Excess Matters

Tag: perimenopause

  • The Great Menopause Myth by Kristin Johnson: Summary, Key Ideas & Review

    Book in one sentence: Johnson and Claps take a blowtorch to the comforting lies women are told about menopause, and to the wellness industry that profits from keeping them in the dark.

    What Is The Great Menopause Myth About?

    Picture the menopause content ecosystem right now: podcasts, Instagram feeds, telemedicine platforms, celebrity supplement lines. Some of it says embrace your symptoms, they’ll pass. Some says lower your cortisol and take these adaptogens. Almost none of it explains why, by age sixty, women match or exceed men in rates of cardiovascular disease, cognitive decline, and osteoporosis.

    That gap is what Kristin Johnson and Maria Claps built this book to close. The two are founders of Wise & Well, a women’s health practice they started after their own frustrating encounters with conventional menopause care. Johnson is a former attorney with board certifications in nutrition and holistic health; Claps holds credentials in functional diagnostic nutrition. Neither is a physician, which is worth noting upfront. But they’ve spent a decade working alongside frontier medical providers, digging into patient outcome data, and sitting on the clinical advisory board of a nonprofit trying to change the standard of care for menopausal women. They write with the confidence of people who have seen what different approaches actually produce.

    The central claim is both simple and uncomfortable: the current menopause conversation is focused on the wrong target. Hot flashes, night sweats, brain fog, the “midlife belly.” All symptoms of a whole-body signaling loss, not cosmetic inconveniences to ride out. Estrogen and progesterone receptors exist in the brain, heart, bone, skin, gut, bladder, immune system, and more. When those hormones decline, every one of those systems gets the message at once. The book argues that treating menopause as a temporary passage, or as a feminist act of acceptance, leaves women unprepared for the chronic disease trajectory that begins quietly in their forties and accelerates through their fifties.

    What Does Menopause Actually Do to Your Weight?

    A lot of women arrive at perimenopause convinced they’re doing everything right (same eating, same exercise) and still watch the scale climb and the belly expand. Johnson and Claps spend real time on this, and the explanation is more mechanistic than most women get from their doctors.

    Estradiol and progesterone are metabolically protective. Both speed up the rate at which you burn calories. Estradiol plays a specific role in keeping blood sugar stable by improving insulin sensitivity, suppressing hunger through leptin and ghrelin signaling, and supporting adiponectin, the hormone that enables fat loss. When estradiol drops, all of that changes: glucose processing becomes impaired, insulin resistance creeps in, hunger signals go haywire, and fat storage shifts from hips and thighs to the abdomen (visceral fat, which carries the highest health risk).

    Then there’s muscle. Estradiol receptors line muscle cells and regulate muscle protein synthesis. Declining estrogen means the body progressively swaps fat for muscle, slowing metabolic rate further. Johnson and Claps describe this as a cascade rather than a single event:

    • Declining estrogen impairs glucose handling
    • Impaired glucose handling leads to insulin resistance
    • Insulin resistance increases fat storage, especially visceral fat
    • Dysfunctional hunger hormones lead to overeating
    • Muscle loss slows the metabolic rate
    • Poor sleep (also hormone-driven) spikes cortisol, which triggers more fat storage and more overeating

    The book takes direct aim at the “less food, more cardio” reflex most women default to when the weight starts shifting. According to Johnson and Claps, this response reliably makes things worse: it creates a catabolic environment that accelerates muscle loss, impairs recovery, and drives women toward fast-energy carbs and caffeine to compensate. Resistance training and adequate protein (more than most women are eating) are the non-negotiable interventions. Not as an aesthetic choice. As metabolic medicine.

    “The scale should never be the sole determinant of a woman’s state of health. We have seen plenty of ‘thin’ women who are prediabetic with high inflammation markers, and we have seen plenty of women 10 to 20 pounds overweight who have beautiful lipids, blood sugar, and inflammation status.”

    The practical takeaway isn’t that menopause makes weight gain inevitable. The book’s argument is the opposite: the cascade is largely modifiable if you understand what’s driving it and address the right levers. Thin is not the goal. Metabolically healthy is the goal. Those two things are not the same.

    Why the “Just White-Knuckle Through It” Advice Falls Apart

    Johnson and Claps give a name to the problem: the menopause gold rush. With an estimated 1.2 billion women worldwide becoming postmenopausal by 2030, the market opportunity is enormous, and investors, wellness brands, and social media influencers have rushed in. The result is a proliferation of interventions that address visible symptoms and aging aesthetics without touching the underlying disease risk.

    The book draws a line between two approaches to hormone therapy that most women don’t know to ask about:

    MHT (menopausal hormone therapy) is symptom-focused. The goal is to suppress hot flashes and vaginal dryness using the lowest dose that relieves discomfort. This is the standard-of-care approach most providers use. The dose is calibrated to feeling better, not to the levels of estrogen that protect bone, brain, and cardiovascular function.

    HRT (hormone replacement therapy), as Johnson and Claps use the term, is restoration-focused. The goal is to approximate premenopausal hormone levels in order to preserve organ function and interrupt the chronic disease trajectory. This requires higher, individually calibrated doses, regular blood testing (not just symptom tracking), and attention to which types and delivery routes are used.

    That gap matters. A dose sufficient to stop a hot flash is often not sufficient to protect your bones, brain, or heart. If your provider’s measure of success is whether you feel better, you may feel better while remaining at elevated risk. Johnson and Claps note that 80 percent of medical residents report discomfort discussing or treating menopause, so the conversation that ends with a low-dose patch and a three-month follow-up is often the most care women can expect from the standard system.

    Their prescription for this gap is metabolic health first. The “hormones need a healthy host” metaphor runs through the middle section of the book: you wouldn’t invite houseguests into a disorganized home. Hormones are the guests; metabolic health is the house. Studies they cite show that adding hormones without addressing insulin resistance, chronic inflammation, and gut dysfunction can increase cancer and cardiovascular risk rather than reduce it. So nutrition, resistance training, sleep, and stress management are the foundation. Not optional lifestyle additions. Clinical prerequisites for hormone therapy to work as intended.

    What the WHI Study Actually Said (And What Got Left Out)

    If you’ve ever been told by a doctor that hormone therapy causes breast cancer, or had a prescription declined because of “the studies,” Chapter Eleven is the one to hand them.

    The Women’s Health Initiative, which published alarming results in 2002, studied women with an average age of 63 (more than a decade past the average age of menopause). It used conjugated equine estrogen (from pregnant horse urine) combined with a synthetic progestin (medroxyprogesterone acetate). When preliminary results showed an apparent breast cancer risk increase in one arm of the trial, the story became: Estrogen Causes Cancer. Millions of women stopped their prescriptions. Most physicians stopped prescribing.

    What didn’t make the headlines:

    • The absolute risk increase was 0.08 percent (from 4 women per thousand per year to 5)
    • The estrogen-only arm of the same study showed a 23 percent lower rate of breast cancer than the placebo group (a finding that received almost no media attention)
    • WHI investigators themselves have since published corrections clarifying that the findings cannot be applied to younger, healthier women in the perimenopause window

    The book introduces what researchers now call the “timing hypothesis.” Estrogen protects healthy cells; it cannot restore function that’s already been lost. Beginning hormone restoration within ten years of menopause (ideally during perimenopause) yields cardiovascular and neuroprotective benefits that starting later cannot provide. The window is real, and most women aren’t being told it exists.

    Johnson and Claps aren’t arguing that every woman should take hormones. They’re arguing that the widespread provider reluctance rooted in a twenty-year misreading of a flawed study isn’t evidence-based, and that women deserve to know that when they’re making decisions about their own care.

    Is The Great Menopause Myth Worth Reading?

    Read this if you’re in your forties or fifties, feel like the information you’ve been handed about menopause is incomplete, and want an accessible book that connects symptoms to underlying biology rather than treating them as separate problems to manage. Especially useful if you’ve been refused or discouraged from hormone therapy and want to understand the WHI story in full, or if you want a framework that integrates metabolic health and hormone restoration rather than treating them as separate tracks.

    Skip it if you want a single-topic deep dive. For cognitive and Alzheimer’s risk specifically, Lisa Mosconi’s The Menopause Brain goes further and has the neuroimaging data behind it. For a more integrative approach that includes non-hormonal options, Suzanne Gilberg-Lenz’s Menopause Bootcamp is more thorough. Johnson and Claps are comprehensive but not always granular. Some chapters cover a lot of ground quickly.

    One caveat: Johnson and Claps are functional nutritionists and health coaches, not physicians or endocrinologists. That doesn’t invalidate their research synthesis (much of which is more current than what you’ll find in popular physician-authored books). But for clinical decisions around hormone therapy, working with a qualified provider remains essential. The authors say so explicitly, and it’s worth taking seriously.

    Books Like The Great Menopause Myth

    BookAuthorBest For
    The Hormone MythRobyn Stein DeLucaDebunking hormonal hysteria with psychological research
    Menopause BootcampSuzanne Gilberg-LenzIntegrative approach, inclusive of non-HRT options
    The Science of MenopauseLeah KayeClinical deep dive, evidence-first format
    The Menopause BrainLisa MosconiCognitive and Alzheimer’s risk, neuroimaging data
    Unlock Your Menopause TypeHeather HirschIndividualized approach by symptom pattern

  • The Natural Menopause Method by Karen Newby: Summary, Key Ideas & Review

    Book in one sentence: A BANT-registered nutritional therapist walks you through a food-first, supplement-supported framework for managing menopause symptoms without relying on HRT.

    What Is The Natural Menopause Method About?

    Most menopause books land in one of two places. Either they read like a clinical briefing (all evidence, no warmth) or they drift into vague “eat clean, reduce stress” territory that sounds helpful and means almost nothing. Karen Newby’s book sits in a more useful middle ground.

    Newby is a BANT-registered nutritional therapist with a degree in Nutritional Medicine. Her angle is practical: she wants you to understand the biochemistry well enough to make confident choices, then give you specific food, herb, and supplement interventions tied to each mechanism. The book is not anti-HRT. A menopause specialist contributes a foreword positioning HRT as one valid tool among several, and Newby frames her approach as complementary rather than competing. That framing matters, because it keeps the book usable for women across a wide range of circumstances.

    What sets this apart from generic wellness content is the specificity. Newby explains why declining oestrogen produces hot flushes (it disrupts insulin sensitivity and triggers adrenaline surges), why sleep unravels (oestrogen supports serotonin, which is the precursor to melatonin; progesterone supports GABA, the brain’s calming neurotransmitter), and why constipation is a hormonal issue rather than just a digestive inconvenience. Once you know the mechanism, the food recommendations stop feeling arbitrary.

    The Four Shifts: How Newby Structures the Approach

    The book’s backbone is a sequenced protocol called the Four Shifts. Each shift addresses a different physiological layer, and the order matters.

    Shift 1: Reset comes first because of something most women don’t know: the adrenal glands are the body’s backup source of both oestrogen (as the weaker form, oestrone) and progesterone when the ovaries start to wind down. Chronic stress means those same adrenal glands are busy prioritizing cortisol instead. As Newby puts it: “Stress (survival) trumps sex hormones.” Addressing cortisol load before anything else is not a soft wellness suggestion. It is a physiological prerequisite.

    Shift 2: Cleanse focuses on the liver and gut as an integrated oestrogen clearance system. The liver converts oestrogen into less active forms; the gut eliminates them. Disruptions anywhere in this pathway (poor diet, constipation, low microbiome diversity) cause processed oestrogen to be reabsorbed rather than excreted, raising total oestrogen load even as the ovaries produce less. Newby calls this the estrobolome effect, and her interventions address both ends simultaneously: brassicas daily for liver support, fermented foods and ground linseed for gut elimination.

