Women are often dismissed when sharing their symptoms, being told they’re “normal,” “just a part of getting older,” or handed a prescription for antidepressants. However, a new generation of women is rising up, refusing to accept these answers and demanding better advocacy for their health This eBook is designed to spark the conversations you may not have had with your healthcare provider and to empower you with the knowledge and direction needed to seek the answers you deserve.
LIV1 HEALTH
JESSICA RAYMOND CEO & NP
WELCOME TO LIV1 HEALTH
MENOPAUSE TRANSITION
Our mission is to empower women with comprehensive, evidencebased information and practical guidance on navigating the menopausal transition We aim to support women in understanding and managing their symptoms, embracing this natural life stage with confidence and vitality, and making informed decisions about their health and wellness.
MENOPAUSE IS AN INEVITABLE PHASE IN EVERY WOMAN’S LIFE, MARKING THE END OF HER REPRODUCTIVE YEARS.
Despite its universality, the experience of menopause can vary widely among women, with different symptoms and challenges. Understanding and preparing for this natural transition can empower women to navigate it with confidence and grace. By embracing menopause as a normal and significant life stage, women can focus on maintaining their health, vitality, and quality of life during and beyond this period.
STATISTICS
100%
100% of women will go through menopause.
Whether it is through natural aging, surgical or chemically induced every women will experience menopause
75%
Hot Flashes affect 75% of women.
Sudden waves of heat, sweating, and flushing can happen anytime with the median duration estimated to be between 7-10 years
51
Average age of Menopause is 51 years old.
However, menopause can occur as early as 45 and as late as 55. Median age of transition into early menopause is 47 and late menopause is 49
50%
Sexual dysfunction is reported in 50% of women.
These include symptoms of low libido, painful sex and vaginal dryness
2ND
Sleep Disturbances are the 2nd most reported symptom.
Hormonal shifts can make it harder to fall or stay asleep.
MENOPAUSE
THE IDEA OF MENOPAUSE HAS LONG-HELD NEGATIVE CONNOTATIONS IN OUR SOCIETY, LARGELY TIED TO STIGMAS OF AGING. W
Menopause is a natural biological process that signifies the end of a woman ' s menstrual cycles and reproductive years. It is officially diagnosed when a woman has gone 12 consecutive months without a menstrual period. Menopause typically occurs between the ages of 45 and 55 but can vary depending on individual factors. This transition results from the ovaries producing less of the hormones estrogen and progesterone, leading to the cessation of ovulation and menstruation. Common symptoms during menopause include hot flashes, night sweats, mood changes, and vaginal dryness. While these changes can be challenging, menopause also marks the beginning of a new life stage, often accompanied by a sense of freedom and personal growth. Understanding menopause helps women navigate this transition with confidence and equips them to maintain their health and well-being during and after this time.
KEY TERMS
Perimenopause
The transitional period leading up to menopause, characterized by hormonal fluctuations and changes in menstrual cycles It can last several years and often includes symptoms such as hot flashes and irregular periods. Can begin as early as age 35.
Menopause Transition
The time when the menstrual period intervals vary by 1 or more weeks up until the Final Menstrual Period and is marked by fluctuations in estrogen
Menopause
Menopause itself is a moment in time when the woman has her Final Menstrual Period. It marks the end of natural reproduction years. In surgical or induced menopause, it’s the time when both ovaries are removed or damaged
Post Menopause
The phase of a woman ' s life following menopause, during which menopausal symptoms may continue but typically become less severe over time
FREQUENTLY ASKED
QUESTIONS
How will I now when I’m entering into Perimenopause?
Signs that you may be entering perimenopause include irregular or missed periods, heavier or lighter flow, hot flashes, night sweats, mood swings, brain fog, and sleep disturbances. You may also experience changes in metabolism, increased PMS symptoms, vaginal dryness, or a drop in libido.
How long on average does menopause last?
Menopause itself is a one-time event, but the transition period, known as perimenopause, can last several years
Symptoms often begin in perimenopause and can continue into postmenopause, gradually decreasing over time.
Are there treatments for menopausal symptoms?
