We’re diving into a conversation every midlife woman needs to hear—because it’s not just about the so-called pill hangover or that mystery fatigue you can’t shake.

Functional nutrition expert Elizabeth Katzman breaks down what’s really going on with your energy, anxiety, hormones, and bone health—and what to do about it. From how to spot nutrient depletion and rebuild bone density to the real reasons you're not bouncing back like you used to, Elizabeth shares evidence-based, actionable strategies to support your body through perimenopause and beyond.

We also talk:

• What to eat in midlife (and what to skip)
• Supplements that actually work
• Birth control’s long tail of side effects
• The surprising symptoms of hormone imbalance
• How to advocate for yourself with your doctor

✨ This episode is your functional health reset—backed by science and built for bold midlife.

Don’t forget to…

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• Host: @redcarpetroxy

First step she can take to find answers if she's not getting it from her doctor.

We're not married to our doctors and even if we were, you can a doctor divorced. You don't necessarily have to fire them. You may just need to hire more people, add different people to your team.

It's not just the calcium and it's more diet centric than supplement centric. I like to drink protein in the morning. Bone broth is great. Doing a smoothie with collagen, really trying to stay away from the coffee right away.

I know that it's so hard. It's so hard.

We need mitochondrial function to feel motivated to go to the gym, to lift weights, you know, and it becomes a vicious cycle of not having enough energy. So you're not doing the things that give you energy.

Would you say it's more genetics than lifestyle or vice versa?

I don't even really think most women think of the pill so much as hormones. They think it's regulating their menstrual cycle when really just taking the menstrual cycle away.

So what is the remedy to the pill hangover? What can we do to try to fix it?

Today on the iconic Midlife, we're talking about a hidden factor behind so many of the symptoms women face in their 40s and 50s. Fatigue, anxiety, gut issues, bone loss even after being told everything looks normal.

My guest, Elizabeth Katzman is a functional diagnostic nutrition practitioner and certified perimenopause hormone specialist who coined the term the pill hangover.

She helps women understand the long term effects of birth control, helps them to protect their bone health and rebalance hormones naturally so they can finally feel strong, energized and in control again. Today, Elizabeth is here to give us the tools our doctors often don't. Welcome to the iconic Midlife. Elizabeth, how are you today?

Hi, Roxy. I'm well. Nice to see you. Thank you.

Nice to see you. So excited that you are here.

As you can imagine, I have like a thousand questions for you because you talk about so many topics that are so important to women in midlife especially.

I was just kind of going through the research and, and looking at some of your stuff and I love this term that you have come up with called the pill hangover. I am just like, oh my God. I feel like it applies to so many women. Definitely applies to me. I feel like.

So would you mind explaining to your audience, to the audience what the pill hangover is?

Well, when a lot of people think of a hangover, they think of just the morning after.

But the Beauty of getting off the pill is you might not realize it until years later when you try to take progesterone, and it may not work as well as you wanted it to.

So basically, we really have to give our time, our bodies time to reset after disrupting its natural function, after disrupting the way our, you know, HPA access works. Everything becomes very disconnected. And so it takes a while for our bodies to get back online, our receptors to get back online.

It could look like acne, depression, fatigue, weight gain. The pill depletes us of minerals, vitamins, methylation capabilities.

So there's just so many things that are involved and you may feel it right away or quite some time later.

Well, I think there's something so interesting too about that. Is that the connection to the gut issues? Because I feel like at this time, so many of us have those, we're like, oh, it's like our guts aren't well.

You know, we feel like we need to take more probiotics or we need to do all these different things. And what if that. If the pill was the root cause of all that kind of stuff?

Yeah, exactly.

I mean, and the thing is that a lot of the reason why people go on the pill in the first place, most of the time, especially in teenage and early 20s, it's actually not contraception at all. It's to deal with other issues that are going on.

And so when we're masking the root cause of why they're having those issues by using the pill, those things are just going to pop up. Not always, but often when you're done. So it may regulate things in the meantime, but we're going to have to get to the bottom of it at some point.

Yes, and I feel like so many of us were on the pill for so long. I mean, I feel like I was on the pill for probably, God, 15 years. I mean, it was a long time. Right. How about you?

Were you on it for a long time as well?

I was, and I was given it in my teen years. And the crazy thing was, it wasn't for contraception. And actually my periods, I was fortunate, were quite regular and normal.

And I didn't have a lot of cramping or irregular bleeding. It was just sort of standard practice. Okay. You have a menstrual cycle now.

Let's just override it and give you the pill, and then you won't have to worry about anything. I mean, that was in the, like, mid to late 80s, so. But I still see it so much now.

So much where you Know, you go into the gynecologist's office as a teenager and even with no complaints, they'll want to put you on the. I think that word's gotten out thankfully that, you know, slowly but surely.

I'm hoping it becomes less, but especially if you're a teenage girl and you are not sexually active but you're having acne or painful periods rather than looking into why you'll often get put on a pill. And for a parent, it's tempting too. I understand that.

Because you don't want your child to suffer and it can be really difficult and costly to sort of get to the bottom line, what is causing it to be a difficult experience. But honestly, it really starts from day one. When I look at.

So my kids range in age from 9 to 18 and when I look at my 9 year old daughter and her friends and the amount of sugar and processed foods that they eat and my daughter doesn't, and I explained to her, we talk about having a period even now before she's even getting one, because I want her to understand if you eat a lot of sugar and processed foods when you're a little girl, the odds of you having difficult periods in your teenage years are pretty good. You know, you're setting yourself up for an uncomfortable experience and it starts from day one.

And I think a lot of people have this mindset of, oh, your kids can do whatever, they're resilient, everything's fine. But no, it, it adds up.

Yeah, it ends up, you end up paying for it one way or another.

It seems like, you know, and I think there's such an interesting argument too because I was talking to one of the doctors that came on my show previously and you know, she was saying, because she talks a lot about HRT in, about bioidentical hormones that, you know, women later in life take and she's like, you know, there's so much resistance to HRTs and there's, you know, bad press and everything else that it's interesting because the same isn't true for the pill because, you know, the pill is synthetic, that those are, those are not bioidentical hormones, you know, but yet they are still messing with your hormonal cycle, your periods. And it's just like, I don't know that people even realize that. Do you know what I mean?

