The Underlying Causes and Solutions for Women’s Hormonal Balances with Dr. Elizabeth Boham

Mark Hyman, MD

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Dr. Elizabeth Boham: Even simple meditation, 15 minutes twice a day can cut back on, can significantly cut in half the amount of hot flashes a woman has. Dr. Mark Hyman: Hey, everybody. It's Dr. Mark Hyman. Welcome to a special episode of The Doctor's Farmacy. That's Farmacy with an F-A-R-M-A-C-Y, a place for conversations that matter. And if you've had any hormone issues, whether it's menstrual issues, or menopause, or perimenopause, or bad pap tests or anything, this is the podcast you should listen to. It's with my colleague and friend, and partner with the UltraWellness center, Dr. Elizabeth Boham, and she's joining us on today's special episode of House Call on The Doctor's Farmacy. And she's an incredible doctor, she's had struggles with herself with hormone issues, and breast cancer. So she knows a lot about this, and we focus on chronic diseases that nobody else can figure out, and get people better when no one else can, using a very different model of care called functional medicine. So I'm super excited to have you here, Liz. Thank you for joining. Dr. Elizabeth Boham: Thank you so much for having me, Mark. Dr. Mark Hyman: All right. Let's get into it. How prevalent are hormone imbalances for women? Dr. Elizabeth Boham: Oh, man. I mean, when I see a woman, so often we're dealing with hormone imbalances. They're so prevalent. Everything from, as you mentioned, PMS, to issues with menopause and perimenopause, to issues with estrogen dominance, or over levels of estrogen, high levels of estrogen in the body, which can lead to breast tenderness, or more PMS, or cancers like uterine cancer and breast cancer. Dr. Mark Hyman: And fluid retention, and heavy bleeding. Dr. Elizabeth Boham: That too. Yes. Dr. Mark Hyman: And all kinds of nasty symptoms. Dr. Elizabeth Boham: Yeah. So hormones are- Dr. Mark Hyman: Emotional swings and mood issues. Dr. Elizabeth Boham: Yes. So we're really thinking about hormones and hormone balance when anybody comes into the office. So, I mean, that's something, I think that that's an area that- Dr. Mark Hyman: And it's so common, right? Dr. Elizabeth Boham: Yeah. Dr. Mark Hyman: 75% of women suffer from PMS. Dr. Elizabeth Boham: Right. Dr. Mark Hyman: How is that normal? Dr. Elizabeth Boham: Right. Dr. Mark Hyman: It's not a normal state of biology, it's an abnormal state. Dr. Elizabeth Boham: Right. Dr. Mark Hyman: Just because it's so common, doesn't mean it's actually optimal. Right? Dr. Elizabeth Boham: Absolutely. So then we need to ask that question, why? Why are the hormones out of balance? And we look at everything from how is the body metabolizing the hormones? How is the microbiome, and how is that influencing it? How is the person dealing with stress, and is that influencing their hormone balance? So you want to look at the whole body when you're trying to figure out what may be out of balance with somebody's hormones. Dr. Mark Hyman: Even fertility issues. I mean, and I- Dr. Elizabeth Boham: Oh, it's getting so common, right? Dr. Mark Hyman: It's so common, it affects one out of seven couples. Dr. Elizabeth Boham: Mm-hmm (affirmative). Dr. Mark Hyman: And that's big. And so, when you go to a regular doctor and you have these symptoms of PMS, or heavy bleeding, or menopause, what do they do? Dr. Elizabeth Boham: So often they'll say, "Okay, I'm going to put you on birth control pills." Dr. Mark Hyman: Oh, yeah. Dr. Elizabeth Boham: Right, right? Like with PMS, and irregular cycles, or perimenopause, that is the common response, is let's just start some birth control pills- Dr. Mark Hyman: Is that safe? Dr. Elizabeth Boham: ... and that's going to even everything out. Dr. Mark Hyman: Is that safe? Dr. Elizabeth Boham: I don't know. I mean, it's a good question, right? I mean, there are side effects to birth control pills. We see stroke and blood clots with some women with birth control pills- Dr. Mark Hyman: Yeast infections, it affects the microbiome. Dr. Elizabeth Boham: Absolutely. There's some women where we know that the longer you've been on birth control pills, or if you're on them more than 10 years, your risk for breast cancer goes up. So there is an association with long-term use of birth control pills. Dr. Mark Hyman: Ovarian cancer, or just breast cancer? Dr. Elizabeth Boham: Just breast cancer. Dr. Mark Hyman: Yeah. Dr. Elizabeth Boham: Yeah. Dr. Mark Hyman: So that's interesting. So you take the pill for a long time and your risk of breast cancer goes up. Dr. Elizabeth Boham: Yeah. For women, when they're on the birth control pill, or if