’ll learn more strategies for increasing circulation, breaking down the fibrin of her long Covid, increasing nitric oxide, being able to tolerate more and more exercise to protect her bones, and also blood flow to the brain.

Dr. Jessica Drummond 00:50:31 She has so much on her plate that small, consistent actions are going to stick better for her than trying to just overhaul this whole situation at once. So when you start working with a client like this, one of the most important things you’re going to learn inside of our program is that slowing down and really listening, holding space for that root root cause financial stress, relationship stress, health stress, parenting stress, physiologic stress from foods or supplements or killing protocols or, you know, NSAIDs every day. You know, there are lots of small and large biochemical and and psychosocial stressors. Getting to the root cause of those stressors requires patience and commitment from you. That’s the number one reason why clients like Jamie come to us as their 17th professional on a practitioner to practitioner road show. As my friend Isa Herrera would say, right. Just looking for the one practitioner that has the magic solution. That’s not how this works. This is why we build these frameworks, these maps for you, these seven step systems, because you need a structure to be committed and confident for the long term.

Dr. Jessica Drummond 00:51:57 There is iteration. There is patience. There’s recognizing the limit subconsciously of your client’s belief system and yours. Everything from hormone therapy is to supplements to nutrition. To exercise can be helpful, but the when and how are very important. You need to commit to your clients healing journeys for months to years alongside of them. You know, even when they get frustrated with full Confidence in their bodies. Capacity to heal. For them to get the best results. When she is ready, you’re going to know exactly how, in which and when to add supplements, the how to collaborate with providers. And we’re also going to teach you, if you are a practitioner who’s a prescriber, to prescribe HRT and peptides like GLP ones and others. We’ll start with MCA’s supportive strategies, mast cell stabilizers. Then we’ll add HRT. We’ll start with progesterone because and then because the estrogen and progesterone ratio can be so important in a case like this, often adding estrogen pretty quickly after starting progesterone. And in most cases like these, oral progesterone is the best option because of those Ala pregnenolone benefits to the brain’s Gaba system.

Dr. Jessica Drummond 00:53:22 Not always, but usually that’s the best place to start. So while the cognitive benefits are not well well-established for testosterone there. There could be an opportunity for using transdermal testosterone to support her libido. Discuss with her the limitations of the current research with her to help her make an informed decision. You know, the bottom line with most hormone therapies is we just don’t yet have enough research. So we talk about the research that we do have so that your clients can make the best decision. Now, the second most important thing to you, being committed over time, to really sticking with her and having that belief that she can heal and then kind of taking it step by step, is Jamie has to start to see herself as a high performer. She needs to start thinking about her health through perimenopause and menopause and beyond, just like as if she was an elite level athlete. Okay. She needs to commit to her recovery in the same way that she commits to her performance. She has multiple high performing jobs.

Dr. Jessica Drummond 00:54:37 She’s a mother. She’s an executive. She has a busy cognitive and or physical job. She might be, you know, a physician or a physical therapist or a nutritionist. she’s often caring for aging parents. She’s often organizing kids birthday parties and navigating teen heartbreak and the college app process. Right. This combination of roles is very demanding, and women in these high, high level roles have got to start thinking of themselves as high performers. And they have to prioritize recovery in the same way that elite athletes do. So we have for you the neuroinflammation, post-concussion and Cognitive resilience map inside of the Perimenopause and menopause program. Confidence in complexity. That is the step by step framework to help your client know what to do next, and really to know for you to guide what to help her do next at her pace with her priorities and her goals in mind. And we also at the bottom of the at the end of those maps give you the milestones. How far has she come? What do we expect in week one and week three and week six? You know what big changes can we see in the first 12 weeks? Because the pacing is a combination of having this be most effective and keeping her motivated engaged over time.

Dr. Jessica Drummond 00:56:06 So bringing it all together in our perimenopause and menopause. Confidence and complexity certification. We teach you step by step systems for complex cases, just like Jaymes. And here’s a little condensed overview of how the seven steps apply to this case. Root cause mapping. We are going to be identifying drivers such as lifestyle stressors, hormonal fluctuations, neuroinflammation, gut dysbiosis, digestive lining and permeability, and nutrient deficiencies that can help each individual client that looks similar or different to Jamie’s case. Comprehensive assessment using her story as being just as important as her HR, her vitamin D, her HRV, her mirror testing her Dutch, testing her GI map, testing her. gosh, so many markers we could be looking at her estrogen levels. Serum levels. Right? Her story and her data will play different roles depending on where she is in her journey. Then she, you and she together are going to collaboratively designed using your health coaching communication skills, a nutrition, lifestyle, supplementation, HRT peptide and other medical and advanced healing and longevity strategies that you’re also going to help her put together a whole team to be able to implement those one at a time commitment.

Dr. Jessica Drummond 00:57:44 Iteration progress over time that sticks. That is actual transformation okay. And you’re going to do this in the context of a coaching experience, because centering and empowering your client her goals is going to be so important to so many factors. It’s going to talk about pacing. It’s going to help her system feel physiologically safe. That’s the key to root cause healing. You’re going to talk about stress I know I’m talking about nervous system regulation ad nauseam, but you are going to equip your clients to be able to do that. A body cannot heal in a stress state and in a in a calm, alive, stable, calm, grounded state. Your client will heal so much faster, especially when we layer on these tools of movement of day and light, alignment of supplementation, of nutrition, of hormone therapies. And then over time you’re going to reevaluate, evolve and celebrate with her. This work is challenging. This work is swimming against the green of our entire society to learn about things like boundaries of self-care at a deep level, not just like fluffy baths and massages and whatever.

