Episode 257: Perimenopause and Weight Gain: What’s Happening to Your Body? with Casey Peterson

[00:00:00] Welcome back to the Back on Track: Achieving Healthy Weight Loss, where I help you get on track and stay on track with your weight loss journey. I'm your host, Dr. Alicia Shelly. So let's get started.

[00:00:27] Welcome back to the Back on Track Achieving Healthy Weight Loss podcast, the podcast where we like to talk about science strategies in real life challenges of achieving healthy weight and maintaining it for a long term. Now, today we're talking about something that I hear from women all the time. They say, I'm doing the same things I've always done. I've exercised. I've ate right. But my body is suddenly changing.

[00:00:56] So for many women, that question starts somewhere in their late 30s or early 40s and the scale can begin to start to creep up. Weight starts settling differently around the abdomen or midsection. Your sleep changes, your energy changes, maintaining muscle becomes even harder. And sometimes women are just told, well, you're just getting older. But you know what? There's much more to this story.

[00:01:23] Today, we are talking about perimenopause, hormones, body composition and weight gain. And most importantly, what women can actually do about it. And I have a wonderful guest joining me for this conversation. Casey Peterson is a nurse practitioner, entrepreneur and owner of The Balanced Life, The Balanced Woman and The Balanced Man, a telemedicine practices that focus on medical weight management and hormone health.

[00:01:50] Casey began her career as an ER nurse and has since treated more than 1500 patients in GLP-1 weight management and men's and women's hormone health. She has completed advanced training in women's hormone therapy and especially passionate about helping women understand and navigate perimenopause and menopause through individualized care, addressing symptoms, hormones, weight, strength, nutrition and long term health.

[00:02:18] Also, she is a wife and a mom of four teenagers. God bless you. I don't know how she does it. I know this is incredibly busy season of life, so she has all the tips and tricks to help us stay on track. So, Casey, welcome to the Back on Track podcast. We're so excited to have you here. Yes, thank you so much. I'm really excited to be a part of this. Thank you. And before we get started, though, would you mind maybe just telling us a little bit more about yourself?

[00:02:47] What led you from emergency room nursing into weight management and hormone health? Yes, absolutely. So I spent about 15 years in emergency room nursing, and then I went back to school to become a nurse practitioner. And the first six years of my career I spent in the geriatric space. So I was helping treat patients in long term care facilities, which I loved. However, there is not a lot I could do to make things better for those patients.

[00:03:14] And so I wanted to branch into something that would allow me to be in more of a preventative role, where I could get on the front end of these problems and make things better for people long term. So preventing illnesses before they happened. And that was the GLP-1s for sure about three years ago. And since then, they have expanded all types of FDA approvals and benefits for those drugs.

[00:03:41] And so that sort of naturally led me into how else can I help my patients? And a lot of them were verbalizing symptoms of perimenopause, whether they realized it or not. And so that seems like a natural transition for me to continue helping my same population, but also expand our reach. Awesome. Awesome. Well, that is amazing because we need more people on the front line being able to help individuals, not just with hormones, but also with their weight management goals.

[00:04:09] But now talking a little bit about perimenopause. If there's somebody who may not know exactly what that is, can you maybe just share what is perimenopause and how is it different from menopause? Absolutely. Great question. Perimenopause can start about 10 years before menopause. So to, you know, separate those out, menopause is the cessation of having your period, right? So 12 full months of no period.

[00:04:37] And sometimes our bodies can kind of play tricks where you don't have a period for six months and then all of a sudden it comes back. It's like the clock restarts, right? So that's the actual menopausal line is when you have no more periods for 12 months. However, before that, far before that, typically about 10 years, you can start having symptoms. Hot flashes, night sweats, inability to sleep. I feel like that one is very common to present first.

[00:05:04] Increased anxiety, heart palpitations, vaginal dryness, etc. A lot of these symptoms are extremely bothersome, not only to a patient's health, but also their social and sexual relationships, their relationships with their spouse. And that can really take a toll on people. So it's sometimes hard to open up about those symptoms to a stranger, right? Yeah, absolutely. Absolutely. And when you talk about the difficulties with sleeping, oh, my goodness.

