Excess Matters

Tag: symptoms

  • 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

  • Menopause Bootcamp by Suzanne Gilberg-Lenz: Summary, Key Ideas & Review

    Book in one sentence: A Harvard-trained Beverly Hills OB-GYN dismantles two decades of hormone therapy fear and hands you the clinical vocabulary to actually advocate for yourself.

    What Is Menopause Bootcamp About?

    Two years before writing this book, Suzanne Gilberg-Lenz decided to stop coloring her hair. Her hairdresser of fifteen years went ahead and mixed up the chestnut dye anyway, without asking. When she questioned him, he said: “You’re not ready.” She spent the next two pages of her introduction unpacking that exchange, because it captures something real about what women face going into this transition: everyone has an opinion, the opinion is usually about looking younger, and nobody asks.

    Gilberg-Lenz is a board-certified OB-GYN who trained at Cedars-Sinai and has been running in-person Menopause Bootcamp groups in Southern California for years. She is also a clinical Ayurvedic specialist, which shapes the book’s integrative tone without sacrificing the clinical rigor. What she built in this book is essentially the education her private patients receive, structured around biology, symptoms, mental health, nutrition, movement, and community, in that order.

    The “bootcamp” framing is intentional. Rather than treating menopause as something to endure quietly, she positions it as a transition you can study, prepare for, and move through on your own terms. “Your mother’s menopause is not your menopause” is the organizing spirit. The science has changed, the treatment options have expanded, and the cultural silence around the whole thing is costing women their health.

    She opens with a number worth sitting with: a 2013 Johns Hopkins survey found that 67% of OB-GYN residents reported limited knowledge of why menopause symptoms occur, 68% didn’t know enough about hormone therapy, and 72% needed to learn more about cardiovascular disease. These are the doctors most women see first. Gilberg-Lenz wrote this book partly because she got tired of watching women come in undertreated, dismissed, and relieved that someone finally asked.

    What Does Gilberg-Lenz Say About HRT?

    The HRT chapter is the one that will make you want to hand this book to your doctor. It is balanced in a way that most consumer menopause books are not, neither reflexively pro-hormone nor still trembling from the 2002 Women’s Health Initiative fallout.

    Here is the short version of what happened with the WHI: The study appeared to show that hormone replacement therapy raised the risk of heart disease and breast cancer. Prescriptions plummeted almost overnight. Women flushed their pills. A generation of doctors stopped recommending it, and millions of women were left to manage severe symptoms with nothing.

    What the WHI actually showed, and what got distorted, is the subject of careful unpacking in this chapter. The average participant was 65, meaning most were ten-plus years past their menopausal transition. Many had preexisting cardiovascular disease. The hormones used were Premarin (conjugated equine estrogen) and Provera (a synthetic progestin called medroxyprogesterone acetate), not the body-identical estradiol and micronized progesterone that thoughtful prescribers now use. The study’s conclusions were applied far more broadly than the data warranted.

    What the research since then supports:

    • Transdermal estradiol (patch, gel, spray) carries meaningfully lower clot risk than oral estrogen
    • Micronized progesterone (sold as Prometrium) appears safer regarding breast cancer risk than synthetic progestins (Gilberg-Lenz avoids synthetic progestins in her own practice for exactly this reason)
    • The “timing hypothesis”: initiating MHT within 10 years of menopause onset, or before age 60, is associated with cardiovascular protection and possibly cognitive protection
    • Women who start early are not in the same risk category as the WHI population

    Gilberg-Lenz is direct about the limits of this, too. She’s not saying hormones are safe for everyone. She’s saying individual assessment matters, formulation matters, and the blanket fear many women carry is based on data that no longer reflects how MHT is prescribed. Her own framing:

    “The conclusion we clinicians draw from this study now isn’t that hormones are actually 100 percent safe; it’s that the data can’t be applied as broadly as we had expected or hoped.”

    She also addresses genitourinary syndrome of menopause (GSM) with particular emphasis (the cluster of vaginal dryness, painful intercourse, and recurrent UTIs that affects a large portion of postmenopausal women). Unlike hot flashes, which often diminish over time, GSM worsens without treatment. Low-dose local vaginal estrogen has minimal systemic absorption and is considered safe by major oncology organizations even for most breast cancer survivors. Many oncologists haven’t communicated this to their patients.

