Episode 118 | Feb 20, 2025

Strength, Hormones, & Women’s Health, With Dr. Stephanie Estima

What role does strength training play in women’s health, especially through midlife? On this episode of Health Coach Talk, Dr. Sandi welcomes Dr. Stephanie Estima, chiropractor, author, and expert in women’s metabolic and hormonal health, to discuss how exercise, nutrition, and lifestyle choices impact female physiology. Their conversation explores the importance of muscle preservation, the hormonal shifts that influence body composition, and how women can adapt their training and nutrition to optimize their health at every stage of life.

“We don’t want to just work out in the gym to get good at working out at the gym. We also want to work out in the gym so that we can get good at life… We want to develop strength, which is something that is very important for women as we age.”

Stephanie Estima, DC

Dr. Stephanie’s journey began in chiropractic care, where she developed a deep appreciation for neuroscience, biomechanics, and the intricate connection between the nervous system and movement. Over time, she observed stark differences in how men and women responded to the same health interventions—particularly when it came to weight loss, muscle development, and metabolic health. This realization led her to focus on women’s health, particularly in the areas of hormones, strength training, and personalized nutrition strategies. Her own experiences with hormonal imbalances, menstrual cycle challenges, and midlife stressors further fueled her passion for helping women understand their bodies and reclaim their health.

In this conversation, Dr. Stephanie shares key insights on how women’s hormonal fluctuations impact everything from metabolism to muscle growth. She discusses why traditional diet and exercise advice—often modeled on male physiology—fails many women, especially as they enter perimenopause and menopause. From understanding how estrogen and testosterone affect strength to recognizing the role of protein in muscle maintenance, she offers practical strategies for adapting fitness routines and dietary choices based on the body’s natural cycles. She also highlights how resistance training is essential not only for body composition but for long-term health, injury prevention, and metabolic function.

Health coaches play a vital role in helping clients navigate these physiological changes with personalized guidance. Dr. Stephanie’s approach aligns with the functional medicine philosophy of tailoring health strategies to individual needs rather than following a one-size-fits-all model. By understanding the science behind hormones, muscle growth, and metabolic shifts, coaches can empower their clients to make informed choices about strength training, nutrition, and recovery—leading to better long-term health outcomes.

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Transcript

Dr. Sandi: When I was in my early 40s, if you had asked me what perimenopause is, I would have said, ‘What? What are you talking about? I have no idea what that is.’ And I can also say that I really didn’t know too much about menopause from my mother. I remember her having conversations with her friends, with her sisters, talking about the change. Someone was going through the change, but I was pretty clueless. And I got to admit, even when I was younger, when I was in my 20s, I wasn’t really that aware of the natural cycle, about hormone balancing, and so that’s why, when I brought on my guest that you are going to absolutely love, I was really amazed at how much more we know today, and a lot of that knowledge has to do with people who are the trailblazers, and one of them is Dr. Stephanie Estima. She is really shedding light on this subject, both for young women who are still getting their periods, as well as for older women like me who are well into menopause. So in this conversation, we talk all about exercise for women, we talk about protein and other nutritional needs. And so I think you are going to really enjoy this conversation.

But first, let me tell you about our guest, Dr. Stephanie. She is a prominent health expert, and she specializes in female centric health span, lifespan and performance. She has a background in chiropractic care, and as a result, she also has a deep understanding of neuroscience, metabolism, nutrition, exercise, physiology and biomechanics, and she empowers women to make informed health decisions. She has a very significant contribution the Estima Diet. Her book has really been a best seller, Betty Body. She has a program designed specifically for women that aligns dietary and exercise regimens with hormonal cycles. She’s also, again, the author of the best selling book, The Betty Body, which offers guidance on intuitive eating, hormone balance and overall health. But in addition, she has a hit podcast, which is called Better and that is where she engages in discussions on various health topics, including nutrition, fitness, hormones and stress management, and it is a top podcast. Her work has been featured in various media outlets. So I am really thrilled to bring to you this conversation that I had with Dr. Stephanie Estima. You are a legend, and I’m so excited to talk with you, Stephanie.

Stephanie: Oh, thank you so much. That is so kind. I receive that with love, and may I also just say a huge fan of yours for many, many years. So, this is just a thrill for me. Thank you for having me here.

Dr. Sandi: Thank you. You got started in something completely different. You were a chiropractor by training, and so many people do start out one area and then where they end up, what’s their passion, is not often where they began. So do you mind sharing that journey? What was that period like where you were working as a chiropractor but then you transitioned, you were focused on only brain health. But how did you then come to where you are now, you know, focusing on hormones, on meals, on muscle? I wanna talk about all that.

Stephanie: Yeah, thank you so much. Yeah, so you’re right. My training is I’m a doctor of chiropractic, and chiropractic is a study of the neuromuscular skeletal system, right? So, my first love, even my undergraduate degree, is in neuroscience and psychology. So, I’ve just had a longstanding affair with neurology, brain function, how that can in real time change someone’s posture, change someone’s tone. And when I say tone, I’m talking about qualities of the nervous system, not like how muscle looks. So, like, hypertonia, hypotonia, atonia, that kind of thing.

