593: Expert insights on thriving in perimenopause & menopause
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Welcome to our second episode of the MBG Compilation podcast series. Every Thursday in May, we're dropping a special episode focused on some of our most popular topics like brain health, strength training, hormone replacement therapy, VO2 max, and more. In each episode, you'll hear expert insights pulled together from some of our listeners' favorite conversations, giving you a quick, powerful look into the topics that matter most for your health and longevity. We'd love to hear what you think of this new format. You just may end up seeing more of them. Now let's get to it.

Menopause is a major transition, yet so many women enter it feeling unprepared, unheard, and unsupported. This week's compilation episode is here to change that. We're bringing together some of the most trusted voices in women's health. Dr. Mary Claire Haver, Dr. Stacey Sims, Dr. Jessica Shepard, and Dr. Lisa Mosconi.

From hormones to muscle mass, brain fog to burnout, these experts break down what's actually going on during perimonopause and menopause, and what you can do to feel stronger, clearer, and more in control. You'll hear the latest science on how to support your changing body through strategic training, protein-rich nutrition, and personalized hormone therapy.

Our guests unpack how these tools can not only ease symptoms, but actually help you build strength, boost brain function, and extend your health span during this pivotal stage of life. Let's get to it.

First up is Dr. Mary Claire Haver, a board-certified OBGYN and a leading voice in the menopause space. She's on a mission to reframe how we understand this life stage, not as a decline, but as a transformation that deserves better care. Dr. Haver explains the biological shifts that begin years before your period actually stops, or the changes that happen after your period actually stops.

what perimenopause really looks like, and why the changes in your body comp, like the increased visceral fat, aren't just about aging, but deeply connected to hormones. Here's Dr. Haver. So let's back it way up. Let's go to birth. Okay, so this is where females and males really differ as far as our reproductive organs. Females are born with all of our egg supply, about 2 million eggs.

Males are born with gonads that create their genetic material fresh every day once they hit puberty, right? We're different. Because we're born with all of our egg supply and that deterioration begins in the womb,

By the time we're born, 2 million eggs. By the time we hit puberty, each month we're losing about 11,000 eggs trying to ovulate. And by the time we're 30, we're down to about 10% of our egg supply. And by the time we're 40, we're down to 3%.

So perimenopause is when your body recognizes something's different, that it's getting harder and harder to produce those sex hormones, harder and harder to ovulate. The brain sending down those stimulating hormones is having to really rev up that process in order to get the ovulatory process to continue.

We start skipping ovulations. Things get delayed. Periods change. So when the body recognizes those changes. So in our 20s, most of us get away with it. Everything's kind of functioning okay. We have enough eggs in reserve to kind of keep the process going naturally. But somewhere in our 30s. So the average age of menopause is 51 in the U.S. That's for Caucasian women. For women of color, you lose about two years on that. Still normal is 45 to 55.

Perimenopause, when our body begins to notice the changes and we start having functional differences,

begin seven to 10 years before the period stops. So if you just do the simple math, somewhere between 35 and 45, something's not right. And what makes it really more puzzling for healthcare providers who, even if they aren't trained, is that that symptomatology can be very, very different from woman to woman. Where one woman, you know, really hot flashes are really cliche, about 85% of patients will have them and you can't really blame them on anything else. Maybe tuberculosis, but that's pretty rare, thank God, you know, for us.

So really the cliche symptoms are the ones that are not easily blamed on something else.

And so mental, usually when women start having increasing depression, anxiety, it's blamed on an underlying mental health disorder. When they start having cognition problems, as you talk with Dr. Moscone, it can get blamed on many other things. Musculoskeletal pain gets blamed on injury. When it's really menopause is the root cause of this, this declining estrogen levels. So there's a lot of studies, there's a lot of contradiction on the actual weight gain. So when we look at

Women traversing time outside of menopause, just all ages, weight gain is a common theme throughout middle age, one to three pounds a year, depending on the woman. However, what is absolutely related to menopause, which is probably really more of a metabolic problem, is where she's gaining weight.

So what we see distinctive to estrogen withdrawal is a new onset of what we call ectopic fat or visceral fat. So that intra-abdominal fat, the fat around the liver, the fat around the pericardium, around the heart, that is new and very much related to the menopause transition. And it also represents increasing risk in chronic disease as far as cardiovascular disease, diabetes, hypertension, stroke, etc.

