Excess Matters

Tag: perimenopause

  • The Perimenopause Solution by Shahzadi Harper: Summary, Key Ideas & Review

    Book in one sentence: A UK menopause specialist and a registered nutritionist make the case that perimenopause starts years earlier than most women suspect, that the symptoms are real and treatable, and that restriction is exactly the wrong response to what’s happening in your body.

    What Is The Perimenopause Solution About?

    You’re in your early 40s. Your weight is doing something new, mostly around your middle. Sleep has gotten strange. Some mornings you wake at 3am, mind racing, no obvious reason. Your appetite feels unreliable, your mood snaps at things it never used to, and the brain that always felt sharp is suddenly foggy. You mention it to your doctor. Your periods are still regular, your bloodwork comes back normal, and you leave with a suggestion that maybe you’re a bit stressed.

    What nobody told you is that you might already be in perimenopause. Not approaching it. Not “too young” for it. Actually in it, years before the hot flashes most people associate with the word.

    The Perimenopause Solution was co-written by Dr. Shahzadi Harper, a UK women’s health physician and co-founder of The Harper Clinic, and Emma Bardwell, a registered nutritionist and member of the British Menopause Society. Both specialize in perimenopause. Both see these women in clinic every week. The book grew out of the conversations they kept having with patients who came in exhausted, dismissed, and convinced that what was happening to them was somehow their own fault, whether from stress they hadn’t managed well enough, weight they hadn’t controlled, or a general failure to hold things together.

    It is a UK-focused book (the prescribing guidance references NHS and NICE, not FDA), but the underlying science travels. If you’ve been puzzling over changes in your body, appetite, or mood since your late 30s and no one has connected those dots for you, this book is likely to feel like an explanation you’ve been waiting for.

    Why Your Body Changed in Your Late 30s (Before You Had a Name for It)

    Here’s the thing most people don’t know: perimenopause and menopause are not the same event. Menopause is technically a single moment, the one-year mark after your last period, average age 51. Everything before that, often spanning four to ten years and sometimes starting in the early 40s, is perimenopause. It is the phase when hormones are actively fluctuating and declining, and it is when the vast majority of symptoms occur.

    The confusion between the two words isn’t just semantic. It’s why a 43-year-old with regular cycles, crushing fatigue, and 3am waking gets told she’s “too young” instead of getting treated.

    Blood tests often miss perimenopause entirely. Hormone levels fluctuate day to day during this phase, which means FSH can read normal on Tuesday and elevated on Thursday. In the UK, NICE guidelines now support diagnosing perimenopause on symptoms alone for women over 45, because the test result is not the diagnosis. The symptom picture is.

    Testosterone is the hormone that falls first. By a woman’s 40s, testosterone levels have dropped roughly 50% from where they were in her 20s, a decline that predates the oestrogen drop most people associate with perimenopause. That fatigue that started years ago, the brain fog, the muscle loss, the flat energy that doesn’t respond to sleep: these are frequently testosterone deficiency symptoms, not character flaws, and not signs that you’re simply aging badly.

    The timeline matters for ExcessMatters readers in particular. The weight changes, the hunger shifts, the mood-driven eating that might have started in your late 30s or early 40s, those weren’t random. They had a hormonal mechanism. Your appetite was not malfunctioning. Your body was changing in a way that had a name, and nobody had given you that name yet.

    What Perimenopause Actually Does to Appetite, Metabolism, and Mood

    Most people know about hot flashes and night sweats. What most people don’t know is that there are over 34 officially recognized perimenopause symptoms, spanning physical, psychological, cognitive, and urinary domains, and only about five of them get talked about. The gap between what women expect and what they experience is where years of misdiagnosis live.

    The weight shift is real and documented. The book is direct about this: perimenopause causes changes to insulin sensitivity and metabolism that increase fat storage, particularly around the middle. Women who gained weight in a consistent pattern for years, then watched it start accumulating differently, are not imagining the change. The mechanism shifted.

    Poor sleep compounds everything. As progesterone drops (one of the earliest declines in perimenopause), sleep quality deteriorates, and the 3am wake window becomes a signature symptom. Disrupted sleep elevates cortisol, which then disrupts progesterone further, which worsens sleep. The book points out directly that poor sleep increases hunger the next day, because of course it does.

    The psychological symptoms are the piece most likely to go misdiagnosed. Menopausal Mood Disorder (MMD) is a hormonal phenomenon characterized by fluctuating (not persistently low) mood, loss of confidence, anxiety, cognitive slowing, and a flatness that women often describe as “not feeling like myself.” It gets misdiagnosed as clinical depression and treated with antidepressants. The authors are unambiguous: antidepressants are not first-line treatment for hormone-driven mood changes. For women who have spent time on SSRIs for symptoms that felt more physical than psychiatric, this chapter is worth reading.

