May 29, 2025 • 59 mins
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In this episode, I have a 360º degree discussion of menopause and how fluctuating hormones affect not just physical symptoms, but our entire wellbeing through an integrative functional medicine approach. Two experienced nurse practitioners with advanced training in functional medicine, Jane Snyder and Mary Ellen Francescani, share evidence-based strategies for navigating hormonal changes.
• Understanding the trio of female hormones - estrogen, progesterone and testosterone - and their far-reaching effects beyond reproductive function
• Perimenopause can begin up to 10 years before menopause, with wildly fluctuating hormone levels causing unpredictable symptoms
• Three nutritional foundations: eating real whole foods, increasing fiber to 45+ grams daily, and reassessing liquid intake (especially alcohol)
• The 80/20 approach to nutrition allows for enjoyment while maintaining healthy habits
• Quality sleep enables "hormonal housekeeping" and significantly impacts weight management
• Resistance training becomes crucial as muscle mass naturally declines after menopause
• Stress management techniques are essential during this often overwhelming life phase
• Menopausal weight gain (averaging 15 pounds) reflects physiological changes rather than personal failure
• Select supplements can help, but require individualized approaches and quality sourcing
• Finding an integrative practitioner who understands menopause can transform your experience
If you're struggling with sleep during perimenopause or menopause, check out Mary's program designed specifically for women in peri- to postmenopause: RESTored.
Click HERE to search for integrative practioners in your geographical area.
You can find out more about Jane and Mary Ellen HERE
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Mary (00:05):
Welcome to No Shrinking Violets.
I'm your host, Mary Rothwell,licensed therapist and certified
integrative mental healthpractitioner.
I've created a space where wecelebrate the intuition and
power of women who want to breakfree from limiting narratives.
We'll explore all realms ofwellness, what it means to take
up space unapologetically, andhow your essential nature is key
(00:28):
to living life on your terms.
It's time to own your space,trust your nature and flourish.
Let's dive in.
Hey, violets, welcome to theshow.
I feel like, as with nearlyanything in life, social media
has benefits and, for sure,drawbacks.
With social media, we get a tonof information.
(00:51):
But well, we get a ton ofinformation, most of which we
didn't ask for, and if you usesocial media, it can feel like
watering your garden with a firehose.
If you pay attention to how youfeel as you're scrolling, you
might recognize that your neckis tense or your stomach is
clenched.
Our brains aren't meant to takein and process information in
(01:13):
the way social media feeds it tous fast, based on what the
algorithm thinks.
We want words and sounds andimages and split screens, and
Okay, let me stop and reframe.
One advantage of social mediais that it helps us recognize
that we're not alone.
And for centuries, women goingthrough menopause felt like
(01:33):
surely no one else wasexperiencing what they were the
brain fog and the crazy hotflashes and the exhausting,
inability to get restful sleep,the waning sexual desire,
irritability and, to use aphrase my college students used
to say, existential angst.
Yes, they really used thosekinds of terms, because all of a
(01:54):
sudden we can feel likedifferent people, less relevant,
and again like we're the onlyones experiencing all the things
, because no one talked aboutthis type of personal stuff even
a couple decades ago.
I mean, yeah, maybe reallyclose friends did, but also
women were socialized and stillare to bear down and deal like
(02:18):
no complaints and no hysterics.
But now, finally, we're sharing, we're admitting how we feel
and we're finding that othershave similar experiences.
Social media, for better orworse, has redefined personal
sharing and private information.
Not a day goes by that I don'tsee some kind of ad for
(02:39):
something related to menopausesymptoms, but then there's the
flip side.
Not a day goes by that I don'thear something about menopause
symptoms, but then there's theflip side.
Not a day goes by that I don'thear something about menopause
and many people want you tobelieve that there's a quick fix
or a one-size-fits-all solutionto symptoms.
And here's where we get intothe weeds again, because, yes,
(02:59):
we all experience waningprogesterone and estrogen.
Our individual bodies reacttotally differently and respond
to interventions totallydifferently.
Honestly, that's one reason Idesigned my sleep program for
women in midlife.
It's built around nature, butit's tailored to each woman so
she can figure out what worksfor her, because we all have
(03:21):
similar experiences, but we'reall unique.
Because we all have similarexperiences, but we're all
unique.
So if you're a woman juststarting to experience the
changes brought on byfluctuating hormones, or you are
in the middle or even the tailend of menopause symptoms, I
think the information that myguests today will share is going
to help.
They are functional medicinepractitioners.
This means that they take afull 360 degree approach to
(03:45):
health, understanding howhormones impact our brain and
our mood, not just our weightgain, and how nutrition affects
the impact of waning hormones onweight gain, and how sleep is
crucial to effective managementof all aspects of health.
I invited them to talk with meso you have a starting point to
sift through all the insistentand sometimes conflicting
(04:07):
messages that you might begetting on or off social media,
and so you have a starting pointto take action or talk with
your own healthcare provider.
My guests today, jane Snyder andMary Ellen Franciscani, are
certified registered nursepractitioners.
Both Jane and Mary Ellencompleted an integrative
medicine fellowship at theUniversity of Arizona Center for
(04:29):
Integrative Medicine under DrAndrew Weil and have advanced
training through the Institutefor Functional Medicine.
Their clinical approach blendsconventional care with holistic
strategies to get to the root ofillness.
With holistic strategies to getto the root of illness, support
healing and promote long-termwellness.
And in 2024, Jane and MaryEllen co-founded Middle Way
(04:51):
Wellness, a direct primary carepractice that is a revolutionary
healthcare model, fostering amore personalized relationship
with their patients.
That emphasizes prevention andwellness through integrative and
functional medicine.
Welcome to no Shrinking Violets, Jane and Mary Ellen.
Jane (05:15):
Thank you, Mary.
We are so excited to be here.
This is a huge topic that welove talking about.
We're big fans of no ShrinkingViolets and we're really excited
to share this information withyour listeners today.
Mary (05:31):
Cool.
So after my very long intro,let's get to it.
So the world of hormones isreally complex.
I had to learn that a lot formyself just going through
menopause, and I swear that wehear balance your hormones all
the time and I know that that'sactually true, but it's also
(05:54):
really complex.
There's no quick fix.
So let's start with what arethe hormones that really impact
us the most as women as we getolder and what are some of the
changes that we might movethrough from peri to
postmenopause.
Jane (06:11):
Yeah, Mary, this is a great place to start and lay
some groundwork for ourconversation today.
You know most of us as womenrecognize that we have estrogen
and progesterone as our main sexhormones, but we also have
testosterone, that we haveestrogen and progesterone as our
main sex hormones, but we alsohave testosterone, just not in
(06:33):
levels that men have it.
And these three sex hormoneswork together synergistically
throughout the body, and I thinkmost of us as females really
recognize that.
They regulate our menstrualcycle every month or preparing
our body for a pregnancy, ifthat were to occur.
It also they help us withpregnancy and delivery.
But what many of us, I think,forget is that they work
throughout our body.
(06:54):
So, for example, estrogen hasover 400 different receptors in
our body, from our head to ourtoe.
So the estrogen is impactingour brain health, our
cardiovascular health, our hair,skin, our nails, our mucous
membranes.
So I really like to think ofour estrogen as more of a
lubricator, and I'm sure womenthat are listening in menopause
(07:16):
could attest to that.
I hear oftentimes that there's alot of drying up that happens
with menopause and that's reallyrelated to our estrogen, Now
our progesterone.
I really like to think of thata little bit differently and it
really impacts more of our bonehealth.
It helps to lower inflammationin our body and this is also the
(07:38):
hormone that oftentimes givesus trouble with sleep as we
enter menopause.
Testosterone is the third sexhormone and testosterone really
does a lot of the heavy liftingin our overall sense of
well-being, our confidence, ourmotivation, and also plays a big
role in our strength, buildingour muscles and, for most women,
(08:02):
it also really influences oursex drive Very good overview,
yeah, and I remember learningabout the complexity of this,
thinking that, okay, so estrogenand progesterone only really
impacted me during mypre-minstrel days.
Mary (08:18):
And then, when I started to recognize the role even
estrogen plays in brainprocessing of certain things, I
was like, wow, no wonder there'skind of this cascade.
And so for me, working inmental health, when women say
like I have these crazy moodswings, it's like well, yeah,
because perimenopause is reallywhen you're going to have a lot
(08:42):
of fluctuation right From monthto month before it kind of like
comes to a halt.
You're going to have a lot offluctuation in how those
hormones are impacting you andyour body.
Jane (08:56):
Yeah, absolutely, and I'm glad you brought up
perimenopause because I thinkthat that's also a confusing
time.
So if we, you know, go back towhen our hormones start kicking
in, that's also a confusing time.
So if we go back to when ourhormones start kicking in,
that's usually during pubertyand then throughout our
menstruating years, ourprogesterone and estrogen
they're just cycling on a 28-daycycle, so really they should be
(09:17):
going nice and up and downregularly.
You get your period.
But perimenopause is that timeframe that comes right before
menopause and what's happeningduring that time is our ovaries
are starting to do their ownthing.
So some months you may havesurges of your hormones, while
other months your ovaries arereally lazy and don't do a whole
(09:38):
heck of a lot.
And that's when women startexperiencing changes in their
menstrual cycles.
So they may skip periods, theymay become heavier, but that
resulting effect influences,like you were saying there, mary
, our mood and that feeling ofjust being unbalanced.
And that perimenopausal timeframe can happen up to 10 years
(10:00):
before actual menopause, withknowing that menopause happens
around the age of 52,perimenopause can start in your
early 40s.
So that's a really, really longperiod of time when women are
frustrated, not sure what to do,and a lot of times they're
being told that you know there'snothing going on with the
(10:20):
hormones, when in fact therereally is.
Mary (10:23):
Yes, and you know this is a topic for another day, but I
just want to kind of throw it inhere that when I approach this
issue with women, especiallywhen we're talking about sleep,
which is, of course, verycomplex a lot of women, as they
enter perimenopause, arestarting to have sleep issues,
and sometimes it's also just theaccumulation of life.
(10:44):
I think that all thatdovetailing at once like you're
in this phase of life where alot has probably happened you
might now be raising children,or you may have a new marriage,
or you might be coming out ofrelationships there's so much
that we store in our bodies andthen, when we start to have the
function of our physical body ontop of that, it does create a
(11:07):
situation where, I think, womencan feel so overwhelmed and
sometimes balance your hormones.
So is that a thing?
Can you balance your hormones?
(11:28):
And, if you can, what would besome of the keys to helping that
happen?
Mary Ellen (11:34):
That's a great question, mary.
We get that question a lot andwhile the phrase, as you said,
balancing your hormones isthrown around now a lot, like
you said, on social media andwellness spaces, the concept
itself is absolutely valid, butI want to just go into defining
it a little bit because I thinkthere's a lot of misconceptions
out there about what thatactually means.
(11:55):
So, backing up a little bitinto going back to biology,
hormones don't exist inisolation and I always explain
to patients they operate in adynamic network and I like to
think of them as an orchestra.
So during perimenopause, yourestrogen, progesterone and
testosterone are all over theplace Women come in complaining
(12:16):
of.
Often what I hear is inperimenopause, I just don't feel
like myself, and so I like touse the gas tank analogy.
So in perimenopause, as Janesaid, sometimes the tank runs
super low, but at other times,without any warning, it's
overflowing and once we get intopostmenopause, our levels of
estrogen, progesterone andtestosterone completely tank and
(12:39):
we have an empty tank.
And it's sudden, if you imaginethat orchestra analogy, and
suddenly you took away all theinstruments from the orchestra.
It's sudden, if you imaginethat orchestra analogy, and
suddenly you took away all theinstruments from the orchestra,
it's going to sound and feelvery different.
And yet, as women, what do wedo?
We keep going.
We keep caring for ourselves,for our children, often for our
parents.
That we're working full-timemany of us so it's a real thing,
(13:02):
but it hasn't really beenacknowledged.
