What Excites Us!

Episode 19 - PCOS with The Hormone Dietitian, Melissa Groves Azzaro

Transcript:

Melissa Groves Azzaro  0:00  
Like I know all the things when it comes to crazy stress lifestyle 90 hours a week, I had one studio apartment where I could literally reach the stove from the toilet. So it's just you know, that that kind of situation

Gwyn  0:25
Hello, and welcome to What Excites Us! the show that discusses sex and sexuality throughout time and place, including the here and now. My name is Gwyn Isaacs, I am a certified sex coach and educator. And today I am talking with Melissa Groves Azzaro RDN LD and the CEO and founder of The Hormone dietitian. She is an integrative dietitian who helps busy women with hormone imbalances, PCOS and fertility issues to regain regular symptom-free periods and get pregnant naturally. Starting with where you are, she uses a functional medicine approach to identify the root causes of your symptoms, and then helps you develop a personalized nutrition, supplement, and lifestyle plan to balance your hormones and optimize your fertility. Melissa works virtually with clients in the US in one on one and in group programs. She is the creator of the "PCOS Root Cause Roadmap" and "The Period Problems Root Cause Roadmap". She is the author of a balanced approach to PCOS. And is the host of the podcast "Hormonally Yours with the Hormone Dietitian." In this episode, we talk about a whole bunch of things, including why there aren't more health studies of or even with women, what is PCOS and how it affects you, polyps, fibroids, and so much more. Before we get into it, though, I'm gonna play a reminder for you about me being a coach. Unless of course you're a Patreon member and listening to the ad free version. And while I am exhausted and I am not in a place to rerecord it today, I also have some phone and video spots opening up in the near future. But to have access to that, we need to work together via text or email first, so if you're interested in having video or phone sessions with me in the future, sign up for the text based things now.

Gwyn Isaacs  2:54  
This episode of What Excites Us! is brought to you by me I'm Gwyn Isaacs. And besides being your podcast host, I'm a certified sex coach and educator. And right now I have some openings for text based clients. I love coaching over email and text. It allows you to be open and vulnerable in ways that may feel too difficult in person, which lets us tackle the concerns you have at your own pace. Very few of us were taught how to have sex. Most of us are feeling our way through the dark hoping we get it right. I can help you build skills in the bedroom and navigate your intimate relationships. I have two ways you can sign up to start texting with me right away. When you go to earthlydesire.com/coaching, you will find a weekly subscription for daily correspondence, and a way to schedule a live one hour text chat. Visit earthlydesire.com to start on your path. Have more pleasure today. You deserve it.

Gwyn  3:58  
Hi, Melissa. Welcome to What Excites Us! I'm so delighted to have you here. Why don't you introduce yourself and tell us a little bit about what you do?

Melissa Groves Azzaro  4:07  
Yeah, thank you so much for having me, I'm super excited to chat with you. This is a little different than the podcasts I'm normally on but it's you know a topic I like to dig into because the conditions I work with primarily, you know, they really do affect sexuality and body image and all of that. I am an integrative and functional registered dietitian and I work exclusively with women's health and hormones. So primarily with PCOS, infertility, sub fertility, and other hormone imbalances and hormone driven conditions like endometriosis, polyps, fibroids, that sort of stuff. That's really my jam. We've kind of chatted a little offline about this, but I'm a second career dietitian. So I worked in New York City advertising for 15 years before going back to school to become a dietitian. I work primarily I'm 100% virtual. I work with clients virtually one on one different programs. I have online courses and group programs and a book I have a cookbook on PCOS the balanced approach to PCOS and I recently started hosting my own podcast as well, hormonally yours with the hormone dietitian.

Gwyn  5:36  
That's great. I'm going to subscribe. That sounds fantastic. What is PCOS for folks who don't know?

