perimenopause symptoms

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Women are very poorly educated on perimenopause and perimenopause symptoms! So much so that we often assume that the subtle, annoying signs of perimenopause are the result of something else.

You probably know some signs of menopause like hot flashes or night sweats.

But as you hit your late thirties to early forties, things start to change that your doctor might tell you are “normal” and nothing to worry about.

Even though they don’t seem normal.

Things like midsection weight gain, skin elasticity + texture changes, mood shifts, poor sleep, brain fog, loss of muscle tone (or difficulty maintaining muscle), fatigue, heavier periods, and low libido are the more common perimenopause symptoms.

So what’s a gal to do?

Ignore it and hope it sorts itself out?

Or start to pay attention and make certain changes?

Because I’m in this boat now, I know how important it is to dive into the vast topic of perimenopause. 

My guest today is Dena Norton, MS, RD, a registered dietitian with over 15 years of experience in conventional and holistic health. Though she helped perimenopausal women for years, she became one of them – getting hit with low libido, love handles, and sleep disturbance. This wake-up call drove her to research perimenopause symptoms more deeply than ever. What she learned reduced her symptoms and put her back in control of her health! Dena is passionate about helping fellow 40-something women navigate this topsy-turvy stage of life with proven strategies to curb nagging symptoms and optimize the aging experience!

If you are struggling with perimenopause symptoms, what’s your biggest concern? Tell me about it in the comments below or on the Youtube video!

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

In This Episode:

  • Perimenopause – What is it + when does it begin?
  • Sneaky perimenopause symptoms no one talks about
  • Protein intake + perimenopause diet: How much should you eat? 
  • Perimenopause symptoms signaling menopause is near
  • Problems with sex hormone testing (BEFORE you buy a test)
  • 5 Key strategies to reduce annoying perimenopause symptoms
  • Hormone replacement therapy (HRT): Dangerous or worth doing?


“I think [HRT] is fabulous. And almost every woman is a candidate, despite what she thought about her family history or whatever risk factors omitted her from that conversation.” [28:58]

“All of us think of hot flashes and night sweats because that's what Grandma and Mom experienced, and that's really later down the line for most women, especially if you are an earlier starter… but some of the earliest [signs] that I see are things like sleep disruption, mood changes + anxiety more so than depression.” [28:39]


Find Dena online | Instagram | Facebook

DOWNLOAD Dena's High vs. Low Hormone Symptoms Guide

Healthy Skin Show 015: Alternative Remedies For Lichen Sclerosus w/ Dr. Anna Cabeca

Healthy Skin Show 286: Is This Normal? (Rashes “Down There” + Hormones Edition) w/ Dr. Jolene Brighten 

Healthy Skin Show 180: How Hormones Impact Your Immune System + Skin Health w/ Heather Zwickey, PhD

323: Signs + Symptoms of Perimenopause Problems (No One Talks About) w/ Dena Norton, RD {FULL TRANSCRIPT}

Jennifer Fugo (00:07.454)
Dena, thank you so much for being here. I'm excited to talk about all things perimenopause and those pesky perimenopause symptoms.

Dena Norton (00:13.054)
Oh yes, thanks for having me.

Jennifer Fugo (00:14.854)
Well, this topic is very, it hits close to home because I am in that perimenopause period and so, I care. I mean, I have a lot of clients too and we're just like, what happened? Is this normal? Is this like a thing? Like, what is going on with my body? I felt like I was, I kinda got what was going on and now all of a sudden things have changed and it's so weird, you go to the doctor and they're just like, oh yeah, that's fine, that's normal. And I'm like, is it though?

Dena Norton (00:45.026)
I don’t think it is.

Jennifer Fugo (00:47.518)
So with that being said, let's talk about perimenopause as this does go back to hormones and specific hormone fluctuations. So, what exactly is perimenopause in the grand scheme of things?

