The Brain-Hormone Conversation

Transcript:
Hello and welcome back. I am Dr. Alison with Little Black Bag Functional Medicine, and today we are getting into episode three of our four-part May series on brain health.

This is the brain-hormone conversation. And I have been waiting all month to get to this one, because honestly, this is where so much of what I see in my practice actually lives, especially in our program with Nurse Jen and our PeriMenopause Power program. The midlife woman who walks in and tells me her brain has changed, her sleep has changed, her mood has changed, her cycle has changed, and nobody is connecting the dots. Today we connect the dots.

If you have been listening to episodes one and two, you know that I have been walking you through five drivers of brain fog. Hormones, infections, sleep, mood, insulin. Last week we went deep on the infections piece with long COVID and the post-viral brain. Today we go deep on hormones. And not just estrogen. We are going to talk about estrogen, progesterone, thyroid, and a piece of you that almost no one talks about, your estrobolome, which is the part of your gut microbiome that is actively running your hormones from inside your intestines.

And before I forget, I want to name two things up front. One, doors close on The Mama Brain Reset this Sunday at midnight. Twelve mamas. Thirty days. The whole framework, the oil kit, two group calls, a private consult with me. If you have been hovering over the comment box thinking about commenting MAMA, this is your week. Two, I am teaching a Feminine Medicine class this Wednesday night called Brain Medicine and the Sacred Mind at the Chakra Healing Room in Wentzville, Missouri. It is going to be a deeper, more embodied version of this conversation, with the energy work I do alongside the functional medicine work. The link is in the description if you want to come.
Okay. Let us get into it.

Dr. Alison DiBarto Goggin (02:45.000)
Friendly reminder before we dive in. What I share on this podcast is for educational purposes. I love sharing this information, but this is not personalized medical advice. It does not create a provider-patient relationship between us. If any of this is hitting home and you want to do the work, please do it with a clinician who knows your full picture. You can find me at littleblackbagmedicine.com, you can join The Mama Brain Reset cohort, or you can work with someone in your area who is willing to actually run the labs and look at the whole story.

Everything in today’s episode, the specific labs, the markers, the supplements, will be in the show notes and on the blog. So if you are folding laundry or driving or hiding from the kids in the pantry, you do not have to take notes.

Dr. Alison DiBarto Goggin (04:15.000)
Let me start by telling you what changed me on this whole topic, because I think it grounds the science.
We know that estrogen directly affects the brain, memory, mood, and energy. And many women in my practice tell me that the second half of their cycle, the luteal phase, is where everything falls apart. They usually suffer through this because there aren’t many options, plus, it feels normal and common. But when either a virus or infection changes hormone patterns, having a baby, maybe the beginnings of an autoimmune issue, or simply perimenopause starts to creep in. The symptoms go from cyclical to daily.

The brain fog, the lost words, the insomnia, the rollercoaster moods. And this is when most women stop and realize that it’s time to take care of themselves. That the life formula of trying to get everything done in the follicular phase, or the 2 weeks of feeling good before the hormones downshift is not going to cut it anymore. And self care becomes a mandated daily event, not just something to squeeze in during your period.

Dr. Alison DiBarto Goggin (07:45.000)
So let us start with estrogen, because for most women in midlife, this is the loudest part of the conversation.
Estrogen, specifically estradiol, the strongest form of estrogen in your reproductive years, is not just a reproductive hormone. Estradiol is a brain hormone. It supports the production of serotonin, which is your mood and your sleep. It supports dopamine, which is your motivation and your reward. It supports acetylcholine, which is your memory and your focus and your word finding. When estradiol drops, which it does throughout your cycle and especially in perimenopause, every one of those neurotransmitter systems gets less support.

Here is the confusing part. The first symptoms of perimenopause are not always the hot flashes. They are often the brain symptoms. The word finding. The memory. The mood shifts. The sleep disruption. The anxiety that comes out of nowhere. These can start in your late thirties or early forties, years before your cycle changes, years before your doctor will even consider testing for perimenopause.

