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Menopocalypse: Thriving During Menopause

Kim: [00:00:00] Welcome to episode 76 of the Fitness Simplified podcast. I’m your host, Kim Schlag. On today’s episode, I’m joined by fitness and women’s health expert, Amanda Thebe. Amanda has a new book coming out this Sunday — which just so happens to be World Menopause Day — Amanda’s book is titled Menopocalypse: How I Learned to Thrive During Menopause and How You Can Too.
Amanda and I spend some time chatting about some little-discussed topics: what is actually happening with your body during menopause? Why is everyone so afraid of HRT? What even is HRT? And how can we build the resilience we need to get through these difficult years? Let’s go.
Hello there!
Amanda: [00:00:49] Hello! How are you doing? 
Kim: [00:01:19] How am I doing? I’m doing good. 
Had a busy podcasting day. This is podcast three for me today. 
Amanda: [00:01:24] Ah, it’s my third one too! But on the receiving end, not on the doing end, right? 
Kim: [00:01:30] Yeah, I was on one this morning and then I recorded one and now this one. 
Amanda: [00:01:35] I did one yesterday with a woman called Ann Marie, and she’s got an Instagram page called @hotflashinc and she’s been on Hello Peri. She sometimes does little videos for Hello Peri. It was one of my favorite interviews I’ve done in ages. She’s a journalist from Canada who, about 13 years ago, decided to move to the United Arab Emirates, lives there as a journalist freelancing now, and it started a very small, but engaging menopause audience.
Kim: [00:02:09] What’s her name again? I forgot already. 
Amanda: [00:02:11] Ann Marie.
Kim: [00:02:12] And what’s her site or her Instagram?
Amanda: [00:02:14] @hotflashinc. 
She just was really good, her questions were really good. They were just, it was like a really intelligent debate. It wasn’t, “what’s perimenopause and what’s –“.
It was an engaging conversation and I just really enjoyed it. So if you’re looking for people, I just think she’s a good one. And then the other one I did was with Jason Lee Hart. It’s the second time I’ve been on his. Have you done anything with him?
Kim: [00:02:46] I haven’t. I’ve listened to this podcast a time or two. 
Amanda: [00:02:51] Yeah. I like him too. 
Kim: [00:02:54] All right, my dear. I’m going to hit go here and we’ll go. My son is helping me with my podcast now and so I can start recording and he trims things for me now. So he handles all of my publishing for me.
Amanda: [00:03:13] He does all the editing? Oh, that’s great. 
Kim: [00:03:15] Yeah. My son just does it for me because he’s very interested in doing this after college and so he’s practicing on me. What I told him is that I’m paying him by giving him experience. He’s never done anything like this and what I told him was like, as he gets this experience, I would eventually pay him when he knows what he’s doing. And then I can introduce him to lots of other coaches who will eventually need to get help with their podcast. 
Amanda: [00:03:40] I used to do that. I used somebody on Upwork and used to send the files off. I wasn’t going to do it myself. 
Kim: [00:03:47] I’ve done it myself. I’ve always done it myself. I have hired somebody to transcribe my podcast for me, so I can put them on my website and he could do full-blown everything for me, but I didn’t want to put the money there quite yet, but he’s transcribing and then my kiddo is handling everything else now.
So I’m glad that’s off my plate. Like, I don’t have to do anything. 
Amanda: [00:04:04] My youngest has discovered photography and I’m quite a good photographer. And I’ve got this big piece going out in the Telegraph in the UK — a big broadsheet paper — and they asked me to wear a yellow dress, which you’ve seen on Instagram that I got from Amazon for $25 that my friend told me to get.
‘Cause she said, “Oh, it’s really nice. And they’ll do for when you’re swimming, you can throw it off the top.” 
It’s something I wouldn’t normally wear 
Kim: [00:04:36] Why do they want you to wear a specific thing?
Amanda: [00:04:39] Well, it’s a colored publication and it’s in their Sunday magazine. And so they want to style it. Their own stylist contacted me, but they need full-res photos and so Elon and I went out, so he’s there with my SLR against this really nice background. And I’m like, it’s so funny that in this really great newspaper, it’s going to be at $25 Amazon dress, shot by my 13-year-old.
Kim: [00:05:10] That’s fantastic. 
Amanda: [00:05:11] Very real. Okay. I’m good to go. 
Kim: [00:05:14] Alright, here we go. 
Today, my very
first Fitness Simplified three-timer, Amanda Thebe. 

Amanda is a fitness and women’s health expert and today I have her on a conjunction with the release of her new book, “Menopocalypse: How I Learned to Thrive During Menopause and How You Can Too.” 
Welcome, Amanda.
Amanda: [00:05:36] It’s not the threesome I wanted, but it’s a threesome I’ll take. We’ll run with it. 
So it’s an honor. Three times. It’s because we’ve got so much in common. And what people don’t know is outside of us talking on this, there’s probably almost a daily chat that we have about everything.
And we have an app on our phone called Marco Polo — which if you haven’t used before, it’s really good fun — and we send little videos to each other. 
Kim: [00:06:14] It’s a lot of fun. We talk all the time today. We’re going to get into this book of yours, which I love. I love it because it is both educational, right? So like, what is going on with our bodies and why, and what do we need to know about it? 
But it’s also solutions-based, like, this is no picnic.,I’m going through menopause. It is no picnic. But there’s so much we can do to manage our symptoms and you really dive into that. And I think that’s so important, right?
It’s education. And now what do I do? What do I actually do? 
We have an entire episode, it is episode 21 of my podcast, which is so fun because I’m on episode 75 and you are on episode 21, your whole story of your experience in menopause, but I do want to touch on it here. So kind of give us the highlights of your experience in menopause.
Amanda: [00:06:59] Well, simply put, the reason I wrote this book was because I wasn’t getting answers to any of my questions. Like you, I had a really terrible time. I’m 49, almost 50, this month. Almost 50, and from my early 40s, had just the most horrendous symptoms with no answers from any of the medical professionals that I saw.
