Hi everyone and welcome back to the show. I’m Meryl Brandwein, integrative nutritionist and founder of the Brandwein Institute, where I help women, especially women 45 and up. Finally get to the bottom of their fatigue, bloating, weight changes, mood shifts, sleep disturbances, and those mysterious symptoms that no one seems to have the answer for.
Today we’re talking about a really hot topic, hormones, perimenopause, and the rush towards HRT hormone replacement therapy. Listen, I am not anti HRT, not at all. For some women, hormone replacement is life-changing in the best possible way. But for many others, it can become the default answer before anyone looks at the rest of the body.
What I want to do today is break down why symptoms that get blamed on hormones aren’t always hormonal at all, and how women can end up chasing the wrong fix, even when intuition is telling them something deeper is going on. So my goal is for you to walk away from this episode feeling informed, grounded, and empowered.
So let’s dive in. Lemme tell you a, personal story to set the scene right. I’m gonna start with a quick story about a woman named Lisa, who came to see me recently. She’s 47, busy career woman, has two teens at home. She’s pretty healthy overall but she had been feeling off for a little while.
She had fatigue, bloating. Her weight was starting to creep up. She had brain fog, mood swings. And she was waking up at 3:00 AM for no apparent reason. So does this sound familiar? And her doctor did exactly what many are doing right now, saying to her, well, you’re almost 50, it’s perimenopause. Let’s get you started on HRT.
And look, she was ready. She wanted that to be her answer, but here’s the thing, once we look deeper at her digestion, at her nutritional status, vitamins, minerals, antioxidants, her stress levels her blood sugar, and her nervous system, the picture was a whole lot more complex. Did hormones play a role?
For sure. Were they the whole story, not even close. And this is why we need a more nuanced conversation around this. So why does every symptom after the age of 45, or even I will say some women, even after 35, right? So I’m gonna go on a limb and say anywhere between 35 and up things are getting blamed on hormones.
And I actually know some women in their twenties where it’s getting blamed on that. Let’s talk about why this happens. Women hit their mid forties, let’s say, or even early forties, and they start experiencing symptoms. And the default narrative is it’s your hormones, it’s perimenopause, this is normal, this is aging.
But symptoms are not diagnoses, symptoms are signals. And here’s the physiology. Most women are never taught. It’s not on social media. And your influencer is not telling you this. Hormones don’t decline in a straight, predictable line during. Perimenopause, they fluctuate sometimes wildly, often day to day, even hour to hour.
And so estrogen doesn’t just drop. It can surge. It can crash, it can spike again, and those swings can stress out the nervous system at the same time. Cortisol, which is your primary stress hormone, becomes more influential. And cortisol does not just respond to stress. It reprograms how your body uses blood sugar, thyroid hormone, and even estrogen itself.
So when cortisol is high or erratic. Estrogen symptoms get much louder. Not because estrogen is at the root cause, but because your system is already overloaded. And why does this matter? Because we want to reframe hormones as responsive, not defective. And what we often call hormonal symptoms are actually things like.
Blood sugar dysregulation, chronic stress and high cortisol, thyroid slowdown, inflammation, poor sleep, gut imbalances or sluggish digestion, liver detoxification in issues, environmental toxin load, and nervous and or nervous system dysregulation. All of these, every single one of these can mimic hormonal symptoms or even worsen them.
And here’s the important point. If the foundations aren’t solid, if the pillars that we talk about, those foundational pillars, your nutrition, your sleep, your stress, as we’ve mentioned, your environment, your mental, emotional state, your movement if those are not solid, HRT can only take you so far. And in some cases it does nothing.
In other cases, it actually can make women feel worse unless the other systems are addressed. So here’s the big myth. If I feel bad, it must be must. Estrogen. Well, let’s break this down because this is one of the biggest myths. Low estrogen they people say is the reason I feel terrible. But as I , just mentioned estrogen doesn’t work alone.
, It interacts with insulin receptors, thyroid hormone receptors, neurotransmitters like serotonin and dopamine, and your liver detoxification pathways. And even your gut bacteria. This means that two women with the same estrogen level can feel completely different. One woman can clear estrogen efficiently through her liver and her gut, and another may recirculate it because her detoxification pathways are sluggish.
