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Perimenopause Endometriosis

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About the episode

“How can we better help ourselves and our clients with endometriosis or other complex conditions navigate perimenopause and menopause?”

Given some of the pervasive myths around perimenopause and menopause in the endometriosis community, many people are confused about the core challenges they may experience while navigating this transition.

As with everything when it comes to our health, what is needed are more nuanced conversations. There is no such thing as a one-size-fits-all fix that suits everyone. For example, for some people, hormone replacement therapy is a crucial element in their toolbox; for others, it’s a bad fit. As coaches and health and wellness practitioners, this is where we can guide our clients to find the best path forward for their specific needs.

In this episode, I’m doing a deep dive into the research and our unique approach to helping women with endometriosis and other complex conditions navigate this transition. I’m debunking common myths, discussing the importance of personalized treatment protocols, outlining the pillars of our seven-step protocol for navigating hormonal health during these transitions, exploring the interconnectedness of bodily systems, the role of lifestyle factors, risks and benefits of specific treatment options, and more.

Enjoy the episode, and let’s innovate and integrate together!

 

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Click here for a full transcript of the episode.

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, 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. And today I have a pretty hot topic to cover with you. We’re going to talk about how to help your clients or yourself navigate perimenopause and menopause. If you have endometriosis or a similar chronic health condition, we’re going to get into other chronic health conditions.

Dr. Jessica Drummond (00:01:32) – We’re really going to mostly focus on the research around endometriosis today. So it’s just me. We’re going to do a deep dive into the research. So you are going to see me reading my notes a bit on this episode, because I wanted to share with you a very cutting edge perspective on navigating perimenopause and menopause with endometriosis, especially given some of the myths in the endometriosis community. So you or your clients might be confused about some of the core challenges with navigating perimenopause and menopause in general. And then if you have endometriosis, what does that mean for you? So is taking medical hormone therapy or hormone replacement therapy dangerous for you? Is it going to exacerbate your endometriosis? As you know, there’s this consideration in the community of endometriosis that endometriosis. And this is true, it can be an estrogen driven disease, though not always. What about the weight gain of perimenopause and menopause? What about the metabolic issues, the cardiovascular issues? Is this exacerbated by endometriosis? Is it common for your other comorbidities like autoimmune diseases, histamine issues, bladder or sexual pain syndromes, vaginal pain issues, changes in the uterine, vaginal, or bladder microbiome? What about your hypermobility or dysautonomia? Are these things going to get worse through perimenopause and menopause? So during perimenopause and menopause, women with endometriosis do you have special considerations they have to think about to take care of their health.

Dr. Jessica Drummond (00:03:17) – So increasingly there’s sort of two different pushes going on in the conversation around perimenopause and menopause. One is everyone gets hormones like add that medical hormone therapy, the estrogen replacement, progesterone replacement, sometimes testosterone replacement. As soon as someone enters perimenopause, there’s a relatively one size fits all prescription. It’s covered by insurance, ideally, and it’s just like as soon as you start feeling any kind of perimenopausal or menopausal symptoms, you should be given this sort of standard prescription of hormones. And we’re seeing that in countries of socialized medicine and in the United States, which does not have socialized healthcare at all in our insurance system, but there is also this other conversation or this other perspective of people in sort of the integrative and holistic world saying absolutely no hormones. You know what’s going on here? Women have been going through menopause and perimenopause for thousands of years without needing these artificial hormones. What about the cancer risk? Forget it. I’m not just taking hormones just because I’m a certain age and have these symptoms. And I think as always, I mean, you probably at this point on this podcast have heard me say this 100 times, if not once, there is a nuanced conversation to be had, which gets even more complicated for those of us living with complex chronic illnesses such as endometriosis hitting ages 35, 40, 45, where we’re also beginning the perimenopause to menopause transition.

Dr. Jessica Drummond (00:04:54) – And by the way, continuing into our 50s and even 60s or beyond, if this is never addressed. So just because someone has completed the menopausal transition, and I saw a gynecologist recently who said to me, you know, these menopausal symptoms, well, they just go away in a year anyway, you know, it’ll soon be over. That is not true. That is just not true. I mean, raise your hand if you’re listening to this right now and you’re over 50 and you might even be over 60 and you still have hot flashes, weight loss resistance, challenges with your cholesterol level, your blood sugar regulation, your bone density like this does not just snap our fingers and get better. Once someone is a year past having their last period or even a couple of years after that, this doesn’t go away on its own. So women from 35 to 65 and beyond are being really dismissed and not given. Nuanced, complete, holistic options for navigating the perimenopause and menopause transition and beyond. Especially if they have chronic conditions like endometriosis.

Dr. Jessica Drummond (00:06:12) – So it’s not one or the other. There’s not one prescription for hormone medley that is going to solve all of your symptoms and your underlying problems. And many people navigating perimenopause and menopause, even if they have estrogen irritated endometriosis, sometimes do benefit more than is problematic with adding low dose medical hormone therapy. So let’s talk about how you can be asking your providers to start thinking in this more nuanced way. And hopefully for all of our providers, women’s health and wellness professionals in this community, your eyes are going to be open to starting to think about, okay, how can I better help my clients with endometriosis or other complex conditions navigate perimenopause and menopause? So first of all, let’s talk about some of the myths in this community. One, it is a myth that endometriosis can’t be diagnosed in perimenopause or menopause, that, you know, you either have it when you’re in your teens or early 20s, when you’re navigating through fertility, or you don’t. And that’s not true. And I even believe that perimenopause can be the trigger that incites someone to actually have endometriosis, who maybe had the genetic vulnerability but did not actually express endometriosis until they’re in their later 40s or beyond.

