The Foundations of Health During Perimenopause
Episode 2
This episode reviews the foundational health habits that can scaffold and support folks as they are navigating perimenopause.
Hellllloooo! This episode reviews the foundational health habits that can scaffold and support folks as they are navigating perimenopause. It is chock-full of resources - check them out bellow!
Katy Bowman - Stack your Life
https://www.nutritiousmovement.com/podcast-transcript-ep-39-stack-your-life-for-more-natural-movement/?msclkid=08f7fb62b4f811ecbef3d6c745e1ce23
Rainbeuas (where I took square dance lessons - highly recommend!)
http://www.rainbeaus.org/?msclkid=260909aab4f811ecbd5d8d10759cbd74
Hunger, Energy, Cravings -
http://www.rainbeaus.org/?msclkid=260909aab4f811ecbd5d8d10759cbd74
Maintenance Phase - BMI episode
https://podcasts.apple.com/us/podcast/the-body-mass-index/id1535408667?i=1000530850955&msclkid=7accdf6ab4f811ec9e30738769287b1b
Tempest (formerly Hip Sobriety)
https://jointempest.com/?msclkid=957f89efb4f811ec904153471a3c8945
Understanding sleep needs :
Brain Basics: Understanding Sleep | National Institute of Neurological Disorders and Stroke (nih.gov)
F.lux app to decrease blue light exposure
f.lux: software to make your life better (justgetflux.com)
Emily Nagoski and all her amazing work on both burnout and libido:
videos & podcasts — Emily Nagoski, Ph.D.
https://www.goodreads.com/book/show/42397849-burnout?msclkid=46a1dde5b4f911ec96ebffd3d9d0e3d5
Understanding ACE (adverse childhood experience )score
What ACEs/PCEs do you have? « ACEs Too High
Nap Ministry - the work of Tricia Hersey amplifying the message of “Rest as Resistance” and specifically addressing the importance of rest for Black people.
The Nap Ministry | Rest is Resistance (wordpress.com)
Full Transcript:
0:14
Welcome to the change a podcast about perimenopause for people in the 30s and 40s. I'm your host, Caitlin O'Connor, naturopathic doctor with a practice in Denver, Colorado supporting patients with their health and hormones throughout the many phases of life. I'm happy you're here. Let's dive in. On our previous episode, we covered what changes are happening in your body during this transition. And this episode is going to offer a basic review of important health habits and how to optimize your routine to support your body during this transition. Let's get started. Today, I want to focus on what I call the foundations, the basic habits on which we can build better health. Now, just to forewarn you, there will be no hacks or top 10 Weird tips that will change your life here. Everything we discuss is actually going to be pretty basic, and maybe even boring. But don't touch that dial. Because like I tell my patients, it's small and often simple habits, repeated slowly over time, that actually are going to have the most significant health impacts. And that doesn't make for a very exciting headline. But it does allow for sustainability over time. And I would rather see folks make a few changes over the years, then go really hard for a month and then leave it all behind when they get burnt out. And the following ideas are not meant to be done in pursuit of perfection. There is no gold star there is no getting it right. In fact, feel free to do the minimum do the least. The point is to find the things that make you feel better. It isn't biohacking or anti aging. This is just figuring out a way to feel better in your body and move the needle on your individual health spectrum so that you can enjoy life more and hopefully mitigate some of the possibly uncomfortable or bothersome or actually really bad symptoms that you might be experiencing with perimenopause We often have to swim upstream and fight against the socialization that people should serve and prioritize productivity and or helping others at the expense of their own health. I'm going to ask you to challenge that story and create something that better meets your needs. So one of the first things I do when I meet with patients is review the foundations, movement, food, sleep and stress. And I have found that we make the majority of our progress by looking at and improving habits in these areas. I think this is especially important in perimenopause. Because as we've discussed before, during perimenopause, the body's trying to find balance as it is adapting to fluctuating hormone levels. I think of this as a physiologic stressor. So a change in the biochemistry of the body that is putting pressure on the system as it's trying to find the new normal. Many of the symptoms that come up during this phase, sleep disruption, mood and memory changes, hot flashes, etc. are a result of the body many times specifically the brain being thrown off by these hormonal fluctuations. And during this time, I found that any additional inputs like higher stress or increased alcohol intake will have a greater destabilizing impact because the system is already in flux. As we are trying to maintain balance in this changeable