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

Episode Date: July 27, 2023

In this episode, double-board certified Dr. Amy Shah is here to explain the science of hormones, how they impact a woman's body, and more importantly, what you can do about it. If you’re tired of PMS, bloating, mood swings, hot flashes, the belly "bread basket," or the brain fog of menopause... grab your pen and get ready to take notes. Dr. Amy, a medical doctor trained at Harvard, Cornell, and Columbia, is an immunologist and leading expert in women’s hormonal health and nutrition. She is here to explain it all in a way that you can understand and apply to your life.   Today, Dr. Amy Shah reveals: What hormones are and how they work.What’s going on in a woman's body from first period to menopause.Why hormone therapy won’t help you lose weight.What 4 things you need to help you naturally boost estrogen.Why walking is better than HIIT or running if you’re in menopause.3 simple changes for a better night’s sleep.How sleeping in a pitch-dark room helps you lose weight.How to hack your 28-day cycle for more confidence and resilience.  I can’t wait for you to learn from Dr. Amy. You are going to feel so empowered! And please share this with all the women you care about in your life: your mothers, sisters, daughters, wives, and girlfriends, because we all deserve to know what the heck is going on and how to feel better in our bodies. Xo, Mel PS: For all of our readers who are men, do NOT stop reading. You have to live with us, so this will help you too. (And will make you wonderful when you forward it to all the women in your life). Plus this research and advice on hacking hormones is just downright fascinating! In this episode, you’ll learn:02:27: Why the hell do I always feel so tired? 04:52: What happens in our bodies during PMS and menopause?09:10: Best metaphor to help you understand what’s going on in your body.11:37: How to optimize your health in every phase of hormone change.15:02: When in your cycle you should train and eat like an athlete.17:03: What is really happening with your hormones during pregnancy?21:09: Where the heck did this muffin top come from?27:32: The top 5 health questions for Dr. Shah and her answers. 30:02: Did you know that PMS is a mini-menopause?34:06: Why sleeping in a cold, dark room will help you lose weight.38:42: Top 3 tricks that regulate your cravings.40:01: Why anxiety increases during PMS.46:48: What you need to know about hormone replacement therapy.56:12: Power nap or meditate at THIS time for best results.59:01: Why it’s way past time we start talking about women’s health.  Disclaimer

Hey, it's your friend Mel, and welcome to the Mel Robbins podcast. All right. I have been wanting to do this episode for such a long time. What are we talking about today? The big M and the big H. What is that? Manipause and hormones. And no, do not touch that off button. Everybody needs to hear this.

Hormone changes in women affects half of the population. Today is a conversation for all of us. If you are in the stage and the age where you feel bitchy and itchy and dry and hot and your hormones are all out of whack or if you're living with somebody who is going through that, everybody needs to hear this.

I'm embarrassed to tell you. I know Jack Shit about menopause and hormone fluctuation in women and in girls. And there is so much misinformation flying around the internet. I thought, I have to have a conversation about this. With you and a medical doctor, somebody who understands this. We are gonna cover everything from PMS to hormones and women

to what to expect when menopause hits. We're not gonna be getting our menopause tips on TikTok people. We're talking to a doctor about what is going on in our bodies. And the thing that everybody that I know is bitching about my age, which is the bread basket that develops in our bodies. And the thing that everybody that I know is bitching about my age, which is the bread basket that develops in the middle. That's what we're doing today.

And who have I asked to guide us through the land of menopause and hormones and women? None other than Dr. Amy Shaw. That's right. She is back. She did her training in nutrition from Cornell. She did a residency at Harvard. She got a fellowship in Columbia. She did a residency at Harvard. She got a fellowship in Columbia. She is an expert on hormones. Dr. Amy Shaw is backed by popular demand. Dr. Amy,

welcome back. What an honor. Thanks, Mal. You're welcome. So I loved your book. I'm so F. Entire titles. Fantastic. By the way, because I do feel F-entireed, and it's a proven plan to be burnout, boost your energy, and reclaim your life. And what I really wanted to talk about, because when I hear the word tired, I think about two things. How everybody I know feels burnt out, and I want to talk about adrenal fatigue, but I also want to talk about menopause, the big M, the big M. The big M. I'm going to be double nickels, 55, this year.

