Navigating Menopause: What Does It Really Mean to Balance your Hormones?

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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Chapters

• 0:00 Introduction to Women's Menopause Experience
• 4:01 Understanding Sex Hormones and Their Functions
• 9:44 Perimenopause vs. Menopause: The Differences
• 13:01 Nutrition Foundations for Hormonal Health
• 26:56 Sleep, Movement, and Stress Management
• 34:23 Addressing Menopausal Weight Gain
• 44:28 Supplement Considerations and Finding Support
• 55:42 Closing Thoughts and Resources

Transcript

Mary: 0:05

Welcome to No Shrinking Violets. I'm your host, Mary Rothwell, licensed therapist and certified integrative mental health practitioner. I've created a space where we celebrate the intuition and power of women who want to break free from limiting narratives. We'll explore all realms of wellness, what it means to take up space unapologetically, and how your essential nature is key 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 the show.

Mary: 0:41

I feel like, as with nearly anything in life, social media has benefits and, for sure, drawbacks. With social media, we get a ton of information. But well, we get a ton of information, most of which we didn't ask for, and if you use social media, it can feel like watering your garden with a fire hose. If you pay attention to how you feel as you're scrolling, you might recognize that your neck is tense or your stomach is clenched. Our brains aren't meant to take in and process information in the way social media feeds it to us fast, based on what the algorithm thinks. We want words and sounds and images and split screens, and Okay, let me stop and reframe. One advantage of social media is that it helps us recognize that we're not alone. And for centuries, women going through menopause felt like surely no one else was experiencing what they were the brain fog and the crazy hot flashes and the exhausting, inability to get restful sleep, the waning sexual desire, irritability and, to use a phrase my college students used to say, existential angst. Yes, they really used those kinds of terms, because all of a sudden we can feel like different people, less relevant, and again like we're the only ones experiencing all the things, because no one talked about this type of personal stuff even a couple decades ago. I mean, yeah, maybe really close friends did, but also women were socialized and still are to bear down and deal like no complaints and no hysterics. But now, finally, we're sharing, we're admitting how we feel and we're finding that others have similar experiences. Social media, for better or worse, has redefined personal sharing and private information.

Mary: 2:35

Not a day goes by that I don't see some kind of ad for something related to menopause symptoms, but then there's the flip side. Not a day goes by that I don't hear something about menopause symptoms, but then there's the flip side. Not a day goes by that I don't hear something about menopause and many people want you to believe that there's a quick fix or a one-size-fits-all solution to symptoms. And here's where we get into the weeds again, because, yes, we all experience waning progesterone and estrogen. Our individual bodies react totally differently and respond to interventions totally differently. Honestly, that's one reason I designed my sleep program for women in midlife. It's built around nature, but it's tailored to each woman so she can figure out what works for her, because we all have similar experiences, but we're all unique. Because we all have similar experiences, but we're all unique.

Mary: 3:30

So if you're a woman just starting to experience the changes brought on by fluctuating hormones, or you are in the middle or even the tail end of menopause symptoms, I think the information that my guests today will share is going to help. They are functional medicine practitioners. This means that they take a full 360 degree approach to health, understanding how hormones impact our brain and our mood, not just our weight gain, and how nutrition affects the impact of waning hormones on weight gain, and how sleep is crucial to effective management of all aspects of health. I invited them to talk with me so you have a starting point to sift through all the insistent and sometimes conflicting messages that you might be getting on or off social media, and so you have a starting point to take action or talk with your own healthcare provider.

Mary: 4:16

My guests today, jane Snyder and Mary Ellen Franciscani, are certified registered nurse practitioners. Both Jane and Mary Ellen completed an integrative medicine fellowship at the University of Arizona Center for Integrative Medicine under Dr Andrew Weil and have advanced training through the Institute for Functional Medicine. Their clinical approach blends conventional care with holistic strategies to get to the root of illness. With holistic strategies to get to the root of illness, support healing and promote long-term wellness. And in 2024, Jane and Mary Ellen co-founded Middle Way Wellness, a direct primary care practice that is a revolutionary healthcare model, fostering a more personalized relationship with their patients. That emphasizes prevention and wellness through integrative and functional medicine. Welcome to no Shrinking Violets, Jane and Mary Ellen.

Jane: 5:15

Thank you, Mary. We are so excited to be here. This is a huge topic that we love talking about. We're big fans of no Shrinking Violets and we're really excited to share this information with your listeners today.

Mary: 5:31

Cool. So after my very long intro, let's get to it. So the world of hormones is really complex. I had to learn that a lot for myself just going through menopause, and I swear that we hear balance your hormones all the time and I know that that's actually true, but it's also really complex. There's no quick fix. So let's start with what are the hormones that really impact us the most as women as we get older and what are some of the changes that we might move through from peri to postmenopause.

