Menopause Mastery: Navigating Nutrition, Exercise And Hormones For Optimal Midlife Health

Hello everybody, and welcome. Happy New Year and happy January 2025. Welcome to this year’s first virtual master class. We are so excited to have our guest with us, but first a few housekeeping items before we get started.

You’ll see a new face here alongside me, and Sue too, but I also want to introduce Pam Buckley. She is about a month now into working with us here at GGW full-time, so I’m very excited to have her in the office and wanted to get her face out there for our virtual master class attendees. You’ll see a lot of Pam here and there, helping out and doing a ton of stuff, and like I said, I’m super excited to have her on board.

A few other housekeeping items on events. For those attending ICE, which is coming up rather soon, we will have a Game Changers panel on January 22nd, along with a brunch and time for networking, running from 10:30 a.m. to 12:30 p.m. during the DEI programming at ICE. If you’re attending, be sure to sign up, go take a look at the panel, start networking, and meet other GGW members.

We also have some educational opportunities coming up. For the first time ever, we’re expanding our in-person education conferences internationally. We’re going to be in Sydney on March 4th and 5th for a leadership conference, and we’re currently accepting applications until this Friday, the 17th. After that, we’re hosting a leadership conference in Toronto, Canada, on April 1st and 2nd, with applications open until Friday, February 14th. On the night before, March 31st, we’re also hosting a membership mixer at the Betty offices, and we’ll be sending out more information about that very soon. I’m looking forward to meeting new members in the Toronto area.

We also have a W Conference that will be hosted here in Las Vegas, with applications open from February 3rd through March 7th and the conference itself running April 30th through May 2nd. If you know anybody at a senior director or VP level, that’s the perfect conference for them, so have them apply. We’ll send out more information as the application dates get closer. Feel free to reach out with any questions at info@globalgamingwomen.org, and we’re happy to answer those for you.

So without further ado, I’m going to introduce our guest today, Sue Page, who joined us last year and whom we’re really excited to have back. Sue is a certified nutrition coach and menopause educator. Inspired by her own menopause journey, she founded 40/50 Fabulous to empower women to become their own health advocates. Sue’s mission is to ensure women have access to evidence-based information and personalized guidance so they can confidently navigate their midlife health. Sue, welcome, and thank you for joining us again. I’m going to turn it over to you so we can get started.

Thank you so much. I’m so happy to be back here. I can’t believe it’s actually been a year since I last presented. Some of you might know me as the CEO of Neoself, but my passion project is my nutrition business. I have an associate’s degree in advanced nutritional science, I’m an MNU certified nutritionist, and I’m a menopause educator. As Kelly said, I really started this business because of my perimenopause journey, which hit me really hard and had a huge impact on my professional and personal life. There was no help out there at all, I had no clue what was happening to me, and I really had to become an advocate for my own health. My business came about because I didn’t want other women to have to experience and suffer the way I did.

Fast-forward five years, and now menopause is much more mainstream. We’ve got great conversations opening up, which is fantastic, but it’s also bringing out what I affectionately term the “wellness w*s.” There’s an awful lot of misinformation out there. It’s a multibillion-dollar untapped category, which means there are many unscrupulous and unregulated products and services preying on women when they’re at their most vulnerable, trying to sell them a magic pill or potion. Everything that I do is evidence-based and backed by science. Unfortunately, I’ve got to tell you, there is no magic pill. But I hope today’s session leaves you with some useful tips and tools to help you navigate your midlife health and give you the ability to separate the helpful from the utter b**t that’s out there today.

I’m going to do a very quick menopause recap, since we talked about this last time. Although we talk about “menopause” a lot, there are actually three stages. Perimenopause can start in your early 40s, and this is where most of us start to become symptomatic and experience the hot flashes, the lack of sleep, and the changes to our periods. As you can see, we have an awful lot going on with our hormones. Estrogen — the pink wavy line — is fluctuating wildly, not just day to day but hour to hour, and it’s really responsible for most of the symptoms we experience because we have estrogen receptors all over our body. You also see progesterone declining in a much more linear fashion. That relationship between progesterone and estrogen can cause the hot flashes and some of the other symptoms experienced by most women. Because estrogen isn’t declining in a straight line, one day you can feel great and the next day you can feel absolutely terrible. It’s really the main instigator for all our symptoms.

