Recently, I interviewed Dr. Jolene Brighten, and we talked why it’s crucial to understand what’s normal for your menstrual cycle, how thyroid health impacts your fertility and sexual desire, myths about low libido and aging, the role of the vaginal microbiome, her flexible 28-day plan, and more. If you would prefer to listen to the interview you can access it by Clicking Here.
Dr. Eric Osansky:
I am super excited to chat with today’s guest. We have Dr. Jolene Brighten. We are going to be talking about sex, hormones, periods, tying some of it into thyroid health. Let me go ahead and dive into Dr. Jolene’s impressive bio here.
Dr. Jolene Brighten is a hormone expert, nutrition scientist, and thought leader in women’s medicine. She is board-certified in naturopathic endocrinology and trained in clinical sexology. Dr. Brighten is the author of Is This Normal, a non-judgmental guide to creating hormone balance, eliminating unwanted symptoms, and building the sexual desire you crave.
A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones through her website and social media channels. Dr. Brighten is an international speaker, clinical educator, and medical advisor within the tech community. Thank you so much for joining us, Dr. Jolene.
Dr. Jolene Brighten:
Absolutely. I’m so glad to be here with you and everyone who’s listening right now.
Dr. Eric:
We were chatting a little bit before I started recording this. I was telling you how I was listening to your audiobook. Really enjoyed it.
I also let you know how my wife was not freaked out, but she was surprised because you don’t hold back in the book. You talk about sex, orgasms. We’ll talk about some of that here. Very necessary book.
What motivated you to write the book, Is This Normal? You had written another book prior to this, The Pill Book, which was also amazing. If you could dive into that background.
Dr. Jolene:
Is This Normal? was born out of all of the questions I receive. So many people not understanding their body, having received misinformation. We know social media is full of it when it comes to women’s bodies. Everyone is asking, “Is this normal?” There was that inspiration. That is how we arrived at the title.
When I look back at where this really came from, and what it was rooted in, firstly, women know their bodies. They know they’re normal. However, they haven’t been given all of the information. In fact, they’ve been given a lot of misinformation.
When you look at the states in the United States, most of them are not teaching medically accurate sex ed. At the same time, we’re being told a lot of things like, “Period pain is normal. Being tired is normal.” I’m sure you have a lot of people who have heard that, especially when it comes to thyroid disease, or the myriad of things that affect women. They are chocked up as being “normal.” When women say, “I know my body. This isn’t normal,” they’re often pushed back on.
I wanted to help answer the question of what’s normal, what’s not when it comes to our anatomy, our hormones, our sex life. Then also help people navigate finding their normal. As anybody who has taken a statistics class knows, normal exists within a bell-shaped curve. Right smack dab in the middle is where a lot of people are hanging out. Then you have the outliers underneath. You have the distribution of normal. Normal is a gradient. Even when you get outside of that bell curve, you will find that people are still normal. It might just be their normal.
I help people navigate all of that and set it up as the book. If you were handed this from the day you got your period, you would be less likely to experience medical gaslighting. You are less likely to struggle with your hormones. You are certainly more likely to experience the pleasure that you’re after in this life.
Dr. Eric:
Everybody’s normal is different. You also mention in the book that people mistake common for normal. Just because something is common doesn’t mean it’s normal. People ask me all the time as well. Maybe not in relation to sex and orgasms. Sometimes, their hormones. For so many different things, is this normal? I’ll often say the same thing, “It’s common, but it doesn’t mean it’s normal.” You expanded on that. Maybe it’s someone’s normal but not necessarily normal for everyone.
Dr. Jolene:
As you bring that up, I think right away about how period pain is chocked up to be normal. It’s not normal. Period pain is not normal. It is common. I have been saying this for well over a decade. If you scroll my Instagram, you will see that. I was popping off about that so long ago.
People have really challenged me. Doctors have challenged me. “If it’s not normal, why do so many women have period pain?” I’m like, “You’re a doctor. Why don’t you look it up?” What is going on is such a disservice to your patients.
We do a big disservice in medicine when we mistake that what we see are sick people. Who comes to us? People who have problems. People who want problems fixed. We mistake our experience of constantly seeing that everybody has period pain as being something that must be normal because everybody has it. You have a bias in that.
In fact, we know from the research that because of this bias, because of the bias that exists in medicine that is against women and puts them at a disadvantage, something like period pain or pain with sex, which gets dismissed or chocked up as normal, is a big reason why it’s estimated for the condition of endometriosis that 6/10 never get the diagnosis. In fact, it can go as far as 11 years for somebody to actually get the diagnosis. This is a condition that affects anywhere from 10-15% of women.