And in my practice, a big part of the curriculum in most chiropractic colleges, and I can say for sure in mine, having gone through…I was a graduate of the Canadian Memorial Chiropractic College in Canada, was a big focus on biomechanics, big focus on musculoskeletal health. And so, that was a really nice pairing for me along with the neurology of my undergrad, and then of course, some of the continuing education programs that I took as a student and as I continued as a doctor in private practice.

So, there’s always been, like, a love of exercise physiology, of how nutrition can affect our moods, or how it can affect our ability to reduce inflammation. It was just a different application of it. So, I had patients coming in with concussions. I had patients coming in from car accidents. I had patients with chronic headaches and period migraines, and, like, all these different presentations that chiropractic certainly can address. And then just with time, I think my…I feel like my ability to affect women’s health, I started really… We would run nutrition programs in the clinic, and I would notice men and women, you know, caring for men and women, and men and women, like, especially when it was like a husband and wife couple, they would sign up for a nutrition program.

And the guy, two weeks would go by and he would lose 10 pounds, 15 pounds, 20 pounds, and he was like, “This is the best program ever.” And then his wife, who’s literally doing the exact same thing, living in the same home, you know, maybe drops two pounds, maybe she’s, like, dropped four initially, but she’s gained back two. So, it was really interesting for me how men and women respond differently to the same stimulus. And so, I’ve pivoted a little bit insofar as I focus mainly on females now, but the exercise, science, the biomechanics, the joint health and mobility, that is still very much alive and kicking in what I like to talk about now, because it’s so important, and I think it’s so…I mean, I’m sure we’ll talk about this, but it’s so important in midlife. Like, you can kind of get away with ignoring it if you’re 20. You can sort of fast and calorically restrict, maintain a certain figure, but when you’re 40s and 50s, we really do have to smarten up, and I say that with love, smarten up, and really start taking care of ourselves in a way that will set us up not only for health now, but of course, you know, into our post-menopausal years as well.

Dr. Sandi: Yeah, absolutely. Well, I love what you say in that example of the husband and wife, that women are not just little men with hormones. And so, their needs, their nutrition needs, may be quite different. And so, you have focused a lot on that perimenopause, menopause transition. And I know you had some issues that started when you were like 38.

Stephanie: Yes. Well, before that, but I wrote a book sort of compiling all the problems that I had. I sort of always…so for me, I guess this is really…I’ve always done this. When I was first pregnant with my first child, I was so into everything pregnancy. Like, I was taking pediatric courses. I was getting degreed in, like, pediatric chiropractic and, like, what tongue-tied looks, all the things. And so, I was so into that. And then, you know, I also struggled. So, the question that you’re asking me is I struggled with my menstrual cycle for decades.

So, in my 20s, in my 30s, and I really chalked it up for a long time to just, like, “This is just, like, the curse of being female.” I have at least two bad weeks every month, sometimes three bad weeks every month. I had, like, one good week and that was, like, when my period finished. And I never, in all my intelligence, like, all my training, all my schooling that I had on top of the degree that I had, all the extra courses and things I was taking, I never for a moment thought that maybe the way that I’m treating myself is, just like you said, it’s like I’m just a small man with more hormones. That’s literally how I looked at it. I was like, “You have to white-knuckle your way through this. You have cramps, like, suck it up, buttercup. Punch it out.”

And it went on and on like that for years and years and years. And then it was around…I think it was around when I was…must have been 37, 38, my clinic burned. I had a fire in the clinic. So, the entire clinic was burned down. And within the same month, my husband at the time and me, we decided to split up. Anybody who’s listening, break up, married or not, is difficult at any point. We had young children at the time. So, my children were five and three. And so, there’s that extra layer of taking care of the children and making sure that they’re gonna be okay. So, that was very, very stressful for me. And my menstrual cycle was a gong show before that, and it just got absolutely worse during that year.

And so what I ended up doing was taking an extended holiday from practice. I took my kids over to Europe. We were getting daily sunshine, daily walks, fresh if you’ve ever traveled to Italy, and pasta bothers you, you know, this side of the pond if you are in the States or Canada, and you have pasta or gelato or whatever, ice cream, and you’re like, “I can’t handle it.” But then you go to Italy and you’re like, “Weird, I can totally handle the pasta here.” The same happened with me. I was able to have pasta, no bloating. I was sleeping.

I actually got my period towards the end of that trip, which would normally require several painkillers. I would usually have a headache, like, what we now call menstrual migraines leading up to and then the onset of my period. But I didn’t have any of that. And it was some of these really basic principles of functional medicine, right? It’s like, “Get out in nature. Get regular…align your food with the sunlight. Walk after dinner. Get early morning light. Reduce your stress. Eat fresh local food.” These were some of the things that really in a very short amount of time changed bleeding experience. Like, I was like, “Oh, we’ve been here for three weeks and I feel amazing.”

My period felt amazing. And so, when we came back home, I said, “Okay, I know that Italy is amazing. Everything’s better in Italy, maybe, but it’s still my body that did it.” My body is the same when it’s in North America as it is when it’s in Europe. So, can I bring some of these principles back home and start building on them? And that’s sort of the body of my first work, my first book, “The Betty Body,” which is all about basically menstrual cycle literacy, what happens every week of your menstrual cycle from a hormonal perspective, how you might think about your nutrition differently over the course of your menstrual cycle, how you might think of your training differently over the course of your menstrual cycle. How you might predict changes in sleep, changes in temperature, changes in mood, and not to run away from it the way that I did. Like, the book is like, “Just basically don’t be me. Like, here’s all my mistakes. Don’t run away.”

