In this episode, I’m answering a common question I get from this community and that is how can we prepare our bodies for perimenopause and beyond. I’ll be breaking down how to figure out when your transition may start and what areas you want to consider focusing on.
As always, I’m a dietitian but I’m not your dietitian. Please discuss any changes you may want to make to your health with your medical provider.
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Amanda Montalvo [00:00:01]:
Welcome to the Are You Menstrual podcast, where we dive deep into all things women’s health to support you on your healing journey. I’m Amanda Montalvo, functional and integrative dietitian, also known as the Hormone Healing Rd. If you enjoyed this podcast and you want to keep learning, check out the podcast Patreon, where I share a bonus episode with additional downloadable resources. Each week you can go to patreon.com, hormone Healingrdez or check out the link in the show notes. All right, in this episode, I’m covering a common question I get from this community, and that is, how can I prepare my body for perimenopause and actually going through menopause? How do I ease this transition? So I’m gonna break down how to figure out when this transition may start for you, areas you wanna consider focusing on, and then basically what a healthy cycle looks like, what it looks like when it becomes out of balance and when we start to go through menopause and then what we can do to support our bodies. As always, I’m a dietitian, but I’m not your dietitian. So make sure you discuss any changes you may want to make to your health with your provider. Okay, let’s start with the transition timing, because I feel like this is something that I don’t hear discussed enough, and it’s usually a lot of fear mongering involved.
Amanda Montalvo [00:01:17]:
And I don’t want anyone to feel scared with this information. It’s more just to empower you and to help you understand if you do see some shifts in your cycle, maybe you have some extra stress in your life life and you are within this window of perimenopause, potentially based on when your mom went through menopause, that it’s like, hey, it’s time to get really serious and take a look at how you’re eating, how you’re living, and what we can do to support your body so that you can put off this transition and make hormones for as long as you possibly can and be healthy and not go through menopause early. Because I am seeing it more and more where women are going through it, menopause at a much earlier age than their mom went through menopause. And I think that stress lifestyle has a lot to do with that. So when it comes to the timing, typically you’re going to go through menopause somewhere around the time when your mom went through menopause. So if your mom went through menopause at about age 50, then your range is going to be like, 45 to 55 of when you could potentially go through menopause if you don’t know, because I have had quite a few clients where they’re like, oh, my mom had a total hysterectomy where they removed her ovaries as well at a young age, and then we don’t really know. Then I’m like, if you know, if you can ask your mom about your grandmother or ask your grandmother yourself, that would be ideal because it’s going to be pretty close. If you don’t know, then I would assume, like, 45 to 50 is pretty average, so you could go with that.
Amanda Montalvo [00:02:47]:
Perimenopause can start ten to 15 years prior to that. So technically around age 35 to 40, depending on when your mom went through menopause. And this can be impacted by nutrition, lifestyle, stress, our overall health in general, too. So, of course, we could go through earlier. We could go through later, ideally later, obviously. Needless to say, most women will actually start going through perimenopause before they even realize it. And we can have inovulatory cycles where we are not actually releasing an egg and making that nice progesterone for up to five years before menopause hits. So you could see very few changes in your cycle for five years, have a regular bleed, but you’re not actually ovulating.
Amanda Montalvo [00:03:33]:
And so then we start to see decreases in progesterone imbalances in estrogen and progesterone, but you’re still getting that monthly cycle. And so that, and then that, you know, of course, if we’re not making progesterone, as we’ll talk about, that’s gonna lead to a lot of symptoms in early perimenopause. Um, and then once you start making less of both hormones, then you get the tip. Typical gamut of menopausal symptoms. Gave you guys, like, a little example, like, real life example for, like, myself. My mom said that I can share this. She’s been working very hard on her health. I am so proud of her.
Amanda Montalvo [00:04:09]:
She’s got four grandbabies now between me and my sisters, so she’s very motivated. She wants to be super active. We call her Mima. Just make sure that she can travel, see her grandbabies all the time, and they’re all incredibly active toddlers and babies right now. So she’s. They’re putting Mima to work when she visits. So, you know, she’s been really working on supporting her circadian rhythm. She has been making lots of shifts with supporting her digestion because she was previously on reflux medication.
Amanda Montalvo [00:04:39]:
So many amazing things, but she’s still been dealing with symptoms, so we’re working on optimizing her health as much as we can. But she went through menopause when she was 52. My grandmother went through menopause, and she was about 55, so pretty close to there. I’m, like, hoping to get closer to 55 if I can optimize my health as much as possible. But 52 puts my ten to 15 year onset between 37 and 42. And right now I’m 34, so I’m like, that’s too close for comfort, personally, way too close. And this. So this is something that I’ve really been diving into because I’m like, I want to support myself as much as I can.
Amanda Montalvo [00:05:19]:
My mom had great cycles for a really long time, like, up until, like, a few years before she went through menopause. Not a ton of crazy symptoms. So I’m hoping to have a similar experience. And it’s just really put this topic on my radar and something where I’m like, I need to make sure I talk about this with you guys because I feel like, you know, I have a huge range of listeners, but I know I have a lot of young moms, young women that listen to me, and I’m like, it might be closer than you realize. So especially, you know, if you have fertility goals or goals of becoming pregnant. Like, we want to know this stuff. So that’s about the transition timing. Just helpful to keep in mind, you know.
