In September of this year, I will walk the Camino Portuguese. I have been planning this walk for a good five years now, ever since I was performing an ultrasound on an 80 year old woman who told me she was on her way to Spain to walk a section of the Camino de Santiago. […]
Like birth, death and taxes, menopause is one of those guarantees in life. And like birth and death, the surprise is only in the when, not the if. Menopause is technically defined as that point in time when you have not had a period for twelve consecutive months. So what do we call all that time leading up to menopause? That is perimenopause.
The average woman experiences menopause at age 51, with anywhere from 45-58 considered normal. Indications of perimenopause can start occurring up to ten years before actual menopause, meaning even as early as 35 a woman can start having associated symptoms.
Those years of a woman’s life between 35 and 50 are hectic enough. Between raising kids, managing a career, working on marriage/partner relationships, caring for elderly parents, keeping a house and yard, or any of the many other things that take up space and time in our life, we barely have the capacity to do it all. But we do. We keep our heads above water for the most part. We make it work. But the symptoms of perimenopause can cause us to come crashing down.
Not every woman will have every symptom, some may have very few, or to a very mild degree. In some women, the symptoms are subtle, in others they are severe. They are caused by the changes in levels of hormones in our bodies, particularly estrogens, progesterone, and testosterone. Our ovaries are responsible for 90% of estrogen production in premenopause, so as the ovaries begin decrease in function, estrogen naturally decreases. Lifestyle choices can dramatically impact the symptoms though. Poor nutrition, sedentary activity level, smoking, chronic illnesses such as diabetes and autoimmune disorders, environmental toxicity, and nutrient deficiencies all contribute to our hormonal imbalances.
So, what are the symptoms of menopause anyway?
Hot flashes and night sweats – 75% of all women will experience hot flashes at some point in time during the perimenopause years. In 20% of women they will be severe. They may last for as little as a few weeks to as long a 10 years or more. They can disrupt sleep and daily life. They can destroy one’s confidence in themselves. You may feel that your temperature is never regulated, being too hot one minute and too cold the next. A simple outing to the grocery store in the winter is complicated by what to wear. If you put on a sweater to keep you warm while traveling there, you may find yourself ready to rip it off in the middle of the produce aisle when the mister comes on. Bedroom ceiling fans become a must no matter how cold it is outside, or how wrong your Feng Shui master says it is. Your partner and the cat (or dog) may have to find another place to sleep. Your relationship will surely not be affected by “I want a snuggle,” one moment, followed quickly by “do not let any part of your body touch me,” the next. Sweaty, sticky sex may have been a thing in the backseat of a car in the middle of a hot summer night when you were in college, but now you realize it was not all it was cracked up to be. You may also revel in the joy of talking to your boss with sweat dripping off your forehead, hoping she doesn’t notice. (Oh, no. I’m not having a hot flash, I just ran a mile during my coffee break.) You may also collect an assortment of handheld fans, distributed in every purse and bag you carry.
Period changes – Periods may become longer, shorter, heavier, or lighter. You may experience more irregular periods or episodes of skipped periods. All this uncertainty to look forward to before they finally fall off the cliff completely. It’s like living through those early teen years of not knowing when and where you will start all over again. Only this time, you may bleed so heavily that you soak through your clothes in a matter of minutes. That old fear of walking into a room of your peers with a huge blood spot on your ass comes crashing back. If you are one of the lucky ones whose periods actually change for the better, or whose periods simply go along as always and just stop one day, thank your lucky stars. Just remember, even if you skip for eleven months and then have one, the clock starts again.
Sleep problems – 30% of women who never had trouble sleeping before, now do. Some of this may be attributed to the hot flashes and night sweats. It is hard to sleep when you are throwing the covers off, then trying to find them again in the dark to get them back on. But some women who don’t report problems with either of those still have trouble sleeping. Either they can’t fall asleep in the first place, or they fall asleep quickly, but wake up in the middle of the night and can’t get back to sleep. Then they fall into the practice of watching the clock tick the minutes away until the alarm goes off. On the plus side, it is a good way to practice math problems, (if I fall asleep right now, I will get in this many hours and minutes. Okay, now subtract 15 from that last calculation.) Seriously though, as the days go on and sleep deprivation becomes more and more pronounced, nothing else in your life is going to get better. Weight gain, low energy, brain fog all are enhanced with poor sleep.
