There are many reasons why you might want to learn how to manage menopause without hormones, but it definitely can be a confusing terrain to navigate. In this episode, Dr. Suzanne Gilberg-Lenz is here to discuss what the options are if you can’t, or don’t want to use hormone therapy. She shares practical, non-hormonal options—from nutrition and supplements to lifestyle changes—that can make a real difference.

We also tackle some hot-button topics, like the debate over cognitive behavioral therapy (CBT) for menopause sleep support and why informed choices always matter. 

Plus, Dr. Suzanne breaks down simple but powerful strategies for better sleep, stress management, and movement. Whether HRT isn’t an option or you’re just exploring alternatives, this conversation will leave you feeling empowered and supported on your menopause journey.

Connect with Dr. Suzanne

The Website: www.thedrsuzanne.com/
Instagram: @askdrsuzanne
📚Grab the Book: Menopause Bootcamp 

 Links Mentioned

EP 67: Hot Flashes 101: Can You Beat the Heat? 

EP 127: The Truth About Soy in Midlife

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TRANSCRIPT

Jenn Salib Huber: 0:00

Hi and welcome to the Midlife Feast, the podcast for women who are hungry for more in this season of life. I'm your host, Dr Jenn Salib-Huber. I'm an intuitive eating dietitian and naturopathic doctor and I help women manage menopause without dieting and food rules. Come to my table, listen and learn from me trusted guest experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife.

Jenn Salib Huber: 0:29

And if you're looking for more information about menopause, nutrition and intuitive eating, check out the midlife feast community, my monthly membership that combines my no nonsense approach that you all love to nutrition with community, so that you can learn from me and others who can relate to the cheers and challenges of midlife. If you're in perimenopause or menopause and you have had symptoms that you have googled or you have asked a friend about, or maybe you've asked me about, or your doctor or anyone else, chances are you've been told about hormone therapy, or your doctor or anyone else, chances are you've been told about hormone therapy, which is absolutely the right thing to do because menopause hormone therapy can be a game changer for lots of people. But, as some of you probably know, it wasn't great for me. It just didn't work out for all kinds of reasons.

Dr. Suzanne Gilberg-Lenz: 1:19

And so.

Jenn Salib Huber: 1:19

I was one of those people who was left wondering well, what else can I do? What other options do I have? Which is one of the reasons that I became so interested in the menopause nutrition piece and why I'm such a fan of foods like soy and phytoestrogens. But there are a lot of conversations that we still need to be having about non-hormonal treatment options, because you may be someone who can't take them.

You may be someone who doesn't want to for whatever reason, or you may be someone who can't take them. You may be someone who doesn't want to for whatever reason, or you might be stuck somewhere in the middle, like me, wanted to tried to and just didn't feel better on them. That's why I invited Dr Suzanne Gilbert-Lenz to talk about non-hormonal treatments.

Jenn Salib Huber: 2:00

Dr Suzanne is an author. She's written a book called the Menopause Bootcamp and she's an integrative health practitioner and had worked very much in an evidence-based practice and way about having these conversations about things like herbs and supplements. But she's really an advocate for informed choice and empowerment.

She wants women to feel empowered with their decisions and she wants women to feel like they are being supported, so I knew that she was the perfect person to have this conversation with about if I can't take hormones, what else can I do? So we cover a lot of great topics. We do cover some of the kind of myths and facts and questions around who can and can't and who shouldn't and what should you do if you're looking for more information.

Jenn Salib Huber: 2:46

So this is a really great episode for maybe people who are just wanting to know what the other options are, because hormones are great, but if you can't take them or don't want to, it's good to know what your other options are. So I would love to hear from those of you who might be in the same situation as I was. What helped, what did you do? What did you find helpful in managing the symptoms of menopause? Hi, Dr Suzanne, Welcome to the podcast.

Jenn Salib Huber: 3:11

Well, hello, it's so nice to see you again I know we actually had a very similar conversation a few years ago when you were writing your book the Menopause Boot Camp, and that's been out for how long now.

Dr. Suzanne Gilberg-Lenz: 3:26

It's been a little over two years since it was published, so October 22, which is like the planet, is the metaverse exists in a completely different form than it did when you and I were talking.