There is a research study from Lisa Mosconi at Weill Cornell that did brain imaging on perimenopausal women, and what they found was extraordinary. Women in perimenopause show metabolic changes in their brain that look more similar to early Alzheimer’s patterns than they do to chronologic aging in men of the same age. That is in Neurology, 2017. And what that tells us is that the perimenopausal brain is in a real, measurable transition state. This is not in your head. This is on the imaging.

Estradiol also does something else that does not get talked about. It helps regulate glucose use in the brain. When estradiol drops, your brain becomes less efficient at using glucose, which is its primary fuel. So suddenly your brain is starving, even when your blood sugar looks normal. That is part of why brain fog and afternoon crashes get worse in perimenopause, and why a woman who used to be able to skip breakfast at 35 cannot do it at 45.

And there is one more piece. Estrogen is neuroprotective. It supports the growth of new neurons, the maintenance of synaptic connections, and the resilience of your brain to inflammation. So when estradiol drops without support, your brain becomes more vulnerable to every other driver we have talked about. Inflammation hits harder. Post-viral effects hit harder. Stress hits harder. Sleep loss hits harder. Estrogen was the buffer, and when it goes, everything else gets louder. Which only goes to compound how infections and inflammation drive hormone symptoms into a vicious cycle.

And let me say something specifically to the women in their late thirties and early forties who are listening to this and thinking, well, I am not in menopause yet, this is not me. I want you to know that perimenopause can start a full decade before menopause. The average age of menopause is around 51, which means perimenopause often starts in the early forties, and the brain changes can start even earlier. The cycles do not have to be irregular yet. The hot flashes do not have to be there yet. The cognitive changes can be the very first sign that the hormone landscape is shifting. So if you are in your late thirties and your brain has been different, please do not let anyone dismiss you because you are too young for perimenopause. You are not too young. The brain knows first.

I had a patient who came in at 38. She was a high-functioning attorney. She had been losing her words in meetings for about six months. She was waking up at 3 a.m. with anxiety she had never had before. Her cycles were still regular. Her primary doctor told her it was stress. Her gynecologist told her she was too young for perimenopause. By the time she got to me, she was convinced she had early onset Alzheimer’s and was preparing for the worst. We ran her hormones and DUTCH test. Her estradiol was dropping into the perimenopausal range. Her progesterone was crashed. Her thyroid was borderline low. Her ferritin was 12. Six months of targeted support and she was sleeping eight hours, finishing her sentences in court, and crying in my office because she had her life back. She was 38. She was perimenopausal. And needed full lifestyle support, not just hormones.

Dr. Alison DiBarto Goggin (13:30.000)
Now let us talk about progesterone, because if estrogen is the loud one, progesterone is the quiet one that does so much of the work without anyone noticing.
Progesterone is your brain’s primary calming hormone. It metabolizes into a compound called allopregnanolone, which acts on the same GABA receptors that calm anxiety, regulate sleep, and stabilize mood. When you have enough progesterone, you feel grounded. You can sleep through the night. You can hold a stressor without spiraling. When progesterone drops, which often happens before estrogen does in perimenopause, you lose that buffer.

This is why so many women in their late thirties and early forties tell me, I started waking up at 2 or 3 a.m. and I cannot fall back asleep. Or, my anxiety came out of nowhere. Or, I used to handle stress fine and now I am crying at small things. These are not personality changes. These are progesterone changes. The allopregnanolone is dropping, the GABA support is decreasing, and your nervous system has lost its sedative.

And here is the thing. In a regular cycle, progesterone rises after ovulation, in the second half of your cycle. So if you are still cycling, you can actually feel this happen. The week after ovulation, you might feel calmer, more focused, more grounded. Then progesterone drops just before your period, and the calm goes with it. PMS, in many ways, is the experience of allopregnanolone withdrawal. And as we move into perimenopause, that withdrawal happens more often, more deeply, and with less recovery in between.

