Hard Conversations in the Menopause Transition: Hormones, Testing, GLP-1s & What’s “Ideal” Now with Carla DiGirolamo, MD, PhD (Episode 260)

You run (or bike or swim or hike…), you lift, you've got the training logs to prove nothing has changed. You eat the same as you always have. And you’ve still gained 10 pounds…or more. Obesity medicine physician Dr. Michelle Gordon is here this week to explain why. She covers the metabolic slowdown of perimenopause, the drop in fat burning, why the new fat lands around your middle, and why "calories in, calories out" doesn't cover it. She also talks about her own experience with tirzepatide as a lifelong athlete: losing 30-plus pounds, running out of motivation to run, and figuring out what exercise means to her now. Michelle E. Gordon, DO, DABOM, DACLM, FACS, FACOS, is board certified in obesity medicine, lifestyle medicine, and general surgery, and is a fellow of both the American College of Surgeons and the American College of Osteopathic Surgeons. She spent 15 years as a surgeon before switching to women's metabolic health, because she kept seeing the downstream complications of disease that had started years earlier. Today she runs a telehealth practice to help high performing midlife women feel like themselves again. Her approach is rooted in physiology and incremental behavior change. She treats obesity as a chronic, relapsing disease that calls for long-term care from a physician. You can learn more about her at drgordon.me and on her Substack. Resources Trajectory of weight regain after cessation of GLP-1 receptor agonists: a systematic review and nonlinear meta-regression here Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial here https://livefeisty.com/training/ Use code HPNP50 to get $50 off. Courses and Coaching: https://livefeisty.com/courses/ Sign up for our FREE Feisty 40+ newsletter: https://livefeisty.com/newsletters/feisty-40/

Recorded live at FeistyFest, the week Hit Play Not Pause turned six, this bonus episode hands the mic to you. Selene starts with how the show began, including her own experiences with 2 a.m. wake-ups and sleepless nights, performance decline, anxiety, the urge to pull back from people, and the changes she didn't see coming. She and longtime producer Carrie walk through their hormone therapy journeys and where they are today. Then they hand the mic to the crowd for a wide-ranging discussion including managing menopause after breast cancer, the cost of HRT, symptoms that don’t seem to stop, getting brushed off by doctors, GLP-1s, and much more. https://livefeisty.com/training/ Use code HPNP50 to get $50 off. Courses and Coaching: https://livefeisty.com/courses/ Sign up for our FREE Feisty 40+ newsletter: https://livefeisty.com/newsletters/feisty-40/

Iron is one of the most-requested topics in the Hit Play Not Pause community, and it's one of the most confusing. Sports dietitian Kristen Arnold, who works with pro teams and everyday athletes, returns to explain what iron does and why you can have symptoms from low iron long before you're anemic. She also covers how our needs change after menopause and how new ferritin thresholds from the American Society of Hematology reset the old, far-too-low targets. We get into the full iron panel, hepcidin, heme vs. non-heme foods, every-other-day supplementing, when an IV makes sense, and why altitude calls for a bigger buffer. We also look at what the popular Iron Protocol gets right and where it goes beyond the evidence. Kristen Arnold, MS, RDN, CSSD, is a board-certified sports dietitian, cycling coach, and retired professional athlete. She has practiced sports dietetics since 2015 through her private practice, Sports Nutrition for Women, where she and her team of qualified, compassionate practitioners work with athletes and teams ranging from recreational to professional and Olympic-level. Kristen’s work centers on empowering active women across the lifespan through evidence-based sports nutrition education and individualized coaching. She has worked with hundreds of athletes and teams and currently serves as a team nutritionist for EF Pro Cycling, a UCI WorldTour team. She is also a first author on peer-reviewed research examining targeted nutrition strategies to support the health of postmenopausal women. Kristen regularly speaks on podcasts and contributes to publications on sports nutrition, with a particular focus on women’s health, endurance performance, and nutrition across the lifespan. Resources: New guidelines for iron deficiency https://livefeisty.com/training/ Use code HPNP50 to get $50 off. Courses and Coaching: https://livefeisty.com/courses/ Sign up for our FREE Feisty 40+ newsletter: https://livefeisty.com/newsletters/feisty-40/