Jane: 6:11

Yeah, Mary, this is a great place to start and lay some groundwork for our conversation today. You know most of us as women recognize that we have estrogen and progesterone as our main sex hormones, but we also have testosterone, that we have estrogen and progesterone as our main sex hormones, but we also have testosterone, just not in levels that men have it. And these three sex hormones work together synergistically throughout the body, and I think most of us as females really recognize that. They regulate our menstrual cycle every month or preparing our body for a pregnancy, if that were to occur. It also they help us with pregnancy and delivery.

Jane: 6:49

But what many of us, I think, forget is that they work throughout our body. So, for example, estrogen has over 400 different receptors in our body, from our head to our toe. So the estrogen is impacting our brain health, our cardiovascular health, our hair, skin, our nails, our mucous membranes. So I really like to think of our estrogen as more of a lubricator, and I'm sure women that are listening in menopause could attest to that.

Jane: 7:18

I hear oftentimes that there's a lot of drying up that happens with menopause and that's really related to our estrogen, Now our progesterone. I really like to think of that a little bit differently and it really impacts more of our bone health. It helps to lower inflammation in our body and this is also the hormone that oftentimes gives us trouble with sleep as we enter menopause. Testosterone is the third sex hormone and testosterone really does a lot of the heavy lifting in our overall sense of well-being, our confidence, our motivation, and also plays a big role in our strength, building our muscles and, for most women, it also really influences our sex drive Very good overview, yeah, and I remember learning about the complexity of this, thinking that, okay, so estrogen and progesterone only really impacted me during my pre-minstrel days.

Mary: 8:18

And then, when I started to recognize the role even estrogen plays in brain processing of certain things, I was like, wow, no wonder there's kind of this cascade. And so for me, working in mental health, when women say like I have these crazy mood swings, it's like well, yeah, because perimenopause is really when you're going to have a lot of fluctuation right From month to month before it kind of like comes to a halt. You're going to have a lot of fluctuation in how those hormones are impacting you and your body.

Jane: 8:56

Yeah, absolutely, and I'm glad you brought up perimenopause because I think that that's also a confusing time. So if we, you know, go back to when our hormones start kicking in, that's also a confusing time. So if we go back to when our hormones start kicking in, that's usually during puberty and then throughout our menstruating years, our progesterone and estrogen they're just cycling on a 28-day cycle, so really they should be going nice and up and down regularly. You get your period. But perimenopause is that time frame that comes right before menopause and what's happening during that time is our ovaries are starting to do their own thing.

Jane: 9:32

So some months you may have surges of your hormones, while other months your ovaries are really lazy and don't do a whole heck of a lot. And that's when women start experiencing changes in their menstrual cycles. So they may skip periods, they may become heavier, but that resulting effect influences, like you were saying there, mary, our mood and that feeling of just being unbalanced. And that perimenopausal time frame can happen up to 10 years before actual menopause, with knowing that menopause happens around the age of 52, perimenopause can start in your early 40s. So that's a really, really long period of time when women are frustrated, not sure what to do, and a lot of times they're being told that you know there's nothing going on with the hormones, when in fact there really is.

Mary: 10:23

Yes, and you know this is a topic for another day, but I just want to kind of throw it in here that when I approach this issue with women, especially when we're talking about sleep, which is, of course, very complex a lot of women, as they enter perimenopause, are starting to have sleep issues, and sometimes it's also just the accumulation of life. I think that all that dovetailing at once like you're in this phase of life where a lot has probably happened you might now be raising children, or you may have a new marriage, or you might be coming out of relationships there's so much that we store in our bodies and then, when we start to have the function of our physical body on top of that, it does create a situation where, I think, women can feel so overwhelmed and sometimes balance your hormones. So is that a thing? Can you balance your hormones? And, if you can, what would be some of the keys to helping that happen?

Mary Ellen: 11:34

That's a great question, mary. We get that question a lot and while the phrase, as you said, balancing your hormones is thrown around now a lot, like you said, on social media and wellness spaces, the concept itself is absolutely valid, but I want to just go into defining it a little bit because I think there's a lot of misconceptions out there about what that actually means. So, backing up a little bit into going back to biology, hormones don't exist in isolation and I always explain to patients they operate in a dynamic network and I like to think of them as an orchestra. So during perimenopause, your estrogen, progesterone and testosterone are all over the place Women come in complaining of. Often what I hear is in perimenopause, I just don't feel like myself, and so I like to use the gas tank analogy. So in perimenopause, as Jane said, sometimes the tank runs super low, but at other times, without any warning, it's overflowing and once we get into postmenopause, our levels of estrogen, progesterone and testosterone completely tank and we have an empty tank. And it's sudden, if you imagine that orchestra analogy, and suddenly you took away all the instruments from the orchestra. It's sudden, if you imagine that orchestra analogy, and suddenly you took away all the instruments from the orchestra, it's going to sound and feel very different. And yet, as women, what do we do? We keep going. We keep caring for ourselves, for our children, often for our parents. That we're working full-time many of us so it's a real thing, but it hasn't really been acknowledged. So, while this is happening physiologically, what I want to tell women who are to your listeners is that they do not need to suffer through all of these symptoms like hot flashes and brain fog and mood swings and poor sleep and vaginal dryness. What we're really talking about here when we say balancing your hormones is restoring some equilibrium in a way that supports your quality of life. That's what's really important.

