Rebirth And Shedding Expectations

Dr. Karen Lamb 0:00

I do think that this process of perimenopause is one of rebirth and opportunity for us to become more aligned with the things that really matter to us. And with that, oftentimes comes the shedding of the social expectations and constructs that we have adopted throughout our lives. Hormones are energy. And when we don't have the energy to maintain those facades, we have to step into a deeper understanding of our truth and our identity. So rebirth in that it's an emergence of who we are meant to be.

Show Opening And Guest Intro

Why HSPs Need Perimenopause Insights

April Snow 0:50

Welcome to Sensitive Stories, the podcast for the people who live with hearts and eyes wide open. I'm your host, psychotherapist and author April Snow. I invite you to join me as I deep dive into rich conversations with fellow highly sensitive people that will inspire you to live a more fulfilling life as an HSP without all the overwhelm. In this episode, I talk with Dr. Karen Lamb about how perimenopause can impact HSPs, the symptoms to look out for as your hormones change in midlife, and why this time of life can actually be an opportunity for rebirth where you can shed those people-pleasing and self-sacrificing habits. Karen is a naturopathic medical doctor and licensed professional counselor specializing in trauma healing, burnout recovery, and mind-body wellness. With a deep understanding of the HSP experience, she blends natural medicine with evidence-based psychological therapies to help her patients restore balance and vitality. Dr. Lamb is passionate about addressing the root causes of emotional and physical imbalances, and through her practice at Pura Vita and Natural Medicine, she empowers individuals to heal, build resilience, and achieve lasting well-being. For more HSP resources and to see behind-the-scenes video from the podcast, join me on Instagram, TikTok, or YouTube at Sensitive Strengths, or sign up for my email list. Links are in the show notes and at sensitivestories.com. And just a reminder that this episode is for educational purposes only and is not intended as a substitute for treatment with a mental health or medical professional. Let's dive in the Welcome back, Karen. I'm excited to have you on the podcast again.

Dr. Karen Lamb 2:57

Yes, me as well. Thank you so much for having me. This is such an important topic. I'm really, really excited for us to delve into all of the pieces. I was thinking, are we gonna have enough time? I hope we have enough time because there's so much to talk about. It's true.

April Snow 3:14

We might have to have a part two.

Dr. Karen Lamb 3:15

Yeah, let's see. Let's see how we do.

April Snow 3:18

Yeah. So today we're talking about perimenopause. This is the most requested topic I've had in probably the last year. People are really hungry for this information, especially through an HSP lens. Last time we talked about burnout on episode 57. People absolutely loved your cake analogy. I still hear about it because as you were saying, you know, we don't talk about sensitive health very often, right? Through that lens, there's not a lot of resources out there. So people are really looking for that. So I'm grateful for your time today.

Dr. Karen Lamb 3:51

Yeah, thank you. And it's another specialized little arm, right, of the health conversation. And I'm really excited to reach this community because it's my heart and soul. You know, we've talked about that. I am a naturopathic doctor, but counseling is really where my heart is and connecting with the highly sensitive person community, especially through therapists, right? Like I love that those are the people that I just so organically can connect with. And so to be able to bring this information to women who are either going through it themselves or are working with people who are going through it's just something that's very special to me.

April Snow 4:32

That's true. That's a good point. It this could be a personal exploration, it could be supporting someone in your life, whether it's a client, maybe a spouse, a family member, or a friend. We all know someone who's probably going through this stage of life where hormones are shifting and we're really unsure what's happening. So I wonder if we could set the foundation for folks who haven't started this exploration. You know, when are we usually going through perimenopause? And what are some of the changes that happen during that time?

Dr. Karen Lamb 5:03

That's a great place to start. There's been such an explosion of information on perimenopause, which is very exciting. We're seeing the results of all of the research that has been done over the last decade where more women are coming into more prominent roles with all women teams that can launch research that brings us such wonderful information. So, what we are learning, and I learned this after I passed the age of 35. So I was like, aha, that's what was happening. That's really what they're finding is that the subtle changes in hormones start around the age of 35. And for me, I had my child at 34 and a half or 33 and a half. I was almost 34. And so for me, it just felt like this continuation of, you know, pregnancy, postpartum, which for me showed us postpartum anxiety. And I want to get into that a little bit more because that the fluctuation of hormones, especially progesterone, which is one of the first hormones that we see shifting in perimenopause, created a lot of anxiety for me. And so I went from 33 and a half, going through the postpartum, and then basically launched right into perimenopause. And it really helped to validate and explain my personal experience. And as women are having children post sowing your oats, you know, traveling or studying or whatever, we're seeing so much of that where it's just this continuation of hormonal surprises.

April Snow 6:43

Surprises.

Dr. Karen Lamb 6:45

It's like a box of chocolates.

April Snow 6:48

Yes. And it's true that it can continue to unfold. You know, we're not just going through hormonal shifts during peppermenopause, it's pregnancy, it's other changes in life. I know my brother struggled with testosterone changes, and that in fact impacted his mental health and his energy levels, his vitality. So, this is something we go through a lot more than we realize. And you know, when I was growing up, I never heard any of the people in my life talking about this. My grandmother, my aunts, no one talked about this. So, yeah, when I hit my mid-30s and my mood dropped, my energy tanked. I was like, what is happening to me? I have all of a sudden my whole body feels different. It's quite a shock.

Dr. Karen Lamb 7:27

It is quite a shock. That's the right word. A surprise. A surprise, a shock. Yeah, all of the above. I really appreciate how you incorporate that, you know, life, just life alone can prompt so many changes in our hormonal experience. And it's not just women, and there's the equivalent for men that's called andropause. And there's not a ton of that out there because it's so simple for men. It's one hormone, right? Like testosterone. And so I think it's fair for us to just focus on perimenopause because you know, we deserve that. Um it's good to know because if you are in a relationship with a man who is middle-aged, they're going to be going through some changes. And I think it's important for our own validation that it's not just us and that they can also bring something to the table when it comes to, you know, the improvement of the health of the household.

