Inflammation and Perimenopause: What is the Connection and What Can We Do About It?
Megan Lyons is a functional and clinical nutritionist, and the owner of The Lyons' Share Wellness, a nutrition consulting company that has helped tens of thousands of people on their way to health. Megan graduated from Harvard University with a degree in economics, received her MBA from Kellogg School of Management, and was a management consultant with McKinsey & Co. for 7 years before opening The Lyons' Share. She is a Double Board Certified Clinical and Holistic Nutritionist, has a Master’s in Holistic Nutrition, a certificate in Health Coaching, and expects her Doctorate of Clinical Nutrition in September 2024. Her podcast, Wellness Your Way with Megan Lyons, reaches thousands each week.
Leslie: What topics come to mind when you think about your clients, background, and what people deal with when going through (peri)menopause?
Megan: A few key topics come to mind. First, inflammation is crucial because an inflamed body experiences hormonal shifts more drastically, impacting perimenopause and menopause. While hormonal changes are inevitable and part of the natural process, our goal is to manage and minimize the symptoms rather than prevent these shifts. By addressing inflammation, we can help ensure that hormonal changes occur more smoothly and naturally. Stress is another significant factor in this process, and it often leads me to emphasize the importance of gut health. A healthy gut is essential for overall well-being, including maintaining hormonal balance and managing shifts effectively.
Leslie: What exactly is inflammation and what does it mean?
Megan: When we sprain an ankle, it becomes hot, puffy, and swollen—this is a natural response to inflammation. Inflammation involves a variety of immune cells, including white and red blood cells, as well as fluids like pus, all working together to repair the damage. This localized inflammation makes sense because it's directly addressing an injury. However, when inflammation becomes systemic, it affects the entire body rather than just one area. Instead of a specific, localized swelling, you might feel general discomfort, achiness, or fatigue. This broader inflammation can occur due to various factors such as hormonal shifts, poor diet, high stress, or a sedentary lifestyle. When inflammation is widespread, it can significantly impact overall well-being and exacerbate hormonal changes, particularly during times of decreasing estrogen. This hormonal shift can further influence immune function, creating a vicious cycle of increasing inflammation and worsening symptoms.
Leslie: What symptoms and outcomes happen when this occurs?
Megan: Some argue that experiencing no symptoms during perimenopause and menopause should be the ideal, but I believe that's not entirely realistic. However, if we look at historical and cultural evidence, it’s interesting to note that in Okinawa, Japan, ancient texts don’t even have words for menopause symptoms, likely due to their anti-inflammatory diet. Records from 60 years ago also show that women experienced far fewer menopausal symptoms compared to today. While it’s valuable to discuss and normalize these experiences, it's clear that our current inflammatory lifestyle plays a significant role in intensifying symptoms. Even though estrogen levels naturally decline during menopause, modern factors such as poor diet and high stress contribute to more pronounced symptoms like hot flashes, fatigue, reduced libido, vaginal dryness, skin dryness, and abdominal weight gain. Addressing inflammation might help alleviate these issues and improve the overall quality of life during menopause.
Leslie: Can you talk more about what causes inflammation?
Megan: I’ll answer your question and then offer a realistic perspective. We don’t need to completely cut out certain foods—enjoying a variety is great. However, understanding the balance between inflammatory and anti-inflammatory foods can help. Inflammatory foods include fried items, added sugars, alcohol, and ultra-processed products. For instance, ultra-processed snacks often have long ingredient lists that aren't real food. While some people are sensitive to gluten and dairy, affecting inflammation, the impact varies. Most of us fall somewhere in between. So, being mindful of these foods can help manage inflammation without drastic restrictions.
Leslie: How does stress play into this?
Megan: Stress and hormonal shifts both trigger inflammation, but we can manage this by focusing on anti-inflammatory foods. Opt for dark-colored fruits and vegetables, which are rich in phytonutrients and antioxidants, and include healthy fats and plenty of water in your diet. When we're stressed, our bodies go on high alert, as if we're running from a lion. This response prioritizes immediate survival over long-term functions like digestion and hormone regulation, leading to more severe symptoms. Chronic stress can exacerbate issues like digestive problems and hormonal imbalances. Although stress is a common challenge, especially during transitions like perimenopause and menopause, we can’t avoid it completely. Instead, balancing stress with good nutrition, regular exercise, and effective stress management strategies can help mitigate its impact and support overall health.
Leslie: What advice do you give your clients on the topic of stress?
Megan: Everyone’s stress needs are unique, even though we all benefit from basic essentials like drinking water and eating vegetables and fruits. To tailor stress management effectively, I like to use a fun thought experiment: imagine you have a magic button that grants you a full day off from work, family responsibilities, and household chores. What would you choose to do? For some, the answer might be attending a Beyoncé concert with friends, which signals a need for social connection and excitement. For others, it might be relaxing alone on a beach in Tahiti, indicating a need for downtime and solitude. While we can’t actually send anyone to a Beyoncé concert or Tahiti, we can incorporate elements of what you enjoy into daily life. This might mean texting a friend regularly or setting aside a few minutes each day to read. Additionally, if negative thought patterns are contributing to stress, techniques like cognitive reframing can help shift those thoughts. This approach, inspired by Dr. Daniel Amen, emphasizes that effective stress management is highly personalized.
