Managing Menopause Naturally with Dr. Briana Sinatra

Dr. Briana Sinatra: You get a hot flash in a business meeting. Your mood feels unpredictable and you don't always understand why. Maybe your desire for sex is fluctuating wildly. These are all symptoms of menopause, and today we're going to get rid of all the embarrassment around this topic and have some real talk. We'll talk about what's happening with your body, how to deal with it, and how to feel better. I'm Dr. Briana Sinatra.

Dr. Drew Sinatra: And I'm Dr. Drew Sinatra. And this is Be HEALTHistic.

Narrator: Welcome to Be HEALTHistic, the podcast that is more than just health and wellness information — it's here to help you explore your options across traditional and natural medicine, so that you can make informed decisions for you and your family. This podcast illuminates the whole story about holistic health by providing access to the expertise of Doctors Steve and Drew Sinatra, who together have decades of integrative health experience. Be HEALTHistic is powered by our friends at Healthy Directions. Now let's join our hosts.

Dr. Drew Sinatra: Hi folks. If you like what you hear today and you want to listen to future conversations on all things integrative and holistic health, subscribe to our podcast on Apple Podcasts or wherever you download your favorite podcasts. Also, check out and subscribe to our YouTube channel, which will feature video versions of our episodes plus video extras you won't want to miss. And finally, we have more with me, Dr. Drew Sinatra, my dad, Dr. Steve Sinatra, and other Healthy Directions experts over on the Healthy Directions site. So visit HealthyDirections.com to explore our database of well-researched content and information. And of course, you can always follow us on our social media channels.

Dr. Drew Sinatra: Well, it's great to have you back on the show again, Briana. And for those listening, this is Dr. Briana Sinatra. She's my wife, and she's actually an expert in women's health. And today we're going to be talking about menopause.

Dr. Briana Sinatra: Thank you, it's so good to be here. And you see a lot of menopausal women in your practice, too. So I'm excited to have this conversation, just to share what we each see and our different practicing approaches for supporting women through this stage of their life.

Dr. Drew Sinatra: Well, let's talk about some of the “unmentionables” of menopause. Because this is something that is not openly talked about in our culture. And I think it's difficult for women to come in and talk about it with their doctor — or their husband for that matter, because a lot of men just don't understand what's going on with menopause.

Dr. Briana Sinatra: Absolutely. I think this is a really good point. I mean, women spend a third to a half of their life in the menopausal years. And so there's symptoms that come along with that that can be embarrassing and really impact their quality of life. Things like, well, the “unmentionables” being, vaginal dryness, pain with intercourse, low libido, urinary leakage. Even if they haven't had babies and held a child to term, there's still changes in their hormones that make their bladder react more to a cough or a sneeze; and that can be embarrassing. And so I think it's important to bring all of those things out of the closet and into the light, so that we can all have a conversation about it. And women don't feel ashamed, and they can go to their health provider and have an open conversation about it, so that they can get the help that they deserve, so they can have a high quality of life during this time.

Dr. Drew Sinatra: And I should share a story of a patient that came in a couple of weeks ago, actually. And I've been treating her for about a year for menopausal symptoms. And one of the biggest issues that she was having was getting her husband to understand what it was like for her to have pain during intercourse, because there's vaginal dryness. And of course, she tried lubricants and I put her on some estrogen. And we tried certain things that had certainly improved her symptom.

Dr. Drew Sinatra: However, it was her husband that didn't really understand what was going on with her body. And I think over the last nine months to a year, I've really talked to her about the importance of talking to him and explaining to him, "This is my body, this is what's going on for me. And I really need you to understand how to adapt to this." And I think she finally did that and had a terrific conversation with him, and now he gets it. And it was such an awakening moment of like, "Ah, yes, now we can have this discussion."

Dr. Briana Sinatra: Yeah, absolutely. I think that's so important because there are so many factors, especially when you're intimate with someone and you're talking about your libido and everything like that, there's so many factors that come into play and it's really a couple issue. The more open and honest a woman can feel with the changes in her body, and the more accepted she feels by her partner, she's going to feel a lot more open to be vulnerable and share those things and really feel support from her partner. So I think that is a really important thing.

