The Dr. Hyman Show - Understanding Menopause: Expert Tips on Curbing Hot Flashes and Mood Swings | Dr. Mark Hyman

Episode Date: November 15, 2024

Menopause doesn’t have to be a mystery. In this episode, I break down how you can navigate this transformative time and come out thriving. We'll explore the significant hormonal changes that occur, how they impact everything from bone density to mood, and what proactive steps you can take right now. I share insights on managing symptoms like hot flashes and sleep disruptions, the role of bioidentical hormone replacement therapy, and how healthy lifestyle choices like diet and exercise can make a world of difference. View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal Which diet really gives you the best shot at optimal health? On Wednesday December 4th, Mark Hyman, MD will answer that question during The Diet Wars, a LIVE digital experience. Joined by Dr. Gabrielle Lyon, they’ll break down the science, debunk the myths, and share their expert perspectives to help you make the best choices for your health. Find out more and get tickets now at https://www.moment.co/markhyman  This episode is brought to you by AG1, Vivobarefoot, and Big Bold Health. Get your daily serving of vitamins, minerals, adaptogens, and more with AG1. Head to DrinkAG1.com/Hyman and get a year's worth of D3 and 10 Travel Packs for FREE with your first order. If you're not barefoot, go Vivobarefoot. Head to Vivobarefoot.com/Drhyman to get 20% off today! Big Bold Health is offering my listeners 30% off their first order of HTB Rejuvenate Superfood Head to Bigboldhealth.com and use code DrHyman30.

Coming up on this episode of The Doctor's Pharmacy. You see, on average, women lose about one to 2% of their bone density per year during perimenopause and menopause. And the rate of bone loss can be even higher in the first five to seven years after menopause. You really gotta be on top of this. Get your bone density checked early,

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this scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, Supplement Store, for a summary of my favorite and tested products. Hey everyone, it's Dr. Mark Hyman. Ever wanted to ask me your health and wellness questions directly?

Well, here's your chance. I have an exciting exclusive event coming up that you can be part of as a thank you for being a loyal listener on The Doctor's Pharmacy. On Wednesday, December 4th, I'm hosting a live digital experience called The Diet Wars, and I want you to join me. I'll be chatting with Dr. Gabrielle Lyon, a board-certified family doc and New York

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community in real time during the event. Plus, if you're a VIP ticket holder, you'll get to join an exclusive Q&A after party where you can ask us all your questions directly. The Diet Wars is a one-time only experience that you don't want to miss, including limited edition merch. It's all happening live on Moment by Patreon. So mark your calendars for Wednesday, December 4th at 9 p.m. Eastern, 6 p.m. Pacific, and head over to moment.co forward slash Mark Hyman to get your tickets. I can't wait to see you there. Welcome back to another episode of the Doctor's Pharmacy and Health Bites, where we take juicy little bites into current health topics. And today we're talking about menopause. That's right, menopause. And this is a significant phase in

a woman's life. It's surrounded by uncertainty and physical changes that are kind of hard to navigate for some women. But understanding what's happening in your body and how to prepare for those changes just makes all the difference in going through it and actually surviving. Today, we're going to dive into the transition known as perimenopause, the years leading up to menopause and around the menopause where your hormone levels begin to shift. And that sets the stage for the eventual end of your menstrual cycle. So during perimenopause,

there's a decline in estrogen and progesterone, and that can lead to all kinds of symptoms, or there can be kind of fluctuations in hormones and up and down, and that can cause hot flashes and mood swings and sleep disruption, and it can affect up to 85% of women. But it's really important to remember that every women's experience is unique, and some may just kind of breeze through it with little or no symptoms, while others might find it more challenging. What's really crucial is being proactive about your health, understanding the changes that are

occurring in your body, and knowing the steps you can take to support your body through the transition. Now, this episode, we're going to explore the hormonal changes that occurred during the perimenopause and menopause and the impact it has on your overall health and the steps you can take to ease the transition. From diet and lifestyle adjustments to understanding the role of hormone replacement therapy or hormone optimization therapy, as we like to call it now, we'll cover it all. So let's get started on this journey to better understand and prepare for menopause. So menopause doesn't just happen overnight, right?

