Dr. J is tackling menstrual irregularities and heavy menstrual flow, symptoms, what your cycle should look like, looking at hormones, when to best test, triggers of irregular cycles, and some tips for helping regulate menstruation.
Most women cope with their PMS and irregular cycles like it's a normal thing, but really heavy menstrual flow can be a sign of something deeper, maybe even estrogen dominance. Heavy menstrual flow can cause fatigue, lethargy, mood issues, irritability, brain fog, hair loss, and most importantly low iron. Heavy menstruation can drive anemia and low iron which is essential to the body, then it can take weeks to replace iron, by the time you feel more yourself the cycle starts all over again. What can we do? Well Dr. J has much to say from the perspective of a functional practitioner.
Dr. Justin Marchegiani
In this episode, we cover:
2:54 Menstrual Issues and Terminologies
11:12 Social Isolation, Supplements and Herbs
15:10 Tests for Menstrual Irregularities
17:44 Fasting as Stressor
20:16 Diet Restrictions
Dr. Justin Marchegiani: And we are alive. It's Dr. J here in the house. Evan and I will be chatting about menstrual irregularities and heavy menstrual flow. Evan, how are we doing today man?
Evan Brand: Doing really well excited to dive in. This is an issue that many women just deal with. And they don't really get help with. They just assume that hay, it's normal to have PMS. It's normal to have this happen with my cycle where this month, it's 28 days. And then the next month, it's 17 days and the next month, it's 36 days. And I mean, we hear these stories all day every day.
Dr. Justin Marchegiani: 100% and the problem with heavy menstrual flow off the bat, it's a sign of something else deeper, usually some kind of estrogen dominance. And then what's driving that right? A lot of times progesterone is falling out too soon in the woman's cycle. And then you have all this heavy menstrual flow, and that can drive in anemia that can drive low iron and that's a problem because we need iron to bind a hemoglobin to carry oxygen. And we need oxygen for aerobic metabolism right for our mitochondria today. burn fuel, generate energy and burn fuel. So we need adequate oxygen. So if we have heavy menstrual flow, you can easily see fatigue and lethargy and mood issues. And a lot of times takes a couple of weeks to even replete that iron back up, and then you do it all over again. So it becomes this really, you know, you're in the boxing ring every month, and you're just getting beaten up, and it's really tough. So you got to fix the anemia, and you got to fix that heavy menstrual flow for sure.
Evan Brand: Would you say this is a functional problem, meaning if you go to your doctor and you're getting conventional bloodwork done, it's going to get missed or even on conventional bloodwork. Are you going to see certain things pop up? That would be a red flag to even a conventional doctor that they would see.
Dr. Justin Marchegiani: It depends. A lot of times conventional doctors aren't going to run like a functional iron panel, they won't run like ferritin or iron saturation or iron binding proteins. A lot of times they don't do that they'll run a CBC and they may look at RBC see if it RBC is below four or a hemoglobins in the elevens or dramatic rates in the middle Low 30s they may run that but it just takes a lot. Like the issue has to be a lot more severe for the RBC, hemoglobin hematocrit to be a problem. So, you know, I'll run a CBC to see where you're sitting, right? We don't want the RBC below 4.2 we ideally want the hemoglobin in the 13th, we want to get in the upper Upper 30s. So we want to make sure that's good. But if you're using a late stage indicator, the problem needs to be going on for a lot longer to fix it. That's the issue.
Evan Brand: Okay, let's go into symptoms briefly. I think this would be helpful for women because they'll say okay, menstrual irregularity, you know, what, what do you how do you classify that? And then what symptoms would be associated with this? Are we talking to typical PMS issues where, you know, there's breast tenderness stuff, or are we talking where the the cycle is changing? Where, like I mentioned, you know, some months it's 28 days, others it's 36 others, it's 17? Are we talking headaches? What are we talking?
