Question: I am forty-six years old and a 34A. Now, I’m a 34BC. My breasts hurt at least two weeks out of the month. Swollen, heavy, painful, have to take ibuprofen. It’s annoying as hell and it’s changed how I view my body. Not to mention, my midsection has changed too. I never wanted large breasts. I know BC cup is not large, but it is to me. And now I need to wear two sports bras to run. And I like to run all the time. And I feel like I did when I was nursing. This totally stinks. Does it get better? 

Short Answer: During a woman’s 40’s, there are many hormonal changes that are happening, which lead to a wide variety of symptoms. Progesterone is declining, and estrogen is still being produced and stress levels can be all over the place. These changes can lead to many unwanted symptoms. Breast tenderness and an increase in cup size is generally related to too little progesterone and proportionally too much estrogen. There is not necessarily an increased amount of estrogen production, but really just a lack of progesterone that leads to many of the symptoms of Perimenopause.

PYHP 115 Full Transcript;

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Dr. Maki: Hello everyone, thank you for joining us for another episode of the Progress Your Health Podcast. I’m Dr. Maki.

Dr. Davidson: And I’m Dr. Davidson.

Dr. Maki: So we’re back, we’re back in the saddle do another podcast.

Dr. Davidson: We sure are.

Dr. Maki: It’s been a little while. We haven’t posted any for a little while. We apologize for that. But we’ve been very busy. We got a new puppy.

Dr. Davidson: We did get a new puppy, a poodle puppy.

Dr. Maki: Alright. So we’ve talked about Bob, our little co-pilot. He is having a little bit of a crisis. He’s kind of having a crisis with the new puppy. About one minute, it was really funny, we brought her into her first grooming sessions placed here in town called Bailey’s and she looked like a little bit of a shaggy mess. And then they just really didn’t do much because this is her first one. She’s only like four weeks old and she came back from the groomer with a nice blowout. She got her hair done. And Bob was all interested and her name is Vivi, Vivian, one of my relatives. Bob’s named after my dad, and Vivi, our new poodle is named after another relative. She was technically my great aunt, but more like my grandmother. So it’s Bob and Vivi. She came back from that groomer, a grooming session. And Bob was, he was very… he changed his tune about Vivi very quickly.

Dr. Davidson: Yeah. He went from being annoyed, “When is she going to go back home?”, to he can’t be separated from her. So it’s really sweet. And I think it’s summertime we’re enjoying the weather, playing with the new puppy, with the dog, and spending time outside. And we went and saw your family reunion in Wisconsin. So it’s been a little bit busy.

Dr. Maki: Oh. Yeah, yeah. And we’ve been, not to mention still…

Dr. Davidson: Good busy. Fun busy.

Dr. Maki: Yeah. Yeah. A good busy. Yeah. Now I know we had some other podcast, we mentioned that we’re in the process of trying to publish this book about perimenopause, it’s called the Perimenopause Plan. From this posting of this episode, it should be like days away from being published. We’re just working on a couple of the website details and there are a lot more things that went into it. Then we realized, that we didn’t understand necessarily we’re doing it all ourselves. For the most part of works, it’s kind of, for the most part, self-publishing it, we didn’t realize how many pieces, how many steps there are to that, or maybe a little naive. And as with everything right, I think this is one thing when you’re in business, you realize that things always take longer than you anticipate them in the beginning.

Dr. Davidson: So anytime you buy a book off of Amazon’s, kudos to all of them because it did take a while. But hey, you know what, it’s always a learning process. So I’m excited. So the book will be out on Amazon. We’ll also have it on our website too. And because it’s about perimenopause, we wanted to answer a question from a, looks like a reader from one of our blog posts about perimenopause.

Dr. Maki: Yeah,. And that the title of the… if you want to look it up. The title of this particular blog post which I actually remember when you wrote it, and the title is, ‘Why Is Perimenopause So Horrible?’ Which I think is just a, a not laughing necessarily why that perimenopause is horrible. But we understand that fundamentally because we talk to women all the time, that they say the same thing. Why is perimenopause so horrible? Even though at the time, maybe a little bit more now, but when we started helping women in their 40s, that’s really what perimenopause is women in their 40s. They didn’t really know what to call it. They just like, “Oh my God, my body is not cooperating anymore and I have all these things going on,” and no one can help them. So that’s why we started, without even realizing it, we were kind of seeing more and more of those. Because I remember we’ve said before, like, when you first got into practice all menopause. So, women, they’re basically in their 50s and now it shifted down a decade or two. Now it’s women between their mid-30s and even to their mid-60s. It’s encompassing the PMS, the perimenopause, and the menopausal postmenopausal, but really lately, it’s been a lot of tremendously, a lot of those perimenopausal women.

