Top 8 Components to a Healthier You in Menopause

                                               Menopause Focused on You

When you think of menopause what comes to your mind? It may be images of hot flashes, restless sleep, irritability or debates on hormonal therapies . . . all of which can produce negative feelings and emotions. In some ways, our American culture has created these strong associations through TV and other media portrayals and we have lost the appreciation for what this transition in life can mean for a woman.

Currently about 50% of the women in this country will be either going through menopause or are post menopausal.  With such a large percentage of our population in this stage of life, I think there has never been a better time to reassess what the ideal holistic approach would be for helping a woman age well and live the next phase of her life with passion and energy. In many health clinics, treatment for menopause is synonymous specifically with hormonal therapy which, unfortunately, has led many health care professionals to ignore other aspects of life that are affected by this change. Furthermore, there have been recent studies that have been widely publicized that question the safety of hormone replacement therapy and have left women and health practitioners with more questions than answers. Once thought to be the elixir for women’s health that could prevent heart disease, help mental functioning, improve sexual function, and slow down aging, these studies instead have shown an increased risk for invasive breast cancer, strokes, blood clots, and even dementia.

Although more studies and experience are needed with the different hormonal options such as bio identical hormones both in pill and topical forms, I do not believe any current hormonal therapy can be considered free of these risks. For that reason, the integrative approach of using natural less invasive treatment is ideal for menopause.  Here are what I feel are 8 essential components to consider for improving your health during the menopausal years. 

                        My 8-Step Approach to Improved Health in Menopause

1. Appropriate Medical Evaluation
As people age, concerns can evolve as to whether particular symptoms represent a dangerous physical condition. It is important that these concerns are addressed and appropriately evaluated as irregular menstrual bleeding can be caused by normal changes in hormones, but also by specific gynecological conditions that could need treatment. Other medical conditions like metabolic syndrome, heart disease, thyroid conditions, and kidney conditions also need to be evaluated so that you can have the peace of mind that all aspects of your health are being addressed while you are focusing on your improved lifestyle. Not all symptoms women have during menopause are related to menopause so a trusting and comprehensive relationship with a primary care provider is essential for complete care.
2. Use Nutrition to Combat Changes in Metabolism and Insulin Resistance
As all of us age, our bodies will naturally replace muscle with fat that will slow down our metabolism and lead to further weight gain. Busy schedules evolving around work and family will further contribute to weight gain and then all of sudden it feels impossible to lose weight and even previous diets that were successful now don’t seem to work anymore. This is in part due to emerging insulin resistance that does increase in menopause and is exacerbated by worsening lean body mass, and higher stress levels. As our insulin levels rise, our hormones (specifically, Leptin) that help control how food is stored as fat or used for energy, become affected and healthy weight maintenance becomes a challenge.  Ideally a provider and patient partner together to understand the obstacles faced in changing the diet and create targeted strategies to reverse these metabolic processes. Review of food diaries, cooking classes, sharing recipes, videos, and sometimes natural supplements are some of my favorite tools to empower true nutritional results.

3. Exercise Plan to Boost Metabolism and Energy
In conjunction with nutrition, exercise is key in helping reverse the aging process that occurs as a result of a slowing metabolism and deteriorating lean body mass. Often, more is not better. Instead focus on the different types of exercises and options that are more time efficient and enjoyable yet better targeted for quicker results.  There may be schedule obstacles, health limitations, or specific preferences on what type of activity is preferred. All of these should be taken into account in creating an exercise program that is right for you. Exercise alone has been shown to improve depression, sometimes as much as anti-depressants. It also helps with hot flashes, improves sleep, reduces physical pain, strengthens bones, reduces future falls, improves energy and lessens the effect of stress on the body all of which are great benefits for someone going through menopause.

4. Focus on Emotional Health and Manage Stress Better
Menopause can be the ideal time to take a break and reflect on aspects of life for which you are grateful. It is also the time to decide what you want for the future. For some, the previous years were focused on others (perhaps children, a spouse or work) but now there can and should be a shift to focusing on you. What is your vision for the next part of your life and what do you have to do to make this happen? This reflection is important and can be an ideal time to share your thoughts with your family and friends.
Also, many are so dedicated to others in previous years that they have burdened themselves with the effects of chronic stress which can contribute to weight gain, sleep disturbance, depression, fatigue, “brain fog”, and physical ailments that have also traditionally been associated with menopause. Taking the time to learn and incorporate mind body techniques into your life can have a dramatic impact on your health and well being.  Each person is unique and will be drawn to different techniques, but I recommend breathing exercises, progressive muscle relaxation, visualization, meditation, biofeedback and cognitive behavior therapy as well. Learning these techniques not only helps you feel better but will also give you the tools to stay healthy for years to come.

