An excerpt from The Menopause Menu.

Whether it’s heart disease or cognitive decline, arthritis or diabetes, getting older is linked to an increased incidence of many different chronic diseases. The menopausal journey adds an extra layer of health risks to some of them but is also an opportunity to fine-tune healthy living goals in a way that helps ward off disease. Knowledge is power!

Chronic Disease Considerations // AMUSE-BOUCHE 

“Menopause can be the portal to accelerated cardiovascular risk: LDL cholesterol rises by 30 mg/dL, weight can rise 10 to 20 pounds, and a woman’s risk starts to equal that of the male counterpart by ten years after menopause. This should motivate our better choices and lifestyle habits with even more vigor as we approach menopause.”
– Humera Ali, MD, cardiologist, Renton, Washington

“I’m not sure how much family history plays a part, but being adopted has me wonder about that.”
– Jen, 48

“I would like to learn more about postmenopausal women and heart disease.”
– Diane, 54

“My existing hormonal autoimmune disorders exacerbate my menopausal health.”
– Beth, 61

“How does the womanly body work after menopause, what changes happen now?”
– Lorraine, 64

“What can I do to stay healthy longer?”
– Roxy, 51

Chronic Disease Considerations // APPETIZER

Menobits

• Genetics, aging, and the menopausal journey can have significant impacts on various aspects of chronic disease.
• Although most “heart palpitations” are innocent, cardiovascular disease evaluation is important.
• Blood pressure, cardiovascular exercise, weight, and cholesterol are all important to manage for reduction of heart attacks and strokes. And stop smoking.
• A number of factors improve menopausal neurologic and memory issues which, in turn, influence cognitive decline.
• Healthy lifestyle goals are a must!
• Kidney dysfunction is often associated with aging; hydration is key, as is careful use of medications and supplements.
• Cater to your liver and pancreas in perimenopause to moderate the potential of prediabetes and diabetes.
• A Mediterranean and anti-inflammatory nutrition approach can help promote healthy metabolism.
• The link between hormone therapy and heart disease is somewhat controversial, and more research is being done.

Chronic Disease Considerations // DESSERT

A personal story

I was diagnosed with pregnancy-induced factor-negative rheumatoid arthritis (RA) in the summer of 2000, just three months after giving birth to my daughter. Well, that is when my near-crippling symptoms suddenly started, literally overnight. My actual diagnosis came 18 months and four rheumatologists later, when I finally acquiesced to my new reality.

Being a physician and being diagnosed with a chronic disease can be challenging, to say the least. When to put on my white coat and when to take it off? What would I do if I were my own patient? Is this really the correct diagnosis? Are these medications really necessary? I explored the full spectrum of treatment options over the first few years, foraying into both right- and left-brain territory. I’ve paired countless $5,000 per month biologic medications with holistic therapies in the way a sommelier pairs a fine wine with a great meal.

I can think of so many aspects of perimenopause that felt worse because of my RA. I also know that my RA was worse at times because of my menopausal journey. Hot flashes and night sweats were akin to my usual low-grade fevers that heralded my RA diagnosis, along with crippling joint pain and stiffness that clearly worsened with sleep disruption. Weight gain, fatigue, skin and hair changes— all of these blurred with my RA-related symptoms.

And don’t even get me started on stress and life changes after that. I was working 15-hour days and had a retired spouse and a daughter in college. My beloved five-year-old cat Buttercup died suddenly. I cared for patients with COVID-19, and lost some of them to the disease. Multiple close relatives died. Newly postmenopausal, I started my free MenopauseMenu informational website, quit my full-time career of 25 years, and opened a virtual medical consultation business, myMDadvocate. And I wrote this book!

Somewhere in the midst of that jumbled time, I found strength, courage, peace … and perspective. I made it through menopause and have been comfortably (maybe!) in post- menopause for a number of years now.

It was not easy. Many times it felt unfair— unfair that my joints were worse at times, my pain and stiffness unpredictable, fatigue impossible to evenly regulate. However, my newfound midlife wisdom triumphed, and, added to my long-standing medical knowledge, made the menopausal journey somewhat easier to navigate.

Telling this personal story leaves me feeling a little vulnerable. By doing so, however, I hope to connect with other women who might benefit. We need to do this for each other more often, as shared experiences can be so valuable.

I have shared some of my midlife wisdom in other parts of this book, but it really does come down to accepting change. And that is something that those of us who deal with a chronic disease are certainly used to doing, whether they want to or not. So, change your mental perspective, adjust your personal focus, learn to look within, and you will get through this phase.

Susan J. Baumgaertel is an internal medicine physician and author of The Menopause Menu.