they've been on it a long time, they have a slightly higher risk, and so that's something we got to pay attention to. Not everybody handles the hormones and the birth control pills the same. Dr. Mark Hyman: So not everybody's being prescribed birth control for birth control. Dr. Elizabeth Boham: Right. Dr. Mark Hyman: They're using it as medical therapy for hormone imbalances, when there's a very different way of treating it. Dr. Elizabeth Boham: Absolutely. Dr. Mark Hyman: That works better, or that women feel better, and their hormones get imbalanced without nasty side effects of stroke and cancer. Dr. Elizabeth Boham: Right, right. I mean, you really want to ask- Dr. Mark Hyman: And migraines, and who knows what else. Dr. Elizabeth Boham: Right, migraines too, absolutely. So you want to ask, well, why is there that imbalance in the hormones, and what may be out of balance for that woman? I think perimenopause is such an interesting time, where we get a lot of women who come in to the office at that time, because they're just feeling so crummy, right? Perimenopause is the timeframe between when your cycles are normal and you easily get... or you could get pregnant, and menopause. So perimenopause are those years, there can be like 10, 13 years of perimenopause, and it can occur anytime you can go into menopause, anytime between 45 and 55, that's typical, and that perimenopause can be 10, 6 to 10, to 13 years beforehand, before you actually go into menopause, is considered perimenopause. And it just means- Dr. Mark Hyman: And what is that, do people feel bad, or? Dr. Elizabeth Boham: Yeah. I mean, there's just, the hormones are not as regular and consistent, right? So what happens a lot in perimenopause is during those years, women will have what are called anovulatory cycles. So they don't ovulate every time they have a monthly cycle. Dr. Mark Hyman: A period. Right. Dr. Elizabeth Boham: Right. And so, those anovulatory cycles, meaning no ovulation that month, results in less progesterone being produced in the body, so- Dr. Mark Hyman: Because when you ovulate, that's when you make progesterone, right? Dr. Elizabeth Boham: Right. Dr. Mark Hyman: If you're sort of weaning down your years of reproductive life, you don't necessarily make progesterone, you don't ovulate every time. Dr. Elizabeth Boham: You don't ovulate every cycle. Dr. Mark Hyman: And then you get these high levels of estrogen, and that causes a lot of these symptoms of- Dr. Elizabeth Boham: Right, because- Dr. Mark Hyman: ... clots, and heavy bleeding, and bad PMS, and mood issues, and sleep issues, and migraines, and all this stuff that women suffer from that is so unnecessary. Dr. Elizabeth Boham: Right. You think of it as when you're having regular cycles with ovulation, you have estrogen and progesterone, and they sort of balance each other out, and then when you're in those perimenopausal years, many women will have cycles where they don't have that progesterone spike. So it feels like, their body feels like it's higher in estrogen because they don't have that progesterone to balance it off, and so, you feel like you have high estrogen and like you mentioned, you get more breast tenderness, or more clotting, or heavier bleeding, and the low progesterone makes us often feel crummy. So you can be more irritable, you can just- Dr. Mark Hyman: Cranky. Dr. Elizabeth Boham: Cranky, harder time sleeping, because progesterone really is a calming hormone, and it helps us, helps women helps people sleep better. So when it's low, many times, you don't sleep as well. You'll have irregular sleep patterns where you've never had that before, and you just feel more irritable and cranky, and it's no fun. Dr. Mark Hyman: Out of balance, yeah. Dr. Elizabeth Boham: Yeah, out of balance. Dr. Mark Hyman: And it's important to understand that we know a lot about what causes these imbalances, and we know a lot about how to fix them, except your traditional doctor is just not doing it, right? Dr. Elizabeth Boham: Yeah, yeah. Dr. Mark Hyman: So what are the things that we know create hormone imbalance, that make things worse for women? And by the way, just to sort of a little aside, it's not just sex hormones that get out of balance. Dr. Elizabeth Boham: Right. Dr. Mark Hyman: And when you see this sort of period of life around perimenopause, there's like four different hormones that are all interacting, that all kind of get screwed up. One is insulin and blood sugar, because you're often in the Sandwich Generation. You have kids, and your parents are getting older, and you're trying to have a career, and it's like, it's a lot going on at that time for women often. Dr. Elizabeth Boham: Yep. Dr. Mark Hyman: And