Perimenopause can last a long time — for me it was 12 years, though the average is around seven to eight. Menopause itself is just one day: the average age is 53, and that’s your anniversary, 365 days after your last period. After that you’re post-menopausal, so basically, welcome to the rest of your life. You’ll still experience some symptoms and there’s still a settling of your hormones, but you’ll start to really regulate and be more at home in your new post-menopausal body.

The key thing is that estrogen receptors are all over our bodies, so it’s not just about the hot flashes. There are so many different symptoms, and it’s different for every single one of us, which is why it can be so challenging when it comes to treatment and even recognizing what’s happening to us. Impacted sleep is the number one reported symptom, and hot flashes, brain fog, weight gain, anxiety, and vaginal issues are all extremely common. At the time of writing there were 34 published symptoms, and there may even be more now, so we’re still counting and still adding to the list.

Many of us don’t associate perimenopause or menopause with these symptoms because we experience them in different ways, and that’s really because estrogen plays a crucial role throughout the body. It matters not just for sexual and reproductive health, but also for maintaining a healthy heart and regulating cholesterol — a lot of women start to see their cholesterol spiking as they go through menopause. It affects brain health, which is why brain fog is such a big issue for so many women, as it certainly was for me. It also regulates our immune system and our response to infections, affects gut health and gut motility (how food moves through your digestive tract), has an impact on vaginal health, and is a key player in maintaining bone mass and bone health. So we really are going through a very big transition.

One of the things I always recommend to my clients is to start paying attention and tracking your symptoms, because we tend to look at things in isolation rather than as interconnected. When you have a symptom tracker and you’re writing things down, it gives you a much better view of what you’re experiencing and how regularly. Most importantly, it gives you a checklist you can take to your doctor. There’s a free symptom tracker download on my site — I’ll send the link to Kelly and Pam so they can distribute it — and I highly recommend you use it and just track what’s going on.

So our bodies can be freaking out at this stage in life, and it can be really overwhelming. There’s a huge amount of misinformation and disinformation in the menopause space, with lots of differing messages. My goal today is to clean some of that up and give you easy, evidence-based tips on how to look after yourself through this transition — how to simplify your nutrition, how to think about weight loss and exercise, and a little bit about the hormone therapy discussion so you have confidence talking to your doctor. Most of this really boils down to finding the right common-sense strategy that suits you and fits into your lifestyle.

Let’s start with nutrition, because this is the biggest one and there’s so much misinformation. First myth: your hormones are making you gain weight. The good news is they’re not; the bad news is they’re creating an environment that makes it difficult to lose weight, but they’re not solely responsible for weight gain. What you’ll notice with estrogen decline is a recomposition of where you store body fat, with an accumulation of adipose tissue on the belly versus where you gained weight previously — hence the delightful terms “meno belly” and “muffin top.” That’s a real thing, and a lot of women find they haven’t necessarily gained weight or gotten heavier on the scale, but their body composition is changing, which can be quite depressing and distressing.

Another myth is that your metabolism has slowed down or is broken and needs to be reset, rebooted, or detoxed. None of that is true and the evidence simply isn’t there. In fact, recent studies show it only starts to slow down when we hit 60, and only by a very small percentage annually. There’s also the myth that you need a special diet. You don’t need to do anything special other than nourish yourself correctly and give yourself the right balance of macronutrients so you’re energized and nourished through this stage.

It’s also not your cortisol levels — it’s not any one thing you can blame. Cortisol is not responsible for fat gain. Your cortisol can be higher because we’re stressed, we’re working hard, we’re the sandwich generation looking after parents and sorting out kids, but that stress hormone is not making you gain weight. It may make you retain water, so you may see scale weight go up, but it’s not responsible for fat gain.

This is one of my favorites: you’re not eating enough and you’re in “starvation mode.” That’s not a thing. Most of us have seen shows like “Naked and Afraid” where they stick people on a desert island for two weeks and watch them all lose weight — that’s actual starvation, so this is definitely not a thing. You also don’t have to intermittent fast to lose weight. Some women really like it and find it’s a good way to get into a calorie deficit if it suits them, but there are no magical health benefits to intermittent fasting and it’s certainly not the only way to lose weight through menopause.