It takes years of gradual changes in hormone levels. And there's a transitionary phase, and this phase is called perimenopause. Peri just means around, right? What is perimenopause? Perimenopause is when a woman transitions from her reproductive years where she's having a regular period to menopause. So how does a woman know when she reaches menopause?

Well, basically, technically, the medical definition is she goes for 12 months without a period in a row, 12 months in a row. But the truth is, it's not always so straightforward or simple. Now, it's a normal phase of aging that happens to women in their early 50s, sometimes earlier in their 40s, sometimes later, but it's generally around 52, and it marks the end of her reproductive

years. Now, during perimenopause, which can start as early as the late 30s or even early 40s, estrogen and progesterone levels change significantly, and that can result in all sorts of changes in the body, including irregular periods, either close together, far apart, heavy bleeding, clotting, PMS getting worse, hot flashes, mood swings, depression, night sweats, sleep disruption, all that stuff can happen. Now, not everybody gets this. In fact, in Japan, I don't think they have a word for hot flashes because of how they eat. Every woman experiences menopause slightly differently. Some women don't really experience any symptoms, but many, many unfortunately do. The good news is you don't have

to suffer. There are ways to deal with this where you don't have to suffer at all. And I'm going to tell you what those are if you stick with me with this podcast. If you don't deal with it, you know, 85% of women have some significant symptoms that disrupt their quality of life. And they're influenced by a lot of factors, genetics. If your thyroid's working or not, a lot of women have some significant symptoms that disrupt their quality of life. And they're influenced by a lot of factors, genetics. If your thyroid's working or not, a lot of women are hypothyroid. About one in five women are hypothyroid. Many of them are not diagnosed, and that can affect your hormonal balance. Various kinds of changes that women get like PCOS or polycystic ovarian syndrome, how many pregnancies you've had, and other factors. Lifestyle, your stress level, your physical activity, exercise plays a big role in regulating hormones. Environmental toxins are

a big one, like BPA, phthalates, heavy metals. All these are endocrine disruptors. They're hormone disruptors. They cause what's called hormonal chaos. And I read a book years ago called Hormonal Chaos by Thea Colburn. She's like the Rachel Carson of today. I think she might have passed, but this was a very powerful book for me. I read it many years ago that kind of helped me understand the role of these environmental toxins that act like estrogens in the body and are extremely toxic. And there are a lot of things though that you can do to support your menopause transition proactively and make it really seamless and easy using the principles of functional medicine. Now, my colleagues and I at the Ultra Wellness Center in Lenox, Massachusetts, we use many of these strategies for our perimenopausal

patients, and we're going to get into what those are today. But first, let's discuss what happens in the body from a hormonal standpoint during the transition from premenopause to meri-menopause. Now, I didn't become an expert on this on purpose, but I have worked in Canyon Ranch, which is a health resort, in my 30s and 40s for almost 10 years, where basically my patients were women in their 30s to early 60s. And so I got to really understand what people were experiencing, what they were suffering, how to work with them, and how to help optimize their health. So what happens during perimenopause? Well, a lot of things can happen.

Ovaries are not necessarily ovulating every month, and you can have these things called anovulatory cycles. You might have less estrogen. You'll have less progesterone because that only happens when you ovulate and you get a sac on your ovary that's called the corvus luteum that produces progesterone. And that basically leads to these hormonal imbalances. That's the take-home here. And you can have low estrogen, high estrogen, low progesterone. Now, these sort of swings in hormones are often irregular and they're responsible for many of the menopausal symptoms, right?

The hot flashes, night sweats, vaginal dryness. That comes with lower estrogen. The drop in progesterone can actually happen earlier than the drop in estrogen, and they result in anovulatory cycles. These are cycles where you just don't ovulate, right? The egg doesn't come out. You kind of run out of eggs. You know, you're born with a certain number of eggs,

and they decline over time, and eventually you kind of always get pooped out, and you just don't produce an egg. And when you don't produce an egg, that leads to a drop in progesterone. And that progesterone drop leads to what we call unopposed estrogen. So it's either an absolute or a relative increase in estrogen to progesterone that leads to all sorts of symptoms. And early on in the perimenopause, you can get

