23. Understanding Menopause: How to Support Your Health in Midlife

In this episode of Midlife and Glowing, Alicia and Nicole delve into the significant topic of menopause as October is Menopause Awareness Month. They discuss the varying experiences of menopause among women, the importance of raising awareness, and breaking the stigma surrounding this natural transition. The hosts cover the biological changes during menopause, common symptoms such as hot flashes, mood swings, and weight gain, and provide practical solutions including lifestyle adjustments, hormone replacement therapy (HRT), and holistic approaches to ease the transition. This episode aims to educate, support, and empower women navigating through menopause, whether they're in perimenopause, already experiencing menopause, or supporting someone who is.

00:00 Introduction to Menopause Awareness
01:32 Understanding Menopause: The Basics
03:00 The Importance of Menopause Awareness
07:09 Hormonal Changes and Their Effects
10:32 Managing Menopause Symptoms: Lifestyle Tips
14:36 Hormone Replacement Therapy: What You Need to Know
21:05 Advocating for Yourself and Others
22:28 Q&A: Common Menopause Questions Answered
27:01 Conclusion and Final Thoughts

📌 Resources:
🧘‍♀️ GB03 Episode: A Breathing Practice You Can Do Anywhere → https://youtu.be/5zIgZlUlxW0
🍋 More on Electrolytes → https://youtu.be/rendXzv5KDg
🎧 Brown Noise Video for sleep → https://youtu.be/uGMvWDRv-lg

Transcript

Alicia: 0:00

Hey there. Welcome back to Midlife and Glowing. I'm Alicia,

Nicole: 0:03

And I'm Nicole. And since October is menopause Awareness month, today, we're having an important conversation that touches every single midlife woman at some point, menopause.

Alicia: 0:14

And here's the thing. Menopause is universal, but the experience is not. Every woman will eventually go through it, but the way it shows up, symptoms, timing, intensity, looks totally different for every one of us.

Nicole: 0:26

and yet for something so common, menopause is still wrapped in stigma and silence. So many women hit this stage feeling blindsided, unprepared, and unsupported. And that's really what Menopause Awareness month is all about, bringing the conversation into the light, sharing knowledge, and making sure no woman feels like she has to go through it alone.

Alicia: 0:46

So in this episode we're going to break down what menopause actually is, why awareness matters, what's happening in your body, the symptoms you might experience, and most importantly, tools to help you navigate this transition with more ease, confidence, and health.

Nicole: 1:03

And we want you to know we're right here with you. We're in the early stages of perimenopause ourselves. So while we haven't personally crossed into menopause yet, we're learning, preparing and having these conversations right alongside you.

Alicia: 1:16

And whether you're already in it, approaching it or supporting someone who is, this episode is for you. So grab a cozy drink, settle in, and let's dive into what menopause really is, why it matters, and how you can support yourself through this powerful stage of life.

Nicole: 1:32

let's start with the basics. What exactly is menopause? Clinically menopause is defined as 12 consecutive months without a menstrual period. That's it. It's really a milestone, and the average age this happens is about 51 years old, but it can range from 40 to 58 or later.

Alicia: 1:50

But the road leading up to that milestone perimenopause. Can last four to 10 years. That's a stage many of us in our forties are already in. When cycles start to get irregular hormones fluctuate, and symptoms like night sweats or mood changes can start showing up.

Nicole: 2:06

Right then once you hit menopause, that 12 month mark, you're technically considered post-menopausal for the rest of your life. So really menopause is just one point on a long journey of hormonal transition.

Alicia: 2:19

And here's the important part. As we already said, every woman's experience is different. Some women breeze through with hardly a symptom, while others are completely derailed by hot flashes, insomnia, anxiety, or brain fog. And most of us are just kind of somewhere in between.

Nicole: 2:35

Yeah. Statistics show that about 75% of women experience menopausal symptoms, but only around 25% feel prepared for them. That's a huge gap, and it's why awareness is so important. We wanna close that gap so women know what to expect and feel empowered to get support.

Alicia: 2:53

So if you're listening and you feel confused, frustrated, or even a little lost, you're not alone. And that's exactly why we're talking about it today.

