menopause

Mastering menopause

Michelle Biton has released a new book. Written in the same style as The Instant Anxiety Solution: 5 Simple Steps to Quiet the Mind & Achieve Calm, her recently released The Menopause Weight Loss Solution: A Woman’s Guide to Menopause Without Pounds offers six steps to help women live their best lives during menopause. Both books are published by Hatherleigh Press Ltd.

The mnemonic device that anchors this book is SHRINK. After an introductory chapter about what menopause is, some of its symptoms, the role of cortisol (“the body’s primary stress hormone”) and a couple of other topics, each section explores one of the letters. So, chapters 2 through 7 are (italics added): Stimulate Your Metabolism; Harness the Power of Your Vagus Nerve; Reinforce the Eight Nutritional Strategies; Incorporate Daily Pelvic Floor and Core Exercises; Nurture Mindfulness and Mindful Eating; and Know Your Female Powers with Confidence.

“Menopause is a natural process,” writes Biton. “You officially hit menopause when you do not get your period for 12 consecutive months. The ovaries stop making estrogen and progesterone and the period disappears. It signifies the end of the reproductive years and the beginning of the wise ‘goddess’ years.

“But that is the easy version. Menopause, or pre-menopause, can feel like a rollercoaster ride of hormones or a symphony of fireworks.”

Pre-menopause, or perimenopause, can start in one’s 30s or 40s and last up to 10 years, writes Biton. “At least 80% of women will experience menopausal symptoms of varying degrees and severity.” And there are many symptoms or changes, including but not at all limited to: slower metabolism, poor memory or brain fog, weight gain around the middle, thinning hair, increased irritability and moodiness, night sweats, increased sadness, diminished sex drive and itchy skin.

Weight gain during menopause apparently affects 65-70% of women, who gain an average of five to 10 pounds. One reason for this is that “women’s ability to burn calories gets cut by 30% or more,” says Biton. “By the time she reaches middle age, she will have to work almost twice as hard to burn the same amount of calories as she did in her 20s.”

Biton recommends many different types of exercise to build muscle and kickstart one’s metabolism. “Simple things like lifting your body weight against gravity does the job perfectly,” she writes. “You can do them anywhere; they are easy to do and very effective. This includes exercises like push-ups, triceps dips, lunges and squats.” She gives a description of how to do lunges and planks, and talks about things like ideal intensity levels: “Regular physical activity [like walking], versus doing one intense workout on the weekend, will be more beneficial at increasing your metabolism long-term.” She notes that adding protein to every meal can help boost metabolism, as can eating the “right kind of fat,” such as omega-3 and omega-6.

A moderate approach to exercise and eating is, not surprisingly, the recommended approach and she dedicates Chapter 4 to nutritional strategies. Chapter 5 is about ways to increase core strength (“namely, your corset and girdle muscles”), to combat weight gain around the midsection, and exercises to strengthen the pelvic floor muscles to keep incontinence at bay.

The chapter on the vagus nerve – the “key” to activating the parasympathetic nervous system (PSNS), which helps us “calm down, handle stress better, regulate your mood and feel more relaxed, connected and compassionate” – takes a lot from Biton’s previous book on dealing with anxiety. (See jewishindependent.ca/ways-to-tackle-anxiety.)

“During menopause, it is common to feel stressed and overwhelmed, not to mention disconnected, irritable, worried, anxious, depressed and questioning a lot of things in life,” she writes.

She advises: “If you’re having a hard time regulating your emotions, feeling overwhelmed or overly emotional, it’s a good idea to activate your PSNS right away.” And she offers many ways to do that, from splashing cold water on your face, to running on the spot as long as you can, to deep breathing, to immersing yourself in nature, and more.