So, while this is happeningphysiologically, what I want to
tell women who are to yourlisteners is that they do not
need to suffer through all ofthese symptoms like hot flashes
and brain fog and mood swingsand poor sleep and vaginal
dryness.
What we're really talking abouthere when we say balancing your
(13:23):
hormones is restoring someequilibrium in a way that
supports your quality of life.
That's what's really important.
So, from a conventionalstandpoint, this often means
considering hormone replacementtherapy, which isn't for
everyone, but when it's usedappropriately, especially within
the first 10 years of menopause, there's really strong evidence
(13:45):
that HRT is safe and effectivefor most women.
Unfortunately, as you probablywell know, due to some
misinformation of data from theWomen's Health Initiative, we
have an entire generation ofdoctors who have completely
forgotten how to prescribehormone therapy and patients who
are afraid of it, and it'sreally a travesty to women.
(14:06):
I myself was at a gynecologista number of years ago and asked
about HRT and I was told oh, wedon't do that anymore and that's
just not true.
So that's again a wholeseparate podcast, hrt.
But I did want to mention thatbecause it's really an important
piece From our perspective.
As an integrative practice, welike to take things further, and
(14:29):
so we're often looking at allof the other hormones in your
body, like insulin and cortisoland thyroid, and we know that
the way that we live, our diet,our lifestyle and everything
that we're doing on a dailybasis is literally interacting
with our hormones.
So there's a lot of back andforth and those things are
really important.
(14:49):
So when we work with people, Ireally I try to emphasize we're
not trying to get you back toyour 25-year-old self.
We're really trying to create asustainable balance that helps
you feel more like yourselfagain, and that's very different
for everyone.
Sometimes that includes hormonereplacement therapy, but
sometimes it will includeoptimizing sleep and stress and
(15:12):
nutrition and supplements, andin many cases it's both.
Mary (15:16):
Yeah, it's very, very complex and I'm glad you brought
up cortisol and insulin becauseall of those things are so
important, and again, this wouldbe a whole other episode.
But sugar, I mean we're findingsugar is one of the biggest
impactors that influences somany things we're going through,
including heart disease anddementia and all of those things
(15:39):
.
So I think simple things thatwe may also get into with our
next question, but simple thingslike adjusting your diet can
actually be and were for me,pretty impactful.
And you know, I think the otherthing that when you mention
hormone replacement therapy, Iknow for me I have a patch of
(16:00):
estradiol patch the lowest thatyou can have, but it really did
make a big impact for me.
And I think so often on my showI talk about nature and so if we
think about nature and how weevolved, we're living way longer
and really nature developsbeings to procreate in most
(16:21):
cases.
So we're now living so muchlonger past the point that we
can procreate.
So I think that you know, firstof all, our body is protecting
us.
If we would try to growchildren, I know at my age, if I
would try to grow a child, thatwouldn't be healthy for me.
So nature has this way of sortof changing us to keep us safe.
(16:46):
But I think too, with livinglonger I think we're starting to
really be able to see long-termwhat is the result, and it's
not.
I don't think it is hopeless.
I think things like brain fog,like our brains are made to have
plasticity.
So a lot of these things we doend up sort of compensating, but
(17:07):
I think, getting that comfortwith knowing that we're not
going to look like we did, andit doesn't matter what input you
use, you're just aging, and soI think one of the basic things
is finding a comfort with that,because our bodies do change and
they don't look the same.
(17:28):
But I want to circle back aroundto this idea of diet because I
think we downplay it, and youbrought up a good point that the
diet in America is one of theworst diets in the world.
In fact it's called the SADdiet right, the Standard
American Diet, the world.
In fact it's called the SADdiet right, the Standard
American Diet, and I thinkthat's a really accurate acronym
because it's built around themost unhealthy things and we've
(17:51):
also, I think, put a framearound things that are actually
healthy, that we've been toldhistorically are unhealthy
things like fats and again,that's not simple because
there's a buffet of fats, right,there's different types of fat.
So I don't know how detailedyou want to get, but I would
love if you would talk a littlebit about how can we utilize
(18:15):
dietary inputs, or what roledoes diet play in that quest to
kind of support our hormonehealth.
Jane (18:23):
Yeah, nutrition is huge in hormonal health, as it is with
all other, you know staying welland chronic diseases in our
body.
So I'm glad that you brought upthis question and we talk about
nutrition every single day toall of our patients.
It's something that we werereally passionate about and we
love and, as you mentioned, it'svery nuanced and, I think,
(18:45):
individual, but overall, youknow what putting into our body
or what we're not putting intoour body affects how our
hormones rise and how they drop.
So they influence not only ourproduction of our hormones, but
nutrition affects how our bodymetabolizes and utilizes our
(19:06):
hormones and also get rid ofhormones or detoxifying.
So all of those processes haveto work well to have quote
unquote the balance of hormones.
Many times I work with women andtheir issues aren't necessarily
that they don't have enoughhormones.
It may be that they're notclearing them appropriately, and
(19:29):
this is how we really start toindividualize nutrition for
women.
Oftentimes, when we're workingwith women, we're testing their
hormones, we're assessing theirimbalancing and tailoring very
specific nutritionalrecommendations for them.
However, I think that there'sdefinitely some baseline,
(19:50):
foundational recommendationsthat we can talk about today,
and I thought about this andcame up with, I would say three
top ones that we're repeatingover and over and over again to
women, regardless of what theirindividual assessment shows.
So number one is eating realfood.
(20:12):
So what I mean by that iseating food as naturally as it
has come from the ground, orthat tree or the fish or the
bison, or that tree or the fishor the bison.
So in doing so, oftentimes thatmeans we're preparing more of
(20:33):
our foods at home.
We often throw around the termprocessed foods, but what that
means is we take the food fromthe ground, from the cow, and
then it's manipulated to be putinto a package.
So we really want to work ongetting away from those packaged
foods and eating real foods.
One of the tips that I talk towomen about is working around
(20:54):
the outside of the grocery store.
So if you think about yourgrocery store, oftentimes if
you're just staying on theoutside of it, that's going to
be where most of your produce is.
Things that you pick up likefresh bell peppers come to mind.
Or you're going through themeat aisle and you see chicken
and fresh fish there.
(21:16):
Now I understand and I'm withyou.
I can't just only shop on theoutside of the grocery store.
I do have to go into the middleand that's where those packaged
foods lay.
And what I would recommend youdo next time you're going into
those aisles is pick up thatpackage and look at the back.
(21:37):
So I want you to look at thatingredient list.
I think we're so used to justlooking at the front.
I think we're so used to justlooking at the front, seeing a
marketing ploy you know this isgluten-free, low-fat and
throwing it into our cart.
But I really encourage you tolook at the back of the
ingredients and if there'ssomething in the ingredients
(22:02):
that you have a hard timepronouncing or grandma would
have no idea what that is thinktwice about throwing that into
your grocery cart.
So eating real food, preparingit from how it comes from the
earth.
Number two is increasing ourfiber.
So a lot of different resourcesrecommend fiber ranging from
(22:22):
about 30 to 50 grams per day,and I really aim on that higher
side for women, especiallymenopausal, aiming for over 45
grams per day.
Now, that's actually a lot offiber and, as you mentioned,
mary, the standard American diethas very, very little fiber in
it.
So we have to be reallyintentional about this and I
(22:43):
think some of the ways I do.
That is encouraging women tostart ramping up their fruit and
vegetable intake, aiming forabout nine servings per day.
That's where we get a lot ofthe fiber in our fruits and
vegetables, especially with theskin.
So making sure you're eatingthe apple with the skin.
On the other area where we geta lot of fiber is in our ancient
(23:06):
grains.
So moving from those processedcarbohydrates so like the box
pastas, white bread, crackers,and moving to the ancient grains
so things like farro, barley,quinoa those are just going to
be packed with way morenutrients outside of even the
increase in the fiber in those.
(23:28):
And number three, foundationally, is looking at your liquids
that you're putting into yourbody.
So it becomes more and moreimportant to make sure that
you're hydrating with water.
As you get older, as we age,our thirst mechanism starts to
decline naturally, so it becomesmore of a habit versus just
(23:49):
relying on your thirst mechanismto kick in to tell you that you
need to drink water.
So making sure that you'rereally getting one of those nice
big 32-ounce mugs and goingthrough a couple of those
throughout the day.
Now, while you're increasingyour water, I also recommend
looking at well, what are theother sources of fluids you're
(24:09):
taking in, so really assessingif you're having those
sugar-sweetened beverages.
So where are you getting yourmorning coffee or latte?
Is there sugar added to that?
Any sodas, things like that?
Starting to remove those fromyour daily habits?
And the last thing I'll mention, with liquids I may get
(24:30):
something thrown at me here or Imay get booed, but it's talking
a little bit about alcohol.
I really have found so manywomen that feel so much better
from a brain perspective, from asleep perspective, if they cut
out or significantly reducetheir alcohol intake, and I
(24:51):
think that this really starts tohappen organically for most
women.
I talk to so many that come inand they're in their forties and
they say to me Jane, you know,I just can't tolerate alcohol
like I used to If I have one ortwo glasses of wine with my
dinner, I feel like I did when Iwoke up with a hangover when I
went out in college the nextmorning, like what's going on,
(25:14):
and so there is something realto that that our body is just
not metabolizing and getting ridof it like we used to when we
were younger.
So I really encourage you toexamine your alcohol intake and
maybe just do a trial of a monthwithout it and see how you feel
intake and maybe just do atrial of a month without it and
(25:34):
see how you feel.
So, really, those foundationalrecommendations would be to eat
real food, increase your fiberto over 45 grams a day and then
assess your liquids, hydratingand starting to remove some of
those sugar beverages or alcohol.
Mary (25:48):
Those are great guideposts , you know, and a couple
comments, as you were talking.
So the first I will addressbecause this was what you most
recently said this idea ofcutting back on alcohol, I think
brings up a bigger issue.
And this isn't saying, oh, youhave to have alcohol, but I
think in our society, again withfood, it's so built around food
(26:11):
and drink as a celebratorything.
I mean, what's one of thethings you often suggest?
Let's go out to dinner, andpart of that tends to be, you
know, there might be a mixeddrink menu that has, you know,
something that sounds delicious.
So I think it can bring up abigger issue for women at this
time of life and it's like, do Ihave to really give up another
(26:33):
thing?
And I think there are waysaround it.
And so one of the things Iwould say about alcohol and I am
one of those people that Icannot tolerate it and I never
really was a drinker, but myhusband makes craft beer, so we
enjoy going to different placesand testing or tasting craft
beers.
And it's now we're to the point, because he's a pretty
(26:56):
supportive partner we will splita 16 ounce beer and the other
thing is have it earlier in theday.
I think when we're talking aboutdiet, what can be hard is if
you focus on what you're notsupposed to do.
I think it can be reallydiscouraging and overwhelming.
So I would say, with what Janejust said look at what can you
(27:18):
add.
Start by adding some of thesethings instead of feeling like,
oh, my, okay, so now I have tostop eating white bread, I have
to stop eating pasta.
Look at how can you cut backand put something else in its
place, because I think thatmakes it feel a little more
doable.
And the other thing is becauseright now I'm working through an
integrative nutrition class andI know one of the guidelines I
(27:41):
learned that really helped mewas try to have fat, fiber,
protein in each thing you eat,and that really helps me kind of
think about okay, so I'm goingto have, you know, not just
dinner, but I'm going to havethis little snack.
How can I have a little bit ofeach of those things?
And finally, I'm going to go tosomething that Jane has said to
(28:02):
me often, which I love, is the8020 rule.
And Jane, can you explain thatin your words?
Because I fall back on that sooften and it makes me feel
actually kind of empowered and alittle relieved when I'm making
dietary choices.
Jane (28:18):
Yeah, absolutely, and everything you just said there I
completely agree with.