You don’t need to cut out carbs, either. Some women prefer to, but I’d never recommend it because we need carbs and actually do much better on them through midlife. Glucose is our brain’s main source of energy, and since most of us suffer from some brain fog, being able to feed our brains as well as our bodies is really important. There’s also no diet out there that will “balance your hormones.” Yes, we want a well-balanced diet with enough protein, a decent amount of healthy fats (fat helps produce cholesterol, which supports hormone production), and enough fiber to keep your gut motility working as it should — but no specific food or diet balances your hormones, and you certainly don’t need to “detox” them. That’s just a marketing term.

Finally, a big one: “calories in, calories out doesn’t work in menopause.” It does. We can’t argue with the law of thermodynamics — that’s just energy balance. The formula doesn’t change with menopause, but the equation becomes far more nuanced, and that’s what makes it hard. It makes it much harder for us to get into a calorie deficit.

So let’s talk about metabolism — what it is, whether it’s broken, and whether you can fix it. My goal is to give you a much better understanding of how it works, because there’s a lot of messaging about it being broken or slowing down, and that really isn’t the case. One of the most comprehensive studies of its kind, from a couple of years ago, showed that even after 60, when it does start to slow, it’s by less than 1% a year, so it really doesn’t have a huge impact.

The biggest part of your metabolism is your BMR, or basal metabolic rate — everything that keeps you alive: your organs, the blood running through your system, your nervous system. It’s the energy used to create cells, move and store energy, and keep your organs functioning. It’s mostly genetic and very difficult to influence, and we tend to forget that we are a highly sophisticated machine. BMR makes up around 65% to 70% of your total daily energy expenditure.

Next is TEF, the thermic effect of food — the energy it takes to move food through your gut and intestines. Protein has the highest thermic effect, which is why we call it the “magic macro,” along with fiber, and that’s great because these are two of the most important parts of your diet as a midlife woman. Still, TEF is only about 8% to 10% of your daily expenditure.

Then there’s exercise. A lot of women, when they start to gain weight in midlife, automatically do more cardio or add more workouts. But if you think about it, 45 minutes working out a day is less than 3% of your day, and exercise represents only about 5% to 8% of your total daily energy expenditure.

The biggest area of influence you actually have is NEAT — non-exercise activity thermogenesis, which is a fancy way of saying all the other movement you do outside of the gym.

Let me introduce you to Sally. She’s struggled with her weight her entire life, losing it and gaining it. She knows how to diet, feels like she’s hardly eating a thing, but still isn’t losing weight. She’s tried everything and nothing seems to work, so she figures she’s menopausal and her body is working against her, and the only way to lose weight is to keep cutting calories. Let’s take a closer look at what she’s actually doing.

She has a desk job and works from home, like a lot of us, at her desk five days a week from 9:00 to 5:00, usually taking about 30 minutes for lunch at her desk. She does go to the gym, working out four times a week for at least 45 minutes, tries to get out for a 30-minute walk with her family a couple of times a week, and meets a girlfriend for an hour of yoga on Sunday mornings. She has great sleep — good on you, Sally — going to bed at 10:00 and waking at 6:00. Most nights she cooks dinner and then watches shows with her family.

So how much is Sally actually moving? There are 10,080 minutes in a week. She spends 3,360 minutes sleeping, 2,250 minutes sitting at her desk, 1,680 minutes Netflixing and chilling, 420 minutes cooking, and only 300 minutes exercising. When you break it down, the time where she’s static and not moving represents almost 50% of her week. This is where there’s such a huge opportunity to increase our movement, increase energy expenditure, and therefore get ourselves into a calorie deficit. When you hear “eat less, move more,” it’s definitely more nuanced and has to account for everything going on hormonally, but the evidence still holds that we need to create that calorie deficit — and sometimes simply moving more, not working out more but just getting up from the desk, lets us expend more energy.

If it’s not the metabolism, why is weight loss so hard? Your body is changing with aging, and subconsciously we’re moving less. When your hormones are going haphazard, there’s a decline in physical activity and we don’t even realize it. A recent study even showed that the more women work out, the less they move throughout the rest of the day. (I have to apologize — for some reason my presentation has got a mind of its own and keeps bouncing, so bear with me, ladies.)

On top of that, many of us have little or no history of resistance training. We haven’t done strength training or trained with purpose in our earlier years, so we don’t have a lot of muscle mass — and when muscle starts to decline, that significantly reduces our daily energy expenditure. Sleep matters too: with less sleep you’re hungrier, your hunger hormones come into play, your food preferences change because you’re tired and irritated, and you have a drive to eat more and make poorer choices, reaching for higher-carb, higher-calorie, less filling foods. That makes it much harder to get into and stay in a calorie deficit.

