There is something appealing about resting on our well-deserving laurels that is so appealing (netflix binge anyone?) but the science really does support exercise as the fix for what ails.

Bone is living tissue that is constantly being broken down and replaced.  Bones effected by estrogen loss can become more porous (osteopaenia, osteoporosis) and can fracture with little effort.   

Fight for those bones, they’ll get you where you need to go with a little love!

Dozens of recent medical studies have shown a direct and positive relationship between the effects of resistance training and maintaining and even increasing bone density. 

Interestingly, the stress on the bones that results from weight bearing activities like running and jumping stimulates bone building.

(This weight (loading) slightly compresses the bone matrix and triggers the cells to assimilate more calcium and other minerals, ultimately increasing bone density).

Prolonged rest or lack of loading, can cause further unloading (or loss of bone density).

Regular loading – walking, jogging, resistance exercise (yoga, pilates) will help and should be done frequently unless you are medically unable.  Further Loading exercises (jumping, weight-bearing) will require trainer guidance at the gym if your bones are already porous but can significantly help!

* Some studies suggest older women require lots of calcium for exercise to have this beneficial effect – so get your calcium – ideally in your food.

Ok, you knew we were going to say it… what you put in your body effects what you get out.  We are all grown-ups here, we know how to make good choices and what those good choices are.

What you may not know is that a calcium supplement isn’t the best fix for those lighter-caliber bones.

Calcium is critical for bone-maintenenace and building (and many other things as well!) and the best way to get it with no side effects (kidney stones?) and with max impact is through food.

Chew on this:
(Ranked in order of highest calcium levels) Milks, calcium-enriched soy or other milks or orange juice, yogurt, cheese, sardines, white beans, rice pudding, figs, raisins, chickpeas, cress, butternut squash, tofu, shrimp, tuna, broccoli, rhubarb, celery, almonds, hazlenuts, carrots, kale…

Hmmm… sounds like a nice cassoulet might be in order!

Vitamin D is so important to bones.  Your 200+ bones are the stacked and intricate jenga structure that keeps you upright and functional.  Did you know you even have bones in your ears that help conduct hearing? 

Vitamin D regulates calcium absorption and the lack of it, it that lead to even further bone density loss.

Where can you get your vitamin D?

Sunlight: (5-15 minutes of sun on your skin mid-day 2x week all year, then get your sunblck on, this isn’t the 90’s!) 

Food:  Fatty fish such as salmon, mackerel, and sardines, egg yolks, or fortified foods such as milk, orange juice, and some cereals.

Supplements: Vitamin d3 (ask your doc, ages 50+: 800-1000 iu/day (National Osteoporosis Foundation).

Happily, the University of Arizona did a study on the best exercise regimen to stave off bone loss and promote bone gain – and it works!

Here it is (we don’t want any one of you to get broken parts, so especially if you’re new to weight equipment or if your bones are fragile, you have joint issues or trouble with balance, please ask a trainer/doc to help get you started or offer alternatives):

1. 3- to 5-minute cardiovascular warm-up
2. 20 minutes of strength-training exercises; 2 sets of 6 to 8 repetitions of each core exercise:

• Back extension
• Lat pull down
• Leg press
• One-arm military press
• Seated row
• Wall or Smith squats

3. 15 minutes of “cardio-weight-bearing activity” such as weighted walking, stair climbing, or jogging

4. 5 minutes of abdominal exercises

5. 5 minutes of balance and stretching

This study had participants do a 1-year trainer-supervised program of the osteoporosis exercises listed above 2 to 3 times per week and progressively increased the weight lifted. They continued to do the osteoporosis exercises on their own during years 2-4.

Over the 4 years, those who stuck with it and lifted the most weight on average had the greatest bone mineral density increases, which were as high as 2.6 percent in the lumbar spine!

There is also research being done and evaluated on whether whole body vibration (WBV) is helpful for thinning bones.  According to recent meta analysis done of WBV study results (by Elena Marin-Cascales et al in “Medicine,”  August 2018 , “this meta analysis demonstrated that WBV is a potential nonpharmacological intervention for improving bone mass in postmenopausal and older women, particularly on lumbar spine, which was shown the most sensitive area. In addition, significant differences were found between intervention and control groups in BMD of the femoral neck in postmenopausal women younger than 65 years. WBV is a safe and effective method and may be used in addition to other training methods to minimize BMD reduction in postmenopausal women. However further studies are still needed to define the optimal protocol in this population. Based on the results obtained in the present meta-analysis WBV training improves bone mass in the lumbar spine in postmenopausal women, particularly in women younger than 65 years of age with a BMI <25 kg/m². When prescribing this type of protocol, professionals should take into consideration the following guidelines: the volume of work should be ≥108 total sessions, the vibration frequency should be ≥20 Hz, and the amplitude of the oscillation should be ≥5 mm/8 g.”

