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

Mel Robbins (00:23:34):

And then there's perimenopause. I guess this is the warmup for menopause. I mean, what happens there,

 

Dr. Amy Shah (00:23:38):

Perimenopause is your estrogen and progesterone are at the are getting low. So if you've ever had toothpaste, like a tube of toothpaste, when you kind of get to the end of the toothpaste, sometimes you press on it and you just got to splatter. And sometimes you just press on it and you get a full squeeze of toothpaste and sometimes you press on it and you get nothing. And so that's what's happening during perimenopause. Some months you're getting a good dose of estrogen and progesterone, you're almost feeling like you're normal and other months you have a low level and you're getting all these symptoms. And some months you're feeling absolutely terrible because your hormone levels are super low. And so you can have a lot of fluctuations during this time where it's, that's perimenopause. Basically you're getting to the end. A menopause is there's nothing left.

 

(00:24:37):

Your levels are very low, you're not ovulating anymore. And so the years of perimenopause can be long confusing and variable based on what's happening. So one of the things that people talk about is hot flashes. And the reason why hot flashes happen is one of the roles of your hormones is to tell your brain center, your hypothalamus, your temperature center, what to do, how to regulate your temperature. So that month, if you just get a splatter of estrogen or you get, none of you get dysregulation of that central thermostat. And so now you're hot, you're sweating and you get these peaks and valleys of temperature. And so that's how I would describe perimenopause. And that can happen for multiple years. And that's why there's treatment. Now, there's things you can do. Hormone replacement therapy is really good for that kind of hot flash temperature dysregulation that seems to help.

 

(00:25:45):

And so you have all that and then you hit menopause. And menopause. The definition is no menstrual periods, so no ovulations for 12 months. And so full year goes by, you don't have fluctuations anymore. You're just at low levels. And so for women, often the five to 10 years after menopause, they are able to now kind of get acclimated to the no hormone state. So it seems like the fluctuations of the hormones are wreaking havoc on our brain and our body. But then once you kind of normalize at a lower level, about five to 10 years, you seem to have a reprieve of the symptoms. So you're no longer getting the hot flashes, you're no longer having some of the menopausal symptoms, no menstrual period for 12 months. But the drop in estrogen and progesterone that we're talking about here happens up to 10 years before

 

Mel Robbins (00:26:46):

Menopause. Wow. So what's interesting is that I started to see a big spike in sort of fogginess and feeling like something wrong probably in my, I'd say early to mid forties.

 

Dr. Amy Shah (00:27:03):

Yes, that's very typical. So it can be as early as 35 for people who are going through menopause a little bit early. But usually in your forties, especially your mid forties is when people really start to see, oh, that exercise that I was doing is not working to control my weight anymore.

 

Mel Robbins (00:27:20):

Well, everybody that I know that is in this range and is talking about the fact that their body shape has changed, that there is this thickening in the middle. My sister-in-law who I love keeps referring to her body as a twine, just like a twine with legs. I'm like, will you shut up? Stop. That's hilarious.

Dr. Amy Shah (00:28:32):

Seem fair. I know. It's because our estrogen levels, as they start to drop, our body is looking for more hormonally active cells. So what I mean to say is the fat that you accumulate in your middle, it produces estrogen.

 

Mel Robbins (00:28:53):

Okay,

 

Dr. Amy Shah (00:28:53):

Wait a minute. Fat produces estrogen.

 

Mel Robbins (00:28:55):

What do you mean fat produces estrogen

 

Dr. Amy Shah (00:28:57):

Fat cells?

 

Mel Robbins (00:28:58):

You didn't say that the estrogen sister was a fat sister. You just said that she was the one that was the party girl.

 

Dr. Amy Shah (00:29:04):

Yes.

 

Mel Robbins (00:29:04):

Okay. So

 

Dr. Amy Shah (00:29:06):

Fat cells, I was talking about that estrogen progesterone that are primarily coming from our ovaries when we are prior to menopause

 

Mel Robbins (00:29:14):

Premenopausal.

 

Dr. Amy Shah (00:29:15):

But as you get into menopause, you start to get a very big dip in your

 

Mel Robbins (00:29:20):

Estrogen. Well, that's true because you're not going to be producing children anymore. So does the estrogen and progesterone supplies that are part of the reproductive system start to drop?

 

Dr. Amy Shah (00:29:29):

Yes. And then as your estrogen, progesterone stops gets lower, your body starts to do things to try to compensate for

 

Mel Robbins (00:29:39):

It. So it's looking for fat.

 

Dr. Amy Shah (00:29:40):

Yes.

 

Mel Robbins (00:29:41):

Do we also get flabbier around the arms?

