Dr. Amy Shah on making menopause the best years of your life

In early 2026, Weight Watchers started a book club series where authors, doctors, thought leaders, and social media influencers lead members through a discussion that’s informative, thoughtful, helpful — and a good time.

In front of a live audience (also livestreamed to members at home) at Weight Watchers HQ, Holly Rilinger, our global fitness coach and founder of the strength-training program The Lifted Method, interviewed Dr. Amy Shah, M.D., author of Hormone Havoc, a double board-certified physician and nutritionist, and author of two bestsellers, I’m So Effing Hungry and I’m So Effing Tired.

Read on for a full recap of the discussion, including questions from WW members on the Zoom. To tune into the next book club event in real time, follow Weight Watchers on Instagram or Facebook so you can get access to RSVP links as soon as they’re live. (You can also catch up on recaps from previous book club meetings on The Lucky Egg, Weightless, and The Ozempic Revolution.)

Dr. Shah: I got a lot of pushback when I was writing it: “There's too many books about women's health. Women's health has been talked about way too much now; that's enough.” I was just floored, because women really do want a nutritional framework and more conversations about hormones and women's health. It's not like your hormones are stable, and then one day they're just gone because you hit menopause. There's this entire 10 years of perimenopause chaos, of roller coasters. And that hormonal up and down is like the end of a toothpaste tube. You know when you're getting to the end of the toothpaste tube, and you try to squeeze out the toothpaste, and sometimes only a little bit comes out, and sometimes you get a huge blob? Well, that is your ovaries right now, when you're going through that perimenopause transition. That can start as early as in your 30s and go all the way into your 50s. It's really, really frustrating, because lots of doctors don't even acknowledge perimenopause. My hope with this book is to really open all of our eyes — our friends, our mothers, our daughters — to what's happening with our bodies, that there's actually a change that often happens in your late 30s, and in your 40s, and 50s, and then beyond in postmenopause. If you don't know what's happening in your body, and no one gives you the tools, of course menopause is going to be the worst years of your life. I’m trying to make it the best years of your life.

Dr. Shah: Think of that toothpaste analogy. Our ovaries are the source of most of our estrogen and progesterone, and so when the ovaries are kind of winding down, we are getting an uneven amount of hormones, so it's a rollercoaster. Imagine that estrogen and progesterone are like sisters, and they go to the same bar. Everybody loves them. Estrogen is really the life of the party: she's social, she's talkative, she likes to stay out, but her sister kind of keeps her in check. Progesterone is the calm one: she likes to go home, go to bed, and she's also really chill. What happens during perimenopause is that one of the sisters stops coming to the bar with the other sister, and so there's a big imbalance. So imagine just estrogen coming by herself, this wild, free estrogen, and she has no one to keep her in check, no one to make sure that she's behaving and coming home on time and going to bed. That happens in early perimenopause.

Then in late perimenopause, neither of the sisters are coming, and the whole crowd at the bar is like, 'Wait a second, where did they go? We miss them!' The only person who can get them to come out is the gut. The gut microbiome calls the sisters and sometimes they'll pop back for a bit. But it's a big change for our body, because they're always used to having these sisters together, and now they're gone some of the time, and sometimes they're there. You can imagine how unsettling that is. Our body is trying to get used to estrogen and progesterone not showing up like they used to.

Dr. Shah: Muscle is not just to help you lift weights. What people don't realize is that muscle also helps absorb glucose and process foods. It's very active. So when we lose muscle, we also lose our ability to regulate glucose a little bit, which is why a lot of people become insulin resistant and their blood sugars are rising.  I know for myself, as I moved into perimenopause, my blood sugar and my A1C was starting to rise, partly because of the changes in my muscle mass.

Dr. Shah: If we go back to that analogy of the progesterone and estrogen that aren’t showing up as much anymore, it's wreaking havoc on the whole body. Everyone's kind of like, 'Oh, this sucks that they're not here — what are we supposed to do?' They can't do their functions as well as they usually do, so it's about adapting. One of the biggest things I tell women is: your gut's changing, your brain's changing, your muscles are changing, your bones are changing, so you have to change with them. That means changing the way you eat, adding more protein and fiber and probiotic foods. Also adding more strength training sessions, more walking, more recovery sessions, more sunlight and nature. These are all things that are gonna really help your symptoms, but also help you feel and look better.

