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Conversations You Should Be Having With Your Doctor By the Time You Are 40


It’s coming ladies, by 2025, it is estimated that there will be 1.1 billion postmenopausal women worldwide, boy there are going to be a whole lot of females running around with menopause rage and hot flashes ‘til then…should there be a public service announcement??


In all seriousness, the menopausal transition, in my view, can be a beautiful time of growth and awakening, it does not have to be filled with dread, despair, and discomfort. In order for this period (see what I did there?) to be a healthy and positive one, we must arm ourselves with as much knowledge as possible, be brave in speaking about our symptoms, and in asking for help. The first stop should be your medical provider. I am hoping by this stage of life you have found one whom you have trust and confidence in, if not, start looking for one. 


A doctor’s job is to listen to and address whatever health and wellness concerns you have. A single professional never has all the answers, but he/she/they should be able to provide you with helpful resources and/or referrals. If you do not ask, you will not get the answers, it is so important to be in control of your health.


Perimenopause (PM) can begin as early as 35 or as late as 55. The list of potential symptoms of this transition is long and wide, for more information I have written a previous article for BeEmpower (Issue #1) on this list, and it will vary from person to person.  Each woman will be on her own individual journey.


If you are already experiencing symptoms I suggest you keep a log for at least 2-3 months, including details as to when symptoms occur, how long they last, and any triggering factors such as foods, stress levels, and time of day. Especially keep track of your periods, including days between cycles, length (days) of the period, level of flow, and any associated PMS issues. Periods can get very inconsistent during perimenopause, sometimes the cycles are short, sometimes long, and sometimes skipped for a month or two.  Keeping a detailed log can help inform your provider where in the journey you may be. There are plenty of free, easy-to-use apps to track this data that you can find with a simple internet search. I have found the pre-installed Health app on my iPhone very user-friendly


The following are some suggested themes and questions to present to your trusted healthcare professional. Write these questions down, and bring a notebook to write any information you receive (remember brain fog and forgetfulness are one of THE most common complaints during PM) so you want to make sure you have a record of your visits for reference.


Discussion #1: When will I know I am in Perimenopause and/or Menopause?


The onset age of Menopause is usually similar among immediate family members so check in with your Mom and/or sisters to get an idea of what you can look ahead to.


There are plenty of resources on the interwebs about the signs and symptoms of menopause but it is a good idea to get a baseline for the most important concerns and when it might be appropriate to seek help. I am going to say, though, as a general rule, you know your body best so if you are having a bothersome issue then it’s always most important and something worthy of addressing. 


Discussion #2: I have been having the following symptoms ___________. What are the possible causes and treatments?


Don't be shy, lay it ALL out there, there is nothing to be ashamed of or have to suffer through. Likely everything you are experiencing is normal and it will not be that shocking to a medical professional. Consider bringing a friend or family member who can support you. 


Inquire about the varying tiers of intervention with questions like:

  • What lifestyle changes can I make instead of going on medications? Sometimes adopting a few healthy habits is all you really need

  • Are there any natural supplements? If you are not too keen on starting medications, there are some fairly well-researched vitamins, minerals, and supplements that can be added to help with hormone balancing, adrenal fatigue, etc.

  • What medications can help?

  • What are the potential side effects, risks, and benefits of the medications? 

  • What are the costs? 

  • How long after starting these medications will I know if they are working? 

  • Could there be anything else that is causing these symptoms? 

  • What tests can be performed to determine causes, and how much do those cost? 


Discussion #3: What is my personal risk for Cardiovascular Disease (CVD), Diabetes mellitus (DM), and Osteoporosis? 


The research and biology are pretty clear, the risk of CVD, DM, and Osteoporosis increases dramatically in post-menopausal women. This is mostly due to a loss of estrogen, which plays a much larger role in the body than its involvement in menstruation and pregnancy. In a previous blog post (https://www.elainemele.com/post/estrogen-the-super-hormone) I detail some of the other super important roles of estrogen that include: keeping blood vessels healthy, increasing HDL (good) cholesterol, reducing LDL (bad) cholesterol, speeding up the absorption of calcium needed for healthy bone structure, inhibition of osteoclasts (cells that break down bone) and aiding in the regulation of glucose (blood sugar). Phew. 


All women who reach menopause will have a significant loss of estrogen however, the risk of developing a chronic disease can also be influenced by your current stats of health, race, ethnicity, and geographic location.


If you find you are at a higher risk for developing one of these diseases, there are still ways to modify this risk, even with those factors that seem unchangeable such as race and ethnicity. So ask your provider: What can I do NOW to lower my risk? The sooner you start addressing any modifiable components the greater your chance of success. 


Discussion #4: Do you recommend I add anyone else to my health team during this transition?


This is the last, but very important question to ask. You all know the saying, “It takes a village…” and it really does. No one is an expert on everything and it often takes a team approach to address the myriad of components arising from the Perimenopause transition period. Don’t be concerned about hurting your provider’s feelings, likely (if they are a smart and supportive clinician) they will welcome the additional team members in order to provide the best care for their patients. 


Who else might you need (this list is not completely inclusive)? 


A Naturopath, if you prefer to take a more holistic route. A naturopath typically orders tests that drill down in finer details issues with hormonal balance, metabolites, stress responses, and prescriptives that include both medical and natural options. (www.naturopathic.org)


Functional Nutrition Provider: Functional nutrition looks at specific diet needs as a nutritionist would, but in the context of an individual’s physiological makeup and how they live, such as how often they move, the quality of their relationships, and their stress level. (www.integrativenutrition.com/blog/what-is-functional-nutrition)


Counselor/ Therapist: a licensed mental health clinician can provide additional support to address the mental health needs many women experience in mid-life (and any time of life, really!) including depression, anxiety, and overwhelm. (www.psychologytoday.com/us/therapists)


Physical Therapist (PT): A PT who specialized in Women’s Health, can provide a safe space to evaluate and treat the myriad of physical and sexual health issues that are very common during perimenopause and menopause such as vaginal dryness, painful sex (dyspareunia), urinary incontinence, pelvic pain, and prolapse. (www.hermanwallace.com/practitioner-directory)


Women’s Health Coach: I stress “Women’s” because we have different needs than men, physiologically, socially, and emotionally. A Health Coach is a wonderful resource to help you disseminate and organize all the information you receive and are experiencing around menopause. A specialized women's health coach will work with you to help select your best healthcare team. He/She/They can also help you set goals for healthy lifestyle change, and support you in achieving those goals by addressing potential obstacles and barriers and providing accountability. (www.integrativewomenshealthinstitute.com/provider-directory)


I hope you have found this article helpful, motivating, and in the spirit of this magazine, empowering so that you can be in the driver's seat on your health and lifestyle journey. The journey from perimenopause can be confusing, overwhelming, beautiful, freeing, and infuriating (sometimes all at once!). I hope you confidently seek out the support you need from trusted friends, loved ones, and professionals as needed. I offer both Physical Therapy and Health Coaching services for Women, and I am always honored and thrilled to inspire, educate and guide women through their own unique perimenopause to menopause experience. You can schedule a FREE discovery call with me at elainemele.com


Thanks for reading :)

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