I bring this up because I think it’s important to understand that sometimes, people are like, “Oh, what’s the big deal? Why should we even care about this?” This happens way too much in women’s medicine.
In the case of endometriosis, this one example, a leading cause of infertility, something that can lead to gastrointestinal issues, problems that evolve with the bladder. Having actual lesions. Endometriosis is when tissues that are similar to the lining of your uterus but not exact exist outside of your uterus, and they respond to estrogen. It is deemed an estrogen-dominant condition because estrogen will stimulate the tissues to grow. Just like the lining of your uterus, they will bleed when you menstruate. Because of that, you can end up with strictures, tightening of tissues, lesions that are very painful, and lots of inflammation. That can affect your ability to have a bowel movement every day.
Dr. Eric:
You said on average, with endometriosis, it can take how long to get diagnosed? Up to 10 years or longer?
Dr. Jolene:
Yes. It can take up to 11 years. When you consider the research says that only 6/10 women are actually getting the diagnosis, then you consider that those six may have had to go 11 years of going to their doctor, saying, “I have period pain. I have pain with sex. I have pain with urination. I have pain with my bowel movements. I have extreme bloating occurring around my period.”
This is something you’ll see a lot on the internet. I don’t know if you’ve seen this meme going around. Women are like, “Oh, all the hot girls have bloating.” I look at that as a practitioner. Wait, if you have bloating, and it’s that significant- Some of these women are showing pictures of 4-6 months pregnant-looking bellies. That’s how bloated they’re becoming.
When you consider that, I’m like, “Hold up. This could be endometriosis,” especially considering how long it takes to get the diagnosis, how misunderstood it is, and how many doctors are really dismissive of these things. As you know, working your patient population, if we see extreme bloating like that, that could also be SIBO, something causing inflammation in the intestines, related to thyroid disease and slow motility. In anybody who says, “All hot girls bloat,” I’m like, “Pause. Back it up.” That’s not normal.
Dr. Eric:
I’m glad you mentioned that. You’re not saying endometriosis is the cause of all bleeding. Same thing with period pain. If a woman has period pain, it doesn’t necessarily mean they have endometriosis, just that it’s commonly overlooked and missed. Many doctors might say that period pain is normal, and maybe it is, or maybe it’s not related to endometriosis. The point is, they just dismiss it. They tell their patients that it’s normal. Maybe the same goes with bloating and some of these other symptoms.
Sticking with the topic of PMS and period pain. Some women have heavy menstrual flow. This is when we get into common versus normal. A lot of women do have some pain and cramping. Some have a heavier flow. In a perfect world, would you say there would be no period pain and a regular flow? Or is it some women’s normal to have a heavier flow and some cramping, for example?
Dr. Jolene:
The question is what is the flow? What are we talking about here? Let’s break down what a normal period should look like. Firstly, having some mild cramping, totally normal. Feeling a bit tired before your period, also normal. Feeling like you’re totally wiped out, exhausted, never should be considered normal.
If you are driven to have to take NSAIDs consistently, every single period, for multiple days on your period, that’s not normal. Sometimes, people will push back and say, “Everybody’s pain tolerance is different.” It doesn’t matter. Your pain tolerance, whether it’s different than anyone else, doesn’t matter.
If your period interferes with your activity of daily living, it causes you to vomit, to cry, you’re having extreme diarrhea with it, these are signs that your prostaglandins can be really elevated. Prostaglandins are hormone-like chemicals that stimulate the uterus to contract. Very good thing until there is too many of them, or they’re super potent.
They also can be part of the inflammatory picture that we see with what people classify as “period flu.” Period flu is feeling really achy, like you’re getting sick, very fatigued before your period. That’s not normal either.
I have more to say about the period. Just to jump in real quick, Omega-3 fatty acids in the diet and contributing magnesium are two things you can do to mitigate those prostaglandins and make an easy period. I typically recommend that you start with diet first. As you know, eating cold water fish consistently throughout the week, getting enough magnesium-rich foods, that can be a struggle for some people.
Looking at something like 1,500-2,000mg of Omega-3 fatty acids, you actually make prostaglandins from Omega-3 fatty acids. That’s why those are so important. Anywhere from 150-300mg of magnesium. I like glycinate best. That helps women sleep as well. That can be really helpful to bring in and mitigate some of that pain. I wanted to give those solutions before I go further with the period talk.
With the period, the average cycle is going to fall 3-5 days. If it’s less than two days, that’s pointing to too little estrogen. We can see that in late-stage perimenopause. Late-stage perimenopause is right before you move into menopause. Totally normal for periods to go all over the place, but also to have those shorter periods.