Dena Norton (01:03.275)
So, hormonal fluctuations can happen at any stage of our lives, right? But we do have these punctuated points, puberty being one of them. But perimenopause is just the time, technically around the menopause, what the word means, but it's the time leading into menopause. So let's define that right quick, because a lot of women are still a little fuzzy on that. So menopause is a single point in time, a day that is your 12-month anniversary of having no periods for 12 months. So once you reach that 12 months without a period, you officially are crossing that menopausal line. 

So everything leading up to that where the hormones are volatile and declining and things are shifting in your body that's considered perimenopause. And for some women, it's quite contracted. It could be a year or two, kind of in and out and done. For other women, it could be really prolonged. You know it could be a decade, some would say even 12 years. It can start a little earlier or could start a little later. So the average age of menopause in the U.S. is 51 currently. So perimenopause for most women will start sometime in the forties, for some women it's even late thirties. So sometime in that forties-ish period where we're noticing, oh, this is changing and that's a little different, and what's going on over here? That sort of like bobbly feeling, whether it's about your periods or whether it's about your sleep and your mood and your skin and everything else, they could be perimenopause symptoms.

Jennifer Fugo (02:23.21)
So what are some common perimenopause symptoms? I could list out my own, but I don't know that people are that interested in my body. What are some symptoms of perimenopause that listeners might say, “oh, I didn't realize that was a sign”?

Dena Norton (02:36.846)
Well, all of us think of hot flashes and night sweats, right, because that's what grandma and mom experienced. And that's really later down the line for most women, especially if you are an earlier starter, like I myself, I think I'm an earlier starter, probably late thirties is when this happened for me. So earlier perimenopause signs, some of the earliest that I see in practice are things like sleep disruption, mood changes, often anxiety more than depression first off. I know that's just my kind of read on it, which as progesterone's declining early on, it makes sense that anxiety would start to peak, those two go together.

We can definitely see mood changes as far as like motivation to get up and go and get things going. We can see brain fog and just like, I can't quite focus on things, I can't follow through with things the way that I used to. Certainly a lot of women feel the change in the midsection weight gain or fat gain and general loss of muscle mass around the same time. You know, I definitely experienced that. That was kind of a wake-up call for me where I was like, hey, that's where I draw the line. Like the muscle loss and the spare tire, like something's gotta be done. The low libido kind of annoyed me, you know, some things kind of perked my ears up a little bit, and then the spare tire came on and I was like, hang on, hang on, stop there, you know. 

So we're all gonna be sort of caught off guard by one or two things. But for most of us, it is this sort of smattering of a variety of different perimenopause symptoms that can show up differently in different women. And when it comes to skin, we'll get into that. But like a lot of manifestations in the skin for all of us. But then if you're a “skin person” and you know you deal with skin issues or skin conditions, it could very well be that those are gonna get exacerbated or become a little harder to manage during this time.

Jennifer Fugo (04:12.234)
I will also share, aside from the spare tire and some weight gain that's like really hard to lose and that, I mean, I don't know if the muscle mass thing, cause I've had all these, everybody knows I've had back problems and all sorts of stuff since 2020 which has not been fun. But I cannot do the like high carb, like low protein thing. Like I need protein. I operate so much better.

Dena Norton (04:13.932)

Jennifer Fugo (04:40.454)
I don't think that's just a “me experience”. It seems like a lot of women during perimenopause tend to need a higher protein diet. What are your thoughts?

Dena Norton (04:41.634)
Most women don't recognize it the way you're describing, but they do need the higher protein perimenopause diet, mainly for the conservation of muscle. Because starting in our mid-30s (but it really ramps up closer to 50 and beyond), we just start wasting muscle.

