Menopause in the Spotlight: Challenges and Opportunities with Dr Michelle de la Vega

Read as you listen or read on the go: Here’s the full interview for you

Maurice Castelijn

Welcome! Today we’re talking about Menopause Health. And this is not necessarily discussed widely, but many women suffer from this life-changing transition in silence. So you hear a lot about menopause in the news these days, but not enough is science-based. And much of it is clickbait or even leads to fear in women. So today we’re talking about changing this and learning about Menopause Health, especially the way that we do it within The Health Sciences Academy. Now, why I or men should care is because the incredible women in our lives, personally and professionally, go through this. And it’s not just a ‘women’s issue’. It impacts families, relationships, and even workplaces. 

Let me tell you, here’s a shocking stat: In the UK alone, more than 40% of women consider leaving their jobs due to the harsh symptoms of menopause. And more than 10% actually have quit their jobs as a result of the symptoms of menopause. This is really considerable. And that’s why today we’re talking with Dr. Michelle de la Vega, Vice President of Science Education here at The Health Sciences Academy. She has a PhD in Molecular Biology, and over 25 years in researching how nutrition affects health. She has analysed thousands of pieces of research and papers on Menopause Health and interviewed professionals and thought leaders worldwide recently. She spearheaded the development of our upcoming certification called Menopause Health and that is why I’m so excited to bring Michelle here with us. 

So, welcome Michelle.

Michelle de la Vega

Thank you, Maurice. Thank you very much for the introduction. Thank you for the invitation. I honestly believe that this is a topic that we really do need to talk about a whole lot more than what we are.

Maurice Castelijn

I agree. Now, I’m going to interview Michelle here. Michelle, I’m going to ask you a number of key questions that we have put together and also questions that you, the audience, have been submitting. 

So the first one is: What is the actual definition of menopause? Now, I might know the answer, but it’s not what most people may think.

Michelle de la Vega 

That is very true. So most people think that menopause is a long transition phase. And by definition, scientifically speaking, the menopause is actually one single day. And that day is 365 days after the last day of menstrual bleeding that a woman has. So let me quickly walk through the phases of a woman’s life so you sort of understand this concept a little bit more. 

So women go through, well actually women and men, go through a reproductive phase – a phase of puberty, right? So then women have our reproductive years, which we can call premenopause. Hormone levels start to drop at a certain point in our lives, in a woman’s life. I won’t go through all the details of it, but to break it down into a really short point is that it’s a decrease of estrogen and progesterone, mostly, that start to occur in a woman’s life that leads into what we call perimenopause. And then that’s basically what we also call a transition, the menopause transition. This leads, then, to the day of menopause, which is a point when a woman can no longer naturally have a baby. After this point, so after the 365 days after menstrual bleeding, after the stop of menstrual bleeding, is what we call post-menopause. So we really have these different phases: we have the reproductive phases of women’s life, we have perimenopause, we have menopause – which is that one day, and then we have postmenopause. 

And this transition period – which is what most people talk about when they talk about menopause – can last anywhere from three, five, seven years. In some women, it actually lasts 12 years. It’s a small population, but this period of adjusting hormones and lowering hormones can last for a long time. So, as I said, menopause does mark the end of menstruation or 12 months after and when a woman can no longer get pregnant. And we only know what this date is by looking backwards. So, in other words, you can’t say that she will have menopause at a certain date. We can’t look forward and know when it’s going to be.

Maurice Castelijn

Now what are the most common challenges women face during menopause, Michelle?

Michelle de la Vega

During this menopause transition, during the day of menopause and during post-menopause, there are a lot of symptoms that a woman may experience. There’s about an 80% average – so about 80% of women experience symptoms during perimenopause. And women experience different symptoms. So, for example, some common ones might be hot flushes, mood swings, brain fog, problems sleeping, an increase in anxiety, depression, and stress, weight gain, migraines. 

There are over 35 different common symptoms that women may experience. There are also not just these symptoms, but they’re what we consider more long-term consequences of this decrease of hormones, especially estrogen and progesterone. So, for example, there’s an increased risk of cardiovascular disease. There’s also an increased risk of bone mineral loss, which means that there may be more breaks and fractures of bones. So, all the negatives that we really don’t want to have. 

