Part 3: Perimenopause 101: How and Why Your Cycle Starts to Change

Transcript:

Leah: Welcome to Dishing Up Nutrition, brought to you by Nutritional Weight & Wellness. We are a Minnesota company that specializes in real food nutrition education and counseling. I'm Leah Kleinschrodt, Registered and Licensed Dietitian, and I am here today with my partner in crime and cohost Kara Carper. It's good to see you again, Kara.

Kara: Great to see you, Leah. Nice to be here. I'm really excited about our topic today. I know you're going to introduce it, but I just want to start out by saying it's relevant to me personally because I have a teen daughter. And I am recently menopausal. So we'll give listeners a little tease on what our topic will be.

Leah: And maybe a, a little insight into what that looks like in your household, that kind of have two ends of the spectrum with that? Yeah, absolutely. Yeah. Today we're tackling a huge topic that it's at the forefront, I would say, of probably most of our female clients that we work with.

Not everybody, but a really good chunk. And for listeners, if you've been following along with the show for the last few months, hopefully you'll have noticed some of the patterns we've been in these last few months with the shows. We first started in February talking about what a healthy menstrual cycle looks like and how our nutrition ties into those monthly hormonal fluctuations.

So that's how we set the stage. I guess we can consider that part one. And then in March, the next month, we focused in on just a few of the common menstrual conditions that we see with clients, and that included endometriosis, polycystic ovarian syndrome, or PCOS and PMS.

So today, now we are fast forwarding to our later menstruating years, and we're going to do a deep dive into what is actually happening with the menstrual cycle in perimenopause, which is those years leading up to when your periods actually stop.

Kara: And I just want to put in a plug for the other two podcasts that you and Teresa recorded, 'cause I recently listened to both of those. So I highly recommend that if you are listening today and haven't checked those out that you do so from February and March, 2025.

Leah: Thank you.

Kara: But I'm going to steal a line. It's from a perimenopause article. This is from our website. And a colleague of ours, Monica, wrote this a few years back. So in this article she wrote, “Nothing has changed yet everything has changed.” And that's a very accurate summary of how a lot of women feel when they're getting into their forties, their fifties, and sometimes even later in the years of their thirties.

They might start seeing a shift in their weight and maybe body composition. Moods can shift; be a little sharper, anxiety rises. Sleep and overall resilience really can be impacted negatively. And then other things as well, you know, they may notice skin issues or lower libido. There's a lot of variables that start to shift and move and can often create some dissatisfaction and disruption of life and daily activities.

Leah: Yeah for sure. Yes, to all of that. And as I was kind of reflecting, preparing for the show, you know, for me personally, I waited to have kids until I was in my thirties and right now my daughter just turned three in February and I kind of just feel like I'm crawling out of the postpartum, that really intense postpartum phase of life and then suddenly I might be staring down the barrel of perimenopause. So that was kind of an unwelcome realization.

Kara: Right.

Leah: I'm hopefully a couple of years out from that still, but it's something on the horizon for sure. And it's something, especially as I work with women, that it brings it to the forefront of my mind of what can I do to just kind of prepare to have in my toolbox as these years approach.

And I know I'm not the only one in that boat. Again, I think the general trend is to wait a little bit later on in life to have kids. So we can end up in some of these back-to-back hormonal transitions that are pretty significant.

I also, wanted to shout out that article that Monica wrote. So that article is called How to Prepare for Menopause in Your 30s & 40s. So it's a very comprehensive resource. There's some great graphs in there. It explains the hormonal changes that happen during a regular menstrual cycle, but then also how things change in perimenopause.

And from what I'm seeing on social media, it seems like, and Kara maybe you've seen some of this too, I think there's a lot more awareness and conversation around these changes that can happen in perimenopause. So I'm hoping as a goal for us today that we can just be another informative and just grounded voice in this space.

Kara: I've noticed that as well. And I think it's a, a fabulous trend to just have more awareness about our bodies and our minds. And what it means that our hormones start shifting. And what does that look like?

Leah: Right. Just normalizing some of it can go a long way with just helping us feel like there's a community of us out there going through the same thing

Kara: Like-minded people.

Leah: Yes.

Kara: And so, as with many other things in life, if we can go into this later phase of life with a good base of knowledge, just have an idea of what options are available for some of these uncomfortable symptoms, women can be more prepared.

They can have more strategies in their back pocket to use and hopefully not get as blindsided, you know? And feel like, oh, I need to figure this all out on my own, or something's wrong with me.

