Your Guide to Menopause: What to Expect and How to Thrive

Foreign. This is open mind. Today we're talking about menopause. That's right, menopause. And this is a significant phase in a woman's life. It's surrounded by uncertainty and physical changes that kind of are hard to navigate for some women. But understanding what's happening in your body and how to prepare for those changes just makes all the difference in going through it and actually surviving. Today we're going to dive into the transition known as perimenopause. The years leading up to menopause and around the menopause, where your hormone levels begin to shift and that sets the stage for the eventual end of your menstrual cycle. So during perimenopause, there's a decline in estrogen and progesterone and that can lead to all kinds of symptoms or there can be kind of fluctuations in hormones and up and down and that can cause hot flashes and mood swings and sleep disruption and it can affect up to 85% of women. But it's really important to remember that every women's experience is unique and some may just kind of breeze through it with little or no symptoms, while others might find it more challenging. What's really crucial is being proactive about your health, understanding the changes that are occurring in your body, and knowing the steps you can take to support your body through the transition. In this episode, we're going to explore the hormonal changes that occur during the perimenopause and menopause and the impact it has on your overall health and the steps you can take to ease the transition from diet and lifestyle adjustments to understanding the role of hormone replacement therapy or hormone optimization therapy as we like to call it. Now we'll cover it all. So let's get started on this journey to better understand and prepare for menopause. Hi, I'm Dr. Mark Hyman and welcome to Health Hacks. Hey everyone, it's Dr. Mark Hyman. Ever wanted to ask me your health and wellness questions directly? Well, here's your chance. I have an exciting exclusive event coming up that you could be part of as a thank you for being a loyal listener to Health hacks. On Wednesday, December 4th, I'm hosting a live digital experience called the Diet wars and I want you to join me. I'll be chatting with Dr. Gabrielle Lyon, a board certified family doc and New York Times best selling author as we tackle one of the biggest wellness questions out there. Which diet really gives you the best shot at optimal health? Should you be a vegan? Should you be a carnivore? Or somewhere in between. From Paleo to vegan to Carnivore and GLP1s, we'll break down the science, debunk the myths, and share our expert perspectives to help you make the best choices for your health. And and here's the best part. You'll be able to interact with me and chat with our amazing community in real time during the event. Plus, if you're a VIP ticket holder, you'll get to join an exclusive Q and A after party where you can ask us all your questions directly. The Diet wars is a one time only experience that you don't want to miss, including limited edition merch. It's all happening live on Moment by Patreon. So mark your calendars for Wednesday, December 4th at 9pm Eastern, 6pm Pacific and head over to Moment co Markheiman to get your tickets. I can't wait to see you there. So menopause doesn't just happen overnight, right? It takes years of gradual changes in hormone levels and there's a transitionary phase. And this phase is called perimenopause. Peri just means around, right? What is perimenopause? Perimenopause is when a woman transitions from her reproductive years where she's having a regular period, to menopause. So how does a woman know when she reaches menopause? Well, basically, technically, the medical definition is she goes for 12 months without a period in a row. 12 months in a row. But the truth is, it's not always so straightforward or simple. Now it's a normal phase of aging that happens to women in their early 50s, sometimes earlier, in their 40s, sometimes later. But it's generally around 52, and it marks the end of her reproductive years. Now, during perimenopause, which can start as early as the late 30s or even early 40s, estrogen and progesterone levels change significantly. And that can result in all sorts of changes in the body, including irregular periods, either close together, far apart, heavy bleeding, clotting, pms, getting worse, hot flashes, mood swings, depression, night sweats, sleep disruption. All that stuff can happen. Now. Not everybody gets this. In fact, in Japan, I don't think they have a word for hot flashes because of how they eat. Every woman experiences menopause slightly differently. Some women women don't really experience any symptoms, but many, many unfortunately do. The good news is you don't have to suffer. There are ways to deal with this where you don't have to suffer at all. And I'm going to tell you what those are if you stick with me with this podcast. If you don't deal with it, you know, 85% of women have some significant symptoms that disrupt their quality of life. And they're influenced by a lot of factors, genetics, if your thyroid's working or not. A lot of women are hypothyroid. About one in five women are hypothyroid. Many of them are not diagnosed. And that can affect your hormonal balance. Various kinds of changes that women get, like PCOS or polycystic ovarian syndrome, how many pregnancies you've had and other factors. Lifestyle, your stress level, your physical activity. Exercise plays a big role in regulating hormones. Environmental toxins are a big one, like bpa, phthalates, heavy metals. All these are endocrine disruptors. They're hormone disruptors. They cause what's called hormonal chaos. And I read a book years ago called Hormonal Chaos by Theo Colburn. She's like the Rachel Carson of today, I think. I think she might have passed. But this was a very powerful book for me. I read it many years ago that kind of helped me understand the role of these environmental toxins that act like estrogens in the body and are extremely toxic. And there are a lot of things, though, that you can do to support your menopause transition proactively and make it really seamless and easy using the principles of functional medicine. Now, my colleagues and I at the Ultra Wellness center in Lenox, Massachusetts, we use many of these strategies for our perimenopausal patients. And we're going to get into what those are today. But first, let's discuss what happens in the body from a hormonal standpoint during the transition from premenopause to Mary Penopause. Now, I didn't become an expert on this on purpose, but I have worked at Canyon Ranch, which is a health resort, in my 30s and 40s for almost 10 years. Were basically, my patients were women in their 30s to early 60s. And so I got to really understand what people were experiencing, what they were suffering, how to work with them, and how to help optimize our health. So what. What