Women Veterans Health Forum: Menopause

I'm so excited for you all to be here today. Um, I did want to take a moment to say that we are talking about a we were speaking on a topic today that normally is not spoken of. Um, how long? Four years I've been putting on these women veteran seminar and I've been saying menopause. >> It's okay to say it. Metopause. >> I'm going to say it again. Metopause. >> Metabol. >> And if you don't know, my name is Naomi Matthysse. I'm the deputy national legislative director for DAV. And I'm so excited to see all of the faces that we've seen uh over the years and some new faces. How many this is your first time in this seminar? Oh my god. Look around y'all. That is amazing. I would be remiss if I didn't give room to our interim women veterans uh members. Our inter interim women veteran committee members. That's a mouthful. Um ladies, as I say your name, please stand and be recognized. is Belinda Hill from Louisiana, Juliet Taylor from Connecticut, Jennifer Alvarado from Jersey, and the general Andrea Bernett. If you or your department, I should say, would like to get a copy or copies of our women veterans report, please, I want you to take this email address down. Go to legislative public or send an email to legislative public dav.org. And there's some key information that we need. Our ladies back at home, uh Janette King and Lisa Bogle, they are happy to fulfill your request. However, we need the date of the event that you need the reports, how many reports you need, and also your contact information. You guys are great at requesting reports, but then it's like, okay, where are we mailing them? So, we need the address of where you're send where we need to send the the uh reports to. I'd also really quickly like to acknowledge my team that's in the room. Um, Shamela Capezy, Kevin Miller, and you all know him, John Rzzer, our national legislative director. Joy Elum has uh retired after 30 wonderful years of advocating for our um for honestly for all service disabled veterans but particularly for women veterans and has stood out as our front runner for women veterans issues within the VSO community. So I don't believe she's here but please let's give Joy a round of applause. We appreciate everything that she has done over over the years and give me one second because of course Okay. Well, Emily Fletcher um is a is our sponsor from Jenn. Emily, if you would please. She is also an AIR FORCE VETERAN. EMILY, PLEASE. >> I love the energy in the room. I'm like, I don't need the stool, though. So, I'm going to just like, does my picture have to stay up there the whole time? No. No. Well, good afternoon. It is such an absolute honor to be here with you at your national convention today. I stand before you, as she said, wearing two hats. I'm a proud employee of Janentech, the presenting sponsor for the session, but also a fellow women veteran. I retired from the Air Force barely a year ago now today. Uh, but I also served in the army in my pri prior life. There you go. I love that the army paid for my college. So, I am very appreciative of uh utilizing all the resources that the military gave me. So, but after and I was a recipient of the VA's healthc care and that you know over 20 years ago right after I got out of the army and man what a difference it is today compared to the VA I walked into 20 plus years ago on accepting women and in that uh facility and it is I'm so proud to see the strides that they have made and continue to make to support our women veterans because we as we can see are a huge majority now as receiving care. So, I love it. Um, so when I transitioned out of the military, I wanted to find a civilian mission that was just as purposeful as the one I left behind. And I did find that with my team at Janentech. We represent the federal part of our business. Uh, represent or liazing with the VAS and DoD treatment facilities. Uh, for those of you who might not be familiar with us, Janentech is a biotechnology company. And simply put, that just means we look at the most challenging complex diseases out there and we use very advanced science to discover and develop breakthroughs in medicine. But what I am most proud of is that women's health has been at the very heart of our scientific legacy. For decades, Janentech has pioneered treatments that completely changed the landscape of care for women. We revolutionized the way breast cancer is treated, giving thousands of women more time with their families. We have dedicated decades of research to conditions like multiple scerosis, which disproportionately affects women. We don't look at just health from a general perspective. We study how diseases uniquely impact a woman's biology. But developing great medicines is only half of the battle. For a treatment to truly work, the science has to reflect the people that will be taking it. And that is why Janentech is fiercely committed to research and treatment that is inclusive of those who need it the need those treatment options. We are actively working to break down barriers so that veterans and specifically women veterans are intentionally included in our medical research and clinical trials. Your lived experiences, your environments, and your unique health profiles matter. You served our country and you deserve to know that the next generation of breakthrough medicines is being designed, tested, and proven to work for you. That is why partnering with the DAV means so much to us. The DAV's mission is to keep our promise to Americans veterans. And Janentech, we believe that promise must include worldclass inclusive healthcare. I will let the incredible experts dive into vital details of today's session on menopause. I said it too. Like as a veteran, an employee of Janentech and a woman who's gone through menopause, I just want to say thank you. Thank you for your service. Thank you for your resilience. And thank you for welcoming us into your incredible community. Have a wonderful seminar. I really did like her until she said army. Here they go. >> Am I grateful for Gen Tech's commitment and are pleased uh to continue today's program with our guest speakers. Thank you so much Emily. Um today's presentation will be divided into two parts. So we we're going to have our clinical side of our discussion and that's going to be led by our VA experts here on here on this side of the of the table and of the lectern and then the second part is going to be our keynote speaker Maria Lu who will speak on the practical real world real world aspects of this important topic. So I'm pleased to introduce our panel of distinguished experts. Uh Ter Teresa Zephrine serves as the women veterans program manager at the Orlando VA. She has over 20 plus years of experience specializing in sexual trauma case management and program administration. Teresa Dr. Ifqar, did I get that right? Is the women's health medical director at the Orlando VA Medical Center with 14 years of VA service. A board certified family medicine physician. She is deeply passionate about women's health and the integration of women's health within the patient aligned care or the packed team model. Dr. If Stephanie Barish is a board certified women's health nurse practitioner. She received her MSN from the University of Pennsylvania. Stephanie, thank you ladies for the important work that you do. Uh we need you. We need everything that you do. And so I will go ahead and let Stephanie take it on over. All right. So as she said, I um I'm a women's health nurse practitioner. I work at or Orlando VA in gynecology and eurog gynecology. And I see do I need >> Okay. Sorry. Okay. Can you hear me now? All right. So, I currently work at the Orlando VA and I'm a eurog gynecology and gynecology nurse practitioner and I see women with menopause every day. So, we're gonna talk all about it. All