Why Stress Makes Menopause Symptoms Worse (and What to Do About It)

Okay, I'm going to talk to you today about probably one of the biggest reasons why you may be suffering more in perimenopause and menopause. And particularly if you're somebody who has tried hormone replacement therapy for sex hormones and you've air quoted failed, or you're trying it and you're just not getting the results you want. This is often the underlying trigger. So today I'm going to dig in on the stress and endocrine system. And specifically how the hypothalamus, pituitary, adrenal, ovarian axis, and through that also thyroid and other hormone-producing organs are all affected. And this is why stress physiology matters more in perimenopause and menopause than any other time other than actual reproductive efforts, right? Right. Often stress is a primary driver of even infertility as well. But when we get to perimenopause and menopause, this is very important because the ovaries are no longer a reliable source of buffering recovery hormones it once was, right? Testosterone, even a little bit of DHEA, but most of that is released from the adrenal cortex, but estrogen and progesterone all are heavily produced by the ovaries. And the fallback is that the adrenals are supposed to carry the load after menopause. Now, carry the load does not also mean that they produce like the ovaries did because that bullshit gets said by wellness influencers all the time. And I'm going to say that I had some arrogance when I was younger in my 30s and I started out in this career after going back to school and getting my nutritional master's and certificates and IFM and all of that. I had the audacity to tell people that I was going to manage my perimenopause and menopause naturally because I was going to help make sure I was hormonally balanced by having the right diet and lifestyle. There is no, and I am saying this with 100% absolute truth because I've gone through the research. I know I went back for a PhD to dig into hormone metabolism. There is no way to restore hormone function at the level the ovaries were performing through adrenal support. I don't care if you're sitting on the top of a mountain doing Buddhist meditation, You can't. Those ovaries produce in cyclical form really important hormones at very high levels for decades of our life. The adrenals are there to sort of set the pace and have a little bit of support, but they can't replace it. But when the ovaries are no longer there and the stress response is high, we no longer have that buffer. And then, the adrenals are there in the central nervous system to take on the responsibility. And so, the core of this is that this HPA adrenal axis does not work in isolation. Right. And it really is important because this HPA, the hypothalamus pituitary axis, is above all the endocrine hormone-producing glands. And so they're upstream of thyroid, they're upstream of your blood sugar control, your sex hormone regulation, your adrenal response and stress, not parallel to them, above them. And it's a system, not a silo. And as long as we understand that, we can understand how it all works together and Start to unravel maybe where your treatment isn't working like it used to. All right. So how does it actually work? So first and foremost, we have 3 major players here when we're talking about the stress response. We have the hypothalamus, which releases CRH, known as corticotropin-releasing hormone. That goes to the pituitary, and the pituitary releases a hormone called ACTH. And ACTH, in response to the CRH message coming from the hypothalamus, says, hey, adrenal cortex, release some cortisol in response to my ACTH message, right? This negative feedback— so cortisol signals back to the hypothalamus and the pituitary to shut off CRH and ACTH. So let's go through this nice and slowly so we get it. For everybody in the back, hypothalamus says, hey, I gotta talk to the pituitary. I'm releasing CRH, corticotropin-releasing hormone. The pituitary gets that message and goes, I need to send out ACTH, corticotropin-releasing hormone, and I need to tell the actual adrenals to respond. When the adrenals respond to that ACTH message, it pushes out cortisol. That cortisol level rising Signals back to the pituitary and the hypothalamus, hey, I'm responding. I got it. And so in response to that negative feedback, the hypothalamus and the pituitary go, okay, I'm going to down— stand down that message. I'm no longer going to send out large amounts of CRH and ACTH. This breaks down when we're under chronic stress. We get receptor resistance. So all the receptors, even on hypothalamus and the pituitary, get resistant to it. Just like you can be insulin resistant. And you get a blunted feedback sensitivity. So all of a sudden the cortisol levels that used to shut that sucker off no longer does it. The circadian rhythm of cortisol, this healthy curve of cortisol awakening as you get up in the morning, rising within the first 2 hours of awake, and then slowly kind of ski sloping down as a healthy curve starts to decline throughout the day. And, you know, has a trough at night, or we get a flattened You know, we don't get that cortisol response early in the morning and we're flat all day, or maybe we have an inverted curve where it looks like, you know, kind of Mount Everest