Is it Perimenopause? with Dena Norton, MSRD

This week on The Less Stressed Life Podcast, I have repeat guest, Dena Norton, who is a registered dietitian with with over 15 years of experience in both the traditional medical system and the holistic health sphere. On this episode we talk about all things perimenopause. Attention to all women in their 40's (and late 30's), it is NOT too early to be perimenopausal. Dena tells us what to look for, what to do and where to find help.

Check out Dena's Forties Fix Crash Course: get $50 off with code “CHRISTA”

Dena's free masterclass: ​​​​​​​​​5 MISTAKES 40's ​​​​​​​WOMEN MAKE  (+ how to fix them)​​​​​​​

Catch Dena's other episode on the LSL Podcast here:  #224 Practical Strategies for gut health, IBS, bloating and constipation

KEY TAKEAWAYS:

• What are symptoms of perimenopause?
• Hormone Replacement Therapy (HRT)
• Strategies to help with perimenopause
• Why we become more insulin resistant as we age

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ABOUT GUEST:
Dena Norton, MS, RD is a registered dietitian with with over 15 years of experience in both the traditional medical system and the holistic health sphere. She owns Back To The Book Nutrition, a virtual practice specializing in chronic digestive symptoms and women's health.
After helping perimenopausal women for years, Dena entered her 40's and was hit with nagging symptoms like low libido, love handles, and sleep disturbance herself. This wake up call drove her to research perimenopause more deeply than ever and, after applying what she learned, has reduced her symptoms and feels back in control of her health!
Now Dena is passionate about helping fellow 40-something women navigate this topsy-turvy stage of life with proven strategies to curb nagging symptoms and to significantly reduce the risk of many chronic diseases that plague aging women.

WHERE TO FIND:
Website: https://www.backtothebooknutrition.com/
Instagram: @backtothebooknutrition 
Facebook: https://www.facebook.com/backtothebooknutrition

WHERE TO FIND CHRISTA:
Website: https://www.christabiegler.com/
Instagram: @anti.inflammatory.nutritionist
Leave a review, submit a questions for the podcast or take one of my quizzes here: https://www.christabiegler.com/links

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TRANSCRIPT:

[00:00:00] Christa: Stress is the inflammation that robs us of life, energy, and happiness. Our typical solutions for gut health and hormone balance have let a lot of us down we're overmedicated and underserved at the less stressed life. We are a community of health savvy women exploring solutions outside of our traditional western medicine toolbox and training to raise the bar and change our stories.

[00:00:26] Christa: Each week, our hope is that you leave our sessions inspired to learn, grow, and share these stories to raise the bar in your life and home.

[00:00:45] Christa: All right. Today on the Less Rest Life, I have a repeat guest, but a very different topic this time. Dina last talked about practical strategies for I B s, so we'll need to remember to link that one in the show notes. But today she's back to talk about perimenopause. So Dina Norton, M S R D, is a registered dietician with over 15 years of experience in both the traditional medical system and the holistic health sphere.

[00:01:11] Christa: She owns back to the book Nutrition, A virtual practice specializing in chronic digestive symptoms and women's health and after helping perimenopausal women for years, she entered her forties and was hit with these nagging symptoms like low libido, love handles, and sleep disturbances herself. This wake up call drove her to research perimenopause more deeply than ever.

[00:01:30] Christa: And after applying what she learned, she has reduced her symptoms and feels back in control of her health. So she's now really passionate about this topic, essentially, and here's what we're gonna chat a little bit about today. Welcome back, Dina. 

[00:01:42] Dena: Yeah, thanks for having me. 

[00:01:43] Christa: All right, so let's talk about the story you had just mentioned offline.

[00:01:47] Christa: It was like, I was trained to look for this, this, and this symptom, but it kind of crept up like all of a sudden. So tell me about the slow onset of this, that kind of just one day hit you in the face. 

[00:02:01] Dena: Yeah, well, I had struggled. I knew with like, quote unquote estrogen dominance. I know that's a love-hate term for a lot of people, but you know, that dynamic of like, oh, a uterine polyp, oh, heavy bleeding, low iron, all that stuff had come up for me like mid thirties.

[00:02:15] Dena: And so I think I was like, oh, I thought I like mostly got a handle on that and I thought that was behind me and it was its own thing. And then these little whispers of other things kind of. Snuck in, you know, like my hair texture started changing. I was a little more allergic, itchy, here and there not a huge deal. I would've blips of sleep disturbance. It was like quiet whispers of random things. 

[00:02:36] Dena: And I was looking so hard at. I ovulate every month. My progesterone looks pretty good. And so I was kind of looking for markers that I had been trained to look for that were associated with perimenopause and like these shifts.

[00:02:47] Dena: And I was totally, totally missing that all of these little quiet things that were maybe less common and less known as part of those early stages of perimenopause were me and then, and the low libido had been part of that. But let's be honest, it didn't bother me as much as the love handles. And then those showed up and I was like, Uh, not on my watch and I, was doing like all these things, right?

[00:03:09] Dena: You know what to do to manage our weight and handle our hormones. You know, I was doing those things and it was working less and less well, and I think that's when I was like, hang on. That's what this, and I sort of woke up to looking back, oh, all these dots were connected. It was the very, very beginnings.

[00:03:26] Dena: And I think I was looking so hard at certain things and missing the others that I didn't even recognize that it was early, early perimenopause for me. So now I'm like deep in the thick of that. Figuring all that out with new strategies, new tools in my belt, and it's going so much better. And I'm also so passionate now about all these other women.

[00:03:43] Dena: You know, you talk about something and everybody resonates and it's like they need to know too. They're not crazy. This is not random. And also, very importantly, this is a window of opportunity like, You gotta get a handle on this. Not just so you feel better, look better, or at ease with yourself, but like these are signs of chronic disease brewing that can really take hold later if you don't get your act together.

