199 Why Perimenopause Feels Harder in 2025 with Dr. Jessica Drummond

Perimenopause can feel like a 10–15 year hormonal remix, but why is it so much harder for women in 2025?. Dr. Jessica Drummond busts myths, challenges outdated narratives, and explains the overlaps nobody talks about: long COVID, autoimmune flare-ups, endometriosis, stress overload, digital overwhelm, and why so many women enter midlife already running on fumes.

🔥 The Big Myth That Needs to Die
Perimenopause is NOT:
✨ “Menopause-lite”
✨ A single moment in time
✨ A sudden cliff-drop hormonal event
✨ A one-size-fits-all hormone prescription
✨ Something you can fix with a supplement stack from Instagram

💥 Why Perimenopause Feels Harder Now
Women today face extra layers:
• long COVID risk
• autoimmune triggers
• endometriosis
• digital overstimulation
• constant work-life overlap
• the “3–5 full-time jobs” workload
• modern toxic load
• stress culture
• chronic under-resting

🚨 The Overlap Nobody Talks About
Fatigue, brain fog, pain, mood swings aren’t just hormones — they can be:
• viral injury
• metabolic dysfunction
• autoimmune activation
• chronic stress fallout
• endo flare-ups
• nervous system dysregulation

🌡️ HRV: The Underrated Biomarker
Heart Rate Variability shows stress resilience — and many women in their 40s have HRV scores of someone in their 90s. Rest isn’t optional; it’s vital.

💆‍♀️ Skincare = Self-care
Gua sha, facial massages, and skincare rituals aren’t just vanity — they support the vagus nerve, lymphatic system, and nervous system. Ten minutes a night can do more for your hormones than you think.

🧠 Integrative Medicine, Demystified
Not woo. Not extreme. Not pills or plants. Science + lifestyle + nervous system + personalized care — because every transition is unique.

💬 What You’ll Walk Away With:
• How hormones ACTUALLY change in midlife
• Why symptoms feel inconsistent or contradictory
• Why one-size-fits-all prescriptions fail
• How viral load, toxins, and stress complicate perimenopause
• What HRV reveals about resilience
• Why rest matters
• How integrative care supports the whole woman
• Practical strategies for real resilience

🌙 There Is Light on the Other Side
Stable moods, better sleep, grounded energy, and a deeper sense of self — it’s possible, and worth it.

📲 Connect with Dr Jessica Drummond:

Website: https://integrativewomenshealthinstitute.com/ 

Instagram: https://www.instagram.com/integrativewomenshealth

Sally's Links:

[Free Guide] Healing The Trauma Underlying Your Menopause Symptom Severity: https://www.sallygarozzo.com/healingtraumatheguide

[On-Demand Masterclass] How To Heal The Trauma Underlying Your Menopause Symptom Severity [£17]: https://www.sallygarozzo.com/healingtrauma

[On-Demand Workshop] Redefine Your Values at Menopause and Live Life in Alignment With Them [£27]: https://www.sallygarozzo.com/redefine 

[Online Practitioners Diploma - Self Paced] Menopause Wellbeing Practitioner [£127]: https://www.sallygarozzo.com/meno

[One to One] Transformational 30 Day Rewire (Includes RTT) [£497]:

Transcript

So my guest today is the lovely Dr Jessica Drummond. Jessica is a pioneering leader in functional nutrition and integrative women's health with over 25 years of clinical and educational experience. As the founder of the Integrative Women's Health Institute, she empowers midlife women

facing perimenopause, menopause and chronic conditions like long COVID, endometriosis, autoimmune disease and metabolic dysfunction. She helps them to reclaim their vitality through root cause care. Dr. Drummond's unique evidence-based approach integrates advanced functional testing, nervous system regulation and personalized nutrition to optimize resilience and wellbeing.

She's a passionate educator and mentor. She's trained over 3,500 students worldwide, bridging the gap between science and compassionate coaching to transform healthcare for women. So Jessica, welcome to the Menopause Mindset podcast. How are you?

Dr. Jessica Drummond (01:38.264)
I'm good, thank you so much for having me.

Sally (01:40.958)
You're so welcome. We are so lucky to have you on the pod today because you have such a wealth of fantastic knowledge to share with us. I really would like to start with this idea that perimenopause is still, after all this time, surrounded by so much confusion and misinformation. So what are some of the biggest myths that you encounter in your practice?

around menopause and the menopause transition and how do you help women navigate this with a lot more confidence so that they can actually feel better and feel empowered.

Dr. Jessica Drummond (02:19.884)
Yeah. So one of the things that I think has improved a lot in the last couple of years is that women are starting to be aware that perimenopause is a more of a 10 to 15 year process. Like decades ago, I was calling it puberty in reverse. And so, you know, it's not an overnight thing. It used to be thought that, you know, it was like one day you hit menopause and you fall off a cliff, but

Sally (02:38.206)
Yeah.

Dr. Jessica Drummond (02:48.738)
That's not really true. Essentially what happens is over the decade of approximately your late 30s to early 40s to early 50s, your estrogen levels begin to decline but inconsistently. And your FSH, the hormone that triggers the egg release from your ovary starts to increase because you're essentially running out of eggs. Everyone is born

with the eggs that they will have for their entire life. And as those numbers decline, FSH levels are ramped up because the brain is trying to say the ovary, like release the egg, release the egg, but it's not happening. Or it's happening very inconsistently. And this is where perimenopause, which wasn't really even a term that anyone talked about until like five years ago,

but has been well known in healthcare for as long as I've been around. But I think your average woman didn't really understand this. It was just like menopause and that's it. So the absolute definition of menopause is one year from the date of your last menstrual cycle. Now that's assuming a lot of things. That's assuming you haven't had surgical menopause or medical menopause or premature menopause that maybe was...

you were able to get your cycle back. even in that case, it's not as cut and dry as it might seem to be. So what happens is because during those 10 years of transition, your number of eggs is declining, the body is still releasing these hormone signals, particularly from the brain and then from the more peripheral organs like the ovaries. And so the decline is very inconsistent.

Sally (04:24.113)
Yeah.

Dr. Jessica Drummond (04:45.088)
And sometimes the estrogen levels are actually higher than they were before on any given day. And other times they're lower. And then over that same decade or so, progesterone is declining and that's a hormone of calmness, but it's also a hormone that's important for maintenance of pregnancy. you know, and it's that luteal phase hormone helps with sleep.

