The Melanie Avalon Biohacking Podcast Episode #121 - Dr. Stephanie's Estima

TRANSCRIPT

Melanie Avalon: Hi, friends. Welcome back to the show. I am so incredibly excited about the conversation that I am about to have. It is a long time coming. I read this book quite a while ago and Stephanie, I have to tell you this, it's so funny. Your people, I think, proposed you to me for the show and I got your book, The Betty Body and I was really excited to read it, and then that same day, a few different listeners in my Facebook group were like, "You have to read this book, you have to bring her on the podcast," and I was like, "Oh, my goodness." I was like, so you just reached out to me. Yeah, I'm so, so looking forward to this. Friends. I'm here with Dr. Stephanie Estima. She is the author of The Betty Body: A Geeky Goddess' Guide to Intuitive Eating, Balanced Hormones, and Transformative Sex. 

You can probably tell why I'm excited. There are a lot of keywords in that title. I haven't done an episode, specifically, focused on females, with females, and their cycle, hormones. I haven't really. I done one sort of dancing around the topic, but this is my first foray into that. So, I am so, so excited. Then listeners, I read The Betty Body and it was so incredible. It was a beautiful empowering book that just as a female made. You just want to take charge of your health, and your hormones, and super approachable, but also very scientific, which I know you guys love, which I love. I mean, the word 'geeky' is in the title. So, that's always a good sign. So. in any case, Dr. Estima, thank you so much for being here. 

Dr. Stephanie Estima: I'm thrilled to be here and we're going to have-- I just have a really great feeling about this. We're going to have a really great conversation. 

Melanie Avalon: Me too. A lot of my listeners probably are familiar with your work but for those who are not, Dr. Estima is a Doctor of Chiropractic and she does have a special interest in all the things I love. Metabolism, body composition, functional neurology, and female physiology. She's been on Thrive Global, The Huffington Post, she's has articles on medium, she has her amazing book, she has her signature program, The Estima Diet, and she has her podcast, which is called Better with Dr. Stephanie. So, super, super excited. That was a little bit of your background. But would you like to tell listeners a little bit more personal about your background, which you do talk about in the book. But what were your own health challenges and struggles particularly as a female and what epiphany did you have? I don't know if it happened all at once or was it over time, but what epiphanies did you have about the role of female in society, particularly, in regard to our health and our hormones and all of that shnazz? 

Dr. Stephanie Estima: All of that shnazz, yeah. So, a big topic really. I would say that I spent many, many years personally really at war with my body. As it relates to my menstrual cycle, I always viewed my menstrual cycle as this punishment that I had every month for being a woman. It was like lots of cramping, moodiness, sleeplessness, had to take medication to be able to function through the day, and it was always just like, it was such a nuisance. For me, I continue to ignore the signs that my body was trying to tell me. It was like, "Slow down, listen, [giggles] stop pushing yourself so hard, stop being in your masculine energy so much," and maybe we'll get to that today.  

I would say that it wasn't a rock bottom, but it was pretty close. I had-- within the same year, my clinic that I had been practicing out of for many years, there was a fire, the clinic burned down, and that same year, I was going through a divorce with the father of my children and our children were very small at the time. They were five and three. So, very, very difficult, very, very stressful, and both of those things are, rebuilding the clinic, trying to find a temporary space, dealing with insurance, then trying to find a new space and rebuilding and all of that, and then going through some of the emotional stuff that just happens with a divorce. I'm really great friends with their father now, but I don't care if you're Gwyneth Paltrow like, it's going to be difficult. When you're going through-- when you're going through a divorce, especially, with young children it's very charged, so emotionally charged anyway. 

It really wasn't until I took the kids, we went on a trip to-- It was Italy that we went to for a few weeks and it really wasn't until I was able to really unwind there. So, getting lots of sunlight, spending lots of time on the beach, playing with them in the water, going for walks to get our meals, just enjoying the very simple pleasures in life that I realized how stressed that I was, and as evidenced by the drastic change that I actually experienced in my menstrual cycle while I was in Italy. So, towards the end of that trip, I actually got my period which would have-- in past lives, I would have been holed up in the hotel room with a mask on, filled to the brim with Midol, and it wasn't like that at all. I felt there was no cramping, there was no heavy bleeding, It really came-- my period came, it was effortless, I felt like-- I remember actually telling my friend I was texting her, and I was saying, "I feel like a goddess. This is what menstruation should feel like."  

Yeah, so, that was really my-- we'll call it awakening if you will to the possibility that it doesn't necessarily need to be punitive. It doesn't necessarily need-- You don't need to suffer through this every month and so what I wanted to do just being the perennial experimenter that I am was to deconstruct what were some of the things that I was doing, I was like, joke and say, "Everything's always better in Italy." But what are some of the things that I can do coming back to North America, how can I continue some of these habits and continue to experience this ease, and grace, and beauty that is my menstrual cycle. So, that was one of the prongs if you will into why The Betty Body book exists, and I started experimenting in the clinic at the time, I had patients that I was running through a nutrition program, also already noticing that women were getting different outcomes.  

And my guys, the guys were like, "This is the best thing. I just dropped 20 pounds this week." The women were like, "This is the worst. I've been following the same diet as my husband and I've only lost two pounds, what's going on?" So, I started experimenting with my patients, my very gracious patients who let me experiment with them on changing the way that they eat based on their menstrual cycle. So, those two things sort of coming together almost at the same time or how I came up with this methodology that I discussed in the book.  

Melanie Avalon: I love it so much and I just want to say that I can't even imagine the stress of your clinic burning down because I feel like that would be something that you could only appreciate if you experienced it having a building burned down. 

Dr. Stephanie Estima: Yeah, it was a nightmare. I actually remember the night I was playing with my kids as we were doing like Legos, and then got the call from the landlord of the property. He's like, "You need to come down here right now and see if we can salvage anything." I had to find care, like I had to find someone to watch my kids and come down, and everything was just torched, nothing I was able to keep. The only thing that I was able to keep, thankfully, was my degree which somehow, I guess, behind the glass, yeah, didn't burn down. 

Melanie Avalon: Oh my God. That's really nice. So, just really quick question about your personal experience. When you had all those stressful events, prior to that, was your cycle always like a thing that you dreaded, or did it become worse when you were super stressed, or what was your relationship with your cycle historically? 

Dr. Stephanie Estima: Oh, that's a great question. Yeah, I'd say historically, I always had trouble with it. I always unbeknownst to me, now looking back-- hindsight of 2020, right? So, looking back is like, "Oh, yeah, I was totally estrogen dominant." I had very tender, angry breaths leading up to my period. My rings, I couldn't get if I was wearing jewelry, I couldn't have. I couldn't fit those on, I was retaining a lot of water, very much changes in my mood, GI distress. So, I had a lot of changes in terms of regularity with my bowel movements, and even just eating lots of-- more bloating than you might normally expect from the same foods that you're eating through the month. And sleep was disturbed, much more emotional, and I've always historically had issues with it. For sure, it would get worse in times of stress as it naturally and normally should. But I've always struggled with silence--  

I always struggled with the symptoms that were coming up that I wasn't addressing, and so, I resorted to silencing them with medication. It wasn't really until I went through this whole-- I don't like to call, I mean, maybe, it is hitting rock bottom. Some people might classify that as you may like divorce with like a five and a three-year old and no place to work. Maybe that is quite traumatic. But it wasn't until those things were happening, and I went to Italy, and had this experience where I was like, "Okay, if I can do this once, yes, the environment was different, but my body was also able to respond to those changes." So, there is something inherently baked into my physiology that I can bring about a peaceful, gracious, beautiful menstrual cycle. So, what are some of those things and how does that contrast with what I was doing in the previous years and decades. 

Melanie Avalon: Yeah, and it's so fascinating that you could experience such quick changes in your experience of your menstrual cycle just on a trip. 

Dr. Stephanie Estima: Yeah, I know. I would have never believed that if you told me. It can just change in one cycle, but yeah right. This has been going on for decades. It's a problem that I've always had to deal with. But it really is like when you can change some of the ways that you are bathing your genes, your epigenetics, which I'm sure we'll talk a little bit about today, then you can absolutely make profound changes in your physiology in a short delta-- in a short period of time.  