[00:04:04] Christa: So let's dig into all of these pieces. Let's just split this all up. So when you say brittle hair allergy symptoms, my brain goes a couple other places. Maybe we can even start with how did you discern what was actually happening? What were the metrics or biofeedback? Or how did you determine this is perimenopause?

[00:04:23] Christa: Because sometimes I think perimenopause, we could maybe use it as a big umbrella term to encompass several things. Cuz I usually talk with clients about, Hey, if we're transitioning to perimenopause, we wanna make sure our adrenal health is in good shape because your ovaries are gonna downshift and your adrenals are gonna take the brunt.

[00:04:42] Christa: And that if things are not going well, could affect thyroid, which could then affect brittle hair. So this is how my brain would think about it. But I'm curious, how did you discern what was happening overall?.

[00:04:55] Dena: Yeah. And those have been on the radar for me for years. Not perfect in those areas, but like thyroid is dialed in.

[00:05:00] Dena: I watched my numbers two or three times a year, like I knew I was good there. Quote unquote adrenals or the whole really nervous system, stress, access, if you zoom out and kind of think of it in the whole context of the person. I mean, that's something that I feel like very resilient symptomatically numbers on paper.

[00:05:14] Dena: It's been a little iffy in the past, but I felt really good, like as far as feeling rested and having energy through the day. Certainly better than I had in my early to mid thirties when I was like deep in the ditch with hormone dysfunction. So I think I felt well in a lot of areas, but you're totally right, like a lot of this is sort of this very slow handoff into like the ovaries signing off, and even that process can take a decade for some people.

[00:05:38] Dena: So it can be this like very, very slow blips, accumulating versus like, you fall off a cliff, your ovaries are gone and you all of a sudden feel very perimenopausal and it looks so different for different people. I mean, some people have like weird itchy ears, like some people have migraines or dizziness.

[00:05:54] Dena: They're all kinds of weirdo things, and maybe their periods aren't even changing yet, whereas some people, it's more about the period stuff they start out with like the heavy cloud periods or that like PMs stretch or the shortening of duration of the period cycle. Those kind of things may be forefront for some people.

[00:06:10] Dena: But I think the point is just, what's happening, track it over time. Like in my case, part of what to me solidified, like that's what this has been all along was taking the main symptoms, and then adding all these little trickles. But looking back at my data, Testing is very controversial during perimenopause, right?

[00:06:26] Dena: We could put that out there. Like some people say don't test stuff's all over the place. There's no point. Other people say you better test so you know where you are and then if you need, something, you're doing it in an educated way with data to guide you. I had been testing hormones once or twice a year for several years.

[00:06:40] Dena: I'm a practitioner and that's what we do. We test ourselves like crazy. And so looking back I could see that, yep, I definitely am like a consistent ovulators, progesterone looks robust, but when I looked at data points over time, It was robust, but it had slightly started a decline. There was a pattern there.

[00:06:55] Dena: It was just gentler and, quieter than it probably would be if I waited five more years to figure it out or than it is for some people. So I could see that hormonal shift pattern going on on top of some of the period changes and all those other like little signs that were happening for me.

[00:07:15] Christa: Yeah. When you bring up all these little signs, I kind of like start to attribute them to lots of other things, to be perfectly honest. Right? Because like, well this is usually a cloudy period. I mean, when it's related to your menstrual cycle. Yeah. We would maybe think hormones in some kind of context. 

[00:07:28] Christa: And even hormones are such a giant catchall word, if you're talking about brittle hair and I'm thinking about adrenals and thyroid, I'm still talking about hormones, just not sex hormones. 

[00:07:37] Dena: Yes. Right, right. , and they all like sink together. 

[00:07:40] Christa: And like you said, allergy symptoms, et cetera.

[00:07:42] Christa: Maybe you could share how perimenopause created some of these symptoms that don't really look like perimenopause. What's a mechanism of, like, how are these also under the list?

[00:07:53] Dena: So I think when you look at like, itchy things or like, I had some nasal congestion and some periods of like, Sneezy watery eye allergy type stuff, which was never me, and it would ebb and flow.

[00:08:03] Dena: And I think, when you do have those earlier stage perimenopause dynamics, like for example, progesterone's too low or estrogen's volatile, sometimes high, maybe not always, but there is that gap between the two, which can happen earlier in life too, granted. But that can happen early stage perimenopause and that can like perpetuate things that are histamine types of dynamics, allergies and stuff. 

[00:08:23] Christa: such as stress, right? 

[00:08:24] Dena: And that too. Yeah. I mean I think that's part of it. I think, the low libido . I chalk that up to testosterone, even though estrogen's certainly involved in libido and that sort of thing. But in me, like I have lab data showing, testosterone was riding a little low for a while, which we know that starts to decline maybe even before progesterone.

[00:08:39] Dena: But it's one of the early ones to start to decline. So when I look back, I was seeing that trend, I was seeing the progesterone trend. The sleep disruption I think probably. That generally is attributed to a decrease in estrogen, honestly. But progesterone two can promote like sleep disturbance.

[00:08:53] Dena: For me, that was very like intermittent, it wasn't an ongoing pattern. The hair changes is like one of those bizarre things that you see, like hair texture changes sometimes with hormonal shifts or some people like when they go through puberty, pregnancy or whatever, they have hair changes. So I don't know all the mechanisms for that.

[00:09:09] Dena: Like you're saying, the more brittle hair or the hair loss, that can certainly be linked to nutrient deficiencies or thyroid disorders or other things as well. Love handles I do feel like some of that, like skinny fat stuff can set in, with the like deterioration of muscle mass and that goes along with progesterone decline.

