E57. Menopause, Hormones, and Mental Health: Oh My! with Menopause Specialist Dr. Leigh Lewis

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
It's not how high or low your estrogen progesterone

(00:04):
is.
It is the fluctuations that arehappening, and we know that
these hormones fluctuatenaturally during our menstrual
cycle and in pregnancy andpostpartum, and then again in
perimenopause that fluctuationbecomes pure chaos.
So it's kind of like thisperpetuation becomes pure chaos.

(00:28):
So it's kind of like this.
And so some women are justexquisitely sensitive to those
changes from high to low andthat can really set women up for
having anxiety and depression,in particular sleep problems.
I kind of lump together withmental health issues as well.

Speaker 2 (00:42):
Hi and welcome to the Air we Breathe finding
well-being that works for you.
I'm your host, heatherSayers-Layman.
I'm a National Board CertifiedHealth and Wellness Coach,
certified Intuitive EatingCounselor and Certified Personal
Trainer.
I help you get organized andconsistent with healthy habits,
without rules, obsession orexhaustion.

(01:04):
This podcast may contain talkabout eating disorders and
disordered eating.
There could also be some adultlanguage here.
Choose wisely if those areproblematic for you.
Hi everyone and welcome to thisepisode of the Air we Breathe.

(01:24):
Today I'm talking to Dr LeeLewis.
She is a certified menopausepractitioner, as credentialed by
the North American MenopauseSociety, as well as a naturopath
.
We talk a lot aboutperimenopause and menopause
today.
Don't run away if it's nothappening to you, because if you

(01:47):
are administrating female, itwill, and it's good to know this
information so that you don'tsuffer, because that happens a
lot.
This stuff shouldn't be asurprise.
It's all how it is.
Anyway, we go over like flagsfor anti-science content because
I think it's so hard to tellwho's the real deal and who is

(02:09):
just selling you some garbage.
So we dive into that.
We talk about weight andmenopause.
I think this is always a bigtopic and not a lot of clarity
around it, so I wanted to coverthat with her.
We do discuss some mentalhealth with times that our
hormones are changingPerimenopause, puberty,

(02:32):
childbirth and I really wantedto get into some facts about our
mental health during thesetimes.
I feel like many times we canget dismissed or not believe
ourselves, and it was good toreally chat with her through
that and also the last partabout believing women and how

(03:01):
treatment for menopause canabsolutely be symptoms-based.
So just imagine a world whereyou tell someone here's what I'm
going through, they believe youand they free you for it.
What?
All right, I hope you enjoythis episode as much as I
enjoyed recording it.
All right, well, I'm very happyto be here with you, dr Lewis.

(03:23):
So why don't you go ahead andintroduce yourself?

Speaker 1 (03:28):
Sure, my name is Dr Leigh Lewis.
I'm a naturopathic physicianand I work here in Phoenix,
Arizona, but I providetelemedicine all around Arizona
and even to some other states aswell.
My specialty is perimenopauseand menopausal hormone therapy

(03:48):
Mainly.
I also do a lot of thelifestyle work around menopause
as well, and that's my firstlove.

Speaker 2 (03:59):
What is it that attracted you to menopause?

Speaker 1 (04:04):
That's a great question.
I was.
I went and this, I think,speaks to a lot of what I really
like about working withmenopause and with women and
hormones is I actually startedas a psychiatric case manager
right out of college and Ireally always saw the value in
psychiatric medications and alot of people think that's very

(04:24):
strange that I then went on tobecome a naturopathic physician.
That is a long story, but Inever really liked the fact that
in medicine we especially inthis country, we really do
separate out mental health andphysical health and I think when
you're working with womenaround hormones you have to
really focus on both or you'reonly going to get so much

(04:48):
benefit from the treatment thatyou're working with.
So I, luckily enough, had thisgreat mentor the first year of
school.
They always matched us up witha mentor and that mentor went on
to do this two-year integrativemedicine residency that had one
spot integrative women's healthresidency, sorry and I applied

(05:11):
for that and was able to getthat.
And so when I graduated I movedfrom Seattle to Portland to do
that two-year postgraduatetraining in integrative women's
health and I from there just hadso much experience to setting
with setting up my all myobservations with medical
doctors, and so I really got tolearn a lot of the conventional

(05:34):
side and what the conventionaldoctors were offering.
But I worked with hormonespecialists and menopause
specialists and reproductiveendocrinologists and OBGYNs and
general endocrinologists and Ireally got a great background, I
think, in hormones and how itcan really impact, or how they

(05:54):
can really impact, womenthroughout their reproductive
lifespan, and so that's alwaysbeen my interest.

