How Hormones Affect Women's Health: From Puberty to Menopause | Dr. Gillian Goddard

Practical Nontoxic Living™ Podcast · Episode 139 · Hosted by Sophia Ruan Gushée

Can you be experiencing hormonal changes associated with perimenopause even if your periods are still regular?

According to endocrinologist Dr. Gillian Goddard, yes. And this is just one of the misunderstandings about women's hormones that she wants to help clear up.

From puberty and fertility to pregnancy, postpartum, perimenopause, and menopause, our hormones influence far more than reproduction. They interact with our brains, thyroid, immune system, metabolism, cardiovascular system, and stress response.

In Episode 139 of Practical Nontoxic Living™, Sophia Ruan Gushée speaks with Dr. Gillian Goddard, a board-certified endocrinologist, adjunct assistant professor of medicine at NYU Grossman School of Medicine, and author of The Hormone Loop, about how women's hormonal systems work across a lifetime—and why trying to “balance your hormones” may be the wrong goal.

The conversation also explores endocrine-disrupting chemicals, everyday habits that support hormonal health, and what Dr. Goddard changed in her own life after researching her book, The Hormone Loop.

What You'll Learn About Women's Hormones

• Fertility and conception: Ovulation timing, stopping birth control pills, and realistic expectations about conception.
• Puberty and adolescence: Heavy or painful periods, changing sleep schedules, and when symptoms warrant medical attention.
• Pregnancy and postpartum: The placenta as an endocrine organ, dramatic hormone changes after delivery, and possible effects on mood, sleep, and immunity.
• Perimenopause and menopause: Why symptoms may begin while periods remain regular, and how changing estrogen levels relate to cardiovascular health.
• Thyroid and immune health: The thyroid's role throughout the body and why autoimmune thyroid conditions are more common in women.
• Endocrine-disrupting chemicals: What research suggests about prenatal exposure to phthalates and phenols, and where uncertainty remains.
• Daily habits: Sleep, exercise, nutrition, stress management, and Dr. Goddard's perspective on supplements.

Do You Really Need to Balance Your Hormones?

One of Dr. Goddard's central messages challenges a popular wellness assumption: Our hormones are generally very good at regulating themselves. She explains four major feedback systems—the reproductive, thyroid, growth hormone, and adrenal loops—and how they respond to changes within our bodies and environments.

Understanding these systems can help distinguish expected physiological changes from symptoms that deserve professional evaluation, rather than assuming every fluctuation requires a supplement or protocol.

Listen to or Watch Episode 139

Listen to the full conversation with Dr. Gillian Goddard:

 

Or watch the video interview:

 

Episode Chapters

Use these timestamps to navigate the transcript. 

1. 00:02:54 — Why Dr. Goddard Wrote The Hormone Loop
2. 00:04:28 — How the Four Hormone Feedback Loops Work
3. 00:09:22 — Fertility, Ovulation, and Birth Control
4. 00:15:56 — Heavy Periods and Teenage Hormonal Changes
5. 00:20:34 — Pregnancy and Postpartum Hormones
6. 00:27:52 — Perimenopause, Menopause, and Heart Health
7. 00:32:43 — Thyroid Hormones and Autoimmune Conditions
8. 00:34:58 — Endocrine-Disrupting Chemicals and Fetal Development
9. 00:42:50 — Cortisol and Chronic Stress
10. 00:48:34 — Sleep, Exercise, and Hormonal Health
11. 00:51:18 — Supplements and Dr. Goddard’s Daily Habits
12. 00:56:38 — Hormones, Longevity, and Healthspan
13. 01:00:42 — How to Prepare for Doctor’s Appointments

Full Podcast Transcript

Sophia Ruan Gushée in conversation with Dr. Gillian Goddard

Edited from the final published episode captions for readability. Timestamps correspond to the published episode. Minor punctuation and paragraph formatting changes have been made; consult the recording for exact wording.

[00:00:00] Sophia Ruan Gushée: A woman tells her doctor something doesn't feel right. She thinks maybe she's in perimenopause. The doctor asks one question: "Are your periods regular?" She says yes, and that ends the conversation. Maybe that's happened to you or someone you know. It's happened to a lot of people I know. And our guest in this episode, Dr. Gillian Goddard, that women arrive in her office all the time with that same experience, And she says it's the wrong question.

[00:00:32] Sophia Ruan Gushée: Because there's a stage that most of us have never heard of where your periods are still regular and your hormones are already doing something new. Gillian is a board-certified endocrinologist and adjunct assistant professor of medicine at NYU Grossman School of Medicine, with more than 15 years in practice. She writes for Emily Oster's ParentData, and she's the author of The Hormone Loop. I spent nearly 20 years studying how endocrine-disrupting chemicals influence our hormones, and I had never heard something that Gillian said in this conversation, which is that our hormones are very good at balancing themselves.

[00:01:16] Sophia Ruan Gushée: And when they aren't, most of what gets sold to us for balancing our hormones won't do the job anyway. Which left me wondering, if balancing your hormones isn't the right goal, then what should it be? Gillian has an answer. It isn't a supplement. It isn't a protocol. It's one thing. It's free. We should all be doing it, and most of us aren't getting enough of it.

[00:01:40] Sophia Ruan Gushée: We also talk about what our hormones have to do with how long and how well we live. So let's dive in and explore how we should be thinking about our hormones with Dr. Gillian Goddard. And to follow how this conversation is changing my life, you can follow me on Substack at Ruan Living. The link will be in the podcast show notes, along with links to Dr. Gillian Goddard's book and her private practice.

[00:02:15] Sophia Ruan Gushée: Before we begin, a quick reminder: This conversation is for educational purposes only, not personal medical advice. Please consult a qualified healthcare professional before making decisions about your health. So, Dr. Goddard, what a pleasure it's been to get to know you and your work. I've been listening to your interviews with others and learning more about The Hormone Loop. And I was curious. You've been an endocrinologist with about 15 years of clinical experience, correct?

[00:02:51] Dr. Gillian Goddard: Yeah, that's — yeah, about, thereabouts.

Why Dr. Goddard Wrote The Hormone Loop

[00:02:54] Sophia Ruan Gushée: So I was wondering, what about your experience led you to eventually publish The Hormone Loop? What were you seeing in women and experiencing that made you want to write this book?

[00:03:06] Dr. Gillian Goddard: Yeah, so I think the biggest thing is, well, there has been sort of an explosion in conversation about women's hormonal health around perimenopause and menopause. We are still talking about women's hormonal health in this sort of really siloed way. It's like we talk about puberty, and we talk about pregnancy, and we talk about perimenopause. But actually, though, each of those processes has a lot of parallels with the others.

