What we get when we get menopause
There were some interesting stats out of a new survey of American health care providers about menopause co-morbidities, symptoms and treatment published recently in Menopause, the journal of the North American Menopause Society.
The study surveyed 238 doctors (an almost even mix of primary care physicians and gynecologists) who provided data for 1,016 women. The women were an average of 52.9 years old and the majority were white (whyyyyy), had some college education and privately insured.
Nearly 64 percent had at least one comorbidity, with the top being hypertension (40.1 percent), headaches or migraines (18.1 percent), and uncomplicated diabetes (14.2 percent). Half listed a mean number of 4.2 menopause symptoms as the primary reason for their first doctor visit, 20 percent listed the following as their top concerns:
• hot flashes (91.2 percent)
• sleep problems (49.9 percent)
• vaginal dryness (47.0 percent)
• mood changes (44.6 percent)
• reduced libido (32.5 percent)
• dyspareunia, aka painful sex (26.9 percent)
• weight gain/slowed metabolism (25.5 percent)
Nearly half of the women had been experiencing symptoms for at least 6 months.
Of 611 people, 430 left with a prescription for hormone therapy. The various forms broke down like this:
• systemic estrogen 30.8 percent
• combination estrogen/progestogen (not bioidentical progesterone, which is more similar to what our body makes and is appearing to perhaps carry fewer risks when used in combination) 33.3 percent
• local estrogen 6.9 percent
• progesterone 4.9 percent
• 76 women – 12.4 percent of them – left with compounded hormone therapy that included estrogen/progestogen, estrogen/progestogen/testosterone, testosterone, systemic estrogen, estrogen/testosterone, progesterone, and local estrogen
The researchers concluded that not enough women are getting help with their symptoms, and that both prescription and non-prescription options need to be better understood.
The study was funded by Astellas Pharma, which is funding a lot of things these days, including Britain’s All Party Parliamentary Group on menopause from June 2022 through to June 2023. Their non-hormonal drug for hot flashes, fezolinetant, is currently awaiting fast-track approval at the FDA.
The ‘root cause’ of depression and anxiety?
Yesterday I moderated four wellness talks as part of the Livehealthy Festival in Abu Dhabi (Livehealthy is the platform I helped start and serve as the editorial director for here in Abu Dhabi, where I am based). One of the talks was given by Dr Bartlomiej Piechowski-Jozwiak, a functional neurologist from Poland. This is literally one of the best conversations I’ve had in my life, and his take on depression and anxiety resonated with me to my core. I’m paraphrasing, as the recordings are still in processing, but basically he said that if people want antidepressants or antianxiety meds, and if they aren’t open to anything else, he will prescribe them. But he doesn’t like to because they won’t tackle the root cause. I’ve never heard anxiety and depression talked about from a “root cause” perspective by a mainstream practitioner, only a “chemical imbalance” angle. The root case? According to Dr Piechowski-Jozwiak, it’s gut microbiome issues or unprocessed, unexamined Adverse Childhood Experiences (ACE), or both. Why did this resonate to my core? Because throughout my 40s when anxiety was the worst I’d ever experienced, augmented with regular nightmares, daytime panic attacks, a sudden fear of flying and regular chest pain, I resisted suggestions of medication because I felt there must be a root cause too. Sure, a lot of it was the hormonal changes due to perimenopause. But not all of it, or even half of it.
And it’s only been in addressing both of these things that I have felt the see-saw of anxiety and depression I’ve experienced for much of my life dissipate, lessen, lift and burn off in a really meaningful way. These are things I want for everyone who has struggled with this too. As a starting point, Dr Bart highly recommends Dr Gabor Mate’s The Myth of Normal.
Book review: The Galveston Diet
Dr Mary Claire Haver is a Texas-based ob-gyn who built a base of two million TikTok followers speaking about menopause. She also has a new private menopause clinic and a new book, which was just released and is already an Amazon, Wall Street Journal and Publisher’s Weekly bestseller. I respect the hustle. This is a bone fide DGM (Doctor Menopause Guru).
