This feature was written by Studio MSP writers. While some of our advertisers were sourced, no advertiser paid to be included.
On her eponymous podcast, former First Lady Michelle Obama recalls a moment where her husband, former President Barack Obama, observed that the women in his executive cabinet sometimes appeared clammy and uncomfortable during meetings. He didn’t realize that these women, some of his closest confidants in the workplace, were quietly suffering from the compounding effects of dealing with hot flashes in power suits. “He’s like, ‘What’s going on?’ and it’s like, ‘…This is just how we [menopausal women] live,’ you know?” she says. “He didn’t fall apart because he found out there were several women in his staff that were going through menopause. It was sort of like, ‘Oh, well, turn the air conditioner on.’”
The only constants across a woman’s life cycle are hormones in flux, yet stigma and taboos remain pervasive in American culture, forcing women to contend with chaotic internal changes in silence. Equipping women with the tools they need to feel their best in the second half of their lives can help reframe the conversation from endings and diminishments to one of empowerment and a newfound sense of self.
When Estrogen Stops Its Reign
It’s been shown that women in their childbearing years have higher levels of HDL cholesterol (the “good” kind) than men, thanks to the cardioprotective properties in the female sex hormone estrogen. When estrogen drops in menopause, HDL levels fall and give rise to LDL cholesterol, which contributes to fatty buildups in arteries. With recent reports coming out about women with premature menopause having an even higher risk of cardiovascular disease than their regularly timed peers, doctors are trying to determine the best protocols for following these women and improving the outcomes. (Premature menopause happens when onset occurs at age 40 or younger.)
“Recent studies have shown that women who go through premature menopause have a potentially 40 percent higher lifetime risk of developing cardiovascular disease compared to women who go through menopause at an average age,” says Dr. Courtney Jordan Baechler, a preventive cardiologist with Allina Health Minneapolis Heart Institute. She says that while the risk factors are not clear, signs point to the lost benefit of high estrogen levels.
“Unfortunately, when we enter menopause, it’s common to see shifts in our metabolism, sleep, body fat distribution, and subsequent risk factors such as [an increase in] high blood pressure and cholesterol,” she says. “Some of the small studies that have been done show that even when we correct for developing high blood pressure, high cholesterol, and type 2 diabetes, the increased risk of heart disease remains for those who go through premature menopause.”
She further breaks down the physiological process that occurs when estrogen production declines in a woman’s body: “Our blood vessels tend to get more sticky, making it easier for plaque and clots to form,” she says. “Our cholesterol levels tend to increase, as well as our blood pressure levels.… We see a gradual stiffening of our arterial walls.” Then there’s the increase in fibrinogen (a protein that helps with blood clotting), which tends to markedly up the risk for clots and strokes.
“Recent studies have shown that women who go through premature menopause have a potentially 40 percent higher lifetime risk of developing cardiovascular disease compared to women who go through menopause at an average age.”
Courtney Jordan Baechler, MD / Allina Health Minneapolis Heart Institute
While it would seem that intervening with hormone therapies to counteract coronary illness would be a foolproof approach, Jordan Baechler says it’s really not that simple—the risk usually outweighs the rewards.
“While it might seem like the natural answer would be to use estrogen replacement therapy as our estrogen levels decrease, in larger trials that were done looking at hormone replacement therapy in women and cardiovascular disease, we saw increased levels of heart attacks and strokes.”
We’re still learning about how heart disease develops and presents in women after the condition—a leading cause of death for both sexes—was inexplicably tied to men’s health for many years. In fact, Jordan Baechler says more data is coming out about the potential risks that develop during pregnancy. Gestational high blood pressure, gestational diabetes, and preeclampsia can increase the risk of developing heart problems up to fourfold.
“It’s important that at each stage of life, we are reducing our risk as much as possible to ensure we decrease this risk long-term,” she says. That means having optimal cholesterol and blood pressure levels, maintaining a healthy weight, incorporating exercise on a routine basis (the American Heart Association recommends at least 150 minutes of moderate to intense aerobic activity per week), keeping a nutrient-dense diet, avoiding tobacco products, and using alcohol in moderation. It’s important to note, however, that there are women who are a healthy weight, exercise regularly, and still have high blood pressure. That’s why knowing your numbers is key.
“If you have a strong family history of heart disease or premature or early menopause, it is worth talking to your doctor and considering preventive cardiology consultation,” Jordan Baechler says.
Postponing Motherhood on the Rise
Having babies on the (once-coined) “wrong” side of our 30s and 40s used to be the exception; now it’s swiftly becoming the rule. While we can thank technological advancements for this extension, we would be remiss not to acknowledge how women are revolutionizing traditional norms. Delaying motherhood, says Dr. Annalise Almdale of Southdale ObGyn, can help set a woman up for success when the time for family planning arrives.
“We see a lot of patients and partners who are looking to finish their schooling and degrees prior to starting a family, which may lead to improved financial health and subsequent emotional maturity,” Almdale says. Attitudes, both culturally and clinically, are changing around what “older motherhood” means.
“Fifteen years ago, there really wasn’t much we could do for women who electively wanted to delay motherhood, except to have a child now or use donor sperm to create embryos for the future,” says Dr. Tana Kim of Reproductive Medicine and Infertility Associates (RMIA). “With advances in assisted reproductive technology, egg freezing is now an option that women can elect to pursue.… We have more options for women in terms of delaying motherhood, and I think more and more women are becoming aware of this.”
Kim says the concept of age-related fertility decline, along with the potential for medical intervention for infertility, has received a lot of coverage in the media, helping to break societal taboo and stereotypes around in vitro fertilization (IVF). “From a health education standpoint, the average pregnancy rate per month is roughly 15 to 20 percent for a reproductive-aged woman,” she says. “The average pregnancy rate per month for a 40-plus-year-old woman is only 5 percent. Most women are shocked to hear how low natural pregnancy rates are.”