    “When you’re feeling low, you may tend to reach for carbohydrates and other high-sugar foods, so be aware of your personal triggers. Eat nutrient-dense food regularly throughout the day to maintain your food intake and energy balance. Not eating will depress your mood and further suppress the release of those happy hormones.”

    The mood-food loop during perimenopause is not a willpower problem. Low mood drives carb cravings. Carb restriction depresses mood further and disrupts serotonin (90% of which is produced in the gut). The body asking for food is often the body trying to regulate hormones that have lost their footing.

    Why Eating Less Makes Everything Worse

    This is the section most directly relevant to anyone who has responded to perimenopausal body changes by restricting.

    The book’s nutritional framework is built on one central mechanism: blood glucose instability amplifies every perimenopausal symptom. When blood sugar crashes, the body releases cortisol and adrenaline as a stress response. Cortisol disrupts progesterone (described here as the “grounding” hormone). Progesterone disruption worsens anxiety, disrupts sleep, increases irritability, and drives cravings. The resulting cravings, if met with refined sugar or simple carbs, spike blood glucose again and restart the cycle.

    The practical intervention the authors recommend:

    • Protein at every meal to slow glucose absorption and maintain satiety
    • The Key 3 at each sitting: protein, fibre, and healthy fat together
    • No sweet foods as standalone snacks (pair fruit with nuts, eggs with toast)
    • Complex carbs replacing refined ones rather than carbs eliminated altogether
    • A short walk after meals to blunt the postprandial glucose spike

    Note what’s not on that list. Calorie counting isn’t there. Elimination isn’t there. The authors are explicit that very low-carb approaches backfire for perimenopausal women: carbohydrates support serotonin production and calm the nervous system, and removing them entirely raises cortisol, worsens sleep, and compounds the hormonal pressure already present.

    “Perimenopause — a time when your body is undergoing significant adjustments — is not a time for deprivation. No good can come from punishing your body into submission because it doesn’t look or feel like it used to any more. On the contrary, this is a time for positive nutrition — a time for nourishing yourself, filling up on the good stuff and making small dietary and lifestyle shifts that stack up over time. It’s about adding in rather than taking away.”

    The gut layer adds another dimension. The estrobolome (the gut bacteria responsible for metabolizing used oestrogen) means that gut health is directly hormonal health. When the microbiome is disrupted, metabolized oestrogen can be reabsorbed into circulation, adding oestrogen imbalance on top of the fluctuations already occurring. The prescription: 30+ different plant foods per week, fermented foods, prebiotic fiber. Not a detox, not a cleanse, just feeding the microbiome consistently.

    The book’s exercise hierarchy is worth noting too. Resistance training comes first, because oestrogen has anabolic properties and its decline accelerates muscle loss. Muscle loss slows resting metabolism, worsens insulin sensitivity, and accelerates the body composition changes that perimenopause already drives. The authors argue strength training should be prescribed. Walking (second in the hierarchy) is cardioprotective, accessible, and weight-bearing. High-intensity work without adequate recovery raises cortisol and can make symptoms worse.

    Is The Perimenopause Solution Worth Reading?

    Read this if you are in your late 30s or 40s and something has shifted (energy, sleep, weight, mood, cognitive sharpness) and you haven’t found an explanation that fits. Read it if you’ve been told your bloodwork is normal but you don’t feel normal. Read it if you’ve been offered antidepressants for symptoms that feel more physical than psychiatric. Read it if you’ve been restricting food to address weight changes that restriction keeps making worse.

    Skip it if you’re primarily looking for US-specific prescribing guidance (the book references NHS systems throughout), or if you want a deep single-topic treatment of sleep, gut health, or nutrition as standalone subjects. The book covers a lot of ground across 15 chapters, and some sections go shallower than others because of it.

    One caveat: The book is UK-specific in its HRT prescribing detail, and it was published in 2021. The broad science holds, but anyone acting on specific HRT recommendations should cross-reference with current guidance from their national menopause society (the Menopause Society in the US, the British Menopause Society in the UK). Guidelines have continued to evolve.

    For ExcessMatters readers with a complicated relationship to food and dieting: the book contains a fat loss chapter (Chapter 15) that is notably respectful. It names the Health at Every Size movement, acknowledges that not every reader wants to address weight, and frames the nutrition guidance throughout as “adding in” rather than “taking away.” The perimenopausal lens here is useful even if weight isn’t the primary concern, because it explains why the body changes in the ways it does, and why deprivation makes those changes worse, not better. The appetite shifts, the mood-driven eating, the cravings that started in your late 30s are not personal failures. They are a physiological event with a name.