Dr. Justin Marchegiani: Yeah, so let's kind of get a couple. Let's get some terminology stuff out here. First, I find it I'm not sure if It's an educational issue. I speak to a lot of women, I say how long is your cycle? And the first thing they tell me is how long they man straight for. So it's this weird kind of disconnect. And I think it's just people aren't really educated in school about this. People, most people conflate their cycle is to how long they men straight. So a woman's cycle is their entire hormonal cycle. Usually it's 26 to 30 days right from day one's the first day of leading to the next day one. That's their whole cycle, right, which is built on a follicular phase right where the follicle grows, and estrogen predominates. It's built on oscillation where estrogen predominates and progesterone rises. That's oscillation and that it's built on the luteal phase, the last half. So think f follicular first, think l luteal last, okay. And then luteal is where progesterone predominates. And a lot of the cycle irregularities may happen because of estrogen bouncing around or progesterone being either too low or dropping out too soon. And so when we talk about a woman cycle, that's the full cycle when we talk about menstruation. That's the period right? So most women they confuse menstruation and cycle length. So menstruation is when flow is happening period blood flow, and the cycle is going to be the entire length of that hormonal rhythm day one the first day they're bleeding blood flow to the next day one, that's your cycle. So just from a terminological standpoint, so when we're looking at the heavy menstrual flow and a lot of the irregularities, it tends to happen a couple of days to even a week before we have blood flow. And of course, some women when there's a lot of estrogen dominance occurring in that progesterone drops out too soon in the cycle and I'm doing a lot of hand gesture stuff so people are aren't quite following on the auditory side. We'll put the video link below so you can see the video. But when that progesterone drops out a little too soon in the cycle, that's where we have a lot of menstrual flow. And this can really mess a lot of women up because of what I said earlier. You're going to have a lot of low iron here, low low iron, low hemoglobin, and then you're ability to carry oxygen really get some hair, and that's gonna make it harder to generate a Robic metabolism and support the mitochondria. Mitochondria needs oxygen. So we need that. So that's one of the collateral damages of menstrual irregularities is the menstrual flow. And then of course, other things can happen like irritability, breast tenderness, back pain, mood issues, brain fog, but the key thing that that's going to happen after that is going to be a lot of that blood flow driving the anemia and the low iron, low hemoglobin. And the I was-
Evan Brand: I would Oh, yeah, I was gonna say the fatigue is probably the big one, right? Maybe exercise intolerance. These are women that they feel like they have to do some exercise. Maybe they're pushing themselves hard, but they just don't feel like they have enough gas in the tank to get the exercise done. It just feels abnormally difficult to do physical things. And then hair loss is big too. I mean, we've seen countless times on bloodwork where women will show up with really low ferritin. And they'll say that every time they take a shower, I mean they're losing a clump of hair, you know, per shower, and that's just insane.
Dr. Justin Marchegiani: Yep 100% 100% so it's always really good to take a look and test where you're sitting during the luteal phase like right around day 21. The 22 is usually a good time to test where that progesterone sits to make sure it's high enough. If you're having a lot of heavy bleeding early, a lot of times that progesterone just falling out a little too soon in that cycle. And so we may support there's a lot of stress, we may support the hypothalamic pituitary, go Natl axis, right that's the brain talking to the to the gonads or to the ovaries in this example or to the adrenals. So we can support adequate levels of progesterone output. And we may use herbs like you mentioned shepherd's purse, we may use things like chase tree, we may use estrogen modulators like Don Chi or black cohosh may use things like that we may use special phenotypes of Makkah, we may even use byway denticle progesterone as well to kind of carve out and work on supporting that healthy female rhythm too.
Evan Brand: And What led to these issues in the first place? I mean, we're talking just age, we're talking stress, we're talking pregnancies having babies, like the xeno estrogens in the environment. I mean, what are you thinking are some of these big triggers?
