Living Your Best Life After Menopause

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From common concerns about weight gain to changes in bone health and sexuality, OB/GYN, Susan Lasch, MD, shares how to live your healthiest life after menopause. This insightful discussion covers the latest research and provides actionable strategies to thrive in this new chapter of life.

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Macie Jepson
You know, here’s the thing about growing older. You feel like you’re still in your 20s until you wake up one day and clearly you’re not, and your body feels older than you really are. Yet somehow we don’t see this coming. Now, Pete, today I want to talk about living well, and I mean really living after menopause. So, this is for your wife. This is for your co-host. This is for your mom, every woman and every person who loves a woman out there who gets discouraged by aging.

Pete Kenworthy
Right. You mentioned my wife, and she used to be an avid runner, but now she’s shifted to walking, doing some workouts at home, and I would think that’s still pretty good when it comes to exercising at 52 years old. But what about all that other stuff after menopause, right? Your body changes. Is there anything you can do about that? And what about mental decline? Can you slow that down? Hi, I am Pete Kenworthy.

Macie Jepson
And I’m Macie Jepson, and this is The Science of Health. Today, we’re going to break down the myth that women have to just accept the signs and the consequences of aging. Joining us today is obstetrician gynecologist, Dr. Susan Lasch of University Hospitals Cleveland. Thanks for being here.

Susan Lasch, MD
Thank you for having me.

Macie Jepson
So, life expectancy for women in this country is darn near 80 years old. That is a lot of living past menopause, which occurs on average at about 51 in the US. In your practice, what are you seeing in your older patients physically and emotionally as they approach or go through menopause?

Susan Lasch, MD
I would say the number one thing that women come to me talking about is gaining weight. Every single woman when she starts to go through the menopausal transition, complains about weight gain. How can this happen? Nothing has changed. I’m eating the same. The second thing that women complain about when they start to go through the changes that lead to menopause is decrease in sex drive. Every single woman will ask, is this normal? What’s going on? I’ve never noticed this before.

Macie Jepson
And before we go too deep into this, are there solutions to this or is it something we just have to accept?

Susan Lasch, MD
There are always solutions to weight gain, and the simplest one is changing your diet. And it’s hard to accept that you need to change your diet again in your lifetime, but you will need to change your diet if you intend to maintain your weight going through the menopausal transition.

Pete Kenworthy
How does where you are physically at menopause play a role in that path forward? Is it too late to turn things around significantly enough to impact quality of life down the road? So, once you’re at that point physically when you start menopause, is it too late? Should you have done something sooner or are there things you can still do physically moving forward through menopause and beyond? Does that make sense?

Susan Lasch, MD
Sure. That’s a great question. Well, probably one of the most important things for getting ready to address that part of your life is being a regular exerciser. It’s recommended 30 minutes most days of the week, and a lot of us don’t maintain that recommendation, so that’s a really important thing for most women to have going for them into their 40s. And becoming familiar with a diet that works for them is also very helpful, something to help them maintain their weight.

Pete Kenworthy
Anything specific from a diet standpoint that women should be paying attention to? Or is it this simple eat right and exercise? Right? I mean, is it that simple? Are the things to avoid are the things specifically for women that they should or shouldn’t be eating as they age?

Susan Lasch, MD
There’s no specific thing that women shouldn’t be eating as they age. It is just getting a healthy diet that works for you, whether that’s the Dash diet, the Mediterranean diet, a whole food diet, something like that. It is recommended to eat fish for all of us in moderation, low mercury fish so that’s an important part of all of our diets, but there’s no bad food that everyone should avoid, most things in moderation, but obviously avoiding sugary foods is very helpful.

Macie Jepson
And important, you said Dash diet, which is for your heart, and we’re going to get into some of the medical side effects of menopause. And so changes to our bodies in the years around menopause may actually raise your risk of certain health problems at low levels of estrogen affecting our bodies as well. Let’s dig into that just a little bit. Let’s talk about heart disease first. Does menopause increase our chances of that?

Susan Lasch, MD
So going through menopause does seem to increase your risk of heart disease, but there are a lot of things that we can do to decrease that: healthy weight, regular exercise and seeing your doctor for recommendations on other health conditions like high blood pressure, elevated lipids.

Macie Jepson
What about osteoporosis?

Susan Lasch, MD
Osteoporosis is sort of the big bad wolf of menopause just waiting there to get you. Your bone density does decrease after menopause. That’s a big, big change for us, although it starts to decrease throughout our lifetime starting after adolescence. Some of the things that can help decrease the risk of osteoporosis are regular exercise, although it’s sort of a modest risk, but having strong muscles can help maintain your bones, keep your bones strong, and then it’s also recommended to have a bone mineral density test at age 65 unless you have other risk factors.

