Well with Arielle Lorre - 137: Understanding Hormones & How to Support Our Bodies with Dr. Aviva Romm

Episode Date: October 27, 2021

In this episode I am talking to Dr. Aviva Romm, MD, midwife and herbalist, about women’s hormones and cycles. We discuss what exactly hormones are and their function; how the menstrual cycle works; how to know when something is off with our hormones and what to do; how to support our hormones and cycles through nutrition and other lifestyle factors; trends like intermittent fasting and seed cycling and their true effect on hormones; what a healthy cycle looks like; conditions like PMS, PMDD and PCOS; what to do about PMS symptoms like acne, and so much more.   www.JustThriveHealth.com/discount/Blonde for 15% off site-wide. www.Ritual.com/BLONDE for 10% off your first three months. www.Helloned.com/BLONDE for 15% off and a Free De-Stress Blend Sample on every order over $40. www.Beekeepersnaturals.com/BLONDEFILES for 25% off your first order.   Produced by Dear MediaSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Auto-hue with Sunny Cars feels as if the children Not me's high. Giselsramble, Zandvorda. Actis forcare, verdwine, vacancy can chaotic

be chaotic. But who'sorgloos an auto-hurt says, Uno-dos, no stress. No, no-verwachted costs, always full-ledged. So,

would auto-huees-on-sor-sonder-zorger. Go to your rice-adviseur or Sunnycars. The following podcast is a dear media production. Hey, welcome to the Blond Files podcast. I'm your host, Ariel Lori, and I'm here to talk all things wellness. From how to achieve optimal health and well-being to the best beauty tips and everything in between, no topic is off limits.

I know there is so much information out there, so I'm here to help you navigate it all and live your best life. Thanks for listening. Let's get into it. Hi, everybody. Welcome to the show. I am very excited about this. episode that I have for you today, very excited about my guest, Dr. Aviva Rom. I mentioned over on Instagram that she was coming on the podcast and I did a little question box thingy and let me just say I was inundated with questions. It seems to me that a lot of people are either having problems with their periods or problems with their hormones or they just want to learn more. and we might end up doing a two-parter on this episode because we had such an interesting conversation and we ran out of time.

But we did answer a lot of your questions kind of integrated into our convo. So a little background on Dr. Aviva Ram. She has bridged her interests in traditional medicine with her knowledge of science for over three decades. She is a midwife and an herbalist for 25 years. And she is also a Yale trained MD board certified in. family medicine with obstetrics, and she's one of the nation's leaders in the field of botanical medicine and the author of seven books on natural medicine for women and children. Her focus is on women's and children's health with an emphasis on the impact of stress on health, energy, food cravings,

weight, chronic disease, and hormone imbalance. And in this episode, we discuss what exactly hormones are and what their function is, how the menstrual cycle works, how to know when something is off with our hormones and what to do. We talk about how to support our hormones and cycles through nutrition and other lifestyle factors. We talk about trends like intermittent fasting and seed cycling, which was a question that I got a lot. And their true effect on hormones. We talk about what a healthy cycle looks like conditions like PMS, PMDD and PCOS, what to do about PMS symptoms like acne and so, so much more. We really get into it in this episode. So without further ado, Dr. Aviva Rom. Okay, welcome to the show. I'm so excited to talk to you. And I know my audience is also very

excited to hear from you. I was just telling you off mic that I have never gotten so many questions as I got when I did an Instagram question box yesterday. It seems like everybody is either having problems with their hormones or they want to know more. So welcome. to the show. Thank you. Those Instagram question boxes can be like Pandora. I'll put it out there and think I'm going to do a little Instagram live and then I've got like 150 questions to sort their own answer. We'll get to as many as we can. Hopefully in our chat, we'll cover a lot of things that people are wondering about and maybe we can do some direct questions at the end. Yeah, that sounds perfect. So to start off, maybe you can just give everybody like a condensed bio of yourself. Sure. Basically,

I am a midwife, an herbalist, and a Yale trained MD. I'm an author, super excited to say now that I'm the author of the New York Times bestselling hormone intelligence book, which is very fun to be able to just like, ah. And let's see, I'm a mom. I have four kids and two grandbabies where I got to midwife at home, which is especially fun to share. And I'm in clinical practice. I teach, I write, and just love connecting with women about just being more empowered in

our bodies around our hormones and our health. Can you talk a little bit about the marriage of your MD from Yale and your herbalism? Because those are kind of opposite ends of the spectrum. Yeah, they are. Long story short, I went to college when I was 15 to be a physician. Within like three months got exposed to natural medicine, healthy eating. But this was like, let's go back in time. We're like in a, you know, like time warp here.

This was like 1980, 1981, before any of this stuff was cool, popular, or you could go to a school to study it. So I left college at 16, apprenticed myself with a home birth midwife, studied with herbalists, studied everything I could find on herbal medicine at the time, which was like, you really had to dig back then, studied some Chinese medicine in Ayurveda, and then practiced as a midwife and an herbalist for three decades almost. And then realized that a couple of things. when I first decided to go back to school to kind of complete that path of becoming a physician, it was still before the curve of all this stuff being cool and trendy and just like on point and integrated into conventional medicine. So originally I wanted to really create a bridge for people

who kind of philosophically wanted to do things more naturally, but maybe their health or their body wasn't really allowing that fully. And maybe they needed something conventional, but didn't want to just be sort of like the sheep in the wolf den, right? Like they wanted to be able to have integrity and listen to their bodies and not just be told, oh, you have to do this drug or this surgery. So that was kind of my original role in it. And now as integrative and functional and more natural approaches have become so widely desired by women, my role has become a lot more around educating physicians, educating other

health care providers on really how to use these therapies thoughtfully and not just throughout the baby with the bathwater. It's not all natural, all diet, all botanicals, all supplements, or all drugs and surgery. But how do we create this, what I call new medicine for women, where it's all allowed and we're picking the best thing for our needs, our philosophical place, where we are in our life, like what's going on physically and what's most appropriate. So that's how I married it together. It was definitely a journey. I mean, it was really interesting because I went to Yale med school and they were super excited to have me there and to kind of like welcome me to learn what I could learn there, but also to learn for me. So I've created curriculum for Yale that's used in over 150

medical and residency training programs around the country, got Yale off to a running start on an actual integrative medicine department. So it's been a really fun road. Wow. That is incredible. And it's so encouraging that it seems like, you know, traditional Western medicine is kind of heading in this direction, at least, of incorporating more of an integrative approach. And I think a lot of people listening, especially when it comes to, you know, women's hormones. And I think for so long the solution has always been like the birth control pill. I mean, so many of the questions that I got were around that. I've had that experience myself. And now it seems like there is more of a focus. on incorporating more lifestyle things, more maybe herbs and supplements and stuff like that. And it's not either or like you said. It's kind of, they kind of work in concert with one another. They do. I mean, unfortunately, most medical education programs don't include anything beyond maybe a little bit of lip service. Like, you know, you might hear a little bit about meditation or the importance of diet or you might hear about, you know, is echinacea safe or not for a cold?

