Of the many ways that the menopause transition makes itself known, some symptoms are more immediately apparent—and more, well, visceral—than others. Hot flashes, super-soaker periods that show up whenever they please, and puzzling weight gain are pretty dramatic physical signs that things are changing, and they can be hard to ignore. Physical symptoms get a lot of coverage in the current conversations about menopause, which is a good thing, since it means more women have the information they need to seek help and relief.
But alongside the uncomfortable physical symptoms, perimenopause can also stir up new or worsening mental health concerns, like anxiety, depression, brain fog, mood swings, even unexpected rage. In our fast-paced culture packed with distractions, stressors, and endless obligations, it may not occur to some women that these symptoms might be connected to the menopause transition, or that they can get help for them. Add to this the fact that menopause and mental health remain somewhat taboo topics and that many women have their mental health concerns dismissed, and it’s clear we need to be having more conversations about the psychological and emotional symptoms to be aware of during perimenopause.
Take this one, for instance: Some women notice a hard-to-put-your-finger-on-it sense of “blahness” or numbness, most profoundly marked by a loss of interest in things they used to enjoy, and a loss of pleasure from things that used to provide it, including food, hobbies, creative pastimes, sex, and social connections.
The term for this is anhedonia, and if it’s not already on your radar, it might be difficult to recognize or articulate at first. Anhedonia doesn’t necessarily rise to the top of the list of conversations about mental health in general, since it’s often considered a hallmark of depression and the neurobiological mechanisms behind it aren’t especially well understood yet.
We think it’s important to spotlight anhedonia in its own right, however, since mental health concerns can vary so widely between individuals during perimenopause, and we’re all about digging into the sometimes uncomfortable and underdiscussed topics you need to know about during this transition.
If you can relate to what we describe here, please consider bringing it up with a healthcare provider or mental health professional, especially one well-versed in menopause. Mental health concerns during menopause can be complex, distressing, and have multiple root causes, but getting help is worth it.
The word anhedonia is derived from the Greek words “an-” meaning “without” and “hedone,” meaning pleasure. It was first used by the French psychologist Théodule Ribot in the late 1800s, and while the definition has expanded over time (especially in the context of clinical depression), you’re still most likely to see it used to describe a lack of interest in formerly enjoyable activities, and/or a lack of pleasure in those activities while doing them.
To understand where anhedonia fits in among other mental health symptoms, it might help to imagine them along a sort of spectrum. Where depression might generally present as a low-energy condition, marked by feelings of sadness, hopelessness, despair, and disinterest in normal activities, and anxiety might present as a higher energy condition, characterized by racing thoughts (and heartbeat!), worry, rumination, and even panic attacks, typical descriptions of anhedonia place it closer to depression. It’s possible to have anhedonia as the sole sign of a mental health disorder (ie, you can experience episodes of anhedonia as a variant of depression without other symptoms), but it is also one of the diagnostic criteria for major depressive disorder (MDD), and several other psychological and neurological disorders, including Parkinson’s disease.
Essentially, anhedonia is responsible for the “disinterest and apathy” symptoms that can accompany depression and other disorders. It’s not associated with having strong negative emotions so much as it is a lack of emotions; it’s waking up feeling “meh,” “blah,” or “take it or leave it,” in the most passive sense, about activities you would ordinarily look forward to and enjoy.
Researchers believe that anhedonia presents when there is dysfunction in the brain’s motivation and reward centers. However, as with so many mental health disorders, it’s hard to narrow down a singular cause or predict what might trigger an episode in any given person, especially since it can be co-present with other conditions.
It’s thought that there may be a genetic component partially contributing to whether an individual is prone to anhedonia. It has also been linked to inflammation in the brain, which interferes with the function of neurotransmitters, such as the “feel-good hormone” dopamine, that play important roles in mood regulation, pleasure, and motivation.
Other contributors to anhedonia can include trauma and PTSD; burnout; substance use disorders; even chronic illness like Long Covid; this raises the question whether it’s driven by something biochemical, circumstantial, or both, in ways science doesn’t fully understand.
As for what spurs episodes of anhedonia during perimenopause, it’s difficult to say with certainty, but plummeting estrogen levels are likely partially responsible. During the menopause transition, we’re at the whims of fluctuating hormones, often for years. These wild hormone swings can bring about not just irritability but other serious mental health concerns, like depression, as we lose the (sometimes) mood-balancing effects of progesterone, and declining estrogen and progesterone interfere with dopamine function.
All these hormonal shifts can result in mood and mental health changes during midlife, and the severity can vary from person to person. Some research suggests that women who experienced depression before beginning menopause may be more prone to depressive symptoms (especially those severe enough to meet the criteria for major depressive disorder) during and after menopause, but mental health struggles can arise for all kinds of reasons, including situational ones, during this time.
Transitions during midlife involve so much more than just hormones: it’s a time when our relationships, body image, sense of identity, roles at home and at work can all go through destabilizing shifts too, sometimes with no predictable end in sight. It’s not unreasonable, then, that stress, burnout, overwhelm, anxiety, depression, and anhedonia can set in and prompt a need for more support.
We all have experiences we don’t enjoy sometimes, right? And is it so bad to lose interest in certain things, especially as you grow and change and adjust to new life phases throughout the years? Does moving on from former activities, hobbies, or social groups always mean you’re dealing with anhedonia?
Of course not—that’s just having preferences! Anhedonia isn’t simply disliking an activity or not being interested in a pastime because it’s not your cup of tea or you’ve found something new to try. It’s better described as a sense of apathy or indifference that extends into multiple areas of your life, or a pervasive numbness that leaves you not caring about much of anything, which doesn’t lift even after your favorite pick-me-ups—anything that used to reliably buoy you through a bad mood.
So how does this show up?
Women responding to discussions about anhedonia during perimenopause in various online forums use phrases like:
“faking my way through life”
“I don’t care about anything”
“everything is boring”
“life just feels gray”
“wouldn’t really care if I never saw my friends again”
“going through the motions”
“no sense of urgency”
“can’t find motivation, even for the fun stuff”
“trying to figure out how to want to want something again”
“nothing calls to me”
“I’m just existing”
“I would feel this in my bones…if I could feel feelings”
They describe abandoning hobbies and businesses, withdrawing from social and family obligations, not looking forward to plans, putting off basic tasks, and doing the bare minimum to get through the day, not because their to-do list feels challenging but because they simply can’t work up the motivation to care about following through.
It’s also not uncommon for people experiencing anhedonia to lose interest in, or fail to get satisfaction from, things they used to find enjoyable like food, sex, or engaging with music and art. Particularly with food, this can lead to changes in appetite and eating habits—some people may struggle to eat enough, while others might seek out highly palatable and less nutrient-dense foods, like salty or sweet snacks, in the hopes of finally tasting something satisfying.
If anhedonia saps your motivation, interest, and sense of satisfaction or joy, it’s fair to say that it isn’t compatible with nurturing your well-being, relationships, or self-image—particularly not during menopause, which can bring forth new challenges on these fronts anyway. Wanting relief from anhedonia is as understandable as wanting relief from hot flashes, and just as important for your menopausal quality of life.
Because it’s so often linked to other conditions and we’re still learning about what can cause it, anhedonia on its own can be difficult to treat. There are no treatments designed specifically for anhedonia yet, outside of those meant to address the other disorders it often accompanies, and frustratingly, it’s not always responsive to some of the go-to medications often used to treat depression, like SSRIs.
To offer some hope, though, it seems that anhedonia isn’t always a persistent state for all who experience it. Depending on the factors involved, its severity can ebb and flow over time, and various mental health interventions can help bring about relief for some people. Though there’s no one remedy that’s a proven anhedonia-buster, a combination of approaches may help.
Cognitive behavioral therapy
Atypical antidepressants
Menopause hormone therapy
Without a better understanding of what really causes anhedonia during perimenopause (and in other circumstances), and better data pointing toward effective treatment options, it can be challenging to treat and frustrating when it affects important aspects of your life, especially during a time of such intense change. But this doesn’t mean there’s nothing to be done. If you’re struggling during menopause—with anhedonia, depression, anxiety, or any combination of these—we encourage you to communicate it to a healthcare provider who listens to your concerns and can support you with the right combination of treatments, lifestyle changes, and other mental health interventions for your needs. You and your well-being are worth it.
If you feel you or someone you care about may be suffering from depression, there is help. You can start finding your way back from depression by talking to a doctor or mental health provider, or contacting the 988 Lifeline for immediate, 24/7 support. Gennev’s clinicians can support you through the unique physical and emotional challenges of menopause with personalized treatment plans; book an appointment to get started.
Feel like saving a life this week? If you read and share this article with all the women you know, you just might.
Your mission is simple, no paramedic training or medical school required. All we need you to do is to take in the information we’re about to share about women and cardiovascular disease, then pass it on. Send it to the group chat, bring it up at book club, forward it to friends and family—you never know who might need to hear it, but considering the statistic that by age 45, one in nine women will have heart disease, increasing to one in three by age 65, the odds are good that someone you care about will be grateful for the information.
We need all the messengers we can get, since heart disease remains the number one cause of death for adults in the United States and affects more than 60 million women, but only about 44% of women today recognize their risks (which, as we have written elsewhere, increase after menopause).
That means more than half of American women are missing out on critical information about how heart disease presents in women, what our unique risk factors are, why heart disease risks increase after menopause, and how to self-advocate for essential care.
That’s not going to be you.
Today we’re sharing insights from a conversation between Gennev’s Chief Medical Officer, Dr. Rebecca Dunsmoor-Su, and cardiologist Dr. Sarah Speck, Director of Cardiac Rehabilitation at Swedish Medical Center in Seattle. They shared invaluable tips about what women over 40 need to know about heart disease and lowering the risk of a cardiovascular event.
While there are different types of cardiovascular disease and different interventions to address them, in this article we’ll focus on the following:
1. Risk factors for common types of heart disease in women
2. Presentation (e.g., the signs and symptoms of acute events like heart attacks)
3. What to ask your doctor about your health history and risks
4. What kinds of lifestyle and clinical adjustments you can make for a healthier heart before and after menopause.
In healthcare terms, a risk factor is something that may signal a higher likelihood of developing a disease. Risk factors can be modifiable (for instance, habits that can be changed, like smoking) or non-modifiable (like age or genes). They don’t necessarily cause diseases, but can be a red flag that conditions are in place for future illness or dysfunction.
Some risk factors for common types of heart disease are well known because they affect men and women, have plenty of research behind them, and are widely publicized. These include:
All of these factors can contribute to inflammation and damage to the endothelium, or the layer of cells that line blood vessels and help them expand and contract for optimal blood flow. Damage to these cells can make veins and arteries less flexible and encourage plaque made of cholesterol, fat, calcium, and other substances to form along blood vessel walls. Too much plaque buildup causes those blood vessels to narrow (a condition called atherosclerosis) which can reduce and even block blood flow to the heart, brain, and other organs.
