Do you ever feel a little bit baffled by menopause or wonder what’s really going on with all those hormones everyone’s talking about? And what’s the difference between menopause and perimenopause? And how do you know you’re in it? More importantly, what can you actually do to make it through this change of life more comfortably?
Today I’m interviewing Dr. Kate Namas, who is a naturopathic doctor and menopause specialist about everything from menopause and perimenopause to hormone replacement and the practical steps that you can take to keep your body healthy. It’s an interview that covers a lot.
Ruth: I am so excited to be able to introduce you to today’s interview guest, Dr. Kate Namas.
Dr. Kate: Thank you for having me.
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Ruth: So let’s just start at the beginning. I want to hear a little bit about who you are and what you do.
Dr. Kate: ‘m a naturopathic doctor and a menopause society certified practitioner through the North American Menopause Society. I’ve been practicing for 16 years.
I actually also have a certificate of midwifery, but I’m not a practicing midwife. And my entire career has been helping women with menstrual disorders and infertility, perimenopause and menopause. And I love continuity of care, so I work with people from first period to last period.
Ruth: That’s amazing. It must be so fun to watch people go through all the different phases and journeys of life from just starting out to having babies to getting older. Have you been doing it long enough to go through the whole cycle?
Dr. Kate: I have. Yeah, the first baby I delivered is in college. And some of my clients who have had like three babies in the practice are now postmenopausal. So I get to see all of those things, get to see their kids grow up. It’s extremely rewarding.
Ruth: So let’s talk about all the things, menopause, perimenopause–lay it out for us. First of all, perimenopause. What is it? How do you know that you’re in it? How is it different from menopause?
Dr. Kate: So perimenopause is the symptomatic years leading up to menopause. And menopause is when our period has stopped for a year. So during perimenopause, we may have the hot flashes that everybody talks about, or the mood changes, or insomnia.
Also another sign is difficulty losing weight, or quick weight gain, when in the past you didn’t have that struggle. Another telltale sign is that our periods start to change. On average perimenopause lasts about seven years. What happens is our ovaries stop producing estrogen and progesterone, and by menopause, we’re barely producing any estrogen or progesterone, so we have a significant hormone deprivation state.
Ruth: So how do you know that you’ve started perimenopause? What are the surefire signs?
Dr. Kate: There are no surefire signs for certain. And that’s why it does help to have someone who can help you identify it. But usually it’s that your menstrual cycle starts changing. So if you were a classic 28 day cycler or a classic 32 day cycler, and now you’re having random 21 day cycles or random 48 day cycles, and you’re between 35 to 50, that’s a pretty good indicator that you’re probably perimenopausal.
Ruth: So do those symptoms subside by the time you actually stop having your period when you’re in official menopause?
Dr. Kate: They keep going for longer. What happens in early perimenopause is our hormones start being more erratic, especially our estrogen. So we’ll have high estrogen days and low estrogen days.
We might have more headaches because our estrogen is changing. We might have more mood changes. And then as we get closer and closer to menopause, when our period is stopping, then everything starts to plummet.
Ruth: So how does that impact weight loss?If your hormones are all changing, what does that do?
Dr. Kate: Estrogen is extremely important for maintaining a healthy weight. Estrogen helps us have a faster resting metabolic rate. So we burn more calories at rest when we have healthy amounts of estrogen. So as our estrogen is dropping. Our resting metabolic rate, our ability to burn calories at rest goes down.
So that’s one reason we can have weight gain. Also, when our estrogen is low, we’re more likely to gain fat around our tummy versus fat around our booty and our thighs. And that visceral fat around our tummy is more dangerous for cardiovascular disease, heart disease, and diabetes. So again, as we’re going into perimenopause and menopause, our estrogen is dropping and we’re gaining more weight around our middle because of the low estrogen.
Estrogen is also anti-inflammatory. So, as you lose your estrogen, you become more prone to pro-inflammation, which can impact weight gain as well as other things like cardiovascular disease and diabetes.
Our testosterone is very likely to drop in perimenopause menopause as well. And testosterone impacts our ability to build lean muscle mass and impacts our resting metabolic rate. So those are some of the big reasons that the hormonal changes of perimenopause lead to weight gain. So basically everything is working against us.