[00:09:24] Dena: I was certainly seeing that as someone who was like always athletic, easy to maintain. Like body mass and all that stuff. And I was just feeling squishy, like skinny fat was starting to set in. I was seeing it visually. So I think that probably you could attribute to like the testosterone decline.

[00:09:38] Dena: So I think there's lots of different ways at which a little of this and a little of that, and then they start affecting one another. And it's just like these symptoms like birth pains, you know, they start to pop up everywhere. And louder and more of them and altogether. And at some point you have to stop and be like, this is not one dynamic.

[00:09:53] Dena: This is like the whole system interacting with the brain and the whole body. 

[00:09:56] Christa: Yeah. So, and I'm gonna play a little bit of devil's advocate because I know you well and I know you're smart and so I'm gonna like tease this out. I know I can with you. And so to me I'm like, well we have an epidemic of low progesterone, so yours is like titrating down and estrogen and progesterone.

[00:10:10] Christa: Often, not always, but they're kind of almost on the teeter-totter. So , if you already struggle with estrogen dominance historically, and progesterone is starting to decline. That would add stress to detoxifying estrogen and histamine and estrogen go along the same pathway together.

[00:10:25] Christa: So when you're saying, It is a dynamic of a whole system. My progesterone was declining. Well, I think my devil's advocate comment is, " is progesterone declining in age, maybe? Yes, for sure. Or is it also you had said before? And here's why I'm digging on this because I resonate with that. It's like, oh, these numbers actually didn't look perfect, but I felt good. Like when my first realized, like my adrenals were like not in good shape, I was like, but I think I'm okay, but if my adrenals are not in good shape on paper, technically, which I think are some symptoms are more important than our labs, technically.

[00:10:59] Dena: Yeah. 100% do. 

[00:11:00] Christa: But if we've got some stressors, which who doesn't right? Then we would have a decline in progesterone too right? And nutrients. But the main conversation is, is there a bounce back version? Right. Whereas like when you're working on, when your body's really focused on procreating and like making babies like that different phase of life versus

[00:11:21] Christa: when is it starting to say, You know, I'm actually cool with declining this progesterone. I guess my question is like, Ooh, was it, or is it part of estrogen dominance and stress? That's described as, I think I'm actually doing fine, but my progesterone is actually low, and that leads to all these other things also.

[00:11:38] Dena: I think it's a valid question and it's like such evidence of why this is so tricky, not only for practitioners to try to figure out where are you and what's gonna be our strategy. But for women who are like, which camp do I fall into? I think for me personally, it was probably this overlap, like a Venn diagram.

[00:11:56] Dena: I definitely started in kind of like the quote unquote estrogen dominant. She's a thirties woman, a lot on her plate, blah, blah, blah. I was very symptomatic when I was like, clearly that. I did all the things. I felt much better with regard to like resilience, energy, things that are like vitality signs my periods start to dial in.

[00:12:12] Dena: I'm ovulating consistently. I feel like I recovered from a like symptomatic standpoint from those things very well, like felt very vibrant, felt great. On paper it looked much better. It was not perfect. Okay. But then you like fast forward, okay. Over the next year, two years, definitely three years. 

[00:12:30] Dena: And now ,you watch the numbers on paper, the testosterone like definitely lower. The progesterone just very steadily clicking a little down. I still feel pretty good. It's just these weird little symptoms starting to pop up now that are much more like perimenopausal types of symptoms. So what happened with me personally.

[00:12:51] Dena: Again, I think women are so varied in how they experience this shift when they even start it. In the first place, what it looks like and how they feel through it. There's a lot of variability because like we said, the whole system is this beautiful symphony and depending on how you come in, nutrient status, thyroid status, stress, access, all that stuff, that's gonna feed into how you feel it and what your numbers look like.

[00:13:12] Christa: Yeah. Literally on the daily right. Because your brain is kinda controlling subconsciously, you know, what be producing or feel. 

[00:13:18] Dena: And I think it's fair to say too, like I'm 43 right. I'm still pretty early days. I'm like the earliest stages of perimenopause. I'm like flat on the ground with my ovarian hormones at all by any stretch. I don't have hot flashes. I don't have the like raging obvious menopause symptoms. My cycles have not changed all that much. 

[00:13:34] Dena: But I think because I've been so on it, trying to figure this out. I sort of backed into like, ah, this is what's happening. And I got super serious about like, I wanna know all things about this.

[00:13:45] Dena: So that I'm like shifting strategy now. Well, maybe it's not even like my back's against the wall and I have to symptomatically, but I genuinely wanted to stay one step ahead and help others. And I think that now that I've been in this literature up to my eyeballs for a year or two, I mean, You wanna start early?

[00:14:02] Dena: There is a fine line right between like awareness and taking action and then like over-diagnosing and looking for problems left and right, that really don't need to be solved . I think we have to be careful about that too. There's a lot of that in the holistic and functional space for sure.

[00:14:16] Dena: Like everybody has this and you have that and it's a problem. You have to fix it and you have to go to all these links. I think this is really more about like listening to your body. Take notes, tune in and know if you think this is you. There are certain strategies you wanna be aware of and start implementing, and they really will help you feel better through this, and at the same time, they're going to be investing in feeling better the rest of your life and having lower disease risk too.

[00:14:39] Christa: Yeah. I want to mention here, or kind of underline or wrap up from this. Things that you said, really it's your brain is communicating with all of your systems that are producing hormones. And when I'm thinking about hormones, I'm typically thinking about adrenal, thyroid and sex hormones. And I don't think you can discount any of those being at play right. 

