Oh hey, I’m Abby, and I’m in menopause.
It has taken me a really long time to get up the courage to admit that to all of you. This is a coming-out of sorts, although I wish I didn’t have to feel that way.
Why would a dietitian want to write about menopause? Easy. So much of menopause involves changes in our bodies, struggles with balancing health (including nutrition) with other life demands, and unfortunately, issues with body image. and I want to give you all the straight story – considering that by 2025, 1.1 billion women worldwide will be menopausal.
Society views women as either young and hot, or old and invisible. As a woman on the cusp of her 50th birthday (December 16th, y’all), I fall squarely into the no-woman’s land that is midlife.
I always felt that revealing my age and menstrual status, if you will, would show me as old and undesirable for both my audience and potential collaborators. I’ve realized though that these feelings are a submission to the patriarchy and its narrative that young is ALWAYS better, always more capable, and always more desirable in every way.
Screw that. I’m so done with it.
I think I have a lot to offer not only with the work I do and content I send out into the world; I can also help to erase the stigma and myths around menopause and the menopausal transition.
In other words, why hide it, when other people can benefit from me speaking out?
What is menopause?
Menopause, for women who have not undergone surgical menopause, is when you’ve gone 12 months without a period. It can take forever to happen – I used to joke with my doctor that my ovaries were breathing their death rattle for years. I started perimenopause in 2012, when I was 40. I am now 49.
Your periods might start getting lighter or heavier, you might start skipping a month here and there, and then skipping more often than that (that’s what happened to me). During perimenopause, or the period before menopause, you may start having symptoms, like hot flashes and bloating.
There’s a lot of toxic positivity around menopause, and I want to avoid that sort of thing. ‘You’ll get through it!’ or, ‘think positive!’ I think diminishes the fact that some women have very prominent and disruptive symptoms in perimenopause and menopause.
When I say the words ‘menopausal woman,’ what do you think of?
Is it someone with grey hair?
Someone in their 70s or older?
A woman who is wrinkly and saggy?
Surprise! Here’s a list of women you might know, who are all in menopause:
And, quite possibly, my bestie Gwyneth Paltrow.
Yup. Unless they’re some sort of miracle of nature, they’ve all gone through this change.
Menopause isn’t all hot flashes and dry vag. In fact, it may be none of those things for some of us. It’s a new chapter in our lives, one that’s unfettered by worries over accidental pregnancy and whether you’re going to get your period in your new white pants. It’s also an era that begs for us to come together as a sisterhood, to fight the stigma around the end of menstruation.
Thanks to the patriarchy, menopause has always been kept in the shadows, like the women in it. We’ve been told, just by society’s attitudes, that menopause isn’t ‘sexy.’ That once you’re out of your childbearing years, you’re no longer a ripe peach that’s begging to be bit into: instead, you’re dried up like a prune.
Heck NO. SNAP OUT OF IT!!!
None of that is remotely true, so let’s start talking about what’s real:
Menopause isn’t shameful.
Menopausal women – and women in general – are still beautiful, no matter what age we are.
We are still vital.
We aren’t ready, and may never be ready, to be put out to pasture like old cows.
I, for one, am still here, and I feel great.
So, gather round, everyone. Here’s what I want you to know about menopause:
Menopause isn’t something that needs to be ‘cured.’
I know that our culture loves a good wellness cure, but listen up – menopause is a completely natural physiological state. The fact that your body is changing and you might not fit into your jeans anymore is going to bring out all sorts of scammers, promising to help with the symptoms of menopause.
I’m looking at you, *Provitalize* and your ‘thermogenic probiotics to cure menopausal ‘muffin-top.’
Give me a break.
Vogue Magazine recently did an article on how menopause is finally being noticed by the wellness community. While I think that in some ways this is a good thing, it’s also had a darker side.
Menopausal women are now the target for a whole new category of supplements and diets like the Galveston Diet (read my post about it here) and anything by Sara Gottfried. No, your hormones don’t ‘reset’….under any circumstances.
Amanda Thebe, author of Menopocalypse, had this to say:
Everywhere you look there are menopause products and diets. Marketers aren’t stupid. They know that middle-aged women have more disposable income but are also likely to be more vulnerable, even desperate. Menopause can leave them feeling like they don’t recognize themselves, so when some savvy company promises to fix what is broken, the pull can be strong. But it’s sleazy and unethical. Using ageist and predatory negative tactics, they promise women the world and they don’t seem to care that what they’re selling is not grounded in any evidence. They literally see us as an easy target.
Infuriating, right? We don’t need to be ‘cured,’ thank you very much.
Yes, menopause (and perimenopause) can have some life-disrupting symptoms for some women. Hot flashes, brain fog, itchiness, sleep issues, constipation, diarrhea, bloating are a few. You don’t have to tough those out – your doctor may have solutions for those things.
If alternative treatments seem to give you some relief, this is also good. I don’t want to discount things like bioidentical hormones (NOT the same as compounded hormones) and supplements completely (I often take magnesium for sleep), but I do want to warn you that the marketing and the claims used to sell some products are disingenuous and often misogynistic.
Hormones aren’t scary, but you need to take the right ones.
Whether or not to take hormones is a very personal decision, which brings me to another point – in menopause (or not), no one thing is right for everyone.
Menopausal Hormone Therapy (MHT), is what we now call ‘HRT.’ Turns out, we don’t have to ‘replace’ missing hormones.