Amanda Montalvo [00:05:57]:
Okay, when. When is your potential timing start? And then that’s something where using, like, monitor. Like, I use fertility awareness method to monitor my cycles. That’s really helpful, because then I can confirm if I’m ovulating every month and is when I see shifts in that, that would be a big red flag for me. So that’s, like, another reason to track your cycles, if you can. So what is happening to our hormones? What’s the transition? What imbalances can come up? So I’ll talk about that in a second. But just so everyone is on the same page, I want to go through what does a healthy cycle look like? What does it create for us? What kind of, like, hormonal environment? And then we’ll talk about what shifts happen as we start to go through perimenopause. And our, you know, ovaries are not signaling the same way that they used to.
Amanda Montalvo [00:06:45]:
So a normal cycle, we start to bleed on day one of our cycle, and that’s when our hormones are at their lowest point. And then our hypothalamus is going to release gonadotropin, releasing hormone, talks to our pituitary. That pituitary gland is then going to release fsH, and that’s going to stimulate the follicles in our ovaries. And then these follicles are going to release estrogen, and that makes the FSH go down. So we’ve got this follicle stimulating hormone coming from our pituitary gland to try to stimulate those follicles in our ovaries to grow, to get ready to release an egg. So we get those follicles, then make estrogen, and then that follicle stimulating hormone goes down. The dominant follicle gets selected, and then the egg development starts. So our brain’s talking to our ovaries, talking to the follicles.
Amanda Montalvo [00:07:38]:
They’re releasing estrogen. Now they’re getting an egg ready to release. We get this nice peak of estrogen, and that causes the egg to mature. Then we get a nice surge of luteinizing hormone, lh, and that FSh. Again, this leads to ovulation. So we need this nice surge of estrogen. We need this LH and Fsh. We get that egg released from that dominant follicle.
Amanda Montalvo [00:08:01]:
And then the FSH and Lh go back down, and then the egg is released. That follicle then becomes what’s called a corpus luteum, and that causes progesterone to peak. That’s where we get a nice production of progesterone. If it is nice and healthy, if we have enough nutrients, if we have a well functioning, we have thyroid that’s giving us enough thyroid hormone. And this leads to a nice mix of estrogen and progesterone, beautiful levels in the body if everything’s working as it should. And so this is happening every single month, typically 28 days. It can rain from like 26 days to 35 days, could be considered a normal cycle. These are things we want to all keep in mind as we age.
Amanda Montalvo [00:08:48]:
Our ovarian reserve of eggs is declining. And then eventually we’re going to have inovulatory cycles where we’re not releasing an egg, so we’re not going to have that follicle that’s released the egg after to make that progesterone. And so this means we’re just making estrogen, we’re not getting that release, not making progesterone. And so typically, when perimenopause begins, when we start to have in ovulatory cycles, we have estrogen dominance. And it doesn’t always mean that estrogen is actually high. It could just be high in relation to progesterone because they both need to go, you know, be right at be balancing each other out. When estrogen is higher, progesterone is going to try to match it. So that’s another thing like leading up to perimenopause.
Amanda Montalvo [00:09:39]:
If we are going into perimenopause transition with already having too much estrogen, we’re typically going to have that imbalance and utilize, use up more of our progesterone quicker because the progesterone is trying to match the estrogen. Progesterone is probably the coolest hormone ever. It’s one of those where it does so many different things. And we have receptor sites for progesterone all over the body. And it’s basically, it has the ability to bind to different hormonal receptors and take up different positions in the body. So if we’re missing out on something else, progesterone can step in and kind of pick up the slack if we have other dysfunctions going in the body. This is why I think that so many women are struggling with their progesterone levels. It’s not just that it might not be that they’re not making enough, but it could be that they have too much estrogen.
Amanda Montalvo [00:10:35]:
So their progesterone is trying to match it that uses more up, and then they have deficiencies other areas in the body, and so they’re going to use up more progesterone to deal with those. It’s kind of just filling in holes. It’s a very supportive, and it’s like, I look at it like a hormone that’s like a caretaker, right? It’s trying to clean up. It’s like a little mom trying to make sure everyone’s all good. So that typically leads to us having depleted levels of it, even if we’re having regular cycles and making enough every month, if we have a lot of stress dysfunction going on in the body. So that’s why we want to enter perimenopause without that is the, is the whole goal. And that’s at least my plan, what we help our clients do. And like, that’s like the number one thing going in.
Amanda Montalvo [00:11:18]:
So basically we start to see symptoms because we have usually enough estrogen, not enough progesterone. Over time, what happens is the ovaries release less and less of that estrogen as well. And so then estrogen and progesterone are both low. And I mean, estrogen is important for pretty much everything when you look it up. Like, it’s important for our gut health, it’s important for our oral health, it’s important for our bones, it’s important for muscle tissue, it’s important for blood sugar and inflammation. I mean, it’s a endless. The things that our body needs estrogen for. And this is why when you look at research that talks about the health of women pre menopause versus post menopause, when they’re no longer making hormones, the health outcomes typically go way down.
Amanda Montalvo [00:12:10]:
And this was kind of the conversation I’m having with my mom of like, all right, we have to just get you as healthy as we possibly can. And then she’s going to use HRTA, she’s going to try it, so we’ll see how it goes. Many of our clients do really well with HRT. We’re going to have that whole episode with Marie and Kristen to kind of go more into that and the importance of having enough hormones post menopausal and how it can impact the health, your health and vitality for the rest of your life. So I promise we’ll cover it. But it’s difficult to have it be super beneficial if you have not prepared your body for it, because, again, those hormones, like progesterone especially, they’re going to get used up and they’re going to be filling in holes in other places. We want to make sure that all those other places are as optimized as they can be first and then consider adding something in. But this is where you would talk to your doctor, of course.
