July 22, 2025 • 32 mins
Episode #214
This week, Terri is joined by Coach Amy Medling for a deep dive into the hormonal rollercoaster of perimenopause. Together, they unpack the changes that occur throughout a woman’s cycle during this transitional phase. Coach Amy offers empowering insights into what’s really happening behind the scenes—and shares practical strategies to help women support their bodies, find balance, and feel more in control during this often confusing time.
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Summary Timestamps
00:00 Intro
01:08 Intro to Coach Amy Medling
02:29 Defining perimenopause
03:09 The role of progesterone and oestrogen during perimenopause
04:59 Thyroid issues
05:24 Increases in cortisol and impact on progesterone
08:01 Daily habits that help soothe your nervous system
09:20 The role estrogen plays in insulin response
11:04 Do more of what brings you joy
12:01 Benefits of grounding and breath work
14:52 Drivers of inflammation and ways to cool it
19:45 Protein and fiber
21:18 Carb cycling to support the luteal phase of your cycle and thyroid function
27:52 Fasting during perimenopause
30:45 The importance of being gentle with yourself
Disclaimer
This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. You should always speak with your physician or other healthcare professional before doing any fasting, changing your diet, taking or adjusting any medication or supplements, or adopting any treatment for a health problem. The use of any other products or services purchased by you as a result of this podcast does not create a healthcare provider-patient relationship between you and any of the experts affiliated with this podcast. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
There's a lot that you can do by practicing
daily habits that soothe your nervous
system. So that's one really
important piece of the puzzle,
is to focus on
ways to soothe your nervous
system. I find that
women in perimenopause
(00:20):
can often feel like they're always
in overdrive.
I think a lot of women push themselves
to go, go, go, and this is a
time in life that we have to do
the best that we can do to sort of soothe
and regulate the stress response.
[music]
(00:43):
Welcome back to another episode of The Fasting
Method podcast.
This is Coach Terri Lance and I
am very excited to be joined today
by Coach Amy Medling.
Amy, in
getting us started today, I wondered if you
could just kind of tell us a little bit
about you and the work that you do
that is so relevant to this topic that
(01:04):
we're going to talk today about -
perimenopause.
Yeah. Well, thank you, Terri, so much for
having me on the podcast.
I'm really looking forward to this
conversation.
I'm a coach at The Fasting Method, and I
really work with women in all phases
of life, from their cycling years,
through perimenopause, menopause, and beyond.
And after spending over a decade
(01:27):
coaching women with PCOS, I really now
help clients navigate that
next phase of their hormonal
adventure - perimenopause
and menopause - really helping
clients work through those metabolic and
hormonal shifts that happen as
we age by using fasting
(01:47):
and lifestyle strategies
that we learn about at the Fasting Method.
But I think it would probably be a good
exercise to just kind of define what
perimenopause is before we get into
the remedies for it.
Absolutely. And, again, I
feel like this is such a great topic
for so many of our listeners, regardless
(02:10):
of what phase of their cycle
that they're in, because if
it's not currently happening for them,
it will or it has, and there's
so much value in knowing this information
that you're going to share.
So I'm a little bit of a blank slate here.
What do I need to know about perimenopause?
Well, I think it's important to know that it's
(02:31):
not a moment in time.
It's really a sequence of hormonal
events that can begin as early
as your mid to late 30s, and last anywhere
from two to twelve years before
your final menstrual period.
I think the average age is about 51
for that, but you certainly can
(02:51):
go longer. I'm 54 and I'm still
in perimenopause.
So it really varies for every
woman, but the process usually
begins with a drop in progesterone,
which can lead to symptoms in and
of itself, like trouble sleeping
and anxiety.
Progesterone is the calming
(03:13):
hormone, so as that depletes,
you will find yourself maybe being a little
more anxious and agitated.
But that drop in progesterone can also
lead to heavier periods.
And then that is followed by
kind of [unintelligible] fluctuating estrogen
and then, eventually, a more sustained
drop in estrogen, which can absolutely
(03:36):
affect insulin sensitivity and
metabolism. So if you haven't
had problems with weight gain
or blood sugar control in
your 20s and 30s, but then all of a sudden
it just hits you and you don't really
understand why you're gaining weight or
why you're having some of these
not-so-nice symptoms,
(03:57):
it's often because of that
drop in estrogen and that
low progesterone.
But also perimenopause begins
with that low progesterone and high estrogen
that can lead to estrogen dominance
(and we can talk about that as well), but
towards the end of perimenopause it
(04:18):
will end with low estrogen, and
with that low estrogen, impaired often
impaired insulin metabolism.
So that entire phase plus the first
few years of menopause, it
really is a critical window
for long-term health.
So if you're here at The Fasting
Method working on your health
(04:39):
with reducing your insulin resistance,
with fasting and refueling,
eating nutrient-dense foods, and working
on your sleep and stress reduction,
that is all going to go a very long
way to helping you improve
your symptoms and then also improve
your long-term health.
(05:00):
The other thing that kind of comes
hand in hand with these
perimenopause hormonal fluctuations
is also thyroid issues.
And while they aren't specifically
caused by perimenopause, they
often worsen and become more symptomatic
during this time, and often
(05:20):
it can be caused by high cortisol
levels.
So one of the other hormonal factors
in perimenopause is,
because progesterone is
lower, there is an
opportunity for increased cortisol.
And also there's
an opportunity-- it kind of goes hand in
(05:42):
hand-- we call it the 'cortisol steal.'
So at this stage of
life, life is stressful.
We have work, we have families,
we're balancing children and potentially
aging parents.
And as our cortisol levels
increase, cortisol depletes
progesterone even further because our body
(06:04):
prioritizes cortisol production.
And then this just creates this negative
feedback loop where low progesterone
leads to elevated cortisol, and it
further stresses reduced progesterone
levels. And as I mentioned, progesterone is
the calming hormone.
So we have nothing to-- you know, we
don't have that nice, calming hormone
(06:24):
to offset the stress hormone
cortisol.