Dr. Shah: Of all of the advice that I've been giving over the years, this makes the biggest difference in women's lives. This is a framework that will not only change your body, but also change your mood, your energy levels, your sleep, and your hormonal symptoms. The idea of “30-30-3” stands for 30 grams of protein in your first meal, 30 grams of fiber throughout the day, and 3 probiotic foods every day. I'm trying to get these all through foods, not supplements, when I can. Probiotic foods — like yogurt, kimchi, sauerkraut, raw apple cider vinegar, miso, tempeh, kombucha, kefir  — are pretty much missing in all of our diets. They're really amazing foods for inflammation, for mood, and for hormone health, but we've left them out of our diets. Sadly, 95% of the U.S. population does not get enough fiber, like less than half the 30 grams you should. It's not really hard to get 30 grams if you know what has fiber — for example, good sources are avocado, chia seeds, hemp seeds, nuts, berries, and pears. In the morning, that can include an egg or tofu scramble, Greek yogurt, or probiotic cottage cheese that has a lot of protein.

Fiber is so important that adding 5 grams of fiber, so 1 tablespoon of chia seeds, is enough to lower your risk of death by 7%. Fiber is essential not only for hormones but literally for everything in life, and so all-cause mortality will go down when you add it. For protein, you want to front-load it in your first meal because you want good energy, a good mood, to support your hormones, and to lower your cravings. Having 30 grams in your first meal makes you most likely to get to your protein goals for the day.

Dr. Shah: It depends on the person. If you are super active, you're lifting heavy, you are looking to actively add more muscle, you're going to want to eat more protein than someone who only works out maximum two to three times a week and is lightly active and not necessarily trying to actively build muscle — maybe they just want to prevent muscle loss — so they are going to need a little bit lower threshold. I actually like to base it on how active a person is, as well as their age, because if you're in perimenopause and menopause, you're going to need a little bit more protein. Just preserving your muscle alone is an accomplishment. And then if we can add some to it, incredible.

Dr. Shah: In the book, I go over the supplements that have the most data behind them. My top three to recommend are vitamin D, omega-3s, and magnesium. My fourth that's up and coming is creatine. The reason why it's not in the top three is that, for women and brain health, those are all emerging studies. We've had muscle studies for a long time, but creatine is just getting that for the brain health part. So for muscle health, 100%. Brain health, it's becoming very interesting, especially for menopause.

With Vitamin D, sunshine's not enough for 75% of people. If you're in midlife and beyond, and you haven't gotten your vitamin D checked recently, this is your wake-up call, because almost every single person I check who’s 40s and up is going to be deficient. Depending on your blood test levels, you can take between 1,000 to 5,000 IU.

For omega-3 fatty acids, there is amazing evidence for inflammation and brain health, with lots of large studies, especially for women. If you're getting it from a fish source or an algae source, amazing. But if you can't, you can supplement it with 1 to 2 grams.

Magnesium has 300 different tasks in our body, and it's something we can get from food. Women with the highest magnesium levels had the slowest brain aging. So I love magnesium, especially for the woman who is going through hormonal havoc, because magnesium glycinate helps you relax, and often is great for before sleep. It's great for women in perimenopause, menopause, and beyond. Remember, magnesium glycinate; magnesium citrate is the one you take if you're constipated. You don't want to get magnesium oxide, which is not usually very effective to absorb. It’s also great to get magnesium through foods like seeds, nuts, leafy greens, and beans. I recommend 550 milligrams per day that can be a combination of food and supplementation; I take about 325 mg from supplements, but I get the rest from food.

Dr. Shah: Women, especially when they're in perimenopause and menopause, are very sensitive to stress. So, if you're someone who is already leading a stressful life, then adding another stressor into your life needs to be considered. A lot of people don't do well with intermittent fasting, for example, because it's just very stressful to be not eating for that many hours. In general, cortisol is our enemy when it comes to belly fat and muscle loss. What happens is, our cortisol is supposed to be high in the morning — that's what wakes you up, that's what makes you energized. By evening, it's supposed to fall to low levels. But we do a lot of things in the evenings. We're at work, we're going to Target, we're talking on the phone, we're upset, we're seeing an email right before bed, so the cortisol rises. Your body does not let you go to sleep if it thinks it's in danger. Cortisol can be very disruptive to sleep. That obviously worsens fat loss and increases belly fat gain. When you have high cortisol issues, your body is never really able to function properly. It's always in a state of emergency, and it's always going to raise your blood sugar in case you need to run away from an animal. It's also gonna keep you focused on the task at hand and not let you make complex decisions. Having high cortisol in midlife is a big problem. Estrogen counteracts cortisol, so as estrogen goes down, your cortisol will rise, so a lot of people will face cortisol issues during these times.

One of the biggest things that happens for women in perimenopause, menopause, and also beyond, is that when you wake up between 2 and 4 AM, it’s because your cortisol is dysregulated. Sometimes you wake up in the middle of the night full of energy, and it's really hard to go back to bed, because of cortisol dysregulation. You have to do a better job at dissipating that cortisol before bed with a nighttime routine where you're disconnecting from your phone and your email, turning the lights down, and dropping your core body temperature by 1 degree to fall asleep.

