Last month an elegant woman in her seventies came into my office for a third opinion on treatment options for her rapidly enlarging uterus. I thought she wanted a surgical consult. I quickly learned, however, that she really just wanted her menopause hormone replacement therapy refilled and I was the third solicitation on the list. Her long-time gynecologist refused to refill her prescription due to fear that a cancer had caused the increase in the size of her uterus. During our visit, she seemed more distraught about losing her hormone replacement therapy than the prospect of cancer. This led me to think about how some women might consider hormone replacement therapy a “fountain of youth,” and about the self-care strategies that I have personally found effective in maintaining vitality.
Quick lesson on hormone replacement: Hormone replacement therapy (HRT) is treatment with estrogen and progesterone with the aim of alleviating hot flashes, night sweats, vaginal dryness and osteoporosis (weak bones). It is safest to start HRT in women who are less than 60 years old or who are within 10 years of menopause onset. The risks of heart disease, stroke, blood clots and dementia increase if HRT is started in women older than age 60 or who are more than 10 years from menopause onset. There are no hard rules on the duration of HRT use; however, results from studies suggest that 5-10 years of therapy from the onset of menopause is safe.
The woman in my clinic on this day had been on hormone replacement therapy since going through menopause in her early 50s.Though she had long since had hot flashes, she believed the HRT kept her skin taut, hair full and waistline thin. As I’ve mentioned before, I am vain, which is why I had such a hard time declining her request. Faced with the prospect of cancer and losing her fountain of youth, she was choosing the latter and I understood.
As the conversation went on, it was very apparent that what this woman desperately wanted was to hold on to her vitality. What do I mean by vitality? For this patient, she relayed that many of her contemporaries not only looked old, but also relied on others to care for them and had limited mobility and capacity to enjoy life to the fullest. She attributed her advantage to HRT. For many women, maintaining vitality also means maintaining their active and fulfilling sexual lives, for which HRT has also shown benefit. Although, I wholeheartedly agree that hormones are wonderful (the relief of my night sweats is my personal testimony), she negated all of the other things she was doing to maintain her sense of well-being. In our brief time together, I learned that she was meticulous about her diet and was an avid tennis player. No doubt her beautiful skin and youthful figure were mainly due to the healthy way she choose to live her life, not solely the HRT. We also know that there are many self-care strategies (beyond HRT) that women can use to maintain vitality in their intimate lives including exercise and much more (for examples, see these posts).
I’ve been reflecting on my own insecurities about aging. It is not rational, but I compare my 45-year-old-self to my 21-year-old-self. And my beautiful patient was comparing her 70-year-old-self to most likely her 45-year-old-self. This epiphany not only helped me put into perspective how I view my own personal menopause journey, but also changed the way I think about counseling patients. My main goal as a physician is to help women stay strong, healthy, vibrant and most importantly independent. Yes, there is a role for HRT, but it is not the only solution. I have found that those who have the most vitality in older age are active and strong, as was this patient. This comes from healthy eating and exercise. These habits, though they can be hard to form, are the first pearls that nourish the fountain of youth. To that end, these are the principles I live by…
Be meticulous with your diet or as I like to say…”be a food snob”
My friends and I love food. All of our outings involve food in some way (probably why they are my friends). When we go out we share. Very rarely will I order an entrée for myself and I almost never order a dessert that isn’t going to be shared. I also stopped “polite eating.” Polite eating entails eating food you do not really want to please others. For example, eating the dry pound cake your co-worker offers to not offend. Along the same vein, this also means not eating anything I do not recognize….monosodium glutamate, maltodextrin etc. It was a conscious decision to eat foods that would give me life, energy and vitality. Initially I thought it would be a sacrifice, but quickly embraced the decision because I felt so much better. I didn’t stop at food choices; I also cut back on portion size. In the process there were foods that I’d previously enjoyed that I stopped eating because they made me feel bloated or extremely fatigued, but for the most part I told myself that I could eat anything I enjoyed, but in moderation. For me, moderation meant limiting white starches/carbs, sugar, cheese and processed foods and eliminating meat. My love of sushi kept me from totally cutting out fish. Veggies and fruit were free. You can look at a juicy red apple or vibrant kale salad and know that you will be energized.
Treat your diet like you treat your bank account.
We all indulge sometimes. I absolutely cannot drive by Sprinkles without getting a red velvet cupcake. Whoever thought of the cupcake ATM is genius. Here’s where the bank account analogy comes in. If I indulge in something decadent, just like if I went on an expensive vacation, I have to scale back later. The conscious decision to eat smaller portions of whole foods has given me more energy than I had as a teenager.
Make exercise a way of life.
There is no getting around it. Exercise, especially weight bearing exercise is the only way to keep it tight! Good genetics goes out the window over the age of 35. There is no shortcut, women who look fabulous midlife and beyond are putting in work. Furthermore, the ability to maintain independence and vitality is dependent on keeping our bodies strong. Midlife is a period where our bodies can deteriorate fairly quickly if there isn’t consistent effort. With that being said, it is imperative that you engage in activity that you enjoy. For me, hands down yoga, walking and biking give me life (in that order). I’m terribly envious of the women running on the lake with their ponytail bouncing in the wind. Believe me, I’ve tried to love running, but I absolutely hate it. My ponytail that starts out bouncing shrivels to an afro puff and the effortless trot that I start out with ends with me gasping for air. Not the Vogue image I like to exude. Don’t judge me, I already disclosed that I was vain.
Whether your motivation be maintaining an ideal weight, youthful appearance, strong core, independence or fulfilling sex life (more on this in the next two blogs so stay tuned), regular exercise and adhering to a healthy diet can help achieve those goals.
As people, and especially as people who undergo menopause, we all find ourselves in the inevitable struggle to hold onto our vitality and strength as we age. While some treatments come close, there is no magic pill for “youth.” Ultimately, we help ourselves most by forming healthy habits, some of mine which I’ve described above. Believe me, I understand how difficult it can feel to begin making these changes in our lives. My patients are struggling daily to balance X,Y, and Z and I know how exhausting it sounds to add in taking care of our physical selves. However, small things can pay off in huge dividends.
Edited by Leilani Douglas