Menopause Research Is Failing Women

You know, I'm always excited when I run into a fellow researcher and nutritionist who is actually making a difference in perimenopause and menopause research. Today, I'm joined by Andrea Donsky. She's a nutritionist, a 7-time published menopause researcher, and entrepreneur with 26 years of experience in the health and wellness industry. She's also a respected multi-award-winning influencer and media personality, speaker, and author. She is She's also the podcast host of Menopause Reimagined. And her new book, Nourishing Menopause: Powerful Nutrition and Lifestyle Strategies to Feel Your Best, published by Simon Schuster, is actually out now. And today, we talked about some very important things, especially some of her direct research that has been published in Menopause Society magazine about women's health and the experience of perimenopause and menopause. So today we covered some deep dives in some of the things that you probably have never heard before, because guess what? The research isn't getting published fast enough. So join me today on Menopause Mastery where I'm talking to Andrea Donsky about the experience of perimenopause and menopause and what the research actually says. Fantastic, Andrea. Okay, I am so excited you're here, because as two research nerds and nutritionist. We're going to dig into a bunch of things that people get told all the time that we haven't looked at yet, right?

Yeah, I'm so excited to be here. It's so nice to meet you.

Yeah, absolutely. So you have been published how many times in medical journals?

7. I have 7 abstracts published in the journal Menopause.

Yeah, so I just need to point out to everybody how much of like a Sisyphus pushing a boulder up the hill that is to get published in general. I mean, really, only 15% of research actually gets published. And then, the hoops you have to jump through, and then the fact that we don't have a lot of dedicated women's journals except for menopause. I mean, I applaud you. I mean, I applaud you, you know, over and over and over again. But, I want to talk a little bit about probably one of the more profound ones that you did, and it was really looking at symptomatology. And it was all the way— like, we hadn't looked at that since the '60s. And you published research on 103 different. Is that right? 103 different symptoms. So let's talk about that, because women think it's hot flashes and night sweats and maybe a little bit of bitchiness and cognitive issues when it's like so many more things.

Yeah, thank you. Yeah, so I published— so the first survey that we came up with was in 2022, was our signs and symptoms survey. And the reason that we launched it was because I was at a party with a friend, and we were getting caught up on what we were doing, and she was you know, telling me that she was creating an app for menopause symptoms. And at the time I'm like, an app for menopause symptoms? Like, don't you actually have to have a lot of symptoms to create an app? Like, in my mind there were like 3, you know, like you said, hot flashes, night sweats, sleep issues, or mood swings, 4 or whatever it was. And she was like, no, Andrea, there's so many symptoms, I'm telling you. And I'm like, well, she's like, there's 34 to 40. And I was like, wow, there's that many. And the way my brain works is like, I went home, I created this document, I'm like, okay, I started tracking it and I looked at the medical journals and I'm looking, looking online and in Facebook groups and just kind of like talking to family and friends.. And I was like, whoa, there is a lot more than even 34 to 40. There was like 80, 85 symptoms. So I thought, you know what, I'm gonna start— years later I was like, you know what, let me just go to our community and ask them what they're experiencing. And we quickly found out that there's 103+ symptoms. And yeah, the last time any type of quantifiable number of symptoms was published in a medical journal was in the '70s. And at that time it was like something like 20-something. So, it's like, to me, understanding that there are so many more symptoms than the ones we think of is so important because we know how much women are dismissed in this phase of life.

Absolutely. You know, you look at it and you go, "Okay, less than 5% of women that are in the perimenopause and menopause and beyond transition are actually being treated appropriately for the symptoms they are probably having." And, we can clarify that based on the ones that we assume they're having, which is that shortlist. —right?—when we're really looking at it and saying these women are suffering with a bunch of other symptoms, and some of them varying degrees of suffer, right? But, they're suffering with other things and they have no idea that it's truly their hormones. And, what makes me then pause is, "Well, then when they go to the doctor, what else are they giving? Antihypertensive, antidepressants, sleep medication, anti-inflammatories." The list goes— we get this polypharmacy, lipids, lowering drugs. And it's just like, it's such a travesty in women's health that we just don't have the capacity to like get this information out there like yesterday, you know. And, and I think women suffer, and it pisses me off. So, I mean, obviously anybody listens to me knows that. Like, Betty's man, amazing. I like eloquently you put that.

It pisses me off too. I'm right there with you. And that's exactly why I wanted to know what the symptoms were, because truthfully, we know. So, we have another survey that was published also in December 2024 on doctor visits, and we know 40% women are dismissed. We also know that they're not getting the treatment. So, so many women are not getting the treatment that they deserve. And when they are getting some type of treatment, number one is, is antidepressants. Number two, which is a close second, which is interesting because it's coming kind of coming around, is hormones. And number three are supplements. So which— when they're— or they're told to take to whatever to help themselves. So I find it interesting that still antidepressants are number one. And you're right, all those other things as well, when truly We can, if they understand that it's hormones or perimenopause or menopause related, they would be getting the treatment a lot faster. They'd be getting things that will work. And I come from the point of view that we need, we have a whole toolbox. The toolbox is nutrition, lifestyle, supplements, and/or hormones, if that's what you choose to do. But to tell women, which many of the women in our survey have told us that, you know, they're being told that either they're too young to be in perimenopause or menopause in their 40s, or there's no treatment, they just have to deal with it because it's part of aging. I mean, all of these things that they're being told is so crazy to me. When we do have solutions and women do not need to suffer.

