Perimenopause, Progesterone & Migraines: Dr. Carrie Jones on Hormones, Detox & Gut Health

January 12, 2026

When I invited Dr. Carrie Jones onto Midlife Realignment, it felt like a full-circle moment.

Carrie was one of my earliest hormone mentors — long before perimenopause ever knocked on my door. She has more than 20 years in women’s health, helped pioneer education around hormone testing, and has taught thousands of clinicians how to think clearly about endocrine physiology.

And yet, even with all that knowledge, perimenopause still humbled her.

That’s the part women need to hear.

When Perimenopause Shows Up as Brain Fog First

Carrie described the exact moment she realized perimenopause had arrived.

She had a brilliant idea, reached for her keyboard… and by the time her fingers touched the keys, the idea was gone.

Not stress.
Not burnout.
Not aging.

Perimenopause.

Since then, she’s experienced symptoms many women don’t realize are hormonally driven:

  • Sudden brain fog
  • Short-term memory lapses
  • Insomnia between 3–4 a.m.
  • Itchy ears
  • Phantom smells
  • Ocular migraines

This is the reality of fluctuating estrogen and progesterone — and it doesn’t always start with hot flashes.

Ocular Migraines and the Hormone–Blood Sugar Connection

One of the most powerful clinical insights Carrie shared was how ocular migraines emerged as part of her perimenopausal transition.

Unlike classic migraines, ocular migraines involve:

  • Temporary loss of vision in one eye
  • Visual disturbances lasting 5–15 minutes
  • Sometimes minimal pain

What helped her get control wasn’t guesswork — it was tracking.

By using a continuous glucose monitor, she saw a clear pattern:

  • Migraines clustered during low-hormone days
  • Blood sugar dips amplified symptoms
  • Back-to-back meetings + skipped meals were a trigger

This is a critical reminder: hormones and blood sugar are inseparable, especially in perimenopause.

Progesterone: Powerful, Helpful — and Dose-Sensitive

Carrie has used progesterone thoughtfully and transparently, adjusting dose based on symptoms, sleep quality, and metabolic response.

What she highlighted is something I see constantly:

  • Too little progesterone → insomnia, anxiety, migraines
  • Too much progesterone → puffiness, blood sugar dysregulation

Her solution wasn’t rigidity — it was responsiveness.

She uses slow-release progesterone, often cycling doses during the luteal phase, and listens carefully to her body’s feedback.

This is what physiologic support actually looks like — not “set it and forget it.”

Why At-Home Hormone Tracking Changes Everything in Perimenopause

One of my favorite parts of our conversation was unpacking how women can see their hormones in real time.

Carrie uses at-home hormone monitoring tools to track:

  • Estrogen metabolites
  • Progesterone metabolites
  • LH and FSH

What makes this powerful in perimenopause is context.

Instead of a single blood draw, women can:

  • See patterns across the entire cycle
  • Identify delayed ovulation or skipped ovulation
  • Understand why symptoms spike on certain days

As Carrie put it, this lets you see the forest, not just a single tree.

One “Normal” Lab Does Not Mean Stable Hormones

Carrie shared an important clinical reality:

A progesterone level can look “great” on one lab day — and be nonexistent the rest of the cycle.

That’s why so many women are told:

  • “Your labs are normal.”
  • “Nothing is wrong.”

…while their symptoms say otherwise.

Daily or frequent tracking reveals what one-day testing can’t: volatility — the hallmark of perimenopause.

Hormone Cycling vs Static Dosing: There Is No Moral High Ground

We also tackled a controversial topic: hormone cycling versus static dosing.

Carrie’s stance is refreshingly honest:

  • Some women thrive on cycling
  • Some feel worse
  • Some do best on steady dosing

There is no “right” method — only what works for that woman’s body.

If a woman feels worse, that doesn’t mean hormones aren’t for her.
It means the approach needs to change.

Pellets, Patches, and Injections: Start Low, Go Slow

Carrie and I are aligned here:

Hormones are powerful tools — not cosmetic upgrades.

She’s seen:

  • Pellets transform lives when done skillfully
  • Pellets derail women when used indiscriminately

Her rule mirrors mine:

Start with the basics.
Earn complexity.
Don’t jump straight to long-acting delivery systems.

Dip your toe in.
Don’t cannonball.

Estrogen Detox, Ferritin, and Why Hormones Must Move

Carrie has an incredible gift for making biochemistry understandable.

She explained estrogen detox using a bathtub analogy:

  • Phase 1 fills the tub
  • Phase 2 processes the water
  • Phase 3 drains it

If the drain is clogged, estrogen backs up — regardless of whether it’s endogenous or from HRT.

Key supports she emphasized:

  • Adequate iron
  • Magnesium
  • Broccoli sprouts (sulforaphane)
  • Hydration
  • Daily bowel movements

Detox isn’t a cleanse.
It’s a daily physiologic process.

Gut Health, Iron, and Hormone Resilience

We also dove into low ferritin — something I see constantly in midlife women.

Carrie explained why ferritin may stay low despite supplementation:

  • Chronic inflammation
  • Gut infections (H. pylori, SIBO, candida)
  • Poor stomach acid
  • Thyroid dysfunction

The solution isn’t more iron — it’s fixing the terrain so the body can use what it’s given.

The Bottom Line

My conversation with Dr. Carrie Jones reinforced something I want every woman to hear:

Perimenopause is not mysterious — but it is dynamic.

When women:

  • Track instead of guess
  • Support blood sugar
  • Respect detox pathways
  • Individualize hormone care
  • Stop minimizing symptoms

This transition becomes manageable — even empowering.

Knowledge doesn’t erase perimenopause.
But it gives women their agency back.

And that is the heart of Midlife Realignment.

Connect with Dr. Carrie Jones:

Connect with Esther

  • Instagram: @gorgeousesther

Disclaimer: This podcast is for education only and is not medical advice.