THE SHORT VERSION

Hormonal shifts during perimenopause and menopause are linked to changes in sleep, hunger, thinking, mood and temperature control, which is why the rules you used to read your body by stop working. Krista Scott-Dixon, PhD, says the answer is not trying harder. It is treating self-trust as a skill and practicing it in small, low-risk experiments.

I’m standing in my dining room, staring through the plantation shutters at the quiet street outside. It’s the middle of the afternoon and I’m still in my workout clothes, even though my workout ended hours ago. My legs ache from this morning’s run. My arms are sore from the strength session that followed. Right now, though, the only thing I feel is shame.

The empty wrappers on the counter are glaring at me. Chocolate again. I don’t know how I got here, but it’s happening almost daily: overeat, regret, repeat. I should know better. I do know better. I’m a certified nutritionist and personal trainer, for crying out loud. I spend my days teaching other people how to live healthy, balanced lives, and if they could see me now, what would they think? I feel like a fraud.

I’m running an hour every day and lifting weights. I’m logging every bite. I’m spending a fortune on supplements, carb blockers and metabolism boosters, hoping one of them is the magic fix. None of it works. I’m exhausted and frustrated, and I have what is probably a stress fracture from overtraining. I’m terrified to take time off because I’m sure I’ll gain weight if I stop. But I know I can’t keep doing this. Either I accept my body as it is, or I find a new way forward.

That’s when I hired a coach. For the first time, I started listening to my body instead of fighting it. She taught me to use a hunger scale at the start of a meal and again at the end, so I stopped getting ravenous and stopped eating until I was uncomfortable. I started trusting the signals I was getting. My cravings dropped and my energy steadied. My sleep got better too.

I was around 45 then. I believe now that I was in the early stages of perimenopause, and I was treating it like a performance problem.

The question I hear from women every week

I’ve now coached thousands of women, and one question keeps showing up in different forms. Why am I awake at 2:00 AM when I did everything right yesterday? Why am I starving an hour after a full meal? Why does a workout that used to leave me feeling great now flatten me? Why can’t I find my words, and why am I this irritable? Why am I suddenly so hot?

For a long time my answer was a version of “it’s complicated.” That’s accurate, and it helps nobody at 2:00 AM. So I went looking for a better one, and I started with someone I trust to explain how change works.

Meet Krista Scott-Dixon, PhD: formerly Director of Curriculum at Precision Nutrition, now developing menopause coaching education. She holds a doctorate in Women’s Studies from York University, has counseling certifications, and has a new textbook out, Applied Nutrition Coaching and Counseling, on bringing counseling skills into health and nutrition coaching. She was on my show in Episode 46, talking about self-compassion. She speaks here for herself, not for any organization she has worked with.

Done with Dieting Episode #46: Deep Health with Krista Scott-Dixon

A note before we go further. Krista is a coach and educator, and I’m a coach. Neither of us is a physician. The physiology below comes from published research, every source is linked, and none of it replaces a conversation with your own clinician.

“Congratulations, you’ve woken up in a new body”

Late in our conversation, I told Krista that women stop trusting themselves in midlife because the signals change. Something that was never an issue before suddenly is, and they have no idea how to square that. Her answer is the line I haven’t stopped thinking about:

“Congratulations, you’ve woken up in a new body. And now you get to discover it. You get to learn all about it, and you can go on little adventures with it, little experiments. It’s kind of like traveling.”  Krista Scott-Dixon

Most of us keep trying to operate the body we had at 30, using the instructions we wrote at 30, and then we blame ourselves when the instructions stop working. Krista’s reframe moves the problem. You haven’t lost the ability to read your body. You’re reading a different one.

If you keep starting over and you’re not sure why, my quiz, You Keep Starting Over. Here’s Why., is a good place to begin.

What actually changes, and what nobody can fully explain yet

Krista and I spent most of our time on what to do about a changing body. The physiology is where I went digging on my own, and I’ll tell you where the research is solid and where it runs out. For context, the average age of menopause in the United States is about 51, Krista put it at 52, and the transition leading up to it can run for years, which is how a 45-year-old ends up in the middle of it.