One woman can be insulin sensitive, another is insulin resistant, and insulin resistance amplifies estrogen related symptoms. So when we say it’s your estrogen, what we’re often missing is how your body is processing, responding to and recovering from hormonal shifts. Here’s the truth, some symptoms are due to declining estrogen.
Some are due to estrogen dominance. Some are due to cortisol. Some are due to thyroid. Some are due to gut issues. Some are due to blood sugar, and most women are dealing with a combination of all of these. Your estrogen may be low, but your blood sugar could be high. Your progesterone may be dropping, but your nervous system is in survival mode.
Your hormones may be shifting. But your liver is overwhelmed and can’t clear estrogen properly. This is why women 40 and Up deserve more than a blanket label and a prescription for HRT because we know, , the body is a network. It’s not a set of silos. Like we’re often told or what we often believe, and this is where conventional care can fall short.
Hormones don’t operate in isolation. They’re influenced by nutrition, movement, stress, sleep, environment, emotional pattern patterns, and nervous system tone. And 📍 let’s be honest women past the age of 40 and even up to 60 or beyond are carrying a lot. They’re dealing with aging parents, teens or adult children, careers, relationships, caregiving, and.
Even identity shifts. And I will tell you that is a real thing and it’s empowering. But all of this is going on, and this is a biological stressful 10, 15 years from a physiological standpoint. Your body doesn’t distinguish between emotional stress, metabolic stress, or inflammatory stress. It all funnels through the same command center, thehy, hypothalamus, and pituitary, which are the control hub.
Of both your stress hormones and your sex hormones. So when the brain perceives chronic demand, without enough recovery, it prioritizes survival. Your body wants to survive, and when survival is the priority, which it always will be, reproduction hormones or reproductive hormones get deprioritized. And this is part of the reason why we are also seeing infertility,
because we’re also stressed out. These reproduction hormones get deprioritized, and that’s a problem. Thyroid output is affected. So people think thyroid, as we age, thyroid goes down, but it’s all connected. And so this can lead to, thyroid output can slow down again. Usually there’s a trigger.
Digestion, weakens and sleep can become fragmented, and so many perimenopausal symptoms are actually the body saying. I don’t feel safe enough to be optimal right now because if you are in fight or flight, your body is not going to relax. It is not going to calm down and you need your body to calm down.
So what do you think happens when the nervous system is overloaded? Cortisol spikes, blood sugar swings, inflammation rises, thyroid slows, sleep, deteriorates, digestion, weakens, and yep, hormones get thrown off. Ho hormones are often the victim and not the villain. So where do the symptoms really come from?
Let’s walk through some common symptoms, women attribute to hormones and the symptoms that often sit underneath, or excuse me, and the systems. So it’s, we’re gonna talk about symptoms. Women attribute to hormones and the systems underneath. So fatigue could be poor glucose regulation, nutritional deficiencies, thyroid issues, chronic stress, poor sleep structure, and gut inflammation.
Fatigue isn’t just low energy. It’s often a mismatch between energy demand. And cellular energy production, blood sugar swings force cortisol to compensate. Cortisol steals resources from thyroid and poor thyroid signaling means mitochondria. Your energy factories, those cells in your body slow down so you’re not lazy.
Your cells are under-resourced. The big one, weight gain around the middle could be high cortisol, blood sugar dysregulation, low muscle mass. This is a big one. Inflammatory and inflammatory diet. Estrogen dominance. Low progesterone, sluggish thyroid. So midsection weight gain is rarely, if ever, about calories.
This is not a calorie in calorie out, eat less, more protein, da da da da. Now it’s driven by insulin and cortisol. Talking to fat cells and high cortisol tells your body to store energy centrally close to the vital organs and fluctuating estrogen, or excuse me, add fluctuating estrogen into the mix. And fat tissue becomes hormonally active, so fat tissue will actually start to produce some estrogen so the body isn’t failing.
It is adapting to perceived stress. If you have bloating or digestive changes, often this could be imbalanced gut bacteria, low stomach acid, especially if you’ve been any on any of those proton pump inhibitors, the Pepcid, the Tums, the Prilosec, any of those, omeprazole, those kinds of things.