I’ve watched Dr Haver blow up over the last two years and when I first started following her, I liked her nuanced approach to the transition. She’s also a certified culinary medicine specialist, and that set her apart even back then. I was impressed at how she talked about menopause: it was a real mix of helpful medical and lifestyle advice. But things took a turn sometime last year, when she seemed to swiftly pivot toward the “menopause is a disease and hormone therapy is the cure” narrative. She’s also been slamming bioidentical hormone therapy pretty hard lately, using similar messaging to other doctors on social media. Add that to a few “trying on bathing suits” TikToks during Covid and a video she made this week, crying about not making the New York Times bestseller list, and I can’t call myself a fan.
But I read her book anyway because I was curious and it’s the book everyone is talking about.
Nothing groundbreaking in those 609 pages. What she’s offering is essentially an intermittent fasting, low-carb plan: 70 percent healthy fats, 20 percent protein, 10 percent carbs – no potatoes or rice or bread. That daily ratio shifts to a more reasonable maintenance range once the weight comes off (ultimately 40 percent fat/20 percent protein/40 percent carbs), but it’s always there for a tune-up if the weight comes back. The Galveston Diet also calls for 16 hours of fasting, with eating conducted in an eight-hour window.
The low-carb part (with Bulletproof Coffee in place of outright fasting until noon) is the kind of eating that I’ve done for years to manage my weight, so I know it works for some people – even if “some people” very recently no longer means me. That’s why it’s getting a big thumbs down here, because if I went on it, I wouldn’t need to worry about what my body looked like or what the numbers on the scale would mean. I’d be too busy laying energy-less on the floor. And after conversations I’ve had with people in this field who I respect – menopause nutritionist and naturopath Jenn Salib-Huber, cognition dietitian Barbie Boules and integrative dietitian Esther Blum – I know I’m not alone. A lot of us need more carbs than this to function.
There is great stuff about how to eat to cut down on inflammation, with information about the worst oils and the perils of processed food and sugar. But I always roll my eyes when people try to pass off simple food assembly as a receipe – banana and almond butter on toast, for example. And in the end, it’s a diet (even if you achieve your goals, you move to The Galveston Diet for Life). I don’t doubt that this program has helped some people find their way to health. But when so many people are finding healthy metabolisms and sustainable weight loss outside of fasting and within a pro-metabolic, carbs-are-a-ok framework, The Galveston Diet just feels a little out-of-touch for 2023.
2 hot flashes (out of 5)
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Sarah Silverman talking about how hard it is for her to get enough Vagifem from her local CVS to take on tour is pure gold @sarahkatesilverman
This woman taking to social media to ask how she’ll make it through the night the day after losing her husband will restore your faith in humanity Twitter
I asked Instagram if I should start to cover andropause – the more gradual version of midlife male hormonal decline – and the response may surprise you @hotflashinc
Then I saw Male menopause: The silent epidemic that leaves millions of men suffering from erectile dysfunction, depression and rapid fat gain Daily Mail
I am thrilled that women’s magazines are also finally acknowledging that celebrities go through menopause too: 10 things we know Shania Twain does to stay fit and strong at 57 Women’s Health
13 of the 18 top firms in The City (Britain’s version of Wall Street) have adopted menopause policies after management became frustrated at the “deluge” of midlife women leaving Financial News
‘Menopause is not this mad demon that arrives at your door… turn it off at your peril’: warm words from a wise woman to counter the HRT narrative @janehardwickcollins
One of the most alarming things to me is when doctors (and researchers) don’t seem to know the difference between progesterone and progestin. Find out more here: DrMariza.com
Editor’s note
Please forgive any typos. I am so tired. More than two weeks with no days off. Two events across two platforms. Total chaos in my organizational systems and errands and chores ignored. Personal life upheaval (all necessary and ultimately ok). Mama needs to rest – and so, sister, do you. Please respect the rhythms that beset you. And I will do the same. And if you need a good show while you do it, please try Bad Sisters on Apple+. I could watch Sharon Horgan cut carrots, but in a mystery of this calibre in and around the gorgeousness of Dublin? It was heaven. Aux