    Shift 3: Rest maps specific food and supplement strategies to the three clinical sleep failure modes she sees in her practice (trouble falling asleep, trouble staying asleep, waking exhausted). Tryptophan-rich foods support serotonin and melatonin production. Magnesium supports GABA. Avoiding tyramine-rich foods near bedtime (cheese, cured meats, wine, chocolate) prevents noradrenaline spikes that keep the brain alert.

    Shift 4: Eat optimizes phytoestrogen intake and nutrient density. This is Newby’s “sparkplug” model: macronutrients are the fuel, micronutrients are the sparkplugs. A car will not run without both. The final shift covers the therapeutic phytoestrogen protocol, whole-food swaps, and supplement quality guidelines.

    The shifts are sequential but not rigid. A woman with severe insomnia might start with Shift 3. The framework is a map, not a prescription, and Newby’s repeated framing is “consistency over perfection.”

    Why Does Blood Sugar Keep Coming Up in a Menopause Book?

    It comes up because it is everywhere. Blood sugar instability is the single highest-leverage variable in the perimenopause symptom picture, and Newby returns to it in nearly every section.

    Here is the short version of the mechanism. Oestrogen helps regulate insulin sensitivity. As oestrogen declines, cells become less responsive to insulin. Foods that produced stable energy at thirty-five now create larger glucose swings at forty-five. Those swings trigger cortisol and adrenaline (already overtaxed at perimenopause). In vasomotor terms, a glucose low triggers an adrenaline surge that causes vasodilation, which is how blood sugar directly drives hot flush frequency. In mood terms, the same low amplifies anxiety, irritability, and the impulse to eat something immediately.

    Newby’s practical protocol is not complicated:

    • A 12-14 hour overnight fast (nothing exotic, just not eating at 10pm)
    • Protein and fat at every meal to slow glucose absorption
    • Never skip breakfast (which extends the cortisol spike from overnight fasting)
    • Caffeine only with food (on an empty stomach, caffeine puts the body into fight-or-flight and raises cortisol directly)

    “I liken sugar to pouring petrol onto a fire — the flames burn really bright and kick out a lot of heat, which can give us a sense of energy; but after this short spike the flames become even smaller than they were before. Putting protein and good fats on the fire I liken to coal — although the flames don’t burn as brightly, more heat is produced and they burn for longer.”

    The food swap table in this section is among the more practically useful pages in the book. The 3pm coffee-and-biscuit ritual (which Newby notes works partly through habituated dopamine cues, not hunger) gets replaced with fresh mint tea, miso soup, tamari seeds, or falafel with hummus. These are crowding-out strategies rather than restrictions.

    She also brings the emotional eating angle into this framework. Physical hunger builds gradually, involves stomach grumbling (the hormone ghrelin), and is resolved by eating. Emotional hunger arrives suddenly, is unrelated to the last meal, and is not resolved by eating (which is why the craving continues after the food is gone). The Japanese have a word for it: kuchisabishii, meaning “lonely mouth.” The dopamine reward system drives craving behavior regardless of hunger state, and ultra-processed foods are engineered to spike that system. Knowing this does not eliminate the craving, but it reframes what is happening: it is a neurochemical response to a product designed to produce it, not a character flaw.

    What About the Weight Changes?

    Weight gain during perimenopause, especially around the middle, follows a specific hormonal logic that Newby explains clearly. As oestrogen declines, the pattern of fat storage shifts from hip and thigh to abdominal, which is a testosterone-dominant pattern. The abdominal fat itself then converts testosterone to oestrogen (through an enzyme called aromatase), which can raise oestrogen load even as the ovaries produce less, creating a feedback loop.

    Phytoestrogens are Newby’s sharpest tool for addressing this pattern directly. These are plant compounds structurally similar to oestradiol that bind to oestrogen receptor sites and modulate them bidirectionally: reducing symptoms from oestrogen excess and relieving symptoms from oestrogen deficiency. NICE guidelines confirm that isoflavones may relieve vasomotor symptoms. Research also supports their role in bone density, memory function, and reduced oxidative stress.

    The three main sources:

    • Isoflavones (soya in cooked or fermented forms): tofu, tempeh, miso, natto, edamame; also chickpeas, lentils, peas
    • Lignans: ground linseed or flaxseed (the highest dietary source), sesame seeds, cashews, brassicas, apples, apricots, cherries
    • Coumestans: soybean sprouts, alfalfa, split peas, pinto beans

    Two practical rules stand out. Cook or ferment soya before eating it (raw lectins may affect iodine uptake and are deactivated by heat and fermentation). Fermented foods also supply the lactic acid needed to absorb phytoestrogens in the first place, which is why kefir, sauerkraut, and miso appear throughout the protocol.

    On the supplement side, Newby’s guidance is quality-first: the form of the mineral matters as much as the dose. Magnesium glycinate or malate over oxide. Zinc citrate or picolinate over oxide. Calcium citrate over carbonate. Many supermarket supplements contain fillers, glycerol, sucrose, and talc, so reading the ingredients list matters more than reading the nutrient label.

    Sage (as herb, tea, or tablet) gets specific mention as an evidence-backed hot flush intervention: research supports reductions in both frequency and severity. Red clover isoflavone supplements similarly have research backing for vasomotor symptoms and mood.

    Is The Natural Menopause Method Worth Reading?

    Read this if you are in perimenopause or approaching it, want to understand the mechanisms behind your symptoms, and are willing to make incremental food-based changes over time. Women who have found generic “eat clean” advice unhelpful will get more traction here because Newby explains the biochemistry behind each recommendation. Women who are not on HRT (by choice, contraindication, or circumstance) will find a comprehensive food-first toolkit that few books in this category match. Women who are on HRT will still find value in the lifestyle layer.

    Skip it if you want a meal plan with precise macros, you are in North America and find UK supplement brands frustrating to source (the food interventions translate; the brand names do not), or you prefer narrative-driven health books (parts of this read more like a clinical reference).

    One caveat: the book covers an enormous amount of territory (biochemistry, recipes, pelvic floor rehabilitation, acupuncture, supplement protocols) in 256 pages. Some sections feel compressed as a result. The supplement lists in particular can feel overwhelming without a background in nutritional therapy. Start with the food interventions and treat the supplement section as a reference to return to.

    Books Like The Natural Menopause Method

    BookAuthorBest For
    The Natural Menopause PlanMaryon StewartBroader lifestyle approach with HRT alternatives
    Eat to Thrive During MenopauseJenn Salib HuberAnti-diet framework with intuitive eating integration
    Healthy HormonesMagdalena WszelakiHormone-balancing nutrition with lab-tested protocols
    The Menopause CompanionKathleen DaviesIntegrative approach covering conventional and natural options
    The Happy Hormone GuideShannon LeparskiPlant-based hormone support with cycle-syncing emphasis

  • Eat to Thrive During Menopause by Jenn Salib Huber: Summary, Key Ideas & Review

    The book in one sentence: A registered dietitian and naturopathic doctor reframes menopause nutrition around symptom relief and food addition rather than weight loss and restriction.

    What Is Eat to Thrive During Menopause About?

    Open twelve browser tabs on “menopause diet” and you’ll find a consistent parade: keto for meno-belly, intermittent fasting windows tailored to midlife hormones, hormone-balancing cleanses, elimination protocols targeting nightshades, gluten, dairy, or all three at once. None of them agree. Most of them center weight loss as the primary menopause health goal. And somewhere in the pile, an influencer has solved all of it with a $200-a-month supplement stack.

    Jenn Salib Huber, a registered dietitian and naturopathic doctor who has specialized in midlife women’s nutrition for over a decade, is writing directly against that landscape. Her central reframe is a single question swap: instead of asking “what’s the best diet for menopause?” (which almost always routes to weight loss), she asks “how can food help me feel better?” Those two questions lead to completely different bodies of evidence.

    Huber came to this work through personal necessity. She entered perimenopause at thirty-seven, tried hormone therapy, found it didn’t work for her body due to progesterone sensitivity, and had to navigate her own symptoms through food while running a clinical practice. She hosts the podcast The Midlife Feast and has spent years tracking the gap between what the research actually shows and what most midlife women are being told. That gap is what Eat to Thrive During Menopause is built to close.

    The book is organized around five “key ingredients” (soy and phytoestrogens, protein, fiber, calcium, omega-3 fatty acids) layered over a macronutrient foundation that never eliminates food groups. Fifty-five recipes are included, tagged by key ingredient. No meal plan here. Just a symptom-mapped framework you fold into eating patterns that already exist.

    The Anti-Diet Approach: What Does “Nutrition by Addition” Actually Mean?

    Most books that claim to be anti-diet spend two paragraphs on not dieting, then describe a diet. Huber’s integration of intuitive eating principles is more substantive than that. It changes what the practical advice actually looks like.

    The organizing principle is “nutrition by addition.” At every meal, the question is: what can be added here, not what should be removed? A tablespoon of ground flax in yogurt. Edamame in the stir-fry that was already happening. Soy milk in the oatmeal instead of water. Canned chickpeas in the soup. None of this requires a food identity shift. None of it requires planning or sacrifice. It accumulates.

    Her metaphor for the whole framework is the capsule wardrobe. A capsule wardrobe is a small, well-chosen collection of versatile pieces that work together without requiring a complete closet overhaul. As she puts it:

    “How many times have you stood in front of a closet full of clothes and proclaimed, ‘I need a new wardrobe’ when what you actually need is someone to show you how to wear the clothes you have?”

    The menopause nutrition equivalent: keep the foundation (protein, carbohydrates, fat at most meals), then add specific pieces based on what symptoms you’re actually managing. Hot flashes? Prioritize soy and Mediterranean eating patterns. Bone density concerns? Calcium and protein move to the foreground. Mood disruption? Don’t cut carbohydrates, because carbohydrates are the primary substrate for serotonin synthesis and reducing them during meno-rage compounds the neurochemical problem.

    Addition is actually the harder, more effective choice, not a soft workaround. For midlife women with long dieting histories (which describes most midlife women), an additive approach sidesteps the psychological tripwires that restriction activates: the moral weight of compliance and failure, the rebound hunger, the all-or-nothing collapse. Huber has watched what happens when dietitians give restrictive advice to women who have been restricting since elementary school.

    The research she cites is real. A 2021 meta-analysis of ninety-seven studies found that intuitive eating consistently predicted better psychological wellbeing, more positive food relationships, and fewer symptoms of depression compared to non-intuitive eating. These outcomes matter in a life stage already characterized by hormonal mood disruption.

    Does Soy Actually Help With Hot Flashes?

    Start with the thing that will change what’s in your grocery cart: Huber’s treatment of soy. The fear of soy has been circulating since the late 1990s, when concerns emerged that phytoestrogens (plant compounds that weakly mimic estrogen) might promote breast cancer. For a generation of women already anxious about hormones after the Women’s Health Initiative study, soy became one more item on the avoid list. Integrative practitioners and wellness influencers still routinely warn against it.

    The evidence does not support the fear. The mechanism explains why: soy isoflavones bind to estrogen receptor beta (ER-β), found in the brain, bones, and blood vessels, producing mild estrogen-like effects without triggering estrogen receptor alpha (ER-α), which is the pathway associated with hormone-sensitive cancer risk. They are not the same thing. The Shanghai Women’s Health Study, following more than 73,000 women over seven years, found that women with the highest soy consumption had nearly 60% lower breast cancer risk than those with the lowest. That is a protective finding, not a neutral one.

