The Hidden Causes of Perimenopause Exhaustion: Stress, Hormones, and Your Brain

26:48And okay, you've got these podcasts that you're preparing, whatever it is, like you have this level of high functioning and you have capacity. But then all of a sudden, it's like you wake up one day and your ability to manage all of these things just flutter. They just flutter away. Or your ability to handle, I think I was reading a stat and I say this only because I am a mom to a young child, but that an average mom with a young child gets pelleted, pummeled with about four to 500 questions a day. And sometimes it's multiple all at the same time. You know, I know you have a little young one. Is your child in school?

27:23Yes. Yes. Yes. I don't blame teachers. I blame admin. And I think about this all the time. It's hell for me. It's hell for every parent that I talk to. And it's hell for the teachers as well. We've got a top-down issue that is seriously about to break. I tell my husband all the time, the worst part of being a parent is school is like, I'm so afraid I'm going to mess it up for them all the time because I got no less than a dozen emails before school started. And then the day before school started, there were the Friday before I was told like, Oh, you need to have all of these things come Monday.

27:55And I'm like, but how it's Saturday. Like, no, totally. Yeah, exactly. Well, I just, it's just the amount that's coming at us. And what's destabilizing about it is you were able to handle it. And then all of a sudden you're not. And then you're snapping at your family or snapping at your partner and you don't have the same capacity. There's a grieving process, I think, when we step in and we realize we're not thinking the way that we used to. We don't have the resilience the way that we used to. And we notice our mental energy isn't what it used to be. There is a reconciliation. I always call perimenopause, I call it the reckoning.

28:36Because you really have to reconcile what is happening. And you have to come to terms with the fact that you have to be a little bit more intentional. You've got to effort a little bit more. And not to this, I don't want women to feel like, oh my gosh, now I have to over-effort. I don't want you to feel that way. I just mean in the sense that things are requiring more intention. You know, gone are the days where you could just get so much sleep or you could just have a stacked day and you're like, I got this. No, you have to be more protective of your energy. You have to be more protective of your time and of your mental bandwidth.

29:09But I think that's the thing that we're not talking about enough is how we are expected to keep it all together and we are holding on by a thread. And that morning that you talked about, I mean, it's real when you start clocking, you know, where you're at in terms of being midlife and realizing that like you are taken down to menopause and then, you know. And then post-menopause. Post-menopause. And there's only so much time left. And I think that not to be like, oh, doomsday about it, but it's that you start recognizing there's only so much time left. You have things you want to accomplish with this time.

29:47And yet physiologically, the body's not on board for that. That's hard. It's a hard place to be. And the brain too. The brain's not on board. I mean, again, when you are, you know, I think every woman listening to this show, I know that they're high functioning. I know that they are, they've got big dreams and they've got aspirations and they are, they are the glue that holds it all together. And when you feel like your glue is melting into the ground, you're like, how am I going to get through this? And that's where, and yeah, I mean, I'm, I guess mentioned I'm 46 this week. Happy birthday. Thank you.

30:22And hopefully I live to 91. I'm not trying to live a long time. I want to live a quality time. That's my intention. But let's, I mean, I'm going to wager a guess that I'm halfway through my life at this point. And I think the question that comes up, the like existential question is, is this it? Is this all? You know, is this, do I want to keep stepping into the second half of my life, doing what I'm doing, living the way that I've been living, being in the relationships that I've been in, you know, I think this is where we take stock and we become more discerning about our boundaries, about what we're a full body yes or a full body no to, about the relationships that are just draining us or keeping us alive and helping us to thrive that feel safe.

31:05Like this is where we, that's why I call it the reckoning is that if whatever got you here isn't what you love, like you've been tolerating, just note that this is the moment where you get to decide, like, am I willing to tolerate this moving forward? Is this a relationship I'm willing to have? I mean, there's a reason why divorce is happening. I think 45 is like the magic divorce number because women are just like, no. I got six months to 45. Someone tell my husband. No, I'm just kidding. He's literally in the other room right now probably being like, what? He's watching us on the screen. But no, I mean, it's, you know, all of this, Everything's up for review.

31:46Yeah. Full body yes, full body no. That sounds like a tool that women could be leveraging to get what they want out of life, but also make sure they're moving incongruent with what their desires are, what their goals are. Can you say more about that? Yeah, I would say anything, any decision that's coming to you. I think one of the best, one of the things that we've been taught is to not trust ourselves. It's not trust our intuition because there's so much power in that. Hey, it's Kelly Rowland. You may not know this, but I have eczema, so I get how it can steal your time. But why let eczema take over when you can talk to your doctor about ebglis?

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32:53You should not receive a live vaccine when treated with EBCLIS. Before starting EBCLIS, tell your doctor if you have a parasitic infection. Paid partnership with Lilly. Respect your time. Ask your doctor about EBCLIS and visit EBCLIS.com or call 1-800-LILLY-RX or 1-800-545-5979. nine. And I think if you haven't been taught to trust yourself, now's the time. I think that the body has a great way, especially in perimenopause, of really telling us what's up. Like whether you want to deal with it or not, it is up for review. And one of the best ways that I check in is if there's something that's coming, an opportunity or, you know, a crucial conversation, whatever it may be.

33:33And if I feel contraction, like I feel inward, like that's probably a full body no. And if you're not sure, tell that person or tell the opportunity, like, hey, can I have a day, a day to think about it before you say yes? I don't know about you, but I was, for a long time, I was very much a yes person. And then I was like, oh, I didn't actually, I don't know how I signed up for this obligation. I never wanted to do. And now I'm like, okay, so this, I can be more discerning. I get to decide. But if you are struggling with that, if you've always been a people pleaser, if you've always been someone who has said yes, and now you're finding yourself at a tipping point where you don't have capacity, take a moment and check in with your body, check in with your intuition.

