Did HRT Cause My Fibroids? Adenomyosis and the HRT–GLP-1 Connection - Esther Blum

Have you been told by your doctor that your labs are normal and everything is fine, but

you still feel like garbage?

And the things are just not adding up.

You're feeling dismissed and stressed and totally confused about what your body truly needs

in paramedics and menopause.

And if that resonates with you, then this episode is for you because today I sit down with

Esther Blum.

She's an integrative dietician, a menopause expert, bestselling author, and the host of

the Midlife Realignment Podcast.

I want to talk about self-advocacy, HRT, fibroids nutrition, and hysterectomies.

I promise you will learn something new.

And if you like what you hear from our guests, then why not meet them in our group meetups

in the Biohacking Menopause membership group.

All of our guests are invited to a live Q&A session to answer your questions, not mine.

And I'll have a link that and how to join in the show notes.

So now let's get started with the show.

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You are now listening to the HackMyH podcast, the show that brings you guests for the woman

going through the menopause journey.

I'm your host, Zora Benemoo, a gerontologist, certified sports nutrition menopause

and breathing coach.

Now, if you're a woman in perimenopause or postmenopause, check out the programs and

freebies on the HackMyH website or the biohackie menopause private membership and Facebook

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Well, it's a real pleasure to have Esther Blum on the show today.

Welcome.

Thank you, Zora.

I'm so stoked to be here.

I'm so excited to have you on today because I just love what you're doing in the menopause

space.

Your Instagram is so awesome.

And I actually learn a lot from you and your podcast as well.

And I'll have all of the links to this in the show notes, but I don't really know your

story.

Like, what pulled you into the menopause space?

Your nutritionist or diet, you know, registered dietitian and all that and you've done

and you are a menopause coaching.

So what was that moment you realized, oh, okay, I have got to help more women out here.

I was a hospital dietitian the first five years of my career working in cardiology units

in the hospital in Beth, Israel, in New York, but I had a side hustle, private practice that

I would do after hours.

And one of the first women to walk into my practice was a therapist.

And she was like, I'm in menopause, I sit all day, I have two days a week to work out.

And you need to help me get this first 10 pounds or this last 10 pounds off.

So I was in my 20s at the time and I said, I'd better really get a handle on this quick.

And fortunately, even while I was in the hospital, I did a functional medicine training that

enabled me to have the tools to start working with diet.

And we really started working on her own unique carb tolerance.

We took out any complex starches other than fruits and vegetables and said unlimited

protein.

You can have fat, have a lot of fiber.

And she lost 10 pounds and she also, she did this on her and I didn't even put her on

this.

She did that cayenne pepper, maple syrup, hot water, fast one day a week.

And between all of those things, she lost the first 10 pounds, or the last 10 pounds.

But then as time went on, I started really integrating Dutch test and GI map and really

doing deep dogs on blood work and hormones and then HRT.

Now the interesting thing is in 2002, when that women's health initiative study came out,

I remember my mom had her hysterectomy.

She was on HRT and I was like, mom, you've got to get off, you're going to get, she was

my mother had a cardiac history and I said, you've got to get off, you're going to stroke

out.

And I pulled her off, she was like, okay, whatever.

And she went off her hormones, which to this day breaks my heart, like I can't believe

I did that to her.

But we did the best we could with what we had, the knowledge we had at the time.

So that's really how I got into it though was because there was a need and there's going

to be 1.2 billion women in menopause by 2030.

And physicians are getting a whopping one hour of perimenopause and menopause education

in their entire medical school training.

And at least in the United States, the FDA has approved vaginal estrogen, estrogen patches

and oral progesterone who still have not approved testosterone for women.

It's considered an off label use.

But you know, we have hormones available for women and doctors are not learning it.

So there's a really huge gap.

So not only have I taught my own clients how to advocate, but I too have moved into the

advocacy space at this point because I'm just like, I'm working on getting medical

school education updated because this is nonsense at this point.

You've done so much education ever since I think sometimes your clients push you into

this when you get all the basics, the nutrition, the diet and exercise and you're like, well,

why isn't it moving?

Like what's going on?

Yeah.

And then you move into hormones or the Dutch testing with the gut issues and it can go deeper

and deeper.

And I think it's sometimes it's our clients who really push us to learn more and more

and so it is interesting that your mother, your own mother, is she back on hormones or is she?

She passed away a few years ago, but you know, it's she went into AFib and three weeks later

was gone.

She went into heart failure and could I say it was a deficiency of hormones?

Yes.

Could I also say she had COVID shots and was boosted out the wazoo because she was in

assisted living also.

Yes.

So PubMed, this is not conspiracy theories, published medical research on the cardiovascular

inflammation that has followed suit from these COVID vaccines.

And so I believe, you know, it was a combination for her, which is really unfortunate.