Vaginal dryness – As estrogen decreases, the vaginal walls thin and have less lubrication and elasticity. This can lead to painful sex. There is often a tearing or burning sensation with intercourse. Just when it should be more fun, it becomes less fun.
Urinary problems – Low estrogen can also cause a loss of tone in the muscles of the pelvic floor. This can lead to leaking of urine when doing anything that puts pressure on this area. Coughing, sneezing, laughing, running, walking, jumping, picking up something off the floor, yelling at the kids, or getting out of bed can cause anything from a little squirt to a mighty flood. Urinary tract infections also can increase due to the lack of lubrication that used to move the bacteria away. The honeymoon cystitis without the honeymoon.
Weight gain and fat redistribution – Because of the way all the hormones of our body work together, when one or two get out of whack, the others tend to follow. Cortisol and insulin get thrown off-balance as the sex hormones give way, causing more fat to be distributed around the belly. The lack of sleep and low energy doesn’t help matters any. Neither does the fact that we seem to have more and more on our plates, both the dinner plate and the life plate. Cholesterol levels seem to change as well, with increasing bad and decreasing good.
Mood changes – Is it any wonder we are in bad moods sometimes with all of the above changes going on? But, there is an increased risk of depression during perimenopause. And a feeling of always being tired doesn’t do much for your overall happiness.
Mild cognitive impairment and poor concentration – Some just refer to it as brain fog. Not remembering where you left the keys to the car more often than you used to. Forgetting to pick up the kids. Not being able to finish a cohesive thought. Jumping from one task to the next, without remembering to go back to the first one. Research shows that those who have some mild impairment during the perimenopause years are more likely to suffer from Alzheimer’s later in life.
Less hair on your head, more hair on your face, and dry skin – These are just thrown in for kicks and giggles. Could anything be more fun than a bald, flaking, bearded woman?
Conventional treatments are mostly targeted to treat specific symptoms. Synthetic and bioidentical hormone replacement therapies and progesterone creams are available but are not without risks. You can use lubricants for better, less painful sex. Sleep aids may provide more sleep, but not necessarily better sleep. Antidepressants may alleviate the mood disorder symptoms, but again, side effects are many. Weight loss aids are not usually very helpful in the long-term.
Using a balanced, whole foods diet, the right kind and amount of exercise, and getting proper sleep can keep your body and hormones in check to minimize the effects of perimenopause. Stress reducing practices such as meditation or yoga will also help. Having good support and community around you is imperative. Herbal treatments may relieve or reduce the severity of some symptoms.
The Japanese have no word for menopause. For centuries they have mostly not had the symptoms that bother us in the west. We can take some clues from their diets and lifestyles. The women who practice a mostly Mediterrainean lifestyle are similarly blessed. Both of these cultures tend to eat mostly plant based foods, supplemented with fish and grass-fed meats. They move every day, mostly walking, and enjoy strong communities and support, especially with other women with whom they develop lifelong friendships.
The fact is that the sooner earlier you delvelop lifestyle strategies to combat these symptoms, the easier your perimenopause years will be. But it is also true that it is never too late to start. Adapting your lifestyle to address better nutrition, movement, and sleep will set you on the path to feeling better every day.
I woke up this morning determined to do something. I wake up a lot mornings determined to do something. But on many of those days, as the hours pass and time slips away like a vapor cloud, my plans burn up like the sun burning off the fog.
So, I’ve decided to start a movement, if only with myself. #todayistheday….
I’ll keep a small book and every morning I will write a sentence of the one thing I want to accomplish that day.
This morning it was to go for a walk.
And I did. It would have been easy to not go. It was raining. I was tired. I had so many other things to do. I used to go for a walk on most days, but lately I have let the habit fall away. It is the one routine that I have been wanting to get back. It provides me with so many positive things. I clear my mind and work things out. I smell the air. I am exposed to the fractal images of nature, even while walking in my neighborhood. I move my body. I feel better about myself when I am done. So today I walked. In the rain. I told myself when I started that I only had to go for thirty minutes. I stayed out for ninety. It felt good.
