This podcast episode aims to help us understand the changes that occur in our bodies during perimenopause and menopause. We wellness girl chat about the importance of being preventive rather than reactive, emphasizing early education on the menstrual cycle, pregnancy, and menopause. The episode covers the common symptoms, hormonal shifts, and the metabolic impact of perimenopause and menopause. It also provides actionable advice on exercise, diet, sleep, and supplements, highlighting the role of hormone replacement therapy. The conversation underscores the need for foundational habits like protein intake and weightlifting to prepare for a healthier transition into menopause.

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So I selfishly started this podcast for one main reason,

2

and that main reason was to get girls

starting to think about what changes

3

happen within their bodies before they.

4

Come to that stage before

they have to actually react.

5

So I want people to be a little bit

more preventative in how they think

6

about their bodies and what's happening

within their bodies before they're

7

actually going through a certain stage.

8

So we've covered a lot on the menstrual

cycle, on pregnancy, on postpartum,

9

but something that we haven't covered

a lot about is perimenopause and

10

menopause, and I feel like it's this.

11

Wild West thought in our heads

of we might get there eventually.

12

We don't really understand

what happens when we go through

13

that phase of our lives.

14

So that's why I'm grateful that you

agreed to come on and help us just better

15

understand and educate us on what happens

within our bodies during perimenopause and

16

menopause and how you go about treating

women in perimenopause and menopause.

17

So let's start with the basics.

18

Okay?

19

What actually happens within

our bodies when we are hitting

20

that stage of menopause?

21

Dr. Larissa O'Neill:

22

Okay, so average age of

menopause is about 51.

23

. Perimenopausal symptoms will start

seven to 10 years before that,

24

so a lot of women in their late

thirties to early forties will start

25

to feel just not like themselves.

26

They may be more tired.

27

They may not sleep as well.

28

They may not be as effective in

the gym when they're working out.

29

They may have some brain fog.

30

Muscle soreness, joint soreness

itchy ears frozen shoulder.

31

the list is actually very long.

32

And that's 'cause everybody responds

to their hormonal shifts differently.

33

And it is like a rollercoaster ride.

34

Some women don't have a lot of symptoms.

35

A lot of women have significant symptoms.

36

anxiety, depression seem to get worse.

37

A DHD gets worse.

38

Again, women just don't feel

like themselves and it can start

39

as early as your late thirties.

40

Kelsy Vick: Is there certain criteria

that have to be met in order to know are

41

we in perimenopause, are we in menopause?

42

Or based on what someone

comes to tell you.

43

You're like, Nope, you are.

44

In that stage, is it more

of like your expertise that

45

goes into the deciding that?

46

Dr. Larissa O'Neill:

47

Yeah, so perimenopause is

really symptoms and age.

48

Okay.

49

If a 20-year-old came to me

and said, I have these we'd be

50

talking about something else.

51

But if you're in your thirties but

forties and you come with symptoms

52

it's basically that checking hormones

and perimenopause, testosterone is

53

one that we can check because it

declines in a different way than.

54

Estradiol and progesterone do.

55

But if you're checking somebody's

estradiol, it's just a snapshot in time.

56

And it could be completely

different two days from then.

57

So in Peron menopause,

it's really symptoms.

58

Menopause is lack of estrogen, lack

of progesterone, and technically,

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clinically no period for a year.

60

But you're gonna get symptoms

long before that happens.

61

Kelsy Vick: So what

happens within our bodies?

62

You mentioned hormones decrease.

63

Can you explain that a little bit of

the process that our bodies go through?

64

Yeah.

65

Physiologically with menopause?

66

Dr. Larissa O'Neill:

67

Yes.

68

up until, let's say mid

thirties, your estradiol and your

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progesterone are pretty stable.

70

You get specific variations

throughout your menstrual cycle.

71

When you get into your later thirties,

early forties, the brain and the ovary

72

are not as good at communicating.

73

Basically, your ovary is trying to

figure out how to output the estradiol

74

so your brain will produce signals.

75

LH and FSH, they're just two signaling

hormones and they go to tell your

76

ovary, Hey, produce estradiol.

77

If your ovary is good at it and

your adrenals are good at it, then.

78

Your brain's happy, the

rest of you's happy.