34:16Go again, like check it against what is a full body yes or no for you. And if there's contraction versus expansion, then that's your answer. Yeah. Dopamine gets derailed, I should say. Dopamine gets derailed, that's the phrase, in perimenopause. And I think that's what contributes to yeses as well because you get a dopamine hit when you say yes. So I RSVP to a party. I'm like, yeah. Now it doesn't happen anymore. Then the day the party comes, I'm like, no. Well, also you were in your follicular phase when you said yes. That is so true. It's so true. I call it the follicular trap because estrogen's riding high and everything's going well.

34:54And then when estrogen's like, I'm going to take a backseat, progesterone, do your thing. Progesterone's like, you stay home, no bra, sweatpants, that's it. Exactly. Yeah. Yeah. You brought up divorce rates highest in perimenopause. I have my theories of why I think this happens. I'd love to hear your theory. My two theories, number one, is that we do have that moment where we say, is this it? But I think number two is that we still live in a society where women are holding it all together. They are taking on the mental load. They are taking on the emotional load. And they get to a point where they don't want to do it anymore.

35:32They're tired of it. And what is it? 70 % of divorce is initiated by women. And the reason for that is that we initiate everything. We probably initiated the marriage in the first place. Oh my God. So true. I mean, when you say that, for women listening, this is leadership. Women lead. And women lead when it comes to the home, when it comes to relationships, when it comes to so many aspects of life. That's where when I see that like, when people will say like, oh, men, like you should let your husband lead. And like, if that's your dynamic, that's fine. But biologically, physiologically speaking, and based on sociological studies, women lead.

36:15Women are the leaders. And it's shown that when we do lead, there's better outcomes because we consider everyone. We don't just consider the end goal. We don't consider our selfish like intentions of like, we just want this thing, we consider how the decision impacts everyone. But, you know, as you bring up your theory, you know, my theory in this is that exactly what you're saying point to men have been borrowing your brain. They have been exploiting you. And, you know, that might sound like a harsh word, but when you are, whether you're working or not, but you're caretaking, taking care of a home is so much work, so much executive function, but there has been an exploitation of what your brain is capable of.

36:57And now it's no longer capable of all of those things. And you are going through a remodeling. You're supposed to redirect your attention. This is what biology dictates for you. It is normal. But often the male partner is like, yeah, I'm not going to give you any lead way for that. I expect you to do the same. They didn't understand the assignment. They did not understand the assignment. But it is that there was a relationship dynamic issue that existed that women compensated for over and over. Now they don't have their hormonal allies to compensate and that relationship dynamic has to change.

37:33And if the male partner is not willing to do that work, then the relationship cannot continue. And I want to be very specific in those words because sometimes people take that as like, oh, well, just because her hormones changed, like that means that like she should divorce him. No, no, no. Relationship issues existed, hormones no longer can compensate and try to basically manage that and put up with a lot of these things. And so it's an opportunity for both partners to shift and change. But unfortunately, what we often see in the cases where women are initiating divorce is men said, I want it all to stay the same.

38:09Always, always, always. You keep going. You keep doing. And I am not. Your hormones are just an excuse. I'm not trying to hear that. That's exactly what's going on. I mean, again, if we are going through a profound neuroendocrine transition and that protective shield, those hormones are fluttering to the wayside and we don't have capacity, yet your partner is expecting you to still operate at a capacity that you don't have. No, yeah, there's a breaking point. And so this is an opportunity for all of us to be better communicators in our relationship, to ask for what we need, and for partners to get educated, for partners to understand what their with their partners, what their female partners are going through so that they can support them, so that they can take on some of that load.

38:54Yeah, right now that dynamic shift for a lot of relationships just isn't there. Yeah. And there's an intimacy level here that you both have to be willing to go into because I think about just this morning, my, so I think I tore my meniscus yesterday. I'm supposed to be icing and elevating right now, but it hurts so bad and I snapped at my husband and he's just like, I can't handle that you are just being so short with me. And I'm like, well, because I'm in like so much pain. And I realized like there's a vulnerability there where I have to be like, I'm vulnerable, I'm weak, I'm in pain. And yes, I also shouldn't be interacting in this way.

39:35And I think that's something where honestly, it would be so great if like we just offered services, right? if mental health services were more accessible for couples because you have to get vulnerable as a woman to be like, these changes are happening and I'm not as capable and we don't want to say that ever, right? But also for men to be able to have that vulnerability in the relationship as well. And again, it's a level of intimacy that's rarely modeled. You're never going to see this in the media and it's not taught. No, it's not. One of the things that have happened to me in perimenopause is that my migraines have become more chronic.

40:13And if you are a migraine sufferer, if you ever had a really bad headache, you know that, I mean, it's to a point where it feels like someone completely scrambles my brain. Like I, my ability to function in terms of any level of executive functioning, like I'm always just grateful that I can fold laundry. I'm always just grateful that I can go, maybe go to the grocery store. Like there are some things I can do. But in terms of particularly being the level of parent that I want to be to my beautiful preschooler, I don't always have capacity when I'm in that level of pain, even with medication. And so I'll let my husband, Alex, know immediately when I have a migraine, because I'm usually the one doing the morning routine.

40:55And I wake up with migraines. I know immediately at 6 a.m. that I have one. And usually Alex will sleep in because he stayed up late, which is a whole other conversation for another day. But I will go into the room because Alex co-sleeps with Kingston and I will say, hey, I have a migraine. It's a migraine day. I need you to step up. I need you to get up with me and help our son, get him ready for school. And so, yeah, it's amazing how the level of communication that needs to exist when you're in pain or when you are not fully at your capacity. And that can be very uncomfortable. But for me, I think as a mom might come through almost every decision, like you talked about how every decision we're making is about the collective.

