Welcome back to the Menopause 200 (MP200). In September, ultrarunning champions Meghan Canfield and Pam Smith shared their menopause and perimenopause experiences. This month, I want to move from heart—the internal passion and supportive family and friends who fuel your running—to heat. Heat is the work you do to keep your body fit and functioning. It includes runs, strength training, plyometrics and mobility. It also includes (gulp) regular appointments with your primary care provider.
Like my running, those appointments have changed. Before menopause, my appointments were quick and easy. I was healthy and strong and convinced I’d be that way forever. Now, I’m supposed to talk about changing menstrual cycles, hot flashes, sleep disruption, brain fog and vaginal dryness. Sharing these details is uncomfortable. I don’t want to admit I am aging, moving from a reproductive adult into some new health space.
Given the choice, I’d skip the appointment for a double speed workout.
I suspect I’m not alone in this, so I challenged myself to reframe the conversation. Early in childhood, I was conditioned to see doctors as authoritarian figures with all the answers. Years later, I can still fall into that behavior. But what if I chose my provider like I choose a running partner? I choose running partners who encourage me, support me, and help me run faster and lift more. We hold each other responsible and show up on time, ready to work out. We also share intimate conversations, protected by the assurance that “what’s said on the trail stays on the trail.”
running partner Health Care Provider
I started with a simple question: what did I want from this relationship? Did I want to continue the one-sided denial of “I’m fine, everything’s fine,” or was I ready to discuss intimate details of my changing body?
Health and fitness are core values for me. I wanted to stay as healthy as possible through the menopause transition. That meant finding a provider with whom I could have open, supported conversations, and who would see me as a unique individual and work with me, adjusting recommendations and treatments to align with my health priorities, fitness focus and lifestyle. I also wanted a provider who was educated about the menopause transition and stayed current on best practices.
Here, I’ll admit that I’m lucky. I live in a large city with many healthcare options. I’ve had the same provider for 10 years. She already met my criteria and I just needed to be honest with myself—and her—about my symptoms. That may not be the case where you live. Consider reaching out to other ultrarunners in your area for recommendations. The North American Menopause Society is another great resource. Their website (https://www.menopause.org/) resources include: The Menopause Guidebook, a directory of NAMS certified menopause practitioners, searchable database with FAQs and their 2022 hormone therapy position statement.1
Warm-up Communicate with Your Health Care Provider
My running partner and I text workouts to each other in advance, so neither of us is surprised at the track. I do the same with my provider, using her office’s secure email.
Prior to an appointment, I send a list of symptoms and questions. My list has included sleep disruptions, brain fog, prolonged recovery after runs and loss of motivation. I include any questions I anticipate asking and my goal or goals for the appointment.
Workout The Appointment
Where you are in the menopause transition will influence what is covered, but changes in your menstrual cycle, vasomotor symptoms (hot flashes), vaginal and bladder symptoms, sleep quality and mood should be discussed at every appointment. The examination should also include an assessment of your heart and bone health.
Menstrual Cycle. Irregular menstrual cycles are typical during the menopause transition and may include heavier periods, longer periods, irregular cycles and bleeding in between cycles.2,3 Bleeding after the final menstrual period is abnormal and should always be discussed with your provider.
Vasomotor Symptoms. This common symptom affects between 75-80% of women in North America, and may continue for 10 years or more.2 As much as I wanted to believe waking up drenched in sweat was just another type of heat training, I had to admit the hot flashes left me tired, anxious and fuzzy-headed. I track frequency, triggers and interventions in my training log, and provide that data to my provider in advance of the appointment.
Genitourinary Syndrome of Menopause (GUSM). Once termed “vaginal atrophy,” GUSM refers to vaginal and vulvar changes of menopause. Estrogen is responsible for maintaining vaginal moisture and lubrication. As the estrogen produced by your ovaries declines, tissues become thinner and drier. Vaginal irritation, pain with sex and decreased libido are common symptoms.
Sleep Disruptions, Depression, Anxiety and Brain Fog. Estrogen made in the ovaries has broad effects on the brain, and changing hormone levels may be associated with mood changes and sleep disruptions. This is another line item in my training log, and we review the data during the appointment.
Cardiovascular Disease. As ovarian estrogen levels decline, our risk of heart attack and stroke equals or exceeds that of men. Beginning at age 40, ensure your provider evaluates your blood pressure, cholesterol and triglycerides at least every two years. If you have a history of endometriosis, polycystic ovarian syndrome, gestational diabetes or high blood pressure during pregnancy, consider more frequent screenings.
Also, educate yourself about the signs of a heart attack. These include shortness of breath, fatigue, body aches, cold sweats, palpitations and weakness. The crushing chest pain men that report feeling during a heart attack? Women say it feels less severe than menstrual cramps and dismiss it.
Body Changes and Bone Health. Muscle mass and bone density declines are part of menopause and aging. Bone density scans are not typically recommended until age 65, but women with risk factors (small size, family history, early menopause) should consider earlier screening. Screening involves a DXA scan, which may not be covered by insurance.
Cool down Care Plan
During a cool down, my running partners and I review the workout and make any adjustments as needed. A similar conversation should happen at the conclusion of your care appointment. In health care, this is termed “shared decision making.” Shared decision making is a process where you and your provider work together, reviewing symptoms and findings to develop a care plan that is based on clinical evidence, and balances risks and expected outcomes with your preferences and values.3
If medication is suggested, ask about the therapies and alternatives, ensure the dosing aligns with your lifestyle and agree about what you will report and when. Ask about the science behind the therapy so you can learn more.
If you feel you have been open but are not satisfied with the answers, seek a second opinion. Just as your running is too important to share with a running partner who is unreliable or unsupportive, your health is too important to entrust to a provider who, for whatever reason, leaves you feeling unheard or dismissed.
Join me next month for a deep dive into Menopause Hormone Therapy.
References, further reading and resources:
1“The 2022 Hormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022 Jul 1;29(7):767-794. doi: 10.1097/GME.0000000000002028. PMID: 35797481.
2Santoro, N., & Sutton-Tyrrell, K. (2011). The SWAN song: Study of Women’s Health Across the Nation’s recurring themes. Obstetrics and gynecology clinics of North America, 38(3), 417–423. https://doi.org/10.1016/j.ogc.2011.05.001
3Dayaratna S, Sifri R, Jackson R, Powell R, Sherif K, DiCarlo M, Hegarty SE, Petrich A, Lambert E, Quinn A, Myers R. Preparing women experiencing symptoms of menopause for shared decision making about treatment. Menopause. 2021 Jul 12;28(9):1060-1066. doi: 10.1097/GME.0000000000001807. PMID: 34260477.