 

Dr. Amy Shah (00:29:45):

I'll tell you why. I

 

Mel Robbins (00:29:46):

Feel like even as I'm doing, I'm like, where did these wings come from?

 

Dr. Amy Shah (00:29:49):

Yes, that's because estrogen the other thing. It does what? It helps us keep our muscle mass. So when you decrease your estrogen over the years,

 

Mel Robbins (00:30:00):

So I'm not going crazy, I literally have been looking at my arms going and saying to myself, something is wrong with my arms. I realize they're toned, but they used to be a lot toner. I don't know if that's the right word, but they're like flappy now. And I'm like, what is that

 

Dr. Amy Shah (00:30:17):

One to 3% of muscle mass

 

(00:30:20):

Is basically per decade, you would say up to 3%. But as you go into menopause, it goes faster, meaning that you're losing muscle at high rates if you're not also weight training, eating the protein. So there, the one therapy I can tell you right away for your arms tell me, is to start to do more weight training, start to build muscle in the places. Not only that it was, but that you can build more muscle on. This is the best time to pick up some weights. Oh, I've used the tonal machine at home. I'm doing the things doc more things than you used to. That's the key.

 

Mel Robbins (00:31:00):

That's not fair.

 

Dr. Amy Shah (00:31:00):

So what I'll tell you is that what we found is that when people start to go into perimenopause and their estrogen drops, their activity level drops a little bit and they don't even notice it. So you maybe gaining some fat cells not only because of the estrogen drop saying to your body it needs more estrogen from fat cells. It's because your body is not as active as it used to be. And it's very subtle and you might not even notice it until you say, oh, I used to naturally just get up and walk. And I used to get 10,000 steps. And now, so one of the other things you can do as someone, if we're talking to our friends, we're talking to the audience, increase your activity level, your baseline activity even if you don't

 

Mel Robbins (00:31:47):

Want to. But I keep seeing, and I realize that Dr. Amy is a New York Times bestselling author and a medical doctor people, and she's also has a degree in nutrition and a dual degree in allergy. Right? There's a fancy word allergy analogy there. It is that fancy word. And so I see shit on TikTok about got to weights, got to eat more protein. Is that what you're talking about with activity level? So what do we need to switch up? Because the other thing that I was talking with a friend about is she's like, I'm on that Peloton every day,

 

Dr. Amy Shah (00:32:23):

Mel,

 

Mel Robbins (00:32:24):

And I am not seeing any results whatsoever. And it's not Pelotons fault. Something is going on with my body.

 

Dr. Amy Shah (00:32:31):

Yes, it is. And she's not crazy. That's the biggest thing is I feel so bad because my mom, when she was going through menopause, felt like she was going crazy. She's had anxiety, she couldn't sleep at night, she was gaining weight. And she was like, I feel like I am literally going crazy. And the thing is, is that the sad thing is is that it happens to all everybody, mammals. Humans are one of the only animals on the planet that go through menopause. By the way.

 

Mel Robbins (00:33:02):

Really,

 

Dr. Amy Shah (00:33:03):

Most animals reproduce till they're dying until they die.

 

Mel Robbins (00:33:08):

Well, thank God we don't, I mean, that would be absolutely awful.

 

Dr. Amy Shah (00:33:12):

So the fact that we live past our reproductive years is pretty unique into the human race.

 

Mel Robbins (00:33:19):

One of the reasons why I wanted to do this topic with you, Dr. Amy, is because selfishly, I want more information for myself, for my friends, for listeners that are writing in about this. But you'd be surprised the number of requests for getting for information on this topic from husbands and sons of women going through this because they don't know what to do. And my daughter recently said to me, mom, every one of my roommates is telling me that their moms are calling just like you're calling me. And they're bitching about their foggy memory or the weight that they've gained. So can you please do something that you can have as an episode that would help people? And so what are the top five things that people complain to you about when they come see you for help with nutrition and hormones, and how do you attack fixing them?

 

Dr. Amy Shah (00:34:12):

The number? I would say number one, two, and three. Okay. So number one is definitely the weight gain. The weight gain is very frustrating because if you're an active person, we're already living in a world that's working against us. We already talked about that. This world, the default is that we are going to be in the categories of medically overweight or obese. 73% of Americans are there now.

 

Mel Robbins (00:34:38):

Wow.

 

Dr. Amy Shah (00:34:39):

It's going to be at 85% before we know it. So we're already working against. So most of us are already metabolically challenged. We're already fighting against this battle. Then we got to deal with the estrogen going

 

Mel Robbins (00:34:51):

Down,

 

Dr. Amy Shah (00:34:52):

Which makes you less active, less energetic, and losing your muscle mass. So now you have more fat and it's making your mood a little bit lower. So the therapies that I recommend a lot of them have to do with things to counteract the changes in the lowering of estrogen.

