Occasionally, the attempt to empathize with someone during a visit falls flat. She knows it, I know it, and the therapeutic encounter is anything but. Since I am around the same age as many of my female patients, when a woman comes in with perimenopausal symptoms I am quick to understand. It’s common for women to complain of sleep disorder, mood swings, weight gain, fatigue, irritability, muscle aches and memory issues on top of the daytime hot flashes and night sweats. A couple of years ago, at my husband’s 35th high school reunion, one of his former classmates was almost frantic because she thought she had early onset Alzheimer’s disease. As she spoke of her word-finding difficulty, walking into rooms and forgetting what she went there for and awakening every 45 minutes, all the women surrounding her were sagely nodding their heads. Nope, we told her, you aren’t crazy or paranoid, you are experiencing the “Menofuzzies”.
In order of magnitude what women most hate is:
- Weight gain.
- Mood swings.
- Weight gain.
- Weight gain.
- Memory issues.
- Yep–Weight gain. It’s a big issue.
- Hot flashes and night sweats.
Even though I struggle with the fifteen pounds I have gained over the last 17 years, I am 5’10’ so the weight distributes well and I don’t look like I’m at the top of the acceptable BMI (Body Mass Index). Having never had any issues at all losing weight until I hit 40, I understand how frustrating it is to walk over fifteen miles a week (often more than that), eat far less than at any other period of my life and still have difficulty with the zipper. The mood swings I can deal with, the insomnia gets better with the exercise, the memory issues fluctuate but my older colleagues and friends (female) tell me that it will improve and the light at the end of the tunnel no longer appears to be a train. Except for the weight. Some of my patients have gained 20 to 50 pounds or more during this time of life and they are frustrated and angry. And they do not need me to empathize with them. Or tell them that other women are having the same problem. What they care about is THEIR weight gain and how to deal with it.
Unfortunately there are no easy answers to mid-life weight gain. It’s still a calories in/calories used kind of equation. I recommend Weight Watchers and these already time-stressed patients are frequently not interested in finding yet another meeting to attend. I suggest using the on-line and app versions of Weight Watchers and they promise to look into it. I encourage exercise and talk about the fact that it is the closest thing yet to a Magic Pill but they are already exhausted and look at me in disbelief when I tell them that one has to invest energy to make energy. I recommend apps like LoseIt to use self monitoring as a technique for weight loss. I advise them that there are no good pharmacologic solutions and rarely recommend lap-band surgeries or other similar procedures except in extreme cases.
I try to steer them away from hormones except when their insomnia from night sweats and persistent awakenings is intolerable. Generally patients don’t find much relief with over-the-counter preparations (OTC) but they seem generally safe to try. Many patients come in requesting anti-depressants but these often worsen their weight issues. Again, that Magic Pill of exercise can make a difference if an individual will stick with it. There’s no down side to exercise (unless you run in front of a truck) and a safe thing to try for many of the issues arriving in peri-menopause and beyond.
The bottom line is, like many health issues, there are no easy answers and certainly no ONE pill is going to make this transition and its difficult aspects all go away. Staying physically fit, maintaining or developing good dietary habits, having a fulfilling home life and a satisfying life outside of one’s home seems to be the best medicine for navigating this time of life. But not everyone has the supports in place to make the kind of lifestyle changes necessary to achieve these goals–their jobs exhaust them, their kids are in trouble, their husbands are unsupportive or absent, there is no flexibility in their schedules, their is no flexibility in their thinking and any number of other difficult circumstances. And when they are frustrated with little or no time to develop these kinds of lifestyle changes, they may find my advice lacking.