From PMS to Menopause: How to Hack Your Hormones and Use Science to Lose Weight, Sleep Better and Get Your Mojo Back

27:59That has to go up. Okay. If you're in perimenopause and you want to fight the weight gain, that's where it starts. And so the reason why running or HIIT classes aren't the greatest thing for women in this category is because it spikes your cortisol? Yes. And what does that have to do with estrogen? The other thing that happens when your estrogen is going down is you're less stress resilient. So I'll give an example for women who even aren't in menopause or perimenopause. The week before your period, you're just less stress resilient. Yeah. You can't handle the things that you usually can handle.

28:39Yes. So your mini PMS is happening for a few years now. So is PMS? A mini menopause. It's a drop in your estrogen and progesterone in the middle of your normal cycle. Yes. No shit. I didn't know that. And that's when your body is like, oh, she didn't get pregnant. The egg didn't get fertilized. We got to shed this lining. They drop the hormones. So you get to basically the lowest level of estrogen and progesterone. And then you shed your lining, which is your period. And then you start all over again. Wow. So will the things that you're saying that help for somebody in peri or menopause itself also help with PMS symptoms?

29:28Yes. That is a revelation. It is. For me too, I thought to myself, wow, the same things that we are doing to improve our nutrition during our cycle. Yes. We just expand on that. The late luteal phase, which is that PMS phase of the cycle, is what's happening. I was going to say, I think it's sexier to say, I'm in my late luteal phase. The late luteal phase. But you're talking, that's a period. Yeah, that's the week before your period. That's PMS. One surprising thing that people have to understand is that hormone replacement therapy does not help with the weight gain part. The weight gain part is not an indication to go get hormones.

30:18The things that I told you about, more neat activity, more weight training, that's going to help the weight loss. Okay. What else do we need to do for the weight loss? Because I know everybody's leaning in. Yes. Because I thought if you get the patch or the bioidenticals, your body will snap back into the way it's supposed to. And that's what's so frustrating for women. The hot flashes definitely get better, right? Like that's one of the indications for hormonal therapy. People will have pain with sex or have dryness. HRT definitely helps with that. But the weight gain portion is not so easy to address just with hormones because there's multiple things going on.

31:01Like you're less active, you're losing more muscle mass, your sleep is dysregulated. So then your appetite, your cravings, your hunger, your appetite are all increased because you're not sleeping well. Yeah. That can't just be solved by adding hormones. I think about adding hormones, like putting gas in your car. So you can add gas to your car, but if there's a traffic jam, you're not going anywhere. So our hormones are like a complicated web of highways that are backed up. And doesn't matter how much gas you pump into the car, it's not going to go anywhere. So the ways to unclog that traffic to keep that traffic moving is the sleep, the exercise, the weight training, the food choices.

31:53The more you can improve your sleep, the better that weight loss part will become because your hunger hormones are really dysregulated when you don't sleep. And so you want to have a good night's sleep, but often you can't sleep because your hormones are disrupted. So it's like the cycle. So one of the things I tell people is really, really try your best to improve your sleep hygiene. If you haven't started a routine to improve your sleep hygiene, start it now in perimenopause. Okay, now tell us your top three things for a better night's sleep. Top three things for a better night's sleep. Cold room.

32:29Okay. Your body temperature has to drop by one degree to fall asleep. Oh. So how do you get that done fastest? You could take a shower. You can cool down the room. You want to cool your core body temperature. That's how you'll fall asleep. Love that. Pitch black. If you can't control the curtains and the light, then wear a face mask or eye mask. The few studies that we have, one is on menopausal women. Even if you have an ambient light in the room, like a light coming through the window, it will stop weight loss if you're on a weight loss plan. Really? Circadian rhythm disruption, especially during that time, seems to really mess up the hormones in that sense.