Yes, there are treatments available, including lifestyle changes, hormone replacement therapy (HRT), and nonhormonal medications It's best to discuss options with your healthcare provider to find what works best for you
How will I know when I’ve reached Post Menopause?
You have reached Post Menopause when you have gone 12 months without a menstrual period. Leading up to this, you might notice changes like irregular periods or symptoms such as hot flashes and mood swings Keeping track of your periods and symptoms can help you know where you are in the transition.
Is It normal to have irregular periods before menopause?
Yes, irregular periods are common during perimenopause as your hormone levels fluctuate Periods may become lighter, heavier, or more spaced out before stopping altogether.
Yes, menopause can affect your health. Decreased estrogen levels can increase the risk of osteoporosis and heart disease. It's important to maintain a healthy lifestyle and discuss preventive measures. Can menopause affect my health?
SYMPTOMS
Menopausal symptoms become most prominent during the late menopause transition, which is characterized by prolonged amenorrhea defined as going more than 60 days without a period but less than 365 days. The median age for this phase is 49, and symptoms such as hot flashes, night sweats, sleep disturbances, mood swings, and cognitive changes often intensify The early menopause transition is marked by irregular cycles, but with at least one period occurring within a three-month timeframe. During this phase, early symptoms such as cycle variability, increased PMS-like symptoms, and subtle hormonal shifts may be noted, with a median onset age of 47. Tracking cycle patterns and symptoms can help identify where you are in the transition and guide appropriate interventions for symptom management
Influences on Duration and Onset:
Non-Modifiable Modifiable
BMI
Mood/Stress
Symptom Sensitivity
Ethnicity:
African American, Native American Onset of hot flashes: earlier they start-the longer they will last Hormones-higher FSH, lower E2 more reports of VMS Genetics
Vasomotor Symptoms
Chief driver for females to seek help from a provider. 60-85% of women will report hot flashes at some point during their transition VMS symptoms will resolve in 85% of women. Median duration: 7-10yrs!
SYMPTOMS
Forgetfulness / Brain Fog
Forgetfulness and brain fog can feel like a mental haze, making it challenging to concentrate, recall information, or stay productive in daily life
Weight Gain & Distribution
Many women experience weight gain, particularly around the abdomen (visceral fat), due to hormonal changes
Psychological Changes
Fluctuating hormones can lead to depression, anxiety, irritability, mood swings, and even panic attacks.
Sleep Disturbances
Difficulty falling asleep or staying asleep is common and often linked to night sweats.
Fatigue
This can result from hormonal changes and sleep disturbances, leaving women feeling physically and mentally tired
Sexual Dysfunction
Reduced estrogen and testosterone can lead to vaginal dryness, decreased libido, and pain during intercourse
GI Issues
Fluctuating hormones can lead to bloating, indigestion, and change in bowel habits
Urinary Dysfunction
Lower estrogen levels can weaken pelvic muscles, leading to urinary incontinence
SYMPTOMS
Neurological Changes
Symptoms like migraine headaches, brain fog, memory problems, dizziness, and tingling sensations in the extremities are common
Musculoskeletal Issues
Joint pain, muscle aches, and an increased risk of osteoporosis are linked to lower estrogen levels
Heart Palpitations
These are usually harmless but can occur more frequently during menopause.
Changes in Hair, Skin and Nails
These include dry, itchy skin, hair loss or thinning, and brittle nails.
Dry or Itchy eyes
Reduced estrogen can affect tear production, leading to dry eyes.
Taste Changes
Hormonal changes can also affect taste, sometimes causing a metallic taste in the mouth
Allergies
Hormonal fluctuations can increase histamine release, exacerbating allergy symptoms.
Body Odor
Increased sweating during hot flashes and night sweats can lead to body odor
TOOL KIT
NUTRITION
Muscle-Centric Diet
Emphasis on anti-inflammatory foods, healthy fats like fish and lots of protein forward meals Obesity confers increased risk of increased CHD, VTE, Breast and Endometrial Cancers and are more likely to have severe/frequent VMS.