    Why Does Menopause Cause Weight Changes?

    Fat moves. That is the clearest way to describe what happens metabolically during the menopausal transition. Weight that previously distributed to hips and thighs tends to shift to the midsection, insulin sensitivity changes, and the body’s response to food, exercise, and sleep shifts in ways that feel like a betrayal. It is not a personal failure. It is physiology.

    Gilberg-Lenz addresses this without catastrophizing and without handing you a diet. The nutrition chapter (Chapter 9, “Eat for Health and Joy”) is one of the most useful for ExcessMatters readers because of what it doesn’t do: it doesn’t give you a meal plan, it doesn’t prescribe macros, and it explicitly warns against the orthorexia she has seen develop in patients who follow rigid clean-eating protocols.

    Her nutrition principles for menopause are anchored in blood sugar stability and anti-inflammatory eating:

    • Protein and fiber at each meal to support blood sugar and reduce hot flash frequency
    • Plants, omega-3s, and fermented foods as the anti-inflammatory core
    • Alcohol and ultra-processed foods minimized, not as moral rules but because of how they interact with inflammation, sleep disruption, and hot flash severity

    The alcohol point is consistent across multiple chapters. Alcohol disrupts sleep architecture, worsens hot flash frequency and severity, is pro-inflammatory, and accelerates cognitive aging. For women who have used wine as a stress management tool in midlife, she treats this as clinical data rather than a character judgment.

    Strength training is presented as non-negotiable for this stage. Not optional, not vanity. It builds bone density (critical as estrogen declines), preserves muscle mass that would otherwise erode, supports metabolic rate, and improves body confidence in ways cardiovascular exercise alone does not. The movement chapter does not suggest punishing your body into a different shape. It makes the case for movement as protective care.

    The body image thread running through the whole book is worth naming. The chapter titled “Breaking Free from the Societal Bullshit” is not a feel-good affirmation section. It is a structural argument about ageism, the sexualization of youth, and the cultural silence around menopause that makes this transition feel shameful when it is, in fact, normal. Gilberg-Lenz practices in Beverly Hills (her description: “ground zero of the absolutely insane notion that only women who are young are worthy of attention”) and does not pretend she’s immune to those pressures. What she offers is not “love your body.” It’s a more honest reframe: the shame doesn’t belong to you, and here is why.

    What About Mental Health and Mood?

    There is a statistic in this book that deserves more attention than it gets. Researchers followed 29 premenopausal women through their final menstrual period and found that in the 24 months surrounding that endpoint, the risk of onset of depression was 14 times as high as during a 31-year premenopausal period. Six of the nine women who became depressed had never had a depressive episode before.

    Women struggling through this are not just having a hard time emotionally. Estrogen modulates serotonin, dopamine, and GABA systems directly. When it declines, there are neurological consequences. The mood instability, sudden tearfulness, and rage that many women experience in this transition are partly hormonal, partly treatable by addressing the hormonal shift itself.

    Gilberg-Lenz’s clinical sequence for this is one of the most actionable frameworks in the book:

    1. Address physical foundations first: sleep, movement, alcohol, and nutrition each function as direct mental health levers. Many women who have been prescribed antidepressants for menopause-driven mood changes would have responded to treating their night sweats or eliminating nightly wine.
    2. Evaluate whether what remains is hormonal. MHT can function as an antidepressant for hormonally driven mood disorders.
    3. Assess for clinical depression or anxiety that warrants therapy and/or medication independent of the hormonal transition.

    The cognitive protection angle also gets serious treatment here. Estrogen has documented neuroprotective effects. The timing hypothesis extends to the brain: MHT initiated early in the transition may reduce Alzheimer’s risk; late initiation may not confer the same benefit. For women with family histories of dementia, she treats this as one of the most consequential treatment decisions in the transition.

    She also covers the medical system’s failures directly, in a chapter she titled “Prejudice in Medicine.” Women were systematically excluded from clinical trials for decades. Black women’s pain and self-reports are documented to be discounted in clinical settings. LGBTQIA+ patients face assumptions that impede accurate care. Gilberg-Lenz does not present this as background context. She builds it into the self-advocacy guidance: enter appointments prepared, use clinical language, ask for the reasoning behind any dismissal, and seek a second opinion from a NAMS-certified menopause practitioner if your current provider lacks expertise.