    Books Like The Perimenopause Solution

    BookAuthorBest For
    It’s Not You It’s Your HormonesNicki WilliamsBroader hormone picture including thyroid and adrenals alongside oestrogen
    The Hormone ShiftTamar Gur & Jessica RitchUS-based, covers the full reproductive lifespan including perimenopause
    Hormone IntelligenceAviva RommFunctional medicine approach, more alternative-medicine oriented
    Menopause BootcampSuzanne Gilberg-LenzAccessible, US-focused, integrative approach to the full menopause transition
    The Menopause BrainLisa MosconiDeep neuroscience of oestrogen decline and cognitive health; the science behind brain fog

  • The Menopause Diet Plan by Hillary Wright: Summary, Key Ideas & Review

    Book in one sentence: Two postmenopausal registered dietitians build a Mediterranean-DASH hybrid eating framework calibrated to the hormonal, metabolic, and body composition changes of menopause. Evidence-backed, no gimmicks, and genuinely useful.

    What Is The Menopause Diet Plan About?

    A 59-year-old woman named Sue opens the book with a single sentence: “Before menopause I could eat anything I wanted without gaining weight, but after menopause I put on 15 pounds even though I hadn’t changed my eating or exercise habits.”

    If you have lived that sentence, this book was written for you.

    Hillary Wright (MEd, RDN) and co-author Elizabeth Ward (MS, RDN) are both practicing registered dietitians and both postmenopausal. They did not write this from a clinical distance. They went through the hot flashes, the belly fat, the metabolic confusion of “nothing has changed but everything has changed,” and then applied decades of nutrition science to explain why it happens and what to do about it. That combination of credentials and lived experience is rarer than it sounds.

    The book’s central argument is that menopause reorganizes multiple body systems at once: cardiovascular risk accelerates, insulin resistance increases, muscle mass declines faster, bone loss spikes in early postmenopause, and brain chemistry shifts. A diet that only targets weight (or only targets heart health, or only targets hot flashes) isn’t enough. The Menopause Diet Plan is a Mediterranean-DASH hybrid, modified to be higher in protein and lower in carbohydrate than either source pattern, designed to address all of these changes simultaneously.

    What Makes This Approach Different From Other Menopause Books?

    The menopause nutrition space has a noise problem. On one end: generic “eat more vegetables” advice dressed in midlife marketing. On the other: aggressive elimination diets, hormone optimization claims, and supplements protocols with little clinical backing.

    Wright and Ward occupy a different position. There are no fad elements here. No dairy elimination. No “detox” phase. No proprietary supplement stack. Just a rigorous, dietitian-built framework grounded in what the research actually supports for this life stage.

    The book is organized around specific health conditions rather than a single diet identity: cardiovascular disease gets a chapter, diabetes prevention gets a chapter, bone health gets a chapter, brain health gets a chapter. That structure reflects how menopause actually works. It doesn’t strike one system. It reorganizes all of them at once, and the eating pattern responds accordingly.

    Worth noting for context: the book was published in 2020 and reflects the research of that period. Some areas (time-restricted eating, the gut microbiome, and hormone replacement therapy) have moved since then. The HRT discussion is brief and cautious in a way that may not match current clinical consensus, given how substantially the evidence has shifted since the Women’s Health Initiative era. The foundational nutrition framework, though, holds up well.

    What Are the Five Core Principles of the Menopause Diet Plan?

    The MDP is built around five principles that work as a system. The authors are clear that you can’t follow four and let the fifth slide.

    1. Eat According to Your Body Clock

    Insulin sensitivity is highest in the morning and falls through the day. Your glucose-processing machinery is more efficient at 8am than at 8pm, and eating most of your calories at night creates a mismatch between food intake and metabolic readiness.

    The trial Wright cites here is worth pausing on: two groups of women ate the same total daily calories. One group’s largest meal (700 calories) was breakfast. The other group’s was dinner. At the end of the study, the breakfast group had lost nearly three times as much weight. Same calories, different timing, dramatically different outcomes. The practical translation: eat breakfast reliably, make lunch substantial, keep dinner lighter, and stop eating as early in the evening as practical. No evening snack in the MDP meal plans.

    2. Focus on Plant Foods

    The eating pattern blends the Mediterranean diet and DASH (Dietary Approaches to Stop Hypertension) into a plant-forward template that isn’t exclusively plant-based but strongly prioritizes vegetables, fruit, whole grains, legumes, seafood, nuts, and seeds. This pattern reduces LDL cholesterol, blood pressure, inflammation, and diabetes risk simultaneously, and all of those outcomes become more urgent for menopausal women when estrogen’s protective effects weaken.

    3. Distribute Protein Across Every Meal

    The standard protein recommendation (0.8 grams per kilogram of body weight per day) was set for the general adult population. It doesn’t reflect what menopausal women actually need. Declining estrogen accelerates muscle loss, and aging muscles develop “anabolic resistance” (they need more protein to produce the same synthetic response). The European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) recommends 1.0–1.2 g/kg/day for women over 50 who exercise regularly.

    For a 150-pound woman, that’s roughly 70–82 grams daily, compared to the standard RDA of about 55 grams. More importantly, it means at least 20 grams per meal, spread across breakfast, lunch, and dinner. Piling protein at dinner and eating light all day is one of the most common patterns among women shaped by decades of diet culture. It’s exactly backwards for muscle protein synthesis.