heavy periods, irregular periods, long periods where you don't have a period, then you have heavy clots. You can get fibroids and worsening PMS symptoms, all because of this drop in progesterone. Also can lead to many, many other things, as we mentioned, in terms of sleep issues and mood issues and headaches and fatigue. And over time, estrogen levels will drop, but sometimes they can actually be quite high. And that's when you get breast tenderness, fluid retention, clotting, heavy bleeding, increased history of uterine cancer. All those things happen in the perimenopause. What about testosterone? Well, testosterone levels also go down in women as they approach menopause due to aging and a natural decline in ovarian function,

which is where half of their testosterone is produced. The rest is produced actually in the adrenal glands. And this results in a loss of libido, sex drive, loss of energy, motivation. And these changes in hormones also have widespread effects on the rest of a woman's biological system. So what are the physiological changes that happen? Well, as women approach menopause, their hormone levels begin to decline and their risk of various diseases increase. So that's really important to know what your hormonal changes are and how to support them through diet and lifestyle before you get into too much trouble. Now, sometimes simple lifestyle changes and some supplements might help.

Herbs are very effective. Things like acupuncture can be effective, exercise, stress reduction, sleep optimization, healthy diet, removing toxins, all those things help. But sometimes you do need help, more help. You need what we call bioidentical hormone replacement therapy. And what does that mean? Well, it just means using hormones that are the same as your body's own hormones. Historically in medicine, we've used something called Premarin, which stands for pregnant mare's urine. Premarin, pregnant mare's urine. Gross, right? But that's what we use. And those are highly conjugated estrogens that are very inflammatory, have increased cancer risk, and cause all sorts of problems. So we don't want to use that. But we're going to talk more about how to use hormones, when to use hormones, and the benefits and the pros and cons

in a bit. But first, let's discuss what actually happens to a woman's body physiologically during this transition period. Well, first thing is bone density becomes a risk, right? Estrogen, as estrogen levels drop, your risk of bone loss goes up, right? Estrogen plays a key role in maintaining bone health by helping regulate bone remodeling. And that involves resorption or breakdown of the bone, an old bone and creating new bone. All that requires estrogen. So how does estrogen do this? Well, it increases the activity of a certain type of cells in your bone called osteoclasts. These are classes like breaking down,

like an iconoclast, something that breaks icons, right? So it's an osteoclast is a cell that is responsible for breaking down bone, which is normal. You want to recycle old bone and build new bone. And it also decreases the activity of osteoblast cells that are responsible for new bone formation. So that's not a good scene. So you get a double whammy with more breakdown and less buildup. So when you actually, in menopause or perimenopause, this combination of bone breakdown and reduced bone growth ultimately leads to a loss in bone density. You see, on average, women lose about 1% to 2% of their bone density per year during perimenopause and menopause. And the rate of bone loss can be even higher in the first five to seven years after menopause.

You really got to be on top of this. Get your bone density checked early, check it regularly, and find out what's going on so you don't get into trouble. We'll talk about how to keep your bone density up too. If you look at what happens, it can lead to up to 20% loss of your total bone mass if you don't do something about it. And we're going to talk about what to do about it, but it involves taking the right supplements, vitamin D, exercise, strength training, and so forth. And this loss of bone basically increases a woman's risk for osteoporosis and fractures if

it's not managed with diet and exercise, particularly strength training. What else goes on? Well, your risk of heart disease goes up, right? Heart disease and stroke are the leading cause of death in women. But the good news is in up to 80% of cases, it's preventable with lifestyle and diet. I've seen studies that show over 90% of heart disease is preventable. So what's happening in a woman's body to increase her risk during menopause? Well, estrogen plays a role that's protective in the cardiovascular system. It enhances the production

of a really important molecule called NO or nitric oxide. It's a vasodilator that helps relax and widen blood vessels and improves blood flow, which we know it works because that's how Viagra works, right? Increases nitric oxide. It also helps reduce inflammation, which is really important because heart disease is an inflammatory disease. And so basically that's all sorts of things. It also helps your blood vessel health and reduce your risk of high blood pressure. And so all these are great. And

the inner lining of your blood vessels is really important. That's what produces nitric oxide. And so that inner lining of your blood vessels is really in part regulated by estrogen. So when it's weak or damaged, that's when cholesterol gets stuck in the arteries and forms plaque that causes hardening of the arteries or atherosclerosis or heart disease. It also increases LDL, the good cholesterol, although there's really no good and bad. It's a little bit more nuanced than that. And it decreases triglycerides, which is awesome. And it also lowers LDL, which tends to be a problem for people. Now, it decreases LDL cholesterol by enhancing the expression of something called LDL receptors in the liver.