Dr. Justin Marchegiani: Um, so in regards to the biggest trigger, in my opinion, is going to be the fact that progesterone can make cortisol. So when women get stressed, their stress hormone is cortisol. So they're going to take a lot of that progesterone, and they're going to, they're going to pull it from their cortisol. All right, I'm sorry. They're going to take a lot of progesterone and they're going to pull it down to cortisol. So then that starts to skew the relationship. So stress, takes progesterone shunts it downstream to cortisol that can create some functional estrogen dominance, okay. Number two is just they're depleting a lot of their cortisol output from the adrenals. And their adrenals are, you know, are making some other hormones but there's needles are just more depleted. That can be a big thing too. And then three would just be potential Xena And exposure, there's three big variables there. That's gonna be from pesticides, right? These chemicals, they kill plants by disrupting their hormonal system and nervous system. So that's one. Number two is gonna be plastics. Plastic does you know estrogens, right BPA or even some of the BPA free ones have other types of xenoestrogens that aren't good. And the third one is going to be hormones and meats, animal products were to dairy milks, beef, chicken, right, just the hormones that are given to the animals to fatten them up. And so it's going to be plastics, pesticides, and hormones in the meat and animal products. So those are the big ones. So of course, eating organics and to be good. Using Pyrex, or glass containers is great, especially when heating plastic isn't that bad, as long as everything's cool, and isn't in the sun, not as big of a deal. Once it's in the sun and you're heating it forget about especially a microwave forget about ovens. Obviously, that's a no brainer. And then of course, um pesticides and pesticides could be in the food Okay, so organic helps that it could also be in the water. So high quality water filter, reverse osmosis, or at least a carbon filter will filter a lot of that junk out.
Evan Brand: Yeah. And people listening, they may say, God, why does everything have to be so complicated? It's like, Well, we've just changed a lot. I mean, you mentioned the adrenal thing. Women now where historically they were in the tribe, and they had other women to help with the kids. Now you've got the stay at home mom, parents-
Dr. Justin Marchegiani: -and grandparents, man. Yeah, I mean, that's back in the day. Think about it. grandparents would be like in their 40s and 50s, probably right. You have kids in your late teens, your kids would have kids in their late teens, that puts you like, you know, that puts your grandparents in their in their 40s, early 50s. And typically, you know, you'd be out earning a living paying for the home and maybe rearing the kids a lot, maybe taking care of the kids. So there was a little bit less stress on the child rearing aspect of it, because you had someone there. And then typically, you didn't have a big mortgage, you didn't have all this. So usually One income was enough. So then, you know, one person could help out with the family, grandparents helped raise the kids, one person required for the income. So there wasn't a ton of stress. And the income back then could be hunting. Right? It could be hunting or fishing, right? It could be doing something that were just really providing food and shelter. And that's it. That's all you need it. So our society has evolved and changed, and there's a lot more financial stress, and some people have to have two incomes to survive to and, and grandparents are older and have their own health issues and can't really participate on the day in day out of raising kids. So a lot of good things have shifted.
Evan Brand: Yeah, well, then you go further back, and before there was even bills and currency and you had the tribe that was hanging out with each other where you'd have, like you said, multi generational tribes, and then you would have potentially other people that are related somehow or maybe not related. They're just part of the tribe. And, I mean, you read about these, you know, hunter gatherer societies where you've got women that would sometimes be nursing the children of the They're not theirs, you know. So there must be a shared motherhood experience. And now you've got the stay at home mom driving the minivan with the three, four kids running them to the park and then doing the groceries and all that alone. So, you know, I think a lot of the social isolation aspect is really big for this stress component you're talking about with this whole pregnenolone, progesterone, cortisol, everything getting robbed and diverted. And, yeah, I mean, it's like, it's a big hormonal chaos, really. And it's because the, we know, there was actually a study done on that isolation issue. And that isolation, being socially isolated, was comparable to like smoking a pack of cigarettes a day. In terms of the the toxicity, we're just not, we've never been a species like this. And now with shutdowns and everything going on, you've got people even more isolated. I mean, I have a client who's a therapist, and she said, Man, everybody's a wreck. And I said, What do you mean? And she goes well, because everybody's separated from each other people are afraid to be next to one another. She said, I'm hearing all sorts have new symptoms for my clients. I thought Wow, that's really interesting. So what's the remedy? Well, you mentioned some of the herbs already some of the adaptogens will use and maka extracts and shepherd's purse and wild yam and cohosh and chase tree and all those things are amazing. But I think at the end of the day, you've got to try to build some type of a community. You know, like Facebook, moms groups are one thing, but you actually have to have like an in person, place where you can sit down with other people have a conversation, you know, let somebody else handle the kids chaos for a minute. While you can just relax. I think we're all just stuck in fight or flight. And that's really one of the big root causes is our nervous systems are just so turned on. And especially if you're watching the news, you're not turning off. And I think that's a big root cause outside of the environmental dietary pieces.