Right. Oh, no, I agree. And, well, and, you know, the other one that I find, and let's be clear, we've got a dearth of real research, but then there's always this, you can't have it after, you can't have it as long as, and like these blanket statements that I'm like, based on what, right? If we take out the Women's Health Initiative and all the data from Women's Health Initiative, how much of that do we have that's outside of that? Flagrant disregard for scientific analysis and statistical measures, right? And so, yeah, I'm with you. I was like, you have to do the underpinnings and the cornerstone. You can't just take medication and it probably ameliorate all your symptoms, but it's important that people have both. And I like the fact that you've come from it from a nutritional biochemical sort of pathway because a lot of times people only have limited tools. And I truly honestly believe that we have unique set of tools. Because we understand mechanistically often really, really well what's happening all the way down to the cellular and mitochondrial and, you know, membrane activity. But, we can also help people address it with things that they can actually take action on. And, I don't know about you, but I find a lot of practitioners that are prescribers kind of— they let that go somewhere along the way. It was like, "Poof, I don't need to know that anymore." And so, they don't always take the right approach and hit all kind of all the cylinders that somebody needs to have their engine running correctly.

Yeah, you know, and then I feel like— and I agree with you, like, it's very much who I am. Like, I believe, like, a lot of the people— and even in the endorsements in our book, people are like, you're the bridge. You're the bridge that kind of brings conventional and integrative together. And it's how I live my life. I live my life in balance. I believe there's a place for everything. And I also don't think that there's only a place for one thing. And one of my friends who's a journalist said that. She's like, you know, your book is provides such an overview of everything together that it's not like this way or the highway. And truly, as a nutritionist for more than 20 years, and you— I know you would agree, it is the foundation of everything. Like, if we can't out-supplement poor nutrition, you can't out-hormone good— poor nutrition. Like, we really need to be looking at our diet as we go into this phase of life, our lifestyle. How are we managing stress? How are we sleeping? How are we exercising? Because at the end of the day, We need that foundation to help ourselves feel better. And then we build on top of that because we're gonna live anywhere from a half to one-third of our li— or thir— one-third of our life to half our life in perimenopause and menopause. And we're more prone to things like heart disease and brain cognitive issues as well as osteoporosis. So now more than ever, we need to be focused on what we're eating and how we're managing stress and how we're living our life more so than any other time in our life, because it's gonna affect our health span. How long are we going to live feeling healthy in this phase of life?

Yeah, you know, it's interesting because I'm just like anybody else, you know, I got into nutrition and other things mostly because of a digestive disorder, but I was reading it in my free time while I was in tech because it was all about the body composition, right? It was, I mean, it was just like anybody. I was like, I don't like the size of my ass, right? And so this was always this. I mean, let's, I'm just being really, I'm so crass and real, like in my journey.

I like you a lot.

This is not the perfect vehicle, which of course Is it ever perfect? No. But, of course, you know, and so, that's where I spent my time reading and everything. Then, it went into why do I have this autoimmune disease and what ways can I address it without taking meds and/or avoid meds or take less of meds and blah, blah, blah, blah, blah. And then, the light bulb went off and it was like, "Oh, these are all female-centric diseases." Like, men are just basically absolved from all of them, right? Like, oh, you get your little outliers, but for the most part, they don't get them. And, that's when I started really looking at it and going, "Okay, all of these things are because we're women and we aren't studied." And, and so, you know, I think the, the thing that I, I find so exhausting today, on top of the lack of the research, is, is just this, um, kind of looking at it as if it's an if-then or, or, right? Like, you can do this or that, but not both. And it's like, no, you need to do all. And I think the thing that I have found the most women struggle with is probably something that you and I cannot give a pill or a dietary recommendation to do, which is learn to own your no. Like, damn, I freaking love my no now. Oh my God, I exercise for it.

Full sentence, period. No, period. That's it. No. No. Yep. And I'm going to play a little bit of like also know your no, meaning your K-N-O-W, like what our worth is. What do we know? How awesome we are. So kind of like a play on both words.

Yeah, but I think, you know, it's— this is a time period for most women, you know, our body's changing, all of that. We're in many cases at the top of our career if we are still working and things like that. We are probably caring for kids that are moving into the teen or getting ready to kind of hopefully leave the nest. And then almost all of us, if we aren't already caring for a parent, we will be. And I think, and I think there, you know, the, the big thing, like, we're going to talk a little bit about kind of your stress, anxiety, sleep research, right? But I think I look at it and I go, dude, this is the nursing home avoidance program at this point. Like, I had the vanity thing, I had the I want to be stronger and do the checkbox triathlete. I did all that. And then I did the, oh my God, I've hurt myself. And now I'm at, I don't want to end up in a wheelchair in a nursing home, and I definitely don't want to lose my mind. And I think that it's understanding the role that perimenopause and menopause plays in the sort of decline of women's health that's very accelerated afterwards, that women just don't see that. We're still operating on this mindset. Like, I'm, I'm still worried, like, a woman with osteoporosis with a, a T-score of a -4, she's like, but I'm worried I might gain weight. I'm like, girl, probably need to. Like, you know, it's, it's, it's also a situation where we have to really start thinking about that, that healthspan capacity. Do you find that a lot in your community?