Mary Ellen: 13:30

So, from a conventional standpoint, this often means considering hormone replacement therapy, which isn't for everyone, but when it's used appropriately, especially within the first 10 years of menopause, there's really strong evidence that HRT is safe and effective for most women. Unfortunately, as you probably well know, due to some misinformation of data from the Women's Health Initiative, we have an entire generation of doctors who have completely forgotten how to prescribe hormone therapy and patients who are afraid of it, and it's really a travesty to women. I myself was at a gynecologist a number of years ago and asked about HRT and I was told oh, we don't do that anymore and that's just not true. So that's again a whole separate podcast, hrt. But I did want to mention that because it's really an important piece From our perspective.

Mary Ellen: 14:25

As an integrative practice, we like to take things further, and so we're often looking at all of the other hormones in your body, like insulin and cortisol and thyroid, and we know that the way that we live, our diet, our lifestyle and everything that we're doing on a daily basis is literally interacting with our hormones. So there's a lot of back and forth and those things are really important. So when we work with people, I really I try to emphasize we're not trying to get you back to your 25-year-old self. We're really trying to create a sustainable balance that helps you feel more like yourself again, and that's very different for everyone. Sometimes that includes hormone replacement therapy, but sometimes it will include optimizing sleep and stress and nutrition and supplements, and in many cases it's both.

Mary: 15:16

Yeah, it's very, very complex and I'm glad you brought up cortisol and insulin because all of those things are so important, and again, this would be a whole other episode. But sugar, I mean we're finding sugar is one of the biggest impactors that influences so many things we're going through, including heart disease and dementia and all of those things. So I think simple things that we may also get into with our next question, but simple things like adjusting your diet can actually be and were for me, pretty impactful. And you know, I think the other thing that when you mention hormone replacement therapy, I know for me I have a patch of estradiol patch the lowest that you can have, but it really did make a big impact for me.

Mary: 16:06

And I think so often on my show I talk about nature and so if we think about nature and how we evolved, we're living way longer and really nature develops beings to procreate in most cases. So we're now living so much longer past the point that we can procreate. So I think that you know, first of all, our body is protecting us. If we would try to grow children, I know at my age, if I would try to grow a child, that wouldn't be healthy for me. So nature has this way of sort of changing us to keep us safe. But I think too, with living longer I think we're starting to really be able to see long-term what 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 do end up sort of compensating, but I think, getting that comfort with knowing that we're not going to look like we did, and it doesn't matter what input you use, you're just aging, and so I think one of the basic things is finding a comfort with that, because our bodies do change and they don't look the same.

Mary: 17:28

But I want to circle back around to this idea of diet because I think we downplay it, and you brought up a good point that the diet in America is one of the worst diets in the world. In fact it's called the SAD diet right, the Standard American Diet, the world. In fact it's called the SAD diet right, the Standard American Diet, and I think that's a really accurate acronym because it's built around the most unhealthy things and we've also, I think, put a frame around things that are actually healthy, that we've been told historically 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 detailed you want to get, but I would love if you would talk a little bit about how can we utilize dietary inputs, or what role does diet play in that quest to kind of support our hormone health.

Jane: 18:23

Yeah, nutrition is huge in hormonal health, as it is with all other, you know staying well and chronic diseases in our body. So I'm glad that you brought up this question and we talk about nutrition every single day to all of our patients. It's something that we were really passionate about and we love and, as you mentioned, it's very nuanced and, I think, individual, but overall, you know what putting into our body or what we're not putting into our body affects how our hormones rise and how they drop. So they influence not only our production of our hormones, but nutrition affects how our body metabolizes and utilizes our hormones and also get rid of hormones or detoxifying. So all of those processes have to work well to have quote unquote the balance of hormones.

Jane: 19:19

Many times I work with women and their issues aren't necessarily that they don't have enough hormones. It may be that they're not clearing them appropriately, and this is how we really start to individualize nutrition for women. Oftentimes, when we're working with women, we're testing their hormones, we're assessing their imbalancing and tailoring very specific nutritional recommendations for them. However, I think that there's definitely some baseline, foundational recommendations that we can talk about today, and I thought about this and came up with, I would say three top ones that we're repeating over and over and over again to women, regardless of what their individual assessment shows. So number one is eating real food. So what I mean by that is eating food as naturally as it has come from the ground, or that tree or the fish or the bison, or that tree or the fish or the bison. So in doing so, oftentimes that means we're preparing more of our foods at home. We often throw around the term processed foods, but what that means is we take the food from the ground, from the cow, and then it's manipulated to be put into a package. So we really want to work on getting away from those packaged foods and eating real foods.