Dr. Suzanne Gilberg-Lenz: 3:39

And we were talking because I came to you, because you were one of the first people that I really met online that I felt, um, a kinship with. There were sort of a group of people that we were following each other online that were sort of doing similar work in similar in a similar space, but they had some synergy and I felt like your perspective on nutrition and food and lifestyle and the growth mindset we have to have about our bodies around nourishment was really important.

Jenn Salib Huber: 4:12

So yeah, well, I mean, that's really nice to hear, and it's also why I invited you today, because, after reading your book and you know, I think, like most of us who are in this menopause or midlife space, I read all the books that come out, or at least kind of have a glance at them, and one of the things that I appreciate about your perspective, both online and you're working in your book, is the topic that we're going to be talking about today, which is that holistic approach and talking about non hormonal treatments.

Jenn Salib Huber: 4:39

And so the disclaimer that I'm going to say is that neither one of us are anti-HRT or menopause hormone therapy. I fully believe that it is a choice that everybody should have and that it has been life changing for people. But, for whatever reason, there are people, myself included who don't do well with it. It doesn't make things better and there are some people who can't or just don't want to use it Right, right, just don't want to use it. And so many of the conversations around hormone there or around managing symptoms really revolve around. You know, hrt is the center of the universe, right?

Dr. Suzanne Gilberg-Lenz: 5:14

Right.

Jenn Salib Huber: 5:15

And so, yeah, so I just wanted to invite you on and but maybe why don't you just start by giving everyone a little intro? Other than writing this amazing book, who are you?

Who Can and Can’t Take HRT? Debunking Common Myths

Dr. Suzanne Gilberg-Lenz: 5:24

giving everyone a little intro, other than writing this amazing book. Who are you? Well, I mean, I'm a board certified OBGYN. I do not do obstetrics anymore. I stopped doing delivering babies or attending births three years ago, which is it feels like a million years ago, but also it really is a blip on the radar. So it's kind of surprising to me how much, how much your world changes when you only do gynecology.

Dr. Suzanne Gilberg-Lenz: 5:47

But I'm also board certified or I was board certified in the past in integrative and holistic medicine, and I came to that because I always had had an interest in indigenous health, in what at the time was being referred to as Eastern medicine. Um, I had studied Ayurveda previously and myself was a practitioner of yoga and meditation, always very, very interested in the healing properties of botanicals, of plants. So I'd already been kind of doing that work, had studied Ayurveda, and then, um, the opportunity to sort of make it more official came up. Um, I haven't to be on a stage super involved in that community other than continuing to be a bridge, but for 20, so people need to understand like this is something that doesn't seem weird now, but 25 years ago when I started practicing, it was definitely outlier land.

Jenn Salib Huber: 6:39

And I was actually kind of quiet about it Jen because I didn't.

Dr. Suzanne Gilberg-Lenz: 6:43

I wanted to make sure that I was practicing evidence-based medicine, that I was working within the standard of care, that my patients and conventional colleagues took me seriously, especially as a young woman. Like there's a lot, you know, there's a lot to unpack in all of that, but I'm glad I did it the way I did it. I just continued to self-study and people started hearing about me and understanding that like I just continued to self-study and people started hearing about me and understanding that like I mean really honestly, that I just wasn't hostile toward it and that I was actually knowledgeable and interested.

Jenn Salib Huber: 7:15

I mean really, that is how low the bar was. You know? Like no, no.

Dr. Suzanne Gilberg-Lenz: 7:17

Yeah, but I mean, unfortunately, you know, in the in the more allopathic conventional world, there still is quite a bit of that actually, still um, like somehow it's less than you know, not really realizing that most of our medicine is coming from indigenous medicine. Anyway, it's like where do you think it came from? You think you made it up? That's funny, that's cute, I mean it's not the case. People use plants. People use plants and lifestyle. They always did.

Jenn Salib Huber: 7:44

Always did. That's not new. Yeah, absolutely, I mean there's so. There's so much historical context to just even the word medicine, right that you know we need to acknowledge that it isn't. Medicine doesn't necessarily mean drug.

Dr. Suzanne Gilberg-Lenz: 7:59

Right, and there are different ways.