I do. There is such a huge disconnect.

There are women who took the pill for a long time or are in perimenopause and are still on the pill, but they're afraid of taking hrt. It's just a huge disconnect in not understanding really the difference between synthetic and bioidentical.

I don't even really think most women think of the pill so much as hormones more as they think it's regulating their menstrual cycle, when really it's just taking the menstrual cycle away. That bleed isn't there for any medical reason. It's not an actual, you know, menstruation.

It's just a synthetically induced bleed really to make women just think that things are normal. And the way that when you go back in history and look, it was really because at the time birth control wasn't legal.

And so the scientist that proposed it, it was like, okay, no, this is not contraception. This is just regulating menstrual cycles. So that's sort of where that story came from. And it just stuck around.

And so people are not realizing that they're not actually having a menstrual cycle, that their hormones are completely being overridden by these synthetic hormones. And it affects you at every stage in life. And I'm not saying it's not right for everyone. There's, you know, this isn't a one size fits all.

It's not black and white. It's every woman's choice.

But I just want women to have some informed consent and know that, you know, if you're a teenager or woman in your 20s, you're not getting that natural progesterone, you're not going to have optimal bone growth as a result. When, you know, we make the majority of our bone before the age of 30, you're blocking that.

So your bones aren't going to be as strong if you're in perimenopause. It's also affecting you because you're not going to know what stage you're in because you're getting a regular quote unquote cycle.

So are you early, mid late? Are you menopausal? Because you're not going to know. And we, again with the bone health.

We lose so much of our bone density in those five to seven years after menopause. And if you're on synthetic hormones, you're really missing out.

Yes, absolutely. So what is the remedy to the pill hangover? What can we do to try to fix it?

Depending on your genetics and your toxic exposures and your lifestyle, it's going to be different for every woman because there are so many ways that the pill affects you.

So it could be, for some women, it's going to Be mostly a gut microbiome issue because it does decrease diversity and it increases intestinal permeability, which increases autoimmunity risks. It also affects the way we convert T4 to T3. It interferes with the enzyme. So for a lot of women, it can result in thyroid issues.

It also involves, you know, the way that we methylate because it depletes our B vitamins. So if you genetically already have a difficult time with methylation, that might be a key one for you.

It affects and depletes our magnesium, zinc, selenium. So again, that's like very thyroid centric, as well as overall immunity. So it depends on the woman.

But if there is someone who's on the pill and looking to get off, I say just make sure to support all of those things to make the transition as easy as possible. So take a probiotic, especially lacto and bifido.

Those are the ones that really tends to deplete, you know, mucosal lining support, aloe, marshmallow, licorice, all of those things. And a methylated B vitamin complex. Zinc, magnesium, potentially iodine.

Iodine can be controversial for some people with thyroid function, but I'm a fan of it. So it can affect each woman differently, but it does make the transition better if you're supporting those things.

And again, it may not turn up right away for you. Someone might feel great, and then it's not until 30 days later, six months later.

And what I see a lot in clients who are now in peri and menopause, if they were. The longer they were on the pill, the greater chance that they're going to have a progesterone intolerance.

Wow.

Because it messes up your receptor function.

Okay.

And so even if you quit taking the pill 20 years ago, it can still have a difficult time with progesterone. Meaning you think it's going to help you sleep or relax you, and instead you have more of an excitatory response and you have a hard time sleeping.

Oh, well, we don't need that because sleep issues are already. Already a problem right now. You know that that would make it even worse.

Yeah. And it's more common than you would think.

And it's sad because women, once they understand the bioidentical hormones are beneficial and they've got a doctor who's on board, and they're like, okay, yes, I'm gonna take my progesterone, finally go to sleep, and then it's like, shoot. I was so excited for this. I did all the research, and it's not working out the way I had hoped.

That's all you want is good sleep. When you're in perimenopause, it's like, just have that. That night of great refreshing. Like, you wake up rested.

And to think to not have that is scary. Yeah, kind of what's really been captivating people is bone health.

Because, you know, it is scary to think about losing our bone density, possibly breaking a bone at some point, you know? And so what do you think for women in midlife? Like, what can we do for our bone health?

Like, what are some of the mistakes that you see women making as it relates to bone health? And what can we do to improve our bone health?

Part of the issue is the fact that I think we're all about in our mid-40s to 60, right? The Perry girl, 40 and a 55ish. And so we all grew up in a time when waist models were very popular. It was just like, the thinner, the better we were.

The aerobics culture. We were not raised to think about weights or protein. It was all about, like, low carb, you know, not low carb, low sugar and low fat.

Everything was like low fat.

So part of it is that our age group, we don't have great bones to begin with because we really wasted those years. A lot of us, those, you know, ages 30 and before, in our teenage years, those are prime bone building ages.

And a lot of us were on the pill, so we're blocking, you know, the progesterone as well. A lot of us then went on to take SSRIs, which also affects bone health. Really, it does.

And it's a common pattern to go from the pill to an ssri, because the pill is a synthetic progestin. And so it doesn't have the same benefits as a progesterone, and it leads to more anxiety and depression, whereas progesterone is very protective.

So it's a common pattern, and it's a double whammy for a lot of women. I know that was definitely the pattern for me. Now I'm not on either, right? But I still.

I am in an osteopenia range, although it's getting closer and closer to normal every time I check. But what we. The tough thing is is that we're at a stage now where, as estrogen's Declining. We're having a difficult time balancing insulin.

Our body is naturally gaining more visceral fat and subcutaneous fat. And so our instincts is to go back to the time where we used to just over cardio and under eat.

And then we're realizing, oh, wait, that's actually not working anymore.

So that's another reason why the GLP1s are so attractive to a lot of women, because they're doing all of the things that used to work and they're getting desperate. But.

And also, GLP1s can be great and they can have a lot of benefits as long as you're eating enough protein, which is hard if you don't have an appetite, because we really need to be doubling down on the protein, the weights. It's not just the calcium. It's more. It's more diet centric than supplement centric.

It's also a time in our life where we're having nervous system regulation issues because as we lose estrogen, we're having a harder time balancing cortisol, balancing our, you know, trying to get into that parasympathetic is really hard when you don't have enough progesterone and all of that. That, that state of being is very catabolic. So it's breaking down our muscle, it's breaking down our bones.