[00:03:36] Dr. Gillian Goddard: And so we can learn a lot from understanding where we've been as we're sort of headed into perimenopause and menopause if we kind of connect the dots from each different stage. And so that was one thing. The other thing is that the conversation has been focused on just a couple of different hormones: estrogen, progesterone, maybe testosterone in someone who's sort of very forward-thinking.

[00:04:04] Dr. Gillian Goddard: Actually, we have dozens of hormones, and they all interact with one another. So estrogen is interacting with thyroid hormone and cortisol and insulin. And so when we view these hormones sort of in isolation, we're not getting the full picture. And when we don't get the full picture, we can't always advocate well for ourselves.

How the Four Hormone Feedback Loops Work

[00:04:28] Sophia Ruan Gushée: So where does the name The Hormone Loop come from?

[00:04:32] Dr. Gillian Goddard: So, The Hormone Loop, it actually describes the feedback mechanism by which our hormone levels are regulated, particularly the four main loops: so the reproductive loop, the thyroid loop, the growth hormone loop, and the cortisol loop. Each of those loops is a feedback loop where one gland tells another gland to do something, tells another gland to do something, and then that end hormone feeds back to the beginning to help keep everything in balance.

[00:05:05] Dr. Gillian Goddard: I think one of the big myths out there is that we all need to be working really hard to keep our hormones optimally balanced. Actually, our hormones are pretty good at keeping themselves balanced for the most part. When they're not keeping themselves balanced, the things that are recommended for hormone balancing are not necessarily going to get the job done. At that point, you usually need an expert.

[00:05:32] Dr. Gillian Goddard: So I think it's helpful to understand how the system works and how it really does sort of turn itself up and down depending on our environment.

[00:05:42] Sophia Ruan Gushée: I'd love to hear more about each of the four loops, and the average female to understand about the reproductive loop, the thyroid loop, the growth hormone loop, and the adrenaline. Yeah, adrenal loop. Exactly.

[00:05:59] Dr. Gillian Goddard: So the reproductive loop is the one that people are most familiar with, right? It's the one that we experience every month as we're having cycles. It is the loop that drives ovulation. It's the loop that drives our menstrual cycles. I think that's often the loop that people are most familiar with as far as function goes. What I think people misunderstand is that it's sort of like you go through puberty, and then the loop stays the same from when you're like 18 to 45, and then you go through perimenopause and menopause.

[00:06:32] Dr. Gillian Goddard: That's not exactly right. The reproductive loop is sort of shifting and changing at various times all along the way, and there's not these hard cutoffs between one stage and another. It's really, those hard cutoffs are really imposed by the scientific community to help us research, which is important, but it doesn't really describe a woman's experience accurately. So I think that's the most important thing about the reproductive loop.

[00:07:02] Dr. Gillian Goddard: I always think of the thyroid loop as being like the gas pedal for the body. So if you press on the gas pedal, if you increase thyroid hormone, it speeds up body processes. It speeds up our metabolism, our heart rate, how quickly we talk. When people have too much thyroid hormone, they actually talk very quickly. It affects the speed of all different kinds of body systems, our gastrointestinal system.

[00:07:30] Dr. Gillian Goddard: If we let off the gas pedal, if we don't have enough thyroid hormone, everything slows down. So the metabolism slows down. Even skin turnover slows down when people don't have enough thyroid hormone. People get dry eyes because they don't make enough lubricant. So really, all these body processes become sort of sluggish. And so really, what we want is to be in the middle, where body processes are humming along at a pace that it feels good and comfortable to us.

[00:08:02] Dr. Gillian Goddard: The biggest thing that's funny about the growth hormone loop is that it's much more important in childhood, and all these other loops tend to come into play more when we're adults. From the age of about three all the way through puberty, the growth hormone loop is in charge. And we can see this in our kids when it seems like they go to bed one size and wake up bigger the next morning.

[00:08:25] Dr. Gillian Goddard: It's because they literally grow overnight. It's not our imagination. And then the adrenal loop is one that people talk about a lot colloquially, but it's not one that people necessarily have a really good understanding of. The most important thing to know about the adrenal loop is that we need cortisol, the stress hormone, to be alive. And actually, our cortisol levels fluctuate over the course of a day to help maintain our circadian rhythms.

[00:08:53] Dr. Gillian Goddard: And so chronic stress can, you know, physical or emotional chronic stress, can affect that diurnal variation. We don't want to get rid of cortisol. Cortisol is critically important to our day-to-day functioning. I'd love to go back to each of them with at least one question, but there are more for the reproductive hormone loop. There always are.

Fertility, Ovulation, and Birth Control

[00:09:22] Sophia Ruan Gushée: Well, I feel like it's so valuable for, especially females, to understand the role of hormones from prenatally, or even before preconception. So thinking of females who look forward to becoming a mom someday, what would you like them to know?

[00:09:44] Dr. Gillian Goddard: I think the biggest thing is that understanding your menstrual cycle and how the menstrual cycle works is sort of critical to knowing how to time intercourse to successfully get pregnant. One of the things that's confusing is people think of ovulation as being a mid-cycle phenomenon, and that is true if you have a 28-day menstrual cycle. But a normal menstrual cycle can be anything from 21 to 35 days in length.

[00:10:15] Dr. Gillian Goddard: And the part of your menstrual cycle that changes in length if you have a shorter or longer cycle is actually the part before ovulation. So most women ovulate 12 to 14 days before their menstrual cycle begins. And so knowing how long your menstrual cycle is and counting back that 12 to 14 days helps you get a better sense of when exactly you are ovulating to time conception.

[00:10:44] Dr. Gillian Goddard: The other thing to know is that in any given month, there's really only about a 20% chance that a person will get— that a woman will conceive. If you think about that, that means that most people will have conceived over the course of six to nine months if they are healthy. And so that's kind of— it's this idea that even if we do everything right, we may not conceive in a given month.

[00:11:15] Dr. Gillian Goddard: We still are less likely to conceive than we are to conceive. And so I think that that's important too. Because I don't know about you, but when I wanted to become pregnant, it felt like I wanted to be pregnant, like, yesterday. It was like, I don't want to be pregnant. I don't want to be pregnant. Now I want to be pregnant. I'd like to be pregnant today.

[00:11:34] Dr. Gillian Goddard: And unfortunately, our bodies just aren't set up to be like that. And so sometimes we have to be—

[00:11:39] Sophia Ruan Gushée: And it didn't even occur to me that it wouldn't happen right away.