Another interesting thing is that when we have low estrogen, we have less microbiome diversity. So we start having less good bacteria both in our vaginal tract and in our gut. Our good bacteria diversity goes down as well. Estrogen is really important for gut bacteria and the diversity of our gut microbiome, which also impacts weight gain.
Ruth: Interesting. So, when it comes to dealing with all of these hormonal changes that are happening in your body, where do you start?
Dr. Kate: I’m a naturopath, so I love exercise. I love diet. I have talked about it with every patient at every visit for the last 20 years.
When your hormones have disappeared, you’ve got to replace those declining hormones, not only to protect against weight loss, but to protect against dementia and bone density loss and cardiovascular disease. So when my patients come to see me and they’re between 35 and 50, and they’re struggling with these symptoms that we talked about, I am going to replace hormones first.
Estrogen helps with motivation. It helps balance our moods so we feel more motivated. Their mood’s going to feel more stable and they’re going to see more results from the efforts of their dietary choices and their exercise choices. They’re also going to see less insulin resistance.
So I start with hormone replacement therapy which is extremely safe and extremely effective. It takes about six months of meeting regularly to get someone on the right dose when their hormones are really erratic, but almost immediately they’ll start feeling better and getting better results from their lifestyle choices and healthy habits.
Ruth: So how soon should you start with hormone replacement therapy? Is that something that you don’t do until you’ve actually hit menopause or is it something that is helpful even when you’re in perimenopause?
Dr. Kate: That’s such a good question. If people take away anything from this, it’s the answer to this question. Start early in perimenopause.
So the data shows that if we start before 59 and we start closer to the beginning of perimenopause, we respond better. So estrogen is better at prevention than cure. We want our estrogen to be able to keep our blood vessels nice and healthy to keep oxygenating our brain. Start once you start having those early signs of perimenopause and a qualified practitioner can help you identify that.
Ruth: So tell me how this is different than just like popping a pill.
Dr. Kate: I’d like to say that when I’m working with young women, I’m almost always managing their hormones without hormones because you can do it so effectively because your ovaries are still alive and they’re working well.
But as we age, our ovaries are literally dying. So, it’s not popping a pill per se because we actually recommend transdermal bioidentical estrogen, which means through the skin instead of orally. If you look at the data and the research oral estrogen has more of the risks associated with estrogen.
And because of the first pass effect through your liver, it’s going to have more risks for clotting that we’ve heard about and gallbladder disease that we’ve heard about. If you take higher doses of transdermal estrogen, it’s extremely safe. It goes through the skin, and it’s just replacing what is no longer being made by your ovaries.
I think what’s unique about me as a natural path is that I’m so attentive to the evidence and I want my patients to get the best possible care. I truly believe that a combined approach with well applied medicine, when needed, in conjunction with lifestyle habits for your whole life is really the best.
When I was practicing in my twenties and thirties and doing mostly fertility and polycystic ovarian syndrome and endometriosis, I was not doing a lot of hormone replacement therapy at all. My patients that were older were coming to me and saying, “What, what should I do in menopause?”
And I said, “I know what the research is, but I haven’t been through it and I just don’t know.”
But when I started to go through perimenopause and really put my thinking cap on and use my biochemistry degree with my 15 years of practice and all that I know about health, I was just extremely convinced of the evidence that we need to replace the hormones that are gone or our body just can’t work right.
Ruth: So when I was in my twenties, I went on birth control pills. I have a really bad reaction to it. So that has always made me worried about taking hormones for perimenopause. IIs it the same? Will you see those same kinds of results or is it a totally different thing?
Dr. Kate: That’s a really good question. So, when you’re in your twenties and somebody puts you on the pill, they should follow up when you don’t feel well. Many, many women feel great on the pill. Those are not the people who come to me. The people who come to me are the people like you. My doctor put them on the pill and they felt horrible.