[00:05:31] I remember one point I was like waking up at 3 a.m. every single night and I'm like, is God waking me up? Like, is this guy like, what is going on? I keep waking up at 3 a.m. It's up. You're like, and I'm up. Okay. And that is so common. And patients will report they are woken up somewhere between 2 a.m. and 4 a.m. like clockwork every single night. And then once they're awake, because we're women and we have so much on our plates, our minds start going.

[00:06:01] Then you have, oh, I forgot to do that load of laundry. Let me just get up and empty the dishwasher, right? And then you're just up. Then it's really hard to get back to sleep. Absolutely. And you can't go back to sleep and you're just tired throughout the day. Yes. Yes. And you wonder why your mood swings are like going from here to there, lack of sleep. Oh yeah. Or why you might have brain fog. It's because you haven't slept in three years. You know, your brain can't operate like it's supposed to. Absolutely. Absolutely.

[00:06:28] Well, let's get down to this whole weight gain that happens during perimenopause. Is it inevitable or is it just like a myth? Is this something that we just need to, you know, come to terms with? So not inevitable. However, I will say I hear all the time that what used to work doesn't work for me anymore. Right? So I used to be able to quit pop and I would drop, you know, five pounds in a month. Now I gained five pounds and I still don't drink the pop, you know?

[00:06:56] So what used to work for patients is not working anymore. And I think it is biology, definitely. And we have to learn how to work with that, right? So we either have to be more aggressive in terms of, you know, managing our protein intake. Yeah. I always say like, if you haven't been bullied into eating more protein by this age, like here I am to bully you some more. But protein is so vitally important. You know, it is supporting our muscle mass, supporting our body composition, but also giving

[00:07:25] our body something to work on to break down, helping us feel full longer. So definitely looking at nutrition first is always my foundational advice, because even if you were to add on a weight loss medication, let's say, if you don't fix the foundation of nutrition and exercise, the chances of you holding on to those results are very poor. So I really advise my patients to look at their nutrition first.

[00:07:51] If you've cleaned up your nutrition, you're eating mostly whole foods, a great amount of protein, you're getting your water. Okay. Then it's not nutrition, right? And then I would look next at exercise. You know, a lot of women are held back by joint problems or chronic pain that we have to work around. But if you tell me your foot and your knee hurt, then my counter to you is, can you do chair yoga? Can you do upper body exercises?

[00:08:17] Can you be on a machine that doesn't hurt your foot or your knee at the gym? You know, there are still things that we can do even when we have to work around an injury. But I will say it's very common that there is some weight gain. And like you mentioned before, it typically, you know, mobilizes to our abdomen where we do not want it right. We are so, you know, into our figure and we definitely do not want that weight around the middle. So hormone therapy definitely can help with that.

[00:08:45] But I never make promises to women that specifically hormone therapy is going to cause weight gain. It does not alone cause that weight gain, but it could be a part of this puzzle that we're trying to put together. Okay. Now you mentioned that it can be biology. What's happening with these hormones such as estrogen, FSH, all the things during premenopause and how do those changes affect our body composition? Like why is it that we're getting this midsection punch? Yeah.

[00:09:14] So as our estrogen levels decrease over that, you know, 10 year period, right? It's not like a hill that we just drop off of. It is a steady decline. As that estrogen decreases, it is mobilizing the fat towards the center where it is the most dangerous. It is moving that fat around our organs where we don't want it. That is the most metabolically dangerous type of fat. And it's obviously, you know, for our vanity, not what we want.

[00:09:42] But as you're getting closer to that menopausal change, what we can see in the lab work is that FSH level, the follicle stimulating hormone level starts to increase. It's really the brain's attempt to say, hey, ovary, I really need an egg. I need it really badly. Please, you know, let me increase my response to you to try to get an egg from you. So we can see those changes in the labs. But what we're trying to do with hormone therapy also is treat the symptoms.