And eventually, two years into the journey, when I did get answers, I really struggled to find definitive reasons why I was feeling the way I was feeling. Because it never stays the same, it’s not static. I mean, I went to my gynecologist about a particular symptom of perimenopause once I understood what it was, and then I had something else six months later. It’s so difficult to stay on top of because things ebb and flow. 
And so I just really found it difficult to find really useful, practical information. There’s more now, I might say, because this is eight years ago and I think we’re talking about it more and more, but that was the other part of wanting to write about it.
And also in my community groups and on my Facebook and Instagram page, I make it an okay topic to talk about, like you do, because it’s been tabooed for so long and it’s one of those eye-rolling topics that people– you say menopause and everyone, like, slowly walks out of the room backwards.
And my family do, actually.
Kim: [00:08:34] So, like everything in the health and fitness space, menopause discussions can get over-complicated. Just this morning I saw you liked a comment I had made it in a group — there’s so many menopause groups and Amanda and I are both in one specific one — and a woman had wrote in talking about how she wanted to balance her hormones with her diet.
And I had asked a couple of questions. I said, “well, what are you actually looking to do? What is the result you want?” Because people were telling her all kinds of things. And I said, “you know, you’re not trying to balance your hormones. Like, you should go see a doctor.” It’s not like she had digestive issues.
Somebody came in after me and started telling her about how she needs to like focus on eating phytoestrogens, really complicated stuff. And I was like, “what you just said could be summed up with ‘eat a well-rounded, balanced, nutritious diet. And if you’re having digestive issues, that’s a separate problem.'”
But so many things are made into confusing issues. 
Amanda: [00:09:26] Yeah. And I think that’s why we align so well, because we’re always like, “why are people making this so complicated when more often than not, the answers are quite simple?” Not always easy, but usually quite simple. 
That posts, I’m glad you brought it up because the person who commented was telling her how she could basically manage everything through diet and health and nutrition  and I disagree with that. I disagree completely with that. I think they play a huge, important role, but they’re not always the answer and neither are taken herbs and neither are doing alternatives. 
Sometimes it’s just not enough and you need to go and see a menopause specialist. And as far as the phytoestrogen argument and all of that type of thing, it comes from the fact that some foods have phytoestrogen properties, but a phytoestrogen property can be an estrogen disrupter. It can actually be an anti-estrogen food as well as an estrogen food, and who knows how it’s going to act in the body?
The studies that I found — and I did really try and dig deep into this, right? I did try and look into if this was an actual thing, because we know that Asian women have less symptomatic time in perimenopause, but genes play a massive part. So you’ve got the genetic factor, and then as far as the phytoestrogens in soy, tofu, et cetera, and the quantities you would have to absorb to make any type of significant impact are going to be unobtainable.
These foods are good for us and they’re healthy for us, so there’s no reason not to include them. It’s just, they’re not the magic pill. And it’s just another way to confuse and bamboozle women who are already confused and bamboozled.  
Kim: [00:11:18] Absolutely. At a time when there’s just so much going on emotionally with us and physically with us. And so it is really a dicey space. 
So let’s talk a little bit and clear up some myths. So let’s talk specifically for a minute about HRT.
Now, before I do this, I want everywhere out there listening to know that neither Amanda, nor I are doctors. This i
s just educational information for you to keep in mind because this topic has become so muddled. 

Amanda. HRT, what is it and why is everyone so suspicious of it?
Amanda: [00:11:53] HRT is hormone replacement therapy and for a woman with a uterus, a womb — I don’t know what you call it here, I always flip flop between the two — for a woman with a uterus that’s estrogen supplemented with progesterone to protect your womb.
If you don’t have a uterus anymore, if that’s been removed, you can go on estrogen therapy only. In 2002, the Women’s Health Institute released a report. It was rushed out to publication without being peer-reviewed, and it came out and said that estrogen therapy alone, without the progesterone, estrogen therapy alone could cause serious diseases in women, including cardiovascular problems and breast cancer.
And so immediately — and at the time they were only testing Premarin, which was a synthetic estrogen. That was the only one on the market. It’s actually the most well-researched hormone out there. So, it’s actually one that’s pretty robust in its research. And it was pulled off the shelves and doctors refuse to prescribe it.
And so it left women who’d been taking it in his place where they were struggling with menopausal symptoms and they weren’t being treated by their doctors. Since then, the report has largely been revoked and some of the people who were part of the study have spoken out and said it was rushed and it’s not accurate.
And so the bottom line is now we know that hormone replacement therapy does not cause breast cancer, estrogen is not a carcinogenic. It will not cause cancer. There’ll be some women that maybe can’t take it because they have estrogen-positive breast cancer, but there’s some women that can as well.
And so, like you said, we’re not doctors and it’s not our place to say who can and can’t. I would suggest reading Estrogen Matters by Dr. Avrum Bluming. It talks about all of this and then go and see your doctor and speak to a specialist. But the North American Menopause Society and most global menopause societies suggest that hormone replacement therapy is the first-line treatment for menopause symptoms.
So when you go to your doctor and you present him with symptoms, that should be what is offered to you. And what usually happens is you are denied or given an antidepressant because usually doctors aren’t — probably through no fault of their own — but they’re not educated in menopause management.
We know this to be fact. It’s not included in any of the training, and OB GYNs, who are the people that we think should be our go-to, only 20% of those in their fellowship do any type of menopause management. So it’s a bit of a gray area and a lot of women get dismissed, unfortunately. But there are some resources.
And I know you talk about them, where women can go and find a menopause specialist. 
Kim: [00:15:01] Yeah, I’ve absolutely talked on here, before about the NAMS website go to the North American Menopause Society website, they have a provider finder. It’s not extensive, I will say. I’ve looked for myself and there are five in my area. Three are not too far away, so I will be heading that way. 
