GLP-1 Meds After 40: What Actually Works, What Doesn’t (with Dr. Tully)

Welcome to Fit in Your 40s Podcast.
If your body feels like it changed overnight — stubborn belly fat, cravings you never had before, low energy, poor sleep, and workouts that used to work but don’t anymore — this episode is for you.

In today’s conversation, Doucky is joined by Dr. Nicole Tuley, a board-certified menopause practitioner with nearly two decades of experience helping women navigate perimenopause and menopause.

We’re diving into one of the most talked-about (and misunderstood) topics right now: Hormone Replacement Therapy (HRT) and GLP-1 medications — and what actually happens when they’re used together, responsibly, and with the right foundation.

This episode cuts through the noise, myths, and social-media hype to explain what’s really happening in your body after 40 — and what actually helps women feel strong, energized, and confident again.

🎧 In This Episode, You’ll Learn:

• Why eating less and exercising more often backfires in your 40s
• How estrogen loss drives insulin resistance and midsection weight gain
• The truth about cortisol, cravings, and online misinformation
• What HRT really is — and who is (and isn’t) a good candidate
• The safest, evidence-based forms of estrogen and progesterone
• What GLP-1 medications actually do (beyond weight loss)
• Who qualifies for GLP-1s — and when micro-dosing may make sense
• Real risks vs real benefits of GLP-1 medications
• How to prevent muscle loss while losing fat in midlife
• Why lifestyle habits still matter — even with HRT or GLP-1s
• How combining nutrition, strength training, HRT, and GLP-1s can finally break the plateau

📲 Links & Resources:

🎯 Book a Free Fat Loss Strategy Call

🩺 Work With Dr. Nicole Tulley / Menopause Care

📘 Learn About the BFF Method (Nutrition + Training for Women 40+) and download free resources

💬 Let’s Stay Connected:

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Transcript

DOUCKY 0:23

Welcome to Get Feeling Your Voice Podcast. Today we have a very important topic to talk about. If you ever felt like your body changed overnight in your forties, weight gain around the middle cravings hot flashes And that frustrating sense that your old routines just don't work anymore. You are not alone. Today, we're diving into one of the most talk about solutions right now. The combination of hormone replacement therapy, HRT, and GLP one Medications. Could this be the missing link for women in perimenopause and menopause who wanted energy, confidence, and body back to help us unpack the science, the myth, and the real life results? I'm joined by Dr. Nicole Tuley, a board certified. menopause practitioner who has spent nearly two decades helping women feel better at every stage of life. You won't want to miss this conversation the answers might surprise you. Welcome Dr. Julie.

DR TULLY 1:17

Thank you so much. this

DOUCKY 1:19

is our second interview with you.

DR TULLY 1:21

know

DOUCKY 1:21

our listeners love you. I

DR TULLY 1:23

love to be here, so I'm so happy to help.

DOUCKY 1:26

thank you so much for educating us and guiding us through this crazy phase of life. So today we're going to be talking about HRT and GLP one. And not only that, but about the combination of both. to help with weight gain and other symptoms So, my question is, for women in their forties and fifties, what is the biggest misconception about weight gain?

DR TULLY 1:50

So misconceptions really, it's that you can do everything you were doing that you did in your twenties and thirties, and you're gonna have the same result women say every day. To me, I used to always gain five pounds and I would just, for two weeks, I would eat healthy and I would out every day and I would be fine. And they come. Sometimes crying and tell me that they've been doing all that for six months, and the scale just keeps going up and they don't know why. Because they've changed nothing of their lives. They're eating well. They're eating small portion sizes with all the three meals they've tried, intermittent fasting, they've tried every combination of high protein, low protein, low fat, high fat. And they're still stuck with the needle going in the wrong direction. It's frustrating. It's really frustrating. there are things we can do and there's help, and really just understanding why, because sometimes it's medical reasons, people think, oh, it's just menopause, but sometimes it may not be. So I think people also, another misconception is that. It's just menopause and there's nothing I can do about it. Mm-hmm. But sometimes there can be medical issues that happen around the same time that people are ignoring and they're not seeing their doctor about it, or their doctor's not really looking at it. They're just saying, oh, stop, you know, eating the cookie when a lot of women don't eat the cookies. I'm looking at their diet diaries and they're really. Really healthy eaters and doing all these things, but still feeling frustrated. Exactly.