Nicole: 3:00

So why does menopause awareness matter so much? For starters, stigma and silence. For generations, women were taught not to talk about menopause almost like it was something shameful. That silence has left so many of us in the dark.

Alicia: 3:14

yeah, actually, we were talking about this with grandma and mom,

Nicole: 3:20

Mm-hmm.

Alicia: 3:21

a little while ago, and grandma said, oh yeah, this was not anything that, you know, anyone talked about. And mom kind of agreed. In fact, mom had gone through it without even realizing she was going through it, and she went into the doctor and was already post menopause. So, you

Nicole: 3:40

Yeah.

Alicia: 3:41

every person's journey is different and I think. Now we are starting to talk about it more and we definitely need to continue that so we're able to arm ourself with more knowledge and make this transition, uh, more comfortable.

Nicole: 3:56

Yeah, absolutely. And speaking of every woman's experience being different and talking about mom and grandma, they couldn't have been more different in terms of how they experienced it. Mom was on the very early end of the spectrum and you know, going through it really early, whereas grandma was on the very late end of the spectrum going through it really late. So it really is such a difference in terms of how you go through it. The interesting part of that is actually there's not a lot of, indicators of, you know, when exactly you will go through it, but one of the best potential indicators is when your mother went through it, that could be an indicator of when you might expect to go through menopause yourself. So, but in that case,

Alicia: 4:42

It

Nicole: 4:42

in mom and grandma's case, that didn't work out so much. So yeah, it's quite a different experience for everyone.

Alicia: 4:49

right. You know, and honestly, a lot of doctors aren't much better equipped,

Nicole: 4:53

Yeah.

Alicia: 4:53

did you know that only about 20% of OB GYN residency programs in the US include formal menopause education? So that means many providers graduate with almost no training in how to support women through this huge transition of their life.

Nicole: 5:11

Yeah, that is, incredible, that statistic, and I believe it when I was going through my perimenopause and menopause certificate program, we had quite a few OBGYNs come in and give lectures. And so many of them said that very thing they said. I was going through it myself and realized how little I knew about it from my training because I didn't actually, even though they're an OBGYN, you know, you're a women's health specialist, they weren't properly trained on menopause and all of the things that goes along with it. So they, you know, these physicians themselves in these lectures were echoing just exactly that. Like they, it's not something that they were at the time getting trained on. I think that's changing. Um, but you know, the lack of awareness has real consequences. Let's talk about the workplace. In the UK, research estimates that nearly 1 million women have left jobs due to menopause symptoms. In the US surveys show that around 20% of women consider reducing hours, changing jobs, or leaving the workforce altogether because of unmanaged symptoms.

Alicia: 6:26

I believe it. And that's not just personal, that's economic. Stanford study found that untreated menopause symptoms are linked to about a 10% drop in women's earnings. That's massive.

Nicole: 6:40

Yeah, that is crazy. And it's not just about money. Menopause can impact relationships, mental health and overall identity, like we've talked about so much on this podcast. Studies Show increased risk of anxiety and depression during this transition. So this isn't a small side note in women's health. It's a big deal.

Alicia: 6:58

And when we normalize the conversation, women can recognize what's happening sooner, seek support earlier, and avoid so much unnecessary suffering.

Nicole: 7:08

All right, let's get into it. What's actually happening in the body? Menopause is driven by the decline in reproductive hormones, especially estrogen, progesterone, and testosterone.

Alicia: 7:19

And estrogen does way more than regulate periods. It supports your bones, heart, brain, skin and metabolism. So when your estrogen declines, you see the impacts everywhere. Bone loss, increased cardiovascular risk, changes in fat distribution. You know, you're carrying it more in the midsection. Hot flashes, skin dryness.

Nicole: 7:41

Yes, absolutely. Progesterone helps with sleep and calming the nervous system. When that declines, women often notice anxiety, more sleep disturbance, and mood changes.

Alicia: 7:52

and testosterone and DHEA though lower than men are important for libido, energy, and muscle tone. Their decline can affect strength, motivation, and sexual health.

Nicole: 8:05

Long term this transition raises risks for osteoporosis, cardiovascular disease, and even dementia. When it comes to bone loss, women can lose up to 20% of their bone density in the first five to seven years after menopause. That's huge.