then they have estrogen imbalances and progesterone, they have adrenal imbalances, because their adrenal glands are their stress response, and they're highly stressed in that time of life. So their adrenals interact with the sex hormones and screw that up, and then of course, you got thyroid thrown in there in a lot of cases. So you've got thyroid, adrenal, sex hormones, insulin, and it's just a big mishmash of hormone chaos, and actually, you can fix it. Dr. Elizabeth Boham: Absolutely. And I'm so glad- Dr. Mark Hyman: These are so easy to fix with functional medicine. Dr. Elizabeth Boham: Yeah, yeah. And I'm so glad you brought that up, because all of our hormones are interrelated. They're all playing off each other, they're all influencing each other. And so, that's important to really understand, because that's how we can really help women feel better. So when you really focus on the adrenal glands, for example, so you have two adrenal glands, typically. They sit up on top of your kidney, and those glands produce cortisol, and they produce DHEA, and a bunch of other things. Dr. Mark Hyman: A bunch of stress hormones. Dr. Elizabeth Boham: Yeah. So cortisol is one of your stress hormones. So when you're under a lot of stress, if you're under chronic stress, for example, I mean, your body's going to be producing a lot of cortisol all the time. And so, what can happen, what can happen is then the body is spending all this time making cortisol to handle that chronic stress you're under, you're dealing with your kids, and then your parents, as you talked about, you're working all the time- Dr. Mark Hyman: Your job, your husband. Dr. Elizabeth Boham: ... your job, you're not giving your body enough time to rest, you're not getting enough sleep, you might not be eating right, you might be just running from one thing to the other, you my not be taking the time to do your meditation or your exercise, right? You're just not doing that self-care, which is so important for your adrenal glands, and hen that's happening, then your body is spending all this time producing cortisol, that it can't do as good a job at producing progesterone. Dr. Mark Hyman: Yeah. Dr. Elizabeth Boham: Right? Dr. Mark Hyman: Right. Dr. Elizabeth Boham: And so then you have- Dr. Mark Hyman: It's like a chicken wired thing. It's all connected, it's not like they're all separate. Dr. Elizabeth Boham: Yup. Right. And so, then you have more of those signs of low progesterone, which we talked about before, which is irregular sleep, irritability, more crankiness, more PMS, right? So, it's really important that we step back and say, "Okay, how can we support your adrenal glands?" And that's really a lot of self-care, by saying, "Okay, I need to give myself time to rest. I need to give myself enough time to sleep." Dr. Mark Hyman: Meditate, maybe. Dr. Elizabeth Boham: Exactly. Dr. Mark Hyman: Exercise. Dr. Elizabeth Boham: I got to get my meditation in. Right? And I think that makes a big difference. It can really help with balancing the hormones. We know that even simple meditation, 15 minutes twice a day, can cut back on, can significantly cut in half the amount of hot flashes a woman has during those perimenopausal... We haven't even talked about hot flashes yet, right? Dr. Mark Hyman: Yeah, yeah. Well, I mean, let's talk about the things that screw up your hormones, right? Dr. Elizabeth Boham: Yeah. Dr. Mark Hyman: So, sugar. Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: That causes insulin resistance, that causes more estrogen to be made, and all the imbalances, right? Dr. Elizabeth Boham: Right, right. We were talking about how when you get more insulin resistance, you gain more weight around the belly, right? And we know that when we gain more weight around the belly, that we have more of that aromatase enzyme, which makes more estrogen, and again, throws us out of balance. Dr. Mark Hyman: And what about alcohol? Dr. Elizabeth Boham: Yeah. Alcohol really is a concern, because the way alcohol... And there's multiple ways that alcohol can impact risk of breast cancer, for example, but it also seems to result in a higher level of free estrogen in the body. And so, we know it disrupts sleep, right? Dr. Mark Hyman: It's a liver toxin. Dr. Elizabeth Boham: Yeah. Dr. Mark Hyman: And it literally impedes the body's ability to metabolize estrogen. Dr. Elizabeth Boham: Yep. Dr. Mark Hyman: And I've seen studies, it was shocking to me, where people were on hormone replacement and drinking, and their liver just can't handle it, and estrogen levels spike, and the risk goes up. So we have an enormous link there. Even, I remember a study I read years ago, which was if a woman had a glass of wine