I love the idea and we do thisa lot is what do we want to add
into your nutrition, versus justnecessarily removing lots of
things, and then it becomes moreof an organic way of eating.
So you're adding things in andyou naturally will start cutting
(28:38):
things out on your own.
But the 80-20 rule is somethingthat I live by and I talk to so
many people about, and when youapply it to nutrition, what it
means is that 80% of the timeyou are really mindfully eating,
being aware of what you'reputting in your body, following
(29:00):
some of these recommendationsand sticking to that.
But we also build 20% into itfor the things that you enjoy.
20% into it for the things thatyou enjoy.
So I know that it's really hardfor someone to go gung-ho,
strict on a diet and after threedays I'm like I'm going to give
(29:20):
that up.
I don't want to continue.
I am just for me.
I love a slice of pizza, so Ibuild that into my 20%.
So for other people like maybeyour husband, mary, his craft
beer, maybe for him that's his20%, so you can pick and choose.
But 80% of the time you'rereally being mindful and
following your eating plan butbuilding in that 20% so that way
(29:44):
you're able to go out to dinnerwith your girlfriends and have
that appetizer and have thatglass of wine, but you know, the
next day you're just jumpingback into your 80%.
So it's a really big mind shiftaround.
You know, not shaming yourselffor quote falling off the wagon,
you're building it in and it'spart of your eating plan.
Mary (30:07):
Well, and you brought up a key at the end there, which is
shame, and I think women have somuch shame around food.
I can't tell you how often Ihave friends, but also a lot of
my clients say I was bad today,like you're not.
You're not bad for indulgingsomething Because, again, we are
surrounded in this country bysugar and you know it also and
(30:31):
again I'm going to say this fora third time, this could be
another episode but what thatdoes in our body and our brain
and how it mimics certainneurotransmitters to make us
feel good, it's a sugar high andwe joke about that, but it's
not really a joke.
So I think it's difficult tomake these changes.
So when you can put a frame onit, that not only gives you a
(30:53):
concrete way to start to do someof these things, but it also
gives you kind of that releasevalve.
So I'm not going to lie if wego out to dinner and there's
chocolate cake on the dessertmenu, both my husband and I are
like that's our 20%, because youknow it's very relieving to be
able to enjoy something and Ithink it makes us more mindful
(31:15):
too when we have something.
It's not like when I was younger, I would have a bowl of
chocolate on my desk, you know,for my students.
But of course midday I'mopening three of those little
Hershey's miniatures and thatkind of thing adds up.
So I think it just makes youmore mindful about your choices
(31:37):
and I think, as we've built morethings into our dietary plan
for the week, it's actually beenkind of fun, like there's been
so many things that we now eatthat either I didn't even know
about or are actually way moredelicious than I would have ever
thought.
So a lot of it is preparation.
(31:58):
But you know, I'm thinkingmaybe in the future you could
come back and we could all do awhole program on diet.
But let's move on from that,because one of the things that I
also wanted to talk aboutbeyond diet, because really it's
a whole lifestyle thing.
So what role do some otherthings in our life play in
(32:19):
supporting hormone health?
So things like sleep and stressmanagement, movement, all of
that kind of stuff.
Mary Ellen (32:25):
Sure Also a great question.
I think lifestyle is just, it'snot just supportive.
We think of that at Middlewayin our practice as sort of the
foundation.
So we have to get thatfoundation set first before we,
you know, even begin.
So I like to think of lifestylething, mary, in terms of
pillars, and I always tell folks, you know, you can't supplement
(32:47):
or medicate your way out ofpoor sleep or high stress or a
sedentary lifestyle.
So hormones function as part ofthat orchestra that I talked
about and they respond andinteract with actually how we
live.
So, in other words, ourlifestyle and how we're sleeping
and moving or not moving andstressing it's going to modulate
(33:08):
our hormones.
So let's first talk about sleep.
That's my favorite topic.
Sleep is a super important timeand when you're sleeping your
body does what I call thehormonal housekeeping.
So during deep sleep, the brainand your endocrine system they
coordinate and sort of worktogether with these feedback
loops to help regulate yourestrogen progesterone, with
(33:31):
these feedback loops to helpregulate your estrogen
progesterone and your cortisolinsulin and even your thyroid
function.
So getting poor sleep is, youknow, a lot of folks think it's
not that big of a deal, but it'sactually a really huge deal and
a lot of my perimenopausal andmenopausal women have the three
or 4 am awakening and they neverquite go back to sleep and they
brush it off, but it's I alwaystry to point out to them it's a
(33:52):
big deal.
So when that is happening,we're raising our cortisol
levels, our stress hormones,which raises our insulin and
that increases inflammation inour body and when that happens
there's a ripple effect.
We get more hot flashes, moresugar cravings, more mood swings
and that dreaded mided,mid-section weight gain.
So sleep is incrediblyimportant and I often start with
(34:16):
sleep before anything else,because if we can get that in
place we can start to build thefoundations.
The second pillar that I focuson is movement.
So, again, really important.
I really focus on resistancetraining and daily walking or
just moving.
I don't like to use the wordexercise because it intimidates
people.
I've really focused onresistance training and daily
walking or just moving.
I don't like to use the wordexercise because it intimidates
people, I just talk about movingyour body.
(34:37):
So strength training, we know,is a really good tool because it
helps preserve those muscles.
Our lean muscle mass and ourmuscles decline after menopause
and when that happens again wehave that increase in insulin
sensitivity, our bone densitygoes down and our cognitive
function and mood go down.
So preserving and actuallybuilding muscle is something
(35:00):
that we really work on.
Here we focus a lot less on theactual number on the scale and
more on the muscle mass.
We have ways of measuring thathere.
And then finally, another hugeone, another huge pillar is
stress.
So, as I sort of referred tobefore, women in perimenopause
and menopause, which often is inyour 40s and your 50s, are
(35:23):
often under tremendous amountsof stress due to work and family
and really being in thatsandwich generation where you're
taking care of your kids butyou're also taking care of your
parents and there's just so manydemands on women and, as I said
before, most women's naturalgo-to is to just keep on going
despite all of this.
So when we have this immensestress on us, it elevates our
(35:47):
cortisol and again it has thatdownstream effect of throwing
off our progesterone, estrogenand our insulin sensitivity and
we end up with this perfectstorm where we feel fatigued,
anxious, we have weight gain andsleep disruption, and so we try
to teach here a lot of reallybasic, simple mindfulness tools
(36:07):
like breath work.
We encourage people to go totherapy and talk to people like
you, mary, and I personallyreally try to get my patients.
I actually give themassignments to find some joy,
whatever that is for them todance in the kitchen, to sing,
but to find joy because it'sessential.
And these techniques you can dothem at home and you can do
(36:28):
them on your own time, andthey're simple and they're free
and they can really help balancethat stress response that we
have.
Having said all those things,mary, I want to say this really
loud and clear to everyonelistening, because it's one of
my pet peeves is that I thinkperimenopause and menopause is a
time of overwhelm, for all thereasons that I mentioned.
(36:48):
And while I'm absolutelythrilled that all of these
online content creators areeducating people about this,
getting the message out aboutmenopause, as you said in the
beginning, you're hearing aboutit every day and every time you
open your phone and I think it'soverwhelmed and I think a lot
of women feel a lot of shamebecause they're trying to, like
(37:09):
you said, do it all and if theydon't get to the gym, they shame
themselves for doing that.
And what I tell all of my womenis that really try to limit
your time.
I will teach you the tools thatyou need, but really small
changes matter and make adifference.
So trying to turn off that firehose and just have a slow
(37:30):
trickle of small changes andslowly build, that's what works
long-term, and anything otherthan that is.
I feel counterproductive towomen and really sort of
sabotaging this whole movement,which I call the menopause
movement, which I think is longoverdue.
Menopause medicine is somethingthat we really need to bring
online here.
Mary (37:51):
Well, I'm glad that you put it in that context.
First of all, the fact that youbrought joy in joy into the
equation is really cool, and Ithink, too, you're right that we
tend to really put a lot ofpressure on ourselves, that you
know I should be doing better orI should be able to figure this
out, but I know for myself that, had I not had Jane to help me
(38:15):
navigate some of this, it'sreally really crazy that there's
always someone saying do this,do that.
And I know from what I learnedfrom myself and my own research
that it is so specific to eachindividual woman and I hadn't
really intended to talk as muchabout this, but the sleep course
(38:36):
that I built has every singlething you just talked about and
it is online, but there's groupcoaching as part of the support
system for it, but it walkswomen through very, very simple
changes over four weeks and itstarts simply with circadian
rhythm, like getting your bodyadjusted to nature, like when it
(38:58):
gets dark, when it gets light,and it starts that simply.
And I think the other thingthat you mentioned is this
weight gain, and I probably seethat more than anything, and I
know for me that has been themost frustrating part of
menopause is the weight gain.
And when you talk about sleepwith weight gain, I remember
(39:20):
when I first read that sleepimpacts weight gain, I'm like
how in the world?
And then, when I started tolearn the role of the
hypothalamus and the role ofghrelin and leptin, learn the
role of the hypothalamus and therole of ghrelin and leptin and
all of those.
There are other hormones thatwork with our sleep cycle and
our ability to manage hunger.
It's very I mean, I've saidthis a lot it's so complex when
(39:50):
you start to think about howhormones work that when people
say you just have to do this onething, it's just not true and
there are things that may workfor your friend and there are
other things that won't work foryou or her.
So it's really trying to takeit down to the most basic things
and getting your body adjustedto what we've always used to
(40:12):
make us sleepy and wake us up,and that's the sun and the
darkness, and simply focusing onfoods that are real and moving
your body in ways that don'thave to be running a marathon.
You already mentioned a fewthings.
Is there anything else thatmight be helpful in managing
(40:35):
some of that specific symptom?
Mary Ellen (40:38):
Yeah, that's a whole podcast, I think, in and of
itself.
But yeah, the weight gain, mary, you are right, it's a really
hot topic and it's very chargedfor most people and the average
weight gain in menopause is 15pounds.
So that's a charged for mostpeople and the average weight
gain in menopause is 15 pounds.
So that's a lot for some people.
And what I really the firstthing I try to do when we're
(40:59):
talking about this topic is helpwomen understand that it is not
that they are suddenly doingsomething wrong.
Their body has drasticallychanged.
As I talked about earlier, thegas tank has been emptied and
what used to work for them issuddenly not working anymore.
But the playing field haschanged.
So we really have to change ourstrategy.
(41:19):
Just briefly to talk aboutwhat's happening and why it's
happening as our estrogendeclines, our fat distribution
changes and unfortunately, thefat changes to grow more in the
visceral adiposity, which is thefat around your organs, which
generally is in your abdominalarea.
So at the same time the fatdistribution is changing, the
(41:41):
muscle mass begins to declinewith that loss of estrogen.
So we develop something calledsarcopenia and when you have
that, your metabolic rate, yourresting metabolic rate, gets
lowered and this contributes toinflammation and insulin
resistance.
So this combination not onlyalters the number on the scale,
it changes everything about ourbody and our body composition.
(42:03):
So we really here focus muchmore here on body composition
rather than on weight.
We use a machine here calledthe InBody which gives patients
this information.
So we try to focus more onmuscle mass and body fat
percentage rather than theactual number, and if the actual
number on the scale goes down,that's a great side effect.
(42:25):
But we're really focusing moreon the muscle mass.
So in terms of what can be done,there are always lots of things
that can be done.
The anti-inflammatory nutritiondiet that Jane talked about and
eating whole foods is somethingwe're always going to counsel
on.
The resistance training that Imentioned before and building
that muscle is going to besomething that we always focus
(42:48):
on.
We're always getting our womenhere to wear weighted vests here
at Middleway to help build thatmuscle mass without really
having to think about it toomuch.
Sometimes we usetime-restricted eating and
fasting.
That can be done for women.
Again, it's very individualdepending on what's going on
with the person, and then thesleep and stress management are
really non-negotiables.
