The Stages of Menopause + How to Support Your Body

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Transcript: The Stages of Menopause + How to Support Your Body

Season 7, Episode 5  | September 19, 2023

Jamie Martin:
Welcome to Life Time Talks, the healthy living podcast that’s aimed at helping you achieve your health, fitness, and life goals. I’m Jamie Martin, Editor-in-Chief of Experience Life, Life Time’s whole-life health and fitness magazine.

David Freeman:
And I’m David Freeman, director of Alpha, one of Life Time’s signature group training programs. We’re all in different places along our health and fitness journey, but no matter what we’re working towards, there are some essential things we can do to keep moving in the direction of a healthy, purpose-driven life.

Jamie Martin:
In each episode, we break down various elements of healthy living, including fitness and nutrition, mindset and community, and health issues. We’ll also share real, inspiring stories of transformation.

David Freeman:
And we’ll be talking to experts from Life Time and beyond who will share their insights and knowledge, so you have the tools and information you need to take charge of your next steps. Here we go.

Jamie Martin:
Hey, everyone. Welcome to Life Time Talks. I’m Jamie Martin.

David Freeman:
And I’m David Freeman.

Jamie Martin:
And in this episode, we are going to be talking about menopause, what it is, the changes that occur in the body, and the corresponding impacts, as well as what we can do to support ourselves during this time, and with us, we have our guest, Sam McKinney.

David Freeman:
Sam McKinney, back again. How you feeling?

Samantha McKinney:
I’m feeling great.

David Freeman:
Let’s give a little background on you. I know you’re a registered dietician, certified personal trainer. You also are the national program manager for nutrition, metabolism, and weight loss at Life Time. You started your career in clinical setting, before switching to a more proactive approach in preventative wellness and fitness, and you’ve been a trainer and coach for over 15 years with Life Time.

Samantha McKinney:
That was quite the intro. Thank you.

David Freeman:
Try to, you know, bubble-y it up a little bit.

Jamie Martin:
So, let’s just level-set right from the start. What is menopause, and also, just with the caveat, like, often, it’s a…there’s a stigma around it. We don’t talk about it enough, so we just want to kind of get it all out there today with this conversation.

Samantha McKinney:
Yeah. I love that. Well, I actually also love that it’s becoming more and more of a conversation and a topic. I think more people are realizing that this is inevitable. It’s something every woman goes through. This is a normal, expected, physiological process, so I think there’s more and more attention around menopause, which I really love, but essentially, a woman is technically menopausal when she is without a menstrual period for at least 12 months. It’s like, happy anniversary. You’re officially menopausal, right, but the process can…David’s laughing. You’re allowed to laugh, Dave.

David Freeman:
Okay. All right.

Samantha McKinney:
We got to insert a little bit of humor in the real talk that we’re going to have around this today, right?

Jamie Martin:
Yes.

Samantha McKinney:
But you know, oftentimes, it can last…you know, some estimates say 10 to 13 years for people. Ideally, you know…not ideally, but I’d say, on average, when a woman’s really healthy and everything’s sort of in line, she might be symptomatic for, like, 2 to 6 years or so. It depends. The average age of that anniversary, of, like, actually hitting menopause is around 51.

But usually, things start to change around the time a woman’s, like, 45 to 47. So, she enters what’s called early menopause, or some people…if you’re looking in medical research, it’ll be referred to as the menopause transition. So, MT is what you see in the literature, oftentimes, but really, what’s…essentially, what’s happening is a woman stops being fertile. So, you know, they’re…she’s no longer releasing eggs from follicles in her ovaries.

She’s not able to get pregnant, and so, what happens is your hormones tank during this time, because, again, you’re not cycling, and so, your body is unable to have a baby or you know, achieve conception anymore, and that entire process, things start to change and shapeshift, and your body’s sort of going down this cliff for a couple of years, but a cliff doesn’t necessarily have to be a bad thing, which I’m sure we’ll get into today.

Jamie Martin:
Right. Exactly. So, there was an interesting fact that was in an article that Experience Life published recently. Humans are one of only five species known to enter menopause. The others are orcas, pilot whales, belugas, and narwals. I just wanted to insert that there, because I thought that was an interesting stat in the animal world.

Samantha McKinney:
Well, what’s interesting is, if you think about this, compare this to, like, hundreds and hundreds of years ago, we’re living a lot longer, too, right? You know, like, historically, people weren’t really living to 80, 90 anymore. So, hopefully, we’re increasing health span, not just life span, but it kind of makes sense. It’s sort of like we’re evolutionarily giving our bodies a chance to hit menopause, but that doesn’t come without some symptoms and some changes that every woman goes through.

Jamie Martin:
Right. Exactly.

David Freeman:
So, before you go into the…I think you framed it up. The birthday phase. You have something that people reach as far as before menopause, called perimenopause. So, can you explain what perimenopause is?

Samantha McKinney:
Yeah, there’s a couple different phases, actually, of perimenopause. So, the earliest phase, the woman is largely…doesn’t necessarily have symptoms, right? Lab markers aren’t changing, but every woman’s born with a certain number of eggs, essentially, and they go down, right?

And there are certain things that you can do, through your physician, if you need to, where you can actually, like, check your follicle count, right, because it declines over age, and that really early stage, there’s no symptoms, but your follicle count starts to go down because you’re sort of starting to, like, take away at that. Then sort of the next stage is called early menopause transition, and during that, periods start to get a little bit irregular. It’s like the first time you miss a period from, like…but you’re not pregnant, right?

So, it’s the very first time that that happens. Your follicle-stimulating hormone, that’s kind of one of the main lab markers to sort of track through menopause. That starts to go up, and what happens is your progesterone levels start to go down. So, because, in this early menopause transition, cycles start to get shorter, so, what happens is, by nature…and we don’t necessarily have to go into all the physiology of a menstruating woman, but if your cycles are shorter, you ovulate sooner, and so, you have less overall progesterone for that cycle, and as soon as a woman’s progesterone starts dropping, she doesn’t feel very good.

