Embracing Menopause

One woman shares her quest to make it through “the change” without the hot flash and weight gain horror stories her mom warned her about. Learn how you can embrace this rite of passage...
By Julie Tilsner

My mom has been right about everything. About the high school typing class that would come in handy later and the boyfriends who would surely fall from the trees for me as soon as I turned 18. She was right about travel, careers, and babies. So naturally I was inclined to believe her about menopause.

And to hear her tell it, I’ll have it bad. Severe hot flashes. Insomnia. Constant irritability. All the nausea and exhaustion of first-trimester pregnancy with none of the payoff. It’ll start in my late 40s and last until I’m about 52. At least I could take comfort in knowing “the change” is still a few years away, I thought.

So imagine my horror when a typical conversation with my girlfriend Debbie led to a shocking revelation. We were laughing and complaining about getting older—our more frequent mood swings, the changes in our hair texture—when suddenly Debbie whispered, “It’s because we’re in perimenopause.”

“Perimenopause?” I hissed. “We’re too young!” Nope, Debbie said. Mid-40s. Wait, I’m just getting used to being in my 40s, a mom of two, a real grown-up. How could menopause be just around the corner? And why am I so horrified by the mere mention of it?

While in theory I want to embrace these wise woman years when they come, in reality menopause (in our culture at least) suggests not-so-graceful aging, accompanied by withering and a loss of femininity and purpose. Is that what my friends and I have to look forward to? Surely there are other ways to approach this transition, I thought. I don’t want to have my mother’s menopause. As it turns out, I don’t have to.

The perils of perimenopause
For my mother the onset of menopause was pretty typical: Her first period at 13, menopause complete by age 52. Shortly after she turned 47, her periods—always 28 days apart—became erratic. Within the year she was walloped with hot flashes, insomnia, weight gain, and virulent mood swings. “I didn’t even recognize myself,” she told me. She figured she was entering menopause because all of her friends were experiencing similar symptoms, but she was unprepared for the havoc these gnarly side effects were wreaking on her life. “I honestly thought I was going out of my mind,” she said.

Miserable, my mom turned to hormone replacement therapy (HRT) to ease her symptoms—and it worked for her. But because the 2001 Women’s Health Initiative study showed that continued use of HRT increases risk of breast cancer, strokes, and heart disease, I don’t see it as an option for me. Frankly, it scares me, and as someone who gave birth to both my kids naturally, I prefer taking a more natural route.

While experts agree that women generally mirror their mother’s experience in menopause, they also say that lifestyle choices, health, and attitude can trump genetics. After talking to dozens of leading integrative doctors and other women who’ve been through it, I now know that there’s another conversation I should be having with my mom and my friends—and it’s not the one about how much menopause is going to suck.

Our bodies, ourselves
Medically speaking, menopause occurs one year after a woman’s last period and marks the end of her fertility. Perimenopause—the four to seven years leading up to menopause—is a time of wildly fluctuating hormone levels, which can spark a variety of physical, mental, and emotional symptoms.

“Think of [perimenopausal] estrogen levels as the Dow Jones industrial average,” says Mary Jane Minkin, MD, a professor of ob-gyn at Yale University. “Estrogen goes way up, then it comes crashing down.” Levels stabilize after menopause, and most of the uncomfortable symptoms go away, she says.

Many of us have come to dread the inevitable march toward menopause, equating it with crazy-producing symptoms we read about or watch our own mothers go through. The move from our fertile years into “withered old age” strikes fear in those of us who were raised to equate female worth with youth and attractiveness. From a holistic standpoint, however, the transition into menopause is a powerful opportunity for self-discovery and renewal. It’s a natural process of a woman’s reproductive cycle, a transition from the childbearing years—not a condition to be “cured,” as Western medicine would have us believe.