a day, it increases her risk of breast cancer by 40%. Dr. Elizabeth Boham: Yeah. Unfortunately, there's a linear relationship between alcohol and breast cancer risk. So for every drink a woman drinks per day, every time she increases the amount she drinks per day, her risk of breast cancer goes up even further. So, what's considered moderation for women is five or less drinks a week, with a drink being five ounces of wine, or an ounce- Dr. Mark Hyman: One ounce of hard liquor. Dr. Elizabeth Boham: Yeah. Dr. Mark Hyman: It's not very much. Dr. Elizabeth Boham: No, it's not very much, and that's- Dr. Mark Hyman: A beer. Dr. Elizabeth Boham: ... for a whole week, but what's interesting is you're right, there has been even studies showing that even one drink a day is linked with an increased risk of breast cancer, and it may be because it is impairing, well, partly because it's impairing our liver and our ability to detoxify, and it's shifting estrogen levels, and it also depletes the body of B vitamins. So there's so many impacts that alcohol has there. Dr. Mark Hyman: Yeah. And even the microbiome plays a role in your hormone balance, right? Dr. Elizabeth Boham: Right. Absolutely. Dr. Mark Hyman: So- Dr. Elizabeth Boham: Right. That's something we're always measuring, right? We're looking at how the body is metabolizing hormones, and we're looking at the microbiome, and I think that that's important when we're dealing with a woman in perimenopause. Sometimes they just don't even understand, why am I feeling this way? Why am I all of a sudden more irritable? Why am I having a harder time with my periods? Why are they heavier? Why can't I sleep? Why am I getting hot flashes now? Right? And so, sometimes just educating them is a great first place to start. And a lot of times women just feel better when they start to understand, okay, my hormones are shifting, and then what can I do to support them? Dr. Mark Hyman: Yeah. Dr. Mark Hyman: Hi everyone, it's Dr. Mark Hyman. So two quick things, number one, thanks so much for listening to this week's podcast. It really means a lot to me. If you love the podcast, I'd really appreciate you sharing it with your friends and family. Second, I want to tell you about a brand new newsletter I started called Mark's Picks. Every week, I'm going to send out a list of a few things that I've been using to take my own health to the next level. This could be books, podcasts, research that I found, supplement recommendations, recipes, or even gadgets, I use a few of those. And if you'd like to get access to this free weekly list, all you have to do is visit drhyman.com/picks. That's drhyman.com/picks. I'll only email you once a week, I promise, and I'll never send you anything else besides my own recommendations. So just go to drhyman.com/picks, that's P-I-C-K-S, to sign up free today. Dr. Elizabeth Boham: And we were talking about how great meditation is, right? Dr. Mark Hyman: So powerful. Dr. Elizabeth Boham: Because it's... Oh, yeah. Dr. Mark Hyman: Yeah, and then the things we see typically, the women who have the worst problems have the worst diet, the most stress, they drink too much, they don't exercise. They have lots of stress, they don't meditate. It's not rocket science why hormones get screwed up. Dr. Elizabeth Boham: Right. Dr. Mark Hyman: And we know how to intervene using various specific diagnostic tests that we do at the UltraWellness Center, to actually help map out what's happening with the hormones. We can look at estrogen metabolism, we can see how to really be sophisticated in manipulating those hormones so that actually, they're better. We can fix the gut and the microbiome. We can look for environmental toxins, which act like estrogens in the body, and get rid of those, or heavy metals. And we can actually have an impact through using various foods to help, whether it's flax seeds, or the broccoli family to help estrogen metabolism, certain soy products that are in your whole foods, soy products are good, and then we can kind of get people's hormones to kind of work better. We may want to even use nutrients, and you were talking about sulforaphane, which is a powerful broccoli chemical that you can take, and there's a whole cocktail of things we use to help estrogen metabolism. Dr. Elizabeth Boham: We should probably talk about soy a little bit, because honestly, this is probably the most common question I get, because people are so confused about soy and- Dr. Mark Hyman: Yes. Tell us, Dr. Boham. What is the deal with soy? Dr. Elizabeth Boham: ... like, "Oh my goodness, should we eat soy or not eat soy?" So, soy, soy foods, they have these things called phytoestrogens in them, and this is what got everybody