Speaker 2 (06:02):
Oh, that is very interesting.
I always think it's kind ofinteresting how, you know, we
weave through and do a lot ofdifferent things and then all
these different places that weland.
And I should also say that youare my doctor, and which I think
now since probably 2000.
So you've been escorting methrough the menopausal process

(06:24):
and which has been reallyhelpful because I watch a lot of
the other content flying aroundand which I specifically picked
you because of your content,because here's a citation and or
like here's a public med id,like okay, so I could actually
go look at this and it is real.

(06:48):
Um, because I think that kind oflike there's, you know, two
issues, I think, because I haveworked, uh, or I worked, with a
nature path before you and shewas very disordered and, I would
say, not really following theevidence.

(07:08):
So I was delighted to find you.
And also you're so vocal onInstagram and sharing evidence,
which I think is reallyimportant to see and like for
you in the field, like are therecertain red flags that you

(07:28):
think are really important forpeople to look?
Because almost everybody nowhas at least a website, but
usually a social media presence.
Like what do you think peopleabsolutely need to look for to
be like ooh, this is a no.

Speaker 1 (07:44):
That's a great question.
I think that it is reallyimportant for people to truly
investigate.
Like you said, there's a lot ofinformation out there and
websites are a great way to geta little bit more information
than the pictures and thesnapshots that you might see on
social media.
And I know I for one have donea lot to really make my website.

(08:05):
You know I don't want to seepeople who were not going to be
a good fit, so I try to put itall out there that I really do
follow the evidence and I havehad this special training.
I am certified by the MenopauseSociety and I am a naturopathic
physician.
I lay that all out.
I think one of the big redflags that I see on social media

(08:26):
is that people will say thatthey're menopause specialists
and they have no extra training.
I mean, I actually I think as anaturopathic physician, I had a
lot of training in hormones, Ithink, and especially then with
the postgraduate training.
But the research changes somuch and you know I did when I

(08:47):
first got out of residency.
I did focus on perimenopauseand menopause as part of again
that physical and mental healthacross the reproductive lifespan
, but just this year I'vedecided to focus solely on
perimenopause and menopause,because there's so many people
out there who need this help andit is more fulfilling to me as

(09:10):
a physician.
I really like to educate peopleand so I see my website is
doing that.
I, you know, really try to putthe information out there so
that you know if someone islooking for just something
different than what I offer.
I want them to be able to knowthat maybe I'm not the right
person for them.
So I don't want to wasteanyone's time or money by, you

(09:35):
know, having an hour longappointment and then just
realizing that the treatmentplan I'm offering is not okay.
So I think people can reallylook for that.
I think also for red flags isyou'll see like and again, we
all have our different places inmedicine, but you'll see
chiropractors and physicaltherapists and maybe even some

(09:57):
people who did like a nutritionsession.
You know calling themselveslike menopause specialists.
In this specific area, prettymuch it's standard practice in
medicine.
You really don't call yourselfa specialist unless you've had
extra training and certificationin that.
And if there is certificationavailable, then why isn't that

(10:19):
person, you know, taking thetime and putting in the effort
and the money to go ahead andget that certification to set
themselves apart, because itdoes mean something.
I at least I think so, and soyou know that to me is a big red
flag as well If you are lookingat someone's website and they
say they treat cancer and theytreat autoimmune conditions and

(10:42):
they treat thyroid problems andthey, you know blah, blah,
gastrointestinal specialist andall this stuff.
You know it's kind of like thatsaying you know, master, oh my
gosh, now I'm going to forgetthe saying, but you can't do it
all.
Unfortunately, you just can't.
I mean, I would say too that ifyou look at my website, in the

(11:02):
resources on the menopause pageI have I've been listing all of
the really recent research thathas come out about menopause and
you'll see, in April and Maythere were 10 kind of
groundbreaking menopauseresearch articles that came out
that you just can't possiblykeep up on that type of
frequency of research unless youtruly are specializing in it,

(11:26):
and I think there's probably abig financial interest in not
necessarily keeping up, becauseI'm assuming a lot of people
that are not as evidence-basedhave a program or a protocol and
so they're gonna recommend thisthing and it doesn't behoove

(11:47):
them to come up with any or, youknow, to read any information.

Speaker 2 (11:51):
that's like, oh, you know what, now we found out
we're doing it a little bitdifferently.
So I could see, um, cause I dosee a lot of like fixed programs
and here's the thing, or here'sthe way to eat, which, you know
, I definitely see the way toeat always like is so glaring to
me with menopause.