Now that we've covered what's happening biologically during the menopause transition, let's talk about what you can do about it. Dr. Haver shares the foundational habits she recommends to every woman, covering everything from fiber and blood sugar balance to muscle building movement and managing stress. These aren't quick fixes. They're sustainable shifts that can help you stay strong, energized, and resilient through every stage of midlife. When we look at least at women, and that's really the studies I focus on,

Fiber intake is very important. So at least 25 grams of fiber per day for a woman. Most women are getting about 12 in their diet, you know, because of this complete mindset of calories in, calories out, you know, skinny over strong. If I'm thin, I'm healthy. It's really done a disservice to women.

So fiber intake is so important. You really should try to get your fiber from food. 25 is minimum. Most of my patients really, you know, after a few months will push for 35 or more grams of fiber per day. And studies are showing that women who do that consistently have less visceral fat. Now, why does that happen? Fiber does a lot of things. We know that they're soluble and insoluble fiber.

Soluble fiber is what feeds the gut microbiome, keeps it healthy. That is their food. That is the prebiotic. And if your gut microbiome is well-fed and happy, everything's going to work better. Your mental health, your rest, your glucose. It's really, we feel like the most...

The biggest thing that turns the needle with fiber is that the gut microbiome is happy and healthy and creating the butyrates, which are anti-inflammatory, being fed into the bloodstream. Also decreasing the rate at which your body absorbs glucose and blood sugar from the gut.

therefore lowering your insulin levels. And insulin is one of the main drivers of fat to the intra-abdominal cavity. Just being menopausal, going through the menopause transition, increases your risk of metabolic syndrome, including insulin resistance, by up to 30%.

Simply by the loss of estrogen. So we're trying to combat that with nutrition. Number two, watching your added sugars. Limit those added sugars, sugars added in cooking and processing, not fruits and vegetables. Limiting those to 25 or less, mostly found in drinks and additives and condiments. And, you know, they do have less visceral fat than others.

diets rich in probiotics. One of the best sources in the U.S., at least for probiotics, is going to be yogurt and some of the dairy products. But if you can't tolerate that, you can do kimchi, miso, kombucha, you know, lots of things are fermented. So, you know, focus on fermentation or a supplement. Turmeric supplementation, again, turmeric's not essential, but it can be really helpful because it's such a powerful antioxidant, anti-inflammatory movement.

So moving your body every day, what does that look like? I have to meet my patients where they are. If they're on the couch, let's go for a walk. If you're already walking, let's put on a weighted vest. Let's pick up some weights. So, you know, doing resistance training to hang on to that muscle strength, as well as that zone two cardio seems to be really helpful for visceral fat and things that lower your cortisol, decreasing the stress in your life, the power of meditation and journaling and gratitude. And that has just changed my life.

for the better, you know, really gave me the headspace and the power to be on this menopause journey and be a warrior for menopause. Dr. Stacey Sims, leading researcher in exercise physiology with a focus on women's health, has been instrumental in reshaping how we think about training, nutrition, and recovery for women, especially through different stages of life. Dr. Sims' approach is all about making evidence-based decisions to support women's strength, performance, and

overall well-being as bodies change dr sims breaks down how to adopt training as you enter menopause and post-menopause emphasizing the importance of lifting heavy sprint interval training and adjusting intensity based on where you are in the menopause transition let's hear her thoughts

So menopause is technically just that one point on the calendar that marks 12 months of no periods. After that is postmenopause. So we have early postmenopause, which is around the five or six years right after that one point in time.

And this is where we still want to keep doing what we did with perimenopause, where we're lifting heavy, we're having two to three days of sprint interval training a week. We're really knocking down the amount of low intensity and moderate intensity activity that we're doing, having a higher eye to increasing your protein content. When we start to get to late postmenopause, so that's six years onwards, we see that we don't respond as well.

to the high intensity work. So what we need to do is we need to have more doses, more regular doses of high intensity, more regular doses of resistance training, but less volume. So what I mean by that, instead of having two days of 30 minute session of sprint intervals, you're having four days of 15 minutes.

So you're splitting it up. So you're having more regular but shorter doses of that. And the reason for that is we've completely lost any kind of sensitivity to any estrogen or progesterone because our receptors are like, there's nothing there. So again, we need to look at what are we doing? We need to have regular doses of this high intensity and resistance training to

to keep lean mass going, to keep vascular compliance, keep our blood pressure in check, to keep our bones going strong and our proprioception and our cognition. So it's a little bit of a range of where you are on that menopause scale, that postmenopause scale. So you have a little bit more play early postmenopause with what you're doing. But when you get into later postmenopause, that's where you really have to

Now look and say, I need to do my high intensity and resistance training almost every day doing something, but a short amount of time.

