Let's Talk about (Peri-) Menopause!
50% of the human population experiences menstrual periods and its inevitable conclusion: Menopause. So why is menopause so poorly understood or supported? Women are either offered no help for life-altering symptoms, or their only option is hormone therapy in often questionable doses and durations with no consideration of its repercussions, or antidepressants.
What can you do to optimize your health and wellness before, during and after this normal stage of life? Plenty! Let’s learn what we can work on, how we can help ourselves, and what should we lean into and accept? Read on and let us know what you think.
What is menopause and why do we go through it?
What are common symptoms?
It’s not just about estrogen, progesterone & testosterone.
What can we do to optimize our health through this transition and beyond?
Truths about menopause
Aging optimally, aging gracefully
1. What is menopause & why do we go through it?
Menopause is diagnosed when you have not had your period for 1 year. But the hormonal changes of menopause are not all, then nothing.
Menses happen because of a complex cascade of hormonal signaling that is like an orchestra, with one hormone triggering the next to start, and the next and so on. Our periods are more like the cymbal crash indicating the orderly completion at the end of the complex song of the monthly female hormone cycles.
Your pituitary, the ‘master gland,’ sits just between and behind your eyes and is the conductor of this orchestra. It sends out hormones (FSH -follicular stimulating hormone and LH -luteinizing hormone) that trigger your ovaries to secrete estrogen and then progesterone. The pituitary monitors hormones levels and adjusts signals to accordingly.
source: https://medium.com/@bicspuc/menstrual-cycle-an-important-process-of-human-reproduction-e22a4abce2e2
In perimenopause and menopause, women’s bodies don’t just go from full-on, regular hormone cycles to no cycling hormones whatsoever. It is more of a gradual “petering out” like the winding down of a pendulum. The weakening hormonal signaling means the threshold necessary to trigger the next sequence of hormones may not always happen.
This leads to changes and irregularity in the timing and volume of your period in the years preceding full menopause. Symptoms of menopause such as hot flashes, sleep, mood, energy and libido changes can all be consequences this period of sex hormone winding down.
But note (more on this below): if menopause was just due to decreasing sex hormones then all women would have all the same menopause symptoms. Clearly this is not the case, so we need to think about more than just estrogen and progesterone in supporting ourselves through this transitional time.
2. What are symptoms** of (peri-)menopause?
**Individual results vary
The end result of the sex hormones estrogen and progesterone cycling less and less leads to, of course the cessation of your period, but can also have other symptoms. Some women sail through this transition without much issue, while others experience significant, even debilitating symptoms, such as:
Hot flashes (with or without sweat, day and/or night)
Inability to sleep
Mood changes
Low energy
Poor recovery from stress or exercise
Change in body composition
Change in libido and/or vaginal dryness
3. It’s not just about estrogen, progesterone (or testosterone).
It is very important to note that while all women will have low estrogen and progesterone after menopause, not all women have difficult menopause symptoms. This means that menopause issues are not just due to low estrogen, progesterone or even testosterone.
This means that it is important to treat the whole person, even when hormone therapy is used.
Menopausal symptoms and aging are about so much than these 3 hormones, and is due to so much more than just hormones. This includes other hormones such as adrenal cortisol output and your thyroid; your nervous system (autonomic nervous system and neurotransmitters in your brain), cellular health, inflammation, telomere length, oxidative stress and more…
Hormone replacement therapy is just one feeling well through menopause and beyond and, depending on your unique case, may not even be right for you.
What else can we do to feel our best as we transition through menopause and beyond? Nutrition & Lifestyle matters.
Menopause is a time when, I hate to say it, but all our crows come home to roost. So you used to get away with not enough sleep, too much stress and an irregular diet?….. Consider this as an opportunity to take stock of physical, mental, emotional and even spiritual health and chart a course towards what truly serves you.
Also: Menopause is not a disease. It is an inevitable time for any menstruating woman fortunate enough to live long enough to go through it. Rather than try to be what we were before, optimize your health within this new phase. What things may be lost to youth are replaced by other things like wisdom, experience,
Fact: There are lots of options to ease and optimize the transition into menopause and optimize aging.