Dr. Jessica Drummond (00:07:48) – And we’ll get to the research on that in a moment. It’s also a myth that endometriosis is, quote unquote, cured by menopause. That is absolutely not true. Now let’s dive a little deeper into some of these myths. In 2019, when a study was published in the journal diseases, where researchers in Greece, the University of Crete and in the United States at Yale University School of Medicine looked at endometriosis in perimenopause and menopause. So this was done across those two research sites in the Perimenopausal group. So this was women ages 45 to 54 who were not yet fully through the menopausal transition. There were 184 patients that were diagnosed with endometriosis, 16.7%. So this is what brings me to believe that one either a woman’s endometriosis was missed, she may have had early signals. So, for example, just today I was talking to a client of mine who’s like, you know, I never felt significant symptoms of endometriosis until I was in my 40s. And I was, you know, starting through the perimenopause transition.

Dr. Jessica Drummond (00:08:56) – But I do remember as a teenager having some painful periods, you know, having to kind of learn to manage that. It wasn’t severe life altering, but it was noticeable. So there’s two things that could be happening there. It could be that someone has had relatively lower symptoms or less expressed and Dimitrios in their younger years, and then it just gets worse, or the symptoms become more noticeable by the trigger of perimenopause and menopause. Or actually they had that predisposition, but it wasn’t expressed at all until the trigger of perimenopause and menopause. So that 16.7% diagnosis of endometriosis in perimenopause could just be a delayed diagnosis. Or it could be a new diagnosis because of the trigger of the hormone shifts of perimenopause and menopause, and potentially the metabolic shifts of perimenopause and menopause, which we’ll get into shortly. And then again in the post menopausal group ages 55 to 80, 46 or 4.2% of the women were diagnosed with endometriosis. Again, could be that menopause or some post-menopausal trigger could have actually triggered the expression of the endometriosis.

Dr. Jessica Drummond (00:10:10) – Or it could be that the symptoms were missed and the diagnosis was significantly delayed. So in that perimenopausal timeframe, the average age of diagnosis was 49 and it was 61. In the post menopause group, advanced endometriosis was actually more aggressive in the perimenopausal group. In the same group, they also noticed in that parental group a higher left sided predisposition of the endometriosis. In comparison with the right side, endometriosis was the most common gynaecological condition among patients with perimenopausal endometriosis in relation to the post-menopausal group. Additionally, they also found more uterine fibroids in the perimenopausal. Group then in the postmenopausal group, which does make more sense because you don’t in fibroids generally are a more estrogenic condition. In contrast, adeno meiosis was found in a higher percentage of post-menopausal cases, and they also found more women with both endometriosis and dry eye in the postmenopausal condition, which is interesting. So the researchers concluded that pre and post menopausal endometriosis is a really important and under considered and looked for condition. Clinicians do need to be aware that there’s a correlation between endometriosis and endometriosis associated ovarian cancer in perimenopause and post menopause.

Dr. Jessica Drummond (00:11:46) – In a study that was published in 2014, in the journal BioMed Research International, researchers considered factors in women with endometriosis, premenopausal, and how they fared from a health standpoint, then postmenopausal. So this is where that early intervention of our entire integrative suite of tools, nutrition and lifestyle and sleep and supplementation and stress management, and in some cases, medications and skilled excision surgery, how if someone took better care of themselves, premenopausal why was the endometriosis expressed postmenopausal? So for women who were aware that they had endometriosis prior to perimenopause, when they improved their fitness, their social connections and their mental health care, that dramatically improved their post menopausal symptoms of endometriosis. So in that premenopausal time frame, they’re exercising more. Their mental health care is more supported, and they had good, strong social connections, which I do see as being a problem for women in their 20s, 30s and 40s with endometriosis, because the pain can be so debilitating and unpredictable that it makes it hard to maintain social connections. So the results of this study strongly suggested that physical fitness and freedom from physical restrictions, a good social environment, and psychological care in both the premenopausal and postmenopausal periods led to market improvements in the postmenopausal period.

Dr. Jessica Drummond (00:13:28) – With regards to the actual physical symptoms of endometriosis, things like pain, things like dyspareunia, things like sexual pain and sexual satisfaction. So for our patients in their 30s and 40s as they enter perimenopause, this is a really important time to emphasize their capacity for movement, making sure exercise at whatever level is appropriate for them at the moment and improving it as tolerated, is a really vital time to get that optimized. Also, optimizing their web of support, their social connections, their mental health support. Health coaching is invaluable in the 30s and 40s for women with perimenopause, because then they can transition into menopause having established these habits that will absolutely reduce their symptomatology. So those are some of the myths. And let’s talk a little bit about the hormonal milieu of endometriosis. So, you know, when I first started getting involved in this diagnosis and this diagnosis community and doing physical therapy, pelvic physical therapy to help my clients with endometriosis, the standard knowledge was that endometrial lesions are fed by estrogen and that the endometrial lesions themselves create their own estrogen.