Poor motility, stress shuts down digestion. You could have food sensitivities, you could have sluggish liver detoxification, meaning your liver is not processing toxins efficiently. So here’s where hormones can play a role. Because estrogen affects bile flow, progesterone affects gut motility. Cortisol shuts the whole system down entirely.
And when stress is high and hormones are shifting. Digestion becomes inefficient. Food can start to ferment. Your gas starts to build up, inflammation increases, so it’s not food that is the enemy, it is the digestive environment. Then we have mood swings or anxiety, which is often driven by blood sugar, highs and lows, high cortisol, poor sleep, low progesterone.
Emotional load and lack of recovery time will make this worse because progesterone is calming and it supports gaba, which is your inhibitory neurotransmitter, helps calm things down, and as progesterone declines in perimenopause, the nervous system loses one of its natural breaks. It’s like the braking system.
Then you layer in blood sugar crashes and poor sleep and anxiety skyrockets. Many women are treating anxiety with willpower when it’s actually a biochemical imbalance. That is so important because this is not willing your way out of these imbalances. Then we have night sweats. The waking up at 3:00 AM it’s often a cortisol surge.
It could be glucose dropping during sleep as well. Poor hydration, alcohol, big one, and stress accumulation. If you’re getting up between two and 4:00 AM Your body is heavily reliant on stable blood sugar and low cortisol, and if your glucose drops overnight too low, cortisol will surge to compensate, and it’s that cortisol spike that’s waking you up.
This is why late dinners, alcohol undereating, and chronic stress are so tightly linked to night waken waking even before your hot flashes begin. Do hormones play a role for sure, but if we don’t address the foundation, we’re building a house on sand. So where does HRT hormone replacement fit in? Let me be crystal clear.
HRT can be amazing. Estrogen replacement can improve bone density Vasomotor symptoms, which is the hot flashes, night sweats. Vaginal tissue integrity and cognitive symptoms for some women, but it doesn’t stabilize blood sugar. It will not lower cortisol. It will not heal the gut. It will not restore mitochondrial function and it will not resolve nutritional deficiencies.
That’s not a failure of HRT itself. It’s a mismatch of expectations. That’s why it shouldn’t be the first step. It should be the supported step. You wanna think of HRT, like amplifying a sound system if your system is clear and balanced. The amplification sounds beautiful. If your system is distorted.
Adding more volume makes the distortion louder, and that never sounds good. Many women are starting HRT when their blood sugar is unstable. When their stress is high, their gut is inflamed, and their sleep is poor, and their metabolism is struggling, and they end up feeling disappointed when HRT doesn’t magically fix everything.
Okay. HRT works best when the terrain, again, that foundation is optimized. What do you do before you try? HRT? Here is my six pillar framework that can really help you identify where some of this stuff is. Before you go in and give HRTA try, which will only set you up better if you decide to do HRT. Many times people do this work and decide they don’t need it.
So it really comes into play and it’s important to consider. So before again, before you jump into HRT, consider building. A foundation in these six areas. As I mentioned, we’re gonna go through, I mentioned these before, but nutrition. Nutrition stabilizes insulin. It lowers cortisol. It supports estrogen signaling, and so nutrition isn’t about eating perfectly.
Please understand that it is about creating metabolic safety because remember, when your body doesn’t feel safe, it’s not gonna be balanced. So when meals are balanced, when enough protein, fiber, and fat. Are in the mix. Blood sugar stays steady, and it is not all about protein. Let’s get off of this myth.
And the misunderstanding that everybody needs. Every woman needs a gram of protein, per pounds of body weight. This is not true and this is not effective. So it really matters what your individual makeup is. It is never, as I always say, this is an individual personalized approach. You can’t just blanketly say, every woman needs this.
So important. And so when blood sugar stays steady, cortisol doesn’t have to step in. When cortisol comes down, estrogen can finally do its job, and that’s why someone may feel hormonally better off, as I mentioned, just by eating consistently and. Adequately, even before they touch supplements or hormones.
And think about anti-inflammatory foods, right? Your colorful fruits and vegetables. Let’s get off of the fruit fear because there’s sugar in it. Let’s get away from this whole, I can’t eat lectins. Like it’s all bullshit. You gotta make sure that you are consuming fruits, veggies, color, okay?