79

But as we get older, we're not as

good at producing the estradiol.

80

So everything gets a little wacky,

testosterone's a little different.

81

Women's peak testosterone typically

is mid twenties, and then we

82

get a steady decline from there.

83

You get some variation, but it's a pretty

steady decline throughout the decades.

84

So that pretty much by the

time women reach perimenopause.

85

In their mid forties.

86

Women's testosterone levels tend to be

fairly low, and again, estradiol can

87

be anywhere from very low to very high.

88

Kelsy Vick: So with some of those hormonal

shifts, is that what causes some of the

89

symptoms that women experience or, yes.

90

Okay.

91

All of them, yes.

92

Dr. Larissa O'Neill:

93

So we have estradiol, testosterone

receptors everywhere in our body,

94

brain, bone, muscle bladder, pretty

much everywhere we have those receptors.

95

And so when things start to

get wacky, we get symptoms.

96

Again, not every woman

is as sensitive to them.

97

But most women are

gonna have some symptom.

98

They may not equate it

to, I'm in perimenopause.

99

They may just think I've got little kids

and I'm running around and I'm tired and

100

I'm not sleeping as good 'cause I have

little kids, but it's usually hormonal.

101

Kelsy Vick: And are the symptoms that

I get related to my genetics or what

102

part of menopause, whether it's the

time that we hit it or the symptoms

103

that we get, is any of that related

to genetics or is it really no one

104

kind of knows, there's no pattern.

105

Dr. Larissa O'Neill:

106

I would say no one kind of knows.

107

Yeah I do always ask, Hey,

when did you start your period?

108

When did you start your cycle?

109

When did your mom start it?

110

When did she go through?

111

You can gauge, but

every woman's different.

112

every woman's got a

different ovarian reserve.

113

Kelsy Vick: Are there environmental

factors that can put someone

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into menopause or has that

not really been studied?

115

Dr. Larissa O'Neill:

116

There aren't really studies on that.

117

Okay.

118

Yeah, it's, I would,

119

I would say we know currently

that there are a lot of.

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What we call endocrine

disruptors in our society.

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And those certainly are gonna play a role.

122

We see lower men, we see lower

testosterone levels now than

123

we used to because of endocrine

disruptors and women are the same.

124

I think we just have more variability

now because there are things in

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our environment and in our diet.

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That affect us more hormonally

than we used to have.

127

Kelsy Vick: So moving to a little

less sciencey, a little less

128

nerdy, moving more towards what the

everyday woman might experience.

129

To notice within their bodies.

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What are some of the physical changes that

women often see when they hit menopause?

131

When it comes to aesthetics, body

composition, skin changes, fueling,

132

you mentioned exercise capacity.

133

What are some of those common changes that

women are challenged with in menopause?

134

Dr. Larissa O'Neill:

135

It's a lot.

136

Estrogen and testosterone both

help us keep collagen around.

137

They help keep our muscles strong.

138

They help keep our.

139

Visceral fat and

subcutaneous fat levels low.

140

So when testosterone starts to decrease

and estradiol starts to get wacky we

141

start to lose collagen in our skin.

142

So you may notice drier skin

wrinkles start appearing.

143

We start to replace our muscle with

fat, which is very discouraging.

144

We start to build visceral fat.

145

A lot of women will start to

notice that they gain weight

146

around the middle that they're not

as strong as they used to feel.

147

But collagen plays a big

role for skin health.

148

And we do see, because at the clinic

here we do aesthetics as well.

149

We see a lot of women who have not

been on hormones, who have not as

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great a skin as they would like to

simply because collagen is gone.

151

Vaginal dryness is a huge one.

152

And that can start in perimenopause.

153

And again, estradiol keeps the

vaginal tissue moist and healthy.

154

And collagen there keeps everything happy.

155

And when it goes away or starts

to get wacky that's a big

156

symptom that women come in with.

157

So physically, women usually

will report dry skin.

158

Weight gain is a big one,

especially around the middle.

159

Kelsy Vick: Given some of the physical

things that women experience, how do you

160

approach it from a physician lens as a

way to guide your patients, whether it's

161

through supplementation, medications,

behavior modifications, education,

162

what sort of stuff have you seen work

really well clinically and then has also

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really research backed, when it comes

to handling some of these challenges?

