Advice to My Adult Daughters: Preparing to thrive in menopause
The midwife part of me feels like I never stop talking about women’s health and transitions, but the mom part of me wonders what important nuggets of wisdom I have forgotten to pass on to my adult daughters and nieces, the next generation.
What is most important about this transition that I want them to know and that I wish I had known as I started to feel changes happening in my body at that time in my life? If this article is too long (TLDR-too long didn’t read), just skim the bold headings. 😉
You are the expert in YOUR body, so trust your intuition.
This is perhaps the most important wisdom from the outset! Sure, get information from trusted sources (like me!), read books (there are lots out there now), ask lots of questions, and poll your friends, but then trust your gut and experience. No one in the world will experience this transition exactly like you, so you might as well own it.
Don’t assume there will be problems!
My basic rule of life (I learned this by necessity in early parenthood) is that we should assume everything is ok until proven otherwise. You don’t want to waste valuable time and energy worrying about things that don’t happen (I’m sure my daughters believe I do this all the time!). Be prepared with information and support, but you may just sail through this menopausal transition brilliantly with no need for assistance. If so, be gentle and supportive with your less fortunate friends.
Studies show that a positive attitude about aging leads to a longer and healthier life. Studies are showing that a person’s belief system has a tremendous impact on their longevity and physical health. We live in such a youth-centric culture; it is common for young people to dread their first wrinkle. But studies also show that many people are happier in their later years and menopausal women speak of finding a sense of freedom with less responsibility to others, less concern about what other people think of them, more confidence to speak their mind, better ability to set boundaries, and more stable mood with steadier hormone levels.
The goal is not just to live longer, but to feel good and thrive during those years.
Dan Buettner and the Blue Zones project have described nine lifestyle habits of the world’s healthiest longest-living people. All these habits are simple, but that doesn’t make them easy. Take a look.
You deserve to be heard.
If at any point you feel there is something wrong or have troubling symptoms that you would like to address, find a medical provider who will listen to you, take your concerns seriously, and provide you with options that feel right to you. All women deserve this, but sometimes we have to be very proactive to find the right health care for ourselves. Prioritize the highest quality health care you can find and consider paying “out of pocket” if you need to (and you are able to). Is this not at least as important as hair highlighting, lash extensions, brow threading, bikini waxing, spray tans, and mani/pedi’s?
Some basics
What is Perimenopause?
Simply put, perimenopause is the time when your hormones start to shift and change. For many women, this starts in their mid-40s, and the changes are gradual, like a missed period every once in a while. For other women, the changes happen much faster, and the symptoms can be more dramatic. The hormone, progesterone, is the first to begin to gradually decrease. Estrogen shifts too, but sometimes rises and falls unpredictably. Some women experience minimal symptoms during this time while some women have significant discomfort. Some of the most common perimenopausal symptoms include hot flashes, night sweats, mood changes, and trouble sleeping. Perimenopause usually lasts from 3-10 years, but every woman is different. During this time, a woman may still be fertile and will want to take measures to prevent conception if she does not want a pregnancy.
What is Menopause?
The definition of menopause is not having a period for a complete year. The average age is 51 but it can be very early (before 40 is considered premature menopause) or it can happen much later (mid-50s). It can also happen abruptly when the ovaries are surgically removed or affected by cancer treatment. For women who were having regular periods, the timing is obvious. For other women, the timing may not be so clear (if she has a history of missed periods with PCOS or is on birth control like the progesterone-containing IUD or implant).
Changes in hormones
Estrogen (estradiol) and progesterone are two hormones primarily produced in the ovaries before menopause. After menopause, estrogen continues to be produced in small amounts in the adrenal glands and adipose (fat) tissue. This is a different type of estrogen (estrone) and not as potent. Testosterone is another important hormone in women (it’s not just a “male” hormone!). It begins to decrease in the 30’s but continues to be produced long after menopause. Other critical hormones in our bodies include thyroid hormone, cortisol, insulin, melatonin, and prolactin.
No one lab test can tell you exactly where you are in the process of perimenopause. The best gauge of how you are doing is how you feel.
If your periods are becoming irregular (you are skipping occasional months) or you are having symptoms like hot flashes, you will want to be seen by a medical provider to confirm that there are not any other possible causes of these symptoms (like pregnancy, abnormal thyroid, or pituitary function for example). If a woman is not having periods (because of removal of her uterus, or a condition like PCOS), sometimes lab work is needed to help assess whether she has reached menopause. There is an interesting lab test called DUTCH (dried urine test for comprehensive hormones) that can check hormone metabolites and help us understand how your body is synthesizing, metabolizing, and excreting hormones. This might be something to consider if you or your healthcare provider want more information about the changes you are noticing, but the actual diagnosis of menopause is clinical, and usually based on symptoms.
We are each so different.
Knowing how old your mom was when she stopped having periods and how the transition went for her might be helpful. But our own experience will be influenced by genetics and our own “exposome” which is the wide range of internal and external factors that impact our health. External factors include environmental exposures from the prenatal period, through childhood to adulthood by things like air, water, chemicals, radiation, smoking, infection, diet, and exercise. Internal factors include inflammation and immunity, oxidative stress and detoxification, gut health (including the microbiome), and hormone production, modulation, and metabolism. Functional Medicine focuses on understanding and addressing all these factors when a person is having distressing symptoms or illness.
There are estrogen receptors in most areas of the body.
