Navigating the Journey of Perimenopause: A Doctor's Personal Experience
Written and edited by Sarah Bonza MD. MPH, FAAFP, DipABLM, NBC-HWC
As a medical doctor, I am well-versed in the intricacies of the human body, the dynamics of health and disease, and the myriad treatments available to address various conditions.
Nevertheless, when it came to managing my own perimenopause symptoms, I found myself at the intersection of my professional knowledge and personal experience. I knew that I had to approach my symptoms from a holistic perspective, incorporating lifestyle medicine, functional medicine, and traditional medicine into my daily routine.
My journey started with training in wellness coaching.
Wellness Coaching: The Cornerstone of Change
Wellcoaches is a leading coaching training program for health and wellness professionals, and its theoretical model is based on several well-established psychological theories and approaches.
Its primary goal is to equip coaches with the tools and strategies they need to support clients in making sustainable behavior changes for improved health and wellbeing.
The Wellcoaches model for wellness coaching rests on three pillars:
Self-determination Theory (SDT): SDT is a human motivation theory, suggesting that individuals are more likely to make and sustain changes when they are motivated by intrinsic factors (those that are personally rewarding) rather than extrinsic factors (external rewards or pressures).
According to SDT, a sense of autonomy (freedom to make choices), competence (confidence in one's ability), and relatedness (feeling understood and cared for) are fundamental to fostering intrinsic motivation.
Positive Psychology: This approach focuses on the cultivation of happiness, strengths, positivity, and personal growth. Instead of merely fixing what's wrong, positive psychology seeks to build what's strong. It encourages coaches to help clients identify their strengths and use them to achieve their health and wellness goals.
Cognitive-Behavioral Coaching: This draws on cognitive-behavioral therapy, a form of psychological treatment that has been widely researched and applied to health and wellness contexts.
It posits that our thoughts (cognition) and behaviors are closely linked and that by changing unhelpful thought patterns, we can change our behaviors and emotions. In the context of coaching, this means helping clients identify and challenge unhelpful thought patterns that may be hindering their progress towards their goals.
The Wellcoaches training blends these theories into a client-centered coaching model. Coaches are taught to create a supportive environment, listen actively, ask powerful questions, and use evidence-based tools and strategies to help clients set realistic goals, cultivate self-motivation, build confidence, navigate barriers, and make sustainable behavior changes.
The coaching process in the Wellcoaches model typically follows a cycle of establishing the coaching agreement, building awareness, designing actions, planning and setting goals, managing progress and accountability. Through this process, clients are supported in their journey towards improved health and wellness, with the coach serving as a facilitator of change rather than an expert giving advice.
Overall, the Wellcoaches model is designed to empower clients to become experts in their own lives, fostering self-reliance, resilience, and long-lasting change.
Wellness coaching helped me set realistic and meaningful wellness goals that reflect my values, aspirations, and personal circumstances. It provided me with tools and strategies to manage obstacles and setbacks effectively and helped me build resilience and a positive mindset.
By understanding and embracing the changes happening within my body and using them as a catalyst for personal growth and lifestyle improvement, I have changed the trajectory of my health and wellbeing during perimenopause. The journey hasn't always been easy, but it has undoubtedly been transformative, bringing a new depth of understanding and appreciation for the power of holistic wellness.
Embracing Lifestyle Medicine
In my pursuit of improved health and wellness, I leaned heavily on the recommendations of the American Academy of Lifestyle Medicine. This included adopting a whole food, plant-based diet, increasing physical activity, getting adequate sleep, managing stress, avoiding harmful substances, and fostering strong relationships.
I made changes to my diet, incorporating more fruits, vegetables, whole grains, legumes, and healthy fats, and reducing processed foods. I prioritized physical activity, focusing on both cardio and strength training exercises. I made an effort to ensure that I was getting quality sleep, and I utilized mindfulness practices to manage stress.
I knew that maintaining a healthy lifestyle was paramount, so I focused on maintaining a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. I also made sure to include foods rich in phytoestrogens, such as soy and flaxseeds, known for their potential to reduce menopausal symptoms.