Might be worth an ask next time you’re visiting your favorite MD.

If you are young when you become one of us (Milestone women), and your bones are already compromised, your doc might want to follow the new 2017 North American Menopause Society (NAMS) recommendations and begin hormone therapy.  Go to a good doc with current knowledge, this individualized therapy can be the perfect solution for many women and help alleviate other symptoms as well.

There are also multiple medications available in several delivery methods that can help slow bone loss.  Be pro-active.

Take good care of your teeth, they are bones too, and dental issues can become more common without good care.

Estrogen has a pretty significant effect on every human brain.

It is thought that estradiol effects how the brain structures are connected, how brain cells communicate, and even the shape of your brain.

Estrogen promotes seratonin production in the brain which plays an important role in mood because serotonin is the mood-balancing chemical in the brain. When estrogen levels are low, serotonin levels decrease. This can have a significant impact on some women, potentially even contributing to depression.

In several studies, scientists with the Alzheimers Prevention Clinic note that Milestone women were more vulnerable to lower brain glucose metabolism as well as more likely to have lower levels of key neuroprotective metabolic enzymes (mitochondrial cytochrome oxidase) and increased protein (amyloid beta) accumulation in the brain.  These things have been associated with brain aging and vulnerability to early Alzheimers.

Women can juggle dozens of things in any given hour.  Do the hormone changes we go through effect how our brain works as we age?

The brain, like all biological systems, ages.  The chemical hormone effects that women experience during hormonal fluctuations, are also real.  Studies have shown changes in the hippocampus related to hormone fluctuations.  Some women experience these effects as mental fatigue, memory issues, confusion, attention issues, etc.

Blood flow changes to the brain can occur in women who have frequent hot flashes.  This affects the part of the brain that deals with processing speeds, which can influence word association and memory.

Estrogen is an integral part of the brain’s internal signaling system and helps communicate the parts of the brain that need more blood flow. When estrogen is irregular or reduced, the body tries to compensate, which can feel like brain and memory-retrieval fatigue.

The good news is that these fluctuations happen throughout life and are not only menopause-related and are typically not permanent or degenerative.

Does sleep sound like a good prescription?  Yes, please!  7-8 hours, every day, friend, PosPause’s orders.

Eat your brain-healthy fats like almonds, avocados and salmon.  (Now I know what I’m having for lunch!)

Dr. Lisa Mosconi, Neuroscientist for the Alzheimers Prevention Clinic makes special note of phytoestrogens (soy, flax seeds, chickpeas, garlic and fruit like apricots). She also notes the importance of antioxidants in brain protection like vitamin C and vitamin E found in berries, citrus fruits, almonds, raw cacao, Brazil nuts, and many leafy green vegetables.  It is said that vitamin D can have an “estrogen-like” effect on the brain as well (think protection), so help yourself to some morels or oyster mushrooms with that fatty fish.

Also, relax and reduce your stress (as detailed in the heart section below) and go for a walk daily if possible.

Weight-bearing exercise is also excellent for both bone loss and the brain as well as increasing endorphins. This type of exercise turns out to be the highest-rated factor in guarding against memory loss and Alzheimer’s.  The cognitive organizational skills needed for exercise make more demands on the brain than reading or playing chess every day.

Sometimes chilling out is easier said than done.  We know that stress (anything stimulus your body biologically reacts to) can effect our nervous systems, brain, heart and GI system in both acute and chronic ways.  It can trigger and exaggerate disease and break these important functions down.

Most women we know are seriously productive, responsible, reliable people.  It’s not the Age of Aquarious, we’re not going to pass the peace pipe, but lowering stress makes the Milestone a much less stressful part of life and more healthy too.

Here are some science-proven stress lowering options.  Pick what works and get your chill on.