Dr. Justin Marchegiani: Yep, I totally agree. There's some data also Showing that there's more relaxing, which is a hormone produced by women's bodies that can relax a lot of the ligaments and tendons. There's some data showing that there may be more ligament laxity in the last half of the cycle where progesterone is. So just be careful of over exercising or doing too strenuous exercise. During the last half of the cycle. Just keep that in the back of your mind exercise stress could be a big one. We don't want to be over exercising that's important. Of course, nutrient density is essential. So nutrient dense, anti inflammatory, low toxin foods are going to be key one because we provide building blocks and two hormones are made from good high quality cholesterol compounds and cholesterol is connected with animal products and that's usually connected with fat soluble vitamins at Okay, so we got to make sure all those foods are dialed in egg yolks. High quality grass fed beef by the grass that are by last night with some organic green beans was wonderful, right? So you can do all these things with the food good paleo template and you know, line up your macronutrients according to what you need. As a woman, if you're more of an ectomorph, you're more lean, you're more skinny, you may be able to handle some more starch starch on the reg. Right? Every day, you can handle more starch. If you're more on overweight, you may have to lean more on your non starchy vegetables and less fruit and starts maybe some but just a little bit less. So really get your macros dialed into.
Evan Brand: Yeah, I would say on the supplement side to one thing we didn't mention would be like calcium D glucoerate could be really helpful. And then also, you know, since we haven't gone down the rabbit hole yet on this podcast about it, you know, we could briefly mention the gut and how the gut is involved in these hormonal issues and how we've had many women that have had issues with their cycles that have spontaneously resolved just by fixing gut infections because we've hit on this idea of the beta glucuronidation enzyme being elevated, which causes the research ulation of toxins and hormones due to bacterial overgrowth. So if you're having menstrual irregularities and you're not addressing or looking into your gut, you know, you could work on the diet piece all day and still have issues. We have many women that have come to us that they've done a great job on the diet. But there's still suffering. And so that's where we dig deeper. And then something like calcium D glucorate may be used. And it can do a lot of good really, really quick with the detox piece, even for mold. It's been helpful.
Dr. Justin Marchegiani: Yeah, so when we test a lot of these, we'll do a Dutch test. And we'll look at things like right around day 20 or so. So we can see where progesterone peaks out. And we'll also look at estrogen levels and ashra metabolism. We'll look at two methoxy, two hydroxy. Estrogen we'll look at methylation markers. We'll look at pirate glutamate, including violence that can give us a pretty good window for impaired on the detoxification side and we can add in phase one, phase two detoxification support whether it's B vitamins and antioxidants, or sulfur amino acids, or extra binders or extra vitamin C or extra fibers to kind of bind up some of that that's a really good option to therapeutically support detoxification, as well as just to help excrete extra hormones that may be laying around from some of the other reasons we chatted about.
Evan Brand: Yep, absolutely. So the testing piece, you know, Dutch is going to be important. I would say stool test is going to be amazing. Blood panels could be important. You know, if we did have a history like heavy bleeding, we're going to look into ferritin do like a full iron panel, potentially thyroid could be important as well. organic acids. I mean, I would argue that be important too, we always run those for looking at the gut piece, the mitochondrial piece, if a woman's complaining of, you know, major fatigue associated with this wells is related to the iron ore is is related to possibly the mitochondria as well that have gotten damaged by some sort of toxicity issue. So I think those would be top priorities. What about anything else? Are there any other tests that you would you would run to investigate this issue?
Dr. Justin Marchegiani: Well, if there's a lot of insulin resistant issues, insulin is a big one. So carbs are out of out of whack and they want to look at insulin levels, make sure they're closer to five, five to sevens ideal. They're too high, there could be some resistance going on. Of course, I always get worried about pcls right. pcls is primarily driven by high insulin and then that can cause elevations in androgens and testosterone and that can also cause an increase in something thing called prolactin and prolactin can start to dis regulate the HPA axis that can kind of dis regulate the cycle. And again, that's all supported by getting blood sugar stable, right. dysglycemia is a major hormonal stressor. And I asked them and don't, don't jump into hormonal stress and start fasting and doing all this stuff. Get your blood sugar relatively stable, you know, make up proteins and fats as the foundation of your meals. And make sure make sure 100% you're getting enough nutrition, go look at go look at your chronometer, or My Fitness Pal and look at your calories. Make sure you're getting enough. Make sure those calories are all nutrient dense, anti inflammatory, low toxin. Make sure you're getting enough magnesium and potassium and high quality minerals. Very, very important.