41:40And so when I'm making decisions in the morning and I am in severe chronic pain, everything I'm running through my son. And so I'm willing to have the more vulnerable conversation with my husband if it means that the quality of my son's life is better because I had the conversation. That's powerful. You know, you have brought up stress multiple times. I don't think that this is talked about. I feel like perimenopause, like right now, it's just like strength training, eat your protein, take your hormones. And I'm like, there's this huge conversation we're not having that you did this in your book.

42:15You have an entire pillar, which is cultivate more peace, calm, and emotional well-being. Okay, so this is absolutely a make or break you moment, I think, in life when it comes to perimenopause and stress. Can you explain what is going on for people? Because I think everything we've been talking about, right, there's stressors, but there's how we respond to stressors. Why is it in perimenopause, it's harder to respond to stressors and stress can get the best of us? Yeah. And I think we've been touching upon it a couple of times throughout this conversation about that protective shield, this neuroprotective shield that we have had for decades all of a sudden begins to falter.

42:56And the hormone that we don't talk enough about, estrogen, is definitely, she always seems to be getting her heyday. She is a major player here, but progesterone is really what we begin to experience first. She is declining first, that progestation hormone in the luteal phase of our cycle. And so I always tell women that symptoms, particularly in perimenopause, at the beginning will be cyclical. Not for all of us. Some of us, unfortunately, it just may all just be a hodgepodge of symptoms throughout your entire cycle. But often, it's usually in the luteal phase. I would say that my follicular phase, I'm still doing okay.

43:29Luteal phase, I mean, it's hit and miss. Yeah. Even with hormones. And I think a big part of the reason why, even with HRT, even with moving my body, even with all of the things, eating my protein out the gate in the morning, that if you are coming into perimenopause and you have a deregulated stress response system, which who doesn't at this point in life, that amount of kind of deregulation, that HPA access, when you have the hormones that are normally keeping that stable enough, they begin to fall apart. It's like that tipping point that we just can't seem to hold it all together. And so I would say it's a combination of you You already probably are coming in to perimenopause with all the things that you are dealing with.

44:14And then the hormones that were barely kind of keeping you afloat or keeping you together began to falter and it all just tips. I would say that is the big reason. The same reason why you're snapping at your partner. It's the same reason why you are noticing mood changes. You're having that sudden bout of rage. It's because we don't have the capacity to carry the amount of stress that we had been able to in the past. Now, something else you brought up in the book is that by age 45, women are more likely than men to be overweight or obese, which is a significant risk factor for diabetes. So that is a stressor in itself, but we also know that in diabetics, that's going to affect your brain function.

44:54It's going to affect your hormones overall, certainly going to affect your longevity. Can you talk to women what is going on there? Because I feel like it does dovetail into the stress conversation as well. Absolutely. Definitely. I wish this was operating in a silo. None of this is operating in a silo. Also, when we're experiencing extra stress, we know that that is going to co-elevate insulin. We know it's going to co-elevate glucose because your body honestly thinks that you are getting chased by something and you're not. Usually you're being chased by a deadline or a harsh conversation. I thought you said deadline.

45:30Deadline. Okay, I got you. Oh, man. No, a deadline. or, you know, or traffic or whatever it may be. Like even getting here today, I remember I mapped the traffic on, you know, a couple days ago, but with the rain and everything, it was an extra 20 minutes. And all of a sudden I was like, oh my goodness, I got to go. Because, you know, it just, you know, all of a sudden we're just on these, we're on these deadlines. And so stress is, it comes in many flavors. It can come in the metabolic changes that we're experiencing. It comes in the declining hormones and it comes in the everyday things that we're dealing with that make life life.

46:06But particularly with the metabolic changes, I think a lot of us, I think in our 20s and our 30s, we had more capacity than we did. With insulin, again, rhythmically doing its job every single month, we had more protection. We had more metabolic protection. We had more glucose and insulin protection. But as those hormones began to decline and we have other hormones like cortisol deregulating, we start to experience those body composition changes. You know, one of the things I was reading in the Journal of Hormones back a 2009 article, when we look at chronic stress, we know that it co-elevates, not only it co-elevates overeating, but it co-elevates cortisol and insulin.

46:47As a result, we see those body composition changes. We see the visceral belly fat that happens. and that becomes this crazy spiral where we drive more insulin resistance and we drive more inflammation and oxidative stress. But I would say the real reason why women are seeing an increase in body weight or changes in body weight composition is due to the fact that we're not only dealing with stressors, but our hormones again are shifting. So it's all interconnected. But luckily, I don't want women to think, oh gosh, there's nothing I can do about this. There's a lot that we can do about it. And I think that first step is just giving ourselves extra grace and just knowing that we aren't broken.

47:24We just need a new level of support. So that was gonna be my next question is what can you do about this? You've got this chronic stress, you've got this metabolic dysregulation. Where would you say is a good starting point? I love this question. And yes, isn't this the million dollar question? I would say where I would start is I would bookend my days. I would be super, I would say treat your sleep like it's a million dollar meeting, but treat your morning like it's also a million dollar meeting. Like I think one of my favorite quotes is by Louise Hay that she says, how you start your morning is how you live your day.

47:58And how you live your day is how you live your life. And if the morning is chaos, the rest of the day is gonna be chaos. The life is gonna be chaos. But even if you are not honoring your sleep routine, so I think booking in your morning and your evening with things that are going to help you feel alive, things that are gonna feel safe and that's going to send your brain safety signals I think that sets you up for a major win. Good sleep is everything. That's why Oli's Science Back Support is made with a blend of melatonin and L-theanine for both kiddos and grownups. So when your mind won't switch off, you've got something that can help.