• Tense, then release every muscle, top to bottom.
• Breathe slowly, deeply and give your head some mental silence.
• Make your senses happy.  Lavender candle? Happy music? Love on your pet or give someone a hug.
• Head out: exercise, church, spa, comedy club?  All four?
• Practice gratitude and look for ways to be kind to others.
• Hang out with friends: tea?  Art-night?  Talk and laugh away your stress.

When the body processes and protection systems slow down, there are still steps that can be taken to help keep away the painful effects.  To help in collagen loss, we have to work a little harder than we used to to help the girl (Miletone body) out. 

The science isn’t totally behind collagen powders yet – there are some side effects and the advertised benefits may be unrealized or short-lived.

A better investment is to lend a hand to your natural collagen production.  Get adequate protein from meat, poultry, fish and plant proteins such as beans, nuts, seeds and grains. Get enough vitamin C and zinc in citrus fruits, berries, bell peppers, leafy greens, shellfish, eggs.  Some studies suggest gelatin in food can help too.  PB & J anyone?

Excess body weight adds additional stress to weight-bearing joints (hips, knees, feet and back). Losing excess weight helps reduce pain and limit further joint damage.

Get your eight hours of sleep.  This is the time your body does all of its healing, growing and regeneration.

When you wake up refreshed, get to stepping.

This is where proactivity comes in.  It may sound counterintuitive but one of the best ways to manage osteoarthritis and aching joints is to get moving.

If you are in severe or debilitating pain or have trouble with balance – don’t do this.  Get help, get intervention.  Get moving again when you get the all-clear.  

New to exercise or trying a new regimen?  Talk to your Doc, get assistance from a physical trainer.

• It can be hard to think of exercise when joints ache but studies show that simple walks and  fun, easy exercise classes can reduce pain and help maintain (or attain) a healthy weight – which will ease the pressure on those joints.
• Strengthening exercises build muscles around  joints, easing the burden and reducing pain.
• Range-of-motion exercise helps maintain and improve joint flexibility and reduce stiffness.
• Slow, gentle stretching of joints may improve flexibility, lessen stiffness and reduce pain. Exercises such as yoga and tai chi are great ways to manage stiffness.

The biology of the Milestone is the end of ovarian follicular production and of ovarian function.  It is both caused by and causal of a continuous drop in production of hormones related to reproduction and sexual maturity.

In a sense, the Milestone is the realization and apex of full female reproductive maturation.   You made the top of the hill, girl!

Rather than worrying about the descent, let’s enjoy the peak… and the tremendous view.

Aside from concluding the complete ability to produce offspring, a Milestone woman’s reproductive tract and external genitalia remain functional. This is thumbs up for sexual activity.  

Interestingly, were she to use a younger woman’s egg, a Milestone uterus retains the ability to sustain a full-term pregnancy at least until her late sixties.  

There can be some consequences related to the drop in collagen production in the Milestone that can negatively affect the vagina, its lubrication and ph that can be seriously bothersome.  That can even lead to tissue breakdown and atrophy.  Urinary issues are fairly common related to thinning tissues.  Do be proactive about this – gynocologists know the answers and are a phone call away.  Living in pain and discomfort and compromising a potentially fun sex life is not cool.

And yeah, do your kegels.  1-3 sets of 10 per day.  Do it while you’re brushing your teeth.  Pretend you’re stopping your pee stream and holding a marble inside for 3 seconds, then release – that’s 1 kegel.  This will help with sneeze-pee prevention and better orgasms.  Plus brushing your teeth is boring.

Vaginal lubrication is provided by cervical mucus produced by the Bartholin’s glands near the vaginal opening and the cervix. The membrane of the vaginal wall also produces moisture.

Before the Milestone, before and during ovulation, the cervix’s mucus glands secrete different variations of mucus, which provides an alkaline environment in the vaginal canal that is favorable to the survival of sperm and keeps the vagina supple and moist – the more estrogen, the more fertile the viscosity of the mucus. The moisture moves down through the vagina, cleansing and removing dead cells. The walls of the vagina are composed of soft elastic folds of mucous membrane which stretch or contract (with support from pelvic muscles).  The vulva is a plump, protective covering of the pubic bone and the vaginal opening. 

The decline in estrogen directly affects not only the cervical lubricating fluid but also the entire vaginal structure.  Clinical studies are being done now to help determine how hormones specifically impact the production of cervical mucus.  The effects of this mucus production decline, however, and the proximally-related discomfort of potential atrophy of the vulvovaginal structure, whether related to lowered collagen or simply the body’s signal ending the biological functions of fertility (or both), effects a large number of Milestone women for an extended period of years. 