And that's good because these receptors basically suck up all the excess LDL in your blood, and it reduces the risk of plaque buildup in the arteries, which is great. It also has antioxidant properties that help reduce oxidative stress and the oxidation of LDL cholesterol, which is what really causes heart disease. It's not just LDL. It's when it's oxidized or rancid, and then it causes heart disease and blockage in the arteries.

So how does estrogen protect against oxidation of LDL? Well, it activates genes that make major antioxidant enzymes, things like SOD or superoxide dismutase and glutathione peroxidase. And these are more powerful than any antioxidants you'll ever take in a vitamin. And they're produced by your own body. Now, these help neutralize free radicals. They protect against oxidative damage or rusting. And it's awesome. And estrogen itself has direct antioxidant properties due to its chemical structure. We call it phenolic structure. Now, the phenolic structure is similar to what we call polyphenols, which are basically these

plant compounds are anti-inflammatory that help neutralize these free radicals. And there's these phytoestrogens, but I don't like that term because it kind of means that they're stimulating the estrogen receptor, but they're actually modulating it in a beneficial way. And they don't actually cause estrogenic effects. They just help modulate it in a good way. And there's ones from soy for like, for example, genistein and dadzine, and they are found in soybeans. Now there there's other plant compounds that also help, like lignans. This is a type of plant phenolic with weak estrogen activity in the body, and they're found, guess where, in flax seeds. So they really help a lot in terms of the overall sort of hormonal balance. So I highly recommend flax seeds for women in general for lots of

things, for constipation and for omega-3s and particularly for helping with hormonal balance. Estrogen also impacts insulin sensitivity and glucose intolerance, meaning it helps regulate your blood sugar, which is key for preventing heart disease and maintaining your metabolic health. So estrogen plays a huge role in insulin sensitivity and keeping your metabolism healthy. It upregulates the expression of something called glucose transporters in our cells, which is basically our muscle and fat

tissue. So essentially, you know, the ability to get glucose out of your blood depends in part on estrogen. It also helps maintain muscle mass, which is key for insulin sensitivity, and it influences accretion of something called adipokines. These are hormones released by fat cells by promoting subcutaneous fat storage rather than a visceral fat. Now, the visceral fat's the dangerous fat. That's around our belly. That's linked to prediabetes, insulin resistance. And when you lower estrogen levels during menopause, it increases a woman's susceptibility to insulin resistance and to weight gain, particularly around the belly. Women notice that. They get more little pudgy around the middle. That's because of this reduction in estrogen. And eventually, it can even contribute to the risk of type 2 diabetes.

What about your brain? Well, brain is important. And research shows that estrogen has a very important role to play in your brain. It's a neuroprotective compound, meaning it protects your brain. And it's involved inective compound, meaning it protects your brain and it's involved in keeping the brain healthy and firing all cylinders. And how does it do that? Well, it helps do it through reducing inflammation in the brain. It modulates the activity of brain immune cells to maintain a healthy brain environment and enhances something called neuroplasticity, which is the ability to grow and strengthen neurons and the connections between neurons. It also influences the production of our neurotransmitters, serotonin, dopamine,

which helps support mood and cognition. And so it upregulates BDNAF, which is essentially like miracle growth for the brain, which promotes the survival growth and the differentiation of neurons and increases connections between them. So your brain's more connected and functional. Also, it protects against something called amyloid beta buildup and toxicity. Now, this is the protein amyloid that accumulates and forms plaque in the brains of people with Alzheimer's, which is why we've seen some data that estrogen is protective against Alzheimer's, which is kind of cool. And that means when estrogen levels decline, the opposite happens, right? Your brain gets more inflamed. You get more brain fog, maybe serotonin dopamine decrease, which can lead to low motivation. Maybe you get anxious.

Your mood changes. It's not because you're crazy. It's because your hormones are changing. Sadly, your risk of dementia goes up and your cognitive decline goes up. So it sounds kind of bummer, right? It's all bummer data. But actually, the reason I'm telling you is because you can do something about it. There's so much you can do about it to prevent all these things and to support your body during this whole time and minimize all these things. So you can't just kind of go through and ignore it and pretend everything's happening fine and not pay attention. You got to pay attention and you got to take care of yourself, ladies, because here's the deal. Most women in this period of their life, perimenopause or menopause, it's called the sandwich generation. They're sandwiched between their parents and their kids.

