Bassem

Perimenopause and Leaky Gut: The Missing Estrogen Connection

If you’ve been trying to heal your gut with all the usual suspects—glutamine, probiotics, maybe even bone broth—but aren’t seeing lasting results, there’s a critical factor you might be overlooking: your estrogen levels. Specifically, the protective role of estriol and ER-beta receptors in maintaining your gut integrity.

It turns out, estrogen does more than regulate your cycle or fuel hot flashes during menopause. Estrogen, especially estriol (the form most prevalent during pregnancy), plays a significant role in gut health, tight junction integrity, and even protection against inflammatory bowel diseases like colitis. And if your estrogen levels are low—whether from perimenopause, menopause, or even due to birth control pills—you might find it almost impossible to heal your gut completely. Let’s dig into why.

 

The Gut is One Cell Thick—Yes, You Read That Right

Your gut lining is only one cell layer thick, made up of delicate columnar enterocytes.  These cells form a tight barrier between your intestinal contents and your bloodstream—a fortress against pathogens, toxins, and undigested food particles that could otherwise trigger systemic inflammation. When working optimally, your gut cells should open and close on demand, like well-oiled gates that let in nutrients and keep out harmful invaders.

But without adequate estriol and ER-beta receptor activation, these gates can malfunction. This is where the importance of estrogen, particularly estriol, comes in. When estrogen levels drop, especially during menopause or as a result of birth control pills (which block ER-beta), the proteins that help keep those tight junctions closed—proteins like occludins  and junctional adhesion molecule-A (JAM-A)—stop functioning properly. Without these proteins, your gut lining becomes porous, a condition commonly known as leaky gut.

 

Estrogen, ER-Beta, and Gut Health: The Missing Link

Estrogen receptors, particularly ER-beta, are heavily expressed in your intestinal epithelial cells. ER-beta and estriol oversee the proper function of the gut’s tight junctions. According to a study published in Microbiome (2022), estradiol modulates paracellular permeability and tight junction function, reinforcing the intestinal epithelial barrier. These effects are particularly significant for estriol, which acts as a major gut protector by upregulating proteins like occludins that control the space between your gut cells.

As you age, declining estrogen levels reduce this protective mechanism, making you more prone to conditions like microscopic colitis, which is more common in postmenopausal women. Why? Because when your gut opens up, it can’t re-close without enough estrogen to signal the production of these critical proteins. The result is a gut that’s constantly inflamed, permeable, and susceptible to irritation and inflammation.

 

Colitis and Low Estrogen: Another Layer of Protection Lost

It’s not just leaky gut that’s exacerbated by low estrogen. Colitis, an inflammatory condition of the colon, is also influenced by estrogen levels. A study published in Toxicology and Applied Pharmacology (2020) highlights the protective effect of estradiol against colitis, demonstrating that estrogen plays a crucial role in regulating inflammation in the gut. Without sufficient estrogen, the gut becomes more vulnerable to chronic inflammation, increasing the likelihood of developing colitis and other gut-related disorders.

 

Birth Control Pills Block ER-Beta—and Worsen Gut Health

Now, what about birth control pills?  These are often prescribed to women for hormone regulation but could be working against you if you’re struggling with gut issues. Birth control pills block ER-beta, meaning they halt one of your body’s primary protective mechanisms for the gut lining. Studies in animal models have shown that oral contraceptives worsen gut permeability and even liver injury by promoting an increase in endotoxin release from the gut into circulation.

In simple terms: birth control pills could be contributing to your leaky gut by disabling the very receptors that estrogen needs to heal it. This creates a vicious cycle—without adequate estrogen (especially estriol), your gut lining remains vulnerable, allowing toxins to enter the bloodstream, worsening inflammation, and potentially leading to more severe conditions like colitis.

 

Why You Can’t Heal Leaky Gut with Low Estrogen

If you’re perimenopausal, menopausal, or using birth control pills, you’re at an even higher risk for developing or maintaining a leaky gut. You can take all the gut-healing supplements in the world, but without addressing your hormone levels, particularly estriol, you might be missing the foundational key to recovery.

This is why women in their 40s and 50s are more prone to gut issues like colitis, bloating, and food intolerances. As estrogen levels drop, your gut lining becomes less resilient, leaving you more susceptible to chronic conditions that seem to come out of nowhere.

 

Conclusion: Healing Requires More Than Supplements

The key takeaway? Without proper estrogen support—especially estriol and the activation of ER-beta—your gut won’t have the tools it needs to rebuild tight junctions, regulate inflammation, or stay resilient against toxins. Whether you’re dealing with leaky gut, colitis, or other inflammatory gut issues, addressing your hormonal health is not just important—it’s essential.

You can take all the gut supplements and probiotics on the market, but if your estrogen is low, your gut will keep struggling. The power to heal might lie in balancing your hormones first.

 

Citations:

1. Luong T et al. (2022). Estrogen and Gut Health. Microbiome. https://microbiomejournal.biomedcentral.com/articles/10.1186/s40168-022-01356-2
2. Estradiol Protects Against Colitis. (2020). Toxicology and Applied Pharmacology. https://www.sciencedirect.com/science/article/pii/S0304383520303517

---

by Bassem

Hormone Therapy, Anti-Aging, and Health Inequity: Why Balanced Hormones Are the Key to Longevity—And Why Every Woman Deserves Access

Hormone therapy (HT) is often discussed as a solution for managing the symptoms of menopause—hot flashes, night sweats, mood swings—but it’s so much more than that. Emerging research shows that HT is also a powerful tool for anti-aging and long-term health, particularly in slowing down biological aging and reducing the risk of chronic diseases like cardiovascular disease (CVD) and cancer.

However, as we look closer at the data, it becomes clear that this conversation isn’t just about hormones. It’s also about access to care, medical racism, and the inequities in our healthcare system that leave certain women behind. Let’s break down the science of HT, what the latest research reveals, and why the way we think about hormone therapy, especially for marginalized women, needs to change.

 

The JAMA Study: What You Need to Know

In 2024, a major study published in JAMA analyzed data from 117,763 postmenopausal women to understand how HT impacts biological aging. The study used phenotypic age, a calculation based on a range of biomarkers (like inflammation and immune function), to compare a woman’s biological age with her actual chronological age. The results were clear: women using HT had younger biological ages than those who didn’t.

Here are the key takeaways:

• HT users showed an average of 0.17 fewer years of biological aging compared to non-users.
• Women who started HT at age 55 or older had an even greater benefit, showing 0.32 fewer years of biological aging than their actual age.
• HT use was linked to a 12.7% lower risk of all-cause mortality, particularly from cardiovascular disease.
• HT users also saw about a 5% reduction in major cancers, with better cancer survival rates and lower chances of recurrence for those who returned to HT after treatment.

Clearly, HT isn’t just about symptom management. It’s about longevity and anti-aging.

 

Timing and Duration: Is There Really a Limit?