Fact: It’s not just about estrogen, progesterone (or testosterone).
Fact: Change is inevitable. Embrace the opportunities.
4. What can we do optimize our health through (peri-)menopause and beyond?
A) It’s not just about the hormones: Lifestyle matters.
If you want to ease your transition through menopause, the first step is (usually) free and available to you any time. Attune your lifestyle closer to what biology intended for us.
That means:
Nutrition.
Sleep.
Stress management.
Exercise.
Not because of weight, or some idealized idea of what it looks like or means to ‘thrive’ as we age. But because this is what our animal bodies need to be and feel their best.
Think of a 50 year old who stays physically and mentally active, engaged with others and prioritizes sleep and stress management. Now think of a 50 year old who is sedentary, eats a modern, processed diet, spends time watching TV or online instead of cultivating personal connections. Research has proven, though the answer seems obvious, the immense benefits of living like the first 50 year old.
Here’s some of the details:
Nutrition
Eat like your ancestors. Eating a whole foods, nutrient-dense, balanced diet can profoundly ease symptoms of menopause, from cognition and weight changes to energy, mood, sleep and even hot flashes. It doesn’t need to be low carb, low fat or low calorie. Focus on if you could grow it, hunt it or trade it with your neighbor a few hundred years ago….it is probably meant for human consumption.
Sleep
There is no tricks to get away with sleep deprivation. The vast majority of humans need 7-8 hours of good quality sleep per night. Whatever you (may have thought you) were getting away with before, you probably won’t now, even while sleep may become more difficult.
Are some of your symptoms fatigue? Poor cognition? Mood? Weight gain? Body aches? Prioritize sleep. You heal and recover when you sleep.
Try sleep tracking. Most smart watches can tell you duration (at least 7-8 hrs), deep (60-90 minutes), REM and waking events.
Just can’t sleep? Work with a qualified Functional medicine provider to optimize all aspects of lifestyle, health and hormones related to sleep and find whatever natural or pharmaceutical solutions will work best for you.
Stress (management)
Modern life offers women much more opportunity but also much more responsibility. Full or part time careers, moms, wives and even caretakers for our parents. The pressures to be able to do and be ‘everything’ can be unrealistic and even damaging.
With aging, we don’t tolerate the same levels of ‘doing’ and busy-ness. Consider your decreasing ability to ‘get away with it’ as an opportunity to pay better attention to yourself. Prioritize what really matters and what is truly possible. Cut out what does not serve you (internal beliefs and thoughts as well as external pressures and issues), delegate what you can, and let go of the rest.
Need more support? Find a counselor or therapist, meditation teacher, life or professional coach and read books on self-improvement. Being a human is complicated and it just makes sense to take some time to study it and find what truly works for you.
Exercise
Fact: Exercise is the #1 most effective anti-aging tool out there.
Whether you have ever exercised regularly in your life before or not, the costs and benefits of exercise become far greater as we age, male and female.
Exercise stimulates our energy-making mitochondria, brains, hormones, endorphins and other ‘happy’ chemicals. It literally slows and can even reverse aging and insulin resistance. No pill, natural or prescription, holds a candle to the many health and anti-aging benefits of exercise.
One of the hallmarks of aging is efficiency: that which we do not use, we lose. Many people complain of the additional weight and decrease in strength and recovery that comes with menopause. It is ok to gain some weight as we get older. But if you want to try to minimize the gradual weight increases that can come with menopause and aging, exercise is crucial
Truth: You will need to find healthful ways to exercise regularly if you want to slow aging and transition through menopause optimally.
B) Natural support.
For many women, lifestyle attunement plus natural support goes a long way to optimize the menopausal transition. Here are some commonly used natural products that can also help ease the symptoms of menopause:
Black cohosh
Soy isoflavones
Rhapontic rhubarb
Acupuncture
Chinese herbal formulas
C) BHRT
Lifestyle changes and natural support not working for you? See this blog for a discussion BioIdentical Hormone Replacement Therapy (BHRT).
