Commusings: Hormone School, the Initiation by Dr. Sara Gottfried

Nov 17, 2023

Dear Commune Community,

Schuyler here. I have pilfered Jeff’s pen for this Commusings introduction because I feel uniquely qualified to speak to the excellence it its author, fellow Commune teacher Dr. Sara Szal Gottfried.

Last weekend, I was lucky enough to co-host a gathering of 32 women at Commune Topanga with Dr. Sara. I was disappointed that she didn't show up with her vagina puppet, but Dr. Sara’s lectures were so smart, funny, raw and authentic that I quickly forgave her.

This woman is a force of nature. And she didn't need a 10-inch felt vulva to school us on the inner and outer workings of womanhood. Somehow, over three days, Dr G transformed the anxieties and frustrations of navigating two X chromosomes into a palpable opportunity for growth.

The bittersweet pill I had to swallow after everything I learned last weekend is that I didn't attune to my hormonal health sooner. Why didn't I start paying attention in my 40s — or even my 30s!? I have never been one for going to doctors and I took so much for granted because I was basically healthy.

But ‘basically healthy’ is far from optimally healthy. Perimenopause came crashing into my life like a freight train during the pandemic, accelerated (I am certain) by the stress of the moment, and I never took the time to address or alleviate my symptoms. For all the miseries of the time we are living in right now, one bright spot is the agency we currently have over our internal workings — physical, emotional and spiritual.

This is why I am thrilled to see Dr. Sara launching a new course on Commune, Beautiful Hormones, for women of all ages, but especially for those moving toward and passing through the great hormonal transition of perimenopause and menopause. I wish I had taken it 15 years ago, but I am also glad I'm not waiting another year to uplevel my relationship to change.

One of the most broken parts of our dysfunctional health care system is that access to innovative health leaders like Dr. Sara is reserved for the privileged few who can afford personalized medicine. And while we can't set every Commune member up with a 1:1 meeting with Dr. Sara, we can give you the next best thing: 5 weeks of lessons and live Q&A calls. I know from leading my own Communiversity programs how impactful these 5 weeks can be. It is not only a deeply enriching way to learn, but a true community endeavor. And when you get a room – even a virtual room – full of women, it is combustible. In a good way.

Last weekend I finally got a formal diagnosis of CRS for one of my primary post-50s complaints. It's possible that you too suffer from Can't Remember Shit — and a whole host of other minor and major concerns that Dr. Sara will address in Beautiful Hormones.

Empowerment is an overused word, so I don't use it lightly. But a skilled teacher and leader has the ability to flip a switch so that we can transform a challenge into an opportunity. Dr. Sara is this kind of teacher. 

Her essay today is just a small dollop of what she has in store for you. And if you enjoy, don't let your CRS kick in... sign up for Beautiful Hormones pronto.

With love,

Hormone School: The Initiation
by Dr. Sara Gottfried

If you believe the cultural conditioning, you may think of major hormonal transitions – postpartum, perimenopause and menopause – as an inconvenience to grind through, burdensome, a problem to solve. You might be in the thick of it and wonder why you sometimes feel moody, bitchy, overwhelmed, irritable, or anxious. Perhaps you are experiencing fear about waning reproductive capacity heralded by changes to or loss of your menstrual cycle. Maybe you are noticing that you’re bracing yourself, setting your jaw just to get through it.

But that cultural message of hormonal transition as a “problem to solve” entirely misses the point. 

I want to offer an alternative, one that I have been exploring and deepening for the past several years now that I am 56 and in the fire of transition. 

When you view the perimenopausal transition into menopause as an archetypal process of spiritual education, psychic liberation, engagement, release, and rebirth into a new role, then an entirely new world of possibility opens. You realize that hormones are designed to transform us in positive ways.

I’m not talking about getting your crone on, because that image doesn’t work for me. If it works for you, that’s great, enjoy. In my opinion, perimenopause (which, by the way, can start as early as your mid-30s) is in need of major rebranding. Let’s roll up our sleeves and brainstorm.

As background, I’m not the first person to describe hormonal transition as an initiation. Jean Shinoda Bolen, MD, a psychiatrist, Jungian analyst, and author of Goddesses in Everywoman, explores the “wise woman” archetype. She describes menopause, literally “meno” (blood) and “pause” (stop), as withholding of blood not to make a child as we did in our teens, twenties, and thirties, but withholding blood to make wisdom.

What wisdom exactly are we to make? As I excavate my own psychic structure, I see perimenopause as a time to examine the ways that my authentic self was adapted and mapped to a persona.