DOUCKY 3:11

for our clients, when they come, to our program, it's kind of like the same thing. They think they need to exercise more, even though they're exercising, they think they need to add more, to their routine, and it's not really it. So for our listeners, let's explain why they are gaining weight, even though they're doing the same thing. Usually the first thing that comes up is hormones. what do we mean by that?

DR TULLY 3:35

Right. Well, it it's about estrogen essentially. Yes. the lack of estrogen that increases insulin resistance. So the same work, the same foods that you were doing. our body processes it differently and because of that, our body has to try harder to use that insulin. Also, around the same time is we're having decreased muscle mass. And because of that, what we call our basal metabolic rate, the way that our own bodies are able to process energy and use it, breaking down the food we're eating is also not happening. So with perimenopause, what we know is that women gain about one to one and a half pounds per year on average. And if perimenopause lasts for some people around 10 years, that's 10 pounds that happen right around 40. That may be the first symptom that women are seeing. Other than their period all of a sudden is a little bit sooner, a little bit funny, where it was used to 28 days from the last. Now it's a little shorter, a little longer, and they're gaining weight. and so this is definitely something that is the reason

DOUCKY 4:36

why. Exactly. Because even though we're doing the same, our bodies.

DR TULLY 4:39

Right

DOUCKY 4:40

are metabolizing everything differently. Right.

DR TULLY 4:42

And it is increasing fat deposits, so what we call increased adiposity in the middle. And we see the middle happening when we're like, we're doing how many. Crunches and how many AB exercises and all of that middle is still happening in spite of our best efforts. because of the changes in estrogen and how our bodies are responding to that.

DOUCKY 5:03

you said something really interesting. the insulin resistant, our clients report that they are having more cravings than before. can we talk about that?

DR TULLY 5:13

Absolutely. I mean, I think also. Sugar feeds into sugar, and sugar is the most powerful addictive ingredient that exists more so than cigarettes. And, and alcohol sugar is much worse. Mm. And so when you do have that sugar, our body just burns it off, it burns it very quickly. So whenever we have carbs, even though we're trying to be healthy, we'll have a stick of carrots. We'll have some, you know, some. Low, you know, fat crackers. but our bodies just burn it off. And without the protein and without some more substantive, healthier fats, our bodies are then just hungry again. Because what happens when you eat the carbs, your pancreas releases the insulin. The insulin causes the sugar to be absorbed into our. Tissues into the muscles, into everything that we're doing, but very quickly, so there's no, substance and we're hungry again because now our blood sugar goes down and we need more food.

DOUCKY 6:05

we are talking about estrogen that is like the responsible of the fat distribution in our body. Everything is going down to our midsection. We're talking about insulin. let's talk about cortisol.

DR TULLY 6:15

So cortisol is a stress hormone. It is released in response to what our bodies need to survive to regulate our blood pressure, to regulate our blood sugar. And so when we have disordered living, what happens if we're not sleeping, if we're stressed more, which I don't know, many middle, middle-aged people that aren't all those things, those levels do become irregular, which again, lead to irregular. Insulin. Resistance. And again, our bodies have a very difficult time bringing down our blood sugars, which then lead to, again, the weight and the fat distribution, and it is very compounding. Now. Our adrenal glands are very, very sensitive, and with all those adrenal treatments and hormones, it can go very bad. Mm-hmm. Diagnosing adrenal fatigue, adrenal resistance, adrenal insufficiency, adrenal excess, is very difficult and should really only be done. Through an endocrinologist, not the home tests with some online sellers. Do you hear that? yes. Please, please. If you really do have concerns, see your doctor and do not buy a kit online.'cause there is no substantive, safety of those tests. As far as what? It's really accuracy, I should say, not safety. Mm-hmm. That those tests are gonna give us. And of course. They're gonna say things are completely abnormal. And when you actually have accurate testing, which is usually done after an overnight fast, there can be a midnight salivary cortisol level, which is very sensitive or. A very early morning blood test while fasting, after taking medication. That should be done only through an endocrinology office.