happens during perimenopause? Well, a lot of things can happen. Ovaries are not necessarily ovulating every month. And you can have these things called anovulatory cycles. You might have less estrogen, you'll have less progesterone, because that only happens when you ovulate and you get a sack on your ovary that's called the corvus. Luteum, it produces progesterone. And that basically leads to these hormonal imbalances. That's the take home here. And you can have low estrogen, high estrogen, low progesterone. Now these, these sort of swings in hormones are, are often irregular, and they're responsible for many of the menopausal symptoms, right? The hot flashes, night sweats, vaginal dryness. That comes with lower estrogen. The drop in progesterone can actually happen earlier than the drop in estrogen and that they result in an ovulatory cycle. So these are cycles where you just don't ovulate, right? The egg doesn't come out. You kind of run out of eggs. You know, you're born with a certain number of eggs, and they decline over time, and eventually you kind of always get pooped out and you just don't produce an egg. And when you don't produce an egg, that leads to a drop in progesterone. And that progesterone drop leads to what we call unopposed estrogen. So it's either an absolute or a relative increase in estrogen to progesterone that leads to all sorts of symptoms. And early on in the perimenopause, you can get heavy periods, irregular periods, long periods where you don't have a period, then you have, like, heavy clots, and you can get fibroids and worsening PMS symptoms, all because of this drop in progesterone also can lead to many, many other things, as we mentioned, in terms of sleep issues and mood issues and headaches and fatigue. And over time, estrogen levels will drop, but sometimes they can actually be quite high. And that's when you get breast tenderness, fluid retention, clotting, heavy bleeding, increased risk of uterine cancer. All those things happen in the perimenopause. What about testosterone? Well, testosterone levels also go down in women as they approach menopause due to aging and a natural decline in ovarian function, which is where half of their testosterone is produced. Uh, the rest is produced actually in the adrenal glands. And this results in a loss of libido, sex drive, loss of energy, motivation. And these changes in hormones also have widespread effects on the rest of a woman's biological system. So what are the physiological changes that happen? Well, as women approach menopause, their hormone levels begin to decline and their risk of various diseases increase. So that's really important to know what your hormonal changes are and how to support them through diet and lifestyle before you get into Too much trouble. Now, sometimes simple lifestyle changes and some supplements might help. Herbs are very effective. Things like acupuncture can be effective. Exercise, stress reduction, sleep optimization, healthy diet, removing toxins, all those things help. But sometimes you do need help, more help. You need what we call bioidentical hormone replacement therapy. And what does that mean? Well, it just means using hormones that are the same as your body's own hormones. Historically in medicine, we've used something called Premarin, which stands for pregnant mare's urine. Premarin, pregnant mare's urine. Gross. Right. But that's what we use, and that's. Those are highly conjugated estrogens that are very inflammatory, have increased cancer risk, and cause all sorts of problems. So we don't want to use that. But we're going to talk more about how to use hormones, when to use hormones, and the benefits and the pros and cons in a bit of. But first, let's discuss what actually happens to a woman's body physiologically during this transition period. Well, first thing is bone density becomes a risk. Right. Estrogen. As estrogen levels drop, your risk of bone loss goes up. Right. Estrogen plays a key role in maintaining bone health by helping regulate bone remodeling. And that involves resorption or breakdown of the bone and old bone and the creating new bone. All that requires estrogen. So how does estrogen do this? Well, it increases the activity of a certain type of cells in your bone called osteoclasts. These are class like breaking down, like an iconoclast. Something breaks icons, right? So it's an osteoclast is a cell that is responsible for breaking down bone, which is normal. You want to recycle old bone and build new bone. And it also decreases the activity of osteoblast cells that are responsible for new bone formation. So that's not a good scene. So you get a double whammy with more breakdown and less buildup. So when you actually in menopause or perimenopause, this combination of bone breakdown and reduced bone growth ultimately leads to a loss in bone density. You see, on average, women lose about 1 to 2% of their bone density per year during perimenopause and menopause. And the rate of bone loss can be even higher in the first five to seven years after menopause. You really got to be on top of this. Get your bone density checked early, check it regularly, and find out what's going on so you don't get into trouble. We'll talk about how to keep your bone density up, too. If you look at what happens, it can. It can lead to up to 20% of loss of your total bone mass if you don't do something about it. And we're going to talk about what to do about it. But it involves taking the right supplements, vitamin D, exercise, strength training and so forth. And this loss of bone basically increases a woman's risk for osteoporosis and fractures. If it's not managed with diet and exercise, particularly strength training, what else goes on? Well, your risk of heart disease goes up, right? Heart disease and stroke are the leading cause of death in women. But the good news is in up to 80% of cases, it's preventable with lifestyle and diet. I've seen studies that show over 90% of heart disease disease is preventable. So what's happening in a woman's body to increase her risk during menopause? Well, estrogen plays a role that's protective in the cardiovascular system. It enhances the production of a really important molecule called no or nitric oxide. It's a vasodilator that helps relax and widen blood vessels and improves blood flow, which we know it works because that's how Viagra works, right? Increases nitric oxide. It also helps reduce inflammation, which is really important because heart disease is an inflammatory disease. And so basically, that's all sorts of things. It also helps your blood vessel health and reduces your risk of high blood pressure. And so all these are great. And the inner lining of your blood vessels is really important. That's what produces nitric oxide. And so that inner lining of your blood vessels is really in. In part regulated by estrogen. So when it's weak or damaged, that's when cholesterol gets stuck in the arteries and forms plaque that causes hardening