So it’s not like there are tons of these people around, but there are enough that you’re going to be able to find somebody in a reasonable distance and it’s going to be worth it because you don’t want to have the experience that I’ve shared here, where my doctor said, no, she would not give me hormone replacement therapy because I had still had my period and it had not been a year yet.
And it didn’t matter that I wasn’t sleeping and had the whole list of symptoms. And luckily, I knew enough to push back, but I think a lot of us would not. A lot of people wouldn’t know because they just show up to the doctor and they’re not well and they think the doctor’s gonna give them the right treatment, right?
Why would we think otherwise? 
Amanda: [00:15:50] And you know, in my book I talk about the different tests and stuff that need to be done depending on your age. If you’re under the age of 40 and you think you may be in perimenopause, you need to have blood work done to ascertain where you are and they most likely can put you on a low dose birth control pill or hormone replacement therapy then.
But if you’re over the age of 45 and you’re presenting with one or more symptoms, you can be diagnosed based on your symptoms, because it’s a fact that you’re going to be in — and this is what the governing bodies are suggesting, but still, women are being dismissed. And I know you want to talk about this, but in that lapse of time between the 2002 WHI study going out where women were left stranded, this was the perfect storm for alternative practitioners and private health clinics to jump out and say, “Oh, we can fill the gap with you with these custom made, bio-identical hormones that are better than Premarin anyway,” because you know, that’s a synthetic, and we can help you.”
And to me, that sounds super appealing. Women are desperate, they need help, but it’s not the true story. And what we know about compounded pharmacies producing hormones is this: they use drugs that are the same as the ones that you would get from your doctor, but they change the environment. So they mix them with sawdust and baby talc, or something along those lines. Changing the variables immediately, making them lose any sort of safety and efficacy that’s been adhered to by the FDA protocols, putting yourself at risk that you literally don’t know can happen. 
For example, there is a huge concern by the medical community that if you take estrogen therapy and progesterone in the form of a cream that the pedestrian cannot absorb and give you adequate protection against uterine cancer. It’s just not sufficient.
And we’re seeing cases of this happening. And the latest thing is to get pellets. Women are going to the doctor and the doctors are prescribing these and they’re not FDA approved. It’s a complete sellout by the medical community. These are uber high doses of hormones and they have been linked to some cancers. 
And the bottom line for all of this is that 1) you’re taking something and putting something in your body that we know hasn’t been tested, but 2) the cost of these things is crazy. Like, these things can cost you hundreds and hundreds of dollars a month, where you can usually get FDA-approved hormones, that can be bio-identical if you want, for a few dollars a month.
I just don’t get way women do it.< br>Kim: [00:18:47] So, help with the terminology there around that, Amanda. It gets a little bit confusing. I know in your motherland, the terminology is a little bit more separate, right? So the prescription you get from your doctor they’re calling body-identical, correct?
Amanda: [00:19:01] Right.
Kim: [00:19:01] And then other things that you’d get outside of that from a compounding pharmacist, that’s what they would call bio-identical, right? 
Amanda: [00:19:09] Correct. 
Kim: [00:19:10] But here in the States, that’s not like that. 
Explain to people what they should be looking for and what should they watch out for?
Because it gets really tricky. 
Amanda: [00:19:20] Oh, my gosh. I went down the rabbit hole of this with you and with our friend Katarina Wilk. We tried to find out if there was standardized language that we could use so that we made this clearer and there isn’t any. And the reason is because the term bio-identical, it was a marketing term adopted by these compounded pharmacies to appeal to the natural side of hormones that they were producing.
And so what happened is drug companies started to produce bioidentical hormones, but then went through the FDA approval process and testing process so that they were effective and safe for us. So now we’ve got bio-identical from a compounding pharmacy and bio-identical from your doctor. And I think that’s where the confusion comes from.
So it’s easier to think about drugs being unregulated and regulated. And so, things like pellets and compounded pharmacy drugs are all unregulated, and then if you go to a doctor and get a prescription, they will be regulated drugs. That’s what you should be asking for: regulated hormones.
And within the spectrum of regulated hormones, you can have bio-identical and you can have synthetic. But they’re all made in a lab anyway. It’s not like you’re injecting pure yams into your body.
Kim: [00:20:45] We had this conversation literally last week in my mother’s kitchen. So my sister has Down syndrome, she is 46, she is having menopause symptoms, and my mom was talking about how she bought her this special cooling pillow and all of these things. And I was talking to her about my HRT and my mom said, “Oh, I’m not going to do that for her. That’s dangerous.”
And she said, “I am looking into some other medicine that I’ve found from a naturopath.” And I said, “Mom, that’s, that’s not the route you want to go. That’s actually the dangerous path”. And she wouldn’t even listen to me. I said, “you know, I think you should make an appointment with the doctor and talk–”  wouldn’t even listen. 
People are very convinced that it’s somehow more natural, the things that they could get outside of their doctor’s office and natural equals better, safer. And in reality, it is not safer. It is the exact opposite. 
Amanda: [00:21:35] In this situation, it most definitely is. And the FDA have actually tried to withdraw these products from the market because of the dangers and because of the increase in cancers that they’re seeing.
Kim: [00:21:46] I wonder what it will take to actually make that happen. 
Amanda: [00:21:49] Oh, I don’t know. I don’t know. 
I think talking about it, having more relevant conversations is happening. There are things in the process at the moment and there are medical doctors going to the FDA and speaking out on behalf of regulated hormones for women and trying to get them to be a mainstream treatment.
I mean, that’s the key. I feel sorry for doctors, honestly. I mean, I don’t feel like they’re trying to cheat us out of treatment. I think there’s an old stigma against HRT and misinformation, and they then literally have to try and keep on top of every single new study that comes out.