[00:11:42] Dr. Gillian Goddard: Exactly, exactly. And I think that that's so common, and it doesn't necessarily mean something's wrong. So I usually tell women, as long as your periods are regular, give it six months. Or unless you're over the age of 35, also give it six months. See how things go. And if after six months you're still not pregnant, have a conversation with your gynecologist or obstetrician and start thinking about troubleshooting.

[00:12:11] Dr. Gillian Goddard: But until you kind of get to that six-month mark, if you're having regular periods, it's not unusual to not be pregnant within that time period.

[00:12:22] Sophia Ruan Gushée: That's so helpful for women to manage their expectations. So don't panic if it's within six months of trying and your menstrual cycles are normal. But before even trying, let's say a woman just got engaged and she and her partner look forward to having children someday, and she's been on birth control since she was a teenager. What would you like her to know about birth control and fertility?

[00:12:51] Dr. Gillian Goddard: Absolutely. So a lot of times, in this case, we're talking about birth control pills. Different types of birth control will affect your planning for pregnancy a little bit differently. So the way birth control pills work in most cases is that they actually suppress the reproductive loop. They take— you are taking a pill that contains estrogen and progestin. And that estrogen and progestin tells your hypothalamus that there's enough estrogen and progesterone in your body, and it turns off from the hypothalamus down.

[00:13:28] Dr. Gillian Goddard: It turns off ovulation, and that's how it prevents pregnancy, which is super effective from a contraceptive point of view. But when you're suppressing the hypothalamus like that, it doesn't always happen that the minute you stop taking the birth control pill, ovulation resumes. So typically, we think about the longer you've been on a birth control pill, the longer it is likely to take for ovulation to resume.

[00:13:57] Dr. Gillian Goddard: And we expect that most people will have resumed having regular periods within nine months of stopping a birth control pill. Three months is a pretty common time period to take for women to get back their regular ovulation and regular cycles. That said, the tricky part is, is that some women will ovulate as soon as they stop taking a birth control pill. And so some of my patients who want to kind of really target a specific time period will stop their birth control pill to get their regular periods back before they plan to conceive and use a non-hormonal form of contraception in that intervening window while they're waiting for their regular cycle to resume, if it's important to them to sort of time conception as much as one possibly can

[00:14:52] Dr. Gillian Goddard: and they want to sort of make sure that they get those regular cycles back. And that can be a good way to think about it. I also tell women that if you don't get your period back within three months of stopping a birth control pill, that's the point at which it would be reasonable to go to your doctor and start talking about if there's something else going on that needs to be addressed.

[00:15:15] Dr. Gillian Goddard: I've had patients who, you know, started birth control pills maybe for, like, really heavy periods when they were teenagers. And then, you know, in their early 30s, they're married, they're ready to try to conceive, and they've been on a birth control pill all this time. And when they get off the birth control pill, it turns out that those heavy periods were part of something like polycystic ovarian syndrome, or what we now call polyendocrine metabolic ovarian syndrome, or PMOS, that just never got diagnosed because the symptoms were being treated by the birth control pills.

[00:15:51] Dr. Gillian Goddard: So we want to be proactive about addressing those types of issues.

Heavy Periods and Teenage Hormonal Changes

[00:15:56] Sophia Ruan Gushée: I'd love to hear more about heavy periods. Should that be something to investigate further, or can that be totally normal?

[00:16:05] Dr. Gillian Goddard: It's funny. When we talk about what is normal as far as period flow is concerned, it's hugely variable from one woman to the next. And I think that the time that this is most confusing and can be most difficult to manage is in teens and adolescents who are just — who are maybe just getting their period. They don't have any frame of reference for what is considered normal.

[00:16:32] Dr. Gillian Goddard: So there is no amount of bleeding that's considered too light. You can't have too light a period. If you have even sort of like spotting for a day, and that's your normal, your normal menstrual cycle, that can be completely normal. When we say a period is too heavy, what we're looking for is really, is the period bleeding or period symptoms, are they negatively impacting your day-to-day functioning?

[00:17:02] Dr. Gillian Goddard: So if your period is keeping you sort of chained to home and chained to your bathroom, that is far too heavy. The other thing that I always think of is, is your period causing you to be anemic? The number of women who come in my office and are like — and I'll say something about anemia, and they'll be like, "Oh, well, yeah, I have heavy periods. I'm always anemic."

[00:17:26] Dr. Gillian Goddard: And I'm like, why are we not addressing this? This isn't a situation that you need to live with. Being anemic can make women feel really crummy. And so I think that we probably don't do a good enough job addressing women's heavy periods. Heavy periods can be from a number of different things. It may be, especially in certain times of our reproductive lives, around puberty, after pregnancy, and in perimenopause.

[00:17:57] Dr. Gillian Goddard: It can be sort of because of the normal hormonal fluctuations that occur in those times. But it can also be, you know, hypothyroidism can cause really heavy periods. Some sort of relatively benign mutations in blood clotting can cause heavy periods. So it's always worth looking into and addressing.

[00:18:20] Sophia Ruan Gushée: Going back to birth control pills, if your daughter was thinking about starting them, do you have any concerns or advice?

[00:18:29] Dr. Gillian Goddard: I think the biggest concern with adolescence — so I have a 15-year-old daughter — my biggest concern in adolescence is making sure that she has the ability to be very regular with taking a pill. One of the biggest problems with birth control pills, if they're not taken really kind of at the same time every single day, is that you can get a lot of spotting and breakthrough bleeding.

[00:18:59] Dr. Gillian Goddard: And anyone who's had an adolescent in their house knows that at different times, their schedule and sleep schedule can change dramatically. My daughter is basically nocturnal right now because it's August and school hasn't resumed in our neck of the woods yet.

[00:19:17] Sophia Ruan Gushée: I'm glad it's not just in my household.

[00:19:20] Dr. Gillian Goddard: No, it's not just in your house. It is a very real hormonal phenomenon that teens shift their sleep cycle significantly. They love to stay up late and sleep late. That is just naturally what their bodies do.

[00:19:34] Sophia Ruan Gushée: So from your perspective as an endocrinologist, that makes sense. I never knew that. Yeah. So with the changing hormones during teenage years, there are, like, biological clock shifts. -Absolutely.- So it's natural for them to be up later.

[00:19:50] Dr. Gillian Goddard: Absolutely, it is. And I think we give them the hardest time about this. I think there's this idea that they're, like, being lazy. That's absolutely not the case. But when we think about birth control pills, we do want to think about, like, if she's suddenly, you know, staying up till 2: 00 a. m. and getting up at 11, when is she taking her birth control pill so that she can be consistent with the timing of that pill?