I’ve been working on a related model in my work guiding people into healing states of consciousness with psychedelic medicine, inspired by a psychiatrist named Omid Naim, MD. He believes that we need to unearth the story of who you needed to be in order to receive attention and love as a child. Often it’s that map of how your authentic self had to become a persona that triggers symptoms. I see how many of my perimenopausal symptoms make sense when we look at this persona and how it splits from authentic self. Let me back up to explain. 

My Story

If you’ve read my books or come to our retreats at Commune, you know that I like to offer my story as a guide for others. My goal is to help people learn how to be your own case study, known as an “n-of-1” experiment, with “n” being the study’s sample size—in this case, one. N-of-1 is a major tool of the work I do as a precision medicine physician. Put another way, you can serve as your own control and then perform experiments to find what personally works for you. That’s true for psychological experiments as well as medical experiments, including addressing your stress, sleep, blood sugar, trauma, antibodies, and even bioidentical hormone therapy — all good tools for making hormonal transitions more graceful.
Like many of you, I have had a life of great joy and also toxic stress. Now that we have survived the pandemic, it seems that most of us are in a similar boat. Trauma has become the norm.
As a child, my parents divorced when I was one. The remarriages were challenging. I felt I had to be a high achieving people-pleaser to receive attention. That kicked off several decades of accommodation of my authentic self as I became an overachiever, type-A person, trying to do all the things for all the people in my life. Maybe you can relate.
Fast forward to my thirties, and I became the poster girl for the hormonal hot mess. I suffered from premenstrual syndrome, moodiness, borderline gestational diabetes followed by postpartum depression. I was stressed and overwhelmed, but still I continued to sacrifice authenticity for attachment. I hung onto ill-fitting jobs and relationships way too long. Still, I started my n-of-1 experiments to address my high cortisol, low thyroid function, and estrogen dominance. The experiments went remarkably well and I started to teach my patients how to perform them. I wrote about these experiments as protocols in my book, The Hormone Cure.
Right on the heels of giving birth to my second child, I entered perimenopausal chaos. In my forties, my periods got closer together and so heavy. My fibroids grew. I became anemic and pelvic pain worsened. My sex drive was missing in action. Sleep, always so sound, became unpredictable. I craved more refined carbohydrates and used food to try to change my emotional state. My persona grew, my soul languished, and my belly fat increased. I developed prediabetes.
All together, I’ve had about 20 years of ongoing perimenopausal transition. It seems that I still have more lessons to learn, so the universe has provided ample opportunity for growth. Now in my fifties, I noticed the symptoms of the final stages of perimenopause: less ability to focus, more brain fog, memory changes, loss of muscle mass, and more conflict in my relationships, at least the ones that rely on my persona. As both of my daughters left home for college, I regrouped, deconstructed, and reconstructed the architecture of my life to become more aligned with my authentic self. 

The Lesson

Beginning at 55, I finally started to speak my truth. I no longer retreat to my cognitive structures (“solve it with my head not my heart”) or simply dissociate. I am more embodied and willing to have difficult conversations when needed.
In this, my hormones have led the way and served as a forcing function.
Think of it as Hormone School: The Initiation. I got schooled by my hormones, and if you want, you can too. I feel like they have set the stage to give me exactly the growth opportunities that I’ve needed at every stage of my life. 

Maybe you’ve heard the idea that your mess is your message. Well, when your hormones are a mess, that’s a message to listen to. Hormones are designed to transform. 
Now I see hormonal transition as a beautiful process that shapes who we are. You may be pulled through a process of engagement and disengagement. You will ascend and descend. You may at times feel like you might die, and then minutes to hours later, feel reborn. 

The point is that hormone transition is an initiation, pulling you to a healing state of consciousness. A changing of the guard.

Menopause is not a problem or dead end. It’s a biochemical initiation.
And there are no shortcuts to initiation.

The only way is to go inward and understand who you are, physiologically and psychologically, and come out the other side changed, wiser. 

If you resist that change – if you just think it’s simply a problem to solve or suffer through – then you are also resisting the person the universe is asking you to become.


Dr. Sara Gottfried is a physician, researcher, educator, mother, and seeker. She graduated from Harvard Medical School and MIT, and completed residency at UCSF, but is more likely to prescribe a CGM and personalized nutrition plan than the latest pharmaceutical.

Dr. Sara is a global keynote speaker and the author of four New York Times bestselling books about trauma, hormones, and health. She is Clinical Assistant Professor in the Dept. of Integrative Medicine and Nutritional Sciences at Thomas Jefferson University and Director of Precision Medicine at the Marcus Institute of Integrative Health. Her focus is at the interface of mental and physical health, N-of-1 trial design, personalized molecular profiling, use of wearables, and how to leverage these tools to improve health outcomes.

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