If you are younger than 45, before we say it could be perimenopause, could it be anything else going on? Is there anything we can do to help with that?
If your period is going beyond seven days, that is problematic. We get worried about that. That’s too heavy of a period. Maybe estrogen is stimulating the endometrium too much. Maybe you have fibroids. Maybe you have adenomyosis, which is a cousin of endometriosis. You can see clots accompanying the menstrual cycle when you have adenomyosis. I will say that condition is missed even more than endometriosis.
I talk about a lot of conditions that are missed in the book, in order to help women advocate for themselves and have a more productive conversation with their doctor.
Now, in terms of the flow, how heavy should it be? Here’s what’s normal, and not always talked about. Firstly, a period that starts and then stops, that’s normal. Maybe your period, “Oh, I’m starting to have a flow for several days.” Then it’s really tapered off. Then it makes an appearance the next day. That’s not necessarily abnormal.
Having a period flow that is so heavy that you need a super tampon and a pad, or you’re changing a tampon or a pad every single hour. I’m not talking about a tampon on a light day. I’m talking about a tampon and a pad because the flow is so heavy, it’s the only way to contain it. If you’re changing one of those products every hour, if you have to wake up in the middle of the night because the flow is so heavy that you have to change those products, this is too heavy.
I have billions of checklists in the book. I have a little checklist on what is not normal for your period versus what is normal. It’s important to understand what these parameters are.
Like I said, your period might be three days up to six days. That’s all considered normal. When we have these outliers, we need to investigate what’s going on. We have talked about period pain. We have talked about the period itself. I’d like to talk about cycling. Are you good with that?
Dr. Eric:
Yes, definitely.
Dr. Jolene:
Cool. This is another one people are confused about. “My period has always come 24 days. Isn’t a 28-day cycle the norm?” Very few people are having a predictable 28-day cycle regularly. We set it up as a way to teach about the menstrual cycle. There is some science to support there is these averages of how long the luteal phase it can last, and how long it should last, and when ovulation might happen.
The myth of the 28-day cycle has lent itself to the myth of everybody ovulates on day 14. None of that is true. You may even ovulate one month on day 13 and the next month on day 15. It shouldn’t be that you ovulate one month on day 10 and the next month on day 28.
Your cycle shouldn’t be something that is less than 21 days or greater than 35 days. Even though I say that, if you consistently have had a 38-day cycle your entire life, and you’ve been worked up and nothing’s going on, then that is your normal.
In medicine, if you’re going beyond 35 days, we need to investigate things like polycystic ovarian syndrome (PCOS). There are other conditions as well, but PCOS is far more common than those.
If your cycle length suddenly changes, we need to look at if this could be hypothyroidism. Changes in the menstrual cycle are one of the most missed symptoms when it comes to hypothyroidism in my experience. That is because clinicians are trained to put someone on the pill when the cycles become irregular rather than test and understand what’s going on, unless, the caveat being, you want to have a baby. Then you might get that thyroid panel.
When it comes to the cycle length, that should be pretty predictable within a few days of itself. It’s not abnormal if you did have 27 days and then 29 days. But it is abnormal if there is a change within your normal, or you are less than 21 or greater than 35. If you never know when your cycle’s showing up, you definitely need to see a provider.
Dr. Eric:
I should say I see a lot of people with hyperthyroidism as well, which can also impact the cycle. In different ways, too. I can’t see there is a consistent pattern. Some people will completely stop cycling for a few months. Sometimes, it might be more frequent. Regardless of whether someone has hyper or hypo, it could impact. Like you said, especially in the case of hypothyroidism, often it’s missed. Doctors will look at other things.
Dr. Jolene:
Totally. I see the same thing with any thyroid disease. Sometimes, the cycle stops. Sometimes, it becomes irregular. Sometimes, the periods become very long. That is something that should always be ruled out.
Most people are not aware of this. You may be, but I definitely want your audience to understand that when it comes to follicular development, this is how we get a mature egg that we then ovulate. That is very dependent on the thyroid hormones being optimized. If you want to have a baby, absolutely crucial. If you don’t want to have a baby, absolutely crucial because only by ovulation do we get the progesterone levels that we need.
You have been in the thyroid space for a long time. Most doctors will just check a free T4. Then you get to functional medicine. We are looking at free T3. We have those patients who just do better on natural desiccated thyroid hormone, which we know also contains T2. I have always said the body doesn’t do something for nothing. If it’s still making these hormones, there is a reason.