April Snow 8:26

Absolutely. Right. Let's build that awareness. And let's say you are the partner of a woman going through perimenopause. I've seen a lot of men stepping up and learning about it. Yes. So they can be the best support, which is so exciting. So refreshing. Refreshing.

Testosterone Drops And Early Signs

Dr. Karen Lamb 8:42

So back to your question 35 is when we start to see some shifts in hormones. And it can last, you know, I'm seeing perimenopause lasts about 10 years. I'm seeing that it's lasting a little bit more than that. So I think expect for it to be minimum of eight to like 12, 15 years, because everybody, the definition of menopause is 12 months of not having had a period. So by the time you hit that 12 months of not having had a period, and I've worked with women who get to that 11th month and you know, 29 days, and then they have a period, it can take a really long time to finally get to a place where you are officially menopausal or postmenopausal. And so it's a long stretch. And during that time, there's very little predictability. We see testosterone usually starts to come down first. And I really want to highlight that because most providers who focus on perimenopause in the conventional world, if you're lucky, will talk about estrogen. And estrogen is actually one of the last hormones to join the party. That's surprising because we hear the most about it. That's right. Yes. Yeah. And I was really excited to talk about that because that made a big difference in my own care of understanding estrogen. You know, we associate low libido or vaginal dryness, erratic cycles with perimenopause slash menopause. But that actually tends to come much later. And there's so much overlap with testosterone and estrogen because testosterone converts to estrogen. And so some of the early signs that we might think are estrogen related might actually be coming from the fact that yes, there is a decrease in estrogen because we're seeing a decrease in testosterone. And that conversion to estrogen is causing overall lower estrogen, but it's not an estrogen pathway issue. It's a testosterone pathway issue. So we first see testosterone, then progesterone, and then estrogen when we start to see the erratic cycles, which that takes a really long time before that hits awareness.

April Snow 10:58

So you could be in this for years potentially before you hit those later stages, which are the more obvious, maybe more talked about symptoms. Yeah.

Dr. Karen Lamb 11:08

I think there's more awareness around those symptoms.

April Snow 11:11

Oh, sure. You know, libido, vaginal dryness that you said, those are things that are if you take it a little bit more seriously, then oh, I'm feeling anxiety.

Dr. Karen Lamb 11:19

Yes.

April Snow 11:19

Or I'm feeling a little off, or whatever it is. My energy is low. Okay. So there's this. This is very eye-opening.

Dr. Karen Lamb 11:28

Yeah, it was for me. It was for me as well. And it really revolutionized the way that I tended to my own symptom picture as well. So with testosterone, we'll see a decrease in energy. So we might see a little bit more fatigue. And again, it can be really subtle. Great motivation, feeling like that gumption, you know. Right, exactly. That go-getter, you know, kind of energy and confidence in pursuing your aspirations and even being emotionally connected to those aspirations. So we can feel a little bit of disconnect in our sense of purpose or passion and desire that I think for sensitive people is really important and a big sign, right? Because we tend to be really connected to the things that are in alignment for us. And then things just kind of start to feel when testosterone starts to come down, they start to feel a little bit less aligned. And that can be a symptom of testosterone deficiency. Another piece is pain, physical pain. So if you think about testosterone and athletic performance, right? That's like an easy association. Recovery time is really, really big with healthy optimal levels of testosterone. And so if we take that down to just recovery time from my day, you know, it can be yeah, yeah, emotionally, you know, and physically. And so we can have a regular workout that we would have had no problems with, even six months prior. And now it's like you're just a little bit more achy, or it takes longer to rebound from a workout like that. And then fast forward several years of continued deficiency of this hormone.

April Snow 13:21

And now you feel like you're not recovering from injuries or you're having spontaneous injuries that you can't really explain and it's not getting makes so much sense because you hear a lot of folks in midlife, and I've experienced this where something spontaneously will start hurting or might pull a muscle, or even just doing normal everyday activities like walking around the house or sleeping, you know, in a weird position. It's like, well, wait, this never happened before. And I'm just thinking about a highly sensitive person who already maybe needs more recovery time, at least emotionally, maybe not necessarily physically, but especially emotionally. Now all of a sudden my cup is even more empty. How frustrating that is. Yes. Makes it even harder to feel that sense of vitality. Cause I remember when my symptoms started coming in, there was like this dullness, this apathy that wasn't like me. And it's like, what is going on with me? And that's the thing, it doesn't make sense given what's going on in life. It can be really confusing and lonely.

Dr. Karen Lamb 14:20

It is, yeah, it is very confusing and lonely. Absolutely. And helping to bring awareness to how common that is is such an important first step in not feeling as isolated and alone because it can present like anhedonia, right? It's just like maybe not to that extent, potentially, maybe, maybe to that extent. Um, but it is just this feeling of disconnect from who you thought yourself to be.

April Snow 14:51

Exactly. Exactly. It's true, where you feel like the things that used to give you joy just don't have that same juice anymore.

Boundaries, Irritability, And Identity

Dr. Karen Lamb 15:01

Yeah, yeah. Yeah. So to close out testosterone, maybe cognition is also affected here. So maybe a little bit more brain fog, libido obviously as well. But for women, estrogen really is the primary driver for libido. So we will see an even, you know, more substantial decline once estrogen becomes more involved in the perimenopausal journey. With a decrease in testosterone early on, it's possible for women to experience a decrease in ability to set and follow through with boundaries because of that confidence piece, because of the energy that it takes. So that's that's a red flag for sensitive people because it's, you know, as you just mentioned, our self-care game has to be like so spot on. And now it's oh wow, okay. Now what am I supposed to do? I thought I was already right, exactly.

April Snow 15:58

Yeah. And it's so right that when you're the most tired, the boundaries are the last thing that you have energy for. It just takes so many internal resources. So then you just then what's happening? You're just doing whatever everybody else wants you to do if you even have the energy for it. Right. Right. Right.

