How To Balance Hormones in Perimenopause with Endometriosis and Long Covid – LIVE Client Case Study (Part 1)

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.

Aurelie Maire (00:00:59) – Oh. Hi there.

Dr. Jessica Drummond (00:01:03) – And welcome back to the Integrative Women’s Health Podcast. I’m your host, doctor Jessica Drummond, founder and CEO of the Integrative Women’s Health Institute. Today I have a really important case study for you. I want to introduce you to one of our Women’s Health Coach Certification graduates. Her name is Aurelie and her website is Aurelie marie.com where you can find the details in the show notes.

Dr. Jessica Drummond (00:01:32) – She brings to us a really important case for this time and place. She is an expert in endometriosis and yoga. As I mentioned, she’s a graduate of our Women’s Health Coach certification and is now a proud member of our alumni association. And in this case, you’re going to see how even someone with a depth of good knowledge and self-care is struggling with the intersection between endometriosis, perimenopause, and long Covid. And this is a very important episode, because what we’re now seeing in the literature is that as people, and this is more and more everyone, as people experience the Covid infection multiple times their risk of contracting long Covid increases. So it’s about 10% on the first experience of long Covid, about 25% risk for your second experience with acute long Covid and a 40% for the third infection. So globally, about 50% of the population is expected to be having to deal with some degree of long Covid. And this is particularly problematic in women ages roughly late 30s to early 50s, which is the exact time that women struggle with perimenopause and menopause.

Dr. Jessica Drummond (00:03:08) – And in this case, we also have an underlying challenge of endometriosis. So if you work with clients with chronic pelvic pain, with autoimmune disease, with endometriosis, for sure, with chronic post-viral illnesses who struggle with perimenopause or menopause symptoms, which is essentially every woman right between the ages of 35 and 55. This episode is for you. This is a two parter because there is so much juicy information here. So get a notebook out, take notes, download this, listen to it multiple times. And in this first part we’re going to cover some of the story and what kind of data we need to collect to start making progress in improving this challenging situation, which is this overlap of endometriosis underlying that was well managed up until this point, but now complicated by perimenopause and long Covid. And then next week we’ll come back with even more solutions. We’ll start into some of the gentler things or like can do now and then. We’ll continue to expound on that in part two. So I’ll see you on the other side of this episode where we’ll highlight a few key features.

Dr. Jessica Drummond (00:04:35) – Welcome back. I’m here with Aurelia. She is one of our brilliant students and graduates, actually at the Integrative Women’s Health Institute. She’s a women’s health coach, and I’d love to have you tell everyone what you’re working on right now. And then we’ll dive into why you’re here as an example, coaching case study. Because you have a really common challenge that we are seeing a lot in our clinic right now. So first of all, what are you up to with your work, with your life?

Aurelie Maire (00:05:12) – So I can thank you for having me today. And so now I’m working on a yoga teacher training. And that’s really specialized for teachers and women having, you know, and their mattresses and yeah, also other exciting stuff. But I had to put that a bit on hold, you know, because I focused on my health and myself. But I’m really excited for the next project that I have.

Dr. Jessica Drummond (00:05:42) – That’s great. So anyone listening to this who eventually wants to have an in-depth teacher training on utilizing yoga for women with endometriosis, you are the expert.

Dr. Jessica Drummond (00:05:54) – So Aurelie is coming to us kind of from the Middle East via France, correct?

Aurelie Maire (00:06:02) – Yes, correct. I’m more Asian now, but I come from France and yeah, moving was also, you know, part of the story. Maybe we will discuss about that.

Dr. Jessica Drummond (00:06:14) – Yes often. So let’s start with a little bit of history. So one of the reasons I wanted to have you on to kind of showcase some of how we do this work is because underlying your recent experience with Covid and this long Covid experience, you have a history of endometriosis. So for anyone who’s listening, who has a history of a chronic illness like endometriosis, autoimmune disease, other post-viral fatigues, or in issues like Lyme or fibromyalgia or me CFS listen in. If you’re working with these women or you’re struggling with this yourself because this underlying chronic condition sets us up for some vulnerability. So share with everyone kind of how your health journey has been up until the last couple of months.

Aurelie Maire (00:07:09) – Yes. So I think it started in 2013. I had no history of pain during, you know, my cycle and during the summer I got, you know, immense pain during my period.

Aurelie Maire (00:07:25) – And I had to go to the emergency. And I’m not the kind of person, you know, to go there. And I didn’t find anything, but I had to see a genealogist because I had this conscious also. And this body of brain is about something and related to my period. But it was not a specialist at this time. And so I did a lot of researches, and at that time we didn’t have so much information as we have, you know, today. But I found, you know, the world and the matrices. And I thought, okay, so maybe, you know, I would check for this. And I was really lucky because I got a diagnosis in six months and we know it takes 7 to 10 years to a diagnosis. So I was pretty lucky. And I decided to implement things that I knew it was really helpful. So with nutrition, with more therapeutic yoga, you know, adaptogen and other stuff, and I was able to manage my pain and I was really fine.