Alicia: 8:20

That is huge. Okay, zooming into hot flashes, your brain's thermostat gets more sensitive as your estrogen declines. So small body temp shifts can trigger a big cool me down moment reaction. You know, you're flushing, you're sweating, you wake up at 2:00 AM just needing to change your clothes'cause you sweat right through'em. But menopause isn't just hot flashes. It's really a whole body transition.

Nicole: 8:46

Yeah. And as estrogen's protective effects on the heart and brain wane, midlife is a key window to shore up cardiovascular health and brain health. So let's talk symptoms. Hot flashes, night sweats, and flushing are the classics. Up to 80% of women experience them and about 25% report them as severe and life disrupting.

Alicia: 9:07

Then there's sleep disruption, waking up multiple times a night or not being able to fall back asleep, and we know how much lack of sleep impacts mood, energy, weight, and brain function.

Nicole: 9:19

Yeah, brain fog is another big one. Forgetfulness. Trouble focusing. Feeling like your mind isn't as sharp.

Alicia: 9:25

And now we have mood swings, irritability, even new anxiety or depression can show too.

Nicole: 9:32

And in this transition, many women experience body composition changes like more midsection fat, and less muscle if they're not strength training. Vaginal dryness is also a really common symptom during menopause, but there's also more skin dryness noted, and even things like dry eyes. When it comes to skin and hair, in addition to thinner skin and more fine lines, more breakouts and hair also starts shedding more. The vaginal dryness also goes hand in hand with discomfort during intimacy, recurrent urinary tract infections and more urgency with urination. When it comes to cycles the few years leading up to menopause, they can get really irregular, either lighter or heavier than usual, and the timing gets either closer or farther apart until they eventually stop altogether. These symptoms are real and they impact daily life, and yet so many women are told it's just aging or you'll just have to live with it. Women are being gaslighted big time by their doctors on this issue, and that's not acceptable. So let's talk about solutions. First, lifestyle. When it comes to nutrition, protein is a big one. Aiming for 0.7 to one gram per pound of your ideal body weight is the recommended target. And if you wanna make that simpler aim for about 30 to 40 grams of protein per meal. Protein supports muscle retention, satiety and blood sugar stability. When it comes to fiber, work towards 25 to 35 grams per day. Get it from veggies, legumes, berries, chia, flax, nuts, oats, fiber supports gut health, estrogen detox pathways, and cholesterol. Carbohydrate quality and timing. Choose slow burning complex carbs like quinoa, beans, root vegetables, and pair it with protein, fat, or fiber to keep the blood sugar nice and stable and avoid large, late night sugar hits. When it comes to healthy fats, focus on olives, olive oil, avocado, nuts, seeds, and omega threes for inflammation, brain and cardiovascular support, and also hormone support as all of our hormones are made from fats. Focus on phytoestrogens like flax and legumes. These are gentle plant compounds that can ease symptoms for some women. When it comes to hydration and minerals, electrolytes help with hot flashes and energy, so make sure you're staying hydrated. A good rule of thumb is half of your body weight in ounces of filtered water every day, and adding in some good quality microplastic free salt to your water can help support electrolyte balance. Alcohol and caffeine. Consider dialing back. Both can worsen sleep and vasomotor symptoms.

Alicia: 12:10

Alright, next, let's talk about movement. Try to get in three to four sessions a week of strength training. This is non-negotiable for bone, muscle, insulin sensitivity and mood. Also get some hit or high intensity interval training or sprint training. These small bursts are safe and progressive for cardiovascular fitness and metabolic support. Make sure you're getting in your walks, take stairs. Try to get in seven to 10,000 steps a day as a ballpark goal. And then mobility and balance, like yoga flows, single leg work, these protects joints and reduce fall risks. Get in jump training. So after 50 years old, it supports better bone density and you can work it in for 10 minutes, three times a week.