And so, the early menopause transition, you’re first becoming symptomatic, because your cycles…let’s say, before, they were every 28 days on the dot or every 30 days. You might start to notice, like, wow, they’re coming every 23 days or they’re coming every 22 days, or then you miss one, right? And when that starts happening, because you don’t have enough time to build up progesterone levels because you don’t have a full-length cycle any more, you start to feel a little bit crummy.

Then there’s kind of the next stage. So, this is still perimenopause or menopause transition. The person hasn’t reached their 12-month anniversary of no periods yet to hit that point. You might hit, like, 60 days in between periods, right? It starts to get really irregular. FSH levels are pretty high. So, if you’re testing, and they’re, like, over 25…and this is really you’re symptomatic, usually, unless you’re doing a lot of interventions that we’ll get into today.

I mean, obviously, every woman’s going to feel some symptoms through menopause, because it’s a major life change, but this might last up to, like, three years or so. So, that’s all that whole perimenopausal phase, and what’s interesting is you’re seeing this rise of what used to be called early menopause, so let’s say women under 40, right, starting to hit this. It’s actually not early menopause. That, it used to be called premature ovarian failure. Now it’s called premature ovarian insufficiency.

So, essentially, what it’s saying is there’s no such thing as early menopause. It’s that the woman has some metabolic issues going on early, and so, it’s actually more…I don’t want to say a pathology, but it’s more of an abnormality. The normality is if it’s less than 40, but I say all of that because the earlier the onset, sometimes people think that means, oh, I’m going to get through it. Like, I’m going to do menopause, right? I’m going to get through…

Jamie Martin:
Get to the other side.

Samantha McKinney:
Yes, I’m going to get to the other side. Really, though, earlier onset, usually, what I’ve seen with clients, just means you have an extended journey and path and adventure through these menopausal years, which, for a lot of reasons, cannot be fun, because there are some major, real symptoms that women feel when their hormones change like this.

Jamie Martin:
Let’s talk about that. Like, you know, what are the hormonal changes? You already mentioned progesterone, which, I think it’s important to talk about, what’s the role of progesterone, but what about the other hormones, and how are they all interacting?

Samantha McKinney:
Yeah, I mean, I would say estrogen’s the main one, right? So, your estrogen, that’s, essentially, the marker of, like, what’s tanking throughout this whole process, and your estrogen dropping is what causes most of the issues that women are feeling. So, common symptoms that almost everyone feels at some point are hot flashes, and I’m talking this is, like, 1 to 5 minutes of extreme flushing, heat, sweating.

Super not fun if you, like, just got dressed up for date night and did your makeup, right, or if you’re like, on camera or doing a presentation or something like that, right? But again, can’t really control it. When they happen at night, those are night sweats. So, sometimes waking up just drenched, right? So, that’s really uncomfortable. Yeah. Just extreme moodiness, so almost not recognizing yourself with, like, how you’re reacting to certain things. Weight gain, oftentimes in the areas that they didn’t gain before, so usually belly fat, as well.

There’s a lot of reasons for that. Insomnia, for sure, and brain fog, I would say. That kind of probably encompasses a lot. Actually, a lot of women complain about joint pain, too. So, especially if you have…I’ve worked with women, both as a trainer and as a nutrition coach, and there’s more pain when estrogen drops, and little sidebar, sometimes if men are on testosterone replacement therapy, they get put on, like, anti-estrogen medication, and if their estrogen goes too low, the biggest thing that they complain about is pain.

So, it just shows that too low of estrogen can cause more joint pain. So, all of those things wrapped up in a little bow, this is…oh, and then the other thing, too, and this is probably why women feel a stigma around it, is that it actually changes your reproductive tissues. So, they have, like, vaginal atrophy, and intercourse becomes really painful. Things become really dry.

If you want to think of it this way, kind of the opposite of low estrogen is, obviously, high estrogen. A woman has really high estrogen when she’s pregnant, right? When you’re pregnant, everything is, like, more…like, your hair’s thicker, your skin is fuller, everything is more lubricated, all of that. Well, think of the opposite of all of that, and that’s what happens when estrogen drops, and it can feel really…and it is really dramatic. Like, right? It’s a big change. So, I know I just threw a lot at you there.

Jamie Martin:
No, I think that’s great. I think one other thing, you know, what about, like, memory and cognitive health?

Samantha McKinney:
Yes. Thank you.

Jamie Martin:
Do a lot of women feel that?

Samantha McKinney:
Yeah. The brain health is huge, and actually, the decline in estrogen…I’m sure we’ll get to this, too. I feel like I’m jumping around a little bit, but the decline in estrogen is tied to the development of things like Alzheimer’s dementia, cardiovascular disease, which is the number one killer of women, but yes, for sure, the brain fog, and that ties to the mood, as well, too, and just the foggy thinking, and that ties back to the insomnia. You talk about, too, when you’re not sleeping, everything else sort of falls to the wayside.

Jamie Martin:
Like, so many health issues, it’s a really…it’s a web of things, and so, it also makes how to address it complicated, too.

David Freeman:
Yeah. So, I mean, obviously, inevitable in the sense that this is just a part of the life, if you will. So, like, what can be done to kind of somewhat be proactive and to help with this process once you arrive there?

Samantha McKinney:
Yeah. There’s a lot to unpack there. I would say it starts decades before the onset of perimenopause, right? The healthier you are, the easier it is to sail through it, and actually, I’ll back up a little bit, too, because the other thing that I wanted to note that I forgot to say is that just the age that this is happening, right, the average age of, like, menopause, of hitting the anniversary is 51.

Think of what else…everyone’s different, but think of the average 51-year-old and what they’re dealing with. Most of them are still working. They’ve got kids. Their kids might be in high school having big-kid problems, right? That’s what they say. Little kids, little problems. Big kids, big problems. They might be going off to college. They might have empty nest syndrome. They might be thinking about retirement. They might be taking care of aging parents.