right. So, what is menopause? Um, scientifically, the definition of menopause is the permanent sessation of menstrual periods after which the ovaries stop producing hormones. The only diagnostic criteria for menopause is no periods for 12 months. No lab work needs to be done just no periods for 12 months. Um lab levels with consistent with menopause include increased follicular stimulating hormone which is called FSH with decreased estradile. However, chemical menopause should not be assessed for unless medically necessary like in the setting of a hyctomy where we don't know where your periods are or medication induced ammenia meaning no periods. Um, and this is because when you're in pmenopause or in early menopause, those levels fluctuate from day to day, week to week. So, we could check your FSH one day and it would be elevated to the menopausal level and then the next day it wouldn't. So, that doesn't really tell us if you're truly menopausal. Women go through menopause around age 51 to 52, but I always tell my patients, average is average for a reason. So women some women go through it much earlier and some women go through it much later. The best indicator as to when you may go through menopause is genetics or family history. So ask your mom or your sister when they went through menopause. And let's not keep it a family secret. The years prior to menopause um which includes the first signs of menopause are referred to as pmenopause or the menopausal transition. One other sort of medical term to know is before the age of 40, if you do go through menopause, that's called premature ovarian insufficiency. That's a totally separate diagnosis. Um, and would require labs and discussion with your provider. After the age of 40 and before the age of 45, that's called early in menopause, but not too early menopause. Okay. So what happens during pmenopause or a the menopausal transition? The ovaries are responsible for the production of estrogen, progesterone and testosterone in reproductive age women. During the parmenopausal transition, hormone levels fluctuate and the levels of estrogen start to decrease which causes a variety of symptoms and changes. The immediate and long-term effects of those hormonal changes impact most body systems. The first signs of pmenopause usually include changes in the menstrual cycle, longer time between periods, bleeding for more days or fewer days, heavier flow or lighter flow. Bleeding changes are often accompanied by das motor symptoms which are more commonly known as hot flashes. 40% of women in early par in early pmenopause suffer from hot flashes and 60 to 80% of women have them in the late transition of menopause. Vasom motor symptoms can also remain well into like menopause, way past menopause, but only in a low percentage of women. So most of the time once you go through menopause and you're about a year or two after those hot flashes go away. Sleep disturbances are also common during pmenopause. Um hot flashes are more common at night and we call those night fl night sweats. um 40 to 60% of women have sleep problems as menopause worsens and that can include sleep apnea and restless leg syndrome which increases during this transition. And then if you are in pmenopause or you've gone through menopause, you may have noticed cognitive or mood changes like uh also that brain fog feeling. Um women also report forgetfulness, difficulty paying attention and there is increased incidences of anxiety and depression and this may be due to the lower estradile levels or that poor sleep hygiene. One key area that is affected by decreased estrogen is changes in weight and body composition. Many women gain weight after menopause. Some of this is due to lifestyle changes, aging, decreased metabolism, and changing sleep habits. The average amount of weight gained after menopause is only 5 lbs. I'm sorry. I'm sorry to say, but it can feel like a lot more. And this this is due to changes in weight distribution. After menopause, women are more likely to gain weight around the abdomen and that increases weight circumference. So instead of that like you go apple shape. Um, as an example, in a study of premenopausal to post-menopausal women, in that study, 64% of post-menopausal women versus 20% of younger women gained weight around the the circumference of the abdomen. So, it's not only just weight gain, it's that distribution of weight that makes you feel worse. Another area of concern is cardiovascular health. So post-menopausal women are at increased risk of heart disease, increased blood pressure and increased cholesterol. Cardiovascular um and then cardiovascular disease is the leading cause of morbidity and mortality in postmenopausal women. Additionally, 42% of permanopausal women and 54% of postmenopausal women may develop benign heart palpitations. But even though they're benign, everything needs to be worked up. So if you are feeling heart palpitations, please see your provider. And then a well-known impact of lack of estrogen after menopause is its effect on bone health. We've all heard about osteoporosis. Estrogen is the key hormone in regulating bone building. And after it decreases, you can only have bone loss. So no more building. This allows for increased risk of fractures. One in three women over 50 will break a bone due to osteoporosis. Bone loss can be helped with weightbearing exercise, calcium, and vitamin D. Joint pain also increases after menopause. We think it's due to the loss of estrogen, but this relationship is not really well understood. Decreased estrogen also leads to thinning of skin. Decreased elasticity and increased dryness and this is due to decreased collagen. Most of that happens in the first five years um after menopause and that can lead to wrinkles. And if you that wasn't enough, you can also get post-menopausal acne. Um which is just cruel I think. Um and then an oft concern from postmenopausal women is decreased libido. So lower estrogen reduces the desire to have sex and makes sexual arousal more difficult. Low estrogen causes fatigue, pain, and vaginal dryness leading to sexual pain. And additionally, as you age, blood fills your genitals more slowly as you become aroused, which changes your sensitivities. Psychological components also do play a role in in libido. And it's important to rule out anxiety, depression, which we are we talked about from the cognitive effects of estrogen and the skin changes and everything like that. And talking about vaginal dryness, a major body system impacted by menopause is the genital urinary system or the vagina and where the ovaries live. With decreased estrogen, all women eventually develop vaginal atrophy, which is the thinning of the vagina, leading to decreased collagen elasticity and that thin vaginal tissue. It can present with a variety of symptoms including vaginal dryness, irritation, vaginal itching without infection, painful intercourse, postmenopausal spotting or bleeding. Or you may be totally asymptomatic and your tissues may still be thinning. Vaginal atrophy also presents with thinning of the urethral tissue. The urethra is what we pee out of. This increases the risk of urinary tract infection as we age. This also increases urinary frequency, incontinence, and blood in your urine. So, as vaginal tissue weakens, we do need to do something about it. So, what do we do? There we go. I told you all these terrible things. So now what do we do about it? If estrogen loss is the problem, is estrogen the solution? Well, oftentimes it can be. Hormone replacement can be amazing for many women. The primary goal of hormone replacement therapy is to treat or decrease v those vasom motor symptoms that we talked about, hot flashes and night sweats. However, it does help with sleep, mood, pain, and lowers fasting insulin, which can help lower BMI and waist