[00:20:14] Dr. Gillian Goddard: Because otherwise, she could potentially have lots of breakthrough bleeding and that kind of thing. But I think it's — but beyond that, I think that birth control pills can be excellent tools for helping adolescent girls and young women manage what can be really debilitating heavy and painful periods.

Pregnancy and Postpartum Hormones

[00:20:34] Sophia Ruan Gushée: So revisiting the woman who just got engaged, she's been on birth control pills since she was, let's say, 15. And we've talked about important considerations to prepare for conception. Once pregnant, is there anything you'd want to say about the hormones changing during pregnancy and how that affects the woman?

[00:20:56] Dr. Gillian Goddard: Yes. So pregnancy hormones are amazing. When we get pregnant, we grow an entirely new endocrine organ. It's actually my favorite one. It's the placenta. The placenta completely takes over. It shuts down the reproductive loop and completely takes over making a number of different hormones. And the placenta just churns out hormones like no other gland does. It's really incredible. And those hormones change the body in a number of important ways.

[00:21:31] Dr. Gillian Goddard: So it stimulates the body to make more blood. We make about 40% more blood while we're pregnant. It stimulates the blood vessels to dilate to be able to deliver that blood to the placenta, to deliver nutrients to the baby. It changes how we process carbohydrates and sugar because it's, those carbohydrates that cross the placenta, to feed the baby, to give the baby the nutrients that it needs.

[00:21:59] Dr. Gillian Goddard: And it changes things like our ligaments, how our joints feel, to sort of prepare our pelvis for delivery. And so I actually think pregnancy is one of the most amazing things that women's bodies can do. I mean, having done it, I was pregnant four times, and you know, it always astounds me that it works as well as it does. It's an amazing process. So, yeah, the placenta is—

[00:22:30] Sophia Ruan Gushée: Is mommy brain related to hormones or lack of -Absolutely.- lower blood supply? Okay.

[00:22:37] Dr. Gillian Goddard: It's probably mostly related to the ways in which estrogen is affecting the brain. The highest levels of estrogen we will ever have is sort of in the weeks leading up to delivery and in the days just after delivery. And so it's not surprising that that changes how our brain functions because our brain is replete with estrogen receptors. And those estrogen receptors change our brain in all different kinds of ways that are fascinating.

[00:23:10] Dr. Gillian Goddard: We also know that during pregnancy, the brain shrinks a little bit. We don't know exactly why that is or what the purpose of that is, and we know that it actually rebounds pretty quickly after delivery. It's a temporary thing, but we're not quite sure why that happens.

[00:23:27] Sophia Ruan Gushée: And then what about after the baby is delivered? What happens to the woman's hormonal system and brain, if you have comments on-?

[00:23:36] Dr. Gillian Goddard: I'm still trying to understand it. -Buckle up because it's a crazy ride.- So as we approach delivery, we kind of meet a new hormone, prolactin. Prolactin does exactly what it sounds like it does. It prepares the breast to lactate, so it promotes lactation. And that hormone starts to rise. After we deliver the placenta, which has been churning out all of these hormones throughout our whole pregnancy, all those hormonal levels start to drop.

[00:24:11] Dr. Gillian Goddard: And our estrogen levels go from the highest they will ever be in our lives to virtually zero in the first six weeks after we deliver a baby. And the same thing happens with progesterone. And so we end up on this huge descent of hormone levels. This change probably has a number of different effects. So it's almost certainly responsible for the change in mood that so many women experience, whether that's just sort of the baby blues that get better on their own or more serious mood changes like postpartum depression and postpartum anxiety.

[00:24:52] Dr. Gillian Goddard: It affects our sleep. We can have hot flushes and night sweats like we have in perimenopause and menopause after delivering, as these hormones drop substantially. And it has a big effect on our immune system. And so it's really common for women, three to four months and beyond, to have a complete change in their immune system, to develop new autoimmune issues. We were talking about

[00:25:25] Sophia Ruan Gushée: estrogen and progesterone kind of going to zero, like six weeks after a baby is delivered, and the effects of that.

[00:25:33] Dr. Gillian Goddard: Yeah, that's exactly right. So with this big descent in estrogen and progesterone, it affects our mood. So this is probably responsible for women having the baby blues, sort of that mild depression that many women experience after pregnancy. And it's probably responsible for more significant or more serious mood changes like postpartum depression and postpartum anxiety, too. It can affect our sleep. It can also trigger symptoms like hot flashes and night sweats.

[00:26:11] Dr. Gillian Goddard: And our estrogen and progesterone levels dropping like that have a big effect on our immune system. Parts of our immune system are dialed up during pregnancy. Parts of our immune system are dialed down during pregnancy. When our hormone levels drop to zero like that, we see that the immune system kind of returns to its non-pregnant state. And when it does that, this is a time when a lot of women can develop new autoimmune disorders, new allergies, and skin changes like eczema.

[00:26:43] Sophia Ruan Gushée: I have melasma from pregnancy.

[00:26:46] Dr. Gillian Goddard: Mm-hmm.

[00:26:47] Sophia Ruan Gushée: Is there anything I can do hormonally to help clear that up? I don't understand why that — like, why does that happen? I think they call it the pregnancy mask.

[00:26:56] Dr. Gillian Goddard: It is. It's a direct effect of estrogen on the skin. It is more common in women of color, but all women can develop melasma. And it is really, the estrogen's effects on the skin cells increase the melanin content in the skin cells. The only real treatment for melasma is to remove the high estrogen, and then over time it will reverse. But it can be very frustrating to deal with.

[00:27:26] Dr. Gillian Goddard: You know, now there's all this interest in using estrogen face creams. One of the big downsides of using the estrogen face cream potentially is that it can cause melasma because you're applying the estrogen directly to the skin cells.

[00:27:42] Sophia Ruan Gushée: Okay. So since I have melasma, I should not be using that estrogen cream.

[00:27:46] Dr. Gillian Goddard: I would be very wary of estrogen skin cream if you've had a personal history of melasma.

Perimenopause, Menopause, and Heart Health

[00:27:52] Sophia Ruan Gushée: Moving on to later on in life, perimenopause and menopause, what would you like women to understand about the hormonal shifts during those phases?

[00:28:04] Dr. Gillian Goddard: Yeah, I think the biggest thing is that people think of perimenopause as this one big thing, and menopause is this one big thing, or they think about the whole process as being kind of all the same. But really, it's a series of stages that women go through over the course of, you know, 15 years potentially, or even more. It actually starts with this stage that I wish more women talked about and that I wish we educated women about more because it's a stage that causes a lot of confusion between women and their doctors.