 

Mel Robbins (00:35:11):

What?

 

Dr. Amy Shah (00:35:12):

So walking more. So what I tell women is our cortisol levels can be really high when we're doing tons and tons of high intensity exercise. So it's better to have a baseline of walking, and you can do bouts of hit if you want, but really having more activity. It's called neat non-exercise activity. Thermogenesis neat activity is actually a bigger driver of

 

Mel Robbins (00:35:39):

Our weight. What is that last word? Thermogenesis. I can't keep up with. What is thermogenesis? That's a big

 

Dr. Amy Shah (00:35:48):

Word. Non-exercise activity. Thermogenesis. Thermogenesis is metabolism.

 

Mel Robbins (00:35:53):

Okay. So what is a non-exercise? Walking is not walking. So

 

Dr. Amy Shah (00:35:57):

If you are not walking for exercise, so the thought is you wear a watch or you wear a pedometer, you park farther, you take the stairs,

 

Mel Robbins (00:36:08):

You

 

Dr. Amy Shah (00:36:08):

Take your dog for a walk. All the stuff that you don't count as exercise, that's non exercise activity thermogenesis that has to go up.

 

Mel Robbins (00:36:17):

Okay?

 

Dr. Amy Shah (00:36:17):

If you are in perimenopause and you want to fight the weight gain, that's where it starts.

 

Mel Robbins (00:36:23):

And so the reason why running or HIIT classes aren't the greatest thing for women in this category is because it spikes your cortisol. And what does that have to do with estrogen?

 

Dr. Amy Shah (00:36:34):

So women tend to do activities. So the other thing that happens during when your estrogen is going down is you're less stress resilient. So I'll give an example for women who even aren't in menopause or perimenopause the week before your period, you're just less stress resilient. You can't handle the things that you usually can handle.

 

Mel Robbins (00:37:01):

Yes. Yes. Doctor Amy yes.

Mel Robbins (00:37:09):

So is PMS

 

Dr. Amy Shah (00:37:12):

A mini menopause?

 

Mel Robbins (00:37:13):

It's a drop in your estrogen and progesterone in the middle of your normal cycle.

 

Dr. Amy Shah (00:37:19):

Yes.

 

Mel Robbins (00:37:19):

No shit,

 

Dr. Amy Shah (00:37:21):

I

 

Mel Robbins (00:37:21):

Didn't know that

 

Dr. Amy Shah (00:37:22):

Happened. That's when your body's like, oh, she didn't get pregnant, the egg didn't get fertilized. We got to shed this lining. They drop the hormones. So you get to be basically the lowest level of estrogen and progesterone, and then you shed your lining, which is your period, and then you start all over again.

 

Mel Robbins (00:37:41):

Wow. So will the things that you are saying that help for somebody in Perry or menopause itself also help with PMS symptoms?

 

Dr. Amy Shah (00:37:52):

Yes.

 

Mel Robbins (00:37:53):

That is a revelation

 

Dr. Amy Shah (00:37:56):

For me too. I thought to myself, wow, the same things that we are doing to improve our nutrition during our cycle.

 

Mel Robbins (00:38:04):

Yes.

 

Dr. Amy Shah (00:38:06):

We just expand on that. The late luteal phase, which is that PMS phase of the cycle is what's happening.

 

Mel Robbins (00:38:14):

I kind of like that. Oh, that's not another name for menopause. I was going to say, I think it's sexier to say I'm in my late L luteal phase, not menopause

 

Dr. Amy Shah (00:38:24):

The luteal age,

 

Mel Robbins (00:38:26):

But you're talking that's a period.

 

Dr. Amy Shah (00:38:27):

Okay. Sorry, that's the week before your period. That's PMS. So the one surprising thing that people have to understand is that hormone replacement therapy does not help with the weight gain part. The weight gain part is not an indication to go get hormones. The things that I told you about, the exercise changes, and I'll talk to you about more changes that we can do more neat activity, more weight training, that's going to help the weight loss.

 

Mel Robbins (00:39:00):

Okay, what else do we need to do for the weight loss? I know everybody's leaning in.

 

Dr. Amy Shah (00:39:04):

Yes,

 

Mel Robbins (00:39:04):

Because I thought if you get the patch or the bioidenticals, your body will snap back into the way it's supposed.