I’ll say this very quickly. A part of the book, I talk about the emotional…like, the exquisite sensitivity that so many women have in that fourth week. Like, right before they start bleeding, they’re crying at commercials or they’re irritated by their husbands. And all of that is just your body asking you to pay attention to the things that are out of alignment in your life. And I, as a sort of achievement-oriented person, completely ignored that. It was like, “Oh, these stupid emotions again, here we go.” And I would try to bury them. And it was exactly those things that were bothering me that were the things that needed tending to in my life.

So, that’s sort of a back-of-the-envelope backstory in terms of my focus on menstrual cycle literacy for women. I can’t tell you, I’ve had, I don’t know, like, thousands of women reach out to me and they’re like, “You know, I’m 42. I just picked up your book, and I never thought to track my cycle before reading it.” And it’s like, “Okay, if that’s the one big takeaway that you got from the book, like, I’ve totally won,” if you can actually learn your cycle, learn the rhythm and the cadence of your cycle, because it is a bit of a unique…you know, there’s a lot of bio-individuality in terms of what we consider normal, but then, like, learning your own cycle so that as it changes, you can say, “Oh, this is a little different.” Like, flow’s a little different, length’s a little different, quality of the blood is a little different. I think that that allows you to forge a deeper relationship with yourself.

Dr. Sandi: This is so inspiring for listeners. And what I’m taking away is that we have changed, we have come so far. And what you’ve just described, this is a revelation. And my generation, we were the dark ages. So, we would talk about, you know, “I got my friend.” That was…

Stephanie: Right. And flow is visiting.

Dr. Sandi: We would hear our mothers say, “We’re going through the change.”

Stephanie: The change.

Dr. Sandi: But the idea, I had no idea. And I was a psychologist, and I focused on stress. And I would see these women who were prescribed antidepressants, but nobody was tracking their cycles. We were not talking about the importance of what you’ve just described: being out in nature, getting sun, some real basic things. But nobody was talking about that back then. And you mentioned 38 or around that period being pivotal for you. And I had a second child at 38. I was working fulltime. And I was a vegan. And I was addicted to cardio. And wondering why I was feeling so exhausted. “Oh, I’ll just eat more kale.” That was the height of the fat-free movement. I can imagine during pregnancy, I was probably getting such a limited amount of fat because we were so scared of fat in those days.

And also focusing on surface-level things like appearance as opposed to working out for health and to preserve muscle. We had no idea back then. And in fact, it was not ladylike or you didn’t want to… I think I heard somebody the other day who was my contemporary, “I don’t wanna lift weights. I don’t wanna bulk up.” And so we still have that myth. I know that you have focused a lot on meals and muscle. Can you talk about those two? Because that is part of my mission to inspire people to preserve muscle, to even gain muscle. I’ve been gaining muscle even though I’m turning 75. And it is possible. But it also took radically changing what I eat.

Stephanie: Yeah. First of all, I think I just told this to you before we got recording. If any of you are not following Dr. Sandra on a social, like, the girl can deadlift. It’s really lovely and really inspiring to see that. So, that is still a…I think it’s changing now, but that is still a persistent myth, which is, “I’m gonna bulk up.” And it’s like, “Oh, if only I could.” It’s like, “If only.” I would die to bulk. I would die to have more muscle. Like, I would love to have more muscle. You know? So, that is a myth that does need to die.

I think the other myth around muscle, specifically for women, so, I like you, you know, I grew up, I was very much influenced by the culture in the ’80s. You know, born in ’77. So, like, I was watching Kate…it was kind of the low… What was it? It was like low fat, high carb. That was sort of, like, the big push at the time. And I remember my mom going… We were living in Canada. And so, she would literally go across the border to Buffalo, which is, like, the closest American city to us. And then she would just get all the fat-free things that were not available in the grocery stores. And, like, we would just go shopping across the border and then come back. So, yeah, fat-free, grew up in that fat-free high carb kind of life.

And then I remember in the ’90s, when I was, like, a teenager, Kate Moss was, like, the supermodel at the time, very much like, I guess you might call her like a waif. Like, she was very, very thin. And I remember looking at that and I was like, “I don’t care if I count out my 10 grapes and my 2 almonds as my snack. Like, there’s no way I’ll ever look like that. Like, my hips are bigger than her head. You know? I’m not built that way.” And the other thing too, I think for women our age, is that we grew up in the cardio section of the gym, like you said, like cardio every single day, you know, on the elliptical, on the treadmill, on the bike, whatever it is.

For a lot of women now in midlife, 40s, 50s, and beyond, now we’re hearing this like, “Oh, you have to have muscle.” Like, now, you don’t wanna be a cardio bunny anymore. You wanna be a muscle mommy, right? So, go to the weight section of the gym. It’s like, “Well, what does that even mean? Am I gonna hurt myself? I don’t wanna lift heavy weights. What if I injure my joints? Like, I have arthritis,” or whatever it might be. And so, there are some considerations. I think there’s some subcategories there.