Melissa Groves Azzaro  5:41  
Ya, PCOS stands for polycystic ovary syndrome. And it's a syndrome so what that means is it's a collection of symptoms that can present. There's sort of three factors and you can have any two of the three in order to get diagnosed with PCOS. The first one is the ana ovulation or no ovulation or irregular ovulation, which then obviously leads to irregular menstrual cycles. The second is high androgen levels. Androgens are those typically male hormones that drive symptoms like acne, oily skin, irritability, male pattern hair loss, and that one can be diagnosed either by lab testing or by symptoms. So if you walk in and it's pretty obvious you have high androgens, you may not have had the testing. And then the third one is polycystic ovaries. And I think that's the one that there's the most confusion about because it's not cysts like those functional ovarian cysts that are painful and that burst. And you know, you go to the ER, because you're in so much pain. There are actually small, immature egg follicles that happen because you're not ovulating regularly. So they start to build up. So you can have any two of those three. And because of that, you can actually not have polycystic ovaries, but have polycystic ovary syndrome, which always makes it confusing. There's some debate about changing the name of the condition to better reflect what it really is. But I think probably the biggest misperception is that it's just a disease of the reproductive system, you know, you'll hear a lot that people will go to their doctors, and they'll get diagnosed. And the doctor says, "Well, here's the birth control pill, come back when you're ready to get pregnant". But the reproductive side of PCOS is only part of it. The other part of it is really all of the metabolic stuff that comes along with it. So, you know, not being able to use carbs as well, as someone without PCOS. Inflammation is really common, insulin resistance and all of those things are the things that lead to the chronic long term risks that come with PCOS. I think, you know, and especially because those are things we can impact with nutrition and lifestyle. I think that's more important to focus on. You know, I hear a lot. Well, I had my babies, I'm done so I don't need to worry about it anymore. And though you still need to take care of your body and lower those risks.

Gwyn  8:26  
Yeah! So I was actually diagnosed by an ex-partner. And so I brought that to my doctor. My doctor didn't say anything. But years later, when I was looking at my, in Vermont, they call it the My Health chart. I was like, oh, yeah, lookit there. They agreed with that. And that was it. There was nothing, there was nothing else.

Melissa Groves Azzaro  8:46  
PCOS doesn't have a look, really, you know, there's a wide spectrum, it can affect people in any body size. And it actually leads to harm, I think, in the medical community, because I hear it from both sides. And I see it from both sides. I see patients who are in larger bodies, get diagnosed with that PCOS diagnosis, diagnosis, and then I'm looking at all their labs like you, you don't have PCOS. But I'm a dietitian, I can't diagnose. So I'm like, alright, we're gonna operate under the assumption that you do, but this does not look like PCOS to me. And on the other hand, I have patients who struggle for years to get a diagnosis of PCOS because they have a lower body weight. So you know, it's like it can't possibly be PCOS, you know, you're not overweight. So yeah, it really goes both ways. And you know, it's damaging because we want to know what we're dealing with so we can start dealing with it with the right approaches.

Gwyn  9:48  
Thanks for breaking that myth. I'm already learning new stuff. That's fantastic. So what are some ways that people can address this?

Melissa Groves Azzaro  9:58  
Yes. So, you know, as a functional practitioner, I really try to approach things from the root causes. So what's driving your symptoms as opposed to sort of the conventional medical approach where you have acne, here, take this topical cream here, take this antibiotic that's going to clear up the acne. Or you have diabetes here's some Metformin, we go upstream. So the four root causes that I approach are insulin resistance, because that is 75 to 95% of people with PCOS have insulin resistance to some degree. I mean, obviously, that's the one that leads to pre diabetes and diabetes down the road. inflammation, which is common in the PCOS, population, gut imbalances, sort of some cool science coming out around, there's been huge interest in the gut microbiome in the last 10, 15, 20 years, tons of studies, and we're still learning. You know, we know that the bacteria that's in our gut can affect our moods. It can affect how we break down and absorb food, all sorts of things that that these guys do for us that we don't even know all the things they do for us. But one of the things that's come up in research is that people with PCOS have a different gut microbiome. So they have different bacteria and different types of bacteria than people without the condition. And there's actually a study where they, they take the gut bacteria from women with PCOS and implant it into mice and the mice developed PCOS, just from that. And the fourth one is really the hormone imbalances. So you know the andro high androgens being really common in PCOS and one of the diagnostic criteria, but there's other hormone imbalances as well, like adrenal imbalances. Having high cortisol having high DHEA can really make those symptoms worse. And then we think about some lifestyle factors, as well, like making sure you're getting enough sleep, getting the sweet spot when it comes to exercise, getting enough movement, but not over exercising, because that is stressful for your body. Managing stress really is important. And then some environmental factors like endocrine disruptors, or hormone disruptors that are found in day to day objects we use, like our kitchen storage plastic in the kitchen, or health and beauty products, or all of those artificial fragrances we're breathing in. All of those can make a hormone driven condition worse. 

