Weight Gain in Perimenopause Over 35: Why Your Body Is Changing and What Actually Works

0:00So good, so good, so good. New summer arrivals are at Nordstrom Rack stores now. Get ready to save big with up to 60 % off brands like Rag & Bone, Levi's, Adidas, and Free People. Join the Nordicub to unlock exclusive discounts, shop new arrivals first, and more. Plus, buy online and pick up at your favorite rack store for free. Great brands, great prices. That's why you rack. Hey, I just Venmo'd you for rent. Nice. Now I can instantly spend it whether I'm checking out online with Venmo or using a Venmo debit card. Say more. More exactly. Because the more you do with Venmo, the more you get. Like earning up to 5 % cash back with Venmo Stash on a bundle of brands.

0:43So, order more pizza. The math demands it. Get the Venmo debit card. Venmo Stash bundle terms and exclusions apply. See terms at Venmo.me slash stash terms. Venmo checkout not available at all merchants. Venmo MasterCard is issued by the Bancorp Bank N.A. weight gain that seems to come out of nowhere and an inability to sleep. Welcome back to the Dr. Brighton Show. Today, we are going to get into one of the most frustrating and most misunderstood issues women face after 35, and that is sudden weight changes that can feel completely out of your control and the sleep problems that always seem to come along with them.

1:20If you feel like your body has changed overnight, if you're gaining weight in places you never used to, or if your sleep is getting worse, you're in the right place. And listen, if you're also feeling more anxious, more inflamed, more tired, there is a reason for it all. And it has nothing to do with willpower and everything to do with your hormones. So after age 35, there's a series of hormonal shifts that begin to fundamentally change our metabolism and our weight distribution. So progesterone is going to quietly drop first. Progesterone is made after ovulation, and as the corpus luteum, the little structure that's left behind after ovulation, isn't as strong as it used to be, and then we slowly, over time, ovulate less regularly, we see progesterone drops.

2:10By the way, in this episode, I'm going to talk about labs that you should have tested and what the lab values are. So definitely stick around for that. Now, the other thing that happens is that estrogen can become more chaotic. Often when you see the diagrams of what happens in perimenopause, it's always like, an estrogen slowly declines. No, it doesn't. Estrogen's doing this before it's like going down and it does decline, but not before it rocks and rolls all over the place. now we also see that cortisol can rise or it can fly now it's really like dealer's choice is what it feels like but for almost all women as estrogen goes down insulin resistance creeps in we're going to talk about why and after age 35 it is more common to see hypothyroidism develop and so thyroid conversion can slow on its own or we can develop Hashimoto's an autoimmune thyroid condition.

3:03That's going to affect our thyroid. That's going to affect our metabolism. And just to be clear, none of this means your body is broken. Your body is adapting. It's adapting to a new era of life. And so it's a lot of changes that your body's going through. We're going to walk through today why this is happening, what labs to run, and the exact steps that I recommend that you would implement today so you can get your metabolism, your mood, your sleep back on track. Now listen, before we get into it, if you can take 30 seconds, leave me a review. I'd really appreciate it. Wherever you're listening to this right now, your reviews help this podcast thrive.

3:44It also helps center women's voices in women's medicine. Podcasting is primarily male, so your support means everything to me, and I really, really appreciate it. Okay, so let's start with what's actually happening biologically, because once you understand the why, everything else makes sense. As I mentioned, progesterone is going to drop first. Most women don't even realize this, but that progesterone decline is why sleep starts to get so bad. And that decline is happening way before even we're detecting estrogen changes in our body. So when we have low progesterone, it means lower allopragnenolone, which is a metabolite that stimulates the GABA receptor in your brain.

4:27When that's down, you feel more stressed. The stress feels more intense. The HPA axis, that's how your adrenal glands are communicating with your brain, that pops off wildly. Now we got cortisol problems. Your sleep, it's not just hard to fall asleep, but it is the staying asleep and it's the early morning waking becomes a problem. Blood sugar can also become unstable during this time with progesterone changes, though it seems less pronounced than with estrogen, but it can start early on. When progesterone is low, it is very common to feel more anxious and more easily overwhelmed and to have worsening PMS symptoms, worsening PMDD symptoms.

