HeraSphere #6: Mastering Your Menopause

In this issue: Mastering Your Menopause

• Understanding Your Orchestra of Hormones

• The Three Stages of Menopause

• Why It's So Challening to Find Good Menopause Care

• The Workplace Impact of Menopause

• Hormone Replacement Therapy (HRT) Demystified

• Menopause Weight Gain: It's NOT Your Imagination

• Lifestyle Strategies for Menopause Symptoms & Weig …

1. Understanding Your Orchestra of Hormones

• Estrogen is actually three hormones: estradiol, estrone, and estriol. Estrogen is your body's multitasker, influencing everything from bone density to brain function. It helps maintain your skin's collagen, regulates body temperature, protects your heart health, and keeps your vaginal tissues healthy. It is your body's Swiss Army knife - it does a little bit of everything!

• Progesterone is your calming hormone that balances estrogen's effects. It's crucial for sleep, helps reduce anxiety, and regulates your menstrual cycle. During reproductive years, it prepares your uterus for pregnancy and helps maintain pregnancy if it occurs. It's like your body's natural chill pill

• Testosterone is critical for women too. It helps us maintain muscle mass, bone density, and sex drive. It also supports cognitive function and energy levels. Think of it as your body's power booster - a little goes a long way

• Cortisol is our stress hormone, which impacts everything from metabolism to immune function. While not a sex hormone, it's crucial to mention because it can throw your other hormones out of whack when chronically elevated. It's your body's alarm system - helpful in emergencies but problematic when constantly activated

• DHEA is a precursor hormone your body uses to make other hormones. It helps maintain energy levels, muscle mass, and cognitive function. Think of it as your hormone factory's raw material.

2. The Three Stages of Menopause

• Perimenopause typically starts in your early to mid-40s, though some women notice changes in their late 30s. During this stage, your ovaries gradually produce less estrogen and progesterone, but in an erratic pattern – imagine a car engine starting to sputter but still running. Your periods might become irregular, and you may experience symptoms like hot flashes, mood changes, and sleep disruptions, even while still having cycles. This phase usually lasts 4-10 years, and it's when most women first notice the physical and emotional changes that signal the beginning of their menopause journey.

• Menopause is officially diagnosed when you've gone 12 consecutive months without a period, typically occurring around age 51. This marks the point when your ovaries have significantly reduced their production of estrogen and progesterone, and you're no longer ovulating. Think of it like your reproductive system retiring from its monthly cycle. The symptoms you experienced in perimenopause might continue or even intensify during this time, as your body adjusts to its new hormonal landscape. It's important to note that while menopause itself is a single point in time (that 1-year mark), people often use the term to describe the years surrounding this transition.

• The post-menopausal phase begins after you've officially reached menopause and continues for the rest of your life. During this time, your hormone levels remain consistently low, with your ovaries producing minimal estrogen and progesterone. Your body learns to function with these lower hormone levels, and many women find that some symptoms like hot flashes gradually improve, though others, like vaginal dryness and bone density changes, may continue. This is when proactive health management becomes crucial, as the long-term effects of reduced hormones can impact your bone, heart, and brain health.

• Menopause is it's a whole-body transition that impacts virtually every system in your body. Your body's response to changing hormone levels creates a ripple effect across multiple systems throughout these stages. The dramatic decline in estrogen affects everything from your brain chemistry to your bone density, fundamentally changing how your body functions. Estrogen helps maintain your cardiovascular health (per HeraSphere issue #5), protects your bones, regulates your mood and memory, maintains skin elasticity, and even affects your dental and eye health.

• Women can experience over 70 different symptoms during perimenopause and menopause according to Dr. Mary Claire Haver, - extending far beyond the commonly known hot flashes and night sweats. From head to toe, the body undergoes significant changes: many women report cognitive shifts like brain fog and memory lapses, emotional symptoms including anxiety and mood swings that seem to come out of nowhere, and physical changes ranging from heart palpitations and joint pain to electric shock sensations and burning mouth syndrome. Symptoms can fluctuate dramatically and appear seemingly unrelated - a woman might experience dizziness, then tinnitus, followed by digestive issues, never realizing they're all connected to hormonal changes. The variety and intensity of symptoms can vary greatly from person to person, making it challenging to diagnose. Fun fact: I realized after researching this topic that some of my random unexplained symptoms are likely due to perimenopause!