I will say that every woman can probably lift heavier than she thinks. If you are a mother, you know that your baby weighed somewhere between, probably on average, five to nine pounds. Like, my first child was 8.3. My second child was 9.1. But, you know… Didn’t walk for a week.

Dr. Sandi: Big babies, yeah.

Stephanie: Yeah, big babies, but maybe your baby was like six pounds or seven pounds. So, that’s seven pounds. And then you put that baby in the carrier, right? Like, in the little thing that goes in the car, the car seat thing that kind of goes on the stroller as well as in the car seat, that thing’s 10 pounds. So, already, we’re at like…let’s say your baby’s 6 pounds, you’re at like 15, 16 pounds on one arm. So, why are you not lifting a 15-pound weight at the gym? Like, put down, you know, the pink two pound weights. Like, you can lift a little more than that.

And I think that we can lift. There can be a couple of reasons. Like, I got into the gym and lifting in the gym, like, be honest, like, I wanted to look good. Like, I wanted to look good in my shorts and my bikinis and all the things. So, if that’s how you found muscle, fine. But we don’t wanna just work out in the gym to get good at working out at the gym. We also wanna work out in the gym so that we can get good at life, right? So, we wanna be able to develop strength, which is something that is very important for women as we age. We wanna also at least preserve, but like in your case, add onto the amount of lean muscle that we have so that we are able to, if we wanna pick something up from the floor, we’re able to. When we have the privilege of, you know, being inducted into the grandmother club and meeting our grandchildren, we can hold our grandbabies.

So, I think that there’s a lot of compelling reasons for women to get into the gym and to be training for the specific outcome of both hypertrophy, so muscle growth, and strength, which are sometimes they overlap each other, but technically are two separate outcomes, right? So, strength usually happens only with heavy weights. So, with heavy loads, low repetitions. Muscle hypertrophy or muscle growth can happen in the gym with the same type of, you know, heavy weight, low repetitions. You can also have slightly lighter weights with higher rep count that can also drive muscle hypertrophy or muscle growth as well.

Dr. Sandi: So, those are two goals. So, hypertrophies, muscle growth, and then you can also aim for strength. So, I’ve lately gotten into things like farmer’s carries and approach it with curiosity like, “I wonder…” And I had heard Peter Attia saying that if you’re 40, you should lift, like, 75 pounds, you should farmer’s carry for a minute. I was like, “Oh, I wonder if I could do that,” and started with 25, and then worked up to 35…between like 35 and 40 would be my body weight, but it’s hard to find that. So, I did find those in the gym. Okay, I can go 30 seconds. Can I take another 10 seconds? So, small increments of change, but approaching with curiosity.

So, I did the same with a deadlift with a kettle ball and said, “Oh, I can do 50. Can I do 60?” So, I picked up the 60. And now, can I do 70? And okay, yes, I was able to lift it. And so, I just wonder if you could comment about, you know, some of…you mentioned before, like, what holds people back? They’re afraid they’re going to get injured. So, what do you say to someone who says, “Well, no, you know, I’m not gonna go in the wet room. I don’t wanna get in. I heard it’s dangerous. You can get injured. I have arthritis. I have pain. It’s not for me.”

Stephanie: Yeah. I would say, first, adopting your philosophy around curiosity, I think, is an excellent one. I think as long as we can…for the entire span of our lives, the more curious and humble we can stay, I think the more color, you know, rich and robust the life is. So, if you can stay curious. If you are afraid of injury, I will say that this is not something to just be like, “Oh, don’t worry, just go for it.” Because there is a real risk. You often hear people will talk about a mind-muscle connection. That is basically a neural motor unit connection.

So, if you have not spent many years honing that mind-muscle or that neuromuscular connection, sure, if you lift something too heavy, and you don’t have the mechanics, you don’t have the stability for it, there certainly is a risk of injury. So, I would say to somebody who’s worried, hire a trainer or somebody, if you’re female, hire somebody who has some training, some experience, a personal trainer or otherwise. I think chiropractors and physical therapists are also very good starting points as well. For someone who has training in women in midlife, so perimenopause and menopause, because we are a different animal. We do behave differently than our younger counterparts and someone who might be 20 or 30, you know, early 40s, that kind of thing.

So, hire someone who can just kind of show you around the gym, how the machines work, where you should be feeling things. A lot of what I noticed in clinic in my 10 years as a clinician, we would often take new patients through a whole roster of exams. But one of them was a squat, like, it was a wall sit test. And then another one was just some air squats to see what their hip mobility, knee mobility, ankle mobility looked like. And I would say probably 80% to 90% of the population doesn’t know how to squat properly. That’s the first observation.

And then the second observation there is when they’re squatting, often, women would say, “I don’t feel it in my butt. Like, I don’t actually feel it where I’m supposed to, right?” Like, they would…you know, I would say, “Are you feeling in the front of your thighs?” “Oh, yes, I’m feeling it there.” So, those are the quadriceps, sartorius, a little bit of adductors kind of towards the inner thigh area. “And are you feeling it in your bum?” “No, not at all.” Does that mean that you’re doing the motion incorrectly? Not necessarily. You might not…like, the glutes are actually very difficult, and the back actually, because we can’t see either of those things unless we’re sort of twisting around in the mirror. It’s very difficult because we don’t have a visual connection to them to feel them working.