Dr. Karen Lamb 16:14

So this is more of an early phase of perimenopause. So we can actually, we might notice stepping into even more people-pleasing types of behaviors when testosterone starts to come down. Luckily, irritability is a pretty significant symptom for perimenopause, which I know very rarely will anybody express gratitude for that. But I do think that for sensitive people is very important because it will eventually come around to help protect us from that, you know, the decrease in energy that might lead to more people pleasing, where it's just like, fine, I just give in, I can't handle all of this. And then the irritability starts to come in, and then that becomes protective of our boundaries, which I think is magnificent because otherwise, where would we land?

April Snow 17:03

Well, exactly. I appreciate that reframe of seeing the irritability as an ally, so to speak. Yeah. Like that it has a function. And it's true, our boundaries are pushed, the anger comes through to protect us through the irritability, and it needs to. Yeah, it does.

Dr. Karen Lamb 17:23

Yeah. And the identity pieces here, as we're talking about hormones, hormones are the scaffolding of our personalities. And so when this starts to shift, identity shifts with it. That's powerful.

April Snow 17:39

Yeah. Obviously, I don't know a ton about hormones. I'm not in the medical field, but it's makes so much sense because they play such a role in our bodies. And by extension, our personalities, our emotions, our energy levels, our sex drive, all of it. Yes. Yeah, that's amazing to hear. Yeah. It just elevates the importance of it.

Dr. Karen Lamb 17:59

100%. 100%. And it helps us to better understand every person's approach to managing perimenopause is unique. And understanding how which of these hormones is diff the deficiency of each of these hormones is reflecting more substantially for you can help you to understand what the best course of action is in terms of your own care and being able to connect with yourself because I do think that this process of perimenopause is one of rebirth.

April Snow 18:35

Can you say more what you mean by that?

Dr. Karen Lamb 18:38

Yeah, I think that it is an opportunity for us to become more aligned with the things that really matter to us. And with that, oftentimes comes the shedding of the social expectations and constructs that we have adopted throughout our lives. And so when our hormones start to piece out and are just like, you're on your own, girl. You know, right. We don't hormones are energy. And so when we don't have the energy to maintain those facades, we have to step into a deeper understanding of our truth and our identity. So rebirth in that it's not a completely new person, it's actually an emergence of who we are meant to be.

April Snow 19:29

Yeah, like a refining or peeling back the mask or the layers. Yes. Yes. That's exciting.

Progesterone, GABA, And Sleep

Dr. Karen Lamb 19:36

It is really exciting. I'm glad you agree with me. I do. It's controversial, you know, because it's very, very difficult. You know, I'm sure we're sugarcoating it in any way. And it has the opportunity to be something incredibly meaningful. And for sensitive people, that carries weight.

April Snow 19:57

Yes, it really does. You know, getting you closer to what's really important to you, who you really are, finding your voice. I feel like there's a lot of opportunity there when you start stripping back the people pleasing and the self-sacrifice that you've done for years.

Dr. Karen Lamb 20:11

Which is so easy for us as sensitive people to fall into because we feel all the things for all the people.

April Snow 20:17

Yeah, we do. Yeah. And so we can maybe set that down a little bit because we don't have the energy.

Dr. Karen Lamb 20:23

It becomes sometimes not an option.

April Snow 20:27

Oftentimes. Oftentimes. So do you see your clients or maybe even with yourself establishing new ways of living, new patterns, new relationship to self during this last decade or so?

Dr. Karen Lamb 20:39

Yeah. And I mean, that's probably my most, my greatest passion in working with this population is getting to do that work because, you know, as a therapist, it's nothing new, right? This is what we are supporting people in doing this all throughout all the different life stages. But there is a leverage during the perimenopausal period that is unlike any other part of life. And it can lead to some pretty extraordinary things.

April Snow 21:09

Yeah. I mean, it's like you're kind of walking through the fire and transforming yourself when you get to the other side. And having it be so long, there's a lot of time to work through things and set new patterns. I mean, I guess that is the advantage of it being so long. It sounds torturous at first when you say eight to 15 years, but then I think the therapist part of me is like, wow, what a great opportunity. Yeah. Yeah. To shed.

Dr. Karen Lamb 21:37

Yes. Yeah. Shed.

April Snow 21:38

Shed.

Dr. Karen Lamb 21:39

And it becoming a requirement, right? It's non-negotiable. I don't have, I just can't do it anymore. And therefore, well, okay. You know. And I think that bringing awareness to this as an option is so helpful because we are learning so much. Much more about perimenopause, and I'm so grateful for that. This piece is not getting the attention that I think it deserves.

April Snow 22:08

Never heard this before.

Dr. Karen Lamb 22:09

Yeah.

April Snow 22:10

You hear a lot about the negative, but yeah, not the transformational aspects of it. So when you say it was a little controversial, like yeah, maybe, but also really important to see that there's an underlying purpose of this time. There's some hope that you could use it as an opportunity for yourself. Yeah. Yeah. Not just going through it for nothing.

Dr. Karen Lamb 22:34

And for sensitive people, I think it's more impactful because it's very difficult for HSPs to engage in things that don't feel purposeful or meaningful, right? And given what you were mentioning earlier, it's like, oh man, self-management and self-care was already so complicated. And now I'm getting, I'm having to level that up. Like, where am I going to find the resources for that? That's the question, is we gotta shed some stuff, right? In order to be able to do the thing, the self-care thing. And that is likely why self-care was so complex, why it was so difficult pre-perimenopause, because we were trying to hold all of the things while taking care of ourselves. And then perimenopause comes and says, All right, we're gonna change some things up here.

April Snow 23:26

Yeah, it's time to shake it up.

Dr. Karen Lamb 23:28

Yeah, shaking it up.

April Snow 23:29

It's true. You don't have any excess anymore that you maybe did in your 20s and early 30s. So yeah, it's time to be really selective with the internal and external resources that you do have. Yeah. Yes.

