Unlocking the Secrets of Nervous System Regulation for Women in Midlife

As women transition into their perimenopausal and menopausal years, they often experience myriad symptoms that can disrupt daily life and make them feel unlike themselves. It can be a turbulent time — physically and emotionally. These symptoms are frequently rooted in hormone imbalances, from stress and weight gain to brain fog and sleep disturbances.

And while hormones tend to take center stage, another important player often overlooked is the nervous system. Understanding and regulating your nervous system can help you unlock better health, energy, and overall vitality.

Understanding the Nervous System

The nervous system is your body’s command center. It regulates everything from your heartbeat to your ability to handle stress. During menopause, hormonal fluctuations upend this delicate balance.

An overactive sympathetic nervous system causes a chronic release of stress hormones like adrenaline and cortisol, making your breathing shallow and fast, sending your heart rate up, and diverting all available resources like blood and oxygen to your heart, lungs, skeletal muscle systems, and amygdala (the fear center of your brain) to get you out of harm’s way.

Since you only have so much blood and oxygen to go around, all the systems that aren’t responsible for survival in those moments–like digestion, reproduction, immunity, and even emotional regulation–get deprioritized to ensure you get to safety.

This is how humans survived over time; our nervous system evolved to prevent us from falling asleep or thinking about reproduction when a threat is nearby (bear! lion!).

Nervous System and Hormone Imbalance

Estrogen, a key hormone that declines during menopause, significantly impacts the nervous system. This decline can lead to heightened stress responses and disrupted sleep patterns. It’s not just about feeling stressed or tired; these changes can exacerbate other menopausal symptoms like weight gain and brain fog.

Regulating Your Nervous System

Fortunately, there are several strategies to help regulate your nervous system:

  • Mindfulness & Meditation: Regular mindfulness practices can reduce stress and improve your body’s response to hormonal changes. Simple techniques like deep breathing or guided meditation can be powerful tools.
  • Exercise: Physical activity, especially yoga and aerobic exercises, can help regulate the nervous system. They not only improve muscle mass and energy levels but also enhance your mood and sleep quality.
  • Nutrition: Foods rich in omega-3 fatty acids, magnesium, and B vitamins support nervous system health. Incorporating these into your diet can aid in managing stress and improving overall well-being.
  • Sleep Hygiene: Prioritizing sleep is crucial. Establish a regular sleep routine (also known as sleep hygiene), limit screen time before bed, and create a calming bedtime environment.
  • Supplementation: Certain supplements, under the guidance of a healthcare professional, can support nervous system health. These might include adaptogens, magnesium, or omega-3 fatty acids.

Products That Support Nervous System Health

When considering products, look for those that support the strategies mentioned above. Whether it’s a meditation app, a yoga mat, or a high-quality supplement, each product should align with the goal of nervous system regulation and overall well-being.

I started doing yoga regularly at the start of 2024 and it’s been wildly beneficial for me. I now attend yoga classes regularly several times a week. Try what works for you–perhaps you’d like to explore the serenity of meditation or supplements that can guide you into a calmer state.

One of my favorite products that helps to regulate the nervous system is the Apollo wearable, especially because it was created by neuroscientists and physicians. It delivers gentle, soothing vibrations that help the body switch from “fight or flight” to a more “rest and digest” parasympathetic state.

Apollo is designed to offer the benefits of mindful practices like meditation and breathwork through your body’s natural response to touch. It also can improve your deep sleep, REM sleep, and total sleep time. (And I’ll keep saying this: Getting better quality sleep is absolutely essential to managing your peri and meno symptoms!)

Navigating the perimenopausal and menopausal years doesn’t have to be such a struggle. By understanding and caring for your nervous system, you can significantly impact your health, vitality, and quality of life. Remember, small, consistent steps can lead to big changes.

I’m always looking for affordable items for my Bettys who want to uplevel their health.  If you choose to invest in an Apollo wearable to help manage your nervous system, click HERE. A DRSTEPHANIE 15% discount will be automatically applied at checkout for you.

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Disclaimer: The information included in a newsletter, email, or on drstephanieestima.com is intended solely for educational purposes. It does not replace a direct relationship with your licensed medical provider and is not intended to diagnose, treat, cure, or prevent any disease.

Affiliate Disclosure: Products mentioned in a newsletter, email, or on drstephanieestima.com, may be part of an affiliate agreement in which Dr. Stephanie Estima receives a small commission on the sale of an item you purchase.

Mini Pause #5: What’s Better: Fasted or Fed Workouts?

Fasted or Fed Exercise?

TL,DR (too long, didn’t read)

Most evidence suggests that fuelling before a workout is better for performance in the gym, and has the same outcome on body composition as fasted workouts. That is not to say that working out fasted is pointless and ineffective. As long as you are fuelling appropriately in the peri-exercise time around your lifts — your body is a genius and knows what to do with the stimulus.