And so it's honestly the basics that are kind of a snooze that most people don't want it. It's like getting a good night's sleep. Trying to manage stress with, you know, without hormones is quite challenging.

And eating enough protein, which is difficult, especially if you're not used to doing it. And also our digestion gets more sluggish. We lose hydrochloric acid, digestive enzymes.

So a lot of women will have to supplement with digestive enzymes and HCl in order to deal with all of that protein. And I just say, eat protein like it's your job, because that's how it feels. It's like the first couple meals, I'm good.

The last one, when I know I still need 20 or 30 grams and I'm not even hungry, I'm like, ugh.

What do you, what do you do in that situation when you're so full and you're just like, oh, I don't even want to eat. But you, like, feel like you still need that protein, like, to get in? Do you have any tricks of how to, like, get that in?

Yeah, for some women. So our cortisol tends to be high in the morning, especially during this time.

And so you don't have the appetite when you wake up, if your cortisol is really high, you're just not hungry. So I like bone broth. I like to drink protein in the morning if you have a hard time, if you're just not hungry. So bone broth is great.

Doing a smoothie with collagen, really trying to stay away from the coffee right away. I know that.

So hard.

It's so hard because it was my favorite part of my morning for so many years was like, coffee. First thing, I'm happy.

Totally, totally.

Now I have to have my smoothie first, I have to have bone broth first, and then I'm fine. Then I can have a cup of coffee and it feels fine. I'm not jittery, it's not too much.

But I definitely have to get food in my system to help balance that response. And it creates such a huge glucose response too.

I mean, I love continuous glucose monitors during perimenopause, especially just, just two weeks every, maybe twice a year.

It doesn't have to be a crazy amount, but what you'll see is that sort of early perimenopause, you wear a glucose monitor, everything looks good, you're having a normal response. You can even have that morning cup of coffee on an empty stomach, fine.

But once you start getting into the realm of needing hrt, it's one of the quickest indicators is you'll see your glucose response change in a way that it didn't before. So all of a sudden, that morning coffee makes your glucose spike, even though it's not sweet.

Like if, even if it's like black.

Coffee, it's because your cortisol skyrockets. And so when cortisol skyrockets, you release insulin. And so it's. It's crazy.

It's also, if you, let's say, have an argument with someone, the husband, let's just say he's the character. Not that that happens to me, but for someone else, you'll see that maybe 10 years earlier, your glucose stays the same.

But now let's say you had chicken and a salad, you'd have protein, you've had fiber, you've had fat, but you get in an argument, your glucose skyrockets. So that will often happen because our ability to have resiliency emotionally just completely declines, so that increases glucose and cortisol.

So we, we have a lot working against us, but at the same time, there's a lot of tools, as long as we're aware. So I. I don't like to be obsessive over labs and glucose monitors and aura rings and sleep scores and the whole thing, because it can make you crazy.

But I like them for just check ins every once in a while because things change overnight in perimenopause where you could be everything could look great, and then six months later you're done for. I just, I just know a lot of women who are in their early 40s and still like that. I am nowhere near that. I'm not even thinking about that.

And I'm like, you know what? Let's just get it based. I'm good, I'm good. And then all of a sudden they're like, I don't know what happened. But literally overnight, I completely.

I'm a different woman.

Yes, it's true.

And you know, speaking of labs, because oftentimes you'll go to your doctor, they'll do like, you know, the list of tests that you're supposed to have. Things come back, you know, within normal limits, they say, but you still feel like crap, like you feel like something is off.

So what is the difference between, let's say something in within normal limits and something being in optimal, like in an optimal range. And also, what are our traditional doctors missing when we're testing as opposed to functional medicine? And what should we be asking for?

I think, well, first of all, I mean, functional tests can get pricey, but there's a lot that we can do with regular, just a CBC with differential, that's covered under insurance. Pretty traditional. You do have to ask for differential, not just a cdc and you can look at those and traditional or optimal ranges.

So optimal ranges tend to be a little tighter. In traditional ranges. You could be pre diabetic very deep into what I would consider already diabetes.

You know, it really lets things stretch for a long time. And most doctors, traditional medicine, won't even give their patients a heads up. They won't say you're pre diabetic or things are creeping up.

They'll say everything's normal. But then one day you go back and you have diabetes. So no real explanation. I think really need to get copies of their labs.

Most of the time, especially with traditional doctors, you'll just be told everything's normal, but you don't take a look at it.

And if you're not in a position of paying a coach or someone who's more functional to look over things, I mean, I'm not saying that Dr. Internet is the best for everything, but tools have gotten pretty advanced and there's a lot of Amazing online charts and references that you can at least get a bit of an insight into just to look at some tighter ranges. It's nice if you can look at your gut microbiome, but let's face it, those are 400, $500 tests.

And at the end of the day, you know, most, most women need to work a bit on their gut health. And what does that look like? It looks like not eating ultra processed foods, having fiber at each meal. So again, if, if you want to pay, it's fine.

But if we stick to the basics and what has traditionally worked, you know, everything in moderation, not to get too crazy, those are, those are the things that work.

I mean, I, I do think traditional doctors have to be pushed a bit on things like, like I said, get making sure it's a differential CBC so you have more information. A basic CVC can tell you if you have a parasitic infection, if your basophils and eosanaphils are elevated.

And most traditional doctors aren't even trained to look at that. So that's something that a woman needs to take some ownership over and go through.

Even though, you know, I go through and just what is that, what does that mean? Neutrophils, I don't know what is lymphocytes? What is that level? Really normal.

And, and you can really, you know, map your way through it if you're not in a position to have someone do it for you. A lot of physicians need to be pushed on having a really thorough thyroid panel.

I mean, just so many times women will say, yeah, I've had a thyroid panel and when I look only TSH.

So it doesn't tell me T4, doesn't tell me T3 or reverse T3, which would give me an indication of how they're actually functioning, how their gut is functioning. TSH is just a pituitary hormone. It's not actually letting me know what's going on with your thyroid. So. And a fractionated lipid panel.

So a lot of traditional physicians will just want to tell you your HDL LDL total cholesterol and kind of end a story. They're not looking into LP apob, so it's important to get a fractionated lipid panel.