of the arteries or atherosclerosis or heart disease. It also increases ldl, the good cholesterol. Although there's really no good and bad, it's a little bit more nuanced than that. And it decreases triglycerides, which is awesome. And it also lowers ldl, which tends to be a problem for people. Now, it decreases LDL cholesterol by enhancing the expression of something called LDL receptors in the liver. And that's good because these receptors basically suck up all the ldl, the excess LDL in your blood, and it reduces the risk of plaque buildup in the arteries, which is great. It also has antioxidant properties that help reduce oxidative stress and the oxidation of LDL cholesterol, which is what really causes heart disease. It's not just ldl. It's when it's oxidized or rancid and then it causes heart disease and blockage in the arteries. So how does estrogen protect against oxidation of ldl? Activates genes that make major antioxidant enzymes, things like SOD or superoxide dismutase and glutathione peroxidase. And these are more powerful than any antioxidants you'll ever take in a vitamin. And, and they, they're produced by your own body. Now these help neutralize free radicals. They protect against oxidative damage or rusting. And that's awesome. And estrogen itself has direct antioxidant properties due to its chemical structure. We call it phenolic structure. Now the, the phenolic structure is similar to what we call polyphenols, which are basically these plant compounds are anti inflammatory that help neutralize these free radicals. And there's these phytoestrogens, but I don't like that term because it kind of means that they're stimulating the estrogen receptor, but they're actually modulating it in a beneficial way. And they don't actually cause estrogenic effects, they just help modulate it in a good way. And there's ones from soy for, like for example, genestein and dazine and that are found in soybeans. Now there's other plant compounds that also help, like lignins. This is a type of plant phenolic with weak estrogen activity in the body. And they're found, guess where? In flaxseeds. So they really help a lot in terms of the overall sort of hormonal balance. So I highly recommend flaxseeds for women in general for lots of things, for constipation and for omega 3s and for particularly for helping with hormonal balance. Estrogen also impacts insulin sensitivity and glucose intolerance, meaning it helps regulate your blood sugar, which is key for preventing heart disease and maintaining your metabolic health. So estrogen plays a huge role in insulin sensitivity and keeping your metabolism healthy. It upregulates the expression of something called glucose transporters within our cells, which is basically our muscle and fat tissue. So essentially, you know, the ability to get glucose out of your blood depends in part on, on estrogen. It also helps maintain muscle mass, which is key for insulin sensitivity. And it influences secretion of something called adipokines. These are hormones released by fat cells by promoting subcutaneous fat storage rather than visceral fat. Now, the visceral fat's the dangerous fat that's around our belly. That's linked to pre diabetes and some resistance. And when you lower estrogen levels during menopause, it increases a woman's susceptibility to insulin resistance and to weight gain, particularly around the belly. Women notice that they get more little pudgy around the middle. That's because of this reduction in estrogen. And eventually it can even contribute to the risk of type 2 diabetes. What about your brain? Well, brain is important. And research shows that estrogen has a very important role to play in your brain. It's a neuroprotective compound, meaning it protects your brain and it's involved in keeping the brain healthy and firing all cylinders. And how does it do that? Well, it helps do it through reducing inflammation in the brain. It modulates the activity of brain immune cells to maintain a healthy brain environment and enhances something called neuroplasticity, which is the ability to grow and strengthen neurons and the connections between neurons. It also influences the production of our neurotransmitters, serotonin, dopamine, which helps support mood and cognition. And so it upregulates BDNFs, essentially, like Miracle growth for the brain, which promotes the survival, growth and the differentiation of neurons and increases connections between them. So. So your brain's more connected and functional. Also, it protects against something called amyloid beta buildup and toxicity. Now, this is the protein, amyloid that accumulates and forms plaque in the brains of people with Alzheimer's, which is why we've seen some data that estrogen is protective against Alzheimer's, which is kind of cool. And that means when estrogen levels decline, the opposite happens, right? Your brain gets more inflamed, you get more brain fog. Maybe serotonin, dopamine decrease, which can lead to low motivation, maybe make you anxious, your mood changes. It's not because you're crazy. It's because your hormones are changing. Sadly, your risk of dementia goes up and your cognitive decline goes up. So it sounds kind of bummer, right? It's all bummer data. But actually, the reason I'm telling you is because you can do something about it. There's so much you can do about it to prevent all these things and to support your body during this whole time and minimize all these things. So you can't just kind of go through and ignore it and pretend everything's happening fine and not pay attention. You got to pay attention and you got to take care of yourself, ladies, because here's the deal. Most women in this period of their life, perimenopause or menopause, it's called the sandwich generation. They're sandwiched between their parents and their kids, their teenage kids, and they're old, aging parents. Plus, they're probably in the middle of their career. There's a lot of stress, so you gotta take care of yourself. Like that thing they say on the airplane when you're, you know, you put the oxygen mask on yourself first, then you put on your kid. That's kind of what you gotta do. And if you do that, then you can preserve your brain function, you can preserve your body, you can protect your heart, you can feel good. You can continue to live a happy, healthy, thriving life. But the more proactive you are about it now, the easier the transition's gonna be. Here's the problem with traditional medicine. It just doesn't know how to deal with this very well. It's like, okay, take the pill until you're 50, and then we'll switch you to hormone replacement therapy. Well, that ain't the answer, right? Conventional docs don't take a proactive, preventive approach to help protect against bone loss, against muscle loss especially. They don't really focus on preventing high blood pressure, heart disease, or protecting your brain during this time. I mean, basically, you might get a platitude, well, just