menopause

Zìjǐ Xiězuò (自己寫作) I Write for Myself: Shooting Blanks

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It was early in the morning; the sun had not quite decided to come up fully in the sky yet but there was enough light to shine on the streets below to make out the morning commuters rushing their way to catch the 25/34 bus. Gòng Gōng had yet emerged from the bedroom, and all remained in the darkness except the light in the opened dining room.

Xiǎo Yí was visiting, alone, curled up on grandparents’ pull-out sofa. Submerged in the shadows, I watched Pópo handing her a piping hot cup of what looked like black gunk that you would fish out of your bathroom sink. I heard low whispers between the two women as if there were some dire secret to be kept.

The preparation of the concoction filled the tiny one-bedroom apartment with an odd putrid bitterness which I recognized as Chinese herbs from the apothecary. Bàba always had a fondness of Chinese herbs which always had to be boiled into some bitter tea or soup or gunk, rather than just popping a neatly packaged pill or two.

The light from outside were filtering through the closed blinds and I can just make out Xiǎo Yí’s squinch nose with every small sip while Pópo dutifully watched over her. I observed the scene with curiosity eating my buttered toast before school and instinctively knew that this was some older woman thing, I was 9. Xiǎo Yí let out a small groan before laying back down and her voice broke through the darkness in an ominous tone, “this is what you have to look forward to (as a woman).”

That was my first introduction to women going through menopause. I understood that the symptoms varied and that it generally hit the women on my mother’s side relatively young. Xiǎo Yí was only in her late 30s and Māmā began her perimenopause in her early 40s. While I was not privy to any of Māmā’s physical discomfort, both my brother and I were intimately familiar with her mood swings, irritability, and anger, there was so much anger.

Now at 53, I’ve been experiencing the joys of perimenopausal symptoms on & off for about a year. Once every 45 days or so, my body would retain water, bloated, crave the nutrition-empty sort of carbohydrate, and a much lower tolerance for people’s antics as if my menstrual cycle was about to start … but then nothing. Sometimes there is so little spotting that it’s not even worth a tampon. This pattern of perimenopausal fun has been going on for over a year now but my family doctor told me that this could go on for a few more years and when I no longer experience any spotting for a consecutive 12 months, only then can I consider myself to be fully in menopause. I grumbled unmentionables under my breath.

The hot flashes had also come and go as they please. While inconvenient – to constantly take my sweater off then putting it back on, but certainly tolerable. Under the recent stress of being laid off, my hot flashes have evolved to a more boisterous version, especially at night. The constant shivering under the covers one minute and kicking everything off the next only to have beads of under boob sweat running happily down both sides of my body.

I had discontinued my beloved OTF membership and opted for just a plain old box gym at a fraction of the cost. The combination of decreased physical activity, emotional distress of looming unemployment, and eating way too much comfort food had all contributed to increased anxiety and disruptive sleep. When Puppy Horse (Great Dane) plopped himself on me as he does every night, all sudden I felt trapped, panicked, and felt my lungs could not get enough oxygen. I rudely shooed him off me, jumped out of bed and had to turn on the ceiling fan before I reasonableness would return. It was time to seek medical intervention.

I have been on Gabapentin 300mg once a day right before bed for a few weeks and while I still have some occasional breakthrough hot flash and sweat, I imagine once I get back to being regularly physically active, it should subside. I don’t know why menopause is such a voodoo topic. It’s like back in junior high school when all the girls know about the menstrual cycle, but no one ever really talks about it. The potential physical symptoms that can go with it. It’s just a very odd phenomenon.

Healthy Byte: What You May Not Know About Menopause

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Menopause mostly deserves its bad rap, what with frustration-inducing symptoms like hot flashes, brain fog, weight gain, and mood swings. But take this to heart: The change doesn’t have to be this big, awful thing you fear or must suffer through.

Unfortunately, 65 percent of women say they feel unprepared for what menopause may bring, reports a study in the journal Maturitas. But unlike other hormonally tumultuous times like puberty and pregnancy, you’ve actually got a lot more control over how you weather this one, says Sarah De La Torre, M.D., an ob/gyn in Seattle.

The facts and the tips that follow will help you feel ready and empowered to deal with menopause — and make these years your best yet.

1. Symptoms could last for 7+ years.

You officially reach the big M after 12 months without a period, a milestone most women hit around age 51. “But it’s not a hard stop — it’s a gradual process,” explains Felice Gersh, M.D., an ob/gyn, director of the Integrative Medical Group of Irvine in Irvine, CA, and author of PCOS SOS: A Gynecologist’s Lifeline To Naturally Restore Your Rhythms, Hormones and Happiness.