[00:14:59] Christa: And I often think, yeah, I've got subclinical science of thyroid stuff when stress is higher, and as a result, sometimes my progesterone has been lower through those times. It does matter, but it's also. You can have multiple things creating the same outcomes. And so when you call it skinny fat or whatever, I'm like, Ooh, I've been kind of thinking about this as like this puffiness from like slightly sluggish thyroid and having a little bit of sluggish lymph and I think it's all overlapped and I think 

[00:15:26] Dena: yes 

[00:15:27] Christa: where I just feel like you have to support all these systems stages

[00:15:30] Dena: The fixes. I think Christa, you and I are like similar places in our practices and everything. And we've talked about this at least at a surface level before.

[00:15:37] Dena: Like it's like the more you know about the nuance and the Intricacies of all this, the more you appreciate the foundations. And like you wanna be strategic and informed, so you're doing the most important things. Lowest hanging fruit first. But you can't skip jump over those. Like you can't use this to be like, it's perimenopause, so I need this certain supplement.

[00:15:53] Christa: Yeah. 

[00:15:53] Dena: And that certain specific protocol. Like no, it's about understanding and connecting with your body and its rhythms and then learning like those rhythms mean changes are happening. So you adapt your strategy just so that you're more connected, better supported, and you feel well .

[00:16:08] Christa: Yeah. 

[00:16:08] Dena: But you're right. It's really.. 

[00:16:09] Christa: Systems, all together. Yeah. 

[00:16:11] Christa: Okay, so you mentioned earlier that when we don't address some of these nuanced things, the technical outcome is chronic disease. So let's give that a lip service for a moment before we jump into strategy and taking advantage of this time.

[00:16:25] Christa: If we wanna think of it like that. Welcoming it, right. How do we welcome it? Potentially, but before that, just to like understand potentially the stakes, and we've had some guests about this before. There's a podcast with Wise and, well, I don't know, when was there was Esther Bloom had see a later Ovulators on the podcast.

[00:16:43] Christa: Loved that one. I thought she did a really nice job of talking about, essentially, once your hormones decline, I think it's 10, 20 years later, you're gonna be looking brain decline, cognitive decline, bone decline, and cardiovascular risks. Correct me if I'm wrong, and anything else you wanna say something about it?

[00:17:01] Dena: Yeah. I know Esther talked about that a lot, and I'm a huge believer in hormone replacement therapy when it's appropriate, and I think it almost always is. And I kind of think that earlier the better after revisiting all this literature. 

[00:17:11] Dena: But that really is the key to pushing off those diseases and living well with them for longer. I think when you wrap that inside of a whole, like food, fitness, lifestyle package, you're sitting pretty.

[00:17:25] Dena: But yeah, four of the five top killers of women are linked to hormones and lifestyle. And tho like you mentioned, I mean, they don't develop overnight. They don't develop in a year or two or five. They develop over a decade or more.

[00:17:37] Christa: Yeah. 

[00:17:37] Dena: So now's the time. You know, to be acting against them. And there's a lot you can do. There's a lot you could do. 

[00:17:42] Christa: Well that's what we're gonna talk about now. Okay. So I actually divided these, you said some things and I was like, okay, there's strategies in lots of buckets, diet, lifestyle, maybe supplement, maybe hormonally.

[00:17:52] Christa: And this feels a little backwards cuz it's probably the frosting in the cake in my opinion, but also maybe the frosting's essential in the cake, which is probably true also. So I've become more pro also bioidentical hormones in this phase because how could we not do it right. So actually, since you already touched on that briefly, if we can, let's start there. 

[00:18:13] Dena: Sure. 

[00:18:13] Christa: These are the questions people ask. It's like, yes, I'm doing this. And unfortunately there's a bunch of nuance here. It's like there's synthetic, there's bioidentical, there is who should manage it, should it be pellets? Should it be oral should be atopical, which it depends on a progesterone, estrogen, and then people will say, well, do I need to do this forever? So those are some of the things that are popping up. Take it away on hormones. 

[00:18:33] Dena: Gosh. Well, I'm pretty clear even I have a course for forties women and when I work with women 1 0 1, that, these are medical decisions they're made with your medical team.

[00:18:40] Dena: They're prescribed by medical people. I've certainly read a lot about it. I have thoughts on it, but I'm probably more middle of the road where, yes, I think bioidentical versions are ideal. Just because they're chemically structured the way that the body's own hormones are, and so they're better recognized.

[00:18:56] Dena: There's definitely literature now to say they are safer and more effective. Than non bioidentical versions. 

[00:19:01] Dena: Now, bioidentical can be compounded by like more holistically folks, or it comes in prescription versions, f d a approved medications that are more and more of them bioidentical because of this recognition based on scientific literature that they're safer and more effective.

[00:19:14] Dena: So there's choices for everyone right. But yeah I think bioidentical hormone therapy is super important and based on what we know about physiology and like the things that fall first, progesterone, namely testosterone falls first. But I think you have to be careful about bringing in testosterone early.

[00:19:28] Dena: And I think most doctors don't for good reason. But progesterone generally is started first for most women and that can be done in a variety of ways. And it can be started, some schools of thought, some doctors would say the earlier, the better. Your late thirties, you have any whisper of a symptom, start that stuff, get it over the counter, I mean, there's that camp, right? That's one extreme. 

[00:19:45] Dena: The other extreme is you wait until pretty deep into this game when you're really not able. To keep on track with your symptoms and you're really not feeling well. Then we bring in hormone replacement therapy. I probably fall somewhere between those two as I always do.

[00:19:58] Dena: But generally progesterone started first, and then sometimes estrodiol, we, or estrogen will be layered on top of that in one form or fashion. And those are kind of the bread and butter. Estrogen and progesterone. And then some doctors, not all, will use some form of testosterone and or D H E A, but that there's no f d A version of that. So like conventional doctors, gynecologists, nams providers, doctors who are falling under that more conventional wheelhouse, even if they're hormone specialists are probably not gonna use testosterone. It's really more the like naturopaths, holistic.

