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

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That's TreatGMG.com. Hey, it's your friend Mel, and welcome to the Mel Robbins Podcast.
All right.

I have been wanting to do this episode for such a long time. What are we talking about today? The big M and the big H.
What is that? Menopause and hormones. And no, do not touch that off button.
Everybody needs to hear this. Hormone changes in women affects half of the population.
Today is a conversation for all of us. If you are in the stage and the age where you feel bitchy and itchy and dry and hot and your hormones are all out of whack, or if you're living with somebody who is going through that, everybody needs to hear this.
I'm embarrassed to tell you. I know jack shit about menopause and hormone fluctuation in women and in girls.
And there is so much misinformation flying around the internet. I thought, I have to have a conversation about this with you and a medical doctor, somebody who understands this.
We are going to cover everything from PMS to hormones in women to what to expect when menopause hits. We're not going to be getting our menopause tips on TikTok, people.
We're talking to a doctor about what is going on in our bodies. And the thing that everybody that I know is bitching about my age, which is the breadbasket that develops in the middle, that's what we're doing today.
And who have I asked to guide us through the land of menopause and hormones and women? None other than Dr. Amy Shaw.
That's right. She is back.
She did her training in nutrition from Cornell. She did a residency at Harvard.
She got a fellowship in Columbia. She is an expert on hormones.
Dr. Amy Shaw is back by popular demand.
Dr. Amy, welcome back.
What an honor. Thanks, Mel.
You're welcome. So I loved your book.
I'm so effing tired. Title's fantastic, by the way, because I do feel effing tired.
And it's a proven plan to be burnout, boost your energy, and reclaim your life.

And what I really wanted to talk about, because when I hear the word tired,

I think about two things.

How everybody I know feels burnt out.

And I want to talk about adrenal fatigue.

But I also want to talk about menopause.

The big M. The big M.
The big M. I'm going to be double nickels, 55, this year.
I am in the thick of it. What the fuck is going on with our hormones and our bodies? And why isn't there more information? I mean, it affects half of the population for crying out loud.
So where do you want to start, Dr. Amy? I think the menopause conversation needs to be had much more commonly and much more openly.
Most women go through this time of life and they have no idea why their anxiety level has increased, why their energy has decreased, why they feel like there's a brain fog. People will present with ear itching, body itching.
Wait, that is something that's- That's part of menopause. It is? Yes.
That explains. Did you just see me as we were walking up? I was itching my back as if like I had just been bitten by a mosquito.
Why does your body- I'm going to hijack this conversation so fast. So keep going with the weird ass symptoms.
Yeah, I think the biggest symptoms that people feel is the brain fog. Yes.
That happens with menopause and the mood changes, the hot flashes, and then the sudden change in temperature. Like what is happening? Why are we feeling like this? We don't have the conversation enough.
And so everybody's kind of feeling like they're going crazy. Yes.
And one of the biggest complaints, and I know that we'll touch on this, is the increase of fat around the middle. Yes.
So brain fog, fatigue, the increase in fat, especially around the middle. And all of these weird symptoms all have to do with your changing hormones.
Okay, you're gonna have to break this down for us. Because the conversations that I'm having with my girlfriends, it's all about this metamorphosis, I feel totally out of control.
The last time I felt like this in my own body was when I was going through puberty. And I started to get, you know, first you get those like knots or whatever they're called, bumps or whatever they are.

And then you get the boobs.

I didn't feel that way about pregnancy when my body was changing because I was so excited about it. Yeah.
And because there is so much written and that you can read about pregnancy and it's so celebrated that you kind of know what to expect, even though when it's your first time, it feels so foreign. But this feels so out of control.
And I also am glad that you're here, because I know it's also a really frustrating time for the people who know and love us. Because it's not just the hot flashes.
I have hot flashes in my mood. Like I will swing from happy to bitchy, like a kitchen door swinging.
And so should we start with understanding what's going on? Yeah. Well, first of all, let's just understand the fact that we don't talk about enough in medical, in the medical sense.
We talk about it all the time with our friends

and colleagues. I mean, your conversations with your friends and my conversations with

my friends match. It's menopause, menopause, menopause all the time, right? Because we're

all trying to figure out what's going on with our bodies. We're trying to help each other

because we don't have enough guidance. It's not like pregnancy where you can say what to expect

