Climbing the Summit of Menopause
Your hormones may plummet but does your happiness peak? Essential information for your perimenopausal journey. Plus, wise words from Dr Suzanne Gilberg-Lenz
Imagine you're on a long hike, heading towards the summit of a beautiful yet rugged mountain. Although the trail is picturesque, this isn't an easy walk in the park; it's filled with rough terrain and unexpected twists and turns.
While the path presents challenges as you progress, you are strong and prepared with reinforced supplies that help you steadily ascend without any serious issue. You reach the summit, which is a significant achievement, and take a moment to reflect on the breathtaking view from the top. What if I told you that from this point onwards, your experience would be more enjoyable and that this expansive vista would be your new normal?
This is how I’d like to symbolically represent our journey towards menopause, which I’m reframing as not the end but rather, the beginning of a new phase of life.
Some of the brightest minds studying menopause, neuroscientists and doctors are sharing this new, optimistic view of our inevitable transition.
Knowing that we can live up to a third of our lives in this exciting place, the crucial question becomes, “what level of capacity and energy do you want to bring with you?” Much of that will depend on what you do now to prepare.
“Many postmenopausal women all over the world report feeling more self-confident, at greater peace with themselves and more comfortable in their own skin than they were before…The outcome is greater emotional stability – which also seems to correlate with greater life contentment.”
— Neuroscientist Dr Lisa Mosconi from The Guardian
Menopause is a natural process but there isn’t anything natural about how we live today from our nutrition to environment. The encouraging news is that women today are enjoying longer lives compared to a century ago, with the average US life expectancy rising from 53 in 1923 to 80 in 2023. However, this extension in lifespan doesn't automatically guarantee a vibrant healthspan. Achieving enduring strength and resilience later in life demands dedicated effort.
As we charter unfamiliar terrain, it helps to have an experienced, trustworthy and resourceful guide. One of mine is Dr Suzanne Gilberg-Lenz who is a leading OBGYN (USC, Cedars-Sinai, UCLA), author of Menopause Bootcamp, and board certified practitioner in integrative and holistic medicine with a degree in clinical Ayurveda. With so many Eastern and Western tools in the kit, she’s like the, “MacGyver of Menopause,” and if you understand that cultural reference from the late 80’s, you definitely need to keep reading.
THE MENOPAUSAL TIMELINE
For women, our hormonal lives can be roughly split into four major phases:
1/ Premenopause » 12-34
Starting with our first menstrual cycle in puberty
2/ Perimenopause » 35-45
A transitional phase called our “second puberty” where estrogen and other hormones fluctuate wildly then start to decline, characterized by irregular periods and accompanied by symptoms such as hot flashes and brain fog.
3/ Menopause » 46-51
Menopause is the cessation of menstrual periods after 12 consecutive months. The average age is 51 and it is only one day.
4/ Post-Menopause » 52+
The day after you “reach menopause” for the rest of your life. Average life expectancy in the US is 80.
🚨PSA: Don’t freak out that pregnancy and perimenopause overlap. It just signifies a time when hormones are shifting. According to Dr Suzanne, there is a narrative that you can’t get pregnant over 35 which is not true. It does get harder due to declining egg count but, the most unplanned pregnancies happen between the ages 40-44. Plus, everyone’s fertility situation is different.
THE SYMPTOMS
For many women, it’s the annoying or even debilitating symptoms that send them into their doctor’s office. There are an estimated 34 different symptoms, that you may or may not experience during (peri)menopause. Here are some of them:
Hot flashes / night sweats
Insomnia / fatigue
Brain fog / forgetfulness
Anxiety / depression
Mood swings / increased irritability
Irregular periods / spotting
Skin: dryness, acne, rashes, loss of collagen/elastin, hyperpigmentation
Hair: thinning, changes in texture, facial hair
Vagina/vulva: dryness, itchiness, lack of lubrication, painful intercourse
Low libido or desire
Weight gain / body composition changes (like belly fat)
Loss of muscle / loss of strength
Joint pain / Muscle pain / Frozen shoulder / Restless legs
Tinnitus
🚨PSA: These symptoms aren’t just a nuisance. Some represent a slow degradation of key organ systems that are impacted by fluctuating or declining hormones.
example: Hot flashes occur when low estrogen levels disrupt the normal functioning of your hypothalamus, the region of the brain responsible for regulating body temperature, causing it to become confused.