They…there’s a lot, concurrently, going on, and then throw in, like, this hormonal bomb going off, right, and it’s just, oh. So, some of that other stuff…and the reason I wanted to mention that, in response to your question, David, is what are some things we can do? Well, you have to…you can’t deny all the other life changes that are happening at once, and you have to kind of get a grip on those, too.

So, even though this isn’t within my scope as a registered dietician and a trainer, like, therapy…like, cognitive behavioral therapy. That, like, figuring out a way to manage the changes outside of just these hormonal issues is going to be key, right, because it’s a lot to emotionally and mentally manage, right, but metabolically, it starts a lot sooner. So, we’ve talked a lot…I don’t know…we’ve talked a lot about blood sugar control on this podcast and everything, but it has to begin there, because if you throw in imbalanced blood sugar, which, alone, can cause mood issues and insomnia and cravings and all that type of stuff, then you end up in a not-so-great spot.

Jamie Martin:
So, talking about, specifically, that metabolic shift that’s happening, because you often hear…and one of the common questions that we get is, like, I am in menopause now. I’m maintaining the same workout routine that I have over the years, and nothing is working anymore. Like, what used to be effective for me no longer is. So, metabolism wise, what’s happening there?

Samantha McKinney:
Yes. So, oh, gosh, that’s just the number of times that I’ve heard that, right? Like, oh my gosh, everything that worked before isn’t working anymore. I’m storing fat in my midsection. So, this all, in a way, does go back to estrogen, and estrogen gets a little complicated because I think, historically, people have this, like, fear of estrogen. Like, oh, I don’t want too much estrogen, right? You got to have the right forms of it.

But so, let me start on that and kind of start chatting through some physiology and then take me a different direction if you need to, but when…so, estrogen, kind of how I mentioned, like, estrogen and pregnancy, right, and all the things that it does, estrogen also kind of has a woman…from a metabolism standpoint, a lot of women are talking about body composition, because they don’t feel like their body looked the way it did before. Estrogen, oftentimes, will direct fat to, like, your hips, your butt. It almost can kind of give you that hourglass figure, right?

When estrogen declines, all of a sudden, belly fat happens, right? So, for a woman that even maybe historically didn’t store belly fat before, all of a sudden, she’s like what…and I’ve heard this from clients. What is this? I cannot get this thing to budge right? And so, the other thing that I wanted to mention from a physiology standpoint, is as your ovaries stop producing these hormones, you kind of get to this new level of hormones when you’re on the other side of post-menopause.

So, it’s not like a postmenopausal woman doesn’t have any hormones. She does have some, but a lot of the production is now taken over by the adrenal glands. If you’re familiar with the adrenal glands, they’re in charge of your stress response. So, think of this for a minute. You’re postmenopausal. Your ovaries, you know, they’re not doing work. They’ve retired for good, right? They’re not coming back. They’re not making hormones anymore. Your adrenal glands have taken over.

Well, what happens if your adrenal glands are really preoccupied with pumping out cortisol and trying to manage unmanaged stressors? Your new levels of hormones are going to be…I don’t want to say worse, because that makes it sounds like they’re bad in the first place, but they’re not where they’re supposed to be, and you’re going to be symptomatic for a lot longer. So, stress management is huge, and I find so…and again, this is…I have not gone through perimenopause yet, right? I have not gone through perimenopause yet, right? I’m in my late 30s, but I’ve worked with a lot of clients that have.

And it’s amazing. I oftentimes see, you know, women are generally so used to caring for other people, and they want to power through, and what’s the supplement I take? And we can touch on…there are helpful supplements out there, for sure, but you have to manage your stress. You have to say no to things. You have to be mindful of your exercise recovery and your…your manageable stressors should be taken under control, right? Like, you can’t quit your job, and you can’t, all of a sudden, cure aging parents of whatever they’re dealing with, but whatever you can say no to, you should.

Jamie Martin:
Right. Well, I think this comes back to we’ve had various episodes on self-care or what last season of the podcast…Brie Vortherms and Barbara Powell were here talking about was, like, this idea of performance recovery. Like, we have to build self-care practices and habits that, when tough times come, when…whether it’s a phase of life or a tragic incident, like, we can turn to, like, those things that we do to take care of ourselves, and if we’re not practicing those things when things are just like, normal and going along like they have always gone along, then it’s hard to, you know, then know what to do when something happens. So, again, it comes back to a lot of it is, like, how do we take care of ourselves in the day to day so that, when these transitions happen, when things change, we have the tools in our toolbox, right, and we know how to use them.

David Freeman:
And I would say, as far as just going off of that…and I’m going to read from this, as far as there was a 2021 survey from Mayo Clinic that estimated about 10% of US women, ages 45 to 60, have taken time off in the last year or so because of menopause symptoms. So, understanding what you just were both talking about and understanding what is eventually starting to take over, like, that’s where I want to go back to, all right, these are the certain things that can help with this transition so when we look at our pillars that we always champion around nutrition, around exercise, supplements, the management of stress that we just were tackling and sleep, which one you want to attack first as far as…I don’t want to say it has to have the priority, but wherever you have our listeners navigate on those pillars as far as, like, focus on this. We talked about the mental part, right? How nutrition, how exercise all can help support in this phase.

Samantha McKinney:
Yeah. Okay. So, the way that each woman goes through menopause, there’s a couple factors that impact sort of how bad it is or isn’t, right? Number one’s, like, underlying genetics, right? Like, what’s your biology, right? And there’s not much you can do about that, but gleaning insights if you have contact with your own mother and you know, ability to get that information, that’s just helpful to sort of know what to expect, right?

Jamie Martin:
I was going to ask, like, just similar to…I’m just thinking about is it similar to from a, like, when you started menstruating? Often, they’ll say that kind of follows a pattern or a genetic pattern. Is it similar? Like, is it similar for potentially menopause, as well, or is that an old wives’ tale?