This atrophy and low level of moisture can lead to fragility of the vaginal tissue, pain with intercourse, increases in urinary tract infections, etc.  Any of these issues can greatly effect general and of course sexual discomfort and lower arousal – both related to and independent of stimulation and interest in intercourse.

What can be done?  Sex is actually a good remedy for this if it’s not painful, so are kegels, so is artificial lubrication, so is estrogen.  All of these things increase blood flow, promote tissue strength and help with some or all of the related issues.  Estrogen is not for everyone but when sex isn’t an option because of pain, and simple functionality is compromised because of burning, tearing, tissue sensitivity, estrogen or hormone therapy should be considered if you are a candidate.  No one should live their life in pain if it is preventable, no matter what or where the pain.  There are multiple options for estrogen delivery methods and your gynecologist and girlfriends will guide you in choosing the right one for you.

If adding estrogen isn’t for you, and it’s not for everyone, try the other options including a good, gentle, non-irritating lube and cleansers (Good Clean Love is wonderful).  Try kegels, gentle orgasm producing stimulation, eating phytoestrogens like soy, sesame, oats, or work with your partner to explore love in non-painful, mutually supportive ways as you navigate forward.  As always, a good gynecologist know what and why this happens better than anyone, ask for help.

Just saying… no periods, no potential for pregnancy… enjoy that bod, it has served you well and still has plenty to teach you and your loved ones.

If your sex-drive, lubrication and vaginal comfort feels on the wane, you’re not imagining it, tissue thinning is common and can be complicating.

More and frequent “sex”* actually increases blood flow to your vaginal tissues. This helps to promote vaginal health and maintain some of the elasticity and thickness of the vagina that is being lost.  And no, your husband didn’t pay us to say that; our first concern is you and your long, happy life.  Good Clean Love lube has good pain-free reviews.  Lube the chassis and start your engine.

* The word sex in quotes above refers to any vaginal/clitoral stimulation that gets your blood flowing – solo or a-deux.  Use it or lose it, baby.

Interstingly, women in Japan report fewer symptoms altogether, notably hot flashes are rare for them during menopause, possibly because of diets high in phytoestrogens like soy and whole foods high in fiber, vitamin e, calcium and magnesium.

High Quality H2O helps!  Drink plenty of the wet stuff.  It helps replace fluids lost to perspiration during hot flashes and can even prevent or minimize the hot flashes themselves.  Shoot for up to 2 quarts/day.

Treatment with estrogen often reliably relieves hot flashes in women depending on age, time since menopause begin and health factors.  Check in with a trusted, well-informed care provider for real solutions.  

Treatment with estrogen often reliably relieves hot flashes in women depending on age, time since menopause begin and health factors.  Check in with a trusted, well-informed care provider for real solutions.  

Body fat (adipose tissue) is loose connective tissue designed to store energy and insulate, it also serves an important endocrine function.  Its endocrine role becomes even more important in Milestone women with its critical estrogen-producing functionality when the ovaries no longer produce the hormone. 

Pre-Milestone, estrogen appears to be responsible for the accumulation of fat in the subcutaneous tissue, particularly in the gluteal and femoral (thigh) regions.  This “pear-shaped” body composition is also associated with some degree of protection against cardiac and metabolic disease.  When the greater influence of androgen hormones in Milestone life promote the accumulation of abdominal fat, that increases other risk factors as well. 

Abdominal fat has its own metabolically unfavorable associations that when combined with other risk factors, can increase the risk of conditions with increased mortality rates like heart disease, stroke, and diabetes.

The SWAN study showed that approximately two years prior to the milestone, women’s rate of fat gain doubled and lean mass started to decline. This continued until two years after the final menses.  These gains in fat mass and losses of lean mass that subside in post-menopause, strongly suggest that the menopause transition affects Milestone women’s metabolism.  This also demonstrates that body weight measurement on a scale alone does not capture the invisible, underlying gains in fat and losses of lean.  

Because Milestone bodies tend to have less muscle mass and tend toward less exertion, their body processes actually require fewer calories to function optimally.  This requires a bit of a behavioral shift.  Those same bodies also need more nutrients to protect the systems that naturally slow their growth and protection capacities.   