And again, over time, it's sort of consistently declining, but then we're overlaying that on a monthly menstrual cycle, which progesterone is higher in the luteal phase, lower in the follicular phase, the luteal phase is after ovulation, the follicular phase is before ovulation. So the challenge with all of this is on any given day, a woman's hormones could feel perfectly normal.

Sally (05:38.28)
Yeah.

Dr. Jessica Drummond (05:38.956)
The next day, she might be sleepy and groggy and more depressed and with a relatively high progesterone level. Another day, she may have a relatively high estrogen level and have migraine headaches or breast tenderness or pelvic and period pain, or her estrogen level may feel really low sometimes and that's going to impact everything from her bones to her heart, to her brain, to the brain fog.

is a really common symptom. So it feels very out of control because the cycles are changing very inconsistently during that period of roughly a decade. It could be less. It could be more like five years that it's noticeable. It could be 15 years. And that can vary. There are some lifestyle things that can help sort of smooth the transition.

Sally (06:10.772)
Yeah.

Dr. Jessica Drummond (06:34.866)
can also be helpful if women are using medical hormone therapies. Again, it has to be skillful and kind of tweaked because we don't have like perfect data that says exactly this hormone protocol throughout all of your perimenopausal cycle. That's very difficult to do because everyone's perimenopausal cycle is very different. So I think that's the biggest myth is that this is you're like in perimenopause, so you need to just take

Sally (06:55.54)
Yeah.

Dr. Jessica Drummond (07:03.374)
hormones, and there's a really clear, simple, one size fits all prescription for that, and or you need to take this particular supplement stack and you're going to be fine. And that's not true. You have to really understand where you are in the transition. You have to know what the variations are day to day, and we have to track what are your core symptoms. And then the other thing that

I'm really passionate about that I think very few people are talking about in this perimenopause menopause space is how many women don't enter their 40s in the perfection of health. This is not their fault. They could be doing absolutely everything right. They could be exercising three times a week, eating an anti-inflammatory diet, getting all the right sleep, but maybe they had COVID.

Sally (07:42.804)
Yeah.

Dr. Jessica Drummond (07:55.47)
or maybe they have endometriosis, which at its core is a genetic condition. Maybe they have an autoimmune disease from a change that happened in their health during pregnancy. Maybe they had gestational diabetes, and so now they are at risk for metabolic issues in perimenopause. And of course, there are certain things that can be improved and mitigated with lifestyle changes.

But for example, think COVID is a really good example. So roughly 20%, every time someone gets a COVID infection, which about 40 % are asymptomatic, so you don't always even know when you have a COVID infection. And increasingly, it's tricky. The testing is still helpful, but it's not perfect. So people don't even always know when they have a COVID infection. So assuming they have a COVID infection, if it's their third infection or later,

They have a 40 % risk of having long COVID. And if they're perimenopausal in between the ages of 40 and 55, that risk increases by 45%. And so some of the symptoms of perimenopause, and let's also overlay with this endometriosis, another one that's super common. 10 % of all women have endometriosis.

Sally (09:10.695)
Mmm.

Dr. Jessica Drummond (09:13.794)
I don't know the absolute number of how many people total have autoimmune disease, but 80 % of those who do are women. So we're talking about like 50 % of women, conservatively, have something going on or something that is triggered in perimenopause. So let's say you wake up one morning and you have deep period pain and you're like cycles late and it's inconsistent and you're not sure what's going on.

Sally (09:25.886)
them.

Dr. Jessica Drummond (09:41.024)
Is that your endometriosis? Is that perimenopause? Is it both? Neither. We have to look at each case. Let's say you're very fatigued or brain foggy. Super common related to long COVID. Long COVID causes a lot of vascular and brain direct inflammation. And this can last for years. And so if it happens all at the same time,

it's hard to tease out, unless you're working with someone who's really skillful and understanding the overlaps between these things, how to kind of what's the best next step to help both mitigate the symptoms, but also mitigate the organ damage, the vascular damage that both of these things can cause, both perimenopause and menopause and long COVID or even any other post-viral issue like...

Sally (10:31.858)
and

Dr. Jessica Drummond (10:37.686)
Epstein-Barr virus, for example, we now know often is an early trigger of multiple sclerosis. So there's a lot going on in our environment now that I actually think is making perimenopause more complicated than it might have been in our mom's generation. I also think in our mom's generation, there were a lot of things that were just sort of overlooked and pushed to the side.

Sally (11:06.387)
Yeah.

Dr. Jessica Drummond (11:07.144)
you know, take some Valium or whatever, you know, women are women are crazy. Yeah.

Sally (11:11.152)
Yes. But we didn't have the digital, did we? Our mums didn't have the digital aspects of life when they were going through the menopause transition. So they didn't have that kind of overstimulation that women have now, know, the amount of information going into the eyeballs really affecting the brain, the nervous system and all of that, you know, affecting the thyroid. And it's this cascade of symptoms.

what's this trickle down effect just from one thing and that's just from digital. mean, let alone all the other Zenoestrogens and other stresses and strains, relationship strains, the stresses of having two people in relationships, both having to work and raise children and all of that. yeah, I'm out the other side now. I am in post-menopause. I had quite an early menopause actually, probably because of stress, but...

I can absolutely feel how much more grounded I am now I'm at the other side. You know, how much more my body is just and relax, you know, there's no more peaks and troughs. There's a few, obviously you get a few peaks and troughs, but my sleep is better. My moods are much more stable now. but there is some, you know, there is a lot to look forward to coming out of the other side. Obviously there are other considerations now like bone density and.

and muscle wastage and things like that. But perimenopause for me was so hard to navigate because of the lack of information really. And it was because of the tumultuousness that I experienced that motivated me to set up the podcast and really look into this whole thing. So thank God for people like you in the world who really understand the depth. And can you just explain a little bit actually what

Dr. Jessica Drummond (12:49.708)
Mm-hmm.

Sally (13:07.312)
I don't know if you say it differently to us, but what integrative, what do call it, integrative medicine actually is.

