Women’s Empowerment During Midlife Means Taking an Evidence-Based Approach to Perimenopause
I think we can all agree it is NOT okay to profit from a woman’s discomfort or pain, but that’s exactly what I see happening to women in midlife, especially around the topic of hormones and perimenopause. And I’m frustrated.
As a board-certified family practice doctor with a fellowship in women’s health and 18+ years of clinical experience, I love that perimenopause is having a moment in the spotlight. Women’s health needs more research and attention so every woman can feel empowered to make decisions for her own body’s unique needs.
What I don’t love is that many marketers and grifters and pseudo-experts are attempting to capitalize on women’s pain points during midlife by offering false promises to fix what they call “pathology” through extreme diet plans, holistic programs, off-label use of medications, and all-natural products that promise to “balance” our hormones or give our ovaries “support.” What may seem like women’s empowerment at first glance is often exploitation and misogyny in disguise!
The conflicting advice bombarding us via social media, documentaries, billboards, and podcasts leaves many women more confused than ever, questioning:
But when will I begin perimenopause? How will I know
What’s up with these hot flashes and all this bleeding?
I can’t remember a single thing, is this just my brain now?
Why is it so hard to lose weight?
Is there anything I can do about my symptoms? Is hormone replacement therapy safe?
And if I can’t take estrogen, am I destined to get dementia and heart disease?
Don’t worry. I’m here to cut through the noise, guiding you toward improved symptoms and better health during midlife, perimenopause, and beyond using an evidence-based approach.
To start, it’s important to understand that menopause is NOT a disease process. Going through perimenopause during midlife in the 4-10 years before your final menstrual period is a normal physiologic process, much like experiencing puberty was a normal physiologic process in your teens. Both are transitional time periods marked by hormonal chaos and resulting symptoms. Therefore, having symptoms related to perimenopause does not make you abnormal and it does not mean something is wrong with you. It simply means you are having symptoms related to the hormonal chaos of your menopausal transition.
Here are a few symptoms of perimenopause you can watch for[i]:
Abnormal menstrual bleeding like heavy or irregular periods, skipped periods, or bleeding between periods
Hot flashes and night sweats which may cause heart palpitations
Changes in sleep like difficulty falling asleep or frequent nighttime waking
Cognitive changes (i.e. the dreaded brain fog)
Hair loss or changes in hair texture
Weight gain (especially in the abdominal region)
Thinning of vaginal mucosa and dryness causing pain with sex
Decreased libido and/or a decreased ability to achieve orgasm
Frequent urinary tract infection
Joint pain and stiffness
I know. It sounds like a lot! But the good news is there are a variety of individualized, FDA-approved treatment options available to reduce or even alleviate your specific symptoms, so you don’t have to suffer through perimenopause on your own.
Since levels of hormones like estrogen and progesterone vary significantly both from day to day within a cycle and from cycle to cycle, hormone levels are NOT used to predict the timing of your final menstrual period, diagnose menopause, or guide therapy. Instead, both the diagnosis and treatment of perimenopause is based on your symptoms. If you are a woman in her forties or early fifties with the above symptoms, then you are clearly in your menopausal transition and should be treated with medication based on your preferences.
Here’s how YOU can manage your symptoms:
A healthy diet containing plenty of protein and fiber
Regular exercise that includes resistance training
Stress management and regular social connection
Proper sleep
And, if you need additional help, prescription medications—which may include both non-estrogen therapy and estrogen-containing menopausal hormone therapy or MHT (previously called hormone replacement therapy).
Estrogen is a safe, effective, and often under-utilized treatment for relief of menopausal symptoms and can be given via transvaginal, oral, or transdermal routes. The lowest dose of estrogen that provides symptomatic relief is the goal. And while use of estrogen can protect against bone loss and osteoporosis, current medical guidelines do not indicate the use of MHT for prevention of dementia or heart disease. Progesterone must be given together with estrogen if you still have your uterus because estrogen given alone is a risk factor for developing endometrial cancer. Testosterone is considered “off-label” therapy for any perimenopausal symptoms other than decreased libido and is never approved via pellet therapy in women[ii].
MHT is a safe treatment option to begin for healthy, symptomatic women younger than age 60 within ten years of their final menstrual period. Risks of certain estrogen-receptor-positive breast cancers, stroke, blood clots, and gallbladder disease do occur, so it is imperative that you talk with your medical provider to understand your specific treatment options.
Remember, we can’t rely on predatory social media or product marketing as a reliable source of medical information. Talk with your personal healthcare provider to discuss your symptoms and confirm a diagnosis of perimenopause, then decide together which treatment options will work best for YOU.
[i] Symptoms of perimenopause. Santoro N, Roeca C, Peters BA, Neal-Perry G. The Menopause Transition: Signs, Symptoms, and Management Options. J Clin Endocrinol Metab. 2021 Jan 1;106(1): 1-15. Doi: 10.1210/clinem/dgaa764. PMID: 33095879.
[ii] Menopause: The 2022 Hormone Therapy Position Statement of The North American Menopause Society, Vol. 29, No. 7, pp. 767-794. 2022. DOI: 10.1097/GME.0000000000002028
You can find more reading about women’s health in midlife here:
Midlife Is About MORE Than Hormones: How To Avoid “Tunnel Vision” During Perimenopause
Hormone Imbalance: What Does It Really Mean?
Bioidentical Hormones Explained: What You Need To Know About Hormone Use in Perimenopause
Or listen to this great podcast episode about perimenopause!
