Birgit Hess slept soundly her entire life — until two years ago, when she turned 50. All of the sudden, “I wasn’t able to sleep through the night because my hot flashes came on so strong,” she says.
Hess knew what was happening. Menopause, the often dreaded “change of life,” is defined as not having a period for one full year, says Dr. Vinita Tandon, Lifeforce’s Medical Director and a board certified endocrinologist. The average age of natural menopause in the U.S. is 51, and the eight to 10 years preceding it are considered perimenopause. This all lined up for Hess. She had talked about menopause with her mom, and heard stories from her friends. She was prepared for the night sweats and was unsurprised when she lost her period.
What she wasn’t expecting was losing parts of herself. “I could sense that I was not being myself. I was impatient and overreacting,” she says. Hess’s abrupt attitude shift impacted her relationship with her husband and her work. “I’m a teacher, so not having patience with kids made me upset and overwhelmed because it’s not me.” Hess felt stuck with this moody, exhausted version of herself. “I thought I couldn’t do anything about it, and I just had to wait until it went away.”
That is the biggest myth of menopause.
RELATED: Can Menopause Lead to Heart Disease? What You Need to Know
Changing Our Outlook on The Change
The truth is that menopause doesn’t have to mean hitting pause on your life. “For years, women got the message that they just have to bear it,” says Dr. Tandon. “Now, more and more women are not satisfied with just plowing through. They want to stay motivated, they want to stay focused, they want to enjoy intimacy. They want to be proactive with their health and maintain their body composition. There are options to help. You can feel better.”
And Lifeforce is committed to changing the way women experience the change. This starts with openly talking about it. In honor of Menopause Awareness Month, we’re sharing what our experts in functional medicine and endocrinology want you to know about menopause (the good and the bad), and which treatments can help get you back to being you. Hint: You probably haven’t heard this from your mom — or even your doctor.
10 Things to Know About Menopause
1. Signs of menopause may start earlier than you expect.
Many women put off thinking about menopause because “they think it starts later and they don’t have to worry about it in their 40s,” says Lifeforce Physician Kimberly Hartzfeld, DO, Institute for Functional Medicine Certified Practitioner. In reality, symptoms of perimenopause can appear in the early 40s and even late 30s for some women, according to Dr. Tandon.
Since the average life expectancy of American women is in the 80s, “that can mean you’re spending more than a third of your life in menopause,” says Dr. Hartzfeld. That may sound surprising and even scary, but it doesn't have to be. “It doesn’t mean you’re old,” Dr. Hartzfeld assures. “You can live a long, healthy life in menopause.”
2. Menopause may last longer than you think.
Another major misconception: “A lot of women think they will only have symptoms for a couple of years, and they just have to get over that hump,” says Dr. Tandon. “For almost half of women, that’s not the case. When untreated, some symptoms can persist indefinitely, and hot flashes can last for 10 years post-menopause.”
3. Menopause is more than hot flashes.
Speaking of hot flashes, they’re the most widely talked about symptom of menopause, but definitely not the only one. “One of the most surprising things about
menopause is how many different things it can affect: cognition, mood, libido, physical body composition, and more,” says Dr. Tandon.
This all comes down to hormones. As women enter menopause, levels of estrogen, progesterone, and testosterone drop dramatically. Here are some surprising ways this impacts your body — and how hormone optimization can help.
Anxiety and moodiness: The decline of estrogen and progesterone impacts brain chemistry and neurochemical signaling, which affects mood. “I hear from a lot of women who have always been calm and able to cope with stress, but when they start to experience perimenopause, they become more anxious,” says Dr. Tandon. “They might be anxious about driving on the freeway, social gatherings, or public speaking.” The good news: Research shows that hormone therapy can help regulate emotional processing in the brain. (Read on for more surprising truths about hormone therapy.)
Brain fog: Some women begin to feel foggy and unfocused and think, ‘well, this is just my 40s.’ In reality, hormones are the likely culprit. Estrogen impacts the production of BDNF (brain derived neurotrophic factor), a growth factor that enhances memory and cognition, explains Dr. Hartzfeld. Research shows that menopausal women on estradiol treatment had greater activation in the region of the brain associated with verbal processing, and progesterone therapy was associated with enhancing visual memory. Hormone therapy has also been associated with higher cognitive ability among women in late life.