    4. Moderate (Not Eliminate) Carbohydrates

    The MDP target is under 50% of daily calories from carbohydrates, compared to the typical American intake of 55–60%. Menopause promotes visceral fat accumulation, and visceral fat is inherently insulin-resistant. Muscle loss further reduces the body’s capacity to clear glucose efficiently. The same carbohydrate load that worked at 35 may produce a different metabolic result at 52.

    Reducing carbohydrate intake by replacing refined grains and added sugar with whole grains, legumes, fruit, and vegetables reduces the glucose and insulin burden without producing the deprivation of true low-carb eating.

    5. Prioritize Both Cardio and Strength Training

    Exercise gets one of the five core principles, not a sidebar, and the book is specific about why both types matter. Aerobic exercise (walking, cycling, swimming) addresses cardiovascular health, hot flash severity, mood, and sleep. Resistance training addresses muscle mass, bone density, and insulin sensitivity, the systems aerobic exercise doesn’t protect to the same degree. Neither substitutes for the other.

    One finding worth noting: 15 weeks of weight training cut hot flash rate by approximately 50% in a study the book cites. Strength training is not just for body composition. For menopausal women, it functions as medicine.

    What Does the Menopause Diet Plan Say About Protein, Supplements, and Weight?

    The Supplement Reality

    The book does something honest that many nutrition books avoid: it names the nutrients where even a well-planned diet leaves most menopausal women short, and prescribes specific supplements to close the gap.

    • Calcium increases to 1,200 mg/day after 50. Most women eating two dairy servings daily get 500–600 mg from food, so supplements fill the gap. No more than 500 mg per dose for best absorption.
    • Vitamin D at 600–800 IU from guidelines, but 1,000–2,000 IU in practice given widespread deficiency (especially in northern climates).
    • Vitamin B12 in synthetic form for all women over 50, since gastric acid production declines with age and natural food-bound B12 requires gastric acid to absorb properly. Women on metformin or proton pump inhibitors face especially high depletion risk.
    • Omega-3 EPA+DHA at 250–500 mg daily for women who don’t reliably eat 8 or more ounces of fatty fish per week. After menopause, estrogen’s cardiovascular protection disappears, and omega-3s directly address triglycerides and arterial inflammation.

    The Weight Conversation

    Wright earns credit here for holding a genuinely difficult balance. She’s direct that excess visceral fat amplifies nearly every major menopausal health risk (cardiovascular disease, type 2 diabetes, cancer, hot flash severity). Pretending otherwise would be medically dishonest.

    At the same time, the MDP sets a calorie floor of 1,600 calories per day, not the 1,200-calorie approach that diet culture has marketed to women for decades, which backfires metabolically and behaviorally at this life stage. The evidence-based weight loss target the book cites is 5–10% of body weight: a threshold where blood glucose, blood pressure, and inflammatory markers measurably improve. For a 170-pound woman, that’s 8.5–17 pounds.

    “The goal is to help you strike a balance between good health and a good quality of life. Even though it’s morphed, your body can still be beautiful, strong, and capable of doing all the things that can make the next phase of life fun, liberating, and adventurous.”

    The Soy Question

    The section on phytoestrogens is one of the more nuanced in the book. Soy isoflavones weakly bind to estrogen receptors, and the popular claim is that they reduce hot flashes. The research says: inconsistently. Some studies show modest reduction; others show no effect. Wright does not recommend whole soy foods as a hot flash treatment because the evidence doesn’t support using them for that specific purpose.

    What whole soy foods are (apart from any hot flash question) is nutritionally excellent. Rich in complete plant protein, potassium, magnesium, and isoflavones that may offer modest bone protection and LDL-lowering effects. Large studies confirm they are safe for most women, including breast cancer survivors in moderate amounts. They belong in the MDP not for their estrogen-like effects but for their overall nutritional profile. Concentrated isoflavone supplements are a different matter and get a “discuss with your provider first.”

    Is The Menopause Diet Plan Worth Reading?

    Read this if you are in perimenopause or postmenopause and your previous eating habits have stopped working in ways you cannot explain. This book is for the woman who has been eating reasonably well and still gaining weight around her abdomen, who wants to understand the physiology behind what’s happening, and who wants a single evidence-based framework that addresses cardiovascular risk, blood sugar concerns, bone health, and weight management at the same time. The protocol format means specific meal plans, calorie ranges, and nutrient targets (either exactly what you want, or exactly what you don’t).

    Skip it if you are looking for a psychological framework for your relationship with food. There is no body-image psychology here, and the authors’ warmth around the weight conversation is genuine but brief. Women navigating a complicated food history may find the directness around calorie ranges activating without the scaffolding to hold it. For that piece, pair this book with something like Geneen Roth.