Dr. Karen Lamb 23:43

Yes. So let's circle back to the rest of the hormones because I think this is really empowering to understand hormones. So progesterone comes next. We first see a decrease in testosterone, then progesterone starts to decline. For me, that was really almost seamless from my postpartum experience. I briefly mentioned that I personally experienced postpartum anxiety. I like to highlight that because you don't hear much about that. You hear a lot about postpartum depression. And that was not my experience at all. It was postpartum anxiety. And I, in working with this population, I have found that it is almost always postpartum anxiety, and that is depressing. And so that it gets misdiagnosed as depression. Uh, and so the reason I bring this up is because progesterone is a very calming hormone. It has a very close relationship with GABA, which is a an inhibitory neurotransmitter that is very soothing to our physiology. And progesterone comes from progestation. So it is meant to support pregnancy.

April Snow 24:49

When you say that support pregnancy, what do you mean?

Dr. Karen Lamb 24:52

Maintain the pregnancy. So estrogen builds, yes, estrogen builds the lining of the uterus in preparation for the implantation and then the placenta and all of that. And progesterone holds what estrogen does. So when you're pregnant, your progesterone levels are very, very high. And as they start to drop, it signals it's time for birth.

April Snow 25:16

Okay. So the women I've known in my life feel very calm and steady. HSP women who are normally maybe more anxious, but they feel maybe the best they've ever felt mid-pregnancy. Is that partly why? Because progesterone is high? 100%.

Estrogen’s Late Entry And Lab Myths

Dr. Karen Lamb 25:30

Okay, it makes sense. That was definitely my experience. Now there are some women who have, and this is very on-brand for highly sensitive people, have paradoxical responses to progesterone. So sometimes it can trigger anxiety, sometimes it can actually trigger suicidal ideation. It's still a lot less common, but it can happen. And so if you are someone who is dosing progesterone for hormone replacement therapy, know that if you do begin to experience symptoms of depression or you just are not feeling like your mood is not where you want it to be, know that that is a possibility. It's very unusual, but I've seen it in my practice. I don't know, maybe about six or seven times. And I've worked with a lot of women who've done HRT. So it's not a high percentage, but it is good to know. And that also means that, you know, if you didn't feel great during your pregnancy in terms of your mood, potentially that might be something to consider that you might not do as well with progesterone hormone replacement.

April Snow 26:34

That's good to know to look out if you're having the opposite reaction.

Dr. Karen Lamb 26:38

But generally, yes, your observation is spot on. It does feel calming and everything relaxes. So it helps to relax tendons in the body, muscles in the body, because that makes sense, right? Like you're making space for a baby, but emotionally and psychologically, you just loosen up, right? There's more flexibility, there's more adaptability in terms of all of the things that are changing, not just with your body, but psychologically or even life circumstances.

April Snow 27:10

Sure. So then progesterone is shifting next. And you said for you that was a pretty maybe the most straightforward shift.

Dr. Karen Lamb 27:21

Yes. Yeah. Well, I went straight from that postpartum anxiety experience, and I knew that progesterone was going to help that. And so that's actually when I started progesterone because of that and realized that it was just continuing to be really helpful. So when progesterone drops, we see more sleep disruptions, insomnia, sleep becomes less predictable. And it doesn't mean it's all the time because you're still having cycles. So you're still going to have periods of time when your progesterone rises and you feel a little bit better, your sleep improves, but then it comes back down right before you start bleeding. And then that's when we're typically we see more of the sleep disruption that happens when you enter into perimenopause.

April Snow 28:02

Okay. So that is an indicator potentially that perim progesterone is shifting. For sure.

Dr. Karen Lamb 28:08

Okay. Yep. Yeah, we might see more rumination because the mind is less pliable, less relaxed, right? There's more fixation, there's more anxiety that can drive the rumination. So anxiety, insomnia, rumination, irritability.

April Snow 28:25

Makes sense. And then of course that's going to disrupt sleep where the body is more agitated, or the mind is more agitated.

Dr. Karen Lamb 28:32

Yes, absolutely. Yeah. Yes. The sleep piece, you know, waking up with less energy and bandwidth to face the day is going to make everything more aggravating.

April Snow 28:45

Absolutely.

Dr. Karen Lamb 28:47

And we can feel more raw. Which is an important note for HSP. Because that's kind of like it feels like it's a default oftentimes. Certainly, it was for me, you know, up until I really learned about being a sensitive person and learning how to take care of myself differently. So if you start to feel like you're maybe revisiting your teen year expresses, it can be because of a change in hormones and an increase in sensitivity due to a decrease in resilience and resourcefulness. Not that you have become less resilient. It's just that the things that were in place to help feel resilient are shifting.

April Snow 29:35

You know, and that brings up something I've heard for years people say, oh, my sensitivity is so much worse with age. And I'm like, why is that? What's changing? And I was like, this feels like a big piece of the puzzle. Right?

Dr. Karen Lamb 29:49

100%. Yes.

April Snow 29:50

Yes. Okay. That's really illuminating. Yeah.

Dr. Karen Lamb 29:54

I wish I had known this at 35.

April Snow 29:58

Same. Like, oh, this is what's happening behind the scenes. Yeah. This is why you feel so differently. And that's a really helpful marker to check in with. Do you feel as similarly as you did during your adolescence? Because that's obviously a very palpable, memorable time. And like, well, this feels reminiscent of that. Okay, something must be happening.

Dr. Karen Lamb 30:19

Yeah. And I think probably a lot of people going through midlife hormone changes might say, oh, yeah, that looks familiar. And I think for sensitive people, there's the added layer of, I was gonna talk about just generally sensitivity, but I'm thinking about how I would have these unsolicited intuitive experiences or, you know, that just were the chaos of it, I think is the kind of like the feel, right? Because I mean, unsolicited intuitive experiences now, you know, and at some point in my life was like, oh yeah, I can I can roll with that. That's cool. Let's see what that's about. And getting curious, and you know, when your tank is full, you can play it.