I had an incident with my own doctor where he refused me HRT. I wouldn’t go until he gave me it. Then he offered me Premarin, I asked for a bio-identical estrogen instead. I knew what I wanted. He then prescribed that to me, reluctantly, without a progesterone. And so then I had to say, “you need to give me a progesterone” and he wouldn’t give me one.
And so I left the office and just said, “you know what? Do me a referral to a menopause specialist, I don’t feel like you fully understand how to treat my symptoms.” And I wasn’t rude, but he emailed me later that night and said, “Oh my God, I had no idea. And yes, you were right, and thank you.” And he gave me a prescription.
He just didn’t know. And he’s a young doctor and he really wants to help people. 
Kim: [00:23:20] Yeah, and it comes back to, we need to be able to advocate for ourselves. And so we need to arm ourselves with information so that we can have these conversations and make sure that we know what we’re talking about when we get there.
Amanda: [00:23:32] Exactly. 
I actually do, in the book, I talk about the treatment options that are available. And when it comes to coming to a doctor, I sort of suggest that women do a type of menopause tracker so that you don’t just go to the doctor with, ” I’m depressed” or “I’ve got incontinence” or “my joints ache.” You actually go in with a full picture of what’s been happening so that they can treat you as a whole and not just individual symptoms, so hopefully you’ll get the right treatment. But then also how to advocate for yourself when you speak to the doctor. 
Kim: [00:24:01] Super, super important stuff. 
Okay, turning from HRT. Let’s talk about, you know, there are so many uncomfortable symptoms that come along with menopause and some are eas
ier to talk about and some are less.

And I liked how in the book, you’re like, “there are no boundaries in my work.” And so we’re going to kind of push those boundaries of what people might be comfortable hearing about on a podcast today. 
Let’s talk about what happens to women’s vaginas during menopause. What are some of the main struggles Amanda?
Amanda: [00:24:30] So, it’s interesting because when I wrote the book, like, I’ve been basically putting my vagina on the line for years now about this, because I realized that I needed to separate my personal feelings about it, to the actual symptoms that lots of women experience. And I remember writing the book and saying to my husband, “I’m going to talk about my vagina a lot in here” and he’s like, “okay, I just needed to know,” because it’s data, it’s information and data, and I wanted to be able to write about it in a non-emotional way. And actually, that’s a really great way to approach it.
It’s just like another part of your body. Which is a terrible thing to have to reframe in your mind. I mean, if you look at something like Twitter, you can’t say the word vagina on there. When Jen Gunter wrote her book, the Vagina Bible last year, she couldn’t promote it because of the word vagina.
Kim: [00:25:26] You really can’t use that word on Twitter? 
Amanda: [00:25:28] It may have changed now, but this time last year, you couldn’t. 
So when it comes to peri-menopause, the decline of estrogen in our bodies impacts the integrity of our whole vagina. The term is “vaginal atrophy,” sometimes referred to as “GSM” because the whole area is impacted. So your incontinence, even your bowels, everything, that whole area can be impacted by the lack of estrogen.
So what essentially can happen is the integrity can sort of degrade a little bit. It’s awful talking the way we’re going to talk, but it sort of can break down slightly and so women can find multiple things happen. They may have incontinence issues and that’s because of the structure and the muscular surroundings of the smooth bladder are impacted.
Women will often have like bad dryness or some tearing. Unfortunately, there’s some bacterial infections that can happen. Some women continually have UTIs or yeast infections or bacterial infections because the pH level in the vagina changes, which is why all of those vaginal washes need to stop being used because they’re usually quite high acid-based and all of the perfumes and stuff that’s in there are going to just irritate you even more. 
You’re not supposed to smell like a rose garden down there. I know it’s called the “lady garden,” but it’s not. And so, all of these things can happen purely down to the lack of estrogen in that area.
And so the problem is that most women will have this. It’s not like just one or two women, they estimate that nearly all women who are older, like through menopause and post-menopause, will have some type of problem that’s either a UTI, incontinence, painful sex, tearing, and some receding tissue, too.
All of those things are likely to happen and they’re all manageable. And that’s the problem: only 20% of women go and seek help because there’s nothing more horrifying than going to a crusty old male doctor and saying, “my vagina’s dry, it hurts when I have sex, and I’m pissing my pants every time I sneeze.”
It’s really uncomfortable.
Kim: [00:28:15] Okay, so women go to the doctor, they say, “this is what’s happening.” What is done to help treat them? 
Amanda: [00:28:22] You know, it’s interesting because, for the UTI and the vaginal infections, you’ll often get prescribed antibiotics. And in some cases that can be a valid treatment, but usually, the thing that doctors should prescribe — and again, this is from the North American Menopause Society and other medical bodies — is a localized estrogen cream. Which is usually something that even women who can’t take HRT for various medical reasons can take, because it doesn’t get into the body systemically. It stays localized in the vaginal area.
And usually using that, either in a cream version or a suppository version — there’s bunches of different ways — is enough to be able to stop those symptoms happening. Some women, just by taking hormone replacement therapy that helps their whole body is enough to help that area. 
You know, it was for me. Being on a microdose of estrogen was enough. I had incontinence so badly and I couldn’t work out why, especially after having two kids and still being able to jump on a trampoline.
Kim: [00:29:30] Interesting. So you didn’t have incontinence problems after birth. 
Amanda: [00:29:34] I went to a pelvic health physiotherapist, which I think every woman should just get, for free, because they’re just a godsend. I really want to talk about this as well, because there’s the overarching message that if you have incontinence, you just do Kegels and just keep squeezing, just keep squeezing.
And it’s so individual that I just tell women, first of all, learn how to do a Kegel correctly. I do talk about that in the book. It’s a very gentle, gentle exercise. Almost like picking a tissue out of a box. It’s not this massive, like, “can I hold a dumbbell from a chain?” There’s a woman that does that, right?