It's devastating.

She was only 83.

Yeah.

I'm so sorry.

I've lost my own mother anyways as well, through breast cancer when she was only 57.

So sometimes I feel like when people still have their mothers around, I'm like, wow,

that's just amazing, amazing.

So you're yourself going through the transition now or are you already on the other side?

I am done, girlfriend.

I had a hysterectomy September 24th of 2025.

I am 55 and I was having the most debilitating menstrual cramps on my left side.

I felt like someone had a searing, hot poker going all the way from my left over, out

through my back.

And it was keeping me awake three to four nights a week because it would last once the

cramps and inflammation started.

I was popping Advil and Tylenol like tic tacs.

I would have to stack each onto the other.

I started developing debilitating my greens like I spent my birthday vomiting, nauseous,

and my GY, I had imaging done.

I had eight fibroids, but they were on the right side.

So I was like, why am I getting this left side of pain?

And she said, well, I'm guessing you have undiagnosed endometriosis.

So we talked about all the options and it was like, it made the most sense to just take

out my uterus but leave the folopian tubes but leave the ovaries.

And I was already on a really nice cocktail of HRT.

So it turned out I had adnomyosis, which is a sister to endometriosis.

And after surgery, my pain from recovery of surgery was so much less than what I was experiencing

day to day.

Within two weeks, I was back walking six miles a day.

I was like, I lost five pounds overnight because my inflammation was gone.

Even post-operatively, I was less inflamed.

That's how bad it was.

I'm so grateful.

And my surgeon was awesome.

I was like, what do you say when I'm knocked out, like throwing a boob job, maybe a tummy

tag.

You was like, no, but like the team was so great.

I have the tiniest of tiniest scars and I just, I don't even care about the scars.

I'm so grateful not to be in pain all the time.

And, but you know, it's interesting, even though I was on a really awesome hormone cocktail,

we still, we reduced my estrogen, but we bumped up my testosterone and my progesterone's

about the same.

So, yeah, it was great.

So interesting about, again, do now recall your episode, I think, with Dr. Kerry Jones

and you were talking about adnomyosis and the pain that happens when you get fibroids,

it's real.

This is where a lot of women struggle, especially in this perimenopause phase, too.

And it seems to be getting worse at times as their hormones are fluctuating.

But what a lot of menopause doctors or coaches these days, not when you're in the menopause

space, usually they're trying other things first, like progesterone or, or, or NAUD or

other things.

Did you try some of those before, because you said you were on hormone therapy anyways,

right?

Yeah.

I'm actually on 450 milligrams of sustained release progesterone, so because my endosage,

yeah.

Because my insomnia was so bad, I had Lyme in mold and just, I have had a lot of insomnia

struggles.

So, it's so much better now because I don't have the inflammation going on in my body.

I mean, we cannot underestimate the impact that this, you know, systemic inflammation

has on our nervous system and our gut.

My gut was also really inflamed and pissed off.

It's much better now.

It's fascinating.

It's fascinating.

I imagine that you've probably tried all the low hanging fruit just didn't work and

then there comes a time you just go and people who have been so much pain and struggling

and they tried everything, the relief that they get unbelievable and it is life changing.

And I know chronic pain more than anyone else because I had osteoarthritis and hip pain

and chronic and it's debilitating and I have so much more empathy for anyone living

with chronic pain.

I hate that I had to go through it, but at the same time you go, well, there's probably

some lessons to be learned here.

And when you get, well, I had to dub two hip replacements, which at 54, now I'm 55 like

you, but I just was, yeah, my life is completely different now when you get pain free.

And I tried the hormones and then the low hanging fruit, who wants an operation, right?

There's, yeah, I think most people who get in this situation have tried it all, surgery

usually is the last resort.

That being said, there's no shame in it, obviously, and look at the relief.

It brought to you and to me.

And yes, I've worked with, I have a functional medicine, GYN, Dr. Suzanne Fenski.

She's one of my dear friends and we did everything.

She said to me, you are my most educated patient.

Like I, I came to her with solutions to, I mean, we partnered together, we did everything.

And I was doing caster oil packs and an anti-inflammatory diet and turmeric and ginger, all the things.

It just, when you have eight fibroids and one's the size of a kiwi and one's the size of

a golf ball, like, it's not going to go good.

It's just, it doesn't know a map.

There comes a point.

And this is where we all have this reckoning, right?

Because we're like functional medicine can fix it.

And there's almost like this arrogance around it and I'm calling myself out on this.

I can fix everything.

And you know what?

We can't.

Sometimes.

So that's the hard, honest truth.

Some things work really well for people, others, it does not as, at all, I have patients

with aloe syndrome.

Some women call it.

What's that?

Sorry.

What is that?

It's a connective tissue disorder.

