Excess Matters

Tag: progesterone

  • 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

  • Sex, Lies, and Menopause by T.S. Wiley: Summary, Key Ideas & Review

    Book in one sentence: Wiley argues that synthetic HRT causes harm while bioidentical hormones at high cyclical doses can restore pre-menopausal health. A critique that is partly right and partly dangerous, depending on which half you take seriously.

    What Is Sex, Lies, and Menopause About?

    In 2002, the Women’s Health Initiative stopped its major hormone trial early and set off a global panic. The drug being tested was PremPro (a cocktail of equine estrogen from mares’ urine and a synthetic progestin called medroxyprogesterone acetate). When the trial found elevated rates of breast cancer, heart disease, stroke, and dementia among users, millions of women stopped their hormone prescriptions overnight. Menopause medicine went conservative and stayed there for years.

    T.S. Wiley published this book two years later, arguing that the panic was misguided. The WHI had tested one specific patented drug, and the findings were being applied to all hormone therapy, including bioidentical estradiol and natural progesterone, which are different molecules entirely. That critique, once considered fringe, is now mainstream. The book’s core pharmacological argument has been validated by subsequent research, including the KEEPS trial, the ELITE trial, and a decade of timing-hypothesis literature.

    Here is where things get complicated: Wiley is not a doctor. She holds an anthropology degree. The book is co-authored with an oncologist (Julie Taguchi, M.D.) and a biochemist (Bent Formby, Ph.D.), which lends some credibility to the mechanistic sections. But the clinical conclusions Wiley draws from the science (including her own proprietary “Wiley Protocol”) have been specifically criticized by the FDA, the North American Menopause Society, and the Endocrine Society. Reading this book fairly requires holding two things simultaneously: some of what she says is correct and ahead of its time, and some of it is speculation dressed as certainty. This review will flag which is which.

    What Does Wiley Actually Get Right?

    A lot, as it turns out. At least in the first half of the book.

    The WHI tested the wrong drug for the question being asked. Premarin is not estradiol. It is a mixture of ten different equine estrogens that the human body never encountered in evolution. MPA (synthetic progestin) binds to progesterone, estrogen, and androgen receptors, producing unpredictable effects throughout the body. Natural progesterone binds selectively to progesterone receptors. The PEPI trials, which Wiley cites accurately, found that the arm combining Premarin with natural progesterone had the best cardiovascular outcomes of all arms tested. Natural progesterone cannot be patented, so the finding received no industry follow-up and never became standard practice. The patentability-shapes-research argument is not conspiracy theory; it is well-documented in health policy literature entirely independent of Wiley.

    Estrogen is not a reproductive hormone. It is a systemic maintenance molecule. Wiley’s most compelling passage cites over 300 bodily processes and more than 9,000 gene products that require estrogen to function, none of them directly involved in reproduction. Estrogen governs myelin maintenance in the brain, serotonin transport, GABA receptor sensitivity, insulin response, cardiovascular function, and bone density. When it disappears at menopause, the downstream effects are not incidental. They are predictable.

    The chronobiology section is stronger than readers expect. The mechanism Wiley traces from artificial light at night through melatonin suppression to disrupted estrogen receptor cycling is grounded in established science. Melatonin gates estrogen receptor availability; artificial light chronically suppresses melatonin; without that signal, the monthly estrogen crescendo is blunted. Sleep disruption raises cortisol, drives insulin resistance, and accelerates perimenopausal dysfunction. Treating sleeplessness with a sleep aid while ignoring its hormonal drivers misses the point. Sleep disruption is not just a symptom of hormonal chaos. It feeds back to create more of it.

    The evolutionary framing is also useful here, even if Wiley overextends it later. Human life expectancy at the turn of the 20th century was roughly 48 years for women. Evolution designed a hormonal system for organisms expected to reproduce and die, not for three or four decades of post-reproductive life. Menopause is not a designed second act. The body’s deterioration after estrogen loss is predictable entropy, not natural flourishing. Wiley’s sharpest rhetorical line: Margaret Mead, famous for coining the phrase “postmenopausal zest,” was receiving weekly estrogen injections from midlife until she died. The naturalistic fallacy applied to hormone decline does not survive contact with that fact.

    What Is the Wiley Protocol (and Why Is It Controversial)?

    This is where the book earns its polarized reception.

    The Wiley Protocol is a proprietary compounding system that doses transdermal bioidentical estradiol and progesterone in a rising-and-falling 28-day cycle. The target: replicate the serum hormone levels of a woman aged 15 to 22. Peak estradiol targets are 350 to 500 pg/mL. For context, typical clinical practice targets 20 to 50 pg/mL. That is not a rounding difference. The Protocol requires a monthly withdrawal bleed as evidence that hormone peaks were sufficient, and it is only available through Wiley Registered Pharmacies in branded syringes.

    The theoretical argument for cyclical dosing is sound. Estrogen drives cell proliferation and also, at peak levels, creates the progesterone receptors needed to receive progesterone’s apoptotic (cell-death) signal. Without the estrogen peak, progesterone receptors never appear. Cells remain in chronic low-level growth without the counterweight. Static daily-dose HRT, even bioidentical daily estradiol, does not replicate this cycle. The mechanism for why rhythmic dosing might matter is real. The specific doses the Protocol uses are not validated.