This picture is not the most flattering of me, I look sort of like a drowned rat in a floppy red rain hat, but it is me walking in the rain. While walking, I was reminded how different the rain smells here in the mountains than it does where I grew up in Kansas. There the rain always has a sharp scent, electric and metal. Here the fragrance is soft and earthy. I remembered the first time I smelled the rain in the mountains. It was on a family camping trip when I was eight or nine. We traveled to Rocky Mountain National Park. It was raining as we set up camp and the smell was intense. Over the next week it rained often and that smell imprinted itself onto my brain. While I was walking today, my mind naturally flowed back to that place in time. It was a sweet memory of my mom and I spending time together. Every day we would go for walks while my dad and brother fished for trout in the streams. My mom passed away six weeks ago and her death is one of the things clouding my mind right now. It was good to just be with that memory for a time. The walk in the rain allowed that to happen. And it would not have happened if I had not decided that today is the day…I go for a walk.
So let’s make #todayistheday…. a permanent thing. It doesn’t have to be something big. It can be anything positive.
#todayistheday…. I eat fish for dinner
#todayistheday…. I do yoga
#todayistheday…. I sleep in
It can be about eating well.
#todayistheday…. I eat five servings of vegetables
#todayistheday…. I have fruit for dessert
#todayistheday…. I plan next weeks meals
It can be about moving your body.
#todayistheday…. I start a Pilates class
#todayistheday…. I go for a run
#todayistheday…. I get 10,000 steps
#todayistheday…. I go for a hike
It can be fun.
#todayistheday…. I take myself to the art museum
#todayistheday…. we play in the park
#todayistheday…. I let the cat decide whether we get up now or stay in bed
Okay, we all know how that one is going to go, unless I forgot to feed her last night.
It can be the same thing five days in a row.
#todayistheday…. I go for a bike ride
#todayistheday…. I go for a bike ride
#todayistheday…. I go for a bike ride
#todayistheday…. I go for a bike ride
#todayistheday…. I go for a bike ride
Then you can do one more day for good measure.
#todayistheday…. I go for a bike ride
It can be something you do often, but have fallen behind on.
#todayistheday…. I catch up on laundry
It can be something that you have been meaning to do but haven’t gotten around to.
#todayistheday…. I write that old friend
#todayistheday…. I make up with my sister
It can be something hard.
#todayistheday…. I say yes to myself, and no to others
#todayistheday…. I forgive
It can be something beautiful.
#todayistheday…. I see the sunrise
#todayistheday…. I take the time to enjoy the sunset
It can be something restful.
#todayistheday…. I take ten minutes at lunchtime to close my eyes and breathe
#todayistheday…. I plan a vacation with friends
What it cannot be is something unattainable.
#todayistheday…. I lose 30 pounds
Not. Gonna. Happen. No matter how hard you try. Don’t set yourself up for failure. And any statement with the word “lose” in it, is not positive.
Instead, let the little accomplishments that happen everyday play a starring role in your life. At the end of the day give yourself a little check mark and a resounding “YES! I DID THAT TODAY.”
If what you chose just didn’t happen that day, don’t fret about it. Don’t write an excuse for it either. Simply check a little box that says “For another day.”
You can keep this to yourself. Or, you can shout it to the world on Instagram, Facebook, Twitter, or whatever social platform you feel comfortable. You can text it to your best friend. Or not. You can whisper it to your husband before you fall asleep. You can do it on paper, or on your phone. You can add pictures or drawings. You can make this your own. You can inspire others. You can inspire yourself.
#todayistheday…. I make it happen
#todayistheday…. You make it happen
How many of you don’t mind cooking meals but absolutely hate coming up with ideas of what to cook each day? If you are like me, this is the worst part of providing meals. My husband is no help in this area either. I ask “What sounds good for dinners this week?,” and his usual response is “I don’t care, whatever you want.” Not helpful.