48:34Erasing thoughts and restless nights won't stand a chance. Find Oli's sleep solutions for the whole family at Oli.com. That's O-L-L-Y.com. And then also, if the morning is what's going to set the tone for the rest of your day, what are you putting in your body? How are you fueling your future self? Like I always ask myself, particularly, I know you and I have both had brain injuries. And I will tell you that since the brain injury, my brain has been extra vulnerable. That was just two years ago that this happened. And ever since, one, I, sleep will make or break me. So even just switching time zones, if I'm not very consistent about my sleep consistency, I will feel like hot garbage the next day.

49:18So sleep is such a big part of that. But also, what am I putting into my future brain? So every meal I have, everything that I consume, I always ask, is this going to fuel my future brain? And that's usually, it's going to require protein, lots of fiber, and healthy fats. Like that's what's the cornerstone of what makes up my breakfast and most meals throughout my day so that my brain is actually functioning. But as a result, I'm fueling my metabolism. I'm fueling my cells at the same time. You have a preschooler. You're talking about protecting your mornings. What do your mornings look like as a busy mom?

49:52Getting up way before that child gets up. That's what it looks like. And so again, that means going to bed early. So my nighttime routine starts right after Kingston goes to bed. So Kingston's asleep at 8 p.m. So that he gets his 12 hours or 11 hours of sleep, right? Everything's reverse engineered around your kids. So after Kingston's asleep, my nighttime routine starts at 8.30. That means no TV. That's no screens. Like I am really, really adamant or very disciplined about my nighttime routine. I take my supplements. I have my book. I've got my dim lighting. I've got everything set up so that I am asleep, like lights are off by 10.

50:30And so that means I wake up, like I have a sleep cue that kicks in around 9.45, 9.50. And I'm asleep. I'm asleep by 10. and then I wake up at 6 a.m. So I have a wake cue at 6. I don't even need an alarm clock anymore. And my son doesn't usually wake up until about 7.15. So I have an hour and 15 minutes that is mine. So that is either walking outside in nature or I'm at least grounding out in my backyard and getting sunlight on my eyes. It's kind of right when the sun is rising. I am moving my body in a meaningful way, whether that's yoga. Personally, for me, it's walking. Like walking regulates my nervous system.

51:07Walking sends safety signals to my brain. Walking supports my blood sugar in the morning, and it helps to wake me up. So walking is usually, like, I would say, if you're stressed, walk. If you want to balance your blood sugar, walk. If you need a moment to yourself to listen to a romantic fantasy book, walk. Like, that to me is the ticket to just vitality and aliveness in the second half of our lives. So that's what I do. I make sure that I've got time where I am not in mom mode to take care of me. Mm-hmm. You brought up reading at night and that is one of the simplest hacks to drop sleep. And we don't talk about it enough because there are studies that show that people who read before bed, their cortisol goes down.

51:49So we're always like doing all these hacks and stuff, but sometimes it can be as simple as reading to help relax you. And I love that you went through this morning routine of like, how do you get your sunshine? How do you ground? You talked about walks. I don't know why the internet is on a, they're on a, uh, let's hate walks and let's hate Pilates thing right now. I'm like, firstly, with Pilates, I don't want to pee my pants. Okay. So like, yes, love Pilates. But secondly, I'm like walking is so much more than just like, what's your calorie burn and what's your heart rate at? Like, yes, that's, that's all important in a day, depending on your goals.

52:27But as you talked about starting with that parasympathetic activity can totally set the tone for the day. And I love that Louise Hay quote that you brought up. And you know, I want to, I want to ask you, I'm going to keep going in the stress conversation, but I thought of this. Okay. So you were talking about like the brain fog, the losing words, like feeling like frazzled. Am I going to meet the deadline? But you just wrote this book, The Perimenopause Revolution in a year. I know what it takes to write a book. I've written, I've written books in a quarter. In a year. I wrote it in three months.

52:56Well, that's the thing, right? Okay. So if a book comes out in a year, y 'all, we wrote it in three months. So Beyond the Pill wrote it in three months. Is This Normal wrote it over a two-year period of time. I felt like that was kind of painful. My next book, writing it in four months. So how did you do that? How did you do that with this perimenopause brain? I know women want to know. Oh, that's such a good question. I want to go back to even the proposal because I was a year out from my brain injury. And I remember I had been wanting to write this book so bad. It was in my heart and it was in my soul.

53:26And finally, I remember it was December 2024, no, 23. And I was like, I think my brain is ready. I think I can do this. Yeah. And so I wrote the proposal. I signed the book deal last August. This is literally like September 2nd today. And they were like, we need it by the end of the year. And so I started it at the end of September. And I, I, you know, I will say this isn't my first rodeo. So thank goodness for that. But I had already had an outline, I was ready. And I, I have a great team that was able to do a lot of the other things that, you know, I didn't need to be involved in. But I carved out probably two to three hours a day writing this book, I took a lot of walks, I did a lot of resets.

54:11And then the thing I was, you know, a lot of people have been asking me, like, I'm sure you get this too, where people want to be an author and they're like, how do you even do it? And I was really grateful. My husband, Alex, gave me, I got to take two writing weekends. So I left the house. Now, mind you, I was down the street because God forbid I'd be gone away from my son very long. But I got a hotel room down the street from the house about a five-minute drive because I needed my favorite coffee and matcha shops that I love. And I worked from Friday morning until Sunday afternoon. And I remember getting, I think, five total chapters done in those two writing weekends.

54:50And I would say that I'm not sure if I would have finished the book without those writing weekends. But yeah, a lot of breaks, a lot of having a good outline and a lot of walking, a lot of walking in between writing. That was how I got the book done. I also walk while you're sitting in the room with treadmill at my desk right now, where if I get stuck, I have to walk. Or if it's time to review a chapter, I have to walk. But you brought up something that I think people neglect and is so important for productivity, but also mental health, and that is rituals. You were like, I have to be by my matcha shop.

