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The Ultimate Guide to Menopause

The Basics:

1. Each Woman's Menopause Journey is Different

Doctors suggest consulting family history for insights, though it's not always precise. Some women face few symptoms, others endure them for over a decade. It's crucial to find suitable solutions for you.

2. People don’t like to talk about it.

Past generations avoided discussing it, leading to ill-informed modern women. Menopause isn't just hot flashes and periods cessation; it includes subtle, often unknown symptoms. Raising awareness is vital for future generations.

3. Even among medical professionals, understanding of women's health and menopause is often lacking.

Few doctors receive formal training on it, often resulting in misdiagnosis or inadequate treatments. It's essential to self-educate, persistently communicate symptoms, and foster support networks.

Menopause stages:

Perimenopause: Usually occurs from ages 40-50 and leads to menopause. Symptoms vary and pregnancy is still possible. Ends one year after the last period.

Menopause: Typically happens between ages 45-60 after a year without periods. Symptoms persist even after periods stop. Post-menopausal bleeding must be examined by a doctor.

Induced/Surgical Menopause: Any age, caused by ovary removal or damage. It's immediate and can have health impacts.

Post-Menopause: Ages 45-60, a year after the last period. Symptoms can continue, and risk for certain diseases increases.

Women spend around 35 years post-menopausal, with more than 1 billion women expected to be post-menopausal by 2025. Post-menopausal bleeding should be medically evaluated.

Symptoms:

Symptoms of peri/menopause, tied to fluctuating hormones, can appear and disappear anytime from perimenopause to post-menopause. Duration varies greatly; some may experience them briefly, while others may face them for decades.

Diagnosis is based on symptoms, as they can mimic other conditions. Tracking symptoms with apps helps identify trends and rule out other issues.

Symptoms include:

Worsening acid reflux/GERD

Acne

New allergies

Anxiety

Atrophic vaginitis/GSM

Balance issues

Bloating

Body odor changes

Breast soreness

Brittle hair and nails

Decreased saliva, libido

Depression

Concentration difficulties

Dizziness

Digestive issues

Dryness (skin, mouth, eyes)

PMS symptoms

Fatigue

Gum problems

Hair loss

Headaches

Irregular heartbeat

Hot flashes

Unusual body hair growth

Food intolerance

Irregular periods

Itchiness

Joint pain

Memory lapses

Migraines

Mood swings

Muscle tension, loss

Nausea

Night sweats

Osteoporosis

Smell changes

Sleep disruption

Stress incontinence

Swollen hands/feet

Thyroid changes

Tingling extremities

Irritability

UTIs

Weight gain

All symptoms link to hormonal changes, especially in estrogen. However, it's essential to consult a doctor to rule out other conditions. If you experience new or unusual symptoms, seek medical help. Various treatments can alleviate symptoms and offer long-term benefits.

Vaginal Dryness and Shrinking:

Atrophic vaginitis or GSM, a common menopause symptom, involves vaginal dryness and shrinkage. Despite being alarming, atrophy is treatable and reversible.

Symptoms include:

Bleeding

Burning during urination

Decreased lubrication during sex

Dryness

Frequent urination

Incontinence

Increased UTIs

Itchiness

Painful intercourse

Vaginal wall shortening/tightening

Tearing

Treatments:

Hormonal:

Estradiol vaginal tablets, cream, or ring: Inserted directly into the vagina and can reverse and prevent atrophy.

DHEA: Rapidly reverses vaginal atrophy by converting to estradiol and testosterone in vaginal tissues.

Non-Hormonal:

Hyaluronic Acid: Reduces symptoms of dryness and reverses atrophy.

Penetration: Keeps blood flowing to the area.

Over-the-counter moisturizers/lubricants: Useful during intercourse but don't treat atrophy. Note: coconut oil, a popular choice, may upset the vagina's natural pH balance and cause UTIs.