But then that elevated cortisol
is also disruptive of
our thyroid.
It reduces conversion of
T4 to T3, which
is kind of our main, active thyroid
hormone. And it also increases
(06:45):
reverse T3 production.
So there's a disruption of thyroid
hormones as well.
So it's really important for women during this
transition to monitor their thyroid
health because you may need some intervention
at this stage of the game, and it will also
help with your symptoms.
So there's a lot of hormone disarray
(07:06):
going on.
I love that way of describing it.
I think when I'm working with clients or
talking with people in Community meetings
at TFM, I often talk about how it
may feel very unpredictable.
What worked well a couple of months ago
might not still be working the same way for
you because the landscape is shifting
(07:27):
a lot.
And then, Amy, I wonder, based on
all that you just described, I'm thinking
insulin in my mind as you're talking.
So as cortisol is increased
and other things being what they
are, less calming and things, what is
that doing to insulin?
And you know, I think that's part
(07:49):
of what many women talk
about struggling with during this time, is
what effect this has on insulin
sensitivity versus insulin
resistance.
Yeah. And I think if you're listening and
what I sort of described, this hormonal
situation, it can feel overwhelming.
(08:09):
But just breathe.
There's a lot that you can do to kind of
help your hormonal situation.
And I think the first step is
( and this is why I wanted to sort of set the
stage with what's going on) just becoming
aware of your hormonal patterns
and knowing that you have a lot of power
to make some shifts, especially with
(08:29):
insulin resistance.
And I think about it as kind of a
multi-pronged approach.
As you mentioned, about cortisol, as cortisol
elevates, insulin also
elevates and progesterone decreases.
There's a lot that you can do by practicing
daily habits that soothe your nervous
system. So that's one really
(08:51):
important piece of the puzzle,
is to focus on
ways to soothe your nervous
system.
I find that women in
perimenopause can often feel
like they're always in overdrive.
I think a lot of women push themselves
to go, go, go, and this is a
(09:13):
time in life that we have to do
the best that we can do to sort of soothe
and regulate the stress response.
So that's one way to increase
insulin sensitivity, that declining
estrogen or that wildly fluctuating
estrogen. Estrogen is such a protective factor
of insulin resistance.
(09:34):
And that's fluctuating, so you may
find that, you know, you're getting cravings
that are coming out of nowhere, that you're
more hungry, especially at certain times
of your cycle. If you've sort of been tracking
your cycle and how you feel during
your cycle, you might find that there's times
that you just are white-knuckling it through
(09:54):
fasting.
So kind of understanding that
estrogen plays a real role in
how insulin is responding
and kind of working more with your body
to support it during those fluctuations
is really important as well.
It's really helpful for me the way you just
described that, Amy, because I'm thinking
(10:16):
about, just kind of traditionally,
I think many women experience cravings
are up, especially maybe cravings
for sweets or desserts
or snack foods.
The hunger hormone is elevated
a bit, it seems, and so
experiencing more hunger.
And the way you describe it as there are
(10:37):
other, more effective ways to support
that hormonal picture
that's happening, rather than
going to those old fixes
of, "Well, you know, I can't help, but I'm
going to have to go get some chocolate," or
something, but to really see that
there are other ways to activate
calming to this system and
(10:59):
helping.
What are some of your favorite ways
to help calm the system?
I think it's as simple as doing more
of what brings you joy.
And I have learned that
oftentimes when I am craving
something sweet, I have to take
a pause and ask myself,
"What am I really craving here?
(11:21):
And how can I find
sweetness in non-food
ways?" So I have a little list
of things that bring me joy,
and I have it kind of mentally handy so
I can kind of run through it.
Do I need to go for a walk out in nature?
Do I need to just take a pause?
And I love to read, so
(11:42):
do I just need to pick up a book and spend
15 minutes without guilt
just reading, you know, a chapter of my book.
Can I call a friend and make
a connection?
So I have a list of things that
really bring me joy, that help to soothe
my stress response.
I am a big fan of grounding,
(12:04):
getting outside when I can, and,
now that the weather's nice and we're in
summer, put my feet in the grass,
or if I'm lucky enough to get to the beach,
and really ground myself
to the earth.
That reduces inflammation and
centers me and really helps to
calm my nervous system.
(12:25):
Breathwork.
You know, doing the box breathing (12:27):
breathe in
for four, hold it for four,
exhale for four, and then take another break
before you sort of go through that cycle
again.
That turns off-- takes me from
fight-or-flight when I'm feeling really
stressed into a more
calm state.
So having these little tips
(12:48):
and tricks to help soothe your nervous
system-- I will do
some vagus nerve activation, and we could talk
a bit more about that.
Humming or singing or some
cold exposure, that also really
helps to calm and soothe my nervous system.
I used to turn to sugar and
carbage to help numb me out
(13:09):
and calm me, but that just made my
health situation so much worse.
So I've had to learn tools and tricks
to find sweetness in non-food
ways and calm my nervous system.
We're going to have to come back and do a
whole other episode on the vagus nerve piece;
I love that you brought that in here.
I think it's so important to highlight
(13:31):
that these are actual things you can do at
home, that you don't need special equipment
for.
Yes, there are vagus nerve things you can do
in a practitioner's office and things, but
there's so much of this that you can do
without anything really (13:44):
humming,
singing, so many ways
to kind of activate that calming.
Because right now, as you highlighted,
those hormones aren't providing
that calming effect.
And so utilizing these other ways,
like you said, the cold exposure,
(14:04):
so many great things.
So thank you, Amy, for sharing those.
Just to reiterate that chronic stress, it
really does raise cortisol, which in turn
increases insulin resistance and worsens
inflammation.
The wonderful thing is you have it within your
power to learn to downshift that
nervous system.
And if you want to get through perimenopause
(14:26):
feeling well, this is foundational.
Downshifting your nervous system is really not
optional, so learn how to do that
and you'll have a much better
two to twelve years during this phase
of your life, and beyond.