DOUCKY 7:47

I have seen cortisol, cocktails or cortisol supplements, and of course they're swearing by and we have to remember that the algorithm know that you are looking information to. On how to ease your perimenopause symptoms. So of course everything has to be with hormones, weight gain, perimenopause in your forties is going to show up in your feet. we have to be very careful, about what we buy because they're really expensive and you're desperate

DR TULLY 8:13

These medications often, or these not medications, these supplements often will have other ingredients in them that can make you feel like they have more energy.'cause there's caffeine in them and there's B12 and other things that your body may need so that it's masking things that they're doing. And the other thing is when you stop these supplements, you feel worse than when you started. Oh. So I would very much, very much recommend staying far away from those and really seeing your doctor and making sure that there isn't a medical reason why. You're feeling the way you are and that you're gaining the weight you are. but really finding someone who listens. Yes. To really figure things out rather than someone just dismisses you and says Everything is fine.

DOUCKY 8:50

Exactly. So we talk about estrogen, insulin, cortisol, progesterone. So it has to be something with our symptoms in perimenopause, our weight gain.

DR TULLY 9:00

progesterone is definitely part of the picture, but really estrogen is the one that feeds back on some hunger sensors and insulin sensors. Progesterone definitely affects mood. Mm-hmm. it can affect hunger. and so in those ways, sometimes again, that can be an issue, but typically what we do see with progesterone during, perimenopause and menopause is that those levels go down along with estrogen.

DOUCKY 9:24

Yeah, because if you feel sad, depressed, or angry, you don't wanna go to the gym and you're eating more. to cope So those

DR TULLY 9:30

are low progesterone. Exactly. We need to supplement both when treating women with. Hormone replacement, assuming they have a uterus If you've had surgery and have no uterus, some women do better with just estrogen alone. it is very important to take progesterone if you're being treated with hormone replacement, because if you don't and have your uterus, you may be at risk of uterine cancer.

DOUCKY 9:50

Exactly.

DR TULLY 9:51

So, but there are some benefits, specifically people who take progesterone supplements. can help with sleep and it can help with mood as well. Feel a little more calm.

DOUCKY 9:58

Exactly.

DR TULLY 9:59

Okay,

DOUCKY 10:00

so now How do we get the levels of the hormones in order to feel better and lose that fat especially in the midsection. What is hormonal replacement therapy, HRT How do I know if I need that?

DR TULLY 10:13

Great question. I think the important part is talking to your provider, hopefully a menopause certified provider by the Menopause Society, where they've had rigorous education, taking testing, and really kind of proven themselves to continue with continued education throughout the course of their care of their patients. But looking at who is a good candidate. And there are women who feel all these perimenopause symptoms when they're still having a period. And I've had friends tell me, patients previously tell me that, oh, they went to their doctor, their levels were still not menopausal or past postmenopausal and they're still getting a period, so they can't really take anything now. And I say, that's ridiculous. You're feeling terrible now. So you're gonna wait another three, five years before you start to feel better. I think that's a really. uninformed way that they're being treated. Mm-hmm. so we treat people, we treat women when they have perimenopause symptoms in different ways and while they're still getting their period. One of the ways may be with birth control pills, with low dose birth control pills that can help supple the estrogen they don't have, because the only issue is, is that they can still get pregnant. Right. another option is if women have a progesterone IUD, they can use just an estrogen supplement on top of that and they don't have to worry about any oral or additional progesterone if they have certain types of IUDs with progesterone. So those are the major ways, the two ways the estrogen comes in different forms. The best and safest are the ones that are through the skin. Mm-hmm. Specifically patches, and then there's gels and there's sprays that women can use for estrogen. There are pills. But they're not as safe and they can cause an increased risk of blood clots. Mm. So the estrogen pills are not advised mm-hmm. And should be only last resort. Okay. the progesterone can come in pills. Mm-hmm. It can come in the IUD. Mm-hmm. And it can also come in the patch combined, but the topical gel progesterones are not absorbed well enough. This is so important'cause I've had people come and the Menopause Society is very strictly said, and re and research suggests that the topical progesterones given in, in topical creams are not enough to protect against uterine cancer. Oh,

DOUCKY 12:21

the uterine cancer.