5:09Like your PMS is super disruptive. And I swear to God, if your partner or your boyfriend or anyone chews wrong or breathes out loud, you may just fly off the handle. and this early change of progesterone can also signal the body to become more prone in storing fat. Again, we always talk about estrogen, but progesterone is involved in this as well. And like I said, when progesterone goes down, GABA doesn't get the stimulation that it needs and that calming neurotransmitter just doesn't keep us calm. Now, the other thing that happens is that with estrogen becoming inconsistent, unreliable, it's erratic.

5:49Some weeks it's high, some weeks it's low, some months it's normal, some months it's not. That's a whole roller coaster, and that roller coaster is affecting your appetite. So estrogen actually weakly suppresses appetite. It doesn't like squash it, but it helps with appetite regulation. When estrogen goes down, we find our cravings come up. When estrogen goes down, we have blood sugar instability. cravings will also come up because your body will panic and say, grab that donut. It's the nearest thing and we need fuel. We need energy now. Estrogen also helps our muscles function better and it really governs where we store fat.

6:29So it's a big player in fat distribution. When we are in our younger years and estrogen's right and high, hips, butt, thighs, that's where we're going to put our fat. When we get older and estrogen declines, we start putting the fat around our organs, deep visceral fat that contributes to a lack of insulin sensitivity. And so estrogen, insulin, they're all involved along with that fat distribution. And this is happening in our late phase perimenopause. And on top of gaining fat, we don't build muscle as easily. So everyone always thinks testosterone for muscle. Yes. And estrogen is super important for that as well.

7:08It's also super important for our joint lubrication and our ability to actually like go to the gym, move our body and not get hurt. So I want you to keep in mind estrogen is not just a reproductive hormone. It is a metabolic hormone as well. Now, progesterone is dropping, estrogen is fluctuating, and now here comes cortisol. The body is shifting into survival mode. Cortisol steps in to compensate, but the problem is cortisol can contribute to you storing fat in your abdomen. Thanks, body. It can feel like a lot, but I just want you to understand what is going on with hormones because this whole like eat less, move more, you just lack willpower is not doing anyone any favors and it's not profound like advice for women.

7:52We have to about the nuance of what women actually need to know about their body and how to support their body at the stage that they're at. Like I said, estrogen regulates your appetite. If estrogen goes down, telling you to just eat less, you're going to feel like a failure. So with cortisol, when that gets dysregulated, you might be waking like 2 or 4 a.m. You might have more cravings for carbohydrates and salt. Cortisol also blunts thyroid conversion. When you have chronic stress, you're not going to take your thyroid hormone into the active form. I will link to our episode all about thyroid health and I give you the reference ranges of the labs you should be looking for.

8:30You'll find that in the show notes at drbrighton.com, D-R-B-R-I-G-H-T-E-N.com. But with cortisol being dysregulated, this is why you feel like you're eating normally and you still feel like your metabolism has suddenly changed and your body's betraying you. We've got progesterone, we've got estrogen, we've got cortisol, and then we've got that insulin resistance I talked about. So I have an entire episode about the labs and the reference ranges on that, what you want to get tested, what you should look for. I will also link to that in the show notes. But I want you to understand estrogen is really like the pivotal little straw who breaks the camel's back here.

9:07It becomes erratic. Insulin resistance is increasing. And so that's going to lead to that midsection weight gain. This is why we want to do a waist-hip ratio. You want to measure your waist circumference around the smallest part. You want to measure your hip circumference around the largest part, and you want to divide the waist by the hip. That number should be less than 0.85. If it is more, then we're looking at visceral adiposity and metabolic health is definitely declining. So with the insulin changes, we'll also see carb cravings, COA, we will see there's blood sugar instability. So you're having afternoon crashes.

9:49And sometimes even when you're eating well and you're like, I'm eating pretty good, we can still see belly fat distribution with insulin resistance. And then more belly fat means more insulin resistance. Now, before we go further into solutions, I do want to give you some of the lab testing, like what to test, when to test, what the numbers mean when it comes to these hormones. And I think it's important that we do lab testing whenever it is feasible, economical, possible, you know, altogether, because without labs, we're guessing. And after age 35, like guessing just like it doesn't work well for us.

10:29I mean, it doesn't work well anytime. But I also understand that some people just don't have access. So I will give you resources to help support your health and your metabolism today, even though I'm going to talk to you about the labs right now. So I want you to understand hormones are rhythmic. So the timing matters if you are still cycling and the interpretation matters. Normal ranges are not like what we're going for. We're going for optimal here. So if you're still cycling, we want to test progesterone and we want to test this mid-luteal phase. So that's going to be seven days after ovulation.