I think one big inflammatory trigger for women in their 30s and being beyond midlife is stress. Estrogen, as it goes down, was helping buffer your stress, so the same stressful, crazy life that you used to lead in your 20s no longer works anymore. Your body is inflamed, you are exhausted, and you need more time to recover. And of course, there's such a tight link between what we're eating and inflammation; 70% of the grocery store today is ultra-processed. And the more ultra-processed foods we eat, the more inflamed we get, which leads to diabetes, cancer, heart disease, early death, brain disease. It's so sad that our entire food system needs to be changed.

For reducing stress, I’m also a big fan of meditation or prayer, if that works for you. If neither of those fit you, going for a sunny nature walk is one of the most anti-inflammatory things that you could do for your body. I'm the crazy lady that does as many calls as I can outdoors — everything I can, actually. The reason why is that studies have shown that getting up to one hour of nature time a day can really improve your hormone health, your brain health, and your inflammation levels. And I feel it. When you go on vacation and you're spending time outdoors in the sun, you automatically feel better, right? But then we go back to our normal lives, and at least for me, I was like, I'm not allowed to go outside in the middle of the day. Well, you're allowed! You can go outside anytime you want. You could be on camera on Zoom outside!

Dr. Shah: I used to use mini weights because I was so worried about hurting myself. Then I realized that doesn't really help with muscle and osteoporosis, and I started to switch. You have to lift heavy weights — like, after four reps, you feel like, “Oh my god, I could be done right now,” but you're gonna do at least four or five more. That's the right heaviness. I also love walking. That's one of my favorite exercises. Coupling walking with strength training is the perfect combo.

Dr. Shah: Protein and strength training, in combination. Strength training alone is what you need to grow muscle, but if you couple it with protein, you get more muscle growth.

Dr. Shah: There are two options, so choose your own adventure. One, you could choose to go outside every morning within an hour of waking up, so while you're brushing your teeth, you can walk out the door, just for a couple minutes. That alone can make such a huge difference. Or the second option is to start with 30 grams of protein in your first meal. That was one of the biggest game changers for me. I started to notice as I started adding more protein in general, but especially in the beginning of the day, things started to change. Protein is not only a building block of muscle, it's also a building block for your neurotransmitters in your brain — dopamine, serotonin, all the things we need to feel good and focused  — so having protein is really important.

Dr. Shah: Our gut and our brain are connected when we're forming in utero. Then they separate, and they go to different parts of our body, but the gut and the brain are always super connected, meaning that they make decisions together. So we always think of our brain making decisions by itself. But no, the brain is talking to the gut, and the gut's talking to the brain, and they're like a shared parenting situation.They're talking to each other all day long and making decisions.

And the reason why that's so important is that the brain and the gut dictate our hormones. When you're emotionally charged, say you get in a big fight, your brain tells your body, “I need more cortisol and adrenaline.” The gut will notice that there's not enough estrogen, or too much, and say to the hormones, “I need more estrogen in my system.” There's actually gut bacteria that decide if estrogen should go back into the circulation or out through our stool. And then they also make decisions talking to the brain about what they should tell the hormones to do all over the body. And so, the easiest way to help your hormones, to help your immune system, and to help your brain, is to feed your gut the right foods.

The problem is, a lot of things that we're doing are killing the gut bacteria and are weakening that communication. The gut has trillions of bacteria in it. They are so intertwined with our own body that we could not live without the gut bacteria. If you give the gut bacteria no food — fiber is their main source of food, and 95% of us are not getting enough fiber — and you don't replenish it with eating probiotic foods, and you're taking antibiotics and foods that kill the gut bacteria, that's not good. Then you wonder why our rates of mental health are on the rise, why our hormonal imbalance is on the rise, why we have so much inflammation in our bodies. It’s because our gut bacteria was literally the communicator with the brain, making all the decisions, and now it's depleted. We know this because, if you look at some tribes that live how we used to live hundreds of years ago, as hunter-gatherers, they have double our gut bacteria, because the way we live today is literally killing it.

Dr. Shah: We've always been told to get smaller, whether it's through weight or through being meeker, sitting down, not being bold. But really, we need to teach women, in midlife especially, how to get stronger: how to get stronger in your body, how to get stronger in your mind, how to get stronger in your spirit. It's time to give women the tools to actually get stronger in every part of their life. Loving your body and thinking about ways to make it stronger is just so much more empowering than trying to make it smaller. Building up that gut bacteria for a better mood will make you happier and healthier in so many ways — not just your hormones, but overall health. In life, it's always more fun to add than to take away.

A lot of people tell us that midlife and beyond are the worst, and that the best years of your life are behind you — that you should just wind it down. That makes people feel small, and it's just not true! Science says you can grow your brain at any age, you can grow muscle at any age, you can build bone at any age. I see people doing big, big things later in life.