These “big 5” factors, says Dr. Speck, are just as common in women as they are in men, and just as preventable. They’re the ones you’re likely to encounter when you first start looking into taking care of your heart health. However! There’s a massive knowledge gap when it comes to heart disease causes, prevention, presentation, and treatment specifically in women. Though there’s been medical and scientific progress on that front in the past few decades, awareness of women’s unique risk factors hasn’t kept pace. We can change that.
Below is a list of other factors that can increase a woman’s risk of developing cardiovascular disease or having a cardiovascular event. Knowing more about them is a great first step toward understanding your options for prevention and treatment, even—or especially—if you have no obvious symptoms.
It’s particularly important to keep these factors in mind during menopause. While some heart disease risk factors can affect women well before midlife and plaque can begin developing as early as our twenties and thirties, we do know that estrogen has an anti-inflammatory effect on blood vessels. It helps to keep them flexible, functional, and less likely to accumulate plaque. This may explain why women’s cardiovascular disease risks go up after menopause; we lose estrogen’s protective effect on our arteries as well as its influence over metabolic functions that help manage inflammation and process substances like LDL cholesterol and triglycerides, which accelerate plaque buildup.
Now that you’re aware of these risk factors, what can you do with that information? Well, the more you know, the faster and earlier you can act if you think you or someone you love is at risk of a cardiovascular event. And that brings us to our next point: cardiovascular disease can look different in women.
We’re not about to ask you to forget everything you know about typical heart attack symptoms, but we now know that women in cardiovascular distress often experience it differently than men. This can lead to missed diagnoses and care delays if women, their loved ones, and healthcare providers don’t know what to look for.
Dr. Speck explains that while women can have the crushing, elephant-on-the-chest type of pain that might be the first thing we think of when we imagine a heart attack, they may also (or instead) experience:
It can be difficult to connect the dots about women’s heart disease symptoms, because they may only have one or a few of the symptoms above. Even if they do feel classic chest pain, it may not be as severe as it is in men, or it may present more as indigestion. Dr. Speck has seen this before: “I’ve met women in the emergency room who swear that if they just burp, they would feel better and they’re having inferior myocardial infarction (heart attack).” Point taken: don’t wait for the crushing chest pain before seeking care for a potential heart attack.
If you’re reading the list above thinking, “Wait, I’ve had heart palpitations…” or “How would I know if my fatigue was unusual?! I’m going through menopause!” there’s good news and, uh, less-good news.
The less-good news is that menopause symptoms and heart disease symptoms can sometimes overlap. This doesn’t mean that one condition is causing the other or that the same mechanism is necessarily behind them, but it does add another layer of concern and confusion to this time of transition. It’s a really good reason to know what’s normal for your body, understand your family history, and have a healthcare provider you trust. If you’re experiencing concerning symptoms, it’s worth keeping track and mentioning them to your doctor.
The actual good news is that we can manage many risk factors for heart disease, and knowledge is power when it comes to taking care of your body.
Here’s what you need to know to be an active, informed participant in your cardiovascular healthcare at any age.
As a cardiologist, Dr. Speck investigates several markers of cardiovascular health, family history, and lifestyle. She particularly wants to know about:
As for the tests women over 40 should consider to understand their cardiovascular risks, she suggests starting with the following:
If you have a family history of heart disease or other risk factors like diabetes, Dr. Speck advises diving even deeper to understand your cardiovascular health profile. The tests she might recommend to higher-risk patients include:
What you should do with all the information from these tests is something to discuss with your doctor. They should help you assess your risks and advise how to lower them, whether through diet, exercise, medication, or a combination. In her practice, Dr. Speck works with a nutritionist and an exercise physiologist who can counsel patients about the many ways to incorporate heart-healthy lifestyle habits.
Of course, if you’re eager to make heart-healthy tweaks to your nutrition and exercise habits, no matter the state of your cardiovascular health or risk factors, it’s always a good time to start. Gennev’s team of Registered Dietitian Nutritionists are a fantastic resource for menopause-specific nutrition, fitness, and lifestyle guidance (including sleep and stress management, both important for heart health), tailored for your individual needs, health history, and goals. No referrals necessary”you can sign up and book with a Gennev RDN directly.
Want a quick cheat sheet for talking to your doctor? If you’ve never asked these questions, it’s worth jotting them down for your next appointment.
So, you know the risk factors for heart disease. You know the signs and symptoms. You know what tests you might need. What else can you do right now to minimize your risk of a cardiovascular event after menopause and be your own best advocate?
Understand the misconceptions
You’re already savvy about some of these, like how women may not have chest pain as their first sign of a heart attack. You should also know that women are less likely to be prescribed statins to lower cholesterol or blood thinners to address blood clots or some types of abnormal heart rhythms. There’s a misconception that statins don’t work as well in women as they do in men, but Dr. Speck and Dr. Dunsmoor-Su confirm that this is false. If your situation calls for a statin, know that it can be a safe and effective way to lower your cholesterol.
When it comes to menopausal hormone therapy and cardiovascular disease, be aware that just as hormones are not an automatic no-go, they’re also not an automatic must-try for everyone. There is strong evidence that MHT can be protective against heart disease during and after menopause for some women, in some forms, under the appropriate conditions” but not as a first line of defense. And for some women, especially those with a history of estrogen-provoked blood clots, hormones are not a safe option when it comes to cardiovascular health. Whatever your situation, your doctor can help you weigh the risks and benefits of using hormones during and after menopause.
Know your numbers and your history
Even if you haven’t had a blood test in a long time, the use of electronic medical records makes it easy to track down past results. If you can access old test results through your online patient profile, jot down the numbers from your lipid panel and nudge your doctor about getting another one if it’s been a few years.
As for your health history, if you have vague memories of a relative who died much too young of a heart attack or know a parent has struggled with their blood pressure (or was it their cholesterol?), get to chattin’! Ask family members how old they were when they started getting abnormal markers, what medications they’ve tried and for how long, and what they can share about other relatives’ cardiovascular conditions. This information can help you know what to watch for and plan your own approach to cardiovascular health.
Change the factors in your control
You can’t change your age, your genes, or the fact that you’ll lose your natural estrogen after menopause, but there are plenty of things you can do to reduce other cardiovascular risk factors. Dr. Speck advises patients to “try to be vegetarian twice a day and eat the Mediterranean diet,” which she likes because it has anti-inflammatory benefits, offers a low saturated fat-to-protein ratio while offering plenty of protein, and champions at least 10 servings of fruits and vegetables a day for heart-healthy fiber.
In terms of exercise, she says, “anything that moves the big muscles between your waist and your knees for 150 minutes a week is beneficial for reducing inflammation and reducing your cardiovascular risk.” Exercise is key for keeping the heart strong and improving metabolic function, so it’s absolutely worth finding a few moderate-to-vigorous workout routines you like to do and can follow consistently.
Find a provider who takes you seriously
Finally, we know that seeking healthcare as a woman can be a frustrating, sometimes even demoralizing, experience. There are gaps in research, lack of awareness about women’s health concerns, fewer opportunities for patient education, and sadly even medical biases standing between many women and quality healthcare. As common as cardiovascular disease has become, it’s of the utmost importance to keep pushing for care if you feel like something’s wrong. You deserve to have your concerns taken seriously, and if you find yourself feeling dismissed or unheard, you deserve to find another provider—one who will listen, ask questions, and help you understand what’s going on with your health.
If you’re of an age where you’ve been googling things like “perimenopause always hungry why?!” and “hot flashes from spicy food,” you’ve probably seen your fair share of nutrition advice come and go throughout the decades—some of it useful and evidence-based, and some of it sheer nonsense.
As with many fields, what we know, believe, and share about nutrition is always evolving thanks to scientific breakthroughs, policy changes, cultural and societal norms, marketing, and the power of trends. Some of this information can help people make life-changing improvements to their health; on the other hand, nutrition misinformation can lead people to waste money, time, and energy on remedies that range from ineffective to downright dangerous.
With social media in the mix, it’s become even more difficult to separate nutrition facts from half-truths (or total fiction) so that you can eat in a way that’s enjoyable, nourishing, and supportive of your health goals. This is especially important during menopause, when bodies start doing unpredictable, unruly things, certain disease risks can rise, and it feels like everyone wants to sell you something to deal with it all.
Now…if you’re curious about perimenopause nutrition, you may be wondering about how much protein to eat, whether intermittent fasting is a good idea, or what foods you can add to round out a healthy diet during menopause, but let us give you one more thing to consider: heart health.
Taking care of your heart in midlife is super important, since heart disease remains the leading cause of death for women in the United States, and the risk of cardiovascular disease rises after menopause. Fortunately, there are ways to lower your risks, including taking medication (yes, statins work for women!), exercising (both cardio and resistance training are recommended), and getting plenty of quality sleep.
By the way: if you’re concerned about the seemingly ever-changing information about hormone therapy for menopause symptoms and cardiovascular disease risks, talk to your doctor! It’s a complex but worthwhile conversation and must account for individual needs and risk factors.
The final piece of the puzzle in a comprehensive approach to a healthy heart is, of course, nutrition. But there are longstanding myths around heart-healthy foods that can be tricky to make sense of, so where do you even start?
That’s where the professionals come in. Menopause nutrition counseling covers an amazing range of symptoms and conditions, and a Registered Dietitian Nutritionist can be one of your best allies when it comes to figuring out what to eat for your specific goals, needs, and preferences. We asked some of Gennev’s RDNs to tackle some of the most persistent myths and questions about nutrition for heart health during and after menopause.
Here’s what they shared:
Q: Should you avoid eggs if you have high cholesterol?
A: Like many other animal-based food sources, eggs do contain some saturated fat, which in excess can lead to elevated LDL cholesterol levels for some people. However, there is no need to completely avoid foods with saturated fat. For optimizing health and keeping LDL cholesterol levels within range, the American Heart Association recommends aiming for 6% or less of total calories from saturated fat. For someone following a 2000 calorie diet, this would equal around 13 grams daily. 1 egg, on average, has around just 1.5 grams of saturated fat.
For most people, eating an egg or two a day can be a great option—they contain many key nutrients such as choline, which is an important nutrient for brain health, along with several other vitamins and minerals. However, everyone’s needs are different, so talk with a dietitian for individualized recommendations.
Q: If you have high blood pressure, should you cut out sodium altogether?
A: Being mindful of sodium intake can be an important part of blood pressure management. However, sodium should not be cut out altogether, as it is a key nutrient/electrolyte needed for the body to function properly. The American Heart Association recommends aiming for 2300 mg of sodium per day or less for most people, while some may benefit from consuming around 1500 mg daily. Individual needs vary, based on medical history and physical activity level (for example, excess sweating can cause a greater release of sodium), and your healthcare provider can advise what approach would be right for you.
-Katie Linville
Q: Can you make up for the loss of estrogen (which has some protective benefits for your cardiovascular system) during menopause by eating more soy products?