Jane: 20:50

One of the tips that I talk to women about is working around the outside of the grocery store. So if you think about your grocery store, oftentimes if you're just staying on the outside of it, that's going to be where most of your produce is. Things that you pick up like fresh bell peppers come to mind. Or you're going through the meat aisle and you see chicken and fresh fish there. Now I understand and I'm with you. I can't just only shop on the outside of the grocery store. I do have to go into the middle and that's where those packaged foods lay. And what I would recommend you do next time you're going into those aisles is pick up that package and look at the back. So I want you to look at that ingredient list. I think we're so used to just looking at the front. I think we're so used to just looking at the front, seeing a marketing ploy you know this is gluten-free, low-fat and throwing it into our cart. But I really encourage you to look at the back of the ingredients and if there's something in the ingredients that you have a hard time pronouncing or grandma would have no idea what that is think twice about throwing that into your grocery cart. So eating real food, preparing it from how it comes from the earth.

Jane: 22:12

Number two is increasing our fiber. So a lot of different resources recommend fiber ranging from about 30 to 50 grams per day, and I really aim on that higher side for women, especially menopausal, aiming for over 45 grams per day. Now, that's actually a lot of fiber and, as you mentioned, mary, the standard American diet has very, very little fiber in it. So we have to be really intentional about this and I think some of the ways I do. That is encouraging women to start ramping up their fruit and vegetable intake, aiming for about nine servings per day. That's where we get a lot of the fiber in our fruits and vegetables, especially with the skin. So making sure you're eating the apple with the skin. On the other area where we get a lot of fiber is in our ancient grains. So moving from those processed carbohydrates 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 more nutrients outside of even the increase in the fiber in those.

Jane: 23:28

And number three, foundationally, is looking at your liquids that you're putting into your body. So it becomes more and more important 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 becomes more of a habit versus just relying on your thirst mechanism to kick in to tell you that you need to drink water. So making sure that you're really getting one of those nice big 32-ounce mugs and going through a couple of those throughout the day. Now, while you're increasing your water, I also recommend looking at well, what are the other sources of fluids you're taking in, so really assessing if you're having those sugar-sweetened beverages. So where are you getting your morning coffee or latte? Is there sugar added to that? Any sodas, things like that? Starting to remove those from your daily habits? And the last thing I'll mention, with liquids I may get something thrown at me here or I may get booed, but it's talking a little bit about alcohol.

Jane: 24:36

I really have found so many women that feel so much better from a brain perspective, from a sleep perspective, if they cut out or significantly reduce their alcohol intake, and I think that this really starts to happen organically for most women.

Jane: 24:55

I talk to so many that come in and 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 or two glasses of wine with my dinner, I feel like I did when I woke up with a hangover when I went out in college the next morning, like what's going on, and so there is something real to that that our body is just not metabolizing and getting rid of it like we used to when we were younger. So I really encourage you to examine your alcohol intake and maybe just do a trial of a month without it and see how you feel intake and maybe just do a trial of a month without it and see how you feel. So, really, those foundational recommendations would be to eat real food, increase your fiber to over 45 grams a day and then assess your liquids, hydrating and 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 address because this was what you most recently said this idea of cutting back on alcohol, I think brings up a bigger issue. And this isn't saying, oh, you have to have alcohol, but I think in our society, again with food, it's so built around food and drink as a celebratory thing. I mean, what's one of the things you often suggest? Let's go out to dinner, and part of that tends to be, you know, there might be a mixed drink menu that has, you know, something that sounds delicious. So I think it can bring up a bigger issue for women at this time of life and it's like, do I have to really give up another thing? And I think there are ways around it. And so one of the things I would say about alcohol and I am one of those people that I cannot tolerate it and I never really was a drinker, but my husband makes craft beer, so we enjoy going to different places and testing or tasting craft beers. And it's now we're to the point, because he's a pretty supportive partner we will split a 16 ounce beer and the other thing is have it earlier in the day.

Mary: 27:03

I think when we're talking about diet, what can be hard is if you focus on what you're not supposed to do. I think it can be really discouraging and overwhelming. So I would say, with what Jane just said look at what can you add. Start by adding some of these things instead of feeling like, oh, my, okay, so now I have to stop eating white bread, I have to stop eating pasta. Look at how can you cut back and put something else in its place, because I think that makes it feel a little more doable.

Mary: 27:34

And the other thing is because right now I'm working through an integrative nutrition class and I know one of the guidelines I learned that really helped me was try to have fat, fiber, protein in each thing you eat, and that really helps me kind of think about okay, so I'm going to have, you know, not just dinner, but I'm going to have this little snack. How can I have a little bit of each of those things? And finally, I'm going to go to something that Jane has said to me often, which I love, is the 8020 rule. And Jane, can you explain that in your words? Because I fall back on that so often and it makes me feel actually kind of empowered and a little 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 this a lot is what do we want to add into your nutrition, versus just necessarily removing lots of things, and then it becomes more of an organic way of eating. So you're adding things in and you naturally will start cutting things out on your own. But the 80-20 rule is something that I live by and I talk to so many people about, and when you apply it to nutrition, what it means is that 80% of the time you are really mindfully eating, being aware of what you're putting in your body, following some of these recommendations and sticking to that. But we also build 20% into it for the things that you enjoy. 20% into it for the things that you enjoy.