(12:12):
It just seems like one of thosekind of vulnerability, like
profiting just off of somebody'svulnerability, I guess.

Speaker 1 (12:23):
Profiting just off of somebody's vulnerability.
I guess, yeah, that's somethingvery specifically that I do end
up posting a lot on, because Iyou know, and I don't really
want to use the word malpractice, but I do think that some
people put them out therethemselves, out there as
specialists, they it's verydifficult to find their degrees
If you look, you know, evensometimes on the websites you

(12:46):
have to go.
Sometimes they don't even eversay, and they call themselves a
doctor.
Well, sure, a chiropractor is adoctor, but the breadth of
treatment you can get from achiropractor for menopause is
very different than what you'regoing to get from someone who's
actually a prescriber.
And sure, not everyone wants todo hormones, but the evidence

(13:07):
base says that menopausalhormone therapy is number one
for treating the symptoms ofmenopause.
So sure, you know, if you see aregistered dietician and they
suggest not over consuming sugaror, you know, cut back on the

(13:28):
alcohol quite a bit to reallyimprove your sleep and your hot
flashes, that's great, like thatis evidence based and that
makes a lot of sense.
But if you're going to see a,you know, there's one particular
chiropractor out there whocalls herself a menopause
specialist, who advocatesfasting, and I'll tell you that
if you again look at thestatistics, we see a bump in the

(13:49):
number of disordered eatingissues in teens and young 20s
and we see another one in the40s and 50s.
So I really it gets my hacklesup when I see people selling
these programs which basicallyadvocate for very restrictive
diets and starving yourself to.
You know, try to get into yourgenes from eighth grade.

Speaker 2 (14:14):
Yeah, I totally know exactly who you're talking about
and I definitely, because Iwill follow people who debunk,
which is my favorite thing, andI see her videos so often and
I'm I just I'm also so surprisedbecause I'm like this, like
this is the one that you're likeyes, she sounds great, because

(14:35):
also anybody that's like thelonger you can go without food,
the better.
Like Like really, and in what?

Speaker 1 (14:45):
way is that better?
Well, and what you brought upabout the programs is they get
you at the front end.
One of my patients shared withme about this physical or
personal trainer who was sellingthis program, which is
similarly priced to thechiropractor it's about $1,500.
They get that money up frontand what she showed me that she

(15:07):
got for that and she got all theway into this without realizing
that it would not also includerecommendations or prescriptions
for hormones, which you know Ihad someone on threads comment
like oh well, buyer, beware, sheshould have looked harder.
But I'll tell you, I looked allthrough that information and I
couldn't find anywhere about hereducation and OK, yeah, that's

(15:27):
a red flag.
But I do think that people gointo these, you know, looking
for assistance because they'restruggling and they're suffering
and they see someone who lookslike they really care, they look
like they have the answer, andthen they get your $1,500 up
front and you basically get whatis a very general meal plan

(15:50):
that, literally, the patientprobably could have written
herself just by.
You know, following aMediterranean food pyramid and
doing all the things we know weshould do Increase fiber,
decrease alcohol, you know, tryas much as possible to eat a
whole foods diet.

Speaker 2 (16:06):
Well, I'm glad you brought up the bump in eating
disorders during menopause,because I absolutely, you know,
obviously I'm in eating disorderrecovery myself and I see you
know exactly how that happens,because bodies change and the

(16:27):
very common narrative is likenot if you work hard enough, it
won't change.
And what like conversations doyou end up having around body
changes and menopause?
Because there absolutely arepeople you know that I can
distinctly think of who say likeyou shouldn't be, that means

(16:49):
that you're doing somethingwrong.
You're just eating too much isbasically what they say.

Speaker 1 (16:55):
Yeah, there's that.
And then there's also thepeople who promise that their
hormone program will help youlose weight.
And there's a couple thingsthat the research does tell us
about midlife body compositionchanges is that with the loss of
estrogen, your body does try tokind of help you out by adding

(17:17):
adipose tissue in the trunk andthe mid section, hips, butts,
thighs, abdomen and sometimeseven the back and the chest area
.
That adipose tissue and this isnew since I graduated, again,
why you have to keep up with theresearch that adipose tissue
actually acts as an endocrineorgan and produces estrogen.
And so you know we are aspecies that you know would go

(17:40):
way back evolutionarily.
We are set up to reproduce, youknow, as far as long as we can,
and so when those estrogenlevels start to drop off, our
body tries to, you know, maybeeke out, you know, a couple more
ovulatory cycles by gettingthat estrogen level up with this
extra fat tissue, and with thatcan sometimes come extra weight