DR TULLY 12:21

So you either need that IUD or you need it in the patch, or you need it in the pill. The

DOUCKY 12:25

pill. Okay.

DR TULLY 12:26

Okay. Oh,

DOUCKY 12:27

this is so important.

DR TULLY 12:28

important. It's

DOUCKY 12:29

not only getting hormones, it has to be the right way. Right. You don't harm your body and then you're not in risk.

DR TULLY 12:34

Absolutely. there's a third hormone that people talk about with hormone replacement and that is testosterone. Mm-hmm. And that is definitely something that can be given to women. I usually will start with the estrogen, progesterone, and then if needed at testosterone. Testosterone, especially for people who have low libido. Who feel very tired, who have low muscle mass. Mm-hmm. Who want more energy and to feel more active. the testosterone can help. The testosterone is something that has to also be very regulated and watched carefully. And it's one of those things that, are misconceptions because there are a lot of people that are getting these pellets that they put in that has a combination, very high dose of all three things, estrogen, progesterone, and testosterone. And there can be a lot of very negative side effects, and it's not reversible, so you have to wait it out, whether it's three months or a year. It really depends on when it wears out. people can be really sick with that. So I definitely don't recommend people get

DOUCKY 13:27

No pellets, please, no pellets, no progesterone cream. So that is like what we learned today. Exactly.

DR TULLY 13:34

Now not related to weight. There are other ways to get estrogen and progesterone. well really estrogen, and that's vaginally. Mm-hmm. And that's for people who have. V pain, dryness, pain with sex. so what we call, the general urinary disorders of menopause. And so that can definitely help people who have those kind of symptoms but don't affect our weight at all. very little gets absorbed and so there no side effects from that other than just the vaginal side effects, which are usually very positive.

DOUCKY 14:01

Okay, great. A lot of great information today about HRT. So now we're gonna go to the other topic. super trendy the last two years, I can say, right? Like the last two years we've been talking about that GLP one. injections. what are GLP one and how do you qualify for a GLP one?

DR TULLY 14:22

So, GLP ones are medications that are actually, there's two types of medication that are GLP ones I should say, that are very popular on the market. One, is ozempic and wegovy, and they're the same medication. One is indicated for diabetes and the other one for weight loss. Wegovy is the one we're gonna talk about. And then the other. One is a GLP one plus another medicine called GIP, and what those medications are are specifically we're talking about on commercially now, Majaro and Z Bound. Mm-hmm. Majaro is for diabetes. We're gonna be talking about zet bound. So those medications are medications that are used very popularly now for weight loss, and they have been around the type of medicine for about 10 years. 2005, the first type of GLP was brought to market for diabetics and it did really well, but there were a lot of side effects. Hmm. So through the years, they really changed the side effect profile having and have improved how well it helps with weight loss. And so those are the ones that it seems like everyone is on right now or wants to be on right now. Yeah. Yes. Mm-hmm. Yes. So COVID definitely made them pretty popular and there were shortages and now there's no shortages anymore. Because manufacturers realized they're really popular and they do a lot of good. Mm-hmm. And then there's some side effects and risks, which Sure. You're asking me about. Yes. But they can be really helpful for people in menopause, who really are trying everything and who are frustrated about everything that they have to do just to feel better. So who qualifies by your insurance? Mm-hmm. are people who are obese. Or who are overweight with A BMI of 27.5 and have another medical condition that can put them at risk of cardiovascular disease. Mm-hmm. So those conditions are usually high blood pressure, high cholesterol, insulin resistance, so like a pre-diabetes. But, a lot of times insurers are now have a disclaimer or a waiver that if it's just for weight loss alone, they will not cover this. Okay. The one thing that they will cover it for is for sleep apnea. Mm-hmm. And then they've had a new liver indication for people who have, That essentially, fatty liver, extreme fatty liver, they can sometimes qualify with some insurances, but not others. So they're pretty hard to get because not all people qualify. And the people who even do qualify, a lot of insurers are saying we're not paying for it. So they can be pretty expensive, but. The pharma companies have figured out how to make it more reasonable. So back in COVID times they were probably 1200,$1,400 a month. Mm-hmm. For these medications, now they're somewhere around 350 to$600. Depends on the medicine that you would have to pay that, per month if you wanted to be on these medications. The compounded medications are no longer legally available in the us. Okay. And so anyone who's getting compounded GLP program products, they are not. allowed. this Melu Tide and the Tirzepatide? Yes. So those previously, because they were shortages, the FDA allowed them and some compounding pharmacies to produce them to try to meet the medical needs of the diabetics. but now because they're plentiful, they're now back on patent and it is illegal for them to be sold.

