Check out this exclusive interview with Jennie Norton, MS, RDN, CD, a Registered Dietitian Nutritionist serving our Auburn, Burien, Lake Stevens and Puyallup Clinics! Jennie recently shared her expertise with Authority Magazine, offering valuable advice for those navigating perimenopause. Dive into her interview below!
Before we dig in, our readers would like to ‘get to know you’. Can you tell us a bit about your background and your backstory?
I’m a 45-year-old cisgender perimenopausal divorced mother of a wonderfully artistic teenager. I have lived in 3 US states (Indiana, California, and now Washington) and attended seven different colleges. I married my prom date a year after graduating high school — we eloped to the sunny beach town of Santa Cruz, CA in 1998. My career path has spanned several different retail sectors (video store, pharmacy, grocery, and banking) with a persistent focus on various food service roles (ice cream scooper, barista, cake decorator, chocolatier, pastry chef, bakery department manager, and director of child nutrition services).
I have always been interested in food, particularly baking and pastry. When my younger sister and I were bored tweens, we experimented with new recipes during Summer Break. We hand-pulled saltwater taffy, threw soft pretzel dough at the ceiling to see if it would stick, and made pizza dough for homemade extra-cheesy pizza. I attended the Professional Culinary Institute for an accelerated 10-month Baking and Pastry Certificate program, and my instructor was Master Baker Chef Stephany Buswell (of Food Network Holiday Baking Championship fame). I currently live near Snoqualmie Pass in the Cascade Mountain Range of Washington State.
Can you share a story with us about what brought you to your particular career path?
As a Registered Dietitian Nutritionist with a focus on community nutrition, I am inspired to help people learn more about healthy eating and how best to approach making changes in their lives.
In the autumn of 2014, I worked as the bakery department manager at a local Fred Meyer. Every day, our department members baked, packaged, and restocked baked muffins, bread, bars, cakes, cookies, and donuts for display and sale to our community members. One of my co-workers, Julie, was a part-time restocking clerk and an exercise science student at the local community college, and she told me about her coursework and the other students in her science classes — people training to be Registered Dietitians. I had never heard about this typer of career before, and when Julie explained some of the roles that RD’s can play in different workplace settings, I was intrigued and curious.
One particular customer interaction during this time further clarified my interest in pursuing a career redirection away from selling refined baked goods to customers. I remember offering help to a significantly obese person in a wheelchair while he chose donuts from the display case. I had a bit of a morality crisis which haunted me for a week:
- Do I want to continue on my current career path as a bakery department manager selling baked goods and refined flour products to my community members?
- Or do I want to take a chance on a new career path and support people with making healthier food choices?
Over the next few weeks, I researched nutrition programs and dietetic internships in Washington State. I completed a financial feasibility comparison to determine the pros/cons of staying in the grocery retail world or returning to school for an advanced degree and unpaid internship. The most cost-effective option proved to be moving to central Washington state to study nutrition at Central Washington University in Ellensburg. My spouse and I packed up our preschooler, our fuzzy Cairn Terrier and all of our worldly belongings to relocate to Kittitas County so I could go back to school (again).
What are some common misconceptions about perimenopause, and how can debunking these myths empower women going through this stage?
1 . Suffer silently through perimenopause symptoms without support.
Discussing your symptoms with a trusted friend, family member, or healthcare provider can be incredibly valuable in helping you determine a course of action to resolve your symptoms. There are many different safe therapeutic options available now for perimenopause support. Actively discussing with a person who can listen, ask questions, and express empathy can help you further define the concern and identify symptom triggers. You can also better understand whether or not you should seek healthcare assistance for the symptoms.
2 . Menopause replacement therapy (MRT) is only for people who have already entered full menopause for 1 year.
There are many different safe options for MRT now, and menopause specialists can help a person identify if this type of treatment is appropriate or if another type of therapy is a safer alternative. A great resource for finding a menopause specialist is available on Dr. Mary Claire Haver’s website at The ‘Pause Life. If your PCP tells you to wait on MRT, you might consider asking for a second (or third) opinion with a specialist. You don’t need to suffer through your symptoms.
3 . Eating fewer calories can affect body weight status during perimenopause.