Jenn Salib Huber: 8:02

But the term, even just the term medicine, is so polarized that you know, medicine is the what we call the highest evidence-based treatment, that is, you know, certified by the FDA, et cetera, et cetera. But that's not really, I think, the the intent of medicine. No, no, it's about a healing.

Dr. Suzanne Gilberg-Lenz: 8:22

Well, I know, I know it's just because of me, because I always do that.

Dr. Suzanne Gilberg-Lenz: 8:25

So, that's my background. That's my background. I practice in a fully conventional setting, but with a, with the heart and the mind of a, an integrated approach bringing in any and everything that I think may be helpful and has evidence to support its use. So there is efficacy and safety around these practices. But I think we're getting tangential, but we're not, because it kind of gets to the heart of what healing and what medicine is in my perspective and I think you share this perspective, and that is something ineffable.

What we do when we work with people who come to us seeking support and guidance and trying to either optimize their health or get better from an illness, is is not, it's not one thing, it is the conversation, it's the listening, it's the creating space and it's making sure that we are evolving with their needs and as as we get more information. So I think it actually is really germane and that is what I have done always and what I continue to do.

Jenn Salib Huber: 9:30

And that comes across in your book. For anybody who hasn't read it, it definitely is, I think, one of the more balanced approaches to menopause that's out there and I definitely appreciate the experience that you bring to that. So if we can talk about what we mean by non-hormonal treatments, so I'm just going to kind of bring some context to the conversation where people will often say to me I tried hormones and they didn't work, or they made me feel worse, or I can't take hormones for whatever reason. What are my options? Because it feels like the only option that is being presented or driven by the main narrative is it's hormones go big or go home. You know that's kind of hormones are bust. So what do we even mean by non hormonal treatments? What is the definition of?

Natural Alternatives to HRT: What Really Works?

Dr. Suzanne Gilberg-Lenz: 10:18

that to me it's a really broad. It's a broad category because it is anything that is not hormones, and it can be botanicals, it can be supplements, it can be micronutrients, it can be macronutrients, but a lot of it really is lifestyle stuff. It's it's, you know, and it's coming from the preventative medicine and the longevity space, and there's a and and also um a lot from kind of, uh, sports medicine and nutritional medicine spaces. So you know, I think that the prop, the great thing about social media, is that people like us can talk to each other and that the conversation has gotten really big and we're reaching people that that we never would have reached, and people feel powerful, seen and heard. And I think there's a lot of advocacy that's going on and a lot of people taking control and realizing that they have agency in the conversation. That's the beautiful thing and there are many beautiful things.

Dr. Suzanne Gilberg-Lenz: 11:12

The problem is the binary approach, the conflict kind of promoting approach, the clickbait approach, the this or that, and most people who are in this space in a serious way, as educators, as professionals, I don't think that they really are meaning to promote that binary or that conflict. But that's that soundbite, is that what comes out? And so that people are like hearing hormone, hormone, hormone. Well, I mean, even if you look at the evidence, it's hormone plus, right? Like you can take all the hormones and you can achieve some levels that are made up. You know that were, you know when you were 20 years old, whatever the hell that means and not be healthy and not be preventing preventing the diseases or the conditions of frailty and aging that we are trying to avoid, right? What is this about?

This is about feeling good in our own skin, being present, enjoying our lives and trying to achieve a health span right, like being around as long as possible in a healthy state where we can be productive, functioning, doing what we want to do, enjoying life. Like this is not that you're going to be 25, that your skin's going to look. You know that you're, you're all the weight that you've been battling, which is really like a mind, body thing and a psychological thing also and a cultural thing like.

Dr. Suzanne Gilberg-Lenz: 12:28

No, that's not how this works. You don't write a script for anything an herb or a medicine or a hormone, because hormones, I guess, are medicines, but they're not really, in my mind, medicines. None of that's going to happen without the foundations, the pillars, right, and this is where I do get back to my Ayurvedic roots, which is look, sleep, stress, sexual health, whatever that means for you, because that doesn't necessarily mean having like cis, hetero penetrative sex, but being like in your body in a very specific sensual way. Nutrition, movement, strength, right.