 

Dr. Amy Shah (00:39:10):

And that's what's so frustrating for women. The hot flashes definitely get better, right? That's one of the indications for hormonal therapy. People will have pain with sex or have dryness, dryness. That definitely HRT definitely helps with that. But the weight gain portion is not so easy to address just with hormones because there's multiple things going on. You're less active, you're losing more muscle mass. You're also, your sleep is dysregulated. So then your appetite, as we talked about, your cravings, your hunger, your appetite are all increased because you're not sleeping well.

 

(00:39:53):

So you end up having a situation that can't just be solved by adding hormones. I think about adding hormones like putting gas in your car so you can add gas to your car, but if there is a traffic jam, you are not going anywhere. So our hormones are like a complicated highway system. Like we're in LA right now. There is a complicated web of highways that are backed up and doesn't matter how much gas you pump into the car, it's not going to go anywhere. So the ways to unclog that traffic to keep that traffic moving is the sleep, the exercise, the weight training, the food choices. So sleep is another thing. So as frustrating as it sounds, the more you can improve your sleep, the better that weight loss part will become because 

Mel Robbins (00:40:57):

And

 

Dr. Amy Shah (00:40:57):

So you want to have a good night's sleep, but often you can't sleep because your hormones are disrupted. So it's the cycle. So one of the things I tell people is really, really try your best to improve your sleep hygiene if you haven't started a routine to improve your sleep hygiene, to start it now in perimenopause.

 

Mel Robbins (00:41:17):

Okay, now tell us your top three things for a better night's sleep.

 

Dr. Amy Shah (00:41:21):

Top three things for a better night's sleep cold room. Okay. Your body temperature has to drop by one degree to fall

 

Mel Robbins (00:41:28):

Asleep.

 

Dr. Amy Shah (00:41:29):

So how do you get that done fastest? You can take a shower, you can cool down the room, you can get into pajamas that cool your, you want to cool your core body temperature. That's how you'll fall

 

Mel Robbins (00:41:39):

Asleep. Love that

 

Dr. Amy Shah (00:41:41):

Pitch black. If you can't control the curtains and the light, then wear a face mask or eye mask. There are good studies on the few studies that we have. One is on menopausal women. Even if you have an ambient light in the room, like a light coming through the window, it will stop weight loss if you're on a weight loss plan,

 

Mel Robbins (00:42:06):

Really

 

Dr. Amy Shah (00:42:07):

Circadian rhythm disruption, especially during that time, seems to really mess up the hormones in that sense. So you want to have a pitch black room. And then the third thing is you want a nightly routine. So you want to prepare your brain and your body for sleep because your body loves routines. Our bodies are built on rhythms and cycles.

 

Mel Robbins (00:42:34):

And

 

Dr. Amy Shah (00:42:35):

If every night you go to sleep at 8:00 PM or 9:00 PM so at 8 45, you start to turn off all the lights, you put away your phone, you start to brush your teeth, you're cluing in your body that it's time for sleep. So keeping that same time and routine is essential for good sleep. So people will sleep one day at nine o'clock and the next day at 11 and the next day they're massively disrupting their sleep cycles. And there are some data now that shows that it's maybe more important to stay on the same bedtime than even the total number of hours slept.

 

Mel Robbins (00:43:16):

Wow. Are there certain foods that we should be eating more of or less of to help with the menopause symptoms and hormone regulation? And for everybody's benefit? I just want to remind everybody, this is your second appearance, and we did a huge show on hunger and craving and the neuroscience and biology of it. And 

Dr. Amy Shah (00:43:53):

Remember that I likened it to PMS in the sense that you're less stress resilient. So what I mean is that the things that spike your cortisol are just now more and at a lower threshold, caffeine, alcohol, sugar, shit. Are we not going to have fun now too? It's like all the people say to me, I always drank this much caffeine and I always ate this much sugar

 

Mel Robbins (00:44:28):

Or had a glass of wine or did whatever. What the hell is going on?

 

Dr. Amy Shah (00:44:31):

Yeah. And that's because now your hormones have changed and your metabolism changed. You're also less insulin sensitive. So you've heard the term insulin resistance.

 

Mel Robbins (00:44:41):

Yes. What does that mean?

 

Dr. Amy Shah (00:44:41):

So that happens during menopause.

 

Mel Robbins (00:44:44):

What does insulin resistance?