Dr. Davidson: And that’s kind of why we wanted to talk about it. And also why we put out that book about perimenopause. We’re going to do another one about menopause, probably on thyroid and a few different other conditions that we love to treat. But there is a definitive distinction between being in perimenopause and being in menopause, so they aren’t all lumped in one beat. And that was probably what kind of spurred a lot of this impetus is, I had so many women coming into me after starting practice dealing with menopause and women would come in saying they want to deal with their menopause. And I’m like, “You know, you’re 44 years old still having a period. You’re not in menopause.”

Dr. Maki: Yeah, right. Yeah. They just had to, you know, probably from their other doctors, their doctors would tell them, they’re in menopause. We’ve heard so many different things of what the other practitioners tell them. That practitioner didn’t even have a word, perimenopause. They are kind of misinterpreting some of the lab work and not understanding the symptoms in there. And really, at the end of the day, the treatment option is where everything falls off. Whether you have a name for it or not, or a diagnosis or not, it’s really what happens on the treatment side and how you’re going to deal with some of those issues. So this is from MW, she didn’t leave her actual name or anything, which we…

Dr. Davidson: That’s okay. We always change them anyway.

Dr. Maki: Which we certainly understand, but why don’t you go ahead and… why don’t you go ahead and read the question.

Dr. Davidson: Okay. So this question is… So this is about a blog post like, Dr. Maki had said on, that I had written called, ‘Why Is Perimenopause So Horrible?’ So this is a response to that blog post and she’s writing, “I see nothing on here about breast size increase, swelling, and pain. I’m forty-six years old and a 34A.” Which was really cute because I had to explain to Dr. Maki, what A, B, and C sizes mean in bras [laughs]

Dr. Maki: You did not.

Dr. Davidson: [crosstalk] you don’t understand what that means as much as I do [laughs].

Dr. Maki: Okay, I’m not a woman. I said that. You didn’t have to explain it to me. I said you would know that better than I would. Okay. I’m not a complete idiot.

Dr. Davidson: [laughs] Hey. You know when you’re thirteen years old when you get your first bra, we learn all about A, B, C, and hopefully would love to have a D. But then okay, I’m going to go back on. So, “I am forty-six years old and a 34A. Now, I’m a 34BC. My breasts hurt at least two weeks out of the month. Swollen, heavy, painful, have to take ibuprofen. It’s annoying as hell and it’s changed how I view my body. Not to mention, my midsection has changed too. I never wanted large breasts. I know BC cup is not large, but it is to me. And now I need to wear two sports bras to run. And I like to run all the time. And I feel like I did when I was nursing. This totally stinks. Does it get better?”

Dr. Maki: Yeah, right. This was a comment on, Why Is Perimenopausal Horrible? Because these are the types of questions and concerns that we get on a regular basis. Alright, there’s kind of a lot going on there, but we’re kind of just dive into her discomfort two weeks of the month.

Dr. Davidson: And truly, when I wrote that blog post, I mean I could write for days on perimenopause which I kind of did when the book comes out and you read it, but I didn’t put a lot in there about the breast increase. And it is important because a lot of women do get swollen breasts. And like she said, she’s forty-six years old, she’s always been a 34A. So this change to go up plus a cup and almost 2 cup sizes. That’s a lot. And a lot of it is inflammation and water weight, which can be really uncomfortable. And when they’re saying two weeks out of the month, so usually now we’re going to kind of play around with this a little bit, is that two weeks is probably two weeks before her period.

Dr. Maki: Yeah, right. So without her actually specifying, so if we broke down her cycle into a 28, 30-day cycle, right? So, there’s the first fourteen days or the first thirteen days, and then there’s the second fourteen days. So more than likely, if we asked her a few more clarifying questions from ovulation. If she still ovulating, which she might be, at forty-six, may or may not be. It’s the second half of her cycle, which is predominantly, usually, from ovulation to her period is what’s called the luteal phase.