exercise and eat better and, you know, manage your sleep and stress. But that's not very helpful information, and that leaves a lot of women to suffer. The truth is, they don't have to. Right? They don't really have to. So let's first talk about where conventional medicine gets the approach to hormone replacement therapy wrong. Right. Often what they'll do is to wait until symptoms appear to do anything about it, which is often late. And even when they do, their interventions just don't support the transition. They just manage symptoms with SSRIs and hormone replacement therapy. I mean, they now have a drug for pms. It was called Prozac. They changed the name to Seraphim. Exactly the same drug, just to make it sound like it was for women. But it's kind of ridiculous. I mean, it's not a Prozac deficiency, Right? There's a change that happens. Sometimes hormones can be helpful and doctors will prescribe them, but they don't usually do it right. They don't do the right kind of hormone therapy, and they use conjugated or equine estrogen. That's horse estrogen. I mentioned the urine. Pregnant marriage urine or estrogen. And that's been linked to a ton of problems. Right. Initially, hormone replacement was seen as highly beneficial based on some observational studies, because they weren't really clinical trials. They just looked at population and shocked them over time. And it was the Nurses Health Study and they found that, you know, were 130,000 women they followed for decades. And seemed like the women who took the hormones did better, right? They had less heart disease, breast cancer, dementia, osteoporosis, everything seemed great. But it wasn't hormones that were doing that per se, it was really their lifestyle. We call it the health user effect. So there was a large trial, billion dollar study funded by the NIH called the Women's Health Initiative and kind of turned upside down these findings. Now, this is a study of over 160,000 women who are postmenopausal who were either on combined estrogen progesterone therapy or estrogen only. And they use synthetic forms. They used pregnant mare's urine and they use synthetic form of progesterone or progestin, which is often very problematic. And now these results were published in a prestigious journal called the Journal of the American Medical Association. And essentially they showed that hormone replacement therapy actually increased the risk of heart attacks, breast cancer, strokes, dementia and blood clots. And they wound up discontinuing the study early because the results were so shocking and they didn't want to harm women further. That study caused a lot of problems because all of a sudden you got 50 million women overnight, boom, stopped hormone therapy and they were miserable, right? And it led to a shift in their recommendations around hormone therapy being very much anti hormone therapy. The problem was that they didn't really get into the nuances and they didn't look at the type of hormone dosage of the hormone. The method of application, is it a pill, is it topical timing of hormones? It's really subtle and personalized. The truth is that that, uh, hormone therapy can be used, and I would like to call it hormone optimization therapy, because you don't want to overdose, you want to do the right forms, you want to do bioidentical forms. And women who actually begin hormone therapy within six to nine years after menopause can start to benefit from the therapy. But starting it too late after menopause may increase risk. So you got to be careful about when to start. Now, hormone therapy may also help women in perimenopause and helps to reduce symptoms and provide relief. But you've got to be very specific and personalized based on the symptoms and the form and the type of hormones used really matter. So in functional medicine, we do things differently. First, personalization matters. Not everybody's the same, especially when it comes to hormone replacement or hormone optimization therapy. It's just not for everyone and has to be personalized. And you have to look at a patient's history. You have to look at the risk, the benefits. You want to minimize the risk, maximize the benefits. And second, most importantly, we use bioidentical hormone replacement therapy or hormone optimization therapy. This means you're using hormones that are the exact same biochemical as your body makes. Your body knows what to do with it because it ain't pregnant mars urine or some weird science project that looks like progesterone, but it really isn't. It has all sorts of other side effects. These are chemically identical to the ones the body produces. Also, the type of hormone matters. There are so many types of hormones used in functional medicine, which really emphasizes the personalization and addressing the root causes of the imbalances. And we have to think about all the hormones. You have to optimize thyroid and insulin. You have to optimize your adrenal hormones and your sex hormones. All of them interact. Before we even think about someone being a good candidate for hormone therapy, we're going to do a bunch of stuff first, right? Because sometimes you don't need it. If you start with diet and nutrition and lifestyle changes first, they can be highly effective, and in many cases, all the symptoms go away. But you got to be proactive about it. The earlier you do things, the better. So if you start with these principles now in your life earlier, you're going to struggle less, you're not going to have a lot of symptoms, and you might have a lot better experience through this whole transition period. And I. I just can't emphasize this enough. Preventive medicine is the best medicine. Let's kind of back up a little bit and talk about what is a more coherent approach to addressing perimenopause and menopause from the perspective of functional medicine. First is you got to know what's going on, because everybody's different and you got to test. Now, the thing about hormones in perimenopause is they're all over the place. So if you test them on Monday, they're different than on Tuesday or Wednesday or Friday or Saturday. And that's confusing. So you have to know how to interpret them. You have to know when you're testing them. You have to take them in the context of an overall history. And there's a lot of important Lab tests to get so you actually know what's going on. Because it's not just about your hormones. It's about all the other biomarkers that matter, that affect your health and how you regulate your metabolic health and your hormonal health. And they also assess where you are in this transition and they help you identify things early on. So you got to be the CEO of your own health. You've got to be proactive. So what are the tests to ask for from your doctor? Well, the first one you want is a DEXA scan. Now, this is a special test. It's a very low dose X ray. It's like one flight from New York to LA in terms of radiation. It'll measure your body