Dr. Jessica Drummond (13:18.158)
Right. So integrative medicine is essentially integrating both pharmaceutical therapies with lifestyle medicine, I call it lifestyle medicine, essentially. We know, for example, that exercise is equally as effective for depression as some of the mental health medications when you put them head to head in randomized controlled trials.

where it's all based in science. It's not necessarily alternative treatments, if you will. But some of them, some particular usefulness of, for example, acupuncture or nutritional supplements, herbal medications, a lot of these do have

science behind them, that's quite strong. A lot of it doesn't, and that's tricky because even nutrition is tricky in terms of effective science, but so is just gynecology in general, for example. There are big science gaps in both what we think of as traditional Western medicine and other forms of alternative medicine, if you will.

Sally (14:18.206)
Yeah.

Sally (14:42.036)
Hmm.

Dr. Jessica Drummond (14:44.008)
So the way we try to teach this at the Intergrated Women's Health Institute, because what I primarily do now is educate health and wellness professionals, generally women, because they care a lot more about it, but people who are physical and occupational therapists, acupuncturists, chiropractors, physicians, nurse practitioners, PAs, herbal medicine professionals, fitness professionals, think exercise cannot be overstated how important it is.

But again, even that, which everyone should exercise. And yet, now we have a population of women due to, the numbers are rising significantly because of post-viral illness in this COVID environment. But people have dealt with this my whole career. There are some women who shouldn't exercise because they have myalgic encephalitis, chronic fatigue syndrome, and maybe they should exercise, but it has to be done very carefully.

Same thing with things like autoimmune diseases. Even perimenopause, if we think about the impact of the brain and the stress resilience system, most of my clients come to me, you you mentioned a few of the other environmental factors. Women are generally working like three to five full-time jobs in my experience. And I mean that with all seriousness.

Sally (16:07.664)
Yeah. Yeah. Yeah.

Dr. Jessica Drummond (16:11.478)
You know, they are working, they are full-time caregivers for children, teenagers, aging parents. They have a full-time job. They often have a side hustle. You know, they're the manager of all other things like everyone's Christmas presents and you know, even the work birthday parties, right? And so,

Sally (16:32.36)
Yeah.

Dr. Jessica Drummond (16:37.294)
You know, if we think about that, not to mention just basic things like cleaning and managing the calendar. You know, have one, I have two children. One of them is home and started her freshman year in high school and a new school. And in the last two weeks, I have done so much like calendar management. And I have like, I have one child and my husband also works from home. It's still, it's a lot of work.

Sally (17:03.57)
Yeah, absolutely.

Dr. Jessica Drummond (17:06.208)
So you think about that and then you think about like you were talking about before, environmental toxins, the physiologic stress of screens and blue light and things like that. But it's also the fact that we can work all the time. You're never really like going home from work. So I think that women's physiologic stress in this time period is dramatically increased. And so for many of my clients, if we actually just

plop exercise on top of that, it's more problematic than beneficial because we're just adding another layer of stress. So before we do that, we often have to kind of really assess and we track, we do a lot of HRV tracking using wearables because heart rate variability or HRV is a really good objective measure of stress resilience. And I've recently seen plenty of

women in my practice who have HRV levels like in the teens, which is really, really low. Like we wouldn't normally want to see that until a woman was like in her nineties.

Sally (18:16.18)
Yeah, so it might be worth actually explaining what heart rate variability is and what is good and what is bad. Yeah.

Dr. Jessica Drummond (18:25.304)
So it's a little bit like there's not a particular number, but we want to see it the higher the better. So it's a little bit of like a personal record kind of thing. what that measures is the change in time of milliseconds between each heartbeat. And you would actually kind of, it's a little counterintuitive. You would normally think that like if the heartbeat is very consistent, that's better, but actually that's not better.

Sally (18:32.573)
Okay.

Dr. Jessica Drummond (18:54.572)
We want the heartbeat variability to be like a little more and a little less, a little more and a little less. So the more that variability is, what that's showing is that the nervous system is flexible. It's ready to take on a stress should one present itself, but most of the time it's deeply at rest. And I mean, look around, how many of the women you know are really ever...

Sally (19:09.64)
Okay.

Sally (19:18.804)
Yeah.

Dr. Jessica Drummond (19:24.856)
deeply at rest. So this is the thing we have to work on the most when we get started in my practice. But also if we think about nutrition and hormone therapies and other sorts of therapies, doing those sort of more external things, if you will, can actually help. I actually, briefly looked at a study right early this morning that was just published and all.

Sally (19:26.748)
Mmm, okay.

Dr. Jessica Drummond (19:54.014)
you the link, but I haven't fully dived into this, but basically the healthier the metabolic system is, the healthier the heart rate variability is. And this is somewhat bi-directional, right? So women eating more fiber can help their heart rate variability, can optimize the diversity of their gut microbiome, can improve their digestion and elimination.

I started my career as a physical therapist, so I'm very grounded in the physical. If we can help the brain and the nervous system from the outside in, and that might be things like self-Vegas nerve massage, which is literally massaging around the ears and the jaw and the back of the head, and even things like gua sha, like self-facial lymph drainage and mobilization.

think actually that this is one of the reasons why so many women and even young girls are really committed to their skincare routine. It's actually like a moment of self-care that physically mobilizes the fascia around the vagus nerve, which is the nerve that connects. It's a nerve that's directly into the brain and it connects through the neck to pretty much all of the organs in the core of the body.

Sally (20:58.036)
Yeah, it feels nice.

Dr. Jessica Drummond (21:21.294)
the heart, the stomach, the intestines, things like this. So there's a lot we can do to lower our stress by just bringing some awareness to it, learning boundaries, learning to say no. But in the sort of capitalistic society that we're in that's very hustle culture driven, and there just is a lot of pressure on women to be the manager of all of these things, we can utilize

lifestyle medicine, nutrition, and even pharmaceuticals to, from the outside in, help the nervous system be more resilient to stress. And I think ultimately that's what everything we're doing is doing.

Sally (22:03.272)
Yeah.

Sally (22:10.268)
Yeah, yeah, it's so important, I think, to use all the tools at our disposal. And I don't know if you saw my Insta story. I was I had a little look at your Instagram and you were talking about some of the benefits of GLP-1. If we use it wisely, sometimes it helps if people microdose, maybe alongside, you know, well, definitely alongside good nutrition and all the things that we know about. And it does annoy me when you get

Dr. Jessica Drummond (22:24.344)
Mm.

Sally (22:39.912)
wellness practitioners who just outright poo poo the idea of anything external like a paracetamol or an ibuprofen or like GLP-1 for example. And I think you were saying how helpful it can be for mast cells on one of your insta on one of your reels. And I've been taking it actually for three months and it's been really, really helpful, you know, just to calm things down, just to.