She’s like the vagina lifter or something, but anyway, it’s so gross, but my problem was, I was hypertonic. I had so much tension in one of my glutes — nothing to do with the vagina, but of course, it’s all connected. It was stopping my pelvic floor working as a whole. 
And what we know about the pelvic floor is that it’s a combination of the full muscles and our whole trunk. So our diaphragm, our multifidus, which is in the back, and the TVA, the transversus abdominis, which is the deep abdominal muscles and the pelvic floor, they all work as a system together.
So my holistic approach to this is: estrogen cream or HRT to help with anything that’s painful and treatable, see a pelvic health physiotherapist to check for prolapses, for function, see how that’s working — they usually give you exercises that include those four muscles all working together — and then focus breathing.
There’s so many benefits to that anyway, but just actually sitting down and doing big diaphragmatic breaths help train the body to work the whole pelvic floor and those muscles together as a system. 
And those things are huge and they can be game changes, but they’re boring. Nobody wants to sit and go, “I gotta sit and breathe.” Well, I know, but usually the things that do us good are those types of exercises., 
Kim: [00:31:49] It’s true. We’re always trying to sell the boring stuff here, Amanda, 
I interviewed Dr. Chana Ross. She’s a pelvic floor physiotherapist. She helped us on our plank article.
So I will link that here, everyone listening, the whole episode is about what is it like to visit a pelvic floor therapist? What happens? What will they do? Because it feels a little bit like, “what’s going to happen at this appointment?” And she walks us through it and she talks about why Kegels aren’t necessarily the answer for all different kinds of incontinence and how they, like in Amanda’s case, they might even be making it worse, that Kegels aren’t necessarily what you need to be doing.
So I will link that at the end of this, so you can make sure you go back and kind of delve deeper into the world of pelvic floor physiotherapy. I agree. I think it’s a great thing for women to do. And I need to take my own advice and actually go see one. 
Amanda: [00:32:40] I mean in France, when you’ve had a baby in Europe, it’s so great. You get all of this postnatal care and it includes a pelvic health physiotherapist. 
Kim: [00:32:52] I thought it was interesting, Amanda, in the book you were talking about how your own experience you began to realize that your incontinence was moving with your cycle. And I have the same experience. So when I lift heavy, I sometimes pee when I deadlift. And sometimes it’s not that much and I’m just used to it, and other times it’s shocking how much I want to pee and I had to work hard not to, and it kind of would come and go. And it took me a while to realize that it was related to my cycle. 
Amanda: [00:33:18] Yeah, it definitely is. My cycles were very erratic, but I sort of knew when it was going to happen.
And then so, to get by, I would wear a tampon before I went for a run or before I deadlifted, because it created enough — I don’t know if it was like feedback or something — and I mentioned this to the pelvic health physiotherapist and she said, “yeah, it’s like that tactile feeling, like it knows to sort of hold it in place,” but you don’t have to suffer in silence.
And the problem is if it’s left untreated, it can get so much worse. There’s a disease called Lichen sclerosis, and many women get misdiagnosed for having this, but apparently, it’s really prevalent in postmenopausal women. And again, it’s treatable. But anybody who has vaginal atrophy, it’s never going away. It’s one of those symptoms that stays with you. So you can’t ignore it. 
Kim: [00:34:17] Definitely do not ignore it. But everybody wants to, right? Because nobody wants to think about that. No one wants to talk about that, nobody wants to think about that. 
All right, ladies, everybody think about your vagina for a minute and how it’s doing. Okay? 
Amanda: [00:34:30] So that chapter, I was telling Kim yesterday in our Marco  Polo session, that when I wrote the book, I wanted to call it, “Let’s Not Beat About the Bush.” I thought that that was really funny. And my editor, who completely understood me, was emailing me back and forth saying, “but isn’t the bush just the front? Aren’t you talking about the whole thing, front and back?” 
Kim: [00:34:53] It would have still been funny. 
Amanda: [00:34:56] Anyway, so let’s not beat about the bush — look after your vagina. 
Kim: [00:34:59] Yes, look after it. 
All right, so the second half of the book you cover four hacks that people can use to really, as the title of the book says, thrive in menopause.
Let’s kind of just hit the highlights of a couple of them. And then we’re going to really hit that last one hard. 
So, the first one: how to eat. 
What do you think people get wrong about nutrition and menopause? 
Amanda: [00:35:19] Oh, well, I mean, we know 80% of women are going to put weight on and so they put weight on and then go, “what is the quickest way I can lose weight?”
I mean, you are the expert on this. You see this all the time. “What can I do quickly now to lose weight?” And so they’ll look for this magic pill that doesn’t exist. And that’s what I think is one of the biggest issues out there. 
What I do in the first part of the book is talk about some of the barriers that make it more difficult during menopause, and I’m sure you’ve spoken about those, you know, just the fact that we become more insulin sensitive, we have to look out for our cortisol levels, which are intrinsically connected to estrogen. Although there’s no specific data on that, it’s not a quantitative thing, it’s just you have to manage stress.
We know that fat deposits shift from our hips to our belly, so we may change shape as well. And that can be stressful for women. GI issues and bloating is another thing that lots of women see.
And even our hunger hormones are impacted slightly by perimenopause, our ghrelin and leptin. So, telling us when we’re hungry and when we’re full, they become a little bit skewed as well. And so to lose weight, it’s always going to be the same answer — I don’t need to repeat what you tell everyone all the time — but the barriers are harder. 
Kim: [00:36:53] Absolutely. All those hurdles you just mentioned, we have to figure out how do we work with them? 

Amanda: [00:36:58] How do we work with them? There was a report came out only three days ago and I haven’t looked into it too much, but it sort of indicated that, the menopause transition, which is peri-menopause, sees more women put weight on then significantly, and that we see a quicker decline in lean body mass through perimenopause. And that was really interesting to me because it sort of felt like that to me, but I couldn’t find any concrete data and I don’t know how concrete that one is, but essentially if you’re a higher risk of putting fat on and a higher risk of losing muscle mass, that’s like a lose-lose situation. So you need to do the things to make that a win-win.
