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guide to menopause: middle aged woman stretching outside

Your Guide To Menopause: Signs, Symptoms, And Solutions

Information about menopause often feels as underground as a college indie rock band. But given that every woman with ovaries eventually experiences this milestone, information should be much more accessible.

We talked with health experts and put together this guide in order to clear the cobwebs on menopause and provide valuable facts and advice. Ahead, learn the science behind menopause, what symptoms it often comes along with, and tips for managing this monumental life change. 

  • ABOUT OUR EXPERTS: Catherine Hansen, M.D., F.A.C.O.G., F.R.C.S.C., N.C.M.P., M.P.H., is a physician and head of Pandia Health’s menopausal hormonal care offerings. Dr. Donna Adams-Pickett, M.D., Ph.D., F.A.C.O.G., is a gynecological surgeon and the founder of a coalition of over 800 Black OB/GYNs to share resources and guidance with women in need of healthcare. Dr. Veena Madhan Kumar, M.D., OB/GYN, is an obstetrician and gynecologist with the online virtual hospital iCliniq.

Menopause, Defined

A natural process at the tail-end of a female’s fertility journey, menopause is marked by an individual having gone a full 12 months without menstruating. “It is the one-year anniversary of the final day of your final menstrual period,” explains physician Catherine Hansen, M.D., F.A.C.O.G., F.R.C.S.C., N.C.M.P., M.P.H., who heads Pandia Health’s menopausal hormonal care offerings. While the term is colloquially used to refer to the symptom-filled period of time leading up to and following this day, medically speaking, menopause is a single-day event.

Prior to this day, any cycle disruptions as well as other systemic symptoms are considered to be a result of perimenopause. Meanwhile, “anything that takes place after this menstruation anniversary is considered postmenopause,” Hansen says. Though a person is considered to be in postmenopause from the date of menopause through the rest of their life, symptoms often associated with menopause typically only last an average of one to two more years. 

Exactly What Happens Before, Upon, and After Menopause

Despite the terminological differentiation between peri-, post-, and prefix-free menopause, there is a lot of overlap regarding what happens internally during these times. 

Quick refresher: Your ovaries are responsible for producing eggs for fertilization, as well as making sex hormones like estrogen, progesterone, and testosterone, explains gynecological surgeon Dr. Donna Adams-Pickett, M.D., Ph.D., F.A.C.O.G., founder of a coalition of over 800 Black OB/GYNs to share resources and guidance to women in need of healthcare. Sometimes referred to as The Big Three, estrogen, progesterone, and testosterone are all essential for overall well-being and work together to support everything from reproductive function and heart health to mental health and emotional well-being, she says. 

Read More: An OB/GYN Debunks 5 Libido Myths

“Surrounding menopause, there is a closure of the ovary factory,” says Adams-Pickett. This means that your body stops maturing and releasing eggs and that your production of sex hormones drastically drops, thus disallowing you from becoming pregnant. Estrogen levels, in particular, take a nosedive, she says. 

The thing is, ovarian function isn’t like a light switch. It isn’t ‘on’ one moment and permanently ‘flipped off’ the next, according to Adams-Pickett. Instead, “ovarian function exists on a kind of ‘dimmer switch,’ as the body gradually starts to slow function,” she says. That’s exactly why the period of perimenopause (and its associated symptoms) can last up to a few years.  

The 3 Most Common Symptoms During The Menopause Transition 

The hormonal changes that happen internally as ovarian function takes a downturn are the root cause for all of the symptoms typically associated with the menopausal period, says obstetrician and gynecologist Dr. Veena Madhan Kumar, M.D., OB/GYN, of online virtual hospital iCliniq. Ahead, a look at the three most common symptoms that occur as the menopause transition takes place.   

1. Lack of body temperature regulation

Around the time of menopause, it is very common for individuals to lose their ability to regulate their body temperature as effectively, says Adams-Pickett. “This results in night sweats while sleeping and feeling overheated at unexpected times (hot flashes),” she explains. Indeed, data suggests that more than 80 percent of women experience hot flashes or night sweats at some point around the time of menopause. 

