Things We Don’t Talk About (But Need To): Menopause

Nearly half of the world’s population will go through menopause at some point in their lives, and yet it remains under-discussed outside of a medical provider's office.

By their late 30s to mid-40s, most women will enter into perimenopause and start experiencing fatigue, insomnia, weight gain, irregular periods, joint pain, headaches, hot flashes, and other physical symptoms, said HHC Nurse Practitioner Andrea Brubaker. When a period has not taken place in 12 months, that’s when a woman goes from being in the perimenopause phase and into menopause.

Beyond the physical symptoms, changes in estrogen and progesterone levels also impact brain functions that influence executive functioning, sleep, stress responses, and emotional regulation. HHC Psychologist Kim Carter said common statements she hears from women going through menopause are, “I don't understand why I can't do the things I used to be able to do” and “I just don't feel like myself.”

“It's just this huge constellation of different things that makes us feel like we don't know ourselves anymore,” Kim said. “It's hard to be comfortable in your own skin.”

While still not talked about widely, Andrea said more patients are coming with some awareness of menopausal symptoms. Between patients asking if symptoms are related to menopause and some medical investigation with Andrea, she’ll work with the patient to try to verify if symptoms are related to menopause. However, it’s difficult to do so, as there’s not a single blood test that could determine if someone is perimenopausal. Checking estradiol, testosterone, and progesterone levels is not always that helpful during perimenopause because levels fluctuate each day, Andrea said. 

Andrea said she’ll help the patient with symptom management by targeting what is most concerning or bothersome to them. Some patients may want relief from hot flashes while others want relief from anxiety or heavy or irregular bleeding. Depending on the symptom, hormone replacement therapy or non-hormonal treatments could be a possibility. Though, Andrea said it’s not advised for folks to seek hormone treatment if they have a history of heart attacks, blood clots, breast or endometrial cancer, diabetes, hypertension or smoking. Women considering hormone replacement therapy or non-hormonal treatments should consult their clinician for the best course of action for them.

HHC Director of Strategic Initiatives Maura Ward (MS, RDN, LDN) said that because estrogen and progesterone can also impact fluid and electrolyte balance, staying hydrated is extremely important and can also reduce the instances and intensity of hot flashes. Hormonal changes can make folks feel less thirsty, so it’s important to focus on fluid intake. She recommended setting alarms throughout the day to remind folks to drink water or eat fruit with each meal.

The body’s metabolism slows during menopause, but appetites tend to increase, leading to the risk of obesity, Maura said. Estrogen has a protective element for cells in the body, so a drop in estrogen can lead to increased inflammation as the cells may lose some of that protection.  Maura said that more antioxidants like berries, nuts/seeds, dark leafy greens, and green tea would be recommended to help with inflammation. She added that the most important thing to focus on is fueling the body with nutrient-rich foods to support an individual’s body.

As menopause increases the risk of heart disease, type 2 diabetes because of new-onset insulin resistance, and osteoporosis, there are key nutrition changes that can be made to reduce risks. Eating smaller meals throughout the day, or cutting out snacks that don't provide many nutrients, reducing sugar-sweetened beverages, and avoiding alcohol can help when metabolism has slowed. Increasing fiber, reducing sodium, and increasing potassium help support heart and blood pressure. For bone health, focus on eating calcium, magnesium, vitamin D, vitamin C, and vitamin B in addition to adequate protein. To accomplish these goals, focus on eating plenty of fruits and vegetables, reducing animal fats or tropical vegetable oils (palm oil), and focusing on whole grains. Eating four to five servings of legumes, nuts, or seeds per week can reduce the risk of heart disease, but it's important to keep in mind the portion sizes to avoid overeating calories. While there is an increased risk of diabetes, Maura still says that you should be eating a minimum of 120 grams of carbs per day.

Outside of Hormone Replacement Therapy, lifestyle changes and mental health therapy will be most impactful for symptom management for women in menopause, Kim said. Generally, Kim advised keeping a pretty strict routine with a sleep and wake cycle for the restoration needed from rest, getting exercise, and limiting caffeine and alcohol intake.

However, she also understands that telling someone to exercise or find ways to destress when they’re already experiencing executive dysfunction feels counterintuitive. Kim said menopause symptoms can often feel like a “vicious cycle.” There’s a hormone change that could cause more executive functioning issues than an individual already had; then there’s more overwhelm and unfinished tasks, which then increases the stress and anxiety levels, causing an increase in self-criticism and guilt, so then sleep can be more impacted. Then, the next day when you wake up, executive function is even more depleted because of lack of sleep.

To help in times of overwhelm, Kim advised folks to create a fairly detailed “menu” of ways to carry out self-care that work for that individual, even breaking them down into self-care items that can be carried out if someone only has 10 minutes, 15 minutes, or if there’s a decent amount of time. She likened it to an appetizer if there’s only a short amount of time or an entree if the person thinks they can set aside more time.

“So when your executive functioning is hijacked, you're tired, and you have a short window of time, we want to take the problem of further executive functioning out of the picture,” Kim said. “All you literally have to do is open up a notes page on your phone or a paper menu in a journal that you've created where all of the thinking has been completed for you. 
You have already sat down with yourself, maybe with your therapist, and thought about what kinds of things can I do?”

Checking in with how your body is feeling or where your thoughts have been throughout the day can help determine what you may need, Kim said. If your body is feeling pain or exhaustion, a guided meditation could be helpful, Kim said. If thoughts have been pretty active, maybe some body movement would release some of the tension. Not only would movement be beneficial for mental health, but Maura said exercise can help reduce the number and intensity of hot flashes, lifting weights can help preserve muscle mass and bone density, and cardio helps with heart health and insulin resistance. Even just a walk after eating meals can help with insulin uptake, Maura said.

Kim gave the example of if someone is feeling overwhelmed by their home, maybe they want to write down options that can help make their space feel less overstimulating and anxiety-provoking. Keeping in mind if someone only has so much time or energy, maybe an appetizer is picking up three items that are out of place and putting them away, or an entree is focusing on only one room that could use some organizing. She also said self-care can be super simple; maybe someone just wants to enjoy aromatherapy and deep breathing for two minutes to feel calm.

“If your self-care is feeling like work, it's not working,” Kim said. “That's when you want to stop and shift over to something else, which is why I like having a menu. You're giving yourself permission to choose the one that is going to be most comforting.”

Keeping track of what you eat, exercising, taking care of your mental health, and what medications and supplements are helpful to take can feel like a lot of things for a person to handle. The team at HHC can help make this burden feel lighter by guiding folks through our services. You don’t have to navigate this alone.

Our Food Access services can provide Better Health Boxes to ensure healthier food options; our Pharmacy staff can discuss medication regimens; our clinicians in the Clinic can help women make choices for themselves, their bodies, and their mental health; and our nutrition team can meet with folks 1-on-1 to discuss nourishment strategies. Note that the information provided is general advice and not a substitute for personalized care. Consult your medical provider and nutrition team to determine what’s right for you. Start by giving us a call at 828-262-1628.