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All About Menopause

Menopause can be a looming phase in life, associated with high emotions, night sweats, and anxiety. But it doesn’t need to be, says Marcelle Pick, OB/GYN NP, author of The Core Balance Diet, Is It Me or My Adrenals? and Is It Me or My Hormones?,and a cofounder of the Women to Women healthcare center. With an integrative approach to nutrition, exercise, and stress management, says Pick, menopause can truly be a powerful, positive, and freeing time in a woman’s life.

“Years ago we had this stigma; once you’re menopausal it’s like, Good luck, girlfriend,” she says. “But women are gorgeous now after 50 — you can’t sometimes tell people’s ages. They can still be sensual and sexy and it’s not a matter of ‘You’re menopausal, you poor thing.’”

We chatted with Pick about what exactly is going on in women’s bodies during menopause and how they can best support themselves. Here’s what she had to say.

Experience Life | What is menopause?

Marcelle Pick | Menopause is the time in women’s lives in which there’s a cessation of menses. The woman is no longer ovulating. And with hormones, the estrogens and progesterones go up and down, and some people are really affected by those fluctuations.

Menopause is also a developmental milestone, almost like adolescence in reverse. What you’ll find from women so often is, Who am I? What do I want to do for the second half of my life and how am I going to get there? Mothers are a little bit older now, so they’ve got kids who are starting their periods when they’re stopping their periods, or their kids are going away to college. There are all kinds of transitions that are happening when they’re in this stage.

EL | What are the symptoms of menopause?

MP | Everybody is a little bit different. Some people might have hot flashes, some people might have night sweats, some people might have anxiety, and some people feel depression. Oftentimes women will come in and say, “I don’t feel sexy anymore. I don’t feel like myself. Something is really wrong.”

What I’m seeing in my practice more than ever before is more anxiety. I’m seeing people who were top executives, driving and flying here, there, and everywhere, and they can’t do it anymore because their anxiety level is so high.

Are our lives affected by stress biochemically? Absolutely. And if we have too much stress the adrenals cause the hormones to be disrupted, the thyroid to not work properly, the digestive system to not work as well, the immune system to not work as well, and it causes horrible problems with fluid retention and also blood-sugar levels.

We have a culture now that’s so busy. As a mother you’re trying to multitask, you have a child to worry about, you’ve got a relationship, you’ve got a job, you’ve got deadlines, you’re thinking, How am I going to do all of this? Plus, we have TV and we see news that’s worrisome, we’ve got the political environment, and the environmental environment. You can’t shut it off. That causes more cortisol, which causes more of the havoc that goes on.

What’s interesting for women is that prior to menopause the adrenals produce about 15 to 20 percent of our hormones. In menopause they produce 50 percent. The ovaries are not working, so we rely on the adrenals to do that. Well, if the adrenals are preoccupied with producing cortisol, we don’t even have the benefit of them producing some of the other hormones we need, such as our sex hormones, estrogen, progesterone, testosterone, and DHEA. So you can see how the perfect storm is set up.

EL | How do most doctors treat menopausal symptoms?

MP | What used to happen many years ago is when we saw women with hot flashes and night sweats, we started using different forms of synthetic hormone replacements. There were a few different hormones that had different strengths of estrogen from pregnant mares’ urine, and then we used a progestin with this. This was considered really good medicine.

In the early 2000s, findings from an ongoing study through the Women’s Health Initiative came out showing some serious side effects from Prempro. This study helped practitioners realize that synthetic hormone replacements like Prempro and Premarin weren’t the best for women, and it put the medical world on its ear. The study found that because women were on these hormones, they had a higher incidence of stroke, blood clots, Alzheimer’s, breast cancer, and cardiac disease. It was a big to-do in gynecology because it was, Now what do we do with the women who are having these menopausal symptoms? 

Premarin is still used today, but in my practice, I use bioidentical hormones, which are more similar to what the body produces on its own — in amounts that more closely mimic the natural state of the body’s physiology. A frequent recommendation for people having a lot of hot flashes and night sweats is, believe it or not, an antidepressant. That’s probably not the greatest choice for people. They’re probably not depressed, but we need to help people figure out what’s the problem, why are they having these symptoms. Changing one’s diet and adding healthy lifestyle choices also help women feel fabulous in menopause.

EL | What are natural remedies for menopausal symptoms?

MP | It’s really about lifestyle. It’s about learning what you can do to create balance. It’s having more protein at every meal; it’s making sure that your sugar load and your carbohydrates are lower; it’s doing exercise and yoga.

We have a sympathetic nervous system, which is the revved-up system, and we have the brakes, which is the parasympathetic nervous system. Too many of us are not doing things to get into that quiet, relaxing mode. That’s going to be crucial for people.