circumference. And of course, estrogen does treat bone loss, although it shouldn't be the primary tool to treat osteoporosis. It is also good to consider causation or correlation with change in symptoms like mood or weight loss. If women don't have hot flashes, they may sleep better. And sleeping better leads to less mood swings. And if you're sleeping better, you can live a more active lifestyle. So estrogen itself doesn't necessarily treat all of those things, but if you're having hot flashes, it will treat those. The idea of hormone replacement is scary for some women and maybe not scary for you. Um, but research has found that the most common risks of hormone replacement therapy are heart disease, strokes, blood clots, and breast cancer. But most women are candidates for it. Your provider can use key factors of your health to calculate an overall cardiovascular risk score from your medical history. And then this score guides decision-making for hormone replacement therapy options for you. Um and as always, use of hormone replacement therapy is a shared decision making um between you and your provider. Based on your risk level, you'll either be eligible for oral hormone replacement therapy, transermal patch, vaginal ring, and possibly topical gel depending on your VA. I don't know. Also importantly, women who've had a hyerectomy only need to take estrogen and women who have not had a hyctomy will need to take estrogen and progesterone. Okay, what if you don't want to take hor estrogen or you're not a candidate for it? There are other ways to treat symptoms of pmenopause and in general those the best treatment is those anti-depressants, SSRIs and SNRIs. You can see on this graph here I don't know it might be a little small but the the best one is called venlaxine um and then there other the other best medications are gabapentin which I feel like a lot of people have already tried for other things but um it works for hot flashes and works best for night sweats there's also a new drug on the market called fisenoltent and that works by treating hot flashes by targeting thermmorreulators in the brain And that's available for women who do not want estrogen or cannot take estrogen. If you prefer not to take medication, holistic therapies have been shown to help with all menopausal symptoms. That includes yoga, hypnosis, exercise, behavioral therapy, and oral supplements. Oral supplements on work differently for each person. So, you just have to trial and error. And it really just depends on what how many you want to try and how much money you want to spend trying them. Um and lastly it is important to treat the vaginal symptoms as we talked about. All post-menopausal women should use lubricants during intercourse. Um and this is due to the decreased secretion. So everybody should use it. You can use whichever kind you want but you should all be using them. And vaginal estrogen itself is extremely safe. I describe vaginal estrogen as like using hydrocortisone on your skin instead of taking an oral steroid. When you take an oral steroid, it's all over the body. But when you put hydrocortisone on your skin, it only goes where you put it. Same thing with vaginal estrogen. When you use it on the vagina, it only goes where you put it. It's very safe. Um, but they make a huge impact in the skin and health there and preventing infections, increasing collagen, and helping with urinary symptoms, preventing urinary tract infections. The only people that really aren't candidates for vaginal estrogen are people with active breast cancer. And if you have abnormal bleeding that we don't know the cause of. And for women who really don't want to use estrogen, you could try hyaluronic acid, but it's only 80% as effective. And we have this great option, vaginal estrogen. Um, so and even when you're using vaginal estrogen, you do need to use lubricants during intercourse. I'm just going to bang you over the head with that one. And and that one thing that I know you're all thinking, but I want to use testosterone. Uh there's actually no FDA approved indication for testosterone in the United States at this point. And data for testosterone use in the United States is only for scientifically diagnosed low libido hyposexual desire disorder. So the VA doesn't have it for this reason. And if you're going to go get testosterone outside of the VA, we really do not recommend injections or pellets. And this is because you cannot control the amount of testosterone absorbed which can result in very high testosterone levels which can lead to side effects like voice changes, body hair growth, male pattern baldness, enlarged clitoris, acne and blood liver abnormalities. So there's the answer to that. And then what about bioididentical hormones? Do you have those? Um the term bio identical hormones is a marketing term. Most hormones are bioididentical and that just refers to the chemical and molecular structure of the body as natural hormones and we have them at the VA. They're just regular medication that we prescribe, not compounded and sold to you at a higher price. I'm gonna Hey, so the so the primary care doctor and me wants to add few things for your awareness. Um, thank you Stephanie for the wonderful job on the menopause. Not everything is doomed. We are still there's still hope for us. Um, so a couple of things I would like to add. Not all hot flashes are menopause. And I have seen it firsthand as a primary care provider where even physicians disregard the symptoms of an important diagnosis, especially heart disease. Um, women present with unusual symptoms. Usually some presents with sweats and that's their first sign of a heart attack. Know that for especially for females, the first heart attack and stroke is way more dangerous than for a male. So the studies have shown that more females have died because we ignore the first signs of a heart attack. So not all hot flashes are menopause. So please take this seriously. And a lot of you have served in areas where there is a high epidemic of tuberculosis or there are different types of diseases. So as I said not all hot flashes are menopause. So kindly make sure though we don't recommend labs but we do want to make sure that we take good history in terms of your general symptoms and not just blindly blame it on menopause because in you are in that bracket range. Menopause is the buzz word right? We think we are in menopause at least I think but then and the providers are thinking the same everything gets blamed on it but I cannot stress enough that not all our symptoms are menopause we need to make sure we rule out important diagnosis the second thing she mentioned about the weight gain um it's 5 lbs I disagree I gained 15 but The part of it is our muscle mass also goes down and a lot of that causes more weight gain because the fat distribution we tend to gain weight in the midsection. So we don't look good but um it's mainly because of your estrogen receptors in your muscles that kind of control the distribution of your weight and then the bone health as well. Um especially in uh female veterans, I cannot stress enough the importance of bone health. Um I have seen 23 year old females with severe osteoarthritis, right? You guys carry 100 to 150 pounds of weight every day during even basic training, right? That stresses your back, that stresses your bones. So, make sure when you go to the doctor, it's very important to talk to your mom because we have these tools where we can decide if you need a bone density test earlier or not. If you are on certain medication, we do need to get that done earlier as well. So, make sure you have your good family history and go to the doctor and get your earlier screening. So do not wait till 65 years of age to get your bone density test. Know your risk and go to the doctor and get the scans earlier. I think that's