Unfortunately, it can feel like an uphill battle.  U.S Female obesity at ages 40-65 years is now calculated as 65%; for women over the age of 65 it’s 74%. 

Milestone women have to be more agile and diligent about changing eating and exercise behavior because it appears the drop in estrogen levels combined with genetic aging and trends in lifestyle often:

• Lowers muscle mass and increases fat (more lean muscle and less fat = increased metabolism).
• Changes caloric needs to require fewer (around 200 less), better calories
• Can change the actual location of our fat.  With less estrogen, the androgen hormones like testosterone that remain and become more available to our systems promote the accumulation of abdominal fat, and abdominal obesity risk increases almost 5-fold among Milestone women. 

Obesity, no matter where the fat is located, is incredibly dangerous to the human body, we know this, right girls?  Like any whole-body condition, obesity acts as a disease in the entire biological system.  It makes physical tasks which are necessary for good health harder to perform, it is associated with a 10-fold increase in artery hardening, puts enormous pressure on the cardiac and vascular system as a whole, affects glucose processing to life-threatening levels, creates a cycle of chemical messages increasing greater fat production, increases risk for disease and is damaging to joints.  The negative impacts are widespread and the benefits are negligible.

Some other physical changes that research shows may be related to the lowering of the estrogen that protects so much in our bodies include:

Lowered leptin levels (this protein communicates satiety (fullness) to the hypothalamus) that can lead to an increased appetite.

Changes in sleep patterns can occur as we age and can be compounded with vasomotor issues (hot flashes).  Sleep disorders can affect the chemicals that dictate appetite and studies have shown these sleep disturbance-related chemical effects to contribute to weight gain.

Cortisol levels can rise with age and have been reported as elevated in transition to Milestone.  Almost every cell in the body has receptors to cortisol.  Cortisol works as part of the adrenal system and helps the body respond to stress. When cortisol prepares the body for a stressful situation, it often signals the breakdown of muscle tissue to release energy.  Cortisol’s effects including controlling blood sugar levels and thus regulating metabolism, acting as an anti-inflammatory, influencing memory formation, controlling salt and water balance, influencing blood pressure.  Chronic stress can result in a continuous release of cortisol which has been associated with accumulation of abdominal fat but is also a precursor to several disease states.

The behavioral shift in vigilance and care of the amazing female body has to start with us.  Turning around the societal view of how women must look and behave starts with us.  Beauty can and should be associated with behavior.  Part of beautiful behavior is kindness to others and kindness to ourselves.

Once we understand what’s going on, we know we are not powerless and we know where and how to make a change.

To make a change in weight in the Milestone body, it comes down to daily vigilance in what we eat and how we exercise, trying to get good sleep and manage stress.  If we have a bad day, start again tomorrow.  Be kind to yourself but also be reliable in doing the best you can to do the right thing.  Almost every negative physical alteration associated with the Milestone can be prevented or reversed by increasing physical activity levels, what and how much you put in your body can have a great impact on the rest.

We know that:

• Regular exercise (30 min/day, at least 2.5 h/week) is the best predictor for achieving long-term weight control and preventing cardiovascular events. It has been proven that behavior that includes healthy eating and more intense physical activity in Milestone women is effective in reducing body weight, in particular, the fat mass, whereas fat-free mass is maintained, and bone mass even increases.
• Evidence shows that regular and consistent exercise reduces abdominal obesity and results in favorable changes in body composition. It has therefore been suggested that exercise is a medicine in its own right and should be prescribed as such. 
• Intense physical activity levels result in significantly lower levels of total body fat in Milestone women.
• Even light physical activity has a greater impact on body composition in Milestone women after menopause than before. 
  • Sedentary lifestyle is also more strongly associated with an increase in waist circumference after menopause than before. 
• Strength training increases muscle mass and quality and helps balance your hormones.  More muscle mass increases metabolism, which may contribute to diminished weight gain and decreased fat mass.  To counteract Milestone loss of muscle mass, aim for strength training exercises at least two times per week 
• You may need about 200 calories less per day for weight maintenance in your 50’s than you did in your 30’s due to Milestone decreases in muscle mass.  Too few calories will lead to muscle loss, which will slow your metabolism.  Instead of restrictive dieting, pay attention to what you eat and drink. Choose nutritious, balanced foods, such as fruits, vegetables, whole grains, and healthy proteins and fats and sea fish. And make sure you get the extra nutrients you need, like calcium, vitamins, and antioxidants.  Avoid processed foods and limit sweets and alcohol.  We know that red wine contains some good reservatrol antioxidants – so maybe keep some of that around.

