Unlock Your Menopause Type (eBook)

Introduction

Whether it’s described as puberty in reverse, puberty’s evil older sister, or premenstrual syndrome (PMS) on steroids, the menopausal transition is an extremely challenging time for most women. Intense hormonal changes, irregular periods, and mood swings may sound a lot like puberty or even PMS. But this time around, the ovaries are gearing down and heading toward full-time R and R, rather than cranking up their function toward reproduction. And because this transition, called perimenopause, often lasts from four to ten years, it can be hard to tell where you are in the meandering journey toward menopause, which is officially defined as one full year from your last period. Even after their periods are behind them, many women find that menopausal symptoms—including hot flashes, night sweats, vaginal dryness, and/or brain fog—continue for a surprisingly long time. In fact, it’s impossible to predict how long they’ll last. All of this adds to many women’s frustrations with this topsy-turvy physiological phase of life.

Meanwhile, trying to find relief for menopausal symptoms is like navigating the wild, wild West, a terrain that’s lawless, unregulated, and untamed. There’s no map, and the landscape is rife with myths and misinformation and self-proclaimed gurus (no, I’m not naming names here; you can probably guess who they are), often with no medical training but claiming to have all the answers and/or the best remedies. Women don’t know what to expect or whom to trust for reliable information and advice, nor do they have a realistic sense of what will work and what won’t to ease their bothersome symptoms. Too many women suffer due to inconsistent and inaccurate information from both physicians and the media. Honestly, it’s a chaotic mess.

In 2010, a small study1 in the journal Women’s Health Issues evaluated the needs of midlife women using focus groups and phone interviews with health experts, and found that women in their forties and fifties crave more information about what to expect around menopause and symptom management. Surprising, huh? The researchers concluded that a serious knowledge gap exists when it comes to “information about symptoms and how to cope with/reduce them, how to communicate with providers about their experience, [and] what to expect.” Sadly, more than a decade later, we haven’t made much progress on this front: Recent research2 reveals that 65 percent of women admit they feel unprepared for the symptoms that menopause may bring.

That comes as no surprise to me. As the clinical program director of the Menopause and Midlife Clinic at the Brigham & Women’s Hospital in Boston, I hear this every day. By the time patients come to see me, they’re typically at the end of their ropes: They don’t feel like their usual selves and they’re alarmed because they hardly recognize themselves. They’re aggravated because symptoms like hot flashes, sleep disturbances, or brain fog have started dominating their days and nights. And they’re often unaware that symptoms like vertigo, pain with urination, hair thinning and hair loss, burning mouth and gums, and heart palpitations may be connected to the hormonal changes their bodies are undergoing. They’re frustrated that they haven’t been able to find relief and they don’t understand why their usual doctors are dismissing their concerns. They’re also worried about the future, fearing that the way they’re feeling now is their new normal.

I’m here to tell you: It’s not—or at least it doesn’t have to be. With the right knowledge and interventions, you can reclaim control of your body and mind. You can feel and function well at midlife and beyond. The key is to identify your personal constellation of symptoms, or your “menopause type”—a unique approach that I have cultivated based on the distinct patterns I have seen in my years of clinical experience. Using these types, it’s possible to identify and prioritize your symptoms to obtain relief, and to develop an appropriate treatment plan. Many women’s experiences will match up with one type; others may experience a combination of types—but either way, the typology approach allows you to pinpoint your unique collection of menopausal symptoms in order to develop a treatment plan that’s most likely to work for you.

Just like puberty, menopause is a universal experience for women—at least we hope it is; otherwise, something is wrong with their reproductive systems, or they die prematurely. Given that millions of women enter menopause each year and have since the dawn of time, it’s kind of crazy that menopause continues to feel like uncharted territory or a shock to the system for the women who are going through it. I’m deeply committed to changing that. With this book, my goal is to help women cut through the informational noise about menopause and learn how to manage it by identifying their personal menopause type(s) so they can treat their constellation of symptoms more effectively.

After beginning my career as an ob-gyn delivering babies, it didn’t take long for me to pivot to internal medicine. I started treating menopausal patients during a two-year fellowship in women’s health at the Cleveland Clinic. Women were flying from all over the country to consult with my mentor Holly Thacker, MD, director of the Cleveland Clinic’s Center for Specialized Women’s Health, about menopause because they were frustrated, confused, and distressed by their symptoms and they weren’t getting the care or relief they needed. Many of these women were downright miserable, and some felt as though they were losing their minds. That’s when I discovered—to my great surprise!—that much of what I’d learned about menopause in medical school and in my residency was incorrect.

Within the field of medicine, we have cardiac experts, kidney specialists, sleep doctors, and other experts—why isn’t there a menopause specialist? Women typically talk to their internists or ob-gyns who should be well versed in the physical, mental (cognitive), and psychological changes that accompany this life transition. But in reality many are not because menopausal matters aren’t sufficiently addressed in medical school or residency programs. In fact, when researchers3 recently surveyed medical residents at programs in internal medicine, family medicine, and gynecology, most revealed that they had had only one or two hours of education about menopause in their program, and 20 percent reported that they’d had no menopause education whatsoever. The biggest shocker: Only 7 percent of these doctors in training said they felt adequately prepared to treat menopausal women!

Armed with the information in this book, you will be in a better position to work more effectively with any doctor to address your menopausal and midlife health concerns; you’ll have the baseline knowledge about what’s happening in your body and the vocabulary to describe it, as well as the options for treating those symptoms, all of which you can bring up with your doctor.

During my fellowship, the more women I treated, the more I realized there are distinct phenotypes to menopause. Based on my clinical experience, I started to see big patterns that couldn’t be found in textbooks. The depth and breadth of patient experiences, backgrounds, and histories was truly eye-opening, and I became convinced that treatment for menopausal symptoms needed to be individualized. There isn’t one effective way to treat women going through menopause and it’s a mistake to pretend there is.

Fast-forward to today: In my work as the clinical program director of the Menopause and Midlife Clinic at the Brigham & Women’s Hospital in Boston, I work closely with my midlife patients, going over their most private and emotional symptoms and patterns in close detail, which helps them feel seen and heard. That’s very empowering and confidence-building for them, so when we do devise a treatment plan, they’re likely to feel invested in it and stick with it, and we can tweak it over time until they feel really good. This approach works wonders, better than anything they’ve tried before, and it enables them to take control of this topsyturvy experience. I love helping women through this challenging time. By and large, my patients are smart, curious, and inquisitive, and they often have a strong connection between their minds and bodies—that’s part of what makes women excited to take control of this journey.

The reality is, there is no one-size-fits-all approach to managing menopause that works for every woman, and that’s because different women have different menopausal experiences. Research has found that the frequency and intensity of menopausal symptoms depend partly on a woman’s age, the presence of underlying health conditions, her menopausal status, and sociodemographic variables. That said, the most frequently reported severe symptoms include depressed mood and irritability, physical and mental exhaustion, muscle and joint aches, hot flashes, headaches, sexual problems, and sleep disturbances. But individual women experience different clusters of symptoms, and it’s impossible to predict who will experience which ones and for how long. In other words, your mother’s, sister’s, or best friend’s menopausal transition may be quite different from yours, which means it’s best to approach...