Exercise was another crucial aspect of my regimen. I found that regular physical activity not only helped to manage my weight but also improved my mood, energy levels, and overall wellbeing.
Sleep became a priority, understanding the impact poor sleep can have on mood, concentration, and overall health. I aimed for seven to eight hours of sleep each night, and employed relaxation techniques such as meditation and deep breathing exercises to help achieve this.
These lifestyle changes, supported by the behavioral change strategies learned from Wellcoaches, significantly improved my perimenopause symptoms. Furthermore, they have led to improvements in my overall health and well-being, aligning with my intrinsic motivations and personal health goals.
Through this journey, I have experienced firsthand how powerful a tool lifestyle medicine can be. It not only alleviated my perimenopausal symptoms but also improved my overall quality of life. As a physician, my experience has further solidified my belief in the importance of lifestyle medicine and wellness coaching in patient care.
Turning to Functional Medicine
Incorporating functional medicine training into my perimenopausal journey provided a broader lens through which to view and address my symptoms. This approach emphasizes understanding the underlying causes of health issues rather than merely treating the symptoms.
With my personal perimenopause experience, it became evident that the hormonal fluctuations characteristic of this phase were significantly contributing to my mood, weight gain, insomnia and hot flashes. Hence, I turned to functional medicine to seek a more holistic solution.
Functional medicine taught me that the body is an interconnected system, and health issues in one area can impact others. In this light, I delved into the exploration of my gut health, particularly given the burgeoning evidence on the gut-hormone connection.
An imbalance in the gut microbiota, also known as dysbiosis, can affect the body’s hormone balance and vice versa. With this in mind, I worked on improving my gut health through probiotics, prebiotics, and a diet rich in fiber. This not only aided in balancing my mood but also had a positive impact on my overall well-being, including improved digestion and a strengthened immune system.
Part of my journey in managing my perimenopause symptoms involved getting to know my body more intimately and understanding the complexities of my hormonal landscape. To do this, I turned to Precision Analytical, a recognized leader in hormone testing. Their comprehensive testing solutions offered me a detailed picture of my hormonal status, helping me tailor a personalized strategy to address my needs.
It is important to note that there is some controversy among traditional laboratory testing and even whether testing is needed. I chose to test myself partially out of curiosity, but also to help guide my decisions in understanding my perimenopause symptoms, my stress hormone levels and my potential for insulin resistance.
Precision Analytical provides a unique test called the DUTCH test (Dried Urine Test for Comprehensive Hormones). This includes urine and saliva testing that helps to evaluate critical hormones in the body, including sex hormones (estrogen, progesterone, testosterone) and stress hormones (cortisol).
Understanding my sex hormones was key in navigating perimenopause. Through the DUTCH test, I was able to see not just my absolute hormone levels, but also the relative balance between them.
Learn more about my personal perimenopause journey and my experience with DUTCH Testing in my blog post, Doctor's Secret Revealed: How I Tested My Own Hormones and Took Control of Perimenopause.
For instance, the balance between estrogen and progesterone was helpful for me to understand my perimenopausal symptoms. I discovered that while my overall hormone levels were low, I had a higher level of estrogen in comparison to progesterone. The testing also helped me understand that I need to support my metabolic system with adaptogens.
The metabolic insights provided by Precision Analytical's testing are not limited to sex and stress hormones. The testing also measures markers related to nutritional status, detoxification capacity, and oxidative stress.
By looking at these markers, I was able to gauge my overall metabolic health and identify areas where I needed extra support. For example, certain nutrient deficiencies revealed through the test led me to incorporate specific supplements into my regimen to support optimal metabolism.
In essence, the comprehensive testing from Precision Analytical provided me guidance on my personal perimenopause journey. It allowed me to move beyond guesswork, offering actionable insights and personalized data to guide my treatment approach.