Amanda Montalvo [00:13:04]:
So those are the shifts that are happening with hormones. Eventually they’re going to be depleted. You’re not making any. Once that ovarian reserve is depleted, typically we even have like 100 follicles left over even once we’ve gone through menopause. And we don’t know why they don’t get stimulated and release an egg eventually. There’s not enough research on that yet, but I think we will maybe in the next few years. But the ovaries cease to continue to function. We no longer get a period.
Amanda Montalvo [00:13:36]:
And once that has happened, typically for about a year, that’s when you’re considered to have gone through menopause. That’s your transition. And typically leading up to that time, your cycles can be much more erratic and irregular. But again, some women have regular cycles for five years without ovulating leading up to menopause. So hormones are slowly going down, becoming out of balance. That’s when we start to see, like, especially things like anxiety can pop up sleep disruption issues with weight gain, all those things, and that’s because of the decrease in hormones are affecting other areas of the body. So one of those I think of, like, the ovaries make less estrogen. So that decrease in estrogen leads to, like, us not tolerating as many carbs because estrogen helps make us more sensitive to insulin, which can lead to more insulin resistance.
Amanda Montalvo [00:14:23]:
Estrogen can also impact leptin signaling. Leptin is a very cool hormone that is telling your body how much energy is reserved, tells your brain every single night, hey, this is how much energy Amanda has on her body. So this is what her appetite should look like tomorrow. This is how many calories we should burn tomorrow when we have many things can impact leptin. We need to have a podcast episode on that. I got to have Carrie Bennett back on to talk about that. Like, light and circadian rhythm has a huge impact on leptin when it comes to hormones, estrogen does, too. So the lower the estrogen level, the more disrupted that leptin signaling can be.
Amanda Montalvo [00:15:03]:
Plus, if we pair that with insulin resistance, then that’s a recipe for weight gain. Right? And then if we also have a sore metabolism that we’re struggling with sleep, that’s, of course, going to impact leptin and insulin resistance. Again, the body’s inflamed, and we have this vicious cycle that is leading to not sleeping well, low energy. It can definitely impact our mood big time. Hormones have a huge impact on our mental health. And then, of course, like, more inflammation that leads to more inflammation in the brain, you know, and then that can lead to more depression and anxiety. But I think a lot of it is. It’s kind of like this snowball effect.
Amanda Montalvo [00:15:41]:
We start to see some imbalances creep up, and then we get symptoms, some dysfunction in the body. They compound because it’s not like our hormones are getting more balanced. The more we go through menopause, they’re becoming more out of balance. And, you know, a lot of times we’re just told that it’s normal. It’s a normal part of aging. It’s normal to gain weight. It’s normal to have more fat in your abdomen and have your body shape change. And it’s a part of aging.
Amanda Montalvo [00:16:10]:
And it’s, like, not that I think we should work against aging. I’m very much, you know, I don’t. I barely even like to wear makeup, so I’m definitely not like a, let’s do a bunch of stuff to look younger. But I just care about women’s health and ultimately long term. Having enough estrogen and progesterone, even in smaller amounts, through HRT, has been shown to help prevent disease and improve health and vitality. So your quality of life in the long run, we need those hormones pumping through us for so many things, and when it. And then again, like that progesterone. So I just think about, like, you know, when our brains are experiencing trauma and a lot of stress, research has shown us that they will release progesterone.
Amanda Montalvo [00:16:55]:
We’ll release progesterone from our brain, we’ll release it from our adrenals when we’re trying to compensate. And so I think a lot of what’s happening in postmenopausal transition, we’re getting a lot of imbalances and we’re experiencing more stress because of these symptoms that are popping up. We don’t feel like ourselves. I mean, that’s really stressful and then typically not having great support from a provider, at least that’s. But my experience with women, in most cases, my mom just found she has a really good PCP right now. Who referred her to endocrinology? She’s an OB. I guess technically that works with HRT, and that’s, like, all she does. And I’m hoping she’s going to be amazing.
Amanda Montalvo [00:17:37]:
But even her PCP is awesome and is so supportive. We’ll run any labs that I ask her to. So it’s not easy to find that, though. And so that’s a. That’s something that I always keep in mind. So then that can be another big stressor of how can I get the help that I need. The other big shift that is occurring is typically our thyroid health. You know, the research shows as we age, our thyroid becomes more sluggish and our metabolism slows down.
Amanda Montalvo [00:18:01]:
We make less stomach acid. That’s why many people are on ppis, like, for reflux and things like that. And that is very unfortunate because that leads to nutrient deficiencies and that can further impact our hormones. Right. And, like, gut health and inflammation in general. But the thyroid’s a big one, and it’s another one where it’s kind of like our hormones. Like, should we accept that as we age, our thyroid becomes sluggish? The way that I would look at it is as we age, we are more likely to have chronic stress, and that will definitely impact how our thyroid gets signaling from our brain to make thyroid hormone. We can also have nutrient deficiencies.
Amanda Montalvo [00:18:43]:
We’re much more likely to have them. That makes it hard to make thyroid hormone and use thyroid hormone. So it’s not that it has to be this normal part of aging. I think it’s more that our thyroid has become tired, we’re deficient and we’ve been stressed for so long that then we eventually have thyroid issues. We need a healthy thyroid for everything in the body, but a big one is digestion. And so that’s something I really like to focus on leading up to perimenopause. How can we optimize thyroid function? How can we optimize our day to day stress and support our adrenals so that we are not having hormone imbalances before we’re even in the perimenopause transition? Right? I mean, I just think of so many women we work with that are not even in that transition myself, for sure, going through my healing journey, like in my twenties, not even close to my transition, and having severe estrogen dominance and not producing adequate amounts of progesterone, or at least like probably using up the majority of that progesterone to deal with stressors. And that’s a huge red flag because that’s the time when I should have the most balanced hormones, the most healthy, functioning thyroid and all those things.
