The Dr. Hyman Show - Exclusive Dr. Hyman+ Functional Medicine Deep Dive: Menopause

Episode Date: October 26, 2021

Hey podcast community, Dr. Mark here. My team and I are so excited to offer you a 7 Day Free trial of the Dr. Hyman+ subscription for Apple Podcast.  For 7 days, you get access to all this and more entirely for free!  It's so easy to sign up. Just go click the Try Free button on the Doctor’s Farmacy Podcast page in Apple Podcast.   In this teaser episode, you’ll hear a preview of our latest Dr. Hyman+ Functional Medicine Deep Dive on menopause with Dr. Elizabeth Boham.  Want to hear the full episode? Subscribe now. With your 7 day free trial to Apple Podcast, you’ll gain access to audio versions of: - Ad-Free Doctor’s Farmacy Podcast episodes - Exclusive monthly Functional Medicine Deep Dives - Monthly Ask Mark Anything Episodes  - Bonus audio content exclusive to Dr. Hyman+ Trying to decide if the Dr. Hyman+ subscription for Apple Podcast is right for you?  Email my team at [e-mail] with any questions you have.   Please note, Dr. Hyman+ subscription for Apple Podcast does not include access to the Dr. Hyman+ site and only includes Dr. Hyman+ in audio content. 

Hey everyone, it's Dr. Mark Hyman here. Now my team and I have been working hard on something that I'm so excited to share a little bit about today. It's a revolutionary new platform called Dr. Hyman Plus, which is a premium membership exclusive for my community. With Dr. Hyman Plus, you get a ton of private content and special access that no one else gets. This yearly membership gives you exclusive access to ad-free Doctors Pharmacy podcast episodes, access to all of my docuseries, including the Longevity Roadmap and Broken Brain 1 and 2, plus all the bonus content. You get monthly functional medicine deep dives where one of our doctors goes deep into a health topic to tell you everything you need to know to heal.

You'll also get access to a monthly Ask Mark Anything Q&A where I answer the Dr. Hyman Plus community's biggest health and wellness questions. This Q&A is only accessible with a membership. Now, because I'm so excited to share this premium membership content with you, I'm releasing a teaser of the brand new Functional Medicine Deep Dive episode diving into one of the most important topics in health. I hope you enjoy it and head over to drhyman.com forward slash plush. That's drhyman.com slash PLUS for more information. Okay, here we go. Hi everyone. Welcome to Dr. Hyman Plus. We're going to be discussing today menopause, everything you need to know. My name is Dr. Elizabeth Boham. I'm a physician and the medical

director at the Ultra Wellness Center in Lenox, Massachusetts. I've worked with Dr. Hyman for many years and worked with many, many women who have navigated that transition from pre-menopause into perimenopause and into post-menopause or menopause. So today we're really going to delve in to what is all the definitions of menopause, what does it mean? And I really want to give everyone the tools to help navigate this time of their life in a really healthy way and really take away some of the fear that many of us can feel around this time of what's going to happen. What does this mean? How are these changes going to impact me?

Take away some of that fear. Give you some tools to help with this transition and help you understand what's going on in your body and why are you getting these symptoms. And I think that's important to really understand. As I said, I'm the medical director and a physician at the Ultra Wellness Center. And I've had a lot of experience with hormones and hormone shifts. As some of you may know, I had breast cancer at the age of 30. I'm now 52. So I've kind of gone through the process of hormonal shifts and menopause a few different times. So when I had breast cancer at the age of 30, I was given chemotherapy. The chemotherapy put me into a menopause for a period of time.

I stopped having my periods for a bunch of months. And so all of a sudden I had this huge change in hormones and I got a lot of those symptoms that occur when you go into menopause from the hot flashes and night sweats and vaginal dryness and irritability and change in sleep. And, and at the age of 30, I was, it was, it was pretty dramatic. And, and all of a sudden that happens a lot of times when you have medication that puts you into menopause. I was really lucky. My periods did come back. I went on to have a couple of very healthy pregnancies and was able to breastfeed and

had periods for many years afterwards. But as many women who go through a chemotherapy experience, I did, if they do get their period back, they go into menopause at a younger age. So then, you know, I did start to go into menopause in a more, you know, that natural menopause a bunch of years ago, and then experienced that whole thing all over again. And because of my history, I did not do any hormone therapy. Nobody wanted to give me any sort of hormones. And so I have a lot of experience with non-hormonal modalities in terms of helping us transition during this period of our lives. But with many women, and we'll discuss this, we do sometimes use hormone therapy,

and it can be very helpful if done in the right way. And I'll give you some clues as to what you want to do and think about if you are choosing to do hormone therapy, and what other things you can do that can help you through this transition. And as I said, a lot of what we want to discuss is just understanding what's going on in your body. So it takes some of the fear away, some of that fear away, you know, away and can help us really navigate this period in our lives in a really healthy way. So welcome to Dr. Hyman Plus and to menopause, everything you need to know. So let's start with some definitions. You know, what does this all mean? What do we mean when we say menopause? Okay. So first of all, we want to talk about what does it mean when we're pre-menopausal?