Jane: 29:16

So I know that it's really hard for someone to go gung-ho, strict on a diet and after three days I'm like I'm going to give that up. I don't want to continue. I am just for me. I love a slice of pizza, so I build that into my 20%. So for other people like maybe your husband, mary, his craft beer, maybe for him that's his 20%, so you can pick and choose. But 80% of the time you're really being mindful and following your eating plan but building in that 20% so that way you're able to go out to dinner with your girlfriends and have that appetizer and have that glass of wine, but you know, the next day you're just jumping back into your 80%. So it's a really big mind shift around. You know, not shaming yourself for quote falling off the wagon, you're building it in and it's part 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 so much shame around food. I can't tell you how often I have friends, but also a lot of my clients say I was bad today, like you're not. You're not bad for indulging something Because, again, we are surrounded in this country by sugar and you know it also and again I'm going to say this for a third time, this could be another episode but what that does in our body and our brain and how it mimics certain neurotransmitters to make us feel good, it's a sugar high and we joke about that, but it's not really a joke. So I think it's difficult to make these changes. So when you can put a frame on it, that not only gives you a concrete way to start to do some of these things, but it also gives you kind of that release valve. So I'm not going to lie if we go out to dinner and there's chocolate cake on the dessert menu, both my husband and I are like that's our 20%, because you know it's very relieving to be able to enjoy something and I think it makes us more mindful too when we have something.

Mary: 31:17

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'm opening three of those little Hershey's miniatures and that kind of thing adds up. So I think it just makes you more mindful about your choices and I think, as we've built more things into our dietary plan for the week, it's actually been kind of fun, like there's been so many things that we now eat that either I didn't even know about or are actually way more delicious than I would have ever thought. So a lot of it is preparation. But you know, I'm thinking maybe in the future you could come back and we could all do a whole program on diet. But let's move on from that, because one of the things that I also wanted to talk about beyond diet, because really it's a whole lifestyle thing. So what role do some other things in our life play in supporting hormone health? So things like sleep and stress management, movement, all of that kind of stuff.

Mary Ellen: 32:25

Sure Also a great question. I think lifestyle is just, it's not just supportive. We think of that at Middleway in our practice as sort of the foundation. So we have to get that foundation set first before we, you know, even begin. So I like to think of lifestyle thing, mary, in terms of pillars, and I always tell folks, you know, you can't supplement or medicate your way out of poor sleep or high stress or a sedentary lifestyle. So hormones function as part of that orchestra that I talked about and they respond and interact with actually how we live. So, in other words, our lifestyle and how we're sleeping and moving or not moving and stressing it's going to modulate our hormones.

Mary Ellen: 33:10

So let's first talk about sleep. That's my favorite topic. Sleep is a super important time and when you're sleeping your body does what I call the hormonal housekeeping. So during deep sleep, the brain and your endocrine system they coordinate and sort of work together with these feedback loops to help regulate your estrogen progesterone, with these feedback loops to help regulate your estrogen progesterone and your cortisol insulin and even your thyroid function. So getting poor sleep is, you know, a lot of folks think it's not that big of a deal, but it's actually a really huge deal and a lot of my perimenopausal and menopausal women have the three or 4 am awakening and they never quite go back to sleep and they brush it off, but it's I always try to point out to them it's a big deal. So when that is happening, we're raising our cortisol levels, our stress hormones, which raises our insulin and that increases inflammation in our body and when that happens there's a ripple effect. We get more hot flashes, more sugar cravings, more mood swings and that dreaded mided, mid-section weight gain. So sleep is incredibly important and I often start with sleep before anything else, because if we can get that in place we can start to build the foundations.

Mary Ellen: 34:22

The second pillar that I focus on is movement. So, again, really important. I really focus on resistance training and daily walking or just moving. I don't like to use the word exercise because it intimidates people. I've really focused on resistance training and daily walking or just moving. I don't like to use the word exercise because it intimidates people, I just talk about moving your body. So strength training, we know, is a really good tool because it helps preserve those muscles. Our lean muscle mass and our muscles decline after menopause and when that happens again we have that increase in insulin sensitivity, our bone density goes down and our cognitive function and mood go down. So preserving and actually building muscle is something that we really work on. Here we focus a lot less on the actual number on the scale and more on the muscle mass. We have ways of measuring that here.

Mary Ellen: 35:09

And then finally, another huge one, another huge pillar is stress. So, as I sort of referred to before, women in perimenopause and menopause, which often is in your 40s and your 50s, are often under tremendous amounts of stress due to work and family and really being in that sandwich generation where you're taking care of your kids but you're also taking care of your parents and there's just so many demands on women and, as I said before, most women's natural go-to is to just keep on going despite all of this. So when we have this immense stress on us, it elevates our cortisol and again it has that downstream effect of throwing off our progesterone, estrogen and our insulin sensitivity and we end up with this perfect storm where we feel fatigued, anxious, we have weight gain and sleep disruption, and so we try to teach here a lot of really basic, simple mindfulness tools like breath work. We encourage people to go to therapy and talk to people like you, mary, and I personally really try to get my patients. I actually give them assignments to find some joy, whatever that is for them to dance in the kitchen, to sing, but to find joy because it's essential. And these techniques you can do them at home and you can do them on your own time, and they're simple and they're free and they can really help balance that stress response that we have.