nervous, right? So they have these components, these phytonutrients, these components in them that can actually impact the estrogen receptor. And so, for a bunch of years ago, an oncologist used to say, "Oh no, it can impact the estrogen receptor. I don't want you to eat soy," but what we know actually is that they bind to the estrogen receptor, preventing your own estrogen from binding to the estrogen receptor, and as a result, you have a lower estrogen-like impact in the body. So multiple studies have shown that that soy is actually associated with a lower rate of breast cancer, and a lower ratio- Dr. Mark Hyman: Yes. But if it's traditional soy. Dr. Elizabeth Boham: Ah, that's a good point. Dr. Mark Hyman: Like tofu, tempeh, natto, miso, soy sauce. Dr. Elizabeth Boham: Edamame, right? Dr. Mark Hyman: Right. Dr. Elizabeth Boham: Yep. Dr. Mark Hyman: Those are whole soy products that are not industrial food, and most soy we're eating today is industrial soy, turned in all kinds of weird ingredients like soy burgers, and soy hot dogs, and texturized vegetable protein that gets inserted in all kinds of protein bars, and isolated soy protein, which, very different than regular whole soy, and it may be linked to cancer in animal studies. So I think it's important that we realize that food is a modulator, and it usually helps the body do what it does, rather than interfere with it. And so, sometimes it's true, like if you eat too much broccoli or whatever, raw broccoli, you're going to affect your thyroid, but the phytoestrogens in soy actually help to act more like a thermos. They keep things balanced, right? Dr. Elizabeth Boham: Mm-hmm (affirmative). Dr. Mark Hyman: And I think recommending those whole soy foods is great, and I think that's a really easy thing to do. Flax seeds are also really helpful, and flax seeds in the gut, the broccoli family vegetables, simple dietary things, and getting more fiber to help to bring prebiotics in the gut, getting rid of all the starch or sugar, the processed food, all those ingredients, alcohol, there's really simple things you can do. Dr. Elizabeth Boham: Yeah, like balancing your blood sugar. Balancing your blood sugar, by making sure that every meal has a good source of healthy fat, has a good source of fiber, and has a good source of protein, right? So that prevents the spikes in blood sugar and the spikes in insulin, right? So you make sure your meals are balanced like that, then you won't get those ups and downs in your energy. And so, you just feel better, and that helps with preventing that high insulin, which then- Dr. Mark Hyman: And then you're going to be binging on carbs and sugar to get your energy up, and all that. Dr. Elizabeth Boham: Right. Right, right. So then that helps with the balance of all the hormones, as you were mentioning earlier. And so, when a woman is going through perimenopause, the first place we look at is, okay, what are these personalized lifestyle factors? What can we really focus on with them? I mean, there might be times where we, at the UltraWellness Center, may use some hormones to help- Dr. Mark Hyman: Progesterone. Dr. Elizabeth Boham: Yeah, to help with their sleep if necessary, but many times just a woman understanding what's going on, and then making some shifts in their lifestyle, can make a huge impact and make them feel better. Dr. Mark Hyman: Yeah. And so, you had this patient who had struggle with sleep, and she was 45, and she had never had a problem before, and woke up all the time with night sweats, and she was terribly not well, and what did you find with her? Dr. Elizabeth Boham: Right. So we found, so she was 45, so she was in perimenopause. We checked her hormones at day 20 in her cycle, so what we ended up finding was her progesterone was low, right? So she was in those anovulatory cycles like we had mentioned earlier, and her progesterone was low. So what we really worked on was supporting her progesterone production with supporting her adrenal gland, taking good self-care, getting good rest, doing her meditation. We also worked on metabolizing her estrogen. So she had some variations in her genetics, and she ended up having some... We worked to really lower her estrogen levels with the cruciferous vegetables, folate-rich foods, we added in some supplements that actually on top of that, were helpful, and she did much better. Dr. Elizabeth Boham: She really started to feel better, and we also, we got her off of caffeine, because we know that caffeine can impact sleep more, and it might not have bothered her in the past, but during this transition in her life, it was really impacting her sleep and her irritability. So we got her off of the caffeine, and we