And it causes just a host of complications and chronic pain and pelvic floor collapse, rectal

prolapse or uterine prolapse.

I mean, it severe constipation, pains out the wazoo.

And I have a patient with illers, danlos who hormones saved her life.

And then I have another who tried HRT and could not tolerate it at all.

It made her feel like a dumpster fire.

So it's like everyone is so different and we have to take into consideration bioindividuality.

What's your genetic makeup?

What are your detox pathways looking like?

What is your inflammation look like?

What is your gut function look like?

So everyone is so unique.

Have one woman's hormones or another woman's poison sometimes or one woman's hysterectomy

is another woman's joy.

So women do terribly after hysterectomies.

But I was on already so much support, but I definitely still felt like things, something

still off.

I also take, I added in 400 milligrams of co-Q10, I added in 5 grams of creatine a day

that I'll probably push up to 10 and I take touring.

I did have to redo my supplements a bit after hysterectomy because I'm still, believe it

or not, like your body is still recovering.

I'm still fatigued a lot.

And I'm like, duh, you just had a surgery a couple months ago.

Just because you went home the same day doesn't mean it's not a surgery.

We're in this health and wellness space or even the biohacking space and we want to

supercharge everything, we want to go faster.

We have the tools, we have the resources and so we get a little patient.

I think sometimes we think we are, our expectations are so high, but we're still human and these

extra things that we do can only go so far.

I think in some ways some things would help us get better, but we kind of still get

very impatient after a surgery, just want to get your life back together again.

Yeah.

And I think also sometimes I was very much like you in when I was diagnosed with osteoarthritis

as like biohacker, like I'll hack this, like whatever, like I didn't even know what

it meant at the beginning, but I'll get it.

I'll hack it.

I have the resources.

I have amazing doctors and regenerative medicine specialists in on my podcast.

I had access to them and when these don't work, you're just, you're shocked.

And I still believe the body can heal and nose.

I just ran out of time and ran out of money and I'm like, I can't do this anymore.

I might want to experiment with stem cells.

I need another six months and $10,000, I guess I want to get my life back now.

So it's time for surgery and it really taught me a lesson that sometimes shit happens.

Even doing all the right things, you get stuck sometimes and say, OK, and I always think

well, there could be worse.

I'm not complaining.

I know what it is.

I have a solution and that's already, I think when people have a diagnosis, at least

after they've been searching over and over and over again for answers, they feel relief

because they've got a solution, whether it's a drug surgery or some new protocol, right?

Yeah, absolutely.

A little bit about the fibroids, though, because I understood that fibroids get better as

women get through the menopause transition, they shrink or they get better, but I've heard

a lot of women in my community too, who it seems to get worse.

And some women would say, oh, it's the estrogen causing them to grow.

What are some of the myths or truths about fibroids and menopause and hormones?

Yeah, well, it's interesting because I asked Suzanne, I was like, did I do this to myself

because I did early intervention HRT, but my body needed it and benefited from it.

And I did add estrogen into my protocol, even though my periods up until about six months

before my hysterectomy, they were somewhat still regular, but I did add an estrogen.

So I was like, shit, did I fuel this?

She was like, no, not at all.

This is just a product of perimenopause.

And I looked again to my mom who had a fibroid, the size of a grapefruit.

She had a hysterectomy when she was 49.

And she was not on any estrogen whatsoever.

So we do get these estrogen spikes.

Our estrogen can be in perimenopause 200 in the morning and 1100 by 2 p.m.

We get these massive surges.

I always say it's the ovary's final hurrah, it's like the fireworks finale and your body

is kicking out these bursts to try and raise your circulating estrogen levels.

That's also why women tend to pack on extra body fat and that menopause because fat and

cholesterol are precursors to hormones.

Is it possible that the estrogen replacement that I added in have exacerbated the fibroid

growth?

It could have, but it's very likely that I had fibroids long before I even went on HRT

and just was a byproduct of perimenopause.

I also had like ruptured cysts, like I almost went to the ER one Thanksgiving day one year

when I was hosting, of course, like 15 people that day, it was just like excruciating.

And that was even before I was on estrogen, so it's unknowable, but I would still say

the benefits of early intervention HRT far outweigh the downsides because we lose the most

and you speak to this all the time and you're an instrument.

We lose the most amount of muscle and bone in the last two years of perimenopause.

Nobody knows that.

We lose them so quickly, nobody knows that.

They think it happens in our 60s.

I'm like, you should be getting a baseline bone density test in your 40s, between 42

and 45, not 65 when you've been 10 years postmenopause and your bones are already frail and osteophenic.

I've heard it's interviewed some bone experts who say no, get it in your 20s.

I mean, we get it.

Oh, interesting.

