How to Hack Your Hormones and Use Science to Lose Weight and Sleep Better | The Mel Robbins Podcast

Mel Robbins 0:01 (ticking sound) Today is a conversation for all of us. We are talking about the big M and the big H, menopause and hormones. Hormone changes in women affects half of the population, and there is so much misinformation flying around the internet, I thought, "I have to have a conversation about this." And I wanna have a conversation with you and a medical doctor. That's what we're doing today. (upbeat music) Hey, it's your friend Mel, and welcome to The Mel Robbins Podcast. All right, I have been wanting to do this episode for such a long time. What are we talking about today? Well, we are talking about the big M and the big H. What is that? We're talking about menopause and hormones. And no, do not touch that off button, everybody needs to hear this, hormone changes in women affects half of the population. And so, I don't care if you are in the stage and the age where you feel bitchy and itchy and dry and hot and your hormones are all out of whack, or if you're living with somebody who is going through that, today is a conversation for all of us. The first time I saw a woman have a hot flash was about 30 years ago. My parents were throwing Chris and I a, um, like, an engagement party at their house in Western Michigan, and I'll never forget this. My mom and I were standing there talking to one of my mom's best friends. I love this woman, I'm not gonna say her name because she would be mortified if I said her name, and so I'm gonna respect her privacy, but I'm sure you're listening and you know who you are and know that I love you. But we were standing there and we each had, like, one of those fancy paper plates, you know, the stiff kind, and we had helped ourselves to the buffet, and we're talking. All of a sudden, out of nowhere, this friend of my mom's flushed bright red and water started dripping down her face. And this particular friend of my mom's is the kind of friend that was always impeccably dressed, like she just looked like a Chanel ad every time she walked into a room, and so I could tell she was mortified. Her makeup foundation was starting to run, and she took her plate and started fanning her face. And I said, "Are you okay?" I mean, I

Mel Robbins 2:27 thought she was having a heart attack, but she said, "No, no, no, I'm just..." (blowing) and she blew her... (blowing) "I'm just having a hot fla- hot flash. It's just so awful." And my mom kinda looked at me and said, "Oh ho ho ho, just you wait. Just you wait, Mel." Well, I have been in the hormonal change for probably six years, and I'm embarrassed to tell you, I know about as much about menopause and hormone fluctuation in women and in girls as I did 30 years ago, which means I know jack shit. And there is so much misinformation flying around the internet, I thought, "I have to have a conversation about this." And I wanna have a conversation with you and a medical doctor, somebody who understands this. We're not gonna be getting our menopause tips on TikTok, people, we're talking to a doctor about what is going on in our bodies. We are gonna cover everything from PMS to hormones in women to what to expect when menopause hits, and the thing that everybody that I know is bitching about my age, which is the bread basket that develops in the middle. That's what we're doing today. And who have I asked to guide us through the land of menopause and hormones in women? None other than Dr. Amy Shah. That's right, Dr. Amy Shah is a double board certified doctor. She did her training in nutrition from Cornell, she did her residency at Harvard, she got a fellowship in Columbia. She is an expert on hormones. In fact, her runaway bestseller, I'm So Effing Tired: Yes I Am, Sister!: A Proven Plan to Beat Burnout, Boost Your Energy, and Reclaim Your Life. Dr. Amy Shah is back by popular demand, and by my begging, because I wanna understand what is going on with my hormones. Dr. Amy, welcome back.

Dr. Amy Shah 4:23 What an honor.

Mel Robbins 4:23 (laughs)

Dr. Amy Shah 4:23 Thanks, Mel.

Mel Robbins 4:24 You're welcome. So, I loved your book, I'm So Effing Tired. Title's fantastic, by the way.

Dr. Amy Shah 4:30 (laughs)

Mel Robbins 4:30 Because I do feel effing tired, and it's a proven plan to beat burnout, boost your energy, and reclaim your life. And what I really wanted to talk about, because when I hear the word tired, I think about two things. First of all, I think about how everybody I know feels burnt out, and I wanna talk about adrenal fatigue, but I also wanna talk about menopause, the big M.

Dr. Amy Shah 4:57 The big M.

Mel Robbins 4:58 The big M. I am gonna be double nickels 55 this year. I am in the thick of it, and I would love to talk to you about what the fuck is going on with our hormones and our bodies, and why isn't there more information? I mean, it affects

Mel Robbins 5:15 half of the population, for crying out loud. So where do you wanna start, Dr. Amy?

Dr. Amy Shah 5:19 Uh, I think the menopause conversation needs to be had, and much more commonly and much more openly. Most women go through this time of life and they have no idea why their anxiety level has increased, why their energy has decreased, why they feel like there's a brain fog. People will present with, um, ear itching, body itching. People will s-

Mel Robbins 5:45 Wait, that is something that's...

Dr. Amy Shah 5:47 That's part of menopause.

Mel Robbins 5:48 It is?

Dr. Amy Shah 5:49 Yes.

Mel Robbins 5:50 That explain... Body itch-

Dr. Amy Shah 5:52 Yes.

Mel Robbins 5:52 Did you just see me as we were walking up?

Dr. Amy Shah 5:53 (laughs)

Mel Robbins 5:54 I was itching my back as if, like, I'd just been bitten by a mosquito. Why does your body... I- I- I'm gonna hijack this conversation so fast.

Dr. Amy Shah 6:01 (laughs)

Mel Robbins 6:01 So keep going with the weird ass symptoms.

Dr. Amy Shah 6:04 Yeah, it, uh, the biggest, I think the biggest symptoms that people feel is the brain fog.

Mel Robbins 6:09 Yes.

Dr. Amy Shah 6:09 That happens-

Mel Robbins 6:10 Yes.

Dr. Amy Shah 6:10 ...with menopause, and the mood changes. Um, the, the feeling of, um, hot-And then- (laughs)

Mel Robbins 6:19 (laughs)

Dr. Amy Shah 6:19 ... colds. You know, the hot flashes and then the sudden change in temperature. Like, what is happening? Why are we feeling like this? And we don't have the conversation enough and so everybody's kind of feeling like they're going crazy.

Mel Robbins 6:31 Yes.

Dr. Amy Shah 6:32 And one of the biggest complaints, and I know that we'll pr- touch on this, is the increase of fat around the middle.

Mel Robbins 6:41 Yes.

Dr. Amy Shah 6:41 So brain fog, fatigue, the increase in fat, especially around the middle, and all of these weird symptoms all have to do with your changing hormones.

Mel Robbins 6:53 Okay. You're gonna have to break this down for us-

Dr. Amy Shah 6:55 Yes.

Mel Robbins 6:55 ... because the conversations that I'm having with my girlfriends, it's all about the fact that we're going through this metamorphous. I feel totally out of control. The last time I felt like this in my own body was when I was going through puberty and I started to get b- you know, first you get those, like, knots or whatever they're called-

Dr. Amy Shah 7:17 Yeah.

Mel Robbins 7:17 ... bumps or whatever they are.

Dr. Amy Shah 7:18 Yeah.

Mel Robbins 7:18 And then you get the boobs, and then hair starts to grow in places that is scary-

Dr. Amy Shah 7:22 (laughs)

Mel Robbins 7:22 ... and then hilarious, and then you're just living with it. I didn't feel that way about pregnancy when my body was changing because I was so excited about it.

Dr. Amy Shah 7:31 Yeah.

Mel Robbins 7:31 And because there is so much written and that you can read about pregnancy-

Dr. Amy Shah 7:35 Yes.

Mel Robbins 7:35 ... and it's so celebrated, that you kinda know what to expect, even though when it's your first time, it feels so foreign. But this feels so out of control. And I also am glad that you're here because when you sa- because I know it's also a really frustrating time for the people who know and love us, because it's not just the hot flashes. I have hot flashes in my mood. Like, I will swing from happy to bitchy-

Dr. Amy Shah 8:04 (laughs)

Mel Robbins 8:05 ... like a kitchen door swinging.

Dr. Amy Shah 8:07 (laughs)

Mel Robbins 8:07 It just goes from one to the other. And so, how do we start to... Should we start with understanding what's going on?

Dr. Amy Shah 8:15 Yeah. Well, first of all, let's just understand the fact that we don't talk about it en- enough. In medical-

Mel Robbins 8:21 True.

Dr. Amy Shah 8:21 ... in the medical sense, we talk about it all the time with our friends-

Mel Robbins 8:25 Yep.

Dr. Amy Shah 8:25 ... and colleagues. I mean, your conversations with your friends and my conversations with my friends match. It's menopause, menopause, menopause all the time.

Mel Robbins 8:33 Right.

Dr. Amy Shah 8:33 Right? Because we're all trying to figure out what's going on with our bodies. We're trying to help each other-

Mel Robbins 8:38 Yep.

Dr. Amy Shah 8:38 ... uh, because we don't have enough guidance. It's not like pregnancy where you can say what to expect when you're expecting on day 22. You know?

Mel Robbins 8:45 Yes.

Dr. Amy Shah 8:45 That kind of thing.

Mel Robbins 8:46 And, and one other thing I will point out is that you read all this stuff, and we now know that the studies were largely wrong-

Dr. Amy Shah 8:54 Yeah.

Mel Robbins 8:54 ... about hormone replacement therapy.

Dr. Amy Shah 8:56 Yes.

Mel Robbins 8:56 And I went to three different primary care doctors that were holistic doctors in the Boston area and asked about bioidentical hormones, and not a single one of them could refer me to anybody. And so I also feel like there are a lack of resources that are accessible to women-

Dr. Amy Shah 9:17 Yes.

Mel Robbins 9:17 ... in terms of understanding what the fuck to do. But I guess we should start with-

Dr. Amy Shah 9:21 (laughs)

Mel Robbins 9:21 ... what the fuck is going on?

Dr. Amy Shah 9:23 Exactly. And the problem is, is that in our lifetime, I think you and I are similar in age, pretty similar, and I was in school when they actually mandated that women be included in medical studies.

Mel Robbins 9:40 Wait, what?

Dr. Amy Shah 9:42 Women-

Mel Robbins 9:42 They had to mandate?

Dr. Amy Shah 9:44 Women were excluded from all medical studies because their fluctuating hormo- you know, our fluctuating hormones or the fact that we could be pregnant during a time of a trial. And so every medication, every intervention, every surgery, everything was done only on men.

Mel Robbins 10:05 Well, I knew that about the ADHD studies-

Dr. Amy Shah 10:08 Mm-hmm.

Mel Robbins 10:08 ... in the 19- late '70s-

Dr. Amy Shah 10:10 Yeah.