Besides being where you might expect (the uterus, ovaries, vagina, and bladder), there are also estrogen receptors in just about every other organ, including in the brain, the heart, the bones, the skin, and the gut. This means that when your estrogen levels decrease during perimenopause and menopause, there are consequences in all these other systems of the body too that you might or might not notice. We know that this is the time when the risks rise for cardiovascular disease, insulin resistance, diabetes, cognition problems, Alzheimer’s disease, thinning of the bones, and osteoporosis, and there is a decrease in collagen and skin elasticity and thickness.
Some strategies
There are lots of strategies to help you manage whatever symptoms you experience.
Integrative medicine has lots to offer during this time, like nutrition, supplements, herbs, acupuncture, CBT (cognitive behavioral therapy), hypnosis, mindfulness meditation, and bodywork like massage, yoga, Pilates, and any exercise you enjoy. Weight-bearing exercise and strength training will be especially important for maintaining muscle mass and bone health as the years go on.
It is during the first years of menopause when menopausal hormone therapy (MHT/estrogen and progesterone) is safest.
MHT can not only help with hot flashes, night sweats, prevention of osteoporosis, and genitourinary syndrome of menopause (the FDA-approved indications) but also decreases the risk of developing cardiovascular disease, diabetes, and cognitive problems later in life. Perimenopause is the perfect time to think about changes you can make to minimize your health risks as your hormone levels shift (see specific recommendations in the next blog). If you are considering menopausal hormone therapy, ask lots of questions and discuss a plan with your healthcare provider.
There is a long list of symptoms that can be attributed to shifting hormone levels, but you are unique.
The list may be long, but it doesn’t mean that each woman will experience all the symptoms. Don’t focus on the list, but instead, focus on what YOU feel, and what your body may be trying to tell you. These are important clues about what support your body needs you to provide so that it can function at its best. If you have questions, find a healthcare provider to talk to about your specific symptoms.
Is there such a thing as your hormones being “out of balance”?
While there is not one right level of estrogen, progesterone, and testosterone, and it is normal for them to shift daily, weekly, and monthly throughout our cycle and our lives, imbalances can occur. For instance, there are quite a few problems during perimenopause (or much earlier) that women experience that are due to excess estrogen (some people call this estrogen dominance). This can be due to having more estrogen than is needed (naturally produced or due to exposure to environmental estrogens) or having a normal estrogen level, but too high in relation to a very low level of progesterone. Symptoms may include painful periods, tender breasts, bloating, PMS, fibroids, and endometriosis.
Environmental exposures can increase the level of estrogen in our bodies.
Xenoestrogens are found in cleaning products, body products, cosmetics, plastics used in food storage, and non-stick pans (and many other things). They are “estrogen-like” substances that can contribute to an overabundance of estrogenic effects. Some women also have symptoms of excess estrogen because their body is not able to process and eliminate even normal levels of estrogen due to problems with their liver (which processes hormones) or their gut (like microbiome disruption or genetic changes that affect metabolism), and constipation (which can cause estrogen to be reabsorbed back into the body instead of eliminated). Minimizing your exposure to xenoestrogens early in your life will help make sure your detoxification system (gut, liver, and kidneys) can function optimally. Think about this now as you set up your kitchen and stock up on cleaning supplies and cosmetics.
Celebrate . . . and then get political!
Celebrate menopause as a period of transformation!
Cultures have always created ceremonies for marking important life transitions (like bat mitzvahs, quinceañeras, vision quests, weddings, baptisms, blessing ways, baby showers, and funerals). Why? Because big changes are happening, and the whole community wants to acknowledge it and show their support to the person/couple going through it. Menopause is another vital transition but one that is often silent and unacknowledged. How will you mark it? Who will you invite? It doesn’t have to be a literal party, but it could be. Or it could be a party of just one (you), acknowledging the importance of this phase and giving yourself gifts (life-affirming wellness habits, downtime to do the things you love, a support network of strong and inspiring women). The butterfly emerges from a cocoon wearing vibrant colors. You get the idea, so now let your creative imagination run wild!
Menopause is a feminist issue!
Menopause needs a rebranding so that women look forward to thriving during this (hopefully very long) period of their lives. There are companies making billions of dollars from our fear of aging, and they not only profit from our insecurities, but they know just how to create them. Activists of previous generations have worked for decades to “take back birth,” and now it is time to “take back menopause.” Menopause is not a disease to be cured, and we are not done having productive and fulfilling lives. With a little preparation, information, and support, some of us are even having the most fun ever!
If you have adult daughters, it’s never too early to share some of your experiences and wisdom gained. I realize now that there are aspects of my own transition that I have never shared with my daughters. When is a good time? Family dinner? Upcoming vacation? If you’ve just never found the right time, I totally understand. . . . Let’s just do it!
But just like birth, it’s the wisdom gained, rather than the dramatic stories that younger women will appreciate. Just as no pregnant woman wants to hear about the worst things that happened to you during your birth, they WILL appreciate effective coping strategies and great resources that helped you through. And you may not want to wait until the young women in your life ask about menopause. In our culture, aging is cloaked in dread, shame, and silence. It’s an act of rebellion just to pipe up and offer your perspective!
About The Author
I’m a Certified Nurse-Midwife with a passion for supporting women through all of life’s major transitions — with a focus now on midlife, perimenopause & menopause. I blend down-to-earth women’s wisdom with evidence-based solutions to common concerns. I’m certified by the Menopause Society and trained in integrative and functional medicine so that I can offer a wide range of information, support, and guidance to women during this critical time in their lives.