Dr. Drew Sinatra: And really, as a culture, I think people understand erectile dysfunction better than they understand menopause, right? Men have issues with getting an erection, and luckily there's a drug out there for men that they can take where they get relief from it, right? But for women, there may not necessarily be that degree of relief that they get from taking a medication.

Dr. Briana Sinatra: Right. It's not as cut and dry. It's not as low blood flow to the penis, take Viagara. Voila, everything is okay. There's so many factors that come into sexual interest and desire for a woman. There's so many aspects. I mean, we're talking about menopause, so we're talking about the biological and hormonal aspects, changes in their androgens, estrogens, maybe different medications and fatigue, and all of that.

Dr. Briana Sinatra: But also expectations of negative outcomes, feeling safe and emotional like you were talking about in that relationship with the patient. Stimulation with their partner, that conversation, how all of that is changing in their body. There's so many factors, it's so multifactorial — that it's not a one-size-fits-all pill, in a woman's case. And so I think it's important for a woman to talk about all of those aspects, and get the support from all the different types of professionals that are out there to support those different aspects that are coming up for her at this stage in their life.

Dr. Drew Sinatra: And for our listeners really, what age are we looking at for a woman right now in terms of going through this perimenopause, and then heading into menopause? What age group are we talking about here?

Dr. Briana Sinatra: Yeah, so perimenopause is that time before menopause when a woman's hormones can be fluctuating. So she might start to have some symptoms associated with menopause — like hot flashes, vaginal dryness, forgetfulness, those types of symptoms might start to come. She might see changes in her menstrual cycle. It might not be as regular as it was. The flow might change. It might start to be heavier. And so as those hormones are fluctuating, that period of time can be very different for each woman. Some women, it might start as early as their late 30s. Typically it starts for a woman in their 40s. It can last a year or two — usually on average, it's about four years for a woman. But it can last upwards of 8 to 10 years for a woman.

Dr. Drew Sinatra: And technically speaking, women enter menopause after 12 months of not having a period, correct?

Dr. Briana Sinatra: Yes. 12 consecutive months of not having a period, then they are diagnosed as being in menopause.

Dr. Drew Sinatra: Exactly. Okay. Well what I see a lot too, is…we talked about a little bit the “unmentionables,” right? Something like vaginal dryness or low libido. We briefly mentioned hot flashes. I see another major symptom present, I wonder if you see this in your practice, too, but — insomnia. A lot of women just develop insomnia during this age, this whole phase that they're going through, and that's really hard to work with sometimes.

Dr. Briana Sinatra: Yeah, absolutely. It can be due to a hot flash at night — but it can also be just they're having trouble sleeping, whereas before they did not. So I agree. I think that is a big thing. And your lack of sleep at night affects everything during the day. It affects your energy level, it affects your cognitive ability. So things that you're already starting to see change around this time just gets exacerbated when you're not sleeping well.

Dr. Drew Sinatra: For women that are experiencing insomnia, what do you recommend?

Dr. Briana Sinatra: Yeah, so I think with insomnia, sleep hygiene is really important. So things even without the menopausal piece, things that everyone can do when they're experiencing insomnia is being mindful of their body's own melatonin production. So winding down lights and electric devices before bed, because all that light inhibits our body's natural production of melatonin — and so that can create dysfunctional circadian rhythm with our melatonin.

Dr. Briana Sinatra: For women, as they are getting more hot flashes and getting warm at night, I think natural fibers for their sleeping attire, but also in their bed. Things like 100% cotton, linen, silks are more cooling, more temperature-regulating than some synthetic fibers that might have polyester or fleece in them. Keeping your room temperature a little lower, having a fan, cracking open a window can be really nice. So that if you need to stay warm, you can put on an extra layer — but then when you get hot in the middle of the night, you can easily take it off and the ambient environment of your room is nice and cool.