I see those kinds of people every day. So this is a question I get asked a lot. Sometimes they were put on the wrong pill. Sometimes they needed to be on B vitamins. Sometimes the pill was not a good fit for them for other reasons, and we need to get to the bottom of all of that. I think a problem with mainstream medicine, and I don’t blame the doctor, I blame the system, is we have really fast visits with our doctors that last five to fifteen minutes, and we don’t have time to really ask the questions that we need to ask.
And so, if I had seen you then, I would have wanted to follow up with you, knowing exactly what didn’t work for you. Were you bleeding too heavy? Were you bloated? Did you have headaches? Did you have weight gain? What were the things? And then we would have figured out why it didn’t work for you, and figure out what to do next.
So now the question is, will you feel good on transdermal hormone replacement therapy?
Probably. Probably you’ll feel more mood-stable than you’ve ever felt. It’s pretty amazing. So the pill is mimicking a cycle, right? So it’s mimicking more fluctuating hormones. But hormone replacement therapy is providing steady state hormones. So you take the same amount of low dose estrogen in a steady state format.
When you take it orally, you can’t get as close to a steady state as you can with transdermal. So that’s one really nice thing about transdermal, but also the pill is meant to mimic ups and downs more like a cycle. Whereas the transdermal is just the same all the time. And then you’re taking the same amount of progesterone every day.
So you actually have steady state hormones. So I would say almost every patient that I see reports more emotional stability, whether they have a history of anxiety, depression, irritability or postpartum depression.
One of my subspecialties is menstrual disorders and mood disorders. I do see a lot of that in my practice too.
Ruth: So it sounds like that’s a great solution for most people, but do you ever see negative effects or have you had any experience with a patient that has not responded well to it?
Dr. Kate: When used correctly, hormone replacement therapy in perimenopause doesn’t feel like a miracle drug, but it feels like a really great drug. It feels like an incredible medicine that has an incredible safety record and it works really well. And when you replace the estrogen there’s less inflammation and you’re storing fat where you should be instead of in your tummy.
You have a better resting metabolic rate, you’re more motivated to make lifestyle changes and then that’s just hanging out in the background. Then we can get to the real work of making lifestyle changes? What are the dietary changes that need to be made?
I eat healthy fats. I manage my stress. I exercise regularly, but I don’t overdo cardio. I do strength training. I take probiotics and I hit perimenopause and I gain 25 pounds.
It truly feels like there’s nothing else that you could do. Yes. You know, I don’t drink alcohol. I don’t eat processed sugar, all of those wonderful things that you talk about, which I am such an advocate of, and then you replace the estrogen and they go back to their normal healthy set point.
Or, you have a woman who never learned the good lifestyle habits. She’s already overweight entering perimenopause and now it gets worse. We have to do both. We have to work on healthy lifestyle habits, but hormone replacement therapy really helps to keep the ship from sinking.
Ruth: So let’s talk a little bit about some of the health risks of being overweight, because I think that those are not always things we want to talk about. Sometimes it’s all about fitting into our skinny jeans, but the reality is that it’s not just about that.
What are the other things that put you at risk when you’re not addressing both the lifestyle and the hormone aspects that are causing you to be overweight?
Dr. Kate: So, if you lose about five to 10 percent of your body weight, you decrease your risk for cardiovascular disease.
And then I have a list of things that I want to say because it’s so cool. Weight loss helps you balance your blood sugar. So in medical speak, we say it reduces hyperglycemia and improves your cholesterol. So specifically your triglycerides, your LDL and your HDL. And it improves your blood pressure. It improves your liver function. It decreases fatty liver disease. And decreases your need for medications like high blood pressure medication, type 2 diabetes medication, and cholesterol medication.
So just, weight loss improves our risk for cardiovascular disease across so many different parameters. I mean, that’s huge just in and of itself.
Ruth: Yeah, so what about cancer?
Dr. Kate: Yeah, iit also decreases your risk of cancer to be at your ideal body weight. So many cancers are connected to obesity, and I think your audience would really be interested to know that breast, uterine, and ovarian cancer are all connected to being overweight.
Ruth: So again, that’s why your message is so important. I mean, we want to be hot. We want to be sexy. We want to fit in our skinny jeans. We want to look beautiful when we go to the party and caring about being in a healthy weight range is important for our long term health. If we want to live into old age and be able to go on a bike ride in our eighties and enjoy our grandkids.