Dr. Davidson: So, usually in that last two weeks, when you’re in your 40s and that’s that perimenopause. So menopause is the hormones have ceased to really dropped that estrogen and progesterone are almost non-existent. Wherein perimenopause, you see a lot of different patterns that can happen most typically, which is probably happening with M here, is that that progesterone is too low for the amount of estrogen she’s making for the last half of the cycle. So then that would exacerbate “PMS symptoms”, one in particular, is the breast size.

Dr. Maki: Yeah, right. And perimenopause like what is- like if someone nailed you down and was asking you for a definition of perimenopause, let’s just start there. I know we’ve talked about this before but we haven’t done any podcasting. We got a book coming out. So what would be your kind of off-the-wall, off-the-cuff kind of definition of perimenopause?

Dr. Davidson: It would be definitely an imbalance between estrogen and progesterone production.

Dr. Maki: So, what do you mean by an imbalance? What does that mean?

Dr. Davidson: So, like you would mention. So the estrogen, estrogen is an awesome hormone and it’s being secreted by your ovaries and when you’re on your period, all your hormones are low, so estrogen and progesterone, I would say, your estrogen and progesterone are low. So that’s what causes the lining of the uterus to shed, but then that estrogen will start to come up and peak on day twelve and then you ovulate, then you make progesterone. Usually, from about day fourteen to day twenty-eight, if we’re looking at a perfect 28-day cycle. So what you end up seeing–

Dr. Maki: Which is a chapter in the book, by the way.

Dr. Davidson: Yes. And not everybody’s perfectly 28-days and that’s okay. But if you’re looking at a perfect 28-day cycle, estrogen surges on day twelve, we have progesterone start to come up on day fourteen, and then the height of progesterone would be right about day twenty-one. And then if there’s no fertilization or pregnancy, then the hormones come down. And then back to day twenty-eight. Day 1, you get a period. So between that day fourteen and day twenty-eight, the last two weeks, as M is talking about here, is that production of progesterone is not sufficient. But in perimenopause, we’re still making estrogen. We might make a little less, we might make a little bit more, we might make exactly what we need to make. But it’s really about, what is that progesterone doing? And so, you think, if you have a good amount of estrogen which like I said, estrogens one of the best hormones in the world, is if you have a good amount of estrogen, but you don’t have that balancing effect on the progesterone. It is going to put you in estrogen dominant or what would be considered or progesterone insufficient balance. So that’s why you see a lot of–

Dr. Maki: So you said two things there. So it really is more progesterone deficiency or insufficiency, but it presents like estrogen dominance.

Dr. Davidson: Exactly. So, you think you’ve got- just like you think salt and pepper if you had to have that balance when you put it on your food. If you have too much salt, it’s too salty. If you have too little pepper, sometimes it tastes too salty because you don’t have the pepper to balance out the salt. It’s kind of like it–

Dr. Maki: Or like even what like was salad oil and vinegar, you have that balance between those two guys [crosstalk]. Okay

Dr. Davidson: If you have a lack of one, the other one presents itself more acutely; even though the level is probably fine. It’s just the other balancing factor to it.

Dr. Maki: So we could base, just based on what you described there which I knew that, but I was just kind of setting you up just so you could actually articulate it. But really then, we could say, if she is having these symptoms that didn’t show up before we could assume that she’s probably not ovulating anymore. Because ovulation is what creates progesterone production. She’s not ovulating, she’s not creating progesterone, and now she has these symptoms she’s never had before.

Dr. Davidson: Exactly. So there’s probably a part of that. Now I know, I don’t want to you know, I feel like I like, want to jump in the deep end right away, but I understand trying to explain this to everybody. So also to when you hit that perimenopausal phase, and, “Hey, we fought this imbalance a little bit with the hormones.” Sometimes our bodies become a little bit more sensitive to other things that in our environment, or what we ingest, or what we’re around, or stress because you’re–

Dr. Maki: How much we’re running on a weekly basis?

Dr. Davidson: I like to run. And honestly, I wear two sports bras too because I don’t like bounce.

Dr. Maki: Yeah, right. No. I know you’ve always- what is your cup size?

Dr. Davidson: I’m about what she is now. That, you know about a 34-36 BC.