April Snow 31:06

It's exciting. So I'm like, oh, this is interesting. I'm getting this hit. Yeah. What is that about? Yeah.

Dr. Karen Lamb 31:12

Yeah. But then when your tank is not full, when our tank is empty or close to empty, it's just like, I did not ask for you. And now I've got this extra thing, and now I got to try to figure out what it's about and what to do about it, what not to do about it. So that's an added thing to assess, I guess, when you're thinking about if it's feels like adolescence again.

April Snow 31:34

Yeah, it can feel burdensome. Like, I don't have space for this.

Dr. Karen Lamb 31:38

Yeah.

April Snow 31:38

Yeah. Wow. Okay. You're really painting a clear picture. Yes. Yes. So we have then now we are moving into estrogen. Yes. Yes. Okay. Okay. So finally we're getting to estrogens. Yes, finally.

Overstimulation, Migraines, And Detox

Dr. Karen Lamb 31:51

We're getting to the the what we thought was the starting point, right? So exactly. Yeah, that's pretty, pretty relevant, is that we have thought that it's and conventional medicine still is in that place. Most, not all, but most providers still think of it as estrogen. So when they're looking at labs, one of the first if they if they do if they even do that. Yeah. Yeah. They're looking at estrogen and they're looking at FSH, follicular stimulating hormone. Oh, right. And that, I mean, in alternative medicine and naturopathic medicine, functional medicine, we start to look at it at 10 when FSH reaches 10 pretty consistently. Then that's perimenopause in in our world. But I have never spoken to a conventional doctor who thinks that way. I start to really suspect it at like if we're consistently seeing it at eight, you know, we're likely there. But we test it because some people are really data driven. But it the picture, the experience of the person tells you everything you need to know.

April Snow 32:56

Right. I hear people say, Well, you don't need to test perimenopause. You know if you're in it. So if a client or patient comes in and they're saying, I'm having all these symptoms, it sounds like you're gonna believe them. Of course. Right, of course, of course. You're not gonna push back. No, so many clients go to their doctor and like, we can't do anything for you. Yeah, even menopause specialists, they're like, No, can't do anything until that estrogen number shifts, our hands are tied, and they're like, But I'm suffering. Yes, I'm suffering for years. Okay, so FSH is a good marker. Now I'm gonna go back. I want to look at my FSH numbers.

Dr. Karen Lamb 33:33

Yeah, yeah, take a look at it. But we are symptomatic long before we get to that test. I still have some issues with it because as long as if you're menstruating regularly, you're gonna have depending on when you test it. So FSH should be tested at day three along with estrogen. And I like to throw testosterone in there, but testosterone tends to be much more, it's not something that's fluctuating with our periods. And so it tends to be more straightforward. But because we have that conversion from testosterone to estrogen, I just kind of lump it in there.

April Snow 34:04

Makes sense.

Dr. Karen Lamb 34:05

Yeah, and then progesterone should be tested on day 21. That's the lowest point in the cycle of progesterone for someone who is having periods every 28-ish days. Got it. So it can fluctuate a little bit if they tend to have slightly shorter or slightly longer cycles, then that can fluctuate. But estrogen is a lot less predictable in its decrease. So it can be decreasing in a linear fashion when we see testosterone start to drop and perestrogen start to drop. Or I'm sorry, progesterone. So testosterone and progesterone, and then it becomes more erratic towards the end of perimenopause. And this is when women start to have hot flashes, more vaginal dryness, and the erratic periods, which not every person has. Oh, okay. Uh, some have worked with women that are like it just stopped, just turned off. Yeah, what a blessing, right? Yeah, yeah. Yeah, about to go through that. Yes. Yeah, some will report having like hemorrhaging, you know, bleeding, and then not having any period for a very long time, and then you don't know when it's coming. So that is a very clear symptom of decreasing estrogen. The higher someone's testosterone, the less likely there is going to be more symptomatic conventionally, you know, what we think of as perimenopausal symptoms. It's going to be less symptomatic if the person has higher amounts of testosterone because they are converting to estrogen.

April Snow 35:44

Right.

Dr. Karen Lamb 35:45

And it can be very protective. So it acts as a resource, essentially. Yeah, a buffer. Got it. Yes, yes, that's a great way of conceptualizing it. It is a buffer and it's very resourcing in many different ways. Testosterone is a very controversial hormone replacement in the conventional world because it is a male hormone, which is just don't get me started. We could have an entire episode on me being on that soapbox because we don't have it. Like that was so so blatantly ridiculous, right? But there are lots of conversations in the gynecological world around how inappropriate it is, literally, these are the words that are used for women to replace a deficiency in testosterone.

April Snow 36:42

Wow. I mean, I know exactly why this happens, but it's even in a therapeutic context, yeah, it's being taken away as an option because of the fear of what people you know think. Yeah, so there's a there's a blocking of care because oh, this testosterone, it's a male hormone. You're a woman biologically, it's not for you. When really it sounds like, like you said, it could really mitigate a lot of the discomfort. Yeah. Wow, what a shame.

Dr. Karen Lamb 37:14

It is, it is a tremendous shame. Luckily, there are some herbs, you know, if people come across that obstacle, depending on certainly what state they're living in, that could be absolutely not an option. Uh, but there are herbs that can help to raise those levels on labs. And I find that sensitive people actually do pretty well with it, uh, with just herbs. So there is hope. Obviously, there's work to be done on that front in terms of advocacy, but I did want to mention that because it's not unusual. That's one of the reasons that they jump right over it, is because it's so controversial.

April Snow 37:51

Well, and good to know that you there's nothing wrong with you if you're requesting this or asking about it, or you feel like it's something you should, you know, use as a patient. It could just be your provider's viewpoints. Yeah. And it's helpful also to know that there are alternatives, especially if you have a sensitive system that maybe doesn't respond well to the hormones. I don't know. Yeah. I know for some things I've had to go the herbal route and it's worked better for me. Not everything. It depends. And like you're saying, everyone is different.