composition, which is really important, tells you how much muscle and fat you have. And that's really critical because your weight is really less meaningful. It'll also tell you where that fat is. Is it in your belly or is it on your. But. And they are different, trust me, in terms of your health risks, because belly fat is the health risk fat, it's what causes most heart disease. But they're also going to look at your bone mineral density and that's great because then you'll know if you have bone loss. They'll look at muscle mass, fat mass, and your risk for we call sarcopenia, which essentially is muscle loss. Now, bone mineral density also goes down with age in general, but you can prevent that, right? And when you have a rapid decline in estrogen production, which is necessary for bone support, well, then you're gonna lose bone. So estrogen plays a really critical role in bone metabolism. And the decline in estrogen that happens after menopause actually can significantly accelerate bone loss. So we see this a lot. And I used to do bone densities all the time when I worked at Canyon Ranch, and we would see, you know, women coming in with pretty significant bone loss and they just didn't know it. But I actually saw people reverse it. I mean, I had a woman who was seven years old, started doing vigorous yoga, power yoga, I should call it, at the time, and she reversed her bone density and increased her bone mineral density by 10%, which is really a lot. Now, studies show that the average loss of bone mineral density is about 10% during menopausal transition period. So it's a lot. And women can lose up to 20% of their bone density in the five to six years around menopause. And about 25% of post menopausal women experience really rapid bone loss. So that can lead to significant increase in the risk of fractures and osteoporosis. You see this with hip fractures. You see kyphosis, that kind of bent over, kind of curved spine that some old ladies get. That's not good. That's because you're fracturing your spine and they're collapsing. Now, according to the International Osteoporosis foundation, one in three women over the age of 50 and one in five men will have an osteoporosis related fracture in their lifetime. One in three women, that's a lot of people. Men, on the other hand, go through their version of menopause called andropause, which is characterized by a decline in testosterone production, or about 1 to 2% a year after age 40. Now, guess what happens when you have the lower testosterone. That also leads to bone loss, and it increases your body fat. So regular DEXA scans can help with the early detection and management of osteoporosis in both men and women. And it also gives you a body composition, which is a critical measure for longevity, health, metabolism, and so much more. Now, there are other hormones we look at too, we call LH and fsh. This is luteinizing hormone and follicle stimulating hormone. They're produced by the pituitary to regulate the menstrual cycle, and they stimulate the growth of ovarian follicles and estrogen production and also stimulate the growth of eggs and the ovaries, which, which is important. And LH triggers ovulation, which is also important. Now, as menopause approaches, the ovaries become less responsive to these hormones. And that's why one of the ways we diagnose menopause or perimenopause even, is that these levels begin to increase. So think about your ovaries kind of getting tired and weak, but your brain's like, come on, let's go, let's go, let's go. And so it keeps pushing out more and more FSH and LH from your brain to tell your ovaries to get with it. But your ovaries just can't do it anymore. So you see high levels of FSH and lh, and it's just. Just a natural process of feedback that is telling your brain that you're low in these hormones and you should be making more. And so that's what you do. You produce more FSH and lh, and they're basically indicative of hormonal changes. But honestly, you might not see any changes there, and you might have all the symptoms. And it depends on which day you're checking them, it can fluctuate widely. So really, you got to check it frequently and get a sense of what's going on. Now, there's another hormone called anti mullerian hormone, or amh, and it's a hormone produced by the cells in the ovarian follicles called the granulosa cells. And it plays a critical role in the development of reproductive tissues and is a key marker of what we call ovarian reserve in women. In other words, low levels of MH can help predict the onset of menopause. So the lower your levels are, the less likely you are to be having healthy ovaries and healthy eggs. And. And it's also an indicator of risk for infertility. So you actually can check this for healthy young women to see if their levels are high, and that can tell them they're fertile. It's not going to be able to help you pinpoint the exact time. But consistently low or undetectable AMH levels suggest that menopause is on its way, maybe in a few years. Another hormone that we want to look at is prolactin. Now, this is a hormone that's produced by the pituitary gland. It's involved in milk production after childbirth, but has a lot of other roles. And elevated levels can sometimes indicate pituitary disorders. It can be connected to low thyroid function or other things that may affect menopausal symptoms. Another hormone we want to look at is dhea, which is an adrenal hormone that serves as a precursor or like a building block for both estrogen and testosterone. Now, it plays a role in energy and mood, immune function, and levels go down as you get older. And it can be very helpful as a therapeutic agent, both for energy and women, for during menopause and also sex drive. Now, another compound we want to look out in the blood is called shbg, or sex hormone binding globulin. Now, this binds to testosterone and estrogen and regulates their activity in the body. Estrogen stimulates the production of SHBG in the liver. And as levels start to decline during the perimenopause and menopause, the production of SHBG does as well. And that leads to an increase in what we call free unbound sex hormones, which, like testosterone, and that can cause issues like acne, body hair, worsening menopausal symptoms. So think of like, SHBG is sort of like the carrier of the estrogen, and, and it, most of it is bound in your blood. But when the SHBG is too low, then you have more free hormone, and you can end up with more problems. And thyroid is also really important. I mentioned that earlier. But thyroid hormones are often out of whack in this time in a woman's life. And you want to check all the right hormones, not what you're typically getting at your annual physical, right, which is just tsh, or maybe you're lucky if you even get that. But also free T3, free T4, and thyroid antibodies. Now, thyroid hormones are critical because they regulate metabolism, they regulate energy levels, their overall