    On hot flashes specifically, at least sixty clinical trials have examined soy isoflavones and vasomotor symptom frequency. The evidence supports a meaningful reduction at doses of 25-50 mg of isoflavones daily, sustained for at least six to twelve weeks before expecting consistent results. Getting there through food is accessible:

    • 1 cup soy milk: approximately 20-25 mg isoflavones
    • ½ cup edamame: approximately 16 mg
    • ⅓ cup soy nuts: approximately 45 mg
    • 1 tablespoon ground flaxseed: lignans (a separate phytoestrogen class) with additional benefit

    Women avoiding soy for fear-based reasons are skipping the most evidence-supported non-hormonal dietary tool available for hot flash management. That is a real cost with no evidence-based benefit attached to it.

    Huber also addresses the estrobolome, the community of gut bacteria that metabolize estrogen. A diverse, fiber-rich diet supports estrogen metabolism and clearance; low-fiber diets and disrupted gut microbiomes can impair this process. This is where the fiber chapter connects back to hormone balance in a way most menopause books don’t trace.

    How Does Huber Handle Menopause Weight Gain?

    She doesn’t dismiss it. Body changes in menopause are real: declining estrogen increases insulin resistance, loss of lean muscle reduces resting metabolic rate, and fat redistributes from hips and thighs to the abdomen. These are physiological changes, not personal failures.

    What she adds, and what makes her treatment different from most, is the physiological role of dieting history itself. The metabolic and hormonal compensation that follows restriction (reduced leptin, increased ghrelin, fat overshooting on regain) is well-documented. Women who have spent decades cycling through diets enter menopause with a physiological disadvantage that was created by the dieting, not by their bodies. Huber names this a mechanism, and she’s right. That reframe changes what “doing something about it” actually looks like.

    Her weight-neutral framework doesn’t ask women to love their bodies or achieve positivity they don’t feel. It offers body neutrality as a functional starting point: the recognition that you are more than your body, and that your body can be cared for even on days when you don’t like it. She frames body appreciation (attending to what the body does rather than how it looks) as a practice for gradually shifting cognitive defaults without requiring feelings that aren’t there yet.

    The Health at Every Size evidence she references is worth taking seriously: four behaviors reduce mortality risk regardless of BMI. Not smoking, moderate alcohol use, regular physical activity, and five daily servings of fruits and vegetables. These are directly actionable. Weight loss is not required as an intermediate step. Focusing on these behaviors as primary outcomes, rather than body size as a proxy, is both more evidence-grounded and more sustainable over time.

    “Hormone therapy will almost certainly cool your hot flashes down, but it won’t have much impact on your body composition or body image.”

    That quote, from Huber on the limits of HRT, is a useful frame for the whole book. Food and movement shape body composition in menopause. Hormone therapy shapes vasomotor symptoms. Neither does what people often hope the other one will.

    Is Eat to Thrive During Menopause Worth Reading?

    Read this if you are in perimenopause or postmenopause and exhausted by conflicting nutrition advice. Also if you have a long dieting history and find that most menopause nutrition guidance immediately triggers restriction thinking. Also if you want to know specifically which foods the evidence supports for hot flashes, bone density, mood, or cardiovascular health, without being told to adopt a new dietary identity first.

    Skip it if you are primarily looking for a structured meal plan with specific daily menus. The book is principled but not prescriptive, and readers who want to be told exactly what to eat each day will find it under-directive. Also skip it if you are firmly committed to ketogenic or low-carbohydrate eating, since Huber’s framework treats carbohydrates as a non-negotiable foundation.

    One caveat: the book covers menopause physiology, body image, intuitive eating, macronutrition, five key ingredients, symptom-specific strategies, and fifty-five recipes in roughly 200 pages of text. It is a broad map, not a deep dive into any one area. Readers who want the full research on soy mechanisms, or the complete intuitive eating evidence base, will need additional reading (Tribole and Resch’s Intuitive Eating, Christy Harrison’s Anti-Diet). That is appropriate for the intended audience, but worth naming.

    The recipes are practical, clearly tested, and thoughtfully tagged by key ingredient so you can match meals to your symptom priorities. They are not inventive cooking. That is probably deliberate. The goal is accessible, repeatable eating that does not feel like a special diet.

    Books Like Eat to Thrive During Menopause

    BookAuthorBest For
    The Menopause Diet PlanHillary Wright & Elizabeth WardA more structured meal-plan approach to the same menopause nutrition territory
    Eat Like a GirlMindy PelzCycle-syncing and fasting framework; a useful philosophical contrast to Huber’s anti-diet stance
    MenuPauseAnna CabecaFive symptom-specific menu protocols; more prescriptive, different evidence framework
    Women Food and HormonesSara GottfriedFunctional medicine lens on menopause and hormones; more restriction-oriented
    The New MenopauseMary Claire HaverBroader menopause guide (HRT, lifestyle, longevity); Huber goes deeper on the food-psychology piece

  • The Science of Menopause by Philippa Kaye: Summary, Key Ideas & Review

    Book in one sentence: A UK GP strips the misinformation out of menopause and replaces it with the actual evidence: hormones, HRT, symptoms, metabolism, and all.

    What Is The Science of Menopause About?

    You ask your doctor about HRT and she says she’s “not really comfortable with it.” You search online and get 457 million results. You find a Facebook group and come away more confused than before. This is the information environment most women are navigating when their bodies start behaving in ways they don’t recognize.

    Dr. Philippa Kaye is a UK GP (general practitioner) and the author of nine books on women’s health. She wrote this one because her consulting room was full of women who didn’t understand what was happening to them, assumed their symptoms were just aging, or were refusing treatments because of clinical trial data from 2002 that was badly misapplied for two decades. The book is structured as a Q&A, so you can open it to “Why am I gaining weight?” or “What is genitourinary syndrome?” and get a direct clinical answer. You can also read it front to back and build a coherent picture of the whole transition.

    At 224 pages, it reads more like a medical briefing than a book. Dense, well-organized, no filler. The tone is what you’d want from a doctor who actually has 30 minutes to talk to you: clear, evidence-grounded, and without an agenda beyond helping you make informed decisions.

    What Does Menopause Actually Do to Your Metabolism?

    This is the section that matters most if weight and eating have been part of your story.

    The average adult gains 1 to 1.5 pounds per year from early adulthood through middle age. That’s not a perimenopause problem specifically. It’s what happens when muscle mass gradually declines with age and nobody replaces it. Muscle burns more calories at rest than fat does, so losing muscle without adding it back creates a slow caloric gap even when nothing else changes. Perimenopause accelerates this process.

    Estrogen also controls where fat gets deposited. As levels fall, fat shifts from the hips and thighs toward the abdomen (visceral fat), and the body simultaneously tries to produce an alternative form of estrogen called estrone from adipose tissue. Visceral fat carries higher metabolic and cardiovascular risk than subcutaneous fat. This is why body composition changes in midlife can feel so different from earlier weight gain (same number on the scale, different distribution, different implications).

    Kaye’s practical recommendation is strength training twice per week as a specific clinical priority, not a general wellness suggestion. The goal isn’t aesthetics. It’s preserving the metabolic engine that’s been quietly losing mass since your thirties. For anyone whose relationship with food and weight has been complicated, this framing is worth sitting with: the changes aren’t a personal failure, and the lever isn’t less food. It’s more muscle.

    “With a lower muscle mass, even if you consume the same amount of food/calories, you will gain weight.” (Philippa Kaye)

    Is HRT Really as Dangerous as Everyone Says?

    The short answer is: the HRT most women are afraid of is not the HRT being prescribed now.

    In the early 2000s, a major US study called the Women’s Health Initiative (WHI) published results suggesting that HRT increased risks of breast cancer and cardiovascular disease. Prescriptions dropped by 50 percent almost overnight. The fear stuck, and it’s still in the room when most women have this conversation with their doctors today.

    Here’s what the coverage got wrong. The average participant in that study was 63 years old. These were not perimenopausal women in their mid-forties. The study also used oral synthetic estrogen and synthetic progestins, formulations that look nothing like what evidence-based practitioners currently prescribe. Kaye walks through the key distinctions:

    • Transdermal estrogen (gel, patch, or spray) bypasses the liver and carries no increased risk of blood clots or stroke. Oral estrogen does carry that risk. Delivery route matters clinically.
    • Micronized progesterone (sometimes called Utrogestan or Gepretix) is body-identical and plant-derived. It carries a much lower breast cancer signal than the synthetic progestins studied in the WHI.
    • Timing matters. HRT started within 10 years of menopause onset may be cardioprotective. Starting much later, in women who already have established cardiovascular disease, carries a different risk profile.

    The WHI findings were real for that population, using those formulations, at those ages. The harm was in applying those conclusions to a completely different group. Kaye doesn’t demonize the researchers. She frames this as a clinical literacy problem, one that has cost women years of unnecessary suffering, bone fractures, and preventable cardiovascular events. Undertreated menopause is its own health crisis, and she makes that case with specifics.

    For women who can’t or don’t want to use HRT, the non-hormonal options get the same rigorous treatment. Fezolinetant (brand name Veoza, FDA-approved 2023) is the first non-hormonal prescription drug specifically targeting the mechanism of hot flashes. SSRIs and SNRIs reduce hot flash frequency by 30 to 60 percent. CBT is clinically validated for hot flashes, insomnia, anxiety, and depression. The book rates each option by evidence quality, which is more useful than a list.

    What About the Symptoms Nobody Talks About?

    Hot flashes get the most airtime, but Kaye explains why they happen in a way most books skip. The hypothalamus keeps body temperature within a narrow range. Estrogen normally moderates a peptide called neurokinin B (NKB). As estrogen falls, NKB overstimulates the thermoregulatory center via NK3 receptors, and the brain reads a temperature emergency that isn’t happening. The body launches its heat-dissipation response: vasodilation, flushing, sweating. Core body temperature doesn’t actually rise. You’re cooling something that isn’t hot. Understanding this mechanism explains why fezolinetant works without hormones: it blocks the NK3 receptor directly.

    Mood symptoms are consistently misidentified. Perimenopausal women are 40 percent more likely to be diagnosed with depression than premenopausal women, and mood changes (anxiety, irritability, low mood, brain fog) often show up before hot flashes do. Women in their mid-forties get put on antidepressants with nobody connecting the symptoms to hormonal fluctuation. Estrogen supports serotonin synthesis and receptor sensitivity; progesterone acts on GABA receptors. As both hormones decline and swing erratically (Kaye’s phrase: “a roller-coaster”), the neurochemical scaffolding for mood stability is progressively removed. HRT can resolve hormonally-driven mood symptoms that antidepressants alone won’t touch.

    Genitourinary syndrome of menopause (GSM) is the symptom with the worst visibility gap. It covers vaginal dryness, painful sex, recurrent UTIs, and urinary urgency, and it affects over half of postmenopausal women. Unlike hot flashes, which often ease over time, GSM is progressive without treatment. Vaginal estrogen is the definitive fix: local application, minimal systemic absorption, safe for most women including breast cancer survivors, reduces UTI frequency by more than 50 percent in studies. It takes three to six months for full effect and should be continued long-term because the condition is chronic. Women don’t report it (stigma, or the assumption that sex is just supposed to hurt now), and clinicians often don’t ask. The silence around GSM costs women years of avoidable suffering that is, in most cases, straightforwardly treatable.