Yes, you want adequate protein, but for most women, 0.8 to 1.0 gram per kilogram of body weight is. Adequate. It’s even more than adequate. So when you figure out kilograms of body weight, you go your weight and pounds divide by 2.2, that’s kilograms. And I will tell you most women are not at the a hundred mark unless you are really working out.
With heavy weights three to four times a week, you probably need a little more at that point. One gram per kilogram, one to 1.2, but certainly not one gram per pound. Absolutely not. But food also helps support the gut. And I mentioned blood sugar balance movement is another. That’s the second pillar movement.
It is. So important. For so many reason, it improves insulin sensitivity, which lowers stress hormones, and it helps estrogen signal much more clearly. Strength training, even with bands, even with your own body weight, makes tissues more responsive to estrogen. The more muscle you have, the more your body is going to respond to estrogen.
So it’s not about. Pushing harder. It is about teaching the body that it’s strong and stable. The other thing that low intensity movement and mobility calms the nervous system. So we don’t wanna go out and go, pardon the expression, balls to the walls crazy four or five days a week. This drives cortisol so high, so we need to balance it with low intensity movement and mobil mobility, especially as we age.
We wanna make sure. That mobility and flexibility are part of our program. And I’ve also added this into my routine, and I tell, I will tell you, it matters. It really matters. So again, it’s not about pushing harder, it’s about teaching the body that it is strong and stable. Strength training low intensity movement, mobility work.
You wanna add all of this into the mix. Stress in the nervous system, pillar three. Stress regulation helps to restore the HPA hypothalamus pituitary adrenal access. The hypothalamus in the pituitary are in the brain. The adrenals are down near the kidneys, and there’s a highway that they talk to each other about stress, when to release cortisol, when to do this and that.
So when your stress is balanced, this signaling this highway. Run smoothly. If you are highly stressed and there’s all kinds of stuff going on, guess what? There’s detours everywhere and traffic jams. So you wanna reset your system by regulating your stress. So stress regulation, let’s be clear, is not about eliminating stress.
We know that’s impossible. That is not the expectation. It’s about restoring. Clear communication between your brain and the rest of the body. ’cause yes, it is all connected. And your HBA access is the signaling system that tells your adrenals, your thyroid, and your sex hormones, how to respond to life when it’s constantly activated, signals get distorted and cortisol stays elevated, your recovery gets suppressed, and hormones lose their rhythm.
So practices like breath work, journaling, and intentional recovery, they’re not soft, they’re not weak. They actively restore this HPA access signaling, and when that signaling resets. Everything downstream starts to recalibrate your sleep, your blood sugar, your mood, your thyroid function, and yes, your hormone balance.
This is why regulating rather than pushing is essential in midlife. The body heals in safety, not in survival. Let’s talk now about sleep. So many women have such a problem with sleep, here’s what we know. Sleep improves. Hormone. . Puls, your hormones are not meant to be released at a steady drift.
We talked about this. They are released impulses, timed waves that follow your circadian rhythm, your internal clock. So think of it like music, healthy hormones. You’ve got a nice rhythm and flow dysregulated hormones. You’ve got static or erratic noise and nothing sounds or harmonious. Okay? And those pulses are how the brain talks to the rest of the body.
Sleep is the conductor, and when you sleep well, especially deep sleep and REM sleep, your brain sends clean rhythmic signals from the hypothalamus. And the pituitary two adrenal hormones, which is again, cortisol, thyroid hormones, insulin regulation, your reproductive hormones including estrogen, progesterone, and lh, which is luteinizing hormone and FSH, which is follicle stimulating hormone, and it also sends signals to growth hormone.
This timing matters more than most people realize. And what happens when sleep is. Poor, which again, common in as we go through perimenopause and menopause. Cortisol pulses become erratic. Insulin sensitivity drops, growth hormone release decreases, and reproductive signaling becomes completely chaotic.
So instead of clear pulses, hormones start to leak. Spike or flatline, and this is when we hear women say, I’m wired, but I’m exhausted. I wake up anxious for no reason. My cycle is unpredictable. My hormones feel all over the place. So you’re not wrong. The signaling is off, right? How do we fix this? You wanna make sure you go into circadian alignment.
