Integrative dietitian Esther Blum is famous for her work helping women through perimenopause and menopause. She has mentored thousands on the diet, lifestyle, and supplement changes that can help them cruise through this notoriously volatile time of life. She even wrote a book on the topic, See Ya Later, Ovulator!.
It’s vital work given that not only are American women not educated on this phase of life, but our doctors aren’t either. A recent New York Times article revealed that "about half of all practicing gynecologists are under 50…might never have received meaningful education about menopause."
That stat didn’t come as a surprise to Blum, who started her career as a dietitian working in hospitals where she only had 10 minutes with critical care patients before sending them on their way. Her experience inspired her to take a functional medicine course and open her own practice. “Over the years, more and more people came to me with the same issues I was going through. I noticed the biggest complaint was just absolute gaslighting from their doctors, no addressing menopausal symptoms, doctors telling them to either go on the pill or go on an IUD, or to wait it out,” Blum says. “I decided that I needed to be the advocate for these women because I did have a platform, and I did have a voice.”
Here, Blum answers Veracity’s questions on what every woman should know to set them up for a gentle and healthy transition through this stage of life.
Veracity: Perimenopause and menopause seem to sneak up on many women because it’s still somewhat taboo to talk about them. Can you share some of the signs women should look out for that might point to being on the cusp of perimenopause?
Esther Blum: The symptoms are often the same between perimenopause and menopause, but with menopause, you go 12 consecutive months without a period. So, some telltale signs that things are changing and you're heading into perimenopause are:
Look at your PMS. If you notice that it went from a day or two to two weeks long, that's a sign that your progesterone levels are starting to fall. Also, if you notice the second half of your cycle is dramatically different than the first. I hear this from a lot of women. They’ll tell me, “I feel like a crazy person during the second half of the month, I'm extra moody, I'm irritable, I'm crying, my breasts are tender. And then as soon as I get my period, it's like I'm totally myself again.” It may be a sign that your hormones are changing.
Watch for changes in your period. Heavier periods, clots, more erratic periods, changes in schedule are all symptoms. Some women get their periods more frequently, like every 21 days, and others get them less frequently with six weeks between cycles.
More brain fog.
Insomnia is also a big indicator. This could be a perimenopause problem especially if you're not sleeping before your period.
Lots of rage. I call it meno-rage.
Increased urinary frequency. If you never used to get up in the middle of the night to pee and now you are, that can be a sign that your estrogen levels may be dipping.
V: Once you begin to notice these signs, what are some lifestyle changes that you should start thinking about making to help protect your hormones as you move towards this transition?
EB: First of all, diet is really important. It plays a huge role in regulating your sleep, your energy, your moodiness, and your irritability. Also, women are at the greatest risk of losing muscle mass during perimenopause and menopause, more so than any other time in life. As your hormones decline, your muscles follow. You should:
Optimize protein. Truly, madly, deeply. Most women are eating one egg, or avocado toast, or oats for breakfast. They're not getting enough protein, and they're feeling exhausted. For most women, optimizing protein means four to six ounces at a meal three times a day. When you optimize your protein, you raise your dopamine and serotonin, so you knock out your cravings, you support your adrenals, you consistently have mad energy throughout the day without the caffeine rush, and you optimize your body's ability to build muscle.
Make sure your ratio of protein outweighs carbs: If you notice you're getting that “meno-pot,” as I like to call it, where your muffin top turns into a cake top, you want to make sure that your ratio of protein outweighs your carbs. A great way to determine this is to log your food for three days.
Eat your carbs at night with dinner. Most women are eating a big bomb of carbs in the morning which is a recipe for fatigue. You're also much more insulin resistant in the morning. So having carbs at night will not only be a good fat loss tool, but also it will help you sleep better because the slight bump in insulin will tamp down cortisol, which is a stress hormone.
Re-examine your relationship with alcohol and caffeine. Both will interfere with your sleep, make your liver a lot less happy, and give you blood sugar imbalances. Alcohol especially makes it really hard to lose weight.
Lift heavy weights. This is very important to maintain your muscle mass. And it needs to be more than three to five pounds – I'm talking 10 to 20 pounds and up.
Finally, stress management. Start to develop a spiritual practice or a breathing practice every night or every morning. At some point during the day, you have to take care of your mental home.
V: Do you have any advice on how specifically to protect your hormones during this time? For example, I know during perimenopause, levels of estrogen can swing up to 30% in one day.
EB: Some of it is going to be out of your control, but certainly supplements can be very beneficial. Chaste tree is a great way to try and get your progesterone up to offset that estrogen running wild.
Maca root is also really nice. There was a study that showed it resolved hot flashes in 87% of women who took it. But again, diet and lifestyle are the foundation. You can't out-supplement any of this. It's got to be behavioral first.
V: You are famous as Gwyneth Paltrow's menopause mentor. What is something that you taught Gwyneth about menopause that you wish all women knew?
EB: I think what Gwyneth did not know about was the impact of gut health on hormones. She had very big exposure to mold in her home and was very sick, and cleaning up her gut made a huge difference because the gut is important to detoxing estrogen.
When it comes to gut health and optimizing hormones, fiber is great. Flax seeds and chia seeds are going to bind excess estrogens and help you detox them. Getting lots of cruciferous vegetables – brussels sprouts, artichokes, cauliflower, broccoli, radishes, kale – helps your liver and your gut excrete excess estrogens and move down less inflammatory pathways. Also, just eating real food is important. For a lot of people, dairy and gluten are a big problem. But I test for those things, I don't guess, because I don't want somebody to have to eliminate food if they're not sensitive to it. Pleasure is a great nutrient, too, and I want people to have as liberal a diet as possible.
V: Is there anything else that you think it’s important for women to know?
EB: If you feel you're educated on hormones and you have a doctor who's dismissing you and not listening to you, go find a new doctor. Medicine's a business like any other and just because they wear a white coat doesn't make them the expert on your body. You are the expert on your body. Women who come to me saying, “I think my hormones are off. I think my cortisol is off. I think my gut is off” are always right. Their symptoms always track in the testing. We are fantastically intuitive around our bodies.
This interview was edited and condensed for length and clarity.