[00:10:10] So we don't rely wholeheartedly on those labs, but sometimes it gives us a little bit of insight. Along with that mobilization of fat, decreased estrogen also can play a role in insulin resistance, which causes us to have higher blood sugars. So we really have to be careful about, you know, what type of damage is that doing to our body as well. So when you have insulin resistance, then the body has to work so much harder to get up and over that fence

[00:10:37] and get our cells to open up and allow glucose to come in. So with those two changes of the mobilization of the fat and the insulin resistance, that really contributes to why we're having weight gain at that time in our lives. Now, you mentioned that the visceral fat or the abdominal fat is one of the metabolically as an increased metabolic risk. Yeah. What are some of the health risks that you see with that type of fat?

[00:11:04] Yeah. Yeah. So increased cardiovascular disease risk is a big one, you know, and adiposity in general or obesity in general has been definitely linked to cardiovascular disease. Insulin resistance and high glucose levels have been loosely linked to increases in dementia. So, you know, there are definitely reasons why we want to avoid that abdominal adiposity. It's also been linked to certain types of cancer. So we want to maintain our weight as much as possible, right?

[00:11:34] We want to maintain our BMI in that normal range if we can or as close to that as possible. We definitely want to keep those blood sugar levels down so that we're not, you know, bathing tissues in high glucose levels that could be damaged by that. Okay. Now, as far as our other body composition that's changing during perimenopause, you know, is there a risk of losing muscle during this time? Is that something we should be concerned about?

[00:12:01] Yeah, that's a great question. And honestly, a huge plug for women to be resistance training, to be lifting weights in some way. Or I even tell my patients, even if you can resist your own body weight in terms of yoga or Pilates, wall pushups, air squats, those types of things. If you don't have access to a gym or can't afford one, I completely understand that. But doing air squats and wall pushups doesn't cost anyone a thing. You just have to do it, right?

[00:12:28] So, yes, there is a risk of losing, you know, that muscle mass and also the strength that goes along with it. We need strong leg muscles. We need a strong core to prevent falls and injuries later in life. And once you've lost that muscle mass, it's extremely difficult to put back on.

[00:12:46] So even just an ounce of prevention is worth a pound of cure kind of thing, even just as a preventative, if women can be weightlifting or viewing some sort of resistance training about three times a week, that is excellent. If you can prioritize yourself to do, you know, 30 to 45 minutes of resistance training three times a week would be wonderful.

[00:13:07] Okay. And when we talk about like poor sleep, maybe high stress, especially during this time, because sometimes women are like in between, like they have their kids that they're taking care of and then they have their older parents who they're taking care of. It can be very high stress. How does poor sleep, high stress, mood swings, all the things that you see with pyramid pause, how does that also can affect your weight, your appetite and other health?

[00:13:32] Yeah, great question. I think a lot of women, like you pointed out, are in kind of this squeeze generation where everyone needs them all the time. They probably progressed in their career to where their career is very demanding at that point or their stay at home mom and they have multiple kids and that's very demanding. So they have a lot of pressures. Our plates are extremely full because we're not the greatest at asking for help. So, yes, that definitely plays in, especially if you throw on poor sleep.

[00:14:02] You're not getting that time where your body can rest and reset, right? That's what you're missing out on. And so, yes, that causes chronic elevations in cortisol levels, which is the stress hormone. And that definitely contributes to weight gain. But I think what you mentioned there as well is really important that sometimes when we're stressed, we make the worst decisions, right? It's very much like I don't want to cook tonight. Just order a pizza.

[00:14:27] You know, I am too busy. Let me just, you know, get carry out because, you know, that's one more thing. And I just don't have time to grocery shop, meal plan, you know, prepare all of the food and clean it up. Oh, cleaning it up kills me. So I totally understand where women sometimes make poorer decisions than they would like when it comes to their nutrition.