Dr. Jessica Drummond (22:46.658)
Mm.

Dr. Jessica Drummond (22:55.96)
Right.

Sally (23:07.912)
really help with cravings and dopamine cravings, especially in the evening and just to sort of dial everything back and that histamine response and all of that. So I do think, I think that's what I really like about the integrative approach is that you're not banishing anything. You're looking at the evidence and you're going, well, what's right for the individual in front of me? It's so important that we take a nuanced approach to women's healthcare, well, all healthcare actually, but.

Yeah, and anything that will help the nervous system. mean, being a trauma informed hypnotherapist, guess for me, the nervous system is very central to how I approach healing with my clients and getting their nervous systems to regulate through changing their perspectives, their beliefs, their behaviors, and just generally how they feel about themselves. So think a lot of the time we talk about the nervous system in terms of

Dr. Jessica Drummond (24:01.144)
Yeah.

Sally (24:06.674)
the stress that we experience today, but we also have stress from way back when, know, from our childhood, from patterns that were really embedded in us from back then, you know. Do you work with people on that level in an integrative setting?

Dr. Jessica Drummond (24:19.202)
Yeah.

Dr. Jessica Drummond (24:23.904)
Yeah. You know, we do a health history that basically starts at birth or even before if someone's mom, you know, or parents had some kind of trauma while they were pregnant with the client or, you know, just before that. The reality is, is that trauma, we know from all of the research done looking at ACE scores in early childhood, that trauma, especially in early childhood, makes kind of

programs the nervous system to be less resilient throughout the life, the whole lifespan. And you know this well doing hypnotherapy. And so the important thing is that the client herself has some awareness of that. And I feel like everything is modifiable. The more we look at the nervous system and the vascular system, the gut microbiome, we have a lot of capacity to improve things.

almost every case. mean, there are certain cases where things are quite progressed, like if someone has advanced cancer, advanced neurodegenerative diseases, like there's only so much we're going to be able to do to unwind some of those things. But for most of what women are dealing with in this phase of midlife, one of the things that I think is helpful to understand when it comes to trauma is that when you think about for women, for everyone, early childhood trauma

Sally (25:34.93)
Yeah.

Dr. Jessica Drummond (25:50.386)
of sets up the nervous system to be more or less sensitive. But for women in particular, and I haven't really studied this in men, so there could be some truth to this in everyone, but in women in particular, if you look at puberty, pregnancy, and postpartum, if they had traumas in those timeframes also, that was where their trauma happened,

Those are also times when physiologically the nervous system is more vulnerable. And so again, often these things show up in perimenopause that women have been kind of powering through for decades or just like gripping the steering wheel, you know, and they weren't really aware they were doing so. But, you know, for example, my youngest daughter, the COVID pandemic happened, the kind of acute phase of it.

Sally (26:32.072)
care.

Dr. Jessica Drummond (26:46.328)
happened when she was going through puberty. And I also personally experienced really intense COVID infection and long COVID. That's a very abrupt thing to happen to you, you with your mom and your school thing changes and everything when you're, you know, she was about 11, 12 years old. That's a, you know, she didn't have any early childhood trauma, but that's a timeframe when things can happen.

Another example would be a woman who maybe had a lot of challenges with fertility and then had a traumatic birth, or a woman who's had gestational diabetes or pre-diabetes, and then things sort of settle down at perimenopause, metabolic issues can arise again. So some of that is trauma related and some of that is more just vulnerabilities in our metabolic physiology. And so I think we can look at

Sally (27:37.671)
I see.

Dr. Jessica Drummond (27:41.038)
That's why we always start like step one of our system is very similar to exactly what you're saying. I don't personally do hypnotherapy, but I think hypnotherapy is a great tool for slowing people down and helping them to have awareness of where some of their behaviors have come from. And even our thoughts, if we think about how we speak to ourselves every day, even my clients are pretty sick at this point.

I actually help them rewire their thoughts and beliefs and self-talk to say things like, every day, I am healthy and getting healthier. Because I think one of the challenges in wellness in particular is there's this idea that you're either like perfectly healthy, you're living like perfection, you're getting up exactly the right time each day, you've had exactly the right number of grams of protein, you've done...

Sally (28:19.785)
Yeah.

Dr. Jessica Drummond (28:37.932)
the perfect exercise organization throughout the week, you know. And to me, most of the time that's more stressful, but let's assume, so there's this idea in wellness that you're either perfectly healthy, which is interesting because of our Instagram culture, there's a particular thing that looks like, and that's challenging too because there are women that are very thin and fit looking.

Sally (28:46.48)
Yeah.

Sally (28:59.806)
Yeah.

Sally (29:06.448)
Mm-hmm. Yeah.

Dr. Jessica Drummond (29:07.15)
who are not healthy or not as healthy as they could be. They're healthy at certain levels. And there are women who maybe don't look the part, whatever that means. And usually it's around thinness and cultural definitions of body shape, even their hair, things like that. And they may be quite healthy. So health is always a continuum because there's all these different domains of health.

Sally (29:11.048)
Yeah.

Sally (29:22.184)
body shape.

Dr. Jessica Drummond (29:36.086)
in my experience for the vast majority of women, particularly in midlife, because they have five or six full-time jobs, is that we start by looking at nervous system stress resilience. And then everything we do from there, whether it's nutrition or supplementation or medication or exercise or meditation, it's all in the service of building that physiologic resilience.

from a stress standpoint, nervous system, from a metabolic standpoint, from an immune standpoint, from a cardiovascular standpoint, which is very related, and things like bone and muscle. Because if women, so we still know that the number one killer of women is cardiovascular disease. So obviously everything we do, we want to be heart healthy, but women also have a high, about I think two thirds of the case of Alzheimer's dementia are in women.

Sally (30:14.483)
Yeah.

Dr. Jessica Drummond (30:34.346)
And so we have to be careful of, you know, the things that we do for our vessels and our heart are also really valuable for our brains. Assuming women avoid both of those common killers or, you know, causes of disability, the next thing is hip fracture or any osteoporotic fracture. And actually, that's the number one cause of death for women, I believe, over 80.

Sally (31:02.9)
Yeah.

Dr. Jessica Drummond (31:03.062)
And so it's about 50 % of women over 80 who have a hip fracture just will never recover from it. And so when we're in our 40s, this is the perfect time, honestly, when you're in your teens, it's the perfect time, but I have a teenage daughter and a daughter in her young 20s and they don't listen to you.