So there's lots to do do I havepatients who want to do all the
(43:11):
things and again, I really Itry to encourage them that we
are not.
The goal is not to get back toyour body when you were 25 years
old.
Um, that's just not realisticand you know we really don't.
We haven't focused a lot onthis podcast about the the
positives of menopause, but I'min menopause and I can say
there's I've made it throughperimenopause successfully and
(43:34):
menopause and there's a lot ofpositive things that happen, and
part of that is accepting thatour bodies are going to change
and we really want to helppeople be healthy but we're not
trying to kind of go back intime because it's just not
realistic.
There's a lot of great powerthat comes to women in menopause
the ability to say no.
I can't count the number ofpatients who've just come to
(43:57):
that on their own.
In their 50s they can actuallystart taking things off their
plate and start saying no topeople.
And so there's just so muchpositive in this whole menopause
world that we try to educatepeople about.
It's not just about their bodychanges.
Mary (44:12):
So those are a few things to yeah, I'm glad you brought up
the positive part of it,because I heard somebody refer
to it as a second spring andreally, once you've mentally
adjusted and emotionallyadjusted to all the changes that
are happening, because it canfeel very out of control that if
you had a certain body type formost of your life and all of a
(44:35):
sudden you can do the things youused to do and it doesn't have
an impact, it can be actuallykind of a little scary.
So I think initially we canfocus on all of the things we're
losing.
But I think as we move throughit, reframing that and looking
at you, know what's differentnow, that I can start over with
or start something new or whatbenefits come from really
(44:59):
slowing down and starting tocare for my body, my emotions
and my mind in a different way.
So I really love that.
And so there's one more thing Iwant to touch on, because we've
really done a huge 360conversation around this and I
think it would be a little bitincomplete if we didn't just
touch on supplements.
And you know I qualify thisbecause this is also a little
(45:21):
part of the program that I havefor women that I think, too, we
can think oh, we've been againin the United States.
We've sort of been conditionedto think there's a solution in
the form of a pill foreverything, and the one thing
about supplements which we'llprobably touch on is they're not
all created the same, becausemany of them aren't regulated
(45:45):
and it's there's no quick fix.
When we're talking about thingslike non-medication, things
that supplement our diet, herbsor other things like that, a lot
of the changes that we'remaking or we need to make now,
they're not quick.
There's not one thing that youcan say oh, I took this and then
(46:06):
the next day I stopped gettinghot flashes or whatever.
So I would love you to talk alittle bit about what role
supplements can play.
And then, if women areinterested in pursuing some
things, how might they framethat conversation?
Because they really should talkto their healthcare provider if
they're adding in some of thesethings.
Jane (46:23):
Yeah, mary, this is a common question, and when we
work with women in perimenopauseand menopause, we talk a lot
about supplements and what herbshave evidence behind them that
can really benefit women goingthrough this phase of life.
So, you know, when women can'ttake hormone replacement for
(46:44):
maybe a medical reason, or theyalso maybe just prefer a more
herbal route, these herbs andsupplements can really be
life-saving.
And I think you mentioned thisearlier, it's very individual.
So, mary, what may work for youmay not work for Mary Ellen,
and vice versa.
But, briefly, there is a lot ofdata really good data out there
(47:07):
and studies looking atdifferent herbs, such as black
cohosh, siberian rhubarb, macaroot and recently, I think the
hot one that's probably oneveryone's Instagram feeds is
creatine powder.
And creatine powder is prettyinteresting because when this
first started coming up for me,I thought about all the, all the
(47:28):
guys in high school and collegethat were using a ton of
creatine and I thought, well, Idon't want to do that.
But we're talking aboutcreatine in much, much, much
lower doses, at about about fivemilligrams a day, and I want to
pause here and just say thatwhen we're talking about these
things, you always want to checkwith your medical provider
(47:49):
before adding them in to makesure that it is a right fit for
you.
And we treat supplements herewith our patients just like a
prescription medication, as youwere alluding to in the question
, mary.
So oftentimes we ask them tobring all of their supplements
into the office for their firstvisit.
And I think it's really helpfulto have those bottles in front
(48:12):
of us for the conversations,because if you tell me that
you're taking a hormone tonic, Idon't know what that is, I
don't know what is in it.
But if you have that hormonetonic in front of me and I can
see on the back that it has 400milligrams of rhubarb and 100
milligrams of maca root, that'sspeaking my language.
I can understand that andwhat's in it.
(48:33):
So we often have women bring inhuge grocery bags that have 20
and 30 supplements in them and Iencourage everyone to do this
with your provider, take them in, and oftentimes it's very
interesting because we pull themall out and I ask why are you
taking this?
When did you start it and is ithelpful?
(48:54):
And I can't tell you how manytimes women say well, I'm not
really sure.
I've just been taking it, I sawit somewhere, or my cousin told
me it might help with my hotflashes, so I've been taking it
for years and I don't know if itworks.
So you alluded to this, mary,that in conventional medicine
we're really trying to get awayfrom a pill for every ill.
(49:17):
So every time you come in withheartburn or knee pain, we give
you a pill.
So we want to move away fromthat, but we also don't want it
to get into the habit of givinga supplement for every symptom,
which is often what I now see.
So as we go through yourbottles of supplements, many
(49:38):
times we're getting rid of 75%of them.
So I really like to minimizesupplements and really focus on
high quality, third-party testedbrands of a very specific dose
of that herb.
Like I mentioned, we treat themjust like a prescription.
So I will never say go getyourself some Maca Ro root at
(49:58):
CVS.
It will always be okay.
This is a third-party tested,trusted brand of maca root and I
would like you to take this onebecause it has 200 milligrams
and that's the dose that'seffective.
Here's the side effects thatcan happen with this herb.
I looked over your othermedications.
It's not going to interact andwe're going to revisit this in
(50:21):
two to three months and evaluatewhether or not this is
effective and you should stillkeep taking it or maybe set it
aside and say that it didn'twork very well for you.
The conversations around talkingwith your medical providers
lends itself to a little bit ofa bigger concern, and I think
women have a really hard timewith these conversations about
(50:44):
menopause, hormones, supplements, nutrition, sleep, and I think
it's really multifactorial andI've been there.
I'm a patient as well.
Just like Mary Ellen saidearlier.
You know her interaction withher OBGYN is that they don't do
hormones.
I've been in that seat too andit's extremely frustrating, but
(51:06):
I want to make sure that youdon't ever, ever get about
advocating for yourself, andwhen I have, women come and sit
in front of me and they're justso happy to be heard and
listened to and their symptomsand how they're feeling
validated.
They're oftentimes telling metheir experiences at other
providers and I really have beenable to put these different
(51:30):
experiences into a couplebuckets and I want to just share
this with you.
I think I'm going off on alittle tangent, but I do think
this is important and oftentimesI have women tell me that they
go to a provider and they'rejust completely dismissed, and
that is the worst case scenarioand I would say, if that happens
to you, find another provider.
That is just completelyunacceptable in 2025.
(51:54):
The second experience that Ihear a lot about is the I want
to categorize it and say alaissez-faire interaction, where
the medical provider's likeokay, sounds good.
And I was one of theseproviders before I continued my
education to really learn aboutthis, and so I'll speak for
myself and many times it wasbecause I just didn't really
(52:16):
know what they were talkingabout and I had lack of
education, but I didn't want tonecessarily say no, because
maybe it was helpful.
So that's the laissez-faireprovider.
And then the third bucket wouldbe the engaged interaction,
where they are able to admit Idon't know what maca root is,
(52:36):
but you know what.
I'm going to do a littleresearch and I'm going to get
back to you on it and that'sprobably the best interaction
that you can have.
But, all in all, I think thebest option is to really find an
integrative practitioner who'strained and well versed in
nutrition, herbs, menopause,perimenopause, hormones, because
(52:58):
, at the end of the day, youreally want someone who's
committed to you, committed toyour health goals, and someone
that you have trust in.
One of the easiest ways to finda practitioner in your area is
to go to the provider search onthe University of Arizona
Integrative Practitioner website.
So there they have compiled allof their fellows that have
(53:20):
graduated from their program,mary Ellen and I included, and
you can plug in your zip code tosee if there's a practitioner
near you that you can work withWell, and we can put the link to
that in the show notes ifsomebody would like to use that.
Mary (53:33):
And I do want to speak a little to that because I know
I've had my own frustrations andit can be little things like
when you go to a conventionalmedicine provider and I'm not
dissing them at all.
I mean, everybody has theirplace in the world of medicine.
I think some people were justtrained in a different model and
(53:56):
it's much more linear.
And as women first of all, verylittle research has been done
on women's health issues as itis, so a lot of it is just
ignorance.
There's not information to goback on.
When many health providers aretrained, they either don't know
how to or don't delve into theseother types of sort of learning
(54:21):
or thought process of theintegrative solutions, because
it takes a lot of time.
You know, when you sit downwith most functional medicine
providers, you're getting a 45minute appointment.
What can be frustrating and ithas been for me when you go to
many allopathic providers, youknow you're on the clock Like
(54:42):
they walk in and you know, okay,I have five minutes to get out
what I need to get out and,depending on the reception, you
get.
If you feel like you're notbeing heard, it can be difficult
.
And the first time I toldsomebody I take turmeric,
they're like what?
Like what is that?
So it's very complex.
I say that word a lot but Ithink we know in our guts when
(55:04):
something doesn't feel right.
And if you go the whole wayback to my episode four where I
talked to my friend Mindy, whohad she has a couple autoimmune
issues and she had no onehelping her through that, she
had to do her own research andthis was several years ago.
There's a lot more things now,like podcasts and free
(55:25):
information.
You have to be a little careful, like vet, what you're reading
or listening to.
But she had to educate herdoctor on thyroid issues and it
was a very long and frustratingroute for her to find wellness.
So I think, trust your body andmaybe, if you feel like there's
a lot happening for you, goback and give a listen to that
(55:47):
episode four because there arethings in there that she's able
to offer.
Hey, here are some places youcan find information that she
did through certain podcasts etcetera.
And the one thing because Ithink we simplify things like
supplements, it's like they'llshow up in your social media
(56:08):
feed and they have quotetestimonials there and it's like
, oh, I'm gonna try this andthere's a payment plan and you
can have all these thingssitting on your counter and,
like Jane mentioned, a grocerybag of supplements.
And so, to have a startingpoint with my sleep program, I
give you a supplement tracker soyou can actually write it down
and have to put in there likewhy are you taking it?
(56:28):
But it also gives you a tool totake to your medical provider,
which I think it feels easier ifyou can walk in with a paper
and say, look, here's what I'vebeen trying, here's why it can
save you a lot of time.
If you are in a situation whereyou know you're going into that
appointment and you are on theclock, they might have allotted
seven minutes for yourappointment.
(56:49):
So just a few small things thatyou can do, I think, to maybe
ease that path a little bit, toget to a space where you feel
heard and where you feel likethere are things happening that
are starting to sort of steerthe ship for you in a healthier
direction.
Well, I have loved ourconversation today.
(57:10):
It actually went a little bitlonger than my typical episodes,
but I think it has been sowonderfully in-depth and
detailed and just a delightfulconversation.
So I want to thank both of youfor taking the time to be here,
because I know building your newpractice has been very, very
sort of all-encompassing, so Ilove that you were able to set
(57:30):
aside time for us today.
Jane (57:33):
Thank you, Mary.
We were so excited to do thiswith you today.
Mary Ellen (57:36):
Yeah, it was really fun.
It was really fun.
You're doing great work outthere, so thanks for including
us.
Mary (57:41):
Thank you, and we're going to find a time to do a whole
episode on diet.
I swear we're going to do it.
So sounds good.
So I also want to thank all ofyou for listening and you know.
More than anything, I'd love tohear from you, because when I'm
sitting behind the mic it canbe sort of like who's hearing
this, and you know what aretheir reactions or responses.
So I'm really also amazed atthe community we're building.
(58:05):
So if you have thoughts aboutthis episode, please comment or
actually you can text me.