hormonal landscape, the more we can offer up a stable routine of habits, the better it can be. Another analogy I use frequently is the example of scaffolding. So if your brain is feeling a little wobbly as it adjusts to the changing hormone levels, we can use our lifestyle to provide a support system. So managing stress, working on sleep, figuring out our movement, balancing blood sugar, and minimizing alcohol are all stabilizing factors that will give our brain a little bit of room to adapt to those changing hormones. So let's start with movement. Listen, I'm so sorry that our culture has messed up the joy of moving your body. For so many of us. There are not a lot of spaces that feel safe and welcoming. There's unequal access and comfort with accessing nature and green spaces. We are made to feel unathletic, or uncoordinated or bad about how we move our bodies or how we look when we move. We've been told the lie that there's only certain bodies that can exercise or hike or bike or roller skate. And that just isn't true. And certainly different bodies are going to be able to do different things and chronic pain or disability might limit what can be done on any given day. But all that being said, figuring out a way to regularly move will offer improvements in many areas that can be disrupted during perimenopause, especially regarding sleep, body aches, mood and brain fog. Additionally, the hormonal changes that occur once folks stop ovulating can actually result in decreased muscle mass, which is bad for bones bad for blood sugar and bad for overall lifespan. So if you aren't actively building and moving your muscles, they get weaker and they get smaller and that increases a number of our risk factors when it comes to aging.
4:55
So what should you do? I'm not sure it really matters. Anything is better. than nothing and the particular type of movement that works for you is going to be variable. So something I do recommend is making exercise a time for social connection. This is a concept called stacking your life. Shout out to Katie Bowman, my favorite bio mechanist, author and podcaster, you can check out all of her work at nutritiousmovement.com. So the concept of stacking your life is pairing something that you are already planning to do or wanting to do and adding movement to it. So an example of that is networking walks instead of doing networking coffee. This works when I'm networking with folks with whom walking is comfortable and enjoyable. So if people reach out to me and want to meet and explore, you know, potential referral relationships or things like that, I'll often offer up a walk instead of meeting in a coffee shop. I also have a hike club with two good friends where we meet up monthly and do a hike where we gossip and catch up. I joined an intro to square dancing class with another friend that met weekly for three months. And that was super fun and a good way to encourage movement after work, which is usually a time that most folks want to go home and zone out. So obviously movement is very important to me, it's a crucial part of my mental health care. So to something I prioritize really highly when planning my life. But I think that by finding folks you want to hang out with anyway and then linking it to a physical activity, you're much more likely to do it. Also, paying for something ahead of time and putting it on the calendar is another way to plan for movement that might not otherwise happen. I highly recommend folks check out their local rec centers, that's long been a place for me to get affordable access to equipment and classes. But the bottom line is start small. Find something you like and increase your dose as you are able. But this is a really important time in your life to make sure you're getting some physical activity. The ideal is about 150 minutes per week divided up however you want. You can do it in bigger chunks, or you can do it in smaller increments. And we should really divest ourselves from a few ideas about exercise before we move on. First exercise does not have to hurt or cause suffering to be effective, gentle movement is still great for your body. And second, we shouldn't expect weight loss with exercise and tying the two together usually results in frustration and a loss of motivation. And finally, small doses, even five to 10 minutes a day can be really impactful, it is fine to start small and even stay small, anything's gonna be better than nothing. So move along your own personal spectrum in a way that you enjoy, or at least in a way that you find tolerable. There's been some attention recently into pairing movement with certain phases of the menstrual cycle or prioritizing different types of movement with certain hormonal stages. And I think that's great, especially for folks who are already active and looking to fine tune their routines. But don't get too bogged down in the details, you can use your own body for feedback about what types of movement are going to