Nicole: 13:01

And then when it comes to sleep, pay attention to light cues to support better circadian rhythm. Focus on morning daylight outside, and then in the evenings, aim for warm, dim light. If you have brighter overhead lights, use blue light blocking glasses at night, or if you're on screens, to support better circadian rhythm. To maintain better sleep rhythm, focus on consistent sleep and wake times even on the weekends. When it comes to your environment. Keep your room cool, use breathable bedding, mouth taping if appropriate, and consider white noise as well.

Alicia: 13:35

Or brown noise.

Nicole: 13:36

Exactly. Consider cutting off caffeine earlier in the day and minimizing alcohol. Finishing meals at least three hours before bed can help as well. And if you do wake in the night, keep lights low, breathe long and slow. Focus on that extended exhale breathing. If you need a refresher, you can go back to our week three glow bite or GB three episode where we explain that technique in more detail. Do a short body scan, but avoid doom scrolling if you wake in the night.

Alicia: 14:04

And cozy self-care matters too. Stress management tools like meditation, yoga nidra, that breath work you were just talking about. They can all regulate the nervous system and lower cortisol, which is huge during hormone changes. And let's not forget about how important connection, laughter, and purpose-filled hobbies are too.

Nicole: 14:24

Absolutely. And boundaries are worth mentioning too. Protect your energy. Saying no can be a fantastic form of self care.

Alicia: 14:32

Agreed. And

Nicole: 14:33

then on the medical side, there are options. I wanna just talk a little bit about hormone replacement therapy, sometimes called menopausal hormone therapy. It's considered the gold standard for symptom relief and current guidelines say it's safe and effective for most healthy women under 60 or within 10 years of menopause. Now this is actually a hot topic. The women's health initiative study that was published in 2002 showed that combined hormone replacement therapy, which means estrogen combined with progestin, was shown to increase risks of breast cancer, heart attack, stroke, and blood clots. And these initial results were highly publicized. And this led to a major pivot where doctors weren't prescribing or recommending hormone replacement therapy and women didn't wanna use it because they were worried about the risks associated with it because of the study results. But I do wanna just touch on that for a moment because there is a bigger recognition in the community of some issues with that study, which I'm gonna touch on in a minute, and. It's being recognized how valuable hormone replacement therapy can be for the women that it's appropriate for. And the FDA recently, I wanna say even just in July of 2025, had a meeting where they decided to take off the black box warnings that were on hormone replacement therapy So this is a big deal. And, you know, something that I just wanted to make sure that we highlighted so that you know, it's an individualized decision for every woman and it's not appropriate for everyone, but there's not as many risks as the study initially reported that there were. So let's talk about it. There were several problems with this study. Some of them include that when you zoom in on the data, it wasn't so much estrogen that was the problem. The increased risk of breast cancer and cardiovascular disease was actually associated with the synthetic progestin that was used in the study. They used medroxyprogesterone acetate. And that's a synthetic progestin. In fact, the cardiovascular disease risks were double in the group, taking the estrogen with the synthetic progestins as they were in the study participants that were only taking estrogen, which means that the progestins were associated with being thrombogenic, which just means something that has the potential to cause your blood to form clots, which can cause heart attack, stroke, and venous thromboembolism. Which is basically, yeah, a blood clot in the vein that can either lead to deep vein thrombosis or pulmonary embolism. So those are nothing to sneeze at. They're big deals, obviously. And it looks like the progestins were responsible for that increase in risk. In the study there was actually a lower incidence of breast cancer and mortality in the women that were taking only estrogen. So that is something to consider. I will also say that the forms of estrogen and progesterone that they used in the study were for estrogen they used conjugated equine estrogen in oral form, and I mentioned the form of progestin that they used. So there's been a lot more data coming out since then showing the protective benefits of bioidentical transdermal estrogen and bioidentical progesterone, sometimes called oral micronized progesterone. Bioidentical progesterone has not been linked to the same breast cancer risk or thrombogenic effects that the synthetic progestins have. It does look like the safest form of estrogen is actually transdermal estrogen, because oral estrogens can increase risk of clotting and also gallbladder disease because basically the oral forms of estrogen first have to go through the liver before they get into circulation. So it changes the estrogen essentially. But when you use a transdermal form of estrogen, that first pass through the liver doesn't happen. I will also say that it's important for women that still have their uterus using hormone replacement therapy that includes progesterone is recommended to protect against endometrial cancer because the progesterone helps prevent the estrogen from creating too much proliferation in that tissue. So these of course, are all things to discuss with your doctor, but I think it's helpful to go into these discussions with a little background knowledge so that you're well informed and you can have a better conversation about what's best for you. Because hormone replacement therapy isn't for everyone, there are contraindications to using hormone replacement therapy like having a history of estrogen sensitive cancers, stroke, heart attack, or venous thromboembolism among other issues. But ultimately for women struggling with symptoms during menopause. Hormone replacement therapy could be helpful and even protective in a lot of ways. We've talked a lot about all the ways that estrogen supports our body, which that changes during perimenopause and menopause as that estrogen declines, right? So it supports bone density, metabolism, brain health, cardiovascular health, skin, you know, vaginal health, all of these things. So it's definitely worth discussing with your doctor to see if it's right for you.