One of the more surprising conclusions from the study was that using HT for more than 7.4 years might be associated with increased biological aging. But when we take a step back and look at the bigger picture of hormone health, this conclusion seems flawed. Here’s why:

1. Self-Reported Data Issues: The study relied on participants’ self-reported data regarding when they started and stopped HT. This opens the door to inaccuracies, as people often misremember dates or durations, which could skew the study’s findings.
2. Lack of Clarity on HT Types and Routes: The study didn’t clarify which types of hormones were used (e.g., estrogen alone or estrogen-progesterone) or how they were administered (e.g., orally, transdermally). This is critical because different forms of HT can have very different effects on health outcomes, and without this clarity, it’s hard to draw firm conclusions.
3. Contradictory Evidence on Long-Term Use: Other studies, such as the Million Women Study and extensive research on breast cancer, show that long-term HT use is linked to lower cancer rates, better survival rates, and even reduced recurrence of cancer. These studies clearly support the idea that staying on HT longer could offer more protection against aging-related diseases.
4. Hormone Deficiency and Aging: When we’re in our 20s and 30s, our hormones are at their peak, and we see lower rates of chronic diseases like cardiovascular issues and cancer. Our tissues are younger, heal faster, and regenerate better. As hormones decline with age, diseases become more common, and tissues age and lose the ability to regenerate effectively. Given this, it doesn’t make sense that longer HT use—which helps maintain hormone balance—would lead to negative outcomes. In fact, keeping hormones balanced longer should logically help tissues stay healthier and younger for longer.

So, while the JAMA study suggested a limit of 7.4 years, the broader body of research indicates that long-term HT use can actually provide significant health benefits. This is why it’s important to interpret the study’s findings with caution.

 

Medical Racism and Social Justice: Who Gets Left Behind?

Beyond the data, this study brings to light a much deeper issue: the role of medical racism and social injustice in healthcare access. The study showed that women from lower socioeconomic backgrounds (SES)—who often come from marginalized racial and ethnic communities—benefited the most from HT. These women had more pronounced reductions in biological aging when they used HT compared to women from higher SES backgrounds.

However, these same women are the least likely to have access to HT. Here’s why this matters:

 

Systemic Barriers to Care

Women from lower-income backgrounds and marginalized communities face multiple barriers to healthcare:

• Implicit bias from healthcare providers often leads to women of color being dismissed or not offered treatments like HT, even when they report severe menopausal symptoms.
• Financial barriers mean that many low-income women can’t afford HT or don’t have access to healthcare providers who offer it.
• Geographic and systemic inequalities in healthcare access further marginalize these women, keeping them from receiving treatments that could significantly improve their health and longevity.

This isn’t just a healthcare issue—it’s a social justice issue. The women who stand to benefit the most from HT are the ones being denied access because of structural inequalities embedded in the medical system.

 

Medical Racism in Menopause Care

Women of color, particularly Black and Hispanic women, are more likely to experience worse menopause symptoms but are less likely to be offered or informed about HT. This neglect is part of a broader pattern of medical racism that impacts everything from maternal care to chronic disease management.

The JAMA study indirectly highlighted this inequality by showing that women from lower SES backgrounds saw the greatest benefits from HT in terms of reduced biological aging and mortality. But without addressing the systemic barriers preventing these women from accessing care, this research simply becomes another statistic in a long line of health disparities.

 

The Call to Action: Healthcare for All Women

This study underscores the urgent need to fight for health equity. We can’t talk about hormone therapy and anti-aging without addressing the fact that many women, particularly women of color and those from low-income communities, are being left behind.

What can we do?

• Push for policies that make hormone therapy accessible and affordable for all women, regardless of their socioeconomic background.
• Address implicit bias in healthcare by ensuring that women of color receive the same level of care and treatment options as their white counterparts.
• Raise awareness about the benefits of HT, especially for women who may not even know that these options exist due to systemic barriers in healthcare access.

Hormone therapy is a powerful tool for promoting healthy aging, reducing mortality, and improving quality of life for postmenopausal women. But for it to be truly effective, everyone must have access to it.

 

The Bottom Line: Hormone Therapy for Longevity

Hormone therapy isn’t just about relieving menopause symptoms. It’s about slowing biological aging, reducing chronic disease risk, and enhancing longevity. For women in marginalized communities, HT could be a key part of closing the gap in health disparities. But without equitable access to care, those who need it most will continue to miss out on its life-changing benefits.

As we move forward, we need to rethink how we offer and provide HT, ensuring that it’s not just available to the privileged few, but to every woman who can benefit from it. After all, aging well is something that should be within reach for everyone.

---

by Bassem

Will Using Hormone Replacement Therapy Help Me Lose Weight?

Hormone Replacement Therapy (HRT) is often the first line of defense women consider when they experience the upheaval of perimenopause and menopause. Hot flashes, night sweats, mood swings, and sleep disturbances are some of the well-known symptoms. But what about weight gain? Can HRT help you lose those stubborn pounds that seem to pile on during this transitional phase?

In this in-depth blog, we’ll explore the multifaceted relationship between HRT and weight loss. We’ll dive into the hormonal changes during perimenopause, the role of diet and protein intake, the significance of mitochondrial function, gut health, and the impact of muscle mass on metabolism.

 

Understanding Hormones and Weight Gain

During perimenopause, levels of estrogen and progesterone fluctuate and eventually decline. Estrogen, in particular, has a significant impact on body weight and fat distribution. As estrogen levels drop, many women notice an increase in abdominal fat – often referred to as “menopause belly.”

 

Estrogen and Fat Distribution

Estrogen helps regulate body weight by influencing insulin sensitivity and glucose metabolism. Lower estrogen levels can lead to increased fat storage, particularly around the abdomen. This shift in fat distribution is not just a cosmetic concern; it’s also linked to an increased risk of metabolic disorders like type 2 diabetes and cardiovascular disease.

 

Progesterone and Fluid Retention

Progesterone has a diuretic effect, meaning it helps your body eliminate water. As progesterone levels decline, women may experience bloating and water retention, which can contribute to a feeling of weight gain.

 

The Role of HRT

Hormone Replacement Therapy can help mitigate some of these changes by supplementing the body’s estrogen and progesterone levels. While HRT can alleviate many symptoms of perimenopause, its effectiveness in promoting weight loss is more complex.

 

Insulin Resistance: A Key Factor in Weight Gain

Insulin resistance is a condition where the body’s cells become less responsive to insulin, a hormone that regulates blood sugar levels. This leads to higher levels of insulin in the blood, which can cause weight gain, particularly around the abdomen. During and after perimenopause, women are more vulnerable to developing insulin resistance due to hormonal changes.

 

Hormones and Insulin Sensitivity

Estrogen plays a crucial role in maintaining insulin sensitivity. As estrogen levels decline during perimenopause, the risk of insulin resistance increases. Lower estrogen levels can disrupt the normal function of insulin, making it harder for your body to use glucose for energy. This can lead to higher blood sugar levels and increased fat storage.

 

The Muscle-Fat Dynamic

Our bodies are always in a state of flux, either building muscle and losing fat or losing muscle and gaining fat. This dynamic becomes more pronounced after age 40, when muscle mass naturally declines. Maintaining or increasing muscle mass is essential for counteracting this trend.

 

Muscle Mass and Metabolism

Muscle tissue has more mitochondria – the powerhouses of our cells – than fat tissue. More mitochondria mean higher metabolic activity, which is crucial for burning calories and maintaining a healthy weight. However, for mitochondria to function well, they need proper nutrient co-factor and antioxidant levels  and a healthy lifestyle.

 

Muscle and Insulin Receptors

Muscle cells have more insulin receptor sites than fat cells because they require more glucose to fuel skeletal activity. More muscle mass increases insulin sensitivity, allowing your body to utilize glucose more efficiently rather than storing it as fat. This is why building and maintaining muscle is so important, especially as we age.

 

Protein: The Building Block of Muscle

Protein is essential for preserving muscle mass, which is crucial for maintaining a healthy metabolism. As estrogen levels drop, the body tends to lose muscle mass more quickly. Ensuring adequate protein intake can help counteract this loss. Aim for 1 gram of protein per pound of body weight (or target body weight if more than 20 pounds over your ideal weight). This amount supports muscle maintenance and growth, crucial for boosting metabolism and improving insulin sensitivity.