work for you, and when. The important thing here is really just to move your body regularly in a way that works for you. Next, I want to review food. So as a doctor who thinks about nutrition a lot and finds it hugely impactful on health, I obviously work a lot with nutrition in my practice. However, I also see the negative health impacts of diet, culture and the myriad of ways the wellness industry has packed up and sold eating disorders. And then we layer on the inequitable access to quality foods, the convenience of processed foods and the fact that many folks are short on time and energy. And I often get paralyzed on how to best offer advice regarding diet that is actually helpful. So I don't have it figured out, honestly. The best I can do is offer some broad swaths of advice, and then acknowledge that much of figuring out what food choices work for an individual person is going to be through experimentation, analysis of bloodwork and finding what is enjoyable and sustainable for the long term. So what does that leave us with exactly? Two big things and two big things that probably aren't going to blow your mind. But first is eating more plants. And second is balancing blood sugar.
8:49
So if we look at this theme across all diets, and all dietary research, the one thing that most folks can agree on eating vegetables is a good thing. And at a minimum, I recommend three cups of vegetables per day. This is even more important during perimenopause, where we can actually see some of the phytochemicals and the fiber that is found in these foods help with the metabolism of those fluctuating estrogen levels. So at a minimum, I recommend three cups of veggies per day. And if you're feeling fancy, you can divide these up across these three veggie categories. We've got your leafy greens, spinach, kale, broccoli, our examples, we've got your cruciferous vegetables, broccoli, cauliflower, brussel sprouts, and then we have our colorful friends, carrots, peppers, and pretty much everything else. They can be cooked. They can be raw, they can be in whatever combo you want. But as a baseline preventative health measure, almost everybody can eat more veggies. Blood sugar balance is another broad swath that has two components. A big one is eating enough to fuel your body and your brain throughout the day. So much of mood and energy dysregulation, especially when it comes to anxiety. For example, can be linked to the fact that many folks aren't getting enough food throughout the day. They're skipping meals or not getting enough calories or protein with meals, then they're experiencing blood sugar dips, which can then cause sugar cravings, which can then cause more blood sugar dips. So a great way to analyze how this might be working for you is to check in on what's called H. E. C, or hunger, energy, cravings. This is a metric I learned about from an ND colleague of mine, Dr. J. Tita and what it means is, after a particular meal, what is your hunger? Like? What is your energy like? And are you having any cravings? If you eat a particular breakfast, and one hour later, you're starving your sleep, you're you're craving sugar, that usually means you need to possibly get more food, more fiber or more protein. This is going to be so variable for everyone. Some folks thrive on a more plant based diet with higher carbohydrate. Some folks feel better with a more meat and veggies approach. This can also change throughout your lifespan. So what worked for you before might not be working as well now. This is where experimentation without bias or judgment comes in. You have to try new things, pay attention to how you feel and then adapt as needed. And I want to be clear here that blood sugar is not a proxy for weight or fatness. So the problem is that smaller folks will be assumed to have no issues with inflammation and blood sugar and not get properly screened. Whereas bigger folks will be assumed to have issues with blood sugar, but not be offered any actionable advice except to generic proclamations to lose weight, which is actually not addressing the root issue of it and can actually exacerbate issues with blood sugar and metabolism. And sidenote, if you want an amazing look at the utter worthlessness of BMI as a health metric, please go listen to the BMI episode of maintenance phase, which is an inspirationally good podcast. So finish this podcast first, but then definitely go listen to that one. And I think more importantly, for food for many folks is alcohol. So before I go deep into alcohol use, I want to provide some background. I was born and raised in Wisconsin, I'm Irish Catholic. I played rugby for almost 15 years. So layering these subcultures onto one another, and you can start to get a picture of what my relationship to alcohol has been. I drank pretty regularly from high school throughout my early 30s. Once I got into my late 30s, I started to notice that alcohol didn't work for me anymore. I couldn't sleep while my anxiety