    Here is what the major medical bodies have actually said:

    • The FDA has sent warning letters to compounding pharmacies carrying the Protocol for unapproved drug claims
    • The North American Menopause Society has specifically criticized doses “far above clinical practice norms without safety data”
    • The Endocrine Society has flagged the cancer prevention claims as unproven
    • The “period forever” requirement (inducing monthly uterine lining buildup in postmenopausal women) is considered a potential cancer risk by many clinicians

    No randomized controlled trial has tested the Wiley Protocol’s safety or efficacy. “Bioidentical” describes molecular identity, not dose safety. High doses of natural estradiol still carry risks that do not disappear because the molecule matches what the body produces. Wiley the anthropologist interprets the mechanistic research with a clear agenda and without the epistemic humility that clinical uncertainty requires. The co-authors with actual clinical credentials (Taguchi and Formby) validate the science of individual mechanisms, not the Protocol’s dosing targets.

    The causal chains Wiley builds are also a problem. She links artificial light to breast cancer, anovulatory cycles to Alzheimer’s, sleep disruption to oncogenesis, and autoimmunity to cancer-compensatory antibody production. Each individual link may have some support. The complete chain as a proven causal mechanism does not. The autoimmunity theory in particular (that postmenopausal arthritis and psoriasis are functioning as a Herceptin-equivalent anti-cancer system, and that treating them with steroids removes cancer protection) is intellectually interesting and almost entirely speculative.

    The Hormone-Weight Connection Wiley Makes

    For the ExcessMatters audience, this is the relevant thread to pull.

    Wiley’s perimenopausal model is clinically useful even if her protocol is not. Perimenopause, she argues, is mechanistically analogous to early puberty. In both states: estrogen is low and fluctuating, testosterone is rising (via adrenal drive), FSH is elevated and erratic, sleep is disrupted, insulin resistance appears, and ovulation is absent. The difference is that in puberty the system is building toward the first ovulatory estrogen peak. In perimenopause, there are no eggs left to generate that peak. The loop never completes.

    The result is a body stuck in anovulatory mode: enough estrogen to drive cell growth and hunger signaling, without the progesterone peak to balance it. Insulin resistance climbs. Cortisol stays elevated. The weight gain of perimenopause is not a caloric failure. It is a hormonal environment. Chasing it with restriction tends to raise cortisol further, which makes the insulin resistance worse.

    The chronobiology piece connects here too. Poor sleep raises ghrelin (hunger hormone) and drops leptin (satiety hormone), independently of calories consumed. Perimenopausal sleep disruption is a driver of weight gain through this route, not just a side effect of it. Fixing the sleep environment (light exposure, sleep timing, cortisol management) is a metabolic intervention, not just a wellness recommendation.

    What Wiley gets right on this topic: hormones drive weight in perimenopause, and treating the symptoms without addressing the hormonal environment is incomplete. What she overstates: the specific idea that the Wiley Protocol’s doses are the correct intervention for this, without any clinical trial data to support it.

    Is Sex, Lies, and Menopause Worth Reading?

    Read this if you want to understand the WHI controversy in depth, you’re evaluating hormone therapy options and want the bioidentical/synthetic distinction explained in detail, or you’re interested in the chronobiology of sleep and hormones. Read the first half critically and carefully.

    Skip it if you need clinical guidance on what to actually do about menopause. This book is not a prescription guide, and using it as one carries real risk. For evidence-based HRT guidance, Menopause Bootcamp by Suzanne Gilberg-Lenz is a better starting point. For the mainstream academic defense of hormone therapy (without Wiley’s dosing extremism), Estrogen Matters by Bluming and Tavris covers the same WHI critique with far more evidentiary rigor.

    One caveat: Wiley’s argument that pharmaceutical economics distort which treatments get studied is correct and important. But the conclusion she draws from it (that the Wiley Protocol must therefore be safe because it hasn’t been funded to be studied) is a logical gap wide enough to drive a truck through. The absence of industry funding for a treatment is not evidence of that treatment’s safety. It is evidence of how research funding works.

    The book’s most honest summary may be this: the difference between bioidentical and synthetic hormones matters, rhythmic dosing is theoretically superior to static dosing, and pharmaceutical economics do shape which treatments get studied. None of that requires accepting the Wiley Protocol as proven, or accepting high-dose untested therapy as safe because the argument for it is compelling. Compelling arguments and proven safety are different things.

    Books Like Sex, Lies, and Menopause

    BookAuthorBest For
    Menopause BootcampSuzanne Gilberg-Lenz, M.D.Evidence-based HRT guidance without the controversy
    The Hormone MythRobyn Stein DeLucaHealthy skepticism about hormone claims
    Hormone IntelligenceAviva Romm, M.D.Integrative balance on women’s hormones
    The Power of HormonesMax NieuwdorpReal endocrinology, accessible and credible
    The Science of MenopauseMary Claire Haver, M.D.Clinical facts, current guidelines