Nevertheless, some women experience one or many of the following symptoms, sometimes relentlessly:

Hot flashes and night sweats. Both are a form of vasomotor (the constricting and dilating of blood vessels) instability. Hot flashes can come on at any time, day or night, and may or may not involve sweating. Night sweats, as the name suggests, involve excessive sweating in the evening, usually while you sleep. Experts surmise these temperature spikes are a response to the body’s search for estrogen.
Insomnia. When estrogen levels drop, the adrenal glands, which are designed to balance estrogen and many other hormones, go on high alert and pump out cortisol, a stress hormone that triggers a fight-or-flight response. Their heightened state upsets our circadian rhythm and disrupts our otherwise normal sleep patterns.
Weight gain. Fat cells carry estrogen, so our bodies produce more of them to replace the lost hormones, says Holly Lucille, ND, RN, a naturopath based in Los Angeles and author of Creating and Maintaining Balance: A Woman’s Guide to Safe, Natural, Hormone Health (Impakt Health, 2004). This causes sudden weight gain for many women regardless of how little they eat or how much they exercise.
Irritability. During perimenopause, estrogen spikes and progesterone drops, creating intense anxiousness and irritability. Overtaxed adrenals also play a role in extreme mood swings.
Brain fog. Profound shifts in hormone levels, much like the ones we experienced during puberty and pregnancy, can make organizing thoughts and finishing sentences challenging.
Loss of libido. Lower estrogen and testosterone levels conspire to flatten our desire—at least temporarily. Some women experience vaginal dryness, which can make intercourse painful. Others have problems with body image, which prevents them from feeling desirable.
Depression. Fluctuating hormones, including a drop in mood-enhancing progesterone levels, can bring you down. Add a foggy head and sleepless nights to the equation, and this low feeling can turn into a bad case of the blues.

Doctors say these symptoms appear to be hammering women harder nowadays because of our lifestyle choices. “There are very few women who breeze through menopause without any symptoms,” says Tracy Gaudet, MD, director of the Duke Center for Integrative Medicine and the author of several books, including Consciously Female (Bantam Books, 2004). “Just about every woman will experience some symptoms. And while you can’t control those symptoms, you can influence them.”

How? By being in good physical and mental health before the transition begins. In other words, if you have a high-stress job, only exercise sporadically, forget to eat or scarf down junk food on the go, and have no down time at all, you’re moving into menopause already depleted—and things will only get worse. “You’re doing yourself a big favor if you’re healthy going into menopause,” says Minkin. “That isn’t to say you’re not going to have challenges. But I tell my patients it’s best to hit the ground running.”

Prepping for perimenopause
If I need to start running, it would help to know where the starting line is. When does perimenopause begin? “There is a huge range of normal,” says Gaudet. “It could be 42 in some women, or it could start as late as your early 50s.” And the transition can last anywhere from four to seven years. For my mother, it was five years, start to finish.

At 44, I’m not experiencing many symptoms—yet. Which means I still have time to get my house in order, so to speak. Where do I start? By accepting and embracing the transition itself.

“It’s not a matter of mental strength or health,” says Gaudet. “In many ways, you just have to dance with the mystery of it. And women should know that if they can greet menopause in a holistic way, they’ll have an easier time of it.”

Embracing the transition means accepting that there is no one-size-fits-all “cure” for the symptoms I might experience, like the HRT claim my mother believes in. HRT promises to relieve symptoms and “make me feel like a woman again” with a simple daily pill or patch. But after numerous studies called into question the safety and effectiveness of Premarin (made from the urine of pregnant horses), millions of women, including myself, started searching for another way. Menopause, like puberty, is a stage we go through, affecting not just our bodies but our minds and spirits. And I’ve decided that a slower, more holistic way of rebalancing and re-shifting is more my style.

Lifestyle and diet changes may not grant me instant relief from my symptoms, but they’ll allow me to move through the “change” much easier. And if I get addicted to yoga, well, so much the better. To best prepare for perimenopause, follow these five steps.

Acknowledge your adrenals. The adrenals balance roughly 50 hormones, and when these glands are stressed, they send alarms throughout your body to correct the situation, resulting in insomnia, fatigue, and brain fog. Trouble is, chronic stress is a way of life in this country, especially in midlife, when women must juggle jobs, relationships, and multiple caregiving roles. But you can make several concrete changes to ensure your adrenals stay in optimal health in perimenopause:

Eat well. Since cortisol, the stress hormone sent out by your adrenals, is tied to your circadian rhythms, you want to keep yourself nourished to prevent your blood sugar levels from dropping and forcing your adrenals to send out more of that fight-or-flight hormone. Cortisol levels peak in the mornings between 6 a.m. and 8 a.m., which makes having a nutritious breakfast especially important.
Move more. Regular exercise can help keep your hormones balanced and increase those mood-boosting endorphins.
Breathe deeper. Stress worsens most perimenopausal symptoms, so make time to take a load off any way you can. Yoga works wonders for women in our age group, thanks to its blend of gentle physical exercise and breathing techniques. But even sitting alone in a quiet room for 30 minutes will help you decompress after a crazy day.