Mel Robbins 10:10 ... and why ADHD has been misdiagnosed at profound levels for women, because they only studied boys. I had no idea that all of the medical studies related to the effect of-

Dr. Amy Shah 10:24 Anything.

Mel Robbins 10:24 Uh, anything?

Dr. Amy Shah 10:25 Anything.

Mel Robbins 10:25 What the f- Why are people not talking about this?

Dr. Amy Shah 10:28 I know.

Mel Robbins 10:28 How do we even know then whether or not the side effects of something-

Dr. Amy Shah 10:32 Are the same.

Mel Robbins 10:32 ... are gonna impact us versus the way they impact dudes?

Dr. Amy Shah 10:35 In fact, what they realize is, what they were just doing is they would just, um, prescribe a smaller dose to women-

Mel Robbins 10:42 Sort of like a golf tee-

Dr. Amy Shah 10:44 Yeah. (laughs)

Mel Robbins 10:44 ... that's closer to the green.

Dr. Amy Shah 10:45 Yeah. (laughs) It's like they didn't even know. They didn't know anything about the biology of women, but they just said, "Well, let's just give them a little less. Um, they're just smaller, you know, than men," and thinking that medications are gonna affect us the same way as they would've in, in men." And that's why women feel like they are the forgotten gender when it comes to healthcare.

Mel Robbins 11:10 Wow. So what year was this in medical school?

Dr. Amy Shah 11:13 I, I think it was in the, I think it's the '80s where they had to mandate that women be included in all studies.

Mel Robbins 11:20 Wow.

Dr. Amy Shah 11:20 Yeah. And then, on top of that, what they weren't doing, and they still don't do, is they weren't seeing the impact on hormones, um, and what women are calling out, doctors are calling out. They're saying, "All right. You're studying. Now you're forced-"

Mel Robbins 11:37 Right.

Dr. Amy Shah 11:37 "... to include women-"

Mel Robbins 11:38 Right.

Dr. Amy Shah 11:39 "... but you're not actually seeing what the impact is on our hormones, if any. And maybe there's no impact, but why not look at what's happening when you're taking medication X? What's happening to the estrogen, progesterone, the test- testosterone? Isn't, there's no data."

Mel Robbins 11:56 Well, if you think about women and the fact that estrogen is like a, just controlling and essential hormone as part of the whole network of the way that we function as women, the monthly cycle that we have, I- I can't, uh, I mean, I can't believe that they're not looking at the impact on hormone levels.

Dr. Amy Shah 12:21 It's-

Mel Robbins 12:21 That's kind of scary, honestly.

Dr. Amy Shah 12:22 It's a shame. In fact-When I was a young mom, uh, I had two, my kids were one and three, and I was par, out of the por, post-partum range.

Mel Robbins 12:35 Uh-huh.

Dr. Amy Shah 12:35 And, but I felt so out of control. Like, I felt burned out but then I couldn't sleep, my hair was falling out but my thyroid levels were fine, and I was so confused about my hormones. So I thought maybe I just didn't pay attention to that part of medical school, or-

Mel Robbins 12:49 Right.

Dr. Amy Shah 12:49 ... maybe I just didn't, you know. So I went to the hormone experts, so-called OB/GYNs, my colleagues who were specialized in women's health or women's-

Mel Robbins 12:58 Right.

Dr. Amy Shah 12:59 And they said to me, "Oh, we didn't learn about that either."

Mel Robbins 13:02 (laughs)

Dr. Amy Shah 13:02 "We learn about (laughs) pregnancy, we learn about puberty, and then it's, the, all you learn about menopause is that it just shuts off and that's basically all we know." And so I said to myself, "Well, that's really sad because at least half of the population is women."

Mel Robbins 13:21 Yeah.

Dr. Amy Shah 13:21 And if doctors can't even know, if they don't even know what's going on then-

Mel Robbins 13:26 Right.

Dr. Amy Shah 13:26 ... how are women gonna know what's going on? So-

Mel Robbins 13:28 So what do you want us to know in terms of the 101?

Dr. Amy Shah 13:31 All right. Let me tell you. It's like, the best analogy is, like, two sisters.

Mel Robbins 13:38 Okay.

Dr. Amy Shah 13:38 Okay? Estrogen is your social, um, and she's super smart, she's super social, um, she is outgoing. Uh, she can be a little bit risk-taker.

Mel Robbins 13:50 Uh-huh.

Dr. Amy Shah 13:51 Um, she can be a little bit out of control.

Mel Robbins 13:53 Got it.

Dr. Amy Shah 13:54 Then you have the sister, the progesterone sister.

Mel Robbins 13:56 Okay.

Dr. Amy Shah 13:56 She's very calm, level-headed. She knows when the other one's, like, kinda going off the rails.

Mel Robbins 14:03 Yeah.

Dr. Amy Shah 14:04 She's the one that kinda keeps you at home-

Mel Robbins 14:07 Uh-huh.

Dr. Amy Shah 14:07 ... says, "No study toni- you know, stay at home."

Mel Robbins 14:09 Yep.

Dr. Amy Shah 14:10 "Let's just chill." Um, she's the one that, um, keeps you calm.

Mel Robbins 14:15 Okay.

Dr. Amy Shah 14:16 Okay? So when we're going through menopause, we are getting less estrogen and less progesterone so you're starting to feel like you're not as sharp, you're not as, you're not taking as many risks, you're, you're not as social.

Mel Robbins 14:35 Yep.

Dr. Amy Shah 14:35 Um, your level of estrogen is going down.

Mel Robbins 14:38 Gotcha.

Dr. Amy Shah 14:38 You might not have the energy levels.

Mel Robbins 14:40 Yep.

Dr. Amy Shah 14:40 You might not feel like doing the things you used to do. Your activity level might go down just without even realizing it.

Mel Robbins 14:47 Yeah.

Dr. Amy Shah 14:47 You're just sitting more.

Mel Robbins 14:49 Uh-huh.

Dr. Amy Shah 14:50 As progesterone goes down, you start to get more anxious. You start to feel like you can't sleep. And you start to feel like your life is out of control.

Mel Robbins 15:03 Wow.

Dr. Amy Shah 15:04 And so what you're noticing-

Mel Robbins 15:06 Is this also why I'm waking up in the middle of the night?

Dr. Amy Shah 15:08 Yes.

Mel Robbins 15:09 The drop in estrogen and progesterone-

Dr. Amy Shah 15:11 And progesterone.

Mel Robbins 15:11 ... is why I'm not sleeping through the night?

Dr. Amy Shah 15:13 Yes.

Mel Robbins 15:14 I thought it was 'cause I had to go to the bathroom, but it's probably because of the hormones?

Dr. Amy Shah 15:17 Yes. Yes.

Mel Robbins 15:18 So Dr. Amy, talk to us about women's hormones throughout her lifetime. What do we need to do to optimize our life throughout every one of these

Mel Robbins 15:29 stages that women go through from puberty to menopause?

Dr. Amy Shah 15:33 Yeah, that's a great question. So women start their hormonal cycles, uh, at puberty. And so you basically see a big surge of hormones and all the aftermath that happens with it, um, from, you know, periods to breast development to, um, uh, body fat distribution changes. There's all kinds of, um, brain changes that happen, um, during puberty and, um, it's, the hallmark is, is the period.

Mel Robbins 16:07 Mm-hmm.

Dr. Amy Shah 16:08 And when you start that period, from then till menopause, every month you have a cycle. And I think what people, what I (sighs) , it's a pet peeve of mine, is that women often aren't even taught what their cycle is and what to expect and how to manage it because you just go through life thinking it's just an annoying period, but you don't really learn anything more about it. So the first day of your period is a very momentous day. It's the start of your 28-day cycle. And the reason why I think it's important for us to understand is that you're starting basically when you shed the lining of your, um, uterus, that's your period, you're starting over. So now from day one of your period all the way till day 14 you get a rise in your hormones, and if you don't get pregnant, then you're gonna get a fall in the hormones.

Mel Robbins 17:09 Get a fall in what hormones?

Dr. Amy Shah 17:11 Estrogen, um, rises, um, throughout the first part of the cycle and progesterone actually rises too. They have, they're kind of different peaks and, um, but they do and testosterone has a little spike closer to ovulation, so day 14. But what's really, um, the interesting part is that at the latter half of your cycle, if you don't, if you're not going to be pregnant, so most months you're going to be experiencing a little, a fall in your hormones. And I think it's really important for women to realize that you can train and eat and fast and live differently throughout those different changes of your hormones to match what's happening. So from day one through day 14 when your estrogen and progesterone levels are getting higher and climbing especially towards that day 14, you're gonna feel more energetic, you're gonna be more stress resilient, you're gonna be able to do more workouts, you're gonna

Dr. Amy Shah 18:15 be... So I always talk about that a- time as like train like an athlete, eat like an athlete. Eat more, train more, energy levels are good, stress levels are good. This is the time to try out intermittent fasting or just kinda like that, um, time-restricted eating that I was saying, like, no, no food two to three hours before bed and, um, try things out.

Mel Robbins 18:34 Mm-hmm.

Dr. Amy Shah 18:34 ... a- at the ladder half of your cycle, especially that one week before the period, so day 21 through 28, so it's called the late luteal phase. So the latter part of the luteal phase, when your hormones are really dipping down there, the kinda mini menopause column.

Mel Robbins 18:52 Mm-hmm.

Dr. Amy Shah 18:52 That's when you pull back on the very stressful activities, you pull back on, um, eating lots e- uh, like maybe you're eating a lot more treats or sugar, carbohydrates, um, in the first half of the cycle. That's when you wanna pull back a little bit.

Mel Robbins 19:07 Mm-hmm.

Dr. Amy Shah 19:08 You want to, um, realize that your body is less stress-resilient, so maybe this is not the time to take on all the projects and to be skimping on sleep and to be working out excessively and to be adding the intermittent fasting for the first time. Like, you don't want to be, um, testing your stress resiliency at this time if possible, 'cause according to your own cycle, this is the time that you're going to be least stress resilient, also gonna be more insulin resistance, uh, resistant, which is why I said to maybe come down f- um, on the sugar and the carbohydrate level-

Mel Robbins 19:42 Mm-hmm.

Dr. Amy Shah 19:42 ... start to eat more fiber and protein, um, to keep yourself fuller. And so, when you understand that, you're like, "Oh, well, that makes sense. I naturally don't feel like doing my high-intensity workouts the, you know, the final week of my period." Or, you know, you wanna, um, get more sunlight or more massages or more walks, and like that's a way to manage the last, um, f- like week of your cycle.

Mel Robbins 20:09 Mm-hmm.