Melanie Avalon: I was debating if I was going to share this. So, growing up, I had a heavy period, didn't like it, similar to your story, not really a fan. Then, when I changed my diet, it actually got really nice, and regular, and not that big of a deal. Then, I went through a period where I had amenorrhea. So, I didn't have a period. I now have a cycle again. But what was really interesting about my experience during that amenorrhea period, no pun intended, is the confusion surrounding feeling actually very free not having a period, because I was like, "Oh, I don't have to deal with any of this hormonal craziness anymore."  

When I would go to doctors, they would say, it was just because I was too low of weigh and that everything else was fine. So, it wasn't a big deal. So, I've been haunted by my own experience, and my own reconciliation of how to have a healthy relationship with perceiving my menstrual cycle in my own body. Especially, because I think in today's society, I think, there's a messaging of like that we don't need a period or that we can be like little men, like that we can be free of this. So, it's very confusing waters to navigate. What are your thoughts on that, the role of our period, and society, and our feelings about it? 

Dr. Stephanie Estima: I think this is such a profound question. I applaud you for your openness, because I think a lot of women have the same experience that you just described, where we're told that, "Hey, you can be free of this, just get on the pill, or get on this patch, or do this, put this oral, or some type of hormonal or mechanical contraceptive on to free yourself, to liberate yourself from this curse." That was actually the name that, if you look back at TV shows in the 60s and 70s, it's like, "Oh, I can't today. I have the curse." I think that-- to your point, I think that our menstrual cycle, there's a lot of shame around it. I remember, as a teenager, the absolute worst thing that I could think of as a 17 or an 18-year old would be to get my period and for maybe to leak through my pants or something, and for that to for people to see that I was menstruating.  

I think that there's a lot of built-in shame in society around our cycles, and as you were saying, there's this like, "Hey, we have all of these tools, and tricks, and hacks to get to rid you of it." But really in reality, our menstrual cycle as women or humans with ovaries, this is a vital sign in the same way that you might look at your heart rate over time, or your oxygen saturation, or your blood pressure, or your respiratory rate. You'd want to monitor those things to make sure that they're in an optimal level and I would also argue that your menstrual cycle, not just your bleed week, not just your period, but the totality of your cycle that 28, 29, 30-day, however long it is, cycle is an expression of your vitality. If you are in your menstruating years, your years where you are reproductive and that includes in your 40s when you-- when we move into perimenopause, which is a slightly different category.  

But what we want to be doing as women is optimizing for fertility, optimizing our menstrual cycle to be as easy as it can be to balance out some of the hormonal derangements that can pop up from things like stress, poor sleep, nutrition that's not aligned with our cycle, overtraining, and different types of training that I think women have been sold. I don't know if we'll have time to get into this, but I'll just say, now, just in case we don't, but I think women have been sold this idea that we have to do cardio, like little cardio bunnies on the treadmill or on the elliptical ad nauseam without really consideration for some of the benefits that resistance training can not only do for your to balance your hormones, but as a prophylactic all through your life in terms of developing lean muscle mass, increasing your muscle mass, increasing your bone density, increasing the weight of your organs, these are things that we want to be flexing for, right? We want to be trying to optimize for over the course of our life.  

We could probably talk for a couple of hours on the patriarchy and why we are just conditioned as women to really hate ourselves, and there's this pressure to be more of a consumer, like we're told, "Hey, you know what? Once you get that $4,000, whatever Chanel bag, or you buy this mascara, or that dress, or these shoes with the red bottoms or whatever, you're going to be full, you're going to be fulfilled." Now, listen, I have red bottom shoes. I have expensive things, but I remember obtaining those things are so fleeting. The thing that lasts in terms of our feelings of self-worth, and our feelings of being fulfilled, and attuned with ourselves comes from within. It's not something that you can buy in a shop.  

Melanie Avalon: That actually leads really well into my next question, because something I struggle with my place in society is, I really like the idea of the feminine body and this whole image, and I feel really comfortable living in that feeling. But then I wonder am I subscribing to some patriarchal version of womanhood in society? In your book, you have this concept of a 'Betty.' What is a Betty and how does that fit into the narrative of society? 

Dr. Stephanie Estima: Great question. The name 'Betty,' we stumbled on it by accident. So, my podcast as you mentioned, at the beginning, it's called Better with Dr. Stephanie. So, we started calling the fans of Better or Betty's. So, it's just a little cutesy name that we were saying, "Oh, our better fans are a little Betty's." Looked it up on the Urban Dictionary and being a Betty actually has a definition. So, this is-- and I'm paraphrasing. I wrote out the full definition in the book, but it's a modern-day queen. She's like a modern-day triple threat. She's quirky, she's loving, she's in the pursuit of excellence. I remember reading this definition going, "Oh, my gosh, I'm quirky, I'm loving, I have the pursuit of excellence." This is exactly the embodiment, the description of a Betty was, the embodiment of who I aspired to be. It was the best version of myself and its diet agnostic, size agnostic, you could be a size, 14, you could be a size four, it doesn't matter. It's really about being attuned to your body signals, and honoring, and knowing how to appropriately respond to your internal and your external environment. So many women, myself-- I would put myself in this in this bucket as well.  

We have been taught in society to really divorce ourselves from listening to our bodies. The doctor knows best or so and so has done this before, they're going to know more than you. When women for millennia have talked about this idea of intuition. This woman's intuition, this sixth or seventh unconscious sense where we can sense that something's not right. Even though, everyone's saying, "Oh, look, your labs are completely normal or you--" I was just talking to Monica Berg from my podcast. She's head of The Kabbalah Center, and she was talking about her second pregnancy, where she had this sense that the pregnancy was not right. I was like, "No, you're fine, it's good, it's no problem." Then, the baby ended up I believe and had I think was Down syndrome. She was like, "There's nothing wrong with my child being Down syndrome, but I knew it. She just had that feminine intuition that society basically tells us to ignore.  

So, back to your original question, what a Betty is, it's a fully embodied woman. It's someone who can tap into her intelligence, her IQ, her emotional intelligence, her EQ, and then to know how to appropriately respond to the ever changing hormonal landscape that she will go through over the arc of her life because a woman will be premenstrual, she won't be menstruating, she will start menstruating somewhere around a huge variance, but we'll call it somewhere around 12 to 15 years old, and then she menstruates, we go into perimenopause in about our 40s, and then, we're menopausal at some point in our 50s and 60s. We might throw in some pregnancy, multiple pregnancies there, some labor and delivery, breastfeeding, and the sleepless nights that we call motherhood. So, there's a huge hormonal variance in a woman's life that men just don't experience and can't relate to. So, I think that a Betty is someone who knows what she needs and how to nourish herself from within without that external looking outside for the answers, but looking within. 

Melanie Avalon: I love it. I love it. It's so empowering. Yeah, and speaking to that about the response from society, so last night, I was reading-- Do you know Dr. Michael Platt? 

Dr. Stephanie Estima: That name sounds familiar. 

Melanie Avalon: He has done a book on Adrenaline Dominance and then Bioidentical Hormones. 

Dr. Stephanie Estima: I'm not familiar with his work, but the name does ring a bell.  

Melanie Avalon: Okay. I was reading his books last night, and I was reading about the history of estrogen therapy. So, like progestin and stuff and it's-- its's really shocking. That's just an example of society not listening or appreciating women, because basically with the rise of progestin, so like synthetic estrogen therapy started being used for so long, and eventually they realized with the Women's Health Initiative that it was related to all of these cancers, and all of these health issues, and actually, I had to stop a study because of what they were finding. But this was after decades of women being on it, and women are still on it today. I just think like, there's so much misunderstanding about female hormones and addressing female hormones, and then the response in the clinical literature and how women are treated by doctors. It's just very frustrating. 