WHY

There are so many of you who struggle with not only what to do in the gym, but what to do in the window that surrounds your workouts.

Fasted or fed training?
Fasted or fed cardio?
What to eat?
When to eat it?
How much to eat?

With conflicting evidence abounding, it can get overwhelming really fast. And based on the comments from a recent Instagram post, you’re also trying to figure out what works, too.

Personally, I used to train fasted (both my lift sessions and cardio) for years, and have since changed my approach.

At the beginning of my fasting journey (when I was completely discounting the fact that I was female) I would work out in the morning and then continue my fast until noon. Needless to say, I was starving, and angry, and as soon as noon came around, I had a very large meal. Larger than what was necessary. The same continued at each subsequent feeding. It was hard for me to admit, but fasting until noon was not working the way I had hoped and the way it seemed to be for many others (mainly men) I admired and respected.

Over time, begrudgingly admitting this was not working well for me, I shifted my fasting window to eat immediately after my workout. I was still fasting for long lengths of time, but the phasic shift to earlier in the day was helpful. This worked well for me for years.

It was only until one of my kid’s soccer practices was moved early in the morning on the weekend that I changed things up again. Since I wasn’t able to get to the gym before his practice, I had the opportunity to experience fed training sessions.

I had breakfast, took him to practice, had another snack, and worked out afterward.

I was shocked at how well I performed. Was it the food? That I had more time to limber up my joints? My core body temperature? I wanted to figure this all out.

WHAT

So in examining this topic, let’s review the literature on the effectiveness of fasted versus fed workouts. Is there a difference?

Fasted Workouts

This meta analysis looked at several studies where the intervention was either:

  • fasted exercise with a standardized post-exercise meal
  • fasted exercise without a standardized post-exercise meal
  • fed exercise with a standardized post-exercise meal
  • fed exercise without a standardized post-exercise meal

What they found was the second intervention (fasted exercise and no post meal) appeared to be the most effective strategy to produce a short-term decrease in energy intake. But there was a catch: it also resulted in increased hunger and lowered energy expenditure afterward.

This is known as metabolic adaptation. If you have a higher energetic expenditure but are not fuelling properly either pre -or post-workout, you might be able to temporarily decrease caloric intake. But, the body will compensate over time by increasing hunger and/or lowering your total energy expenditure. This is the “calories out” part of “calories in, calories out.”

Said another way, aerobic exercise performed in the fasted state with no post-workout fuel induces higher fat burning WHILE DOING THE EXERCISE, but will then correct for energy output after the exercise is finished. This means, there is nothing inherently superior to fasted workouts.

Another study looked at 20 healthy young females and looked at the difference between fasted exercise on body composition. They kept calories constant between the two groups and either gave them a meal before exercise or had them work out fasted and fed them after the exercise was completed. Again, no significant difference was noted between the two groups in terms of body composition. They both demonstrated equivalent weight and fat loss.

Fed State

So here is where it gets interesting! Even though body composition seems to be agnostic to whether you are in a fed or fasted state, there’s a significant difference in performance and repair of muscles when you are fed before exercising.

Specifically, when you consume carbohydrates and protein before a workout, this positively affects muscle glycogen stores. This is going to give you the oomph you need to maintain energy and execution during your lifts. It’s also going to improve the repair of muscles and help to improve the short-term and long-term adaptations to training.

Said another way — being fed before a training session helps with the performance during that session and the repair afterward. I would argue that this speeds up changes in body composition over the long term because it is going to favor muscle tissue performance and repair. The faster you can put on muscles, the better your body composition is going to be.

For those of you wanting to go even deeper, check out this article on nutrient timing, and listen to one of the authors of the paper, Alan Aragon, on my Better! podcast.

HOW

If you want to try fueling before a workout and have been training fasted for years, start small!

Here is a short list of pre-training meals you can experiment with:

  • Add protein to your coffee. I often add a Core Power to my coffee, or I will blend Equip Foods or Schinoussa protein powder into my coffee.
  • Have a banana. It is light enough to avoid that “brick in the stomach” feeling.
  • Have a Protein Shake. (½ banana, scoop of whey protein powder and water)
  • My overnight oats recipe (check it out here)
  • Greek yogurt with some honey and walnuts
  • A few rice cakes with peanut butter and jelly

Personally, I am a creature of habit so it’s either my overnight oats or I add one scoop of whey protein to oats and mix. I eat either one of these options before every lift. When it’s leg day, I will also add a banana into the mix.

This clocks in somewhere between 350-400 calories, which is about right for the length and intensity of my workouts. I would say the bare minimum calories should be around 200, especially if you just starting to experiment with food intake early in the morning.