11:05We do five to seven days after ovulation. What we want to do, we're going to look for a temperature spike if you're doing fertility awareness method, or maybe we're going to use LH test strips. You're going to pee on a little test strip. And when you have that spike, seven days later, we're going to go ahead and test. And if you're not tracking and you're not doing any of that, then it's seven days before you expect your next period. But in late stage perimenopause, we have to use symptoms a little bit more. Sometimes we have to use cycle estimation because anovulation is common. that means you're not ovulating.

11:36But if you're not ovulating and your periods are really irregular, I'm not really interested in testing progesterone, okay? I just want you to understand that if you've got all the symptoms of low progesterone, you're over 45, your periods are like going away, I'm not really interested in running that test because it's not going to tell us a whole lot. Now, for progesterone, we want to see that above 10, usually like 10 to 20, but we want to see at least above 10 so that we know that we ovulated. If you are seeing numbers that are below five, that strongly suggests that you are not ovulating. If you measure it on your period, that's normal to see.

12:12But if you measured it at the right time of your cycle, you're not ovulating. And if you're below 10, the corpus luteum isn't really doing its job as well to make ample progesterone. And low progesterone is a top driver of forced sleep, anxiety, irritability, terrible PMS and feeling like you're at the mercy of stress cyclically once a month, just feeling like stress is kicking your booty. Now, when it comes to estradiol or E2, we want to test that days two, three, four of your cycle. Day three is the best, but two to four of the cycle is typically the range in which we will test it. So you're on your period.

12:54Day one is the first day of your period. In perimenopause, if you're having no cycle, we can just test this anytime, but we have to interpret in the context of fluctuations that if you haven't had a cycle in 60 days, that doesn't mean your cycle won't come back. But if you haven't had a cycle in like six months, your cycle is probably not coming back, but you may be an outlier and it might. But for those women who are still cycling, optimal is day two or three of your cycle. we're looking for like the number we're looking for is 30 to 50 picograms per milliliter um you know even getting closer to 80 can be normal if we're going above 80 and we've got symptoms of estrogen excess that can definitely be problematic and we we want to address that but often when you're having sleep and weight gain problems we're seeing under 25 which is indicating the ovaries have aged into menopause.

13:51They are graduating into their menopause era. And we will correlate that with an FSH. And if that FSH is hitting double digits, going above 25, yes, we are in perimenopause. And so this is all really helpful if you've had a hysterectomy, but you kept your ovaries to know where things are at. Now, estrogen instability, it's a major contributor to the midsection weight gain and blood sugar swing. So that is why this information can be helpful. And we always want to correlate it to your symptoms. Now, when it comes to cortisol, we want to be looking at a curve. I don't do this by the blood because it's four points that I want to see in the day and I don't want you getting stuck four times in the day.

14:29Blood cortisol is nearly useless unless it's extreme and that's like Addison's and Cushing's and I'm running an ACTH at the same time. But anyhow, what the average person is going to do is a four-point salivary cortisol test. there's several companies like ZRT Labs. Dutch has a cortisol test with metabolites. They do a cortisol awakening response, which tells us about your morning cortisol, which is when cortisol should be spiking. And the optimal pattern for cortisol is we want to see it's high in the morning and then it's gradually decreasing through the day. You might get a second wind in the afternoon and then by evening it's nice and low because cortisol and melatonin are going to oppose each other.

15:11And melatonin should be rising at night and cortisol should be coming down. We also want to look for a gradual slope. We don't want to see, and I've seen this many times, spikes high in the morning, drops by 10 a.m. That's a problem. You're going to be crashing in the afternoon for sure. If your cortisol is flat, it's too low, it's elevated at night, it's spiking in the morning and dropping low, that's going to make it harder to sleep. That's going to mess with your daytime energy. Sometimes you're going to have cravings skyrocket. You may have weight loss issues. Like, look, if you can't even get the energy to go to the gym, you're definitely going to have some weight loss issues.

15:51One thing I hear from women all the time is that they're struggling with symptoms like hot flashes, sleep disruptions, and brain fog, but aren't sure where to turn to for help. Menopause is inevitable, but suffering through it isn't. That's why I want to tell you about Alloy. Alloy is a digital health platform that connects you with a menopause specialized doctor who can create a personalized treatment plan tailored to your needs, all from the comfort of your home. Join the 95 % of women who tried Alloy and saw relief in the first two weeks. Head to myalloy.com and use the code Dr. Brighton. That's myalloy.com M-Y-A-L-L-O-Y.com and the code Dr.