Dr. Amy Shah 20:09 So from the time you hit puberty to the time you go into menopause, you have these monthly cycles, so I think it- it's imperative for us to learn them and to learn how to optimize them. So when we know that there's a testosterone burst in the middle of the cycle, like around day 14, if you're trying to build muscle, if you're trying to do something that requires a little more confidence and bravado, maybe it's asking for a raise, maybe it's doing that thing that you're really scared to and you can- you have some ability to schedule that, the mid-cycle time is the time to do it.

Mel Robbins 20:46 Wow. This is so interesting. You know, if we were all clued into this, in terms of how to optimize your energy or your focus during certain stages of your cycle, and if we knew what really worked for our bodies from a younger age, by the time we get to menopause, we wouldn't have to have the discussions that we're having today. I mean, it's kind of lame that as a 54-year-old woman, I'm still going, "What the fuck is going on with my body?"

Dr. Amy Shah 21:12 Exactly. The problem is, is that the more- the- the world is a man's world, at least the medical research world, because that's what we've researched. And so because we don't have enough research on this topic-

Mel Robbins 21:27 Mm-hmm.

Dr. Amy Shah 21:28 ... it's almost like, well, where's the research that says that there is a, you know, a d- this happens in women? We don't have 10,000 women studies where we look at their cycles and we look at menopa- I mean, we need that. We need that data, so we can say, "Hey, if you are trying to optimize your muscle mass, um, you should be training hard in the middle of your cycle." Like w- where are those studies? Where is the data, so we have a toolbox? So instead of speaking in a hypothetical sense, in the physiological sense, we have hard data like we have for other things.

Mel Robbins 22:05 That makes a lot of sense. So a woman goes through puberty, she gets her menstrual cycle, and then what happens when somebody gets pregnant? What happens to the hormones then?

Dr. Amy Shah 22:18 So basically what happens is if at ovulation, the egg gets fertilized, the hormones stay high. They don't drop to let the lining shed.

Dr. Amy Shah 22:33 So as the hormones, they stay high, you get uh, obviously hCG, people know this because this is the one hormone that actually rises during early pregnancy, you get h- um, and that's what you check when you pee on a stick is the hCG levels are in the blood, you can check the hCC- that's the hallmark that says, "Oh, the body knows that you're pregnant and has released hCG, um, because y- uh, it's- there's been an implantation." And so you don't get the whole last part of your cycle that you usually do. There's no late luteal phase, and there's no PMS. Your hormone levels stay high, you know, at- at those levels, um, for the duration of the pregnancy. And then when you have the baby, um, it can take a few months actually to normalize. There's some fluctuations, but then you'll go back to having kind of that, uh, approximately 28 day to 32 day cycle, um, with the rise and fall of hormones.

Mel Robbins 23:33 And then there's perimenopause. I guess this is like the warmup for menopause. I mean, what happens there?

Dr. Amy Shah 23:38 Perimenopause is your estrogen and progesterone are at the bottom, uh, are getting low. So if you've ever had toothpaste, like a tube of toothpaste, when you kind of get to the end of the toothpaste, sometimes you press on it and you just get a splatter, and sometimes you just press on it and you get a full squeeze of toothpaste, and sometimes you press on it and you get nothing. And so that's what's happening during perimenopause. Some months you're getting a good dose of estrogen and progesterone and you're almost feeling like you're normal, and other months you have a low level and you're getting all these symptoms, and some months are- you're feeling absolutely terrible because your hormone levels are super low. And so you can have a lot of fluctuations during this time where it's- that's perimenopause. Basically, you're getting to the end. Menopause is there's nothing left. Your levels are very low. Um, you're not ovulating anymore.

Mel Robbins 24:42 Mm.

Dr. Amy Shah 24:43 And so...The years of perimenopause can be long, confusing, and variable-

Mel Robbins 24:52 Mm-hmm.

Dr. Amy Shah 24:52 ... based on what's happening. So one of the things that people talk about is hot flashes, and the reason why hot flashes happen is one of the roles of your hormones is to tell your brain center, your hypothalamus, your temperature center, um, what to do, like how to, uh, regulate our temperature. So that month, if you just get a splatter of estrogen or you get none, um, you get dysregulation of that central thermostat. And so now you're hot, you're sweating, and you get these, um, peaks and valleys of temperature. And so that's how I would describe perimenopause, and that can happen for multiple years, and that's why there's treatment now. Like, there's things you can do. Um, hormone replacement therapy is really good for, um, that kinda hot flash temperature dysregulation, um, that seems to help. And so you have all that, and then you hit menopause, and menopause, the definition is no menstrual periods, uh, so no ovulations for 12 months. And f- so full year goes by, you don't have fluctuations anymore, you're just at low levels. And so for women, um, often the at five to 10 years after menopause, they are able to now kind of get acclimated to the no hormone state.

Mel Robbins 26:14 Mm-hmm.

Dr. Amy Shah 26:14 So it seems like the fluctuations of the hormones are c- wreaking havoc on our brain and our body, but then once you kind of normalize at a lower level, about five to 10 years, you seem to have a reprieve of the symptoms, so you're no longer getting the hot flashes, you're no longer having, um, some of the menopausal symptoms. No menstrual period for 12 months.

Mel Robbins 26:38 Okay.

Dr. Amy Shah 26:38 Okay? But the drop in estrogen and progesterone that we're talking about here happens up to 10 years before menopause.

Mel Robbins 26:47 Wow. So you know what's interesting is that I started to see a big spike in sort of fogginess and feeling like something wrong, probably like in my, I'd say early to mid-40s.

Dr. Amy Shah 27:03 Yes. That's very typical. So it can be as early as 35 for people who are going through menopause a little bit early, but-

Mel Robbins 27:09 Uh-huh.

Dr. Amy Shah 27:09 ... usually in your 40s, especially your mid-40s, is when people really start to see, "Oh, you know, that exercise that I was doing is not working f- to control my weight anymore."

Mel Robbins 27:20 Well, everybody that I know that is in this range and is talking about the fact that their body shape has changed.

Dr. Amy Shah 27:30 Yes.

Mel Robbins 27:30 That there is this thickening in the middle. My sister-in-law, who I love, keeps referring to her body as a Twinkie.

Dr. Amy Shah 27:36 (laughs)

Mel Robbins 27:36 Just like a Twinkie with legs. I'm like, "Will you shut up? Stop."

Dr. Amy Shah 27:40 That's hilarious.

Mel Robbins 27:41 And, you know, I

Mel Robbins 27:42 know that I'll get flak for saying this because I'm a lean, athletic build kind of person.

Dr. Amy Shah 27:47 Yeah.

Mel Robbins 27:47 But all my pants fit very differently now.

Dr. Amy Shah 27:49 Yeah.

Mel Robbins 27:50 The... It's as if I have a, uh, you know like those inner tubes that you sit in in a pool?

Dr. Amy Shah 27:55 (laughs)

Mel Robbins 27:55 It's like I've put one from the belly button to the crotch, and around the back too. It's like all of a sudden it's filled out, so my pants don't fit anymore.

Dr. Amy Shah 28:05 Mm-hmm.

Mel Robbins 28:06 Even though it doesn't seem like my body's changed. I mean, it looks like it has.

Dr. Amy Shah 28:13 Yeah.

Mel Robbins 28:13 Why the f- why are we all... I could not do more crunches, I couldn't eat healthier if I tried, I am already getting eight or nine hours of sleep. For God's sakes, I've cut back on the alcohol, I smoke a little weed here and there, that's not putting on this shit in the middle, I don't even get the munchies when I-

Dr. Amy Shah 28:28 (laughs)

Mel Robbins 28:28 ... when I smoke weed. Why is this happening?

Dr. Amy Shah 28:31 This is happening-

Mel Robbins 28:32 It doesn't seem fair.

Dr. Amy Shah 28:33 I know. It's because our estrogen levels, as they start to drop, our body is looking for more hormonally active, um, cells. So what I mean to say is the fat that you accumulate-

Mel Robbins 28:49 Yes.

Dr. Amy Shah 28:49 ... in your middle-

Mel Robbins 28:50 Yes.

Dr. Amy Shah 28:51 ... it produces estrogen.

Mel Robbins 28:53 Okay, wait a minute.

Dr. Amy Shah 28:54 Fat produces estrogen.

Mel Robbins 28:55 What do you mean fat produces estrogen?

Dr. Amy Shah 28:57 Fat cells, uh-

Mel Robbins 28:58 You didn't say that the estrogen sister was a fat sister.

Dr. Amy Shah 29:01 (laughs)

Mel Robbins 29:01 You just said that she was the one that was the party girl.

Dr. Amy Shah 29:04 Yes. She-

Mel Robbins 29:04 Okay, so fat cells?

Dr. Amy Shah 29:06 In our ov- I was talking about that estrogen, progesterone, that are primarily coming from our ovaries when we are, uh, prior to menopause.

Mel Robbins 29:14 Got it.

Dr. Amy Shah 29:14 Pre-menopausal.

Mel Robbins 29:14 Okay.

Dr. Amy Shah 29:14 Okay? But as you get into menopause-

Mel Robbins 29:17 Yes.

Dr. Amy Shah 29:17 ... you start to get a very big dip in your estrogen.

Mel Robbins 29:20 Well, that's true because you don't, you're not gonna be producing children anymore.

Dr. Amy Shah 29:24 Yes.

Mel Robbins 29:24 So the, does the estrogen and progesterone supplies that are part of the reproductive system start to drop?

Dr. Amy Shah 29:29 Yes.

Mel Robbins 29:30 Oh.

Dr. Amy Shah 29:30 And then as your estrogen, progesterone stops, uh, gets lower, your body starts to do things to try to compensate for it.

Mel Robbins 29:39 So it's looking for fat.

Dr. Amy Shah 29:40 Yes.

Mel Robbins 29:41 It d- do we also get flabbier around the arms?

Dr. Amy Shah 29:45 I'll tell you why.

Mel Robbins 29:45 Like I'm talking, like I feel like even as I'm doing, I'm like, "Where did these wings come from?"

Dr. Amy Shah 29:49 Yes. That's because estrogen, the other thing it does?

Mel Robbins 29:53 What?

Dr. Amy Shah 29:53 It helps us keep our muscle mass.

Mel Robbins 29:56 (gasps) .

Dr. Amy Shah 29:56 So when you decrease your estrogen over the years-

Mel Robbins 30:00 So I'm not going crazy. I literally have been looking at my arms going, and saying to myself, "Something is wrong with my arms." I realize they're toned, but they're, they, they used to be a lot toner.