    Is Menopause Bootcamp Worth Reading?

    Read this if you are in your 40s or 50s and your doctor has minimized your symptoms, if you have avoided the hormone therapy conversation because of fear from the WHI fallout, or if you are experiencing mood changes, sleep disruption, or weight redistribution that feel tied to hormonal shifts and want to understand why. It is also worth reading if you want language and evidence to advocate for yourself more effectively in medical appointments, or if you have a history of estrogen-receptor-positive breast cancer and want to understand what treatment options still exist.

    Skip it if you are well past the transition with an established, satisfying care team and are looking for a strictly evidence-based resource with no integrative medicine. Gilberg-Lenz’s Ayurvedic training shapes the book, and while her clinical standards are solid, the integrative framing occasionally outruns its evidence base. Readers who are skeptical of that framework will find moments of friction.

    One caveat: The book’s scope is broad (biology, symptoms, mental health, nutrition, movement, supplements, community) and some sections go deeper than others. The GSM section contains genuinely important clinical information that is easy to miss because it is embedded in a longer symptom chapter. If vaginal dryness and painful sex are your primary concerns, you may want to supplement with a specialist consultation alongside this book.

    It won’t replace a good doctor. Gilberg-Lenz is clear about that. What it does is make you a much better patient.

    Books Like Menopause Bootcamp

    BookAuthorBest For
    The Menopause BrainLisa MosconiDeeper dive on cognitive changes, Alzheimer’s risk, and neurological effects of estrogen decline
    The New MenopauseMary Claire Haver, MDMore clinical, less integrative; strong on HRT protocols and symptom management
    The Menopause Diet PlanHillary Wright & Elizabeth WardFocused specifically on nutrition, weight, and metabolic changes during menopause
    Unlock Your Menopause TypeHeather Hirsch, MDPersonalized approach to symptom patterns; good companion if Bootcamp feels too broad
    Hormone IntelligenceAviva Romm, MDBroader hormonal health lens; covers perimenopause and cycle irregularity in more depth

  • Unlock Your Menopause Type by Heather Hirsch: Summary, Key Ideas & Review

    Book in one sentence: A Harvard-trained menopause specialist lays out six distinct symptom profiles and builds a personalized treatment plan for each one, because “there isn’t a one-size-fits-all approach to dealing with menopausal discomfort.”

    What Is Unlock Your Menopause Type About?

    Picture a doctor’s appointment that goes like this: you describe symptoms that have stolen your sleep, your concentration, and your sense of self. Labs come back fine. The doctor says something like “this is normal” and sends you home with nothing. You leave wondering if you are, somehow, the problem.

    Heather Hirsch has spent her career treating the aftermath of that appointment. As clinical program director of the Menopause and Midlife Clinic at Brigham and Women’s Hospital in Boston, she sees women who have been bounced around for months or years, collecting diagnoses that don’t fit and suffering through symptoms no one has connected to the obvious culprit. By the time they reach her, many are, in her words, “at the end of their ropes.”

    Her book’s core argument is simple and worth stating plainly: women are not all experiencing the same menopause. A framework built on averages and population data will fail most of them, because most of them are not average. Hirsch’s six-type model came out of pattern recognition across thousands of clinical encounters. It is a diagnostic shortcut designed to do what a rushed generalist rarely has time for: match your specific symptom cluster to a specific treatment hierarchy.

    The book is clinical, organized, and refreshingly free of wellness-industry noise. Hirsch trained at Harvard and the Cleveland Clinic. She cites the North American Menopause Society guidelines, she names drugs by their actual names, and she tells you when a treatment is well-supported versus still emerging. For a reader who has been burned by social media menopause gurus, that credibility matters.

    What Are the Six Menopause Types?

    This is the core of the book. The types are based on onset timing, which body systems are most affected, duration, and functional impact. Two types can overlap (she calls that a hybrid).

    The Premature Menopause Type covers periods ending before age 40 (or between 40 and 45, which Hirsch calls early menopause). The issue here is not just managing current symptoms. Decades of estrogen deprivation dramatically elevate long-term risk for heart disease, osteoporosis, mood disorders, and cognitive decline. Hormone therapy in this context is physiological replacement, not optional symptom management, and doses are higher to reflect that.