all I had. Stephanie did an amazing job and I know it's a big topic. Um it's there's so much and it's out it's growing and we are trying to change the culture in the VA. uh when I took the position 5 years ago, we were only 37 women's health PCPs in the VA. Now we are 103. So it's cultural change. We are trying to educate our providers. We are not there yet. Um because research and science is growing. So we still have miles to go, but know that we are in the process of change. and be your own advocate for your health, for your mental health, your physical health. And um talk to your primary care doctor. >> Oh, no. I'm good. Thank you. >> Hello. I feel like I need to come in as your friendly neighborhood social worker and tell you all to hug yourselves. Like just we're going to love our bodies, right? Because I know this information can feel like man. But you know, I think if we could think back for when we were really young, right? And when we were young girls maybe getting ready to get to that next stage, right? And maybe for some of us it was exciting cuz like we saw our friends getting u maybe their first periods and then we were like, "Oh, we want to have that too." And then we get it and we're like, "No, go away." And now it's going away and we're like, "No, come back." you know, it's just so I I felt like I wanted to give a little humor um just because I know this could be very overwhelming, but I want you to know that the VA is here for you and we want you to feel like you can come and talk to us and we're going to help support you and every um woman is unique. So, sometimes it's hard as community, we want to rely on each other, but we also want to understand that we have very unique um you know, bodies. We have very unique treatment goals and um just to make sure you're advocating for yourself just like Dr. Ifar said. So I really want to help you. So again, my name is Teresa Zephrin. I'm the women veteran program manager. I oversee women's care here with Dr. Ifar for Orlando VA, but there is one of us at every single VA. There's always a WVPM and a WHMD. and we're here to really help our women veterans really help navigate um the system. We tend to be a little complicated sometimes, but we want to be here to help you navigate and advocate for yourself and really help you with care. So, I have a quiz and I hope our fellow men were taking notes and that's why you should buy us flowers and candy cuz we're only going to gain five pounds. So, I'll take the candy. Okay. All right. So let's see let's see who's listening. Menopause always begins at all right very good very good. So the average age is around 51 but menopause can occur naturally anywhere between ages 45 and 58. Right? So we talked about that earlier or even earlier in early menopause before 40 and premature cases many symptoms arise um during pmenopause years before menopause periods cease. Okay. So um again hug your body. It's okay. Hug your body. We love our bodies. Okay. They do amazing things as women. All right. I think we know the answer. Hot flashes are the only symptom. Right. Right. Okay. While common hot flashes are just one of the many. Um we also experience as we talked about sleep disturbances, mood swings, anxiety, all those wonderful things that we see listed here. Um and symptoms often start during parmenopause. I will say when um a really good friend of mine, she started menopause. She invited me to a party and she threw herself a party with some of her closest friends and they they like burned tampons and things like that and that was fun. Um, so I just want to say whatever type of celebration this is a time, you know, it might feel like a period of mourning but it can also be an opportunity for a season of celebration and kind of entering a new stage of life, right? So it's really what we make it. So, I feel like I have to say that between each slide as we talk about all these things. All right. All right. We talked about weight gain. That's a hot topic, right? >> Yes. Well, yes. So, let's talk a little bit about weight gain. So, there's a lot of hormonal shifts that are happening, right? So, weight gain isn't guaranteed. Um, however, so when we look at um especially at the VA, we have some programs around menopause. We want to look at the whole woman, right? So, we're also not just thinking um how do we approach hormonal changes from a holistic standpoint. I know our our lovely um speaker Dr. Lu is going to talk a little bit about that. Um but really just considering diet, also sleep disturbances if you're not getting enough sleep at night, thinking about exercise and strength training can really help manage weight. I can't I can't stress enough strength training and weights. um just because we were talking about risk for osteoporosis. Um so really strength training I know when like when back in the 70s and 80s it was all about the cardio, right? Like we had Richard Simmons and some of our other favorite um trainers, but really strength training is where it is. So just want to encourage you to look into that. I'm sure our speaker will speak more. Uh this is a good one. Menopause ends your sex life. >> That's right. She's like, "No, ma'am. It does not. You are correct. It doesn't have to." Right. I think this is another opportunity for us to kind of reframe what's happening and re with our bodies and and thinking about the partners and people that we are with. And it's like how do we reframe what's happening? How do we maybe do things a little bit differently? So um though estrogen loss may reduce libido um these effects can be managed with lubricants, moisturizers, hormone therapy, really open communication, right? Open communication really can enable a fulfilling sexual life. So sexual health is really important uh for part of your healthcare and you want to make sure you fight for that. Okay? to really have conversations that might feel, you know, a little taboo or maybe um, you know, I think the thing good thing about menopause is there really used to be a stigma um, for women that were going through menopause, but now that we've kind of really opened up those conversations, I really encourage you to continue to communicate about all areas, including your relationships and your sexual health. It's really important. Treatment options are limited. What did we learn today? That's right. Many options exist and Stephanie went through all those options earlier. So really there's a lot of support and a lot of um areas where maybe some medications had black blackbox labels before are really they've been taken down. So that's why this is an exciting time for us really to look at really improving quality of life and what does that look like for each individual. So, I wanted it's a very small screen, but um you know, I wanted to talk a little bit about what your your WVPM, which is what I am, what we do. We really help you kind of answer questions um about women's health services at the VA. Um also welcoming respectful environments. Culture change is one of our top priorities and making sure women that come into the VA know that they belong there. um and that we really want to hear about cases of any harassment or where you might feel uncomfortable. We're there to really help navigate that. I I'm I'm at um every new employee training every two weeks to talk about women veterans. we have I have a whole slot in new employee training and that doesn't happen for a lot of services but um I'm glad that you know our VAC it's important for us to really talk about women veterans and um your special needs and make sure that that is um that is known by everyone anyone from the canteen um to podiatry whoever is treating and working with women veterans we want to make sure they have information also we lead programs and services related to women veterans women's healthcare and um we also