    One caveat: The HRT discussion is cautious in a way that reflects 2020 clinical consensus, not 2026. If hormone therapy is relevant to your situation, talk to a current provider rather than relying on this chapter.

    Books Like The Menopause Diet Plan

    BookAuthorBest For
    Eat to Thrive During MenopauseStephanie HuberPlant-forward eating with more flexible structure
    MenuPauseAnna CabecaHormonal balance through food, more lifestyle-oriented
    The Menopause Metabolism FixStephanie MetzMetabolic focus, weight loss emphasis
    Menopause BootcampSuzanne Gilberg-LenzWhole-picture menopause care beyond nutrition
    The Longevity DietValter LongoLongevity science and fasting-mimicking protocol

  • It’s Not You, It’s Your Hormones by Nicki Williams: Summary, Key Ideas & Review

    Book in one sentence: A UK nutritional therapist walks women through the four hormones wrecking their health after 40, and shows how food and lifestyle can actually fix them.

    What Is It’s Not You, It’s Your Hormones! About?

    Picture this: you’re standing at the kitchen sink, too depleted to think, and your seven-year-old comes in to show you a drawing she made at school. You snap at her. Her face falls. She says, “Why are you always so grumpy, Mummy?” That moment happened to Nicki Williams in January 2007. She was 42, exhausted, gaining weight around her middle despite trying every diet, and had just left her GP’s office holding a Prozac prescription she didn’t want.

    Williams sat in her car and cried. Then she called her father (also a doctor, one who had long since moved toward functional medicine) and he said: “Don’t worry, Nick. It’ll be your hormones.” That conversation sent her back to school, through a four-year qualification at the Institute of Optimum Nutrition, and eventually into a clinical practice built around the population she had become: women over 40 who feel terrible and keep being told their bloodwork is fine.

    It’s Not You, It’s Your Hormones! is the book that came out of that journey. Williams is not an academic, and she writes like a practitioner, not a researcher. What she offers is a clear, accessible framework for understanding why perimenopause-era symptoms (fatigue, abdominal weight gain, brain fog, mood swings, broken sleep) happen at a physiological level, and what food and lifestyle changes can do about them. The UK origin means NHS references and British supplement brands appear throughout, but the underlying physiology translates cleanly anywhere.

    Why Am I Gaining Weight When Nothing Has Changed?

    That question drives most of the women who pick up this book. They haven’t changed what they eat. They’re not sedentary. They’re doing all the things that used to work, and the scale is still creeping up, specifically around the middle, in a way it never used to.

    Williams’s answer centers on cortisol and insulin working together against you. Cortisol, the stress hormone, has a direct effect on abdominal fat storage: abdominal fat contains four times more cortisol receptors than fat anywhere else in the body. When cortisol is chronically elevated (from any form of stress, including poor sleep, refined carbohydrates, or skipped meals), it mobilizes blood glucose. That glucose spike triggers insulin. Insulin is the fat-storage signal, and with blood sugar elevated, it’s chronically activated regardless of how little you’re eating.

    “Not only do we have four times more cortisol receptors in our abdominal fat than any other part of the body, but cortisol also stimulates appetite — sugar and carbs are vital when you need energy to run from that lion.”

    The practical consequence is brutal: calorie restriction often makes this worse. A severe cut signals famine to the brain, which triggers more cortisol, which slows metabolism and breaks down muscle for glucose, which produces powerful cravings for sugar and refined carbohydrates. Williams draws on Zoe Harcombe’s work to note that 98% of people either fail to lose weight on a calorie-controlled diet or regain what they lost. The mechanism itself produces those outcomes.

    The loop she describes is also behind the 3am wake-up and the afternoon crash. Blood sugar drops overnight, cortisol surges to correct it, and you’re wide awake. The morning exhaustion that follows sends you to coffee and carbohydrates, blood sugar spikes and crashes again, and the cycle restarts. Understanding that this is a physiological cascade, not a willpower failure, is the orientation shift the book is built around.

    What Is the Happy Hormone Code?

    Williams organizes her intervention into four steps: Eat, Rest, Cleanse, Move. Each maps to a specific hormonal lever. The whole system is built around what she calls the “Feisty Four”: cortisol, insulin, thyroid, and estrogen/progesterone. These four hormones interact so tightly that dysfunction in one tends to cascade into the others.

    A few things worth knowing from each step:

    Eat reframes food as hormonal information rather than calories. The practical targets are protein at every meal, low-glycemic-load carbohydrates, cruciferous vegetables (which contain indole-3-carbinol to support estrogen metabolism through the liver), healthy fats, and 35 grams of fiber daily. Ground flaxseeds get specific attention: two tablespoons a day, because flaxseeds contain lignans at roughly 100 times the concentration of any other food source, and lignans bind excess estrogen for elimination via the gut. A minimum 12-hour overnight fast is also recommended for insulin management.