Dr. Karen Lamb 38:22

Yes, I'm the same way. I'm the same way. Herbs oftentimes will work really well for me, and other times I do better with conventional.

April Snow 38:29

Yeah, same.

Dr. Karen Lamb 38:30

I do a mix.

April Snow 38:31

Yes.

Dr. Karen Lamb 38:31

Yeah. I think integrative care is really that should be the model, but you know, here we are.

April Snow 38:37

Here we are. Yep, exactly. I want to see if there's anything else, and then I want to talk about the provider experience.

Gentle Supports: Sleep, Herbs, And Cortisol

Dr. Karen Lamb 38:44

Yes. So with estrogen, there's physical symptoms. There can be breast tenderness, obviously, the erratic periods. Overstimulation is really common with estrogen. So I wanted to really highlight that estrogen deficiency and not just estrogen deficiency, the erratic pattern of what happens towards the end of perimenopause. It's not just that you're slowly losing estrogen, it's that some days you might be low and some days you might be way in a like estrogen dominance kind of picture. And that's when you're going to see more of the overstimulation, more sensory sensitivity, very for us. Yeah. Migraines have been known to be associated with estrogen metabolic blocks in those pathways. So if you're having a really high estrogen dominant kind of day or week, you're going to be more prone to headaches and migraines. So that's good to know.

April Snow 39:39

That makes a lot of sense. I have some clients who deal with that and were suspecting it might be hormone related. I'm like, that's yes. I mean, there's a clear connection.

Dr. Karen Lamb 39:49

Yes. And supporting detox pathways to help remove the old estrogen from the body can that alone, right? You don't necessarily have to do a huge medical workup around it. It can just be supporting the body and removing the old and less effective estrogen because these hormones get reabsorbed over and over and over. And so you have these moments of having really high estrogen, and then they just keep getting reused if you don't have adequate amounts of fiber in your diet, or there's lots of different reasons why that can happen. But now you've got these really like third round, fourth round estrogens that are just like not anymore. Yeah, and they do wreak havoc and they're still stimulating those receptors, but in a really unhealthy way. And those solutions can be very, very simple depending on the person's picture.

April Snow 40:42

Wow. So I'm just thinking about the sensitive person who is so attuned to what's happening inside, is so aware of those little changes, but now we're getting huge shifts up and down, up and down. So you alluded that there's some things you can do to make that process a little bit more comfortable. Are you open to sharing what some of that might be?

Dr. Karen Lamb 41:02

Yeah, yeah. And just to close out the hormone piece, there are so many other hormones that are involved with perimenopause. And I think for the sake of time, it is important that we move on. I just wanted to highlight, you know, there's going to be changes in blood sugar, there's going to be changes in thyroid function. All of these hormones, they're all coming from hormone-producing organs. And those organs, the endocrine family, I like to think of it. If one hormone organ is starting to retire, the other organs have to take over. And so that puts a lot of extra pressure on the other endocrine organs for digestion and stress response and blood sugar regulation and all of that. So it's just something else to keep in mind. It is a very complex dynamic of what's happening.

April Snow 41:47

Yes. It sounds like, you know, pretty much every system in the body is being impacted. Mm-hmm. Mm-hmm. Wow. I mean, this is so much more than I ever realized. Yeah.

Dr. Karen Lamb 41:58

So I mean you probably still knew, right?

April Snow 42:00

Like you're like intuitively, yes, for sure. New, you know, oh, brain fog, energy, mood, sensitivity, all of it. But it now to kind of pull back the curtain and say, well, this is exactly why this is happening. It's like, oh, okay. I'm not making this up. I'm not crazy.

Dr. Karen Lamb 42:18

Yeah.

April Snow 42:19

There's just a lot of physical changes happening. And I hope you know listeners are validated by that. Right.

Dr. Karen Lamb 42:27

Yeah, that's definitely my goal as well.

April Snow 42:29

Yeah, I hope so. And just can learn about what's going on in their bodies and maybe have a little bit more information so they can have pointed discussions.

Dr. Karen Lamb 42:36

Yeah. Yeah. Yeah. Absolutely. So to answer your question, uh, there are so many things that we can do to feel more comfortable through this period of transition. I do the first plug is if you don't already have a therapist, that's number one. I'm guessing probably most of your listeners are already there. And I'm so glad for that because I do think that the opportunity for a deeper, meaningful transformation is becoming available to you. And to step into it. Yes, yes, really lean into it and leverage it as much as possible because it is hard. And if it's hard and you're gonna have to do it anyway, you might as well make it really worthwhile. Yeah, make it good. Yeah, yeah. I know that's not what your question was really, but I couldn't feel it.

April Snow 43:30

And it comes back to that hopeful opportunity piece of like this is happening for a reason and it could be a point of transformation, not just a struggle or a painful period.

Tools For HSPs: Teas, Magnesium, GABA

Dr. Karen Lamb 43:42

Yeah, yeah, absolutely. So, in terms of physical comfort, um, number one always with sensitive people is sleep. Protect your sleep. Number one. There are herbs, yes, there are herbs that help to support progesterone. I Get a little bit nervous recommending herbs because you just don't know people's backgrounds. But white peony is consistently shown to support the production of progesterone, which is found in a lot of Chinese medicine combination products. And the FDA has been sticking their nose in people's business as of late that is not beneficial for sensitive people trying to find gentle approaches, you know. And so I'm just seeing a lot of movement in the products. So I wish I could recommend a product specifically, but the ones that are my go-tos are not currently available. But if you look for that specific herb, um, you will probably find something that can support progesterone and therefore support sleep. So that's really, really important. So the things you already know sleep hygiene, protecting your schedule, giving yourself more downtime in that transition period. Cortisol management is also really important. That was one of the other hormones because the adrenals are an endocrine gland that produce cortisol. And so in the family of organs that produce hormones, these glands are not going to be really stressed. And that is particularly relevant for sensitive people because we already have overfunctioning adrenals because we are constantly discerning between all of that information that we're perceiving. Is this safe? Is this not safe? And every time that your body asks that question, there's a little bit of a spurt of cortisol. And cortisol determines our wake and sleep patterns, our pedian rhythm. And so if we're having these random spikes of cortisol, which can happen during perimenopause, it'll cause random wakings in the middle of the night. It will cause blood sugar crashes or blood sugar spikes that can also wake us up. So there are specialty tests for that that can be helpful if you're suspecting that might be the case. But phosphatutal serine is a supplement that can help to reduce cortisol and support sleep at bedtime. Again, you know, be very, very careful when you're supplementing these things. Talk it over with a provider because who's really listening and collaborating with you. Because if that's not the case and then you drop your cortisol even more, that's going to lead to other problems. So right.