 

Dr. Amy Shah (00:44:45):

Insulin resistance means that when the sugar is trying to get into your cells, the insulin has to open the door to let the sugar in. That's insulin. So it usually matches meaning when you have a lot

 

Mel Robbins (00:44:59):

Of, so what does it mean when you're insulin resistant? The door is shut, the door is open, the

 

Dr. Amy Shah (00:45:03):

Door shut, and you don't hear it as easily. You're knocking louder and louder to try to get in. And the insulin's like, dude, we just let sugar in. We're not going to let more sugar in. And the body's like, no, but I need to get it out of the bloodstream. I need to put it. And the insulin's like, no, but the cell is packed. It can't take any more sugar. And so while they're having these fights and discussion, that's called insulin resistance. And so when insulin resistance happens, the body gets signals to store fat to say, let's get this sugar out of here because it's not going into the cell, so we got to put it somewhere. So we end up having, when insulin resistance happens, not only do you have a higher risk of getting type two diabetes because your sugar level is so high all the time, you also have more signaling to store fat.

 

Mel Robbins (00:45:58):

Oh, man.

 

Dr. Amy Shah (00:46:00):

So insulin resistance, it's something that we can control by saying, well, if the cells are so full of sugar and they can't let any more sugar

 

Mel Robbins (00:46:10):

In, you better eat some vegetables.

 

Dr. Amy Shah (00:46:12):

You better just cut some of that sugar out and add in some things that help you lower the blood sugar in your body, which is fiber. So fiber is one of the most helpful things that you can add to your diet besides cutting down the sugar because your cells are overwhelmed with sugar. Cut down the sugar, add more fiber so that your blood sugar can be regulated in your body. Move more, like we said, add

 

Mel Robbins (00:46:44):

In weight training, sleep more, sleep

 

Dr. Amy Shah (00:46:47):

More. And remember the water that we talked about in the other episode, water. Our thirst centers are often mixed with our hunger centers. Like the signals can be mixed. So you want to hydrate enough so that you are not eating mindlessly. And then of course there's

 

Mel Robbins (00:47:04):

So, and the trick there, just for those of you that have not heard the other episode, is when you feel your appetite coming on in order to determine whether or not you just have a mindless craving, you can say, would I like a bowl of vegetables right now? And if the answer's no, that means you're not actually hungry. Another trick is drink a glass of water because that typically can satiate that appetite that flares up. Why do we have anxiety? Why is there an increase in anxiety during PMS and menopause?

 

Dr. Amy Shah (00:47:40):

Remember that sister, the progesterone sister,

 

(00:47:44):

She was the calming one. She was the one who was keeping you chillaxed and careful. And when progesterone goes down, you don't have that chill relaxer anymore. You don't have someone to keep you calm. That sister that was inside saying, calm down, it's okay, Mel, you'll be fine. Your progesterone levels are lower, and all of a sudden you are anxious about everything. The things that never made you anxious before are making you anxious. And the sleep, you wake up in the middle of night, you're like, oh my God, 

Mel Robbins (00:48:33):

Does hormone replacement therapy tend to help with anxiety?

 

Dr. Amy Shah (00:48:37):

Yes. If progesterone replacement.

 

Mel Robbins (00:48:39):

Gotcha. Can you explain what a hormone is? I am not sure I would know how to explain what a hormone is and what it does.

 

Dr. Amy Shah (00:48:49):

Yeah, that's a great question. I always feel like there's so much confusion about hormones. Hormones is a chemical messenger. So in my analogy of the highway, it's the car. It's the car. It travels from your brain or from your ovaries to wherever it needs to go. It can go to the muscle. It can go to the heart, it can go. So it's a traveling message, and we need it. Our bodies cannot function without hormones. People get so annoyed with hormones, but you cannot function without your hormones. Even cortisol. Cortisol is a good hormone. It has to be balanced.

 

Mel Robbins (00:49:35):

So what is the estrogen? The, oh, I'm getting this now. So the fun party sister,

 

Dr. Amy Shah (00:49:42):

The social one.

 

Mel Robbins (00:49:43):

The social one is driving one car.

 

Dr. Amy Shah (00:49:46):

Yes.

 

Mel Robbins (00:49:46):

And when she arrives, it's time to party.

 

Dr. Amy Shah (00:49:49):

Yes.

 

Mel Robbins (00:49:50):

When the progesterone sister is driving another car, when she arrives, party's over

 

Dr. Amy Shah (00:49:56):

And she calms everybody down, let's just chill, relax. Now guys, let's just tone it down.

 

Mel Robbins (00:50:01):

Let relax. Is insulin a hormone?

 

Dr. Amy Shah (00:50:03):

Insulin is a hormone,

 

Mel Robbins (00:50:04):

Really? So when insulin gets in the car, what is insulin telling you to do?

 

Dr. Amy Shah (00:50:08):

So insulin is telling you to open the door to let the glucose in. It's signaling to store, store. It's a storage signal, meaning that our body sends insulin out to say, Hey, we need to store a little more glucose here, glucose coming in. So it's a messenger to tell people Thyroid hormone is also, it goes all over the place. So people think, oh, thyroid hormone is just about weight. No, it goes, it's controlling weight temperature, it's controlling heart rate. It's controlling a million things. It's not just going to one destination.