Dr. Amy Shah 30:11 Yeah.

Mel Robbins 30:11 I don't know if that's the right word, but they're, they're like flappy now. And I'm like, "What is, what is that?"

Dr. Amy Shah 30:17 One to 3% of muscle mass-

Mel Robbins 30:20 Yes.

Dr. Amy Shah 30:20 ... is g- like basically per decade you'd say up to 3%, but as you go into menopause, it goes faster, meaning that you're-

Mel Robbins 30:28 Wow.

Dr. Amy Shah 30:28 ... losing muscle at f- high rates. If you're not also weight training, eating the protein. So there-

Mel Robbins 30:36 Yes. Yes.

Dr. Amy Shah 30:36 The one therapy I can tell you-

Mel Robbins 30:38 Yes.

Dr. Amy Shah 30:38 ... right away for your arms-

Mel Robbins 30:39 Tell me.

Dr. Amy Shah 30:40 ... is to start to do more weight training, start to build muscle.... in the places, not only it, that it was, but that you can build more muscle on. So, this is the best time to pick up some weights.

Mel Robbins 30:52 Oh, I have a- I've used the Tonal machine at home.

Dr. Amy Shah 30:55 (laughs)

Mel Robbins 30:55 I'm, I'm doing the things, doc.

Dr. Amy Shah 30:57 More things than you used to.

Mel Robbins 30:58 Ugh.

Dr. Amy Shah 30:59 That's the key.

Mel Robbins 31:00 That's not fair.

Dr. Amy Shah 31:00 So, what I'll tell you is that what we found is that when people start to go into perimenopause and their estrogen drops, their activity level drops a little bit and they don't even notice it.

Mel Robbins 31:12 Mm-hmm.

Dr. Amy Shah 31:12 So, you may be w- gaining some fat cells, not only because of the estrogen drop, uh, a- s- saying to your body it needs more estrogen from fat cells, it's because your body is not as active as it used to be, and it's very subtle, um, and you might not even-

Mel Robbins 31:30 Wow.

Dr. Amy Shah 31:30 ... notice it until you say, "Oh, you know, I used to naturally just get up and walk. I used to get 10,000 steps and now..." So, one of the other things you can do as someone f- we're talking to our friends, we're talking to the audience-

Mel Robbins 31:43 Yeah.

Dr. Amy Shah 31:44 ... increase your activity level, your baseline activity, you're-

Mel Robbins 31:47 But-

Dr. Amy Shah 31:47 ... even if you don't want to.

Mel Robbins 31:49 So, but I keep seeing and I realize that, you know, Dr. Amy is a New York Times best-selling author-

Dr. Amy Shah 31:55 (laughs)

Mel Robbins 31:55 ... and a medical doctor, people, and she's also, uh, has a degree in nutrition and a dual degree in allergy, right? If, if there's a fancy word.

Dr. Amy Shah 32:06 Allergy immunology.

Mel Robbins 32:06 There it is.

Dr. Amy Shah 32:07 (laughs)

Mel Robbins 32:07 That fancy word. And so, I see shit on TikTok-

Dr. Amy Shah 32:11 Yeah.

Mel Robbins 32:11 ... about gotta lift weights, gotta eat more protein. Is that what you're talking about with activity level?

Dr. Amy Shah 32:16 Yeah.

Mel Robbins 32:16 So what do we need to switch up? Because the other thing that I was talking with a friend about is she's like, "I'm on that Peloton, like, every day now."

Dr. Amy Shah 32:23 Yeah.

Mel Robbins 32:24 "And I am not seeing any results whatsoever and it's not Peloton's fault."

Dr. Amy Shah 32:29 (laughs)

Mel Robbins 32:29 "Something is going on with my body."

Dr. Amy Shah 32:31 Yes. It is, and she's not crazy. That's the biggest thing is I think, I feel so bad because my mom, when she was going through menopause, felt like she was going crazy. She's had anxiety, she couldn't sleep at night, she was gaining weight, and she was like, "I feel like I'm literally going crazy."

Mel Robbins 32:48 Yeah.

Dr. Amy Shah 32:49 Um, and the thing is, is that the sad thing is, is that it happens to all- everybody.

Mel Robbins 32:55 Yep.

Dr. Amy Shah 32:56 Uh, mammals. Humans are one of the only animals on the planet that go through menopause, by the way.

Mel Robbins 33:02 Really?

Dr. Amy Shah 33:03 Most (laughs) animals reproduce till they're dying, until they die.

Mel Robbins 33:08 Well, thank God we don't.

Dr. Amy Shah 33:09 (laughs)

Mel Robbins 33:10 I mean, that would be absolutely awful.

Dr. Amy Shah 33:12 So the fact that we live past our reproductive years is pretty unique-

Mel Robbins 33:16 Huh.

Dr. Amy Shah 33:17 ... and to the human race.

Mel Robbins 33:18 You know, one of the reasons why I wanted to do this topic with you, Dr. Amy, is because, selfishly, I want more information-

Dr. Amy Shah 33:26 Mm-hmm.

Mel Robbins 33:26 ... for myself, for my friends, for listeners that are writing in about this, but you'd be surprised the number of requests we're getting for information on this topic from husbands and sons-

Dr. Amy Shah 33:38 Yeah.

Mel Robbins 33:38 ... of women going through this, 'cause they don't know what to do, and my daughter recently said to me, "Mom, every one of my roommates is telling me that their moms are calling, just like you're calling me, and they're bitching-"

Dr. Amy Shah 33:51 Yeah.

Mel Robbins 33:51 "... about their foggy memory or the weight that they've gained. So, can you please do something that you can f- you can, like, have as an episode?"

Dr. Amy Shah 34:00 Yeah.

Mel Robbins 34:00 "That would help people." And so, what are the top five things that people

Mel Robbins 34:04 complain to you about-

Dr. Amy Shah 34:05 Yeah.

Mel Robbins 34:05 ... when they come see you, uh, for help with nutrition and hormones?

Dr. Amy Shah 34:09 Yes.

Mel Robbins 34:09 And how do, how do you attack fixing them?

Dr. Amy Shah 34:12 The number, I would, I would say, uh, number one, two, and three. Okay, so number one is definitely the weight gain.

Mel Robbins 34:18 Okay.

Dr. Amy Shah 34:18 The weight gain is very frustrating because if you're an active person, we're already living in a world that's working against us, right? We already talked about that. This world, the default is that we are going to be in the categories of medically overweight or obese. 73% of Americans are there now.

Mel Robbins 34:38 Wow.

Dr. Amy Shah 34:39 It's gonna be at 85% before we know it, right? So, we're already working against the s- uh, so most of us are already metabolically challenged. We're already fighting against this battle. Then, we gotta deal with the estrogen going down-

Mel Robbins 34:51 Yes.

Dr. Amy Shah 34:52 ... which makes you less active, less energetic, and losing your muscle mass, so now you have more fat, and it's making your mood a little bit lower, right?

Mel Robbins 35:01 Mm-hmm.

Dr. Amy Shah 35:01 So, we can... The therapies that I recommend, uh, a lot of them have to do with things to counteract the changes in the lowering of estrogen.

Mel Robbins 35:11 Okay, like what?

Dr. Amy Shah 35:12 So, walking more.

Mel Robbins 35:14 Okay.

Dr. Amy Shah 35:14 So what I tell women is, like, our cortisol levels can be really high when we're doing tons and tons of, um, l- high-intensity exercise, so it's better to have a baseline of walking, and you can do bouts of HIIT if you want, but really, having more activity. It's called NEAT, non-exercise activity thermogenesis. NEAT activity is actually a bigger driver of our weight.

Mel Robbins 35:40 What is that last word? Thermogenesis?

Dr. Amy Shah 35:42 Yes.

Mel Robbins 35:42 Non-activity, non-electric.

Dr. Amy Shah 35:44 (laughs)

Mel Robbins 35:45 What I, I can't keep up with, what n- what is thermogenesis? (laughs) That's a big word.

Dr. Amy Shah 35:49 Non-exercise-

Mel Robbins 35:49 Yeah.

Dr. Amy Shah 35:50 ... activity thermogenesis. Thermogenesis is metabolism.

Mel Robbins 35:53 Okay, so what is a non-exercise... Is walking is non-ex-

Dr. Amy Shah 35:56 Walking. So-

Mel Robbins 35:56 Okay.

Dr. Amy Shah 35:57 ... if you're not walking for exercise, um, so the, the, the thought is you wear a watch or you wear a pedometer.

Mel Robbins 36:04 Yeah.

Dr. Amy Shah 36:04 You park farther.

Mel Robbins 36:05 Yeah.

Dr. Amy Shah 36:06 Um, you take the stairs.

Mel Robbins 36:08 Yep.

Dr. Amy Shah 36:08 You take your dog for a walk. All the stuff that you don't count as exercise-

Mel Robbins 36:12 Yep.

Dr. Amy Shah 36:13 ... that's non-ex exercise activity thermogenesis. That has to go up.

Mel Robbins 36:17 Okay.

Dr. Amy Shah 36:17 If you're in perimenopause and you wanna fight the weight gain-

Mel Robbins 36:21 Yes.

Dr. Amy Shah 36:22 ... that's where it starts.

Mel Robbins 36:23 And so, the reason why running or HIIT classes aren't the greatest thing for women in this category is because it spikes your cortisol?

Dr. Amy Shah 36:32 Yeah, so-

Mel Robbins 36:32 And what does that have to do with estrogen?

Dr. Amy Shah 36:34 So women, um, tend to do activities... So the other thing that happens during when your estrogen is going down is you're less stress resilient. So, I'll give an example. For f- women who even aren't in menopause or perimenopause, the week before your period-You're just less stress resilient.

Mel Robbins 36:57 Yeah.

Dr. Amy Shah 36:57 You-

Mel Robbins 36:57 Crying.

Dr. Amy Shah 36:58 ... can't handle the things that you usually can handle.

Mel Robbins 37:01 Yes, yes, doctor. Yes. (laughs)

Dr. Amy Shah 37:03 So your, your

Dr. Amy Shah 37:04 mini PMS is happening for a few years now.

Mel Robbins 37:09 So is PMS-

Dr. Amy Shah 37:12 A mini menopause.

Mel Robbins 37:13 I- it's a drop in your estrogen and progesterone in the middle of your normal cycle?

Dr. Amy Shah 37:19 Yes.

Mel Robbins 37:20 No shit.

Dr. Amy Shah 37:21 That's what's happening.

Mel Robbins 37:21 I didn't know that.