Samantha McKinney:
Yes. Yes. No, it is, but there’s just so many other things that…like, what I’m about to say that, like, impact it too.

Jamie Martin:
Yeah. Okay. Got it.

Samantha McKinney:
And can adjust it. So, the second thing is your underlying metabolic health. That was, like, my nod to blood sugar. What environmental things are around you? Like, literally toxins, right? So, environmental pollutants, body care products, things like that, like, what…environmental and like, metabolic health, and then, lastly, it goes back to what I had said, like, attacking first, like, working with a therapist, it’s how much support do you have, right? The psychosocial stress.

Are you lonely? Do you have a good support system? You know, do you have a supportive spouse, supportive friends, things like that? But in terms of, like, things to do and kind of start on is, like, let’s just start with exercise. You know, we’ve always said, you know, if all the benefits of exercise were in a pharmaceutical, everyone would be on that pill, right? But your maintaining your lean muscle tissue is critical. Like, you have got to strength train, and your protein needs actually go up as you go…

David Freeman:
Say that again, please. Say it again, please.

Samantha McKinney:
So, you have to maintain, and ideally gain, lean muscle to have, like…it’s almost like a wealth of aging, and what I mean by that is, like, the ability to be independent and move and stay strong and all of that. Like, it’s critical, and it will not…you’re not going to fall into that. It takes work, and it takes protein, and it takes strength training. There is no shortcut around those things. You just have to do them, especially, whether you’re a male or female. As you get older, your risk of age-related muscle decline is huge, and menopause is a catalyst there, so you’ve got to…you can’t…you will not go through menopause nicely without exercise. It just is not going to happen. Like, you have to do it.

Jamie Martin:
So, it’s, like, building up your reserve, right, or your account, have it ready to go so you have more to work with when it starts?

Samantha McKinney:
Yes, and it’s like you have to have that stimulus of strength training and muscle tears, but then you have to have the protein and the amino acids to rebuild that, and that’s why, whenever we talked about…like, this starts decades before, right, the more muscle mass you have going in, and I think we’re largely getting away from this myth, but I still just want to address it.

Like, sometimes I think, especially if maybe somebody’s newer to health and fitness, they’re like, oh, I don’t want muscle mass, because they’re picturing, like, you know, bodybuilding magazines. Muscle mass is everything, and I guarantee you, in your mind, if there’s a certain physique that you’ve seen that you’re like, wow, like, that is aesthetically pleasing to me. I would like to look like that. Guaranteed there’s more lean muscle tissue on that person than you would ever think, for sure. So, exercise is key. The other thing is, what I do notice…and again, this gets tricky because you have to balance stress.

Oftentimes, women are going to need a little bit more cardio, okay? You know, we try to aim for 150 minutes for women that are struggling with obesity. As they’re entering into menopause, we try to get it upwards closer to, like, 300 minutes a week, which is a lot, and that doesn’t…I don’t want you to hear that if you’re sitting right now and saying, like, I don’t exercise at all. I have obesity right now. I’m entering menopause. I have to do 300 minutes. It all adds up.

So, just little by little, just chip away at it, but that’s for a couple different reasons. It’s not just to burn calories. It is to send the right metabolic signals to your body to be healthy and to protect your heart. I can’t emphasize enough that cardiovascular disease is the number one killer of women, and this decline in estrogen really puts you at higher risk of heart disease, and so, doing cardiovascular training is imperative. Again, just like strength training, you cannot get around it. So, try to hit at least that 150 minutes a week.

David Freeman:
I want to stay on that, because you said 150 minutes or so of cardio. Can you just define cardio so all the listeners can understand what that is?

Samantha McKinney:
Okay. Good question. So, thanks for backing up there. Let me actually…I’ll start by to just frame it up, defining strength training, because, sometimes, I think people do…well, okay, lifting three-pound dumbbells, for the average person, for a really long period of time, right, even if you’re sweating is not strength training, right? This strength training is pushing against force.

That resistance, it could be your body weight. You can do great strength training with body weight, but oftentimes, it’s going to be machines, dumbbells, kettle bells, barbells. This is all David’s world right here. I’m singing his tune. Yes. Cardio, so conditioning, that is structured. I would say, time moving your body, not necessarily against force. So, this is, think traditional forms of cardio are going to be running, elliptical, rowing, hiking, swimming, and sometimes people think, like, oh, like…

Oh, cycling is another one, and you don’t want to get the two confused, because sometimes people think, like, cycling, this is a strength workout for my legs because they’re tired. I’m like, that is not a strength workout for your legs. You’re going to hit muscle fatigue, but that doesn’t mean that that’s strength training. So, thank you for bringing that up, David. Yes.

So, you want at least 150 minutes a week where you are running, swimming, biking, rowing, elliptical, something like that, and it doesn’t always have to be on a machine, right? It can be something outside. You could be hiking with a heavy backpack on, you know, outside in a mountain if you need to be out in nature, that type of a thing, too.

David Freeman:
So, within that cardio of them doing…let’s just say they’re doing 30-minute blocks a day, what should be…because we kind of spoke, on some earlier episodes, around active metabolic assessments and heartrates. Like, where should they be at while they’re doing this cardio? So, like, I just walked the dog and good movement. I mean, I want you moving, but I think we need to be intentional within cardio if we’re going to do it, right?

Samantha McKinney:
So, I think there’s this overarching caveat here of, like, if someone’s brand new to exercise, you don’t want to overcomplicate it. Why don’t we start with, like, can you go for a walk outside and lift weights a few times a week, right? Let’s assume, with your question, that we’re talking about sort of a seasoned exerciser, maybe somebody already coming to Life Time on a regular basis or already has, like, a workout routine. Maybe they’re connected with a coach, and they’re like, okay, I already have their frequency and duration down.