And so it takes more protein to hang on to that than we previously ate. And that just goes up and up. Like in elderly individuals, it's quite a bit more protein they have to consume to just stop that loss. Not to mention if you're someone who really is trying to gain a little muscle, like a lot of us realize we should now to kind of preempt the changes of aging. But what you're describing, I wonder if there's something to do with like stress and/or blood sugar regulation, because in those situations, which certainly also are a part of this transition for a lot of women, we feel a little more stress sensitive. We can't quite hang with those same workouts. We don't quite recover as well from stressful situations, you know. We do feel a little more hangry or dippy with our energy. And because of some of those hormonal shifts under the surface, we are becoming more sensitive to stress. It is getting harder to keep our blood sugar level. And in those situations, the body would want more protein because it's such a stabilizer of mood and energy and blood sugar. So maybe that's a piece of it for what you're describing as the perimenopause diet.

Jennifer Fugo (06:01.23)
I think it definitely could be. I also will say, and I think it's worth stating upfront because I always feel like my listeners appreciate honesty. Like when I'm on Instagram looking at, I follow a lot of different people. There are certainly people that I follow whose diets I would never, ever follow. It's just like, I like to know what they're up to and what they're saying. But there are so many young influencers that have really gotten really far into doing like, I would argue like a high starch diet because it's very, very plant-based, and it's like tons of starch. And I, mm-mm, hard pass. Like I cannot do that. I could do that in my 20s and I could maybe still hang with that in my early 30s. But now, no way. So you, I just will say, and I don't know what your thoughts are on this, but I have to watch who I take dietary cues from because if I'm looking at somebody who's like, oh, look how healthy I am, but they're in their 20s, it doesn't work the same way.

Dena Norton (06:57.182)
You're right, that might not translate. We have all these like GI changes, motility changes, digestive juice changes, immune system changes. All these things do go into what kinds of foods we do well with, right? And they're all shifting at some level because of these hormonal transitions. So the whole thing, it doesn't get slipped upside down, I don't wanna be like a fatalist. There are parts of it that are totally annoying and frustrating and some of it we can't control. But a lot of it is like, it's just that you need a strategy shift, which we can certainly get into. 

Because this happened for me. It took me a little while to wake up to the fact of like, “this is perimenopause”, this is totally what this is. And then I was like, “all right, we're doing it.” I doubled down on like all the research, all the things connecting all the dots in my health. And I was like, ah, here I need to tweak, here I need to shift, over here I'm gonna change this a little. It didn't get all slipped upside down. I just had to get super strategic about working smarter, not harder in a few key areas. And it was like, okay, the love handles are gone, the muscle's back, I feel like myself, sleep's in order, the libido's coming back.

I was able to course-correct easier. And of course, I got an early start, which is always easier too. I mean, you're talking about these younger influencers. I'm only 43, I'm gonna be 44 soon. Probably some people who are 55 are looking at me going like, “girl, you don't even know”, you know? And I'm like, “I'm sure I don't”. I'm sure I'll know more later, like we all will. But you can't just say, I don't know it all now, so I won't do anything now. You have to be where you are now, learn as best you can, and take action when it comes to perimenopause signs and symptoms. Because one of the other things I'm super big on for women at this stage is getting the message, all the way to the back, that some things are never going to get easier than they are today. They may not be easy today, but they're not going to get any easier. So like managing that weight, building that muscle, getting that sleep in order. All these things are easier now than they ever will be. So now's the time to get a handle on it.

Jennifer Fugo (08:43.194)
Yeah, and it's interesting. You sent me over some information that, like again, this is not necessarily my wheelhouse, everyone. Right, so I'm experiencing it. It might be like my personal experience right now, but I'm not an expert in this area. And one thing that I found, Dena, that was really fascinating was that there are these interesting hormonal shifts that happen within almost like stages of perimenopause. Can you talk a little bit about that? Because we're aware things are changing, but you really made this very clear, and I was like, oh, that's what's going on.

Dena Norton (09:19.886)
Yeah, and perimenopause starts earlier than a lot of us realize. It starts very quietly under the surface with, some would even say, you know, some research suggests in the mid-20s. And I will preface this by saying, the more I get into the nuance of this, the more I'm like, really our whole lives as women are just this like, river of movement with our hormones. I used to think of it as like you go through puberty at 13, you go through menopause at 65, you know, whatever I thought it was. You have some pregnancies in the middle, maybe? Other than that, you're just rocking it every month, right? Like you're stable. And I really think it's more of this like just steady stream of like, now we're moving toward that stage that's up ahead. Anyway, okay, so mid to late 20s testosterone starts to tick down a little bit and it just, if we forecast that, it just steadily ticks all the way to the bottom around menopause. So that's already declining by our 30s for sure.