So, Amy, you just talked about, I think, the
first kind of prong of what you described,
(14:46):
the second prong being cooling
inflammation. Can you say more about that?
Yeah. So we know that insulin resistance
really drives up inflammation, and
we've already kind of established that
women in perimenopause (because of the
hormonal situation) have elevated
insulin resistance.
Inflammation really
(15:08):
is a big driver of weight gain, fatigue,
mood issues, joint pain.
For a lot of those symptoms
during perimenopause, the root
causes can be more than just insulin
resistance, so looking at these
other areas of your life to cool inflammation.
So not only managing the insulin resistance
but poor sleep quality is a big
(15:30):
driver of inflammation.
And a lot of women experience
poor sleep quality at this stage
in life because of the lowering
progesterone.
Progesterone really helps with
sleep. And you know, it might
be as simple as talking to your doctor
about some bioidentical
(15:52):
progesterone therapy, whether it's
topical or oral; that can really
help with sleep quality.
We talk a lot about sleep here at
The Fasting Method.
We have group meetings about it, there's
resources.
Sleep, having high-quality sleep,
it's going to improve cortisol, it's going to
improve your insulin resistance.
(16:12):
So taking time to look at your
sleep hygiene and try to get
better sleep quality is going to help cool
that inflammation.
Stress again comes into this
pillar of managing perimenopause.
Elevated stress drives inflammation,
so cooling your stress levels
will cool inflammation.
(16:33):
The other important piece here
is looking at gut imbalances
or food intolerances.
Gut imbalances like SIBO, food
sensitivities like gluten,
dairy or histamine
intolerance, they can really drive
up inflammation.
So trying to identify
(16:55):
any issues that you have and treat
them, whether it's an elimination diet
to kind of figure out what's going wrong or
work with a functional practitioner
to find out what is going on with
your gut. It's really important to
cooling inflammation at this stage of the
game.
The other topic that I think is often
overlooked is environmental toxins
(17:18):
from plastics, pesticides,
personal care products.
These products can often
add to the estrogen dominance
issues and hormonal disarray,
because a lot of compounds and
plastics and pesticides and personal
care products can mimic estrogen,
(17:40):
bind to estrogen receptors, and
create problems.
So really looking at
living as clean as you can.
Don't microwave your food
in plastics.
Really be mindful of things that
have bisphenol A (or BPA)
in them, and then try to purchase
(18:00):
personal care products without
phthalates and parabens can really go
a long way to helping your hormonal
situation and cooling inflammation.
And then the last thing that I wanted to talk
about is probably not a very popular [laughs],
I guess, ask, but just to really
be mindful of the alcohol, especially
(18:22):
wine; it can really hit harder now
than ever. And I'm not saying you can never
have alcohol again.
It's just be more mindful of it.
It can really disrupt your gut microbiome.
It can affect your sleep.
If you start tracking your sleep
with an Oura ring or
other sleep tracker, you will most
(18:42):
likely be able to see a connection
with an evening that you've had a couple of
glasses of wine and your sleep quality
that evening.
And then, of course, if you're not sleeping
well, it's going to drive up inflammation
and cortisol and insulin
resistance over time.
So really being mindful of the alcohol you're
(19:03):
consuming; you just don't metabolize it as
well as you may have in earlier
years. So working to cool that
inflammation with stress reduction,
improving your gut health and your
sleep, and then your nourishment
too. And we can talk about that as
my sort of third pillar of
(19:23):
managing perimenopause.
Yeah. I'm curious just
to kind of hear more about how
to help nourish what our body needs
during this time, and it
may be different than what we have found
to be nourishing for our body in the other
stages. So what are some of the things
we should take into consideration?
(19:45):
I find that most clients that come
to me who are really struggling, especially
with appetite control, and
they're having a hard time fasting,
they are not eating enough protein.
And I think they are surprised
at the amount of protein that we
like to see women in perimenopause
(20:07):
trying to aim for - 100g
a day or more.
You know, I think 100g a day is a good goal
over two or three meals
to preserve their muscle and support
hormone production.
And you really need to combine that
with eating lots of healthy fats
and fibrous vegetables.
(20:28):
I thin fiber and fibrous
vegetables to help escort
used-up estrogen metabolites out
of the body are kind of underrated.
I don't think we hear enough about the
importance of those types of veggies.
The liver and our gut play a
huge role in metabolizing and eliminating
(20:48):
estrogen, so supporting
our liver and our gut through food
is really key.
So I think prioritizing
fiber and those fibrous vegetables
is really important.
Amy, I think I've also heard you talk before
about the value of exploring
(21:09):
how you utilize carbohydrates during
this time, how you use those as nourishing
the body.
I wondered if you could share something more
about that.
Yeah. So in my early days
of perimenopause, I was fasting
and refueling,
but I was doing it in a way that
worked when I was younger,
(21:31):
you know, in my 30s.
And as this hormonal
disarray started beginning
in these perimenopause years,
I found that I was having
a lot of cravings during that second
half of my cycle, that luteal phase
of my cycle.
I was able to really
(21:52):
fast well in
the estrogen or the follicular phase
of my cycle, but then
I was really having trouble during that
second phase of my cycle.
And I thought I was to blame (that I
just wasn't trying hard enough) until
I really understood the role that my
hormones were playing according to my cycle.
(22:14):
So as I loosened up
or turned down the fasting dial
(like Terri talks about on different
podcasts), I had to turn down the fasting
dial sometimes, especially
that week before my period, and know that
that was okay.
Tuning into my body
and what it needs.
(22:35):
It needed more nourishment during that time,
and I needed to eat more and kind
of replenish myself, and
do that without guilt.
And I also realized that I
needed some complex carbohydrates
during that second part of my cycle,
more so than I did in the first
(22:56):
phase. I mean, I'm always eating fibrous
vegetables and leafy greens.
I don't really count those as carbs,
but I do count root vegetables or
winter squashes or other carbohydrate
like quinoa.