Many of you work out early, and I do as well. I eat my oats and protein of choice almost immediately after waking and then I get dressed and get to the gym. This buffer gives me about 30-45 minutes from the time I eat to the time I am in the weight room. Precisely about the time those glorious amino acids and glucose are spilling into the blood so I can drive them into my muscles to werk. Not work. WERK.

NOW

Decide on what small meal you are going to try. Tomorrow (or your next planned lift session), wake up and march into your kitchen to eat. Naked if need be — we’re talking about better muscle performance and recovery here! Then go about your regular morning schedule and head to the gym.

Be patient with yourself. It may take a few weeks to adapt to eating on a new schedule. I would choose one food and just have that before your workout for two to four weeks to see if you notice a difference in your performance at the gym.

It may or may not work for you. Either outcome is fine. That you are willing to try different things is what makes you the champion you are.

In this article, I mentioned my two favorite protein powders. Take a look and choose the one that’s right for you: Equip (use code DRSTEPHANIE to save 15%) or Schinoussa.

Question of the Week

Q: What does it mean when I’m spotting before my period?

Spotting outside your bleed week can be unsettling and there are a few explanations for it.

Before we dive in, consider your age, where you are in your cycle, and if you could be pregnant. And a word to the wise: I’ve had several friends in their late 40s get pregnant, so this is something to always rule out!

EVALUATING

Menstrual Cycle:  

  • Ovulation: Not all, but some women will notice some light pink blood mid-cycle around the time of ovulation. The pink color most likely is a mixing of the blood and cervical fluid. It should not be heavy enough to warrant a tampon, a cup or a pad, and this is considered uncommon, but normal.
  • Luteal Phase: This is most common in perimenopause when we see falling levels of total progesterone and estrogen. Lowered progesterone is unable to maintain the endometrial lining and premature shedding of the tissue can occur as it becomes ischemic and dies. Discussing hormone replacement with your provider might be in order here.
  • The spotting prior to bleeding might also be due to an estrogen deficiency or luteal phase defect where the luteal phase is shorter than the follicular phase. Typical diagnostic criteria consider 10 days as a luteal phase defect coupled with elevated FSH and LH. This can be confirmed on a blood test.

Hormonal Birth Control: If you have recently started on any kind of hormonal birth control like pills, patches, injections, or intrauterine devices, you may find you are spotting for the first few month as your body adjusts to its new hormonal environment.

Implantation Bleeding (Pregnancy): If you are pregnant, implantation bleeding often happens in the six- to eight-week mark of your pregnancy. This is right around the time you “should” be getting your period. The fertilized egg is burrowing itself into the womb and can cause noticeable spotting. This is normal, although you might mistake this for your period!

Sex: Penetrative sex can cause some spotting afterward, especially if you are experiencing vaginal dryness. This happens most commonly in perimenopause with declining levels of estrogen leading to reduced lubrication. The friction from sex can cause microtearing in the walls of the vagina. So, either ramp up the foreplay, grab some lubrication, or both.

You can also see some post-coital bleeding from cervical polyps. These are benign growths on the muscular wall of the cervix.

In all of these cases, keep a log of what is happening so you can discuss the specifics with your doctor. You’ll want to note where you are your cycle, how much, how consistent, what colour, and duration of the spotting.

TESTING & NEXT STEPS

I love to run lab tests on myself and patients every six months. This is ESPECIALLY true in perimenopause when your sex hormones can drastically change from visit to visit.

YOUR TURN!

‘ll be answering your questions every week right here in the Mini Pause! Let me know what’s on your mind. I’ll be checking for both questions and feedback at support@drstephanieestima.com.

WHAT I RECOMMEND: Living Libations

As your hormones fluctuate in mid-life and your skin begins to change, you want products that deeply nourish.

Best Skin Ever-Rose is crafted to bring all skin types into balance and uses Rose Otto to replenish your skin. Use it as a cleanser, a gentle exfoliator, or a luscious face and body moisturizer.

It’s been a favorite face oil of mine for YEARS and for good reason. It is pure luxury. This is my “special” night oil when I want to up the glow and dewiness of my skin.

I also love the lightweight Rose Glow Serum that’s rich with ingredients like jojoba, seabuckthorn, and geranium. It makes my skin feel silky soft while soothing and protecting.

Visit Living Libations link and save 15% off. (The discount is automatically applied at checkout.)

P.S.

MISSING LINK: In last week’s Mini Pause, I included a link to a hand-held vacuum I like to use on my mattresses, but the link wasn’t functional. Here it is!

HEALTH TOOLKIT: I’ve put together a toolkit for you on my brand new website. I designed these resources for my Bettys who are menstruating, experiencing perimenopause or have gone through menopause. There are commonalities between the categories and also specifics for each one. Everything I recommend, I use myself. That’s my rule. I invite you to take a look!