We talk about that all the time in our program. Because we market it as a weight loss program (you have to market it as a weight loss program because that’s typically what people want). But people come in and all of a sudden realize, “Oh, I actually feel good.”.
It’s not even about the weight anymore. It’s about feeling better and feeling younger and more vibrant and having more energy, just because you’re starting to make these changes. And I love that. That the hormone piece of it can have such a big impact.
DR. Kate: Yeah, exactly. And then other benefits of weight loss are improved mobility, decreased chronic pain, decreased joint pain, decreased dementia and decreased gallbladder disease.
Ruth: Wow. So basically everything. Let’s talk a little bit more about the science behind why everything just get so much harder.
Dr. Kate: We don’t build muscle mass as easily. Our resting metabolic rate gets slower, so we don’t burn calories at rest as well. When we have less lean muscle mass, we don’t burn calories at rest as well. And then instead of gaining fat on our booty and our thighs, which is totally fine for our health, we gain weight around our tummy, and that’s visceral abdominal fat, and that’s the dangerous fat that’s connected to cardiovascular disease and diabetes.
And then on top of that, estrogen is really important for our blood vessels to be healthy and nice and soft and pliable when they’re contracting and moving. So when we lose estrogen, basically our blood vessels become more rigid. So before menopause, women have much less cardiovascular disease than men of the same age, but once we go through menopause, our risk for cardiovascular disease becomes the same, and that’s because our estrogen is gone.
So now we have just as many strokes as men, just as many heart attacks as men and just as much cardiovascular disease and heart disease as men. And that’s really because of all of those beautiful, beneficial effects of estrogen.
Ruth: Wow. So when you start taking that hormone replacement, is that something that you have to take for the rest of your life to keep that going? Because you’re not producing it anymore, you have to maintain that for the rest of your life. Or is there a point where you’re like, okay, I’m good. I’m stable now.
Dr. Kate: So for bone density, for example, women suffer more from fractures and then the consequences of bone fractures than almost anything else.
It really ruins our quality of life and we’re very likely to die the year after a serious fracture in our old age. A few years after menopause is when we have our biggest bone density loss and by taking estrogen we prevent that bone density loss, but once you are off the estrogen, then you will start losing bone density. So you want to stay on estrogen as long as possible.
Ruth: Is there a point at which it’s too late to start taking it? Like say somebody is listening to this, she’s seventy years old. She’s like crap, I missed my chance, or will it be helpful no matter when we start?
Dr. Kate: So if you’re 10 years past menopause or over 65, you need to make sure you talk to a North American menopause society certified practitioner before you get on hormone replacement therapy. They’ll look at your family risk, your family history and your personal medical history and talk to you about the risk benefit and then they’ll decide if it’s safe for you.
Ruth: So how does somebody find a doctor like you?
R. Kate: I would go to The American Association of Naturopathic Physicians to find a licensed naturopath. Then I would find either a functional medicine doctor or a naturopath that has the certification through the North American Menopause Society that’s a menopause society of certified practitioners.
And we have to study for a big test, and then we take a big test, and we have to pass it, and then we have to do continuing education every year in menopause to keep that certification. So that’s what I would do. I would find someone with both, a functional medicine doctor or a naturopath that has the menopause certification.
Ruth: So how can somebody find out more about all of this stuff?
Dr. Kate: It’s hard to find real information that isn’t tainted by whatever agenda that’s out there. And a lot of things are filtered off the internet, it’s crazy.
Ruth: So how does somebody actually really dig in and find out more about this?
Dr. Kate: I love the book Estrogen Matters. And I think the North American Menopause Society has excellent data on menopause. For example, they’ll go through the evidence based treatments for hot flashes. Does weight loss help with hot flashes? Yes, it does. Does hypnotherapy help with hot flashes? Yes, by evidence based research, yes, it does. Does acupuncture? No. So they go through all of the different herbal treatments and vitamins and look at all the data and then they’ll show patients what works and what doesn’t based on evidence.
Ruth: Oh, that’s a great resource. And that brings me to another question. Why do we get hot flashes?