• Wondering where you might be? Take the menopause quiz by Dr. Haver to determine where you are on the journey.

3. Why It’s So Challenging to Find Good Menopause Care

• The story begins with the 2002 Women's Health Initiative (WHI) study, a watershed moment that fundamentally changed how doctors approach menopause treatment. This $1 billion study, which linked hormone therapy to increased breast cancer risk, sent shockwaves through the medical community. Doctors, fearing liability and unsure of the risks, dramatically reduced or stopped prescribing hormone therapy almost overnight. What many don't realize is that the study's findings were later shown to be flawed - it used older forms of synthetic hormones on women well past menopause, yet its impact continues to influence medical practice today.

• There is also a startling gap in medical education. Most medical schools provide less than two hours of education on menopause - a transition that affects half the population for potentially decades of their lives. Dr. Mary Claire Haver reveals that during her medical training, women with menopausal symptoms were often dismissively labeled as "whiny women" (WW) in medical charts because doctors simply didn't understand what was happening. 

• This education gap leads to frequent misdiagnosis. Women experiencing perimenopause symptoms are often prescribed antidepressants for mood changes, sleep medications for insomnia, or anxiety medications for heart palpitations - treating individual symptoms without addressing the underlying hormonal causes. 

• The lack of standardized menopause treatment guidelines further aggravate the issue. Unlike conditions such as diabetes or hypertension, where doctors follow clear protocols, menopause treatment varies widely between practitioners. Some doctors still cite the outdated WHI study as a reason to avoid hormone therapy altogether, while others may prescribe it but disagree on optimal dosing, timing, or delivery methods.

• Insurance coverage for hormone therapy can be inconsistent and frustrating. Many insurance companies require women to try other medications first (like antidepressants) before covering hormone therapy, or they may only cover certain forms of hormones while excluding others that might be more beneficial. Some plans don't cover compounded hormones at all, leaving women to pay out of pocket for treatments that can cost hundreds of dollars monthly.

• There has been systemic neglect of menopause research, linked to our culture’s deep societal bias that it is something to “go through” rather than a critical health transition deserving of understanding and treatment. In 2023, only $15 million of NIH’s $45B research budget was spent on menopause research in the U.S. (that is 0.033% of the total on a condition that affects 55 million women). That is a pittance compared to other health conditions affecting similar numbers of people. 

• The landscape is slowly improving as more doctors seek specialized training and advocacy groups push for better research funding and insurance coverage. Until then, we need to be informed advocates for our own health, understanding that our symptoms are real and treatable. 

• Want to take action? Find a menopause provider near you through the Menopause Society’s menopause practitioner list. If you prefer telemedicine, are also now virtual menopause care options, including Evernow, Alloy Women’s Health, Midi Health, and Vira Health. I’m not affiliated with any of these providers, but hopefully they can be valuable resources in managing your symptoms.

4. The Workplace Impact of Menopause

• Here is what is often unspoken: Perimenopause often coincides with peak career years (typically ages 45-55) and this creates unique challenges for women in the workplace. Women may struggle with brain fog during important meetings, experience anxiety during presentations, or deal with unpredictable hot flashes during work interactions. Sleep disruption from night sweats can affect daytime performance, while joint pain and fatigue may impact physical stamina. Yet despite affecting roughly 50% of the workforce, menopause remains largely unaddressed in professional settings.

• Brain fog can impact meetings and important presentations - It isn’t due to stress or aging. Dr. Sharon Malone explains that its your brain adapting to changing estrogen levels. Estrogen receptors in your brain affect everything from memory to concentration, making this a serious workplace issue.