[00:28:40] Dr. Gillian Goddard: So I see women all the time. They've gone to see their gynecologist. They go in and they say, "I'm having all these symptoms. I'm not really feeling all that great, and I think I have perimenopause." And their doctor asks them one question, and that one question is,"Are your periods regular?" And they say yes, and then their doctor says, "It's not perimenopause," and it completely closes down the conversation.

[00:29:06] Dr. Gillian Goddard: In many cases, what those women are experiencing is the signs and symptoms of a stage that occurs sort of between our peak reproductive years and perimenopause called the late reproductive stage. And in this stage, we're still having regular periods, but it's taking more hormones to get the last eggs in our ovaries to ovulate. And so our estrogen levels are still rising and falling the same way they have throughout our menstrual cycles throughout our lives, but they're rising higher and they're dropping lower.

[00:29:43] Dr. Gillian Goddard: And so during the late reproductive stage, women can start to have symptoms like heavier periods, more closely spaced periods. They can have lots more symptoms like PMS symptoms or even get a new diagnosis of PMDD, or premenstrual dysphoric disorder. Because these hormones are rising and falling so much more, it can really create havoc on our moods. Some women will even have hot flushes and night sweats, especially around the times in their cycle where estrogen levels are low, like ovulation and just before they start their period.

[00:30:20] Dr. Gillian Goddard: There are things we can do to treat symptoms in the late reproductive stage, in perimenopause, and in menopause. And so the thing I hate to see the most is when I see someone suffering unnecessarily.

[00:30:35] Sophia Ruan Gushée: Would you talk more about how the changing hormones during menopause affect some major organs, like the heart? We talked a little bit about the brain, but also the heart, because I definitely have noticed cardiovascular changes.

[00:30:51] Dr. Gillian Goddard: Cardiovascular changes are quite common. Estrogen is very protective in the arteries. So the lining of the arteries is very much affected by inflammation, circulating cells from the immune system that cause inflammation in the lining of the arteries. And estrogen really protects our arteries against that inflammation. What can happen after, you know, when our estrogen levels are spending more time low is that it allows that inflammation to start to take hold, and it can start us down the path toward building cholesterol plaques in the arteries, which can lead to blockages and cardiovascular disease.

[00:31:35] Dr. Gillian Goddard: But there's other ways in which estrogen affects our cardiovascular disease, too. Estrogen helps keep cholesterol low, and particularly low-density lipoprotein, or LDL cholesterol, which is the cholesterol that we think of as being responsible for forming the plaques in the arteries. And so when estrogen levels drop, a lot of women will see their LDL cholesterols rise. They often come in saying, "But I don't eat any cholesterol."

[00:32:03] Dr. Gillian Goddard: And it's not a function of the cholesterol in your diet. It's a combination of your genetics and the drop in estrogen that occurs around perimenopause. And the other thing that happens is that estrogen dilates blood vessels. We talked about this in pregnancy, how estrogen and progesterone keep the blood vessels really dilated so that the blood can get to the placenta. Well, estrogen is always helping the blood vessels dilate.

[00:32:30] Dr. Gillian Goddard: And so when estrogen levels fall, we can see blood pressure go up as well. And high cholesterol and high blood pressure are key sort of factors in the development of cardiovascular disease.

Thyroid Hormones and Autoimmune Conditions

[00:32:43] Sophia Ruan Gushée: Okay. So why don't we move on to the thyroid loop? How sensitive is it to what we eat, drink, how we sleep?

[00:32:55] Dr. Gillian Goddard: Yeah, the thyroid loop. We have thyroid hormone receptors everywhere. The thyroid loop touches every single one of our body systems. It controls our cognitive function, how focused we are. It controls how quickly our heart beats, how food moves through our gut. It controls how we metabolize things like cholesterol, like we were just talking about. And so thyroid hormone really sort of has its fingers in all of our different body systems.

[00:33:25] Dr. Gillian Goddard: Thyroid problems are also among the more common endocrine problems that people have. About 5% to 8% of the population in the United States has an underactive thyroid, which is the most common type of thyroid problem. And most of those people are women. Women develop thyroid disease at a rate of five to one compared to men. And so you can imagine that by the time women get to midlife, we're looking at something in the neighborhood of 15% to 20% of women will have a thyroid problem, whether that's an underactive thyroid, which is quite common, an overactive thyroid, which is much rarer, or thyroid nodules, which are really, really common and luckily largely benign, not cancerous.

[00:34:14] Sophia Ruan Gushée: Why are thyroid issues so much more common in females?

[00:34:18] Dr. Gillian Goddard: Most thyroid issues are autoimmune. And because we have these fluctuations in estrogen, women in general are more susceptible to autoimmune disease because of the ways estrogen affects our immune system. And so, as a result, almost all autoimmune disorders are more common in women than they are in men. There are specific times when women are more likely to develop new hypothyroidism in particular, and there are times when we have big fluctuations in our estrogen levels: so puberty, pregnancy, and perimenopause.

Endocrine-Disrupting Chemicals and Fetal Development

[00:34:58] Sophia Ruan Gushée: From the perspective of in utero, I want to ask about hormones to set the stage to talk about endocrine-disrupting chemicals and how that comes into play with human health and development, and, as is natural for you, to talk about how that affects reproductive health.

[00:35:20] Dr. Gillian Goddard: Yeah, absolutely. So growth hormone can be important in fetal development, but it is actually not the most important hormone. The hormones that are most important during fetal development are estrogen, progesterone, a bunch of growth factors that are not necessarily hormone-loop related. And then in boys, there is this moment. It's more than a moment, but there is this narrow time period where there is a surge in testosterone in the fetus that makes a boy fetus, an XY fetus, have a male phenotype.

[00:36:05] Dr. Gillian Goddard: So the development of testes and a penis. And this is an area where we have some understanding of the idea that certain endocrine-disrupting chemicals do seem to come into play. We are still working out all the nuts and bolts. But this is an area where we think that endocrine-disrupting chemicals can affect the rise in testosterone, how high testosterone goes during this sort of narrow little time period in a male fetus's development that can change the development of the male reproductive system, the testes and the penis, and in particular, the testes.

[00:36:55] Dr. Gillian Goddard: And we think that it's more about the timing than it is about the amount of exposure. And the best evidence here is really for phthalates and for phenols. However, it's really, really tricky to work these things out because these endocrine-disrupting chemicals are so ubiquitous in our environment that it's difficult to find people who have not been exposed. And obviously, because we know that these chemicals may be harmful during fetal development, we can't ethically create a randomized controlled trial to try and work out the causality.