Dr. Stephanie Estima: Oh, 100%. We haven't been studied either. So, we've been purposely excluded historically from clinical trials, because our menstrual cycle has been considered a confounding variable. It's like, "Well, she's too different." The point like, you have to understand that, when we are looking at high-quality studies like a randomized control study, double blind, what have you, we are trying to tamper down any possible variable that could alter the results. So, women were just historically excluded because our menstrual cycle is something where we essentially have a different hormonal composition every single day all through our menstrual cycle. So, I think, it was only in 2014 that the NIH mandated that women need to be included in all studies, unless if you're specifically studying like, something that's going on in males or whatever. It's 2021, please, with the Women's Health Initiative, I will say maybe this is a different podcast, different conversation, but I will say that, they really did botch that study. The results that they took from that, first, the population that they studied, they tended to be--  

They were looking at what the intervention like, putting in progestin as you were mentioning, synthetic progesterone, synthetic estrogen, so, Premarin, pregnant mares' urine, that's where Premarin comes from. Giving that to a largely very sick cohort. So, the women tended to be obese, there was a large proportion of them that were smokers, a lot of them were over the age of 65, and so, they already had all these cardiometabolic risk factors, and then you add on a stress like giving them a synthetic hormone, and of course they're going to have-- of course you're going to get terrible results from that. I think, there's been some revision since the original publication has released. But I'm a fan of bioidenticals. I think that if you have a solid foundation of some of the things we're going to talk about today. So, nutrition, and fitness, and lifestyle, and sleep, you know, sleep hygiene and stress mitigation, and you're still having, if you're a woman in your late 40s, whatever it is, and you are having symptoms of low testosterone, or low estrogen, or you're moody, and you still can't get it right, then bioidenticals might be a beautiful solution for you.  

I think that there's been the shame again, around-- If you give estrogen, you're going to give someone a heart attack in the same way that we thought classically about cholesterol, "Oh, cholesterol, too much, No, you're going to have a heart attack." Or, same with salt. "Oh, you have too much salt. You going to have a heart attack." These overly simplistic sound bites, I think, have really prevented a lot of women from getting, whether it's fat that they need in their diet, the therapeutic intervention that they need, or even just like salting their food to support their thyroid. So, I've realized that that's a tangent.  

Melanie Avalon: I love tangents. I personally really think the salvation of it all is in the nuance, and it's really a travesty how much it has become just very black and white in simplistic. Like you said, this is not female hormones, this is not my forte at all, but I think the place I've currently landed is very much what you just said that, diet and lifestyle is the foundation but then beyond that, I definitely think there's a role for bioidentical hormones. So, a foundational question to paint a really good picture going back to the menstrual cycle. Could you actually just walk listeners through the menstrual cycle like the four phases and the implications of the hormones during those four phases? I just think it's such a foundational knowledge that people don't really think about.  

Dr. Stephanie Estima: Yeah. No, it's such a great question and I just want to applaud you as well, because I think that if you can't understand what's happening, finding a solution is going to be just impossible. This is what you're doing here is, you're setting the stage for empowerment for the women and the men who love them to help their women so that we can find solutions. Yes, I'd love to answer this question. Menstrual cycle length varies. We typically talk about it in 28 days, just because it very easily divides into seven, which is a weeklong. It's four weeks. But of course, the typical length of a menstrual cycle can vary anywhere from 26 days up to 33 days. I'm going to talk about it just for simplicity in the context of weeks like week one, week two, week three, week four. If you are someone who menstruates every 31 days or 27 days, this also applies to you, but you're just going to have slightly longer or shorter weeks. So, that's my little shtick about length.  

In the book, I talk about four main points in the cycle. The first, everybody knows. It's week one of your cycle, this is your bleed. This is when we are shedding the endometrial lining. Everybody knows when they're in that phase because we were bleeding. We need to either wear a cup, or a tampon, or whatever it is that you're using. In this week in terms of hormones, most hormones are relatively low. So we will see-- especially, at the beginning of the week at the onset of your period, we will see estrogen very low, it will tend to increase as the week goes on, progesterone is not around. So, progesterone is our pro-pregnancy hormone. We'll see her make her appearance in the second half of the cycle in week three and four. The only hormone that's really working here is something called FSH or follicular stimulating hormone. This is released from the brain. The idea here around FSH is to kind of what it is--  

Follicular stimulating hormone is doing what the name suggests. It's stimulating the follicles. In the beginning of your cycle in this bleed week, there are going to be many follicles that respond to FSH, but there will only eventually be one that is chosen with the egg inside that will eventually be released. Luteinizing hormone again released from the brain not really around here either. So, that sort of the hormonal environment if you will. Everything's kind of low as we move towards the end of week one, we will start to see a rise in estrogen. Estrogen is phenotypically ascribed as the female hormone. It's the hormone that gives us our, at least, very initially, our secondary sex characteristics. The development of our breasts and the curvature in our hips. It tends to-- when you have an appropriate amount of estrogen, you will tend to deposit fat in a female centric way, which is to say in the hips, in the thighs, in the bum, even though, we all don't like that, but that's normal. What you don't want is you don't want an ectopic fat distribution, which is where you're getting fat accumulating in the belly. So, what I'm describing as optimal is more of an hourglass figure or maybe more of a pear-shaped figure where we have a waist, and then estrogen will direct our fat deposition to the lower half of our body. The apple is when we start to see lower estrogen or we start to see more, which we'll talk about more androgen dominance. So that's week one. 

Week two, estrogen has started to rise towards the end of week one, and then into week two, this is where you'll see estrogen, there'll be a massive increase in estrogen concentration, it is the apical-- it is the highest point that you should reach with estrogen through your cycle. Other hormones that are present in week two, you'll see testosterone also making its debut. Testosterone is a very important hormone. It's involved in maintaining muscle mass, and I have a huge bias towards resistance training. So, the more muscle mass you have, the naturally more testosterone you'll have. It's also involved in libido. So, I always make this joke that I always know in this week two or this pre-ovulatory week, I'm like, "Where's my husband?" Chasing him around the kitchen, the kitchen island. We're more interested in sex this week. Physically, you might also notice that if you are climaxing, if you are having orgasms this week, they're much more intense that's usually under the direction of testosterone. You may also notice like more sensitivity, for example, in your genitalia, like your clitoris might be more sensitive as well.  

We also will see luteinizing hormone this week as well. Luteinizing hormone is the hormone that comes in and comes out. It's like a really high amplitude pulse of luteinizing hormone and that is what's going to help that one follicle that's been chosen to release the egg. We have ovulation which is actually the main point of our cycle. A lot of-- I always say that, our period is like the popular girl. Like she gets all the attention. But the point-- the main point of our cycle is ovulation. We want to be optimizing for ovulation. This is our fertility. So, your egg is released at some point somewhere between 10 to 36 hours after that luteinizing hormone spike, and your egg is released. Your egg is, depending on your age will be viable for somewhere between four to 24 hours. So, this is a really important point. I always like to pause here because your ability to get pregnant in your cycle is mere hours. I think that this is why this question, Melanie is so important, because I think that we've all been-- at least I was taught, when I was little, it's like, "You could get pregnant going into the swimming pool. You could get pregnant like just by looking at someone you know?"  

Of course, we know physiologically, there are times in your cycle where it is impossible, you cannot get pregnant. So, your fertility window changes as you age, but somewhere between four and 24 hours. Then after ovulation we move into the second half of our cycle. Now, we're into week three and four, collectively, we call this the luteal phase, because the follicle that once held the egg, now, we refer to that follicle, that's empty as the corpus luteum. The corpus luteum will start secreting progesterone. After you ovulate, your body will also start to secrete progesterone and this is why we will see a warming. If you're tracking your temperature, you will be warmer after you ovulate in the same way that you're warmer right before you get your period. Progesterone is a warming hormone. It increases our core body temperature.  

In week three right after ovulation, I mentioned in week two, estrogen is really, really high, reaches its highest peak in the cycle and then she drops. Right before ovulation, estrogen just tanks, and then starts to slowly come back up again in week three, and there'll be a sustained secretion of estrogen until about the middle of week four. Progesterone as I mentioned is starting to be secreted from the corpus luteum, and it will reach its peak at the end of week three, beginning of week four. Like somewhere between day 19 if we're doing a 28-day cycle, somewhere between day 19 and 22.  