So, if you were to go in the mirror and do some bicep curls, you can watch the bicep contract and, you know, that concentric and eccentric movement. And you can forge a mind-muscle connection with the bicep. It’s harder to do that with the glute. It’s harder to do that with the back, which are huge muscle groups, right? The glutes and the legs sort of in totality are a huge muscle group by weight. And then the back would be like a close second in terms of the sheer mass of muscles that we have in the back.

So, women will often complain, “Well, I don’t feel it there. So, that means that I’m not doing it properly.” It’s not that you’re not doing it properly. It’s just you don’t have the mind-muscle connection there yet. You just gotta put in the reps. It’s like you gotta put in the 10,000…you know, they say, like, becoming a master is like 10,000 hours. So, it’s like you just gotta put in the miles, you just gotta put in the reps there. And over time, I promise you’ll be able to feel your butt.

Dr. Sandi: Yeah. You actually get better. So, I aim for 100 squats a day. I do my first 30. I do pour over coffee. And while I’m waiting for that to be ready, I’m just in the kitchen and I do a set of 30. And then some other time during the day, I’ll keep doing more. One of the things I’ve noticed is that if I think about ballet and like a plié, and I can do more of the sumo, a little bit of turned out. That, I can get down much farther ,and I really feel it in my butt more. But I love that reference because I can relate to that. To dance, I still take ballet class.

And so many women say, “Well, I don’t need strength training. I would get it from yoga or I do Pilates.” And I love it. I do yoga every day. I do Pilates, I have a reformer, and I work on posture and core work. What are your thoughts on those forms? And I know it all plays into what you’re doing at the moment because I think about tightening my core when I’m, you know, doing a strength move, for example. So, I rely on that yoga or that Pilates training. But what about if you think only Pilates or only yoga, I’m good enough?

Stephanie: Yeah, I’m gonna say no. The short answer is no. I do love yoga. I love a hot yoga class. Like, that is such a great stress relief, and Pilates is wonderful as well. So, Pilates, and they have the reformers, and many of them have like, you know, graded resistance, which is lovely. Pilates, you’re gonna work a lot of the smaller accessory muscles. You’re gonna work a lot of the muscles of the core, as you mentioned, postural muscles. So, that’s really lovely. And then again, like the mobility aspect of therapy or of movement.

So, we talked about hypertrophy and strength being two different outcomes. Mobility is also very important as well, flexibility and mobility. This is often overlooked. Yoga and Pilates do an excellent job of preserving joint range of motion, helping with improving range of motion. And this is actually especially true kind of coming back to the squat, where I would see the most deficits in the breakdown in technique for squats is at the ankle. So, most people can squat, like, most people can hip-hinge. Most people have a decent amount of knee range of motion, assuming there’s no injuries there, ACL tears or, you know, something previous in their history. But ankle mobility usually is terrible for most people. And you know this by just asking anyone, maybe not your two-year-old, because they can probably do it with ease, but any adult to just get down into a full squat. Most people cannot.

If you look at a two-year-old, a three-year-old, they are basically giving us a masterclass in mobility, and biomechanics, because they will, if they’re just playing in the yard or something, and they get down, they see like, I don’t know, like, a worm or whatever, they’re observing something on the ground, blade of grass, whatever, they just get down in squat position, and they stay there for as long as they want. And they play with the dirt, they play with the grass, they play with the whatever, and then they get back up whenever they want. And we as humans start to lose that around the age of six years of age, which is usually concurrent with kindergarten, where we start sitting for long hours of the day.

So, I would say, back to your original question, yoga/Pilates, I think is a very important and essential part of any movement program, once or twice a week, or more if you love it. But if we were to sort of rank-order an ideal movement program, if you were coming to me, I am a resistance training first practitioner. So, I am always going to design a program that prioritizes resistance training. Wherever you are on the spectrum, you’re a newbie, and you’ve never touched a weight, and you’ve been lifting for 35 years, whatever it is, I’m always gonna prioritize resistance training first.

We’re gonna find a cardiovascular activity that you love. And you’re gonna do that a couple of times a week, and we can play around with zones. You know, we could get into that if you’d like. And then, of course, the mobility aspect, which as we age is something that we also lose. So, if we are not prioritizing joint range of motion, and this actually comes back to another comment that you made earlier that I’ll kind of circle back to, which is if you are somebody with an arthritis, so you have osteopenia, or the full-blown disease, osteoarthritis, rheumatoid arthritis, psoriatic arthritis, any of the arthritis, so any sort of the diseases, the arthritic disease states, your goal should be primarily not necessarily to lift heavy weights, but it should be to at least preserve the range of motion, the joint range of motion that you currently have with an idea to expand it over time.

I had a friend, like, very severe case of RA, so very severe case of rheumatoid arthritis. Lifted weights for several, several years. We started to see this disease progress. He wasn’t able to lift as heavy as he wanted anymore in the gym. So, he had to lighten up the weight, so, you know, destroying his ego, because he’s used to lifting really heavy weights. But what he really had to do is prioritize his joint health. So, I’ll sort of wrap this up in a bow, I know I’m going on a little bit, but I do think yoga and Pilates are useful. They should be a part of most people’s exercise program, but it is after there is a base of resistance training that is in place.