The average age is 51.3 for menopause, but our hormones start changing about 10 to 13 years before menopause. We already see shifts that are happening, so get on board in your early 40s and say, “You know what? I’m going to start taking care of myself.” What I say to people is, “If you don’t take care of your body it may not take care of you.”

EL | In what ways can women support their bodies to make this transition easier?

MP | Certainly exercise, no sugar, lower amounts of carbohydrates, sometimes taking particular foods out of your diet that are problematic.

It’s paying attention and at least doing a little bit of self-care on a regular basis, which is so hard for women because they’re always multitasking. What I say to mothers is, “Look, do 10 to 15 minutes a day.” OK, there’s dishes, there’s this that has to be done. Just forget it. Just go and breathe.

Then there’s herbs, of course, such as black cohosh, dong quai, and maca. From my perspective, the key piece is adrenals, because adrenals are really upstream. If we treat adrenals, we often don’t need to use so many of the interventions for the menopausal symptoms. There are adaptogenic herbs like astragalus or ashwagandha that are very helpful in bringing down high cortisol or bringing up low cortisol.

But a lot of times, quite honestly, it’s finding out what created that stress to begin with. Is it a really stressful job? Is it trying to do too much? Is it three kids who are in four thousand activities, plus a job, plus a relationship that’s not equal in terms of who is taking responsibility? I mean, it’s a lot. And it’s being able to kind of identify, for you, what do you need to shift? What do you need to change in that dynamic?

So it’s also putting the burden back on you to say, “OK, I’m looking at my life from this perspective, what do I need to do differently?” For many women in menopause, they’re starting to think a little bit more about tomorrow. When you’re younger, it’s just about the kids, but a lot of times in menopause it’s like, “OK, how do I want to do this differently now?”

EL | If people are working longer than they used to, do you think that affects things as well?

MP | Not necessarily. It’s how are you working. Are you doing something you love? Are you making a living or are you making a dying?

EL | Can women make menopause a meaningful and positive time in their lives?

MP | Absolutely, because it can be that time of freedom of I don’t have periods anymore, I don’t have the moods that go up and down, I’m not tired before my period.

It’s really helping women understand that this is a time in their lives that they can actually have the freedom. They don’t have kids necessarily around, and they can take care of themselves.

It’s about saying, I need to take personal responsibility for how much I exercise or what kinds of foods I choose to eat or how I’m going to do this in a different way.

You can also go down this path, and some women do, of, Part of my life is over. I have no purpose anymore. So it’s kind of reinventing one’s self. If you were at home with children, what do you want to do? What makes you happy? How do you want to connect? Do you want to do more volunteer work?

So it’s really looking at what you want and how are you going to do this differently. How can you have this second half of your life be wonderful?

EL How can those close to you offer support during menopause?

MP | Having an awareness. Reading some books and understanding menopause, because for some people the journey is that they come alive and they start to say no when they’ve always said yes, so it feels like, What happened to this person? Who invaded her body? But we all need to change as we grow older. Relationships change too, and both people might start to understand each other differently. There’s not much that someone on the sidelines can do other than support the person because it’s generally that person’s journey.

EL | In what ways do we make menopause worse?

MP | The diet we have, doing too much, ignoring it, just expecting a quick fix.

There are some countries in the world in which people have no symptoms at all. They don’t even have a name for it. So why is that different here? I suspect some of it is the fast-paced society that we have, plus the foods we eat, plus the ubiquity of hormone-disrupting chemicals.

Everybody is a little bit different. For some women who are menopausal, they’ve had a high burden because they haven’t eaten well for a long time. They have some genetics that they’re eating the wrong food for, and bad genes get turned on. So, it’s about looking at all those equations and starting to understand you have the potential to be able to change things.

EL | What are your top tips for someone in menopause?

MP | Well, that’s a little tricky because it depends on the symptoms they’re having. But food is medicine. Food is the most powerful drug we have, and what goes on at the end of your fork really changes your biochemistry. So: changing your diet, stopping sugar, and, if you’re drinking a lot of alcohol, cutting back on alcohol — because alcohol and caffeine, in general, can make hot flashes much worse and anxiety much worse.

Exercise, as well. It’s going to be really important to get outside and be part of nature and the earth.

Also, look at your schedule. Do you have a little bit of quiet time during the day? What kind of self-care are you doing for yourself on a regular basis? What kind of loving are you giving yourself? Are you treating yourself like a bad boyfriend or a good girlfriend? 

EL | Is there anything else you’d like to add?

MP | Menopause can be an amazing journey, and so many people on the other side say, “Wow, it was a wake-up call for me. It was a great journey.” Or some people say, “It was hardly a blip on the radar. There was not very much there.”

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