And then mid to late 30s, progesterone starts to decline, tick tick tick, downward. And both of those steady track down, all the way to menopause. So those shifts setting the stage for perimenopause are already starting under the the surface. And those reductions can drive muscle loss, decreased libido, decreased motivation, anxiety, sleep disturbance, changes in the skin. So those things that we were talking about is, quote-unquote, early-stage perimenopause symptoms for a lot of women. That's why a lot of these perimenopause symptoms are perking up in the 30s. And women are like, “wait a minute, what's happening? This can't be that. I'm definitely too young for that, but what is going on?” So those shifts start then. And then for a lot of us, it's a good bit later deeper into perimenopause where the estrogen starts to really come down to decline as well. 

But estrogen behaves differently as it goes out the door. This girl's like kicking and screaming, right? She's up, she's down, she's everywhere. She can't even decide if she wants to stay on scene or not. She's up, down, all around, the whole way out. So whenever that sort of starts to pick up for you, probably early to mid-40s, where the estrogen is getting very, very volatile, and even at the beginning it's not even headed too far down, it's really just up and down. So you can have these spikes of high estrogen symptoms for a little while before it starts to give out a bit and even when it does, mid to late 40s, it generally is volatile all the way down its decline at menopause. 

So there is this kind of layered change in these different hormones and keep in mind that they can share receptors all throughout the body. As women, we have hormonal receptors all throughout the body. That's why we feel menopause and perimenopause everywhere, in our hair, in our gut, in our vagina, on our skin, you know, everywhere, because all these areas use hormones to thrive. So as one or more are starting to decline, those receptors that don't have a hormone, you know, sitting in them, sometimes the other ones can fill that space if there's extra. So it gets a little muddy, and rocky, and hard to put your finger on.

Like, oh, this is one thing. This is low progesterone. It looks like this. Easy peasy. Here's what I'll do for it. It becomes this very sometimes chaotic milieu of symptoms. And that's why you need to like recognize early that you're there, figure out where you are on the timeline. This is something we go deep into in my perimenopause course and with clients, like figure out, you are here on the map, so that you know, like what are your tools for now? And also what's coming next? Because there's more coming and you wanna be prepared for that too.

Jennifer Fugo (12:47.658)
There is! You cannot stop that train. It just keeps going. You mentioned skin changes, skin shifts as we go through this river, so to speak, of hormonal changes.

Dena Norton (12:57.623)
Yeah. Sounds so peaceful, doesn't it? Just a little ride down the river. Some rapids here and there, whatever.

Jennifer Fugo (13:15.342)
It does, lazy river, and then it gets rocky. Yeah, so what are some of the perimenopause signs that indicate low estrogen or lower progesterone? What are some of these perimenopause symptoms that people could look out for?

Dena Norton (13:25.898)
Yeah, so meaning skin specifically?

Jennifer Fugo (13:30.727)

Dena Norton (13:33.994)
So, for progesterone – it impacts the skin itself by changing the oiliness of the skin. So as you lose progesterone, you can lose some of that like sheen and oil and glow. So drier, more dull skin, maybe some more skin sagging as well. So that can be low progesterone. So that could, again, start, you know, earlier on. Then low estrogen can do some of those same things. Estrogen is definitely a plumping, you know, it's really good for that, like, youthful glow, that like full face, and so as we lose estrogen we can also have some dry or more sagging skin. 