[00:37:42] Dr. Gillian Goddard: And so what we're really left with are animal studies, which are helpful but obviously imperfect because there are definitely differences between the reproductive development of a human versus a rat or a mouse, but also — and then observational studies. But the tricky thing about observational studies is that people who are exposed to more phthalates and phenols and other endocrine-disrupting chemicals are often different in really important ways from people who are not exposed to those chemicals.

[00:38:19] Dr. Gillian Goddard: There's often really important differences in things like socioeconomic status, education, diet, all of which can also affect fetal development. Access to healthcare is another big difference. And so it's been really hard to work out exactly how and when these endocrine-disrupting chemicals are acting.

[00:38:43] Sophia Ruan Gushée: So I understand what it's like to have a teenage daughter. I have a 19-year-old, 16-year-old, and 14-year-old.

[00:38:50] Dr. Gillian Goddard: Oh my goodness!

[00:38:52] Sophia Ruan Gushée: But if your daughter were to listen to you and care what you thought about endocrine-disrupting chemicals, what would you want her to know?

[00:39:04] Dr. Gillian Goddard: I think that the biggest thing is is while they are impossible to completely avoid, there are some things that are helpful for reducing overall exposure. And it does seem that in utero exposure is sort of the area of endocrine-disrupting chemical exposure that we understand the best. And that, of course, may change over time. But particularly phenols and phthalates, trying to avoid your highest exposure to those things during pregnancy may have lasting impacts later.

[00:39:43] Dr. Gillian Goddard: So the things that people can do that are most impactful are pretty, pretty simple. There are things like not storing hot or acidic liquids in plastic, not microwaving foods or heating foods in plastics, not drinking the water from the plastic water bottle that you left in the car for three days where it got heated up. It's really heating the plastic and exposing the plastic to acid, are the two things that leach these particular chemicals out of the plastic most effectively.

[00:40:22] Dr. Gillian Goddard: So while we can't get rid of the phthalates and the phenols in our water and food supply single-handedly, these are sort of high-benefit, low-lift things that we can do at certain times in our life. But I also — I'm always a little careful to make recommendations along these lines because I think it can be very stressful for people to hear. And, you know, we've all been in that situation where we're like in the airport and we need water. And I don't want people to be afraid when they're pregnant to pick up a plastic water bottle in that situation, because the risk - benefit there of staying hydrated is much more important.

[00:41:07] Dr. Gillian Goddard: But when you think about how you set up your household, I think it can be really helpful to minimize plastic food storage. In our house, this is something we've been talking about for a long time. The idea that BPA, which contains phenols, is harmful is something, is information that really came to light when my oldest son was a baby. He's also 19, so we were probably starting to think about these things at the same time. And we very, you know, kind of slowly over the next several years, really tried to get the plastic out of our kitchen as much as possible, within reason.

[00:41:48] Dr. Gillian Goddard: I mean, we don't drink out of plastic cups. We don't store our food in plastic containers. We use a lot of — we don't use plastic wrap or Ziploc baggies. We use a lot of reusable things, and we use a lot of stainless steel and glass. And, in fact, part of the reason we do this is for our own exposure, but the biggest reason we do this is to not contribute more plastic to the environment, which is where so much of these chemicals are getting into our food supply. If we can put less plastic out into the world, it will reduce the — hopefully, over the long run, reduce the phthalates and phenols that we're getting exposed to in places like our drinking water and in our food.

[00:42:36] Dr. Gillian Goddard: So it's both a short-term, the things that you can do that are impactful, but it's also sort of thinking long-term about what will ultimately happen to those plastics that we bring into our house.

Cortisol and Chronic Stress

[00:42:50] Sophia Ruan Gushée: Moving on to the last loop, the adrenal loop.

[00:42:54] Dr. Gillian Goddard: Everybody's favorite loop.

[00:42:57] Sophia Ruan Gushée: The first interview I did this week got me very mindful of chronically high cortisol levels, which I am aware I have.

[00:43:07] Dr. Gillian Goddard: I feel like if you live in modern life, you definitely have times where your cortisol levels are high.

[00:43:12] Sophia Ruan Gushée: So please tell me more about the adrenal loop. I actually don't know anything about it.

[00:43:19] Dr. Gillian Goddard: I think it's helpful to think about the parts and sort of how the adrenal loop works. All of the loops actually have the first same two steps. A hormone, as something, some stimulus comes into our brain. And our hypothalamus is sort of half gland, half brain tissue, and it sits at the crossroads of our brain. And it takes in information about our external environment and information about our internal environment.

[00:43:45] Dr. Gillian Goddard: When we are exposed to a stressor, that information comes into our brain, into our hypothalamus. And our hypothalamus makes a hormone called corticotropin-releasing hormone. But the name is less important. That is a teeny-tiny little peptide hormone that travels a very short distance and stays in our circulation very briefly. It just goes from the hypothalamus to the pituitary gland, a little gland that sits straight back behind the bridge of our nose, hanging just below the brain, and it looks like a Jelly Belly jelly bean.

[00:44:22] Dr. Gillian Goddard: That hormone, in response to that CRH, makes a hormone called ACTH. ACTH gets released into the blood and travels to our adrenal gland, where it triggers the adrenal gland to make cortisol. So our adrenal glands are hat-shaped. They look like three-cornered hats. They sit right on top of our kidneys, and they make a bunch of different hormones. But one of the most important hormones, and one of the hormones we talk about the most, is cortisol.

[00:44:54] Dr. Gillian Goddard: Cortisol does things to our body to prepare our body to manage stress. So it increases our blood sugar so that our muscles and brain have increased blood sugar. It increases our heart rate. It increases our focus. It goes to the brain and helps us focus more closely on whatever the stressor is. We have to remember that this whole system evolved when stressors were oftentimes life and death, but also kind of short-lived typically, right?

[00:45:31] Dr. Gillian Goddard: So if we're out in the caveman days and we run into an animal who could potentially harm us — everybody always talks about the saber-toothed tiger — everything that cortisol does prepares us to either stay focused and focus on the tiger and address that issue, or to hightail and run away from the tiger, right? What we need, the energy we need for our muscles to work well and our heart to pump well so that we can run away.

[00:46:00] Dr. Gillian Goddard: What's different about our modern world is that sometimes we're in these situations where the stressor doesn't last, you know, 20 minutes. It lasts 20 days or maybe longer. And cortisol, in that situation where it's sort of, where chronically stimulating the release of cortisol, can have effects on our sleep and our moods, and over long, long periods of time, our blood sugar and our glucose metabolism.

