Can you prepare for a good menopause? Maybe you can start thinking of it as a ‘second spring’
THere’s a hilarious sequence of events in Miranda July’s latest book, All Fours, in which the main character finds herself staring at a graph showing how estrogen drops off a cliff during menopause. Worried about what this might mean for her sex drive, she desperately questions her older friends about their experiences, gathering anecdotes and wisdom in a valiant attempt to be prepared for the onslaught.
But can you play through menopause well? Many women in their 30s and 40s may wonder, as the realization of this major life change finally arrives.
“And that’s good,” says Dr Karen Magraith, a GP and past president of the Australasian Menopause Society, because “it’s always good to talk about menopause”.
But with more awareness, some women can feel anxious about what to expect, and an entire industry has sprung up offering solutions and serums for their worst fears. Meanwhile, some women are left in denial or ignorance about what lies ahead.
With a range of possible symptoms, from hot flashes, decreased libido and weight gain to mood swings, insomnia and blurred memory, the prospect can be daunting. But it doesn’t affect everyone the same way – and much of what women experience during menopause is beyond their control.
Either way, making some early adjustments before or even during perimenopause—a transition period that can last two to 10 years—can help soften the impact on our bodies, our brains, and our relationships.
There are two ways women can prepare, says Magraith. “The first is to get information, and the second is to get healthy.”
‘Women were angry’
In a 2022 Survey Among Perimenopausal Women In determining their attitudes and knowledge about menopause, lack of education was a key issue: “The women were angry that they had reached this point in their lives without any knowledge about how perimenopause would affect them,” Joyce Harper and her co-authors wrote. “They spoke of their woeful lack of preparation, which left them feeling powerless and losing confidence in themselves and their bodies.”
Dr. Michelle Woolhouse, an integrative health physician and author of The Wonder Within, compares menopause to adolescence. Remember the tumultuous teenage years, when our bodies unleashed those tiny but powerful hormones on us—and our poor parents? Those powerful little chemical messengers prepare us for reproduction, with another big surge occurring during pregnancy and childbirth.
Menopause marks the end of the reproductive cycle and usually occurs between the ages of 45 and 55. During this time, fluctuating hormone levels can cause us to question our sanity again.
So, what can we do?
“The secret to a healthy menopause is lifestyle medicine,” says Woolhouse. “I’m seeing more and more people coming in with the intention of being more proactive, which is fantastic to see.”
Get strong
To prepare for menopause, healthy lifestyle principles still apply, says Dr. Tamara Nation, a family physician at the National Institute of Integrative Medicine. And now more than ever is the time to act on them, says Magraith. In particular, she explains that menopause is a turning point for heart health, cardiometabolic health, and bone health, so it It is wise to approach this life change with healthy habits and strength.
If Some women tend to gain weight around the middle because their bodies no longer need to prepare their hips for childbirth, this can have metabolic consequences that increase the risk of heart disease, elevated blood lipids and diabetes. Declining estrogen levels can also cause bones to lose calcium, increasing the risk of osteoporosis.
It is crucial to adjust your diet to include more vegetables and legumes and avoid sugar and processed foods. This also promotes a healthy gut microbiome, which preliminary investigation suggests that it may be important in the transition.
“It doesn’t have to be really complicated,” says Magraith. “Eat as much whole foods or home-prepared foods as possible.” Get adequate calcium intake and vitamin D.
Magraith recommends Healthy Bones Australia as a resource and says that perimenopause in general can be a good time to visit your doctor for screenings for breast, cervical, and colon cancer. Also ask to have your blood pressure, lipids, fasting blood sugar, and other heart health indicators checked.
The importance of exercise can’t be overstated. “Exercising more before menopause can be great for a lot of reasons,” says Magraith. “It’s really helpful for general health and also for mental health.” It can also have positive effects on sleep quality in perimenopausal women, Nation notes.
While any form of exercise is good, weight-bearing exercises and resistance training are especially important for healthy bones. It’s vital to maintain muscle mass, Woolhouse says, which can help reduce falls, regulate blood sugar levels and support metabolism. She recommends a combination approach, including resistance training, yoga and walks in nature.
That said, Magraith has an important caveat.
“In general,” she says, “there is a great element of unpredictability in terms of the severity of symptoms. A common misconception is that if women have a healthy lifestyle, they will survive menopause.”
The extent of hot flashes and night sweats may have a genetic influence and while the onset of menopause cannot be reliably predicted, early menopause can run in families, Woolhouse says: “It’s worth finding out details from your mother and grandmother.”
A powerful life change?
It’s long been known that changing hormones can affect mental health, and stress can worsen symptoms like hot flashes, heart palpitations and insomnia, Woolhouse says. “The changes during this time can cause stress, and stress exacerbates symptoms,” she says. “It’s a chicken and an egg.”
If women have already learned to manage stress, they’ll be well-served when symptoms strike, using techniques like mindfulness, physical activity and connecting with nature. Some women may be more vulnerable to depression, which Nation says has a complex relationship with psychological resilience, social connections and overall health — all of which are factors in addressing it.
Developing healthy social connections can help prepare in other ways, too. Increasing fatigue, poor sleep, and mood swings can all affect relationships at home and at work, and decreased libido, vaginal dryness, and painful intercourse can make intimacy less appealing. “Relationships are vital at every stage of a woman’s life,” says Woolhouse, “but having the support of caring people during this time can help ease the uncertainty. By both having the conversation and being aware of common signs and symptoms, women and those who love them can be attuned to their changing needs. This allows them to seek support early.”
Despite healthy lifestyle changes, some women may still struggle—even during perimenopause—and may benefit from medical help. Surveys suggest that more than a quarter will experience moderate to severe symptoms. As Magraith points out, you don’t have to be superwoman. “Every now and then I see someone in my clinic who has been struggling for years, and women often feel like they just have to keep going and juggle everything.” If you’re struggling, there is help available, including hormone therapy to help buffer your symptoms.
Ultimately, the experience varies greatly and involves more than just hormones. menopause series in The Lancet proposes an ’empowerment’ approach that would help make the lead-up to perimenopause more positive, giving women more control and confidence.
The authors write: “Rather than focusing on menopause as an endocrine deficiency, we propose an empowerment model that recognizes factors that influence the experience, in which the patient is an expert in their own condition and the provider supports the patient to become an equal and active partner in managing their own care.”
The medicalized, disease-based view of menopause, they say, ignores potential positive effects, such as improved mental health with age and the absence of menstruation, menstrual disorders and contraception.
Reframing menopause can help ease the fear of it, by seeing it as a powerful life transition that offers an opportunity for emotional growth. “It’s a time when a woman … is transitioning from the childbearing years to the wisdom years,” Woolhouse says.
“The transition into menopause is one of the most powerful experiences in a woman’s life,” she adds. “It is a time of reverence and respect for her body, her fertility, and her intuition and wisdom. In Chinese medicine, it is called the ‘second spring.’ Spring is about growth, vitality, color, expansion and abundance.”