STRESS REDUCTION
Mind, Body, Soul
Techniques such as mindfulness, meditation, and breathing exercises are recommended to lower stress levels. Tools like journaling and cognitive behavioral therapy (CBT) can also help manage stress
SLEEP QUALITY
Quality over Quantity
Establishing a bedtime routine is essential for achieving quality sleep, which is often disrupted by menopause symptoms Getting enough sleep helps reduce inflammation and supports overall health
EXERCISE
Training for our marginal decade.
Regular physical activity is crucial, specifically resistance training to build strong muscles and bones Aerobic activities for cardiovascular health, stretching and balance exercise such as pilates or yoga are great compliments to resistance training.
COMMUNITY
Thriving Together
Being part of a supportive community can provide encouragement, accountability, and a sense of belonging. Sharing experiences with others can help women navigate menopause with more confidence
HRT
Menopausal Hormone Therapy
This involves treatments prescribed by healthcare providers to manage symptoms like hot flashes and bone loss. Most often times includes Estrogen, Progesterone and Testosterone Therapies
C O M M O N
SUPPLEMENTS
CREATINE MONOHYDRATE
Known for its benefits in enhancing muscle strength and endurance, creatine can be particularly helpful for menopausal women in maintaining muscle mass and physical performance It may also support cognitive function
FIBER
Increasing fiber intake through diet or supplements can help manage weight and improve digestive health, which can be affected by hormonal changes during menopause
B VITAMINS
B vitamins, particularly B6 and B12, support energy levels, brain health, and mood regulation They can help combat fatigue and mood swings associated with menopause
MAGNESIUM
This mineral plays a role in bone health, muscle function, and sleep regulation It can help alleviate insomnia and muscle cramps, which are common during menopause
OMEGA - 3 FATTY ACIDS
Found in fish oil, omega-3s have anti-inflammatory properties that can help reduce the risk of heart disease, improve mood, and support cognitive function during menopause
CALCIUM + VIT D
These nutrients are essential for bone health, which declines during menopause due to lower estrogen Calcium strengthens bones, while vitamin D enhances its absorption and mineralization
MEDICATION
MHT: Menopausal Hormone Therapy A few options are listed below that are most commonly prescribed at LIV1 However, there are other delivery methods available for hormone replacement therapy that can be discussed with your provider.
ESTROGEN
Estradiol Patch
patch delivers estrogen directly through the skin into the dstream, providing a steady hormone level To apply the patch, t a clean, dry area of skin on your lower abdomen or buttocks d areas that are oily, irritated, or where clothes might rub. Peel off backing and press the patch firmly onto the skin for about 10 nds. It is essential to rotate application sites with each new patch nimize skin irritation Patches are usually replaced once or twice a , depending on the specific product instructions
PROGESTERONE
Oral Micronized Progesterone
Oral micronized progesterone is a form of hormone replacement therapy often prescribed to women undergoing menopause who still have a uterus. It helps balance the effects of estrogen and reduces the risk of endometrial hyperplasia, which can occur if estrogen is taken alone This form of progesterone is made from natural sources and is designed to be absorbed efficiently when taken orally It is typically taken once daily at bedtime, as it can cause drowsiness
STOSTERONE
tions or Cream
osterone replacement is sometimes used to address symptoms of opause in women, such as low libido, fatigue, and mood changes administered as a Sub-Q or IM injection or applied topically, wing the testosterone to be gradually absorbed into the dstream. The dosage and frequency depend on individual needs should be determined by a healthcare provider. Pellets are NOT mmended.
MEDICATION
MHT: Menopausal Hormone Therapy A few options are listed below that are most commonly prescribed at LIV1 However, there are other delivery methods available for hormone replacement therapy that can be discussed with your provider.
VAGINAL ESTROGEN 0.01%
Low Dose
Vaginal estrogen is a localized hormone therapy used to treat symptoms of genitourinary syndrome of menopause (GSM), including vaginal dryness, irritation,
CONSIDER
Even if a woman doesn’t meet the standard criteria for menopausal hormone therapy (MHT), she can still have a discussion with her provider to explore the potential benefits and risks Every woman ’ s health, symptoms, and risk factors are unique, and a personalized approach is essential A thorough evaluation of medical history, symptom severity, and lifestyle factors can help determine if MHT is a viable option. Discussing the pros and cons allows for an informed decision that aligns with individual health goals and quality of life.