Sally (31:24.084)
Yeah, so the second best time is in your 40s.

Dr. Jessica Drummond (31:27.214)
Correct. The second best time is in your 30s, 40s, 50s when you can build up that bank of muscle and bone is so valuable. And so I think of the physiologic systems as being very interconnected, but also a little bit hierarchical. So we start with our stress resilience. We start with our vascular health and our nervous system resilience.

heart health, and then we layer on top of that immune health, musculoskeletal health. And we think of these things as being very interactive because like that study I was just talking about, your blood sugar and your metabolic health is related to your heart rate variability, is related to your gut microbiome diversity. So the good news is, is with a lot, like just a few day-to-day

habit shifts, a few nutritional supports, movement supports, recovery supports, and pharmaceuticals to support the hormones that have declined, you can really hit a lot of these things all at once. So that's the good news. It doesn't have to be like a whole second, a whole sixth full-time job.

Sally (32:42.835)
Yeah.

Sally (32:49.108)
Yes, yeah, so you hit that sort of central point and then it has a cascade effect or ripple effect out on all the other systems and processes because it's true, isn't it? If you improve your stress resilience, you are going to improve your cardiac health, your immune system's going to improve your gut health and then, you know, and so on and so forth. And then if something on the outer edges of those ripples are not quite functioning, then you can go in a little bit more targeted.

Yeah, I love that.

Dr. Jessica Drummond (33:18.922)
Exactly. Yeah. So I've developed for my practitioner students a series of what we call maps. So basically you're looking at where estrogen receptors are, and they're in about 300 places across the body. So when estrogen is at a healthier level, then you're improving all of these systems at once. So we have five or six hormone maps, and then we have about six or eight

chronic illness maps. I'm always optimizing these. Cortisol is that stress buffering hormone. That's at the core of the hormone map. While each individual case, may start in a different place. If a practitioner's like, okay, I don't know where to begin. We give them a systematic approach because as you were just saying,

you improve stress resilience, five things improve, then you improve metabolic resilience, that gets even better and then a few more things improve, then you start to build an excess bank of muscle, that gives you more resilience for longer. And so the nice thing about this is everything is really additive.

Sally (34:41.884)
Yeah, yeah, brilliant. What's the link between chronic illness and hormones? Because you often do see, don't you, there is some kind of interplay between chronic illness, you long COVID. I'm really interested actually in things like POTS, hypermobility, MCAS, and how

Dr. Jessica Drummond (35:04.097)
Mm-hmm.

Sally (35:08.66)
how that might interact with the hormonal shifts around perimenopause and if there are any kind of strategies that you use to help someone with that particular sort of over-inflammatory profile.

Dr. Jessica Drummond (35:24.77)
Yeah, that's a great question and one that's huge because a lot of women, even if they don't, aren't aware that this is long COVID, are aware that they have POTS or their POTS got worse after COVID or in some cases COVID vaccine. The risk is dramatically lower for vaccine, but it's still there. And there are at this point, many people who have had both a vaccine and COVID. So, you know, it's gotten messy in the data. But the reality is that

Sally (35:42.473)
Yeah.

Dr. Jessica Drummond (35:53.108)
Long COVID is ... It's sort of like a COVID infection is a trigger for a lot of things that tend to present post-viral. Could be flu, could be Epstein-Barr, could be a lot of viruses. But we've seen this dramatic increase in this post-viral presentation, which could also actually happen in any case of stress. So before COVID existed, we've seen POTS, we've seen ... which is

postural orthostatic tachycardia syndrome or a form of dysautonomia. And dysautonomia is when the brain's kind of control of the heart becomes less reliable. like blood pressure is all over the place, things that we should, I always say like, this is when your basic physiology goes from like an automatic transmission to like a stick shift. Like you have to.

Sally (36:51.142)
Okay, that makes sense.

Dr. Jessica Drummond (36:52.394)
you have to start kind of actively controlling things that you didn't really think about before because a very lower part of your brain would organize your heart rate, your blood pressure, your blood volume, things like that. When that gets messed up, when that connection gets broken or that autonomic nervous system regulation is out of control. So this is really a neurologic issue that presents as cardiovascular.

Sally (37:19.22)
That makes sense, okay.

Dr. Jessica Drummond (37:21.226)
So these kinds of things have existed before COVID. It's just that COVID really amplified them. It was a big trigger for a huge percentage of women. So we're now particularly because women are the highest risk. Now this also is happening in kids and teenagers and men, but perimenopausal women are at a 45 % increased risk. So, and it could happen with any stressor. I, in my, you know, career before this, you could see these kinds of things be triggered by

Sally (37:43.251)
Yeah.

Dr. Jessica Drummond (37:51.362)
divorce or mold or moving to a really different environment. So COVID isn't the only stressor that can trigger this, but it is a pretty big one. COVID causes a huge inflammatory response, particularly in the brain. And we know now that every COVID infection ages the vascular system by five years. It accelerates aging. Now,

Sally (38:16.2)
Wow. Wow.

Dr. Jessica Drummond (38:19.562)
I believe, because I've been talking about everything's modifiable, we don't have a lot of data to support this, but because it really is vascular aging, and we know how to reverse vascular aging with polyphenol anti-inflammatory nutrition and exercise and hydration, and there are some things around clotting factors that we can do with enzymes. We have some tools to help reverse this aging, but I am still a

a pretty strong proponent of N95 masking, particularly in high risk situations like flights, medical appointments, public transportation. And we also know now that there are about two big surges of COVID a year, right around summer back to school and the holidays. Yeah. So like now and the holidays. So Christmas, New Year's, that kind of timeframe.

Sally (39:12.03)
about now. Yeah.

Sally (39:19.166)
Okay, okay.

Dr. Jessica Drummond (39:19.854)
Those are when we get the most, the largest surges. you know, I realized there are some challenges with masking all the time. I have the same challenge myself, but during those high risk times, during high risk situations, the fewer COVID infections you get, the better for your vascular aging. Because if like every single year you're aging yourself five years,

and you don't really have enough time to kind of heal that system, by the time you get your next infection, that's where it becomes a problem. So that's an issue that we don't have a great tool for yet. There is some good research going on on better kinds of vaccines that could prevent transmission. There's some research on things like PrEP medications, sort of like we have an HIV now to take, to mitigate.