Gwyn  12:47  
Wow. 

Melissa Groves Azzaro  12:48  
Yeah, it's complicated. It's not just like, here, follow this diet, and you'll feel better.

Gwyn  12:56  
Oh, how I wish were. Having all four of the things that you mentioned. Okay. Great. So, alright,

Melissa Groves Azzaro  13:04  
It's ok, you break it down step by step. You know, I really approach it with a stepwise approach with my patients because it is overwhelming when you hear it all like that. We start with balancing blood sugar, because that is crucial. Once we've mastered that, then we layer on anti inflammatory diet and lifestyle. Once we've mastered that, then we do some gut tweaking based on what's going on for you. And then finally, that's when we address those hormone imbalances. I think a lot of people want to jump to the sexy part. They want to jump to the hormone balance stuff, because you could go buy a hormone balancing supplement, wouldn't it be great if that fixed your problems, but those foundations are actually what matter more. So we just, we break it down step by step. I always talk about the fact that PCOS is a lifelong condition. And so any changes that we make, have to be sustainable. Like it has to be something you can see yourself sticking with for the lifetime, you know, and there's no such thing as perfect. We're all human, there's, there's room for treats. It's all about what you're doing the majority of the time and consistently that makes more of a difference. You know, you've sort of alluded to some some diets you've tried in the past, but we tend to go very gung ho on a diet and just the all- in and then three months later, it's like I never want to do that again. 

Gwyn  14:34  
Exactly, yes. 

Melissa Groves Azzaro  14:36  
Yeah, we start with where you are, and then make tweaks based on that to improve it. I'm a big fan of what can we add to your diet to make it more PCOS friendly? What can we what habits are you already doing well in your lifestyle that we can add to and build on that sort of thing? Realistic, I'm all about balance realistic.

Gwyn  14:59  
What should people be looking for if they are thinking that this might be something that they are struggling with?