Woman
< age 60
Within 10 years of Last Menstrual Period
Bothersome Symptoms
Bone Density Concerns
Personal Preference to use MHT
Low risk of CVD or Breast Cancer
TREATMENT
Even if a contraindication for menopausal hormone therapy (MHT) exists, a meaningful conversation with a provider is still essential to explore alternative strategies for managing menopausal symptoms and supporting long-term health. Non-hormonal options, including lifestyle modifications, targeted supplementation, and prescription medications, can help alleviate symptoms such as hot flashes, sleep disturbances, and mood changes Additionally, proactive approaches to bone health, cardiovascular disease prevention, and brain health such as strength training, adequate protein intake, vitamin D and calcium supplementation, and hearthealthy nutrition can be implemented to mitigate risks associated with estrogen decline A comprehensive discussion ensures that an individualized plan is created to optimize well-being during and beyond the menopausal transition.
Unexplained Vaginal Bleeding
Prior Estrogen-Sensitive Cancers
History of Stroke or Heart Attack
History of or High Risk for Thromboembolism (VTE)
Severe Active Liver Disease
ASCVD Risk Factors:
Hyperlipidemia, Hypertension, DMII, Fam Hx of premature CVD in First Degree Relative M<55 F<65, Obesity with BMI>30, physical inactivity, cigarette smoking, CAC score>100, Hx of preeclampsia, Hx of systemic autoimmune collagen vascular disease (Lupus, RA)
May Consider MHT:
ASCVD risk <5% (low risk) & </= 1 CVD risk factor
May Consider MHT-Transdermal:
ASCVD risk 5-10% or
Low ASCVD risk <5% but >/= 2 CVD risk factors
Not Recommended to use MHT:
Age >/=60 or >10yrs post menopause or ASCVD >10%
RISK VS REWARD
This table provides an example of the potential benefits and risks associated with hormone therapy, but each woman ’ s case should be evaluated individually based on her medical history, symptoms, and personal health goals. The type, dose, and delivery method of hormone therapy can significantly impact outcomes, making a personalized approach essential Bioidentical hormones, which are structurally identical to the body’s natural hormones, are preferred over synthetic options like combined ethinyl estradiol and progestin, as they may offer a more favorable safety profile and better physiological compatibility A thorough discussion with a knowledgeable provider can help determine the most appropriate and effective approach for each woman ’ s unique needs
WHEN TO STOP
STOPPING MENOPAUSAL HORMONE THERAPY (MHT) IS NOT REQUIRED
There is no set time limit once treatment is initiated.
MHT does not need to be routinely discontinued in women over 60 or 65, as long as the benefits continue to outweigh the risks Long-term use may be considered in healthy women at low risk for cardiovascular disease (CVD) and breast cancer, especially those experiencing persistent vasomotor symptoms (VMS) or at elevated risk for fractures where other therapies are not appropriate The risk-versus-reward ratio should be reassessed regularly, with the goal of using the lowest effective dose for symptom control and overall health benefits. Additionally, low-dose vaginal estrogen can be safely continued long-term to maintain vaginal and urinary health. Ongoing discussions with a provider ensure an individualized approach that prioritizes both symptom management and long-term well-being.
For the majority of women, the benefits are likely to out weight the risks.
MHT may not be the right choice for every women but EVERY woman deserves the opportunity to discuss MHT and if it is right for them based on their own risk vs reward ratio in combination with the severity of their symptoms. The risk-reward ratio touches on cancer history, cardiovascular disease risk factors, severe active liver disease, recent embolic events and unexplained vaginal bleeding The benefits can include symptom relief, preserved BMD, 30-50% reduction in cardiovascular disease if started on MHT within the first 10 years of thier LMP, reduced genitourinary symptoms and overall quality of life. Shared decision making is essential if risk factors are present.