Amanda Montalvo [00:19:54]:
So that’s something where if we’re focusing on supporting thyroid, making sure we have good digestion so that we can break down our food, well, get those nutrients we need, not constantly being on the go, not running on stress hormones all the time, because eventually we’re going, going to get depleted. And that signaling that dysfunction and the signaling in our hypothalamus, pituitary, adrenal axis that controls our stress hormones, that will impact our thyroid and that will absolutely impact our production of sex hormones as well. So there’s so many different shifts that are occurring. It’s not just that our body is no longer making hormones or the amounts that they’re making is shifting over time before we get through menopause. It’s also that we have dysfunction in other areas of the body. So basically we’re seeing this reduction in sex hormones and then we’re typically seeing a slowing down of thyroid that will lead to more of a reductions in sex hormones. We see chronic stress leading to that dysfunction, and how we make stress hormones that hpa access dysfunction. And then we see lots of inflammation because of this lower sex hormone amount, but also from things like stress, thyroid dysfunction, and having that over and over and over impact things like blood sugar, leptin signaling, and then lead to inflammation.
Amanda Montalvo [00:21:11]:
So there’s many shifts that are occurring. It’s not just sex hormones. I have a whole series on supporting thyroid health and understanding your thyroid health. The link for that, it’s called the functional thyroid series, is going to be in the show notes if you have not gone through it yet and you, you want to start learning about how to understand, is my thyroid functioning well? The series is worth it. It’s six videos. It’s really good. It’s a lot of information on thyroid, but it helps you understand where are your thyroid imbalances coming from? Because thyroid’s not as straightforward as you’re not making a thyroid hormone. It’s like, why? Is it coming from signaling issues in the brain? Is it coming from nutrient deficiencies? Is it coming from stress? And looking at blood work and a hair test can help you understand where yours is coming from.
Amanda Montalvo [00:21:59]:
So that is something that, I mean, I do that anyway because I have a thyroid health history. But I would say leading up to this, your window for perimenopause to begin focusing on thyroid health is going to be huge. That’s going to make sure you can have a really healthy corpus luteum, make lots of progesterone, make sure you’re ovulating every cycle, have good digestion. I mean, once your thyroid slows down, everything starts to slow down. So thyroid’s a really big part of preparing for perimenopause and menopause. We also want to have a healthy, functioning thyroid as much as we can before we start taking HRT, because you want to get all the benefits from it. And that is something where we can use hormones even if we have not gone through menopause yet. Something like a bio identical progesterone, I think can be very helpful for women in that perimenopause time, because if you’re starting to make less progesterone, maybe it’s a thyroid issue, maybe you have a lot of stress and you can’t keep, keep up with production or like with how much your body needs.
Amanda Montalvo [00:22:59]:
Then that could be a time where maybe you talk to your doctor about using bioidentical progesterone after you test your hormones, of course. Of course, to make sure it’s appropriate. But that’s like, what can really help with that early transition. When estrogen is higher than progesterone and you’re getting a lot of those symptoms, it can really make it so that you’re filling up a lot of the holes. If you have other dysfunction in the body and then also meeting the needs so that you can balance estrogen, progesterone during that time and avoid symptoms. I heard people discuss how it can be very helpful for delaying that perimenopause transition as well, especially for women that are in their window and still want to conceive. Then bio identical progesterone could be really, really helpful. So that’s something to consider again, I’ll have Marie and Kristen on.
Amanda Montalvo [00:23:47]:
We’ll talk about all things HRTA. Improving our thyroid health can be complex, right? It’s so much more than just knowing, am I making enough thyroid hormone? We really need to zoom out and look at the full process and picture and understand, okay, how is the signaling from my brain going? Is my thyroid getting the signal to make more thyroid hormone? And then you have to think about, is there anything my thyroid might need that it’s not getting to produce that thyroid hormone? Maybe there’s a nutrient deficiency, maybe there’s too much inflammation or stress. Then we want to think about, can it convert it? Right? That’s the next big step. And that’s typically impacted by stress, inflammation and nutrient deficiencies as well. And then finally we have to realize, can it get inside the cells? And this is where minerals come in big time. So zooming out, understanding your full picture is so critical for thyroid health. This is why I created my free functional thyroid series. That is six part video series.
Amanda Montalvo [00:24:44]:
It’s a mini course. I’m really proud of it. It gives you a ton of information, and it’s going to help you figure out what is the root cause of your thyroid issue. Where in the process is it breaking down for you. I even go through lab tests and teach you how to understand what your lab tests mean and what you might want to optimize based on your results. So make sure you check it out. You can go to the description of this podcast and get the link to join for free. Thyroid health should be on your radar.
Amanda Montalvo [00:25:11]:
I have the six part series for that because that would be an incredibly. It would be like a two hour podcast episode. So definitely go watch that if you want to understand how you can support your thyroid. The other thing we want to think about is what are the most important daily habits that we want to start focusing on as we move into this transition. Maybe just like your time, you know that, that ten to 15 year window leading up to menopause. What can we do? How can we support our bodies? I think the number one thing is going to be to support your circadian rhythm and have healthy light exposure. This is something where we all have a circadian rhythm. It is this biological clock in our bodies that communicates to all the different systems when different functions should be occurring in the body.