Sally (39:53.667)
Hmm.

Dr. Jessica Drummond (40:14.946)
the risk, there's better, you know, acute medications. So things are coming along, but five years out, we still don't have any great, we don't have a lot of great tools for this. Yeah.

Sally (40:24.34)
Yeah, and perimenopause, of course, just heightens the vulnerability, I guess, to these external pathogens. Yeah, and all of it. So, so can you explain a little bit what MCAS is? Because I'm really interested in that and how it relates to hypermobility and how perhaps GLP-1 can help.

Dr. Jessica Drummond (40:44.865)
Yeah.

Dr. Jessica Drummond (40:53.39)
Absolutely. our map, so I was talking about how I kind of create these map systems because there are some things that very commonly intersect. Three of those, we call the triad map, are hypermobility syndromes, including like Ehlers-Danlos, POTS, and Masthill activation syndrome. So COVID is a common stressor now, but there are lots of things that can stress that.

When the immune system is hyper activated, so you asked a minute ago about how does the hormone environment in perimenopause make this worse? So, mast cell activation syndrome, MCAS, is when the immune system gets turned on, particularly the mast cell part of the immune system, and mast cells release histamines and other inflammatory cytokines

which are designed to kind of clean up infections and pathogenic issues, which is totally fine if that's what they're doing and then they shut off. In mast cell activation syndrome, the genetics that inform that part of the immune system are changed. Some people have just an at birth genetic vulnerability to

Sally (41:54.152)
Yeah. Yeah.

Dr. Jessica Drummond (42:13.71)
having mast cell activation syndrome. These are the people you hear about like ever since I was a kid, I was allergic to everything, I was sensitive to everything, I got a bee sting and I'd blow up, I couldn't live in mold at all, like everything, they're just very sensitive to. COVID and other pathogens can change our genetics such that we have this triggered MCAS that gets turned on and it's hard to turn it off.

Sally (42:29.171)
Yeah.

Sally (42:41.012)
Turn it off, yeah.

Dr. Jessica Drummond (42:42.402)
We don't yet know, because we do know that COVID lives in the body for up to two years. That's about as long as the studies have gone on. In some people that present as long COVID are with MCAS. And it may be the case, because we've seen this in things like Lyme and other long-term chronic infections. It's possible that if you clean up the kind of hidden viral reservoirs,

that then the immune system will quiet back down. I do think that the immune system is turned on for a reason. And then the problem with a lot of these viruses and other pathogens is that they hide everywhere. In COVID, we know in the brain and the ovary even. And so the immune system is trying to still clean it up. That may be what's happening. And then if we can find some tools, which we don't have drugs that do this yet, but hopefully we will at some point.

Sally (43:23.752)
Okay.

Sally (43:30.324)
Okay.

Dr. Jessica Drummond (43:38.85)
that clean up the reservoirs, perhaps the immune system will settle down. Sometimes it just settles down on its own once other stressors are calmed down or the total stress load. So like, let's say someone had COVID, was living in mold, was getting a divorce and lost their job because of the pandemic, right? That's a huge stress load. Let's say you take like most of those things off.

Sally (43:44.094)
I don't know.

Sally (44:01.172)
That's a stress load, yeah.

Dr. Jessica Drummond (44:06.254)
Two years later, they have support, they have a new job that they love, they start healing. In general, their vascular system, their inflammatory, their level of inflammation comes down, then the immune system can become less reactive. We also have about 10 to 12 pharmaceutical tools and about 10 to 15 non-pharmacologic tools that can kind of quiet the mast cells.

And this is more of just a symptom management, everything from quercetin to quark, crom, and sodium to a more antihistamine type diet. fasting can be really helpful if we do that, you know, intermittently. do, even myself, I do about a 36 hour fast roughly once a month. So like doing things where you just sort of like calm that. And then GLP-1 is another one of those tools. There was just a case series

Sally (44:38.569)
Yeah.

Sally (44:56.115)
Wow.

Dr. Jessica Drummond (45:05.485)
published where low, low doses of GLP-1s are used to... There are GLP-1 receptors on the mast cell. So it might not even be a high enough dose that anyone would lose any weight necessarily, but it quiets down that excessive immune response. GLP-1s are also anti-inflammatory. So again, that could lower one of the contributors of the stress load.

Sally (45:32.862)
Nice.

Dr. Jessica Drummond (45:34.092)
We are seeing a lot of that triad, MCAS, POTS, and hypermobility syndrome, and there's a little overlay with neurodivergence, women with ADHD or some form of autism spectrum or OCD or some other mental health conditions, some mental health, some just neurodivergence. And a lot of it has these sort of genetic predispositions.

Sally (46:00.475)
Yes.

Dr. Jessica Drummond (46:01.538)
just like endometriosis has a genetic predisposition. It doesn't mean absolutely everyone with the genes are going to express the condition. Same here, but perimenopause is a time where someone might've had hypermobility genes, maybe not to the fullest expression of having EDS, for example, but they were dancers, and then they were super fit. They were lifting weights. They were very...

strength strong. Then they got COVID or another infection, and then they got ME-CFS, myalgic encephalomyelitis or chronic fatigue syndrome. Then they couldn't exercise as much, or they were just fatigued from organ damage or something else. And so then they start to realize, I've had this hypermobility all along.

I've been a dancer my whole life or I've been lifting weights my whole life." And then they couldn't, they lost that kind of buffer of strength. And then it starts to express. Same thing with pots. I generally see in my practice that women who have pots, they always were kind of vulnerable to, I used to faint in church or if I didn't eat on a regular basis, I would feel shaky. There tends to be these genetic

Sally (47:04.445)
Yeah.

Dr. Jessica Drummond (47:25.624)
vulnerabilities that then are exacerbated by something like a Lyme or COVID infection, particularly if that's wrapped in other stressors, which often they are.

Sally (47:36.156)
Yeah. Yeah, and also if there's been other kinds of traumas as well, not just medical traumas, but, you know, being in traumatic situations or even potential, potential, I can't speak potentially, relational experiences, you know, being in a relationship with a narcissist or being enmeshed with a mother or father, you know, these things can turn on the gene expression.

can't they? And make these symptoms worse for people, especially going through midlife. So it's so fascinating, this work, isn't it? When you, for thinkers, probably like me and you, when you actually go down all these rabbit holes and go down all these avenues and start to connect the dots, you see what a big picture and what a web it really is and how it all links. And of course,

Dr. Jessica Drummond (48:05.39)
Yeah.