So these are things that are the basics, but I think, when you look at like, so those to me are non-hormonal treatments, you know, or whatever the botanicals I think is where I really am interested in how these products work and what the evidence is, and I think that's a really I love talking about that too, because there is some pretty decent evidence for very specific herbs for everything from hot flashes to sleep and mood, and so these are things that people can choose to use, but I think they need to be careful, right, because everything that comes across your feed, based on your user algorithm and marketing, is not created equally, and I think the other challenge people face is working with a practitioner who has a any real confidence or knowledge around this, because you this is where you get a lot of like that's not safe, like even now Okay, so I'm not going to name the brand, but like in the last couple of weeks, I saw a lot of posting about a popular supplement that is used for hair growth, right and cause.

Dr. Suzanne Gilberg-Lenz: 14:18

There was a case report of liver failure. This is always, by the way, what happens there's a case report, a case report, and even though it's true that one case report may mean that there's many more that weren't reported, but give me a break, can we just okay, really, one case report of liver failure. So now we're going to say this brand is terrible and you should be careful, and ashwagandha is trying to kill you. And give me. Do you know how many death from acetaminophen are reported every year? It's like 1800 or something like it's a lot, and that's over the counter. So stop it. That makes me mad, um, but having said that, you do have to be careful, and I think if you're working with practitioners that are not, that are not well in this area, you need to understand what you're doing if you're going to talk to them about what you're using, so that you're not just getting shut down and scared.

Lifestyle Interventions for Menopause: Sleep, Stress & Movement

Jenn Salib Huber: 15:13

And this is one of the big problems, I think in the integrative space in general is there's a lack of regulation of not only the products but the practitioners. It varies by country, it varies by state, by province. You know I'm living in the EU, which you know, everything is different as well. So the problem is that there's no standardization. And so it really does come down to. You know, I hate the word do your research because that has been co-opted, but being able to have trustworthy conversations with maybe other healthcare practitioners that you know and trust who can guide you to working with the right person or guide you towards that.

Dr. Suzanne Gilberg-Lenz: 15:52

Well, I will say that in the United States though I do want to say this we do have the Dachet, the dietary supplement, and health and something else. It's not. You know, it's not that it's unregulated, it's regulated differently than the FDA. It's not as strictly regulated. And I think I'm not like some conspiracy theorist, I'm not like a major outlier, but I think we all know the FDA is motivated, especially when you look at the women's health space in some weird ways Like so the FDA is. I'm glad we have regulation and I believe we should regulate. But it's not a hundred percent accurate that the supplements aren't regulated at all, but they're not regulated as strictly and there's no prescription. There's no prescribing. In other words, you don't have to get them from a regulated, licensed practitioner. So it does become the wild west and that's how you get supplements in your feed that are like is that? So let's just say yeah, go ahead.

Jenn Salib Huber: 16:51

I'm gonna say I think the difference too is that drugs, you know, by the fda and equivalent organizations, are regulating a little bit more for efficacy, whereas supplements are regulated for safety, which is important so that you know that you're not going to have, like lead and mercury and all those kinds of things, contaminants. But they're really going to do what they say Exactly. And so that's the wild west part, that you can have companies put together a safe blend of herbs or, you know, supplements or whatever, but really it's working with that practitioner who can help you figure out okay this is where the evidence is for efficacy, and then these are some safe brands that you can try.

Jenn Salib Huber: 17:33

That's kind of where I think the missing conversation often is. So can we just backtrack a little bit? What are some of the reasons why someone couldn't use hormone therapy? Because I feel like this is a very muddy conversation, because there's a lot of like myth and lore. Someone you know, people will say my great grandmother's sister had breast cancer so I can't take hormone. So what are some of the kind of contraindications to hormone therapy that might make someone consider alternatives?

Dr. Suzanne Gilberg-Lenz: 18:03

Yeah, I mean, they're actually pretty limited People who are known to have a genetic predisposition for blood clotting and who have had blood clots. So, and when people have blood clots, either what we call a deep vein thrombosis, so usually originating in the leg or, more dangerously, when it breaks off and goes to the lung or the brain, but that's what we're trying to prevent, okay, so people who have had what's called an unprovoked clot in other words, they weren't, you know, pregnant or post-surgical, or have cancer, or sitting on a long flight for 18 hours these are things that we know increase anybody's risk. But people who had an unprovoked clot, they're really not a candidate. You're now on blood thinners for life. No, you're not a candidate for systemic estrogen. Okay, thanks for clarifying.