Absolutely. But I also, I feel like that's a Gen X thing. It really is. Like, we grew up with, you know, don't eat so many calories, watch what you're eating, don't eat your fat, don't eat your this, don't eat your carbs, watch it. Like, it was like we have so much PTSD left over from like the whole like diet culture that I feel like it plays such a big role specifically in our generation. And I'm sure it's the other generations that, you know, as well, but it's kind of different. Things, right? And I feel like now, absolutely, it is about owning. Like, I look at my father-in-law and he had sarcopenia. He's going to be— he's 90. He just turned 90 and he can hardly speak. Like, we're talking about muscles, muscles in his vocal— like, his vocal cords don't even work well, right? So like, when I— when my husband and I talk about aging well or healthspan, we're like, our muscles play such a big role. So yeah, how do we stay out of that nursing home? How do we live the best life that we possibly can doing what I mean and, you know, doing what we need to be doing. But at the same time, what I find is women get very— we get very overwhelmed now because we are more stressed than we were before. We're less able to cope with it. Women in general deal with and feel stress so much more strong, like so much stronger, right, than men do. And also when our hormones are declined, it just exacerbates it that much more. So I feel like it becomes— and I was having this conversation the other day with a friend of mine.. And we were saying how, like, she's like, I'm so overwhelmed, Andrea. Like, every— I should be doing this, I should be doing that. And she's an exercise fiend. She's like, I'm working out, I'm doing everything I need to be doing, but yet I still feel like a failure because am I not getting enough protein in my diet? Am I not drinking enough? Like, it comes overwhelming. And I think that's where, as our generation and for what we do, what I do, what you do, it's like, how do we simplify it for women so that it doesn't become this unattainable thing or this overwhelming thing where they're like, forget it. I'm not even gonna do anything. Like I'm literally, I'm just forget everything. I'm just going to go and do that one thing that I'm doing. So I feel like there has to be that happy medium of like, how do we provide this information in an easy to absorb, easy to understand way that doesn't overwhelm us to the point that we go the other direction and end up doing nothing? Yeah.

You're like, forget it. I'm just going to do chips, salsa, and a glass of wine at night. And then I'm going to have some chocolate and go to bed. And scroll, doom scroll for hours, right? Exactly. Yeah, because I think, I mean, I don't know about you, I mean, I'm a kind of a reluctant social media user, right? I'm just, you know, everybody has their thing, but, but, you know, I would say anybody that's on social media for any amount of time feels kind of like a, you know, midlife schizophrenic. It's like, I'm supposed to, I've got to, oh, I'm doing that wrong today. And yeah, I think it's I think it's a challenge. And that's why I like, number one, that you do all the research, but two, that you've, you know, written Nourishing Menopause, because it helps put it into perspective in a way that, you know, they can take on a little piece of it. They can go, okay, this is the thing I'm working on now, because it's, it's an additive thing. We usually don't change everything at once. We might change one or two things, and then we become effective.

Yeah, exactly. And, and you know what, it's so funny that you say that about social media, because that is where I feel I get way overwhelmed and I suck at social media. I'm really not great.

I'm terrible. I am so terrible.

I mean, I love it on TikTok and I, you know, for a long time I was like, so like I did a great job. And now when I was writing my book, it took me 2 years to write my book. I was like the whole multitasking thing. Now that I'm in menopause, it just kind of went out the window and I was like so busy writing my book for the last 2 years that I wasn't great at being on social media too. And to your point, my book is 26 years of my experience in health and wellness. Like, I have been in health and wellness for a really long time. I've been in the menopause space almost 10 years. I've published research. So everything that I've learned— and myself, I'm a menopausal woman. I have got the reason. And, and like you said earlier, you're in— you became a nutritionist because you were having digestive issues. Same. And I started studying menopause because I knew absolutely nothing about perimenopause and menopause. So learning everything I'm learning, spending the last 2 years, it literally blends all my experience over the last 26 years having been in health and wellness, having now been in the menopause space, and bringing it all together. So I'm able to provide a guidebook that, like you said, like, you, you read it slowly, take one thing away from you. Like, when you read it, it's one thing that you're like, okay, I'm going to change this today. You don't have to do everything all together or all at once. Do what works for you. Because the last thing I want you to do, to be, is overwhelmed and do nothing. So just take one little, one little bite-sized tidbit and maybe do it every couple of weeks when you're reading the book, right? Like, you don't have to absorb it all at once, and it makes it so much more digestible. Yes, play on the word, but more digestible.

Yeah. Well, and I think, you know, I think also, I think there's a level of let's bring awareness. So for instance, my, my team at Minerva, our telemedicine company and the clinic in Dallas, and myself, we have deep, deep, deep skills in osteoporosis. Like, we have a DEXA. We do Echolite in the office, right? And I love it because we're starting to teach women to look for osteoporosis before it becomes a problem. We're starting to bring awareness because the standard of care today is to test somebody at 65. Great. That train left the building 15 years ago, if not more. But I think also women are traumatized and terrorized by the experience, right? And I don't know about you, but I find myself as a scientist, like I know when I started looking at it, like osteoporosis, like I know if you go to Asia, the eastern part of the world, we have different reference ranges because structurally they are not the same as the average Caucasian female. And, you know, and I look at those things and I was like, is it fair to women to generalize us into a group when, you know, if you're height challenged, so I'm not even 5'3". Right? I'm height-challenged. I'm vertically challenged. Like, I'm behind the 8-ball potentially because of body size for something like osteoporosis, but we bucket everybody into this larger bucket. Because I was looking, I was like, "Blue zones." I was like, "I wonder if they've ever dexed all those little ladies." Because I bet you $100, I just bought a house in Italy. I can tell you all those little ladies that I tower over, I mean, I tower over them. They're hoofing it up and down those hills. Don't know if they have osteoporosis, but they're— there's a level of awareness that they probably don't have, which means they're not fearful of it. Yeah. But they're also mobile and things. I don't know, I like— I struggle with research sometimes when we bucket people, and we, we have to do that in population, but then no one ever says, hey, we should probably look at this other population that's closer to your body composition of how you've been your entire life to assess your own personal risk.