April Snow 46:20

So you don't want to tank it. You want to make sure you're supplementing responsibly.

Dr. Karen Lamb 46:25

Yes.

April Snow 46:25

Yes.

Dr. Karen Lamb 46:26

Yeah. So protecting the sleep is number one because that's where we get the majority of our resource and how we can feel our most resilient. I really like teas. We kind of touched on how sometimes herbs can be really helpful and supporting detoxification through teas can be an easy way. Traditional medicinals is one of my favorite brands. I love them.

April Snow 46:51

Yeah.

Dr. Karen Lamb 46:51

Yeah. They're a wonderful company. I have actually a colleague who works for them and does research and development, and they are as great on the inside as they are on the outside. And that's just a wonderful thing. I love that. Yeah. So there's some alignment there. Yes. Yes. So they have, I think it's a daily detox tea or something like that. That especially PMS, you know, during the times of irritability, during times of overstimulation, supporting detoxification can really help to lower the total burden that we're carrying.

April Snow 47:23

Makes sense. Yes. You're kind of clearing things out. So, well, the estrogen piece was I opened like, yes, you do need to make sure you're clearing things out and making more internal resources available. Yes. Yes.

Dr. Karen Lamb 47:36

Yes. Okay. And magnesium falls into that same category, actually. It's very helpful for detoxification. It also helps to reduce cortisol in a much more gentle way. So that's why sometimes you'll hear about dosing magnesium at bedtime because it will help to reduce cortisol, which then signals the body to produce more melatonin because cortisol and melatonin have an inverse relationship.

April Snow 47:59

That makes sense. A lot of things clicking into place for me today. Yeah.

Dr. Karen Lamb 48:03

Yeah. I don't know about you, but when I really understand a pathway or I understand why something works, it just makes all the difference. It just like can more easily become a part of my routine versus feeling like I have to remember or force it to happen.

April Snow 48:19

Absolutely. Having that context for me, I have more buy-in. Yes. Yes, absolutely.

Dr. Karen Lamb 48:26

Hydration is a natural part of detoxification. So, you know, finding the right type of electrolyte for you, which I'm very particular about, the type of ratios that sensitive people really thrive with in their electrolytes, but finding the one that feels good to you and consuming the right amount of water because anytime you clean anything, water is almost always sometimes the only thing that you need, right? Um making sure that that water is getting into the cells and cleaning things out will be really helpful for supporting energy and balancing hormones in a really gentle way.

April Snow 49:06

Yeah, I think we talked about that too in the conversation of burnout, which makes sense because we're kind of gathering resources.

Dr. Karen Lamb 49:13

Yeah. One thing to note about sleep support is more isn't always better. I think I'm preaching to the choir here because as sensitive people, we learn that long.

April Snow 49:22

We need to hear it though.

Dr. Karen Lamb 49:23

Yeah, it is helpful because we can feel desperate, right? To like, I need to get some sleep. This is not okay. But I see it probably more consistently with sleep is if we do too much in terms of supplements, sometimes that can be overstimulating to our sensitive physiology. And then it has the opposite effect. It could be it's very counter counterproductive.

April Snow 49:49

So being mindful about how much you're putting into your system.

Dr. Karen Lamb 49:53

Yeah, yeah. I really like to rotate things that work, but doing too much can sometimes do more harm than good.

April Snow 50:01

I'm just curious, how might you know if you're doing a little bit too much? I think that you would not sleep well. That makes sense. Right. Stirring things up. Immediate response.

Dr. Karen Lamb 50:12

Immediately no. But yeah, if you're feeling if you're waking having slept pretty thoroughly throughout the whole night with minimal disruption, and you wake up feeling decent energy where it's not really difficult to get out of bed, then that sounds like it's working. And it's possible that you may still want to cycle through different interventions because we can sensitive people tend to become, it's not necessarily a tolerance, but I just find that my body loves variety. And the more that I keep, you know, just shifting the things that I'm doing, it my body seems to remain responsive to those. That makes sense. Yeah. We touched briefly on GABA. So that's worth mentioning here. There, you can find it anywhere. Uh, I really love, and I think I may have mentioned this actually in our burnout chat 200 milligrams of zen by allergy research.

April Snow 51:12

I think I mentioned that.

Homeopathy And Individualized Care

Dr. Karen Lamb 51:14

I get it's a combination of L-theanine and GABA. I love it. I can't say enough about it. But the thing to consider is when progesterone starts to decrease, so does GABA. And so you're replenishing a deficiency here. So it's almost like it's a neurotransmitter replacement therapy, and you don't necessarily need it all the time. It can be used as needed. You might find if you're really feeling burnt out and raw, then you might want to dose it every single day at a low amount because it can be too calming. And then, you know, you start your day. But dosing it daily, you could dose it at bedtime. Some people really love it for sleep support. And then once you get more of your reserves up, then you can dose it as needed. It doesn't necessarily have to be.

April Snow 52:01

You can shift it depending on what you're needing.

