Menopause Memo

07/10/2023

Menopause Memo: Running

I’ve been a runner since age 10 when my dad took me out for my first jog in the neighborhood. Upon returning home, I caught a glimpse of my flushed, sweaty self in the mirror and knew I was in love with running. I have also known so many people who loathe to run that I’ve never been one to try to make runners out of self-proclaimed non-runners; it just feels like I’d be putting too much pressure on them, promising something that might never blossom into the love affair that I have had. But as the years go by, the benefits of running just continue to rack up and I have to sing its praises for all to hear.
I run for its physical benefit to my heart and muscles for sure but also for what it does for my brain. It is my main source of STRESS REDUCTION. Running can boost my mood, dissipate my frustrations, and hold a space for working through challenges either on my own or while chatting with running buddies. Many things can “bubble to the surface” while running solo and with the boost of endorphins or “feel-good” brain chemicals by the end of a run, I am full of energy, mental sharpness, and fortitude to address any issue, solve a problem, create a solution; I am jazzed and “on fire”. My husband frequently has to say, “Take it down a level,” for all of the thoughts, connections, and bright ideas pouring forth immediately upon my return from a run. Emerging studies from the neuroscience of fitness show exercise actually increases the levels of brain neurotransmitters that are mood regulators as well as triggering the growth and development of new neurons and synapses. Not only is physical activity associated with reduced symptoms of depression and anxiety but the growth of new cells and synapses counteract cognitive decline and improve memory. Additionally, the area of the brain responsible for various cognitive functions appears to improve with exercise likely due to increased blood flow which delivers more oxygen and nutrients to the brain improving attention, working memory, and executive function, all areas which suffer as we age in general but especially as we go through menopause.
Regular physical exercise also helps improve SLEEP quality, a critical factor in brain and body health and something frequently diminishing as we age and go through menopause in particular. During sleep, our body repairs muscles, new neural connections are reinforced consolidating memory, and toxins are cleared from the brain and blood.
To be fair, it is not just running that induces these benefits but any regular aerobic exercise. Swimming is a popular substitute which has been shown to have the exact same beneficial effects but you have to love the water, getting wet, and wearing those tight little swim caps and goggles. Can you tell I’m not in love with swimming? In any case, with such a powerful role in improving not only our physical selves but our mental state as well, it is important to try to incorporate some form of regular aerobic exercise into our lifestyle. To all the run-haters, if swimming isn’t going to do it, I would start with walking for 30 minutes. Then transition to a walk-run program alternating one minute of running with the same of walking. Gradually increase the time spent running with interspersed one-minute walking breaks. Even if you never move beyond the walk-run to the goal of running non-stop for 30 minutes, you will still reap the benefits of aerobic exercise detailed above and are still called A RUNNER! So give running a try and reap the amazing benefits for your body and mind. Always check in with your primary care physician for a green light to start any new exercise program.
For getting started also check out:
https://www.menopause.org/for-women/menopauseflashes/exercise-and-diet/exercise-for-busy-people-making-time-for-your-health