What’s interesting is when you look at the research, T2 is actually involved in that follicular development and interaction with the mitochondria, which are really tending to the health, the quality of the eggs, and the health of the ovary overall. Thyroid health directly impacts ovarian health. This is so crucial not just for pregnancy but in the longevity conversation.
The longer we can have our own natural hormones taking care of us, the less risk we have for things like dementia, cardiovascular disease, osteoporosis, type 2 diabetes. I could keep going. Take care of your thyroid, your mitochondria. That is one key to taking care of your ovaries.
Dr. Eric:
Based on what you just said, if someone is taking levothyroxine, synthetic T4, and if they are having fertility issues, not to say it’s definitely related to that, but it could be. When they are taking T4, they are obviously missing out on the T2. They are hoping that will convert to T3.
Dr. Jolene:
The hope, right? Will it convert? Unless you’re post-thyroidectomy, which means your thyroid has been removed, your thyroid will still make some T2. It will putt along. It will do that. What we do understand really well from the research is that T4 is absolutely crucial, not just in follicular development in that egg health, but also preventing miscarriage.
The long-term studies that have looked at when Mom had insufficient T4 showed that even these children, they followed this cohort up to 16 years of age, and they were behind in terms of cognition and motor skills. We know it has a tremendous impact on fetal growth and development.
For anyone listening, if you’re like, “Why is my doctor giving me T4?” T4 crosses the placenta. There is this magic thing that happens in medicine where as soon as you become pregnant, you become the thing that’s carrying the baby in the way of the baby, and everyone is focused on the baby. They forget your health and wellbeing matter as well.
I say that backhandedly. We know there are great providers out there. But we also know that the United States, we’re at the bottom. We rank bottom when it comes to maternal/fetal outcomes, when it comes to obstetric violence. We win at that. We’re not doing well as a developed nation.
I want people to understand that if you have a great provider, yay. Celebrate it. Maybe share it in the comments. That would be really great. If you don’t have a great provider, and you feel like it’s just you, it is not just you.
Back to your point. I want to say something that’s been very interesting that I have observed and used in my clinical experience. Women who aren’t necessarily presenting with hypothyroidism, but they are going through IVF, sometimes giving a very low dose, like 25mcg of levothyroxine, can actually improve the outcomes of IVF. Do I have great studies that I can tell you about that? No.
When we see things like that free T4, it’s hanging around 1, sometimes it drops below 1. Ideally, we want that 1.2, 1.4. That is somewhere where it’s like let’s just try. We’re only going to do it for one cycle. It will only be a few weeks to support you. You’re not going to have hyperthyroid symptoms from that. I have seen some pretty good outcomes. Take that clinical pearl, people, for what it’s worth, and discuss it with your provider.
Dr. Eric:
That was awesome information. Low sex drive, low libido, something else that maybe practitioners in general, maybe not functional medicine practitioners but medical practitioners, would say is normal and more common. Why is that so common? What are some of the underlying causes?
Dr. Jolene:
Hypothyroidism and hyperthyroidism. Oh man, the way your nerves are so grated in hyperthyroidism. Good luck getting in the mood. That can be really hard.
To answer your question. Why is it that so many women go to their provider and say, “I’m struggling with low libido,” and their provider is like, “Well, you were born with ovaries. That’s just normal?” I break this down.
If we go back and look at the history of medicine, the history of medicine has essentially said we have this male component. That is the standard. That is perfection. We will measure everything against this. This other inferior model over here with baby-making accessories, that one should match, right? Everything is through the lens of men.
With that lens, the myth, and I say this is a myth because I think it’s unfair pressure that society puts on men, is that men are always in the mood. Men always want sex. Men have more testosterone than they are using at a cellular level; therefore, testosterone is the key hormone driving it. Men are always in the mood.
What we understand, firstly, is that for women, it’s not just testosterone. There is the estrogen component as well that’s really important in terms of your desire, your ability to self-lubricate. At the same time, all the other hormones matter as well, along with stress hormones.
The stress hormone picture that I’m talking about, and thyroid, and insulin, this applies to all bodies. Doesn’t matter if it’s ovaries or testes. All bodies are affected by these hormones. It can affect their desire.
Now, when we look at the research, and we look at psychologically, are there these differences going on? What we understand is that there are more women who will identify with what’s called responsive desire. That’s where you talk about how you have to get things going to get things going. You’re not in the mood for sex until you’ve actually started foreplay. That is normal. It’s called responsive desire. Both men and women experience that.
Then we have spontaneous desire, which is what the media shows us that all men should be like. They’re always wanting sex. Sex is always on the brain. They’re always chasing tail, so to speak.
