47: Weight Loss After 40 | Hormones, HRT & GLP-1s

Why does it suddenly feel impossible to lose weight after 40? Daffney talks with women's health specialist Adrian Thompson, PA-C, to unpack what happens during perimenopause, why weight gain isn't simply a matter of willpower, and how changing hormones affect everything from metabolism and muscle mass to insulin resistance and food cravings. They also separate fact from fiction around hormone replacement therapy (HRT) and GLP-1 medications, explain why standard lab work often misses perimenopause, and discuss why so many women are dismissed when they seek answers. If you've been wondering why your body suddenly feels different, this conversation offers evidence-based explanations and reassurance that you're not imagining it.

Connect with Adrian Thompson:

vidawomenshealth.com

instagram.com/vida_womenshealth

In This Episode:

• (01:30) Adrian's personal menopause journey
• (04:00) The misinformation many women still receive about hormone therapy
• (10:10) When to seek help and what providers should be looking for
• (12:00) The labs Adrian uses to identify underlying issues
• (17:10) How HRT supports muscle recovery and metabolism
• (20:30) The science behind "food noise" and cravings

Connect with Daffney:

liftprowellness.com

Instagram | YouTube | Merch

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Transcript

SPEAKER_01 0:00

Hey everybody, thanks for joining us for another episode of Don't Fucking Shrink the Podcast. You know, as women, we are always trying to figure out the next hack, the next move, what's gonna make us skiddy, what's gonna lose five pounds, and where the hell did that pooch come from? But today I am talking with one of my favorite folks. This is Adrien Thompson. She is a women's health medical specialist. She actually specializes in the questions I just posed to you there. And Adrien loves to give raw, honest information. And what her clients say most is wow, how dynamic and how personalized her approach is. Welcome to Don't F and Shrink, the podcast, where we stop playing small and start showing up big. I'm your host, Daphne Allwine. And I'm here to cut through the noise, ditch the self-doubt, and get honest about what it takes to live and lead with unapologetic confidence. Each week you'll hear unfiltered conversations, powerful stories, and in real life strategies to help you take up space in your life, your work, and your world. So buckle up because shrinking is not an option here. Let's dive in. Hey Adrian, how are you?

SPEAKER_00 1:17

Good. I'm good. Thanks for having me.

SPEAKER_01 1:21

There's so much in the news with HRT and with GLP Ones, and you are an expert in this because not only are you a PA who really specializes and understands these things and has traveled the world to practice as well, but you actually created your own micro business because there were just more questions than answers. So, Adrian, how did you get into this field?

SPEAKER_00 1:44

What's your story? Yeah. So my story starts with me going through perimenopause and getting bad information myself. So I started going through perimenopause probably about six years ago. And I literally thought I was going crazy. I also had classic night sweats. So I've kept my ears open over the years to menopause and hormone therapy. And I graduated PA school in 2003. So I was in school in 2002 when the WHI, the Women's Health Initiative, came out and said, you know, hormones are bad, don't take them in the black box. Yeah. Everything that's been debunked. But I had kept my ears open to it over the years and knew that hormones weren't bad. They don't do what they said they did. So when I started going through it, I kind of knew what I needed, right? And I knew the resources to go to to find the good information, the evidence-based information versus just like trying to take it in from social media and not knowing what was going on. And so I was able to get what I needed, my estradiol, my progesterone, and it saved my life. Saved my life. I mean, took me back to myself. I mean, people are serious when they say, I just do not feel like myself. I feel crazy. So, and then I decided that I was going to go back to my old time GYN for something because I had done an online HRT provider. And she scolded me for what I was taking because I was still bleeding and having periods. And she told me I couldn't be on what I was on. I shouldn't be on what I was on, be on only a birth control. I should get my estrogen levels checked. And at this point, I was a menopause society certified practitioner. And I was absolutely floored. I left there just flattened. And I couldn't believe my long-term GYN would have such bad information. Yes. But then I had to have a different GYN consultation for a surgery, who scolded me again. And so by this time, I was ready to go out on my own, leave the insurance model so that I could have actual time with my patients.

