We hope you find this information helpful. It is important to Dr. Goodman that you expand your knowledge during this new phase of your life. But please note that Dr. Goodman is no longer accepting new menopausal medicine patients. He is, however, accepting new patients for difficult/chronic GYN issues (ask staff for details*) and genital plastic and cosmetic procedures.
1. Look At Your Glass as Half-Full, not half-empty! There is so much that you can do to regain control, temper stress and enjoy the long span of life ahead of you.
2. Put Yourself First! You are no good to all of those other people (kids, spouses, aging parents, boss, etc.) you feel you have to care for, if you do not. Pamper Yourself! Spend some money on a good menopause practitioner, guide, etc.; massage; personal trainer; aesthetic surgery; etc.
3. Learn Your Triggers for hot flashes, mood disruptions, etc. Learn how to put on your own “safety”, and be prepared to disarm should they fire. Avoid hot beverages, spicy foods, chocolate, hot, stuffy rooms, heat in general, stressful situations, etc. Carry small fans: in your purse, desk at work, kitchen, bedroom, etc. Dress in layers. Have some Calms Forte®, 5-HTP, Xanax® (alprazolam) or Ativan® (lorazepam) in your purse. Learn quick, calming meditations (slow breathing; “counting respirations”; roll breathing, etc.).
4. Make Sure You Get Enough Restful Sleep!
i. The best sleep aid I am aware of is 30 minutes or more of vigorous exercise earlier in the day!
ii. Prepare yourself for sleep: No stressful activities (arguments, disturbing TV or reading material, etc.), close to bedtime; low light level 1-2 hours prior to bedtime.
iii. “Bedtime Ritual” of a warm calming bath, gentle music, half-cup soothing tea, etc. plus five-ten minutes of calming, controlled breathing prior to retiring.
iv. Go to sleep at more or less the same time each night, when your body is tired and ready. Not one hour after you are tired because you are on the computer; not one hour earlier than you are “ready” because that’s when you think you should go to sleep…
v. Good botanical sleep aids: 5-HTP 100-150 mg; valerian 200 mg; L-theanine 100 mg. Melatonin 2-6 mg good only if your schedule has changed and you must adjust to a new bedtime.
vi. Do not rule out short term prescription sleep aids–they can be life savers! Ambien®, Ambien C-R®, Lunesta®, Restoril® (temazepam) are good full-night sleepers; Sonata® is a fast-acting, short duration sleeper to get to sleep or for late-night wake ups (“2-4 club”).
Most peri-menopausal insomnia problems involve crashing estrogen levels; estrogen therapy solves this problem.
“Pearl”: A wonderful way to get to sleep (or to get back to sleep in the middle of the night) is to divert your attention from your brain to your body. Your body really wants you to get to sleep, but if things are whirling around in your brain, you will stay awake. Direct your entire attention to how good and comfortable and sensual it feels to be in bed–have two or three pillows that you can hug, put between your legs, etc.; stretch your legs out; move your legs to a cooler place in the sheets–pay total attention to how good it feels to “luxuriate” in bed. If you feel your mind wandering, bring it back to the good sensations of being in bed. Remember–your body wants you to go to sleep; if you concentrate on these sensations, you will be “sawing logs” before you know it.
5. Do Not Rule Out Any Therapeutic Modality. Go first with what intuitively seems most appropriate, but keep an open mind. Help may come from places that initially may seem distasteful or not applicable to you. Remember, just because its “natural” does not mean it is either safe or effective. Many (? most) products hyped as “natural” have undergone no rigorous testing…
6. Seriously consider hormone therapy (“HT”) to “cushion the blow” as a short-or long-term solution. “HT” may include estrogen, testosterone and progesterone in combinations and ratios determined by a skilled practitioner.
Estrogen has been studied perhaps more than any other medication on the market today. Its risks (especially when paired against its symptomatic and health benefits) are truly minimal when administered properly. Estrogen has gotten an undeservedly bad rap from sensationalist media, the “New Player” in healthcare, and researchers and pundits more interested in enhancing their reputation so as to secure funding, than in truth-in-research reporting.
The “WHI” estrogen-scare involved misrepresentation and premature reporting of a study of the effects of the administration of estrogen along with a strong synthetic progesterone in high doses to a population of women 10-15 or more years post-menopause; it had nothing to do with the positive and negative effects of hormone therapy on newly menopausal women (which, with later analysis, was shown to have beneficial effects and much less breast cancer risk than previously reported).
DO NOT BELIEVE most of what you read in the press (or see on TV news). Millions of women stopped HT unnecessarily, became miserable, and will pay the price with increased risk of cardiovascular disease, osteoporosis, and Alzheimer’s in the years to come!
When administered properly by a skilled practitioner, the risks of breast cancer, stroke and blood clot are truly tiny, especially when paired with the diminished risk of cardiovascular disease, colon cancer, osteoporosis and Alzheimer’s if HT is begun near time of menopause.
HT includes BHRT, by the way. Bioidentical Hormone Replacement Therapy is hormone therapy with compounds synthesized from plant sources to be biologically identical to what your own ovaries produce.
