Hello, health enthusiasts, and welcome to Rev Up Health, your go-to podcast for all things wellness. I'm Dr. Mark Hechler, and I'm Tandi Hechler. Together we're here to fuel your health journey with the best of functional medicine and holistic well-being. Each episode, we'll dive deep into topics that matter to your health, bringing you the latest insights, research, and inspiring stories. Whether you're on a quest for vibrant health or just looking for daily health tips, we've got you covered. So let's embark on this journey together and transform the way you live. So, Tandi, what's on our wellness radar for today?
Hello, and welcome to the Rev Up Health Podcast. Today we're going to be talking about perimenopause and menopause. Perimenopause has been a big topic lately, and one of the main reasons for the big push recently is Dr. Mary Claire Haver's new book called The New Menopause. We're super excited — it's quite an interesting book, and we really got the privilege to actually go see and hear her in person, speaking to the public about The New Menopause. It's certainly getting a lot of attention, because the auditorium was packed full. And it was really encouraging to see that there were actually a few men in the audience — it wasn't just all women. Other than Dr. Mark, there were a few men, and that was really nice to see.
Undertreated and Underserved
One of the biggest reasons this is such an important time for women is that for so long, we have been undertreated and underserved in the area of perimenopause and menopause. There are so many symptoms women have — literally a list of more than 70 symptoms of menopause and perimenopause. It's an extensive list. Women would go to their doctor or a healthcare provider, get their labs drawn, and go through the whole rigmarole of hearing, "Okay, your labs are normal, this is part of perimenopause, you can deal with it," or "here's your antidepressant."
It gets frustrating, even on our side of the fence, knowing there are so many beneficial things that could be done for a female — not only to help control their symptoms, but to help improve, maintain, or avoid chronic illnesses and diseases, anywhere from osteoporosis to heart disease to diabetes to dementia. It's quite extensive.
Perimenopause Lasts Years
One of the biggest misconceptions — I don't think it's very well educated — is that perimenopause lasts lots of years. It can start in your 30s and will last until menopause, which is the end of your cycles. It's a transition period, and this transition period lasts for years and can start at a variety of ages. It can start in the 30s, but typically in the 40s and 50s for women. You just have to remember that it doesn't happen all of a sudden — you don't wake up one day in menopause.
Beyond Hot Flashes
The other misconception a lot of people have is that hot flashes are the symptom of perimenopause and menopause. It is one of the symptoms, but I would say that's not probably the first symptom you're going to experience when you start perimenopause. It could be something as simple as brain fog, or ringing in your ears is even one of the symptoms of menopause in some circumstances, and mood changes — there's a laundry list, and the book includes them all. It has lots of great questions to get you thinking about your health and areas you might not have been thinking about.
One of the things that was most surprising to me is that frozen shoulder is a symptom. I have had frozen shoulder and had no idea that was related to perimenopause. I was very lucky to be able to start treatment of perimenopause very early, in my 40s, which is becoming more the norm now — but that is new. I feel like there's a generation of women that missed out.
The WHI Trial and Its Fallout
That's something of interest and importance — the Women's Health Initiative trial back in 2002. When that came out, it really did quite a disservice. The information that came out of it was not appropriately presented and was interpreted wrong, to an extent, and as a result, women and doctors stopped their hormone treatment. That's slow to come around, and it's still very early, in its infancy, but at least we're on the right path to disprove that a lot of the problems suggested are simply not true — especially not with the different new forms of bioidentical hormone replacement.
When the ovaries stop, there are all kinds of labs we can draw to identify those times when we're getting close to menopause, or we're in perimenopause. There are a lot of different levels of labs we use sometimes to identify that.
Diagnosing Menopause
In summary, perimenopause is the time — several years — leading up to menopause, when you actually quit cycling. You'll have irregular periods; you may have been regular, and now you're starting to space them out, and now you're skipping some. When those monthly cycles become irregular, and then you start having symptoms, mood swings, and hot flashes, that's when things start to take off and become more consistent.
With the misdiagnosis, it's not easy to diagnose menopause sometimes. They suggest that if you haven't had a period for one year — well, "okay, I had spotting here in July, does that really count?" So it's kind of a culmination of symptoms, history, and labs that dictate it. There's not necessarily always one thing that pinpoints the onset of perimenopause and menopause. But according to diagnosis codes, the definition of menopause is one year without a cycle.
Trust Your Intuition
This is also an invitation to really use your intuition and listen to your body. There are some stories in the book, and stories I've heard other people say, about how women have gotten somewhat gaslit as far as their symptoms — "Oh, she's just a whiny woman," making you think these things are just in your head. They're not — this is real. So it's a reiteration to let this population know that your feelings are real, and what you feel in your body is real. If you're not able to get a provider to listen to you, keep looking for a provider. You've got to find somebody who will not just say, "Okay, you're just going to deal with it," or "here's your antidepressant." There are a lot of ways to take care of this, both hormone-related and non-hormone-related, and that's the benefit of what we do and what other functional medicine providers with specialty background training in hormone replacement do. It's just another tool in our belt — and there are multiple tools in our belt to take care of it.
Lifestyle Changes and Treatment Options
The lifestyle changes are extensive. We're putting together a 21-day perimenopause wellness guide that we're going to link in the show notes — those are lifestyle changes you can do to improve your overall health and wellness, but also related to perimenopause. Lots of things you can do on your own, experimenting with different things that work for you.