Progesterone is a very interesting hormone. I mentioned warming, it's very warming in terms of neurological impact. I always refer to progesterone--. I don't know why, anthropomorphize everything but progesterone is a she in my brain. She will also have a calming effect on the brain. She will activate inhibitory transmitters like GABA. We often feel very chill in week three, the other thing that she does is she slows everything down. So, she will slow down GI motility. You may notice that your bowel movements might slow. Maybe, you're used to having one or two bowel movements a day, and now maybe you're just squeaking one out or maybe not even. You may also notice that you have more, we'll call it GI distress. Maybe bloating or some type of discomfort post-eating. So, that's the hormonal environment in week three.  

Then in week four, another really interesting week. What we're really essentially doing in week three and week four is we're trying to build up the endometrium. The whole point of your cycle is, we release this egg, that's ovulation, and the hope whether or not you want to get pregnant, your biology is trying to make sure that there's a fertilized egg, and then that fertilized egg has a home, and that's the endometrial lining. Then we move into week four. So, this is also a really interesting week because now we have this frenzied, the endometrium, it's like do or die. It's peak week. If you've ever competed or seen any ice of competing figure and we call this week before the competition like peak week. So, this is like do or die. This is where we either have a fertilized egg or we have to scrap everything and start again. So, in this week your metabolism will also go up and this is why a lot of women will notice that they are warmer this week that they are and this can often disrupt their sleep, it can often lead to feelings of uncomfortable, maybe they're sweating, etc.  

But if we were to do a blood draw, we would see things like lowered glucose, lowered amino acids, lower free fatty acids, lower glutathione, lower vitamin D, lower zinc, lower selenium, lower-- everything is lower because your body is literally shoving it all into the endometrium to make it big, and thick, and fluffy, so that there's a home for that fertilized-- potential fertilized egg. What we see this week is, continuing from week three, we've had the sustained secretion of estrogen. About the middle of week four it drops off. And the same is true for progesterone. So, three or four days, let's say, before you get your period, you will see that progesterone will drop off an estrogen because they've realized that there's nothing there. So, now, the endometrial lining, which has been under the influence of progesterone is now going to become its oxygen supply, it's basically going to start to die. So, it's going to become ischemic, and then it's going to start to shed. Then the shedding of the endometrial lining is day one.  

When you see blood, let's say in your underwear or what have you that is the endometrial lining being cleared. So, that's in a nutshell, as I mean, I could probably do an entire textbook. I'm just like, "Oh, that's the back of the envelope." That's the main points are in terms of what's happening from a hormonal perspective in your menstrual cycle. 

Melanie Avalon: Thank you so, so much for that. That was so incredibly helpful. I know for me, personally, I would always hear these words like LH, and follicular, and ovulation, and estrogen, and progesterone. But I never really got a sense of what was actually happening. Like you said before, I just think it's really, really empowering for women to understand what's actually happening, because how can you make changes if you don't know what's actually going on? I have so many questions to follow up for that. So, you just talked about the levels of these different hormones during these four phases. How does that manifest in our experience of our body? So, how do we feel in our bodies during each phase, is there a change in vibe per se for different phases or is it not quite as delineated as that? 

Dr. Stephanie Estima: Oh, I think, there's absolutely different. We will experience-- under the influence of these hormones, we will experience differences in our mood, our attention, our focus, whether or not we're chatty or not. So, I'll walk you through each week. Again, back to week one, where we have that, the onset of our period, that bleed week. In the first, day or so, it's very normal for a woman to feel, maybe a little crampy, little lethargic that's normal. But if you need to medicate as I was describing when we were talking at the top of the hour, that's not normal. You should still be able to do all of your activities of daily living. In terms of a vibe or a mood, what I've often found is like this bleed week, and I talked about this in the book that this is a week for solving problems.  

A lot of times men when they're trying to solve problems, they'll say, "Okay, I want think about it, I want to strategize." For a woman, I think we need to bleed on it. I think we need to sit and we need to shed. It's almost like it's a death in a way. So, there's a clearing out of space, so that we can let in what it is that we need. I think, I talk about this a bit more in the emotional realm, but we are essentially cleaning out. We're cleaning out the dead. So, we are allowing for more space in our bodies to occupy what we would like to do. So, in the first week, I really like for women to journal, of course, in terms of movement and nutrition, we can talk about that. But in terms of our emotional well-being and capacity, this is a really great time to go within. It's a really great time to sit with your body and say, "Okay, what is it that I really want in this next cycle of my life?"  

When we move from week one into week two, so now the bleed has stopped. We are now seeing, as I mentioned before, these hormones that are all rising, we're seeing estrogen rising, testosterone rising, luteinizing hormone rising. We will also see a corresponding rise in energy. So, people will feel, women will often report feeling much more extroverted. They will feel much more happy. They have a lot of energy. I think and I've talked about this before, if you understand from the previous week, what it is that you need to bring about in your life. If you bled on your problem and you say, "Okay, this is what I need to solve." This energy that you've been given in this week two is sacred energy for you to put towards that problem solving. So, a lot of women will be like, "Hey, it's time for drink. It's time to go and--." If that's what you need, like if you have thought about it like, "God, I have not been social, I have not been deepening my connections with my friends, or my family, or my boyfriend, or my girlfriend, or whatever," then that energy that is being gifted to you that next week, use it for that. But also, I also just want I mean, this is my own opinion. So, take it for what it's worth. But I believe that this energy is sacred, and it's a gift to us in order to continue to self-actualize and to continue to bring about the change and the bliss that we are we are searching for in this life. So, that's week two.  

Then in week three, I mentioned that estrogen dips right before ovulation then it comes back up. This is the proverbial fall. Whenever we think of fall, we think of cozy sweaters, we think of socks, we think of maybe pumpkin spice lattes, and all of these different cozy things. This is a time of productivity. So, under that sustained secretion of estrogen, we have estrogen receptors all over the body. But in women, of course, we have a lot of estrogen receptors in the brain. So, our verbal articulation centers, our ability to put together beautiful sentences and to draw on our vernacular, this is a really great week for you to schedule a podcast, for you to give a presentation, for you to ask for a raise, because you're just going to be so much more articulate and you're going to be able to construct sentences in a way that is just more fluid and easy than maybe other times in your cycle. So, this is more of a productivity. It's like hashtag get stuff done like GST. So, that would be like week three.  

Then week four, I mentioned, we have progesterone and estrogen drop off in those days leading up to your period, and this is the time if a woman is going to experience any of that PMS, any of that premenstrual like the moodiness, irritability, the sensitivity, the emotionality, the sleep disturbances, the GI stuff, the tender breasts, any of that, this is a time for us to feel our feelings. I often noticed in myself and the women that I've worked with that, it's this time where everybody annoys us versus when we think about ovulation like that, preovulatory week, we love people. We're peopling or extroverted. This is a time where your boss is going to annoy you, maybe your kids are going to annoy you, your girlfriends are going to annoy you, you can't find the right outfit, it's not washed, it's at the cleaners, like can't find the right nail polish like everything's wrong. But this is important because this is a negativity bias. So, you are going to typically see things in a more negative slant this week than you might throughout the rest of your cycle. 

This is-- again, I'm bringing in my woo here. This is like an energetic portal. This is your body's way of telling you, these are the things that are not right, right now. So, your relationship with your partner, there needs to be a conversation there. This career that you've chosen, your boss' on your-- maybe you need to switch companies or switch career. The things that come up this week, I want you to pay attention to them, because so often, we don't feel our feelings. That's not really accepted in society. We're called, oh we our emotional, oh is it that time a month? It's like, yes. It is a time of month. This is when my body is telling me what's wrong, so that next week, when I'm bleeding, I can figure out the problem. If you recall, we were just talking about we bleed on it. That's how we come up with solutions. This time is going to tell us what we need to focus on. That's how I would look at some of the ebbs and flows of our mood and our vibe as you mentioned, and I think that the more we attune to these signals, the more that we embrace this ever-changing hormonal milieu. this is how we become the baddie that is within all of us.  