that goes straight up and straight down, or it's low during the day and high at night is what, where we start to see this dysregulation. And we have acute dysregulation. Let's say under a significant stress response, maybe you wreck your car. You're going to see an increase in these hormones. But the chronic activation, the adaptive purpose of the acute stress response is something that then transforms the physical body to respond to that stressor. So that acute stress response mobilizes glucose, actually immune modulates. So it suppresses some parts of your immune system and stimulates others and pushes vigilance, right? Vigilance. So imagine your immune system's acting like a bunch of vigilantes. Watching for something that really isn't, isn't a problem. And when the system never fully downregulates, this HPA axis crosstalk with a hypothalamic-pituitary-gonadal system. So now we got the gonads, the ovaries in there start to suppress the pulsatility of growth hormone and gonadal hormones. And this literally is the mechanism that bridges between stress and hormones. Right? So, let me say this for everybody in the back because this is very, very difficult. It's difficult even for practitioners to understand. Over time, chronic activation of our stress system mobilizes glucose, immune modulates, and causes vigilance. And so, this is a primary driver also of the stress response and how it plays a role in autoimmune conditions, particularly with women. Because we're chronically stressed out, the immune system gets activated, becomes vigilant, We mobilize glucose, so we're constantly driving insulin up. And when you never fully downregulate, the controllers in the brain, the hypothalamus and the pituitary, don't get the correct feedback loop to calm back down. And then they add the gonads to that message because they go, crap, I'm freaked out. Nothing's safe anymore. I need to directly suppress the pulsatility or the variability of our gonads' GnRH messenger, which is what stimulates the ovaries to do things, and then it'll stimulate things like follicular stimulating hormone and luteinizing hormone, it has a pulsatility. So it goes up and down. This then suppresses that activity and we get a suppression of ovarian function. And ultimately it makes your perimenopause worse, right? Now, this is what we call allostatic load. It's the cumulative wear and tear or unresolved stress activation. And it's why this is clinically way more useful than the old school term of adrenal fatigue. Your adrenals never get so fatigued that they cannot function. They get the message from the hypothalamus and the pituitary and the lack of pulsatility and receptor sensitivity to that cortisol to then downregulate adrenal function to slow the system down so you can cool your jets. Adrenal fatigue is not real. It is hypothalamic pituitary adrenal gonad dysregulation that causes all of it. And essentially you get resistance to the receptors that bind to cortisol. And help it respond appropriately, which brings downstream inflammation because cortisol can't do its normal anti-inflammatory efforts. Yes, cortisol is anti-inflammatory when it's pulsatile, when it's responding to an inflammatory response or a short-term acute activation, but chronic stimulation is inflammatory. Your autonomic nervous system, right? The stuff that you don't think about that becomes downregulated and your sympathetic nervous system, the stuff that responds to stressors become dominant. You get reduction of vagal tone, which helps control the limbic system and does the crosstalk between the gut and the brain. You get things like heart rate variability decreases. This is what things like the Oura Ring are testing. You get loss of parasympathetic recovery capacity, which starts to then screw up your R-Sleep-R architecture and your cortisol-melatonin antagonisms, because cortisol needs to come down, melatonin comes up. And this is why waking up at 3:00 AM is often a central nervous system regulatory problem, not just a hormone, sex hormone system problem. Here's a way to tell if you're waking at 3:00 AM and you wake up and let's say you're kind of hot and sweaty around your neck, like you put on a scarf. But the rest of your body isn't hot. That is often a sign of blood sugar and cortisol release, not a hot flash or hot sleeping due to sex hormone changes. That 3 AM waking is often a central nervous system response to chronic stress activation now, and it's and it's very much kind of competitive, right? Your ovaries are going to sort of compete with that activity, but the chronic activation of stress under sustained threat. Signaling, it— our body deprioritizes reproduction, it deprioritizes metabolic luxury functions in favor of survival. And this underlying mechanism is kind of all of the stuff. So next, I'm going to talk a little bit about this cascade, right? This is specifically the blood sugar relationship to cortisol and the role in a thing called gluconeogenesis and insulin sensitivity. When we have chronically elevated cortisol, it keeps your blood sugar elevated. It drives compensatory, what they call hyperinsulinemia. So your insulin becomes higher than what it is necessary because your receptors are resistant to it. And then your feedback loop between stress and blood sugar and cortisol, the swings