Yeah. And that's why we need research on women's health. If you want, you know, circling back to the beginning, like, for decades, the research was done on men, and then it was kind assume that women were the same, and it's just not. So having research on women— and I know it can be difficult because of hormones and pregnancy and perimenopause, like, I understand it— but we— there are other ways that we can also research and survey women. Like, for what I do is one way, right? Like, it doesn't always have to be a specific way that we can actually find out and learn more about women. So it's so nice to see more funding is becoming available, but we need way— first of all, way more research in perimenopause because there's even more— as little as there is in menopause, there's way more than there is in perimenopause. So, we just need so much more research available to us. Yeah.

Well, and I think, you know, it's— yes, I agree. And particularly perimenopause because there's, you know, where do you start doing things? Is it, you know, you don't wait for obviously for the hormone complete crash and the loss of periods because at that point, everything is accelerated. But then, it's like, "Okay, we know we need to start hormones earlier, but how do you know?" Right? Which is why we're building Minerva, quite literally. You know, the other thing that I think is really frustrating is the kind of weaponization of different types of studies, right? You know, as a fellow researcher, you know, there's the gold standard, I'm going to air quote that, that's often presented, particularly in medical groups, is that it's a double-blind placebo-controlled trial. And then, depending on who somebody is, they weaponize that as the only truth, right? If you don't have that, that's the only truth, and therefore anything else can't be that. And then you have all the, the sort of categories that fall into guidelines, which includes observational data, study, you know, survey data, retrospective, causal comparative. There's so many other ways to look at it. And I always tell people, it's like smoking. We identified the relationship between smoking and lung cancer. We never did a double-blind placebo-controlled trial of smoking. Right? But no one would question that. But I would say, in women's health, that has become highly weaponized recently. And, as menopause and perimenopause has become more in the public sphere, we have basically two camps, right? And, I try and dance in the middle, I think, like you do, where it's important that we're promoting the opportunity for women to see their health in a different way, and that there's some evidence, maybe less evidence, maybe more. And then, on the other side, you have people that are just basically harbingers of doom. And if it's not in the Women's Health Initiative, it doesn't exist because it's not a double-blind placebo-controlled trial.

I totally agree with you, and it's very frustrating to me. And I'm going to give you some examples. So a positive, and then kind of like, you know, another one of just my own observation as kind of one. And when I— before I published our research, our survey, I was very— you know, we had written some some press releases and I, we were like, okay, we went to the Menopause Society show and I was a little bit, we had white papers and I was a little bit nervous cuz I'm like, okay, this isn't double-blind placebo control. This is our community research given, by the way, we have over 20,000 women that have filled out our surveys. We have 15, 15 on our website, 20,000 women. We're not talking about 5 women here. 5. Yeah. So a massive, incredible number. And we went to, we had a booth, my partner Randy and I at the show and Doctors were coming by and I was so nervous before, and I'm like, what are they gonna think of my research? And let me tell you, they loved it. And they were the ones that inspired me to actually get published. So when I walked away from that show, I was like, oh my gosh, this was the best thing ever. Because these doctors who were like, we love what you're doing because you're speaking to the patient. You are the one that's out there speaking to the actual women who are in perimenopause and menopause. We love it. You go do you. Please. And more of it. And that's when I decided to say, okay, you're right. Thank you. And I love what you're— that you're like inspiring me to go and be a researcher, which they did. On the flip side, which amazes me all the time, is being a nutritionist and having interviewed Dr. Katherine Shanahan or Dr. Kate Shanahan, who put seed oils on the map. I don't know if you've interviewed her. If not, let me introduce you to her. She's incredible. Okay. So she's a biochemist, like also brilliant MD, published several books. Like the woman is a genius. And she gets all the time hate because she talks about seed oils, which are, you know, canola, cottonseed, corn, soy, safflower, you know, um, sunflower oil, grapeseed oil. And she gets all the time, she gets like, well, it doesn't say— the research shows that, you know, seed oils are totally fine. They're anti-inflammatory. They're excellent for us. And she's like, well, my research is showing that it can create oxidative stress in the body and then therefore lead to inflammation. So I'm like, you know, Kate, I've interviewed her, like I said, a few times. She's amazing. And I love what everything she has to say, but I kind of like, I'm not going to stand on ceremony either way. What I'm going to do is listen to my body. What does, how does my body respond to seed oils? So when I first was introduced, when I first interviewed her, she made me aware of them. And I was like, oh, that's so interesting. Like I was having like all these prickly pins and needles on the bottom of my feet. And I realized I was eating the seaweed with sunflower. Oil, I cut it out, it went away. Then if ever I have too many seed oils, now it's a threshold. If I have too much seed oils or too many seed oils from, let's say I'm eating out in a restaurant or whatever it is, I will wake up with pain in my joints. My knee will hurt me and I have no pain on a day-to-day basis. I have zero pain, but I will wake up with pain in my joints. My knee will hurt me. My body will ache me. And if I talk about that on social media, I get like on Instagram, I was like, I get, you know, the people going, it doesn't, it's not true. It's not true. Your, your experience isn't valid. This is what the research says. And I'm very, you know, and, and very nicely, I'm like, listen, you know, even if the research said it's the best thing since whatever, my body doesn't like it. And we are all individual. So because my body doesn't like it for me, and I'm sure other women in perimenopause and menopause, we've never really actually, I, I mean, maybe there is a study on seed oils in women in menopause. I'm not sure. Yeah, exactly. Like, so I'm like, I'm in menopause. I'm telling you what it feels like for me to eat it. And by the way, joint pain is on the list of the top 10 most common symptoms. So I just feel like we really have to look at these research conversation, like you were saying in air quotes, as to like, how does it affect different people in different stages of life, different genders? And, you know, just because it's been proven one way here doesn't mean that it also doesn't, you know, can't mean this here, because we can all find results. We look hard enough, we can all find things that we want to find those results for. And even like artificial sweeteners, another great example. Like, there's so many examples out there of like these controversial ingredients that there might be research on both sides for. But at the end of the day, how do you feel when you ingest it? Yeah.