I am in the thick of it. What the fuck is going on with our hormones and our bodies? And why isn't there more information? I mean, it affects half of the population for crying out loud. So where do you want to start, Dr. Amy? I think the menopause conversation needs to be had much more commonly and much more openly. Most women go through this time of life and they have no idea why their anxiety level has increased,

why their energy has decreased, why they feel like there's a brain fog, people will present with ear itching, body itching. Wait, that is something that's that's part of metapods. It is? Yes. That explain. Did you just see me as we are walking up? I was itching my back as if like I had just been bitten by a mosquito. Why does your body? I'm gonna hijack this conversation so fast. So keep going with the weird ass symptoms. Yeah, I think the biggest symptoms that people feel is the brain fog that happens with menopause. And the mood changes, the hot flashes,

and then the sudden change in temperature. Like what is happening? Why are we feeling like this? We don't have the conversation enough. And so everybody's kind of feeling like they're going crazy. Yes. And one of the biggest complaints and I know that we'll touch on this is the increase of fat around the middle. Yes. So brain fog, fatigue, the increase in fat, especially around the middle. And all of these weird symptoms all have to do with your changing hormones.

Okay, you're gonna have to break this down for us because the conversations that I'm having with my girlfriends, it's all about this metamorphosis. I feel totally out of control. The last time I felt like this in my own body was when I was going through puberty and I started to get, you know, first you get those like knots or whatever they're called bumps

or whatever they are and then you get the boobs. I didn't feel that way about pregnancy when my body was changing because I was so excited about it. Yeah. And because there's so much written and that you can read about pregnancy and it's so celebrated that you kind of know what to expect even though when it's your first time, it feels so foreign. But this feels so out of control. And I also am glad that you're here because I know it's also a really frustrating time for the people who know and love us

because it's not just the hot flashes. I have hot flashes in my mood. Like I will swing from happy to bitchy, like a kitchen door swinging. And so, should we start with understanding what's going on? Yeah. Well, first of all, let's just understand the fact that we don't talk about enough in medical.

True. In the medical sense, we talk about all the time with our friends and colleagues. I mean, your conversations with your friends and my conversations with my friends match. It's metapause, metapause, metapause all the time, right? Because we're all trying to figure out what's going on with our bodies. We're trying to help each other because we don't have enough guidance. It's not like pregnancy where you can say what to expect when you're expecting on day

22. Yes. So I guess we should start with what the fuck is going on. Exactly. And the problem is is that in our lifetime, I was in school when they actually mandated that women be included in medical studies. Wait, what? Women were excluded from all medical studies because are fluctuating hormones or the fact that we could be pregnant during a time of a trial. And so every medication, every intervention, every surgery, everything was done only on men.

Well, I knew that about the ADHD studies in the late 70s and why ADHD has been misdiagnosed at profound levels for women because they only study boys. I had no idea that all of the medical studies related to anything. Anything. Why are people not talking about this? I know. of the medical studies related to the effect of anything, anything. Why are people not talking about this? I know.

How do we even know then whether or not the side effects of something are going to impact us versus the way they impact dudes? In fact, what they were just doing is they would just prescribe a smaller dose to women. Sort of like a golf tee that's closer to the green. It's like they didn't know anything about the biology of women, but they just said, well, let's just give them a little less. They're just smaller, you know, than men and thinking that medications are going to affect us the same way as they would have in men.

And that's why women are the forgotten gender when it comes to healthcare. Wow. So what year was this in medical school? I think it's the 80s where they had to mandate that women being included in all studies. Wow. Yeah. And then on top of that, what they weren't doing and they still don't do

is they weren't seeing the impact on hormones. All right. Now you're forced to include women, but you're not actually seeing what the impact is on our hormones, if any. Right. Maybe there's no impact, but why not look at what's happening when you're taking medication X? What's happening to the estrogen, progesterone, testosterone? There's no data. I can't believe that they're not looking at the impact on hormone levels. That's kind of scary on the shame. In fact, when I was a young mom, my kids were one in three, and I was out of the postpartum range,

but I felt so out of control, like I felt burned out, but then I couldn't sleep. My hair was falling out, but my thyroid levels were fine. And I was so confused about my hormones. So I thought maybe I just didn't pay attention to that part of medical school. So I went to the hormone experts, so called OB-GYNs, my colleagues who were specialized in women's health

or raise. And they said to me, oh, we didn't learn about that either. We learned about pregnancy, puberty, and then all you learn about metapods is that it just shuts off, and that's basically all we know. And so I said to myself, well, that's really sad because at least half of the population is women.