Dr. Suzanne Gilberg-Lenz: 18:58

That's really important. If you've had a stroke or a heart attack, you're really no longer a candidate. You really aren't, even though we know that transdermal estradiol through the skin really doesn't increase your risk for a blood clot. I think anybody who prescribes would be extremely careful with that. If you're currently being treated for an estrogen-dependent cancer, that's kind of it. It's not family history, it's not genetic. Let's say you, you're a carrier of BRCA one or two, which are high risk conditions for estrogen dependent cancers. Um, if you're, if you have been managed appropriately and let's say, you've had preventative surgeries, you can use hormone therapy. If you have family members that have had breast cancer, you can use. You can use hormone therapy.

Dr. Suzanne Gilberg-Lenz: 19:43

You, I'm a breast cancer survivor. I've been very public about this because of the data that I think exists and I'm not encouraging anybody to do anything. I'm telling you what I do. I am an 11-year breast cancer survivor and I am on hormone therapy because I understand the data and that's another podcast. We can talk about that at another time. So it is not cut and dry.

Dr. Suzanne Gilberg-Lenz: 20:03

And when we say estrogen dependent, that means there's receptors Doesn't mean the breast cancer was caused by estrogen, because that's actually not what the science says that's right. I'm going to say it again Receptor status doesn't mean that the thing that fits in the receptor caused the cancer. That's not what it means. So that's really important. There's actually not that many people who can't use hormones. Strictly speaking, people may choose not to use hormones, people may have had bad reactions to hormones, and I do want to say that every single one of those people on that list that I just gave you, jen, who can't use systemic hormones, can use vaginal estrogen for the prevention of urinary and vaginal symptoms, which is very, very important to know. That's not what the podcast is about, but um, but always important to say.

Jenn Salib Huber: 20:51

So thank you.

Dr. Suzanne Gilberg-Lenz: 20:51

Yeah, and I, and I think the other thing that I say all the time is that it's not informed consent if you don't have all the information. So sometimes people are choosing not to use hormones because they they have been. They are adopting the narrative that's a mythology, that isn't accurate. And so as long as people understand like these are reasons that you could use that you might choose, that you might not to choose why you can't. As long as they understand that and where they fit into that, if they're choosing not to use hormones, that is totally okay. It's not okay when they didn't get the information and they got scared off of them. That I have a problem with.

Dr. Suzanne Gilberg-Lenz: 21:25

So, having said that, it's not really a huge number of people that can't use hormones, but not a lot of people. We know in this country something like 4%, depending 4 to 6% of women who are the age of hormone therapy are on it. So the fact is that the vast majority of women in the United States are not using hormone therapy. Okay, so what are? What can we use, assuming that? I mean, it's not true, but let's say you know 95% of women in the United States don't want to use hormones. Okay, that's not true, but, but let's say a lot of them really are making a choice. In the affirmative, then what can they do? There's so many things they can do. I think it depends on what the issue is for them, right?

Jenn Salib Huber: 22:08

What is?

Dr. Suzanne Gilberg-Lenz: 22:08

what are they trying to address? Are they trying to address specific symptoms? Are they trying to look at longevity, bone, brain and heart health? Cause, those are the things that are gonna, those are the things that are going to kill us not breast cancer, you know, very true, right, and those are lifestyle things. Those are lifestyle.

Best Supplements & Herbs for Menopause Symptom Relief

Jenn Salib Huber: 22:28

I love that you referred to it as hormones plus, because I think hormones are such an important piece of the conversation for many people, especially, depending you know, people who go into early and premature ovarian deficiency, all that kind of stuff like they're very important. But the plus part, I think, is, you know, that missing piece of the conversation and so it's really one part of what needs to be a relatively big pie of things that you do to support your health and your wellness and how you kind of feel and survive and thrive.