33:14So you want to have a pitch black room. And then the third thing is you want a nightly routine. So you want to prepare your brain and your body for sleep because your body loves routines. Our bodies are built on rhythms and cycles. And if every night you go to sleep at 9 p.m., so at 8.45, you start to turn off all the lights, you put away your phone, you start to brush your teeth, you're cluing in your body that it's time for sleep. So keeping that same time and routine is essential for good sleep. People will sleep one day at 9 o 'clock and the next day at 11 and the next day. They're massively disrupting their sleep cycles.

34:01And there's some data now that shows that it's maybe more important to stay on the same bedtime than even the total number of hours slept. Wow. Are there certain foods that we should be eating more of or less of to help with the menopause symptoms and hormone regulation? And for everybody's benefit, I just want to remind everybody, this is your second appearance. and we did a huge show on hunger and craving and the neuroscience and biology of it. And so that will be linked in the show notes along with both of your books. But, you know, if you had to bottom line it for people that are really wanting to use food to regulate hormone, what are the top recommendations?

34:48Remember that I likened it to PMS in the sense that you're less stress resilient. So what I mean is that the things that spike your cortisol are just now more and at a lower threshold. Caffeine, alcohol, sugar. Shit, are we not going to have fun now too? I mean... People say to me, I always drank this much caffeine and I always ate this much sugar. Yes, or had a glass of wine or did whatever. What the hell is going on? Yeah. And that's because now your hormones have changed and your metabolism changed. You're also less insulin sensitive. So you've heard the term insulin resistance. Yes. What does that mean?

35:30So that happens during menopause. What is insulin resistance? Insulin resistance means that when the sugar is trying to get into your cells, the insulin has to open the door to let the sugar in. That's insulin. So what does it mean when you're insulin resistant? The door is shut, the door is open. The door is shut and you don't hear it as easily. You're knocking louder and louder to try to get in. And the insulin is like, dude, we just let sugar in. We're not going to let more sugar in. And the body's like, no, but I need to get it out of the bloodstream. I need to put it. And the insulin is like, no, but the cell is packed.

36:07It can't take any more sugar. And so while they're having these fights, that's called insulin resistance. And so when insulin resistance happens, the body gets signals to store fat. to say, let's get this sugar out of here because it's not going into the cell. So we got to put it somewhere. So not only do you have a higher risk of getting type two diabetes because your sugar level is so high all the time, you also have more signaling to store fat. Oh man. So insulin resistance is something that we can control by saying, well, if the cells are so full of sugar and they can't let any more sugar in.

36:50You better eat some vegetables. You better just cut some of that sugar out. Okay. And add in some things that help you lower the blood sugar in your body, which is fiber. Add more fiber so that your blood sugar can be regulated in your body. Move more, like we said. Yep. Add in weight training. Sleep more. And remember the water that we talked about in the other episode, our thirst centers are often mixed with our hunger centers like the signals are can be mixed so you want to hydrate enough so that you are not eating mindlessly so and the trick there just for those of you that have not heard the other episode is when you feel your appetite coming on in order to determine whether or not you just have a mindless craving uh you can say would i like a bowl of vegetables right now.

37:44And if the answer is no, that means you're not actually hungry. Another trick is drink a glass of water. Yes. Because that typically can satiate that appetite that flares up. Why is there an increase in anxiety during PMS and menopause? Remember that sister, the progesterone sister? Yes. She was a calming one. She was the one who was keeping you chillaxed and careful. And she, when progesterone goes down, you don't have that chillaxer anymore. You don't have someone to keep you calm. Like that sister that was saying like, calm down. It's okay, Mel. Like, you know, you'll be fine. Your progesterone levels are lower.

38:29And all of a sudden you are anxious about everything. The things that never made you anxious before are making you anxious. And the sleep, you wake up in the middle of the night, you're like, oh my God, I can't believe X, Y, and Z happened. And it starts a whole anxiety spiral. And a lot of women during menopause have crippling anxiety. Does hormone replacement therapy tend to help with anxiety? Yes. Progesterone replacement. Gotcha. I'm not sure I would know how to explain what a hormone is and what it does. Yeah. There's so much confusion about hormones. Hormones is a chemical messenger. So in my analogy of the highway, it's the car.