(18:02):
.
And we do see that happening inthe research, even though,
again, there are some people wholook at the research and say
there's no increased weight gainassociated with menopause.
You know, maybe in somescientific studies where you're
looking for statisticalsignificance, you're not going
to find that most people do, butI definitely see people who

(18:23):
they're like you know.
Two years ago I started to, youknow, I couldn't fit in my
pants anymore, and then one yearago my menstrual cycle started
changing and that's like okay,well, that sounds like
perimenopause to me.
So, you know, sometimes you dohave to put that together.
The good news is is thatsometimes you know the weight

(18:43):
change that is typically.
I do see people outside of thisor people who don't gain weight
at all, but it's typicallyabout five to 10 pounds and it,
you know again, it is in thatmidsection.
The good news is is that if youdecide to use hormones like
estrogen, that if you giveestrogen from the outside,
sometimes it's a signal to yourbody like you don't need to help

(19:11):
me anymore.
I can, you know, handle givingyou some estrogen through this
patch from the outside, and sothen your body gets that signal
and due to the you know, goodnutrition you have and the
activity that you had prior toperimenopause, you oftentimes
can get back to that, but notall 100%.
And then you have to think alsoof the other symptoms that go
along with menopause, that dohave to do with the hormones,

(19:34):
but they don't seem specificallyhormonally related.
When you lose estrogen andtestosterone in particular, you
can be really tired andunmotivated and kind of like meh
about everything.
Like you used to maybe bereally motivated to wake up and
go to that 5.30 exercise classand now you are waking up at 3

(19:55):
am and not getting back to sleepand you don't feel like getting
up and going to that exerciseprogram and so and then poor
sleep.
We know that poor sleep canreally impact your weight and
body composition again.
The mood changes that canhappen with anxiety and
depression.
Sometimes it gets you justdon't really feel like you know

(20:16):
working out because you'redepressed and you know that is
one of the symptoms is ofdepression, is feeling like you.
You know, maybe let some ofyour self-care things go because
of that symptom.
So there are ways that thehormones can impact weight
through these other channelsthat might not be very evident

(20:37):
at first.

Speaker 2 (20:38):
And that's I definitely that's where I see a
lot of predatory pieces whetherit is, you know, hormones,
pellets or a diet to be able tokind of like get back and I
think that's one thing like whenI discuss with my clients it
just might not be a get backthat your body has changed and

(21:01):
you know what would that looklike if we were more accepting
of that and trying to find somepeace around.
Like my body changed at puberty, my body changed after having
kids.
My body's changing now, BecauseI think that is certainly a
narrative that isn't supportedin a lot of places.

Speaker 1 (21:22):
Yeah, another post that I did was from a patient
who ended up spending.
Well, she spent $400 for theinitial appointment and then she
was offered testosteroneinjections for $100 a week.
And when she told me the nameof the clinic, I won't say the
whole thing, but basicallyageless was in the title

(21:43):
Hormones and perimenopausalhealth postmenopausal health.
It has nothing to do withagelessness.
We are not vampires Like we arenot ageless, like aging is going
to happen and if we look atperimenopause as a time to reset
our focus on the healthiest wecan be at our given age, that is

(22:07):
where the importance come from,and I know, heather, that you
are really an advocate, too, forhealth at every size.
I like, maybe put a little spinon that health at every age,
like we're not going to have theskin that we did at 20.
I'm sorry, and I know that alot of people, if you're
listening here and you live inScottsdale, you see all the
plastics that people do to theirface.

(22:29):
They don't look like they're 20.
They look like they're 70 witha lot of plastics.
You know so it's.
You know, maybe that is whatyou want to look like, that you
know.
Again, not body shaming people,but if we're going to be the
healthiest psychologically andphysically that we can, it is
not by trying to be ageless orhaving these, you know, ideal

(22:53):
body weight or ideal figures.
That you know.
We don't even know what thesepeople on Instagram are doing to
look like that.
I can tell you that I hear alot of people.
You know, after their last kidthey're getting their breasts
lifted and they're getting, youknow mommy makeovers and having
liposuction and tummy tucks andthings like that, and they're

(23:13):
not talking about that onInstagram, right?
So you know everything with agrain of salt.
But there are predatory clinicsout there that are promising
hormones to you know causeweight loss.
It's not how it works,unfortunately cause weight loss.

Speaker 2 (23:34):
It's not how it works , unfortunately.
Do you feel like thedo-it-yourself approach to
improving your healthy habitsdoes nothing except feel
overwhelming, guilt-inducing anddefeating?
You don't need more rules,influencers or structured
programs.
Let me help you discover whatyou want, what works for you and
how to maintain healthy habitsduring the ever-changing
circumstances of your life.