themselves become stressors activating more and more cortisol release. So this is the other thing that I see in perimenopause, especially we start to see the metabolic changes that causes perimenopausal weight Women freak out. And then, so we double down, we start removing more carbs. We start restricting more foods. We start working out more intensely. We start going to Orangetheory 4 times a week because we just need to do more HIIT. And then we skip meals and we stimulate because we're starving. And then when we have that blood sugar variability, that adds to the stress response and it just activates more cortisol release. And then therefore, all of a sudden you're like, well, I'm burning 800 calories. I'm eating 1,000 calories. My resting metabolic rate is 1,300 calories. How can I possibly not lose weight when the law of thermodynamics say I should? And this is where the bro science breaks down. Our hormones will control the metabolic activity at all levels, including the systems I'm talking about today, when it thinks you're going to die if you can't survive this. So this matters a lot during perimenopause and menopause because that declining estrogen reduces insulin sensitivity already. So, the hypothalamic-pituitary axis dysregulation just compounds an existing vulnerability, right? So, if you're already going through perimenopause, just the stress response and what I just described is going to be made worse because we already have problems because of the loss of estrogen. Sex hormones suppress CRH. Suppression of the pulsatility of gonadotropin-releasing hormone actually reduces Luteinizing hormone and follicular stimulating hormone, which are the two hormones coming from your pituitary that tell the ovaries to ovulate and prepare everything. And if they aren't pulsatile, what that does is reduce ovarian production of estrogen and progesterone. This is often called the pregnenolone steal, but it's essentially the body going, "Hey man, look, I need to use my pregnenolone and even my DHEA and skip progesterone completely and not release." FSH and LH because I need to respond to the stress response because cortisol is out of control. And it's a simplified teaching model to say that it's being stolen by pregnenolone. But the reality is the mechanism is more of a receptor signaling. So it's the receptors, it's the signaling by the pituitary and the hypothalamus rather than a depletion. You can't deplete pregnenolone. You can't deplete progesterone directly. You can have a loss of production because the ovaries are no longer producing progesterone or the adrenals have been downregulating the production of other hormones from pregnenolone. But it's not that you're, you lose the capacity to do that. The only time we see that is in things like Addison's disease where the immune system is actually attacking the adrenals. But the reality is it's not a substrate depletion. It is a regulatory control mechanism that is upstream. So progesterone is the most stress-vulnerable hormone in early perimenopause. And especially when you get anovulatory or cycles where you're not actually shooting an egg out on its way down the fallopian tube. And this is very common under stress response. And this really compounds the perimenopause estrogen-progesterone volatility that we see. And it's, it's rather than causing it independently, it compounds it. And so the woman that's often been under a lot of stress will have more severe perimenopause and menopausal symptoms because that regulatory activity behind the scenes is being, is being stimulated and de-stimulated in an abnormal way. Now, the other thing that plays a role here is we have thyropause. There is an interaction between our pituitary hypothalamus, our adrenals, Our gonads, our ovaries, and the thyroid. Cortisol has a suppressive effect on TSH and peripheral T4 to T3 conversion. And T3 is that active hormone you really need. T4 is the firewood your thyroid cuts up and puts out on the front porch, but it's not the active hormone. Cortisol suppresses that activity downstream. And so when suppressing TSH, you could have a normal looking TSH, you could have a normal looking T4, but still have a low conversion to T3. And a relative low thyroid function, even though you're not classically hypothyroid, which is clinically defined as high TSH and also low T4, which is why your endocrinologists only look at those. And then they say, well, if your TSH is high, then I'll give thyroid hormone. But you are a subclinical poor converter of T3, and stress is driving that massive activity. Elevated reverse T3 can be an adaptive conservation under chronic stress signaling. And most of that has been studied in people that are either significantly senior, like our more seasoned individuals, but we also see it in the hospital. However, we do see it chronically elevated in people under stress. And reverse T3 is like a skeleton key that doesn't work on the lock. And so, it blocks your regular T3 and it suppresses your actual ability to use the T3 that you have. So again, if you're not looking at these and not testing for these, which is why we always test for them because we need to see what's really happening, so many women have low thyroid function but aren't actually getting the support they need because doctors assume that TSH is the