The new weight-loss drugs and cancer

Breast Cancer At 41 Led Me To Medically-induced Menopause: What You Need To Know About Saggy Skin, Painful Sex

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Contact a qualified medical professional before engaging in any physical activity, or making any changes to your diet, medication or lifestyle.

Like Olivia Munn, writer Sarah DiMuro was put into medically-induced menopause after having a double mastectomy due to breast cancer. (Image via Instagram/@oliviamunn and Sarah DiMuro)

When Olivia Munn revealed last month that she's in medically-induced menopause after being diagnosed with breast cancer in April 2023, I immediately felt a knot in my stomach. April is always a bittersweet month for me; it's when my first child was born but also, it marks six years since I had my double mastectomy.

I can remember the morning of my surgery, standing bare-chested as my surgeon marked with a Sharpie all the areas he would be removing. I looked like one of my kid's drawings, purple marker everywhere. Looking down at my miniature mounds, droopy from nine months of breastfeeding, I gave them a quick goodbye, eager to get the cancer out of my body. Sure, I was nervous, especially when they wheeled me under the harsh lights of the operating room, but I was ready.

Sarah DiMuro before her double mastectomy. (Image provided by Sarah DiMuro)

A little over four hours later I woke up feeling sore but relieved that whatever was trying to kill me had hopefully exited my body. It was two long weeks of waiting for the final pathology results, celebrating my son's first birthday and trying my best not to Google "What happens if breast cancer spreads?"

I took my sister with me to the follow-up appointment where we both let out an audible sigh of relief when my doctor reported that the cancer had been contained to the breast. I learned that I might not even need chemo, but would know more after I met with my oncologist.

We left the office ready to celebrate the good news. The oncology appointment wouldn't be for another week but no matter what, I was prepared to do whatever it took to make sure I would be there for as many of my son's birthdays as possible.

In honor of Women's Health Week, it's important to openly share how difficult diagnoses impact women's lives — and how little we talk about them. Here's what you need to know about my experience.

What is medically-induced menopause?

My oncologist immediately put me at ease with her warm smile and calm demeanour. Years ago, everyone with breast cancer would automatically undergo chemotherapy, but today she explained that treatments are tailored based on tumour genetics and make-up.

Breast cancer is sneaky, and even after a double mastectomy, it can come back to areas of the body such as the bones, liver, brain and lungs — and this can happen many years later. In my case, estrogen and progesterone fed the tumour and my doctor wanted to be as aggressive as possible to cut off its hormone supply by putting me into medically-induced menopause, also known as chemical menopause.

Menopause it is, I thought to myself. How bad could it be? A few hot flashes?Sarah DiMuro

Menopause? I was shocked. It seemed so extreme. I was 41. My mom didn't go into menopause until her mid-50s. Was this really necessary? If I agreed, the plan was for me to receive the first of what would be monthly shots, to shut down my ovaries and put me into menopause.

While my doctor left to give me a few moments to think it over, I answered a call from my mother-in-law, who was watching my newly minted one year old. My son had just tried avocado and loved it. He had a lifetime of new things to explore and I wanted to be there for as many of them as I could. Menopause it is, I thought to myself. How bad could it be? A few hot flashes?

I soon discovered that menopause is so much more than hot flashes and changes you in ways I could have never imagined.

What happens to the body during medically-induced menopause?

How does menopause affect your bones? (Image via Getty Images)

For people who are not breast cancer patients, the process of menopause tends to happen in stages, with perimenopause to give the body time to adjust to the reduction of estrogen. But what happens when you immediately shut down or remove the ovaries?

"The side effects of induced menopause can be more abrupt than the symptoms experienced during a more gradual 'natural' menopause," Dr. Robin Noble, the Chief Medical Officer of Let's Talk Menopause, tells Yahoo Canada.

Of course everyone is different, Noble says. While some people experience very few symptoms, others can experience a host of symptoms such as hot flashes, skin changes, mood swings, painful sex, joint pain and heart palpitations. Skin changes are also significant when you deplete your body quickly of estrogen. "Estrogen impacts collagen and elastin as well as our immune system and vascular system–thus there are many impacts on the skin, skin thickness, blood flow and the appearance," she explains.

Estrogen is also critical for bone health. Being put into menopause early caused my bones to weaken significantly. In order to combat this I consume 2,000 units of vitamin D everyday, incorporate strength training into my workouts and get an injection of a bone strengthening agent every six months. Each year I receive a bone density scan and a fracture risk assessment to monitor any changes. The best I can hope for is that I don't lose too much more bone density but the chances of the damage being completely reversed is highly unlikely.