But most physicians don't come out of medical training, having enough knowledge or information to really help their patients make meaningful changes with these kind of other therapies. And also what's been really interesting is that on the one hand, we have more physicians and a lot more women physicians who are open to alternatives, if you will, especially because sometimes they themselves have run into a wall with what they were getting from conventional medicine. and they wanted something different for themselves or saw something really work for themselves. But as these alternative therapies, if you will, have become more popular, you know, we see goop in the crosshairs of like attack. Then there's also been some pullback by physicians, you know,

where I was just what, I love Gray's Anatomy. I started watching Grey's Anatomy like in med school. And I was watching an episode recently. And it was really interesting because this, woman was one of the patients and she had come in and somehow she was saying that she was doing a prosperity ritual and it involved, and they said this on Gray's Anatomy, it involved a strawberry and a yoni egg and she accidentally ate the strawberry and put the yoni egg. I mean, she actually accidentally ate the yoni egg and put the strawberry where the yonie egg was supposed to

go. But I thought it was incredible. Like when I used the word yoni like in 1980, it was such a fringe word, right? And now it's like on national television. And so there's definitely acknowledgement. And at the same time, it's almost made out to be a little bit ridiculous. Like there's a little backlash. But on the other hand, one of the physicians in the room was male and the patient, and he was like, what is this stuff? And the patient looked at him. She's like, how old are you? Like that you just don't know what this is. So it's really been an interesting, like, yes, there's more awareness. Yes, there's more demand for it. But physicians are so really skeptical.

So it leaves women to sort of still sort these things out on their own. And that's kind of where I've tried to come in with my role. You know, there's so many wonderful people in the wellness space. So any one of us who's in it has to say, well, where am I adding value? And I think for me where I probably add the most value is, you know, I've got 35 years of lived experience in the wellness space before it was the wellness space and really using these therapies in my life and in clinical practice. So, you know, on the one hand, I can really say, yeah, this stuff really has value.

And on the other hand, I can also say, well, maybe we do need an antibiotic for this. You know what I mean? Like finding that, being that voice of balance in there. When I was having really bad gut issues, my cortisol was through the roof. And as a result, my reproductive hormones and my cycle kind of just went offline. Everything was way out of whack. And part of healing all of this was incorporating. a good probiotic into my daily regimen. So we touch on this in today's episode and we know that a good

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Some of the other products that I love from beekeepers naturals are the bee chill honey with CBD and I love the Be Smart brain fuel that really helps with that like midday slump and brain fog and they just have something for everything. So I definitely recommend going to check that out. Today, beekeepers naturals is offering you an exclusive offer. You can go to beekeepers naturals.com slash blonde files or enter the code blonde files to get 25% off your first order. That is B-E-E-K-E-E-P-E-E-R-S-N-A-T-U-R-A-L-S dot com slash blonde files, or the code blonde files to get 25% off your first order. order. Start feeling better every day today. I'm Amanda Lipman. I run an organization called Run for Something. I wrote a book called Run for Something. And now I host this show also called

run for something. My mission is simple. Find people who care about solving problems and help them run for office. Every Tuesday, I'll talk with amazing and incredible candidates and elected officials who are already making a difference. They're in local offices that might seem small and not so sexy, but are actually hugely important for your day-to-day life. Fixing our broken system. will take all of us and people like you. Listen in every Tuesday wherever you get your podcasts. Okay. So we need to be careful with time today since we got thousands of messages. And I know we want to get to as much of it as we can. So I wanted to start out by asking you just what is a hormone. I'm sure everybody listening is kind of familiar. But I think the name hormone just gets thrown around.

So what exactly is it? And what specifically is it in women? So a hormone simply is a chemical messenger. It's a chemical that's produced in one part of the body. For example, you can have insulin produced in your pancreas or estrogen produced in your ovary or cortisol produced in your adrenals. And then it's released into your circulation and then either acts locally on cells to make certain things happens or it travels through your bloodstream somewhere else. So in women and men, and we have, we pretty much have most of the same. all of the same hormones. We just have them in different proportions at different times, and ours are very cyclic. So in women, we tend to think of estrogen, progesterone. We also have testosterone. The precursors of like that stimulate our ovaries are actually usually produced in our brain. They travel through our bloodstream to our ovaries and get things going where they stimulate ovulation and then they stimulate our menstrual cycles in our uterus. But we also want to think about things like insulin because insulin, even though it's a blood sugar hormone, it has a huge amount to do

with our metabolism, which can affect things like polycystic ovary syndrome. Or we want to think about our thyroid hormone, even though we don't think of it as like a female hormone, like estrogen and progesterone, for example, it's so critically central to our energy, again, our metabolism, but also our ovarian function. Cortisol, when our cortisol from our adrenals is off-kilter, because we're really stressed out or we're not sleeping or we've been ill, that can have a huge effect on our female functions like ovulation and menstruation and fertility. So they're all connected and really powerful. We produce them in teeny tiny parts per million.

Like if you can imagine one drop of blue dye in an Olympic swimming pool, we produce these teeny tiny amounts, but they have a mighty role. And they govern pretty much everything or interrelate with everything from our mood, our emotions, our mind, our energy. Even we now know that like our food choices, maybe even our clothing choices at different times of the month. The exercise, that's better for us. The foods are better, better for us vary with our menstrual cycles and very also with our life cycles, like whether we're in puberty or our fertility years or pregnancy or menopause.

What are some signs that something might be awry with a woman's hormones? Well, anytime our energy is low, we're emotionally all over the place, our thinking is off, we're having a difficult relationship with food, cravings, how much to eat. Those are some of the more hidden signs. Some of the more obvious signs could be heavy periods, skip periods, irregular periods, hair loss, hair and unwanted places, sleep problems, not ovulating, fertility challenges, pelvic pain, low sex drive. And they're just kind of of like there isn't a lot that isn't actually connected to our hormones. So there's a whole big list. But those are some of the top ones. Low sex drive. I didn't mention that one. That's a big one.