As Jen Gunter, M.D. writes in her book The Menopause Manifesto, ‘HRT falsely implies that estrogen or other hormones are missing because of a medical problem, and the low levels of estrogen after menopause are biologically abnormal.’
I personally have found MHT to be helpful for menopause symptoms, especially for sleep and for hot flashes. Do I still get symptoms of menopause? For sure – but I think they’re less. I also take hormones because of their protective effect on my heart and bones, and because my risk level is low. That’s me, but MHT for you personally is something to research and speak to your doctor about. As with anything, there are risks to MHT, although maybe not as much as the media would like us to believe.
For example, as Gunter outlines in her book, there’s a 9 in 10,000 risk for blood clots with MHT.
In pregnancy though, that risk is 5-20 for every 10,000 pregnancies. Nobody is out there telling women not to get pregnant because of the blood clot risk, but suddenly MHT is too high of a risk?
The one menopause hormone therapy I’m going to caution you against is unregulated hormones and/or pellets. These are custom compounded and are often marketed as ‘safer,’ because they’re ‘natural,’ which is total BS. They’re completely unregulated and, as Amanda Thebe says, ‘you have no idea when the quality of compounded hormones are, they could be mixed with sawdust and mouse sh*t for all you know.’
Unregulated bioidentical products have been found to have inconsistent dosage labelling that can lead to users receiving a higher or lower dose than what they need (and what is safe). Please stick with FDA approved products.
As far as getting phytoestrogens from food, there’s no evidence that suggests that this works. In fact, phytoestrogens, while similar in structure to endogenous estrogen, don’t work in the same way. By the same token, according to the AICR, soy and flax don’t increase the risk for breast cancer (or any cancer), and are very healthy, fibre-rich foods. I recommend including them in your diet.
You’ll have body changes during menopause, and that’s okay.
While we as women may face pressure to look young for as long as possible, realistically 1. that sucks and 2. it’s almost impossible.
Along with aging and declining hormone levels comes changes to your body. Even with hormone therapy, I’m seeing changes like a thickening waist and crepey skin. I’m not saying it’s an easy transition, either – for me, it seemed to happen overnight.
One day I was my normal self, and the next day, I looked in the mirror and was like, ‘whoa! What the heck just happened…aka where did my waist go?’
It’s an adjustment to see your body changing, but bodies change, and that’s okay. While there are several reasons why women may gain weight during menopause, what many of us are seeing is a weight redistribution: lack of estrogen leads to fat to be redistributed around our midsection.
As far as metabolism, recent research shows that metabolic rate stays mostly stable from age 20 through to age 60, at which point it starts dropping very slowly.
Where we used to believe that menopause precipitated a slowing of the metabolism, we now know that it likely does not.
Still, many women complain about weight gain during this time and beyond. When I’ve looked closely at some of these women’s diets, I found some recurring challenges:
Alcohol consumption. I know, I bang on and on about how women drink too much. But we do, and not only are women getting ill and dying from alcohol-related diseases like never before, alcohol is also a source of calories.
And while I don’t recommend calorie counting for most people (read why, here), calories still factor in to weight. If you’re drinking several times a week, this may be affecting your health and your weight. So can restaurant meals. Being social is important, but if you’re eating takeout or restaurant food often, you may want to cut that back as much as you can.
Diet hopping. On one diet, off that diet. On to the next diet, off that diet. In their bid to lose a couple pounds, you may find yourself diet hopping. But if you’re frequently restricting and in the mindset of ‘on-plan’ and ‘off-plan,’ this may fuel compensatory overeating. It’s also tough emotionally, which, let’s face it – do we really want MORE emotional challenges at this time of life?
Many of the diets for menopausal women serve up a mostly unsustainable, joyless combination of keto and fasting, which you don’t have to submit yourself to. In fact, if you encounter any diet plan that’s targeted to menopausal women, I recommend that you consider it a red flag until proven otherwise (you can always send me a screenshot of the diet site and I’ll take a look at it for you).
What you want to aim for is consistency, and I don’t mean ‘consistently being on a diet.’
Base your meal off of protein and plants, and eat as much fibre as you can. When I plan my meals, I choose a vegetable, then a protein. I of course eat carbs too, because I run on carbs…but whole grains and starchy vegetables are what I choose most often. (Ezekiel bread is my favorite).
Also, aim for 25 grams of fibre per day. Reduce the number of ultra-processed foods you eat.
Being distracted by life situations. Life at this age is really, really full for a lot of us. It can be hard to eat the way you want to, find time to be active, and deal with stress. Sometimes, we just can’t avoid these things. Prioritizing sleep (I know, easier said than done), saying ‘no’ to events and projects that tip the scale to OVERWHELMED, and setting boundaries with people who make things more difficult for us can help.
Not exercising. No, exercise hasn’t been shown to help a great deal with weight loss. But it sure can give you an outlet for stress, as well as keep your heart and bones healthy, and help retain muscle mass. Even fitting exercise into your day may be tough, but your workout doesn’t have to be super strenuous or even all that long.
I always tell people that any activity they do, over and above what they’ve been doing, is helpful.
Even though menopause and menopause symptoms might sound scary, if you haven’t gone through it yet, know that you won’t necessarily have major issues.
Embrace your age and your changing body – this is a time to connect with other women, learn about what’s happening to you, and to embark not on a mission to stop time, but to make the most of it. Use this time to connect with other women and collaborate (and commiserate if needed).
There are a lot of reputable perimenopause and menopause resources out there, including Thebe and Gunter’s books. Thebe has an exhaustive list on her site, which you can access here.