I kind of refrain from those in the first part
of the cycle (I don't really feel like I need
them), but I have found that I
need some carbs in that second
(23:18):
half of the cycle to feel rooted and
grounded, and to avoid
leaning on more refined
carbohydrates and sugar.
So if I don't add those in, then I find
that I'm really craving carbs
that don't serve me well.
The other thing is that being a
woman with PCOS, my progesterone
(23:40):
level is already low.
So when you go into
perimenopause already low
in progesterone, you want
to make sure that you can do whatever you can
to support progesterone production,
and carbs actually support
progesterone production.
Glucose availability is really important
(24:00):
for the corpus luteum to produce adequate
progesterone, and if you're
really extremely restricting
carbs during the luteal phase, it may
suppress the progesterone
production and lead
to lower progesterone in that phase.
The other thing, too is if you are suffering
(24:22):
with thyroid function, especially
conversion of T4 to T3,
carbohydrates are necessary for that
conversion. So I think that
carb cycling during this
stage of the game, in that second half
of this cycle, can be helpful
for a lot of people.
(24:42):
I do want to say, too, that
everybody is different and you have
to know your body.
After the years of kind of working on my
insulin resistance, I am more metabolically
flexible than I was earlier
on in my journey, and my
body can tolerate root
vegetables like sweet potato or
(25:04):
beets.
You have to figure out what you can tolerate,
so it's not a blanket statement
that 'everybody needs carbs at this stage
of the game' in this luteal phase,
but it's an opportunity to experiment
to see how your body might respond.
Can you get through that second
half of your cycle with more ease
(25:25):
and less cravings and feeling
more stable?
Does it improve your sleep, and regulate your
mood, and reduce some PMS
symptoms if you add a little
bit of carbohydrate at this stage?
You have to experiment and it's not
going to be the same for everyone, but I
think it's important for people to kind of be
(25:46):
aware of that connection with
carbs and the support
of that luteal phase of your cycle.
I think that's so important to hear you
describe that, Amy, because I know so many
people who listen to this
podcast, or who are members at
TFM, focus on a lower-carbohydrate
(26:06):
approach, and to hear you
kind of describe that there are
ways of incorporating
certain carbohydrates in ways
that nourish us, that it's
not just a blanket statement of, "Yes, go
ahead and add whatever you want," but yours
are very targeted.
And the other piece that you really
(26:26):
highlighted is figuring out what works
for you. There is not one
right amount or which carbohydrates
are the right ones for anyone.
So I really appreciate the way you described
that, that this is an important time
to be exploring, "Do I need
to do some carbs cycling?
Do I need to find some whole-food
(26:48):
carbohydrates that can help nourish
me during this time?"
Yeah, and I think it's really adding carbs
strategically.
I would look at doing it in your last
meal to aid sleep and minimize
blood sugar disruption.
And also do not eat naked good carbs.
[laughs] Really pair
them with fat and fiber,
(27:10):
and even acid like
vinegar or lactic
acid. You could sort of have a little side
of sauerkraut, or some other fermented food,
or citric acid.
Those will all help to kind of buffer
that glucose response
when you're eating carbohydrates.
And of course, your protein and fat first.
(27:32):
Amy, you mentioned earlier kind of your own
experience of, at this
certain phase in your life, approaching
fasting and things the same way you had
previously. So I'm curious, during
perimenopause, how might women
look differently at fasting or approach
it differently to help support them during
this time?
(27:53):
Yeah, of course. So really in that follicular
phase (the first kind of 15
or so days of your cycle from
your period to ovulation), estrogen is
rising and insulin sensitivity
is better, and you can
typically fast more aggressively.
The food chatter really isn't there
(28:13):
as much.
I think this time frame
is a great time to go for your longer
fasts, do some extended fasting
or your alternate-day fasting.
It's just easier.
You kind of feel like you're in the flow and
it just comes very easily.
When you're approaching ovulation--
(28:34):
ovulation is a time when you need
a lot of nourishment and nutrients,
you know, to support ovulation, so maybe
a day or two of some
refueling time; two or three
meals a day with lots of protein,
fat, and fiber around that
stage. And then you can probably
(28:56):
get a little bit more fasting in as
you lead up to your
period. But as you go into that luteal
phase after ovulation, you
may notice your body is becoming more
and more insulin resistant.
I find for me, I can still fast
up to about a week before my period,
and then I become really hungry.
(29:18):
And it's funny, Terri, it's
a very subtle kind of
message, and I have to be really aware
that if I notice that I'm out and about
and I start convincing myself
that I can just drive through the Starbucks
line at 3 o'clock and get a latte,
and that would just be fine.
(29:39):
You know, I have to really monitor that
internal chatter and that hunger chatter,
and know that that's usually the insulin
talking and not Amy talking.
[laughs] And so that's when
I may need to dial back the fasting
dial. And it's a time
for me to be gentler with myself,
(29:59):
with just some time-restricted
eating, real, nutrient-dense
meals, adding in those healthy carbs
like we talked about (squash or
maybe some berries or sweet potatoes).
And this cyclical approach, I
find that it really honors my body
and it prevents me from being burnt out
from fasting and when I'm
(30:21):
white knuckling it through the whole month
like I did in my early 40s.
You know, just knowing that you're not failing
when fasting feels harder; it's
your hormones shifting and your strategy
just needs to shift with them.
You have such a good balancing way of
describing these things.
I could listen to you all day.
[laughs] You just have such a gentle way
(30:42):
of saying these things that I think we need to
hear.
I spent a good bit of my life beating
myself up for things that I felt
like I couldn't do, and it wasn't until I took
kind of a gentle, more partnering approach
with myself that things started
to shift with me.
It's been a long process, but I've realized
that being kind of my own cheerleader and
(31:04):
coach is what works for
me. We don't need to beat ourselves up,
but knowing that there's nothing wrong with
us, it's our hormones shifting, and
we need to just be aware of them
and honor it.
And I think with perimenopause,
it's really-- it's a season, and
it's not about pushing harder,
(31:25):
it's about tuning in.
And when you align with your body instead
of fighting it, when you partner
with it, then, it's so true, everything
really begins to shift in the right direction.