164

Dr. Larissa O'Neill:

165

Yeah, so we do a lot here.

166

We do blood work, we

test a lot of biomarkers.

167

We do body composition testing because

when you think about perimenopause and

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menopause and the changes that happen

with the hormones, a lot of that is that

169

we get a lot less metabolically healthy.

170

So again, we get visceral fat.

171

We get fat buildup in our muscle.

172

We get less insulin sensitive,.

173

A lot of women will come in and

say, I haven't changed a darn thing.

174

I eat the same, I work out the

same, I've gained all this weight.

175

What's going on?

176

So we do body composition

testing on everybody.

177

We measure their muscle mass, their

visceral fat their percent body

178

fat, and I don't even care about

their weight number as much as

179

I care about those three things.

180

And it's very interesting

for some women who.

181

When you look at them physically

look like they shoulda a low body fat

182

percentage, but they don't because

they've replaced some of their muscle

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with fat and they have a higher

visceral fat load than they expected.

184

And it's all because of

those hormonal changes.

185

So we do body composition testing,

we do a lot of blood testing to

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look at different just like even

vitamin levels, like vitamin D.

187

Let's take vitamin D we say.

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We call it a vitamin, but

really it's a pro hormone.

189

It helps us with all of

our other sex hormones.

190

So if a woman's vitamin D level is low,

one of the first things we're gonna do

191

is say, you gotta get that vitamin D

level up and it needs to sit around 70.

192

And most of the time we check

in and it's usually around 20.

193

And people are like, but

I'm outside all the time.

194

You are, but it's still not enough.

195

We don't have enough in our diets

anymore for most people to really

196

have A really good level, again,

which needs to be around 70 plays

197

a role in bone growth for women.

198

Osteoporosis is a huge thing that happens

for women as they go through menopause.

199

and actually it happens before that

so I want to back up a little bit.

200

So I've actually started talking

to women a lot earlier, and I

201

wish that primary care physicians.

202

Even pediatricians would talk

more to young women about

203

exercise and protein intake.

204

Peak bone density for

most women is around 20.

205

It starts to decline after that.

206

So I've had two women come into me

with premenopausal spinal fractures

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from weightlifting because they

said, I'm gonna go get healthy.

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And then so they start lifting

weights and they get a compression

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fracture or stress fracture.

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We start them on testosterone and

a little bit of estradiol and bone

211

density improves over a couple years.

212

But if we started to talk to

younger women about the importance

213

of this, we'd see less of that

as they went through menopause.

214

and maybe it's different with

kids now, like my daughter lifts

215

weights, but she lifts weights.

216

'cause we talk about lifting weights.

217

I don't know how many 21 year olds

get that talk from somebody that

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this is really important for you.

219

But muscle health and bone health,

very important muscle health because

220

again, it keeps us metabolically

more healthy as we go through life.

221

And perimenopause and menopause

are just times when women get

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very metabolically unhealthy.

223

So we talk a lot about body composition.

224

We talk a lot about protein intake.

225

'cause again, protein intake

needs to be different for women.

226

Our body doesn't deal with

it the same way men does.

227

We have to have.

228

A certain spacing of it.

229

We really need three meals a day

with a good amount of protein,

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and women need at least a gram

of protein per ideal body weight,

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especially when we're in menopause.

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So I like women to break it up.

233

And let's say your ideal

body weight is 120 pounds.

234

You need 45 at breakfast.

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45 at dinner.

236

And the rest at lunch.

237

So higher protein intakes.

238

At the two ends of the day, really

better for muscle synthesis for women.

239

So better protein intake,

different exercise.

240

Most women are really good about cardio.

241

They'll go out, they'll take a walk,

they'll get on a treadmill, they'll go

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get on a stair step or whatever, but

that doesn't help you build muscle.

243

And so talking to women about

weightlifting, everybody that

244

comes in, we talk about it.

245

And not just lifting, but lifting heavy.

246

Really trying to keep your muscle mass

around and build it if you don't have it.

247

Because muscle's, the organ of longevity.

248

If it gets unhealthy, which it does

when women go through perimenopause and

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menopause, we just don't age as well.