They're teenage kids and they're olding, aging parents. Plus they're probably in the middle of their career and there's a lot of stress. So you got to take care of yourself. Like that thing they say on the airplane when you're, you airplane when you put the oxygen mask on yourself first then you put on your kid. That's kind of what you got to do. And if you do that, then you can preserve your brain function. You can preserve your body.

You can protect your heart. You can feel good. You can continue to live a happy, healthy, thriving life. But the more proactive you are about it now, the easier the transition is going to be. If you heard me talk recently, you probably know how much I love Himalayan tartary buckwheat, a gluten-free seed loaded with longevity-promoting nutrients. My good friends at Big Bolt Health have been carefully growing and researching this ancient plant for years. After tons of

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medicine. It just doesn't know how to deal with this very well. It's like, okay, take the pill until you're 50 and then we'll switch you to hormone replacement therapy. Well, that ain't the answer, right? Conventional docs don't take a proactive preventive approach to protect against bone loss, against muscle loss, especially. They don't really focus on preventing high blood pressure, heart disease, or protecting your brain during this time. I mean, basically, you might get a platitude. Well, just exercise and eat better and, you know, manage your sleep and stress. But that's not very helpful information. And that leaves a lot of women to suffer. The truth is they don't have to, right? They don't really have to. So let's first talk about where conventional medicine gets the approach to hormone replacement therapy wrong, right? Often what they'll do is to wait until symptoms appear to do anything about it, which is

often late. And even when they do, their interventions just don't support the transition. They just manage symptoms with SSRIs and hormone replacement therapy. I mean, they now have a drug for PMS. It was called Prozac. They changed the name to Serifam, exactly the same drug, just to make it sound like it was for women. But it's kind of ridiculous. I mean, it's not a Prozac. They changed the name to Serifam, exactly the same drug, just to make it sound like it was for women. But it's kind of ridiculous. I mean, it's not a Prozac deficiency, right? There's a change that happens.

Sometimes hormones can be helpful and doctors will prescribe them, but they don't usually do it right. They don't do the right kind of hormone therapy and they use conjugated or equine estrogen. That's horse estrogen. I mentioned the urine, pregnant mare's urine or estrogen. And that's been linked to a ton of problems, right? Initially, hormone replacement was seen as highly beneficial based on some observational studies because they weren't really clinical trials. They just looked at populations, shocked them over time. And it was the nurse's health study. And they found that,

you know, we're 130,000 women. They followed for decades and seemed like the women who took the hormones did better, right? They had less heart disease, breast cancer, dementia, osteoporosis, everything seemed great. But it wasn't hormones that were doing that per se. It was really their lifestyle. We call it the health user effect. So there was a large trial, billion-dollar study funded by the NIH called the Women's Health Initiative and kind of turned upside down these findings. Now, this is a study of over 160,000 women who are postmenopausal who were either on combined estrogen progesterone therapy or estrogen only. And they use synthetic forms. They use pregnant marriage urine and they use synthetic form of progesterone or progestin, which is often very problematic. And now these results were published in a prestigious journal called the

Journal of the American Medical Association. Essentially, they showed that hormonal replacement therapy actually increased the risk of heart attacks, breast cancer, strokes, dementia, and blood clots. And they wound up discontinuing the study early because the results were so shocking and they didn't want to harm women further. That study caused a lot of problems because all of a sudden, you got 50 million women overnight, boom, stopped hormone therapy, and they didn't want to harm women further. That study caused a lot of problems because all of a sudden you got 50 million women overnight, boom, stopped hormone therapy and they were miserable, right? And it led to a shift in their recommendations around hormone therapy being very much anti-hormone therapy. The problem was that they didn't really get into the nuances and they didn't look at the type of hormone, dosage of the hormone, the method of application.

Is it a pill? Is it topical? Timing of hormones. It's really subtle and personalized. The truth is that hormone therapy can be used, and I would like to call it hormone optimization therapy, because you don't want to overdose. You want to do the right forms. You want to do bioidentical forms.