As an Olympic cyclist and speed skater with scores of medals, Clara Hughes thought she knew how to breathe. Then came menopause, along with a catastrophic knee injury, COVID, and months stuck in stillness. All of it broke open what she'd spent a lifetime outrunning. In this conversation about her new memoir, Learning to Breathe, Clara opens up about her dark journey through the menopause transition, being offered antidepressants instead of hormone therapy, finally getting care from a women's health specialist, and how somatic therapy, psychedelic-assisted therapy, breathwork, and long days on trail helped her face childhood trauma she had pushed down for decades. We also cover why menopause can feel like a betrayal to athletes, how her relationship with movement has changed from punishment to love, and the two questions she hopes every woman will ask herself. Six-time Olympic medalist Clara Hughes became the only athlete to win multiple medals in both the Summer and Winter Games. She is a member of the Order of Manitoba and an officer of the Order of Canada, has received a star on Canada’s Walk of Fame, and was inducted into Canada’s Sports Hall of Fame. Clara was Canada’s flag bearer for the 2010 Olympic Winter Games. She was the founding spokesperson for Bell Canada’s Let’s Talk initiative, a campaign dedicated to breaking down the stigma of mental health. In 2014, she was awarded the Meritorious Service Cross, which recognizes those whose outstanding personal commitment has brought honour to Canada. In 2022, she was named an Olympian for Life in recognition of her making the world a better place by promoting the Olympic Values at every stage of her life. Clara lives with her husband, Peter, on Vancouver Island, and continues to enjoy bike touring and hiking. Resources Learning to Breathe by Clara Hughes https://livefeisty.com/training/ Use code HPNP50 to get $50 off. Courses and Coaching: https://livefeisty.com/courses/ Sign up for our FREE Feisty 40+ newsletter: https://livefeisty.com/newsletters/feisty-40/

October is Breast Cancer Awareness Month. So, this week breast oncologist and lifestyle medicine physician Dr. Amy Comander returns to explain what comes after a diagnosis: why breast cancer isn't one disease, how treatment decisions get made, and why cancer guidelines tell oncologists to talk about exercise. We cover training through treatment (including when to postpone the race), how chemo and aromatase inhibitors can bring on "menopause 2.0," and the non-hormonal options for hot flashes and aching joints. We also get into the harder question of hormone therapy after hormone-sensitive breast cancer, why "estrogen doesn't cause breast cancer" leaves a lot out, and what the research on vaginal estrogen, Duavee, and women with BRCA mutations shows so far. Amy Comander, MD, DipABLM, FACLM, MSCP, is a breast oncologist and Medical Director of the Mass General Brigham Cancer Institute in Waltham. She also directs the Cancer Institute's Lifestyle Medicine Program and is an instructor in medicine at Harvard Medical School. With Dr. Beth Frates, she launched the PAVING the Path to Wellness program for breast cancer survivors and co-authored "PAVING Your Path Through Breast Cancer and Beyond." She was the first oncologist to serve on the Board of Directors of the American College of Lifestyle Medicine and the first oncologist named a Fellow of the College. She's also a marathoner who has run 13 consecutive Boston Marathons. Resources Link to the PAVING workbook Menopausal hormone therapy for breast cancer patients: what is the current evidence? Here Menopausal Hormone Therapy After Breast Cancer: Personalization, Not Prohibition Here Menopausal hormone therapy and the risk of breast cancer in women with a pathogenic variant in BRCA1 or BRCA2 Here https://livefeisty.com/training/ Use code HPNP50 to get $50 off. Courses and Coaching: https://livefeisty.com/courses/ Sign up for our FREE Feisty 40+ newsletter: https://livefeisty.com/newsletters/feisty-40/