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What about, you know, another hot topic, building, maintaining lean muscle mass? How are women different? This is another hormone profile thing. So when we're looking at

pre-menopause, we can look at doing more hypertrophy stuff and get your 10 to 12 reps, three sets, the traditional kind of work. We know that there is a recovery time difference between men and women because women are more endurant. So they need less recovery between sets than men. But as we start getting into perimenopause and postmenopause, and we lose estrogen and estrogen is women's testosterone with regards to building lean mass.

Then we have to look at stimulating through a, like I said earlier, a central nervous system response. And I say that because estrogen is responsible for how strong a muscle contraction is, how fast that muscle contraction is, as well as how lean mass is developed. So if we take away estrogen, then we lose a satellite cell response. So we're not getting necessarily signaling to build lean mass.

We're also losing the ability for our two major proteins to bond together and create a very tight contraction. So that's our strength. And we're also losing the amount of the neurotransmitter responsible for nerve impulse.

So if we do a central nervous system response by lifting heavy, so we're doing our three to five reps, we're doing three to five sets of that. We're having around three minutes recovery in between. So heavy is 80% or more of one rep max.

This is where we have the central nervous system go, oh my gosh, we have a heavy load. So we have to make sure we can stimulate those muscles, do it quickly, do it strongly. And we also need to build and or maintain the lean mass we have in case we have to overcome this load again.

And women have a really, really difficult time putting on lean mass and keeping it on as they get older. So it's super, super important to get that central nervous system response as well as follow it up with a good dose of protein. So on that note, protein...

What is your view on protein needs for women and also timing before or after working out? So protein in itself is one of those, I feel like everyone's under-proteined. And we look and the current recommendations are really low. So what I want women to understand is when you look at the RDA for protein in the States,

It is based on sedentary older men. And the reason why they did that is because they're like, oh, it's around the same body composition as a 20-year-old woman. And it's based on the minimum amount of protein that you need not to be malnourished. But as soon as you start adding activity and younger muscle in, we know you need more.

So we do have the research to back it up to show that women who are recreationally active, who are premenopausal, need minimum of 1.6 to 1.8 grams per kilogram of body weight. So that's about 1.2 to 1.4 grams per pound of body weight. So it's up there.

When we get into peri and postmenopause, it's closer to that 2.2 to 2.4 grams per kilogram. And when we're talking about timing, super important to get it in post-exercise because women's bodies come back down to a baseline level a lot faster than men. And we see that 30 grams in premenopausal tends to be the sweet spot to continue muscle protein synthesis for up to 24 hours.

and 40 grams in late peri and postmenopausal women. So it's a far cry from that 20 grams that circulates.

Now let's turn to Dr. Jessica Shepherd, a renowned OBGYN, author, and expert on women's health, particularly around the menopausal transition. She's passionate about empowering women to feel their best throughout their lives with a focus on nutrition, fitness, and hormonal balance. Dr. Shepherd shares her insights on why menopause is often misunderstood and the importance of fueling the body properly. Plus, she'll cover the key factors that impact women's quality of life as they age.

Why do you think this transition in many ways is misunderstood? I'm so glad you started that there because I think that there's so much that presents this implication of

Misunderstanding is because of societal norms of what is a woman's worth after she's passed a certain age? What are we willing to do when she starts to have symptoms or conditions that decrease her quality of life? And we don't place importance on the value of women and who they are in improving their quality of life.

then that's where we do have the issue. And so the more that we suppress women in the understanding of what they can accomplish and how they can feel better, then that's going to be the message that they're going to take for themselves and follow along with that. So the narrative itself needs to change tremendously.

And that is where we are going as we start to talk more about empowering women to feel better through these transitions of perimenopause and menopause, but also truly understanding that they don't have to suffer. I think we did Women Such a Disservice, you know, a decade or so ago, it was about, you know, cleansing and detoxing and dieting. And it was this, you know, scarcity mentality, if you will, is about eating, eating less and withering away and running on the treadmill. And now it's about, you

no, you need to eat more protein and you need to lift. And no, you're not eating enough. No, you don't need to lose weight. We need to do a body recalb.