Brain fog during menopause

Making changes to your diet and and exercising can help alleviate brain fog. (Image via Getty Images)

Brain fog can be one of the most frustrating parts of menopause. According to Dr. Eleonora Teplinsky, Head of Breast and Gynecologic Medical Oncology at Valley Health System, "brain fog or cognitive impairment can occur with menopause and/or endocrine therapy and can manifest in many ways such as forgetfulness, problems with concentration and focus." The reason for this she says is "in part due to the decline in estrogen and can also be made worse by other side effects that can occur such as insomnia and hot flashes."

Chemotherapy treatment can also make these side effects worse with some people referring to the condition as "chemo brain." There's something unsettling knowing that your mind is changing and the medicine helping to keep you alive is contributing to that change. Breast cancer takes so much from you that way.

Dr. Nilda Abellera, Chief Medical Officer of the integrated cancer center Infuze MD in Northern California, recommends upping your antioxidants from fruits and vegetables to help reduce hot flashes and adding flax seeds to your diet to help alleviate night sweats. Abellera tells Yahoo Canada that exercise and meditation are key for brain health as they "allow more oxygenation to the brain."

Working out daily has been significant for me in mitigating any mental side effects. Following a mostly plant-based diet and adding in some fatty fish weekly has also helped my brain stay on point, well, mostly.

How does menopause impact sex?

Has menopause put a damper on your sex life? You're not alone. (Image via Getty Images)

Yes, the thinning hair sucks, and saggy skin is no picnic either, but one of the biggest challenges of being put into menopause is how it impacts your sex life. I love my husband so much and being intimate with him is amazing, but it's been more challenging since having breast cancer. Many other survivors I know have voiced similar concerns and it can be a real struggle for their mental health.

About 80 per cent of breast cancer survivors will report sexual concernsDr. Lauren Walker

Dr. Lauren Walker, Adjunct Associate Professor of the Department of Oncology, Division of Psychosocial Oncology at the Cumming School of Medicine, University of Calgary, says that because many breast cancer patients are "catapulted into estrogen deprivation or menopause virtually overnight," sexual satisfaction is a prominent issue.

"About 80 per cent of breast cancer survivors will report sexual concerns, ranging from loss of sexual desire to sexual discomfort and pain with sexual activity as well as vulvovaginal health concerns like dryness," Walker says.

"Women may also experience problems such as low libido (sex drive), pain, trouble reaching orgasm…," Teplinsky says, adding that "psychological factors" can also have a huge impact after a breast cancer diagnosis. "Anxiety, depression, lack of intimacy with oneself or partner, body image concerns and loss of femininity can significantly impact sexual health."

But all is not lost. There many things you can do to help overcome these issues. For vaginal dryness, Teplinsky suggests non-hormonal vaginal moisturizers and vaginal estrogen–which has been found to be safe for breast cancer patients. She also recommends pelvic floor physical therapy, vaginal dilators and psychosocial and psychosexual counselling.

Most importantly, I also remind you to be open with your partner. In the beginning, my husband thought I was rejecting him when in fact I was just trying to process what was happening. It was such a relief to be honest with him and things have been much smoother ever since.

Whatever it takes

DiMuro's son was just an infant when she was diagnosed with breast cancer. (Image courtesy of Sarah DiMuro)

Munn told People magazine, "Cancer doesn't care who you are; it doesn't care if you have a baby or if you don't have time. It comes at you, and you have no choice but to face it head-on." I've been in medical menopause almost six years and even with all the side effects and struggles, they have been some of the best years of my life. We welcomed our second baby via gestational surrogate and my sister and I surprised my parents with a trip to Italy for their 50th wedding anniversary.

Not every moment has been perfect and there have certainly been challenges along the way, but I got to live to do and see it all. So, I get my monthly shot and take my daily vitamins and pills and as long as it buys me more time with my family, more time to do all the things I love, it's totally worth it.

Let us know what you think by commenting below and tweeting @YahooStyleCA! Follow us on Twitter and Instagram.

View comments

My Daughter Has Been Suffering From Perimenopause, Help! Dr Zoe Williams Answers Your Health Questions

DO you care enough for your digestive health? Particularly if you are among the one in three who suffers symptoms such as constipation, bloating or wind.

Tomorrow is World Digestive Health Day and we could use a reminder that the digestive system – which includes the giant tube that runs from the mouth to the anus, the liver, gallbladder and pancreas – needs looking after.