want to make sure that we have all the we advocate for all the things and all the treatments and really hearing from women and really making sure that we are connected in that way and that what you what you're saying you need. I mean I I think these DAV reports are amazing. I really gives us good information on on where we need to make change and where we need to advocate. So there is a website you can go on to the va.gov website. You can look up WVPM and like I said, there's one listed at every site and um we'll get you connected. Um so if you have questions about gynecology, if you need to get connected to a primary care provider, if you want information on how to enroll, you can make sure you contact your local WVPM. And that is it. So thank you. What have we learned? >> Oh yeah, sure. I can go back. I know that this slide is small one. Um, if you take out your phone, you can zoom in on it, but these slides also will be available online after this after the, uh, the convention. So, don't worry. I got you. I've got you. Um but no, thank you so much especially to the Orlando VA and I just want to say um as there's over a million women veterans that are currently enrolled in the VA healthc care system and currently the center for women veterans are out there and they are trying to reach out to the other million of women veterans that that could potentially be reached and to have the benefits and services that they have earned through their military service and so with that VA needs to be of they need to have the resources right they need to uh be able to handle that influx of of those that those women veterans all right so I am so excited to introduce our keynote speaker uh Dr. Maria Lu and I will say this has been in the works for a couple of years all right I am so excited okay Dr. Maria Luke is an energetic and accomplished fitness expert, menopause coach, Air Force veteran, former healthc care science professor, and founder of fitness and menopause with a PhD and MS in health sciences and over two decades of experience. She's one of the most credentialed and trusted voices in women's midlife fitness. And are you ready? The menopause coach to Halib Berry. Her book, New Moves in Menopause, a fearless guide to a stronger, healthier, and ser midlife, offers practical information as well as transformational explorations that help women understand what's happening in their bodies, build mental and physical strength, and engage with midlife as a time of freedom rather than a collection of symptoms. Dr. Luke, they're yours. PASSING the baton. I'm taking it. >> And the stool. >> I'm going to ease into the microphone because I have a loud voice. So I Is this okay? I'm going to stay right back here so I don't scare anybody. First of all, I'm so excited. As Naomi said, this has been in the works for several years. We just could never make it happen. Um, so I'm very excited to be here and I'm very excited to see so many men here. So I'm going to say that shout out that you're taking the time to come out and listen and learn because this menopause is not just a female problem or a phase because um we all have partners or you have spouses or mothers or daughters that are going to be going through it. So, it's really important to have the conversation for all of us. Um, so, thank you for being here. Um, I thank you for bringing the medical expertise because that way I can skip all over that and go straight into the fun stuff because menopause is not just the end of something. We I want to share how we can rephrase this stage in life. And so before we even start, I would like for you to look under your seat. Not everyone has a little orange orange little thing under there. But if you do, and if you want to I I want ah you you already saw it. I know. I thought this is a bunch of veterans. They're going to see it and they're going to say litter. I'm going to pick it up early. So I was hoping you didn't throw it away. If you want to share what you found under there, I would really love I know you all have loud voices. You're veterans. You know how to speak up for yourself. Anybody that wants to stand up and just yell out what they found, >> you know. Ex. >> Go for it. Yell it. >> YEAH. GO FOR IT. >> You asked for that raise. That's right. >> Yep. >> Yes. You stop. >> Yes. Stop shrinking. >> Yes. Let's do two more. I know we could I I could just let you all do finish this and then we were done, but I promised Naomi I would do bring my worth here today. But let's do two more. Yes. >> Yeah. I know you all very excited to share it. Those of you that were standing, go and say it. I I see some smiles. Let's share those couple more. >> Hang up people. you. >> Yeah. One more. >> Yes. >> And so I wanted to start this. These are all things positive things. Oh, one more. Okay. >> See, these are superpowers. I want you to all take a deep breath. These are all your superpowers. Now, we just need to recognize that they exist, that this is something new. For me, menopause came with a a a big like anxiety episode. But also, once I really dove into it, I realized that one thing I I thought I was turning into the grumpy old lady because that's how we're portrayed as, oh, she's just a grumpy old lady. And now I want to be the grumpy old lady because it means that I don't care as much about what people think. Um I do care about people and the people that are close to me but I just don't care as much about other people's opinion. And that is what we are told is wrong. Then we become grumpy and uh and that's that is a superpower. So for me that once I started seeing this is actually really nice then we can move on into the positive part of menopause. And so I um want to I mean we do need to go into some of this. I don't go into symptoms but more the mindset. If any of these sound familiar, feel free to hooler and holler. But I always been skinny and now I have belly. I know we've talked about it. You all mentioned it. This is common. I keep gaining weight. Nothing seems to work. I don't find pleasure in things I used to. I feel like I'm losing my mind. I can't control my emotions even though sometimes I don't want to. what is happening? I feel like a stranger in my body. And that is a common um theme throughout when I hear women's stories. Often there is a I just don't know who I am anymore. Like what is happening? And we don't talk about menopause enough to where we're normalizing that this is a normal part of life. And you are not the only ones that are experiencing this. So if it's not you and it's not then what is actually going on? So I like to look at menopause. We all know menopause is the transition and we heard about the medical transition. Um and that is valid and that's important. But what we don't talk about a lot is that there are three distinct phases to the other part of menopause, not the medical part. And it includes an ending, a messy middle, a very messy middle physically and mentally, and a new beginning. But the problem um with this menopausal transition is that we're like frontloaded all of the ending to the front and we're not being told that there is a new beginning at the end. We're getting to experience all the the physical symptoms, the mental symptoms, all often while we're not understanding what is going on. And we're concentrating very much at the end of things instead of focusing on what this new beginning could possibly look like because there is a new beginning. And one of the big changes that happen in that messy middle which you have already talked about is how this menopause tends to show up first. And that is with a transition into how we feel about our bodies. Because that belly fat, although one not the only by far not the only symptom there is to menopause, is tends to be the number one challenge that I hear women talk about because it is even women