If somebody is experiencing any of these things or multiple of them, what is the best course of action to take? Is there a test that people can do? Should they go see their doctor or is there something they can order? How do they go about that? So it depends on what the symptoms are and the severity of symptoms. So obviously, if you're feeling really sick, you're having like crazy amounts of vaginal bleeding, something that can put you at risk. It's definitely a great idea to go see your doctor and get tested. If you're having like new onset of pain or like extreme fatigue, anything like that. But what's really interesting is that each of our different hormones has almost like her own kind of rhythm and her own flavor, if you will. So there are sets of symptoms that we can say,

okay, if someone's having like regular breast tenderness, heavy periods, a lot of PMS, really like their breasts are just like full and achy, for example, they're having a lot of mood swings. We can often lean in and say, okay, that's probably something going on with estrogen, whereas we can look at other sets of symptoms and say, okay, that's probably progesterone, that's probably testosterone, that's probably thyroid, that's probably cortisol. So getting a good checklist, which obviously you can do in hormone intelligence, my book, or you can find online that shows you which hormones are out of balance and how that relates to what symptoms can be really helpful. But just getting a test and just knowing what hormone

it is isn't necessarily the answer unless you're going to take a pharmaceutical approach. So if you have symptoms of low progesterone and you're going to take progesterone, sure, that's going to be helpful. And maybe getting a test will confirm that's what's going on for you. But usually the lifestyle approaches, whether those are dietary, nutritional, like supplements, herbal supplements, et cetera, kind of approach the whole constellation of hormones at once. And so if you're going to take a natural approach, it's really more about how can I sort of realign with my cycles. How can I bring my cycles back into like their healthy natural blueprint?

Testing can help, but not always. But checklists can really make a difference. And then understanding like, okay, this is really what's happening with my body. This is what progesterone is supposed to do. This is what estrogen is supposed to do. These things aren't happening. What can I do to bring this back in balance? Are there certain lifestyle practices?

I know that nothing is really, quote, unquote, universal, but generally that are beneficial for supporting hormones and a healthy cycle. And then conversely, are there things that can be detrimental to balanced hormones in a regular cycle? Obviously, we know stress can affect that. And you mentioned cortisol. But are there specific things?

Yeah, I would say probably if there were two things that women could really focus on to have generally good hormone flow, good hormone balance, it would be what are we eating and especially avoiding low blood sugar and getting our sleep groove on. Because when sleep is disrupted, it really deeply affects our entire circadian rhythm. And that can have a huge impact on stress, you know, drive sugar cravings of fatigue, make, no, push us to drink more coffee,

not take care of ourselves as well, but it also can really throw off our ovarian function and our general hormonal menstrual cycles. It can affect us in perimenopause and menopause too. So sleep is a huge one. And then blood sugar balance and then just make sure within that, within our diet,

getting all the nutrients that we need. So for example, if our blood sugar balance is off, if we're constantly skipping meals, if we're not getting enough protein and fats. One, we're driving our brains into a stress response. So we're doing the same thing that happens if we're not getting good sleep or we're too stressed out. We're jacking up that cortisol.

But the other thing is your body really relies on some basic nutritional building blocks to actually make hormones. So if you're underweight, if you're not getting enough fat, you actually can't make hormones because hormones are built off of cholesterol and you have to get fat to have to have. cholesterol to build hormones. We have to have enough zinc, enough selenium, enough iron, enough vitamin D, enough magnesium, and the list goes on. So if we're skimping on our diets and not getting those nutrients, then we can't actually produce the hormones that we need to produce. It's really quite basic in some ways and yet really powerful. I noticed in the questions that people sent in that there were a lot of questions about intermittent fasting and hormones. So does that

cause the blood sugar to be low and then consequently affect the hormones or cannot be appropriate for some women? Yeah, it's a great question. I was just teaching about this actually earlier today. So the studies on intermittent fasting that have shown so many great results like improved metabolic, you know, parameters, reduce insulin, reduced inflammation, have largely either been done in men or like there was one great study that found that people who did intermittent and fasting had reduced depression and less binge eating, but that was in specifically people who were already overweight and who had depression. The metabolic parameters have been specifically in people who are pre-diabetic and most of the studies have been done in men. So the limited number

of studies have shown that for some women, intermittent fasting may be beneficial. So if somebody has metabolic syndrome, they have high blood sugar, they have high cholesterol, they've put on a lot a weight around their middle, short bursts of intermittent fasting, but no more than three weeks at a time may be beneficial. Women with polycystic ovary syndrome, if they have insulin resistance, may benefit. But overall, the restriction that happens with intermittent fasting may actually rebound on women. So I always say, look, if you're pregnant, if you're trying to conceive, if you are breastfeeding, definitely not for you. But if you're 55, And you're in menopause now and you've gained five or seven pounds or 10 pounds or 15 pounds.

And you're like, I'm not so happy with this. And you want to try intermittent fasting for a short time. Great. If you're really struggling with weight that's hard to lose or if you have insulin resistance or high blood sugar, it can be great if you try it. But just for like a short time, see how you feel. And I don't recommend for women the whole eight hours, 16 hour, like the 8 to 16, which is eat within an eight-hour window and then fast for 16 hours.

I really recommend doing either a 12-12, which is keep your eating to 12 hours and you're overnight basically fasting for 12 hours. So let's say you stop eating dinner at 7. You don't eat breakfast until 7 the next morning. Like that's a good way to give your body that same reset. You get a little bit of ketosis. You get that reduced inflammation, but you don't get the stress on your system. And some women do fine with a 10-14.

So they eat within a 10-hour window. and then they don't eat basically like after dinner until the next morning. One really important thing for women who try intermittent fasting is two things. Don't drink coffee as your breakfast to the next day and then not eat breakfast until like 10 or 11 o'clock. That is not great for your cortisol and your hormones. The other thing is when you do eat that first meal of the day, it's really important not to in some ways like psychologically reward yourself and say, okay, now I did this fast.