Mel Robbins (00:51:28):

Wow. So they're just kind of driving in the wrong directions, or they're not arriving where they used to arrive and that's making the changes. So the hormones are the root cause of PMS and menopause?

 

Dr. Amy Shah (00:51:41):

Yes.

 

Mel Robbins (00:51:42):

Wow. And for some of the symptoms, hormone replacement therapy will alleviate symptoms, but for other things like the fat redistribution or the losing muscle tone or that you're going to have to make lifestyle changes.

 

Dr. Amy Shah (00:52:03):

So the other hormone that we didn't talk about, but that's really important even in women, is testosterone.

 

Mel Robbins (00:52:09):

Really?

 

Dr. Amy Shah (00:52:09):

Testosterone is actually in higher levels four times the level of estrogen or progesterone. It's high

 

Mel Robbins (00:52:16):

In women.

 

Dr. Amy Shah (00:52:17):

Yes. Really. And we always think about testosterone as like a male hormone. Of course, males have much higher levels

 

Mel Robbins (00:52:25):

Of

 

Dr. Amy Shah (00:52:25):

Testosterone than women, but our testosterone is also high compared to our other hormones. And so having testosterone there. So testosterone is the sister that doesn't live as close to the other sisters, but testosterone is the leader. It's the one, it's the muscular, it's the aggressive, it's the leader sister. So testosterone is something that we get a spike of testosterone at ovulation. So if you know your cycle roughly a week after your period is when your testosterone levels are peaking. And so that's when you want to build the most muscle, that's when your libido will be the highest. Your confidence levels will be similar to the other gender. Like people that take too much testosterone, for example, when they're taking replacement and they go overboard, they'll be angry, aggressive, and maybe even a risk taking behavior. And so we know that testosterone can be good in small amounts, especially for women during perimenopause and during the cycle, if you're lower than you need to be, but of course you don't want to overdo it and people overdo it all

 

Mel Robbins (00:53:45):

The time. How do you figure out what to take?

 

Dr. Amy Shah (00:53:47):

Yeah, I know. I know. There's so much misinformation out there. Example,

 

Mel Robbins (00:53:52):

The big ones. Yeah. Give me some of the big myths.

 

Dr. Amy Shah (00:53:54):

Big example. The one thing that all doctors can agree about that no hormones, is that those pellets that people get are no good.

 

Mel Robbins (00:54:07):

I don't know what the hell a pellet is. I've just heard about this. What the hell are

 

Dr. Amy Shah (00:54:11):

Pellets? So pellets are testosterone releasing extended release testosterone that they implant under the skin, and it's supposed to release testosterone. What happens is you keep this in there for months and you get it replaced. And what's happening is that you can't adjust the levels. So you're getting, and most of these pellets are giving you super therapeutic levels. And like I said, hormones are not something that you just want to add because they're doing a lot of other things besides maybe the one thing that you're targeting. And so what we say is why would you use an implantable testosterone that can't be titrated, that usually releases too much

 

(00:55:02):

In the same dose in every woman? Why would you do that? And the answer is that you can charge. You can charge for testosterone pellets. And when you do testosterone like a cream or a ingestible, it's not money in the pocket of the practitioner. And so I know once I said this on social media, and people went crazy because they said, I love my testosterone pellets. And I said, great, but make sure your levels are at the level that you want it and not way high, because I bet you that a lot of people who are taking testosterone pellets are at super therapeutic levels, and we've seen so many negative side effects from those levels. So hormone replacement can be so amazing, but go to the right person, choose the right dosing, and even if you do pellets, great, choose what's right for you, but make sure you're not getting levels that are too high for your body.

 

Mel Robbins (00:56:04):

I am so glad you said this because we had another amazing person on who uses pellets herself and was so excited about them that I'm like, I got to get me some pellets. I got to go. I got to get in there and get the pellets. I got testosterone. Chris Robbins, get ready because the libido is coming back. But I'm glad that you gave us the reason why, so that you can make a choice for yourself.

 

Dr. Amy Shah (00:56:31):

Yes.

 

Mel Robbins (00:56:33):

Is it true that women of different races experience menopause differently?

 

Dr. Amy Shah (00:56:37):

Yes. And the problem is, again, Mel, is not only are we not educating our doctors or the population about menopause, we don't even know the differences between different backgrounds, different races, different ethnicities,

 

Mel Robbins (00:56:55):

Because they're not studying it.