3

Dr Zoe Williams shares her top tips for anyone struggling to get a GP appointmentCredit: Olivia West

For a more comfortable tummy, don't rush food, skip meals or have large meals before bed.

Excess weight, smoking and binge drinking can all increase the chances of acid reflux and heartburn.

And de-stress! Stress can either slow down or speed up digestion, and lead to unwanted symptoms.

If you feel overwhelmed, breathe in for a four-count, then slowly breathe out until you have no breath left.

Most of us do not eat enough fibre.

Easy ways to add it include having a large helping of fruit or veg with every meal, adding a can of beans or lentils to dinner, and choosing the brown versions of starchy foods, such as pasta or bread.

Here is a selection of what readers have asked this week.

BRUTAL FLARE-UPS

Q: I HAVE been suffering from diverticulitis for ten years. I've had two serious bouts that left me in hospital.

Most read in Health

NIP & TUCK-OFF

Barmy 'Turkey-teeth' surgeons ridiculed for 'impossible' transformations

CHEAT IT

Popular diet 'slashes your risk of dying young by 23%' & wine is still on the menu

LIFELINE FOR BRITS

'Best' lung cancer drug halts tumours - giving YEARS to dying patients

MEDICAL MARVEL

My earliest memory is from the womb and I remember 95% of my life

Is there anything I can do to help myself when I feel this ­coming on? It normally lasts for up to two weeks at a time, but it can be brutal.

A: Diverticulosis is a condition that affects the large intestine, known as the bowel.

Davina McCall on what you should know about menopause

It is when people have little pouches in the wall of the intestine, called diverticulas, and if they become inflamed or infected it causes diverticulosis.

Symptoms can include diarrhoea, bloating, constipation and tummy pain that gets worse after you eat but improves after you pass wind or have a bowel movement.

The pain tends to be at the left lower area of the abdomen and sometimes people have blood in their stools.

Treatment includes painkillers, ­laxatives, medicines for stomach cramps, and antibiotics if there is an infection.

You don't mention your weight or whether you smoke but the condition can be made worse with excess body weight or smoking.

So what can you do? We know that consuming a diet high in ultra-processed items – think packaged foods or anything that is not in its raw, original state – can exacerbate the symptoms.

In fact, some studies suggest it's a condition caused by Western diets. So try to avoid too much heavily processed food and eat plenty of fruit, vegetables and whole foods.

A high-fibre diet has been shown to reduce episodes of diverticulitis too, so foods such as avocados, broccoli, almonds and lentils can help.

A word of warning, though. While raising our fibre intake is something that most of us will benefit from in the long run, it's important to increase it slowly and gradually, or else it can cause tummy discomfort, bloating and other unpleasant­ ­symptoms.

What is the menopause and how does it affect women?

The menopause is a transitional period all women go through in mid-life.

Hormones related to the reproductive system deplete namely oestrogen, over a period of time. 

This doesn't just cause periods to stop. Sex hormones act all over the body, from the brain, skin, vagina and more.

Therefore, dozens of symptoms affect all areas of the body, to varying degrees.

Women's experiences of menopause vary greatly. While some breeze through it, others' lives are significantly impacted. It can feel as though it lasts a couple of years, or for decades.

It cannot be predicted how each woman will fare. 

When is menopause?

Perimenopause is when symptoms start but periods have not yet stopped, although they will be irregular. This can start in the early 40s.

Menopause is when periods have completely stopped for a year. The average age this happens is 51, but it can be any time from 45 to 55, according to the NHS. 

The term 'menopause' is used to describe the experience overall.

Menopause before the age of 45 is called early menopause, affecting five per cent of women. Menopause before the age of 40 is called premature menopause, affecting one per cent of women before 40 and 0.1 per cent of women under 30.

This may happen for no clear reason, but also as a result of surgery, genetics or medications. 

A year after that the final period, a woman is considered to be entering the post-menopausal stage. 

How does it impact a woman's life?

The menopause can be an extremely testing time in a woman's life and for those around her.

The body is going through a significant change, and the symptoms that come with it can feel alien, with women sometimes describing a loss of sense of self.

Physical symptoms include hot flushes (a sudden feeling of heat in the face, neck and chest), difficulty sleeping, night sweats, heart palpitations, headaches, muscle and joint aches, weight skin, skin changes, reduced libido, vaginal dryness and more.

Symptoms affecting mental health or cognition include brain fog, memory loss, low mood, anxiety, low self-esteem and irritation.