Melissa Groves Azzaro 15:02  
Gotta find a doctor who's willing to work with you and willing to do the tests to find out if you do have PCOS in the first place, and then looking into some of those tests that can help us identify maybe which of those root causes are problems for you. So someone who comes to see me I'm doing thorough insulin testing, you know, I'm looking at blood sugar and insulin in detail. I'm running some systemic inflammation markers to see if there is systemic inflammation. If we do see inflammation, it just tells us it's there. It doesn't tell us what's causing it. So that often can require a little detective work. Sometimes it's got issues that are causing the inflammation. Sometimes it's just PCOS itself causes inflammation. Excess body fat causes inflammation. So it's really it's all kind of a vicious cycle with the inflammation and PCOS. You know, really good medical history working with someone, I would say probably the things I tend to see most often are IBS, which is, of course, a very amorphous diagnosis. It just means you don't have IBD, which is Crohn's or colitis, and you don't have celiac, but clearly you have gut symptoms. So we're going to tell you, you have IBS. Other gut stuff, a lot of GERD reflex that can happen, constipation, loose stools, really kind of all over the place with that. Constipation makes hormone imbalances worse, because it allows hormones to recirculate in a more toxic form. So we always want to make sure we address that. Gallbladder issues, I see a lot of gallbladder issues with PCOS, too. And then the hormone stuff really, I personally think that conventional medicine fails us when it comes to hormone testing. It's not very thorough, we don't get very good information from it. We don't know why the hormones are imbalanced. So I'm using very thorough functional hormone testing to see not only what your hormone levels are, but what's happening to them after you make them. Where are they going, you know, doing like 24 hour cortisol testing too and seeing what your pattern looks like. You know, a lot of people want to want to jump to the specifics and know well what type of exercise should I do and what time of day should I exercise and like I need to see what your cortisol looks like before I can even begin to suggest that to you. But yeah, when it comes to the sexy fun stuff, I feel like one of the most unfair things about PCOS it's like bad enough that you have this condition that affects your reproductive health and your metabolic health. But a lot of the symptoms of PCOS are cosmetic, you know, acne, hair loss, facial hair, spotty hair, that dark ring that you talked about that acanthosis nigricans that can happen from insulin resistance, weight, you know, tend to put weight on and in the middle area of your body which is like, well, that's not great. I've had a lot of clients tell me they feel like less of a woman when they have PCOS. And you know, there's there's the relationship aspect of it too, where if you're planning on building a life with someone, you kind of have to have that conversation kind of early in the relationship like hey, I don't I don't know how easy it is for me to have kids or not. It definitely requires a supportive partner who loves you for you and like doesn't care if you have children or not, or recognizes that it might be difficult to do so. So yeah, it really can impact things when it comes to relationship and sexual health. You know, and depending on what the hormone levels are too may impact libido, sex drive. Classically androgen spike right before ovulation, which helps put you in the mood right when you're at your most fertile time. It really kind of goes either way with PCOS. Some people do have feel like they have higher sex drive, you know, all month long others they have more adrenal involvement or something like that. They may have lower sex drive, you know, also fatigue is big with PCOS, so you just don't have energy sometimes. Yeah, it's really, really complicated when it comes to relationships.

Gwyn Isaacs  19:47  
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Gwyn  21:29
You mentioned testing? Are you running blood tests and other lab work?

Melissa Groves Azzaro  21:33  
Yes, for the hormone tests that I use, I use urine hormone tests. It's just easier to do because we're looking at four different points during the day. What else am I using, I'll do stool testing for gut issues. If I suspect something, you know, really not good going on in there. There's a lot we can do to address gut health just through diet and lifestyle. But if my sort of like go to tips, like chew your food well and slow down and then don't eat when you're stressed, if that doesn't really seem to make a difference and gut symptoms that I might suspect, you know, you have an imbalance in something going on. And one of the most common causes are reasons why our gut microbiome can get thrown off is if you've ever taken antibiotics at all, which most of us have. I mean, I know so many, so many people who had chronic sinus or ear or throat infections as a kid. And it's like, well, antibiotics are a wonder when it comes to keeping us alive through childhood these days. Like it's modern technology at its greatest, but it does really negatively impact your gut microbiome. So a lot of us can use some extra extra help there. It sort of gives the bad guys an opportunity to come in and take over.

Gwyn  22:57  
So when someone comes to you, what's the first thing that you do?

Melissa Groves Azzaro  23:01  
Yeah, I go through their whole history. I want to know when they got their first period. I want to know when they got diagnosed with PCOS, I want to know what the symptoms were that drove them to be diagnosed with PCOS. I kind of see two categories when it comes to diagnosis. I see a lot of women who went on the pill in their teens, got married, went off the pill, decided that time to start trying for a family went off the pill. And all the symptoms cropped up and their cycles were irregular. And you know, that sort of leads them down the fertility diagnosis path, and that's when they're getting diagnosed. So early to mid 30s is probably the most typical I see for that category. But lately, and I really think this gives me hope, I'm seeing a lot of young women diagnosed around 14 to 16. And they think it's because moms who are my and your age are very on top of hormones and hormone imbalances. And the second that something's wrong. They're marching into the doctor's office asking for testing. And a lot of it comes from we don't want them to have to go through everything that we went through, you know, we want it to be easier for them. And so we're just very proactive. So I am seeing a lot of younger women diagnosed with PCOS. I think it's hopeful because it's like, oh, we can start working on this stuff. But definitely if someone went on the pill early, I want to know why because most likely it was for acne or irregular cycles or heavy bleeding. And so all the time you were on the pill. It was just masking what was there all along. It's not like you've suddenly developed PCOS in your 30s, it was there all along