Leah: Yep.

Kara: That's the big thing. You know, nothing's wrong with you ladies. Your hormones are shifting and we're going to do a little bit of a deeper dive on those perimenopausal into the menopausal years.

What is perimenopause & what might be experienced?

But as nutritionists and dietitians, we have seen firsthand that nutrition choices can be very powerful to help to improve some of these troubling times. And so first, Leah, let's just start out with an explanation of what perimenopause is and what kinds of things women might experience during perimenopausal years.

Leah: Yeah, we're going to try to break it down and just kind of explain it simply. And I think to start, I just want to anchor us with a timeline. So menopause, and I know I've said this with other, on other shows that Teresa and I have been on together, that menopause is just actually one day on the calendar.

When we talk about perimenopause, we tend to use menopause and perimenopause interchangeably. That's just kind of how we talk about things. But we're going to try to be more specific and say, all right, menopause is one day on the calendar that is like your 12-month mark after your very last menstrual period.

So that represents the time we've run out of our egg supply and we're no longer able to make any meaningful amount of sex hormones from the ovaries. And we'll get into a little bit more of the hormone stuff, but perimenopause is the two to 10 years before we hit that one day on the calendar.

And as I was diving into some of the research and doing a little bit more digging into how other providers explain perimenopause, they explain it more of like, this is a spectrum of hormone shifts that just occur over time. There's not necessarily a clean cut and dry all of a sudden one day you're in perimenopause and then the next day you're in menopause and now you're post menopause.

Like it's not quite as clear cut and dry. So symptoms can kind of ebb and flow over time or things gradually change. So think about this more as I would say, a spectrum of things that happen over a longer period of time versus like very definitive clear cut dates.

Kara: And there might be similarities in women, you know, sitting around talking about their hormone shifts. Some will say, oh, I've never had that symptom. And others are going to be on board with the same symptoms. So it really can vary with each individual woman as well.

Leah: A hundred percent.

Kara: Perimenopause starts when the egg supply in our ovaries has been depleted to a critical level and the brain signals to the ovaries start to not work as effectively as they did before. So the cells in the ovaries, they're now older, the ovaries have significantly fewer amount of eggs than they did, you know, when we start having eggs.

I mean, like think back to puberty and teens. And even in the twenties. And the ovaries start becoming resistant to brain signals. And this was new information that I just learned in preparation for this show. And so does that process sound familiar? Because we talk a lot about the same phenomenon related to something called insulin resistance. So that's just another term of our cells becoming resistant to a hormone.

Leah: Yeah, exactly. I mean, when, yeah, I learned about that same thing: our ovaries becoming resistant and immediately my mind went to, oh, yeah, this is the same type of phenomenon when we talk about insulin resistance. So the ovaries, so when they don't respond like they used to, and then they don't produce the usual amount of hormone; so with women, we tend to think mostly about estrogen and progesterone.

When those hormone levels get a little lower than what our brain is used to, the brain kind of starts to put up some red flags and say, hey, we're lacking some of these hormones. So it starts to send out more of those brain signals to the ovaries in order to force that egg to ovulate from the ovary.

So I, I think about it like, you know, when you knock on someone's door, but then nobody answers  you know that person is home, so you keep knocking and then you're like, okay, I'm just going to knock harder. I'm going to knock louder. It's going to be more aggressive. Eventually the door opens, but you never know exactly that moment when it's going to, like, you might fall forward through the door a little bit.

So, same kind of idea here. You know, eventually that signal from the brain goes through to the ovaries. But now because there's been this big buildup of those brain signals, now we get a big burst of estrogen coming through. When we get a big burst of a hormone, eventually that's actually going to come back down. So now we can see a more of a rollercoaster type of effect, especially with estrogen.

We do continue to make progesterone when we ovulate each month, but eventually progesterone also starts to take a hit as the eggs age, as we start to not ovulate as frequently. So we just start to not make progesterone, as much as we used to as well. So again, like we've got progesterone that's starting to go down, estrogen's kind of on a bit of a roller coaster, and these shifts can start to happen even before we start seeing changes with our periods.

So again, here's where it's, I wish there was a clear-cut test that would tell us yes or no that we're in perimenopause; so we can be in perimenopause even if we're not quite skipping periods yet. That hormonal chaos is usually already underway at that point, so you might already be having symptoms even if you're not skipping periods yet.