Sleep, including the 2:00 AM wake-up

Start with the one I hear most. SWAN, the Study of Women’s Health Across the Nation, has followed women through the menopausal transition for decades. A review of its sleep findings cites estimates that sleep problems are reported by 16% to 42% of premenopausal women and 39% to 47% of perimenopausal women. Night sweats are part of the picture, since hot flashes and night sweats show up in up to 70% of women across the transition. But they don’t explain all of it. Researchers who tracked sleep diaries alongside hormone levels note that sleep disruption can show up without night sweats, and the SWAN review says plainly that the cause is still unclear.

So here’s what I can say honestly: more waking at night is a documented feature of this stage. It is not proof that you’ve mishandled your bedtime routine.

Hunger and overeating

You finish dinner and you’re hungry again an hour later. A recent review of eating behavior in menopausal women describes estrogen as part of the brain’s appetite regulation, working alongside leptin and ghrelin, the hormones tied to fullness and hunger. The same review reports that postmenopausal women often show higher appetite, a stronger reward response to food and more carbohydrate cravings.

Some caveats. Much of the mechanism work comes from animal studies, and that review focuses on postmenopause, so it can’t tell you exactly what’s happening to you at 46. Still, “my signals changed” is a theory with actual evidence behind it, which is more than “something is wrong with me” can say. Those changed signals are also the ones diet culture trained you to ignore. More on that in a minute.

Energy, and the workout that flattens you

I know this one personally. My version ended in a stress fracture. Here the evidence is thinner than the internet suggests. In animal studies, estrogen influences how muscle responds to exercise damage, but a review in Sports Medicine found that human studies haven’t clearly shown the same effect. So I won’t tell you estrogen is why your recovery slowed down, because nobody has pinned that down.

What Krista offered instead was a practical observation from her own life. In her 20s, she says, “I would walk into the gym, right into the squat rack, do some heavy squats, literally zero warmup.” Now, “if I get up in the morning and I do my mobility on the living room floor for like 5, 10 minutes, my body feels better, and that is a new thing.” You can argue about the mechanism and still adjust the plan.

Brain fog

SWAN also tested thinking. In a four-year study of 2,362 women, women in late perimenopause stopped showing the usual improvement from repeated testing on a processing-speed task, and that learning effect rebounded after menopause. The lead researcher described the difficulties as transient and subtle. A later SWAN review noted that the changes were not accounted for by self-reported hot flashes, anxiety, depression and sleep disturbance.

None of that makes the fog less annoying when you lose a word mid-sentence at 10 a.m. It does mean researchers see it as time-limited, which is more reassuring than the alternative.

Mood

A 2016 meta-analysis found that women in perimenopause had about double the odds of depressive symptoms compared with premenopause, although the rise in formal depression diagnoses fell just short of statistical significance. The authors also noted that menopausal symptoms themselves may inflate scores on depression questionnaires. A 2024 meta-analysis of 17 cohort studies put the increase at roughly 40% higher odds of depressive symptoms and diagnoses compared with premenopause, with no significant increase after menopause.

Irritability that seems to come out of nowhere may have a reason behind it. If low mood is heavy or lingers, take it to a clinician rather than white-knuckling it.

Hot flashes

Everyone expects this one on the list, and the research is not exactly comforting. In SWAN, women with frequent hot flashes or night sweats (six or more days in two weeks) had them for a median of 7.4 years, including a median of 4.5 years after the final period. The range was wide, from a median of 4.8 years in Japanese women to 10.1 years in Black women. Women whose symptoms started before menopause or in early perimenopause had them the longest. Seven years is a long time to be told it will pass soon.

Not one of these studies describes a broken body. They describe a system with changed signals, which is exactly the point Krista kept coming back to.

Why trying harder backfires

Here’s the part I think matters most. Krista says self-trust gets socialized out of us early. “Childhood is just full of these moments where adults are like, ‘I don’t believe your version of reality.’” Then we hit the dieting world, where the instruction is to “completely dissociate from your hunger cues, from your fullness cues,” and from how your food affects your energy and mood.