I can eat anything. and don't make it two meals worth of food at once. It's still supposed to be like one healthful meal. So that's kind of my run, you know, my skinny on intermittent fast thing. So ultimately it is kind of calorie restriction. Not that that's the approach, but if you're not doubling up, say, when you have your first meal, like ultimately that balances out to probably using more energy than you're taking in. And that's usually.

Okay. So I like to use this concept called. time-cycled eating. And so it's the concept of intermittent fasting or what in science is called time-restricted eating, but I do not like the word restriction and food in the same sentence. So time-cycled eating is essentially saying, I'm going to eat within this window of time during the course of a day. So I'm going to eat breakfast, lunch, and dinner. I'm going to keep my blood sugar really nice and steady. I'm going to try not to eat between meals so that my body goes into like that nice rest and digest mode in between meals, maybe space meals, three,

to four hours apart, but okay, I'm going to eat between eight in the morning and eight at night. Or I'm going to eat between seven in the morning and seven at night. And then the other time I'm not going to eat. And it's just sort of a gentle way to approach it. That gives us all the same benefits as time restricted eating or intermittent fasting. But I think it's just much more physiologic for women. Intermittent fasting to me conjures like a biohacker. Yeah. You know, it's really interesting. I really, this word, biohacking. I know this isn't a side, but it actually really bothers me. I feel like it's such a I mean, look, I'm like a very like driven, intense, competitive, high achieving human being.

And at the same time, I don't equate those qualities with being male. Like I equate those with like high achieving women. But when we start getting into like biohacking, it feels so robotic and so masculine to me. And it also feels like we're looking outside of our bodies for devices and tools and things that are going to give us information about our bodies. When I feel like for us as women, especially because we're so like kind of taught to measure ourselves up about against everything external from like what we see in magazines to like so many things that I really prefer the idea of going within and listening to our bodies, more of an intuitive eating approach. I just really don't love that term hacking or biohacking in women's health.

Yeah. There's an image in my head when I think about it. And it's kind of that toxic masculinity. I agree. And I know a few women in the wellness space who were just really big on it, some hormone colleagues of mine. And I'm just like, can we just not call it that? Totally agree.

Okay. Bio-alignment. Maybe we should call it bio-aligning. I like that. Bio-aligning. Yes. Okay. So there were two other things that came to my mind.

just since we're talking about kind of eating, a lot of people also wanted to know about seed cycling. And I know your opinion on this because I've heard it on other podcasts, but can you share with the audience? Yeah. So I have no problem with seed cycling. You know, seeds, talking about the nutrition that I was talking about, like the zinc and all these nutrients. Seeds are hugely rich in the nutrients that our ovaries need. I kind of think about it like, I mean, seeds in some ways are like the ovary of the plant, not to get too philosophical here. But I feel like the energy that seeds create in order for their own reproduction is just filled with the same nutrients that we need for our ovarian function and reproduction. So seeds are phenomenal. Pumpkin seeds. I'm like, I should get stock in a tahini company as much as Tiffany is like pumpkin seeds, sesame seeds. Tahini is like one of my favorite seed sources, sunflower seeds. They're phenomenal. Flack seeds are great. So I'm all about women eating seeds in their diet pretty much every day. Seed cycling is a

biohacking concept that says if you eat certain types of seeds at certain times in the cycle, you will get certain results. And the science is very different than that. So for me, you know, if you love seed cycling, because it makes you feel more in touch with your cycle and more in touch with the rhythms of your month. And you just love that, then do it. it. If it reminds you to eat pumpkin seeds, you know, two weeks of the month and it reminds you to eat sesame seeds and sunflower seeds two weeks of the month, awesome, do it. But a tablespoon here and a tablespoon there and like which seeds you eat in your follicular phase or your alludeal phase, that is a made-up brand. Again, if you love it, there's no harm in it, but just know that

the science of seed cycling isn't accurate. That's the main thing. Dr. Rahm talks about how helpful a daily multivitamin can be in this episode, and I have to share my absolute favorite is ritual. Rituals essential for women 18 plus multivitamin was formulated by exhaustive research to help fill nutrient gaps in the diets of women ages 18 plus. It is formulated with nutrients to help support brain health, bone health, blood health, and provide antioxidant support. But ritual didn't stop there. they invested in a gold standard university-led clinical trial to prove the impact of Essential for Women 18 plus multivitamin. The results, essential for women 18 plus was shown to increase vitamin D levels by 43% and omega-3DHA levels by 41% in 12 weeks. So I have taken ritual for years and I absolutely love them.

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And also, cardam helps to combat stress by helping reduce your blood pressure and cortisol levels. Another thing that I really appreciate about Ned that was super important to me is their transparency. They share third-party lab reports, like I said, who farms their products, and their extraction process all on their website. So if you've never tried CBD or you're a little wary or trepidacious, you can head over there and see all of that for yourself. And you can also see their over 1,500 five-star reviews. And they also have other amazing products on their website. I always talk about mellow, their magnesium blend that does not have CBD. It's absolutely incredible, so I definitely recommend trying that too. So if you want to try the new de-stress blend from Ned,

they have a special offer for my audience. Every order, over $40, will qualify for 15% off and a free de-stress blend sample. Just go to www.com slash blonde or enter blonde at checkout to take advantage of this offer. That's H-E-L-L-O-N-E-D dot com slash B-L-O-N-D-E, or use the code B-L-O-N-D-E, to get 15% off plus a free de-stress blend sample on any order over $40. So let's talk periods. What is a normal, healthy period? What does that look like? So there's a lot of variety. Let's just start with that. There's a lot of variety in what is normal and healthy. So coming from that kind of perspective, I'm going to kind of give you a general range. For most women, a normal healthy menstrual cycle happens somewhere between every 26 and every 34 days.