According to a study in JAMA, the median length of the whole shebang, as marked by hot flash symptoms, is 7.4 years total (roughly 3 before your last period and 4.5 after). In those years before menopause, your cycle can get erratic, your periods may grow heavier or lighter, and you might experience classic symptoms like hot flashes, sleep problems, brain fog, and mood swings, Dr. Gersh says. After menopause, symptoms linger as your body adjusts.

2. No, hot flashes aren’t random.

Up to 80 percent of pre-menopausal women and 65 percent of post-menopausal women experience this trademark symptom. And while you may not be able to entirely avoid hot flashes, there are ways to minimize their impact.

“Triggers such as stress, hot drinks, caffeine, and sleep deprivation can definitely kick off hot flashes and make them worse and more frequent,” Dr. De La Torre says.

Spicy foods, hot rooms, and tight clothing also turn up the heat. So avoid those things, and swap them for more sleep, healthy foods, and plenty of exercise.

3. You can still have sex — and enjoy it.

“A lot of women feel like sex won’t be as good after menopause or that it will be painful,” Dr. De La Torre says. Sure, waning hormones can leave the vagina naturally drier and less elastic, but you don’t have to live with it or let it kill your sex life any more than you have to live with a headache in the age of ibuprofen.

“Vaginal estrogen inserts, lubricants, and red light therapy can all help improve the health of your vagina and maintain your sex life,” Dr. De La Torre says. Surprisingly, while 50 percent of women experience vaginal dryness and painful sex, as many as 90 percent don’t seek help, reports Harvard Women’s Health Watch. So be like the 10 percent, and talk to your doctor.

4. You can still get pregnant.

“I’ve had quite a few 44-year-olds with surprise pregnancies,” Dr. De La Torre says. “I think some women get more casual about birth control in their 40s, thinking there’s no way they could get pregnant — but you’re still fertile, just less so.”

There’s another reason to keep taking hormonal birth control: It could help smooth your path through menopause. The steady dose of hormones in pills and IUDs means your body may not fully register the decline of natural estrogen and progesterone. In other words, symptoms might not be as erratic. “A lot of women have ridiculously heavy or erratic periods in perimenopause, and progesterone-releasing IUDs, especially, help avoid that,” Dr. De La Torre says.

5. Menopause doesn’t just affect your reproductive system.

Estrogen is the “master of metabolic homeostasis [a.k.a balance] and function,” Gersh says. So when production ceases, it impacts everything from fat production and distribution, appetite hormones and thyroid function to energy levels, sleep, mood, inflammation, and so much more.

That’s partly why up to 90 percent of women gain weight after menopause and why you may feel hungrier or more fatigued, Dr. Gersh says. Estrogen also helps manage cholesterol levels and keeps artery walls and blood vessels flexible and healthy, which is one reason the risk of heart disease jumps as the hormone declines. But you’re only in real trouble if you do nothing.

“Now is the time to start taking really good care of yourself,” Dr. De La Torre says. That means eating lots of fruits and veggies, exercising, practicing good sleep hygiene (no more scrolling social media in bed!), and reducing stress. All help prevent a dangerous pile-on of risk factors, keeping you healthy.

6. Your mental health might take a hit.

“Taking care of your mental health should be a huge priority,” Dr. Gersh says. “Women already have twice the risk of depression and anxiety as men, and that can escalate during the menopause transition.” Menopause symptoms also bring about extra stress (as if your kids flying the nest and aging parents who need care weren’t stressful enough).

You already know it feels good to vent or laugh your way through the tough parts of life, but research suggests positive social support can increase longevity in post-menopausal women, too.

Healthy Byte: Weight Management After Menopause

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Whether you’re currently going through the big M or have already gotten past it, you may have noticed that losing weight is more difficult—and “it’s not just in your head,” says Amanda Horton, MD, an OB-GYN at Johns Hopkins Medicine. “It really is harder to lose weight [during this period].”

Indeed, women gain, on average, 1.5 pounds per year in their 50s and 60s, notes Dr. Horton. That’s because low estrogen levels during menopause can alter the balance of leptin and ghrelin levels—the hormones responsible for managing hunger—and increase appetite. Thyroid issues, stress, sleep problems, and certain medications can also contribute to weight gain.

“All the things that lead to weight gain also make it difficult to lose weight. But we do know it’s possible. It just requires continued effort,” says William Yancy, MD, program director for Duke Diet and Fitness Center.

Women who are going through menopause also tend to store more belly fat and lose muscle mass. “Despite following the same diet and exercise routines they’ve had for years, they still gain weight. If you decrease muscle mass, you burn fewer calories at rest,” Dr. Horton explains.