So when you're pre-menopausal, those are the years before you go into perimenopause or menopause. So typically when you're premenopausal, you're having a cycle, you're having your periods, and you're fertile. You could get pregnant. So those years, you know, can be from when you started having your period up until that perimenopausal years. That's considered premenopausal. So then perimenopausal around the time of menopause, perimenopausal is that period in your life before menopause, when hormones are shifting and you may be getting a lot of symptoms because of these shifting hormones. And surprisingly, this is surprising for a lot of women, this can occur for, you know,

five to 13 years. It can be a long period of time, frustrating. I know it is, but it can be a long period of time when they're shifting hormones, hormones, you may have months in perimenopause where your hormones are very similar to when you were premenopausal. And then you may have other months where your hormones are very different, where you have what's called an anovulatory cycle. We'll talk a little bit more about that. Your progesterone levels are low and you have a lot of symptoms because of that.

So there can be this up and down in symptoms and that can be very frustrating for women and concerning for women. And it makes them confused as to why this month is better than this month. But that is, that can happen with perimenopause. And as I said, this may start many, many years up to, you know, 13 years before you go into menopause. And so you may be having some of these symptoms in your late thirties or forties. Some women even, you know, even a little earlier, depending on what, where their, what their timing is in terms of menopause. You are less fertile during these years, but you still could get pregnant. And then there is menopause. So when somebody is post-menopausal or they've gone through menopause,

officially they haven't had a period for a year. So you have to have a whole year where you haven't had a period that typically the average age of menopause or becoming post-menopausal is 51. And it can occur typically natural menopause occurs between the ages of 45 and 55. That's the most common, those most common years of going into menopause. But, you know, as I was mentioning earlier with chemotherapy, certain medications can put you into an abrupt menopause surgery. Of course, if you have surgery to remove your ovaries, you can go into an abrupt menopause. And sometimes that abrupt menopause can result in more acute symptoms, more significant symptoms for some women. The symptoms that occur with perimenopause and menopause are really variable.

Some women sail through and don't have a lot of symptoms and other women really struggle. And it's important to understand we're all different. And there's a lot of things going on that influence how we experience this time in our lives. And so we're going to kind of delve into that a little bit. So with perimenopause, those years around menopause, what kind of symptoms may you have? As I said, there's a wide range of symptoms. And as I mentioned, it can vary from month to month. You may have a month where you do not ovulate.

And that happens very commonly in perimenopause, where there's some months you ovulate, but other months you don't ovulate. Ovulation is when there's a release of the egg from your ovary. When that happens and that you will have a rise in progesterone, that's typically what happens during premenopausal years. And that rise in progesterone, many times, you know, when our progesterone is higher, we may feel more calm, have better sleep for some women, for a lot of women. So when you have these anovulatory cycles, when you don't ovulate, you don't get that rise in progesterone that was typically occurring.

When this occurs, or when these months occur, you may have some variation in symptoms. You may feel more irritable or more anxious, or you might snap at people more or feel a little bit more sad. You may notice that your sleep is variable. You may have been a great sleeper your whole life, and now you're waking up more at at night and you can't really understand why your sleep has shifted or changed. You may feel more tired and you may start to have some of these hot flashes or night sweats. So night sweats are really just hot symptoms that occur because there's a dysregulation in the temperature regulatory system in our body. So in our brain, our hypothalamus can regulate our temperature.