How do I optimize it from here? I would say, you want at least, I would say, 20%…at least maybe two sessions a week that would be considered high-intensity interval training, where you are doing all-out effort, right, all-out effort for intervals, and then recovering in between each interval. It doesn’t mean it’s all out every single…like, for the full 30 minutes. It’s you might be going all-out for one minute, and then you recover, and that recovery could be one minute. It could be four minutes before you’re ready to do another one, but like, you should feel tired, right?

The rest of it, for the most part, should be kind of…you know, if you go back and listen to the AMA episode, or if you do any of the reading on Experience Life blog about active metabolic assessment or heartrate training, should be in what we call Zone 2. So, that’s sort of where your heartrate is elevated. Like, let’s say David and I were doing a Zone 2 workout together, we could probably converse, and our breathing would be heavier, but if you were listening in on a phone call, you would know we’re exercising, right?

Jamie Martin:
Right. Yeah.

Samantha McKinney:
It’s not like a leisurely stroll.

Jamie Martin:
Right. You can kind of hear a little bit of that breathlessness, but you can still complete sentences and keep going.

Samantha McKinney:
Yeah, but this all does go back to that backdrop of where is somebody already at with frequency and duration? Like, let’s say someone’s like, I can work out three times a week, Sam, for 30 minutes. What do I do? I would probably have them…like, all three of those times, I would have them maybe do 20 minutes of strength training and then 10 minutes of hit intervals? Is that optimal? No, but they’re on a limited time, and that’s probably the most I can do with 90 minutes of total exercise a week.

Jamie Martin:
Right, and optimizing the time that you do have within that.

Samantha McKinney:
Yeah, and again, is that the perfect split? No, but that’s not the perfect amount of frequency or duration, either. So, like, are there other areas that we could sneak in throughout the day? And again, all of this, I mean, this applies to everything beyond menopause, too. Like, right? It comes down to, like, the art of coaching, and it’s working within what is realistic for someone and making sure that they don’t feel defeated, because there’s every single opportunity to get healthy, and every choice you make truly does matter, and it really adds up.

Jamie Martin:
Absolutely. For sure. Okay, so, we hit on exercise there quite a bit. What about…you mentioned sleep. Let’s talk about sleep, and you know, obviously, that’s a time for our bodies to heal, to recover, all of those things, but let’s talk about that a little bit more in relation to menopause.

Samantha McKinney:
Okay. So, around menopause, insomnia is a huge symptom. You know, technology, it’s defined as people having troubles sleeping for, like, more than six months. I’m like, more than six months? Like, if I can’t sleep well for a couple days, I’m crabby pants already. You know, I’m not feeling good, right, but in menopause, oftentimes…not every time, but the insomnia is due to hot flashes and mood changes. So, it kind of goes back to very real anxiety and depression that women might start to experience for the first time ever.

So, this isn’t a perfect framework, but when you look back at the literature, oftentimes, you know, in menopause…so, I want to touch on those kind of mental health issues, because they tie back to the inability to sleep, right? But a woman going through menopause is, like, 2 to 5 times more likely to be depressed than ever in her life. If you’ve ever experienced depression premenopause, right, or sometimes if you have underlying inflammation or you’re carrying a lot of excess body fat, your risk of depression is a little bit higher during menopause, too.

Anxiety, paradoxically, for…oftentimes, the women that get the worst anxiety during menopause are women that never experienced anxiety before. So, it’s sort of like, hey, if you had depression, your risk of depression during menopause is worse. For women that all of a sudden get anxiety, it sort of rocks them, because you’re like, I’ve never felt, like, this, you know, worried or anxious or anything before. So, the depression and the anxiety can really keep you up a lot at night.

So you can see how this is, like, this complex web of stuff, which we talk about all the time, but you got to attack the right thing for each woman, and every person is a different, you know, kind of cluster of issues, which is why it’s so important to find a practitioner that will work with you, because there’s no like, hey, just throw this pill at it and you’ll feel better, and the other thing is the hot flashes and the night sweats will keep you up. So, this all goes back to that decline in estrogen.

So, our bodies will regulate body temperature throughout the day, and for somebody with premenopause, we might have this little rise in body temperature. No big deal. When you’re in perimenopause, that rise in body temperature will, all of a sudden, trigger this whole cascade of issues, and all of a sudden, you’ve got all this vasodilation, and you’re, like, sweating. Like, it’s almost this, like, complete overreaction, and so, when you’ve got those going on at night, you’re going to be struggling a little bit, and you’re going to be tossing and turning quite a bit.

So, you know, there are things that you can go back, and you can look at some of the content that we have on blood sugar control. That’s all going to…and we’ll get a little bit deeper into nutrition here, too, but you have to control your blood sugar, and then there are certain supplements and things that you can take that could be super helpful. I wouldn’t jump right to melatonin. Melatonin is good for intermittent use, like if you’ve got jet lag or you’re traveling or what have you, but you’re going to need magnesium.

Magnesium’s huge. It’s very closely tied to hormonal cascades and processes. You just have to replete magnesium, particularly if you exercise. You just have to. Secondly, 5-HTP is a great option. So, 5-HTP, it’s a precursor to serotonin and melatonin, and the beauty of using 5-HTP is that it can actually help address food cravings, and it can help you feel a little bit happier. It’s shown to reduce a little bit of aggression. So, again…

Jamie Martin:
Those moods and those swings, those mood swings.

Samantha McKinney:
Yes. Irritability, and so, you usually want to take that at night. That also…you just want to be careful with 5-HTP and if you’re on certain mental health medications, like SSRIs, because it…again, it can boost serotonin, so you don’t want serotonin to go too high. So, definitely check with your doctor there, but there are blends…like, Life Time has an awesome one that works for sleep in general, but it’s one of my favorite perimenopausal supplements.

It’s called Relax, ironically, but it has 5-HTP and a couple of other really helpful constituents in there that help specifically around menopause, like valerian root. Like, valerian root is great. It also has PharmaGABA in it, which is really relaxing. It’s a neurotransmitter that kind of helps put the brakes on the nervous system. So, especially if somebody’s feeling a little bit anxious, it has L-theanine in it, which is an amino acid that is also calming, but not sedating, but I would say, like, check out that Relax supplement, for sure, if you’re struggling with sleep.