In reality, that spontaneous desire isn’t something that every man experiences, and women do experience it. When women experience it, they’re often told things like, “Oh, you have the sex drive of a teenage boy. You are more like a man.” Really, when you stand back, this is just a misframing and misunderstanding that men are supposed to be one way, and women are supposed to be another way. It’s absolutely not true.
I talk about in the book the clitoral conspiracy. Everybody’s heard, “The clitoris was discovered in the 1990s.” Lies. No, it wasn’t. It was discovered a very long time ago. In French, the translation is “shameful member.” What does that tell you right there? It was something to be shameful of.
They cut it out of anatomy textbooks. Even to this day, the majority of medical anatomy textbooks—this means the books your doctor is learning from—do not have medically accurate illustrations of the clitoris, which is why in Is this Normal? you will find three. I put three in there. If nothing else, y’all are going to know more than what your doctor knows about the clitoris.
So far, I’ve talked about: We have the component of the different ways that sexual desire can work: responsive and spontaneous. The idea that women have to be different, and if it’s a problem, it has to be testosterone. We don’t know about the clitoris. A lot of people don’t. My necklace, which you can’t see behind the mic, actually says “Cliterate.” It’s a term that Dan Kearn coined to talk about being actually literate about the clitoris.
Then we have a whole other component called the dual control model, which is all about things that turn us on, things that turn us off. this was research done by Bancroft and Janssen to understand men.
If everybody is listening, “Well, she’s in women’s health. Why is she talking about men?” I think it’s so important to understand that these experiences are universal. There is a lot of similarity although I did tell you with hormones, it can be different with women. I will talk about that a little bit more.
The similarity being that our nervous system has to be ready and tuned to accept the sexual inputs. Those are the accelerators. If we have too many brake pedals on, those are things like stressing about our body image, stressing about unintended pregnancy, stressing about our relationship. A lot of stress is what you’re hearing. That is going to basically create a nervous system chaos in which you cannot receive the signals that maybe your partner is trying to throw your way. In those instances, it’s also another time to feel like, “Why am I out of the mood?”
When I talk about stress, and I talk about women, I want people to understand that the female body is more attuned to the stressors of the environment because biologically speaking, whether or not you want a baby, whether or not you can have a baby, the tissues, the cells, everything about your being is set up to survey whether it’s safe or not to have a baby.
Let’s just face it. Babies are noisy. They will give you away if you are hiding from a predator. That’s like my biggest fear. What if there is a zombie apocalypse, and I have a baby? Or I’m pregnant? How am I going to outrun a zombie? I don’t know how I’m going to do that. That’s way out there. But if it’s a different kind of predator, like the real kind, like a tiger, how will you do that? The body knows. The body is inherently wise.
Your doctor says, “Eat right and exercise. You just need to eat less and move more.” You’re doing that. Now you’re never in the mood. That’s a negative input on the system. You just told your body, “The environment isn’t safe. You don’t have enough food.” These different types of stressors will cause biological shifts, shifts in our hormones that can impact our sexual desire, which is our ability to get in the mood. The safest way to live your life in moments that are high stress is to protect you from not becoming pregnant, which means you have no interest in having sex. Does that all make sense?
Dr. Eric:
Yeah, definitely. In functional medicine, they talk about the pregneninolone steal, the cortisol steal, where the body is prioritizing cortisol production at the expense of DHEA and the sex hormones. Is that what you’re talking about?
Dr. Jolene:
I’m so glad you brought that up. Pregneninolone steal is an outdated way to think about it. I’m not shaming you or scolding you for saying that. If you ever learned about it back when we learned about it, that’s how we talked about it. it’s this idea that pregneninolone, the mama hormone, she has given birth to cortisol and progesterone. In that moment, she is like, “I have to birth more cortisol. Forget the progesterone.” There is nothing left over.
Now that we have more research understanding the mitochondria and how this is all working, what’s actually happening is the master orchestrator of hormones, your pituitary gland, your HPA of wherever it goes, whether it’s the adrenal axis, the ovarian axis, the ovarian-adrenal-thyroid axis, that is orchestrating things to say, “Let’s get cortisol up. Let’s make sure we are dampening down progesterone.”
In the book, I have a whole diagram of how stress affects you. Too often as doctors, we say, “You need to work on your stress.” You know in functional medicine, we don’t do it like that. But the average provider that the woman is experiencing, she may go in, and they’re going to say, “You just need to get a handle on your stress.” What does that mean? What does it do?