Amanda Montalvo [00:25:59]:
And it’s a all impacted by light that’s coming through our eyes. That’s what tells our body what time of day it is. We want to get lots of natural light exposure in the morning, get light throughout the day, like short breaks if you can, and then block artificial blue light whenever it’s dark out. So at nighttime, and then if you get up before the sun comes out, you’d want to block it in the morning, too. I did a full podcast episode with Carrie Bennett that I’ll link in the show notes, but that is one that is incredibly helpful. All of our perimenopausal, menopausal clients, that’s the first thing that we do with them. That’s something that my mom worked on and for the last, I would say, bad with timelines. I was probably eight, probably nine months now.
Amanda Montalvo [00:26:48]:
And that’s what really helped her see a lot of success with her health and improve a lot of her symptoms. In the beginning of starting to work on her health, I got her blue blockers, like, let’s get outside in the morning. She’s really good at getting light during the day, but not as much in the morning. But now she’s great with it. And I got her eating breakfast, not waiting till, like, 11:00 a.m. to eat breakfast, not skipping breakfast, because eating is the other thing that tells our body what time it is. So that’s why ideally, especially in this perimenopause menopause time frame, you get that morning light, you eat within an hour of getting that light, and you also only eat when it is light out. So I don’t recommend nighttime snacks for this population unless they absolutely need it.
Amanda Montalvo [00:27:32]:
Like, if we have someone that sleeps better when they have the snack, obviously you’re going to eat this. You know, you. It’s a hard enough having good sleep during that season as it is, but we do find that most do better without that nighttime snack. And I think a lot of it is because of that leptin signaling in the brain that happens at night and because it’s more supportive for their circadian rhythm if they’re only. Only eating when it’s light out, primarily the time of year can obviously impact this. Where they live is going to impact this. Our clients are within the US. We haven’t had anyone in Alaska, actually.
Amanda Montalvo [00:28:07]:
So that’s because that would obviously be an extreme. That would be tricky, and you’d have to shift things, but supporting circadian rhythm, getting healthy light exposure, eating with the light is something that we have found be especially helpful for this season of life. A lot of them also have gut issues they don’t know about because they’ve thought that things were normal for most of their life. They’re told by their doctors that it’s normal to not have a bowel movement every day. That’s not constipation, unless you go a whole week without a bowel movement or a certain number of days. And then they’re learning, oh, this actually is not normal. This could be impacting estrogen and different shifts I’m seeing with my gut health and inflammation in my body. Supporting your circadian rhythm can be really helpful for those having those regular bowel movements too.
Amanda Montalvo [00:28:51]:
It’s great for digestion, good gut bacteria, all the things. So that’s typically where we start. And then the other thing that I think about for this population is how’s your nutrition going to shift and change as you move through imbalances in estrogen and progesterone, lowering of sex hormones in general, how that’s going to impact how you, how sensitive you are to carbohydrates. So your nutrition will shift throughout your perimenopause and your menopause transition, because how much hormones you’re making is going to change, and that’s going to impact how sensitive you are to carbohydrates. But the thing that we can all focus on and something that I really, really, really encourage women to have in a good place before they start getting into this window of perimenopause is eating enough protein. And I know I talk about this all the time, but I am telling you, I go through, I mean, probably at least five to ten new client applications a week, and we have a food journal in there, and I would say 90% are not eating enough protein. And that’s something where I’m like, you can start working on this before you start working with us. You do not have to wait for one on one to begin working on this because you will feel better, you’ll see some improvements just right off the bat from doing that.
Amanda Montalvo [00:30:13]:
When we go through this transition of menopause, one of the top things that we also unfortunately have happen is we lose muscle mass. We have to really fight to keep it on. You don’t have to lose muscle mass if you eat enough protein and you strength train. I have seen women gain muscle mass even post menopause without HRT. So it’s not impossible, but it is something that you have to be very mindful of and intentional with. So eating enough protein. I would say for most women that are peri and post menopausal, that’s going to be probably 40 to 50 grams a meal. And you’re ideally eating three meals a day.
Amanda Montalvo [00:30:52]:
If you are very petite, it could definitely be closer to the 40. I would say probably no less than 40, especially if you’re like, I would like to not lose muscle, or I’m doing strength training and I want to put more muscle on. So that’s something that you definitely want to consider. But protein rich meals and dense meals. Protein rich meals are going to be dense meals, but not eating these small, snacky meals throughout the day, but bigger, denser meals. And having those breakfast, lunch and dinner breakfast an hour after you wake up, get that natural light in your eyes. At least 30 grams of protein. I would say ideally 40, depending on, you know, height, weight, activity level, things like that.
Amanda Montalvo [00:31:34]:
And then that will make it so that your blood sugar stays more stable throughout the day. The carb intake is what’s going to change the most throughout your transition. It’s pretty cool. I’ve had women kind of start with us, and they are, they’re like, I think I’m going through perimenopause. We look at their charts for the last, like, year, and we’re like, yeah, I mean, there’s definitely some irregularities in your cycle. And then they work on stress, they work on their nutrition, their light exposure. I would say light exposure and nutrition are like, the number one ones. And then as we optimize, those other areas start to optimize like they’re digesting their food better, they’re having better bowel movements.
Amanda Montalvo [00:32:11]:
They feel better overall. Usually we use bio identical progesterone as well. They’ll notice that they actually tolerate more carbohydrates, whereas previously they had to lower them because they noticed they were gaining weight. They were constantly hungry. Maybe they were feeling sleepy after a lot of their meals. Their sleep was really disrupted at night from, like, you know, blood sugar shifts and stress hormones from the insulin resistance. And so that’s something where we lowered them at first. Then as they start optimizing all these things and they’re like, wow, I’m actually tolerating more carbohydrates now.