Kara: Yeah, I'm, you explained that very well and I don't know if everybody knows that. You know, a lot of women might be thinking they're, they're under the impression, oh, I'm just going to wake up one day and I'm in perimenopause. And that because I'm skipping periods. But by the time you start skipping periods, you're already in the later phase of perimenopause.

Leah: Yeah. Right.

Kara: So hopefully we can understand why perimenopause can be kind of a rollercoaster ride. Some months we're going to have a normal amount of estrogen and there's going to be some months when we're dramatically spiking and crashing with estrogen.

Some months we may be ovulating and making adequate progesterone. And then the next month we may not be making adequate progesterone due to, you know, not ovulating. So periods eventually become less frequent and do stop. And I think women are familiar with that. But in that interim, the menstrual cycle can often become infrequent.

You know, it's, the periods are less frequent. They can be heavier, but they also might be lighter. So, you could have either way, and eventually women get off that hormonal rollercoaster once the ovaries completely retire. But it's difficult to say how long the fluctuations are going to happen. The average, though, is a four year time span.

Leah: Yeah. And you pointed out perfectly Kara, that it's going to differ per woman. There is a lot of crossover, but everyone's going to have a different journey in that aspect. So yes. Average four years, sometimes it's only two years.

It might be 10 years for some women. So you just, you never know. Yeah. So that's what's happening from a biological standpoint. And so let's talk about what a lived experience might be. And Kara, I remember this, I think it was a show that you and Melanie had done a while back, but you had pulled some of your friends because, this is kind of your community, your age group right now.

You polled some of your friends on their perimenopause symptoms, so why don't you kick us off? And just like, what was the result from your little informal poll that you did with your friends of like, what were they experiencing?

Kara: Yeah. I would love to share that. I do remember doing that show with Melanie. That was a fun show. And so it's worth noting that this was all in a text chain. Because that's what we do.

Leah: Yep.

Kara: So, first of all, with my friends who are all, or let's say early fifties. Anywhere from 50 to 55. There was a lot of overlap in the symptoms that they reported back to me. The most common struggles were surrounding weight gain. What they were saying is the weight gain was mostly around the midsection or the belly, the tummy area.

Kara: For some though, it was a feeling of gaining weight everywhere. And one of my friends said even though she hadn't changed any of her eating or amount of physical activity she was doing each day, she was continuing to gain weight on a regular basis. And felt like it was getting out of control. So that was really frustrating for her.

Leah: Yeah. And I mean, that goes back to what Monica had said. Everything has changed and yet nothing has changed at the same time.

Kara: Right, right. Yeah. So all the weight changes were likely just those hormonal fluctuations since some of those other factors had not changed.

Leah: Yeah.

Kara: There were also emotional ups and downs reported. And some described it as mood swings or higher levels of either depression or anxiety, irritability, that word came up more than once; having a bit of a short temper increase, bouts of anger. So that's interesting. I mean, think about this. This can really affect everybody: kids, spouses, parents, colleagues for that matter.

Leah: Yeah. Just relationships in general.

Kara: Just a lot of fluctuating moods kind of all over the place.

Leah: Yeah. And I know, again, preparing for this show, as I was diving into some of the perimenopause literature, I came across a couple stats where it shows that antidepressant usage in women doubles in this age group. So like age 40 to 59. We see a doubling of the amount of antidepressant use in this age group versus younger women.

And also divorce rates tend to spike during these perimenopausal years. Now I'm, we can't blame all hormones on divorce and stuff like that. But I think it's a very interesting correlation. And I think these stats, they just go to show just how much of an impact these fluctuating hormones can have on a woman's body and her brain chemistry and it's not all about like, oh, okay, like we can't have babies anymore. It's actually, it is a major endocrine transformation.

Kara: Right. And on the same note, not only can moods take a hit, but we also, you know, hear from women that they experience more brain fog. My friends were also saying that memory and concentration had declined during this perimenopausal time. So you might call those tip of the tongue moments, like I don't remember what I was going to say.

What was that person's name? And then it can be leaving Target and just completely standing there, no clue where your car is. Things like that. They just happen more frequently.

Leah: And I can a hundred percent relate to that. Actually that's one of my biggest issues since having kids. So I'm a little nervous as to what maybe perimenopause has in store in that respect. I definitely like blank on words and I'm like talking to my kids and they fill in the words for me and it's like, oh boy. But yeah, so like the, all of those things, so it's the brain stuff, it's weight gain.