SPEAKER_01 4:01

Yes, thank God.

SPEAKER_00 4:03

In the 10-minute appointment, I'm going on to more personalized, individualized care where I can spend an hour with all my patients. So I decided to leave the insurance model, start my own practice, but then specialize in those things that women have a very hard time finding good information for. Because people usually find me when they've been dismissed by their doctor or they've been given the wrong information or told they can have this or they can't have that. They know it's not right, but they need an expert to go over it with them.

SPEAKER_01 4:38

So it's it's funny. We I went, I think it's generational too in a lot of ways. I remember growing up the doctors were just the voice, right? We didn't question them. We didn't ask questions. I think I had a grandmother who actually, I think she she underlined him as like her choice. Like, oh, the doctor said I can have this. Oh, my doctor, you know, said this. So it was like the ultimate authority. We didn't question, we didn't ask questions. What? So what you know, yeah, you went through it. You went through the certification, you went through school. You know the information is incorrect or or no longer valid, right? Maybe, maybe that was the information they had then. It is different now. And thank God, as you and I were at the same uh, the same leadership or the or talk conference once, like this is new information. This these are things that are have not been studied before, haven't been studied enough. And now we and now we know better. We can do better.

SPEAKER_00 5:29

But the problem is, as clinicians, unless we've gone back on our own, on our own time and our own dollar to study this information, educate ourselves on the new information, we are still stuck in the old information and giving bad advice to our patients. And so unfortunately, there's so many clinicians in this day and time that don't have the right information because they haven't gone back and learned it. And maybe they don't know it exists. I don't know. But there's also a fault in our medical system or our medical school system to where we're not taught this in school and we're still not taught this in school. You go ask OBGYN residents and they maybe get a month on menopause care. There's definitely a lack of comfort in prescribing these medications from many, many clinicians.

SPEAKER_01 6:24

Well, you said you had success and you said that you were actually feeling better from this. Oh my gosh, night and day. Can you tell us what that experience was like? So all of a sudden, same thing, you know, I I I have a very similar story that I will share too, but you notice that you are sweating, maybe you smell it a little differently, you maybe panic attacks, whatever the case may be. Yeah. And you're recognizing that there's no other reason for this than a change or dip of hormones, right? Right. When did you know enough was enough?

SPEAKER_00 6:55

Like was there when I couldn't sleep. Because I am a person who needs her sleep. I need a good seven, eight hours, and I am just no good without sleep. I would wake up drenched at night, just drenched, you know, me, my clothes, my bed. And you wake up and then you have the chills and you're cold, you can't get back to sleep, and then you're just kind of waking up every morning at 3 or 4 a.m. You can't get back to sleep. I was barely able to function. Of course, a lack of sleep can lead to brain fog and difficulty with focus and attention, but it went to a new level. You know, I was seeing patients virtually and having a really hard time just staying focused during that time to be able to take in what they're saying, remember what they're saying. You know, I just felt so scatter brained and all over the place that I was like, I am I even a good clinician? Should I even be doing?

SPEAKER_01 7:55

Oh, this underlines everything you're doing. Yeah, yeah. I just felt so scattered and that's very related. Yeah. Yeah. It was tough. I mean, the interesting thing in this is that we think that there's this checklist. We think that there's this test for perimenopause. And I had to learn the hard way as someone who's been in the industry for a long time, that I didn't know if I was in postpartum or if I was in perimenopause. Because I I had, you know, had first baby at 39, right? Almost 40. And I'm waking up, as you mentioned, just drenched in sweat after baby. And I'm like, oh, it's a hormone shift. This happens. All of a sudden you smell a little differently, things are going on, you can't sleep. And they're like, oh no, you have a new baby. That's why you're not sleeping. And all these compound things that you think about, but there is no test. Cause I, that's the other thing I bump into with clients is they're like, well, you know, can I get tested for this? And I'm like, no, actually you can't.