And if doctors, if they don't even know what's going on, then how are women gonna know what's going on, then power women going to know what's going on. Can you explain what a hormone is? Yeah, that's a great question. Hormones is a chemical messenger. So what do you want us to know in terms of hormones? The 101. All right, let me tell you. It's like the best analogy is like two sisters. Okay. like the best analogy is like two sisters. Okay. Astrogen is super smart. She's super social. She is outgoing. She can be a little bit risk-taker. She can be a little bit out of control. Got it. Then you have the sister, the progesterone sister. She's very calm, level-headed. She knows when the other one's like kind of going off the rails. She's the one that kind of keeps you at home.

Says, no, study to, you know, stay at home. Let's just chill. She's the one that keeps you calm. Okay. So when we're going through menopause, we are getting less estrogen and less progesterone. So you're starting to feel like you're not as sharp, you're not taking as many risks, you're not as social.

Yeah. Your level of estrogen is going down. Gotcha. You might not have the energy levels. Yeah, might not feel like doing the things you used to do. Your activity level might go down, just without even realizing it, you're just sitting more. As progesterone goes down, you start to get more anxious. You start to feel like you can't sleep.

And you start to feel like your life is out of control. Wow. And so what you're noticing? It's also why I'm waking up in the middle of the night. Yes. The drop in estrogen of a gestorant is why I'm not sleeping through the night? Yes.

I thought it was because I had to go to the bathroom but it's probably because of the hormones. Yes. Dr. Amy, I cannot thank you enough for explaining this to us. Let's hit positive clicks. We can hear a word from our sponsors because they're allowing us to bring this to everybody at zero cost. And don't you go anywhere.

We got so much more to cover when we come back. Welcome back. I'm Mel Robbins. I'm here with Dr. Amy Shaw. You know what we're talking about? The big age people, hormones. So Dr. Amy, talk to us about women's hormones throughout her lifetime. What do we need to do to optimize our life throughout every one of these stages that women

go through from puberty to menopause? Yeah, that's a great question. So women start their hormonal cycles at puberty. Women often aren't even taught what their cycle is and what to expect and how to manage it because you just go through life thinking it's just a annoying period, but you don't really learn anything more about it.

It's so true. It is annoying and you don't know a lot about it. So the first day of your period is a very momentous day. It's the start of your 20-day cycle. And the reason why I think it's important for us to understand is that you're starting basically when you shed the lining of your uterus, that's your period, you're starting basically, when you shed the lining of your uterus, that's your period, you're starting over. So now, from day one of your period, all the way till day 14, you get a rise in your hormones.

If you don't get pregnant, then you're gonna get a fall in the hormones. Get a fall in what hormones? Astrogen rises throughout the first part of the cycle and progesterone actually rises to testosterone has a little spike closer to ovulation. So day 14, but the interesting part is that at the latter half of your cycle, if you are not pregnant, so most months, you're going to be experiencing a fall in your hormones.

And I think it's really important for women to realize that you can train and eat and fast and live differently throughout those different changes of your hormones to match what's happening. What does that mean? So from day one through day 14, when your estrogen and progesterone levels

are getting higher and climbing, especially towards that day 14, you're gonna feel more energetic, you're gonna be more stress resilient, you're gonna be able to do more workouts. So I always talk about that time, is like train like an athlete, eat like an athlete, eat more, train more, energy levels

are good, stress levels are good. This is a time to try out intermittent fasting or no food two to three hours before bed. So day 21 through 28. So it's called the late luteal phase when your hormones are really dipping down there, the kind of mini menopause call them. That's when you pull back on the very stressful activities. You pull back on eating lots of like maybe you're eating a lot more treats or sugar or carbohydrates in the first half a cycle. That's when you want to pull back a little bit. You want to realize that your body

is less stressed resilient. This is not the time to take on all the projects and to be skimping on sleep and to be working out excessively and to be adding the intermittent fasting for the first time. You don't want to be testing your stress resiliency at this time if possible, because according to your own cycle, this is the time that you're going to be least stressed resilient. Also going to be more insulin resistant come down on the sugar and the carbohydrate level, start to eat more fiber and protein to keep yourself fuller. And so when you understand that, you're like, oh, well, that makes sense. I naturally don't feel like doing my high intensity workouts the final week of my period. So from the time you hit puberty two of the time,

you go into menopause, you have these monthly cycles. It's imperative for us to learn them and to learn how to optimize them. Wow, this is so interesting. You know, if we were all clued into this, how to optimize your energy or your focus during certain stages of your cycle. And if we knew what really worked for our bodies from a younger age, by the time we get to menopause, we wouldn't have to have the discussions that we're having today. It's kind of lame that as a 54 year old woman,

I'm still going, what the fuck is going on with my body? Exactly. The problem is the world is a man's world, at least a medical research world, because that's what we've researched. Because we don't have enough research on this topic, we don't have 10,000 women's studies where we look at their cycles and we look at menopause.