There's a laundry list of other challenges that women have in perimenopause. The more well known ones are like hot flashes, night sweats, disrupted sleep, and low libido. But you also have to remember too, there are things like vaginal dryness. There's increased joint pain or just joint stiffness and frozen shoulder. I didn't know that frozen shoulder is actually called 50-year-old shoulder.

Kara: I didn't know that either. Yeah. Interesting.

Leah: In some different cultures; heart palpitations, I've heard that one from a couple clients with heart palpitations and that being a perimenopause symptom and then thinning hair. I have heard of that one. I've had women complain about that one as well. So it's just that every tissue, every single tissue in our body has estrogen receptors in it, so it makes sense then when we start to drop in that estrogen and also progesterone and testosterone, it can have just profound system wide effects. It's not just one little thing. It can have a body wide effect.

I've been working with a client over the past couple of months now. She is more in the post menopause side of things, but during her more intense years, she was having up to 30 intense hot flashes every single day. And that went on for years. I'm like, I don't know how you did that.

Kara: That sounds debilitating.

Leah: Yeah. She managed somehow. But like, holy moly.

Kara: Yes, we do.

Leah: Yeah, yeah, exactly. As we do as women, right?

Kara: Yeah, I recently experienced what it had to be a hot flash, and then I was thinking back to my perimenopausal years, a few years ago when I thought I was having a hot flash, but now I think that was a warm spell.

Leah: Oh, sure. Yep. That was the warm up for…

Kara: Yeah, a warm up. I can't imagine having 30 per day though. So, all right, well, we're going to pause here for a quick break, but we'll be back in a moment and we're going to continue our conversation about perimenopause and what you can do to ease the transition.

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Leah: Welcome back. Before we went to break, we were just rehashing some of the symptoms that tend to go along with perimenopause, knowing that everyone's experience is going to be a little different, but there are a lot of crossover symptoms that women just commonly tend to have.

So we wrapped up on that, and now we're going to chat a little bit about, all right, well, where does food and nutrition and some of these other biochemistry pieces come into play.

How real food, balanced nutrition & key supplements can help with perimenopausal symptoms

Kara: Yeah. So that was a good transition because first half of the podcast, we talked about the biology of perimenopause and how it affects women. And now we're going to dive into how eating real food, balanced nutrition, and possibly a few key supplements, can help women to feel like they have more control during this somewhat chaotic time.

So, Leah, let's just say when you're working with a client or even a friend or family member, where do you like to start when you're talking with a woman about perimenopause and how to leverage nutrition to improve things?

Leah: Right. I mean, I start, like if I'm sitting down with a client, I start with whatever is bothering that client the most. I always open it up and say like, what, what is it that you want to talk about today? Or what would be the top two or three things that you would want to tackle today that you want to walk away with information from? I would say the weight gain and the belly fat tends to be like, probably one of the biggest topics that we cover for my perimenopausal gals.

They just, they want to feel good in their skin again. They want to feel like their clothes fit again. They just want to kind of feel like they move around easier, better. Close second, I would say is probably sleep issues. The hot flashes come in there, the brain fog is in there too, but I would, I would kind of rank them as weight and more just fat accumulation. And then the sleep pieces are usually the things that we tackle first.

And luckily, I always reiterate this with my clients, is anything we do with our food and our nutrition to help with the weight is also going to be beneficial for sleep. And it's also going to be beneficial for the brain. And the skin and everything else. And that's, I love that about nutrition. It, that's the power of food. It's going to impact the body system wide.

Kara: So true. Love that.

Tackling blood sugar control to reduce symptoms

Leah: Yeah. Yep. So if a woman is really distraught about her weight and midsection, first and foremost, I'm going to tackle blood sugar control. And so this'll tie us back into insulin resistance that we were talking about more towards the top of the show. This is when that insulin resistance, like you said, Kara, is an example of where our cells are not using insulin as effectively as they should in order to clear sugar or glucose from the bloodstream.

So when we start to see shifts in estrogen and some of these hormones that occur in perimenopause, it does actually, this shift causes our metabolism to edge more in the direction of insulin resistance. This results in an easier time, both gaining weight and then things that maybe worked before to help somebody lose weight now just isn't as effective or it's actually not even working at all anymore.

Kara: It’s so interesting too, we talk about this in a lot of our shows that insulin is a hormone. We sometimes call it the master hormone. It's so powerful. So all these hormones, including insulin, are intertwined with progesterone, estrogen and testosterone. And so to counteract this shift that naturally tends to happen towards being insulin resistance and more in a fat storing mode, we want to make sure that the carbohydrates we're eating are from whole food sources as much as possible. So what does that look like? Well, vegetables are a wonderful real food carbohydrates.