skyrocketed the next day and the hangovers were 100% Not worth it. So I don't think that alcohol is an evil that everyone must abstain from. But that being said, many folks are drinking at a level that might be negatively impacting their health. And it is my opinion that during perimenopause, when the brain is already trying to adapt to a new normal, that this challenging impacts of alcohol in the brain are going to be exacerbated. Many symptoms, especially related to sleep and mood are going to be worse with alcohol. But if you're drinking regularly, you may not be able to make this connection. So my recommendation is to decrease baseline alcohol intake to zero to four drinks per week for at least a month and see how you feel. Have alcohol be more related to special occasions than daily routines. And then you can see how your sleep and mood respond with less alcohol and then modulate your consumption based on those results. One thing to figure out is what is alcohol representing for you? Is it stress relief? Is it ritual at the end of the day, is it a reward, and then fill your toolkit with some other options that meet those needs. As basic as it may sound, some of these might include getting a tea that you really like and brewing that. For some folks, I have people drink pomegranate juice out of a wineglass. So they're getting that same ritualistic experience. Other times, it might mean taking a walk, taking a bath, journaling, or figuring out what it is that alcohol is providing you and seeing if there's another way that need can be met.
13:44
Another thing is forming social connections that don't revolve around alcohol. I think this is really important because so many of the social outlets for adults are centered around drinking, and it can be lonely or isolating to try to socialize without alcohol. A good friend of mine pivoted to sobriety when we were in our late 30s. And it was great because it forced us to figure out how to have fun without drinking, where previously the majority of our friend group interactions were alcohol focused. It gave us the opportunity to get creative and also deepen our friendship. So think about opportunities to connect with people differently. An art class a bike ride, a book club that actually reads the book! Figure out some ways to connect, we're drinking isn't the focus. And just to clarify for folks, heavy drinking for women is defined in the medical literature, seven drinks per week, or more than three drinks per day at any given day. So even folks who think they may be consuming moderately with maybe one to two glasses of alcohol every night, are possibly putting themselves into a higher risk group than they may think. We have normalized alcohol consumption in our culture to the degree that I think most folks don't have a clear idea on what moderate consumption really looks like. One rule of thumb you find is the 1-2-3 rule, which is one serving per day, no more than two at a time, no more than three days a week. And I think that's pretty reasonable for most folks. Although there will be people, especially during the pre menopausal period that might find even moderate consumption has a negative impact on how they feel. And if the advice to discontinue or slow down with drinking might sound really scary or unattainable. If that's the case for you, I'd really think about that. Because folks might need more help with their alcohol use, and for them, there's a number of options. It's sort of like therapy or dating, you have to shop around a little bit to find one that fits. But one of my favorite first stops is the hip sobriety movement and the book quit like a woman, even if you aren't interested in completely cutting out alcohol. This critique of the alcohol industry, and the way American culture approaches alcohol use is really interesting and worth a read. And a quick side note, I want folks to start paying attention to the way alcohol is marketed towards women and especially moms. Wine mom and mommy juice and all these weird ways we've totally normalized regular alcohol consumption as part and parcel of motherhood is pretty disturbing. In fact, I think it's a tool that's used to distract from the fact that modern parenthood is pretty unsustainable. And instead of demanding adequate parental leave and universal childcare, the solution is we should just drink wine every night to numb the pain. So the bottom line is, some brains and bodies seem to be more sensitive to the impact of alcohol, especially during perimenopause. And the way to know if this is you is to take a break and see how you feel and then you can moderate your consumption based on the results of that experiment. And remember that this is a phase, many folks will notice they're able to tolerate more alcohol doses once this transition is complete, and they are happily on the stable side of menopause. Okay, next is sleep. And this is a cruel joke for some, as oftentimes perimenopause is a time where sleep is