But if you always have a 35 day cycle or you always have a 25 day cycle, nothing else is going on that's like a symptom. I wouldn't go, oh my God, she said, you know. So 26 to 34 days generally lasts from three to seven days. Doesn't require you to constantly be changing pads or tampons and think, oh my gosh, I'm going to like blow through tampons. And if I don't double up, I'm going to be like bleeding through everything or a pat that you can't double up your tampon but double up your pad or like tampon and pad. So really flow should be manageable, not take you out of your life.

and ditto that on discomfort. So it's really normal to have some physical sensations that let you know you're in a different phase of the month. So often around ovulation, we're feeling great. We're like energized and we're like feeling sexy and like creative and like getting our groove on and like sticking with our food plans and getting our exercise on. It's like all great. Then we all know like right before our period, maybe like three days before,

we're kind of like I would rather go in a cave with Netflix and a book right now or take a bath and not be all out there in the world. That's normal. Like to feel that pull in of energy is really normal. To feel a little fullness in your breasts. To feel a little fullness in your pelvis. All of that is normal. To feel some mood changes. That's all normal. When it starts to get uncomfortable for you or take you out, like your breasts are really hurting. Or you're like your mood, you just don't even want to be around your own self because your mood is so off the chain or, you know, like you're really down or you're really anxious or you're not sleeping or you're having pain. Like you're really when your period comes, you're having pain. Our periods

should be basically painless. And I know that sounds so radical to say, it's not that you don't feel a little uncomfortable. Like it's not fun to have blood coming out of your vagina. And like, you do want to think about, am I going to wear white pants right now, right? But, but you shouldn't be taken out. Like, you shouldn't actually have to take ibuprofen ever for people. period pain. The other thing is that your period should ideally be generally predictable. So if you're having a period 26 days one month and then 35 days another month and then 24 days another month and 50 days another month, like you can't predict anything based on that. So think about a rhythm. Like it should be pretty consistent within about four days from month to month. There's a lot

being made out there about period blood color. And again, up there with seed cycling and biohacking. there's a lot that's not true. So your period when you're first in puberty and, you know, kind of a teenager that first couple of it, it could be like brown, black. That doesn't mean you have stagnation or some problem. And as we get into perimenopause, it may be quite light. And that can be normal too. The color may be lighter. Our uterus isn't creating that thick lining. It's normal to have some clotting, but not a lot of clotting. So you really don't want clots to be more than the size of like a nickel, and you don't want clotting on the regular. If you're having clotting on the regular, it means you're having a heavier flow and your body's trying to keep you from bleeding too much.

If your period blood is really, really dark, you're either having some remnants of blood from your uterine lining from the previous cycle or you're just not looking at your pad or your tampon very frequently because once that blood hits the air, it starts to turn black. It oxidizes. So I think there's a little bit being, a little bit too much being made and causing us to be a little bit overly concerned about certain things that we could kind of go with the flow with a little bit more. I'm just going to self-disclose here because this is fascinating to me and I'm like, cannot relate because I have had, I have the most irregular periods and currently I have had it for six weeks. So, and I have PCOS. And I actually went to my doctor yesterday and she said everything. We did an

ultrasound. Everything looks gorgeous in her words, but it's the PCOS and probably stress. Yeah, and see, that's the thing. So like, you know, to the flip side of your question is, what do you do if these things aren't like normal, right? Like all the parameters I just shared. Yeah. And I'm doing air quotes for anyone who can't see me. I'm doing air quotes around normal. So that's when we say, okay, something's going on here. Just being, you know, in my book, I say being a woman is not a diagnosis. And we're, we've been taught like, oh, it's normal to have miserable period pain, just take ibuprofen and use a hot water bottle. It's normal to feel, you know, like a raving betch before we have our periods. And like, maybe it is if you're like

forced to go to work or do things when you really actually do want to be in the cave. But all these things are just kind of chalked up to normal instead of like, no, we're actually not supposed to feel miserable or have this like wild unpredictability or discomfort. So when those things are happening, kind of like the way I was saying that each hormone has its own flavor and when we see certain symptoms, we can tell which hormone it is. Most gynecologic conditions or things that we're dealing with also have their own flavor or symptoms. So PCOS like you know you have. One of the cardinal symptoms is periods that are all over the place, often skipping periods for a long time. And then when you do get the period, it's like the period from hell. Because now you're,

uterine lining has been building up for like two months or three months or six months or in like some case of patients. I've had eight months. And then it's like the gusher that finally comes out. So it sounds like that's what you are experiencing. Yep. I'm sorry. Thank you. It's okay. We're working through it. Working on it. A few people asked me about PMDD as well. And this is also something that I have experience with where like it's not just not normal. I mean, you're saying like it shouldn't be, it shouldn't disrupt your life. But I know from the questions that I got and just from, you know, even the experience of like my friends that so many of us do get really bad cramps, really bad mood swings, really bad tenderness, really bad hormonal acne, all of these things. And then there's an even more aggressive experience, I guess, which is like the PMDD.

And I get this where it's like debilitating anxiety. I mean like soul crushing anxiety. And depression too. Yeah, and like crazy insomnia and like crazy cramps. So yeah. So what, well, can we step back for, I just want to step back for one minute and really acknowledge that I think as women, first of all, when we have things going on with our cycle. And especially right now when the wellness kind of space and movement is so keyed in on cycles

being sort of perfect and a certain way, right? Our period blood color are, you know, are like. rhythms and our cycles and cycle-sinking, it can make you feel like there's something really wrong with you when you have endometriosis or PMS or PMDD or PCOs. As women, I think the first thing we think is what's wrong with me or what am I doing wrong or most commonly both of those things. So I want to step back and to say so many women are experiencing so many hormone imbalances right now. And it's nobody's fault. Well, it's none of the women's fault. There are factors that are happening from the lives that we're being pushed to

live in terms of like the amount of hours that we're working, the stress that we're under, the incredible performance pressure to look a certain way. The factors that are affecting our gut microbiome, like by the time a woman is 18 years old, she's had on average 20 rounds, not 20 doses, but 20 full rounds of antibiotics in her life. By the time we're 30, another 10 rounds. So that's a lot of antibiotics, you know, just doping up your microbiome and really that has a huge impact on our hormones.

We are exposed to an unbelievable amount of environmental toxins, 99% of which have never been tested on women's reproductive health. So there are all these factors that are affecting us that are setting off our natural biological blueprint. And so part of the answer to all of this is acceptance and saying, okay, this is not my fault. Something's going on.