250

We don't do as well.

251

Protein intake exercise or two of the big

things, we talk to everybody about making

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sure that your blood work looks good

from a vitamin and mineral standpoint.

253

The biggest supplement we

probably put everybody on is

254

Vitamin D, just 'cause it's low.

255

And then we start talking about hormones.

256

We do a ton of hormone replacement here.

257

Estradiol, progesterone, testosterone.

258

There are lots of different

ways to get it replaced.

259

Testosterone I think, is huge for women.

260

Again, we've got androgen receptors

everywhere, muscle bone, brain bladder.

261

start a lot of premenopausal

women on testosterone.

262

It does help alleviate a lot of

the symptoms through perimenopause.

263

'cause you do get some conversion

to estrogen, estradiol.

264

And then if they're very symptomatic from

lack of estrogen, we'll do some estradiol

265

and perimenopause at lower doses.

266

And then once they get into

menopause, we do full doses.

267

But.

268

It's really about trying to stay

strong, metabolically healthy, eat

269

right, really watch body composition

and then address the hormones.

270

Kelsy Vick: What about when

it comes to skin health?

271

Is there anything that you guys like to do

or recommend when it comes to skin health

272

Dr. Larissa O'Neill:

273

hormones?

274

Yeah.

275

Okay.

276

So estrogen deficient

skin is a real thing.

277

If you're not on systemic hormones,

there are estradiol, estriol.

278

Face creams that you can get compounded.

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We also talk a lot about the lasers

that help you build collagen.

280

'Cause there are some

very good ones out there.

281

And then good medical grade skincare.

282

One of our favorite ones that we sell

here is Pavis because it has so many

283

amazing adaptogens and antioxidants

in it that help your skin repair.

284

And then some kind of.

285

Retinol or acid type product that

again helps you build collagen.

286

I love copper.

287

GHK, copper.

288

I think it's all over Instagram right

now, but you can use it topically.

289

You can inject it.

290

It's a peptide.

291

it is.

292

amazing for collagen build and skin.

293

It takes time.

294

Everything does.

295

But it is one of our favorite

peptides to use for skin.

296

But it's a good combination of

good medical grade skincare.

297

A really good sunscreen.

298

I cannot stress sunscreen enough.

299

I know I'm a redhead, so I

talk to everybody about it.

300

But any coloring in

your skin is sun damage.

301

Sunscreen and a physical

block over a chemical block.

302

So something that's a zinc.

303

For sunscreen and then lasers

that again, help with sun

304

damage and help build collagen.

305

there a class of, I'll call them fillers.

306

They're really biostimulators, sculptural

radius and Bella Field that really

307

help you build your own collagen.

308

So we do a combination of all those.

309

to build out a plan.

310

We're not just a one and

done kind of thing for us.

311

If a woman's coming to see us and

they come to see us for a skin

312

consult and they're not on hormones,

we talk to them about it because.

313

Your skin's not gonna age as

well if you're not on some

314

kind of systemic hormone.

315

And there are very few women that

hormones are contraindicated for.

316

Very few.

317

Kelsy Vick: You said you can start them,

maybe not preventatively fully, but

318

like when people first start showing

symptoms to help with some of the symptoms

319

This is a very probably elementary

question, but do y'all taper off too?

320

Is there like a ending phase

that you guys taper off?

321

Or is, once a woman is in menopause

and starts to have some of these

322

changes, they really are changes that

are gonna have to be managed for life

323

Dr. Larissa O'Neill:

324

It's permanent, right?

325

It does.

326

It doesn't, once you stop hormone

replacement, all of your benefits go away.

327

And the benefits are many luckily the

FDA removed the black box warning from

328

estradiol six weeks ago, which was huge

because those of us who have been in

329

the space for as long as I have been,

know what the science is and know that

330

we should have been using hormones all

along, we should have never stopped

331

because of that one silly study.

332

We know heart prevention, dementia

prevention, osteoporosis prevention.

333

When you look at the leading causes of

death for women, heart hip fracture,

334

dementia, and the hormone replacement,

menopause hormone replacement really

335

does help prevent all of those things.

336

So we're huge proponents of it.

337

Kelsy Vick: And like you said,

hormones, there's receptors on all

338

different systems within our bodies.