The Milestone effects on skin tissue has to do with the loss of the hormone estrogen’s protective influence on the skin’s mechanics which adds up to what might be visibly considered skin aging. The Loss of estrogen receptors in the dermal matrix can also cause a 50% decrease in Type 3 collagen within a few years of menopause.  Collagen is a complex protein family made up of amino acids.  ITs fiber support body tissues and cells. Collagen and keratin give the skin its strength, waterproofing, and elasticity.

Connective tissue is also primarily composed from collagen that provides the structure for fibrous tissue, such as ligaments and tendons. Collagen is found in cartilage, bone, blood vessels, eye corneas, intervertebral discs, muscles, and the gastrointestinal tract.

Collagen production declines along with the estrogen and also with genetic age.  It can be damaged by smoking, sunlight, and other oxidative stressors.

Over time, a decrease in estrogen means lowered collagen production.  The reduction in collagen and keratin production leads to thinning and fragility of the outer layer of skin as well lower vitamin D production and loss of skin moisture.  These can be compounded by the effects of living a life: the effects of time itself along with years of sun and wind, fallout from choices like tanning and smoking.

Regions of skin in which there is a higher concentration of estrogen receptors, including the face, pelvis and breast are particularly susceptible to these changes.

Specific regions of delicate skin may be affected more than others.  A recurrence of acne way past those teen years, breakdown and sensitivity of vulval and vaginal skin leading to discomfort and sensitivity.

Let’s not forget the significant psychological effect of determining our beautiful face and skin is considered to be”aging.”  Societal perceptions of beauty and Milestone skin can affect self-image and intimate relationships.   The question is how much will we let it?

Yes, science can “fix” these things with facials and injectibles. 

How about starting with feeding and nourishing yourself body and soul.  Eat good food, lots of phytoestrogens and antioxidants, get vitamin D and exercise.  Put wholesome ingredients on that amazing skin to keep it protected and well-fed inside and out.  Vitamin C guards against sun damage and increases collagen production for hair and skin – chop up some bok choy in that salad. Prevention is smart too, use a good sunblock.

Lift self-talk with what we would tell our daughters, mothers and best friends.  You are beautiful.  Full stop.  You are beautiful because of who you are and the life that you’ve lived, not in spite of it. Full stop.  Let’s change the perception, admiration and beauty of Milestone Women to what it should be.

The lipids that comprise the reproductive messaging system – our hormones – are estrogens, progesterone, and testosterone.  These hormones influence nearly every system, organ and operation in the human body in some way.

Their most studied role is in the processes related to human reproduction and reproductive development.

And while every female shares a similar chemical messaging system, the levels, timing, intervening factors, and response can still vary.

As you went through puberty, your peers each went through a similar biological process, and while each girl’s experience of it had similarities, they had differences as well.  Some girls had severe cramps every month.  Some had such heavy flow, they could hardly leave the house for a week each month.  Some girls had no issues at all except for the need for tampons, and everything else in between.

Likewise, when friends had pregnancies, childbirth and post-partum experiences, they each varied in many ways in their personal experience of the processes, hormone levels and bodily response.

This Milestone – the process of ending production of these chemical hormones, perimenopause, menopause, the climacterix is what we call the Milestone because it is the culmination of our reproductive experience.  This milestone, like the others, we will each bear and experience in both similar and very different ways.  It is something that bonds every woman to one another, a road that each must travel, however different each road might be.

Prior to menstrual cessation, during perimenopause, the International Menopause society notes the changes in hormone levels that can lead to varied physical outcomes.

As with menstruation cycles, all women experience perimenopause differently, in different combinations, and to varying degrees.  Here are some common hormonally-mapped physical issues.