Yeah, everything you've shared here today
really is about how do I work with
my body during this time to support it?
Not fight it, not wrangle
(31:47):
it to do what I want it to do, but really
to support it. So I really appreciate
your approach to this.
Well, thank you so much for letting me be here
and sharing some of my insights
over the years of just going
through perimenopause myself and helping
hundreds of women do the same.
Absolutely.
Well, Amy, I am looking forward to having
(32:09):
you back on the podcast to continue talking
about hormonal health and lots of other
things that you bring to The Fasting Method,
so thank you for being here.
And thank you, everyone, for listening, and we
will be back next week with another episode.
Take good care, everyone.
[music]
There's a lot that you can do by practicing
daily habits that soothe your nervous
system. So that's one really
important piece of the puzzle,
is to focus on
ways to soothe your nervous
system. I find that
women in perimenopause
(00:20):
can often feel like they're always
in overdrive.
I think a lot of women push themselves
to go, go, go, and this is a
time in life that we have to do
the best that we can do to sort of soothe
and regulate the stress response.
[music]
(00:43):
Welcome back to another episode of The Fasting
Method podcast.
This is Coach Terri Lance and I
am very excited to be joined today
by Coach Amy Medling.
Amy, in
getting us started today, I wondered if you
could just kind of tell us a little bit
about you and the work that you do
that is so relevant to this topic that
(01:04):
we're going to talk today about -
perimenopause.
Yeah. Well, thank you, Terri, so much for
having me on the podcast.
I'm really looking forward to this
conversation.
I'm a coach at The Fasting Method, and I
really work with women in all phases
of life, from their cycling years,
through perimenopause, menopause, and beyond.
And after spending over a decade
(01:27):
coaching women with PCOS, I really now
help clients navigate that
next phase of their hormonal
adventure - perimenopause
and menopause - really helping
clients work through those metabolic and
hormonal shifts that happen as
we age by using fasting
(01:47):
and lifestyle strategies
that we learn about at the Fasting Method.
But I think it would probably be a good
exercise to just kind of define what
perimenopause is before we get into
the remedies for it.
Absolutely. And, again, I
feel like this is such a great topic
for so many of our listeners, regardless
(02:10):
of what phase of their cycle
that they're in, because if
it's not currently happening for them,
it will or it has, and there's
so much value in knowing this information
that you're going to share.
So I'm a little bit of a blank slate here.
What do I need to know about perimenopause?
Well, I think it's important to know that it's
(02:31):
not a moment in time.
It's really a sequence of hormonal
events that can begin as early
as your mid to late 30s, and last anywhere
from two to twelve years before
your final menstrual period.
I think the average age is about 51
for that, but you certainly can
(02:51):
go longer. I'm 54 and I'm still
in perimenopause.
So it really varies for every
woman, but the process usually
begins with a drop in progesterone,
which can lead to symptoms in and
of itself, like trouble sleeping
and anxiety.
Progesterone is the calming
(03:13):
hormone, so as that depletes,
you will find yourself maybe being a little
more anxious and agitated.
But that drop in progesterone can also
lead to heavier periods.
And then that is followed by
kind of [unintelligible] fluctuating estrogen
and then, eventually, a more sustained
drop in estrogen, which can absolutely
(03:36):
affect insulin sensitivity and
metabolism. So if you haven't
had problems with weight gain
or blood sugar control in
your 20s and 30s, but then all of a sudden
it just hits you and you don't really
understand why you're gaining weight or
why you're having some of these
not-so-nice symptoms,
(03:57):
it's often because of that
drop in estrogen and that
low progesterone.
But also perimenopause begins
with that low progesterone and high estrogen
that can lead to estrogen dominance
(and we can talk about that as well), but
towards the end of perimenopause it
(04:18):
will end with low estrogen, and
with that low estrogen, impaired often
impaired insulin metabolism.
So that entire phase plus the first
few years of menopause, it
really is a critical window
for long-term health.
So if you're here at The Fasting
Method working on your health
(04:39):
with reducing your insulin resistance,
with fasting and refueling,
eating nutrient-dense foods, and working
on your sleep and stress reduction,
that is all going to go a very long
way to helping you improve
your symptoms and then also improve
your long-term health.
(05:00):
The other thing that kind of comes
hand in hand with these
perimenopause hormonal fluctuations
is also thyroid issues.
And while they aren't specifically
caused by perimenopause, they
often worsen and become more symptomatic
during this time, and often
(05:20):
it can be caused by high cortisol
levels.
So one of the other hormonal factors
in perimenopause is,
because progesterone is
lower, there is an
opportunity for increased cortisol.
And also there's
an opportunity-- it kind of goes hand in
(05:42):
hand-- we call it the 'cortisol steal.'
So at this stage of
life, life is stressful.
We have work, we have families,
we're balancing children and potentially
aging parents.
And as our cortisol levels
increase, cortisol depletes
progesterone even further because our body
(06:04):
prioritizes cortisol production.
And then this just creates this negative
feedback loop where low progesterone
leads to elevated cortisol, and it
further stresses reduced progesterone
levels. And as I mentioned, progesterone is
the calming hormone.
So we have nothing to-- you know, we
don't have that nice, calming hormone
(06:24):
to offset the stress hormone
cortisol.
But then that elevated cortisol
is also disruptive of
our thyroid.
It reduces conversion of
T4 to T3, which
is kind of our main, active thyroid
hormone. And it also increases
(06:45):
reverse T3 production.
So there's a disruption of thyroid
hormones as well.
So it's really important for women during this
transition to monitor their thyroid
health because you may need some intervention
at this stage of the game, and it will also
help with your symptoms.
So there's a lot of hormone disarray
(07:06):
going on.
I love that way of describing it.
I think when I'm working with clients or
talking with people in Community meetings
at TFM, I often talk about how it
may feel very unpredictable.
What worked well a couple of months ago
might not still be working the same way for
you because the landscape is shifting
(07:27):
a lot.