339

Yeah, exactly.

340

So there's probably not a system

that it doesn't benefit, especially

341

if that was how our bodies normally

functioned in our twenties and thirties.

342

We're still gonna have some of those

receptors, so how can we maximize

343

their reach when we can no longer

produce what we used to be able to.

344

Yes.

345

Dr. Larissa O'Neill:

346

Yep.

347

So I have 80 plus year olds on.

348

hormones still because they want

to continue to reap the benefits

349

and they feel good on them.

350

And if they have tried to stop them in

the past, they're like, I don't feel good.

351

So we just keep 'em on.

352

No reason to stop.

353

Kelsy Vick: I love what you said too about

just different education and guidance

354

that you give your patients, because

as a PT I'm a huge muscle building.

355

Bone mineral density.

356

How can we shift the viewpoint early on,

especially in girls that working out is

357

for aesthetics, which yes, it can be.

358

Yes.

359

And that's confident building.

360

Like I do the same thing, but how can we

get more of that long-term view of yes,

361

I see patients all the time who have

muscle atrophy, who have bone marrow

362

density issues, and then they're gonna

become fall risks later on and have

363

that fracture and lose some of their

mobility and some of their function.

364

And knowing that's even

more important in menopause.

365

I don't know if this is a good

way to put it, but our bodies.

366

Are not necessarily working with us as

much as they are in our twenties, when

367

exactly we can maximize some of that

bone marrow density disease and some

368

of that muscle, our muscle mass too.

369

yes, that peaks in what?

370

Thirties, early thirties, and then it's

the, it gets the graph for increasing

371

the linear, the slope is a little less.

372

So it's how can we work to build what

we can when we're younger, because

373

that's when we can really build that

solid foundation and then continue

374

to work towards that in our thirties,

our forties, our fifties, when our

375

bodies again are maybe converting

that muscle to fat a little bit.

376

But we have to work a little

harder for some of those benefits.

377

Dr. Larissa O'Neill:

378

Yeah, exactly.

379

We need to be doing more

education in younger women.

380

And it's funny 'cause when I started

doing it here with my late 20 year

381

olds, they would kinda look at me

and I'd be like, I promise this is

382

coming and if we can just do something

about it now to help you be better.

383

From a muscle standpoint, from a metabolic

standpoint, menopause is gonna be easier.

384

So

385

Kelsy Vick: I call it the longevity fund.

386

It's like putting in little habits

every single day, whether it's exercise,

387

a mindfulness thing, hydration,

fueling the right way, enough protein

388

i've noticed so many more of my

patients healing better after injury.

389

Having a better mindset when it comes to

a mental health challenge or challenge

390

that their families are going through.

391

There's just these little

things that we can do early on

392

to help us when we're older.

393

And I think coming from the medical

field, we see that, and maybe it's

394

more of a fear-based motivation for

us to be like, no I know what I can

395

do preventatively to help me whenever

I get to even pregnancy, postpartum,

396

our bodies go through changes then.

397

But menopause as well, it's.

398

What can I do now knowing what I know

happens in these later stages of life?

399

How can I help my body and how can I

transfer that mindset to other girls too?

400

To realize you can do all the cardio yes.

401

If you love that, but build the muscle,

build the bone marrow density, do

402

the jump training to have some of

those long term effects, so Exactly.

403

Dr. Larissa O'Neill:

404

Yeah.

405

And training does need to change right?

406

Throughout your life, your body responds

to things differently menopausal

407

women really need to do sprint

training, like true sprint training.

408

And that's because of the effect that HIIT

exercise has on cortisol for women, which

409

affects our insulin level and everything.

410

our stress response is different

because of our hormonal challenges.

411

a true sprint exercise is gonna

be better for us than a hit

412

exercise cold plunge for women.

413

And there's not a lot of science

behind cold plunge in general, but for

414

women, not good intermittent fasting.

415

for women, again, not good.

416

We lose lean muscle mass.

417

So for us, again, we need that protein

in the morning for our muscles.

418

So don't fast till six o'clock at night.

419

Sauna's much better for Yes, for women.

420

And the science on the health

benefits from saunas Is good.

421

It's really there.

422

So I do, I encourage my women if

they've got access to one to do it.