Dr. Maki: BC, okay. I thought you were like a C.

Dr. Davidson: No. I’m more like a BC. I would love to be a big C, maybe a D.

Dr. Maki: Oh. Whoa. That might be fun. Okay. so you see that; even though I- that’s how much I don’t know. Like, I don’t know.

Dr. Davidson: Like I thought [laughs].

Dr. Maki: I thought you were a C and you’re saying like a BC so, I didn’t understand.

Dr. Davidson: I will tell you all, the ladies listening to me now if you go to a shop at one store versus another store and you buy this bra, that bra, this bra, sometimes they’re different.

Dr. Maki: And which makes no sense.

Dr. Davidson: I know.

Dr. Maki: How can they not be the same?

Dr. Davidson: Just like jean sizes, a perfect 7, a perfect 3, a perfect 9, a perfect 12. I mean, it’s all you know, anyway, we won’t go into sizes. But what I was mentioning is things that you’re exposing themselves, whether it’s stress or food and I do think when you go into perimenopause, you know, we’re in their 40s things change. But she could be ultra-sensitive to caffeine now that she wasn’t ten years ago because caffeine will create fibrocystic density in the breast tissue and some people are more sensitive to it than others and it can cause sore breasts.

Dr. Maki: And now she says–

Dr. Davidson: Chocolate can do that too.

Dr. Maki: She says, she’s not happy because of the running. She says, in parentheses, in her question that she runs all the time. The reason why I kind of picked on that part is that that type of stress on a regular basis, running, exercise in general of any sort, is another stressor for the body. In some ways, that is actually putting more pressure on her adrenals, which is further dropping her progesterone production. Because her body is increasing cortisol production because of the running. The proverbial runner’s high is really nothing more than an increase in cortisol. A lot of women, the only time they feel good is either when they’re running or right after they’re running, depending on how many miles per week. And she also mentions in there, the midsection that she’s never had before. That is basically cortisol redistributed body fat deposition. With a big mouthful right there. Women normally put weight on the hips and thighs. They are not prone to put weight around the midsection unless there is maybe an overproduction of cortisol for some reason. So again, we have a short little section on this in the book as well, because this is something that we see over and over and over. We’re speculating here, we don’t really know much about her life other than she likes to run a lot. But if does she have kids, is she working full-time. How many miles a week is she actually running? How well does she sleep? What is her overall stress burden on a weekly basis? All those things matter. And it’s going to translate the more stress she has, a lack of sleep, a busy family life, a demanding job, plus excessive running, and I think excessive- In a seven-day week, what would you consider to be excessive running in this context?

Dr. Davidson: Everybody’s different. That’s really hard to put a point down to. I have some patients that love to run 5 miles a day and my jaw drops because I can maybe do 3 and then feel pretty good after that, and maybe not every day. Some people want to run every day. As you said, it really depends on the symptoms. If they’re getting good sleep. They’re getting good nutrition. They’re not skipping meals or not super stressed and they’re running every day and they still feel pretty good and they don’t have any of these issues, then maybe that’s alright for them.

Dr. Maki: Yeah, right. You’re right. That is a little bit of an unfair question. I think somewhere between 3 to 4 days a week at the maximum, I think is reasonable

Dr. Davidson: Because I think humans, especially in our country, do need to be more active. Granted there are only 24 hours in the day. So I get it when you can’t fit in but I love that she’s trying to be active.

Dr. Maki: Okay. Yeah. Certainly, we can’t discourage especially in the country nowadays. You can’t discourage anybody from exercising, maybe like you said most people probably could be a bit more active but there’s also a limit there. There is a point where a good thing becomes maybe not so much of a good thing. And this is something that we see quite often where there’s running all the time means she’s probably doing it 5 to 7 days- 5 to 6 days a week.

Dr. Davidson: Well, you mentioned, so just to try to clarify a little bit, that the running, doing a little bit too much or you might be pushing it too much is going to raise the cortisol.

Dr. Maki: Yes.

Dr. Davidson: And then you also said, a little bit other things that raise the cortisol.

Dr. Maki: Yes. Stress, just stress in general, lack of sleep, family job, all the demands.