    Is The Science of Menopause Worth Reading?

    Read this if you want one reliable, clinical reference on perimenopause and you’re done wading through wellness influencer content that can’t tell you why hot flashes happen or what micronized progesterone actually is. Kaye treats readers as adults. For anyone who has struggled with weight and wants to understand the metabolic mechanics of this transition (not just “eat less, exercise more”), the muscle mass and fat distribution sections are unusually well-sourced and direct. If you’re on a GLP-1 medication and navigating perimenopause at the same time, the sections on muscle preservation and metabolic rate are directly relevant to how both interventions interact.

    Skip it if you want a diet plan, a step-by-step protocol, or extended personal narrative. This is a reference book. The lifestyle chapter is evidence-grounded but concise: it points to what works and why, without building out full programs. Also worth noting: Kaye is a UK GP, so her treatment recommendations follow NICE guidelines, which sometimes differ from US FDA approvals. The distinctions are flagged in the text, but you’ll need to translate some of it.

    One caveat: The reader rating reflects the fact that some readers found it too dense or too clinical. That’s accurate. It reads like a thorough GP who won’t waste your appointment. Whether that’s a feature or a bug depends entirely on what you showed up for.

    Books Like The Science of Menopause

    BookAuthorBest For
    Menopause BootcampSuzanne Gilberg-LenzA warmer, more lifestyle-forward companion to Kaye’s clinical lens
    The Menopause BrainLisa MosconiGoes deep on the cognitive and neuroprotective angle Kaye covers briefly
    The Great Menopause MythKristin JohnsonFunctional medicine approach, more integrative, less evidence-rigorous
    The Power of HormonesMax NieuwdorpBroader hormonal context, useful for understanding the full endocrine picture
    It’s Your HormonesGeoffrey RedmondUS-focused, clinical, good for understanding HRT formulation options in more depth

  • The Hormone Shift by Tasneem Bhatia: Summary, Key Ideas & Review

    Book in one sentence: An integrative medicine physician maps the full hormone arc from adolescence to post-menopause and offers a sequenced, five-phase protocol for midlife women whose symptoms keep getting dismissed as “just aging.”

    What Is The Hormone Shift About?

    You’ve probably had the experience of eating the way you always ate, moving the way you always moved, and watching your body respond in ways it never did before. Weight collecting around your middle. Sleep unraveling for no clear reason. A fog that settles in around 3pm and won’t lift. You go to your doctor, she runs labs, and then comes the sentence: “Everything looks normal.”

    Tasneem Bhatia, MD (“Dr. Taz”), wrote this book for that moment. She’s a board-certified integrative and holistic medicine physician who founded CentreSpringMD in Atlanta after spending fifteen years watching women cycle through the same pattern: symptoms, dismissal, a prescription for anxiety or sleep, repeat. She’s also been on the receiving end of that dismissal herself. At twenty-eight, her hair was falling out, she’d gained weight, her knees ached, and six separate specialists told her she was fine before she crashed her car after a blood pressure drop caused by a medication none of them had thought to check for interactions. That experience sent her into Chinese medicine, Ayurveda, and Andrew Weil’s Integrative Medicine Fellowship. The book comes from that foundation, not from a wellness brand looking for content.

    The Hormone Shift lands in a gap between two frustrating options: conventional medicine, which tends to minimize or medicate symptoms without investigating the underlying hormonal picture, and the wellness-influencer world, which offers seed cycling and moon rituals without clinical grounding. Bhatia’s approach is both more rigorous than the second and more holistic than the first. She provides specific lab ranges, supplement dosing, and a structured thirty-day protocol. She also takes Chinese medicine and emotional patterns seriously as clinical data. The combination won’t satisfy everyone, but for women in perimenopause who’ve been failed by the conventional approach, it’s worth the friction.

    Why Does Midlife Weight Gain Feel Different?

    A calorie-deficit approach that worked at thirty frequently stops working at forty-five. Bhatia’s explanation for this isn’t complicated, but it’s rarely given plainly: your hormonal environment has shifted, and your body is responding to different signals than it was before.

    Perimenopause (roughly ages 39 to 55 in Bhatia’s framing) involves a declining estrogen-progesterone ratio, rising cortisol sensitivity, insulin resistance that accumulates quietly for years, and thyroid changes that often fall within “normal” lab ranges while producing real symptoms. Each of these independently affects body composition. Together, they create the specific pattern most midlife women recognize: belly fat that wasn’t there before, cravings that are harder to override, and effort that doesn’t produce results.

    The craving map is one of the more useful sections of the book. Bhatia ties specific nutrient deficiencies and hormonal states to specific craving patterns:

    • Low progesterone pulls toward salt
    • Low estrogen pulls toward fat
    • Low iron pulls toward sugar (quick energy)
    • Thyroid disruption produces craving variability that doesn’t follow any predictable pattern

    None of these are willpower failures. They’re the body signaling an imbalance. Restriction-based responses to these cravings often make the underlying problem worse, because severe caloric restriction depletes progesterone, raises cortisol, and can worsen the estrogen dominance that’s driving the weight in the first place.

    Her alternative is what she calls biorhythmic eating: eating when genuinely hungry, anchoring meals around 20 to 30 grams of protein every three to four hours for blood sugar stability, and keeping a twelve-hour overnight fast as a baseline practice. It’s less a diet than an attempt to work with the body’s hormonal timing rather than override it with external rules.

    Bhatia also structures the whole book around a Five Power Types framework, a life-stage map of the female hormonal journey. The stages run from Rock Star (13 to 19), through Hustler (20 to 28), Superstar (29 to 38), Superwoman (39 to 55), and Commander (56+). The practical value is that it stops treating perimenopause as an isolated event. The hormonal patterns in your forties were set up in your twenties and thirties, and the conditions you’re managing now in menopause were shaped by what accumulated before. Knowing your Power Type tells you which hormonal layer to investigate first, rather than throwing every available intervention at the problem simultaneously.

    How Does Your Gut Control Your Hormones?

    Most hormone books treat hormone replacement as the logical first step when symptoms appear. Bhatia’s structural argument is that this is exactly backwards, and the reasoning is biochemical, not philosophical.

    The gut microbiome contains a community of bacteria called the estrabolome. These bacteria produce enzymes that determine how estrogen is metabolized and recycled. When the microbiome is disrupted by antibiotics, processed food, alcohol, stress, or chronic inflammation, the estrabolome becomes dysfunctional. Estrogen then either recirculates in forms that drive excess (estrogen dominance) or gets metabolized poorly, regardless of how much estrogen the body is actually producing.

    “Your gut is ground zero for your health. It processes your food. It gets rid of waste. It produces neurotransmitters. It fights off toxins. And it plays a pivotal role in hormone balance.”

    The practical implication: adding hormones to a compromised gut means the new hormones get mishandled by the same dysfunctional system that’s already mishandling your endogenous hormones. This is why her thirty-day protocol puts gut repair before hormone correction, always.

    The gut-symptom pattern table she includes is worth examining carefully:

    • Chronic constipation maps to estrogen dominance and high insulin
    • Diarrhea and IBS map to low progesterone and sluggish thyroid
    • Bloating maps to thyroid disorders and estrogen/progesterone imbalance
    • Reflux maps to high progesterone and low estrogen

    If you’ve been treating these as digestive problems while also experiencing hormonal symptoms, you may be looking at a single root cause from two different angles. That’s the core observation Bhatia keeps returning to throughout the book: conventional medicine treats these as separate domains, and that separation is where women fall through the cracks.

    What Are “Dirty Hormones” and Why Does It Matter?

    “Dirty hormones” is Bhatia’s term for hormone metabolites, specifically the breakdown products of estrogen that accumulate when the liver can’t clear them efficiently. These metabolites aren’t inert. They act on the body in ways that amplify estrogen dominance, raise DHT (the androgen behind hair loss and acne), and worsen insulin dysregulation. They’re a direct driver of the weight, mood, and body-composition symptoms that midlife women bring to their doctors.

    The liver becomes overburdened by what modern life piles on it: alcohol, processed foods, acetaminophen (Bhatia mentions this specifically), fragranced personal care products, plastics, and pesticide residues. No single exposure is catastrophic in isolation. The aggregate load in a typical modern woman’s life is a different order of magnitude than prior generations carried, and the liver, which is also the primary organ for hormone detoxification, bears the cost.

    Practical reduction starts with the least glamorous interventions. Switch personal care products to fragrance-free and paraben-free. Use glass or stainless steel for food storage. Filter your water. Choose organic for the EWG’s dirty dozen produce list. Reduce alcohol (not necessarily eliminate it, but reduce). Add cruciferous vegetables, dandelion greens, beets, and garlic to support liver function.

    The section on DIM (diindolylmethane), found in cruciferous vegetables and available as a supplement, is one of the most actionable in the book. DIM supports the liver’s Phase 1 and Phase 2 detoxification of estrogen, shifting metabolism away from the more inflammatory estrone metabolites toward safer excretion pathways. For women with estrogen dominance symptoms, such as breast tenderness, heavy periods, weight gain in the hips and thighs, or fibroid growth, this is a high-leverage, no-prescription-required intervention.

    The emotion-hormone section gets its own chapter, and it’s worth taking seriously even if you’re skeptical of TCM frameworks. The core claim is documented physiology: chronic stress elevates cortisol, which competes with progesterone at receptor sites, suppresses thyroid function, raises insulin, and impairs gut healing. Hormonal imbalances in turn produce anxiety, depression, and emotional volatility. The bidirectional loop is not speculative. What Bhatia adds, from her clinical observation, is that major psychological losses (divorce, betrayal, death of a parent) tend to be followed by a hormonal or autoimmune diagnosis approximately eighteen months later. She’s seen this often enough that she anticipates it. Her explanation draws on psychoneuroendocrinology and early mitochondrial science. The evidence is preliminary but coherent.

    Is The Hormone Shift Worth Reading?

    Read this if you’re in your late thirties, forties, or fifties and you’re experiencing weight changes, sleep disruption, mood shifts, or fatigue that your doctor has attributed to stress or aging. Read it if you’ve been told your labs are normal while feeling clearly unwell. Read it if you’ve tried calorie restriction and exercise without results and want a more complete picture of what’s actually driving your body composition.

    Skip it if you’re already working with a knowledgeable integrative medicine physician who’s running full hormone panels and adjusting your protocol accordingly. The book’s value in that case is more as a conceptual framework than a clinical guide.

    One caveat: Bhatia integrates peer-reviewed physiology with TCM frameworks and clinical pattern recognition without always distinguishing between them. The gut-hormone connections and cortisol-progesterone competition are textbook science. The emotion-meridian mapping is more speculative, though it’s clinically consistent with what psychoneuroendocrinology is slowly documenting. Both are useful. They’re not the same level of evidence.

    This is a less dense read than Aviva Romm’s Hormone Intelligence, more clinically grounded than most conventional menopause books, and more integrative in its framework than Anna Cabeca’s The Hormone Fix. For women who want a practical entry point into understanding their midlife hormonal picture, it’s a solid starting place.