Then there's the option for some people — some people are candidates for hormone replacement therapy — and there's a wide variety of options there. From the non-hormone standpoint, you've got diet and exercise; diet is pretty important as far as gut health and GI tract health. Reducing stress is also very important to help women get through this time. But the hormone options — there are the synthetic versions, which is what most of the old WHI trial information came out of, and then there's the more appropriate treatment, which is bioidentical hormone replacement. It's more identical to what women naturally produce, so you get better symptom relief, and frankly it's a safer form of treatment.
It's a conversation you and your provider will need to have regarding your risks — what are the risks versus the benefits? Is there a history of blood clots in my family, is there a history of breast cancer, do I have a history of breast cancer? Just because you have had breast cancer does not mean you cannot be a candidate for bioidentical hormone replacement — though you have to be very careful with that.
Do Hormones Cause Cancer?
It's important to know that the studies have not really shown that hormones cause cancer. You do have to be aware that if you are on hormone therapy — if you're on estradiol — and you get cancer, you'll have to come off of it while going through treatment of the cancer, because the hormone can increase the rate of growth of the cancer. So it's a very different story than what was originally presented. Not only is perimenopause a transition, but it's also a transition in how it's treated.
Delivery Methods
The other piece of hormone replacement therapy is that every type of hormone has several modes of delivery. You can take it orally, apply it topically, and there are troches, which would be a sublingual delivery. There are a lot of different types of hormone therapy out there. For the purpose of this, it's kind of more of an estrogen-driven topic, but there are a lot of different ways of looking at it.
Estrogen, Progesterone, and Testosterone
Menopause is the time when your estrogen really drops off, and then you start needing estrogen replacement. But progesterone is vitally important, especially for sleep — that's something that typically starts very early in perimenopause: trouble sleeping and staying asleep, and an anxious brain, where you wake up at 2 o'clock and your brain just won't shut off and you can't go back to sleep. When that progesterone level starts to drop and not come back up again, it can create quite a bit of mood issues and inability to sleep.
Testosterone is another part of the picture — looking at where the testosterone level is, because testosterone is going to get converted into estrogen; women make their estrogen through that too. It's something that can't be forgotten. When you hit 30, you start losing muscle, and we know that muscle is so important to live a long, healthy life with a great health span.
Estrogen and Bone Health
Then there are the effects of estrogen on the brain, the breast, and the bone, and even cardiovascular improvements. There are limits on when a person gets the most benefit from a cardiovascular standpoint for hormone replacement therapy, but that doesn't mean they can't still take it. You may be past 10 years from your last menstrual period, and your doctor may say, "Well, the cardiovascular benefits are no longer there" — but your brain, your breast, and your bone are very important. Estrogen is one of the more important things we need for bone health, bone production, and turnover. To have strong bones, you really need a good estrogen level; it's vitally important. Breaking bones and fractures when we get older is very significant.
We recently met, at one of the conferences we went to, an orthopedic surgeon who is now solely treating osteoporosis and looking at it through the lens of hormones — estrogen replacement. He's a huge fan, because he knows the studies and what they say. It's not that we need to be scared — we need to be very aware and think, "It's not just about treating the symptoms; we're also preventing a lot of chronic illnesses that are down the line, staring you in the face, and you have something you can do to avoid that or put it off as long as you possibly can."
Blind Spots and Cognitive Dissonance
Another book we recently read is Marty Makary's book, Blind Spots, and there's a whole chapter on HRT and how the medical community kind of got it wrong with the WHI trial. It's a great book, and it goes into a lot of other things in medicine where we just get into "this is the way we've always done it" — cognitive dissonance, that's what he calls it. Just that idea that "this is the way I was trained in medical school, the way I was trained in residency, so this is the way it is, there's no other way." If you have that much blindness going into and through your practice, then you're not looking for the updates, different options, or different avenues to help individuals. So it was really enlightening to understand that you have to be open-minded and understand that you maybe don't know everything — we still don't know everything. There are so many updates that are going to be happening in the next 10 years alone; it's going to be incredible. It's an ongoing process, and you have to have that hunger and curiosity to really understand and look for these different ways — but there are options out there.
Wrapping Up
Our understanding of how hormone replacement therapy can help women going through perimenopause and menopause is certainly becoming more noticeable. More change is happening, and we're getting more intelligent, both as a medical community and the public, in understanding what needs to happen to help these things play out.
I think that pretty much wraps it up. If you have any questions, please feel free to comment or reach out on social media or our website — we'd love to help navigate this. And educate yourself, be aware, spread the word, talk to your friends. If you're a woman going through these symptoms, these conditions, these feelings — you're not alone. It's so prevalent; if you sit a group of women of the same age in a room, I guarantee three-fourths, 75%, are going to have the same or similar symptoms. Our understanding of it now is going to help women be able to have a better quality of life into their older years, and that's encouraging. It really is. So thanks for tuning in, and we look forward to talking to you next time.
Thank you for tuning in to another episode of Rev Up Health. We hope you're leaving with some valuable insights to supercharge your health journey. Don't forget to follow or subscribe to Rev Up Health wherever you listen to your podcasts, and if you enjoyed today's episode, please leave us a rating and review. Have a topic you want us to explore? Reach out to us on our social media channels — we love hearing from our wellness community. Until next time, keep thriving, and remember: your journey to health is a journey to a better you. Stay well, and we'll connect with you again soon. This is Tandi, and this is Dr. Mark, signing off from Rev Up Health. Take care.
The information provided in this podcast is for educational purposes only and is not intended as medical advice. The content is designed to support, not replace, the relationship that exists between a patient and their healthcare provider. Always consult with a qualified healthcare professional before making any changes to your healthcare regimen, including diet, exercise, or treatment plans. The views and opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the official policy or position of Revelation Health and Wellbeing.