Dr. Jessica Drummond (00:15:00) – But we actually learned in 2018. So that 2018 study was published in the Journal of Gynecological Endocrinology by a group of Belgian researchers. Our thoughts collectively in the clinical world of endometriosis shifted from endometriosis being an estrogen driven disease that’s been thrown out the window. This specific study was entitled heterogeneity of estrogen receptor alpha and progesterone receptor distribution in Lesions of deep infiltrating Endometriosis. So they did only study deep infiltrating endometriosis of untreated women or during exposure to various hormonal treatments. What did they find? Well, first of all, it’s been known for a decades now that endometriosis responds to hormonal therapy, but inconsistently. We also learned that mutations in cancer driver genes have been identified. In a fracture of the topic endometrial epithelial cells, suggesting a functional heterogeneity of these lesions. These lesions are not all exactly the same, so thus this study looked to evaluate that functional and phenotypic heterogeneity in these deep infiltrating endometriosis cells by measuring the expression of estrogen receptor alpha and progesterone receptors in the deep infiltrating endometriosis of untreated women or those under various treatments, they examined the estrogen and progesterone receptors in these lesions, and they observed a high variability in the same gland among distinct glands in the same woman and across different women, receiving some of the same treatments, so within the same person, even within the same lesion, but certainly across different lesions in the same person.

Dr. Jessica Drummond (00:16:59) – Some had upregulation of estrogen alpha receptors, some had upregulation of progesterone receptors, some had both and some had neither. So clearly there’s not just this sort of one size fits all estrogen suppressive treatment or increasing progesterone. That’s kind of a new thing I’m hearing out of the more integrative and holistic community that women with endometriosis just need progesterone creams? Absolutely not. Sometimes that can make the situation worse and can actually contribute to certain cardiovascular risks that are unique to women. So we have to be really careful of any kind of sort of one size fits all approach to hormonal support for women with endometriosis. And, you know, this heterogeneity in the estrogen and progesterone receptors could be part of the explanation about why hormonal treatments for endometriosis have never been a good, consistent cure or even symptom management. So when I learned about this study back in 2018, it really changed my focus, even from an integrative and nutrition standpoint on endometriosis. So, you know, we used to avoid, like the plague, things like maca, which can support better, healthier, more robust estrogen levels.

Dr. Jessica Drummond (00:18:23) – Or we would really promote estrogen metabolism to be revved up and by, you know, making sure estrogen metabolism was optimized in the liver. I still think that’s important because women do have estrogen, and we may want to support estrogen in the perimenopause to post menopause period. We’ll talk about that in a second. We do want to make sure it’s metabolized, but not sort of. We don’t want to push a quote unquote estrogen detox necessarily, because women of all ages, but certainly women in perimenopause and menopause. So if you are 35, 40 and older, you probably have felt in your body as the metabolic changes and the endocrine changes as estrogen levels decline inconsistently, by the way, for a period of, gosh, 10 to 15 years in perimenopause. So as that estrogen declines and it kind of pops up and down as progesterone varies and slowly declines over that period of perimenopause, certainly symptoms increase sleep problems, blood sugar regulation becomes more difficult, cardiovascular health and risks increase dramatically really, really quickly. Post menopause for women, brain fog, brain health, neuroinflammation.

Dr. Jessica Drummond (00:19:46) – So women entering perimenopause and menopause just have to be so much more dialed in in terms of their metabolic health because of the changes in hormones. So when I have a client with endometriosis, let’s say she’s in her 20s and 30s, I’m not focusing on estrogen suppression or estrogen detox, quote unquote, detox because women of these ages to optimize their fertility, their brain health, their cardiovascular health, their bone health, their ability to build musculature, need healthy, robust hormone levels beyond anything about their endometriosis. And this is really how I think we need to be thinking about hormonal health in the perimenopause menopause transition in different women, adding hormonal therapies could impact their endometriosis symptoms. So we have to be really mindful of that. But we don’t want to throw the baby out with the bathwater. It’s not like absolutely no low dose transdermal estrogen for someone with endometriosis. To me, that makes no sense at all because of all the other reasons that these women need estrogen. For cardiovascular health, for brain health, for dementia risk.

Dr. Jessica Drummond (00:21:06) – I mean, I could go on and on. So let’s move on to part three. How can we help women with endometriosis to now better navigate perimenopause and menopause? So this is what we do in our practice. And stay tuned. This summer we’re going to be launching a group program. So get ready for that. And a more targeted program where we’re working on now having the capacity to deliver those prescriptive services as well for hormones and some other tools that we’re going to talk about in a minute. So navigating perimenopause and menopause with a complex chronic illness like endometriosis, like autoimmune disease, like Post-viral syndrome, like Marcus is tricky. And that is what we specialize in. And we do it through a seven step protocol. So first of all, no matter what’s going on from a chronic disease or even a chronic transition or a transition state, we have to focus as practitioners for our clients, a nervous system, regulation. People cannot heal in a chronic fight or flight state. And that can be ruminating thoughts.

Dr. Jessica Drummond (00:22:18) – That can be chronic anxiety, that can be a chronic free state, which is kind of the inability to get going. Sense of doom all the time. Like you might be sitting on your couch, but you’re not relaxed. Being in a relaxed state of, as I say in poly vagal theory, calm aliveness, true rest and digest takes focused practices on a day and day out level things like mindfulness, meditation, slow flow yoga, breath work, spending more time in nature, laughing with friends, playing music, making or observing art, connecting with people you love or pets. We really lost a lot of that important nervous system nourishment, which is foundational to helping people with chronic illnesses navigate through perimenopause and menopause. Because these hormone shifts make that nervous system vulnerability even more pronounced. So we absolutely have to start there. The more that the woman’s system is in a calm, relaxed, focused, peaceful, attentive state, joyful state, pleasurable state, the less irritated the immune system will be chronically. Because we know endometriosis is this chronic state of produces and it promotes this chronic state of inflammation, oxidative stress, elevated levels of localized lactic acid.