Gwyn  24:54  
My son is a trans man. How does PCOS affect folks who are taking testosterone?

Melissa Groves Azzaro  25:01  
Ya. It's a big question mark? You know, there's there's not really any studies on it, I would assume it would make the androgen symptoms worse. Let's say if you already had high androgens and now you're taking exogenous androgens on top of that. But some of those things that are perceived as negatives, I would say, in in female presenting people like facial hair, the bigger muscles are more desired in trans people. Those are the reasons why you're taking the exogenous androgens in the first place. So I think it is a big question mark in terms of the risks though. Because of the increased heart disease risk and the increase diabetes risk. High androgens make us make more insulin. So if insulin resistance is already a problem, adding androgens that might make it worse, you know, I would say that would take a practitioner who's very well schooled in the effects of hormone therapy and monitoring for those risks along the way.

Gwyn  26:16  
Oh, good. Another reason to worry about my kid.

Melissa Groves Azzaro  26:19  
I know, it's tough. It's not like reason enough to worry about your kid. But you know, you're you're one of those mamas. So you'll stay on top of it and make sure that all those all those cardiovascular markers are checked, and all the blood sugar markers are checked to make sure things are are okay. And I mean, it's one of those we don't know.

Gwyn  26:40  
We know. Yeah, definitely. I'm concerned.

Melissa Groves Azzaro  26:43  
So yeah, yeah, I would I would be just because the I mean, that's a risk for anyone PCOS or not to be taking hormones, you know, that comes with risks. But 

Gwyn  26:55  
Yeah, but he's his own person and I don't make those choices. So

Melissa Groves Azzaro  26:58  
I know what's the other side of that not getting to be who you are, right? Not an option. So sometimes, and that's why it's so difficult, because it's up to every person. That really is my approach when it comes to treating PCOS. Like I don't treat it as a condition. It's not like, you have this that means you have to eat like this, you have to take these supplements, you have to do this kind of exercise, because so much of your own preferences and goals have to play into that. And I think that's sort of a another misperception is this idea that evidence based medicine is just what's been published in randomized clinical trials. But it is not. It's a combination of the best available evidence. So may or may not be those gold standard, randomized controlled trials, clinical judgment, and the patient's preferences and goals. You have to start with, what do you want? And what are your goals and preferences and culture and access and all of the things that we have to take into account when working with people? Because we're, we're people, we're all different. You know.

Gwyn  28:13  
That was actually what I was going to ask next is, what does it look like when someone is managing this, when it's under control?