Leslie: How does gut health play into all of this?
Megan: Gut health plays a crucial role in overall well-being, especially when it comes to hormone balance and managing menopause. One important factor to consider is beta-glucuronidase, an enzyme that helps clear excess estrogen from the body. If this process is impaired, or if you’re experiencing constipation, excess estrogen can recirculate and exacerbate symptoms. Constipation, in particular, can prevent the body from effectively eliminating estrogen, leading to recurring symptoms. Therefore, addressing constipation is a key first step. When stool remains in the intestines too long, it can hinder detoxification, affecting the liver, kidneys, and overall elimination process, making symptoms worse. In addition to managing stress and consuming a diet rich in fruits, vegetables, fiber, and essential vitamins and minerals like magnesium and vitamin E, these foods support gut motility and overall digestive health. Sometimes, supplements can help provide the nutrients needed to support this process. Healthy gut bacteria break down food and produce beneficial short-chain fatty acids that help reduce inflammation and support overall hormonal balance.
Leslie: How would you know that this is a problem for you? What should you do to make sure this isn’t a problem?
Megan: To determine if you have a constipation issue, start by noting if you have to strain excessively to have a bowel movement or if you’re not having regular bowel movements. Ideally, you should have a bowel movement at least once a day, with two to three times a day being optimal. If you’re having fewer than this, you might be constipated. You can also evaluate the quality of your stool using the Bristol Stool Scale, which has seven types of stool images. Types 1 and 2 indicate constipation, with stool resembling small pellets or hard lumps. Type 4, similar to soft, smooth sausage or frozen yogurt, is considered ideal. If your stool is on the low end of the scale, even if you’re going daily, it suggests constipation. This occurs because your colon extracts too much water from the stool when it lingers too long. For short-term relief, magnesium can be effective. A higher dose, similar to what is used before a colonoscopy, can help clear out the system, but be sure to return to a normal dose afterward. Magnesium is also found in foods like leafy greens, nuts, and dark chocolate, and your Vitaminis products. Additionally, increasing fiber intake and drinking plenty of water are crucial for preventing constipation. Proper hydration is essential, as even well-functioning gut health can suffer without adequate water. Regular physical activity also promotes healthy digestion, so find opportunities to move throughout the day, even if it’s just standing or stretching during work. These basic strategies can significantly improve gut health and reduce constipation.
Leslie: When you discuss water intake, what should our daily goal be, and do other beverages count?
Megan: My recommendation for daily water intake is to start with half your body weight in ounces. For example, if you weigh 150 pounds, your baseline would be 75 ounces of water per day. If you engage in activities that cause sweating—like exercising, using a sauna, or spending time outside in hot weather—add an extra 16 ounces of water for each hour of sweating. So, if you exercise for 30 minutes daily, you’d add an additional 8 ounces (half of 16), bringing your total to 83 ounces per day. Personally, I drink more than this amount because I sweat a lot and have a higher hydration need. Many people I work with, however, are only consuming about half of their recommended intake. Remember, alcohol and caffeinated drinks like coffee or strong tea don't count toward your water intake, as they have diuretic effects. On the other hand, herbal teas, broths, and coconut water do count. Even fruits and vegetables, like watermelon or cucumber, contribute to your hydration. While it might be too complex to calculate every ounce from these sources, focusing on liquids for your primary intake and treating fruits and veggies as bonus hydration is a good approach. Adding fresh ingredients like strawberries, mint leaves, peaches, or lemon to your water can make it more enjoyable and help you drink more. As you increase your water intake, your body will naturally start to crave more.
Leslie: Are there any other topics that are important to cover when it comes to women and (peri)menopause?
Megan: We've discussed inflammation, stress, and gut health, but another key factor that can intensify hormonal shifts during menopause is the balance of other hormones in your body. While estrogen, progesterone, and to some extent testosterone, DHEA, and FSH are the primary sex hormones affected during menopause, other hormones like ghrelin, leptin, insulin, and cortisol also play significant roles. Ghrelin and leptin regulate hunger and satiety—ghrelin increases appetite, while leptin helps you feel full. Imbalances in these hormones can lead to constant snacking and an inability to feel satisfied, which is often related to unstable blood sugar levels. This can exacerbate menopausal symptoms. Similarly, insulin, which regulates blood sugar, and cortisol, which manages stress, can both influence how severe menopause symptoms are. Unstable blood sugar or high-stress levels can make symptoms worse. Additionally, thyroid function is crucial for overall hormonal balance. Checking and stabilizing these hormones can help alleviate some of the more challenging symptoms of menopause and contribute to a smoother transition.
Leslie: Where can people find you if they are interested in learning more?
Megan: All my information is at https://www.thelyonsshare.org/. I have blog posts, a podcast, and information on how to work with me. Basically, everything you need is right there.
