Ask The Expert: Menopause and Wellness

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As we recognize Menopause Awareness Month, it's essential to address the unique challenges and misconceptions surrounding menopause. Menopause is a natural phase of life that every woman goes through, yet it often comes with unnecessary taboos.

Menopause is a complex hormonal shift that affects various aspects of a woman's health, including bone density, mental health and overall well-being. To dispel these myths and promote a better understanding of menopause and all that comes with it, we've interviewed Jackie Giannelli, FNP-BC, NCMP, a menopause specialist and the Founding Nurse Practitioner at Elektra Health.

Disclaimer: If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Well Guide contain information from peer-reviewed research, medical societies and governmental agencies; however, these articles are not a substitute for professional medical advice, diagnosis, or treatment.

What does a wellness plan for menopause entail?

Elektra’s menopause wellness plans include tailored product and supplement recommendations, lifestyle changes, and symptom-specific educational content. They’re developed by our expert Guides, aka menopause-trained healthcare professionals (or “doulas”).

We also offer care plans for telemedicine-eligible members, which are developed by Elektra’s board-certified clinicians (NPs & MDs). These contain specific supplement guidance (including dosage information), nutrition and lifestyle recommendations, and prescription medications/lab work as needed.

What are the most common misconceptions about menopause and wellness?

Probably the biggest misconception that I encounter in my work is that women have to suffer in silence through this period of their life when, in reality, there is so much that can be done: hormone therapy, non-hormonal treatments, supplements, lifestyle changes, etc.

Unfortunately, only 1 in 5 OBGYN’s have received any menopause training in medical school or residency, which certainly contributes to this misconception. I recommend seeking out a provider certified by The Menopause Society (formerly known as NAMS). And if you’re going to talk to your doctor about menopause, don’t do it during your annual visit! Make a separate appointment, write down your questions in advance, and focus on your main symptoms.

How does menopause affect a woman's overall physical and mental well-being?

When most people hear “menopause,” they think about things like hot flashes, brain fog, sleep difficulties, and weight gain — all of which are very common and disruptive to our quality of life. But there are actually 34 symptoms, including anxiety and depression, dizziness, fatigue, vaginal dryness, low libido, irregular periods, sore breasts and, of course, osteoporosis. It’s really difficult to overstate just how much this transitional period affects our physical and mental well-being.

How does menopause impact bone health?

The most important risk factor for bone loss is menopause — one in every two women over the age of 50 will break a bone because of osteoporosis. Unlike some other menopause symptoms, the science behind bone loss during menopause is somewhat straightforward: estrogen plays a protective role on our bones, so when levels of this key hormone decline during perimenopause into menopause, so does bone density. This is what can lead to osteopenia and osteoporosis, which are associated with significant morbidity and mortality.

How does exercise factor into a wellness plan for menopause?

Physical activity is an integral component in wellness plans. We especially stress the importance of strength training to maintain muscle mass, keep our metabolism up, and help with weight management. Weight-bearing and resistance exercise are some of the best things we can do for our bones in menopause. Balance and core strength prevent us from falling, which is an added risk factor for fracture. Additionally, we recommend aerobic exercises to maintain cardiovascular health, sleep, energy, cognition, and mood. And of course, there’s pelvic floor exercises as well, which help with urinary and vaginal symptoms and are vital to overall, long-term health and wellness.

What elements of care or treatment do you feel are missing for women going through or post-menopause?

Earlier this year, Elektra completed an Actuarial Cost Report investigating healthcare costs incurred by menopausal women ages 40 to 60 according to claims data. We found that women who receive a clinical menopausal diagnosis incur, on average, 45% more healthcare costs per year (an additional $4,637 higher than non-diagnosed women). The reason? Lacking appropriate care from existing providers, menopausal women seek additional specialty care and undergo unnecessary tests and labs in an attempt to treat their symptoms. What we’re missing is a holistic approach to menopause for more preventive and effective, coordinated treatment and higher-value diagnostics.

What are some of the most common symptoms of menopause?

The most common symptoms of menopause include anxiety, brain fog, decreased libido, hot flashes/night sweats, irregular periods, sleep problems, vaginal symptoms, weight gain, and osteoporosis.

Diving deeper into some stats: 80% of women experience hot flashes during menopause, 60% report brain fog and other cognitive issues (including difficulty concentrating), 50% report anxiety, and 40-60% experience insomnia. Collectively, these symptoms have a significant burden not only on our personal lives, but on our professional lives as well. Our 2022 Menopause in the Workplace Report revealed that 1 in 3 women report menopause negatively impacts their work performance, 20% have left or considered leaving their jobs due to symptoms, and 18% have not pursued a promotion because of menopause symptoms.

What are some of the less common symptoms?

Some of the less common symptoms that people may not know are associated with menopause include brittle nails, Burning Mouth Syndrome (which, as the name suggests, is when it feels like you’ve just burnt your mouth on a too-hot spoonful of soup or sip of tea…except you didn’t), gum problems, headaches, and hair loss.

Why do you think menopause has traditionally been a taboo topic?

50 million women are currently navigating menopause in the U.S. And while this transition is a universal female experience, it’s shrouded in stigma, shame, and secrecy — which affects our personal and professional lives. There are many factors contributing to the taboo, including negative depictions of women in the media (as “hysterical,” hormonal, and irrational). Menopause is shrouded in its fair share of “isms,” including sexism and ageism.

While a pregnant woman may be able to chock up her memory lapses to “pregnancy brain,” you’d be hard-pressed to find a menopausal woman mentioning brain fog in a corporate setting because of what it may imply about her age or ability to perform her job well. That needs to change.

Are there any pseudoscience myths you’d like to dispel?

One big myth that we see often on social media is this concept of “balancing our hormones” when, in reality, our hormones are never balanced. They go up, they go down…but they do so in an orchestrated way that makes sense in the body. Once we hit perimenopause, our hormones fluctuate even more because our body is going through a transitional period. This is why, in the field of menopause medicine, we prioritize and respond to symptoms rather than labs.

So be wary of products, supplements, or programs that promise to balance your hormones. They may not cause any harm (except to your wallet!), but their claims may be misleading and unrealistic.

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