also saw when we did that, her hot flashes significantly decreased, and her sleep started to improve. Dr. Mark Hyman: Yeah. And you just see so many of these patients who suffer with things like PMS, or perimenopause, or sleep issues, or mood issues, or depression, or migraines, which are common when your hormones are out of balance. Dr. Elizabeth Boham: Right. Dr. Mark Hyman: Or abnormal pap tests, or we call it dysfunctional uterine bleeding, which you have clots, and painful periods. And it makes me really angry when I see these patients, because they're not getting the advice they need, they're not actually given a doorway into a way of thinking, and diagnosis and treatment that actually fixes their problems, and they're either told they're emotional or they're anxious, or they give them an antidepressant or they give them a hormone treatment, which sometimes is okay, but a lot of times, it's not the right hormones, it's giving them a birth control pill, or giving them Premarin. Dr. Mark Hyman: And what we see in functional medicine is by working in this way, using the thyroid approach, and the adrenal treatments, and the insulin approach, fixing the insulin resistance, and fixing the estrogen metabolism, and the gut, and the toxins, it's different for every woman, but you sort of look at what's for them, the issue, and you then personalize it, and you can create an incredible roadmap for women to feel good and get rid of PMS, and get rid of heavy bleeding, and get rid of the cramps, and get rid of migraines, and get rid of the sleep and hot flash issues, and so forth, right? Dr. Elizabeth Boham: Yup, absolutely. Dr. Mark Hyman: So it's a pretty exciting model, that I think is one of the best applications of functional medicine, is helping women with all these hormone imbalances, that are actually relatively easy to fix. Dr. Elizabeth Boham: Yup, I would agree. I would agree. It's really fun. It's a fun place to be. Dr. Mark Hyman: Yeah. And I remember there's one patient I had who had abnormal pap tests, because that's a big thing for women, right? Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: Cervical cancer screening, and what they do is they screen you, and then they say, "Well, come back if it's worse," and then they cut your cervix out or they do some surgical thing, they burn it, and that has consequences, and it may save your life, but it's not necessarily the only thing you can do. Dr. Elizabeth Boham: Right. Dr. Mark Hyman: And I had one woman, very interestingly, she had a really abnormal pap test, but when I checked her, she had these weird genes that made it hard for her to metabolize estrogen, the methylation genes, the things that have to do with B vitamins, and she also had some nutritional deficiencies, and various things. We just fixed it up, and then we gave her methylfolate, and we gave her various nutrients, B6, which helps estrogen metabolism. And we also gave her something called indole-3-carbinol, which essentially is broccoli pill. Dr. Elizabeth Boham: Yup. Dr. Mark Hyman: And there's a lot of research on how if you have an abnormal pap test, if you take these phytochemicals that help estrogen metabolism, you actually have a reversal. And I can't tell you how many patients I've had, when using this actually helped them get their- Dr. Elizabeth Boham: Like 3000 micrograms of methylfolate, again, we want the methyl form, but 3000 micrograms of methylfolate really can be helpful in terms of reversing that cervical dysplasia, right? Dr. Mark Hyman: Yeah. Right, right. Dr. Elizabeth Boham: And of course, we always go with food, and the folate-rich foods are your foliage, your green leafy veggies, but when there's actual dysplasia in the cervix, when we give that higher dose of methylfolate, it really can be very helpful. Dr. Mark Hyman: So powerful. And there's so many things, we talked a little bit earlier, maybe we need to do another podcast on this, but fertility is such an issue. Dr. Elizabeth Boham: Right. Dr. Mark Hyman: One in seven couples are infertile, it's increasing, and it has to do with things that are often treatable or reversible. Now you're using tons of hormones, or in vitro fertilization, or all these things. And I've had so many patients in my practice who couldn't get pregnant, and you treat them using a functional medicine approach, and they get... I can just think of two right now. One's a 44 year old woman who actually was so sick with all kinds of issues, wanting to have another baby, couldn't get pregnant, and got pregnant naturally after we fixed her. Another one was about a 38 year old woman who also struggled with infertility, and she literally just had her baby last week. And it's so gratifying