David Freeman:
Yeah. Let me give you a real-time scenario, all right? Right now, I’m going to be training Jamie. I’ve been training Jamie now, let’s say, for six months. She works hard. She comes 3 to 4 days in the week. She puts in the work. Right now, fast-forward, she’s not struggling with weight gain, and we’re doing any and everything underneath the sun. I now bring her in…I’m sitting across from you because I know you’re a subject matter expert in this space. What do you say to the coaches who are also probably dealing with what I’m about to say or what I’m sharing with you right now, and then how would you navigate Jamie in this situation?

Samantha McKinney:
Well, it’s going to start with, like, a whole intake and background and understanding Jamie’s underlying metabolic health and everything, but let’s talk about a couple general things that we want to focus on. So, first is magnesium status, so taking magnesium. The second is, Jamie, are you working with a practitioner, too? So, I’ll touch on this. I don’t want to go too in depth here, because I need to stay within my scope of practice.

But when it comes to hormone replacement therapy, there are dos and don’ts there, but my opinion, and what I’ve seen play out in real life with real clients, is that it has been too villainized, right? HRT can be a game-changer, and it can be a huge blessing. It really, truly can. So, we talk about this decline in estrogen, right? So, there’s a lot of fear around estrogen replacement and breast cancer, right? A lot of that came from the Women’s Health Initiative. If you look…and you can do your own digging.

There’s a lot of valid critiques on the takeaways of the Women’s Health Initiative and these fears of breast cancer. I’m not saying that there’s no increased risk, but the number one killer of women is cardiovascular disease. This decline in estrogen contributes to the development of cardiovascular disease. So, every woman needs to sort of see their own situation, but here’s what I will tell you that’s been shown pretty conclusively, is that HRT can be beneficial, especially with, like, bioidentical type hormones, right?

The Women’s Health Initiative was not using bioidentical hormones, but HRT can have the most positive impact if it is started in perimenopause, like, while this is happening, right? Like, while this is happening. Where it’s actually one of the benefits of the takeaways of the Women’s Health Initiative was that women that were starting hormone replacement therapy, let’s say, like, 10 years after menopause was done, that’s where a lot of negative health outcomes usually happen, right?

So, replacing it after you’ve not had these hormones for a decent amount of time. So, I would say, again, if you…let’s say we were working in the club together and you brought Jamie to me as a client and we were going to kind of partner on what we can do, my first thing is are you working with a skilled practitioner that understands the nuances of HRT, because this is something that you at least want to ask about. So, I’ll say that.

From the nutrition side, you know, people ask me all the time around, like, phytoestrogens or plant-based estrogens that you can get through nutrition, and so, usually soy is, like, the number one. So, there’s a lot of research around, like, soy isoflavones, right? So, a phytoestrogen, meaning it’s estrogen-like, it’s obviously going to be a lot weaker than the HRT, right? You have to be careful with soy for a couple reasons.

It’s not one of the things that I go to first, although there is significant research to show that use of soy isoflavones can help a woman through menopause symptoms. There’s a lot of asterisks there, in my opinion, as a registered dietician. Number one, women, oftentimes, will develop thyroid issues around menopause, and soy is a goitrogen that can impact thyroid function. Number two, it’s one of the two food sensitivities out there. Number three, the processing of soy in this country is atrocious.

Most people are not eating, like, a traditional, fermented, real soybean, right? There’s a lot of genetic modification. The way that…if you’re getting, like, soy protein off, you know, a shelf somewhere, the way that it’s processed, oftentimes, it’s going to be contaminated with certain neurotoxins and aluminum. So, this isn’t just like, hey, just go start taking soy protein, right? But you can use phytoestrogens to your benefit. So, one thing that I would…if Jamie was your client, you brought her to me, I would say, hey, why don’t we consider using a different phytoestrogen, like ground flaxseed?

So, could you do…it’s kind of a lot, but if you’re doing shakes, like, 2 to 4 tablespoons of ground flaxseed every day, that can help. It is not going to be anywhere close to the impact of real HRT estrogen replacement, but it is something that is absolutely beneficial, particular if Jamie is, let’s say, not eating enough of a high fiber diet, or let’s say you’ve got some work to do with your nutrition, adding ground flax is great. The other thing that’s super helpful, that I actually, like, now, as a…like I said, I’m in my late 30s. As a shake ingredient is matcha.

So, there’s actual research around matcha helping women with menopausal symptoms, and matcha, if you’ve never tried it before, it’s a powder you can get at most health food stores. If you add it to protein shakes, it gives it, like, a malt type flavor. So, it’s actually really good, but the beauty of matcha is that, the number one thing that’s known for in menopause, if you’re using it, is helping with, like, libido and sexual function, too. So, matcha’s great. Whether you’re a male or female, pre-menopausal, post-menopausal, it’s adaptogenic.

So, adaptogenic herbs help your adrenals adapt to stress. We talked about the importance of stress. So, matcha is really great. Then I would be careful to…specifically because if you said, hey, I’m bringing Jamie to you. She’s gaining weight all of a sudden. In menopause, yes, there’s this decline in estrogen, but this weight gain is almost always tied to inflammation. There’s an inflammatory process going on, and again, this is a buzzword, so I can dig in here, but eating, in air quotes, “anti-inflammatory diet” is really helpful.

So, first and foremost let’s get rid of inflammation with really obvious factors, like processed foods. Like, highly processed, hyper-palatable foods, like, get them out, right? That’s an issue. Secondly, try doing temporary eliminations of really commonly inflammatory foods that people have underlying sensitivities to, like gluten, dairy, soy, right, all that type of stuff. So, that’s part of the reason, for any listeners that have ever tried or heard of detox, right, our detox program, really, the food portion is designed to take away the most common underlying food sensitivities to help somebody pinpoint if any of them are causing inflammation.