You know, it's funny that you brought up the seed oil thing because I was like, okay, I have to, I have to take one for the team. I'm going to go out and because I knew the existence of both, right? Mostly, mostly mechanistically in the beginning when you're looking at the inflammatory response to seed oils. But when you look at a lot of placebo-controlled or human-controlled dietary studies looking at particularly safflower oil, They, they, they show to be pretty favorable. And again, I look at that and I go, what's the genetic variation or the genetic and epigenetic combination that may make it different for somebody, which is, I think, a nuance that's missing. But, um, you know, I think it's, it's also kind of like absolute and relative risk, right? It's, it's the relative risk may be over here, but what's your absolute experience or absolute risk? It may be much narrower or much greater based on your own Yeah.

And also like the amount you have. So you might be able to like, so small amounts of it are fine. Like, doesn't bother me. But if I'm going to be eating a meal that has tons of oil in it 3 times a week, well, that's when I'm going to— it's going to affect me. Right. So at smaller amounts, it might be totally fine, but it's like, what's that threshold for you? And I think that's what— there's always nuance in every conversation. And that's the important conversation to have, not to say absolutely not, absolutely yes. It's like, well, no, we kind of all land in the middle again, which is I'm all about that balance of finding what works for you. Yeah, yeah.

Now, I'm curious, you know, you know, you found 103 different symptoms of menopause. I can tell you, I've never had a hot flash or a night sweat. And I went into perimenopause in my late 30s, which was kind of— at that point, even being in functional medicine, I was like, well, that can't be it. This must be my adrenals, you know, it's got to be other things. And I was told that by all of my friends that were functional medicine physicians And then, I went through menopause at about 48. But, I've never had a hot flash or a night sweat. I had a lot of other ones, but not like that. Sleep for me, that was like the hard— I never slept well prior to that, but man, when I hit my 40s, I was like, "I am going to have an aneurysm in the middle of the night because I cannot sleep." That was my most profound symptom. Yeah.

It's so tough. First of all, I'm going to say you So blessed that you did not have night sweats or hot flashes. Oh my gosh. Like, I, that was what literally catapulted me into this work that I do now was because at 47, I got my first hot flash. I now realize I started perimenopause in mid-30s, but I was 47 when I got my first hot flash. And that's when I was like, oh, I'm in menopause. Wait, is it menopause for like my grandmother and my mother? Like, I couldn't even get my head wrapped around it. And I had hot flashes and night sweats for years and years and years. And in, you know, this was 2017, way before the whole WHI and all this talk about hormones as to what it is today. Right. And back then I had had my genetics tested and the person who read me my genetics was— I was on bioidentical progesterone and they're like, get off everything. You can't be on any hormones. And I was like, got scared at the time because we weren't talking about it the way we talk about it now. So I suffered for so many years until I actually did find supplement solutions that worked and had to relearn everything I knew from nutrition and lifestyle and exercise and everything that I thought I knew. I actually didn't know for this, you know, particular perimenopause and menopause stage. So it's like, you're very lucky that you didn't have them, my point. But regardless, like, I love that. And yes, sleep issues are the third most common symptom of perimenopause and menopause. The nu— what do you think the number one most common symptom is? And again, this is according to 5,300 women as of today, and 73% of women experience this in perimenopause and menopause. What do you think the number one symptom across the board is?

I mean, I know what we get told. I would say it's, it's a more gray area thing. I don't feel like myself, like mood. It's fatigue. Fatigue. Fatigue. Yeah.

Just brain fog, mood, fatigue. So fatigue number one, brain fog number two, sleep issues number three. And Hoflaas— Oh, so, okay. So you're gonna love this. Out of the top 10 most common symptoms, 90% are mental health, cognitive health, brain health related. Neuro-related. That's what our research shows. 90, so 9 outta 10 of the most common symptoms are neuro-related. Like, and that was something that I was like, wait, well, we all hear about the physical symptoms of perimenopause and menopause, but no, mental, emotional. By the way, even more so, like, yes, physical for sure. We also know when we stratified the data between perimenopause and menopause is that in perimenopause, the neuro symptoms, the brain health, the cognitive, the mental health symptoms are way worse than they are. Once we go into menopause, which is more so physical, they're both, they both exist, but the more so physical in menopause than they are in perimenopause. So it's so fascinating. And on average, women are experiencing 31 different symptoms. So we're not talking about one symptom. We're talking on average, women are experiencing 31 different symptoms at the same time, by the way. Yeah. At the same time. Yeah.

Yeah. Which is why I forgot who did the study, but it was like 60% of women that were in this didn't realize they were, that what they were having was menopause. Right? Is this transition period? Because they were like, I don't know, there's just too much going on.

It becomes overwhelming, you know. Yeah, 20% of women, our research shows, that don't know what stage they're in, if they're in perimenopause, menopause. So that just shows us we still have so much work to do.

Well, and I would think that you have some healthy user bias, right? So you have a more tuned-in, educated population, right? So we take that 20%, it's probably closer to 40 to 50% Yeah, and the average woman who's kind of still not aware, right? Yeah. And so, yeah, that's it. That's a big, big deal. So tell me, so obviously stress, sleep, anxiety, cognitive fatigue are the biggies. Tell me, you did a study on sleep. Tell me a little bit about what you found there, because I think that's, you know, that's one of those things that people sort of accept that it's going to happen.