It's how we learn how to appropriate, it's how we learn how to set boundaries for ourselves, how we advocate for ourselves, how we nourish ourselves with food, or with rest, or time with people that fills our soul up. But if we're not paying attention, we can always be on autopilot and then wonder why we're miserable, why it seems like our periods hate us, but all she's doing is like she's trying to get your attention for you to sink. I always call it blow the throat. I'm super like Type A personality. I love to run algorithms in my head and being in my body can be scary, but once you sink in a little bit to see, put your toes in to check the water temperatures as they say, you can really extrapolate a lot of wisdom from our bodies. Our bodies are always wiser, always wiser than the linearity of our thinking. 

Melanie Avalon: It's so empowering. Even like what you're saying with the fourth week and how we have a negativity bias, and so normally, if we didn't have this knowledge of what was going on, we might experience that as being moody or being in an unpleasant state of mind, but we could reframe it. To me, it sounds like when you're growing a plant, and when you're at the pruning phase, and you decide, what to cut off and reevaluate everything through your critical lens. So, I love that. Some follow up questions. Is it true the idea that they often say that women when they're ovulating are like super attractive to men? Is there truth behind that? 

Dr. Stephanie Estima: Yeah, there is some truth to that. I mentioned before estrogen, it develops our secondary sex characteristics like our breasts and hips. But it also plumps up our cheeks, it fattens our lips, it whitens our eyes. They've actually done studies on, I think, exotic dancers is the right name for them. So, women who dance and they compare them to women who are on the birth control pill. They noticed that women who were not on hormonal contraceptives were getting better tips, and it often coincided with that pre-ovulatory week. So, one of the things I was talking about with my friend and colleague, Dr. Jolene Brighton, and we were like, "Okay, so the birth control pill, basically, it also affects your bottom line." So, instead of also affecting your hormones, it's also affecting your tips. Because you don't have-- with hormonal contraception, you don't have that ebb and flow. Yeah, it is very true and they've also done like, they've printed out pictures of the same woman during different times of her cycle, and of course they put it in with lots of other women and consistently men rated the women who were in that pre-ovulatory week more attractive because estrogen tends to create more symmetry in our face. It's natural lip filler, natural cheek filler, whitens up our eyes, it just makes us look perky and awake. 

Melanie Avalon: I'm glad you mentioned the birth control. A question we actually got recently from a listener and it was something I was curious about myself was, if you're not cycling or you are on birth control, and you don't have a cycle, do you still go through these hormonal changes at all or are they just gone?  

Dr. Stephanie Estima: Yeah, when you are under the influence of the birth control pill, basically that hypothalamic pituitary ovarian access is shutdown. There is no communication between your brain, the pituitary gland, and your gonads because you have the progestin as you were saying, even with air quotes, I'm using air quotes here, like "low-dose birth control pill, you effectively shut off your cycle, because you are tricking your body into thinking that you are pregnant, so you will not ovulate. Even when you bleed like, you look at the pill, there's usually if it's 28 days or whatever it is, there's usually like some green pills that are just like basically sugar pills. That's not a period. That's just a medical bleed." So, I guess to answer her question is, yeah, you don't cycle and so you won't have access to this wisdom, and just the general hormonal landscape like just the changes that happen, and it's any hormonal contraception. So, it could be the pill which is oral, there's IUD, there's lots of different ways that there's hormonal contraception.  

Melanie Avalon: Another question I had. I was reading about how estrogen receptors are all over the body and you were speaking just a second ago about how we have estrogen receptors in different parts of our brain. So, is that individual as far as maybe concentration or where they are and if so, would that explain or would that speak to why people experience different symptoms when they have maybe excess estrogen? Do people who have breast tenderness? Is it because they have more estrogen receptors in their breasts? 

Dr. Stephanie Estima: Oh, that's a good question. It's not necessarily about the receptors. It's about the metabolites of estrogen metabolism. When we are metabolizing estrogen as we do our hormones, it has three main metabolites. We have the first metabolite is called 2-hydroxy estrogen, which is basically we've added an OH group to the number two position. We have 4-hydroxy estrogen, and then we have 16α-hydroxy estrogen. The 2OH is a estrogen antagonist. It cannot retain its ability to activate the estrogen receptor. 4OH is an agonist meaning that it does continue to activate estrogen receptors throughout our body and particularly it has an affinity for the breast tissue. So, we want to be very careful and this is where I think tests like the DUTCH test are very important, because it can actually give you a percentage of the types of estrogen metabolites, which pathway you favor. There's a genetic component to it but you can also see on a DUTCH test, how much of the 2OH versus the 4OH versus a 16α-OH which you're producing, and then there can be interventions like epigenome. So, for example, if you are someone who favors that 4OH pathway, we know that it quinone producing DNA damaging, you will get tender breasts, which was my case.  

Actually, if you look at my work, I genetically favor 4OH and I produce not surprisingly more of the 4OH pathway. What those individuals need to do is to try and move the preference towards that 2OH pathway, and you can do that by consuming foods in the brassica genus. So, things like cauliflower and broccoli, and Brussel sprouts, and broccoli sprouts. They contain something called Diiodomethane or DIM for short and that will preferentially shift. It'll actually lower the total amount of estrogen that you have, and these foods also have a compound in them called sulforaphanes and the sulforaphane content will actually shift your metabolism towards that 2OH pathway. So, if you are someone who tends to get this PMS, the angry, the tender breast, the bloating that kind of thing, it may be that it's the way that your body is currently metabolizing the estrogen that's causing the problem. 

Melanie Avalon: Do you have a theory for historically because I always feel like there's a reason evolutionarily for why we have different genetic variants and genetic predispositions. What do you think would be the benefit of going down that 4OH pathway? 

Dr. Stephanie Estima: Oh, that's a good question. That's not something I've ever considered. I don't actually have a good answer for you. Yeah, there is a significant, at least with the-- I can tell you with the women that I work with. At least 30% to 40% of them, when we do some of the more advanced testing, we are seeing a preference for that 4OH just like DNA damaging. Actually, I tend to see it and maybe I should look at, maybe do a little bit of further workup. I tend to see it in my Mediterranean women. So, I do tend to see it in my women of Italian origin, Portuguese, Spanish, Greek, French. I tend to see it and that's not an all-inclusive list, but that typically is what I see is that tends to be Mediterranean in origin. So, I don't have a good answer for you. It's a good question. 

Melanie Avalon: I'm always just really curious about that with everything, even like ApoE4, it's like why, what was the reasoning for this variant that for whatever reason in today's society is often a problem? 

Dr. Stephanie Estima: ApoE, I think that there are some good theories around it. So, ApoE4 as you know is one of the apolipoproteins that's involved in metabolizing fat, saturated fat in particular and anyone that has one or more alleles, so, increases your risk of Alzheimer's. One allele I think, increases your risk by 30% and then two alleles, I think it's like 50% or 60% or maybe even higher than that. There's this concept of antagonistic pleiotropy meaning that ApoE4 actually showed up before a ApoE3, when you look at the history. Women who have the ApoE4 one allele or more, there is a direct corollary with their fertility. So, they are more fertile. So, people who have this ApoE4 one or more are actually more fertile in their earlier years. If you think about 10,000 years ago, 20,000 years ago, we didn't live until we were 70. We lived until we were maybe until childbirth and we died in childbirth, or we lived until we were 30.  

But there's this flip that happens now because we've extended our lifespan so much through the advent of sanitation and cleaning up our water systems and all the things that lead to modern life that we are seeing people live a lot longer where the average lifespan now I think is somewhere like 72 for a man and I forget what it is for a woman, maybe 76. Don't fact check me on that. I think that number is wrong. But yeah, it's in the 70s like the average. But now, of course, the longer that you poorly metabolize the saturated fats, now that risk, of course, of the LDL being able to invade the lumen of the artery increases and when it deposits its cholesterol there, then all the problems like atherogenesis and all that stuff happens. So, I think that the reasoning at least what I've studied is that the ApoE4 gene conferred a fertility advantage to our-- Women and men were more fertile and then it kind of flips, it becomes this thing that is not advantageous the longer that you live. 

Melanie Avalon: I was actually reading about this week and I'd read that it was actually the ancestral type that it was like the oldest which I did not know. But I did not know that about the fertility that it's fascinating. I love that. Going back to the menstrual cycle and the cycles, so, I have two big questions about it. One is, how does it most normally manifest when things are out of balance as far as the hormones go? Is it normally high estrogen, low progesterone, is it a multitude of combinations? When women experience exacerbated, unpleasant effects with their menstrual cycle, I know you can't make a blanket statement but what is often going on? 