Dr. Jessica Drummond (00:23:59) – This is inflammatory, inflammatory, inflammatory and the nervous system, if it’s in a fight or flight or freeze state, will promote and enhance the immune system to do more of that, which is what we don’t want. We want to help the nervous system settle the immune system from being over reactive to anything, including the endometriosis or other chronic conditions that exist within that person’s body. Then we have to move to step two of our protocol, which is making sure that we’re super clear about your client’s vision. What does health mean to them? What are their goals? What is so important to her specifically, does she want to be a very present parent for her teenagers in this transition for everyone? Does she want to be able to hike crazy trails when she’s 70 or 80 or 90? Does she want to be able to have a child at 45? Does she want to be an energetic mom? Does she want to get a big promotion at work? Does she want to be able to do a lot of international travel? We have to be very clear about our client’s goal, so that we can help prioritize the pace and the prioritization of therapeutic strategies.

Dr. Jessica Drummond (00:25:19) – So it’s really important to be clearly defining for yourself. If this is you, a person with endometriosis or other chronic disease, navigating perimenopause and menopause, or if you are the practitioner working with her, then in step three and four, we begin to collect data and use all the tools slowly but surely. And there are hundreds of them. I’m not going to get into all of them on this podcast, but it’s very important to understand that there are lots of changes in this time frame for people with endometriosis that are unique. So what is this client’s estrogen metabolism look like? Right? Have you done a Dutch test? Is she. Hooping, right? Is she able to metabolize her estrogen? Is she constipated or how’s her liver function? And so we can utilize testing things like Dutch testing to look at the liver pathway of metabolism of the estrogen. What are her inflammatory markers? Has she utilized liver function tests or things like the hepatic detox profile from doctors data? We have access to this functional testing.

Dr. Jessica Drummond (00:26:27) – It’s direct to consumer and it’s really valuable for women to understand are their detoxification their normal healthy detoxification pathways functioning optimally before we add more hormones to this situation? And what are her hormone levels? So working with skilled practitioners like our team who can do that prescriptive analysis of serum hormone levels or urine hormone levels, whatever makes most sense for that client, then is she experiencing any symptoms of low hormone levels or high hormone levels or inconsistent hormone levels? If she’s in perimenopause, low libido, vaginal dryness? What about more systemic issues like brain fog or joint pain? You know, it’s not just the reproductive system. It’s not just the pelvic floor and urogenital system that is impacted. Is she experiencing symptoms of progesterone independent of her endometriosis? Things like poor sleep, insomnia, depression, bloating, headaches so she could have endometriosis contributing to any of those and or low progesterone. Is she experiencing symptoms of low testosterone independent of her endometriosis? What is her personal cancer risk? So we do know that endometriosis can increase cancer risk.

Dr. Jessica Drummond (00:27:51) – What about family history of breast cancer? Does she have high risk factors for breast cancer that could be related to her genetics or her family history? We do know that endometriosis leads to a 2 to 3 times increase in ovarian cancer, especially for more rare ovarian cancers. So how can this cancer risk be mitigated even utilizing some of these treatments? In a meta analysis published in 2022, was found that endometriosis can increase the risk of endometrial cancer and breast cancer. But in a 2024 population study, patients with endometriosis were found to have higher risks for ovarian and endometrial cancer. No significant risk for cervical cancer. Plus, this group of researchers observed a reduced risk of breast cancer with endometriosis on a population based level. So this is really important. There’s not just a one size fits all, which I think is actually calming to the nervous system of people with endometriosis, because it’s not just automatically this elevated risk. There’s so much we can do to mitigate the risk. So the cancer data is mixed and needs to be individually assessed using things like cancer markers like CA 125 or the gallery cancer screening for early detection.

Dr. Jessica Drummond (00:29:17) – Blood markers of many female cancers, including breast, cervical, ovarian and uterine cancers. And then don’t forget that the digestive, immune and nervous systems are intricately connected with the endocrine system. This is where things start to get interesting and why it’s different for people with complex chronic illness to navigate perimenopause and menopause, then someone who isn’t dealing with that because endometriosis is a chronic inflammatory condition with autoimmune characteristics. And for many people with endometriosis, there is an impact to digestive function and gut, uterine bladder and vaginal microbiome, and more maybe even potentially influenced by the penile microbiome of someone’s male partner. Thus, before we even address the hormone shifts of perimenopause and menopause, or at least we want to be doing this concurrently, it’s essential to optimize the functioning of the digestive system of the gut microbiome of the immune system. So this means that anti-inflammatory lifestyle not just nutrition, lifestyle, sleep, nature, social connections, pleasure, joy, all of it is sometimes way more important than exactly what someone eats. That anti-inflammatory lifestyle.

Dr. Jessica Drummond (00:30:40) – Looking at lowering environmental toxin load. You know, we live in an environment where it’s just contaminated. How can we lower that load? And then considering triggers that can happen in or around the perimenopause and menopause period, such as viruses, bacterial infections, vaccine injuries, other major. Emotional triggers, such as a divorce or other significant life stressors. You know, a car accident, a surgery could be anything that triggers the, like, straw that broke the camel’s back among, you know, this constellation of inflammatory lifestyle, inflammatory food, heavy toxin load, heavy stress load, heavy infectious load. Over time, you know, someone might have gotten Epstein-Barr when they were 16, in high school, and now it’s reactivated because in perimenopause they were exposed to Lyme, or they had quiet Lyme that they got in their 30s. Never knew about it. It’s been hiding in their microbes and their body and biofilms potentially. We’ll get into biofilms in a second. But then, you know, they got Covid when they were 42.