Dr. Briana Sinatra: I think also being really mindful of your blood sugar at this stage. As your estrogen levels go down, your body is a lot more affected by insulin, and a little bit of an insulin resistance can occur. So making sure that you're really good about keeping your blood sugar regular throughout the day, that can really help at night, too. And that helps, as well, with cortisol. So there's many aspects that you can look at with your diet to support this — and also when we're looking at cortisol, with your adrenals and how you can support your stress level. So all those can also be done during the day, and they definitely make an impact on your quality of sleep at night.

Dr. Drew Sinatra: Those are some great tips. And what about for women that are experiencing mood changes with menopause, for instance, anxiety or depression or irritability? Is there something that you think about, in terms of helping mitigate those symptoms?

Dr. Briana Sinatra: So anxiety and depression is really tied in to your stress level, or can be for people. And I think also going through the menopausal years as our estrogen levels change, we're more acutely reactive to cortisol and the effects of stress. So this is really a time to implement those relaxing, self-care activities. Whether that is meditation, deep breathing, yoga, going for a walk, connecting with a friend…all of those things, getting a massage. All of those self-care things are so important and so vital for our nervous system, and for nurturing ourselves during this stage. I think it absolutely should not be overlooked.

Dr. Drew Sinatra: And I'm really happy you mention those, because it's so hard to quantify stress in our society, right? I wish we had, like, a stress meter that we could put on someone and really determine their level of stress. But unfortunately we don't have that, and it's really a matter of trial and error with these things. You go out, go to yoga, learn some meditation technique, maybe try some Tai Chi — whatever it is that works for you to help reduce stress. Because doing those things is amazing for women, helping with their mood, anxiety and depression.

Dr. Briana Sinatra: Yeah, and I think it's always important to ask a woman — what is she interested in doing? Because if she's interested and motivated to do it, then it's something that she's going to be much more likely to incorporate on a daily basis. And even if she can commit with a friend to go to a restorative yoga class every Wednesday or something like that. Usually, not always, but often as women we like to be in community, and I think this time in our lives is no exception. If we can find a community which we can tap into that can help with our accountability and support us to do those self-care things, then it's going to be a lot more successful, and more of a long-term practice that is more likely to be incorporated into their lives.

Dr. Drew Sinatra: Well, let's transition onto one of the biggest and most common symptoms that we see in menopausal women, which is hot flashes or night sweats.

Dr. Briana Sinatra: Yeah, absolutely. And if you're in a business meeting and you get a hot flash, I imagine it really sucks! So, some things that you can do, and they sound simplistic, but…dressing in layers is super important. Being able to take a layer off, feel cooler, even having a fan on you. Practicing your deep breathing exercises during that time can really help. Even if it means you have to step out for a minute and just collect yourself, I think that's important.

Dr. Briana Sinatra: I think, like we were talking about before, being honest about it. Because the other women in the room who are experiencing it, too, will completely empathize with you. And the men that are in the room that can't empathize will hopefully gain a lot more empathy and sympathy for the women in their life when they go through it, too. So I think it's important to be real about it, and not try and hide it.

Dr. Briana Sinatra: I think you can also do things like have sage tea, or some cooling cucumber water or lemon water that you can have on hand to sip. And there's also some great herbals that might be indicated for you, to help support and reduce those hot flashes.

Dr. Drew Sinatra: Well, what kind of herbals do you like to use? Is there any in particular in mind?

Dr. Briana Sinatra: Yeah, some main ones that come up for me are black cohosh. Maca is fabulous, because it can support your hormonal levels, but it's also really adrenal supportive, which we talked about as being really important at this stage in your life, too. Rhubarb is an herbal that you can get…

Dr. Drew Sinatra: The rhubarb extract.

Dr. Briana Sinatra: Yeah, that you can get in a capsule, that has had some really great research on it for reducing hot flashes and night sweats, and some of the symptoms of menopause.

Dr. Drew Sinatra: And women listening to this might be wondering about hormone therapy, and hormone replacement therapy. I'll speak to my thoughts in a moment, but I'd like to know your thoughts on hormone therapy for women.