So when I talk about nutrition, before I talk about what to do, I always talk about the how to eat, and it’s worked for me and I think that changing behaviors and habits is definitely the way for long-term success.
Well, we know it is anyway. It’s been proven so many times. So I get people to clue in to real hunger cues. Are you really hungry? And if you are, how much to eat? When do you feel satisfied? When is enough enough? How quickly to eat and all of those things. And I give you tools to help you. 
I was on another podcast and I gave a story about my Nana. She’s not alive anymore. We used to call a “Funny Nana” because she’d laugh so hard her teeth would fall out. And I used to always watch when she ate, because we’d go out for these family meals and she was this tiny little woman, but she never was worried about her weight, but she would eat really, really slowly. And she never ate very much. 
Actually, my brother used to sit next to her so he could eat the leftovers, but like, she never ate very much and she ate really slowly, so we’d all finish and she was still eating. And she would always leave something on the plate and put her knife and fork down and go, ” oh, that was sufficient.” 
And they were always her words. And I just was like, that’s actually a really great example of how to eat. She ate slowly, she felt nourished, she stopped when she had enough, and because the ghrelin and leptin signals are a little bit skewed, you sort of have to retrain — like you’ve retrained your pelvic floor, you now need to sort of retrain your body regarding all of those things we like. 
Kim: [00:39:16] Well put. Well put there, Amanda.
And you started to allude to this with that study you were just talking about. So, the next part: how to move, why is it important to move well in menopause? 
And you started talking there about losing muscle, so that’s definitely one of the reasons. 
Amanda: [00:39:33] Yeah. I mean, sarcopenia happens. It’s an age-related phenomenon and actually a movement-related phenomenon. Sedentary people obviously struggle with it more.
And it’s sort of rapidly accelerated in menopause, and so we need to do everything we can do to maintain lean body mass. I’ve experienced the soft, squishiness as well, and I’ve pulled it back. You know, it’s possible. We can help women to show that you can still build muscle as you age.
It might take longer and there’s maybe things you need to really focus on, like protein consumption, for one, because our muscle protein synthesis, which is the ability to break down proteins in order to build muscle, is also impeded slightly. So we have to really focus on getting protein into our diet. 
And then the other flip side of the building lean muscle is that it’s been shown to help with the vasomotor symptoms, which are hot flashes, night sweats, and cold sweats. Anything that impacts your temperature.
And actually, I’ve never had that. Which is interesting.
Kim: [00:40:46] I remember you saying that. I think this is a fascinating piece of information, and I know it was pretty strong data that suggests that hot flashes and night sweats are lessened with the more lean you are. So the more lean muscle you have, the better chance you have of not having — I don’t know if not having them — but having fewer vasomotor symptoms. And I often wonder like, wow, if I wasn’t doing what I’m doing, would I just be one big hot flash? Because I’ve had such a massive struggle with them. 
Amanda: [00:41:18] Yeah, I know.
But like we say, genetics play a huge part in all of this, of course. One of the studies was on postmenopausal women who’d never lifted weights before, and they were pure cardio bunnies and they split the group into strength training and cardio only and the strength training postmenopausal women — and hot flashes are the one of the symptoms that can stay with us. They don’t necessarily go. Like, women in the 80s still have them — reduced by 50%. 
And as far as I’m concerned, I’m like, “well, what have you got to lose?” 
Kim: [00:41:55] Well, because there are so many other benefits we already know anyway, right? And so this is another additional one, why not? 
Amanda: [00:42:03] And so in the book I do a 12-week program, it’s like an entry-level program, but I also show people how to pimp it up if they want to work a bit harder, as well.
Kim: [00:42:12] Pimp it up. 
Okay. Next hack is: how to manage stress. 
Such a problem in menopause. Why do you think that is? Why are we dealing with so much stress? I think a lot of people right now are probably like, “well, hello, Kim, I can tell you 12 reasons I’m dealing with stress.”
Amanda: [00:42:28] Oh my God, yeah. And I don’t think I can probably hit on them all because I mean, we’re in a pandemic, for one. I mean, there’s that and all of the knock-on effects of that, but I mean, so, first of all, women probably can’t cope it stresses as well as they could before perimenopause, because, as I said to you, our cortisol is intrinsically linked with estrogen, and as that fluctuates and declines, you can see our stress hormones just go crazy. 
And if you’re then stressing your body more by over-dieting and over-exercising, as well, you know, you just adde
d more stress to stress. And so it really becomes important to just change the way you look at how you function as a whole.

I know that was a really big shift for me. So, being someone who exercises most days of the week, like maybe four strength training sessions and three runs, that was always my thing, and I had to pull right back and I had to pull right back in an intelligent way so that I still could actively work out and be efficient and do the best for my body, but also support it with adequate rest and recovery. And that became key. 
And you’re really good at promoting that because of your “get up! Get up!” We know one of the benefits of getting up and going out and walking is stress management. 
Kim: [00:43:52] Yeah. Absolutely. And one of the other things you talk about, which is something I’m truly terrible at, is meditation.
That’s been a big part of stress management for you, right? 
Amanda: [00:44:01] I don’t do it well, but the thing is that meditation can look different for everyone and that’s what I’ve learned. But I talk really more about mindfulness. 
Kim: [00:44:14] That’s the word I’m looking for. 
Amanda: [00:44:16] So mindfulness is a little bit different to meditation because you can use meditation as part of your mindfulness training, but mindfulness training is about bringing everything back to the present and being in the moment as we are right now. And you don’t have to meditate to do that. You could do that on one of your walks — I go outside and sit and have a cup of coffee on my own every day and just be quiet, drink the coffee, enjoy it and every time a thought comes to my head I sort of acknowledge and then let it go. 
