Menopause and the related transition period from start to finish can take up a considerable amount of time in a woman’s life extending over a period of over 20 years in some cases. There is a lot of information written about menopause and various approaches that can be used to address the symptoms related to the transitional hormonal changes. Many women want an integrated approach to manage the transition, and this is not often an option in our Western medicine health care system. Most of our attention in Western society is to focus on the physical aspects of the menopause transition. While there are a wide variety of holistic treatments available to manage these, the inadequacy of the Western medicine model to share this approach results in a common mindset that women must suffer through the discomforts of menopause. What I see most often in my practice is that women commonly do not fully understand the menopause transition, nor do they feel informed about holistic symptom management options, effectiveness, and safety. About 70% of women who are going through menopause are living with untreated symptoms. This has become a widespread and growing health matter. There was a recent article in Bloomberg News about the millions of women who are leaving the workforce due to bothersome and mismanaged symptoms related to the menopause transition. It is thought that this will only keep trending upwards as the population ages unless there is more of a public health approach to addressing this health concern. Offering women the information they need pertaining to this issue as well as holistic management options, would improve the situation and allow women the quality of life they desire and deserve. The purpose of this article is to give an overview of the menopause transition and to offer a holistic perspective for management from a mind-body-spirit approach.

Pre-menopause
Prior to the menopause transition, women are in a pre-menopausal state. This is the period when a woman is having regular menstrual cycles. This begins with menarche or onset of menses and extends into the mid 30s or early 40s when ovarian function begins to change, and symptoms related to these changes may start to occur. In the pre-menopausal stage, the focus of concern is management menstrual cycle symptoms and consideration of family planning options.

Perimenopause
Perimenopause is the transitional period when ovarian function begins to change and therefore onset of related symptoms begins to occur. This transition typically begins around age 45 but can begin as early as age 35 in some cases. A classic presentation during this time is for the periods to become irregular and unpredictable. This means that menstrual cycles may become shorter or longer, bleeding may become lighter, or heavier, regular, or irregular. Ovulation continues during this time but may begin to present sporadically and contraception must continue to be a consideration through this time if pregnancy is not desirable. With the perimenopausal onset of hormonal fluctuations and changes in the menstrual cycle, other symptoms may begin to occur such as hot flashes, night sweats, libido changes, mood changes, vaginal tissue changes, urinary tract changes, and sleep disturbances. This can be a frustrating time given the unpredictable nature of the cycling and symptomatic changes and the general lack of support for management of this phase from the Western medicine model. The perimenopausal stage ends once a woman has stopped menstruating for good.

Menopause
Menopause is considered complete once a woman has had 12 consecutive months without a menstrual period or menstrual bleeding. The average age for this is 51 years. Symptoms during this time are a continuation of those that begin in the perimenopausal stage and often become more intense and frequent leading up to the final menses and following. Symptoms persist for some time following the final menstrual period and can last 5-7 or even 10 years or more. Common symptoms during this time include hot flashes, night sweats, vaginal dryness, painful intercourse, libido changes, dry skin/hair/nails, mood changes, forgetfulness, brain fog, insomnia, joint pain, sinus problems and weight gain. Women often experience the menopausal transition much like their mothers with some women experiencing mild symptoms and others more bothersome and life disrupting symptoms.
The most impressive issue I see during the menopausal transition is that women suffer physically, mentally, and emotionally from many of the symptoms they are experiencing due to lack of knowledge and lack of support from the medical system. It is frequently that I spend a significant amount of time educating women about their passage and the related symptoms and have a broad and detailed discussion about all the available treatment options, the effectiveness of those options and the safety concerns. My most important message to women during this time is that YOU DO NOT NEED TO SUFFER. There are many options to consider that will address and, in many cases, eliminate the symptoms of menopause so that quality of life is improved. Treatment options are broad and extensive. There are both hormonal and nonhormonal solutions, prescription and nonprescription options, synthetic options, and natural options. With the array of choices at hand, there really is no reason for women to suffer through the symptoms that the menopause brings. An integrated approach ideally would use a blend of western, eastern, and complementary alternative therapies to address the menopausal symptoms.