    Rest addresses cortisol directly. Williams is clear that stress management isn’t optional, it’s the foundational intervention. Consistent sleep before 11pm, diaphragmatic breathing (five-count rhythm, ten repetitions), and screens off one hour before bed are her baseline. Adaptogenic herbs like ashwagandha and rhodiola get a mention as cortisol modulators, and magnesium glycinate at bedtime comes up repeatedly as a first-line supplement because magnesium is rapidly depleted by stress and supports both cortisol regulation and sleep.

    Cleanse focuses on xenoestrogens, the environmental chemicals from plastics, pesticides, and personal care products that mimic estrogen in the body. Williams recommends switching to glass and stainless steel where possible, choosing organic produce for high-pesticide items, and supporting the liver and gut as the main clearance routes for excess estrogen. The cruciferous vegetable recommendation reappears here.

    Move reframes the exercise question for cortisol-depleted women. More cardio is not better. Williams advocates 30-minute daily walks, brief HIIT sessions (15 minutes, two or three times a week, because short HIIT raises growth hormone and improves insulin sensitivity without adding significant cortisol load), resistance training, and yoga or Pilates for their cortisol-lowering effects specifically.

    One of the more useful distinctions in the book is Williams’s separation of estrogen dominance from low estrogen. These are two different perimenopausal states that require different responses. Estrogen dominance (too much estrogen relative to declining progesterone, common from the mid-30s onward) produces heavy or painful periods, breast tenderness, PMS, bloating, and conditions like fibroids. Low estrogen (the later perimenopausal and menopausal state) produces hot flushes, night sweats, dry skin, and memory changes. Using phytoestrogen support for the dominance phase can worsen it. The framework to tell them apart is one of the book’s more distinctive contributions.

    What Does “Normal” Lab Work Actually Miss?

    A significant portion of Williams’s readership has already been to their GP, had blood drawn, been told everything looks fine, and left no closer to understanding why they feel awful. The testing chapter is written for them.

    Williams draws a sharp line between “normal” (anywhere within a reference range) and “optimal” (in the range where symptoms actually resolve). The thyroid example is the clearest illustration. The NHS upper limit for TSH is 5.0 mU/L. Many integrative practitioners treat 2.5 mU/L as the functional upper limit. A result of 4.2 is entirely “normal” by conventional standards and may prompt nothing further, while a patient at that level could be functionally hypothyroid.

    “There is often a huge difference between someone with optimal TSH and someone with a level that is just within range. It will most often show up in their symptoms. If you ask me, I’d be wanting OPTIMAL levels not ‘normal’ levels.”

    Standard thyroid panels measure only TSH, which is the pituitary’s signal to produce thyroid hormone, not whether the body is converting that hormone into its active form (T3) or whether the cells can receive it. Williams recommends requesting TSH, free T4, free T3, Reverse T3, and TPO antibodies (the last one for Hashimoto’s autoimmune thyroiditis, which she notes accounts for roughly 80% of hypothyroid cases). She also introduces the Barnes Basal Temperature Test, six consecutive mornings of underarm temperature readings before getting up, as a low-cost screen: consistent readings below 36.6°C suggest low thyroid function even with normal labs.

    For adrenal function, she recommends saliva cortisol testing over serum testing, because saliva captures cortisol at multiple points through the day (including the critical morning cortisol awakening response) rather than a single snapshot. For sex hormones, she specifies timing: days 19-20 of the cycle, when progesterone should be at its peak and the estrogen-to-progesterone ratio is most informative. A woman tested on day 5 or day 28 gets a picture that tells a very different story.

    Is It’s Not You, It’s Your Hormones! Worth Reading?

    Read this if you’re between roughly 35 and 55, experiencing the cluster of symptoms Williams describes (fatigue that doesn’t resolve with sleep, abdominal weight gain, worsening PMS or cycle changes, mood instability, brain fog), and especially if you’ve had normal labs and been told there’s nothing wrong. Also useful if you’re a health coach or practitioner working with this population and want a clear client-education framework.

    Skip it if you want a heavily cited research text or if you’re primarily post-menopausal and focused on HRT decisions. The HRT chapter is balanced and honest about the limits of Williams’s expertise in that area, but it’s thin coverage for someone who needs it to be the main event.

    One caveat: the book was published in 2017, the research base for several claims (especially around HIIT for women over 40 and some of the adrenal fatigue framing) has evolved since then, and the UK-specific medical references require translation for anyone outside the NHS. Williams does not always distinguish clearly between interventions with strong evidence and those with more preliminary or clinical-observation-only support. Take the supplement protocols as a starting point for a conversation with a practitioner, not a prescription.

    Books Like It’s Not You, It’s Your Hormones!