DOUCKY 17:29

Wow.

DR TULLY 17:30

Because they're unsafe, right? They can be unsafe. They can, there can be dosing issues, there can be, there the FDA does not regulate them.

DOUCKY 17:38

about the dose, we have seen a lot of microdosing.

DR TULLY 17:41

so when people are taking these medications. You're supposed to start at the lowest dose, and if you don't, you're gonna feel terrible. you start at a low dose and some doctors advance the doses very aggressively to get to a point where people are pretty much just tolerating it and not sick all the time and losing weight. To be that high very quickly. People can feel very badly and there are side effects. So I think now's a good time to talk about side effects of these medications. Mm-hmm. Because some of them, some people are scared and sometimes some people have tried it, but they were with providers that were very aggressive with increasing their dosing and then they felt so bad that they stopped it. So side effects, typical ones are nausea, vomiting, constipation. Some people have the opposite, have diarrhea. other side effects can be. If severe and hair loss, if you lose weight too quickly, gallstones. Mm-hmm. Especially if you lose weight too quickly. there can be bowel obstruction, there can be pancreatitis. Mm-hmm. So inflammation of the pancreas. So those are all quite severe. We have also seen cases of blindness. Mm-hmm. Um, irreversible blindness usually gradual, not so sudden, but it can be sudden. Okay. That has been more seen in diabetics than about two out of a hundred thousand users of Semaglutide. And, and these GLP ones have been noted to have this issue. So it's not a small number. Mm-hmm. But it's a small number. but that is something you have to talk to your doctor about if there are some vision changes to immediately evaluate,

DOUCKY 19:04

check the dose and everything. Exactly. so let's say a person like me, I'm not obese, I'm not Diabetic. but what I have heard is like, let's micro dose because I'm not obese.

DR TULLY 19:13

We can do that. You have to find a doctor who will do that. Mm-hmm. Who will follow you with these small doses and how to get it. Because when you buy it in the pharmacy, these come as injections that you can't use Small doses. The lowest dose is 2.5 some. People are using it less than that in small little amounts and spreading it out. Mm-hmm. Instead of once a week, they may take it every one or two or three or four weeks, just enough to help with the continued weight loss and not feeling hungry and snacking all the time and feel better. There are some properties that, these medications I talked about, all the bad stuff, but what people do feel is finally, something's working. They're, although they're reported. People who've had depressive symptoms, I find my patients are happy. They feel well. A lot of people will have their pain go away, their anti-inflammatory properties. That's what I

DOUCKY 20:02

was about to say, anti-inflammatory properties. Yeah. So

DR TULLY 20:05

these joint symptoms go away. People's acne sometimes go away because of the insulin resistance. Sometimes people who have PCOS and insulin resistance can have excess facial hair. that again, as it improves, gets better. Infertility because of irregular periods can accident. Some people on it can accidentally get pregnant because all of a sudden they're ovulating spontaneously. So there are some very positive benefits, but we're seeing people with coming off cholesterol medicine coming off. High cholesterol, blood pressure, high cholesterol medicine, people coming off diabetes medicine. We see people have lower rates of heart disease and stroke. Mm-hmm. And even cancer and even some studies looking at reducing your risk of dementia. And I think that's probably all because of the decreased weight and the decreased risk of cardiovascular events like stroke. So there's so much that it does offer. That's why after 10 years of a lot of research and data, I felt comfortable prescribing them. Mm-hmm. I did not prescribe them until. Literally about a year and a half ago. Okay. There was so much data that came out that was positive that I very often prescribe them to patients who need them, but also patients maybe like you who tried everything, who don't feel well, who feel like they're not their best selves and they wanna try it. Mm-hmm. I will. Even though that is not necessarily evidence-based medicine, but there are some longevity studies going on that these medications reduce inflammation so much. That it can lead to healthier longer, and. Healthier lives.