Dr. Amy Shah 37:22 That's when your body's like, "Oh, she didn't get pregnant. There's, you know, the egg didn't get fertilized. We gotta shed this lining." They drop the hormones, so you get to be basically the lowest level of estrogen and progesterone-

Mel Robbins 37:36 Yep.

Dr. Amy Shah 37:36 ... and then you shed your lining, which is your period, and then you start all over again.

Mel Robbins 37:41 Wow, so will the things that you're saying that help for somebody in perior or menopause itself also help with PMS symptoms?

Dr. Amy Shah 37:52 Yes.

Mel Robbins 37:53 That is a revelation.

Dr. Amy Shah 37:55 It is for me, too. I thought to myself, "Wow, the same things that we are doing to improve our nutrition during our cycle-"

Mel Robbins 38:05 Yes.

Dr. Amy Shah 38:06 "... we just expand on that." The late luteal phase, which is that PMS phase of the cycle-

Mel Robbins 38:12 Okay.

Dr. Amy Shah 38:12 ... is what's happening. Now-

Mel Robbins 38:14 I kinda like that, um, oh, that's not another name for menopause. I was gonna say I think it's sexier to say, "I'm in my late-"

Dr. Amy Shah 38:22 Luteal. (laughs)

Mel Robbins 38:23 "... luteal phase." Not menopause.

Dr. Amy Shah 38:24 The late luteal phase.

Mel Robbins 38:25 Luteal phase.

Dr. Amy Shah 38:26 That-

Mel Robbins 38:26 But you're talking, that's a period, okay, sorry. (laughs)

Dr. Amy Shah 38:27 Yeah, that's a per- that's, that's the, that's the week before your period, that's PMS.

Mel Robbins 38:32 Gotcha.

Dr. Amy Shah 38:32 Um, so the, uh, one surprising thing that people have to understand is that hormone replacement therapy does not help with the weight gain part. The weight gain part is not an indication to go get hormones.

Mel Robbins 38:48 Okay.

Dr. Amy Shah 38:48 The things that I told you about-

Mel Robbins 38:50 Yep.

Dr. Amy Shah 38:51 ... uh, the exercise changes, and I'll talk to you about more changes that we can do, more knee activity, more weight training.

Mel Robbins 38:57 Right.

Dr. Amy Shah 38:57 Um, that's gonna help the weight loss. So-

Mel Robbins 39:00 Okay, what else do we need to do for the weight loss?

Dr. Amy Shah 39:02 So-

Mel Robbins 39:02 'Cause I know e- everybody's leaning in-

Dr. Amy Shah 39:04 Yes.

Mel Robbins 39:04 ... 'cause I thought if you get the patch-

Dr. Amy Shah 39:06 Yes.

Mel Robbins 39:06 ... or the bioidenticals, your body will snap back into the way it was.

Dr. Amy Shah 39:10 And that's, and that's what's so frustrating for women.

Mel Robbins 39:12 Oh.

Dr. Amy Shah 39:12 The hot flashes definitely get better, right?

Mel Robbins 39:16 Yep, yep.

Dr. Amy Shah 39:16 Like, that's one of the indications for hormonal therapy. Uh, the lib- uh, people will have pain with sex or have-

Mel Robbins 39:24 Yep, dryness.

Dr. Amy Shah 39:25 ... dryness. That definitely, you, HRT definitely helps with that.

Mel Robbins 39:28 Okay.

Dr. Amy Shah 39:28 But the weight gain portion is not so easy to address just with hormones, because there's, uh, multiple things going on. Like, you're less active. You're losing more muscle mass. You're also, um, your sleep is dysregulated, so then-

Mel Robbins 39:45 Mm-hmm.

Dr. Amy Shah 39:45 ... your appetite, as we talked about, your cravings, your hunger, your appetite are all increased because you're not sleeping well.

Mel Robbins 39:52 Yep.

Dr. Amy Shah 39:53 Um, so you end up having a situation that can't just be solved by adding hormones. I think about adding hormones like putting gas in your car. So you can add gas to your car, but if there's a traffic jam, you're not going anywhere.

Mel Robbins 40:11 Hmm.

Dr. Amy Shah 40:11 So our hormones are like a complicated highway system. Like, we're, you know, in LA right now, there's a complicated web of, uh, of highways that are backed up and doesn't matter how much gas you pump into the car, it's not gonna go anywhere. So the ways to unclog that traffic, to keep that traffic moving is the sleep, the exercise, the weight training, the food choices. So sleep is another thing. So as frustrating as it sounds-

Mel Robbins 40:44 (laughs)

Dr. Amy Shah 40:44 ... the more you can improve your sleep, the better that weight loss part will become, because

Dr. Amy Shah 40:50 your appetite, um, as we said, you know, your hormones, your hunger hormones are really dysregulated when you don't sleep.

Mel Robbins 40:57 Yes.

Dr. Amy Shah 40:57 And so you wanna have a good night's sleep, but often you can't sleep because your hormones are disrupted, so it's this, like, the cycle. So one of the things I o- tell people is really, really try your best to improve your sleep hygiene. If you haven't started a routine to improve your sleep hygiene, start it now in perimenopause or postmenopause.

Mel Robbins 41:17 Okay, now tell us your top three things-

Dr. Amy Shah 41:19 Ho-

Mel Robbins 41:20 ... for a better night's sleep.

Dr. Amy Shah 41:21 Top three things for a better night's sleep, cold room.

Mel Robbins 41:24 Okay.

Dr. Amy Shah 41:25 Your body temperature has to drop by one degree to fall asleep.

Mel Robbins 41:29 Oh.

Dr. Amy Shah 41:29 So how do you get that done fastest? You could take a shower. You can cool down the room.

Mel Robbins 41:33 Yep.

Dr. Amy Shah 41:34 You can get into pajamas that cool your bo- you know, you want to cool your core body temperature.

Mel Robbins 41:39 Okay.

Dr. Amy Shah 41:39 That's how you'll fall asleep.

Mel Robbins 41:39 Love that.

Dr. Amy Shah 41:41 Pitch black.

Mel Robbins 41:42 Mm-hmm.

Dr. Amy Shah 41:42 If you can't control the curtains and the light, then wear a face mask-

Mel Robbins 41:46 Yep.

Dr. Amy Shah 41:46 ... or a eye mask. Uh, there are good studies on, w- the few studies that we have, one is on menopausal women, um, even if you have a ambient light in the room, like a light coming through the window, um, it will stop weight loss if you're on a weight loss plan.

Mel Robbins 42:06 Really?

Dr. Amy Shah 42:07 Circadian rhythm disruption, especially during that time, seems to really mess up, um, the hormones in that sense. So you wanna have a pitch black room. Um, and then, uh, the third thing is you want a nightly routine. So you wanna prepare your brain and your body for sleep because body, your body loves routines. You know, our bodies are built on rhythms and cycles.

Mel Robbins 42:34 Yes, yes.

Dr. Amy Shah 42:34 And if every night you go to sleep at 8:00 PM or 9:00 PM-

Mel Robbins 42:40 Mm-hmm.

Dr. Amy Shah 42:40 ... and then so at 8:45, you start to turn off all the lights, you put away your phone, you start to brush your teeth, you're cluing in your body that it's time for sleep. So keeping that same-Time and routine is essential for good sleep, so people will sleep one day at nine o'clock and the next day at 11:00 and the next day. They're massively disrupting their sleep cycles, and there's some data now that shows that it's maybe more important to stay on the same bedtime-

Mel Robbins 43:13 Huh.

Dr. Amy Shah 43:13 ... than even the total number of hours slept.

Mel Robbins 43:16 Wow. Um, are there certain foods that we should be eating more of or less of to help with the menopause symptoms and hormone regulation and, you know, for everybody's benefit, I just wanna remind everybody, this is your second appearance.

Dr. Amy Shah 43:32 (laughs)

Mel Robbins 43:32 And we did a huge show on, uh, hunger and craving and the neuroscience and biology of

Mel Robbins 43:39 it, and so that will be linked in the show notes along with both of your books. But, you know, if you had to bottom line it for people that are, you know, really wanting to use food to regulate hormone, like, what are the top recommendations?

Dr. Amy Shah 43:53 Remember that, um, I likened it to PMS in the sense that you're less stress-resilient, so you're, what I mean is that the things that spike your cortisol, um, are just now more and at a lower threshold.

Mel Robbins 44:10 Mm-hmm.

Dr. Amy Shah 44:11 Caffeine, alcohol, uh, sugar.

Mel Robbins 44:17 Shit, are we not gonna have fun now too?

Dr. Amy Shah 44:19 (laughs)

Mel Robbins 44:19 I mean... (laughs)

Dr. Amy Shah 44:20 It's like all the, people say to me, "I- I always drank this much caffeine and I always eat- ate this much sugar."

Mel Robbins 44:28 Yes.

Dr. Amy Shah 44:28 And-

Mel Robbins 44:28 Or had a glass of wine.

Dr. Amy Shah 44:29 Yeah.

Mel Robbins 44:29 Or did whatever. What the hell is going on?

Dr. Amy Shah 44:31 Yeah, and that's because now your hormones have changed and your metabolism changed. You're also less insulin sensitive. So, um, you know you've heard the term insulin resistance?

Mel Robbins 44:41 Yes. What does that mean?

Dr. Amy Shah 44:41 So that happens during, uh, menopause.

Mel Robbins 44:44 What is insulin resistance?

Dr. Amy Shah 44:45 In- ins- insulin resistance means that when the sugar is trying to get into your cells-

Mel Robbins 44:50 Yeah.

Dr. Amy Shah 44:51 ... the insulin has to open the door-

Mel Robbins 44:53 Oh.

Dr. Amy Shah 44:53 ... um, to let the sugar in. That's insulin.

Mel Robbins 44:55 Oh.

Dr. Amy Shah 44:56 Yeah. So it usually matches, meaning the- when you have a lot of-

Mel Robbins 44:59 So what does it mean when you're insulin resistant? The doors shut, the doors open?

Dr. Amy Shah 45:02 It's the doors shut and you don't hear it as- as easily, like you're knocking louder and louder to try to get in.

Mel Robbins 45:10 Oh.

Dr. Amy Shah 45:10 And the insulin's like, "Dude, we just let m- sugar in. We're not gonna let more sugar in." And the body's like, "No, but I need to get it out of the bloodstream. I need to put it..." And- and the insulin's like, "No, but the cell is packed. It can't take any more sugar." And so while they're having these fights and discussion, that's called insulin resistance.

Mel Robbins 45:30 Oh.