There’s also a lot of fear and stigma around the menopause in many countries. Maybe not all, but many women across many countries sort of have this. So, women actually fear it. Women in their 30s, women in their 40s, even women who are going through it or post-menopause – they really don’t want to talk about it. So, we basically don’t. It’s sort of that hush-hush. And a lot of women also think that it’s going to change our lives. It’s the end of our reproductive years – yes. But some women see it as not only an end of our fertility years but an end of basically our life, an end of our usefulness, our vitality, of what we are capable of. And as I mentioned, with these symptoms, about 25%, so about a quarter of all women actually claim or say that they have really severe symptoms, which can dramatically impact their day-to-day life.

Maurice Castelijn 

That’s a huge number. Are these symptoms the same for all women?

Michelle de la Vega

No. So, most women – probably ALL women – have different symptoms. There are some common ones, as I mentioned, that a lot of women will have, but not everyone has the same exact symptoms. 

Let me give you a couple of examples. 

So we ran a survey recently, and we asked women about their experiences through menopause, whether they were in perimenopause, postmenopause if they were in their 30s, or even thinking about it. So one woman said, “I didn’t have any menopausal symptoms, which were noticeable to me, simply passed me by, so I didn’t even notice.” And we have another woman who said, “It can make you feel like you don’t recognise yourself. You lose all self-confidence and motivation at times.” So it’s basically these two sides that we have and these two viewpoints from two different women who had very different experiences going through menopause. And it’s common for different women to have different experiences. Some might notice their symptoms, some symptoms might affect their day-to-day life, and they have problems, whereas others don’t even notice the whole transition period. And because of these symptoms, some women are actually – like you mentioned before – forced to quit their job or they just can’t work and go on with their normal activities.

Maurice Castelijn

I was kind of processing all of this because it’s really serious, and that’s what we’re talking about at the beginning when we just kicked off about these shocking stats that more than 40% of women consider leaving their jobs due to these symptoms and over 10% have actually quit. 

That brings me to my next question: How well do women understand menopause in general?

Michelle de la Vega 

Unfortunately, not very well. Before I started researching, I knew a little bit but I didn’t know a lot. And I think a lot of it is because of that fear. We think that, oh, it’s just a phase in our life where we’re going to get all these symptoms, and we just have to suffer through it. There’s this shame, this taboo about menopause that we really don’t want to talk about, which leads to misinformation and lack of reliable information. Who are you going to ask? Who are you going to talk to? Where do you go for that information? Even a problem with some professionals is that they don’t have the resources; they don’t have all the information that is provided to women. 

Let me tell you another story: another study that was done about two years ago by a US company. They asked women about their experiences going through menopause. And it saw that:

• Less than 10%, so only 9% actually spoke to their mother about menopause and menopause symptoms. And we do know that, for example, for early menopause, if a mother has it, the chances of their daughter having an early menopause is also increased. So, it is something important for women to talk about with their mothers.
• About 29% of women never sought out information about their menopausal symptoms. So they had symptoms, but never went to a medical doctor for help or advice or any support. 
• 34% of women – so about a third – were never formally assessed or were diagnosed as being menopausal. So, they just sort of went through these stages and never even realised that they were in peri-menopause or were in menopause, post-menopause. They never really considered it, never thought about it, never thought about that stage of their life. And nearly three-quarters of them are women. 
• About 73% were reportedly not treating their menopausal symptoms. So let me say that again. About 73% of women, so almost three-quarters of women, were not treated for menopausal symptoms. So, they are suffering in silence and not seeking medical help.

Maurice Castelijn

Wow, that’s huge.

And where does this knowledge gap stem from, you think?

Michelle de la Vega

 The truth is, we really don’t know that much about what menopause is, how it works, all of the changes. We know some general information, but we don’t know the details. And it’s because of a couple of different reasons.

One is that scientifically speaking in research, most research is done in men. And this has been the tradition from the past for multiple reasons. One, because women have their menstrual cycles each month, and we go through hormonal changes. So, it’s more difficult to analyse a woman if you’re looking at certain factors because our hormones affect how we live and all these different characteristics. So, if you’re doing studies, in order to get 100 women that have similar estrogen levels, for example, similar testosterone levels, similar progesterone, is a lot harder than getting 100 men because we’re all cycling at different stages. It’s harder to compare with statistics. So, we don’t have all that information that we have. 