Dr. Sandi: For younger women, are there more ideal times? Like, would you go lighter on the resistance and do more things that are restorative, more yoga, more Pilates, [inaudible 00:26:09.028] walks, depending on times in your cycle? And I noticed you had an Oura Ring, I’ve got one too. And that can be so useful also to look at your markers to say, “Well, maybe you can have a rest day.” I know for me, the hardest thing is to have a rest day. I’ll struggle and I’ll still manage to do something on a rest day, push-ups or something, but not a total rest day. But does that matter? Can you burn yourself out based on your hormone pattern?

Stephanie: Great question. Yes, you can. So, this is sort of the crux of the first book. What we talked about is how to understand the ebbs and flows of that hormonal landscape over the course of a woman’s cycle. The first thing I’ll say before I kind of get into some of the particulars for your audience is above all, irrespective of what your Oura ring is telling you, irrespective of your woot, like, whatever you’re wearable, whatever it’s saying, I always want you, rather than relying on technology first, I want you to always check in with yourself. Because I’ll tell you for the longest time, and Oura is getting better at it now, but it would ding me at ovulation and right before I got my period. It was like, “Oh, your readiness is low.” I was like, “Yeah, I just ovulated.” You know what I’m saying?

Dr. Sandi: Yeah.

Stephanie: I’m about to bleed. Yes, of course, my readiness is a little lower. Like, my body is working, you know, a little differently than it does at other times in the month. I used to get really annoyed. There’s a time when I sort of, like, I chucked this ring across the room. I was like, “I feel great today. Stop telling me my readiness is bad. You know? Stop making me feel bad about myself, my natural rhythms.” So, first thing is like auto-regulation, right? Check in with yourself. If you feel great today, and you feel like pushing it, then that’s exactly what you should do. And on the contrary, if you feel absolutely bagged, but your ring or your wearable is like, “You are great, it’s time to go for a marathon run,” but you don’t feel like that, you can certainly make the call. You are the adult in this situation, not the tech. So, I’ll just say that first.

Now, menstrual cycle, yes. So, there are a lot of times in the cycle where we might feel more ready to push. And there are gonna be times where we are gonna want to lighten up on the weights. I always like to say to people, no matter where you are in the cycle, you wanna be lifting heavy enough weights so that you are approaching muscle failure. You don’t have to get to muscle failure, but within one to three repetitions of muscle failure, meaning you can no longer do any more reps, but that’s gonna change over the cycle.

So, if we assume a four-week cycle, I know that there’s variation there, but just for ease of explanation, you know, the first day that you start bleeding is day one of your cycle. A lot of women, many women, feel very crampy. There’s a lot of like the uterus is contracting, there’s prostaglandins, all the things, right? So, we often can feel a little crummy, one, maybe day two, and even into day three of the cycle. Day three, we start to see estrogen kind of rising again. A lot of women start to feel more like themselves around day three. There’s lots of memes. I’ve seen like menstrual cycle memes where it’s like the…what is the Disney character? She turns into Cinderella. I forget what she is before that, but you know, it’s like day one, two, and three, she’s like scrubbing the floor. She’s feeling terrible. And then day three, estrogen starts to rise and now, you know, she’s the princess that she once was.

If you feel terrible day one, two, and three, it’s absolutely okay to, A, take a day off, or B, lighten your volume. I often will counsel women, if they are very susceptible to the cramping and that general crummy feeling, to reduce their volume in those first three days by, you know, 50%. It’s a nice little deload. It’s like a little mini deload week. Once estrogen starts to rise, day three, you can jump right back into a moderate rep range. So, somewhere between 8 reps and 12 repetitions. So, if it’s 12 reps, that means that rep 9, 10, 11, and 12 are incredibly difficult, right? So you should be very close to failure at that point, and choosing a weight that’s heavy enough that will approximate muscle failure there.

As the period stops and we move into the second half of that follicular phase, we see a couple of things happen with our hormones. We see estrogen rise, which is an anabolic hormone, anabolic to many things in the body, including muscle. Testosterone also rises in the second week of our cycle. So, again, another anabolic hormone. And I’m sure you’ve talked about this on the show before, but testosterone, in case you haven’t heard, is the most abundant sex hormone in the female body, right? We often sort of phenotypically ascribe estrogen as the female hormone, but actually, the female hormone is testosterone. It is the most abundant sex hormone in the female body.

So, testosterone and estrogen peak in week two. And along with it, our motor coordination. So, we not only have estrogen receptors in our reproductive cells and in our muscle cells, but we have it systemically. So, we have it in our motor cortex. We have it in our brain. We have heart, lungs, like, everywhere. Same with testosterone. We have much better motor coordination this time of the month. The other thing that estrogen does is that under that sort of huge surge of estrogen that we see in that second week, usually for most women around day 10-ish, we also see a tightening. It has a very prominent effect on the tendons, makes the tendons stiffer. So, this actually sets the stage for being able to really push a heavy weightlifting session this week. So, all week long, if you’re doing full body, you like to split your whatever, if you have a bro split, you do legs, one day chest, the other day, you know, whatever it is all week long, you can go as heavy as you can. So, I define that by, like, five to seven reps as heavy as you can.