Dr. Stephanie Estima: Well, I can tell you what's most common. Most commonly, we actually see what I would call androgen dominance. I've been talking a little bit about what it looks like to be estrogen dominant, the angry breast and all of that. When we are more androgen dominant, this is when we are not converting our testosterone, because testosterone is the chain of things. We have cholesterol, progesterone, progesterone turns into testosterone, and then testosterone goes into estrogen. It is the conversion of testosterone to estrogen that is a problem. For women, I was talking earlier. I mentioned it just briefly this ectopic fat distribution, this sort of apple shape. This is when a female body is subject to more androgens, one of those being testosterone then she should, and then she starts to develop characteristics and symptoms that look like a male body. So, that may be that central fat deposition around the tummy for a woman with polycystic ovary syndrome, which is the most common hormonal derangement that we see. We will start to see things like chin hair, and not just like peach fuzz, the black hair that you have to tweeze out. Of course, culturally if you are of middle eastern descent or maybe even Mediterranean descent, you're naturally predisposed to a little bit more thick hair there. So, if you have a couple of chin hairs it might not necessarily be PCOS. There's a couple of diagnostic tools that you need in order to rule that in. But you'll see more chin hair, you'll see around the beard line around the mandible, and the chin, there'll be more thicker hair, it can even be more hair on the chest, so in and around the breasts, in between the breasts, and then even more hair on the back, which is of course what we see more typical of a male's hair pattern.  

For women, we also might see like hair loss around the temples. When we think about male pattern baldness, it's that receding hairline usually starting at the temples and then there's like a little bit of a patch sometimes at the posterior-superior aspect of the skull. You might see that in a woman as well. And this is the most common hormonal derangement that women experience. For the most part, this can be corrected through the application of a ketogenic diet, which I hope we'll get a chance to talk about today and fasting, because PCOS for the most part, of course, there's different-- I'm painting some general broad strokes here, but for the most part has its roots in hyperinsulinemia. Meaning that the insulin levels are chronically elevated and that will influence how much testosterone is around. So, the higher your insulin levels, the more free testosterone we have. There's a decrease in a binding globulin called sex hormone binding globulin, which is basically, just like a-- it's like, think of it as like a cab-- taxicab in New York that just takes people and take them to their destination. When insulin is high, you will have higher free testosterone, which is going to be able to exert more of its androgenic effects on the cell. One of the most beautiful things about PCOS is that it's very well, very receptive to nutritional interventions like a carbohydrate restriction and/or fasting and/or the addition of resistance training to help dispose of the excess glucose that's being consumed or that's stored. That's the most common one. 

The other thing that we see very commonly and you mentioned it is the, as women move into their 40s, early 40s, even into late 40s, we see this declining levels of progesterone relative to estrogen in the second half of their cycles. If you recall, we were talking about how progesterone like she only shows up in the luteal phase, but at about age 35, we will naturally, normally start to see a stepwise decline in progesterone. If it happens too abruptly too suddenly and things that can accelerate it are things like stress, poor diet, poor sleep, not enough natural sunlight. mouth breathing, things like that, then we can get this differential, this difference where estrogen is running dominant relative to progesterone and progesterone should always be the dominant hormone in the second half of the cycle. So, those are very, very common, which both-- you can't do anything about the progesterone lowering, that's normal. But you can bring estrogen into balance, say, if we're doing bioidenticals. But if you're just taking the natural route first, there are things around nutrition, around exercise, around sleep, around stress management that can help bring those hormones back into balance.  

Melanie Avalon: A resource for listeners. I interviewed Dr. Benjamin Bikman on the show, and we dived deep, deep, deep into insulin. So, if listeners would like to learn more about that, I'll put a link to that in the show notes. Ben is great. He's like a wealth of information.  

Dr. Stephanie Estima: Yes, he's awesome. 

Melanie Avalon: He's so kind. He's just like a really kind person. One of the questions that this leads really well into you're speaking about the role of a keto diet. And listeners, we're not even going to remotely touch on all of the wealth of knowledge that is in The Betty Body. So, just get the book now, because it's all in there. You do talk in the book about how to modulate your diet and your macros according to your cycle and how to best support that. So, just briefly, what does that look like? Because you talked about the keto diet, for example. So, are you prescribing keto diet all the time, when do carbs come into play in our diet and our cycle? 

Dr. Stephanie Estima: Love it. Yeah. So, the way that I've structured the ketogenic diet is specifically for the application of women. So, often when we are talking about keto and traditionally, it's really been talked about from a male perspective. We will see-- if you do blood draws and even in the studies, it's like growth hormone shoots through the roof and fertility as measured by sperm count and sperm agglutination, and all-- like kind of the morphologies of the sperm. All these things improve, and sleep improves, and testosterone improve. But it's not the way that the traditional ketogenic diet like actually, if we're like going classic, classic ketogenic diet, it's like a 4:1 ratio of fat to proteins and carbs. So, it's like, you'll basically have 80% fat, 10% protein, 10% carbohydrates.  

For women, that is, you can do it. Historically, the ketogenic diet was used prior to the advent of seizure medication for seizures and they noticed and they couldn't explain it. But when there was carbohydrate restriction that these patients they were seeing a cessation in these tonic-colonic seizures. So, that's the history of it. But for women in 2021 and beyond, who don't have seizure disorders. We want to be thinking about how we can support our hormones. As we've been talking about hopefully, what you know now is that, our hormones are always changing and so to think that we should be applying the same diet every single day of our cycle is wrong. It's just wrong. We have to modulate our food to be able to support our hormonal needs. So, in the book, I talk about two main phases, which is, one is a therapeutic intervention of a ketogenic diet, and then the second phase is, syncing up your foods like your macros with your cycle.  

The first phase is all about metabolic flexibility. I'm sure Ben Bikman and others on your show have talked about what metabolic flexibility is. But just as a quick refresher, it's the ability for your body to easily be glycolytic or ketogenic. Meaning that your body is easily using glucose either from exogenous, or endogenous, like outside or inside sources like your diet or your body, or it can produce ketones in the absence of glucose, that's like basically what metabolic flexibility is. So, we do an initial cycle like a 28-day ketogenic diet that is female focused. So, the macros are about 70% fat, 20% to 25% protein, and then the fill is carbohydrates. So, somewhere between 5% to 10% carbohydrates. That's only for one cycle. Maybe, someone like I've played around with it enough now that sometimes I'll extend that. So, if you are someone who has Hashimoto thyroiditis, or you have multiple sclerosis, or some type of lupus, or some type of autoimmune condition, we can extend this phase. But for most women, you need one month or so like about 20--, however long your cycle is to do this therapeutic intervention for metabolic flexibility. Then we start to move into increasing and decreasing your carbohydrates based on where you are.  

This is where I think I depart from most people who are talking about the ketogenic diet, and I actually see this in the communities, these keto communities where people are like deathly afraid of carbohydrates, and they are not the enemy. When we think about the enemy, it's really the-- it's the processed foods, it's the carbohydrates that are like the chips, the cookies, the crackers, the Häagen-Dazs, all of those things. But vegetables are carbohydrates. You're never going to hear me say, you can never have a berry or you can never have broccoli, or spinach, or whatever it is. Yeah, so, I think that when we get into the cycling piece, we will have weeks where there's high protein, high carbohydrates, and that's to support your metabolism, is to support your thyroid, is to support your neurotransmitters, is to support muscle protein synthesis, which is a really important construct, which is just kind of what it sounds like where you are building muscle from the protein that you're eating. Of course, that your muscle mass is directly related to your bone mass, and every woman in her 40s, and 50s, and 60s, and 70s, this should be a primary-- this should be a priority like maintaining and/or improving your bone density.  