    Books Like The Hormone Shift

    BookAuthorBest For
    Hormone IntelligenceAviva Romm, MDMore evidence-focused; stronger on root-cause analysis of modern hormonal dysfunction
    The Hormone FixAnna Cabeca, DONarrower dietary focus; the keto-green approach as a complement to Bhatia’s broader protocol
    Menopause BootcampSuzanne Gilberg-Lenz, MDMore conversational; good for women who find Bhatia’s protocol framework dense
    The New MenopauseMary Claire Haver, MDStrong emphasis on HRT as first-line treatment; less integrative but highly practical
    Eat to Thrive During MenopauseStephanie HuberFood-forward companion for the dietary aspects of hormone balance

  • The Menopause Companion by Sasha Davies: Summary, Key Ideas & Review

    Book in one sentence: A readable, no-jargon overview of the full menopause transition, written by a health journalist (not a doctor) for women who want one clear starting point before going deeper.

    What Is The Menopause Companion About?

    Picture the stack of menopause books your doctor’s waiting room has never had. One shelf holds thick clinical texts full of mechanisms and dosing tables. Another holds wellness titles promising to “reset” your hormones in 30 days. Sasha Davies wrote something different. She’s a health journalist (her previous books covered artisanal cheesemaking) who partnered with Tori Hudson, ND, a naturopathic physician with nearly four decades of women’s health practice, to produce what is genuinely a companion: warm, organized, honest about what it can’t tell you.

    The book opens with a disarming line that sets the tone for everything that follows:

    “When you ask what menopause will be like, what you’re really asking is a similar but distinct question: What will menopause be like for me? Your question cannot be fully answered with the generalized information we have about physiology, symptoms, and treatments.”

    That’s rare honesty for the genre. Most menopause books imply they have your specific answer. Davies declines to pretend. She explains the physiology, walks through common symptoms, covers treatment options (HRT, non-hormonal options, supplements, lifestyle tools), and then spends a full chapter on something almost no menopause book touches: how to build human support around the transition.

    This is a first-book book. If you’re in your early forties and want a single clear orientation before the fog rolls in, this is a strong candidate. If you’re already deep in symptoms and need protocol-level guidance, it will feel too light.

    What Does the Book Actually Cover?

    Davies organizes the book into three parts, which map cleanly onto the questions most women bring to this topic.

    Part One (What Is Menopause?) covers the physiology without overwhelming. You’ll understand what perimenopause actually means (the transition before the final period, which can last up to a decade), why hormones affect so many systems at once, and why your doctor might be behind on this topic (ob-gyn training has historically given menopause minimal attention).

    Part Two (What Could It Be Like for You?) is the symptom chapter, and Davies frames it well. She presents it not as a checklist you’ll tick through but as a landscape of possibilities, with the explicit acknowledgment that any given woman might experience a few, several, or none of these. That framing matters. The conventional symptom narrative centers hot flashes and cycle changes, which means women whose perimenopause shows up first as anxiety, brain fog, or joint pain often go unrecognized for years, by their doctors and by themselves.

    Part Three (What Can You Do About It?) covers preparation, treatment, and support. This is where Hudson’s clinical voice is clearest, most present in the treatment chapter.

    One idea worth borrowing from the cultural section of Part One: Davies frames menopause as a “three-body problem” (borrowed from physics), where the personal (your body, your symptoms), the cultural (attitudes about aging and women), and the political (healthcare systems, research funding) all interact. A dismissive doctor isn’t just a personal inconvenience; he’s a symptom of a system. That framing helps explain why the same physiology produces wildly different experiences in different women.

    What Does It Say About Nutrition and Weight?

    Honestly: not that much. Davies covers nutrition in the lifestyle section of Part Three with appropriate breadth but limited depth. The basics are there: protein matters more after menopause, processed sugar and alcohol tend to worsen hot flashes and sleep disruption, anti-inflammatory eating patterns are broadly helpful. The weight changes that come with the hormonal shift (especially abdominal fat redistribution) are acknowledged.

    What you won’t find is a menopause-specific nutrition protocol, detailed macros, meal timing guidance, or a rigorous treatment of the metabolic shifts that estrogen decline triggers. Davies is writing a companion, not a diet plan, and she stays in her lane.

    For readers on this site who are managing weight alongside menopause, this book is good background. It won’t replace a more focused resource on the nutrition side (the table at the bottom lists a few that go deeper). But understanding the hormonal context, and understanding that weight changes in menopause are physiological and not a character flaw, is genuinely useful framing even before you get tactical.

    The book also touches on the psychological side of body changes during the transition. Davies uses the concept of solastalgia (the grief of feeling estranged in a familiar place) to name what happens when your body starts behaving like someone else’s. That’s a much more precise description than “mood swings,” and it’s the kind of naming that helps.

    How Does It Handle the HRT Question?

    Better than most popular books, and with appropriate humility. Hudson’s clinical voice takes over for the treatment chapter, and she does the work that many anxious readers need: she separates the actual WHI findings from the cultural panic that followed.

    The short version, as Hudson explains it: the 2002 Women’s Health Initiative study was applied far too broadly. The participants were mostly ten or more years past menopause, many had preexisting cardiovascular disease, and the formulations tested (conjugated equine estrogen and synthetic progestin) are not what thoughtful practitioners prescribe today. Current evidence distinguishes meaningfully between transdermal estradiol and oral estrogen, between bioidentical progesterone and synthetic progestins, and between starting hormone therapy close to the transition versus years later.

    Davies does not tell you what to take. Neither does Hudson. What the chapter gives you is the vocabulary to have a real conversation with a provider rather than a reflexive refusal or reflexive acceptance. That’s the correct scope for a companion guide.

    The supplement section is similarly useful for its restraint. Davies doesn’t present a menopause supplement stack. She notes that black cohosh has reasonable evidence for hot flash relief in some women, while many other widely marketed products have little to none. In a category full of expensive supplements sold on anxiety, that kind of honesty earns trust.

    Is The Menopause Companion Worth Reading?

    Read this if you’re in your early-to-mid forties and want a clear, readable orientation to the menopause transition before symptoms become acute. Also a good pick if you have a partner or family member who wants to understand what’s actually happening and how to help without being dismissive.

    Skip it if you’re already in acute perimenopause and need protocol-level guidance on symptom management, or if you want depth on HRT research, neurological mechanisms, or nutrition science. This book will point you toward better resources for all of those, which is one of its better qualities.

    One caveat: Davies is not a clinician. Hudson provides the medical grounding, but the book is written from a journalist’s perspective. That’s mostly a strength (it’s readable, it doesn’t overwhelm), but readers who want clinical rigor will hit the ceiling quickly. The reader rating reflects this split: readers who wanted a light introduction tend to love it; readers who wanted depth tend to feel it stops short.

    For a first book on menopause, especially one that covers symptoms, HRT basics, nutrition, mental health, and support in a single readable volume, this is a solid choice.

    Books Like The Menopause Companion

    BookAuthorBest For
    Menopause BootcampSuzanne Gilberg-Lenz, MDMore clinical depth on HRT and treatment options
    The Science of MenopauseSarah KayeEvidence-based deep dive, less conversational
    The Natural Menopause MethodKaren NewbyNutrition and lifestyle-first approach
    Unlock Your Menopause TypeHeather Hirsch, MDPersonalized symptom framework by type
    The Menopause BrainLisa MosconiNeuroscience behind every symptom Davies describes

  • Next Level by Stacy T. Sims: Summary, Key Ideas & Notable Quotes

    10 min read

    Why This Book Matters

    If you are a woman in your forties or fifties who has been exercising regularly, eating carefully, and watching your body change anyway — more belly fat, less muscle, less energy, less of everything you worked for — this book is for you. Not because it will tell you to try harder. But because it will tell you why everything you have been doing is working against your physiology, and exactly what to do instead.

    Next Level was written by Stacy T. Sims, PhD, an exercise physiologist and nutrition scientist who has spent her career studying how women’s physiology differs from men’s — and how dramatically wrong most mainstream fitness advice is for women at this stage of life. Sims spent years at Stanford University and later at the University of Waikato in New Zealand researching female athletic performance. Her previous book, ROAR (2016), focused on training and nutrition around the menstrual cycle. Next Level is its sequel: everything that happens when those cycles start to end.

    The book is co-written with Selene Yeager, an elite cyclist and endurance athlete who was living through perimenopause while they were writing it. That matters. This is not a theoretical text produced at clinical distance. It is written by two women who know what it feels like when the body you have trained for decades suddenly seems to be working against you — and who have the research to explain why, and what to do.

    Here is the core problem the book addresses: when estrogen and progesterone begin to decline, all the physiological functions those hormones were quietly performing — building muscle, regulating blood sugar, protecting bone, managing body temperature, keeping cortisol in check — start going undone. The symptoms women experience during menopause are not random misfortunes. They are the predictable downstream effects of specific hormonal signals going offline. And the standard response most women (and most doctors) reach for — eat less, do more cardio — makes nearly all of them worse.

    Sims’s prescription is specific, evidence-based, and often the opposite of conventional wisdom. That is what makes it worth reading.

    The Core Framework: Picking Up the Slack

    The animating concept behind Next Level is one the book introduces in the very first pages and returns to throughout: “What you’re really doing when you act on the advice in this book is picking up the slack and starting to do the work that your fluctuating and dwindling hormones have always done.”

    This reframe is important. For most of a woman’s life, estrogen and progesterone have been performing anabolic, metabolic, and regulatory work in the background — stimulating muscle protein synthesis, maintaining bone density, balancing cortisol, regulating blood sugar and fat storage. You did not need to think about these functions because your hormones were handling them. As they decline, those functions do not continue automatically. The work simply goes undone unless you intervene.

    Sims maps each lost hormonal function to a specific intervention:

    • Estrogen’s anabolic stimulus for muscle → Heavy lifting (low reps, high load)
    • Estrogen’s blood sugar regulation → Sprint interval training + strategic carbohydrate timing
    • Estrogen’s mitochondrial support → Both sprint intervals and plyometrics
    • Estrogen’s fast-twitch muscle and power signal → Plyometrics and heavy lifting combined
    • Estrogen’s bone remodeling signal → Plyometrics and resistance training
    • Progesterone’s cortisol regulation → Adequate sleep, post-workout nutrition, eliminating fasted training

    This is the map. Every specific recommendation in the book flows from it.

    Key Ideas

    Sprint Interval Training Is the Cardio You Actually Need

    The cardio most women default to during menopause — long, moderate-intensity sessions, the kind that feel virtuous and sustainable — is precisely the kind most likely to make things worse. Long steady-state cardio chronically elevates cortisol in women who already have elevated cortisol due to declining progesterone. The result is more abdominal fat storage, more muscle breakdown, and more fatigue, not less.

    What works instead is sprint interval training, or SIT. Genuinely short, genuinely all-out efforts — 10 to 40 seconds — with full recovery between them. The key word is “all-out.” Not hard. Not elevated heart rate. Maximal. A Tabata protocol (20 seconds all-out, 10 seconds rest, 6-8 rounds) done on a bike or with full-body movements like kettlebell swings. Hill repeats of 20-30 seconds going as hard as possible, then walking back. This level of intensity provides the metabolic stimulus that estrogen used to provide — improving insulin sensitivity, preserving lean mass, building mitochondrial density — while the brevity of the effort prevents the chronic cortisol elevation that moderate-intensity cardio creates.

    Two sessions per week is sufficient. The long run or easy bike ride does not disappear — it becomes active recovery on different days, not the primary training driver.

    Lift Heavy — Not Light, Not Moderate, Heavy

    The fitness industry has sold women on high-rep, low-weight training for decades, promising “toning” and “sculpting” without “bulking up.” For menopausal women, Sims is blunt: this advice is not just ineffective, it is actively unhelpful. High-rep light-weight training builds muscular endurance. Menopausal women need muscular strength.