Dr. Davidson: Skipping meals

Dr. Maki: And that’s the other one too. And maybe a way to balance out the running is there has to be a commensurate increase in caloric intake. So, that way recovery can happen on a regular basis. So if you’re gonna be an athlete, if you’re going to run all the time or exercise all the time, the calories have to be adequate enough, and believe me, this is another thing we’re going to do a whole podcast and probably a series of podcast on how common it is for women to be under eating as a way to achieve their weight loss goals. And there’s a lot of them are under-eating anywhere from five hundred to a thousand calories, if not more on a daily basis, that puts a tremendous amount of pressure and stress on the adrenals and it manifests as female hormone-related problems.

Dr. Davidson: On a separate topic, I do notice that nowadays, hey, it’s 2021 that finally, you’re seeing a lot more things in the media, from other doctors, from experts, what not saying we need to eat. So because I remember, in the 90s eat less and exercise more. That was how to, or maybe just skip eating and that was how you were supposed to lose weight and that doesn’t work long term. So I do love now in this day and age, you do see people advocating like, “Hey, we got to eat.” Like, I had a patient that’s pregnant and she’s asking me, “How many calories can I take? Or can I reduce my calories so I don’t gain weight?” I’m like, “You’re pregnant.” Please!

Dr. Maki: Yeah, right. You’re eating for two, you need more calories.

Dr. Davidson: You’re so focused on that whole, caloric intake and reducing, that I love that you’re saying like, hey, if you’re going to exercise which I’m sure M’s loves it. You got to eat.

Dr. Maki: Yeah, and it’s really counterintuitive to think that in order to lose weight to get your body to change the way you want, you actually need more food as opposed to less food. Now it makes perfect sense and I can see logically why if you just exercise more and eat less that is going to make it work, okay. But that is only the very kind of superficial logic that turns a very complex system like the human body with all the hormones and all these sensory inputs into basically a math equation. The math equation on paper works, but it does not work in the real world. And especially after the age of forty, for both men and women that math equation works when you’re twenty-five. Eat a little bit less, and drink a little more coffee. Maybe have a couple of cigarettes every once in a while and then exercise a bunch in your body will just do whatever you want. Because that’s what women tell us both all the time. But when you’re in your mid-40s and beyond, it doesn’t work that way. So your whole strategy needs to be different in order to get your body to cooperate the way you want it to. And I can certainly see why she would never correlate the running to contributing to her symptoms. She would never understand that. And even her gynecologist would never even understand that.

Dr. Davidson: As you said about that cortisol is when your hormones you know, “hey”, they always say, “Well I’m getting older,” and doctors will say that, “Oh well, you’re getting older is your metabolism going to slow down so it is what it is just deal with it.”

Dr. Maki: That’s ridiculous.

Dr. Davidson: I totally agree, but you think about those female hormones, especially that progesterone does have an effect to buffer some of those adrenal stressors like the cortisol, which is why when you’re twenty-five years old, you can drink milkshakes and stay thin or exercise and eat a little less and lose 5 pounds overnight, but you can’t do that when you’re forty-five years old because you don’t- the female hormones have readjusted themselves in a way that can’t buffer that stress anymore.

Dr. Maki: Yeah, right. I mean that’s really at the end of the day, a woman is actually- so in a case like this, right, we’re talking progesterone or a lack thereof – you said progesterone insufficiency.

Dr. Davidson: And then there’s some cortisol manifestation happening. That’s probably a little higher than it might have even been when she was in her 30s.

Dr. Maki: Yeah right. So and maybe there’s not necessary more cortisol. There’s just like you said, there’s less of a buffer between the female hormones and that may be just our own way to explain it, may not be actually physiologically true or just kind of talking in layman’s terms here, but it sure seems that way. That once the female hormones disappear and they flat line, which is what menopause happens, there are no more peaks and valleys that are just basically a flat blade baseline. That’s when all these things seem to be magnified. Woman’s up until her 40s, everything’s going well and all said now her stress goes up everything else. Now, the female hormones start declining and her body starts not cooperating anymore. All right, and they’re completely kind of dumbfounded as to what’s going on. So this is the reason why I picked this one out, just because I thought it’s broad enough, but it’s also something we see very repetitively. Even though she’s talking specifically about her breast size, there are so many nuances to that as to- In a very “holistic” sort of way. Checking with her sleep, see what her stress level is. How many miles a week is she running? What is your caloric intake? A little bit of bioidentical progesterone could be very helpful. Maybe even a little dim or something like that to tone down some of the estrogen maybe. That might not be appropriate, but it certainly could be in a case like this. It’s not just, let’s take a pill or let’s go on birth control and be done with it. Right? And it doesn’t work.