It's an amazing surprise because with the diet and the lifestyle, like the sad American

diet, for example, that can be doing a number on your bones and not everybody has strong

bones when you're in your 20s, but it also gives you a baseline to understand and in your

20s.

Sometimes, Dr. Doug Lucas, have you interviewed him?

He's brilliant.

He's a bone expert.

He's a bone doctor and he said he had osteoporosis, or maybe it was osteopenia, don't quote me

on this, when he was in his 20s.

I was like, wait, wait, wait, wait.

How?

He said it was a really bad diet that he had and that's just, but he doesn't have high fracture

risk.

That's a whole other story.

You can have osteoporosis.

You can have low bone mineral density or have this diagnosis on a DEXA, but yet have

strong bones.

That's why I tell a lot of people to go get a REM scan, R-E-M-S, because it tells you not

only the bone density, but it tells you the bone quality, the bone strength, and what

is the actual chance of fracture, because I don't care about a number on a DEXA scan.

I care, am I going to break a bone?

What are the probabilities?

I think it's one of these things we get so scared by this number, or this low bone density,

but what does that really mean, because it's just one marker.

That's why he says, get your DEXA as early as you can.

Not that you do it all the time, but you get a baseline in your 20s.

I'm going to send my kids to do this, because I just want to know.

Then you can do it five or 10 years before you do this again, unless you had actually

when you found something, and then you want to go into it.

I would far sooner do a REM scan than a DEXA.

And also, I'm sure you've read Estrogen Matters by Dr. Avram Blooming.

He cites so much research that shows that early intervention Estrogen, it also strengthens

the bones in a way where they can withstand impact.

If there's a fall, it almost gives them like a bendability, so they don't snap.

And it's, again, far better than, and you should still be getting vitamin D, boron,

vitamin K1 and K2, magnesium, all the cofactors, and, guess, eating collagen and bone broth

and protein and strength training, but above all else, Estrogen is scientifically proven

to make the biggest difference and have the largest impact.

And so we cannot throw that research away either.

We have to really understand the benefits of it, of Estrogen.

That's actually the one thing, but there are very few things that everyone agrees on when

it comes to hormone therapy or dosing, and yes or no, but everyone seems to agree, men

upon societies and experts out there, like, yeah, the Estrogen is good for the bone.

Like there's no doubt, you can prescribe it for osteoporosis or people who have low

and bone density, but you wouldn't prescribe it for somebody, there's some doctors who

are so stinky and they're like, well, you haven't reached menopause age yet and you're

not complaining that much and won't really give it to you, which, to me, seems ridiculous.

But if you have low bone density, it seems like they all agree they would give it to you.

So that shows you just how, because everyone agrees on it.

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So I want to talk a little bit about, because you do have a lot of women in your community.

You have a fabulous community. You have people you're helping. You've been working with women

for many, many years. And in midlife, we so often feel misunderstood and dismissed.

When someone comes to you, someone new in your community that you're working with,

what is the most common frustration you hear when they first come to you?

Oh, that they feel like a dumpster fire and they're told one woman,

Dr. Literally told her to change sex positions. I'm not even kidding. I'm not it like that

enrages me. I mean, we laugh because it's so horrific, but it enrages me.

Or they're told it's all in their head. I can't even tell you this is like what kills me is

how many women say, I must be crazy. No, like when is a woman ever wrong about what is going on

inside of her body? My famous gaslighting story is when I was in, I referenced earlier that I had

insomnia. Well, I had severe Lyme and mold toxicity and was also probably in the beginning of

parimenopause. And I went to this doctor sobbing. I was getting two to four hours of broken sleep

a night. That's it for years. So I go to the doctor and I'm just, I am just a mess. And he's, he

literally handed me a copy of the cabala, which is a book of Jewish mysticism. I am Jewish and he

was Jewish told me to put it under my pillow and then handed me a prescription for Xanax and said,

don't worry, it's not addictive. PS, it's highly addictive. So it was devastating. Like what when

women are gaslit, the implications for what unfolds in her life are tremendous because she shuts

down. She starts internalizing messages from someone who doesn't know her or doesn't know her body.

And then says, well, I must be crazy or they all say, not all, but a lot of women say, well, I guess

I have to live with this the rest of my life. This is just the rest of my life now. Even though

they're not sleeping, they've gained weight, they're exhausted, they have no libido, they can't

listen to their, their husband's breathing or chewing. They want to kill everyone and they

wake up 10 pounds heavier without changing a thing and they feel like they are a shell of

themselves watching their lives pass them by. And so to actually reprogram women to understand that

there is a light at the end of the vaginal tunnel and that they don't have to tolerate shit men

up as care and that they can actually demand more for themselves like they literally come back

to life. And I interviewed actually one of my former client Stacey who when she came to me, she

was wearing a hoodie and the hoodie was pulled over her head and she was a shell of herself.