It’s not saying those foods are bad, take them out forever. It’s saying let’s do a short-term elimination of potentially inflammatory foods and get them out. The other thing, I talked about the importance of stress, because, right, the ovaries aren’t working anymore. Your adrenals have taken over. You have to make sure you’re not causing stress through nutrition. So, I oftentimes see women go immediately, I’m going to go Keto. I’m like, okay, do you know that, for a lot of people, a ketogenic diet is going to raise cortisol levels and stress?

And if anything, I’ve seen women in menopause that I worked with do better with carbohydrate intake, as long as it’s coming from the right source, like root vegetables and stuff like that, and then you guys, I mean, you’ve heard us, as a nutrition team, talk about this ad nauseam, but oh my word, just start with protein. You have…like, oh, I cannot stress that enough. Like, if you are a woman listening to this right now and you are like, okay, I’m menopausal.

I’m having all of these issues, and you know that you’re eating, like, half the protein that you need right now, don’t listen to anything else I’m saying. Just go address that first. You will be shocked at the impact that it has. It’s not going to reverse you to your premenopausal years. I’m not saying that, but if you are not hitting your protein targets, you are pushing a rock up a hill. You’re going to make everything else harder on yourself.

You just have to, have to, have to, and then, obviously, things that we talk about in general with really great nutrition is tons of produce and antioxidants. If you don’t have enough antioxidants in your system, which comes from colorful fruits and vegetables, berries, et cetera, things like green tea or chamomile tea…sage tea, actually, is really great with menopause for women that like that, but if you don’t have enough antioxidants in your system, you’re going to have more oxidative stress, which, what that leads to is inflammation, which leads to an exacerbation of weight gain.

Jamie Martin:
The cycle continues, you know?

Samantha McKinney:
Yes.

Jamie Martin:
With, like, one thing.

Samantha McKinney:
Yes, and this is kind of out of left field, but the other thing that I realized that I didn’t hit on with this whole decline of estrogen, too, is bone health, right? Like, bone health is really important, and that’s a whole other reason why you have to strength train. You just do. Without that physical stress on your bones, they’re going to get porous and weak. You just have to do it.

Jamie Martin:
Okay, so, we’ve talked about stress, nutrition. Any other factors that we should think about?

Samantha McKinney:
One other thing I want to focus on with nutrition, you got to be real careful with intermittent fasting. So, women around menopause will do better…I’m all about, like, time-restricted eating can helpful, right? So, that means, like, shortening your eating window to, let’s say, 10 to 12 hours. What I’ve seen over and over and over again with clients, women will do better if their eating window starts first thing in the morning.

You are much better off skipping dinner-ish, right, than skipping breakfast, right? So, eat first thing in the morning. So, let’s say maybe your eating window is 6 a.m. to 6 p.m., I would much rather see that than, like, noon to midnight or like, 9 to 9, right? That’s going to be a lot better, and you also want to be careful of grazing. Try to eat enough protein, but get at least four hours of not eating in between meals.

Jamie Martin:
Oh, that’s, like, the tricky thing for me right now, is the grazing.

Samantha McKinney:
If it is, you need to eat more.

Jamie Martin:
I know it is, like, grazing.

Samantha McKinney:
Yeah.

Jamie Martin:
Look at me. _____ 00:40:03.5.

Samantha McKinney:
Well, every single client I’ve ever had that struggles with I need to snack, I need to snack, I need to snack, I look at their food log. I’m like, you’re eating half of what you should at meals. We have to completely beef up your meals. So, it is, you know…it’s not drastically different than pre-menopause, other than the addition of, like, you know, certain things, like I said, like the sage tea, the matcha, the ground flaxseed. Soy isoflavones, again, it’s an option, but you got to be real careful and make sure that that’s right for you, but it is like, hey, do a little bit of time restriction right? Like, maybe shorten your eating window to 10 to 12 hours. Get that protein in. Be diligent about your exercise, and have a lot of antioxidants.

Jamie Martin:
Got it. Okay, we’ve talked about bone health. We’ve talked about brain health. We’ve talked about heart health a lot, and actually, you know, there’s often, for a lot of people with heart health, in particular, a genetic factor or a family history. Are those people…when estrogen starts to decline, is there a greater risk there with that?

Samantha McKinney:
Okay. So, somebody that has…if you’re familiar with Lp(a) or lipoprotein (a), that’s a marker that you can get tested through your blood that can kind of identify if you have underlying genetic risk. If you have elevated Lp(a), you’ve got to be 10 steps ahead of the next person when it comes to heart disease prevention, because you…just everything else puts you at more risk.

So, you can sometimes see that. It’s tricky nowadays in families. Oh, it’s in my family. I’m like, is it, or is poor lifestyle habits in your family? You just never know, right? So, yes, it can. One thing that I’d really recommend that you test and test on a regular basis is called Apo B. It’s Apolipoprotein B. A lot of countries use this as almost a super marker to LDL, because it tells a better story, but if you look at the research and the aggregate of all of the studies and information out there, there’s no scenario where your Apo B goes down and your heart disease risk doesn’t go down with it.

So, again, you’ll see all these people talk about, like, oh, well, I’m Keto, and you know, I actually heard this specific, like, stat on another podcast of, hey, I’m Keto, and my insulin resistance is better, but my Apo B went up, so it doesn’t matter. Well, it actually does, right? Like, so, your Apolipoprotein B, monitor that, and keep it low, and you know, for some people, it’s…I’m not saying, hey, I’m a proponent. Go on a statin medication.

But for some people, it’s going to require a statin medication, because there’s a certain point where your diet and your lifestyle will get you so far, and then that’s what you need, is the extra edge. For a lot of people, and just from clinical experience, from what I’ve seen working with clients, oftentimes, you can control it just with lifestyle and nutrition and supplementation, and just, yeah, making sure that you have as much dialed in as you can within what you have control over.