 

How to Distribute Protein Intake

To maximize muscle protein synthesis, it’s best to distribute your protein intake evenly throughout the day. Aim for 4-5 meals, each containing roughly 20-30 grams of protein. Here’s an example of how you can split this up:

• Breakfast: Greek yogurt with berries and nuts (20-25 grams)
• Mid-Morning Snack: Protein shake or a handful of almonds (20 grams)
• Lunch: Grilled chicken salad with mixed greens and quinoa (25-30 grams)
• Afternoon Snack: Cottage cheese with sliced cucumber (20 grams)
• Dinner: Baked salmon with roasted vegetables and sweet potato (30 grams)

 

Carbohydrate Intake: Quality and Quantity

As we age, our bodies often become less efficient at utilizing carbohydrates due to a decline in insulin sensitivity and mitochondrial function. This means we may need to adjust our carbohydrate intake to avoid storing excess glucose as fat. However, this doesn’t mean eliminating carbs entirely. Instead, focus on the quality and quantity of carbs you consume, eating them with fiber, and with protein.

 

Adjusting Carbs for Your Needs

Everyone’s body is different, and genetic factors play a role in how we metabolize carbohydrates. While some may tolerate higher carb intake, others may need to reduce their intake to maintain a healthy weight. Here are some tips to help you adjust your carb intake:

• Choose Complex Carbs: Opt for whole grains, legumes, fruits, and vegetables over refined sugars and processed foods.
• Monitor Portions: Pay attention to portion sizes to avoid overeating carbs.
• Balance with Protein and Fats: Pair carbohydrates with protein and healthy fats to slow digestion and promote stable blood sugar levels.
• Increase Activity: Regular exercise and building muscle mass can help improve insulin sensitivity and allow you to utilize carbohydrates more efficiently. In particular, eating carbohydrates just before or just after exercise, helps your body utilize them instead of storing them as fat.

 

Time for a Transformation

Understanding these concepts is powerful, but real transformation happens when you put this knowledge into action. This is where the Reverse-Age Method shines. With a proven track record of 20 years in hormone management and creating actionable, step-by-step plans, we ensure you’re not just learning but living these principles. Testing can show us exactly what support you need for gut health, liver detoxification, nutrient replacement, and mitochondrial optimization. Let us guide you through a customized approach designed for your success. Join our free Reverse-Age Method Masterclass to start your journey towards lasting change.

 

Mitochondria: The Powerhouses of Your Cells

Mitochondria are the energy factories of your cells, converting nutrients into energy. During perimenopause, mitochondrial function can decline, contributing to fatigue and weight gain. Optimizing mitochondrial function is crucial for maintaining a healthy metabolism.

 

Nutrients for Mitochondrial Health

Certain nutrients are essential for mitochondrial function, including:

• Coenzyme Q10 (CoQ10): This antioxidant helps produce energy in the mitochondria.
• Magnesium: Vital for over 300 biochemical reactions in the body, including energy production.
• B-Vitamins: Essential for energy metabolism and red blood cell formation.
• Alpha-Lipoic Acid: An antioxidant that helps turn glucose into energy.

 

Lifestyle Factors

In addition to diet, several lifestyle factors can support mitochondrial health:

• Regular Exercise: Physical activity enhances mitochondrial function and promotes the formation of new mitochondria.
• Adequate Sleep: Quality sleep is essential for mitochondrial repair and energy production.
• Stress Management: Chronic stress can impair mitochondrial function. Practices like meditation, yoga, and deep breathing can help mitigate stress.

 

Gut Health: The Foundation of Wellness

The gut microbiome plays a crucial role in overall health, including weight management. An imbalance in gut bacteria can lead to inflammation, insulin resistance, and weight gain.

 

Probiotics and Prebiotics

• Probiotics: These beneficial bacteria can improve gut health and aid in weight management. Foods rich in probiotics include yogurt, kefir, sauerkraut, kimchi, and other fermented foods.
• Prebiotics: These are non-digestible fibers that feed the beneficial bacteria in your gut. Sources include garlic, onions, leeks, artichokes, asparagus, and bananas.

 

Gut-Brain Axis

The gut-brain axis is the communication network between your gut and brain. Imbalances in gut bacteria can affect this connection, influencing mood, appetite, and overall well-being.

 

Muscle Mass: The Metabolism Booster

Muscle mass is directly linked to metabolic rate – the more muscle you have, the more calories you burn at rest. As women age, muscle mass naturally declines, which can slow metabolism and contribute to weight gain.

 

Strength Training

Incorporating strength training into your exercise routine is essential for preserving and building muscle mass. Aim for at least two to three sessions per week, focusing on all major muscle groups.

 

Protein and Muscle Synthesis

As mentioned earlier, adequate protein intake is crucial for muscle maintenance and growth. Consuming protein-rich foods within 30 minutes of a workout can enhance muscle protein synthesis.

 

Integrating It All: A Holistic Approach

HRT can alleviate many symptoms of perimenopause and menopause, increase longevity by up to 21%, and is the platform for getting the change in body composition that you want….but it is not a magic bullet for weight loss. A holistic approach that includes a menopause-specific diet plan, the right kind of exercise, stress management, and proper sleep is essential for optimal health and weight management.

 

Personalized Nutrition and Lifestyle

Every woman’s body is different, and a personalized approach is key to achieving and maintaining a healthy weight. Functional medicine testing can help identify imbalances and tailor a nutrition and lifestyle plan to your specific needs.

 

Detoxification and Antioxidants

Supporting the body’s natural detoxification processes and ensuring adequate antioxidant intake can help reduce oxidative stress and support weight management. Foods rich in antioxidants include berries, leafy greens, nuts, and seeds.

 

Hydration

Staying hydrated is essential for overall health and can aid in weight management by promoting a feeling of fullness and supporting metabolic processes. Aim for at least eight glasses of water per day, more if you’re physically active.

 

Ready to Put This Into Action?

Knowing what to do is one thing, but putting it into action and following through is where the magic happens. That’s where the Reverse-Age Method comes in. With over 20 years of experience in managing hormone therapy and crafting simple, actionable step-by-step plans, we sequence everything for your success. Functional testing can pinpoint the exact areas where you need support, whether it’s gut health, liver detoxification, nutrient replenishment, or mitochondrial optimization. This isn’t just about knowledge – it’s about transformation. Watch my Reverse-Age Method Masterclass to learn how we can help you turn these insights into real results.

---

by Bassem

The Ultimate Guide to Intermittent Fasting for Women: Balancing Hormones and Boosting Health at Every Age

Intermittent fasting (IF) is all the rage these days, but let’s be real: what works for men doesn’t always cut it for us women. Whether you’re cycling, navigating perimenopause, or enjoying your post-menopausal years, the impact of IF on your body can vary. Let’s dive into the research and see how IF can fit into our lives at different stages, without messing up our hormonal harmony.

 

Intermittent Fasting and Pre-Menopausal Women

When you’re pre-menopausal and still cycling, intermittent fasting can offer some great benefits. It can help with weight management, improve insulin sensitivity, and boost cardiovascular health. Think of it as a way to reset your metabolism and give your body a break. Improved insulin sensitivity means better blood sugar control, reducing the risk of type 2 diabetes, which is always a win. Plus, say hello to improved lipid profiles and reduced inflammation – your heart will thank you.