when you're expecting on day 22. Yes.
So I guess we should start with what the fuck is going on. Exactly.
And the problem is, is that in our lifetime, I was in school when they actually mandated that women be included in medical studies. Wait, what? Women were excluded from all medical studies because our fluctuating hormones or the fact that we could be pregnant during a time of a trial.
And so every medication, every intervention, every surgery, everything was done only on men. Well, I knew that about the ADHD studies in the late 70s and why ADHD has been misdiagnosed at profound levels for women because they only study boys.
I had no idea that all of the medical studies related to the effect of anything. Anything.
Why are people not talking about this? I know. How do we even know then whether or not the side effects of something are going to impact us versus the way they impact dudes? In fact, what they were just doing is they would just prescribe a smaller dose to women.
Sort of like a golf tee that's closer to the green. It's like they didn't know anything about the biology of women, but they just said, well, let's just give them a little less.
They're just smaller than men and thinking that medications are gonna affect us the same way as they would have in men. And that's why women are the forgotten gender when it comes to healthcare.
Wow, so what year was this in medical school? I think it's the 80s where they had to mandate that women be included in all studies. Wow.
Yeah. And then on top of that, what they weren't doing and they still don't do is they weren't seeing the impact on hormones.
All right. Now you're forced to include women, but you're not actually seeing what the impact is on our hormones, if any.
Maybe there's no impact, but why not look at what's happening when you're taking medication X? What's happening to the estrogen, progesterone, testosterone? There's no data. I can't believe that they're not looking at the impact on hormone levels.
That's kind of scary, honestly. It's a shame.
In fact, when I was a young mom, my kids were one and three, and I was out of the postpartum range, but I felt so out of control. Like, I felt burned out, but then I couldn't sleep.
My hair was falling out, but my thyroid levels were fine. And I was so confused about my hormones.
So I thought maybe I just didn't pay attention to that part of medical school. So I went to the hormone experts, so-called OBGYNs, my colleagues who were specialized in women's health or brains.
And they said to me, oh, we didn't learn about that either. We learned about pregnancy, puberty, and then all you learn about menopause is that it just shuts off.

And that's basically all we know.

And so I said to myself, well, that's really sad because at least half of the population is women.

And if doctors, if they don't even know what's going on, then how are women going to know what's going on?

Can you explain what a hormone is? Yeah, that's a great question. Hormones is a chemical messenger.
So what do you want us to know in terms of hormones, the 101? All right, let me tell you. It's like the best analogy is like two sisters.
Okay. Okay.
Estrogen is super smart. She's super social.
She is outgoing. She can be a little bit risk taker.
She can be a little bit out of control. Got it.
Then you have the sister, the progesterone sister. She's very calm, level headed.
She knows when the other one's like kind of going off the rails.

She's the one that kind of keeps you at home. No, stay at home.
Let's just chill. She's the one that keeps you calm.
So when we're going through menopause, we are getting less estrogen and less progesterone. So you're starting to feel like you're not as sharp.
You're not taking as many risks. You're not as social.
Your level of estrogen is going down. You might not have the energy levels.
You might not feel like doing the things you used to do. Your activity level might go down just without even realizing it.
You're just sitting more. As progesterone goes down, you start to get more anxious.
You start to feel like you can't sleep. And you start to feel like your life is out of control.
Wow. And so what you're noticing- Is this also why I'm waking up in the middle of the night? Yes.
The drop in estrogen and progesterone is why I'm not sleeping through the night? Yes. I thought it was because I had to go to the bathroom, but it's probably because of the hormones? Yes.
Dr. Amy, I cannot thank you enough for explaining this to us.
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Welcome back.

I'm Mel Robbins.

I'm here with Dr. Amy Shaw.

You know what we're talking about?

The big H, people.

Hormones.

So Dr. Amy, talk to us about women's hormones throughout her lifetime.

What do we need to do to optimize our life throughout every one of these stages that women go through from puberty to menopause? Yeah, that's a great question. So women start their hormonal cycles at puberty.
Women often aren't even taught what their cycle is and what to expect and how to manage it. Because you just go through life

thinking it's just annoying period, but you don't really learn anything more about it.

It's so true. It is annoying.
And you don't know a lot about it.

So the first day of your period is a very momentous day. It's the start of your 28 day

cycle. And the reason why I think it's important for us to understand is that

You're starting, basically, when you shed the lining of your uterus, that's your period, you're starting over. So now, from day one of your period all the way till day 14, you get a rise in your hormones.
If you don't get pregnant, then you're going to get a fall in the hormones. Get a fall in what hormones? Estrogen rises throughout the first part of the cycle, and progesterone actually rises too.
Testosterone has a little spike closer to ovulation, so day 14. But the interesting part is that at the latter half of your cycle, if you're not pregnant, so most months, you're going to be experiencing a fall in your hormones.
And I think it's really important for women to realize that you can train and eat and fast and live differently throughout those different changes of your hormones to match what's happening.

What does that mean?

So from day one through day 14,

when your estrogen and progesterone levels

are getting higher and climbing,

especially towards that day 14,

you're gonna feel more energetic.

You're gonna be more stress resilient.