Gearing Up for Your Doctor’s Visit:

Prepare for your doctor to lack comprehensive knowledge about menopause and its treatments. Some physicians may dismiss symptoms as stress or aging and hesitate to prescribe hormone therapies due to outdated cancer risk information. However, OB/GYNs may be better informed about current menopause research.

The FSH test, a common diagnostic tool, is not always reliable due to hormonal fluctuation during menopause. Its outcomes can lead to misinterpretations:

'Normal' results may cause dismissal of your symptoms.

'Post-menopausal' results can cause distress over sudden perceived aging.

These tests can mislead and serve as a basis for profit-driven menopause clinics offering hormone 'balancing' products.

FSH testing is still useful for post-menopausal individuals without periods, or younger women without periods indicating premature ovarian failure.

Provide concise personal and family medical history, and lifestyle habits. Include details of all symptoms and their impacts on your life. Don't let your doctor overlook your symptoms due to 'normal' aging or FSH results alone.

Some symptoms warrant further tests to rule out other issues, such as physical exams, blood work, mammograms, etc. Request additional testing if not offered.

Potential tests include:

Heart stress test, EKG, Heart Holter monitor

Dexa Scan (bone density) FRAX

Regular Mammogram

X-rays (for joint pain)

Blood work:

Lipids (cholesterol)

Thyroid

Iron (ferritin)

B12

Vitamin D

Magnesium

Potassium

Blood sugars

Rheumatoid Arthritis

Ask for treatment recommendations and express your interest in Menopausal Hormone Therapy (MHT) if you feel it's right for you.

Be cautious of quick prescriptions for medications treating only symptoms, not underlying hormonal issues. Such drugs may have side-effects or addiction risks.

If you're dissatisfied with your doctor, consider finding another who understands menopause better. The North American Menopause Society lists nearby practitioners.

Seeing gynecologists doesn't exclude considering other health factors. A full body check-up, especially for heart and bone health, is crucial.

Boost Your Health:

Quit smoking

Improve diet

Lose weight - track calories, explore subs like: r/keto, r/intermittentfasting, r/loseit /r/GetMotivated

Exercise - build muscle, increase balance

Take vitamins

Prioritize mental health - meditate, breathe deeply, be mindful

Sleep regularly - manage hot flashes or other sleep-interrupting symptoms

Allow emotional release, then resume

Monitor symptoms

Find a proficient, understanding menopause doctor

Do annual blood work (especially thyroid)

Educate yourself - read studies, accumulate knowledge

How to Minimizing Symptoms:

Healthy habits such as losing weight, quitting smoking, eating well, reducing stress, and sleeping enough can help manage menopause symptoms.

Limit sugars, caffeine, processed food, introduce plant-based foods, fiber, drink water.

Exercise needn't be intense, balance and low weight bearing exercises may suffice.

Explore acupuncture/acupressure, massage, physiotherapy, pelvic floor therapy.

Prioritize good sleep, consider changing bedding, fans, windows, or taking sleep aids, CBD.

Include small estrogen boosts from foods like isoflavones (tofu, tempeh, miso, chickpeas/hummus); lignans (flaxseeds, pumpkin seeds, green/black tea, broccoli); coumestans (sunflower seeds, bean sprouts).

Weight Gain during Menopause

While diminishing hormones do not necessarily lead to weight gain, they do alter weight distribution, resulting in increased abdominal fat. When the waist circumference exceeds 88cm (35"), this is classified as abdominal obesity, and it considerably elevates the risks for heart disease, diabetes, stroke, high cholesterol, and high blood pressure.

As metabolism naturally slows with age, weight loss becomes more challenging and requires a long-term commitment to healthier eating habits and calorie control.

Many women have found success with intermittent fasting, where food intake is limited to a certain timeframe (e.g., 11:00 am to 7:00 pm), with only water consumed outside this window. Others have found benefits with a keto diet or similar variations.