Dr. Jessica Drummond (48:14.253)
Yeah.

Sally (48:32.498)
because women tend to have more health problems, not a lot of this is being expressed in the traditional industrial medical complex. You don't see it. You don't see it being studied. You don't see this information being dished out over there. So what do you think really needs to change? What are your thoughts about this sort of disparity between the two worlds?

Dr. Jessica Drummond (48:46.018)
Yeah.

Dr. Jessica Drummond (48:53.976)
Yeah.

Dr. Jessica Drummond (49:03.564)
Well, in terms of that medical and healthcare system.

That's a very difficult question. In the United States, we're in a tricky moment right now because the funding, a lot of our funding for the kinds of research that was looking at things like this has just been dramatically cut. And so I do think there are certain groups in the United States, certain research groups, there is a center at Mount Sinai that just launched, it's a hospital in New York.

Sally (49:11.06)
Yeah.

Sally (49:23.924)
That's so sad, yeah.

Dr. Jessica Drummond (49:36.812)
that is starting to look at this complexity. I actually do think one of the benefits of the COVID pandemic, if you could even say that, is that because so many people are dealing with it all at the same time, and because it's not only women now, it's more women, but it's still about a third men, we are getting a little more research into this whole kind of overlapping chronic illness presentation.

But that research is tricky to do because you have to do it whether it's through complex case studies because the issue is everyone's expression is a little different or their priorities are different or it depends on where they are in the lifespan, what traumas they've had. So you asked before about how hormone shifts can make this worse. Let's look at, for example, estrogen. As estrogen declines systemically, then you have...

less resilience to blood sugar insulin resistance. So estrogen helps with insulin sensitivity, which is a big benefit, but estrogen can also exacerbate mast cell instability. So let's say someone's 48 has some recent stressor that triggered...

MCAS, but their blood sugar is also all over the place and they're 48 years old and their estrogen is declining, it would seem obvious to add estrogen. But if we do that, often their mast cell activation syndrome is going to get worse unless that is first controlled. And then we also have the overlay then of neurodivergence. And if their progesterone is declining, sometimes just adding progesterone for

for that 10 % of women can actually exacerbate their symptoms. They sort of have almost an inverse response. It's like the kid who you give Benadryl to and they don't fall asleep, but they get hyperactive. Progesterone can do that to about 10 % of women. It should help really calm you and help you fall asleep, but about 10 % of women feel a lot of anxiety. And in our practice, what we've seen is that when...

Sally (51:34.206)
Yeah.

Dr. Jessica Drummond (51:47.15)
When the progesterone is added without appropriate estrogen levels to kind of balance it, we get more sometimes mental health symptoms, but we can't always add estrogen until the MCAS is controlled. So we really do have to look at these in concert through individual cases, and that research is hard to do.

Sally (52:04.788)
Yeah.

Dr. Jessica Drummond (52:15.234)
But like I said, I do think there is some increased interest in the last five years because so many people are dealing with this. So that's encouraging. Science is absolutely at risk in the United States. So I think if other countries start stepping up and seeing how they can contribute to some of this research, that would be really helpful. We still have...

as privately funded research, the scientific community is significantly at risk right now in the US. And then the other hard part about the healthcare delivery system, in the United States, we have public hospitals, we have private hospitals, we have private insurance, and quite frankly, to do really good integrative healthcare in this kind of situation.

doesn't fit very well with our modern system because our modern system is designed essentially, you your brain is separated from your gut, is separated from your mental health, you know, whatever. And so for example, where I live, the long COVID clinic is housed in the pulmonary clinic. So it's only looking at the lung symptoms. Many people don't have lung symptoms at all.

Sally (53:24.509)
Yeah.

Dr. Jessica Drummond (53:38.05)
They only have brain symptoms or they only have vascular symptoms. And it was kind of just shoved in there three, four years ago. So the people there aren't really that interested in it. They have their whole other job to do. So I do think that, you know, it's challenging because we do need acute care medicine, but how it's being delivered right now is not very good. It's extremely inefficient. It's very expensive.

Sally (53:51.271)
Yeah.

Dr. Jessica Drummond (54:07.818)
And so how I would change it, guess, and here's how I expect it's going to change, whether I like it or not. I do think that we have increasingly individual access to both AI tools, direct consumer testing, direct consumer medications and supplements and other options. And fortunately or unfortunately, I think individual people are going to have to skill themselves up.

to be their own doctors. And I think the tools are gonna be made more available to make that possible. And I still hope that they're integrating with physicians and other licensed and certified health professionals who have the depth of experience to help guide them. But I think the next decade to two decades in medicine is gonna see a huge shift. I think a lot of people are just gonna get no care at all.

Sally (54:38.227)
Yeah.

Sally (55:05.821)
Hmm.

Dr. Jessica Drummond (55:07.118)
Probably 60 % of Americans are just gonna get absolutely no care. They're gonna just do their best they can. And I think there's a subpopulation that's going to really take ownership of this and get help. But unfortunately, people don't tend to do that until after they're sick. So, you know, it's not gonna be preventative much. And I do think there's a small group of people at the very highest levels of wealth who care a lot about kind of optimizing their health. Some of those have a lot of stress, so.

Sally (55:23.795)
Yeah.

Dr. Jessica Drummond (55:37.142)
it could be very expensive to optimize that health when it might actually be really simple. And that's talking about what we talked about at the very beginning. Slow down, assess if what you're doing is in alignment with what you want to be doing. Get support for your trauma, your stressors. And I think the other thing that I'm hoping we can make some improvements in

Sally (55:44.359)
Yeah, yeah.

Sally (55:59.124)
Hmm

Dr. Jessica Drummond (56:06.634)
is social media, of course, has its benefits. It's connected people like us, but mostly it's made people much more lonely and individual. And I do think that community healing is really important because a lot of our stressors come from the fact that we're kind of all trying to figure this out in isolation.

Sally (56:12.243)
Yeah.

Dr. Jessica Drummond (56:35.198)
So I think these kinds of communities that help women come together, we have a group, we have a menopause group where every week we meet for an hour and a half, help everyone in the group. There's a lot of like, me too, I feel that, that's happening for me. And I think the more we do that, the better.

Sally (56:52.073)
Yeah.