Pete Kenworthy
And this is, you talk about the bone density issues for women that start immediately after adolescence, right? Is there nothing, is that just a thing with women, there’s nothing you can do to keep that better, keep it as good as it was when you were an adolescent? It’s just one of those things. Or is there a magic pill? Is that the daily exercise? Is that calcium supplements? I don’t know. I’m just kind of spit-balling here. Is it just one of those facts?

Susan Lasch, MD
Well, calcium plus vitamin D may slightly decrease your risk of fractures. The jury is still a little bit out on that, so getting enough calcium in your diet seems to be helpful, but how much supplementation with calcium is a little bit unclear, but having vitamin D supplementation in your diet may also help if you don’t get enough through light exposure or the foods that have vitamin D in them. There is probably nothing to totally reduce osteoporosis, but there are kinds of exercise that are more helpful for osteoporosis than no exercise at all. Specifically weightbearing exercise such as walking, Tai Chi, yoga can decrease the risk of fractures to the femoral neck, and progressive resistance exercises, that’s exercises using bands or weights also decrease risk of fracture to the femoral neck. And then weightbearing exercise and other resistance exercise can decrease risk to the spine of fractures.

Macie Jepson
When you say weightbearing, you mean…?

Susan Lasch, MD
Weightbearing is anything where you’re using your weight to get around, walking, even riding a bike, Tai Chi, yoga, things where you’re standing and just holding your weight.

Macie Jepson
I’m hearing from you that maybe the most important thing is that you’re keeping your body fit and strong so that you can avoid those falls down. If you have a strong core, you’ve got some muscles in your legs and your arms, you might avoid an accident that could lead to a fracture because the osteoporosis is there, right?

Susan Lasch, MD
Well, if you already have osteoporosis, you should be careful initiating an exercise program if you don’t already have one going, because it can be associated with risk of falls, which can increase your risk of fracture. So, for women who already have osteoporosis, starting with basic walking and using the resources available to them, such as a Silver Sneakers program or a trainer or gym that has specific programs for seniors would be advised.

Macie Jepson
So, we need to ease into it if we’re not accustomed to working out. So, I guess that begs the question, is it ever too late to actually become active?

Susan Lasch, MD
It’s never too late to become active, but if you have not been active previously, you should probably consult your doctor to make sure you’re healthy enough to begin activity. And then if you’re doing things beyond just walking, you should probably check with a senior program before you start weight exercises or resistance exercises.

Macie Jepson
We’re throwing those words around a lot. So, I guess I’d want you to get specific. Do you have three top activities that you like to suggest to your patients?

Susan Lasch, MD
Top activities that I suggest to my patients are walking, walking and doing something involving some kind of weights. For most of us, walking is very accessible. Most of us live in a place where we can walk. We can walk almost all year round if we just put a coat and hat on and we’re pretty much good to go. Most of the time the roads are not too slick or the sidewalks too slick to walk outside, so walking outside is a great way to get that exercise, get to have a regular habit, and being outdoors is also a mood lifter, which a lot of us need, especially in these cloudy days of winter.

Pete Kenworthy
Kind of reminds me of an article I read a long time ago about these hundred-year-old athletes, and each of them when asked how they were able to still be athletic at a hundred was each of them almost said to a T, the secret has never stop moving, right?

Susan Lasch, MD
Right. Secret is never stop moving. And if you’re walking now and you feel like you could start doing more, then there’s nothing wrong with increasing your activity. Just go slow. Maybe consult a trainer in that area.

Macie Jepson
Ten thousand steps, though, isn’t necessary. Is it? When you say walking, how much?

Pete Kenworthy
Well, 30 minutes, right?

Susan Lasch, MD
Thirty minutes most days of the week. Yeah. A lot of us talk about taking stairs as a way that we get our exercise, but to go up a flight of stairs only takes about 10 seconds. So, for most of us, that’s not going to cut it unless we do a lot of stairs.

Pete Kenworthy
So, we talked a little bit about diet, controlling heart disease, blood pressure, those kinds of things, but when women need additional help, I mean, we see lots of supplements marketed toward women, right? Are they worth it? Do they work? Are they worthwhile?

Susan Lasch, MD
No. Most supplements are not worth it. If there was a supplement that was like a secret hack for losing weight, it would be the most popular item on the market, and it’s clearly not. So, really, it’s about using your diet. Lots of vegetables is always a good way to start, seeing a dietician, if you need additional resources, talking to your doctor. Sometimes there are medications that may help, too. There’s no secret sauce for a healthy diet.