Alicia: 19:47

Right, because only about 15 to 20% of eligible women in the US are actually using it. That means millions are missing out because of outdated fears or lack of education.

Nicole: 19:57

Yeah, exactly. It's definitely worth talking to your doctor about, especially if you're concerned about your bone density or have vasomotor symptoms or genitourinary symptoms. Now, there are also non-hormonal options like vaginal moisturizers, and even certain supplements offer great support for overall health in this stage of life. It's important to work with a nutritionist or provider to make sure that you're taking supplements that are right for you and to make sure you're taking quality products. Friends, when it comes to supplements, quality matters a lot. So you wanna make sure that what you're taking is high quality, safe and right for your specific individual needs. And then also there are other holistic approaches like acupuncture that can help with menopausal symptoms too.

Alicia: 20:43

So the key takeaway, you have options. You don't have to white knuckle your way through it. If one path isn't right for you, there are others. So your care should be personalized.

Nicole: 20:54

Definitely menopause is not the end. It's a reset. It's a time to reevaluate priorities, focus on vitality, and step into a new chapter of life.

Alicia: 21:05

And it starts with the advocating for yourself. If your provider dismisses your symptoms, push back and find another provider. You deserve that support.

Nicole: 21:14

It also means advocating in the workplace, in families, and in communities. By 2030, there will be 1.2 billion women worldwide in menopause or post menopause. This is not a niche issue, it's half the population.

Alicia: 21:28

Right. And the more we talk about it, the more the stigma fades and the more we support each other, the more empowered this transition becomes.

Nicole: 21:37

So let's go through a little doctor visit checklist. Make sure you bring a symptom log and cycle notes. List your top three concerns. Ask, am I a candidate for transdermal estradiol and micronized progesterone? If you're struggling with genitourinary symptoms during menopause, ask about local estrogen, whether that's appropriate for you. If you're dismissed, ask for a referral to find a menopause trained provider.

Alicia: 22:02

Okay, so let's talk about the workplace. So you could advocate for flexible temps or a small fan you can put on your desk. Adjust presentation timing if nights are rough. Maybe try to have your meetings or presentations later in the morning or in the afternoon, and use brief breathing resets between meetings.

Nicole: 22:22

When it comes to advocating with partners, share what you're experiencing and what helps.

Alicia: 22:28

All right. Let's jump into the top questions we hear from midlife women. This is going to be a rapid fire style q and A.

Nicole: 22:34

All right,

Alicia: 22:35

All right. Are you ready?

Nicole: 22:36

ready.

Alicia: 22:37

How do I know if I'm in perimenopause?

Nicole: 22:40

So irregular periods plus new symptoms. Think sleep, hot flashes, mood, brain fog, in your forties are strong clues. A single hormone test is often not definitive because levels swing a lot during perimenopause. Your symptom patterns really are what are gonna tell the story.

Alicia: 22:59

next one. My labs are normal, but I feel awful. Now what?

Nicole: 23:05

Normal ranges don't always reflect symptom reality, so you'll need to track your symptoms, bring a list, and seek a menopause informed provider. You're not imagining it. You should definitely advocate for getting care in some capacity for those symptoms.

Alicia: 23:19

Is HRT, which is hormone replacement therapy, safe?