You're gonna be able to do more workouts. So I always talk about that time is like train like an athlete, eat like an athlete, eat more, train more.
Energy levels are good. Stress levels are good.
This is a time to try out intermittent fasting or no food two to three hours before bed. So day 21 through 28.
So it's called the late luteal phase when your hormones are really dipping down there, the kind of mini menopause column. That's when you pull back on the very stressful activities, you pull back on eating lots of like maybe you're eating a lot more treats or sugar or carbohydrates in the first half of cycle.
That's when you want to pull back a little bit. You want to realize that your body is less stress resilient.
This is not the time to take on all the projects and to be skimping on sleep and to be working out excessively and to be adding the intermittent fasting for the first time. You don't want to be testing your stress resiliency at this time, if possible, because according to your own cycle, this is the time that you're going to be least stress resilient, also going to be more insulin resistant, come down on the sugar and the carbohydrate level, start to eat more fiber and protein to keep yourself fuller.
And so when you understand that, you're like, oh, well, that makes sense. I naturally don't feel like doing my high intensity workouts, the final week of my period.
So from the time you hit puberty to the time you go into menopause, you have these monthly cycles, it's imperative for us to learn them and to learn how to optimize them. Wow, this is so interesting.
You know, if we were all clued into this, how to optimize your energy or your focus during certain stages of your cycle, and if we knew what really worked for our bodies from a younger age, by the time we get to menopause, we wouldn't have to have the discussions that we're having today. It's kind of lame that as a 54-year-old woman, I'm still going, what the fuck is going on with my body? Exactly.
The problem is the world is a man's world, at least a medical research world, because that's what we've researched. Because we don't have enough research on this topic, we don't have 10,000 women studies where we look at their cycles and we look at menopause.
I mean, we need that. We need that data.
So we can say, hey, if you are trying to optimize your muscle mass, you should be training hard in the middle of your cycle. Like, where are those studies? Where is the data? So we have a toolbox.
So a woman goes through puberty. She gets her menstrual cycle.
And then what happens when

somebody gets pregnant? What happens to the hormones then? So basically what happens is if at ovulation, the egg gets fertilized, the hormones stay high. They don't drop to let the lining shed.

So as the hormones stay high,

you get obviously HCG. People know this because this is the one hormone that actually rises during early pregnancy.
That's what you check when you pee on a stick is the HCG levels are in the blood. The body knows that you're pregnant and has released HCG because there's been an implantation.
So you don't get the whole last part of your cycle that you usually do. There's no late luteal phase.
There's no PMS. Your hormone levels stay high for the duration of the pregnancy.
And then when you have the baby, it can take a few months actually to normalize or some fluctuations, but then you'll go back to having kind of that approximately 28 day to 32 day cycle. And then there's perimenopause.
I guess this is like the warmup for menopause. I mean, what happens there? perimenopause is your estrogen and progesterone are getting low like a tube of toothpaste

when you kind of get to the end of the toothpaste, sometimes you press on it and you just get a splatter. And sometimes you 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. That's perimenopause.
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 hypothalamus, your temperature center, what to do, like how to regulate your temperature.
So that month, if you just get a splatter of estrogen or you get none, you get dysregulation of that central thermostat. And so now you're hot, 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, like there's things you can do. Hormone replacement therapy is really good for that kind of hot flash, temperature dysregulation that seems to help.
And so you have all that and then you hit menopause and menopause, the definition is no menstrual periods. So no ovulations for 12 months.
And so full year goes by, you don't have fluctuations anymore. You're just at low levels.
The fluctuations of the hormones are wreaking havoc on our brain and our body. But about five to 10 years, you seem to have a reprieve of the symptoms.
So you're no longer getting the hot flashes. You're no longer having some of the menopausal symptoms.
So menopause is defined by having 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 menopause.
Wow. So, you know, what's interesting is that I started to see a big spike in sort of fogginess and feeling like something wrong, probably like in my, I'd say, early to mid 40s.
Yes, that's very typical. So it can be as early as 35 for people who are going through menopause a little bit early.
But usually in your 40s, especially your mid 40s, is when people really start to see, oh, you know, that exercise that I was doing is not working to control my weight anymore. Well, everybody that I know is talking about the fact that their body shape has changed.
Yes. That there is this thickening in the middle.
My sister-in-law, who I love, keeps referring to her body as a Twinkie, just like a Twinkie with legs. I'm like, will you shut up? Stop.
And I'll get flack for saying this because I'm a lean, athletic build kind of person, but all my pants fit very differently now. It's as if I have like those inner tubes that you sit in in a pool.
It's like I've put one from the belly button around the back. It's like all of a sudden it's filled out.
So my pants don't fit anymore. I could not do more crunches.
I couldn't eat healthier if I tried. I am already getting eight or nine hours of sleep.
For God's sakes, I've cut back on the alcohol. I smoke a little weed here and there.
That's not putting on the shit in the middle. I don't even get the munchies when I smoke weed.
Why is this happening? This is happening. It doesn't seem fair.
I know. It's because our estrogen levels, as they start to drop, our body is looking for more hormonally active cells.
So the fat that you accumulate in your middle, it produces estrogen. Okay, wait a minute.
Fat produces estrogen. What do you mean fat produces estrogen? Fat cells.
You didn't say that the estrogen sister was a fat sister. You just said that she was the one that was the party girl.
I was talking about that estrogen and progesterone that are primarily coming from our ovaries prior to menopause, premenopause. Okay.
But as you get into menopause, you start to get a very big dip in your estrogen. That's true because you're not going to be producing children anymore.
So does the estrogen and progesterone supplies that are part of the reproductive system start to drop? Yes. And then as your estrogen progesterone gets lower, your body starts to do things to try to compensate for it.
So it's looking for fat. Yes.
Do we also get flabbier around the arms? I'm like, where did these wings come from? Yes. That's because estrogen, the other thing it does, what? It helps us keep our muscle mass.
So when you decrease your estrogen over the years. So I'm not going crazy.
I literally have been looking at my arms and saying to myself, something is wrong with my arms. I realize they're toned, but they used to be a lot toner.
I don't know if that's the right word, but they're like flappy now. And I'm like, what is that? One to three percent of muscle mass.
Yes. Per decade, you'd say up to 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 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. So this is the best time to pick up some weights.
Oh, I use the tonal machine at home. I'm doing the things, Doc.
More things than you used to. That's the key.
That's not fair. So what I'll tell you is that what we found is that when people start to go into perimenopause and their estrogen drops, their activity level drops a little bit and they don't even notice it.
So you may be gaining some fat cells, not only because of the estrogen drop saying to your body it needs more estrogen from fat cells, it's because your body is not as active as it used to be. And it's very subtle.
And you might not even notice it until you say, oh, you know, I used to naturally just get up and walk and used to get 10,000 steps. And one of the other things you can do as someone, 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 want to.
I see shit on TikTok about gotta whiff weights, gotta eat more protein. Is that what you're talking about with activity level? So what do we need to switch up? Because the other thing that I was talking with a friend about is she's like, I'm on that Peloton like every day, Mel.

