Content from an interview with Dr. Azra Shaikh, by Maggie Brown

Recently a colleague and I gave a presentation about menopause to a group of Blue Cross and Blue Shield of North Carolina (Blue Cross NC) employees. It wasn’t a widely promoted event, but there were more than 60 women in attendance – fully engaged and asking great questions.

I’m not sure this kind of event would have taken place just five years ago, and certainly not when I was in medical school. The conversation around menopause has changed dramatically over the past few years – it’s much more open and empowering. 

Along with raising our teenagers and worrying over our elderly parents, it’s the topic that comes up most when I’m with my friends. There are books and podcasts, and products, and entire health care companies all focused on perimenopause and menopause. 

Even with the plethora of information out there, or maybe because of it, it can be an overwhelming and confusing time for women. I’m here to tell you that it doesn’t have to be that way, and that help is available. 

Menopause is technically one year from the date of a woman’s last menstrual period. It’s one moment in time, but we use the word broadly to talk about this stage of life. The average age of menopause is 51.¹

Perimenopause is the timeframe leading up to menopause. This can be a few years, or it can be up to a decade. The fluctuation and gradual decline of estrogen and progesterone during perimenopause and menopause can cause a variety of symptoms. There are the better-known hot flashes, but also lesser-known symptoms such as sleep disturbances, mood changes and depression, as well as joint aches and pains.

If you think you’re in perimenopause, then you probably are. There is no one definitive test that tells you this. Because hormone levels fluctuate during the transition period to menopause (and really day by day), perimenopause is usually a clinical diagnosis, drawn from a reporting of symptoms such as hot flashes, brain fog, fatigue, insomnia, joint pain, and mood changes.²

The great news is that there are effective treatments available that have been around for a long time and are widely considered safe for most women. The main treatment option is Menopausal Hormone Therapy (or MHT), previously called Hormone Replacement Therapy (HRT), which replaces declining estrogen and eases related symptoms.

Generally, both estrogen (usually in the form of a patch) and progesterone (usually as pills) are prescribed. The progesterone keeps the estrogen in check – without it there is an increased risk of uterine cancer. For women who have had their uterus removed, they only need estrogen. 

Other treatment options can include a selective serotonin reuptake inhibitor (SSRI) such as Zoloft or Paxil, to help treat mood disorders, and topical estrogen cream for vaginal dryness and to prevent urinary infections. 

MHT got a bad rep from a Women’s Health Initiative study in 2002 which showed a potential for increased risk of breast cancer and heart disease among study participants. This, along with heightened media coverage of the study, made the use of MHT plunge dramatically for the next 20 years. 

It eventually came to light that the average age of women in the study was 63 – well past the average age of menopause, making the results inapplicable to perimenopausal and newly menopausal women. The study is now considered misinterpreted and flawed.

Today’s MHT is more advanced and safer than it was even 20 years ago.³ We also know more about how important replacing these hormones can be. The long-term effects of estrogen deficiency can include increased risks of osteoporosis, heart disease, and possibly dementia.⁴

The first step is to reach out to your primary care provider or your gynecologist. Schedule an appointment to discuss symptoms. Your physician may do some tests to rule out other conditions that can cause similar symptoms, like thyroid issues or diabetes. 

Talk with your physician about treatment options. Menopausal Hormone Therapy is generally safe and effective for most women without contraindications (a personal history of certain types of cancer) who are within 10 years of menopause. 

You may have to advocate for yourself in getting prescribed what you need. Most physicians, myself included, did not have much training in the treatment of menopause in medical school. With it being more and more a part of our cultural dialogue, physicians are becoming more informed, and this is a trend I hope to see continue. 

Your social media algorithm may be full of ads for supplements, weighted vests, and recipes for how to get more, and more, (and more) protein. There’s so much out there, but I like to keep things simple. In addition to hormone therapy, I always recommend:

• Calcium and Vitamin D for bone health
• Protein to maintain muscle mass
• Omega-3 fatty acids for heart health
• Fiber to support heart and gut health
• Weight bearing exercise for bone health 
• Aerobic exercise for heart health

With the decline in estrogen also comes a decline in metabolism, so many women find it harder than ever to lose weight. This, along with the decline in energy levels, can feel like a cruel twist of fate. You may have to double-down on your nutrition, sleep, and exercise, and give yourself a lot of grace. 

For me, I walk most days and do Pilates at least once a week. I eat an easy, high-protein breakfast every morning and drink a lot of water throughout the day. My goal is to maintain a healthy daily lifestyle. You have to find what works for you. Start with one or two healthy habits at a time – don’t try and do everything at once. 

While perimenopause and menopause can present challenges, support is available. This stage of life also brings confidence and clarity and an appreciation for life’s experiences – and we’re not letting menopause hold us back. Let’s keep the conversation going.

Some Blue Cross NC health plans include membership in Progyny, a women’s health company that offers menopause and midlife care. Check with your insurance plan benefits, or your employer’s benefits manager, to see if your plan qualifies. Members receive coaching through in-house advocates to manage symptoms, and have access to credentialed, menopause-trained providers.