    Estrogen was the primary driver of muscle stem cell activation — the biological process that repairs and builds muscle tissue. When estrogen declines, that signal drops precipitously. Research shows that removing estrogen from animal models causes muscle stem cell regeneration to fall 30 to 60 percent. The only training that can replace this stimulus is lifting heavy enough to recruit high-threshold motor units: compound movements (squats, deadlifts, rows, chest press) performed in the 3-6 rep range at near-maximal load.

    The downstream benefits extend far beyond appearance. Heavy lifting increases resting metabolic rate, improves joint stability and posture, reduces cardiovascular disease risk, strengthens bone, and produces the lean body mass that is the most significant determinant of fat metabolism in postmenopausal women. A study found that postmenopausal women had 33 percent lower fat burning during cardio than premenopausal women — and the entire difference was explained by the 9.5 pounds of lean mass they had lost.

    The Cortisol Paradox: Why Eating Less Makes You Store More Fat

    This is the concept that most often stops women cold when they first encounter it. They are eating less. They are exercising more. They are gaining belly fat. They are not imagining it, and they are not failures. They are caught in a cortisol paradox.

    Menopausal women have elevated baseline cortisol because progesterone — the hormone that kept cortisol in check — has declined. Adding long cardio sessions (which spike cortisol), training fasted (another cortisol spike), restricting calories (which triggers metabolic survival mode), and sleeping poorly (cortisol falls 6 times more slowly in sleep-deprived people) creates a self-reinforcing stress cascade. The body interprets this cascade as survival emergency and responds accordingly: break down muscle for fuel, store abdominal fat as an energy reserve, suppress the thyroid to conserve resources.

    The intervention that breaks the cycle is counterintuitive: eat enough (especially around training), replace long cardio with short intense intervals, add heavy lifting, and protect sleep. Not the “work harder, eat less” message women have been given. The opposite of it.

    The 30-Minute Recovery Window and the Leucine Threshold

    For muscle protein synthesis to occur, the body needs to receive a specific amino acid signal — approximately 3 to 3.5 grams of leucine per feeding — at the cellular level. This “leucine threshold” triggers the anabolic response. Meeting total daily protein without hitting the threshold at each meal does not produce the same effect.

    For menopausal women, the post-workout recovery window is 30 minutes — not the 2 to 3 hours that research in male subjects suggested. After hard training (sprint intervals, heavy lifting, endurance work), cortisol is high and the body is actively breaking down muscle. Eating 30-40 grams of high-quality protein (with sufficient leucine) within that 30-minute window stops the breakdown, lowers cortisol, and initiates muscle repair. Skipping post-workout eating in an attempt to “burn more fat” does the opposite: it extends the catabolic state, elevates blood sugar through cortisol-driven glycogen release, and drives fat storage.

    The practical math: 25 grams of whey protein provides about 2.5 grams of leucine. Meeting the 3-3.5 gram threshold requires 30+ grams of whey or equivalent animal protein. Plant-based athletes need roughly 50 grams of soy protein to match the leucine in 25 grams of whey — a commonly misunderstood gap.

    Plyometrics for Bone Density (10 Minutes, 3x a Week)

    Women can lose up to 20 percent of bone density in the five to seven years following menopause. Resistance training helps, but running and cycling — the cardio most women use — provide limited osteogenic stimulus because they involve repetitive single-plane loading rather than the multidirectional, varied-impact loading that triggers bone remodeling most effectively.

    Plyometrics — jump training — fill this gap. Even 10-20 jumps twice daily has been shown in research to produce measurable improvements in hip bone density after 16 weeks. Sims recommends 10 minutes of plyometric circuits three times per week, starting with beginner movements (squat jumps, jumping jacks, side hops) and building toward more advanced options (tuck jumps, speed skaters, burpees). The investment is small. The bone density, fast-twitch muscle preservation, and insulin sensitivity benefits are significant, and there is no training category more commonly neglected by women in this age group.

    Notable Quotes

    “What you’re really doing when you act on the advice in this book is picking up the slack and starting to do the work that your fluctuating and dwindling hormones have always done.”

    This is the book’s thesis in one sentence. Every exercise and nutrition prescription that follows is an answer to the question: which hormonal job just went undone, and how do I do it myself?

    “There’s a tendency for women to lift lighter weights for high repetitions, like picking up five-pound dumbbells and lifting them 20 times. This is often called ‘body sculpting’ by trainers, who promise women that they can ‘tone up’ without ‘getting bulky muscles.’ This mindset needs to go because it’s misleading, misguided, and honestly not helpful for women whose sex hormones, lean muscle mass, and strength are on a precipitous decline.”

    Sims is not gentle with the fitness industry’s treatment of menopausal women. Light weights are not a conservative starting point. They are the wrong tool for the job.

    “One of the first things that happens when the body isn’t getting the energy it needs is that it starts increasing body fat. Without enough energy to perform basic functions (let alone your long runs or strength workouts), your endocrine system signals for your body to start breaking down muscle and to store more fat, so you have a reserve of energy.”

    The explanation most women who are dieting and exercising and getting worse results have never heard. Not willpower failure. Survival biology.

    “For menopausal women, high-intensity sprint interval training sessions can provide the metabolic stimulus to trigger the performance-boosting body composition changes that our hormones helped us achieve in our premenopausal years. The key here is the intensity.”

    Intensity — not duration, not consistency, not moderate effort — is the operative word. The intensity of genuine all-out effort cannot be replicated by working “hard-ish” for longer.

    “Menopausal women often reach for soy because they want the plant estrogens to relieve menopausal symptoms like hot flashes. The problem is that you need twice as much soy to provide the muscle recovery benefits of animal-based protein like whey.”

    A specific, commonly misunderstood finding. Soy’s phytoestrogen content does not translate into equivalent muscle protein synthesis capacity.

    “Women in their forties are still in their athletic prime. We see that in inspirational athletes like seven-time world champion Rebecca Rusch, who didn’t even start bike racing until her late twenties and is still crushing competitions in her early fifties.”

    The cultural reframe the whole book rests on. Menopause is not the beginning of athletic decline. It is a transition that demands a specific response — and the response produces a body that can perform at the highest levels for decades.

    Who Should Read This

    Next Level is best suited for women in their forties or fifties — peri- or postmenopausal — who are already active and finding that what worked before is no longer working. If you have been training consistently, eating carefully, and watching your body composition change in the wrong direction anyway, this book explains why and tells you exactly what to change.

    It is also essential reading for women entering perimenopause who want to get ahead of the transition — the interventions are most effective when started early, before significant muscle and bone loss has accumulated.

    Coaches, trainers, and healthcare practitioners working with women in midlife will find it valuable for the specificity of its prescriptions. The book is more useful than most clinical resources for translating physiology into actionable programming.

    It is less suited for sedentary women who are just beginning to exercise. The protocols assume a baseline level of fitness and familiarity with training concepts. A complete beginner would benefit from starting with a simpler movement foundation before implementing the sprint and lifting protocols.

    Women primarily dealing with the non-fitness dimensions of menopause — hormonal symptoms, vaginal changes, cognitive shifts, MHT decisions — will find this book addresses those topics but is not the primary resource for them. The New Menopause by Mary Claire Haver is a better clinical companion for that dimension.

    ROAR — Stacy T. Sims: The predecessor to Next Level, covering training and nutrition optimization across the menstrual cycle for premenopausal women. Establishes the energy availability and nutrition timing principles that Next Level builds upon.

    The New Menopause — Mary Claire Haver: The clinical complement to Next Level. Where Sims focuses on exercise and nutrition, Haver covers hormonal symptom management, HRT options, and medical decision-making. Best read together.

    Good Energy — Casey Means: Covers metabolic health and blood sugar regulation from a precision medicine angle. Strong overlap with Next Level‘s nutrition content; more detailed on biomarker tracking.

    Outlive — Peter Attia: Covers the exercise science of longevity with significant overlap on strength training and cardiovascular training for long-term health. Approaches similar conclusions from different research; less women-specific but broader in scope.

  • Women, Food, and Hormones by Sara Gottfried: Summary, Key Ideas & Review

    Book in one sentence: Keto was designed for men. This is the version built for how women’s hormones actually work.

    What Is Women, Food, and Hormones About?

    Picture this: you and your husband go on the same diet. Same meals, same macros, same commitment. He loses twelve pounds in ten days. You gain two, feel brain-fogged, and quietly blame your own willpower. Gottfried calls this the Keto Paradox, and her core argument is that it isn’t a personal failure. It’s a design flaw in the diet itself.

    Sara Gottfried is a Harvard-trained OB-GYN with 25 years in clinical practice and several previous books (including The Hormone Cure and Brain Body Diet). She’s also, by her own account, a former keto refugee who gained weight on the classic protocol before eventually redesigning it for her own hormonal biology. What’s in this book is the result of those experiments (on herself first, then on hundreds of patients).

    The argument she builds is narrow but solid: the ketogenic diet was developed, tested, and refined primarily on men. Decades of nutrition research excluded female subjects entirely. Dietary prescriptions shaped by that research get applied to women wholesale, without accounting for estrogen cycling, cortisol sensitivity, thyroid function, or the gut bacteria that clear estrogen from the body. Gottfried’s solution isn’t to abandon keto. It’s to fix it for the body that was left out of the original equation.

    Why Does Keto Work for Him and Not for You?

    Gottfried names the specific mechanisms here, which is where the book earns its keep. It’s not that women are just “different” in some vague way. There are four concrete failure modes when women follow classic keto.

    Cortisol spikes. Carbohydrates help regulate the HPA axis (your stress-response system). Cut them completely and many women’s cortisol rises, storing fat rather than burning it. Men don’t experience this the same way because their HPA axis responds differently to carb restriction.

    Thyroid suppression. Aggressive carb restriction can block the conversion of inactive T4 into active T3, the thyroid hormone your metabolism actually uses. The result looks like standard hypothyroid symptoms: fatigue, hair loss, cold hands, slowed weight loss. Women are more vulnerable to this than men are.

    Estrogen recirculation. Here’s the one most keto guides completely miss. Your gut houses a community of bacteria called the estrobolome (their job is to metabolize estrogen so it can be excreted). They need fiber to do that. Classic keto crashes dietary fiber to around 6 grams per day; Gottfried considers 25 grams the floor. When the estrobolome is starved, estrogen gets reabsorbed rather than cleared, and the result is estrogen dominance: weight gain, PMS amplification, breast tenderness, mood swings.

    Inflammation from saturated fat. Some women respond to high saturated fat intake with elevated CRP (a marker of inflammation), driven by differences in gut microbiome composition and how estrogen receptors interact with dietary fat. This doesn’t happen in everyone, but it’s a real pattern that classic keto doesn’t account for.

    “The ketogenic diet has mostly been studied in men and works quite well for them. Women, on the other hand, tend not to do so well on this diet. A man and a woman can go on an identical keto diet and get completely different results.”

    None of these are willpower problems. They’re predictable consequences of applying a male-derived protocol to a female body.

    The Four Hormones That Drive Weight Loss (or Block It)

    Gottfried organizes female metabolism around four hormonal levers. Insulin is the master lever. When it’s chronically elevated, it suppresses every other fat-burning signal in the body, blocks growth hormone, disrupts thyroid conversion, and parks fat preferentially in the visceral (abdominal) region. Her clinical targets are specific: fasting insulin below 5 mU/L, fasting glucose at 70-85 mg/dL, HbA1c below 5.4%.

