What I Wish Every Woman Knew

from birthday reflections to body transitions: understanding the changes ahead

Happy Monday and MLK day, Noosers! Some of us have the day off, but for others it’s a work day — either way it’s a Monday so here we are! One of us (you’ll see who down below 😉) celebrated a birthday last week and the other got some maintenance gel and PRP injections — getting older, one way or another.

As we settle into the quiet days of January, we’ve been enjoying ski weekends, hand warmers, and the way the sun hits just a bit differently in the afternoons — and savoring the fact that the days are creeping a touch longer each day. Take some time this week to just be. I overheard a conversation at school drop off — “I can’t believe it’s the middle of January, time is flying, it will be spring before we know it.” Have you ever noticed that we’re always on to the next, thinking about what’s to come, playing out weekends and events down the line? Use this “slower” time to just be. As

Dr Paddy Barrett

quoted in his recent post:

“I often feel that life is about to begin, only to realize it is almost over” - Oliver Sacks

This week’s Noosletter is a little different. We love experimenting to see what resonates and what’s helpful to our readers, while also writing about what we are passionate about: all things health. This week, Anne took the wheel, writing a little post birthday reflection. We hope you enjoy the essay and that it offers some insight into a phase all of us women will go through (and if you’re a male reader, check it out — it might be helpful insight to your wife/girlfriend/sister, etc!).

Let us know what you think and as always, comment or like the post if it resonates with you! Thanks, Noosers, Enjoy ❤️

#41

Every birthday (mine was last week), I take some time to reflect and take stock of the year. Although isn’t that what we’ve all been doing these last few weeks since new year’s?! Yeah, yeah more reflection, my goodness! The past few birthdays, I’ve noticed a shift. Instead of looking forward to celebrating with indulgent foods and drinks, I find myself looking forward to movement and connection (ok and also not cooking dinner!). One year my husband and I played hooky and went skiing for the day in VT. Another year my mom and I snowshoed at our local nature preserve. Last year, Avery and I completed our first misogi, running 20 miles. This year I awoke at 430am for my morning run with my dad AND I took a mid-day walk in the sun with Avery. What a gift to be outside when the sun is up AND out! Noos has been a gift in itself—as Avery put it recently, “building something creative that helps others.” Everyday I get to be reflective and challenge my thought process on a magnitude of levels.

Every year brings new challenges and gifts. With my most recent birthday, I find myself thinking about a lingering “challenge.” Damn it, another year closer to menopause! Ha! Who else out there has that same sentiment? No matter what age you are, as a female, you will go through menopause. Now, before I lose all the male readers, while you won’t experience this, someone you may know will — be it your wife, girlfriend, sister, cousin, aunt, or friend. It can be really helpful to understand what they are going through, or perhaps you could send this to someone who may find it insightful!

For decades women's health (particularly surrounding menopause and perimenopause) was severely understudied in medical research. This created a significant knowledge gap in understanding how these natural transitions affect women's bodies, mental health, and overall well-being. Historically, menopause was often dismissed as just "something women go through," with minimal attention paid to the complex hormonal changes and their wide-ranging effects. Until recently, most medical research focused predominantly on male subjects, assuming findings would apply equally to women.

​​However, there's been a recent shift. Growing awareness and advocacy have led to increased attention on menopause research. Dr. Marie Claire Haver has led this charge, writing books, The New Menopause and The Galveston Diet, while also having a very active presence on social media. Menopause had always seemed like something that happened when you were “really old,” and not something I’d need to think or worry about anytime soon. But all of the sudden, patients of a certain age (mid-late 40s-50s) started popping up with reports and evidence of stubborn abdominal weight gain, high cholesterol, feeling “inflamed” and other symptoms.

Knowing perimenopause is knocking on the door I thought, “OK, I want to be in the best place I can as I approach this stage.” Is abdominal weight gain inevitable? Will I automatically lose muscle and develop osteoporosis? These are just a few health risks of menopause that have been on my mind.

I’ve heard so many women say, “I wish I had known.”

I feel really lucky that in 10 years there will be even more information out there. I want to be able to visit this post every 6-12 months and check-in. How am I feeling? Heading into perimenopause at a healthy weight, with a good relationship with food (lots of fiber!), and a focus on building skeletal muscle (an area I need to work on) — how will this set me up for a phase of life during which so many women struggle?

Despite recent progress, there is still so much to learn. The field is finally acknowledging that menopause isn't just about hot flashes. It's a complex transition affecting multiple body systems, deserving of comprehensive research and understanding. My hope for you is know better, do better. I’ve provided some information on both perimenopause and menopause — what it is, when it happens, and what to expect. These are some things I’ve heard patients and friends wish they had known sooner, so I’m hoping this can serve you at whatever stage you’re in.

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Perimenopause

6-10 year transitional period before menopause (~40-50 y/o, but can be as early as late 30s)

• Stage 1: cycles start to change by 7 days

• Stage 2: cycles changing by 16 days, skip cycles, hormones start to shift significantly

Hormonal changes: Hormone fluctuations all start when your ovaries begin to run out of eggs. Estrogen and progesterone remain low as your ovarian function is declining. Dramatic drops in estrogen bring on hot flashes and skipped ovulations and other unpredictable symptoms tend to arise. Progesterone levels decline.

Perimenopausal transition is associated with leaky gut, less microbial diversity, increased systemic inflammation, increased depression, and brain changes.

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Menopause

Menopause (average age 51) is officially marked when a woman has gone 12 consecutive months without a menstrual period. This transition has been referred to as “inflammopause” largely because of the decline in estrogen levels and the resulting shift in the balance of pro-inflammatory and anti-inflammatory cytokines.

Common Physical Symptoms:

• Hot flashes and night sweats

• Sleep disruption

• Visceral fat gain

• Sarcopenia (Muscle loss)

• Bone density decrease

• Vaginal dryness

• Changes in skin elasticity

• Joint pain

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Postmenopause: 12 consecutive months without a menstrual cycle. On the 13th cycle free month, you are considered postmenopausal even if you’re still symptomatic.

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An area I focus on with patients (and myself!) is supporting our microbiome, specifically short chain fatty acids (SCFAs). See the visual below.

Whether you're years away from perimenopause, in the thick of it, or have already navigated these waters, understanding this natural transition is crucial for all of us. It's encouraging to see the conversation shifting from whispered symptoms to open discussions about hormone changes, weight management, muscle maintenance, and overall wellbeing during this phase of life.

As I approach these changes myself, I'm grateful for the growing resources and research available to us. But more importantly, I'm thankful for the community of women sharing their experiences, making it easier for others to recognize, prepare for, and navigate these changes!

I’ve noticed some small changes myself and am beginning to see that what may have worked in the past, no longer works now.

By staying informed, maintaining healthy habits, and being proactive about my health, I hope to approach this transition with confidence rather than concern. Let's keep this conversation going because understanding our bodies better helps us care for them better, at every stage of life.

So, aren’t you glad I had a birthday?! Here's to being prepared, staying strong, and supporting each other through life's transitions. After all, knowledge really is power, especially when it comes to our health!

Until next time…