And that's just so empowering because who the hell wants to starve themselves and not eat anything? I remember, you know, back in my 30s, you know, like the whole diet culture. At some point, every woman has tried a diet. I tried to do a carb-free diet for a week. And I am sure there are some people who are like, you are the most horrible person right now. And I was like, you are right, but I'm not having any carbs. Yeah.

And the other thing that I would say is exactly what you just said is changing the mentality of women understanding why it's important to eat more. But what are you fueling when you're eating yourself and changing that? But estrogen receptors are all over the body. I know I said it earlier, but in addition to when we think of skeletal muscle, estrogen receptors are in with our actual muscle. So there is going to be a direct role between estrogen and skeletal muscle. And as we start to decrease our muscle mass,

and not having estrogen as well, there has to be some way that we are going to increase our muscle mass. Even, I mean, if you're taking estrogen, that's going to be helpful. But if you're not, we still have to substantiate that skeletal muscle mass, the muscle function, but also muscle strength, because that's what's going to solidify our bones.

which also take a hit during the menopause phase because of estrogen. If you were to take the three main things that I would say as women start to age that really limit their longevity and quality of life would be muscle mass. And so that's going to be with decrease in bone. So fall and break a hip.

The mortality rate after falling and breaking a hip is in the 1670th percentile. So quality of life decreases, but you also have a really increased risk of just dying after that type of injury. And then what's the number one killer of women worldwide? Heart disease. And heart disease is usually what we see again with women in the menopausal phase. Because why? Estrogen. And then the other thing is diabetes.

Our brain, our brain has estrogen receptors as well. And now we are seeing studies, you know, Dr. Lisa Moscone, she actually contributed to the book Generation M, but also has a book called The Menopause Brain.

And there is amounts of study that are now giving us direct correlation between dementia, which if you think of all dementia cases, 70 to 80% of them are women, is a direct correlation because of the loss of estrogen. So now you have three things with later on in life that are clearly, clearly related to estrogen decline. So again, estrogen rules.

And that's the perfect segue into my conversation with Dr. Lisa Moscone, a leading neuroscientist and certified integrative nutritionist and holistic healthcare practitioner, especially in relation to menopause. Dr. Moscone explains why menopause symptoms often begin in the brain and not the ovaries and how these neurological changes can affect everything from memory to mood. Let's dive into it. So what are some of the things that are happening if this starts years before 49, you know,

Maybe we start in our 30s. Can you walk us through what's happening in the brain in 30s, 40s, 50s, 60s and beyond? Everything is fine until you hit one of these very important transition states, which I call the three Ps. Puberty, pregnancy, perimenopause, which is a transition to menopause. Those are neurologically active states.

It means that your brain is just as impacted by these processes as much as the ovaries are. We're just not used to thinking about that as a neurological process or something that impacts your brain as well. So that is important to know because a lot of women are really scared now.

of menopause. They're really confused. They don't know what's hit them. They don't associate the symptoms with the process of going through menopause, in part because they feel like, I'm not old enough to be going through menopause. I'm in my 30s. I'm in my 40s. What is this? It's actually menopause. It's a process that takes many years that impacts your brain in ways that are subtle

but consistent. And you may have seen some of the symptoms as you go through puberty or pregnancy as a woman. They're just stronger, sometimes more severe as we go through menopause. So when women say that they're having hot flashes, nice sweats, insomnia, depression, anxiety, brain fog, brain fog is a huge concern, memory lapses,

Those are symptoms of menopause that don't start in the ovaries, they start in the brain. Those are brain symptoms that are triggered by the way that menopause changes the brain. While menopause is often seen as a daunting experience, Dr. Mary-Claire Haver shares a powerful message that captures the essence of navigating menopause with empowerment and confidence. Here's her final takeaway that will leave you thinking differently about this life transition.

So let's say you've got a billboard. It's on the freeway. On this billboard, you could put any short message. Maybe it's a mantra, maybe it's a quote, but this is your opportunity to spread your message. What would be on your billboard? Menopause is inevitable, but suffering through it is not.

From the role of hormones in our health to the importance of strength training, nutrition, and mindset, it's clear that menopause can be a period of positive change, not just a challenge. As we've learned today, while menopause is a natural part of life, suffering doesn't have to be. Keep educating yourself, stay empowered, and approach this phase with strength and confidence.