Mary Ellen: 36:35

Having said all those things, mary, I want to say this really loud and clear to everyone listening, because it's one of my pet peeves is that I think perimenopause and menopause is a time of overwhelm, for all the reasons that I mentioned. And while I'm absolutely thrilled that all of these online content creators are educating people about this, getting the message out about menopause, as you said in the beginning, you're hearing about it every day and every time you open your phone and I think it's overwhelmed and I think a lot of women feel a lot of shame because they're trying to, like you said, do it all and if they don't get to the gym, they shame themselves for doing that. And what I tell all of my women is that really try to limit your time. I will teach you the tools that you need, but really small changes matter and make a difference. So trying to turn off that fire hose and just have a slow trickle of small changes and slowly build, that's what works long-term, and anything other than that is.

Mary Ellen: 37:38

I feel counterproductive to women and really sort of sabotaging this whole movement, which I call the menopause movement, which I think is long overdue. Menopause medicine is something that 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 you brought joy in joy into the equation is really cool, and I think, too, you're right that we tend to really put a lot of pressure on ourselves, that you know I should be doing better or I should be able to figure this out, but I know for myself that, had I not had Jane to help me navigate some of this, it's really really crazy that there's always someone saying do this, do that. And I know from what I learned from myself and my own research that it is so specific to each individual woman and I hadn't really intended to talk as much about this, but the sleep course that I built has every single thing you just talked about and it is online, but there's group coaching as part of the support system for it, but it walks women through very, very simple changes over four weeks and it starts simply with circadian rhythm, like getting your body adjusted to nature, like when it gets dark, when it gets light, and it starts that simply. And I think the other thing that you mentioned is this weight gain, and I probably see that more than anything, and I know for me that has been the most frustrating part of menopause is the weight gain. And when you talk about sleep with weight gain, I remember when I first read that sleep impacts weight gain, I'm like how in the world? And then, when I started to learn the role of the hypothalamus and the role of ghrelin and leptin, learn the role of the hypothalamus and the role of ghrelin and leptin and all of those.

Mary: 39:33

There are other hormones that work with our sleep cycle and our ability to manage hunger. It's very I mean, I've said this a lot it's so complex when you start to think about how hormones work that when people say you just have to do this one thing, it's just not true and there are things that may work for your friend and there are other things that won't work for you or her. So it's really trying to take it down to the most basic things and getting your body adjusted to what we've always used to make us sleepy and wake us up, and that's the sun and the darkness, and simply focusing on foods that are real and moving your body in ways that don't have to be running a marathon. You already mentioned a few things. Is there anything else that might be helpful in managing 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 charged for most people and the average weight gain in menopause is 15 pounds. So that's a charged for most people and the average weight gain in menopause is 15 pounds. So that's a lot for some people. And what I really the first thing I try to do when we're talking about this topic is help women understand that it is not that they are suddenly doing something wrong. Their body has drastically changed. As I talked about earlier, the gas tank has been emptied and what used to work for them is suddenly not working anymore. But the playing field has changed. So we really have to change our strategy. Just briefly to talk about what's happening and why it's happening as our estrogen declines, our fat distribution changes and unfortunately, the fat changes to grow more in the visceral adiposity, which is the fat around your organs, which generally is in your abdominal area. So at the same time the fat distribution is changing, the muscle mass begins to decline with that loss of estrogen. So we develop something called sarcopenia and when you have that, your metabolic rate, your resting metabolic rate, gets lowered and this contributes to inflammation and insulin resistance. So this combination not only alters the number on the scale, it changes everything about our body and our body composition. So we really here focus much more here on body composition rather than on weight. We use a machine here called the InBody which gives patients this information. So we try to focus more on muscle mass and body fat percentage rather than the actual number, and if the actual number on the scale goes down, that's a great side effect. But we're really focusing more on the muscle mass.

Mary Ellen: 42:29

So in terms of what can be done, there are always lots of things that can be done. The anti-inflammatory nutrition diet that Jane talked about and eating whole foods is something we're always going to counsel on. The resistance training that I mentioned before and building that muscle is going to be something that we always focus on. We're always getting our women here to wear weighted vests here at Middleway to help build that muscle mass without really having to think about it too much. Sometimes we use time-restricted eating and fasting. That can be done for women. Again, it's very individual depending on what's going on with the person, and then the sleep and stress management are really non-negotiables. So there's lots to do do I have patients who want to do all the things and again, I really I try to encourage them that we are not.

Mary Ellen: 43:17

The goal is not to get back to your body when you were 25 years old. Um, that's just not realistic and you know we really don't. We haven't focused a lot on this podcast about the the positives of menopause, but I'm in menopause and I can say there's I've made it through perimenopause successfully and menopause and there's a lot of positive things that happen, and part of that is accepting that our bodies are going to change and we really want to help people be healthy but we're not trying to kind of go back in time because it's just not realistic. There's a lot of great power that comes to women in menopause the ability to say no. I can't count the number of patients who've just come to that on their own. In their 50s they can actually start taking things off their plate and start saying no to people. And so there's just so much positive in this whole menopause world that we try to educate people about. It's not just about their body changes.

