Peri & Pause The Podcast

In this follow-up episode of Perimenopause the Podcast, Jamie Gallagher moves beyond the "why" behind menopause weight gain and inflammation and focuses on the "how."
After explaining the science behind hormonal changes, inflammation, belly fat, insulin resistance, and metabolic slowdown in the previous episode, Jamie now shares practical strategies women can use to interrupt the cycle and regain control of their health. 
This episode explores resistance training, high-protein nutrition, the Mediterranean diet, menopausal hormone therapy (MHT), GLP-1 medications, and why traditional approaches to weight loss often stop working during perimenopause and menopause.
If you've been doing all the "right things" but still struggling with weight gain, inflammation, low energy, or changes in body composition, this episode offers a science-based roadmap for navigating this transition. 

00:00 – Welcome back and recap of the previous episode
00:45 – Why understanding the "how" matters
01:15 – Pillar One: Rebuilding your metabolic engine
01:45 – Why endless cardio isn't the answer anymore
02:00 – Resistance training and reducing inflammation
02:30 – HIIT workouts and visceral fat reduction
03:00 – Why protein becomes more important during menopause
03:30 – Protein recommendations explained
03:45 – The Mediterranean diet and obesity prevention
04:15 – Alcohol's impact on belly fat and metabolism
04:45 – Pillar Two: Menopausal Hormone Therapy (MHT)
05:15 – How estrogen influences fat distribution
05:45 – Hormone therapy and inflammation reduction
06:15 – What happens when hormone therapy stops
06:30 – Pillar Three: GLP-1 medications explained
07:00 – Semaglutide, tirzepatide, and women's health
07:30 – Why women often respond differently than men
07:45 – Protecting muscle while losing weight
08:00 – The importance of strength training during GLP-1 use
08:15 – Building a complete weight-loss strategy
08:30 – The role of nutritionists, trainers, and clinicians
08:45 – Changing your strategy instead of blaming yourself
09:00 – Final thoughts and encouragement

Creators and Guests

Host
Jamie Gallagher DNP, FNP-C, MSCP
Jamie is a doctoral-prepared, board certified family nurse practitioner and a Menopause Society Certified Practitioner. She is the owner and founder of Peri & Pause. She has served as a nurse practitioner in the Triangle area of North Carolina since 2009 in family medicine, urgent care and women's health. She is an active member of The Menopause Society, the HERmedicine Provider Alliance, the National Association of Nurse Practitioners in Women's Health, and the International Society for the Study of Women's Sexual Health. She is also a proud military spouse, mother of four and grandmother of three.

What is Peri & Pause The Podcast?

The Peri & Pause Podcast is for women in midlife who know something in their body has changed—but haven’t been given real answers, or have been left overwhelmed by conflicting information.

Hosted by Jamie Gallagher, DNP, FNP-C, MSCP, a nurse practitioner specializing in perimenopause and menopause care, the show explores hormones, metabolism, mental health, sleep, sex, weight changes, and chronic conditions through an evidence-based, deeply practical lens. We unpack the physiology of midlife alongside the lived experience of women navigating careers, relationships, finances, and identity during this transition.

Every woman deserves this conversation—and the clarity, language, and confidence to advocate for better care.

Because “Your Labs Are Normal” Is Not the Whole Story.

13 - Peri and Pause
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Jamie Gallagher: [00:00:00] Hey, everyone. Welcome back to Perimenopause the Podcast. I'm Jamie Gallagher, board-certified family nurse practitioner and Menopause Society certified practitioner, owner and founder of Perimenopause, a comprehensive midlife women's healthcare practice here in North Carolina.

We're continuing our Ask Us Anything series today, and we're keeping the conversation going with Missy, Bridget, Stacy, and Laura from Oak Island, North Carolina. . In our last episode, we answered their big questions about why inflammation and weight gain happen in perimenopause and menopause, even though you eat the same, you work out the same, you might even eat better and work out a little more, and it just doesn't move.

We broke down the science, proving that midlife weight gain and total body puffiness are not two separate [00:01:00] problems. They're a biological domino effect driven by shifting hormones that no amount of willpower can override. But we aren't gonna just leave you hanging with the why. Missy, Bridget, Stacy, and Laura, and all of you listening at home, today we're tackling the how to.

We're diving into four major medical and lifestyle tools we have that actually interrupt this cycle, put out the inflammatory fire, and help you get your body back on your team. Let's get into some solutions in what I'll call pillars. Pillar one, rebuilding your primary engine. Let's start with the absolute foundation.

It's movement, but not just any movement. The old advice was to go on a jog for an hour. The new science says that is exactly the wrong tool for this specific job. Those of us longtime runners that kept ... You know, that running kept us sane and let us burn off the day's stress, this one hits. But as a former runner myself, I could feel it, the stamina, the prolonged recovery.

Some days I would feel like I had the flu even after just a three or four-mile jog, t- you know, taking the rest of the day to [00:02:00] recover. There's been some grieving over the loss of that, honestly. But to stop the hormonal cascade, we need to build muscle and burn the deep belly fat or the visceral fat.

Studies show that a two-pronged approach works best here: resistance training and high-intensity intervals. Resistance training is lifting weights. , Lifting weights is the ultimate tool. A massive analysis of multiple clinical trials found that lifting weights caused the single biggest drop in C-reactive protein, called CRP, which is just medical speak for the main indicator of inflammation in our bodies. So the high-intensity intervals, or HIIT intervals, short bursts of intense effort, are significantly better at burning off that deep, stubborn belly fat than long, slow cardio.

So when you combine lifting weights with a little intensity, you reduce your inflammatory markers, protect your muscle, and rev up your resting metabolism. You cannot build muscle without raw materials, though, right? So as our hormones drop, our bodies become less efficient at processing [00:03:00] protein. To combat this, we need to aim for 1 to 1.2 grams of protein per kilogram of your body weight every day.

