New strategies for dealing with menopause and perimenopause


It’s not exactly a welcome development. You’re eating and exercising as you always have, yet you’re gaining weight, especially around your midsection. If you’re a woman in her 40s or 50s, chances are your body is transitioning to menopause.

Those entering this natural stage of life not only gain weight and belly fat (sometimes called “menopause belly”), they also experience such troubling symptoms as sleep-interrupting night sweats, hot flashes, vaginal dryness that causes pain during sex, urinary tract infections, irregular periods, depression, thinning hair, mood swings and more.

As if all that was not enough, it is increasingly recognized that women also have to deal with perimenopause, a sort of trial run of full-fledged menopause. Little discussed in the past, “perimenopause is having a millennial moment,” according to a recent headline in the health section of the Washington Post, as some millennials experience the first symptoms of the menopausal transition and want to talk about it.

According to the Post, “Emily McDowell, founder of the stationery company Em & Friends, was flummoxed when she started having some of the premenopausal symptoms that comprise perimenopause at age 39.

“‘I didn’t know what was happening,’ said McDowell, now 48 and a business consultant. When she finally figured it out, she posted about it on Instagram and got more than 10,000 likes. ‘I felt like, OK, clearly we need to talk about this more,’ she said.”

Ann Quesada, a certified APN (Advanced Practice Nurse) who works at Health First’s Women’s Health, describes perimenopause as being like a flickering fluorescent light bulb – sometimes you have symptoms and sometimes not; sometimes your body is producing estrogen and sometimes not.

Scientists divide perimenopause into two stages, notes the Mayo Clinic. Early-stage perimenopause is when your menstrual cycle, which was regular before, starts to become erratic. (If you have always been erratic, it can be difficult to tell when you have entered this phase.) You are in early-stage perimenopause when, over several months, your period comes a week or more later than usual.

You enter late-stage perimenopause when there are at least 60 days between some periods.

This can happen soon after the early stage begins or, more commonly, not for several years.

The hormones in a woman’s system are in flux during this time, and the fluctuations may trigger symptoms such as hot flashes.

When you look back at your calendar and see that you have gone one full year with absolutely no menstrual bleeding, then you are in menopause. You might go a long stretch of months without getting a period, but if one eventually comes before 12 months have passed, you are still perimenopausal.

Quesada says there are things you can do to make your menopause journey more comfortable. “There’s even a new non-hormonal drug recently approved by the FDA to treat hot flashes,” she says. Veozah works by binding to and blocking the activities of the NK3 receptor, which plays a role in the brain’s regulation of body temperature.

Since Johns Hopkins University states that 75 percent of women have these sudden, brief, periodic increases in their body temperature, that’s great news for a lot of people.

The primary goal of Herstasis Health Foundation is to provide valuable science-based information to women experiencing severe symptoms of perimenopause.

Its website describes several different therapies that can be used to treat symptoms, Including:

  • Hormone therapy – the delivery of a specific hormone into the body to decrease the intensity of certain menopause transition symptoms.
  • Movement therapy – overwhelming evidence shows that the state of health before menopause impacts the menopausal transition. That is why exercise therapy is important, regardless of what age you start.
  • Nutritional therapy – eating a balanced and healthy diet is crucial for overall health.
  • Naturopathic therapy – the naturopathic approach focuses on treating diseases and disorders (primarily without the use of drugs) by treating the whole person – mind, body and spirit.
  • Mind body wellness therapy – experiencing symptoms of the menopausal transition can range from mildly annoying to debilitating. Managing symptoms is one aspect of perimenopause, as is managing adjustment to the changes in your body.

“Actress Naomi Watts, 55, recently founded a wellness brand called Stripes that offers ‘menopause solutions from scalp to vag,’ and other big names, including the actress Halle Berry, 57, and former first lady Michelle Obama, 60, are sharing their menopause experiences publicly,” according to the Post. “Drew Barrymore, 49, interrupted a live TV segment last year to remove her striped suit jacket and fan herself, telling everyone that she was in the middle of a hot flash.

“The time is right for these conversations. Millennials, who are known for talking about, well, everything, from periods to postpartum depression, are now talking about perimenopause, which can begin to affect women in their mid-30s and 40s. (The oldest millennials are now in their early 40s.)”

Perimenopause and menopause vary widely from woman to woman. “For some women, the mood swings can be as profound as those during puberty,” says Quesada. “Other people don’t have that experience at all. Some women suffer from overwhelming hot flashes, others feel them very minimally. Science simply can’t account for what causes the differences.”

The National Institute on Aging confirms that the menopausal transition affects each woman uniquely and in various ways.

The body begins to use energy differently, fat cells change, and women may gain weight more easily. You may experience changes in your bone or heart health, your body shape and composition, or your physical function.

In the United States, women typically enter menopause between ages 40 and 58, with the average being 51, according to North American Menopause Society. Some are in their sixties. Typically, women reach menopause around the same age as their mothers or other women in their family.

Menopause weight gain is caused by the decrease in estrogen and progesterone, along with aging in general, triggering metabolic changes in the body, says the University of Chicago Medical School website. One of the changes is a decrease in muscle mass, resulting in fewer calories being burned. If fewer calories are being burned, fat accumulates.

Genetics, lack of sleep and a sedentary lifestyle play a role as well. It can be a vicious cycle: Women lose muscle tone and accumulate more fat as metabolism slows down, which then contributes to more weight gain.

And that stubborn belly fat? Blame it on the muscle tone lost from reduced hormone production being replaced by fatty tissue deposits. The areas where muscle is usually lost are around the midsection, so that’s where the fatty tissue goes.

Here too, genetics are a factor. If the people in your family carry more weight in the midsection, especially after menopause, there is a higher likelihood that you will, too, if nothing is being done to prevent it.

Unfortunately, Quesada says, even though exercise is important, it’s not going to get rid of “menopause belly.” You need to cut your calories with a healthy, rich-in-protein diet.

It’s important to be aware that changes in your periods are not always caused by menopause.

“I never just assume it’s menopause if a woman is in her 40s or 50s,” says Quesada. “I always confirm my findings with blood work.”

Changes to your period could be caused by other medical conditions, including endometriosis, cancer, fibroids, polyps or – of course – pregnancy.

Ann Quesada is a certified APN. She received her Bachelor of Science from SUNY Utica/Rome in 1992 and her Master of Science degree in Nursing from Russell Sage College in 1994. She practices in Health First’s Women’s Health with a special focus on menopause and female infertility. Quesada is a member of the North American Menopause Society and the American Nurses Association. She is certified through the American Nurse’s Credentialing Center. Her office is located at 1223 Gateway Dr., Suite 1D, Melbourne. The phone number is 321-434-3131.

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