[00:46:32] Dr. Gillian Goddard: And so those things can, over time, be problematic. In fact, if you think about it, if you're not sleeping well because you have chronic stress, it actually increases the stress. So it can become sort of a little bit of a feed-forward cycle. The best way to short-circuit that kind of chronic stress behavior — and it's not always the easiest things to do, but it's things like doing your best to get adequate sleep.

[00:47:06] Dr. Gillian Goddard: Mindfulness can be very helpful. Meditation can be very helpful. Exercise is a great way to help deal with chronic stress and the cortisol surge that comes with it. Because exercise uses up sort of, you know, it is what cortisol is meant to help us do, to run away from the tiger. You know, if we can exercise and use them, and then, to the degree that we are able to, reducing that chronic stress.

[00:47:36] Dr. Gillian Goddard: And that doesn't mean leading a stress-free life. There is lots of data to show that a certain amount of stress over short periods of time is actually beneficial for our brain. It reduces our risk for things like dementia, and it's good for our moods and our overall function. And so the goal isn't to lead a stress-free life, but the goal is to, when possible, minimize really toxic, stressful situations.

[00:48:04] Dr. Gillian Goddard: The challenge, of course, is that that's not always possible. We can have a sick family member, elderly parents, a toxic job environment, but most of us need to work for a living, and so we can't just leave a toxic work environment. And those, you know, those types of stresses can be challenging for people to manage. But the methods that I mentioned for reducing chronic stress can be helpful even when you can't get rid of the stressor.

Sleep, Exercise, and Hormonal Health

[00:48:34] Sophia Ruan Gushée: You've provided an amazing overview over key aspects of the endocrine system. What are natural — you just talked about wonderful natural ways to support the adrenal loop through behavioral changes. Are there other natural ways we can protect and rebalance our endocrine system?

[00:48:55] Dr. Gillian Goddard: So the good news about our endocrine system is that most of the time, it is pretty good at balancing itself. I think that the key ways in which our life gets in the way of our endocrine system functioning well often actually do come through that adrenal loop, through that stress, because the adrenal loop then has effects on the other loops. And when we- When humans were evolving, if there was chronic stress like famine, it wasn't a good time to reproduce.

[00:49:28] Dr. Gillian Goddard: And so chronic stress can affect our reproductive loop by shutting down ovulation. Even today, you know, we still have these mechanisms in place that evolved when humans lived very different lives. And so the best thing that we can do for all of our loops is sleep. I always say, now that nobody smokes cigarettes anymore — when I first started practicing medicine, you still had to do a lot of smoking cessation.

[00:50:02] Dr. Gillian Goddard: Luckily, these days, that is not so true. So now that nobody smokes, the number one thing we can do is get adequate sleep. And for most people, that means seven to nine hours a night on average. So sleep. Exercise is super helpful for our entire endocrine system. Moving our bodies, it doesn't have to be in the gym, but moving our bodies is super important for our entire endocrine system.

[00:50:30] Dr. Gillian Goddard: Both aerobic exercise and strength training have different benefits for our endocrine system. Strength training is especially important for our bones, which are, believe it or not, endocrine organs respond to hormones. —I didn't know that.— Yes. Eating a balanced diet. And that doesn't mean you need to follow this fat or that fat. It really means eating a diet that's balanced in protein, fruits and vegetables, whole grains, and trying to limit the very processed grains and sugars.

[00:51:09] Dr. Gillian Goddard: And those are really the things that have been proven to do what we need to do to keep things in balance most of the time.

Supplements and Dr. Goddard’s Daily Habits

[00:51:18] Sophia Ruan Gushée: I assume that even though you're an endocrinologist, that you did do research for writing The Hormone Loop. And so, in doing the research and sitting down to write The Hormone Loop, I'm wondering how that process changed your life, if there are things about your lifestyle or products based on what you were learning.

[00:51:43] Dr. Gillian Goddard: Yeah. I think that the biggest thing is that I really narrowed down my goals as far as, like, supplements and stuff. So one of the things I think people really don't understand is the way that supplements are studied and regulated. One of the things that I was really reminded of in doing the research that I did was how little we know about so many supplements, how little studied they are.

[00:52:14] Dr. Gillian Goddard: And so I really boiled down my routines to just a handful of supplements that I found had sort of the best data behind them for a woman my age. And I'm 48 years old, so a woman solidly in midlife. And the ones that I really boiled down to were creatine for helping muscle recovery and helping with brain fog, collagen, which is great for those of us who are vain about our skin, but also for our bones, um...

[00:52:53] Dr. Gillian Goddard: -And skin.- A little extra... Yes, a little extra protein, just because I want to be able to maintain my muscle mass. One of the things I really focused on in the last couple years, like so many others, is making sure I'm getting the strength training that I need. And then calcium, which, you know, the pendulum has swung, but I think we're in a nice middle spot.

[00:53:16] Dr. Gillian Goddard: Women under the age of 50 should get 1,000 milligrams of calcium from their diet and a supplement combined. Women over 50 should get 1,200 milligrams of calcium combined from their diet and from a supplement. And one of the things that was really fun to research was there's a table in the book that lists all kinds of non-dairy foods that are high in calcium and how much calcium those things contain.

[00:53:47] Dr. Gillian Goddard: I had no idea how calcium-rich black beans were, for example. Um, they're almost as good as milk and yogurt. So that was a really fun discovery.

[00:53:59] Sophia Ruan Gushée: How do you eat black beans? Like soup, or do you have a favorite recipe?

[00:54:04] Dr. Gillian Goddard: Yeah, I do a soup, and then I do, I do like a Mexican bowls like with a little bit of whole-grain rice, some black beans, some cheese. I really like old onions and, you know, and salsa. I'm from Arizona originally, so I still have a soft spot in my heart for Mexican food.

[00:54:27] Sophia Ruan Gushée: How much creatine do you take?

[00:54:29] Dr. Gillian Goddard: I take five grams of creatine monohydrate once a day.

[00:54:34] Sophia Ruan Gushée: Great. And since you're a New Yorker and a mom, a full-time working mom, I have to ask your sleep routine. How do you get seven to nine hours of sleep each night? Oh, yes.

[00:54:47] Dr. Gillian Goddard: So my kids are older now. My kids are 19, 15, 13, and 10, and it is much easier to get seven to nine hours of sleep now that they are big than it was when they were little. Those early childhood years, it can be really hard. But the biggest thing I do is some advice I got from a friend and fellow author, Laura Vanderkam.

[00:55:11] Dr. Gillian Goddard: She writes about productivity, and she always talks about how giving yourself a bedtime and going to bed early is like sleeping in for grown-ups. And so I give myself a bedtime. In the evenings, we try to have family dinner as many nights as we can. It's definitely not every night. People have different activities and are in and out, but whoever's in the house sits down.