    The Sudden Menopause Type arrives via oophorectomy, chemotherapy, radiation, or abrupt ovarian failure. It bypasses the gradual perimenopause transition entirely, dropping estrogen fast and hard. Symptoms tend to be more severe because there was no runway. Hirsch also addresses the psychological dimension: women navigating surgical menopause after cancer treatment are processing identity loss and existential shock alongside hot flashes, and that processing is clinically important.

    The Full-Throttle Menopause Type is the simultaneous, everything-at-once presentation: hot flashes, night sweats, sleep disruption, hair loss, weight gain, joint pain, libido loss, brain fog. All at once. Hirsch describes women with this type as feeling “like they’ve been hit by a truck.” Her core treatment strategy here is triage: identify the single most distressing symptom, treat that first, and address downstream effects before layering anything else.

    The Mind-Altering Menopause Type shows up mostly from the neck up: brain fog, word-finding difficulties, working memory deficits, anxiety, depression, mood instability. This is the type most likely to be misread as a psychiatric problem, aging, or stress, especially when vasomotor symptoms are minimal. Women with a history of severe PMS, postpartum depression, or prior major depression are at elevated risk for this type. They are also the women most likely to spend years cycling through antidepressants without anyone noting the menopausal connection.

    The Seemingly Never-Ending Menopause Type is exactly what it sounds like: one or two symptoms that started at menopause and simply never resolved. Vaginal dryness, painful intercourse, recurrent UTIs, occasional hot flashes. Six years out. Ten years. Fourteen. Women with this type often stop reporting because they are embarrassed or have resigned themselves to it. The clinical reality is the opposite: genitourinary symptoms worsen over time without treatment. The window for intervention does not close.

    The Silent Menopause Type has no perceptible symptoms, which sounds like the lucky outcome until you understand what is quietly accumulating. Bone density declining. LDL rising. Blood pressure trending up. Vaginal tissue thinning without pain yet. Insulin resistance establishing itself. The American Heart Association designated the menopausal transition as an independent cardiovascular disease risk factor in 2020. Women with this type are at disproportionate risk of delayed diagnosis on all of these fronts because they have no reason to seek care.

    “Your mother’s, sister’s, neighbor’s, or best friend’s experience with menopause is likely to be quite different from yours, so interventions that helped them may not help you.”

    What Does Heather Hirsch Actually Say About Hormones?

    The Women’s Health Initiative published its alarming findings in 2002 and effectively froze menopause medicine for nearly two decades. Hormone therapy went from mainstream to radioactive. Women who had been managing their symptoms well were taken off HRT. And for twenty years, millions of women either suffered through debilitating symptoms or navigated a chaotic supplement market because no one in their care team felt safe prescribing.

    Hirsch devotes a full chapter to what the WHI actually studied and what it did not. The WHI was not designed to evaluate hormone therapy for symptom relief. It studied women aged 50 to 79 (average age 63, many more than a decade past menopause) and looked at whether hormones could prevent chronic age-related disease. The breast cancer findings that made headlines applied to a specific synthetic hormone combination in a population much older than most women seeking perimenopause treatment.

    The picture that emerged from subsequent analysis is different. For healthy women under 60 who are within 10 years of menopause onset, the benefits of hormone therapy generally outweigh the risks. This is now the position of the North American Menopause Society.

    A few practical distinctions worth knowing:

    • Route matters. Transdermal estrogen (patches, gels, sprays) bypasses first-pass liver metabolism, which means lower clotting risk and less blood pressure effect than oral estrogen. For women with hypertension, high cholesterol, diabetes, or migraines, transdermal is the preferred route.
    • Progesterone applies to anyone with a uterus. Systemic estrogen without progestogen protection risks the uterine lining. Women who have had hysterectomies can use estrogen alone. Micronized progesterone (Prometrium) has a different risk profile than the synthetic progestin used in the WHI.
    • “Bioidentical” does not automatically mean safer. Standard pharmaceutical estradiol is chemically identical to the estrogen your body produced and is FDA-regulated. Compounded formulations are not. The term has been absorbed by marketing in ways that obscure this.
    • Contraindications are real. Estrogen-receptor-positive breast cancer, unprovoked blood clot history, prior heart attack or stroke are legitimate contraindications. Hirsch covers non-hormonal alternatives for every type.