Amanda Montalvo [00:32:42]:
I want. I’m craving more carbs. I want more. They experiment with it and they can add more in. So I don’t think that, like, we have to have perfect health going to perimenopause to fix imbalances and to not have a ton of symptoms. But I think that we, like you, can start going through that transition and still ease a lot. I mean, my mom didn’t work on anything until after she was postmenopausal, and she’s seen a ton of things improved. She’s gotten off medication, she’s feeling way better, and she has the motivation to keep.
Amanda Montalvo [00:33:10]:
Continue to work on your health. So it’s possible to make changes regardless. But it’s like, if we’re gonna, you know, try to enter this season with as much ease as we can, it’s gonna be supporting your thyroid. You already have good light exposure. You’re mindful of your stress, or you know, how to calm yourself down after you’ve dealt with a lot of stress. You know, what nutrition works for you, like, how to eat enough protein, how much carb do you feel the best eating? You have good sleep, all those kinds of things. But again, it doesn’t mean it can’t be optimized. Carb intake adjusts the most.
Amanda Montalvo [00:33:44]:
This is when I would say reducing carbs for a lot of people can be helpful, but upping protein has to take place. I see a lot of women reduce their carbs during this season because they read stuff online about how, like, they shouldn’t have as many carbs when they’re perimenopause post menopausal. And then it tanks their thyroid, they have. Their body is super stressed and they feel worse. It’s typically because they didn’t increase protein in their calories enough in general. So they just started eating way less, and their body was like, what’s happening? So that it’s not just a one size fits all approach and it’s definitely not just lower carbs, but I do think, like, lower carbs during breakfast can be helpful for this season because often leptin signaling is not the best. And so if we get sunlight in the morning, have a lower carb breakfast, plenty of protein, fat, I mean, even like, veggies and stuff, obviously that’s fine. And then, you know, have carbs with lunch and dinner, depending on how active you are and what you feel the best eating, I found that that can make women in that perimenopause transition feel really good, like that’s all they need.
Amanda Montalvo [00:34:52]:
They don’t have to lower all the carb, their total carbs that much. They just don’t have a ton with breakfast, and they find that works for them. It’s all going to depend on the person and meeting yourself where you are now is, I think, one of the most important that we can do. Most important things we can do. Obviously, like, I’m trying to touch all the different areas when I cover how to prepare for perimenopause, but we’re all going to be entering this in a different way. I think of, like, I just had my second daughter and I’m 34. My transition could potentially start in three years based on when my mom went through menopause. So I’m like, that’s only three years to replenish minerals, optimize my thyroid, minimize my stress as much as I can.
Amanda Montalvo [00:35:33]:
I have clients that don’t have their first child until they’re like 37, 38. So obviously that’s going to shift their hormones, their potential deficiencies and stressors, and could potentially lead to an earlier menopause if they’re not being mindful of things, everyone’s going to be entering this at a different season. Some people have already had all their children, and maybe it’s been five to ten years before they’re entering that season, and so they could be in a much more balanced place potentially. It just kind of depends, and I think, too, like, what other health issues do you have? I just think of a lot of clients with, like, chronic health conditions, like autoimmune conditions, endometriosis, pcos, where they already have levels of inflammation and imbalances. And so that’s when it’s like, we’re just wanting to optimize everything as much as we can before you get to this season of life. And again, it doesn’t mean perfect health. It means awareness and understanding. How do I support these different systems of the body? And a lot of them, it’s the same thing.
Amanda Montalvo [00:36:33]:
So it doesn’t have to be like, oh, this is how I support my thyroid, this is how I support my adrenals, this is how I support blood sugar. A lot of them, it’s all the same thing. Helps support them. When I have that thyroid series that I did, and everything you’ll learn in there will support many other areas as well. Movement is the other area I want to talk about. So if we’re going through daily habits, good light exposure, eating with the light, getting enough protein, finding the carb intake that’s appropriate for you, and then the next big thing is making sure you are strength training. This is a must, in my opinion, but if you want to maintain your muscle mass or potentially gain muscle mass or lose fat, kind of restructure that body composition, we have to strength train, especially postpartum it is harder to keep on muscle and build muscle because of the decrease in sex hormones, but it’s not impossible. Ideally, we are strength training way before we go through this season, but we have had many clients where they’re perimenopausal, and we’re like, can you please let weights please? And it makes a huge difference.
Amanda Montalvo [00:37:41]:
One, they’re like, I wish I did this sooner. A lot of times it’s like they just didn’t know how to do it. And so once they learn, maybe they go through an online program or something. Maybe they work with a trainer. Um, there’s so many different ways you could do it now. Then they’re like, wow, I feel way better doing this. This is not as scary as I thought, and I do think it’s having a positive impact on, like, I feel stronger, I look stronger, things like that. So I think strength training is a must.
Amanda Montalvo [00:38:08]:
It’s going to help muscle mass, it’s going to help your bone health keep that much improved for much longer. And that’s something, that’s the next thing I’m going to do with my mom is I’m going to teach her how to strength train. She does pilates, but which is great, and I don’t want her to stop that. But I’m like, okay, we’re going to teach me how to lift weights is my next big goal. Not anything crazy, just like the basic squat, deadlift, push, press, rows, probably a little bench press. Those will probably be, you know, squat, push, pull. That’s really all you need. It’ll help develop all the different muscles in her body or her core and then make sure that she can, you know, pick up all her giant grandchildren.