only regulatory body that needs to be looked at. But again, TSH is a pituitary hormone that depends on the hypothalamus-pituitary axis. To get it right, so many women are functionally hypothyroid with good labs. If it's only being you know TSH is the only thing being looked at. So the thyroid stress sex hormone triangular sort of triangle each axis suppresses the other under sustained threat signaling, right? So that's the big take home message: stress. Stress suppresses ovarian output. Stress will alter adrenal response, receptor sensitivity, insulin control, and then all of those have a feedback loop on each other that ultimately signals back to the hypothalamus and pituitary that things aren't working right, but now they can't have the right response because their receptors are being blunted by the chronic stress activation. All right. So let's talk about how you start to fix this, right? So there's some tactics to start with. How do I set my central nervous system, right? So that's your brain, your nervous system, your limbic system, your vagus nerve. We need to tell it to like downregulate the stress response. Most of our stress response is not under our conscious control. And I think that's the hardest thing. We want to think about it and then control it, but our parasympathetic and sympathetic system is not under our conscious control. So we often have to back into this by doing things that are somatic therapies that work on the physical body that help tell the central nervous system to stand down. So what are some of those things that help tone the vagus nerve and the parasympathetic system? One of the ones that's really interesting is physiological sighs, the extended exhale. So it's that actually does help send a physical response up and down the vagal nerve to help sort of downregulate the stress response. So doing physical sighs, which is what's interesting is you can watch your dog. Your dog does this when they're exacerbated with you or something's been going on and they're not happy about it. They will do a physical sigh. They aren't thinking about it. They aren't like, you know, Making connections here and trying to figure out how to, how to manipulate their limbic system. They just do it right now. We also have an extended exhale breathwork. So you've probably heard of box breathing where you inhale for 4, hold for 4, exhale for 4. Well, that works really well to help sort of regulate, but then if you can extend the exhale a little bit longer, 6 to 8 beats, and then do it again, that actually helps reset your central nervous system. Cold exposure. Now this works better on men than it does women. Our cold exposure doesn't have to be 32 to 34 degrees. It's actually closer to about 57 degrees if you're actually getting into cold water, but changing your body temperature, heat and cold exposure, that hormetic control needed between getting hot and getting cold actually helps our central nervous system reset itself. So the fact that I live in Texas and you basically go from one air-conditioned building to another, Actually makes your central nervous system less capable of handling the stress response. So getting hot, getting cold is actually good for us. Humming and chanting. So humming or yodeling, chanting, all stimulate via the pharynx and help stimulate the vasovagal nerve. Those are good things that you can do all the time. The reason why that helps is it works on the parasympathetic reregulation of the stress response. And helps that pituitary hypothalamus adrenal axis reregulate without having to do something that changes your environment. Because often we can't change what caused the stress. We can only change our response to it. So those kinds of parasympathetic activation types of practices really help. They're also things that you can do under short-term activity that can just help it. Number 2, circadian anchoring. So morning light exposure. So getting up and getting your butt outside, seeing the sun come up where the sky goes from pink to the blues helps actually reset your cortisol awakening response. It regulates melatonin release in the evening. It is so very vital to our bodies. So many times I talk to women, they're like, my sleep is all messed up. I stay up till 4:00 AM and then I sleep in most of the morning. I feel terrible. And I'm like, no shit, no shit. You're going to feel terrible because you didn't wake up with the planet. Everything down to our gut bacteria have a clock in it and they all regulate to the cortisol awakening response and to the circadian rhythm. So even if you're somebody who's staying up till 4 o'clock in the morning, what we do is every couple of days we march it back by an hour, right? So 4:00 AM, I'm going to go to bed at 3:00 AM. I'm going to go to bed at 2:00 AM. And we start going until we actually Get back to a normal sleep time, which for most women is by 10:00 PM. You get a second wind if you make it to 10:30, 11 o'clock at night, and then you're up all night. That's not because you were supposed to do it. You're not a night owl. A night owl is about a difference between 30, 40 minutes. That's it. It's because you made it past the sleepy zone into this sort of cortisol release zone in the middle of the night. So often what happens is we force the bedtime Earlier. And we force the morning