39:13It's the car. It travels from your brain or from your ovaries to wherever it needs to go. It can go to the muscle. It can go to the heart. So it's a traveling message. our bodies cannot function without hormones like people get so annoyed with hormones but you cannot function without your hormones even cortisol cortisol is a good hormone it has to be balanced so what is the estrogen the ester oh i'm getting this now so the fun party sister the social one the social one is driving one car yes and when she arrives it's time to party yes The progesterone sister is driving another car. When she arrives, party's over.

40:00Yes. And she calms everybody down. Like, let's just chillax now, guys. Let's just, you know, tone it down. Is insulin a hormone? Insulin is a hormone. Really? So when insulin gets in the car, what is insulin telling you? So insulin is telling you, open the door to let the glucose in. It's a storage signal, meaning that our body sends insulin out to say, hey, we need to store a little more glucose here because there's glucose coming in. So it's a messenger. So people think, oh, thyroid hormone is just about weight. No, it goes, it's controlling weight. Temperature is controlling heart rate. It's controlling a million things.

40:39It's not just going to one destination. Wow. So you can't just replace hormones and think that it's going to have one effect. So for example, we see people getting high, high doses of thyroid hormone. And I say to people that more is not always better, right? Like it's not just doing one thing. It's doing five different things. And one of the things it's doing is it's going to the heart. And if you send too much thyroid hormone to the heart, you're going to have all kinds of problems, including arrhythmias, heart palpitations, people that are taking too high doses of thyroid hormone will have heart problems often.

41:20It's like playing with fire. Wow. So they're just kind of driving in the wrong directions or they're not arriving where they used to arrive. And that's what's making the changes. So the hormones are the root cause of PMS and menopause. Wow. And for some of the symptoms, hormone replacement therapy will alleviate symptoms, but for other things like the fat redistribution or the losing muscle tone or the, that you're going to have to make lifestyle changes. So the other hormone that we didn't talk about, but that's really important even in women is testosterone. Really? Testosterone is actually in higher levels, like four times the level of estrogen or progesterone, like it's high.

42:10In women? Yes. Really? And we always think about testosterone as like a male hormone, right? Of course, males have much higher levels of testosterone than women, but our testosterone is also high compared to our other hormones. So testosterone is the sister that doesn't live as close to the other sisters, but testosterone is the leader. It's the muscular, it's the aggressive, it's the leader sister. So we get a spike of testosterone at ovulation. So if you know your cycle, roughly a week after your period is when your testosterone levels are peaking. That's when you want to build the most muscle.

42:58that's when your libido will be the highest your confidence levels will be similar to the other gender people that take too much testosterone for example when they're taking a replacement and they go overboard they'll be angry aggressive and maybe even a risk-taking behavior we know that testosterone can be good in small amounts especially for women during perimenopause and during the cycle, if you're lower than you need to be. But of course, you don't want to overdo and people overdo it all the time. How do you figure out what to take? Yeah, I know. I know. There's so much misinformation out there.

43:36For example - What are the big ones? Yeah, give me some of the big myths. Big example. The one thing that all doctors can agree about is that those pellets that people get are no good. I don't know what the hell a pellet is. I've just heard about this. What the hell are pellets? So pellets are testosterone releasing, like extended release testosterone that they implant under the skin. Okay. And it's supposed to release testosterone. Yes. You keep this in there for months, okay? And you get it replaced. And what's happening is that you can't adjust the levels, right? And most of these pellets are giving you super therapeutic levels.

44:20And like I said, hormones are not something that you just want to add because they're doing a lot of other things besides maybe the one thing that you're targeting. Okay. And so why would you use an implantable testosterone that can't be titrated, that usually releases too much? Yep. Why would you do that? And the answer is that you can charge. You can charge for testosterone pellets. And when you do testosterone, like a cream or a ingestible, it's not money in the pocket of the practitioner. And so I know there, once I said this on social media and people went crazy because they said, I love my testosterone pellets.