SPEAKER_00 8:50

Or they go to their clinician who tests their hormones and they all come back normal and they say, Oh, you can't be in perimenopause. All your labs are normal.

SPEAKER_01 9:00

Well, the other thing is too, is we we don't say this enough, right? And this is something you and I know, your hormones literally change every hour, right? So because you've got this level of hormones now, an hour from now, it's gonna look different in the other. So it's it's really a snapshot.

SPEAKER_00 9:16

So unless you're in a second that that nurse puts that needle in your arm, throws the blood, that's it. That's it. And we know perimenopause is also called the time of hormonal chaos. Your estrogen or progesterone or even testosterone levels can be higher than high, what they used to be. And we know that they're lower than they used to be. Most of our symptoms that we get are from the lower, most likely estrogen levels overall. Yes. But we still can get really high levels. People get a lot of breast tenderness and other high estrogen symptoms. And so the time you get it drawn, it could be super high, it could be super low, it can be normal, and it's usually normal.

SPEAKER_01 10:04

Yeah. So that being said, I know you are working with patients, and this is your area of expertise now. And you've even added the obesity element, like you've gone back and certified through this because there is so much weight gain that happens or weight changes that happen as a result of these hormones. So it's not that you're failing or all of a sudden you've overeaten. Yeah, we need comfort food from time to time. But how are you engaging with clients? So when someone comes to you, is there a panel of labs? Is there symptoms that you're looking for that would sort of help our listeners know, yeah, you know what? I need to call Adrian. I need to reach out to her. Like what how do I know?

SPEAKER_00 10:43

So if you read the definition in a textbook of what perimenopause is, perimenopause usually starts when periods become irregular. By definition, they usually get closer together, they get heavier, and then as we go on through the transition, they start to spread out and get lighter, and then we go through menopause. And we know that, you know, the average age of menopause is 52, and perimenopause can start seven to 10 years before menopause happens. So if anything over 45 is normal, then people can start with symptoms in their late 30s. I was 48 when I went through menopause. So I I could have been 38 when I started into perimenopause. Yes. Yes. And so for me, it's getting a really good history. You know, what are your periods doing? What are your symptoms? What kind of symptoms have you had in the past? And how are these different? But it's also ruling out other causes, right? You might have some classic hot flushes, night sweats, even some joint pains, or, you know, difficulty with sleep, weight gain. And I can chalk that up all to perimenopause, or I can make sure and rule out other things that could be causing thyroid, things like that, right? Exactly. So I like to get a full blood panel on my patients, and I go a lot deeper than the normal, you know, annual physical screenings. But I like to look at those things. What's your vitamin D doing, what's your B12 doing, what's your insulin doing? I calculate what's called a HOMA IR, homeostatic model for insulin resistance. So it's a way to identify insulin resistance before you get to pre-diabetes. Yes. I like to get a full cholesterol panel. A lot of people see cholesterol changes in this midlife transition, some of the more advanced lipids, the lipoprotein A and apolipoprotein B, and looking, of course, at their fasting blood sugars and all the things that if there's something else going on and we don't treat that, it's a lot more difficult to treat, you know, any other symptoms. So treat anything else that's going on. And then we dive into, well, this is perimenopause and what do we do about it?

SPEAKER_01 13:18

I think it's interesting. And there's, you know, we take numbers like cholesterol and things like that, but you and I are going to nerd out here for a second. But cholesterol, I mean, how do you think we get hormones? Right. I think that's one of the things where, you know, cholesterol is a static number, theoretically. But as our hormones are shifting or we're producing hormones, or as you and I know that sex hormones or estrogen, right, are cholesterol molecules, right? You should be noticing changes as you get older, as you get into menopause, right? So one of the things I notice with clients is when they're, especially women, their cholesterol numbers start spiking as menopause starts approaching. Yeah. That is one of the one of the gentle ways I start talking to them is like, this is how hormones are being made or or subset in in this chapter. So I'm glad you said that, that like cholesterol is one of those numbers. If you notice that it's starting to go this way, then maybe there's a really good chance that menopause is closer than you think. So I'm glad you said that. Nerding out. Tell me about the weight gain that you see with people coming into this chapter.