06/26/2023

It is Monday so that means it is a strength training day. I am following a plan set forth by an online running coach coachparry.com that I started 2 years ago. I have been a runner most of my life. One of the absolutes about running, sadly, is you WILL get slower as you age; there is even a mathematical formula that calculates the typical rate of decline. And MENOPAUSE will also contribute to that loss of speed with a decreased ability to build muscles as estrogen declines. I had been getting minor overuse injuries and when I happened upon this coaching program, it promised Women In Menopause a solution to declining performance and minor injuries; not that the age-related decline wouldn’t happen but that it might have less of an impact and certainly wouldn’t be accelerated. I jumped in with two feet and have never been better. I don’t mean never been faster. For sure I was faster just a few years ago BUT at the expense of irritating a certain muscle (looking at you, Piriformis!) or the dreaded iliotibial band (ITB). Now with twice weekly 45 minute strength training sessions, I have gained core and gluteal strength in particular but also with a comprehensive program including the upper body as well, my arms remain strong and toned, too. For this activity, no gym is needed! No special equipment is required but can be added as one progresses. Body weight only is typically all that is used; sometimes mini-bands (https://www.amazon.com/s?k=minibands+pack&crid=2RM4VGZ2V60WD&sprefix=minibands%2Caps%2C138&ref=nb_sb_ss_ts-doa-p_1_9), light weights (3lbs), or even a kettle ball might be used if one has been in the program for a while and progressing in intensity.
Not only has strength training allowed me to run with less injury, it has also allowed me to train with more intensity, and in the long run will deter the development of SARCOPENIA which is the loss of muscle mass which happens in menopausal years. This type of muscle loss can have a detrimental effect on bone which increases the risk of OSTEOPOROSIS or brittle bones more likely to break. Weaker muscles also affect STABILITY and BALANCE which can increase the risk of falling and therefore fracture risk as well. So if you’re heading into menopause, in addition to aerobic exercise, consider incorporating a program of strength training to your exercise regimen, concentrating on proper form to gain the most benefit and lessen the risk of injury or strain. The requirements are fairly minimal to get started as stated above: an area maybe 10’ x 10’, a yoga mat or something to cushion knees especially if not a carpeted surface; a sturdy step and/or a chair that can be used to step up on, be sat upon, and/or be used for balancing.
Here is a simple routine to get started: https://www.nytimes.com/guides/well/strength-training-plyometrics
Or for more information on osteoporosis prevention with exercise, visit:
https://www.bones.nih.gov/health-info/bone/bone-health/exercise/exercise-your-bone-health
https://aging.ohio.gov/care-and-living/health-and-safety/fall-prevention/exercise-to-prevent-falls-1

06/19/2023

Menopause Memo:
It’s 3am and I’ve awoken for some unknown reason once again. Then I feel the whisper of a rumble that within a few seconds has progressed into a full-fledged hot flash to be followed by a sweat. If I’m covered up in blankets, they need to be thrown off to release all of this raging heat and within a few minutes replaced as the sweat has cooled off the body and chills will surely follow. Sometimes I awaken in the midst of a hot flash or night sweat but just as often I awaken right before it; maybe there is an electrical signal that precedes the flash that I cannot sense but it awakens me nonetheless.
Two hours later, I’m still awake and I’ve decided to do this blog! I’ve gone thru many possible topics to address, thought about audience, tone, frequency, and the rights to intellectual property. I’ve thought about what I might make for dinner tonight, what to cook this weekend, and what leftovers I still have in the fridge. I’ve reviewed what I might wear to various upcoming events, what items my wardrobe might still need, and what shoes will pair well. I’m three years into the menopause so early mornings like this are not new to me. But thankfully there is no longer a panic about not being able to fall back asleep because I don’t have to get up to run today nor get to an early job. A few months ago, the additional layer of panic overlying these early AM awakenings made me so worked up that falling back asleep was all the more impossible. Not every night is like this though. Some nights I sleep very well and never feel like I had any temperature instability at all. Some nights I wake up for less than a minute and notice I am sweaty but fall back asleep notwithstanding. Why these events have yet to diminish in frequency or severity after three years is perplexing. When I have a good night, I think optimistically that improvement is certain and the end of them imminent! When I am yet again wallowing in sweaty damp sheets and pjs, I begin to consider options, the scope of which I know very well, having shepherded many women thru this stage and these symptoms many times. These annoying temperature variances are “VMS” or vasomotor symptoms and they are the most common manifestations of the menopause transition and beyond. They are called “hot flashes” and when they happen at night “night sweats” and a range of remedies do exist from behavioral changes to OTC products to prescription medications.
There is scant evidence to support most of the behavioral modifications but I’m not above trying simple, free fixes if they might work. The room is already kept cool, with a ceiling fan going. I’m not drinking alcohol, didn’t have spicy food last night, and can’t really sip on cold beverages at night. I’ve considered special expensive sheets. I’ve even tried special nightwear specifically for menopausal women but didn’t think it changed anything about my experience except lightening my wallet considerably. There are herbal over-the-counter products I could try but strong efficacy data is lacking. Dietary changes including more soy may show some possibility of improvement but the amount of soy day in and day out would be overwhelming even to me, someone who eats edamame and tofu with regularity already. The most recent NAMS (North American Menopause Society) publication (https://www.menopause.org/docs/default-source/professional/2023-nonhormone-therapy-position-statement.pdf) on non-hormonal options does show some evidence for both hypnosis and CBT (cognitive behavioral therapy) but I am not ready to pursue either of those. I would have thought a discussion about starting medication would have been most likely relevant in year one or two of menopause but for some reason, my body just loves this switch-on-the-heat-pump thingy and doesn’t want to stop it anytime soon. They are still frequent and severe! So here I am in year three contemplating prescription options. I’m going to see how the next couple of weeks go and then we will dive into a review of the HRT option and non-hormonal alternatives in future posts. But here’s to hoping they just vanish into thin air…
flashes sweats
Photo credit: unsplash.com/