The chapter on mindfulness focuses on differentiating between physical and emotional hunger. The former “begins in the stomach” and is “a physiological need,” while the latter is “when you eat in response to feelings…. Emotional foods tend to be high in carbohydrates, as they allow more L-tryptophan, a mood-regulating amino acid, to enter the brain. Carbohydrates (and sugar) help the body to make serotonin, the ‘feel-good’ neurotransmitter, so it makes sense why emotional eaters tend to consume foods that give them a ‘sugar high.’” Biton suggests practices like mindful eating (slowing down, chewing your food well); trying “to eat out of physical hunger 95% of the time,” while allowing yourself occasional treats; and, again, adding protein to meals “to feel full for longer.”

The last chapter of The Menopause Weight Loss Solution is about retraining our minds to think more positively and reduce negative thoughts about ourselves. It also tackles perhaps sensitive topics like changes to the vagina, body odor, breast tenderness, skin and more that happen during menopause.

There’s nothing revolutionary or in-depth in this book, but rather it provides an overview and the basics of what a woman can do to understand and get through menopause more easily.

Biton has a master’s in holistic nutrition, a bachelor’s in psychology, and a certificate in kinesiology and fitness studies. She is a former Vancouverite who now lives in Los Angeles. For more information, visit michellebiton.com.

New views on heart disease

Dr. Ross Feldman is leading various teams as the principal investigator for women’s health at the Institute of Cardiovascular Sciences at the city’s St. Boniface Hospital. (photo from Dr. Ross Feldman)

Many of us are under the impression that heart disease mainly affects men. But researchers have been trying for the last few decades to change this skewed view. One such researcher, Dr. Ross Feldman, recently found his way to Winnipeg. Feldman is leading various teams as the principal investigator for women’s health at the Institute of Cardiovascular Sciences at the city’s St. Boniface Hospital.

According to Feldman, “Most of what we know in terms of risk and benefit and treatment of those factors that contribute to heart disease initially came from studies of younger people with more advanced risk factors – be it cholesterol, high blood pressure, [etc.] – and what the benefit was from the treatment of those problems, in terms of reducing risk of heart attacks or strokes. Women tended not to be included in those studies, because premenopausal heart disease risk is so much lower. So, in the earlier days, we developed guidelines that were mostly based on findings in younger men. It really wasn’t appreciated that women had accelerating risk after menopause.”

This new understanding about the connection between post-menopause and heightened risk of heart disease has only come to light in the past 10 to 15 years. The Heart and Stroke Foundation is only now, within the last year, opting to make the topic a priority.

“I think it’s taken even longer for it to register on the psyche of healthcare professionals … that women are at an increased risk post-menopause,” Feldman told the Independent. “They’re also much less likely to be diagnosed appropriately, less likely to get appropriate treatment, and they are more likely to have complications with trying to fix blood vessel problems. They’re less likely to be sent out following a cardiac event on all the right medications. And then, ultimately, a little more likely to die of heart disease.”

Feldman believes this lag time – for women to get the correct diagnostics and treatments – will not change anytime soon, unfortunately, as the training provided in medical schools is still based on past knowledge about women and heart disease. Medical students are still being taught that women are more likely to present with atypical chest pain, with no further explanation, said Feldman.

“If women are most likely to present that way, why are you calling it atypical chest pain?” he asked. “It gives you an idea of how male-centric our whole approach to heart disease has been. What we get out of it is, you often see a dichotomy, that sometimes you’ll see premenopausal women at risk of being over-treated.

“A woman, premenopause with hypertension, probably doesn’t need blood pressure-lowering therapy unless their blood pressure is greater than 160 over 100. Whereas, a post-menopausal woman with multiple smaller elevations in individual risk factors – a little bit higher blood pressure, a little bit higher cholesterol – will often get overlooked…. Yet, she is at a much greater risk than will be projected, based on consideration of any individual risk factor.

“There needs to be a sex-specific approach to management of the risk factors of heart disease and the presentation for heart disease,” he said. “The guidelines for that approach are still in flux.”