EXPLAINING HORMONES
Dr Suzanne explains that our hormones are chemical messengers — and a way for our body to speak to itself. The uterus, ovaries, pancreas, gut, skin, bones and heart all communicate with each other through hormonal signaling. Hormones manage our waking and sleeping, metabolism, immune response, reproduction and more. As it pertains to menopause, here are The Big 4 to know.
Estrogen
While the ovaries (and specifically our eggs) produce most of our supply of estrogen, there are receptors in our breasts, brain, bone and vagina.
Estrogen protects our heart, brain and bones. Once it declines, we are at significant risk for cardiovascular disease, dementia and osteoporosis.
Progesterone
Considered a magical steroid hormone that supports in menstruation and pregnancy, progesterone balances out our estrogen
Declining progesterone can result mood changes, trouble sleeping, bloating and irregular periods
Testosterone
We think of it as a “male hormone” but we have more of it than estrogen when we are younger
Testosterone works with other hormones to help build muscle mass, strong bones and healthy metabolism, all of which are impacted when it declines in menopause
DHEA
Produced in the adrenals, this is a precursor hormone that can convert to estradiol or testosterone as needed
DHEA can be used to raise hormone levels in postmenopausal women looking for support with decreased sex drive and vaginal dryness
🚨PSA: Unlike blood sugar or cholesterol, there is no standard “normal” level for each hormone. So constantly checking your wildly fluctuating hormones during perimenopause can be an act of futility as well as an unnecessary expense. Once your rule out any thyroid issues or other conditions that can mimic perimenopause, your doctor should be able to prescribe treatment for you based on your symptoms and how you feel.
TREATMENT OPTIONS
I often remind my health coaching clients, “if you want to perform at the level of an elite athlete in your life, you’ll need to dial in the fundamentals, including your nutrition, sleep, fitness, stress management and relationships.” Nowhere is this more true than in perimenopause, where just managing basic, everyday needs can become overwhelming. It can feel like running a marathon and one you didn’t sign up for.
Lifestyle Interventions
These suggestions are not meant to add even more to your plate, but I promise you the small daily investments will be worth it.
Think of the below as the daily conditioning and preparation you’ll need to climb the summit.
Diet
The allocation of your macros (carbs, fat, protein) matters a lot during menopause and, in lesser degrees, your caloric intake. Increase lean protein and fiber paired with healthy fats (avocados, olive oil, nuts).
It’s more protein that you think so a minimum of 0.8 to 1g for each pound of body weight. Eat a diversity of colorful plants with each meal.
Sorry to be a buzz kill but alcohol is not your friend. It can trigger hot flashes, disrupt an already disrupted sleep and contribute to more anxiety and mood swings. Plus, its a known carcinogen so manage your risk.
Sleep
This is a non-negotiable for reducing inflammation and risk of cognitive impairment in old age, but arguably more difficult to achieve during this phase because of hot flashes and night sweats. Aim for 8-9 hours every night to really get the rest you need.
Magnesium is reported to help. Melatonin (1-3mg) on occasion and not for more than 2 weeks consistently is an option.
Fitness
Lift heavy weights 2-3x a week. It’s the only way to protect against the accelerated muscle and bone loss that come with lower estrogen and testosterone. Pilates is somewhat weight bearing but not as impactful as dedicated strength training.
Consistent Zone 2 workouts (light hiking or stationary bike) should round out the routine with HIIT or cardio as weekly option.
Stress management
We are less resilient to stress right now so putting aside time to down regulate is important. Meditation, yoga, and other modalities that trigger your parasympathetic nervous system will keep cortisol and mood in check.