Jenn Salib Huber: 23:05

Controversial things that came out in the UK last year, which was recommending cognitive behavior therapy as a first line non hormonal treatment, and I mean there are some types, so CBT, which is cognitive based behavioral therapy for insomnia. I think the evidence is quite good and I certainly have had lots of people say that it has been a game changer for their sleep issues. So yeah, this is not at all a knock on CBT, but there was a lot of flack when the government guidelines came out with that. What I mean? Did that make it to your side of the pond?

Dr. Suzanne Gilberg-Lenz: 23:35

Like yeah, oh, yeah, yeah, Well, amongst the menopause experts, I mean, I don't, I don't know how much the lay public is really paying attention to that. I think the the the criticism of that is that, first of all, cbt is not widely available. Okay, it's not. It's also not inexpensive, I mean, it's not. It's just not widely available at all.

Dr. Suzanne Gilberg-Lenz: 23:57

And where are people supposed to be going to get this CBT? Like it's just, it didn't make any sense to me. And I think the other thing is that I think for insomnia, that's really like insomnia, right, not hormonally mediated, that's just a different situation, like we're really are hot flat. But it also positions a lot of this symptomatology that is well documented as being extremely disruptive and severe, like vasomotor symptoms, you know, like hot flashes, night sweats, as like somehow psychological and basis, which it's not. So I don't get it and I'm not going to lie, I had a lot of other things going on and I didn't do a deep dive into all the literature, but I certainly was involved in the, the response to it, because I think it. It was like also weirdly anti-estrogen, I think.

Jenn Salib Huber: 24:54

I think a lot of the data that comes out.

Dr. Suzanne Gilberg-Lenz: 24:57

Yeah, yeah. Well, that's why I'm saying like as if like a psychological issue isn't a thing, but it's like it, like your night sweats that soak through your sheets are absolutely not going to get better with CBT, that you can't find a practitioner for, that costs a lot of money out of pocket, like what.

Like it just was so tone deaf and I think this is a whole other conversation, but I think it's important for the listeners to understand there's a lot of weird back channel politics around this stuff and around people who have published on this and are considered experts in their field for decades, and these experts experience of cognitive dissonance, like the data is coming at them that just does not fit their narrative from 25 years ago or specifically from 22 years ago, and they just cannot see it. It's like their frontal lobe shut down. So, cause there've been conversations and there's a lot of like weird stuff around that. So I'm not against CBT. If it works for you and you can access it and you want to use it, you should do it.

Dr. Suzanne Gilberg-Lenz: 26:03

I personally, and insomnia and sleep disruption specifically, is one of the worst problems that people face humans, all kinds of humans because it sets you up for more insulin resistance for cortisol, uh release for um, much more stress, for inflammation and mood disorders, and then you can't actually attack lifestyle in terms of, like you know, looking at your nutrition, looking at your fitness and movement because you feel so terrible. We know that people reach for different kinds of food when they are sleep deprived. We know that, you know, nighttime shift workers have much worse health outcomes. So if your sleep doesn't get dealt with like, it's going to be hard to do the rest of it. So I think that was the other reason that people kind of responded to that because they were just like what and you nailed it it was, I felt, gaslighting, it really did.

Why Non-Hormonal Treatments Take Time to Show Results

Jenn Salib Huber: 26:53

It did, and it was so, and especially in the midst of this major conversation that's happening worldwide about access to hormones, to have this government document come out and say, well, actually try CBT first.

Jenn Salib Huber: 27:04

It was like wait, yeah you don't need hormones, so if we could just kind of like summarize, because you know the non hormonal conversation, I think everybody, whether you use hormones or not, you need to be thinking about the non hormonal ways to support yourself and just kind of your health. So it really is a conversation for everyone. But if somebody is in that like small group of people who can't, or people like me who tried and it just didn't work, what do you feel are kind of the avenues for them to explore options that are going to be evidence?

Dr. Suzanne Gilberg-Lenz: 27:38

based Hygiene is really, really overlooked and I want people to look up sleep hygiene. I'll mention a couple of things Keeping the room cool and there are things you can do. By the way, if you are having vasomotor symptoms and hot flashes, there's cooling jets. You know mattresses are expensive, but they work really, really well. Keeping that room cool. Nobody wants to do this, jen. You've got to turn your blue light off like an hour or two before you go to bed. You've got to put the phone down. You just have to. I can't tell you how many people I have this conversation with and I'm like tell me the truth. Come on, are you finishing emails? Is the TV on? When you fall asleep, dude, you're going to wake up. That is like very well documented. You just got to do it.