Dr. Jessica Drummond (00:31:53) – This is a spiral that can build over someone’s lifetime, especially in the underlying context of also having the genetic vulnerability of endometriosis, whether or not that disease has been expressed before perimenopause. So we have a whole suite of tools, from nutrition to sleep to movement to supplementation, pre and post probiotics, mental health support, movement, exercise, fitness coaching and so much more. So this is why our approach to perimenopause and menopause for people with endometriosis is so unique. Very rarely does a practitioner have the time to dig into all of this, but it can’t be overlooked and just masked with, you know, a kind of short term therapeutic for perimenopause and menopause. But once all of these factors are addressed, supported, and these lifestyle changes are implemented, transformative slowly over months and years, but then sticking there for the long term, then the supplemental medical hormone therapy dosing can become simpler and smaller. Not so much hormone support is even needed, and some may not even need supplemental hormones at all. They might do fine with simpler tools like peptide bio regulators or evidence based maca.

Dr. Jessica Drummond (00:33:17) – Again, keeping in mind individual cancer risks associated with even these tools. So uniquely, there are metabolic impacts of endometriosis that can worsen the symptoms of perimenopause and menopause, which we have these tools for. And we don’t have to just, you know, slap on a one size fits all protocol. These metabolic symptoms range from weight loss, resistance and hot flashes to cardiovascular risks, neuroinflammation, brain fog, dementia and sleep issues, which is huge, is probably the number one thing we hear people complain about, and rightly so. I mean, I’m obsessed with good sleep. So let’s talk about the new research that’s giving us even more information. And insights into these metabolic risks of endometriosis, specifically in the context of perimenopause and menopause. So in a study published in 2022, in the International Journal of Molecular Sciences, researchers evaluated the levels of ten energy metabolism factors. This study is so amazing. It’s so important because they looked at C peptide ghrelin, which is that hunger hormone GIP, which we’re going to be hearing more and more about it.

Dr. Jessica Drummond (00:34:32) – The peptides are now being looked at in the same way that we’re looking at GLP one agonists, otherwise known as Ozempic. Well, all of these brand names. So this study looked at C peptide, ghrelin, GIP, GLP one, glucagon, insulin, leptin, pi one or otherwise known as spine one. We’ll get back to that resistance. And this phaeton. And they looked also to determine the expression of the DLP one receptors CD ten CD 26 proteases and other pro-inflammatory markers looking at the macrophages in the peritoneal fluid so that fluid all around the abdomen and pelvis in patients with endometriosis. So they’re looking at these metabolic and inflammatory markers in a way that hasn’t been studied before. This is a very new study from just last year. The study included 54 women with endometriosis and a control group of 30 women with uterine myeloma, but no signs of endometriosis. It was found that women with endometriosis, the concentrations of ghrelin, which is the hunger hormone GLP one, which is that peptide that you’re hearing all about in these weight loss drugs, glucagon and this phaeton in peritoneal fluid were all reduced at the same time.

Dr. Jessica Drummond (00:35:59) – The. There was a noted increase in the KD ten protease expression by the peritoneal macrophages. So more inflammation. These results indicate that these decreases in the various metabolic factors that they were looking at may contribute directly to endometriosis development through their impact on the expression of pro-inflammatory markers of peritoneal fluid macrophages. In fact, for women with endometriosis with metabolically and immune dysregulated infertility, a 2022 animal study published in the journal biomolecules discuss that there’s now substantial evidence suggesting crosstalk between the reproductive gut axis. So we talked about this all the time, like the endocrine system and the gut microbiome talk to each other. There’s this Co coordination. There’s still a lot of question marks about the mechanisms linking metabolism with reproduction. But we know there’s a clear link. And it’s probably mediated by the gut microbiome or other microbiota in the system like the uterine microbiome or the vaginal microbiome or all of these. That animal study evaluated the possible role of using Gips or GLP ones in reproductive function by examining the receptor distribution and the effects of global GI receptor and GLP one receptor deletion on estrus cycling.

Dr. Jessica Drummond (00:37:30) – So it’s like menstrual cycling in animals and reproductive outcomes in mice, GLP receptors and GLP one receptor gene expression were readily detected by PCR in female reproductive tissue, including pituitary ovaries and uterine horn. So for women who are taking Ozempic or other GLP one agonists and there are GIP drugs coming out on the market as well, that’s in kind of final stages of research, so keep looking for that. We know the receptors for those GLP one peptides are in pituitary, in the brain, in the ovaries, in the uterine horn. So these drugs are not just impacting weight loss. They’re impacting the inflammation associated with these various tissues. And to me that’s great. This is promising. We now have some tools to support the deficiencies that women with endometriosis are expressing in these areas where they need these peptides. And that’s what these drugs really are. These drugs are a form of the peptides that have been studied for anti-inflammatory and diabetes for more than 20 years. So while I don’t believe that taking GLP one agonist like Ozempic is like a one size fits all cure and helps with metabolic health for women with endometriosis immediately through perimenopause, I do think there’s an important role for her kind of supporting the deficiency that we now know that women have in GLP one peptides, so functional studies in these mice basically revealed that the female mice that did not have or they were lacking that GLP one receptor in the GIP receptor, they had significantly dysregulated estrus or menstrual cycling compared to the control mice.