disrupted, insomnia is worsened and hot flashes are wreaking havoc on the whole system. And we will have a lot of advice peppered through many of our episodes on what to do with sleep issues are preventing you from sleeping well. But outside of insomnia and sleep disruption, many folks just aren't getting the sleep that they need. Remember, your brain is being challenged right now. It is adapting to this hormonal state and anything we can do to help our brain will help our Peri menopausal symptoms. And most folks need seven to nine hours asleep, some slightly more, some slightly less. But the myth of six hours actually comes from studies that we're looking at the minimal amount of sleep that caffeinated factory workers need in order to still be productive in the factory, while making minimal mistakes. That's not wellness based, that is capitalism! For health and well being the average is much closer to eight to nine hours. And I see so many folks who think something is wrong with them because they need too much sleep to feel well. They're literally just sleeping a normal human eight to nine hours a night. So get your sleep and get it proudly. Sleep is so healing and important. And the ideal schedule is to fall asleep and wake up within the same one hour period every day of the week. So minimal variations in your bedtime and wake up times. And this might not be attainable for everyone based on work schedules, childcare, etc. But it is something to consider for folks who have the opportunity. So even if you can't get your full eight hours, you can optimize the sleep environment, setting the thermostat to 60 degrees or lower sleeping in total darkness like you can't see your hand in front of your face darkness which will optimize melatonin production. So you might consider blackout shades asleep mask using tape to cover any light sources coming from electronics. And then additionally getting off screens in the evening, which I know is hard, but it is so disruptive to sleep. Do your best. But then when you can't help it be sure to minimize the impact on your brain by blocking the light with either blue blocking glasses, or downloading F.lux or a similar app that decreases the light emission from your phone or tablet.
18:38
So in summary, prioritize sleep, get what you can when you can and create an environment that results in the most restful sleep possible. Finally, we'll look at stress, and this can be broken down into so many categories and it's such a complex topic. But to reiterate a major point of this podcast and this episode. People in perimenopause are more susceptible to stress because they are already experiencing a major stressor in their body as they adapt to hormonal change. So external stressors can be fuel to the fire. So many people will notice that the extent of their symptoms will ebb and flow based off the extent of the stressors in their lives. Unfortunately, I do not have the magic cure for stress. And I think the elusive goal of a zero stress lifestyle or the myth of perfect life balance can be a stressor in and of itself, because it's just not going to be reality for so many of us. So I like to break stress down into two categories. First is the stress that we can control. And the other is the stress that we need to manage stress. We can control my look like this. Clear your plate a little bit. Don't take on extra projects or volunteer for things that you don't find compelling tune into your inner voice and anything that is not a resolute Yes, should be a no. This is also known as setting healthy boundaries. At this time. More than ever, it's really important to recognize the importance of your own needs, and to really focus on a simplified routine. Now, we can't remove all stressors from our lives. So what do we do with what is left over once we've trimmed away what is out of our control? One way is to ask for help. We are not meant to deal with it all alone. So figuring out a network of support that works for you is crucial. This could be arranging a childcare Co Op with friends, it could be working with a therapist, it could be hiring someone to clean your house, or negotiating chores with your partners. Having a robust support system is really important for mitigating some of the impacts of stress. Another option is to create space. A strategy for this could be to create a Sabbath for yourself. This can be any day of the week, but carve out a day or even just some hours that you block off regularly for activities that fill your cup. Create opportunities for joy. But make sure it is true joy, not a staged photo up of what you think joy is supposed to look like. We also want to modulate the impact of stress on your body. And this one is really important. Our brains cannot differentiate between the modern day stressors of email and interpersonal relationships, and the evolutionary stressors of survival. Our brains create a similar response when we are running from tigers, as it does when we are