SPEAKER_00 14:24

I mean, most everybody, not everybody, but you know, it's I'm gaining weight. Most likely it's in the midsection. I'm exercising the same, I'm eating the same, or I've increased my exercise or made sure my nutrition's perfect and I'm either still gaining weight or I've gained weight and I can't lose the weight I've gained. So I hear it all the time. And so it is so multifactorial and there's so much biologically happening. I want women to know that it is not their fault. You know, they think, oh, I should do more, I should do this. It is not their fault. We know that this transition from perimenopause to postmenopause with these fluctuating hormones, lower levels of estrogen, lower levels of testosterone, progesterone lead to this perfect storm of weight gain, fat storage, and difficulty losing it. You can read the textbooks, women gain weight in midlife. Like I said, it's multifactorial, but we start to lose muscle. As we age, we're gonna lose muscle. So we have to work hard at keeping them. But estrogen and to an extent, testosterone, help us build and keep our muscles. And when we work them out really good, you know, we do a good exercise or work resistance training session. And then at night we're supposed to sleep and rebuild our muscles and keep them nice and healthy. Well, if we don't have those hormones, we're not able to keep those muscles quite as healthy and it's robust. So it feels like a rec a recovery, right? Like it's a recovery seventh. Okay. Yeah. And so, you know, if we're losing muscle or not keeping what we have or being able to build muscle, muscles are such a big piece of our overall resting metabolic rate. So how many calories do we burn at rest? Right. Right. Muscles are a huge piece of that. And as we lose muscle, we lose our metabolism rate.

SPEAKER_01 16:34

Yeah, you're right. We we know that. I mean, anybody who's doing their basic one-on-one is that the more muscle in your body, right? And there's different types of muscle, um, we want to hold on to our skeletal muscle. We want to make sure our dynamic muscle, you know, moves us forward, fast twitch, slow twitch, but just the composition and the amount of muscle in your body determines your metabolism. I like to sometimes talk about this like mid-section weight gain as tactical girth. Um for the, you know, because we're taking on a new chapter. It's it's a joke, but a lot of times people quickly move to it's a cortisol issue. It's a stress. And believe me, that can definitely be that could definitely be a factor. Yeah. Where where does HRT take its place in that case? Is it the recovery portion of the exercise? Or where does HRT kind of come in with those replacements? With the muscles.

SPEAKER_00 17:26

Yeah. Well, helping us recover our muscles and being able to build our muscles. They both, estrogen and testosterone, play a role in that, being able to recover, but also being able to build.

unknown 17:40

Yes.

SPEAKER_00 17:40

And they both play a big part in that.

SPEAKER_01 17:42

And no, and no, ladies, because that's the other side I got was uh you're not gonna get bulky. This is not you're not you're not injecting anabolic steroids. I think that's the other thing is when people hear hormones, they go to steroids, right? And that's that's not the same classification. No. Can you talk to me about how GLP1s are sort of contributing in that way too?