Pete Kenworthy
I have a note here to myself that says multivitamins can be marketed like you talked about, like vitamin D or B12 or less iron. But I also have a note here that says, unless you have a poor appetite or conditions keep you from eating a healthy diet, you probably don’t need them. Is that it?

Susan Lasch, MD
That seems to be the truth, right? There is not a lot of evidence in favor of vitamins for those who have a healthy diet. Right.

Macie Jepson
So, we’re all looking at social media, a lot of us are and see promises out there, and what do you tell them?

Susan Lasch, MD
There is always going to be some change in our mental cognition as we get older. There isn’t any way around it, and it affects each person in their own way. One of the things that women talk about frequently when they start to go through the menopause transition is trouble finding names, and that’s probably one of the most common things that we notice initially.

Pete Kenworthy
So, post menopause, when something doesn’t feel right for a woman, how do they know if it’s just a result of those hormonal changes versus something else they should be concerned about? Right? It’s probably easy to say, oh, that’s just because I went through menopause, that’s why I’m feeling this way. Right? But it’s not necessarily true.

Susan Lasch, MD
You should probably see your doctor if there’s changes that you’re noticing that you’re attributing to menopause. They may or may not be, but it’s something to discuss with your doctor.

Pete Kenworthy
Are there common things your patients will say to you like, oh, I’m sure this has to do with me just going through menopause, and it’s heart failure. I went pretty extreme there, but…

Macie Jepson
Or an inability to sleep, not giving good sleep anymore. Do you just write that off or could there be another issue? That’s when you send them to the sleep specialist to answer those questions.

Susan Lasch, MD
I mean, there are definitely a lot of sleep disturbances that come with menopause, mostly like waking up in the night and feeling like you’re wide awake and trouble going back to sleep. A lot of times if you’re having trouble falling asleep, it might be a mood disorder that is inhibiting that, but again, that’s something to talk to your doctor about.

Pete Kenworthy
What do you tell your patients about hormone replacement?

Susan Lasch, MD
I tell my patients that there are risks and benefits to hormone replacement and for some people it’s the right choice of medication for the things that they’re experiencing.

Pete Kenworthy
What is it? Give me an explanation for that woman out there who doesn’t even know what it’s for.

Susan Lasch, MD
Hormone therapy is best used for treatment of hot flashes and night sweats. That’s where it’s most effective. It may have some improvement in sleep. It may have some improvement in mood disorders if they’re related to the menopausal transition. There are risks, but there are benefits. It also decreases the risk of osteoporotic fractures, too, so it has some benefit in that regard.

Pete Kenworthy
What are the risks?

Susan Lasch, MD
Most of the risks that we have associated with hormone therapy are from the Women’s Health Initiative study, and it showed increased risk of stroke, thromboembolic events, heart disease and breast cancer. Some of those risks are probably lower than they were shown to be in that study as that was an older population, not women around the menopausal transition, which is when most women seek out hormone therapy. And we’ve also changed the way we give hormone therapy using more topical estrogens such as a patch and different progestins that may have less of a negative effect on breast cancer and heart disease.

Macie Jepson
If you have a predisposition to or family history of breast cancer and you don’t want to do hormones, do we just have to accept that we’re not going to sleep well or that we’re going to have hot flashes or are there any natural ways to approach this?

Susan Lasch, MD
There are other medications that you can use for hot flashes and night sweats. Antidepressants can be helpful in this regard. Some of the neuromodulators like gabapentin can be helpful. There is also a newer medication that works in the neurotransmitter area that may reduce hot flashes. As far as sleep disturbances, we do not have great medications that will help women not wake up in the night. We have more medications that help women fall asleep at night, which doesn’t seem to be as much of a menopausal problem. So, it is hard to address that early morning awakening that a lot of women experience in menopause. Some women feel better on hormone therapy, but not everyone.

Macie Jepson
I want to follow up because you mentioned antidepressants, so it made me start thinking about what women are going through emotionally at this time, and while that might not be your level of expertise, you’re certainly seeing them and you’re probably the first visit where they start talking about. Some women praise menopause and say, my cycle’s over, I don’t have to deal with that anymore. Other women see it kind of as a, I don’t want to say, death seems like a strong word, but it’s an end to a time in your life. Do you deal with that with your patients? What emotionally are you seeing?

Susan Lasch, MD
Like you said, both sides, both sides of the coin. Definitely. Some women are glad to find out that they don’t or are glad to know that they don’t have to worry about pregnancy any longer and that there are not more feminine hygiene products in their lifetime as far as changing and ruining their clothes. But other women feel like that loss of their, they might feel like they have a loss of their femininity or their womanliness if they’re not having cycles anymore and starting to see the changes that come in their body with menopause.