“Calories in = calories out” is an equation that is affected by hormonal status and disease state throughout a person’s lifetime. When you significantly restrict calories over an extended period during perimenopause, you can run the risk of malnutrition. Meeting with a Registered Dietitian during this time frame can help you determine the most supportive eating pattern for this stage of your life.
4 . Aerobic exercise is the most effective way to reduce belly fat during perimenopause.
Dr. Stacy Sims recommends a rotation of 3 activity approaches to reduce belly fat during this period in our lives:
- Lift heavy
- Focus on including SIT training several times per week (short duration, high-intensity interval training)
- Plyometric activities as part of the above training techniques
5 . The most expensive menopause supplement will treat your symptoms.
Expensive supplements won’t treat peri- or menopausal symptoms. However, a few helpful and healthful supplements available have been rigorously tested in a clinical setting and can potentially help with symptoms. Seeing a menopause specialist to find the best fit for you is a fantastic step towards improving your outlook and finding safe treatments.
Many women experience unexpected emotional challenges during perimenopause. How can they develop mental resilience and maintain a positive mindset through this transition?
The dramatic swings of estrogen and progesterone levels during perimenopause can contribute to emotional upheavals that can be disruptive to the natural order of things. Six months ago, I started experiencing bouts of unexpected rage without a clear cause for each incident. At that time, I started researching personal organization and relaxation methods that have served me well. The two most helpful personal practices to reduce the turmoil include using a daily structured journal for writing and organization (Silk and Sonder) and listening to alt-rock and grunge 90’s music (NIN, Nirvana, Marilyn Manson, Alanis Morisette, and Weezer, to name a few). Singing, rage walking, and dancing to my favorite memorized songs from high school connect my hormonal perimenopausal self to my angsty teen self, and this memory link calms the raging mood. Chatting with an empathetic friend about the mood swings can be cathartic, and finding a mental health therapist can be a great option for people who see the emotions as too overwhelming.
What lifestyle adjustments — including diet, exercise, and sleep routines — do you recommend to help alleviate some of the most common symptoms of perimenopause?
Nutrition
The menopause plate, described in “The Menopause Diet Plan” by Registered Dietitians Hillary Wright and Elizabeth M. Ward, has fantastic guidance on adjusting nutritional practice to support a perimenopausal person better. With an emphasis on lean plant and animal proteins as part of every meal, half the plate of fruits and veggies, a serving of whole grains with each meal, and small amounts of plant-based healthy fats, this approach can be a bit of a change for some people. Additionally, working with a Registered Dietitian to calculate your estimated protein needs based on your perimenopausal status can be quite helpful. Dr. Haver, in “The New Menopause,” recommends 1.3 to 1.6 grams of protein per kilogram of ideal body weight. In comparison, Dr. Sims in “Next Level” recommends a higher range for highly active people (1.8 to 2.4 grams of protein per kilogram body weight). When you work with an RD, you can get assistance with dialing in your specific needs based on your activity level and any chronic conditions that are also present.
Stress Relief
Including some opportunities for stress relief daily and weekly is incredibly important during this period. The stress hormone cortisol can be consistently elevated for perimenopausal people who are juggling all the things (family responsibilities, workplace stress, spousal or partner relationships, home tasks, etc). Dr. Sims states that “low progesterone combined with high levels of the stress hormone cortisol… produced the highest pain levels” for people with fibromyalgia in a 2018 study (p. 38). Cortisol levels can be reduced through relaxing activities, healthy nutrition, adequate sleep, regular physical activity, and other lifestyle adjustments, as described below.
Activity
As I’ve mentioned, moving more frequently and with some variety in your movement is the best approach to reducing the symptoms of perimenopause. Ultimately, how much movement to do each week is up to you. If you aren’t very mobile now, adding small, regular movements to your weekly routine is the best start to increasing your activity level. If you have mobility restrictions, checking in with your healthcare team about your options is necessary to support safe movement specific to your needs.
Sleep
Developing a consistent evening sleep routine is very beneficial for perimenopausal people. Dr. Sims has an entire chapter in “Next Level” devoted to the topic, and here is a brief summary:
- Consider switching out your glass of red wine for tart cherry juice, as alcohol can contribute to hot flashes during the night. Tart cherry juice is high in melatonin, antioxidants, and polyphenols.