I mean, we need that, we need that data. So we can say, hey, if you are trying to optimize your muscle mass, you should be training hard in the middle of your cycle. Where are those studies? Where is the data? We have a toolbox. So a woman goes through puberty.

She gets her menstrual cycle. And then what happens when somebody gets pregnant? What happens to the hormones then? So basically what happens is, if that ovulation, the egg gets fertilized, the hormones stay high. They don't drop to let the lining shed. So as the hormones stay high, you get obviously HCG, people know this because this is the one hormone that actually rises during early pregnancy. That's what you check when you pee on a stick, is the HCG levels are in the blood.

The body knows that your pregnant is released HCG because there's been an implantation. So you don't get the whole last part of your cycle that you usually do. There's no late luteal phase and there's no PMS, your hormone levels stay high for the duration of the pregnancy. And then when you have the baby, it can take a few months actually to normalize or some fluctuations, but then you'll go back to having kind of that. Approximately 28 to 32 day cycle. And then there's paramedicause. I guess this is like the warm up for menopause. I mean, what happens there? Paramedicause is your estrogen and progesterome are getting low, like a tube of toothpaste.

When you kind of get to the end of the toothpaste, sometimes you press on it and you just get a splatter. And sometimes you just press on it and you get a full squeeze of toothpaste. And sometimes you press on it and you get nothing. And so that's what's happening during a paramedic pause. Some months you're getting a good dose of estrogen and progesterone. You're almost feeling like you're normal. Other months, you have a low level and you're getting all these symptoms and some months

are you're feeling absolutely terrible because your hormone levels are super low. You can have a lot of fluctuations during this time, that's pariamenopus. One of the things that people talk about is hot flashes. The reason why hot flashes happen is one of the roles of your hormones is to tell your hypothalamus, your temperature center, what to do, like how to regulate our temperature. So that month, if you just get a splatter of estrogen or you get none, you get dysregulation of that central thermostat. And so now you're hot, sweating, and you get these peaks and valleys of temperature. And so that's how I would describe paramanopause, and that can happen for multiple years.

And that's why there's treatment now, like there's things you can do, hormone replacement therapy is really good for that kind of hot flash temperature of dysregulation. That seems to help. And so you have all that. And then you hit menopause and menopause, the definition is no menstrual periods. So no ovulations for 12 months. And so full year goes by. You don't have fluctuations anymore.

You're just at low levels. The fluctuations of the hormones are wreaking havoc on our brain and our body, but about five to 10 years, you seem to have a reprieve of the symptoms. So you're no longer getting the hot flashes, you're no longer having some of the menopausal symptoms. Some menopause is defined by having no menstrual period for 12 months, okay?

But the drop in estrogen and progesterone that we're talking about here happens up to 10 years before menopause. Wow. So you know what's interesting is that I started to see a big spike in sort of fogginess and feeling like it's something wrong, probably like in my, I'd say early to mid-40s. Yes, that's very typical. So it can be as early as 35 for people who are going through metapods a little bit early,

but usually in their 40s, especially your mid-40s, is when people really start to see, oh, you know, that exercise that I was doing is not working to control my weight anymore. Well, everybody that I know is talking about the fact that their body shape is changed, that there is this thickening in the middle. My sister-in-law who I love keeps referring to her body as a twinkie, just like a twinkie with legs.

I'm like, were you shut off? Stop. I'm too late. And I'll get flack for saying this because I'm a lean athletic build kind of person. But all my pants fit very differently now. Yeah. It's as if I have like those inner tubes that you sit in a pool.

It's like I've put one from the belly button around the back. It's like all of a sudden it's filled out so my pants don't fit anymore. I could not do more crunches. I couldn't eat healthier if I tried. I am already getting eight or nine hours of sleep for God's sakes. I've cut back on the alcohol.