A: Unfortunately, no. Phytoestrogens from plants are weaker than those made by the ovaries and are not equivalent to estrogen that the body produces when it comes to their cardioprotective properties. That said, soy products are a good source of plant-based protein in the diet, and for some women, their regular consumption may lead to a reduction in the frequency and/or severity of hot flashes.
Q: Could caffeine be making your hot flashes (and maybe blood pressure) worse?
A: Yes, caffeine can exacerbate hot flashes and it may lead to a brief rise in blood pressure as well. Caffeine has a long half-life and can take up to 12 hours to leave the body, so even an early afternoon cup of joe can negatively impact your sleep—and poor sleep is associated with higher blood pressure.
– Pamela Malo
Q: They say nuts are a heart-healthy food, but aren’t they high in fat? Should you skip those that are higher in saturated fat?
A: Most nuts are high in heart-healthy fat—monounsaturated and polyunsaturated. Heart-healthy fats like these can help improve cholesterol levels and lower the risk of heart disease. There are a few nuts that are higher in saturated fat—including Brazil nuts and macadamia nuts—although these can still be part of a balanced healthy diet if eaten in moderation. Other good reasons to eat nuts: they’re also a good source of vitamins and minerals like vitamin E, magnesium, manganese, zinc, and more.
Q: If saturated fats mostly come from animal-based foods, are vegetarians and vegans in the clear when it comes to heart health?
A: It’s not quite that simple. Heart health is important to everyone whether you choose a plant-based or animal-based eating plan. Genetics is a big determining factor in your overall risk of heart disease. Animal products tend to contain more saturated fat, which can lead to elevated cholesterol levels and therefore increase your risk for heart disease and other chronic diseases. Plant-based foods like fruits and vegetables are low in saturated fat and can help promote heart health and overall lower your chronic disease risk. Overall, physical activity and balanced diet of a variety of foods—lean protein, colorful fruits and veggies, and whole grains—are optimal strategies for decreasing your risk for heart disease.
-Beth Wolfgram
Q: If you have a family history of high cholesterol or heart disease and risks go up after menopause anyway, will a heart-healthy diet and exercise even help?
Genetics and family history of cardiovascular disease and how it influences your cholesterol varies. Because of this, how much diet and exercise affect cholesterol levels varies too. That doesn’t mean lifestyle behaviors don’t matter if cardiovascular disease runs in your family. But don’t start shaming yourself into doing them or blaming yourself if the lifestyle behaviors don’t affect your cholesterol levels like you’d hoped if you have high familial cholesterol.
Overall, diet and exercise have about a 20-30% effect on cholesterol, and consistency matters! Don’t go crazy with your fiber intake or exercise routine, thinking that your cholesterol will dramatically change if you can’t sustain those behaviors consistently.
The key to consistency is enjoyment. If you like how the exercise makes you feel during or after, you’ll do it more often. The same is true with food. Heart-healthy diets like the Mediterranean, DASH, Plant-based, and MIND diets all follow similar patterns and encourage heart-healthy eating. However, consistency matters more than the specific dietary guidelines you follow.
While these recommendations are a fantastic place to start if you’d like to eat more heart-healthy foods, you may want even more personalized guidance to meet your specific nutritional needs during menopause, especially if you’re navigating other health concerns. That’s where our clinicians shine. Learn more about working with a Gennev RDN, or book an appointment today.
you know there and you are here. And at the same time
A common midlife mystery women face during the menopause transition is, “I’m gaining weight, but I follow the same routines I always have and can’t figure out what’s changed. Is this perimenopause, my metabolism, or something else altogether?”
It’s impossible to answer that question without exploring individual lifestyle factors and health history, but during this period of hormonal shifts, physical and emotional stressors, life’s daily demands, and the natural effects of aging, it’s normal to notice some changes to how your body looks, feels, and functions.
The metabolism, or how our body converts nutrients from food into energy to keep physiological processes working properly, is a complex, sensitive system. It’s determined by our genes, age, hormones, body composition, and factors such as what we eat, how much we move during the day, certain medications, and how we sleep. Directly and indirectly, the quality of your sleep (and how much of it you get) can affect how your metabolism functions, and thus how your body burns calories and holds on to weight.
If you’re experiencing weight concerns during menopause that aren’t responding to diet and exercise in the way you’d expect, one thing to consider is the role sleep plays in metabolic function. Understanding this relationship can help make sense of what’s going on with your metabolism during midlife, which is often a time when regular, restorative sleep becomes more elusive, and we face new sources of stress.
We know it feels like you can’t catch a break from hormone swings during perimenopause, given all the effects of fluctuating and declining estrogen, progesterone, and testosterone. The truth is, all hormones fluctuate to some extent based on internal and external cues”it’s how your body runs essential processes like digestion, circulation, tissue repair, and more. So, while changing hormone levels aren’t necessarily abnormal or a bad thing, the ratios between them need to stay balanced so that they can cue your body to do what it needs to do. Interference from things like stress, dietary changes, and sleep deprivation can throw hormone levels out of balance and affect systems like your metabolism.
Some of the hormones involved in metabolism that are particularly sensitive to disrupted sleep are:
Cortisol as You may know cortisol as the “stress hormone,” and recognize it as the subject of many social media videos lately. And no wonder, since it does an awful lot in our bodies and having imbalanced levels can cause noticeable symptoms. While cortisol does play a big role in your body’s stress response, it has other functions too, like rising and falling throughout the day to cue your body to wake up and get drowsy during the sleep-wake cycle. As for its involvement in metabolism, cortisol works alongside other hormones, like insulin, to regulate blood sugar.
Most of the time, cortisol’s fluctuations are normal, natural, and necessary. However, sources of stress, like poor or insufficient sleep, can cause cortisol levels to stay elevated instead of following the ideal ebb and flow of their daily rhythms. Over time, this can interfere with how efficiently your metabolism works and result in:
Insulin as Insulin is a hormone that helps the body metabolize fat, protein, and carbohydrates. One of its main roles is to help different tissues absorb glucose from the bloodstream so it can be converted into energy”in other words, insulin’s a major player in regulating blood sugar.
Sleep loss, especially when it’s chronic, reduces the body’s sensitivity to insulin, meaning cells in the muscles, liver, and body fat become less responsive to its signals. When that happens, glucose can build up in the bloodstream instead of being absorbed by our cells and turned into energy. Over time, this can lead to insulin resistance and contribute to metabolic disorders like Type 2 diabetes or metabolic syndrome in people who may already be at risk.
Ghrelin and Leptin as These two hormones regulate hunger and satiety (a sense of fullness and satisfaction after eating) and have important roles in managing the body’s energy intake (eating and drinking) vs expenditure (burning calories). Ghrelin, made mostly in your stomach but also secreted by the brain, small intestine, and pancreas, is often called the “hunger hormone” because it stimulates the appetite.
Leptin, otherwise known as the “satiety hormone,” is produced by fat cells when your body recognizes that it has enough energy reserves. It suppresses hunger by telling your brain you’ve had enough of the right nutrients to replenish your energy.
Together, these hormones help your body prioritize which nutrient sources to use for fuel and sense when energy stores are low so you can fill them back up with a meal.
Like other hormones, ghrelin and leptin respond to inputs like physical activity, dietary habits, circadian rhythms, levels of other hormones, stress, and”you guessed it”sleep. Lack of sleep or poor-quality sleep can cause ghrelin levels to spike and leptin levels to drop; this can lead to increased cravings for calorie-dense foods for quick hits of energy and difficulty sensing fullness, making it easier to eat past satisfaction and consume more than your body needs.
A good night’s sleep is more than just the amount of time you spend in bed”the sleep stages matter.
If we’re healthy and sleeping well (that is, not dealing with sleep disorders or interruptions during the night) we can expect to cycle through rapid-eye movement (REM) sleep and multiple stages of non-REM sleep several times a night. During these stages, our brain wave activity changes and follows different patterns; these cycles determine when we dream, organize memories and process information, or carry out cellular healing to restore tissues to optimal function and repair them after injury and inflammation.
The stage called deep sleep, also known as slow-wave sleep, helps us wake up feeling well-rested and is critical for cellular recovery. And properly functioning cells are essential for a properly functioning metabolism!
Lack of deep sleep, either because of trouble getting to that stage or from not spending enough time in it, can interfere with:
It’s typical to get less deep sleep as we age, but the menopause transition can make it even harder to get the amount we need. This period of life is full of things that keep us awake, be they hot flashes and night sweats caused by declining estrogen; night awakenings due to hormone shifts; circadian rhythm disruptions; sleep disorders; stress and anxiety; or interruptions from kids, partners, or pets.
Gennev’s Chief Medical Officer Dr. Rebecca Dunsmoor-Su points out that prolonged lack of deep sleep can reduce the basal metabolic rate (how many calories we burn at rest), keep cortisol levels higher than they ought to be, and generate some insulin resistance, all of which can contribute to changes in what kind of body fat we accumulate and where we store it, particularly during menopause when the body is adjusting to a whole host of new conditions.
Time for a judgement-free truth: The best-laid plans can often go awry when chronic sleep loss is involved. Poor sleep and fatigue affect energy levels, coordination abilities, emotions and mood regulation, memory and cognitive abilities, and appetite, so is it any surprise that we might not feel up to our ideal routines if we’re frequently not sleeping well?
Of course not! Tired minds and bodies want to save energy, not spend it, so it’s normal to choose less taxing activities when we’re not well-rested. Menopause can compound this, introducing levels of fatigue that can catch many women off guard and interfere with their quality of life.
The resulting cycle might sound like a familiar one: long stretches of poor sleep leave you perpetually exhausted while juggling a never-ending to-do list. For many, that makes it harder to consistently do things that support metabolic function and optimal sleep patterns, like prioritizing exercise or eating foods that provide plenty of complex carbs, protein, and healthy fats. That’s not a personal shortcoming, by the way”life asks a lot of us all, and today’s culture doesn’t always make it easy to nail sleep, nutrition, and physical activity the way we’re told we should.
In the long run, this cycle of fatigue from sleep loss, little exercise, and a diet that might offer quick calories without enough nourishment can take a toll on metabolic health as the body tries to keep all systems working efficiently. Without adequate fuel and recovery, it must make some adjustments to compensate, like holding on to body fat and lowering the basal metabolic rate to conserve energy (thus burning fewer calories), and has a harder time keeping hormones balanced and blood sugar stable. If these conditions continue for too long, it may increase the risk of more serious metabolic disorders and chronic disease associated with poor sleep.
Sleep and metabolism are incredibly complicated topics, and both aging and menopause can make them even more so. It can be difficult to say exactly what the culprit is for some of these complaints, but if you’re troubled by changes to your sleep, your body composition, or your energy levels, you don’t have to struggle through them alone.
Consider making an appointment with a menopause-trained Gennev physician or Registered Dietitian Nutritionist who can help you understand your metabolism, make sense of your symptoms, and find relief through personalized care plans.