[00:20:27] Dena: Some MDs, but they use compounding cuz it has to be compounded. There's nothing F D A available. But that's kinda like, I don't know the overview of what's done. 

[00:20:35] Christa: And I think that makes it more tricky and less accessible. And I think that's kind of the challenge is that what we have seen in the last few years is we have more and more people popping up to do injections. It's just where nurse practitioners are like, I don't like doing this other stuff, and this can give some instant results. So I enjoy it. And we like instant gratification, so it's kind of like practicing medicine differently and also not bad, but just there's more availability so that's good. I think this is a really good thing that there's more availability, but sometimes navigating it could be interesting. 

[00:21:05] Christa: And I have found, progesterone and estrogen are pretty well available and of note, there's very specific ways you want to give estrogen cuz other ways are not good. You can talk about that if you want, but Yeah. With testosterone that's tricky and I don't know, maybe you can share what you did because you were seeing lower testosterone and there's some herbal things that can support it.

[00:21:25] Christa: But then I found also when it's really flatlined, it's like that's not enough and we have to refer out to someone who knows what they're doing. 

[00:21:30] Dena: Yeah. I won't go too deep into like what I'm doing and what I'm not cause people start to try to like, I'll do some of that too cause I have same.

[00:21:35] Christa: Yeah, I get it.

[00:21:36] Dena: I have not even touched testosterone. Don't plan to, for quite a while what I did was got serious about lifting weights cuz that's decently established in a literature to boost testosterone. I did try herbals like a few years back and I didn't see much symptomatic anything from it. 

[00:21:49] Dena: So I got serious about eating protein and building muscle. That's what I've done. And I do feel like, some of those things that could be linked to low testosterone have improved. I don't know. I'm more keyed in right now on like progesterone closing the gap and keeping an eye on that.

[00:22:01] Dena: But yeah, I think, back to that, like who prescribes, who do you get, what's available? My general caution to people is I definitely have things I feel like are not wise to do. That's just my read on the literature. Like I wouldn't take pellets, I wouldn't take progestins, synthetic progestins. I wouldn't take oral estradiol. Those are kinda like my hard lines.

[00:22:18] Dena: But everybody's gonna have different ones based on their read of literature. And I try, like in the work that I do to really provide like raw data distilled data and really handing you these to educate you. So you go and have a great conversation with your doctor versus like, I'm gonna pick a camp and tell you to do it the way that I think you should do it.

[00:22:32] Dena: But those are kind of hard lines for me. But I think the good news, what you said about, becoming more available and then you have the wild west aspect, of like, What should they be doing it? Are they doing it in the way that's abouts for you? But I think what's really encouraging to kind of like go alongside that is nams.

[00:22:46] Dena: I don't know how closely you follow them, but until just this most recent issue of guidelines that they put out for their 2022 guidelines, I feel like a little behind the research. So North American Menopause Society, it's mostly doctors, but other providers can join that as well.

[00:23:01] Dena: And so they issue these guidelines, mainly for physicians who are prescribing H R T. So like among conventional doctors like gynecologists and other doctors who consider themselves hormone experts and give hormone therapy, most of them are following NAMS guidelines. So that's like more conventional side of H R T and I just felt like until just this recent issue, it was like, they were still kind of saying things like, give them enough to like help with the symptoms a little but not too much cuz it's kinda scary to give too much hormone.

[00:23:29] Dena: And I think this most recent set of guidelines was much more forward and much more, I think research based, where it's like, let's go for it, let's take precaution. So I feel like even the conventional groups that are administering H R T are like, Getting a little more like proactive and aggressive with it, to really, really help these women not just feel a little better leaving the office, but like, let's give them therapeutic doses so they feel really good. And we protect the bonds, we protect the brain, we protect the heart. We get those long game benefits too. 

[00:23:57] Dena: So, I don't know. I agree. It's, tricky finding resources. That's the number one question women have. Where can I go to get hormones and what kind should I ask for? It's really hard. 

[00:24:06] Christa: Right.

[00:24:06] Dena: But I think there are more and more resources, and I think this is where like part of the shift in this stage of life comes not looking for answers from one practitioner or one doctor. Like you really have to get your head around like, I have to learn this stuff and I have to advocate and I have to lead the discussion.

[00:24:22] Dena: Like probably you're not gonna go into your annual gynecology visit and they're gonna bring up hormones for you. And maybe even if you ask, they're not going to be interested or be super, super knowledgeable about how to give those, how to monitor them, how to adjust them the way that you would really need to dial you in.

[00:24:39] Dena: You really. Have to kind of like seek out someone. Maybe they're a physician also, but who is trained in that, who that's their thing and vet them out and make sure they're really aligned with how you wanna do it. So it takes a lot of research. 

[00:24:51] Christa: Yeah. You offered some really good pieces cuz I was gonna ask you about common mistakes or hard stops on H R T and you said oral estrogen, no pallets and no synthetic progestin. So that was good. That was what I was looking for. 

[00:25:03] Christa: And then you have to see who's available in your area and there popping up more and more and more. 

[00:25:07] Dena: Yeah. 

[00:25:08] Christa: So that's not a bad thing, that's a good thing. On the note of pellets, I will say my hormone mentor just says, they kind of start at like maximum and kind of dial down and the other option is like start at the lower dose and titrate up, which is what I would grab 

[00:25:21] Dena: with pellets. Are there people who start at the low, low doses? 

[00:25:24] Christa: Oh no.

[00:25:25] Dena: Oh, I was like, I've not heard of that. 