You can thank changes in estrogen here. You see, estrogen works with the hypothalamus (a part of the brain dubbed the body’s thermostat) to keep your body temperature steady, explains Adams-Pickett. So, when estrogen levels fluctuate sporadically, as they do during perimenopause and at the start of postmenopause, the hypothalamus gets confused and reads the fluctuations as a sign that you’re too hot, says The North American Menopause Society

Estrogen also functions as a vasodilator, which means it promotes the widening of blood vessels to increase the amount of blood that can flow through them. When estrogen levels drop, the body can’t dissipate heat quite as effectively. 

As uncomfortable and frustrating as these symptoms can be, the good news is that, for the vast majority of women, they last on and off for just six months to two years. 

2. Weight gain 

The period leading up to and following menopause is often associated with increased weight gain, with data suggesting that most women put on an average of one pound per year during this transition. This may sound like a lot, but the average gain throughout the menopausal transition is just two to five pounds in total.

A couple of factors seem to contribute to these additional pounds. Reduced estrogen levels are thought to play a small part, as estrogen receptors regulate various aspects of glucose (sugar) and lipid (fat) metabolism. Thus, as estrogen levels lower, the metabolism of these nutrients is thought to slow, leading to weight gain. 

Decreased testosterone production may play a role, too, as testosterone supports muscle growth and retention, explains Adams-Pickett. Muscle is a metabolically active tissue, with one pound of muscle burning about five times as many calories as a pound of fat per day. When testosterone levels dip, women may lose muscle mass (even if their activity levels remain the same), which can result in a slightly slower metabolism, Adams-Pickett says. Over time, this difference may lead to a slight increase in weight if daily calorie intake is not adjusted accordingly. 

However, some of the weight gain associated with menopause actually has nothing to do with menopause transition, specifically, but with regular aging. In fact, one study found that most middle-aged women gained belly fat and lost muscle regardless of whether or not they’d entered their menopausal transition or not. The perimenopausal women did have a slightly higher rate of fat accumulation; however, after hitting actual menopause, their rate of fat gain returned to the baseline the other women experienced.

Changes in lifestyle factors like diet and exercise may be to blame here, according to The North American Menopause Society. Many individuals wrongly assume that entering menopause marks the end of their vital years, and begin to do less to support their health, suggests Hansen. 

3. Mood changes

Increased instances of anxiety, heightened feelings of depression, and decreases in energy are all common around the time of menopause, says Adams-Pickett. About 40 percent of women report mood swings during this time. 

What gives? For starters, dipping estrogen levels can have a direct psychological side effect for some women, according to research published in Drugs and Aging. The researchers suggest this is because estrogen has a neuroprotective effect on levels of serotonin, dopamine, and other mood-boosting chemicals in the body. So, when estrogen levels around menopause, levels of these mood-boosters do, too.

Read More: Ways To Boost—And Balance—The ‘Feel Good’ Hormone Serotonin

The series of unpredictable physical manifestations of menopause can also be tough to navigate mentally—and can compound the experience of mood issues, says Adams-Pickett. Having to plan and accommodate for sudden temperature changes, PMS symptoms, and more can be stressful, especially on top of other life stressors like work and family, she says. This combination can raise levels of the stress hormone cortisol, exacerbating symptoms further.

How To Navigate Common Menopause Symptoms and Find Relief

Some people will be able to mark that date of menopause on the calendar and carry on with their lives without making too many lifestyle adjustments, or leaning on medicinal, hormonal, or supplemental remedies, says Adams-Pickett. 

However, other people—including those with a high BMI and older age of onset of symptoms—often find themselves struggling a bit more upon the anniversary of their now-gone menstrual cycle. Those who had a seven-day (or longer) period when they did menstruate, were pregnant more than three times in their life, and breastfed for more than twelve months at a time have also been found to have worse symptoms upon menopause compared to others. 

If you’ve crossed the threshold of menopause and find that it has been negatively impacting your life, the good news is that there are steps you can take to reclaim a sense of balance, says Adams-Pickett. With the right resources and strategies, you may even go so far as to actually celebrate and enjoy this milestone moment. Here are four tips to start with.

1. Dial in your diet 

While no single menopause-specific diet plan exists, Adams-Pickett says prioritizing nutrient-dense foods like fruits and vegetables, lean protein, whole grains, and healthy fats can help offset symptoms. The antioxidants in these foods are thought to have a positive, anti-inflammatory effect on the system, thus helping reduce symptoms of all kinds. Meanwhile, research has linked increased protein to reduced weight gain during this transition. Data suggests that individuals aim to consume at least 1.1 grams of protein per pound of body weight to maintain an optimal fat-to-lean body mass ratio during this transition. 