Dr. Amy Shah 45:31 And so when insulin, um, resistance happens, the body gets signals to store fat, to say let's get this sugar out of here because it's not going into the cell, so we gotta put it somewhere. So we end up hav- when insulin resistance happen, not only do you have a higher risk of getting type 2 diabetes-

Mel Robbins 45:51 Yep.

Dr. Amy Shah 45:51 ... because your sugar level's so high-

Mel Robbins 45:53 Yeah.

Dr. Amy Shah 45:53 ... all the time, you also have more signaling to store fat.

Mel Robbins 45:58 Oh, man.

Dr. Amy Shah 46:00 (laughs) So insulin resistance is something that we can control by-

Mel Robbins 46:04 Okay.

Dr. Amy Shah 46:04 ... saying, well, if the cells are so full of sugar and they can't let any more sugar in-

Mel Robbins 46:11 You better eat some vegetables?

Dr. Amy Shah 46:12 You better just cut some of that sugar out.

Mel Robbins 46:15 Okay.

Dr. Amy Shah 46:16 And add in some things that s- you know, help you lower the blood sugar in your body, which is fiber. So fiber is one of the most helpful things that you can add to your diet besides cutting down the sugar-

Mel Robbins 46:30 Yep.

Dr. Amy Shah 46:30 ... because, you know, if your cells are overwhel- whelmed with sugar, cut down the sugar, add more fiber so that your blood sugar can be regulated in your body, move more like we said. (laughs)

Mel Robbins 46:43 Yep.

Dr. Amy Shah 46:44 Um-

Mel Robbins 46:44 Add in weight training.

Dr. Amy Shah 46:46 Sleep more.

Mel Robbins 46:47 Sleep more.

Dr. Amy Shah 46:47 Um, and remember the water that we talked about in the other episode. Water, our thirst centers are often mixed with our hunger centers, like the signals are, can be mixed. So you wanna hydrate enough so that you are not eating mindlessly. And then of course, there's-

Mel Robbins 47:04 So and the trick there, just for those of you that have not heard the other episode is when you feel your appetite coming on, in order to determine whether or not you just have a mindless craving, uh, you can say, "Would I like a bowl of vegetables right now?" And if the answer is no, that means you're not actually hungry. Another trick is drink a glass of water.

Dr. Amy Shah 47:28 Yes.

Mel Robbins 47:28 Because that typically can satiate-

Dr. Amy Shah 47:31 Yes.

Mel Robbins 47:32 ... that appetite that flares up.

Dr. Amy Shah 47:34 E-

Mel Robbins 47:35 Why do we have anxiety when, why is there an increase in anxiety during-

Dr. Amy Shah 47:39 So-

Mel Robbins 47:39 ... PMS and menopause?

Dr. Amy Shah 47:40 Remember that f- um, sister, uh, the progesterone sister?

Mel Robbins 47:44 Yes.

Dr. Amy Shah 47:44 She was the calming one.

Mel Robbins 47:46 Mm-hmm.

Dr. Amy Shah 47:46 She was the one who was keeping you chillaxed and careful.

Mel Robbins 47:49 Mm-hmm.

Dr. Amy Shah 47:50 And, um, she, when progesterone goes down, you don't have that chillaxer anymore. You don't have someone to keep you calm like that sister that was in- inside saying like, "Calm down. It's okay, Mel." Like, you know, "You'll be fine." Your progesterone levels are lower and all of a sudden you are anxious about everything. The things that never s- made you anxious before are making you anxious. And-

Mel Robbins 48:18 Wow.

Dr. Amy Shah 48:18 ... the sleep. You wake up in the middle of the night, you're like, "Oh my God.

Dr. Amy Shah 48:22 I can't believe X, Y, and Z happened," and it starts a whole anxiety spiral, and a lot of women during menopause have crippling anxiety.

Mel Robbins 48:33 Does hormone replacement therapy tend to help with anxiety?

Dr. Amy Shah 48:36 Yes, if progesterone replacement.

Mel Robbins 48:39 Gotcha. Can you explain what a hormone is?

Dr. Amy Shah 48:44 Yeah.

Mel Robbins 48:44 Like I- I don't even, I'm not sure I would know how to explain what a hormone is and what it does.

Dr. Amy Shah 48:49 Yeah. I- i- that's a great question. I always, uh-... feel like there's so much confusion-

Mel Robbins 48:56 Yeah.

Dr. Amy Shah 48:56 ... about hormones. Hormones is a chemical messenger, so in my analogy of the highway-

Mel Robbins 49:03 Yeah.

Dr. Amy Shah 49:03 ... it's the car. It's the car.

Mel Robbins 49:06 Oh.

Dr. Amy Shah 49:07 It travels from your brain or from your ovaries to wherever it needs to go. It can go to the muscle, it can go to the heart, it can go... So, it's a traveling message and we need it. Our bodies cannot function without hormones. Like, people get so annoyed with hormones, but you cannot function without your hormones, even cortisol. Cortisol is a good hormone. It can... Just doesn't... It has to be balanced.

Mel Robbins 49:35 So, what is the estrogen, the estro... Oh, I'm getting this now. So, the fun party sister-

Dr. Amy Shah 49:42 The social one.

Mel Robbins 49:43 ... the social one is driving one car.

Dr. Amy Shah 49:46 Yes.

Mel Robbins 49:46 And when she arrives, it's time to party.

Dr. Amy Shah 49:49 Yes.

Mel Robbins 49:50 When the progesterone sister is driving another car, when she arrives, party's over.

Dr. Amy Shah 49:55 Yes.

Mel Robbins 49:56 Then-

Dr. Amy Shah 49:57 And she calms everybody down, like-

Mel Robbins 49:58 Yeah.

Dr. Amy Shah 49:58 ... "Let's just chillax now, guys. Let's just, you know, tone it down. Let's relax."

Mel Robbins 50:01 Is insulin a hormone?

Dr. Amy Shah 50:03 Insulin is a hormone.

Mel Robbins 50:04 Really? So, when insulin gets in the car, what is insulin telling you to do?

Dr. Amy Shah 50:08 So, insulin is telling you to let... Open the door to let the glucose in. It's signaling to store, um, store, it's a storage signal.

Mel Robbins 50:16 Uh-huh.

Dr. Amy Shah 50:16 Meaning that- that our body, um, sends insulin out to say, "Hey, we need to store a little more glucose here because there's glucose coming in," so it's a messenger to tell people. Thyroid hormone is also... It goes all over the place. So, people think, "Oh, thyroid hormone is just about weight." No. It goes... It's controlling weight, temperature, it's controlling heart rate, it's controlling a million things.

Mel Robbins 50:44 Wow.

Dr. Amy Shah 50:44 It's not just going to one destination.

Mel Robbins 50:46 Wow.

Dr. Amy Shah 50:47 So, you can't just replace hormones, um, and think that it's gonna have one effect. So for example, we see people getting

Dr. Amy Shah 50:55 high, high doses of thyroid hormone and I say to people that more is not always better, right? Like, it's not just doing one thing. It's doing five different things, and one of the things it's doing is it's going to the heart. And if you send too much thyroid hormone to the heart, you're going to have all kinds of problems, including arrhythmias, heart palpitations. People that are taking too high doses of thyroid hormone will have heart problems often. So, it's not... It's- it's like playing with fire.

Mel Robbins 51:28 Wow. So, they're just kind of driving in the wrong directions, or they're not arriving where they used to arrive, and that's what's making the changes. So, the hormones are the root cause of PMS and menopause.

Dr. Amy Shah 51:41 Yes.

Mel Robbins 51:42 Wow. And for some of the symptoms, hormone replacement therapy will alleviate symptoms.

Dr. Amy Shah 51:50 Yes.

Mel Robbins 51:50 But for other things like the fat dis- redistribution or the losing muscle tone or the... That you're gonna have to make lifestyle changes.

Dr. Amy Shah 52:02 Yeah. So, the other hormone that we didn't talk about but that's really important even in women is testosterone.

Mel Robbins 52:09 Really?

Dr. Amy Shah 52:09 Testosterone is actually in higher levels, like four times the level of estrogen or progesterone. Like, it's high.

Mel Robbins 52:16 In women?

Dr. Amy Shah 52:17 Yes. In women.

Mel Robbins 52:18 Really?

Dr. Amy Shah 52:19 And we always think about, uh, testosterone as like a male hormone, right? Of course males have much higher levels-

Mel Robbins 52:25 Yeah.

Dr. Amy Shah 52:25 ... of testosterone than women, but our testosterone is also high compared to our other hormones. And so, having testosterone there... So, testosterone is the sister that doesn't live as close to the other sisters, but testosterone is the leader. It's the one... It's the muscular, it's the aggressive, it's the leader sister. So, testosterone is something that we get a spike of testosterone-

Mel Robbins 52:55 Yep.

Dr. Amy Shah 52:57 ... at ovulation. So, if you know your cycle, roughly a week after your period, um, is when your testosterone levels are peaking. And so, that's when you wanna build the most muscle, that's when your libido will be the highest.

Mel Robbins 53:14 Yeah.

Dr. Amy Shah 53:14 Your confidence levels will be similar to the other gender. Like, uh, your people that take too much testosterone, for example, when they're taking replacement and they go overboard, they'll be angry, aggressive, and maybe even a risk-taking behavior.

Mel Robbins 53:31 Huh.

Dr. Amy Shah 53:32 And so, we know that testosterone can be good in small amounts, especially for women during peri- perimenopause and during the cycle if you're lower than you need to be, but of course, you don't want to overdo it. People overdo it all the time.

Mel Robbins 53:45 How do you figure out what to take?

Dr. Amy Shah 53:47 Yeah, I know (laughs) . I know. It's... They're so much misinformation out there. For example-

Mel Robbins 53:52 What are the big ones? Yeah.

Dr. Amy Shah 53:53 They-

Mel Robbins 53:53 Give me some of the big myths.

Dr. Amy Shah 53:54 Big example. The one thing that all doctors can agree about that no hormones, is that those pellets that people get are no good.

Mel Robbins 54:08 I don't know what the hell a pellet is. I've just heard about this.

Dr. Amy Shah 54:10 Yes.

Mel Robbins 54:10 What the hell are pellets?

Dr. Amy Shah 54:11 So, pellets are, um, testosterone b- uh, releasing, like, extended release testosterone-

Mel Robbins 54:19 Yeah.

Dr. Amy Shah 54:19 ... that they implant under the skin.

Mel Robbins 54:21 Okay.

Dr. Amy Shah 54:22 And it's supposed to release testosterone.

Mel Robbins 54:25 Yes.