(23:55):
If you're ready to createsystems that stick head to
heathersayerslaymancom backslashhealth dash coaching and click,
let's do it it.

(24:18):
I think it's such an opportunityto like redefine health.
I mean, health means somethingdifferent to everyone and it
should.
But it seems like um, takingthe lens off of weight gives you
an opportunity to say like okay, so what?
What do I want health to looklike?
Because, um and I certainly runacross, like so many women that
are like I'm done with this, Idon't want to count anything

(24:40):
anymore, like I'm sick of, likenever eating this food or never
eating this food, and they'rejust trying to find some kind of
comfort and balance.
And I think you know my focusis also that we don't have to
overdo.
I mean, I talk all the timeabout healthy habits without
obsession and exhaustion, but weare able to still pursue health

(25:04):
, but then we also get to kindof decide what flavor that will
be, especially if you've beenpursuing weight loss for a
really long time, because Iassume you see a lot of people
that really have that focus andlike, how do you help them kind

(25:26):
of widen their viewpoint of whathealth means?

Speaker 1 (25:32):
Well, I really do, and it might sound a little cold
but I really do lean in Factsare facts right?
So you know, I did just do apresentation for a community
group about metabolism andmenopause and say, for example,
with the push for semaglutideinjections and a lot of people

(25:54):
come to me wanting that butdon't meet the criteria, and
what I will share with them aresome of the facts about the
research that's out there thatdon't necessarily get shared.
For example, the research thathas been done on semaglutide for
weight loss and for improvementand reversal of diabetes and
that such thing.
First off, the people who arein those studies, their BMI

(26:17):
which I know BMI is imperfect,but the BMIs where people have
to meet these criteria to evenget in the studies, they're 47
to 52 BMI, and I'm not saying Idon't see people of that size,
but the majority of women that Isee actually have a normal BMI.

(26:39):
And again, they're just lookingat that weight distribution
that has changed because of thehormonal changes.
So that's one thing.
So when you look at 15 to 20%weight loss, that's not in
someone with a BMI of 27.
That's in someone with a BMI of50.
So that looks very different.
And so when you look at it, likethat person might be losing 50

(27:01):
pounds in the study, but our youknow kind of typical gal who
might have a BMI of 27 or 28,she might lose like 7 to 10
pounds, spending $1,000 a monthto get that Ozempic injection.
And you know, for some people 7to 10 pounds really, you know,

(27:22):
does mean a lot to them withtheir scale, but it doesn't
change health.
And again, looking at thepeople who are really who
Ozempic is made for and Wagobeis made for, those are people
who are going to be on lifelongmedications anyway because of
their blood sugar and diabetesissues.
They were also probably lookingat bariatric surgery or already

(27:42):
had bariatric surgery, sothat's in addition to those
medications.
So that, I think, is, you know,part of that that comes out
when I talked to that communitygroup again, this is just the
people who happen to be, whohappened to show up for it but
they were like, you know, when Ikind of when I asked like, well
, seven to 10 pounds, is thatworth $1,000 a month?

(28:03):
And then, when you stop it, tohave two thirds of the weight
gained back within six months,no, they were like that.
No, that's not worth it.
But you don't see that from RedMountain or these clinics that
are pumping out, you know, thecompounded semaglutide for a

(28:23):
very large price margin forthemselves large price margin
for themselves.

Speaker 2 (28:34):
Yeah, that is really interesting because it also to
me, because I've certainly hearda lot of conversations of I'm
going to do this for threemonths, because I think also
those clinics are packagingthings of like, yeah, you come
in, you'll do it three months orsix months or whatever, and
then, as long as you've got yourhealthy habits in place, like,
you'll be fine, which is wildlyinteresting to even say, because

(28:58):
if you go off of the medicationand you're hungrier, like you
can have all of the healthyhabits you want, but at some
point your body is speaking andyou're going to have to listen,
like I always just think that issuch a.
I mean, I just think it justsounds so weird that like, oh,

(29:19):
okay, I've got my healthy habitsin place, because also in
pursuing health for the betterpart of my adulthood, that
changes constantly because like,oh, now I hurt my back, so I
guess I can't, you know, reallywork out and do this.
Or, um, you know, affordabilityof food, like all of these
different things.
So I think it's just theweirdest thing to be like, yeah,

(29:41):
this is, you know, in the shortterm, like this will help and
it just it has that same quickfix mentality that you know.
You and I've heard a bazilliondifferent things that are going
to help.
It's just a short term thingand then you're going to be good
to go.