Dr. Suzanne Gilberg-Lenz: 28:28

Looking at alcohol intake Alcohol intake is not good for you in general, but it's really bad for sleep. Looking at limiting caffeine, setting your own resetting and committing to circadian rhythms People really want to take a lot of melatonin. I'm a little plus minus on melatonin. I don't think it's dangerous, but the problem is you are trying to reestablish a circadian rhythm. Taking melatonin isn't where it's at. Getting early morning sunlight is because early morning sunlight tells you oh, now we're awake, it's going to help set that cycle. So really committing to looking at what sleep hygiene is is, I think, very, very effective in combination with other things, right?

Dr. Suzanne Gilberg-Lenz: 29:05

So let's say we're talking about the hot flashes a lot, because that's the most obvious and it's, I think, that the data on botanicals around hot flashes is some of the most robust. But let me just say we're not going to have a seven-year study with the NIH does for a billion dollars on 70,000 women prospective randomized double-blind on black cohosh. That's never going to happen. But we do have studies that are robust, that are interesting. So you're talking about the EU. I mean Germany in particular has some of the best data on botanical medicine that is out there. There's a lot of what we call ethnobotanical journals, scientific journals that have looked for ages at a lot of these kind of more indigenous remedies and they're pretty good studies. So things like black cohosh have been shown to decrease hot flashing by like maybe 50 percent.

The Controversy Over CBT for Menopause: What You Need to Know

Dr. Suzanne Gilberg-Lenz: 29:55

Um siberian rhubarb is also very effective for hot flashes. Um chaseberry, we know vitex is really helpful for a number of the sort of more perimenopausal PMS kind of symptoms. People get breast tenderness, mood stuff, and it's probably because one of the things it does is increases native progesterone production, so that probably works better in the more perimenopausal world. There are some great herbs for sleep, like jujube, which helps to restore sleep, because a lot of times it's not falling asleep, it's staying asleep. And jujube, which helps to restore sleep, um, cause a lot of times it's not falling asleep, it's staying asleep. And jujube has been shown to help you stay asleep. Um, I think the cannabis literature. I really wish it was better.

The Entourage Effect: Why Botanical Medicine Works Differently

Dr. Suzanne Gilberg-Lenz: 30:38

I, you know I I just wish they'd do more, but there's some decent data on use of various kinds. You know THC, cbn, cbd, cbg for mood and for sleep. You know I'm say it with caution. I'm really interested in looking more at what's happening with the mushrooms in general, like not just psilocybin and microdosing, which is very popular here even though it's not legal, but also things like lion's mane for cognition and focus. We know that there's a lot of really great data in the immune world with a lot of the mushrooms turkey, tail, reishi there's great stuff on gut and immunity. So we don't have necessarily made that leap to women's health, but I think there's a big discussion forthcoming around that. And the cool thing about the mushrooms is that the non-indigestibles are high in fiber and really good for the gut. Microbiome Isn't that interesting.

Jenn Salib Huber: 31:34

So you're getting like Fiber. I mean, mushrooms are a great source of soluble fiber. They're actually a source of big glucan, very like related to what's in oatmeal. So mushrooms across the spectrum are awesome.

Dr. Suzanne Gilberg-Lenz: 31:44

Mushrooms are amazing yeah yeah, so and this is the thing, and let me say that this is the thing about the natural world. It's very hard. In conventional medicine and empiric science we take one little component, we amplify it and we use that and we look at that in the lab because it's easier to study and that's just the way we do it and that's fine. That's the way it is. It's a little more complicated in botanical medicine and looking at herbs and these things and mushrooms right, which are not plants, because you're looking at something called the entourage effect. You're looking at how all of these multiple components in the plant work together synergistically and we can't always pull the one thing out, which is why it's harder to do these studies. So people just need to understand that. But the great thing about the entourage effect is you're getting more than one effect.

Dr. Suzanne Gilberg-Lenz: 32:28

Yeah, yeah so it's kind of great.