- When timing your last meal of the day, aim for a 2-hour window between the meal and your bedtime to provide sufficient time for digestion.
- Turn off all screens 30 minutes before bedtime.
- Create a cool, dark cave of your bedroom with a temperature around 65 degrees Fahrenheit and covered light sources. I use a comfortable sleep mask to cover my face while sleeping.
- Block out noise with earplugs or use a white noise machine.
- If you enjoy physical activity in the evening, time it for 60 minutes before bedtime with a cool shower afterward.
- If you enjoy caffeine in the afternoon, try to enjoy a small beverage no later than 2 p.m. to allow time for the stimulant to be eliminated from your body.
In your experience, what are the most effective natural remedies or alternative treatments for managing symptoms like hot flashes, mood swings, and fatigue?
My education at Central Washington University was focused on community nutrition, and the coursework did not include a lengthy discussion of the safety of adaptogens, natural remedies, and supplements. As I’m learning more about this topic, I’m discovering that it’s a huge area of interest for many people. My general advice about supplements is to check if the NSF or USP logo is on the packaging. These are third-party verification organizations that a company can pay for a safety check of the product’s contents and that it matches the packaging label. The FDA does not regulate adaptogens and supplements, which can contain harmful materials if prepared incorrectly.
Regarding specialists in this topic, I’d love to refer you to Drs. Sims, Malone, or Haver. Dr. Sims talks about adaptogens and supplements in her book, Dr. Haver focuses more on hormonal and alternative treatments for menopausal symptoms, and Dr. Malone has a series of case studies with approachable evidence-based recommendations for each of the various situations that her patients have encountered.
Hormonal changes can impact cognitive function, often referred to as “brain fog.” What advice would you give to women looking to keep their minds sharp and focused during perimenopause?
Brain fog, which is triggered by declining progesterone and estrogen levels, can impact a perimenopausal person at the most inconvenient of times. In addition to the lifestyle practices (nutrition, movement, sleep, and stress relief) that are referenced in this article, here are a few additional recommendations:
Consider asking your healthcare provider about starting MRT if you enter menopause before the age of 45, as this can significantly increase your risk of developing Alzheimer’s, according to Dr. Sharon Malone in “Grown Woman Talk.” She also endorses many of the healthful practices introduced in this article.
There is a consensus between the referenced providers here (Drs. Malone, Sims, and Haver) that brain fog improves once a person fully transitions into menopause and diminished levels of estrogen stabilize.
In “The Menopause Brain,” Dr. Lisa Mosconi discusses at length the body of research focused on the cognitive changes that this organ undergoes as hormone levels fluctuate and eventually diminish.
Check in with your healthcare provider if you have significant concerns about your experience of brain fog. It could be an opportunity for further testing to see if an unrelated condition is impacting your cognitive ability.
Can you please share “5 Things You Need to Thrive Through Perimenopause”?
1. Find your specialists
Matching with the appropriate healthcare specialist can be challenging, but the effort can be highly supportive of improving your symptoms and life satisfaction. I had a female patient aged 47 who had already consulted with her PCP about her brain fog, abdominal weight gain, and hot flashes. The PCP followed the standard protocol and ordered a blood lab panel to rule out any red flags (thyroid dysfunction, nutrient deficiencies, etc). When this patient saw me, she was anxious to resolve her symptoms as she’d been experiencing them without relief for several months. The blood panels were within normal limits, and her PCP said it was “too early to start MRT.” I provided the appropriate educational resources, some referenced in this article, and Dr. Haver’s list of recommended menopause specialists practicing in a telehealth setting. Once a healthcare provider offers the resources, it’s up to the patient to determine how to proceed with their highest focus area.
2. Practice daily intentional movement
I can attest that daily yoga practice of 5 to 8 minutes at the beginning of each day has helped me to relieve my stress levels, improve mobility, and elevate my mood. Before I started this practice in June, I was a ball of hormonal rage attempting to calm down through inconsistent power walks in the hills of the local Pacific Northwest mountainous neighborhood where I live. The walks helped, but the practice was sporadic and unfocused. After a few weeks of daily yoga sessions, I noticed that my moods became more even throughout the day, I had a clearer focus for each morning, and my range of motion improved.