Aurelie Maire (00:08:34) – So at that time, also, I had a new job and I started a new job, an MBA. And I think that my vision also of enjoying, you know, this part of my life helped also a lot, you know, in the process then. So I had my annual check and, you know, it was fine. And it was at the end of 2022. In September, I got the Covid, you know, for the first time. And after that I felt that something was off. So I consulted, you know, my GP and she told me, no, no, no, it’s fine. But something was off. I started to have where the symptoms and especially with my right hand. So it was blue and with things on my skin and it was swollen. And so I consulted on the side, you know, okay, maybe that’s another G or something. I’m not sure. And I got also some hematoma on my skin and also during the night. So I woke up and I could say, you know, these things on my skin.

Aurelie Maire (00:09:50) – And I started also to have this autonomy. So from a seated position to a standing position, I got, you know, dizziness and, and a lot of fatigue. And I was not able to, to have the kind of physical activity or body work that I had before and even going outside to do some shopping, it was like, okay, the big highlight of the day. And also I had some cognition also issues. So I couldn’t talk maybe more than 20 minutes in a call or focus on the work. More than 20 minutes. I had to sleep, so I had to take a nap. I was totally exhausted and I thought at that time, yeah, that’s maybe because I had a lot because I was preparing, you know, my move to Asia to it was not planned and I didn’t want to move. So it was a lot of stress at that time. And then so I came here and also with my hand. So it was still really swollen and.

Dr. Jessica Drummond (00:11:01) – Blue and just one hand or both.

Aurelie Maire (00:11:04) – It was one hand. So that’s why it was quite surprising to me. I used to have called in French syndrome, the Renault Renault syndromes.

Dr. Jessica Drummond (00:11:14) – Reynolds. Yeah.

Aurelie Maire (00:11:15) – Yes, I used to have that, you know, when I was a student. But then it was okay. And at first I thought, okay, maybe that’s that, that I was not sure. So when I arrived, I took also my blood pressure because I had dizziness and big fatigue. And also my heart rate was really lower than it was. And I was afraid that, you know, I had a clot or something, you know, and with the plane and with the travel, I thought, okay, I have to check. And we did an ultrasound, you know, the veins and fingers.

Dr. Jessica Drummond (00:11:54) – Essentially in your arm and hand.

Aurelie Maire (00:11:57) – and also, you know, the neck. And it was fine. And I said, you know, always. No, it’s not fine. Something is off. And, you know, my blood pressure is down, my heart rate.

Aurelie Maire (00:12:10) – Also, I have dizziness, you know, I have this weird things and this fatigue. But I explained at that time to myself, yeah, maybe it can be also because of the move, because it was a stressful event. I had to leave my home, my family, my friends, and to close my business and I said, okay, all this new. It was a lot of stress. It can explain also the fatigue and so on. It’s a new place, new environment, new food, new hair, you know, all kinds of things. And my body will adapt. But it didn’t go away. And and one day also you told me yeah, it can be, you know, long Covid because of these autonomia and things or maybe also perimenopause because I’m 45. But I thought yeah, that because all is new. My body, you know, need time to adapt. But no, it went so much better. And I saw them also a different kind of specialist to rule some serious condition out.

Aurelie Maire (00:13:23) – So I took the initiative also to yeah to see different doctors and say and they said yeah, no all is fine. I say no. And I could feel that. And now it’s getting better that I still have this, you know, fatigue after, you know, a long day or if I have a long walk or after exercising or, you know, even working on the computer. And so yeah, it’s better, but, you know, not the same, I would say.

Dr. Jessica Drummond (00:13:58) – Yeah, yeah. So that’s so interesting. And I think I want to point out a few key features here. So one is that you have this underlying history of endometriosis that you were diagnosed with back in 2013. So it’s like 11 years ago. And at the time you well controlled your endometriosis with nutrition, with lifestyle. Your symptoms were well managed, your pelvic pain was well managed. Any symptoms like did you ever have a surgery for endometriosis or you just managed it with integrative perspective? Yeah. Did you take any medications for the endometriosis.

Dr. Jessica Drummond (00:14:34) – No. Okay. Great. So you had a very stable case of endometriosis. Now one thing that we’re seeing interestingly, and I spoke about this on our episodes with Sally Carroll and a little bit with Ginger Gardner. Also more about the gaslighting, the medical gaslighting that you experienced. You’re fine, you’re fine. But I think you have seemed to have experience the perfect storm that I’m seeing some elements of amongst almost every one of my practice with a version of long Covid. And that is okay. So you have this very stable and well managed underlying condition, but with endometriosis, you know, independent of long Covid, we’re also seeing that endometriosis can shift or progress or get worse or change, certainly with a stressful event that could always happen, but also with the hormonal shifts of perimenopause. And sometimes it’s not even expressed until perimenopause. The data is that around 14 to 15% of women are actually who are in perimenopause, are diagnosed with endometriosis, then, which is actually a higher rate than the average rate of endometriosis, which is 10%.