Leah: Yep.

Kara: And fruit, preferably lower sugar fruits such as berries, kiwi, melons. And it's fine to have some starchier carbohydrates as well such as white potatoes or red. I like red potatoes.

Leah: Yeah, me too.

Kara: Sweet potatoes, beans and legumes, squash. Maybe some wild rice, brown rice. Quinoa is another great gluten free starch. But it's the carbohydrates that are more processed and more refined, those will tend to spike insulin higher. And we're going to have higher blood sugars and higher insulin, and that can lead to more fat storage. The more processed and refined carbohydrates are going to be things like breads, regular crackers, pasta, cereal, bagels, pastries and muffins. Things like that.

Leah: Yep, absolutely. And I am, I'll chime in there too with those sneaky added sugars also, those can quickly add up if we're not careful. So yeah. Kara, you mentioned some great, some of those more refined starches, but then sugar gets snuck into a lot of these processed foods also, even if they don't necessarily taste sweet.

So I think about ketchup. It's, well someday it'll be summer here around here. So I'm thinking like barbecue sauces. That's a big like grilling sidekick there; salad dressings. You can see some sugars snuck into there. Depends on what you put in your daily morning coffee.

Like that can have some added sugars. Yogurts; man, I feel like that's been a big one with some of my clients lately is trying to get them more into the, the plain flavored yogurts or using some fruit to sweeten that up versus having the food companies do the sweetening for them. Spaghetti sauces are another one. So again, some of these things you don't necessarily taste to be sweet, but they still could have added sugars in them. So I find when I have my clients just focus on getting foods in their more natural whole form, a lot of the extra stuff falls away naturally. So it's, you know, we don't always have to have our guard up for every single little thing.

If we can follow a general principle of real whole food carbohydrates, like you mentioned before, Kara, like, then by default some of the more processed stuff just falls away.

Kara: Yeah.

Leah: Yeah.

Kara: Right. It doesn't have to be overly complicated, I think. And going into it with the mentality of what can I eat to nourish my body and not, oh, all these foods are being taken away from me. Absolutely. Because there's so many things to eat. One of the other pieces to that blood sugar picture is to make sure that the real food carbohydrates that we're choosing, that they're also paired with an adequate amount of protein.

And so four to five ounces is ideal. And if you prefer grams to count over ounces, that's going to be 28 to 35 grams of protein. And then for healthy fat, it really depends on the type of fat. If it's like one or two tablespoons. But we're striving for about 15 grams of added healthy fat.

Leah: Yep.

Kara: And so when we pair our real food carbohydrate with a good amount of protein, that four to five ounces, 15 grams of fat. Those are both going to act like anchors for the blood sugar. So what they do is they prevent the blood sugar from spiking up too high after eating. And that means that our pancreas does not need to work so hard to produce all that insulin to clean up the blood sugar.

Leah: Yep.

Kara: And so what does that look like for women listening? Well, it means that you are not going to be in fat storing mode, and you can go back into a fat burning mode more quickly and remain there for several hours.

Leah: Yep. Yeah, exactly. That's a great translation. Like we avoid some of those big spikes and dips with the blood sugar. It keeps us more even keel with our blood sugar, so then we actually can access our fat stores a lot easier. Yeah, and I've heard that, I've heard people describe that as dressing up your carbohydrates and avoiding naked carbs, so you put protein and fat clothes on your carbs.  

Kara: I like that.

Leah: Yeah, I like it too. I think it's kind of fun thinking about dressing up your, your food in clothes, but hopefully people get the idea like we're, we're not just eating the carbohydrates alone by themselves. We want to pair those anchors of protein and fat to go along with them. And I think honestly women do a good job of this at dinner.

This is a very common one, like you grab a meat, you grab a potato or a different starch and you serve it alongside with some vegetables or a side salad or something like that. That's a perfectly balanced meal right there. You have your protein. You've got some real food carbohydrates with fiber in them with your vegetables, and then you know, a little bit of starch.

Some of the other meals, I think tend to be a little bit more challenging. I think breakfast and lunch, just depending on the client, can be harder to strike that balance if we're not really intentional about it. I just met with a new client the other week and he, kind of that same pattern, like breakfast and lunch were a little off balance, and we were really working on his blood sugar.