Jamie Martin:
Right. Like within those lifestyle factors that we’ve talked, you know, at length about in this episode. Anything that we missed, Sam, that you want to make sure that we hit on? I mean, we have quite a few articles and resources. You’ve written a couple, too, that we want to…we’ll point people to in the show notes, for sure, so there’s deeper reading for everyone, as well.

Samantha McKinney:
Yeah. I’d say…and this is, again, just from working with people closely that have been through perimenopause and menopause. It is, as hard as this is…and I realize this is coming from someone who hasn’t gone through it. I’ve seen a massive difference in people that embrace this versus fight it, and you know, that’s going to be different, depending on what symptoms you’re struggling with and how you’re feeling and you know, do you have new anxiety and depression popping up and all that type of stuff?

But if you could look at this as, like, almost like a rite of passage, right, of, hey, this isn’t something to be feared. You still have a ton of meaning and adventure and things that you can do in your life postmenopause. You know, I’ve literally heard women say stuff like, oh, I feel like I’ve gone through menopause, so, like, it’s all over. I’m like, what’s all over? Like, right? Like, there is so much to be experienced and you can still learn new skills. You can still have life achievements. You can still start a relationship. You can still get married.

Like, there’s…whatever it is that…things aren’t over. Things are just different, right? So, I would say, the one thing that I would leave you with is, like, hey, this is…think of this as, like, the reverse of puberty, right? Like, this is just sort of a…it’s just a transition that you’re going through, and with the right mindset and the right strategies, you’ll come out on the other side. It’s just a little bit of a new, different, and hopefully even better version of you, but you have to have the mindset there in the first place.

Jamie Martin:
I love that, and it’s kind of moving beyond some, like, old stereotypes about what, like, you know, women of a certain age know that used to be a thing, and we can change that narrative, you know, and do things differently.

Samantha McKinney:
And just to say it directly, you can still be desirable and sexy and all these different things, and I’ve seen it play out, right, and you can still be this awesome, achieving, you know, kick in the behind, woman, right? Postmenopause is not going to stop you from that, but again, you have to control your stress and do all of these other things that we’ve been talking about.

David Freeman:
Say it again for the people in the back. We do have that mic-drop moment, yeah?

Samantha McKinney:
Yeah.

David Freeman:
You ready for it? And this, actually, is probably something close to you, because you actually wrote this article around five myths around menopause. You don’t have to do all five, but if you just want to think of, like, okay, I want to debunk this about menopause, what would you say?

Samantha McKinney:
I would say, number one, it’s going to be an extreme struggle for every woman. That’s not necessarily the case, right? Like, you can impact how you go through menopause. You can, right? So, that’s the first thing. It’s not this, like, let me just sit back and see how hard this tidal wave hits me, right? You’ve got a lot more control over it. Number two, I would say this idea of, like, I have no hormones left.

You do have hormones left. They’re obviously at different levels, but they’re still there, right, and there are still things that need to be optimized, right? I would say another one would be you don’t have to accept every single symptom that you’re experiencing as a given, right? So, if you’re struggling with, let’s say, rapid weight gain, right, there might be something else going on, particularly if you’re dialed in, right?

Samantha McKinney:
So, like, weight gain, especially, I hear that a whole lot. Like, do the anti-inflammatory diet. Get your thyroid checked. This might trigger…just like puberty and pregnancy can trigger thyroid issues, menopause can. Get your thyroid checked. We’ve talked about this on this podcast before. If your thyroid’s off, you’re not going to lose weight no matter what you do, right? You got to optimize it. Another one around, I would say, bone health is immediately, women might go from taking no supplements to, like, just taking calcium. Well, I got to just start taking calcium right now.

Bone health is way more complex than calcium, and actually, just taking calcium by itself can be kind of dangerous, right? So, you’ve got to focus on strength training. You need to focus on magnesium, vitamin D, vitamin K, and calcium, right? And then, lastly, I would say kind of what I had nodded to before of, like, it’s all over. I’m just not going to feel like myself again. You can feel like yourself, and you can feel like a better, wise, more mature version of yourself. Like, what a cool thing to do and sort of experience and kind of get to this new perspective that I would say that you have, right?

Jamie Martin:
Right. I love that. Well, if people want to hear more from Sam, they can find you on Instagram @lifetime.coachsam. You also have lots of articles. You’ve been on many past episodes, you know, our gut health and with thyroid, and what else have we talked…so many different things.

David Freeman:
It depends.

Jamie Martin:
It depends, but yeah, lots of ask-the-experts type thing.

Samantha McKinney:
Am I the only one that says that one that much?

Jamie Martin:
Oh, no, you’re not. Well, Sam, thank you for coming back again. We always appreciate your insights.

Samantha McKinney:
Thanks for having me. I appreciate it.

David Freeman:
Thanks for joining us for this episode. As always, we’d love to hear your thoughts on our conversation today and how you approach this aspect of healthy living on your own.

Jamie Martin:
And if you have topics for future episodes, you can share those with us, too. Email us at lttalks@lifetime.life, or reach out to us on Instagram @lifetime.life, @jamiemartinEL, and @freezy30, and use the hashtag #LifeTimeTalks. You can also learn more about the podcast at experiencelife.lifetime.life/podcasts.

David Freeman:
And if you’re enjoying Life Time Talks, please subscribe on Apple Podcasts, Spotify, Google Podcasts, or wherever you listen to podcasts. If you like what you’re hearing, we invite you to rate and review the podcast and share it on your social channels, too.

Jamie Martin:
Thanks for listening. We’ll talk to you next time on Life Time Talks. Life Time Talks is a production of Life Time Healthy Way of Life. It is produced by Molly Kopischke and Sarah Ellingsworth, with audio engineering by Peter Perkins, video production and editing by Kevin Dixon, sound cand video consulting by Coy Larson, and support from George Norman and the rest of the team at Life Time Motion.

David Freeman:
A big thank-you to everyone who helps to create each episode and provides feedback.