She wasn't sleeping. She was a fitness instructor. So she would get up and she would slog her way

through classes, teaching, teaching, teaching. She was eating 40 grams of protein a day.

Oh my gosh. Like 11,1200 calories at most. Oh wow. And then with B in a haze all afternoon and she

has three boys and a husband and was trying to raise her boys and just was in a living hell.

And the first thing we did obviously was fix her sleep. I sent her to her doctor Suzanne and once

she started sleeping, I was like, get on her just around now. So she did. And once she started

sleeping, then we began refeeding her, refueling her. She now eats 120 to 140 grams of protein.

She lifts four days a week. She's down 30 pounds. But it wasn't overnight. But she said,

you brought me back to life because she had been to almost 20 doctors. That's devastating.

That's devastating. And the money wasted and the impact that has the stress on her health

is magnifying everything on top of it. It's terrible. I'm so sorry.

You dial into the money too. I mean, I joke that I could have a kelly bag by now with all the money

I spent looking just even find a proper Lyme doctor. Like I was told a million times I didn't

have Lyme. And my doctor was like, you didn't do the right test. So when I went to him, he's like,

we're going to redo all your tests. And sure enough, I had Lyme, I had co-infections.

I had to do home remediations two or three times for the mold. Like it was not inexpensive at all.

But I was like, I will sell the rights to my firstborn child if I can get my life back and feel

like a human again while I'm taking care of other humans. So yes, my goal is, and this is the advocacy

work I'm doing now. My goal is to have, I never want to have another woman in my practice show up

in tears. I never want to have another woman be a ghastlet. I never, I want her to be able to go

to any provider in any specialty. And they have enough knowledge to know, hey, put two and two

together, you know what? I'm going to refer you to a hormone specialist. I, you probably have

some perimenopause going on here. I want you to address that. Or a psychiatrist, imagine you go

to the psychiatrist and you say, I think I need anti-anxiety meds or I'm super depressed right now,

I want to kill myself. And the psychiatrist says, wow, she's like in her 40s or even late 30s,

she's starting to exhibit signs of hormone changes. Or the cardiologist, right? I went to

cardiologist because I had all these heart palpitations and my heart was pounding at night.

It wasn't a cardiac issue. It was a hormone deficiency. It doesn't pound anymore. So imagine

you go to any specialist and the specialist says, by the way, you're probably in perimenopause.

It's such a ridiculously simple thing. And yet because providers don't look at the whole person

and don't put two and two together, women are bouncing from specialists to specialists,

not getting the support they need, losing bone and muscle, losing their minds, losing their figures

and their feelings of self-worth. And all they had to do was just to their diet, maybe take a couple

supplements and add in hormones. It is so infuriatingly simple. So that is the goal. I see the story

all the time too. It does infuriate me when they go to doctors, even quote unquote,

menopause specialists, they tell me, they leave crying because they don't have the answers.

They're not heard. They're a ghastlet. In fact, one of the more popular reels that I made was

how to, was it with the five phrases to have your doctor take your menopause concerns more

seriously. And wow, that one went like wildfire because people were like, I need these five

phrases. This has happened to me. I've been, oh, these discussions go and it's so sad. I mean,

it's, it's, it's good that the real and viral people see it and they have these phrases.

It's so depressing to see the stories. When you read the comments, it's so sad. And I,

and we still have a lot of work to do, but the good thing is that we're learning their books out

there and podcasts like yours and mine. And it's funny. Some people like, oh, don't get your

information on Instagram. I'm like, well, if we got the information from our doctors, we wouldn't

need to go to social media. But that's right. In the meantime, there's information, misinformation,

whatever, it's all out there. We just have to learn how to filter it. But if we just, yeah,

had the care that we need or we felt like we were heard, then we, we honestly would not be

going to social media for these things. So 100%. So I want to move into a little bit about,

because you did mention the menopause. And I think weight is an issue for a lot of women during

this transition. So what do you, and I actually see a lot of women in ensure someone listening

now who are like literally doing everything that they're told to eat clean and exercise,

mental stress, and they still feel inflamed, exhausted, stuck. So one, I want to talk a little bit.