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 and really, once you've mentally adjusted and emotionally adjusted to all the changes that are happening, because it can feel very out of control that if you had a certain body type for most of your life and all of a sudden you can do the things you used to do and it doesn't have an impact, it can be actually kind of a little scary. So I think initially we can focus on all of the things we're losing. But I think as we move through it, reframing that and looking at you, know what's different now, that I can start over with or start something new or what benefits come from really slowing down and starting to care for my body, my emotions and my mind in a different way. So I really love that. And so there's one more thing I want to touch on, because we've really done a huge 360 conversation around this and I think it would be a little bit incomplete if we didn't just touch on supplements.

Mary: 45:18

And you know I qualify this because this is also a little part of the program that I have for women that I think, too, we can think oh, we've been again in the United States. We've sort of been conditioned to think there's a solution in the form of a pill for everything, and the one thing about supplements which we'll probably touch on is they're not all created the same, because many of them aren't regulated and it's there's no quick fix. When we're talking about things like non-medication, things that supplement our diet, herbs or other things like that, a lot of the changes that we're making or we need to make now, they're not quick. There's not one thing that you can say oh, I took this and then the next day I stopped getting hot flashes or whatever. So I would love you to talk a little bit about what role supplements can play. And then, if women are interested in pursuing some things, how might they frame that conversation? Because they really should talk to their healthcare provider if they're adding in some of these things.

Jane: 46:23

Yeah, mary, this is a common question, and when we work with women in perimenopause and menopause, we talk a lot about supplements and what herbs have evidence behind them that can really benefit women going through this phase of life. So, you know, when women can't take hormone replacement for maybe a medical reason, or they also maybe just prefer a more herbal route, these herbs and supplements can really be life-saving. And I think you mentioned this earlier, it's very individual. So, mary, what may work for you may not work for Mary Ellen, and vice versa. But, briefly, there is a lot of data really good data out there and studies looking at different herbs, such as black cohosh, siberian rhubarb, maca root and recently, I think the hot one that's probably on everyone's Instagram feeds is creatine powder. And creatine powder is pretty interesting because when this first started coming up for me, I thought about all the, all the guys in high school and college that were using a ton of creatine and I thought, well, I don't want to do that. But we're talking about creatine in much, much, much lower doses, at about about five milligrams a day, and I want to pause here and just say that when we're talking about these things, you always want to check with your medical provider before adding them in to make sure that it is a right fit for you.

Jane: 47:54

And we treat supplements here with our patients just like a prescription medication, as you were alluding to in the question, mary. So oftentimes we ask them to bring all of their supplements into the office for their first visit. And I think it's really helpful to have those bottles in front of us for the conversations, because if you tell me that you're taking a hormone tonic, I don't know what that is, I don't know what is in it. But if you have that hormone tonic in front of me and I can see on the back that it has 400 milligrams of rhubarb and 100 milligrams of maca root, that's speaking my language. I can understand that and what's in it. So we often have women bring in huge grocery bags that have 20 and 30 supplements in them and I encourage everyone to do this with your provider, take them in, and oftentimes it's very interesting because we pull them all out and I ask why are you taking this? When did you start it and is it helpful? And I can't tell you how many times women say well, I'm not really sure. I've just been taking it, I saw it somewhere, or my cousin told me it might help with my hot flashes, so I've been taking it for years and I don't know if it works.

Jane: 49:09

So you alluded to this, mary, that in conventional medicine we're really trying to get away from a pill for every ill. So every time you come in with heartburn or knee pain, we give you a pill. So we want to move away from that, but we also don't want it to get into the habit of giving a supplement for every symptom, which is often what I now see. So as we go through your bottles of supplements, many times we're getting rid of 75% of them. So I really like to minimize supplements and really focus on high quality, third-party tested brands of a very specific dose of that herb. Like I mentioned, we treat them just like a prescription. So I will never say go get yourself some Maca Ro root at 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 one because it has 200 milligrams and that's the dose that's effective. Here's the side effects that can happen with this herb. I looked over your other medications. It's not going to interact and we're going to revisit this in two to three months and evaluate whether or not this is effective and you should still keep taking it or maybe set it aside and say that it didn't work very well for you.

Jane: 50:32

The conversations around talking with your medical providers lends itself to a little bit of a bigger concern, and I think women have a really hard time with these conversations about menopause, hormones, supplements, nutrition, sleep, and I think it's really multifactorial and I've been there. I'm a patient as well. Just like Mary Ellen said earlier. You know her interaction with her OBGYN is that they don't do hormones. I've been in that seat too and it's extremely frustrating, but I want to make sure that you don't ever, ever get about advocating for yourself, and when I have, women come and sit in front of me and they're just so happy to be heard and listened to and their symptoms and how they're feeling validated. They're oftentimes telling me their experiences at other providers and I really have been able to put these different experiences into a couple buckets and I want to just share this with you. I think I'm going off on a little tangent, but I do think this is important and oftentimes I have women tell me that they go to a provider and they're just completely dismissed, and that is the worst case scenario and I would say, if that happens to you, find another provider. That is just completely unacceptable in 2025.