Macie Jepson
How do you talk them through that?

Susan Lasch, MD
In my practice, I just try to help women embrace the new you. This is you. This is who you are, and you’ve gone through a lot to get to this point and this is who you are until you’re not with us anymore. So, there’s not a lot of value in mourning the loss of those things. It’s more about just embracing what’s ahead of you.

Pete Kenworthy
That’s great advice.

Macie Jepson
But here’s the thing. When I think about aging, I want to look and feel like that beaming, graying active woman that we see in all of those commercials that honestly what she’s doing, I would fear I’d break a hip. I mean, she’s playing tennis. I want to take trips. I never want to slow down. What would you say is the secret to that kind of life?

Susan Lasch, MD
Healthy diet and exercise.

Macie Jepson
Oh, it’s always that. Nice.

Pete Kenworthy
That’s it, though. But that starts well before menopause, right?

Susan Lasch, MD
It can.

Pete Kenworthy
You can’t just decide after menopause to completely shift your diet if you weren’t doing well before that?

Susan Lasch, MD
Sure, you can.

Pete Kenworthy
You can?

Susan Lasch, MD
Yeah, sure. If it’s a big shift, see a dietician and work through it. If it’s a big shift in your activity, go to a gym that has specialization in senior programs and get into it. You’ll see older people running marathons, at CrossFit, doing gymnastics, hiking, climbing, doing all those things. It may have been something they’ve been doing their whole life, but it may be something totally new.

Pete Kenworthy
Yeah.

Macie Jepson
Sounds like the key to that success is it starts with your frame of mind.

Susan Lasch, MD
That’s a great way to look at it. Yeah. Obviously, your mind is very powerful for controlling your body.

Pete Kenworthy
If we could tie a bow on this whole conversation and you had advice for, well, probably three different women coming to you, right? I know I’m about to go into menopause or I’m in menopause or I’m coming out of menopause, what’s the takeaway?

Susan Lasch, MD
My advice for women starting to go through the change in menopause, I guess is be familiar with the changes that are coming, and healthy diet and exercise is probably the way to get through menopause the best way and continue for hopefully a long and healthy life.

Pete Kenworthy
You said be familiar with it. What do you mean?

Susan Lasch, MD
The changes that most women experience with menopause: weight gain changes in their menstrual cycle, sometimes mood changes, more premenstrual syndrome. They may notice decreasing their libido also.

Pete Kenworthy
It’s all normal.

Susan Lasch, MD
It’s all normal. It’s all normal. Every woman experiences those things.

Pete Kenworthy
Yeah, I mean, and it’s frustrating, but it’s normal.

Susan Lasch, MD
Correct.

Pete Kenworthy
Right.

Macie Jepson
Wait a minute. We didn’t talk about libido. And I mean, come on. That’s important. And you said that that’s what women come in and they’re concerned about.

Susan Lasch, MD
Libido is important, and being aware that there is a natural change is probably one of the most important things. It’s not necessarily something wrong; it’s just something natural. It’s just something to talk to your partner about. Maybe you never had to talk to your partner about the changes that you notice in your libido, but it’s okay to be honest and be truthful. And figuring out a way to work through that together can be sexy, can be great.

Macie Jepson
Any medications out there for that?

Susan Lasch, MD
There are some medications for problems with libido that are very mildly effective.

Pete Kenworthy
Yeah. But there’s other things that go along with that, right? Cause like dryness or pain or those kinds of things, and those are treatable.

Susan Lasch, MD
There are a lot of different ways to manage dryness and pain with sex. Definitely. That’s definitely something to talk to your doctor about.

Pete Kenworthy
And there are medications for that.

Susan Lasch, MD
There are medications, and there’s a lot of over the counter things, too.

Pete Kenworthy
Yeah.

Macie Jepson
I feel like there are some warning signs that your body is telling you, this is coming. What would they be?

Susan Lasch, MD
Some women might notice that their periods get a little shorter but heavier, but still coming monthly. The interval might become slightly shorter before it starts to extend, and then you might start to skip menstrual cycles. But if you have questions about how often you should be bleeding or the bleeding seems out of the ordinary, you should definitely contact your doctor because that could be a warning sign for something serious.

Macie Jepson
And to be clear, if your cycle resurfaces in month 11, you are starting over, right?

Susan Lasch, MD
You are starting over, but that’s a good topic to discuss with your doctor, too.

Pete Kenworthy
Dr. Susan Lasch from University Hospitals in Cleveland, thank you so much for joining us today.

Susan Lasch, MD
Thank you for having me.