I smoke a little weed here and there. That's not putting on the shit in the middle. I don't even get the munchies when I smoke weed. Why is this happening? This is happening. It doesn't seem fair. I know. It's because our estrogen levels, as they start to drop,

our body is looking for more hormonally active cells. So the fat that you accumulate in your middle, it produces estrogen. Okay, wait a minute. Fat produces estrogen. What do you mean fat produces estrogen? Fat cells. You didn't say that the estrogen sister was a fat sister. You just said that she was the one that was the party. Yes. She, in our cells. I was talking about that estrogen progesterone that are primarily coming from our ovaries prior to menopause.

Premenopause. Okay. But as you get into menopause, you start to get a very big dip in your estrogen. Oh, that's true, because you're not going to be producing children anymore. So does the estrogen and progesterone supplies that are part of the reproductive system start to drop?

Yes. And then as your estrogen progesterone gets lower, your body starts to do things to try to compensate for it. So it's looking for fat. Yes. Do we also get flabier around the arms? I'm like, where did these wings come from? Yes.

That's because estrogen, the other thing it does, what? It helps us keep our muscle mass. So when you decrease your estrogen over the years, so I'm not going crazy. I literally have been looking at my arms and saying to myself, something is wrong with my arms. I realize they're toned, but they used to be a lot toner.

I don't know if that's the right word, but they're like flappy now. And I'm like, what is that? One to three percent of muscle mass. Yes. Per decade, you'd say up to three percent, but as you go into metapause, it goes faster, meaning that you're losing muscle at high rates.

If you're not also weight training, eating the protein, so there's the one therapy I can tell you right away for your arms. Tell me. It's the start to do more weight training, start to build muscle in the places, not only that it was, but that you can build more muscle on. So, this is the best time to pick up some weights. Oh, I have, I've used the tonal machine at home. I'm doing the things, Doc.

More things than you used to. Ugh. That's the key. That's not fair. So, what I'll tell you is that what we found is that when people start to go into paramanopause and their estrogen drops, their activity level drops a little bit

and they don't even notice it. So you may be gaining some fat cells, not only because of the estrogen drop, saying to your body it needs more estrogen from fat cells, it's because your body is not as active as it used to be. And it's very subtle and you might not even notice it until you say, oh, you know, I used to naturally just get up and walk and used to get 10,000 steps.

And one of the other things you can do as someone, we're talking to our friends, we're talking to the audience, increase your activity level, your baseline activity, even if you don't want to. I see shit on TikTok. I've got to, got to eat more protein. Is that what you're talking about with activity level? So what do we need to switch up? Because the other thing that I was talking with a friend about is she's like, I'm on that peloton, like every day. And I am not seeing any results whatsoever. And it's not palatones fault. Something is going on with my body.

Yes, it is. And she's not crazy. That's the biggest thing is I feel so bad because my mom, when she was going through menopause, felt like she was going crazy. She's had anxiety. She couldn't sleep at night. She was gaining weight. And she was like, I feel like I'm literally going crazy.

The sad thing is, is that it happens to all everybody. Yeah. Humans are one of the only animals on the planet that go through menopause, by the way. Really? Most animals reproduce till they die. Well, thank God we don't. I mean, that would be absolutely awful.

So the fact that we live past our reproductive years is pretty unique. Huh. Dr. Amy, I love listening to you. You just have this incredible Mac for taking all this sciencey complicated stuff and distilling it down into something I can actually understand. Let's take a quick break and we'll be right back with Dr. Amy. Stay with us.

Welcome back. I'm Mel Robbins and we're talking to Dr. Amy Shaw about menopause, PMS hormones, all the men. I can just hear them running off into the distance. Do not go anywhere. There's an important conversation for all of us. So Dr. Amy, what are the top five things that people complain to you about when they come see you for help with nutrition and hormones and how do you attack fixing them? Okay, so number one is definitely the weight gain. The weight gain is very frustrating because if you're an active person, we're already living in a world that's working against us. The default is that we are going to be in the categories of medically overweight or obese, 73% of Americans are there now.

Wow. It's gonna be at 85% before we know it, right? Most of us are already metabolically challenged. We're already fighting against this battle. Then we gotta deal with the estrogen going down, which makes you less active, less energetic and losing your muscle mass. So now you have more fat and it's making your mood a little bit lower, right? The therapies that I recommend, a lot of them have to do with things to counteract the

changes in the lowering of estrogen. Okay, like what? have to do with things to counteract the changes in the lowering of estrogen. Okay, like what? So walking more. So what I tell women is like, our cortisol levels can be really high when we're doing high intensity exercise. So it's better to have a baseline of walking

and you can do bouts of hit if you want, but really having more activity. It's called neat, non-exercise activity thermogenesis. Neat activity is actually a bigger driver of our weight. What is that last word? What is thermogenesis? That's a big word. Non-exercise activity thermogenesis.