And women who actually begin hormone therapy within six to nine years after menopause can start to benefit from the therapy, but starting it too late after menopause may increase risk. So you got to be careful about when to start. Now, hormone therapy may also help women in perimenopause and helps to reduce symptoms and provide relief, but you've got to be very specific and personalized based on the symptoms and the form and the type of hormones used really matter. So in functional medicine, we do things differently. First, personalization matters. Not everybody's the same, especially when it comes to hormone replacement or hormone optimization therapy. It's just not for everyone and has to be personalized. And you have to look

at a patient's history. You have to look at the risk, the benefits. You want to minimize the risk, maximize the benefits. And second, most importantly, we use bioidentical hormone replacement therapy or hormone optimization therapy. This means you're using hormones that are the exact same biochemical as your body makes. Your body knows what to do with it because it ain't pregnant marriage urine or some weird science project that looks like progesterone, but really isn't. It has all sorts of other side effects. These are chemically identical to the ones the body produces. Also, the type of hormone matters. There are so many types of hormones used in functional medicine, which really emphasizes the personalization and addressing the root causes of the imbalances. And we have to think about all the hormones. You have to optimize thyroid and insulin. You have to optimize your adrenal hormones

and your sex hormones. All of them interact. Before we even think about someone being a good candidate for hormone therapy, we're going to do a bunch of stuff first, right? Because sometimes you don't need it. If you start with diet and nutrition and lifestyle changes first, they can be highly effective. And in many cases, all the symptoms go away, but you got to be proactive about it. The earlier you do things, the better. So if you start with these principles now in your life earlier, you're going to struggle less. You're not going to have a lot of symptoms and you might have a lot better experience through this whole transition period. And I just can't emphasize this enough. Preventive medicine is the best medicine. What should you be avoiding, right?

You want to be avoiding certain things that cause worsening symptoms, things that cause inflammation, that cause imbalances in hormones that make menopausal symptoms worse and perimenopause worse, right? And it just worsens the whole experience of hot flashes, night sweats, sleep problems. So what are those things that make things worse? Well, I don't think you're going to be surprised, right? It's sugar. It's refined carbs and flour. It's alcohol. Really bad. If you're a woman and you're having hormone issues and you're drinking, it's going to be really bad for you, I promise, because alcohol is basically a liver toxin and it affects your ability to eliminate excess estrogen, worsening all your symptoms. Also, don't eat those ultra-processed foods. They're high in inflammatory oils, trans fats,

and sugars, and refined flours. It's basically a science project you don't want to be eating. And if you're wondering more about what they are and you're listening to this for the first time, check out my podcast, The Doctor's Pharmacy, and others that I've done on the dangers of these ultra-processed foods. Now, you're also going to want to stay hydrated, right? When you're dehydrated, your skin becomes drier, and estrogen also, as it goes down, makes the skin a little drier. Estrogen helps the skin produce oil.

It helps retain moisture. So it's kind of important to stay hydrated. So drink about half your weight in ounces per day of water. So if you're 120 pounds, that's 60 ounces, a couple of liters of water. It's not terrible. Also, I encourage you to add electrolytes. I think that really helps to add a little electrolytes. You can just put a pinch of sea salt in and squeeze a lemon, that's enough, or one little extra magnesium, zero sugar electrolytes like Element, LMNT, or we call it Element, or Light Show.

Now, supplementation is also important for correcting a lot of nutritional deficiencies that are common, and they're so common. Over 90% of us are deficient in one or more nutrients. So one of my favorites for menopause, magnesium, particularly magnesium glycinate, 400 to 600 milligrams a day, which helps hormone balance and sleep and mood swings. You can take it at night. Calcium citrate if you are worried about your bone health, but you can get a lot of that from diet, a lot of that from diet. So leafy greens, sesame seeds, tahini is great. I love

tahini for calcium. Chia seeds, very good. So you don't need to get it all from pills, but probably about 600 milligrams a day that helps with bone health and other factors. Vitamin B6 is really important in estrogen metabolism. So 50 to 100 of B6, folate, preferably in the form of methylfolate, about 800 micrograms a day helps hormone metabolism clearance. So there's a whole process of methylation, talked about in the podcast before, but this also affects estrogen metabolism. You need to methylate your hormones in order to extricate them and detoxify them, and you need methylating vitamins. This is B6, methylfolate, and B12 in the form of methylcobalamin, about a