Dr. Jessica Drummond (00:15:54) – So I think it’s really interesting. So the perfect storm of things that happen then. So you’re all good. You have endometriosis, but you’re doing all the things your nutrition. You have a really solid yoga practice. Your nervous system is regulated, you’re moving, you have work that you love. You’re connected with your family, with your friends. You’re comfortable in your home, the place you’ve always lived. And then in September of 2022, you get Covid and that was your first Covid infection. Have you had any other Covid infections?

Aurelie Maire (00:16:26) – No, not that I know.

Dr. Jessica Drummond (00:16:28) – Okay. And any Covid vaccinations I.

Aurelie Maire (00:16:31) – Had.

Dr. Jessica Drummond (00:16:32) – Before or after.

Aurelie Maire (00:16:33) – It was before.

Dr. Jessica Drummond (00:16:35) – Okay.

Aurelie Maire (00:16:36) – And I noticed also hematoma on my skin.

Dr. Jessica Drummond (00:16:40) – When you had the vaccine, you had some of the skin bleeding. So you had that. When was the vaccine like 2021 sometime?

Aurelie Maire (00:16:47) – Yeah, I don’t remember exactly. I noticed also a change in my period. I got some pain and more bleeding during the period.

Dr. Jessica Drummond (00:16:59) – Okay, so you had vaccine sometime in 2021.

Dr. Jessica Drummond (00:17:03) – You started getting these sort of splotchy redness, potentially hematomas throughout your skin, and you started having changes in your period. Heavier flow, more pain, consistent cycles or changes in the timing of the cycles.

Aurelie Maire (00:17:21) – I noticed a change, but, you know, after maybe 2 to 3 months, it was, you know, stable again.

Dr. Jessica Drummond (00:17:28) – Okay. So it was kind of this temporary shakeup of your immune and endocrine systems, if you will, and maybe vascular even then at the time and again. So at that time you were about 43. Yeah. Okay. So also again perimenopause which makes it so complicated. One of the like red flags I’m seeing just clinical purl here is that when women are in the lower estrogen state, we do have data that that puts them at higher risk for complications from Covid. So the challenge with perimenopause is we never really know if we’re in a low estrogen state or an estrogen dominant state or a declining estrogen state. It’s kind of all over the place. So it could just be a matter of timing.

Dr. Jessica Drummond (00:18:18) – I’ve seen multiple times in my practice where like someone has had two Covid infections, were fine, had vaccine was fine, and then on there like third infection maybe was during the luteal phase. And that’s when the long Covid hit. So I do think there’s this interesting protection that estrogen may provide. So you know the research supports it at some level. And we’ve talked about this before on the podcast. But there’s also I think more to that story. All right. So you have your first infection September of 2022. You’re also perimenopausal. And then you’re also making a major international. A move that requires you to do stuff that you don’t want to do, moves you away from your support network, and it’s a pretty stressful experience. So when was that move?

Aurelie Maire (00:19:11) – It was in March 2023, but I had to do another move because I was in another country. So it was in fact a year to move. And it was two moves.

Dr. Jessica Drummond (00:19:24) – Yeah.

Aurelie Maire (00:19:24) – So it was a lot. And when I arrived here, you know, I didn’t know the medical system or the health care system.

Aurelie Maire (00:19:33) – I didn’t have any references. And also, you know, it’s quite a thing, but I tried also, you know, to rule perimenopause out in a way. So I ask also for some blood testing just to have a snapshot. I know that hormones can, you know, fluctuate. And it was surprising because my testosterone level, it was really, really low, almost zero. And I said, yeah, that’s interesting, but I didn’t know what to do with that when I listened. Also to my clients who were, you know, in the transition into menopause, it seemed that on the paper, you know, I could have, you know, some of the symptoms or similar symptoms, but the feeling that I had, it was not that. So it was, you know, quite interesting. But yeah, I think it was linked to the Covid and long Covid.

Dr. Jessica Drummond (00:20:34) – Yeah. So when you did the snapshot of your hormones, as we know it’s a moment in time, but it’s still valuable.

Dr. Jessica Drummond (00:20:40) – Was your estrogen and progesterone normal? They were okay. That’s good to know. So you had relatively well quite low testosterone but normal estrogen progesterone. You’re now roughly 4445 years old and you’re kind of experience being perimenopause. And this is where I think it gets very complicated from a long Covid standpoint. So the differences that I see, and I think you’re probably seeing these with your clients too, is that in perimenopause, menopause. Yes, we have the sleep disturbance, but we don’t always have this like intense fatigue that that’s a real hallmark of the Post-viral syndrome, the needing to take a nap but not be restorative symptoms worsening with activity, which is why pacing is so valuable. Kind of slowly increasing our levels without pushing too far past that envelope too often. And the other really like blaring, flashing light for me is this experience that you had of all these vascular symptoms and the disorder anemia, the blood pressure and heart rate being up and down, the dizziness, the heat intolerance, which is really tough when you moved to a country that’s much hotter.