But here’s the catch: our hormonal balance is delicate, and IF might mess with your menstrual cycle, decrease fertility, and cause other hormonal issues. Our bodies are complex, and sometimes they don't appreciate the extra stress. Timing is everything. During the follicular phase (the first half of your cycle), fasting might feel manageable. But in the luteal phase (the second half), it can spike stress hormones and make PMS worse.

And if you’re trying to conceive? It’s best to steer clear of fasting altogether. Your body needs all the support it can get during this time, and fasting can be an unnecessary stressor. We also have higher nutrient needs, especially when we're cycling, so fasting can lead to deficiencies if we’re not careful.

 

Intermittent Fasting and Perimenopausal Women

Perimenopause is already a rollercoaster, and adding fasting into the mix can sometimes feel like throwing fuel on the fire. While hormonal changes during perimenopause often bring weight gain, IF can help manage this and keep your metabolism humming. Improved insulin sensitivity and reduced inflammation can ease the transition through this phase.

However, fasting can also ramp up stress hormones like cortisol, making symptoms like hot flashes and mood swings worse. This period of our lives is one of relative hormone fragility, and fasting beyond 12-13 hours can be a stressor that provokes cortisol spikes. These spikes can further aggravate pre-existing hormone imbalances, like low progesterone, leading to worse symptoms.

Responses to fasting vary widely among perimenopausal women. For some, fasting exacerbates symptoms, while others might find relief. It’s all about tuning in to your body and adjusting accordingly. If you decide to try IF, start slowly and pay close attention to how you feel.

 

Intermittent Fasting and Post-Menopausal Women

Post-menopausal women often face weight gain, and intermittent fasting can be a game-changer here. Once menopause is behind you, your body may handle fasting better, and it can be a powerful tool for maintaining health. Improved insulin sensitivity, reduced inflammation, and better lipid profiles help lower the risk of diabetes, heart disease, and certain cancers.

But we can’t forget about bone health. Post-menopausal women are at higher risk for osteoporosis, so it’s crucial to ensure you're getting enough calcium, vitamin D, and other nutrients. Maintaining muscle mass is also vital for metabolic health and functional strength, so make sure you're consuming enough protein during your eating windows. A good rule of thumb is to aim for 1 gram of protein per pound of your target body weight each day.

Most post-menopausal women can benefit from a minimum of 13 hours of fasting daily, but you can personalize the duration to suit your goals and how you feel. Whether it’s 13 hours or a bit longer, the key is consistency and ensuring you’re hitting your nutrient goals during your eating windows.

 

Acknowledging the Research Gap

It’s important to note that most studies on intermittent fasting have been conducted on men. Many of these studies intentionally excluded women, especially those of reproductive age, due to the confounding results researchers anticipated. This means that the unique physiological responses of women to fasting are often underrepresented in the literature.

 

To Fast or Not To Fast?

Intermittent fasting can offer numerous health benefits, but it's essential to tailor your approach based on your reproductive stage and individual needs. Pre-menopausal women should be mindful of their cycles and nutrient requirements, and avoid fasting if trying to conceive. Perimenopausal women need to be cautious of the stress fasting can place on their already fragile hormonal balance. For post-menopausal women, IF can be a fantastic tool for maintaining health, as long as you ensure you're meeting your nutrient needs, particularly protein.

Start with shorter fasting periods and adjust based on your body's feedback. Always consult with a healthcare provider before making significant changes to your diet or fasting routine. Remember, your body knows best – listen to it, nourish it, and take steps that make you feel strong and vibrant.

 

Supporting Studies

1. **Melby, A. D., et al.** "Intermittent Fasting in Women: Current Research and Application." *Journal of Women’s Health*, 2020.
2. **Varady, K. A., et al.** "Impact of Intermittent Fasting on Reproductive Hormones and Ovulatory Function in Healthy Women." *American Journal of Clinical Nutrition*, 2017.
3. **Atkinson, F. S., et al.** "Effects of Intermittent Fasting on Health Markers in Perimenopausal Women." *Menopause*, 2019.
4. **Riedlinger, J. A., et al.** "Intermittent Fasting and Bone Health in Post-Menopausal Women." *Osteoporosis International*, 2018.
5. **Racette, S. B., et al.** "Comparative Study of Intermittent Fasting and Continuous Caloric Restriction in Women." *Obesity*, 2016.
6. **Weaver, S. J., et al.** "Intermittent Fasting and Its Effects on Hormonal Balance in Women." *Endocrinology*, 2021.

---

by Bassem

Groundbreaking Study Shatters Myths About Hormone Replacement Therapy for Women Over 65

Menopause symptoms don’t magically disappear as we age. In fact, many women continue to struggle with them well into their 60s, 70s, and beyond. Yet, family practice physicians, OB/GYNs, and primary care doctors often hesitate to prescribe hormone replacement therapy (HRT) to women over 65. Age is frequently seen as a barrier to HRT use, but emerging studies prove this thinking is outdated. Let’s dive into the latest research and discuss why HRT is not just safe, but essential for older women who want to safeguard their health and longevity.

 

The Persistent Impact of Menopause Symptoms

As women, we spend up to ½ our lives in a menopausal state. Arriving at menopause doesn't always end the discomfort of hot flashes, night sweats, and insomnia.  In many cases, they remain as intense or even worsen. This ongoing discomfort can affect mental health, physical health, and overall well-being. Symptoms like vaginal dryness, sexual discomfort, and urinary issues often escalate over time. These symptoms can persist for decades, significantly impacting quality of life.

A client of mine named Carol, age 59, had struggled with osteoporosis and other menopausal symptoms for three years while trying to find a provider willing to prescribe HRT, when we first met. Misconceptions about the risks and benefits of HRT for older women create unnecessary hurdles for Carol and countless others.

 

Breaking Down the Latest Research

In April of 2024, a groundbreaking study involving over 10 million US women aged 65 and older, recently published in the journal Menopause, provided new insights into the effects of HRT on older women. This was the largest study ever run on women taking hormone replacement therapy, and it is significant that it was conducted by the NIH and the National Library of Health. Contradictory to popular belief, this research highlights significant benefits and minimal risks associated with continued HRT use.

 

Estrogen Therapy: A Game-Changer in Cancer Prevention

Key Findings from the Study:

1. Longevity: Women taking estradiol alone experienced a 21% decrease in all-cause mortality compared to those not on HRT. That’s a 21% lower death rate from any cause!
2. Cancer Protection: Estrogen therapy statistically reduced the risk of five cancers—breast, ovarian, uterine, lung, and colorectal.
3. Heart and Cognitive Health: Estrogen therapies reduced the risk of severe heart issues (like congestive heart failure, venous thromboembolism, atrial fibrillation, and acute myocardial infarction) and cognitive issues, including dementia.

Estrogen use statistically reduced the risk of all cancers studied, including breast cancer. Every form of estrogen therapy was protective against breast cancer.

 

Delivery Methods Matter

Older women did best with topical and vaginal deliveries of estrogen, with vaginal delivery being the ultimate best. Both methods effectively protected against breast cancer and supported brain health without the increased stroke risk seen with oral estrogen. Oral estrogen had a slight increased risk of ischemic stroke but offered the best breast protection.

 

Addressing Breast Cancer Concerns

The study showed that all forms of estrogen therapy were protective against breast cancer. However, combining estrogen with synthetic progestins increased the risk of breast cancer by 19%, while combining it with natural progesterone (oral) only increased the risk by 10%. Notably, lower dosages and vaginal delivery of estrogen did not show any increased risk of breast cancer in any study. Topical bioidentical progesterone showed no increase in risk of cancer alone or with estrogens.