Dr. Jessica Drummond 00:59:16 Not that those things aren’t great, but, you know, deep. Evidence based root cause healing. This is what we teach in this program. We want. I want every woman’s brain from 40 to 90 to feel locked in, excited, connected, calm. Just I our brains are so important to how we feel and live. Jamie’s story illustrates that brain fog, that anxiety, that mood changes during perimenopause and menopause are so multifactorial. It’s not just perimenopause, menopause. It’s hormone fluctuations. It’s hormone decline. It’s neuroinflammation from past injuries and infections. It’s gut health. It’s chronic stress. It’s the belief in physiologic healing. Evidence shows that estrogen withdrawal can trigger migraines that low progesterone weakens Gaba mediated calm, that post-concussion symptoms worsen during hormone withdrawal, particularly progesterone and estrogen withdrawal, and the long Covid so, so common in perimenopausal women, 45% higher than in any other group can lead to chronic inflammation, micro clotting, epithelial and gut lining damage, and brain fog. Put this all together and we have to have a complete system.

Dr. Jessica Drummond 01:00:47 So many of your clients look like this. It’s not just one thing. And then chronic stress, psychosocial stress increases intestinal permeability, leaking of LPs and other toxins, further fueling neuro immune symptoms. With the right tools, including quantitative testing, wearable tracking, personalized nutrition and lifestyle interventions, stress management and stress, and step by step, supported coached care. Women like Jamie can regain clarity, mood, stability and vitality. And it’s not overnight. And it’s not a one size fits all protocol. It’s not even a perfect protocol for anyone. Our Confidence and Complexity certification trains you to apply these frameworks to your real life clients. If you’re a practitioner ready to grow a thriving perimenopausal menopause practice, you will be the only person in a huge radius of women who is thinking at this level of complexity. And so go watch our free webinar and how to build a thriving perimenopause and menopause health coaching practice. Learn to design your own fulfilling and flexible career because I want you. If you’re 35 and up to have and hey, if you’re younger, even better get started now.

Dr. Jessica Drummond 01:02:10 to have the thriving kind of career specializing in midlife women because they all show up with this level of complexity. And I don’t know one other program that is teaching you how to build a flexible, fulfilling, flexible career. Our brains need flexibility. Now you’ll find all these links in the show notes, because the reality is, no one is letting women show up to their practices with the complexity of all these issues. It’s like, go see the long Covid clinic, go see the post-Covid clinic. Here’s your HRT. Oh, that didn’t work. Well, just stop it. No slow, iterative commitment over time. Every single one of your women is struggling with this level of complexity, and the current system is just saying go here, go there. Look for the magic wand here. Look for this supplement stack here. See a natural path. See this person? See a nutritionist only see a pelvic PT. Only know we have to have the skill set to put it all together, and we have to have the time and commitment.

Dr. Jessica Drummond 01:03:19 Because when we do, your client’s brains will heal. This great news is that by following this approach, Jamie gets her brain back and she can even expand her learning connection. Cognitive growth. Focus. Attention. Thank you so much for joining me today on the Integrative Women’s Health Podcast. Your homework for this week is just start getting curious. Do your Perimenopausal clients tend to be high performers with multiple goals, jobs, roles, responsibilities, but they’re not recovering and focused on their healing like elite athletes, right? Is that your client? They’re high performers, but they’re not aware of that, so they’re not recovering. How could change your clients beliefs about the high performance level of their lives? Help them to heal more deeply? And let’s use some self-assessment self curiosity. Are you patient and confident that from day one, every client that walks through the door, you will fully commit to her healing goals? Help her get to her definition of root cause healing. Even if it’s slow, even if it’s non-linear and challenging at times.

Dr. Jessica Drummond 01:04:40 This is the key to your clients building that trust in themselves and in you, and getting off that train of practitioner to practitioner looking for the magic healing sparkle dust. That practitioner doesn’t exist. You are the person to get confident. And also make sure that you have a level of health and abundant energy that you can commit to that for your clients. okay. Because you. It starts off with your space holding your nervous system regulation and surely, but slowly but surely and actually pretty quickly. That will help your clients trust herself to fully heal. So this week, your homework is get curious about how you and your clients are showing up for the healing experience. Are you searching for the perfect supplement stack? Are you stressed by that or the exact right HRT prescription? Or are you committing to a process? A map of iteration, regulation, and day to day healing lifestyle behaviors over time, enhanced by nutrition, supplements, pharmaceuticals, and not any one magic solution to complex challenges like Jaymes. Get curious how are you showing up? How are your clients showing up? Thanks so much for being here with me this week.

Dr. Jessica Drummond 01:06:07 I hope you enjoyed this case. Walk through our neuro inflammatory and cognitive health map. I’ll see you next week and I look forward to seeing you inside of our perimenopause and menopause program. Confidence and complexity, where we talk about cases like Jaymes literally every week. I’m actually going to go hop on one of those calls right now. I’ll see you next week.

Dr. Jessica Drummond 01:06:33 Thank you so much for joining me today for this episode of the Integrative Women’s Health Podcast. Please share this episode with a colleague and if you loved it, hit that subscribe or follow button on your favorite podcast streaming service so that we can do even more to make this podcast better for you and your clients. Let’s innovate and integrate in the world of women’s health.