Estrogen also has to do with the skin barrier itself, so like skin that's more prone to tearing or getting infected, that kind of thing can partly be due to low estrogen. So those are a couple, let's see, low estrogen also just throughout the body but certainly on the skin surface is known for regulating our immune function. So as we lose estrogen we tend to lose regulation on the immune front, especially if you're someone who's dealing with an immune-related skin condition, you might see that get a little more flarey or volatile, hard to control as you lose estrogen. So that inflammatory component can be a piece of it. And there is even some chatter, you may know more about this than me, Jen, but you know about like psoriasis and certain conditions, you know, being like more prone to show themselves in perimenopause or menopause, and there's a lot of discussion I think around like how much could that do with hormones and those things versus other issues. So there's the immune dysregulation piece. 

Then low testosterone can also cause dry or thinning skin. So that can also show up on the surface there. It's not as common but some women can experience like peaks in testosterone or a usually temporary increase in testosterone as they go through perimenopause, and there are multiple reasons for that we don't have to go off into, but some women will get this like androgenic acne oily skin kind of thing or even more systemically, they might feel a little bit of rage or have a spike in libido kind of for a season, things like this that would sort of feel androgenic. Or they might have more issues with insulin-related issues or blood sugar regulation, and it could go back to spikes in testosterone. So that can happen for some women. That's not super common, but I have seen it in a couple of cases. And I think more commonly, honestly, now that HRT is becoming more accessible for supporting perimenopause symptoms and more of a buzzy thing, there are unfortunately, I think, some people who are going and getting testosterone at doses that they have no business taking. In my opinion, the excessive use of testosterone for perimenopause in women can definitely create some of these symptoms, so that can appear. Especially that like acne oily, you know, puberty skin kind of feel to it could be spikes in testosterone. 

Let's see. Then we have like the sort of underlying changes that can show on the skin, like to the gut, for example. So we have hormone receptors for all three of the biggies, estrogen, progesterone, and testosterone, top to bottom in the GI tract. So as they decrease and change, you definitely can get increases in GI dysfunction, whether it's like reflux and bloating, those often go up in perimenopause, slowing down to the GI motility, affecting the microbial balance, so you can get some dysbiosis or prone to certain overgrowth or dysfunction in the GI tract. And then those can, of course, relate to what's showing up on the skin since the gut and the skin are so closely connected. 

And then we have decreasing estrogen in the vaginal area during perimenopause – so things like vaginal atrophy, lichen sclerosus… that are super, super uncomfortable and disruptive to quality of life. Oftentimes women are also experiencing dry skin, dry eyes, dry oral cavity, things like that, but sometimes not. Sometimes it's just in the vaginal area, or urinary leakage can go along with that. These perimenopause signs would be like, estrogen might be too low. Testosterone can also play a role there but estrogen really seems to be the heavy lifter as far as like the vaginal and vulvar tissue lubricating and becoming healthy and nice and juicy, so that can really cut back on dryness, atrophy, pain with sex, prone to infections in that area that are microbial in nature, urinary leakage, things like that. 

Jennifer Fugo (17:57.322)
And Dena, you mentioned a lot about low hormone levels. It would be helpful for listeners to know your take on hormone and perimenopause testing. I've had blood tests run. I've done DUTCH hormone tests. I've actually done the two different types of DUTCH – one's a saliva, one's a urine. There's all different types of tests out there. What are your thoughts on that?

Dena Norton (18:18.87)
Oh gosh. Yeah, I think testing for perimenopause hormone levels can be very valuable in some women. It's super controversial in the like, menopause and perimenopause world, whether you should test ever at all. If so, you know, what kind and how often and for what reasons. And I see both sides of most of those issues. I'm a centrist on so many things. I'm like, you know, let's just decide for your situation, what are the pros and cons and help you decide. So I don't have like a hard line on any of that. I will say, maybe like you, I don't know, the longer I'm in practice and certainly the longer I'm in like, quote-unquote, functional medicine, holistic practice, the less enchanted I am with the fancy expensive perimenopause tests. I definitely use them, OK, because I definitely think there's value in certain cases, but I definitely am not like, “everybody has to have this, it's absolutely necessary.” 