So I mean, but who likes algebra? What does this even mean? This means that if you weigh about 160 pounds, you wanna consume 75 to 90 grams of protein each day. So when you pair that protein with an anti-inflammatory diet pattern, kinda like- The Mediterranean style of eating, um, that's where you're gonna get your wins.

You can Google Mediterranean diet, Mediterranean snacks, things like that, to help find foods that you like that will kinda fall into that category. Um, additionally, a massive study tracking over 38,000 women during the menopausal transition found that eating this way, focusing on nuts, seeds, vegetables, fish, whole grains, while cutting back on processed meats like fries, fried potatoes, slash their midlife obesity risk by 54%, and that is so significant. Here's another tip here. Reduce or avoid alcohol. That's an entire podcast in itself, but drinking [00:04:00] alcohol stops the fat-burning process, so it's better able to break down, process, and get rid of the alcohol itself.

So keep that in mind because alcohol adds to belly fat, and that's a hard stop. It just does. So when women ask me why they continue to have belly fat when they're doing all the things above but are still drinking alcohol regularly, that's 100% not helping at all. So maybe try not using alcohol for two to three weeks.

See how that helps you. You'd probably be surprised. And I mean, not to say stop drinking alcohol altogether, but be acutely aware of its impact on your body, your gut health, your brain health, and weight, so you can make your, your choice to drink or not be very well informed. So let's go to pillar two, uh, addressing the root cause with menopausal hormone therapy.

So the next tool targets the very top of the cascade, menopausal hormone therapy, or what I'll call MHT. So remember how we talk about estrogen being the master protector of your fat cells and your immune system? Well, MHT puts that protector back in the game. [00:05:00] So a major study called the Osteo-LS cohort found that women currently using MHT had significantly lower deep belly fat and overall body mass index compared to women who didn't take it.

So over a 10-year period, menopausal hormone therapy users essentially reduced or prevented that typical midlife shift where fat redistributes straight to the stomach area. And on the immune side, uh, the hormone therapy actively reverses the expansion and increase of in- inflammatory immune cells in our body.

It's kind of cooling down that internal fire inflammation. A quick but important medical note here. If you take oral estrogen or estradiol, your lab work might show an increase in that inflammatory marker called CRP. Um, don't panic. Research has found that this is just a side effect of the liver processing the pill, not an actual sign of true inflammation in the blood vessels.

Um, so other real inflammatory markers actually go down. So the one catch this study found, the moment you do stop taking [00:06:00] hormone therapy, these protective benefits fade. It works beautifully but only while you're actively taking it. So pillar three, this is really cool, the new horizon. It's GLP-1 medications.

So let's talk about the newest tool in the toolkit, GLP-1 receptor agonists. These are medications like semaglutide and tirzepatide. First, let me say, these are not weight loss cheat drugs. They are not. Research has shown health benefits beyond simply weight loss with these, like improvement in liver health, uh, sleep apnea, heart disease, and now investigations are involving Alzheimer's disease and how these GLP-1s can help with that as well So while these were originally designed for diabetes and general weight loss, new data shows they have a fascinating and uniquely powerful effect on women.

In fact, clinical trials show that women lose significantly more weight on these medications than men do, averaging nearly 11% percent of their body weight compared to just under seven for men. So scientists think [00:07:00] this might be due to how the medications interact with our remaining estrogen signals.

What makes GLP-1s so helpful during menopause and perimenopause is that they cause a selective drop in fat while keeping your strength intact or your muscle intact, but that's a bit more with the tirzepatide, I believe. There is a major caveat for midlife women. When you lose weight rapidly on these medications, which ideally you will not lose weight rapidly, a portion of that weight that's lost is naturally gonna be your muscle because menopause already causes us to lose muscle, and this can be a dangerous combination if you are not careful.

So if you utilize a GLP-1, it is absolutely essential to pair that with heavy resistance training and plenty of protein to protect your metabolism. So here's the ma- the master strategy, the ultimate takeaway. No single option in this is a ma- magic eraser. The real magic happens when you stack these tools together to build a multi-target strategy.

So step one, structural base, right? Commit to lifting [00:08:00] heavy weights three days a week. Join a gym, get a personal trainer to start off with. Um, find a free YouTube exercise platform. Also, eat high protein, again, Mediterranean-style diet to stabilize your muscle and cool down the cellular inflammation. If you need help with diet choices, see a nutritionist.

They are a fantastic resource helping us understand something we do every single day, which is eat. Um, number two, the hormone reset. Work with a knowledgeable clinician who is fully up to date to see if you're a good candidate for menopausal hormone therapy. That can help reduce or slow the fat redistribution at the root.

Third part, the advanced medical tool if you're a candidate. So if lifestyle and hormones aren't enough to move the needle on significant metabolic dysfunction, overweight with another health problem like prediabetes, high blood pressure, high cholesterol, and others, discuss whether a GLP medication can be appropriate for your body.

Your body is not working against you. It's just operating under a brand-new set of biological rules, and once [00:09:00] you understand the rules, you can change your strategy, whether we like the rules or not, right? The old rulebook needs to go away. It's just no longer helpful at all. So I hope you found this episode helpful.

It's probably one of the most frustrating concerns our patients have. So if this resonated with you, please share this episode, and we'll see you next time.

Thanks for listening. If this episode helped you feel more informed or less alone, please subscribe, leave a review, and share it with another woman who needs this information. You can also follow us on social media for more education and updates at facebook.com/perryandpause and Instagram at perry.and.pause.

Until next time, take good care of yourself. The information shared on the Perry and Pause podcast is intended for informational and educational purposes only and should not be considered medical advice, diagnosis, or treatment.