There are ways to manage symptoms and cope with menopause - and women need to know that they are not alone in facing it.

Medication, such as HRT or oestrogen gel, can help attack the symptoms.

However, experts often say it needs a rounded approach incorporating good lifestyle habits, such as a balanced diet and less alcohol. 

Many women report that their life began after menopause after it drew them to a healthier way of living.

However, the huge burden it can have - on work, family life and more - is important for society to recognise, as adapting policies at work, for example, can make it easier for women to stick with their job.

Read more about menopause on The Sun's Fabulous Menopause Matters campaign.

Q: MY daughter is 39 and has been suffering from perimenopausal symptoms for the past year.

As well as night and daytime sweats, she has forgetfulness, mood swings, painful periods, poor sleep and has lost interest in sex.

3

Dr Zoe helps a reader suffering with night and daytime sweatsCredit: Getty

She has seen several doctors and they basically say, "It's one of those things" or, "She's too young to be going through these things".

I'm sure my daughter is not the only one suffering like this. She has tried herbal remedies to no avail.

She's a busy working mum and generally healthy, but I can see the change in her over the last year.

Do you have any advice?

A: It's not uncommon for women in their late 30s and early 40s to begin experiencing symptoms of perimenopause, which for many, can last four to eight years.

The average age of menopause (one year after your last period) is 51, but around five per cent of women, experience it by the age of 45.

What age did you reach menopause? Numerous studies show genetics play a strong role in determining the age of menopause.

Women who are black or Asian reach menopause earlier, on average, than white women, according to a huge US study.

Given the severity of her symptoms and the impact on her quality of life, your daughter needs to find a doctor or nurse who takes her concerns seriously and offers appropriate support and treatment options.

It's also important to rule out other conditions such as abnormal thyroid function, anaemia, B12 deficiency and hypertension, if this hasn't been done already.

Get her to ask if the practice has a doctor or nurse who has a special interest in women's health.

She can submit an e-consult online if she's reluctant to return.

Of course, she could see a private menopause specialist if financially possible.

If HRT or other medication is commenced, she could ask her NHS GP to take over the prescribing.

It's important we all advocate for ourselves during medical appointments and it's easier to do this if we have done some prior research.

Good resources include nhs.Uk, patient.Info and for menopause- related issues, thebms.Org.Uk.

Take a written list of symptoms and be prepared to give a timeline of how and when they started, and how they affect everyday life.

High BMI is thwarting son's hip op

Q: FOUR years ago my son had an accident at work and broke his hip. He is 42.

After a scan, the surgeon said his BMI of 35 was too high for a hip replacement. He stated it needs to be 30.

3

And Dr Zoe also helps another reader who broke his hipCredit: Getty

My son is struggling to lose weight as he cannot exercise or move around very easily. He went back to his GP who further advised him to "starve". What would your advice be?

A: This is a really difficult position for your son to be in. NICE guidance on arthritis states that BMI should not be used to exclude people from referral to surgery – but restrictive policies are still in use in some regions.

In your son's case, it sounds as though the problem is due to a hip fracture, rather than arthritis per se.

While we know hip replacements work well when they have less weight to bear, it does seem unfair to me that a person would be excluded without being offered professional support to lose weight.

In some areas, surgical teams delay ­surgery but provide a weight-loss-support programme.

My advice is to return to the GP and see what support is available for your son.

If he tries this and still has a BMI of 35 then I think you are well within your rights to seek a second opinion with another surgeon, possibly at a different hospital.

You can check the average wait time to be seen at different hospitals at myplannedcare.Nhs.Uk.

In the meantime, a few dietary tips for him: He needs fibre, fluid and whole foods and to avoid white processed carbohydrates as much as possible.

Oatmeal, peanut butter on wholemeal toast or eggs are great breakfast ideas, and roasted vegetable salad or soup (with protein) are good for lunch.

Dinner should be lean proteins Such as chicken breast with lots of salad or veg.

Drink water rather than fizzy drinks and, over time, ditch sugar in tea and coffee.

Some evidence suggests eating all meals in an eight-hour window can support weight loss, too.

Tip of the week

PRESCRIPTION costs rose again recently, to £9.90 an item. But many people can get theirs for free, including those over 59 or some people who have, or live with someone, on benefit support.

Find out if you are eligible at this website: check-for-help-paying-nhs-costs.Nhsbsa.Nhs.Uk.

Menopause Impacts 33% Of A Woman's Life. It's Time To Stop The Stigma.