Bioidentical progesterone, given in the right form at the right time of cycle, can be transformative for the women I see. Oral micronized progesterone at night can rebuild the GABA support, restore sleep, calm the nervous system. Topical creams can do similar work. The dose matters. The timing matters. And the form matters. Synthetic progestins, which are what is in most hormonal birth control, do not do the same thing. They are different molecules. They bind to different receptors. So if your doctor offers you birth control for perimenopausal symptoms, please know that is not the same conversation as bioidentical progesterone support. That is a critical distinction.

I want to expand on this for a minute because so many women have been put on hormonal birth control as their solution to perimenopausal symptoms, and they come to me confused about why it is not working or why they feel worse. Synthetic progestins are not progesterone. They are progesterone-like compounds that the pharmaceutical industry created because they could be patented. They do not metabolize into allopregnanolone the way bioidentical progesterone does. They do not give you the GABA-calming effect. In fact, some of them actually block progesterone receptors, which can make symptoms worse, not better. So when a woman tells me she went on the pill for her perimenopausal symptoms and her mood got worse, her sleep got worse, her anxiety got worse, I am not surprised and honestly that is what happened to me.

Bioidentical progesterone, which is what your body naturally makes, is available as a prescription. It is called Prometrium when it is oral, and it comes as topical creams from compounding pharmacies. Sometimes I work with women who already have a primary care doctor or a gynecologist who is open to bioidentical progesterone. Sometimes I refer out to a prescriber I trust. Most of the time I can supplement with low dose topical progesterone creams that are available without a prescription, which can be effective for some women in early perimenopause. The point is, there are options, and bioidentical is the option that gives you the brain support.

And one more thing on progesterone. Stress eats progesterone. There is a phenomenon called the pregnenolone steal, where chronic stress shunts the precursor hormone pregnenolone toward making cortisol instead of progesterone. So the woman who has been chronically stressed for years has lower progesterone than she would have otherwise, even before perimenopause hits. Which means by the time her ovarian progesterone drops, her body has even less buffer. This is part of why stress management and nervous system regulation is not optional in this work. It is hormone medicine, even if nobody is calling it that.

Dr. Alison DiBarto Goggin (18:00.000)
Okay. Thyroid. Because we cannot leave thyroid out of the hormone conversation, even though it gets sorted into a separate category in most medical practices.
Your thyroid is the gas pedal for your entire metabolism. Every single cell in your body, including every neuron in your brain, depends on thyroid hormone to make energy. When thyroid hormone is low, even slightly low, your brain runs on fumes. Brain fog, memory issues, low mood, fatigue, slow thinking, all of it.

Here is the problem. Most doctors only check your TSH, which is thyroid stimulating hormone. TSH is a signaling hormone from your pituitary. It is not actually a thyroid hormone. And the lab range for normal TSH goes up to 4 or even 5 in most labs, when the functional medicine range for optimal is closer to 1 to 2. So you can be walking around with a TSH of 3.5, being told everything is fine, while your brain is starving for thyroid support.

What we actually need to run is a full thyroid panel. TSH is one piece. We also need free T4, which is the storage form of thyroid hormone. We need free T3, which is the active form, the form your cells actually use. We need reverse T3, which is the brake your body puts on thyroid function under stress. And we need thyroid antibodies, specifically TPO antibodies and thyroglobulin antibodies, which tell us if there is an autoimmune process happening, which is incredibly common in midlife women and is called Hashimoto’s thyroiditis.

If your TSH is normal but your free T3 is at the bottom of the range, your brain is not getting enough active thyroid hormone. If your reverse T3 is high, your body is putting on the brakes, often because of chronic stress, blood sugar instability, or inflammation. If your TPO antibodies are positive, you have autoimmune thyroid, and it needs to be addressed differently than simple low thyroid. Every one of these markers tells a different part of the story.
And thyroid and estrogen are deeply intertwined. Estrogen can affect thyroid hormone binding. Thyroid affects how your cells respond to estrogen. They are toxic coworkers, in the best sense of the phrase. You cannot fix one without looking at the other.