I can't answer you, but there'sa text link in the show notes.
If you want to have a moreprivate communication, and if
you have someone in your lifethat's struggling with the
symptoms that we've talked abouttoday, please consider
forwarding this episode to themand you can check out the
(58:26):
program I designed specificallyfor women who struggle with
sleep.
It's really again a 360approach to lifestyle, because
everything, everything isrelated to sleep and sleep's
related to everything.
You can find a link for that.
It's called Restored.
It'll be in the show notes and,if you love listening, consider
joining the Growing Garden ofViolets and support the show
(58:48):
using the heart button or thelink at the bottom of the show
notes, depending where you'restreaming from, and until next
time, go out into the world andbe the amazing, resilient,
vibrant violet that you are.
Welcome to No Shrinking Violets.
I'm your host, Mary Rothwell,licensed therapist and certified
integrative mental healthpractitioner.
I've created a space where wecelebrate the intuition and
power of women who want to breakfree from limiting narratives.
We'll explore all realms ofwellness, what it means to take
up space unapologetically, andhow your essential nature is key
(00:28):
to living life on your terms.
It's time to own your space,trust your nature and flourish.
Let's dive in.
Hey, violets, welcome to theshow.
I feel like, as with nearlyanything in life, social media
has benefits and, for sure,drawbacks.
With social media, we get a tonof information.
(00:51):
But well, we get a ton ofinformation, most of which we
didn't ask for, and if you usesocial media, it can feel like
watering your garden with a firehose.
If you pay attention to how youfeel as you're scrolling, you
might recognize that your neckis tense or your stomach is
clenched.
Our brains aren't meant to takein and process information in
(01:13):
the way social media feeds it tous fast, based on what the
algorithm thinks.
We want words and sounds andimages and split screens, and
Okay, let me stop and reframe.
One advantage of social mediais that it helps us recognize
that we're not alone.
And for centuries, women goingthrough menopause felt like
(01:33):
surely no one else wasexperiencing what they were the
brain fog and the crazy hotflashes and the exhausting,
inability to get restful sleep,the waning sexual desire,
irritability and, to use aphrase my college students used
to say, existential angst.
Yes, they really used thosekinds of terms, because all of a
(01:54):
sudden we can feel likedifferent people, less relevant,
and again like we're the onlyones experiencing all the things
, because no one talked aboutthis type of personal stuff even
a couple decades ago.
I mean, yeah, maybe reallyclose friends did, but also
women were socialized and stillare to bear down and deal like
(02:18):
no complaints and no hysterics.
But now, finally, we're sharing, we're admitting how we feel
and we're finding that othershave similar experiences.
Social media, for better orworse, has redefined personal
sharing and private information.
Not a day goes by that I don'tsee some kind of ad for
(02:39):
something related to menopausesymptoms, but then there's the
flip side.
Not a day goes by that I don'thear something about menopause
symptoms, but then there's theflip side.
Not a day goes by that I don'thear something about menopause
and many people want you tobelieve that there's a quick fix
or a one-size-fits-all solutionto symptoms.
And here's where we get intothe weeds again, because, yes,
(02:59):
we all experience waningprogesterone and estrogen.
Our individual bodies reacttotally differently and respond
to interventions totallydifferently.
Honestly, that's one reason Idesigned my sleep program for
women in midlife.
It's built around nature, butit's tailored to each woman so
she can figure out what worksfor her, because we all have
(03:21):
similar experiences, but we'reall unique.
Because we all have similarexperiences, but we're all
unique.
So if you're a woman juststarting to experience the
changes brought on byfluctuating hormones, or you are
in the middle or even the tailend of menopause symptoms, I
think the information that myguests today will share is going
to help.
They are functional medicinepractitioners.
This means that they take afull 360 degree approach to
(03:45):
health, understanding howhormones impact our brain and
our mood, not just our weightgain, and how nutrition affects
the impact of waning hormones onweight gain, and how sleep is
crucial to effective managementof all aspects of health.
I invited them to talk with meso you have a starting point to
sift through all the insistentand sometimes conflicting
(04:07):
messages that you might begetting on or off social media,
and so you have a starting pointto take action or talk with
your own healthcare provider.
My guests today, jane Snyder andMary Ellen Franciscani, are
certified registered nursepractitioners.
Both Jane and Mary Ellencompleted an integrative
medicine fellowship at theUniversity of Arizona Center for
(04:29):
Integrative Medicine under DrAndrew Weil and have advanced
training through the Institutefor Functional Medicine.
Their clinical approach blendsconventional care with holistic
strategies to get to the root ofillness.
With holistic strategies to getto the root of illness, support
healing and promote long-termwellness.
And in 2024, Jane and MaryEllen co-founded Middle Way
(04:51):
Wellness, a direct primary carepractice that is a revolutionary
healthcare model, fostering amore personalized relationship
with their patients.
That emphasizes prevention andwellness through integrative and
functional medicine.
Welcome to no Shrinking Violets, Jane and Mary Ellen.
Jane (05:15):
Thank you, Mary.
We are so excited to be here.
This is a huge topic that welove talking about.
We're big fans of no ShrinkingViolets and we're really excited
to share this information withyour listeners today.
Mary (05:31):
Cool.
So after my very long intro,let's get to it.
So the world of hormones isreally complex.
I had to learn that a lot formyself just going through
menopause, and I swear that wehear balance your hormones all
the time and I know that that'sactually true, but it's also
(05:54):
really complex.
There's no quick fix.
So let's start with what arethe hormones that really impact
us the most as women as we getolder and what are some of the
changes that we might movethrough from peri to
postmenopause.
Jane (06:11):
Yeah, Mary, this is a great place to start and lay
some groundwork for ourconversation today.
You know most of us as womenrecognize that we have estrogen
and progesterone as our main sexhormones, but we also have
testosterone, that we haveestrogen and progesterone as our
main sex hormones, but we alsohave testosterone, just not in
(06:33):
levels that men have it.
And these three sex hormoneswork together synergistically
throughout the body, and I thinkmost of us as females really
recognize that.
They regulate our menstrualcycle every month or preparing
our body for a pregnancy, ifthat were to occur.
It also they help us withpregnancy and delivery.
But what many of us, I think,forget is that they work
throughout our body.
(06:54):
So, for example, estrogen hasover 400 different receptors in
our body, from our head to ourtoe.
So the estrogen is impactingour brain health, our
cardiovascular health, our hair,skin, our nails, our mucous
membranes.
So I really like to think ofour estrogen as more of a
lubricator, and I'm sure womenthat are listening in menopause
(07:16):
could attest to that.
I hear oftentimes that there's alot of drying up that happens
with menopause and that's reallyrelated to our estrogen, Now
our progesterone.
I really like to think of thata little bit differently and it
really impacts more of our bonehealth.
It helps to lower inflammationin our body and this is also the
(07:38):
hormone that oftentimes givesus trouble with sleep as we
enter menopause.
Testosterone is the third sexhormone and testosterone really
does a lot of the heavy liftingin our overall sense of
well-being, our confidence, ourmotivation, and also plays a big
role in our strength, buildingour muscles and, for most women,
(08:02):
it also really influences oursex drive Very good overview,
yeah, and I remember learningabout the complexity of this,
thinking that, okay, so estrogenand progesterone only really
impacted me during mypre-minstrel days.
Mary (08:18):
And then, when I started to recognize the role even
estrogen plays in brainprocessing of certain things, I
was like, wow, no wonder there'skind of this cascade.
And so for me, working inmental health, when women say
like I have these crazy moodswings, it's like well, yeah,
because perimenopause is reallywhen you're going to have a lot
(08:42):
of fluctuation right From monthto month before it kind of like
comes to a halt.
You're going to have a lot offluctuation in how those
hormones are impacting you andyour body.
Jane (08:56):
Yeah, absolutely, and I'm glad you brought up
perimenopause because I thinkthat that's also a confusing
time.
So if we, you know, go back towhen our hormones start kicking
in, that's also a confusing time.
So if we go back to when ourhormones start kicking in,
that's usually during pubertyand then throughout our
menstruating years, ourprogesterone and estrogen
they're just cycling on a 28-daycycle, so really they should be
(09:17):
going nice and up and downregularly.
You get your period.
But perimenopause is that timeframe that comes right before
menopause and what's happeningduring that time is our ovaries
are starting to do their ownthing.
So some months you may havesurges of your hormones, while
other months your ovaries arereally lazy and don't do a whole
(09:38):
heck of a lot.
And that's when women startexperiencing changes in their
menstrual cycles.
So they may skip periods, theymay become heavier, but that
resulting effect influences,like you were saying there, mary
, our mood and that feeling ofjust being unbalanced.
And that perimenopausal timeframe can happen up to 10 years
(10:00):
before actual menopause, withknowing that menopause happens
around the age of 52,perimenopause can start in your
early 40s.
So that's a really, really longperiod of time when women are
frustrated, not sure what to do,and a lot of times they're
being told that you know there'snothing going on with the
(10:20):
hormones, when in fact therereally is.
Mary (10:23):
Yes, and you know this is a topic for another day, but I
just want to kind of throw it inhere that when I approach this
issue with women, especiallywhen we're talking about sleep,
which is, of course, verycomplex a lot of women, as they
enter perimenopause, arestarting to have sleep issues,
and sometimes it's also just theaccumulation of life.
(10:44):
I think that all thatdovetailing at once like you're
in this phase of life where alot has probably happened you
might now be raising children,or you may have a new marriage,
or you might be coming out ofrelationships there's so much
that we store in our bodies andthen, when we start to have the
function of our physical body ontop of that, it does create a
(11:07):
situation where, I think, womencan feel so overwhelmed and
sometimes balance your hormones.
So is that a thing?
Can you balance your hormones?
(11:28):
And, if you can, what would besome of the keys to helping that
happen?
Mary Ellen (11:34):
That's a great question, mary.
We get that question a lot andwhile the phrase, as you said,
balancing your hormones isthrown around now a lot, like
you said, on social media andwellness spaces, the concept
itself is absolutely valid, butI want to just go into defining
it a little bit because I thinkthere's a lot of misconceptions
out there about what thatactually means.
(11:55):
So, backing up a little bitinto going back to biology,
hormones don't exist inisolation and I always explain
to patients they operate in adynamic network and I like to
think of them as an orchestra.
So during perimenopause, yourestrogen, progesterone and
testosterone are all over theplace Women come in complaining
(12:16):
of.
Often what I hear is inperimenopause, I just don't feel
like myself, and so I like touse the gas tank analogy.
So in perimenopause, as Janesaid, sometimes the tank runs
super low, but at other times,without any warning, it's
overflowing and once we get intopostmenopause, our levels of
estrogen, progesterone andtestosterone completely tank and
(12:39):
we have an empty tank.
And it's sudden, if you imaginethat orchestra analogy, and
suddenly you took away all theinstruments from the orchestra.
It's sudden, if you imaginethat orchestra analogy, and
suddenly you took away all theinstruments from the orchestra,
it's going to sound and feelvery different.
And yet, as women, what do wedo?
We keep going.
We keep caring for ourselves,for our children, often for our
parents.
That we're working full-timemany of us so it's a real thing,
(13:02):
but it hasn't really beenacknowledged.
So, while this is happeningphysiologically, what I want to
tell women who are to yourlisteners is that they do not
need to suffer through all ofthese symptoms like hot flashes
and brain fog and mood swingsand poor sleep and vaginal
dryness.
What we're really talking abouthere when we say balancing your
(13:23):
hormones is restoring someequilibrium in a way that
supports your quality of life.
That's what's really important.
So, from a conventionalstandpoint, this often means
considering hormone replacementtherapy, which isn't for
everyone, but when it's usedappropriately, especially within
the first 10 years of menopause, there's really strong evidence
(13:45):
that HRT is safe and effectivefor most women.