Now, mind you, this is changing. So, in the past 10, 15 years, more research has been done on women to figure out not only how about menopause but in different scientific areas as well. As a result of this, it’s really not taught enough in a formal education system. 

So, because of that lack of information that we have and lack of scientific studies, it’s really not translated into education the way it should be, which leads to a lot of misinformation and women being anxious and unprepared for this stage of their life. Adding to that problem is that there’s very little menopause-specific training for medical professionals.

Maurice Castelijn 

That’s so surprising in so many ways, right? And so I also know that during your research in conversation with professionals who have actually worked with menopause clients, you’ve unearthed lots of shocking truths. I’d like to dive a little bit deeper into the last point you mentioned. What typically happens when a woman visits a medical doctor and discusses her symptoms?

Michelle de la Vega

So it really depends. Let’s look at a couple of examples that will help us understand this a little bit more. 

A woman who’s 45 goes to her medical doctor. She’s feeling anxious and sort of just out of it, not her normal self. Maybe she’s a little bit more lethargic, a bit more tired, but she feels anxious, not normal. Her doctor assumes you’re stressed because that’s a fairly obvious thing. You’re anxious, you’re feeling out of it, probably due to stress levels. And they provide her with medication. So she goes home, she takes her medication, and it might help, right? A medication for anxiety, for depression that might help her. But because she’s 45, there’s a good chance that she is going through perimenopause or started perimenopause. But the doctor might not think of that angle and might not ask the initial other questions that are involved. So is your menstrual cycle changing? Have you noticed any other symptoms – hot flushes, weight gain? Or any of these other questions that could help figure out more of just not the solution or the solution for the specific problem, but know the holistic approach of really what’s going on underneath. 

Another woman might go to her medical doctor with hot flushes, which is one of the most common symptoms during perimenopause. And her doctor may prescribe her HRT, which is Hormone Replacement Therapy, which is a really common treatment for hot flushes. But not all women want to take HRT. There’s a lot of stigma, a lot of misinformation, and it might help some women and it might not help other women. So, it’s very specific about who may benefit, who may not benefit. And it’s not ideal for everyone. It has side effects. Not every woman is going to want to take medication. So, these are sort of two different examples of where women sort of go to their medical doctor looking for help. And in one case, menopause hasn’t really been brought up when it could be a contributing factor to her symptoms. And the other, it’s sort of brushed off as one of these cases where, yes, okay, it’s hot flushes, it’s menopause, here you go, here’s something to take it, without thinking of other possibilities that could potentially help. 

So, another study in the UK this time, a couple of years ago, came out and said that it looked at women who went to the GP about their menopausal symptoms. So, on average, a woman had to visit their medical doctor three times before giving appropriate medical attention for their menopausal symptoms. And 40% of women who went to their GP (General Practitioner) about their symptoms were basically just told you’ll have to live with it.

Maurice Castelijn 

That’s really tough, I think. So what kind of key messages would you like to share with women who are listening now?

Michelle de la Vega 

Menopause is different for everybody. No menopause transition is going to be exactly the same for all women. And there are things that we can do – that women can do – to lessen the severity and the frequency of our symptoms. Mind you, it’s not 100% under our control. There are things that are always out of our control, but some of it is under our control. And there are things that we can do to decrease those symptoms and to help us feel better.

Maurice Castelijn

 So what can women do if they have symptoms?

Michelle de la Vega

Fortunately, as I mentioned, there are some tweaks that we can make in our daily habits and routines to help us out. For example, some of the symptoms that we may have like weight gain is going to be a common symptom. So on average, a woman gains a couple of kilograms, a few pounds, five, six pounds, during the menopause transition. When the traditional idea is that okay, you’re gaining weight, just eat less, eat less calories and exercise more. Well, that doesn’t work during this phase of life because of those changes in hormones. So, we have to address a different angle rather than just looking at this calories-in-calories-out idea. 

There’s also a lot of excess inflammation or increase of systemic inflammation in the body, which also would need to be addressed. There may be an increase in gut issues and dysbiosis. Women, like I mentioned before, might be having more anxiety, more just bailing out of it, brain fog, or problem sleeping. So these are sort of different areas and different aspects that we can look at to help a woman going through perimenopause, postmenopause.