Low Progesterone levels 
Bleeding • Short cycles • Heavier flow
• Premenstrual spotting
PMS (Premenstrual Syndrome – often seen during pre-menopause) • Moodiness • Hot flushes • Depression • Poor concentration • Irritability • Anxiety • Headaches (menstrual migraine)

High Estrogen Levels
Bleeding • Too much • Too long • Too soon • Erratic
Breast tenderness
Bloating
Headaches
Weight gain
Vaginal discharge

Low Estrogen levels
Hot flushes, night sweats/heat intolerance Insomnia
Fatigue
Vaginal dryness
Headache

As with everything related to climbing the hill toward the Milestone, each hike will take a different path and be individually challenging.  You can do this, you’ve done much harder things.  Rally your girlfriends around you and take time to vent and laugh.

We know that hormone levels are largely influenced by how we eat, sleep, and exercise, and many studies have shown a direct relationship between diet and menopause symptoms.  An example of this is the studied inverse relationship between hot flashes and the amount of soy products consumed. (Soy is good for Milestone women).

Like everything having to do with hormones, each person’s experience is different and their need for hormones after menopause differs.  

The current science tells us that estrogen fairly reliably helps with women who experience unbearable hot flashes.  We also know it is advised for women who experience premature menopause (under age 40) or who have measurable bone density loss at a young age.

For asymptomatic women, it is unnecessary and for women over 10 years past menopause (period cessation for 1 year), or over 60, the negative side effects seem to outweigh the positives. 

It is almost never recommended for women who have heart disease or breat cancer or a family history of either.

Hormone therapy is offered in multiple forms and may be incredibly beneficial and may also not be well-tolerated and can have both positive and negative side effects. 

Our best advice is to be open and self-advocating for complete bodily comfort nd wellness at every age and seek advice and the proactive cooperation of a well-informed physician.

The 2017 Hormone Therapy Position Statement of The North American Menopause Society (NAMS) updates the 2012 Hormone Therapy Position Statement of The North American Menopause Society and identifies future research needs.

An Advisory Panel of clinicians and researchers expert in the field of women’s health and menopause was recruited by NAMS to review the 2012 Position Statement, evaluate new literature, assess the evidence, and reach consensus on recommendations, using the level of evidence to identify the strength of recommendations and the quality of the evidence. The Panel’s recommendations were reviewed and approved by the NAMS Board of Trustees.

Hormone therapy (HT) remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM) and has been shown to prevent bone loss and fracture. The risks of HT differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. Treatment should be individualized to identify the most appropriate HT type, dose, formulation, route of administration, and duration of use, using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing or discontinuing HT. For women aged youngerthan 60 years or who are within 10 years of menopause onset and have no contraindications,the benefit-risk ratio is most favorable for treatment of bothersome VMS and for those at elevated risk for bone loss or fracture. For women who initiate HT more than 10 or 20 years from menopause onset or are aged 60 years or older, the benefit-risk ratio appearsless favorable because ofthe greater absolute risks of coronary heart disease, stroke, venousthromboembolism, and dementia. Longer durations of therapy should be for documented indications such as persistent VMS or bone loss, with shared decision making and periodic reevaluation. For bothersome GSM symptoms not relieved with over-the-counter therapies andwithoutindications for use of systemicHT,low-dose vaginalestrogentherapy or othertherapies are recommended.

This NAMS position statement has been endorsed by Academy of Women’s Health, American Association of Clinical Endocrinologists, American Association of Nurse Practitioners, American Medical Women’s Association, American Society for Reproductive Medicine, Asociacio´n Mexicana para el Estudio del Climaterio, Association of Reproductive Health Professionals, Australasian Menopause Society, Chinese Menopause Society, Colegio Mexicano de Especialistas en Ginecologia y Obstetricia, Czech Menopause and Andropause Society, Dominican Menopause Society, European Menopause and Andropause Society, German Menopause Society, Groupe d’e´tudes de la me´nopause et du vieillissement Hormonal, HealthyWomen, Indian Menopause Society, International Menopause Society, International Osteoporosis Foundation, International Society for the Study of Women’s Sexual Health, Israeli Menopause Society, Japan Society of Menopause and Women’s Health, Korean Society of Menopause, Menopause Research Society of Singapore, National Association of Nurse Practitioners in Women’s Health, SOBRAC and FEBRASGO, SIGMA Canadian Menopause Society, Societa` Italiana della Menopausa, Society of Obstetricians and Gynaecologists of Canada, South African Menopause Society, Taiwanese Menopause Society, and the Thai Menopause Society. The American College of Obstetricians and Gynecologists supports the value of this clinical document as an educational tool, June 2017. The British Menopause Society supports this Position Statement.