We want to see if your cholesterol is being oxidized or not because it's not necessarily that high. Cholesterol is the issue. And in fact, active vegetarians, pretty much all of them have elevated cholesterol. It can be very protective.

That's how we make our hormones. It's not a villain. If you have high cholesterol, but you go down the fractionated panel and you say, oh, but it's not oxidized.

I don't have a bunch of tiny particles. Everything is large and fluffy. I'm in good shape. And a lot of that is genetics.

So it's more. Would you say it's more genetics than lifestyle or vice versa?

I would say it depends on the case. So women that have an elevated lp, that's usually genetics, like me. I have high oxidized cholesterol. I have an APOE 4 genotype.

It's also more associated with Alzheimer's, but it has to do with how I transport cholesterol. I don't do a great job of it. It gets oxidized. So I have to take a lot of supplements. CoQ10, bergamot, garlic. I take arterosil.

I do nitric oxide support, and I. So according to my OURA ring, you know, I'm eight years younger than my age. But when I. Before I started adding those supplements, I was.

It was three years younger. Oh, there's been a tremendous amount of progress. I also do cimt.

It's ultrasound for your carotid artery, so it's less invasive and no radiation as compared to CT scan. So if you want to get a sense of how your arteries are doing, if there's calcifications, CIMT is great.

And there was a point where I was a little bit younger than my age, and then all of a sudden, late Perry, that year, that I finally was like, okay, it's HRT time. I. My CIMT jumped to. I was 48, but it showed I was 51. And I was not happy with that. I started HRT. It's like, we're going.

I don't want to go that direction.

Go down.

So I started HRT, I started the supplements, and I took off three years. So my last CIMT, I'm 51 now, but it shows 49.

Reversed it. Okay.

Yeah. And that's what I. When I say things change quickly. It's like, I don't want people to obsess over this stuff.

I just want to every year or six months, give yourself a check in. Because if I would have let that go for two years instead of six months, who knows? I may have had some calcifications and some plaques building up.

It's. You know, it's one of the reasons why they say it's preferential to start HRT within 10 years of your last menstrual cycle.

Because the longer you wait, the faster that calcium builds up. And then when you add in estrogen, it can dislodge soft plaque and lead to a cardiovascular event. Ooh.

That's the whole issue of, you know, try to do it within 10 years of menopause. And, I mean, I could see it in my own labs that, wow, my cardiovascular health was changing rapidly, and I caught it right away, thank goodness.

But if you wait 10 years, there's a lot of buildup that can happen quickly.

Yeah, that does. Because they'd always say, like, you always hear, you know, estrogen is cardio protective.

But that is really kind of the explanation right there of what, you know, what can happen if you let things go. Go and not do anything about it. That's scary that it could loosen plaques, and then those are loose running around the body.

And, you know, who know, who knows what happens after that?

Right. So that's why you can still take it after 60 or even when you're 70. But you want to go get a CIMT ultrasound, or you want to get a CT scan.

You want to have some sense of if you have plaque buildup. And also, estrogen is associated with nitric oxide, which we need for heart health and circulation.

So I take nitric oxide support even though I take estrogen as well. And again, I've done a really deep dive into my genetics, and I try to for my clients, if they're up for it.

Some people don't want to know the information. I find it to be helpful. I don't have great nitric oxide genetically, so I do support that.

Yeah. Genetics, I would think, would play such a key role in finding out some of these answers, at least, you know, kind of seeing how that plays a role.

Right.

It helps because there's so many supplements, and honestly, there are a lot of great ones, but every woman doesn't need them. And a bottle can be a hundred, $150. So how do you know where to spend your money?

For me, you know, if you can do a $300 genetic test, there's a 3x4 that this test, it used to be not through their company, but thousands of dollars through other companies that are still charging thousands of dollars. They charge a couple hundred bucks, same amount of information.

And that's really how I can answer a client when they say, well, what should I be eating? Can I. Because some women can handle way more fat than someone else. Some women can handle way more red meat.

Like, I love the way I feel when I eat red meat. I feel you know, I have a lot of energy. I feel very satiated.

However, because of my genetics, I really can't eat it more than once or twice a week because, again, I oxidize fat easily. I also have some iron genetics going on.

So when I hear noise online saying chicken is an inferior protein and you should be eating red meat and whey, well, okay, but not everyone can do that. I eat a lot of chicken. It's not the greatest. I know. It's got some arsenic. I know. Whatever. That's the. That's what I'm dealing with, so.

Or mitochondrial function. Genetically, I'm not great with that.

So I do spend the money on mitochondrial support, you know, like Mito Pure and Coq 10, which isn't that expensive, but nad, like, some of it can get pretty pricey. I can tell a big difference when I use it and when I don't. But does every woman need to spend that? No.

Yeah, no, absolutely.

And I love that you brought up mitochondrial dysfunction and just the whole, like, all of that, because I feel like it's an issue that maybe women don't know, are not that familiar with.

So can you kind of break that down and how it actually shows up in our lives, you know, through fatigue, through anxiety, through brain fog, which is just so common with everybody I know in perimenopause and menopause.

Well, because we desperately need estrogen, estradiol, specifically for mitochondrial function. Without it, we lose it. And without proper mitochondrial function, everything goes by the wayside. We don't have the energy.

We don't have that get up and go. I mean, that also is related to testosterone a bit. But we need mitochondrial function to feel motivated, to go to the gym, to lift weights.

And it becomes a vicious cycle of not having enough energy. So you're not doing the things that give you energy, and you can spiral downward very quickly.

But we desperately need estrogen to have proper mitochondrial function. And for some women, even if they're on hrt, that's not going to be enough. So that's when you think of things like red light or infrared saunas.

You know, there's a lot of great ways to support your mitochondrial function that we really do lose quite significantly during perimenopause. And like you were saying, brain fog is one of the quickest things that you see. And also skin health and ovarian aging in general.

We have the most mitochondria in our ovaries. So anything that you do to support your mitochondria is going to prolong your Ovarian health.

So is there any sort of a correlation between mitochondrial dysfunction and ovarian cancer?

I don't know. But at the end of the day our bodies do not function properly in any way without proper mitochondrial function.