55:26I have to be by these places. There's something that, as you were saying, people will ask, like, how do you do it as a writer? You gotta know your rituals and like what is like home for your brain, what your brain is like. We love this. This makes us happy. It's like little bits of like joy or delight that you get in your day. And I think that people start to neglect rituals and especially women start to think that rituals are kind of frivolous, not necessary. How important do you think rituals are to overall health? I think they are 100 % necessary if we want to get through this transition and we want to feel good.

56:00I think it's important. There's two mantras that I say to myself a lot because I always, we could go so far as to say that maybe I create problems to solve problems. And so there's something that I say, and that is nothing is wrong. Nothing is wrong because I think we're always constantly trying to solve problems. And then there's no time for feeling good. There's no time for like tending to yourself. There's no time for just doing something that feels good. And then the other mantra is it feels good to feel good. And I remember when I heard that mantra for the first time. I think it may be a Gabby Bernstein mantra.

56:34And I remember it really messed with me. I was like, wait, we get to feel good? Like I get to feel joy? Like, I don't know about that. Like, I feel like, again, that must be frivolous. Like, I don't have time for that. I don't have bandwidth for that. But like, you can't afford not to. Like, we got to create joy. I always think about like, what's the whole point of all of this? You know, and it's doing the things that we love with the people that we love, doing things that fill our cup, sending the brain safety signals that everything is okay so that we're not in a constant state of vigilance and hyper-awareness and, again, solving problems.

57:11And I think our bodies deserve it. Our bodies need it if we are going to have vitality into our 50s, 60s, and beyond. What you just touched on, people who have high ACE scores, adverse childhood events, or trauma. I want you to rewind and listen to that again because these are the people that have the hardest time thinking that they just get to feel good for feeling good's sake. These are the people that think that exactly, like, and it's not like you just decided this. It is something that is part of the trauma response to think you have to earn joy, that you have to earn these things. And so that's a message I want.

57:46You know what? Literally, everybody rewind and listen to that again, please. I want to talk about progesterone that you brought up earlier, because without that, it's pretty easy to fly off the handle, to have rage moments, but people pleasing goes out the door. What can people do if they get triggered in the moment and they feel that, right? This is coming like the three, five, seven days before your period and perimenopause, it starts to become more unpredictable for loss of progesterone. What are your tips to not allow little life stressors, sometimes big life stressors to completely override our nervous system?

58:21I love this question. Number one, track your cycle. Please track your cycle. The more data that you have on yourself, the more that you know yourself, that you know your normals. If you know that on day 21, it's about to get unhinged, be ready for day 21. Like, know on day 19, communicate with people, let them know that the day 21 is coming, right? So be ready for that. Look at your schedule in advance. If you know that you're going to have more rage, you're going to have more irritability, mind you, you know, be talking to, have the conversation around hormone replacement therapy, be thinking about that.

58:57But I will say that I'm still on HRT and day 21 rolls around for me and some months are better than others. And I carve out more alone time. I carve out time with friends. So my recommendation is if you know you are going to, like work isn't going to shift, family obligations aren't going to change. What can you carve out for yourself? Can you carve out five minutes of alone time, 10 minutes of alone time, 20 minutes of alone time. Also know your triggers, like you said, is it going to be, you know, kind of the end of a day situation for you where you're trying to figure out dinner? How can you set yourself up on days where I have migraines?

59:36We have an amazing, organic, beautiful taco restaurant where I'm not cooking. Yeah. Like on those days, we're going to, I don't need a migraine to order tacos, but yeah, you go off. I just mean like, how can I simplify my life? You know, how can I make it easier where there's some things I can't change, Jolene, right? I can't, I have, I'm always going to still be the mom. You know, there's going to be some parts of my life and my day that I'm going to have to be involved in. But how can I make it easier for me in some ways? Also, after dinner, especially if the family's watching something, I'll ask, you know, ask your partner, can I just go for a walk?

1:00:12can I have a minute before I need to clean the kitchen or do the nighttime routine, whatever it may be? Can I just go and have five minutes? Like the sun is setting right now, right at the end of dinner. And so I'm like, hey, can I go and watch the sunset for five minutes? And then I'll be back and I'll be more resourced. I also know when I start to spiral, I'll start to be more reactive. I'll notice that I'm talking faster. Again, I'm problem solving too quick. So I know my triggers. and at that point, it's time for me to shift my state. And the thing that will shift your state the quickest, for some, it's gonna be movement.

1:00:49Maybe you just need to go into another room and do some squats or do some yoga moves. Maybe you just need to be outside for a second and walk around the block, or maybe it's breath work. Just know the thing that's gonna move the needle for you that's gonna help you to shift your state. And then also connect with somebody, whether it's a bestie on a two-minute voice memo or it's your partner, whatever that may have, have connection. I always find that what makes me feel the safest is knowing that people have my back and that people understand what I'm going through. So that would be, it's a one, know your trigger, shift your state.

1:01:25It's often know your senses and then connect with somebody that feels safe. This community piece of health is so important, but can you talk about why community is so important for perimenopausal women and especially those who have nervous system dysregulation, they're feeling at the mercy of stress most days. Oh, yeah. I mean, I would say that isolation, we know that isolation alone. And there's no more of an isolating time than when your body is changing without permission and you have been taught to blame yourself. And so a lot of us will think, gosh, no one understands what I'm going through.

1:02:03I'm embarrassed to talk about it. I'm embarrassed to talk about the leakage. I'm embarrassed to talk about the rage. I'm embarrassed to talk about the fact that I don't feel like myself anymore. I think society expects us to just keep it all together. And so we end up going inward. We end up isolating because we think that no one understands what we're going through. And I will say on the days that I have migraines, even though I know millions of other women are having migraines across the world, 80 % of migraine sufferers are women, that it's still like, it feels like no one understands what I'm going through.