[00:25:26] Christa: My hormone mentor is like pellets. The thought behind pellets is like start at the high dose and then come down if you want.

[00:25:31] Dena: Let it trickle down. Yeah. 

[00:25:32] Christa: Yeah. Whereas like other types of intervention or harm sort of lower amounts and increase basically. 

[00:25:38] Dena: Yeah. And I think with hormones, You really don't have that much in your body. You don't need that much. I think anything that like starts slow and goes slow is generally better for the body.

[00:25:46] Dena: But yeah, the whole concept of pellets as you put in a three month dose and you let it just kind of fizzle out. And then, the thing is over time, I mean, it seems that over time there's like compounded issues with it right. So yeah. It makes me nervous. 

[00:26:00] Christa: Right. Yeah.

[00:26:01] Christa: There are definitely some symptoms and side effects from onboarding some of this stuff if you do it. A little too much, too fast. 

[00:26:07] Dena: Yeah. And this is my general take at this point. Some of the stuff is available over the counter, like you say, I don't feel like it should be done over the counter, I don't know.

[00:26:14] Dena: I mean, progesterone I think it is a little different than estrogen, when you talk to different doctors about it. And certainly when you look at the literature on it, it does seem much more friendly and lower risk.

[00:26:23] Christa: Right,

[00:26:23] Dena: than I think the others. But this isn't something you wanna bootstrap and try a little of this and that, or you let your nutritionist give you over the counter, like work with somebody, you know?

[00:26:33] Christa: Yeah. Okay, so you mentioned a couple diet and lifestyle things you mentioned with lifting weights in protein. So let's talk about diet and lifestyle strategies in perimenopause. 

[00:26:45] Dena: Yeah. So I think the big mistake I see a lot of women doing, especially in response to a little bit of weight gain or the spare tire kind of showing up or just not feeling like themselves physically, is to just dial back what they're eating and cardio harder, which may have worked before.

[00:27:01] Dena: But really, I think you have to get strategic in this stage. Like that's not a good idea. Back to the whole like stress, access nervous system, as the ovaries are very slowly handing off the baton too. The adrenals, the fat cells, other hormone production factories. We don't wanna put more stress on those systems by like running them harder and harder and harder as part of that.

[00:27:20] Dena: But metabolically, which is the bigger issue, and this ties into those like chronic disease actual shifts that are going on at the surface, we wanna get where we're like, Throwing logs on this fire of our metabolism and really like cranking up the heat and building muscle, I think is the most like biggest R o I way to do that and is so critical for long-term disease prevention as well. 

[00:27:45] Dena: So I think you have to, just two small things would be like, you have to crank that protein up much more aggressively than most women do. And proteins having a heyday, right? Like all women of all ages right now are eating more protein, which I think is wonderful and their strength training, which is great. 

[00:27:58] Dena: But you really have to combine that aggressive protein intake with progressive overload and strength training. Like you have to get comfortable lifting weights. You don't have to turn into a meat head, but you do have to build muscles to hedge that loss of muscle.

[00:28:12] Dena: And that's really, really a big key to driving the metabolism, growing that muscle. So that's one thing. I think the other thing is being aware of like, Insulin resistance, blood sugar regulation issues, how that does become a little harder in the stage. And certainly the deeper you go, it becomes harder and harder because that's one of those shifts that's happening under the surface.

[00:28:31] Dena: No matter what your symptoms are, you're becoming more insulin resistant over time as you age 

[00:28:37] Christa: and by the way, strength, strength and protein will help. But why, when you're aging, will you become more insulin resistant? 

[00:28:43] Dena: Yeah. Well, I think estrogen does have a lot to do with that. Estrogen does improve insulin sensitivity so does testosterone.

[00:28:49] Dena: Ultimately, I think it does come down to the hormones in one way or another. They're affecting all these big shifts because hormones are active in every part of our bodies, so I think it's the hormonal shifts largely and that like inflammaging and insulin resistance and all that, I think is tied back to the hormones in one way or another.

[00:29:06] Dena: So you really wanna be like dialing in nutrition where you're like, You don't have time for all the extras anymore. You can have them on occasion for fun, but like, you gotta be serious every day about like protein, produce, eating in the right kind of balance, having space between your meals, not overeating, you don't have to restrict, but not overeating.

[00:29:23] Dena: You can't afford that. Like earlier days, you can get away with a little more, right? But the deeper you go into this, the higher the stakes are. And you have to be like, just very purposeful about what you eat that it's super nutrient dense that the macros are like decently balanced. We don't get like, Super crazy about it, but you have to have a decent balance there, and then you have to pair it with the fitness side of it and then the stress management side of it.

[00:29:45] Dena: You have to be sleeping and that can get harder during this stage, so you have to pull out all the stops To protect sleep. You really have to get strategic in all these areas, which we're all familiar with, right? If we're health conscious, we know all these things are important and we're all working hard.

[00:29:59] Dena: To dial them in, but you have to get a little more focused on like what's happening in your body and then tweak that strategy so you're meeting that new need of the body in this stage. 

[00:30:08] Christa: Anything else you wanna say about diet and lifestyle? Because the last section I had was supplement strategies, and you can add any more strategies you want as well, but anything else to say about diet and lifestyle?

[00:30:17] Dena: Yeah. I think that this is more of a mindset shift, but because women are so keyed in on diet and fitness. I think you have to be viewing all this stuff as like providing what your body needs. We're all into symptom alleviation, myself included. Like I said, it was love handles, like it was the vanity factor that for me was like, okay, I gotta figure this out, you know? And that's fine, like no judgment on that. 

[00:30:42] Dena: But we have to be thinking beyond that too, and like, I wanna get my body to do what it wants, but I wanna understand my body so that we're communicating well. And I'm really dialing in the nutrition. So I'm not a super fan of Crazy diets are super restrictive.