Sleep disturbances: “Perimenpause and menopause wreak havoc on sleep,” says Dr. Tandon. In addition to hot flashes keeping women up at night, dips in progesterone also disrupt the REM cycle. “When you don’t have deep restorative sleep, this sets off a vicious cycle,” says Dr. Tandon. “The next day, you’ll be tired and unfocused so you may want a nap or reach for sugary snacks to try and increase your energy.” The combination of estrogen and progesterone has been shown effective for treating insomnia and improving sleep quality. Says Dr. Tandon, “When we fix sleep with hormone optimization, that is the one thing women are most grateful for.”
Changes in body composition: “Some women are surprised when they see more belly fat come on, especially if they haven’t changed their diet or exercise routine,” says Dr. Tandon. She explains that lower testosterone can lead to a decrease in lean muscle mass. When estrogen levels drop, metabolic health also declines, which can cause abdominal fat, Dr. Hartzfeld adds. Studies demonstrate that hormone therapy can prevent an increase in visceral and abdominal fat post-menopause.
Drop in sexual satisfaction: Estrogen loss can also lead to vaginal dryness. “Many women don’t expect how this causes uncomfortable intercourse, which can affect libido,” Dr. Tandon says. Another side effect: more common urinary tract infections. When vaginal walls are dry, bacteria can more easily enter, she explains. Treatment with vaginal estradiol cream may help improve moisture and restore the barrier against bacteria.
Hair and skin changes: This one really gets under women’s skin. “Women will notice that their hair is thinner and dryer or that they see an increase in wrinkles,” says Dr. Hartzfeld. That’s because estrogen is essential for hair and skin health. “Estrogen can support collagen production, help reduce thinning of the skin, and diminish skin aging.”
RELATED: 5 Hormone Hacks to Get Ahead of Hair Loss and Aging Skin
4. Don’t wait for your doctor to address it.
If you’re experiencing any of these symptoms, “Don't wait for your doctor to bring it up because that may not happen,” warns Dr. Tandon. “You have to be your own advocate.”
Dr. Tandon explains that it’s unfortunately very common for physicians to miss or misdiagnose symptoms of menopause. For example, a doctor may prescribe an antidepressant or anti-anxiety medication without checking hormone levels. “Doctors don’t get enough training and education in this. Even OBGYNs may only get minimal menopause training during residency,” she says. “Plus, doctor visits are often short and focused on what’s urgent, so things like mood, cognitive, or libido changes are not addressed.”
Our mission at Lifeforce is to help fill in those gaps. In addition to speaking with your primary doctor, you can take your health into your own hands with our Hormone Optimization for Women program. The first step is measuring your hormone levels to detect imbalances. Then, you’ll have a consultation with a physician to get a holistic picture of your health and receive a personalized plan.
5. Menopause can increase your risk for other health issues.
This holistic approach is essential because menopause can not only cause quality of life symptoms, but it can also increase your risk for medical issues. “When women lose hormones, they are at greater risk for heart disease, dementia, osteoporosis, and hip fractures,” says Dr. Tandon. Additionally, with the drop in hormones, you may see a rise in cholesterol, blood sugar levels, and inflammation.
6. Hormone optimization is the key to feeling better.
We’ve talked a lot about the drawbacks and dangers of menopause, so let’s get to the good news: You don’t have to live this way. When you bring your hormones back into balance, “it changes everything!” says Dr. Tandon.
Medically speaking, “we see improvements in people’s metabolic and cardiovascular labs,” Dr. Tandon says. Cholesterol and blood sugar levels start to normalize. Dr. Hartzfeld also notes that hormone treatment improves insulin sensitivity, reduces inflammation, and lowers the risk of metabolic syndrome.
Hormone optimization will also change the way you feel right now. “Balancing hormones will restore sleep, almost completely eliminate hot flashes, and improve cognition, mood, and libido. People will notice more lean muscle and their skin and hair texture will improve,” Dr. Tandon says. “Almost everything kind of gets back to where it was pre-menopausal.”