45:06And I said, great, but make sure your levels are at the level that you want it and not way high. because I bet you that a lot of people who are taking testosterone pellets are at super therapeutic levels. And we've seen so many negative side effects from those levels. So hormone replacement can be so amazing, but go to the right person, choose the right dosing. And even if you do pellets, great. Choose what's right for you, but make sure you're not getting levels that are too high for your body. I am so glad you said this because another amazing person who uses pellets herself was so excited about them that I'm like, I got to get me some pellets.

45:46I got to go. I got to get in there and get the pellets. I got testosterone. Chris Robbins, get ready because the libido is coming back. But I'm glad that you gave us the reason why. So that you can make a choice for yourself. Is it true that women of different races experience menopause differently? Yes. And the problem is, again, Mel, is that not only are we not educating our doctors or the population about menopause, we don't even know the differences between different backgrounds, different races, different ethnicities. Because they're not studying it? They're just not studying it. I mean, we're just at the basic levels of finding out that women present differently with heart attacks than men.

46:34And women will be shamed for symptoms that are actually real. Yes. Because they just think, oh, she's just a complainer. Well, and then the other thing that I have really not appreciated is that there is an acknowledgement that you get foggier. Yeah. And there's an acknowledgement that you will start to feel flabbier and start gaining weight in places that you've never had it before. But there's no what to do. Yeah. That it's sort of this, oh, well, yeah, me too. Or, yep, that's that'll happen. And everything will kind of go back to where it should be when you're 60 or you're 10 years into this.

47:09And I am sorry, I'm not settling for that. And that's one of the reasons, Dr. Amy, I wanted you on. And so I think it'd be really helpful if you could walk us through the day of what you would recommend for anyone to either better manage PMS or have a better routine that's aligned with your recommendations and the science out there to help us both regulate our hormones and do the proactive steps to feel better during these very normal changes? Yeah, that's a great question. I'll start with saying that we live in a society that has a problem with women getting older, right? Like we basically have been told that if you don't fit into the societal ideals of young, fertile women, that you're no longer worthy, you're no longer beautiful, that you're no longer wanted, that you're no longer smart and motivated.

48:18And I think that that's one of the biggest challenges that we are going to have to face in this next generation where we feel good even into our 40s and 50s. And if we do the things that we're going to talk about, this could last till our 70s. And we can look younger and feel younger. We already know the biological age, like our age of ourselves is completely different, 20 years different than our chronological age. So you're really just 35 right now. Thank you. Thank you, which is why I'm pissed off that I have a dry vagina and I sweat at night and I feel like somebody's grandmother. Exactly.

48:55So here's how we move through the day. Okay. You wake up hopefully without an alarm. This is really important because we talked about sleep, how it helps with appetite regulation. And we just, as a society, shit on sleep and don't allow ourselves to sleep. So go camping, go somewhere where there's no ambient light and there's no distractions in social media and see what time you sleep and wake up. I bet you you're not a night owl like you thought. So you're gonna get an adequate night of sleep. You're gonna go get that sunlight in the morning. So circadian biology, again, the light that you get in the morning tells every cell in your body that it's morning.

49:37And the benefit of that is that our hormones need that input. If our hormones don't get input from our brains and our bodies that, hey, it's time to release now cortisol. Cortisol is high first thing in the morning. Then it causes hormonal dysregulation, which is like how people say, oh, I feel so tired all day or adrenal fatigue. Like I feel so burned out. It's not that the adrenals are burned out. There's no such thing as adrenal burnout. Adrenal fatigue makes it sound like these adrenal glands get tired. Yeah, they don't. No, it's this hormonal highway that we're talking about gets clogged.

50:16It's not just the adrenals. It's coming from the thyroid. It's coming from the brain. It's the whole traffic jam is happening because of all the other things, you know, the lifestyle, the age-related hormone changes. So you want to retune those clocks. Those clocks can get damaged if you don't, if you misalign them so long, so many times. Yeah, like if you never get outside or you spend hours and hours and hours, like in the daytime inside. Well, what I love about this, I think just to kind of keep with the analogy, because the visuals really help me put it all together. It's almost as if the circadian rhythm and the sunlight in the morning is like the remote starter to your car.