Nicole: 23:23

For many healthy women during menopause benefits often outweigh risks. Transdermal estradiol, and micronized Progesterone is a common, well tolerated regimen. This is personalized medicine, so discuss your history with a knowledgeable clinician to see if it's right for you.

Alicia: 23:38

I can't or don't want HRT do I have other options?

Nicole: 23:42

Yes, lifestyle levers, local vaginal therapies, acupuncture, and select supplements can often be very effective for a lot of women in the stage.

Alicia: 23:52

Why am I gaining weight around my middle?

Nicole: 23:55

Lower estrogen shifts fat storage and reduces insulin sensitivity, stress and sleep disruption worsen it. So the antidote is strength training, protein, fiber, walking, stress management, sleep hygiene. It's not just calories, it's a whole hormonal shift and lifestyle is a great way to support that.

Alicia: 24:17

Is there any help for waking up at two or three in the morning?

Nicole: 24:20

Yes, support blood sugar regulation, balanced evening meals, making sure to focus on protein, healthy fats, and fiber Limit alcohol, limit caffeine after noon. Make sure your room is cool. Consider things like magnesium, practice the extended exhale breathing or yoga nidra to return to sleep, and if vasomotor symptoms are severe. And that's hot flashes, by the way. I don't know if I mentioned that earlier or not. Vasomotor symptoms are gonna be hot flashes, night sweats, flushing talk about treatment with your provider.

Alicia: 24:53

Okay, my libido has changed. What can I do?

Nicole: 24:56

Normalize the change and remove pain first. So local estrogen or DHEA can often be helpful. Pelvic floor physical therapy, this is another really great tool. And then build context for desire. Make sure you're getting good quality sleep. You're focusing on connection, reducing your stress or managing your stress in some way. Sometimes low dose testosterone or testosterone boosting supplements can also be used for this issue too.

Alicia: 25:23

Sex is uncomfortable. Is that just part of aging?

Nicole: 25:27

It's common, but not necessarily mandatory. Not every woman experiences this issue, but local vaginal estrogen or DHEA creams are highly effective and generally safe. Moisturizers and lubricants and pelvic floor therapy are really great tools for this as well.

Alicia: 25:43

Okay, so what about bones? How do I protect them?

Nicole: 25:47

Strength training is huge. Prioritizing protein and vitamin D, getting your vitamin D levels tested, getting sunlight, walking, jump training, and considering HRT if it's appropriate. Bone density scans can help guide decisions in this department as well

Alicia: 26:04

I feel more anxious. Why is that?

Nicole: 26:07

with hormone fluctuations and sleep loss and just general life load in this stage of life, that can happen. Use nervous system tools like breath work, movement, connection, and also consider therapy as well.

Alicia: 26:21

Are hot flashes dangerous?

Nicole: 26:23

They feel dangerous. Yeah, it can feel dangerous.

Alicia: 26:27

Yes.

Nicole: 26:28

They're not dangerous themselves, but they disrupt sleep and quality of life and that can signal broader hormone changes. So treating them can have ripple benefits.

Alicia: 26:37

Where should I start if I'm overwhelmed?

Nicole: 26:40

Pick one of these three. Walking daily for 10 to 20 minutes, especially after meals can be really helpful for blood sugar regulation. Eating 30 grams of protein at breakfast. Or dimming your lights after dinner and putting your phone down one hour before bed. Consistency beats intensity every time. So here's the bottom line, menopause is a universal transition, but not a universal experience. Awareness matters because it prepares us, supports us, and reminds us that we're not alone.

Alicia: 27:12

And while symptoms can be tough, this stage also can be empowering. It's a chance to care for yourself in deeper ways, advocate for your needs, and embrace a new season of strength and wisdom.

Nicole: 27:23

So if you're in perimenopause, menopause, or beyond, know this, what you're experiencing is valid. You're transitioning, and actually you have more tools and support available than ever before.

Alicia: 27:35

Thanks for hanging out with us on Midlife and Glowing.

Nicole: 27:38

If you love this episode, it would mean the world to us. If you'd follow the show, leave us a review or share it with a friend who's glowing through midlife right alongside you.

Alicia: 27:46

Let's make it our best era yet. We'll see you next time.