wake-up time earlier at the same time, shortchanging your sleep in the short term. In the long term, what that does, it starts pulling you back to that circadian rhythm, especially if you get outside and get that early morning exposure. I don't care if it's cold, you got to go outside, no blue-blocking glasses, get some exposure to the sunlight. And set a consistent waking time. If, if you're somebody that already has decent sleep, keep that waking time consistent. If you're working on resetting it, get it backwards to a time that actually coincides with the light-dark circle and cycle, and cycle that we have on the planet. Now daylight savings time and all of the resetting of the clock stink because in a lot of the United States and other parts of the world, that means you get up in the dark and you come home in the dark. That makes it very, very difficult. And so in many cases, even just if you're driving to work as the sun comes up, Or if you can have a few minutes with some sun exposure, even if you happen to be at work, that's great. You just want to try and get that light anchoring. If you're somewhere that has, you know, the, you know, the crazy short days and you don't have access to it because of your work, you can also buy light fixtures that are, that are made for sunlight that can help do that. There's even eyeglasses that you can buy. This is really, really important because we can leverage that circadian lever. That, and helps blood sugar stabilization. So actually just doing this helps stabilize your blood sugar. And then the next thing that we look at too is how do we do the other part of the metabolic activities? Because cortisol and glucose control, insulin response, GLP activation, all, all of that are interrelated here with stress. So blood sugar stabilization is part 3. It is so important that when you're stressed out under chronic stress and you have all of this going on, that you're not burning the candle at both ends and skipping meals. Having a protein-forward breakfast in the first hour of waking is important to this person. Yes, I do some fasting here and there. Yes, I think fasting can work. No, this is not a person that should be fasting. So a protein-forward breakfast, I always shoot for 40 to 50 grams of protein. at that first meal that breaks the fast because it stabilizes the blood sugar. It helps with muscle protein synthesis and it helps avoid this glucose cortisol rollercoaster since the blood sugar swing themselves actually stimulate your glucose rollercoaster and sympathetic activation, right? So 3 meals a day, have adequate protein in every meal, have carbohydrates. They're not illegal. They're not going to kill you. Remember fruits and vegetables, nuts and seeds, whole grains, legumes, root vegetables are also carbohydrates. You, this is not the time to go, I'm going to Atkins this, or I'm going to keto this. You're better off having some carbohydrate so your body can use it in the glucose pathway because you already have insulin circulating. So if it doesn't have something to do, it's going to store stuff as fat. Strength training. And movement dosing is really, really important. The distinction between movement that supports your HPA axis is really, really important here because it leads to either supporting your allostatic load or pushing it too hard. High-intensity cardio, high-intensity HIIT, long-duration high-intensity interval work, or excessive strength training without recovery Are all things that are going to throw off your HPA axis. So this is where we do strength training in appropriate levels with good recovery between. So that's usually a combination of higher repetitions, lighter weight, and then maybe a combination of lower repetition, lower or higher weights. So you do a combination. We don't need to go into the gym and do an hour and a half circuit every day. Right. You want to do a combination. And what I find is this is in strength training. This is where classic kind of bodybuilding splits really help because in bodybuilding, they're focused on building muscle. And so often when they do splits, it might be push-pull one day. So you're doing back exercises and pulling exercises, right? So I'm doing a little bit of chest and I'm doing a little bit of back, and then they might do legs the next day. And then they might do active rest. The reason why they do splits like that is because it helps your body recover. You don't want to hit those muscle groups all the time because the value is in the recovery. So looking at your weight training and figuring out what makes it work best, I find introducing splits like legs one day, back one day, chest one day. And some people like to do arms and abs. Those are vanity muscles. They get worked in the other stuff. I don't really worry about those. But then I would do some active, active relaxation and/or zone 2 on the next day to help improve your overall body's health, but to allow those muscles to grow. Now, zone 2 cardio is low-intensity cardio and it's movement, but it is not getting your heart rate. In most cases, if you're midlife, it's not getting your heart rate above 135. Most people train too high here and it stays catabolic and cortisol-raising. And so I've done several, several Podcasts about how to, how to integrate your exercise. But this is the place