Thermogenesis metabolism. Okay, so what is a non-exercise? Is walking is not... Walking, so if you're not walking for exercise, we are a watch, or you wear a pedometer, you park farther, you take the stairs, you take your dog for a walk, all the stuff that you don't count as exercise,

that's non-exercise, activity, thermogest, that has to go up. Okay. If you're in parry menopause and you wanna fight the weight gain, that's where it starts. And so the reason why running or hit 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 metapods or paramedicods, the week before your period, you're just less stress-resilient. You can't handle the things that you usually can handle. Yes, so your mini-PMS is happening for a few years now.

So your mini PMS is happening for a few years now. So is PMS a mini monopause? It's a drop in your estrogen and progesterone in the middle of your normal cycle. Yes, no shit. That's a no thing. 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 dropped 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 parry or menopause itself also help with PMS symptoms.

Yes. 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 gonna say, I think it's sexier to say,

I'm in my late luteal phase. That's the late luteal phase. Luteal phase. But you're talking, that's a period, I'm sorry. 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.

Okay. The things that I told you about more neat activity, more weight training, right? That's going to help the weight loss. Okay. What else do we need to do for the weight loss? So, I know everybody's leaning in. Yes. Because I thought if you get the patch or the bio identical, your body will snap back into the weight 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. That definitely, HRT definitely helps with that. But the weight gain portion is not so easy to address

just with hormones because there's a multiple things going on. Like 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 is 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 gonna 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. The 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. And that's a tell us your top three things for a better night sleep. Top three things for a better night sleep. Cold room. Okay. Your body temperature has a drop by one degree to fall asleep. Oh.

So how do you get that done fastest? You can take a shower. You can cool down the room. Okay. You want to cool your core body temperature. That's how you'll fall asleep. Love that. Pitch black. Mm-hmm. If you can't control the curtains and the light, then wear a face mask or I 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. So 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 nine o'clock in the next day at 11 and next day. They're massively disrupting their sleep cycles. And 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 if you had to bottom line it for people that are really wanting to use food to regulate hormone. What are the top recommendations? Remember 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 gonna fund those? I mean, people say to me, I always drink this much caffeine. And they always eat this much sugar. Yes, they're head and glass of wine.

Yeah. Whatever, what the hell is going on? Yeah, and that's because now your hormones have changed and your metabolism, you're also less insulin sensitive. So you've heard the term insulin resistance. Yes. What does that mean? So 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's like, dude, we just let sugar in.

We're not gonna let more sugar in. And the body's like, nobody's like, I need to get it out of the bloodstream. I need to put it. And the insulin's like, no, but the cell to get it out of the bloodstream. I need to put it and the insulin is like, no, but the cell is packed. It 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 2 diabetes because your sugar level so high all the time, you also have more signaling to store fat. Oh, man. Yeah. So it's a resistance.

It's something that we can control by saying, well, the cells are so full of sugar and they can't let any more sugar in. You better eat some vegetables. You better just cut some of that sugar out. 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, which is fiber. Add more fiber so that your blood sugar can be regulated in your body. Move more like we said. Yep. And weight training. Sleep more. And remember the water that we talked about in the other episode, our third centers are often mixed

with our hunger centers, like the signals can be mixed. So you want to hydrate enough so that you are not eating mindlessly. So in 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, you can say, would I like a bowl of vegetables right now? And if the answer is no, that means you're not actually hungry. You can say, what I like a bowl of vegetables right now. And if the answer's 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? 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 chillax or anymore. You don't have someone to keep you calm. Like that sister that was saying, like calm down, it's okay now. Like, you know, you'll be fine. saying, like calm down, it's okay, Mal, like, you know, you'll be fine. Your protestant levels are lower. And 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 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. It's the car. Oh. 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 estrogen, 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 parties over. Yes. That and she calms everybody down by yeah, this is 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 insulin is telling you open the door to let the glucose and 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, wait, no. It goes, it's controlling weight, temperature, it's controlling heart rate, it's controlling a million things. It'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 that 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 two high doses of thyroid hormone will have heart problems often. It'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. Yes. Wow. And for some of 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 in 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. That'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 parimenopost

and during the cycle if you're lower than you need to be. But of course, you don't want to overdo it people, overdo it all. How do you figure out what to take? Yeah, I know. I know. There's so much misinformation out there. For example, big, big example. The one thing that all doctors can agree about is that those palettes that people get are no good. I don't know what the hell of 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 a replace.