Melissa Groves Azzaro  28:22
Yeah, the magical thing is, you actually can manage your symptoms. And I hate that all that marketing around reverse your PCOS or cure your PCOS, because there's no such thing. You can't reverse it, you can't get rid of it. I like to think of it like the tendency is always still there. So you know, you may be doing things and your PCOS is managed. But if you were to stop that, the symptoms would just come back. But what's what's really kind of cool is you could clinically reverse it through nutrition and lifestyle changes. So if you're managing your blood sugar, you're lowering your inflammation, you're working on your gut health, all of a sudden, your cycles have gone from 90 days down to 30 days. So your cycles are regular now. Maybe your androgens are coming down into the within normal range. Maybe your cysts have started to shrink and reabsorb and they aren't there anymore. So if you were to walk into a doctor's office at that point, you wouldn't receive a PCOS diagnosis because you don't meet the criteria. But it just means you're you're managing it well and you're not struggling with the symptoms. But yeah, I see really good results with kind of simple nutrition and lifestyle changes. You don't have to eat in a way that's restrictive. You don't have to spend hours in the gym. It's really really small changes. So you know, I had mentioned the foundation for everyone is blood sugar balance, we start there and what that means it doesn't mean intermittent fasting, doesn't mean go keto, or cut out sugar entirely that's just not realistic or sustainable. What it does mean is being mindful of your carb choices and quantities, and making sure to pair your carbs with protein, fat and fiber so that it, you know, slows their impact on your blood sugar. Huge fan of treats. I love to have my dark chocolate peanut butter cups after lunch, you know you have a treat, keep it with your balanced meal, because it's not going to spike your blood sugar the same way as it would if you were to eat a treat on an empty stomach. So it doesn't really have to be that hard. We focus on adding the protein so animal protein or soy, legumes, adding the fiber fruits, veggies, legumes, nuts again, and then adding fat healthy fats like avocados, olives, things like that to our diet, just to lessen the impacts of the carbs on our bloodstream.

Gwyn  31:06  
You also mentioned household lifestyle, plastics, and beauty products. And I had not heard this before. Can you talk a little bit more about that?

Melissa Groves Azzaro  31:17  
Yeah, the environmental toxins key is you know, we don't really know what causes PCOS, we think it's a combination of triggers. One of the potential triggers being exposure in utero to various substances, you know, we have genes that get turned on and off depending on environment. And hormone disruptors are chemicals that are found in our environment that can either act like hormones in our body or interfere with the action of hormones in our body. We do know that BPA, which is the chemical found in plastic has been found in higher levels in people with PCOS than people without PCOS. There are other hormones that can act like androgens in the body as well, which can obviously worsen symptoms being driven by high androgens. So it's, again, much like everything in my approach. It's about being realistic about what you can do and not trying to control everything. But there's some really easy swaps we can make, like, just completely eliminating plastic from our kitchens as best as we possibly can. And what I mean by that is don't put wet or hot foods into plastic, because that will leach the chemicals in the plastic. I once posted in my Instagram stories, I had a ziploc baggie that had pretzels in it, you would not believe the outcry that I got in my DMs about how I was poisoning with and it's like, well, they're they're dry, you know, there's very little chance that I'm leaching, you know, and I do use my plastic bags, but as much as you can. And I also don't freak out about stuff I've had people really take it to the extremes and say, Well, what about yogurt, you know, you buy yogurt in those plastic containers, is that safe or not? And it's like well, I rarely see yogurt and glass containers. So I'd rather you you eat yogurt than avoid it because of the plastic but really like my my cardinal rule is never heat food in plastic. So if something comes in a little plastic tray, I will transfer that to a plate and microwave that instead. And then when it comes to the health and beauty stuff, I really prioritize anything that goes on the skin so anything that can be absorbed into the skin and it can take years to make that shift so the more natural product still have not I'm not going to make the shift I'm not even like I'm going to I just haven't done yet. I'm not going to shift to natural hair color like I'm not like it's sorry. Yeah, so again, it's really it's up to the person what they're willing and able to do and what's a priority for them and what's not. I swore I would never ever I mean I tried about 10 different natural mascaras and I was just like they they all suck like I'm not they all are terrible. Finally I did find one so like yay I found a natural mascara but it's like your eyelashes are dead you know it's not like you're absorbing through your eyelashes so wasn't a huge priority for me for a long time. Menstrual products I do prioritize because you are putting some of those up one of the most absorbent mucous membranes of your All righty. So, definitely making sure I'm not putting any endocrine disrupters up there.

Gwyn  35:07
Oh, that's really interesting. So like the Diva Cup or other cups,

Melissa Groves Azzaro  35:10  
Cups are great, the silicone cups are totally fine. It's another thing. I think that the youth are really much more open to trying these alternative period products that are much less toxic, period panties and the cup and all of that is better than a bleached tampon for fragrance filled maxi pads that we grew up with.