Dr. Jessica Drummond (00:21:54) – So those are different. Like I don’t tend to generally see women in just normal perimenopause transition have such extreme disorder and vascular warning signs. Now, we do know that the menopause transition does increase people’s cardiovascular risk, but it’s usually a bit more subtle. Like we’re not seeing hematomas everywhere, we’re not seeing blue hands. We’re seeing things like elevated cholesterol, you know, kind of out of nowhere. Weight loss resistance in the abdominal area, especially things like that. So these things can coexist with long Covid. But I think the hallmarks that you’re presenting of long Covid are the disorder anemia, the heat intolerance, the vascular changes. Even if you don’t have an actual blood clot, which is good news. But we also know from the literature around long Covid that micro clotting, which is little tiny blood clots in the capillaries, is one of the potentially key drivers of long Covid. The question is why is there still infection? Is it a change to the immune system that the research has not yet fully elucidated? But it does seem like with long Covid, kind of like with chronic Lyme or chronic EBV, there’s this sort of continuation, this persistent viral infection that’s going on.

Dr. Jessica Drummond (00:23:27) – All right. So your infection was September of 2022. You had a big move in March of 23. You started to get oriented to your new health system. And you had a lot of serious issues ruled out, such as a blood clot or, you know, any other major issues that you remember having rolled out.

Aurelie Maire (00:23:49) – Yeah, it was anxiety, fear.

Dr. Jessica Drummond (00:23:53) – Oh, this is what they told you. It was like panic attack.

Aurelie Maire (00:23:57) – No, it. Was me, you know, fitting that and despite having my yoga practice. So every day being in nature and having a restorative practice and meditation, breath work and good sleep, yeah, I could feel, you know, this anxiety coming from nowhere, panic attack. And in December last year, I got, you know, the vivo, the Garmin Vivosmart. And I was so amazing. Surprised because I thought, oh, no, you have a good night. You know, every night. And I see, you know, my level, my battery level in the morning it was maybe 60, 65, 70.

Aurelie Maire (00:24:45) – And during the night I could see, you know, my HRV. It was very, you know, low or and it was. So I’m not having, you know, a restful night and also during the day, even if I was just resting and I said something is wrong there and my, you know nervous system is all over the place.

Dr. Jessica Drummond (00:25:10) – Yeah. Okay. So that is such good information. That’s why we always have our clients wear a wearable tracker to track HRV and sleep quality and stress, because it is hard to know physiologically. Are you having that restorative sleep. So we have a seven step system around here where as you know, we kind of walk through a coaching LED path. So we’ve heard your story, which is essentially step three. But let’s back up to step one a bit, where in step one, even within our sessions here, and hopefully you’re feeling this way now, although it’s a little bit unusual that we’re filming this, you know, and you’re very aware of this because of your yoga background and your ability to track autonomic nervous system and your breathwork background in meditation.

Dr. Jessica Drummond (00:26:04) – Clearly you were living in kind of a fight or flight. You know, there’s sort of three different states that people can be in, and that’s a bit of a continuum. So ten is like chronic fight or flight, anxious, wired and tired. All of that. Five is where we want to live. That’s the rest. And digest calm aliveness, a feeling of peace, but also that cognitive engagement is possible. There’s energy that’s kind of where you were knocked out of. But know what that feels like because you spent ten years living there when you were really working on your yoga practice, and you’re working on optimizing your health from the endometriosis diagnosis. So you know what that feels like. And then there’s zero the continuum, which is like the Free state. And that’s where you just kind of get overwhelmed, panicked, but in a way that’s just paralyzing sleeping kind of or just checking out scrolling but not really being restorative. So where have you been living, say, for the past six months in terms of your autonomic nervous system?

Aurelie Maire (00:27:18) – I think it was between the phrase, you know, state and fight and fly.

Aurelie Maire (00:27:25) – And at the beginning, you know, of this year I started to come back, you know, in the middle and that it’s, yeah, it was weird, you know, to have also foundation in place and still have, you know, this feeling of, yeah, anxiety, panic attack, nervous system, you know, dysregulation and and other things. It was I couldn’t explain, you know.

Dr. Jessica Drummond (00:27:54) – Yeah. I really appreciate you sharing that because I think there is conversation in the world of integrative health that you won’t be knocked out by Covid if you have a strong foundation of autonomic nervous system regulation. But I was the same as you. I was doing a lot of yoga. I was meditating every day, and it took me about a year to resettle my nervous system despite using those tools. And it sounds like it took you roughly the same amount of time. And so I think the good news about that is that having that foundation helps, because if you’re feeling perfectly well right now, you’re listening to this as a practitioner, not a person living with this or a caregiver or anything else.