Let's why do these usual health strategies backfire? And what can a woman do to help her get

the body that she's wanting to live in? So often these strategies backfire, because women

can be eating so-called clean, but they're not understanding the biological needs

of a midlife body versus a body in our 20s and 30s. In your 20s and 30s, you cut calories,

you can do skip meals, intermittent fast, and you're going to be down 5 pounds by the end of the

week. In our 40s and 50s, we actually have to fuel our bodies much more. We actually have to

stoke our metabolic fire, and we do this in a few ways. So one is severely cutting calories

puts more stress on a midlife body. It raises our cortisol. Our bodies think we're

in danger. Starvation puts a lot of stress on the bodies on a midlife body, so all of a sudden

we go into conservation mode. And some women lose weight initially, but then they plateau and regain,

especially if carbs are restricted. We want, I cannot stress enough, the importance of carbohydrates

in midlife. And I'm not talking about twizzlers and popcorn, obviously. I'm talking about fruit

and vegetables, and I promise you, ladies, no one's getting fat on papaya as in bananas. So

eat fresh fruit. I don't care if it's, quote, a higher sugar fruit, like pineapple or papaya,

because there's so much anti-inflammatory nutrients in them. And no one is binging out on plates

of fruit. It's just, we can all snort lines of M and M's off the counter, but nobody is like,

oh, I have three oranges today. Woo! Good deal. It's so much fiber anyway. It's not the fruit

that's making you fat. It's not the fruit that's making you fat. It's not. In complex starches,

sweet potatoes, legumes, if you tolerate them, lentils and beans, plantains, cassava,

quinoa, winter squashes. All of those are rice potatoes, sweet potatoes. All of those are

complex starches, and we need to have them actually with our dinners. And most women, we were taught

never to have starch at night, but guess what? When you have starch coupled with, of course, protein

and fibers vegetables, you're going to get an insulin bump, even with fiber. You still get an

insulin bump with carbs. However, what does that insulin do? Well, it tamps down your cortisol.

So all of a sudden, if you've been waking up at 3 a.m. in a state of fight or flight because

your blood sugar is dropping and your cortisol is going up, once you start fueling yourself with

carbs at night, you're going to sleep much better. Now, while you do that, you also need to bump

up your protein a minimum four to six ounces minimum three meals a day. If you are intermittent fasting,

it is very difficult to meet your protein needs. You're going to have to supplement and have

a protein snack within that window plus your meals. But bumping up your protein, it's going to

stabilize your blood sugar. So it's going to fuel your neurotransmitters. It raises your

serotonin and dopamine. So you're mentally focused. It clears out a lot of brain fog. It stabilizes

your blood sugar. So you're not having hot flashes all night and your blood sugar isn't spiking and

dipping all day and all night, support your adrenals as well. So you pair that with carbohydrates,

fibrous carbs. And the fibrous carbs help convert T4 to T3, which is the active form of thyroid

hormone. For me, too, I was eating very low carbs like well under 100 grams a day and I could not

lose weight. And when I bumped it up to 120 grams of carbs a day, I lost five pounds. I was like,

this is awesome. I don't just apply the rules to my clients. I apply it to myself too. And carbohydrates

do refuel your adrenals and your cortisol can really take a hit in the absence of hormones.

So we need to make sure that we are not starving our bodies. We need to make sure that we are moving.

If you are too fatigued to really do intense workouts, just walk, walking really regulates your

cortisol. It burns fat beautifully. It's the most underrated form of exercise. If it's cold snowy

weather where you are, like you can get a walking pad or a stationary bike. Just do some gentle

cardio just to get your blood flowing and some calories burned. And of course, strength training is

important. But like fueling your body differently in midlife is really important. And I have seen

more women lose weight from bumping up their calories than any other diet they've tried.

And I know this because I get my ladies to track on my fitness pal or chronometer and they see

how little they're eating. And when they don't believe me, I'm like, ladies, when I worked in hospitals,

when patients were intubated, unrespirators lying in bed, they were eating. We were fueling them with

on tube feedings or intravenous fiends, 12 to 1800 calories, just lying there and breathing.

So don't tell me you think you can fuel your body on 1200 calories a day. When you're working out,

you're, you have a job, you're meeting the needs of your family or running a home. I'm like, that's

such a myth. So refueling is really important. And then there was a second question you asked,

but I can't remember. Oh, yeah. That was the minnow belly. The minopod. Okay. Yes. So that being said,

I do have a subset of clients who do track their food, who aren't meeting their macros,

who are straight training and their fasting insulin is still elevated. It's seven to 12.

It should be under five and their glucose is still running in the high 90s to low 100s.

Those women benefit from a metformin, which is it's an old medication for type two diabetes,

but it works. It was what was around before the GLP ones or GLP ones can also be in a wonderful

adjunct two. And it's not a dieting fail. It's not any failure on your part. It's a failure of

your biology at this point because your cells are not so receptive to insulin in midlife.