We also overestimate how many calories we’ve burned and underestimate what we’ve consumed. That’s not a criticism, but the fancy trackers we wear are at a minimum 25% to 35% inaccurate and probably overestimate how much we move. On the consumption side, a study from last year showed most of us underestimate what we eat — some by up to 50% — so unless you’re actually weighing and tracking everything, it’s really difficult to know how many calories you’re consuming.

Finally, and it sounds simple, but we need to reset our expectations. We all have this unrealistic idea that we’re supposed to lose two pounds a week or 10 pounds in six weeks. We have a great week, get on the scale the following week, and it’s gone up again, and that becomes a trigger. Understanding that weight loss is not linear — that the scale goes up as well as down, that our bodies are supposed to fluctuate, and that it takes longer to lose weight in menopause — means we just have to keep going. We don’t give up just because we were good Monday to Friday and nothing happened; it takes weeks, if not years, to lose and maintain weight loss. In summation, menopause itself does not cause the weight gain, but it creates the environment where a calorie surplus is more likely.

The good news is you’re not broken. There’s nothing in your body fighting against you, and there are so many things you can control and influence. The margins are narrower, but you can control the outcome. The fitter you are, the more muscle you have, and the better you sleep — which I know is a big ask — the easier this transition becomes. It’s not that you need to do lots of different things through perimenopause and menopause; it’s more that the things you did before now have less wiggle room, because the margin to get into a calorie deficit is smaller.

So what can you do? I approach this with my executive clients like a work project: lay the foundations and really commit to making change. First, commit to tracking or journaling everything you eat for one to three days — I recommend three, but if that feels hard, do one. Include everything that passes your lips, and get really honest with yourself. Don’t eat differently because you’re tracking, because we’re trying to find out how many calories you’ve actually been consuming. Log the bites, the licks, whatever you take off your kids’ plates, whatever you put in your coffee, and how many glasses of wine you’re having. Don’t rely on recall — write it down as you eat it, because recall skews the data. Remember, this is all about data.

Next, consider learning about portion control and weighing your food. If you have a kitchen scale, use it; if not, I highly recommend getting one. Don’t weigh out what you think the serving size should be — pour yourself a serving as you normally would, then weigh it and see how big the portions you’ve been giving yourself really are. US portion sizes are huge, and I think we’ve lost all perspective on what a serving of pasta, for example, actually looks like.

Then work out your calories so you can be in a deficit. The easiest way is to look at your target weight — keep it realistic, not your college weight or what you weighed at 21 — and multiply it by 12. For example, if 150 pounds is your goal, you’re looking at eating 1,800 calories a day to be in a calorie deficit. If that number seems surprisingly high, go back and do task number one to see exactly how much you’re consuming, because you’ll be very surprised.

After that, focus on what you’re eating and how your meals are balanced. With your calorie deficit in place, add protein at every meal. An approximate target is 0.8 to one gram of protein per pound of target body weight. That can seem really high, especially if you’re not used to it, so start small and build up, but aim to add it to every meal. If you like avocado toast, put some salmon on it; add cottage cheese or egg whites to your scrambled eggs; add protein powder to overnight oats. More protein at each meal also helps keep you satiated.

Next, consider fiber, because most of us aren’t eating enough. Think whole grains — oats in the morning are amazing — plus lots of beans, fruit, vegetables, chia seeds, and raspberries. Look at how you can add more fruit and veggies to your day. Be careful, though: if you’re not used to a lot of fiber, you can create digestive issues, so go slowly and build up.

And get moving. We’ve just seen how easy it is to be sedentary, and this isn’t only about weight loss — sitting for extended periods is associated with a 40% to 60% greater risk of heart failure. So we need to get up. I know how hard this is, because it’s a real struggle for me: I go to the gym, come back in the morning, and sit at my desk all day. If you can’t get out for a walk, set a timer, get up, do some squats, or walk up and down the stairs — just do something to keep moving. Finally, be consistent and realistic, because Rome wasn’t built in a day. If you wing it at weekends, you’ll just spin your wheels. Build that big foundation and stay in it for weeks, if not months, to create sustainable weight loss.