Speaker 1 (29:57):
Which, if you look at and you probably have heard of
this term, you know with theresearch you've done on
disordered eating there is aprocess called metabolic
adaptation or compensation,where, if you are so, say, for
people who are, you know, kindof over exercising, doing more
than they need for health orstrength or balance like the

(30:20):
things that we really need goinginto our 50s and 60s so that we
don't fall and break a hip they, they will just like, naturally
crave more calories becauseyour body, if you're working out
that much and you're literallystarving yourself.
So some of these weight lossclinics like to do it used to be
very fashionable and I just sawsomeone come in who was doing
it with the HCG, the HCG diet orthe human growth hormone diet.

(30:45):
The same thing.
Give these injections of thismedication or substance I guess
you might call it, and theylimit you to a 500 calorie a day
diet.
Sure, you're going to loseweight for doing that.
For again, like you said, theseare always time limited for a
month, six weeks, 90 days butthen they push you out the door

(31:06):
and they don't expect to see you.
But when you leave, you're notgetting that injection but
you're also eating more than 500calories a day.
They also don't let youexercise.
So, again, your body kind of,you know, if you're starving it,
it actually does have amechanism whereby it will hold
on to body weight.
It'll hold on to fat inparticular, and let muscle go

(31:28):
because it's worried that you'renot going to feed it.
Again, you know our bodies areset up for like the cold, dark,
winter or, you know, the harvestfailing or something like that.
And so if we're not consumingenough calories, that can
actually backfire on you to alsonot lose weight.
And so we see that again withover exercisers or people, or
even people who are exercising,say, for a half marathon or a

(31:51):
marathon.
That's your goal, or somethinglike that.
Again, if you're not consumingenough calories to support that,
you'll see people who arerunning a lot or cycling a lot,
stuff like that.
They'll gain weight whenthey're doing that because
they're not eating enough.
And your body just is holdingon for dear life, just in case
you get sick or in case youcan't find food.

(32:12):
Well, we don't have a problemwith that in this society, but
we do still have thatevolutionary mechanism, is still
holding on and can sometimesagain in some people.
We're not all the same, but insome people, when you really
restrict your calories down, youmight not see it the first week
, you might not see it the sixthweek, but you will see it, this
rebound of weight gain, even ifyou're you know I talk to

(32:35):
people all the time they saythey barely eat and they don't
lose weight.
That's, your body is not goingto let those calories go.

Speaker 2 (32:41):
That's always really interesting because I think
there is like a prize or trophy,like all kinds of things out
there of like you know, I'meating the least amount possible
and it's like it's.
It's not the flex that youthink it is, because your body
is not a big fan of this.

Speaker 1 (33:00):
Yeah, yeah, and of course it can't.
It can't, then it loses thenthe nutrients that are the
building blocks forneurotransmitters, the building
blocks to make energy or ATP inour body.
Our brain is fat like.
We need those fatty acids to dothat.
And then, like I alluded tojust generally, is the muscle

(33:23):
loss that goes along with that.
Well, perimenopausal women, whooftentimes are, you know, have
undetectable testosterone levels, are already losing muscle.
So then you add that onto itand that actually can really
turn around and bite you,because the less muscle you have
, kind of like the less yourbasal metabolic rate is, or just

(33:46):
the less calories you burnthroughout the day.
So you know you're, you'redoing these things at the
expense of very important partsof your body that, like, again,
we need our muscles there sothat we don't trip, fall and
become weak and break a hip.
So you know, again, we just wedo that to our detriment.
It might not be in the shortterm, but down like future, you

(34:09):
will be annoyed that you reallylimited your calories and maybe
you even have brittle bonesbecause you weren't eating
enough calories.
You know, even despite the lackof estrogen that we have to
deal with, that also can causebone loss in the 50s.
So a lot of these things cancompound on each other.

Speaker 2 (34:32):
We want to switch gears a little bit into mental
health, because you mentionedthis before we got started about
some research that's coming out, or recently came out, about
mental health and perimenopause.
Can you talk a little bit aboutthat?

Speaker 1 (34:50):
Yeah, there is.
First off, I would like to say,a resource that I think is
really great for anyone who is aprovider or also anyone who's
just interested in mental healthand women's health, is the
Massachusetts General Hospitalhas a Center for Women's Health
and they put out a weekly emailthat shares a lot of the

(35:11):
research that has come out,regardless of which stage of
life you're in.
It could be for PMS orperimenstrual mood disorders or
perinatal mood disorders orperimenopause, and they write
their abstracts of the study ina way that anyone can understand
.
So that's very nice.