Yeah, it's so important just to be seen, just to be heard, to be understood. I think that's what a lot of people crave actually in this day and age is just understand me, you know, and because that actually settles your nervous system. You know, it improves heart rate variability. It's something you said before about living your life in alignment with your values actually improves your heart rate variability because you've got less cognitive dissonance.

Dr. Jessica Drummond (57:08.387)
Yeah.

Yeah.

Dr. Jessica Drummond (57:15.192)
Yeah.

Sally (57:25.428)
you know, your mind and body are operating in alignment, your energy system is better and everything just feels good. So all of these things outside of just food and exercise are so important to, you know, treating our nervous systems in the right way. And I think one of the key takeaways for me has actually been using heart rate variability as a tool. How do we measure our heart rate variability, by the way?

Dr. Jessica Drummond (57:46.659)
Yeah.

Dr. Jessica Drummond (57:55.798)
So in our programs, we generally use a tool called the Garmin Vivo Smart 5, I think is the current version. The one thing I like about the Garmin, it's a watch, it's a fitness watch. What I like about it is its heart rate variability is displayed all throughout the day and night. And it's displayed as an algorithm that basically it's like orange, you're stressed, blue, you're calm. And that's just a nice kind of like visual and people...

are able to get a lot of information from that. A lot of my clients are like, I'm not stressed. And then they're just like always orange or they're orange all the moment their eyes open and, they're blue at night. So that's really valuable to learn. So that's a tool we often use. It's not as expensive as some of the others. What I don't like about it is that it tends to be, it's kind of a fitness driven app. It's designed to kind of more steps, more running, more stairs, so it is a little bit.

Sally (58:32.052)
Okay.

Dr. Jessica Drummond (58:52.768)
Some of my patients don't need that. They need to like spend a few weeks in the blue before we do anything. But there are other tools too. I personally have worn an aura ring for like five or six years now. That gives you your overnight average heart rate variability. It does now have a daytime tracker of like active, stressed, recovering.

Sally (58:59.464)
Yes.

Dr. Jessica Drummond (59:17.254)
And it's funny, a year or two ago, I watched this documentary about US football players in the NFL. And it's such a good analogy. Using elite sports, I think is such a good analogy for women who are just functioning at this high, high level in perimenopause. These guys take deep commitment to their recovery as much as they do to their training. And all elite athletes do that. Women's soccer players, skiers,

Sally (59:41.822)
Bye.

Dr. Jessica Drummond (59:46.964)
all lead athletes do this. And so my original, original background is in sports medicine. And I think it's a really apt analogy because so many of my clients don't spend any time every day in that resilient space. So all the tools we've tested all have that, you sometimes it's a little more algorithmic, sometimes it's direct HRV. It really doesn't matter. You just want to see where you are.

Sally (01:00:04.105)
Yeah.

Dr. Jessica Drummond (01:00:16.31)
and spend more time in recovery.

Sally (01:00:18.746)
Yeah, so you could even do it really without a monitor, couldn't you? You could just sort of check in with yourself, like how are you feeling? Especially if you're really tuned into your own nervous system, your own body sensations, you could do that.

Dr. Jessica Drummond (01:00:35.67)
You could, I've found that a lot of women can't tell, like they just are so disconnected from it, they don't know yet. So they may not, there's been some interesting studies on using those devices. Usually it takes only about six months to sort of learn your body's messages. And so you don't have to have this thing forever, but that study was done particularly in breast cancer survivors. So I think when women are taught,

Sally (01:00:40.692)
can't tell.

Sally (01:00:44.393)
Yeah.

Dr. Jessica Drummond (01:01:04.238)
how to feel those sensations and are encouraged that it's a safe and okay and beneficial thing to do. Because think about, you're 45 by the time they meet us, right? For 45 years, school, their parents, their bosses have been like, more is better, power through, no pain, no gain, keep going. You silence those messages. So I think it's good to use a monitoring tool for at least six months.

Sally (01:01:28.648)
You do.

Dr. Jessica Drummond (01:01:34.432)
and just remember what it feels like in your body when it's actually at rest.

Sally (01:01:40.038)
Yeah, I think I'm going to get one actually now. I've been without a watch for ages, an iWatch or I left my standard timepiece on the plane unfortunately. So I think I've benefited from not having one but I am curious. I am definitely curious so thank you for that inspiration. Listen thank you so much I'm just checking the time I think we're running out of time now but

Dr. Jessica Drummond (01:01:51.31)
Mmm.

Sally (01:02:06.296)
I think our conversation has been hugely beneficial. Definitely has been for me. So I'm guessing it will have been for our listeners too. Slightly more technical than some of the other conversations I've had. But I think it's really good to go to those places actually. And if anyone's struggling with what MCAS means or something else means, you can just pop it into Google. We have that now. Or you can just reach out to Jessica on Instagram. Talking of which.

Dr. Jessica Drummond (01:02:29.624)
Yeah.

Sally (01:02:33.736)
How do you recommend that people work with you if they've liked you? Obviously you have a plethora of practitioners that you have trained. Can they work with you or one of your trainers? How does it work?

Dr. Jessica Drummond (01:02:47.276)
Yeah, so primarily we educate health and wellness professionals. So if you have a license or certification in any health or wellness discipline, you can take our programs. And a lot of people do it. We focus now on a deep dive program in perimenopause and chronic illness. A lot of healthcare professionals and wellness professionals need this for themselves first. So you are welcome to join and use yourself as your first case study. That is primarily what we do.

Sally (01:03:10.12)
So true.

Dr. Jessica Drummond (01:03:17.27)
I also run a kind of a client level, know, layperson level group that's called the Menopause Solution, but we do all of the things we talked about here. That's a weekly group and you can find out more about that on the website. If you go to that part of the website where we talk about the Menopause Solution, if you just want to do one session with me and my team, you can scroll down into the FAQs and there's a link to schedule just a one-off visit with us.

Primarily what we do is educate professionals because most of them are in the same boat. They're also busy working people and women as well. And we love to see healthy health professionals. And we do have a directory of the people who have trained with us. And you can also just anytime send me a question at integrative women's health on Instagram and our website is integrativewomenshealthinstitute.com.

Sally (01:04:11.974)
Lovely. Brilliant. Thank you so much, Jessica. It's been a pleasure talking to you today.

Dr. Jessica Drummond (01:04:17.944)
Thanks so much, thanks for having me.