Older women, living their best life, driving a car.

getty

Amy Pearlman was 45 years old when she noticed weight gain, frequent periods and brain fog. She suspected the symptoms were related to motherhood. "I thought I was just dealing with my body after having a child," she recalls. When symptoms persisted she raised concerns to her primary care doctor, who never mentioned menopause as a possible cause. Her gynecologist reinforced, "It isn't menopause because you are still having periods." In neither appointment were her symptoms attributed to hormonal changes.

Pearlman's experience mirrors data around clinician and patient comfort with menopause. Only 31% of ob/gyn residency programs include menopause in their curriculum. Another study found 80% of women under age 40 had inadequate knowledge of menopause. "People don't talk about menopause in my generation," she says.

In a study of perimenopausal and postmenopausal women, 40% reported shame and 83% reported stigma surrounding their symptoms. The two-way avoidance of discussion—between patients and clinicians—has led generations of women to feeling isolated while having unmanaged or mismanaged symptoms.

A Cultural Shift

Tennille Murphy (IG: @thetennillife) showing beauty, confidence, and aging can coexist

getty

Social media has recently provided a source of unity, empowerment and education to this overlooked community. Influencers demonstrate aging positivity via posts on gray hair, nutritious eating, exercise, meditation, sex and fashion after menopause. They are building a culture where aging women can enjoy serenity over shame and stigma.

"Menopause is having a moment because women with a platform and authority do not want to ignore symptoms when treatments are available," says Dr. Karen Tang, board certified gynecologist, author of It's Not Hysteria and founder of Thrive Gynecology.

Women are realizing that the way menopause has been handled in the past is adequate. Tang says progress starts by debunking myths and embracing positive direction in education, research and advocacy within the medical community. She acknowledges that the symptoms of menopause are real and disruptive. And yet, she wants aging women to, "live their best life. Embrace being at the peak of your professional life, having less responsibility with raising young children and never worrying about periods."

To sustain the ongoing cultural shift, we need to adjust how women's health is described and researched. Though not all women experience motherhood, women's health is often centered on prenatal and postnatal care. There is a need to recognize that women's health still exists outside of pregnancy, labor and delivery.

Widening the perspective on women's health needs to be reflected in academic research. "There are 1.1 million academic medical articles related to women's health. Only 97,000 are related to menopause and 6,500 for perimenopause" says Dr. Mary Claire Haver, board-certified ob/gyn, author of The New Menopause and founder of Mary Claire Wellness.

"Physicians get little to no training on a process that affects 50% of the population for one third of their life," she adds. Haver wants the field of medicine to understand that menopause treatment is multidisciplinary and involves education and care delivery from all specialties. Some menopausal symptoms are cardiac, such as palpitations, that might need evaluation by a cardiologist. Other symptoms are related to mental health and may need the support of a psychiatrist or therapist. Haver says women tell her they have lost their resilience and ability to cope, and their anxiety is interrupting productivity.

Education, for patients and clinicians, starts with the basics: understanding the difference between premenopause, perimenopause, menopause and postmenopause. Dr. Sharon Malone, board-certified ob/gyn, author of Grown Woman Talk and chief medical advisor to Alloy Health, shares that premenopause starts at puberty and represents peak fertility years. Perimenopause starts about five to 10 years before menopause. This transition is when symptoms may develop (e.G. Hot flashes, weight gain, insomnia, mood changes, joint aches, night sweats, brain fog and dozens of others). Menopause is defined as the moment you had your last period. Technically, one must have no additional period for 12 months to confirm that was in fact one's last period. Malone is less enthusiastic about the term postmenopause, as "it implies you are at some finite point over menopause. All of these symptoms that one has experienced before and during menopause can continue for years."

There is an association between being unfamiliar with menopause and not prescribing hormone-replacement therapy to treat symptoms. In a study of multiple specialities, only 6.8% of physicians felt comfortable managing symptoms of menopause.

Women's Health Initiative And Hormone Replacement Therapy

The use of HRT started in the 1960s and became popularized in the 1990s. "We were frequently prescribing hormones for menopause. HRT was the most effective treatment for the symptoms of menopause." Malone shares.

There was also observational data that women who take HRT have a 50% decrease in risk of cardiovascular disease. Inspired by the observational trends, the women's health initiative (WHI) hormone trials enrolled over 160,000 women ages 50 to 79 years old to study effects of HRT in postmenopausal women. It is one of the largest projects examining women's health in the United States and is commonly credited for being largely responsible for the current under-prescribing of HRT.

