How often do you hear people openly discussing menopause? Probably not nearly enough. For something that every woman will experience, it’s surprising how often it’s brushed aside, treated as something to quietly endure instead of something to understand. That’s what makes The New Menopause by Mary Claire Haver such an eye-opener that shares the insights we’ve all been missing.

Haver’s perspective is uniquely shaped by both her professional expertise and personal experience. Having gone through menopause herself and witnessing more of her patients navigating the same challenges, she took the conversation to social media, where it clearly struck a chord. This blend of professional insight and personal relatability gives the book its warm, approachable tone.

The New Menopause is like a roadmap for understanding menopause. It’s packed with information about what menopause really is, strategies for managing it, treatment options, and even things you didn’t realize you should know. From the start, Haver is upfront about the fact that this isn’t a replacement for medical advice, but it’s a resource to help you rethink how you approach perimenopause, menopause, and postmenopause.

Haver does seem to favor hormone replacement therapy. However, I still appreciate the one message that stood out to me is her reminder that menopause isn’t something a single pill can fix. Preparing for this powerful life transition takes long-term lifestyle adjustments and a healthy mindset that starts well before menopause begins.

The highlight is the “menopause toolkit.” It’s brimming with practical strategies, explanations, and real-world advice to tackle just about everything from A to Z—hair loss, skin changes, mood swings, and more.

The New Menopause invites us to rethink how we see this stage of life. Whether you’re getting ready for it, going through it now, or supporting someone who is, this book meets you where you are with practical advices.

So, why don’t we talk about menopause more? Maybe this book is the push we all need to start the conversation.

Summary

Understanding Menopause

Menopause is a natural phase of life, but that doesn’t mean it comes without challenges. As your body reduces its production of estrogen, the risk of developing serious health conditions increases. While it’s entirely valid to leave your lifestyle or hormonal levels unchanged, it’s crucial to be fully informed about these potential risks and the options available to address them.

The Life-and-Death Importance of Menopause Care

For women in perimenopause or menopause, receiving excellent care isn’t just about comfort—it can be a matter of life and death. Declining estrogen levels directly impact cells’ ability to support critical functions like heart health, cognitive performance, bone strength, and blood sugar regulation. These issues often contribute to some of the leading causes of death in women.

This is why it’s vital to prioritize your health during this pivotal stage. Building a strong understanding of how hormonal changes manifest and recognizing the gaps in how these symptoms have historically been addressed can empower you to take control of your well-being.

The Silent Struggles of Menopause

Menopause comes with a long list of symptoms, yet the support for those experiencing it often falls short. Why? A combination of systemic gaps, cultural bias, and medical shortcomings perpetuate inadequate care:

• Lack of Awareness Misunderstandings about menopause’s pathology lead to underdiagnosis and mistreatment. Many menopause symptoms are mistaken for unrelated conditions, resulting in misdiagnosis and missed opportunities for proper care.
• Unpredictable Symptoms Menopause isn’t a one-size-fits-all experience. Its symptoms are highly individualized, making it difficult to pin down patterns or approaches that fit every woman’s journey.
• No Standard Diagnostic Tools There’s no universal screening or criteria to help identify menopause consistently, further complicating treatment.
• Gender Bias in Medicine Menopause is often dismissed as a mere “women’s issue,” trivialized by doctors and society alike. Symptoms like mood swings are frequently written off as emotional or psychological rather than being seen as legitimate medical concerns. This dismissive attitude has persisted for generations.
• Insufficient Medical Training Most doctors receive limited training on menopause during medical school and residency, often focusing only on stereotypical symptoms. As a result, many aren’t equipped to diagnose or treat patients effectively during this critical transition.
• Flawed Definitions of Aging The medical community predominantly defines aging by chronological age but neglects endocrinological age. Ovaries age at twice the rate of other organ systems, yet this vital factor is rarely considered in care protocols.

The Three Stages of Menopause: What to Expect from Perimenopause to Postmenopause

The journey through reproductive aging involves three distinct stages: perimenopause, menopause, and postmenopause. While each stage is defined differently, the symptoms often feel similar because they stem from the same root cause—a decline in sex hormones like estrogen, progesterone, and testosterone due to the gradual end of ovarian function.

The entire transition typically lasts an average of 7.5 years, though it can stretch to nearly 12 years for those experiencing early hot flashes. These timelines are based on current research, which continues to evolve.