Dr. Davidson: The last thing a 46-year-old woman wants to be on is birth control pills–

Dr. Maki: Or should be on, is birth control.

Dr. Davidson: I agree. So but I will have to say like I said perimenopause, and that’s why we wanted to talk about this, I didn’t write too much about the breast tenderness in the blog and I’m glad that M called me out for it. But I did want to say perimenopause is different from menopause because yeah, she’s noticing a change in breast size because of the hormonal imbalance that’s- and I wouldn’t call it an imbalance it’s natural, it happens in your 40s, but there is an imbalance between the estrogen and progesterone. But once you hit menopause and those ovaries have decided, “We’re in full retirement, we’re not working anymore. We’re not making any estrogen, any progesterone”, you actually see a lot of women lose about a cup, a half a cup to a full cup size from the breast tissue because estrogen is what can pretty much grow that breast tissue. That’s why when you, as you know, go through puberty, you start to grow breasts. So when you see those hormones ceased to be produced from the ovaries you will see a reduction. And then when we do some hormone replacement if that’s warranted for them and that’s okay for their personal history. You do see it grow back. They get it, but it doesn’t grow back bigger than it was before because that would be too good to be true.

Dr. Maki: Yeah, right. but you’re right. The breast is a very- as we as women, all know, as practitioners understand. The breast tissue is a very hormone-sensitive tissue. So, of course, it’s going to respond. Usually in a good way, at least when we’re in charge of something, but in a case like this, it kind of goes a little bit racked[?]. Because Is that, like I said, that, teeter-totter, the balance between the extra estrogen progesterone. It’s not necessary that the estrogen is necessarily too high, it’s just too high in relationship to the lack of progesterone, at least, in this case, it could be different in other cases, [crosstalk] at least in this case,

Dr. Davidson: Possibly. And we’re in some ways speculating but we’ve seen this so many times over, but we do a lot of lab work to correlate or I don’t even know where the correlate or justify or whatnot to put that symptomatic picture of a 46-year-old female that likes to run who has breast tenderness for two weeks out of the month. We do, do blood work to make sure that that coincides together. So like you said, we’d probably do some labs with M, maybe some bioidentical progesterone if warranted or that works out or maybe you would start a little bit lower on balancing those hormones with lifestyle, with other supplementation, like herbs or vitamins or minerals. That’s the cool thing about all of this, there’s so much stuff we can do.

Dr. Maki: Yeah, but that’s also the confusing part is because there’s not really one way to do it, right? Even with functional medicine, natural medicine, integrative medicine, whatever. That’s part of the problem is not one size- now, that’s the best part. It’s not a one-size-fits-all because we’re not- like we don’t practice cookie-cutter medicine. We shouldn’t be practicing cookie-cutter medicine or everybody gets the same treatment. So from a conventional standpoint, that’s why women are reaching out to us and doctors like us because they just keep getting told “no, or there’s no treatment or there’s nothing you can do,” or the options they are given antidepressants, anti-anxiety, medication, and birth control, it’s not helpful. It doesn’t work, it doesn’t help, but that’s the only options that are offered to them, and that’s why we have a bunch of comments on the website that we, are still pending. One thing about that, if you are going to write in a question on the website, either through the email [email protected] or if you post a comment right on the website because we do like to, got into a- I didn’t realize this at first but realizing it right now if you put your name on there and then we publish the comment and could be a little bit of a privacy issue. So you might want to use either initial like in this case or a fake name or something. So that way, it’s just, if we do publish your comment on the website, so other people can read what we wrote or at least referring. We might not be able to write on every single one, but at least point you to the episode, that answers your question now, no one gets to see your name. That’s, to be honest, part of the reason why we haven’t published some of the comments because their names, on there and I don’t want other people to see their names when they’re asking some of these things. I mean she’s talking about her cup size and it hurts and I mean that’s kind of a female-specific issue. Not everybody needs to see that or know who actually wrote it. So something to think about if you decide you want to- we love the comments, we love the questions, we love to be able to facilitate in that way, but we certainly want to keep a certain level of anonymity for everybody. So we’re not hearing it all out there for the world to read.