Dr. Amy Shah 54:25 What happens is you keep this in there for months, okay? And you get it replaced, and what's happening is that you can't adjust the levels, right? So, you're getting... And most of these pellets are giving you super therapeutic levels. And like I said, hormones are not something that you just wanna add, uh, because they're doing a lot of other things besides maybe the one thing that you're targeting.

Mel Robbins 54:50 Okay.

Dr. Amy Shah 54:51 And so, what we say is, like, why would you use an implantable, um, testosterone that can't be titrated-

Mel Robbins 55:00 Right.

Dr. Amy Shah 55:00 ... that usually releases too much-

Mel Robbins 55:01 Yep.

Dr. Amy Shah 55:02 ... in the s- like, the same dose in every woman? You know, why would you do that? And the answer is that it... You can charge. You can charge for testosterone pellets. And when you do, testosterone, like, a cream or a, a, a, uh, ingestible...... y- it's, it's not money in the pocket of the practitioner, and so I, I know there ... Once, I said this on, on social media and people went crazy because they said, "I love my testosterone pellets!" And I said, "Great, but make sure your levels are at the level that you want it and not way high-

Mel Robbins 55:39 Right.

Dr. Amy Shah 55:39 ... because I bet you that a lot of people who are taking testosterone pellets are at super therapeutic levels, and we've seen so many negative side effects from those levels. So, hormone replacement can be so amazing, but go to the right person, choose the right dosing-

Mel Robbins 55:57 Yep. Yep.

Dr. Amy Shah 55:57 ... and even if you do pellets, great. Choose what's right for you, but make sure you're not getting levels that are too high for your body.

Mel Robbins 56:04 I am so glad you said this because we had another amazing person on who uses pellets herself and was so excited about them that I'm like, "I gotta get me some pellets."

Dr. Amy Shah 56:15 Yes.

Mel Robbins 56:15 "I gotta go. I gotta, I gotta get in there and get the pellets. I got, I got testosterone. Chris Robbins, get ready-

Dr. Amy Shah 56:21 Yes. (laughs)

Mel Robbins 56:21 ... because the libido is coming back." But I'm glad that you gave us the reason why.

Dr. Amy Shah 56:26 Yeah.

Mel Robbins 56:27 So that you can make a choice for yourself.

Dr. Amy Shah 56:31 Yes.

Mel Robbins 56:32 Um, is it true that, that women of different races experience menopause differently?

Dr. Amy Shah 56:37 Yes. And the problem is, again, Mel, is that not only are we not l- educating our doctors-

Mel Robbins 56:45 Yeah.

Dr. Amy Shah 56:45 ... or the population about menopause, we are ... we don't even know the differences between, um, different backgrounds, different races, different ethnicities.

Mel Robbins 56:55 Because they're not studying it?

Dr. Amy Shah 56:56 They're just not studying it. And so we're just finding out now that people present different ... I mean, we're just at the basic levels of finding out that women present differently with heart attacks than men, and that women produce, you know, will be, um, will be shamed for symptoms that are actually real, um-

Mel Robbins 57:16 Yes.

Dr. Amy Shah 57:16 ... because they just think, "Oh, sh- she's just a complainer."

Mel Robbins 57:18 Well, and then the other thing that I have really not appreciated is that there is an acknowledgement that you get foggier.

Dr. Amy Shah 57:25 Yeah.

Mel Robbins 57:25 And there's an acknowledgement that you will start to feel flabbier and start gaining weight in places that you've never had it before. But there's no what to do.

Dr. Amy Shah 57:36 Yeah.

Mel Robbins 57:37 That it's sort of this, "Oh, well, yeah, me too," or, "Yep, that's, that'll happen and everything will kinda go back to where it should be when you're 60 or you're 10 years into this," and I am sorry. I'm not settling for that, and that's one of the reasons, Dr. Amy-

Dr. Amy Shah 57:52 Yes.

Mel Robbins 57:52 ... I wanted you on. And so I think it'd be really helpful if you could walk us through the day of what you would recommend for anyone to either better manage PMS or have a better routine that's aligned with your recommendations and the science out there to help us both regulate our hormones and do the proactive steps to feel better during these very normal changes.

Dr. Amy Shah 58:24 Yeah. That's a great question. Uh, and I'll start with saying that we live in a society that has a problem with women getting older, right? Like, we basically have been told that if you don't f- fit into the societal ideals of young, you know, fertile women-

Mel Robbins 58:47 Right.

Dr. Amy Shah 58:48 ... that you're no longer worthy, that you should ... you're no longer beautiful, that you're no longer wanted, that you're no longer, um, you know, smart and motivated, and I think that that's one of the biggest challenges that we are going to have to face in this next generation where we feel good even into our 40s and 50s, and if we do the things that we're gonna talk about, this could last till our 70s and we can look younger and feel younger. We already know the biological age, like our age of ourselves is completely different, 20 years different than-

Mel Robbins 59:24 Wow.

Dr. Amy Shah 59:24 ... our chronological age. So you're really just 35 right now.

Mel Robbins 59:28 Thank you.

Dr. Amy Shah 59:28 (laughs)

Mel Robbins 59:29 Thank you, which is why I'm pissed off that I have a dry vagina and I sweat at night and I feel like somebody's grandmother.

Dr. Amy Shah 59:36 Exactly. So here's, here's- (laughs)

Mel Robbins 59:39 (laughs)

Dr. Amy Shah 59:39 Here's how we move through the day.

Mel Robbins 59:41 Okay.

Dr. Amy Shah 59:42 You wake up, hopefully without an alarm. This is really important because, uh, we talked about sleep, how it helps with appetite regulation, and we just, as a society, um, shit on sleep and don't allow ourselves to sleep.

Mel Robbins 59:54 Yes.

Dr. Amy Shah 59:54 So, you know they say, um, "Go, go camping. Go somewhere where there's no ambient light and there's no distractions and social media and see actually what time you sleep and wake up." I bet you you're not a night owl like you thought, you know? It's really just a societal thing that we try to escape from our, our days at night. So, okay, so you're gonna get an adequate night of sleep.

Mel Robbins 1:00:16 Right.

Dr. Amy Shah 1:00:16 You're gonna go get that sunlight in the morning.

Mel Robbins 1:00:18 Yep.

Dr. Amy Shah 1:00:18 So, circadian biology, again, the light that you get in the morning tells every cell in your body that it's morning, and the benefit of that is that our hormones need that input. If our hormones don't get input from our bo- our brains and our bodies that, um, "Hey, it's time to release now," cortisol. Cortisol's high first thing in the morning. Then their, uh, it, uh, f- causes hormonal dysregulation, which is like how people say, "Oh, I feel so tired all day."

Mel Robbins 1:00:52 Yes.

Dr. Amy Shah 1:00:53 Or adrenal fatigue, like, "I feel so burned out." It's not that the adrenals are burned out. There's no such thing as adrenal burnout. Um, the m- word adrenal fatigue makes it sound like these adrenal glands get tired.

Mel Robbins 1:01:07 Yeah. They don't?

Dr. Amy Shah 1:01:07 And how ... No, it's ... This hormonal highway that we're talking about-

Mel Robbins 1:01:11 Yes.

Dr. Amy Shah 1:01:11 ... gets clogged, right? So we're ... It's not just the adrenals. It's coming from the thyroid. It's coming from the brain. It's ... The whole traffic jam is happening because of all the other things, you know, the lifestyle, the age-related hormone changes. So, um, you wanna get up. You wanna, um-... retune those clocks. Those clocks can get damaged if you don't tune, if you misalign them so long, um, so many times.

Mel Robbins 1:01:37 Yeah, like if you live in your parents' basement-

Dr. Amy Shah 1:01:39 Mm-hmm.

Mel Robbins 1:01:39 ... and you never get outside, or you spend hours and hours and hours, like, in the daytime inside. Well, what I love about this, I think I, just to kind of keep with the analogy, 'cause the visuals really help me-

Dr. Amy Shah 1:01:51 Yeah.

Mel Robbins 1:01:51 ... put it all together, it's almost as if the circadian rhythm and the sunlight in the morning is like the remote starter to your car.

Dr. Amy Shah 1:01:58 Yes, yes. And it's unclogging that, um, it's keeping those roads open and clean. So, you can know, okay, it's time to drive, like-

Mel Robbins 1:02:09 Yep.

Dr. Amy Shah 1:02:09 ... everything's opened up.

Mel Robbins 1:02:10 Yep.

Dr. Amy Shah 1:02:11 So, you get the circadian, um, rhythm.

Mel Robbins 1:02:13 Yep.

Dr. Amy Shah 1:02:13 And remember that if you start to damage those cars-

Mel Robbins 1:02:17 Yep.

Dr. Amy Shah 1:02:19 ... um, you basically get these things called senescent cells. So, the word is a lo- a, a, a very scientific word, but basically it means your cells become zombie cells.

Mel Robbins 1:02:30 Huh.

Dr. Amy Shah 1:02:30 Um, and they no longer can work, the car doesn't work, but it actually, the emissions from the car is inflammatory signals. And aging and all the things that come with aging is these cars that are broken down and they're sending off these, um, inflammatory signals to your whole body.

Mel Robbins 1:02:49 Yep.

Dr. Amy Shah 1:02:50 And that's the process of aging. We need to clean those cars up and get those out of there if they're not working, right? So, keeping with that analogy, that's, we don't want senescent, senescent cells is the big area of anti-aging that we're trying to understand, like, how do we clear those out faster? How do we not break down those-

Mel Robbins 1:03:06 Yep.

Dr. Amy Shah 1:03:06 ... you know?

Mel Robbins 1:03:06 Yep.

Dr. Amy Shah 1:03:07 So, um, then you want to, so working out in the morning actually has been shown in studies to be the, not necessarily the ide-, only ideal time to work out, but-

Mel Robbins 1:03:20 Right.

Dr. Amy Shah 1:03:20 ... the best time to stay with a routine. So, people are compliant with exercise when it happens in the morning.

Mel Robbins 1:03:28 Well, it's-

Dr. Amy Shah 1:03:28 And I see this-

Mel Robbins 1:03:29 ... common sense-

Dr. Amy Shah 1:03:29 Yeah.

Mel Robbins 1:03:29 ... because your day doesn't hijack your energy and your time.

Dr. Amy Shah 1:03:34 It's, I see it over and over again, especially in women, because we're-

Mel Robbins 1:03:39 Does, sorry, go ahead.

Dr. Amy Shah 1:03:40 No, 'cause women, we are doing everything for everyone. Our mental load starts from the morning, and so if you don't get that workout in, there's a big chance that you're not going to make time for it later, because the kid needs a ride-

Mel Robbins 1:03:57 Yep.