Dr. Jessica Drummond (00:39:29) – And that indicated their reduced fertility treatment. So in this study, they treated these mice with the GI, GLP deficiencies in the receptor and the GIP receptor deficiencies with oral metformin. This is normally used to help with PCOS fertility, and they did find no amelioration of pregnancy outcome, except the litter size was approximately two times greater in the second breeding cycle for those that were lacking those receptors. So it is an animal study, but it really highlights the significance of increase in receptors, the receptors of these peptides that we now have access to as medications in modulation of female reproductive function, which may provide future targets for pharmacological interventions in reproductive disorders. And in 2023, an expert opinion was published in the Journal of Expert Review of Anticancer Therapy, called research into the use of GLP one agonists for obese patients with malignant endometrial pathology to improve fertility by reducing weight, decreasing inflammation, and decreasing insulin resistance. So while endometriosis is not cancer, it is a chronic condition that does impact the health of the endometrial lining and can increase risk of certain reproductive cancers and women with endometriosis, we do know.

Dr. Jessica Drummond (00:41:00) – Struggle with increasing inflammation challenges with insulin resistance. So thus this tool could be very, very useful GLP one for fertility in this population, even if it has not become cancerous. And look, this research is urgent because actually more women of reproductive age are now beginning to express malignancies or cancers of the endometrial lining. Another study kind of supporting this use of GLP one agonists in women with fertility challenges is women with PCOS, with fertility challenges, in a 2023 meta analysis and systemic review. This was published in the journal BMC Endocrine Disorders on the effects of GLP one receptor agonist on pregnancy rate and improving of the menstrual cycles, so women with PCOS tend to have longer menstrual cycles not as consistent short regular length menstrual cycles. So in this study there was a total of 840 patients, 469 individuals in the GLP one receptor agonist group and 371 in the control group. There were 11 randomized controlled trials included in this meta analysis and systemic review. The GLP one receptor agonist usage was associated with improvements in natural pregnancy rate and menstrual regularity across women with PCOS.

Dr. Jessica Drummond (00:42:29) – There was no significant differences in total pregnancy rate IVF pregnancy rate between the two groups, but total pregnancy rate elevated in a short time after the GLP ones in the subgroup analysis. Randomization to GLP one receptor agonist. These drugs. This treatment was associated with a greater improvement in insulin resistance, BMI, waist circumference, sex hormone binding globulin, and a slight reduction in total testosterone, which again could be good or bad depending on your client’s issue compared to the control group. And in the European population that was studied in this, there was seen a decrease in total body fat in those using the GLP one receptor agonist. So their conclusion was that prescription of GLP one receptor agonist improves natural pregnancy rate, menstrual cycle and insulin sensitivity. Anthropometric so waist to hip ratio and hormonal indexes in women with PCOS. So while the research that we just discussed this body of research. Well actually before I get into this I want to sort of summarize okay GLP one agonist. So let’s talk about what we’ve talked about so far. Women with endometriosis specifically and other chronic diseases in general, should not be excluded from medical hormone therapies because of their underlying chronic condition.

Dr. Jessica Drummond (00:44:02) – However, these hormone therapies need to be used carefully in an environment where we’ve done everything we can to optimize digestive function, detoxification function, immune function, gut microbiome health, nervous system function. We have tons of lifestyle medicine, nutrition, supplemental tools to help those systems work optimally so that if we layer on a little bit of supportive hormone therapy and used in a specific way that can reduce risk without increasing side effects and the same thing, I believe we’re going to see more and more for women with endometriosis who are perimenopausal 40s, late 40s, mid 40s and want to have children, or even 30s. Because don’t forget, perimenopause begins as early as age 35 or so. We can support fertility from a metabolic standpoint using GLP one receptor agonist medications. However, oftentimes the pharmaceutically available medications are at a very high dose, too high of a dose, and can incite a lot of side effects. There are low dose compounded options of these peptides that have been used for years in naturopathic medicine in sort of quote unquote, alternative medicine, even integrative medical communities to support metabolic health at that cellular level.

Dr. Jessica Drummond (00:45:38) – And this is where I think we need to begin. You know, unless your client really has true obesity, type two diabetes, then those relatively higher doses that are available, you know, just in general, pharmaceutical prescriptions may be the place to begin. But for our clients who get. All the support around strength training, walking, sleep hygiene, social connections, anti-inflammatory nutrition, nutrient dense nutrition, antioxidant, nutrition, hydration, detoxification, support, lowering the toxic load, cleaning up chronic infections. We get kind of the foundation nice and clean no matter what the quote unquote diagnosis or genetic vulnerability exists, then these tools can be super, super valuable hormone therapies and GLP one peptides in very, very low doses to start and possibly to stay. So I’m very encouraged by this because I think women with endometriosis are often sort of left out to dry when it comes to that perimenopausal transition. Without thinking about how to integrate these more complex, more cutting edge tools with the lifestyle strategies that we know set a good foundation.

Dr. Jessica Drummond (00:47:04) – But many women will tell you they did all the right things, right? They ate really well. In fact, some of it can become too perfectionistic if we leave it to only lifestyle changes, only nutrition as being the only options, right? They have to be perfect at their sugar free, gluten free, grain free, dairy free, right? It ends up becoming a path to an eating disorder potentially. We do want a nice, clean, anti-inflammatory, nutrient dense diet, but it doesn’t have to be perfectionistic if there’s a little boost of metabolic support. Sometimes it’s enough to use supplements like berberine or chromium or cinnamon, but sometimes people need a little more support as they lose the estrogenic support. And so we do also have research that GLP one receptor agonist, combined with estrogen therapy is even more beneficial for women. So moving into perimenopause that neuroinflammation, that chronic joint pain, the pelvic pain of endometriosis, bladder pain, many of these symptoms, sleep irregularities can be influenced by metabolic dysregulation. So working with a team like ours that utilizes that completely integrative approach, where we’re going to help you with the nutrition and lifestyle and actually how to integrate it in your life without it becoming an overwhelming full time job, but also supporting the body in the environment that we live in, which is very high stress, very high toxin, more and more infectious agents that we’re exposed to by the day.