Strengthen your bones. Dropping estrogen levels also means weaker bones. In this country, osteoporosis rates increase dramatically at menopause. If you haven’t yet begun taking calcium supplements and doing weight-bearing exercises, now is the perfect time to start. “It’s never too late to start building bone strength,” says Minkin. “It doesn’t matter if you’ve been sedentary before now. You’ll do better building bone density at 40 than you will at 50.”

Take heart. It’s crucial to adopt heart-healthy practices now, says Gaudet, who cites an Albert Einstein College of Medicine study that looked at 13,000 women between the ages of 42 and 52 and found more than half of them needed some kind of lifestyle change or drug to avoid heart attack or stroke. The study deemed perimenopause the ideal time to make changes that could prevent heart disease. Now’s the time to drop extra pounds, says Minkin. “If you’re 50 pounds overweight going into menopause, you can expect more severe symptoms.”

Eat more soy. Soy contains isoflavones, which mimic estrogen. You can find plenty of soy products on grocery shelves—tofu, soy milk, whole soy beans, and tempeh. If you have or are at risk for breast cancer, experts believe you should avoid estrogenic foods, such as soy. Lentils and chickpeas, however, are also good sources of isoflavones. Check with your practitioner before upping your soy intake.

Decompress. “In my experience, perimenopause and menopause are well-named,” says Gaudet. “You’re preprogrammed to pause at this time. You’ll have a better transition if you recognize that and work with it, rather than trying to overpower it.”

The perimenopause plan
If all these changes sound more daunting than the actual menopause symptoms, relax. You don’t have to become a strict vegan yogi to avoid hot flashes and insomnia. “Shoot for balance,” Gaudet told me. “Now is the time to make rebalancing your life a priority.”

My mother went into menopause with a little black book of vices: She was 30 pounds overweight and partial to her vodka tonics, cigarettes, and fast food. By contrast, I am fit, don’t smoke, and prefer fruits and veggies to burgers and fries. I’ve also had a yoga practice for 12 years now (although admittedly, I’m not rolling out my mat every week). On the other hand, I sit in front of my computer every day, stressed by everything from paying my rent to making my deadlines. By the time my mom started her perimenopause, my brothers and I were in our 20s and long out of the house. When I’m 47 I’ll have two teenagers and be working double-time to pay for college. I’ll be mighty disinclined to give up my nightly glass of red wine.

As far as rebalancing goes, my plan so far includes getting back to my yoga mat—at least twice a week—and continuing my commitment to long walks. Six miles every other day does seem to clear one’s fuzzy head. Gaudet told me I should also consider adding weight training to this plan as a way to build healthier bones.

But whether or not I have a “better” menopause than my mom is not the issue. It’s not a contest to be won, says Gaudet. Each woman must decide how she’ll enter the transition, and deal with the symptoms that come up for her. “Try not to get angry at your body during this time,” says Gaudet. “Treat yourself with compassion as best you can.”

Good advice, to be sure, and something I’m committed to trying. Menopause will challenge me to pay attention to what’s going on and forgive my body when it refuses to cooperate. Maybe I can share weekly cries with my hormonal 15-year-old daughter and assure her and my 13-year-old son that I’m not going crazy. I’m simply entering a new life phase—much like they are. Perhaps I can also look to women who’ve been there, like my mother, for the wisdom I need to take my own journey.

“You know,” I said to my mom recently, after another talk about menopause. “I’m planning on taking the natural route through this.”

“Talk to me after six months of hot flashes,” she said, and then laughed. “I know you’ll do it your way,” she said. “Because you’re your mother’s daughter.”

Julie Tilsner is a freelance writer in Los Angeles.

Natural cures for symptoms
When menopausal symptoms do strike, these alternatives to drugs can help you cope.