Dr. Kate: Because of the drop in estrogen, but it’s a little more complicated than that. Basically something’s going on in our brain where we don’t regulate, and we have poor thermoregulation. And part of that is due to estrogen in the brain.
Estrogen helps us with maintaining our body temperature. So, one of my first symptoms of perimenopause was when we were living in Texas and I just would get so cold, like bone chilling cold.
And then another day I’d feel all flushed and warm. I was also having irregular cycles, but I was only in my late thirties. It didn’t even register. But if I look back, my periods are not like they used to be, not like clockwork 28 days and my temperature regulation is all over the place.
Ruth: What are some other practical tips?
Dr. Kate: I think that all hormones are connected, so when you go through menopause, your thyroid might get off. So I also recommend that women just get a screening thyroid test if they’re struggling with weight loss or weight gain.
I really want women to focus on strength training because the testosterone can drop and the estrogen can drop, so we have to work harder to maintain our muscle mass and our bone density. Strength training is a great way to do that.
And I love a weighted vest. That’s one of my favorite tips for this phase of life is to wear a weighted vest when you exercise or you’re cleaning, if you’re doing chores or you’re working in your yard, or you’re going on a walk with your bestie. Put on that weighted vest and just add that to your lifestyle.
Ruth: How heavy should the vest be?
Dr. Kate: Well, you want to put on about 5 – 10 pounds. And they have really cute ones that you’re not embarrassed to wear outside.
Ruth: That’s amazing. And so easy. I love anything you can do that you’re already doing and you just make it better. Any other tips?
Dr. Kate: I really prioritize sleep. I’m sure you know this, but sleep deprivation is associated with increased cortisol, which causes increased inflammation, which makes it harder to lose weight and reduces glucose tolerance.So when we don’t sleep well, we have a harder time losing weight.
For some people it’s, it’s easy. You just prioritize it and then you sleep. But for perimenopausal women, it is not so easy.
My number one advice to help with sleep and perimenopause is called hormone replacement therapy.
Also any ditched alcohol. It will make it harder for you to sleep. When our estrogen starts to drop in perimenopause, it directly impacts dopamine. So low estrogen leads to low dopamine, leading to more desire for alcohol. So when we correct that estrogen, we don’t crave the alcohol as much.
And then taking probiotics, um, because of the importance of the microbiome and our gut bacteria on maintaining a healthy weight.
Also as your estrogen drops, the diversity of your gut microbiome microbiome decreases, so I recommend taking probiotics. Probiotics help with the vaginal microbiome as well.
Also, boost your protein intake. Basically meat at every meal, that’s how you’ll get enough protein. And if you’re not, then you’re not probably not getting enough. And don’t be afraid of eggs. Don’t be afraid of fish. You have to eat protein and you have to eat way more than you think.
My tip for women in my practice is not to start by eating more protein right away. I just say “Until our next visit, I just want you to note how much protein you’re eating a day”. And women are shocked that they’re only getting between 10 and 20 grams a day.
And that’s totally normal because the normal diet that we eat is very low in protein. It’s so loaded with carbohydrates, which is basically sugar and so deficient in protein and healthy fats and inflammatory fats.
If you wait until the end of the day to feed yourself, you’re going to crave alcohol because it’s a quick sugar boost.
Next, focus on eating low glycemic index carbohydrates.
Where I learned this was not in perimenopause. I learned it by working with people with polycystic ovarian syndrome. Women with polycystic ovarian syndrome often have insulin resistance and they’re the client that comes in and says, “I exercise more than anybody. I work harder than anybody on my diet and I am so frustrated. I cannot lose weight and it’s because they have insulin resistance”.
And so one of the first things that we do is talk about complex carbohydrates and simple carbohydrates and low glycemic index carbohydrates. And getting enough protein and all of a sudden their hard work starts paying off.
Where you can find Dr. Kate:
Instagram @healthyhormonedoctor
On her website at drkatedallas.com
Or if you’d like to hear more about perimenopause, you can DM her “pod” (as in podcast) to get her mini podcast. It gives you the scoop on all the evidence-based medical and holistic treatments that keep your symptoms at bay during perimenopause.