With this information in hand, I felt more empowered and equipped to make informed decisions about my health and well-being. It helped me realize that while perimenopause is a natural process, it doesn't have to be a disruptive one.
Overall, functional medicine has been an integral part of my perimenopausal journey. By addressing the root cause of my symptoms and viewing my health from a systemic perspective, it has allowed me to regain a sense of control and balance during this natural life transition. It's a testament to the power of this holistic and personalized approach to health and wellness.
Integrating Traditional Allopathic Medicine
As a medical doctor, my initial training and foundation are rooted in allopathic medicine, a field that addresses disease through the use of treatments like drugs or surgery that produce effects different from those caused by the disease itself. My training is grounded in robust scientific research and evidence-based practices that guide patient care.
One of my primary responsibilities as an allopathic physician is to ensure the application of FDA-approved treatments, ensuring that my patients receive therapies that have undergone rigorous testing for safety and effectiveness.
These therapies are typically indicated for specific conditions, symptoms, or disease states based on a wealth of clinical trial data. Hence, when it is necessary, and indicated, I utilize these tested and approved treatments for the best possible patient outcomes.
FDA-approved hormone therapies for menopausal symptoms include a variety of preparations, ranging from oral to topical formulations. These medications primarily contain estrogens and/or progesterone or progestin (a synthetic form of progesterone). They are prescribed to help alleviate symptoms caused by the decrease in hormone levels associated with menopause.
Extensive population studies suggest that transdermal applications of estrogen therapy such as patches, gels, and sprays, along with FDA-approved low-dose estrogen tablets, may carry fewer risks of blood clots and strokes compared to conventional dosage forms of estrogen pills. However, direct comparative studies between oral and transdermal hormone therapies are yet to be conducted.
The FDA has sanctioned a range of hormone therapy options, including estradiol and progesterone, which are biochemically identical to hormones naturally produced by the body. Nevertheless, it's important to note that there is currently no scientific evidence that custom-compounded bioidentical hormone therapy is either safer or more efficacious than these FDA-approved hormone therapies.
There is an absence of sufficient safety evidence to endorse the application of hormone therapy for women who have been diagnosed with breast cancer. In the management of menopausal symptoms for survivors of breast cancer, non-hormonal treatment options should be considered as the initial strategy.
As of May 2023, The Food and Drug Administration (FDA) has approved Veozah (fezolinetant), an oral medication for the treatment of moderate to severe vasomotor symptoms (hot flashes) caused by menopause. It is the first medicine of its kind (neurokinin 3) to be approved for treating vasomotor symptoms.
However, it's essential to note that while my foundation is in allopathic medicine, I am a firm believer in integrating various forms of healing and wellness approaches for a holistic treatment plan.
These include principles of lifestyle medicine, functional medicine, and even traditional medicine when appropriate. This integrative approach not only aligns with evidence-based practices but also recognizes that each individual's path to health and wellness is unique, and there's no one-size-fits-all solution.
In essence, my goal as a physician is to leverage the best that all medical approaches have to offer. Whether it's through FDA-approved medications, lifestyle modifications, or the use of bioidentical hormone therapy, each intervention is chosen based on its evidence, safety, effectiveness, and alignment with each patient's unique health situation and preferences. This ensures comprehensive, personalized, and effective care for all of my patients.
Seeking Support and Encouragement
No one should navigate perimenopause alone. I sought support from friends, family, and medical professionals who understood my experiences. Joining support groups and participating in discussions with other women going through the same transition was incredibly helpful. This support network provided comfort, shared experiences, and practical advice.
Be sure to join the FREE Bonza Health Perimenopause Support Group on Facebook!
By adopting this holistic approach, I found that I could manage my perimenopause symptoms effectively, transforming a potentially challenging period into an opportunity for personal growth and self-care.
This journey, while personal to me, has also shaped my approach as a doctor. It has given me a deeper understanding of the perimenopausal experience, allowing me to provide more empathetic, comprehensive, and effective care to my patients. It is my hope that sharing this journey can provide comfort and guidance to others navigating the same path.