health. And actually, if you're hypothyroid, which is really common, it actually can mimic or worsen menopausal symptoms. So you treat the thyroid, and all of a sudden, the symptoms go away. Seen that many times. Also, you want to look at, obviously, estradiol, which is the main estrogen in the body, and progesterone. These are the primary female sex hormones. Now, a decline in estradiol and progesterone as women approaches menopause is a natural consequence of aging and the gradual loss of ovarian function. And that's where you know estrogen and progesterone are produced in the ovaries. And that that's significant. But sometimes you'll see a really spike in estrogen or estradiol and a drop in progesterone because the body's trying to stimulate the ovaries, but there's no eggs. But the ovaries will start to make estrogen, and you'll get these really wildly high estrogen levels, which can cause a lot of symptoms like fluid retention, breast tenderness, migraine headaches, worsening pms, heavy bleeding, heavy clotting, long cycles and painful periods, and a whole host of other things. All right, so what about metabolic health? Well, you also want to look at your metabolic health because hormones affect that as well. So looking at insulin, that's fasting, fasting glucose, hemoglobin A1C, the average blood sugar, your cholesterol profiles, all that can be affected by hormones and increases the risk of type 2 diabetes and cardiovascular disease if your hormones are out of whack. And last but not least, it's important to look at your nutrient levels, because guess why? Your nutrients are important in regulating hormones, particularly magnesium, iron, zinc, calcium, omega 3s, and vitamin D. These are really important, particularly in the perimenopause. For example, you're having a lot of heavy bleeding and clotting. You're gonna lose iron, you need calcium. Make sure your bones are healthy. And vitamin D, omega 3 is also important for regulating hormones. How do you get all these tests? Well, you. Good luck. Your doctor may or may not order them. They may or may not think they're important. You might have to argue with him or her. You're going to have to try to get them covered by insurance. It's kind of a pain. And I believe that you should be the CEO of your own health. And that's really why I co founded this company, Function Health. It gives people access to all the lab tests I mentioned and more, a lot more, and for less than 500 bucks a month. So if you want to learn more and get the test done, there's a 300,000 person wait list. Sorry, guys, but you can skip that wait list for podcast listeners. Just go to functionhealth.com mark and see what you get during this transition. You should be focusing on eating whole, nutrient dense foods to support balanced hormones, to support liver detoxification, gut health, and balancing your blood sugar. And you should prioritize eating a whole bunch of stuff that's really important. Fiber. Fiber really is important because it helps you regulate your hormones, because your hormones are regulated in your gut, too, because estrogen, for example, is excreted in the gut. And if you don't have a healthy gut, you're going to reabsorb it and cause more problems. You also want to eat lots of fruits and veggies and whole grains, some, but not whole grain flours. Right. The actual grain. These are rich in really important nutrients, antioxidants. They have prebiotic fibers which helps reduce inflammation, feeds our good gut bacteria, and it supports our hormone metabolism. And what are those prebiotic foods? Well, there's asparagus, artichokes, jicama, green bananas or plantains, cooked and cooled sweet potatoes. All great source of prebiotic fibers. And then you want to eat a lot of other fibers are great, like dark leafy greens, berries, apples, onions, garlic also contain prebiotic fibers. And they also contain polyphenols, which are plant phytochemicals like anthocyanins and quercetin, which are critical for immune system health. Healthy gut, brain, healthy aging, all that stuff. Now, there's a special class of veggies I want you to eat a lot of. Okay, These are veggies that are really important because they do regulate a lot of things that have to do with estrogen and hormone metabolism, especially the risk of breast cancer. And these are the cruciferous vegetable family. Broccoli, collards, kale, cabbage, brussels sprouts. They have ISO thiocyanates glucosinolates, sulforaphane, all really important phytochemicals for protecting against hormone related cancers and other things. Now, these phytonutrient support the detox and the elimination of estrogen metabolites in your stool. Because you want it, you really want to get rid of all the toxic estrogens that are being metabolized and not reabsorb them. Estrogen metabolites can be harmful and they can increase the risk of estrogen related cancers. So there's certain compounds that are made from broccoli, like diandol, methane or dim, and other compounds like calcium glucarate, which helps with estrogen metabolism. Folate and methylation is really important. So methylfolate, all that enhances hormone metabolism. It reduces this phenomena we call estrogen excess or dominance. Basically the, the relative excess of estrogen to progesterone, which happens during the perimenopause. Flaxseed's also great. That's kind of a little hack. Think if you can remember nothing else. Just eat a lot of flaxseeds and cruciferous vegetables. Those are great for hormone balance. They have these lignans that are really great for binding to and eliminating these toxic estrogen metabolites. You need good fats, right? Hormones are made from fat. Healthy fats are really key. So no exception there. And you know, we're talking fat was bad for us and it makes us fat. If you eat fat, you get fat. Just doesn't work like that, right? I wrote a book about it called Eat Fat, get thin. You can read it, but. But the bottom line is if you cut out starch and sugar and you eat more fat, you're gonna lose weight and you're gonna get healthier metabolism. What do fats do? Well, fats also help fill you up. They support your brain health, they stabilize your blood sugar, they balance your hormones. So you know, what are the right fats you should be eating? Well, omega 3 fats are key, right? From fish, small fish, sardines, herring, mackerel, watch out for the big fish. You can take omega 3 fat supplements. I recommend that monounsaturated fats, which are from olive oil, a healthy source of saturated fat, if you're not a person who reacts badly to them. Some people are genetically unable to tolerate a lot of saturated fat, but most of us are, particularly if you're metabolically unhealthy, like 93% of Americans. But things like grass fed butter, ghee, coconut oil are fine. The best sources of Fats include avocados, nuts, all kinds of nuts, almonds, pecans, walnuts, macadamia nuts. Those are my favorite. Those are like the olive oil nuts. Various seeds are also great