DOUCKY 21:31

I think that is very important. Number one, that you have to do it with a professional like you. It's not like going crazy and just injecting yourself or going, to a spot to get the injections, but with a professional guiding you to make sure that you are not at risk. also I feel a lot of judgment for, you know, like with the people who are doing it. No, but you are skinny or you're not obese. So, while you're doing it, it's important to understand that this medication is not only for weight loss but has many benefits Doctors who have been following for the last 10 years now that, it's a good option for, for some people, like, why suffer if we have these available.

DR TULLY 22:11

Right? I mean, there are some. Doctors who think and, and they're all these Instagram headlines, right? Should it be in the water? Should it, I mean, should it be on Time magazine, like Drug of the Year? Right. And in some ways, in all of these positive aspects of the GLP ones, I think. Sure. I think yes, it, it could be potentially in the water. It won't pass in Jersey, but the idea of there are very positive health benefits for people who struggle especially and who don't feel well or have, again, even though you may look like you do, you may have. High cholesterol, you may have hypertension. So judging people by their book cover is also not very well. That has

DOUCKY 22:50

been forever. judging by your appearance. Not knowing what you're going through. now you are doing this with your patients, the combination of HRT and GLP one. for midlife women.

DR TULLY 23:02

For, yes. For women in their, I mean, at any age. Right. Who are mm-hmm. Feeling unhappy about how they're feeling or have medical complications that will benefit with these medications? Yes, I am doing that. because again, I think mentally that is equally as important as treating. Than numbers on a page. so for women who also feel that, they need it, I will, I will work with them very closely and monitor their weight to make sure that they don't also become too undernourished. but I also am very careful with my patients. Again, there are a lot of providers that just escalate doses and escalate doses and people feel really bad and that's how they lose the weight'cause they can't eat anything. I spend a lot of time educating my patients. I go through diet diaries, I refer them to nutritionist. If they feel stuck, I really make sure that they're changing what they're doing and how they're doing it. I talk to them about diet and exercise because all of it is what's gonna help them be successful later on. Mm-hmm. And not gaining all the weight back.

DOUCKY 23:59

Exactly. Because I have heard also these stories, it's like, of course I lost everything, but now I'm getting it back. So let's talk about how to maintain the progress. When you are doing both, treatments, right? Like the HRT, the GLP one, and also let's talk about how to avoid the muscle loss.'cause that is something that is also talked about a lot. They're scared, right? Mm-hmm. of the muscle loss. So what do you have to say about that?

DR TULLY 24:26

Well, I think it's important to know that if you lost 50 pounds on a GLP one or not on a GLP one, there will be muscle loss regardless. You're losing fat on muscle, whether it's a GLP one or not, but in order to maintain, in order to prevent, and especially with bone loss eventually as well, with that muscle loss,

DOUCKY 24:43

especially at this age, right?

DR TULLY 24:44

we really need. Moderate aerobic activity, low to moderate aerobic, right? So I think people will say, I'm on this. I don't even have to work out and look I'm losing all this weight. Or, they think there's a lot of misconception that during menopause you shouldn't do any cardio, and that's wrong. You need low to moderate cardio activity. At least three to five hours a week to be healthy. Mm-hmm. Forget about weight loss. You really need to maintain that and at least 90 minutes of weightbearing exercises a week. So that is still the recommendation that will help you be successful in maintaining and, and continuing to lose weight, or at least be stable, healthy eating. Right. And again with the GLP ones, it's not a magic anything. You really need all of it, if you're going to be healthy and use this to be well. Later on in life because again, if you lose all this weight, you lose all your muscle. You're gonna be also at risk of then bone loss and risk of fracture. So you really need all of it. And again, if you're eating healthy and starving yourself, you're gonna also be nutritionally deficient. So you need to make sure to eat healthy and make really good choices about what you're eating. So the diet and exercise is key in order to be healthy while taking these medications.

DOUCKY 25:51

A hundred percent. So if you wanna avoid muscle mass loss, if you wanna avoid the ozempic phase that is so popular now you need to do strength training. You need to eat the adequate amount of protein, even if you're in GLP one. I know that maybe you're not super hungry, but you need to eat an adequate amount. And you need to walk, do some type of aerobics. this is called the Miracle Medications, but you have to do the work.