There is one more piece I want to mention here, because it keeps coming up in my practice. Iron. Specifically ferritin, which is the storage form of iron in your body. Your thyroid needs iron to convert T4 to T3, which is the active form. If your ferritin is low, even if your hemoglobin looks normal, your thyroid is not making active hormone efficiently. And ferritin is dropping in women across the board because of heavier or longer perimenopausal cycles, dietary changes, and chronic low-grade gut inflammation. I look for ferritin above 70, ideally closer to 100, for optimal thyroid and brain function. Most labs will tell you anything above 15 is normal. That is not optimal. That is bare-minimum-not-anemic. Big difference.

And while we are here, Hashimoto’s deserves its own moment. Autoimmune thyroid disease is one of the most common autoimmune conditions in women, and it is hugely underdiagnosed. Many women have Hashimoto’s for years before it gets named, because the standard TSH alone does not catch it. You need to look for TPO antibodies and thyroglobulin antibodies. If those are elevated, your immune system is attacking your thyroid, and the protocol becomes different. It is not just thyroid replacement. It is autoimmune support. Gut healing. Stress regulation. Always a gluten-free trial. Sometimes addressing underlying viral triggers like Epstein-Barr, which we talked about last week. So if you have a family history of autoimmune disease, or you have ever had a positive ANA, or you have been on the thyroid replacement roller coaster of feeling better and then worse, please get the antibodies checked. It can change everything.

Dr. Alison DiBarto Goggin (25:30.000)
Okay. I want to pause here, because I know this is a lot. If your inner voice is saying, oh my gosh, I need every one of these labs, or wait, that is me, or how did no one tell me this, just pause for a second.

This information is not meant to overwhelm you. It is meant to take the mystery out of what your body has been doing. The brain fog, the lost words, the 2 a.m. wake ups, the mood shifts, the anxiety, the exhaustion. They are not random. They are not in your head. They are the predictable, measurable, treatable result of a hormone system that is in transition without support.

And the work is not, you need to fix everything immediately. The work is, let us actually look. Let us run the labs. Let us see what your body is doing. And then let us build a protocol that meets you where you are.

Dr. Alison DiBarto Goggin (27:30.000)
Now I want to introduce you to a part of your body that probably nobody has ever talked to you about. Your estrobolome.
The estrobolome is the part of your gut microbiome, the bacteria that live in your intestines, that is actively involved in metabolizing and recycling estrogen. These bacteria produce an enzyme called beta-glucuronidase that deconjugates estrogen, which means it unhooks estrogen from the package your liver wrapped it in so it could be excreted, and allows it to be reabsorbed back into your body.

In a healthy estrobolome, this recycling is balanced. The right amount of estrogen gets reabsorbed, the rest gets eliminated, and your hormone balance stays where it should be. In an unhealthy estrobolome, where there is dysbiosis or imbalance, the recycling can be too much or too little, and your estrogen levels can be either too high or too low compared to what your ovaries are actually making.

This is part of why two women with the exact same ovarian estrogen output can have completely different hormone pictures, and completely different brain symptoms. The estrobolome is one of the variables. And almost nobody is testing it. Almost nobody is talking about it. But it matters enormously.

How do you support a healthy estrobolome? You support your gut. Diverse fiber from plants, fermented foods if you tolerate them, probiotics in some cases, addressing any underlying gut issues like SIBO or candida or leaky gut. You also reduce the things that disrupt the estrobolome. Chronic antibiotic exposure. Hormonal birth control taken for years. Chronic stress. Processed foods. Alcohol.

And here is the connection back to your brain. If your estrobolome is out of balance, your estrogen levels are out of balance, your neurotransmitters are out of balance, and your brain is out of balance. The gut is the brain’s closest neighbor, and the estrobolome is one of the most overlooked rooms in the house.