7. Seek an Expert in Perimenopausal Medicine. This may not be your OB-GYN whose office is filled with pregnant women and emergencies, nor your “PCP” whose knowledge of up-to-date menopausal therapeutic options may not be deep.
**For an expert near you, go to www.menopause.org and seek a “Certified Menopause Practitioner.”
Whom not to seek:
i. Any healthcare practitioner (“HCP”) who only has ten minutes for your problem, talks at you rather than with you, isn’t really listening, and is not willing to explain benefits, risks and alternatives.
ii. Any HCP who does not have the legal ability to prescribe. Because so many helpful options are not available to them, many of these practitioners will “pooh-pooh” or put down helpful therapies because they do not have the educational and legal ability to prescribe them. “If all you have is a hammer, everything looks like a nail”.
8. Work Hard on Lifestyle Adjustments: Hormonal balancing, herbs and botanicals and sleep and anxiety medications may be well and good but, simply stated, you will not optimize you midlife passage (nor will you sleep optimally) without lifestyle adjustments in the area of diet, exercise and especially mindfulness/stress reduction. (I will be writing a whole piece on this soon on this website).
DIET: Eat frequently (five-eight “mini-meals” per day). Complex carbs and protein; easy-access pre-prepared small meals. Eat when you are hungry ‘til you are no longer hungry (different from “full”). Avoid simple carbs (refined flour, sugary stuff, white rice, white pasta, potatoes, etc.). Yogurt, fruit, veggies and dip, hummus, whole-grain breads, nut and nut spreads, hard boiled eggs, “half pint” deli dishes, half sandwiches, granola and whole grain cereals, salads, left over meat, fish, etc.
EXERCISE: You don’t have to like it, you just have to do it. Exercise is important work. A total of 20-60 minutes of high-intensity aerobic and weight exercise most days. Power walking with light weights; aerobics classes; Curves®; health club or physical therapy facility; at-home machines; etc. Listen to music–loud, high-intensity music with a beat–while you exercise; the time will pass less painfully…
MINDFULNESS: Health and disease are in large part determined by the immune system. Stress wrecks and stress reduction enhances immune response. “Mindfulness” is the process of psychic relaxation through meditation, yoga, vigorous exercise, stress reduction classes, etc. Stated plainly: Stress kills; stress reduction heals.
If you eat excessively, have a BMI greater than 30, exercise rarely and are stressed, you have at least five times the heart attack/stroke/cancer risk of the average person.
DO NOT FEEL HOPELESS if you are enmeshed in a life that appears to preclude these necessary changes. Find a life coach, menopause practitioner or counselor to put you on the right road. A small amount of money spent will pay huge dividends. “It’s not on my health plan” is a sorry excuse for not taking personal control, and a harbinger of poor health to come.
9. Maintain and Nourish Your Sexuality and Sensuality and sexual communications with your partner (if applicable). Few things in life are fun–and free. Sex is one! “Use it or lose it” certainly applies here.
Vaginal lubrication is a must. Start out with Replens® for the inside; a light oil, (baby oil, massage oil, etc.) for the outside. A tiny dose of vaginally applied prescription estrogen will work wonders, with very minimal systemic absorption.
Understand also that you can enjoy very satisfying sex in the relative absence of sexual desire. Sexual desire is an inherently male quality (no desire; no erection). Men’s sexuality is linear: Desire leading to arousal leading to erection and sexual intimacy. Women are different; their sexuality is more circular and circuitous (“women need a reason for sex; men just need a place”), and starts with intimacy, not desire. Women first must be approachable. To be approachable, a woman must feel trust and intimacy with her partner. Given this, plus some gentle physical intimacy, she may become aroused and only then may have desire for sex…which leads ‘round again to approachability. Sexual satisfaction for women involves intimacy and arousal. Don’t feel bummed or abnormal if your desire appears down–you are normal! Sexual desire for women is dependent mostly upon the novelty of a relationship; it is not an inherent part of female sexuality.
Separate touch from sex. Gentle touch, stroking, massage is inherently therapeutic for all of us, yet couples are afraid to touch or be touched by their partner out of fear that desire for sex is the initiating factor. Ask your partner to have a clear communication when he desires sex (something like “…wanna fool around…?”), so that you both can touch and be touched without fear of “ulterior motive”.
10. Transdermally (patch, cream, gel) is the best and safest method of administering HT, especially estrogen. Therapeutic levels are smoother, risk of stroke or blood clots considerably less, adverse effects on testosterone less, and risk of breast cancer possibly less with transdermal therapy. There is virtually no rationale, in this day and age, for oral hormone therapy!
Additionally, consider replacement of testosterone (probably necessary in over 50% of postmenopausal women; necessary in 100% of surgically menopausal women) and the adrenal hormone DHEA. Add the adrenal pre-hormone pregnenolone if your stress level is elevated.
10-1/2. Read “The Mid-Life Bible–A Woman’s Survival Guide!” It will tell you everything you need to know for a successful menopausal transition.