Gwyn  35:38  
Yeah, those are just awful. I've never been able to wrap my head around that. Okay. You also mentioned polyps and fibroids. Let's just start with what are they? And is there a difference between them? And that versus a cyst?

Melissa Groves Azzaro  35:55 
Yeah, so polyps are on the inside lining of the uterus. So you know, every month you build up a new lining, and then you shed it. When you have your period. Polyps are kind of pieces of that lining that kind of juts out into the center of the uterus. Fibroids are really in the wall of the uterus, and then adenomyosis is actually deeper into the muscle of the uterus. And then endometriosis is the other kind of growth condition. And it's uterine like tissue that grows outside of the uterus, so sort of anywhere in your peritoneal cavity, you know, can I've had people have it all the way up to their diaphragm and all the way down to their sciatic nerve, so it can really kind of take hold anywhere. The thing that they all have in common, although you know, there's endometriosis seems to have an immune component to it as well. There's inflammation involved with some of them. But estrogen makes them grow, they have estrogen receptors on them, so estrogen makes them grow. So I don't always see them. I I always tell people with PCOS, just because you've been diagnosed with PCOS doesn't mean you don't also have other hormone imbalances. So you could have estrogen issues on top of PCOS. But not everybody does. Not everybody with PCOS has high estrogen. It's really kind of either or. But yeah, that's, that's usually what drives it to grow. Some of them may or may not be a problem, like you could live with fibroids and polyps, and they may never bother you. They start to become a problem when you're trying to conceive, because there's less surface area in in the uterus for the embryo to implant. They also can start to become a problem if they're causing heavy bleeding, or they're causing sort of constant bleeding throughout the month. And then that can lead to anemia and feeling tired, and some of them can cause a considerable amount of pain. Again, you can have any of these and not really know it or be bothered by it.

Gwyn  38:22  
And is that something that um that can also be addressed with nutrition?

Melissa Groves Azzaro  38:29  
Yeah, there's actually a lot we can do with nutrition to help estrogen. So we make three different types of estrogen. Nobody ever talks about that. And they only ever test for estradiol, but we make two other types of estrogen, estrone and estriol. And then once we make estrogen, we get rid of it down three detoxification or metabolism pathways. A lot of people don't like the word detox, but it's really estrogen metabolism. There's three pathways that it can go down, and only one of them is the good pathway. So only one of them is the good protective pathway. So there's actually a lot we can do to shift how our body gets rid of estrogen with nutrition, lifestyle, and some targeted supplements sometimes, depending on what's going on.

Gwyn  39:26  
This is amazing. I've learned so much. 

Melissa Groves Azzaro  39:29  
It's kind of mind blowing. Then, you know, we didn't really talk about this before, but I don't have PCOS. I do have really poor estrogen detoxification. Um which I, you know, have had painful, heavy, awful periods all my life until I discovered why. And then it was like, oh, well, this is why because none of my estrogens going down that good pathway. So I've been able to see that myself firsthand, how responsive If all of that is to the right foods and the right supplements,

Gwyn  40:04  
Amazing, I am completely blown away. There's so much here. I feel like I just have question after question. But we're getting close to the end of time. And I don't want to keep you here forever.

Melissa Groves Azzaro  40:16  
It's so fascinating. And it's it's sort of why I work in this area and not in a more general field of nutrition, because it's just we're complicated. The menstrual cycle is complicated. And that's the reason why women have been excluded from clinical trials for so so long until recent history, because it's just a variable they can't control for. And so they didn't study us. It's time to start looking at how does this work in this phase of your cycle? Or how does this work in that phase of your cycle? Traditionally, studies on diet have been done in men and postmenopausal women.

Gwyn  40:55  
That makes me so angry. 