As stress goes up, we know cortisol production goes up, and ovarian function goes down. It’s not just progesterone, but all of the cycle can be impacted. Extreme stress, like hypothalamic amenorrhea, we see that you will lose your period. You are not getting enough calories; you are overexercising.
Anyone who has ever had a significant life stressor, like your dog dies, someone close to you passes away, maybe you were in a car accident, and you miss your period, that’s actually normal. Your body was like, “Hold up.” Survival will come before procreation. Your body is shifting in a way to protect you.
That’s what I think functional medicine does a lot differently. We stand back and ask why. Why would your body choose to take this path? Rather than trying to strongarm the body into submission, “Body, you’re misbehaving. I’m going to give you a medication. Going to suppress that. Going to do these things.”
Listen, sometimes we need medications. However, even when we need a medication, we still need to ask why. Why did the dysfunction develop? I say “dysfunction” as in if you are not menstruating, therefore not ovulating regularly, and you should be, something has become dysfunctional in the system. The adaptation, which is meant to keep you alive, has adapted too far. You’ve adapted too close to the sun. You’re burning up. What is happening here? We have to ask the question: Why did this happen? Why did this shift happen? And work at that level.
Dr. Eric:
All of this is really fascinating. I want to talk about orgasms. I am 100% sure I have not spoken about this on the podcast.
Dr. Jolene:
Everyone wants to talk about orgasms.
Dr. Eric:
Exactly. Obviously, there will be overlap. For many people, thyroid health will play a role. Stress hormones, like cortisol. There is also going to be some psychological aspects as well. Let’s talk more about orgasms.
Before we get into orgasms, if this is going to take long, we can skip over this. Every now and then, there will be someone who has a heightened libido. What would be the cause of having too high of a libido?
Dr. Jolene:
There’s no such thing as too high of a libido. That is your normal. When we say someone’s libido is too high, what we are really saying is they have spontaneous desire. That is the mode they are activated on and in which they are going through life. That is completely normal.
We get into trouble when we start pathologizing what is normal. That is definitely one of those instances where people are like, “Your sex drive is just too high.”
The other thing that happens sometimes in those situations is that person’s default of when they are stressed is actually to have desire. That’s not as common, to be in the mood when you’re stressed. But I think those people’s biology are really hip to the fact that the orgasm that we are going to talk about is going to release oxytocin, which combats cortisol’s negative effects.
Cortisol will not only age you in what you can see, but cortisol will age you at the cellular level. If you are exposed to chronic stress, we know the brain suffers significantly. You can have memory deficits, cognitive deficits. With that, orgasms can actually help.
This is what everybody gets when they’re intimate. These people will also get the connection. The connection, that intimacy, that act of mindfulness, which if you want to have an orgasm, it is an act of mindfulness. You have to be present in your body to even arrive there. Those things, we know help stress. If it was outside of sex, it would help stress.
Sometimes, that is also where people are like, “Something’s wrong with you because you want to have sex when you’re stressed.” It’s because something about their being knows, “I can check so many boxes with this that are going to help me drop my stress and optimize my hormones.”
Dr. Eric:
A question I have with orgasms then: I’m in my 50s, even beyond that, 60s, 70s. You’re going to have natural decreases in hormones. Can someone in their 70s, 80s expect to have orgasms like they would in their 20s and 30s or even people in their 50s? Should they expect a decline, where maybe they can still orgasm as they get older, but it’s more challenging? Is it just because of what we’ve been discussing as far as the older people get, they’re more likely to have some of these other health issues develop? Some people have them for years, like Hashimoto’s can be undiagnosed for 10-15 years. I’ll stop rambling and have you talk about orgasms.
Dr. Jolene:
When I tell you how rampant STIs are in nursing homes, that’s all I gotta say. No, you shouldn’t be losing your ability to orgasm because you are aging.
As you brought up, with the case of Hashimoto’s, and hyperthyroidism, long periods of undiagnosis that are going to affect the cardiovascular system. Anything that negatively impacts the cardiovascular system or our blood glucose, blood sugar, and our insulin levels, that can impact your ability to orgasm.
Now, as we get older, we are at higher risk of developing diabetes and having circulatory issues. When we look back at the research, most of it has been done on men. Shocker, I know. If a man can’t have an erection, it’s like, stop everything. We have to figure out what’s going on. I think that’s a very good thing. We should also apply that to women.
The clitoris and the penis are the exact same embryological tissue. When you’re an embryo, you get this hormone called testosterone that comes through. If you have a Y chromosome with the right genes, you have a penis, a scrotum, testes. If you don’t, you have labia, a clitoris. I outline all of this in the book.
The clitoris and the penis, same tissues, get erections. Erections require nitric oxide, which we know those pathways can slow as we age. They also require good blood flow and circulation.