(35:31):
You can kind of keep up withwomen's health, mental health
research, in that way as well.
But what we really see and thisis again something that I don't
think is oftentimes understoodis that if you've had mental
health issues or psychologicalsymptoms at puberty, with PMS,
with perinatal mental healthissues, all of these things can

(35:56):
predict kind of the next stageof having mental health issues.
So we know that women who havemental health issues at any time
of her life prior couldpotentially, or is at an
increased risk forperimenopausal mental health
issues.
The second thing that we reallyknow is it's not how high or

(36:17):
low your estrogen progesteroneis.
It is the fluctuations that arehappening, and we know that
these hormones fluctuatenaturally during our menstrual
cycle and in pregnancy andpostpartum, and then again in
perimenopause that fluctuationbecomes pure chaos.
So it's kind of like this, andso some women are just

(36:43):
exquisitely sensitive to thosechanges from high to low, and
that can really set women up forhaving anxiety and depression,
in particular sleep problems.
I kind of lump together withmental health issues as well and
so with a lot of these again,if we can kind of reflect back

(37:03):
to people who are promisingthese programs or you know,
menopausal hormone fix, quickfixes and stuff like that,
they'll oftentimes sell thesehormone tests, and hormone tests
are not helpful for any ofthese mental health issues in
perimenopause or even earlier on, because what they do is they

(37:24):
take a snapshot of how youlooked on a specific day,
whether it's through blood orurine or saliva.
It is not helpful because whatwould happen is you could look
perfectly normal during thattime where they checked your
hormones, but you could still bereeling from the mental health
symptoms that go along with justthe changeability of the

(37:47):
hormones during this phase.
And if they were to check yourhormones six weeks later which I
don't recommend because we'dhave to be at a specific time.
Six weeks later it could looktotally flip-flopped and it
would show that your hormonesare in the toilet.
That is just the reality ofwhat happens during
perimenopause.
So you can work with theseproviders who might sell these

(38:09):
Dutch tests or saliva that'sdried urine.
Hormone tests is what Dutchstands for and then the saliva
tests for, you know, $200, $400,$600, and they're not going to
tell you anything, they're notgoing to inform the provider how
they should treat you either.
Like I said, if we, a lot ofthe treatment that I do is based

(38:31):
on retrospective symptoms.
So if someone tells me you know, a year ago they started having
problems sleeping, they gotreally irritable with their
partner and their kids, or theyjust don't feel like themselves
anymore and you know theirperiod has changed a bit, it
doesn't have to completely stopfor it to be a perimenopausal or
menopausal hormone issue, butjust the changeability maybe

(38:55):
it's gotten lighter, maybe thecycles have gotten longer, like
that basically closes the caseand we know that this is
perimenopausal psychologicalsymptoms, even, you know, in a
woman who's still having herperiod, even in a woman who's
not having hot flashes like youdo not need to have those things
and, like I said, despitenormal hormones, we can still

(39:17):
use hormones to treat thesesymptoms.

Speaker 2 (39:21):
That's a huge piece of what I have found so
comforting about your approach,because you know it's also
dealing with the.
You know entire other side ofyou, know my thyroid and things
like that with other doctors,because your whole approach is
tell me how you feel and thenI'm going to believe you and

(39:42):
then we'll actually create atreatment plan based on what you
just said, which in the otherside of medicine that I deal
with luckily I have a goodendocrinologist now like that
doesn't exist.
They're like well, you know, andit gets dismissed.
But I think that it also feelslike it really makes sense

(40:07):
because, like you can't measure,like I remember having that
irritability piece and Iremember being like like this is
, um, this is not rational forwhat is happening.
I could, I could totally likesee like well, this, you are
more upset than what is beingcalled for.
Um, and like there there isn'ta test, like, like should I have

(40:29):
to go to my doctor and say like, so he said this and I got this
mad.
Like oh, sounds normal to me,but you know the fact that
you're like oh, okay, well,you're saying that you feel
irritable, let's treat that likeshouldn't be groundbreaking,
but it kind of is.

Speaker 1 (40:49):
Well, and you know, another resource that I really
like is the InternationalAssociation of Perimenstrual
Disorders.
That's a kind of a mouthful butit's IAPMDorg Very easy, and
they have some great trackers onthere and I'll oftentimes ask
women who are in their 30s or40s to use those if they're

(41:10):
still menstruating, because themental health symptoms they
might not be always justpre-menstrual, they could also
be periovulation or maybe evenwhen your period it stops and
maybe those are only the gooddays that you have.
But we can kind of track thatthe hormones are changing again
in the buildup to ovulation.