DR TULLY 26:16

It's not an easy cheaty way. It'll help support what you need to do, but my most unsuccessful people are the ones who are just kind of sitting at home and not doing it. and just. Taking the medications, the people who are really successful, who feel really well are the ones that are doing it all, and they're gonna be the ones that are able to keep the weight off and eventually, even from a high dose, cut back and do that. Microdosing we talked about where they'll maybe just use a quarter of the dose that they're on, maybe once every two or three weeks, and maybe eventually even. Able to come off once they learn how to manage their food cravings and how to eat and continue the exercise that has made them feel so good.

DOUCKY 26:51

So if you're wondering how we work with our clients, Dr. Thule is part of our team this is what we do first, we work with our clients in the nutrition and the fitness. If they are still feeling. the perimenopause symptoms super intense or, have a lot of cravings even though they're eating their fiber, the protein, and they're doing everything that we have in the program. We go with Dr. Thuli and Dr. Thuli take care of the HRT and the GLP one. If. Needed. it's important to start working on your lifestyle first, regardless, just for you to be ready when you have that progress, just to keep that off. So that's what we recommend first, working on your habits. Eating the right amount of macros, protein, carbs, and fat, getting the habit to work out, do cardio, learning how to do your strength training three times per week controlling your stress, controlling your cortisol naturally without supplementation first and sleep. Sleep is so important. Dr. Tule was yelling at me before this interview because I had the brilliant idea of drinking matcha at 5:30 PM yesterday. And guess what? I slept nothing. we have to take care of our sleep. sleep walking. fiber, protein and If you see that that doesn't work for six months, you have to go with a specialist, to tune in on the things that you need and have progress. But the habits are so, so important, even if you are doing HRT and GLP one.

DR TULLY 28:19

And I love when I have my patients that have the. Almost decided to consider these because they've already made that life choice of taking care of themselves for the first time. Finally, yes, because really oftentimes in this perimenopause 40 50 transition, we realize we don't feel well, and we realize we've spent so much time taking care of everyone else and in our careers, in our lives, or in our homes, and now we self-reflect and feel badly. Mm-hmm. And so I'm. Thrilled when, and not all doctors, sometimes doctors are like, oh my God, there are gonna be so many questions, not another perimenopause patient. And I just get excited because I know I can help. you

DOUCKY 29:00

are part of this change because we weren't talking about these. Before and this generation is willing to do the work. This generation is willing to feel better'cause it's not fair at all. right. So what would you tell a woman who are in their forties or even fifties that you wish we knew before

DR TULLY 29:21

That you don't have to live with? Symptoms of feeling bad, Frustrated. like you can't sleep, like you have to starve yourself to make a point of being healthy, that it's okay to want more, and it's important to ask questions and to find a doctor who's going to listen and to really put yourself first for the first time.

DOUCKY 29:41

Exactly so we can enjoy the last 40 years of our life. we are in midlife.

DR TULLY 29:47

Exactly. The point of longevity and, and is really being healthy for as long as you can. And 50 is a new 30. Really? Yes. I'm just turning 50. Um, don't tell anyone,

DOUCKY 29:58

but Well, we need the skin routine, by the way.

DR TULLY 30:01

Oh my gosh. You're very sweet. But the idea is just living as long and as healthy. As you can and being strong and being fit and feeling well. And really this is part of that process, really asking for help and knowing that there is help. because you don't have to feel bad with perimenopause because it's really a new stage in our lives and it can be in a wonderful stage where we're setting our new precedents, our new lives. And really now we have hopefully financial stability. We have hopefully a career family that is really. Launched and we can really look back and know that there's really great things forward as well. but really time to take care of ourselves as women for sure.

DOUCKY 30:42

Yeah. So we can be the most fun grandmas ever if our kids decide to have kids, right? You so much for joining. this is all for today. in the notes you will find a link with all the information, of Dr. Tule for you to make an appointment if you need more guidance. And also you will find a link for you to book a call if you need guidance on nutrition and fitness in your forties. Thank you so much for watching and see you in the next episode.