Perimenopause: The Beginning of the Transition

Perimenopause marks the start of the ovarian decline, often beginning in the 40s or even mid-30s. This extended transitional stage is triggered by fluctuating levels of estrogen and progesterone, leading to irregular periods.

• Average Duration: Around 4 years, but it can range from 2 to 10 years.
• Challenges:
  • A broad range of symptoms with varying severity.
  • Unpredictable onset age.
  • No standardized diagnostic methods or evidence-based tests to confirm the stage.

Menopause: The Milestone Moment

Menopause is officially reached when it’s been 12 consecutive months since your last period. Defined by a date rather than specific symptoms, menopause typically occurs around age 51 but can range between 45 and 55.

• Key Considerations:
  • Menopause isn’t just about reproductive aging—it accelerates cellular aging and impacts overall health.
  • Later natural menopause is linked to a longer life expectancy, better bone health, and reduced risks of heart disease.

Postmenopause: A New Chapter

Postmenopause begins once you pass the 12-month milestone without a period and lasts for the rest of your life. While many symptoms like hot flashes, heart palpitations, and sweating may continue, they typically last between 4.5 and 9.5 years after the final menstrual period.

This stage signifies a turning point, offering opportunities to focus on long-term health and well-being.

Top 5 Symptoms of Menopause-Related Changes

1. Weight gain or body composition changes
2. Brain fog and memory issues
3. Anxiety and depression
4. Sleep disruptions
5. Hot flashes

What Influences the Timing of Natural Menopause?

The age at which you enter natural menopause is shaped by various factors, ranging from genetics to lifestyle choices. Understanding these influences can help you prepare for this transition and make informed decisions about your health.

Key Factors Affecting Menopause Timing

• Genetics
  • Family history plays a significant role in determining the age of menopause.
• Reproductive History and Menstrual Patterns
  • Women who haven’t had children are more likely to experience premature or early menopause.
  • Starting menstruation at age 11 or younger can also increase the likelihood of early menopause.
  • The number of births impacts menopausal symptoms—women with three or more children often report more severe symptoms than those with fewer births.
  • Cycle length matters, too. Women with cycles shorter than 26 days may reach menopause about 1.5 years earlier than those with longer cycles.
• Race and Ethnicity
  • Structural disparities, including unequal access to healthcare, influence menopause timing and symptoms. For instance, Black women tend to enter menopause 8.5 months earlier than white women and report more severe symptoms, such as hot flashes and depression, but are less likely to receive appropriate treatment.
• Weight and Body Mass Index (BMI)
  • Low BMI during early adulthood or midlife is linked to a higher risk of early menopause, while a higher BMI is associated with later menopause due to prolonged estrogen exposure.
  • However, excess weight, especially around the abdomen, may counteract these benefits by increasing risks for heart disease, high cholesterol, and inflammation. Maintaining a healthy weight is key to supporting reproductive and overall health.
• Premenopausal Cardiovascular Health
  • A heart disease event, such as a heart attack or stroke before age 35, can double the risk of early menopause. This occurs because conditions like atherosclerosis (plaque buildup in arteries) restrict blood flow to the ovaries, damaging hormone-producing tissues.
• Lifestyle Factors
  • Physical activity, diet, and alcohol consumption all play a role in menopause timing.
  • Cigarette smoking is another significant factor, as it accelerates ovarian aging.
• Stress and Trauma
  • A history of abuse can also influence the timing of menopause.
• Medical and Hormonal Interventions
  • Use of oral contraceptives, hysterectomy, or removal of an ovary.
  • Surgically or chemically induced menopause.
  • Premature ovarian insufficiency (POI), a condition where the ovaries stop functioning early.

Recognizing these factors allows women to take proactive steps toward managing their health as they approach menopause.