So if you're doing all the things, not moving the needles, a GLP one, especially when combined with

HRT, when a GLP one is combined with HRT, it's 15% more effective. There is now published medical

research that shows this. So getting on hormones, if you don't want to do a GLP one at a gate,

getting on hormones, there is a supplement called calocurb. I have no affiliation with it,

but I've tried it myself and I found it gave me GI pain, but other I've had other clients that

had good success with it. It does decrease your appetite, but metformin can really help improve

insulin sensitivity, although it doesn't not change your appetite. GLP ones improve insulin

sensitivity, and they slow down motility of food through your GI tract. So food stays in your

stomach longer, so you're less hungry, and you fill up easier on meals. And it does also get rid of

food noise and chatter. And the most interesting thing about that is I have so many clients who

were fat-shamed as girls. So they always have that inner voice, that inner asshole I call it,

being like, don't eat that, it's going to make you fat. You're looking chubby right now, don't

eat that shame, and it's like the shame blame cycle. So the GLP ones totally shut that off,

which is glorious for a lot of women, because then they never feel guilty when they're eating.

Really, so it does, I mean, I think that it takes away the cravings, but I didn't

reel on that noise, but I didn't realize that it would take away that feelings of shame,

because I'm not people who've had, who are on the GLP ones, and they're eating their twinkies

and their donuts, and they're like, well, I can eat this and still lose weight. And so I'm like,

okay, I don't think you're supposed to be doing that way, okay, but there it happens,

but I think I didn't realize that it would also take away that I shouldn't be eating this.

So this is going to go straight to my hips, even if you know that's okay to eat. I didn't know that.

Well, it takes away the GLP from not being in control, in quotes, in control of your eating.

And so they're like, oh, you over ate again. You're so fat, how could you do that?

And then they feel shame, and then they wake up the next morning, and the whole cycle begins

of the every calorie. There's this great scene from Eat, Pray Love, the movie, where Julia Roberts

is like, I'm so tired of counting every calorie and seeing how much shame and loving I can take

into the shower the next morning. And I put the post on my Instagram, it's so powerful because

we've all been there and done that. So imagine not feeling in control, or by the way,

you're not always in control because when you, when your estrogen is on a rollercoaster ride,

you're not always in control of your eating because you are ravenous. I was almost 10 pounds heavier

in the height of my perimenopause because I was starving all the time. I was waking up

ravenously hungry at 3am, and I was ravenous. I had to have three meals plus a snack, the size of

another meal, just to avoid that 3am wake up. And if I tried to decrease my calories, I was up

all night starving. It was like, I was trapped. And so when you can get out of that cycle,

it's liberating because all of a sudden, you're not ashamed because you have assistance

at being in control. You have support. So I'm not, and it's funny, I do present it as an option

to allow my clients very few of them take it. They're like, I don't want it. They see it as a failure,

or it's expensive because they're not type 2 diabetic. So it could be $300 for supply. And

or they just say, I don't like needles, or I just don't want to. I don't feel they're nervous

about it. The good news is with, and it's every woman's choice, I'm like, that no worries,

we'll work around it. There's no do or die at all. I'm never attached to it. But the good

news is with GLP ones, I see good results even when women are on a half dose. They don't necessarily

need the full dose. And there's far fewer side effects with a half dose. So that's the other thing.

I tell them, you can space the cell, and then it makes it more cost effective, and then you don't

have a side effects. I could have a whole episode with you and GLP wants to learn about it,

and the women in your community using it, the women in my community are using it. Not everyone,

but like you said, some like it, some don't. I did interview, oh, can't remember her name anymore,

someone on eating disorders. And I said, well, it seems GLP ones could really help with the food

noise. And she says, yes, but the moment you go off of it, it comes back. And so it's not really

solving the problem. So I think anyone who's going on the GLP ones, even if it's a low dose,

it sounds like it may need to be for the rest of your life. And like you said, it's quite

expensive until we have alternatives, right, because everyone's talking about who wants to inject.

I'm sorry, I'm not even injecting, but I think that there's a lot of people like me who'd be like,

oh, maybe, you know, you'd be interested in it, but no way I'm injecting. And that is why

optimizing your protein is so important, because protein is the only nutrient that shuts off

the hunger mechanism in the brain and gives you true satiety. So if you don't bump up your

protein, hey, you're going to lose muscle. So that is not the goal. Don't think that you can

write checks your body cannot cash. If you have only twinkings on GLP ones, you're going to

wreck your body composition. So you still have to do protein. You still have to lift weights.

Now the goal is to me, my goal is to get women doing more strength training so that they can

and need to eat more. The leanest women I know are eating at least 2000, sometimes up to 2500

calories a day. They're having at least 150 to 180 grams of carbs a day and they're on at least

150 grams of protein a day and they are lifting heavy because if they don't eat enough, they don't

have the strength and energy to work out and they cannot build lean muscle. So my goal is, yes,

initially I love to meet women where they're at and give them those so-called vanity metrics,

which by the way also help eliminate inflammation, help reduce cholesterol and cardiac risk,

help normalize blood sugar. So we get them over the metabolic hump where they're sleeping again,

they have energy, they're regulating their appetite and then introducing if they're not already

doing strength training, doing progressive overload where you slowly bump up the volume of weights

that you're lifting and increase the poundage of weights that you're lifting and then they can

taper down off the GLP ones, do them every two weeks, every three weeks and then eventually go off

and your appetite, it will be regulated under those circumstances and you can

totally possible to not regain the weight but you must do all the things. It's a partnership,

no one thing can do all the heavy lifting. No, I agree. There's a lot of work to be done. It's

just that it's such an easy route for so many people and it's amazing how effective it is.