And then, Amy, I wonder, based on
all that you just described, I'm thinking
insulin in my mind as you're talking.
So as cortisol is increased
and other things being what they
are, less calming and things, what is
that doing to insulin?
And you know, I think that's part
(07:49):
of what many women talk
about struggling with during this time, is
what effect this has on insulin
sensitivity versus insulin
resistance.
Yeah. And I think if you're listening and
what I sort of described, this hormonal
situation, it can feel overwhelming.
(08:09):
But just breathe.
There's a lot that you can do to kind of
help your hormonal situation.
And I think the first step is
( and this is why I wanted to sort of set the
stage with what's going on) just becoming
aware of your hormonal patterns
and knowing that you have a lot of power
to make some shifts, especially with
(08:29):
insulin resistance.
And I think about it as kind of a
multi-pronged approach.
As you mentioned, about cortisol, as cortisol
elevates, insulin also
elevates and progesterone decreases.
There's a lot that you can do by practicing
daily habits that soothe your nervous
system. So that's one really
(08:51):
important piece of the puzzle,
is to focus on
ways to soothe your nervous
system.
I find that women in
perimenopause can often feel
like they're always in overdrive.
I think a lot of women push themselves
to go, go, go, and this is a
(09:13):
time in life that we have to do
the best that we can do to sort of soothe
and regulate the stress response.
So that's one way to increase
insulin sensitivity, that declining
estrogen or that wildly fluctuating
estrogen. Estrogen is such a protective factor
of insulin resistance.
(09:34):
And that's fluctuating, so you may
find that, you know, you're getting cravings
that are coming out of nowhere, that you're
more hungry, especially at certain times
of your cycle. If you've sort of been tracking
your cycle and how you feel during
your cycle, you might find that there's times
that you just are white-knuckling it through
(09:54):
fasting.
So kind of understanding that
estrogen plays a real role in
how insulin is responding
and kind of working more with your body
to support it during those fluctuations
is really important as well.
It's really helpful for me the way you just
described that, Amy, because I'm thinking
(10:16):
about, just kind of traditionally,
I think many women experience cravings
are up, especially maybe cravings
for sweets or desserts
or snack foods.
The hunger hormone is elevated
a bit, it seems, and so
experiencing more hunger.
And the way you describe it as there are
(10:37):
other, more effective ways to support
that hormonal picture
that's happening, rather than
going to those old fixes
of, "Well, you know, I can't help, but I'm
going to have to go get some chocolate," or
something, but to really see that
there are other ways to activate
calming to this system and
(10:59):
helping.
What are some of your favorite ways
to help calm the system?
I think it's as simple as doing more
of what brings you joy.
And I have learned that
oftentimes when I am craving
something sweet, I have to take
a pause and ask myself,
"What am I really craving here?
(11:21):
And how can I find
sweetness in non-food
ways?" So I have a little list
of things that bring me joy,
and I have it kind of mentally handy so
I can kind of run through it.
Do I need to go for a walk out in nature?
Do I need to just take a pause?
And I love to read, so
(11:42):
do I just need to pick up a book and spend
15 minutes without guilt
just reading, you know, a chapter of my book.
Can I call a friend and make
a connection?
So I have a list of things that
really bring me joy, that help to soothe
my stress response.
I am a big fan of grounding,
(12:04):
getting outside when I can, and,
now that the weather's nice and we're in
summer, put my feet in the grass,
or if I'm lucky enough to get to the beach,
and really ground myself
to the earth.
That reduces inflammation and
centers me and really helps to
calm my nervous system.
(12:25):
Breathwork.
You know, doing the box breathing (12:27):
breathe in
for four, hold it for four,
exhale for four, and then take another break
before you sort of go through that cycle
again.
That turns off-- takes me from
fight-or-flight when I'm feeling really
stressed into a more
calm state.
So having these little tips
(12:48):
and tricks to help soothe your nervous
system-- I will do
some vagus nerve activation, and we could talk
a bit more about that.
Humming or singing or some
cold exposure, that also really
helps to calm and soothe my nervous system.
I used to turn to sugar and
carbage to help numb me out
(13:09):
and calm me, but that just made my
health situation so much worse.
So I've had to learn tools and tricks
to find sweetness in non-food
ways and calm my nervous system.
We're going to have to come back and do a
whole other episode on the vagus nerve piece;
I love that you brought that in here.
I think it's so important to highlight
(13:31):
that these are actual things you can do at
home, that you don't need special equipment
for.
Yes, there are vagus nerve things you can do
in a practitioner's office and things, but
there's so much of this that you can do
without anything really (13:44):
humming,
singing, so many ways
to kind of activate that calming.
Because right now, as you highlighted,
those hormones aren't providing
that calming effect.
And so utilizing these other ways,
like you said, the cold exposure,
(14:04):
so many great things.
So thank you, Amy, for sharing those.
Just to reiterate that chronic stress, it
really does raise cortisol, which in turn
increases insulin resistance and worsens
inflammation.
The wonderful thing is you have it within your
power to learn to downshift that
nervous system.
And if you want to get through perimenopause
(14:26):
feeling well, this is foundational.
Downshifting your nervous system is really not
optional, so learn how to do that
and you'll have a much better
two to twelve years during this phase
of your life, and beyond.
So, Amy, you just talked about, I think, the
first kind of prong of what you described,
(14:46):
the second prong being cooling
inflammation. Can you say more about that?
Yeah. So we know that insulin resistance
really drives up inflammation, and
we've already kind of established that
women in perimenopause (because of the
hormonal situation) have elevated
insulin resistance.
Inflammation really
(15:08):
is a big driver of weight gain, fatigue,
mood issues, joint pain.
For a lot of those symptoms
during perimenopause, the root
causes can be more than just insulin
resistance, so looking at these
other areas of your life to cool inflammation.
So not only managing the insulin resistance
but poor sleep quality is a big
(15:30):
driver of inflammation.
And a lot of women experience
poor sleep quality at this stage
in life because of the lowering
progesterone.