[00:14:50] And just think about when you're eating at home, you're in complete control of how much butter, fat, salt, olive oil, etc. goes into your food. When you eat out, even if it was the best choice of what you could find there, it's always going to be higher calorie, more fat, you know, than what you would have cooked at home. So I think all of those factors definitely play together. You know, earlier you were talking about how nutrition and exercise are important.

[00:15:17] Is there any particular diet for women during this time that they need to focus on? Yeah, that's a great question. So honestly, with my patients, like you mentioned before, I do a lot of weight loss and hormone therapy. And my biggest, I guess, desire for my patients is to find a sustainable dietary plan that they enjoy. So I always tell my patients I want an 80-20 approach.

[00:15:44] 80% of the time, if you can be eating at home, preparing your own lunch, preparing your own food, controlling the butter, fat, salt kind of thing, then I commend you for that. And 20% of the time, I want you to live your life. Do not skip out on birthday cake at your son's 10th birthday to lose a pound, right? Like that is not realistic for most patients. And that's not what we want. I don't want you to be on a restrictive diet, but I want you to learn portion control and making the right choices.

[00:16:14] So if I had to choose one thing for my patients to focus on, it is eating their protein first. So if you have scrambled eggs on your plate, along with toast and sausage, I want those scrambled eggs and sausage gone first. It's not that you can't have the toast. It's that we have to prioritize that protein intake over everything else. Then if you want to get more in the weeds about it, I could give you a calorie count to shoot for. If you want to get further into the weeds, we could talk about macros.

[00:16:42] But a lot of that is not really sustainable for an average, everyday, stressed out woman, you know? Absolutely. They don't have time. We do not. Well, thinking about like medication management, you mentioned hormonal therapy. You said you can't guarantee that it'll help with wake up. But is that something that somebody should be getting if they have other perimenopausal symptoms or is that something they should wait until they hit menopause? Yeah, great question.

[00:17:11] I think, again, earlier is better and not suffering. I feel like women are sometimes too strong for their own good. They'll put up with too much for too long and they didn't need to necessarily. So I think treating the symptoms as they arise is very important and understanding that this is a journey.

[00:17:31] What you start today at maybe age 40 might not be the exact same medication regimen that you're on at 49 because as your hormones change, your regimen needs to change with that. Maybe you started only on progesterone for sleep and that was amazing, right? Life-changing for you. But then, you know, three or four years down the road, you're like, now I'm having hot flashes. What is this about? I'm still on my progesterone. Now what do I do?

[00:17:59] Well, maybe then you need to introduce the estrogen patch or cream or an estrogen of some sort, some route. I say options because I know the patches are on such short supply right now. So everyone loves the patches, but yeah, they're very hard to get. So maybe it's a cream or something else. But I think not being too tough for your own good is really important. And asking for help when you need it. You know, if you're having painful intercourse because of vaginal dryness, that is such an easy thing to treat.

[00:18:29] That is so easy. Vaginal estrogen is, it's not absorbed systemically. It's not expensive. And it's not hard to do. Twice a week, you apply it. Patients can feel so much better. And enjoy a sexual relationship with their partner without pain. So things like that, I think, are really important to have an open conversation with your provider about how you're feeling. And understand that those symptoms are going to change over time. And so your regimen will change too. Okay.

[00:18:58] What are your thoughts about like the non-hormonal therapies like Vioza? Or there's another one that starts with an F. Or maybe that's the same one. I'm not sure. But what are your thoughts on that? I think that they definitely serve a role. I am disappointed sometimes with how expensive those treatments can be if insurance won't pay for them. So I hate that sometimes that holds patients back from a very important treatment.

[00:19:24] But it's the real story of how we live in the United States that sometimes we have to make decisions based on finances. And so I think that Vioza serves a great role, especially for a patient who maybe is not a candidate for hormone replacement therapy because of a previous cancer or because of another concern that they are not interested in hormone therapy, but they're having a lot of hot flashes. Then, you know, one of those non-hormonal treatments could be really, really helpful.