Jane: 51:54

The second experience that I hear a lot about is the I want to categorize it and say a laissez-faire interaction, where the medical provider's like okay, sounds good. And I was one of these providers before I continued my education to really learn about this, and so I'll speak for myself and many times it was because I just didn't really know what they were talking about and I had lack of education, but I didn't want to necessarily say no, because maybe it was helpful. So that's the laissez-faire provider. And then the third bucket would be the engaged interaction, where they are able to admit I don't know what maca root is, but you know what. I'm going to do a little research and I'm going to get back to you on it and that's probably the best interaction that you can have.

Jane: 52:44

But, all in all, I think the best option is to really find an integrative practitioner who's trained and well versed in nutrition, herbs, menopause, perimenopause, hormones, because, at the end of the day, you really want someone who's committed to you, committed to your health goals, and someone that you have trust in. One of the easiest ways to find a practitioner in your area is to go to the provider search on the University of Arizona Integrative Practitioner website. So there they have compiled all of their fellows that have graduated from their program, mary Ellen and I included, and you can plug in your zip code to see if there's a practitioner near you that you can work with Well, and we can put the link to that in the show notes if somebody 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 and it can be little things like when you go to a conventional medicine provider and I'm not dissing them at all. I mean, everybody has their place in the world of medicine. I think some people were just trained in a different model and it's much more linear. And as women first of all, very little research has been done on women's health issues as it is, so a lot of it is just ignorance. There's not information to go back on. When many health providers are trained, they either don't know how to or don't delve into these other types of sort of learning or thought process of the integrative solutions, because it takes a lot of time. You know, when you sit down with most functional medicine providers, you're getting a 45 minute appointment. What can be frustrating and it has been for me when you go to many allopathic providers, you know you're on the clock Like 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 not being heard, it can be difficult. And the first time I told somebody I take turmeric, they're like what? Like what is that? So it's very complex. I say that word a lot but I think we know in our guts when something doesn't feel right. And if you go the whole way back to my episode four where I talked to my friend Mindy, who had she has a couple autoimmune issues and she had no one helping her through that, she had to do her own research and this was several years ago. There's a lot more things now, like podcasts and free information. You have to be a little careful, like vet, what you're reading or listening to. But she had to educate her doctor on thyroid issues and it was a very long and frustrating route for her to find wellness. So I think, trust your body and maybe, if you feel like there's a lot happening for you, go back and give a listen to that episode four because there are things in there that she's able to offer. Hey, here are some places you can find information that she did through certain podcasts et cetera.

Mary: 55:59

And the one thing because I think we simplify things like supplements, it's like they'll show up in your social media feed and they have quote testimonials there and it's like, oh, I'm gonna try this and there's a payment plan and you can have all these things sitting on your counter and, like Jane mentioned, a grocery bag of supplements. And so, to have a starting point with my sleep program, I give you a supplement tracker so you can actually write it down and have to put in there like why are you taking it? But it also gives you a tool to take to your medical provider, which I think it feels easier if you can walk in with a paper and say, look, here's what I've been trying, here's why it can save you a lot of time. If you are in a situation where you know you're going into that appointment and you are on the clock, they might have allotted seven minutes for your appointment.

Mary: 56:49

So just a few small things that you can do, I think, to maybe ease that path a little bit, to get to a space where you feel heard and where you feel like there are things happening that are starting to sort of steer the ship for you in a healthier direction. Well, I have loved our conversation today. It actually went a little bit longer than my typical episodes, but I think it has been so wonderfully in-depth and detailed and just a delightful conversation. So I want to thank both of you for taking the time to be here, because I know building your new practice has been very, very sort of all-encompassing, so I love that you were able to set aside time for us today.

Jane: 57:33

Thank you, Mary. We were so excited to do this with you today.

Mary Ellen: 57:36

Yeah, it was really fun. It was really fun. You're doing great work out there, 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 of you for listening and you know. More than anything, I'd love to hear from you, because when I'm sitting behind the mic it can be sort of like who's hearing this, and you know what are their reactions or responses. So I'm really also amazed at the community we're building.

Mary: 58:05

So if you have thoughts about this episode, please comment or actually you can text me. I can't answer you, but there's a text link in the show notes. If you want to have a more private communication, and if you have someone in your life that's struggling with the symptoms that we've talked about today, please consider forwarding this episode to them and you can check out the program I designed specifically for women who struggle with sleep. It's really again a 360 approach to lifestyle, because everything, everything is related 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 of Violets and support the show using the heart button or the link at the bottom of the show notes, depending where you're streaming from, and until next time, go out into the world and be the amazing, resilient, vibrant violet that you are.