Progesterone really helps with
sleep. And you know, it might
be as simple as talking to your doctor
about some bioidentical
(15:52):
progesterone therapy, whether it's
topical or oral; that can really
help with sleep quality.
We talk a lot about sleep here at
The Fasting Method.
We have group meetings about it, there's
resources.
Sleep, having high-quality sleep,
it's going to improve cortisol, it's going to
improve your insulin resistance.
(16:12):
So taking time to look at your
sleep hygiene and try to get
better sleep quality is going to help cool
that inflammation.
Stress again comes into this
pillar of managing perimenopause.
Elevated stress drives inflammation,
so cooling your stress levels
will cool inflammation.
(16:33):
The other important piece here
is looking at gut imbalances
or food intolerances.
Gut imbalances like SIBO, food
sensitivities like gluten,
dairy or histamine
intolerance, they can really drive
up inflammation.
So trying to identify
(16:55):
any issues that you have and treat
them, whether it's an elimination diet
to kind of figure out what's going wrong or
work with a functional practitioner
to find out what is going on with
your gut. It's really important to
cooling inflammation at this stage of the
game.
The other topic that I think is often
overlooked is environmental toxins
(17:18):
from plastics, pesticides,
personal care products.
These products can often
add to the estrogen dominance
issues and hormonal disarray,
because a lot of compounds and
plastics and pesticides and personal
care products can mimic estrogen,
(17:40):
bind to estrogen receptors, and
create problems.
So really looking at
living as clean as you can.
Don't microwave your food
in plastics.
Really be mindful of things that
have bisphenol A (or BPA)
in them, and then try to purchase
(18:00):
personal care products without
phthalates and parabens can really go
a long way to helping your hormonal
situation and cooling inflammation.
And then the last thing that I wanted to talk
about is probably not a very popular [laughs],
I guess, ask, but just to really
be mindful of the alcohol, especially
(18:22):
wine; it can really hit harder now
than ever. And I'm not saying you can never
have alcohol again.
It's just be more mindful of it.
It can really disrupt your gut microbiome.
It can affect your sleep.
If you start tracking your sleep
with an Oura ring or
other sleep tracker, you will most
(18:42):
likely be able to see a connection
with an evening that you've had a couple of
glasses of wine and your sleep quality
that evening.
And then, of course, if you're not sleeping
well, it's going to drive up inflammation
and cortisol and insulin
resistance over time.
So really being mindful of the alcohol you're
(19:03):
consuming; you just don't metabolize it as
well as you may have in earlier
years. So working to cool that
inflammation with stress reduction,
improving your gut health and your
sleep, and then your nourishment
too. And we can talk about that as
my sort of third pillar of
(19:23):
managing perimenopause.
Yeah. I'm curious just
to kind of hear more about how
to help nourish what our body needs
during this time, and it
may be different than what we have found
to be nourishing for our body in the other
stages. So what are some of the things
we should take into consideration?
(19:45):
I find that most clients that come
to me who are really struggling, especially
with appetite control, and
they're having a hard time fasting,
they are not eating enough protein.
And I think they are surprised
at the amount of protein that we
like to see women in perimenopause
(20:07):
trying to aim for - 100g
a day or more.
You know, I think 100g a day is a good goal
over two or three meals
to preserve their muscle and support
hormone production.
And you really need to combine that
with eating lots of healthy fats
and fibrous vegetables.
(20:28):
I thin fiber and fibrous
vegetables to help escort
used-up estrogen metabolites out
of the body are kind of underrated.
I don't think we hear enough about the
importance of those types of veggies.
The liver and our gut play a
huge role in metabolizing and eliminating
(20:48):
estrogen, so supporting
our liver and our gut through food
is really key.
So I think prioritizing
fiber and those fibrous vegetables
is really important.
Amy, I think I've also heard you talk before
about the value of exploring
(21:09):
how you utilize carbohydrates during
this time, how you use those as nourishing
the body.
I wondered if you could share something more
about that.
Yeah. So in my early days
of perimenopause, I was fasting
and refueling,
but I was doing it in a way that
worked when I was younger,
(21:31):
you know, in my 30s.
And as this hormonal
disarray started beginning
in these perimenopause years,
I found that I was having
a lot of cravings during that second
half of my cycle, that luteal phase
of my cycle.
I was able to really
(21:52):
fast well in
the estrogen or the follicular phase
of my cycle, but then
I was really having trouble during that
second phase of my cycle.
And I thought I was to blame (that I
just wasn't trying hard enough) until
I really understood the role that my
hormones were playing according to my cycle.
(22:14):
So as I loosened up
or turned down the fasting dial
(like Terri talks about on different
podcasts), I had to turn down the fasting
dial sometimes, especially
that week before my period, and know that
that was okay.
Tuning into my body
and what it needs.
(22:35):
It needed more nourishment during that time,
and I needed to eat more and kind
of replenish myself, and
do that without guilt.
And I also realized that I
needed some complex carbohydrates
during that second part of my cycle,
more so than I did in the first
(22:56):
phase. I mean, I'm always eating fibrous
vegetables and leafy greens.
I don't really count those as carbs,
but I do count root vegetables or
winter squashes or other carbohydrate
like quinoa.
I kind of refrain from those in the first part
of the cycle (I don't really feel like I need
them), but I have found that I
need some carbs in that second
(23:18):
half of the cycle to feel rooted and
grounded, and to avoid
leaning on more refined
carbohydrates and sugar.
So if I don't add those in, then I find
that I'm really craving carbs
that don't serve me well.
The other thing is that being a
woman with PCOS, my progesterone
(23:40):
level is already low.
So when you go into
perimenopause already low
in progesterone, you want
to make sure that you can do whatever you can
to support progesterone production,
and carbs actually support
progesterone production.
Glucose availability is really important
(24:00):
for the corpus luteum to produce adequate
progesterone, and if you're
really extremely restricting
carbs during the luteal phase, it may
suppress the progesterone
production and lead
to lower progesterone in that phase.