So I think most women, especially early, early in their perimenopause journey, so if you're like, I definitely have some smattering of perimenopause symptoms, I'm in my early 40s or I'm in my mid-40s or late 30s or somewhere around there, and I'm like, this is probably it. You could totally go run like a hormone panel or start tracking your cycles at home or even do some at-home testing like pee-on-a-stick type of testing just to get like an affordable, quick and dirty, like, where do I think I am on the map, you could certainly run like a hormone panel in serum if you wanted to, but none of these are going to like definitively explain every nuance of your hormonal shift, okay? Because the whole season is shift and volatility. So I don't care if you wanna pay like next to nothing and get a one-day blood sample or wanna pay to the moon and get a whole month of data, there can be value in any of that. But it's not the end all be all, and you may not even need it to get started. You know what I'm saying?

Jennifer Fugo (20:05.89)
I will also share, you probably know Dr. Carrie Jones. She's been on the show and she showed this one slide that she presented someplace or maybe, I know she was at a conference, and she put it up on Instagram and she's like, here's all the different sex hormones tested all throughout the day at different times, and they're all over the place. It's the zigzag of some are up, some are high. She's like, “What?! This is why it's so hard to test hormones because they're all over the place in the same individuals at different times throughout the day.”

Dena Norton (20:39.148)
Yes. And then there's 24-hour urine hormone testing, which I've learned some about, and I think it's quite valuable. It's just not widely available out there. Not many doctors are aware of it or run it, and non-doctors can't order it. I think there's value in that. Over a 24-hour period, collect the sum total so that you can sort of draw out the patterns. But it's like, you know how it is, all these different camps, right? The conventional medical camp and the functional camp, and then the nutritionists over here. Everybody seems to have their different favorites about how they assess things, and none of them agree.

So usually we're like, we ourselves as women, like you and I both, but also the clients we deal with, like we're in the middle. We just want to feel better. We want to understand what's going on. We want to do what works and we want to feel better. So I'm not sure any one of the methods of perimenopause testing or, you know, camps about whether you should test or whether you should never test is altogether right in my opinion. But I definitely use it. But it's more like individual, case-by-case basis and then deciding how to test to get the information we're really looking for.

Jennifer Fugo (21:36.358)
Yeah, I will also share that I think, so this is my opinion, but I will not claim to be a hormone expert, I think it's better to probably mix different types of testing when dealing with sex hormones. I'm sort of like, do blood and do urine, or blood and saliva, or something like that. 

Dena Norton (21:53.954)
Yeah, they all have their own benefits.

Jennifer Fugo (21:59.246)
Just to sort of look at things from different perspectives. And then the other thing that I also think is important is if you have like a lot of other, more base level issues, sometimes hormone, I don't know why sometimes the hormone test is the first thing that someone will pull out the gate and I'm like, so much could change if you worked on other foundational things.

Dena Norton (22:16.494)
I totally agree. And that's another reason I really push testing off. And I'm like, I mean, not yet. OK, not yet. We can decide that later.

Jennifer Fugo (22:21.054)
Right, right. Pros and cons. So if somebody knows they're in our little camp right now, right? So we're like talking early to mid-40s, maybe you're even into like your early 50s, whatever. You're in the perimenopause community. You're there. What are some things that you feel like are the most beneficial for someone either to be aware of or to start acting on now that could be helpful?

Dena Norton (22:50.829)
Yeah. Let me touch on one more thing that could affect skin that's not so much the reproductive hormone. So I think sometimes it can get overlooked, but it's this like other hormonal category of insulin, cortisol and thyroid, which can always be an issue with skin issues, but those too can become particularly difficult or volatile during this stage, which we've already alluded to briefly. But just know that those also can affect inflammation, skin integrity, your microbiome. So those are also like B-class hormones, I guess. They kind of are on the “B team”, but they're very important and they're very key during this stage. So those would also be skin-relevant. 