Then we ovulate, which is sort of the demarcation between follicular and luteal. Right before we ovulate, we have that big rise in estrogen as I was describing, and then it falls off as we ovulate, and then comes back up again, right? So, it starts to climb up again in week three. So, I actually feel like this week looks hormonally with the exception of progesterone, which we’ll talk about in a moment, looks a lot like week one. We see that low estrogen the first couple days of week one, and the same is true in week three, estrogen drops off and starts to rise up again, and reaches its secondary peak towards the end of the third week.

So, I like to just repeat what we did in week one there. So, if you are moderate weights in week one, you can do the same thing in week three. And then as we move into week four, as you probably know, and I know that through, you know, IFM and all the courses that you have around perimenopause and PMS and the menstrual cycle in general, if someone’s going to feel inflamed, it’s the second half of the cycle, right? It’s like week three, and particularly week four, like, most women are gonna feel like they’re hotter because of progesterone, they’re, like, bloated, again, because of progesterone, because it slows down our digestion. Mood is a little wonky. Sometimes we’re a bit…you know, the emotionality that we were talking about before, we’re more sensitive to things. You can also experience migraines, which is usually towards the end of week four.

What I often will counsel women to do here if they feel really crummy is not to skip the gym. And, in fact, the gym is so important for you this week, but this is where you can do the lighter weights, not the pink weights, not the two pounders, because you’re better than that. But you can do a longer set. So, there can be more repetitions, right? So you can do 15 reps, 20 reps, even 25. I mean, if you can do 25, you know, God bless you, because that’s a really long set. But, you know, 15 to 20, 25, if you have the patience of a nun or something. But by necessity, that means that the weights are gonna be lighter.

And the reason why I counsel people to do that is one thing that we know about muscle contraction is as the muscles are contracting, as we see the muscle shortening and then releasing again, it acts like a pump insofar as it’s releasing chemicals into the bloodstream that actually actively reduce inflammation. So, these are called myokines, which I know you’ve heard of. These are just like anti-inflammatory cytokines. They cross the blood-brain barrier. So, they go into the brain. They reduce inflammation. If you’re feeling brain foggy, you walk into the room, you don’t know, where are your keys? Where’s your phone? You know, that kind of thing is gonna help ameliorate that. It’s gonna help ameliorate your mood. It’s gonna help with your sleep. So, I do really like women to continue training all through the cycle.

There was a period of time, I think, when there were people talking about you should never train in the second half of your cycle. It’s like, “No, no, no, no, that’s the most important time for you to train.” You just have to be able to give yourself a little bit of compassion to go a little bit lighter. But know that what you’re doing, every time that that muscle is contracting, is that you are releasing some of these anti-inflammatory molecules into the body to help you feel better, right? To help you have a better period, essentially. I know that was a lot.

Dr. Sandi: Wow.

Stephanie: That’s a lot.

Dr. Sandi: This has been such incredible information, and health coaches who might be listening, you can educate your clients about this and empower them to take charge and personalize their routine, and then go to their trainer if they’re working with a trainer to inform, because often, trainers are not aware of this and they’re just gonna take people through the same routine. So, let’s turn to a final topic, which is something I’m so passionate about, which is…you describe as meals and muscle. I was doing it all wrong when I was younger. So, many years, I was a vegan, then I was a raw vegan, never felt worse during that time. And finally, now, I’m focusing on protein. You know, my lunch was a 30 grams. I had these amazing force of nature meatballs and feel wonderful and energized. And I’m talking to you and I’m not falling asleep as I would have with that previous high carb meal with hardly any protein.

Stephanie: I love that. Yeah. Was it called a macrobiotic diet? Was that what it was?

Dr. Sandi: I did macrobiotic, yeah. That was when my kids were little. I was in a co-op. That was ages before whole foods. And we would have a co-op where we’d order, we’d place the order, fax it in, and get these cases of…yeah, I was cooking brown rice every night and soaking beans and… Yeah.

Stephanie: I mean, I think that there’s some validity. Like, I remember there used to be this restaurant, it’s closed now, but they used to…I don’t know, they would only cook…like, if you ordered a pizza, let’s say, it was a vegan restaurant, but they would only cook it to, like, a certain temperature. Like, they would never go above because they felt like the enzymes or whatever were destroyed in it. So, anyway, yeah. I think that in midlife where I am currently, I’m currently 47, and beyond…I mean, I would say even before, but it’s especially true for us ladies that did the high carb, low fat, you know, the extra…like, what was that thing? The Jane Fonda, like, all that stuff, right?

Dr. Sandi: The Jane Fonda. I did all that in the late ’70s.

Stephanie: The buns of steel, like, all that kind of stuff, right? So, all of us who kind of grew up there, we do have to move…the one macronutrient that changes as we age is protein. So, as you’ve correctly identified, we actually increase our protein needs as we age for several reasons, but the most important one, and the easiest one for most people to understand is that we’ve just become, as a natural function of aging, if you’re not being strategic, and just as we age, we become more insulin-resistant. Meaning that our cells, particularly at the level of the myocyte, like, at the level of the muscle cell, down-regulates its sensitivity to insulin somewhat. So, insulin, of course, everybody knows is a peptide hormone that is responsible for taking primarily glucose, but also amino acids out of the bloodstream and putting them into the cell so the cell can use that as food. It ends up making energy, etc.