50:58Yes, yes. It's keeping those roads open and clean. So you can know, okay, it's time to drive. Like everything's opened up. So you get the circadian rhythm. If you start to damage those cars, you get these things called senescent cells. So the word is a very scientific word, but basically it means your cells become zombie cells. And they no longer can work. The car doesn't work. But the emissions from the car is inflammatory signals. and aging and all the things that come with aging is these cars that are broken down and they're sending off these inflammatory signals to your whole body. That's the process of aging.

51:43We need to clean those cars up and get those out of there if they're not working, right? So just keeping with that analogy, that's, we don't want senescent. Senescent cells is the big area of anti-aging that we're trying to understand. Like, how do we clear those out faster? How do we not break down? So working out in the morning actually has been shown in studies to be the, not necessarily the only ideal time to work out, but the best time to stay with a routine. So people are compliant with exercise when it happens in the morning. Well, it's common sense because your day doesn't hijack your energy and your time.

52:21It's, I see it over and over again, especially in women, because we are doing everything for everyone. Our mental load starts from the morning. And so if you don't get that workout in, there's a big chance that you're not going to make time for it later because the kid needs a ride. Your husband needs you to be home. You know, the meeting came up, somebody needs you to be somewhere. So get it done in the morning if possible. There's a second peak time late afternoon. And late afternoon, it's a better time to muscle build. So if you're doing two mini workouts that you could just split it up. And then high protein.

53:01Protein is one of the biggest things that doesn't happen with women in perimenopause. Because what happens is women think that you're trying to be skinny. And when they start to see themselves gaining some middle section weight, they often cut down even more and you're in this like very tight calorie restriction. And what you really need to do is eat more protein, more fiber, more real foods, and less of that ultra processed crap. So having a high protein breakfast, dopamine booster breakfast, high fiber, we talked about that a lot in the other episode. And then you want to do your biggest concentrated tasks of the day early in the day.

53:46So that you don't spike your cortisol. Exactly. Boom, I'm getting this. I am getting this. If you're someone who can do a meditation or a nap, the best time to do it is when your cortisol is naturally low, like one to 4 p.m. When your cortisol dips, it's a great time to either do a power nap, 20 minutes, do a meditation, do something calming. Because remember when your progesterone's dropping, you're likely more anxious, you're overwhelmed. It's a nice break from the day when you can do it. do something that's very centering, prayer, whatever it is. I've heard what I think is probably a myth, that if you just ride it out, just like three years, Mel, ride out the hot flashes, the dryness, the bitchiness, all this stuff, the brain fog, and in three years, you'll just snap right back.

54:34Is that true? Well, what happens is that your body just starts to get used to it. And so you're operating at a level that's just stable. There's no squeezing of the toothpaste. There's nothing there. Your body starts to accommodate. And so it's not that it's snapping back, but that the symptoms seem to go away. A lot of the symptoms that were really troublesome during perimenopause. And so it's often the time where people feel a little reprieve. But remember that disease risk goes way up after menopause, our hormones protect us from heart disease and all of the disease of aging. And so once you hit menopause, you start to have an increased risk of all of those inflammatory diseases.

55:25Okay. Wow. Yet another thing to look forward to. Is there anything more that we should know about the increased risk of inflammatory diseases? So one of the big criticisms of hormone replacement therapy was that it would cause cancer. But now we know that it's the opposite, that hormones actually protect us from a lot of these diseases, especially heart disease. And for women, it can actually be protective. And then the right population of women, like very close to the start of menopause or perimenopause, the earlier you start it, the better risk protection you get from hormone replacement therapy.

56:05So what is the biggest myth around menopause? My biggest pet peeve about menopause is the fact that women feel shame around it. And they can't have conversations with their doctors. They often feel like they're marginalized and they're not listened to from their provider. When they say, I don't feel right, I feel tired, but I feel anxious. My sleep is off. and they often get a prescription and no explanation about what's happening. I know countless women who've just come home with anti-anxiety medications and no one explained to them that there's a lot going on in your body that could explain why you're feeling this anxiety at this time.