Amanda Montalvo [00:38:48]:
So that’ll be like the next big thing. And again, like, you can do this later in life, but it’s not going to. You’re going to get a ton of benefits from it still. And then the lat. So those are, like, the daily habits that I think of, like, light exposure. Eat with the light, get enough protein, eat dense meals, figure out your carb intake, strength train, stay active. Make getting in the habit of, like, taking regular walks one year outside. So you get all the benefits of that, the good light exposure, the grounding, all the things.
Amanda Montalvo [00:39:19]:
But it can be also very beneficial for your blood sugar when you’re not sitting all day, you know, that’s like a big one. I think about if we are going to start to see some shifts in our blood sugar, our insulin sensitivity during this time, it’s bound to happen. So what’s another way that we can minimize that. And it’s going to be to not sit too much, not move. Like, standing in the same position for long periods is also not great. So just trying to get more movement into your day, I find. I mean, it’s. It’s just tricky when you’re working, obviously.
Amanda Montalvo [00:39:52]:
So just seeing like, maybe that’s a treadmill desk, maybe that’s not an option for you. So maybe that means just going for short, quick walks and even just getting up and like, get up, go to the bathroom, get up, stretch your legs a little bit. Just not sitting or standing in the same position for extended periods. Also great for your joints, tightness, pain, those sorts of things. So those are like, the daily habits that I think are incredibly helpful. The other thing that I like to consider once we have those in a good place are things like alternative therapies, like hot and cold exposure. I know that there’s a lot of controversy around these in the women’s health space. Like, cold therapy is not good for us.
Amanda Montalvo [00:40:37]:
Some people love it. A lot of people slam it, saying that we’re not meant to do cold therapy. Cold exposure, I think they can both be really beneficial. Cold therapy especially can have a ton of benefits when it comes to how we are aging. And a lot of the symptoms, like inflammation that comes up, sleep issues, night sweats, hot flashes, things like that. It has been shown to be beneficial and reducing hot flashes. So that’s something to consider. It can help your sleep.
Amanda Montalvo [00:41:07]:
It can. It does release endorphins, so it can definitely help with mood. But I think, like, pain and inflammation and how it can impact your immune system are the biggest ones. The biggest thing for me that I’d be considering during that season of life of like, okay, I want to incorporate this regularly because I want to looking at natural ways to mediate things like inflammation, which is, some of it’s going to be inevitable, but it’s like, how can we reduce it as much as we can support the immune system as the hormone levels are lowering and shifting and can cause changes with immune system function as well. Those are, like, some of the reasons that I’d be looking to use it or use it with clients. Cold exposure also doesn’t have to be as intense as, like, a lot of people make it out to be. It’s anything that’s colder than your body temperature. So, and if you’re already experiencing a lot of stress, obviously there’s going to be nuance with this.
Amanda Montalvo [00:41:57]:
So if you’re already experiencing a lot of stress. Maybe you are feeling very depleted. Maybe you did a hair test and you see, like, my minerals are really depleted. Maybe you’re a fast four, have low minerals across the board, or you feel like you’re not super resilient to stress, which is a lot of the women that we see in that peripost menopausal season, then we would want to ease into cold therapy and only do what you can tolerate. And I think we see a lot of cool videos online of people getting dunking into ice baths that are like, you know, 30 degrees and it’s very intense. It doesn’t need to be that. Cold therapy can be as gentle. Like, if your body, obviously our bodies are like 98 degrees.
Amanda Montalvo [00:42:41]:
If you’re in 80 degree water, technically that’s cold therapy. And the colder the water is, it doesn’t increase the benefits because even, like, anything is going to be a stressor. But if something is too stressful for us, then it’s going to really have negative benefits rather than all the beneficial ones. So things that, like, you could consider doing is like just putting your wrists in cold water to start and seeing how you tolerate that. And it doesn’t have to be like a ton of ice. Like, I love face dunks. Like, ice face dunks. I love them.
Amanda Montalvo [00:43:14]:
I think they keep my skin looking as young as possible. I feel so good when I’m doing them, but that could be really stressful for some people. I don’t put a ton of ice and make it like, freezing cold. I don’t take the temperature of it, but I basically just put some ice in there. The water’s definitely cold, but it’s not too extreme. And then I’ll hold my face in there as long as I feel comfortable. Take it out, repeat a couple times. Love them.
Amanda Montalvo [00:43:36]:
I’ve done them for like eight years, so my body’s very used to it. But that’s something where it’s like, if we’re looking at, okay, how could we potentially, they can be great for your skin and stuff, too great for circulation to the skin, which can really help with just like, our overall health of the skin. So that’s something where it’s like, okay, maybe that’s something that you want to incorporate. If that’s one of your concerns and you feel like it wouldn’t be as stressful, again, maybe you just use cold water the first time. You don’t even add ice. Put your face in for as long as you feel is good for you, feel comfortable with, and then take it out, take a break. And do it again when you feel ready. Or just do it once, but typically you want to do it like three or four times and then just do what works for you.
Amanda Montalvo [00:44:19]:
How, you know, if a type of cold therapy isn’t, or just if you like, in the winter, do cold therapy in the winter. Just go outside and let your body be cold. We’re in very, like, controlled environments, so probably the easiest and most natural way to incorporate hot and cold therapy is to depending on where you live, like, living more, like, with the seasons. So I think of people that live, like, in the midwest or like, I’m from Connecticut, and so obviously, like, it gets really cold in the winter. So, like, letting yourself get cold in the winter, don’t always be completely bundled up every single time you go outside. Maybe you just spend a little bit more in the cold where you let your body feel cold. Take a short walk or something like that. That is cold therapy.