I read an article recently that stated that most of us eat the same ten meals over and over. Thinking back to what we eat each day, I realized that is probably true. But, if I am sitting down to do my weekly meal planning, or walking through the grocery store trying to come up with what to have for dinner that night, I find myself at a total loss for ideas. Either I can’t think of anything at that moment, or nothing sounds good. I can walk around a store for half an hour hoping something catches my eye. I get frustrated at the waste of time.
Realizing that we eat these same meals over and over, but that at any one time when I most need the information I can’t come up with a single one gave me an idea. I decided to make a physical list of our most common meals. I keep this list in two places. One is on the front of the refrigerator; the other is on my phone.
My list includes four to five easy, fast, healthy meals that I can put together when I get home from work with little or no effort. Three or four that are a bit more time-consuming for nights when I have more time, and the last two are a bit fancier, maybe for a lovely weekend meal with friends.
Having this list does not mean that these are the only meals I cook. If I happen to think of something else that sounds good, or come across a recipe that I find interesting and want to try, or on the rare occasion when my husband had an idea about what to have for dinner, I will undoubtedly deviate. I will modify the list at times. We may get tired of a particular meal. Maybe something we have tried recently makes a big splash. My summer list may have more fresh vegetables and salads. My winter list more soups and stews. I may put more of the easy meals on in the seasons when our weather is such that we can spend more time biking. Winter has more comfort foods. Summer more cold dishes.
Your list may have more or less than ten. You can structure it however you want. Maybe all your meals are easy and fast. Perhaps you and your family’s evenings are always filled with activities that don’t allow you time to prepare much, but you want to have better options than pre-packaged microwave blah. You may have all the time in the world to cook meals, but just have trouble thinking of what to prepare. The trick here is not the list itself, but having the list available to you when you need it; when planning your weekly meals before going to the store or when at the grocery store and trying to come with a dinner that fits your needs that night.
Sometimes it is the little things that add up to bring us down. Finding ways to make these little things just a bit easier is vital. When our minds get bogged down in trying to figure out the minute details of everyday sustainability, we have no space left for the things that matter. Every hour spent in planning meals or at the grocery store is time lost from doing the things we love. I would much rather use that space and time for the big stuff, or the fun stuff, or the comforting stuff. We all have to take care of the mundane. We just don’t need the mundane to take over us.
What does paradise mean to you? Where would your paradise be? A few days ago a friend texted me on a particularly windy day that “the wind may catch me under the ears and move me to paradise.” I cautioned her to be careful; paradise is not always what it seems.
A few years ago I took a break during a rough time in my life. I went on a yoga retreat to a place in Mexico called Yelapa. The retreat was wonderful. We practiced yoga every morning and evening on an outside terrace that overlooked the small town and its beautiful bay. The sky was always a dramatic blue. As we lay on our backs during the ending Shavasana, large frigate birds circled overhead. The trees that rimmed one side of the terrace buzzed with the wildlife that lived within. The bougainvillea draped dramatically over the railing; it’s deep pink contrasting radiantly with the blue of the sky.
After morning yoga ended, we gathered for breakfast on an open portico. Homemade corn tortillas, fresh eggs, avocado, and tomatoes played starring roles most mornings. The middle of the day was filled with hikes, exploring the small town, relaxing on the beach, and late afternoon naps. A few of us even had a Watsu massage with an expat American who had lived there for many years.
On one of the days, the leader of the group arranged for a local boater to take as many of us who wanted to go to another small beach further along the shore. There were a small village and a few residents, but the beach was mostly deserted and was reported to be a great snorkeling site. About five of us decided to go. What could be better than spending an afternoon lazily laying on a beach, or playing in the surf and snorkeling? We landed on the beach during exceptionally high tide, the waves crashing on shore made navigating the boat in difficult. We decided that we would keep the vessel away from the shore and swim in, ferrying our gear and a cooler we had brought with food and beverage along our human chain. We managed to keep everything high and dry as we all crash-landed into the sand. We made a collective decision that snorkeling was not on the menu for the day. Instead, we set up towels and blankets on the beach and settled in for the afternoon. A local man drilled a couple of coconuts for us to sip on. A gentle breeze blew through our hair as we watched the ocean waves. As the palm trees bent in mild submission, we began to talk of paradise.