“You also want to limit dairy, simple carbs, and foods with added sugars,” Adams-Pickett adds. This will help decrease gut inflammation and support overall mood health. After all, the gut is responsible for 95 percent of the body’s serotonin. Also, “avoiding these ingredients can help prevent the accumulation of visceral abdominal fat, as well as overall weight gain that is common during this time,” she says. 

2. Lift weights 

If you already have an exercise routine, stick with it through menopause and beyond—and if you’ve been sedentary, consider menopause the perfect moment to make a change towards being more active, says Hansen. Strength training, in particular, is a good place to focus your efforts.

“Weighted resistance training can help improve muscle mass, which helps support the maintenance of metabolism and limit weight gain associated with reduced metabolism and aging,” she says. Plus, picking things up and putting them back down may also help postmenopausal women maintain and increase bone density, which is a major concern for many, per research published in the Journal of Mid-Life Health

Read More: 6 Strength Training Tips Specific To Women

To start, Hansen suggests sticking to the Physical Activity Guidelines for Americans’ recommendation of two strength sessions per week, in addition to logging 150 minutes of moderate-intensity exercise like jogging or swimming.  

3. Find ways to relieve stress

In case you need another reason to implement stress-busting activities like meditation, yoga, or grounding: “Increased levels of the stress hormone, cortisol, can increase the frequency and intensity of hot flashes, as well as contribute to weight gain around menopause,” says Adams-Pickett. 

As best you can, “avoid stressful social and work environments to keep cortisol to a minimum,” she says. And when you can’t quite escape those inevitable bumps in the road, make a regular habit of stress-lowering day-to-day activities like deep breathing, meditating, volunteering, stretching, or Tai Chi. 

4. Consider hormone treatment 

“For most women with symptoms, prescription hormone therapy will alleviate symptoms that at-home remedies and lifestyle changes cannot fix,” says Hansen. 

There are a wide variety of menopausal hormone therapy (or, mHT) treatments available—ranging from oral pills and vaginal suppositories to topical sprays and lotions. Most contain a low dose of estrogen that is designed to fill the void left by the ovaries’ downward production, she explains. 

When started at the onset of symptoms, these treatments can both help alleviate not-so-favorable symptoms and help offset the bone, heart, and brain health deterioration that starts to happen rapidly when the hormones decline during the menopausal transition, she says. 

If you think you might be a good candidate for this kind of treatment, she recommends getting in touch with a Menopause Society Certified Practitioner as soon as possible. 

5. Get Support From supplements

If it’s more natural menopause support you’re after, know that there are a number of supplements that can support overall health and well-being during this time. 

On a basic nutrient level, getting ample omega-3 fatty acids, calcium, and zinc may be helpful. 

“Omega-3 fatty acids supplementation may have a positive effect on vasomotor symptoms,” says Hansen. Indeed, a study published in The European Journal of Obstetrics and Gynecology found that menopausal individuals who took omega-3 supplements experienced less frequent night sweats. Experts recommend menopausal women consume at least one gram of omega-3 fatty acids each day, with a special focus on DHA and EPA

Meanwhile, calcium can help support bone health and density as you age. Actually, The North American Menopause Society recommends that individuals in the menopause transition get 1,200 milligrams of calcium per day, which is 200 milligrams more than other premenopausal women. If you cannot reach this intake through diet alone, a calcium supplement may help. 

Finally, zinc is thought to help regulate mood (which can get out of whack during this time), as well as work to support healthy vitamin D levels, improve testosterone levels and sexual function, and buffer levels of circulating folate. Research suggests that short-term supplementation with 50 milligrams of zinc supports women in this life phase, but talk to your healthcare team about how to best incorporate this mineral into your routine.

If adding multiple bottles to your daily supplement line-up doesn’t appeal to you, another option is to consider a supplement made specifically for individuals navigating the menopause transition. Products such as Health & Her Menopause combine several specific vitamins, minerals, and active botanicals to support the unique nutrient needs of this time (think B vitamins for energy support and zinc for healthy testosterone levels, cognitive function, and more). Health & Her’s formula also includes red clover, a natural source of phytoestrogens.

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