    BookAuthorBest For
    Happy HormonesAngelique VermeulenWomen who want a broader hormonal overview beyond perimenopause
    The Hormone ShiftTasneem BhatiaDeeper clinical detail with a heavier research base
    Hormone IntelligenceAviva RommIntegrative MD perspective with stronger evidence citations
    The Perimenopause SolutionDr. Shahzadi HarperUK-based GP who covers HRT and lifestyle together
    Is It Me or My Hormones?Marcelle PickSimilar audience, more emphasis on the emotional and relational side

  • Is It Me or My Hormones by Marcelle Pick: Summary, Key Ideas & Review

    Book in one sentence: A functional medicine nurse-practitioner explains why your hormone labs can look completely normal while you feel completely terrible, and what to do about it.

    What Is Is It Me or My Hormones? About? {#what-is-it-about}

    Picture a woman who has seen ten doctors. Her labs keep coming back normal. She keeps getting offered antidepressants. She’s not depressed, she says. Or maybe she is, but only for one week out of every four, which seems like a different problem entirely. Nobody has a satisfying answer for her.

    Marcelle Pick built her career treating that woman. She co-founded Women to Women, a Maine clinic she started alongside Christiane Northrup, and spent decades in clinical practice before writing this book. Her argument, built from patient case after patient case, is that conventional medicine keeps looking at the wrong hormones. It tests estrogen and progesterone, finds them in the “normal range,” and calls it a day. Meanwhile, cortisol and insulin (the hormones that actually run the show) are never checked, never addressed, and never implicated.

    Pick is an OB/GYN nurse-practitioner writing from a functional medicine framework. Her tone is warm and direct without being breathless. The book opens with her own story: sitting in a car outside a pottery shop at age 20, too numb to feel anything, unable to understand why her exciting life wasn’t landing. Only later did she recognize it as PMS. That personal grounding gives the book something most hormone guides don’t have: the writer has actually been in the body she’s describing.

    The book covers estrogen dominance, adrenal dysregulation, thyroid, mood, weight, cravings, libido, and perimenopause, then delivers a graduated four-week plan for fixing it. What makes it useful for anyone thinking about eating and emotions is that Pick connects the mood-hormone link directly to food behavior: cravings, stress eating, comfort eating, loss of motivation, and the particular misery of doing everything “right” and still gaining weight.

    Why Your Mood, Your Eating, and Your Hormones Are Running the Same Loop {#the-loop}

    Here’s the pattern Pick describes over and over: a woman’s hormone levels look fine on paper, but two weeks of every month she’s snapping at everyone, craving sugar, gaining weight, and barely sleeping. Her doctor shrugs. She wonders if she’s losing her mind.

    She’s not. The cravings aren’t weakness. The mood swings aren’t character flaws. They’re downstream effects of a system running out of balance upstream.

    Pick’s central framework is the hormonal cascade. Your body has more than 100 hormones, and they talk to each other constantly. Cortisol and insulin are the dominant voices. When cortisol stays elevated from chronic stress (or poor sleep, or skipping meals, or a life that runs too hot), it suppresses thyroid function, disrupts leptin and ghrelin (your hunger and fullness signals), and depletes the precursors your body needs to make progesterone. Dysregulated insulin causes blood sugar spikes and crashes that trigger more cortisol. Estrogen and progesterone sit downstream of all of this, which is why fixing them directly often doesn’t work.

    The mood-eating connection runs right through this cascade. When cortisol is high, your brain craves fast fuel (sugar, refined carbs). Low progesterone pulls serotonin down with it, making cravings worse and emotional regulation harder. Blood sugar crashes after the granola bar you had for breakfast, and your body reads it as an emergency and reaches for the nearest quick fix. This isn’t psychological weakness. It’s biology.

    “If you crave sugar, sweets, and starches, that’s partly because of the ways hormones affect your brain’s response to serotonin. Anxiety, depression, and mood swings can likewise result from imbalanced levels of stress hormones, serotonin, and other neurotransmitters, including dopamine.”

    Pick’s most useful reframe: you cannot diet your way out of hormonal eating patterns. Restricting calories when cortisol is elevated and insulin is dysregulated tends to make things worse (more cortisol, more cravings, more fat storage). The tractable entry point is blood sugar stabilization, not restriction.

    One caveat worth naming: Pick uses the term “adrenal fatigue” throughout the book. Conventional endocrinologists don’t recognize it as a diagnosis, and the evidence base is genuinely thin. The underlying concept (that chronic stress dysregulates cortisol patterns) has real clinical support. The specific term is contested. Read it as “chronic HPA axis dysregulation” if you prefer language with harder evidence behind it.

    What Is Estrogen Dominance and Why Isn’t Anyone Testing for It? {#estrogen-dominance}

    Estrogen dominance is probably the most practically useful concept in this book. It’s also the one most likely to explain what’s happening when your labs come back fine and you still feel terrible.

    Estrogen dominance doesn’t mean your estrogen is high. It means your estrogen is high relative to your progesterone. Both values can sit comfortably inside the reference range while the ratio between them is badly off. High-normal estrogen plus low-normal progesterone produces a recognizable symptom picture: bloating, breast tenderness, weight gain in hips and thighs, cyclical mood instability, heavy or irregular bleeding, and a general sense of feeling overwhelmed that gets worse in the week before your period. Two “normal” numbers on a blood test won’t flag it.

