THE MIDLIFE TRANSITION TO MENOPAUSE
Just like last month’s newsletter – you may initially look at this topic and think it’s not for you. I encourage you to read it anyway. There are nuggets of information any woman can use and I encourage women to be proactive and learn about the next stage of life before they are thrown into it.
This topic is near and dear to my heart. If you know my background – you know I made it a focus of my Ob/Gyn practice in the early 1990’s – years before it became a trendy topic. Early in my career, I saw the suffering women could experience as their ovarian production of hormones fluctuated and then eventually ceased. Unfortunately my own field of medicine, which is supposed to be dedicated to helping women, has a history of showing indifference to this suffering and has a history of letting drug companies formulate and dictate treatments for women (many of those treatments later found to be harmful). THE GOOD NEWS is that women are now demanding to be heard and demanding better treatments as they navigate their midlife years and enter menopause. Hallelujah – the midlife transition to menopause is finally getting the attention it deserves!
Sadly, instead of indifference, what we now have is the opposite problem (especially since 2020 when so many started looking for an online “market” to tap). Everybody and anybody is now talking about the midlife transition. Social media influencers are now flooding into the midlife/menopause space (it seems anyone who has experienced a hot flash is now a qualified expert). To stand out, influencers often gravitate toward controversial and sensational content leaving out the important fine details. I frequently see social media posts that promote only one way to deal with midlife/menopause (ie. by using the product or program they sell) or I see posts that are designed to generate fear (great for clicks). Anyone who has worked with tens of thousands of women like I have (or anyone with common sense) knows that for most things in life (including midlife management) the best approach is holistic and looks at many aspects of a woman’s health. The best approach also involves nuance and individualization – it’s not a one size fits all approach. Finally, I feel women get the best results when you educate and empower them instead of promoting fear and reliance on a “guru”.
Can you tell I’m passionate about helping women navigate the midlife transition in a way that honors and supports them – instead of treating them like a commodity!!
So… where to begin….this midlife transition to menopause often takes years and can affect almost every system in your body. Since this topic is so vast it’s way too much information to digest in one setting. Since this is the first time I have talked about this subject to Mallory’s audience I will begin the conversation with four important midlife concepts/topics that are often misunderstood. Understanding this BASELINE information will help you build the type of health FOUNDATION that is required for a successful midlife transition. I will provide more depth in future newsletters.
NUMBER ONE : RECOGNIZE THAT MANAGING YOUR MIDLIFE HEALTH IS IMPORTANT
I used to own The Midlife Wellness Center and so many times I would meet women who said – I don’t need your services yet – I’m not menopausal. Well unbeknownst to those women – MIDLIFE HEALTH IS SO MUCH MORE THAN JUST MENOPAUSE. It’s a whole TRANSITION of your mind and body AND just like puberty – it is a complicated transition. That’s why I started a special clinic for women designed to address the many issues (not just menopause) that occur at midlife. I wanted to do this period in a woman’s life justice. It’s really a critical junction in a woman’s life and health.
What surprises most women is MY SIMPLE DEFINITION OF MIDLIFE which is…if you’re not at the BEGINNING of your life (where most of us are naturally healthy) and if you’re not at the END of your life (which is when your health only declines) – YOU’RE MIDLIFE.
In general terms – midlife is women in their 30s thru 70s (which is probably the majority of women reading this newsletter). Early in midlife is a time in life where the physiology of the body starts to change and due to societal pressures it can also be the busiest time of a woman’s life. A LOT IS GOING ON! Menopause by definition is actually just one day in a woman’s life – the day she has gone one full year without a menstrual cycle. Since currently the average age of menopause is 51 the midlife transition to menopause for some women can last almost two decades!
In the midlife years leading up to menopause your ovarian hormone production will become erratic and eventually cease. During this time of transition, the LIST OF SYMPTOMS you can experience that lower your quality of life is not only mind boggling but the hormonal changes that occur can actually CONTRIBUTE TO DISEASE. During this time it is important to listen to what your body is telling you! Midlife is a very important time to be proactive and INVEST in your health (just like financial health – the earlier you begin investing the more long term benefits you will reap). To put it simply – during midlife – MAINTENANCE IS REQUIRED! It’s much easier to prevent a disease than treat a disease. In my experience – the women in my practice who took this message to heart and did INVEST in their midlife health were for sure my healthiest patients (I could compare them to women who didn’t make this investment).These women invariably looked better and experienced a better quality of life.