As medical practitioners are lagging behind the latest findings about women and heart disease, Feldman said that premenopausal women don’t need to be as concerned about risk factors that may be a little out of whack, such as LDL cholesterol or blood pressure. However, he said, post-menopausal women need to be advocates for more aggressive treatment for even seemingly marginal elevations in risk factors.

“The problem is that primary care professionals, a lot of them, will tend to underestimate the risks,” said Feldman. “There are reasonable calculators that will tell people, if you add up several small risks for a post-menopausal woman, that translates into an overall risk level that mandates more aggressive therapy. Generally, blood pressure and cholesterol are the most important factors to look at, but it’s the whole aggregate risk based on the calculation that tells you how aggressively you need to treat, regardless of the extent of the elevation.”

While researchers like Feldman are working on sex-specific therapies, women can help themselves by reducing their degree of risk via exercise, maintaining a healthy weight and a healthy diet, keeping hydrated and finding ways to keep stress and anxiety levels down.

“As women age, as with men, excessive salt intake increases blood pressure and often that excessive salt doesn’t primarily come from the salt shaker, but from processed foods,” said Feldman. “When shopping, shop the rim of grocery stores. Stay away from the aisles. Maybe shop in the frozen food sections, but probably not.

“To date, there is no real sex-specific preventative approach. That is, exercise, as far as I know, is as effective in blood pressure reduction and weight reduction for men as it is for women … maybe a little more effective in women, but likely marginal differences. I think it’s important for women to know that weight gain and a more sedentary lifestyle are bigger risks for them than for men. Men tolerate being couch potatoes a little better than women do.

“The slope of the line for weight gain in men is pretty linear,” he said. “In women, there’s an increase in slope of weight gain after menopause. Women’s systems are less tolerant of the kinds of changes that occur with age than men’s.

“We know there are ethnic differences in risk tolerance,” he added. “We know that Asians are less tolerant to weight gain than Caucasians. That is a genetic difference. We hadn’t appreciated that sex differences work the same way, although we should have, as, ultimately, a sex difference is a genetic difference.”

Rebeca Kuropatwa is a Winnipeg freelance writer.

Getting through menopause

Harriet Berkal unveils the secrets of menopause. Berkal began the support group Menopause Matters after experiencing a lack of help when she went through that stage of life. (photo by Manny Berkal-Sarbit)

Medical advocate Harriet Berkal recalls eagerly anticipating going through menopause, imagining it to be a fabulous life stage without having a period every 28 days or so.

“Now, if I could go back and have my periods and not go through this other nonsense, I would say, give me my periods back,” Berkal told the Independent.

Berkal works as an executive financial consultant for Sarbit Advisory Services in Winnipeg and has been struggling with menopause-related issues for the past seven years. She has leaned from experience that there is next to no help out there for dealing with the effects of menopause, and this has led her to take matters into her own hands and create a support group.

“One problem with this issue of menopause is, if you complain to a physician about something like weight gain, a symptom of menopause, they bundle everything you say after that behind that carriage,” said Berkal. “So, my GP missed the fact that I had a thyroid condition, because it was thrown into menopause – the same way that people get thrown into the irritable bowel syndrome (IBS) or the fibromyalgia hole … where anything you complain about is automatically assumed to be related to that, when it might not actually be.”

Menopause symptoms for many women include hot flashes, night sweats, migraine headaches, bladder infections, gastroesophageal reflux disease, lost libido, and painful intercourse. There are also some very rare reactions, such as feeling as though you have bugs crawling all over you, and emotional depression or anxiety, which are also related to hormonal fluctuations.

While typically menopause begins in one’s 50s, it can start in one’s 40s, where the cycles become more erratic, and, in some cases, even earlier, from induced conditions via cancer treatments, for example.

As Berkal searched for solutions, she decided to share the information she gathered with other women undergoing menopause. She approached Winnipeg’s Jewish Child and Family Services (JCFS) about starting up a learning and support group.

The idea was welcomed and the group was called Menopause Matters. Some 20 women meet once a week for five weeks to learn about different approaches to dealing with menopause symptoms and management.