Dr. Jessica Drummond (00:28:45) – Life can knock you off balance, whether it’s this infection or something else, and it might take a while to come back to that baseline, depending on how severe of a knock you get. But I’ve seen this time and time again, and it’s been people who have been vaccinated, not vaccinated, ever had one Covid infection, had five, Covid infections, had a combination of both. Even people in the integrative health space that I’ve worked with in my practice, you know, yoga professionals, functional medicine practitioners, therapists, manual therapists, I have seen time and time again, no matter what the circumstance, that this key nervous system regulation piece is very surprising to them about how problematic even just one Covid infection could be for someone who had a really strong foundation, just like you were eating all the perfect things. Maybe they got vaccinated, maybe they didn’t. I’ve seen cases of absolutely of both the exact same circumstance. So, you know, that sense of having anxiety, that sense of feeling stuck. So that’s the bad news.

Dr. Jessica Drummond (00:30:00) – But the good news, you can do all the right things and still be really knocked on your butt by this. You really can. And having that foundation. Dation is still so valuable because you’re seeing now, a year later. And I think that’s the other reason to wear a trackable wearable device tracking your HRV. You use an aura ring, use a Garmin. It’s just a little watch, and if you have yours, you can show it. If not. Yeah. Oh, yeah. No. That’s okay, I found it. Yeah. Some little. Yeah. Right. Looks like that. So if you prefer ring a watch. It doesn’t matter. There’s lots of different tools. We use the Garmin Vivosmart four in our practice just because of what exactly you saw. It’s a little bit more real time data that’s a little bit simpler to read about the stress piece. So if you are stressed overnight, it’s gonna look orange. You know, you’re going to wake up with this body battery algorithm which shows you like, okay, I just slept 12 hours and I’m not restored or I am restored.

Dr. Jessica Drummond (00:31:13) – So a foundation of yoga breathwork, mindfulness, a real awareness of nervous system regulation and tracking the data of your heart rate variability, your restorative sleep, your stress. This sets the foundation for step one. And the good news is doing that. Also have seen this time and time again as quickly as three months, but sometimes a year to 18 months depending on because you had a number of things shake you up at the same time, not just Covid. You know, I’ve had people who just had nothing else. Just one Covid infection got to see me within two weeks of it, and then everything else was still in place. They had their support system, they had their sense of connection. They were in nature. You know, you also had to move and you were going through perimenopause and like there was a lot of other stuff going on. So it could be just a few months, but even it is a few months for people that just have one simple Covid infection sometimes, or a year or 18 months, it doesn’t matter.

Dr. Jessica Drummond (00:32:22) – We don’t want to put a time limit on it, but it does recover. And so now that you’ve been doing this consistent yoga breathwork mindfulness practice, are you finding that your disorder is improving in any way? The blood pressure, the heart rate, symptoms.

Aurelie Maire (00:32:43) – It has improved. It’s still not as it was, you know, before, but also because, you know, I’m pacing. So I really adapt my day, my week, even my month. So if I know that I have an engagement or something, I will have a ton of rest before and after. And I am fortunate to do my own schedule so I can also, you know, schedule my day in function and it makes a big difference. So I think I’m more aware about, you know, what I can do or if I maybe would need more rhythms and so on. So it helps. But still, if I overdo physically or mentally, yeah, I know that I will have some bad days after. And I just wanted to add also something about the device, because when I went, you know, for work with my husband, I said and I told him, okay, I cannot anymore.

Aurelie Maire (00:33:48) – I’m so tired and said, no, we did nothing now and it couldn’t understand. And I showed him, you know, the data and you know, the battery level, HIV and so on. I said, oh, wow. And at that time, you know, having the data thing that he could understand. And then it was much more, okay, we will take a break or how do you feel? And so because that’s like endometriosis, you know, it’s invisible.

Dr. Jessica Drummond (00:34:20) – Yeah. That’s so valuable to share. In fact, just yesterday the Harvard Business Review came out with an entire guide. And we’ll make sure we link it to this show notes about supporting people in the workplace with long Covid. Because of exactly that, you can look perfectly normal when you have kind of set your life up to manage your schedule. You know, kind of stay in your energy level envelope very slowly, progress your exercise only as your body heals, not to heal your body. I think that’s kind of a you know, a lot of times, especially in the world of physical therapy and medicine, like exercise is part of the healing.

Dr. Jessica Drummond (00:35:05) – But in this case it’s the opposite as you. Heal. You rest enough, you nourish enough. You know, you get all the right treatments, which we’ll get into. Then you have more capacity to even walk. Not even like more exercised, even walk, even do yoga, even stand up and take a shower like some of the basics and work, you know, if especially if your work is physical. But even if you have a sedentary job, that tool can be very valuable because it’s the stress of everything eating, digesting, getting dressed, putting makeup on, doing something on a computer, which is cognitive work, any kind of emotional perturbation. So if like, you know, your kid was having a meltdown in the morning that could mess up, you know, your energy envelope. And so I really love that tip that if someone’s living with someone or has a manager or a child or anyone in their life who’s really not understanding it, because some days you are normal, you’re functioning normal, you look normal.