Post Menopause
Post menopause is the period following the last menstrual cycle. This phase brings several new health considerations in addition to ongoing symptoms related to the decline and cessation of ovarian function. Primarily, management of postmenopausal symptoms can continue for up to 7-10 years and can be safely managed during this time. In addition, this is a wonderful time for women to reevaluate their general health and lifestyle as they look forward to the years ahead and consider the quality of life they would like to live during those years. Postmenopausal women are more at risk for chronic disease, and some of the hormonal changes of menopause can have an additional effect on these risks and conditions. For example, once the body stops producing normal levels of estrogen, bone health can decline. This is a prominent issue to attend to with the intent of reducing bone health decline and the potential for fractures. Mobility, strength, endurance, and flexibility become super important to manage during this time as well for bone health and fall prevention. Cardiovascular risk is higher during the postmenopausal years due to age and there is thought to be influence from hormone changes that can add to the risk. It is important to have a plan in place to address cardiovascular disease risk and manage disease that is already present. Brain health is also something that can be impacted by menopausal changes as well as the normal aging process. There are several holistic modalities to promote brain health during these years to reduce risk for cognitive decline or dementia.

A Holistic Approach
A holistic or mind, body, spirit approach is extremely beneficial in managing all the menstrual cycle transitions and, the perimenopausal, menopausal and postmenopausal stages. An integrated approach goes far in reducing chronic disease risk and promoting quality of life. Consideration of the whole person including the mind, the emotions, the energy body, the physical body, and the spiritual being will bring quality of life and a health foundation that will empower women and equip them to move forward into their older years with health, vitality, vibrance, optimism and allow them to live the way they would like to live for the remainder of their lives. Following is a breakdown of my thoughts regarding the mind, the body and the spirit as pertaining to the menopausal transitions.

Treating the Mind During Menopause
Our mindset about the reproductive cycles and menopausal transitions that we go through as women can have a profound influence on how we travel through these transitions. So many times, I see women who have come to understand this cycling and transitioning as a negative experience – a bothersome aspect of their lives that they must “put up with.” This attitude extends to the menopausal transition and post menopause. Although this seems to be changing over time, there still exists some stigma about menstrual cycling and the menopausal transition that brings a less than desirable perspective about it and keeps open discussion hidden and information inaccessible. Women continue to miss access to information about their transitioning bodies, the physiology of the cycling and hormonal changes, the physical, mental, emotional, energetic, and spiritual aspects that can be expected, and the management of all of this. Although society has come far in this regard since my generation of women, there remains room for growth.

With the evolution of technology, women are now exposed to the possibility of more information about reproductive cycling and the menopausal transition, but the experience varies and the modeling of adults in their personal lives also varies in terms of how the menstrual cycle and reproductive health in general are viewed. In an ideal world, women would have access beginning at an early age to the information they deserve to understand about their bodies. They would also be exposed to positive role modeling and a mindful approach to cycling transitions in support of the amazing gift that they have received as potential life-giving beings in this world. In biblical times, there is history of women banding together to support each other during the various cycle transitions, but this mindset and ritual has fallen away long ago. I believe this can change with intention. It rests on all women to take to heart the responsibility to provide accurate information to women and to support them as they travel through the reproductive transitions. This becomes a public health issue that has begun to unfold in the earlier stages of the life reproductive cycle but still has room to develop for the menopausal transition that affects all of us and can have profound influence on our work and home lives. Women can act as role models and support those who come after us as travelers of this magnificent journey. We can all work to address this as a public health issue. We have the power in our bodies to reproduce life, and we also have the gift of mind and the ability to influence how young women receive this gift and carry it forward and how older women transition through the ending of the journey of reproductive cycling.

Holistic approaches to address the mind through the menopausal transition include the following:
Fostering creativity which is often enhanced during the menopausal transition.
Prioritizing connection with other women or loved ones for support.
Giving attention to emotions.
Practicing soothing self-care.
Allowing a slowing down, rest, grace, and ease in life.
Attention to movement and time spent in activities that are enjoyed.
Allowing changes in moods, energy level and libido without judgement.
Breath work which can calm the nervous system.
Positive affirmations and body talk.
Relaxation techniques.
Cognitive Behavior Therapy or hypnosis.

Treating the Body During Menopause
The physical body becomes the most obvious focus of the many details of the reproductive and menopausal transitions. In premenopausal years, the management of establishing first cycles and managing cycles during the reproductive years is best carried forward on a foundation of good health. Certainly, basic health practices such as nutrition, hydration, physical activity, sleep, and hygiene all play a part in how the cycling and transitioning of a women’s body manifests itself. During perimenopause, the unpredictable changes take center stage as our body sorts through the mixed messages it receives during hormonal fluctuations. And the menopausal stage brings transition to an opportunity to re-evaluate physical health and reestablish health practices that will help us to transition into our older years as healthy and vibrant middle aged and older aged women. The body is utterly amazing. And if well supported with basic health practices for a solid foundation of health, the journey will be more forgiving. Each woman is unique in her own presentation of this amazing transition throughout life.