 

Dr. Amy Shah (00:56:56):

They're just not studying it. And so we're just finding out now that people present different, I mean, we are just at the basic levels of finding out that women present differently with heart attacks than men, and that women produce will be shamed for symptoms that are actually real because they just think, oh, she's just a

 

Mel Robbins (00:57:18):

Complainer. Well, and then the other thing that I have really not appreciated is that there is an acknowledgement that you get foggier and there's an acknowledgement that you will start to feel and start gaining weight in places that you've never had it before, but there's no what to do

 

(00:57:37):

That. It's sort of this, oh, well, yeah, me too, or, yep, that'll happen. And everything will kind of go back to where it should be when you're 60 or you're 10 years into this. And I am sorry. I'm not settling for that. And that's one of the reasons Dr. Amy, I wanted you on. And so I think it'd be really helpful if you could walk us through the day of what you would recommend for anyone to either better manage PMS or have a better routine that's aligned with your recommendations and the science out there to help us both regulate our hormones and do the proactive steps to feel better during these very normal changes.

 

Dr. Amy Shah (00:58:24):

Yeah, that's a great question. And I'll start with saying that we live in a society that has a problem with women getting older. We basically have been told that if you don't fit into the societal ideals of young, fertile women,

 

(00:58:48):

That you're no longer worthy, that you're no longer beautiful, that you're no longer wanted, that you're no longer smart and motivated. And I think that that's one of the biggest challenges that we are going to have to face in this next generation where we feel good even into our forties and fifties. And if we do the things that we're going to talk about, this could last till our seventies, and we can look younger and feel younger. We already know the biological age. Our age of ourselves is completely different, 20 years different than our chronological age. So you are really just 35 right now.

 

Mel Robbins (00:59:28):

Thank you. Thank you. Which is why I am pissed off that I have a dry vagina and I sweat at night and I feel like somebody's grandmother. Exactly. So

 

Dr. Amy Shah (00:59:39):

Here's how we move through the day. Okay. You wake up hopefully without an alarm. This is really important because we talked about sleep, how it helps with appetite regulation, and we just as a society, shit on sleep and don't allow ourselves to sleep. So they say, go camping. Go somewhere where there's no ambient light and there's no distractions in social media. And see actually what time you sleep and wake up. I bet you you're not a night owl. You thought it's really just a societal thing that we try to escape from our days at night. So you're going to get an adequate night of sleep. You're going to go get that sunlight in the morning.

 

(01:00:18):

So circadian biology, again, the light that you get in the morning tells every cell in your body that it's morning. And the benefit of that is that our hormones need that input. If our hormones don't get input from our brains and our bodies that, Hey, it's time to release now cortisol. Cortisol is high first thing in the morning, then it causes hormonal dysregulation, which is like how people say, oh, I feel so tired all day, or adrenal fatigue. I feel so burned out. It's not that the adrenals are burned out. There's no such thing as adrenal burnout. The word adrenal fatigue makes it sound like these adrenal glands get tired

 

Mel Robbins (01:01:07):

And now they don't.

 

Dr. Amy Shah (01:01:07):

No. This hormonal highway that we're talking

 

Mel Robbins (01:01:10):

About

 

Dr. Amy Shah (01:01:11):

Gets clogged. So it's not just the adrenals, it's coming from the thyroid, it's coming from the brain. The whole traffic jam is happening because of all the other things, the lifestyle, the age-related hormone changes. So you want to get up, you want to retune those clocks. Those clocks can get damaged if you misalign them so long. So many times

 

Mel Robbins (01:01:37):

If you live in your parents' basement and you never get outside, or you spend hours and hours and hours in the daytime inside. Well, what I love about this is I think just to kind of keep with the analogy, because the visuals really help me put it all together. It's almost as if the circadian rhythm and the sunlight in the morning is like the remote starter to

 

Dr. Amy Shah (01:01:58):

Your car. Yes, yes. And it's unclogging that it's keeping those roads open and clean so you can know, okay, it's time to drive. Everything's opened

 

Mel Robbins (01:02:10):

Up

 

Dr. Amy Shah (01:02:11):

So you get the circadian rhythm. And remember that if you start to damage those cars, you basically get these things called senescent cells. So the word is a very scientific word, but basically it means your cells become zombie cells and they no longer can work. The car doesn't work, but actually the emissions from the car is inflammatory signals and aging, and all the things that come with aging is these cars that are broken down, and they're sending off these inflammatory signals to your whole body. And that's the process of aging. We need to clean those cars up and get those out of there if they're not working. So keeping with that analogy, we don't want senescent cells is the big area of anti-aging that we're trying to understand. How do we clear those out faster? How do we not break down those? So then you want to, so working out in the morning actually has been shown in studies to be not necessarily the only ideal time to workout, but the best time to stay with a routine. So people are compliant with exercise. When it happens in the morning,

 

Mel Robbins (01:03:28):

And

 

Dr. Amy Shah (01:03:28):

I see this, well, it's common

 

Mel Robbins (01:03:29):

Sense because your day doesn't hijack your energy and your time.