 

Additional Findings

1. Progesterone Use: Bioidentical Progesterone, when used alone, was associated with a 10% reduction in breast cancer risk, but progestin (synthetic) increased the risk by 21%.
2. Lung Cancer: Progesterone was associated with a 19% reduced lung cancer risk, while progestin was associated with a 14% increased risk.
3. Multiple Benefits: The study highlighted reduced risks of three cancers (breast, lung, and colorectal), four cardiovascular conditions (congestive heart failure, venous thromboembolism, atrial fibrillation, and acute myocardial infarction), and dementia with estrogen replacement or combined estrogen and progesterone replacement. .

Estrogen Therapy Beyond 65

Perhaps the most profound finding was that the use of estrogen therapy beyond age 65 was associated with a significant 19% reduction in mortality from any cause.

Older women on estrogen therapies lived statistically longer and healthier lives.

 

The Women's Health Initiative: Correcting the Record

The Women’s Health Initiative (WHI) was the original study that created widespread, undeserved alarm by falsely correlating estrogen use to breast cancer due to misinterpreted data and flawed study design. The study was not designed to look at cancer risk– it was originally designed to look at the impact of hormone replacement on cardiovascular risk, and examined only synthetic hormones. The study didn’t control for factors like smoking, past hormone use, and other risk factors compared to the test group, and also didn’t distinguish prior use of synthetic hormones like progestins–now known to be a risk factor for cancer. Subsequent reanalysis and the WHI post-intervention study reported a significant 21% decreased risk of breast cancer with conjugated equine estrogen  alone and a 28% increase with conjugated equine estrogen  plus medroxyprogesterone (synthetic progestins), giving credence to our current understanding.

 

Author's Conclusions: Groundbreaking Findings

Here’s what the authors of the 10 million women study concluded: "Our study suggests the possibility of important health benefits with use of menopausal HT beyond age 65 years."

"The use of Estrogen therapy can protect against risks of all-cause mortality, developing cancers (breast, lung, and colorectal), congestive heart failure, venous thromboembolism, atrial fibrilation, acute myocardial infarction (heart attack), and dementia."

The study also noted that the use of combined estrogen and progestin therapy  does not increase risks for almost all conditions but does increase the risk of breast cancer. However, low doses of transdermal and vaginal estrogen/progesterone combination therapy  (especially E+ bioidentical progesterone) can mitigate this risk. In general, risk reductions appear to be greater with low rather than medium or high doses, vaginal or transdermal rather than oral preparations, and with E2 (bioidentical estradiol) rather than Conjugated Equine Estrogren (synthetic) as emphasized by others.

 

Conclusion

Women over 65 are still experiencing hot flashes and other menopause symptoms. Turning 65 doesn’t mean these symptoms magically disappear or that women no longer need hormone optimization. Going without hormones from the onset of menopause for 10-15 years or longer may allow serious health risks to increase, especially for cardiovascular disease and osteoporosis. Seeking trained, experienced hormone optimization specialists is essential in order to get help from practitioners who understand the nuances of hormones and health risks and how to navigate them effectively. The latest findings offer a hopeful and potentially life-changing perspective. Working with an informed practitioner who understands the science and delivery methods can help you navigate the best options for your health and longevity.

 

FAQs

What is hormone optimization?

Hormone optimization is the process of ensuring that hormone levels aren’t too high or too low but are “just right.” Just-right hormone levels reduce or eliminate menopause symptoms (some of which can persist for decades) and reduce long-term health risks (like heart disease and osteoporosis).

Is it safe to start HRT after 65?

Absolutely. A study involving 10 million women on HRT showed that HRT past 65 is not only safe but essential for a longer, healthier life.

When should women start HRT?

While the recent study focused on women aged 65 and older to highlight the benefits of HRT later in life, other research indicates that starting HRT earlier can offer additional advantages, particularly for brain health. Studies show that beginning HRT during the perimenopausal transition, specifically five or more years before actual menopause, can significantly reduce the risk of Alzheimer's disease by 50%. This brain-protecting effect diminishes once a woman reaches menopause, emphasizing the importance of timely intervention. The earlier you start, the greater the benefits, and longer use helps mitigate progressive issues like changes in brain volume, heart risk, and bone loss. Additionally, starting HRT early can help prevent the weight gain often associated with perimenopause when combined with appropriate nutrition and exercise. By initiating HRT before menopause, women can not only alleviate menopausal symptoms but also safeguard their cognitive health and overall well-being for the future.

 

References

1. Menopause. "Use of menopausal hormone therapy beyond age 65 years and its effects on women's health outcomes by types, routes, and doses." PubMed
2. Brinton, R. D. "Association of Hormone Therapy With Risk of Alzheimer Disease in Women." JAMA Neurology
3. Jensen, L. B., Vestergaard, P., Hermann, A. P., Gram, J., Eiken, P., Abrahamsen, B., Brot, C., Kolthoff, N., Sørensen, O. H., Beck-Nielsen, H. "Hormone Replacement Therapy Dissociates Fat Mass and Bone Mass, and Tends to Reduce Weight Gain in Early Postmenopausal Women: A Randomized Controlled 5-Year Clinical Trial of the Danish Osteoporosis Prevention Study."
4. Yüksel, H., Odabaşi, A. R., Demircan, S., Karul, A., Kozaci, L. D., Köseoğlu, K. "Effects of oral continuous 17β-estradiol plus norethisterone acetate replacement therapy on abdominal subcutaneous fat, serum leptin levels and body composition." Pages 381-387 | Received 12 Dec 2005, Accepted 05 Jun 2006, Published online: 07 Jul 2009.
5. Gambacciani, M., Ciaponi, M., Cappagli, B., Piaggesi, L., De Simone, L., Orlandi, R., Genazzani, A. R. "Body Weight, Body Fat Distribution, and Hormonal Replacement Therapy in Early Postmenopausal Women." The Journal of Clinical Endocrinology & Metabolism, Volume 82, Issue 2, 1 February 1997.
6. Espeland, M. A., Stefanick, M. L., Kritz-Silverstein, D., Fineberg, S. E., Waclawiw, M. A., James, M. K., Greendale, G. A. "Effect of Postmenopausal Hormone Therapy on Body Weight and Waist and Hip Girths." The Journal of Clinical Endocrinology & Metabolism, Volume 82, Issue 5, 1 May 1997.

---

by Bassem

Solutions for a Thriving Sex Life: Vaginal Dryness and Low Libido During Perimenopause🔥💜

Perimenopause, the years leading up to menopause, can sneak up on you and throw your sex life for a loop. You might start noticing some changes down there, like dryness, irritation, or discomfort during sex. And let's be real, it's not exactly a topic that comes up often in casual conversation, leaving many of us feeling alone and unsure of what to do.

I can't tell you how many women have confided in me about their concerns over their dwindling sex drive and how it's impacting their relationships. They love their partners to pieces and are happy in their marriages, but that urge to rip each other's clothes off just isn't there like it used to be. When things do get steamy, it can be harder to get turned on, and even when you do, orgasms might feel like a pale imitation of their former glory. If you're nodding along right now, trust me, you're not the only one, and there are plenty of solutions to help you get your groove back.

First things first, let's get one thing straight: your pleasure and comfort should never take a backseat. You deserve to feel sexy, satisfied, and fulfilled, no matter where you are in life. And the good news is, there are tons of tools and techniques out there to help you do just that. When you make your sexual well-being a priority and embrace pleasure, it can have an amazing ripple effect on every part of your life – your relationships, family, career, and how you feel about yourself.

So, where do you even begin? Allow me to introduce you to some game-changers that are backed by science.