Dr. Briana Sinatra: Yeah, I don't think that it is always an easy topic. Even within our profession, I feel like there's so many varying opinions on even the safety of bioidentical hormones. We have an opinion on non-bioidentical hormones — but are bioidentical hormones safer? I think there's definitely a camp that says they are, and then there's a definite camp that says we still need to use caution. And what about if a woman has a family history of breast cancer?

Dr. Briana Sinatra: So when I'm ever having that conversation with a woman, I think it's so important to see where she's at, have a really honest conversation about it. And see where she's at, also, with the severity of her symptoms. And because I have seen some natural therapies really help and really be effective, and I've seen some instances where people are having such severe symptoms that going to bioidenticals can be really helpful. So I think it's always important to talk with your healthcare provider, and have an honest conversation about the pros and cons in your specific situation to find what's right for you.

Dr. Drew Sinatra: Well, we usually start…at least in my practice, we usually start with the basics first. All these things that we just covered, right? The herbals, reduction in stress, wearing different types of clothing or the sheets you're going to use, talking about all these things. And I actually learned this from my dad years ago, but he used to tell me, "Look, there's a place for hormonal replacement therapy. And that place is when the quality of life is so poor for a woman, that she can't even go outside, or she can't have a social event with friends without being embarrassed and just uncomfortable having a hot flash."

Dr. Drew Sinatra: And I really learned that from my father, and I really took that to heart. And I have been prescribing over the last six or seven years a fair amount of hormone replacement therapy, a bioidentical hormone replacement therapy for women. And I do find it to be pretty effective for helping with all these symptoms that we're talking about — whether that's hot flashes or vaginal dryness or fatigue or anxiety, depression, insomnia, easy forgetfulness or cognitive issues. Estrogen, and using in conjunction progesterone and sometimes testosterone, these hormones really do seem to help a lot of women. But like you said, they're not for everyone. And we have to have a conversation beforehand about the pros of going on it, and also the cons. So happy we're having this conversation.

Dr. Briana Sinatra: Yeah, absolutely. And for how long, and when or if do you transition your patients off of it? So I think, exactly to your point, there is a reason for why different medications and different hormones exist. And so, thank goodness they do when we need them, and working with someone to find what is best for your specific situation, what your specific levels should be and all of that, so you can really have individualized care.

Dr. Briana Sinatra: I think it's really important as a woman if you feel like you are either maybe being pushed towards a hormonal path that you don't feel comfortable with, or you feel like that is not being given to you as an option and you strongly feel like you are indicated for it and it would be a helpful thing, then it's important to be your own advocate. And if you feel like your current health practitioner isn't listening to you, and meeting you where you're at, and providing all the options that would be helpful for you — then go find another practitioner, one who will really sit with you, listen to your needs and desires, and find the best course of action for you.

Dr. Drew Sinatra: Yeah, that's a great point, because a lot of times people get pigeonholed into one doctor they're seeing, right? It's their Kaiser doctor, it's their Blue Shield doctor, whoever it is. And that doctor may not know a lot about how to treat women in menopause. And so therefore, it's a good idea to get a second opinion, or even a third opinion sometimes. Or talk to your friends about who they see, and who they like, and who listens to them. And really, who takes the time to figure out how best to serve you.

Dr. Drew Sinatra: Because any doctor out there that really has all the answers…I always say, look, I'm humble in the way that I approach medicine. I'm learning something new every day. So I look at it as, one doctor may know a lot about this, but they may not know a lot about that. So always seek additional advice, when needed.

Dr. Briana Sinatra: Yeah, it's hard to be the Jack-of-all-trades. It's important to learn from each other — and we're learning every day, and every conference, it's always new. So I think that's a very good point. So, I think what you said about stress was really important. How we all experience stress on a daily basis. And for our listeners who aren't aware, it's actually our adrenal glands that release cortisol in response to perceived stress. So when we experience a stressful situation, that cortisol is secreted to help us handle that stressful situation. To either give us that adrenaline boost to fight like heck and deal with what's at hand, or to run in the opposite direction. And when we are exposed to daily chronic stress, our adrenals are continually secreting cortisol on a daily basis.