• The workplace impact is compounded by the fact that women often feel compelled to hide their symptoms out of fear of being perceived as less competent or reliable. A recent study found that 28% of women have quit their jobs or considered leaving their jobs due to menopause symptoms, while one in three women expressed moderate to severe challenges in managing their work due to symptoms - yet few feel comfortable discussing the real reason with their employers. This silence carries a significant economic cost: lost productivity due to menopause symptoms is estimated at $1.8 billion annually in the U.S. alone.

• Menopause is a workplace equity issue that deserves attention, accommodation, and open discussion. Just as we've normalized workplace support for pregnancy and early parenthood, we need to develop similar understanding and accommodations for this natural life transition that affects half the population.

5. Hormone Replacement Therapy (HRT) Demystified

• The benefits of HRT can be transformative for many women, offering relief from debilitating menopause symptoms while providing long-term health benefits. Beyond alleviating hot flashes and night sweats, HRT helps prevent bone loss and may reduce the risk of heart disease when started early in menopause. It can improve sleep quality, mood, and cognitive function while helping maintain muscle mass and skin elasticity. Women often report feeling "like themselves again," with better energy and mental clarity. Research also suggests that starting HRT during the "window of opportunity" (within 10 years of menopause onset) may help protect brain health and reduce the risk of Alzheimer's disease.

• The risks of HRT have been significantly clarified since the Women's Health Initiative study. When using modern forms of HRT, the risks are generally low for most women, particularly when started before age 60.  For women with a uterus who take combined estrogen and progesterone therapy, there is no increased risk of uterine cancer, and while breast cancer risk may increase very slightly if hormones are taken for more than 4 years, any diagnosed cancers tend to be lower stage with better outcomes compared to women not on hormone therapy. Women without a uterus who take estrogen-only therapy have no increased breast cancer risk for the first 7 years of use, with only a slight potential increase after that timeframe. Importantly, even women with a family history of breast cancer do not face any additional increased risk from hormone therapy beyond their existing genetic predisposition. 

• There are two key types of HRT: For women who no longer have a uterus (due to hysterectomy), estrogen-only therapy is typically recommended. Women with a uterus typically need combination therapy - taking both estrogen and progesterone together. Think of progesterone as your body's protective shield: it prevents the estrogen from causing unwanted cell growth in your uterine lining. Testosterone therapy may also be an option as an add on to or in place of the two traditional approaches, depending on your symptoms.

• Dosing and formats of HRT are very personalized. Hormones are often dispensed in patches that work like small bandaids, steadily delivering hormones through your skin throughout the day. Many women prefer this method because it's simple and you only need to change it twice weekly. Gels and creams offer a similar approach - you just apply them to your skin daily, giving you more control over your dosing. Hormone therapy also comes in pill form, though many doctors now recommend other options first. Newer delivery methods include sprays, which offer easy application and quick absorption. There are also vaginal rings, which are particularly effective for treating local symptoms like vaginal dryness and discomfort. Please note that hormone pellets made by compounding pharmacies are not FDA approved, usually not covered by insurance and quality can vary between pharmacies.

• Want to learn more? Check out the Menopause Society’s guide to HRT

6. Menopause Weight Gain: It’s NOT Your Imagination

• Here's what's actually happening: As estrogen levels drop, your body launches a desperate search for more of this crucial hormone. Since fat cells can produce estrogen, your body cleverly (but frustratingly) starts holding onto fat as a survival mechanism. It's like your body creating its own backup generator when the main power source starts failing.

• Before menopause, many of us gained weight in our hips and thighs (the pear shape), but now it seems to all go straight to our middle. This isn't just a coincidence - declining estrogen actually changes how and where your body stores fat.

• Menopause also changes how your body handles insulin, which is basically your body's key for processing sugars and fats. It's like your body's switching from a high-speed metabolic internet connection to dial-up! This means the carbs and sugars we eat might get stored as fat more easily than before.

• Estrogen is your body's natural appetite manager. When levels start dropping during menopause, uour body might not send those "I'm full" signals as clearly anymore - making it easier to overeat without realizing it. Plus, those frustrating sleep disruptions from night sweats and hot flashes aren't just leaving you tired - they're actually messing with your hunger hormones too. When you're exhausted, you're more likely to reach for those quick-energy carbs and sugary foods.