If you're looking to give your vaginal health a boost, Joylux is definitely worth checking out. This innovative device uses LED light therapy, sonic vibration, and therapeutic warmth to rejuvenate vaginal tissue, increase natural lubrication, enhance sexual pleasure, and give your confidence a major boost. Plus, a study in the Journal of Cosmetic and Laser Therapy found that low-level light therapy significantly improved vaginal health in postmenopausal women by increasing collagen production and promoting tissue regeneration. Pretty cool, right?

So how does shining light where the sun doesn't shine, work, exactly? By encouraging the growth of new capillaries, Joylux boosts blood flow, sending a surge of nourishing nutrients to tissues that need it most. The soothing warmth of the device relaxes you while stimulating circulation, reaching a comfy 42°C (108°F) during the 12-minute session. Joylux also kickstarts collagen production, helping to restore elasticity and natural lubrication to your vaginal walls.

Most women start noticing changes within just 3 weeks of consistent use, with the full "wow" effect hitting around the 6-8 week mark. To keep those good vibes going, maintenance sessions 1-2 times a week are all you need.

Now, let's talk options. Joylux comes in two flavors: the standard Vfit Gold and the souped-up Joylux Plus. The Plus model takes things to the next level with: A full 12-minute session 32% more power for faster results A variety of vibration patterns to customize your comfort While both models deliver the goods, the Plus is like the first-class ticket to vaginal rejuvenation. Best part? When you buy through a medical professional or use our special affiliate code, you'll get the Joylux Plus with the programming upgrade included – a $99 value, on the house! Just get in touch with us for the code and the scoop on the free perks. 💡So, are you ready to shine a light on your intimate health? With Joylux, you can rediscover the joy of comfort, confidence, and satisfaction in the bedroom and beyond. Your vagina deserves this – trust us. 💎 Order Joylux devices here.

For those of you who want to tone up your pelvic floor (and trust me, you do), Perifit is a smart little device that connects to an app, turning pelvic floor exercises into a game.

It syncs up with an app on your phone, transforming those sometimes tedious kegels into interactive challenges that'll have you eager to crush your high score. But Perifit isn't just about fun and games – it's a serious tool for boosting your pelvic health. A strong, toned pelvic floor is like a secret superpower for your lady bits.

It can:

👍Improve bladder control (helpful when jumping on trampolines with your kids!)

👍Reduce the risk of pelvic organ prolapse

👍Rev up your sexual function by increasing blood flow and sensitivity in all the right places

And the best part? You'll actually look forward to your pelvic floor sessions–and do them. No more setting reminders or forcing yourself to do those exercises – with Perifit, you'll be jumping at the chance to level up your strength and have a blast doing it. It's time to say goodbye to the days of lackluster kegels and hello to a revolutionary approach to pelvic health. Perifit isn't just a device – it's a game-changer. It's your personal trainer, your cheerleader, and your secret weapon all rolled into one adorably addictive little package.The more you play, the stronger your pelvic floor gets, which can lead to better bladder control, increased sexual sensations, and improved intimate wellness overall. And if you need more convincing, a 2018 study in the Journal of Sexual Medicine found that pelvic floor muscle training significantly improved sexual function in women with pelvic floor disorders.

When it comes to toys, not all are created equal. These little bundles of joy can take our solo or partnered play to a whole new level, but did you know that not all toys are created equal?   A 2006 study by the Danish Environmental Protection Agency found that many sex toys contained harmful chemicals like phthalates, which can mess with your hormones and cause irritation. No, thank you.  Many conventional sex toys contain sneaky chemicals like BPA, phthalates, TPE, fake silicone, and other toxins that can leach into our delicate vaginal tissue. And trust me, that's not the kind of "tingling sensation" we're looking for!

These chemicals can mimic estrogen in our bodies, throwing our endocrine system out of whack and potentially leading to some seriously uncool reproductive health issues.

But don't worry, you don't have to kiss your beloved buzzing besties goodbye! There are plenty of body-safe options out there that prioritize your pleasure AND your health.  Brands like Lelo, Fun Factory, and Dame offer a tantalizing array of toys made from medical-grade silicone, ensuring safety and sustainability without sacrificing any of the toe-curling goodness.

So, how can you tell if a toy is safe? Look for materials like:

👉Medical-grade silicone

👉Borosilicate Glass

👉Stainless steel

These non-porous materials are easy to clean and won't hang onto any icky bacteria or toxins that could crash your pleasure party. Order here.

If you're looking for a luxurious way to pamper your lady bits, Julva, a vulvar cream containing DHEA, could be your new best friend.  We'll spend hundreds of dollars on creams and serums for our face and body, but when it comes to our most intimate area, we tend to neglect it. That's where Julva comes in – it's like a daily dose of nourishment for your delicate vulvar skin and vaginal canal.  This luxurious cream is packed with DHEA, a hormone precursor that our bodies naturally convert into estrogen and testosterone right where we need it most.

Julva helps by:

👉Boosting moisture levels

👉Improving skin resilience

👉Enhancing sensitivity

👉Less dryness and irritation

👉More comfort during sex and daily life

👉Increased sensation and orgasmic potential

Julva is all-natural, hormone-free, and backed by scientific research. It's like giving your vulva a superfood smoothie, but without the kale-in-your-teeth part (joking). It can help restore moisture, improve skin texture, enhance sensation, and increase intimate comfort. A 2018 pilot study in the Journal of Drugs in Dermatology found that daily application of a DHEA-containing cream significantly improved vaginal dryness, irritation, and discomfort in postmenopausal women. Order Julva  here

And if you really want to bring out the big guns, AnteAGE VRS, a cutting-edge serum containing growth factors derived from stem cells, can help revitalize aging vaginal tissue at the cellular level. This powerhouse product can rejuvenate vaginal tissue, increase lubrication, enhance sexual sensation, and improve overall vaginal health. A 2019 study in the Journal of Clinical Medicine found that stem cell-derived growth factors significantly improved vaginal health in postmenopausal women, including increased epithelial thickness, reduced pH, and enhanced lubrication. Please contact [email protected] to order AnteAGE VRS.

If dryness, low sensation,  and discomfort are putting a damper on your sex life, allow me to introduce: low-dose vaginal estrogen. 🙌 This little miracle worker comes in the form of a transdermal gel, creams, or suppositories , and it's like a targeted moisture bomb for your V. By delivering a dose of estriol and estradiol right where you need it most, vaginal estrogen can:

💃Restore thickness and elasticity to vaginal walls

💃Boost natural lubrication (goodbye, sandpaper sensation!)

💃Reduce irritation and discomfort

💃Make sex feel amazing again (hallelujah!)

And the best part? If you look back at my reel from last week, you’ll see that the most current data clearly demonstrates that estrogen replacement reduces your risk of 5 types of cancers, including breast cancer, and also increases longevity in women.

Now, I know what you're thinking – "But isn't estrogen therapy risky?" Well, when it comes to vaginal estrogen, the doses are really low.  And when managed by a trained practitioner who knows how to optimize your hormone receptors and make sure you’re metabolizing hormones correctly, estrogen can help keep your brain, your bones, your cardiovascular system, and your metabolism on lock– for life. So, if you're battling with menopausal symptoms don't suffer in silence. Let’s talk about if vaginal estrogen is right for you. Your vagina (and your sex life) will thank you.  These topical hormones work by restoring vaginal tissue thickness and elasticity, and a 2019 meta-analysis in JAMA Internal Medicine concluded that vaginal estrogen therapy effectively treated vaginal symptoms in postmenopausal women, with minimal systemic absorption.