That's what he came in for. But dinner was again, spot on with the meat, potato, vegetable type of idea. And I told him, I was like, if I could have you eat that dinner meal three times per day. Like your blood sugars would be rock solid.

Kara: And the three squares, right?

Leah: The three, the three squares meals. Yeah. And then he went on to tell me, oh, he was raised on a dairy farm and that's basically how he ate as a kid at all three meals, 'cause that's just what was available when he was growing up. There wasn't mac and cheese to microwave or corn dogs to cook in the oven or pizza pockets or anything like that. So it's like, great. So you've been there before. We're going to resurrect some of that again.

Kara: Oh, to go back in time. There's so many processed foods we're inundated with now, but we can still work around that. And you know, I think that's a really great reflection on his part. And I agree with you, Leah, that dinners naturally tend to be more balanced. Whether people are sitting around a table together or not, they just often will contain a protein and a vegetable and a starch. And a healthy fat.

A few breakfast/meal ideas

So we thought we would just give a couple examples of other meals that might be a little harder to kind of put together in your head. Like what do I do for breakfast? What do I do for lunch? If it's okay, I'd like to share what I had for breakfast this morning. And my breakfast did have to shift, my plan shifted dramatically when our power went out.

And I didn't have a lot of time. So my two go-tos normally would be a smoothie. Can't use the blender. Or I would scramble up three eggs and you know, I would often add like half ounce of ham, half ounce of cheese, and some sauteed veggies. So in lieu of not being able to use the stove or the blender, I had to get creative.

Fortunately I had full fat, plain yogurt. I had to quickly open the refrigerator, not for too long to let the warm air in and the cold air out, but I was able to gather my full fat plain yogurt. And I added a scoop of vanilla whey protein powder; just to up the protein to get that to the equivalent of about 30 grams. Which is what I like to have for breakfast.

And then I added three quarters cup of frozen blueberries, a tablespoon of ground flax. And a handful of almonds. So no cooking, no blender. It was actually really delicious, and I've had that before.

Leah: Yeah. I love that. I mentioned the yogurt stuff before. That, exactly what you did with putting like a little vanilla protein powder into the yogurt is one way that I try to hook people to doing the full fat plain yogurt, but it's still a way that you can add a little flavor plus some protein into that mixture. So it's not quite as tart as, as just eating the yogurt plain.  

Kara: I do prefer a little sweet, I will say. I mean, I, I can eat plain yogurt by itself. But I enjoy it more in our protein powder that I was referring to is sweetened with just a touch of, I believe natural stevia. So it's, you know, either no sugar or maybe like a half gram of sugar. Very low.

Leah: Right. So those are, I love all three of those examples and I love that you provided an option, like a no cook option also, because that's another, it is another barrier to people kind of getting that, that first meal in, in the morning. So that's all about blood sugar and insulin resistance.

Sleep, its effect on health & how can we support it during perimenopause?

But I do want to talk about another thing that will rock good blood sugar balance, and really, I think this is just kind of savage of nature, but savagely, this is also part of the perimenopause process for many women is if you don't sleep well, your blood sugars are going to be much more all over the place.

You're going to stay in more of that insulin resistant frame. And again, then it makes, not only does it make us cranky, and I'll talk about that in a minute, but it also puts us more in that fat storing mode versus a fat burning mode. We know that people who are under-sleep, it puts you at two to four times greater risk for developing pre-diabetes than somebody who is sleeping seven to eight hours a night.

They've done studies on healthy young men and they've sleep deprived for only three nights in a row, and their blood sugars are already in the prediabetic range. Yeah, it doesn't take long.

Kara: It can happen so quickly.

Leah: It does not take long. So I think about some of my clients that are like, they haven't slept well in years, and it's like, okay, we've got some work to do. So, and I know personally, my brain does not function well on six hours of sleep, and even for me, seven hours gets a little iffy.

So I always try to strive for more like that seven and a half, eight, like eight and a half's a little out of reach right now with, with little kids. But I do really try to protect my sleep with like, at least seven and a half to eight hours. And so I feel like with my clients when they're struggling with sleep as a consequence of perimenopause, like they need help and they need help fast with that.

And I rarely have anybody argue with me about that, which is good. I know Kara, you've had just some of your own unique personal sleep challenges, plus you teach, you've taught our Menopause Solution series. So tell me about like, how would you approach sleep or somebody who comes up to you and says like, I'm not sleeping good. Like, what, what do you got for me?