The key to successful weight loss during menopause is maintaining consistent daily calorie intake, drinking plenty of water, and establishing a sustainable routine.

Fortunately, weight loss is not reliant on exercise; although exercise plays a vital role in overall health and bone strength, it doesn't significantly contribute to weight loss.

Understanding your Total Daily Energy Expenditure (TDEE) and finding a weight loss regime (lifestyle modification) that suits you is crucial.

Our bodies contain three types of estrogen: (1) Estrone, (2) Estradiol, and (3) Estriol. During perimenopause/menopause, estradiol levels decrease.

Estrone is generated by our fat cells. In our reproductive years, we usually produce less estrone. However, as our bodies start to accumulate fat during menopause and our metabolism slows down, our fat cells produce more estrone. This leads to further fat storage, creating a vicious cycle.

Estradiol, produced in our ovaries, is the estrogen replaced with HRT. This hormone plays a significant role in maintaining bone, brain, and heart health and does not lead to weight gain.

Estriol is exclusively produced to support pregnancy.

Progesterone can lead to weight gain (it's the hormone behind PMS symptoms, bloating, etc).

Testosterone can also contribute to weight gain.

Menopause Hormone Therapy (MHT)

MHT, comprising estrogen and progesterone, is prescribed by doctors. Including progesterone is mandatory for those with a uterus. Various dosages and forms (tablets, patches, gels, creams, etc.) are available.

The 2002 WHI study linked MHT with breast cancer risk, leading to its reputation and usage decline. However, heart disease deaths increased among women discontinuing estrogen, highlighting its role in heart health. Today, despite misperceptions, MHT is now recognized as a safe and effective treatment for menopause symptoms.

MHT not only addresses menopause symptoms but also contributes to long-term health. It's crucial for bone, heart, and brain health, reducing disease risks and promoting overall wellbeing. Unfortunately, misinformation and systemic fear hinder its promotion.

MHT is often prescribed at minimal doses for short periods, but research supports long-term use for optimal benefits. It's crucial to prioritize personal health needs and find doctors who understand MHT's benefits.

MHT benefits:

Bone health: Estrogen can reduce osteo-hip fractures up to 50%.

Brain health: Estrogen can lower Alzheimer's risk between 20-50%.

Heart health: Estrogen can decrease heart disease risk up to 50%.

Colon health: Estrogen can reduce colon cancer risk by 20-25%.

Diabetes: Estrogen seems to decrease the risk.

Skin, hair, joints health: Improves skin/hair and reduces joint pain.

MHT and Breast Cancer?

Estrogen may promote, not initiate, cancer. The WHI study showed a slight risk increase in older women, similar to obesity and low physical activity levels. Synthetic progesterone slightly increased breast cancer risk. However, heart disease, not breast cancer, should be the primary concern, killing 1 in 2 women compared to 1 in 29 from breast cancer. Therefore, MHT's benefits must be weighed against its risks, and heart health must be prioritized. Those considering MHT, especially cancer survivors, must consult with healthcare professionals.

MHT Risks:

Like all medicines, MHT has side effects and risks:

Thyroid disease patients should consult a doctor when taking MHT.

Minor risk of pulmonary embolism (blood clots) with MHT tablets; risk is absent with transdermal (skin) methods like patches/gels.

Additional risks: dry eyes, headaches, gallbladder disease, and PMS-like symptoms.

Optimal time to start MHT is under 60 years old and within 5-10 years of menopause. Starting later may increase stroke and heart attack risk in the first year but doesn't exclude MHT use.

Understanding bio-identical, synthetic, pharmaceutical, and compounded MHT:

Bio-identical hormones: Similar to body's natural hormones, produced by the pharmaceutical industry and compounding pharmacies.

Synthetic hormones: Mimic body's hormones, more risks but potentially more effective.

Pharmaceutical hormones: Mass-produced, well-researched, FDA approved.