that have never had issues with their weight or their body image suddenly start feeling where did this come from? Like what is it? I've heard it called the bagel, the tire. There's been nice names to it, pet names, not so nice names. I've heard it all called like there's a whole new personality that is being given to this new thing that has grown in the middle. And we all tend to go through it in a smaller amount. Even like I said, even women that have never had issues with weight gain tend to see a distribution there. And body image is not something that is related to weight or size. It is really something that happens in your mind and how you feel with your body. And so I throw these numbers out there. I don't need to talk about them. They're staggering by themselves. But a large majority of women report that their body image really takes a dive, that they feel they're scared to gain weight. They scared what that means from an identity perspective and from just from a perspective of how do I show up in the world? I have to buy new pants. What am I going to do? Um, and so really looking at how this affects your professional life, your sex life, your partnerships, your relationships, because how you feel about yourself does impact how you show up in the world. And so I think it's important to understand why body composition happens. I know um, we've heard a little bit about it already. I want you to know and I'm just going to add to this. It is not there's a a medical reason why some of these composition changes happen. Not the weight gain because as you've heard I know the five pounds got everybody really upset. So I'm not going to say it again because for most women it seems to be a little bit more but where it shows up and there is it does not mean that you are lazy and it definitely doesn't mean that you're failing but it does mean that your body is now working overtime to provide some homeostasis with a brand new system that it's working with. So, this isn't really about what am I not doing, but you're working with a different set of pots and sometimes it takes a little while to figure out how to cook in it. And um I was going to say something, but I'm not going to say it. So, the first thing that we tend to want to do is diet. fix your diet and fix your exercise. We tend to work out more or want to work out more and eat less and that does not work out most of the time because again you're not working with the same numbers. That said, when what I see and what's a little scary often times is that we are so used to being in a diet culture mindset and because in the past we were able to control our bodies with diet and exercise that that is our default. We automatically default with that. And when that doesn't fix it, then we get really frustrated. And so why doesn't exercise and diet fix it? It's because you're not, this isn't a willpower deficit of any for sure, shape, or form. This is a hormonal difference. It's like saying you want your car that always has run on gasoline now run on diesel. It doesn't work and you get upset at it. You can't make it work the same way. So, how do we become a little bit easier on ourselves? I do want to say as it was mentioned before, nutrition and movement are still important. They've never not going to be important. They're important way beyond the weight aspect of things. They can help with symptoms. They can help with um all sorts of quality of life improvements. However, they may not work as well as you were before to control how you gain weight. And so doubling down, I want to just word of caution. Doubling down on diet and exercise more often than not can backfire. So if I hear one more woman say I need to try harder on the treadmill, I will set that treadmill on fire and call it a day. Please don't start going faster and fueling less. Um those two things do not match up you. They might work for 5 seconds and then they won't work because it's never worked before. The amount of women that have come up to me and said, "I guess I'm just going to do the diet that worked for me before." Um, and I say, "Well, if it worked for you before, why do you have to do it again?" >> Good point. >> Because it didn't work. It didn't work. It works for that small amount of time that you were you restrict. And then when you can't restrict anymore and you can't sustain it, you let go and it comes back and it doubles back, which is the bad part. And so we can't these days talk about weight loss without talking about the GLP elephant in the room. So let's bring the elephant in. We will talk about GLP1's a miracle or moral failure. Neither. They're neither. And before I dive into this, I'm not a medical doctor. I'm going to say that. I'm also not your mother and I'm not here to tell you what to do, to take them, not take them. This isn't This slide is not meant to provide you with a yay or nay, but I like I'm an educator. I like to provide education and I want for anybody that wants to make a decision for or against because they're everywhere and they're great. Making a decision based from a health and agency perspective is what I want rather than a decision or choice made from a fear-based position or from that ideal that skinny is still more worth or better. So that is where we start and there is a case for GLP1s because they are game changers for thousands tens and thousands of people that have improved their health that have improved their quality of life. So they're game changers. There is no arguing that. And you won't get an argument for me. There are game changers for many many many people. A word of caution, the case for caution. I am in the space of fitness and wellness and menopause coaching and there I always like to bring up the cautionary part of it all because for women that have either dealt with eating disorders or disordered eating patterns or have bad body image or are trying to break those cycles. seeing the GLP-1 carrot in front of them may put them on the wrong track. And I talk a personal personal experience. I've struggled with body image issues most of my life. I've uh have been on the disordered eating wagon once or twice. And even for myself, and I ask these questions because I'm on this roller coaster with you all. These are questions that I know I have and feelings that I have. So, I know other people have them and in my groups I talk about them. This is why I bring these topics up because even for someone that might be put together and gives talks about these topics, hearing all of this talk can be, huh, maybe am I am I not am I so against it that I don't want to do it? Why am I doing it? That's my my cause. Why? Knowing your why is your north star. So for anything that I say today, always know your why on why you're making a decision to do something. And now we're going into the positive framework, which is the new moves in menopause framework. I base my coaching style and my ma my mission and my teachings and education on four distinct faces. Not faces but how how to reconnect with your body, embrace the now, be more flexible and move with joy. I will dissect all of these right now. Reconnect with your body. I find that these four things are the pillars of quality of life in midlife. Reconnecting with your body is not just getting over get over it like body positivity. We hear a lot about well just be positive like can you just be like your body, love your body. put those stickers and those sticky notes on the mirror and you wake up and you look at the mirror and it says love your body and you say okay I will love my body. That is just not realistic. It's not realistic to always love your body. However, the body positivity movement has done a really good job at making you feel like you're always failing because it is impossible to feel positive all the time. So therefore, you're failing. Um and someone's