Yeah.

And I am not seeing any results whatsoever.

And it's not Peloton's fault.

Something is going on with my body.

Yes, it is.

And she's not crazy.

That's the biggest thing is I feel so bad because my mom, when she was going through menopause, felt like she was going crazy.

She's had anxiety.

She couldn't sleep at night. She was gaining weight.
And she was like, I feel like I'm literally going crazy. Yeah.
The sad thing is, is that it happens to all, everybody. Yep.
Humans are one of the only animals on the planet that go through menopause, by the way. Really? Most animals reproduce till they die.
Well, thank God we don't. I mean, that would be absolutely awful.
So the fact that we live past our reproductive years is pretty unique. Huh.
Dr. Amy, I love listening to you.
You just have this incredible knack for taking all this science-y, complicated stuff and distilling it down into something I can actually understand.

Let's take a quick break, and we'll be right back with Dr. Amy.
Stay with us.

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Fees apply. Welcome back.
I'm Mel Robbins and we're talking to Dr. Amy Shaw about menopause,

PMS, hormones, all the men. I can just hear them running off into the distance.
Do not go anywhere. This is an important conversation for all of us.
So Dr. Amy, what are the top five things that people complain to you about when they come see you for help with nutrition and hormones and how do you attack fixing them? Okay.
So number one is definitely the weight gain. The weight gain is very frustrating because if you're an active person, we're already living in a world that's working against us.
The default is that we are going to be in the categories of medically overweight or obese. 73% of Americans are there now.
Wow. It's gonna be be at 85% before we know it, right? Most of us are already metabolically challenged.
We're already fighting against this battle. Then we got to deal with the estrogen going down, which makes you less active, less energetic and losing your muscle mass.
So now you have more fat and it's making your mood a little bit lower, right? The therapies that I recommend, a lot of them have to do with things to counteract the changes in the lowering of estrogen. Okay, like what? So walking more.
So what I tell women is like our cortisol levels can be really high when we're doing high intensity exercise. So it's better to have a baseline of walking and you can do bouts of HIIT if you want, but really having more activity.
It's called NEAT, non-exercise activity thermogenesis. NEAT activity is actually a bigger driver of our weight.
What is that last word? What is thermogenesis? That's a big word. Non-exercise activity thermogenesis.
Thermogenesis is metabolism. Okay.
So what is a non-exercise? Walking is non-exercise? Walking. So if you're not walking for exercise, wear a watch or you wear a pedometer, you park farther, you take the stairs, you take your dog for a walk, all the stuff that you don't count as exercise, Yep.
non-exercise activity thermogenesis, that has to go up. If you're in perimenopause and you want to fight the weight gain, that's where it starts.
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? Yes. And what

does that have to do with estrogen? The other thing that happens when your estrogen is going

down is you're less stress resilient. So I'll give an example for women who even aren't in

menopause or perimenopause. The week before your period, you're just less stress resilient.

Yeah. You can't handle the things that you usually can handle.
Yes. Yes.
So you're

Thank you. You're just less stress resilient.
Yeah. You can't handle the things that you usually can handle.
Yes. So your mini PMS is happening for a few years now.
So is PMS? A mini menopause. It's a drop in your estrogen and progesterone in the middle of your normal cycle.
Yes. No shit.
I didn't know that. That's when your body is like, oh, she didn't get pregnant.
The egg didn't get fertilized. We got to shed this lining.
They drop the hormones. So you get to basically the lowest level of estrogen and progesterone.
And then you shed your lining, which is your period. And then you start all over again.
Wow. So will the things that you're saying that help for somebody in peri or menopause itself also help with PMS symptoms? Yes.
That is a revelation. It is.
For me too, I thought to myself, wow, the same things that we are doing to improve our nutrition during our cycle. Yes.
We just expand on that. The late luteal phase, which is that PMS phase of the cycle is what's happening.
I was going to say, I think it's sexier to say, I'm in my late luteal phase. The late lute, that's a period.
Yeah, that's the week before your period. That's PMS.
One surprising thing that people have to understand is that hormone replacement therapy does not help with the weight gain part. The Weight gain part is not an indication to go get hormones.
Okay. The things that I told you about, more neat activity, more weight training.
Right. That's going to help the weight loss.
Okay. What else do we need to do for the weight loss? Because I know everybody's leaning in.
Yes. Because I thought if you get the patch or the bioidenticals, your body will snap back into the way it's supposed to.