Malone states that the trial was flawed from the beginning, as it selected patients who were older than the typical patient who would get HRT. "We prescribed them when symptomatic, usually around 50. The average age in the study was 63, and many were more than 10 years from their last period," she explains.

The investigators of the trial stopped parts of the study when initial results fell flat: they didn't find a decrease in cardiovascular disease. Worse, they reported a 26% increased risk in breast cancer.

After the WHI, patients returned to offices wanting to be taken off hormones. "That was the beginning of the end," Malone says. "It cemented that the hormones cause cancer. And now new doctors in training now think hormones are harmful."

Luckily, with the benefit of hindsight and reevaluation of the WHI data, research shows that the increase in breast cancer for that population was "not statistically significant"—a term used to clarify that the increased risk could be just by chance. Meaning, the initial report of WHI should not define the gold standard in directing care of menopause with HRT.

Instead patients should walk into their doctors offices and decide, based on their age, symptom burden and medical history, which, if any, hormone could alleviate symptoms. "This discussion is needed because we have magnified the cancer risk and forgotten about quality of life, the value of sleep and the challenges of hot flashes," she adds.

Woman physician and patient having a collaborative discussion about menopause solutions

getty

Dr. Ashley Winter, a urologist and clinical educator for Midi health, has helped develop protocols for hormone therapy in menopausal women. "We have excellent data on low-dose vaginal hormones that begin in mid-life to control genitourinary symptoms of menopause." she adds.

Infections, overactive bladder, incontinence, bladder pain syndrome and urethral burning are menopausal symptoms and can benefit from vaginal estrogen. When it comes to menopause, Winter adds, we "describe hot flashes and night sweats, but we don't consider the bladder, which weakens with menopause." Instead of only putting people on vaginal moisturizers, antibiotics or overactive bladder medications, she recommends dialing back those treatments and addressing the root cause from hormonal changes.

Self-Advocacy For Hormones

To give women hope, the field of medicine must provide women with evidenced-based solutions that are easily accessible. Hormone replacement therapy has been credited by expert gynecologists as life-changing during this phase of life. Individuals should speak with a doctor, ideally familiar with the latest menopause research, about their age, type of hormones available, duration of use and their personal or family history of cancer. Draft a list of questions, or an agenda, for an appointment. Read books on menopause, subscribe to podcasts on menopause and discuss the topic with friends and family.

Agency to gather information and adequate treatment is important for all, especially women of color. Studies show that Black women have symptoms earlier than white women and that their symptoms are more intense. Black women are less likely to get prescribed HRT, a trend cited decades ago that is still present in recent research.

"We have underserved an entire generation of Black women who have been symptomatic and have suffered," Malone states. "For Black women in particular, we have gotten to the point where the expectation of aging is suffering and misery."

Older woman, hopeful for a better future for herself and her daughters

getty Additional Solutions For Menopause

Another strategy to help with menopausal symptoms is one's diet. Casey Farlow, M.P.H., R.D.N., registered dietician and founder of The Perimenopause Nutritionist, focuses on food and menopause.

"The fluctuations of hormones makes menopausal women insulin resistant," Farlow explains. Insulin is a hormone that helps regulate glucose levels in blood. Without insulin functioning normally, glucose is preferentially stored in fat cells. Additionally with age, basal metabolic rate decreases, which means you burn less calories, making it easier to gain weight, especially in the abdomen.

"Women are eating the exact same thing now as when they were younger, but now the abdominal fat won't go away," Farlow says. She teaches the benefit of a diet that understands how their body is less sensitive to insulin with menopause. For instance, she encourages eating PFF foods: proteins every meal, health fats and diverse fibers. PFF foods helps to balance blood glucose and decrease inflammation, which can also lead to insulin resistance.

Resources such as a menopause doula can help women learn new content and become self-advocates. Grace Veras Sealy is a menopause doula at Elektra Health who works directly with patients during their menopause journey. She has one-on-one calls and assesses members' needs upfront.

"As a doula, I'm there to provide information and support in a way that is clinically aware. Telling someone the acne, vaginal bleeding, palpitations, brain fog is from menopause can be a source of relief and could avoid money, time, stress," Veras Sealy says.

Pearlman felt the hardest part of her menopause journey was that she recognized women's health in this country is centered around maternal health. While a mother herself, a much larger part of her lifespan has been centered on perimenopause and menopause, which she feels has been looked over for far too long.

---