Dr. Jessica Drummond (00:36:10) – But having that data is a really valuable way to be like. But inside this is all the stuff I’m managing.

Aurelie Maire (00:36:21) – Yeah, it’s so valuable.

Dr. Jessica Drummond (00:36:23) – Yeah. Really good. Well, and I’m glad he was able to hear that too, because sometimes there’s even resistance with that. All right. So step one is nervous system regulation. I can’t overstate how important that is and how patient someone with long Covid and their caregivers and their employers and their friends and their partners are going to have to be when it comes to the amount of time, even for really skilled practitioners who have a baseline of doing this for a decade or more, it can take three, six, 12, 18 months easily to start getting that nervous system regulation back in balance so that sleep is more restorative day to day. We’re not just using energy, trying to maintain nervous system regulation. All right then step two of our process is to focus on our client’s goals. So now where we stand. So you’re, you know, a year and a half outside of your Covid infection that kind of knocked you off kilter.

Dr. Jessica Drummond (00:37:27) – What would you say. And this is important to reassess every six months or so because things progress and improve. So what would you say your vision and goals are now for your own health? What are some of your priorities say between we’re now in May, so say between now and the end of this year.

Aurelie Maire (00:37:45) – It’s to just maintain the bases but also regain, you know, this kind of energy because it’s not, you know, as I would like to be. And so I can really engage in life, travel to visit. But also, you know, for my business and my work. So to do the projects that I would like to implement and I didn’t feel I have, you know, the energy to do that. So I’d like to, you know, regain my energy and also to prevent the risk related to endometriosis, long-covid and perimenopause, because I know that menopause, you know, I could have some not complication but like exacerbation. Exactly. So that’s why I really like to also maybe optimize, you know, other things, but really also that this energy level physical and cognitive energy level, I would say.

Dr. Jessica Drummond (00:38:49) – Yeah. So that’s super valuable because we want to keep that energy goal attached to your life goal, which is okay, maybe we even define further. You can sit with your husband. You can work on this on your own, like 2 or 3 particular trips a year. Or you want to make sure by, you know, this time next year or by October of this year, whatever the date is that you launch your practitioner training for yoga and endometriosis, whatever the project that are priority. Because one of the things that can be really valuable about for someone living with a kind of chronic illness constellation like this, especially around the time of perimenopause, menopause, is that the energy deficiency is one piece of the puzzle that we want to work on physically, and we absolutely can do that. And from a life standpoint, you’re here now and we don’t want to waste it. Right. I’ll give you an example. So two weeks ago or so, I went on a girls trip to New York City for my birthday.

Dr. Jessica Drummond (00:39:55) – And, you know, we were walking like literally 20,000 steps, 11 miles, 13 miles. And I was there for two and a half days, roughly three days. And I knew it was going to be a lot of walking. And I’ve been working on walking for a long, long time. Always. Some days are somewhat better than others. It depends on the weather. There’s all these factors, right. And so I designed that trip so that no matter what energy intolerance, whatever, I could attend it. It was one of my key goals. Like I was visioning even when I was like laying in bed four years ago that I would be able to walk around a city. It’s one of my favorite things to do, just and enjoy. You know, stopping at a cup of tea walk in Central Park. You know, if I’m in Paris, look in all the little boutiques, whatever. I wanted to be able to walk around a city. It was a really big goal. And to do it with my friends was even better.

Dr. Jessica Drummond (00:40:48) – So one, you’re going to have to connect with your support network to make sure that they’re comfortable with you know how to support you and you just support them and everyone has a good time. And then you also might have to plan, as you were talking about before, a couple days of rest, before a couple days of rest after. We’ll talk about some of the treatments to really kind of support the mitochondria physically. But I think it’s two things that have to be held gently together. One is we absolutely want to be working on optimizing your health. And two, at the same time, we don’t want to be limiting the key priorities of your life. We want to be doing them and kind of balancing that with the rest and support that you need ideally. And it may limit like maybe five years ago, you and your husband could travel once a month somewhere all around Asia. You could just like, show up. You didn’t need to think about where you were going to eat or where you were going to sleep.

Dr. Jessica Drummond (00:41:51) – You could just figure it out. Now there’s going to be some planning. You might have to do it three times a year or twice a year, not every month. But I think that connection to like the priorities of your life is very important. What do you think about that?

Aurelie Maire (00:42:08) – It is. It really isn’t. You know, at the beginning of the year, I decided also in a way, to come home and to feel also safe again, you know, inside and with my body. And I took another basic foundational yoga teacher training because I wanted to go in a maybe place in the mountain, you know, in the Himalayas and so on from, you know, a few months. But physically I thought, no, I will not be able. So I did it and it was a great place, you know, to start in. The recovery process. And I think also to be very specific about what I really want is also the key. And when you need also to manage your energy level, you have to make choice.