Key Health Risks Associated with Menopause

• Increased Stress Hormones and Inflammation
  • Without estrogen to balance them, stress hormones like cortisol and other inflammatory agents become more active, contributing to various health issues.
• Osteoporosis
  • Estrogen slows bone breakdown by activating estrogen receptors in bone tissue, which are essential for bone formation. Without it, the risk of osteoporosis rises significantly, leading to weaker bones and a higher chance of fractures.
• Coronary Artery Disease
  • The loss of estrogen and progesterone affects heart health in multiple ways:
    • Blood vessels constrict more often.
    • The liver produces excessive clotting proteins, increasing the risk of blood clots.
    • Damage to endothelial cells (which line the blood vessels) disrupts smooth blood flow.These factors heighten the risk of plaque buildup in arteries, heart attacks, and blood clots.
• Insulin Resistance
  • Estrogen plays a vital role in glucose metabolism, and its decline during menopause makes women more susceptible to insulin resistance. Key contributing factors include abdominal obesity (visceral fat) and reduced physical activity.
• Neuroinflammation and Cognitive Decline
  • Menopause-related inflammation in the brain and spinal cord can damage nerve cells critical to cognitive function. Women are twice as likely as men to develop Alzheimer’s, and emerging research links this to hormonal changes during menopause. The loss of estrogen accelerates neuroinflammation and increases the rate of aging in the female brain.
• Visceral Fat Gain
  • Menopausal hormonal changes, coupled with aging, decreased physical activity, and poor sleep, make women more prone to gaining visceral fat (fat around internal organs). Tracking your waist-to-hip ratio can help monitor these changes.
• Sarcopenia (Muscle Loss)
  • Estrogen is essential for muscle regeneration. As its levels drop, muscle mass begins to decline, leading to reduced mobility, strength, and metabolic health, as well as an increase in fat mass.

Preparing for Your Doctor’s Appointment to Take for Better Menopause Care

Getting the most out of a doctor’s appointment during menopause starts with preparation. Finding the right doctor and having a clear plan can help you feel more confident and ensure your concerns are addressed effectively.

• Choose a Doctor You Can See In Person

An in-person visit allows the doctor to assess your overall health more thoroughly. It also makes communication easier, enabling you to ask questions, get immediate feedback, and establish a strong doctor-patient relationship. Specialized treatments or screenings can often be done on the spot, making in-person appointments more efficient.

• Plan Ahead for a Productive Appointment
  • Timing
    • Schedule Before Symptoms Escalate: Meeting your doctor early, before symptoms become severe, allows you to establish care, review your options, and learn what to expect.
    • Book an Early Appointment: Morning appointments can help ensure you see a fresh and focused physician.
    • Be Clear About the Purpose: Let the office know you need a “problem visit” to ensure enough time is allotted for a detailed discussion.
    • Show Up Fasting: If lab tests requiring fasting are needed, being prepared can save you from needing another visit.
  • Information
    • Family History: Write down details of illnesses and diseases in your family, noting which relatives were affected and at what age.
    • Symptom Journal: Track noticeable changes to your health and bring these notes to share with your doctor.
    • Personal Preferences: Think about your approach to treatment—are you open to hormone therapy, or do you prefer nonhormonal options and lifestyle changes?

By taking these steps, you can make your appointment more efficient, informative, and empowering.

Making the Most of Your Annual Exam During Hormonal Changes

As your hormones shift, your annual exam becomes an essential opportunity to monitor your health and identify potential risks early. By asking for key tests and add-ons, you can get a clearer picture of your overall well-being and take steps to address any issues proactively. Here are the key Tests to Request

1. Standard Blood Test
   • HDL-to-Triglycerides Ratio:
     • Ideal: 2.0 or less
     • Good: 4.0–6.0
     • Bad: 6.0 or above
   • If your ratio is in the “bad” range, ask for additional tests:
     • Lp(a) and ApoB:
       • Lp(a) assesses heart disease risk, particularly for coronary artery disease. Elevated levels can lead to plaque buildup in arteries, increasing the risk of heart attacks and cardiovascular disease.
       • ApoB measures the protein that carries cholesterol to the arteries. High levels are linked to atherosclerosis.
     • HbA1c:
       • Provides a 2–3 month average of blood sugar levels to evaluate the risk of type 2 diabetes. High HbA1c levels may also increase the risk of Alzheimer’s.
     • Thyroid Panel:
       • Check TSH (thyroid-stimulating hormone) and additional markers like free T4, free T3, reverse T3, anti-TPO, and anti-thyroglobulin.
       • Particularly useful if you experience fatigue, cold intolerance, hair loss, weight changes, or depression.
     • Vitamin D:
       • Low levels increase the risk of osteoporosis and may affect immune and heart health.
2. Essential Nutrient Add-Ons
   • Zinc:
     • Necessary for cell production and immune function. Deficiency can lead to slow wound healing, weight loss, or decreased senses of smell and taste.
   • Magnesium:
     • Plays a role in sleep, mood regulation, and nerve health. Low magnesium is linked to muscle cramps, fatigue, headaches, and brittle nails or hair.