Yeah, so, we'll have weeks where if we pull the fat down, but we'd double the protein, so if you go from a 70, 20, 10 you might go to a 40% fat, 40% protein, 20% carbohydrate macro breakdown in week two. I go through like which weeks are for what? So, week two, we want higher protein to coincide with the testosterone rising, and then in week three, we return to the ketogenic diet. There's a couple of extra steps that I add in there for the different hormonal presentation that's there. Then in week four, I actually want you to increase all of your calories, which is for some women is like, "Oh, my God, what? What? No? I can't." But you have to because your metabolism is ample-- like it's higher this week. If you try to white knuckle your way through this week without eating more, you're probably going to crash, and burn, and clean up the pantry. Yeah, so, there's all these different ways that we can change the way that we eat based on the hormonal a presentation of our cycle. 

Melanie Avalon: I think my listeners are going to be thrilled to hear this because I definitely see a lot of conversation surrounding this, especially, from women, because a lot of my listeners are in the low carb sphere, Whole Foods, paleo, but there's, well, I definitely see a fear of carbs a lot, and I definitely see a lot of women just really confused about just what to do with the macros and this idea that one is right, and it's what you should be doing all the time. So, for listeners you've got to get the book because all the details, it's all in there. So many listeners will find it so helpful. Going back to that we were talking about progesterone, because you were saying how progesterone is something that's not modulated by diet? Is that correct? So, estrogen can be addressed by diet but progesterone not so much. 

Dr. Stephanie Estima: Yeah, you can indirectly, if you're having things like yams and sweet potatoes, you can maybe indirectly influence it, but there's no direct way to influence progesterone through diet in the same way that estrogen. If you were having some of these foods in the brassica genus that have these DIMs and these sulforaphanes you can drastically alter the way that your estrogen is handled in the body, whereas you don't necessarily have that access with progesterone unfortunately.  

Melanie Avalon: Gotcha. And then also with the estrogen, there's phytoestrogens, so you can be increasing the estrogen. How do you feel about progesterone creams and things like that? 

Dr. Stephanie Estima: Yeah, I'm a fan. I think that if you are a woman who has been getting her-- she's eating in accordance with her cycle, she's feeding her body and she's not having these-- I just posted something on Instagram. It's just like this thing that's just irking me right now is, the women that I care for, so many of them are like, "I just want to have a 1,200 calorie." They just want to have this 1,200-calorie diet. It's like you are starving yourself. You are putting yourself three steps backwards. So, I think that if you are someone who's eating in the way that you should, you're exercising and that exercise includes resistance training, you are practicing adequate rest and recovery, which so many women don't know how to do, and you're managing your stress then absolutely-- I'm a huge fan of progesterone cream. I haven't yet started using it, but when the time is right and I want to try and prolong it as much as I can, but when I can't avoid it anymore, I will be using progesterone cream. 

Melanie Avalon: I feel like progesterone cream at least in a more holistically minded health sphere often is the thing that a lot of practitioners recommend. So, I'm always really curious people's thoughts on that. So, again for listeners, for more on the cycles, and the diet, and everything get the book. But one topic I do want to talk to you about before we're out of time is sex. Because you have a lot of amazing information on that in the book, in particular, the Benefits of sex and the benefits of orgasm. You have your seven-day orgasm challenge, which I decided to do and change it into everyday orgasm challenge. 

Dr. Stephanie Estima: Forever? Yes, it's like, it's going to be forever now. [laughs]  

Melanie Avalon: So, I was wondering if you could just talk a little bit about the benefits of sex, particularly orgasm for women.  

Dr. Stephanie Estima: Absolutely. This is again one of the things I don't think is discussed enough in the healthcare sphere. When we think about for women in particular, when we think about the balancing effects, even if we just want to forget that it feels amazing. But if we want to just think about the balancing effects that it has on our brain, it reduces our anxiety. It brings balance to-- If you are someone who experiences a lot of PMS, having regular orgasms actually increases your pain tolerance. So, some of that prostaglandin activity and the contractions that you may experience or that discomfort that you may experience can be really attenuated and mitigated by regular orgasms. Of course, it has effects on the brain and effects on mood. It's like nature's Ambien. It helps us all get a better, more restful sleep. So, I think that orgasms are really, really important.  

Again, coming back to societal views on a woman who enjoys sex, I think that you're either frigid, and you don't like it, and you're cold or whatever, or if you enjoy it too much, there's so many names that I won't even go into about a woman who enjoys herself. So, my advice there is screw that and get after it. So, when we think about orgasms in general, I talked about this in the book, there's different phases in terms of how we climax. One of the things that I think is really important. So, there's four different phases. One is called excitement, second phase is called plateau, the third phase is the orgasm, which is the peak, and then the resolution that happens afterwards. But one of the phases there that I want to highlight is called the plateau and this is-- When this is the distinguishing factor, I was talking in the book to vibrate or not to vibrate. Do we use toys or are we going to manually stimulate ourselves? In this phase there is increased activity in the pleasure centers in the brain like the amygdala hippocampus, which is like learning and memory as well. Anxiety centers, as I mentioned in the brain will shut down, and we're able to experience more dopamine and adrenaline. This is the phase in this whole climax series where we can experience that increase in pain and stress tolerance. Then of course, the muscle tension from that-- from the excitement phase is now being transformed into contractions, and muscle spasms, and you may even find that your hands might be contracting a little bit, your feet might be curling, that kind of thing.  

It's really important as women that we get to know ourselves manually. You can for sure use toys. I'm not saying not to use toys. You can use as many toys in as many ways as you want. But also make sure that you're incorporating manual stimulation, whether it's yourself or it's your partner. Because this is going to help you bathe in that plateau phase, which is right before you orgasm a little bit longer so that you can get some of-- all of these brain benefits, all of this hormonal regulation benefits as well. So, big fan of orgasms, big fan of sex in general. I think that we should be having it but if it's not, if you're not with someone, you don't have a partner that doesn't mean that you can't be benefiting from orgasms. You can have toys, you can get some organic coconut oil, and go at it. 

Melanie Avalon: Sometimes, I read a book, there's a very, very practical takeaway that I implement in my life that I just like will probably keep for the rest of my life, and this was one of them. Especially, like I said, you have the seven-day orgasm challenge and you actually recommend that listeners take a picture of their face before and after. 

Dr. Stephanie Estima: Did you do that? Did you take a picture before and after of your face? 

Melanie Avalon: I didn't but I've been looking at my face [giggles] for the difference. Actually, you know that's not true. I've been taking pictures of my face every day. So, not for this but I could compare. 

Dr. Stephanie Estima: I'd be really interested to see what you observe because a lot of women will say that their eyes look brighter-- We were talking about those effects of estrogen before how it plumps up the cheeks, plumps up the lips, rosy cheeks, like a lot of people will see decreased inflammation. So, if you have-- a lot of women will, especially, if we have insulin resistance, we'll have dark circles under the eyes. That usually is improved as well. There's just generally the inflammation, the puffiness in the faces down, and then our lips look fuller, our cheeks look fuller, our eyes are a bit wider, like the whites of our eyes are a little bit brighter as well. 

Melanie Avalon: That is so incredible. No, I just love it so much and quick clarifying question. So, the plateau that you're talking about. So, that's the period leading up to the orgasm? 

Dr. Stephanie Estima: Yeah. So there is like-- excitement is like when you just start, so it's for your heart rate, maybe your blood pressure starts climbing. For some women they might notice reddening of their skin, maybe if they're light skinned, especially chest and neck area. Then after you're kind of into that plateau is that time before the climax. So, the longer that you stay there and of course, there's tantric philosophy that you should bring yourself up to or right before orgasm, and then come back down, and right up and then, so you have these long-- I think there's been-- was it Sting? I forget who it was, talking about how they've had these sex sessions that were two hours, three hours, four hours in length. So, the longer that you can be in that plateau, and of course, you don't have to-- Some people might call that torture. But the longer that you can be in that plateau phase, the better that you are going to have some of these brain and body benefits. 

Melanie Avalon: Okay, I'm so glad you said that, because I have some more questions about that. Not to get super granular because you were talking about using the vibrator or not using the vibrator. So, what if you're using the vibrator, but you're extending the plateau? Is the problem shortening the length of a plateau or is the problem like the vibrator? 