Something that we know that is affecting far too many people in the United States that can impact our clitoral health/penile health is diabetes. If you have somebody with erectile dysfunction, you need to look at their cardiovascular health and diabetes. This is what I was taught in my nutrition science classes 20 years ago. The same is true of the clitoris.
If someone starts complaining of inability or orgasm, simplest thing. I like to validate it. Yeah, it can sometimes be a struggle for a lot of different reasons.
Getting older isn’t a death sentence for your sex life. In fact, many women who are post-menopausal report having much better sex at 50+ than their 20-something self. Part of it is you’re more comfortable with your body. Others is experience, and you understand your body more. But it’s also that the threat of an unintended pregnancy, which can mess with your nervous system, pull you out of the mood, is no longer there. They’re finding that they do orgasm better. They have a much better sex life.
I want people to understand that. Not a death sentence. If you’re starting to struggle, get that investigated. Get it looked into. Something else might be going on.
Now, the other piece that I want to say about sex as you age is lubrication is a must. If you are not having adequate lubrication, which as estrogen dips during certain times of your cycle, or post-menopausal, then you will need more lubrication. That is absolutely normal as well.
I said that was the last thing I was going to say. I’m going to say one more thing about orgasms. The research tells us that only about 18% of women report being able to orgasm via vaginal penetration alone. That is based on their anatomy. Their ability to do that is based on their anatomy. Predetermined , nothing they can control. The distance. Where is the clitoris? Where is the vagina? This is important for people to understand because it may very well be you need more clitoral stimulation in order to reach an orgasm. That is completely normal.
Dr. Eric:
More foreplay, you’re saying? As an example.
Dr. Jolene:
I appreciate this. I talk about it in the book, about foreplay. Using the word “foreplay,” we all know what that means. I like to use common language, so we can arrive at the same place.
We have to also recognize that foreplay is actually sex. It can be totally gratifying. You can achieve an orgasm. By the way, when you ask people, “Hey, remember the best sex of your life. Tell us what made it the best sex,” they don’t often report orgasm. I want people to understand that as well. Best sex of your life, people say things like intimacy, connection, vulnerability. They don’t say orgasm.
We put so much emphasis on the orgasm. As a hormone doctor, I do think having an orgasm is great. If you can’t, we should investigate things.
Understand that every sexual adventure, you’re not going to hit an orgasm. You may hit your orgasm in foreplay and decide not to have penetration if you’re in a heterosexual relationship. Or you might hit it in foreplay and have penetration and hit it again. It’s totally up to you.
When we use the word “foreplay,” I never want people to feel the pressure. I want to acknowledge the pressure that foreplay is, to most people in their minds, the stuff that happens before, not the main event. But it can totally be the main event.
When it comes to clitoral stimulation, that can happen on its own, or it can happen in conjunction with a partner and having vaginal penetration at the same time.
I list in my book a lot of ways to reach an orgasm. There are people who it’s like documented thinking off. People can just think about it and have an orgasm.
There are people who go to the gym and work out and randomly have an orgasm. It’s called a coregasm. They are working their abs, and they did not intend for this to happen.
There are a lot of ways to arrive there. However, the majority of people are going to only arrive there via the clitoris. Because the clitoris is not on the outside, like the penis, and it doesn’t have to pass urine and ejaculate- The penis has a lot of jobs to do. The clitoris has one: provide pleasure.
The clitoral structure, what you see on the outside is the tip of the iceberg. The clitoral structure extends inside. Because of that, it can be more sensitive because it is more protected. It is not being stimulated all the time. Those neuronal pathways are the primary way that people orgasm.
In the book, I also talk about people who have spinal cord injuries and how they find new ways to orgasm. This is how important pleasure is. I think If somebody is tuning out right now, or their doctor’s dismissing them, understand that the pleasure of being a human is so important that if you have a spinal cord injury, that pathway that went to the penis or the clitoris, those nerves will set up other places. Now, people are noticing that they can be stimulated on this other area of their body and achieve an orgasm. I want people to understand that that is because the brain is set up to be the big sex center, and it sends out those nerves, seeking out pleasure.
Your body thinks it’s important. The World Health Organization thinks It’s important. The research says it’s important. This is not something we should take for granted.
Dr. Eric:
A lot more in the book for sure. Highly recommend everyone either read it or listen to the audiobook version like I did.
I have two quick questions, but they might not be two quick answers. If you don’t have time-
Dr. Jolene:
I’m gonna try. I talk a lot. I get excited.