Her math on the result: “We have to start not just from zero, but from like negative 100 in learning to trust ourselves again.” Then the part I wish every woman I coach could hear:

“The good news is that signal is always there. It just takes practice to come back to it.”  Krista Scott-Dixon

There is an opposite trap, and I fell into it hard in my dining-room days. Krista calls it metrics farming: someone stops asking whether they feel better when they sleep well and starts trying to please a sleep score. “What is the point of the sleep score?” she asked. “The whole goal here is to help you sleep better so that you can do the things you wanna do in your life and feel good, right?” She added that her own Garmin “gives me the whackest heart rate sometimes.”

I logged every bite for months, and the log never once told me what I needed. When I called all of this bro dieting in a different context, Krista’s verdict was, “It is bro diet. That’s exactly what it is.” If you’re afraid of your own hunger, Episode 256, Fearing Hunger: How Dieting Trained You to Overeat, goes deeper.

How to rebuild trust in your body’s signals

Krista treats self-trust as a skill, which means you practice it in small reps and expect it to be messy at first. These are the practices she walked me through.

1. Amplify the signal. Drink a very big glass of ice water and notice it traveling down your esophagus and into your stomach. If you’re comfortable with it, put a hand on your belly and add a little pressure while you eat. Her question: “Can you amplify the information that you’re getting so that you can actually hear it and perceive it?”
2. Treat hunger as information. If you’re afraid of being hungry, Krista suggests, and “if you can do this safely,” try skipping a lunch or even a 24-hour fast, and keep a journal of what it’s like. “Oh, wow, I’m lightheaded. My tummy’s growling. Okay, cool.” The point is to learn what hunger feels like when you let it exist. If restricting food has ever been a problem for you, skip this one and start with the others.
3. Start with what you don’t like. We don’t always know what feels good, Krista says, “but we sure know what we don’t.” Cross those things off. Her example is a high-protein food you hate: “It’s dead to you now. You never have to eat it again.”
4. Write the owner’s manual. “You think about writing yourself a little owner’s manual of handling instructions for yourself, except you’re starting on day zero today.” Note what you learn without judgment. Shrimp used to work and now doesn’t? That goes in the manual. So does the morning mobility.
5. Run 1% experiments. Krista runs what she calls the 1% Better Academy, built on tiny actions. Her practice for anyone who struggles to express a preference: order at a coffee shop, then politely change your mind. Or when someone asks where you want to go to dinner, say where you want to go. “Have a preference.”

My hunger scale did a version of this for me. I didn’t need a new belief about my body. I needed reps at noticing. If you want to see where your own pattern of starting over is breaking down, the quiz at elizabethsherman.com/quiz is a good next step.

Why Krista calls this the best part

Krista is more optimistic about this stage than most people I interview. She calls perimenopause and menopause “truth serum,” and offered a theory she introduced as “wackadoodle, probably completely unscientific”: that the hormones present earlier in our reproductive lives “anesthetize us against a lot of the BS,” and when they shift, “the veil gets ripped away from our eyes.” Treat that as her hypothesis, not established biology. She said so herself. Her verdict on the stage is plainer: “I feel like the whole first 52 years was just a warmup, and now we’re really getting cooking.”

She also argues that avoiding what this stage shows you leads to worse outcomes. The research points the same direction, with a caveat: a 2022 meta-analysis found that experiential avoidance, the habit of steering away from uncomfortable thoughts and feelings, is linked to depression, anxiety and related conditions. Linked is the key word. That shows an association, not a cause. The practical version, in Krista’s words, is to turn and face it, “not even in a confrontational way, but in a way of engagement.”

What I took away

I went looking for a single answer to the 2:00 AM question, and I didn’t get one. I got a better explanation and a better response. The explanation: the signals you’ve relied on are changing, and researchers can’t yet fully say why for every symptom. The response: treat the changes as information to gather, not as a verdict on you. Krista calls it day zero with a new body, and I can’t stop thinking about it.

If you’re tired of starting over, take the quiz: You Keep Starting Over. Here’s Why.

You can hear the whole conversation in Episode 290, and you can find Krista’s work at kristascottdixon.com.

Done with Dieting Episode #290: Why It Feels Like You Woke Up in a New Body at 50