Some people find meditation actually easy to do. I’m a little bit like, “oooh, what am I making for dinner?” And, you know, I get a bit squirrely. Whereas I find if I’m doing something like drinking coffee, that takes the squirlyness away.
But mindfulness is not just some woo woo alternative, right? We know from MRI scans that you can actually change the structure of your brain by doing mindfulness practice. 
Kim: [00:45:20] So tell us about some of the mindfulness practices that you use, or that you’ve heard of others using. What are some things people can try to do to be more mindful?
Amanda: [00:45:28] Well, we were talking about stress initially, and so stress management, mindfulness is one of the things you can do and it’s sort of all integrated to me. And so, diaphragmatic breathing to me is part of a stress management program. We know that when you do big, deep, belly breaths — which essentially then contracts and releases the diaphragm — it elicits the parasympathetic nervous system. And so it gets rid of that fight or flight. 
If you’re in perimenopause, you are literally constantly being chased by that tiger down the street, which is like what I say in the book, you need ways to be able to pull back and get your heart rate back down and so, breathing diaphragmatic breath could work.
And I promote box breathing. There’s so many different ways of doing it, but I like the idea of 3 breaths in, hold for 3 breaths, out for 3 breaths, hold that for 3 breaths, and continue in that box shape.
Then the meditation is another method, going out for walks. As we said, walks are just a great way of doing it. Some people can meditate by going swimming or going out on their bike. It can be a moving meditation and it can still be very valid.
But the whole point is that when you get these thoughts — and especially if you’re prone to anxiety, where you’re worrying about all of the stuff that potentially can come ahead and you’re bringing it back to the president and you’re like, “well, what can I control right now? And what can I do to get through this situation that’s causing me stress and anxiety?” And reframing those situations. Which isn’t easy to do in the moment, but it works. 
I have a son who is on the autism spectrum, he has Asperger’s and one of the key characteristics of Asperger’s is anxiety, because he’s an over-thinker. They have these massive brains that just can’t stop working.
And so he’s always wondering when the next failure is going to happen. It’s terrible, really. So, in his years of therapy he’s learned — and cognitive behavioral therapy is another great way to sort of access this through a licensed professional — he’s learned that taking this time out to do deep breaths and bring things back to the present and just reframing the question that was causing him anxiety to, “what can I control?” It works for him. He’s like a completely different person. But it takes time and practice and all of those things.
Kim: [00:48:07] Yeah. And I think sometimes it’s overwhelming. Whenever I hear like, “okay, you should be more mindful,” I think, “I’m too busy!” 
Amanda: [00:48:15] Yeah. And we, menopausal women, are kind of like the ultimate road runners. We never, never stop.
Kim: [00:48:22] There’s so much going on, but I do think it’s something worth prioritizing.
I have, on my horizon, to consider, I interviewed a woman a few days ago. I haven’t even put the podcast out yet. She runs an organization called “99 Walks.” I’d never heard of her before, but she’s on a mission to get a million women walking. And so it’s this big walking community of women. Anyway, one of the things she does in this group is walking meditation.
And I was like, “what is that?” She’s like, “it’s literally what it sounds like. We go on walks and then we have meditations playing while we do it. “And I was like, “Hmm. Maybe that’s something I could do,” because I’m already walking, right? And I think I could possibly try that because I do feel like being present in the moment is not something that is a great skill of mine. Because, like a lot of people our age range, I’ve got kids, I’ve got parents, I’ve got a job, I’ve got the home. It’s just so much going on. 
Amanda: [00:49:11] Yeah. And I mean, I know you use your walks to call
your clients and to catch up on videos and stuff, and so you’re really good at multitasking. But there’s something that happens in perimenopause I think we need to really acknowledge. And I think, especially, it became really clear to me now I’m in menopause and stuff started to calm down, is how we need to prioritize ourselves.

I talk about it in the book, how we move from the “we to me” phenomenon and it’s been written about many times where our connections to our families and stuff are all changing all the time. You know, we may become empty-nesters, we’re maybe in that squeeze generation, divorced, there’s so much going on.
And there’s a shift that happens and it’s part of the hormonal changes, because oxytocin declines, and it’s like a bonding hormone, and we’re natural nurturers and carers and a shift happens and we start thinking, “What would  happen if I put myself first today?” 
It’s not selfish. It’s almost self-preservation, I think. And I think we need to encourage that more in women and say to them, “what would happen if you said to your kid, ‘get your own bloody lunch, you can make a sandwich. I’m gonna sit outside on my own for five minutes.'” 
Kim: [00:50:42] I love that, Amanda, I think that’s fantastic. I think that’s fantastic.
That kind of leads into this next section of yours where you’re talking about how to think. And one of the sections you talk in there about is about building resilience and I think that’s such an important quality for us to focus on, particularly now. Talk a little bit about that. 
Amanda: [00:50:59] Yeah. So the, the final hack, the final part of the book, number four, is all about building a resiliency mindset. 
It’s not something I’ve made up. I worked with a psychologist on this. He was a really good friend of mine and we’d have these really deep, long conversations. And I just found that what she was saying just made so much sense to me. And two of the things, as well as talking about a mindfulness practice and how you can sort of incorporate that and how it can actually change how the brain operates and thinks, we talk about looking at your values and your strengths. 
And so these are actual psychological tools that are used, they’re not just me making two things up. And so, basically, I wanted to do this and I really wanted to do this because I got so tired of hearing women being so down on themselves, like saying, “I can’t do this,” or, “I’m too old for that,” or, “I hate myself,” “I hate the way I look,” “I can’t stand my wrinkles,” and all of these really negative messages. And I’m not asking people to be uber positive and be that annoying grinding woman that’s always like, “Woo! Woo!. Look at me. I’m so brilliant.” I’m just sort of saying, look at yourself and stop being so down on yourself. 
You know, there’s that thought monster that’s always in our head and we have to replace it with some positive outlooks.
