Am I Crazy or Is It Perimenopause?

7 Surprising Things I've Learned as a Menopause Educator

Happy Menopause Awareness Month to all who celebrate. (Ha.) Tap the ❤️❤️❤️ or leave a comment if you’re interested in a calendar of events from the menopshere in next week’s newsletter.

“There is nothing in life to be feared, only to be understood.” — Marie Curie

I’ve always loved this quote – it so perfectly states why I decided to become a menopause educator. In my early 40s, I saw specialist after specialist trying to get to the bottom of my joint pain, insomnia, fatigue, brain fog, and suddenly reactive skin. I’ve written this before but it’s worth restating: Not one doctor suggested that this constellation of symptoms could be connected as part of perimenopause – not even my OB/GYN. I felt dismissed, exhausted, and alarmed – that is until I began to do my own research, talk to friends, and connect the dots with a different set of doctors.

As I’ve made peri/menopause my mission over the last few years, I’ve learned from brilliant experts in multiple fields who are stepping up and paving the way for more research, more funding, and more awareness of how to increase longevity and improve quality of life for peri/menopausal women. I’ll be introducing some to you in the coming weeks as part of the Phosis advisory board, but until then, here are some illuminating truths I’ve uncovered about the profound ways hormonal changes affect women's bodies.

1. Estrogen Affects More Than You Think
Most of us know estrogen supports our reproductive system, but its influence extends far beyond to cardiovascular health, muscle function, and your bones, brain, and gut. Estrogen has a protective effect on many body systems, and as levels decline, the list of potential symptoms is longer than the line for the fitting room at Zara. Yeesh. Finding a meno-friendly doctor who helps you find relief in the short term and protects your health over time can save your sanity — and maybe even your life. 

Here’s a script to take to your appointment if you’re not sure what to say to your healthcare practioner: I’m experiencing [SYMPTOMS] and think they might be related to hormonal changes from perimenopause or menopause. I’ve read about solutions like hormone replacement therapy, supplements, and diet and lifestyle changes. Can you walk me through what you recommend for me and why?

2. The Cardiovascular Link No One Talks About
When estrogen levels drop, blood vessels can stiffen, increasing the risk of heart issues down the line. Estrogen helps dilate blood vessels, promoting healthy blood flow and better cholesterol levels, and without it, inflammation and plaque build-up can become more likely. I know it’s hard to think about your long-term health when you’re looking for symptom relief RIGHT NOW, but consider this an important nugget of info to have in the back of your brain when you’re talking to your doctor about what kind of testing you may need to find out if you’re at risk as you age. Remember, cardiovascular disease is the number one killer of women nationwide; it’s worth having a conversation with your doctor to assess personal risk factors and what you can do about them.

3. Eat Like an Italian (or Spaniard or Croatian)
The idea of aging used to be distressing to me, but knowing what I need to do now to maintain my energy, strength, mobility, and vitality helps me feel empowered as the years go by. Inflammation is something that happens every day to both men and women as part of natural aging –  “inflammaging” if you will. This process can lead to the aforementioned cardiovascular disease, insulin resistance, cognitive decline, and even loss of mobility over time. Distressing stuff, but you can absolutely do something about it starting today. Read this past substack to learn more about the Mediterranean Diet, the most well-studied anti-inflammatory eating pattern (recipes!), but the right kind of movement is also a must.

4. Strength-training, Strength-training, Strength-training

If you’re 35+ you grew up in an era where step cardio classes were queen. These days, step cardio is still a good choice for getting your heart rate up, but at a certain point, lots of high-impact cardio might be causing more harm than good (a.k.a. contributing to inflammation and unnecessary wear/tear on your joints). Besides, my achy joints just don’t enjoy those jumping movements the way they used to. However, limiting your routine to only cardio means you may be missing something we know is critical for feeling great now and making sure you can travel, play pickleball, and live independently later.

