THere’s a hilarious sequence of events in Miranda July’s latest book, All Fours, in which the main character looks at a graph that shows how estrogen plummets during menopause. Worried about what this might mean for her libido, she desperately asks her older friends about their experiences, gathering anecdotes and advice in a valiant effort to prepare for the onslaught.
But can you successfully go through menopause peacefully? Many women in their thirties or forties may be asking themselves this question, knowing that this momentous life transition has finally arrived.
“And that’s a good thing,” says Dr Karen Magraith, a GP and past president of the Australasian Menopause Society, because “it’s always good to talk about menopause.”
But with the growing awareness, some women may be worried about what lies ahead, and an entire industry has sprung up offering solutions and serums to ease their worst fears. Meanwhile, some women remain in denial or ignorance about what lies ahead.
With its range of potential symptoms, from hot flashes to low libido and weight gain, to mood swings, insomnia and memory problems, it can be a daunting prospect. But it doesn’t affect everyone equally, and much of what women experience during menopause is beyond their control.
Regardless, making a few early adjustments before or even during perimenopause—a transition period that can last anywhere from two to ten years—can help lessen the impact on our bodies, brains, and relationships.
Magraith says there are two ways women can prepare: “One is to educate themselves and the other is to adopt a healthy lifestyle.”
“The women were angry”
In a 2022 survey of perimenopausal women to determine their attitudes and knowledge about menopause, lack of education was a key issue: “Women were angry that they had reached this stage in their lives without knowing how perimenopause would affect them,” wrote Joyce Harper and her co-authors. “They spoke of their own woeful lack of preparation that left them feeling helpless and losing confidence in themselves and their bodies.”
Dr Michelle Woolhouse, a GP specialising in integrative health and author of The Wonder Within, compares menopause to adolescence. Remember the tumultuous teenage years, when our bodies released those tiny but powerful hormones onto us – and our poor parents? These powerful little chemical messengers prepare us for reproduction, with another major surge occurring during pregnancy and childbirth.
Menopause marks the end of this reproductive cycle, which typically occurs between the ages of 45 and 55. During this time, fluctuations in hormone levels can cause us to question our mental health.
So what can we do?
“The secret to a healthy menopause is lifestyle,” says Woolhouse. “I’m seeing more and more people coming to me with the intention of being more proactive, which is fantastic to see.”
Become strong
When it comes to preparing for menopause, healthy living principles apply more than ever, according to Dr. Tamara Nation, a primary care physician at the National Institute of Integrative Medicine. And now is the best time to take action, Magraith says. She explains that menopause is a turning point for heart, cardiometabolic, and bone health, so it’s important to prepare for menopause. It makes sense to face this life transition with healthy habits and strength on board beforehand.
As Some women tend to gain weight around the waist because their bodies no longer need to prepare their hips for childbirth, which can have metabolic consequences that increase the risk of heart disease, hyperlipidemia, and diabetes. Decreased estrogen levels can also lead to loss of calcium in the bones, increasing the risk of osteoporosis.
It’s essential to adapt your diet to include more vegetables and legumes and avoid sugar and processed foods. This also promotes a healthy gut microbiota, which preliminary research suggests may be important for coping with menopause.
“It doesn’t have to be complicated,” says Magraith. “Eat as many whole or home-prepared foods as possible.” For bone health, make sure you’re getting enough calcium and vitamin D.
Magraith recommends Healthy Bones Australia as a resource and, in general, says perimenopause might be a good time to see your GP for screening for breast, cervical and bowel cancers, and ask to have blood pressure, lipids, fasting blood sugar and other indicators of heart health checked.
The importance of exercise cannot be overstated. “Increasing physical activity before menopause can be beneficial for many reasons,” says Magraith. “It’s really beneficial for general health as well as mental health.” Exercise can also have positive effects on sleep quality in perimenopausal women, notes Nation.
While all exercise is beneficial, strength and resistance training are especially important for bone health. Maintaining muscle mass is key, Woolhouse says, as it can help reduce falls, manage blood sugar levels and support metabolism. She recommends a combination approach that includes strength training, yoga and nature walks.
That being said, Magraith issues an important caveat.
“Overall,” she says, “the severity of symptoms is largely unpredictable. There is a common misconception that if women have a healthy lifestyle, they will get through menopause without any problems.”
The extent of hot flushes and night sweats may have a genetic influence, and while the onset of menopause cannot be reliably predicted, early menopause can be hereditary, says Woolhouse: “It’s worth asking your mother and grandmother.”
An enriching life transition?
It’s long been recognized that hormonal changes can affect mental health, and that stress can worsen symptoms like hot flashes, heart palpitations and insomnia, Woolhouse says. “The changes that happen during this time can cause stress, and stress amplifies symptoms,” she explains. “It’s a chicken-and-egg situation.”
Having already learned how to manage stress will be a big help to women when symptoms arise, using techniques such as mindfulness, physical activity and connecting with nature. Some women become more vulnerable to depression, which Nation says has a complex relationship with psychological resilience, social relationships and overall health – all of which are factors to consider when dealing with it.
Developing healthy social relationships can also help prepare in other ways. Increased fatigue, poor sleep, and mood swings can all impact relationships at home and work, and decreased libido, vaginal dryness, and painful intercourse can make intimacy less appealing. “Relationships are essential at any stage of a woman’s life,” says Woolhouse, “but having the support of caring people during this time can help ease the uncertainty. Opening the conversation and being aware of common signs and symptoms helps women and those who love them adjust to their changing needs. It allows them to seek help early.”
Despite healthy lifestyle changes, some women may still struggle – even during perimenopause – and could benefit from medical help. Surveys suggest that more than a quarter of them will experience moderate to severe symptoms. As Magraith points out, you don’t have to be a superwoman. “Every now and then I see someone in my clinic who has been struggling for years, and women tend to think they just have to keep going and keep going.” If you’re going through a tough time, there is help available, including hormone therapy to help with symptoms.
Ultimately, the experience varies widely and is not just about hormones. A series of articles on menopause in The Lancet proposes an “empowerment” approach that would help make the period leading up to perimenopause more positive, giving women more control and confidence.
The authors write: “Rather than focusing on menopause as an endocrine deficiency, we propose an empowerment model that recognizes the factors that modify the experience, in which the patient is the expert on her own condition and the health care professional helps the patient become an equal and active partner in managing her own care.”
They say the medicalized, disease-based view of menopause overlooks potential positive effects such as better mental health with age and the absence of menstruation, menstrual disorders and contraception.
Rethinking menopause can help alleviate the anxiety it brings by viewing it as a rewarding life transition that offers an opportunity for emotional growth. “It’s a time when a woman … moves from fertile years to wise years,” Woolhouse says.
“Menopause is one of the most significant experiences in a woman’s life,” she adds. “It’s a time of reverence and respect for her body, fertility, intuition and wisdom. In Chinese medicine, it’s called the ‘second spring.’ Spring is about growth, vitality, colour, expansion and abundance.”