Diet. Holly Lucille, ND, recommends the following changes to the all-American diet: • Cut out refined sugars and processed foods in favor of whole grains and organically raised meats. • Increase your intake of fresh fruits and veggies as well as good-quality fats (such as olive oils). • Eat cold-water fish for fatty acids. • Cut back on your alcohol and caffeine intake and look into a liver cleansing supplement, such as milk thistle or dandelion tea, to help rid your liver of stress-causing toxins.
Supplements. Take a multivitamin that includes calcium for bone health and omega-3 fatty acids for your heart. Omega-3s also appear to alleviate some of the anxiety and mood swings caused by fluctuating hormone levels, according to a recent study by researchers at Universite Laval’s Faculty of Medicine.
Phytoestrogens. Plant-based estrogens curb hot flashes, weight gain, and other complaints. Black cohosh, whole or fermented soy, red clover, dong quai, and chasteberry (vitex) are the most common. The products we recommend for overall relief (see page 61) contain one or more phytoestrogens.
Herbs. These herbs, alone or in combination, can alleviate—or at least mitigate—your menopausal challenges:
wild hops. This herb can help you sleep, eases anxiety, and may relieve night sweats and hot flashes.
Ashwaganda. Called “mood food,” this adaptogenic herb calms nerves and lifts spirits.
Sea buckthorn. Also called Omega 7, it combats vaginal dryness and regenerates thinning mucus membranes.
Holy basil. Another adaptogen, this ayurvedic herb reduces stress and guards against fatigue.
Ginkgo. This herb increases circulation and eases depression and brain fog.
Licorice root. Mildly estrogenic, licorice stimulates the adrenals and may ease depression. Don’t use if you have high blood pressure.
Raspberry leaf. This tonic herb eases cramping and tones the uterus.
Motherwort. A lovely herb to calm anxiety, it also helps promote restful sleep.

A Supplement Guide
Fortunately, there are a host of products to balance your hormones, cool your body temp, and even bring your libido back to life. To help your most uncomfortable symptoms:
For overall relief. Daily Balance Harmony ($26.99, 30-day supply; drlark.com) • Enzymatic Therapy AM/PM Menopause Formula ($22.95, 60 tablets; enzymatictherapy
) • Gaia Herbs Phyto-Estrogen ($18.75, 60 capsules; retail stores) • NOW Foods Menopause Support ($15.99, 90 capsules; thecatalog.com) • Solgar Herbal Female Complex ($17.90, 50 vegetarian capsules; retail stores)
For vaginal dryness. Culturelle Probiotic ($19.99, 30 capsules; culturelle.com) • New Chapter SC Omega 7 ($29.95, 30 capsules; retail stores) • Home Health Vitamin E Oil (0.5 oz; $5.95; retail stores)
For stress & anxiety. Garden of Life Oceans 3 Healthy Hormones—also good for overall relief ($44.95, 90 soft gels; retail stores) • Source Naturals L-Theanine ($28.50, 60 tablets; retail stores)
For depression. Rainbow Light Complete Menopausal Support ($35.95, 120 tablets; retail stores) • Barleans Omega Swirl Fish Oil ($26.95; 16 oz; barleans.com) • Nordic Naturals Omega 3D ($17.95, 60 softgels; nordicnaturals.com)

Homeopathic Remedies
Lachesis. Use this common menopausal remedy if you get flushed with heat but don’t perspire; you experience heavy bleeding, hemorrhoids, and dizziness; your throat feels sensitive to the touch; and you get emotionally heated—jealous, talkative, intense.
Sepia. Beneficial if you have hot flashes accompanied by weakness and a lot of sweating; excess bleeding; and a heavy sensation in your uterus. It’s also good if you feel depressed or chilled, have a low libido, and want to be left alone.
Staphysagria. Great if you suffer from vaginal dryness and thinning or painful soreness after intercourse.
Sanguinaria. Try this if your hot flashes are accompanied by red cheeks, burning sensations, pulsating headaches on the right side, and an itching sensation all over your body.
Cimicifuga. Use this if you are depressed and have a gloomy, sad outlook on life—lots of sighing, heart palpitations, and insomnia coupled with arthritic pains.
Coffea. This helps insomnia—awakening around midnight or after 3 a.m.—especially if your mind won’t shut off and you feel restless, nervous, or oversensitive to pain, odors, or noise.