So I'm sure it, you know, is an element as well as all the other things, whether it's blood sugar or toxic exposures or fungus, mold. There's a lot of roads to get there. But without mitochondrial function you don't, you've got nothing.

So if we're, let's say we go into the, you know, one of the health, health food stores and you know, you're standing there, you're looking at all the supplements.

Are there like maybe three universal supplements that you think are good for every woman, that every woman should have in her medicine cabinet regardless of her genetic makeup or her, you know, whatever's going on right now?

Yeah, I would say magnesium for sure and there's many different kinds of magnesium for different reasons.

I personally love and I don't have a financial relationship, I love bioptimizers magnesium because it has somewhere between seven and nine different kinds. And so you're hitting all your bases. Most people think of magnesium as being an evening supplement but we actually deplete most of it at night, noon.

So I take it three times a day, just 250 milligrams. It doesn't give me an upset stomach. It's not too much, it's just kind of all day and, and night. But our for, for a variety of reasons.

If someone is, was on the pill, they for sure depleted in magnesium. But most of us are especially perimenopause menopause just stress depletes it so quickly. So that's a favorite.

Omega 3 is a good quality source that you know, isn't contaminated and is processed properly. It's just so anti inflammatory. It's great for cardiovascular health, great for brain health. So omegas magnesium and then a methylated B vitamin.

So if you don't know your genetics then if it's methylated you don't have to worry about it because if you have MTHFR snips and you take folic acid that can build up, make you feel worse.

And so if you don't want to do genetic testing and you don't know if you've got MTHFR issues or not, just get the methylated version and don't worry about it. At many stages of our life, B vitamins become an issue. But perimenopause for sure, when we can have more estrogen than progesterone.

We really need to make sure that we're metabolizing everything properly.

Absolutely.

And you know, you bring up a good point when you say, like, you want to get supplements that are clean, you know, not contaminated, not with, you know, additives and things like that. So how do we know that we're actually getting clean supplements?

Honestly, unless you sort of live and breathe in this world, it's very hard to know. Especially a lot of the supplement companies will get sold to larger companies and so you're not quite sure if the quality is still there.

And so that's a good time to work with someone and to make sure that the brands that you're using are good ones, because it can be really hard to research. And I would say I definitely wouldn't buy supplements on Amazon, as much as it's a hassle to go directly to the suppliers.

There's just so much fraud on there that there's no way to know what you're getting is actually from.

I mean, let's say you've done your research and you've decided that Pure Encapsulations or Thorn or, you know, those are the ones you want to just go to their site direct or designs for Health, just go to their website directly and buy from them instead of third parties.

Yeah, that's a good point. You don't know what you're getting sometimes with the bigger sites and everything, you know.

Yeah, it's a lot for them to manage and it's nothing nefarious on their end. It's just they have so many vendors impossible to quality control. So instead of worrying about it, just go to the vendor that you like directly.

Yes, absolutely. You connect hormone suppression with HPA axis dysfunction.

So can you kind of explain to the audience what that is and how stress resilience changes after you're. You've been on the pill for so long.

Well, being on the pill cuts off the HPA access. So we're. Or the HPO axis, hypothalamus, pituitary, ovarian access. So our brain and our ovaries are no longer having a conversation.

So again, this is where people think that they are cycling, but they're not. They just cut off the connection. They're having an artificial bleed.

And so your brain and your ovaries need to learn how to reconstruct, communicate, and that can take some time. It also decreases our mental resiliency, our nervous system is impacted.

And again, this happens in perimenopause when we're losing Hormones and our ovaries and our brain are having really chaotic interactions. So you know, you have a bunch of estrogen and so your brain thinks, okay, we don't need estrogen, but then there's not enough.

And then, you know, it's. So it's quite a few years of. That's why they say it's the, you know, cycle of chaos. It's the time of chaos.

Because that brain ovary connection is just very confused because, you know, one month you might ovulate, the next month you won't want. So that, that means that one month your estrogen progesterone have a good balance. One month they don't.

So you'll have more anxiety and less sleep that month. So it gets very hard to regulate.

And so that's often when it's nice to add in a little bit of hormones or you can do adaptogens to help support the HPO access, the HPA access. So things like MACA can be very supportive.

So these are things that I don't advise for if you're already on hrt, but if you're early to mid perimenopause and you want to calm the communication between your brain and your ovaries and kind of smooth things out, MAA can be very helpful. If you are ovulating some months and not others, Vitex can be very helpful.

There's black, both black cohosh and but and maca can be great at helping with hot flashes.

So, you know, maybe your estrogen is a little crazy and you're not wanting to add it in and you're not sure which month you're ovulating, which month you aren't. It's great to add in some herbs during that time. At some point, of course, we are going to stop ovulating and having menstrual cycles.

And think of those herbs aren't really, you know, going to cut it. And it's an individual decision, you could say on them and choose not to do hrt, but they can be quite helpful.

So I, you know, a lot of women just assume because they are having a period, a menstrual cycle every, well, I should say a period every month doesn't mean they're necessarily having a menstrual cycle if you're not ovulating and unless you're testing for ovulation, you won't really know. So that lack of all of those months that you don't ovulate, you obviously don't have any progesterone.

And so that's going to really affect your mental health and your resiliency. So anything you can do to smooth out that hpa, HPO access is very helpful in those years. And it's really, it's a pain in the butt.

I mean, just is, you know, to kind of keep track if you wanted to at that time, add in progesterone. There are tools, there are ovulation, you know, strips that you can pee on. I like OOVA a lot.

And if you ovulated that month, you might not need progesterone. If you skipped it, you could add in some. But there's no exact science to this.

Our cycles ebb and flow and things are, you know, not consistent those last couple years. So if you're, if you're up for the challenge of kind of monitoring and you can smooth it out quite a.

Bit, that's actually great advice because I've had several women write into the show reach out via DMs asking about natural kind of therapies to try to balance their hormones at this time of life. Some women have had cancer and they're not really able to take HRTs.

I have actually a friend who has something called lynch syndrome or which makes her prone to a number of cancers and she was actually recommended not to take hrts too.

So for somebody like that who's just going to try to wing it like, you know, the natural way, I guess, although, you know, bioidentical hormones could be considered natural also, if they weren't going to go that route, what would you say, would you say to kind of continue with those, those things that you mentioned or would you put some more items on the list?