And that's what's so frustrating for women. The hot flashes definitely get better, right? Like that's one of the indications for hormonal therapy.
People will have pain with sex or have dryness. That definitely, HRT definitely helps with that.
Okay. But the weight gain portion is not so easy to address just with hormones because there's multiple things going on.
Like you're less active, you're losing more muscle mass, your sleep is dysregulated. So then your appetite, your cravings, your hunger, your appetite are all increased because you're not sleeping well.
Yeah. That can't just be solved by adding hormones.
I think about adding hormones, like putting gas in your car. So you can add gas to your car, but if there's a traffic jam, you're not going anywhere.
So our hormones are like a complicated web of highways that are backed up. And doesn't matter how much gas you pump into the car, it's not 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. The more you can improve your sleep, the better that weight loss part will become because your hunger hormones are really dysregulated when you don't sleep.
And so you want to have a good night's sleep, but often you can't sleep because your hormones are disrupted. So it's like the cycle.
So one of the things I tell people is really, really try your best to improve your sleep hygiene. If you haven't started a routine to improve your sleep hygiene, start it now in perimenopause.
Okay. Now tell us your top three things for a better night's sleep.
Top three things for a better night's sleep. Cold room.
Okay. Your body temperature has to drop by one degree to fall asleep.
Oh. So how do you get that done fastest? You could take a shower.
You can cool down the room. You want to cool your core body temperature.
That's how you'll fall asleep. Love that.
Pitch black. If you can't control the curtains and the light, then wear a face mask or eye mask.
The few studies that we have, one is on menopausal women. Even if you have an ambient light in the room, like a light coming through the window, it will stop weight loss if you're on a weight loss plan.
Really? Circadian rhythm disruption, especially during that time, seems to really mess up the hormones in that sense. So you want to have a pitch black room.
And then the third thing is you want a nightly routine. So you wanna prepare your brain and your body for sleep because your body loves routines.
Our bodies are built on rhythms and cycles. And if every night you go to sleep at 9 p.m., so at 8.45, you start to turn off all the lights, you put away your phone, you start to brush your teeth, you're cluing in your body that it's time for sleep.
So keeping that same time and routine is essential for good sleep. People will sleep one day at nine o'clock and the next day at 11 and the next day.
They're massively disrupting their sleep cycles. And there's some data now that shows that it's maybe more important to stay on the same bedtime than even the total number of hours slept.
Wow. Are there certain foods that we should be eating more of or less of to help with the menopause symptoms and hormone regulation? And for everybody's benefit, I just want to remind everybody, this is your second appearance.
And we did a huge show on hunger and craving and the neuroscience and biology of it. And so that will be linked in the show notes along with both of your books.
But if you had to bottom line it for people that are really wanting to use food to regulate hormone, what are the top recommendations? Remember that I likened it to PMS in the sense that you're less stress resilient. So what I mean is that the things that spike your cortisol are just now more and at a lower threshold.
Caffeine, alcohol, sugar. Shit, are we not going to have fun now too? I mean...
People say to me, I always drank this much caffeine and I always ate this much sugar. Yes.
Or had a glass of wine or did whatever. What the hell is going on? Yeah.
And that's because now your hormones have changed and your metabolism has changed. You're also less insulin sensitive.
So you've heard the term insulin resistance. Yes.
What does that mean? So that happens during menopause. What is insulin resistance? Insulin resistance means that when the sugar is trying to get into your cells, the insulin has to open the door to let the sugar in.
That's insulin. So what does it mean when you're insulin resistant? The door is shut, the door is open.
The door is shut and you don't hear it as easily. You're knocking louder and louder to try to get in.
And the insulin is 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 is like, no, but the cell is packed. It can't take any more sugar.
And so while they're having these fights, that's called insulin resistance. And so when insulin resistance happens, the body gets signals to store fat, to say, let's get this sugar out of here because it's not going into the cell.
So we got to put it somewhere. So not only do you have a higher risk of getting type 2 diabetes because your sugar level is so high all the time, you also have more signaling to store fat.
Oh, man. So insulin resistance is something that we can control by saying, well, if the cells are so full of sugar and they can't let any more sugar in.
You better eat some vegetables. You better just cut some of that sugar out.
Okay. And add in some things that help you lower the blood sugar in your body, which is fiber.
Add more fiber so that your blood sugar can be regulated in your body. Move more, like we said.
Yep. Add in weight training.
Sleep more. And remember the water that we talked about in the other episode, 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. 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. Yes.
Because that typically can satiate that appetite that flares up. Why is there an increase in anxiety during PMS and menopause? Remember that sister, the progesterone sister? Yes.
She was a calming one. She was the one who was keeping you chillaxed and careful.
And she, when progesterone goes down, you don't have that chillaxer anymore.