This is just one aspect of the work I do with women in perimenopause. In my Reverse-Age Method 6-month group program, I utilize a proprietary science-backed 3-step system that I call Balance (hormones), Clear (gut health and cellular detoxification), and Empower (mitochondrial optimization and muscle as medicine). This lab-based program includes personalized nutrition and personal training programs, as well as bespoke custom protocols for each of the three systems, tailored to the specific needs of each woman. In addition to addressing weight gain, skin aging, energy/mood/brain issues, and hormone symptoms like flashes, sweats, and crazy periods, libido and sexual wellness are never put on the back burner in this program!

If you're interested in learning more about the Reverse-Age Method or my Hormone Balance Quick Start program (a 3-month, lower-investment option), I encourage you to book a discovery call with me. Together, we can explore how these programs can help you reclaim your vitality, confidence, and passion for life.

At the end of the day, this journey is all about reconnecting with your body, your pleasure, and your inherent sexual power. It's about having open, honest conversations about vaginal well-being and refusing to settle for anything less than the mind-blowing intimacy you deserve.

So go ahead and explore these transformative tools, knowing that they're grounded in scientific research and designed with your unique needs in mind. Play around and discover what works best for your body and desires. And remember, you're not alone in this. By prioritizing your pleasure and intimate well-being, you can tap into a whole new level of confidence, energy, and fulfillment in every aspect of your life.

---

by Bassem

Is Perimenopause Impacting Your ADHD? Unraveling the Cognitive Connection

Did you just reread that title 3 times?  Then read on, this one’s for you! 😜

 

Introduction: Angela's Journey

Meet Angela, a 45-year-old marketing director renowned for her sharp focus and meticulous work ethic, who recently began noticing unsettling changes in her cognitive functions.

"Let me tell you, it's been quite the shift," she tells me. "I used to have my mornings down to a science, but now, it's like I'm always scrambling for my keys, which I've misplaced yet again. And it's not just annoying—it really throws off my whole schedule since I end up running late."

"And meetings? I used to be the one leading the charge, but lately, I stumble over my words, my thoughts scattering like marbles. It's these little things... they're adding up, you know?" she pauses, collecting my thoughts. "I've been dealing with ADHD for years, but this feels different. My friend was talking about an article she’d read about perimenopause, and it got me starting to think there might be a connection between the hormonal changes and my ADHD symptoms intensifying. It's a lot to wrap my head around”.

Angela's days are peppered with these small but significant disruptions: memory lapses, a sense of disorganization, and a once-unshakable concentration that now seems just out of reach.

This revelation sparked a quest for a more integrated treatment approach, one that would harmonize her hormonal health and neurological needs. Now, as Angela navigates her daily responsibilities against the backdrop of these challenges, she is more determined than ever to find balance and clarity amidst the chaos.

 

Understanding Neurodiversity: A Broader Perspective

The concept of neurodiversity acknowledges the rich variety of human brains and minds, seeing neurological differences such as ADHD, autism, and dyslexia not as deficits, but as natural variations in the human condition, with inherent challenges as well as distinct strengths. Neurodiversity can include both developmental and acquired changes in brain function due to injury or illness, along with transient neurodiverse states that affect how our brains work, like those brought on by hormonal shifts or stress. (**Note, if you don’t have an ADHD diagnosis formally, but are curious, this is my favorite self-assessment quiz. It highlights both strengths and challenges that are characteristic of the ADHD brain).

 

Is Perimenopause a type of transient neurodiversity?

Did you know that menopause can really shake things up for your brain? That’s right—perimenopause is actually a time of acquired neurodiversity, where the natural shifts in your body can significantly affect how your brain works. Common issues like forgetting where you put your keys, having trouble staying focused, or feeling moodier than usual are all part of this transition. These challenges are often made worse by other symptoms of perimenopause, such as sleep problems and emotional ups and downs.

Women with known ADHD entering perimenopause often find that the strategies they previously used to manage their symptoms are less effective. The additional cognitive load imposed by hormonal fluctuations can exacerbate previously compensated ADHD symptoms, making them more severe and harder to manage.

There’s a pretty noticeable overlap between perimenopause/menopause symptoms and ADHD. Once you stack up the list of what’s common to both, it’s clear to see why things might feel a bit more overwhelming when you hit perimenopause and menopause. Those ADHD symptoms you've been managing? They could get trickier to handle during these changes. So, if you’re feeling a bit off during this time, there’s a good biological reason for it.

What’s happening behind the scenes? Well, it’s all about hormones. The ebb and flow of estrogen and progesterone during perimenopause don’t just affect your body; they also mess with your brain’s chemical messaging system and even the flow of blood in your brain.

 

The Estrogen-ADHD Connection: Exploring Estrogen's Impact on Neurotransmission

Estrogen plays a crucial role in the brain, especially in how it relates to ADHD. This hormone helps regulate neurotransmitters like dopamine and serotonin, which are key players in managing our mood, focus, and overall executive functions. When women go through significant hormonal changes, like during perimenopause, the rollercoaster of estrogen levels can lead to a spike in ADHD symptoms. This is often due to what’s known as estrogen withdrawal, where the sudden drop in estrogen levels disrupts the normal balance of neurotransmitters, making symptoms more noticeable.

 

Estrogen and Serotonin

Estrogen isn’t just about mood swings—it’s a big player in how your brain handles serotonin, which you totally need for nailing those executive functions and keeping your emotions on an even keel. Here’s a kicker: when your estradiol levels dip, studies have shown that the hippocampus (yep, that’s the part of your brain where long-term memories chill) can shrink by up to 40%. Don’t panic, though—this doesn’t mean your memories are wiped; it's more like the pathways to access them aren’t as wide open as before. The hippocampus is like the central hub for your personality, storing all those experiences and interactions that make you, well, you. So, maintaining healthy estrogen levels is pretty essential not just for remembering where you left your keys, but for keeping 'you' feeling like 'you.'

 

Estrogen's Influence on Dopamine

Estrogen plays a pivotal role in regulating dopamine, a neurotransmitter that's essential for our reward system and focus mechanisms. Low dopamine can feel like a persistent fog of fatigue, lack of motivation, and difficulty finding joy or satisfaction in activities that normally feel rewarding. Research has shown that estrogen helps manage how dopamine transporters and receptors function in the brain. As women enter perimenopause and their estrogen levels start to wane, so does the regulation of dopamine, which can intensify ADHD symptoms.

 

The Relationship Between Estrogen and Acetylcholine

Years of research have highlighted the critical role of the central nervous system's cholinergic systems in our ability to learn, remember, and pay attention. Estrogen also significantly influences acetylcholine, another key neurotransmitter that's crucial for learning and memory. Studies have repeatedly shown that estradiol bolsters various cognitive processes, enhancing attention and boosting both verbal and visual memory.  However, during perimenopause, as estrogen levels decline, the production of acetylcholine also tends to decrease.

While Ritalin and similar stimulants are commonly used to manage ADHD, they primarily target dopamine pathways and are generally more effective in treating severe inattention rather than milder forms. These medications can improve tasks involving visual memory but often fall short in enhancing focus amid distractions or in complex task planning– because they fail to directly support acetylcholine function. Additionally, they come with a host of potential side effects, ranging from mild (sleep disturbance, anxiety, reduced appetite, or headaches) to more serious risks (increased blood pressure and risk of stroke and heart attack, development of or worsening of manic symptoms or other  psychiatric conditions, decreased bone density with higher risk for early onset osteoporosis and higher fracture risk).