If you or your doctor suspect you may have a sleep disorder due to symptoms that don’t respond to medications, hormones, behavioral or habit changes, you may want to be evaluated for sleep apnea. It’s a common sleep disorder that affects women more frequently after menopause and can be linked to other health conditions. You can’t diagnose yourself, but convenient at-home sleep studies are available through companies like Complete Sleep. If you do have sleep apnea, Complete Sleep also offers custom mouth guards, covered by insurance, for an easy-to-use treatment option that can support better, more restful sleep.
We’ve all been here after a bad night’s sleep: we spend the day groggy, irritable, and unable to focus. Even minor mishaps throw us off our game. Our fuse feels shorter and it’s harder to self-regulate. When this is just an occasional occurrence, it’s usually possible to salvage the day through strong coffee, extra patience, and the promise of an early bedtime and the chance to try again tomorrow.
The impact of chronic sleep issues lasting weeks or months, however, is far more severe: long-term sleep debt and disrupted sleep can take a toll on physical and mental health over time, even going so far as to affect our interpersonal relationships and sense of self. If you’re constantly tossing and turning all night, especially during major life transitions like menopause, it’s not just your sleep quality that’s jeopardized; it’s your ability to thrive at work and at home each day.
The American Academy of Sleep Medicine (AASM) recommends that adults sleep seven or more hours per night to promote optimal health. While sleep needs vary from person to person and can change a bit with age, ideally we’re all getting enough to let our brains cycle through the different stages of sleep that help with memory, cognition, mood regulation, and more. Below, we’ll explore the emotional impacts of sleep problems and offer practical strategies to reclaim your rest and restore some much-needed emotional balance”particularly during menopause, when quality sleep becomes elusive and emotions can take you on a wild ride.
Sleep and mental health are intertwined in a complex, often cyclical relationship. Poor sleep can exacerbate existing mental health conditions such as anxiety and depression”and these mental health challenges can in turn make it harder to fall asleep, wake you up with racing thoughts in the middle of the night or early in the morning, or prevent you from reaching the stages of deep sleep you need to feel rested the next day. It’s a frustrating loop that can leave you feeling helpless and overwhelmed.
Here are some of the ways that sleep deprivation can wreak havoc on your emotional state:
Given that good sleep is a necessity, not a luxury, make it a top priority to get sufficient, high-quality sleep every night, including weekends. It’s an act of self-care: by breaking the cycle of poor sleep, you can begin to reclaim your emotional balance. In addition to improving sleep hygiene”through a consistent sleep schedule, a relaxing bedtime routine, and an optimal sleep environment”try the following activities to help boost your mood:
Shifting your sleep habits often feels much easier said than done, so know that finding a solution is sometimes more than a matter of trying new routines. If you’re dealing with a medical condition, sleep disorder such as sleep apnea, or challenging menopause symptoms that can affect sleep, mood, and mental health as well, talk with a doctor for guidance. You don’t have to solve this all by yourself.
We know that our diet can affect our moods, our risks for diseases such as diabetes and cancer, and our cognitive functioning. But food is also connected to sleep. Growing research suggests that the quality of our diet (i.e. having sufficient amounts of key nutrients on a regular basis) can actually affect the quantity and quality of our sleep. That may explain why diets that are low in fiber, high in saturated fat, and high in sugar have been associated with poorer quality sleep. Another large study found that deficits in certain nutrients”including magnesium, calcium, and vitamins A, C, D, E, and K”are associated with sleep problems.
A quick word about sugar: don’t be too quick to write off all sources of sugar and carbohydrates as problematic. While there is good evidence for avoiding refined, processed sugars for all sorts of health benefits, our bodies need carbs to function, and even simple carbohydrates (which can get a bad rap at times) are found in foods that offer additional nutritional value, like fruits and some dairy products. Even though it’s recommended to eat complex carbs like legumes and whole grains for a slower release of energy and fewer blood sugar spikes, you don’t necessarily need to give up sweet treats like a piece of delicious after-dinner fruit just in the hopes of sleeping a little better. It’s full of fiber and other nutrients you need to thrive.
If you’re looking to improve your sleep quality, mood, and overall health through nutrition, Melissa Burton, Registered Dietitian Nutritionist at Gennev, offers the following framework for thinking about a healthy diet:
Carbs + protein and/or fat
Why this formula? Carbs provide energy and are the preferred fuel for your brain, protein supports muscle tissues, hormone regulation, and satiety (the feeling of fullness and satisfaction from eating), and fat helps protect your tissues and organs and assists with brain function, hormone production, and vitamin absorption as well as satiety.
Burton advises her patients to pay attention to their hunger and fullness cues before and after eating and to try to eat every 3-4 hours during the day, including having breakfast shortly after waking to fuel the brain and body for the day ahead. She also emphasizes consuming fiber, vitamins, and minerals from a variety of foods to round out a healthy diet and being mindful of fluid intake.
In addition to consuming necessary macro and micronutrients, building healthy food-related sleep habits can help too: for instance, limit caffeine intake in the afternoons and evenings; avoid alcohol before bedtime; limit or avoid large late-night meals; and consider experimenting to see if certain foods trigger (or relieve!) your hot flashes.
If you’ve been dealing with chronic sleep disruption that’s not responding to lifestyle changes, it could be time to investigate the possibility of a sleep disorder. During menopause, women are at increased risk for disorders like sleep apnea, but the good news is that relief is possible: with Complete Sleep, you can get screened for sleep apnea through an easy, accurate test that you can take from the comfort of home. And if you do have sleep apnea, Complete Sleep offers effective treatment with custom-fitted night guards.
If your sleep troubles have coincided with menopause and brought with them a whole host of new or more worrisome mental health concerns like anxiety, depression, even out-of-nowhere rage, know that while this is not uncommon, it’s not something you just have to live with until your hormones decide to even out.
You’re not alone, and there are resources available to help you manage the combined challenges of sleep loss, emotional distress, and menopause symptoms. Reach out to one of the menopause-trained clinicians at Gennev to discuss a personalized care plan to treat fatigue, brain fog, mood swings, and more.
There are a lot of reasons for sleepless nights during menopause: racing repetitive thoughts, a cocktail too close to bedtime, late-night demands from your bladderasseems like your body can come up with endless ways to avoid sleeping peacefully. While the occasional restless night isn’t usually something to worry about, sleep disorders and chronic sleep issues like insomnia, night sweats, and sleep apnea can show up or worsen during menopause. If you find yourself waking up too early or sleeping fitfully lately, you’re not alone. We’ll take a closer look at some of these sleep disturbances, the causes behind them, and what you can do about them.
Quality sleep is essential for supporting aspects of healthy brain function, such as cognition and memory, and physical health, like metabolism. When we don’t sleep enough, our mood suffers: we might feel cranky, impatient, short-tempered, sad, or generally unable to cope. Getting more (and deeper) sleep can help us feel more resilient, energized, and better able to tackle our days, whatever they might bring.
The primary culprit behind sleep problems during menopause is the fluctuating levels of hormones, particularly estrogen and progesterone, which play a critical role in regulating the sleep-wake cycle. As levels of these hormones shift and decline, it affects the signals your brain sends to your body, making it harder to fall asleep, stay asleep, or both. Here’s a closer look at the functions of each hormone:
Existing research indicates that these hormones may even help protect women against sleep apnea”but unfortunately, menopause can cancel out that benefit. Menopause influences the prevalence of sleep apnea, with postmenopausal women experiencing sleep apnea severity comparable to that of men.
While fatigue is a common menopause symptom, many people don’t realize that their sleep disturbances may be due to an underlying sleep disorder like sleep apnea. Sleep apnea is a condition in which breathing repeatedly stops and starts during sleep, and if left untreated, it can lead to serious health complications such as high blood pressure, heart disease, and cognitive impairment.
The hormonal changes that occur during menopause”particularly the decline in estrogen and progesterone”can contribute to airway instability, making women more susceptible to sleep apnea. Additional risk factors include:
Women with sleep apnea may not have the same symptoms as men. While men often experience loud snoring and gasping for air, women tend to report more subtle symptoms, such as:
Ugh, sounds a lot like menopause too, right? Because these symptoms overlap with common menopause complaints, sleep apnea often goes undiagnosed in women. But since you can’t diagnose yourself with sleep apnea, it’s important to get tested. If you suspect you may have sleep apnea, consider a home sleep test to determine if further evaluation is needed.
There are three main types of sleep apnea:
The good news is that sleep apnea is treatable. Some use CPAP therapy, which relies on a machine that uses air pressure to keep airways open and facilitate breathing during sleep, while others prefer oral appliances such as custom-fitted night guards that help by gently repositioning the jaw and tongue.
In addition to sleep apnea, menopause can also increase the likelihood of experiencing other sleep disorders, such as insomnia, frequent night wakings, and restless leg syndrome.
Insomnia
Many women experience menopause-related insomnia, which differs from chronic clinical insomnia. While chronic insomnia is often linked to psychological factors, menopause-related insomnia is largely driven by hormonal changes. Symptoms include:
Cognitive behavioral therapy for insomnia (CBT-I) is considered the first-line treatment, with menopausal hormone therapy (MHT) as an option for some women. Some melatonin and serotonin-based medications may also provide relief to help regulate the sleep-wake cycle, but always check with your physician to see if these options are compatible with your needs and any other medications you may take.
Frequent Night Wakings
A common complaint among menopausal women is waking up between 3-4 AM and struggling to fall back asleep. While this can be classified as insomnia, it can also be a result of:
To manage these wake-ups, try practicing relaxation techniques before bed, keeping your room cool, and avoiding heavy meals or alcohol before sleep. If these disturbances happen often, Gennev Registered Dietitian Nutritionist Melissa Burton suggests that it could be a good time to have your Hemoglobin A1c (which measures your average blood glucose levels over the previous 2-3 months) tested to see if blood sugar regulation issues could be the culprit. Blood sugar levels are supposed to fluctuate throughout the day as your body carries out digestion and metabolism, but wild spikes and downswings at night can both affect hormones and contribute to night awakenings. While medications and/or menopause hormone therapy may be helpful in those cases, simple dietary changes can also help stabilize blood sugar overnight.
Restless Leg Syndrome (RLS)
Restless leg syndrome is a neurological condition that causes an uncontrollable urge to move the legs, particularly at night. Women going through menopause may notice their symptoms worsening due to:
Simple strategies like stretching before bed, taking iron supplements (if deficient), and practicing relaxation techniques may help alleviate these symptoms. Burton notes that while there is limited research into dietary supplementation for restless leg syndrome, some vitamins and minerals do show promise. Some of her patients have found relief for RLS and other sleep issues with magnesium, a key mineral that supports muscle, nerve, bone, and heart health in addition to helping with mood and sleep. If you’re tempted to try it, a few tips: there are different forms of magnesium, some of which can cause vivid dreams or digestive discomfort, so Burton advises first-timers to look for magnesium glycinate, since it can be gentler on the GI system. It’s also a good idea to take your first dose when you’re not facing a busy day, just to minimize the chance of an upset stomach disrupting your plans.