for hormonal balance. Pumpkin seeds, flax seeds, chia seeds, sesame seeds, sunflower seeds, all that. And, and make sure you eat fatty fish that's rich in omega 3s, salmon, sardines, amazing source of vitamin D. Another really good food to have, by the way, is soy. Now, I'm not a fan of the way soy is produced in this country and consumed, right? The soy that most Americans consume is genetically modified. It's contaminated with large amounts of glyphosate, pesticides, it's industrial processed, it's not good. Do not eat that. You don't, you don't want to also eat the soy. That's the way the majority of soy is eaten in America, which is soybean oil, which is from ultra processed junk food. So get rid of that. You don't want that, right? America is the second largest consumer of soybean oil in the world, next to China. It's just bad news. And they owe a lot more people than we do. The average American consumes 38 pounds of soybean oil a year. Now, that might not be something you even put in your food, but it's from all the processed food you're eating. When you go out to restaurants, it's often bad, it's often hydrogenated, it's often oxidized, it's, it's bad. Now these hydrogenated fats are linked to heart disease, cancer, and lots of other chronic health issues. And the thing is, if you're eating real whole soy that's non gmo, that's traditionally grown, it's organic or regeneratively raised. That's actually a health food, right? It has a whole bunch of things. In its whole food form, it contains these phytochemicals that are often known as phytoestrogens. These are things called isoflavones, which are plant compounds that have a structure similar to human estrogen, but they modulate estrogen receptors. Sort of like the cancer drugs called SERMs. Basically, they're, they're like tamoxifen, which is a drug used to treat cancer, breast cancer in women. But it's, it's, it sort of binds to the estrogen receptor, but it blocks the bad effects of too much estrogen, which is what you want to do. And the two main type of isoflavones are Genestein and Diadzine. Now, there's concern about these phytoestrogens in soy promoting estrogen related cancers because they bind to estrogen receptors, but they just weakly bind to them, they block the effects of the harmful estrogen metabolites. There's no link to cancer, and in fact, there's a lower risk of breast cancer and breast cancer recurrence. In fact, in the Shanghai Women's Health Study, where they eat a lot of tofu, which is a traditional soy food, a large study of over 5,000 women in China found that women at a high risk for breast cancer who consumed the most Soy had a 30% reduced risk of breast cancer mortality and recurrence compared to those who had the lowest intake of soy. So more soy, less breast cancer. So don't believe your oncologist when he tells you to avoid soy. Just eat traditional organic non GMO soy like tempeh, tofu and so forth. But don't drink soy milk by the gallon. That's not good for you either. Now, some studies show that it actually can help also with the frequency and severity of hot flashes and night sweats, although evidence is sort of mixed on that. So what does this mean for you? Well, if you're concerned about breast cancer, including high quality non GMO soy in your diet might be helpful for protecting while also helping to ease any menopausal symptoms. However, it's worth noting that the women in these studies who did see a protective effect from soy were also more physically active. They ate more veggies, they took their supplements, which maybe introduces the potential for what we call healthy user bias. Meaning if you're eating tofu, you're probably focused on your health at the start, so that maybe that's partly why you have a lower risk. Regardless, consuming whole non GMO soy can be part of a healthy, well rounded diet. So what else could be responsible for this positive effect from soy? Well, soy is also naturally rich in protein, fiber, magnesium, calcium, and lots of phytochemicals, which are key nutrients for supporting the transition to menopause. Now, these nutrients can also help protect against osteoporosis and even heart disease. So go for organic non GMO soy products. Edamame, tempeh, tofu, traditional soy products make sure you're getting the highest quality products. So what about protein? Well, protein is also very important to prioritize in your diet. Not only does it help stabilize blood sugar and keep you satiated, but also prevents the loss of lean muscle mass or sarcopenia. And that happens with aging and declining estrogen levels, since muscle Mass is key for healthy aging. We want to make sure we're eating enough protein at every meal to prevent metabolism or the breakdown of our muscle tissue. So that's really important. You want to build muscle so you got to eat probably about 30 grams of protein per meal, about 4 to 6 ounces of high quality animal protein. Pasture raised chicken, turkey, grass fed beef, wild caught seafood, all great sources. Now for plant proteins, you know, basically you want about one and a half cups of cooked non GMO tofu, edamame, black beans or lentils, two cups of chickpeas, three cups of quinoa, which is a lot of stuff and it's unlikely you really eat that much. So you do, I think need some animal protein. Unless you're seriously committed to being a vegan, which I don't think is normally good for your health. But you're going to have to supplement with a lot of supplemental proteins like processed plant proteins. Also hemp seeds are great source too. About six tablespoons of those are great. Now one thing to know about plant protein is you have to have a lot more volume and that comes a lot more calories and also a lot more starch just to get the protein that you can get from a small amount of animal protein. It's also less bioavailable and that means that your body doesn't absorb it as well, doesn't use as much of the protection protein from it as it does from animal sources and also is potentially bound to anti nutrients like phytates, lectins, oxalates which can interfere. Now you can have a, a supplement protein powder which is great, but be careful of what this the protein is and make sure it's not industrial soy protein because that is very toxic and that has been linked to breast cancer. So make sure you can use other animal or plant based proteins. I like regeneratively it's goat way, but you can find others on the market. What should you be avoiding? Right, you want to be avoiding certain things that cause worsening symptoms, things that cause inflammation, that cause imbalances in hormones, that make menopausal symptoms worse and perimenopause worse. Right. And it just worsens the whole experience of hot flashes, night sweats, sleep problems. So what are those things that make things worse? Well, I don't think you're going to be surprised. Right. It's sugar, it's refined carbs and flour, it's egg, alcohol, really bad. If you're a woman and you're having