Jenn Salib Huber: 32:30

And that is the synergism of plant-based medicine, botanical medicine is that, you know that effect, that entourage effect, which I love that term. You know, my experience was also that soy and phytoestrogens from soy foods was extremely helpful, but one of the challenges with that is that you know it's. You have to eat it regularly, essentially forever and for some people.

Jenn Salib Huber: 32:55

you know it's hard to wait six or eight weeks or 10 weeks to notice a change. When you do, it's worth it and it's easier to kind of keep going. But we're so used to something hurts, I just want it gone. That is like well, if it doesn't work in 72 hours, it's not working, and I think that's kind of. One of the challenges with any non-hormonal treatment is that it is probably not going to have that immediacy of effect.

Dr. Suzanne Gilberg-Lenz: 33:22

That's a huge point. People need to be patient. It's hard to tell what is really affecting them. Need to be patient. It's hard to tell what is really affecting them. And I think, as people are recognizing what's going on with their bodies and their and the developmental phase that they're going into, they're coming in earlier, which is great.

The Role of Gut Health in Managing Menopause Symptoms

Dr. Suzanne Gilberg-Lenz: 33:37

But the thing about perimenopause is that not only is it a really long, you know trajectory could be a decade but the the the hallmark of perimenopause is unpredictable fluctuations. So you know, sometimes somebody is like I'm, it's I feel great immediately and I'm like you might be getting a period in three weeks. Actually, maybe you're not. You know what I mean Like. Or or now they've finally started skipping five minutes in a row and they feel absolutely awful and it's like it's not that the herb is not working and said it's going to take longer and they're in a low state. So so it's complicated. I mean.

Dr. Suzanne Gilberg-Lenz: 34:13

This is why perimenopause and menopause can be really challenging for people to experience and for the practitioner working with them If they don't really know that this is, this is like part and parcel. It's not. It's not a one and done. You're not going to like here's your script for black cohosh. See you next year. That's not how it's going to work. And I think the other thing is the movement and fitness. I just want to say that I know we got a wrap, but moving your body on a regular basis, getting your steps in it's actually 7500 steps a day is really for less mortality, not 10 000, that's debunked. Um, you know, lifting heavier, progressively, um, not over working out like.

Jenn Salib Huber: 34:47

I can't understate how important movement is for life, joyful movement like doing things you enjoy, moving your body regularly in ways that you enjoy is like, I think, the the piece that's missing from um the movement conversations, especially in menopause um and but yeah, I'm a big fan of movement and I think that it's it's an essential part of being a human is finding ways to move your body in ways you enjoy.

Why Movement & Strength Training Are Essential in Midlife

Dr. Suzanne Gilberg-Lenz: 35:14

Well, you're using your brain at the same time too, so it's really really good for um, for the aging brain, getting the blood flow and also like challenging it dance, boxing, whatever it is you like to do. These are things that are you have to move your body and use your brain in a new way, and so it's a challenge, it's fun, it's interesting, it keeps you going and it really is there. There are tons of documented impacts, not just on like your muscle and your bone, but on your brain.

Jenn Salib Huber: 35:43

Yeah, this has been an amazing conversation. Thank you so much for your time and your expertise and your wisdom. As I always ask my guests, what do you think is the missing ingredient in midlife?

Dr. Suzanne Gilberg-Lenz: 35:56

Oh, I mean, I think just ease, Like why are we being so hard on ourselves? Oh my gosh. I love that so much. I think some of what goes on is people just feel so overwhelmed and so burnt out and maybe we need to listen to that and just slow down.

Jenn Salib Huber: 36:12

Lower the bar. That's what I'm all about. I love it. Yes, thank you so much. So we will have links in the show notes to your book and how people can learn more about you. But thank you so much, it was lovely to have this conversation with you.

Dr. Suzanne Gilberg-Lenz: 36:27

No, I'm so glad we did it, thank you.

Jenn Salib Huber: 36:30

Thanks for tuning in to this week's episode of the Midlife Feast. For more non-diet, health, hormone and general midlife support, click the link in the show notes to learn how you can work and learn from me. And if you enjoyed this episode and found it helpful, please consider leaving a review or subscribing, because it helps other women just like you find us and feel supported in midlife.