Melissa Groves Azzaro  40:57  
I know. Well, now we need PCOS studies on trans men taking exogenous testosterone too. Like that is an area we need research in, you know, it is that makes you really angry. And that's part of why I do what I do. Because I'm so angry about the state of things. I'm just like, I can do better than this. Let me let me help.

Gwyn  41:20  
Ya. Well, thank you for that. And thank you for this, is there anything else that you want to share before we start wrapping it up?

Melissa Groves Azzaro  41:28  
First of all, when you're taking advice on nutrition and hormones, you want to look at where it's coming from, you want to make sure that it's coming from a reputable licensed, credentialed practitioner, I see a lot of quote unquote, hormone coaches out there, and it's so dangerous. You know, when I'm working with a client, we've talked about how I do the intake, and I'm looking at their other medical conditions, I'm looking at the medications they're on. And so I'm making sure that the recommendations that I make for them, are safe for them. And that's not something you're gonna get from a hormone influencer, who's telling everyone to take the same supplement. And the other thing I want to say as a few things, I want to saya few things, I want to say keep pushing. If you're not getting the answers you need from your doctor, keep pushing, find another doctor if that's a possibility for you, explore maybe outside of conventional medicine, working with functional practitioners who are going to be more willing to do the deeper digging, if that's a possibility for you. And then the last thing I want to say is really, it doesn't have to be so hard. We feel like we're accomplishing something when we're following a very strict diet, or we're implementing this exercise regimen that's really difficult and extreme, but it doesn't have to be that hard. It's really just regular balanced meals, making sure we're getting enough sleep on a regular schedule, moving our bodies enough, but not too much. And then really managing stress. That's the hard part. I think it's it's the hardest part to do, but it is possible and there are changes you can make and boundaries you can implement to make sure that your stress is being managed.

Gwyn  43:22  
Boundaries are key. Melissa Groves Azzaro. Thank you so much for being here with me. I have one last question. What excites you?

Melissa Groves Azzaro  43:32  
Its gonna sound so dorky but, you know, recently moving to Western New Hampshire and having a yard for the first time in my life. Yesterday, I went to a farm down in Vermont and I bought three blueberry bushes, a blackberry bush and a golden raspberry bush and so I'm currently super excited to get those going. I think you know, we share a love for food and good food and I've really been enjoying you know, in whatever small part I can grow my own food and eat food that that I grew has been really exciting to me maybe

Gwyn  44:10  
Not at all dorky that is delightful. Golden raspberries are delicious. I absolutely adore them. And my partner's property has a whole ton of high blueberry bushes. So I'm right there with you. So yippee. This has been wonderful. I truly appreciate it. I've learned so much like I'm going to keep learning as I edit this episode. And I'm absolutely going to subscribe to your podcast. Speaking of which, tell us again how to find you.

Melissa Groves Azzaro  44:44  
Yeah, so my website is thehormonedietitian.com It's Dietitian with a 't' not a 'c'. My Instagram is the same it's the dot hormone dot dietitian. And I'm posting there daily on you know all things hormones. So that's a great place to kind of go through the archives and pick up little tidbits there. And then my podcast is Hormonally Yours with the Hormone Dietitian, and it is available anywhere you listen to podcasts.

Gwyn  45:17  
I did indeed learn so much while working on this episode. Aren't bodies amazing? So many ways that they support us and learning about what we can do to support them to support us is so helpful. Be sure to reach out to Melissa at the hormonedietitian.com where she does group learning and one on one work. And she has a few spots open in her PCOS answers program that's happening now. She won't be running that again until September and the prices will be going up between now and then. So if you're interested, check it out. The hormonedietitian.com

And if you enjoyed this episode, please tell a friend and be sure you're subscribed. What Excites Us! is produced, edited and hosted by me, Gwyn Isaacs. All music is used under the Creative Commons Attribution license. And this week that includes The Vendetta by Steven Kartenberg, Harmony by PolyPlus. And this is The Magnificent Woman by Julius H. Tickle.life hosts the podcast and many others and they have lots of other great sex and sexuality content too. Thanks so much for listening!