“Most women are shocked to learn how low natural pregnancy rates are [after age 40].”
Tana Kim, MD / Reproductive Medicine & Infertility Associates
Of course, with age, the quality of a woman’s eggs becomes compromised, resulting in a higher risk of chromosomally abnormal embryos or pregnancies. With IVF and other fertility treatments, women now have the option to genetically test their embryos to screen for abnormal chromosomal potential prior to conception.
“Genetic testing on the embryos can not only decrease miscarriage risks; it can also increase the chance for a woman to have a healthy baby, irrespective of her age,” Kim says. “Even for a woman who may be beyond the age of being able to utilize her own eggs for conception, donor eggs are a viable alternative.”
She says that so much emphasis is put on contraception and pregnancy prevention when it comes to family planning, but when it comes to the timing of family building, providers just aren’t really having those conversations. “We still have a ways to go, but I see more women being proactive now and seeking out a consultation, even if it is just to gather more information.”
So, is it safe to say the term geriatric pregnancy is on its way out? “The current medical coding system is ICD-10. (ICD-9 used elderly primigravida.) They use the term advanced maternal age now for women 35 and older,” says Kim.
The Interplay between Adrenal Health and Estrogen
The years between the ages of 40 and 55 just so happen to be when many women’s children transition away from home. And when careers achieve peak responsibility. And when aging parents start to face health challenges. And when planning for retirement kicks into high gear. These life events individually top lists of life’s biggest stressors. So when you stack them all up, one on top of the other, and add a life-changing biological transition to the mix too… Well, it’s no mystery why menopause can be a time when depression strikes, perhaps for the first time in a woman’s life.
Making lifestyle changes in your 30s and 40s can have an ROI on your mind, body, and spirit during one of the most important transitions of your life. Dr. Tolu Oyelowo, professor in the College of Chiropractic at Northwestern Health Sciences University, says that in today’s go-go-go society, between juggling careers and parenting and relationships, a woman’s adrenal glands are zapped well before entering perimenopause.
“And that’s a problem, because you need adrenal glands to make it smoothly through menopause.” Adrenal glands, endocrine glands located on top of both kidneys, are responsible for producing hormones that regulate metabolism, immunity, blood pressure, response to stress, and other essential functions, according to Johns Hopkins Medicine.
Our bodies are designed to handle the occasional bout of stress well, but when that stress turns chronic, it requires our adrenal glands to produce large amounts of cortisol, impeding the production of estrogen precursors. This results in estrogen levels that dip uncomfortably low. “Estrogen influences many functions in the body, including the neurotransmitter balance required for good mental health,” says Oyelowo. “If estrogen levels are too low as a woman enters and goes through menopause, addressing adrenal health becomes vital for bringing hormones back into balance.” Protecting adrenal health looks like building a foundation of good health habits like being active, getting adequate rest, having a social network (but not overscheduling yourself!), and eating nutritious foods.
For women in peri- or postmenopause, it’s important to pay close attention to stressors that can be controlled—even the good kinds of stressors, like exercise. Dr. Oyelowo cautions, “This is not the time to go bonkers on high-intensity exercise, especially if your schedule can’t allow adequate time for rest and recovery. You don’t want your body in a permanently stressed state, which impairs estrogen levels. Instead, focus on daily moderate exercise, stretching, and really good nutrition. This is a great time to take an inventory of all the stressors in your life and dial back where you can.”
“If estrogen levels are too low as a woman enters and goes through menopause, addressing adrenal health becomes vital for bringing hormones back into balance.”
Tolu Oyelowo, DC, PHD, Professor / College of Chiropractic, Northwestern Health Sciences University
Does IVF Trigger Menopause?
Kourtney Kardashian made headlines this year when she said that IVF trials sent her into early menopause. Did this really happen, or did she conflate IVF side effects with symptoms of menopause? Dr. Tana Kim sets the record straight.
IVF cannot put a women into early menopause. This is how I explain the IVF process to my patients: A woman is born with all of her eggs inside her ovaries. Now those eggs are in “hibernation” mode. Every month, her body will decide how many eggs it will wake up out of “hibernation” that month to start the growth process.
As an example, let’s say 15 eggs were recruited to wake up out of “hibernation” that month and start the growth process—those eggs grow unevenly so that at the end, only one egg typically reaches the finish line; that’s the egg that will ovulate that month. The remaining 14 eggs that never made it to the finish line regress and get lost. IVF is taking advantage of all the eggs that got recruited to grow that month, and it attempts to get as many of the 15 eggs to the finish line as possible. In other words, IVF takes advantage of the eggs a woman would have lost that cycle anyways. It does not waste or use up eggs to drive her into menopause.
Now, it is possible that some of the side effects of the medications could have caused menopausal-like symptoms. There are some that can induce a temporary menopausal-like state by reducing the amount of hormones the ovary makes. Although biologically this is not the same as menopause, the symptoms may feel similar.
This article originally appeared in the October 2022 issue of Mpls.St.Paul Magazine.
Sources and Resources
Hughes Dental 18305 Minnetonka Blvd., Deephaven, 952-936-2206, hughes-dental.com
Nash Frame Design multiple metro locations, nashframe.com
Northwestern Health Sciences University 2501 W. 84th St., Bloomington, 952-888-5444, nwhealth.edu
Smiles at France 4999 France Ave. S. #230, Mpls., 612-824-7033, smilesatfrance.com
Twin Cities Orthopedics 4010 W. 65th St., Edina, 952-456-7000, tcomn.com