I'd probably add in some organic non GMO fermented soy, just, you know, phyto estrogen. Flax seeds can be helpful.

And also, even if you have a history of cancer or at significant risk, you can still protect your vaginal health by doing a low dose vaginal estrogen because that is one of the number one causes of death later in life. Life is urosepsis.

Oh, what? Wait, tell us more. Like what? Tell me the whole thing. Like what, what, what?

It often happens to women in nursing homes and they just, it's just the saddest things. So you, or you might notice it with, you know, grandma or elderly people in your life that they get a lot of UTIs.

And so when we lose estrogen, we lose our microbiome diversity and the ph changes. So not only do you have risk for prolapse and atrophy and Dryness that can be so sore it's hard to sit for women.

But that can also lead to a deathly sepsis infection. And so these women will often be given antibiotic after antibiotic and it's not successful really.

The most successful is to apply a low dose vaginal cream locally into the vagina. It's very successful at getting rid of UTIs and preventing urosepsis and preventing a whole lot of discomfort. And it's not systemic.

So even if you had breast cancer, it's not systemic. And I should make a differentiating point point. So it's not just that it's in the vagina, the, the difference is the dose.

So if you had a higher concentration of a topical estrogen, but you applied it vaginally, that would still systemic. So it's a low concentration and you apply it directly to the vagina to protect your vaginal health.

And I recommend this for any woman really 40 and above. I think a couple times a week it's time to start taking care of your vagina.

Because if you notice the skin on our faces starts sagging significantly, 40 onward. And it's the same thing with our vaginas, right. We lose our elasticity, our collagen.

So I think of taking care of your vagina the same way you think of taking care of your face. You want to put on face cream, do the things.

But, but your best vagina face forward.

That's right.

Maybe somebody's looking at it.

And here's. And even if you don't have a partner and you don't care about that sort, it's, it's really to protect you against UTIs, € sepsis and discomfort.

So it doesn't matter if you know you have a partner or not. It's really about your health.

Absolutely.

And women need it younger than they think they do.

Do you think it makes sex more enjoyable?

So it does. It is lubricating. You can do estriol or you can do estradiol. Estriol tends to be more lubricating, but then you have to worry about transference.

But it has sort of a compounding effect. So you wouldn't want to take it every day. But let's say if you take it on a Monday, it would help with Tuesday's sex.

You just wouldn't want to take it right before as a lubricant. DHEA applies. The vagina helps also with elastin and muscle and all of that. And so. And men can take DHEA the same way women can.

So that one I Wouldn't worry about if you wanted to apply some dhea.

Oh, okay. And men can also take it.

Yeah. So transference wouldn't be a big issue.

Okay. So that's not a big deal. I know that's. I mean, all the things. There's so many body changes right now.

It's like trying to keep up with everything is crazy.

It's very overwhelming and there are a lot of options. And so it makes it challenging to figure out what options. Right. For you. And it's also, things can change quickly from, you know, every couple months.

And so even if you are, you've got a great practitioner and you're on HRT and everything's going along great, and then one day, all of a sudden, you start gaining weight and you're not feeling as well. Well, it's time. Then you got to go back and change your dose and dose of what? Estrogen. Progesterone. Which one is it? So it's no fun, really.

I mean, at some point you do get to a point where you're further out and you've been an HRT for a while, you found your dose and things are good, but for the transition and the few years after, it's. You really have to keep after. And there's nothing terribly fun about that.

Exactly. How was when you got on hrts? Was it a journey to find the right dose? How was that for you?

At first? It was great. At first it was pretty easy.

I was still cycling, but I wasn't ovulating every month and I was taking a pretty low dose topical estrogen and I was taking progesterone half the month. Everything was going fine. And then maybe 10 months into it, I got deeper into late perimenopause. So I'm. I'm still cycling, but it's erratic.

Still ovulate, but erratic. So I'm definitely late perimenopause, but I needed more estrogen because all of the sudden I gained 10 pounds just out of nowhere.

And I mean, it was out of nowhere and I was eating the protein and lifting the weights and doing all the thing, and I'd wake up the next day and another pound. Another pound.

Yeah, I know.

And then I. So I upped.

I talked to my doctor and said, listen, I think what is going on is that I just lost more estrogen than I had last year and we need to up it. And she said, I. I think you're right. I think that sounds good. So we changed the concentration and within like two weeks, I mean, it was like Boom.

I, my body comp was back. It was, it was pretty great. So other than that, I would say the transition went pretty well. I waited a year to add in testosterone.

My testosterone has always been very low. Even in my early 40s it was very low. But I never wanted to supplement it with it. And also timing wise, it competes for the estrogen receptor.

So if you block your estrogen with testosterone too early, it can lead to weight gain. So that is important. But I finally, when I felt like everything else was the way it should be, my estrogen levels, progesterone, everything was good.

I did add in a little bit of testosterone and I felt great. And I noticed right away and testosterone is one that often women with a history of cancer, they can still take testosterone.

It's a very breast protective which most people don't realize.

So for, for women who can't take estrogen for whatever reason, they can still consider the low dose vaginal estrogen and testosterone and often progesterone. There's a lot of different ways you can play around with it. I just, for the moment I'm in a good place. But I know that it can change at any time.

That's the thing.

I feel like it's so trial and error and it ebbs and flows like you're saying, you know, it can be one way one day and totally different in like a month.

So for a woman who's never done HRTs but wants to start, she, and she goes into her doctor, you know, she probably gets her, you know, hormonal testing done via blood tests and things like that. Is there anything else she should be asking or telling her doctor at that time?

It's really important to look at your insulin. Insulin is a hormone. So I think a lot of women just think of it as sugar or something.

When they're thinking of their hormones, they're just thinking of estrogen, progesterone, testosterone.

But insulin's a really important hormone and if that's not in check, it's going to make everything very difficult and that can be a tough one to get in check. And, and sometimes you do need to do estrogen in order to help you.

But if your insulin is elevated, you've got to really lean heavy into the protein fiber building your muscle. Because it's high. Insulin is just going to make hot flashes a mess.