HEALTH YOURSELF ACTION – REALIZE DURING MIDLIFE YOUR HEALTH IS AT A TURNING POINT. MAKE INVESTING IN YOUR HEALTH A PRIORITY.
NUMBER TWO: I WANT TO BE PROACTIVE BUT WHERE CAN I FIND QUALITY MIDLIFE EDUCATION AND QUALITY MIDLIFE HEALTHCARE?
I know – I know….Since the interest in the midlife transition is fairly new it can be hard to find seasoned providers. Unfortunately, as it stands now – most providers were not adequately educated concerning women’s midlife and hormonal health in school – even if they trained to be an Obstetrician/Gynecologist or Endocrinologist! So currently the midlife providers that do exist – took it upon themselves to obtain extra training and education concerning the management of midlife.
Since most women already see an Obstetrician/Gynecologist it makes sense to inquire if they have expertise in managing midlife. Some good questions you can ask:
Are they aware of nutrition and lifestyle changes that you can make to help manage your health during midlife?
If needed, are they willing to prescribe bioidentical hormones?
Are they willing to do more comprehensive laboratory testing at midlife to assess your health and hormone levels?
Do they screen for common midlife diseases such as osteoporosis, insulin resistance and inflammation?
Hopefully your Obstetrician/Gynecologist has the expertise to help you. If they don’t and you are experiencing a midlife decline in your health – use the questions above to shop for a new provider.
Another way to find a provider well versed in midlife is to contact your local compounding pharmacies and ask them for recommendations. Most midlife health providers will be well versed in bioidentical hormone therapies – some of which are obtained through compounding pharmacies. So these pharmacies should be able to direct you to providers that are managing women at midlife.
In the age of technology you can also find providers/companies online that offer midlife virtual services and education. There are laws that limit what a provider can do online but you can get lots of good information about midlife changes and how to manage them, you can get testing and you can even get some common midlife prescriptions online.
EXAMPLES OF SOME ONLINE OPTIONS:
MIDLIFE AND HORMONE THERAPY SUPPORT UNDER THE GUIDANCE OF A PROVIDER.
An example of a good online service is The Menopause Method developed by Dr Rosensweet. He offers online hormone services himself and has trained other providers who offer in person or online services. Something to note -most online services (it depends on the State) cannot provide testosterone since it is considered a controlled substance but Biest, Progesterone and Dhea are available. PRO TIP – use caution when looking at online hormone services since currently online services are the WILD WEST and you have to make sure a provider is legitimate and following good practices.
ONLINE SERVICES THAT OFFER PRESCRIPTIONS FOR COMMON DRUGS USED DURING THE MIDLIFE TRANSITION.
These services may or may not take insurance – examples are Midi Health or My Alloy. These solutions help women who want traditional hormone prescriptions but can’t find a provider to prescribe them.
Bywinona.com is another online service for midlife prescriptions but this company offers traditional therapies and compounded bioidentical creams.
WEBSITES THAT SELL OVER THE COUNTER HORMONES.
Progesterone creams have been available for years over the counter as has oral Dhea but recently transdermal forms of estradiol and estriol have also become available through sources such as WholeScripts which is an online supplier of quality supplements (this link allows you to access your account or create an account). WholeScripts offers hormone options from the Quicksilver Scientific brand. I love EMPOWERING WOMEN with these options but do feel strongly that you should not use an over the counter hormone (especially an estrogen) without guidance from a provider and saliva testing (available at store.zrtlab.com) to assure that hormone levels are appropriate. When working with a provider – direct to the consumer hormones and hormone testing can be appropriate and can often be more cost effective.
SOCIAL MEDIA.
I find Instagram or other social media entertaining but when it comes to complex issues that I feel need to be individualized – social media can only offer cursory tidbits of information. So you can use it to gain generic tips but beware – pick and choose wisely who you follow. Avoid the sensation seekers and look for honest, grounded in fact, advice. If you do find someone you trust they usually offer educational courses and community support for women at midlife. Examples of good influencers that I follow on Instagram are drjennsimmons who has introduced the QT scan, a new way to safely and accurately image breasts without radiation. She also provides lots of information concerning breast health and hormones and she is challenging current breast cancer treatment dogma. On insta I also like dr_mosconi a brain researcher who is also looking at hormones. Finally I like saragottfreidmd.com for science backed general women’s health advice.