where if you are going all out because you're worried about your body composition, less is usually more. I've seen it repeatedly. I've lived it repeatedly where when I ate more protein, when I ate more consistently and actually cut back what I did in the gym over time, it balanced out. Now it's not going to balance out in 2 weeks, right? It's not. So don't get on the scale and expect things to start shifting or to watch, you know, a half a pound of weight. Every 2 or 3 days. That's probably not going to be what happens. Your body needs to realize it's safe, but we have to help the system reregulate. And high-intensity cardio is not going to be your friend. And if you do HIIT, shorter duration, short bursts of intensity, exercise snacks are also really good here, like squatting, you know, in between meetings and things like that can all help. One of the other really important things here is sleep. is non-negotiable. You can't out-supplement sleep. You can't, there's just no way. And you will never recover your HPA if you don't get sleep dialed in. So if you can't sleep, we got to figure out why. This is a perfect place to look at hormone replacement therapy because it might also be that you've got estrogen and progesterone declining behind the scenes that are causing things. Get checked out for sleep apnea or sleep disorders. We have a sleep partner that we can connect you with that is great to help you understand what is going on. With your ability to sleep. And sleep apnea and upper airway resistance affects women at much lower doses than men and is way more prevalent in women than what has been perceived in the medical community. So, get it checked out. You know, also doing things like nervous system, what we call bottom-up tools. These are those somatic practices. We talked a little bit about sighing earlier, but doing things like before bed, doing progressive Muscle relaxation. Yoga nidra is one of these relaxation techniques, but even just starting and saying, okay, I'm going to squeeze my hands. I'm going to squeeze my forearms and relax can help sort of downregulate the central nervous system, orienting your muscle relaxation to progressively relax over time. Cognitive tools, they have a place, but they don't really work here. Right? Again, you thinking your stress out of the way isn't going to help it. And then targeted nutraceuticals, right? I shouldn't laugh about that, but it's true because I've tried, man. I tried for so long. to like logic my way out of stress and it just doesn't do it. All right. So let's talk about the nutraceuticals, because this is what everybody always asks me. What can I take? Look, supplements supplement, but the things I've talked about here, you've got to do because the supplements themselves, unless you take an arsenal, are usually not strong enough on their own to make up for the chronic stress, the poor eating, the overexercising, the lack of circadian rhythm, the stress response that's gone on for 30 years. It's just too much. And When you do them hand in hand, they work. Now, a lot of things are great here. Magnesium, almost always. I have yet to find anybody that isn't supplementing that has enough magnesium. Serum testing is really piss poor. Even red blood cells, only about 21% of your magnesium. Most people need it. You can't OD on it because you will get diarrhea. Doesn't matter how you take it or what kind you take. If you get too much, you will have diarrhea. Magnesium before bed helps relax the central nervous system, helps with sleep. Particularly magnesium bisglycinate. Phosphatidylserine. This doesn't get enough attention. Phosphatidylserine is a derivative from choline and it comes from phosphatidylcholine. Your phospholipids are produced inside the body. They're also part of your choline pathway that we get in foods. They are a methyl donor too, but phosphatidylcholine actually lowers cortisol in the brain. And so it can help downregulate cortisol activity in the brain without being a direct sedative. I happen to like a product called PS150 by Designs for Health, but there's lots of them out there. Adaptogens. These are all of your herbs and medicinal mushrooms that all have a nervous system resetting activity. They adapt the central nervous system. So things like ashwagandha, rhodiola, your lion's mane, all of your medicinal mushrooms, all of your herbs in this class, holy basil, They all help regulate the stress response and can help, but again, they can't make up for the body and lifestyle things that you need to do on top of it. And so they're not a replacement for it. So those I would add in the last part. So let's go back to the system frame and why this is important, because you can't fully address your sex hormones. So if you're trying to get your perimenopause and menopause under control and feel like you did before, feel just right. You can't really do this if the blood sugar is wildly off or if the stress response is wildly out of control or the thyroid is being downregulated because the stress response, or maybe you genetically aren't great at converting T3. You've gotta address all of it. And by addressing the HPA axis, by really going to that stress response first and addressing it, Alongside the other steps you're taking, this is often the step that's necessary to help you get feeling