“Most of the primary group are those in the throes of menopause and who aren’t functioning well,” said Berkal. “We had about 18 at last week’s meeting. It was an emotional meeting. There were some people who were extremely – not just frustrated with the system, but at the end of their rope. They don’t know who to turn to, what to do. We provide them, each week, with a different speaker and go through the whole gamut of solutions from traditional to non-traditional.”

Some education is provided by the clinic Vitality Integrated Medicine, which is run by a former pharmacist. Participants are informed about drug interactions, different kinds of tests to help determine actual lacks in their systems, and three different kinds of estrogen. According to Berkal, what often happens is that menopause-affected women consult their doctors and are told they need estrogen, and then they just take whichever one is prescribed.

Recently, Menopause Matters participants had a guest speaker who is an acupuncturist discussing stress control and how it affects hormones, and various acupuncture relaxation techniques that could help. “She brought needles and tried them out on some people,” said Berkal. “People were appreciative of that approach.”

Another scheduled guest speaker at the time of Berkal’s interview with the Independent was gynecologist Dr. Maggie Morris. She was to speak “about mainstream methods for dealing with things like Premarin estrogen application.”

Berkal’s personal experience with conventional medicine in general is that its practitioners are uncooperative from the moment she mentions that other approaches will be presented.

“The pharmacies have these ready-made solutions,” she said. “They aren’t one-size-fits-all solutions in my mind. We’re trying to provide people with a range of different solutions and methods to cope with this. One solution doesn’t do everything. You don’t want to mask symptoms. You want to get to the root. Everyone’s jockeying for position here and everyone has different approaches, so you should try figuring out what system fits you the best.”

Another speaker booked to address the support group is to talk about the importance of exercise, while another will highlight a treatment called Mona Lisa Touch, which involves the use of a laser inserted into the vagina to stimulate vaginal collagen production.

“It rejuvenates the tissue in the vagina without hormones, so you can get increased libido and increased moisture,” explained Berkal. “It helps create a better balance of health in the vagina.

“Many women get bladder infections, because the bladder and the vagina are closely linked. And, if you don’t have the right environment in the vagina, which is decreased because of menopause, you can end up with UTIs [urinary tract infections] … which I had probably 10 of last year before I started treatment.”

When Berkal underwent menopause, she said, “It was a pretty extreme and exacerbated reaction. Mood swings are a very big issue. Last week, there were several women in the group who said, ‘Does anyone feel like they’re going crazy?’ Almost everyone raised their hand.

“Hormones are so powerful. When they are working great, that’s great. When they are depleted, you are left with a shell of a body, susceptible to bone loss, memory fog, you think you’re getting the early stages of Alzheimer’s … but really, you’re not.”

Berkal believes that integrated medicine is the right direction and, in fact, integrated clinics are popping up in many places.

“But, the fact that I couldn’t find a menopause support group was mind-boggling,” said Berkal. “I approached the Mature Women’s Clinic at the Victoria Hospital and asked if they would start a support group. They said ‘no.’

“Why would they not want to help women in need? Yet, when the pharmaceutical companies sponsor a forum for one of their gynecologists to speak, they get thousands of women to come down who are in dire need of help … but they are only giving one approach.”

Shelley Levit, a social worker at JCFS, was very receptive to the integrated approach Berkal described, and the concept of letting women choose for themselves what they want to pursue.

Berkal hosted a Menopause Matters free, five-week support group from Sept. 15 to Oct. 13, via JCFS.

“We call it ‘the Sisterhood of Sharing,’” said Berkal. “Sharing is deeply required in order to feel camaraderie and kinship with these other women who really have no one else to talk to. It wasn’t intended to be targeted at Jewish women specifically. It’s like cancer – not specific to any ethnicity.”

Berkal wants to see if the group would be receptive to having partners and spouses join, so they can be present and hear from other women.

Rebeca Kuropatwa is a Winnipeg freelance writer.