And I'm going to do everything I can to because I deserve to live comfortably and happily in my body. But I'm also not going to blame myself because actually not all of this is even in my control. Like some of this got set in motion like PCOS. We now know endometriosis. we now know may get set in motion in our bodies when our moms are pregnant with us because of a variety of environmental and dietary, you know, exposures and factors. So having that sense of, okay, this is happening. I'm not broken. There are factors that are doing this to me. Now, like,

what can I do to get down to it to like do everything I can to feel how I deserve to feel in my body, which is phenomenal? And what are the things that are within my control of the change? So with PMDD, this is a big one. And we know just in general, the rates of depression in women have been skyrocketing for the last three decades, but especially the last decade. And I will say, like, we know in teenagers, there's been a tripling of suicide rate exactly in conjunction with the increased rate of social media use, especially Instagram. And it's not like we suddenly hit 21 and we're immune to it. Like, I'm 55 and I know it affects me. I get compare and despair. on the regular because I have to be on Instagram for my work. It just happens. And so there's depression

from that. There's depression from inflammatory diets we have. There's depression from an anxiety from the environmental toxins that we're exposed to. It goes on and on. So we have these situations that are coming up, PMDD being one of them. So what can we do? Well, there are a few things. So one of the things that happens with PMS and PMDD is that as we get to our periods, our estrogen goes way down. And as our estrogen goes way down, our serotonin goes way down too. So serotonin is that feel-good hormone. And when people take SSRIs like Prozac, those drugs help to keep serotonin levels circulating

and elevated. That's exactly how they're working. And interestingly, there's been no hormonal therapy found that helps with PMS, or PMDD, it's been SSRIs that help with them. So doing the things that we can do to help with our neurotransmitters, stress reduction, of course, being obvious, things like meditation and time in nature really can make a difference. But if you struggle with depression generally and or especially around your period

or anxiety, but especially depression, a light box can really make a difference. So in that week before your period, start sitting in front of a light box in the morning. Another thing is that a lot of women go grain-free. There's been so much pushback against whole grains. But whole grains, and especially in that week before our period, can keep that serotonin up because whole grains provide the building blocks for serotonin. The other thing is getting enough essential fatty acids. And especially if people are vegan, which I'm 100% in supportive, but if you're not getting essential fatty acids in your diet like fish oil or salmon and sardines and things like that, that can really affect your mood. And then a lot of women are low and be complex in magnesium. So, you know, taking a multi, adding in some fish or fish oil, a probiotic can really make a difference. We've seen probiotics make a huge difference in anxiety and depression for women taken throughout the month or a probiotic rich food if you eat yogurt or coconut yogurt or cashew yogurt, lactofermented vegetables are all really great. And I want to say, you know, for me, coming from being a mid-weigh,

wife and an herbalist. When I became a doctor, there was a lot of pressure on me. People were just kind of waiting to see, oh, is she going to go really conventional now and basically lean into pharmaceuticals? And I really don't. I actually 99% of what I still recommend in my practice is natural. I very rarely prescribe pharmaceuticals. But if you're experiencing hell, you know, you're just like living in hell for five days of the month or two weeks of the month, I think that it's really important for us to embrace the options that are out there. And if SSRIs are going to make a difference in your life, I think it's worth exploring them. And the really cool thing with SSRIs for PMS and PMDD is that you don't have to take them your whole cycle. Like, you don't have to take them all the

time. You can actually take them just on those days of the month, which can be really liberating if like, if you're only experiencing it during that time. And you can also take it just as a bridge while you're like working on the dietary and lifestyle stuff because that that usually doesn't change things like overnight. It can take a few weeks or a few months. I'm curious if you said that your hormones can affect like your neurotransmitters like serotonin. Does it work the other way around? Can your serotonin affect your hormones in the way that cortisol can? I mean cortisol is a hormone, but yeah, I don't think there's just the same direction, the connection between serotonin and hormone levels, it's more the other way around melatonin can affect our hormone levels.

Like estrogen and melatonin have a nice interaction with each other. Cortisol and estrogen have a close interaction with each other as hormones. I don't think that serotonin works the other way. However, I have heard over the many years of my practice some really interesting things like women who are in really difficult relationships and marriages having horrible menstrual cycles and then separating or getting divorced. And all of a sudden, it's like, huh, that's not happening anymore. I've worked with couples who have struggled with fertility, who at the end of the day, for whatever reason, usually having nothing to do with their fertility, end up getting

separated or divorced. Then they're both in another relationship. And if it's a male, female heterosexual relationship, the male's partner is pregnant and she's pregnant, like, but in different relationships. So I would say that our life experience has a huge impact. Our well-being, our happiness, our satisfaction has a huge impact on our reproductive functioning and our cycles. And we know it affects our sexuality so much. Right. Yeah, I was just thinking of my own experience. Like years ago, I was put on a low-dose SSRI. Actually for gut issues, they were like, this is before I knew what was going on. And they said sometimes a non-therapeutic dose. of an SSR, I could help probably with the serotonin in the gut. I'm not sure.

Yeah. And also mood, like anxiety and stress can help and depression can impact the gut so much. Yeah. And I'm thinking back to that and that was the last time my period was really normal. I went off since, but I'm like maybe it's just because I was feeling a little bit less anxious and maybe a little happier. I don't know. I think it's so important. And this has been really a powerful kind of like transition and transformation for me is how do we lean into the most natural options only because often they're the most safe and also most ecologically friendly, but also not limit ourselves when we do need something beyond that. And then how do we make the choice of what that thing is? Like should you ever use the pill and when? Should you ever use an SSRI and when?

And this can be hard decisions to make. But I think allowing ourselves to be expansive in how we think so that we don't, because what I see in my practice is so often women suffer for a really long time before we're willing to let ourselves get help, partly because I think we just are told this stuff is normal. Like I can't tell you how many women I've worked with who had like horrible, horrible, like take narcotics level period pain, who just thought it was normal because their mom had horrible period pain. So getting the help we need and not suffering with it indefinitely so important to give ourselves that. So you mentioned the pill. Can you talk about like when it is appropriate or maybe when it's not? And I did get a lot of questions from people about how to support their bodies when going

off the pill. Yeah. I know that can be a difficult transition. Yeah. So for the pill, from a birth control contraceptive perspective, it's a totally personal choice. So there's never really a time that it's not appropriate if that's what you really want, unless you have medical contraindications, like you have a migraine with aura and you can't take estrogen or something like that. So there are some definite medical contraindications. But if you want to take the pill,

I wouldn't let all of the internet negativity about the pill stop you from doing it. It's a convenient, usually effective, usually safe form of contraception. But what we do have to understand is, it can have very real and very serious risks And it often makes people feel crappy. Like you take it for contraception because it's easy, but then your sex drive goes down and then like, what's the point?