Should you try (B)HRT? Each person is not only biologically unique, but also has different risk factors and goals. For some women (B)HRT is wonderful game-changing. For others it doesn’t help enough or much at all or even may have negative side effects. You’ll want to work with an experience Functional medicine provider who will pay attention to all the causes of your particular health issues as well as your goals and risk factors for things like hormone-sensitive cancers.
In short: Individualized and integrative approaches are best.
Base menopause optimization in a holistic and integrative approach to overall health.
Layer in natural support.
Add (B)HRT, if necessary and depending on personal preference and risk factors.
5. A couple truths about menopause.
Menopause marks a very real physical change that, if navigated sagely, can actually bring us more into our true selves. Ease the transition, optimize aging and lean into this new phase of our lives.
First: Weight & body composition.
Metabolism slows and muscle mass decreases and as we age. So one of the most common complaints about menopause is weight increases, especially fat around the abdomen.
Marketing companies have made a gold-mine out of convincing us that HRT or other supplements will magically cure us of our weight gain. While there is a lot to be done to work on your health, permanent, healthy weight loss doesn’t, and never has come in a pill. You still need to work on nutrition & lifestyle (don’t forget stress and sleep!)
Also: body compositions changes may still be happen, even if you are doing everything else “right.”
A (hopefully) funny fact I like to point out to women dealing with weight changes around menopause is: Madonna and J-Lo.
These powerful, wealthy, women whose fame has pivoted on their bodies are heavier now than before menopause.
What’s the point? If anyone could have avoided weight gain after menopause….it would have been Madonna and J-Lo.
The take-home message? Take good care of your health and find a balanced approach to aging optimally and easing the menopausal transition. Exercise and nutrition matter now more than ever and some body composition changes are likely going to happen regardless.
Don’t conflate body composition changes with real health markers, well-being or self-worth.
Second: Libido, desire and pleasure.
You don’t need to suffer or tolerate painful or unpleasurable sex. Natural supplements and BHRT can help if you are experiencing negative sexual side effects such as painful intercourse or the inability to orgasm.
Our sexual nature is also determined by numerous other variables, including our particular partner, our energy and stress levels, mood and ‘bandwidth’ for devoting time to sexuality. If sexuality is an area in your life that could use some support, you’ll benefit from cultivating extra energy, time and space for relaxation and intimacy.
Also, especially as we grow older, women are “manual drive” rather than “automatics.” This means we’ll benefit from lots of personalized foreplay and stimulation prior to, or even instead of, vaginal penetration.
If you are dealing with vaginal dryness, sensitivity or difficulty obtaining orgasm, try working with your partner (or on your own) to have more stimulation to (or almost to) orgasm before vaginal penetration to make sex and pleasurable and enjoyable again.
6. Aging optimally, aging gracefully
Be empowered to feel your best through menopause as at any stage of life.
Also, lean into the inevitable changes and find the opportunities and freedoms that come with the grace of living into old age.
Here’s what we can work on and use an integrative & Functional medical approach to optimize:
Lack of refreshing/inability to sleep.
Too much fatigue or unexplained poor recovery.
Disturbing hot flashes.
Unmanageable mood changes.
Painful sex.
High cholesterol/heart disease risk.
High blood pressure.
Significant weight swings.
Pain & inflammation.
What we can ease in to:
Take it a little slower.
Allow more time for recovery.
Allow more time and creativity with pleasure.
Love our bodies and all they have enabled us to do.
Focusing more on our physical and mental health through nutrition, exercise, sleep and stress management.
All life transitions require us to let go of previous identities that are no longer supported and grow into the next, best version of ourselves. Menopause can feel particularly challenging because, unlike many other transitions when we are younger, it comes with very real physical changes.
We can mourn the loss of our previous identities and abilities, but with aging comes a lot of wisdom, experience and grace, Choose to embrace and celebrate these changes and take it as a call to make your health and wellness a priority.