It may not be news to you that the perfect complement to cardio exercise is strength training. But what might be newsworthy is that sarcopenia and osteopenia, the loss of muscle mass and bone density respectively, start earlier than you probably realize. Sarcopenia can begin in our 30s, while osteopenia (the precursor to osteoporosis) is often detected in our 50s. As we age, it becomes increasingly more challenging to build muscle and bone strength. In fact, bone remodeling happens at a slower pace after menopause, which often puts women at risk for osteoporosis. I cannot emphasize this enough; the time to build muscle and bone strength is in perimenopause. If you’re menopausal, do not give up on building strength; but you may need to work at it more consistently to see results. (This susbtack gives some ideas for how to start using free weights in a healthy way — scroll to the bottom if you want to watch and copy a quick version of my workout.) The benefits of a routine that includes moderate cardio (such as brisk walking, biking, swimming, or dancing) plus strength-training is well-studied.

4. Stress Is Stealing Your Estrogen
Ever wonder why stress seems to hit harder in midlife? There are some obvious external factors: aging parents, kids in school, managing a career, money, and relationships, but there are some internal ones as well. When you’re stressed, a trio of glands around your brain and kidneys (the HPA axis) elevate your cortisol levels, the hormone responsible for “fight or flight.” This isn’t great for a couple of reasons: It can disrupt sleep and digestion, and over time your body can start to prioritize making cortisol over estrogen and progesterone, potentially making peri/menopausal symptoms worse. I’ll admit that I struggle with this one, especially over the last couple of weeks as we get ready to launch the brand. While I’ve maintained my yoga practice (and meditation routine), it doesn’t always take the edge off when unexpected and challenging issues arise. And as much as I love to hike in nature, that is not always possible these days. But it makes me curious, what do you do to manage stress?

Check out my favorite smoothie recipe here. It’s a base that you can doctor up with different fruits, veggies, or supplements as needed.

5. B Vitamins Are Your Best Friend
Many of us are familiar with the importance of vitamins C and D, but I was surprised to learn all the way B vitamins, especially B6, B12, and folate, are key for maintaining a healthy nervous system. They support your heart and brain, and if you’re not getting enough you’re at risk for weaker bones (osteopenia and osteoporosis), which makes them even more crucial during menopause. Some good sources from food: 

• Eggs

• Avocado

• Milk

• Salmon

• Milk

• Citrus

• Nutritional yeast (I add this to my popcorn)

While there are many types of supplements and multivitamins designed for women in perimenopause and menopause, it’s always a good idea to ask your doctor if you actually need additional supplementation based on your individual risk factors and bloodwork. It can be tempting to take some promising pill you see promoted on social media, but without knowing if you’re actually deficient in that nutrient, it may not be in your best interest to take it without consulting your healthcare professional who understands your lifestyle and any potential risk factors.

7. Your Brain Is Rewiring Itself
Like puberty, pregnancy, and post-partum, hormones cause significant brain changes in peri/menopause. I like how Dr. Lisa Mosconi, author of the book The Menopause Brain, describes the process. She says that the female brain “prunes back” certain areas, which can explain common symptoms like brain fog and mood swings. Even more interesting to me is how her research demonstrated that the perimenopausal and menopausal brain actually increase in estrogen receptors. While still don’t have a full understanding of why this happens, it does prove that the male brain is quite different from the menopausal female brain. Understanding and expecting these symptoms can help you extend a little more grace to yourself during this transition, and the awareness to seek the right help if symptoms are impacting your quality of life. 

This Week’s Movement Snack

Surprise – a Pilates instructor loves an ab series! (That was an inside joke for Pilates people.) Building core strength is key for fending off back pain, improving balance, and maintaining good posture. I love this version because you can do this series on a mat without any special equipment. These movements strengthen muscle while protecting your neck and low back. Tip: It’s important to keep your belly muscles pulled towards your spine for these exercises — enjoy!

Cheers to looking and feeling your best, 

Susan
Susan Campbell
Founder & CEO, Phosis