Pelvic Pain Unpacked, Episode 23 — with Tamar Hill and Julie M. Jones, CNM
🌿 Key Takeaways
- Perimenopause can begin as early as age 35 — and the most common dismissal women receive is “you’re too young.” Don’t accept that answer.
- Hormonal fluctuation in perimenopause isn’t just hot flashes. Brain fog, joint discomfort, fragmented sleep, heightened nervousness, and vaginal dryness are all driven by the same underlying hormonal instability.
- CBD suppositories relax hypertonic pelvic floor muscles, restore blood flow to the tissue, and provide meaningful relief for women who can’t or won’t use HRT — without sedation or drug transfer concerns.
- Vaginal estrogen has had its FDA black box warning removed. It does not circulate systemically and is appropriate for the vast majority of women.
- Starting hormonal support earlier — before symptoms become severe — produces better long-term outcomes than waiting until you’re in crisis.
If you’ve ever been told you’re “too young” to be in perimenopause, dismissed when you described symptoms that felt very real, or simply didn’t know where to turn when your body seemed to change overnight — this conversation is for you.
In Episode 23 of Pelvic Pain Unpacked, host Tamar Hill of MedRoots — a company specializing in CBD products for pelvic discomfort relief, menopause support, sexual pleasure, muscle discomfort, and overall wellness — sat down with Julie M. Jones, CNM, a certified nurse midwife and sex therapist now practicing at Jordan River Women’s Health in Salt Lake County, Utah. Julie specializes in menopause, perimenopause, painful intercourse, pelvic discomfort, and sexual health issues including low desire, orgasm, and arousal concerns. She is a member of both the American College of Nurse Midwives and ISSWSH, the International Society for the Study of Women’s Sexual Health — which is also where she and Tamar met, roughly four years ago.
The conversation covers everything from what’s actually happening hormonally during perimenopause, to HRT options, to why CBD has earned a real clinical role in Julie’s practice.
Why Women Keep Getting Dismissed — And Why That Has to Change
Julie went straight to the most common frustration she hears from patients.
Julie Jones: “Women get told, ‘Oh, you’re still having periods. You’re too young for perimenopause.’ But perimenopause can start as early as 35 and go until around 50. So women in their late 30s are experiencing real symptoms and getting put on medications for each individual symptom instead of being looked at hormonally.”
The average age of menopause has also shifted — it was previously around 55, now it’s approximately 50 to 51. That means perimenopause can realistically span 15 or more years of a woman’s life, starting well before most people expect it.
The core problem with dismissal isn’t just an inconvenience. Julie shared a case from Australia where a woman in perimenopause was hospitalized in a psychiatric ward for roughly a year because no one checked her hormones. She was placed on antipsychotic medications one after another. When someone finally ran a hormone panel and identified perimenopausal hormonal chaos, she was started on HRT and discharged shortly after. That’s not a cautionary tale about rare extremes — it’s an illustration of how badly unrecognized hormonal disruption can spiral when the medical system isn’t looking in the right place.
What’s Actually Happening in Your Body During Perimenopause
The physiology of hormonal balance during the reproductive years follows a reliable pattern. Estrogen peaks, drops, progesterone peaks, drops, and your period begins. Julie describes it as a clean, predictable EKG waveform.
Perimenopause, she says, is like taking a bowl of wet spaghetti noodles and throwing them against the wall.
Julie Jones: “That’s how women feel. And they get told, ‘You’re still having periods. You don’t need hormone replacement therapy.’ But what HRT does is try to straighten out those noodles and make some sense of it.”
Because estradiol — the primary form of estrogen — exists in every cell of the body, when levels fluctuate wildly and begin to decline, nearly every system is affected. That’s why the symptom list is so long and so unpredictable: hot flashes, night sweats, fragmented sleep, brain fog, heightened nervousness, joint discomfort that moves from the knee to the toe to the hand and then disappears, dry eyes, itchy ears, irregular periods, vaginal dryness, reduced libido, and pelvic discomfort.
The joint symptoms in particular are worth noting. Frozen shoulder is one that Julie flags specifically — because estrogen plays a role in joint function, its fluctuation can cause inflammatory episodes in the shoulder that come and go. She estimates about 1–2 per 100 patients experience this specifically, but the broader pattern of migratory joint discomfort is common.