16:39Brighton, D-R-B-R-I-G-H-T-E-N. Share your symptoms and you'll get a fully customized treatment plan and unlimited messaging with your doctor. Plus, you'll get$20 off your first order today. That's M-Y-A-L-L-O-Y.com, code Dr. Brighton. now with a thyroid panel because they did a whole episode breaking down what all of these numbers mean exactly what to look for um the full test why we do it i'm not going to spend a lot of time in this episode again drbrighton.com it's going to be linked there if you're a newsletter subscriber i send this all direct to you when these episodes come out but briefly tsh free t4 free t3 thyroid peroxidase and thyroglobulin antibodies, and we may also consider a reverse T3.

17:29Hypothyroidism or low thyroid hormone is a very big contributor and overlooked driver of weight changes that are happening after age 35. Age 35 is the magic number we're most commonly going to see hypothyroidism develop. So we definitely want to be checking that. And then again, I said I did a whole episode on insulin. I'm going to direct you to that at drbrighton.com. You'll find it in the show notes for what levels of fasting insulin, hemoglobin A1c, everything we're looking for in testing insulin. And keep in mind, when we have insulin resistance, even if the numbers are just slightly off, weight loss can become an uphill battle.

18:08So now that you know what's changing and how to test it, I want to talk about the part that everyone really wants to know, which is how do we fix it? what do we do about it? Now, if you go to drbrighton.com slash plan, you can grab a free meal plan, recipe guide, guide to sleep. I mean, it's got tons in it for helping you navigate perimenopause. And what I'm going to cover in here is a lot of what we need to do. That plan will give you exactly how to do it and guide you through it. So drbrighton.com slash plan. First thing we want to do, we want to get that blood sugar stabilized as soon as possible.

18:46This is a foundation. You cannot out-exercise, out-supplement, or out-willpower unstable glucose. However, all of those things will help you stabilize glucose. So yes, we need to exercise. Yes, we need to sleep. And yes, there are supplements that can help. But there are people out there that are promising weight loss supplements like take green tea extract or take things that speed you up or just shake on a machine and you'll lose weight. And none of that is going to be very effective if we're not addressing the foundation, which is blood sugar dysregulation. Now, if that's linked to estrogen and you are a candidate, we want to consider doing estrogen hormone therapy.

19:25I have a whole episode talking about that. I have several, actually. I will link to those so you can have all the resources to make an informed decision. But when it comes to regulating insulin, this is what we want to do. We want a protein forward first breakfast. 30 grams of protein at breakfast. This alone can change your entire day. And then we want to get like five to seven grams of fiber. Maybe you are someone who eats a lot of fiber. You hit 10 grams of fiber. You're hitting 10 grams of fiber every meal three times a day. That's great. But at least five grams. When you're eating carbohydrates, protein and fat and fiber, we want to partner that with them.

20:04We don't want just a bagel. That's going to just be metabolic mayhem for our poor metabolic system and our insulin regulation. And the cool thing about fiber is that it blunts glucose spikes and it's going to support your microbiome. In a healthy microbiome, people who eat more fiber have more microbial diversity. That has been associated with a lower risk of developing visceral adiposity. So having that deep belly fat. So don't overlook your microbiome. And also don't overlook your evening meals. We want to make sure that the evening meals are preventing nighttime blood sugar crashes. That can be a major reason why you wake up at 2 to 4 a.m.

20:45So we want to make sure that we're eating protein, fiber, and getting fat at our evening meal. We're not just eating a bowl of pasta. If you're going to have a bowl of pasta, when I throw some veggies in there, you can mix flax seeds in there sometimes into your pasta, like ground flaxseed. You can add in ground beef, like things to support stable blood sugar. Now, I did mention supplements, and some people are going to need supplements to help manage their blood sugar, especially those that have a history of PCOS. So myoinositol is the top one. I look to myoinositol all the time. It improves insulin sensitivity, ovulation, cravings.

21:26it has been shown time and again in the research to be just a real ally for metabolic health. And so doing this strategy of like protein, fat, fiber for breakfast, making sure you get that at every meal and definitely looking at your evening meal. And then considering adding something like myo-inositol plus in can really help support you in reducing the belly fat, helping get better sleep, improving your blood sugar and really setting the hormonal foundation. You know, my book is This Normal. I talked about how cortisol and insulin are the hormonal foundation. And if those are not set right, everything else just gets off balance.