The next piece is working out, and there seem to be so many rules about what we shouldn’t be doing. But I love this quote: “If exercise could be packaged in a pill, it would be the single most widely prescribed and beneficial medicine in the nation.” (I think the original said “nation,” but I’d make it “globally.”) Exercise should be a non-negotiable. It’s one of the main tools to improve your sleep, minimize menopausal symptoms, and support your mental health. We were born to move, and I think we should separate exercise from being just a weight-loss tool and instead see it as a way to build strength and muscle, increase bone density, and improve heart and mental health. We don’t need a special plan and we don’t have to limit ourselves — the best combination is lifting heavy and adding cardio to stay efficient. We absolutely do not need a special “menopause workout plan,” and I guarantee you have no idea what you can achieve.

For optimal health, just get yourself out there and get moving. Even if you’re brand new to working out, the very best thing you can do is get outside for a walk. For cardio — and despite what you might see, it’s not having a massive impact on your cortisol — your levels will go up while you exercise, which is exactly what they’re supposed to do. Cortisol spikes are part of a healthy system; they go up and come back down, and that’s a great way of relieving stress. Do the cardio you enjoy, whether running, cycling, or rowing. You don’t have to go all out with crazy HIIT. Zone two means you can still speak to a friend while doing it, and you should aim for 150 minutes a week or about 20 minutes a day, which doesn’t have to be all at once — even 10 minutes here or five minutes there matters.

The next thing is to lift heavy s**t, and this is my mantra — it’s the most important thing you can do right now. No matter your age, if you’re pre-menopausal it sets you up to be far healthier and better able to cope with perimenopause and menopause; and for those of us out the other side as post-menopausal, like me, it protects your joints. Muscle is the organ of longevity, and resistance training is an incredible way to diminish long-term joint stress and increase bone density. It improves health outcomes by increasing muscle strength, raises your basal metabolic rate, reduces body fat, lowers cardiac risk factors, and — probably most importantly — promotes cognitive function and psychological well-being. Imagine prescribing a drug that could do all of that.

Remember that “heavy” means heavy for you, and you’re way stronger than you think. Don’t go to the gym for little five-pound, two-kilo weights — you’re already picking up heavy grocery bags, so you can probably carry 10 to 15 pound dumbbells, you just don’t know how strong you are. Push yourself, do something heavy for you, and consistently build on it each week, adding more weight as you get stronger. If I put my female CEO hat back on, I can tell you nothing in my life has had such an impact on my self-esteem and confidence as strength training. Walking into a conference room full of men as the only woman, looking around and knowing I can out-lift every single one of them, is one of the most empowering things there is. So get out there and lift heavy s**t — I guarantee it will be a game changer.

Be consistent and realistic: get a program and stick to it, because random workouts get random results. It’s like business — fail to plan, plan to fail — so you get back what you put in. And with strength training, your body isn’t getting “confused.” You don’t need to swap it up every week; you just need to do the same thing repetitively and add more weight, because you’ll get stronger and more powerful as you go.

Now let’s talk about hormone therapy. My caveat is that I’m not a medical practitioner, so my goal is just to give you an unbiased view of the landscape and some tips to discuss with your doctor if you feel it’s the right course for you.

A few things to know: hormone therapy is the gold-standard treatment for hot flashes and night sweats, and it’s also prescribed for the prevention of osteoporosis. If you’re around 50 and haven’t had a bone density scan yet, get yourself booked in — that’s very important. If a scan shows you have osteopenia, which is the precursor to osteoporosis, estrogen therapy can be prescribed to help prevent osteoporosis. It’s not a magic pill and it’s not a weight-loss tool, but it can help with the redistribution of adipose tissue and belly fat, and it can help indirectly with weight loss because you feel better — you hopefully get better sleep without night-sweat interruptions, so you’re more inclined to work out and eat well.

So what is it exactly? It’s known as menopause hormone therapy, hormone therapy, or hormone replacement — though “replacement” is used less now, because we’re not trying to replace hormones back to pre-menopause levels, just to mitigate menopausal symptoms. Estrogen therapy comes either as a pill or transdermally as a patch, spray, or gel, so it’s about finding which is easiest and fits your lifestyle. Really importantly, if you still have your uterus, you have to take progesterone alongside estrogen, because progesterone protects against endometrial cancer — so it’s super important that’s prescribed as well. Progesterone is also known as the “keep calm and carry on” hormone; it isn’t prescribed for this, but a lot of women find it helps with anxiety and sleep. It comes as a pill or a coil (the Mirena IUD), so if you already have the IUD, you’ll just need to add estrogen for hormone therapy. One important note: progesterone is not absorbed through the skin, so please don’t buy yam-based creams off Amazon — you see a lot of misinformation here, and it’s critical to have the correct, properly prescribed dose to balance the estrogen.