• Muscle mass is the final piece of the puzzle: women typically lose 3-5% of their muscle mass during each decade of menopause transition. Since muscle burns calories even when you're resting, this loss means you're burning fewer calories per day than you did at 35 - even if you're eating and exercising exactly the same way.  

• The good news? Understanding these changes means we can be strategic about managing them through targeted protein intake, strength training, and smart eating patterns that work with our new hormonal landscape, not against it.

Lifestyle Strategies for Menopause Symptoms & Weight Control

Based on my research and the latest science, here are a few lifestyle strategies to manage your menopause symptoms (in addition to HRT if recommended by your provider):

1. Your nutritional needs change dramatically, so protein intake becomes increasingly crucial. Aim for 1-1.2 grams of protein per pound of ideal body weight. While this might seem daunting, spreading it throughout the day makes it manageable. Start your day with protein to help regulate insulin levels, which becomes more challenging during menopause. Consider exploring intermittent fasting with a menopause-specific approach (check out the Fast Like a Girl book and podcast by Dr. Mindy Pelz), but listen to your body as too much fasting can increase stress hormones. Keep added sugars under 25 grams daily and ensure you're getting at least 25 grams of fiber for gut health and satiety. I like the Zoe app because I can just take a photo of my food, and it automatically calculates the nutritional content!

2. Exercise also becomes both more important and more nuanced. Strength training is non-negotiable - aim for 3-4 sessions weekly. Don't fear heavy weights; they're your allies in maintaining muscle mass and bone density. Complement this with 150 minutes of zone 2 cardiovascular exercise weekly for metabolic and heart health. Start each day with stretching and balance training to maintain flexibility and prevent falls - these become increasingly important as hormones change. I use my Amazfit tracker to target 8000 + steps per day to stay moving, and it tracks sleep also.

3. Managing stress and sleep are crucial as high cortisol levels can lead directly to increased belly fat. Begin your day with morning sunlight to regulate your circadian rhythm and boost serotonin production. Practice grounding by walking barefoot in nature to reduce stress hormones and inflammation. Prioritize 7-8 hours of quality sleep, using a sleep tracker if helpful to optimize your rest. Create a sleep environment that supports temperature regulation, as this becomes particularly challenging during menopause. The sleep tracking feature on my Amazfit helps me stay on top of patterns with a weekly sleep score, which motivates me to get to bed earlier.

4. Support your body's changing needs with targeted supplementation. If your fiber consumption falls short, supplement to reach a 25-gram daily target. Consider daily supplements of Omega 3 fatty acids, Vitamin D3, and Creatine - these support metabolism, bone health, and muscle maintenance. Collagen supplementation can help maintain skin elasticity and bone strength. Always discuss supplementation with your healthcare provider to ensure it's appropriate for your specific situation.

5. The key to success with this toolkit is gradual implementation - Start with the elements that feel most manageable and build from there. Remember that managing menopause symptoms and weight isn't about quick fixes but rather creating sustainable habits that support your body's new needs. Pay attention to how your body responds and adjust accordingly - what works for one woman may need modification for another.

We are all in this journey together - please hit reply and share your best perimenopause or menopause tips!

Embracing the journey,

Lilly

P.S. If you found this helpful, please share it with a friend who might be struggling alone on her menopause symptoms. We are all traveling this road together 💕

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Note: While I love diving deep into research and sharing what I've learned about women's health and wellness, I want to be crystal clear: I'm a passionate health advocate and researcher, not a medical professional. Think of me as your well-informed friend who does extensive homework – but not your doctor.

Everything I share in HeraSphere comes from careful research and personal experience, but it's meant to inform and inspire, not to diagnose or treat any medical conditions. Your body is uniquely yours, and what works for one person might not work for another. Always consult your healthcare provider before making significant changes to your diet, exercise routine, or wellness practices, especially if you have underlying health conditions or take medications.