[00:30:55] Dena: So I don't do like extended intermittent fasting. I don't think keto is really necessary, but I do think you wanna have a protein and produce centric eating plan where you're eating two or three square meals across the day, and you better feel good between those. If you don't, you need to adjust that. I think you just have to be attentive to the quality of nutrition and the basic balance of it.

[00:31:15] Dena: So I think it's really about Knowing a little strategy, dialing it in, and then watching your metrics, your symptoms, your labs, whatever you're watching to make sure that it's working for you. You need to be watching your blood sugar, you need to be checking labs on these things as we age to make sure that the data is matching up with what you need. 

[00:31:32] Christa: I think it's easier as we get busy. I mean, there's all times where it's easy to let all these things slide, right? 

[00:31:38] Dena: Yeah. 

[00:31:39] Christa: Okay. So we've talked a little bit about the big picture strategies as we enter late thirties, early forties perimenopause, which can last eight to 10 years.

[00:31:47] Christa: We talked a little bit about biodentical hormones, hard stops on hormones, a little bit about diet and a little bit about lifestyle. Anything you wanna say supplementally?

[00:31:55] Dena: I think that supplementally, again, I would probably fall back on some a few foundational things and then thinking about inflammation, insulin resistance, oxidative damage being like hallmarks of aging that we're tiptoeing into through this stage. 

[00:32:09] Dena: So I would probably consider layering on things like a high quality fish oil, maybe a few good strong antioxidants, things like that. Liver support, herbs, incorporating that through food or lifestyle.

[00:32:21] Dena: And then as far as perimenopausal or hormone altering supplements, herbs and such, I tend to like, Maybe try one or two things, but I'm more about like the food lifestyle stuff. Watch the symptoms. Watch the labs, dial that in. And then if you need hormones, you need hormones. 

[00:32:43] Dena: Like you might try an herbal product here or there to stretch you across a year or two to help you feel a little better before you actually need hormones.

[00:32:50] Dena: But it's also about recognizing when it's time to get down to business and start replacing things with the help of a doctor. 

[00:32:55] Christa: On that note, are you measuring metrics or have you turned that over to a provider? 

[00:33:02] Dena: I think with one-on-one clients, most people who I'm seeing lack a medical provider who's like driving this boat with them, you know? So most people I'm seeing are consulting me to help them know what to go ask for, or we send them to the lab and get it themselves. So most people, I'm kind of directing them toward that and then trying to match them with if they need h r t with a doctor who's reputable, who aligns with them, who can do that for them.

[00:33:27] Christa: Yeah. 

[00:33:28] Dena: But it's a big project. It's hard. I don't know if you do that, like co-managing like perimenopause or H R T clients with doctors. It's really hard to get the right team members and everybody aligned and getting the right data right. 

[00:33:39] Christa: We do in short, I kind of say, this looks like this problem. Let's do an intentional experiment for this duration of time. If this is effective, you need to go seek someone who manages this more long term for multiple reasons, but also from an expense perspective. 

[00:33:58] Dena: Yes. 

[00:33:58] Christa: Because some of the things I have access to are just not the best price point. It's a good place because we wanna test the water. We wanna get curious, see if this is what the issue is, and then we can go in and assess from it. 

[00:34:09] Dena: Right. Totally agree. Yeah. I'm always trying to like match the, like ideal with the practical, and there's no reason to shell out like hundreds and hundreds on some big fancy test if then it's just gonna affirm for us what we suspected and then you're gonna go to a doctor and they're gonna wanna start from scratch anyway.

[00:34:21] Dena: You're trying to like, like you say, get enough to know like, ah, this is the direction I, why don't you go over there and get that from them and we'll keep working over here on this stuff. 

[00:34:28] Christa: You can sure learn a lot from symptoms and not testing. 

[00:34:31] Dena: Yeah. There's a whole school of camp, which I think's very respectable in H R T, and they strongly advocate not to test.

[00:34:37] Dena: I mean, they're just like, just start 'em super low, listen to how you feel. We'll adjust as we go. And then once you feel better, then we'll test and see where you're at. And then we can optimize the number. So there's a lot of different ways to skin that cat. And I think, again, it just comes back to each woman needing to research enough to know generally what she wants, who she thinks she trusts, and then take a few steps down that road with that provider and make sure.

[00:34:59] Dena: This is what I want and it works for me because if it doesn't, there are others out there who do it differently. 

[00:35:04] Christa: Are there any other strategies you want women to know about that help them get off on the right foot that we didn't talk about? 

[00:35:11] Dena: I think, we didn't touch on too much of the lifestyle and it won't be surprising to anybody, but you know, really this is the time where like boundaries, self-care, sleep, those things have to be prioritized and this is a hard season of life it's always hard, especially in today's world. It's getting harder all the time for everyone to do those things. 

[00:35:26] Dena: But in this stage of life, a lot of women are dealing a lot especially, when you get into that later forties, fifties, and then you're in the sandwich generation and you're launching kids and your parents need you and there's a lot going on.

[00:35:36] Dena: Sometimes relationships are shifting, big things in life. Can feel like they're shifting. And a lot of women feel from the inside that they're changing, they're growing or they're grieving losses of things about themselves. 

[00:35:46] Dena: They're like facing really, really deep things. And I think, this is a time in life where it really takes like carving out time for yourself to sit with yourself, to understand yourself, to investigate things that you know are not right to investigate relational things and deep spiritual things and things that really are cropping up for us and shifting in a lot of ways and tend to those and care for self. Like you never have before. 