As for testing — there isn’t a clean test for perimenopause. FSH (follicle-stimulating hormone) can indicate where the ovaries are headed, and a level above 25 is a signal that they’re beginning to retire. But because FSH fluctuates throughout the cycle, it can’t be used as a definitive standalone marker. Most clinical guidance now recommends going by symptoms, though Julie uses both.
The HRT Landscape: More Options Than Most Women Know About
When it comes to pursuing hormonal balance during perimenopause, the options go well beyond “the pill.” Julie walked through the key categories:
Progesterone-only pills are sometimes the right first step, particularly for younger women or those for whom adding estrogen may not be appropriate. One option, drospirenone, carries a lower risk profile for blood clots and is safer for women who smoke, are overweight, or have elevated blood pressure.
Estradiol patches and gels are transdermal — they go through the skin and into the bloodstream. Julie sometimes uses them for specific parts of the cycle to help stabilize hormonal fluctuation and reduce hot flashes and night sweats.
Vaginal estrogen is the local option — applied directly to the vaginal tissue, it does not circulate systemically. It thickens thinning tissue, restores some elasticity, supports the urethra and bladder, and raises the pH of the vaginal environment back toward the healthy 4–5 range. When estrogen declines, pH rises, which increases susceptibility to low-grade bacterial disruption and makes tissue more fragile during intercourse.
There’s also an emerging conversation about testosterone. Julie noted that women actually produce more testosterone than estradiol, and that testosterone maintains a steady state across the cycle rather than peaking and dropping. Testosterone replacement is increasingly part of the hormonal balance conversation, and researchers recently brought a petition to the FDA specifically addressing testosterone for women — a developing area that Julie is watching closely.
Setting the Record Straight on the WHI Study
One of the most important moments in this episode is Julie’s breakdown of the 2001–2002 Women’s Health Initiative study — and why the fear it generated has left women suffering unnecessarily for over two decades.
Julie Jones: “The study was given to cardiologists to look at what HRT does to the cardiovascular system. The progestin arm showed a reported increased risk of breast malignancy. The estrogen arm actually showed a decrease — but that isn’t how the report came out in the media.”
What made it worse was the reporting of relative risk rather than absolute risk. The absolute risk was approximately 3%. The relative risk sounded alarming. Physicians instructed patients to stop their HRT cold turkey. Some women likely experienced strokes and cardiovascular events from abrupt discontinuation.
The correction has taken over 20 years, but it came: the FDA recently removed the black box warning from vaginal estrogen — and then extended that removal to all estrogen. Julie’s response was direct: it should have happened far sooner, and the cost of the delay was measured in women’s health.
Where Vaginal Discomfort, Libido, and the Pelvic Floor Intersect
Julie approaches sexual health concerns by first pinpointing where the discomfort is coming from — entry, deep penetration, or somewhere in between — and how long it has been present. That guides the treatment path.
When low estrogen is the primary driver of vaginal dryness and tissue fragility, vaginal estrogen is often the first recommendation. But the pelvic floor muscles are just on the other side of that tissue — and they’re often contributing to the problem.
Julie Jones: “If there’s discomfort in the place where the world says it should be the best thing ever, libido is going to be almost universally affected. That’s not a character issue — it’s a physiological response.”
Pelvic floor physical therapy is a standard part of what Julie calls the “village” approach to restoring pleasure during intercourse. But PT alone, and HRT alone, often aren’t enough — which is where CBD enters the clinical picture.
How CBD Fits Into the Perimenopause Toolkit
Julie recommends CBD suppositories as her second tool after vaginal estrogen for pelvic discomfort and painful intercourse. The mechanism is straightforward: CBD relaxes hypertonic (overly tight) pelvic floor muscles. When those muscles release, blood flow returns to the area, which supports tissue repair and rejuvenation.
Julie Jones: “MedRoots has the combination of CBD and magnesium in the suppository, and I think it’s an overall well-rounded offering. It’s hard to get compounded magnesium suppositories — some pharmacies will do it and some won’t — but here we have it in a ready-to-use form.”
She’s clear with patients that it will not make them high. For those with concerns about THC, MedRoots offers THC-free options. For those who are open to it, the full-spectrum formula is what she tends to recommend.
One practical advantage CBD suppositories have over Valium (diazepam) suppositories — which are sometimes used off-label for pelvic floor relaxation — is that Valium goes more readily systemic, causing sedation that leaves patients unable to function normally during the day. CBD doesn’t produce that effect. Tamar also raised an important safety point: Valium can transfer to a partner during penetrative sex without a condom. CBD does not carry that concern.