Dr. Davidson: Exactly, which is why M’s mentioning this, and when I read that, I was like, “Oh, yeah,” gosh, there’s so many symptoms and perimenopause I didn’t put that in that blog. Maybe I need to readjust the blog or something. But if she’s having these symptoms, just like we said before, lots of other people are having the same symptoms. So it’s nice to- I don’t know what the word is, but just when someone feels that validation, that you’re not alone, or that there are options, or that we can learn from each other. So we do really appreciate the comments.

Dr. Maki: One little other side note about breast tenderness in general, because we talked about the breast does, of course, have a lot of estrogen-progesterone receptors. It also has ironically a lot of iodine receptors. And iodine, we should do a whole other episode about iodine. I know we’ve done some of those in the past, a couple of things to think about, evening primrose oil, number one, that can be a nice anti-inflammatory to help kind of reduce some of the tenderness, but iodine specifically for breast tenderness can be very helpful. However, a little caveat to that, there’s a lot of supplements on the market that had these huge mega doses of iodine. We’re talking six, twelve, twenty-five, fifty milligrams of iodine. Be very careful with those types of doses because in most cases, if you have a normal functioning thyroid, and you take those big mega doses, you’re going to create some thyroid suppression and that might contradict what you’re trying to accomplish.

Dr. Davidson: Because yes, we have noticed when you do high doses of iodine it can suppress the thyroid. If you do even kind of like lower doses of iodine, it can make the thyroid go up. I mean everybody is a little different. So whenever we use something that might have another effect downstream on another organ or maybe have another possible side effect, then we test for it. Hey, you know what? You test for iodine and it’s through the roof. It’s not something you want to take.

Dr. Maki: We’ve seen it many times. You take iodine and these mega doses. There are a few products out there that have these really high doses. Those, we usually use for hyperthyroid situations. That is a very small percentage of all the thyroid problems. Most people are having hypothyroid problems in the last thing you want to do. If you take iodine is too much your TSH increases as opposed to and hyperthyroid, your TSH goes down. So the RDA for iodine is 150 micrograms, in a situation like this, you don’t need a lot to actually have an impact on something like this.

Dr. Davidson: And we about… The caffeine intake that she might be extra sensitive to caffeine that she might just want to cut that out and all other sources of caffeine.

Dr. Maki: Which can also be a little challenging to do. People love their coffee or love their chocolate, and stuff but… Yeah.

Dr. Davidson: Something to think about.

Dr. Maki: Yeah, that’s why I thought this was a good one to discuss because even though it’s very much about her breast size and it’s painful, there’s a few other things in there that allow us to elaborate and really paint a picture of what’s really going on there, even though we know very little about M, so hopefully, that was helpful. Do you have anything else to add about that one?

Dr. Davidson: No, no, I yeah, hopefully, that was helpful in the context of perimenopause. As you said, we could go on and on and on and no lab testing, screenings, ultrasounds all that, [crosstalk] we are talking about.

Dr. Maki: We have a lot more episodes. We can’t do it all in one episode. So you might be hearing a lot over the next to several episodes about perimenopause. But we’re going to try to keep it broad enough so other people can listen and delve into some of the thyroid stuff in some of the adrenal stuff, even into some of the menopausal stuff because it’s all related. A lot of those women that are in perimenopause are going to be soon enough into menopause, so we’ll try to keep it relevant but yet, cover enough basis, so everyone find some value. So I mentioned it just a minute ago, [email protected], you can send us an email. You may or may not get a response but we, please send them in. We do run through them, pick and choose what emails, what questions are going to be read. And we appreciate you taking the time to do that. We try to facilitate as many as we can. It is a little challenging to get a lot of them. And the book, it’s called the perimenopause plan. It will be published from the posting of this episode. Probably, it’s either already been published, that would be nice, or it’s going to be published within a few days of this episode’s airing. So pay attention to that. If you’re not on our email, go to our website. There’s a little video course you can sign up for and then we’ll give you updates on different things like that. So until next time, I’m Dr. Maki.

Dr. Davidson: And I’m Dr. Davidson.

Dr. Maki: Take care. Bye-bye.

Dr. Davidson: Bye.