1:02:34Like no one can understand this migraine right now. And yeah, it's so easy to want to go inward. But that's the last thing we need to do because we know that that isolation isn't protecting our brain. It's not protecting our cardiovascular health. It's not protecting our peace. There's nothing peaceful about suffering and silence. And so if there's ever a time where I know we want to lean out from relationships and connection, I just want you to know that leaning in is going to be the safer move, that leaning in is going to be the thing that's going to protect you. And it's going to help your brain feel more safe inside and you just feel more safe inside of yourself.

1:03:10Whether that is a animal or a friend or a family member, like please lean into relationships in this transition because it's what's going to get you through it. I mean, tend and befriend, the research is clear, like that is what we need to leverage this perimenopausal journey. For women that are listening to this right now and they're like, well, I don't feel like I have much of a community. What are some tips to start cultivating community? I love that. Number one is decide that friendship is worth it.

1:04:03the first six months of card membership. Terms apply. Learn more at go.amex.com. Just decide because it's going to require a little bit of effort. I think especially women in Perry, a lot of our friendships were probably maybe preschool moms or sports moms or just like we created community because we were within the same proximity. But if you're finding that all of those relationships are dissipating because kids are off to school or you're not in that group anymore, begin thinking about who in your life can be upgraded to a friend. Maybe it's a colleague or maybe it's someone that you've seen at the coffee shop a couple of times and be okay with initiating.

1:04:43I always say that I like to often when I'm getting a new friend, I'm often courting that friend. So be the one who follows up, be the one who sets the date, be the one who brings the special little gift, buys the matcha, you know, creates the experience. And if you're still having a hard time with that, I mean, you can always connect to social networks, lots of communities around perimenopause and menopause, or even begin to join things that you love, whether it's a Pilates class or it's yoga class, or it's a meetup group, maybe it's a hiking group. You know, I think of my mom, you know, she's training for another marathon right now at 64 years old.

1:05:18And actually there was a marathon this weekend here in Mexico City. We saw it and she was so bummed. She's like, oh my God, I could have been running this marathon. But she does, she runs not because she even loves running anymore. Although I think there's some level of loving it she does love, but she does it because she loves the group. She does it because she loves the women. That's the reason why she has a running group. That's the reason why she's running another marathon. I'm like, you know, you could have the running group and maybe not run the marathon. But yeah, I mean, just whatever hobby or thing that you love, there are people who love it too.

1:05:50That's another way to develop those friendships. Yeah. So I wish I would have known your mom was coming. She loved running so much. There are running nightclubs. So everybody gets together. They run through the parks. It ends in a fiesta and basically you're eating tacos and you're having like a disco dance party. Like it is people don't like there are people that still club here, but in Mexico City, there's a big, big focus on health. And so everything is about health, community, and how do you party and celebrate like your movement. I've actually been working up to it with my physical therapist.

1:06:20That's why I'm so mad I hurt my knee because I was like, dang it. Like I wanted to go to the, I don't even like running. I just want to like hang out with the disco party and the tacos. It's like, yeah, yeah. Maybe I should meet them at the end. Maybe like spray myself with a water bottle. Oh, I'm so sweaty. You could just be the friend that's cheering them on, right? You think about even the marathon runners. Oh my gosh, I'm definitely not telling my mom that this is happening here because she would have wanted to go. But like, I always think like If I had the ultimate hack, it would be walking or hiking with my friends after grabbing a matcha.

1:06:53I'm right next to the beach, like a block away from the beach. And so we go to our favorite little organic cafe. We grab our matcha. We head down to the beach. We walk barefoot. So now I'm grounding. I am talking with my friend, usually talking about romantic fantasy books with one of my friends. I've got my matcha, and my body and my brain feel safe. So that's my favorite. That's my favorite hack of all time. Let me ask you, in writing this book, what are a few surprising underrated tips that you learned in the research that you're like, why weren't women told about this? Like, were there any aha moments for you?

1:07:28I would say, I think it's the moving all day as much as possible. The neat movement is so critical. I remember growing up thinking if I didn't do the big workout, then the walking wasn't what it needed to be. Like, walking wasn't running. Walking wasn't strength training. And so I was like, oh my gosh, you mean the bigger, like the juice is worth the squeeze in terms of, you know, just moving and punctuating your day with movement. So I think the big takeaway for me in the book and in the research was that we need to build our life around movement. I think that is so mission critical. Also, I had no idea how important community and friendship was, especially when you're going through this transition and everyone is telling you that something is wrong with you.

1:08:13Like when there's nothing more, you know, more gratifying or more relieving when your best friend also thinks she has dementia, you know, you're like, oh, okay. So we all have dementia. We're good. It's because so often when you're, when you think it's just you having these symptoms, you're like, oh my gosh, it's all falling apart. And then you have your friend. She's like, oh girl, I can't even, I still haven't found my keys today. You know, you're just like, oh, or I, oh yeah, I absolutely sneezed. and peed a little. Like, you know, and so you're just, you're like, oh, we're all, we're all in this together.

1:08:48So I think that was, I was like, friendship is so mission critical. And I would say the other thing that really I thought the research was really interested in was that being, being out, just being outside, being in greenscape, like, gosh, it's so, it's so nurturing for the soul and it feels so good. You want to regulate yourself. You want to regulate your immune system and your nervous system. Just be outside in nature. Get into a park, get into the grass, go smell the roses. That is so instantaneous for shifting your state. It doesn't have to be complicated. I think that's the other thing. None of this needs to be complicated.