And of course, before trying any new vitamin or mineral supplement, check with your healthcare provider or a pharmacist to make sure there’s no risk of interaction with other supplements or medications you’re taking or contraindications with other health conditions you may have.
Time and time again, research shows that not getting enough sleep over a long period of time impairs our mental and physical health. Being sleep-deficient can interfere with our ability to work, drive, focus, remember things, make decisions, get tasks done, regulate our emotions, and be fully present for our children, family members, and friends. Our overall well-being suffers.
Sleep deprivation also increases the risk of chronic diseases such as diabetes and heart disease and serves as a kind of “warning sign” for other medical and neurological issues, such as congestive heart failure, osteoarthritis, and Parkinson’s disease. While sleep duration needs vary from person to person and do decrease a little bit as we age, sleep quality is still extremely important for short-term and long-term healthasso know that you don’t have to just power through poor sleep if you’re not getting the rest you need.
While sleep disturbances during menopause are common, there are steps you can take to improve your sleep quality:
If your sleep problems are severe or persistent, it might be time to consult a healthcare professional. They can help identify any underlying medical conditions, recommend appropriate treatment options, and rule out other possible causes of sleep disturbances. Potential solutions may include:
Sleep disorders during menopause are a common”but manageable”challenge, so it’s important not to give up hope. By understanding the underlying causes and building healthy sleep habits, you can start to reclaim your nights and enjoy more rejuvenating sleep. If you’re struggling to get deeper sleep no matter what you try, be sure to reach out to your healthcare provider for personal advice and support. “If you suspect your sleep is being affected by your hormones, take a home sleep test and talk to your physician regarding treatment,” says Mary Best, NP, Nurse Practitioner at Complete Sleep.
When it comes to treatment, there are a variety of options available depending on the cause of sleep disturbances. “Treatment options include hormone replacement therapy (HRT), SSRIs, and acupuncture, in addition to cognitive behavioral therapy,” Best says. And if sleep apnea is a factor, she explains, “manual devices to assist in airway support are also a viable and reasonable option without the risks of medication side effects.”
If you’re dealing with sleep apnea (or worried that you might be), Complete Sleep can help you get tested with easy, accurate testing right from the comfort of home. Even better, if you find out that you have sleep apnea, Complete Sleep offers a helpful, effective treatment with custom-fitted night guards.
You can also find support for sleep issues through Gennev. Our menopause-trained MDs and Registered Dietitian Nutritionists can help identify the root causes of your sleep concerns and address fatigue, night sweats, insomnia, racing thoughts, anxiety, and more via personalized care plans designed to help you find relief.
No matter what stage of menopause you’re in, know that support is available and that getting better sleep is absolutely possible.
With spring underway, we’re looking forward to warmer weather, longer, lighter days, and summer vacations to new places (and new time zones). As welcome as they are, all these seasonal shifts can cause disruptions to our sleep schedules that can take some getting used to due to changes in routines, environments, and even hormones.
If you’re already dealing with the fitful, inconsistent sleep that comes along with perimenopause and menopause, you might also wonder if seasonal time changes like Daylight Saving Time or jet lag from changing time zones while you travel could be hitting you harder than before.
Although we lack research on the specific connection between Daylight Saving Time and menopause symptoms, we do know that time changes of all kinds, whether from the biannual clock switch-up, travel, or working night shifts, absolutely affect how we feel and function. Throw the hormonal highs and lows of menopause into the mix and you may notice more sleep challenges than usual, even if time changes previously didn’t affect you much. It all boils down to the relationship between our hormones and our circadian rhythms.
“Circadian rhythms” might sound like a fun aerobic dance class from the eighties, but it’s just the scientific term for the body’s internal clock. That internal clock runs the roughly 24-hour cycle of processes that determine things like our core body temperature, digestion, mood, and when we’re naturally inclined to wake up, feel alert, and get sleepy throughout the day. Circadian rhythms are largely controlled by the part of the brain called the hypothalamus, which tells various organs to perform their functions at specific times based on environmental cues (like how much light we’re exposed to) or behavioral cues (like when we habitually eat and exercise). It’s a pretty sensitive system, as anyone who has spent their first days of a vacation groggy, cranky, and queasy might know.
Many of the processes governed by our circadian rhythms, like our sleep-wake cycle, depend on the production and regulation of hormones like melatonin, cortisol, and serotonin. When the levels of these hormones ebb and flow at times we’re not used to, it’s a recipe for disorientation and dysfunction.
A time change of just an hour, like when we spring forward or fall back for time changes, doesn’t sound like much compared to jet lag after traveling across multiple time zones, but as we are reminded twice a year, it can feel surprisingly disruptive.
Many of the circadian rhythm disruptions we experience during the spring and fall time changes happen because of how our bodies respond to light. Natural light is the body’s cue to run the sleep-wake cycle by releasing and modulating levels of melatonin and cortisol, two of the hormones that help control when you get sleepy at night and begin to wake up in the morning.
As the days get longer after the “spring forward” time change, even a little more light later in the evening can delay melatonin production, meaning sleep onset might happen later too. This, of course, also affects when our bodies send wake-up signals”not just the ones that pull you from sleep without an alarm clock, but the ones that determine what time of day you’re likely to feel awake and alert instead of groggy.
In a less scheduled world, where we could allow our bodies time to gradually sync up with shifting levels of sunlight throughout the seasons and follow our unique circadian rhythms (also called chronotypes), we might not feel time change effects as much. Unfortunately, just because the time on the clock has changed doesn’t mean work, school, commute times, or business hours start any later.
For many of us, that means sleep loss”according to the Sleep Foundation, the average person gets 40 minutes less sleep on the Monday after Daylight Saving Time begins. There’s actually a term for the mismatch between one’s circadian rhythms and scheduled, time-bound obligations like work or school: it’s called social jet lag, and it’s not great for us!
Social jet lag can make you feel fuzzy-brained in a meeting or cause you to give your equally sleep-deprived and irritable teenager a run for their money, but it has also been linked to more serious health concerns. The American Academy of Sleep Medicine notes that chronic social jet lag is associated with higher risks of obesity, metabolic syndrome, cardiovascular disease, and depression.
While chronic social jet lag is more of a concern if you have to stick to a long-term schedule that’s not compatible with your natural sleep needs, the switch to Daylight Saving Time gives everyone a little jolt of short-term social jet lag, and the consequences can be surprisingly serious.
Studies have found that the days after Daylight Saving Time are associated with a range of fascinating but troubling occurrences, from increased risks of heart attacks, strokes, and atrial fibrillation (a type of irregular heartbeat), to higher rates of work and school absences, medical errors, traffic accidents, and suicide.
Of course, these increased risks are due to complex knots of physiological, social, behavioral, and environmental factors, but there is good evidence that the jarring effects of sleep loss and disrupted circadian rhythms can touch just about every aspect of our lives.
As the weeks go on, most people acclimate to Daylight Saving Time enough to not notice the effects quite so profoundly. But what about those who already struggle to get consistent, quality sleep? Those who wake up at all hours sweating, ruminating, or with a startling snore, thanks to menopause? Does menopause mean every time change from here on out is about to feel a whole lot worse?!
Frankly, we don’t have much data exploring the relationship between Daylight Saving Time effects and menopause symptoms”at least, not enough to say that women in midlife are consistently more or less affected by the time change compared to the general population.
Whether menopause affects circadian rhythms at all is another story altogether. We do know that estrogen is among the hormones that help regulate circadian rhythm-driven processes like the sleep-wake cycle, appetite, digestion, and metabolism, and body temperature fluctuations. When it declines during menopause, the effects are just as noticeable as the short-lived effects of a time change”often worse. Our brains and bodies like to stick with the patterns they’re accustomed to, and when those patterns change due to internal factors like hormone swings or external factors like a new time zone, the adjustment process can be slow and uncomfortable.
The menopause transition can introduce all kinds of sleep struggles: Irregular sleep patterns, insomnia, waking up in the middle of the night, never feeling fully rested no matter how much you sleep, daytime fatigue…to say nothing of vasomotor symptoms like hot flashes and night sweats, which aren’t triggered by the sleep-wake cycle but can still keep you from a good night’s rest. Poor sleep, of course, can lead to or worsen mental health symptoms that may have already reared their heads during menopause, like brain fog, irritability, anxiety, and depression, which in turn can lead to”you guessed it”even more trouble sleeping. It is truly a vicious cycle.
All of this is to say, if you’re dealing with sleep disturbances during menopause and feel more sensitive to your symptoms after experiencing a time change, that’s valid! Your already irregular circadian rhythms suddenly have to adjust to new cues. It’s also perfectly valid if you have these symptoms without the influence of a time change. Menopause sleep problems are common and sometimes complex, but in many cases, they are treatable. And seeking care is not just about feeling better; it’s about investing in your long-term health. Both menopause and chronic sleep issues are linked to increased risks of cardiovascular conditions like high blood pressure and atrial fibrillation, metabolic dysfunction, and body composition changes (i.e., where we gain and hold on to body fat).
Lifestyle changes, medications (including hormone therapy, when appropriate), cognitive behavioral therapy, and solid sleep hygiene routines can go a long way toward resolving chronic sleep concerns. Gennev’s menopause-trained doctors and Registered Dietitian Nutritionists can help address sleep issues like night sweats and fatigue, so if you’re struggling, don’t hold back”make an appointment today. If you suspect something more serious is keeping you from sleeping well, consider a sleep study to check for disorders like sleep apnea. You can even do an assessment from the comfort of your own bed through a company like Complete Sleep, which offers easy, at-home sleep apnea screenings and treatment via custom-fitted night guards.
Even if you don’t usually struggle with sleep, a restless night can happen to anyone, whether from travel, stress, seasonal time changes, illness or menopause symptoms, or just a fun evening out. Here are our top tips for bouncing back when sleep just did. not. happen.
Hydrate: “
The fatigue, brain fog, and malaise that wallop you after a bad night’s sleep might not be due to reduced sleep time or quality alone”they could also be signs of dehydration. While it’s normal to lose some fluids overnight through breathing and sweating, some research has found that adults who slept six hours or fewer had up to a 59% higher risk of dehydration compared to those who regularly slept longer. Even if you are getting more than six hours of sleep, menopause-triggered night sweats could mean that you’re waking up more dehydrated than you realize. This can worsen your symptoms of both sleep deprivation and menopause, so rehydration is a must.
Plain water is a quick and easy option, but for extra flavor you can add a squeeze of citrus, sliced fruit or cucumbers, or crushed herbs like mint, lemon balm, or basil. Electrolytes can help too; you can get these key minerals from fruits and veggies, or in the form of supplemental tablets, powders meant to be mixed with water, or DIY recipes. Gennev’s Registered Dietitian Nutritionists advise patients to look for ones without excess sugar, artificial sweeteners or caffeine, particularly if you plan to consume them later in the day, as these can lead to digestive distress and further trouble sleeping. Sugar alcohols like erythritol are used in some electrolyte formulas as sweeteners, but many people don’t digest these well and there is some research linking high levels of erythritol to blood clots; when in doubt, go for unflavored electrolytes or look up a recipe for a homemade version instead.
