The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts

“There are so many problems with this that I’m not even sure where to start. But first on the list is the fact that there are major medical consequences of this denial of care and guidance. If a woman in perimenopause or menopause is not getting top-notch care, it’s a matter of life and death. Really.”

“Hysterectomy Even if your ovaries are spared during a hysterectomy, the collateral blood flow to the ovaries is disrupted, and you can expect to enter menopause 4.4 years earlier than women without a hysterectomy.”

“Hormones 101 Hormones are chemical messengers that tell your cells what to do. Your cells have internal or surface-based receptors, which allow them to receive communication from your hormones and to follow the instructions as delivered. The instructions may be to metabolize fuel, rebuild tissue, or perform other tasks that are vital to keeping the machine that is your body in top form. When hormone levels decline because of disease, age, or the menopausal transition, cells and tissues can be left waiting to be told what to do, and essential tasks may not get completed—this is when trouble can start.”

“Another consideration in the use of statins is the potentially debilitating side effect of musculoskeletal pain. One of the most common complaints of people taking statins is muscle pain, which may be felt as soreness, tiredness, or weakness in your muscles. The pain can be a mild discomfort, or it can be serious enough to make it hard to do your daily activities. Given that up to 70 percent of women already report experiencing musculoskeletal pain as a side effect of menopause alone, adding a statin to the mix may lead to further discomfort.”

“Heart disease remains the number one killer in women, even after a diagnosis of breast cancer, and markers of declining heart health, such as dyslipidemia and increased arterial plaque, can be brought about by the loss of estrogen in menopause”

“Estrogen deprivation is the most likely cause of chronic UTIs in the menopausal woman.”

“There are estrogen receptors throughout almost every organ system in your body, and as your levels drop, these cells begin to lose their ability to assist in maintaining your health in other areas, including your heart, cognitive function, bone integrity, and blood sugar balance.”

“United States was allocated for research in the area of women’s health. Of this amount, research on menopause received a mere $15 million, which equals 0.003 percent of all federal funds for women’s health research.”

“Concerns over an increased risk of clotting should automatically exclude you from using MHT. FALSE. There is nuance here between venous blood clots (like those found in deep venous thrombosis or pulmonary embolism) and arteriolar clotting (like those found in certain strokes). For venous clotting, the use of oral estrogen is well established to increase the risk in DVT in high-dose ORAL formulations containing estrogen. However, nonoral formulations like transdermal or transmucosal formulations do not increase the risk of clotting due to these formulations avoiding the first-pass effect of the liver. Arteriolar clotting is usually due to “sticky platelets” and is slightly increased in any systemic form of estrogen. It is important to note here that in the WHI, no increase in risk in arteriolar clotting was seen among women who started HRT within the 10-year window of the last menstrual period.”

“Her work, conducted with a team at Weill Cornell, has revealed that endocrine aging and the associated hormone changes, such as the precipitous decrease of estrogen during perimenopause and menopause, can accelerate chronological aging in the female brain. And this aging can”

“How menopause expresses itself in your body can depend upon genetics; lifestyle factors such as diet, exercise, smoking, and reproductive history; and influences like weight/BMI, climate, socioeconomic status, and even cultural beliefs and attitudes around menopause.”

“Many will argue that menopause is a natural process and we should just let it take its course and allow our bodies to do what they’re supposed to do. My response is that yes, the process is natural, but that doesn’t mean that it is not harmful.”

“I honestly thought I was losing my sanity. I knew about hot flashes/night sweats but nothing about the other symptoms. Lack of sleep due to night sweats, which caused me to be irritable and have anxiety and paranoid thoughts. I was becoming someone I did not like and was a little afraid of because I could not control my emotions or understand where they were coming from. But thankfully I now know that I am not crazy but normal. We talk about periods and sex education when we are younger—menopause should be included in that. Having the knowledge about what menopause is and being able to discuss it would have made going into it less traumatic for me (and no doubt for others, too).”