Go, I got to wrap up here. I still have so many questions for you and I want to have a rapid

fire but I just to add to what you're saying because this question about the woman who does

everything right. I've seen so many of them come to my community as well and they really are.

I don't think that they're lying. I think they really are doing and what I kind of default to

very often is that I think that they're trying too hard. They're really pushing, like you said,

maybe fasting or they're eating very too low calorie and they are exercising too much and they're

trying every single supplement on the planet and I just strip them off of everything. I said,

don't exercise. Go for a walk. If that's too much, just go to some stretching at home but they get a

lot of fear. I already like this. If I were to stop exercising and eating more, which is basically

what I'm telling them and then work a lot on the nervous system because it seems as they're just

not only physically, they're stressed out, emotionally, mentally because they're putting so much

effort. They're trying so hard that the moment we just kind of stop everything to stop,

to stop and work on yourself in your nervous system, things start to regulate and that's quite

effective for some of the women who are just overloaded doing everything right.

Correct, because if their cortisol is in the toilet, you can't pour from an empty bucket.

So we do have to also get your cortisol curve up and regulated or alternatively tamp down your

cortisol if it's too high and again, it's really hard to regulate that if you're doing interval

training and starving yourself. So what you're doing is regulating, which is beautiful.

Okay, rapid fire now. I'm going to end with the rapid fire and I would just want you to say

whatever comes to your mind. No need for combinations. Your favorite breakfast.

Protein smoothie, a dollop of Greek yogurt. It's this one I use called Icelandic provisions.

It's super high for it's 17 grams of protein and I think three quarter cup and then I do a scoop

of way protein, a scoop of collagen, one to two tablespoons of flax seeds and a banana and a shot

of like hemp milk and that's my morning smoothie. Yeah, fasting in menopause. Really individual

works for some but very few. It's really a 12 hour fast is fine but more than that gets really

tricky for a lot of women. Now that being said and there isn't a lot of research on intermittent

fasting in women let alone menopausal women. So for some women it's great for most women.

The opposite is true when we start fueling their body more is when we see the needle move.

Cardio versus strength training. I mean both. It's really a lot of walking and two to three days

a week of strength training. HRT. A must. Hormone testing. Very helpful once especially once

you have started using hormones. A baseline is nice but if you're in perimenopause it's a moving

target. So you know if your doctor won't do a baseline or provider have them do it after you've

started introducing HRT for six to eight weeks and also monitoring your symptoms but I do think

testing is important because especially for estrogen you do want to have a certain baseline level

for bone density. Hormone detox supplements. I have heard some of them work. I have not seen it in

practice but I really haven't done a lot of work with it either. Stress management. Number one

because stress drives hormones from the top down. So whatever is going on in your head whatever

trauma whatever grief whatever stress is going to impact more than anything in perimenopause your

progesterone levels which will impact your sleep your anxiety your body composition. So stress

regulation management is a must. It only takes 10 minutes of deep breathing every day to lower

your cortisol. That's it. So it's a non-negotiable. One habit you swear by every morning. Walking.

And it outside in the sun every morning. Now I'm a little bit of a hypocrite right now because

there's two feet of snow outside my window. So I bought a walking pad. I'm not outside as much

as I should be right now. But otherwise like three quarters of the year. 10-12s of the year I'm

doing that. Yes. One thing women should stop blaming themselves for. We can. Wonderful answers.

Okay I'm not gonna let you go. I think we need a part two because I didn't even get my questions

but I want to show you a little bit before we go with the you've got your menopause coaching

and you've got a freebie for us some top hormone tests that every perimenopausal woman needs to know

tells a little bit more what you're offering here. Yeah so this is a guide of that you can print out

and take to your provider and say I want to get these tests done if you think you're in perimenopause.

If you're cycling regularly you should have these tests down between days 19 and 21 of your

cycle. If you're late perimenopause days one to five of your cycle but it's a really handy guide

that you can have and of course listen to my podcast the Midlife Realignment. Join me on Instagram

at Gorgeous Esther and I'm here to support excellent. I'll have links to this in the show notes

and your website estreblum.com has everything as well loads of information there. Thank you so

much Esther for your time and thank you everyone who's made it to the end of the podcast. We appreciate

your time and you're obviously very interested in this topic so please hang out for more and follow

Esther and you're gonna learn a ton. Thank you Esther. Bye bye. Hey did you enjoy the podcast?

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