Holistic management of physical symptoms during this time includes the following:
There is a wide array of options to add to the western approach including vitamin supplements, herbals, homeopathic remedies, bioidentical hormone therapies, alternative complementary therapies such as Reiki, acupuncture, massage, hypnosis, biofeedback. A blend of western, eastern, and alternative complementary therapies is best utilized in individualized treatment plans.
Journaling or symptom tracking apps are often useful in helping women to stay in touch with their bodies and measure response to treatment modalities.
Herbal teas or supplements can address hot flashes, mood changes, libido changes, forgetfulness, and brain fog.
Topical or vaginal moisturizers and lubricants with hyaluronic acid can address skin changes and vaginal dryness.
Some vitamins and spices such as turmeric as well as magnesium or Epsom salt baths can be used to manage joint inflammation and pain.
Dietary management with increasing calcium, magnesium, healthy fats, vegetables, and fluids can help with mood changes and weight loss.
Activities that promote mind/body connection, flexibility, muscle strength and balance such as yoga, tai chi, mindfulness, journaling, meditation, gentle movement such as walking are great for the body symptoms of menopause.

Spirituality and Menopause
Menopause can be a spiritual opportunity, and spirituality should become a priority during this significant period. The spiritual body or soul is typically not addressed in Western medicine, and if we attend to spirituality with more priority, the management of the mental/emotional and physical body will be easier, and health and wellbeing will start to fall into place with less effort.

As women we are powerful beings. Our reproductive cycling gifts us with the awesome possibility to bring life to this world. When you think about the magnitude of this ability that we have been given, it aligns on a spiritual level as miraculous, and the ultimate creative gift given to human beings. How amazing is it that our body is equipped with the ability to conceive, carry, deliver, and nurture life?

Our intuitive gifts and wisdom and the ability transform cyclically both monthly and throughout our lifetime should be honored and celebrated. We are such wise and resilient beings following the many transitions we have experienced throughout our lives. Our cycling and transitioning can provide spiritual connection, for some through the moon cycles, and for others through creativity and emotional processing and connection with other women. Recognizing the spiritual aspects of our cyclic and transitional gifts from pre-menopause through post menopause should be encouraged. This is an opportunity to attend to our spirit and raise our vibration. Everything has a vibrational quality and as ours rises, we become tuning forks for those around us to rise as well.

As we transition through menopause and into post menopause, we can shift the paradigm and be present for a new beginning. A beginning of the second part of our life when we can focus inward and at a soul level. And where we can become leaders of wisdom in our society, communities, families and hold a powerful influence for those who will come after us on this journey.

Holistic management of spirit during the menopausal transition could include journaling or writing, connection with other women in groups, intergenerational connections among women, ceremonial activities, tuning in to vibrational frequency in the whole being and making efforts to raise our vibration through lifestyle, mind body techniques, meditation, prayer, and participating in joyful activities that move us from a heart and soul level. This is a wonderful time to foster our intuition. Energy work can be quite helpful during this time. Reiki and acupuncture are both wonderful ways to foster balanced energy.

Menopause is a powerful and magnificent transition in a woman’s life and should be revered. This transition should be considered an honorable and celebratory time. Menopause is an ideal time to rethink our health practices and to place priority on foundational health practices that will allow us to live our lives in our older years as we want to live and have dreamed of living. Throughout the reproductive cycling process and the many transitions, I feel that so many women who interface with our health care system, are not given the information they need to address pre-menopause, perimenopause, menopause, and post menopause from a holistic perspective. Our western medicine model is just not set up to offer a holistic perspective, but this needs to change from a public health standpoint. There are so many holistic practices that can be integrated into the management of the reproductive cycling transitions, including menopause, and it is my mission to provide women with this information so that they can feel empowered to make informed decisions for themselves and raise up the quality of their lives as they move into their older years. Menopause should be a journey that signifies a transitional new beginning towards the best years of a woman’s life, and a holistic approach to managing this transition would best support the significant journey that leads to the honorable status of a woman’s wise older age.