Unfortunately, as you probablywell know, due to some
misinformation of data from theWomen's Health Initiative, we
have an entire generation ofdoctors who have completely
forgotten how to prescribehormone therapy and patients who
are afraid of it, and it'sreally a travesty to women.
(14:06):
I myself was at a gynecologista number of years ago and asked
about HRT and I was told oh, wedon't do that anymore and that's
just not true.
So that's again a wholeseparate podcast, hrt.
But I did want to mention thatbecause it's really an important
piece From our perspective.
As an integrative practice, welike to take things further, and
(14:29):
so we're often looking at allof the other hormones in your
body, like insulin and cortisoland thyroid, and we know that
the way that we live, our diet,our lifestyle and everything
that we're doing on a dailybasis is literally interacting
with our hormones.
So there's a lot of back andforth and those things are
really important.
(14:49):
So when we work with people, Ireally I try to emphasize we're
not trying to get you back toyour 25-year-old self.
We're really trying to create asustainable balance that helps
you feel more like yourselfagain, and that's very different
for everyone.
Sometimes that includes hormonereplacement therapy, but
sometimes it will includeoptimizing sleep and stress and
(15:12):
nutrition and supplements, andin many cases it's both.
Mary (15:16):
Yeah, it's very, very complex and I'm glad you brought
up cortisol and insulin becauseall of those things are so
important, and again, this wouldbe a whole other episode.
But sugar, I mean we're findingsugar is one of the biggest
impactors that influences somany things we're going through,
including heart disease anddementia and all of those things
(15:39):
.
So I think simple things thatwe may also get into with our
next question, but simple thingslike adjusting your diet can
actually be and were for me,pretty impactful.
And you know, I think the otherthing that when you mention
hormone replacement therapy, Iknow for me I have a patch of
(16:00):
estradiol patch the lowest thatyou can have, but it really did
make a big impact for me.
And I think so often on my showI talk about nature and so if we
think about nature and how weevolved, we're living way longer
and really nature developsbeings to procreate in most
(16:21):
cases.
So we're now living so muchlonger past the point that we
can procreate.
So I think that you know, firstof all, our body is protecting
us.
If we would try to growchildren, I know at my age, if I
would try to grow a child, thatwouldn't be healthy for me.
So nature has this way of sortof changing us to keep us safe.
(16:46):
But I think too, with livinglonger I think we're starting to
really be able to see long-termwhat is the result, and it's
not.
I don't think it is hopeless.
I think things like brain fog,like our brains are made to have
plasticity.
So a lot of these things we doend up sort of compensating, but
(17:07):
I think, getting that comfortwith knowing that we're not
going to look like we did, andit doesn't matter what input you
use, you're just aging, and soI think one of the basic things
is finding a comfort with that,because our bodies do change and
they don't look the same.
(17:28):
But I want to circle back aroundto this idea of diet because I
think we downplay it, and youbrought up a good point that the
diet in America is one of theworst diets in the world.
In fact it's called the SADdiet right, the Standard
American Diet, the world.
In fact it's called the SADdiet right, the Standard
American Diet, and I thinkthat's a really accurate acronym
because it's built around themost unhealthy things and we've
(17:51):
also, I think, put a framearound things that are actually
healthy, that we've been toldhistorically are unhealthy
things like fats and again,that's not simple because
there's a buffet of fats, right,there's different types of fat.
So I don't know how detailedyou want to get, but I would
love if you would talk a littlebit about how can we utilize
(18:15):
dietary inputs, or what roledoes diet play in that quest to
kind of support our hormonehealth.
Jane (18:23):
Yeah, nutrition is huge in hormonal health, as it is with
all other, you know staying welland chronic diseases in our
body.
So I'm glad that you brought upthis question and we talk about
nutrition every single day toall of our patients.
It's something that we werereally passionate about and we
love and, as you mentioned, it'svery nuanced and, I think,
(18:45):
individual, but overall, youknow what putting into our body
or what we're not putting intoour body affects how our
hormones rise and how they drop.
So they influence not only ourproduction of our hormones, but
nutrition affects how our bodymetabolizes and utilizes our
(19:06):
hormones and also get rid ofhormones or detoxifying.
So all of those processes haveto work well to have quote
unquote the balance of hormones.
Many times I work with women andtheir issues aren't necessarily
that they don't have enoughhormones.
It may be that they're notclearing them appropriately, and
(19:29):
this is how we really start toindividualize nutrition for
women.
Oftentimes, when we're workingwith women, we're testing their
hormones, we're assessing theirimbalancing and tailoring very
specific nutritionalrecommendations for them.
However, I think that there'sdefinitely some baseline,
(19:50):
foundational recommendationsthat we can talk about today,
and I thought about this andcame up with, I would say three
top ones that we're repeatingover and over and over again to
women, regardless of what theirindividual assessment shows.
So number one is eating realfood.
(20:12):
So what I mean by that iseating food as naturally as it
has come from the ground, orthat tree or the fish or the
bison, or that tree or the fishor the bison.
So in doing so, oftentimes thatmeans we're preparing more of
(20:33):
our foods at home.
We often throw around the termprocessed foods, but what that
means is we take the food fromthe ground, from the cow, and
then it's manipulated to be putinto a package.
So we really want to work ongetting away from those packaged
foods and eating real foods.
One of the tips that I talk towomen about is working around
(20:54):
the outside of the grocery store.
So if you think about yourgrocery store, oftentimes if
you're just staying on theoutside of it, that's going to
be where most of your produce is.
Things that you pick up likefresh bell peppers come to mind.
Or you're going through themeat aisle and you see chicken
and fresh fish there.
(21:16):
Now I understand and I'm withyou.
I can't just only shop on theoutside of the grocery store.
I do have to go into the middleand that's where those packaged
foods lay.
And what I would recommend youdo next time you're going into
those aisles is pick up thatpackage and look at the back.
(21:37):
So I want you to look at thatingredient list.
I think we're so used to justlooking at the front.
I think we're so used to justlooking at the front, seeing a
marketing ploy you know this isgluten-free, low-fat and
throwing it into our cart.
But I really encourage you tolook at the back of the
ingredients and if there'ssomething in the ingredients
(22:02):
that you have a hard timepronouncing or grandma would
have no idea what that is thinktwice about throwing that into
your grocery cart.
So eating real food, preparingit from how it comes from the
earth.
Number two is increasing ourfiber.
So a lot of different resourcesrecommend fiber ranging from
(22:22):
about 30 to 50 grams per day,and I really aim on that higher
side for women, especiallymenopausal, aiming for over 45
grams per day.
Now, that's actually a lot offiber and, as you mentioned,
mary, the standard American diethas very, very little fiber in
it.
So we have to be reallyintentional about this and I
(22:43):
think some of the ways I do.
That is encouraging women tostart ramping up their fruit and
vegetable intake, aiming forabout nine servings per day.
That's where we get a lot ofthe fiber in our fruits and
vegetables, especially with theskin.
So making sure you're eatingthe apple with the skin.
On the other area where we geta lot of fiber is in our ancient
(23:06):
grains.
So moving from those processedcarbohydrates so like the box
pastas, white bread, crackers,and moving to the ancient grains
so things like farro, barley,quinoa those are just going to
be packed with way morenutrients outside of even the
increase in the fiber in those.
(23:28):
And number three, foundationally, is looking at your liquids
that you're putting into yourbody.
So it becomes more and moreimportant to make sure that
you're hydrating with water.
As you get older, as we age,our thirst mechanism starts to
decline naturally, so it becomesmore of a habit versus just
(23:49):
relying on your thirst mechanismto kick in to tell you that you
need to drink water.
So making sure that you'rereally getting one of those nice
big 32-ounce mugs and goingthrough a couple of those
throughout the day.
Now, while you're increasingyour water, I also recommend
looking at well, what are theother sources of fluids you're
(24:09):
taking in, so really assessingif you're having those
sugar-sweetened beverages.
So where are you getting yourmorning coffee or latte?
Is there sugar added to that?
Any sodas, things like that?
Starting to remove those fromyour daily habits?
And the last thing I'll mention, with liquids I may get
(24:30):
something thrown at me here or Imay get booed, but it's talking
a little bit about alcohol.
I really have found so manywomen that feel so much better
from a brain perspective, from asleep perspective, if they cut
out or significantly reducetheir alcohol intake, and I
(24:51):
think that this really starts tohappen organically for most
women.
I talk to so many that come inand they're in their forties and
they say to me Jane, you know,I just can't tolerate alcohol
like I used to If I have one ortwo glasses of wine with my
dinner, I feel like I did when Iwoke up with a hangover when I
went out in college the nextmorning, like what's going on,
(25:14):
and so there is something realto that that our body is just
not metabolizing and getting ridof it like we used to when we
were younger.
So I really encourage you toexamine your alcohol intake and
maybe just do a trial of a monthwithout it and see how you feel
intake and maybe just do atrial of a month without it and
(25:34):
see how you feel.
So, really, those foundationalrecommendations would be to eat
real food, increase your fiberto over 45 grams a day and then
assess your liquids, hydratingand starting to remove some of
those sugar beverages or alcohol.
Mary (25:48):
Those are great guideposts , you know, and a couple
comments, as you were talking.
So the first I will addressbecause this was what you most
recently said this idea ofcutting back on alcohol, I think
brings up a bigger issue.
And this isn't saying, oh, youhave to have alcohol, but I
think in our society, again withfood, it's so built around food
(26:11):
and drink as a celebratorything.
I mean, what's one of thethings you often suggest?
Let's go out to dinner, andpart of that tends to be, you
know, there might be a mixeddrink menu that has, you know,
something that sounds delicious.
So I think it can bring up abigger issue for women at this
time of life and it's like, do Ihave to really give up another
(26:33):
thing?
And I think there are waysaround it.
And so one of the things Iwould say about alcohol and I am
one of those people that Icannot tolerate it and I never
really was a drinker, but myhusband makes craft beer, so we
enjoy going to different placesand testing or tasting craft
beers.
And it's now we're to the point, because he's a pretty
(26:56):
supportive partner we will splita 16 ounce beer and the other
thing is have it earlier in theday.
I think when we're talking aboutdiet, what can be hard is if
you focus on what you're notsupposed to do.
I think it can be reallydiscouraging and overwhelming.
So I would say, with what Janejust said look at what can you
(27:18):
add.
Start by adding some of thesethings instead of feeling like,
oh, my, okay, so now I have tostop eating white bread, I have
to stop eating pasta.
Look at how can you cut backand put something else in its
place, because I think thatmakes it feel a little more
doable.
And the other thing is becauseright now I'm working through an
integrative nutrition class andI know one of the guidelines I
(27:41):
learned that really helped mewas try to have fat, fiber,
protein in each thing you eat,and that really helps me kind of
think about okay, so I'm goingto have, you know, not just
dinner, but I'm going to havethis little snack.
How can I have a little bit ofeach of those things?
And finally, I'm going to go tosomething that Jane has said to
(28:02):
me often, which I love, is the8020 rule.
And Jane, can you explain thatin your words?
Because I fall back on that sooften and it makes me feel
actually kind of empowered and alittle relieved when I'm making
dietary choices.
Jane (28:18):
Yeah, absolutely, and everything you just said there I
completely agree with.
I love the idea and we do thisa lot is what do we want to add
into your nutrition, versus justnecessarily removing lots of
things, and then it becomes moreof an organic way of eating.
So you're adding things in andyou naturally will start cutting
(28:38):
things out on your own.
But the 80-20 rule is somethingthat I live by and I talk to so
many people about, and when youapply it to nutrition, what it
means is that 80% of the timeyou are really mindfully eating,
being aware of what you'reputting in your body, following
(29:00):
some of these recommendationsand sticking to that.
But we also build 20% into itfor the things that you enjoy.
20% into it for the things thatyou enjoy.
So I know that it's really hardfor someone to go gung-ho,
strict on a diet and after threedays I'm like I'm going to give
(29:20):
that up.
I don't want to continue.
I am just for me.
I love a slice of pizza, so Ibuild that into my 20%.