Dr. Karen Lamb 52:03

Yep. And the last thing that's coming to mind right now, I'm sure there's there's so many things that can be done to find comfort through perimenopause is homeopathic remedies because they're so comprehensive. And I just want to clarify homeopathic, it's not interchangeable with naturopathic. So homeopathic remedies are a type of naturopathic intervention, and they are very energetically based. And so I love, love this form of treatment or intervention for sensitive people because it's like speaking our language, you know, we're very much on the energetic plane and noticing shifts before they manifest physically or tangibly. Right. They're very individual. So that's that's the only thing I wanted to say. Just because a remedy worked really well for a friend for the same exact symptom, it does not mean that that's going to be the right remedy for you. So don't become discouraged if you're like, oh, well, my friend told me to take sepia or whatever, and it just didn't do anything for me. It just means that it's not aligned with your presentation of that symptom.

April Snow 53:08

That makes sense. So being open to experimenting a little bit and finding the right match for you. Yes. It makes sense too that homeopathics are subtle and we pick up the subtle, and our bodies respond to those smaller doses or gentler remedies. So that seems like a really like just a good fit. And another approach in your toolbox.

Dr. Karen Lamb 53:31

Yes, I love that. It is all about having as many tools in the toolbox.

April Snow 53:38

It's true, and just finding the right pathway for you, whether it's hormonal therapy or herbal remedies or diet or homeopathy, there's so much available, which is very reassuring and comforting, honestly.

Dr. Karen Lamb 53:52

Yeah, and how that can shift from one day to another. I mean, I think that's been my life experience as an HSP generally, and it has not changed in perimenopause.

April Snow 54:02

Right. At least there's some things that are the same.

Dr. Karen Lamb 54:04

Right. Yeah. But one day one thing works really well, and the next day something else needs to be put in place. And so having that variety of what has worked and cycling through, you know, all of those different tools.

April Snow 54:17

Yeah. What a masterclass in meeting your needs. Right. Okay. Just our last few moments. I wonder if there's any final thoughts, anything that feels important to share before we wrap up. Well, a lot. I know there's a lot more. We're just scratching the surface here.

Dr. Karen Lamb 54:36

Yeah. Yeah. I'm really glad that we got to the hormones. I think that was really important. I don't know where to go because there's so much more that we could chat about. And maybe, you know, if you have a lot of people that come back and say, I'd really love to learn more about this, I would love to continue this conversation.

April Snow 54:53

Absolutely. Me too.

Dr. Karen Lamb 54:54

Yeah.

April Snow 54:54

There's so much more we could get into.

Spiritual Meaning And Purpose In Midlife

Dr. Karen Lamb 54:56

So much more. I launched a podcast with a couple of colleagues of mine, and we do a deep dive into a lot of these topics. And I try to incorporate the HSP aspect of it. They're very, very supportive of me doing that. It's just a little bit different. Like getting to talk to you about it and you being in a place where you so understand, you know, I think really helps to highlight what matters for us as sensitive people. And one of the things that I really want to dive into on the Messi Midlife podcast is the spirituality of perimenopause. And that kind of ties into a little bit of what we were talking about today and our sense of purpose as sensitive people and how it's really a time for us to shine and let that come through. So there's so many different topics here that I think we could explore further. But I'm really glad that we got into some of the fundamentals because it's so empowering to understand that.

April Snow 55:55

Absolutely, to understand just what's happening in our bodies. And I think we wove in maybe some of this sensive experience throughout. Obviously, so much more to get into. And I would love to dive into that spiritual lens through this process because, yeah, as transformation is happening internally, we're often connecting with things that are more meaningful, maybe things we haven't prioritized in the past. Like spirituality. It's definitely something that I have always been drawn to, but I've taken more seriously in my 40s at this stage. It feels even more important than ever. Yeah. I think that's pretty common.

Dr. Karen Lamb 56:30

And at a time when we feel in some ways more disconnected, it can be more difficult to explore that. But there's also, I just think that sensitivity is here for a reason, right? We didn't just randomly, I don't know. I'm sure there are some very scientific people that will say, well, yes, 20% of the population and evolutionarily, and sure, I get that. And I think that our sensitivity has a purpose. And that sensitivity of being tapped into an energetic shift that is happening in and all of the science that we don't understand yet, right? This doesn't have to be, you know, the religious spiritual. This can be scientifically, you know, the energetic things that we pick up as sensitive people. And I think that there is a purpose for that. And I think that the more that we align with that in a time when other things start to fall away, is something that can be transformative for our communities and maybe even something bigger. And I think that if there was ever a time when sensitive people were needed, it is now.

April Snow 57:39

Right now. Right now. And yes, we have a biological purpose, but we also have a deeper spiritual emotional purpose. Yeah. And yeah, we are needed more than ever. So let's take good care of ourselves.

Dr. Karen Lamb 57:50

Yes. Agree. Absolutely.

April Snow 57:53

Thank you so much. This is so great. I'll be sure to share your new podcast, the Messy Been Life Podcast, in the show notes. I think you have a perimenopause and sensitivity episode coming up.

Dr. Karen Lamb 58:02

Yes.

April Snow 58:03

Perfect. So we can have an extension of this conversation for folks. And also excited to hear it through a different lens with some different perspectives. And then, of course, I'll share your website and your social media for anyone who wants to reach out to you. Yeah. Thank you so much. Thank you so much.

Dr. Karen Lamb 58:16

Always such a pleasure. Always a joy. Maybe we'll get to do this again. I we will.

Closing Resources And Next Steps

April Snow 58:21

I think so. I think there's a lot more to talk about. Thanks so much for joining me and Karen for today's conversation. I hope you found it validating and it'll help you remember that you know your body best. For more information on Perimenopause from Dr. Lamb, listen to the Messy Midlife podcast. Links are in the show notes. If you enjoyed this episode, subscribe to the Sensitive Stories podcast so you don't miss our upcoming conversations. Reviews and ratings are also helpful and appreciated. For behind the scenes content and more HSP resources, you can sign up for my email list or follow Sensitive Strengths on Instagram, TikTok, and YouTube. Check out the show notes or sensitivestories.com for all the resources from today's episode. Thanks for listening.