Dr. Amy Shah 1:03:57 ... your husband needs you to be home.

Mel Robbins 1:03:59 Yep.

Dr. Amy Shah 1:03:59 You know, the meeting came up. Somebody needs you to be somewhere.

Mel Robbins 1:04:02 Yep.

Dr. Amy Shah 1:04:02 So, get it done in the morning-

Mel Robbins 1:04:04 Okay.

Dr. Amy Shah 1:04:05 ... if possible.

Mel Robbins 1:04:05 Great.

Dr. Amy Shah 1:04:06 There's a second peak time if you, um, that seem to be equivalent, um, late afternoon.

Mel Robbins 1:04:11 Okay.

Dr. Amy Shah 1:04:11 In late afternoon, you get a little bit of surge, um, and it's a better time to muscle build. So, if you're doing two mini workouts, that you could just split it up. And then high protein.

Mel Robbins 1:04:21 High protein.

Dr. Amy Shah 1:04:21 Protein is one of the biggest things that doesn't happen with women in perimenopause, because what happens is women think that you're trying to be skinny, and when they start to see themselves gain, gaining some middle section weight, they of- often cut down even more, and you're in this, like, very tight calorie restriction. And what you really need to do is eat more protein, more fiber, more real foods, and less of that ultra-processed crap. So, having a high protein breakfast, dopamine booster breakfast, high fiber, you know, we know, uh, we talked about that a lot in the oth- other episode. And then you wanna do your biggest, um, concentrated tasks of the day early in the day, because-

Mel Robbins 1:05:07 So that you don't spike your cortisol.

Dr. Amy Shah 1:05:09 Exactly.

Mel Robbins 1:05:10 Boom. I'm getting this. I am getting this.

Dr. Amy Shah 1:05:13 So, um, and then, you know, if you're someone who can do meditation or a nap, um, the best time to do it is when your cortisol is naturally low,

Dr. Amy Shah 1:05:23 between about 3:00, like, 1:00 to 4:00 PM. When your cortisol dips, um, it's a great time to either do a power nap 20 minutes, do a meditation, do something calming, because remember, when your progesterone's dropping, you're likely more anxious, you're overwhelmed.

Mel Robbins 1:05:39 Yep.

Dr. Amy Shah 1:05:39 It's a nice break from the day, um, when you can do it. Do something that's very centering, prayer, whatever it is.

Mel Robbins 1:05:46 Let me ask you a question about that. These menopausal symptoms that you're talking about, I've heard what I think is probably a myth, that if you just ride it out, just, like, three years, Mel, ride out the hot flashes, the dryness, the bitchiness, all this stuff, the brain fog, and in three years, you'll just snap right back. Is that true?

Dr. Amy Shah 1:06:07 Well, what happens is that your body just starts to get used to it. And so you're l- operating at a level that's just stable. There's no squeezing of the toothpaste, there's nothing there. Your body starts to accommodate. Um, and so it's not that it's snapping back, but that the symptoms seem to go away, a lot of the symptoms, um, that were really troublesome during perimenopause. And so, um, it's often the time where, uh, people feel a little reprieve. But remember that disease risk goes way up after menopause. Our hormones protect us from heart disease and all of the, uh, disease of aging, and so once you hit menopause, you start to have an increased risk of all of those inflammatory diseases.

Mel Robbins 1:06:59 Okay. Wow, yet another thing to look forward to. Is there anything more that we should know about the increased risk of inflammatory diseases?

Dr. Amy Shah 1:07:07 So, one of, um, the big criticisms of hormone replacement therapy was that it would cause cancer, um, but now we know that it's the opposite, that actually, hormones actually protect us, uh, from a lot of these diseases, especially heart disease.

Mel Robbins 1:07:23 Mm-hmm.

Dr. Amy Shah 1:07:24 And for women, it can actually be protective. Um, and then in the right population of women, um, like, very close to the start of menopause or perimenopause, the, the earlier you start it, the better risk protection you get from-

Mel Robbins 1:07:41 Wow.

Dr. Amy Shah 1:07:41 ... uh, hormone replacement therapy.

Mel Robbins 1:07:43 So, what is the biggest myth around menopause?

Dr. Amy Shah 1:07:47 I think the biggest... Honestly, my biggest pet peeve about menopause is the fact that women feel shame around it, and they can't have conversations with their doctors. They often feel like they're, um, marginalized and, um, and they're not listened to from their provider when they say, "Oh, I have this correlation... th- the symptoms. I don't feel right. Feel tired, but I feel anxious. My sleep is off." And they often get a prescription and no explanation about what's happening. And I know countless women who've just come home with anti-anxiety medications, and no one explained to them that there's a lot going on in your body that could explain why you're feeling this anxiety at this time, and there are things that you can do. Not to say there's anything wrong with medications. There's a great need for medications, but there's also a big need for education around menopause.

Mel Robbins 1:08:53 I agree. There is a huge need for education, not only around menopause, but also around women's hormonal health and cycles in general. And I consider myself to be a very well-educated person. I'm intellectually curious, I read all the time, and I have flunked this topic.

Mel Robbins 1:09:12 And when I've gone to my doctor or to my OB-GYN, it feels like people are like, "Yeah, well, it's gonna last till you're 60," and, "You know, you can do hormones," or, you know, whatever. "You're gonna have to tolerate the weight gain. It'll disappear, uh, by the time you're 60."

Dr. Amy Shah 1:09:29 I hate that. I think that term is like gaslighting, like, you know, medical gaslighting where women just feel like they're not listened to, um, and their, their complaints are just dismissed. And I think that's something we really need to work on as a society because, like I said, 40, age 40, age 50, age 60 is now very different than it was even just 20 years ago. Women are doing things in their 40s, 50s, and 60s that women did not do. And so, we're changing the... Uh, we gotta change the conversation. So, it's not that, "Oh, you're just, th- you know, you're just worried, you're just stressed, you're just getting old," and dismissing their concerns. These people are running companies. They're leading countries. They're... I mean, they... We need to have conversations about what they could be doing to optimize themselves at that level, not just saying, "Oh, well, you're just getting old."

Mel Robbins 1:10:33 So, what would you advise any of us who feel like we are just not getting the answers from the doctors, like, that we're seeing? Do you just change your doctor? I mean, what do you do?

Dr. Amy Shah 1:10:46 I think in this day and age, we have enough physicians that are interested, educated, um, and can be an advocate for you, that you should go seek that out. Uh, because I think that we're changing the conversation, not only within ourselves, but in the medical community of saying like, "Hey, listen, um, if a woman comes with you, to you with these complaints, don't just write it off as separate things. Think about, like, where is she in her cycles? Like, where is she with her hormones? Could it be, um, this?" And one big myth that I wanna bust is that you must check your hormone levels to diagnose a hormone problem or menopause. So, there is this big myth that in order to be considered in menopause or perimenopause, you must get your hormone levels checked, because that's what you hear on the internet. Menopause is not a diagnosis of hormone levels. It is a diagnosis of symptomatology, um, and the definition has nothing to do with the level of hormones. And so, um, a lot of people spend thousands and thousands of dollars trying to get testing to figure out what their hormone levels are, um, but that's not necessarily the first place you need to go.

Mel Robbins 1:12:02 Well, when should you get your hormone levels tested?

Dr. Amy Shah 1:12:05 If you're getting replacement therapy and you're trying to troubleshoot something. But the diagnosis of menopause is not made through a lab test.

Mel Robbins 1:12:15 Well, that's one thing that we learned today, that the diagnosis of menopause is made after you have gone an entire year without menstruating.

Dr. Amy Shah 1:12:25 And the problem is, is that, um, like I said, there's a lot of, um, misinformation, there's a lack of research, and there's a lack of interest, to be honest. And so, uh, I think that all of those things make menopause an area that is mismanaged, that is, um, an area... Like, if you look on the internet and you look for supplements around PMS or menopause or hormones, it's a wild, wild west. I mean, clearly people are looking to alternative practitioners and online therapies for their hormonal concerns. But when you see what's out there, it is like, very scary. And so, that's a clear sign that women are looking for answers, and so we need to have more information. Even the basic things like we talked about here, this should be basic education for all women.

Mel Robbins 1:13:21 Dr. Amy Shah, I'm having you back to talk about circadian rhythm-

Dr. Amy Shah 1:13:26 Yes.

Mel Robbins 1:13:26 ... and I'm having you back to talk about the rhythm of the day. You are a freaking rockstar. The book is I'm So Effing Tired, But We Ain't So Effing Tired No More-

Dr. Amy Shah 1:13:35 (laughs)

Mel Robbins 1:13:36 ... because Dr. Amy has given us simple things backed by profound science that you learned today, that will help you take control of your hormone health so that you can...... live a much better life. Thank you, thank you, thank you. You are going to, I- I cannot wait to have you back.

Dr. Amy Shah 1:13:55 Ah, I'm so honored to be here and I would love to.

Mel Robbins 1:13:58 (beep) What is that last one? Thermogenesis?

Dr. Amy Shah 1:14:01 Yes.

Mel Robbins 1:14:01 Non-activity, non-electric, what-

Dr. Amy Shah 1:14:04 (laughs)

Mel Robbins 1:14:04 ... I can't keep up with. What, what is thermogenesis? (beep) You're, you're in fucking menopause, so your mind is going.

Narrator 1:14:10 (laughs)

Mel Robbins 1:14:12 (laughs) There we go, yeah, we'll talk about that later.

Narrator 1:14:14 We'll do that later.

Mel Robbins 1:14:14 (beep) Do you want me to say which hormones?

Narrator 1:14:17 No, it's ...

Mel Robbins 1:14:17 It is? Okay, well then I would say what hormones. (laughs)

Narrator 1:14:24 (laughs)

Mel Robbins 1:14:24 (laughs) Yeah, no, we'll definitely keep it in what hormones then. (beep) I think that, uh, Diet Coke-

Narrator 1:14:30 Oh, yeah.

Mel Robbins 1:14:31 ... and the outside put a little life in, uh, sinus-infected Mel Robbins here. Oh, and one more thing. I know this is not a blooper. (laughs) This is the legal language. You know, what the lawyers write and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. I'm just your friend, I am not a licensed therapist, and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist or other qualified professional. Got it? Good. I'll see you in the next episode. (instrumental music) Hey, it's Mel. Thank you so much for being here. If you enjoyed that video, by God, please subscribe, 'cause I don't want you to miss a thing. Thank you so much for being here. We've got so much amazing stuff coming. Thank you so much for sending this stuff to your friends and your family. I love you. We create these videos for you, so make sure you subscribe. Mwah.