Amanda Montalvo [00:45:01]:
And then being outside in the heat, that is heat therapy. And just kind of living more with the seasons, not always trying to keep your body at exactly the same, same temperature. 24 7365. That is a very natural and gentle way to incorporate hot and cold therapy. Plus, you’re living more seasonally. You’re probably going to have a healthier circadian rhythm, and that will support your health overall. But that is something that you could consider getting into, like the cold therapy piece. I will link to some resources on that, like my favorite ones, and then hot therapy.
Amanda Montalvo [00:45:35]:
Heat therapy is great if you want to consider that. That could be sauna, but it doesn’t necessarily have to be. It could just be going outside. There’s even studies that show, like, working out, just doing a hard workout in the sun, getting that infrared heat from the sun is similar to benefits from a sauna. So you don’t have to have fancy devices, you don’t have to have a cold plunge. You can just let yourself be cold, let yourself be hot when it is naturally available to you. And that could be really supportive of your health, too. Constantly trying to control the environment.
Amanda Montalvo [00:46:09]:
Those can be good positive stressors on the body because we don’t want to get rid of all stress. We want some positive ones as well. And that can really challenge us and then make us show up more resilient. If you’re doing these things and you start to notice you’re more tired, you’re more hungry, maybe you’re not sleeping as well. That means that it’s too much and you need to pull back, it’s not going to help. That’s when it’s going to cause more harm than good. But if you are someone that you are supporting your circadian rhythm, you’ve really dialed in your nutrition, you’ve worked on all those other things first. That is typically when you can consider things like hot and cold therapy to get the positive benefits of it.
Amanda Montalvo [00:46:49]:
But I think too many people try to do those first because they look really cool and they seem like helpful tools, which they can be, and they haven’t worked on the other areas and so they don’t see all the benefits. And oftentimes they can just make them feel more depleted. So I would say those are like bonus items, more like alternative tools that can be a bonus. Once you have a solid foundation, they’re not necessarily going to make or break your experience, but I like to mention them because they are things that we do discuss with our clients once we’ve already worked on other areas. So when it comes to menopause, perimenopause, and like getting ready for the transition, we want to think about when is our transition going to be? Ten to 15 years before your mom went through menopause. So figure out what that timeline is for you and then what do we want to start supporting? I would say if you can track your cycle, that’s ideal. I know a lot of the women in my community use fertility awareness method to keep an eye on their cycle and their hormones. You can also like Anito in I t o is a way to track your hormones throughout your cycle.
Amanda Montalvo [00:47:52]:
We have a lot of our fertility clients use that so we can get a look at what’s going on. But it could also be helpful if you’re not sure if you’re ovulating or if you’re having some. It’s just nice to test it and not guess. And then when you can look at your whole cycle, then you can understand, okay, am I good? We listen to this podcast episode and go back to the beginning when I talk about what’s supposed to be happening in a healthy cycle where we’re making enough hormones. It’ll measure estrogen, progesterone, but it’s also going to measure FSH and LH. So you get to see, am I getting that peak in estrogen, that surge in estrogen, and then the LH and FSH release, leading to ovulation, and then getting that peak in estrogen and peak in progesterone. Ideally you are, but if we’re unsure, it can be helpful to look at that. I think hair mineral testing is a must for everyone.
Amanda Montalvo [00:48:43]:
But especially for when you’re trying to optimize thyroid function, trying to make sure you have adequate minerals to support the different functions in the body. Ideally, we’re doing this before we enter perimenopause. I have that whole free training on thyroid. And how do you. I teach you how to use different labs, understand what’s going on with your thyroid. I talk about nutrition, lifestyle stuff. I have an in depth circadian rhythm lesson in there, and it’s all for free. So make sure you take advantage of that and then just understanding, okay, how can I support myself on a daily basis? What kind of habits can I build so that I am easing this transition, being really taking really good care of yourself so that you can feel good forever? And that is when we want to think about getting a healthy light exposure, eating with the light blocking blue light at night.
Amanda Montalvo [00:49:30]:
And then, of course, looking at nutrition, women need to eat more protein. So getting enough protein at your meals and making sure that you are figuring out what carb intake works for you. Maybe that’s limiting carbs in the morning and having some with lunch and dinner. Maybe that’s. That’s just having a smaller amount with each meal experiment, because there’s no perfect kind of way to set it up. You just have to figure out what works for you, what’s going to give you the most energy, the least amount of fatigue and cravings. And then we also want to consider things like, what’s my movement look like? Am I strength training? Am I sitting last during the day? Can I minimize that and get more strength training in maybe a few days a week? Finally, if you want to consider alternative therapies, something like hot and cold therapy could be really helpful. I’ll try to put some resources in the show notes for that, or do a future podcast episode on those more in depth than we can get into here.
Amanda Montalvo [00:50:24]:
But those are my tips for preparing for perimenopause, preparing for this transition. Again, if you are in the thick of perimenopause, you can absolutely apply this information after you talk with your doctor and still see really great results. If you are post menopause, you can apply this information after you talk with your doctor and still see great results. So there is no timeline on it. But if I know a lot of the women in my audience are very thoughtful and intelligent, and they’re like, how can I prepare my body? So I hope that this episode helps you. Thank you for listening to this episode of the Are You Menstrual podcast. If you want to support my work, please leave a review and let me know how you like the episode. This lets me know, like, what you guys want more of, less of.
Amanda Montalvo [00:51:10]:
I read every single one. I appreciate them more than you know. If you want to keep learning, you can get access to the bonus episode and additional resources on patreon.com hormonehealingrd. I’d love to have you in there. Thanks again, and I will see you in the next episode.