Aurelie Maire (00:42:59) – And in a way is good because I had okay, what do I really, really, really want. And so the other stuff, you know, I just put them away because it was not so much important. But I’m sure that a few years ago I would have, you know, done all the things, also work projects and so on. But now I’m really focused. And in a way that’s really good.

Dr. Jessica Drummond (00:43:24) – Yeah, that’s so valuable. So the connection kind of to your goal can also be about a reconnection with your own living in your own body safely. And I think this is something that anyone with a chronic illness, especially if it’s related to an infection. And so Covid is a big challenge because it’s still out there. And so is EBV. 95% of the population have it. It can be reactivated by almost anything. Lyme. You know, if it’s an infectious issue, it’s hard to keep living in life knowing this can happen again. Now, of course, we want to be taking precautions in the same way we’re going to use like bug spray when we go hiking in a dense, you know, forest or whatever, and do tick checks and all these things that we do for Lyme and have done for Lyme forever, we can do precautions to reduce the risk of additional Covid infections, and we’ll get into that later.

Dr. Jessica Drummond (00:44:27) – But that feeling of home and safety within your own body, so you can begin to re trust yourself when your health has been rocked, I think is a really important endeavor that you did, and I love that point about now you have to make deliberate choices because you have an energy limitation, but that can be really good. It kind of shakes out all the fluff. You know.

Aurelie Maire (00:44:54) – It’s a big learning and I will take that, you know, with me. And it’s a great. So I see that, you know, just like a life experience. I’m learning a lot about myself, you know, scientific studies, you know, integrative also techniques that we can apply related to also long Covid and complex chronic illness. And I’m quite happy with that in a sense. Of course that’s bad. But I try to take all the positives and the learning and to turn it also in a positive way. And it’s helpful also for sure.

Dr. Jessica Drummond (00:45:31) – I mean, it gives you a very unique insight into your clients who are living with the same thing.

Dr. Jessica Drummond (00:45:37) – I saw just a short clip of a video yesterday where a woman who was like a pediatric. I forget what her specialty was, but she was a physician and she said, you know, she talked to the parents of a kid who was diagnosed with this same genetic defect or whatever that she had, and she was just like, oh, I have this, too. And their ability to relax was dramatic because now it’s like, oh, my kid could be fine. You know, it may be challenging, they may have challenges. But here’s this woman who’s lived with the same thing her entire life, and she’s good, more or less so. And we’re all kind of good, more or less. Right. Who doesn’t have something true?

Aurelie Maire (00:46:20) – And also, when you don’t really know what you have or weird symptoms coming, you know, back and forth. And I think having, you know, this holistic approach is very valuable. And just to support all the systems and not going, okay, I have this, I will check this, it doesn’t work.

Aurelie Maire (00:46:42) – And so yeah, we do as head coach. It’s so, so helpful.

Dr. Jessica Drummond (00:46:49) – Absolutely. So with any complex chronic illness as you’re saying, and with the perimenopause menopause transition. So there is some value in certain cases to ruling out major problems. Blood clots. You know, let’s say you have endometriosis growing on a nerve or in your lung or on your diaphragm, like there are times where there are more urgent kind of Western medicine, things that need to be looked at and ruled out. And I strongly encourage that. In any case of mystery or invisible illness, no matter what the driver is. So I appreciate you sharing what you did there. And by the way, I had the same thing. I had like a blue hand. And so I had an ultrasound and, you know, no blood clot, so you never know. And I had done the same thing. It was right after a trip I had traveled. So we’re going to get into the vascular pleasures of Long-covid in just a minute.

Dr. Jessica Drummond (00:47:43) – But. So we’re ruling out serious issues, which is important to do. All right. So you have the tools to regulate your nervous system. All of our clients should have that. We should be working with every single client on that. We know your vision and goals. You have 1 or 2 key work priorities. You have 1 or 2 key life priorities, and you’re steadily expanding. Your energy envelope is what it’s called. And kind of the pacing terminology. Or there’s the spoon theory. You kind of wake up in the morning with five spoons, you know, how many are you going to still have by the end of the day? You’ve got to be mindful of that. And it can fluctuate. You know, sometimes you got a great night of sleep, sometimes you have eight perfectly, sometimes you didn’t, sometimes you were in a plane, whatever. So now in step three we gather the data. So we know from the story you’ve told us where you are. You’re on that perimenopausal spectrum.

Dr. Jessica Drummond (00:48:38) – You have low testosterone. We know your story. We know you have a history of endometriosis. We know when your Covid infection was and how that changed your symptoms pretty quickly. And so we can piece some things together. Is there any other key pieces. We also have your wearable data which is valuable. We know you have low testosterone. Are there any other lab markers that you want to talk about here?

Aurelie Maire (00:49:04) – No, it was not really remarkable. So I did a full checkup in March this year also with the stress test, you know, on a treadmill. And it was fine. So because I thought, okay, maybe I have also some effect because of the long Covid, but it was fine. And yeah, all the things were fine.

