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A Message for Millennials about Menopause

Happy new year! This day 24 years ago defined our generation

Don’t freak out: but perimenopause may be on the horizon

dr mandelberger menopause specialist

Based on my interactions with patients and friends, it seems millennials generally fall into two camps: those deliberately avoiding the thought, assuming it's a distant concern, and those grappling with symptoms, only to be told they're too young for such matters.

The truth is that perimenopausal symptoms can surface as early as one's thirties. This can be particularly daunting for those still considering pregnancy. Complicating matters, these symptoms often mimic those of other common issues, such as PCOS.

Much like you'd ensure your daughter is well-prepared for her first period, my aim is for you to be equipped with knowledge about the changes that accompany menopause. It's crucial to understand your options and avoid unnecessary suffering. I've seen too many women shrug it off with  "it’s not that bad, I don't want the risks of taking hormones” only to change their tune once we discuss the actual risks and benefits. 

For those who want the short version, here are some key points: Hormone replacement therapy (HRT) as we use it today, doesn't cause breast cancer. That idea came from a study on different estrogen and progesterone types, used mainly on older women. Most of today’s certified menopause practitioners use estrogen that gets applied to the skin or vagina, and oral progesterone or a progesterone IUD. It's a game-changer for minimizing symptoms and tackling the risks that come with menopause. Yes, there are risks, and here's a rundown of some of the detrimental changes that may occur:

-increase in LDL cholesterol and triglycerides-decreased sensitivity to insulin, higher risk of type 2 diabetes

-increase in visceral fat (this is the fat that surrounds the internal organs that is particularly dangerous) 

-accelerated loss of lean muscle

-loss of collagen 

-poor sleep (which leads to increase in cortisol levels, stress, weight gain, cardiovascular disease)

-increased risk of depression and anxiety 

-accelerated bone loss 

Estrogen replacement can help tremendously with all of these, but of course taking hormones is not for everyone! Luckily many of these risks can also be mitigated with specific lifestyle changes:

-Focusing on strength training and muscle hypertrophy (which leads to a slew of metabolic improvements including insulin sensitivity and visceral fat loss)

-Optimizing sleep with good sleep hygiene and a few key evidence-based supplements

-Early treatment of hyperlipidemia and hypertension

-Working on mental health with mindfulness based stress reduction, or cognitive behavioral therapy 

-Optimizing nutrition through food, focusing on gut-health (making sure to stick to science and not to fall into booby-traps) 

-Increasing mitochondrial (/metabolic) health with aerobic “zone 2” training and VO2 max training, which also mitigates cardiovascular disease risk (more on this in later posts)

Lifestyle plays a huge role, and now is the time to start working on better habits for long-term health. If there's one thing to take from this post, it's the importance of muscle mass. We'll all lose some as we age, but the more you start with, the more you'll keep. They say "muscle is the organ of longevity," and it's not just a catchy phrase. So go pick up those heavy weights while you still have the muscle-gaining benefits of your reproductive years. 

You may consider hormone therapy as an additional tool to mitigate the risks (not to mention help with symptoms). In this age range, it is important to also consider contraception as a factor when considering treatment options. 

Come in for a consultation, “menopause 101” to learn more about your individual risks and options. 


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