Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You!

Here are the top 10 key takeaways from Dr. Sara Szal's discussion about hormones, perimenopause, and women's health on "The Diary of A CEO" podcast that could transform how you understand your body's inner workings.

1. Hormones are critical messengers in the body

Hormones function as essential biochemical messengers that keep our bodies functioning optimally. Dr. Szal explains that most people have imbalanced hormones, with around 90% of the 40,000 patients she's tested having problems with their cortisol levels. These imbalances can manifest in various ways, affecting energy levels, stress management, and overall wellbeing.

The expert emphasizes that cortisol acts more like a dictator than a team player in the hormonal system. Unlike other hormones such as estrogen or testosterone, cortisol is absolutely critical for survival. It significantly impacts immune function, blood sugar regulation, and stress response, making it perhaps the most important hormone to balance first.

2. Cortisol imbalance affects multiple body systems

Elevated cortisol levels can lead to a cascade of health problems. When cortisol is chronically high, it's associated with increased belly fat because fat cells in the abdominal region have more cortisol receptors. High cortisol is also linked to depression, with approximately 50% of people with depression showing elevated cortisol levels.

For women specifically, high cortisol can cause brain shrinkage starting in their 40s, which doesn't happen to men. This contributes to cognitive difficulties and energy issues. Additionally, when the body produces excess cortisol, it often makes less testosterone, creating further hormonal imbalances. Managing cortisol through lifestyle modifications, breathwork, and occasionally supplements like Ashwagandha or Rhodiola can help restore balance.

3. Childhood trauma affects long-term health

Early life trauma has lasting effects on physical health throughout adulthood. Dr. Szal references the Adverse Childhood Experiences (ACE) test, a validated questionnaire that measures childhood trauma. Research shows that people with higher ACE scores have greater risk for 45 different chronic diseases later in life.

These childhood traumas live on in the body unless properly addressed. For some people, trauma manifests as immune system problems, leading to allergies, food intolerances, or autoimmune conditions. Others experience nervous system dysregulation resulting in anxiety, depression, or PTSD. Still others develop endocrine issues like chronic cortisol problems, demonstrating how early life experiences shape long-term physiological health.

4. Conventional medicine often fails to address root causes

Dr. Szal argues that mainstream medicine is fundamentally broken, especially for people with chronic conditions. The conventional approach typically treats symptoms with pharmaceuticals rather than addressing underlying causes. For example, a person with high cholesterol might be prescribed a statin, but statins have to treat 100-200 people for just one person to benefit.

This "medicine for the average" approach ignores individual variations and optimal health. Despite lifestyle medicine being able to prevent 70% of modern diseases, the profit motive pushes pharmaceutical solutions instead. Medical training often neglects crucial areas, with Dr. Szal noting she received only 30 minutes of nutrition education and similarly limited information about perimenopause and menopause during her Harvard medical education.

5. Women experience higher rates of certain health conditions

Women face significantly higher rates of numerous health conditions compared to men. They experience double the rate of depression, double the rate of PTSD, double the rate of insomnia, four times the rate of autoimmune disease, and nine times the rate of thyroid dysfunction. These disparities stem from both biological sex differences and socially constructed gender differences.

The biological differences include hormonal variations and chromosomal distinctions. Women's immune systems tend to be more reactive than men's. However, gender-based social constructs also play a substantial role. Women often struggle to say no, overfunction, prioritize others' care over self-care, and carry more emotional labor. Together, these factors create what Dr. Szal describes as "a health hazard to be female."

6. Perimenopause affects women earlier than commonly recognized

Perimenopause typically begins between ages 35-45, much earlier than many women and even doctors recognize. During this transition, ovaries start running out of viable eggs, and the mitochondria in the eggs don't function as efficiently. This leads to hormonal changes affecting not just reproductive hormones but also metabolic, immune, and neurological systems.

Dr. Szal notes there are over 100 perimenopause symptoms, yet many women seeking help are dismissed by healthcare providers as being "too young" for perimenopause. Common concerns include difficulty managing stress, decreased libido, painful sex, unexplained belly fat, and inability to lose weight using previously effective methods. Approximately 73-75% of women don't receive adequate treatment for perimenopause and menopause.

7. Blood sugar regulation is fundamental to hormonal health

Blood glucose levels provide critical insights into overall metabolic health. Dr. Szal emphasizes the importance of blood sugar regulation for energy production, mitochondrial function, and hormonal balance. She uses continuous glucose monitors with patients to provide real-time feedback on how food choices affect blood sugar, which has proven highly effective in changing eating behaviors.

Proper glucose utilization is essential for producing ATP, the energy currency of cells. When blood sugar is poorly regulated, it can lead to pre-diabetes, insulin resistance, and various inflammatory conditions. Dr. Szal often finds elevated glucose levels in patients that previous doctors have overlooked, highlighting the importance of watching this metric even before clinical thresholds are crossed.

8. Environmental toxins disrupt hormonal balance

Modern environments expose us to numerous endocrine-disrupting chemicals. Dr. Szal identifies over 700 known endocrine disruptors, including BPA in plastic containers and can linings, parabens in skincare products, and flame retardants in household items. These chemicals interfere with normal hormone function and contribute to imbalances in both men and women.

To optimize hormonal health, Dr. Szal recommends evaluating everyday exposures. This includes examining skincare routines, cleaning products, air quality, and food storage containers. Reducing exposure to these toxins can significantly improve hormonal function. Additionally, she notes our increasingly digital world contributes to nervous system dysregulation, creating what she describes as "a hum of dysregulation" that's worse than ever before.

9. Sleep quality profoundly impacts hormonal health

Sleep quality has immediate and significant effects on hormonal balance. Dr. Szal describes sleep as "as close to a panacea as we have," noting that disturbed sleep impacts hormones within 24 hours. Just one night of poor sleep raises insulin and cortisol levels, increases hunger, and triggers carbohydrate cravings the following day.

Despite its importance, many high-performing individuals believe they're exceptions to the 7-8.5 hour sleep requirement. In reality, only about 2% of the population carries the "short sleep gene." For optimal hormonal health, Dr. Szal recommends tracking sleep quality metrics like deep sleep, REM sleep, interruptions, heart rate variability, and respiratory rate. Morning sunlight exposure for 30+ minutes also supports better sleep and hormonal regulation.

10. Women experience clearer priorities during menopause

Menopause often brings heightened clarity about life priorities for women. During reproductive years, fluctuating levels of estrogen, progesterone, and testosterone create flexibility and accommodation in women's thought patterns and behaviors. As women enter perimenopause and menopause, this "hormonal veil" lifts, enabling more direct truth-speaking and less accommodation of situations that don't serve them well.

This newfound clarity often contributes to the increased divorce rate observed during menopausal years. Women become less willing to tolerate unsatisfying relationships or circumstances they previously accepted. Interestingly, research on psychological well-being shows a U-shaped pattern across adulthood—highest in the early 20s and early 30s, dipping through the 30s and 40s, then rising again around age 50, suggesting improved satisfaction and happiness in post-menopausal years.