1:09:25I know there's so many complicated protocols out there and so much of what you have to do. No, it's simple. It doesn't have to be complicated. But make time for you and be consistent. I love all of that. And I want to say, I purposely wanted to have a conversation about perimenopause that wasn't solely focused on hormone replacement therapy or menopause hormone therapy or whatever. Whatever we're called, PET. It's honestly - Progesterone, estrogen, testosterone. I want to say that I appreciate all the women putting their effort forward to try to get a better name for this. But being in the endometriosis community, watching what happens with PCOS, often as practitioners, when we want to rename things, we've kind of lost the plot of what patients really want and what patients really want is just education and access.

1:10:11And so I don't know where that'll actually go because I'm like, that's a scan. That's like a lot of, and also what happens to O-estrogen people, which is like most of the rest of the world outside the United States using that. So I'm like, it's also, I always have a problem when people are very like, we're the US, we're the center of everything. Therefore we name, we control everything where I'm like, we have to be like, we have to have a global movement for women. I don't know what's going out with that. I'm not being critical. I appreciate efforts, but I also think like whenever we've seen PCOS, endometriosis, other women's health conditions that we're fighting to get attention and correct treatment and just diagnosis for, and then people start stepping in to change the name, we see that efforts get diluted and change never really happens.

1:10:55And you look back and you're like, wow, 10 years, that actually set us back. So we'll see. I'm open to it, but here's my thing. I agree with you. And we're still failing women even or in the U.S. or the U.K. where, let's just say, hormone replacement therapy is a little bit more readily available. I mean, we're just failing women across the board. You know, we're far from giving women the level of access and education that they deserve. In Mexico, HRT is over the counter. You just go to your pharmacist and talk about it and they'll hook you up. Oh, that's awesome. I know. It's not cheap. It's not cheap.

1:11:24No, it's not cheap. But it is something that people will ask me, like, how do you feel about, like, do you think this should be over the counter and women should have access to it. And I'm like, well, there are countries doing that. When you look at the countries that are doing that, like there's some pretty good outcomes. Like the only thing in Mexico you don't get over the counter is narcotics, yes, and antibiotics. Great. You don't see people abusing medication. So I think that it is something that I'm like, oral estrogen, that one's a little tricky, like, you know, clot risks, different factors with all of that.

1:11:56But it is something where I'm like, if doctors are going to gatekeep, gatekeep labs, gatekeep these life-saving medications, chronic disease-preventing medications, then we have to start to ask the question, should we actually put the doctor between these things anymore? I'm going to hate for that. I was just having this conversation with two dear friends about just gatekeeping labs. Just, my gosh, like women deserve to know what's going on with their bodies, particularly at a time where it's going to change. You know, what your labs look like in your early 40s, they are not going to look the same in your late 40s.

1:12:31And then by the time we start to see these changes moving in an unfavorable direction, we should have been taking action at that point way before that. And so I agree with you. And what's interesting, even if, let's say, doctors are prescribing the medication progesterone or estradiol, you're still having to figure it out. It's your body. You know, I can't tell you how many times I have changed my dosage. And then I'm also changing my dosage at the house. I'm experimenting in my own right. So, I mean, women are just trying to feel better. We're just trying to get back to a place of equilibrium.

1:13:04I'm constantly messing with my estrogen dosage. You know, I'm cutting my patch. I'll just say it, you know, because, you know, in order like to have, even when I have a great provider, a doctor that I love and admire, I love her, but even just getting in front of her, she slammed, you know, and so I'm constantly playing with it myself. And so I love that that's accessible here because women are just trying to figure it out. They have to take it home and figure it out, even if a doctor is guessing at a dosage. Yeah. It's something that I think doctors are going to have to either adapt rapidly or they're going to find themselves in a really uncomfortable place in society because for too long, doctors have gatekept labs.

1:13:46They have gatekept so much. And they gatekept the knowledge that they didn't even have. That's exactly what I was going to say is they would keep the knowledge of like, what is true? What is true informed consent? All of that, because they're like, I have to get a woman to do what I want. And so no matter the cost and taking choice away from her. But when I'm seeing more and I'm not necessarily advocating for this, but women are going on chat GPT, putting in their symptoms. They're getting the lab report. They're going, they're going and getting, they're getting the list of labs. They're going and getting their blood drawn.

1:14:20then they're putting those results in there and they're proceeding and they have completely circumvented their doctor and I want people to know that AI has great utility but there it doesn't know what to ask you it doesn't know it only knows what you put in so if you have a family history of something if you need it's not going to know these things like that there's a necessary role for the doctor but when doctors make women feel like trash every time they see them gaslight them I mean, nothing that I'm saying isn't well documented in the research that doctors have absolutely violated their oath in not doing harm because they absolutely have in women's medicine.

1:15:00And when we consider something like HRT, you know, I was gobsmacked when I saw it was Mary Claire Haver who was like, I just started prescribing HRT like a couple years ago and I was never trained in this. And I was like, I was trained in this. And I was fortunate that in my women's health rotations that my attending was going through perimenopause. So she was like, y 'all better know how to manage this. And I'm like, but I was just blown away to hear that in gynecology, they're not trained at all, but they're out there. Like they're gynecologists who are like, I'm a hormone expert. But when you ask them, they can prescribe the pill.

1:15:36And that's where it stops. Yeah. I mean, it's a surgical residency when you think about gynecology. That's really what it is. And no, none of them are getting, I think now in the U.S., we're up to 30 % of gynecological residencies are getting a level of menopausal care, not perimenopausal care, just maybe menopausal care. And that's up from 21 % about five years ago. But we still have such a long way to go. And I think that's the other issue. We're gatekeeping information that we don't even know. Yeah. I mean, that's the biggest problem is that doctors feel it's a liability to prescribe, to give women what they need.