Dr. Stephanie Estima: The problem is the shortening of the plateau. If you are very disciplined, [laughs] you can use your toys as well. But I still think that the vibrator's still mechanical. Some people feel like they've just been buzzed afterwards. So, there's also learning different types, different strokes, different pressures, different patterns. I think is also really important for when we're thinking about manual stimulation. But the main issue that I take with only climaxing from a toy is that we tend to skip-- that plateau phase is really rushed. It can be having your session, but you go from excitement really quickly through plateau right to orgasm. Like I said, if you're very disciplined, I am not. So, I cannot. So, I typically will have like, there's a combination of both for sure. 

Melanie Avalon: Just to clarify, again, the health benefits from this. Are just really intense hormonal changes happening in that brief amount of time that you're engaging in that activity or what is actually happening to your hormones beyond that? 

Dr. Stephanie Estima: Well, I think, if you only have one orgasm and never do it again, it's very similar to going in the gym and lifting weights once and it never doing it again. You'll have that transient change, but if you don't build upon it. It's like any health habit. I would never say, "Hey, I had one salad, now I can have burgers for the rest of my life, because I was healthy that one time." It's something that builds on itself. So, I think that when we are consistently engaging, and the science suggests for-- to have these profound effects on your hormones, and your brain, and your body, and to have the oxytocin, and the melatonin, all the things that happen is around twice a week. I actually think that they looked at couples and happiness in the marriage, and I think it was a minimum of once a week, but ideally, it was like two or more times a week that they were engaging in some type of like, whether it's oral sex or penetrative sex, or whatever with each other. So, if you are orgasming once or twice a week, I think that directionally you are going to help with some of these hormonal balancing effects that we've been discussing. 

Melanie Avalon: Are there health benefits if you have sex, but don't orgasm? 

Dr. Stephanie Estima: I think so. I think that when you are having sex with someone, hopefully this is a person that's very important to you, and I think that we are at our most vulnerable as women. There's like someone is entering your body. So, there's trust and bonding that happens, and we are never as vulnerable as we are when we are engaging in, if we're talking about penetrative sex, I think that someone's body part is coming into your body like it's not an invasion, but in a way it is. So, you really have to trust, and surrender, and open up to this person. So, I think that there's a lot of benefits around oxytocin. Oxytocin, we typically think about oxytocin rushing in after an orgasm. But of course, if you don't orgasm, but you share this experience with this person, you are going to feel more bonded to them. So, I think that-- I think that while orgasming should be a goal, whether you are with someone or without, I think that there can also be a really beautiful exchange of energy with somebody and there's not necessarily an orgasm there.  

Melanie Avalon: Well, again, there's so many other things that we could touch on, but maybe something to end on, for women who feel like they're just a slave to their hormones. I know, my sister for example has PMDD. For her-- she really feels like it just rules her life in a way like she has, what she calls, she has a name for it. She has her period of time where her symptoms are really, really bad, and she has a name for it, and it's basically like, just choose us like, get through that time. Then she has like her golden week when she feels good. So, for women who maybe that extreme, maybe not, but women who feel they are just slaves to their hormones, can anybody make change and again, I refer listeners to your book, but where is the first place to start? Is it diet, is it stress, is it everything just what is your message to women who feel like they're struggling on the hormone bus? 

Dr. Stephanie Estima: What I would offer is that, your body is magical and your body wants to be healthy. These symptoms are not working against you, they're working for you. What your body's trying to do is show you where some of the misalignment is, whether it's your physiology, or your life, or some kind of combination of the two. I think that everybody can improve. I've seen massive improvements from women with Hashimoto's, going in remission to endometriosis, adenomyosis. I've seen all sorts of things, and I think that when we combine and the other thing I want to say is like, you don't have to do all of it at once tomorrow. It's not like, "Okay, well, I guess, I'm going to do keto tomorrow." No. 

We want to just very slowly and gently layer on some of these behaviors. I talk about how to do it in The Betty Body. The last chapter is kind of your roadmaps. I've given you all of this information, which can feel like you're drinking from a firehose. It's like, "Okay, what do I do with all of this now?" So, there's like a template for you to go through the book, choose what it is that you are going to work on, and then work on that for a period of time that is beyond your comfort zone. Because a lot of times, we're like, "I'm just going to work on this for a week and it'll be done. I can move on to the next thing." It's like well when we're thinking about metabolism, body composition, weight loss, these things take time, and your body, I want you to talk to your body as if she was your best friend or if you are a woman who maybe is carrying trauma from her past, if you are speaking to your little girl inside you, how would you handle her? Would you yell and scream at her or would you say, "Okay, we got this. We're going to do this one step at a time."  

You would never scream at a newborn baby for not walking, right? You expect that with time, with practice, with trials and errors, that newborn baby is eventually going to figure out how to lift it's head and then maybe after that-- after tummy time, it's going to figure out how to get on all fours, and then it's going to crawl, and then it's going to pull itself up to sitting, and then it's pulling itself up to standing, and then it's walking. But you don't go from newborn baby to walking. We often have these unrealistic expectations of ourselves. So, I would say choose a timeline that you're not comfortable with, which is usually like six months, 12 months, 18 months, and then master one aspect of the book, and then as you have mastered that, you can start layering in new behaviors. Because you didn't wake up this last week. This is probably something that has been developing slowly with time. The reverse is also true. You're probably going to maybe not have the exact same amount of time that it took you to get here, but you are going to have to give your body a chance to catch up to what your mind wants.  

All that to say is that your body is beautiful, it is magical, and it wants to be healthy. You just have to put the right input in to get the output that you want and be gentle and patient with yourself. So, the book details all the things that you need, so, you can find The Betty Body on any online, Amazon, Barnes & Noble, all the places you'll have the book. You can also-- If you want to pop over to my podcast, you can kind of see what we're talking about, there's a lot of the similar subjects that we talk about in The Betty Body. and yeah, that would be my starting place. You pick up the book, read through it, and just sit with yourself and figure out, what is the first thing that I need? Because for you, Mel, it might be nutrition. For me, it might be exercise. For one of your listeners, it might be getting her morning routine on track, and for someone else it might be getting her sleep routine on track. So, there's a lot of different pathways. All roads lead to Rome, but there's just a lot of different ways that you can get there.  

Melanie Avalon: Yeah, for listeners, Dr. Stephanie just touched on two other things that we didn't even touch on that are massively explored in the book, and that's the morning routine, the role of sleep. There's so much, so much information in there. So, definitely do not hesitate to get it. Also, you have a nutrition and fitness guide that you can get at bettybodybook.com. So, the last question, I ask every single guest on this show, and it's just because I realize more and more each day how important mindset is, which is also something that you talk about in the book. So, what is something that you're grateful for? 

Dr. Stephanie Estima: Oh, my goodness. Right now, in this moment?  

Melanie Avalon: Sure. Yeah. Now, forever, whatever you like. 

Dr. Stephanie Estima: I think I'm really grateful that I listened to my body's whispers. So, I don't know if you've ever attempted to write a book. It is a labor of love. It is like birthing a child. In many cases, it's painful, and there's lots of stalls, and you don't know if the baby's head is ever going to crown. And I really felt-- In the process of writing the book, I really had to not only become Betty like to become the person that I was talking about, but to really have an opportunity to understand the science in a way that, I might have not made the time for in my clinical life. So, I'm very grateful that I followed my intuition that I know my women in my practice were like, "This needs to be a book. You need to document this, you need to share this with people." I was like, "That's not right. People don't want to hear about this." I'm really grateful that I listened to myself to follow through on that. That's why The Betty Body is here in a way because I listened to that little whisper that was telling me that I should help more women on a bigger scale.  

Melanie Avalon: Well, I love that so much and as well I am so grateful for all of your work. I know my listeners are as well. It's just really, really incredible. It just echoing everything I said in the beginning, and now listeners understand a little bit more why. You're just really doing a service to women. The knowledge that you're providing, it's empowering, and then, on top of that, you provide very real practical implementable lifestyle solutions. So, I cannot thank you enough. This has been so amazing. Thank you so much for your time, and hopefully we can talk more in the future.  

Dr. Stephanie Estima: Looking forward to it. Thank you so much. 

Melanie Avalon: Thanks, bye.