(peri)Menopause: Management and Interventions
Dr. Emily Anne McDonald, Dr. Stephenie Pisacano | Dec 18, 2024
Hand tinted maple leaf circles Daphne Boyer, visual artist
“What is the meaning of life? That was all - a simple question; one that tended to close in on one with years, the great revelation had never come. The great revelation perhaps never did come. Instead, there were little daily miracles, illuminations, matches struck unexpectedly in the dark; here was one.”
In our third and final (peri)Menopause Webinar of 2024 we covered the essential strategies to address common symptoms and risk factors with hormonal and non-hormonal pharmaceuticals, nutraceuticals, and lifestyle interventions. Sign up for our 2025 (peri)Menopause Series to follow along with the latest clinical research.
Understanding Menopause: The Basics
Menopause is defined as the cessation of menstrual cycles for 12 consecutive months, typically occurring around age 51. The transitional phase leading up to menopause, known as perimenopause, involves fluctuating hormone levels and significant changes in mind and body. The ovaries shift their role in hormone production with an overall decline in estrogen, progesterone, and testosterone over time. These hormonal changes seem to affect all organ systems and have been linked to an increased risk in developing osteoporosis, cardiovascular disease, and metabolic disorders in addition to other difficult to manage symptoms. While this transition can be quite challenging, emerging research and traditional wisdom both indicate that important changes are happening physically, mentally, and spiritually that promote long-term well-being.
Symptoms and Management Strategies
1. Hormonal Therapy
Hormonal replacement therapy (HRT) is most effective in managing hot flashes, vaginal dryness, and bone density loss. The North American Menopause Society’s 2022 consensus recommends tailored approaches:
Estrogen Alone: For those without a uterus.
Estrogen + Progestin: For those with a uterus to reduce the risk of endometrial cancer.
Delivery Methods: Oral and transdermal options are available; each has distinct benefits and risks.
Note: Compounded bioidentical hormones lack standard regulation, and salivary testing for dosing is not recommended.
2. Non-Hormonal Pharmaceuticals
For those who cannot or prefer not to use HRT, alternatives include:
SSRIs/SNRIs: Paroxetine, venlafaxine.
Gabapentinoids: For hot flash management.
Neurokinin B Antagonists: Emerging options like fezolinetant.
3. Lifestyle and Supplemental Care
Adopting healthy behaviors can mitigate symptoms and improve overall well-being:
Diet and Nutrition: Omega-3s, reduced sugar, and anti-inflammatory foods.
Exercise: Weight training to improve bone density and metabolic health.
Herbal Supports: Silica-rich horsetail for collagen stability; Bacopa monnieri for cognitive health.
Environmental Detox: Reducing exposure to toxins in cleaning products and cosmetics.
Common Symptoms and Approaches
Genitourinary Syndrome of Menopause (GSM) affects over 50% of postmenopausal women, presenting symptoms like vaginal dryness, urinary discomfort, and infections. Management includes:
Low-Dose Vaginal Estrogen: Shown to reduce urinary tract infections and improve vaginal health.
Supportive Ecosystem: Lactobacillus species maintain an optimal pH and protect against infections.
The menopause transition is critical for cardiovascular health due to adverse changes in cholesterol, blood pressure, and glucose metabolism. Lifestyle interventions can reduce these risks:
American Heart Association’s Life’s Essential 8:
Eat better.
Be more active.
Quit tobacco.
Get healthy sleep.
Manage weight.
Control cholesterol.
Manage blood sugar.
Manage blood pressure.
Cognitive changes during menopause include memory lapses and mood shifts, often linked to hormonal fluctuations. Strategies to support brain health:
Sleep and Stress Management: Enhance glymphatic flow for brain detoxification.
Nootropic Herbs: Bacopa monnieri supports cognitive function and neuron health.
Collaborative Care and Education
Our approach combines lifestyle medicine, functional lab testing, and naturopathic care. By understanding individual biomarkers and predispositions, we offer personalized strategies for hormone replacement, symptom management, and health optimization.
Join our next webinar on Hormone Testing and Interpretation on January 28th at 7:30 PM for deeper insights into individualized care.
Menopause is not necessarily an end but a transition filled with opportunities for growth and self-care. With evidence-based strategies and holistic support, you can navigate this phase with confidence and vitality.
For personalized consultations or questions, connect with us for an appointment.