AUDIO BOOKS OR BOOKS.
I’m not a huge fan of health books because many times by the time they are published – information in them is already outdated. It is also rare for me to find a book where I agree with everything in it and feel comfortable recommending it to women. When I read a book I tend to PICK AND CHOOSE what information I find helpful. What I can tell you is that it seems the books are written to support one of two messages. They either tout the traditional/ pharmaceutical approach to health or they rail against any traditional treatments. I prefer to use the best ideas from both sides. Two books that I think can be helpful during midlife are – WHAT YOUR DOCTOR MAY NOT TELL YOU ABOUT PREMENOPAUSE (My Amazon Store) and WHAT YOUR DOCTOR MAY NOT TELL YOU ABOUT MENOPAUSE (My Amazon Store) by Dr John Lee.
HEALTH YOURSELF ACTION – INFORMATION AND GUIDANCE IS AVAILABLE TO HELP YOU NAVIGATE MIDLIFE. USE IT! YOU DESERVE TO BE THE BEST VERSION OF YOURSELF.
NUMBER THREE – OPTIMIZING YOUR HEALTH AT MIDLIFE WILL REQUIRE A BASIC UNDERSTANDING OF HOW DECLINING OVARIAN HORMONES AFFECT YOUR HEALTH.
The ovarian hormones are primarily estrogen and progesterone. Testosterone is not exclusively produced in the ovary – it is also produced by the adrenal glands. The primary function of the ovarian hormones is reproduction – so of course your sexual organs have receptors built to receive messages from the ovarian hormones (the lock in a key analogy). The body is wise however and also knows that reproduction requires a generally healthy individual. Because of this, the ovarian hormones actually have receptors throughout the body – basically delivering the message that you need to be strong and at the top of your game – strong bones, strong muscles, strong mind, healthy cardiovascular system, healthy skin and tissues to name just a few of its many messages. So it’s no surprise that research has revealed that at midlife, when you slowly begin to lose these hormone messages, your health can decline. If you live long enough after menopause (which most of us do) you can experience a decline in your mood and brain function, a loss of muscle and bone, thinning of skin, increased risk of cardiovascular disease, changes in your metabolism, bladder and vaginal issues – the list of problems IS LONG – but you get the message! Bottom line – Menopause (the loss of reproductive function) is a natural process but in general terms loss of ovarian function does contribute to aging.
NUMBER FOUR – WHY IS HORMONE REPLACEMENT THERAPY CONTROVERSIAL?
I’m actually amazed that in 2025 the various experts in hormonal health still can’t agree on whether a woman should or should not use hormone replacement therapy and if she does decide to use it – what is the best therapy! I don’t think there is another area of medicine where so much controversy exists. I am frequently networking with providers who do recommend hormone therapy (at least to some women) and I rarely find two practitioners that agree on the same hormone therapies or hormone testing. As a woman I am also dismayed at how often I see poor hormone research designed basically to promote a drug and treatments based on poor science that are adopted primarily for financial gain. Due to this lack of consensus – hormone therapy really is a mish-mash of recommendations. If you want a more detailed discussion (and my opinion) of various types of hormone therapies in use and the types of hormone testing that I recommend – see this article I wrote.
So let me try to condense for you the long and twisted history that has left both practitioners and patients confused. Since around the early 1930s ovarian hormone replacement has been used in the hopes of prolonging a woman’s quality and quantity of life. Fast forward to the 1990s – hormone therapy was so popular that the number one blockbuster drug at that time was a hormone therapy called Prempro. The message to women was that EVERYONE should be on hormones. Unfortunately, this choice of hormone replacement therapy, an “estrogen like” hormone derived from pregnant horses urine and a nonbioidentical progesterone called Provera was not the best choice for a woman.