    Non-hormonal options get substantial treatment here, which matters because many women either cannot use HT or choose not to. For vasomotor symptoms, first-line options include SSRIs and SNRIs at low doses, gabapentin, and oxybutynin. For genitourinary symptoms, low-dose vaginal estrogen delivers local treatment with minimal systemic absorption and is often available even to women with estrogen-receptor-positive breast cancer history, with oncology guidance.

    Why Does This Matter for Weight and Metabolism?

    The weight piece is woven throughout the types rather than siloed into its own chapter. That is actually useful, because the metabolic changes of menopause are not uniform across women.

    For the Full-Throttle Type, sleep disruption is often the primary driver of weight gain. When sleep is shattered by night sweats, cortisol rises, leptin falls, ghrelin rises, insulin resistance climbs, and the appetite regulation system stops working properly. Treating sleep first, Hirsch argues, partially resolves what many women experience as separate symptoms: the irritability, the weight creep, the afternoon brain fog. Getting sleep right reduces the complexity of everything else.

    For the Silent Type, the metabolic changes are accumulating without any obvious signal. Insulin resistance is establishing itself quietly. Central fat is redistributing toward the abdomen (what Hirsch calls the “menopot”) regardless of whether the scale has moved. The absence of symptoms is not evidence that the body is not changing. This is the type that most benefits from proactive metabolic monitoring.

    For the Mind-Altering Type, the connection runs through the adrenal axis. When the ovaries wind down, the brain turns to the adrenal glands for hormonal support. The adrenals respond with cortisol instead of estrogen, which worsens metabolic dysfunction, promotes abdominal fat storage, and contributes to the cognitive fog.

    Hirsch’s four-pillar self-care model applies to all types: Mediterranean-style eating, weight-bearing exercise, consistent sleep hygiene, and active mental health management. On nutrition, she is specific where other books are vague. Adequate protein (at least 20g per meal for Sudden Type women recovering from surgery, for example), cardiovascular-protective eating for Silent Type women, and anti-inflammatory focus where chronic symptoms are driving tissue damage. The approach is not a diet; it is a metabolic maintenance framework calibrated to type.

    Is Unlock Your Menopause Type Worth Reading?

    Read this if you are in perimenopause or postmenopause and have not received satisfying answers from your current provider. It works especially well as a pre-appointment tool: reading it before a gynecology or primary care visit gives you the vocabulary to describe your type, ask specific questions, and push back if you are being dismissed. Women navigating premature or surgical menopause who have only seen generalists will get the most out of it.

    Skip it if you are already working with a knowledgeable menopause specialist. You will be covering familiar ground. Women with complex medical histories (chronic autoimmune disease, eating disorder history, multiple psychiatric medications) may find the type-specific protocols require more individualization than the book can provide; in those cases it is a starting point, not a complete answer.

    One caveat: the treatments Hirsch describes (specialist menopause clinic care, multiple medication trials, pelvic floor therapy, testosterone prescribing) are available to a relatively small subset of women. Many readers will absorb the framework and then encounter a generalist who does not share it. That is not a failure of the book. It is a failure of the healthcare system the book is written around. Go in prepared for the gap.

    “After spending years putting other people first, some of my patients have embarked on new careers, taken up new hobbies or artistic pursuits, enjoyed exciting travel adventures, volunteered for meaningful causes, or discovered the best sex of their lives after menopause.”

    If you have ever been told “this is just menopause” as if that were a complete sentence, this book was written for you.

    Books Like Unlock Your Menopause Type

    BookAuthorBest For
    Menopause BootcampSuzanne Gilberg-Lenz, MDA warmer, more narrative take on the same evidence-based menopause landscape
    Super Woman RxTaz Bhatia, MDSimilar typing/quiz approach, broader hormonal scope beyond menopause
    The Menopause BrainLisa Mosconi, PhDDeep neuroscience on cognitive changes; the research behind Hirsch’s Mind-Altering type
    The Hormone ShiftTaz Bhatia, MDPerimenopause-focused, integrative approach, practical protocols
    The Science of MenopauseMary Claire Haver, MDDenser on clinical research; pairs well with Hirsch for a complete evidence picture

  • 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