Perimenopause and Self-Care: What Actually Works
It all begins with an idea.
In the world of perimenopausal health, everything seems complicated. Women are dealing with multiple symptoms and there are lots of “influencers” on the scene to solve their every ail! So, what is real? What works? And what should women really do if they are not yet ready for hormones but want to see some benefits?
Let’s start with supplements because, Lord knows, there are a thousand out there and if someone listened to every TikTok/Instagram/Facebook recommendation, the whole day would be spent taking pills (yep, with their own potential risks and side effects!). The Menopause Society has not endorsed any supplements for the treatment of perimenopause or menopause symptoms. But I will break it down into the 3 that I think are a good place to start and then one extra for all the girls with Hashimoto’s Thyroid problems.
Vitamin D. I cannot remember ever checking a patient’s Vitamin D levels, and barring them already being on supplements, having it in the optimal range of 50-60ng/mL. Vitamin D being low can make you feel fatigue and sometimes aid in brain fog. You can get it from the sun, but I’d rather you protect your skin than try to up it that way. So this means most women will need to supplement and getting around 2000 international units to 5000 international units per day is safe. Vitamin D is a fat soluble vitamin so you can technically overdose, but it is also slowly absorbed and therefore, as long as a patient is getting it checked, those dosages are safe. I have had patients note a significant improvement because of taking this as their only supplement. It may not be the only one you need, however!
Magnesium. This may be my favorite supplement. It’s versatile, coming in different forms, and it is generally well-tolerated. I had a friend who bought a shirt saying, “99 Problems and Magnesium fixed 98!” While that gave me a good laugh, magnesium may not be quite that accurate! You also must know the different variations of magnesium because they treat different things. Let’s look at the many forms that I recommend and what I use them to treat in my patients:
1. Magnesium Citrate: This can be found in a couple forms: liquid and pills. It is highly absorbable and is mainly used to treat constipation. It can increase a low magnesium number but it may also create a lot of number two…if you catch my drift!
2. Magnesium Glycinate: This is maybe my favorite of the magnesiums, although I love them all! It is the form that is well-tolerated, calms, helps with sleep, anxiety/stress, and muscle relaxation. I give it to patients with restless legs, new onset anxiety (that is not to a level where other meds need to be considered), and many women who share that they are stressed.
3. Magnesium Oxide: This form doesn’t absorb as well as some of the others and I will use for constipation as well, especially if Magnesium Citrate is causing diarrhea.
4. Magnesium L-Threonate: This is my go-to in the perimenopausal fogginess! This supplement offers cognitive support, memory help, focus, and brain health benefits. It is not going to treat/cure a dementia or a brain injury but it can certainly be a place to start when we start seeing small snippets of cognitive lapses.
There are more forms of Magnesium but I find these do most of the heavy lifting and the others are really used for very specific issues. If I was going to start on just one supplement, I would probably pick a form of magnesium.
Iron. Women are prone to iron loss because of menstruation. When we lose blood, iron dips and in the midlife when some women’s periods become heavier than ever, this can be a big source of fatigue, new onset restless leg syndrome, and decreased quality of life. A ferritin level is recommended as the source being checked, not just a hemoglobin or hematocrit (these are standard checks in your annual blood counts (generally ferritin and iron have to be ordered as add-ons). Ferritin literally means the iron IN your cells and if it is not there, it is not doing anything for you. I have seen numerous women with normal hemoglobin/hematocrit and REALLY low ferritin. So, adding iron may be helpful. Researchers are now looking at iron’s role in treating restless leg syndrome, which would be exciting if an element could be the answer to this issue that plaques so many!
And now for my women with Hashimoto’s Thyroid issues…Selenium. Selenium is something that has been study and there are some studies that point to the addition of Selenium helping with Hashimoto’s symptoms of fatigue, hair/skin/nail issues, etc. This does not mean that you should not take the meds your provider is recommending. In fact, you can add Selenium onto your med regimen.