[00:36:08] Dena: Not in a selfish, me, me, me way, but in a way that's like, let me make sure that I'm tuned in because my body needs me right now. I've been in stages where I'm dishing it out for everybody else who needs me, but my body's entering a huge transition and it really needs me. So I think the self-care piece that's gonna look different for each woman is huge. 

[00:36:26] Christa: So we talked about strategies. Is there anything else that you feel like we didn't cover, that we should, when we're addressing or talking about or I think what speaks to me here is you said, I want people to know this sooner and sooner because we tend to be really reactive instead of proactive. 

[00:36:42] Dena: Right. 

[00:36:43] Christa: And here I am in my late thirties, pondering if I need to do anything else and feeling like I need to check my metrics regardless anyway, which I was feeling before I got here anyway. I know that was like one of your big goals or objectives with our conversation today. 

[00:36:59] Dena: I think that's it. Is just like, if you're in your later thirties or early forties, and. You're experiencing some things that you know are different, whether it's about your period or not.

[00:37:11] Dena: If you know things are changing, even if you've gone to the doctor and they tell you you're normal and your labs are fine, even, you aren't kind of falling into any group you're like, it doesn't look like this. And I don't think it's that. If things are changing and you know it, It could be perimenopause, and it's not a disease, right? It's a stage of life. It's very normal. It's wonderful. It's beautiful in a lot of ways. I feel like I'm rediscovering or newly discovering things that are beautiful about it, but you do want to keep listening in, keep putting the pieces together and adjusting your strategy to help your body in this stage because it's not going away. It's only gonna get louder. 

[00:37:48] Dena: You're only gonna have more signs, and the sooner you understand what's going on and have the right strategies, the sooner you'll feel better. But you can also start paving that course in front of you, because really, I think your forties are a window of opportunity. That's what's very apparent in the literature when it comes to H R T, when it comes diet and lifestyle. It's never too late, right? It's never too late to get healthier, no matter how old you are, but because of the way things are changing, It's so much easier now to stay ahead of the ball and to get a leg up on all that's coming down the pipe.

[00:38:20] Dena: And we're living longer than ever. We just wanna make sure we're living healthier than ever at the same time. 

[00:38:24] Christa: Yeah. What I hear is that, we're not like gonna be fighting with our bodies.

[00:38:28] Dena: No, no. 

[00:38:29] Christa: This season that we're kind of welcoming and we have to shift these foundations if we haven't shifted them to protein and building muscle and things like that.

[00:38:38] Christa: And maybe away from possibly so much cardio and some other things. It's just an opportunity, I guess is what you're talking. 

[00:38:46] Dena: Yeah, and I think like you just mentioned, and this is kinda where I am too, where I'm like, I feel pretty good, but I force myself to Order that lamb go check on that.

[00:38:54] Dena: Like I wanna make sure the data's lining up too, because some of this stuff can happen quietly and I've said before to people like, be grateful for your symptoms. But to be honest, like some people are fairly asymptomatic, like they won't have many symptoms are hardly at all till they get right to the end of that and their menopausal.

[00:39:10] Dena: And if you don't have symptoms, like the things are still happening under the surface, inflammation, insulin resistance, or hormonal decline, those things are happening and they're actively brewing. Chronic diseases you don't want. So it's not to like scare people and be like, everybody has a problem, even if they don't know it.

[00:39:25] Dena: I mean, I think that's stupid. But it should be like, check in if you're this age, especially if you're seeing things, check in, check in with your labs, check in with your strategies, make sure you're really dialed in. To make sure this goes well for you. 

[00:39:37] Christa: Yeah. You brought up that you're enjoying digging into the literature, distilling it down, and providing what people need to go ask for the right things, which is a time saver.

[00:39:47] Christa: And I feel like you compiled all this, you have a program. I mean, this is like really, you are pretty on fire on this topic right now just because it affected you so much. So you compiled a little thing called the forties fix crash course. Right. Will you tell me what is inside of that, just quickly?

[00:40:04] Dena: Yeah. So the forties Fix Crash course was in response to all these women complaining about all these things and wanting guidance and not knowing where to turn. And so it is just that, it's a crash course. It's like, The user's manual for your forties body. So it helps you understand where you are on this timeline, what are the signs, what's changing under the surface, and then it spends the rest of the time on what can you do about it.

[00:40:25] Dena: So there are five areas that teaches you how to strategically. I call it fortifying. So all of those five foundational areas, and then it has like additional fixes, food, supplements, lifestyle, h r T, other tests to ask for the most common complaints like low libido and insomnia and anxiety and all these.

[00:40:41] Dena: Where do you go next? Once your foundation is solid, it does have a ton of cheat sheets for like, order these tests, do this. Here's my supplement stack. This is how your eating should look. Here's how you see if this is working for you. So it really is like D F Y walking you through how to set yourself up.

[00:40:56] Dena: For this to go well, so I have that course as a entirely self-paced course. People can combine it with one-on-one, one work with me if they want. So that's available. I'll give you the link. So if you wanna share that with people and if people wanna enter the, the code Christa a checkout, they can get $50 off.

[00:41:10] Dena: So I'll share that. I also have a free masterclass if people are like, is this even me? What's this all about? They can join the free masterclass and it kind of walks through laying the case for this and covers five mistakes I see forties women making and how to fix them. 

[00:41:23] Christa: Cool. Well, you've been busy. 

[00:41:24] Dena: Yeah.

[00:41:26] Christa: We'll put that in stuff in the show notes. Thanks so much for coming on today. 

[00:41:28] Dena: Yeah, thanks for having me.

[00:41:30] Christa: Sharing and reviewing this podcast is the best way to help us succeed with our mission. To help integrate the best of East and West and empower you to raise the bar on your health story, just go to review this podcast.com/less stress life. That's review this podcast.com/less stressed life, and you'll be taken directly to a page where you can insert your review and hit post.