Most women who come and see me experience many symptoms at once, like hot flashes, low libido, night sweats, insomnia, vaginal dryness, sudden weight gain, and brain fog. They ask their doctors to run blood tests, and when the results come back, they’re told, “Everything looks fine, and your labs are normal for your age.”
But normal does not mean optimal. Normal in this country means you’re struggling with weight and are either on a blood pressure medicine, Statin drug (or both), and Prisolec, an acid blocker, because you have reflux. At night you use a CPAP machine, and maybe you’re also taking a sleep medication or antidepressant.
Historically, you’ve also been on five to ten diets, and recently, you’ve tried keto and Whole 30, and the needle won’t budge. You notice that what worked in your 20s doesn’t work in your 40s and 50s, and it seems like overnight you’ve put on10 to 20 pounds. What gives?
Welcome to the hormonal roller coaster ride that starts in perimenopause and takes you through menopause.
Perimenopause
Perimenopause begins before a woman officially reaches menopause. This stage can last nearly a decade, and most of us have zero ideas of what lies in store. Our mothers never told us, and our doctors don’t have much to offer in terms of relief aside from prescribing birth control. Truth is, we all have suffered in silence without knowing how to get some blessed relief.
I like to think of menopause like this: You are backing out of your period and your body’s as confused about what to do as when you went into menstruation in the first place. Your periods weren’t always regular then. You had mood swings like no one’s business, and you never knew exactly what to expect. Except now, your body’s telling you, “Time’s up! The baby-making shop is closing (even if you’ve never had children), so the last call, everyone!”
You are now on a rollercoaster ride of fluctuating estrogen and progesterone. Hold tight because your ovaries are in flux with quick drops and steep rises in hormone levels that cause your symptoms. And because women have estrogen receptors all over their bodies, every organ system can be affected by the changes occurring in their ovaries. No wonder we experience so many frustrating symptoms! Your period doesn’t show up on time anymore, you skip it altogether for a month or two, and it can either get shorter or lighter. Or, wait for it, you start to clot heavily with no apparent warning (“Perfect for those times at the beach or wearing white pants to a summer party!”, said no one, ever).
This Girl is on Fire
If you’ve ever had a hot flash, you know it can feel like a sudden overwhelming blast of heat that extends from your forehead to your toes and leaves you soaking with sweat.
You’ll also notice that you can’t sleep well past 4:00 am, feel exhausted, and develop brain fog. Your hormones are now mixing up your body’s temperature regulator (the hypothalamus). You can experience hot flashes all over your body or in just one area, but the extreme temperature change is wickedly uncomfortable no matter where you feel it.
Your face may also flush and turn red and blotchy. Or you wake up in the middle of the night drenched in so much sweat you can wring your clothes out. Left untreated, hot flashes can last for a couple of years or more after menopause; I’ve treated women in their 60s and 70s who still had flashes long after their periods were gone.
Menopause, by definition, means you’ve gone 12 months without a menstrual cycle. Some of us will start and stop our periods for years, wondering if our menstrual circuit system has gone awry. Some of us will go 6 months without a period, only to have Flo show up out of the blue. Regardless, every time you restart your period and have a cycle, you’ll also need to restart the menopause countdown clock.
Some women go through menopause like a high-speed train moving through a narrow passage. For other women, menopause is slower and has more ups and downs.
However quickly or slowly you move through this change, here are some surefire ways to alleviate the worst symptoms that menopause will throw at you:
HEAL YOUR GUT. If your gut is inflamed or leaky and you are not pooping daily, you can keep reabsorbing estrogen in the gut wall. Hormones need to move through you and not stay stuck and stagnant. Get plenty of water and fiber to bind estrogen and ensure your microbiome is healthy and balanced.
CLEAN UP YOUR LIVER. 32% of post-menopausal women develop non-alcoholic fatty liver disease. Make sure your liver is functioning well so your estrogens are being properly detoxified and eliminated from your body. What you put in must come out!
ENJOY ALCOHOL JUDICIOUSLY. Every drink you consume raises your circulating estrogens for 4-6 hours afterward. Plus, alcohol can trigger hot flashes, screw with your sleep, interfere with thyroid function, and make the fat loss all the more challenging. (Sugar and caffeine, too, btw).
MANAGE YOUR STRESS + SLEEP. Ditch the screens and blue light an hour before bed so your brain can start producing melatonin. Sleep in a cool, dark room and wear lightweight cotton pajamas. Use a cooling mat if you’re prone to hot flashes.
DEVELOP A SEXUAL WELLNESS ROUTINE. Vaginal atrophy post-menopause is very real and can lead to dry and painful sex and often trashes your libido as a result. Using a vibrator for clitoral stimulation to orgasm is like abdominal crunches for the vaginal walls! Use it or lose it to keep the muscles strong and healthy.
LIFT WEIGHTS to prevent age-related muscle loss and maintain bone density.
DON’T ONLY RELY ONLY ON HORMONES TO REBALANCE YOU. This is the time to step up your game with lifestyle management, nutrient-dense foods, and taking exquisite care of yourself!”
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Esther Blum, MS, RD, CDN, CNS is an integrative dietitian, certified nutritionist, and menopause expert. She is the bestselling author of Cavewomen Don’t Get Fat, Eat, Drink and Be Gorgeous, Secrets of Gorgeous, and The Eat, Drink, and Be Gorgeous Project. Her upcoming book, See Ya Later, Ovulator!, will be released on October 4th. Widely respected as an industry expert, Esther was voted Best Nutritionist by Manhattan Magazine. She has appeared on Dr. Oz, the Today Show, Good Day NY, Fox News Live, and the goop podcast. She’s been quoted in E! Online, In Touch, TIME, The New York Post, The Los Angeles Times, In Style, Harper’s Bazaar, Self, Fitness, Marie Claire, Cosmopolitan and Well + Good. Follow Esther on Instagram or Facebook.
By Esther Blum, women’s health expert and author of See Ya Later, Ovulator!