[00:19:52] Or maybe they're having libido issues, but they don't really want to do testosterone. Then maybe, you know, one of those drugs like flibanserin could come in and really be helpful for them. I just wish the cost wasn't a factor. Yeah. It's hard when you like have one or two non-hormonal drugs in this space. As I said, cost can be astronomical.

[00:20:12] So if someone gets started on the hormonal therapy or the non-hormonal therapy earlier, like you said, early, like maybe when they start having symptoms, how long do you expect them to need it? Or how long does impairment of pause last would be the thought. Or how long do you expect it? Yeah, that's a great question. And a lot of patients do ask that. Well, do I have to be on this the rest of my life?

[00:20:38] Some patients, they say like, you're going to have to pry this out of my cold dead hands, right? Like you're not taking this away from me. I feel so good. I want to stay on this, right? Like I want to do this as long as it's safe for me, then I want to stay on it. I do think it's a very personal decision. It is understandable that maybe some patients would view it as symptom management only. And once they get over, you know, pick an age, right? But once they stop having their periods and they feel like, okay, I kind of want to try

[00:21:07] off of it and see how I feel. Okay. Like that's completely reasonable. But I think for other patients, they are going to look more at the holistic picture of an estradiol level, you know, greater than 60 has been proven to, you know, decrease my risk of osteoporosis and cardiovascular disease and dementia. So no, I don't want to come off of this because I don't want to take on those health risks, right? So as far as a stop date, there's not a hard and fast rule.

[00:21:37] It is again, that conversation, ongoing conversation with your provider. Is this still safe for me? I'm tolerating it really well. I would prefer to stay on it. Great. You know, it's that decision making together. If there's new data that comes out, then reviewing that together with your provider and making the best decision you can at the time. I always tell patients too, like you don't have to decide on forever. You just need to look at the next six months. You know, do you want to stay on this six months?

[00:22:05] If so, let's continue to work together, continue to follow up regularly and have these conversations and we can make a different decision in six months if that's where you're at at that point. Awesome. Awesome. Well, you know, as we conclude, what is the single most empowering message you want women to hear in regards to perimenopause and weight? Oh, that is such a great question. I want women to know they don't need to be miserable.

[00:22:32] They do not need to weight this out, that there is help, that there are providers who are very motivated at making you feel better and improving your life. And it's worth it. You are worth it. You have to put yourself, you know, on that priority list a little higher and you have to take some time for yourself, but this could be very life-changing and really improve your overall quality of life.

[00:22:59] Well, thank you so much, Casey, for just coming on and just sharing your knowledge about what's you with perimenopause and weight gain and how, you know, we can live better lives during this season of life. Would you mind just sharing with our audience, like, how people can reach you? What do you offer? That type of thing. Yes, absolutely. Thank you so much. This has been so much fun. People can reach us through our website or phone call.

[00:23:24] So our website is www.thebalancedlifehealth.com or our phone number is 260-207-4378. We have a secretary that answers the phones eight to five. She'll get me a message or she'll schedule you an appointment, but she can also answer some questions. Overall, we offer weight loss medications, both oral and injectable, and we offer hormones.

[00:23:51] So all three hormones for women, testosterone, progesterone, and estradiol. And then for men, we offer testosterone. We also do urgent care visits. So if you have, you know, pink eye, sore throat, you know, things like that that can be taken care of via telemedicine, we also do that. Everything that we do is telemedicine, and we try very hard to keep our prices reasonable so that everyone can afford the care that they need. Well, thank you again, Casey, for coming on to the Back on Track Achieving Healthy Weight Loss podcast.

[00:24:20] We were so excited to have you. And for our audience, if this episode was helpful for you, please share it with someone, like and subscribe to the podcast. We want to see your reviews. And if you have any questions that you want me to address, please leave that in the comments section. We'll be happy to make a podcast just for you. And until next time, remember to stay committed, stay healthy, and we remember that we are stronger together.