Relationships
The quality of our relationships matter because we will need extra patience, compassion and support. Learn that “NO” is a complete sentence.
Understanding that sex can be impacted by mood and physiological issues, expand the definition of pleasure to include other forms of physical touch and intimate connection, which can boost natural feel-good hormones.
🚨PSA: Investing in your daily routine will contribute the critical resources you’ll need take with you through menopause and to last you for the rest of your life. Your healthy habits will make you feel good today and safeguard you from the early onset of chronic disease which could lower your quality of life in the future. Some benefits:
Lean skeletal muscle
Strong bones
Increased Mobility/Flexibility
Resilient Immune System
Balanced Blood Sugar
Sharp memory and cognition
Supplements
Getting your nutrients and minerals from whole foods is where you should start but these supplements can support most (peri)menopausal women. More on page 62-66 of Menopause Bootcamp
Fiber (to support gut microbiome and glucose metabolism)
Vitamin B6, B9, B12 (for for brain, heart and nervous system)
Vitamin D3/K2 (for healthy bones and immunity)
Omega 3’s (anti-inflammatory for brain and heart health)
Hormone Replacement Therapy
While there is no magic pill to miraculously speed us through menopause, HRT can positively impact our health if initiated at the right time. It has been shown to significantly reduce all cause mortality and cardiovascular disease1.
While we cannot ignore the small risk of breast cancer, it pales in comparison to the rapidly escalating risks of cardiovascular disease, dementia, and osteoporosis during menopause. Every woman deserves the opportunity to explore this option and engage in an honest, informed dialogue with their doctor.
Vaginal Estrogen
This is the first line treatment for all genital urinary symptoms (vaginal dryness, pain, urinary incontinence, recurring UTIs). It’s a topical treatment which provides relief locally without being absorbed into the bloodstream so it’s safe for those who cannot take oral HRT.
Transdermal Estrogen / Oral Micronized Progesterone
This combination seems to be the preferred delivery system for HRT for its efficacy and reduced risk profile. Transdermal estrogen bypasses the liver, lowers risk of blood clots and has 5 different strengths. Oral Micronized Progesterone more reliably delivers the dose and ensures your uterus is protected.
Testosterone
There is still no FDA approved testosterone treatment for women but many doctors prescribe off label for patients experiencing sexual dysfunction or low muscle mass.
🚨PSA: It's essential to understand that the longer you go without estrogen, the risk escalates while the benefits diminish. The optimal window for hormone replacement therapy (HRT) to mitigate risks of heart disease and osteoporosis is about 10 years. For neuroprotective advantages, initiating HRT within 5 years of menopause is recommended.
How to find a menopause trained doctor? Check the North American Menopause Society (NAMS) and come prepared with your questions, concerns and notes on your symptoms. The best doctor for you is the one that listens to you.
For telemedicine support and prescriptions for hormones and peptides targeted at perimenopause, Joi Women’s Wellness is a trusted resource. Use CELIA15 towards your first purchase of advanced labs, supplements or treatments.
The take-away: If the goal is to reach the pinnacle of your life with optimal health, then the approach you take to climb the mountain — and, the resources you bring for your lifetime stay — matter tremendously. Investing in your well-being and resilience ensures you’ll be able to enjoy the view from the top.
🔒 EXCLUSIVE CONTENT
I’m sharing some incredible highlights from our subscriber event on March 21st, “Navigating Menopause with Mastery and Self-Love.” It was a mini masterclass and conversation between OBGYN Dr Suzanne Gilberg-Lenz and myself (supported by KNESKO Skin).
Why our risk for osteoporosis outweighs that of breast cancer
Can we stay on birth control pills through menopause?
The truth about bioidentical hormones
Tips to deal with body composition changes (weight redistribution and loss of muscle and bone)
When do genital urinary symptoms begin and the proven treatments for pain relief and increased pleasure from topicals to technology
The best lube to use during perimenopause and beyond
How changes in the brain alter our attitude towards life
Subscribe to read the take-aways and transcript highlights as well as for future invitations to exclusive events with leading health experts.
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