And what's happening is that you can't adjust the levels, right? And most of these pellets are giving you super therapeutic levels. And 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. And so why would you use an implantable testosterone that can't be titrated, that usually releases too much?

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, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, I said this on social media and people went crazy because they said, I love my testosterone pellets. And I said, great. But make sure your levels are at the level that you want to 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 dose thing. 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 yourself was so excited about them that I'm like, I gotta get me some pellets. I gotta go, I gotta 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. Yes.

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 our 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. And women will be shamed for symptoms that are actually real because they just think, oh, she's 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 flabbyer 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 yeah, 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. And I am sorry, I'm not settling for that. And that's one of the reasons Dr. Amy, I want to do 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, you know, fertile women, right, 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. And 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 to 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 drive a giant eye and I sweat at night

and I feel like somebody's grandmother. Exactly. So here's how we move through the day. 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 going to get an adequate night of sleep. You're going to go get that sunlight in the morning. Yep. So circadian biology, again, the light that you get in the morning tells every cell in your body that it's morning. And 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. They don't. No, it's this hormonal highway that we're talking about gets clogged. It's not just adrenals, it's coming from the thyroid, it's coming from the brain, the whole trafagym is happening because of all the other things, you know, the lifestyle, the age trafagiam is happening because of all the other things, 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 day time inside, well what I love about this, I think I'm 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.

Yes, 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 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. We need to clean those cars up and get those out of there if they're not working, right? So keeping with that analogy, that's we don't want 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. And I see this. And I see this. Because your day doesn't hijack your energy and your time. It'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. Okay. Possible, right? There's a second peak time late afternoon and late afternoon. It's a better time to muscle build. So if you're doing too many workouts that you can just split it up and then high protein. High protein. High protein is one of the biggest things that doesn't happen with women in

parimentopause because what happens is women think that you're trying to be skinny and when they start to see themselves gaining some middle section with they often cut down even more and you're in the 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-process 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. So that you don't spike your cortisol. Exactly.

Oh, 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 four 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 is 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. Is 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 paramedicment and pause. And so it's often the time where people feel a little reprieve, but remember that disease risk goes way up after metapause. Our hormones protect us from heart disease and all of the disease of aging. And so once you hit metapause, you start to have an increased risk of all of those inflammatory diseases. Okay. 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 an 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 paramedicause,

the earlier you start at the better risk protection you get from a hormone replacement therapy. So 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, 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, and 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 gonna last till you're 60, and you know, you can do hormones or, you know, whatever, you're gonna 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 conversations. It's not that, oh, you're just worried, you're just stressed, you're just getting old

and dismissing their concerns. These 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 hold. 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 with you to you with these complaints, don't just write it off as separate things. Think about like where she and her cycles, like where is she with her hormones?

And there is this big myth that in order to be considered in menopause or parimenopause, you must get your hormone levels checked. Because that's what you hear on the internet. Metapause 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? If you're getting replacement therapy and you're trying to troubleshoot something, but the diagnosis of metapause 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 in 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. Clearly 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, there 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 effentyred, but we ain't so effentyred no more because Dr. Amy has given us simple things backed by profound science that you learn today that will help you take control of your hormone health so that you can live a much better life. Thank 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, I believe in you, and I believe in your ability to create a better life. All right. Talk to you in a few days. What is that last word, thermogenesis? Nonactivity, non-electric.

I can't keep up with what is thermogenesis. You're in fucking menopause, so your mind is going. There we go, yeah, we'll talk about that later. Do we say which hormones? It is, okay, well then I would say what hormones? Yeah, that will definitely keep it in what form was it. I think that, uh, diet coke. And the outside put a little life and, uh,

slightest infected noir ovens here. Oh, and one more thing. And no, this is not a blooper. This is the legal language. You know what the lawyer's right 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 this podcast is not intended as a substitute for

the advice of a physician, professional coach, psychotherapist, or other qualified professionals. Got it? Good. I'll see you in the next episode.