Or you're depressed. You know, there's a huge, a huge amount of depression that happens for women who start taking the pill. So, you know, you have to decide if it's for you and what kind of birth control is for you. If you have hormonal challenges that you're thinking about going on the pill for, I would say for women who have really, really heavy, really different. periods, sometimes the pill can help and it can be a bridge while you're working toward the other lifestyle and dietary changes that we've been talking about. The other time is if you have PCOS and you have really severe cystic acne, you know, having acne for men and for women is really up there with things that cause severe anxiety and depression. And I've had patients who have come to me

at their first appointment who have not gone out of their home other than when absolutely necessary in weeks because of an acne flare and they just, they don't want to be in public. Acne can keep you from applying for a job, showing up for a job interview, you know, just taking all kinds of like wonderful chances and opportunities in your life. So if it's getting in your way at that level, or it doesn't even have to be that severe to get in your way, then low dose progesterone, the pill in that form can really, really help. It's not the answer. The pill is never the answer. It's only just a band-aid, but it's a solution that kind of can cover some symptoms while you're doing the healing. When you come off the pill, about 80 to 90 percent of women will have a normal cycle within three

months if they went on the pill for contraception and didn't have an underlying pre-existing hormone problem that they went on the pill for. But the rest of the rest of the pill. But the rest of the pill, you know, of women, so 20% of women, it can take up to a year or more to get their cycle back regularly. And that's probably much more likely if you went on the pill because you were already having irregular cycles or hormone problems. Over on my website ataviram.com and also in my book, Hormone Intelligence, I have a whole protocol for what to do. It's very simple, but for how to support yourself going off the pill. Some basic things, a multivitamin, you know, make sure that you're getting magnesium, B12, vitamin D, all of these nutrients that the pill, B6 is a huge one,

that the pill depletes. You can get all of that in a multi, except the vitamin D. You won't get enough vitamin D in a multi. So you need to add that on. There's also an herb called Vitex. Sometimes it's called chasteberry that you can take, you could either just take it when you go off the pill if you had hormonal problems before, like irregular cycles and you want to transition to a regular cycle. I don't usually recognize. recommend that. They'll usually recommend giving your cycle a good three months to see what happens. And if at that point, you haven't started cycling again or your cycles aren't regular yet, then you could add in the Vitex. It helps support progesterone and estrogen levels. And it also, in doing that, helps bring back

regular cycles. So those are some of the things that I do. So you mentioned cystic acne. What about just acne around breakouts? That was another really, really common question that I got. It seems to be something that a lot of people struggle with. What causes that? Premensual acne. So premencial acne is caused by changes in testosterone that happen premenstrually and changes in our actual pores. It's really weird. And like on an evolutionary basis, I cannot for the life of me imagine why this happens. But our pores get a little bit tighter premencially and our testosterone goes up a little bit. The testosterone stimulates the sebum production in those pores and those tighter pores make it harder for it to, you know, just get out

and lubricate your skin, it can form zits. So some of the things that you can do premenstrually are, well, let me add to that insulin resistance or high insulin levels and inflammation make that testosterone level higher and also the inflammation can make the skin more irritated so that that just kind of like throws everything off balance. So anything you can do with your diet, with your lifestyle to keep inflammation down and keep your blood sugar steady is really going to be some of the best stuff that you can do to prevent acne. It's like an inside job. I mean, premenstrual acne is definitely like an inside job. So if you're doing all the things that we're talking about, good sleep, blood sugar balance, eating good fish in your diet, essential fatty acids, being really careful to avoid.

So it's interesting, chocolate does not seem to aggravate premenstrual acne or acne in general, but sugar does. So if you're eating milk chocolate and it's got a lot of sugar in it or just going for it with the sugar premencially, that will probably aggravate it. So having those things that you love to go to, if you're having those little premenstrual sugar cravings, which is normal, our energy goes down. So we want to kind of like fluff it up with those feel good foods. You know, think about something like chia pudding that you make with dates and maybe put like a little shave chocolate on it or just like I have this great tahini fudge over in my Instagram live, which is chocolate and tahini. So now you're getting all that good calcium and you're getting the

chocolate, which, you know, raises your serotonin and dopamine. It makes you feel good. So enjoy those healthful indulgences that are also keeping your hormones healthy and yourself happy. Love that advice. topically, be careful too, because I think a lot of us end up leaning into things like benzodia peroxide and things that actually can dry out your skin and make it worse. And then I want to add in just a couple of thoughts on that dairy. So I'm not opposed to dairy. I'm definitely not a food restrictor with my patients or myself. But dairy can be a real trigger in a lot of people for acne. So cystic acne, but also cyclic acne, so premenstrual acne. So I would definitely take the dairy

out. And I would just take it out for three months and see if it helps. And people are always like, well, what about organic? What about raw? What about goat dairy? What about sheep dairy? Those forms of dairy are definitely better than conventional dairy. But no matter what animal it's coming from, that milk has more hormones in it and you're going to get those hormones. And no matter what animal, no matter how organically raise it are, based on the environment we live in, those animals are picking up environmental toxins and chemicals, and they do store them in their fat cells and their breast. It's like one of the most common places to store them. So take the dairy out for like three months and see if that doesn't make a huge, huge difference for you. That in and of itself, I think is a really

important one. And when it comes to environmental toxins, are there a few ingredients or anything that we should be looking out for if you have like a few top of the list kind of Big ones to avoid. Definitely. So my top of the list's guidance around environmental toxins is one, check out the environmental working group, Clean 15 and Dirty Dozen. Lean into the Clean 15 for anything that you can afford to eat it. If it's on the dirty dozen, just avoid it if you can't afford it organically. So Clean 15, Dirty Dozen. If you're going to eat dairy or meat, it has to be grass-fread, antibiotic-free, et cetera, et cetera. It's so important.

The second thing is don't drink out of plastic water bottles. Don't eat food stored in plastic. Really lean into glass, stainless steel. Don't use plastic, Tupperware. Really store your food in glass or bamboo. We do know, absolutely, that we are absorbing those chemicals, those plastics, those thallates into our circulatory system. And we know beyond a shadow of doubt.

the BPA, BPS, the phthalates, disrupt our hormone balance. And then along with that, if you're going to use body products, cosmetics, lotions, soap, shampoo, anything that you put over a large surface area of your body and anything that you put on your lips, because, you know, we're always eating our lipstick right off our lips, right? We're like doing that all day long. Make sure those are from good, clean sources. So Cretto, Folloy, The D-Tox shop, anywhere you can get those really tried and true clean cosmetics. Because again, those thallates, anything that has fragrance in it, especially if it's synthetic fragrance.