thousand micrograms a day. A lot of other things can help, like evening primrose oil. It's a form of fat called GLA, About 500 milligrams, one or two capsules twice a day with food helps hormonal balance. Fish oil, EPA, DHA, about 1,000 milligrams once or twice a day. Also really important for regulating inflammation, hormonal health, and lots more. Also, you want to support your liver detoxification. Taurine can be very helpful with that. About 500 milligrams a day, which helps support hormone metabolism and liver detox. Probiotics, really important to keep your gut healthy because the gut has a huge role in hormone metabolism. So 5 to 10 billion organisms per day at least to help normalize estrogen and hormone metabolism. I love seed probiotic. You can use that. One of my

favorites, broad spectrum probiotic. Black cohosh, often used with hot flashes and other menopausal symptoms. Although it really helps sleep and reduces irritability when you combine it with lifestyle changes. So there's a lot of supplements you can take. There's more herbs and things that work. Stress, also a big factor, right? Stress has a huge impact on menopausal symptoms. More stress, worse symptoms, and more severe, and more frequent.

So stress increases the production of a hormone called cortisol. That's the body's stress hormone. And when you have high cortisol levels, it disrupts this balance, this delicate balance between estrogen and progesterone, which are already kind of wacky during perimenopause. So chronic stress leads to adrenal dysfunction, where adrenal glands just kind of overworked. And often women in their 40s are overburdened by family and work and older parents and stress and midlife crisis and whatever. Basically, you end up with a lot of trouble with cortisol. And that works as menopausal symptoms, fatigue, mood swings,

sleep disturbances. And also stress activates menopausal symptoms, fatigue, mood swings, sleep disturbances. And also stress activates something called the sympathetic nervous system, which is not sympathetic at all. It's kind of harmful when it's over-activated. And that causes higher heart rate, blood pressure, can make sugar cravings worse, have insomnia, hot flashes, night sweats. It can lead to mood swings and weight gain, depression, headaches, joint pain, all kinds of digestive issues. So not good. So you really want to learn how to regulate stress. It's not something we learn, right? It's something we have to actually educate ourselves about and learn how to manage our stress. So lots of things you can do there,

yoga, meditation, breath work, exercise is great. I love it as a stress reliever. Deep breathing, mindfulness, all kinds of practices are great. Next, you want to eat a real food. Just eat whole food diet. Get out of processed food. Don't eat crap. Prioritize sleep.

You know, getting enough sleep is important. Sometimes you do need help. If you're having struggle, you might need hormone support or other support to sleep. The other thing that can happen for stress is great that you can use is adaptogenic herbs. Things like ashwagandha, particularly at night, rhodiola, lemon balm, cat's claw.

And that can be really helpful. Also, you know, don't be alone. You know, find your friends who are going through this. Share your experiences. Going through this with people and they can help teach you what might be helpful. So you don't have to suffer, bottom line. You know, menopause symptoms and perimenopausal symptoms are optional if you know what to do. If you manage them with lifestyle, the right nutrients, supplements, potentially hormone support, all really important. So my friends, as we wrap up today's podcast on preparing for menopause, it's really clear that this transition doesn't have to be so daunting, right? By understanding these hormonal shifts that occur, by taking proactive steps to support your body, you can really navigate this phase with grace, with confidence. And remember,

menopause is a natural part of life. It's not a disease, right? And with the right knowledge and the tools, you can manage the symptoms and maintain your health and well-being. You know, whether it's dietary adjustments, stress management, maybe exploring the role of hormone replacement therapy, there's lots of ways to ensure that you are going to continue to thrive during this stage of life and feel good, right? The key is to be proactive. So work with your healthcare practitioner, hopefully a functional medicine doc, and tell your plan that's right for you. So thanks again for joining me today.

And don't forget to rate, review, and follow The Doctor's Pharmacy wherever you get your podcasts. Stay healthy, stay informed. I'll see you next Friday for another episode of Health Bites. Thanks for listening today. If you love this podcast,

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or send you anything else besides my recommendations. These are the things that have helped me on my health journey, and I hope they'll help you too. Again, that's drhyman.com forward slash Mark's Picks. Thank you again, and we'll see you next time on The Doctor's Pharmacy. This podcast is separate from my clinical practice at the Health and Wellness Center and my work at Cleveland Clinic and Function Health, where I'm the chief medical officer. This podcast represents my opinions and my guests' opinions, and neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes

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