For patients on vaginal estrogen, MedRoots’ vaginal moisturizer suppositories can be used on the days between estrogen applications — twice-weekly maintenance is the standard protocol for vaginal estrogen, leaving room to support tissue on the off days with a hormone-free option.
CBD for Sleep When Hormones Alone Aren’t Enough
Progesterone works directly on GABA receptors in the brain — which is why it has a naturally calming effect and supports sleep. It also, when at normal levels, reduces the risk of obstructive sleep apnea. Low progesterone increases that risk.
But a subset of women’s GABA receptors don’t respond adequately to progesterone. For those patients, Julie turns to CBD gummies.
Julie Jones: “I’ll show them the MedRoots menopause bundle. For women where progesterone isn’t doing the job on sleep, I recommend starting with just a sliver of the gummy — a quarter dose — and seeing how they respond. The patients I’ve recommended it to who actually buy it are able to sleep and aren’t groggy the next day.”
This tracks with what Tamar hears directly from MedRoots customers. Reviews frequently cite unexpected sleep improvements from customers who came to the product for something else entirely. At one ISSWSH conference, a practitioner walked up to Tamar’s booth in tears the morning after trying a gummy — she had slept through the night for the first time in 15 years.
The cannabinoid system is separate from the hormonal system. CBD does not appear to affect estrogen levels or interact negatively with HRT — making it a genuinely complementary tool rather than a competing one.
Non-Hormonal Options for Women Who Can’t Use HRT
Very few women are truly contraindicated for vaginal estrogen — updated evidence shows it does not meaningfully increase the risk of malignancy or cardiovascular events. But for those who cannot use any form of estrogen, options still exist:
Hyaluronic acid helps plump the upper layers of vaginal tissue, though it doesn’t reach the collagen level the way estrogen does. It’s particularly useful for women recovering from treatments for hormone-sensitive malignancies who are on estrogen-blocking medications.
Non-hormonal prescriptions for hot flashes and night sweats are available — including a new one that came to market recently, and certain antidepressants that have documented effectiveness for thermal symptoms. Night sweats specifically interrupt REM sleep, so treating them can meaningfully improve sleep quality even before CBD is added.
Supplements exist but quality is inconsistent due to lack of US regulation. Julie recommends finding a provider specifically knowledgeable in supplements, and notes that Germany sets a higher bar for supplement regulation if that’s a useful frame of reference.
In all cases, sex therapy and pelvic floor PT round out the non-hormonal toolkit. And CBD — in both suppository and gummy form — can sit alongside all of these options.
Finding a Provider Who Actually Knows Menopause
This point comes up repeatedly in the conversation and deserves its own space: most OBGYNs are not trained in menopause.
Julie is direct about this — it’s not a criticism, it’s simply a reality of how medical education is structured. Menopause-specific training exists through the Menopause Society certification and ISSWSH fellowship. Mary Claire Haver’s website also lists clinicians who align with her menopause-focused protocols. ISSWSH’s directory allows patients to find providers in their area.
The quality that matters most isn’t a specific credential — it’s a willingness to listen, stay current on evidence, and not dismiss what a woman is experiencing as “just getting older.”
Your Perimenopause Doesn’t Have to Wait
If something feels off — irregular periods, broken sleep, brain fog, joint discomfort, reduced libido, vaginal dryness — don’t explain it away. Julie’s closing message is simple: your symptoms are real, they have solutions, and getting in front of them early produces better outcomes than waiting until you’re in crisis.
You don’t have to choose between doing nothing and jumping straight to full hormone therapy. There’s a full spectrum of support available, and MedRoots is part of that spectrum. Our CBD suppositories, vaginal moisturizer, gummies, and menopause bundles are designed to work alongside whatever care plan you and your provider build — whether that includes HRT or not.
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The things you enjoyed at 20 are still available at 50 and beyond. Let us help you get there.
This article is based on Episode 23 of Pelvic Pain Unpacked featuring Julie M. Jones, CNM, certified nurse midwife and sex therapist at Jordan River Women’s Health in Salt Lake County, Utah. Provider resources mentioned: Menopause Society certified practitioners, ISSWSH fellow directory, and Mary Claire Haver’s clinician list. This article is for informational purposes only and does not constitute medical advice. Please consult your healthcare provider before making changes to your treatment plan.