Gennev RDN Melissa Burton also cautions that since electrolyte formulas can be quite high in sodium and potassium by design, they might not be suitable for those with high blood pressure or kidney issues. If you’re dealing with hypertension or kidney concerns, check with a doctor or RDN before trying electrolytes.
Move:
Gentle movement, especially in the morning, can help you shake off sluggishness and set yourself up for better sleep that night. Physical activity is one of the cues that regulate your circadian rhythms, so if you’re woozy after a time change or jet lag, a bit of exercise could help you feel back to normal faster.
If lack of sleep has left you too foggy to function, it’s fine to skip the workout class that calls for complicated footwork or slinging heavy weights around”a walk is a great lower-impact choice instead. Here’s how to get the most out of your walks.
See the sun:
Or natural light, at the very least. Morning light and fresh air feel good no matter what condition you’re in, but if you’re sleep-deprived, light exposure shortly after you wake up can help you feel more alert. It’s another one of those signals that circadian rhythms depend on, meaning that not only will it make you feel a little livelier during the day, it will also prepare your brain to produce the hormones that make you drowsy in the evening. Think of it like pre-ordering better sleep for the night to come.
Caffeinate cautiously:
While your daily coffee or tea can taste extra satisfying after a rough night, more is not always better when it comes to caffeine. There’s no need to skip your coffee or switch to decaf if you haven’t slept well (nobody likes a caffeine withdrawal headache!) but drinking more than usual won’t make up for the missed hours. It could tip you from slightly energized to jittery and anxious before you know it”not ideal if you’re already dealing with menopause-related anxiety or irritability. Caffeine has a half-life of 4-6 hours and traces of it can stay in your system even longer, so any extra caffeine you consume in the afternoon could still contribute to keeping you awake that night if you’re sensitive to it.
The FDA’s recommended safe daily limit for caffeine is 400 milligrams before unpleasant side effects set in, but everyone processes it differently and caffeine content can vary between types of teas, energy drinks, and even coffee blends. If you’re curious about how much caffeine you could be consuming, check out this chart of caffeine content in popular products.
Other vices to skip? Alcohol, processed sugar, and long naps”alas. It’s tempting to take the edge off with an afternoon snooze, a sweet treat, or a nightcap, but they can all interfere with sleep quality, mess with circadian rhythms, and aggravate symptoms of menopause. If sugar-induced hot flashes sound like a special kind of indignity you’d like to avoid, fresh fruit and decaf tea (like ginger, rose, or hibiscus) can tick the boxes for something sweet and hydrating.
Stick to your schedule:
Shouldn’t the remedy for not getting enough sleep be…more sleep? Not in the way you might think. Sleep experts like those interviewed in this episode of NPR’s Life Kit caution against long naps too close to bedtime and sleeping in later than usual. As good as they feel, both practices can further throw off your circadian rhythm and confuse your brain so it doesn’t send the sleep-wake signals when it should. A better solution, if you really need some sleep to get through the day, is a brief nap: no more than an hour long, and at least six hours before you plan to go to bed.
While we’re used to observing American Heart Month in February, we’re pretty sure we don’t have to tell you about the importance of staying on top of heart health all year round. Our hearts beat all day every day, and we’d like to keep it that way as long as we can.
The statistics about women and heart disease are sobering”even more so when you consider that cardiovascular disease risks increase significantly after menopause due to estrogen’s cardio-protective effect declining as hormone levels decrease during the menopause transition. Lack of information about these risks, combined with the fact that many symptoms of heart conditions can present differently in women than in men, means women often delay seeking and receiving lifesaving care.
While we’d love to wave a magic wand and close that cardiovascular care gap in an instant, healthcare doesn’t work like that. What we can do is educate and encourage women to take an active role (literally!) in supporting their cardiovascular systems for long-term health. One tried and true way to do that? Get moving.
To understand why women’s cardiovascular disease risks go up after menopause, we’ve got to turn to that powerhouse hormone, estrogen. Estrogen is believed to have a protective, anti-inflammatory effect on the heart and blood vessels, keeping them flexible for improved blood flow and mitigating the accumulation of plaques that can build up in the arteries (a major contributor to some types of heart disease). Estrogen also helps manage the metabolic processes that keep markers like cholesterol and blood glucose levels in check.
During the decline of estrogen that accompanies menopause, those protective effects decline too, which is why some women see unwelcome changes to their blood pressure, cholesterol levels, and insulin regulation. All of these markers can affect heart and blood vessel health if they get out of control and aren’t managed over time. To make matters worse, the uncomfortable symptoms of hormone swings”like night sweats, hot flashes, and sleep disturbances”may put additional stress on the cardiovascular system by increasing blood pressure and heart rate.
Even circumstances from before menopause can affect our hearts; women who have been pregnant should be aware that a history of pre-eclampsia and gestational diabetes can significantly raise the risk of developing cardiovascular diseases with age.
Is reading all this making you want to get up and do a quick circuit of jumping jacks, squat jumps, and mountain climbers like right now? Honestly, same. Let’s do a few, then dig into some common questions about exercising for heart health before and after menopause.
We spoke with Stasi Kasianchuk, Gennev’s Senior Director of Lifestyle Care, Registered Dietitian Nutritionist, and certified Exercise Physiologist. She explained what we all need to know about how women can approach heart-healthy exercise from perimenopause through postmenopause.
Exercise can’t bring your estrogen back once it has started to decrease, but it can help your body handle the consequences of this hormonal taper and stay healthier through the natural effects of aging.
Exercise supports your cardiovascular system by:
All the above is true for people of any age, of course, but when you consider how much estrogen does to help these physiological processes work smoothly before menopause, it becomes even clearer that exercise is critical for staying healthy after menopause. It mitigates the effects of dwindling estrogen in a big way.
Short answer: YES. If you already have a moderate-to-vigorous cardio workout routine of choice, like running, cycling, swimming, cardio-based exercise classes like dance, or interval training, keep it up, says Stasi. The protective benefits of aerobic exercise for your cardiovascular system are tremendous, and can help ease other bothersome menopause symptoms, like stress and poor sleep.
So where did the idea that you have to give up cardio once you hit menopause come from? As with a lot of ideas about menopause, exercise, and health in general, this probably started as a kernel of truth addressing a very specific situation or piece of research and evolved to become a major misconception.
One thing that could be behind this idea is that many women find that the cardio routines they followed in their 20s and 30s don’t feel as effective as they used to, in that they may no longer ward off the weight gain and body composition shifts that accompany perimenopause and menopause. A common recommendation in that case is for women to try strength or resistance training, like lifting weights or bodyweight exercises. These workouts can more actively build muscle mass than cardio exercises on their own, and more muscle means a lot of good things during menopause: improved metabolic functioning, steadier blood sugar regulation, better bone health, and for some, an easier time managing weight changes. But that’s not to say that they are better than cardio workouts or should replace them altogether.
If you’re still enjoying your cardio routines but feel like you’re working harder than you used to (or would expect to), or struggling to recover as quickly as you’d like, that’s not necessarily a reason to give them up. But you may want to investigate whether perimenopause or menopause could be contributing to your experiences. Your body’s needs for fuel and rest do change with menopause, and it’s normal to feel those effects, especially as age and hormones do their thing and you begin to lose some of the protective effects of estrogen on your arteries, muscles, and bones. It is completely okay to switch up the kind of cardio you do if high-impact aerobic workouts aren’t working for you after menopause.
If you have any concerns about your heart health, talk to your doctor and familiarize yourself with signs of heart disease in women. Stasi also recommends seeking guidance from a credentialed exercise professional and approval from a physician before starting an intense new cardio workout routine.
Make no mistake: strength training, especially weightlifting, is great for your heart. If you have done resistance training at a level that was at least somewhat challenging, you probably recall breathing faster and feeling your heart beating faster. That is a sign that your heart is pumping harder”nice work! While resistance exercises may not get the heart pumping as vigorously as a high-intensity aerobic workout can, any intentional increase in heart rate is a win. Additionally, by helping you build muscle mass and improve your metabolism, strength training can lower blood pressure, improve blood sugar levels, and improve total cholesterol markers. This is particularly important for preventing the buildup of plaque in the arteries that can decrease blood flow to the heart or brain and cause heart attacks or strokes.
Now, here’s where the devil is in the details. While it is possible to obtain all necessary cardiovascular benefits from weightlifting alone, that usually requires following an intentional and strategic plan created with an exercise professional. Stasi advises that in order to optimally support heart health, most people would benefit from including cardio-specific exercise in addition to weight training.
One encouraging thing about finding workouts for menopause heart health is the range of activities to choose from. Not a runner? Try rowing. Rather be in the water instead of skimming along on top of it? Swimming is great for your heart and easy on your joints if you are one of the “lucky” ones experiencing joint pain. Firmly a creature of dry land? Hiking, especially done at a moderate pace with a few hills in the mix, is a great way to get a dose of cardio plus the added health benefits of spending time in nature.
You get the idea”there are a lot of ways to move, and they can all serve your body a little differently.
Some forms of cardio are considered “low-impact steady state” or LISS, and usually involve keeping the heart rate within a certain beats-per-minute zone for a longer period of time, without a great deal of variation. Other forms fall into a category that might be familiar to you: “high-intensity interval training” or HIIT. HIIT exercises are exactly what they sound like: bursts of intense effort at a fairly high heart rate followed by short rest periods, then repeated. The workouts tend to be short and spicy, with some studies showing they can accelerate fat burning, improve heart rate variability more quickly than moderate steady state cardio, and improve overall cardiometabolic health markers in women.
There’s no question HIIT exercises work your heart, but it’s fair to be curious about whether they’re appropriate during midlife, especially since there’s not a great deal of research about HIIT’s effectiveness for women going through menopause. The intensity can be taxing on your body and some HIIT workouts may involve movements (or accessories, like weights) that take practice to perform at speed without risking injury. Paired with conditions that can come along with aging and/or menopause, like decreased muscle mass and bone density, poor sleep, thyroid disorders, joint issues, high blood pressure, or existing heart disease, HIIT might not be a suitable type of cardio for everyone, particularly those new to exercise or picking it up again after a long break.
If you’re regularly going to HIIT classes, working out without getting injured or experiencing extreme fatigue, adequately fueling and recovering, and feeling pretty good, don’t let us discourage you from your workout of choice! And don’t be afraid to modify your workouts if you need a change; there are many activities you can do in a HIIT format, and you can experiment with different interval lengths to adjust the intensity of your routine.
If you’re not in the habit of regular cardio exercise, the Physical Activity Guidelines for Americans’ recommendation (supported by the American Heart Association) of 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week, plus at least 2 days of strength training, can sound incredibly daunting. Then again, so does heart disease! Even small changes to get more movement into your routine can have positive effects on your heart health, and building momentum once you’ve gotten started is sometimes easier than taking the first steps.
Our advice?
