Fit and Sexy For Life: The Hormone-Free Plan for Staying Slim, Strong, and Fabulous in Your Forties, Fifties, and Beyond

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Your Changing Body
A Head–to–Toe Guide
One thing that I have learned about getting older is that every woman’s experience is unique. For some, it can come with a tremendous sense of freedom—freedom from menstrual periods, childrearing responsibilities, and worries about unintended pregnancy. For others, it can be filled with feelings of sadness, anxiety, shame, and loss—the loss of our fertility, our femininity, our figures, and our looks.

Likewise, there’s a lot of variability when it comes to the physical and emotional side effects. Approximately 75 percent of women report some troublesome symptoms, but the type and severity can vary drastically from one to the next. For example, some women are plagued by night sweats and insomnia, while others never have a single hot flash or lose a wink of sleep. Some start noticing a change in their periods as early as their thirties, while others continue having regular menstrual cycles until they’re well into their fifties.

I have to admit that before I started working on this book, menopause was a bit of a mystery to me. I really didn’t know what to expect, or how it might affect me, and that was just fine. I vaguely remember my mom going through it, though I didn’t realize the significance at the time. And of course, when you’re younger, it’s the furthest thing from your mind. But now that I’m on the brink of perimenopause myself, I realize that it’s important to understand what’s happening to my body. After all, knowledge is the key to staying healthy and getting through the changes that lie ahead.
Demystifying Menopause

Literally speaking, menopause is the time in your life when you stop having menstrual periods. Meno comes from the Latin word meaning “lasting a month”; pause comes from the Greek word with the same meaning. In other words, a pause in monthly events. But it really isn’t an event that occurs suddenly, without any warning, as the definition implies. Rather, for most women, it’s a change that happens gradually over a period of years.

The first stage of menopause, known as perimenopause, is when the changes and symptoms typically start. During this time, your ovaries begin producing less estrogen and progesterone—hormones that play important roles in ovulation and menstruation. Estrogen causes the endometrium (the lining of the uterus) to start to thicken in preparation for a fertilized egg. Progesterone prepares the lining of the uterus for the implantation of a fertilized egg. If a fertilized egg does not reach the uterus, the endometrium is shed as a menstrual period.

As their estrogen and progesterone levels drop, most women notice their menstrual cycles becoming irregular. You may skip a period, or experience lighter, heavier, shorter, or longer flows than usual. This shift in hormones also affects other organs and systems in your body. The result can be disturbing side effects including hot flashes, headaches, mood swings, and forgetfulness. It also may cause problems such as achy joints, urinary incontinence, and vaginal dryness.

Throughout perimenopause—which can start as early as your thirties and last up to ten years or more—your levels of estrogen and progesterone continue to decline until your menstrual cycle stops for good. Once twelve months have passed since your last period, you’ve reached menopause. On average, this stage occurs between ages fifty and fifty–one, but it can also happen much sooner or later. You’re likely to go through menopause around the same time that your mother, grandmother, or sister did, give or take a few years.

In the final stage of menopause, which is called postmenopause, those hot flashes and other menopausal symptoms usually begin to ease up. But unfortunately, now that your body is producing less estrogen, your risk of heart disease, osteoporosis, and breast cancer is higher—which is why it’s more important than ever to take care of yourself and make any necessary lifestyle changes to stave off these deadly diseases.

For most women, menopause is a natural biological process that occurs with age. But it also can be caused by surgery to remove the ovaries and certain medications and treatments, such as radiation and chemotherapy. These are typical reasons for menopause in women under age forty. Low levels of estrogen and damage to the ovaries can also cause early menopause.

In previous centuries, few women lived beyond menopause. But today, with a life expectancy of 79.7 years, we experience at least one–third of our lives after menopause. By 2020, the number of American women older than age fifty–five is estimated to be 45.9 million, compared with 31.2 million in 2000. As our life span improves, so does the accepted wisdom about menopause. Rather than being the beginning of the end, I like to think of menopause as the end of the beginning.
But Wait, Aren’t I Too Young for This?