(41:32):
So you'll meet women inperimenopause which PMS can
worsen and get longer for peoplewho had PMS previously, to the
point where they have one goodweek a month and that too, as
they track that out, it can tellme sometimes you don't need to
do a tracker.
I, you know again, believe thewoman.
I happen to have a selectionbias of a lot of medically savvy

(41:57):
women.
They've already researched thisstuff, you know.
They can tell me that you knowit's cycle day 10 and they can
basically be very mean to anyonethat they meet with.
You know, for the next 30 weeksand I'm going to believe them
and that is definitelyhormonally mediated.
We do not need a hormone testto corroborate that for us.

(42:17):
You know it's just like with.
You know we believe women ifthey say they're changing their
tampon pad protection every hourin terms of determining that
they're having like basicallyhemorrhaging with menses.
So why wouldn't we believe themwhen they're, you know,
reporting mental health symptoms?

(42:38):
Or you know energy issues, likeif your energy really drops
after ovulation and it doesn'tpick up until day two of your
menses, that is also, you know,hormonally mediated.
There are hormone and then,like I said, because during
perimenopause the hormoneproduction can just be all over
the place, that we're not goingto be able to map out this nice,

(43:01):
you know consistent slope thatwe had when we were 20 years old
and the other thing is slopethat we had when we were 20
years old and the other thing iswe talk a lot about age with
these hormonal changes, but youcan be perimenopausal at any age
.
I've had women who stop theirnormal menses in their 20s.
So you track back.

(43:21):
You can have perimenopausalsymptoms for 10 to 15 years
before that final menstrualperiod.
That woman could have been inher teens and so things that
might have been like oh, you'rejust.
You know, this is just relatedto puberty.
You're not getting your, you'renot hitting your stride with
your normal menstrual cycle.
Well, that woman might neverhave hit her stride with a

(43:41):
normal menstrual cycle becauseshe went from puberty into
perimenopause, into her finalmenstrual period at 28 years old
or again.
More normally will be the womanwho is in her late 30s, early
40s and starts noticing thesechanges.
You know, and I'll just kind oflump them all into quality of

(44:02):
life, their, their mood changes,their sleep changes, their
energy changes, their libidochanges, and these can all be
early perimenopausal symptoms.
That can go on, even forsomeone who's going to have
their normal or average finalmenstrual period at 51 or 52.
You can be experiencingsymptoms in your late 30s, early

(44:25):
40s, totally normal.

Speaker 2 (44:33):
So much.
Well, I appreciate you comingon and talking about all of this
, because I would I reallyappreciate your vantage point
and the evidence that you alwaysdo bring.
So tell everybody where theycan find you.

Speaker 1 (44:45):
So I'm on Instagram.
I'm also on threads.
I don't do that quite as oroftentimes I repeat, the stuff I
do on Instagram is Dr Lee Lewisand my website is
wwwarcadiowomenswellnesscom.
It's a big change, or a bigpain, I should say, to change

(45:07):
your domain name.
So, even though I'm working allover Arizona and doing telemed,
even with people in otherstates, that's going to stay.
So I mean, I do live and kindof play here in Arcadia.
So it matches that, I guess.
And that's the best way to findme is, you know, through the
contact form.
Like I said, I try to keep a lotof updated content about

(45:30):
menopause on my website.
You don't need to see me to,you know, learn about that.
And another resource that Iwant to share is menopauseorg.
That's very easy to rememberand you can do a provider search
or get a lot of up-to-dateevidence-based research there.
So I mean, you know, heather, Ithink we were talking before we

(45:52):
got online about like theanalysis paralysis that happens,
where people, just you know,are constantly looking at all
these new accounts, all thesenew influencers.
Find a couple that you reallytrust and again, those are
probably people who have had anextra education and
certification through themenopause society and just limit

(46:15):
yourself to you know the fivepeople that you really like or
the people that you can see arenot really gimmicky with
nutrition, menopause nutritioninformation and menopause
exercise information.
If they're, I'll tell you thered flags.
If they're asking for hundredsor thousands of dollars for a
program, that's a red flag.

(46:36):
You should not need to pay thatmuch for rational, practical
menopause information.

Speaker 2 (46:42):
Great Well, thank you for all of your information
today.
It was really nice chattingwith you.

Speaker 1 (46:47):
You too, Heather.

Speaker 2 (46:48):
All right, take care, take care.
Bye-bye, as always.
Please follow the show, or youcan leave a five-star review on
Apple or Spotify.
That would be fun too.
See you in the next episode.

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E57. Menopause, Hormones, and Mental Health: Oh My! with Menopause Specialist Dr. Leigh Lewis

Are You A Charlotte?