hormone issues and you're drinking it's going to be really bad for you, I promise. Because alcohol is basically a liver toxin and it affects your ability to eliminate excess estrogen, worsening all your symptoms. Also, don't eat those ultra processed foods. They're high in inflammatory oils, trans fats and sugars and refined flowers. It's basically a science project. You don't want to be eating now. You're also going to want to stay hydrated, right? When you're dehydrated, your skin becomes drier. And estrogen also, as it goes down, makes the skin a little drier. Estrogen helps the skin produce oil, it helps retain moisture. So it's kind of important to stay hydrated. So drink about half your weight in ounces per per day of water. So if you're 120lbs at 60oz, a couple of liters of water, it's not terrible. Also, I encourage you to add electrolytes. I think that really helps to add a little electrolyte. You can just put a pinch of sea salt in and squeeze a lemon. That's enough. Or you want a little extra magnesium, zero sugar electrolytes like Element, LMNT or we call it element or light show. Now. Supplementation is also important for correcting a lot of nutritional deficiencies that are common. And they're so common. Over 90% of us are deficient in one or more nutrients. So one of my favorites for menopause, magnesium, particularly magnesium glycinate, 4-600mg a day, which helps hormone balance and sleep and mood swings. You can take it at night. Calcium citrate if you are worried about your bone health. But you can get a lot of that from diet. A lot of that from diet. So leafy greens, sesame seeds. Tahini is great. I love tahini for calcium. Chia seeds, very good. So you don't need to get it all from pills, but probably about 600 milligrams a day. That helps with bone health and other factors. Vitamin B6 is really important in estrogen metabolism. So 50 to 100 would be 6 folate, preferably in the form of methylfolate. About 800 micrograms a day. Helps hormone metabolism clearance. So there's a whole process of methylation talked about in the podcast before, but this also affects estrogen metabolism. You need to methylate your hormones in order to excrete them and detoxify them. And you need methylating vitamins. This is B6 methylfolate and B12 in the form of methylcobalamin. About a thousand micrograms a day. A lot of other things can help, like evening primrose oil. It's a form of fat called GLA at 500mg one or two caps at twice a day with with the food. Helps hormonal balance. Fish oil, epa, dha, about a thousand milligrams once or twice a day. Also really important for regulating inflammation, hormonal health and lots more. Also you want support your liver detoxification and taurine can be very helpful with that. About 500 milligrams a day, which helps support hormone metabolism and liver detox. Probiotics really important to keep your gut healthy because the gut has a huge role in hormone metabolism. So 5 to 10 billion organisms per day at least to help normalize estrogen and hormone metabolism. I love seed probiotic. You can use that. One of my favorites, broad, broad spectrum probiotic, black cohosh. Often used with hot flashes and other menopausal symptoms. Although it really helps sleep and reduces irritability when you combine it with lifestyle changes. So there's a lot of supplements you can take. There's more herbs and things that work. Stress also a big factor, right? Stress has a huge impact on menopausal symptoms. More stress, worse symptoms and more severe and more frequent. So stress increases the production of a hormone called cortisol, that's the body's stress hormone. And when you have high cortisol levels, it disrupts this balance, this delicate balance between estrogen and progesterone, which are already kind of wacky during perimenopause. So chronic stress leads to adrenal dysfunction, where adrenal glands are just kind of overworked. And often women in their 40s are overburdened by family and work and older parents and stress and midlife crisis and whatever. And basically you end up with a lot of trouble with cortisol. And that words is menopausal symptoms, fatigue, mood slings, sleep disturbances. And also stress activates something called the sympathetic nervous system, which is not sympathetic at all. It's kind of harmful. And when it's overactivated, and that causes higher heart rate, blood pressure, it can make sugar cravings worse, makes you have insomnia, hot flashes, night sweats. It can lead to mood swings and weight gain, depression, headaches, joint pain, all kinds of digestive issues. So not good. So you really want to learn how to regulate stress? It's not something we learn, right? It's something we have to actually educate ourselves about and learn how to manage our stress. So lots of things you can do there. Yoga, meditation, breathwork, exercise is great, I love it. As a stress reliever, Deep breathing, mindfulness, all kinds of practices are great. Next you want to eat a real food. Just eat whole food diet, get rid of processed food, don't eat crap, prioritize sleep. You know, getting enough sleep is important. Sometimes you do need help. If you're having struggle, you might need hormone support or other support to sleep. The other thing can happen for stress is great that you can use is adaptogenic herbs, things like ashwagandha, particularly at night, rhodiola, lemon balm, cat's claw and that can be really helpful. Also, you know, don't be alone. You know, find your friends who are going through this. Share, share, share your experiences going through this with people and they can help teach you what might be helpful so you don't have to suffer. Bottom line, you know, menopause symptoms and perimenopausal symptoms are optional if you know what to do if you manage them with lifestyle, the right nutrients, supplements, potentially hormone support, all really important. So my friends, as we wrap up today's podcast on preparing for menopause, it's really clear that this transition doesn't have to be so daunting, right? By understanding these hormonal shifts that occur by taking proactive steps to support your body, you can really navigate this phase with grace, with confidence. And remember, menopause is a natural part of life. It's not a disease, right? And with the right knowledge and the tools, you can manage the symptoms and maintain your health and well being. You know, whether it's dietary adjustments, stress management, maybe exploring the role of hormone replacement therapy, there's lots of ways to ensure that you are going to continue to thrive during this stage of life and feel good, right? The key is to be proactive. So work with your healthcare practitioner, hopefully a functional medicine doc, and tailor your plan that's right for you. So thanks for joining me today. Don't forget to rate, review and follow Health Hacks wherever you get your podcasts. Stay healthy, stay informed and I'll see you next Tuesday for another episode of Health Hacks.