[00:55:38] Dr. Gillian Goddard: We have dinner together. After that, we have some sort of time where people do homework. I like to read or do some other activities. And then around 9: 00, I head up to get ready for bed, and I spend half an hour to 45 minutes watching an old television show with my two middle kids. Right now, we're watching The West Wing. But we've watched Friends, and we've watched Parks and Rec and The Office.

[00:56:08] Dr. Gillian Goddard: So we watch old TV that isn't too stressful, and a lot of times we choose comedies because it's good to have a little bit of a light watch. And then at 10: 00, my 13-year-old goes to bed. My 15-year-old, the nocturnal one, probably goes up to do more homework, and it's lights out for me. I get up very early two days a week on the days when I see patients to go into the city, and so it's important to me to really protect that sleep.

Hormones, Longevity, and Healthspan

[00:56:38] Dr. Gillian Goddard: And so most nights, I'm in bed with lights out at 10: 00 p. m. About health span, I'm wondering if you have any comments. It's a hot topic now, a hot trend. It is a hot topic.

[00:56:51] Sophia Ruan Gushée: Do you have anything you'd like to share about health span

[00:56:55] Dr. Gillian Goddard: —and hormones?— I think that the biggest... Yeah, the biggest thing about health span — well, there's two things about health span and hormones. One is estrogen does seem to be related to health span. We know that women who naturally keep their own estrogen longer tend to live longer. Now, this may have nothing to do with the estrogen itself. It may have to do with what the estrogen tells us about how quickly the ovaries are aging.

[00:57:25] Dr. Gillian Goddard: And so, you know, there's all these studies that show, oh, if you have a kid in your 40s, you live longer. If you have menopause after age 55, you're more likely to live longer. It's not necessarily because of the estrogen. It may be because that's a sign that the ovaries are aging slower. And if the ovaries are aging more slowly, then the rest of our cells may be aging more slowly as well.

[00:57:54] Dr. Gillian Goddard: But the other piece is that, unfortunately, the biggest factor in both health span and lifespan, genetic. Unfortunately, we don't get to control our genes. All we can really do is work with the information that we have to lead as sort of healthy a life as possible. I always talk about my grandmother. She lived to be 99, and she was in good shape until her mid-90s.

[00:58:23] Dr. Gillian Goddard: She lived in her own home until she was 97. And I always think of her as sort of being the model of how to have a long life and a long health span. And it's funny, she didn't do a lot of the things that we think of as being super healthy. She wasn't a big exerciser. She didn't smoke, but my grandpa lived in the house with her for 45 years, and he smoked.

[00:58:48] Dr. Gillian Goddard: But she did all of these things in moderation. So she didn't exercise, but she cleaned her own house until she was 97 years old, which I think kind of counts as exercise. She would have a cocktail, but she would have one cocktail. She used to make the best chocolate milkshakes, but she served them to us in — anyone who grew up in the ' 70s and ' 80s will remember those Tupperware cups that were bright colors.

[00:59:15] Dr. Gillian Goddard: She would serve us, they're like seven-ounce cups. They're like tiny, and that's what we drank our milkshakes out of. And she would have one too, usually, but she would also drink it out of this little tiny seven-ounce Tupperware cup. And then she did other things that were super important. She used her brain. She actually worked until she was 85. She read the paper every single day, basically from cover to cover, and basically until the day she died.

[00:59:41] Dr. Gillian Goddard: And she had a really, really flourishing social life. She was surrounded by friends and family and had great relationships around her. She played bridge with friends until she was well into her 90s. And to me, it's sort of this combination of moderation as far as things that are may not be so good for us, indulging in moderation, and really doing things like using your brain and surrounding people surrounding yourself with people who you love and care about are really the things that have the best data for helping us to live long, healthy lives.

Preparing for Doctor’s Visits

[01:00:25] Sophia Ruan Gushée: I love that. Thank you for sharing that. I'll be thinking about your grandmother often now. So you have been so generous in sharing so much invaluable information about the endocrine system. What else can listeners find in The Hormone Loop that we haven't talked about?

[01:00:42] Dr. Gillian Goddard: Oh, so much more. I think that one of my favorite things about The Hormone Loop is the illustrations that really put these ideas in an understandable way. And my other favorite part of The Hormone Loop is actually the last chapter. The last chapter is really a step-by-step guide for how to think about preparing for your time with your doctor. Doctors only have about 10 to 15 minutes to spend with patients, and it's really important to take some steps before and after your visit to make sure that you get the most out of that time.

[01:01:23] Dr. Gillian Goddard: And I really guide you through a step-by-step process for preparing for your doctor's visits. And that, I think, is one of the more practical ways to use the book.

[01:01:35] Sophia Ruan Gushée: It sounds important for every adult who's going to visit a doctor.

Frequently Asked Questions About Women's Hormones

Can perimenopause symptoms begin while periods are still regular?

Yes. Dr. Goddard describes the late reproductive stage, when periods may remain regular even as hormonal fluctuations contribute to symptoms such as mood changes, heavier periods, and occasional hot flashes. Symptoms should be discussed with a qualified clinician rather than assumed to have one cause.

Do women need to balance their hormones?

Not necessarily. The endocrine system uses feedback loops to regulate hormone levels. Dr. Goddard explains that attempts to optimize individual hormones may be unnecessary, while persistent or disruptive symptoms deserve appropriate evaluation.

How can endocrine-disrupting chemicals affect hormonal development?

Some chemicals can interfere with hormone signaling. Dr. Goddard discusses research on prenatal exposure to phthalates and phenols, particularly during sensitive developmental windows, while emphasizing the limitations of animal and observational studies.

What everyday habits can support hormonal health?

Dr. Goddard emphasizes adequate sleep, regular physical activity—including strength training—and balanced nutrition. She highlights sleep as an especially important foundation for overall endocrine health.

About Dr. Gillian Goddard

Dr. Gillian Goddard is a board-certified endocrinologist, adjunct assistant professor of medicine at NYU Grossman School of Medicine, and author of The Hormone Loop. Her clinical work and writing help women better understand hormonal changes across different stages of life.

Continue Exploring Practical Nontoxic Living

For Sophia's personal reflections on the relationship between hormones, identity, and growing older, explore Ruan Living on Substack. To learn more about reducing everyday exposures at home, visit Ruan Living.

Medical disclaimer: This podcast and transcript are for educational purposes only and do not constitute individualized medical advice. Consult a qualified healthcare professional about personal health concerns, diagnoses, or treatment decisions.