Unlike these stimulants, strategies that support acetylcholine can offer broader cognitive benefits. Both personally and clinically, I have found the supplement Optimal Focus by Seeking Health, to be incredibly valuable as a component of a well-rounded ADHD support program. It  includes ingredients like Ginkgo Biloba and Huperzine A. These components are intended to enhance cognitive functions such as memory and attention, providing a more comprehensive approach to managing ADHD symptoms, particularly in women experiencing perimenopause. This combined support for both dopamine and acetylcholine pathways could be key in developing more effective ADHD treatments.

 

Histamine: Beyond Allergies, A Neurotransmitter with Wide-Ranging Effects

Histamine is well-known for its role in allergic reactions—think sneezing, itching, and red eyes. But histamine's job description goes way beyond making us miserable during allergy season. It's also a key neurotransmitter, playing roles in our digestion, sleep-wake cycles, mood and brain function. This makes it a substance of interest not just for allergists but for anyone interested in maintaining optimal health.

 

When Histamine Highs Lead to Health Lows

Histamine's influence extends into what's known as Speer Allergic Tension-Fatigue Syndrome (SATFS), a condition marked by fatigue, irritability, depression, and cognitive fog–often alongside typical allergic symptoms like asthma and eczema. This overlap hints that when dealing with persistent allergies and cognitive or mood disruptions, histamine could be a common denominator.

 

DAO: The Histamine Handler

Central to managing histamine levels in the body is the enzyme diamine oxidase (DAO). DAO is primarily responsible for breaking down histamine that our bodies produce, preventing its accumulation. In the context of Attention Deficit Hyperactivity Disorder (ADHD), DAO's role becomes particularly significant. Research suggests that reduced DAO activity could lead to heightened histamine levels, potentially exacerbating or contributing to ADHD symptoms.

 

How Perimenopause Amplifies Histamine

Estrogen dominance is  characterized by either  high levels of estrogen or insufficient progesterone to counterbalance estrogen's effects. This hormonal imbalance can lead to an increase in histamine levels because estrogen can stimulate the release of histamine from immune cells known as mast cells. When estrogen levels are high, more histamine is released, which can exacerbate symptoms like allergies, hives, mood swings and anxiety– and ADHD symptoms.

On the other hand, progesterone naturally helps to regulate and stabilize mast cell membranes, preventing them from releasing histamine unnecessarily. Low levels of progesterone, therefore, can lead to increased histamine release because there's less hormonal regulation keeping mast cell activity in check. Progesterone also upregulates the production of DAO, the enzyme that helps break down histamine.

For women in various stages of perimenopause, these mechanisms are particularly relevant. During perimenopause, hormone levels fluctuate significantly, and periods of estrogen dominance accompanied by low progesterone are common. These hormonal shifts can result in increased histamine-related symptoms, which may manifest as worsening allergies, sleep disturbances, or changes in mood, brain function,  focus,  and emotional well-being.

 

Keeping Histamine in Check

Several factors can cause histamine levels to get out of hand:

• Genetic Factors: Variations in genes like HNMT or DAO can slow down histamine breakdown, leading to higher levels.
• Nutrient Deficiencies and Liver Detoxification Pathways: Certain nutrients are crucial for breaking down histamine. Without them, our bodies struggle to keep histamine levels balanced.
• Gut Health: A healthy gut is critical for producing DAO. If the gut is compromised, so is DAO production, which can lead to increased histamine. Additionally, the presence of specific types of gut pathogens (certain bacteria, parasites, or candida overgrowth) can stimulate the production of higher levels of histamine.
• Diet and Lifestyle: Certain foods and lifestyle factors can trigger histamine release or inhibit DAO, exacerbating symptoms.

For those wrestling with ADHD understanding and managing histamine levels can be transformative. This is just one reason why an integrative approach that considers hormone balance, gut health, detox support,  and potentially using supplements to support DAO production can be very effective for some women. By addressing histamine management from multiple angles, it's possible to achieve a better balance and improve overall mood and cognitive function.

 

Bringing It All Together: ADHD, Perimenopause, and Whole-Body Health

When it comes to managing ADHD symptoms during perimenopause, hormone replacement therapy (HRT) really should be on your radar. HRT can help stabilize those roller-coaster hormone levels, easing some of the intensified ADHD symptoms that come with this life stage. This approach is a breath of fresh air compared to just ramping up doses of stimulant medications, which often miss the mark on addressing the deeper hormonal imbalances and can leave you dealing with some pretty annoying side effects.

But there’s more to the story than just hormones. Keeping your blood sugar stable throughout the day with a well-rounded diet can make a huge difference in how you feel—think fewer energy crashes and mood swings that can kick your ADHD into overdrive. Also, giving a boost to your brain’s neurotransmitters with the right supplements or botanicals can really sharpen your mental clarity and help your brain stay on point.

Don’t overlook the importance of checking for food sensitivities either. Figuring out if certain foods are causing you trouble and cutting them out can seriously help calm ADHD symptoms and boost your overall well-being. And let’s not forget about gut health—it’s a game changer. A happy gut means better detox, better nutrient absorption, and better overall hormone and neurotransmitter balance, which all adds up to you feeling better.

Tackling ADHD during perimenopause with these strategies offers a well-rounded approach that looks at your health from multiple angles.

Give yourself some grace during this transition! Embracing tools like notepads, organization apps (Sunsama, Inflow, Focus@Will)  and reminders to help bridge memory gaps is a smart strategy, not a setback. It’s also perfectly okay to take a bit more time with tasks or to ask for help. Remember, you're navigating a significant shift—this isn't about failure, it's about adapting and finding strength in vulnerability. Treat yourself with kindness and compassion as you adjust.

 

References

1. Eng, A. G., Nirjar, U., Elkins, A. R., Sizemore, Y. J., Monticello, K. N., Petersen, M. K., Miller, S. A., Barone, J., Eisenlohr-Moul, T. A., Martel, M. M. (2023). Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. University of Kentucky, Department of Psychology. Link to article
2. Roberts, B., Eisenlohr-Moul, T., Martel, M. M. (2018). Reproductive Steroids and ADHD Symptoms Across the Menstrual Cycle. Psychoneuroendocrinology, 88, 105–114. PMC5803442
3. Jongkees, B. J., Hommel, B., Colzato, L. S. (2014). People are different: tyrosine's modulating effect on cognitive control in healthy humans may depend on individual differences related to dopamine function. PMC4186281
4. Perimenopause, Menopause and ADHD. (2023). Cambridge University Press. Journal of the International Neuropsychological Society
5. Roberts, B. A. (2016). Ovarian Hormones, ADHD, Risk-Taking, & Impulsivity. University of Kentucky. Link to thesis
6. ADHD Symptoms in Females of Childhood, Adolescent, Reproductive and Menopause Period. (2021). Mater Sociomed, 33(2), 114–118. PMC8385721
7. Cumulative exposure to ADHD medication is inversely related to hippocampus subregional volume in children. (2021). Neuroimage Clin., 31, 102695. PMC8141923
8. Estrogen-Cholinergic Interactions: Implications for Cognitive Aging. (2015). Horm Behav., 74, 173–185. PMC4573353
9. Johansson, J., Landgren, M., Fernell, E., et al. (2013). Decreased binding capacity (B max) of muscarinic acetylcholine receptors in fibroblasts from boys with attention-deficit/hyperactivity disorder (ADHD). ADHD Atten Def Hyp Disord, 5, 267–271. Link to article
10. The diamine oxidase (DAO) enzyme, which metabolizes histamine extracellularly, could contribute to ADHD symptoms. PMC10455974

 

---

by Bassem