Dr. Jessica Drummond (00:49:29) – So moving on. Now we’ve got the story, we’ve got some data points. We have some of the key areas of challenge. Because the other thing about long Covid is it can look different for everyone. And so which systems are out of whack.

Dr. Jessica Drummond (00:49:44) – So as you mentioned earlier, our perspective is always don’t chase symptoms optimize systems. But the symptoms can give us some clues as to which the systems are the priority. So in step four we start thinking in terms of recommendations. So with an underlying history of endometriosis, we know that you have some autoimmune vulnerability or immune system dysregulation vulnerability. With the long Covid your symptoms are presenting from the cardiovascular system, from the lymph system, from the autonomic nervous system, not so much the endocrine system, because your period’s kind of normalized, but still a little bit of a change in your cycle that we want to keep in our back pocket. And then certainly the energy and metabolic and mitochondrial systems for sure. And then with perimenopause on top of that, you do have some endocrine markers of low testosterone, which sometimes comes from that metabolic perturbation of blood sugar, dysregulation and inability to strength train and kind of build muscle, which helps promote healthier testosterone levels and kind of vice versa. So it’s a little bit of a downward spiral which is related to your energy limitations.

Dr. Jessica Drummond (00:51:03) – So given your goals where I would want to begin, and also just given the physiology is one you’re already doing your autonomic nervous system regulation. That’s key. That has to be a foundational piece. Two is the energy window of pacing. So if you haven’t heard of pacing and I know you have. But for our listeners, pacing is where you’re aware of how much cognitive work, how much emotional stress you can take, how much walking you can do, how much exercise you can do before your symptoms get worse. And it’s tricky because this is something that people have to learn individually, because often that symptom exacerbation or that fatigue is delayed by 12 to 24 hours. So you might do a workout, you feel good, you have a busy day of work, and then like a day or so later or even the next morning, you wake up and you’re like, I was kind of hit by a dryer. Yeah. There’s like what people call the crash. Like, oh, okay. So or like the system just fails.

Dr. Jessica Drummond (00:52:16) – Like if you don’t sort of put all the right pieces in place there hits a point where the system kind of fails. And I had this experience when I was on that New York trip. I felt really good 90% of the time. I had everything in place, but the second day we were there, I walked literally 20,000 steps. And then we went to dinner and I ate some bread that had some gluten in it, which is pretty unusual for me. And on the walk home from that restaurant, it was like my brain failed, like my cognitive system. failed. I had no alcohol, nothing like that. And I could not navigate us home. I felt drunk, so? So PSC or PM post exertional symptom exacerbation. Post exertional malaise can come from putting too many stressors on the system to a point of sort of something failing. And that could be, you know, eating a suboptimal nutrition plan that can be exercising too much, that can be doing too much cognitive work, that can be not getting enough sleep, that can be time zone change, that can be an emotional thing.

Dr. Jessica Drummond (00:53:25) – And I don’t want to put any guilt on anyone. Look, I don’t regret whatsoever. The day I had that day, my brain stopped functioning for a little while. I went to bed and I was fine the next day. But I’m also four years out of this. It might have taken me out, you know, 2 or 3 days in the past. Again, still probably worth it, right? That’s why we have to always connect to our goals. And sometimes we can’t control these things. So you didn’t want to move to Asia, and yet that was happening in your life for other reasons. You know, you maybe don’t want to live in a hot place that’s happening. So I think we have to be careful for anyone listening, especially practitioners. Patients are doing their very best, and we have to keep celebrating the fact that they’re working on this and they’re living their lives in the most joyful and connected ways possible.

Aurelie Maire (00:54:23) – Yeah, and that’s a good point, because having this joy or so fun and that’s also a key component, and I think it’s part also of all this ecosystem.

Aurelie Maire (00:54:36) – And sometimes, you know, when you deal with that every day, we tend to maybe forget that. And so bringing that joy and things that brings joy. So it’s so supportive also.

Dr. Jessica Drummond (00:54:51) – It’s so true. It’s also part of the healing. Even if there’s a temporary shakeup in the energy envelope if you will. Thank you so much to OReilly for sharing her really vulnerable experience with struggling with an underlying endometriosis condition, and then it being more complicated by her transition into perimenopause and also struggling with long Covid. What a really important story. I hope you downloaded this episode and are taking notes. So take some notes about how we can pull in and integrate someone’s story and experience, where they can tell us so much about what’s going on, and then layer on top of that some of the objective measures we can use some wearable measures, some wearable data we can collect, some functional lab testing that we can collect and start to get a kind of an overview of what you think is going on in this case.

Dr. Jessica Drummond (00:55:57) – And then we’ll meet again next week and talk about some of the next steps, solutions that Orla and I discussed during our conversation. And see if you agree. See if you’re on the same page. See if you learn something. See if you have some other ideas. Absolutely share them with us. So I look forward to coming back and sharing more of this case with you and next week in part two. See you then. 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.