menopause talk

treating menopause symptoms—holistically!

In this blog post, I’m glad to welcome a guest co-blogger—my friend Dr. Jeff O’Boyle! This post is a collaboration in which we want to educate our clients/patients and the community on treating menopausal symptoms—more specifically on how lifestyle and nutrition choices can affect them and what medications can positively influence those symptoms.

Dr. O’Boyle is the owner of Beyond Primary Care, a family medicine and addiction medicine clinic located in Ann Arbor. Dr. O’Boyle practices a direct primary care model of medicine, which is insurance free, membership based, and offers patients virtually unlimited office visits, wholesale medications dispensed from the clinic, and wholesale blood work completed at the time of visit. (Sounds a bit different from your usual doctor’s office, doesn’t it?)

menopausal, peri-, and post-

First, a little bit of clarity about the menopause timeline:

  • Menopause is defined as the complete cessation of the menstrual cycle for 12 months, after which time it is extremely rare for it to resume. The average age at which menopause occurs in the United States is 52.
  • Peri-menopause is the period of our lives when our bodies (if not our conscious thoughts) begin to move toward the end of our child-bearing years, and it can begin as long as 10 years before the final menstrual cycle—that’s right: you can enter menopause as early as your late 30s to early 40s. And yes, you can still get pregnant during these years! (As we know from the British comedy Sex Education!)
  • Women are considered post-menopausal once they have been cycle-free for 12 months.

identifying menopausal symptoms

Every woman experiences menopause differently. Some of us reach the end of our cycles almost without noticing; others don’t have a period for some months and then get surprised to find that it was just loitering in there—and then we need to start the countdown over again. Your “regular” periods may have stopped years ago—regular in the sense of their timing and length and heaviness.

Like most women, you may have an idea what to expect:

  • Physical symptoms such as hot flashes, night sweats, vaginal dryness, dizziness, nausea, breast tenderness, insomnia, skin changes, abnormal uterine bleeding, urine incontinence, and headaches.
  • Changes in mood such as increased anxiety, reduced sex drive, memory issues, and fluctuations in mood.
  • And there are a lot more!

These symptoms can last months to years, and even post-menopause, you can still sometimes “feel menopausal.” These symptoms can be severe, disruptive, and even feel embarrassing at times.

In a previous blog post, I reminded us that it doesn’t help to approach this shift in hormones as a problem, like we are entering this stage of life from the perspective of “we’re broken.” Instead, it’s important to approach this as a woman’s health experience within the context of identifying our own individual symptoms and getting clarity about all possible therapies.

treating menopausal symptoms—and causes

You may have mined the women’s health section of your local bookstore looking for informed (dare we say evidence-based?) resources to guide you. What you likely found is a broad spectrum of seemingly science-based approaches from “here is why you should be on hormone replacement therapy (HRT)” to “here is why you absolutely should NOT be on HRT!”

I’m a firm believer that when advice falls on a spectrum (HRT: YES! HRT: NO!), the truth likely lies somewhere in the middle. And it’s important to remember that many of the top health problems and conditions in our country are so-called “lifestyle diseases”—meaning that they can be reversed and/or prevented through our food and lifestyle choices.

My own personal experience with peri-menopause involved a large number of the most commonly recognized symptoms listed above—including raging migraines after decades of their absence and an appearance by intense anxiety and panic attacks, neither of which I’d ever experienced before.

And perhaps because I had been raised with fairly good food and lifestyle choices and began to make even better ones once I had my own family, many of my symptoms were quite mild.

That said, as a health coach, my work with clients is based on the principle of bio-individuality: your perimenopause is not my perimenopause; what works for you may not work for me; your kale may be my kryptonite. From a physician’s perspective, Dr. O’Boyle explains it this way:

Discussing the scope of treatment … is extensive and always carries asterisks for certain populations…. [T]reatment is multi-dimensional and must be individualized, your classic N of 1 trial.

What matters most is that we—as patients/clients and as practitioners—take a holistic approach: yes, it’s about reducing the severity of symptoms, and it’s also about taking a longer view of what caused them and how we can shift that in a more positive direction. It’s as much (more?) about prevention as it is about a cure.

And it’s about giving you—the client/patient—permission to have some agency over your health care. As Dr. O’Boyle says,

Mainstream medicine has a challenge: continue to ignore your story and lose you to a subjective fantasy built on the mistakes of our brain, or join you in your life story ensuring you are taking responsibility for your wellbeing while making you central to the care and cure.

a medical approach to menopausal symptoms

The stress involved with menopause can be disruptive on many levels. Some women feel awful and don’t want to be subjected to a physical exam, let alone interact with a physician when they can’t interact with their families, co-workers, and friends in a way that has meaning. At Dr. O’Boyle’s Beyond Primary Care clinic, you can be assured there will be no judgement and no unnecessary physical exams—just compassion and an opportunity to share your story.

At Beyond Primary Care, Dr. O’Boyle uses an eclectic and personalized approach—not a “canned” conversation—towards accessing and resolving life changes and stressors. In a thorough health history, he is going to ask about your family, where your quality of life is being most affected, and—most importantly—what you want to do. He finds that validation of your concerns and education about a subject are often powerful methods of support when you are not feeling well. As you read above, some women prefer enhancing their diet and exercise along with emotional support in allowing their symptoms to play out more naturally.

If these approaches don’t work, Dr. O’Boyle can get innovative with estrogen and progesterone hormone replacement therapy depending on your needs. Getting the dosage right using hormone patches, pills, and creams is always individualized, and Dr. O’Boyle works with his patients to customize how much or how little may be needed. While HRT is sometimes a last resort for a woman, the relief it gives can be life-changing. Additionally, just like a great chef (shameless cookbook plug) working with ingredients, he is constantly measuring and remeasuring your for safety and goal achievement.

make the connection | decisions, decisions

Consider this your permission to make the decision about treating perimenopausal symptoms based on what’s right for you—because you do have options! And you do have the option of working with a team, not just with one practitioner!

If you suspect some of the symptoms you are experiencing may be due to perimenopause, or if you notice any coworkers, friends, or family members silently struggling, send them a link to this post so that they can join the conversation!

Please share comments and questions below. You can also contact Dr. O’Boyle or me, Liza Baker, directly. We look forward to hearing from you!

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