It's really hard to regulate your vasomotor symptoms without getting your insulin checked out. And so a lot of times doctors will just look at fasting glucose, but insulin is going to Elevate before you're going to see it in your glucose.

So I would definitely ask for that right away. And. And a lot of doctors, I hear all the time, they don't want to check because you're in perimenopause and things can change day to day.

And yes, of course that's true.

You could take your hormone levels at six in the morning and they're going to be different than 12 in the afternoon, and they're going to be different at six in the morning the next day. And by the way, that's not just perimenopause. That's our whole life. Our hormones change very quickly. So. But it's about patterns.

So get your blood work done and look at those levels, and most importantly, look at the patterns and see how they're shifting.

Yeah, I mean, there's just. There's so much. It's like constantly checking things and then also waking up with like, the 10 extra pounds.

I'm like, oh, my God, like, what else can we do to get rid of those ten pounds?

I can tell you because that in that moment, and it lasted a while for me, because it takes a while to sort of figure it out, have the conversation, get the prescription, get it filled, get it shipped. It's a process. So by the time I got everything I needed, you know, it had been a couple months of living like that.

And I thought, wow, I can really see why the, you know, Ozempic and Mounjaro, like, that's tempting. I get it.

And for some people, if they want to microdose that for a period of time while they can get the rest of it together, I totally understand it. That can be helpful.

But I think that as much as I understand why we want it to change overnight, it's just a process that we have to be patient with, and we have to really trust that when you're eating three meals a day with enough protein and fiber, and if you're lifting weights, just trust the process.

You know your body is going to respond with proper hormone amounts at some point, because if you just keep lowering your calories, you're just going to lower your metabolic rate and your body is just going to be able to handle less and less calories. And before you know it, you're eating nothing and just still gaining weight.

So avoid that pattern for as much as possible, because then you really get yourself stuck in a hole that's not enjoyable. No one wants to live their life that way. It's miserable.

Miserable to live in calorie Restriction all the time.

Yeah.

And the thing is, so many people are doing the microdose of the GLP1s. What is your take on that? Do you think it's okay for a small amount of time or do you see it, like, being a problem?

I think it very much depends on the personality type.

So a lot of women are using tirzepatide, which tends to have less side effects, and semaglutide, and they microdose it enough just to sort of take the edge off, take the hunger noises away. But even for women that don't have a lot of noise around hunger, it just does seem to reset their body. It obviously helps with insulin levels.

So it can also calm them down sort of mentally because it will help with cortisol and everything else. So it can be nice for someone who's spiraling and they're really stuck and. But I would say give yourself a time limit.

Say, I'm going to do this for eight months and I'm going to. And write down, like, eat protein, like it's your job. I'm going to eat this much protein. I'm going to do it this time. I'm going to go to the gym.

On these days, you have to be really diligent to protect your bone health because you can lose a lot quickly. I've seen women who are on it for a short period of time who stuff their toe and break it, who fall and break the wrist.

Your bones can lose a lot of density very quickly, especially when we're, you know, already have hormonal depletion. So.

But what I see happen with a lot of women is they get this body dysmorphia that when they start losing the weight and they get really addicted to it and they start looking a lot older, you know, the skin size, they're losing muscle tone, but all they know is that they're fitting into a pair of jeans that they haven't been able to fit into since 10 years ago. And so that's their goalpost. That's all they care about. And they're not objectively seeing how they look in the mirror.

They don't realize that that little butt is actually youthful and a little bit fuller cheeks is youthful. They don't care. They're just looking at the scale and they're looking at, you know, how they fit in those jeans. So you can lose sight of it.

So I would say, buddy up. You know, if you're going to do that, say to your best friend, you have to be honest with me. Let me know when I've taken this too far. I'm spiraling.

You know, let's make sure that we're or you know, eating enough. I think it's nice to have a buddy in it with you who's gonna keep it real. Yeah.

Somebody who will tell you the truth like no matter what.

Yeah. If just I would say know your personality. If you think that you're inclined to take it too far, you may not want to start it to begin with.

That's a good point. What is the breakdown for how much, you know, protein, fiber, fats, carbohydrates that we should be eating?

Is there like a certain amount or an equation to figure out what the amount perfect amount is for each person.

Proteins, generally a gram per pound of desired body weight. So if you, regardless of how much you weigh, let's say you just want to weigh 130, then eat 130 grams.

And snacking is really our enemy at this time because we already are having a hard time balancing cortisol, insulin, glucose.

So you want to just do good old fashioned three meals, no snacks, you know, so 30 to 40 grams per meal and ideally fiber is about 40 grams, so maybe 10 to 15 per meal. For some women who aren't used to eating fiber, take it slow, you know, maybe add 5 grams of fiber per week.

Take some digestive enzymes when you do it, if you haven't eaten fiber, don't try to eat 45 grams of in a day where you're, you'll never leave the bathroom. And the same thing for protein, you know, that can really mess up your gut if you're not used to eating it.

So take baby steps, give yourself a few weeks, a month, six weeks to sort of get, get up to that point and definitely, you know, as we're losing, as I said before, our HCl and digestive enzymes, if you're not used to eating that way, it's a really good idea to supplement with those. And then as far as fat and carbs go, it's really depends on the person. Again, a lot of that has to do with genetics.

I love fat, but again I can't eat a lot of it because it oxidizes. So for me, you know, keto is not something I could do.

For someone else who transport transports cholesterol, amazingly they, they could eat more fat than me. Carbohydrates, I think, you know, you kind of have to earn your carbs when as we get older.

So if it's a day where I'm really lifting either Right before or right after, I can eat however many carbs I want. Doesn't matter if. If I have a day where I have more office work to do and I'm a little bit more sedentary, then I'm not going to be eating as much.

And again, it's. It's individual.

But I feel like for most women that I work with at this stage in life, they do sort of have to judge their carbs on their activity level.

That's a good point.

So if a woman is feeling really out of balance, you know, anxious and tired right now, but, you know, the doctor keeps saying, oh, your labs are fine, you know, you're in great health, and, you know, not really. She's not really getting answers.

What is the first step she can take to advocate for herself and find answers if she's not getting it from her doctor?

Well, for one thing, we're not married to our doctors. And even if we were, you can any relationship you don't want, right?