Start with what feels manageable. Don’t write off walking and lower-impact activities if you’re easing into an exercise routine”just focus on moving more at first. That can even include gardening and yard work, so if you’re not sure what kind of workouts you’d like to try yet, you can work toward meeting your weekly movement goal by raking leaves, mowing the lawn, or briskly weeding the flowerbeds.
Pause to appreciate the movement you do get and what it’s doing for you. Next time the elevator’s out at work and you have to take the stairs with a messenger bag in one hand and a full 64 oz water bottle in the other (“cause you’re hydrating your way through menopause like a pro), take a second to appreciate it as, say, cardio in the wild. Reflecting on the positive effects of your daily activities can make you want to look for even more opportunities to move, and it’s nice to remember that you don’t always need to suit up in workout gear to get your heart rate up and work those large muscle groups.
Lean on your team, whether that’s friends who are willing to try a new workout class with you, a doctor or Registered Dietitian Nutritionist who can give you tailored fitness and nutritional advice for menopause, or family members cheering you on for the changes you’re making.
Have more snacks”exercise snacks. “Exercise snacks,” short bursts of heart-pumping activity, aren’t a particularly new concept, but they’re one more way to boost your baseline activity level even on days when you don’t have the time or energy for a workout. There’s plenty of research linking prolonged, uninterrupted periods of sitting to increased risks of heart disease and Type 2 diabetes, but there are things you can do to counteract the effects of sitting too much (even with a desk job!). You might rally a coworker to join you for a walking meeting, or set a timer to remind yourself to get up and move every hour. If you work from home or have a lighthearted workplace, make it fun”a dance break in the kitchen while you heat up your lunch gets the blood moving and is great for morale. The point is not to obsess about how active you are, but to find little ways to break up sedentary periods throughout your day.
Know what motivates you. You don’t have to be an athlete or absolutely love to exercise, but finding your core motivation can go a long way toward making it a regular part of your life. Maybe you’re a data-driven person who likes to track progress over time, or you thrive on routine. Maybe you enjoy setting and reaching goals or are inspired by learning the science behind what exercise does for your body. Maybe you’re feeling feisty and want to live long enough to see true healthcare parity for women”pretty good reason to exercise, if you ask us.
If you’re ready to find your reason, book an appointment with one of our Registered Dietitian Nutritionists for personalized, evidence-based guidance about maintaining a heart-healthy lifestyle through menopause.
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Something you should know about Gennev is that we’re not afraid to go there. We’ve covered topics many people are tempted to talk about in whispers, if they talk about them at all: Vaginal atrophy. Lichen sclerosus. Ovarian cysts. Inverted nipples. You may never have thought to search for those phrases, and you may never want to, but if you ever need to, you deserve evidence-based, expert-backed information. Women’s healthcare has long been under-researched, under-served, and under-funded (you could even say it’s under siege…), but that’s all the more reason to have a trustworthy source of accurate answers to your most important questions. This is no time to be coy about our health.
Today, we’re going there to unpack a topic with a lot of chatter around it: the skyrocketing popularity of GLP-1 drugs, a class of medications gaining attention for their use in treating obesity and diabetes.
These drugs are no secret, and weight is not a shameful topic, but we want to acknowledge that not everyone wants to read about weight-related matters for a range of totally valid reasons. If this is not the post for you, that’s okay.
At Gennev, we believe that healthy bodies come in all shapes and sizes, and that if weight management is something you’re interested in, it should be one part of a comprehensive plan to have the kind of healthy life you want, regardless of your age, where you are in menopause, and what’s going on in your world.
That said, we live in a culture that talks a lot about weight: how to lose it, how to keep it off, how to manage it safely and sustainably, why we gain it back. The messaging is hard to miss, and during menopause, it seems to get even louder, as women wonder what’s behind the mysterious “meno belly“ and try to figure out why they seem to gain weight overnight. It’s no wonder, then, that weight loss drugs with a high success rate are getting so much airtime in the cultural conversation.
Since so many are curious about GLP-1s, and Gennev MDs can prescribe them in appropriate circumstances as part of our weight management program, we want you to have all the information you need about this potential option in your menopause weight management toolkit.
But first, some science.
Let’s make the proper introductions: this drug class is broadly known as Glucagon-like Peptide-1 Receptor Agonists. You may know them by their generic pharmaceutical names, like semaglutide, or their commercial brand names like Ozempic or Wegovy (FYI: both Ozempic and Wegovy are brand names for semaglutide, but the drugs are approved and formulated to treat different conditions, so they get different names. The more you know!).
In the body, these medications mimic GLP-1, a naturally occurring hormone that helps manage blood sugar and regulate the appetite. When you eat, the small intestine secretes GLP-1, which signals to other cells that it’s time to perform several digestive and metabolic functions.
The signals that GLP-1 puts out can:
And what about “receptor agonists”? If that sounds like a job title for a secret agent in a spy movie, well, they do kind of act like undercover operators when the body’s systems aren’t working as they should be.
An agonist is a manufactured substance (in this case, synthetic GLP-1 molecules) that binds to a compatible receptor site in or on the surface of a cell. This triggers the effects of the naturally occurring substance (the GLP-1 hormone the body should produce) and tells that cell what to do next (carry out the digestive and metabolic processes the body may struggle to perform on its own).
GLP-1 Receptor Agonists, or just GLP-1s, as you may see them called, have been approved for the treatment of Type 2 diabetes to help regulate blood sugar since 2005. Researchers took notice when patients taking GLP-1s for diabetes also experienced significant weight loss, and in 2014, the FDA approved the first GLP-1 to treat obesity.
Since then, multiple GLP-1 drugs approved for obesity and diabetes treatment have hit the market, with more in development. They also show some promise for treating or lowering the risk of other conditions; while much more data is needed, it’s unsurprising that the drugs have become such a hot topic given all their potential applications.
Before we go much further, let’s get specific about some terms. With full acknowledgement that GLP-1s are casually called “weight loss drugs” in headline after headline, we’ll mostly refer to “obesity” and “weight management,” rather than “weight loss” in the rest of this article. It’s important to anchor the conversation around GLP-1s on the fact that they’re indicated for something specific: Managing weight concerns, like obesity, associated with metabolic dysfunction and chronic disease”not the normal, gradual weight gain associated with aging (and yes, sometimes menopause).
Gennev’s Chief Medical Officer, Dr. Rebecca Dunsmoor-Su, says this is an important distinction.
“GLP-1s are for obesity, not menopause weight gain. In general insurance companies will not cover these medications for those with a BMI of less than 30, or 27 if they have medical comorbidities related to obesity [like diabetes or heart disease]. We tend to follow these guidelines, as the medications are very expensive if not covered.”
As effective as they are, she says, GLP-1s are not a quick fix, and they’re not for people who need or want to lose the 10-15 pounds that can accompany the transition into midlife (for those folks, Gennev’s menopause-trained MDs and RDNs have many weight management strategies that can be tailored to patient goals). GLP-1s do come with some risks, and can be expensive, subject to shortages, or not covered by insurance, so it’s wise to make an informed decision about whether they’re the right choice before starting them.
That said, there’s always nuance to consider. We know that the hormonal havoc of menopause can raise the risk of metabolic syndrome emerging in those who are genetically predisposed to conditions like high cholesterol, insulin resistance, high blood pressure, and obesity. Sometimes, it does make sense to consider GLP-1 drugs for menopausal patients dealing with metabolic dysfunction identified via lab work.
In an upcoming paper, Gennev physicians Dr. Hana Mikdachi and Dr. Rebecca Dunsmoor-Su note that as popular as GLP-1 drugs have become, they haven’t specifically been studied in peri- or post-menopausal women. This is a major opportunity for further study for a few reasons: many women report that weight gain during menopause feels harder to manage and less responsive to their usual eating and exercise habits, and some anecdotally cite GLP-1s as the most effective intervention they’ve tried.
Also, women in midlife may have other health concerns alongside weight, such as bone health, cardiovascular health, and loss of muscle, which could affect how they respond to GLP-1s. More research on the use of GLP-1s for weight loss during menopause will help both patients and providers understand what kinds of risks and benefits to expect.
The decision to start a GLP-1 should be made with your doctor, who should take a thorough medical history and current health status, including your weight, metabolic profile (for example, cholesterol and blood glucose levels), and consider additional health conditions like heart disease, Type 2 diabetes, or even pre-diabetes”the drugs’ effectiveness at regulating blood sugar levels can help lower the risk of developing more severe metabolic disease.
Dr. Dunsmoor-Su says that patients who come in with questions about the drugs usually want to know about the risks and side effects, and whether they can use them for a short period of time, or if they’re a lifelong commitment.
We’ll break it all down below.
Most GLP-1 medications are administered via injection with a small dosing pen that patients can learn to use at home. As with any drug, GLP-1 side effects can range from mild to severe, and will vary from patient to patient.
More common side effects:
Severe but less common side effects:
The FDA recommends that patients with certain conditions avoid GLP-1s. Some of these contraindications are due to known serious risks, and others are out of an abundance of caution based on early or inconclusive studies.
These conditions include:
The answer to this is quite complicated and may depend on the patient and why they’re taking the drug. The medical community is still learning about the long-term outcomes of GLP-1 usage for weight management, and what happens when the drugs are discontinued.
Here’s what we do know:
We promised you real talk, so let’s touch on another important topic in the GLP-1 conversation: compounded drugs.
Compounded drugs are not generic versions of brand-name formulas, but custom-made compounds assembled in pharmacies or independent labs. They’re sometimes used when a patient can’t tolerate an ingredient in a generic or branded drug, and are often cheaper to purchase and not subject to ingredient shortages that can make drugs harder or more expensive to make.
The catch? Compounded drugs aren’t FDA-approved, and the standards of the facilities that produce them vary widely. This makes it virtually impossible to guarantee the safety, effectiveness, quality, or dosage accuracy of compounded formulas and the ingredients used to create them.
Compounded semaglutide for weight loss can look like an appealing option to those starting to explore the GLP-1 landscape. It’s custom-made, may be more widely available and more affordable than prescription medications like Wegovy, particularly when insurance won’t cover them, and comes tidily marketed by direct-to-consumer companies with slick branding. Some companies even make it easy to buy compounded semaglutide online without an in-depth conversation with a doctor”sounds fast and simple, but this can be dangerous.
Another thing to watch for is murky labeling issues, since some companies describe their compounded GLP-1 formulas as “generics.” This is misleading, since generic drug formulas are FDA-regulated and must meet the same ingredient, safety, dosing, manufacturing, and quality standards as their brand-name counterparts. As of February 2025, when we’re writing this, there is no approved generic formula for any GLP-1 drug”anywhere. What this means is that any medication being marketed as “generic” semaglutide is, in fact, a compounded drug using unregulated imported ingredients. That’s a significant ethical and health concern, since there’s no easy way to know what these ingredients are, how much of them the formula actually contains, or what risks they present to patients.