And when our hormones start to shift, our ability to regulate our body temperature shifts as well. We don't understand everything about hot flashes, but later on in this presentation, we're going to talk about things we can do to help improve our hot flashes or decrease our hot flashes. But what's important to understand is that they're not just occurring because of low hormones. They're occurring because of hormonal fluctuations. Changes in hormones really can stimulate these to occur. And I guess what that means is that these hot flashes or night sweats typically improve over time. That when we go into menopause and then after a few years in menopause, many times there's improvement in these hot flashes or night sweats. For most women, they really ease up, that they're not going to last. You might have some later on in years, but they typically really, really significantly decrease or diminish in severity for many women. And as I mentioned here, shifts in cycles, your cycles may become

more frequent, less frequent, heavier, lighter, might skip periods. And all of this is common in these perimenopausal years. And so in menopause, after you haven't had a period for a year, typically your estrogen and progesterone are now lower. You're not having those normal cycles of variations in hormones and both estrogen and progesterone are lower in levels. In perimenopause, many times that progesterone is low when you're having those anovulatory cycles, but you may still have a higher level of estrogen. And that, you know, that variation in hormones can cause significant symptoms as well as we were talking about. So in menopause, those hot flashes or night sweats continue because of this hormonal fluctuation. But after women have

been in menopause for years, those hot flashes or night sweats typically really significantly diminish. You may always still be a little bit more sensitive to temperature fluctuations in the room, but it's much better than for that period of years. So 60 to 80% of women do report having some amount of hot flashes or night sweats. There's a wide range of severity. Some women, these hot flashes or night sweats are so disruptive that they're changing their life, that they're so disruptive. They're really having a hard time with going to work or getting enough sleep.

And other women, they're just mild. And what does it feel like? What does a hot flash feel like? going to work or getting enough sleep and other women, they're just mild. So, and what does it feel like? What is it? What does a hot flash feel like? You know, it often, you might, the heat comes on in your body. You may feel hot in your chest, or it may start in your face. Your face may flush and get red. You may have some sweating, perspiration that occurs with that. Some women notice the heat starts at the top of their head and goes down. Other women notice that they get hot in their feet. As I mentioned, it can last between one to five minutes typically. And it can be pretty significant for some women and just mild for other women

or depending on the time of day or your month or your cycle or where you are, the severity of those hot flashes may vary. As I said, those hot flashes typically get better over time as the longer you're in menopause. Vaginal dryness or pain with intercourse is different in the sense that it doesn't typically get better. It typically, it can get worse over the years. This is another area where we're all different and women notice different severities of vaginal dryness or pain with intercourse. But as our estrogen levels go down in our body, we can have

more vaginal dryness, less lubrication, and more pain with intercourse. And as we get further and further away from that time, that perimenopausal, menopausal time, typically those symptoms do not get better. So that is something that many women need to address. And we'll talk about how you can do that. That's the same thing with the bone density. Our bone density typically decreases when we have this shift in our hormones. So we're more common to have osteopenia or osteoporosis after we go through menopause. And that, that, that period in our life where our hormones decrease, we often see a significant shift in our bone density. And that's why it's often recommended that you get a DEXA scan or

a bone density scan around menopause, just so you know your baseline, because depending on where your bone density was before menopause or how strong your bones became when you went through puberty and early life and to the age of 25, you know, depending on how strong your bones became at that young age, that's going to influence how much that shift in hormones is going to weaken your bone density. So, you know, there's so many things that go into building strong bones from good nutrition to lots of exercise to good, strong lean muscle mass. And so, you know, there are some women that are higher risk depending on their body size, the amount of lean muscle mass, their nutritional status, their digestion and absorption.

So those are all the things we take into account when we're wondering about somebody's bone density. As we go further and further into menopause, our bone density does not typically get better unless we're doing something active about it. So that lower estrogen level that we have, it's not like you have an increased risk for a period of time and then it gets better. It's something we need to really address for many women. We also see a shift in

our metabolism. You know, this is frustrating for women when you're pre-menopausal, when you do gain weight, it's more in your hips and thighs. When you're post-menopausal, you gain more weight in your abdominal area, in your belly area. That then increases risk of insulin resistance, metabolic syndrome. You can see shifts in your cholesterol or your lipids, as I mentioned here. All of those things together can increase our risk of vascular disease, heart disease, stroke. And so, you know, as a woman goes into menopause, we really need to pay attention to those risk factors for v you. You gain a lot of weight around the belly where you weren't gaining it before. And that risk for insulin resistance,

metabolic syndrome significantly increases. And therefore, so does our risk for heart disease, stroke. And so we just have to really pay attention to that. Well, I hope you enjoyed that teaser of exclusive content that you get every single month with Dr. Hyman Plus. If you want to listen to the full episode and get access to ad-free podcast episodes, plus all the content from my docuseries and, of course, any future ones we're going to release, plus monthly Ask Mark Anything episodes, plus monthly functional medicine deep dive episodes.

I guess, right, that's why we call it Dr. Hyman Plus. Head over to drhyman.com forward slash plus, that's drhyman.com slash PLUS to learn more. I'll see you there. Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not

constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.