    The patient case she uses to illustrate this is worth understanding. A 38-year-old woman (Melissa) came in 30 pounds overweight, with borderline thyroid dysfunction alongside insulin resistance. After completing the Gottfried Protocol, which addresses insulin first, her thyroid function improved without any thyroid-specific treatment. The hormones weren’t separate problems requiring separate solutions. They were one tangled system with one primary entry point.

    Cortisol is the second lever, and it’s where most women’s keto attempts unravel. Women are twice as likely as men to experience chronic stress, anxiety, and depression, which means they’re starting from a higher cortisol baseline. Add aggressive fasting or hard carb restriction to that, and cortisol climbs further. Gottfried’s fasting protocol ramps gradually (12:12 to 14:10 to 16:8) to avoid the cortisol spike that sudden OMAD or extended fasting triggers.

    Testosterone gets its own chapter because most women don’t know they have it in meaningful amounts. It’s actually the most abundant biologically active hormone in women (more abundant than estrogen), and it declines steadily from age 20, reaching about half its peak by 40. Low testosterone shows up as muscle loss, fatigue, joint pain, passive mood, and difficulty maintaining weight. One finding that’s genuinely counterintuitive: both caffeinated and decaffeinated coffee lower testosterone in women. The opposite is true in men. Eliminating coffee is among Gottfried’s first recommendations for women with these symptoms.

    Growth hormone rounds out the four. It declines 1-3% per year after age 30, and the decline accelerates with every lifestyle stressor (sugar, poor sleep, stress, sedentary behavior). Women are positioned to recover GH quickly because they produce it in more frequent pulses than men, and anaerobic exercise triggers a disproportionately large GH response in women. A 24-hour fast raises GH by approximately 1,300% in women. Even a 14-16 hour overnight fast produces meaningful elevation. GH is produced primarily in the first 3-4 hours of sleep, which makes sleep quality a direct metabolic lever.

    What Is the Gottfried Protocol?

    The protocol runs four weeks, structured sequentially so each phase sets up the next.

    Week 1: Detox before ketosis. The most unusual element. Gottfried’s rationale: environmental toxins (BPA, glyphosate, endocrine disruptors she calls “obesogens”) are stored in fat cells. When fat burns, they’re released into the bloodstream. Without active liver and gut support, those liberated toxins drive inflammation and contribute to weight regain. Week 1 front-loads cruciferous vegetables, high fiber, MCT oil, and magnesium. Overnight fasting starts at 12-14 hours on non-consecutive days, so the longer fasting window later doesn’t arrive as a shock.

    Days 8-28: Full implementation. The macro formula differs from classic keto in ways that matter. Classic keto runs roughly 10% carbs, 20% protein, 70% fat. The Gottfried Protocol uses a 2:1 ratio (2 grams of fat per 1 gram of combined carbohydrate + protein), with net carbs at 20-25 grams and protein kept deliberately modest at 50-75 grams. The lower protein cap prevents gluconeogenesis from breaking ketosis. Daily ketone testing (goal: 0.5-3.0 mmol/L) replaces vague adherence with actual measurement. Fasting extends to 16:8.

    Day 29 onward: Transition. Net carbs are reintroduced in 5-gram increments every three days while continuing to track ketones. This process finds each woman’s personal carbohydrate threshold (the amount she can eat while staying in mild ketosis). That number is different for every woman and can’t be found any other way. One patient in the book stabilized at 60 grams of net carbs per day, far more than the implementation phase allows, and lost 39 pounds across several protocol cycles.

    Integration: Ongoing. The protocol is designed as a repeatable metabolic reset, not a one-time intervention. Re-enter it when symptoms return, weight climbs more than 5 pounds, or sugar cravings resurface.

    Two sections in the troubleshooting chapter are worth flagging for anyone mid-protocol. Gottfried lists nine plateau-busters in priority order: resistance training first, then food weighing to catch portion creep, L-carnitine, cold exposure, dropping carbs further, and extending the fasting window. She also names seven common derailment patterns (excess calories from calorie-dense fats, alcohol, slow thyroid or adrenal function, constipation, inability to sustain ketosis, severe carb intolerance, and what she calls the “F*ck Its”). Each pattern has a mechanical fix, which keeps women from abandoning the protocol when what they actually need is a small adjustment.

    Is Women, Food, and Hormones Worth Reading?

    Read this if you’ve tried standard keto, followed it closely, and either saw no results or felt worse (more tired, more brain fog, more cravings). Also worth reading if you’ve watched a male partner lose weight effortlessly on the same plan you were both following and never got a coherent explanation for why. The estrobolome section alone is worth the price of admission for anyone with estrogen dominance symptoms (PMS, breast tenderness, bloating, mood swings) that their doctor has chalked up to “just hormones.”

    Skip it if you already have a solid grounding in female metabolic health and are looking for new research rather than a clinical protocol to follow. The conceptual content (the Keto Paradox, the estrobolome, the cortisol-fasting interaction) will be familiar to anyone coming from functional medicine. The four-week protocol itself is still useful, but the book’s value is highest for readers encountering this framework for the first time.

    One honest caveat: the protocol requires real investment. Daily ketone testing, food weighing, macro tracking, a 10-supplement stack during active phases, and ideally lab work. Gottfried doesn’t clearly prioritize which elements matter most when you can’t afford all of them, which is a gap for women with limited time or money. The case studies lean heavily toward 20-39 lb losses, but non-responders and cases requiring adjustment are underrepresented. That’s a fair criticism of a book that otherwise does a genuinely good job explaining why the thing that worked for your husband didn’t work for you.

    Books Like Women, Food, and Hormones

    BookAuthorBest For
    Fast Like a GirlMindy PelzWomen who want fasting protocols mapped to their hormonal cycle across the full month
    Hormone IntelligenceAviva RommA botanical and integrative medicine approach to the same hormonal themes, useful counterpoint to Gottfried
    The Hormone FixAnna CabecaKeto-alkaline hybrid approach for perimenopause and menopause; overlaps with Gottfried on insulin and estrogen
    Eat to Thrive During MenopauseMia HuberPractical nutrition guidance for the menopause transition
    The Menopause Diet PlanHillary WrightRegistered dietitian’s take on eating for hormonal health through menopause

  • The Menopause Reset by Mindy Pelz: Summary, Key Ideas & Review

    Book in one sentence: A practical five-step lifestyle protocol for menopausal women, built around fasting, ketogenic eating, gut repair, detox, and stress reduction (with the gut-hormone connection, the estrobolome, as the book’s most original contribution).

    What Is The Menopause Reset About?

    You’re eating the same food you’ve always eaten. You’re exercising. You’re doing everything “right.” The weight is still going up, the sleep is still a disaster, and you’re crying in the car for reasons you can’t entirely explain. The doctor offers two options: ride it out, or consider HRT. Neither of those answers tells you why any of this is happening.

    Mindy Pelz is a chiropractor and functional medicine practitioner who spent ten years inside her own chaotic perimenopause before writing this book. That’s not a small thing. She came into it already health-conscious, already fasting, already eating cleanly, and still couldn’t sleep or lose weight. The book she wrote afterward is a sequenced five-step protocol that treats menopause as a system-level problem rather than a single hormonal event. The core argument is worth stating plainly: estrogen and progesterone sit at the bottom of the hormonal hierarchy, not the top, and most women (and most doctors) are trying to fix the wrong end of the chain.

    This was Pelz’s first menopause-focused book, written before Fast Like a Girl. It’s shorter and more focused. If you’ve already read her fasting work and want the menopause-specific application, this is where she built that framework.

    The Five-Step Reset: What Pelz Actually Recommends

    The five steps aren’t a menu. Pelz is specific about the order, and the order reflects a biological hierarchy she lays out early in the book. Insulin sits above sex hormones. Cortisol sits above insulin. Oxytocin sits above cortisol. Trying to fix estrogen while chronic cortisol is running the show is like mopping water with the tap still open.

    1. Change When You Eat

    Intermittent fasting is the entry point because it directly reduces insulin, and insulin is the upstream controller of every sex hormone downstream. The immediate feedback loop also makes it the easiest step for most women to feel quickly. Pelz recommends starting at 13-15 hours daily.

    2. Change What You Eat

    The “ketobiotic” framework is ketogenic macros (under 50g net carbs, under 50g protein, over 60% calories from fat) combined with a hard emphasis on plant diversity. Standard keto done without enough vegetables slowly erodes the gut bacteria that process estrogen. The protein cap matters more than most keto books acknowledge. Excess protein spikes insulin, just less dramatically than carbs.

    3. Repair Your Gut (The Estrobolome)

    It’s underrepresented in popular menopause writing, and it gets its own section below. Short version: a specific collection of gut bacteria controls what happens to the estrogen you’re still producing. If those bacteria are depleted, the estrogen can’t be reactivated. Rebuilding them is a two-part process: stop destroying them first, then actively feed them.

    4. Reduce Your Toxic Load

    Menopausal hormonal shifts trigger the release of stored toxins (lead from bones, mercury from tissue) into the bloodstream. Those toxins migrate toward fat and nervous tissue. The hypothalamus and pituitary (the brain areas that run hormone production) sit outside the blood-brain barrier, making them unusually vulnerable. Mood instability, memory difficulty, and anxiety that exceeds what progesterone loss would explain may have toxic load as the upstream cause.

    5. Stop Rushing

    The last step is hardest because it requires restructuring a life, not just a diet. Pelz describes finding her own DUTCH hormone test results showing sex hormones at rock-bottom levels despite having implemented all four previous steps. The culprit was chronically elevated cortisol from an overscheduled life depleting DHEA, the precursor hormone from which both cortisol and sex hormones are made. She quotes the realization directly: “I realized that just because I am a skilled rushing woman doesn’t mean it’s in my hormonal best interest to keep rushing.”

    What Is the Estrobolome and Why Does It Matter for Menopause?

    Most people have never heard this word. It’s worth knowing.

    The estrobolome is a collection of 60+ gut bacterial strains whose job is to metabolize used estrogens and reactivate the beneficial ones. In a woman with a healthy estrobolome, even the declining estrogen production of menopause is partially offset by the gut’s ability to recycle what’s still available. In a woman whose gut bacteria have been hammered by antibiotics, antibacterial products, and processed food additives, the small amount of estrogen still being produced can’t be properly activated.

    The enzyme at the center of this process is beta-glucuronidase. When gut bacteria are thriving, beta-glucuronidase ensures that healthy estrogen gets pulled into the cells rather than excreted. When the microbiome is disrupted, that process breaks down, and even the estrogen you’re still making goes to waste.

    Pelz’s protocol for rebuilding the estrobolome:

    • Stop destroying it first: Eliminate antibacterial soaps and mouthwash, avoid conventionally raised meat (which carries antibiotics), remove synthetic preservatives and artificial sweeteners
    • Feed existing bacteria: Polyphenol-rich foods (cloves, dark chocolate, berries, olives, raw nuts)
    • Fertilize them: Prebiotic fiber from chia, hemp, and flax seeds
    • Add new strains: Fermented foods (sauerkraut, kimchi, kefir, kombucha)
    • Target strains: Lactobacillus reuteri and Lactobacillus rhamnosus are the two she names specifically for estrogen metabolism

    The liver matters here too. It’s the second estrogen-processing organ, and it needs the same kind of support: less alcohol, fewer unnecessary medications, more cruciferous vegetables.

    For women who’ve been told their estrogen is “fine” on a standard blood panel while still experiencing classic estrogen-deficiency symptoms, the estrobolome offers a plausible explanation. The estrogen may be there. It’s just not being activated.