You don't have someone to keep you calm.

Like that sister that was saying like, calm down.

It's okay, Mel.

Like, you know, 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 the night, you're like, oh my God, I can't believe X, Y, and Z happened.
And it starts a whole anxiety spiral. And a lot of women during menopause have crippling anxiety.
Does hormone replacement therapy tend to help with anxiety? Yes. Progesterone replacement.
Gotcha. I'm not sure I would know how to explain what a hormone is and what it does.
Yeah. There's so much confusion about hormones.
Hormones is a chemical messenger. So in my analogy of the highway, it's the car.
It's the car.

Oh. It travels from your brain or from your ovaries to wherever it needs to go.

It can go to the muscle.

It can go to the heart.

So it's a traveling message.

Our bodies cannot function without hormones.

Like people get so annoyed with hormones, but you cannot function without your hormones. Even cortisol.
Cortisol is a good hormone. It has to be balanced.
So what is the estrogen? Oh, I'm getting this now. So the fun party sister.
The social one. The social one is driving one car.
Yes. And when she arrives, it's time to party.
Yes. The progesterone sister is driving another car.
When she arrives, party's over. Yes.
And she calms everybody down. Like, let's just chillax now, guys.
Let's just, you know, tone it down. Is insulin a hormone? Insulin is a hormone.
Really? So when insulin gets in the car, what is insulin telling you? So insulin is telling you, open the door to let the glucose in. It's a storage signal, meaning that our body sends insulin out to say, hey, we need to store a little more glucose here because there's glucose coming in.
So it's a messenger. So people think, oh, thyroid hormone is just about 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.
Wow. So you can't just replace hormones and think that it's going to have one effect.
So for example, we see people getting high, high doses of thyroid hormone. And I say to people that more is not always better, right? Like, it's not just doing one thing, it's doing five different things.
And one of the things it's doing is it's going to the heart. And if you send too much thyroid hormone to the heart, you're going to have all kinds of problems, including arrhythmias, heart palpitations, people that are taking too high doses of thyroid hormone will have heart problems often.
It's like playing with fire. Wow.
So they're just kind of driving in the wrong directions or they're not arriving where they used to arrive. And that's what's making the changes.
So the hormones are the root cause of PMS and menopause. Yes.
Wow. And for some of the symptoms, hormone replacement therapy will alleviate symptoms.
But for other things like the fat redistribution or the losing muscle tone or the that you're going to have to make lifestyle changes.

So the other hormone that we didn't talk about,

but that's really important even in women,

is testosterone.

Really?

Testosterone is actually in higher levels,

like four times the level of estrogen or progesterone.

Like it's high.

In women?

Yes.

Really?

And we always think about testosterone

as like a male hormone, right? Of course, males have much higher levels of testosterone than women. But our testosterone is also high compared to our other hormones.
So testosterone is the sister. That doesn't live as close to the other sisters.
But testosterone is the leader. It's the muscular.
It's the aggressive, it's the leader sister. So we get a spike of testosterone at ovulation.
So if you know your cycle, roughly a week after your period is when your testosterone levels are peaking. That's when you want to build the most muscle.
That's when your libido will be the highest. Your confidence levels will be similar to the other gender.
People that take too much testosterone, for example, when they're taking a replacement and they go overboard, they'll be angry, aggressive, and maybe even a risk-taking behavior.

We know that testosterone can be good in small amounts,

especially for women during perimenopause

and during the cycle if you're lower than you need to be.

But of course, you don't want to overdo

and people overdo it all the time.

How do you figure out what to take?

Yeah, I know.

I know.

There's so much misinformation out there.

For example-

What are the big ones?

Yeah, give me some of the big myths.

Big example.

all.

The

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

For example, big example, the one thing that all doctors can agree about is that those pellets that people get are no good. I don't know what the hell a pellet is.
I've just heard about this. What the hell are pellets? So pellets are testosterone releasing, like extended release testosterone that they implant under the skin.
Okay. And it's supposed to release testosterone.
Yes. You keep this in there for months, okay, and you get it replaced.
And what's happening is that you can't adjust the levels, right? And most of these pellets are giving you super therapeutic levels.

And like I said, hormones are not something that you just want to add because they're doing a lot of other things besides maybe the one thing that you're targeting.

Okay.

And so why would you use an implantable testosterone that can't be titrated,

that usually releases too much?

Why would you do that?