22:07And so while you might chase sex hormones or even thyroid health, and you may need to address those, if you do not address that foundation, then you will constantly just be chasing symptoms. So let's talk about that second part of the foundation, which is the cortisol curve. Cortisol is not our enemy, despite what well-meaning influencers, well, sometimes not well-meaning influencers, but people on the internet will tell you cortisol is the devil. No, it's not. It's absolutely necessary. It regulates your inflammation, but dysregulated cortisol, that's what the problem is. So we need a spike in the morning.

22:39We need to go low at night. So here's how to get that back. First thing in the morning, open up those curtains. If you can do 30 minutes outside, barefoot on the grass walking around fantastic in in nature oh we love that but if nothing else just morning sunlight drink your coffee in front of the window that will help anchor your morning cortisol now if you're somebody who's really struggling with your cortisol curve sometimes I will say like you have to eat breakfast and have a full stomach before you have your coffee however if you are like, no, I'm not doing that. Okay. Cause definitely have those patients that are like, no, first thing in the morning, I'm having coffee, nothing else.

23:26Okay. Not a lot. Like you're going to be surprised that in a way, like talking about weight loss cream, can we use a little bit of full fat cream? It doesn't have to be a whole lot, but a little bit. And then a couple scoops of collagen in your coffee, that's going to help give you a little protein and fat to help stabilize your blood sugar. And then you can have your coffee in front of, you know, the window and then go make your breakfast. But what we don't want to do is drink black coffee on an empty stomach and then wait three to six hours to eat. That's horrible for our cortisol and our blood sugar.

23:58Do you like high intensity workouts? I like high intensity workouts. I think they're great for women, but they're not great for women who have cortisol dysregulation when we do them at night. So if you like high intensity workouts, hit it in the morning, try to get it in before noon because they can raise cortisol. And that's great, but not at night when we need it to come down. I'd also recommend, as often as you can in your day, but definitely before bed, nervous system regulation, deep breathing, box breathing, humming, 90-second somatic discharge count, vagus nerve stimulation. I'll put an episode link to that.

24:35And then we want to look at supporting our adrenal rhythm. So I have like a couple of products that I recommend. It's called the Optimal Adrenal Kit. I'm going to explain what's in them. It's never pressure to buy my products. I do have a code for you if you want to try them for 15 % off, POD15, drbrightnessentials.com. You're always welcome to try them. But if you're like, no, I want to go a different route, I like to just explain what's in them so you know what to be looking for. So here's how I personally formulated these ingredients to make them work for my patients and for me and my family.

25:14My husband takes them. Okay, so first thing in the morning is adrenal support. Have that with breakfast, two caps, rhodiola, eleutherococcus, asparagus resmosis, holy basil, really important adaptogenic herbs along with nutrients that feed your adrenal glands that helps you have energy in the morning, signals, get your cortisol up and keep it through the day. It is not going to leave you wired and tired at night because you're taking it in the morning. I also recommend taking B active plus in the morning. Methylated activated B vitamins because when we've been under chronic stress, we often need more B vitamins and more magnesium, especially when we are struggling with sleep and perimenopause and HPA dysregulation.

26:00So that's morning. You can take one B active, that's going to help you have energy throughout the day. In the evening, you can do this right at bed. You can do it with dinner anytime in between. Adrenal Calm. That is going to have phosphatidylserine in it. Very key nutrient for bringing down your cortisol. It's also going to have L-theanine and passionflower. Very key when your progesterone leaves the building for stimulating GABA and helping you chill out, be calm, not hate everybody, not have ruminating thoughts, not replay your day on repeat and think about all the ways you hate yourself. Just go to sleep.

26:36That's it. That's it. That's adrenal calm. Just go to sleep vibe. So that's what I recommend for resetting that cortisol curve. Now, the next bit of sad reality, the wah-wah I'm going to drop on you, is that after 35, muscle becomes your metabolic engine, except you're deleting your muscle cells. What? We lose muscle, we lose metabolic flexibility, but we gain muscle and we gain metabolic flexibility. So this is why muscle is non-negotiable. It improves insulin sensitivity. And what happens, which is just like the worst, I had to give a presentation to, it was a bunch of practitioners, and I gave a presentation on why eat less and move more is not life-changing for perimenopausal women.