there to sell you something to fix that. Now, body neutrality. I call this the valley of neutrality because I'm a very visual person and I like to see things in fairy tale maps. Is you're in the middle here. Sometimes we're over here where we're thinking I am sexy and then you come over here and you're thinking, who's this troll looking back at me? And those days will happen. But I want you to be in the middle somewhere where you're not thinking about how you look and how this affects you most of the time. And I say most of the time, and the more you practice this, the easier it's going to be to swing from those pillars of negativity and positivity into the middle. So when you do that little, you know, the the little ball thing that goes back and forth, click, click, and if you let it go far enough, it'll stop in the middle and it'll lose momentum. You just have to stop touching it. It's very tempting. Just let it go and it'll pivot in the middle somewhere. So, it's practice though. So, I'm not saying that this is an easy easy task, but it is practice. And one of the biggest things that can help is to focus on nonweight related goals. Not have I lost weight, have I gained weight, but am I able to do whatever you set your mind to it. Some people want to do push-ups or some people want to do their first pull-up. That's a goal. You can work towards that. These are tangible goals. I want to be able to walk around the block one time. How about doing 10 squats on your chair? I want to do that. Set yourself a goal that has meaning to you that has nothing to do with weight. And these are hard. Again, this isn't easy to overcome the mindset switch, but setting those goals and then achieving them one at a time will set your perspective onto it's the not touching the ball. Just don't touch it. Set yourself in the middle there. And the next one is making friends with your body. And that takes time, a long time. I'm friendly with my body image monster these days, but they can bite sometimes. And so making friends with your body can take a long time. But again, it's not realistic to think that we're going to feel great about ourselves all the time. Here are a couple of strategies that work. Stop the comparison game. You will not look like Jennifer Aniston at some point. I don't know. I don't know why people want to honestly, but you won't have so and so's arms and so and so's butt. It's really that Frankenstein approach to things that is concerning when you're picking, you're cutting things out and you're making your own version of things. Stop comparing yourself to others and to your past self, which is another thing. Just stop comparing. Where are you at now? Where are you now? And how do you feel about that? Spring clean your wardrobe. This is a really powerful one. Who has a skinny closet? Anyone not raising their hand is a liar. Uhhuh. I know it. And let me rephrase. I maybe you don't call it the skinny closet. It's that part of the closet you hide behind the door or somewhere right over here. It's probably covered cuz you dry cleananed it for the time you're going to come back and and wear it, but you're never going to wear it cuz you're not but you keep it there because it's failure to it's kind of giving up. You feel like you're giving up if you give those clothes away. Um that's holding you back. That little part is holding your mindset back because you still believe that that is worth achieving and that is where your worth lies. Think of of um giving away. I've done this exercise with many, many people. Grab a bag, garbage bag, a box, whatever it is. Pack those things up with a lot of love. Say thank you. This served you well when they served you well and take it to a women's shelter. Take it to or give it to someone that you know needs it. Maybe your friend's kids are going to a job interview or someone. They these clothes can serve someone right now and they're doing nothing but hold you back in your closet. It sounds maybe silly, but it is truly powerful. Give it a try. Unfollow accounts and people that give you that, you know, you scroll on there and you're like, "Ooh." But somehow you're not unfollowing them. And next time they do it, you're like, "H." and you just get used to feeling kind of yucky when you feel see that fear-mongering message. Just unfollow, clean it. Actually spend less time on social media. That's will be really good for your mental health. Diversify your portfolio as well. We need to see people of all colors and shapes in your portfolio of social media consumption. Make sure that you follow people that look different than you because we all come in different sizes and different looks and that's really important. You wouldn't want to put all your stocks into one thing. That's very dangerous because what happens when that one tanks diversify. And then this one's my favorite because Charlie's my daughter. I call this the Charlie test. Would you say what you say to yourself, to your daughter or to your best friend or all those nasty things that you talk tell yourself when you talk badly to yourself? Would you say that to your children or again a best friend or anybody? And if you don't, let's revise that. Be more flexible. And this goes way beyond the physical aspect. I'm still working on the physical flexibility and you should as well. But menopause is like a puzzle. Well, just when you're about to put down that last piece of THE PUZZLE, YOUR CAT JUMPS UP ON the thing and kicks it all away and you're like, "OH MY GOD, WHAT HAPPENED?" THAT'S MENOPAUSE. Just when you think you have it all together, something pops up. And that's how symptoms work, too. You may have had hot flashes and you're like, "Oh, I'm done with hot flashes." Now, bingo card comes back and refreshes and it might come back later again. You never know what's going to hit you. So, be more flexible. What does that mean? It allows you to be to not be derailed by things coming your way. So, when you are um just cruising along and something comes from left hand, you're like, "Oh, got that. I have a tool for that in my menopause tool belt." and you are able to adjust and so why it works as said menopause is unpredictable. It helps with stress reduction and oo do we need that. We talk a lot about cortisol supplements. You know what you can do instead of taking that cortisol supplement? You can work on reducing your stress and that's going to make you have less cortisol. Isn't that magical when you're less stressed about taking a supplement to reduce your stress? Um, and then embrace variety. Don't get so focused on just this thing worked for me forever. I've uh always done CrossFit and I'm going to do CrossFit until I die. But you're no longer seeing the results that you want. You pro constantly getting injured. Maybe you want to add something else to that plate of exercising. So look at embracing variety and this is the biggest one. Um embrace the now. The struggle of letting go is a part of a grieving process. Um I for my personally I until I realized and this through talking through to hundreds of women. I didn't realize this myself until I I have the luxury to talk and the honor to talk to a lot of women and hear their stories. Um I didn't realize that I was grieving. I was grieving my old body. I was grieving how well it responded to that perfect formula I had I had deciphered for myself. Everything was working great and then menopause hits and then not only menopause, I had a child in my 40s and that does a number on your body as you many of you probably know. And so lots of things happened and I never really gave myself time to let go and to grieve and to again not to say I'm going to leave this behind but just say thank you. Thank you for where what that was. It helped me be where I'm at now and I'm going to let it go. Like one of those lanterns that you light and