And the answer is that you can charge. You can charge for testosterone pellets.
And when you do testosterone like a cream or an ingestible, it's not money in the pocket of the practitioner. And so I know there, 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. I am so glad you said this because another amazing person who uses pellets herself 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. Yeah.
So that you can make a choice for yourself. Yes.
Is it true that women of different races experience menopause differently? Yes. And the problem is, again, Mel, is that not only are we not educating our doctors or the population about menopause, we don't even know the differences between different backgrounds, different races, different ethnicities.
Because they're not studying it? They're just not studying it. I mean, we're just at the basic levels of finding out that women present differently with heart attacks than men.
And women will be shamed for symptoms that are actually real. Yes.
Because they just think, oh, she's just a complainer. Well, and then the other thing that I have really not appreciated is that there is an acknowledgement that you get foggier.
Yeah. And there's an acknowledgement that you will start to feel flabbier and start gaining weight in places that you've never had it before.
But there's no what to do. Yeah.
That it's sort of this, oh, well, yeah, me too. Or, 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? Yeah, that's a great question. I'll start with saying that we live in a society that has a problem with women getting older, right?

Like we basically have been told that if you don't fit into the societal ideals of young, you know, fertile women, that you're no longer worthy, you're no longer beautiful, that you're no longer wanted, that you're no longer smart and motivated. And I think that that's one of the biggest challenges that we are going to have to face in this next generation where we feel good even into our 40s and 50s.
And if we do the things that we're going to talk about, this could last till our 70s. And we can look younger and feel younger.
We already know the biological age, like our age of ourselves is completely different, 20 years different than our chronological age. So you're really just 35 right now.
Thank you. Thank you, which is why I'm pissed off that I have a dry vagina and I sweat at night and I feel like somebody's grandmother.
Exactly. So 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 go camping, go somewhere where there's no ambient light and there's no distractions in social media and see what time you sleep and wake up. I bet you you're not a night owl like you thought.
So you're gonna get an adequate night of sleep. You're gonna go get that sunlight in the morning.
So circadian biology, again, the light that you get in the morning tells every cell in your body that it's morning. And the benefit of that is that our hormones need that input.
If our hormones don't get input from our brains and our bodies that, hey, it's time to release now cortisol. Cortisol is high first thing in the morning.
Then it causes hormonal dysregulation, which is like how people say, oh, I feel so tired all day or adrenal fatigue, like I feel so burned out. It's not that the adrenals are burned out.
There's no such thing as adrenal burnout. Adrenal fatigue makes it sound like these adrenal glands get tired.
Yeah, they don't. No, it's this hormonal highway that we're talking about gets clogged.
It's not just adrenals, it's coming from the thyroid, it's coming from the brain, it's the whole traffic jam is happening because of all the other things, you know, the lifestyle, the age related hormone changes. So you want to retune those clocks, those clocks can get damaged if you don't tune if you misalign them so long, so many times.
Yeah. Like if you never get outside or you spend hours and hours and hours, like in the daytime inside.
Well, what I love about this, I think I'm just to kind of keep with the analogy because the visuals really helped me put it all together. It's almost as if the circadian rhythm and the sunlight in the morning is like the remote starter to your car.
Yes. Yes.
It's keeping those roads open and clean. So you can know, okay, it's time to drive.
Like everything's opened up. So you get the circadian rhythm.
If you start to damage those cars, you get these things called senescent cells. So the word is a very scientific word, but basically it means your cells become zombie cells and they no longer can work.
The car doesn't work, but the emissions from the car is inflammatory signals and aging. And all the things that come with aging is these cars that are broken down and they're sending off these inflammatory signals to your whole body.
That's the process of aging. We need to clean those cars up and get those out of there if they're not working, right? So just keeping with that analogy, that's we don't want senescent.
Senescent cells is the big area of anti-aging that we're trying to understand. Like, how do we clear those out faster? How do we not break down? So working out in the morning actually has been shown in studies to be the, not necessarily the only ideal time to work out, but the best time to stay with the routine.
So people are compliant with exercise when it happens in the morning. Well, it's common sense because your day doesn't hijack your energy and your time.
I see it over and over again, especially in women, because we are doing everything for everyone. Our mental load starts from the morning.
And so if you don't get that workout in, there's a big chance that you're not going to make time for it later because the kid needs a ride. Your husband needs you to be home.
You know, the meeting came up, somebody needs you to be somewhere. So get it done in the morning if possible.
There's a second peak time late afternoon. And late afternoon, 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.
High protein. 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 like 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. So that you don't spike your cortisol.
Exactly. Boom.
I'm getting this. I am getting this.
If you're someone who can do a meditation or a nap, the best time to do it is when your cortisol is naturally low, like 1 to 4 p.m. When your cortisol dips, it's a great time to either do a power nap, 20 minutes, do a meditation, do something calming.
Because remember, when your progesterone is dropping, you're likely more anxious, you're overwhelmed. It's a nice break from the day when you can do it.
Do something

that's very centering, prayer, whatever it is. I've heard what I think is probably a myth,

that if you just ride it out, just like three years, Mel, ride out the hot flashes, the dryness,

the bitchiness, all this stuff, the brain fog, and in three years, you'll just snap right back.