423

'cause I just think it's

424

Kelsy Vick: beneficial.

425

Dr. Larissa O'Neill:

426

for us.

427

Yeah.

428

Kelsy Vick: When we did the cold plunge

episode that'll come out next week.

429

It was talking about how

cold plunging for women.

430

if you're going to do cold plunging,

it's not the colder, the better.

431

Like we think for men it's more of our

body's sense, the cold as a bad stress

432

and kick on our bad stress response.

433

Yep.

434

And I actually mirrored it to

fasting because fasting, I've had

435

a PhD researcher, dietician like

physiologist, exercise physiologist

436

who studies some of the metabolic.

437

Effects that women go

through and all of this.

438

And she was saying for fasting,

our bodies sense the same thing,

439

where it's like we go into this.

440

Survival mode a little quicker when our

body senses lower energy availability.

441

So both with cold and with fasting

and things like that, our bodies

442

as women handle it differently than

men and sense that bad stress a

443

little earlier on where men might.

444

Think of it or their body sense it as

more of a good stress and adaptable

445

stress that they can grow from.

446

So I just thought it was

interesting, cold and fasting.

447

It's like both of these things

are very popular right now,

448

especially intermittent fasting.

449

and fasted training, fasted exercise,

all of those sorts of things.

450

So it's just interesting to link those

two and to have the women's health and

451

female science Be showing some of these

differences between men and women.

452

I think it's awesome.

453

Dr. Larissa O'Neill:

454

Yep.

455

I think it's great.

456

It's studies have been

needed for a very long time.

457

My background's primary care and the thing

that I always remember, 'cause again,

458

we always think about heart disease and

how women present differently than men.

459

Had this one patient come in and

she just said, I get short of breath

460

when I get to the top of the hill.

461

And that's new.

462

And I did an EKG on her in

my office and she was having

463

a heart attack in my office.

464

But men come in with crushing chest pain.

465

Women don't.

466

Right?

467

But that's, again, the studies

haven't been out there.

468

We're now starting to see

some of them, which is great.

469

happy that we have people who are focusing

more on women women's health because.

470

We are very different Yeah.

471

Than men.

472

Totally.

473

Very different

474

Kelsy Vick: from our metabolic capacities

to our thermo regulation when it

475

comes to sauna and heat and Yeah.

476

I love that.

477

I love learning about that and actually

like seeing some of the differences.

478

I also think with probably the women

that you're seeing right now who are

479

in that perimenopause menopause stage.

480

It's a little bit of a mindset shift

that you're having to coach them through

481

too, because I think younger women are

starting to understand the importance

482

of strength training over cardio

for some of these aesthetic changes.

483

But I bet there's a heavy sort of like

mindset shift because a lot of my loved

484

ones, like my aunts and my, older women

in my family that I look up to, their

485

exercise has consistently been cardio.

486

Yeah.

487

And thinking of cardio for fat

loss, it's like cardio burns fat.

488

That has been the.

489

mantra that people have had for years

and years, and then having to understand

490

the shift of, okay, hang on, our bodies

handle that a little differently.

491

That might be great for men, but we

might need to focus on something a

492

little differently as women or have

a little bit of a different ratio

493

when it comes to that sort of thing.

494

Dr. Larissa O'Neill:

495

Yeah.

496

Strength.

497

The strength training is huge.

498

you have to think of your muscle as.

499

Your metabolic regulator

beyond your hormones.

500

They're very important.

501

But your muscle, basically

controls your insulin sensitivity.

502

So if your muscles aren't healthy you're

metabolically not gonna age as well.

503

You will gain weight,

you will lose strength.

504

And weightlifting will

definitively help that.

505

we really try to build

these plans for women.

506

It's not just, Hey, come in and get

some hormones and you're gonna be good.

507

We really do a ton of education.

508

We talk about how to

address the visceral fat.

509

We talk about how to address muscle mass.

510

With all of those other things that aren't

just the hormones, but hormone replacing

511

women's hormones is of huge importance.

512

When we look at.

513

How to really help women age better.

514

So we talk about it all.

515

It's a complete plan.

516

We talk sometimes about peptides.

517

There are different peptides that we

use that can help address visceral fat

518

differently and muscle gain differently.