The other thing, too is if you are suffering
(24:22):
with thyroid function, especially
conversion of T4 to T3,
carbohydrates are necessary for that
conversion. So I think that
carb cycling during this
stage of the game, in that second half
of this cycle, can be helpful
for a lot of people.
(24:42):
I do want to say, too, that
everybody is different and you have
to know your body.
After the years of kind of working on my
insulin resistance, I am more metabolically
flexible than I was earlier
on in my journey, and my
body can tolerate root
vegetables like sweet potato or
(25:04):
beets.
You have to figure out what you can tolerate,
so it's not a blanket statement
that 'everybody needs carbs at this stage
of the game' in this luteal phase,
but it's an opportunity to experiment
to see how your body might respond.
Can you get through that second
half of your cycle with more ease
(25:25):
and less cravings and feeling
more stable?
Does it improve your sleep, and regulate your
mood, and reduce some PMS
symptoms if you add a little
bit of carbohydrate at this stage?
You have to experiment and it's not
going to be the same for everyone, but I
think it's important for people to kind of be
(25:46):
aware of that connection with
carbs and the support
of that luteal phase of your cycle.
I think that's so important to hear you
describe that, Amy, because I know so many
people who listen to this
podcast, or who are members at
TFM, focus on a lower-carbohydrate
(26:06):
approach, and to hear you
kind of describe that there are
ways of incorporating
certain carbohydrates in ways
that nourish us, that it's
not just a blanket statement of, "Yes, go
ahead and add whatever you want," but yours
are very targeted.
And the other piece that you really
(26:26):
highlighted is figuring out what works
for you. There is not one
right amount or which carbohydrates
are the right ones for anyone.
So I really appreciate the way you described
that, that this is an important time
to be exploring, "Do I need
to do some carbs cycling?
Do I need to find some whole-food
(26:48):
carbohydrates that can help nourish
me during this time?"
Yeah, and I think it's really adding carbs
strategically.
I would look at doing it in your last
meal to aid sleep and minimize
blood sugar disruption.
And also do not eat naked good carbs.
[laughs] Really pair
them with fat and fiber,
(27:10):
and even acid like
vinegar or lactic
acid. You could sort of have a little side
of sauerkraut, or some other fermented food,
or citric acid.
Those will all help to kind of buffer
that glucose response
when you're eating carbohydrates.
And of course, your protein and fat first.
(27:32):
Amy, you mentioned earlier kind of your own
experience of, at this
certain phase in your life, approaching
fasting and things the same way you had
previously. So I'm curious, during
perimenopause, how might women
look differently at fasting or approach
it differently to help support them during
this time?
(27:53):
Yeah, of course. So really in that follicular
phase (the first kind of 15
or so days of your cycle from
your period to ovulation), estrogen is
rising and insulin sensitivity
is better, and you can
typically fast more aggressively.
The food chatter really isn't there
(28:13):
as much.
I think this time frame
is a great time to go for your longer
fasts, do some extended fasting
or your alternate-day fasting.
It's just easier.
You kind of feel like you're in the flow and
it just comes very easily.
When you're approaching ovulation--
(28:34):
ovulation is a time when you need
a lot of nourishment and nutrients,
you know, to support ovulation, so maybe
a day or two of some
refueling time; two or three
meals a day with lots of protein,
fat, and fiber around that
stage. And then you can probably
(28:56):
get a little bit more fasting in as
you lead up to your
period. But as you go into that luteal
phase after ovulation, you
may notice your body is becoming more
and more insulin resistant.
I find for me, I can still fast
up to about a week before my period,
and then I become really hungry.
(29:18):
And it's funny, Terri, it's
a very subtle kind of
message, and I have to be really aware
that if I notice that I'm out and about
and I start convincing myself
that I can just drive through the Starbucks
line at 3 o'clock and get a latte,
and that would just be fine.
(29:39):
You know, I have to really monitor that
internal chatter and that hunger chatter,
and know that that's usually the insulin
talking and not Amy talking.
[laughs] And so that's when
I may need to dial back the fasting
dial. And it's a time
for me to be gentler with myself,
(29:59):
with just some time-restricted
eating, real, nutrient-dense
meals, adding in those healthy carbs
like we talked about (squash or
maybe some berries or sweet potatoes).
And this cyclical approach, I
find that it really honors my body
and it prevents me from being burnt out
from fasting and when I'm
(30:21):
white knuckling it through the whole month
like I did in my early 40s.
You know, just knowing that you're not failing
when fasting feels harder; it's
your hormones shifting and your strategy
just needs to shift with them.
You have such a good balancing way of
describing these things.
I could listen to you all day.
[laughs] You just have such a gentle way
(30:42):
of saying these things that I think we need to
hear.
I spent a good bit of my life beating
myself up for things that I felt
like I couldn't do, and it wasn't until I took
kind of a gentle, more partnering approach
with myself that things started
to shift with me.
It's been a long process, but I've realized
that being kind of my own cheerleader and
(31:04):
coach is what works for
me. We don't need to beat ourselves up,
but knowing that there's nothing wrong with
us, it's our hormones shifting, and
we need to just be aware of them
and honor it.
And I think with perimenopause,
it's really-- it's a season, and
it's not about pushing harder,
(31:25):
it's about tuning in.
And when you align with your body instead
of fighting it, when you partner
with it, then, it's so true, everything
really begins to shift in the right direction.
Yeah, everything you've shared here today
really is about how do I work with
my body during this time to support it?
Not fight it, not wrangle
(31:47):
it to do what I want it to do, but really
to support it. So I really appreciate
your approach to this.
Well, thank you so much for letting me be here
and sharing some of my insights
over the years of just going
through perimenopause myself and helping
hundreds of women do the same.
Absolutely.
Well, Amy, I am looking forward to having
(32:09):
you back on the podcast to continue talking
about hormonal health and lots of other
things that you bring to The Fasting Method,
so thank you for being here.
And thank you, everyone, for listening, and we
will be back next week with another episode.
Take good care, everyone.
[music]
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