Dr. Briana Sinatra: And in menopause, as our estrogen levels go down, we are much more acutely sensitive to that level of cortisol in our system. So, our stress response is that much more heightened, and I think that can contribute to the anxiety that is felt for women. So the more we can do to balance and manage our stress, and our perceived experience of stress, through those stress-reducing activities, that deep breathing. And even herbs that support our adrenal health can be really, really helpful during this time for women.

Dr. Briana Sinatra: Some herbs I love — we talked about Maca, which is specifically helpful for hormonal balance, but also helps to feed and build the adrenals. Ashwagandha I love, holy basil I love, rhodiola I love, ginseng I love. It always depends kind of how stress is manifesting for that woman. If it is causing more of a wired, anxious experience, then you want to use more gentle-acting, calming herbs like ashwagandha.

Dr. Briana Sinatra: If someone has had chronic stress repeatedly over her lifetime, and now her adrenals aren't secreting as much cortisol to give her that get up and go. Like, in the morning we naturally want our cortisol to rise, to give us that energy to get out of bed and tackle the day. If she's having a lot of morning fatigue, using more of a stimulating adrenal supportive herb can be helpful. Something like ginseng or licorice can be really helpful in those situations.

Dr. Briana Sinatra: So I think some important takeaways for our listeners from today, are bring menopause into the light. It is nothing to be ashamed of. It's completely natural, and every woman is going to go through it. Sleep hygiene is really important, especially if you're struggling with insomnia. Self-care is going to be even more important than usual, so don't feel guilty about getting a massage, going to yoga, going for a walk, taking that time for yourself. It is so important and vital for your health. Layer your clothes in case of hot flashes, so you can add or remove, as needed. And hormone therapy has its pros and cons, so find a practitioner who will work with you to find out what's indicated in your specific situation.

Dr. Drew Sinatra: This is definitely a topic where we need to continue the conversation, and we definitely will in a future podcast.

Dr. Drew Sinatra: Before we wrap up this episode of Be HEALTHistic, I wanted to share our Wellness Wisdom for the day. Since we've been talking about women and menopause, and that's really one of Briana's specialties, I'm going to let her take it away.

Dr. Briana Sinatra: We discussed a lot of different facets of this stage of life that begin with peri-menopause and end with menopause, which we know can take many years. Each woman's menopausal journey is different, but there are a few symptoms that every woman will experience at one time or another. One of the worst, night sweats. To get natural relief from night sweats — hot flashes that occur during sleep — try these strategies to stay cool while you sleep. Dress in light night clothing. Use layered bedding that can easily be removed during the night. Use natural, temperature- regulating materials, such as 100% cotton, linen or silk, versus synthetic fleece or polyester material. Cool down with an electric fan or open a window. Keep a frozen cold pack under your pillow, and turn over the pillow often so that your head is always resting on a cool surface — or put a cold pack on your feet.

Dr. Briana Sinatra: I also like to recommend these nutraceuticals to help women manage their hot flashes. These include black cohosh, chase tree, or Maca and rhubarb. And do talk with your healthcare provider to determine which of these recommendations is best for you. I hope some of these tips help all the menopausal women out there get some relief from their night sweats.

Dr. Drew Sinatra: Remember everyone, if you liked what you heard today and you want to be an active member of the Be HEALTHistic community, subscribe to our podcast on Apple Podcasts or wherever you download your favorites. And subscribe to the Healthy Directions YouTube channel. You can also find more great content and information from us and the Healthy Directions team at HealthyDirections.com.

Dr. Drew Sinatra: I'm Dr. Drew Sinatra.

Dr. Briana Sinatra: And I'm Dr. Briana Sinatra, and this is Be HEALTHistic.

Narrator: Thanks for listening to Be HEALTHistic, powered by our friends at Healthy Directions, with Doctors Drew and Steve Sinatra. See you next time.