We don’t want to scare or shame anyone for being curious about compounded semaglutide or other compounded GLP-1 drugs, but the unfortunate truth is that these formulas can come with serious safety concerns, so we at Gennev do not prescribe or recommend them. The FDA issued a statement in December 2024 about the risk of using unapproved GLP-1 formulas, and all North American obesity medicine societies recommend against their use as well.
It’s an incredible time to be in women’s healthcare, breaking taboos and giving women the information they need to make responsible decisions about their well-being. We know everyone has a unique relationship to the topic of weight, shaped by decades (okay, an eternity) of cultural conditioning and personal experiences, but that’s why we speak candidly about it”particularly during times like menopause, when our bodies start pulling stunts we’ve never seen before and it’s hard to know what advice to trust.
We’ve created a patient-focused, evidence-based weight management program (eligible for self-referral under some insurance providers) meant for exactly that situation: your body’s changing, you’re not sure how to feel about it, and you want to protect your long-term health. GLP-1 medications may or may not ultimately be part of your strategy, but the good news is you’ll have plenty of ways to reach and stay at a healthy weight, overseen by our menopause-trained Registered Dietitian Nutritionists and MDs.
Dr. Dunsmoor-Su sums it up: “We designed the program to focus first and foremost on lifestyle changes and the support to make those [by] working with an RDN. These are the changes that will over the long term make the most difference. When thinking about medications (GLP-1 or others) we consider other medical conditions, other symptoms and what medication interactions might be an issue. Even if GLP-1 medications are inaccessible due to cost there are other medications that might help, and we can discuss risks and benefits of these.”
So if menopausal weight gain is on your mind, and the chatter about semaglutide and other GLP-1 medications has you curious, please don’t be shy. We hope we’ve given you plenty of information to consider about these drugs and the variety of options for healthy, body-positive weight management through Gennev. If you have more questions or are ready to try something new, book your intake to get started.
Real quick”off the top of your head, can you name everything you’ve done today? If you’re reading this over your morning coffee, your list might be short: woke up, walked the dog, made breakfast, and sat down to catch up on Gennev’s blog. If you’re reading this on your commute home from work, it’s fair to say your list might be a little longer. No matter what’s on it, we’re going to guess there are a few things it probably doesn’t include:
And thank goodness, right? If we had to add biochemical bodily functions to our to-do lists on top of everything else we juggle, we just might lose it. Luckily, we all come with built-in programming that handles many of those processes for us without any extra planning on our part: our metabolism.
Wait, how does the metabolism work again?
Think of the metabolism as a sort of engine that runs two complementary processes:
Catabolism, in which your body breaks down nutrients to create energy (a process that includes burning calories)
and
Anabolism, which uses that energy to build and repair molecules in the body. These can go on to become new or healed tissue (for example, muscle growth after exercise).
When these processes are in sync, your body can do everything it needs to: breathe, digest food, circulate blood, regulate hormones, eliminate waste”all the things you’re glad to not have to put on your daily to-do list, because if all’s going well inside, they’re already getting done.
What’s going on with my metabolism during menopause?
To understand what can happen to your metabolism during menopause, it’s helpful to frame overall metabolic health as “the balance of nutrients and activity that supports the fundamental systems that run your body,” says Gennev’s Chief Medical Officer Dr. Rebecca Dunsmoor-Su. She emphasizes that metabolic health is highly variable between individuals and depends a great deal on genetics, lifestyle, and personal risk factors. Supporting a healthy metabolism at any age requires understanding and balancing your body’s needs for fuel, movement, and rest.
Midlife ushers in unique circumstances for women, though. As we age, especially during the transition into menopause, the balance between those needs for energy, activity, and recovery starts to shift, and the body reacts accordingly. Dr. Dunsmoor-Su reminds her patients that this is not unusual. She explains that if you’ve noticed changes to your energy levels, appetite, body composition (i.e., where you carry your weight), or bloodwork (like cholesterol and blood sugar levels), you’re not imagining them; they can be a normal part of aging, to an extent, and a consequence of hormonal fluctuations starting even in perimenopause. (Fun, we know.)
If it feels like your menopausal body has a whole new set of demands lately, Dr. Dunsmoor-Su confirms that may not be far from the truth. Reacting to your body’s changing needs is key for staying metabolically healthy, she says, and maintaining that nutrient-activity balance after menopause can require different proportions of nutrients, different types of exercise, and more attention to quality rest for optimal health.
This is by no means impossible, particularly if you’re not genetically predisposed to certain metabolic disorders (we’ll get to those), but you may already know that it can take a little extra patience, creativity, and support to make the lifestyle changes that will keep your metabolism thriving.
If patience and creativity alone aren’t getting you where you want to be on your menopause journey, let Gennev add the support. Make an appointment with a menopause-trained MD or RDN today.
If some changes are normal, what kinds of metabolic changes during menopause should I be concerned about?
While everyone can expect some metabolic changes as they age, some people may be prone to metabolic disorders that can arise or worsen during menopause due to genetic and lifestyle factors. One example is a term you may have heard before: metabolic syndrome.
Metabolic syndrome describes a cluster of disorders, most related to your body’s ability to process insulin, that can raise the risk of Type 2 diabetes, stroke, and cardiovascular disease. It’s commonly indicated by having three or more of the following biomarkers, which are considered out of range for optimal metabolic health:
For those genetically predisposed to metabolic syndrome, menopause may be the time when these conditions begin to show up, affect your health, and become more challenging to treat.
Menopause strikes again. Why does this happen?
There’s a lot we’re still learning, but from a physiological standpoint, some conditions that contribute to metabolic syndrome during menopause can be due to hormonal changes. Hormones like estrogen, progesterone, testosterone, and insulin are just a few of the key players in the metabolic processes that your body needs to function. When their levels fluctuate during perimenopause and menopause, it can lead to a cascade of consequences that can include:
These changes also often come along just as midlife throws its curveballs: you hit a career high with a big promotion, but it leaves less time to fix healthy home-packed lunches. Your kids and aging parents are somehow both keeping you up at night. Staying active has gotten harder as your family’s schedule has gotten busier. You have global news, celebrity gossip, and life updates from everyone you know at your fingertips 24/7. And you’re supposed to be able to clear your mind and de-stress just like that?!
Between the onslaught of hormonal changes, physical symptoms, and lifestyle stressors that can make those symptoms tougher to manage, it’s no surprise that menopause is the time when disorders like metabolic syndrome may start to come out in full force. This is concerning because without intervention, conditions like insulin resistance and inflammation can get worse. These in turn can raise the risk of cardiovascular disease, stroke, diabetes, thyroid disease, and even cancer”all good reasons to take metabolic syndrome seriously.
It’s important to keep in mind that menopause doesn’t automatically come with a side of metabolic syndrome despite the increased risks due to hormone changes, and there are steps you can take to start improving your health and metabolic function at any time. This is true during perimenopause too, when many women first notice body composition changes or get unexpected results from lab work”sometimes the first signs that metabolic shifts might be taking place.
It can be disconcerting when these changes and symptoms come along, so we always encourage women to seek support from providers who are knowledgeable about menopause.
If you have specific concerns, or want some guidance about what to prioritize, chat with a doctor or Registered Dietitian Nutritionist. They’ll help you make a plan that might include diet, regular exercise, and lifestyle changes to reach your desired goals. Your doctor may also discuss hormone therapy and medication, if appropriate, and both providers can discuss the impacts of the various treatments that may be available to you.
Gennev clinicians in action
Helping patients find long-term solutions for their unique health concerns during menopause requires thoughtful detective work from Gennev MDs and RDNs. Like other Gennev clinicians, Melissa Burton, RDN, looks well beyond standard lab work to take a holistic look at all factors that could be contributing to her patients’ symptoms.
Though Gennev RDNs don’t order lab work, they work closely with MDs and patients to get all the necessary information for a thorough intake. When Melissa begins working with a new patient, for example, she may recommend they have their doctor order labs like a complete cholesterol panel, which measures LDL cholesterol levels alongside HDL and triglycerides, and tests that measure glycemic control over a period of months instead of hours, which may give her more information than a single fasting blood glucose test.
She’ll consider vitamin and nutrient deficiencies; low levels of Vitamin D, Vitamin B12, and iron”to name a few”are common culprits of many symptoms that can crop up during midlife. She’ll also ask her patients about stress, sleep, and other lifestyle factors, and have them keep a thorough food journal to keep track of what they eat and when. All these details help Melissa get a complete picture of what may be going on for her patients metabolically, so she can craft a plan to help them manage their symptoms and health conditions.
Dr. Dunsmoor-Su adds that Gennev patients can talk with an MD about their risk for diabetes and cardiovascular disease, particularly if there’s a family history of those conditions to consider. She also encourages patients to explore whether hormone therapy could play a role in reducing certain troublesome symptoms during menopause and the long-term health risks associated with them.
I’m ready to support my menopausal metabolic health. Where do I start?
Feeling motivated? You don’t have to figure it out alone. Check out our tips for the best exercises for metabolic health, read up on dietary tips for hormonal weight gain from Gennev’s Registered Dietitian Nutritionists, or incorporate more delicious anti-inflammatory foods for a simple change you can make right away.
Your metabolic health wasn’t determined in a single day, though sometimes it can feel like menopause wreaked havoc on it overnight. Whatever you’re going through, even small adjustments are worth it for your long-term well-being. If you’re eager to learn more about how to keep your metabolism healthy during menopause, reach out to a Gennev menopause specialist to get started with a personalized care plan.
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The holiday season is a time of giving, and finding the perfect gift for the women in your life can be a meaningful way to show you care. For women experiencing menopause, a thoughtful gift can go beyond the ordinary, offering comfort, empowerment, and a reminder that their wellness matters. Whether you’re shopping for your mother, sister, friend, or partner, gifts that support her journey through menopause can make this season even more special.
From cozy solutions for those sleepless nights to self-care essentials that celebrate her strength and resilience, this guide is full of holiday-inspired gift ideas that she’s sure to appreciate.
Menopause often brings stress and fatigue, making self-care gifts a practical choice. Consider:
Well-being is crucial during menopause. Support her health with these practical gifts:
Staying active is crucial during menopause for managing weight, boosting mood, and maintaining bone health. Consider these fitness-focused gift ideas:
Menopause is as much a mental journey as a physical one. Help her stay positive and mindful with these ideas:
Clothing that prioritizes comfort without sacrificing style is a winner:
Modern problems call for modern solutions. Tech gifts can help manage symptoms:
Sometimes, the most meaningful gifts are those tailored to her unique preferences:
Nourishment and comfort often go hand-in-hand:“
If she values experiences more than material gifts, consider these:
For a truly thoughtful and expert-driven gift, consider these recommendations from the Gennev team.
Menopause is a complex and deeply personal journey. The most meaningful gifts are those that show thoughtfulness, understanding, and love. Whether you choose a wellness item, an experience, or a sentimental keepsake, your gesture will remind her that she’s supported and cherished during this transitional stage. This shopping season, let your gift speak volumes about your care and appreciation. Happy Holidays!