Evan Brand: Well, you said it quick. So let me just restate it and confirm to make sure it's clear. You're mentioned you're mentioning fasting as potentially being a big stressor that could make this situation worse, correct because you're saying if a woman's already nutrient deprived, or she's having major issues Potentially too much blood loss. Fasting is something that could throw off blood sugar balance. But also, as you mentioned before, there's no nutrition and starving. So you're saying in this case, three meals a day maybe better than doing a fasting protocol?
Dr. Justin Marchegiani: Yeah, the problem with fasting fasting can help when there's insulin resistance, but one there needs to not be a lot of blood sugar stress meeting up and down, right? So people think like, oh, if I have blood sugar issues, then fasting is great. Well, not if there's display see me because this glycemia means your blood sugar's up and down and up and down. And every time it goes up, your pancreas kicks in every time it goes low, your adrenals kick in with cortisol and adrenaline. So there's stress on those glands. So the problem with that is you want to make sure you buffer that with healthy proteins and fats, it's like putting a fire going and having putting, you know, twigs and paper on it. If you ever started a fire that way, you'd be feeding the fire every 30 minutes to an hour or even more because the fire would burn out fast. So a log on the fire that stays For hours, it's like proteins and fats. And most women, they metabolically keep their fire going with twigs, and paper and gasoline, and you just can't you're going to be next to the fire all day. Those are your grazers, okay? Or if you're trying to fast, well, eventually the fire is just not on you're going to get cold, ie your metabolism is going to decrease. And if you're already nutrient deprived, and now you're fasting and not getting enough nutrition, that's a problem. Now, of course, if you're going too fast, and you're compressing your feeding window, the key mistake is not getting enough nutrients. So you have to get enough nutrients. Now, if you're doing it a day or two a week and you're already healthy, and you're getting an overabundance of nutrients those other five days, of course, you get your body can handle that right. But most aren't in that over abundant state, they're already depleted. And that's where it's a problem.
Evan Brand: Yeah. And you're mentioning the grazers. I mean, these people are not grazing on grass fed beef jerky, typically they're going to be grazing on, I don't know, maybe some gluten free pretzels or something. I mean, it's going to be more of a A process thing it's not going to be. I mean, maybe it is maybe you're grazing on macadamias or something like that, and you'd be okay. But in general, you want to be able to have three solid meals per day. I find, once women do actually calculate how much they're eating, most of them are under eating.
Dr. Justin Marchegiani: Most are and then also, I'm not a big fan of snacks. Snacks typically mean a carbohydrate, primarily a carbohydrate macronutrient balanced meal, it's smaller, and it's primarily carbs and it's usually not enough. And a lot of times snacks can be used to compensate for a poor meal previously. So I like the word mini meal, because it provides a there's a balanced like a meal, meaning there's some protein fat, maybe a little bit of carbs in there. Ideally, you're doing a mini meal because your next meal is just a longer gap. So like if you had lunch at noon, but you and your husband are going out to eat at seven, well that may be a little bit long for you. So maybe you want like a good protein, fat, kind of keto bar here or a little more Any smoothie like around five o'clock, right? to kind of give you a little bump so your blood sugar doesn't go super low until you feel good. Now if you're healthy, you could maybe be able to handle it if you have blood sugar issues, and maybe a little mini meal is good right there to provide balance. Does that make sense?
Evan Brand: Yeah, it does. It does. And you're mentioning to like the meals should be nutrient dense enough to where you shouldn't have to snack But yeah, I mean, I don't go much more than five hours. I will start to get a little shaky if I go six, seven hours. It's too much for me.