So for other people like maybeyour husband, mary, his craft
beer, maybe for him that's his20%, so you can pick and choose.
But 80% of the time you'rereally being mindful and
following your eating plan butbuilding in that 20% so that way
(29:44):
you're able to go out to dinnerwith your girlfriends and have
that appetizer and have thatglass of wine, but you know, the
next day you're just jumpingback into your 80%.
So it's a really big mind shiftaround.
You know, not shaming yourselffor quote falling off the wagon,
you're building it in and it'spart of your eating plan.
Mary (30:07):
Well, and you brought up a key at the end there, which is
shame, and I think women have somuch shame around food.
I can't tell you how often Ihave friends, but also a lot of
my clients say I was bad today,like you're not.
You're not bad for indulgingsomething Because, again, we are
surrounded in this country bysugar and you know it also and
(30:31):
again I'm going to say this fora third time, this could be
another episode but what thatdoes in our body and our brain
and how it mimics certainneurotransmitters to make us
feel good, it's a sugar high andwe joke about that, but it's
not really a joke.
So I think it's difficult tomake these changes.
So when you can put a frame onit, that not only gives you a
(30:53):
concrete way to start to do someof these things, but it also
gives you kind of that releasevalve.
So I'm not going to lie if wego out to dinner and there's
chocolate cake on the dessertmenu, both my husband and I are
like that's our 20%, because youknow it's very relieving to be
able to enjoy something and Ithink it makes us more mindful
(31:15):
too when we have something.
It's not like when I was younger, I would have a bowl of
chocolate on my desk, you know,for my students.
But of course midday I'mopening three of those little
Hershey's miniatures and thatkind of thing adds up.
So I think it just makes youmore mindful about your choices
(31:37):
and I think, as we've built morethings into our dietary plan
for the week, it's actually beenkind of fun, like there's been
so many things that we now eatthat either I didn't even know
about or are actually way moredelicious than I would have ever
thought.
So a lot of it is preparation.
(31:58):
But you know, I'm thinkingmaybe in the future you could
come back and we could all do awhole program on diet.
But let's move on from that,because one of the things that I
also wanted to talk aboutbeyond diet, because really it's
a whole lifestyle thing.
So what role do some otherthings in our life play in
(32:19):
supporting hormone health?
So things like sleep and stressmanagement, movement, all of
that kind of stuff.
Mary Ellen (32:25):
Sure Also a great question.
I think lifestyle is just, it'snot just supportive.
We think of that at Middlewayin our practice as sort of the
foundation.
So we have to get thatfoundation set first before we,
you know, even begin.
So I like to think of lifestylething, mary, in terms of
pillars, and I always tell folks, you know, you can't supplement
(32:47):
or medicate your way out ofpoor sleep or high stress or a
sedentary lifestyle.
So hormones function as part ofthat orchestra that I talked
about and they respond andinteract with actually how we
live.
So, in other words, ourlifestyle and how we're sleeping
and moving or not moving andstressing it's going to modulate
(33:08):
our hormones.
So let's first talk about sleep.
That's my favorite topic.
Sleep is a super important timeand when you're sleeping your
body does what I call thehormonal housekeeping.
So during deep sleep, the brainand your endocrine system they
coordinate and sort of worktogether with these feedback
loops to help regulate yourestrogen progesterone, with
(33:31):
these feedback loops to helpregulate your estrogen
progesterone and your cortisolinsulin and even your thyroid
function.
So getting poor sleep is, youknow, a lot of folks think it's
not that big of a deal, but it'sactually a really huge deal and
a lot of my perimenopausal andmenopausal women have the three
or 4 am awakening and they neverquite go back to sleep and they
brush it off, but it's I alwaystry to point out to them it's a
(33:52):
big deal.
So when that is happening,we're raising our cortisol
levels, our stress hormones,which raises our insulin and
that increases inflammation inour body and when that happens
there's a ripple effect.
We get more hot flashes, moresugar cravings, more mood swings
and that dreaded mided,mid-section weight gain.
So sleep is incrediblyimportant and I often start with
(34:16):
sleep before anything else,because if we can get that in
place we can start to build thefoundations.
The second pillar that I focuson is movement.
So, again, really important.
I really focus on resistancetraining and daily walking or
just moving.
I don't like to use the wordexercise because it intimidates
people.
I've really focused onresistance training and daily
walking or just moving.
I don't like to use the wordexercise because it intimidates
people, I just talk about movingyour body.
(34:37):
So strength training, we know,is a really good tool because it
helps preserve those muscles.
Our lean muscle mass and ourmuscles decline after menopause
and when that happens again wehave that increase in insulin
sensitivity, our bone densitygoes down and our cognitive
function and mood go down.
So preserving and actuallybuilding muscle is something
(35:00):
that we really work on.
Here we focus a lot less on theactual number on the scale and
more on the muscle mass.
We have ways of measuring thathere.
And then finally, another hugeone, another huge pillar is
stress.
So, as I sort of referred tobefore, women in perimenopause
and menopause, which often is inyour 40s and your 50s, are
(35:23):
often under tremendous amountsof stress due to work and family
and really being in thatsandwich generation where you're
taking care of your kids butyou're also taking care of your
parents and there's just so manydemands on women and, as I said
before, most women's naturalgo-to is to just keep on going
despite all of this.
So when we have this immensestress on us, it elevates our
(35:47):
cortisol and again it has thatdownstream effect of throwing
off our progesterone, estrogenand our insulin sensitivity and
we end up with this perfectstorm where we feel fatigued,
anxious, we have weight gain andsleep disruption, and so we try
to teach here a lot of reallybasic, simple mindfulness tools
(36:07):
like breath work.
We encourage people to go totherapy and talk to people like
you, mary, and I personallyreally try to get my patients.
I actually give themassignments to find some joy,
whatever that is for them todance in the kitchen, to sing,
but to find joy because it'sessential.
And these techniques you can dothem at home and you can do
(36:28):
them on your own time, andthey're simple and they're free
and they can really help balancethat stress response that we
have.
Having said all those things,mary, I want to say this really
loud and clear to everyonelistening, because it's one of
my pet peeves is that I thinkperimenopause and menopause is a
time of overwhelm, for all thereasons that I mentioned.
(36:48):
And while I'm absolutelythrilled that all of these
online content creators areeducating people about this,
getting the message out aboutmenopause, as you said in the
beginning, you're hearing aboutit every day and every time you
open your phone and I think it'soverwhelmed and I think a lot
of women feel a lot of shamebecause they're trying to, like
(37:09):
you said, do it all and if theydon't get to the gym, they shame
themselves for doing that.
And what I tell all of my womenis that really try to limit
your time.
I will teach you the tools thatyou need, but really small
changes matter and make adifference.
So trying to turn off that firehose and just have a slow
(37:30):
trickle of small changes andslowly build, that's what works
long-term, and anything otherthan that is.
I feel counterproductive towomen and really sort of
sabotaging this whole movement,which I call the menopause
movement, which I think is longoverdue.
Menopause medicine is somethingthat we really need to bring
online here.
Mary (37:51):
Well, I'm glad that you put it in that context.
First of all, the fact that youbrought joy in joy into the
equation is really cool, and Ithink, too, you're right that we
tend to really put a lot ofpressure on ourselves, that you
know I should be doing better orI should be able to figure this
out, but I know for myself that, had I not had Jane to help me
(38:15):
navigate some of this, it'sreally really crazy that there's
always someone saying do this,do that.
And I know from what I learnedfrom myself and my own research
that it is so specific to eachindividual woman and I hadn't
really intended to talk as muchabout this, but the sleep course
(38:36):
that I built has every singlething you just talked about and
it is online, but there's groupcoaching as part of the support
system for it, but it walkswomen through very, very simple
changes over four weeks and itstarts simply with circadian
rhythm, like getting your bodyadjusted to nature, like when it
(38:58):
gets dark, when it gets light,and it starts that simply.
And I think the other thingthat you mentioned is this
weight gain, and I probably seethat more than anything, and I
know for me that has been themost frustrating part of
menopause is the weight gain.
And when you talk about sleepwith weight gain, I remember
(39:20):
when I first read that sleepimpacts weight gain, I'm like
how in the world?
And then, when I started tolearn the role of the
hypothalamus and the role ofghrelin and leptin, learn the
role of the hypothalamus and therole of ghrelin and leptin and
all of those.
There are other hormones thatwork with our sleep cycle and
our ability to manage hunger.
It's very I mean, I've saidthis a lot it's so complex when
(39:50):
you start to think about howhormones work that when people
say you just have to do this onething, it's just not true and
there are things that may workfor your friend and there are
other things that won't work foryou or her.
So it's really trying to takeit down to the most basic things
and getting your body adjustedto what we've always used to
(40:12):
make us sleepy and wake us up,and that's the sun and the
darkness, and simply focusing onfoods that are real and moving
your body in ways that don'thave to be running a marathon.
You already mentioned a fewthings.
Is there anything else thatmight be helpful in managing
(40:35):
some of that specific symptom?
Mary Ellen (40:38):
Yeah, that's a whole podcast, I think, in and of
itself.
But yeah, the weight gain, mary, you are right, it's a really
hot topic and it's very chargedfor most people and the average
weight gain in menopause is 15pounds.
So that's a charged for mostpeople and the average weight
gain in menopause is 15 pounds.
So that's a lot for some people.
And what I really the firstthing I try to do when we're
(40:59):
talking about this topic is helpwomen understand that it is not
that they are suddenly doingsomething wrong.
Their body has drasticallychanged.
As I talked about earlier, thegas tank has been emptied and
what used to work for them issuddenly not working anymore.
But the playing field haschanged.
So we really have to change ourstrategy.
(41:19):
Just briefly to talk aboutwhat's happening and why it's
happening as our estrogendeclines, our fat distribution
changes and unfortunately, thefat changes to grow more in the
visceral adiposity, which is thefat around your organs, which
generally is in your abdominalarea.
So at the same time the fatdistribution is changing, the
(41:41):
muscle mass begins to declinewith that loss of estrogen.
So we develop something calledsarcopenia and when you have
that, your metabolic rate, yourresting metabolic rate, gets
lowered and this contributes toinflammation and insulin
resistance.
So this combination not onlyalters the number on the scale,
it changes everything about ourbody and our body composition.
(42:03):
So we really here focus muchmore here on body composition
rather than on weight.
We use a machine here calledthe InBody which gives patients
this information.
So we try to focus more onmuscle mass and body fat
percentage rather than theactual number, and if the actual
number on the scale goes down,that's a great side effect.
(42:25):
But we're really focusing moreon the muscle mass.
So in terms of what can be done,there are always lots of things
that can be done.
The anti-inflammatory nutritiondiet that Jane talked about and
eating whole foods is somethingwe're always going to counsel
on.
The resistance training that Imentioned before and building
that muscle is going to besomething that we always focus
(42:48):
on.
We're always getting our womenhere to wear weighted vests here
at Middleway to help build thatmuscle mass without really
having to think about it toomuch.
Sometimes we usetime-restricted eating and
fasting.
That can be done for women.
Again, it's very individualdepending on what's going on
with the person, and then thesleep and stress management are
really non-negotiables.
So there's lots to do do I havepatients who want to do all the
(43:11):
things and again, I really Itry to encourage them that we
are not.
The goal is not to get back toyour body when you were 25 years
old.
Um, that's just not realisticand you know we really don't.
We haven't focused a lot onthis podcast about the the
positives of menopause, but I'min menopause and I can say
there's I've made it throughperimenopause successfully and
(43:34):
menopause and there's a lot ofpositive things that happen, and
part of that is accepting thatour bodies are going to change
and we really want to helppeople be healthy but we're not
trying to kind of go back intime because it's just not
realistic.
There's a lot of great powerthat comes to women in menopause
the ability to say no.
I can't count the number ofpatients who've just come to
(43:57):
that on their own.
In their 50s they can actuallystart taking things off their
plate and start saying no topeople.