Behind us was a large house, surrounded by a low wall, made of round glass blocks and concrete. From our vantage point, it looked like a grand palace. The house rose to two levels. Soon two women emerged from the gate and made their way toward us. We talked for a bit. The woman who owned the house was an American, probably in her early fifties. She and her husband had worked hard and saved to be able to retire early to move to this area and build the house of their dreams. The other woman was a Canadian who had a house a few miles away. With them was a small dog who frolicked at their feet as they talked. We could tell by their actions that they were half smashed, but a little alcohol on a sunny afternoon in paradise with friends is no big deal. As they wandered off down the beach, they told us to feel free to go up and see the place.
We eagerly took her up on the offer. We all dreamed of living in paradise as well someday and wanted to see what we could expect. When we got to the gate, her husband was there in his underwear. He politely excused himself to put on some pants and just like his wife, told us we could wander around the house and property. He then staggered away. The lower level of the house was the kitchen. The upper level consisted of the master bedroom, and maybe some other bedrooms for guests. The house was round, and the side facing the ocean was open on both levels. The walls of the house were made of the same glass blocks and concrete as the surrounding wall. The opening was about a third of the radius and a stone patio extended from the kitchen, which seemed to functions as the primary gathering area. In the working part of the kitchen was a rounded countertop. An elevated bar with stools on the outside was adjacent to the countertop. The first thing we noticed as we walked inside was that the countertop and bar were completely covered. Half-eaten bags of chips, cookies and other packaged foods spilled onto the counter. There was no fresh food in sight; no fruits, no vegetables. At least thirty bottles of every kind of liquor and wine available littered the space, some empty, some half full, all opened.
We declined from visiting the upstairs, fearful of running into the man in his underwear again. Instead, we wandered along the garden path the extended from the patio. It meandered along another low stone wall and to a couple of guest houses and a bathroom with an open shower. Again all constructed of the same materials. As we got to the end of the wall, I noticed that it was about a ten inches thick, and that the opposite side was made up of small round holes. It slowly dawned on me that these were not glass blocks. Every wall consisted of liquor bottles set in concrete. Thousands of liquor bottles. How much liquor must they have had to consume to build their paradise? I spun around in total disbelief as the realization of that set in. The sight we had encountered in the kitchen was not a once in a while activity with friends. It was their daily life in paradise.
We left the property and returned to our little spot on the beach. The two women were still playing with the small dog further down. We watched as a pack of larger dogs descended upon them and attacked the smaller dog. We rushed to help them fight them off. One of the women jumped into the middle of them and grabbed the little dog, but in the fray was bitten herself. A man came out of the brush behind us with a stick to drive them away. She saved the small dog, the others ran off, and the women staggered back to the house crying and bleeding. We had seen and even petted the pack of larger dogs since we arrived. We learned from the man who came to help that these dogs were mostly pets who had been abandoned by their owners and had learned how to survive on their own. Most of the time they were harmless but would attack and kill anything they could for food. The women seemed to know the dogs as well, one of them pleading as she passed us that she didn’t want to see them hurt and that she was sure they didn’t mean to hurt her. I couldn’t understand why, if they knew them so well, they had decided to take the smaller dog with them to the beach? They surely knew their habit of attacking and killing small animals. Our group was left sickened by the event.
We left the beach shortly after. Getting off was no easier than getting on. I returned to Yelapa that day with a new understanding of paradise. For the most part, aside from that one afternoon, I loved my time there. The beautiful days, the yoga, the hikes, the downtime, the food, the friendships I found, the quiet, the time for reflection all created a paradise in my mind. But, I realized in that one afternoon that my life at home was mostly a life I loved. I couldn’t live my days without structure, without purpose, without community. I wondered if the people we met that day had pictured their life in paradise playing out as it was. I wondered if they were happy. I couldn’t see the happiness there. It was not visible to me. I couldn’t feel it either.
Even now, years later, when I start to become weighed down in the messiness of everyday life, I think back to that day. It helps me appreciate what I have. It helps me clarify what I need. Visiting paradise is a powerful and necessary diversion. Living in paradise may not be all it’s cracked up to be.