But even like the more clean organic products, fragrance does not have to be declared as 100% like organic naturally sourced. So lean into the companies that are doing the work for you like Terrafoliate, Folane, Cretto, they're like they're telling you what products are. really safe for your body because we do absorb those. So those are just some three, you know, three basic things. Clean 15, dirty dozen, organic meat and dairy if you eat at your water and your food, not in plastic and your cosmetics, especially the ones you put. I'm not so worried about mascara. You know, like, how much mascara do we absorb if you need to like,

right? But it's better for the environment if you can go 100% clean and green. I do. I'm like so committed to my cosmetics. I need to start transitioning over. I do love Cretto. And I buy a lot from there, but I'm a work in progress. Yeah, it's all a work in progress, isn't it? It's just like you do what you can and you feel good about it. And yeah. And I think, you know, it doesn't have to be super expensive. Like one, I think we can do a lot. We can use a lot. I like, I love the French woman approach. You know, it's just like using so much less. Like right now, I have no foundation, no anything like all over. You know, it's like a little eyebrow stuff, a little. a mascara, a little bit of Gucci Westman and an ilia on my cheeks. Then I have Gucci Westman on my lips.

It's just clean and simple. We don't need that much. So we can invest a little bit more in a lot less. Yeah. And I think hopefully, you know, I have a lot of plastic surgeons and people in aesthetics on the show as well. And I'm always so interested to talk to them about where like beauty standards are heading. And I think that after kind of this decade of exaggeration, we're hopefully moving towards a more natural thing. And if you look at Gen Z, like, I mean, they like under eyebags. Like, those are trendy. They want to have those. And like, you know, that's, I don't want to have those because I want to know that I'm getting good sleep and my kidneys are working. But so funny. But like makeup isn't cool. My daughter, she's 33 and she's the chief of staff at O.C. Malibu, which is just an amazing inter-c. Yeah. I love

them too. And I don't get a kickback. She doesn't get back. I just love them too. I use them. And she sent me an article yesterday on Linda Evangelista and that cold treatment that she had. It's so heartbreaking. Yeah. And I really feel it. Like, you know, at 55, you know, I think a lot. So I've got 11s. You know, like my cheeks aren't as tight as they were before menopause.

And then it's like, but what do I want to put in my body? And I truly like, I have zero judgment for any woman who chooses to do whatever she chooses to because I really understand the pressure. And the fact is that our culture does make choices. I mean, even this is crazy, but medical students are more likely to be selected into higher caliber medical training programs based on appearance. The more attractive you are by cultural standards,

the more likely you are to get one of those high-place positions. And so it's really complicated, but I do worry, like, I worry about what some of those things are that we're putting in our bodies and how do they affect our hormones over time? How do they affect our well-being over time? A little bit scary. I know, I can't part with my Botox, but I'm waiting for them to come up with maybe less toxic. I mean, the dose makes the poison, right, with that one, but I wonder too. I have a phone chat with Christy Turlington on Friday because we know each other through the midwifery and birth movement. And I actually sent her the article about Linda Evangelista,

I mean, they were models together, right? And Christy is really all about going all natural. And I was like, can we talk about this when we chat? Because I also just wonder, like, what would it be like if we all decided? Because I've never, I so far, like, I haven't done anything. I haven't done Botoxville or anything. But I'm like, I think about it. I feel pressure to.

I don't want to. And I don't think I will because for me, it feels inconsistent for me. Right. But I just wonder, like, what if we all just stock? I mean, think of all the shoes and beautiful clothes we could buy if we weren't spending a few thousand dollars on Botox. And then we would all just be more comfortable in our own skin and we would all actually see what healthy aging really looks like. Yeah, I think the standard would change of a planet like that. Yeah. I think the standard would change and the expectation would change. Yeah. Okay,

well, I know we're out of time. Maybe we can do a part two one of these days. We should totally do it. I get to the listener questions. But I always like to ask my guests, what is one thing? Maybe we should stop doing today and one thing we can start doing. I mean, the one thing we should stop doing today, I like to not use the word should. So I'm just going to say that. When I was in my early 20s, I had a midwife mentor and she said, Aviva, stop shitting on yourself. So since you asked me what's wondering we should stop doing, I'm going to say like, what would

our life be like for a week if we just took the word should out in relationship to ourselves? Like I should be eating this. I should be. No, I'm not dissing you. I'm just saying like, no, no. Said it. That's what came up for me. Like, what if we just were like, I should, if we just stop saying, I should, I should be doing this by now. I should have achieved this by now.

I should do that choice. I should eat this. It's just like, what if we just were more present with ourselves? So I would say that's one thing. We can all stop shitting on ourselves. And one thing that we could do, I'm just going to go with what is so simple. And this just sounds so ridiculous. And it just came to me because I have my big glass of water in front of me.

I chronically underhydrate. And it's really funny. I was getting my hair cut maybe like about 10 years ago. And it was like four in the afternoon. And I kept yawning. And the woman cutting my hair, Bridget, of all people, like my hairdresser, she's like, have you hydrated today? And I'm like, no.

It's like I have hardly had any water today. So she brought me this big glass of water. And I drank it. and I stopped yawning. And we actually have these lakes in our brain cells that get dehydrated. And when they get dehydrated, our nerves in our brain don't work as well. So just drinking enough water, not out of plastic water bottles, eight ounce glasses a day, six eight ounce glasses of day can be really phenomenal in your mood, in your appetite.

A lot of times I think we think we're hungry for a snack when we're thirsty and our cognitive function. Like, if we're feeling brain foggy, ask yourself, have I had enough water to drink? Amazing. I love that. Well, where can everybody find you? You can hang out with me on Instagram at doctor.divaram over at my website at Avivaram.com. You can get my book, hormone intelligence, over at my website, because I think that'll probably answer a lot of the questions that are in the chat. I've been doing this for a really long time. So it's a huge book because I just kept anticipating the next question. So it'll probably be really helpful. And lots of free articles over at my website. Amazing. Thank you so much for coming on. Thanks for chatting with

me. I hope you enjoyed that episode. If you liked it, and if you like the show in general, please take a second to rate, review, and subscribe. It goes a long way, and it's actually the best way to support the show. Also, if you want to see more about each episode, you can head over to with the Blonde Files podcast on Instagram. I'm always posting about each episode there or over on my personal page at Ariel Lori.