519

But that's after we've

done everything else.

520

And somebody's doing the workout

and they're eating like they should

521

and they're taking their creatine.

522

We know creatine is, all over Instagram

right now but The science on creatine

523

for women is actually very good.

524

Not just for muscle, but for brain health.

525

The studies that have come out on

Alzheimer's and when the Women's Health

526

Initiative study came out and it really

deterred hormone use for women the rates

527

of Alzheimer's went up tremendously.

528

But we know that's not just related

to hormones, it's related to creatine.

529

It's related to.

530

Omega-3 levels declining in

women's brains as they get older.

531

Some of the things that are, really

important to talk to women about omegas,

532

creatine, vitamin D hormones, all of that.

533

Just because women are far more

likely to get Alzheimer's than men

534

and without hormones even more likely,

all, that's to say that there's a lot

535

to talk to women about as they age.

536

And you need to be seeing somebody

who will take the time to really

537

talk to you about all that.

538

'cause sometimes educating yourself

on Instagram isn't the best idea.

539

Kelsy Vick: And I love how you're

talking about the foundations.

540

It's yeah, we can do the peptides,

we can do other treatments on top of

541

it for your skin health and things.

542

But what I'm also hearing is like

the foundations are the same that we

543

should be focusing on throughout life.

544

they might shift a little bit, but

if we can reset a little bit or

545

teach someone who's maybe new at

it and struggling with some of the

546

challenges that come with menopause.

547

If we can teach 'em good exercise,

habits and routines, good fueling,

548

good supplementation, all of those

sorts of things, maybe help 'em

549

with their sleep a little bit,

550

Dr. Larissa O'Neill:

551

sleep is super important and it gets

very disrupted in perimenopause because

552

progesterone is our sleep hormone

and when progesterone goes away.

553

We do not sleep well at all.

554

And not sleeping affects,

cortisol, insulin, all of that.

555

So we do focus a lot on sleep health.

556

I have a lot of patients

that have wearables.

557

And I say that's great as long

as it's not distracting to you.

558

I have one I wear sometimes, not

consistently, but get a little

559

data and then I go on my merry way.

560

But sleep is huge and progesterone.

561

Is very important for that.

562

And so we do replace progesterone

early for a lot of women because

563

they just, they're not sleeping.

564

The 41-year-old will come into me

and say, I don't sleep at night

565

and I'm falling asleep in Carline.

566

Okay?

567

I know what that is,

and we can address that.

568

Kelsy Vick: Sleep is one of those

where I feel like a lot of women,

569

whether it's hot flashes or different

things that they experience at night

570

too, sleep seems to be disruptive.

571

And knowing how important

sleep is for just recovery,

572

muscle building, brain health,

573

All of it.

574

And if we can.

575

Help with that in some way.

576

And like you're saying, if it's through

hormones, because of course hormones

577

affect every part of our system.

578

Then why not help that earlier on

that way people aren't struggling

579

with some of these sleep disturbances

that is negatively impacting all of

580

the other work that they're putting

into Their bodies in general too.

581

Dr. Larissa O'Neill:

582

Yeah.

583

When interestingly when women's

testosterone starts to go down,

584

they'll start to get night sweats.

585

So when women wake up just

drenched at night, it's usually

586

'cause their testosterone is low.

587

And again, that's an easy fix.

588

Kelsy Vick: I love y'all's

approach too, because.

589

Like you said, attacking it from every

single angle and I was able to walk

590

through y'all's clinic before, which

is amazing, and seeing all of the ways

591

that you're touching every single system

within the body, because our hormones

592

affect every single system within

the body, is absolutely wonderful.

593

On the topic of creatine and

supplementation specifically, have you

594

noticed a difference in dosage needed

for creatine when women hit menopause?

595

I know one of my friends subjectively has.

596

Experienced more bloating,

and bloating is oftentimes a.

597

Something that people worry

about and are concerned with.

598

And she has said, I know the research

says that water retention is not a thing,

599

but in my body that is what I'm feeling.

600

so is there a shift in how our bodies

manage creatine once we get to that age.

601

Dr. Larissa O'Neill:

602

So I think people bloat with creatine

or they don't, and just, again,

603

everybody's body's a little different.