And so there's just so muchpositive in this whole menopause
world that we try to educatepeople about.
It's not just about their bodychanges.
Mary (44:12):
So those are a few things to yeah, I'm glad you brought up
the positive part of it,because I heard somebody refer
to it as a second spring andreally, once you've mentally
adjusted and emotionallyadjusted to all the changes that
are happening, because it canfeel very out of control that if
you had a certain body type formost of your life and all of a
(44:35):
sudden you can do the things youused to do and it doesn't have
an impact, it can be actuallykind of a little scary.
So I think initially we canfocus on all of the things we're
losing.
But I think as we move throughit, reframing that and looking
at you, know what's differentnow, that I can start over with
or start something new or whatbenefits come from really
(44:59):
slowing down and starting tocare for my body, my emotions
and my mind in a different way.
So I really love that.
And so there's one more thing Iwant to touch on, because we've
really done a huge 360conversation around this and I
think it would be a little bitincomplete if we didn't just
touch on supplements.
And you know I qualify thisbecause this is also a little
(45:21):
part of the program that I havefor women that I think, too, we
can think oh, we've been againin the United States.
We've sort of been conditionedto think there's a solution in
the form of a pill foreverything, and the one thing
about supplements which we'llprobably touch on is they're not
all created the same, becausemany of them aren't regulated
(45:45):
and it's there's no quick fix.
When we're talking about thingslike non-medication, things
that supplement our diet, herbsor other things like that, a lot
of the changes that we'remaking or we need to make now,
they're not quick.
There's not one thing that youcan say oh, I took this and then
(46:06):
the next day I stopped gettinghot flashes or whatever.
So I would love you to talk alittle bit about what role
supplements can play.
And then, if women areinterested in pursuing some
things, how might they framethat conversation?
Because they really should talkto their healthcare provider if
they're adding in some of thesethings.
Jane (46:23):
Yeah, mary, this is a common question, and when we
work with women in perimenopauseand menopause, we talk a lot
about supplements and what herbshave evidence behind them that
can really benefit women goingthrough this phase of life.
So, you know, when women can'ttake hormone replacement for
(46:44):
maybe a medical reason, or theyalso maybe just prefer a more
herbal route, these herbs andsupplements can really be
life-saving.
And I think you mentioned thisearlier, it's very individual.
So, mary, what may work for youmay not work for Mary Ellen,
and vice versa.
But, briefly, there is a lot ofdata really good data out there
(47:07):
and studies looking atdifferent herbs, such as black
cohosh, siberian rhubarb, macaroot and recently, I think the
hot one that's probably oneveryone's Instagram feeds is
creatine powder.
And creatine powder is prettyinteresting because when this
first started coming up for me,I thought about all the, all the
(47:28):
guys in high school and collegethat were using a ton of
creatine and I thought, well, Idon't want to do that.
But we're talking aboutcreatine in much, much, much
lower doses, at about about fivemilligrams a day, and I want to
pause here and just say thatwhen we're talking about these
things, you always want to checkwith your medical provider
(47:49):
before adding them in to makesure that it is a right fit for
you.
And we treat supplements herewith our patients just like a
prescription medication, as youwere alluding to in the question
, mary.
So oftentimes we ask them tobring all of their supplements
into the office for their firstvisit.
And I think it's really helpfulto have those bottles in front
(48:12):
of us for the conversations,because if you tell me that
you're taking a hormone tonic, Idon't know what that is, I
don't know what is in it.
But if you have that hormonetonic in front of me and I can
see on the back that it has 400milligrams of rhubarb and 100
milligrams of maca root, that'sspeaking my language.
I can understand that andwhat's in it.
(48:33):
So we often have women bring inhuge grocery bags that have 20
and 30 supplements in them and Iencourage everyone to do this
with your provider, take them in, and oftentimes it's very
interesting because we pull themall out and I ask why are you
taking this?
When did you start it and is ithelpful?
(48:54):
And I can't tell you how manytimes women say well, I'm not
really sure.
I've just been taking it, I sawit somewhere, or my cousin told
me it might help with my hotflashes, so I've been taking it
for years and I don't know if itworks.
So you alluded to this, mary,that in conventional medicine
we're really trying to get awayfrom a pill for every ill.
(49:17):
So every time you come in withheartburn or knee pain, we give
you a pill.
So we want to move away fromthat, but we also don't want it
to get into the habit of givinga supplement for every symptom,
which is often what I now see.
So as we go through yourbottles of supplements, many
(49:38):
times we're getting rid of 75%of them.
So I really like to minimizesupplements and really focus on
high quality, third-party testedbrands of a very specific dose
of that herb.
Like I mentioned, we treat themjust like a prescription.
So I will never say go getyourself some Maca Ro root at
(49:58):
CVS.
It will always be okay.
This is a third-party tested,trusted brand of maca root and I
would like you to take this onebecause it has 200 milligrams
and that's the dose that'seffective.
Here's the side effects thatcan happen with this herb.
I looked over your othermedications.
It's not going to interact andwe're going to revisit this in
(50:21):
two to three months and evaluatewhether or not this is
effective and you should stillkeep taking it or maybe set it
aside and say that it didn'twork very well for you.
The conversations around talkingwith your medical providers
lends itself to a little bit ofa bigger concern, and I think
women have a really hard timewith these conversations about
(50:44):
menopause, hormones, supplements, nutrition, sleep, and I think
it's really multifactorial andI've been there.
I'm a patient as well.
Just like Mary Ellen saidearlier.
You know her interaction withher OBGYN is that they don't do
hormones.
I've been in that seat too andit's extremely frustrating, but
(51:06):
I want to make sure that youdon't ever, ever get about
advocating for yourself, andwhen I have, women come and sit
in front of me and they're justso happy to be heard and
listened to and their symptomsand how they're feeling
validated.
They're oftentimes telling metheir experiences at other
providers and I really have beenable to put these different
(51:30):
experiences into a couplebuckets and I want to just share
this with you.
I think I'm going off on alittle tangent, but I do think
this is important and oftentimesI have women tell me that they
go to a provider and they'rejust completely dismissed, and
that is the worst case scenarioand I would say, if that happens
to you, find another provider.
That is just completelyunacceptable in 2025.
(51:54):
The second experience that Ihear a lot about is the I want
to categorize it and say alaissez-faire interaction, where
the medical provider's likeokay, sounds good.
And I was one of theseproviders before I continued my
education to really learn aboutthis, and so I'll speak for
myself and many times it wasbecause I just didn't really
(52:16):
know what they were talkingabout and I had lack of
education, but I didn't want tonecessarily say no, because
maybe it was helpful.
So that's the laissez-faireprovider.
And then the third bucket wouldbe the engaged interaction,
where they are able to admit Idon't know what maca root is,
(52:36):
but you know what.
I'm going to do a littleresearch and I'm going to get
back to you on it and that'sprobably the best interaction
that you can have.
But, all in all, I think thebest option is to really find an
integrative practitioner who'strained and well versed in
nutrition, herbs, menopause,perimenopause, hormones, because
(52:58):
, at the end of the day, youreally want someone who's
committed to you, committed toyour health goals, and someone
that you have trust in.
One of the easiest ways to finda practitioner in your area is
to go to the provider search onthe University of Arizona
Integrative Practitioner website.
So there they have compiled allof their fellows that have
(53:20):
graduated from their program,mary Ellen and I included, and
you can plug in your zip code tosee if there's a practitioner
near you that you can work withWell, and we can put the link to
that in the show notes ifsomebody would like to use that.
Mary (53:33):
And I do want to speak a little to that because I know
I've had my own frustrations andit can be little things like
when you go to a conventionalmedicine provider and I'm not
dissing them at all.
I mean, everybody has theirplace in the world of medicine.
I think some people were justtrained in a different model and
(53:56):
it's much more linear.
And as women first of all, verylittle research has been done
on women's health issues as itis, so a lot of it is just
ignorance.
There's not information to goback on.
When many health providers aretrained, they either don't know
how to or don't delve into theseother types of sort of learning
(54:21):
or thought process of theintegrative solutions, because
it takes a lot of time.
You know, when you sit downwith most functional medicine
providers, you're getting a 45minute appointment.
What can be frustrating and ithas been for me when you go to
many allopathic providers, youknow you're on the clock Like
(54:42):
they walk in and you know, okay,I have five minutes to get out
what I need to get out and,depending on the reception, you
get.
If you feel like you're notbeing heard, it can be difficult
.
And the first time I toldsomebody I take turmeric,
they're like what?
Like what is that?
So it's very complex.
I say that word a lot but Ithink we know in our guts when
(55:04):
something doesn't feel right.
And if you go the whole wayback to my episode four where I
talked to my friend Mindy, whohad she has a couple autoimmune
issues and she had no onehelping her through that, she
had to do her own research andthis was several years ago.
There's a lot more things now,like podcasts and free
(55:25):
information.
You have to be a little careful, like vet, what you're reading
or listening to.
But she had to educate herdoctor on thyroid issues and it
was a very long and frustratingroute for her to find wellness.
So I think, trust your body andmaybe, if you feel like there's
a lot happening for you, goback and give a listen to that
(55:47):
episode four because there arethings in there that she's able
to offer.
Hey, here are some places youcan find information that she
did through certain podcasts etcetera.
And the one thing because Ithink we simplify things like
supplements, it's like they'llshow up in your social media
(56:08):
feed and they have quotetestimonials there and it's like
, oh, I'm gonna try this andthere's a payment plan and you
can have all these thingssitting on your counter and,
like Jane mentioned, a grocerybag of supplements.
And so, to have a startingpoint with my sleep program, I
give you a supplement tracker soyou can actually write it down
and have to put in there likewhy are you taking it?
(56:28):
But it also gives you a tool totake to your medical provider,
which I think it feels easier ifyou can walk in with a paper
and say, look, here's what I'vebeen trying, here's why it can
save you a lot of time.
If you are in a situation whereyou know you're going into that
appointment and you are on theclock, they might have allotted
seven minutes for yourappointment.
(56:49):
So just a few small things thatyou can do, I think, to maybe
ease that path a little bit, toget to a space where you feel
heard and where you feel likethere are things happening that
are starting to sort of steerthe ship for you in a healthier
direction.
Well, I have loved ourconversation today.
(57:10):
It actually went a little bitlonger than my typical episodes,
but I think it has been sowonderfully in-depth and
detailed and just a delightfulconversation.
So I want to thank both of youfor taking the time to be here,
because I know building your newpractice has been very, very
sort of all-encompassing, so Ilove that you were able to set
(57:30):
aside time for us today.
Jane (57:33):
Thank you, Mary.
We were so excited to do thiswith you today.
Mary Ellen (57:36):
Yeah, it was really fun.
It was really fun.
You're doing great work outthere, so thanks for including
us.
Mary (57:41):
Thank you, and we're going to find a time to do a whole
episode on diet.
I swear we're going to do it.
So sounds good.
So I also want to thank all ofyou for listening and you know.
More than anything, I'd love tohear from you, because when I'm
sitting behind the mic it canbe sort of like who's hearing
this, and you know what aretheir reactions or responses.
So I'm really also amazed atthe community we're building.
(58:05):
So if you have thoughts aboutthis episode, please comment or
actually you can text me.
I can't answer you, but there'sa text link in the show notes.
If you want to have a moreprivate communication, and if
you have someone in your lifethat's struggling with the
symptoms that we've talked abouttoday, please consider
forwarding this episode to themand you can check out the
(58:26):
program I designed specificallyfor women who struggle with
sleep.
It's really again a 360approach to lifestyle, because
everything, everything isrelated to sleep and sleep's
related to everything.
You can find a link for that.
It's called Restored.
It'll be in the show notes and,if you love listening, consider
joining the Growing Garden ofViolets and support the show
(58:48):
using the heart button or thelink at the bottom of the show
notes, depending where you'restreaming from, and until next
time, go out into the world andbe the amazing, resilient,
vibrant violet that you are.
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