06/12/2023

Welcome to Menopause Memo! I am so glad you’re here. This is a space where I hope to educate, enlighten, and empower midlife women with regard to the many changes and challenges brought about by this stage of our life called MENOPAUSE. You may be curious about what’s ahead, confused or frustrated by what you are experiencing, or hoping that the transition and symptoms are over and you have survived the worst of it.
As a Board-certified gynecologist, women’s health has been my focus and passion for the past 30 years. And I am here to announce that menopause is having a MOMENT! From a thirty second ad during the Super Bowl to define VMS (https://www.youtube.com/watch?v=JsNIh6azVYc) to a NYT cover article https://www.nytimes.com/2023/02/01/magazine/menopause-hot-flashes-hormone-therapy.html?unlocked_article_code=-nJmgmLoXRWqkJ56Z5FUMgRpDb8eJD6v2vSCff0RF9Pmfx2S-Pt8tk8_oUj_NpOx_Y9CdAX7fDLS-TBpWxn1QHbs6alKXpR2KcUm1WYFRZO1LisFMIjqkit7r66o0Zyf1UOzJWzvY2kXWxfhjY5oVVF3zYCpq4wxeU5o1oCMqmnUSRTcLk8tJ7fjRfcwccsDTN2gnd4BeAjVX8jlijjGA4ZwzV9qc6cF8NPF3dH_3zaWykrRMh1cz7xKNAMy2S0GSoO2sBFW_8HtgHFNgn2Ec6cYDrB-xKRtCJHql5ncP3CnWnUooE8pPDYJhnk1m3atXeiz_pRmCcQLaXuOuxiuhItMbcAxsO_Kmw61UmwIAJ7G&smid=nytcore-ios-share&referringSource=articleShare regarding the silent suffering women have had to endure, to an Oprah lead panel and Masterclass on Menopause,
https://www.google.com/search?q=Oprah+masterclass+menopause&ie=UTF-8&oe=UTF-8&hl=en-us&client=safari =ive&vld=cid:35f7d72e,vid:aI_ZHubzc_k it seems that it is finally time to be able to talk about menopause and its myriad of symptoms in an open and honest way. Hear this: ALL women at some point are going to go through menopause! But that journey and the symptoms involved are not one-size-fits-all. Naming, normalizing, and validating these symptoms does a tremendous amount by itself but opens the door for a discussion of the available treatments as well. Join me as we look at various aspects of menopause and I relate stories, opinions, tips, and tidbits!

Hot flashes, sleeplessness, pain during s*x: For some of menopause’s worst symptoms, there’s an established treatment. Why aren’t more women offered it?