Vaginal estrogen is something we don’t talk about enough, and I think every single woman should know about it. It’s safe for everybody. It’s a topical application, so it’s not systemic and doesn’t get into the bloodstream, which means even people going through or surviving breast cancer can take it. Many vaginal issues in menopause — very frequent UTIs, vaginal atrophy that can cause painful sex, and GSM (genitourinary symptoms of menopause) such as bladder leakage and loss of bladder control — respond to it. If I said there were no miracle cures, I’ll take my hat off here and say vaginal estrogen is actually a miracle cream. It’s available with GoodRx for around $8, and I believe you can also get it with insurance, so definitely talk to your doctor about it if you’re suffering from those symptoms.

Finally, and importantly, you do not need testing. If you’re over 45, it’s a symptom-based diagnosis and a symptom-based treatment. If a practitioner tells you that you need blood tests every three months and charges you a fortune for them, that is not standard of care, and you can choose to get better care elsewhere. If you’re under 45, you do need a blood test to see what’s going on, but otherwise it’s symptom-based.

Not every woman has to be on hormone therapy. A lot of women don’t do well on it, so if you don’t want it or don’t feel it’s right for you, you’re not missing out on health benefits — hopefully you’re nourishing yourself and doing all the exercise and other important things we’ve discussed, and those lifestyle changes are just as important and can actually be more impactful. Hormone therapy is more like the cherry on top of the cake; you’ve got to build the good foundation first.

There are non-hormone options out there. There’s Vezoa, which you’ve probably seen advertised, recently approved by the FDA for hot flashes. Some antidepressants can be very helpful — I won’t name them all because I’ll get tongue-tied, but they’re worth discussing with your prescriber — and gabapentin has also proven useful for hot flashes. With anything herbal or supplement-based, I’d say proceed with caution. None of it is regulated, so you can’t guarantee that what’s claimed on the label is actually in the bottle, and some ingredients like black cohosh have been linked to contraindications with certain medications and to liver issues, so be very careful and speak to your doctor before starting any treatment. And again, vaginal estrogen for all.

Things are getting better, but unfortunately we’re still not there. Be aware that most doctors are not trained in menopause or receive very little training, and even those who are tend not to be up to date with the latest hormone therapy guidance. You can look at the latest guidelines from NAMS — the North American Menopause Society — on their site, or there’s a link on my website. They say the benefit is greatest before age 60 or within 10 years of menopause (10 years from your last period), because there is a slight increase in the risk of breast cancer and some cardiovascular contraindications. So find yourself a professional and ask them to explain the risks and benefits to you, because this is your choice.

You don’t have to wait and you don’t have to suffer — that’s a really key message. So many women I’ve worked with, and I did this myself, say, “Oh, it’s not really that bad, I’m only waking up three times a week, I won’t go to the doctor yet.” But you don’t have to suffer; there’s no prize for suffering through. If you’re struggling, talk to your doctor, take the symptom tracker, and have that conversation — but be aware that you have to advocate for your own health. I think that’s difficult for women of our age, who were brought up not to question anything. What I’ve learned is that your doctor is not judge, jury, and executioner; he or she is there to guide you, but ultimately the decision is yours. Ask the questions, and if you don’t feel you’re getting the right standard of care, you’re perfectly entitled to change your doctor until you do. A lot of the telehealth services are quite good now too, and I’ll put some links there for Kelly and Pam to share later.

Unfortunately, the grift is real. Menopause is the buzzword, and a lot of people are preying on vulnerable women who are desperate for help, so be aware and do your research. Watch out for terms like “estrogen dominance,” which is not a medical term — it doesn’t exist, it’s a marketing term. “Progesterone cycling” is similarly pushed as marketing and isn’t anything a doctor would ever discuss with you. The “Dutch test” is not recognized by the medical profession; it’s a waste of money, often costing hundreds of dollars while telling you nothing, so avoid it. Anyone pushing a “hormone detox,” “reset,” or “hormone balancing” is not an expert.