This was early in my career and to me it was quickly evident (based on side effects or lack of symptom relief that my patients experienced) that Prempro was not an optimal treatment. It also bothered me that these hormones were foreign to a woman’s body. So in 1993 I began to recommend bioidentical hormones to my patients. This turned out to be a good decision. Almost 10 years later in 2002 the highly promoted Prempro was “dethroned” – when initial data from a research study revealed increased cancer and cardiovascular risks. Overnight millions of women were advised to stop hormone replacement therapy. Doctors (especially those not dedicated to women’s health) then refused to prescribe ANY hormone therapy. The message to women was that NO WOMAN should be on hormones. Eventually this data was “revised” to indicate no significant risk and in the meantime better hormone replacement such as bioidentical hormones became more mainstream. The damage, however, had already been done as women’s symptoms were essentially ignored and they were denied hormone therapy for years. Here is a good article on this subject
Fast forward to now and the pendulum has swung again. Bioidentical hormones (a much better solution) is all the rage – with claims that it can solve all your midlife problems.
SO SHOULD YOU USE HORMONE REPLACEMENT AFTER MENOPAUSE. To condense my years of experience with bioidentical hormones I would tell you that THE TRUTH IS SOMEWHERE IN BETWEEN these two extremes. It was wrong to recommend that all women avoid hormone replacement and it’s wrong to recommend that all women should be on hormone replacement. Obviously, I am a proponent of proper use of bioidentical hormones for women and I chose to use them myself but I believe you have to carefully weigh multiple health factors and carefully monitor women for safe use of hormones. ALL therapies have a risk/benefit ratio to consider. Currently, on social media the trend is to promote hormone therapy and downplay any potential risk. I do not think every woman needs to be on hormones – we have ways to help women with bone health, to reduce cardiovascular risk, to practice neuroprevention etc. without the use of hormones. The risk of using estrogen is that it is proliferative and can increase breast density or cause your uterine lining to become too thick and both of these conditions can end up increasing cancer risk. Also in some women – estrogen can increase clotting and autoimmune risk. It is very nuanced and individual – so careful consideration of all aspects of a woman’s health status should be considered. Bottom line -hormone therapy is just one tool in the midlife toolkit. I have known many women over the years who chose to optimize their nutrition and lifestyle and adopt preventative health strategies and who maintained excellent health without the use of hormones.
HEALTH YOURSELF ACTION – AT MIDLIFE OVARIAN HORMONE REPLACEMENT IS AN OPTION THAT WOMEN SHOULD EXPLORE WITH AN INFORMED PROVIDER TO DETERMINE IF IT IS RIGHT FOR THEM.
NUMBER 5 – ARE THEIR SOME BENEFITS TO MIDLIFE?
ABSOLUTELY!!! I tend to always look for the positives in any situation and also have encouraged my patients to do the same. A positive outlook can do wonders for a woman’s health.
TRUTH BE TOLD it can be a fabulous time of life. As midlife progresses women have more time, confidence in themself and freedom. I see women BLOOM into a better version of themself in midlife all the time. In a previous newsletter I talked about 2 of them – Denise Evans on Instagram @ zeninhighheels who became an author and motivational speaker in midlife and Rhonda Barber on instagram @ rhondabarberart who in midlife discovered she was a talented artist, photographer and poet!
I have to conclude (especially since Mallory just gave me my 2nd grandson) by mentioning the GRANDMOTHER HYPOTHESIS. This is a theory anthropologists have proposed to help explain why human females (unlike many species) can live a long time after menopause. Let me sum it up – BECAUSE WE ARE SO VALUABLE AND CONTRIBUTE SO MUCH TO SOCIETY! Our presence in an extended family and society at large is a very valuable asset – we provide assistance, wisdom and serve as role models. Midlife happens to be the time of life when we get this option of being a grandmother. I can personally tell you that this special role in life expands the love we give and the love we receive.
HEALTH YOURSELF ACTION – EMBRACE YOUR MIDLIFE – IT CAN BE A FABULOUS TIME OF LIFE
Your Women’s Health and Wellness Expert,
Dr Brenda Smith M.D.
Dr. Brenda Smith, M.D. newsletter provides general health information for educational purposes only. The information in this newsletter is not to be used as a substitute for medical advice, can not diagnose or treat any health condition, and does not substitute for care from your own in person physician. Any questions regarding your own health should be addressed to your own primary care physician or other healthcare provider .