Okay, so what can you do? So I'm all about ROI, right? Going in the right order, tackle the big stuff first, eat the elephant, then you could go off chasing rabbits and paying more money for fancy stuff, whatever. But like, if you don't get your house in order now, it's going to be a bumpy ride, and that's on you. You know, and like, I can help you, I can teach you, I can give you all the tools, but a lot of this is in our control. It's really, really the fundamentals. And you do need some 40s-specific strategies. So I would say, step number one, just recognize that what you're experiencing could be perimenopause symptoms, you know? Like I was saying, you know, I live in this world and it took me two or three years to wake up to like, oh, put my finger on like, this is what it is. So just the fact that you're listening to a podcast like this and hopefully you'll continue to learn about it is step number one. Could this be me? Maybe. All right, lean in and learn more. That's step number one. 

Number two is then, I call it “forty-fying.” Forty-fy some of these key areas that we're familiar with – nutrition, stress, working out, sleep, relationships, and purpose in life. These key areas, all of us are like, of course, I know what I should be doing there. But when you're in this stage, like Jen even mentioned, you know, one of the tweaks is like, you can't just be like healthy-ish eating and salads and veggies out the wazoo anymore. Those are lovely. They're very important. They're loaded with antioxidants and fiber and great, okay. But if you're not clicking in at a really aggressive protein target for a perimenopause diet, you're losing muscle. And you know what that means? You're losing bone, you're losing brain function, you're losing cardiovascular health, you're losing things that matter to you, I promise, you just don't recognize it yet. So we've got to understand these strategies enough to like shift them for our 40s. And I promise you'll feel better because it's what your body needs whether you know it or not, but you're also investing in tomorrow so today gets better, tomorrow gets better as well, because you're reducing chronic disease risk significantly and extending that health span right alongside the longer lifespan. So forty-fying your nutrition would be like, lots of colorful produce of course, but meet those protein targets. And I would say for most women like 30 to 40 grams of protein a meal, if you’re eating three square meals, is a great place to start, you know? Great place to start. You could definitely get more aggressive. If you're lifting heavy, you probably need to get more aggressive to kind of work on what you're working on, but that's a great place to start. 

And then like with the fitness category, you gotta lift. You gotta lift. And this is so buzzy right now. Like everybody now is like, oh yeah, I'm all into lifting, which is wonderful. But I do find a lot of women, a lot of clients I work with, are still sort of falling back into that, I hate this weight gain, I'm gonna push harder on the treadmill. Or I'm just gonna try to get more steps in in a day. And of course I lift the obligatory like purse size dumbbell every now and then or twice a week. That's not what we're talking about. We're talking about aggressively building muscle mass. You will not look like a meathead, it's not even hormonally possible, but you have to increase your muscle mass at this stage of life. Again, it's an investment in long-term, but it's also gonna help you be more satisfied without excess calories. It's gonna help you manage the blood sugar better. It's going to improve your brain function and energy levels to boost that perimenopause fatigue. It's going to improve your waistline because the more muscle you have, you do burn a few more calories a day. So it's a good like, backdoor hack to increase that metabolic rate a smidge. So it is working for you in so many ways. It just has to get done. 

And then there are some other, kind of, those forty-fying strategies to our foundational efforts that we really have to learn about and then just get serious about doing it. I mean, consistency over time, that's what it's about. Not perfection, but you have to click these in consistently. You can't just have good intentions and you can't go on and off plan. Like, this is the season, more than ever, you got to be consistent if you want to see consistent results. So that's forty-fying kind of your area, your kind of foundational areas. That would be step number two. 

I think that another thing to do would be to make sure that, I'm sure that your audience is very familiar with like kind of the more non-toxic, you know, personal care, cleaning, you know, household items, which I think is wonderful and really important because a lot of those do have like hormone-disrupting chemicals that can definitely clog up detox drains, things that we're really trying to get in order in this stage of life. But what I have found, even personally, as your eye bags start to develop and your skin starts to sag and you lose that glow, sometimes you just like, in desperation, reach for any and every cream on the market that promises.