A doctor, divorced or, you know, you may love that doctor for other reasons, but maybe you need to add on to your team.

So maybe this is your gynecologist who delivered your kids, but they probably have not been trained in hrt, so still keep them for your pelvic exams and keep them. You have that relationship. But you may want to go out and look for someone who is more educated in the areas that you're looking for help in.

So you don't necessarily have to fire them. You may just need to hire more people, add different people to your team. It doesn't have to be cash pay.

You can add other people who have everything covered under insurance. Just because it's functional doesn't mean it doesn't have to be covered under insurance. I think a lot of people do think that.

But you can search up physicians who have been functionally trained, you know, through the Institute of functional medicine or A4M, and you can get a sense of, okay, you know, they have a more holistic overall view. They've been trained specifically in hormone replacements.

So I wouldn't get too caught up on disagreeing with your physician because we have to meet people where they're at. And rather than getting frustrated, I think it's fair to either keep them or fire them. But you may need to have someone else on your team.

Good point.

But it's the struggle. The struggle can be quite stressful for women, and it can also waste a lot of precious time.

True, true.

That's the thing when you feel like you're not getting an answer here and you're still looking and it, it just gets so confusing, you know, and you don't know really know sometimes where to look. So that's a good point to kind of, you know, shake down the tree a little bit and investigate, you know, maybe reach out to some other people.

Yes. Ask your friends who are taking hrt, who, you know, if they're happy and a lot of women are doing it now.

I mean, the numbers used to be much smaller, they're still pretty small, but it's becoming more and more common. So if you have friends who are taking it and they're happy, that's a great way to find a practitioner.

Absolutely. So rolling back the clock a little bit, what advice would you give your 25 year old self?

Oh, easy. I would say eat more, lift weights. Think I was already off the pill by then, but lift more and I mean eat more and lift weights for sure.

I was an undereater and I was an over cardioer.

Gosh, I mean, weren't we all? That was like the thing, it was like cardio, cardio, cardio, nonstop. It was every aerobics class, like you're saying.

Yeah, and my nervous system, you know, as a result, if you're not having enough nutrients and if you're doing so much cardio, My nervous system was a mess.

It's sad to look back and think of sort of how I dealt with situations and things that I just could have completely ignored and not paid attention to. I could have been much happier if I had fueled my body more.

And how are you living iconically right now?

I would say at this point things have become very habitual for me.

So even though it seems like a lot for women, I just, I guess I would like them to know for me, yeah, okay, I've got a good pattern, but it didn't happen overnight. I just sort of gradually. Okay. I started eating breakfast and doing my coffee after I started. You know, I would do saunas at night to relax.

I would make sure I got enough protein at lunch because if I didn't, I was snacking at 3 o' clock and eating a bunch of carbs and stuff I didn't want to eat. All of these little habits added up to now I feel like I've got a pretty tight schedule.

You know, I, I make my juices ahead of time, I make my chicken salad ahead of time. I've got enough stuff already prepared and ready to go and I have my little routine.

So although I'm doing all the Things that might seem overwhelming, it's just habitual at this point. And I'm very happy. I don't have a lot of noise. I don't have a lot of decisions to make around it.

I just know my program and I do it, and it makes me happy.

That's great.

And time management is so important because that is key when you want to get kind of your life back on track a bit as it relates to health and wellness.

Yeah. And sort of planning ahead. Like in my purse.

I mean, I always joke that if I were to get lost in the woods, I mean, I probably have enough in my purse to last, like, a week. I know for me, if I go too many hours without eating, like, four hours is my cutoff. So I have, even though I shouldn't be eating a lot of red meat.

In my bag, I've got beef sticks because they're easy to transport. So I have beef sticks with 10 grams each. Venison sticks. So just three of those is 30 grams right there.

Oh, that's good.

It's easy. And I've got mixed nuts. I usually have an apple or something, so. And I'll save the apple for after the fat and protein, say, because of the glucose.

But if I am stuck in between meetings or in traffic and this is my time to eat, I have a full meal that's really comprised of snacks, but it is not a snack because it's enough macros to keep me satiated to protect my bones and muscle until the next meal. And it also prevents me from rushing into the house and what am I doing?

I'm, like, getting out chips and salsa or something because I'm just starving. So it really prevents that.

And that's a good point. Don't starve yourself. Like, that's probably the worst thing somebody can do.

Stay ahead of it.

Stay out of it.

You know, that's the thing with the morning eating. It's like, even I understand that your cortisol is high.

You don't feel like eating, but you really within that first hour to set yourself up for success the rest of the day, whether it's drinking, drinking a smoothie, even if it has to be liquid, just set. Set the precedent early on in your day because you're going to set yourself up for success.

That's great. Oh, my goodness, Elizabeth, you are amazing. I have learned so much this hour. I'm like, oh, my God, I've got, like, some homework to do now.

I'm like, okay, check that off the list. Check that. I'm Like, I've got an itemized list, and I'm sure the listeners will feel the same.

So thank you so much for coming on the show on the Iconic Midlife. Please let everybody know where they can find you and what's next for you.

Thank you, Roxy. Thank you for having me. They can find me on Strong Choices one on Instagram. I like to post educational content.

My website is Strong Choices, and I have just finished my book on bone health, and so I don't have a release date, but it's finished. And I'm excited because that's been a labor of love. So at some point that will be out.

I heard that it was. Is the name Sexy Bones?

Sexy Bones.

Oh, I love that name.

Well, the concept is if your bones are in good shape, there's a pretty good chance your hair looks good, your nails look good, your skin looks good, you're living a vibrant life. It's all very much connected. And I want younger women in their 20s to make that connection to.

Absolutely. It's a great tool. I'm sure it'll be amazing when it comes out that women of all ages can read and learn from. So that's amazing.

So you're not sure when it's coming up, but it's coming out?

Yes. I will keep you posted.

Yes, please, please, please, and please come back and hang because I again learned so much, so much good stuff.

Thank you. I love chatting with you, Elizabeth.

Thank you for bringing so much clarity and honesty to this conversation.

Your work on the pill, Hangover, Bone health, and holistic hormone balance gives women a language for what we've been experiencing and real tools to finally feel strong, energized, and in control. If today's episode resonated with you, share it with a friend who needs to hear this.

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