SPEAKER_00 18:02

Well, they help in a way. So another really important factor that happens in midlife and why we gain weight and have a hard time keeping it off is estrogen helps with the sensitivity of how we use our insulin. So when we're not using our insulin properly and our cells can't use the insulin to break down the sugars, we get a larger amount of insulin floating around. And insulin is like a brick wall to fat. If you have too much insulin on board, you can't break down your fat for energy. If you have too much insulin on board, your blood sugar is gonna kind of say, no, I'm tired of you. I see you too much, I'm not gonna use you. Yes. So you're almost going into a state of starvation or low energy because you can't break down the sugars in your blood and you can't draw from the fat for energy. And so your body increases its hunger hormones, so you get more hungry, you crave more, you're more fatigued, and it's a weight-gaining state. And so it's this vicious cycle. So estrogen plays a role in the sensitivity of our cells to insulin, and so better using our insulin. And GLP1s are kind of multifactori in how they help us lose weight. But one of the ways they work is on the pancreas. And so they help kind of regulate that insulin that the pancreas is producing. Because usually in an insulin-resistant state, you're getting too much insulin. So it helps down regulate the pancreas and the insulin production so that we have less floating around and we're able to start using it again. So that's one place where GLP1s are really important. Yeah. Um, that's why we see it works so well, you know, on type two diabetics as well, because it does have that role and a couple other roles in the pancreas and in the liver. But then, you know, it slows that travel of food through your digestive system. So food sits there a little bit longer in your stomach. So you feel more full. It upregulates our satiation hormones called leptin, and it decreases those hunger hormones, ghrelin. And so you get more of this ability to be satisfied with what you eat and staying full longer. It's that food noise everybody talks about, right? And that's in the brain where people think, oh, GLP1s are just in our gut and our, you know, intestines. No, we have GLP1 receptors from the top of our head to our toes. And so that food noise is actually the center of our brain. We call it the like hedonistic area where we just kind of crave food and we use food for reward for that dopamine spike. And so that GLP1 actually down regulates those receptors a bit. And that's where we get less food noise, less craving, less thinking about food, less needing food to satiate either that emotional stress or dopamine high or burst that we need. So it works on many different areas of the body that help us control our weight.

SPEAKER_01 21:34

I love that you have this holistic approach too. Like you recognize that like there's a lot of specialists who specialize, right? They just do this one thing and they they're like, I'm gonna stay out of this lane and that lane. And I think even when I talk to clients, you know, they've got three or four specialists, but one problem. And I always think that's really dynamic. And what I love about your practice is you are actually looking at the totality of this chapter, of what women are going through.

SPEAKER_00 22:01

Yeah.

SPEAKER_01 22:01

So when somebody comes to work with you, what's the expectation? Or what's what are they seeing? What are they feeling? They're and you know, are they working with you for six months? Are they working with you for the for the rest of the to cross fully over to the bridge? Like, like what is that experience?

SPEAKER_00 22:17

Yeah. So the beauty about my practice is I give women time to talk and I give women time to tell their story. And then I'm able to validate their symptoms. We talk about their symptoms. And so the biggest, I think, difference between a visit with me versus a lot of the other clinicians is they feel seen, they feel heard, and they feel validated.

SPEAKER_01 22:45

Adrian, thank you for one doing this work and thank you for like giving the giving women a platform where they can actually come in, share their story with you because it is so unique. Like I said, I am in this stage where I am postpartum, 18 months, you know, and also coming into perimenopause. And some days it's hard to know the difference. But and it probably overlaps too, right? Absolutely. Every day. And I'll I'll see you in a week, I'm sure, if I can get to set something up here. But Adrian, how do people connect with you? How do people get the the joy of working with you and having having that feeling?

SPEAKER_00 23:21

So uh my practice is called Vita Women's Health, and the website is vitawomen's health.com. On my website, you can book a free 15-minute consultation just to kind of see if, you know, if my practice is right for you, if if it's what you need.

SPEAKER_01 23:39

You are solving and doing the Lord's work here, I have to say, because this is uncharted territory for all of us, and it looks different for every single one of us.

SPEAKER_00 23:47

It does, even for me, you know. There's no if somebody asks me, oh, what kind of HRT do you prescribe? I mean, I I couldn't say that unless I had this scenario in front of me because it changes. Every person is different.

SPEAKER_01 24:03

Adrian, thanks for being with us today. And uh thanks for not fucking shrinking. No way, no way.