Minnesota Women’s Press and The Edge magazines co-hosted “Sex, Menopause, and Aging Bodies” at the Women’s Club on April 22, featuring several panel discussions, vendors, experiential sessions, and belly dancers who were all over the age of 59. Here are insights gleaned from diverse panelists about the physiology and treatment options for menopausal symptoms. We talked to practitioners trained in conventional, integrative, holistic, and Eastern approaches.
Q: What physiologically is happening with menopause?
Peter D’Ascoli, former medical director for Planned Parenthood and retired ob/gyn: Basically, menopause is when the ovaries are shutting down, no longer ovulating, which means that the hormones your body is making for your adult life are now mostly gone. Estrogen is a big piece of that, so that loss has implications on a health basis.
Estrogen can increase your capacity to make clots. It also reduces the amount of atherosclerosis. Women who have estrogen or are premenopausal rarely get heart attacks. Men start to have heart attacks around age 50. Women usually start later in the 60s, because that’s when the protection that was there goes away.
Blood supply to the vaginal area gets reduced. That means there’s less lubrication, so it’s drier and intercourse can become uncomfortable. [A future story from the discussions explores the impact of aging bodies and sex.]
Carolyn Torkelson, retired women’s health specialist at the University of Minnesota, author of “Beyond Menopause: New Pathways to Holistic Health”: With menopause, the short-term effects are hot flashes, night sweats, difficulty sleeping, mood changes, skin and hair changes. The long-term effects are bone loss, and maybe cardiovascular predisposition. The transition is a period of time. For some women, it can start in your 40s. You can have mild symptoms, but you’re kind of working into the change from four to eight to 10 years.
Q: What can be done to mediate symptoms?
Kimberlee Reece, licensed acupuncturist and Chinese medicine practitioner, NE Wellness: Menopause is unique for each woman. There’s not one treatment approach for menopause. It’s a natural process that we go through, kind of like the reverse of adolescence. With Eastern medicine, we often approach dietary therapy as a way to balance the hormones.
There are studies that women from Asia experience fewer menopausal symptoms and they believe it’s due to eating soy from a young age, and dietary and lifestyle and herbal remedies they’ve passed down from generation to generation.
We’re often looking at the kidneys from a Chinese medicine perspective. As we age, the balance between the water and fire in our bodies is out of balance. Our fire can be in excess, leading to symptoms like hot flashes, anxiety, irritability — so we’re trying to balance the body a little different.
D’Ascoli: If you’re in peri-menopause or just starting menopause, that would be a time I would think about replacement hormones. If you’re 10 years out from that stage and having hot flashes, we have to think of something else to do because that gets much riskier. My usual take on it is that if someone’s mother has osteoporosis, they should be taking estrogen, because it gives you stronger bones. But if they have a mother who has breast cancer, I think probably not. That’s a simplistic way to look at it.
The women who most benefit from hormone replacement have begun to suffer from sleep deprivation. Sometimes you have hot flashes while you are asleep — you’re half awake, and then you’re right back to sleep. This goes on all night and you don’t get good sleep. Once you start sleeping, life is a lot better.
Q: How do you advise women to consider integrative medicine as a way to advocate for their health needs?
Torkelson: My passion is about helping aging women, for those 30 to 50 years that we have beyond the reproductive age, to be as vital and purposeful as we possibly can be. And to be visible — we are often forgotten as we age and this is a time for us really to be visible. Menopause is not a disease. It is a change in your physiology — hormonal and metabolic change symptoms that we want to soften.
Integrative medicine is about considering all dimensions of health. It’s the physical, emotional, spiritual, cultural, financial. There is this vast network of holistic and health systems that we can consider beyond our conventional model to be as healthy as we possibly can. As individuals age, symptoms are often minimized or neglected in the healthcare system. We really need to advocate for what we need and find practitioners who listen so you can tell your story.
Zeynep Tuzcu, founder, Evren Chiropractic: My specialty is musculoskeletal health — joint pain, muscle pain, muscle tension. I work with folks who are dealing with persistent headaches, which can come with hormonal changes and drops in estrogen. We see certain areas of the body that carry more tension.
Integrative care is about doing a better job of working together with other providers who may not treat the same way, knowing that we all have the same goal of helping the individual become well and that none of our methods of treating are the only way. People might come to me from their primary doctor, sharing that they didn’t feel heard or understood, that their needs were overlooked. I might respond, ‘Okay. Can I call them?’
That’s integrative care. We all can do a better job of working together.
Q: How does self-care play a role?
Reece: There’s not enough emphasis on rest. I think that so many of us still think we have to go go, do do, produce produce. I think a big part of menopause is working on our tired adrenals. This is really a time to slow down. Treating menopause is not trying to eliminate the symptoms — we’re just trying to smooth them over a little.
Tuzcu: As I turned 30, I started noticing shifts in my body. ‘Why am I sore?’ Hanging out with my friends who are younger than me, I would make comments about aging in a negative way — as if there something wrong with me. If we shift the narrative a bit — ‘I’m experiencing these changes in my body’ — it sounds simple and ethereal, but it can make a huge difference in how we’re perceiving the symptoms we are feeling. At my clinic, we try not to use the words good and bad. It’s just information, right? This thing happened. Okay, so that’s good information.
It’s about normalizing the discussions.
Thoughts on the Politics of Health Care
AJ, psychotherapist, Rainbow Health: I think it’s worth noting that gender-affirming care goes all ways. It’s important for any folks who are women in their gender identity to have these hormones, too. Everyone deserves to have that care. As we’re thinking about stories we’re hearing in the news, I think it’s worth taking a broader look and say, ‘This is an important option for everyone who wants it.’ [PrEP (pre-exposure prophylaxis) is an HIV prevention medication option for people who do not have HIV but are at risk of getting it.] PrEP is also under attack. It’s important to support these forms of care. We want protection for everyone.