But yeah, I mean, once we did the top 10, that was like, you know what, what's so interesting to me, because I love understanding things more like deeply, I'm like, okay, so Why are we not sleeping? It's number 3, which is a huge number. Why are we, which is 66% of women, why are we not sleeping in this phase of life? So we launched our sleep survey and we asked women if they're waking up between 2 and 4 AM. We, you know, what were the reasons that they're, that they're not sleeping well? So the number 1 that came back, the number 1 reason was they're waking up between 2 and 4 AM. And now as a nutritionist, my first thought was it must be cortisol rising at the wrong time. However, I didn't ask the right question in that particular survey, so I asked it in the next one, which I'll explain. So my thinking was, okay, it's got to be cortisol rising at the wrong time, which means stress. Number 2 were bathroom visits. So many women were saying they were waking up several times a night. So if we're waking up more than once a night, that's too much. And I had one woman tell me she was waking up every hour on the hour. I mean, so many times going to go pee. And then the third reason is night sweats. The fourth reason was stress. So because I had that inclination, but I couldn't, you know, prove my hypothesis in that particular survey, we launched the stress survey, the stress and anxiety survey. And in that survey, what we discovered were 66% of women are more stressed now than they were before, were less able to cope with it. And I also asked the question if they're waking up between 2:00 and 4:00 AM. The majority said yes, over 80% said yes. And then I said, okay, why? What is keeping you awake between 2:00 and 4:00 AM? And 67% of the women were like, brain— can't turn my brain off, my brain keeps going and going, uh, heart palpitation, anxious feelings. So I was able at that, in that survey, to say, okay, I'm right, it has to do with our stress levels. So the number one reason we are not sleeping in perimenopause and menopause is due to stress, cortisol rising at the wrong time. Now, a lot of women will say to me when I tell them that, they're like, but I don't feel stressed, like, I'm not stressed, I don't know why I'm still waking up between 2 and 4 AM. So, what I'll say to them is, well, maybe you're not consciously thinking about stress, but maybe subconsciously or unconsciously, you have, you know, you have stress going on, but it's just a matter of like maybe before you go to bed doing something that helps you to relax. And what the women in our survey said that they love to do is watch a movie, a funny movie, or a funny show before bed, and exercise, meditation, like all of the things that we think, walks in nature, deep breathing, journaling, gratitude, whatever it is that makes you stimulate that parasympathetic part of your nervous system that helps you to relax, to get you that better night's sleep.

Yeah. You know, I always explain to people, because I don't like overwhelm and stressed out is not two words that I use very frequently. I just don't like— I don't. And I, you know, I have a friend that's a Marine, and I was like, do you think we've anesthetized ourselves to the actual stress response? He's like, to some degree, you know, at some point your body just adapts, right? But I'd say the other thing is it always felt like By the time I woke up, my brain was already to-do listing. Like, I woke up to a really active conversation internally, you know, and I'd be like, what? And I'm like, what? But now my brain's like, diggity diggity, and then it won't shut up, you know. And I sleep soundly now. I sleep soundly through the night, you know, 8 hours at least every night. But it was 3, on average, like 3, and then like a little bit over here right before I had to get up in the morning. I was like, oh my gosh. So I feel for everybody that does that. Yeah, no.

So the key is just turning it off and maybe taking some magnesium before bed. Like, for me too, I sleep 7-8 hours a night and like, I have a wearable, so I'm obsessed with my, you know, my sleep data. Yeah. So sleep data for me is so important and understanding. And when I tell— when I tell women, like, I sleep 7-8 hours and they're like, what? How do you do that? And it literally is a combination of different things, like making sure your room is nice and cool at night, making sure that it's not too hot so you're not throwing on and off the covers a million times. Not eating too close to bed, like trying to give yourself 4 hours if you can, 3 to 4 hours before you go to bed, making sure your room is dark, wearing, you know, a sleep mask or a dark, you know, blackout blinds, not exercising close to bed, making sure your room isn't noisy. Like there's so many things that we could do. I have a whole list of it actually. Because sleep is so important. I have an entire chapter dedicated to it. Chapter 7, literally providing so many different tips and tricks of what you could do to help you sleep better. But, I, you know, for me talking about perimenopause and menopause, I always say like there's two places we really wanna start and sleep is one of them and digestion is another. And really looking at, you know, that food that we're eating, how are we digesting our food? Are we digesting our food? Are we getting enough nutrients? So all of that, and, and I talk about it all in the book because for me it's, it kind of wraps everything up with a big bow as to like, okay, so what are the focuses that we need to be looking at so that we can get our 7 to 8 hours of sleep a night and we can, and digest our food properly without having gas and bloating and indigestion and all of the things that tend to show up now. Yeah.

I mean, I think it's— I would agree with you, the sleep and the digestion, because we have estrogen receptors everywhere, particularly the liver, gallbladder function. And then, even digestively, like my research when I was finishing my PhD, I looked at hormone metabolism and beta-glucuronidase in women with and without IBS. Specifically, you know, looking at different age groups, and we found definitely a correlation between— or I found, I guess I should say, I found a correlation between IBS constipation dominance and, and beta-glucuronidase levels, you know. And I still think there's a lot there because you've got receptors for all of your neurotransmitters like dopamine and everything else that all utilize similar pathways and and everything else. I just think there's so much there. Yeah. And I, you know, and I think, you know, women have a— we are better at paying attention to our diet, but a lot of times we fall back into what worked for us before, right? Like, I got my tubal, so this is kind of how I shifted gears. I was like autoimmune, digestive. I got a tubal, and then I had an ablation because right after my tubal, which they said nothing would really happen, my period started coming every 21 days. So I was like, awesome. You know, I'm like, I'm anemic. So I had an ablation because it was just like, there's only so much you can do. I was already low on iron because of digestive stuff with my diagnosis. And so, um, like, shortly after that, it was like acne, hair growth, and then all of a sudden my digestive symptom goes completely haywire. Gain weight like nobody's business, like 30 pounds in months doing the exact same thing I'd done before. And I was like, "There's so much going on here." But, what I did is what everybody does. And I'm like, "I used to bodybuild, double down, eat protein, cut all the carbs out, work out harder, get more of this in." And every time I did all the things that worked before, it just got worse. And then, they're like, "You need testosterone." Go on testosterone, I gained 10 pounds in 2 months. Yeah. And then, will it come back off? Oh, hell no. And, you know, and I'm like, uh-uh, you know. But I was like, if I am immersed in functional medicine and I'm going through this, dear Lord, I feel sorry for every woman that has to go through it, you know. And, and I know from your experience and your research, you see it too. It's like, what worked before will not work here for most women. And doubling down, yeah, it does not help.