A few years ago, when my good friend Carolyn, a forty–one–year–old real estate broker, didn’t get her period, she started to panic. Her menstrual cycles had been regular since puberty. She’d never skipped a period except at age twenty–four, when she was pregnant with her twins. You could set your clock by her menstrual cycles, she often joked.

It occurred to her that she could be pregnant, but she quickly banished the thought from her head. Not only are she and her husband careful when it comes to birth control, she’d just finished reading an article on how difficult it is for women to get pregnant after age thirty–five. Then she had another intrusive thought. What if she had cancer?

She quickly dialed her gynecologist’s number. He didn’t seem concerned. “It sounds like you’re showing the signs of perimenopause,” he told her. Carolyn was stunned. She was approaching menopause? She told herself that it couldn’t be possible. She was in great physical shape, training for her second marathon. At work and at home, she felt sharper and more energetic than ever. It was that simple. She was too young for menopause.

Carolyn remembered all too clearly how weepy her own mother was when she went through menopause. She would have a hot flash at the dinner table and then lie on the kitchen floor to cool off. Her mother often felt faint and dizzy and complained about it for years. Carolyn didn’t feel anything like that. Not even close.

Carolyn’s doctor suggested that she start keeping track of her periods in a diary or on a calendar. He also asked her to note if her flow was heavy or light or lasted longer than usual. He asked her to come in so he could run some routine tests. That’s when he took a complete history and ran blood tests to rule out other conditions such as pregnancy and thyroid disorder.

He also did a blood test that measured levels of FSH (follicle-stimulating hormone). Produced by the pituitary gland in the brain, FSH helps regulate the growth and development of our eggs and follicles. However, in menopause, those eggs and follicles don’t develop. So the pituitary gland releases more FSH, hoping to push the ovaries into action. This is why a high FSH level may be the first clue that you’re approaching menopause.

Sound simple enough? Well, there is a catch. During perimenopause, your FSH levels can fluctuate wildly as your estrogen levels wax and wane—from month to month and even from day to day. So your doctor may need to do more than one FSH test to attain useful information. Even then, the results may be misleading. The bottom line: The only way to know for certain that you’ve reached menopause is if you’ve gone twelve consecutive months without having a period.

If, like Carolyn and me, you’ve been noticing changes in your menstrual cycle, or experiencing symptoms such as insomnia or hot flashes, I recommend scheduling an appointment with your ob–gyn or primary–care doctor. Keeping a diary to track changes in your menstrual pattern is also a good idea, so you can see when and where changes occur and share them with your health provider. I’ve been doing this ever since I was in college on the advice of my gynecologist. To this day, I record the start date of each period in my Filofax. You might also want to write down how many days it lasts and whether it’s light or heavy.

Keep in mind that not all bleeding irregularities are caused by perimenopause. As noted earlier, abnormal menstrual cycles can be a sign of thyroid disease, uterine fibroids or polyps, or even cervical or uterine cancer. To pinpoint the exact problem, your doctor will probably order a blood test to check your FSH level and thyroid. You may also be advised to get a Pap smear, a transvaginal ultrasound, or an endometrial biopsy, depending on your symptoms.

If your physician suspects perimenopause, however, he or she may order certain screening tests, including ones to measure your cholesterol level and bone density. If you’re experiencing any unpleasant or unusual side effects—no matter how embarrassing they seem—you’ll want to mention them and ask about possible treatments. Be sure your doctor knows your medical history—including whether you or any of your immediate family members have had heart disease, osteoporosis, or breast cancer.
Managing Your Menopot

I’m a very active person, and always have been. Because I exercise so much, I rarely have trouble maintaining my weight. That is, until recently. Now that I’m in my forties, my body is changing. Even though I’m eating the same amount that I used to, my pants are getting tighter, my hips are getting wider, and I’m gaining weight around my middle. Recently, I eve...