3. Reach out for help when you need it
When I mention that I’m specializing in peri/menopause with friends who are also in their 40s, the response has been enlightening. One of my local friends has read Dr. Haver’s book and checked in with her endocrinologist about her symptoms. She is well-informed and very motivated to ask for consultations with healthcare specialists who can best serve her needs.
4. Create your toolbox
Each of the books referenced in this article has toolboxes available that can support your improved health status. My toolbox is a bit complex as I’m a Registered Dietitian Nutritionist who counsels people daily and tries not to allow my empathy for others to overwhelm me. Currently, my toolbox includes stress relief via planning my day with Silk and Sonder, crafting (jewelry making and handmade tree ornaments), and short snippets of episodes of “Buffy the Vampire Slayer.” You can probably guess that my nutrition is pretty focused on the Harvard Healthy Eating Plate, with baked goods and seasonal chocolate thrown in — yes, Dietitians eat treat foods, too! My weekly movement toolbox includes yoga, trail running on Little Si, Supernatural dance and boxing workouts, and brief arm/ab resistance videos with Schellea or Petra. I also have my sleep hygiene routine in the evening and aim for a bedtime of 8:30 or 9 pm for a daily 4 am alarm (5 am on the weekends). This toolbox was developed over 6 months of trial and error and will probably continue to evolve as I learn more about effective practices from other people.
5. “Let It Go”
Elsa tells us to “let it go,” this can be especially challenging when the messaging in our environment is so demanding. I’m thinking of a menopausal patient whom I worked with for almost a year. She reported a lifetime of disordered eating patterns and daily habits that provided a structure that she needed to avoid binging. When she was especially aggravated by the nutrition messaging she received from other people in her sphere, she would attempt to “let it go” and move on. If it were particularly hurtful, she would process it with her mental health specialist or with me.
What role does community and social support play in navigating perimenopause, and how can women find or create supportive networks during this time?
You are not alone, and you don’t need to suffer silently through perimenopause. This period of your life can last an average of 4 years, and you have an opportunity to reach out for support from your friends and family. If you’ve moved to a new area and are looking for local friends, the app Meetup provides opportunities to meet with new people interested in sharing stories about perimenopause — you can even start your own focused interest group. There are several cell phone apps focused on this life stage — Perry and Balance Menopause Support are both helpful resources for finding support in a shared online space. Local organizations may also be focused on connecting you to like-minded individuals. Consider reaching out to your healthcare team to see if there’s an online or in-person peri/menopause support group. Check the online event schedule of the craft supply store in your neighborhood or the local public library to see which groups you might attend over the next few weeks with mid-life people attending.
Looking forward, what proactive steps can women take in their 30s and 40s to prepare for perimenopause and set themselves up for a healthier, smoother transition?
- Focus on a balanced plate approach rather than a restrictive diet. The Healthy Eating Plate from Harvard is a fantastic model for portion sizes of your chosen foods, and it doesn’t emphasize dairy like USDA’s My Plate does. Both plates recommend half the plate of fruits and veggies, which is a really fun way to eat throughout the week.
- Incorporate movement throughout the week, and little bursts might be the easiest way to accommodate a busy life and work schedule. When running errands, park farther from the store and walk over to the entrance to add some steps to your day. Take the stairs rather than the elevator when visiting your healthcare provider. Add 5-minute yoga to your morning routine to stretch your body — Black Yogi Nico Marie and Yoga with Bird are both fantastic free resources.
- Determine your top 3 ways to reduce stress and add them to your weekly schedule. Do you like to meet up with friends for drinks or brunch once a month? How about seasonal crafting projects such as handmade ornaments or vividly colorful mandala sand paintings? If you find home baking therapeutic, Becca Rea-Tucker published “Baking By Feel” in 2022 to support you with this activity. You do you!
- Accept that your physical body will be changing and that you can determine the direction of that change. Choosing healthier foods, practicing regular body movement, learning new things every day, and incorporating balanced lifestyle practices can help you live a long and healthful life.
Nutrition Services Near Seattle, Washington
RET Physical Therapy and Healthcare Specialists offer medical nutrition in-person at select locations and are available virtually to any client. For more information about medical nutrition therapy, please visit our webpage Medical Wellness Therapy & Medical Nutrition Therapy or schedule an appointment with one of our dietitians today.