Kara: Yeah. Again, this is a topic that does come up. Especially when I'm with this, you know, particular group of friends that we're all going through that perimenopausal into menopausal shift but if I have someone coming to me with sleep concerns, the first thing that I would ask is. Okay. Let's figure out what exactly what is the most challenging for you? What part of sleep? Is it the falling asleep that you have trouble with? Is it waking in the middle of the night? And not being able to get back to sleep? Or do you fall asleep okay. And then you are just waking up every couple of hours and kind doing that kind of surface sleep. So it could be a variety of things.

I often hear that women are just waking up very early. Not by choice. But you know, maybe 90 minutes before their alarm is due to go off. And then, you know, if you're human and you look at the clock and you start getting stressed, that's an additional cortisol rush. Which makes it even more challenging to get back to sleep when you're counting how many hours of sleep you have left.

Leah: Yep. Been there, done that.

Kara: I think we all have. It's very frustrating. It could be that the bladder is waking up the woman. Or, you know, let's fast forward into, you know, some other symptoms of perimenopause and especially menopause; hot flashes and night sweats.

That can be very disruptive. It could be that you are snoring, could be your partner is snoring. So there's so many different factors when it comes to not getting a good night's sleep that I would want to explore that. And then kind of like what you do when you're meeting with a client and you're like, let's pick the top two or three things that you want to focus on. I would say let's really pinpoint like one or two ways that we can improve the poor sleep.

Leah: Who would've thought there was so much to sleep? Like you just listed off what, eight to 10 questions that like we might ask somebody about sleep. So it is, it's like we're kind of trying to be detectives and, and nailing down or trying to narrow in a little bit on like what might be actually going on.

And each of those questions just gives us little clues. So could it be that blood sugar is dropping during the night, you know, do you have untreated sleep apnea or, or is it truly really the hormonal chaos of, of perimenopause that's running the show at night? Again, all those questions give us clues as to what's going on.

Kara: Now one thing that I've noticed personally is that balancing blood sugar levels, not just before bed. Which is important. We'll get to that. But balancing blood sugar levels from the minute you wake up and for the whole day can affect sleep that night. And so, you know, if we're eating regularly and we're balancing it with real food protein, carbohydrate, like vegetables and fruit and healthy fat and eating every few hours, that's what we would refer to as balancing blood sugar throughout the day.

And that can help, you know, just to keep blood sugars more balanced at night. Which leads to sounder sleep. And some women find that they, in addition to balancing their blood sugar throughout the day, they do better with a little bedtime snack. Anywhere between, what do you think, Leah? 30 to 60 minutes.

Leah: Yeah. Somewhere around there

Kara: Before bed. That's kind of what I do. And what that looks like is you know, about 20 gram, 15 to 20 grams of carbohydrates. I like to have about a half of an apple and a tablespoon and a half of nut butter. And that would be, that's giving me a little carbohydrate, a full serving of healthy fat. And that can really help to stabilize blood sugar throughout the night and prevent those wake up.  

And that's especially helpful if someone tends to eat, maybe they have the, the old farm supper time. They're eating at 5:00 PM. But they're not going to bed till 9:30 or 10, their blood sugar might kind of start crashing and it could be helpful to have just, just that moderate snack prior to bed.

Leah: Yeah. The peanut butter apple combo is a favorite in our household too. It's just easy.

Kara: Yeah. Or maybe I would say a banana can be pretty high sugary, but a half of a banana. With some nut butter could also work. And scheduling a sleep study, that can also give information and pinpoint whether sleep apnea is a problem. There are also several supplements that can be helpful. They can be calming and they can lower anxiety and balance out sleep disruptions that are, coming from hormonal shifts.

First thing that comes to my mind would be a quarter teaspoon of natural progesterone cream. And that's over the counter. It's not a prescription or anything. It's, it's a low dose. It's basically what our ovaries would produce if they were producing progesterone in a day. About 20 milligrams, I believe. And so that natural progesterone cream, that's been really helpful for, I know for clients it can help to tame hot flashes and night sweats and it can prevent some of those frequent awakenings throughout the night.

Leah: Yep. Yeah. I've had it really improve moods for my clients also. I know we're talking about sleep, but like that's the one thing I've really noticed too, is like, it just helps kind of soothe the edge a little bit if moods or the irritability tends to be a big thing.