    Pick identifies the main drivers:

    • Chronic stress steals progesterone precursors (cortisol and progesterone share a biosynthetic pathway)
    • Insulin resistance promotes estrogen production in fat cells
    • Excess body fat is itself a source of estrogen, which creates a self-reinforcing loop
    • Xenoestrogens from plastics, pesticides, and synthetic fragrances mimic estrogen and add to the total burden
    • Poor liver detoxification means spent estrogen isn’t being cleared properly

    One thing Pick says that most books in this genre miss: estrogen dominance tends to get worse in perimenopause, not better. Progesterone drops first and faster as the transition begins, so the ratio tips further toward dominance even as absolute estrogen levels fall. This is why many women in their 40s feel more hormonally chaotic than they did at 35, not less.

    The practical answer isn’t necessarily prescription hormones. Daily cruciferous vegetables, ground flaxseed, adequate fiber, and regular bowel movements all support the liver’s ability to clear spent estrogen. Reducing xenoestrogen exposure (glass containers over plastic, filtered water, unscented personal care products) reduces the incoming burden. These aren’t dramatic interventions, but they work on the actual mechanism.

    What Pick Actually Recommends You Do {#what-to-do}

    The second half of the book is a graduated four-week plan. Pick adds one or two changes per week deliberately, because asking for a complete overhaul on day one is how most plans fail. The core of it:

    Dietary foundations first:

    • Half the plate is nonstarchy vegetables, one quarter protein, one quarter low-glycemic carbohydrate
    • Never eat a carbohydrate alone (always paired with protein and fat)
    • Three meals and two snacks, eating within 30-60 minutes of waking
    • Daily cruciferous vegetables for estrogen detox support
    • Two tablespoons of ground flaxseed or chia daily for estrogen metabolism
    • Eliminate sugar, refined flour, gluten, and cow’s milk dairy (at minimum initially)

    Lifestyle anchors:

    • Seven to nine hours of sleep consistently (Pick frames sleep as a hormonal intervention, not just rest)
    • Moderate interval exercise four days a week, not long steady-state cardio (which raises cortisol)
    • A daily parasympathetic practice that starts at five minutes of belly breathing and scales to 30 minutes by week four

    Supplement foundations for everyone:

    • Methylated multivitamin (with 5-MTHF, not just folic acid)
    • Fish oil for hormone synthesis and inflammation
    • Magnesium (depleted by stress, supports sleep and muscle function)
    • Ground flaxseed (lignans for estrogen metabolism)

    Targeted additions (for PMS, perimenopause, mood, or cravings) layer on after the foundation is established. Pick is firm about sequence: you can’t supplement your way out of a destabilized foundation.

    The most actionable single change: stabilize blood sugar first. Protein and fat at every meal, starting at breakfast, is the intervention with the most downstream hormonal benefit. It quiets cortisol, reduces cravings, and begins to let progesterone normalize. Everything else builds on top of it.

    Is Is It Me or My Hormones? Worth Reading? {#worth-reading}

    Read this if you’ve been told your labs are normal but you don’t feel normal, especially if mood, cravings, or weight are involved in a way that feels cyclical. If you’ve tried restricting and exercising your way through it and it isn’t working, Pick’s upstream-first framework is a useful reorientation. She’s warmer and more emotionally attuned than most hormone books, and more clinically grounded than most wellness books.

    Skip it if you’ve already read Sara Gottfried’s The Hormone Cure or Brain Body Diet, which cover the same framework with more granular testing protocols. Also skip if you’re looking for heavily cited research; Pick gestures at evidence without pointing to specific papers, which is a fair criticism.

    One caveat: the book is built on Pick’s clinical practice at Women to Women, a patient population that sought out functional medicine practitioners. Women with severe hormonal disorders, autoimmune conditions, or complex psychiatric histories may need more than this framework offers. Pick acknowledges this, but the book’s optimism about what’s achievable through diet and lifestyle alone can sometimes outrun what the evidence supports.

    The reader rating reflects the niche audience more than the book’s quality. For its intended reader, it’s one of the better hormone guides available.

    Books Like Is It Me or My Hormones? {#books-like}

    BookAuthorBest For
    It’s Not You It’s Your HormonesNicki WilliamsUK-based companion; covers similar ground with a sharper tone
    The Hormone ShiftTasneem BhatiaMore clinical; useful if you want deeper testing context
    Hormone IntelligenceAviva RommBroader scope, more research-forward, integrative medicine angle
    The Perimenopause SolutionEmma Ellice-Flint & Shahzadi HarperUK clinical focus; strong on perimenopause specifically
    Rising StrongBrené BrownPairs well if the emotional side of hormonal shifts is what you’re working through