    How Does Pelz Use Fasting for Menopause?

    Pelz was already known for her fasting work before this book, and the fasting section here is more cycle-specific than anything in mainstream fasting literature. She identifies seven distinct fasting styles, each serving a different physiological purpose:

    • 13-15 hours daily: reduces insulin, triggers light autophagy, the entry point
    • 17+ hours (autophagy fast): cellular self-repair; protein must stay under 20g that day
    • 24-hour (dinner to dinner): specifically repairs the gut’s mucosal lining by stimulating intestinal stem cells
    • 3-5 day water fast, twice yearly: reboots the immune system entirely

    One guardrail matters above all others: women who still have a menstrual cycle should never do a fast longer than 24 hours after Day 21. Extended fasting during the progesterone-building phase of the cycle drops progesterone further, and progesterone is already the hormone most at risk in perimenopause. This is absent from virtually all mainstream fasting advice, which is written for a gender-neutral audience. It also explains why some perimenopausal women try fasting, experience worsening symptoms, and conclude that fasting doesn’t work for them.

    The 28-day eating protocol builds on this. Rather than static ketogenic eating, Pelz proposes a cycle that shifts food choices at key hormonal windows:

    • Days 1-11: Ketobiotic eating with chosen fasting style
    • Days 12-14: Estrogen-building foods freely eaten (flax seeds, sesame seeds, edamame, garlic, berries, crucifers)
    • Days 15-21: Back to ketobiotic
    • Days 21-28: Progesterone-building foods freely eaten (potatoes, beans, squash, quinoa, tropical fruits), extended fasts paused

    For women in postmenopause (no natural cycle to track), Pelz simplifies it to 80% ketobiotic and 20% hormone-building foods without calendar timing. The insight underneath the protocol: long-term strict keto suppresses sex hormones if it’s never cycled. Many women see dramatic results from keto at first, then hit a wall at six to twelve months. This is her explanation for why, and the structural fix.

    Is The Menopause Reset Worth Reading?

    Read this if you’re in perimenopause or early menopause, you’ve tried some combination of cleaner eating and fasting, and you’re getting only partial results. The sequenced framework is the book’s real value: not a list of things to do, but an explanation of why the order matters and which upstream lever to pull first. It’s especially useful if you’ve noticed that the approaches that worked at 38 are failing at 50 and want a mechanistic explanation for why.

    The estrobolome section alone is worth the read for anyone interested in the gut-hormone connection. It’s genuinely underrepresented in popular health writing, and Pelz explains it clearly.

    Skip it if you need clinical management for severe menopausal symptoms. This is a lifestyle-first framework, not a substitute for medical care. Pelz doesn’t engage substantively with the evidence base for HRT, and women with serious symptoms shouldn’t use this book as a reason to avoid it. Some of the detox recommendations (chelation, coffee enemas, provoked heavy metal testing) are outside mainstream clinical practice and deserve a conversation with a qualified provider before you try them.

    One caveat: The evidence quality across the book varies considerably. The fasting protocols and estrobolome material are well-grounded. The cycling-eating protocol (Days 1-11, 12-14, etc.) is plausible based on hormonal timing logic, but the RCT support is limited. Read it as an intelligent clinical hypothesis rather than established protocol.

    Books Like The Menopause Reset

    BookAuthorBest For
    Fast Like a GirlMindy PelzCycle-synced fasting in full detail; the fasting chapters here expanded
    Eat Like a GirlMindy PelzPelz’s food and recipe framework for women
    Age Like a GirlMindy PelzLongevity through the Pelz framework for older women
    The Hormone FixAnna Cabeca, DOA keto-alkaline approach to menopause; more clinically conservative than Pelz
    Menopause BootcampSuzanne Gilberg-Lenz, MDA conventional OB-GYN’s perspective; strong counterweight on HRT evidence

  • Hormone Intelligence by Aviva Romm: Summary, Key Ideas & Review

    Book in one sentence: A Yale-trained MD and former midwife maps six root causes behind most women’s hormone conditions and gives you a 6-week plan to address them.

    What Is Hormone Intelligence About?

    Imagine going to your doctor with heavy periods, brutal PMS, fatigue, and cravings that feel like a separate person living inside you. Your labs come back normal. You leave with a birth control prescription and a vague suggestion to “reduce stress.” Aviva Romm has heard some version of this story from thousands of patients, and Hormone Intelligence is her answer to it.

    Romm’s credential stack is worth paying attention to: she spent twenty years as a midwife before going to medical school at Yale. She has practiced integrative medicine long enough to be frustrated by both sides of the conventional/wellness divide. Her argument is not that your doctor is wrong and your herbalist is right. Her argument is that most hormone conditions share a small set of treatable root causes that neither conventional medicine nor most wellness protocols actually address. The book is her attempt to name those causes and give you something to do about them.

    At 592 pages, this is a genuinely dense read. Think of it more as a reference you return to than a book you power through in a weekend. The payoff for the density is specificity: doses, timing, mechanisms, and the actual research behind every recommendation.

    The Six Root Causes Romm Keeps Coming Back To

    Romm builds the first half of the book around a single claim: PCOS, endometriosis, fibroids, PMS, and most other common gynecologic conditions are not random bad luck. They are predictable responses to a specific modern environment. Six interconnected drivers account for the vast majority of cases she sees.

    1. Diet. Not in the calorie-counting sense. The specific dietary patterns that disrupt hormone function include ultra-processed foods that spike insulin, conventional dairy and excess red meat that increase estrogen load, and a general deficit of fiber, omega-3s, and phytonutrients the body needs to produce and clear hormones. Her recommended fix is a modified Mediterranean template with targeted additions (two tablespoons of ground flaxseeds daily, daily cruciferous vegetables) tied to specific mechanisms.

    2. Chronic stress and the HPA axis. When the stress response runs continuously, cortisol climbs and directly suppresses the hormonal cascade that triggers ovulation. This is a documented neuroendocrine mechanism, not a metaphor. Many women with irregular cycles or missing periods are not broken; they are in a chronic stress state that has deprioritized reproduction.

    3. Disrupted sleep and circadian rhythm. The brain’s master clock coordinates the LH surge that triggers ovulation, FSH secretion, and melatonin production. Late nights, irregular sleep schedules, and evening screen exposure disrupt all of these simultaneously. Women sleeping under seven hours secrete measurably less FSH.

    4. Gut health. A subset of gut bacteria called the estrobolome produces the enzyme that determines how much estrogen your intestines reabsorb versus eliminate. Dysbiosis shifts this toward estrogen excess (which feeds endometriosis, fibroids, PMS, and heavy periods) without any change in what your ovaries are producing. This is the chapter most likely to change how you think about hormones.

    5. Environmental toxins. Phthalates, BPA, parabens, and pesticide residues interfere with estrogen and metabolic hormone signaling at concentrations far below what was previously considered harmful. Women carry a disproportionate body burden due to cosmetic use and higher fat tissue, where fat-soluble toxins accumulate. Romm’s detox protocol is practical, not expensive: filtered water, organic produce for the EWG Dirty Dozen, glass food storage, fragrance-free personal care products.

    6. Disconnection from body signals. The sixth root is the one no other clinical book addresses: decades of medical dismissal teach women to distrust their own symptoms. That distrust is not just psychological. Chronic self-doubt is a stressor with real HPA consequences. It compounds every other root cause.

    Why Blood Sugar Is Usually the First Domino

    If you read only one chapter, read the diet chapter. Romm spends considerable time on insulin resistance as the upstream driver for conditions that look unrelated on the surface. In PCOS, insulin resistance is the primary mechanism (not just high androgens), and it is what keeps symptoms cycling back after any treatment that only addresses the surface.

    The mechanism matters here because it reframes what “eating for hormones” actually means. It is not about avoiding carbs or eating clean. It is about stabilizing blood sugar through the composition and timing of meals: protein at every meal, fiber from whole food sources, slow carbohydrates (legumes, root vegetables, buckwheat) instead of refined grains, and fat from olive oil, avocado, and nuts. These choices prevent the insulin spikes that drive androgen production in the ovaries and keep cortisol from compensating for blood sugar crashes.

    For PCOS specifically, the evidence Romm presents for myo-inositol plus D-chiro-inositol is worth knowing about. Multiple randomized trials show effects comparable to metformin for restoring ovulation, reducing insulin resistance, and lowering testosterone, without the gastrointestinal side effects. Spearmint tea (two cups daily) has also reduced testosterone in clinical trials within 30 days. These are not fringe claims. They are findings that most gynecologists do not mention because they fall outside standard prescribing protocols.

    “Our hormone imbalances are not solely individual problems; they are reflective of much larger social and environmental problems that we’re all facing.” – Aviva Romm, Author’s Note

    What This Has to Do With Cravings and Emotional Eating

    This is where the book lands hardest for the ExcessMatters audience. The hormonal chaos Romm describes does not stay in the reproductive system. It radiates outward into appetite, mood, cravings, and the capacity to self-regulate around food.

    Cortisol elevation drives cravings for dense, calorie-rich foods as a biological survival mechanism. Blood sugar instability (from poor sleep, from adrenal dysregulation, from a low-fiber diet) creates real physiological hunger and urgency that willpower cannot override. The gut’s role in producing 95 percent of the body’s serotonin means that dysbiosis contributes directly to the mood dysregulation that makes emotional eating more likely in the first place.

    None of this is an excuse or a way to avoid responsibility. It is a more accurate description of what is actually happening. When cravings feel disproportionate, they often are physiological before they are psychological. Understanding the mechanism is the first step toward addressing it at the right level instead of blaming yourself for failing at something that was never purely a willpower problem.

    Romm does not write about emotional eating directly. The book does not address the psychological dimensions of disordered eating, and it was not designed to. What it does is provide a solid biological foundation for understanding why your body has been doing what it has been doing. That foundation matters. Women who have spent years managing their eating in the dark, with no map of the hormonal terrain underneath the cravings and mood swings, often find that understanding the biology changes something about how they relate to the struggle.

    Is Hormone Intelligence Worth Reading?

    Read this if you have been diagnosed with PCOS, endometriosis, fibroids, or perimenopause symptoms and feel like you have only been offered symptom management. Read it if your PMS or cyclic mood changes are severe enough to affect your work or relationships. Read it if you have a history of unexplained weight resistance, cravings that track your cycle, or fatigue that lab work cannot explain.

    Skip it if you want a fast-start protocol or a specific eating plan without the underlying biology. At 592 pages, the book asks a significant time investment before you reach the condition-specific chapters. Lara Briden’s The Period Repair Manual covers similar ground more efficiently if you have one specific condition and want targeted protocols.

    One caveat: Romm is careful about evidence quality, but the book occasionally moves between well-replicated findings and single-study results without clearly flagging the difference. Readers without a science background may not notice. The supplement protocols in particular mix high-confidence evidence (omega-3s, inositol) with lower-confidence evidence. Use this book as a starting framework, not a final authority.

    Books Like Hormone Intelligence

    BookAuthorBest For
    Women Food and HormonesSara Gottfried, MDHormones + weight specifically; more diet-protocol focused
    The Hormone FixAnna Cabeca, DOKeto-alkaline approach to perimenopause hormones
    In the FLOAlisa VittiCycle syncing diet and lifestyle; more accessible entry point
    The XX BrainLisa Mosconi, PhDHormones and brain health; strong on menopause and cognition
    Eat to Thrive During MenopauseStephanie HuberPractical nutrition focus for the perimenopause transition