Kara: And Leah, another one of my personal favorites. It's a supplement, it's an amino acid called GABA, G-A-B-A. And I've been taking GABA and something called 5-HTP, which is similar to a form of tryptophan. It's five hydroxytryptophan. 5-HTP. I really like that combination. I've been probably taking that for 10 years. It just works. And they're both calming. One kind of the 5-HTP tends to really work on brain chatter. Whereas the GABA tends to work on kind of a physical sense of restlessness.

Leah: Yeah. 'cause in the five HTP is working on the serotonin pathways, both serotonin and GABA, I think of like, those are like your brake pedals. That's like the calm, chill pill neurotransmitters that we have in our brain. So, you know, one might work a little bit better for someone versus the other, but it's, there're definitely options that we want to look at for clients. If they're struggling with sleep, anxiety or kind of like, I call it like monkey brain or the runaway brain, the hamster wheel brain in the middle of the night kind of thing.

Those are solid suggestions. And then, I mean, I always go back to magnesium also, and I know that's always a forefront for most of our counselors here too. I mean, I get that on board with people 90% of the time if they're not already taking magnesium; 200 to maybe 600 milligrams of Magnesium Glycinate at night.

Magnesium's my favorite mineral if I had to pick one. It's such a jack of all trades that it's great for sleep and relaxation and stress relief, but it is also really important for us to help manage our blood sugar, calm some of our cravings, especially for chocolate.

And also if you deal with restless leg or charley horses or muscle cramps or twitchy eyes, anything where you get those "spasmy" kind of muscles. Yeah, like magnesium's so great for that. So I mean, what's not to love about magnesium?

Kara: We're big fans of that in our house.

Leah: There needs to be a supply chain going to your house at all times.  

Kara: So as we close our show today, I just want to reiterate that we did dive deeper into the biology and physiology of what is happening in perimenopause, but we really only brushed the surface of what nutrition can do to help support women through this remarkable transition time in their lives.

You know, weight issues, sleep issues, they're common things that we see in clinic, but there are other symptoms that we just, we don't have time to address in just our 45 minutes.

Leah: Yeah, right. And we've done other shows on Dishing Up Nutrition about perimenopause and menopause. So I really encourage listeners, if this caught your attention or you're just looking to learn a little bit more, go dig back in our archives.

There's some great gems in there. And that is one of the nice things if you search for some of these old shows on our website, you can filter by topic so you can narrow that search down a little bit quicker. And also, Monica's article that we talked about earlier is also on our website and all of this is at weightandwellness.com.

And if you want to hear more from Kara, which I think everyone should check out, the online Menopause Solutions series that she recorded with our colleague, Melanie. And it takes you top to bottom on perimenopause, menopause, and on natural solutions that really work. So for $149, I mean, you get so much amazing information. 

Sign Up For Menopause Solutions – Online!

Kara: Yeah, Leah, you're right. There's a lot of great information in that series and you know. For those who have not gone to our website or aren't familiar with it, I'll just give a very brief snapshot of what is in, it's basically six prerecorded videos that Melanie and I did a few a couple years ago.

And so we kind of start things out with balanced eating and we do kind of what we did today here is identify the different stages of perimenopause, menopause, post menopause. The second class we do a deep dive on solutions for sleep and hot flashes and weight gain. We talk about estrogen dominance and we talk about how nutrition can really help to balance all of these fluctuating hormones and ways to avoid something called xenoestrogens. Which are artificial estrogens.

And then we do cover topics that a lot of women struggle with, such as urinary tract infections, incontinence, vaginal dryness, low libido, hair thinning, hair loss hair in all the wrong places. You know, that's all connected to hormone shifts. We look at bone health, osteopenia.

Leah: That's a big one.

Kara: And osteoporosis can be very big concerns as women get older. And then we wrap it up with some frequently asked questions and even discuss things like wrinkles and very important that we include the brain and we talk about anxiety, depression, moods, and memory. So it's very comprehensive.

Leah: Yeah. It's a great series and well worth the time. If you just have, you know, a couple hours to sit in front of a video and do some learning, it's well worth it.

Kara: And as always, if you would like to sit down and talk with someone one-on-one and get individualized support, just be sure to make an appointment with one of the dietitians or licensed nutritionists, and you can book on our online platform or you can call our office at (651) 699-3438. There's a couple ways to get in touch with us.

Schedule Nutrition Counseling

Leah: And our goal at Nutritional Weight & Wellness is to provide each and every person with practical real life solutions for everyday health through eating real food. It's a simple, yet powerful message that eating real food is life changing. Thank you for listening and make it a great day.