Daily Habits for Better Menopause Health

Achieving good health after menopause isn’t a coincidence—it’s the result of consistent, intentional behaviors. After reviewing countless studies, two universal truths emerge: good menopausal health doesn’t happen by accident, and it can’t be achieved through a single pill or treatment. Instead, it requires adopting a collection of daily habits. This is the Menopause Toolkit that is recommended:

1. Nutrition: Fueling Your Body the Right Way

• Focus on anti-inflammatory foods to counteract the increased inflammation caused by declining estrogen:
  • Eat healthy fats, lean proteins, antioxidant-rich fruits and vegetables, and plenty of fiber.
  • Limit alcohol, processed meats, and sugary or highly processed foods.
  • Consider intermittent fasting.
• Key intake guidelines:
  • Protein: 1.3–1.6 g per kg of ideal body weight daily.
  • Added Sugars: Less than 25 g per day.
  • Fiber: At least 25 g per day.

2. Exercise: Strengthening Your Body for the Long Term

• Focus on strength and endurance-building activities to combat muscle and bone loss.
  • Resistance exercises like weightlifting or bodyweight movements.
  • Aerobic exercises such as walking, jogging, or cycling for cardiovascular health.
• Include daily stretching and balance training to improve mobility and reduce injury risk.

3. Evidence-Based Pharmacology

• Menopausal hormone therapy (MHT) is an effective option to consider for managing some symptoms of menopause. Discuss with your doctor whether it’s right for you.

4. Supplementation

• Supplements should address known deficiencies, not replace a nutrient-rich diet.
• Suggested daily doses for common supplements:
  • Omega-3: 2 g/day.
  • Vitamin D with Vitamin K: 4,000 IU/day.
  • Creatine: 5 g/day.
  • Specific Collagen Peptides: Fortibone for bone strength, Verisol for skin health.
  • Optional: Turmeric, Berberine, Vitamin E (depending on your risk factors).

5. Stress Reduction

• Chronic stress exacerbates metabolic dysfunction associated with menopause. Manage stress to improve mental health and reduce symptoms.
• Techniques to lower stress levels:
  • Mindfulness, meditation, journaling, and yoga.
  • Spend time in nature—“grounding” (bare hands or feet on natural surfaces) can lower stress hormones and reduce inflammation markers.
  • Sunshine exposure and counseling, such as cognitive behavioral therapy (CBT), can also help.

6. Sleep Optimization

Menopause often disrupts sleep with night sweats, restlessness, and other conditions. Here’s how to improve your sleep quality:

• Set the right temperature: Aim for 60–67°F (~16–20°C).
• Exercise regularly: Helps you fall asleep faster and improves sleep duration.
• Prioritize sleep hygiene:
  • Avoid napping after 3 PM.
  • Create a relaxing bedtime routine and stick to a consistent sleep schedule.
  • Avoid heavy meals close to bedtime and minimize light exposure, especially from LED screens.

By building these habits into your daily routine, you can take charge of your health during and after menopause, improving your quality of life and overall well-being.

Understanding Hormone Therapy

Hormone therapy, once widely known as hormone replacement therapy (HRT), is now more commonly referred to as menopausal hormone therapy (MHT). The goal of MHT is to replace or supplement the natural hormones your body no longer produces, ensuring that the critical functions once driven by these hormones continue effectively.

Types of Hormone Therapy

1. Synthetic Hormones
   • Created from chemical compounds.
   • They don’t share the same molecular structure as the body’s natural hormones and must be converted into a usable form after administration.
2. Bioidentical Hormones
   • Derived from natural, often plant-based ingredients.
   • Structurally identical to the hormones naturally produced by the body.
   • Categories of Bioidentical Hormone Therapy:
     • Compounded Bioidentical Hormone Therapy
       • Customized to each individual, allowing healthcare providers to adjust the dosage and delivery method.
     • FDA-Approved Bioidentical Hormone Therapy
       • Pre-formulated and regulated for safety and efficacy.

By understanding the different types of hormone therapy and their purposes, women can make more informed choices to manage their menopausal symptoms and maintain overall health.

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Author: Mary Claire Haver

Publication date: 30 April 2024

Number of pages: 304 pages

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