Dr. Alison DiBarto Goggin (31:30.000)
So now we have the whole hormone picture. Estrogen, the brain hormone. Progesterone, the calming hormone. Thyroid, the metabolic gas pedal. The estrobolome, the gut-hormone recycler. All four are talking to each other. All four are talking to your brain. And all four are measurable and supportable.

Here is what I want you to take from this episode, even if you forget the rest. Your brain in midlife is not the same brain as your brain at 25. The hormone landscape is different. The needs are different. The support is different. And the women who get the support, who run the right labs, who address the gut piece, who replace what is depleting, who adjust their nutrition and their sleep and their nervous system to the new landscape, those women get their brains back. I have watched it happen over and over.

And the women who do not get support, who get told their labs are normal, who get put on antidepressants for what is actually a progesterone drop, who get told to just exercise more, those women suffer for years longer than they need to. Often decades.

I want to share one more story because it brings all four pieces together. I had a patient come in last year. She was 46. She had been put on antidepressants at 41 for what her primary care doctor called perimenopausal anxiety. She had been on three different SSRIs over five years, none of which fully worked. She was also on synthetic progestin birth control to manage her cycles. She was tired, foggy, gaining weight, sleeping badly, and her sex drive had completely disappeared. Her labs, of course, were normal.

When we ran the full picture, here is what we found. Her estradiol was perimenopausal. Her progesterone was crashed because the synthetic progestin was suppressing her own production. Her free T3 was at the bottom of the range, her TPO antibodies were elevated, she had undiagnosed Hashimoto’s. Her ferritin was 22. Her cortisol was inverted, high at night and low in the morning, which is a classic sign of HPA axis dysregulation. And her stool test showed elevated beta-glucuronidase, which meant her estrobolome was recycling estrogen inefficiently, contributing to estrogen imbalance even on top of the perimenopausal decline.

Six months. Bioidentical progesterone replacing the synthetic. Targeted thyroid support with attention to the autoimmune piece. Iron support. HPA axis work with adaptogens and circadian reset. Gut work to support the estrobolome. By eight months in, she was off two of the three antidepressants and tapering the third. Sleeping eight hours. Back to her work at full capacity. She told me, I forgot what it felt like to be myself. Now I remember.

This is what happens when we look at the whole picture instead of one piece at a time. This is what root cause functional medicine actually means in midlife. Not a miracle. Not a quick fix. A systematic, layered, hormone-aware approach that respects the complexity of the female body.

Dr. Alison DiBarto Goggin (34:00.000)
Which brings me to the close, and to the reason I built The Mama Brain Reset.

Doors are closing this Sunday at midnight. Twelve mamas. Thirty days. The five-driver framework we have been teaching all month, hormones included, brought into a real container where you have me, you have the oils, you have the Brain Recovery Plan PDF, you have two group calls, and you have a private 30-minute consult with me where we will look at your specific picture and build your next steps. The cohort starts May 25 and runs through June 23. Investment is $247 all-in, which is less than the oil kit alone would cost you retail.

If you have been listening to these episodes and recognizing yourself, this is the moment. I am not going to do another live launch like this until the fall. The Power Pack with Nurse Coach Jen will still be there, and one-on-one consults will still be there, but the cohort container with this specific brain focus closes Sunday.
Comment MAMA on my Facebook post from this morning. DM me directly. Come find me at littleblackbagmedicine.com. I will personally walk you through whether this is the right fit. No pressure. Just a conversation.

And one more thing. This Wednesday night, May 20, I am teaching a Feminine Medicine class called Brain Medicine and the Sacred Mind. It is going to be a deeper, more embodied version of what I just walked you through, with the shamanic and energy work I do alongside the functional medicine. If you want to come, the link is in the description. Anyone who comes to the class gets a $20 off code for The Mama Brain Reset, called CLASSMAMA, which is good through the end of the day Sunday.

Thank you so much for being here today. I am so glad you listened. Make sure to like, subscribe, and share this episode with the woman in your life who has been told her labs are normal while her brain is anything but. She needs to hear this.
Remember, you are doing a good job taking care of yourself. Keep it up. And we will see you next time.