I spoke with someone by phone today who is looking for a physician who prescribes bioidentical hormones. I’ll frequently speak by phone to prospective clients and explain my perspective and philosophy and approach. This saves us both time and saves her money, because really if I don’t agree with an approach to therapy that she wants, why come see me?  This woman outlined her current therapy and explained what she was looking for in a doctor. Unwinding her menopausal story was so much more than hormone levels and lab tests! I heard phrases like “I look great for my age” and “not the way my mother’s menopause happened” and recognized immediately that many of her issues are rooted in a real fear of aging and especially a fear of playing out an aging pattern that her mother or aunt or cousin experienced.

51 is the average age of menopause – which by definition means no menstrual cycle for a year.  The time frame five to ten years prior to menopause is called the perimenopause or climacteric.  Most symptoms associated with menopause begin during the perimenopausal period.  Hot flashes, changes in sleep patterns, mood changes (especially anger or depression), libido changes and weight gain are all common concerns. I find that menopausal symptoms are different for every woman, however, and the suggestions and treatment plans are just as varied. I also see that often chronic stress can mimic the majority of menopausal symptoms, so sometimes the best treatment isn’t always adding hormones to the milieu!

But why does menopause occur?  The simple medical answer is that our ovaries gradually stop producing the hormones estrogen and progesterone.  Without the signaling, the lining of the uterus or endometrium stops building up and sloughing.  But why does this occur?  Why not cycle our hormones indefinitely?  (or are you asking: Why not be fertile to the ends of our lives?) We really don’t know the answer. Regardless of the reason, it appears we were designed to start cycling at puberty and stop in our fourth or fifth decade.

In my role as a physician, my job is to make sure that the menstrual cycle changes aren’t because of an anatomic problem with the uterus or ovaries or a problem with one of the other hormones such as thyroid or adrenal hormones.  In addition, this is an excellent platform to discuss health in general and encourage health screenings such as pap smears, mammograms, blood work, colonoscopies and bone density screenings.  Lifestyle habits such as regular exercise, healthy nutrition, and regular meditation or prayer can be reviewed and encouraged.

Aging gracefully is not an accident.  We bring our genetic predisposition to age-related illnesses such as heart disease or arthritis, but our future is not rigidly set.  We can bathe our genes in the “environmental cues” of nutritious and colorful organic fruits and vegetables.  We can move our bodies and stretch each day.  We can acknowledge our life stressors and continue to work towards life balance and resilience.  Our attitude and our outlook pave the way for healthy life choices. We can surround ourselves with people that support us in our choices. And we can practice laughing.  A lot!