You’ve also got a proliferation of people on social media calling themselves hormone experts or hormone coaches simply because they “fixed” themselves or their own hormones. A real hormone expert is an endocrinologist who has spent years studying. So do your research and understand that a doctor listed on the North American Menopause Society site, or one of the telehealth menopause specialists, will generally give you a far better standard of care than someone promoting a hormone reset online.

Finally, “bioidentical” versus “body identical.” I’m sure you’ve all seen this, and it’s misleading. All hormones — even the FDA-approved ones — start from yams or soy, are plant-based, and are then synthesized in a lab. So whether they’re called body identical or bioidentical, marketing them as “natural” and “plant-based” is misleading. You’re not getting a better-quality hormone from someone calling it bioidentical than you are from an FDA-approved estrogen patch.

Hopefully this helps. The general message is to keep things simple and focus on whole foods — you know the rules. Try to keep highly processed and sugary foods to 15% or less of your diet, but don’t restrict and don’t tell yourself you’re not allowed a cake, cookie, or bagel, or whatever brings you joy, because that just sets you up for failure. We want an environment where all foods fit. Focus on eating more protein and fiber, aiming for around 30 grams of protein with each meal. Get outside — walking 20 to 30 minutes a day is highly recommended, especially straight after a meal, because that helps regulate your blood glucose. Lift heavy s**t. And avoid alcohol; I haven’t gone into it here, but it goes without saying that alcohol is not our friend in midlife, and limiting or avoiding it will have a huge impact on your sleep quality and the severity of your symptoms. Talk to your doctor and don’t suffer in silence. And finally, work with a professional — you can work with me. I have a special offer for Global Gaming Women members of 20% off any of my services, and I work one-on-one with women to help them navigate this whole midlife journey. Thank you so much for having me; I know it’s so much information, but I hope it was useful.

Kelly: We love it. I’m sitting here staring across the office at Pam saying, “Okay, when the weather gets nicer, we’re hitting the pavement, walking around.” After a month working together, now I know I’m not alone in feeling chained to my desk, because Pam equally sits at her desk, so we’re going to hold each other accountable and start walking — and as you were talking, she literally stood up and started walking in place. It’s so helpful, Sue, but it’s also that recognition that it’s really hard to do. I’m at a standing desk now, but I’ve spent all day sitting down. It’s so easy to do.

Sue: The other part of this message is to just be kind to yourself. You really have to be kind to yourself, and don’t try to do everything at once. If you can take little bite-sized pieces and focus on just a couple of things a week, it’s going to be far easier than trying to do the whole thing at once.

Kelly: Exactly. We do have a question that came in: “Is the target weight formula in grams or pounds, and is it total or net after exercise?”

Sue: It’s total, and the weight is in pounds. So if your goal weight is 150 pounds, you multiply by 12 to get 1,800 — that’s the only math I can do. We’re not netting exercise out. And one of the biggest pieces of advice I can give you: ignore the trackers. You didn’t burn 500 calories going to a spin class, so ignore that. Just focus on the calorie deficit and on moving more throughout the day.

Kelly: Thank you for that — great question. I’m not sure if we have any other questions.

Sue: Any other questions? I’ve just blinded everybody with science and info.

Kelly: This is great. I love that you said we can still keep a little bit of sugar in our daily diets, because for a minute I thought, “Oh my gosh, what am I going to do if I can’t have my sweets at night?” Thank you for making me feel okay that I can still have them in moderation.

Sue: Absolutely. It’s unconditional permission to eat — just not to eat everything. There’s no good or bad food; food has no morals. So it’s important to find a balanced diet that works for you, since we’re all very different and what works for me is different to what works for you. You can go out and experiment and find your own way.

Kelly: That’s important too, because everybody gets caught up with “Oh, this works for so-and-so,” and then you compare and hold yourself to that same limitation, but everybody’s not equal. That’s one thing to really keep in mind. Thank you again — for me it was very helpful, and I’d been looking forward to this. We appreciate you and all the work you continue to do, and I still love the story of how you got to where you are with this.

Sue: Oh, thank you. I’m happy to come back, and you’ll find me at GGW events — come see me and chat with me, look for the pink hair. If this was good and you’d like me to come back, tell me what you want me to focus on and I’m more than happy to, because knowledge is power.

Kelly: Yes, it is. We’ll be in contact with you at some point. Thank you, and get out for a walk!

Sue: Exactly. Thank you so much, everybody. Have a great evening.