then let flow away and it just goes away and it looks so pretty. That's I want you to let go. But I think it is important to also recognize that as any grief, let yourself grieve the process. Don't just step over into ah, I need that. I'm going to go over here and I'll be fine. Because as any grief, everybody grieavves differently, but recognize that this is there's a grieving process to this entire transition. And then liberation and acceptance, letting go of that is not a past self. It's just it's not who you are right now. And that's what I wanted. You have to let go. And it's very freeing. It really, really is. And so this one is your biggest ally. Movement. This is really besides diet as well. But movement regardless of what your symptoms are, regardless of who you are and what your capabilities are, is your biggest ally. From a health perspective, from a mental health perspective, from a quality of life perspective, from who you are as a person perspective, movement will always, no matter what, be an improvement in your life. But you do have to do it. No one else can do it for you, which is why people don't do it. And um one of the secret ingredients in movement is that you have to pick something that brings you joy. You have to stop following what your friend liked or you know Mary really loved this one. It worked for her. Did you see her lose the 20 pounds? I think I'm going to do that. And then you don't do it because it's not you're not Mary and you didn't like it. And you have to pick joy. If this stage in life is not the time where you pick joy, then what are we doing? This is it right now. You heard everybody when you got up and you read out all those little notes I left for you. Love notes. Take them home. Put them on the wall and take the love your body sticker away and put that one on there on the mirror from now on. Um, joy is the magic ingredient. Doesn't matter what else you do. Joy. Focus on picking things that bring you joy. And strength training. I know this was brought up earlier. You cannot skip this one. I'm sorry. I never say absolutes. You have to strength train. How that looks and what that looks like for you is different for everybody else. It everybody has a different that crossfitter. Go for it. If you don't like it, you don't like group exercise, individual exercise. If you don't want to get into a gym outdoor, if you don't want to, there's a million ways to do strength training, grab your dogs. The bigger the better. And you can strength train that beast right there. Look at her. She'd love to be cuddled up and squatted. I can tell. And so, she'd make a good workout, buddy. grandchildren, children, whatever it is. It doesn't have to be something that you don't like. Find joy in that strength training. I uh follow me if you want some fun approaches to exercising. I want to help women, everybody, but obviously women are my demographic, find an approach to removing the hurdles that keep you from getting into strength training because strength training is what's going to keep your bones strong. And as you all heard, those numbers are scary and they are real for uh fractures. and balance balance training cuz the best way to not break a bone is to not fall. So, you want to do strength training. You want to do balance work. But strength training, honestly, it's a non-negotiable. If you need help on how to get started, please reach out. Y'all, if you don't have my card, I there's some back there. I'll also have the QR code up in a second here. Um, please reach out. I really am am fairly accessible. So, please reach out and then treat movement like a buffet. It is you do not you don't treat it like the food aisle. You don't just have one spice in your spice cabinet. I know. No, nobody here does. Make sure that you use movement. Maybe today you want to go dancing. Tomorrow you want to go gardening. Maybe a hike. Maybe things. It's not an it. You have to remove the it has to be 60 minutes to count. It has to be this to count. It has to be that to count. It has to be that. Who sets up these parameters? Someone else does, not you. Someone else did it and you're still listening to them. Please let go of it. If you are tempted to start something, think back to what I said earlier to your why. That north star. If you don't know your why, every time that you make a decision, this is for life. I'm giving you some extra life advice here besides menopause. Anytime you make a decision, think why? Why am I doing it? And if you don't have a clear answer, you probably don't need to be doing it. It is it's but it's hard because you have to sit with yourself but if you don't take again if you now don't take the time to sit with yourself and make yourself a priority have a coffee have a tea have a drink whatever you it suits you and think what is it that I want why do I want it and then based on that take that first step because menopause is a rewrite Right? You're not approaching an ending as many people want to tell you, but it's not. It's not an ending. There's a rewrite. You are in charge here. Like you are the person that is, if you let it again, you have to want this. You have to want to rewrite your next stage in life. And as I was saying, I can't say this often enough. Every rewrite needs a why. Why am I doing this? So, choose a why that is yours. Not the one you inherited, not the one you're performing for anyone else. Choose joy always. always because that one will never lead you wrong. It's never anytime you choose joy, you go on the right path regardless of what anybody else tells you. So you are holding that pen. Look how magical it is. >> Look the magic. It makes me happy every time I look at I'm very proud. This probably my proudest thing I've ever done in my life. this magical slide. But you hold that pen, that arm, that hand, that's you. And you have the choice to decide what you want this next stage in life to look like from a movement perspective. Do you want to sprinkle in some strength training, a little bit of a walk with your best friend to chat it up? You want to listen to an audiobook while you walk your puppies? That's my favorite way to um get out and do some cardio. Audio book. and my puppies and but anything you see possibilities are endless. It really comes down to what you want to do. This is about you and it's just you just have to want to pick up that pen and start drawing in magical lines. And that is all I got for you. I hope you enjoyed it. UM, I am I I just want to say I do want to I know many people say that if you have questions past after this today, please reach out. I mean, I really email me, follow me, and reach out to me. There's a I could talk about this for hours. So, please reach out, okay? I'm here to help. Okay, >> thank you. >> GIVE HER ANOTHER HAND. SO, THERE WERE SOME CARDS IN THE BACK. What What have we learned? Okay, pack up those clothes. Pack up that skinny closet and donate it to someone and say, "Thank you for doing your job and for being there for me. You have passed your use." And now off you go. Don't touch the pendulum. Don't touch it. Stay there in the middle. Right. That's Don't touch it. >> Don't touch it. Uh there were some cards in the back and um there's a QR code here up on the screen. There's also some cards in the back. I'll have this one up front and you can go ahead if you want to um if you're not able to get it off the slide, you can use use this. This is this one's mine. Y'all can't have it, but you can go ahead and snap it. Um and then also Maria's card uh is here if you want to reach out to her. And the website is fitnessandmenopause.com. Um, and no, she will not have you. You will not be able to contact Halib Berry. Okay, that is Maria's friend. But honestly, guys, I'm so happy that we really had this discussion. I'm so happy we finally got to this. Thank you. I want to