1:16:13And so I'm not surprised that women are going outside. I mean, we are a place, at least in the US and in Europe, where we're stepping into a time of not only bio-observability, but we can order our own labs. And that's what people are doing, women are doing. Because it's that or they suffer. I have to tell you, we met like 10 years ago, I think. And at the time, I was prescribing HRT and I would get the nastiest emails, letters like from doctors who were like you're gonna kill your patient like this is like the worst thing you could be doing and um oh that I gave progesterone if you didn't have a uterus and I'm like well she needs sleep she has anxiety she has mood and like dealing with stress the hate that I got and people like I mean it was there was just so much it was like a witch hunt for like any of us who were prescribing HRT.

1:17:06And now it's like things are starting to turn. We see more acceptance, but those people with that mindset, they're still out there. They have a fixed mindset. And so for anyone listening, if you meet someone like that, get a second opinion. You know, I was just actually telling my assistant today, because she was like, are you going to have to have surgery on your knee? And I was like, anyone who tells me I'm going to have surgery, I need surgery on my knee, I'm going to have three more people I meet with before I commit to something that big. So it's not that you keep seeing people because you don't like the answer that you're getting.

1:17:36You just need to confirm that it's right for you. And when it comes to a doctor saying no HRT, they're working off women's health initiative information, you need to confirm is that true for you? Because sometimes your doctor, they're working off the information they have, but it's not updated information. Yeah. I always say that it's not necessarily, it's not malice and, well, I don't know, with women's health, who knows if it's medicine center or not. But I always say it's just that they don't know what they don't know. They only know what they know. And if they're not willing to step outside of what they've learned or lack of learning, then there's a big stopgap.

1:18:13There's that big knowledge gap that is existing. And so if you are going to your doctor, I always say, ask them point blank. Do you take care of women in perimenopause? Do you feel confident with perimenopausal care? Are you prescribing hormone replacement therapy to your patients? And if they don't have an answer or they're not sure, or they're kind of, you know, kind of stepping around it, it's time for you to get a second opinion, find someone that this is where they're well-versed in this. They're working with women just like you, with symptoms just like you, and they've got the nuance taken care of.

1:18:42They know how to manage this with you. And yes, unfortunately, I know that those doctors are few and far between, but they're out there and it's worth, it's your health, your vitality, your aliveness, the second half of your life, you deserve to feel good and you deserve support. Yeah. And, you know, as you say, all of that, there's been doctors out there for a long time. Dr. Tara, I will link to her episode. You know, I talked about how like, you've been prescribing more than a dozen years, the hate I got. She's like, try doing it 25 years. She's like, you have no idea how like people would try to contact my board and say like, I was doing bad things and like, I'm just trying to help women live their best life.

1:19:22So the whole reason I actually started down this rabbit hole of HRT is that you're using HRT, but you're doing all of this nutrition, lifestyle means so much more. What percent do you feel like HRT is contributing to you filling your best compared to all of the other things that you're doing in your life? I would say somewhere between 10 and 20 percent. 10 and 20 percent. I would say the number one thing that helps me is walking. like i'm gonna pass this episode and it's just gonna be you being like walking walking walking walking i'm like if i haven't if i haven't reiterated this a thousand times no i i actually asked myself this the other day as i was putting on my estrogen patch i'm like what percentage of of my health and vitality is based on hrt and i was like you know it's got to be i would say max 20%.

1:20:17Now, 20 % is a lot. It's still, I think it's worthwhile, but it's the lifestyle strategies. It's sleep, it's movement, and it's alone time. It's, you know, an alone time, meaning I am voice memoing my besties when I'm alone. So it's not being a mom in that moment or a partner. I would say those are the things that are moving. And also, obviously, eating to support my body and keeping inflammation down. Those are going to be major players. But I would still say lifestyle and allowing my body to be a good, healthy host for hormones is probably the bigger lever that I'm pulling. Yeah. I think that's so powerful for women to hear because HRT is having its moment.

1:20:57It needs its moment, rightly so. But what's getting left out of the conversation is that there's this promise that HRT is your solution for everything and not enough empowerment that women have the tools every day to step towards health. And that, I mean, 20%, not insignificant, But when you consider what the 80 % is, that doesn't need a doctor's prescription. That is all the things you can be doing on your own. Yeah, and I think that's the reason why, although HRT is a pillar in this book, in the perimenopause revolution, the other pillars are movement, are stress reduction, are sleep and circadian rhythm optimization, are balancing your blood glucose.

1:21:34All of those are the pillars that I really feel are moving the needle in terms of women's cellular energy. Because the biggest complaint outside of the brain-related changes, which are profound, is going to be the energy and cellular energy. I mean, that is the quality of what you think, what you feel, and what you do. And so a lot of the pillars in this book are based around the quality of your cellular energy. And for me, that is the through line for how to feel alive in your body and how to navigate the second half of your life. HRT is a cherry on top. Now, I will say that can estrogen get you in the gym?

1:22:07Yes. If you have lacked the motivation, if you have been feeling flat and lacking that confidence, and you bring HRT in and it's the light bulb movement for you to actually finally move the needle in doing the lifestyle, then amen to that. And so I always joke that HRT isn't going to lift the weights for you. It's not gonna walk you outside, but it could give you a little bit of that boost to actually do those actions. So it's a yes and, like I would never, it breaks my heart when I hear that doctors and providers are gatekeeping HRT because women aren't doing the lifestyle, but what if they're not doing the lifestyle because they just feel flat?

1:22:46They feel depressed. They feel unmotivated. And if a little bit of testosterone or a little bit of estrogen can change the game so that they're actually doing the things to feel more alive in their body, then I am a full body yes to that. This has been a phenomenal conversation. Thank you so much for one, overcoming perimenopause and writing this book for everybody. And two, taking the time to sit down with us today. Yay to overcoming perimenopause. Thank you. Awesome. Legally, we can't say drinking Storm makes you smarter and more focused. But with zero sugar, 200 milligrams of caffeine, and immunity support, you're smarter and more focused for drinking Storm.

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