Is that true? Well, what happens is that your body just starts to get used to it. And so you're operating at a level that's just stable.
There's no squeezing of the toothpaste. There's nothing there.
Your body starts to accommodate. And so it's not that it's snapping back, but that the symptoms seem to go away.
A lot of the symptoms

that were really troublesome during 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, 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.
Okay. Wow.
Yet another thing to look forward to. Is there anything more that we should know about the increased risk of inflammatory diseases? So one of the big criticisms of hormone replacement therapy was that it would cause cancer.
But now we know that it's the opposite, that hormones actually protect us from a lot of these diseases, especially heart disease. And for women, it can actually be protective.
And then the right population of women, like very close to the start of menopause or perimenopause, the earlier you start it, the better risk protection you get from hormone replacement therapy. So what is the biggest myth around menopause? My biggest pet peeve about menopause is the fact that women feel shame around it and they can't have conversations with their doctors.
They often feel like they're marginalized and they're not listened to from their provider when they say, I don't feel right, feel tired, but I feel anxious. My sleep is off.
And they often get a prescription and no explanation about what's happening. I know countless women who've just come home with anti-anxiety medications and no one explained to them that there's a lot going on in your body that could explain why you're feeling this anxiety at this time.
And there are things that you can do. Not to say there's anything wrong with medications.
There's a great need for medications, but there's also a big need for education around menopause. I agree.
There is a huge need for education, not only around menopause, but also around women's hormonal health and cycles in general. And I consider myself to be a very well-educated person.
I'm intellectually curious. I read all the time.
And I have flunked this topic. And when I've gone to my doctor or to my OB-GYN, it feels like people are like, yeah, well, it's going to last till you're 60.
And, you know, you can do

hormones or, you know, whatever, you're gonna have to tolerate the weight gain. I hate that.
I think the term is like gaslighting, like, you know, medical gaslighting, where women just feel like they're not listened to, and their complaints are just dismissed. And I think that's something we really need to work on as a society.

Because like I said, age 40, age 50, age 60,

it's not that, oh, you're just worried. You're

just stressed. You're just getting old and dismissing their concerns.
These people are

running companies. They're leading countries.
We need to have conversations about what they

could be doing to optimize themselves at that level, not just saying, oh, well, you're just

getting old. So what would you advise any of us who feel like we are just not getting the answers from the doctors like that we're seeing? Do you just change your doctor? I mean, what do you do? I think in this day and age, we have enough physicians that are interested, educated, and can be an advocate for you that you should go seek that out.
Because I think that we're changing the conversation, not only within ourselves, but in the medical community of saying like, hey, listen, if a woman comes to you with these complaints, don't just write it off as separate things. Think about like, where is she in her cycles? Like, where is she with her hormones? And there's this big myth that in order to be considered in menopause or perimenopause, you must get your hormone levels checked because that's what you hear on the internet.
Menopause is not a diagnosis of hormone levels. It is a diagnosis of symptomology.
And the definition has nothing to do with the level of hormones. And so a lot of people spend thousands and thousands of dollars trying to get testing to figure out what their hormone levels are, but that's not necessarily the first place you need to go.
But when do you get your hormone levels tested? If you're getting replacement therapy and you're trying to troubleshoot something. But the diagnosis of menopause is not made through a lab test.
Well, that's one thing that we learned today, that the diagnosis of menopause is made after you have gone an entire year without menstruating. And there's a lot of misinformation.
There's a lack of research. And there's a lack of interest, to be honest.
And so I think that all of those things make menopause an area that is mismanaged, that is an area like if you look on the internet, and you look for supplements around PMS or menopause or hormones, it's a wild, wild west. Clearly, people are looking to alternative practitioners and online therapies for their hormonal concerns.
But when you see what's out there, it is very scary. And so that's a clear sign that women are looking for answers.
And so we need to have more information. Even the basic things like we talked about here, this should be basic education for all women.
Dr. Amy Shaw, I'm having you back to talk about circadian rhythm.
And I'm having you back to talk about the rhythm of the day. You are a freaking rock star.
The book is I'm So F-ing Tired, but we ain't so F'n Tired no more because Dr. Amy has given us simple things backed by profound science that you learned today that will help you take control of your hormone health so that you can live a much better life.
Thank you. Thank you.
Thank you. I cannot wait to have you back.
I'm so honored to be here, and I would love to. So before we go, I just want to remind you that I love you, I believe in you, and I believe in your ability to create a better life.
All right, I'll talk to you in a few days. What is that last word?

Thermogenesis?

Yes.

Non-activity?

Non-electric?

I can't keep up with it.

What is thermogenesis?

You're in fucking menopause, so your mind is going.

There we go.

Yeah, we'll talk about that later.

Do you want to say which hormones?

It is?

Okay, well then I would say what hormones.

Yeah, we'll definitely keep it in what hormones. I think that Diet Coke and the outside put a little life in sinus-infected Mel Robbins here.
Oh, and one more thing. And no, this is not a blooper.
This is the legal language. You know, what the lawyers write and what I need to read to you.
This podcast is presented solely for educational and entertainment purposes. I'm just your friend.

I am not a licensed therapist, and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good.
I'll see you in the next episode. Stitcher.
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