Not what worked for you before perimenopause and menopause most probably will not work for you now. We need to relearn what we knew and learn it for the body that you're in now. And I think that is one of the most important messages because the longest time, like you, I'd be like, I don't understand why am I gaining 20 pounds? Why am I gaining and losing 8 to 10 pounds overnight for years? Had no idea why I was doing the same thing I was always doing. Hey, I'm a nutritionist. I should know what I'm doing, right? But I didn't because I knew what I knew, what I was doing great for before I got here. Definitely not once I was after. So relearning all of that was a key kind of aha moment for me to be like, oh, okay, well, we're always evolving human beings. So we need to evolve other things too, to be able to kind of grow with where we're at. Cause we don't stay the same, thankfully, right? We're always changing. So I feel like that is like the biggest message to get across to women listening is like, it's just relearning. It's not— and it's easy things, right? Like we have our Balanced Blueprint method. It's like, it's not like you have to, and you have to, and you should. It's like, Here's the guideline. Here are 7 principles to follow. We, you know, make it really easy for you to understand. And by the way, it's eating a whole food diet and it's, you know, 80/20 rule, or maybe it's a 90/10 rule or whatever it is that makes, you know, works for you. But the key that I find is that stress that comes along with it, like we talked about earlier, has to be minimized because cortisol itself is gonna shoot up and cortisol's gonna cause us to gain weight in our belly. Like when I was writing my book. Oh my gosh, I gained so much weight because of the stress that we went. And as soon as I handed it in, the stress, it fell off the weight. Like, so I'm like, I am like an N of 1 research example of like what stress and cortisol can do to you. And, and that's why being so intentional of trying to manage our stress, having some type of stress management tools in your day, and not just me saying, oh, you need to manage your stress. Like, it's not that easy. But doing what you can can make a difference because stress itself will cause you to gain weight.

Oh, for sure, for sure. So if you were to kind of give everybody that's on the Menopause Mastery Podcast today an inside look in Nourishing Menopause, what are like 3 things that they probably didn't know that are like key things that you found that you share in that book, you know? Yeah.

So, well, we talked a lot about it. So we talked about nutrition, digestion, nutrition, sleep, but I would say it's probably the balance blueprint is probably the biggest kind of like, that's where that chapter ties everything together. It brings everything that we talk about in the book together and what that is. So it's not 3, I have 7. I hope that's okay. So, yeah. So what we, what it, what we're, what we found in our research, what we found. So Lisa Tsakos, who's been a clinician, a practicing nutritionist for 30 years. What her and I have dug— digging through the research, looking at everything, what we found was following these principles, these basic principles, will make a big difference. So number 1 is balancing blood sugar levels. Number 2, so A, adding more fiber. We focus so much on protein, which by the way, loading up on protein is L, very important, but we don't— I don't want you to forget about the fiber part because that's really important too. A is adding good quality fats, so like our omega-3s, excellent. N is nurturing digestion. C is choosing more plants, and E is ensuring you're hydrated. So those are the basic guidelines to be like, okay. And then we go through each one and I provide examples. And examples, by the way, that you can implement right after reading the book that won't cost you any money. Like, how do we nurture our digestion? What are some tips and tools? So the entire book kind of brings it all together in chapter 11. And just— and, and this is from our experience of being in health and wellness for 26 years and bridging that gap between everything we've learned, integrating creative, conventional, and everything is backed by research and science. And if it's not, I'll say, well, there is no double-blind placebo-controlled study for this. However, as a nutritionist, this is what we learned in nutrition school and we'll provide, you know, some insight, right? So I feel like that would be kind of like, if as a good takeaway to be like, that's a good guideline to follow.

Yeah, absolutely. That's, that's awesome. Cuz it is, it's those foundational pieces have to come in. You know, no, I don't think women need to earn their hormones. Like, I've heard people say that too. You got to do all these things first to earn your hormones. No, you want to do hormones, and that is the right thing for you. You do hormones because they will probably help you get all these other things done, but you can't ignore these other things.

Yeah, interesting. I never heard a phrase like that. That's so interesting. But you've heard people say it.

Oh, you got to work on all these other things. You got to earn the hormones. You got to, you got to get your diet dialed in, your exercise dialed in. I'm like, yeah, but if you can't sleep and you want to kill people by the time you wake up in the morning, like, that's not gonna work, right? Because I can tell you, without hormones, and if I don't sleep, somebody's dying that day, and it's not me, right? Like, my filter is broken and my rage is going to be way higher than it needs to be, you know? Yeah, nobody should have to gatekeep those. But the lifestyle pieces are just fundamental. They really, really are so fundamental.