Jennifer Fugo (27:54.662)
You're like, I know I could have done this 10 years ago, but…

Dena Norton (27:59.834)
I have definitely cut some corners in the skin and hair department, I will admit that. But just be careful, be careful and be aware that could be part of the burden and the load for you. And if you can get away with it, okay, that's fine. But if you're really struggling, like your skin condition is flaring out of control, harder than ever to manage or whatever, and maybe you're up against like a medication increase or something that you just really don't want, that would be one of the stops to pull out, really go back to fully clean products and make sure that you haven't bought into the anti-aging sells that have a lot of these adders in them that are not so friendly.

Jennifer Fugo (28:37.164)
Yeah. And lastly, do you feel like HRT perimenopause supplements can be helpful? That is also extremely controversial nowadays. And obviously, yeah, I also want to preface this with that we're not doctors. So we're not telling you what to do, and you've got to make your own decision. But what's your approach to HRT?

Dena Norton (28:40.755)
Yes! It is, but I think it's getting less so. I really do. I think as the information gets out there. 

Dena Norton (28:58.03)
I think it's fabulous. And I think almost every woman is a candidate, despite what she thought about her family history or whatever risk factors omitted her from that conversation. So as I've in the last couple of years delved into the research, read all the books, read the papers myself, gone back to some of the more controversial studies, and now there's this emergence of all these doctors from every camp and scientists coming out and agreeing with this consensus that HRT for perimenopause is an investment in your longevity. It will absolutely help you with the perimenopause symptoms you're experiencing now and the literature seems to suggest the earlier you start the better, but it will also significantly decrease most major chronic diseases and causes of death in women. So it's hugely beneficial. I do think ideally you get your house in order with these fundamental things so that your body handles it well. And then you do your research on which method, who's gonna be your practitioner, and you may have to start with one and see how it goes and change course, but there's a lot of different ways to “skin that cat.” 

I think there are pros and cons to each of them. There's no one right way to do it. But I think the good news for us as women is there are more and more choices and it's more and more accessible and more and more affordable all the time. So I use HRT, I promote it for the clients who are open to it. I certainly try to point people to reputable information about it. The word is getting out. So if you're hearing mixed messages or you're getting a hard no, or some blanket statement about like, that causes cancer or that's dangerous, or you can’t do that. There's more to the story, I promise. You just need to do your research. So I'm all about that.

Jennifer Fugo (30:31.462)
I think that's an important point, is that everybody should decide what's best for them once you've looked at the pros and cons and had a real heart-to-heart talk with yourself about what you're comfortable with, what you're not comfortable with, and you decide for yourself what's best. I wanted to make sure everyone knows, because I think this could be helpful after this conversation, it is tricky to know whether you're high or low in hormone symptoms. And you've got a really great free downloadable guide that will help listeners actually figure that out without having to necessarily right now go pay for testing. So I put a link to that guide in our show notes, so that way everybody connect with you, because you're just such a wealth of perimenopause knowledge! I love how practical you are as well. I mean like, I know you guys are hearing us kind of like laugh and stuff but like, what else are you supposed to do? There's moments when I was like, all right I just, I have to kind of giggle.

Dena Norton (31:26.504)
You gotta laugh so you don't cry. That's for sure.

Jennifer Fugo (31:30.994)
I'm like, yep, that's me. You know?

Dena Norton (31:32.398)
And that's actually a really healthy coping mechanism, right? That's part of the maturity of aging. Like, let go of what you can't control, laugh a little more, and move on. 

Jennifer Fugo (31:36.778)
Exactly. I'm like, well, what am I going to do? I'm just going to try to figure out what the best way forward is, and it is what it is. This episode very much hits home for me. Dena, thank you so much for being here. I really appreciate you sharing all of this. And I hope we can, you know, in the future dive deeper into some of these topics, because I feel like many of the listeners would really appreciate it. And I definitely want to encourage everybody to go check you out, not only on social media, but your website and download your guide so they can stay in touch with you and start figuring this out for themselves.

Dena Norton (32:09.366)
Yeah, thanks for having me.

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