Compounded hormones: Mixed by pharmacists, not standardized or FDA regulated.

No Hormone Intervention ('Natural')

'Going natural' suggests a healthier menopause response, embracing symptoms without medical aid. A century ago, life expectancy was around 60, eliminating the need for symptom management or hormone intake. Today, many live well into their 80s, making natural hormone restoration relevant.

'Natural' often means using herbs, supplements, OTC treatments, traditional medicine, diet, exercise, and comfort items. Some combine these with prescribed medications like anti-depressants, sleep-aids.

Though some women find a balance to manage symptoms, evidence supporting these methods is lacking. Holistic treatments can enhance overall health, but don't address the hormone deficiency. Effectiveness varies among individuals.

Estrogens in soy products can alleviate some symptoms but not entirely, nor do they offer preventative benefits linked to larger dose estrogen.

It's crucial to understand the side effects and risks of any OTC herbal/supplement/vitamin. Consult health professionals and dietitians to navigate these interventions.

Common herbals/supplements/OTC medications:

Black Cohosh, Rhubarb Extract, Evening Primrose, CBD/Cannabis, Probiotics, Maca Root, Ashwagandha, Soy products, Flaxseed, Wild Yam, Red Clover, Bioflavonoids, Essential oils, Collagen, Rogaine, Biotin.

By 2025, over 1 billion women globally will be post-menopausal. Marketing agencies are targeting this demographic with OTC treatments (Estroven, Remifemin, Amberen, Menosmart) and websites. These products are expensive and their efficacy isn't established. It's often cheaper and better to buy individual vitamins/supplements.

Online menopause services are emerging, offering customized hormone testing and treatments at a cost. They claim to be run by medical professionals, but it's vital to research these services thoroughly. They prescribe menopausal hormone therapy/HRT, typically compounded in-house, but these are not FDA-approved or proven effective. Compounded hormones are not recommended for long-term preventative benefits.

Vitamins

Disclaimer: The following are suggestions, not cures or proven solutions. Conduct your own research and consult your doctor/pharmacist to decide what's best for you.

Ideally, vitamins should be obtained through food for effective absorption, though this can be challenging.

Omega 3's (joint pain, skin)

B Vitamins (B6, B9) (heart health)

B12 (age-related deficiency)

Vitamin D3 (aids calcium absorption)

Elemental Calcium

Magnesium Citrate (keeps things moving)

Magnesium Glycinate (reduces anxiety, aids sleep)

Potassium (blood pressure health)

Vitamin K (bone health, clotting)

Vitamin E (skin)

Vitamin C (enhances Calcium/Magnesium absorption)

Melatonin (regulates sleep)

Iron (for heavier bleeding, hair loss/fatigue)

Coenzyme Q10 (antioxidant, heart health, dry skin)

CBD (Cannabidiol) and/or THC (Tetrahydocannabinol)

Find a reputable source for your CBD needs. Start with a low-dose CBD gummy or tincture. Adjust CBD to THC ratio according to your needs. Start with a higher CBD and lower THC ratio. CBD oils/creams/lotions can also aid arthritic/joint pain.

SERMS (Selective Estrogen Receptor Modulator)

SERMS mimic some estrogen benefits and are an option for those against taking estrogen. They relieve symptoms and prevent osteoporosis. Discuss these with your doctor if you can't take MHT.

Tamoxifen - chemo agent, prevents osteoporosis and heart attacks

Tibolone - synthetic, reduces menopause symptoms, prevents osteoporosis

Raloxifene - mainly for osteoporosis prevention

The Bottom Line:

We're all in this together, all one billion of us. You're not alone, even if symptoms differ. We, the sandwich generation, juggle caring for young adults, aging parents, and managing other responsibilities. Menopause brings an unexpected emotional toll, so reach out, ask questions, and seek help.

Symptoms won't last forever. We can be happy and healthy in this next life stage.

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