Article by: MaryEllen | Thursday, July 5, 2012

By Shira Miller, M. D. 

Ten weeks ago I had my first baby.  It was an amazing home birth and, with the support of my husband and midwives, the result was a beautiful baby boy.

As you can imagine, preparing for a home birth requires a lot of research, planning, and preparation.  We had to interview multiple midwives, doctors, pediatricians, read many books, take various classes, get our house ready, and so on.  In addition, as a solo physician, I had to figure out how much time I would give myself for maternity leave.

Most working moms are familiar with this level of preparation and planning, but when it comes to the inevitable menopause, most women don’t have anything even close to a plan.  Do you?

The average age a woman goes into menopause is 52, though it could occur in your mid-40s or as late as your mid-50s.  Unlike many diseases– heart disease, diabetes, dementia, cancer–which you may or may not get as you get older, every woman (if she lives long enough) will go into menopause. And, with the average woman living into her eighties, that means you will most likely spend 1/3 of your life in menopause.

As a menopause physician, I see that most women are completely blindsided by menopause. They suffer for anywhere from six months to over a decade without seeking treatment because they don’t think anything can be done.  Or, because they hear hormones are dangerous.  And, it’s true.  Some hormone therapies are dangerous–but many are not.  So, what is a woman to do?  How can she navigate this often confusing but inevitable part of life that she must face?

Below I have outlined 3 easy steps you can take to prepare yourself for menopause:

1) Understand what menopause is.

The term “menopause” literally means the end of a woman’s monthly cycles, from the Greek men- which means month, and pausis which means cessation.  It’s also commonly known as marking the end of a woman’s fertility.  And for many, including many doctors, this is where their understanding of menopause ends.

So, what more is there to know about menopause?  Let’s start with the ovaries themselves.  The main function of the ovaries is to store, develop, and release eggs for reproduction.  Many women know this, but what most don’t know is that:  It’s this process of developing and releasing eggs that produces the hormones estrogen and progesterone.  When the ovaries’ supply of stored eggs runs out, this is menopause, and a woman is left with both infertility and permanent estrogen and progesterone deficiencies.  No more eggs also means no more estrogen and progesterone.

Some women pray for the day when they no longer have to worry about regular vaginal bleeding.  But, during menopause, the lack of estrogen and progesterone effects on the uterine lining, also means that estrogen and progesterone aren’t getting to the rest of her body.  Estrogen and progesterone are two of the most important hormones necessary for reproduction, and they are also responsible for the monthly build up and shedding of the uterine lining (resulting in a period, which occurs if pregnancy does not).  But, an overlooked fact is that there are estrogen and progesterone receptors all over the female body, not just in the uterus.  For example, there are receptors in the brain, breasts, heart, skin, bladder, and bones.  This is why estrogen and progesterone are required for a woman’s overall health.

The most common symptoms of menopause are hot flashes, night sweats, vaginal dryness, and cessation of the menstrual cycle. Other symptoms are weight gain, insomnia, fatigue, depression, anxiety, mood swings, heart palpitations, vaginal dryness, loss of libido, itching, urinary incontinence, “brain fog,” and accelerated skin wrinkling.  And then there is also an increased risk of osteoporosis, dementia, and atherosclerosis (hardening of the arteries) in the long term.

2. Learn about Treating Menopause

In traditional medicine, a chronic disease is one which has persistent signs and symptoms, no cure, and requires chronic treatment.  Menopause, although it causes permanent hormone deficiencies, is communicated as merely “a change” or “passing phase” which women must endure and accept–or somehow even look forward to!  I disagree.  I view menopause like any other permanent hormone deficiency…as a chronic disease which requires treatment.  When people (diabetics) run out of the hormone insulin, we give them insulin replacement.  If you run out of thyroid hormone, you will be prescribed thyroid replacement.  I approach menopause in the same way.  So that when a woman permanently runs out of estrogen and progesterone, i.e. when she is in menopause, she should receive estrogen and progesterone replacement.

Traditional hormone replacement therapy (HRT) for menopause, unfortunately, mainly consists of molecules which look like estrogen and progesterone, but aren’t exactly the same and aren’t administered in a way which mimics how the ovaries rhythmically produced them. These estrogen and progesterone substitutes, although they may help some menopause symptoms, also have side-effects and in 2002 were implicated to increase the risk of heart disease and breast cancer in the Women’s Health Initiative.  The repercussions have an been an ongoing controversy and fear of hormone replacement for the treatment of menopause.

The good news is that there are estrogen and progesterone replacement therapies which consist of molecules which are identical in molecular structure to those produced by the ovaries; aka “bio-identical” hormones. And there is a type of bioidentical hormone replacement therapy (BHRT) which is biomimetic, which means it is administered in a way which mimics normal ovarian function.  These type of hormone replacement therapies are safer and more effective than traditional HRT, and current evidence suggests they prevent chronic diseases–most notably, osteoporosis.

3) Get your hormone levels checked – while you are still having a menstrual cycle.

Having a baseline of your hormone levels during your reproductive years may help optimize hormone treatment once you are in menopause.  There is a laboratory range of estrogen and progesterone levels for healthy reproductive women, but every woman is different.  Knowing your levels could help optimize your treatment.  Levels should be checked at their peak times during the cycle, so estradiol should be checked on day 12 of the menstrual cycle, and progesterone levels should be checked on day 21.  (The first day of bleeding always marks day 1 of the menstrual cycle, so start counting from there).

Learn about menopause.  Do your research online, read books, interview menopause doctors, and have a treatment plan.  And find out your baseline hormone levels.  You don’t have to wait until your period stops or you start having hot flashes.  If you time it right, you may be able to avoid suffering from menopause for even one day. By the way, did you know that there is evidence that menopause is a contributing factor in the development of dementia? I discuss this in an interview that I’m very proud of in a new, free interview series called The Future of Health Now 2012.  You have the opportunity to hear my hour-long, full length discussion as well as interviews with many other forward-thinking doctors and health experts.  Just click here: for your complimentary access.

About the Author

Dr. Shira Miller is board certified in internal medicine and is the founder of The Integrative Center for Health & Wellness, a concierge menopause and anti-aging clinic.  She is a member of Americans for Free Choice in Medicine (AFCM) and is on the Board of Directors of the American College for Advancement in Medicine (ACAM).  Dr. Miller is also Facebook’s most popular menopause doctor and the creator of The Luxurious Menopause.TM