And so, there’s two things I recommend women do. The first one is a values test. And if you go to — I think everyone should do this and values change — and so I did mine about three years ago and I re-did it them, and the things that came out top for me and my values were people, passion, nurture, health, and excitement.
So it looks for the values. Now, values aren’t goals, these are things that you want to achieve, things that make you want to live your life fuller. And it’s true, people and my family, and everything I do centers around that and I’m passionate and I love excitement. 
So all of these things, it really summed to me as well, and I think that that probably won’t change so much. 
But what you can do when you understand what your values are, is you can start changing things to suit those values, and that’s the whole purpose of it. 
And then the next one is your strengths.
And this is something I really liked because most women don’t value themselves at this time for a whole number of reasons. But, I encourage them to focus on their strong points, their strengths. And so if you go to, these are your qualities. These are things that come naturally to you and that’s the whole point of this. 
And then what it’s suggesting is that when you have these strengths, that you use them to your advantage and you use them to forge forward. So, for example, mine came out this order: curiosity first, kindness, social intelligence, humor, and creativity.
I knew I had a high social intelligence score and probably a low intellectual score — I’m just joking — but I knew that because I’d done that test before. But I was very surprised that my top strength was curiosity. It really was like, “really? That’s my top and not humor or not social intelligence?” But the definition of that is” taking an interest in ongoing experiences that you find fascinating and then exploring and discovering them.”
So that basically is me going down my menopause rabbit hole. And I think that that’s like you, it’s probably going to be similar to you. 
Kim: [00:54:56] Well, I did my test last night, Amanda. 
My daughter and I, there’s a teenage version of that too, and so we did it together. My top one was, “appreciation of beauty and excellence.” 
Amanda: [00:55:05] Oh, my gosh. And do you feel like that’s… 
Kim: [00:55:08] Well, we were kind of talking about it. And I said, I guess — because you know, it says “it’s noticing and appreciating beauty, excellence, or skilled performance in various domains of life from nature to art,” and I am a person, we were talking, I’m like, “it’s true. Like, I do buy flowers for the house every week and I’m always the person to be like, ‘stop guys, look at the pretty sunset.'” That is me. That’s what I do. And I really do find energy from those kinds of things. 
Amanda: [00:55:30] And that’s the point. It feeds your soul, right? It feeds your soul. And that’s what this thing encourages you to do. 
Kim: [00:55:35] I thought it was a really interesting test. I thought that was very interesting.
So, for
sure, listeners go and give that a try. It’s It was really easy to do.

What a great thing for us to be conversing about, because I think at this age, the women that I meet with, the women who contact me, they really are kind of struggling to find themselves and figure out like, “where is my place? What is going on? I’m busy, I’m a mom,” and they’ve kind of gotten to this point where they’re not really sure what the next step is or “is this it?” 
And so I love the idea figuring out, “what am I good at? What are my strengths? Because I still have a whole lot of life to build here with these strengths.”
Amanda: [00:56:23] And it’s interesting, as well. So I talk about those four things; the nutrition, the exercise, the stress management — which comes with sleep — and then this resiliency mindset because I do believe that when you talk about menopause, you need to look at everything together and how it looks. 
But what you just said there is the story I hear all the time and it really makes me quite sad. But it’s understandable, as well. 
I also talk, in the book, about the U-curve of happiness. And the U-curve of happiness, I think is worthy to end on.
So, if you think of a U, the age around menopause, we’re in the bottom of that U-curve. We’re in the doldrums and we’re hanging out there and it’s probably what they consider to be one of our lowest times. But as you enter your mid-50s and going up to 60s, we start climbing up that happiness curve and we see people being the happiest that they’ve ever been, the most content and satisfied with their life.
And so I’m now out of the worst of menopause and the mental shift has been huge for me because most of my symptoms were neurological and on the mental health side. And coming out of the other side has been a game-changer for me. It’s not to say won’t have the symptoms, I’m not suggesting that, but I sort of want to give a glimmer of light at the end of the tunnel, the menopause tunnel. 
Kim: [00:58:01] That it just doesn’t lead to continued darkness.
Amanda: [00:58:03] Because when you’re in that — and you felt it too — you’re like, “Is this how it’s always going to be? Is my character now changed? Is this my new personality?” And it’s actually quite hard to even think that it could lift. 
Kim: [00:58:18] Yeah, absolutely. Well, Amanda, this has been a fantastic conversation. Everyone listening, know that the things that we have just discussed here, we just barely got the tip of the iceberg, each of these subjects are covered in-depth in Amanda’s book, Menopocalypse.
Amanda, when is the book gonna be available? 
Amanda: [00:58:34] It comes out on World Menopause day, which is October 18th, and it’s available for preorder now if you wanted to get it. 
Kim: [00:58:42] All right. So get your copies. And Amanda, where can everyone find you? 
Amanda: [00:58:47] So if you were to head to my website, you can get access to my menopause community there, my Instagram, Facebook, and also there’s a link there to my books and it tells you, globally, where you can buy the books. 
I definitely recommend, if you can, supporting your local bookshop or buying independently. Amazon’s definitely where I’m going to get most of my sales, but if I can push a small business, then I would like to do that. 
Kim: [00:59:20] That’s a great idea.
Or you guys could just find Amanda. Head to Texas and listen for a British accent. 
Amanda: [00:59:25] That’s too funny. 
Kim: [00:59:29] Thanks so much for being here, Amanda. 
Amanda: [00:59:30] Thanks for having me on again. Three-timer! Woo woo! 
Kim: [00:59:38] Thanks so much for being here and listening in to the Fitness Simplified podcast today. I hope you found it educational, motivational, inspirational, all the kinds of -ational.
If you enjoyed it, if you found value in it it would mean so much to me if you would go ahead and leave a rating and review on whatever platform you are listening to this on. It really does help to get this podcast to other people.
Thanks so much.