Dr. Jessica Drummond (00:48:47) – So let’s get our bodies even more resilient through this transition and use the tools that we have. One last issue I want to talk about before we wrap up our protocol is while the research we just discussed on the metabolic markers that were studied in those with endometriosis, this particular research study did not find a general increase in pi one deficiency, also known as spine one deficiency, for people with endometriosis. But a study published in 2018, in the journal Biology of Reproduction analyzed the role of pi one, which is otherwise known as plasminogen activator inhibitor one, in endometrial lesion growth. These researchers studied the effects of pi one inhibition by using a mouse model of endometriosis that allows noninvasive monitoring. The endometrial tissue from the donor mice, was collected and labeled with an adenovirus, and then implanted into a subcutaneous pocket on the ventral abdomen of the recipient mice. Seven days after transplantation, the mice were randomly allocated to two groups and treated once daily for two weeks with either control or a Pi one inhibitor. The endometrial lesion that was generated in the recipient mice was then monitored by that signaling.

Dr. Jessica Drummond (00:50:15) – Animals were then euthanized after 21 days, and scientists were able to look for the endometrial lesions and look at the fibrin within those lesions. Look at the vascularization, the collagen content to see like, what do these lesions look like? If you think about like fibrin is that growth of connective tissue in women with endometriosis, they’ll often say like I have adhesions. If you’re looking at people that have chronic viral syndromes, they’ll have a lot of micro clots or chronic infections that are hiding in biofilms. So it’s this connective tissue like stuff that keeps things kind of tied up in. The system, and it can express in a number of different ways depending on what’s going on. But in endometriosis, essentially they’re looking at like endometrial lesions that are more fibrotic and there are more adhesions. So basically, when the mice lacked the Pi1 inhibition, there was more of that fibrin, more neo vascularization. They didn’t see a change in the density of collagen, but it was more fibrotic. Also, the lesion size could be increased due to that increase in vascularization because the body is trying to sort of feed with vascular system, the areas that maybe there’s more micro clotting.

Dr. Jessica Drummond (00:51:45) – Otherwise it’s just that it’s fibrotic. So this is important because even though this is not found generally in people with endometriosis, I’ve been doing Neutrogena Omic studies for our clients with endometriosis for a long time now, and it’s very common for my clients with endometriosis or with a Post-viral syndrome profile. And that could be Epstein-Barr, that could be flu, that could be Covid. It doesn’t really matter, people, the chronic viruses that hide in biofilms. So bladder pain is another key place to look for this. They often have genetic snips around Pi one or Sabine one. It’s the same thing. It just has two different names. And so they need to eat and have more enzymes to break down this fibrotic tissue, these biofilms, these micro clots. This is why things like Sarah peptides are so valuable in women with endometriosis or lumbar kinase is now being studied in long Covid. Just more enzyme dense foods, kiwi and papaya and pineapple and digestive enzymes are so valuable and will be enzyme like, we use all these different kinds of enzymatic tools.

Dr. Jessica Drummond (00:53:03) – And I think the reason that this is so important in the transition from perimenopause to menopause is if someone has these pi one or Sabine snips and they are more Claudy, more fibrotic, have more adhesions, estrogen can make that worse. And that’s problematic. So we have to be really careful about the dosing of the estrogen. You know, and especially we have to be supporting this with adding more enzymes, whether it’s through nutrition or supplements. It’s something to really keep in mind. Now there are not only risks of adding supplemental estrogen, but there are important risks of GLP one receptor agonist medications, which is why, again, it’s so important to start at the lowest possible dose and with the fewest in a compounded way when possible, so that you’re not adding other things for the body to be sensitive to. Some of these risks of GLP one receptor agonist include disordered eating risks. So especially for clients that are already really, really restricting, we have to be careful of disordered eating, nausea, vomiting, diarrhea, thyroid cancer, pancreatitis, intestinal obstruction, loss of appetite, dizziness, mild tachycardia, headaches, indigestion and sudden kidney diseases.

Dr. Jessica Drummond (00:54:26) – Now, some of these side effects are pretty severe. So we want to keep an eye on them. And this is why is anyone using these medications I strongly discourage you from just ordering them online willy nilly or, you know, working with your kind of local. You know, there’s a lot of kind of wellness gyms that are just offering ozempic pens, like, and, oh, this is not a good idea. It needs to be looked at with a skilled licensed practitioner who works with a population of people with endometriosis and perimenopause. This is not something to do just randomly. You have to be mindful that some of these are very serious risks. Now, there are also some very important side benefits of these tools, especially the low dose GLP one receptor agonist improvement in cardiac tissue and function, reduced cholesterol and blood pressure. Stimulation of the vascular endothelium to produce more nitric oxide, reduce oxidative stress and reduce atherosclerosis. Also, anti-inflammatory effects throughout from the brain to the joints to the cardiovascular system. Studies have shown positive impacts on kidney outcomes and patients with type two diabetes and as I said, glucagon like peptide one.