Dr. Eric:
Just because nobody has spoken about the vaginal microbiome. The first question is if you can briefly talk about the vaginal microbiome and how to support it. And then briefly talk about your 28-day plan. I know people will have to read the book because there is no way to talk about the whole 28-day plan in a couple of minutes. Can you touch upon those two things before we wrap it up?
Dr. Jolene:
I just want to say I have ADHD. I write my books for brains with ADHD. You never have to read it front to back. You can jump in anywhere you want, and you can still get what you need out of it. Same with the plan. If you just want to jump in the plan, you can do that. While you’re going, go back and read it as you go.
You wanted me to talk about the 28-day plan. Before we get there, I want to get into the vaginal microbiome. Everybody needs to understand that it’s not just the vaginal microbiome; there is a cervical microbiome, an endometrial microbiome, a tubal microbiome, an ovarian microbiome. These microbes are everywhere.
I talk all about it in the book. The biggest thing I think women need to understand is that your estrogen matters so greatly to the health of your entire microbiome. Your skin, your gut. As you enter menopause, we see that microbial diversity drops as estrogen drops. Your estrogen is so important. Your vaginal microbiome is no different.
Estrogen stimulates the cells that produce the glycogen that is the sugar that feeds the Lactobacilli in the vagina. Lactobacilli are why you have a pH that keeps yeast in check, BV out, and helps protect against other pathogens. Taking care of your estrogen as I outlined in the book is absolutely essential to taking care of your vaginal microbiome.
I have an entire chapter about discharge and talking about BV, yeast infections, other types of infections as well. What you can do naturally to be working on that every day to optimize your vaginal microbiome. I think we are going to find in the future as it relates to cancers that there is a link to what’s happening in the microbiome there, not just by way of hormones, but also the inflammatory processes that can occur. That’s probably going to be like when I’m well into menopause.
Don’t wait on the research. Just start taking care of your body now in the common sense ways that maybe your mama already taught you, and the new science is showing you that I talk about in the book.
28-day program. That is where we are going to get into how to optimize your hormones and how to understand your normal when it comes to sex throughout your cycle. I design the program so you can do the hormone thing if you want, or you can also bring in the sex stuff, too. You can understand your normal.
The thing about libido and orgasms. We don’t go to our neighbors, “Let me compare my sleep to you,” and judge and shame myself for it. Are you talking to them about their periods and feeling shame and judgment? You are not.
When it comes to libido and orgasms, we often compare ourselves to others and think something is wrong with us. Odds are, there is absolutely nothing wrong with you. We need to help you discover your normal. If we know that normal, you can get the pleasure that you want and also enjoy the hormone benefits that come along with it.
Dr. Eric:
Thanks for discussing all of this. Do you have two chapters dedicated to the 28-day plan? It was in great detail. It’s not spending 5-10 minutes on it.
Dr. Jolene:
There have been people who are like, “I got the audiobook, and I needed the real book to see the checklist, the charts, to go through the plan.” It’s a very interesting book because so many people have said they’re listening to the audio, and they have the physical book and are looking at it as well. That’s so interesting to me. That’s how I usually do things.
With the 28-day plan, there is a chapter setting it up, so you understand the why, the how, what to be tracking. Then there is the actual plan, of let’s get in and do it. I separate it that way because I think it can become way too much information when it’s like, “You’re doing the plan. I’m explaining to you all the reasons why you’re doing the plan. Here’s the next step of the plan.” Some people don’t want the explanation. They just want to do it.
Dr. Eric:
Where can people get the book? Should they go to your website? Should they go to Amazon, like I did? Anything else you’d like to share? Social media? The resources?
Dr. Jolene:
If you go to DrBrighten.com/ITN-Resources, there is a four-week meal plan, a recipe guide for you to help you optimize your hormones. We have other bonuses and goodies there. It goes along with the book really well. You can grab it now. Pick up the book later.
You can get the book anywhere books are sold. Of course, most people use Amazon. You can request it at your local bookstore or call your library about it. DrBrighten.com also has the book. We can ever rarely outcompete Amazon. I’ll just be honest there.
Dr. Eric:
You’re on social media. TikTok?
Dr. Jolene:
Instagram, TikTok, YouTube, Threads, @DrJoleneBrighten.
Dr. Eric:
Wonderful. Thank you so much, Dr. Jolene. It was awesome listening to your book. It was awesome chatting with you about your book. I’m sure the listeners learned a lot. I definitely did as well.
Dr. Jolene:
Awesome. Thank you so much. It was so great to see you again.
Dr. Eric:
Same here. Take care.
Dr. Jolene:
You, too. Bye!
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