That said, there are things you can do to help you lose weight post-menopause and offset the symptoms of lower estrogen levels. Keep reading to learn how.

Try interval training

When it comes losing weight through exercise, cardio workouts are still the gold standard. But high-intensity interval training (HIIT) has been shown to be more effective for burning fat and building muscle than low-intensity, steady-state (LISS) cardio.

“Some studies suggest that HIIT can improve overall strength and increase endurance, especially in those 65 and older,” says Liana Tobin, CSCS, personal trainer coordinator for the National Strength and Conditioning Association. “For muscle mass, a combination of HIIT and strength training would likely yield the best results.”

Both Dr. Horton and Dr. Yancy recommend working out at least 30 minutes per day, five days per week—but if you’re doing intense workouts that leave you breathless, you should aim for three 20-minute sessions per week.

Healthy Byte: Perimenopause: Symptoms, Signs and Treatment

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Struggling with irregular periods, extreme bleeding, vaginal dryness, loss of libido or migraine headaches? All of these symptoms could spell the start of the perimenopause.

The precursor to the menopause, perimenopause is a time of transition for women, when the ovaries gradually start to produce less oestrogen.

While symptoms are usually less severe than the menopause, this phase can nevertheless see you suffer from very real symptoms, including irregular periods, changes in mood and hot flushes. Here’s everything you need to know:

What is perimenopause?

‘Menopause occurs when the ovaries stop releasing eggs,’ explains Aly Dilks, clinical director for The Women’s Health Clinic. ‘By definition, menopause is diagnosed in hindsight – the absence of periods for one year is diagnostic of menopause. But we all know our bodies don’t work like a switch – on one day and off the next.’

‘For a few years preceding menopause, our ovaries start running out of eggs, and release them on and off,’ adds Dilks. ‘Hence irregular periods are very common before menopause, and this period is known as perimenopause. There is no ‘golden age’ that perimenopause starts, as it’s more of a gradual process. The majority of women go into perimenopause less than five years before menopause.’

What are the symptoms of perimenopause?

Perimenopause symptoms can be similar to the menopause, albeit usually less frequent or severe. Abbas Kanani, pharmacist at Chemist Click, offers this checklist of symptoms:

  • Irregular periods: this is the most common sign of perimenopause, as your ovulation pattern starts to vary.
  • Insomnia: sleepless nights may be as a result of hot flushes, but can also be caused by emotional changes.
  • Decreased libido: lower levels of oestrogen during this time can mean you lose your appetite for sex.
  • Uncomfortable sex: this is due to a decrease in oestrogen levels, which means the vagina doesn’t lubricate well. TRY THIS!
  • Changes in mood: lower oestrogen levels means less serotonin (one of the ‘feel-good’ hormones), which can lead to your emotions being thrown off balance.
  • Increase in cholesterol: as oestrogen levels decline, HDL (good cholesterol) also experiences a decline, which can have a negative impact on cholesterol levels.
  • Hot flushes: these are not as common as they are in menopause, but they can still happen.

Can you treat perimenopause naturally?

The good news is with just a few simple lifestyle adjustments you can sail through this phase of your life. Kanani offers the following advice:

🔹 Exercise

Lower oestrogen levels can cause ‘feel-good’ hormones, such as serotonin, to drop. Fitness can have a positive impact on your mood and help to stabilise your emotions. Regular exercise can also have a positive impact on your sleep quality, as well as helping you to feel re-energised.

🔹 Eat well

Not only will eating a healthy and balanced diet help to reduce your cholesterol level and provide you with the right nutrients, but it will also help you feel good about yourself. Certain foods, such as caffeine and alcohol, can trigger hot flushes and affect your mood, so try to avoid these.

🔹 Meditation

This is often undervalued in perimenopause, but you are essentially entering into a new stage of your life where your body is experiencing changes. It’s important to recognises this, so take a few minutes each day to meditate and change your frame of mind. Coming to terms with these changes increases your chance of winning the mental battle. Being still and focusing on your breathing allows your thoughts to settle, helping you to feel calmer and in control. Meditation can also have a positive impact on your sleep.

However, if you’re attempting to ease symptoms naturally with no luck, you are not alone.

‘Exercise, staying fit and healthy, and avoiding refined sugars can help with symptoms,’ says Dilks. ‘However, if the symptoms are severe and are affecting your quality of life, lifestyle modifications are not likely to help. Many herbal medications are available over the counter, but caution should be taken before using them, as some may contain unopposed oestrogen.’