Dr. Jessica Drummond (00:55:50) – GLP ones suppress neuroinflammation and improve neural structure. So these medications and. These tools are not to be taken lightly. This is why we have a skilled licensed medical provider on our team who’s going to work with us in collaboration with the lifestyle strategies to do this with the absolute most benefit and least risk from a client. By client perspective, this is not a one size fits all strategy. And before we wrap up this podcast episode that I hope is blowing your mind, I really do. I have one more point to circle back on regarding the biomarkers. When we talked about the Pi ones, you know, we really have to be supporting using the enzymes, using the liver support. And this issue of increased fibrosis and clotting risk because it can be exacerbated by estrogen, we have to be focusing on that foundation first. So whether your client or you will benefit from a low dose of GLP one agonist or a hormone supplemental therapy or combination of therapies estrogen, progesterone, testosterone, it always has to be in the context of that healthy lifestyle anti-inflammatory nutrition, anti-inflammatory lifestyle, connections, social support, movement, and considering things like mast cell activation, which can be exacerbated by estrogen post exertional symptom exacerbation.

Dr. Jessica Drummond (00:57:31) – If we’re dealing with endometriosis and a chronic post-viral syndrome, how much can we exercise? What are the metabolic impacts of that? You know, what are people tending to be sensitive to from an inflammatory perspective? So none of these tools can be utilized and just, you know, kind of a simple protocol way. We really have to set those foundations and then wrap up our coaching protocol by creating these changes in lifestyle, changes in breakfast and morning routine and sunlight in nature, exposure in, you know, how people are, you know, adding strength because sometimes GLP ones also can contribute to muscle loss unless someone is strength training. So these foundational lifestyle changes, none of our clients, none of us can do all of them overnight. So in step five, we create one week, one month at a time integrated, transformational lifestyle changes that are well supported in step six by the entire web of support. So we go with the pace that the client can handle. Maybe she has little kids, maybe she’s got a really busy job.

Dr. Jessica Drummond (00:58:47) – Maybe she’s caring for a sick family member. Women in ages 35 to 65 have a ton on their plates, so this is not a quick one month fix it all. But a lot can happen with slow paced transformational change. And if we use the support, we use the coaching model. And we continuously in step seven balance and reassess where we are celebrating how far we’ve come, celebrating the vision, where we are in that vision, what we want to change about the vision. What the client’s goals are around health. This is a sustainable strategy that can be used from age 35 to age 100 plus. Because we’re always centering what is the client’s health goal now and a little bit in the future, being open to that flexibility. What support do they need to live the life that they actually want? And in perimenopause and menopause that there’s no exception. It’s just sometimes a bit more complicated as women lose that support, that beneficial supportive estrogen, which is so complicated in that environment of the underlying endometriosis or other complex chronic illness.

Dr. Jessica Drummond (01:00:10) – So if we just take simplify it, do everything we can to optimize foundational health and then use the tools we now have access to with supplemental hormones and peptides in a way that is very thoughtful regarding the individual risks and goals. I mean, I really see us being able to support women and their health goals well into their hundreds. Like they can be dancing, they can be present with children, grandchildren and great grandchildren. They can be traveling, they can run businesses when they’re 60, 70 or 80. The sky’s really the limit as long as we’re patient and implementing at the pace, that feels really aligned and supportive. For each client. So I hope that the, I don’t know, 15 research papers we just dove into were really exciting to you. I’ll list them all in the show notes if you would like to work with us in our practice. As I said, we now have medical provider who can help us really specifically fine tune these prescriptive recommendations for you. Just simply reach out to support Integrative Women’s Health Institute.

Dr. Jessica Drummond (01:01:29) – Com and we’ll be announcing our group program for helping people transition through perimenopause and menopause with endometriosis or any other complex chronic illness. We are here for the complexity. We are not afraid of it. This is what I’ve been doing for 25 years now, and I’m excited about this because I think there are very few places in our conventional medical system, and even in our integrative medical system, where complexity for women navigating perimenopause and menopause, there’s a safe space for that. We’re here if you’re struggling with histamine stuff, if you have dis autonomia, you know, if you have bladder pain, if you have gut dysbiosis. This is what we’ve seen and been doing for years and decades. So we’ll help you navigate that perimenopause and menopause transition with the most vibrant health. You know, I’ve been seeing women in their 40s and 50s, 60s, 70s and beyond really have healthy, thriving health, no matter how much they felt like their bodies were just like falling apart and going haywire before they came into work with us.

Dr. Jessica Drummond (01:02:39) – So I’m really ready to scale this up and see lots and lots of women doing absolutely whatever the heck they want, with as much energy and as much health as they want well into their 60s, 70s, 80s and beyond. So I’ll see you next time on the Integrative Women’s Health podcast. Reach out to our team at support at Integrative Women’s Health Institute. Com and if you want to learn how to do this for your practice, follow us at Integrative Women’s health.com, where you can see all of our professional level training courses, and follow us on Instagram at Integrative Women’s Health. Please press follow on this podcast. The more people following the podcast, the more exciting guests I can bring you. All right. See you next week. Bye. 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.

Dr. Jessica Drummond (01:04:00) – Let’s innovate and integrate in the world of women’s health.

 

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Dr. Jessica Drummond

Founder & CEO

The Integrative Women’s Health Institute

At the Integrative Women’s Health Institute, we’ve dedicated 17 years to crafting evidence-driven, cutting-edge programs that empower practitioners like you to address the complexities of women’s health.

Dr. Jessica Drummond’s unique approach focuses on functional nutrition, lifestyle medicine, movement therapies, nervous system dysregulation, trauma, and mindset – essential elements often overlooked in traditional health education.

In addition, your training will be fully evidence based, personalized, and nuanced (this is not a cookie cutter approach) in functional nutrition, exercise, recovery, cellular health, and all other lifestyle medicine tools.

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