So while there are a million and one supplements out there, many are not studied or don’t provide any robust improvements. However, these are a few that could be beneficial if you are looking for a place to start feeling better!
If you’d like to have a more thorough analysis of your vitamins and minerals, please make an appointment and Sapphire Wellness can get the right labs ordered and interpreted to get you started appropriately!
Follow back next week when we will continue on this self-care journey by discussing Perimenopausal Diet Shifts!
What Many Get Wrong About Menopause
If you are female and plan to live into your 60s, you WILL go through menopause! As old Ben Franklin is credited to say, “In this world, nothing can be said to be certain, except death and taxes!” But I would argue: death, taxes, and menopause (if you’re living beyond your early 50s). Women starting to actually talk about the issue, has jump started a revolution…one where women are taking control of their midlife health and aiming to have better quality of life through their 70s and 80s.
One of the many things that most get wrong about menopause is: When do symptoms start? The Myth: Menopause Starts In Our 50s
The answer to this question is: usually 10 years prior to actual menopause (a 12 month timeframe where you haven’t had a period/spotting).
For some women, this can mean symptoms start in their mid-30s! And often, when symptoms start this early, they are not addressed or are blown off at regular doctors’ visits. Things like feeling more fatigued, more anxious, achy shoulders, new inflammation, weight gain, changes in blood pressure readings or cholesterol despite not changing anything about your diet or exercise, just to name a few.
Why is this happening? The Myth: It’s Natural So You Just Have To Get Through It
Research reveals that estrogen receptors are everywhere in our body-in our brain, in our gut, in our blood vessels. Think of circulating estrogen like a cap on top of a boiling pan. As long as that cap stays on, there’s nothing to worry about (so inflammation is in better check, serotonin, insulin, and other circulating hormones stay in their regulated lanes), but when that estrogen level decreases and there are less caps on the boiling pan, things that weren’t a problem now become a problem. No longer are things staying tidy and in place.
Who can help me? The Myth: My GYN, PCP, or Endocrinologist Will Know What To Do!
Chances are…they don’t. Every medical provider is taught about menopause but the truth is, it is abysmally small amounts and generally doesn’t cover the many issues that women will face during the menopause transition and into their menopausal years. The general medical education usually gives clinician about 4 hours of dedicated menopause education. In 2017 the Mayo Clinic published a report that only 20% of OB/GYN residents felt “adequately prepared” to manage women in menopause! And another study found just 6.8% of all clinicians (remember estrogen receptors are everywhere!) felt adequately prepared to address menopause issues.
So, who are women supposed to see? The good news is we are starting to fill in this HUGE gap! Clinicians are seeing the value of having more education and a large thanks goes to the Menopause Society (NAMS) in North America and also our counterparts around the world. They offer trainings, continuing education and even certification to help clinicians be more informed in this area. Any woman with a computer/smartphone can search their database to find providers in their area. And if you are reading this, you have already found one! The menopause transition isn’t a one size fits all solution, women don’t have to just grin and bear all the potential issues they encounter, and how we handle the transition has a direct effect on how our quality of life is in our 70s and 80s.
Where do I start? The Myth: You Can Only Do Hormone Therapy and If You Do Hormone Therapy, It’s For The Shortest Time Possible, At The Lowest Dose.
The truth is, there is a wide range of options, hormone and non-hormonal, that can help women through this phase of life. We are getting new medications, like Veozah, to the market as we speak and with the Gen Xers not going quietly into menopause and much more social awareness of options, we will drive further breakthroughs in this category of meds. Supplements, diet and exercise, therapies like pelvic floor PT, CBT, and talk therapy have all been found to be helpful.
The truth is, you are an individual! Your transition into menopause is individual and what works for one person may not work for another. However, you deserve to have your concerns address and not be taken for granted! You deserve options to helping you thrive through this time of life! We are changing the way women will go through midlife for generations to come and it is so exciting to see my patients taking control of their health and really feeling better than they though was possible.
If you are looking for a provider that can really listen and hear YOUR issues and work to improve your health goals, book an appointment with Lisa today!