Local Experts Help Women Navigate Perimenopause

What does Atlanta business owner and mom of two Blair Green have in common with Oprah, Gwyneth Paltrow and Halle Berry? All are taking on the topic of menopause.

If you’re a woman in your 40s or 50s, you’ve probably noticed that menopause is everywhere, from social media to podcasts to celebrity interviews. And everyone seems to have opinions about what to eat, which supplements to take, how much weight to lift and what products to buy.

Despite all the information out there, or maybe because of it, there is a lot of confusion surrounding the topic. But Green, along with Atlanta doctors Mimi Zieman and Lillian Schapiro are here to help cut through the noise.

Green, who owns Catalyst Physical Therapy in Dunwoody and recently launched Not Your Mother’s Menopause, a program to help women navigate the perimenopause years, just turned 50 and is in “full on perimenopause.”

“I’ve had symptoms for four or five years. Subtle ones, not the typical hot flashes and night sweats but increased anxiety, all-over-the-place emotions, monthly headaches for probably seven years, joint pain out of nowhere. I’m waking up in the middle of the night,” she says.

Even with her background in women’s health (Green has been a physical therapist for the past 26 years and owns a women-only concierge practice) she did not initially realize her symptoms were connected to perimenopause.

“We hear so much about mood changes, sleeplessness, irritability,” says Zieman, an Atlanta OB-GYN and nationally known women’s health advocate. “But also, things are coming to light much more now, such as joint pain or other systemic bodily changes.”

To clarify, while the terms menopause and perimenopause are often used interchangeably, menopause is the moment in time when you haven’t had a period for a year. Perimenopause, however, can last for up to 10 years before menopause and occurs when a woman’s ovaries start to gradually produce less estrogen, causing hormones to fluctuate and triggering a host of symptoms.

“There’s no test that says you’re in perimenopause. Your blood work doesn’t tell you because your hormones are all over the place,” says Green.

Even more confusing is that there is no uniform treatment.

“It’s very symptom-specific and woman-specific,” says Zieman. “A woman and her healthcare provider will discuss her particular health risks, conditions, any menopausal symptoms she’s having and then decide what the best treatments are.”

But amidst the confusion, there is hope.

One option that has gained renewed attention is hormone therapy, referred to as HRT (Hormone Replacement Therapy) or MHT (Menopausal Hormone Therapy). In 2002, after a landmark study found hormone therapy increased the risk of breast cancer, stroke and heart attack, many doctors stopped prescribing it. And while new research has found that the results were flawed, the stigma remains.

“Risk depends on the timing or age when women start hormones, as well as the type of hormone used and the dosage,” says Zieman. When women start hormones before age 60 and within 10 years of the onset of menopause, the “benefits often outweigh the risks,” she says. Add to this that today’s formulations of hormones are very different.

MHT is not for everyone. Women who have estrogen-sensitive cancers may not be candidates. And not every woman wants to take hormones. “If you can’t take estrogen,” says Dr. Lillian Schapiro, Atlanta gynecologist and menopause expert, “there are other medicines that do the same thing.”

Finding a doctor who is up to date on the latest research is essential but can be difficult. Doctors, including OB-GYNs, get very little, if any, menopause training in medical school. Additionally, overall research into women’s health has been almost nonexistent, with medical studies historically being done on men and the results extrapolated to women.

The good news is that this seems to be changing. “I think we’re definitely moving in the right direction,” says Schapiro. “Women are not only talking about it but being heard.”

When Green went to her longtime OB-GYN and asked about hormone therapy, she was told that because she wasn’t having classic symptoms, MHT would make things worse. She dove into the research herself and searched for a new gynecologist.

“I looked on the Menopause Society website,” says Green, referring to a directory of doctors who have been certified by the Society. Menopause guru Dr. Mary Claire Haver’s website, The Pause Life, also has listings of doctors by region. She looked on social media and asked around, eventually finding someone through a colleague.

“She acknowledged how I felt,” Green says. “She was willing to work with me.”

“You need to find a doctor who’s going to listen to you,” says Schapiro, adding that women must also listen to themselves. “By the time we get to menopause, women have been in their bodies for several decades and you know your body and how it’s changing. There are a lot of options out there and it’s not one size fits all.”

While medication is one part of treating perimenopause, lifestyle changes play an important role, too.

“The more we can do in perimenopause, figure out the hormone situation, get you on the right type of exercise program, maximize your muscle strength, maximize your joint integrity, the better you’ll feel and healthier you’ll be later on in life,” says Green, who has her doctorate in physical therapy and has done extensive menopause research.

But she stresses that the approach must be realistic for each person. Lifting heavy weights, for example, “is the so-called gold standard” to prevent bone loss, says Green. “But if someone doesn’t want to lift a lot of weight, that’s OK. Something over nothing is most important.”

Schapiro concurs with some common-sense advice. “What everybody has to do is exercise and eat a healthy, well-balanced diet.”

“Women shouldn’t have to suffer. There is help out there,” says Green.

“Embrace it,” adds Schapiro. “Think of it as the next chapter. It’s not the sequel. We’re still in the main book,” she says.