Struggling through menopause? Look for these red flags at the doctor’s office

Tamsen Fadal had been a news anchor at WPIX for over a decade when one night in 2019, she was unable to pronounce basic words on the teleprompter. During a commercial break, heart racing and brain foggy, Fadal went to lie down on the women’s bathroom floor and didn’t return to the anchor desk. It was the first time in her 25-year news career that she’d left a news broadcast unfinished.

Fadal consulted doctor after doctor to explain her symptoms of brain fog, nausea and a racing heart. It wasn’t until one of them left a note in her patient portal that she received a clear diagnosis: “In menopause. Any questions?”

Shelf Help is a wellness column where we interview researchers, thinkers and writers about their latest books — all with the aim of learning how to live a more complete life.

Read the stories

Shocked by the lack of education she received from healthcare practitioners about such a tumultuous stage of her life, Fadal started researching menopause and educating women online about her findings. Her new book, “How to Menopause: Take Charge of Your Health, Reclaim Your Life, and Feel Even Better Than Before” (Hatchette), combines the wisdom of neuroscientists, relationship therapists, physicians and other lifestyle mentors to create the ultimate women’s manual on menopause.

Before her journey with menopause, Fadal never could have predicted the symptoms she experienced. “I didn’t even know perimenopause existed,” she recalls. But finally finding a doctor educated in menopause and willing to talk to her about hormone therapy was a “game-changer” for her.

The Times spoke with Fadal about how women can speak up for themselves at the doctor’s office and how menopause can affect a woman’s career. (Readers can attend her book signing at Barnes & Noble at the Grove on April 1.)

This interview has been condensed and edited for clarity.

Tamsen Fadal, author of “How to Menopause”

(Jenny Sherman)

What did your life look like before menopause hit, and how does menopause typically interact with the life circumstances of a woman?

During midlife, I was constantly asking myself, “What now? What am I supposed to do? Where am I going next, and what do I want?” I think those are the four hardest words that anybody can answer: “What do I want?” Midlife is a time when many of us hit a second chapter or transition period, and we often think we’re supposed to know exactly what to do, but we don’t.

There’s no road map for this time of our lives. With kids and aging parents who need and rely on us around this time, something often changes in relationships, and then on top of that comes perimenopause or menopause, and we don’t know what to do with all of it.

When we have a hormone shift, everything changes. It’s not just periods or brain fog or sleep. It’s everything. A lot of women start to feel very, very lost. Our communities change, our relationships change, our workplaces change and how we feel about ourselves changes.

In your book you argue that the medical system is not designed to treat women in midlife. How would you change it for the better?

We’ve got to do whatever we can to help doctors and those studying to be doctors understand menopause — and in all practices, not just OB/GYN. Menopause training should be part of the main curriculum for all doctors — we’re seeing even so many OB/GYNs now who have had to train themselves on menopause.

The other part is educating women. Just as we have timelines for things like mammograms and colonoscopies, I would love to see timelines for menopause training where at age 35, we start explaining symptoms to women. Often menopause is diagnosed by symptoms, not bloodwork, so women need to be able to spot those symptoms early.

Women were not part of health studies until the mid-’90s, and there’s still not a lot of money that goes toward medical research on women in the midlife period. For that reason, my team and I are constantly advocating for more funding so we can get more research done and have more answers. We still focus on medical studies conducted 20-plus years ago, and we need newer information.

“How to Menopause” by Tamsen Fadal

(Hatchette)

What red flags should women look out for in health practitioners who aren’t knowledgeable or comfortable discussing menopause, and what questions should women ask their doctors early?

Red flag: Everybody goes through that. If your symptoms aren’t that bad, don’t worry about it.

Red flag: If you’re still getting your period, you don’t need to even worry about any of the symptoms. You can’t do anything until after you’re done 365 days of your period.

Red flag: Hormone therapy is dangerous. You shouldn’t do that.

I recently did a panel with two doctors, and both of them said people are calling their front desk asking: “Is your doctor educated in menopause, and are they comfortable talking about hormone therapy?” which is everything we’ve been talking about for the last five years.

Once you get into the office, you should ask:

• What are my options for hormone therapy? When can we start that?
• What are the different types of options for hormones?
• Are there contra-indicators for hormone therapy? Am I a candidate for it?
• What are the lifestyle changes that would be good for me to implement during this time, so I can be treating my whole body well rather than just easing hot flashes?
• Are there any other tests I should be taking right now?

Your book states that one in five women in the U.S. has left or considered leaving a job due to menopause symptoms. How can menopause affect a woman’s career and how would you suggest women broach conversations about menopause in their workplaces?

The symptoms of menopause can be debilitating. If you don’t sleep at night, you’re not operating fully functionally. If you’re dealing with brain fog or sweating in your clothes all the time, it can be embarrassing and you can lose confidence.

Women should be asking their workplaces:

• Is there an option for flexible hours?
• Is there an option for uniform changes, if you’ve got uniforms?
• Is there an option to go outside to take a break?
• Is there a way you can offer benefits?
• Can you give women resources to go to for some type of menopause coaching?

I think there are many ways workplaces can help women that don’t have to be so high-level and expensive such that they’d automatically say no. It’s important for workplaces to consider these flexibility options because we don’t want to lose women at this important time in their careers.

At my previous workplace, I went into my HR department and said, “I’m a 52-year-old woman. I know I’m in menopause, and we need to have some kind of policy to help women. What is part of our policy to help us get some treatment for this, or are we on our own?” I left before this policy was fully implemented, but I know they took me seriously and are still working on making positive changes.

It wasn’t easy, but workplaces are changing: CVS just became the first U.S. company to receive Menopause Friendly Accreditation from MiDOViA, a company we work with, and it’s really exciting to see things like that start to happen.

(Maggie Chiang / For The Times)

What are some of the most common but not talked about symptoms of menopause and some of the best remedies you preach?

Heavy bleeding, hair loss, weight gain, painful sex and low libido are some of the most common symptoms that people don’t like to talk about. Not everyone can do hormone therapy, which has really helped me. If my mom were alive today, hormone therapy would not be an option for her because she had breast cancer. In that case, she’d have to look at major lifestyle changes like taking magnesium to improve her sleep, increasing her protein intake and strength training, and decreasing her stress. She’d have to look at trigger foods and drinks for hot flashes, like alcohol and caffeine. I’d want her to take vitamin D supplements and collagen as a routine.

Why do you think menopause has been a hush-hush topic in the past, and why is it so important that open conversations about it continue?

Talk of menopause has often been so wrapped up in ageism, and I think it made a woman always feel like she was at the end of her best years. We are very clear now that that’s not the case. In fact, I think menopause can signal that we’re at the beginning of a whole new part of our lives that’s really exciting. I call these my bolden years, not my golden years.

It’s important that people understand how to tame their symptoms of menopause because it means so much for their long-term health. It’s not just uncomfortable hot flashes, it’s changing our brains, our hearts and our bone health.

I encourage younger women to learn about menopause early so they can understand when they’re going through perimenopause and not wonder on their own what those symptoms mean. I’m really encouraged by the fact that I have a lot of young women in their mid-30s online in my community who ask great questions. If we don’t keep talking about menopause, we’re just going to keep this cycle going where women are not important and a priority, and we can’t do that any longer. We just can’t afford to.

Shelf Help is a wellness column where we interview researchers, thinkers and writers about their latest books — all with the aim of learning how to live a more complete life. Want to pitch us? Email alyssa.bereznak@latimes.com.