So, how do we do this? With Lifeforce’s Hormone Optimization for Women program, you’ll get your hormone levels checked with an at-home blood test, consult with a physician to review your results, and receive a personalized dose of bioidentical progesterone and testosterone to balance your hormones and treat your symptoms. Every three months, we’ll retest your levels to understand what’s working and what may need adjusting. Everyone’s body and needs change over time — we focus on what’s working for you at every point in your journey.
7. Hormone therapy is safe.
When we talk about hormone therapy, the first question we often hear is, “But is it safe?” Unfortunately in the medical community, there is a lot of “misinformation and confusion about hormone therapy and its safety,” says Dr. Tandon.
Let’s back up and talk about why: An alarming study in 2002 by the World Health Initiative (WHI) found that animal-derived estrogen plus synthetic progesterone increased the risk of breast cancer, heart attack, and stroke among women.
This study was later discovered to be fundamentally flawed and imprecise. “The WHI study participants were older women, with an average age of 63, many of whom were more than 10 years from their last menstrual cycle, meaning they were in menopause for years, allowing time for disease processes to already set in,” Dr. Hartzfeld explains. “This can be a very different picture when compared to women close to onset menopause.”
Another major issue: Participants in the study received synthetic progesterone, which is not what we use today. “At Lifeforce, we prescribe micronized progesterone, which is bioidentical, meaning it is molecularly identical to the progesterone our ovaries make,” says Dr. Tandon. “The synthetic progesterone in the old study has a different chemical structure and is associated with the increased breast cancer risk. However, many people and physicians lump all progesterone products under one umbrella.”
The truth is that multiple newer studies find that micronized progesterone does not cause breast cancer, and it may even help prevent it.
8. The sooner you start HRT, the better.
Don’t put off treating menopause. “If you start on hormones early and stay on them for a short period to time, you get the maximum benefits for heart health, brain cognition, and bone health,” Dr. Hartzfeld says. Studies show better cardiovascular outcomes for women who were treated with progesterone and estradiol earlier. Another study found that receiving hormone therapy near the start of menopause led to a 64% decreased risk of cognitive impairment 5 to 15 years later.
Starting treatment within 1 to 2 years of the onset of menopause is ideal, says Dr. Tandon. “We can even start progesterone and testosterone in perimenopause. It’s a great time to optimize your hormones because it can really help your quality of life.”
9. There are positive changes with the change.
We’ve all heard the horror stories about menopause, but not many people talk about the good stuff (yes, there is good stuff!). “Menopause should not be looked upon as an awful thing,” says Dr. Hartzfeld. “Midlife can be the best time in your life as long as we get everything optimized and balanced. It can be a very liberating time for women. You don’t have to worry about getting pregnant and you don’t have to bleed every month.”
Birgit Hess, for one, loves that aspect of menopause. “I didn’t know how nice it would be once you’re no longer menstruating,” she says. “It’s awesome!”
10. You CAN feel like you again — and even better.
Hess is back to feeling like herself. As a Lifeforce member, she worked with her doctor to optimize her hormones. She is currently using a testosterone cream, in addition to estradiol prescribed through her primary care physician.
“I noticed a difference within a few weeks. My hot flashes are almost completely gone and I sleep better. I’m patient and positive again,” she raves. “It’s like I’m not even in menopause anymore. My old me is back!”
Hess urges other women going through perimenopause and menopause not to wait to seek support. She says, “As soon as you know you are starting, look for help and try to find a solution that will work for you.”
The first step toward balancing your hormones and optimizing your health is knowing your levels. Our at-home blood test measures 40+ biomarkers, including comprehensive panels for hormone balance and metabolic health.
The article was medically reviewed by:
Kimberly Hartzfeld, DO, ABOG American Board of Obstetrics and Gynecology, IFMCP Institute for Functional Medicine Certified Practitioner
Vinita Tandon, MD, ABIM Board Certified in Endocrinology and Metabolism
Originally published on October 18, 2022. Updated on October 7, 2024.