If insulin is being released from the pancreas, and the cells see insulin is there, but they’re not responding to it, the net-net there is that we still have those substrates floating around in the plasma. We still have the glucose and the amino acids floating around. And, of course, you know, glucose floating around in the blood is not an ideal…this is not an ideal scenario. So, it is very important for us to be prioritizing protein. I, just from my neuroscience kind of geeky background, really was enamored with the ketogenic diet for a long time, ran a program about it in terms of helping people reinstate insulin sensitivity. And it does have its merits. But what I did notice, especially in my women, is that once we…like, we’d pull back on carbs quite a bit, but then when we reintroduced them, they were just petrified. They were just like, “I don’t wanna gain any more weight. I don’t want…”

So, I still like the ketogenic diet, but I find with women, it’s harder long-term to get them off of it. They’re like, “No, this worked for me, so I’m just gonna stay here.” Like, they don’t wanna leave keto land. So, where I like to start is a protein-forward…you know, a protein-centric way of building your caloric needs or your macros, however. Like, those are two sides of the same coin. Macros are calorie counting, calorie counting is calorie counting. So, I like protein first. A general recommendation that’s, you know, widely accepted in the literature is 0.7 to 1 gram per pound of ideal body weight. So, that’s where I like everybody to start. And you don’t have to do that. A lot of people say, “How are you gonna do that with, like, real food? Like, I don’t wanna have whey protein, or I don’t have protein powder.”

It’s totally possible to do that. We have egg whites, nature’s superfood, or eggs, nature’s superfood, really. And I like to do eggs and egg whites. Like, I like to top up the eggs with more egg whites. You know, we have chicken, we have turkey, we have, like, red meat, all the things. So, totally possible to do. And yogurt. Oh my gosh, yogurt and cottage cheese are like…you know, at least for me, that’s what really helps me reach my protein targets. So, protein first.

And then depending on the movement, you know, the fitness program of the individual, we play around with, like, carbs. I like to strategically time carbs around the workout if possible, either immediately before and after, because we do actually want…like, insulin is an anabolic, it’s a growth signal, right? So, when we’re thinking about muscle growth, if you sort of think of a very simple equation, like, muscle growth equals muscle protein synthesis minus net muscle protein breakdown, right? So, the protein helps with the muscle protein synthesis. It helps to create new muscle, proteins, and the carbohydrates, which drive up insulin, help prevent against net muscle protein breakdown. So, when there’s glucose and there’s insulin around, your muscles are preserved somewhat, especially when you are having an appropriate amount of protein. So, I like to sort of time carbohydrates around workouts if I can, to replace glycogen and all the things that are lost when you’re training.

And then fat, I think, can be…you know, we need a certain amount of essential fat for skin, hair, nails, neuronal function, brain function, as well. So, obviously, the individual sort of program is gonna shift from person to person. But generally, it’s like, first, we’re gonna build out your protein targets. So, it’s gonna be with whole foods primarily. No foods are good, no foods are bad. They’re all just foods. Generally trying to stay away from ultra-processed foods, including protein bars. They can be filled with fillers and stuff that you don’t really want. And then, like, a good amount of fat, and then you’re just, like, on repeat, do that on repeat forever. That’s how I like to look at food, is like whole foods first.

Certainly, like, I had a protein bar today. So, I’m just, like, calling myself out here. I had a protein bar today, but I don’t have one every day. Today is a heavier recording schedule for me. So, I’m just, like, in between, blah, blah, blah. So, I do use them when I need to. And we don’t demonize anything. So, even the occasional chips and, you know, guac and, like, whatever your… you know, I have people that are like, “I’d just die for a chocolate chip cookie. Like, I’d just love to have a chocolate chip cookie.” It’s like if I take that away from you, what’s the likelihood of you adhering to that over the long term? It’s very low.

Dr. Sandi: That’s right. Yeah. And the stress of denying yourself or the guilt afterwards. So, you let it go and you focus on moving on to the next meal. And that’s so important. Well, I think we have the same mission. So, I see my contemporaries still stuck in counting calories and fat phobia and undereating protein. I do a lot of work on eating psychology and gender differences. And there are so many gender differences where men…like, steak houses have dark paneling with, you know, stuffed animals. And it’s very masculine, and women have tea houses with little cucumber sandwiches traditionally. And, you know, I’ve planned many bridal showers and not once did the committee want to have a steak that luncheon. It’s all salads with tiny little strips of chicken. And those kind of stereotypes die hard. Really, it has a lot of different connotations about you and what you order.

But, well, this has been absolutely a fascinating conversation. And I know that our audience learned so much. And again, I want to let people know about your work. You have a hit podcast, Better, which is amazing. Check that out. Check out her website or YouTube, Betty Body. And where can people find you?

Stephanie: Oh, thank you so much for that. You’re so kind. Yeah. So, all the places that you just mentioned, you can head over to my website, which has all of that. That’s sort of a starting point. So, drstephanie.com. We also have a newsletter there. I put out a weekly newsletter called The Mini Pause, which is my take on menopause. So, it’s just basically action items. It’s like a weekly roundup of the best action items for women 40 plus. I think those are really good…and it’s free. So, lots of resources on the website and the newsletter. I love writing. It’s like one of the favorite things that I do in my work.

Dr. Sandi: Well, you’ve inspired millions of women. Thank you for being with us.

Stephanie: Thank you so much.