 

Dr. Amy Shah (01:03:34):

I see it over and over again, especially in women because

 

Mel Robbins (01:03:39):

We're Sorry, go ahead.

 

Dr. Amy Shah (01:03:40):

No women. We are doing everything for everyone. Our mental load starts from the morning, and so if you don't get that workout in, there's a big chance that you're not going make time for it later because the kid needs a ride, your husband needs you to be

 

Mel Robbins (01:03:58):

Home.

 

Dr. Amy Shah (01:03:59):

The meeting came up, somebody needs you to be somewhere. So get it done in the morning.

 

Mel Robbins (01:04:05):

If

 

Dr. Amy Shah (01:04:05):

Possible. There's a second peak time. If you, that seemed to be equivalent late afternoon

 

Mel Robbins (01:04:11):

And

 

Dr. Amy Shah (01:04:11):

Late afternoon, you get a little bit of surge. It's a better time to muscle build. So if you're doing two mini workouts that you could just split it up. And then high protein.

 

Mel Robbins (01:04:21):

High protein

 

Dr. Amy Shah (01:04:22):

Protein is one of the biggest things that doesn't happen with women in perimenopause. Because what happens is women think that you're trying to be skinny. And when they start to see themselves gaining some middle section weight, they often cut down even more. And you're in this very tight calorie restriction. And what you really need to do is eat more protein, more fiber, more real foods and less of that ultra processed crap. So having a high protein breakfast, dopamine booster, breakfast, high fiber, we talked about that a lot in the other episode. And then you want to do your biggest concentrated tasks of the day early in the day

 

Mel Robbins (01:05:07):

So that you don't spike your cortisol.

 

Dr. Amy Shah (01:05:09):

Exactly.

 

Mel Robbins (01:05:10):

Boom, I'm getting this. I am getting this.

 

Dr. Amy Shah (01:05:13):

And then if you are someone who can do a meditation or a nap, the best time to do it is when your cortisol is naturally low 

Mel Robbins (01:05:46):

Let me ask you a question about that. These menopausal symptoms that you're talking about, I've heard what I think is probably a myth that if you just ride it out just like three years, Mel, ride out the hot flashes, the dryness, the bitchiness, all this stuff, the brain fog, and in three years you'll just snap right back. Is that true?

 

Dr. Amy Shah (01:06:07):

Well, what happens is that your body just starts to get used to it. And so you're operating at a level that's just stable. There's no squeezing of the toothpaste. There's nothing there. Your body starts to accommodate. It's not that it's snapping back, but that the symptoms seem to go away. A lot of the symptoms that we're really troublesome during perimenopause, and so it's often the time where people feel a little reprieve. But remember that disease risk goes way up after menopause. Our hormones protect us from heart disease and all of the disease of aging. And so once you hit menopause, you start to have an increased risk of all of those inflammatory diseases.

 

Mel Robbins (01:06:59):

Okay. Wow. Yet another thing to look forward to, is there anything more that we should know about the increased risk of inflammatory diseases?

 

Dr. Amy Shah (01:07:07):

So one of the big criticisms of hormone replacement therapy was that it would cause cancer. But now we know that it's the opposite, that actually hormones actually protect us from a lot of these diseases, especially heart disease. And for women, it can actually be protective. And in the right population of women, very close to the start of menopause or perimenopause. The earlier you start it, the better risk protection you get from hormone replacement therapy.

 

Mel Robbins (01:07:44):

So what is the biggest myth around menopause?

 

Dr. Amy Shah (01:07:47):

I think the biggest, honestly, my biggest pet peeve about menopause is the fact that women feel shame around it and they can't have conversations with their doctors. They often feel like their marginalized and they're not listened to from their provider when they say, oh, I have this correlation. The symptoms that I don't feel right, feel tired, but I feel anxious. My sleep is off. And they often get a prescription and no explanation about what's happening. And I know countless women who've just come home with anti-anxiety medications and no one explained to them that there's a lot going on in your body that could explain why you're feeling this anxiety at this time. And there are things that you can do. Not to say there's anything wrong with medications, there's a great need for medications, but there's also a big need for education around menopause.

 

Mel Robbins (01:08:53):

I agree. There is a huge need for education not only around menopause, but also around women's hormonal health and cycles in general. And I consider myself to be a very well-educated person. I'm intellectually curious. I read all the time and I have flunked this topic.