5. Natural Supplements to Help Ease Specific Symptoms of Menopause
As concerns have grown over hormonal options for menopause, the role of natural supplements has increased. Certain supplements like Black Cohosh combined with St. John’s Wart or adaptogens like Ashwagandha, Rhodiola, or Schizandra can be helpful in mitigating the symptoms of hot flashes and changes in mood without the use of hormones. Additional supplements can also be recommended to help with other symptoms such as joint inflammation, anxiety or sleep difficulties. By having both conventional and natural options available, it allows a broader range of treatment options that reflect individual preferences and responses.

6. Utilize Alternative Therapies like Acupuncture and Yoga to Enhance Current Lifestyle Plan
Outside of this country other cultures have had great success in helping women as they go through menopause and using some of their time tested techniques can be of great value. Acupuncture can help ease hot flashes, improve sleep, decrease headaches and treat musculoskeletal pains that interfere with physical activity.
For some, yoga may seem intimidating and something only for those that are flexible, but when led by an experienced instructor anyone can enjoy basic yoga and reap the many benefits. Studies have shown that yoga improves anxiety, lowers blood pressure, assists weight loss, and helps prevent falls to list just a few of the benefits. Taking a yoga class with others can be fun and relationships can develop that nourish your soul and your body making it a great addition that addresses both your emotional health and physical well being at the same time.

7. Hormonal Therapy Can be Appropriate for a Specific Period of Time to Treat Severe Menopausal Symptoms
As mentioned previously, there are potential health risks to hormonal therapy, however, there are times when menopausal symptoms like hot flashes can be so debilitating and life altering that hormonal therapy is warranted and can be very efficacious. There is a lot of confusion surrounding bio identical hormones (hormones produced to resemble the same type of estrogen or progesterone that our body produces). There are now bio identical forms of estrogen that are pharmaceutically available in a variety of forms such as pills, transdermal devices and even vaginal insertion products. As an added benefit, the latter two seem to be associated with a reduced risk of blood clotting compared to oral forms. Progesterone is also available in a bio identical pill form called Prometrium that in initial studies appears to be safer than its non bio identical predecessor by having less cardiovascular risk and also less risk of blood clots.
Sometimes there is the perception that hormone levels need to be checked (whether from saliva testing or blood work) to determine the appropriate dosing of hormones, but this is not the case. There is not a specific grid that matches doses of hormones to a patient’s level partly because in perimenopause hormone levels can change day to day. Many of the leading integrative medicine’s physicians agree that the best dose is the lowest one that adequately treats the menopausal symptoms like hot flashes. Once someone is on a well tolerated hormonal regimen it is usually not intended to be continued indefinitely, but instead for a few years (usually less than 5) and then tapered off gradually to allow a better tolerated transition to the post menopausal years while limiting the potential medical complications from long term hormonal use.

8. Focus on Both Inner and Outer Beauty
As women go through menopause they may notice skin changes over time such as thinning of their skin and increased wrinkles. There can be up to a 30% decline in collagen in the skin in the first 5 years after menopause and a continued 2% decline per year over the next 20 years.  In addition there are estrogen receptors on the skin that can affect the appearance of the skin as hormone levels change. Even when eating a healthy diet full of antioxidants those nutrients often are not able to adequately protect the skin from free radical skin damage and other age related skin changes. There are now some easy to use topical products that can help improve a women’s skin care and even injections like Botox and collagen fillers that can hide some of these menopausal skin changes. Obviously one’s skin care goals and preferences are very individual, but spending time on one’s appearance can be fun, improve self confidence, and enhance motivation for improving one’s physical health simultaneously.

The Best is Yet to Come . . .
Although sometimes women dread or have uncertainty about the perimenopausal years, the good news is that many studies on women indicate that the post menopausal years from the 50’s to 65 are considered the happiest time of a woman’s life. Many report a feeling of contentment with who they are and enjoy a time of their life when they can focus on themselves as a priority. By taking a natural and holistic approach, many women can gain confidence, feel better about their health, and even have more energy. Your improved health and outlook on life can be inspiring and perhaps change other’s perception of menopause for the better!

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