better while taking hormones. And so let's just think about this. What I want you to think about is of the things I talked about today, I explained number one, what's happening, how the hypothalamus, the director of the show and the pituitary, the conductor in the brain, talk to your glands that produce these hormones. And how they get feedback from those hormones being produced that tell them to regulate what they're up to and how that gets broken under the stress response. And then its impact on your thyroid and your sex hormones and ovaries and what they're up to. I also talked about what happens with your blood sugar under this chronic stress activation and why you become insulin resistant and you get blood sugar variability and you— your body's gonna start packing on weight too. Now, what did we talk about that helps fix it? Circadian rhythm control, getting out in sunlight, protecting your sleep, making sure you eat on a regular basis, starting within an hour of waking up. And you eat at least 3 meals a day. You definitely don't skip in the middle of the day. That's the worst thing that you can do. Take your exercise that you're doing and really take a good look. Now you could be somebody who's overdoing it and you need to just retool what you're doing. It doesn't mean stop, but it does mean Look at it and figure out, am I overdoing it where I might be pushing my stress response too much? If you're somebody who's not doing it because you have so much going on that you can't get it in, you need to move. You need to move because your body needs a physical outlet for that stress response because it thinks it's trying to save you. So this is where you would add in exercise snacks like squats between meetings, having a little bit of exercise in the morning or the evening. That's a great way to get sunlight, go out and take a walk. Just get moving, right? Just get moving and give your body's stress response something to work on. And then look at the other fun things to add, the adaptogenic herbs, the magnesium, the phosphatidylserine, after you've dialed in those other efforts, because that's really where you're going to make the difference. And if you happen to be a woman and you're on hormone replacement therapy and it isn't working, or you're like, I feel better, but not really. Or I'm not sure. There's multiple reasons. This is probably one of the primary drivers. And so if you start doing all these things and it's still not working, the next question is, are you on the right dose for you? Not the dose. The dose doesn't matter. What your friend takes doesn't matter. What matters is how your body metabolizes it. Can it use it? And how did— how, how much does it bring your actual systemic levels up? 2 women can have the exact same dose of patch or pill or whatever they're taking. And have a completely different outcome. It depends on your genetics, your absorption, your body's ability to receive that hormone in the medium it's in, meaning is it cream? Is it this or is it that? And if your doctor isn't testing this kind of stuff, your adrenal activity, your thyroid activity, your sex hormones, and they're just going off your symptoms, they're sort of guessing, right? Hormone deficiency in menopause is the only time we say don't test. If you had a loss of capacity to make your insulin, we would test you constantly. If you had a loss of thyroid function, they wouldn't prescribe it without testing first. If a man thinks he has low testosterone, we don't give it to him without testing first, and we test after they get it. Sex hormones are no different. And if you're doing all of these things and your hormones are still not right, then you're being under or overprescribed, or your dose isn't right for you, or the delivery isn't great for you. All of those things are things that need to be looked at. But often when you go to a hormone provider and that's the blinders they have on, they forget the relationship with all of these other hormonal pictures. And if they miss that, they're throwing sex hormones at an adrenal thyroid insulin hypothalamic pituitary adrenal corticotropin slash gonadal hormone issue, right? They're missing the boat because their narrowed lens doesn't actually give a full picture of what's necessary. And, this is why we created the Minerva Technology. It's why we created Minerva Telemedicine. It's because we ran into women all the time in my clinic and out in the world that many of which were trying to get treatment and weren't getting better because they were still being siloed into this very narrow pigeonhole view where people were missing that the body is a system and a symphony. So, thank you for listening to Menopause Mastery. I hope You found this to be insightful and helpful. Let me know in the comments, what would you like me to talk about more? Do you want me to go more into the thyroid? Do you want me to go more into the impact on the ovaries? Do you want me to go more into what's happening in the brain when your ovaries take a nosedive? Let me know in the comments, because I love to make sure that you're getting to know the science. So thank you for listening to Menopause Mastery. And if you've heard this and felt it was a great message and you have a friend that needs to know, please share it with her. Because together we rise.