responding to a passive aggressive work email. This is detailed in the work of Emily Nagurski and her amazing book 'Burnout', which offers great detail on the very real impacts of stress on the body. A quick overview is as follows. When we get activated into our sympathetic nervous system, our stress mode, our fight or flight, historically, it would have resulted in a true fight or flight experience we would need to run from or fight the tiger. And then once that stress was gone, we close the loop by participating in physical activity, actually fighting or running, and then reconnecting with our community, running home to tell folks the tale. This mix of physical activity and reconnection creates a change in the hormonal patterns that allow us to move from that sympathetic dominant stressed out state to the parasympathetic state of rest. Many of us spend our days stuck in a sympathetic loop without closure, which will then amplify the impact of stress on the body. Then there are the specific activities, movement (yes, I'm talking about exercise again) physical connection, could be sex, massage, cuddling, skin to skin contact, deep breathing, laughter, connection with others. All of these can trigger a response in our body to tell us that the stress is over and we are safe. So by building these activities into our day, we can minimize the impact that stress has on the system. Another important thing to acknowledge is that our experiences with trauma over the lifespan impact how we respond to and perceive stress. This can be seen in two areas of research. The first is aces. Aces stands for adverse childhood experience score, and it's a number that is given to folks based on a survey of childhood exposures to potentially traumatic experiences. There's a study that shows that people with higher ACE scores will have more severe symptoms and perimenopause. And I think this makes a lot of sense. When we're exposed to trauma at a young age, it wires our brains for hyper vigilance and a more prolonged and long lasting stress response. So then, when we experience the stressors of perimenopause, the brain may have a harder time adapting.
23:14
Another area where exposure to stressors can impact Peri menopausal experiences can be found with black women. Black people report a higher degree of severity with pre menopausal symptoms. And a plausible explanation for this is the stress of having to navigate the micro and macro aggressions of living in a racist country. This then creates a state of heightened stress and hyper vigilance, that has a real impact on the experience of perimenopause. And this is not fair. But it does result in an extreme importance of stress management and self care for folks who have had this experience. And I would refer to the impactful work of the nap ministry who can be found on twitter, instagram, Patreon and on their website for ways to rest and recover from these particular stressors. So to highlight during the pre menopausal transition, you were uniquely sensitive to stress and stressors that in the past may have seemed manageable might now be having an impact. consider removing any stressors that you can control, and then creating a robust practice of stress management and mitigation to modulate the impact of the inevitable stressors that come your way. So that concludes today's episode. And I'm wondering if you thought this was kind of pretty boring or basic? Well, it kind of is, however, I have noticed that many of us try to sweep over the harder work of shoring up the basics in search of the magic pill that cures all but still allows for us to be under rested, overworked and slightly hungover. I really think that the simple assessment of lifestyle is so important and foundational. All the other things menopausal hormone therapy, herbs, supplements, etc. Those are all icing on the cake, but we have to bake the cake first.
24:55
Thanks so much for listening to this episode of the change podcast about perimenopause for folks in their 30s and 40s. I'm Dr. Caitlin O'Connor and our executive producer and audio engineer is Janece Matsko of empowerment ventures, theme song created by Lady Gang music from Denver, Colorado. You can check out show notes and find and share episodes at Drcaitlin.com/podcast. And while you're there, you can sign up for my newsletter. This podcast is a labor of love and if you like it, please tell your friends and subscribe rate and review on Apple podcasts Spotify or wherever else you listen. Now for the legally appropriate disclaimers. This podcast is for general informational purposes only. This does not constitute the practice of medicine and this podcast does not give medical advice. No doctor patient relationship has been formed. listeners should not delay or disregard medical advice for any condition they have. And if you aren't getting good care advocate for yourself, explore your options and try the best you can. Until next time, I love you and you're doing a great job.