And yeah, I can't stress it enough that that— and that can make the biggest difference, right? Like exercise and strength training. I've had women who told me they felt a world of difference just by movement and going to the gym, or not even gym, just like, you know, doing the exercise and the strength training has made a big difference for them. That helps with blood sugar, right? Because our muscles, we want it— yeah. So like, everything is kind of interconnected.

Yeah, yeah, completely. Like, look at PCOS, which is a metabolic disorder that happens to interplay with sex hormones, right? It's metabolic first, right? And so I wish I knew that.

I wish— I really wish I knew that. I have PCOS, and I really wish— we actually have a survey on our website, PCOS and Menopause. For those of you, if you have it listening, please go fill out our surveys because I would love to hear from you. But I have it and I wish looking back now, I wish I knew it was a metabolic issue, but I didn't. I only learned that like, you know, recently. I didn't know that that could have changed so many things for me, how I suffered. Yeah.

You know, I don't know if I ever, you know, because obviously it's a continuum. So on one side, people don't have periods on a regular basis, but there are a lot of people have the metabolic disorder. That may still have cycles, right? And, and I think that, you know, I look back at my experience and I'm like, I think I was probably on that continuum and I had no idea, you know, no, no idea. And I still think we lack enough research to help define it. If you're not one of those classically, hey, my period doesn't come, like, oh, we got it, we'll figure that out. But it's— but there are a lot of women. I mean, yes, we can look at hormones and blood and other things, but I think there's still that continuum is there that we just haven't really got enough research on.

I find it fascinating. I have two daughters, and one of them who's 15, and so because I never got my period regularly, like I had it once, I got it when I was 12 and a half, and then I didn't get it again for like, I think, a year. At that point, my mother should have been like, hmm, like none of us knew, right? Like my mother didn't know, none of us knew. But when I had my girls, I was like, I'm very much like, are you tracking your cycles? Like, and they all have their apps, like the Gen Zs, like they're amazing. It's such a different generation. They're on top of it, they're talking about their periods. And my daughter though, which is interesting, is that if she uses things that have chemicals in it, parabens and things that are messing with our hormones, she will not get her period. And she will say to me, yep, she'll say, Mom, I didn't get my period on time this month. And I'm like, what did you use? She's like, well, I tried this new lip gloss, or I tried this new whatever. And she's like, okay, I'm not going to use it next month. And sure enough, it comes the next month. So what's so fascinating to me is that this generation, and you know, they're able to kind of like, they're on top of it, they understand it a little, so much more so than I did, at least. And I love seeing it because— and they're also making that connection between what they're putting on their body, what are they eating, and how is it affecting their monthly cycle. So I'm so hopeful for like our future generations, like that they will not go through perimenopause and menopause like we did, knowing nothing, like being taken by surprise. They're going to come into it knowing so much more than we did, which makes me really happy.

Yeah. Did you see that? You may not have seen the study. They did a study looking at breast cancer tumor tissue and, and looking at exposure to things like, you know, parabens, phthalates, all of that, and then removal of exposure and showed that there's an absolute, I would say, causal correlative activity of tumor growth just with a topical exposure. Wow. That's what they showed. So literally the tumor starts exploding in size and when they withdraw it, it starts to shrink. So, I'm like, well, we've been telling women it's their hormones. Maybe it's the crap they're putting on their body that they know nothing about.

I come from that whole world. Like, my whole world before menopause was all about chemicals, like, in our food, what we're putting on our body, and just being aware of that. And, there is such a massive correlation in obesogens and all of these chemicals that mimic estrogen in the body. So, I feel like it's good to see that it's getting attention. And, interesting about that study, just to show you, like, changing certain things, like, maybe changing, you know, whatever, I don't know what they were using in the, in the actual study, but like changing creams and the deodorants and perfumes and all these things that we're putting on our body and being bombarded with, just to opt out and switch it out for maybe some other options, right, that won't create the same situation.

No, no, I agree. I agree completely. I guess that's the next frontier of, you know, getting personalized medicine really, really out there. Well, tell my listeners, where can you— because your book is coming out, so this is going to come out right around your book— where can they find your book, Nourishing Menopause? Nourishing Menopause. Yeah, so thank you.

So Nourishing Menopause: Powerful Nutrition and Lifestyle Strategies to Feel Your Best. You can find it anywhere you shop for books. So it's gonna be in bookstores, online on Amazon, Walmart, wherever you shop for books, uh, you should be able to find it. And then you can also go to my website, which is www.nourishingmenopausebook.com, and then we have links there as well that you can find it out. And then you could follow me on social media. @andreadonski and @wearemorphous. I live on TikTok. That's kind of more my thing, TikTok. But we're everywhere, like Instagram and Facebook, but, um, more so I do a lot more on TikTok than I do anywhere else. Do you?

Yeah. I'm a TikTok novice. I love it.

I, you know, I just love the energy on TikTok. I love our community on TikTok. I guess I've just been, I spent a lot of time there, so there's so many women in perimenopause and menopause there, like who— yeah. Yeah. Like, it's really cool.

Yeah, it's really cool. I've made, I've made a stronger commitment this year. I was like, I will make time for it. Last year I was capital raising for Minerva to build the technology so we can personalize medicine. And I was just like, I don't have it in me. And so this year I was like, all right, I might, I might get on there.

I love it. Well, I love what you're doing. Thank you so much for what you're doing and helping women. We need you. We need what, you know, the work that you're doing. So thank you. Thank you.

And thank you, Andrea, for being on here. And for everybody listening to Menopause Mastery, if you happen to be listening on your favorite podcast platform, don't forget to give us a 5-star review, subscribe so you get it every time. And if you happen to be on YouTube, leave us a comment and don't forget to subscribe so you don't miss the next episode. And we will see you next week.