You want to have evening wind down rituals, create a sleep hygiene plan. That you can follow consistently. It doesn’t have to be perfect. It just needs to be consistent. All right, pillar number five, your environment. Your environment matters because your hormones are constantly interacting with it. Many everyday chemicals in water, in plastic, in .
Beauty product, in household cleaning. Cleaners, they act as endocrine disruptors. That means they mimic block or interfere with natural estrogen signaling. And at the same time, your liver is responsible for breaking down and clearing both hormones and toxins. And so when that system is overloaded, estrogen doesn’t clear efficiently and it recirculates.
And that can be a problem for so many reasons. So including setting you up for hormonal based cancers. So supporting detox pathways isn’t about extreme cleanses. We’re not talking about, fasting or water fasting or these crazy three seven day juice cleanses. No, it is about reducing the incoming load when possible and giving the liver what it needs to do its job.
Clean water, cleaner products, and mindful swaps. Lower the background noise so your hormones can communicate clearly and effectively. Six. Here we go. Last pillar, emotional and behavioral health. Last but certainly not least, emotional and behavioral health shape hormone balance. More than most of you realize chronic overgiving poor boundaries and constant self pressure and self-judgment.
I will say. Keep the nervous system on high alert, right? So none of you do that do you? And a nervous system that never feels safe will always prioritize survival over repair and recovery. Boundaries aren’t just emotional, they are biological. I’m gonna tell you that personally, when I finally learned how to set boundaries and understanding boundaries, and it wasn’t until I was 50, , I have a podcast with Nancy Levin and she wrote a great book called setting Boundaries Will Set You Free.
Definitely go listen to that podcast, check out her book, but because it’s so, so important and helpful. Here’s what happens when you do all of these things. It helps to lower cortisol. It creates internal conditions for hormones to become regulated and supportive. Habits like self-compassion and realistic expectations send a powerful signal to the body.
You’re not under attack, and so when your nervous system feels safe, hormones will stabilize. Then when all of these foundations are in place. HRT if you choose, it integrates cleanly and effectively, but like I mentioned, so many women find that they don’t actually even need it. So you, up to you, there is no judgment here.
You are your own person. You know what you feel like, use your intuition, but you definitely want to make sure you are resetting and optimizing your foundation before you jump into HRT. And so if you’re listening and wondering, okay, well where do I start this week? Here are some things that I’m gonna mention.
Make sure you’re really looking at your diet. You want to make sure that you’re stabilizing blood sugar at every meal. So that doesn’t mean only consuming protein. It means protein with your veggies, with, you can do some kind of. Starchy vegetable like a potato. Everybody’s so afraid of potatoes.
Potatoes are some of the best foods in the world, okay? Starchy root vegetables. Your squashes, for example. When you start adding those in, it adds satiety. It adds that feeling of fullness, it adds that satisfaction when you’re eating, and so that can really help balance your blood sugar. You wanna make sure that you’re doing at least 10 minutes.
So number two, incorporate at least 10 minutes of daily nervous system. Downregulation could be breathing, it could be walking, it could be journaling, it could be stretching, and it could be any and all of those. But if you do not spend some time inactive recovery your nervous system is going to be out of whack.
And number three, try cutting alcohol for 14 days. The impact on sleep, mood, hot flashes and bloating can be huge. And so these are small changes that create big shifts. So if this episode resonated with you and you’re, if you’re 40 and older and you’re navigating symptoms that aren’t getting better, if you feel like your body is changing and you want a guide who can look at the whole picture, I would love to support you.
You can follow me. On social media, you can subscribe and like these podcasts and share them please, because. You may have found help and relief from us. And not everybody, I don’t know how you found us, but people need to find us. And so even though I share daily education, hormone support, tips, and real life tools, we always appreciate if you can share this with someone who you think might benefit or if you can even benefit yourself because.
It does matter. And , as always, I provide a 15 minute complimentary consultation to see if this work is right for you. So hope you found some interesting tips and pointers and maybe that aha moment that you didn’t come in with. And reach out again if you have any questions. And make it a great day everyone.
This is your rebel nutritionist signing off.