604

You can get some water retention with it.

605

You can get bloating.

606

I think the biggest thing with creatine

is you've gotta drink water with it.

607

So if you're somebody who just,

I had a friend tell me, she was

608

like, I just throw the creatine on

my tongue and I'm like, oh, okay.

609

One, it's usually so chalky.

610

Really.

611

Like you actually get that down.

612

But secondly, you really need

water with it for absorption.

613

And if you're good about drinking

a lot of water with it, you're

614

gonna get less bloating and

less water retention in general.

615

Five grams a day is the standard, right?

616

That's what we need.

617

The studies that came out on

Alzheimer's we're actually done with

618

15 to 20 grams of creatine a day.

619

You have to be really good about

water with that, and somebody

620

needs to be monitoring some blood

work on you if you're gonna do

621

that high of a dose of creatine.

622

My recommendation is usually

just five grams a day.

623

If I have somebody that I'm really

trying to get some muscle on,

624

like they really have low muscle.

625

I'll tell them to do an extra five

grams on the day that they lift, like

626

after they lift, do an extra five grams.

627

But just standard five grams a day.

628

Kelsy Vick: have you seen, someone

who is putting in the behavior

629

modifications with the exercise.

630

With the eating right.

631

Who has maybe declined

hormone replacement therapy

632

Dr. Larissa O'Neill:

633

we do have some women

who choose not to do.

634

Hormone therapy, which is fine.

635

It's everybody's personal choice.

636

I usually will direct them to

certain resources to try to influence

637

them to take it, but you can do

it without hormone replacements.

638

It's just not as easy.

639

it gets harder to build muscle, like

you talked about as we age anyway.

640

So when your hormones go

away, it gets really hard.

641

You have to lift exceptionally heavy.

642

To maintain and build muscle.

643

When you're in menopause, if you're

not gonna be on hormone replacement,

644

it's also a lot harder to address

the visceral fat that happens.

645

Again, you've gotta be diligent about

what you're doing in the gym and how

646

you're eating, what you're eating.

647

hormones, just make it easier

because the effect they have on our

648

muscles and on our fat distribution

and on our insulin sensitivity.

649

So just makes it a little easier.

650

Kelsy Vick: So we've talked a lot about a

lot of different parts of the body today,

651

about menopause, about perimenopause,

about just being a woman in general.

652

Is there something that you wish girls

in their twenties and thirties knew?

653

And we've touched on it a little

bit, but what would be maybe your

654

top one to three things that you

wish younger girls understood about

655

their bodies at this age to help

them in perimenopause and menopause,

656

Dr. Larissa O'Neill:

657

protein intake and weightlifting.

658

Those are really the two things that.

659

Every woman in their teens

needs to be educated on.

660

if you can get your eating habits

good, if you can get the protein intake

661

right, if you can build that muscle

and that bone density when you're

662

young and maintain, not that it's

gonna make perimenopause and menopause

663

a breeze, but it's gonna be easier.

664

It's just in general gonna be an easier

transition 'cause you're gonna go

665

into it more metabolically healthy.

666

So you might not gain as much weight.

667

the belly bulge that happens

will be less your risk of

668

osteoporosis is gonna be less.

669

It just protein and weightlifting

at the two most important things.

670

A 20-year-old could be doing right now.

671

Kelsy Vick: I love that.

672

So consistent with what we

are, trying to, teach women

673

and educate them on earlier on.

674

So thank you so much for joining us.

675

I learned a lot.

676

I know this is something that.

677

I selfishly wanted more people to

understand about menopause, myself

678

included and perimenopause and just

what happens within our bodies, why it

679

happens, what we might expect to change,

how we can work to not necessarily prevent

680

'cause that's not the case, but be more

prepared for it once it does hit us.

681

So thank you so much.

682

Yes.

683

I will leave the link to Dr.

684

O'Neill's clinics below

her clinic in Georgetown.

685

If you are in the Austin area and know

someone or are someone who might want to.

686

Come see her for her holistic

approach to just being a woman and

687

going through perimenopause and

menopause and all of the stages.

688

So I hope you guys learned a lot from her.

689

I know I did.

690

And I will see you guys again on the

next episode of Wellness Fixes the Pod.