[Originally written in July, 2024.]

First off, thanks so much for the comments and support on my previous post. As I’ve started this journey, I’ve become so passionate about the topic because it’s a conversation that’s clearly been missing and if I can in any way contribute as another small voice to assist in raising awareness on this topic, I’m going to do it.

The update, though, to my previous post is that I actually got to jump the waitlist and got into see the specialist early! Originally, my appointment wasn’t supposed to be until March. But the day after I called the office to add myself to the waitlist, I got a call back from the office asking if there was any way that I could make an appointment work that day. Lucky for me, my calendar was light and flexible. The receptionist said she was going down the cancellation waitlist and no one was answering, so she tried me due to my responsiveness the day before. Yay! Pure luck. And apologies to all you ladies still waiting. I feel slightly guilty for jumping the line – but it was an opportunity I had to take.

Right away meeting with the CNP, the consultation felt different than any of the doctor’s visits before. I felt heard. I felt like the symptoms I was experiencing wasn’t in my head. She acknowledged that much of this is likely due to perimenopause. She had me go through an extensive questionnaire where I rated my symptoms and their severity. We also went through my cycle history and where things were currently at. I shared my frustration with my previous doctors who didn’t seem concerned at all about my latest bloodwork when I personally thought the trend lines on my cholesterol and blood sugar looked concerning. She confirmed these elevations can often happen due to our dwindling hormone supply and she said she’d like to pull her own labs to see how my initial doses of estrogen and progesterone were working for me.

She also talked me through a lot of options and her methodology of treatment. She talked about the importance of protein, something that I’ve seen Dr. Mary Claire Haver talk about in her socials – as well as it being a well-established best-practice of many personal trainers. She wants me at 125 grams per day – which is A LOT. But she coached to try and not get to that total immediately. She recommended increasing slowly to that level to offset the tendency to overeat to get there. The good news is that when I tracked what I ate the next day, I came in close to 100 grams on a 1700 calorie day so, while it’ll take some tweaking, but it’s not a huge shift from my current behavior.

The doc also recommended strength training 2-3x a week, specifically heavy lifting. She is a big of a fan of getting this work through pilates or sculpting classes. She said my yoga classes are great, but those should be in addition to lifting… so, no, all those chaturanga push-ups are not a substitute for the dumb bells.

On the topic of exercise, she also said to quit running! This gave me pause, especially since I just dedicated two months to building back up to small runs. But when I explained how much I used to love it and what I missed about it, she then clarified her advice to run only because I loved it and wanted to, but that high intensity cardio wouldn’t do me any favors at this stage of life. She recommended walking instead and no cardio that includes high-intensity intervals which is a departure from old me. The theory is that it stresses the body and releases more cortisol.

This isn’t the first time I’ve heard this feedback about rigorous workouts and menopause not being friends. Her recco was to keep up the yoga, add in the strength. The good news is that I do love to lift, so I’m not sad. However, I had moved my focus recently away from lifting as I’ve been focused on my running and yoga practices, so shifts are (again) in order.

We talked about water intake. This is an area where I feel like a chronic failure. I aim for 75 oz a day but usually end up around 60. She said that was actually pretty good which surprised me when I see so many women pushing 90 to 100 oz a day in social. Still, a good reminder that I need to drink my water.

Then the topic turned to alcohol… something that I love. I am and have been a regular drinker for many years and I shared how often we consume. Typically there is a daily drink and some excessiveness on occasion over the weekends. And this is where she was very firm in her message that if I’m here to focus on my longevity and reducing my risk for cardiovascular diseases and cancer, I needed to significantly reduce my alcoholic intake. My previous doctors have never had this conversation with me so directly and I’ve always been honest about how much I drank. But she was very clear that the elevated blood sugar, cholesterol and blood pressure can all stem from alcohol, especially during perimenopause and menopause. She said that during this phase, alcohol can exacerbate a lot of those conditions.

Fun.

Her recco is 2/3 drinks per week maximum.

Maximum.

I took the feedback.

Finally, we discussed the different hormone options and she asked me if I’d consider adding testosterone to the mix. She said it could help with energy, focus and libido but also with sleep, bone density and mood. There are a couple of downsides to T. The first is that insurance never covers the cost. And the second is that it’s harder to test for in blood panels so it’s a “how does it feel” sort of thing when judging if getting too much. My CNP said she likes to push it with the initial prescription and we can cut back from there. Fortunately, I can afford it and I went with the creme option that you apply topically 1x per day.

Walking away from that appointment, I felt so good about having a list of actionable things that I can do to combat all these symptoms that I’ve spent years thinking were inevitable because of my age. My high blood pressure has plagued me and having the hard line drawn on alcohol may make a difference. I’ve stressed myself out trying to get “all the forms of exercise” and now I know to prioritize walking and weights. I like idea of tracking food again just to check in on my protein intake and see what kind of difference changes there may make overall. I also got a list of other recommendations to help with inflammation overall that included using the sauna 2-3x a week, taking walks after meals to lower blood sure and to consider intermittent fasting.

The next step was also to come in for my blood draw so she could see how the low dose of estrogen that I’ve been on is doing as well as look at my other values for additional adjustments and advice.

Net, net – I walked away from that July appointment so much more hopeful than I have been in years. Could it be that feeling better is on it’s way? I guess we will see. But like I said, I’m hopeful. SUPER, SUPER HOPEFUL.

Photo by Tima Miroshnichenko

[Note from November 25, 2024: I drafted this back in July right after my appointment but never got to posting due to some personal issues including a death in the family. This is my attempt to catch-up in documenting this process since I think it is very important, both for me personally to capture but also to share with others who are going through similar symptoms and feeling as frustrated with mainstream western medicine as I have been]