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For a perfectly normal process of life, menopause still has an aura of mystery.

Yes, menopause is normal, but what constitutes as normal for each woman experiencing this life-changing stage is the enduring mystery. The journey can be overwhelming without assistance in navigating a world where one-size-fits-all does not exist.

Not a solo journey

“Build a tribe,� recommended Clarissa Kristjansson, PhD, neuroscientist, menopause educator and holistic health coach. Kristjansson is the host of the “Thriving Thru Menopause� podcast and author of “The Mindful Menopause and Beyond Hormones: 7 Holistic Ways to Thrive Thru Menopause.�

“This is not a journey to be taken alone,� Kristjansson emphasized. “Track your symptoms and their triggers so you can have an informed conversation with your health care provider. Ask questions, research information about menopause from evidence-based sites like North American Menopause Society (NAMS). Don’t get your health advice from a celebrity.�

The NAMS has published its 9th edition of “The Menopause Guidebook,� which gives up-to-date information on perimenopause, premature menopause, menopausal symptoms and a variety of therapies. Guidance includes treatments for various symptoms as well as information about crucial health issues women need to face when hormones start to change.

Cardiometabolic turning point

“Women are at increased risk of cardiovascular disease and osteoporosis,� Kristjansson said. “I love the quote from The Lancet that calls menopause a cardiometabolic turning point for women. Menopausal hormone therapy is proven to support women in these areas. Women should also exercise for bone and heart health. Maintaining a healthy weight helps reduce bad cholesterol levels and keeps blood pressure in the normal range.�

Cardiometabolic health refers to the state of the heart, blood and blood vessels. Optimal health is measured in an ideal body mass index and waist circumference, no prior heart attack or stroke, normal blood sugar levels, ideal cholesterol levels and normal blood pressure (the last three based on not having to take medication). One study by the Journal of the American College of Cardiology found that out of 55,000 adults in the U.S., only 6.8% had optimal cardiometabolic health.

“Most men and women are fearful of cancer, as we should be,� advised Mark Menolascino, MD. Menolascino is board certified in Internal Medicine, Integrative Holistic Medicine, Advanced Hormone Management and Anti-Aging Medicine, and he is a science advisory board member for Designs for Health. “Yet it is heart disease that kills most of us. If your family history is positive, you should work on an epigenetic personalized heart prevention plan with advanced blood tests.�

Natural estrogen levels prevent heart issues in premenopausal women by improving cholesterol, increasing blood flow and reducing free radicals. Once estrogen levels decline, women have equal risk of heart problems as men. Menolascino suggested testing for lipoprotein (a), a low-density lipoprotein that causes plaque, and the inflammation marker C reactive protein.

“When perimenopause and menopause symptoms are bad,� Menolascino added, “many women cut back on precisely those activities that benefit their hearts the most. When you don’t feel good, your mood is off, and it is just plain harder to exercise, eat clean, be social and reap the benefits of good self-care.�

No one solution

Hot flashes have become synonymous with menopause, but not every woman gets them. Smoking and obesity increase the risks of having hot flashes, and research is pointing to a connection between hot flashes and increased risk of heart disease and greater bone loss.

“Menopausal hormone therapy is the proven and recommended way to manage vasomotor symptoms,� Kristjansson said, referring to hot flashes. “But cutting down on alcohol and caffeine may also help, as can eating more foods rich in phytoestrogen like flaxseed.�

Hormone replacement therapy (HRT) replaces estrogen in the body. HRT does have risks that include heart disease, stroke, blood clots and breast cancer.

“Based on the Women’s Health Initiative study,� Menolascino said. “We know that oral estrogen and progesterone are not ideal. When women are taking hormones, I advocate for compounded bioidentical hormones. Whether you are taking hormones or not, there are several natural supplements to consider that may be good choices for you. Be careful of all the internet hype and influencers. Trust a professional grade brand and seek advice from a certified practitioner with experience in natural supplements if possible.�

Menolascino mentioned black cohosh, chasteberry and DIM and added there is no one solution.

“My experience shows that not every woman responds to the same herbal in the same way,� Menolascino said. “I try to use a natural blend that is safe but effective to treat the symptoms.�

Listen to your body

Besides hot flashes, brain fog, sleep disruption and weight gain are menopause’s biggest disruptors. Kristjansson said dealing with stress is critical for brain fog, sleep problems and weight gain. Women report that stress management, strength training and a diet rich in protein, good fats and fiber have improved their lives for the better. Kristjansson added that women should prioritize rest within their day.

“Listen to your body,� Kristjansson advised. “The symptoms are telling you something valuable.

Menolascino, too, stressed the importance of a healthy diet. Along with advising to “let food be medicine,� he recommends a multivitamin, vitamin D and omega-3 fatty acids daily for all his patients, as well as magnesium (citrate, glycinate, and threonate).

“You are not doomed to have the same illnesses as your parents and grandparents for the most part,� Menolascino said. “Heart disease, dementia and diabetes may all be lifestyle diseases, and you have the power to alter your genetic destiny. How? Eat the colors of the rainbow in real fruits and vegetables, not from chemical dyes and artificial colors. Keep your body moving and get exercise. I feel like a daily walk is the best medicine I can offer. And do it with a loved one or a friend. The social connection may be just as powerful a health benefit as the exercise.