Dr. Justin Marchegiani: Yeah, also just go to chronometer, man, just try to like put a sample me at like people that do omad stuff one meal a day. I'm like, dude, go to chronometer and put all the things you have to eat in that one meal and you tell me if you're getting six to eight servings of vegetables, you tell me if you're getting a pound and a half of me, you tell me if you're getting that much fat, it's really hard. Like, you're going to literally be eating like eating probably for over an hour like eating chewing. It's probably gonna be hard. Oh, yeah. Really full and you'll probably take a break. That's why two meals is doable, but you really have to be like There can't be slack in the meal. It's got to be a very intentional awesome meal. And you have to do it three meals. It's relatively easy. Yeah, you know, you have two really good meals and one pretty good one and that you're there. One is very hard. Yep. Yep. I would agree if you have tummy issues, if you have SIBO and you already have low stomach acid, well, now you're just now you're eating all that calories in one sitting. It's like, Whoa, yeah. And how would you possibly digest and assimilate all that without having any issues to that'd be very, very difficult. It's harder now people can do it if they have a really chill night and they can just sit around and relax for two three hours and in their lives aren't that stressful, right? But in their digestion is really good. They can maybe get away with it, but I think minimum two meals is gonna just make your life easier.
Evan Brand: Yep. I just want to point out that if you have menstrual irregularities, you may need to come in and do some specific herbs to address those but sometimes this issue in the same category as many other issues we've talked about, where it gets fixed as a side effect of just getting healthy, just running you through kind of our functional medicine workup, supporting and looking at adrenal supporting and working on gut, the mitochondria, the nutrient absorption, the acid and enzymes, the probiotics, sometimes just those simple steps fix this. But if they're having an issue that's not resolved, then we can come in with these extra tools. Yep, that and vice versa. And maybe we should mention this to vice versa. You can't just come in and do the chase tree, or the vytex, or the wild yam or whatever, and call it a day. You can't do that either, because now you've ignored the issues that led to this problem in the first place, whether it was the glucuronidation pathway, or the bacterial overgrowth or the parasite infections and messed up the nutrient absorption which caused the nutrient deficiency which caused the hormonal issue. So you really have to do all of it. But I don't want this to be Hey, let's go to the hormone section at Whole Foods, buy a supplement and call it there. You don't want to do that either.
Dr. Justin Marchegiani: Yes, you want to really get to the root cause of the food. stuff is important. We talked about some of the herbs we talked about even doing a kind of a cyclical augmentation kind of reset by using progesterone accordingly. And of course, we're supporting the adrenals. The adrenals play a big part. So when I always test, when I test hormones, I'm always looking at female and adrenal together, they tell a really big role. And it's nice to be a look at hormone detoxification. That's really helpful too. Because it really gives me a window in all three sides of it.
Evan Brand: Yep. I think I've said all I need to say, do you have anything else you want to go into?
Dr. Justin Marchegiani: Yeah, so blood sugar, nutrition, right diet stuff's very important. The gut plays a big role, because that's where we digest and absorb all the building blocks to make our hormones. So if we have bloating or digestive issues, that could be a problem. Don't just get myopic on the female hormones. Don't you got to remember the adrenals play a huge role. So female and adrenals. And, you know, don't jump on these fat things. Oh, just fast and do this and you'll get better. You know, get your nutrition gets your blood sugar. Get it dialed in. And then if there's things like iron, that's a problem in the interim, you know, you really want to support that I have a product called Iron Supreme, it's a bisglycinate iron. That's a really better iron ore. If you're more sensitive, a high quality liver, glandular is great. And then obviously eating a lot of high quality red meat before and during menstruation if flow is heavy, just to really make up some of that extra iron if needed.
Evan Brand: You know, good news is you can reverse this is not something you have to live with. So like I said, in the beginning, many women just kind of live with this and they just know hey, I'm quote messed up, you know, my cycle does this or that and they just live with it. But you can get it resolved to where if you track it on an app, I mean, my wife, she'll track it on an app, and it says, cycles supposed to start boom 28 it's 28 day cycles. So you know, and before due to birth control and other issues, I mean, her cycle was not always perfect. So you can fix these things. You can adjust them you can modulate them and there is hope.
Dr. Justin Marchegiani: 100% so if you guys want additional help and support, we are available worldwide. Feel free to head over to EvanBrand.com you could schedule a consult with Evan or JustinHealth.com you could schedule a console with myself we're there to help you. Click down below for links and if you enjoy the content give us a review we really appreciate it EvanBrand.com/iTunes, JustinHealth.com/iTunes, and share with family and friends. And we appreciate you guys for joining. Take care y'all.
Evan Brand: Take care. Bye now.