“prescribe nonoral forms of estrogen, such as skin patches, gels, or vaginal rings, which are proven to be safer because they bypass the liver during their initial journey into the bloodstream.”

“You don’t need to know everything about menopause to get the support you need. But what will be helpful is to have a fairly detailed understanding of the changes in the endocrine system that lead up to menopause, as well as the significant impact these changes can have on the body. Many practitioners will use the difficulty of the subject and the general lack of knowledge to sweep your symptoms under the rug quickly without offering any potential solutions.”

“Women are four times as likely to develop osteoporosis as men. The primary reason for this discrepancy is the loss of estrogen in menopause, which is considered the most common cause of osteoporosis. Osteoporosis happens because the process of bone remodeling, which is like a continuous renovation of your bones, gets out of balance. Normally, your body removes old, weak bone tissue and replaces it with fresh, strong bone. But in menopause, because of estrogen deprivation and potentially a decline in testosterone levels, this remodeling process is disrupted, and more old bone is taken away than new bone is built. This makes your bones weak and more likely to break, which is why osteoporosis is often called “brittle bone disease.”

“people who eat at least 1.2–1.6 grams of protein for every kilogram of ideal body weight have less belly fat, more muscle, and lower fragility scores (based on functional strength measures—grip strength, getting up off the floor, etc.) than people who eat less.”

“How to Make the Most of Your Annual Exam as Your Hormones Change”

“The evidence reviewed suggested no increase in risk of recurrence with MHT in women with early-stage endometrial cancer; squamous cell carcinoma of the cervix or adenocarcinoma of the cervix (cervical cancer); or vaginal or vulvar cancer. Evidence also showed no adverse effect on survival rates with hormone therapy in women with epithelial ovarian cancer. On women with a history of breast cancer, their conclusion was that it should be a contraindication to the use of systemic MHT.”

“some of the best years of our lives. And guess who gets to decide whether best means dedicating our resources of experience, wisdom, and confidence to others who are younger than us, or celebrating the luxury of being liberated from our periods, or doing a little bit of both? YOU DO. Because whether it’s thanks to evolution or not, you’ve earned it.”

“In the WHI study, the chance that a woman would develop breast cancer was four out of one thousand per year on placebo. When estrogen and progestin were added, that risk increased to five out of one thousand women per year. When this is calculated as relative risk, it’s presented as a 25 percent increase. But when the data is instead calculated as absolute risk, the increase is 0.08 percent. In case it’s not obvious, this is a big difference. A 25 percent increase is disruptive, it gets people talking. A 0.08 percent increase? Let’s just say it would not have led to frantic whispers among my ob-gyn residency professors on that fateful day in 2002.”

“Menopause has been linked to the following microbiome changes: REDUCED MICROBIAL DIVERSITY: Menopause and lower estrogen levels have been associated with a decrease in the diversity of the gut microbiome. This decrease can disrupt the delicate balance within the microbiota, potentially leading to health complications. SHIFT TOWARD MALE-LIKE COMPOSITION: Research suggests that menopause may alter the gut microbiome composition, shifting it to be more like the male microbiome. While we don’t know yet how this may correlate to changes in health, menopause-related microbiome alterations have been linked to adverse cardiometabolic profiles, which may include high blood sugar, high cholesterol, and increased waist circumference. ESTROBOLOME POTENTIAL: A new area of research is related to the estrobolome, which is a collection of enzyme-producing genes found in the gut microbiome that allow your gut bacteria to metabolize estrogen. Interestingly, the actions of the estrobolome allow for inactive estrogen to become active again and re-enter the bloodstream. During menopause, there may be a reduction in estrobolome potential, which could affect estrogen metabolism and hormone-related health. Researchers are exploring the potential role of the estrobolome as it relates to estrogen-responsive cancers, and I suspect we’ll be hearing a lot more about it in the future. INCREASED GUT BARRIER PERMEABILITY: The decline in estrogen and progesterone levels during menopause may lead to increased permeability of the gut barrier. Greater permeability can allow bacteria and their by-products to cross into the bloodstream and potentially trigger inflammation”