56:54And there are things that you can do. Not to say there's anything wrong with medications. There's a great need for medications, But there's also a big need for education around menopause. I agree. There is a huge need for education, not only around menopause, but also around women's hormonal health and cycles in general. And I consider myself to be a very well-educated person. I'm intellectually curious. I read all the time. And I have flunked this topic. And when I've gone to my doctor or to my OB-GYN, it feels like people are like, yeah, well, it's going to last till you're 60. And, you know, you can do hormones or, you know, whatever.

57:38You're going to have to tolerate the weight gain. I hate that. I think the term is like gaslighting, like, you know, medical gaslighting where women just feel like they're not listened to and their complaints are just dismissed. And I think that's something we really need to work on as a society, because like I said, age 40, age 50, age 60 is now very different than it was even just 20 years ago. Women are doing things in their 40s, 50s, and 60s that women did not do. We got to change the conversation. So it's not that, oh, you're just worried. You're just stressed. You're just getting old and dismissing their concerns.

58:22These people are running companies. They're leading countries. We need to have conversations about what they could be doing to optimize themselves at that level, not just saying, oh, well, you're just getting old. So what would you advise any of us who feel like we are just not getting the answers from the doctors like that we're seeing? Do you just change your doctor? I mean, what do you do? I think in this day and age, we have enough physicians that are interested, educated, and can be an advocate for you that you should go seek that out. Because I think that we're changing the conversation not only within ourselves, but in the medical community of saying like, hey, listen, if a woman comes to you with these complaints, don't just write it off as separate things.

59:10Think about like, where is she in her cycles? Like, where is she with her hormones? And there's this big myth that in order to be considered in menopause or perimenopause, you must get your hormone levels checked because that's what you hear on the internet. Menopause is not a diagnosis of hormone levels. It is a diagnosis of symptomology. And the definition has nothing to do with the level of hormones. And so a lot of people spend thousands and thousands of dollars trying to get testing to figure out what their hormone levels are. But that's not necessarily the first place you need to go. But when do you get your hormone levels tested?

59:52If you're getting replacement therapy and you're trying to troubleshoot something, but the diagnosis of menopause is not made through a lab test. Well, that's one thing that we learned today, that the diagnosis of menopause is made after you have gone an entire year without menstruating. And there's a lot of misinformation. There's a lack of research and there's a lack of interest, to be honest. And so I think that all of those things make menopause an area that is mismanaged, that is an area like if you look on the internet and you look for supplements around PMS or menopause or hormones, it's a wild, wild west.

1:00:39Clearly, people are looking to alternative practitioners and online therapies for their hormonal concerns. But when you see what's out there, it is very scary. And so that's a clear sign that women are looking for answers. And so we need to have more information, even the basic things like we talked about here. This should be basic education for all women. Dr. Amy Shaw, I'm having you back to talk about circadian rhythm, and I'm having you back to talk about the rhythm of the day. You are a freaking rock star. The book is I'm So F-ing Tired, but we ain't so F-ing tired no more because Dr. Amy has given us simple things backed by profound science that you learned today that will help you take control control of your hormone health so that you can live a much better life.

1:01:33Thank you. Thank you. Thank you. I cannot wait to have you back. I'm so honored to be here and I would love to. So before we go, I just want to remind you that I love you. I believe in you and I believe in your ability to create a better life. All right. I'll talk to you in a few days.

1:01:55what is that last word thermogenesis non-activity non-electric what i can't keep up with what what is thermogenesis you're you're in fucking menopause so your mind is going there we go yeah we'll talk about that later do you want to say which hormones it is okay well then i would say what hormones.

1:02:22Yeah, that will definitely keep it in what form. I think that Diet Coke and the outside put a little life in sinus infected Mel Robbins here.

1:02:39oh and one more thing and no this is not a blooper this is the legal language you know what the lawyers write and what i need to read to you this podcast is presented solely for educational and entertainment purposes i'm just your friend i am not a licensed therapist and And this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I'll see you in the next episode. Stitcher.