Maurice Castelijn

And that’s basically why we need more professionals, right? You know, who are adequately trained to understand what it’s really about – not just in the medical space, but also when it comes to health, wellness, nutrition, or any kind of contact when it comes to menopause…

Michelle de la Vega

Correct. We definitely need more professionals who are knowledgeable in this area, specifically in Menopause Health. Because, like I said with weight gain – it’s not the typical weight gain that women are going to see in their 20s or 30s, and you have to face it, and look at the different aims. So, students aim to sort of focus on diet and nutritional habits and help support these hormonal changes. While nutrition plays a huge part, it’s not the only thing we go through. We do need to have a holistic approach. So, in addition to the nutrition professionals, personal trainers can help with exercise looking at those angles, health coaches, massage therapists, stress management, and sleep quality advisors as well. So it’s all these different areas that we really need to focus on and work on, and professionals can help women through that.

Maurice Castelijn

Of course, it brings me to the next question: How does our new Menopause Health certification help?

Michelle de la Vega

So we designed and developed the Menopause Health certification because of all these challenges that we were hearing from women going through it, from nutrition professionals that had clients and didn’t know how to help them. So we listened to the stories, and saw an opportunity to create a certification that will help women thinking about menopause. They might be in their 30s, thinking about going through it. Maybe they’re in perimenopause with symptoms, or they’re already in postmenopause, and they do have symptoms, and they want to get through it. So, this Level 5 continuing education certification teaches what menopause is. Because, like we said at the start, not a lot of women, not a lot of people really know what menopause is and the different phases and what’s going on in that. We look at those hormonal changes, and then the certification expands into helping women thrive through this. 

So I’ve heard a lot of women talk about surviving menopause – I don’t like that. Let’s change that. Let’s change surviving menopause into thriving through menopause.

Maurice Castelijn 

Of course, you know my next question, then. How, Michelle? Tell us.

Michelle de la Vega 

So, let’s start by preparing women in their 30s. Let’s not wait until women are sort of already in the mix of having those severe symptoms. Let’s start early. Let’s teach women about these common symptoms they may encounter, prepare them from the get-go, and how they can reduce their frequency and severity through nutrition and lifestyle changes that we have control over. And let’s arm women with the tools they need during this stage of their life, like I said, to thrive through this phase. And that’s just the women, right?

We also talked about how men can also contribute and support us. So, there will be a lot more opportunity for broader impact. And although we’re talking about professionals, everyone would benefit from learning more about Menopause Health.

Maurice Castelijn 

Absolutely.

Michelle de la Vega 

For example, I wish I knew more about menopausal health years ago. With my friends as well, it’s the same way. People want to know more about it so that a woman in her 30s can start preparing at this stage of life. They don’t have to wait until they start getting symptoms. A woman in her 40s may notice that her menstrual cycles are starting to change. She might not have other symptoms, but she can start making changes at this point to help her through that transition stage. Spouses or partners of women who may be in perimenopause or postmenopause. CEO of a company, for example, whether female or male, can also help their employees because we heard the statistics about the workplace as well. In my honest opinion, I think that everyone, male, female, basically no matter what age, from adolescence sort of up, should really have some fundamental knowledge about menopause, about what the symptoms are, and basically how we can reduce the severity and sort of live through, thrive through this.

Maurice Castelijn

I think that’s excellent, Michelle. And I personally agree because there is a lot of misinformation and disinformation about Menopause Health, and practitioners can make a real difference with clients. But also, people themselves can learn much more about what they either ‘might be’ going through or ‘are’ going through. I’m also excited about the various areas of Menopause Health, and we’ll be covering that in our upcoming webinar on the 26th of January. In the meantime, if this interview opened your eyes and minds, stay tuned for our next interview, which is about the transformation journey – from awareness to empowerment – with another VIP guest. Also wanted to say thank you very much, Michelle, for your insights. And I really look forward to learning more about this topic and helping raise further awareness on such a crucial issue.

Michelle de la Vega

Well, my pleasure, Maurice. And I also look forward to those next interviews.

Maurice Castelijn

Excellent. Well, thank you very much and speak to you soon. Bye for now.