to me to see that we can actually focus on how to treat these things using food. There's whole textbooks written on this, and Fertility Diet, written by Walter Willett, which talks about how sugar is a big factor for infertility. Dr. Elizabeth Boham: Huge, huge. Dr. Mark Hyman: And people don't realize that. They're eating bread, they're eating sugar and they think, "Oh, this is fine," but actually, maybe it caused their infertility. So- Dr. Elizabeth Boham: Right, that whole connection with that high insulin and your hormones, and it's so connected. Dr. Mark Hyman: So if anybody's listening out there as a woman, there's probably a few out there, I would really not accept the traditional messaging from conventional doctors that you just have to suffer through all this. Dr. Elizabeth Boham: Yeah. Dr. Mark Hyman: PMS, again, is one of those things it's relatively easy to fix using this functional medicine approach. Dr. Elizabeth Boham: Yup. Dr. Mark Hyman: Whether we use diet, exercise, supplements, various kinds of herbs, nutrients, even sometimes natural hormones like progesterone, it can make a huge difference. And if we do use hormones, we actually use bioidentical hormones, which things like Premarin, is horse urine, pregnant mare's urine, and it produces all these secondary metabolites and we're more likely to get stroke and cancer. Dr. Elizabeth Boham: Increases inflammation in the body. Dr. Mark Hyman: Inflammation, increases C-reactive protein. I mean, it's not great. Dr. Elizabeth Boham: Mm-hmm (affirmative). Dr. Mark Hyman: And by using a different approach, using bioidentical hormones delivered through the skin or certain ways, can have a profound benefit to women. And I think we're going to have to come back and do another podcast on menopause, because we didn't even talk about hormone replacement therapy, which is a whole big category of thinking about how do you actually find the right dose in the right person, and the right way, is delivered in the right method, that actually has the most benefit, because there are risks to it, but I think we can mitigate those risks using this whole approach. Dr. Elizabeth Boham: Absolutely, I agree. Dr. Mark Hyman: So what do you think as a woman about... Any last words to women and what they should think about when it comes to their hormones and being out of balance? Dr. Elizabeth Boham: Yeah. I mean, I think really appreciate the connection with all the different hormones in the body, that when you really work to support your adrenal gland, when you really work to manage your stress, when you really work to get enough sleep and rest in your body, that really helps with your hormones rebalancing themselves. And I think that that's a really important area that so often women, are just taking care of others, right? They're taking care of their kids, they're taking care of their spouse, they're taking care of their parents, and they really need to take this time to say, "Okay, maybe some of these symptoms are telling me that I've got to start taking care of myself," and that really can make a huge difference. Dr. Mark Hyman: Sort of like on the airplane, they tell you to put the mask on your face before you put it on your kids, I think that's what women need. And it's hard, because women are programmed in our culture to be caretakers, to help everybody else, to neglect themselves, and feel guilty and bad if they do it, and I think it's really important that women start to put themselves first, and actually prioritize their own well-being, which will help everything in their life. Dr. Elizabeth Boham: Absolutely. Dr. Mark Hyman: Well, Dr. Boham, Liz, thank you so much for being on The Doctor's Farmacy. I really loved having you on this little mini episode we're doing regularly called House Call, that helps guide people in what to do. People want to learn more about hormone imbalance, what tests they should do, the kinds of therapies that are effective. There's free information on the website, drhyman.com/uwc, and you can go there and download it, and it's a great guide. You can come see us at the UltraWellness Center in Lenox, Massachusetts. You can try to find a functional medicine doctor in your area, but I encourage you not to just suffer through the misery of hormone imbalance, because we have a way to figure it out. Dr. Mark Hyman: So thank you so much for being on the podcast, that's it for this week's House Call. If you enjoyed this mini episode of The Doctor's Farmacy, share it with your friends and family on social media. Leave a comment, we'd love to hear from you. Subscribe wherever you get your podcasts, and we'll see you next time on The Doctor's Farmacy. Dr. Elizabeth Boham: Thank you, Mark.